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

Research output: Contribution to journalArticle

Patrick Thomas White, Gillian Lynn Gilworth, Simon Lewin, Lauren Hogg, Rachel Tuffnell, Stephanie JC Taylor, Nicholas Hopkinson, Nicholas Hart, Sally J Singh, Alison Wright

Original languageEnglish
Article number188731
Pages (from-to)631-643
Number of pages13
JournalInternational journal of chronic obstructive pulmonary disease
Accepted/In press28 Dec 2018
Published12 Mar 2019


King's Authors


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.

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