PURE PRIME: Implementing PUlmonary REhabilitation in PRIMary care - A randomised-controlled feasibility trial

Abstract Rationale Pulmonary rehabilitation (PR) is one of the most effective interventions for chronic respiratory disease, however access remains limited. Private physiotherapy and exercise physiology practices may be settings in which PR can be conducted to increase access and overcome some of the known barriers to PR uptake and completion. Objective This study to investigate whether it is feasible to conduct PR in primary care, specifically in private practices. Secondary objectives were to assess whether PR conducted in primary care achieved the known clinical benefits of PR, compared to usual care. Methods A randomised controlled feasibility trial was conducted. Participants with chronic respiratory disease were randomised to either a twice weekly, 8-week PR program conducted in private physiotherapy or exercise physiology practices, or usual care. The primary outcome was proportion of randomised participants who completed the intervention. Clinical outcomes of exercise capacity, health status and health-related quality of life (HRQoL) were collected at baseline and after eight-weeks. Safety data were collected. Results 55 participants entered the study, with 52 (95%) randomised. 72% of participants who were randomised to the intervention group completed the intervention. Due to trial logistics, some participants who were allocated to the control group completed the intervention. In those who undertook the intervention, there were significant within-group changes (mean difference (95% CI)) in the incremental shuttle walk test (53.7 (37.8 to 69.6) metres), 1-minute sit-to-stand test (4.7 (3.3 to 6.0) repetitions), St George’s Respiratory Questionnaire (-7.38 (-12.23 to -2.54)) and COPD Assessment Test (-3.1 (-5.5 to -0.8)). Only one minor study-related adverse event occurred. Conclusion An 8-week PR program is feasible and safe to conduct in private practices. Completion rates were high and changes in exercise capacity, health status and HRQoL exceeded known minimum important differences.