Developing equitable, personalised community rehabilitation interventions for people with peripheral artery disease.

Provision of community rehabilitation is inequitable. Many interventions are not evidence-based or acceptable to patients or providers. Rehabilitation of some high burden conditions, such as peripheral artery disease (PAD), receive relatively little national support, prioritisation or research funding, fuelling health inequalities. PAD affects over 237 million adults globally. One common PAD symptom is intermittent claudication (IC) although in its most severe manifestation, it leads to chronic limb threatening ischaemia (CLTI). Over half of those with symptomatic PAD will die, have an amputation or cardiovascular event within five years of diagnosis. CTLI prognosis is extremely poor; commensurate with terminal cancer. The economic burden of PAD is substantial and rising. PAD patients report dissatisfaction with care and improving outcomes across the PAD symptom range is the highest ranking James Lind Alliance research priority among all vascular conditions. Providing PAD rehabilitation and supporting self-management will save money. Yet, equitable access to community rehabilitation is compromised by lack of acceptable, feasible interventions that were co-designed with patients and providers, restricted resources and a high and increasing demand from a diverse patient group with complex needs. Many people with PAD are also excluded from research and unable to access or use new treatments e.g., digital interventions. New scalable, co-designed, inclusive PAD interventions such as provider supported community rehabilitation, self-management programmes and 'next-generation' mobile?based health technologies (mhealth) are promising. Yet, evidence is mixed, none have been designed with PAD patients and providers, or commissioned in the NHS. The aim of this professorship is to transform the care for people with peripheral artery disease through community rehabilitation interventions. Over five work packages, I will lead research that will: 1. Maximise diverse and inclusive involvement, participation and engagement of PAD underserved groups. 2a. Through systematic review, qualitative and participatory approaches, codesign an inclusive supported self-management intervention to improve quality of life in CLTI patients. 2b. Develop trial protocol, funding application, set-up/commence a trial. 3a. Through secondary analysis of existing quantitative and qualitative data, participatory approaches, co-refine and feasibility test an inclusive home-based walking exercise behaviour-change programme for people with IC in primary and community services. 3b. Develop trial protocol, funding application, set-up/commence a trial. 4a. Through qualitative approaches, co-design, adaptation and user testing, develop an inclusive mhealth intervention for PAD patients to increase physical activity. 4b. Develop trial protocol and submit funding application. 5. Drawing on data from workstreams 2-4, specify the implementation context, outcomes and mechanisms and co-design a programme theory, preliminary implementation and evaluation strategies for inclusive PAD community rehabilitation services. This ambitious programme of work balances building on my existing work with guaranteed high impact outputs, and projects which promise a rapid upward trajectory within five years. It will spearhead the shift of PAD care into the community and develop research capacity in under represented disciplines. Mitigating research and digital exclusion and involving patients and the public are central to this research. Patients identified the research questions, helped plan this research and will help deliver and mobilise research progress and findings using co-designed, creative approaches.