Community based pulmonary rehabilitation among chronic respiratory disease patients using peer volunteers: A feasibility study in rural south India

Clinical Research Results Abstract IntroductionRandomized controlled trials have shown that comprehensive pulmonary rehabilitation (PR) program with evaluation, physical exercise, self-management awareness, nutritional intake and psychological support has decreased symptoms, improved exercise tolerance and physical activity thereby improving HRQoL and reducing health care utilization [1-2]. In LMICs like India, patients from rural, low-literacy settings rarely, if ever access PR. This study aimed at developing a low-cost feasible model using peer volunteers from the community to encourage PR in such settings. MethodsThe study was a prospective, pre-post feasibility trial. Participants were chosen from a list of adult patients who had confirmation of CRD diagnosis, optimisation of treatment, MRC, UK dyspnoea scale grade 3 or more; forced vital capacity <65% or forced expiratory volume in 1 second <65%, of predicted. Peer volunteers (PVs) were adults with 12 years or more of schooling, from the same community. After completing baseline assessments, participants underwent 8 weeks PR training (16 sessions) in 5 groups at 5 centres, supervised by peer volunteers and assisted by professionals for 2 days a week and unsupervised exercises for the rest.Results30 participants were recruited; 15 (50) % were females, 20 (66.7%) were COPD patients and the median age was 57.5 years. The completion rate was 70% based on completing minimum of 12 sessions . At the end of the intervention period, there was improvement in aerobic capacity, upper limb strength and exercise endurance with significant changes in 6-M walk test, hand grip strength and endurance cycling time (Table 1). Patients also reported ability to do their work with ease. Nutritional and psychological counselling was provided to 21 and 19 patients who had malnutrition/anaemia or anxiety/depression, respectively during assessment. DiscussionBased on completion rates and clinical outcomes [3] PR training for CRD patients is possible in low-literacy LMIC settings involving peer volunteers. Research Idea Abstract Service Development & Evaluation Abstract Declaration of Interest The authors declare no competing interests. Funding: NIHR RESPIRE (16/136/109)CTRI/2020/09/027818 References and Clinical Trial Registry Information McCarthy B et al. Pulmonary rehabilitation for chronic obstructive pulmonary disease. Cochrane Database Syst Rev. 2015 Feb 23;(2):CD003793. doi: 10.1002/14651858.CD003793.pub3. PMID: 25705944.Waterhouse JC. et al. A randomised 2 x 2 trial of community versus hospital pulmonary rehabilitation, followed by telephone or conventional follow-up. Health Technol Assess. 2010 Feb;14(6):i-v, vii-xi, 1-140. doi: 10.3310/hta14060. PMID: 20146902.Holland AE et al. Defining Modern Pulmonary Rehabilitation. An Official American Thoracic Society Workshop Report. Ann Am Thorac Soc. 2021 May;18(5):e12-e29. doi: 10.1513/AnnalsATS.202102-146ST. PMID: 33929307; PMCID: PMC8086532.