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Sagen JS, Kjeken I, Habberstad A, Linge AD, Simonsen AE, Lyken AD, Irgens EL, Framstad H, Lyby PS, Klokkerud M, Dagfinrud H, Moe RH. Patient Involvement in the Rehabilitation Process Is Associated with Improvement in Function and Goal Attainment: Results from an Explorative Longitudinal Study. J Clin Med 2024; 13:320. [PMID: 38256454 PMCID: PMC10816630 DOI: 10.3390/jcm13020320] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2023] [Revised: 12/22/2023] [Accepted: 01/04/2024] [Indexed: 01/24/2024] Open
Abstract
The objective was to explore the associations between patient involvement in the rehabilitation process and improvements in function and goal attainment in the first year after rehabilitation. The longitudinal multicenter study RehabNytte provided data from participants who had been referred to rehabilitation (n = 2113). Quality indicator (QI) pass rates (% yes) were used to assess patient involvement in the rehabilitation process. The Patient-Specific Functional Scale (PSFS) (10 = best possible) was used to assess function. The outcome QI on goal achievement (response options of yes/no) was used to assess goal attainment. Logistic regression and paired sample t-tests were used to examine associations and mean changes in function from rehabilitation admission up to 3, 6, and 12 months. Most participants (95%) were involved in goal-setting, which was positively associated with younger age (OR 0.97, 95% CI 0.95-0.99) and female sex (OR 1.87, 95% CI 1.15-3.02). Function improved over the follow-up period, with greater improvements in the active goal-setting group. Being involved in goal planning almost tripled the odds of goal attainment (OR 2.78, 95% CI 1.60-4.83) and involvement in the rehabilitation plan almost doubled it (OR 1.99, 95% CI 1.41-2.81). Most participants were involved in rehabilitation goal-setting/planning and being involved was associated with beneficial functional outcomes and greater goal attainment.
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Affiliation(s)
- Joachim Støren Sagen
- Faculty of Health Sciences, Oslo Metropolitan University, St. Olavs plass 4, 0130 Oslo, Norway;
- Diakonhjemmet Hospital, Center for Treatment of Rheumatic and Musculoskeletal Diseases (REMEDY), Norwegian National Advisory Unit on Rehabilitation in Rheumatology (NKRR), Diakonveien 12, 0370 Oslo, Norway; (I.K.); (H.D.); (R.H.M.)
| | - Ingvild Kjeken
- Diakonhjemmet Hospital, Center for Treatment of Rheumatic and Musculoskeletal Diseases (REMEDY), Norwegian National Advisory Unit on Rehabilitation in Rheumatology (NKRR), Diakonveien 12, 0370 Oslo, Norway; (I.K.); (H.D.); (R.H.M.)
| | - Andreas Habberstad
- The Norwegian Federation of Organizations of Disabled People, Mariboesgate 13, 0183 Oslo, Norway;
| | - Anita Dyb Linge
- Muritunet Rehabilitation Center, Grandegata 58, 6210 Sylte, Norway;
| | | | - Anne Dorte Lyken
- Sørlandet Rehabilitation Center, Ola Garsons vei 1, 4596 Eiken, Norway;
| | - Eirik Lind Irgens
- Helsepartner Rehabilitation Center, Follumsvei 1, 9510 Alta, Norway;
| | - Heidi Framstad
- Røysumtunet Rehabilitation Center, Røysumlinna 41, 2770 Jaren, Norway; (A.E.S.); (H.F.)
| | - Peter Solvoll Lyby
- Catosenteret Rehabilitation Center, Kvartsveien 2, 1555 Store Brevik, Norway;
| | - Mari Klokkerud
- Faculty of Health Sciences, Oslo Metropolitan University, St. Olavs plass 4, 0130 Oslo, Norway;
| | - Hanne Dagfinrud
- Diakonhjemmet Hospital, Center for Treatment of Rheumatic and Musculoskeletal Diseases (REMEDY), Norwegian National Advisory Unit on Rehabilitation in Rheumatology (NKRR), Diakonveien 12, 0370 Oslo, Norway; (I.K.); (H.D.); (R.H.M.)
| | - Rikke Helene Moe
- Diakonhjemmet Hospital, Center for Treatment of Rheumatic and Musculoskeletal Diseases (REMEDY), Norwegian National Advisory Unit on Rehabilitation in Rheumatology (NKRR), Diakonveien 12, 0370 Oslo, Norway; (I.K.); (H.D.); (R.H.M.)
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Kocher A, Simon M, Dwyer AA, Blatter C, Bogdanovic J, Künzler-Heule P, Villiger PM, Dan D, Distler O, Walker UA, Nicca D. Patient Assessment Chronic Illness Care (PACIC) and its associations with quality of life among Swiss patients with systemic sclerosis: a mixed methods study. Orphanet J Rare Dis 2023; 18:7. [PMID: 36624535 PMCID: PMC9828378 DOI: 10.1186/s13023-022-02604-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2022] [Accepted: 12/19/2022] [Indexed: 01/11/2023] Open
Abstract
BACKGROUND The Chronic Care Model (CCM) is a longstanding and widely adopted model guiding chronic illness management. Little is known about how CCM elements are implemented in rare disease care or how patients' care experiences relate to health-related quality of life (HRQoL). We engaged patients living with systemic sclerosis (SSc) to assess current care according to the CCM from the patient perspective and their HRQoL. METHODS We employed an explanatory sequential mixed methods design. First, we conducted a cross-sectional quantitative survey (n = 101) using the Patient Assessment of Chronic Illness Care (PACIC) and Systemic Sclerosis Quality of Life (SScQoL) questionnaires. Next, we used data from individual patient interviews (n = 4) and one patient focus group (n = 4) to further explore care experiences of people living with SSc with a focus on the PACIC dimensions. RESULTS The mean overall PACIC score was 3.0/5.0 (95% CI 2.8-3.2, n = 100), indicating care was 'never' to 'generally not' aligned with the CCM. Lowest PACIC subscale scores related to 'goal setting/tailoring' (mean = 2.5, 95% CI 2.2-2.7) and 'problem solving/contextual counselling' (mean = 2.9, 95% CI 2.7-3.2). No significant correlations were identified between the mean PACIC and SScQoL scores. Interviews revealed patients frequently encounter major shortcomings in care including 'experiencing organized care with limited participation', 'not knowing which strategies are effective or harmful' and 'feeling left alone with disease and psychosocial consequences'. Patients often responded to challenges by 'dealing with the illness in tailored measure', 'taking over complex coordination of care' and 'relying on an accessible and trustworthy team'. CONCLUSIONS The low PACIC mean overall score is comparable to findings in patients with common chronic diseases. Key elements of the CCM have yet to be systematically implemented in Swiss SSc management. Identified gaps in care related to lack of shared decision-making, goal-setting and individual counselling-aspects that are essential for supporting patient self-management skills. Furthermore, there appears to be a lack of complex care coordination tailored to individual patient needs.
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Affiliation(s)
- Agnes Kocher
- Department Public Health (DPH), Institute of Nursing Science (INS), Faculty of Medicine, University of Basel, Bernoullistrasse 28, 4056, Basel, Switzerland. .,Department of Rheumatology and Immunology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland.
| | - Michael Simon
- grid.6612.30000 0004 1937 0642Department Public Health (DPH), Institute of Nursing Science (INS), Faculty of Medicine, University of Basel, Bernoullistrasse 28, 4056 Basel, Switzerland ,grid.5734.50000 0001 0726 5157Department of Nursing, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Andrew A. Dwyer
- grid.208226.c0000 0004 0444 7053Boston College, Connell School of Nursing, Chestnut Hill, MA USA ,grid.32224.350000 0004 0386 9924Center for Nursing Research, Massachusetts General Hospital Munn, Boston, MA USA
| | - Catherine Blatter
- grid.6612.30000 0004 1937 0642Department Public Health (DPH), Institute of Nursing Science (INS), Faculty of Medicine, University of Basel, Bernoullistrasse 28, 4056 Basel, Switzerland
| | - Jasmina Bogdanovic
- grid.6612.30000 0004 1937 0642Department Public Health (DPH), Institute of Nursing Science (INS), Faculty of Medicine, University of Basel, Bernoullistrasse 28, 4056 Basel, Switzerland
| | - Patrizia Künzler-Heule
- grid.6612.30000 0004 1937 0642Department Public Health (DPH), Institute of Nursing Science (INS), Faculty of Medicine, University of Basel, Bernoullistrasse 28, 4056 Basel, Switzerland ,grid.413349.80000 0001 2294 4705Department of Gastroenterology/Hepatology, Cantonal Hospital St. Gallen, St. Gallen, Switzerland ,grid.413349.80000 0001 2294 4705Department of Nursing, Cantonal Hospital St. Gallen, St. Gallen, Switzerland
| | | | - Diana Dan
- grid.9851.50000 0001 2165 4204Service of Rheumatology, Lausanne University Hospital, University of Lausanne, Lausanne, Switzerland
| | - Oliver Distler
- grid.7400.30000 0004 1937 0650Department of Rheumatology, University Hospital Zurich, University of Zurich, Zurich, Switzerland
| | - Ulrich A. Walker
- grid.410567.1Department of Rheumatology, University Hospital Basel, Basel, Switzerland
| | - Dunja Nicca
- grid.6612.30000 0004 1937 0642Department Public Health (DPH), Institute of Nursing Science (INS), Faculty of Medicine, University of Basel, Bernoullistrasse 28, 4056 Basel, Switzerland ,grid.7400.30000 0004 1937 0650Department of Global and Public Health, Institute for Epidemiology, Biostatistics and Prevention, University of Zurich, Zurich, Switzerland
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