Moving Singing for Lung Health online: experience from a randomised controlled trial

Philip, K. E. J.; Lewis, A.; Jeffery, E.; Buttery, S.; Cave, P.; Cristiano, D.; Lound, A.; Taylor, K.; Man, W. D.-C.; Fancourt, D.; Polkey, M. I.; Hopkinson, N. S.

Introduction Singing for Lung Health (SLH) is a popular arts-in-health activity for people with long-term respiratory conditions, which participants report provides biopsychosocial benefits, however research on impact is limited. The SHIELD trial, a randomised controlled, single (assessor) blind, trial of 12 weeks SLH vs usual care for people with Chronic Obstructive Pulmonary Disease (COPD) (n=120) was set-up to help to address this. The first group started face-to-face (5 sessions) before changing to online delivery (7 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 semi-structured interviews and thematic analysis regarding barriers, facilitators and key considerations regarding transitioning from face-to-face to online delivery. Pilot quantitative outcomes include attendance, pre and post measures of quality of life and disease impact (SF-36, CAT score), breathlessness (MRC breathlessness scale, Dyspnoea-12), depression (PHQ9), anxiety (GAD-7), 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 semi-structured interviews identified three themes regarding participation in SLH delivered face-to-face and online, these where 1) perceived benefits; 2) digital barriers (online); 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, p= 0.0487, MCID 5) balance confidence (treatment effect +17.21, p=0.0383, MCID 14.2), and anxiety (treatment effect -2.22, p=0.0659, MCID 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 anxiety, and improved balance confidence.