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

TY - JOUR

T1 - Improving uptake and completion of pulmonary rehabilitation in COPD with lay health workers

T2 - feasibility of a clinical trial

AU - White, Patrick Thomas

AU - Gilworth, Gillian Lynn

AU - Lewin, Simon

AU - Hogg, Lauren

AU - Tuffnell, Rachel

AU - Taylor, Stephanie JC

AU - Hopkinson, Nicholas

AU - Hart, Nicholas

AU - Singh, Sally J

AU - Wright, Alison

PY - 2019/3/12

Y1 - 2019/3/12

N2 - Purpose: This 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 chronic obstructive pulmonary disease (COPD). Patients and methods: LHWs, trained in confidentiality, role boundaries, and behaviour change techniques, supported patients newly referred for PR. Interactions between LHWs and participants were recorded with smart-phones. Outcomes were recruitment and retention rates of LHWs, questionnaire and interview-evaluated acceptability and analysis of intervention fidelity. Sample size for a cluster randomised controlled trial was calculated. Results: Forty (36%) of 110 PR-experienced COPD patients applied to become LHWs. 20 (18%) were selected for training. 12 (11%) supported patients. 66 COPD patients referred for PR received the intervention (5.5 participants per LHW). 10 LHWs were retained to the end of the study. 73% 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. A trial seeking an absolute increase of 20% in the proportion of patients completing PR with 85% power and alpha = 0.05, will require a sample of 381 patient-participants across 8 centres. Based on this proof of concept, a cluster randomised controlled trial of a lay health worker intervention to improve uptake and completion of PR is feasible. Conclusions: PR-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 randomised controlled clinical trial is feasible.

AB - Purpose: This 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 chronic obstructive pulmonary disease (COPD). Patients and methods: LHWs, trained in confidentiality, role boundaries, and behaviour change techniques, supported patients newly referred for PR. Interactions between LHWs and participants were recorded with smart-phones. Outcomes were recruitment and retention rates of LHWs, questionnaire and interview-evaluated acceptability and analysis of intervention fidelity. Sample size for a cluster randomised controlled trial was calculated. Results: Forty (36%) of 110 PR-experienced COPD patients applied to become LHWs. 20 (18%) were selected for training. 12 (11%) supported patients. 66 COPD patients referred for PR received the intervention (5.5 participants per LHW). 10 LHWs were retained to the end of the study. 73% 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. A trial seeking an absolute increase of 20% in the proportion of patients completing PR with 85% power and alpha = 0.05, will require a sample of 381 patient-participants across 8 centres. Based on this proof of concept, a cluster randomised controlled trial of a lay health worker intervention to improve uptake and completion of PR is feasible. Conclusions: PR-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 randomised controlled clinical trial is feasible.

KW - completion

KW - intervention fidelity

KW - recruitment

KW - retention

KW - uptake

UR - http://www.scopus.com/inward/record.url?scp=85063281907&partnerID=8YFLogxK

U2 - 10.2147/COPD.S188731

DO - 10.2147/COPD.S188731

M3 - Article

SN - 1176-9106

VL - 14

SP - 631

EP - 643

JO - International journal of chronic obstructive pulmonary disease

JF - International journal of chronic obstructive pulmonary disease

M1 - 188731

ER -