Patient-specific goals and supportive follow-up in rheumatology rehabilitation: Analysis of content, summary of evidence, and evaluation of health effects
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AbstractThe purpose of this thesis was to explore and evaluate strategies to enhance and prolong beneficial health effects of rehabilitation for patients with rheumatic diseases. It comprises a systematic review with meta-analysis of published effects of supportive follow-up interventions, a qualitative descriptive study with content analysis of written rehabilitation goals, and a pragmatic stepped-wedge multicentre cluster-randomized controlled trial including 389 participants. The results demonstrated moderate quality evidence for small beneficial effects of supportive follow-up on physical function in patients with rheumatic diseases, and that the design of follow-up interventions varied considerably. The rehabilitation goals covered a broad range of topics which changed slightly over the rehabilitation period, with healthy lifestyle as the most frequently occurring topic. Goals differed with respect to structure, specificity, measurability, coherence and complexity, and were influenced by patient gender and health profession. A small, but significant treatment effect of an add-on structured goal planning and tailored follow-up program was found on health-related quality of life at discharge from rehabilitation, but no group differences were found 6 and 12 months after discharge. The conclusions are that supportive follow-up probably improves physical function in patients with rheumatic diseases, but there is currently no clear data regarding what constitutes the optimal design of follow-up support. In rehabilitation goal setting practice, healthcare professionals need to be receptive to the diversity of topics patients present, and aware of their potential influence on goal content. Further, patients may need considerable help to develop precise and measurable goals. An add-on structured goal-planning and tailored follow-up program increased the short-term effect of rehabilitation in terms of health-related quality of life, but it did not prolong the effect as intended.
List of papers
|Paper I: Berdal G, Smedslund G, Dagfinrud H, Hagen KB, Kjeken I. Design and effects of supportive follow-up interventions in clinical care of patients with rheumatic diseases: a systematic review with meta-analysis. Arthritis Care Res 2015;67:240-254. DOI 10.1002/acr.22407. The paper is not available in DUO due to publisher restrictions. The published version is available at: https://doi.org/10.1002/acr.22407|
|Paper II: Berdal G, Sand-Svartrud AL, Bø I, Dager TN, Dingsør A, Eppeland SG, Hagfors J, Hamnes B, Nielsen M, Slungaard B, Wigers S, Hagen KB, Dagfinrud H, Kjeken I. Aiming for a healthier life: a qualitative content analysis of rehabilitation goals in patients with rheumatic diseases. Disabil Rehabil 2018 Apr;40;7:765-778. DOI 10.1080/09638288.2016.1275043. The paper is not available in DUO due to publisher restrictions. The published version is available at: https://doi.org/10.1080/09638288.2016.1275043|
|Paper III: Berdal, G. , Bø, I. , Dager, T. N., Dingsør, A. , Eppeland, S. G., Hagfors, J. , Hamnes, B. , Mowinckel, P. , Nielsen, M. , Sand‐Svartrud, A. , Slungaard, B. , Wigers, S. H., Hagen, K. B., Dagfinrud, H. S. and Kjeken, I. (2018), Structured Goal Planning and Supportive Telephone Follow‐up in Rheumatology Care: Results From a Pragmatic, Stepped‐Wedge, Cluster‐Randomized Trial. Arthritis Care Res, 70: 1576-1586. DOI 10.1002/acr.23520. The paper is not available in DUO due to publisher restrictions. The published version is available at: https://doi.org/10.1002/acr.23520|