Arthritis, Back Pain, Chronic Disease, Hypertension, Obesity
Conditions
Keywords
Occupational therapy, Physical therapy techniques, Primary health care, Chronic disease, Rehabilitation, Disease management, Self care
Brief summary
The purpose of the study is to determine whether occupational therapy and physiotherapy delivered in a primary care setting to adults with chronic illness is effective in improving health.
Detailed description
Primary health care is changing so that people receive the care that they need at the front line. Rehabilitation has been identified as one service that should be offered in primary care, to address the needs of adults who have or are at risk of poor health from chronic conditions such as arthritis, heart disease and depression. Two full time therapists (one physiotherapist and one occupational therapist) will offer rehabilitation to a sample of 170 adults with chronic illness over an 18 month period (170 people will also be enrolled in a control group) at the Stonechurch Family Health Centre. Key outcomes include health, hospital admissions and emergency room visits.
Interventions
BEHAVIORALOccupational therapy
BEHAVIORALPhysiotherapy
BEHAVIORALSelf-management
Sponsors
Ontario Ministry of Health and Long Term Care
Hamilton Health Sciences Corporation
Study design
Allocation
RANDOMIZED
Intervention model
PARALLEL
Primary purpose
TREATMENT
Masking
SINGLE (Outcomes Assessor)
Eligibility
Sex/Gender
ALL
Age
44 Years to No maximum
Healthy volunteers
No
Inclusion criteria
* At least 1 chronic condition * 3 visits to family physician in the past year
Exclusion criteria
* None
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| SF-36 Physical Component | 15 months | health related quality of life. Minimum: 0; Maximum 100. |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| Independence in Activities of Daily Living (ADLs) and Instrumental Activities of Daily Living (IADLs) | baseline, 15 months | Late Life Function and Disability Instrument: A measure of disability and functional limitations in older adults. (Score range 0-100 with 100 representing better ability and less disability/functional limitation) |
| Functional Limitations | baseline, 15 months | Late Life Function and Disability Instrument: A measure of functional limitations and disability in older adults. |
| Falls and Injuries | baseline, 15 months | self-reported number of falls in last 6 months |
| Use of Hospital Services | baseline, 15 months | self report use of hospital service |
| Self-management and Self-efficacy | baseline, 15 months | Individual's self-reported ability to carry out behaviours to self-manage their health condition, and their confidence level in being able to carry out these behaviours. (Score range 0= not confident at all, 10= totally confident). |
| Physical Abilities (Strength, Balance) | baseline, 15 months | Grip strength was measured using a JAMAR hand grip dynamometer (in kilograms). The Lower Extremity Function test is a battery of three tests used to measure lower extremity function and balance: a balance test, 8 foot walk test, and repetitive standing from a chair. A performance summary score is created by adding the number of seconds achieved on the balance test, the number of seconds to walk 8 feet and the number of seconds it takes the person to stand up from a chair five times consecutively (no maximum score exists on this measure). |
| Patient Satisfaction Questionnaire - 18 (Modified) | 15 months | Patient satisfaction with the care they received. (Score range 0-5) |
| HOME Falls and Accident Screening Tool (FAST) | baseline, 15 months | This is a home assessment of safety hazards for falls present in the individual's home. This tool helps to identify seniors at risk of falls. Score 0-25. |
Countries
Canada
Participant flow
Recruitment details
All participants recruited from a family health practice.
Participants by arm
| Arm | Count |
|---|---|
| Intervention Group A rehabilitation multi-component intervention delivered by a physiotherapist and occupational therapist in a primary care setting included collaborative goal setting for rehabilitation needs, a six-week chronic disease self-management workshop, referral to community programs and a web-based education programme. | 152 |
| Control Group Usual care from the primary health care team which did not include physiotherapy or occupational therapy. | 151 |
| Total | 303 |
Baseline characteristics
| Characteristic | Intervention Group | Control Group | Total |
|---|---|---|---|
| Age, Categorical <=18 years | 0 Participants | 0 Participants | 0 Participants |
| Age, Categorical >=65 years | 66 Participants | 65 Participants | 131 Participants |
| Age, Categorical Between 18 and 65 years | 86 Participants | 86 Participants | 172 Participants |
| Sex: Female, Male Female | 98 Participants | 94 Participants | 192 Participants |
| Sex: Female, Male Male | 54 Participants | 57 Participants | 111 Participants |
Adverse events
| Event type | EG000 affected / at risk | EG001 affected / at risk |
|---|---|---|
| deaths Total, all-cause mortality | — / — | — / — |
| other Total, other adverse events | 0 / 152 | 0 / 151 |
| serious Total, serious adverse events | 0 / 152 | 0 / 151 |
Outcome results
Primary
SF-36 Physical Component
health related quality of life. Minimum: 0; Maximum 100.
Time frame: 15 months
| Arm | Measure | Value (MEAN) | Dispersion |
|---|---|---|---|
| Intervention Group | SF-36 Physical Component | 42.6 units on a scale | Standard Deviation 11.8 |
| Control Group | SF-36 Physical Component | 43.1 units on a scale | Standard Deviation 11.9 |
Secondary
Falls and Injuries
self-reported number of falls in last 6 months
Time frame: baseline, 15 months
Secondary
Functional Limitations
Late Life Function and Disability Instrument: A measure of functional limitations and disability in older adults.
Time frame: baseline, 15 months
Secondary
HOME Falls and Accident Screening Tool (FAST)
This is a home assessment of safety hazards for falls present in the individual's home. This tool helps to identify seniors at risk of falls. Score 0-25.
Time frame: baseline, 15 months
Secondary
Independence in Activities of Daily Living (ADLs) and Instrumental Activities of Daily Living (IADLs)
Late Life Function and Disability Instrument: A measure of disability and functional limitations in older adults. (Score range 0-100 with 100 representing better ability and less disability/functional limitation)
Time frame: baseline, 15 months
Secondary
Patient Satisfaction Questionnaire - 18 (Modified)
Patient satisfaction with the care they received. (Score range 0-5)
Time frame: 15 months
Secondary
Physical Abilities (Strength, Balance)
Grip strength was measured using a JAMAR hand grip dynamometer (in kilograms). The Lower Extremity Function test is a battery of three tests used to measure lower extremity function and balance: a balance test, 8 foot walk test, and repetitive standing from a chair. A performance summary score is created by adding the number of seconds achieved on the balance test, the number of seconds to walk 8 feet and the number of seconds it takes the person to stand up from a chair five times consecutively (no maximum score exists on this measure).
Time frame: baseline, 15 months
Secondary
Self-management and Self-efficacy
Individual's self-reported ability to carry out behaviours to self-manage their health condition, and their confidence level in being able to carry out these behaviours. (Score range 0= not confident at all, 10= totally confident).
Time frame: baseline, 15 months
Secondary
Use of Hospital Services
self report use of hospital service
Time frame: baseline, 15 months