Protocol for the cultural adaptation of pulmonary rehabilitation and subsequent testing in a randomised controlled feasibility trial for adults with chronic obstructive pulmonary disease in Sri Lanka.

INTRODUCTION: International guidelines recommend pulmonary rehabilitation (PR) should be offered to adults living with chronic obstructive pulmonary disease (COPD), but PR availability is limited in Sri Lanka. Culturally appropriate PR needs to be designed and implemented in Sri Lanka. The study aims to adapt PR to the Sri Lankan context and determine the feasibility of conducting a future trial of the adapted PR in Sri Lanka. METHODS AND ANALYSIS: Eligible participants will be identified and will be invited to take part in the randomised controlled feasibility trial, which will be conducted in Central Chest Clinic, Colombo, Sri Lanka. A total of 50 participants will be recruited (anticipated from April 2021) to the trial and randomised (1:1) into one of two groups; control group receiving usual care or the intervention group receiving adapted PR. The trial intervention is a Sri Lankan-specific PR programme, which will consist of 12 sessions of exercise and health education, delivered over 6 weeks. Focus groups with adults living with COPD, caregivers and nurses and in-depth interviews with doctors and physiotherapist will be conducted to inform the Sri Lankan specific PR adaptations. After completion of PR, routine measures in both groups will be assessed by a blinded assessor. The primary outcome measure is feasibility, including assessing eligibility, uptake and completion. Qualitative evaluation of the trial using focus groups with participants and in-depth interviews with PR deliverers will be conducted to further determine feasibility and acceptability of PR, as well as the ability to run a larger future trial. ETHICS AND DISSEMINATION: Ethical approval was obtained from the ethics review committee of Faculty of Medical Sciences, University of Sri Jayewardenepura, Sri Lanka and University of Leicester, UK. The results of the trial will be disseminated through patient and public involvement events, local and international conference proceedings, and peer-reviewed journals. TRIAL REGISTRATION NUMBER: ISRCTN13367735.

Socioeconomic status is a predictor of neurocognitive performance of early female adolescents.

OBJECTIVE: Previous studies have shown that high socioeconomic status (SES) is significantly associated with inhibitory control, working memory, verbal comprehension and IQ. However, in the Asian setting, with its prevailing poverty, information about the influence of SES on cognitive development of female adolescents is limited. This study was aimed to investigate the association between SES and neurocognitive performance of early female adolescents in Sri Lanka. METHODS: Female adolescents aged 11-14 years (n = 200) of low and middle SES were studied to assess neurocognitive function. After obtaining baseline data, eight subtests of the Wechsler Intelligence Scale for Children (WISC - IV), Test Of Nonverbal Intelligence (TONI-3) and two computer-based executive function tests (inhibition and visuo-spatial working memory) were administered to assess neurocognitive measures of the above adolescents. The results were compiled into a data base and analyzed using SPSS version 20 statistical software. RESULTS: Higher SES was associated with higher performance in all neurocognitive tests. Low SES adolescents obtained significantly poor test scores for executive function test (inhibitory control: p < 0.0001) and for WISC [verbal comprehension index (VCI): p < 0.0001), working memory index (WMI): p < 0.0001 and estimated full scale IQ (EFSIQ): p < 0.0001)] when compared with middle SES adolescents. Maternal education alone significantly predicts VCI and EFSIQ than the combined influence of parental education, occupation and income. Psychosocial adversities of adolescents were inversely correlated with VCI (r = -0.30; p < 0.001) and EFSIQ (r = -0.20; p < 0.001) of WISC and mathematics performance (r = -0.34; p < 0.001) at examination in school. CONCLUSION: Findings of the study revealed the importance of upliftment of SES of the society to improve the cognitive and academic outcomes of low SES individuals.