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Is inspiratory muscle training (IMT) an acceptable treatment option for people with chronic obstructive pulmonary disease (COPD) who have declined pulmonary rehabilitation (PR) and can IMT enhance PR uptake? A single-group prepost feasibility study in a home-based setting
  1. Cath O’Connor1,
  2. Rod Lawson2,
  3. Judith Waterhouse3,
  4. Gary H Mills4,5
  1. 1 Integrated Care Team-Therapy, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, UK
  2. 2 Respiratory Medicine, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, UK
  3. 3 Respiratory Function Unit, University of Sheffield, Sheffield, UK
  4. 4 Anaesthesia and Critical Care Medicine, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, UK
  5. 5 Department of Anaesthesia, University of Sheffield, Sheffield, UK
  1. Correspondence to Cath O’Connor; cath.o%E2%80%99connor{at}nhs.net

Abstract

Objectives This feasibility study aimed to assess the acceptability of inspiratory muscle training (IMT) in people with chronic obstructive pulmonary disease (COPD) who declined pulmonary rehabilitation (PR) as a potential treatment option or precursor to PR. Objectives were to assess attitudes to IMT, PR and alternatives to PR; factors influencing adherence with IMT and acceptability of outcome measures, research tools and study protocol.

Design A pragmatic, mixed methods, prepost feasibility study was conducted. Recruitment took place over a 4-month period. Participants were followed up for a period of 6 months.

Settings IMT sessions and assessments were conducted in the domiciliary setting.

Participants Inclusion criteria: people over the age of 35, stable COPD, Medical Research Council Dyspnoea scale of 3 or above, declined PR. Exclusion criteria: history of spontaneous pneumothorax, incomplete recovery from a traumatic pneumothorax, asthma, known recently perforated eardrum, unstable angina, ventricular dysrhythmias, cerebrovascular event or myocardial infarction within the last 2 months. Participants were selected from a purposive sample. Of the 22 potential participants screened, 11 were recruited and interviewed. Ten participants commenced IMT. Seven participants completed the follow-up assessment.

Intervention Eight weeks of IMT twice a day, 5 days a week with visits once weekly by a physiotherapist. Unsupervised IMT twice a day three times a week until follow-up at 6 months.

Outcomes Acceptability of IMT and the study process was explored via semi-structured interviews. Adherence with IMT was assessed by the Powerbreathe K3 device and participant diaries. Uptake of PR was identified.

Results IMT was found to be acceptable. Adherence was explored. Four people went on to participate in PR.

Conclusions Feasibility was established. A randomised controlled trial is warranted to establish efficacy and cost-effectiveness of IMT in those who decline PR and IMT as an intervention to promote uptake of PR.

Trial registration number NCT01956565; Post-results.

  • chronic airways disease
  • pulmonary rehabilitation
  • inspiratory muscle training
  • adherence
  • rehabilitation medicine
  • uptake

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Footnotes

  • Contributors CO’C: substantial contributions to the conception and design of the work; the acquisition, analysis, the interpretation of data for the work. Drafting the work and revising it critically for important intellectual content. Final approval of the version to be published. Agreement to be accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved. RL andJW: substantial contributions to the design of the work and the interpretation of data for the work. Revising the work critically for important intellectual content. Final approval of the version to be published. Agreement to be accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved. GHM: substantial contributions to the design of the work and revising it critically for important intellectual content. Final approval of the version to be published. Agreement to be accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved.

  • Funding Funding was secured from a Sheffield Teaching Hospitals Medicine Directorate Charitable Fund.

  • Competing interests None declared.

  • Ethics approval The feasibility study was approved by Sheffield NHS Research Ethics Committee.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Data sharing statement Data are available upon reasonable request.

  • Patient consent for publication Not required.

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