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

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 4 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 8 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