Everyday life activities of people with chronic obstructive pulmonary disease : performance, management and everyday technology use

Background: When a person is living with chronic obstructive pulmonary disease (COPD), his/her participation in everyday life activities is challenged due to a complex multitude of symptoms. Moreover, everyday technology utilised in daily life at home and in society also impacts on participation in everyday life activities. Knowledge of everyday life activities and everyday technology use of persons with COPD is sparse but is important to obtain for use in pulmonary rehabilitation. The overall aim of this thesis was to evaluate and explore everyday life activities including everyday technology use in persons with COPD to generate knowledge that can be applied in COPD rehabilitation.

Methods: To evaluate and explore everyday life activities, both quantitative and qualitative studies have been conducted using a cross-sectional design (Study I, II, IV) and qualitative interviews (Study III). First, a reliability testing was performed to ensure the psychometric evidence of the Everyday Technology Use Questionnaire (ETUQ) (Study I) to apply in the following data collection. Data for Study I were collected among persons both with and without COPD. In Study II, the associations between health-related quality of life (HRQOL) and activities of daily living (ADL) performance, everyday technology use and demographic data were investigated. In Study IV, ADL performance was further explored, and the relationship between observed and self-reported ADL performance and everyday technology use was investigated. Statistical analyses such as Svensson’s method for paired ordinal data, correlational and multiple regression analyses were applied in these studies. In Study III, the experiences and management of everyday life activities were explored through qualitative interviews, which were analysed using content analysis. All included participants in Study IIIV were diagnosed with COPD.

Findings: An overall finding was that, although different concepts, ADL performance and everyday technology use were related and they were associated with HRQOL among people living with COPD. The personal ADL (PADL) tasks found to be most affected among the participants were related to moving around inside and outside the home, bathing and lower dressing. The instrumental ADL (IADL) tasks most affected were related to cleaning, washing and transportation. The ADL motor skills most challenging for persons with COPD were Positions, Stabilizes, and Endures, and for ADL process skills they were Organizes, Accommodates and Benefits. Inter-rater and test-retest reliability of ETUQ was initially confirmed. The overall ability to use everyday technology was relatively high in relation to the difficulty presented by the technologies included in the ETUQ. However, some participants demonstrated lower ability scores indicating a potential need for support also in using everyday technology. Lastly, the participants experienced a complex juggling when managing their everyday life activities, being constantly aware of bodily symptoms and limitations related to COPD, which meant that valued and pleasurable activities were not in focus and were not prioritised.

Conclusion: The participants in this thesis were affected by their disease while performing both PADL and IADL tasks in which everyday technology was involved. Moreover, they experienced a complex juggling seeking to manage their everyday life activities being constantly aware of bodily symptoms and limitations related to COPD. It is therefore important in pulmonary rehabilitation to address and support persons with COPD in choosing and performing everyday life activities of personal interest and value for them and to support them in using everyday technology. By evaluating and exploring everyday life activities through the dimensions of doing, and in natural and relevant settings, this thesis can contribute with new insights into the field of COPD.

List of scientific papers

I. Kaptain RJ, Kottorp A, Patomella AH, Helle T. Inter-rater and test-retest reliability of the Danish version of the everyday technology use questionnaire. SJOT. 2019; 26(3):226-234.
https://doi.org/10.1080/11038128.2017.1395910

II. Kaptain RJ, Helle T, Patomella AH, Weinreich UM, Kottorp A. Association between everyday technology use, activities of daily living and health-related quality of life in chronic obstructive pulmonary disease. Int J COPD. 2020;15:89-98.
https://doi.org/10.2147/COPD.S229630

III. Kaptain RJ, Helle T, Kottorp A, Patomella AH. Juggling to manage activities of everyday life when living with chronic obstructive pulmonary disease. [Submitted]

IV. Kaptain RJ, Helle T, Patomella AH, Weinreich UM, Kottorp A. New insights into activities of daily living performance in chronic obstructive pulmonary disease. [Submitted]