Personalised Exercise-Rehabilitation FOR people with Multiple long-term conditions (multimorbidity)-The PERFORM trial

Research question Is a personalised exercise rehabilitation for people with multiple long-term conditions (PERFORM) more clinically effective and cost-effective than usual care? Background Rehabilitation, the action of restoring someone to health or normal life illness remains a core component of health service provision. A substantive body of evidence has demonstrated improvements in functional capacity and health-related quality of life and reduction in hospital admissions following exercise-based rehabilitation for single index diseases, notably, chronic obstructive pulmonary disease, post-myocardial infarction/ revascularisation, heart failure (i.e. pulmonary and cardiac rehabilitation (CR/PR). However, it is increasingly recognised that such rehabilitation programmes do not meet the needs the increasing number of people presenting with long-term conditions or NHS where they are managed. Continuing to develop single indication rehabilitation programmes despite accumulating evidence for diverse disease groups is unlikely to be attractive or efficient for health services or for patients. The recent NHS Long Term Plan highlighted the urgent need for innovative approaches to address the needs of people with multimorbidity. Aims and objectives To co-develop (with patients, caregivers, clinicians, and service commissioners) a bespoke programme of personalised exercise-based rehabilitation for people with multimorbidity and to evaluate its acceptability, clinical effectiveness, and cost-effectiveness of its implementation into the NHS. Methods The project will comprise 5 work packages (WPs). WP1 (identification of outcome clusters): seeks to identify clusters of LTCs with greatest need with clear evidence of effectiveness in at least one of the candidate diseases and highest healthcare costs applying data science approaches to routine data (WP1a); systematic review (WP1b); and health economic approaches (WP1c); WP2 (Intervention development): work with stakeholders to integrate, adapt and transform existing CR and PR programmes into a novel integrated rehabilitation programme (PERFORM) to treat a wide range of people with multiple LTC and develop a training package to support workforce development and training to deliver the PERFORM intervention. WP 3 Feasibility trial to inform the planning of a full-scale trial evaluating PERFORM and further develop the intervention and programme theory. WP4 Full randomised controlled trial LTCs to assess the clinical and cost-effectiveness of PERFORM compared to routine care and traditional cardiac and pulmonary rehabilitation programmes . WP5 (study within a trial) will evaluate the use of social media to support trial processes. Timelines for delivery The project will be conducted over 63 months. WP1 and 2 will be conducted in parallel. WP3 will recruit over an 8-month period. WP4 is the main trial and will work with 12 sites across the UK with a 12 month follow up period. WP5 is a study within a trial embedded in WP4. Anticipated impact and dissemination We anticipate the PERFORM intervention will provide step change in the delivery of rehabilitation for individuals with multiple LTCs. This novel intervention will be supported by a work force training package to support service transformation. Dissemination and will be supported by our stakeholder group and patient advisory group. We will seek to identify barriers and facilitators to future wide scale implementation and develop an implementation toolkit.