Pulmonary rehabilitation – a preference clinical trial of centre based and mHealth delivered rehabilitation.

Participants will have the choice of which intervention group they wish to be in. They can opt for Group A - centre-based PR (standard care) or Group B - home based PR delivered with technology (mPR). All participants in both groups will undergo a baseline assessment and a centre. The baseline assessment follows standard PR practise. Group A: will be described below as the comparator. Group B: mPR Participants who opt for the mPR will receive a technology delivered PR programme with content mapped from standard PR programmes and based on best practise guidelines (Alison, McKeough et al. 2017). Materials – participants will use their own device (computer or smartphone) to access the mPR programme. For those who do not have access to a internet-enabled device, they will be given the option of a text messaging programme and a paper copy of mPR. Procedures The programme includes a core component of tailored exercise prescription consisting of aerobic, resistance and balance exercises. Information regarding the safe and effective technique of each exercise is demonstrated at assessment and also provided in written and video format. Exercise prescription is based on their initial assessment scores (6 minute walk test distance and breathlessness score (Medical research council scale (MRC)) with participants being stratified to four different exercise levels by the recruiting clinician. Participants are encouraged the work at an intensity equivalent to 3-4 on the modified BORG scale. Information regarding the BORG scale will be provided in the mPR-app and in a paper manual. The programme is adaptive to patients current health state via; offering alternative exercises if participant are unable to complete the prescribed activity, allowing participants to pause the programme if they are unwell via a question at the end of the week if they are ready to progress their exercise. Participants can monitor their progress in the mPR-app which displays the number of exercises completed each day. Where appropriate, participants will be asked if they would like to wear a sensor for the eight-week period. The mPR-sensor used in this component of the study will be a commercially available Fitbit or Withings smartwatch, which monitors step count. This will be provided to participants. Participants who already use a sensor can integrate the data with their own sensor to the mPR-app. Participants will be asked to wear the mPR-sensor as they wish over the eight-week period and will be shown how to use the accompanying app at registration. Daily step count and weekly average step count data will be displayed on the My Progress page of the mPR-app. Step count data from the sensor will be accessed at the end of the study as well as usage data (how the sensor was used and how often). The mPR programme also includes 12 self-management education modules titled ‘tips and tools’ Each module includes written information, a short video clip and links to further information. The information can be accessed at any time and is designed to help participants to manage their health condition. The information is supported through daily text messges sent to participants. The modules are mapped from the education component of centre-based PR sessions. Who The mPR intervention has been designed and developed by a team of clincians and researchers with extensive experience in delivering PR and mHealth interventions. The content has been mapped from PR best practise guidelines (Alison, McKeough et al. 2017) The recruiting clinician will be an experienced physiotherapist (> 3 years clinical experience)from the PR team. Mode of delivery The programme can be delivered in a variety of formats. All participants will receive daily text messaging. All core information will be sent in the text messages. The mPR-app can be accessed on participants own computer or smartphone. If they do not have access to a device, the information will be provided in a written manual. Number of times Participants are asked to complete the prescribed exercise programme 5 x per week for 8 weeks. The exercise programme will take between 30 – 45 minutes to complete. Each week participants will be asked if they are ready to progress their exercise programme. If yes, a slightly increased exercise programme will be delivered, if answer no, the same exercise programme is repeated. Participants will have the option to pause the programme if unwell. The programme can be extended up to 12 weeks. Location Participants will complete in their own home. The exercise programme is personalised based on assessment findings. The exercise programmes are stratified to four levels. The exercise level prescribed will be determined by the recruiting physiotherapist and will be based on distance walked on six minute walk test, breathlessness score MRC). The text messaging content contains core modules for all participants, and optional modules which are discussed with the participant at recruitment. These include; smoking cessation, information to assist with secretion clearance, information for people with low body mass index(BMI). The programme has been designed to monitor adherence with exercise by 2-way messaging. Each week on day 7, a message will be sent asking the participant how many times they have completed their exercises that week. Participants are asked to reply with the number. In addition, the number of exercises completed will be recorded. This information will be access from the mPR-app or alternatively paper activity diary for participants without a device. Daily text messages will provide information and motivation to encourage participants to keep up their exercise programme.