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Valaas HL, Klokkerud M, Hildeskår J, Hagland AS, Kjønli E, Mjøsund K, Øie L, Wigers SH, Eppeland SG, Høystad TØ, Klokkeide Å, Larsen M, Kjeken I. Follow-up care and adherence to self-management activities in rehabilitation for patients with rheumatic and musculoskeletal diseases: results from a multicentre cohort study. Disabil Rehabil 2022; 44:8001-8010. [PMID: 34846264 DOI: 10.1080/09638288.2021.2008523] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
Abstract
PURPOSE Follow-up care (FU-care) and self-management are recognized as important to ensure prolonged effects of rehabilitation. Objectives of this study were to explore current FU-care and self-management after specialized rehabilitation for patients with rheumatic and musculoskeletal diseases. MATERIALS AND METHODS This multicentre cohort study included 523 patients who self-reported need and plans for FU-care and plans for self-management activities (SMAs) at rehabilitation discharge. The FU-care received and adherence to SMA were self-reported after 4-, 8-, and 12-months. Predictors for received FU-care and adherence to SMA were explored in multiple logistic regression models. RESULTS Plans for FU-care were significantly associated with received FU-care. Younger age, better coping skills, and performing regular social activities and hobbies were significant predictors for received FU-care. Throughout the follow-up year, 221 (51%) participants had adherence to their SMA plans. Older age, regular physical activity, more severe pain, and performing regular social activities and hobbies were significant predictors for adherence to SMA. Participants with SMA adherence more often reported planned FU-care, and more frequently received the FU-care they needed. CONCLUSIONS Planning FU-care should be integrated in specialized rehabilitation. Patients with poor coping skills and sedentary lifestyle may need more support over longer time to implement behavioral changes for healthy self-management.Implications for rehabilitationPlanning follow-up should be integrated in specialized rehabilitation as it supports self-management and receiving follow-up at home.Patients with sedentary lifestyle, poor coping skills, and depression may need more support over longer time to implement healthy self-management.Structure and routines in daily life enhance self-management.
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Affiliation(s)
- Helene Lindtvedt Valaas
- Norwegian National Advisory Unit on Rehabilitation in Rheumatology, Diakonhjemmet Hospital, Oslo, Norway
| | - Mari Klokkerud
- Regional Center for Knowledge Translation in Rehabilitation, Sunnaas Hospital, Oslo, Norway
| | | | | | | | | | - Lars Øie
- North-Norway Rehabilitation Centre, Tromsø, Norway
| | | | | | | | | | - Mona Larsen
- The Norwegian Rheumatism Association, Oslo, Norway
| | - Ingvild Kjeken
- Norwegian National Advisory Unit on Rehabilitation in Rheumatology, Diakonhjemmet Hospital, Oslo, Norway
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2
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Valaas HL, Klokkerud M, Hildeskår J, Hagland AS, Kjønli E, Mjøsund K, Øie L, Wigers SH, Eppeland SG, Høystad TØ, Klokkeide Å, Larsen M, Kjeken I. Rehabilitation goals described by patients with rheumatic and musculoskeletal diseases: content and attainment during the first year after rehabilitation. Disabil Rehabil 2022; 44:7947-7957. [PMID: 34854330 DOI: 10.1080/09638288.2021.2003879] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
Abstract
PURPOSE We explored the content and attainment of rehabilitation goals the first year after rehabilitation among patients with rheumatic and musculoskeletal diseases. METHODS Participants (n = 523) recorded goals in the Patient Specific Functional Scale at admission and reported goal attainment at admission, discharge, and 12 months after rehabilitation on an 11-point numeric rating scale. Goal content was linked to the ICF coding system and summarized as high, maintained, or no attainment. Changes in absolute scores were investigated using paired samples t-tests. RESULTS Goals had high attainment with a significant positive change (-1.83 [95% CI -2.0, -1.65], p > 0.001) during rehabilitation, whereas goals had no attainment with a significant negative change (0.36 [0.14, 0.57], p > 0.001) between discharge and 12 months after rehabilitation. Goals focusing on everyday routines, physical health, pain management, and social or work participation were highly attained during rehabilitation. Goals that were difficult to enhance or maintain after rehabilitation addressed everyday routines, physical health, and work participation. CONCLUSION The positive changes in goal attainment largely occurred during rehabilitation, but they appeared more difficult to maintain at home. Therefore, rehabilitation goals should be reflected in the follow-up care planned at discharge.Implications for rehabilitationThe contents of rehabilitation goals reflect the complexity and wide range of challenges patients with rheumatic and musculoskeletal diseases experience.Positive changes in goal attainment largely occur during rehabilitation and appear to be more difficult to enhance or maintain at home.Rehabilitation interventions and follow-up care should be tailored to support patients in maintaining their attained goals for healthy self-management.Rehabilitation goals should be reflected in the follow-up care planned at discharge.
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Affiliation(s)
- Helene Lindtvedt Valaas
- Norwegian National Advisory Unit on Rehabilitation in Rheumatology, Diakonhjemmet Hospital, Oslo, Norway
| | - Mari Klokkerud
- Regional Center for Knowledge Translation in Rehabilitation, Sunnaas Hospital, Oslo, Norway
| | | | | | | | | | - Lars Øie
- North-Norway Rehabilitation Centre, Tromsø, Norway
| | | | | | | | | | - Mona Larsen
- The Norwegian Rheumatism Association, Oslo, Norway
| | - Ingvild Kjeken
- Norwegian National Advisory Unit on Rehabilitation in Rheumatology, Diakonhjemmet Hospital, Oslo, Norway
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Moen VP, Tvedter AT, Herbert RD, Hagen KB. Development and external validation of a prediction model for patient-relevant outcomes in patients with chronic widespread pain and fibromyalgia. Eur J Pain 2022; 26:1123-1134. [PMID: 35263480 PMCID: PMC9311427 DOI: 10.1002/ejp.1937] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
BACKGROUND The objective of this study was to develop prediction models and explore the external validity of the models in a large sample of patients with chronic widespread pain (CWP) and fibromyalgia (FM). METHODS Patients with CWP and FM referred to rehabilitation services in Norway (n=986) self-reported data on potential predictors prior to entering rehabilitation, and self-reported outcomes at one-year follow-up. Logistic regression models of improvement, worsening and work status, and a linear regression model of health-related quality of life (HRQoL), were developed using lasso regression. Externally validated estimates of model performance were obtained from the validation set. RESULTS The number of participants in the development and the validation sets was 771 and 215 respectively; only participants with outcome data (n = 519-532 and 185, respectively) were included in the analyses. On average, HRQoL and work status changed little over one year. The prediction models included 10-11 predictors. Discrimination (AUC statistic) for prediction of outcome at follow-up was 0.71 for improvement, 0.67 for worsening, and 0.87 for working. The median absolute error of predictions of HRQoL was 0.36 (0.22-0.51). Reasonably good predictions of working at follow-up and HRQoL could be obtained using only the baseline scores as predictors. CONCLUSIONS Moderately complex predictions models (10-11 predictors) generated poor to excellent predictions of patient-relevant outcomes. Simple prediction models of working and HRQoL at follow-up may be nearly as accurate and more practical.
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Affiliation(s)
- V P Moen
- Centre for Habilitation and Rehabilitation, Haukeland University Hospital, Bergen, Norway.,Department of Health and Functioning, Western Norway University of Applied Sciences, Bergen, Norway
| | - A T Tvedter
- National Advisory Unit on Rehabilitation in Rheumatology, Department of Rheumatology, Diakonhjemmet Hospital, Oslo, Norway.,Department of Physiotherapy, OsloMetropolitan University, Oslo, Norway
| | - R D Herbert
- Neuroscience Research Australia (NeuRA), Sydney, Australia.,School of Medical Sciences, University of New South Wales, Sydney, Australia
| | - K B Hagen
- National Advisory Unit on Rehabilitation in Rheumatology, Department of Rheumatology, Diakonhjemmet Hospital, Oslo, Norway.,Division of Health Services, Norwegian Institute of Public Health, Oslo, Norway
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Hamnes B, Berdal G, Bø I, Kjeken I. Patients' experiences with goal pursuit after discharge from rheumatology rehabilitation: A qualitative study. Musculoskeletal Care 2020; 19:249-258. [PMID: 33002288 DOI: 10.1002/msc.1515] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2020] [Revised: 09/14/2020] [Accepted: 09/14/2020] [Indexed: 12/22/2022]
Abstract
PURPOSE/OBJECTIVE To explore rehabilitation goals and experiences with goal striving in patients with rheumatic diseases after rehabilitation discharge. METHOD Thirty-three patients with rheumatic diseases participated in goal-setting conversations with healthcare professionals during a 1-week rehabilitation programme. After discharge, they received four follow-up phone calls over a period of 5 months to support individual goal striving and self-management. A qualitative thematic analysis was conducted of the patients' rehabilitation goals, action plans and their statements about their experiences pursuing their goals at home after discharge. RESULTS Analysis revealed that the experiences were related to five overarching themes: (1) things take time, (2) the importance of changing ways of thinking, (3) the pieces fall into place, (4) own health = own responsibility and (5) events outside of the plan. CONCLUSION At discharge, the participants had set between one and five long-term goals, focussing mainly on having a healthier lifestyle and a better quality of life. The study showed that, to a large extent, the participants employed different self-management strategies after discharge from rehabilitation. In addition, the findings demonstrated that they experienced certain challenges when pursuing their goals. These challenges were related to health problems and changes in routine, such as holidays. Health professionals should explain to participants who pursue their own rehabilitation goals after discharge that changes in habit require conscious decision-making, priority setting and time, as well as the importance of having alternative plans for holidays and periods of disease exacerbations.
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Affiliation(s)
- Bente Hamnes
- Hospital for Rheumatic Diseases, Lillehammer, Norway.,Department of Health Science Gjøvik, Norwegian University of Science and Technology, Gjøvik, Norway
| | - Gunnhild Berdal
- National Advisory Unit on Rehabilitation in Rheumatology, Diakonhjemmet Hospital, Oslo, Norway
| | - Ingvild Bø
- Hospital for Rheumatic Diseases, Lillehammer, Norway
| | - Ingvild Kjeken
- National Advisory Unit on Rehabilitation in Rheumatology, Diakonhjemmet Hospital, Oslo, Norway
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Ambrosino P, Iannuzzi GL, Formisano R, Spedicato GA, D'Abrosca V, Di Gioia L, Di Minno MND, Pappone N. Exergaming as an Additional Tool in Rehabilitation of Young Patients with Rheumatoid Arthritis: A Pilot Randomized Controlled Trial. Games Health J 2020; 9:368-375. [DOI: 10.1089/g4h.2019.0167] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Affiliation(s)
| | | | | | | | | | - Luisa Di Gioia
- Istituti Clinici Scientifici Maugeri IRCCS, Pavia, Italy
| | | | - Nicola Pappone
- Istituti Clinici Scientifici Maugeri IRCCS, Pavia, Italy
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Berdal G, Bø I, Dager TN, Dingsør A, Eppeland SG, Hagfors J, Hamnes B, Mowinckel P, Nielsen M, Sand-Svartrud AL, Slungaard B, Wigers SH, Hagen KB, Dagfinrud HS, Kjeken I. Structured Goal Planning and Supportive Telephone Follow-up in Rheumatology Care: Results From a Pragmatic, Stepped-Wedge, Cluster-Randomized Trial. Arthritis Care Res (Hoboken) 2019; 70:1576-1586. [PMID: 29361197 DOI: 10.1002/acr.23520] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2017] [Accepted: 01/16/2018] [Indexed: 11/10/2022]
Abstract
OBJECTIVE To evaluate patient-reported health effects of an add-on structured goal-planning and supportive telephone follow-up rehabilitation program compared with traditional rehabilitation programs in patients with rheumatic diseases. METHODS In this pragmatic stepped-wedge, cluster-randomized, controlled trial, 389 patients with rheumatic diseases recruited from 6 rehabilitation centers received either traditional rehabilitation or traditional rehabilitation extended with an add-on program tailored to individual needs. The add-on program comprised a self-management booklet, motivational interviewing in structured individualized goal planning, and 4 supportive follow-up phone calls after discharge. Data were collected by questionnaires on admission and discharge from rehabilitation stay, and at 6 months and 12 months after discharge. The primary outcome was health-related quality of life (HRQoL) measured by the Patient Generated Index (range 0-100, where 0 = low). Secondary outcomes included patient-reported health status, self-efficacy, pain, fatigue, global disease activity, and motivation for change. The main statistical analysis was a linear repeated measures mixed model performed on the intent-to-treat population using all available data. RESULTS A significant treatment effect of the add-on intervention on HRQoL was found on discharge (mean difference 3.32 [95% confidence interval 0.27, 6.37]; P = 0.03). No significant between-group differences were found after 6 or 12 months. Both groups showed positive changes in HRQoL following rehabilitation, which gradually declined, although the values remained at higher levels after 6 and 12 months compared with baseline values. CONCLUSION The add-on program enhanced the short-term effect of rehabilitation with respect to patient-specific HRQoL, but it did not prolong the effect as intended.
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Affiliation(s)
| | - Ingvild Bø
- Hospital for Rheumatic Diseases, Lillehammer, Norway
| | | | | | | | - Jon Hagfors
- Norwegian League Against Rheumatism, Oslo, Norway
| | - Bente Hamnes
- Hospital for Rheumatic Diseases, Lillehammer, Norway
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7
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Johansen I, Klokkerud M, Anke A, Børke JB, Glott T, Hauglie U, Høyem A, Klovning A, Lande KA, Larsen M, Nordvik JE, Wigers SH, Øyeflaten I, Hagen KB, Kjeken I. A quality indicator set for use in rehabilitation team care of people with rheumatic and musculoskeletal diseases; development and pilot testing. BMC Health Serv Res 2019; 19:265. [PMID: 31036000 PMCID: PMC6489243 DOI: 10.1186/s12913-019-4091-4] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2018] [Accepted: 04/10/2019] [Indexed: 01/08/2023] Open
Abstract
Background Systems for monitoring effectiveness and quality of rehabilitation services across health care levels are needed. The purpose of this study was to develop and pilot test a quality indicator set for rehabilitation of rheumatic and musculoskeletal diseases. Methods The set was developed according to the Rand/UCLA Appropriateness Method, which integrates evidence review, in-person multidisciplinary expert panel meetings and repeated anonymous ratings for consensus building. The quality indicators were pilot-tested for overall face validity and feasibility in 15 specialist and 14 primary care rehabilitation units. Pass rates (percentages of “yes”) of the indicators were recorded in telephone interviews with 29 unit managers (structure indicators), and 164 patients (process and outcome indicators). Time use and participants’ numeric rating of face validity (0–10, 10 = high validity) were recorded. Results Nineteen structure, 12 process and five outcome indicators were developed and piloted. Mean (range) sum pass rates for the structure, process and outcome indicators were 59%(84%), 66%(100%) and 84%(100%), respectively. Mean (range) face validity score for managers/patients was 8.3 (8)/7.9 (9), and mean answering time was 6.0/5.5 min. The final indicator set consists of 19 structure, 11 process and three outcome indicators. Conclusion To our knowledge this is the first quality indicator set developed for rehabilitation of rheumatic and musculoskeletal diseases. Good overall face validity and a feasible format indicate a set suitable for monitoring quality in rehabilitation. The variation in pass rates between centers indicates a potential for quality improvement in rheumatic and musculoskeletal rehabilitation in Norway. Electronic supplementary material The online version of this article (10.1186/s12913-019-4091-4) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Inger Johansen
- National Advisory Unit on Rehabilitation in Rheumatology, Diakonhjemmet Hospital, P.O. Box 23, 0319, Oslo, Norway. .,Department of General Practice, Institute of Health and Society, Faculty of Medicine, University of Oslo, P.O. Box 1130 Blindern, 0318, Oslo, Norway.
| | - Mari Klokkerud
- National Advisory Unit on Rehabilitation in Rheumatology, Diakonhjemmet Hospital, P.O. Box 23, 0319, Oslo, Norway
| | - Audny Anke
- Department of Rehabilitation, University Hospital of North Norway, Tromsø, Norway.,Faculty of Health Sciences, Department of Clinical Medicine, UiT The Arctic University of Norway, Tromsø, Norway
| | - Janne-Birgitte Børke
- Department of Physical Medicine and Rehabilitation, St. Olavs Hospital, Trondheim University Hospital, Trondheim, Norway
| | - Thomas Glott
- Sunnaas Rehabilitation Hospital, 1453, Bjørnemyr, Norway
| | - Uno Hauglie
- The Municipality of Sandefjord, PO Box 2025, 3202, Sandefjord, Norway
| | - Audhild Høyem
- Centre for Quality Improvement and Development, University Hospital of North Norway, Box 20, N-9038, Tromsø, Norway
| | - Atle Klovning
- Department of General Practice, Institute of Health and Society, Faculty of Medicine, University of Oslo, P.O. Box 1130 Blindern, 0318, Oslo, Norway
| | | | - Mona Larsen
- Norwegian Rheumatism Association, PO Box 2653, Solli, N-0203, Oslo, Norway
| | | | - Sigrid H Wigers
- Unicare Jeløy Rehabilitation Centre, Bråtengaten 94, N-1515, Moss, Norway
| | - Irene Øyeflaten
- National Advisory Unit on Occupational Rehabilitation, Haddlandsvegen 20. 3864, Rauland, Norway.,Uni Research Health, Nygårdsgaten 112, 5008, Bergen, Norway
| | - Kaare Birger Hagen
- National Advisory Unit on Rehabilitation in Rheumatology, Diakonhjemmet Hospital, P.O. Box 23, 0319, Oslo, Norway
| | - Ingvild Kjeken
- National Advisory Unit on Rehabilitation in Rheumatology, Diakonhjemmet Hospital, P.O. Box 23, 0319, Oslo, Norway
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8
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Dager TN, Kjeken I, Berdal G, Sand-Svartrud AL, Bø I, Dingsør A, Eppeland SG, Hagfors J, Hamnes B, Nielsen M, Slungaard B, Wigers SH, Hauge MI. Rehabilitation for patients with rheumatic diseases: Patient experiences of a structured goal planning and tailored follow-up programme. SAGE Open Med 2017; 5:2050312117739786. [PMID: 29163943 PMCID: PMC5682579 DOI: 10.1177/2050312117739786] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2017] [Accepted: 10/04/2017] [Indexed: 12/20/2022] Open
Abstract
OBJECTIVE To explore the significance of the content of rehabilitation in terms of achieving a personal outcome, and to understand the significance of tailored follow-up interventions for individual efforts to prolong health behaviour change after rehabilitation. DESIGN Semi-structured interviews with patients who had received an extended rehabilitation programme. All interviews were transcribed verbatim. A thematic analysis was applied. SUBJECTS A purposeful sample of 18 patients with rheumatic diseases who had attended specialized multidisciplinary rehabilitation with an extended programme consisting of a self-help booklet, structured goal-setting talks and tailored follow-up calls based on motivational interviewing. RESULTS Four overarching and interrelated themes were identified. Experienced Person-centred interventions represented a basis for the patients' motivation and personal outcomes. Confident self-management describes a new confident approach to exercise and illness management after rehabilitation with person-centred interventions. For many, this included reaching a different mindset, a change of illness perception. Continuity of the personal outcomes describes the importance of follow-up telephone calls to maintain the focus on goals and continued efforts. Building on established relationships and practising person-centred communication were essential. CONCLUSION Tailoring of communication and rehabilitation interventions may be a premise for enhancing health behaviour, including a beneficial illness perception. Structured goal setting and follow-up telephone calls using motivational interviewing enhance motivation and may contribute to prolonged goal attainment.
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Affiliation(s)
- Turid Nygaard Dager
- Norwegian National Advisory Unit on Rehabilitation in Rheumatology, Department of Rheumatology, Diakonhjemmet Hospital, Oslo, Norway
- Norwegian National Unit for Rehabilitation for Rheumatic Patients, Department of Rheumatology, Diakonhjemmet Hospital, Oslo, Norway
| | - Ingvild Kjeken
- Norwegian National Advisory Unit on Rehabilitation in Rheumatology, Department of Rheumatology, Diakonhjemmet Hospital, Oslo, Norway
| | - Gunnhild Berdal
- Norwegian National Advisory Unit on Rehabilitation in Rheumatology, Department of Rheumatology, Diakonhjemmet Hospital, Oslo, Norway
| | - Anne-Lene Sand-Svartrud
- Norwegian National Advisory Unit on Rehabilitation in Rheumatology, Department of Rheumatology, Diakonhjemmet Hospital, Oslo, Norway
- Norwegian National Unit for Rehabilitation for Rheumatic Patients, Department of Rheumatology, Diakonhjemmet Hospital, Oslo, Norway
| | - Ingvild Bø
- Department of Rehabilitation, Lillehammer Hospital for Rheumatic Diseases, Lillehammer, Norway
| | - Anne Dingsør
- Department of Rheumatology, Betanien Hospital, Skien, Norway
| | | | - Jon Hagfors
- The Norwegian Rheumatism Association, Oslo, Norway
| | - Bente Hamnes
- Department of Self-management, Lillehammer Hospital for Rheumatic Diseases, Lillehammer, Norway
| | | | - Bente Slungaard
- Department of Rheumatology, Martina Hansens Hospital, Bærum, Norway
| | | | - Mona-Iren Hauge
- Department of Psychology, Faculty of Social Sciences, University of Oslo, Oslo, Norway
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9
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Klokkerud M, Dagfinrud H, Uhlig T, Dager TN, Furunes KA, Klokkeide Å, Larsen M, Nygård S, Nylenna S, Øie L, Kjeken I. Developing and testing a consensus-based core set of outcome measures for rehabilitation in musculoskeletal diseases. Scand J Rheumatol 2017; 47:225-234. [PMID: 28988517 DOI: 10.1080/03009742.2017.1347959] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
OBJECTIVES Rehabilitation is important for people with musculoskeletal diseases (MSDs), and evaluating the effect of rehabilitation on both an individual and group level is advocated. A consensus concerning use of outcome measures will improve collaboration between healthcare providers, and increase the possibility of conducting meta-analyses in future research. The aim of this study was to develop a consensus-based core set of outcome measures for rehabilitation in MSDs, and to test the feasibility and responsiveness of the set. METHOD The core set was developed through a stepwise process comprising a Delphi consensus procedure, systematic literature searches, and a pilot study, including 386 patients, to test the feasibility and responsiveness of the set. RESULTS The following aspects and outcome measures were selected: pain [numeric rating scale (NRS)], fatigue (NRS), physical fitness (the 30-second Sit to Stand test), mental health (Hopkins Symptom Checklist 5), daily activities (Hannover Functional Questionnaire), goal attainment (Patient-Specific Functional Scale including motivation score for baseline assessment), quality of life (5-level EuroQol 5 Dimensions), social participation (the social participation item from COOP/WONCA) and coping (Effective Musculoskeletal Consumer Scale-17). All tested outcome measures were found to be feasible, with high completion rates and acceptable score distribution. Standard response means varied from 0.3 to 0.9. CONCLUSIONS A consensus-based core set of patient reported outcome measures is presented for evaluating rehabilitation in MSDs. The core set is feasible and responsive for use in Norway, but needs further testing in other countries.
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Affiliation(s)
- M Klokkerud
- a National Advisory Unit on Rehabilitation in Rheumatology, Department of Rheumatology , Diakonhjemmet Hospital , Oslo , Norway
| | - H Dagfinrud
- a National Advisory Unit on Rehabilitation in Rheumatology, Department of Rheumatology , Diakonhjemmet Hospital , Oslo , Norway
| | - T Uhlig
- a National Advisory Unit on Rehabilitation in Rheumatology, Department of Rheumatology , Diakonhjemmet Hospital , Oslo , Norway
| | - T N Dager
- b Norwegian National Unit for Rehabilitation for Rheumatic Patients with Special Needs, Department of Rheumatology , Diakonhjemmet Hospital , Oslo , Norway
| | | | - Å Klokkeide
- d Haugesund Rheumatism Hospital AS , Haugesund , Norway
| | - M Larsen
- e The Norwegian Rheumatism Association , Oslo , Norway
| | - S Nygård
- f Municipality of Skedsmo , Skedsmo , Norway
| | - S Nylenna
- g Patient Research Panel, Department of Rheumatology , Diakonhjemmet Hospital , Oslo , Norway
| | - L Øie
- h North-Norway Rehabilitation Center , Tromsø , Norway
| | - I Kjeken
- a National Advisory Unit on Rehabilitation in Rheumatology, Department of Rheumatology , Diakonhjemmet Hospital , Oslo , Norway
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10
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Mengshoel AM, Skarbø Å. Rehabilitation needs approached by health professionals at a rheumatism hospital. Musculoskeletal Care 2017; 15:210-217. [PMID: 27748577 DOI: 10.1002/msc.1162] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
OBJECTIVE The aim of the present study was to examine the characteristics of patients referred to occupational therapists (OTs), physiotherapists (PTs) and social workers (SWs) at a rehabilitation unit in a hospital specializing in rheumatology, and the rehabilitation needs that clinicians and patients agreed should be addressed in the encounters with the particular health professional groups. METHODS Consecutive hospitalized patients at a rheumatism hospital were recruited by the health professionals. Questions about patient characteristics and rehabilitation needs were posed. Free-text responses to questions about rehabilitation needs were coded by the International Classification of Functioning, Disability, and Health (ICF). RESULTS The patients varied considerably in age distribution, disease duration, disability level and diagnoses, and several patients had comorbidities. The rehabilitation needs classified under the component Body Function fell into the chapters: Sensory Functions and Pain (PTs), Functions of Cardiovascular System (PTs), Neuromusculoskeletal and Movement-Related Functions (OTs, PTs); under the Activity and Participation component, these were: General Tasks and Demands (OTs), Mobility (OTs), Self-Care (PTs), Interpersonal Interactions and Relationships (SWs) and Major Life Stress (SWs); and under the Environmental Factors component these were: Products and Technology (OTs) and Services, Systems and Politics (SWs). CONCLUSIONS The patients were fairly heterogeneous. The needs identified in the encounters with the different professional groups fell into all three components of the ICF, and there was only a minor overlap between the health professionals at the chapter level of the ICF.
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Affiliation(s)
- Anne Marit Mengshoel
- Department of Health Sciences, Institute of Health and Society, Medical Faculty, University of Oslo, Norway
- Hospital for Rheumatic Diseases, Lillehammer, Norway
| | - Åse Skarbø
- Hospital for Rheumatic Diseases, Lillehammer, Norway
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11
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Hamnes B, van Eijk-Hustings Y, Primdahl J. Readability of patient information and consent documents in rheumatological studies. BMC Med Ethics 2016; 17:42. [PMID: 27422433 PMCID: PMC4947296 DOI: 10.1186/s12910-016-0126-0] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2016] [Accepted: 06/22/2016] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Before participation in medical research an informed consent must be obtained. This study investigates whether the readability of patient information and consent documents (PICDs) corresponds to the average educational level of participants in rheumatological studies in the Netherlands, Denmark, and Norway. METHODS 24 PICDs from studies were collected and readability was assessed independently using the Gunning's Fog Index (FOG) and Simple Measure of Gobbledygook (SMOG) grading. RESULTS The mean score for the FOG and SMOG grades were 14.2 (9.0-19.0) and 14.2 (12-17) respectively. The mean FOG and SMOG grades were 12.7 and 13.3 in the Dutch studies, 15.0 and 14.9 in the Danish studies, and 14.6 and 14.3 in the Norwegian studies, respectively. Out of the 2865 participants, more than 57 % had a lower educational level than the highest readability score calculated in the individual study. CONCLUSIONS As the readability level of the PICDs did not match the participants' educational level, consent may not have been valid, as the participants may have had a limited understanding of what they agreed to participate in. There should be more focus on the readability of PICDs. National guidelines for how to write clear and unambiguous PICDs in simple and easily understandable language could increase the focus on the readability of PICD.
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Affiliation(s)
- Bente Hamnes
- />Hospital for Rheumatic Diseases, Margrethe Grundvigs vei 6, 2609 Lillehammer, Norway
| | - Yvonne van Eijk-Hustings
- />Department of Patient & Care, Maastricht University Medical Centre, PO Box 5800, 6202 AZ Maastricht, The Netherlands
| | - Jette Primdahl
- />Institute for Regional Health Research, University of Southern Denmark, Winsløwparken 19, 5000 Odense, Denmark
- />Hospital of Southern Denmark, Kresten Philipsens vej 15, 6200 Aabenraa, Denmark
- />King Christian 10th Hospital for Rheumatic Diseases, Toldbodgade 3, 6300 Graasten, Denmark
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Garratt AM, Klokkerud M, Løchting I, Hagen KB. Rasch analysis of the Norwegian version of the Arthritis Self-Efficacy Scale (ASES). Scand J Rheumatol 2016; 46:33-39. [PMID: 27187620 DOI: 10.3109/03009742.2016.1155644] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
OBJECTIVES To apply the Rasch model to the Norwegian version of the Arthritis Self-Efficacy Scale (ASES). METHOD The ASES was included in a self-administered questionnaire sent to 224 patients attending one of three rehabilitation centres for rheumatic diseases in Norway in 2009. The fit of the ASES to the Rasch model was assessed together with hypothesized associations with the Modified Health Assessment Questionnaire (MHAQ), the 36-item Short Form Health Survey (SF-36), the numerical rating scale (NRS) for pain, and NRS fatigue. RESULTS A total of 145 (64.7%) patients responded to the questionnaire. The two scales of other symptoms and pain showed good fit to the Rasch model with no evidence for differential item functioning (DIF) according to eight sociodemographic and disease-related variables. The Person Separation Index (PSI), which is equivalent to Cronbach's alpha, ranged from 0.74 to 0.78. Correlations with scores for other instruments were as hypothesized: ASES pain had the highest correlations with SF-36 pain and NRS pain and ASES other symptoms had the highest correlations with other aspects of the SF-36 and NRS fatigue. CONCLUSIONS The ASES had good fit to the Rasch model and correlations with other instrument scores that followed hypotheses, lending further support to the application of the instrument in patients with rheumatic diseases.
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Affiliation(s)
- A M Garratt
- a National Advisory Unit on Rehabilitation in Rheumatology , Diakonhjemmet Hospital , Oslo , Norway.,b Knowledge Centre for the Health Services , Norwegian Institute for Public Health , Oslo , Norway
| | - M Klokkerud
- a National Advisory Unit on Rehabilitation in Rheumatology , Diakonhjemmet Hospital , Oslo , Norway
| | - I Løchting
- c Communication and Research Unit for Musculoskeletal Disorders (FORMI) , Oslo University Hospital , Oslo , Norway
| | - K B Hagen
- a National Advisory Unit on Rehabilitation in Rheumatology , Diakonhjemmet Hospital , Oslo , Norway
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Uhlig T, Bjørneboe O, Krøll F, Palm Ø, Olsen IC, Grotle M. Involvement of the multidisciplinary team and outcomes in inpatient rehabilitation among patients with inflammatory rheumatic disease. BMC Musculoskelet Disord 2016; 17:18. [PMID: 26762160 PMCID: PMC4711082 DOI: 10.1186/s12891-016-0870-9] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/27/2015] [Accepted: 01/05/2016] [Indexed: 12/03/2022] Open
Abstract
Background The last decades have for patients with inflammatory rheumatic diseases seen a shift towards more physically active rehabilitation programs, often provided as out-patients with less use of inpatient facilities. There is little research on which effect the multidisciplinary team has on health outcomes for patients with rheumatoid arthritis, psoriatic arthritis, ankylosing spondylitis, and connective tissue disease. This study examined patient reported outcomes for patients with inflammatory rheumatic diseases receiving rehabilitation care as inpatients in departments of rheumatology, and studied how number of consultations with the multidisciplinary team affected these clinical outcomes. Methods Patients with inflammatory rheumatic diseases were included in a multi-center prospective observational study if rehabilitation was considered a focus during an inpatient stay at four departments of rheumatology. At admission, discharge, and after 3 and 6 months, 317 patients were assessed with patients reported outcomes (PRO) including health assessment questionnaire (HAQ), short-form 36 (SF-36), pain, fatigue, patient global assessment of disease activity, self-efficacy scales, rheumatoid arthritis disease activity index (RADAI), and SF-6D utility. Patients stated consultations with the multidisciplinary team. Results Improvements were short-lived, and at 6 months follow-up period only mental health, pain and utility remained improved with small effect sizes. Extensive involvement of health professionals was not associated with improved outcomes. Conclusions Patients with inflammatory rheumatic disease receiving inpatient multidisciplinary rehabilitation had small and mainly short-term improvements in most PROs. High use of the multidisciplinary team did not enhance or preserve rehabilitation outcomes in inflammatory rheumatic conditions when admitted as inpatients.
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Affiliation(s)
- Till Uhlig
- Department of Rheumatology, From the National Advisory Unit on Rehabilitation in Rheumatology, Diakonhjemmet Hospital, Oslo, Norway. .,Institute of Clinical Medicine, University of Oslo, Oslo, Norway.
| | | | | | | | - Inge Christoffer Olsen
- Department of Rheumatology, From the National Advisory Unit on Rehabilitation in Rheumatology, Diakonhjemmet Hospital, Oslo, Norway.
| | - Margreth Grotle
- Oslo and Akershus University College of Applied Sciences, Oslo, Norway. .,Oslo University Hospital, FORMI, Oslo, Norway.
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Bearne LM, Byrne AM, Segrave H, White CM. Multidisciplinary team care for people with rheumatoid arthritis: a systematic review and meta-analysis. Rheumatol Int 2015; 36:311-24. [PMID: 26563338 DOI: 10.1007/s00296-015-3380-4] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2015] [Accepted: 10/05/2015] [Indexed: 10/22/2022]
Abstract
The objective of this study was to systematically review the evidence from randomised controlled trials (RCTs) evaluating the effectiveness of multidisciplinary team (MDT) care for the management of disability, disease activity and quality of life (QoL) in adults with rheumatoid arthritis (RA). Data sources identified published (MEDLINE, PsychINFO, EMBASE, CINAHL, Web of Science, CENTRAL) and unpublished (OpenGrey) literature. Independent data extraction and quality assessment, using the Cochrane risk of bias tool, were conducted by two reviewers. The primary outcome was change in disability at 12 months; secondary outcomes included disability at other time points and disease activity and QoL at 12 months. Where possible, the pooled effect sizes were calculated for inpatient or outpatient MDT interventions. Four hundred and fifteen studies were retrieved. Twelve manuscripts, which reported 10 RCTs, representing 1147 participants were included. Only data from five high- or moderate-quality trials were pooled according to clinical setting. There was no difference in disability between inpatient MDT care and any comparison group [mean difference (95% confidence intervals) 0.04, -0.13 to 0.20] or between outpatient MDT care and comparison groups (0.09, -0.07 to 0.25) at 12 months. There was no difference in disability at 2 years or <12 months or disease activity and QoL at 12 months between MDT care and any comparison group. There is limited evidence evaluating the effect of MDT care on disability, disease activity or QoL in people with RA. There is likely to be no effect of MDT care on disability at 12 months or other time points.
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Affiliation(s)
- Lindsay M Bearne
- Division of Health and Social Care Research, Faculty of Life Science & Medicine, King's College London, Shepherd's House, Guy's Campus, London, SE1 1UL, UK.
| | - Anne-Marie Byrne
- Division of Health and Social Care Research, Faculty of Life Science & Medicine, King's College London, Shepherd's House, Guy's Campus, London, SE1 1UL, UK
| | - Hannah Segrave
- Division of Health and Social Care Research, Faculty of Life Science & Medicine, King's College London, Shepherd's House, Guy's Campus, London, SE1 1UL, UK
| | - Claire M White
- Division of Health and Social Care Research, Faculty of Life Science & Medicine, King's College London, Shepherd's House, Guy's Campus, London, SE1 1UL, UK
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Kjeken I, Berdal G, Bø I, Dager T, Dingsør A, Hagfors J, Hamnes B, Eppeland SG, Fjerstad E, Mowinckel P, Nielsen M, Rørstad RW, Sand-Svartrud AL, Slungaard B, Wigers SH, Hagen KB. Evaluation of a structured goal planning and tailored follow-up programme in rehabilitation for patients with rheumatic diseases: protocol for a pragmatic, stepped-wedge cluster randomized trial. BMC Musculoskelet Disord 2014; 15:153. [PMID: 24886382 PMCID: PMC4057897 DOI: 10.1186/1471-2474-15-153] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/25/2013] [Accepted: 04/09/2014] [Indexed: 11/10/2022] Open
Abstract
Background Comprehensive rehabilitation, involving health professionals from various disciplines, is widely used as an adjunct to pharmacological and surgical treatment in people with rheumatic diseases. However, the evidence for the clinical- and cost-effectiveness of such interventions is limited, and the majority of those who receive rehabilitation are back to their initial health status six to 12 months after discharge. Methods/design To evaluate the goal attainment, health effects and cost-effectiveness of a new rehabilitation programme compared to current traditional rehabilitation programmes for people with rheumatic diseases, a stepped-wedge cluster randomized trial will be performed. Patients admitted for rehabilitation at six centres in the south-eastern part of Norway will be invited to participate. In the trial, six participating centres will switch from a control (current rehabilitation programme) to an intervention phase (the new rehabilitation programme) in a randomized order. Supported by recent research, the new programme will be a supplement to the existing programme at each centre, and will comprise four elements designed to enhance and support lifestyle changes introduced in the rehabilitation period: structured goal-planning, motivational interviewing, a self-help booklet and four follow-up telephone calls during the first five months following discharge. The primary outcome will be health-related quality of life and goal attainment, as measured by the Patient Generated Index directly before and after the rehabilitation stay, as well as after six and 12 months. Secondary outcomes will include self-reported pain, fatigue, a global assessment of disease activity and motivation for change (measured on 11-point numeric ratings scales), health-related quality of life as measured by the Short Form 36 Health Survey (SF-36) and utility assessed by the SF6D utility index. The main analysis will be on an intention to treat basis and will assess the clinical- and cost-effectiveness of the structured goal planning and tailored follow-up rehabilitation programme for patients with rheumatic diseases. Discussion The findings will constitute an important contribution to more cost-effective- and evidence-based rehabilitation services for people with rheumatic diseases. Trial registration ISRCTN91433175.
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Affiliation(s)
- Ingvild Kjeken
- National Advisory Unit on Rehabilitation in Rheumatology, Department of Rheumatology, Diakonhjemmet Hospital, PO Box 23 Vinderen, N-0319 Oslo, Norway.
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Eppeland SG, Diamantopoulos AP, Soldal DM, Haugeberg G. Short term in-patient rehabilitation in axial spondyloarthritis - the results of a 2-week program performed in daily clinical practice. BMC Res Notes 2013; 6:185. [PMID: 23651526 PMCID: PMC3653691 DOI: 10.1186/1756-0500-6-185] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2012] [Accepted: 04/30/2013] [Indexed: 01/21/2023] Open
Abstract
Background From a health service perspective, society, with its limited resources, needs to be reassured that evidence-based medicine is also effective when carried out in the frame of ordinary clinical practice. The effectiveness of rehabilitation programs in ankylosing spondylitis (AS) has been proven to be effective in clinical trials. However, less is known when this is carried out in clinical practice. The aim of this study was to evaluate the effect of a 2-weeks rehabilitation program on self-reported outcome and physical function in patients with axial spondyloarthritis (ax-SpA) including AS patients carried out in ordinary clinical practice. The program contained of daily water exercises, exercises for flexibility, muscle strength, and cardio-respiratory fitness. Results A total of 87 ax-SpA patients (60 men, 27 women), aged ≥ 18 years were identified to have participated in the 2-weeks in-patient rehabilitation program. Mean age was 49 years and disease duration was 14 years. 92.5% were HLA-B27 positive, 62% were current users of non-steroidal anti-inflammatory drugs, and 17% were current users of tumour necrosis factor inhibitors. After 2-weeks, a statistical significant improvement (p < 0.001) was observed for patient-reported outcomes (Bath Ankylosing Spondylitis (BAS) Disease Activity Index 4.3 vs. 3.1, BAS Functional Index 3.1 vs. 2.4) and physical measured outcomes (BAS Metrology Index 3.23 vs. 2.29, Gait Velocity 2.2 vs. 2.6 m/s, timed-stands test 22.5 vs. 16.3 s, finger-floor distance 17.9 vs. 8.9 cm, chest expansion 3.9 vs. 4.6 cm). Conclusion Data, from our retrospective case series report, support that patient with ax-SpA benefit from short-term rehabilitation when it is carried out in ordinary clinical care. Data from ordinary clinical care may be important when discussing the effectiveness of a treatment and allocating resources in the health care system.
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Klokkerud M, Grotle M, Lochting I, Kjeken I, Hagen KB, Garratt AM. Psychometric properties of the Norwegian version of the Patient Generated Index in patients with rheumatic diseases participating in rehabilitation or self-management programmes. Rheumatology (Oxford) 2013; 52:924-32. [DOI: 10.1093/rheumatology/kes401] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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Løchting I, Fjerstad E, Garratt AM. Illness perceptions in patients receiving rheumatology rehabilitation: association with health and outcomes at 12 months. BMC Musculoskelet Disord 2013; 14:28. [PMID: 23324450 PMCID: PMC3556086 DOI: 10.1186/1471-2474-14-28] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/21/2012] [Accepted: 01/12/2013] [Indexed: 11/30/2022] Open
Abstract
Background Illness perceptions have been found to change over time and following health care. Hence, addressing illness perceptions alongside existing health care interventions may be important for the sustainment of health gains following rehabilitation. The aim of this study was to measure the illness perceptions of patients receiving inpatient rheumatology rehabilitation and assess the association with aspects of health and outcomes at baseline, discharge and 12 months. Methods Patients with a rehabilitation stay of one week or more at three institutions in Norway in 2009 were invited to participate in the study. At baseline, discharge and 12 months, patients completed The Rheumatic Disease Illness Perception Questionnaire (RD-IPQ) which includes aspects of illness perceptions important to patients with rheumatic diseases. Stepwise regression analysis was used to assess associations between RD-IPQ scores and different aspects of health at baseline and follow-up after controlling for other aspects of health and sociodemographic variables. Results For the 134 patients included in the study, baseline RD-IPQ scores had a mean of 58.2 (SD 14.9) on a 0–100 scale, where 100 is the worst possible. Scores showed improvement after the rehabilitation stay which were maintained at 12 months. RD-IPQ scores were positively associated with health and outcomes. At baseline RD-IPQ scores were statistically significant in explaining variation in pain, physical function and SF-36 mental health scores. Baseline RD-IPQ scores were significant in explaining fatigue, pain, SF-36 role limitations and social function scores following rehabilitation and at 12 months. Conclusion Illness perceptions as measured by the RD-IPQ were associated with health and outcomes as measured by rheumatology-specific and generic instruments. The consideration of illness perceptions as a component of rehabilitation may be important in achieving desired outcomes.
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Affiliation(s)
- Ida Løchting
- National Resource Centre for Rehabilitation in Rheumatology (NRRK), Department of Rheumatology, Diakonhjemmet Hospital, P.O. Box 23 Vinderen, Oslo 0319, Norway.
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Cost of illness for patients with arthritis receiving multidisciplinary rehabilitation care. Rehabil Res Pract 2011; 2011:487025. [PMID: 22110975 PMCID: PMC3195367 DOI: 10.1155/2011/487025] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2011] [Accepted: 04/14/2011] [Indexed: 11/17/2022] Open
Abstract
Purpose. To describe healthcare consumption and costs prior to, during, and after multidisciplinary rehabilitation due to arthritis. Methods. 306 patients (age 18-75 years) with arthritis scheduled for multidisciplinary rehabilitation care in 9 rehabilitation centres and 4 rheumatology hospital departments were included and followed for 6 months. Costs were estimated in Euros (€) for the total sample and five clinical subgroups. Results. Healthcare costs ranged from €3,033 to €91,336 and were significantly higher at hospital departments compared to rehabilitation centres: €9,722 (SD 5,406) and €4,250 (SD 1,040). While total costs prior to and after rehabilitation were stable for those receiving rehabilitation at a hospital, there was a significant increase in costs for those being at a rehabilitation centre. Total mean costs were more than doubled when including social costs: from €32,410 (95% CI 20,074-37,017) to €51,491 (95% CI 49,055-61,657). Conclusions. Healthcare and social costs for arthritis rehabilitation were substantial both before and after a rehabilitation stay. It is important to explore methods to reduce the length of rehabilitation stay and production loss connected to rehabilitation of patients with rheumatic disease.
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