The PRACTICE (Pulmonary Rehabilitation and ACTivity In COPD Exacerbations) Trial

Elderly ExercisingDTS staff Stephen Walters and Daniel Hind, along with Allan Wailoo from HEDS, Respiratory Physicians and Physiotherapists from Sheffield Teaching Hospitals and Aintree University Hospitals have been awarded over £300,000 from the National Institute for Health Research (NIHR) Health Technology Assessment (HTA) Programme (http://www.nets.nihr.ac.uk/projects/hta/132403).

The PRACTICE (Pulmonary Rehabilitation and ACTivity In COPD Exacerbations) Trial is a pilot and feasibility randomised controlled trial (RCT) in pulmonary rehabilitation for patients admitted to hospital with Chronic Obstructive Pulmonary Disease (COPD).  It is sponsored by Sheffield Teaching Hospitals and the Chief Investigator is Dr Rodney Hughes.

The purpose of this project is to assess whether it is possible to undertake a large scale RCT of exercise training in patients who have been admitted to hospital with a COPD exacerbation.

The study will look at two different sorts of exercise: 1) a bedside bicycle based activity that can be undertaken whilst the patient is sitting at the edge of their bed in hospital, and 2) a supervised exercise program to be undertaken during the first two weeks after they have been discharged.   Both forms of exercise will be supervised by a Physiotherapist.

Participants will be randomly assigned to one of four groups:

  1. Patient will receive 1) hospital physiotherapy and 2) home physiotherapy
  2. Patient will receive 1) hospital physiotherapy but not 2) home physiotherapy
  3. Patient will not receive 1) hospital physiotherapy but will receive 2) home physiotherapy
  4. Patient does not receive either treatment

We aim to find out whether patients will be willing to be randomised to these groups and if they are willing to participate and undertake the exercises.  We will see if this will allow patients to recover more quickly, and get back to their previous level of activity without needing to stay in-hospital for a prolonged period.  We will also see if participants are willing to complete the outcome measures, which includes completing questionnaires, an ultrasound of the leg, a walking test and wearing a movement watch at home. Measures will be collected from the participants at baseline, at 5 days post-randomisation (in hospital), at discharge + 7 days (at home), and at 30 days and 90 days (in hospital).

There has been considerable input to this study by patients who have experience of such flare ups of their COPD.  It is hoped that utilising their expertise and the results of this feasibility study, we can establish whether a larger, more conclusive trial will be possible.

Other DTS staff involved in running this project are Katie Biggs, the Trial Manager, Oscar Bortolami, the Medical Statistician, and Richard McGregor Edwards, the Trial Support Officer.