NHS Glos. ICS: Long COVID – Impacting Fatigue

25 August 2022

80% of Participants Report Improvements in their Self-Efficacy to Manage Fatigue

Overview

In addition to the results published in our report of June 2022 for referrals from the NHS Gloucestershire ICS Long COVID recovery pathway, we’ve conducted a secondary analysis that offers deeper insights into patient impact.

All KiActiv® Health participants are asked to complete a patient reported outcome measures (PROMs) questionnaire consisting of multiple validated scales both pre and post 12-week programme. This enables us to gauge the impact of the programme on various metrics, including quality of life, mental wellbeing and self-efficacy.

At the time of analysis, 109 participants have started their KiActiv® Health programme, of which 72 (66%) have completed and 28 (26%) remain within their initial 12 weeks. Of the 72 completers, 44 (61%) have completed both the pre and post PROMs questionnaire.

PROMs Analysis – Self-Efficacy for Managing Fatigue 

Group Split

Individuals suffering from Long COVID typically report lingering fatigue as one of their primary symptoms. One particular question within the self-efficacy section of our questionnaire focusses on the individual’s self-efficacy when it comes to managing their fatigue:

This question originates from the self-efficacy for managing chronic disease scale, a validated metric commonly used to assess self-efficacy, and asks the patient to rate their self-efficacy for managing fatigue between 1-10 (1 being low and 10 being high). We analysed a group of 44 participants who had completed both the pre and post version of the questionnaire (from a possible 72 completers; 61% response rate) to assess whether an individual’s self-reported self-efficacy for managing their fatigue at baseline had any impact on their experience and outcomes whilst participating in KiActiv® Health.

To conduct the analysis, participants were split into three different groups depending on their response to the self-efficacy for managing fatigue question in the pre-questionnaire. The following categories were defined:

  • High self-efficacy for managing fatigue – a score of 7-10 (n=5)
  • Moderate self-efficacy for managing fatigue – a score of 4-6 (n=19)
  • Low self-efficacy for managing fatigue – a score of 1-3 (n=20)

Changes to Distribution of Participants Between Self-Efficacy Groups

The general distribution of participants across self-efficacy groups at pre-programme and at post-programme is shown in Figure 1 (below). Please note, self-efficacy scores were sorted in ascending order to display distribution, so participant #1 in pre-graph (top) is not necessarily participant #1 in post-graph (bottom) and so on.

Figure 1: Distribution of self-efficacy for managing fatigue scores at pre and post (n=44). Light blue dashed lines indicate thresholds between low, moderate and high self-efficacy. Pre-score distribution indicated in top graph; post-score distribution indicated in bottom graph.  

In the pre-programme questionnaire, 20 participants (45%) were classified in the low self-efficacy to manage their fatigue group (see Figure 2, below). Impressively, only 4 participants (9%) remained in the low self-efficacy group, with all others progressing into the moderate or high self-efficacy groups by the end of their 12-week programme (see Figure 2, below). Similarly, 84% of participants classed as having moderate self-efficacy to manage their fatigue were able to progress into the high self-efficacy for managing their fatigue by the end of the 12-week programme. Pre-programme, just 5 participants (11%) were in the high self-efficacy group. Post-programme, this had increased to 27 participants (61%) (see Figure 2, below).

Figure 2:  Group split for self-efficacy for managing fatigue scores at pre and post (n=44). Data labels above light blue bars denote % split at pre; Data labels above dark blue bars denote % split at post.

Changes to Self-Efficacy Score

Participants in the low self-efficacy group exhibited the greatest overall improvement, followed by the moderate and high self-efficacy groups, respectively (see Figure 3, below). Individuals reporting low self-efficacy in the pre-programme questionnaire reported a six-fold greater improvement compared to their counterparts from the high self-efficacy group pre-programme. Despite this, it’s clear that self-efficacy was improved across the board, with those in the high group at baseline maintaining a high level of self-efficacy for managing their fatigue post-programme.

Figure 3:  Self-efficacy for managing fatigue score pre vs. post, grouped by self-efficacy to manage fatigue at baseline (n=44). Data labels denote average change between pre-post self-efficacy scores for each group.

Changes to Quality-of-Life Score

Similarly, participants who self-reported low self-efficacy at baseline saw the greatest improvements in quality of life, measured using the WHOQOL-Bref combined score (see Figure 4, below). For context, a +0.876 or greater increase is deemed ‘clinically meaningful,’ which means individuals in the low and moderate self-efficacy for managing fatigue groups at baseline both saw clinically meaningful increases in their quality of life, on average. Although the high self-efficacy group did not make a clinically meaningful increase, their average quality-of-life score was high to begin with. This was sustained post-programme, with this group recording the highest average quality-of-life score of all 3 groups (see Figure 4, below).

Figure 4:  WHOQOL-Bref combined Quality of Life score pre vs. post, grouped by self-efficacy to manage fatigue at baseline (n=44). Data labels denote average change between pre and post Quality of Life scores for each group.

Changes to Mental Wellbeing Score

We assess mental wellbeing using the Short Warwick-Edinburgh Mental Wellbeing Scale (SWEMWBS). Participants in the moderate self-efficacy for managing fatigue at baseline group saw the biggest post-programme improvements in SWEMWBS, closely followed by those in the low self-efficacy group (see Figure 5, below). For context, an improvement of 1.0 or greater is considered ‘statistically important,’ which means that all 3 groups saw statistically important improvements to their mental wellbeing.

Figure 5:  Short Warwick Edinburgh Mental Wellbeing score (SWEMWBS) pre vs. post, grouped by self-efficacy to manage fatigue at baseline (n=44). Data labels denote average change between pre and post mental wellbeing scores for each group.

Self-Efficacy – Impact on Engagement Analysis

On average, the low self-efficacy to manage fatigue group visited the platform over three times more frequently than the high self-efficacy group (see Figure 6, below). Whilst further analysis is required here, this could be explained by the low self-efficacy group having a greater need to utilise the technology to support them in managing their fatigue-related symptoms. It’s important to recognise the difference in group size here too, as low (n=20), moderate (n=19) and high (n=5) group weightings may have influenced these outcomes.

Figure 6: Average percentage platform visit days within each group logged into the platform (n=44). A higher number indicates a greater level of engagement. The programme consists of 84 days. However, participants only get access to their platform after their baseline week. This means that platform visit days are expressed as a percentage of 77 days. Grouped by self-efficacy to manage fatigue at baseline. Low (n=20); Moderate (n=19); High (n=5). Data labels denote y-axis value.

KiActiv® Health Evaluation Questionnaire

A second questionnaire is sent to all participants post-programme, presenting an opportunity for them to provide further feedback on the programme. At the time of analysis, 34 from a possible 72 participants (47%) had taken the opportunity to provide feedback using the evaluation questionnaire. Further analysis showed that the vast majority of participants felt that they had improved their understanding of everyday physical activity, were now confident in managing their own health and physical activity, and felt that KiActiv® Health had benefitted them in some way (see Figure 7, below).

Figure 7: Percentage of participants who answered “yes” to the above question within their KiActiv® Health post-programme evaluation questionnaire (n=34). PA = physical activity.

25th July 2022

B&NES Pilot: Employee Wellbeing Evaluation Report

9 March 2022

University of Bath: Novel approaches to evaluating continuous free-living physical activity data

25 February 2022

Liverpool University Hospitals NHS Trust: Cardiac Rehabilitation Study (RCT)

25 February 2022

St George’s University Hospitals NHS: Lymphoedema & Lipodema

3 February 2022

NHS Glos. ICS: Long COVID Recovery  

10 August 2022

Executive Summary

Sophie Middleton, Megan Hassall & Ewan Cranwell BSc.

Background

Since the COVID-19 pandemic began in early 2020, many individuals who have received a COVID-19 diagnosis, whether they have been hospitalised or not, are suffering from a novel condition referred to as long COVID. It is estimated that ~2 million people are suffering from the impacts of long COVID (NHS, 2022), which is commonly associated with ongoing symptoms including chronic fatigue and shortness of breath. Findings from the REACT-2 studies show over a third of people who had COVID-19 reported symptoms lasting at least 12 weeks. NHS Gloucestershire ICS Commissioners felt that KiActiv® Health could be a valuable tool to support individuals suffering with the ongoing effects of long COVID to improve self-management.

Innovation

This pilot evaluated KiActiv® Health, a personalised and guided online service that empowers participants to optimise their everyday physical activity in the context of their condition. KiActiv® Health provides personalised feedback in an interactive online dashboard that displays accurate physical activity data from a validated wearable and is supported remotely by phone calls with a dedicated KiActiv® Mentor over 12 weeks. At the end of the 12 weeks, participants retain access to their personalised technology, enabling them to continue their self-management as required.

Purpose/objective

To provide an accessible service to enable participants suffering with long COVID to improve self-care through the optimisation of their everyday physical activity. 

Methodology

Eligible participants were invited to participate in KiActiv® Health via a letter. Enrolled participants were sent a wearable activity monitor, before participating in the 12-week KiActiv® Health programme. They were supported at key time points throughout by a trained KiActiv® Mentor. Data was analysed from a range of sources: the KiActiv® Health platform, KiActiv® Mentor calls, and a self-administered online questionnaire.  

Key Findings

  • Demographics: 109 participants started KiActiv® Health, average age category of 44 years, average body mass index (BMI) = 24.1kg/m2.
  • Completion: 59 participants (33 females, 26 males) have completed the 12-week programme to date. 42 participants are within the 12-week programme.
  • Engagement: The use of the technology was excellent and included 96% of days being classed as having complete data sets.
  • PROMS: A self-administered online questionnaire was completed on completion of the 12-weeks of KiActiv® Health.
    • An increase of 1.2 in the combined WHOQoL score, which is greater than the minimum clinically important difference for that domain (0.876).
    • An increase of 2.4 in the physical health domain score, which is greater than the minimum clinically important difference for that domain (1.545).
    • An increase of 2.0 in the Short Warwick-Edinburgh Mental Wellbeing Scale, which is statistically important (>1.0).
    • 78.1% of participants increased their self-efficacy levels
    • Patient reported benefits included:
      • An increased awareness of all movement, not just exercise.
      • Understanding the accessibility of everyday physical activity, and finding more enjoyment in daily activities.
      • Improved pulmonary symptoms (i.e., reduced breathlessness, improved lung capacity).
      • Benefits to other aspects of lifestyle such as improved sleep, feeling fitter, stronger and more energised.
      • The ability to set realistic goals, self-manage, and improve daily physical activities.
      • A sense of control around how everyday physical activities affect their health and wellbeing, which has led to an improvement in physical and mental health, as well as overall quality of life.
  • Physical Activity Data: Physical Activity Data: Increasing physical activity is not always the primary goal for people recovering from hospitalisation due to COVID-19 or for those living with long COVID. However, 54 of 59 patients (91.5%) who have completed their 12-week programme to date have expressed a desire to increase their physical activity levels, yet many wanted to be cautious and not risk doing too much.
    • 100% of participants improved their physical activity in 3+ dimensions.
    • 98% of participants improved their physical activity in 4+ dimensions.
    • The average increases in physical activity from baseline (i.e., physical activity dose) across an average of 67 complete days were:
      • Non-Sedentary Time: +40hrs 31mins (+13%)
      • Moderate Activity: +18hrs 57mins (+21%)
      • Moderate Bouts: +17hr 10mins (+400%)
      • Calorie Burn: +7,047kcals (+4%)

A recent systematic review and meta-analysis of physical activity monitor based interventions showed increases of 6.9 minutes per day of moderate to vigorous physical activity and a 9.9 minutes per day increase per day in non-sedentary time (Larsen et al., 2022). In comparison, those who completed KiActiv® Health increased their moderate to vigorous physical activity by 17.0 minutes per day and increased their non-sedentary time by 36.3 minutes per day, equating to 2.5-fold and 3.5-fold improvements, respectively.

Conclusion

KiActiv® Health proved effective amongst this cohort in part due to the accessibility of everyday physical activity, shifting the narrative away from structured exercise, instead adopting a more personalised approach to everyday physical activity, where the individual is able to self-manage their physical activity to determine what works best for them. This is important within this group, physical activity is often avoided by individuals with long COVID, given the effect of physical exertion on cognitive and physical fatigue (Rudrofff et al., 2020). Despite such perceptions, maintaining and improving physical activity is extremely important as it has been shown to reduce breathlessness, as well as increase muscle strength and exercise capacity (Lan et al., 2013; Torres-Sánchez et al., 2017).

KiActiv® Health also provided participants with the tools to optimise physical activity to better manage fatigue levels. This is important given that long COVID recovery must be tailored to the individual, accounting for their personal experiences of fatigue symptoms and post-exertional malaise (Nijs et al., 2004; Larun and Malterud, 2011; Humphreys et al., 2021).

These results should also be reviewed in the context of our recently published pilot for participants with CFS/ME undertaken on behalf of the NHS, which included enrolments during the pandemic and highlight valuable comparisons.

June 2022

Sirona Care and Health & West England AHSN: Moving to Better Health

3 February 2022

Executive Summary

Rosie Brown, Emily Bull, Clare Cook, Lisa Denyer, Alex Leach, Hayley McBain, Tommy Parker, Kirstie Tew, Jen Tomkinson, Sam Tuvey

Background

This project was part of the West of England Academic Health Science Network (AHSN)’s Future Challenges under the theme of ‘Keeping Healthy at Home’. KiActiv® Health was selected as an innovative solution to be implemented in Bristol, North Somerset and South Gloucestershire with Sirona Care and Health, who were keen to trial the technology.

Physical activity has numerous benefits for people with pulmonary conditions and is the cornerstone of Pulmonary Rehabilitation (PR). The impact and effectiveness of KiActiv® Health for supporting people with Chronic Obstructive Pulmonary Disease (COPD) was independently assessed by evaluators. The project began prior to the Covid-19 pandemic, and from March 2020 it was adapted to reflect the changes in care pathways, facilitating a Covid-19 safe option for remote patient support.

Innovation

This pilot evaluated KiActiv® Health, a personalised and guided online service that empowers participants to optimise their everyday physical activity in the context of their condition. KiActiv® Health provides personalised feedback in an interactive online dashboard that displays accurate physical activity data from a validated wearable and is supported remotely by phone calls with a dedicated KiActiv® Mentor over 12 weeks. At the end of the 12 weeks, participants retain access to their personalised technology, enabling them to continue their self-management as required.

Purpose/objective

The ‘Moving to Better Health’ project was co-designed to explore whether KiActiv® Health could help people living with COPD by supporting them to understand and optimise their everyday physical activity, whilst evaluating its effectiveness and the potential for ongoing use in a real-world setting.

The project was initially designed to offer KiActiv® Health to patients who were otherwise unable to, or chose not to, undertake face-to-face PR. However, from March 2020, KiActiv® Health was offered as part of a remote PR programme to provide a Covid-19 safe option for patients.

Methodology

Between February 2020 and January 2021, individuals who were referred to the Sirona respiratory service with a confirmed chronic obstructive pulmonary disorder (COPD) diagnosis were introduced to KiActiv® Health by the clinical team. They included back-dated referrals from December 2019 and January 2020, who were on the waiting list for PR services. Data for this pilot was analysed from a range of sources: the KiActiv® Health platform, KiActiv® Mentor calls, and a self- administered online questionnaire (completed pre- and post-intervention).

The published report does not contain analysis of the objective, continuously captured physical activity
data. Subsequent to the report being published, we have analysed and evaluated the participants
physical activity in the context of the condition pathway and thisis now available to view below.

Key Findings

  • Uptake: Of the 80 individuals who contacted KiActiv® to express their interest, 74 completed their enrolment and went on to start the KiActiv® Health programme (93%).
  • Completion: 70% of participants who enrolled went on to complete the initial 12-week programme.
  • Engagement: The use of the technology was excellent and included 91% of days being classed as having complete data sets.
    • Post-intervention engagement was also impressive; 52% of participants were still using their personalised technology at 6-months, with the longest use case exceeding 830 total days and counting.
  • PROMS: All values reported as mean (±SD) unless otherwise stated.
    • Participants experienced statistically significant improvements in Patient Activation Measure (PAM) score.
      • Average PAM score increased from 55.5 (±11.6) at baseline to 61.7 (±8.7) post-intervention (p<0.05).
      • An improvement of points or more is deemed clinically meaningful (Anderson et al., 2018).
    • Participants experienced statistically significant improvements in overall health status measured using EQ-5D Visual Analogue Scale (VAS).
      • Average VAS increased from 54.0 (±18.7) at baseline to 64.2 (±22.3) post intervention (p<0.05).
      • An improvement of points or more is deemed clinically meaningful for individuals diagnosed with COPD (Zanini et al., 2015).
    • Participants experienced statistically significant improvements to knowledge of how to improve physical activity levels (p<0.05).
    • Participants experienced statistically significant improvements to confidence in performing physical activity (p<0.05).
    • Additional reported benefits included:
      • An increased awareness of all movement, not just exercise
      • Understanding the accessibility of everyday physical activity
      • A sense of control around how everyday physical activities have a positive influence on their health and wellbeing
      • Feelings of empowerment, autonomous choice and self- management, which promoted sustainable behaviour change
      • Improvements in overall fitness, which led to a reduction in condition-specific symptom burden, such as reduced breathlessness
  • Physical Activity Data: In their 2020 Cochrane Review, Burge and colleagues found that, in comparison to no intervention, the mean difference in time spent in moderate to vigorous intensity physical activity following pulmonary rehabilitation was 4-minutes per day. On average, KiActiv® Health participants increased in the same dimension by a total of 12-hours 19-minutes over 70 complete days, which is equivalent to 11-minutes per day of the intervention.
    • 100% of participants improved their physical activity in 3+ dimensions
    • 69% of participants improved their physical activity in 4+ dimensions
    • The average individual improvements in physical activity from baseline
      (i.e., total physical activity dose) across an average of 70 complete days
      were:
      • Non-Sedentary Time: +29hrs 20mins (+17%)
      • Moderate Activity: +12hrs 19mins (+112%)
      • Moderate Bouts: +6hrs 51mins (+594%)
      • Calorie Burn: +4,847kcals (+3%)

Amongst the 22 participants who did not complete the full 12-week programme, 7 cited
technological difficulties, 7 cited ill health, and 10 chose not to provide a specific reason.

Conclusion

Previous research in individuals with a COPD diagnosis indicates that without an intervention, physical activity levels over a 16-week period remain stable in less severe stages (GOLD A, B and C; Agarwal et al., 2012) and declined in those with the most severe COPD (Global Initiative for Chronic Obstructive Lung Disease 2011 Group [GOLD] D). When observed over a period of 18 months to 3 years, physical activity has been shown to substantially decrease across all severity stages of COPD (Durheim et al., 2015; Waschki et al., 2015).

On average, KiActiv® Health participants increased in moderate intensity physical activity by a total of 12-hours 19-minutes over 70 complete days, which is equivalent to 11-minutes per day of the intervention. This is a near 3-fold improvement on current care (Burge et al., 2020).

The project met its objectives which suggests that KiActiv® facilitates increased self-management skills and all participants involved received person-centred care along with tailored individual advice on managing their daily activity to best support their respiratory diagnosis. The remote nature of KiActiv® Health overcomes the travel barrier; ensuring participants were supported from the safety of their own homes. It also provides an alternative to face-to-face PR for those who are unwilling or unable to access traditional face-to-face services.

June 2022

NHS Glos. CCG: Type 2 Diabetes & Prediabetes

3 February 2022

Kirstie Tew, MSc., Abby Barton, BSc., & Sophie Middleton

Executive Summary

Background

Physical activity is fundamental to the treatment of Type 2 Diabetes and should be prescribed by a healthcare professional at initial diagnosis, prior to medications (Nathan et al., 2009), and continue throughout the management of the condition (Duclos et al., 2015; Andrews et al., 2011). NHS Gloucestershire Commissioners felt that KiActiv® Health could be a valuable tool to support individuals who have been diagnosed with Type 2 Diabetes and Prediabetes, in order to better manage their condition and reduce the likelihood of further complications.

Innovation

KiActiv® Health is a personalised and guided online behaviour change service that empowers participants to optimise everyday physical activity in the context of their condition. KiActiv®’s patented technology evaluates minute-by-minute physical activity data from a validated wearable monitor, which is displayed instantly in the user’s personalised online dashboard, and is available 24/7 to provide meaningful and actionable feedback. Patients are also supported remotely by phone calls with a dedicated KiActiv® Mentor at 6 key time points during the 12-week programme, to help them build an understanding of the value of their daily activities and the confidence to plan, monitor and improve. At the end of the 12-weeks, the patients retain access to their personal dashboard and activity monitor, enabling them to continue their self-management using the technology if desired.

Purpose/objective

To provide an accessible service to enable patients diagnosed with Type 2 Diabetes or Prediabetes to improve self-care through the optimisation of their everyday physical activity.

Methodology

Eligible patients were invited to participate in KiActiv® Health via a letter or email sent out by their GP practice, or through community services. Once enrolled patients were sent a wearable activity monitor, before participating in the 12-week KiActiv® Health programme. They were supported at key time points throughout by a trained KiActiv® mentor. Data was analysed from a range of sources: the KiActiv® Health platform, and KiActiv® Mentor calls.

Key Findings

  • Demographics: 554 patients started KiActiv® Health (241 females, 313 males), average age = 63 years, average body mass index (BMI) = 32.5kg/m2.
  • Completion: 422 patients (76.2%) (173 females, 249 males) have completed the 12-week programme and 11 (2.0%) are currently within the 12-weeks.
  • Engagement: The use of the technology was excellent and included 92.5% of days being classed as having complete data.
  • Patient Reported Benefits:
    • Weight Loss – an average of 3.2kg over the 12 weeks
    • Improvements in HbA1c and a reduction in blood glucose levels to pre-diabetic levels.
    • Reduction in diabetes-specific medication use
    • An increased awareness of all movement, not just exercise
    • Understanding the accessibility of everyday physical activity, and finding more enjoyment in daily activities
    • Benefits to other aspects of lifestyle such as improved sleeping patterns and healthier eating habits
    • Feelings of empowerment, autonomous choice and support from the KiActiv® Mentor, which promoted sustainable behaviour change
    • Improvements in quality of life
    • Reduced Fatigue
    • Improved Mental Health
  • Physical Activity Data:
    • 100% of patients improved their physical activity in 1+ dimensions
    • 100% of patients improved their physical activity in 3+ dimensions
    • 88% of patients improved their physical activity in 4+ dimensions
    • The average increases in physical activity from baseline (i.e., physical activity dose) across an average of 67 complete days were:
      • Non-Sedentary Time: +29hrs 43mins (+16%)
      • Moderate Activity: +13hrs 24mins (+40%)
      • Moderate Bouts: +9hrs 22mins (+851%)
      • Calorie Burn: +5,867kcals (+3%)
    • 86.7% of the group achieved physical activity levels exceeding 150 mins of Moderate Activity per week, which is associated with reductions in HbA1c of 0.89% (Umpierre et al., 2011)

Amongst the 121 patients who did not complete the full 12-week programme, some patients indicated that ill health was the reason for withdrawing. Others cited difficulties or a lack of confidence with technology, and some stated that they were simply too busy to find the time to engage with the programme.

Conclusion

It is widely accepted that physical activity is an effective method for managing Type 2 Diabetes and is recommended in the NICE Guidelines (NICE NG17, 2015; NICE NG28, 2015). Physical activity has been shown to directly improve glycaemic control (Kujala, 2009) as well as reducing body weight, which is crucial for the control of Type 2 Diabetes (Wilding, 2014). The physical activity improvements demonstrated by this cohort are associated with reductions in HbA1c that are comparable to those seen with oral antidiabetic medication (Sherifali et al., 2010).

KiActiv® Health increased self-management skills and participants received person-centred care along with tailored individual advice on optimising their daily physical activity to improve self-management of their diabetes and any comorbidities. The remote nature of KiActiv® Health overcomes the travel barrier, ensuring participants are supported from the safety of their own homes. Not only is this particularly pertinent due to ongoing COVID-19 restrictions but reducing our reliance on transport to receive care will also reduce carbon emissions, supporting the vision for a healthier planet. Ultimately, KiActiv® Health provides support to those diagnosed with Type 2 Diabetes to optimise their physical activity for the good of their health, which can help to reduce the burden of further associated health complications in the future.

29th November 2021

Liverpool University Hospitals NHS: Cardiac Rehabilitation

3 February 2022

Professor Michael Fisher, Dr Tom Rayner, iBSc. (Hons), MBChB., Kirstie Tew, MSc.

Executive Summary

Background

During the COVID-19 pandemic, the provision of face-to-face cardiac rehabilitation (CR) has been scaled back due to national lockdowns and social distancing rules. The clinical team felt that KiActiv® Health could be a valuable tool in addressing this service disruption to support eligible patients and empower them to optimise their recovery and prevent significant unintended long-term consequences.

Innovation

KiActiv® Health is a personalised and guided online behaviour change intervention that empowers participants to optimise everyday physical activity in the context of their condition. KiActiv®’s patented technology evaluates minute-by-minute physical activity data from a validated wearable monitor, which is displayed instantly in the user’s personalised online dashboard, and is available 24/7 to provide meaningful and actionable feedback. Patients are also supported remotely by phone calls with a dedicated KiActiv® Mentor at 6 key time points during the 12-week programme, to help them build an understanding of the value of their daily activities and the confidence to plan, monitor and improve. At the end of the 12-weeks, the patients retain access to their personal dashboard and activity monitor, enabling them to continue their self-management using the technology if desired.

Purpose/objective

The aim of this pilot study, was to provide a digital support service to patients who were not able to access CR, with the goal of promoting positive behaviour change and optimising physical activity in the context of their condition.

Methodology

Between September 2020 and April 2021, adult patients referred for CR at LUH were introduced to KiActiv® Health at their initial assessment by either a clinician or specialist CR Nurse who confirmed their eligibility and provided an activity monitor. The patient was then contacted by KiActiv® to ensure that they were eligible to take up the service, complete the enrolment process and arrange a start date. The 12-week KiActiv® Health programme began with a set-up call with a KiActiv® Mentor.

In addition to collecting objective physical activity data and qualitative data from 2-hours of Mentor calls, patients also completed validated self-report questionnaires (HADS and Dartmouth COOP) at their initial and final assessments.

Key Findings

  • Demographic: 17 people started the programme (14 Males, 3 Females), average age = 58 years, average BMI = 29.4 kg/m2, range of diagnoses leading to CR referral, range of comorbidities.
  • Completion: 82% of patients completed the 12-week programme.
  • Engagement: The use of the technology was excellent and included 92% of days being classed as having complete data sets. 79% of patients continued to engage with their KiActiv® technology beyond the initial 12-week programme.
  • PROMS: Statistically significant improvements were seen in self-reported Physical Fitness and Overall Health measured using the Dartmouth Coop Charts.
    • Improvements were seen in 8 of the 9 domains
    • 100% of patients improved in at least 1 domain
  • Mental Wellbeing:
    • 56% of patients showed an improvement in their scores for anxiety and 56% in their scores for depression, assessed using the HADS score
    • The mean symptom scores improved for both anxiety and depression, despite the majority of people being categorised as “normal” at baseline
  • Physical Activity Data: A large proportion of participants were able to improve their physical activity.
    • 93% of people improved their physical activity in 1+ dimension
    • 79% of people improved their physical activity in 3+ dimensions
    • 64% of people improved their physical activity in 4+ dimensions
    • The average increases in physical activity from baseline (i.e., physical activity dose) across an average of 67 complete days were:
      • Non-Sedentary Time: +58hrs 10mins (+32%)
      • Moderate Activity: +33hrs 43mins (+69%)
      • Moderate Bouts: +31hrs 27mins (+1004%)
      • Calorie Burn: +12,002kcals (+6%)
    • Based on the scientific evidence, the total dose of Moderate Activity of 33-hours and 43-mins reported here could produce changes in cardiorespiratory fitness (CRF) of 1.10 to 2.92 metabolic equivalents (METs). A 1 MET increase in CRF reduces all-cause and Coronary Heart Disease (CHD)/Cardiovascular Disease (CVD) mortality by 13% and 15%, respectively (Kodama et al., 2009), and as such, the improvement shown in the present analysis could equate to reductions in all-cause and CHD/CVD mortality anywhere from 14.3% to 38.0% and from 16.5% to 43.8%, respectively
  • Patient reported benefits included:
    • An increased awareness of physical activity and the value of everyday movement, with many clients shifting their perspective away from solely focusing on traditional exercise and recognise the importance of everyday movement too. Understanding the accessibility of everyday physical activity, where many had previously disregarded activity as unachievable and daunting
    • Feelings of empowerment, autonomous choice and self-management, which promote sustainable behaviour
    • Motivation to improve other health behaviours including improvements to their diet and consequential weight loss

Amongst the 3 patients who did not complete the full 12-week programme, 1 chose to withdraw stating that they did not have the want nor motivation to engage with the system. Two patients disengaged and did not respond to contact.

Conclusion

This pilot demonstrates the effectiveness of KiActiv® Health as a tool for supporting and encouraging patients to optimise their physical activity and recovery in the wake of a cardiac event, and to improve the management of heart failure.

The disruption caused by the COVID-19 pandemic to usual CR services has highlighted the appeal and accessibility to patients of this remote service, which suggests that it may similarly engage those patients unable or unwilling to attend current provisions going forward. The pilot was offered to phase-3 CR patients only but the results suggest that it can be equally successful with those requiring phase-4 CR and managing heart failure. The programme delivers person centred care at home and without the need to travel.

The 12-week KiActiv® Health programme is currently employed by the NHS in multiple pathways and can be scaled immediately across the country to offer eligible patients the support they need and deserve, as well as helping to manage growing waiting lists and reduce mounting pressure on CR services.

1st November 2021

NHS Glos. CCG: Pulmonary Rehabilitation

3 February 2022

Kirstie Tew, MSc., Abby Barton, BSc., Sophie Middleton

Executive Summary

Background

Physical activity has numerous benefits for people with pulmonary conditions and is the cornerstone of Pulmonary Rehabilitation (PR). During the COVID-19 pandemic, healthcare practitioners were unable to provide their usual offering of group-based face-to-face PR, leading to rapidly growing waiting lists. NHS Gloucestershire Commissioners felt that KiActiv® Health could be a valuable tool to support individuals who were waiting to receive traditional PR, in order to better manage their condition and ease pressures on growing waiting lists.

Innovation

KiActiv® Health is a personalised and guided online behaviour change service that empowers participants to optimise everyday physical activity in the context of their condition. KiActiv®’s patented technology evaluates minute-by-minute physical activity data from a validated wearable monitor, which is displayed instantly in the user’s personalised online dashboard, and is available 24/7 to provide meaningful and actionable feedback. Patients are also supported remotely by phone calls with a dedicated KiActiv® Mentor at 6 key time points during the 12-week programme, to help them build an understanding of the value of their daily activities and the confidence to plan, monitor and improve. At the end of the 12-weeks, the patients retain access to their personal dashboard and activity monitor, enabling them to continue their self-management using the technology if desired.

Purpose/Objective

To provide an accessible supplementary service to traditional PR for those who were unable to attend in-person PR due to the COVID-19 pandemic, with the aim of helping to manage growing waiting lists.

Methodology

Eligible patients were invited to participate in KiActiv® Health via a letter sent from the Gloucestershire PR team. Enrolled patients were sent a wearable activity monitor, before participating in the 12-week KiActiv® Health programme. They were supported at key time points throughout by a trained KiActiv® mentor. Data was analysed from a range of sources: the KiActiv® Health platform, KiActiv® Mentor calls, and a self-administered online questionnaire (completed pre- and post-intervention). 

Key Findings

  • Demographics: 80 patients started KiActiv® Health as part of the first cohort (44 females, 36 males), average age = 70 years, average body mass index (BMI) = 28.6kg/m2.
  • Completion: 42 patients (53%) (22 females, 20 males) have completed the 12-week programme. 18 patients (23%) are currently within their 12-week KiActiv® Health programme.
  • Engagement: The use of the technology was excellent and included 92% of days being classed as having complete data sets.
  • PROM’s: All values reported as mean (±SD) unless stated otherwise.
    • Patients experienced statistically significant improvements in their COPD Assessment Test (CAT)
      • The average CAT score decreased in response to KiActiv® Health, by 1.94 points, from a mean of 24.75 (±7.27) at baseline to 22.81 (±7.53) post-intervention (p≤0.05)
      • A reduction of 2 points or more on the scale is deemed clinically meaningful (Kon et al., 2014)
      • Those most at-risk saw the greatest improvement in CAT scores, with the 9 patients who started at ‘Very high’ health impact reducing by a mean of 5.20 (±3.51) points
      • Overall, 78.1% of patients decreased their CAT scores across the 12-weeks
    • Patients experienced a statistically significant improvement to their average knowledge score
      • Responses improved from a mean of 2.75 (±0.57) at baseline to 3.28 (±0.52) post-intervention (p≤0.05)
      • Patients were responding to the following statement: “I know how to take appropriate steps to improve my physical activity levels.”
      • Post-intervention, 96.8% of respondents answered either ‘Agree’ or ‘Strongly Agree’ to this question
    • Patients experienced a statistically significant improvement to their average confidence score
      • Responses improved from a mean of 2.31 (±0.69) at baseline to 2.69 (±0.64) post intervention (p≤0.05)
      • 31.3% of respondents answered ‘Agree’ or ‘Strongly Agree’ at baseline, compared to 59.4% after 12-weeks
      • Patients were responding to the following statement: “I feel confident in my ability to perform physical activity.”
  • Patient reported benefits included:
    • An increased awareness of all movement, not just exercise
    • Understanding the accessibility of everyday physical activity
    • Feelings of empowerment, autonomous choice and support from the KiActiv® Mentor, which promoted sustainable behaviour change
    • The ability to plan, self-manage, and improve daily physical activities
    • A sense of control around how everyday physical activities affect their health and wellbeing
  • Physical Activity Data: In their 2020 Cochrane Review, Burge and colleagues found that, in comparison to no intervention, the mean difference in time spent in moderate to vigorous intensity physical activity following pulmonary rehabilitation was 4-minutes per day. On average, KiActiv® Health participants increased in the same dimension by a total of 12-hours 31-minutes over 69 complete days, which is equivalent to 11-minutes per day of the intervention.
    • 100% of patients improved their physical activity in 3+ dimensions
    • 68% of patients improved their physical activity in 4+ dimensions
    • The average increases in physical activity from baseline (i.e., physical activity dose) across an average of 69 complete days were:
      • Non-Sedentary Time: +22hrs 50mins (+14%)
      • Moderate Activity: +12hrs 31mins (+33%)
      • Moderate Bouts: +6hrs 36mins (+587%)
      • Calorie Burn: +4,318kcals (+2%)

Amongst the 20 patients who did not complete the full 12-week programme, some patients indicated that ill health was the reason for withdrawing. Others cited difficulties or a lack of confidence with technology, and some stated that they were simply too busy to find the time to engage with the programme.

Conclusion

Previous research with COPD patients indicates that without an intervention, physical activity levels over a 16-week period remain stable in less severe stages (Global Initiative for Chronic Obstructive Lung Disease 2011 Group [GOLD] A, B and C; Agarwal et al., 2012) and declined in those with the most severe COPD (GOLD D). When observed over a period of 18 months to 3 years, physical activity has been shown to substantially decrease across all severity stages of COPD (Durheim et al., 2015; Waschki et al., 2015)

On average, KiActiv® Health participants increased in the same dimension by a total of 12-hours 31-minutes over 69 complete days, which is equivalent to 11-minutes per day of the intervention. This demonstrates a near 3-fold improvement on current care.

KiActiv® Health increased self-management skills and participants received person-centred care along with tailored individual advice on managing their daily activity to best support their respiratory diagnosis. The remote nature of KiActiv® Health overcomes the travel barrier; ensuring participants are supported from the safety of their own homes. This helps reduce carbon emissions, by reducing the number of unnecessary visits to healthcare facilities. It may also provide a good alternative to face-to-face PR for those who are unwilling or unable to access the traditional service.

31st January 2022

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