6 minute read
RESEARCH UPDATE
Cystic Fibrosis Ireland caught up with Ms Nicola Hurley, final year PhD student in DCU to hear an update about her most recent research publication.
What is the Title of your Research?
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Recommendations to Improve Physical Activity Prescription for the Cystic Fibrosis Population: An Irish Perspective
Who are your co-authors?
Nicola Hurley, Bróna Kehoe (my Supervisor), Noel McCaffrey (Director of ExWell Chronic Illness Rehabilitation), Karen Redmond (Cardiothoracic Surgeon and supervisor), Lydia Cullen (Senior CF Physio), Niall Moyna (DCU Professor and Supervisor).
What were your research questions for this paper?
We hoped to answer the following:
- What level of education do CF healthcare professionals receive at undergraduate and postgraduate levels, with respect to physical activity prescription for CF populations?
- What level of knowledge do CF healthcare professionals have, with respect to the current consensus guidelines (ECFS) and physical activity prescription for CF populations?
- Are CF healthcare professionals actively prescribing physical activity to their CF patients? How frequently? Are they employing the current consensus guidelines? Is advice written, verbal or a combination of both?
- What barriers challenge or prevent CF healthcare professionals from prescribing physical activity to their CF patients?
How is this question important to PWCF?
It is important as we know physical activity is deemed as central to the management of CF, as a result of the incredible associated benefits (improvements in exercise tolerance, aerobic capacity, muscle strength, bone density, sputum expectoration, decreased hospital admissions, pulmonary exacerbations and a slower rate of decline in pulmonary function).
Patient outcomes can improve dramatically with appropriate and evidence-based physical activity prescription and promotion.
What did you do?
I conducted a 30-item online survey (SurveyMonkey) among 48 CF healthcare professionals from 6 CF centres across Ireland, to identify i) the level of education received at both undergraduate and post-graduate levels, with respect to physical activity prescription and promotion, ii) the level of knowledge among CF healthcare professionals with respect to the current consensus guidelines (as published by the ECFS), iii) to evaluate to what extent physical activity was being actively prescribed and promoted by CF healthcare professionals, and iv) what barriers prevented or challenged the healthcare professionals from prescribing physical activity to their patients – from this we were able to develop a list of recommendations to be employed to improve physical activity prescription by the healthcare professional, to improve outcomes in PWCF.
What did you find?
We found that education regarding physical activity prescription and promotion was barely visible at undergraduate level, with only ~12% of respondents receiving this education at undergraduate level. Subsequently, ~75% of the healthcare professionals sought to improve their knowledge within this domain post-graduation, yet the sources for achieving this education were widely varied, inconsistent and typically informal in nature (conference attendance, workshops, informal discussion, in-service study days, etc.).
There was unanimous consensus among all healthcare professionals that the physiotherapist should be the lead when it comes to physical activity prescription, however ~86% of healthcare professionals agreed or strongly agreed that recommending (or promoting) physical activity was part of their professional role.
With respect to physical activity prescription, almost all physiotherapists reported discussing physical activity at every patient interaction, with more than ¾ using a combination of written and verbal advice, predominantly based on the current consensus guidelines. However, other healthcare professionals (remaining members of the multi-disciplinary team; clinical nurse specialists, psychologists, consultants, registrars, dieticians, etc.) used verbal communication only, and rarely employed the guidelines (lacking relevant education and confidence).
The three major barriers preventing or challenging CF healthcare professionals from prescribing physical activity to their patients were: i) lack of compliance among patients to adhere to physical activity advice, ii) lack of motivation for physical activity among patients, iii) lack of physical activity programmes to refer their patients to.
What do your results mean?
There is scope to develop strands of education for undergraduate, post-graduate and continuing professional development streams, to enhance the knowledge of the CF healthcare professionals of today and tomorrow with respect to physical activity prescription and promotion (ultimately improving patient outcomes, as we know regular participation in physical activity has the potential to improve exercise tolerance [hallmark of CF disease], aerobic capacity, muscle strength and quality of life, while slowing the annual rate of decline in pulmonary function).
Our findings highlight the need for the development of physical activity programmes for healthcare professionals to refer their patients to, and the development of referral pathways between healthcare professionals and exercise scientists to facilitate the delivery of such programmes.
Should we be cautious with your research findings?
Firstly, it is important to acknowledge the possible presence of sampling bias. Opportunistic sampling may have resulted in a sample of healthcare professionals who recognise the therapeutic impact of physical activity, overlooking the opinions of those who are not interested in using physical activity as a therapeutic modality for CF populations.
There was also an over-representation of physiotherapists within the current study as a result of the survey invitation being sent to the National Physiotherapy CF Clinical Interest Group and not to other professional clinical interest groups.
Also, as the nature of the data is self-reported, there is a risk that social desirability bias (where people report what they believe is right as opposed to what they actually practise day to day) may have occurred making the results more desirable and portraying a less realistic representation of current knowledge and practice.
Has your research brought any improvements for PWCF?
Too early to say yet!
What are the next steps?
A subsequent study has been conducted, analysed and written for publication – to assess the factors that influence participation in physical activity among individuals with CF in Ireland. This study is a follow-on study, whereby we investigated motives and barriers, along with exercise preferences from the patients perspective. This informed served as PPI in the design of our exercise intervention, combined with the results from the healthcare professional study.
We are passionate about placing the patient at the heart of our research.
How did you find working in the field of CF research in Ireland?
Fantastic. The healthcare professionals working in CF care are wonderful, responded very timely and offered their assistance very readily. I am very grateful for their participation and would like to thank all of the healthcare professionals for their time in participating in this very novel and necessary piece of research!
What were the main challenges?
The main challenges were predominantly around GDPR regulations (not being able to contact certain healthcare professionals directly – however, we were able to overcome this barrier by contacting one “champion” from each CF centre who was then responsible for the dissemination of our plain language statement, and online survey link (which contained an in-built confirmation of informed consent)
How has this project changed your perspective?
This project has proven the need to improve education for CF healthcare professionals at both undergraduate and postgraduate level, and so too at the professional level – this is becoming increasingly important, primarily as the CF population now begins to age more than ever before as a direct result of the incredible improvements in CFTR modulator therapies. We know physical activity and exercise have the potential to decrease all-cause mortality by 30%, and rates of certain cancers by ~40%, depression by ~30% and dementia by ~30%. It is imperative that our healthcare professionals are educated, upskilled and possess the confidence to appropriately describe evidence-based physical activity to their CF patients.
Also, the development of physical activity programmes tailored to the CF patient is of paramount importance to bring the education and prescription alive, for the patients to realise the benefits of this evidence-based literature, and ultimately improve patient outcomes and longevity.
What does the future hold for you?
Taking the future one step at a time. I’m currently focusing on finishing my PhD and hope to submit in the New Year. I look forward to updating you on my subsequent research studies once they are published.
