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From Good Science to Good Practice: An Implementation Evaluation of a Home-based Exercise Intervention for COPD Patients

English title From Good Science to Good Practice: An Implementation Evaluation of a Home-based Exercise Intervention for COPD Patients
Applicant Frei Anja
Number 190329
Funding scheme Spark
Research institution Institut für Epidemiologie, Biostatistik und Prävention Universität Zürich
Institution of higher education University of Zurich - ZH
Main discipline Respiratory Diseases
Start/End 01.01.2020 - 31.03.2021
Approved amount 41'600.00
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All Disciplines (2)

Discipline
Respiratory Diseases
Methods of Epidemiology and Preventive Medicine

Keywords (8)

Chronic obstructive pulmonary disease (COPD); Home-based; Sustainability; Implementation; Exercise training intervention; Minimal equipment; Evaluation; Transfer to practice

Lay Summary (German)

Lead
Von der guten Wissenschaft zur guten Praxis: Eine Evaluation der Implementierung eines heimbasierten Trainingsprogramms bei Patienten mit COPD
Lay summary

Lead

Viele medizinische Interventionen, die unter den kontrollierten Bedingungen einer wissenschaftlichen Studie erfolgreich getestet wurden, finden nicht den Weg in die Praxis. Das Projekt zielt darauf ab, diesen Transfer für ein heimbasiertes Trainingsprogramm für COPD Patienten zu gewährleisten.

Inhalt und Ziele des Forschungsprojekts  

Obwohl Menschen, die an der Lungenkrankheit COPD leiden, besonders stark von körperlichem Training profitieren, trainieren nur wenige Betroffene regelmässig. Das HOMEX-Trainingsprogramm wurde spezifisch für diese Personen entwickelt und ist einfach zu Hause durchführbar. Im Rahmen von zwei randomisierten, kontrollierten Studien wird aktuell die Wirksamkeit des Programms geprüft. Ziel des Projekts ist es, basierend auf den Erfahrungen der Patienten, durchführenden Coaches sowie Gesundheitsdienstleistern die Implementierung von HOMEX zu untersuchen.

Die Resultate des Projekts sollen Einblicke in die Aspekte des Trainingsprogramms aus unterschiedlichen Perspektiven erlauben und Unterstützungsfaktoren sowie Hindernisse der Implementierung identifizieren. Basierend darauf werden die Elemente des Trainingsprogramms optimiert und für bestimmte COPD Patientengruppen, Anbieter aus dem Gesundheitswesen und Gesundheitssettings angepasst. Somit soll die langfristige Nachhaltigkeit und Nutzung des HOMEX-Trainingsprogramms sichergestellt werden.

Wissenschaftlicher und gesellschaftlicher Kontext des Forschungsprojekts

Das Projekt befasst sich mit der Evaluation der Implementierung eines heimbasierten Trainingsprogramms für COPD Patienten, die über die Prüfung der Wirksamkeit hinausgeht. Es soll sichergestellt werden, dass das Programm längerfristig in das Gesundheitswesen integriert werden kann und möglichst viele Betroffene dauerhaft davon profitieren können.


Direct link to Lay Summary Last update: 06.12.2019

Responsible applicant and co-applicants

Employees

Abstract

The most elegant, effective, and scientifically-supported medical treatments cannot relieve patient suffering if they are not used by patients. Often these treatments must be first introduced by a physician, sup-ported by other health professionals, and integrated into the patient’s daily life. For the best science to work, it must work in the real worlds of real physicians, health professionals, and patients, not only within the controlled conditions of a trial. The current proposal aims to make this connection from science to practice in the context of an intervention designed to reduce the burdensome, socially isolating symptoms of one of the most common chronic diseases in old age - worldwide and here in Switzerland.Chronic obstructive pulmonary disease (COPD) is a progressive, but manageable, lung disease charac-terized by breathlessness and frequent coughing. COPD will be the third leading cause of death worldwide in 2020. Although regular exercise training is effective for reducing COPD symptoms, relatively few people with COPD participate in training programs. Others do not successfully integrate the prescribed exercises into eve-ryday life after pulmonary rehabilitation. Rising to this challenge, our interdisciplinary team developed a training program specifically tailored to the German-speaking Swiss population of older COPD patients. This program is delivered at home, with the support of a coach facilitator. Two funded, currently running randomized controlled trials (RCTs) assess the “good science” component of this intervention. The current proposal facilitates the “good practice” component. Through an implementation evaluation of a currently-running RCT, we will assess acceptability, accessibility, dose, fidelity and compliance among original RCT participants, coach facilitators, and health care providers, with the goal to optimize the training program and systematically identify which the elements facilitate the introduction of the program to specific settings to ensure its long-term sustainability.Notable about our home-based intervention for COPD is our departure away from current trends to-ward increasing reliance on digital smart phone apps for health intervention delivery and monitoring. Our in-tervention was developed by a team including a visual artist, a physiotherapist, an exercise scientist, a behavior change expert, and epidemiologists. The principles of User Experience Design (UX) go hand in hand with the principles of Implementation Science (i.e., getting good science into practice) and are reflected in the training and materials of our intervention. Our materials are designed to have the fewest barriers to entry, the fewest possible distractions, and be pleasurable to use. Our analog, low-tech intervention features high-quality, pro-fessional, accessible illustrations printed on heavy cardstock. The intervention does not require a Wi-Fi signal or a fully-charged smart phone battery. With funding from SPARK, the proposed study seeks to determine how to best make the bridge be-tween our currently running RCTs of this intervention and providing useful, sustainable access to current and future COPD patients in German-speaking Switzerland.
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