Three-million dollar trial aims to help people with multiple chronic health conditions.

The PERFORM clinical trial will address outcomes that matter to people living with multimorbidity

The University of Leicester is partnering with Monash University in Australia, the National Institute of Health and Care Research (NIHR) Leicester Bio Medical Research Centre (BRC), and Glasgow University to undertake a multi-million dollar trial to evaluate an exercise rehabilitation model to help people with multiple chronic health conditions. 

Multimorbidity, the coexistence of two or more long-term conditions, affects millions of people worldwide. Those with multimorbidity have high levels of disability and psychological distress and are 2.5 times more likely to be hospitalised than those without multimorbidity. 

Now the University, together with its partners, has co-designed an exercise rehabilitation model with patients, caregivers, health professionals and policymakers to provide effective care for people with multimorbidity, who are frequently excluded from single disease rehabilitation models. 

The PERFORM (Personalised Exercise-Rehabilitation For people with Multimorbidity) trial will test this model in the UK and Australia. Researchers will evaluate the effectiveness of PERFORM in people who are excluded from existing single-disease rehabilitation models, and compare outcomes of PERFORM to traditional heart and lung rehabilitation programs. 

“The PERFORM clinical trial addresses outcomes that matter to people living with multimorbidity (quality of life, physical function) and are of critical importance to our health system (hospital admission),” said Professor Anne Holland, who will lead the Australian trials. 

“If successful, multimorbidity exercise rehabilitation can be rapidly implemented in practice to improve health and wellbeing for people with multimorbidity, and substantially reduce healthcare costs.” 

Exercise rehabilitation is a highly effective treatment for people with a single long-term condition such as heart or lung disease, and for these conditions it is considered critical to evidence-based healthcare across the world. However, the potential of exercise rehabilitation to improve health outcomes in multimorbidity is unrealised.

The trial will test two different models of exercise rehabilitation: one for people eligible for existing heart and lung rehabilitation programs, and a second for those without rehabilitation options (other chronic conditions such as stroke, dementia, orthopaedic problems, and diabetes).

It will involve more than 2,000 participants and be conducted at nine sites in Australia (funded by a $3 million grant from the Medical Research Future Fund) and 12 sites in the United Kingdom (funded by the National Institute for Health and Care Research). 

It is the largest trial of its kind, and the only one large enough to look at important outcomes like hospital admissions. It will include health economic evaluation and an embedded process evaluation to support future decisions on implementation in Australia and the UK.

Professor Sally Singh, Head of Pulmonary and Cardiac Rehabilitation at the University of Leicester and UK based Chief investigator on the trial said: "PERFORM is a great opportunity to establish more effective treatment and rehabilitation protocols for people suffering from multimorbidity - which affects millions of people in the UK.

"So often those suffering from multiple long-term conditions are denied the chance to access research and care that could really benefit them. With this trial we hope to improve patients' quality of life and address the disproportionately high levels of hospitalisation we've observed." 

Professor Singh added: “This will also be a great chance to collaborate with our colleagues at Monash. By undertaking this international collaboration, we shall be able to access a wider pool of data, providing us with a better foundation for our study. This could enable us to establish better practices on a global scale and help a wider range of communities worldwide.” 

The trial will begin recruiting participants in 2024.