Singing for lung health in COPD: a multicentre randomised controlled trial of online delivery

Abstract

Background: Singing for lung health (SLH) is an arts-based breathing control and movement intervention for people with long-term respiratory conditions, intended to improve symptoms and quality of life. Online, remotely delivered programmes might improve accessibility; however, no previous studies have assessed the effectiveness of this approach.

Methods: We conducted an assessor-blind randomised controlled trial comparing the impact of 12 weeks of once-weekly online SLH sessions against usual care on health-related quality of life, assessed using the RAND 36-Item Short Form Health Survey (SF-36) Mental Health Composite (MHC) and Physical Health Composite (PHC) scores.

Results: We enrolled 115 people with stable chronic obstructive pulmonary disease (COPD), median (IQR) age 69 (62-74), 56.5% females, 80% prior pulmonary rehabilitation, Medical Research Council dyspnoea scale 4 (3-4), forced expiratory volume in 1 s % predicted 49 (35-63). 50 participants in each arm completed the study. The intervention arm experienced improvements in physical but not mental health components of RAND SF-36; PHC (regression coefficient (95% CI): 1.77 (95% CI 0.11 to 3.44); p=0.037), but not MHC (0.86 (95% CI -1.68 to 3.40); p=0.504). A prespecified responder analysis based on achieving a 10% improvement from baseline demonstrated a response rate for PHC of 32% in the SLH arm and 12.7% for usual care (p=0.024). A between-group difference in responder rate was not found in relation to the MHC (19.3% vs 25.9%; p=0.403).

Discussion and conclusion: A 12-week online SLH programme can improve the physical component of quality of life for people with COPD, but the overall effect is relatively modest compared with the impact seen in research using face-to-face group sessions. Further work on the content, duration and dose of online interventions may be useful.

Trial registration number: NCT04034212.

Keywords: Complementary Medicine; Emphysema; Exercise; Pulmonary Rehabilitation; Respiratory Muscles.

Figure 1

Singing for Health: Improving Experiences of Lung Disease trial study procedures.CAT, chronic obstructive pulmonary disease assessment test; GAD-7, Generalised Anxiety Disorder-7 questionnaire; MHC, Mental Health Composite; MRC, Medical Research Council; PHC, Physical Health Composite; PHQ-9, Patient Health Questionnaire (9 question); SF-36, 36-Item Short Form Health Survey.

Figure 2

CONSORT diagram. CONSORT participant flow. AECOPD, acute exacerbation of chronic obstructive pulmonary disease; CONSORT, Consolidated Standards of Reporting Trials; SLH, Singing for Lung Health.

Figure 3

Singing for Lung Health session attendance.

Figure 4

Impact of Singing for Lung Health on health-related quality of life. MHC mental health component score of RAND SF-36; PHC physical health component score. Boxes indicate 25th to 75th percentile; central line is the median; whiskers are upper and lower adjacent values; outliers are values beyond the upper and lower adjacent values. MHC, Mental Health Composite; PHC, Physical Health Composite; SF-36, 36-Item Short Form Health Survey.