Evaluation of a breathing retraining intervention to improve quality of life in asthma: quantitative process analysis of the BREATHE randomized controlled trial

Abstract

Objective:

Explore qualitative differences between interventions (DVD and booklet (DVDB) versus face-to-face and booklet (F2FB) versus usual care) in the BREATHE (Breathing Retraining for Asthma Trial of Home Exercises) trial of breathing retraining for asthma.

Design:

Quantitative process analysis exploring group expectancy, experience and practice before and after intervention delivery for the main trial.

Setting:

Primary care.

Subjects:

Adults with asthma (DVD and booklet, n = 261; F2FB, n = 132).

Main measures:

Baseline – expectancy about breathing retraining; follow-up 3, 6 and 12 months – self-efficacy, treatment experience (enjoyment of treatment, perceptions of physiotherapist, perceptions of barriers), amount of practice (weeks, days/week, times/day), continued practice; all time points – anxiety (Hospital Anxiety and Depression Scale), AQLQ (Asthma Quality of Life Questionnaire).

Results:

No group differences in baseline expectancy. Statistically significant results (P < 0.05) indicated that at follow-up, F2FB participants perceived greater need for a physiotherapist than DVD and booklet participants (3.43 (0.87) versus 2.15 (1.26)). F2FB participants reported greater enjoyment of core techniques (such as stomach breathing: 7.42 (1.67) versus 6.13 (1.99) (DVD and booklet)). Fewer F2FB participants reported problems due to doubts (24 (22.9%) versus 90 (54.2%)). F2FB participants completed more practice sessions (75.01 (46.38) versus 48.56 (44.71)). Amount of practice was not significantly related to quality of life. In the DVD and booklet arm, greater confidence in breathing retraining ability explained 3.9% of variance in quality of life at 12 months.

Conclusion:

Adults with asthma receiving breathing retraining face-to-face report greater enjoyment and undertaking more practice than those receiving a DVD and booklet. Greater confidence in ability to do breathing retraining is associated with improved QoL.

Keywords

Breathing exercises randomized controlled trial quantitative process analysis quality of life

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References

Bruton

Lee

Yardley

et al . Physiotherapy breathing retraining for asthma: a randomised controlled trial. Lancet Respir Med 2018; vi(1): 19–28.

Arden-Close

Yardley

Kirby

et al . Patients’ experiences of breathing retraining for asthma: a qualitative process analysis of participants in the intervention arms of the BREATHE trial. NPJ Prim Care Respir Med 2017; 27(1): 56.

Edwards

Saglani

Schwarze

et al . Addressing unmet needs in understanding asthma mechanisms: from the European Asthma Research and Innovation Partnership (EARIP) Work Package (WP)2 collaborators. Eur Respir J 2017; 49(5): 1602448.

Bruton

Kirby

Arden-Close

et al . The BREATHE study: Breathing REtraining for Asthma – Trial of Home Exercises. A protocol summary of a randomised controlled trial. Prim Care Respir J 2013; 22: PS1–PS7.

Juniper

Guyatt

Epstein

et al . Evaluation of impairment of health-related quality of life in asthma: development of a questionnaire for use in clinical trials. Thorax 1992; 47(2): 76–83.

Zigmond

Snaith

RP.

The Hospital Anxiety and Depression Scale. Acta Psychiatr Scand 1983; 67(6): 361–370.

Wilkinson

Barczak

Psychiatric screening in general practice: comparison of the general health questionnaire and the Hospital Anxiety and Depression Scale. J R Coll Gen Pract 1998; 38(312): 311–313.

Devilly

Borkovec

TD.

Psychometric properties of the Credibility/Expectancy questionnaire. J Behav Ther Exp Psychiatry 2000; 31(2): 73–86.

Lorig

Stewart

Ritter

et al . Outcome measures for health education and other health care interventions. Thousand Oaks, CA: SAGE, 1996, pp.2537–2538.

10.

Bishop

Yardley

Lewith

GT.

Treatment appraisals and beliefs predict adherence to complementary therapies: a prospective study using a dynamic extended self-regulation model. Br J Health Psychol 2008; 13(Pt 4): 701–718.

11.

Kirby

Donovan-Hall

Yardley

Measuring barriers to adherence: validation of the problematic experiences of therapy scale. Disabil Rehabil 2014; 36(22): 1924–1929.

12.

Yardley

Spring

Riper

et al . Understanding and promoting effective engagement with digital behavior change interventions. Am J Prevent Med 2016; 51(5): 833–842.

13.

Lally

Chipperfield

Wardle

Healthy habits: efficacy of simple advice on weight control based on a habit-formation model. Int J Obes 2008; 32(4): 700–707.

14.

Yardley

Barker

Muller

et al . Clinical and cost effectiveness of booklet based vestibular rehabilitation for chronic dizziness in primary care: single blind, parallel group, pragmatic, randomised controlled trial. BMJ 2012; 344: e2237.

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