No abstract

ISRCTN00061628.

IntroductionSARS-CoV-2 has restricted access to face-to-face delivery of pulmonary rehabilitation (PR). Evidence suggests that telehealth-PR is non-inferior to outpatient PR. However, it is unknown whether patients who have been referred to face-to-face programmes can feasibly complete an online-PR programme.MethodsThis service evaluation used a mixed-methods approach to investigate a rapid PR service remodelling using the University of Gloucestershire eLearn Moodle platform. Quantitative baseline demographic and PR outcome data were collected from online-PR participants, and semistructured interviews were completed with PR staff and participants.ResultsTwenty-five individuals were eligible from a PR waiting list. Thirteen declined participation and 14 completed PR. Significant pre-post online PR improvements were achieved in 1 min sit-to-stand (CI 2.1 to 9 (p=0.004)), Generalised Anxiety Disorder (CI −0.3 to −2.6 (p=0.023)), Primary Health Questionnaire-9 (CI −0.3 to −5.1 (p=0.029)), Chronic Respiratory Questionnaire dyspnoea (CI 0.5 to 1.3 (p=0.001)), fatigue (CI 0.7 to 2 (p=0.0004)), emotion (CI 0.7 to 1.7 (p=0.0002)), mastery (CI 0.4 to 1.3 (p=0.001)). Interviews indicated that patient PR inclusion was made possible with digital support and a PR introduction session improved participant engagement and safety. Incremental progression of exercise was perceived as more successful online compared with face-to-face PR. However, perceptions were that education sessions were less successful. Online-PR required significant staff time resource.DiscussionOnline-PR improves patient outcomes and is feasible and acceptable for individuals referred for face-to-face PR in the context of a requirement for social distancing. Face-to-face programmes can be adapted in a rapid fashion with both staff and participants perceiving benefit. Future pragmatic trials are now warranted comparing online-PR including remote assessments to centre-based PR with suitably matched outcomes, and patient and staff perceptions sought regarding barriers and facilitators of online delivery.

Background Pulmonary rehabilitation (PR) is a multidisciplinary programme which has been shown to improve symptoms and exercise tolerance in patients with COPD and is recommended by national guidelines. Attendance at pulmonary rehabilitation following referral is low and many patients drop-out of the programme before completion. The aim of this study is to obtain quantitative data to assess predictors of attendance and adherence at PR. Methods We performed a retrospective analysis of a database of patients with COPD, who had been invited to attend a pulmonary rehabilitation programme over a 5-year period. Data was obtained from 727 patients. Patients were divided into three groups based on the number of sessions attended; non-attendance (0% attendance), non-adherence (1%e63% attendance), adherence (>63% attendance). Data were compared between attenders vs non-attenders and adherers vs non-adherers to identify predictors (Gender, Smoking status, pack years, cohabitation, referral route, employment status, body mass index, forced expiratory volume in 1 s (FEV 1 ), FEV 1 % predicted, oxygen therapy (LTOT), oxygen saturations at rest, lung information needs questionnaire*, shuttle walk distance*, previous hospitalisation and year of referral) of attendance and adherence to be identified. *Included in adherence analysis only. Results 31.8% of patients referred for PR did not attend and a further 28.3% were non-adherent. Univariate predictors of attendance were male gender (OR¼1.53 95% CI (1.05 to 2.25)), cohabitation (1.77 (1.17 to 2.67)) ex-smoker (2.29 (1.50 to 3.50)). Predictors of adherence were age (64e70: OR 1.99 (1.20 to 3.30); 71e76: 2.57 (1.48 to 4.45)) ex-smoker (4.86 (3.18 to 7.41)), FEV 1 (higher more likely), FEV 1 % predicted (higher more likely), LTOT (0.54 (0.30 to 0.96)). Multiple logistic regression revealed that LTOT (OR 0.39 (0.18 to 0.84)) and cohabitation (1.84 (1.03 to 3.30)) were independent predictors of attendance. Multiple logistic regression revealed that only ex-smoker was predictive of adherence (OR 5.68 (3.33 to 9.7)). Discussion This large quantitative study has reaffirmed previous smaller observations regarding attendance at pulmonary rehabilitation. Disease severity and lack of potential supportive partner also has a negative impact on attendance. Smoking status appears to be a strong factor in predicting attendance and adherence to sessions. Contrary to previous observations, we found no association between type of professional referring and attendance at pulmonary rehabilitation. Introduction COPD patients are often assessed by MRC scale and comparisons made to a healthy population. MRC grade of a healthy population is not usually reported and assumed to be 1, however this may not be accurate. The characteristics of COPD individuals with MRC grade 2 aren't well defined and furthermore it has not been established if physical activity is impaired, compared to a similar healthy population.Aim To establish if there is a difference in activity and exercise capacity between COPD individu...

BackgroundThe symptom burden of ARD is similar to that of cancer, however patients with COPD are less likely to access Specialist Palliative Care (SPC) Services, and less likely to die at home. In Worcestershire there is a comprehensive COPD service providing an ARD pathway, but there exists a group of patients with ARD, who are too unwell to attend the pulmonary rehabilitation and fit to breathe groups, who need a differing level of support, but who are reluctant to attend generic hospice day care.AimsThe monthly joint out-patient clinics aim to enhance end of life care for patients with ARD and their carers by:▸ Providing specialist medical and nursing input from Respiratory and Palliative Medicine consultants, COPD CNS, and SPC day hospice team to minimise symptoms, and maximise activity and function.▸ Improving joint working and increasing accessibility and acceptability of SPC services.▸ Challenging and changing the culture and aims of care for ARD patients.▸ Reducing un-planned hospital admissions.▸ Offering ACPResultsMonthly clinics were set up at two hospice sites, and have been running for 18 months.Approx 50 patients have attended.Unplanned hospital admissions have reduced, deaths at home have increased.Patient and Carer satisfaction survey, HADS and distress thermometer have been used.ACP has been undertaken using the Worcestershire advance statement document.ConclusionsThe clinics have evolved over the 18 months and benefits have occurred beyond just the scope of the patients who actually attend in person. There exists the ability to offer another treatment pathway, with culture change occurring because of this extra option for care. Teams have been empowered to engage in ACP, there has been enhanced carer support and improved joint working.