Development of a Complex Intervention to Promote Pulmonary Rehabilitation Uptake Post Hospitalisation for an Acute Exacerbation of Chronic Obstructive Pulmonary Disease

Abstract

Background: Pulmonary Rehabilitation (PR) uptake rate post-Acute Exacerbation of Chronic Obstructive Pulmonary Disease (AECOPD) is known to be suboptimal. Recent research has advocated for targeting patient care priorities to make PR more appealing to its stakeholders. However, limited data is available about the stakeholders' non-pharmacological patient care priorities and the most bothersome exacerbation impact on the patient. Objectives: To develop a complex intervention based on the stakeholders' patient care priorities to promote PR uptake post-AECOPD. Explore the key stakeholders' non-pharmacological care priorities and the most bothersome impact of exacerbation on the patient during hospitalisation and post-discharge. Lastly, review the effectiveness of interventions developed to promote conventional PR uptake post-AECOPD. Methods: The Medical Research Council framework was utilised to develop the intervention. The following research steps were conducted; I) Consider context by identifying the problem and refine the understanding of it (conducted through qualitative study), II) Engage key stakeholders who will use the intervention (conducted through Survey and Delphi studies), III) Review published evidence to identify the effectiveness of the previously developed interventions (conducted through Systematic review), IV) Draw on existing theories, V) Articulate the aspect of the programme theory, and VI) Design the preliminary version of the intervention. Results:12 participants were recruited in the qualitative study, 50 hospitalised participants were recruited in the patient survey, 46 Healthcare professionals (HCPs) were recruited in round one of the Delphi survey, 45 in round two and eight studies were included in the systematic review. The data synthesis and mapping resulted in a prototype version of the intervention that is set to be delivered in three phases (introduction, preparation, and action) that included a brief educational package, behavioural therapy, and AECOPD PR pathway. Conclusion: The findings generated from the exploratory research steps highlighted a need for a phased approach to introduce PR that initially targets barriers and secondly supports the stakeholder's prioritised care needs to facilitate PR engagement.</p