The Feasibility and Acceptability of Culturally Appropriate Pulmonary Rehabilitation for Adults with Chronic Obstructive Pulmonary Disease in Sri Lanka: Randomized Controlled Trial

Akila R Jayamaha,1,2 Chamilya H Perera,1,2 Mark W Orme,2,3 Ravini De S Karunatillake,4 Amitha Fernando,4 Andy Barton,2,3 Michael C Steiner,2,3 Jesse Matheson,5 James Manifield,2,3 Amy C Barradell,2,3 Suresh Chathurantha,4 Ruwin R Dias,6 Thamara D Amarasekara,7 Savithri W Wimalasekera,8 Sally J Singh2,3 1Faculty of Nursing, KIU, Colombo, Sri Lanka; 2Department of Respiratory Sciences, University of Leicester, Leicester, UK; 3Centre for Exercise and Rehabilitation Science, University Hospitals of Leicester NHS Trust, Leicester, UK; 4Central Chest Clinic, National Hospital of Sri Lanka, Colombo, Sri Lanka; 5Department of Economics, University of Sheffield, Sheffield, UK; 6Faculty of Music, University of Visual and Performing Arts, Colombo, Sri Lanka; 7Faculty of Allied Health Sciences, University of Sri Jayewardenepura, Nugegoda, Sri Lanka; 8Faculty of Medical Sciences, University of Sri Jayewardenepura, Nugegoda, Sri LankaCorrespondence: Akila R Jayamaha, Department of Respiratory Sciences, University of Leicester, Leicester, UK, Email akila@kiu.ac.lk; arj22@leicester.ac.ukPurpose: Pulmonary rehabilitation (PR) is recommended internationally for individuals with chronic obstructive pulmonary disease (COPD), but there is limited evidence and practice of PR in Sri Lanka. Key challenges for PR such as poor accessibility, uptake and completion need to be addressed when designing and delivering new PR programmes. Accordingly, this study determined the feasibility and acceptability of culturally adapted PR for adults with COPD in Sri Lanka.Patients and Methods: A randomized controlled feasibility trial was conducted with 50 adults living with COPD in Colombo, Sri Lanka. A culturally adapted PR comprised a 6-week rolling programme with sessions conducted twice every week. Sessions involved endurance and resistance exercise training, education and cultural adaptations of nutritional support and group singing. The control group received usual care, which did not include any form of PR or exercise training. Feasibility was determined by uptake (≥ 60% of eligible participants consented) and completion (≥ 70% of recruited participants). Acceptability was explored by focus group discussions (FGDs) analysed thematically.Results: Seventy-nine eligible individuals (94% of screened) were referred in order to recruit 50 participants (63% uptake). The majority of participants in both intervention (72%, n=18) and control (64%, n=16) groups completed the study. Based on qualitative focus group discussions four themes emerged: (1) Increased knowledge following PR, including dispelling misbeliefs about COPD and improving medication adherence; (2) Perceived improvements in health following PR, including improved walking ability and reduced breathlessness (3) Enjoyment and benefits of cultural adaptations to PR, and (4) Challenges during PR, including adherence to exercise and travel requirements.Conclusion: Culturally adapted PR was feasible and acceptable to adults with COPD in Sri Lanka. A fully powered trial is warranted for evaluating clinical and cost-effectiveness of culturally adapted PR.Keywords: COPD, culturally adapted PR, Colombo Sri Lanka, practicality, suitability