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Pearce G, Holliday N, Sandhu H, Eftekhari H, Bruce J, Timms E, Ablett L, Kavi L, Simmonds J, Evans R, Magee P, Powell R, Keogh S, McGregor G. Co-creation of a complex, multicomponent rehabilitation intervention and feasibility trial protocol for the PostUraL tachycardia Syndrome Exercise (PULSE) study. Pilot Feasibility Stud 2023; 9:143. [PMID: 37582801 PMCID: PMC10426060 DOI: 10.1186/s40814-023-01365-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2023] [Accepted: 07/15/2023] [Indexed: 08/17/2023] Open
Abstract
BACKGROUND There is a dearth of research to support the treatment of people with postural tachycardia syndrome (PoTS). Despite expert consensus suggesting exercise is recommended for this patient group, there are no randomised control trials examining this rigorously. The aim was to co-create a feasibility trial protocol and a rehabilitation intervention for people living with PoTS. METHODS The intervention and feasibility trial design were co-created as part of the PostUraL tachycardia Syndrome Exercise (PULSE) study. We used the 'three co's framework' of co-define, co-design and co-refine. Recruitment included key national charities and National Health Service Trusts treating people living with PoTS in the UK. Eighteen patient and public involvement members attended the co-define session, and 16 co-creators with a mix of expertise attended the subsequent co-design and co-refine sessions. Seven intervention practitioners were trained in the rehabilitation intervention, providing feedback for further co-refinement. RESULTS The final co-created intervention comprises online physical activity, and lifestyle and behaviour change support sessions. It is based on functional movement activities using a patient-centred approach tailored to individual needs. Physical activity intensity is guided by individuals' perception of effort rather than by objective measures. Recumbent bikes are provided for home use. Patients deemed randomisation to be acceptable because research in this area was considered important. CONCLUSIONS An innovative approach was used to co-create the PULSE intervention and feasibility trial protocol to meet the evidence-based and logistical needs of people living with PoTS, clinicians, service deliverers, third-sector organisations, academics and funders. This can be used as a successful example and template for future research internationally. People living with PoTS were recognised as experts and involved in every aspect of conceptualisation, design and refinement. This complex rehabilitation intervention is currently being tested in a randomised feasibility trial comparing the PULSE intervention with best-practice usual care for people living with PoTS. TRIAL REGISTRATION ISRCTN45323485 was registered on April 7, 2020.
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Affiliation(s)
| | | | | | - Helen Eftekhari
- University of Warwick, Coventry, UK
- University Hospitals Coventry and Warwickshire NHS Trust, Coventry, UK
| | - Julie Bruce
- University of Warwick, Coventry, UK
- University Hospitals Coventry and Warwickshire NHS Trust, Coventry, UK
| | - Emma Timms
- Patient and Public Involvement, Coventry University, Coventry, UK
- Oxford University Hospital NHS Foundation Trust, Oxford, UK
| | - Laura Ablett
- Patient and Public Involvement, Coventry University, Coventry, UK
| | | | | | - Rebecca Evans
- University Hospitals Coventry and Warwickshire NHS Trust, Coventry, UK
| | | | - Richard Powell
- Coventry University, Coventry, UK
- University Hospitals Coventry and Warwickshire NHS Trust, Coventry, UK
| | | | - Gordon McGregor
- Coventry University, Coventry, UK
- University of Warwick, Coventry, UK
- University Hospitals Coventry and Warwickshire NHS Trust, Coventry, UK
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McGregor G, Evans B, Sandhu H, Simmonds J, Joshi S, Devi G, Zhupaj A, Holliday N, Pearce G, Patel C, Hee SW, Powell R, Heine P, Patel S, Kavi L, Bruce J, Hayat S, Lim B, Eftekhari H, Panikker S. Protocol update for a randomised controlled feasibility trial of exercise rehabilitation for people with postural tachycardia syndrome: the PULSE study. Pilot Feasibility Stud 2022; 8:101. [PMID: 35525992 PMCID: PMC9077338 DOI: 10.1186/s40814-022-01056-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2022] [Accepted: 04/28/2022] [Indexed: 12/02/2022] Open
Abstract
BACKGROUND The PULSE (PostUraL tachycardia Syndrome Exercise) study is a randomised controlled trial assessing the feasibility of conducting a multicentre RCT testing supervised exercise rehabilitation with behavioural and motivational support, compared to best-practice usual care, for people with Postural Tachycardia Syndrome (PoTS). The original trial protocol was published in BMC Pilot & Feasibility Studies (accessible at https://doi.org/10.1186/s40814-020-00702-1 ). The PULSE intervention consists of (1) individual assessment; (2) 12-week, twice-weekly, supervised exercise training; (3) behavioural and motivational support; and (4) guided lifestyle physical activity. The control intervention is best-practice usual care with a single 30-min, one-to-one practitioner appointment, and general advice on safe and effective physical activity. Sixty-two people (aged 18-60 years) with a confirmed diagnosis of PoTS will be invited to enrol on a feasibility RCT with an embedded qualitative study. The primary outcome will be feasibility; process-related measures will include eligibility, recruitment, randomisation and withdrawal rates, along with indicators of exercise programme adherence and acceptability. Secondary physiological, clinical and health-related outcomes will be assessed. In response to the COVID-19 pandemic, here we describe amendments to the trial protocol. METHODS Restrictions imposed by the COVID-19 pandemic meant it was necessary to change the delivery of the PULSE and control interventions. These changes reflected the need to limit the risk of COVID-19 transmission in a clinical population, some of whom were at increased risk of contracting the virus and suffering serious illness. The major change was that the originally intended centre-based PULSE and control interventions would now be delivered remotely on-line. Subsequently, there were minor changes to the participant eligibility criteria. These decisions followed an on-line co-creation session with people affected by PoTS, and relevant public and professional stakeholders. CONCLUSIONS We present an update of the original trial protocol in response to the COVID-19 pandemic. No participants were recruited to the original protocol; thus, results will reflect the on-line delivery of the intervention. PULSE will be the first randomised trial to assess the feasibility of conducting a definitive multi-centre RCT testing supervised on-line exercise rehabilitation with behavioural and motivational support, compared to best-practice usual care, for people with PoTS. TRIAL REGISTRATION ISRCTN45323485 registered on 7 April 2020.
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Affiliation(s)
- Gordon McGregor
- Department of Cardiopulmonary Rehabilitation, Centre for Exercise & Health, University Hospitals Coventry & Warwickshire NHS Trust, Coventry, CV1 3LN UK
- Centre for Sport, Exercise and Life Sciences, Research Institute for Health &Wellbeing, Coventry University, Coventry, UK
- Warwick Clinical Trials Unit, Warwick Medical School, University of Warwick, Coventry, UK
| | - Becky Evans
- Department of Cardiopulmonary Rehabilitation, Centre for Exercise & Health, University Hospitals Coventry & Warwickshire NHS Trust, Coventry, CV1 3LN UK
| | - Harbinder Sandhu
- Warwick Clinical Trials Unit, Warwick Medical School, University of Warwick, Coventry, UK
| | - Jane Simmonds
- UCL Great Ormond Street Institute of Child Health, Faculty of Population Health, University College, London, UK
| | - Shivam Joshi
- Research & Development, University Hospitals Coventry & Warwickshire NHS Trust, Coventry, UK
| | - Gita Devi
- Centre for Sport, Exercise and Life Sciences, Research Institute for Health &Wellbeing, Coventry University, Coventry, UK
| | - Albiona Zhupaj
- Department of Cardiology, University Hospitals Coventry & Warwickshire NHS Trust, Coventry, UK
| | - Nikki Holliday
- Centre for Sport, Exercise and Life Sciences, Research Institute for Health &Wellbeing, Coventry University, Coventry, UK
| | - Gemma Pearce
- Centre for Sport, Exercise and Life Sciences, Research Institute for Health &Wellbeing, Coventry University, Coventry, UK
| | - Chloe Patel
- Centre for Sport, Exercise and Life Sciences, Research Institute for Health &Wellbeing, Coventry University, Coventry, UK
| | - Siew Wan Hee
- Division of Health Sciences, Warwick Medical School, University of Warwick, Coventry, UK
| | - Richard Powell
- Department of Cardiopulmonary Rehabilitation, Centre for Exercise & Health, University Hospitals Coventry & Warwickshire NHS Trust, Coventry, CV1 3LN UK
- Centre for Sport, Exercise and Life Sciences, Research Institute for Health &Wellbeing, Coventry University, Coventry, UK
| | - Peter Heine
- Warwick Clinical Trials Unit, Warwick Medical School, University of Warwick, Coventry, UK
| | - Shilpa Patel
- Department of Cardiopulmonary Rehabilitation, Centre for Exercise & Health, University Hospitals Coventry & Warwickshire NHS Trust, Coventry, CV1 3LN UK
- Warwick Clinical Trials Unit, Warwick Medical School, University of Warwick, Coventry, UK
| | | | - Julie Bruce
- Warwick Clinical Trials Unit, Warwick Medical School, University of Warwick, Coventry, UK
| | - Sajad Hayat
- Department of Cardiology, Hamad Medical Corporation, Doha, Qatar
| | - Boon Lim
- Department of Cardiology, Imperial College Healthcare NHS Trust, London, UK
| | - Helen Eftekhari
- Research & Development, University Hospitals Coventry & Warwickshire NHS Trust, Coventry, UK
- Division of Health Sciences, Warwick Medical School, University of Warwick, Coventry, UK
| | - Sandeep Panikker
- Research & Development, University Hospitals Coventry & Warwickshire NHS Trust, Coventry, UK
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