Optimising participation in a pulmonary rehabilitation programme for people living with chronic respiratory diseases in rural India: a feasibility study.

BACKGROUND

Pulmonary rehabilitation (PR) plays a vital role in managing chronic obstructive pulmonary disease and other chronic respiratory diseases (CRDs). However, implementation of this multidisciplinary approach in resource-poor settings may not be sufficient because of referrers' uncertainty regarding the effectiveness of PR, inconvenient timing, travel issues, patients' lack of motivation, and poor family support. The aim was to test the feasibility of a peer-led, professionally assisted community-based PR programme for CRD patients in a rural, low literacy setting.

METHODS

We conducted a single-centre, pre-post feasibility study. Participants with a confirmed diagnosis of CRD were recruited and treatment was optimised. After completing baseline assessments, the participants underwent eight weeks of PR training (16 sessions) in six groups at five local facilities led by peers selected by the participants and assisted by professionals. Exercise capacity was assessed with 6-Minute Walk Test. Other outcomes were: International Physical Activity Questionnaire; Hospital Anxiety and Depression Scale; London Chest Activity of Daily Living scale. Upper and lower limb strength were assessed using a handheld dynamometer and cycle ergometer, respectively. Descriptive analysis was performed, and pre-and post-outcomes were compared using parametric tests.

RESULTS

Thirty participants (20 chronic obstructive pulmonary disease and 10 asthma; 15 female; median age 57.5 years) completed baseline and endline assessments. Seventy percent completed at least 12/16 sessions. After eight weeks of training, the 6-Minute Walk Test had improved from 263.3 (standard deviation (SD) = 72.3) to 319.6 (SD = 84.7) metres (P < 0.001) with significant improvement in modified Medical Research Council (P = 0.022), London Chest Activity of Daily Living scale (P < 0.001) and dominant handgrip strength (P < 0.001) but no significant change in physical activity (P = 0.791).

CONCLUSIONS

The community-based PR led by peer volunteers and supported by professionals proved to be feasible in our low-resource setting and was associated with improved exercise tolerance and other outcomes.

REGISTRATION

The study was registered at the Clinical Trials Registry - India (CTRI/2020/09/027818).