The REACH Trial - Can REhabilitation delivered immediately on hospitalisation for an Acute exacerbation of Chronic respiratory disease improve long term Health outcomes?

Principal Investigator: Dr Neil Greening

Other key staff: Dr Mick Steiner, Professor Sally Singh, Professor Mike Morgan, Dr S Fayyaz Hussain,  Dr John Bankart, Theresa Harvey-Dunstan, Rudo Chimera, Johanna Williams

Partners involved: University Hospitals of Leicester NHS Trust and Kettering General Hospital NHS Foundation Trust

Summary:
One of the main features of moderate to severe chronic respiratory disease (CRD) is shortness of breath which gradually leads to a long-term decline in physical activity, muscle weakness and the ability to walk (often termed de-conditioning). Many people with CRD also have problems with anxiety and depression and often can be socially isolated. Pulmonary rehabilitation for patients with stable CRD has been proven to help people make significant improvements in physical activity, quality of life and the ability to walk.

Chronic respiratory disease is also associated with acute flare-ups (exacerbations) of symptoms. Many patients are admitted to hospital with an exacerbation and although immediate treatment may only require 24 hours of medical care,  the recovery process may be prolonged. The hospital admission (and often the recovery period at  home)  is often characterised by the inactivity of bed rest and is linked with loss of muscle strength, particulary of the legs, and the reduced ability to walk. This loss of muscle strength and deconditioning may mean that patients leave hospital less able to withstand further exacerbations and with an increased likelihood of readmission. Patients also report that being admitted with an acute exacerbation is one of the most detrimental features to their quality of life.

Rehabilitation that aims to prevent the decline in function associated with hospitalisation may be an effective way to address the negative effects of the admission and reduce the risk of patients being readmitted to hospital. This study proposes to compare the effectiveness of rehabilitation delivered during an acute exacerbation of CRD to usual standard care.

The study aims to recruit 419 patients from the two hospitals involved. The rehabilitation intervention is designed to be a comprehensive package of care consisting of exercise training and self–management education. Rehabilitation will be delivered as early as possible, commencing within 48 hours of admission. Patients allocated to the intervention group will receive daily rehabilitation comprising of an individually prescribed, graduated exercise programme and self management education advice.

Aims:

• To reduce the burden of unplanned admissions by investigating a novel rehabilitation approach, delivered as soon as possible for patients admitted with an exacerbation of their chronic respiratory disease

Further information:
The pulmonary rehabilitation department has strong links with the local patient support group ‘Breathe Easy Glenfield’.  This study has been discussed with a group of respiratory disease patients and carers at an open meeting of the Breathe Easy group. The study has also been discussed with a group of pulmonary rehabilitation programme volunteers, all of which have had direct experience of being an in-patient with an acute exacerbation. All of the comments made at these discussions were taken on board when designing the study. If you would like to be involved in this study, or for more information, please contact This e-mail address is being protected from spambots. You need JavaScript enabled to view it , Principal Investigator.

Start date: 01/2010                                                                                                                    Expected end date: 03/2013

Study outcomes:

• Primary outcome are all-cause unplanned admission rate at the end of the 12 month follow up period
• Secondary outcomes will cover a wide range of measures including assessment of muscle strength, exercise performance, physical activity, markers of systemic and muscle inflammation, health status, anxiety and depression and health care utilisation

The purpose of this study is to answer the question – ‘Can early and proactive rehabilitation which is delivered immediately on hospitalisation for an acute exacerbation, prevent the decline in physical function associated with the exacerbation, improve clinical outcomes and reduce the risk of subsequent hospitalisation?’