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Delivering effective non-invasive ventilation in amyotrophic lateral sclerosis using intensive remote support
Carla Girling1, Gemma Ryan2, Mike Bradburn2
1School of Medicine and Population Health, University of Sheffield, Sheffield, UK. c.girling@sheffield.ac.uk.
Implementation Science Communications
|June 20, 2026
Summary
Delivering Effective Non-Invasive ventilation in Motor neuron disease (DENIM) trial evaluates remote support to improve patient adherence to ventilation. This process evaluation examines implementation strategies for better patient outcomes and health equity.
Area of Science:
- Health Services Research
- Implementation Science
- Respiratory Medicine
Background:
- Non-invasive ventilation (NIV) is crucial for motor neuron disease (MND) survival, yet many patients struggle to achieve recommended usage.
- Current National Health Service (NHS) follow-up is insufficient for optimizing NIV therapy in MND.
- The Delivering Effective Non-Invasive ventilation in Motor neuron disease (DENIM) trial aims to improve NIV adherence through intensive remote support.
Purpose of the Study:
- To understand the implementation processes of the DENIM intervention across diverse NHS settings.
- To identify barriers and facilitators influencing the adoption and normalization of evidence-based NIV practices.
- To explore how implementation strategies can address the evidence-to-practice gap in complex, technology-supported care.
Main Methods:
- A convergent mixed-methods multiple-case study design across twelve NHS ventilation services.
- Data collection includes ethnographic observations, semi-structured interviews with staff and patients/carers, the NoMAD questionnaire, and ventilator adherence data.
- Analysis integrates qualitative (NPT-informed thematic analysis) and quantitative data using joint display tables.
Main Results:
- (Study ongoing) This process evaluation will identify key factors influencing the successful implementation of intensive remote NIV support.
- Insights into barriers and facilitators for research participation among underserved populations will be generated.
- The study will provide data on patient and staff experiences with remote NIV support.
Conclusions:
- This evaluation will yield explanatory insights into effective implementation strategies for technology-supported care in progressive diseases.
- Findings will inform strategies to address the evidence-to-practice gap, enhancing health equity.
- The study has implications for wider NHS digital transformation and optimizing NIV use in MND.
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