Proof of Concept of a Tailored Rehabilitation Programme for Interstitial Lung Disease, including Idiopathic Pulmonary Fibrosis

Abstract

Ph. D. Thesis.Although the National Institute for Health and Care Excellence (NICE) recommended pulmonary rehabilitation program (PRP) for subjects with interstitial lung disease (ILD), tailored services and research in this key treatment area are limited. In this project UK Biobank data was retrieved and analysed for 122 subjects with ILD. A regional service of PR for ILD was established and 18 subjects with ILD were recruited. This was followed by a proof of concept RCT for 20 subjects with ILD. Similar methodology for the clinical regional service and the RCT was used and in the RCT subjects were allocated/ and or randomised to intervention inspiratory muscle training (IMT) with PRP or PRP alone. The subjects attended an 8 week program in a hospice care setting with one supervised and two unsupervised sessions. The supervised session was conducted in a novel hospice care partnership setting and included education, exercise, and relaxation sessions. After PRP, feedback was collected from all subjects. The UK Biobank data provided limited data for ILD, however, sedentary time showed correlation with weight (r=0.39, n=51, p=0.004), and with moderate and vigorous activities (r=- 0.32, n=51, p=0.021). The regional PRP service and RCT were shown to be feasible and appreciated by patients and carers, and attendance for RCT was 81%. In the RCT in general, when IMT was used, improvement was seen in maximum inspiratory pressure (MIP and sixminute walk test (6MWT). Circulating (Matrix Metallopeptidase 7 (MMP7) levels and 6MWT data showed improvement regardless the use of IMT. Variability was seen in other outcomes, where they either maintained, dropped, or improved. The feedback showed an appreciation for ‘exercise’, ‘information’ and ‘group’, stressing the importance of the education talks in the group therapy. There were also suggestions/requests for longer PRP, showing subjects appreciation for the program. In conclusion, UK Biobank contained limited data specifically for ILD research. A novel tailored PRP was established and was feasible in collaboration with a hospice healthcare partner. This was valued by subjects, carers and healthcare colleagues. Response to outcomes varied considerably in the RCT and regional service but the data suggested potential end points for further research trials. These could be investigated in future studies with larger sample sizes