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OP0255-HPR An add-on programme improved the short-term, but not the long-term effect of rehabilitation in patients with rheumatic diseases: results from a pragmatic multi-centre stepped-wedge cluster randomized controlled trial
  1. G Berdal1,
  2. K Hagen1,
  3. H Dagfinrud1,
  4. P Mowinckel1,
  5. I Bø2,
  6. TN Dager1,
  7. A Dingsør3,
  8. S Eppeland4,
  9. J Hagfors5,
  10. B Hamnes2,
  11. M Nielsen5,
  12. A-L Sand-Svartrud1,
  13. B Slungaard6,
  14. S Wigers7,
  15. I Kjeken1
  1. 1National advisory unit on rehabilitation in rheumatology, Diakonhjemmet Hospital, Oslo
  2. 2Hospital for Rheumatic Diseases, Lillehammer
  3. 3Betanien Hospital, Skien
  4. 4Sørlandet Hospital, Arendal
  5. 5The Norwegian Rheumatism Association, Oslo
  6. 6Martina Hansen's Hospital, Bærum
  7. 7Jeløy Kurbad Rehabilitation Center, Moss, Norway

Abstract

Background Multidisciplinary rehabilitation is widely used alongside medical treatment of patients with rheumatic diseases. Although beneficial effects of such rehabilitation have been demonstrated, patients are mostly back to their initial health status 6 to 12 months after discharge.

Objectives To evaluate an add-on rehabilitation programme designed to enhance and prolong the effect of rehabilitation in adult patients with rheumatic diseases.

Methods We conducted a pragmatic multi-centre stepped-wedge cluster randomized controlled trial in six rehabilitation centres in Norway. All centres started simultaneously to include patients in the control phase (traditional rehabilitation), whereupon they switched to the intervention phase (add-on programme) sequentially and in randomised order. The add-on programme comprised structured individualized goal planning, motivational interviewing, a self-help booklet and four supportive follow-up phone calls the first five months after discharge. Data were collected on admission, discharge, 6 and 12 months after discharge. Primary outcome was health related quality of life (HR-QoL) measured by the individualized Patient Generated Index (PGI). The main statistical analysis was a linear repeated measures mixed model performed on the intention to treat population (all available data).

Results 389 patients with various rheumatic diseases (SpA, RA, OA, and SLE) were included (table 1). A significant treatment effect of the add-on intervention on HR-QoL was found on discharge (mean difference =3.32 [95% CI: 0.27, 6.37], p=0.03). There were no significant differences between the groups at 6 and 12 months. Treatment compliance was 94%, and response rate >80% at all time points. Both groups showed a positive effect of rehabilitation in terms of increased HR-QoL at discharge, which subsequently declined, although the values remained at higher levels after 6 and 12 months compared with baseline values (figure 1).

Table 1.

Baseline characteristics of included patients (n=389)

Conclusions The add-on intervention enhanced the short-term effect of rehabilitation with respect to HR-QoL, but did not prolong the effect as intended. The findings suggest that individualized structured goal planning should be considered important and relevant in rehabilitation of patients with rheumatic diseases. Although this study evaluated the effect of a complex intervention, and not the effect of single components, the results indicate that supportive telephone follow-up after discharge do not prolong the effect of rehabilitation. However, this study showed a longer lasting effect of rehabilitation in both the control- and intervention group, compared to previous reports.

Disclosure of Interest None declared

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