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The hand-held fan and the Calming Hand for people with chronic breathlessness: a feasibility trial

Swan, Flavia; English, Anne; Allgar, Victoria; Hart, Simon P.; Johnson, Miriam

Authors

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Dr Flavia Swan F.Swan@hull.ac.uk
Research fellow in cancer rehabilitation

Anne English

Victoria Allgar

Simon P. Hart



Abstract

Introduction
The battery operated hand-held fan (“fan”) and the Calming Hand (CH), a cognitive strategy, are interventions used in clinical practice to relieve chronic breathlessness.

Objective
To test the feasibility of a phase III randomised controlled trial (RCT) evaluating the impact of the fan and/or CH compared with exercise advice alone for the relief of chronic breathlessness due to respiratory conditions.

Methods
Single site, feasibility “2x2” factorial, non-blinded, mixed-methods RCT. Participants randomly allocated to four groups: fan + exercise advice vs CH + exercise advice vs fan + CH + exercise advice vs exercise advice alone. Measures included: recruitment, acceptability; data quality and study outcomes (baseline, day 28); modified incremental shuttle walk test (mISWT), recovery time from exertion-induced breathlessness, Life-space, General Self-Efficacy Scale and breathlessness numerical rating scales. Willing participants and carers were interviewed at study end.

Results
Recruitment/acceptability/data completion: 53 people were screened, 40 randomised and completed; (mean age 72 years (SD 9.8), 70% male). There were few missing data (2 mISWT). Recovery time [seconds] from exertion-induced breathlessness showed most improvement for the fan; mean reduction from baseline -33.5 vs CH mean increase from baseline 5.7. This represents a recovery speed at day 28 -20.4% faster for the fan vs 4.1% slower for the CH.

Qualitative data indicated participants valued the faster recovery and identified the fan as a useful “medical” device, but found the CH unhelpful.

Conclusion
A phase III RCT is feasible. Mixed-method data synthesis supports recovery time as a novel, meaningful outcome measure.

Journal Article Type Article
Publication Date 2019-06
Journal Journal of Pain and Symptom Management
Print ISSN 0885-3924
Publisher Elsevier
Peer Reviewed Peer Reviewed
Volume 57
Issue 6
Pages 1051-1061.e1
Institution Citation Swan, F., English, A., Allgar, V., Hart, S. P., & Johnson, M. (2019). The hand-held fan and the Calming Hand for people with chronic breathlessness: a feasibility trial. Journal of pain and symptom management, 57(6), 1051-1061.e1. https://doi.org/10.1016/j.jpainsymman.2019.02.017
DOI https://doi.org/10.1016/j.jpainsymman.2019.02.017
Keywords Anesthesiology and Pain Medicine; General Nursing; Clinical Neurology
Publisher URL https://www.sciencedirect.com/science/article/pii/S0885392419300958?via%3Dihub