Papers by Anne-Marie Selzler
Self-efficacy, defined as behaviour specific confidence, is a consistent correlate of physical ac... more Self-efficacy, defined as behaviour specific confidence, is a consistent correlate of physical activity and other health behaviours. In people with Chronic Obstructive Pulmonary Disease (COPD), self-efficacy has been found to be related to key clinicalhealth outcomes and is deemed an important contributor to disease self-management. The purpose of this dissertation was to (i) contribute to the understanding of how pulmonary rehabilitation (PR) and vicarious experiences (i.e., observing someone) impact self-efficacy types among patients with COPD, and (ii) examine the relationships of several different types of self-efficacy (i.e., task self-efficacy for exercise, coping selfefficacy for exercise, scheduling self-efficacy for exercise, coping self-efficacy for breathlessness, and walking self-efficacy) to clinical-health and behavioural outcomes: functional exercise capacity, health status, and physical activity. In study 1 (Chapter 2), self-efficacy increased as much or more with PR in COPD patients recently hospitalized for an acute exacerbation of COPD (AECOPD) compared to COPD patients without a recent AECOPD (stable COPD). Among the AECOPD patients, PR delivered within one month or between three and four months after an AECOPD did not impact the amount of improvement in self-efficacy observed. Study 1 also found that among both AECOPD and stable patients self-efficacy for walking was a superior predictor of all clinical-health and behavioural outcomes than self-efficacy for managing breathlessness. Additionally, the association between self-efficacy and physical activity was stronger among stable COPD patients compared to AECOPD patients at both pre-and post-PR. In Chapter 3, a two-part pilot study examined salient exercise-model characteristics to COPD patients and examined patient experiences with cardiopulmonary exercise tests (CPET). The results of this study informed the creation of the intervention evaluated in study 3 (Chapter 4), which examined the effects of coping and mastery model interventions on self-efficacy for walking and exercise (i.e., task self-efficacy for exercise, coping self-Preface This thesis is an original work by Anne-Marie Selzler. The research projects, of which this thesis is a part, received research ethics approval from the
COPD: Journal of Chronic Obstructive Pulmonary Disease, Sep 27, 2012
Although participation in pulmonary rehabilitation (PR) improves the health outcomes in patients ... more Although participation in pulmonary rehabilitation (PR) improves the health outcomes in patients with Chronic Obstructive Pulmonary Disease (COPD), there are insufficient resources to provide PR to all patients with COPD. Thus, predicting which patients are at risk for drop-out and non-response to rehabilitation is necessary in order to optimize limited resources. This study examined which patient characteristics are predictive of PR drop-out and non-response. 814 patients with COPD took part in standard out-patient PR for 8 weeks. Demographic and standard clinical data were collected before the rehabilitation program had started. Data was analyzed retrospectively to determine if baseline patient characteristics could predict drop-out and non-response to rehabilitation. Drop-out was defined as participation in less than 50% of the rehabilitation sessions. Non-response was defined as improvement less than 4% on the St. George's Respiratory Questionnaire (SGRQ). A discriminant function analysis identified age, smoking history, and health status as predictors of patient drop-out, p < .0001, with younger, current smokers and patients with lower health status being at risk for drop-out. No variables measured significantly predicted who those at risk would be for non-response to rehabilitation, p > .05. Pulmonary function data did not predict drop-out or non-response to PR. These findings indicate that perceived impairment (i.e., health status) is more likely to influence completion of rehabilitation than actual pulmonary impairment and that demographic and standard clinical data do not adequately predict patient drop-out and non-response to rehabilitation.
Journal of Sports Sciences, Jun 1, 2013
Coaching has been recognised as a demanding occupation, associated with a range of stressors. The... more Coaching has been recognised as a demanding occupation, associated with a range of stressors. The extent to which coaches perceive stress is likely to be influenced by various personal and situational factors. The purpose of this study was to identify coaches' levels of perceived stress and examine the personal and situational factors that may influence coaches' perceptions of stress. In total, 502 coaches working with university, college, Canada Games, and/or nationally identified athletes completed this study. Coaches completed an online survey, which included questions regarding demographics, work/job-related considerations, and aspects relating to their contract. Coaches also completed the Perceived Stress Scale (Cohen, Kamarck, & Mermelstein, 1983). Overall coaches indicated slightly below average levels of perceived stress (M= 15.13 out of 40) compared to norm-values (Cohen & Janicki-Deverts, 2012). Demographic factors, job-related characteristics, and certain aspects of their contract were associated with coaches' perceptions of stress. Particularly, unclear expectations, long-working hours (>40), lack of agreed upon evaluation criteria, higher salaries, and a lack of social support were related to higher perceptions of stress. As such, the findings of the current study indicate that a reduction in perceived stress is likely to be achieved through a multi-faceted approach that addresses multiple factors associated with coaching.
Chronic Respiratory Disease
Background Pulmonary rehabilitation (PR) has major benefits for patients with chronic obstructive... more Background Pulmonary rehabilitation (PR) has major benefits for patients with chronic obstructive pulmonary disease (COPD). An enhanced PR program was developed with a self-management education intervention. The objective of our study was to evaluate the implementation of the enhanced PR program into a single centre. Methods Pre-post implementation study consisted of two evaluation periods: immediately after implementation and 18 months later. Guided by the RE-AIM framework, outcomes included: Reach, Effectiveness, Adoption, Implementation and Maintenance . Results Reach: 70–75% of referred patients agreed to a PR program ( n = 26). Effectiveness: Clinically important improvements occurred in some patients in functional exercise capacity (64% of the patients achieved clinical important difference in 6-min walk test in the first evaluation period and 44% in the second evaluation period), knowledge, functional status, and self-efficacy in both evaluation periods. Adoption: All healthc...
Canadian Journal of Kidney Health and Disease
Background: Living donor kidney transplantation (LDKT) is the optimal treatment for eligible pati... more Background: Living donor kidney transplantation (LDKT) is the optimal treatment for eligible patients with kidney failure, although it is underutilized. Contextually tailored patient- and family-centered interventions may be effective to increase LDKT. Objective: We outline a protocol to test the feasibility of the Multidisciplinary Support To Access living donor Kidney Transplant (MuST AKT) intervention designed to increase LDKT. Design: Non-blinded single-center pilot randomized controlled trial with a qualitative interview component. Setting: Academic transplant referral center in Northern Alberta Region with a population of more than 2 million in its catchment area. Patients: English-speaking patients of the age range 18 to 75 years who are referred for kidney transplantation are eligible to participate. Measurements: Feasibility will be assessed by indicators of recruitment, retention, and completion rates, treatment fidelity, adherence to intervention, engagement in interventi...
COPD: Journal of Chronic Obstructive Pulmonary Disease
Physiotherapy Canada
Purpose: We aimed to elicit patients’ views of research priorities related to pulmonary rehabilit... more Purpose: We aimed to elicit patients’ views of research priorities related to pulmonary rehabilitation (PR). Method:We used a modified nominal group technique in which participants with chronic lung conditions who had completed PR attended one of five meetings during which they generated ideas, discussed them with the group, and prioritized their top three topics. Afterward, they completed member checking and satisfaction questionnaires. Results:Fourteen participants (mean age 71 years) prioritized 25 topics, which included music as a motivator, education about the reason for various assessments and exercises, and ongoing patient assessment and follow-up. Most participants “totally agreed” that the summarized topics matched what they thought was important in PR research (75%) and that the meeting was a positive experience (100%). Participants indicated that the findings of this study accurately reflected their priorities. Conclusions:Individuals who have completed PR may have questi...
Abundant research suggests that exercise self-efficacy is a critical determinant of behaviour and... more Abundant research suggests that exercise self-efficacy is a critical determinant of behaviour and a multidimensional construct. The purpose of this study was to examine the trajectories of task, coping, and scheduling self-efficacy over a six month exercise program in men and women. Forty men (Mage = 43, SD = 10) and sixty women (Mage = 44, SD = 11) completed assessments of self-efficacy at baseline, 7, 12, and 24 weeks of the exercise program. The self-efficacy sub-types exhibited invariance over time and by gender. Latent growth curve models revealed individual differences in initial levels of task, coping, and scheduling self-efficacy and rates of change for coping and scheduling self-efficacy. Task self-efficacy did not change over time. For coping and scheduling self-efficacy, the functional form of change was quadratic, such that self-efficacy levels increased from baseline to 7 weeks, and then decreased at 12 and 24 weeks. Women's scheduling self-efficacy decreased more r...
British journal of health psychology, Jan 7, 2018
The objectives of this study were to (i) investigate directional influences of self-efficacy, out... more The objectives of this study were to (i) investigate directional influences of self-efficacy, outcome satisfaction, and attendance during an exercise programme and (ii) examine the predictive capabilities of self-efficacy and outcome satisfaction on participant dropout. Adults aged 35-65 years were recruited to a 12-month exercise programme. Self-efficacy was collected at baseline, three, six, nine, and 12 months, and outcome satisfaction at the same time-points except baseline. Cross-lagged panel analyses and logistic regression analyses were conducted to examine the primary and secondary objectives, respectively. Coping and scheduling self-efficacy had stronger reciprocal relationships with outcome satisfaction than task self-efficacy, although the strength of these relationships varied across time. Initially, task self-efficacy predicted programme attendance. Midway through the programme, outcome satisfaction predicted attendance, and by the end of the programme, coping self-effi...
Chronic Respiratory Disease, 2017
Several different applications of telehealth technologies have been used in the care of respirato... more Several different applications of telehealth technologies have been used in the care of respiratory patients, including telemonitoring, teleconsultations, tele-education, and telehealth-pulmonary rehabilitation (PR). Telehealth technology provides an opportunity to assist in the management of chronic respiratory diseases and improve access to PR programs. While there is inconclusive evidence as to the effectiveness of telemonitoring to reduce healthcare utilization and detection of exacerbations, teleconsultations have been shown to be an effective means to assess patients' disease prior to the initiation of PR, and telehealth PR has been shown to be as effective as institution-based PR at improving functional exercise capacity and health-related quality of life. To improve PR access across Canada and ensure a high standard of program quality, a team of clinicians and researchers has developed and begun to implement a national standardized PR program that can be delivered across different settings of practice, including remote satellite sites via telehealth PR. The program has adapted the "Living Well with COPD" self-management program and includes standardized reference guides and resources for patients and practitioners. A progressive and iterative process will evaluate the success of program implementation and outcomes. This initiative will address nationwide accessibility challenges and provide PR content as well as evaluations that are in accordance with clinical standards and established self-management practices.
Rehabilitation Psychology, 2016
Objective: Pulmonary rehabilitation (PR) improves functional exercise capacity and health status ... more Objective: Pulmonary rehabilitation (PR) improves functional exercise capacity and health status in people with chronic obstructive pulmonary disease (COPD), although these outcomes are often not maintained following PR. Self-efficacy is a precursor to outcomes achievement, yet few studies have examined the importance of self-efficacy to outcome improvement during PR, or how it develops over time. Further, the contribution of exercise-specific self-efficacy to outcomes in PR is unknown. The aims of this study were to determine (a) whether baseline exercise self-efficacy predicts PR attendance and change in functional exercise capacity and health status over PR, and (b) if exercise self-efficacy changes with PR. Method: Fifty-eight out of 64 patients with COPD completed PR and assessments of exercise self-efficacy (task, coping, scheduling), the 6-minute walk test (6MWT), and St. George's Respiratory Questionnaire (SGRQ) at the beginning and end of PR. Analyses were conducted to predict attendance, and change in 6MWT and SGRQ, while controlling for baseline demographic and clinical indicators. Change in 6MWT, SGRQ, and self-efficacy with PR was also examined. Results: Clinically significant increases in the 6MWT and SGRQ were achieved with PR. Stronger task self-efficacy predicted better attendance, while stronger coping self-efficacy predicted greater 6MWT improvement. No variables predicted SGRQ change. Scheduling self-efficacy significantly improved with PR, whereas task and coping self-efficacy did not. Conclusion: Baseline exercise self-efficacy appears to be a determinant of rehabilitation attendance and functional exercise improvement with PR. Clinicians should evaluate and target exercise self-efficacy to maximize adherence and health outcome improvement with PR. Impact and Implications Recent reports suggest that targeting self-efficacy during pulmonary rehabilitation is critical to achieve behavioral changes and improved outcomes, yet few studies have examined self-efficacy as it relates to physical performance and outcomes during pulmonary rehabilitation. This study extends the literature by examining the relationship of exercise-specific self-efficacy (i.e., task, coping, scheduling) to clinically relevant outcomes (i.e., health status, functional exercise capacity) in patients with chronic obstructive pulmonary disease attending pulmonary rehabilitation. This study found that task and coping self-efficacy are factors involved in attendance at pulmonary rehabilitation and change in functional exercise capacity, respectively. However, this study also found that the only type of self-efficacy impacted by pulmonary rehabilitation, scheduling self-efficacy, was the type least associated with pulmonary rehabilitation outcomes. This study provides preliminary evidence that suggests a greater focus on enhancing all types of exercise self-efficacy within pulmonary rehabilitation is needed along with experimental studies to determine the most effective strategies for improving exercise self-efficacy within this setting.
Research quarterly for exercise and sport, 2014
This article examined the conceptual and statistical distinction between perceived competence and... more This article examined the conceptual and statistical distinction between perceived competence and self-efficacy. Although they are frequently used interchangeably, it is possible that distinguishing them might assist researchers in better understanding their roles in developing enduring adaptive behavior patterns. Perceived competence is conceived in the theoretical framework of self-determination theory and self-efficacy is conceived in the theoretical framework of social-cognitive theory. The purpose of this study was to empirically distinguish perceived competence from self-efficacy for exercise. Two studies evaluated the independence of perceived competence and self-efficacy in the context of exercise. Using 2 extant instruments with validity and reliability evidence in exercise contexts, the distinctiveness of the 2 constructs was assessed in 2 separate samples (n = 357 middle-aged sedentary adults; n = 247 undergraduate students). Confirmatory factor analysis supported the con...
Background: The aim of this study was to determine if exercise self-efficacy predicts attendance ... more Background: The aim of this study was to determine if exercise self-efficacy predicts attendance and functional exercise capacity at the end of pulmonary rehabilitation over and above demographic and clinical indicators. Methods: Sixty-four people with Chronic Obstructive Pulmonary Disease completed assessments of exercise self-efficacy (task, coping, and scheduling) and the 6-minute walk test (6MWT) at the beginning and end of pulmonary rehabilitation. Demographic and standard clinical data were obtained from health records. Hierarchical multiple regressions were conducted to predict attendance and post rehabilitation 6MWT, with demographic and clinical indicators entered before exercise self-efficacy. Findings: Task self-efficacy (?=.32) was the only statistically significant predictor of attendance. Age (?= -.15) and coping self-efficacy (?=.20) were statistically significant predictors of post rehabilitation 6MWT, after controlling for baseline 6MWT. The 6MWT increased by 32m from baseline to post rehabilitation, p=.00, ?2=.18. Discussion: Future research designing and implementing strategies to increase exercise self-efficacy in pulmonary rehabilitation are warranted.
Rehabilitation Psychology, 2013
Objective: Cardiovascular disease (CVD) is the leading cause of death in the developed world. Car... more Objective: Cardiovascular disease (CVD) is the leading cause of death in the developed world. Cardiac rehabilitation (CR) is a comprehensive treatment program centered on structured exercise that has been demonstrated to achieve significant decreases in mortality and morbidity in cardiac patients, yet few patients adhere to exercise post-CR and so fail to maintain any health benefits accrued during rehabilitation. One reason for the lack of adherence might be that CR fails to address the challenges to adherence faced by patients when they no longer have the resources and structure of CR to support them. Self-efficacy (SE) is a robust predictor of behavioral persistence. This study therefore focuses on changes in different types of SE during CR and the relationship of SE to subsequent levels of physical activity. Method: A sample of 63 CR patients completed assessments of task, scheduling and coping SE at baseline and the end of CR, as well as self-reported exercise behavior at the end of CR and 1-month post-CR. Results: Task SE (for performing elemental aspects of the behavior) was found to be most changed type of SE during CR and was strongly related to self-reported exercise at the end of CR. However, scheduling SE (for performing the behavior regularly) was most strongly related to selfreported exercise post-CR. Conclusions: These results are theoretically consistent and suggest that scheduling SE should be targeted during CR to improve post-CR exercise adherence.
Patient Education and Counseling, 2014
This study examined if ongoing support delivered by telephone following pulmonary rehabilitation ... more This study examined if ongoing support delivered by telephone following pulmonary rehabilitation (PR) assisted chronic obstructive pulmonary disease (COPD) patients to maintain health outcomes. Methods: Phase one (n = 79) compared post-rehabilitation telephone-based support delivered by peers compared to usual care (UC). The second phase (n = 168) compared post-rehabilitation support from peer educators, respiratory therapists (RT), or UC. Primary outcome variables were St. George's Respiratory Questionnaire (SGRQ) total score and the six minute walk test (6MWT). Measures were obtained at baseline, immediately following PR, and six-months post PR. Results: Six-month follow-up data for phase one was collected for 66 COPD patients (n = 35 peer support, n = 31 UC) and 142 for phase two (n = 42 peer support, n = 52 RT support, n = 48 UC). Per-protocol and intention to treat (ITT) analysis in both phases found no significant group by time differences for SGRQ or 6MWT. Conclusion: Providing peer or RT support via telephone following PR was not more effective than UC for maintaining health outcomes. Practice implications: There are concerns with using peers to provide ongoing support to COPD patients. Additionally, COPD patients require a higher level of care than telephone support can provide.
Journal of Behavioral Medicine, 2013
Techniques to increase physical activity among pulmonary rehabilitation patients outside of the r... more Techniques to increase physical activity among pulmonary rehabilitation patients outside of the rehabilitation context are warranted. Implementation intentions are a strategy used to initiate goal-directed behaviour, and have been found to be useful in other populations. This study compared the long-term effects of exercise and social implementation intentions interventions on objectively measured physical activity in 40 pulmonary rehabilitation patients randomly assigned to condition. Repeated measures ANOVAs found that those in the exercise implementation intentions group took more steps (p = .007) at the end of pulmonary rehabilitation than those in the social implementation intentions group. Improvements attained by the exercise group during the intervention were not maintained 6-months following rehabilitation. Implementation intentions targeting physical activity appear to have positive short term effects on physical activity, although the long term effects are less consistent. This may be due in part to methods used to assess physical activity behaviour.
Disability and Rehabilitation
Purpose: Informal caregivers play an important role in chronic disease management but their exper... more Purpose: Informal caregivers play an important role in chronic disease management but their experience is often neglected. The objective of this study was to explore the content validity of the Zarit Burden Interview (ZBI) in caregivers of individuals with COPD in Canada and Portugal. Materials and methods: Cognitive debriefing interviews were conducted with informal caregivers of individuals with moderate to very severe COPD. Participants completed the ZBI and verbalised their thinking process to assess the adequacy of the questionnaire's content and instructions. Content validity was assessed using deductive content analysis of interviews and descriptive statistics of questionnaire responses. Results: Nine caregivers from Canada (age ¼ 67 ± 8 years) and 13 from Portugal (age ¼ 69 ± 7 years) participated. For Canadian caregivers, 3/22 items were not understood, and 8/22 items were not relevant to at least 1/3 of them. For Portuguese caregivers, 1/22 items were not understood, and 20/22 items were not relevant to at least 1/3 of them. The distribution of response choices was approximately symmetrical for 17/22 items in the Canadian sample. The response option "no/never" was selected by at least 75% of Portuguese participants for 18/22 items. Conclusions: The instrument was well understood by caregivers of people with COPD, but its relevance is uncertain. � IMPLICATIONS FOR REHABILITATION � Informal caregivers provide essential care for people living with disability and chronic disease, but their experience is often neglected. � The Zarit Burden Interview assesses caregiver burden but has not been validated in caregivers of people with chronic obstructive pulmonary disease. � In its current form, the Zarit Burden Interview does not adequately represent the experience of COPD caregivers. � We recommend selecting tools that assess caregiver burden that have been validated in the caregiver population of interest.
American Journal of Respiratory and Critical Care Medicine, 2005
In patients with pulmonary disease, disease severity and prognosis are determined not only by lun... more In patients with pulmonary disease, disease severity and prognosis are determined not only by lung function impairment (1, 2). In patients with mild, moderate, or severe disease, exercise capacity,
Additional file 1. PCN data set
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Papers by Anne-Marie Selzler