FEASIBILITY of A PHYSIOTHERAPIST LED, BEHAVIOUR CHANGE INTERVENTION to IMPROVE PHYSICAL ACTIVITY in PEOPLE with RHEUMATOID ARTHRITIS

Background: Physical activity (PA) is an important component in the management of people with rheumatoid arthritis (RA) (1). Interventions incorporating Behaviour Change (BC) theory are needed to target physically inactive people with RA. The study Physiotherapist-led Intervention to Promote Physical Activity in Rheumatoid Arthritis (PIPPRA) was designed using the Behaviour Change Wheel (BCW) and a pilot study of feasibility undertaken (ClinicalTrials.gov Identifer: NCT03644160). Objectives: To obtain reliable estimates regarding recruitment rates;participant retention;protocol adherence and possible adverse events, and to producing estimates of the potential effect sizes of the BC intervention on changes in outcomes of physical activity;fatigue;disability and quality of life. Methods: Participants were recruited at University Hospital (UH) rheumatology clinics and randomly assigned to control group (physical activity information leafilet) or intervention group (four BC physiotherapy sessions in eight weeks). Inclusion criteria were diagnosis of RA (ACR/EULAR 2010 classifcation criteria), aged 18+ years and classifed as insufficiently physically active. Ethical approval was obtained from the UH research ethics committee. Participants were assessed at baseline (T0), 8-weeks (T1), and 24-weeks (T2). Descriptive statistics and t-tests were used to analyse the data with SPSS v22. Results: 320 participants were identifed through chart review with direct contact then with people meeting the inclusion criteria at rheumatology clinics. Of the clinic attendees n=183 (57%) were eligible to participate and n=58 (55%) of those consented to participate. The recruitment rate was 6.4 per month and refusal rate was 59%. Due to impact of COVID-19 on the study n=25 (43%) participants completed the study (n=11 (44%) in intervention and n=14 (56%) in control). Of the 25, n= 23 (92%) were female, mean age was 60 years (sd 11.5). Intervention group participants completed 100% of BC sessions 1 & 2, 88% session 3 and 81% session 4. No serious adverse events were reported. Secondary outcome measures data is Table 1. Conclusion: The PIPPRA study designed using the BCW to improve promote physical activity was feasible and safe. This pilot study provides a framework for larger intervention studies and based on these fndings a fully powered trial is recommended.

'i LEARNT so MUCH about MY APPROACH to BEING ACTIVE': EXPERIENCES of PEOPLE with RHEUMATOID ARTHRITIS on the IMPACT of A PHYSIOTHERAPIST LED INTERVENTION to PROMOTE PHYSICAL ACTIVITY

Background: Physical activity is an important component in the management of people with rheumatoid arthritis (RA) [1]. A Physiotherapist-led Intervention to Promote Physical Activity in people with RA (PIPPRA) was undertaken using the Behaviour Change Wheel, with the aim of examining the feasibility of promoting physical activity in RA. This qualitative study involved participants and health care professionals who participated and were involved in a behaviour change pilot RCT intervention. Objectives: To determine, qualitatively, the acceptability of PIPPRA to participants with RA and health care professionals, in order to capture their reality. Methods: A qualitative study design of face-to-face semi-structured interviews was undertaken. The interview schedule explored the following areas: experience of the intervention;unintended consequences;experience and suitability of outcome measures used;views regarding the intervention;perceptions of behaviour change and physical activity. Interviews were transcribed verbatim by a professional transcriber. Thematic analysis was used as an analytical approach [2]. The research team searched for patterns, analysed and coded the data, and generated themes and sub-themes. Themes were reviewed by the research team to check if they worked in relation to the coded extracts and the entire data set. The COREQ checklist provided guidance throughout [3]. Results: Fourteen participants [13 female/1 male;mean age of 59 (SD 6.3);mean RA diagnosis of 8.6 (SD 6.8) years;moderate to severe disability (HAQ-DI: 1. 4 (SD 0.50)] and 8 healthcare staff [4 female/4 male;mean age of 41 (SD 5.6)] participated. Three main themes were generated from participants:-1) Positive experience of behaviour change intervention-'I found it very knowledgeable to help you get stronger';2) Improvement in self-management-'.motivate me maybe to go back to doing a little bit more exercise';3) Negative impact of COVID-19 on intervention-'I don't think doing it online again would be really good at all.' T w o main themes from health care professionals:-1) Positive learning experience of behaviour change delivery-'Really made me realise the importance of discussing physical activity with patients';2) Positive approach to recruitment-'Very professional team showing the importance of having a study member on site'. Conclusion: The fndings demonstrated that participants had a positive experience of being involved in a behaviour change intervention in order to improve their physical activity and found it acceptable as an intervention. However, if given the choice they would prefer the intervention delivery face to face rather than telehealth. Healthcare professionals also had a positive experience and in particular found it benefcial to their own development, in particular the importance of recommending PA to patients.

Impact of COVID-19 on a physical activity feasibility pilot study: The pippra experience

Background: The PIPPRA (Physiotherapist-led Intervention to Promote Physical Activity in Rheumatoid Arthritis) project is a feasibility project examining the impact of a physical activity behaviour change intervention in people who have rheumatoid arthritis (RA). The PIPPRA study recruitment commenced in October 2019, with participant assessment and intervention commencing in November 2019. In the Republic of Ireland people who have RA are categorised as high risk category for Covid-19, due to immunosuppression [1], although this categorisation contrasts with EULAR's provisional recommendations [2]. Objectives: To examine the impact of the Covid-19 pandemic and public health restrictions on a pilot randomised controlled feasibility study in 2020. Methods: Participants (aged 18 years+, diagnosis of RA, independently mobile and low levels of physical activity [3]) were recruited from a rheumatology clinic at an urban hospital. Target recruitment was four participants per month for one year (N=48). Assessments were planned at baseline, eight and twenty-four weeks (N=144). Participants were randomised to intervention group or control group. The intervention group received four 1:1 sixty minute sessions with a physiotherapist (N=96). The intervention was delivered over eight weeks. Intervention and control groups received a physical activity information leaflet. Results: The Covid-19 pandemic and associated public health restrictions forced the study to be formally paused in April 2020 and the study formally resumed in August 2020. N=48 participants were recruited between October 2019 and March 2020 (six months). N=20 participants have commenced in the study, N=16 are awaiting baseline assessment, N=6 withdrew and N=6 were lost to follow-up prior to baseline. Trial protocol planned for the delivery of N=55 assessments and N=36 intervention sessions for participants who had commenced in the study. N=22 assessments and N=26 intervention sessions were delivered between November 2019 and March 2020. N=5 assessments and N=6 intervention sessions were conducted between August and October 2020. No assessment or intervention delivery occurred in November-December 2020 due to participant hesitancy in attending for assessment and/or intervention with increased public health restrictions. The impact of Covid-19 restrictions resulted in N=33 (60%) deviations from assessment protocol and N=10 (27%) deviations from intervention delivery protocol (Figure 1). Conclusion: The Covid-19 pandemic has had a significant impact on the delivery of the PIPPRA study. Feasibility study outcomes, including participant retention rate, and study delivery as per protocol, have been affected due to the Covid-19 pandemic. Participant reluctance to attend face-to-face sessions demonstrates the need to consider alternative methods of delivery, e.g. virtual delivery of interventions, where attending in person is not acceptable to participants [4], in future studies.

Toward a Compare and Contrast Framework for COVID-19 Contact Tracing Mobile Applications: A Look at Usability

This paper reports on the progress in the project COVIGILANT, which is aimed at developing an evaluation taxonomy for Contact Tracing Applications (CTAs) for COVID-19. Specifically, this article describes the development of Usability, one pillar of the COVIGILANT taxonomy, discussing the classification and decision-making processes, and the initial model validation. The validation process was undertaken in two stages. First, we validated how the Usability pillar could be used to evaluate the Irish Health Services Executive (HSE) COVID-19 CTA. While this supported many of the attributes that we had within the Usability pillar, it also identified issues. We made amendments based on these, and undertook a second study, this time evaluating 4 CTAs used in other countries. This has led to the completion of the Usability pillar, which can now be used to evaluate global CTAs.

A mixed methods protocol to evaluate the effectiveness and acceptability of COVID-19 Community Assessment Hubs

Background: Ireland's health system has been under significant strain due to staff shortages and inadequate capacity. Critical care bed capacity per capita in Ireland is among the lowest in Europe, thus, the coronavirus disease 2019 (COVID-19) pandemic has put additional strain on an over-stretched system. COVID-19 Community Assessment Hubs (CAHs) were established to mitigate unnecessary admission to acute hospitals, and reduce infection spread by supporting COVID-19 positive or suspected positive patients to isolate at home, or in isolation facilities. There is some evidence that similar assessment centres may be a successful triage strategy to reduce burden on hospital and acute care. Aim : The aim of this study is to evaluate the impact of COVID-19 Community Assessment Hubs on service delivery in one region in Ireland. Methods: A mixed-methods approach will be used, incorporating co-design to engage stakeholders and ensure informed data capture and analysis. Online surveys will assess CAH patients' experiences of access to and quality of care. Clinical patient data from CAHs will be collected and analysed using multinomial logistic regression to check for association with patient demographics and COVID-19 symptoms, and CAH early warning scores and outcomes (Transfer to Emergency Department, Transfer to isolation unit, Sent home with care plan). Semi-structured interviews will be conducted with: patients to elicit an in-depth understanding of experiences and acceptability of attending CAHs;and staff to understand challenges, benefits, and effectiveness of CAHs. Interview data will be analysed using a thematic analysis approach. Discussion: This study will provide valuable insights from both patient and staff perspectives on the operation of CAHs. We will evaluate the effectiveness and acceptability of CAHs and propose areas for improvement of the service. This will contribute to international literature on the use of community assessment centres during infectious disease pandemics.