A pilot study; the feasibility of very early exercise after COPD exacerbation to improve patient outcomes, experience and healthcare costs.

Purpose

To ascertain whether the inclusion of very early exercise post-COPD exacerbation via the addition of a full-time technician to the COPD Team improves patient outcomes, experience and healthcare related costs above and beyond outcomes already achieved by the existing service.

In addition, to reduce barriers to participation in physical activity and pulmonary rehabilitation attendance commonly observed within this patient group, including being housebound, transport difficulties, geographical inequality in service provision, carer responsibilities, disease severity and high levels of physical and mental comorbidity. Currently inactivity, activity avoidance owing to anxiety regarding dyspnoea and a poor uptake and/ or completion of pulmonary rehabilitation are demonstrated within this cohort of patients, who often have severe disease, which is advocated as a key management strategy nationally and internationally for COPD .

The purpose of this service change is to facilitate other options in assisting patients to achieve better outcomes and an enhanced quality of life through early exercise in conjunction with pre-existing self-management support.

Approach

After the acquisition of technician hours which were procured from the pulmonary rehabilitation team, a service improvement methodology was utilised. The formation of an aim led to the construction of a driver diagram to guide team actions and changes required to deliver the agreed aim. This model of change will be tested using a PDSA process incorporating PROM and PREM measures, such as the COPD Assessment Test (CAT) for disease burden, EQ5D5L for quality of life, patient satisfaction questionnaire and for changes in physiological parameters the Borg Scale, MRC scale, grip strength, sit to stand in 30 seconds, timed up and go test, time in unsupported standing and 180 degree turn. Outcome measures are being collected pre and post intervention.

Results will be analysed in six months and compared to usual outcomes obtained by the COPD Team. Changes will be made if required based upon this analysis using a further PDSA cycle.

Outcomes

Results are awaited, but there is the potential for change in patient experience, outcomes, financial implications and cost avoidances. Results will be disseminated as appropriate.

Pending conclusion. 

Implications

Dependent on outcomes, the results may lead to a permanent position of exercise technicians within community COPD Teams locally and perhaps more widely after dissemination of results.

National guidelines advocate early exercise after exacerbation and hospital discharge, yet only suggest this is achieved by attending a pulmonary rehabilitation course, which is often not feasible for this patient group, especially after exacerbation. Providing early exercise in conjunction with education and self-management support via a community COPD Team may prove to be an effective alternative to traditional pulmonary rehabilitation and increase participation in physical activity.

Fund acknowledgements

This work was unfunded. 

Additional notes

This work was presented at Physiotherapy UK 2019