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The development of a community-based maintenance program for individuals with COPD is one of the innovative projects receiving funding through the Care to Know Centre’s first annual Applied Client-focused Team (ACT) research grants program.
This research team is led by Dr. Dina Brooks who is an Associate Professor at the University of Toronto and a Canada Research Chair in respiratory rehabilitation. One of the main focuses of Dr. Brooks’ research program is delivery models to enhance the continuity of care for patients with chronic illness and she has considerable experience in this area.
Recently Dr. Brooks shared a research update with us.
Q: Please tell us about your project.
A: We have developed a new model of care for people with COPD to help better maintain their quality of life and exercise capacity after completion of in-hospital respiratory rehabilitation.
A formal partnership was formed between West Park Healthcare Centre and the City of Toronto Parks, Forestry and Recreation Division in order to provide a seamless transition between the hospital and the community for individuals with COPD. Recent graduates from the respiratory rehabilitation program at West Park Healthcare Centre are invited to join a community-based exercise program, supervised by a fitness instructor, at a local community centre in Etobicoke.
Individuals who join the program exercise twice a week for one year and have the support of fitness staff who have been trained about their lung condition. Participants also have access to a hotline that they can call at any time to speak to a research coordinator from West Park if they are experiencing new symptoms or have any difficulties with their program.
Q: How can a community-based maintenance exercise program - as opposed to a hospital-based program - enhance client-centered care for individuals with COPD and their families?
A: One of the goals of the program is to provide a seamless transition between the hospital and the community for individuals with COPD who have completed rehabilitation, not for one to replace the other.
The community-based maintenance program allows people with COPD to take an active role in their health care by facilitating continued regular physical activity in a comfortable setting. In individuals with COPD, participation after pulmonary rehabilitation in regular physical activity such as walking has been associated with a slower decline in health-related quality of life and shortness of breath during activities of daily living, and a reduction in hospital admissions and mortality.
By participating in regular exercise at a public community centre, our clients are empowered to take charge of their health and fitness while socializing with other clients with and without a lung condition.
Q: What are some of the key barriers and facilitators to developing a community-based maintenance program of this nature?
A: The key barrier in the development phase was finding the right partners and the right centre to help implement the program from the community side. However, once the partnership was formed we were extremely fortunate to have such strong support from the staff at the Etobicoke Olympium Health Centre. In particular, the charge fitness instructor at this site is wonderful with our members and is a real asset to our team.
Q: So far, have you been surprised by any findings or unexpected insights from clients and families?
A: We expected clients to find value in the program but it is often surprising to hear just how much satisfaction and progress the participants have been reporting from the program. For example, one client complained of difficulty walking just a few metres upon starting the program, whereas now he is able to walk several laps on the track. This has meant a huge difference to this client in terms of his day-to-day functioning.
Q: How will the findings for your work impact the client and/or their families during and after the project?
A: We expect that the findings of this program will help to optimize the function and quality of life of individuals living with lung disease. If the program proves to be feasible and sustainable then similar programs can be implemented across the GTA and Canada for individuals with lung disease and other chronic conditions.
It is also our hope that our clients will continue to exercise and benefit from the community exercise program, long after the study is completed.
Q: How important is the ACT Research Grants program to ensure smaller, quality projects have a chance to get off the ground?
A: Funding smaller pilot projects is of utmost importance for developing new strategies to improve the delivery of community health care.
Small-scale preliminary studies are critical to check the feasibility and to improve the design of the research before larger studies are conducted.
Q: What would you say to larger funding bodies, government or industry to encourage them to support similar initiatives?
A: Given the increasing number of Canadians living and aging with chronic conditions, more funding is required to support clinical research aimed at developing strategies to promote disease self-management and community integration.
Increased funding for smaller scale pilot studies is necessary before large-scale quantitative research can be completed in an attempt to avoid both time and money being wasted on inadequately designed projects.
Q: What are your plans for the project after the funding period ends?
A: The partnership we have formed with the City of Toronto Community Recreation Centre will be permanent and sustainable. Individuals with COPD will continue to be referred to the community exercise program after the research project is completed, and we are committed to maintaining the link between healthcare professionals at West Park Healthcare Centre and local community centres.
The results of this pilot project will be used to: 1) inform a larger randomized controlled trial to definitely evaluate the effect of the supervised exercise program on maintenance of outcomes one-year following pulmonary rehabilitation; and 2) develop and disseminate a model for community-based exercise programs that can be adapted and implemented for patients with COPD across Canada.
Additional information about the ACT Research Grants Program is available at: http://www.caretoknow.org/actgrantsprogram.html.
Tell us about your experience with COPD and rehabilitation. We’re interested in your perspective.
