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Respiratory research
Moving singing for lung health online in response to COVID-19: experience from a randomised controlled trial
  1. Keir EJ Philip1,2,
  2. Adam Lewis3,
  3. Edmund Jeffery2,
  4. Sara Buttery1,2,
  5. Phoene Cave1,
  6. Daniele Cristiano2,
  7. Adam Lound4,
  8. Karen Taylor2,
  9. William D-C Man1,2,
  10. Daisy Fancourt5,
  11. Michael I Polkey1,2 and
  12. Nicholas S Hopkinson1,2
  1. 1National Heart and Lung Institute, Imperial College London, London, UK
  2. 2Respiratory Medicine, Royal Brompton and Harefield NHS Foundation Trust, London, UK
  3. 3Brunel University London, London, UK
  4. 4Respiratory Medicine, Imperial College Healthcare NHS Trust, London, UK
  5. 5Department of Behavioural Science and Health, University College London, London, UK
  1. Correspondence to Dr Keir EJ Philip; k.philip{at}imperial.ac.uk

Abstract

Introduction Singing for lung health (SLH) is a popular arts-in-health activity for people with long-term respiratory conditions. Participants report biopsychosocial benefits, however, research on impact is limited. The ‘SLH: Improving Experiences of Lung Disease trial’, a randomised controlled, single (assessor) blind, trial of 12 weeks SLH versus usual care for people with chronic obstructive pulmonary disease (COPD) (n=120) was setup to help to address this. The first group (n=18, nine singing and nine controls) started face-to-face (five sessions) before changing to online delivery (seven sessions) due to COVID-19-related physical distancing measures. As such, the experience of this group is here reported as a pilot study to inform further research in this area.

Methods We conducted semistructured interviews and thematic analysis regarding barriers, facilitators and key considerations for transitioning from face-to-face to online delivery. Pilot quantitative outcomes include attendance, premeasures and postmeasures of quality of life and disease impact (Short Form 36 Health Survey, COPD Assessment Test score), breathlessness (Medical Research Council breathlessness scale, Dyspnoea-12), depression (Patient Health Questionnaire-9, PHQ-9), anxiety (Generalised Anxiety Disorder-7), balance confidence (Activity specific Balance Confidence, ABC scale) and physical activity (clinical visit PROactive physical activity in COPD tool, combining subjective rating and actigraphy).

Results Attendance was 69% overall, (90% of the face-to-face sessions, 53% online sessions). Analysis of semistructured interviews identified three themes regarding participation in SLH delivered face to face and online, these where (1) perceived benefits; (2) digital barriers (online) and (3) digital facilitators (online). Findings were summarised into key considerations for optimising transitioning singing groups from face-to-face to online delivery. Pilot quantitative data suggested possible improvements in depression (treatment effect −4.78 PHQ-9 points, p<0.05, MCID 5) and balance confidence (treatment effect +17.21 ABC scale points, p=0.04, MCID 14.2).

Discussion This study identifies key considerations regarding the adaptation of SLH from face-to-face to online delivery. Pilot data suggest online group singing for people with COPD may deliver benefits related to reducing depression and improved balance confidence.

  • complementary medicine
  • exercise
  • infection control
  • viral infection
https://creativecommons.org/licenses/by/4.0/

This is an open access article distributed in accordance with the Creative Commons Attribution 4.0 Unported (CC BY 4.0) license, which permits others to copy, redistribute, remix, transform and build upon this work for any purpose, provided the original work is properly cited, a link to the licence is given, and indication of whether changes were made. See: https://creativecommons.org/licenses/by/4.0/.

https://doi.org/10.1136/bmjresp-2020-000737

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    Footnotes

    • Contributors The authors meet criteria for authorship as recommended by the International Committee of Medical Journal Editors. All the authors played a role in the content and writing of the manuscript. In addition, KEJP performed the analysis of the data, NSH and KEJP prepared the first draft.

    • Funding KEJP was supported by National Institute for Health Research Academic Clinical Fellowship award and the Imperial College Clinician Investigator Scholarship. DF was supported by the Wellcome Trust (205407/Z/16/Z), SB by the UK NIHR (PB-PG-1014–35051).

    • Disclaimer The funders had no say in the design and conduct of the study; collection, management, analysis, and interpretation of the data; preparation, review, or approval of the manuscript; and decision to submit the manuscript for publication. This publication presents independent research. The views expressed are those of the authors and not necessarily those of the NHS, the NIHR or the Department of Health and Social Care.

    • Competing interests None declared.

    • Patient consent for publication Not required.

    • Ethics approval Ethical approval for the SHIELD trial was granted by the National Health Service Health Research Authority, Stanmore REC (19/LO/0418).

    • Provenance and peer review Not commissioned; externally peer reviewed.

    • Data availability statement Data are available on reasonable request.

    • Supplemental material This content has been supplied by the author(s). It has not been vetted by BMJ Publishing Group Limited (BMJ) and may not have been peer-reviewed. Any opinions or recommendations discussed are solely those of the author(s) and are not endorsed by BMJ. BMJ disclaims all liability and responsibility arising from any reliance placed on the content. Where the content includes any translated material, BMJ does not warrant the accuracy and reliability of the translations (including but not limited to local regulations, clinical guidelines, terminology, drug names and drug dosages), and is not responsible for any error and/or omissions arising from translation and adaptation or otherwise.