The IMPROVE trial is underway

The UK’s first multi-site clinical trial examining the benefits of using lay health workers to improve healthcare delivery is underway.

The IMPROVE trial will test whether people with COPD who have done pulmonary rehabilitation and are trained in the role can help others to complete the treatment and receive the benefits. The trial is funded by the National Institute of Health and Care Research (NIHR), part of the NHS.

Pulmonary rehabilitation (PR as we call it) is an exercise-based treatment that can transform people’s lives. That is especially true for people with chronic obstructive lung disease (COPD) the second most common lung disease in the UK. COPD causes cough, breathlessness and fatigue and can impair severely the everyday lives of sufferers. As a GP I saw how much the lives of people with COPD were improved by PR. I also saw how enthusiastic those who completed the treatment were about it. The evidence behind PR is so good that the NHS says that everyone with symptoms from COPD should have PR. Sadly, most people with COPD that are referred to PR either don’t go at all or don’t complete it.

In my research on COPD, I worked with a group of people who had COPD and who understood the benefits of PR. We came up with the idea of training people who had completed PR to motivate and support others to take it up and stick with it. In many situations people who do this work are called lay health workers. Lay health workers (LHWs) are effective in improving health care delivery in a range of health issues, but they have not been used much in the NHS.

We carried out a successful feasibility study, also funded by NIHR. In the feasibility study we showed that COPD patients who completed PR could be recruited and trained as lay health workers, and could support COPD patients newly referred to PR. These lay health workers called themselves PR-buddies. It was clear that there was real potential for this intervention to make a difference to the quality of patients’ lives. At the end of the feasibility study more robust data were needed to justify rolling out this intervention in the NHS.

In collaboration with colleagues at Imperial College, King’s College London (KCL), the Norwegian University of Science and Technology, Queen Mary University of London, and the University of Leeds, we were awarded funding by NIHR to conduct a national clinical trial. The trial will test the effectiveness of using volunteer PR buddies to improve the take-up and completion of PR by people with COPD. It will also test if PR-buddies can be implemented in the NHS.

The IMPROVE trial has begun. The funding we have received will pay for a team of researchers based at both KCL and the University of Leeds. The researchers will support the setting up of the trial in 38 sites throughout England. The grant also includes funding of this website where we will keep you informed of the progress of the trial and our findings.


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