Shirley Harris

High prevalences of anxiety and depression have been found in those with COPD which can exacerbate physically related impacts of increased levels of disability, and reduced enjoyment of life. Of particular concern is the anxiety-breathlessness cycle and reduced self-efficacy, which both adversely affect self-management of symptoms. Recognition of the need to address these issues has led to use of adjunctive psychologically based therapies including mindfulness. Standard mindfulness programmes have been found to be helpful in promoting a less distressing view of breathlessness and increasing self-efficacy in self-management; however, they can be difficult to access due to significant time commitments and need to travel for groups. This study examines a novel, portable, flexible mindfulness intervention for breathlessness that can be self-delivered in the person’s home, enabling access to a potentially effective intervention to improve self-efficacy in COPD self-management. The primary aim of this study is to establish the feasibility of delivery of this intervention in terms of uptake and retention in the study, adherence to, and acceptability of the MBI. The secondary aim is to obtain preliminary estimates regarding change in self-efficacy in managing COPD. This mixed method pre-post-study with 3-month follow-up will assess feasibility of recruitment, acceptability, and report preliminary descriptive data regarding this novel mindful breathing intervention (MBI) in up to 30 adults with COPD. A secondary outcome measure is change in the COPD self-efficacy scale. Other self-report measures include the St. Georges Chronic Respiratory Disease Questionnaire, Five Facet Mindfulness Questionnaire, Hospital Anxiety and Depression Scale, the EQ-5D-5L, and a daily diary recording breathlessness and mindfulness practice. Descriptive statistics and pre-post-change scores will be reported for quantitative data. A qualitative interview exploring participant experiences of the MBI will be undertaken at the 3-month follow-up point with 10 participants. Qualitative data will be analysed using thematic analysis. Data collection is ongoing at the time of submitting this manuscript. This study is the first to assess feasibility of a self-delivered MBI for those with COPD in New Zealand. This study will also establish preliminary estimates of change on self-efficacy and other measures of health outcomes. If feasible, with preliminary evidence of positive impact on functioning, this will support the development of a larger clinical trial. Provision of self-delivered in-home mindfulness-based interventions for people with COPD may not only contribute to improved health, but potentially a reduction in resources, costs, and the time required for travel to group treatments), reducing barriers to treatment for people with COPD. Australian New Zealand Clinical Trials Registry (ANZCTR) ACTRN12623000560695 . Date registered: 24 May 2023.

Aim: The aim of this study was to evaluate the clinical effectiveness (improvement in health status and/or functioning and use of health services) of transdiagnostic health management interventions for people aged 65 years and older.Background: The care of older people with multimorbidity is of increasing concern for nurses. A transdiagnostic approach to health management interventions (promote self‐management or lifestyle) may be apposite for providing older people with the skills to manage symptoms that may or may not be disease‐specific.Design: Quantitative systematic review.Review methods: Cochrane methods using Cochrane's Effective Practice and Organization of Care Methods (EPOC) for assessing risk of bias and the Grading of Recommendations, Assessment, Development and Evaluation (GRADE) for assessing the weight of evidence.Data sources: Medline, CINAHL, PubMed and PsycINFO 1999–2014.Results: Twelve studies were included in the review (n = 10,393). All 12 studies provided results for health outcomes (health status and functioning) and six provided results for health outcomes and health service utilization. Ten studies reported statistically significant improvements in health outcomes but of these studies only two were of low risk of bias. Three studies identified some statistically significant reductions in health service utilization. The weight of evidence for the health management interventions included in the review, were low/moderate for improvements in health status and low for improvements in health service utilization.Conclusion: While there is some very preliminary evidence suggesting that structured transdiagnostic health management interventions may be clinically effective for older people with multimorbidity the effect sizes are small and the quality of this evidence is generally low.