Plain English Summary
Background and study aims
Chronic lung disease in low- and middle-income countries (LMICs) is associated with fumes from cooking on open stoves, air pollution and infections such as tuberculosis (TB). Chronic lung disease usually affects the most vulnerable people in developing countries, where people are unable to work from a younger age, and therefore increases the burden of the disability in LMICs. Sufferers are frequently disabled by their breathlessness. As a result, the individual experiences a reduced ability to perform daily activities, poor quality of life and social isolation. The disease is characterised by sudden flare-ups of symptoms, known as acute exacerbations, when symptoms become severe and the level of disability increases. Furthermore, medication in developing countries remains largely unavailable, expensive, and does not reverse the disability caused by chronic lung disease. Pulmonary rehabilitation is a non-drug, low cost, high impact intervention that reverses the disability associated with chronic lung disease. It brings together health professionals from many disciplines, offering supervised exercise training and disease education. However, pulmonary rehabilitation is largely unavailable in developing countries like Sri Lanka and this study seeks to fill this gap and address the unmet needs. The aim of this study is to develop and assess the feasibility and acceptability of a culturally appropriate pulmonary rehabilitation service in Sri Lanka.
Who can participate?
Patients aged 18 and over with COPD
What does the study involve?
Participants are randomly allocated to either a pulmonary rehabilitation group or a control group (usual care). The pulmonary rehabilitation programme consists of 6 weeks of disease-related education and exercises conducted twice weekly. Participants are encouraged to undertake exercise whilst at home too. Participants are asked to attend an appointment at the time of entry into the study (baseline) and at the end of the programme (6 weeks).
What are the possible benefits and risks of participating?
Pulmonary rehabilitation is not routinely available in Sri Lanka. It is envisaged that participants will benefit from taking part in the intervention. Benefits may include improved fitness and reduced severity of symptoms such as breathlessness or chest tightness. There are no anticipated risks of participating.
Where is the study run from?
Central Chest Clinic, Western District, Colombo, Sri Lanka
When is the study starting and how long is it expected to run for?
April 2018 to March 2021
Who is funding the study?
National Institute for Health Research (NIHR) (UK)
Who is the main contact?
Dr Mark Orme
mwo4@leicester.ac.uk
Trial website
Contact information
Type
Public
Primary contact
Dr Mark Orme
ORCID ID
http://orcid.org/0000-0003-4678-6574
Contact details
Centre for Exercise and Rehabilitation Science
NIHR Leicester Biomedical Research Centre - Respiratory
Glenfield Hospital
Groby Road
Leicester
LE3 9QP
United Kingdom
+44 (0)1162583113
mwo4@leicester.ac.uk
Type
Scientific
Additional contact
Dr Marl Orme
ORCID ID
http://orcid.org/0000-0003-4678-6574
Contact details
Centre for Exercise and Rehabilitation Science
NIHR Leicester Biomedical Research Centre - Respiratory
Glenfield Hospital
Groby Road
Leicester
LE3 9QP
United Kingdom
+44 (0)1162583113
mwo4@leicester.ac.uk
Additional identifiers
EudraCT number
Nil known
ClinicalTrials.gov number
Nil known
Protocol/serial number
Version 1
Study information
Scientific title
Assess the feasibility and acceptability of a community based pulmonary rehabilitation programme incorporating dancing for people with COPD in Colombo district in Sri Lanka: Global RECHARGE Sri Lanka
Acronym
Global RECHARGE Sri Lanka
Study hypothesis
To develop a culturally adapted community-based Pulmonary Rehabilitation programme that is feasible and acceptable according to patients and healthcare staff.
Ethics approval
Approval pending, Faculty of Medical Sciences, University of Sri Jayewardenepura, Sri Lanka & University of Leicester, UK
Study design
Single-centre qualitative study and feasibility randomised control trial
Primary study design
Interventional
Secondary study design
Randomised controlled trial
Trial setting
Community
Trial type
Treatment
Patient information sheet
Not available in web format, please use contact details to request a participant information sheet
Condition
Chronic obstructive pulmonary disease
Intervention
A feasibility RCT of Pulmonary Rehabilitation versus usual care (control). Participants will be individually randomised (1:1) to the Pulmonary Rehabilitation programme or to the control group (usual care). Due to the nature of Pulmonary Rehabilitation, it will not be possible for patients to be blinded to the allocation. All measures will be taken by a blinded assessor.
The intervention (Pulmonary Rehabilitation) will consist of a six-week programme, with sessions occurring twice weekly for at least two hours with approximately one hour for education and one hour for exercise. It will be provided by a team of respiratory doctors, physiotherapists, nurses and singing/dancing experts. The education component focus on causes of breathlessness, coping techniques, the role of smoking, biomass smoke, TB and HIV and the value of exercise. The exercise component consists of a combination of resistance and aerobic training, using minimal equipment, individually adjusted over the course of six weeks. Pulmonary Rehabilitation will be provided in groups of up to 10 people with COPD. The exercise regime will be individually prescribed to participants based on their exercise capacity. The regime is based on international guidance and will consist of the following:
1. Stretching/flexibility exercises
2. Resistance training for upper and lower limbs including sit to stand, step ups, bicep curls and pull ups
3. Endurance exercise included walking and cycling on a stationary bike
The content of the programme will also likely include culturally appropriate activities, such as singing and dancing. These will be guided by the data gathered in previous Global RECHARGE:Sri Lanka trials.
The participants in the control arm will receive usual medical care. All participants, regardless of study arm, will receive the "Living with COPD: 5 steps to better lung health" brochure. This is an educational booklet containing information about lungs.
Patient focus groups
Participants allocated to the intervention group will be invited to participate in focus group discussions at the end of their Pulmonary Rehabilitation programme to learn about their experience of Pulmonary Rehabilitation. Focus groups will give an insight on views, experiences, opinions and recommendations which will be then helpful to inform design of future Pulmonary Rehabilitation programmes. We anticipate that we will conduct up to 6 focus groups with 2-10 participants in each. Focus groups will involve a mix of participants from the intervention group who completed the Pulmonary Rehabilitation programme and those who dropped out of Pulmonary Rehabilitation to understand their experiences of the intervention. Focus group discussions will be audio-recorded, each lasting approximately 45-60 minutes, and will be conducted face-to-face by an interviewer and note taker (observer). Focus groups will be transcribed verbatim, with identifiable information removed.
Staff interviews
Health care personnel involved in Pulmonary Rehabilitation will be invited to participate in interviews at the end of study to discuss aspects of feasibility and acceptability, such as insights into barriers and facilitators to referral, uptake and completion of Pulmonary Rehabilitation. We anticipate conducting up to 15 interviews. Interviews will be audio-recorded, each lasting approximately 30-45 minutes, and will be conducted face-to-face by an interviewer. Interviews will be transcribed verbatim, with identifiable information removed.
Book of testimonies
Patients attending Pulmonary Rehabilitation will be asked to log their experience of PR as they progress through the programme. This will be in the form of a Pulmonary Rehabilitation log book accessible to patients before, during and after sessions, as well as a dedicated patient evaluation form. Participants will be regularly prompted in order to gain the experiences of as many patients as possible. Patient satisfaction will also be recorded using a survey; staff involved in Pulmonary Rehabilitation will also receive the same evaluation form at the end of the study.
Intervention type
Behavioural
Phase
Drug names
Primary outcome measure
Feasibility measures including:
1. Suitability of the inclusion criteria
2. Refusal rate
3. Uptake and completion of the study
4. Willingness of patients to be recruited and the willingness of healthcare professionals to refer to this study and future trials
5. Service provider and multi-disciplinary teams’ willingness and ability to deliver the new PR programme
6. The practicality of delivering the intervention in the proposed setting
7. The time needed to collect and analyse the data
8. Test methods for the collection of data as well as data completeness and accuracy
9. The acceptability of the PR programme, assessed through focus groups
10. Compliance to the PR sessions
11. Adherence to home exercise assessed via a self-report exercise diary
12. The training and resource needed to deliver the intervention (ensuring readiness for a future multi-centre trial)
Secondary outcome measures
Measured at baseline and 6 weeks post baseline:
1. Anxiety and depression level, measured using Hospital Anxiety and Depression Scale (HADS)
2. Breathlessness, measured using Medical Research Council (MRC) Dyspnea scale
3. Health status, measured using COPD Assessment Test (CAT) and Clinical COPD Questionnaire (CCQ)
4. Economic impact, measured using Work Productivity and Activity impairment (WPAI) Questionnaire
5. Nutritional status, measured by body weight using scales, body composition using bioelectrical impedance and skinfold thickness, and 7-day diet diary
6. Lung health, assessed by spirometry, impulse oscillometry and diffusing capacity for carbon monoxide
7. Exercise capacity, measured by incremental shuttle walking test (ISWT) and the endurance shuttle walking test (ESWT)
8. Physical activity, measured by ActiGraph wGT3x-BT accelerometer
9. Physical function, measured by 5x sit-to-stand test
Overall trial start date
01/04/2018
Overall trial end date
31/03/2021
Reason abandoned (if study stopped)
Eligibility
Participant inclusion criteria
Stage 1 (patient):
1. Aged ≥18 years
2. Physician diagnosis of COPD
Stage 1 (staff):
1. Healthcare staff that would typically refer patients to a clinical Pulmonary Rehabilitation programme, such as physicians & clinicians.
Stage 2:
1. Aged ≥18 years
2. Physician diagnosis of COPD
3. Spirometry confirmed COPD, based on GOLD criteria, with FEV1/FVC <0.7, and FEV1<80% predicted
4. Medical Research Council (MRC) dyspnoea score grade 2 or higher
Participant type
Mixed
Age group
Adult
Gender
Both
Target number of participants
As this is a feasibility trial, no formal sample size is required, yet the researchers hope to recruit 50 patients
Participant exclusion criteria
1. Comorbidities such as severe or unstable cardiovascular, other internal diseases and locomotor difficulties that preclude exercise
2. Malignant disease or other serious illness which will interfere with participation in the Pulmonary Rehabilitation programme
3. Unable or unwilling to provide informed consent
Recruitment start date
01/09/2020
Recruitment end date
31/01/2021
Locations
Countries of recruitment
Sri Lanka
Trial participating centre
Central Chest Clinic
Dr Danister De Silva Mawatha
Colombo
Sri Lanka
United Kingdom
Sponsor information
Organisation
University of Leicester
Sponsor details
University Road
Leicester
LE1 7RH
United Kingdom
+44 (0)116 252 2522
smd8@leicester.ac.uk
Sponsor type
University/education
Website
Funders
Funder type
Government
Funder name
National Institute for Health Research
Alternative name(s)
NIHR
Funding Body Type
government organisation
Funding Body Subtype
National government
Location
United Kingdom
Results and Publications
Publication and dissemination plan
The researchers will publish a protocol paper for this study. It is anticipated that the results from this study will be published in international journals and presented locally, nationally and internationally at appropriate meetings and conferences. All data that will be collected is anticipated to be published.
IPD sharing statement
The data sharing plans for the current study are unknown and will be made available at a later date.
Intention to publish date
31/03/2021
Participant level data
To be made available at a later date
Basic results (scientific)
Publication list