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Personalised Exercise Rehabilitation FOR people with Multiple long-term conditions (PERFORM): findings from a process evaluation of a randomised feasibility study

Por: Brown · S. E. · Simpson · S. A. A. · Greaves · C. · Daw · P. · Dean · S. G. · Evans · R. A. · Withers · T. M. · Ahmed · Z. · Barber · S. · Barwell · G. · Doherty · P. J. · Gardiner · N. · Ibbotson · T. · Jani · B. · Jolly · K. · Mair · F. · Manifield · J. R. · McIntosh · E. · Miller · D. · O
Objective

The number of people living with multiple long-term conditions (MLTCs or ‘multimorbidity’) is growing. Evidence indicates that exercise-based rehabilitation can improve health-related quality of life and reduce hospital admissions for a number of single long-term conditions. However, it is increasingly recognised that such condition-focused rehabilitation programmes do not meet the needs of people living with MLTCs. The aims for this study were to (1) evaluate the acceptability and feasibility of the newly developed Personalised Exercise Rehabilitation FOR people with Multiple long-term conditions (PERFORM) intervention; (2) assess the feasibility of study methods to inform progression to a definitive randomised controlled trial (RCT) and (3) refine our intervention programme theory.

Design

Semi-structured qualitative interviews were conducted with patients receiving and healthcare practitioners delivering the PERFORM intervention, to seek their experiences of the intervention and taking part in the study. Interviews were analysed thematically, informed by Normalisation Process Theory and the programme theory.

Setting

Three UK sites (two acute hospital settings, one community-based healthcare setting).

Participants

18 of the 60 PERFORM participants and 6 healthcare professionals were interviewed.

Intervention

The intervention consisted of 8 weeks of supervised group-based exercise rehabilitation and structured self-care symptom-based support.

Results

All participants and staff interviewed found PERFORM useful for physical and mental well-being and noted positive impacts of participation, although some specific modifications to the intervention delivery and training and study methods were identified. Scheduling, staffing and space limitations were barriers that must be considered for future evaluation and implementation. Key intervention mechanisms identified were social support, patient education, building routines and habits, as well as support from healthcare professionals.

Conclusions

We found the PERFORM intervention to be acceptable and feasible, with the potential to improve the health and well-being of people with MLTCs. The findings of the process evaluation inform the future delivery of the PERFORM intervention and the design of our planned full RCT. A definitive trial is needed to assess the clinical and cost-effectiveness.

Trial registration number

ISRCTN68786622.

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