NHS Glos. CCG: Pulmonary Rehabilitation

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 otherwise stated.
    • 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=0.008).
      • 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=0.0002).
      • 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=0.04).
      • 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