Background
The Future Challenges programme is a central part of the West of England Academic Health Science Network (AHSN)’s remit to assist industry, and work with the NHS to adopt and spread innovative products and services, to benefit patients and to encourage economic growth in the UK. The programme identifies and articulates local healthcare challenges and connects healthcare professionals with small to medium enterprises (SMEs) to support the development of healthcare solutions. Following engagement with local experts across the West of England, a national call for innovative solutions under the theme of “Keeping Healthy at Home” was launched and focused on two main areas: staying well and confident, and staying connected and supported.
KiActiv®’s technology, KiActiv® Health was selected, along with the Bath Centre for Fatigue Services (BCFS) at the Royal National Hospital for Rheumatic Diseases (RNHRD), part of the Royal United Hospitals Bath NHS Foundation Trust, who were keen to trial the technology. Specialist evaluators, based within the South West AHSN, were also selected to assess the impact and effectiveness of this programme.
Innovation
The project evaluated KiActiv® Health, a personalised and guided online intervention that empowers participants to optimise physical activity within their everyday lives. KiActiv® Health provides an interactive personalised dashboard to display accurate physical activity data and is supported remotely by phone calls with a dedicated mentor over 12-weeks. At the end of the 12-weeks, participants retain access to their personal dashboard and activity monitor, enabling them to continue their self-management using the technology if desired.
Purpose / objective
The ‘Replenish-ME’ project was co-designed to use the KiActiv® digital behaviour change programme, in parallel with current services for patients living with Chronic Fatigue Syndrome (CFS) / Myalgic Encephalomyelitis (ME), and explore whether KiActiv® Health could help those diagnosed with CFS/ME to develop a greater understanding of how their day-to-day activities impact on their health and energy levels. In the context of CFS/ME, understanding how physical activity impacts on energy balance and how to maintain a level of movement within their energy availability, is an important component of self-management for some.
BCFS is a nationally recognised centre of expertise, providing outpatient-based, specialist assessment and treatments for adults experiencing long standing fatigue. The clinical team were keen to understand how KiActiv® Health might work alongside their current programme and evaluate any benefits to the patients and the service.
Methodology
Between February and September 2020, adult patients referred to BCFS with a confirmed diagnosis of CFS/ME were introduced to KiActiv® Health by members of the BCFS inter-professional team. Patients enrolled directly with KiActiv®, who then contacted them to complete the enrolment process, if eligible. 118 patients were informed about KiActiv® Health, 43 were recruited and 41 completed the 12-week programme, whilst also engaging in the BCFS programme.
Qualitative and quantitative data was collected. Patients completed a pre- and post- intervention questionnaire and data was also collected to demonstrate patients’ adherence and engagement. Following completion, patients were asked whether their expectations of the KiActiv® Health programme had been met and what had helped or hindered them to use the technology. The evaluation team also reviewed contemporaneous notes taken by the KiActiv® Mentors, conducted eight one-to-one semi-structured interviews with the five BCFS clinicians and held one group discussion with four BCFS clinicians. Clinicians were asked about the barriers and enablers to integrating KiActiv® Health into the BCFS programme, as well as how implementation of the project had been impacted by COVID-19.
Key findings
36% (n=43) of patients with CFS/ME who were told about the KiActiv® Health programme were willing to engage alongside the evidence based BCFS treatment programme, and 95% (n=41) were highly adherent. The impact on patients was reported in some key findings such as: 66% (n=23) of patients reported an improvement in their overall health and 60% (n=16) of patients gained greater awareness of how different activities could impact on their energy expenditure. Analysis of the quantitative data collected at the start and on completion of the programme indicated that patients with CFS/ME experienced a statistically significant improvement in CFAQ-8, EQ5D, awareness and confidence. Providing patients with accurate and comprehensive physical activity data in combination with the specialist clinical treatment given in the BCFS programme, also led to a statistically significant improvement in their awareness of what diminished and restored their energy levels. By helping patients to successfully pace, and with Mentors providing strong encouragement and support, in combination with the BCFS specialist treatments, patients experienced a statistically significant improvement in the confidence they had to manage their daily activities and better use their energy, as well as their ability to pursue life activities regardless of their fatigue. This meant 60% (n=15) of patients were more accepting of their fatigue, culminating in a statistically significant improvement in overall health and the expectations of KiActiv® being met or exceeded by 71% of patients (n=29).
Lessons learned and conclusions
High levels of engagement and low dropout rates were seen in the 41 patients that completed the 12-week programme. Although this was a relatively small sample size, it shows some patients with CFS/ME are willing to use KiActiv® Health. Statistically significant improvements across a range of outcomes suggests KiActiv® Health could be offered as part of a personalised approach to managing CFS/ME for some patients.
Patients’ prior values and behaviours are important factors to consider when introducing KiActiv® Health; an individual approach to uptake was essential. KiActiv® Health was not felt to be appropriate for all patients by the BCFS team, and so having clear eligibility criteria prior to beginning recruitment is key.
Clarity and agreement between all parties about how KiActiv® integrates and complements usual care is vital to potential implementation and engagement.
It is acknowledged that there are clear benefits to interventions delivered virtually, particularly during a pandemic. However, clarity regarding the integration of KiActiv® Health with personalised care is an important consideration for its application in other settings and patient groups. Future implementation could consider having clinicians who are given devices and trained to facilitate shared learning.
Recommendations
The results from this evaluation indicate that the use of KiActiv® can have a positive impact in combination with specialist CFS/ME provision. Key areas for development have been identified to optimise use in this patient cohort and KiActiv® has begun scoping some adaptations, which include general user interface (UI) and user experience (UX) upgrades. Further discussion with BCFS clinicians would help to understand the potential opportunity to continue exploring the integration of KiActiv® into their service. The West of England AHSN business development team will continue to support KiActiv® to further explore a cost-benefit evaluation, development of a business case for CFS/ME and applications of this technology in the landscape of long COVID.
If you would like to request a copy of the full report, please email weahsn.innovation@nhs.net
