Arthritis, Chronic Conditions, Chronic Pain, Diabetes, Hypertension
Conditions
Brief summary
People who have long-term conditions such as heart disease, diabetes, arthritis etc. face challenges in staying active and able to participate in activities that are important to them. There is some research that suggests that a care model that focuses on physical functioning and helping patients to manage their own conditions will assist them to stay active and healthy longer. In this project, the investigators are testing whether physiotherapy and occupational therapy offered to groups of patients and information about rehabilitation offered to other members of the health care team can help people with chronic conditions to maintain their physical abilities.
Detailed description
Participants older than 44, with at least one chronic disease, (n=60) will participate in a before-and-after study integrating a population based, rehabilitation-focused program targeting physical function into a Family Health Team. The program, delivered by a Physiotherapist and Occupational Therapist, will consist of comprehensive functional assessments and individualized self-management care plans; a rehabilitation based chronic disease self-management program; and on-line self-monitoring of physical function. Process and outcome measures will be administered at baseline and 4 months follow-up.
Interventions
BEHAVIORALPhysiotherapy
group self-management classes
BEHAVIORALOccupational Therapy
group self-management classes
BEHAVIORALCapacity Building
workshops and case reviews with primary health care team members
Sponsors
Ontario Neurotrauma Foundation
Hamilton Health Sciences Corporation
Study design
Allocation
NON_RANDOMIZED
Intervention model
PARALLEL
Primary purpose
SUPPORTIVE_CARE
Masking
NONE
Eligibility
Sex/Gender
ALL
Age
44 Years to No maximum
Healthy volunteers
No
Inclusion criteria
* 44 years and older * 1 or more chronic conditions * 3 visits to physician in the past year * access or willingness to access email
Exclusion criteria
* none
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Physical Functioning Inventory (PFI) | 4 months | The PFI is used to assess physical functioning in older adults. It contains 21 tasks from 4 subscales: activities of daily living, instrumental activities of daily living, mobility, moderate activities. A series of questions is used to determine whether the person experiences difficulty in completing a task, the level of difficulty they experience, and any changes to the method and/or frequency of task performance. The PFI is sensitive to steps in the natural history of functional decline that are often not assessed clinically. Range of scores: 0 (most difficulty); 100 (least difficulty). |
Secondary
| Measure | Time frame |
|---|---|
| Health Care Utilization | 4 months |
| Self-efficacy for Chronic Disease Scale | 4 months |
| Rapid Assessment of Physical Activity | 4 months |
| Grip Strength | 4 months |
| Self-rated Health | 4 months |
| Patient Assessment of Chronic Illness Care | 4 months |
| Primary Care Resources and Supports | 4 months |
| Balance Screen | 4 months |
| Eight Foot Walk Test | 4 months |
| Two Minute Walk Test | 4 months |
Countries
Canada
Participant flow
Recruitment details
Participants were recruited from two distinct locations of the McMaster Family Health Team.
Participants by arm
| Arm | Count |
|---|---|
| Intervention Group Rehabilitation self-management group, on-line self monitoring of physical function, and organizational capacity building. | 65 |
| Case Matched Controls Usual care in primary health care. | 59 |
| Total | 124 |
Withdrawals & dropouts
| Period | Reason | FG000 | FG001 |
|---|---|---|---|
| Overall Study | Ill health | 1 | 1 |
| Overall Study | Lost to Follow-up | 6 | 1 |
| Overall Study | Withdrawal by Subject | 3 | 2 |
Baseline characteristics
| Characteristic | Case Matched Controls | Intervention Group | Total |
|---|---|---|---|
| Age, Categorical <=18 years | 0 Participants | 0 Participants | 0 Participants |
| Age, Categorical >=65 years | 22 Participants | 25 Participants | 47 Participants |
| Age, Categorical Between 18 and 65 years | 37 Participants | 40 Participants | 77 Participants |
| Age Continuous | 62.62 years STANDARD_DEVIATION 10.48 | 63.57 years STANDARD_DEVIATION 11.81 | 63.08 years STANDARD_DEVIATION 11.05 |
| Region of Enrollment Canada | 59 participants | 65 participants | 124 participants |
| Sex: Female, Male Female | 42 Participants | 43 Participants | 85 Participants |
| Sex: Female, Male Male | 17 Participants | 22 Participants | 39 Participants |
Adverse events
| Event type | EG000 affected / at risk | EG001 affected / at risk |
|---|---|---|
| deaths Total, all-cause mortality | — / — | — / — |
| other Total, other adverse events | 0 / 65 | 0 / 59 |
| serious Total, serious adverse events | 0 / 65 | 0 / 59 |
Outcome results
Primary
Physical Functioning Inventory (PFI)
The PFI is used to assess physical functioning in older adults. It contains 21 tasks from 4 subscales: activities of daily living, instrumental activities of daily living, mobility, moderate activities. A series of questions is used to determine whether the person experiences difficulty in completing a task, the level of difficulty they experience, and any changes to the method and/or frequency of task performance. The PFI is sensitive to steps in the natural history of functional decline that are often not assessed clinically. Range of scores: 0 (most difficulty); 100 (least difficulty).
Time frame: 4 months
| Arm | Measure | Value (MEAN) | Dispersion |
|---|---|---|---|
| Intervention Group | Physical Functioning Inventory (PFI) | 5.50 units on a scale | Standard Deviation 12.14 |
| Case Matched Controls | Physical Functioning Inventory (PFI) | 2.96 units on a scale | Standard Deviation 10.81 |
Secondary
Balance Screen
Time frame: 4 months
Secondary
Eight Foot Walk Test
Time frame: 4 months
Secondary
Grip Strength
Time frame: 4 months
Secondary
Health Care Utilization
Time frame: 4 months
Secondary
Patient Assessment of Chronic Illness Care
Time frame: 4 months
Secondary
Primary Care Resources and Supports
Time frame: 4 months
Secondary
Rapid Assessment of Physical Activity
Time frame: 4 months
Secondary
Self-efficacy for Chronic Disease Scale
Time frame: 4 months
Secondary
Self-rated Health
Time frame: 4 months
Secondary
Two Minute Walk Test
Time frame: 4 months