Clinical measurement of functional outcomes of pulmonary rehabilitation.

Chronic Obstructive Pulmonary Disease "COPD" is a chronic condition characterised by progressive deterioration in the lung function. COPD co exists with other clinical conditions resulting into complex cases. People with COPD suffer from progressive functional limitations and participation restrictions. Pulmonary Rehabilitation "PR" is a multidisciplinary intervention designed to improve functional outcomes in people with COPD. Despite the established effectiveness of PR, a number of clinical problems in the provision of PR services remain unresolved. In order to address these problems an outcome measure that is appropriate for implementation in clinical settings is required. The aim of this thesis was to develop a clinical tool for the measurement of functional outcomes of PR in people with COPD. The research process included three phases. A "conceptualisation" phase, the phase of "development", and a "clinical testing" phase. During the phase of conceptualisation a critical review of the literature was performed. This resulted in the development of a framework for the measurement of functioning in people with COPD, and the identification of the specifications for a clinical outcome measure.The phase of development resulted in the selection of the TELER method of measurement and the development and validation of TELER "function" indicators using extensive qualitative research that used indepth interviews and focus groups methods. The final phase was testing the indicators in clinical PR settings. This resulted in providing evidence of the usefulness of the TELER "function" indicators in producing informative data appropriate for full clinimetric analysis. The clinimetric analysis of TELER data developed new insights about the provision of PR. This thesis has contributed to the development in the measurement of the functional outcomes of PR, by providing a new clinical tool that is underpinned by sound theoretical, clinical and empirical knowledge. The tool is appropriate for use in clinical evaluation, and has the potential to resolve clinical problems in the provision of PR.