Samantha Pilsworth

Edge Hill University

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John M. Shneerson

Papworth Hospital

Sarah Sibley

University of Liverpool

Dennis Wat

University of Liverpool

D Wat

University of Liverpool

David Barber

Queen's University

Ian E. Smith

Royal Marsden NHS Foundation Trust

Max Bettany

University of Liverpool

Martin King

University of Kentucky

Bashir M. Matata

Liverpool Heart and Chest Hospital

Linda Jones

Charles Sturt University

Cooperative Institutions

University of Liverpool

Liverpool Heart and Chest Hospital

University of Cambridge

Papworth Hospital

Addenbrooke's Hospital

Liverpool Heart and Chest Hospital NHS Trust

National Institute for Health Research

The Ohio State University

University of Alabama at Birmingham

Liverpool John Moores University

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Pulmonary effects of illicit drug use- A Pictorial Review.

Sparsh Prasher Diana Penha Erique Pinto Dennis Wat Samantha Pilsworth

Poster: ECR 2019 / C-2656 / Pulmonary effects of illicit drug use- A Pictorial Review. by: S. Prasher 1, D. Penha2, E. Pinto1, D. Wat1, S. Pilsworth 1, M. Ledson1, B. Hochhegger3, E. Marchiori4, K. L. Irion5; 1Liverpool/UK, 2Lisbon/PT, 3Porto Alegre/BR, 4Rio de Janeiro/BR, 5Manchester/UK

Illicit drug

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Pulmonary Rehabilitation (PR) in Cheshire and Merseyside (C&M)

09.02 - Physiotherapists (2020)

Samantha Pilsworth Dennis Wat Sarah Sibley

PR is a pivotal treatment for managing chronic respiratory disease, despite this referrals into PR remain low, as highlighted from the national COPD audit programme. The NHS long term plan, for the first time highlighted respiratory is as a key area for improvement, encompassing improving access and uptake of PR. However little is known about the ability of local PR services to be able to provide this. A scoping exercise was undertaking in C&M to review current service provision. Clinical leads from all the PR services in C&M were contacted in 2019 and a face to face or telephone discussion was conducted. This was followed up with an email document detailing further information required about funding, staffing numbers, challenges to service and further developments. 10 services were contacted to be involved in the project. 8 services responded. PR provision across C&M is patchy, with good access in some areas and more limited access in others. Waiting times vary across the area from 2- 24 weeks, as do inbound referral numbers. Outcome measures vary widely across the area, as do length and type of programme and provision of post exacerbation PR. There was good engagement from PR services; however it highlights the significant variation in provision across a small area in the UK, and a postcode lottery patient's face in trying to access services. Staff running programmes were dedicated and keen to increases access and uptake, however many were faced with significant staffing problem and commissioning strictures. Quick wins are available such as rolling programmes and diversifying, but clearly investment in grass root services is required.

10.1183/13993003.congress-2020.71

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Emerging Pulmonary Rehabilitation (PR) in the digital world

01.02 - Rehabilitation and chronic care (2021)

Samantha Pilsworth R. L. Gorman Laura Pearson David Barber Helen Tickle

Introduction: PR teams globally have faced significant challanges, due to the impact of the covid-19 pandemic. This includes rapid suspension of services and complete pathway re-design due to the impact of local and national lockdowns, shielding advice and the fast adoption of digital technology to replace face to face appointments. There is limited evidence into the effectiveness of non-traditional models of pulmonary rehabilitation delivery. Method: Outcome data from patietns completing PR via one of the following methods - virtual groups, 1:1 support at home and a home exercise plan with telephone support was analysed to see if alternative methods of PR delivery can achieve positive results. Results: The first 20 patients to complete PR via alternative delivery methods had the outomes analysed. 6 completed PR via virtual groups via Attend Anywhere (AA), 10 were provide with a home exercise plan (HEP) with weekly telephone support and 4 were supported with 1:1 home exercise sessions. Discussion: PR can be delivered effectively in different ways with patients still gaining benefit regardless of method of delivery. More improvement was demonstrated in CRD the AA and 1:1 groups, perhaps suggesting the HEP missed the face to face enagement with staff. The AA and HEP groups both demonstarted improvements in 6MWT. More research is needed in this area for staff to suport patients appropriately.

10.1183/13993003.congress-2021.pa2111

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A service evaluation of the accuracy of the Gold Standard Framework Proactive Indicator Guidance (GSF PIG) in predicting 12 month mortality in patietns with a diagnosis of Chronic Obstructive Pulmonary Disease (COPD).

Samantha Pilsworth Dennis Wat Sarah Sibley Julie Crane

Patients with COPD often have poorer quality of life and reduced life expectancy when compared to the general population, especially towards the terminal phase of their illness. Patients can experience a higher symptom burden than those reported by patients with end stage lung cancer. The importance of palliative care (PC) in this group is well known, but frequently have poorer access to PC services. When to initiate PC in this group is challanging due to prognostic uncertainty. The GSF PIG is recommended for use with this patient group to predict 12 month mortality and belived to be accurate in 70% of cases, despite little evidence. To address the accuracy this study aims to evaluate this tool in predicting 12 month mortality in patients with a diagnosis of COPD. Method: Data collection was from a single service9 PC list, of patients deemed to be entering the last 12 months of life by triggering the GSF PIG. The length of time on th palliative register until death or Janruary 2017, when data analysis commenced, was reviewed. All data analysed was rotuinely collected by the service. Results: 448 patietns were included in the study, n=122 died with in 12 months, showing the GSF PIG to be accurate in 27% of cases. Subgroup ananlysis showed the importance of pulmonary rehabilitation to reduce mortality (p=0.001) with gait speed of <0/15 m/sec having the potenital to be an early prognostic indicator (p=0.008). Conclusion: These results suggest the GSF PIG is not an accurate 12 month mortality predictor, more research is needed re:gait speed as a prognostic indicator.

10.1183/13993003.congress-2018.pa3859

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S8 Pulmonary rehabilitation – time for change?

Samantha Pilsworth

Introduction

The importance of pulmonary rehabilitation (PR) is well known for the management of chronic respiratory disease and is a core component of disease management. The important of increasing uptake and availability of PR is made clear within the NHS long term plan. Despite this push little is known about patient's perspective or PR and how to engage people further to participate despite its proven benefit in health related quality of life.

Method

To evaluate patient perceptive and opinion of PR 4 group interviews were conducted in different PR groups in the North West of England. Patients were asked to discuss their thoughts on PR, including preconceptions of the programme, importance of PR and how to engage better with people with chronic respiratory disease. Interviews were recorded and themes were highlighted.

Results

21 patients enrolled in an 8 week PR programme were interviewed for a total of 130 minutes. 10 males and 11 females were interviewed, 18 patients had a diagnosis of COPD, 2 were diagnosed with bronchiectasis and 1 was diagnosed with asthma. Thematic analysis showed patients perceived the importance of physical activity and saw gains in attending PR. Patients felt the positive impact of PR was not well delivered and that people offering a referral to PR did not know about the course. They felt PR was frequently offered too late in their disease process. There was much debate about the appropriateness of the term 'exercise' and 'rehabilitation' as they had negative connotations.

Conclusion

Preliminary finding suggest that patients feel PR is offered too late in there disease pathway and health professionals (HCP) need to be offering PR at every clinical point of care. HCP lack of knowledge regarding PR was discussed by many patients, suggesting the need for HCP to improve their own knowledge and understanding. Another key area of debate was the terminology used to describe PR, 'rehabilitation' and 'exercise' were felt to bring negative thoughts to mind, and did little to sell the positive impact PR can have on their lives. A more positive name would have helped to support people to attend.

Thematic Analysis

10.1136/thorax-2019-btsabstracts2019.14

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Effect of Treatment With Continuous Positive Airway Pressure or Oxygen on Sleep‐Disordered Breathing in Patients With Heart Failure: Results of the Sleep Events, Arrhythmias, and Respiratory Analysis in Chronic Heart Failure (SEARCH) Study

Congestive Heart Failure (2008)

William T. Abraham Robin J. Trupp Barbara Phillips Robert C. Bourge Susan M. Harding

The response to sleep‐disordered breathing (SDB)–directed therapy was evaluated using the Clear Path home‐based monitoring system. There were 26 patients with heart failure enrolled in the Sleep Events, Arrhythmias, and Respiratory Analysis in Chronic Heart Failure (SEARCH) study with SDB requiring treatment (apnea‐hypopnea index [AHI] ≥15 events/h). Patients were monitored using both standard polysomnography and the Clear Path system to determine the change in SDB parameters before and after initiation of therapy. Accuracy of the Clear Path system compared with polysomnography was ≥87% to detect SDB events. A marked reduction in the mean number of sleep time respiratory disturbances was observed by both techniques after the initiation of SDB‐directed therapy, and 21 patients (87.5%) experienced a 16.7‐events/h mean reduction in AHI. Thus, the Clear Path system appears to be a useful device to monitor response to SDB‐directed treatment for apnea in patients with heart failure.

Positive airway pressure

Central sleep apnea

Periodic breathing

Cheyne–Stokes respiration

Hypopnea

10.1111/j.1751-7133.2008.07841.x

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Validation and Clinical Utility of a Simple In‐Home Testing Tool for Sleep‐Disordered Breathing and Arrhythmias in Heart Failure: Results of the Sleep Events, Arrhythmias, and Respiratory Analysis in Congestive Heart Failure (SEARCH) Study

Congestive Heart Failure (2006)

William T. Abraham Robin J. Trupp Barbara Phillips Robert C. Bourge Brian Bailey

Fifty patients with New York Heart Association class III systolic heart failure were enrolled in this prospective multicenter study that compared the diagnostic accuracy of a home‐based cardiorespiratory testing system with standard attended polysomnography. Patients underwent at least 2 nights of evaluation and were scored by blinded observers. At diagnostic cutoff points of ≥5, ≥10, and ≥15 events per hour for respiratory disturbance severity, polysomnography demonstrated a sleep‐disordered breathing prevalence of 69%, 59%, and 49%, respectively. Compared with polysomnography, the cardiorespiratory testing system demonstrated predictive accuracies of 73%, 73%, and 75%, which improved to 87%, 87%, and 83%, respectively, when analysis of covariance suggested reanalysis omitting one site's data. The system accurately identified both suspected and unsuspected arrhythmias. The device was judged by 80% of patients to be easy or very easy to use, and 74% of patients expressed a preference for the in‐home system. Therefore, this system represents a reasonable home testing device in these patients.

10.1111/j.1527-5299.2006.05693.x

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Digital pulmonary rehabilitation (PR)

09.02 - Physiotherapists (2022)

Samantha Pilsworth D Barber S Taylor R Hughes M Coleiro

Introduction: The Covid-19 pandemic has had considerable impact on PR services and COPD patients9 health. We need alternative ways to reach patients and taking PR programmes into patients9 homes via digital PR was an obvious choice. One PR service piloted a digital exercise prescription and remote management system, Rehab Guru, to provide personalised digital exercise and educational support. Rehab Guru is an on-line platform which enables clinicians to independently prescribe exercise, monitor progress, view outcomes and submit educational content. Method: During May - November 2021, 33 patients with a diagnosis of COPD in a PR service in England were offered and accepted Rehab Guru. Results: The programme was completed by 61% (n=22), with 24% (n=8) patients still on the course at time of data analysis (January 2022). 9% (n=3) did not complete the digtial programme. Discussion: The results show that digital PR is an alternative option for appropriate patients, outcomes demonstrated the minimal clinically important difference (MCID) was reached in 6MWT, quality of life measures for dyspnoea and mastery as well as MRC scores. Patient acceptability was high with 88% (n=22 of a possible 25) reporting digital PR to be an aceptable intervention. Rehab Guru offers an effective alternative to more traditional PR in appropriate patients. Rehab Guru9s ability to individualise patients rehab programme and monitor patient's outcomes is key and demonstrate digital PR9s place in a menu of options for patients with COPD who would benefit from PR.

10.1183/13993003.congress-2022.889

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Group-Based social identity intervention during pulmonary rehabilitation improves COPD patients experience with exercise programmes

01.02 - Rehabilitation and chronic care (2019)

Samantha Pilsworth Adrian Mcgonigle Lyndsey Wigelsworth Linda Jones Max Bettany

COPD is a debilitating lung condition, one of the main aims of pulmonary rehabilitation (PR) is to improve the quality of life for patients who have been diagnosed with COPD. The challenge for PR is that many patients fail to complete or engage. An intervention underpinned by social identity theory through group goal setting was developed and delivered by trained PR staff. It is believed that this encourages patients to interact and support each other and work as a team in order to achieve mutually agreed goals. However, there is an absence of research evidence to guide current practice. Methods: 84 patients enrolled in an 8-week PR programme and were recruited into pilot randomised trial to provide feasibility information on whether PR sessions based on a social identity theory intervention were acceptable to patients and would improve health-related quality of life. In depth analysis of patient's perception of the social identity theory intervention was undertaken through focus group to explore issues such as acceptability. Interviews were transcribed verbatim. Results: Thematic analysis revealed that there was a positive social and motivational experience associated with the social identity theory intervention. The intervention promoted bonding, togetherness, friendship and support. Conclusion: The preliminary findings lend support for the development of a group-based identity intervention for creating a rehabilitation environment that was socially and motivationally inclusive. Findings suggest that group identity can help COPD patients collectively comply with exercise prescription during PR and could help promote sustainable exercise engagement.

10.1183/13993003.congress-2019.pa644

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Periodic limb movement in a community population detected by a new actigraphy technique

Sleep Medicine (2002)

Emma Morrish Martin King Samantha Pilsworth John M. Shneerson Ian E. Smith

Epworth Sleepiness Scale

10.1016/s1389-9457(02)00064-3

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Citations (44)