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Keogh A, Mc Ardle R, Diaconu MG, Ammour N, Arnera V, Balzani F, Brittain G, Buckley E, Buttery S, Cantu A, Corriol-Rohou S, Delgado-Ortiz L, Duysens J, Forman-Hardy T, Gur-Arieh T, Hamerlijnck D, Linnell J, Leocani L, McQuillan T, Neatrour I, Polhemus A, Remmele W, Saraiva I, Scott K, Sutton N, van den Brande K, Vereijken B, Wohlrab M, Rochester L. Mobilizing Patient and Public Involvement in the Development of Real-World Digital Technology Solutions: Tutorial. J Med Internet Res 2023; 25:e44206. [PMID: 37889531 PMCID: PMC10638632 DOI: 10.2196/44206] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2022] [Revised: 08/09/2023] [Accepted: 08/31/2023] [Indexed: 10/28/2023] Open
Abstract
Although the value of patient and public involvement and engagement (PPIE) activities in the development of new interventions and tools is well known, little guidance exists on how to perform these activities in a meaningful way. This is particularly true within large research consortia that target multiple objectives, include multiple patient groups, and work across many countries. Without clear guidance, there is a risk that PPIE may not capture patient opinions and needs correctly, thereby reducing the usefulness and effectiveness of new tools. Mobilise-D is an example of a large research consortium that aims to develop new digital outcome measures for real-world walking in 4 patient cohorts. Mobility is an important indicator of physical health. As such, there is potential clinical value in being able to accurately measure a person's mobility in their daily life environment to help researchers and clinicians better track changes and patterns in a person's daily life and activities. To achieve this, there is a need to create new ways of measuring walking. Recent advancements in digital technology help researchers meet this need. However, before any new measure can be used, researchers, health care professionals, and regulators need to know that the digital method is accurate and both accepted by and produces meaningful outcomes for patients and clinicians. Therefore, this paper outlines how PPIE structures were developed in the Mobilise-D consortium, providing details about the steps taken to implement PPIE, the experiences PPIE contributors had within this process, the lessons learned from the experiences, and recommendations for others who may want to do similar work in the future. The work outlined in this paper provided the Mobilise-D consortium with a foundation from which future PPIE tasks can be created and managed with clearly defined collaboration between researchers and patient representatives across Europe. This paper provides guidance on the work required to set up PPIE structures within a large consortium to promote and support the creation of meaningful and efficient PPIE related to the development of digital mobility outcomes.
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Affiliation(s)
- Alison Keogh
- Insight Centre Data Analytics, University College Dublin, Dublin4, Ireland
- School of Medicine, Trinity College Dublin, Dublin2, Ireland
| | - Ríona Mc Ardle
- Translational and Clinical Research Institute, Faculty of Medical Sciences, Newcastle University, Newcastle, United Kingdom
| | - Mara Gabriela Diaconu
- Department of Neuromedicine and Movement Science, Faculty of Medicine and Health Sciences, Norwegian University of Science and Technology, Trondheim, Norway
| | - Nadir Ammour
- Clinical Science and Operations, Global Development, Sanofi Research & Development, Chilly-Mazarin, France
| | - Valdo Arnera
- Clario, Clario Holdings Inc, Geneva, Switzerland
| | - Federica Balzani
- Mobilise-D Patient and Public Advisory Group, Newcastle, United Kingdom
| | - Gavin Brittain
- Department of Clinical Neurology, Sheffield Teaching Hospitals National Health Service, Foundation Trust, Sheffield, United Kingdom
- Sheffield Institute for Translational Neuroscience, The University of Sheffield, Sheffield, United Kingdom
| | - Ellen Buckley
- Department of Mechanical Engineering, University of Sheffield, Sheffield, United Kingdom
- Insigneo Institute for in Silico Medicine, University of Sheffield, Sheffield, United Kingdom
| | - Sara Buttery
- National Heart and Lung Institute, Imperial College London, London, United Kingdom
| | - Alma Cantu
- School of Computer Science, Newcastle University, Newcastle, United Kingdom
| | | | - Laura Delgado-Ortiz
- Non-Communicable Diseases and Environment Programme, ISGlobal, Barcelona, Spain
- Department of Medicine and Life Sciences, Universitat Pompeu Fabra, Barcelona, Spain
- Centro de Investigación Biomedical en Red Epidemiologia y Salud Publica, Barcelona, Spain
| | - Jacques Duysens
- Mobilise-D Patient and Public Advisory Group, Newcastle, United Kingdom
| | - Tom Forman-Hardy
- Mobilise-D Patient and Public Advisory Group, Newcastle, United Kingdom
| | - Tova Gur-Arieh
- Mobilise-D Patient and Public Advisory Group, Newcastle, United Kingdom
| | | | - John Linnell
- Mobilise-D Patient and Public Advisory Group, Newcastle, United Kingdom
| | - Letizia Leocani
- Department of Neurology, San Raffele University, Milan, Italy
| | - Tom McQuillan
- Mobilise-D Patient and Public Advisory Group, Newcastle, United Kingdom
| | - Isabel Neatrour
- Translational and Clinical Research Institute, Faculty of Medical Sciences, Newcastle University, Newcastle, United Kingdom
| | - Ashley Polhemus
- Epidemiology, Biostatistics and Prevention Institute, University of Zurich, Zurich, Switzerland
| | - Werner Remmele
- Mobilise-D Patient and Public Advisory Group, Newcastle, United Kingdom
| | - Isabel Saraiva
- Mobilise-D Patient and Public Advisory Group, Newcastle, United Kingdom
| | - Kirsty Scott
- Department of Mechanical Engineering, University of Sheffield, Sheffield, United Kingdom
- Insigneo Institute for in Silico Medicine, University of Sheffield, Sheffield, United Kingdom
| | - Norman Sutton
- Mobilise-D Patient and Public Advisory Group, Newcastle, United Kingdom
| | | | - Beatrix Vereijken
- Department of Neuromedicine and Movement Science, Faculty of Medicine and Health Sciences, Norwegian University of Science and Technology, Trondheim, Norway
| | - Martin Wohlrab
- Dr. Margarete Fischer-Bosch-Institute of Clinical Pharmacology, Stuttgart, Germany
- University of Tuebingen, Tuebingen, Germany
| | - Lynn Rochester
- Translational and Clinical Research Institute, Faculty of Medical Sciences, Newcastle University, Newcastle, United Kingdom
- Newcastle Upon Tyne Hospitals National Health Service Foundation Trust, Newcastle, United Kingdom
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Philip KEJ, Buttery S, Williams P, Vijayakumar B, Tonkin J, Cumella A, Renwick L, Ogden L, Quint JK, Johnston SL, Polkey MI, Hopkinson NS. Impact of COVID-19 on people with asthma: a mixed methods analysis from a UK wide survey. BMJ Open Respir Res 2022; 9:9/1/e001056. [PMID: 35027428 PMCID: PMC8762134 DOI: 10.1136/bmjresp-2021-001056] [Citation(s) in RCA: 29] [Impact Index Per Article: 14.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2021] [Accepted: 12/24/2021] [Indexed: 12/12/2022] Open
Abstract
INTRODUCTION The impact of acute COVID-19 on people with asthma appears complex, being moderated by multiple interacting disease-specific, demographic and environmental factors. Research regarding longer-term effects in this group is limited. We aimed to assess impacts of COVID-19 and predictors of persistent symptoms, in people with asthma. METHODS Using data from an online UK-wide survey of 4500 people with asthma (median age 50-59 years, 81% female), conducted in October 2020, we undertook a mixed methods analysis of the characteristics and experience of those reporting having had COVID-19. RESULTS The COVID-19 group (n=471, 10.5%) reported increased inhaler use and worse asthma management, compared with those not reporting COVID-19, but did not differ by gender, ethnicity or household income. Among the COVID-19 group, 56.1% reported having long COVID, 20.2% were 'unsure'. Those with long COVID were more likely than those without long COVID to describe: their breathing as worse or much worse after their initial illness (73.7% vs 34.8%, p<0.001), increased inhaler use (67.8% vs 34.8%, p<0.001) and worse or much worse asthma management (59.6% vs 25.6%, p<0.001). Having long COVID was not associated with age, gender, ethnicity, UK nation or household income.Analysis of free text survey responses identified three key themes: (1) variable COVID-19 severity, duration and recovery; (2) symptom overlap and interaction between COVID-19 and asthma; (3) barriers to accessing healthcare. CONCLUSIONS Persisting symptoms are common in people with asthma following COVID-19. Measures are needed to ensure appropriate healthcare access including clinical evaluation and investigation, to distinguish between COVID-19 symptoms and asthma.
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Affiliation(s)
- Keir Elmslie James Philip
- National Heart and Lung Institute, Imperial College London, London, UK .,NIHR Respiratory Biomedical Research Unit, Imperial College London, London, UK.,Respiratory Medicine, Royal Brompton and Harefield Hospitals, London, UK
| | - Sara Buttery
- National Heart and Lung Institute, Imperial College London, London, UK.,NIHR Respiratory Biomedical Research Unit, Imperial College London, London, UK.,Respiratory Medicine, Royal Brompton and Harefield Hospitals, London, UK
| | - Parris Williams
- National Heart and Lung Institute, Imperial College London, London, UK.,NIHR Respiratory Biomedical Research Unit, Imperial College London, London, UK.,Respiratory Medicine, Royal Brompton and Harefield Hospitals, London, UK
| | - Bavithra Vijayakumar
- National Heart and Lung Institute, Imperial College London, London, UK.,NIHR Respiratory Biomedical Research Unit, Imperial College London, London, UK.,Respiratory Medicine, Royal Brompton and Harefield Hospitals, London, UK
| | - James Tonkin
- National Heart and Lung Institute, Imperial College London, London, UK.,NIHR Respiratory Biomedical Research Unit, Imperial College London, London, UK.,Respiratory Medicine, Royal Brompton and Harefield Hospitals, London, UK
| | - Andrew Cumella
- Asthma UK and British Lung Foundation Partnership, London, UK
| | | | - Lizzie Ogden
- Asthma UK and British Lung Foundation Partnership, London, UK
| | - Jennifer K Quint
- National Heart and Lung Institute, Imperial College London, London, UK.,Respiratory Medicine, Royal Brompton and Harefield Hospitals, London, UK.,Respiratory Epidemiology, Occupational Medicine and Public Health, Imperial College London, London, UK
| | - Sebastian L Johnston
- National Heart and Lung Institute, Imperial College London, London, UK.,NIHR Respiratory Biomedical Research Unit, Imperial College London, London, UK
| | - Michael I Polkey
- National Heart and Lung Institute, Imperial College London, London, UK.,NIHR Respiratory Biomedical Research Unit, Imperial College London, London, UK.,Respiratory Medicine, Royal Brompton and Harefield Hospitals, London, UK
| | - Nicholas S Hopkinson
- National Heart and Lung Institute, Imperial College London, London, UK.,NIHR Respiratory Biomedical Research Unit, Imperial College London, London, UK.,Respiratory Medicine, Royal Brompton and Harefield Hospitals, London, UK
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Buttery S, Philip KEJ, Williams P, Fallas A, West B, Cumella A, Cheung C, Walker S, Quint JK, Polkey MI, Hopkinson NS. Patient symptoms and experience following COVID-19: results from a UK-wide survey. BMJ Open Respir Res 2021; 8:8/1/e001075. [PMID: 34732518 PMCID: PMC8572361 DOI: 10.1136/bmjresp-2021-001075] [Citation(s) in RCA: 35] [Impact Index Per Article: 11.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2021] [Accepted: 10/19/2021] [Indexed: 12/22/2022] Open
Abstract
OBJECTIVES To investigate the experience of people who continue to be unwell after acute COVID-19, often referred to as 'long COVID', both in terms of their symptoms and their interactions with healthcare. DESIGN We conducted a mixed-methods analysis of responses to a survey accessed through a UK online post-COVID-19 support and information hub, between April and December 2020, about people's experiences after having acute COVID-19. PARTICIPANTS 3290 respondents, 78% female, 92.1% white ethnicity and median age range 45-54 years; 12.7% had been hospitalised. 494(16.5%) completed the survey between 4 and 8 weeks of the onset of their symptoms, 641(21.4%) between 8 and 12 weeks and 1865 (62.1%) >12 weeks after. RESULTS The ongoing symptoms most frequently reported were: breathing problems (92.1%), fatigue (83.3%), muscle weakness or joint stiffness (50.6%), sleep disturbances (46.2%), problems with mental abilities (45.9%), changes in mood, including anxiety and depression (43.1%) and cough (42.3%). Symptoms did not appear to be related to the severity of the acute illness or to the presence of pre-existing medical conditions. Analysis of free-text responses revealed three main themes: (1) experience of living with COVID-19: physical and psychological symptoms that fluctuate unpredictably; (2) interactions with healthcare that were unsatisfactory; (3) implications for the future: their own condition, society and the healthcare system, and the need for research CONCLUSION: Consideration of patient perspectives and experiences will assist in the planning of services to address problems persisting in people who remain symptomatic after the acute phase of COVID-19.
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Affiliation(s)
- Sara Buttery
- National Heart and Lung Institute, Imperial College London, London, UK
| | - Keir E J Philip
- National Heart and Lung Institute, Imperial College London, London, UK
| | - Parris Williams
- National Heart and Lung Institute, Imperial College London, London, UK
| | - Andrea Fallas
- Asthma UK and British Lung Foundation Partnership, London, UK
| | - Brigitte West
- Asthma UK and British Lung Foundation Partnership, London, UK
| | - Andrew Cumella
- Asthma UK and British Lung Foundation Partnership, London, UK
| | - Cheryl Cheung
- Asthma UK and British Lung Foundation Partnership, London, UK
| | - Samantha Walker
- Asthma UK and British Lung Foundation Partnership, London, UK
| | - Jennifer K Quint
- Department of Respiratory Epidemiology, Occupational Medicine and Public Health, Imperial College London, London, UK
| | - Michael I Polkey
- National Heart and Lung Institute, Imperial College London, London, UK.,Respiratory Medicine, Royal Brompton and Harefield NHS Foundation Trust, London, UK
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Polhemus A, Delgado-Ortiz L, Brittain G, Chynkiamis N, Salis F, Gaßner H, Gross M, Kirk C, Rossanigo R, Taraldsen K, Balta D, Breuls S, Buttery S, Cardenas G, Endress C, Gugenhan J, Keogh A, Kluge F, Koch S, Micó-Amigo ME, Nerz C, Sieber C, Williams P, Bergquist R, Bosch de Basea M, Buckley E, Hansen C, Mikolaizak AS, Schwickert L, Scott K, Stallforth S, van Uem J, Vereijken B, Cereatti A, Demeyer H, Hopkinson N, Maetzler W, Troosters T, Vogiatzis I, Yarnall A, Becker C, Garcia-Aymerich J, Leocani L, Mazzà C, Rochester L, Sharrack B, Frei A, Puhan M. Walking on common ground: a cross-disciplinary scoping review on the clinical utility of digital mobility outcomes. NPJ Digit Med 2021; 4:149. [PMID: 34650191 PMCID: PMC8516969 DOI: 10.1038/s41746-021-00513-5] [Citation(s) in RCA: 32] [Impact Index Per Article: 10.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2021] [Accepted: 08/09/2021] [Indexed: 02/08/2023] Open
Abstract
Physical mobility is essential to health, and patients often rate it as a high-priority clinical outcome. Digital mobility outcomes (DMOs), such as real-world gait speed or step count, show promise as clinical measures in many medical conditions. However, current research is nascent and fragmented by discipline. This scoping review maps existing evidence on the clinical utility of DMOs, identifying commonalities across traditional disciplinary divides. In November 2019, 11 databases were searched for records investigating the validity and responsiveness of 34 DMOs in four diverse medical conditions (Parkinson's disease, multiple sclerosis, chronic obstructive pulmonary disease, hip fracture). Searches yielded 19,672 unique records. After screening, 855 records representing 775 studies were included and charted in systematic maps. Studies frequently investigated gait speed (70.4% of studies), step length (30.7%), cadence (21.4%), and daily step count (20.7%). They studied differences between healthy and pathological gait (36.4%), associations between DMOs and clinical measures (48.8%) or outcomes (4.3%), and responsiveness to interventions (26.8%). Gait speed, step length, cadence, step time and step count exhibited consistent evidence of validity and responsiveness in multiple conditions, although the evidence was inconsistent or lacking for other DMOs. If DMOs are to be adopted as mainstream tools, further work is needed to establish their predictive validity, responsiveness, and ecological validity. Cross-disciplinary efforts to align methodology and validate DMOs may facilitate their adoption into clinical practice.
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Affiliation(s)
- Ashley Polhemus
- Epidemiology, Biostatistics and Prevention Institute, University of Zurich, Zurich, Switzerland.
| | - Laura Delgado-Ortiz
- ISGlobal, Barcelona, Spain
- Universitat Pompeu Fabra, Barcelona, Spain
- CIBER Epidemiología y Salud Pública, Barcelona, Spain
| | - Gavin Brittain
- Department of Neuroscience and Sheffield NIHR Translational Neuroscience BRC, Sheffield Teaching Hospitals NHS Foundation Trust & University of Sheffield, Sheffield, England
| | - Nikolaos Chynkiamis
- Department of Sport, Exercise and Rehabilitation, Faculty of Health and Life Sciences, Northumbria University Newcastle, Newcastle, UK
| | - Francesca Salis
- Department of Biomedical Sciences, University of Sassari, Sassari, Italy
| | - Heiko Gaßner
- Department of Molecular Neurology, University Hospital Erlangen, Erlangen, Germany
| | - Michaela Gross
- Department of Clinical Gerontology, Robert-Bosch-Hospital, Stuttgart, Germany
| | - Cameron Kirk
- Translational and Clinical Research Institute, Faculty of Medical Sciences, Newcastle University, Newcastle upon Tyne, UK
| | - Rachele Rossanigo
- Department of Biomedical Sciences, University of Sassari, Sassari, Italy
| | - Kristin Taraldsen
- Department of Neuromedicine and Movement Science, Norwegian University of Science and Technology, Trondheim, Norway
| | - Diletta Balta
- Department of Electronics and Telecommunications, Politecnico di Torino, Torino, Italy
| | - Sofie Breuls
- Department of Rehabilitation Sciences, KU Leuven, Leuven, Belgium
- Department of Respiratory Diseases, University hospitals Leuven, Leuven, Belgium
| | - Sara Buttery
- National Heart and Lung Institute, Imperial College London, London, UK
| | - Gabriela Cardenas
- ISGlobal, Barcelona, Spain
- Universitat Pompeu Fabra, Barcelona, Spain
- CIBER Epidemiología y Salud Pública, Barcelona, Spain
| | - Christoph Endress
- Department of Clinical Gerontology, Robert-Bosch-Hospital, Stuttgart, Germany
| | - Julia Gugenhan
- Department of Clinical Gerontology, Robert-Bosch-Hospital, Stuttgart, Germany
| | - Alison Keogh
- Insight Centre for Data Analytics, University College Dublin, Dublin, Ireland
| | - Felix Kluge
- Department of Artificial Intelligence in Biomedical Engineering, Friedrich-Alexander-Universität Erlangen-Nürnberg (FAU), Erlangen, Germany
| | - Sarah Koch
- ISGlobal, Barcelona, Spain
- Universitat Pompeu Fabra, Barcelona, Spain
- CIBER Epidemiología y Salud Pública, Barcelona, Spain
| | - M Encarna Micó-Amigo
- Translational and Clinical Research Institute, Faculty of Medical Sciences, Newcastle University, Newcastle upon Tyne, UK
| | - Corinna Nerz
- Department of Clinical Gerontology, Robert-Bosch-Hospital, Stuttgart, Germany
| | - Chloé Sieber
- Epidemiology, Biostatistics and Prevention Institute, University of Zurich, Zurich, Switzerland
| | - Parris Williams
- National Heart and Lung Institute, Imperial College London, London, UK
| | - Ronny Bergquist
- Department of Neuromedicine and Movement Science, Norwegian University of Science and Technology, Trondheim, Norway
| | - Magda Bosch de Basea
- ISGlobal, Barcelona, Spain
- Universitat Pompeu Fabra, Barcelona, Spain
- CIBER Epidemiología y Salud Pública, Barcelona, Spain
| | - Ellen Buckley
- Insigneo Institute, Department of Mechanical Engineering, University of Sheffield, Sheffield, UK
| | - Clint Hansen
- Department of Neurology, University Medical Center Schleswig-Holstein, Kiel, Germany
| | | | - Lars Schwickert
- Department of Clinical Gerontology, Robert-Bosch-Hospital, Stuttgart, Germany
| | - Kirsty Scott
- Insigneo Institute, Department of Mechanical Engineering, University of Sheffield, Sheffield, UK
| | - Sabine Stallforth
- Department of Molecular Neurology, University Hospital Erlangen, Erlangen, Germany
| | - Janet van Uem
- Department of Neurology, University Medical Center Schleswig-Holstein, Kiel, Germany
| | - Beatrix Vereijken
- Department of Neuromedicine and Movement Science, Norwegian University of Science and Technology, Trondheim, Norway
| | - Andrea Cereatti
- Department of Biomedical Sciences, University of Sassari, Sassari, Italy
- Department of Electronics and Telecommunications, Politecnico di Torino, Torino, Italy
| | - Heleen Demeyer
- Department of Rehabilitation Sciences, KU Leuven, Leuven, Belgium
- Department of Respiratory Diseases, University hospitals Leuven, Leuven, Belgium
- Department of Rehabilitation Sciences, Ghent University, Ghent, Belgium
| | | | - Walter Maetzler
- Department of Neurology, University Medical Center Schleswig-Holstein, Kiel, Germany
| | - Thierry Troosters
- Department of Rehabilitation Sciences, KU Leuven, Leuven, Belgium
- Department of Respiratory Diseases, University hospitals Leuven, Leuven, Belgium
| | - Ioannis Vogiatzis
- Department of Sport, Exercise and Rehabilitation, Faculty of Health and Life Sciences, Northumbria University Newcastle, Newcastle, UK
| | - Alison Yarnall
- Translational and Clinical Research Institute, Faculty of Medical Sciences, Newcastle University, Newcastle upon Tyne, UK
| | - Clemens Becker
- Department of Clinical Gerontology, Robert-Bosch-Hospital, Stuttgart, Germany
| | - Judith Garcia-Aymerich
- ISGlobal, Barcelona, Spain
- Universitat Pompeu Fabra, Barcelona, Spain
- CIBER Epidemiología y Salud Pública, Barcelona, Spain
| | - Letizia Leocani
- Department of Neurology, San Raffaele University, Milan, Italy
| | - Claudia Mazzà
- Insigneo Institute, Department of Mechanical Engineering, University of Sheffield, Sheffield, UK
| | - Lynn Rochester
- Translational and Clinical Research Institute, Faculty of Medical Sciences, Newcastle University, Newcastle upon Tyne, UK
| | - Basil Sharrack
- Department of Neuroscience and Sheffield NIHR Translational Neuroscience BRC, Sheffield Teaching Hospitals NHS Foundation Trust & University of Sheffield, Sheffield, England
| | - Anja Frei
- Epidemiology, Biostatistics and Prevention Institute, University of Zurich, Zurich, Switzerland
| | - Milo Puhan
- Epidemiology, Biostatistics and Prevention Institute, University of Zurich, Zurich, Switzerland
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Philip KE, Lewis A, Jeffery E, Buttery S, Cave P, Cristiano D, Lound A, Taylor K, Man WDC, Fancourt D, Polkey MI, Hopkinson NS. Moving singing for lung health online in response to COVID-19: experience from a randomised controlled trial. BMJ Open Respir Res 2020; 7:e000737. [PMID: 33239406 PMCID: PMC7689537 DOI: 10.1136/bmjresp-2020-000737] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2020] [Revised: 09/29/2020] [Accepted: 10/21/2020] [Indexed: 01/07/2023] Open
Abstract
INTRODUCTION Singing for lung health (SLH) is a popular arts-in-health activity for people with long-term respiratory conditions. Participants report biopsychosocial benefits, however, research on impact is limited. The 'SLH: Improving Experiences of Lung Disease trial', a randomised controlled, single (assessor) blind, trial of 12 weeks SLH versus usual care for people with chronic obstructive pulmonary disease (COPD) (n=120) was setup to help to address this. The first group (n=18, nine singing and nine controls) started face-to-face (five sessions) before changing to online delivery (seven sessions) due to COVID-19-related physical distancing measures. As such, the experience of this group is here reported as a pilot study to inform further research in this area. METHODS We conducted semistructured interviews and thematic analysis regarding barriers, facilitators and key considerations for transitioning from face-to-face to online delivery. Pilot quantitative outcomes include attendance, premeasures and postmeasures of quality of life and disease impact (Short Form 36 Health Survey, COPD Assessment Test score), breathlessness (Medical Research Council breathlessness scale, Dyspnoea-12), depression (Patient Health Questionnaire-9, PHQ-9), anxiety (Generalised Anxiety Disorder-7), balance confidence (Activity specific Balance Confidence, ABC scale) and physical activity (clinical visit PROactive physical activity in COPD tool, combining subjective rating and actigraphy). RESULTS Attendance was 69% overall, (90% of the face-to-face sessions, 53% online sessions). Analysis of semistructured interviews identified three themes regarding participation in SLH delivered face to face and online, these where (1) perceived benefits; (2) digital barriers (online) and (3) digital facilitators (online). Findings were summarised into key considerations for optimising transitioning singing groups from face-to-face to online delivery. Pilot quantitative data suggested possible improvements in depression (treatment effect -4.78 PHQ-9 points, p<0.05, MCID 5) and balance confidence (treatment effect +17.21 ABC scale points, p=0.04, MCID 14.2). DISCUSSION This study identifies key considerations regarding the adaptation of SLH from face-to-face to online delivery. Pilot data suggest online group singing for people with COPD may deliver benefits related to reducing depression and improved balance confidence.
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Affiliation(s)
- Keir Ej Philip
- National Heart and Lung Institute, Imperial College London, London, UK
- Respiratory Medicine, Royal Brompton and Harefield NHS Foundation Trust, London, UK
| | | | - Edmund Jeffery
- Respiratory Medicine, Royal Brompton and Harefield NHS Foundation Trust, London, UK
| | - Sara Buttery
- National Heart and Lung Institute, Imperial College London, London, UK
- Respiratory Medicine, Royal Brompton and Harefield NHS Foundation Trust, London, UK
| | - Phoene Cave
- National Heart and Lung Institute, Imperial College London, London, UK
| | - Daniele Cristiano
- Respiratory Medicine, Royal Brompton and Harefield NHS Foundation Trust, London, UK
| | - Adam Lound
- Respiratory Medicine, Imperial College Healthcare NHS Trust, London, UK
| | - Karen Taylor
- Respiratory Medicine, Royal Brompton and Harefield NHS Foundation Trust, London, UK
| | - William D-C Man
- National Heart and Lung Institute, Imperial College London, London, UK
- Respiratory Medicine, Royal Brompton and Harefield NHS Foundation Trust, London, UK
| | - Daisy Fancourt
- Department of Behavioural Science and Health, University College London, London, UK
| | - Michael I Polkey
- National Heart and Lung Institute, Imperial College London, London, UK
- Respiratory Medicine, Royal Brompton and Harefield NHS Foundation Trust, London, UK
| | - Nicholas S Hopkinson
- National Heart and Lung Institute, Imperial College London, London, UK
- Respiratory Medicine, Royal Brompton and Harefield NHS Foundation Trust, London, UK
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6
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Pavitt MJ, Tanner RJ, Lewis A, Buttery S, Mehta B, Jefford H, Curtis KJ, Banya WAS, Husain S, Satkunam K, Shrikrishna D, Man W, Polkey MI, Hopkinson NS. Oral nitrate supplementation to enhance pulmonary rehabilitation in COPD: ON-EPIC a multicentre, double-blind, placebo-controlled, randomised parallel group study. Thorax 2020; 75:547-555. [PMID: 32376732 DOI: 10.1136/thoraxjnl-2019-214278] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2019] [Revised: 03/23/2020] [Accepted: 04/15/2020] [Indexed: 12/25/2022]
Abstract
RATIONALE Dietary nitrate supplementation has been proposed as a strategy to improve exercise performance, both in healthy individuals and in people with COPD. We aimed to assess whether it could enhance the effect of pulmonary rehabilitation (PR) in COPD. METHODS This double-blind, placebo-controlled, parallel group, randomised controlled study performed at four UK centres, enrolled adults with Global Initiative for Chronic Obstructive Lung Disease grade II-IV COPD and Medical Research Council dyspnoea score 3-5 or functional limitation to undertake a twice weekly 8-week PR programme. They were randomly assigned (1:1) to either 140 mL of nitrate-rich beetroot juice (BRJ) (12.9 mmol nitrate), or placebo nitrate-deplete BRJ, consumed 3 hours prior to undertaking each PR session. Allocation used computer-generated block randomisation. MEASUREMENTS The primary outcome was change in incremental shuttle walk test (ISWT) distance. Secondary outcomes included quality of life, physical activity level, endothelial function via flow-mediated dilatation, fat-free mass index and blood pressure parameters. RESULTS 165 participants were recruited, 78 randomised to nitrate-rich BRJ and 87 randomised to placebo. Exercise capacity increased more with active treatment (n=57) than placebo (n=65); median (IQR) change in ISWT distance +60 m (10, 85) vs +30 m (0, 70), estimated treatment effect 30 m (95% CI 10 to 40); p=0.027. Active treatment also impacted on systolic blood pressure: treatment group -5.0 mm Hg (-5.0, -3.0) versus control +6.0 mm Hg (-1.0, 15.5), estimated treatment effect -7 mm Hg (95% CI 7 to -20) (p<0.0005). No significant serious adverse events or side effects were reported. CONCLUSIONS Dietary nitrate supplementation appears to be a well-tolerated and effective strategy to augment the benefits of PR in COPD. TRIAL REGISTRATION NUMBER ISRCTN27860457.
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Affiliation(s)
- Matthew J Pavitt
- National Heart and Lung Institute, Royal Brompton Campus, Imperial College London, London, UK
| | - Rebecca Jayne Tanner
- National Heart and Lung Institute, Royal Brompton Campus, Imperial College London, London, UK
| | - Adam Lewis
- National Heart and Lung Institute, Royal Brompton Campus, Imperial College London, London, UK
| | - Sara Buttery
- National Heart and Lung Institute, Royal Brompton Campus, Imperial College London, London, UK
| | - Bhavin Mehta
- Respiratory Medicine, Royal Brompton and Harefield NHS Foundation Trust, London, UK
| | - Helen Jefford
- Greenwich Adult Community Health Service, Oxleas NHS Foundation Trust, Dartford, Kent, UK
| | - Katrina J Curtis
- National Heart and Lung Institute, Royal Brompton Campus, Imperial College London, London, UK
| | - Winston A S Banya
- National Heart and Lung Institute, Royal Brompton Campus, Imperial College London, London, UK
| | - Syed Husain
- Respiratory Medicine, Maidstone and Tunbridge Wells NHS Trust, Maidstone, Kent, UK
| | - Karnan Satkunam
- Greenwich Adult Community Health Service, Oxleas NHS Foundation Trust, Dartford, Kent, UK
| | - Dinesh Shrikrishna
- Musgrove Park Hospital, Taunton and Somerset NHS Foundation Trust, Taunton, Somerset, UK
| | - William Man
- National Heart and Lung Institute, Royal Brompton Campus, Imperial College London, London, UK
- Respiratory Medicine, Royal Brompton and Harefield NHS Foundation Trust, London, UK
| | - Michael I Polkey
- National Heart and Lung Institute, Royal Brompton Campus, Imperial College London, London, UK
- Respiratory Medicine, Royal Brompton and Harefield NHS Foundation Trust, London, UK
| | - Nicholas S Hopkinson
- National Heart and Lung Institute, Royal Brompton Campus, Imperial College London, London, UK
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Buttery S, Kemp SV, Shah PL, Waller D, Jordan S, Lee JT, Banya W, Steiner MC, Hopkinson NS. CELEB trial: Comparative Effectiveness of Lung volume reduction surgery for Emphysema and Bronchoscopic lung volume reduction with valve placement: a protocol for a randomised controlled trial. BMJ Open 2018; 8:e021368. [PMID: 30337307 PMCID: PMC6196851 DOI: 10.1136/bmjopen-2017-021368] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
INTRODUCTION Although lung volume reduction surgery and bronchoscopic lung volume reduction with endobronchial valves have both been shown to improve lung function, exercise capacity and quality of life in appropriately selected patients with emphysema, there are no direct comparison data between the two procedures to inform clinical decision-making. METHODS AND ANALYSIS We describe the protocol of the CELEB study, a randomised controlled trial which will compare outcomes at 1 year between the two procedures, using a composite disease severity measure, the iBODE score, which includes body mass index, airflow obstruction, dyspnoeaand exercise capacity (incremental shuttle walk test). ETHICS AND DISSEMINATION Ethical approval to conduct the study has been obtained from the Fulham Research Ethics Committee, London (16/LO/0286). The outcome of this trial will provide information to guide treatment choices in this population and will be presented at national and international meetings and published in peer-reviewed journals. We will also disseminate the main results to all participants in a letter. TRIAL REGISTRATION NUMBER ISRCTN19684749; Pre-results.
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Affiliation(s)
- Sara Buttery
- NIHR Respiratory Disease, Biomedical Research Unit, Royal Brompton and Harefield NHS Foundation Trust, Imperial College London, London, UK
| | - Samuel V Kemp
- NIHR Respiratory Disease, Biomedical Research Unit, Royal Brompton and Harefield NHS Foundation Trust, Imperial College London, London, UK
| | - Pallav L Shah
- NIHR Respiratory Disease, Biomedical Research Unit, Royal Brompton and Harefield NHS Foundation Trust, Imperial College London, London, UK
| | - David Waller
- Thorax Centre, Barts Health NHS Trust, London, UK
| | - Simon Jordan
- NIHR Respiratory Disease, Biomedical Research Unit, Royal Brompton and Harefield NHS Foundation Trust, Imperial College London, London, UK
| | - John T Lee
- School of Public Health, National University of Singapore, Singapore
| | - Winston Banya
- NIHR Respiratory Disease, Biomedical Research Unit, Royal Brompton and Harefield NHS Foundation Trust, Imperial College London, London, UK
| | - Michael C Steiner
- Leicester Respiratory Biomedical Research Unit, University Hospitals of Leicester NHS Foundation Trust, Leicester, UK
| | - Nicholas S Hopkinson
- NIHR Respiratory Disease, Biomedical Research Unit, Royal Brompton and Harefield NHS Foundation Trust, Imperial College London, London, UK
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Buttery S, Lewis A, Oey I, Hargrave J, Waller D, Steiner M, Shah PL, Kemp SV, Jordan S, Hopkinson NS. Patient experience of lung volume reduction procedures for emphysema: a qualitative service improvement project. ERJ Open Res 2017; 3:00031-2017. [PMID: 28835891 PMCID: PMC5553440 DOI: 10.1183/23120541.00031-2017] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2017] [Accepted: 06/01/2017] [Indexed: 11/27/2022] Open
Abstract
The aim of this service improvement project was to gain understanding of the patient experience of lung volume reduction surgery (LVRS) and endobronchial valve (EBV) placement, from referral through to post-discharge care. Focus group interviews were carried out in two tertiary centres in London and Leicester, UK. Sixteen patients who had undergone lung volume reduction surgery (LVRS), endobronchial valve (EBV) placement, or both, were recruited. Prior to participation in each focus group, participants completed a questionnaire to guide and focus discussion. Thematic analysis identified common themes to the participant experience of receiving lung volume reduction interventions. Themes included patient focus on declining health and the need to “fight” for a referral; consequences of having procedures and potential unexpected complications; and vulnerability post discharge and limited continuity of care. Participants were clear that the benefits of having had either LVRS or EBV procedures outweighed any difficulties experienced. Participants were keen to have further similar interventions if appropriate. These data confirm the need to develop more systematic lung volume reduction pathways, provide appropriate information, and ensure that post-discharge care is optimal. Patients feel they have to fight to get a lung volume reduction procedure; a more systematic approach is neededhttp://ow.ly/82Oy30cLORk
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Affiliation(s)
- Sara Buttery
- NIHR Respiratory Disease, Biomedical Research Unit at the Royal Brompton and Harefield NHS Foundation Trust and Imperial College London, London, UK
| | - Adam Lewis
- NIHR Respiratory Disease, Biomedical Research Unit at the Royal Brompton and Harefield NHS Foundation Trust and Imperial College London, London, UK
| | - Inger Oey
- Leicester Respiratory Biomedical Research Unit, University Hospitals of Leicester NHS Foundation Trust, Leicester, UK
| | - Joanne Hargrave
- Leicester Respiratory Biomedical Research Unit, University Hospitals of Leicester NHS Foundation Trust, Leicester, UK
| | - David Waller
- Leicester Respiratory Biomedical Research Unit, University Hospitals of Leicester NHS Foundation Trust, Leicester, UK
| | - Michael Steiner
- Leicester Respiratory Biomedical Research Unit, University Hospitals of Leicester NHS Foundation Trust, Leicester, UK
| | - Pallav L Shah
- NIHR Respiratory Disease, Biomedical Research Unit at the Royal Brompton and Harefield NHS Foundation Trust and Imperial College London, London, UK
| | - Samuel V Kemp
- NIHR Respiratory Disease, Biomedical Research Unit at the Royal Brompton and Harefield NHS Foundation Trust and Imperial College London, London, UK
| | - Simon Jordan
- NIHR Respiratory Disease, Biomedical Research Unit at the Royal Brompton and Harefield NHS Foundation Trust and Imperial College London, London, UK
| | - Nicholas S Hopkinson
- NIHR Respiratory Disease, Biomedical Research Unit at the Royal Brompton and Harefield NHS Foundation Trust and Imperial College London, London, UK
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Buttery S. Hapten inhibition of the reaction between Mycoplasma mycoides polysaccharide and bovine antisera. Mol Immunol 1970. [DOI: 10.1016/0161-5890(70)90168-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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Hudson JR, Buttery S, Cottew GS. Investigations into the influence of the galactan of Mycoplasma mycoides on experimental infection with that organism. J Pathol Bacteriol 1967; 94:257-73. [PMID: 4965241 DOI: 10.1002/path.1700940204] [Citation(s) in RCA: 38] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
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