PhD Study : Optimising Pulmonary Rehabilitation for patients with Chronic Obstructiv Pulmonary Disease

Summary

Promoting exercise and physical activity, and decreasing inactivity has been recommended as a key component of care for people with respiratory disease. This is mostly achieved through pulmonary rehabilitation programmes (exercise, education and self-management) and there is evidence that these are effective for people with Chronic Obstructive Pulmopnary Disease (COPD) [Bolton et al 2013].

This PhD project will help to identify key approaches to optimise results from Pulmopmary Rehabilitation programmes for patients with COPD. Currently not all patients referred to pulmonary rehabilitation attend for assessment or enroll in the programme after assessment, and dropouts and non-adherence rates are high [Steiner et al 2016]. There is an urgent need to identify key ways to optimise participation in and outcomes from Pulmonary Rehabilitation.

Aim:

To identify reasons for poor uptake, retention, non-adherence and decline of Pulmonary Rehabilitation programmes in Northern Ireland and identify key strategies which could optimise results from Pulmonary Rehabilitation.

Objectives:

*To identify reasons for poor uptake, retention, non-adherence and decline of pulmonary rehabilitation

*To evaluate pulmonary rehabilitation services including the impact on important patient outcomes e.g. exercise capacity and quality of life

*To identify key realistic strategies to promote engagement and participation in evidenced based pulmonary rehabilitation.

Methods Study 1.  An in-depth analysis of existing Pulmonary Rehabilitation programmes in Northern Ireland will be conducted using a qualitative study (using Focus Group methodology). This will include providers of pulmonary rehabilitation, also those who attended but did not complete rehabilitation and where possible those who have been referred to programmes but who declined. Exploration will include accessibility, points of entry and the pathways through the pulmonary rehabilitation and follow on services. This will enable better understanding of the outcomes of pulmonary rehabilitation and it will identify areas of good practice as well as explore gaps and/or any areas for improvement or adaptation.

Analysis: thematic analysis.

Study 2. A cohort study to retrospectively evaluate patient engagement with pulmonary rehabilitation programmes, as well as patient outcomes. Patients with COPD (N=40) will be recruited from HSCTs in Northern Ireland that offer Pulmonary Rehabilitation. The investigation will include review of active referrals, uptake and patient through put. Outcome measures data (exercise capacity and quality of life) will be collected for patients before and after attending pulmonary rehabilitation. Analysis: descriptive and pre-post comparison.

Project output

This project will identify areas of strength and good practice that could be shared across sites delivering pulmonary rehabilitation, it will identify key strategies to optimise outcomes for patients with COPD. The PhD will provide an opportunity to work with a dynamic respiratory research team with strong links to clinical teams nationally and internationally.

How the proposals fit the Centre’s themes

Physical activity and exercise in COPD link to key research themes in CHaRT (1. intervention development and testing, and 2. physical activity). The project fits CHaRT aims by specifically exploring how we could ‘enable healthy living throughout the life span for people with long term conditions’ and informing how we could optimise pulmonary rehabilitation services to ‘support and empower patients to develop skills and strategies to manage their long term condition’.

This project will have high impact as it links to the delivery of standards of care for people with COPD from the Northern Ireland Service Framework for Respiratory health and well being (2018). Given the size of the population with COPD throughout the UK and Globally it has the potential to make significant impact given its broad reach across all settings in health care.

PhD project must be achievable

This project is achievable as the team have established links with clinical sites delivering pulmonary rehabilitation programmes and who have indicated that they are keen to support this research. The team have experience obtaining research governance and ethics approvals at the sites for previous clinical research in pulmonary rehabilitation. The population with COPD (1.2million in the UK) is available and the study sample sizes are feasible based on recent research in COPD and pulmonary rehabilitation by this team.

AccessNI clearance required

Please note, the successful candidate will be required to obtain AccessNI clearance prior to registration due to the nature of the project.

Essential criteria

Applicants should hold, or expect to obtain, a First or Upper Second Class Honours Degree in a subject relevant to the proposed area of study.

We may also consider applications from those who hold equivalent qualifications, for example, a Lower Second Class Honours Degree plus a Master’s Degree with Distinction.

In exceptional circumstances, the University may consider a portfolio of evidence from applicants who have appropriate professional experience which is equivalent to the learning outcomes of an Honours degree in lieu of academic qualifications.

• Experience using research methods or other approaches relevant to the subject domain
• Sound understanding of subject area as evidenced by a comprehensive research proposal
• A comprehensive and articulate personal statement
• Clearly defined research proposal detailing background, research questions, aims and methodology
• A demonstrable interest in the research area associated with the studentship

Desirable Criteria

If the University receives a large number of applicants for the project, the following desirable criteria may be applied to shortlist applicants for interview.

• First Class Honours (1st) Degree
• Masters at 65%
• Practice-based research experience and/or dissemination
• Sound understanding of subject area as evidenced by a comprehensive research proposal
• Relevant professional qualification and/or a Degree in a Health or Health related area

Funding and eligibility

The University offers the following levels of support:

Vice Chancellors Research Studentship (VCRS)

The following scholarship options are available to applicants worldwide:

• Full Award: (full-time tuition fees + £19,000 (tbc))
• Part Award: (full-time tuition fees + £9,500)
• Fees Only Award: (full-time tuition fees)

These scholarships will cover full-time PhD tuition fees for three years (subject to satisfactory academic performance) and will provide a £900 per annum research training support grant (RTSG) to help support the PhD researcher.

Applicants who already hold a doctoral degree or who have been registered on a programme of research leading to the award of a doctoral degree on a full-time basis for more than one year (or part-time equivalent) are NOT eligible to apply for an award.

Please note: you will automatically be entered into the competition for the Full Award, unless you state otherwise in your application.

Department for the Economy (DFE)

The scholarship will cover tuition fees at the Home rate and a maintenance allowance of £19,000 (tbc) per annum for three years (subject to satisfactory academic performance).

This scholarship also comes with £900 per annum for three years as a research training support grant (RTSG) allocation to help support the PhD researcher.

• Candidates with pre-settled or settled status under the EU Settlement Scheme, who also satisfy a three year residency requirement in the UK prior to the start of the course for which a Studentship is held MAY receive a Studentship covering fees and maintenance.
• Republic of Ireland (ROI) nationals who satisfy three years’ residency in the UK prior to the start of the course MAY receive a Studentship covering fees and maintenance (ROI nationals don’t need to have pre-settled or settled status under the EU Settlement Scheme to qualify).
• Other non-ROI EU applicants are ‘International’ are not eligible for this source of funding.
• Applicants who already hold a doctoral degree or who have been registered on a programme of research leading to the award of a doctoral degree on a full-time basis for more than one year (or part-time equivalent) are NOT eligible to apply for an award.

Due consideration should be given to financing your studies. Further information on cost of living