Improving uptake and completion of pulmonary rehabilitation in COPD with lay health workers: feasibility of a clinical trial.

Patrick White,Lauren Hogg,Sally Singh,Simon Lewin,Rachel Tuffnell,Nicholas Hart,Stephanie Jc Taylor,Alison J Wright,Gill Gilworth,Nicholas S Hopkinson

doi:10.2147/copd.s188731

Abstract

PurposeThis study was designed to evaluate the feasibility of a cluster randomized controlled trial to test the efficacy of lay health workers (LHWs) in improving the uptake and completion of pulmonary rehabilitation (PR) in the treatment of COPD.Materials and methodsLHWs, trained in confidentiality, role boundaries, and behavior change techniques, supported patients newly referred for PR. Interactions between LHWs and participants were recorded with smartphones. Outcomes were recruitment and retention rates of LHWs, questionnaire and interview-evaluated acceptability and analysis of intervention fidelity.ResultsForty (36%) of 110 PR-experienced COPD patients applied to become LHWs. Twenty (18%) were selected for training. Twelve (11%) supported patients. Sixty-six COPD patients referred for PR received the intervention (5.5 participants per LHW). Ten LHWs were retained to the end of the study. Seventy-three percent of supported patients were satisfied or very satisfied with the intervention. LHWs delivered the intervention with appropriate style and variable fidelity. LHWs would welcome more intensive training. Based on this proof of concept, a cluster randomized controlled trial of an LHW intervention to improve uptake and completion of PR is feasible.ConclusionPR-experienced COPD patients can be recruited, trained, and retained as LHWs to support participation in PR, and can deliver the intervention. Participant COPD patients found the intervention acceptable. A cluster randomized controlled clinical trial is feasible.

Highlights

There is strong evidence that pulmonary rehabilitation (PR) is effective across the symptoms and disability of COPD and improves health status and quality of life.[1]
In this feasibility study completed in south London, UK, we recruited and trained COPD patients experienced in PR to carry out a new lay health workers (LHWs) role
COPD patients experienced in PR can be trained as LHWs and can take on the role of promoting uptake and completion of PR among referred COPD patients

Summary

Introduction

Exercise training, education, and behavior change, designed to improve the physical and psychological condition of people with chronic respiratory disease”.2. There is strong evidence that pulmonary rehabilitation (PR) is effective across the symptoms and disability of COPD and improves health status and quality of life.[1] PR is “a comprehensive intervention based on ... It is recommended in national and international guidelines for people who are functionally impaired by COPD.[2] In many settings, access to PR is inadequate.[3] In a UK national COPD audit, only 15% of COPD patients eligible for PR were referred.[4] Where PR is available, its effectiveness is limited by poor uptake and completion.

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Conclusion