Title: Maintaining the benefits of Pulmonary Rehabilitation With Harmonies And Melodies via Singing for Lung Health. The WHAM randomised feasibility study.
Funder: Department of Health and Social Care

Abstract: Research Question Is it feasible for individuals with chronic respiratory disease, who have completed pulmonary rehabilitation (PR) to complete group singing classes for 12 weeks with home-exercise advice, compared to receiving home-exercise advice only? Background Evidence-based guidelines recommend PR for individuals with chronic respiratory diseases, but many patients remain functionally limited with disabling symptoms following completion. Singing for Lung Health (SLH) is an arts-in-health programme, that aligns with the social prescribing agenda, and may maintain the holistic benefits of PR, reduce health decline and lower the costs of disease management. Qualitative studies show that SLH is both enjoyable and has physical benefits for those with chronic respiratory conditions. No study has investigated the benefits of SLH after PR completion for this group. Aims and Objectives This research aims to establish the feasibility of SLH group participation post-PR. The primary outcome will be the proportion of randomised participants who complete SLH. We are interested in: feasibility and acceptability of randomisation. number of eligible participants across PR programmes. feasibility of conducting a health economic evaluation. numbers completing home exercise and singing practice sessions. Questionnaire data will provide information regarding the appropriateness of outcome measures, and feasibility data will be used to plan a further definitive study. Methods A one hour SLH taster session will be added to the participating PR programmes education sessions. Patients with stable chronic respiratory diseases attending PR will be invited to take part in the trial after they have experienced this. Baseline assessments will be performed immediately following PR completion and participants will then be randomised to receive either: standard care of home-exercise advice (control arm), or home-exercise advice plus SLH group participation (intervention arm) for 12 weeks, after which they will be re-assessed. Further health economic and quality-of-life data will be collected via postal questionnaire at 24 weeks. SLH participants, clinicians and singing leaders will participate in semi-structured interviews at the end of the study. Timelines for delivery Patient recruitment will last eight months. The intervention will last 12 weeks and all data will be collected in 19 months. Quantitative and qualitative data analysis will be completed between 18 and 21 months. Publications and drafts of follow-up study protocols will be drafted by the end of the funding period at 24 months. Dissemination, anticipated impact and benefit for patients and the NHS Lay advisors will be consulted throughout the trial on appropriate trial dissemination to maximise impact. Trial outcomes and process evaluation will be shared at a participant feedback event, on the British Lung Foundation website, presented at national and international conferences and published in open-access research journals. Partnerships will be forged between NHS PR providers and singing leaders that will enable more patients to access SLH programmes, with improved continuation of care, improved patient health, and efficiency savings. The partnership communities built with patients will help inform further research in this area, potentially changing long term health and social care provision for large populations globally.

Lay abstract: Aim: To find out if individuals with lung disease, who have completed an exercise and disease education programme, can then attend 12 weeks of singing classes designed for individuals with lung conditions. Background: Pulmonary Rehabilitation (PR) is an education and exercise programme recommended for people with lung conditions to improve the management of breathlessness, their quality of life and ability to exercise. Improvements from PR are typically lost after a year without continuing activity in supervised maintenance programmes which are not widely available. Without joining these programmes people increase their risk of getting chest infections, being hospitalised and dying. Singing for Lung Health (SLH) classes are led by trained leaders. Singing is used to provide management of breathlessness and other symptoms. By improving singing techniques, individuals gain skills that help them to cope with their lung condition. We know from research that people taking part in SLH groups find them enjoyable, sociable and useful in managing their conditions. However, despite emerging evidence of the clinical effectiveness of singing, only small, short-term studies have been done so far. Research has not yet shown if it is beneficial for individuals with respiratory disease to participate in singing groups immediately after completing PR. Design: In this study: A taster singing session will be added to the pulmonary rehabilitation education programme. Patients completing PR will be randomised to receive standard care home-exercise advice, or else to attend local SLH groups once a week for 12 weeks, as well as receiving the home-exercise advice. All patients will complete diaries of their home practice sessions of singing and exercise. Patients will complete research assessments before starting their first SLH session and again after completing 12 weeks of singing. The research team will help develop working relationships between PR group leaders and SLH leaders. Clinicians, singing leaders and participants will be interviewed about their experiences of working together, and participating in the research. Participants will be paid to attend singing sessions and assessments. Outcomes: The outcomes are as follows: How many people take part in, and complete SLH (main outcome). Completion rates and referrals of individuals from PR programmes. Changes in symptoms between the two groups after 12 weeks. Outcomes will help designing future studies on the benefits of SLH. Dissemination: Outcomes will be shared across music and health publications, on social media, at a participant feedback event, presented at national and international conferences, and published in research journals accessible by the public.

Research activity codes: 6.7 PHYSICAL
Health categories: RESPIRATORY