Pulmonary rehabilitation programmes that help people with chronic lung disease breathe more easily and stay active are almost non-existent in low- and middle-income countries, even though lung disease rates there are high due to tuberculosis, smoking, and pollution. This research group aims to change that by building an international collaborative network to co-develop effective, low-cost rehabilitation services in countries that currently lack them. The team at the University of Leicester has already led major clinical trials and national audits of pulmonary rehabilitation in the UK, including a database of over 7,000 patient cases. They have also developed alternative delivery models that do not require patients to travel to a clinic—an approach that matters greatly where transport and healthcare access are limited. If successful, the project could establish standardised, accessible rehabilitation programmes across partner countries, improving health, well-being, and economic productivity for people living with disabling lung conditions. It would also build local research capacity and create internationally benchmarked quality standards, helping to close the gap between what is known to work and what is actually available to patients worldwide.
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1) Our objective is to develop an international research collaborative to further develop PR in the field of global health, this will provide the practical and research environment required to foster high quality applied research for measurable health, societal and economic impact. Our proposal aligns with the UoL’s “Discovery-led and Discovery-enabled International strategy (2016-20)” which places emphasis on the development of long term international relationships with the aim of transforming people’s lives through the intellectual and practical impact of such relationships. The proposal will extend and enhance UoL’s existing partnerships (e.g. from EU H2020 FRESH AIR programme) and also establish new relationships in regions where rehabilitation provides a low cost solution to the increasing burden of chronic lung disease. The overarching objective of the proposal is to improve health, well-being and economic productivity for patients suffering with chronic, disabling lung diseases in LMICs through the co-establishment of effective and accessible PR programmes in partner countries, providing an equitable collaborative environment to collaborate to develop multidisciplinary research capacity. The clinical and health economic benefits of exercise based rehabilitation in chronic lung disease have been unequivocally established in the developed world, both in published clinical trials and in large scale audit series of real-life clinical practice (1). However, clinical PR services are not available in most LMICs despite the high prevalence of chronic lung diseases due to lung infection (e.g. TB), tobacco consumption and indoor and outdoor pollution. 2) The Centre for Exercise and Rehabilitation Science, part of the NIHR Leicester BRC is a world leading academic centre in cardiopulmonary rehabilitation science and clinical practice with expertise in development and evaluation of interventions, collaborative research with international partners and strong links to national and international quality setting/benchmarking • The centre has a track record of delivering high impact clinical trials of exercise based interventions in chronic lung disease embedded in real-life clinical practice. Furthermore the team at CERS have led the development of alternative modes of delivering rehabilitation that can be time and location independent which is of great important in LMIC settings (2,3). • We are experienced in providing support and mentorship in PR research and policy to collaborating academics and institutions in partner LMICs. Members of CERS have been influential in the development of national and international rehabilitation guidelines and health policy in the UK and internationally (4,5,6,7). The applicants have been closely involved in the development of the ATS/ERS PR policy document (SS) (8) which sets out the steps required to enhance referral and uptake of PR internationally. • The applicants have been at the heart of the quality agenda in pulmonary rehabilitation service development in the UK through the establishment of quality standards for PR (SS, MS), the delivery of national scale auditing of PR services and outcomes against these standards as part of the National Clinical Audit for COPD (MS clinical lead) and the implementation of a QI and accreditation strategy for PR through the British Thoracic Society (SS clinical lead). The national PR audit with over 7,000 individual cases, the largest single database held in the world. This resource has already resulted in a small number of high impact publications (9,10). • The applicants have developed core datasets/quality indicators for PR and piloted site assessment visits for PR accreditation incorporating metrics relating to staff skill mix, service leadership and patient involvement. The centre is therefore well placed to develop the necessary datasets and systems for internationally standardised benchmarking of rehabilitation se
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