Global RECHARGE: Establishing a standard international data set for pulmonary rehabilitation in low- and middle-income countries

Orme, Mark; Free, Robert C; Manise, Adrian; Jones, Amy; Akylbekov, Azamat; Barton, Andy; Emilov, Berik; Girase, Bhushan; Jayamaha, Akila R; Jones, Rupert; Katagira, Winceslaus; Kirenga, Bruce; Matheson, Jesse; Miah, Ruhme B; Perrera, Chamilya; Sahasrabudhe, Shruti; Salvi, Sundeep; Sekibira, Rogers; Sooronbaev, Talant; Steiner, Michael; Wimalasekera, Savi; Singh, Sally

doi:10.7189/jogh.10.020316

Cited by 21 publications

(17 citation statements)

References 19 publications

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“…Availability and access to rehabilitation is recognized as AMERICAN THORACIC SOCIETY DOCUMENTS fundamental to achieving WHO Sustainable Development Goal 3. Data are emerging that culturally adapted PR can be successfully implemented for COPD in LMICs (54)(55)(56)(57)(58), but cost-effectiveness data are missing and are necessary to help address major challenges around staff training, space, the provision of equipment, the retention rate in programs, and the awareness and support needed to refer people to such programs. Alternative approaches, including digital options, may improve access to PR, but there has been little study of the use of "remote PR" in LMICs.…”

Section: Discussionmentioning

confidence: 99%

Challenges in the Implementation of Chronic Obstructive Pulmonary Disease Guidelines in Low- and Middle-Income Countries: An Official American Thoracic Society Workshop Report

Hurst¹,

Buist²,

Gaga³

et al. 2021

Annals ATS

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There is a substantial burden of chronic respiratory diseases, including chronic obstructive pulmonary disease (COPD), in lowand middle-income countries (LMICs). LMICs have particular challenges in delivering cost-effective prevention, diagnosis, and management of COPD. Optimal care can be supported by effective implementation of guidelines. This American Thoracic Society workshop considered challenges to implementation of COPD guidelines in LMICs. We make 10 specific recommendations: 1) relevant organizations should provide LMIC-specific COPD management guidance; 2) patient and professional organizations must persuade policy-makers of the importance of lung function testing programs in LMICs; 3) healthcare education and training should emphasize the early-life origins of COPD; 4) urgent action is required by governments to reduce airborne exposures, including exposures to tobacco smoke and indoor and outdoor air pollution; 5) guidance for COPD in LMICs should explicitly link across Essential Medicine Lists and the World Health Organization package of essential noncommunicable disease interventions for primary health care in low-resource settings and should consider availability, affordability, sustainability, and cost-effective use of medicines; 6) the pharmaceutical industry should work to make effective COPD and tobacco-dependence medicines globally accessible and affordable; 7) implementation of locally adapted, cost-effective pulmonary rehabilitation programs should be an international priority; 8) the World Health Organization Global Action Plan for the Prevention and Control of Noncommunicable Diseases should specify how improvements in respiratory health will be achieved; 9) research funders should increase the proportion of funding allocated to COPD in LMICs; and 10) the respiratory community should leverage the skills and enthusiasm of earliercareer clinicians and researchers to improve global respiratory health.

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Section: Discussionmentioning

confidence: 99%

Challenges in the Implementation of Chronic Obstructive Pulmonary Disease Guidelines in Low- and Middle-Income Countries: An Official American Thoracic Society Workshop Report

Hurst¹,

Buist²,

Gaga³

et al. 2021

Annals ATS

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“…Table 1 shows all baseline and follow-up assessment data that will be collected during the trial, in accordance with a minimum recommended dataset for PR trials in LMIC. 16 …”

Section: Methodsmentioning

confidence: 99%

“…For the primary analysis, the differences in the primary outcome (walking distance on the ISWT) with the corresponding two-sided 95% CI and p value will be estimated using a stratified analysis; a p<0.05 will be the measure for statistical significance. Predictive analytics software (SPSS 16 ) will be used to analyse the data. Continuous data will be presented as mean and SD or median and IQRs, while categorical data will be presented as frequencies and percentages.…”

Section: Methodsmentioning

confidence: 99%

“…31 32 The PHQ-9 is a nine item, validated, short, selfadministered and positively worded questionnaire designed to measure the severity of depression over the last 2 weeks. 33 The total score ranges from 0 to 27, with high scores indicating high depression, specifically; no depression (0-4), mild (5-9), moderate (10)(11)(12)(13)(14), moderately severe (15)(16)(17)(18)(19) or severe depression. 20-27 33 The PHQ-9 has an estimated MCID of 5 points.…”

Section: Psychological Well-beingmentioning

confidence: 99%

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Study protocol for a randomised controlled trial assessing the impact of pulmonary rehabilitation on maximal exercise capacity for adults living with post-TB lung disease: Global RECHARGE Uganda

et al. 2021

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IntroductionThe burden of post-tuberculosis (TB) lung disease (PTBLD) is steadily increasing in sub-Saharan Africa, causing disability among TB survivors. Without effective medicines, the mainstay of PTBLD treatment evolves around disease prevention and supportive treatment. Pulmonary rehabilitation (PR), a low-cost, non-pharmacological intervention has shown effectiveness in a group of PTBLD individuals but has not been tested in a clinical trial. This study aims to assess the impact of a 6-week PR programme on maximal exercise capacity and other outcomes among adults in Uganda living with PTBLD.Methods and analysisThis is a randomised waiting-list controlled trial with blinded outcome measures, comparing PR versus usual care for patients with PTBLD. A total of 114 participants will be randomised (1:1) to receive either usual care (on the waiting list) or PR, with follow-up assessments at 6 weeks and 12 weeks postintervention. The primary outcome is change in walking distance measured by the Incremental Shuttle Walk Test from baseline to the end of 6 weeks of PR. All secondary outcomes will be compared between the PR and usual care arms from baseline to 6-week and 12-week follow-ups. Secondary outcomes include self-reported respiratory symptoms, physical activity, psychological well-being, health-related quality of life and cost–benefit analysis. All randomised participants will be included in the intention-to-treat analysis population. The primary efficacy analysis will be based on both per-protocol and modified intention-to-treat populations.Ethics and disseminationThe trial has received ethical clearance from the Mulago Hospital Research and Ethics Committee (MHREC 1478), Kampala, Uganda as well as the Uganda National Council for Science and Technology (SS 5105). Ethical approval has been obtained from the University of Leicester, UK research ethics committee (Ref No. 22349). Study findings will be published in appropriate peer-reviewed journals and disseminated at appropriate local, regional and international scientific meetings and conferences.Trial registration numberISRCTN18256843.Protocol versionVersion 1.0 July 2019.

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“…Study team and IDMC only will have access to final trial dataset. Data from the Global Health Research Group on Respiratory Rehabilitation (Global RECHARGE) Core Dataset 44 will be made available following the completion of this project and we are considering the best tools to use to make this database available to the wider community. Any modifications of the protocol will be updated on trial registry (ISRCTN) and will be informed to the ethics review committee and the participants.…”

Section: Ethics and Disseminationmentioning

confidence: 99%

Protocol for the cultural adaptation of pulmonary rehabilitation and subsequent testing in a randomised controlled feasibility trial for adults with chronic obstructive pulmonary disease in Sri Lanka

et al. 2020

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IntroductionInternational guidelines recommend pulmonary rehabilitation (PR) should be offered to adults living with chronic obstructive pulmonary disease (COPD), but PR availability is limited in Sri Lanka. Culturally appropriate PR needs to be designed and implemented in Sri Lanka. The study aims to adapt PR to the Sri Lankan context and determine the feasibility of conducting a future trial of the adapted PR in Sri Lanka.Methods and analysisEligible participants will be identified and will be invited to take part in the randomised controlled feasibility trial, which will be conducted in Central Chest Clinic, Colombo, Sri Lanka. A total of 50 participants will be recruited (anticipated from April 2021) to the trial and randomised (1:1) into one of two groups; control group receiving usual care or the intervention group receiving adapted PR. The trial intervention is a Sri Lankan-specific PR programme, which will consist of 12 sessions of exercise and health education, delivered over 6 weeks. Focus groups with adults living with COPD, caregivers and nurses and in-depth interviews with doctors and physiotherapist will be conducted to inform the Sri Lankan specific PR adaptations. After completion of PR, routine measures in both groups will be assessed by a blinded assessor. The primary outcome measure is feasibility, including assessing eligibility, uptake and completion. Qualitative evaluation of the trial using focus groups with participants and in-depth interviews with PR deliverers will be conducted to further determine feasibility and acceptability of PR, as well as the ability to run a larger future trial.Ethics and disseminationEthical approval was obtained from the ethics review committee of Faculty of Medical Sciences, University of Sri Jayewardenepura, Sri Lanka and University of Leicester, UK. The results of the trial will be disseminated through patient and public involvement events, local and international conference proceedings, and peer-reviewed journals.Trial registration numberISRCTN13367735

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Global RECHARGE: Establishing a standard international data set for pulmonary rehabilitation in low- and middle-income countries

Cited by 21 publications

References 19 publications

Challenges in the Implementation of Chronic Obstructive Pulmonary Disease Guidelines in Low- and Middle-Income Countries: An Official American Thoracic Society Workshop Report

Challenges in the Implementation of Chronic Obstructive Pulmonary Disease Guidelines in Low- and Middle-Income Countries: An Official American Thoracic Society Workshop Report

Study protocol for a randomised controlled trial assessing the impact of pulmonary rehabilitation on maximal exercise capacity for adults living with post-TB lung disease: Global RECHARGE Uganda

Protocol for the cultural adaptation of pulmonary rehabilitation and subsequent testing in a randomised controlled feasibility trial for adults with chronic obstructive pulmonary disease in Sri Lanka

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