Singing for lung health following completion of pulmonary rehabilitation - feasibility of a randomised controlled trial
Authors: Lewis Adam , Jung Peter , Williams Parris J. , Steinmann Jennifer , Ingram Karen , Longley Noah , Trivedi Puja , Clarke Stuart , Lammin Helen , Edwards George , Koulopolou Maria , Sureshkumar Arun , Moore Anna , Pfeffer Paul E. , Reardon Leanne , Sorley Kim , Kenman Jarvis , DeLuca Brendan , Maguire Michelle , Smith Laura-Jane E. , Elkin Sarah , Lound Adam , Moth Laura , Rickman Penelope , Alexander Sharon , Lohan Natasha , Garsin Emily , Young Susan , Harris Amanda , Watters Rosie , Lane Cleo , Nolan Claire M , Conway Joy , Man William D-C , Banya Winston , Anokye Nana , Philip Keir E.J. , Cave Phoene , Hopkinson Nicholas S. 
Published: February 2025

Background

Pulmonary rehabilitation(PR) is a highly effective intervention for people with chronic respiratory disease, however it is not known how best to sustain its benefits. Clinical trials are needed to establish if participation in Singing for Lung Health(SLH) groups following PR will improve health-related quality-of-life, healthcare utilisation and exercise capacity compared to usual care. A feasibility study would help to guide development of these.

Methods

In a multi-centre, mixed-methods randomised controlled feasibility trial, PR participants at 4 sites, were pre-screened at baseline assessment. An SLH taster session was included routinely as part of the PR programmes. Eligible PR completers were invited to take part in the trial and randomised to usual care or a 12-week SLH course. Feasibility outcomes included recruitment rate, intervention compliance (at least 8/12 sessions) and completeness of data collection including symptom questionnaires, walk tests and physical activity monitoring. Interviews with participants and study personnel about their experience and views of the study were subjected to thematic analysis.

Results

Between October 2022 and November 2023, 1311 patients were assessed to start PR, 838 completed. Of those completing, 243 were ineligible to take part, (predominantly due to vaccination status and other primary PR diagnoses), and 531 declined. 64 people (33 female, mean(SD) age 69(12), 41 ethnically white, COPD/asthma/interstitial lung disease/bronchiectasis n=33/16/9/6) were recruited with 30(93.8%) SLH and 29(90.6%) controls completing the study. 20(62.5%) of the SLH group completed at least 8/12 SLH sessions. There was enthusiasm for a definitive trial from participants, clinicians and singing group leaders perspectives based on positive experiences of trial involvement. Improvements to recruitment strategy, intervention structure, outcome measures and staffing were suggested.

Conclusion

A definitive RCT of SLH post-PR appears feasible, with acceptable uptake and completion rates.

Trial Registration

ISRCTN11056049

What is already known on this topic?

Singing for Lung Health(SLH) has previously been shown to improve health-related quality-of-life for people with Chronic Obstructive Pulmonary Disease. Pulmonary Rehabilitation is a gold standard intervention, but it is not known whether SLH groups can be delivered as a maintenance programme after PR completion, or whether an RCT comparing this approach to usual care is feasible.

What this study adds

It is feasible to conduct an RCT investigating the clinical and cost effectiveness of a 12-week SLH post PR maintenance programme compared with usual care.

How this might affect research, practice or policy

This study will inform the design and delivery of a definitive RCT. The feasibility methodology used in this study can be applied to other creative health interventions which may be considered as maintenance options post-PR.