http://bura.brunel.ac.uk/handle/2438/8616 Wed, 22 Apr 2026 19:44:32 GMT 2026-04-22T19:44:32Z http://bura.brunel.ac.uk/handle/2438/33189 Title: Clinical and cost-effectiveness of SPACE for COPD delivered as a pulmonary rehabilitation maintenance programme: a randomised controlled trial Authors: Houchen-Wolloff, L; Hong, A; Alqahtani, K; Gerlis, C; Gardiner, N; Barradell, A; Nolan, CM; Man, W; Richardson, M; Khan, A; Gumber, A; Szczepura, A; Singh, SJ Abstract: Introduction: The benefits of pulmonary rehabilitation (PR) decline after 6–12 months. Previous studies of maintenance in the literature have been labour-intensive and concentrated on secondary care healthcare utilisation only. We aimed to investigate whether Self-management Programme of Activity, Coping and Education (SPACE) for chronic obstructive pulmonary disease (COPD), a light-touch self-management programme, was clinically and cost-effective following PR. Methods: We conducted a prospective, multicentre, assessor-blind randomised controlled trial. Patients with COPD were randomised 1:1 to usual care (control) or SPACE. The intervention included a home-based manual and four facilitated group sessions, delivered over 12 months. Primary outcome: Endurance Shuttle Walking Test at 12 months. Secondary outcomes: maximal exercise capacity, mood, patient activation, physical activity, healthcare costs and health-related quality-of-life (HRQoL). Results: 116 participants were recruited (October 2019–June 2022). Baseline characteristics: SPACE (65% male, aged 71.8 years, median Medical Research Council (MRC) 3, mean pack years 41.1, mean body mass index (BMI) 29.1), control (51% male, aged 71.8 years, median MRC 3, mean pack years 44.5, mean BMI 28.3). SPACE completion rate=83% and intervention fidelity (assessed via checklist) was excellent. No statistically significant differences at 12 months for primary and secondary outcomes. Economic analysis at 12 months shows a positive HRQoL difference between groups of 0.0871 quality adjusted life years (QALY) and reduced National Health Service (NHS) costs of £139 per participant, driven primarily by a reduction in general practitioner visits in favour of SPACE. Conclusions: Endurance exercise tolerance was maintained in both groups. The programme improved HRQoL at 12 months in the intervention group (above control) and was cost-effective, driven by reduced primary care costs. Description: Data availability statement: Data are available on reasonable request. The datasets generated during and/or analysed during the current study are/will be available on request from (Linzy Houchen-Wolloff, Linzy.Houchen@uhl-tr.nhs.uk, anonymised quantitative and qualitative data, after all publications are completed).; WHAT IS ALREADY KNOWN ON THIS TOPIC: * There is currently a lack of evidence to support formal maintenance programmes following pulmonary rehabilitation (PR) and previous studies have been labour-intensive, with a focus on secondary care healthcare use only. WHAT THIS STUDY ADDS * This study used a light-touch self-management approach to PR maintenance and took a holistic review of clinical and cost effectiveness. HOW THIS STUDY MIGHT AFFECT RESEARCH, PRACTICE OR POLICY * The programme did not improve endurance exercise tolerance above usual care but was cost-effective and may therefore be a valuable programme to implement. Sat, 11 Apr 2026 00:00:00 GMT http://bura.brunel.ac.uk/handle/2438/33189 2026-04-11T00:00:00Z http://bura.brunel.ac.uk/handle/2438/33157 Title: Navigating Transition to Adulthood: Perspectives from Young People with Cerebral Palsy, Parents, and Health Professionals Authors: Norris, M; Fortune, J; Ryan, J; Walsh, A; Kroll, T; Lavelle, G; Hensey, O Abstract: ... Description: ... Thu, 01 Jan 2026 00:00:00 GMT http://bura.brunel.ac.uk/handle/2438/33157 2026-01-01T00:00:00Z http://bura.brunel.ac.uk/handle/2438/33146 Title: Determinants of private health insurance uptake and its association with healthcare utilization in Gulf Cooperation Council countries: a systematic review Authors: Althabaiti, KS; Bhuiyan, MB; Hunsberger, M; Ahmed, S; Khan, J Abstract: All Gulf Cooperation Council (GCC) countries have a multi-payer healthcare system that comprises governmental health coverage (GHC), funded by the government, and private health insurance (PHI), mainly sponsored by employers and purchased by individuals. Both are expected to influence healthcare utilization and contribute to system efficiency and patient well-being. This systematic review explored the determinants of PHI uptake and its association with healthcare service utilization in the presence of GHC in GCC countries. We systematically searched CINAHL, PubMed, Scopus, Web of Science, and Cochrane Library for peer-reviewed studies published between January 2012 and October 2022. Study quality was assessed using the Critical Appraisal Skills Programme (CASP) checklists for both quantitative and qualitative studies, following PRISMA guidelines. Twenty-six studies met the inclusion criteria. Determinants of PHI uptake were mapped to Andersen’s Behavioral Model of Health Services Use (BMHSU) and categorized into (1) predisposing factors (sex, age, marital status, and education), (2) enabling factors (employment/income and health system-related factors such as access and perceived service quality), and (3) need factors (health status, including chronic noncommunicable diseases). PHI uptake was positively associated with being male, married, highly educated, employed with a high income, and having chronic diseases. PHI was positively associated with healthcare utilization, particularly routine check-ups, preventive services, and the use of prescribed medicines. In GCC countries, PHI uptake is influenced by sociodemographic and socioeconomic characteristics, health status, and perceived service quality. PHI is also associated with higher healthcare utilization, underlining the need for evidence-informed policies that enhance equity and expand coverage. Description: Paper context: • Main finding: Private health insurance uptake across Gulf Cooperation Council countries was influenced by sociodemographic and socioeconomic characteristics, health status, and the quality of services. Additionally, private health insurance was likely to be associated with higher utilization of healthcare services. • Added knowledge: This systematic review identifies how shifts in health policy across Gulf Cooperation Council countries, particularly the move from universal public coverage toward mixed systems combining governmental and mandatory private insurance which have redefined the determinants of private health insurance enrollment and healthcare utilization. It highlights how socioeconomic characteristics and policy reforms interact to shape access patterns under differing insurance schemes. • Global health impact: The findings can support policymakers in developing equitable and sustainable health financing reforms toward universal health coverage.; Supplemental material is available online at: https://www.tandfonline.com/doi/full/10.1080/16549716.2026.2647528# . Wed, 25 Mar 2026 00:00:00 GMT http://bura.brunel.ac.uk/handle/2438/33146 2026-03-25T00:00:00Z http://bura.brunel.ac.uk/handle/2438/33091 Title: Ageing well with a lifelong disability: A scoping review Authors: Smith, KJ; Gupta, S; Fortune, J; Lowton, K; Victor, C; Burke, E; Carew, MT; Livingstone, E; Creeger, M; Shanahan, P; Walsh, M; Ryan, JM Abstract: Background and Objectives: Existing literature highlights notable health and social inequalities for people aging with a lifelong disability and the need for research to better understand how we can support this group to age well. This scoping review mapped existing literature related to “aging well” in people with lifelong disabilities. Research Design and Methods: Five scientific databases and gray literature sources were searched for studies related to “aging well” and “lifelong disability” (defined as a disability that a person had lived with since birth or early childhood). Results: We identified 81 studies that discussed aging well with a lifelong disability, with most (70%) focusing on intellectual disabilities. Two themes captured existing research on aging well with a lifelong disability: (1) framing aging well with a lifelong disability, which included the ways that people with lifelong disability, their supporters, and existing research frame aging well for this group and (2) supporting people to age well with a lifelong disability, which involves the micro-, meso-, and macro-level factors where research suggests interventions to facilitate aging well could be situated. Discussion and Implications: This synthesis highlights how aging well is currently framed in the literature and where interventions to improve aging well in this group could be situated. Literature highlights the importance of considering multilevel interventions to improve aging well. Evidence gaps include the lack of research conducted with groups other than those with intellectual disabilities and the need for more research examining aging well interventions. Description: Data Availability: The search strategy is available as Supplementary Material and protocol was preregistered on the Open Science Framework (https://osf.io/y42md). Tue, 23 Jul 2024 00:00:00 GMT http://bura.brunel.ac.uk/handle/2438/33091 2024-07-23T00:00:00Z