The development and evaluation of a self-managed digital PROSPER (Prevention of Shoulder Problems) exercise and education programme for patients undergoing breast cancer treatment: increasing reach and uptake through digital technology

Background Breast cancer is the most common form of cancer in women. Many women will experience shoulder and arm problems following treatment impacting on function and quality of life. The Prevention of Shoulder Problems (PROSPER) Trial was a multicentre NIHR funded randomised controlled trial that evaluated a physiotherapy led rehabilitation programme to prevent shoulder problems following breast cancer treatment in patients at risk of shoulder problems compared to usual care. The PROSPER programme substantially improved function and quality of life and reduced pain over 12 months and was cost-effective. After the trial, we undertook knowledge mobilisation activities by launching a free online course to train physiotherapists to deliver the PROSPER programme. Evaluation of the course showed that although it equipped learners to deliver the programme, few managed to implement it within the NHS. The main barriers were lack of funding or capacity to provide the programme. The online course was an open course so although it was for health professionals, many people who had undergone breast cancer treatment completed the course identifying a need for accessible trustworthy information and rehabilitation. Consultation with patient partners confirmed this. This work prompted us to develop this proposal. Development work questions How can we optimise the PROSPER programme for implementation via digital applications to increase the reach and uptake within the NHS?? Is digital PROSPER acceptable to patients and easy to use? Aims To develop a digital version of PROSPER for patients undergoing breast cancer treatment who are at risk of shoulder and arm problems. Objectives: To estimate the effectiveness of all types of digital rehabilitation interventions for breast cancer and review relevant clinical guidelines including prehabilitation. To co-design digital PROSPER (two versions, an app and a website) with a working group of patients, clinicians, digital experts and other stakeholders to maximise uptake within the NHS To establish usability and acceptability of digital PROSPER To finalise a funding application to evaluate the implementation and clinical and cost-effectiveness of digital PROSPER Development work plan Work package 1: Literature review We will undertake a mixed methods systematic literature review to estimate the effectiveness of all types of digital rehabilitation interventions following breast cancer treatment and identify intervention components associated with effective interventions. We will review the broader literature including clinical guidelines regarding prehabilitation. Work package 2: Design Undertake co-design with our working group including a needs analyses related to prehabilitation/rehabilitation to inform the design. Work package 3: Usability testing Undertake usability testing of the prototype versions of digital PROSPER with up to 20 patients to produce the near final products. Work package 4: Funding application Finalise a funding proposal to evaluate digital PROSPER. Timelines for delivery Months 1-6: systematic literature review, form working group Months 7-12: co-design of digital applications Months 13-18: usability testing Months 19-22: reporting, finalise funding application Anticipated Impact and Dissemination We will develop two versions of digital PROSPER for implementation and evaluation. We will prepare a funding application to carry out a high quality evaluation in the NHS evaluating clinical and cost-effectiveness.