Wiltshire Health and Care & West England AHSN: Keeping Active During COVID-19

Rosie Brown, Emily Bull, Nikie Catchpool, Claire Fox, Anne Johnson, Alex Leach, Hayley McBain, Tommy Parker, Kirstie Tew, Sam Tuvey

Executive Summary

Background

During the COVID-19 pandemic Wiltshire Health and Care (WHC) were unable to provide group face-to-face Pulmonary Rehabilitation (PR). The clinical team and commissioners felt that KiActiv^® Health could be a valuable tool to support isolated, vulnerable people living with a respiratory condition to better manage their condition and prevent deterioration.

Innovation

This pilot evaluated KiActiv^® Health, a personalised and guided online behaviour change intervention that empowers participants to optimise their everyday physical activity in the context of the condition. KiActiv^® Health provides an interactive personalised dashboard to display accurate physical activity data and is supported remotely by phone calls with a dedicated Mentor over 12-weeks. At the end of the 12-weeks, participants retain access to their personal dashboard and activity monitor, enabling them to continue their self-management using the technology if desired.

Purpose/objective

As WHC was unable to provide group face-to-face PR, the clinical team and commissioners felt that KiActiv^® Health could be useful for those patients who would normally be referred for PR. The main objective of this pilot was to offer a remote solution to support isolated, vulnerable patients who are living with a respiratory condition. 

Methodology

Patients were assessed by the WHC respiratory team, and 29 people with a respiratory diagnosis and a Medical Research Council Dyspnoea Scale score of 3 or more were invited to pilot KiActiv^® Health. Data for this pilot was analysed from a range of sources: the KiActiv^® Health platform, KiActiv^® Mentor calls, a self-administered online questionnaire (completed pre- and post-intervention) and a post-intervention questionnaire provided by the WHC clinical team. 

Not all participants had completed their 12-weeks when the published report was written and no physical activity was included. Subsequent to the final participant completing we have now analysed and evaluated their physical activity in the context of the condition pathway, which is available to view.

Key Findings

• Uptake: All 29 people who were offered KiActiv^® Health contacted KiActiv^® to express their interest, and 28 of those completed their enrolment (97%).
• Completion: 89% of people who enrolled completed the 12-week programme.
• Engagement: The use of the technology was excellent and included 80% of days being classed as having complete data sets.
• PROMS: A statistically significant number of participants reported that they felt more confident in their ability to be physically activity following KiActiv^® Health.
  • More people responded that they “Agree” or “Strongly agree” with the following statements at the end of 12-weeks compared to baseline:
    • ‘I know how to take appropriate steps to improve my physical activity levels’
    • ‘I feel confident in my ability to manage my condition’
    • ‘I feel supported and connected when it comes to managing my health’
  • On completion of the 12-week programme, 85% of people that responded felt that KiActiv^® Health had met their expectations and included:
    • Improved breathing
    • A better understanding of physical activity and health
    • Improved overall health
  • 61% of people expressed feeling better as a result of their participation in KiActiv^® Health, with reported benefits being both physical and mental
    • This was despite the reported negative impact of the Covid-19 restrictions and other external factors such as illness and injury
  • 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 self-management, which promoted sustainable behaviour change
    • The ability to undertake physical activities which they had previously stopped (i.e., climbing the stairs, walking for longer without the need for a walking stick)

• Physical Activity Data: A statistically significant number of participants showed a clinically meaningful improvement in physical activity.
  • 100% of people improved their physical activity in 3+ dimensions
  • 68% 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 70 complete days were:
    • Non-Sedentary Time: +20hrs 35mins (+11%)
    • Moderate Activity: +8hrs 41mins (+225%)
    • Moderate Bouts: +5hrs 19mins (+269%)
    • Calorie Burn: +3,676kcals (+2%)

Amongst the 3 patients who did not complete the full 12-week programme, one did not attend their first mentor session. The other 2 patients chose to withdraw, without citing a specific reason.

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 (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).

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 521-minutes over 70 complete days, which is equivalent to 7.4-minutes per day of the intervention.

The pilot met its objectives which suggests that KiActiv^® facilitates increased self-management skills and participants in the project 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 may also provide a good alternative to face-to-face PR for those who are unwilling or unable to access the traditional service.

August 2021