{
  "abstract": "Introduction The benefits of pulmonary rehabilitation (PR) decline after 6–12 months. Previous studies of maintenance in the literature have been labour-intensive and concentrated on secondary care healthcare utilisation only. We aimed to investigate whether Self-management Programme of Activity, Coping and Education (SPACE) for chronic obstructive pulmonary disease (COPD), a light-touch self-management programme, was clinically and cost-effective following PR.Methods We conducted a prospective, multicentre, assessor-blind randomised controlled trial. Patients with COPD were randomised 1:1 to usual care (control) or SPACE. The intervention included a home-based manual and four facilitated group sessions, delivered over 12 months. Primary outcome: Endurance Shuttle Walking Test at 12 months. Secondary outcomes: maximal exercise capacity, mood, patient activation, physical activity, healthcare costs and health-related quality-of-life (HRQoL).Results 116 participants were recruited (October 2019–June 2022). Baseline characteristics: SPACE (65% male, aged 71.8 years, median Medical Research Council (MRC) 3, mean pack years 41.1, mean body mass index (BMI) 29.1), control (51% male, aged 71.8 years, median MRC 3, mean pack years 44.5, mean BMI 28.3). SPACE completion rate=83% and intervention fidelity (assessed via checklist) was excellent. No statistically significant differences at 12 months for primary and secondary outcomes. Economic analysis at 12 months shows a positive HRQoL difference between groups of 0.0871 quality adjusted life years (QALY) and reduced National Health Service (NHS) costs of £139 per participant, driven primarily by a reduction in general practitioner visits in favour of SPACE.Conclusions Endurance exercise tolerance was maintained in both groups. The programme improved HRQoL at 12 months in the intervention group (above control) and was cost-effective, driven by reduced primary care costs.",
  "authors": [
    {
      "affiliations": [
        "Centre for Exercise and Rehabilitation Science, NIHR Leicester Biomedical Research Centre, Leicester, UK",
        "Respiratory Sciences, University of Leicester, Leicester, UK"
      ],
      "name": "Linzy Houchen-Wolloff"
    },
    {
      "affiliations": [
        "Cardiovascular Sciences, University of Leicester, Leicester, UK"
      ],
      "name": "Annabel Hong"
    },
    {
      "affiliations": [
        "Respiratory Sciences, University of Leicester, Leicester, UK",
        "Respiratory Therapy, Jazan University, Jazan, Saudi Arabia"
      ],
      "name": "Khaled Alqahtani"
    },
    {
      "affiliations": [
        "University of the West of England, Bristol, UK"
      ],
      "name": "Charlotte Gerlis"
    },
    {
      "affiliations": [
        "Cardiac & Pulmonary Rehabilitation, University Hospitals of Leicester NHS Trust, Leicester, UK"
      ],
      "name": "Nikki Gardiner"
    },
    {
      "affiliations": [
        "School of Psychology and Vision Sciences, University of Leicester, Leicester, UK"
      ],
      "name": "Amy Barradell"
    },
    {
      "affiliations": [
        "College of Health Medicine and Life Sciences, Brunel University London, Uxbridge, UK",
        "Harefield Respiratory Research Group, Royal Brompton & Harefield NHS Foundation Trust, London, UK"
      ],
      "name": "Claire Marie Nolan"
    },
    {
      "affiliations": [
        "Respiratory Medicine, Royal Brompton and Harefield NHS Foundation Trust, Harefield, UK"
      ],
      "name": "William Man"
    },
    {
      "affiliations": [
        "Centre for Exercise and Rehabilitation Science, NIHR Leicester Biomedical Research Centre, Leicester, UK",
        "Respiratory Sciences, University of Leicester, Leicester, UK"
      ],
      "name": "Mathew Richardson"
    },
    {
      "affiliations": [
        "Research Centre for Healthcare and Communities, Coventry University, Coventry, UK",
        "Department of Economics, Institute of Business Administration, Karachi, Pakistan"
      ],
      "name": "Amir Khan"
    },
    {
      "affiliations": [
        "Research Centre for Healthcare and Communities, Coventry University, Coventry, UK",
        "Faculty of Health and Wellbeing, Sheffield Hallam University, Sheffield, UK"
      ],
      "name": "Anil Gumber"
    },
    {
      "affiliations": [
        "Research Centre for Healthcare and Communities, Coventry University, Coventry, UK"
      ],
      "name": "Ala Szczepura"
    },
    {
      "affiliations": [
        "Centre for Exercise and Rehabilitation Science, NIHR Leicester Biomedical Research Centre, Leicester, UK",
        "Respiratory Sciences, University of Leicester, Leicester, UK"
      ],
      "name": "Sally J Singh"
    }
  ],
  "title": "Clinical and cost-effectiveness of SPACE for COPD delivered as a pulmonary rehabilitation maintenance programme: a randomised controlled trial",
  "uid": "4450317b-7e68-5dbd-9953-dbf020769f82"
}