An interactive web-based pulmonary rehabilitation programme: A randomised controlled feasibility trial

Chaplin, Emma; Hewitt, Stacey; Apps, Lindsay; Edwards, Kelly; Brough, Christopher; Glab, Aga; Bankart, John; Pulikottil-Jacob, Ruth; Schreder, Sally; Williams, JE; Singh, Sally

doi:10.1183/13993003.congress-2016.pa2064

Cited by 5 publications

(8 citation statements)

References 23 publications

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“…The duration of the supported phase of the intervention was comparable to the recommended length of a rehabilitation programme26 and uniquely offered less direct or indeed indirect supervision. More recently digital versions of rehabilitation have been tested with encouraging results for those completing the programme 27. This study is important as it demonstrates benefits acquired in a short time period similar to the outpatient model of PR.…”

Section: Discussionmentioning

confidence: 89%

Comparison of a structured home-based rehabilitation programme with conventional supervised pulmonary rehabilitation: a randomised non-inferiority trial

Horton

Mitchell

Johnson

et al. 2017

Thorax

129

148

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BackgroundStandardised home-based pulmonary rehabilitation (PR) programmes offer an alternative model to centre-based supervised PR for which uptake is currently poor. We determined if a structured home-based unsupervised PR programme was non-inferior to supervised centre-based PR for participants with COPD.MethodsA total of 287 participants with COPD who were referred to PR (187 male, mean (SD) age 68 (8.86) years, FEV1% predicted 48.34 (17.92)) were recruited. They were randomised to either centre-based PR or a structured unsupervised home-based PR programme including a hospital visit with a healthcare professional trained in motivational interviewing, a self-management manual and two telephone calls. Fifty-eight (20%) withdrew from the centre-based group and 51 (18%) from the home group. The primary outcome was dyspnoea domain in the chronic respiratory disease questionnaire (Chronic Respiratory Questionnaire Self-Report; CRQ-SR) at 7 weeks. Measures were taken blinded. We undertook a modified intention-to-treat (mITT) complete case analysis, comparing groups according to original random allocation and with complete data at follow-up. The non-inferiority margin was 0.5 units.ResultsThere was evidence of significant gains in CRQ-dyspnoea at 7 weeks in both home and centre-based groups. There was inconclusive evidence that home-based PR was non-inferior to PR in dyspnoea (mean group difference, mITT: −0.24, 95% CI −0.61 to 0.12, p=0.18), favouring the centre group at 7 weeks.ConclusionsThe standardised home-based programme provides benefits in dyspnoea. Further evidence is needed to definitively determine if the health benefits of the standardised home-based programme are non-inferior or equivalent to supervised centre-based rehabilitation.Trial registration numberISRCTN81189044.

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Section: Discussionmentioning

confidence: 89%

Comparison of a structured home-based rehabilitation programme with conventional supervised pulmonary rehabilitation: a randomised non-inferiority trial

Horton

Mitchell

Johnson

et al. 2017

Thorax

129

148

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“…A webbased platform of the SPACE for COPD© self-management programme has shown promising results in stable COPD. 2 The primary aim of this study was to assess the feasibility of the web-based programme for individuals hospitalised with an AECOPD. Methods Eligible patients had confirmed COPD, were web-literate and had an email address.…”

mentioning

confidence: 99%

S11 Feasibility of a web-based self-management programme, as a ‘bridge’ to starting pulmonary rehabilitation, for individuals hospitalised with an acute exacerbation of chronic obstructive pulmonary disease (AECOPD)

Houchen–Wolloff

Orme

Clinch

et al. 2018

Use It or Lose It: Effective Delivery of Pulmonary Rehabilitation

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“…One of the quantitative studies is reported in three papers. [198][199][200] Operating programme theories [198][199][200] community gym facilities, 201 lung centre, 205 web based, 206 hospital as acute admission, 203…”

Section: Number and Type Of Uk Studiesmentioning

confidence: 99%

“…(Grade A)'. 197 Eight-week programme with follow-up (cluster), [198][199][200] 7 weeks, 206 8 weeks, 207 6 weeks 201,203,204 How often? The British Thoracic Society 2013 guideline recommends 'Pulmonary rehabilitation programmes including the attendance at a minimum of 12 supervised sessions are recommended, although individual patients can gain some benefit from fewer sessions.…”

Section: Community Settings 204mentioning

confidence: 99%

“…Future trials could investigate choice-based pulmonary rehabilitation, enabling patients to choose location-based or web-based programmes. 206 One study 203 investigated whether or not introducing rehabilitation while in hospital for an acute exacerbation of COPD could reduce risk of re-admission. The study found that early rehabilitation did not reduce the risk of subsequent re-admission and concluded that the results from their study suggest that, beyond current standard physiotherapy practice, progressive exercise rehabilitation should not be started during the early stages of the acute illness.…”

Section: Role Of Evaluation/measurementmentioning

confidence: 99%

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Implementation of interventions to reduce preventable hospital admissions for cardiovascular or respiratory conditions: an evidence map and realist synthesis

Chambers

Cantrell

2020

Health Serv Deliv Res

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Background In 2012, a series of systematic reviews summarised the evidence regarding interventions to reduce preventable hospital admissions. Although intervention effects were dependent on context, the reviews revealed a consistent picture of reduction across different interventions targeting cardiovascular and respiratory conditions. The research reported here sought to provide an in-depth understanding of how interventions that have been shown to reduce admissions for these conditions may work, with a view to supporting their effective implementation in practice. Objectives To map the available evidence on interventions used in the UK NHS to reduce preventable admissions for cardiovascular and respiratory conditions and to conduct a realist synthesis of implementation evidence related to these interventions. Methods For the mapping review, six databases were searched for studies published between 2010 and October 2017. Studies were included if they were conducted in the UK, the USA, Canada, Australia or New Zealand; recruited adults with a cardiovascular or respiratory condition; and evaluated or described an intervention that could reduce preventable admissions or re-admissions. A descriptive summary of key characteristics of the included studies was produced. The studies included in the mapping review helped to inform the sampling frame for the subsequent realist synthesis. The wider evidence base was also engaged through supplementary searching. Data extraction forms were developed using appropriate frameworks (an implementation framework, an intervention template and a realist logic template). Following identification of initial programme theories (from the theoretical literature, empirical studies and insights from the patient and public involvement group), the review team extracted data into evidence tables. Programme theories were examined against the individual intervention types and collectively as a set. The resultant hypotheses functioned as synthesised statements around which an explanatory narrative referenced to the underpinning evidence base was developed. Additional searches for mid-range and overarching theories were carried out using Google Scholar (Google Inc., Mountain View, CA, USA). Results A total of 569 publications were included in the mapping review. The largest group originated from the USA. The included studies from the UK showed a similar distribution to that of the map as a whole, but there was evidence of some country-specific features, such as the prominence of studies of telehealth. In the realist synthesis, it was found that interventions with strong evidence of effectiveness overall had not necessarily demonstrated effectiveness in UK settings. This could be a barrier to using these interventions in the NHS. Facilitation of the implementation of interventions was often not reported or inadequately reported. Many of the interventions were diverse in the ways in which they were delivered. There was also considerable overlap in the content of interventions. The role of specialist nurses was highlighted in several studies. The five programme theories identified were supported to varying degrees by empirical literature, but all provided valuable insights. Limitations The research was conducted by a small team; time and resources limited the team’s ability to consult with a full range of stakeholders. Conclusions Overall, implementation appears to be favoured by support for self-management by patients and their families/carers, support for services that signpost patients to consider alternatives to seeing their general practitioner when appropriate, recognition of possible reasons why patients seek admission, support for health-care professionals to diagnose and refer patients appropriately and support for workforce roles that promote continuity of care and co-ordination between services. Future work Research should focus on understanding discrepancies between national and international evidence and the transferability of findings between different contexts; the design and evaluation of implementation strategies informed by theories about how the intervention being implemented might work; and qualitative research on decision-making around hospital referrals and admissions. Funding The National Institute for Health Research Health Services and Delivery Research programme.

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An interactive web-based pulmonary rehabilitation programme: A randomised controlled feasibility trial

Abstract: Objectives: The aim of this study was to determine if an interactive web-based pulmonary rehabilitation (PR) programme is a feasible alternative to conventional PR.

Cited by 5 publications

References 23 publications

Comparison of a structured home-based rehabilitation programme with conventional supervised pulmonary rehabilitation: a randomised non-inferiority trial

Comparison of a structured home-based rehabilitation programme with conventional supervised pulmonary rehabilitation: a randomised non-inferiority trial

S11 Feasibility of a web-based self-management programme, as a ‘bridge’ to starting pulmonary rehabilitation, for individuals hospitalised with an acute exacerbation of chronic obstructive pulmonary disease (AECOPD)

Implementation of interventions to reduce preventable hospital admissions for cardiovascular or respiratory conditions: an evidence map and realist synthesis

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