Title: Improving uptake of post-hospitalisation pulmonary rehabilitation using a patient designed video
Funder: Department of Health (England)

Abstract: Exacerbations of Chronic Obstructive Pulmonary Disease (COPD) are the second commonest cause of emergency hospital admission and are associated with significant morbidity and mortality. Several randomized controlled trials and a Cochrane review suggest that post-hospitalisation pulmonary rehabilitation (PR) is a highly effective intervention to improve functional capacity and health-related quality of life, to reduce hospital admissions, and to decrease mortality in patients with COPD. Consequently post-hospitalisation PR has been recommended in national and international COPD guidelines. Despite this, only a small proportion of eligible COPD patients receive post-hospitalisation PR due to poor uptake; a recent audit from the applicants revealed that only 32% of eligible COPD patients discharged from hospital are referred for post-hospitalisation PR with only 15% completing. Further qualitative work showed that many patients had no understanding of what PR involved and felt too unwell to participate. Many welcomed a form of patient-delivered (and focused) education during hospital admission to promote understanding of the intervention. The aims of the study are three-fold: to develop a video, using patient video clips, to promote the benefits of post-hospitalisation PR; to conduct a feasibility study comparing different methods of delivering this video to hospitalised patients with acute exacerbations of COPD against usual care; and to perform a qualitative evaluation (one-to-one and focus groups) of patients participating in the feasibility study to gather views and attitudes to help inform design of a future multicentre trial. To develop the video, we will use the principles of experience co-based design and hold a series of patient and staff feedback events to edit existing patient video footage to produce a short patient-focused video designed to educate about PR and to promote the benefits of post-hospitalisation PR. We will then conduct a feasibility study and randomise 120 hospitalised COPD patients to usual care, usual care and patient video delivered through a bedside media system, or usual care and patient video delivered via a tablet computer and healthcare professional. Outcomes will focus on aspects that may inform the design of a multi-centre future randomised controlled trial, such as recruitment rate, compliance with intervention (including patient preference for delivery modes), practicalities associated with the intervention (including staff time), patient and staff acceptability, likelihood of wider implementation and limited efficacy testing, which will help inform sample size calculation for a future multi-centre randomised controlled trial. Data from this study will be corroborated by in-depth structured one-to-one interviews of patients in the intervention groups and staff participating in the feasibility study. Qualitative interviews will include 10 patients who subsequently accepted PR, and 10 patients who subsequently declined PR as well as health care professionals delivering the interventions. Interviews will be audio-taped, transcribed verbatim and examined for emergent themes using a framework approach through the steps of 1) data management; 2) descriptive accounts; 3) explanatory accounts. Data generated from these studies will be used to design a future two-arm multi-centre randomised controlled trial in hospitalised COPD patients to test the effects of the patient video against usual care in patient uptake for post-hospitalisation PR. Despite the proven substantial benefits of post-hospitalisation PR, uptake for this intervention remains limited, primarily due to lack of patient awareness. The proposed study will provide preliminary data to plan a future multi-centre randomized controlled trial. As the video is cheap, it is potentially a highly cost-effective method of encouraging COPD patients to take up and adhere to a highly beneficial therapy, namely post-hospitalisation PR.


Research activity codes: 7.1 INDIVIDUAL CARE NEEDS;6.7 PHYSICAL
Health categories: RESPIRATORY