Background Current inpatient rheumatology care is provided by short hospital stays and with focus on advanced management of complicated conditions. Limited research exists on the effect of multidisciplinary rehabilitation on health outcomes within such hospital settings.
Objectives To explore whether use of the multidisciplinary health care team changes health outcomes after inpatient hospital rehabilitation of patients with inflammatory rheumatic diseases.
Methods In a prospective multicenter study four departments of rheumatology included patients with inflammatory rheumatic diseases if rehabilitation at admission was expected to be a focus, i.e. consultation with at least two different health professions (besides doctor and nurse), and hospitalization duration for at least one week. Patients completed a questionnaire at admission, discharge and after 3 and 6 months. Health outcome measures were pain and fatigue on 100 mm visual analogue scales, HAQ, SF-36 physical and mental component, patient reported global disease activity, Rheumatoid Arthritis Disease Activity index (RADAI), coping with pain and symptoms (Self-Efficacy Scales), and the utility measure SF-6D. Patients reported number and type of consultations with health professions which they had during the inpatient stay and during the last year before admission.
Linear regressions mixed models were applied with the different health outcomes as dependent variables, and with specific analysis of the interaction between use of the multidisciplinary team*time. Use of the multidisciplinary team during and before rehabilitation was categorized (highest versus lowest tertile).
Of 373 patients included, 317 (85.0%) completed 6 month follow-up period with diagnosis rheumatoid arthritis (52.5%), ankylosing spondylitis (19.3%), psoriatric arthritis (17.7%), collagenosis or other conditions (10.5%). Mean age (SD) was 53.3 (14.0) years, disease duration 13.1 (10.9) years, hospitalisation duration 13.4 (6.4) days, 77% females).
Results The number of different health professions consulted by patients was mean 4.9 (SD 1.8) during and 3.6 (SD 1.8) during the year before the rehabilitation stay. All the assessed health outcomes were statistically significantly improved at discharge after adjusting for age, gender, diagnosis, education, baseline level of respective outcome, and multidisciplinary involvement. However, at 3 months followup only pain, fatigue, and at 3 and 6 months onlySF-6D utility and SF36 mental component remained slightly improved
Importantly, extensive consultations with members of the multidisciplinary team during the stay (highest tertile ≥6 professions) or before rehabilitation (≥5 professions) was not independently associated with consistent change in any of the measured health outcomes during rehabilitation or at 3 or 6 months followup. However, patients with higher levels physical disability and fatigue had higher use of multidisciplinary team (both p<0.05).
Conclusions Extensive use of the multidisciplinary team during or in the last year before inpatient rehabilitation in departments of rheumatology was not independently associated with improvement of any health outcomes in patients with inflammatory rheumatic diseases and may present a marker of rehabilitation need rather than predictor of improvement.
Disclosure of Interest None declared
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