Background Rehabilitation for people with rheumatic disorders (15% of worldwide population) is a long term project (Stoffer et al. 2015). Rheumatic patients do not exercise as often as recommended (Holm et al. 2015). Intensive multidisciplinary interventions in rehabilitation-centers are in some countries an option – of which there is little effect knowledge. Perhaps data from a quality-management report can shed some preliminary light on this subject.
Objectives Primarily to observe short and long term effects of a three weeks intensive multidisciplinary program for people with rheumatic disorders, and secondary to see if a correlation can be found between level of training frequency and levels of pain, stiffness, and self rated health.
Methods 738 patients (age 62.0+11.1, 84% women), followed a three weeks multidisciplinary program of individual and group sessions - with physiotherapy as main focus - during the period of August 2010 to September 2016 at Skogli Health- and Rehabilitation Center, Lillehammer, Norway.
3-month follow-up: N=252 and 12-month follow-up: N=118. Data from self-reported questionnaires at T1-T4 was gathered. Paired sampled T-tests and Pearson product-moment correlation coefficients was used to analyze the data obtained, using IBM SPSS Statistics v.23.
NRS-11 for pain and stiffness at baseline (T1), at discharge (T2), and at 3- (T3) and 12 months (T4) after discharge.
Likert scale (1–6) for self-rated level of health at T1, T2, T3 and T4.
Self-reported level of training frequency at T1, T3 and T4
Results There was a clear mean improvement (p<0.0001) on all factors at T2 of moderate/large effect-size. At T3 there was a mean improvement (p<0.05) on all factors, except pain, of small/moderate effect size. There was a mean improvement (p<0.05) on self-rated level of health and training frequency at T4 of a small effect size. Worth noting is that the degree of stiffness and pain at T4 is back to T1-level.
There was a correlation (p<0.05) between level of training frequency and self-rated level of health (small at T1/T3, medium at T4), but no correlation between level of training frequency and level of pain or stiffness, at any time. This suggests that a higher training frequency is associated with a higher sense of health – regardless of symptom levels.
Conclusions People with rheumatic disorders seem to have a very positive short term effect on all aspects after a three week intensive multidisciplinary program, but gradually return to pre-rehab levels during the following year – especially regarding symptoms like stiffness and pain. At the same time there seems to be a much slower decline in self-rated level of health – especially for those who regularly exercise. Properly randomized controlled trials are however needed to be able to draw any clear conclusions.
Implications There might be a need for intensive multidisciplinary programs for rheumatic patients at intervals of less than a year, to be able to better keep the general health and function gained. Another possible implication is to implement a stronger focus on teaching rheumatic patients the necessity for an active lifestyle – including regular exercises – for them to be able to maintain their sense of general health, regardless of symptom levels.
Stoffer MA, Smolen JS, et al. Ann Rheum Dis 2015; 74: 1145–1149.
Holm I, Tveter AT, et al. Physiotherapy 2015; 101 (3): 273–8.
Disclosure of Interest None declared