Norwegian National Advisory Unit on Rehabilitation in Rheumatology, Center for treatment of Rheumatic and Musculoskeletal Diseases (REMEDY), Diakonhjemmet Hospital, Oslo, Norway.
Muritunet Rehabilitation Centre, Valldal, Ålesund, Norway.
Clin Rehabil. 2023 Sep;37(9):1153-1177. doi: 10.1177/02692155231153341. Epub 2023 Mar 2.
To compare the effectiveness of a structured goal-setting and tailored follow-up rehabilitation intervention with existing rehabilitation in patients with rheumatic and musculoskeletal diseases.
A pragmatic stepped-wedge cluster randomized trial.
Eight rehabilitation centers in secondary healthcare, Norway.
A total of 374 adults with rheumatic and musculoskeletal diseases were included in either the experimental (168) or the control group (206).
A new rehabilitation intervention which comprised structured goal setting, action planning, motivational interviewing, digital self-monitoring of goal progress, and individual follow-up support after discharge according to patients' needs and available resources in primary healthcare (the BRIDGE-intervention), was compared to usual care.
Patient-reported outcomes were collected electronically on admission and discharge from rehabilitation, and after 2, 7, and 12 months. The primary outcome was patients' goal attainment measured by the Patient Specific Functional Scale (0-10, 10 best) at 7 months. Secondary outcome measures included physical function (30-s Sit-To-Stand test), health-related quality of life (EQ-5D-5L-index), and self-assessed health (EQ-VAS). The main statistical analyses were performed on an intention-to-treat basis using linear mixed models.
No significant treatment effects of the BRIDGE-intervention were found for either primary (Patient Specific Functional Scale mean difference 0.1 [95% CI: -0.5, 0.8], = 0.70), or secondary outcomes 7 months after rehabilitation.
The BRIDGE-intervention was not shown to be more effective than existing rehabilitation for patients with rheumatic and musculoskeletal diseases. There is still a need for more knowledge about factors that can improve the quality, continuity, and long-term health effects of rehabilitation for this patient group.
比较结构化目标设定和定制随访康复干预与现有康复治疗在风湿和肌肉骨骼疾病患者中的效果。
实用分步楔形集群随机试验。
挪威二级保健的 8 个康复中心。
共有 374 名风湿和肌肉骨骼疾病患者纳入实验组（168 人）或对照组（206 人）。
一种新的康复干预措施，包括结构化目标设定、行动计划、动机访谈、数字自我监测目标进展以及根据患者在初级保健中的需求和可用资源进行的个别随访支持（BRIDGE 干预），与常规护理进行比较。
患者报告的结果在康复入院和出院时以及在 2、7 和 12 个月时通过电子方式收集。主要结局是患者在 7 个月时通过患者特定功能量表（0-10，10 最佳）衡量的目标实现。次要结局指标包括身体功能（30 秒坐立测试）、健康相关生活质量（EQ-5D-5L 指数）和自我评估健康（EQ-VAS）。主要统计分析采用意向治疗线性混合模型进行。
BRIDGE 干预对主要结局（患者特定功能量表平均差异 0.1[95%CI：-0.5, 0.8]，=0.70）或康复后 7 个月的次要结局均未显示出治疗效果。
BRIDGE 干预对风湿和肌肉骨骼疾病患者并不比现有康复治疗更有效。对于这个患者群体，仍需要更多关于可以提高康复质量、连续性和长期健康效果的因素的知识。
