{
  "abstract": "Objective Existing exercise-based rehabilitation services, such as cardiac and pulmonary rehabilitation, are traditionally commissioned around single long-term conditions (LTCs) and therefore may not meet the complex needs of adults with multiple long-term conditions (MLTCs) or multimorbidity. The aim of this study was to assess the feasibility and acceptability of the newly developed personalised exercise-rehabilitation programme for people with multiple long-term conditions (PERFORM) and the trial methods.Design A parallel two-group mixed-methods feasibility randomised controlled trial (RCT) with embedded process and economic evaluation.Setting Three UK sites (two acute hospital settings, one community-based healthcare setting).Participants 60 adults with MLTCs (defined as the presence of ≥2 LTCs) with at least one known to benefit from exercise therapy were randomised 2:1 to PERFORM intervention plus usual care (PERFORM group) or usual care alone (control group).Intervention The intervention consisted of 8 weeks of supervised group-based exercise rehabilitation and structured self-care symptom-based support.Primary and secondary outcome measures Primary feasibility outcomes included: trial recruitment (percentage of a target of 60 participants recruited within 4.5 months), retention (percentage of participants with complete EuroQol data at 3 months) and intervention adherence (percentage of intervention group attending ≥60% sessions). Other feasibility measures included completion of outcome measures at baseline (pre-randomisation), 3 months post-randomisation (including patient-reported outcomes, exercise capacity and collection of health and social care resource use) and intervention fidelity.Results Target recruitment (40 PERFORM group, 20 control group) was met within the timeframe. Participants were 57% women with a mean (SD) age of 62 (13) years, body mass index of 30.8 (8.0) kg/m 2 and a median of 4 LTCs (most common: diabetes (41.7%), hypertension (38.3%), asthma (36.7%) and a painful condition (35.0%)). We achieved EuroQol outcome retention of 76.7% (95% CI: 65.9% to 87.1%; 46/60 participants) and intervention adherence of 72.5% (95% CI: 56.3% to 84.4%; 29/40 participants). Data completion for attendees was over 90% for 11/18 outcome measures.Conclusions Our findings support the feasibility and rationale for delivering the PERFORM comprehensive self-management and exercise-based rehabilitation intervention for people living with MLTCs and progression to a full multicentre RCT to formally assess clinical effectiveness and cost-effectiveness.Trial registration number ISRCTN68786622.",
  "authors": [
    {
      "affiliations": [
        "Respiratory Sciences, University of Leicester, Leicester, UK",
        "Centre for Exercise and Rehabilitation Science, NIHR Leicester Biomedical Research Centre Respiratory Diseases, Leicester, UK"
      ],
      "name": "Rachael A Evans"
    },
    {
      "affiliations": [
        "MRC/CSO Social and Public Health Sciences Unit, University of Glasgow, Glasgow, UK"
      ],
      "name": "Sharon A Simpson"
    },
    {
      "affiliations": [
        "Respiratory Sciences, University of Leicester, Leicester, UK",
        "Centre for Exercise and Rehabilitation Science, NIHR Leicester Biomedical Research Centre Respiratory Diseases, Leicester, UK"
      ],
      "name": "James R Manifield"
    },
    {
      "affiliations": [
        "Respiratory Sciences, University of Leicester, Leicester, UK",
        "Centre for Exercise and Rehabilitation Science, NIHR Leicester Biomedical Research Centre Respiratory Diseases, Leicester, UK"
      ],
      "name": "Zahira Ahmed"
    },
    {
      "affiliations": [
        "Leicester Clinical Trials Unit, University of Leicester, Leicester, UK"
      ],
      "name": "Shaun Barber"
    },
    {
      "affiliations": [
        "Leicester Clinical Trials Unit, University of Leicester, Leicester, UK"
      ],
      "name": "Gwen Barwell"
    },
    {
      "affiliations": [
        "MRC/CSO Social and Public Health Sciences Unit, University of Glasgow, Glasgow, UK"
      ],
      "name": "Sophie Eleanor Brown"
    },
    {
      "affiliations": [
        "School of Sport, Exercise and Rehabilitation Sciences, University of Birmingham, Birmingham, UK"
      ],
      "name": "Paulina Daw"
    },
    {
      "affiliations": [
        "Medical School, University of Exeter, Exeter, UK"
      ],
      "name": "Sarah G Dean"
    },
    {
      "affiliations": [
        "Health Sciences, University of York, York, UK"
      ],
      "name": "Patrick J Doherty"
    },
    {
      "affiliations": [
        "Health Economics and Health Technology Assessment (HEHTA), University of Glasgow, Glasgow, UK"
      ],
      "name": "Heather Fraser"
    },
    {
      "affiliations": [
        "University Hospitals of Leicester NHS Trust, Leicester, UK"
      ],
      "name": "Nikki Gardiner"
    },
    {
      "affiliations": [
        "School of Sport, Exercise and Rehabilitation Sciences, University of Birmingham, Birmingham, UK"
      ],
      "name": "Colin Greaves"
    },
    {
      "affiliations": [
        "School of Health and Wellbeing, University of Glasgow, Glasgow, UK"
      ],
      "name": "Tracy Ibbotson"
    },
    {
      "affiliations": [
        "General Practice and Primary Care, School of Health and Wellbeing, University of Glasgow, Glasgow, UK"
      ],
      "name": "Bhautesh Jani"
    },
    {
      "affiliations": [
        "Department of Applied Health Research, University of Birmingham, Birmingham, UK"
      ],
      "name": "Kate Jolly"
    },
    {
      "affiliations": [
        "General Practice and Primary Care, School of Health and Wellbeing, University of Glasgow, Glasgow, UK"
      ],
      "name": "Frances Mair"
    },
    {
      "affiliations": [
        "Health Economics and Health Technology Assessment (HEHTA), University of Glasgow, Glasgow, UK"
      ],
      "name": "Emma McIntosh"
    },
    {
      "affiliations": [
        "Department of Sport, Exercise and Rehabilitation, Northumbria University, Newcastle upon Tyne, UK"
      ],
      "name": "Dimitrios Megaritis"
    },
    {
      "affiliations": [
        "University of Leicester, Leicester, UK"
      ],
      "name": "Daniel Miller"
    },
    {
      "affiliations": [
        "School of Health and Society, University of Salford, Salford, UK"
      ],
      "name": "Paula Ormandy"
    },
    {
      "affiliations": [
        "School of Medicine, Trinity College Dublin, Dublin, Ireland"
      ],
      "name": "Susan Smith"
    },
    {
      "affiliations": [
        "Department of Sport, Exercise and Rehabilitation, Northumbria University, Newcastle upon Tyne, UK"
      ],
      "name": "Ioannis Vogiatzis"
    },
    {
      "affiliations": [
        "Leicester Clinical Trials Unit, University of Leicester, Leicester, UK"
      ],
      "name": "Ghazala Waheed"
    },
    {
      "affiliations": [
        "School of Sport, Exercise and Rehabilitation Sciences, University of Birmingham, Birmingham, UK"
      ],
      "name": "Tom M Withers"
    },
    {
      "affiliations": [
        "MRC/CSO Social and Public Health Sciences Unit, University of Glasgow, Glasgow, UK",
        "Robertson Centre for Biostatistics, University of Glasgow, Glasgow, UK"
      ],
      "name": "Rod S Taylor"
    },
    {
      "affiliations": [
        "Respiratory Sciences, University of Leicester, Leicester, UK",
        "Centre for Exercise and Rehabilitation Science, NIHR Leicester Biomedical Research Centre Respiratory Diseases, Leicester, UK",
        "University Hospitals of Leicester NHS Trust, Leicester, UK"
      ],
      "name": "Sally J Singh"
    },
    {
      "affiliations": [],
      "name": "on behalf of PERFORM Research Team"
    }
  ],
  "title": "Personalised exercise-rehabilitation for people with multiple long-term conditions (PERFORM): a randomised feasibility study",
  "uid": "bf832bc5-ad23-572e-bfa2-afe6d9b8131b"
}