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Amy C Barradell,1– 3 Noelle Robertson,4 Linzy Houchen-Wolloff,1,2 Sally J Singh1,2 1Department of Respiratory Sciences, University of Leicester, Leicester, UK; 2Centre for Exercise and Rehabilitation Science, University Hospitals of Leicester NHS Trust, Leicester, UK; 3Multiple Long Term Conditions, National Institute for Health Research (NIHR) Applied Research Collaboration (East Midlands), Leicester, UK; 4Department of Neuroscience, University of Leicester, Leicester, UKCorrespondence: Amy C Barradell, Email ab1081@le.ac.ukBackground: We are developing a shared decision-making intervention for individuals with COPD who are deciding between Pulmonary Rehabilitation (PR) programme options. Previously, we identified Healthcare Professional (HCP) beliefs about the characteristics of COPD individuals as a barrier to PR conversations. Beliefs can lead to implicit biases which influence behaviour. To inform our shared decision-making intervention, we aimed to measure the presence of implicit bias amongst HCPs who refer individuals with COPD to PR.Methods: We utilised the Implicit Association Test to measure HCPs response times when categorising words related to smoking or exercise (eg stub, run) to matching concepts or evaluations of concepts (eg “smoking, unpleasant” or “exercise, pleasant”) and unmatching concepts or evaluations of concepts (eg “smoking, pleasant” or “exercise, unpleasant”). We approached HCPs across the UK. Following consent, we collected demographic data and then administered the test. The primary outcome was the standardised mean difference in response times from the matching and unmatching categorisations (D4-score), measured using a one-sample Wilcoxon Signed Rank Test. We explored the relationship between HCP demographics and their D4-scores using Spearman Rho correlation analysis and logistic regression.Results: Of 124 HCPs screened, 104 (83.9%) consented. Demographic data were available for 88 (84.6%). About 68.2% were female and most (28.4%) were in the 45– 54 years age category. Test data were available for 69 (66.3%) participants. D4-scores ranged from 0.99 to 2.64 indicating implicit favouring of matching categorisation (MD-score = 1.69, SDD-score = 0.38, 95% CID-score 1.60– 1.78, p < 0.05). This was significantly different from zero, z = − 7.20, p < 0.05, with a large effect size (r = 0.61, (28)). No demographic predictors of implicit bias were identifiable.Conclusion: HCPs demonstrated negative bias towards smoking and positive bias towards exercising. Since implicit bias impacts behaviour, we plan to develop intervention components (eg decision coaching training) to enable HCPs to fully and impartially support shared decision-making for a menu of PR options.Keywords: implicit bias, COPD, healthcare professionals, pulmonary rehabilitation

Supplemental Material for The Recovery Journey and the Rehabilitation Boat - A qualitative study to explore experiences of COVID-19 rehabilitation by Charlotte Gerlis, Amy Barradell, Nikki Y Gardiner, Emma Chaplin, Amye Goddard, Sally J Singh and Enya Daynes in Chronic Respiratory Disease

Objective A proportion of those recovering from COVID-19 are likely to have significant and ongoing symptoms, functional impairment and psychological disturbances. There is an immediate need to develop a safe and efficient discharge process and recovery programme. Established rehabilitation programmes are well placed to deliver a programme for this group but will most likely need to be adapted for the post-COVID- 19 population. The purpose of this survey was to rapidly identify the components of a post-COVID- 19 rehabilitation assessment and elements of a successful rehabilitation programme that would be required to deliver a comprehensive service for those post-COVID- 19 to inform service delivery. Design A survey comprising a series of closed questions and a free-text comment box allowing for a qualitative analysis. Setting Online survey. Participants Multiprofessional clinicians across specialties were invited to take part. Results 1031 participants responded from a broad range of specialties. There was overwhelming support for an early posthospital discharge recovery programme to advise patients about the management of fatigue (95% agreed/strongly agreed), breathlessness (94%) and mood disturbances (including symptoms of anxiety and depression, 92%). At the time point of 6-8 weeks, an assessment was considered important, focusing on a broad range of possible symptoms and supporting a return to work. Recommendations for the intervention described a holistic programme focusing on symptom management, return of function and return to employment. The free-text comments added depth to the survey and the need 'not to reinvent the wheel' but rather adapt well-established rehabilitation services to individually tailor needs-based care with continued learning for service development. Conclusion The responses indicate a huge interest and the urgent need to establish a programme to support and mitigate the long-term impact of COVID-19 by optimising and individualising existing rehabilitation programmes.