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Development of a complex exercise rehabilitation intervention for people with pulmonary hypertension : the supervised pulmonary hypertension exercise rehabilitation (SPHERe) trial
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Ennis, Stuart, Sandhu, Harbinder, Bruce, Julie, Seers, Kate, Pincus, Tamar, Underwood, Martin and McGregor, Gordon (2023) Development of a complex exercise rehabilitation intervention for people with pulmonary hypertension : the supervised pulmonary hypertension exercise rehabilitation (SPHERe) trial. BMJ Open, 13 (8). e066053. doi:10.1136/bmjopen-2022-066053 ISSN 2044-6055.
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Official URL: https://doi.org/10.1136/bmjopen-2022-066053
Abstract
Background: People with pulmonary hypertension (PH) are not routinely referred for exercise rehabilitation despite the potential for reducing breathlessness and improving quality of life. We describe the development of a supervised pulmonary hypertension exercise rehabilitation (SPHERe) programme for people with PH. Methods: Development was completed in three phases: (1) systematic review, (2) stakeholder engagement with consensus from patients and experts and (3) prepilot intervention acceptability testing. We completed systematic reviews to identify international cardiopulmonary rehabilitation guidance and trials of exercise-based interventions for people with PH. Evidence from systematic reviews and stakeholder consensus shaped the SPHERe intervention, including addition of individual behavioural support sessions to promote exercise adherence. The draft SPHERe intervention was ratified through discussions with multidisciplinary professionals and people living with PH. We acceptability tested the centre-based intervention with eight participants in a prepilot development phase which identified a number of condition-specific issues relating to safety and fear avoidance of activity. Comprehensive intervention practitioner training manuals were produced to ensure standardised delivery. Participant workbooks were developed and piloted. Trial recruitment began in January 2020 but was subsequently suspended in March 2020 further to COVID-19 pandemic ‘lockdowns’. In response to the pandemic, we undertook further development work to redesign the intervention to be suitable for exclusively home-based online delivery. Recruitment to the revised protocol began in June 2021. Discussion: The final SPHERe intervention incorporated weekly home-based online group exercise and behavioural support ‘coaching’ sessions supervised by trained practitioners, with a personalised home exercise plan and the optional loan of a stationary exercise bike. The intervention was fully manualised with clear pathways for assessment and individualised exercise prescription. The clinical and cost-effectiveness of the SPHERe online rehabilitation intervention is currently being tested in a UK multicentre randomised controlled trial. Trial registration number: ISCRTN10608766.
| Item Type: | Journal Article | |||||||||
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| Subjects: | R Medicine > RC Internal medicine | |||||||||
| Divisions: | Faculty of Science, Engineering and Medicine > Medicine > Warwick Medical School | |||||||||
| SWORD Depositor: | Library Publications Router | |||||||||
| Library of Congress Subject Headings (LCSH): | Pulmonary hypertension , Pulmonary hypertension -- Exercise therapy , Pulmonary hypertension -- Treatment | |||||||||
| Journal or Publication Title: | BMJ Open | |||||||||
| Publisher: | BMJ Publishing Group | |||||||||
| ISSN: | 2044-6055 | |||||||||
| Official Date: | 3 August 2023 | |||||||||
| Dates: |
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| Volume: | 13 | |||||||||
| Number: | 8 | |||||||||
| Article Number: | e066053 | |||||||||
| DOI: | 10.1136/bmjopen-2022-066053 | |||||||||
| Status: | Peer Reviewed | |||||||||
| Publication Status: | Published | |||||||||
| Re-use Statement: | ** Embargo end date: 03-08-2023 ** From BMJ via Jisc Publications Router ** History: received 27-01-2023; accepted 29-06-2023; ppub 08-2023; epub 03-08-2023. ** Licence for this article starting on 03-08-2023: http://creativecommons.org/licenses/by-nc/4.0/ ** Acknowledgements: We thank all patients, people living with pulmonary hypertension and healthcare professionals for their contribution to the design of the intervention. | |||||||||
| Access rights to Published version: | Open Access (Creative Commons) | |||||||||
| Date of first compliant deposit: | 15 September 2023 | |||||||||
| Date of first compliant Open Access: | 15 September 2023 | |||||||||
| RIOXX Funder/Project Grant: |
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