None listed
Conditions
Brief summary
Chronic obstructive pulmonary disease (COPD) affects approximately 20% of Indigenous Australian adults and an even greater proportion in remote regions. The prevalence of COPD is 2.5 times higher, death rate from COPD is three times higher and hospitalisation rates are five times higher in Aboriginal and Torres Strait Islander peoples than in non-Indigenous Australians. Best-practice care of COPD includes accurate diagnosis, smoking cessation, optimising medication and pulmonary rehabilitation to improve symptoms, activity levels and well-being. There is Level 1 evidence that pulmonary rehabilitation for people with COPD improves quality of life and reduces disability, reduces hospital admissions and length of stay, and is cost-effective. However, the implementation of this effective intervention into clinical practice in Indigenous communities is virtually non-existent, furthering the inequity of access to best-practice management of chronic lung disease. The research project will evaluate the implementation of an innovative program, the Breathe Easy Walk Easy Lungs for Life (BE WELL) program, in four distinct Aboriginal communities - metropolitan, regional, rural, remote- using the Knowledge to Action Framework. The BE WELL program aims to build the capacity of Aboriginal and Torres Strait Islander health workers to deliver best-practice management of COPD, Specifically, the project will evaluate the ability of the program to increase Aboriginal health workers’ knowledge and skills in managing COPD; improve exercise capacity and health-related quality of life of Indigenous people with COPD; and reduce hospital admissions and length of hospital stay for exacerbations of COPD. The resources for this program have been developed but the BE WELL program has not been implemented in Indigenous communities. We hypothesise that the BE WELL program will improve Aboriginal health worker knowledge and skills in the management of COPD and, for Indigenous people with COPD, BE WELL will improve exercise capacity and quality of life, and reduce hospital admissions and length of hospital stay. Knowledge gained from this project will be valuable for policy makers and health services in informing the future response to chronic lung disease management in Indigenous communities.
Interventions
There will be two levels of intervention:
1. A 2 day workshop to upskill Aboriginal Health Workers in the assessment of people with chronic obstructive pulmonary disease (COPD) and the provision of a pulmonary rehabilitation program. The workshop will be provided by a physiotherapist experienced in the assessment of patients with COPD and in the provision of pulmonary rehabilitation. The workshop attendees will be Aboriginal Health Workers, who will either be undertaking or have completed a Cert
There will be two levels of intervention: 1. A 2 day workshop to upskill Aboriginal Health Workers in the assessment of people with chronic obstructive pulmonary disease (COPD) and the provision of a pulmonary rehabilitation program. The workshop will be provided by a physiotherapist experienced in the assessment of patients with COPD and in the provision of pulmonary rehabilitation. The workshop attendees will be Aboriginal Health Workers, who will either be undertaking or have completed a Certificate IV in Allied Health Assistance with a major in Fitness Training. It is anticipated that there will only be a small group of attendees at each workshop within an Aboriginal Medical Service. The workshop will have theory and practice components and will include: assessment of lung function (spirometry); functional exercise capacity using the six-minute walk test (6MWT); quality of life using the Indigenous version of the St George's Respiratory Questionnaire (SGRQ-I) and the COPD Assessment Test (CAT); exercise prescription; education about lung disease; how to deliver a pulmonary rehabilitation program; and patient reassessment at program completion. The workshop will incorporate the 8 ways of Aboriginal learning to facilitate engagement of Aboriginal Health Workers. 2. Aboriginal or Torres Strait Islander people with COPD will be invited to attend a supervised pulmonary rehabilitation program, twice a week for eight weeks at the Aboriginal Medical Services. Exercise sessions will be approximately 1 hour. The exercise training prescription for each participant will be individualised and based on their functional exercise capacity measured on entry to the pulmonary rehabilitation program with the aim of participants exercising at a level that achieves a breathlessness or rate of perceived exertion score of 3 to 4 (‘moderate’ to ‘somewhat severe’) on the Borg 0-10 scale. The exercise training program will consist of aerobic, strength and balance exercises. Walking training and/or dance will be used for aerobic exercise. Body weight and/or resistance bands will be used for lower limb strengthening. Hand weights and/or resistance bands will be used for upper limb strengthening. Specific balance training will include exercise such as changes in body position, standing and walking on uneven surfaces, single leg standing. The exercise and education components of the program will be developed in consultation with the Aboriginal communities at each participating Aboriginal Medical Services to ensure that they are culturally appropriate. The exercise training will be supervised by an accredited exercise physiologist or physiotherapist and an Aboriginal health worker with an Allied Health Assistant Certificate IV and a major in Fitness Training.
Sponsors
The University of Sydney
Study design
Allocation
Non-randomised trial
Intervention model
Single group
Primary purpose
Treatment
Masking
Open (masking not used)
Eligibility
Sex/Gender
All
Age
40 Years to 90 Years
Healthy volunteers
No
Inclusion criteria
Aboriginal Health Workers will be eligible for inclusion if they are employed in a participating Aboriginal Medical Service and are enrolled in or have completed the Certificate 4 in Allied Health Assistant. Patients will be eligible if they have a diagnosis of COPD. confirmed by spirometry with a forced expiratory volume in 1 second (FEV1) to forced vital capacity (FVC) ratio (FEV1/FVC) of < 0.7
Exclusion criteria
Exclusion criteria will be co-morbidities such as severe cardiovascular, neurological or musculoskeletal conditions that are likely to adversely affect performance during assessments or exercise training.
Outcome results
None listed