Division of Psychiatry, Haukeland University Hospital, Bergen, Norway.
Department of Clinical Psychology, University of Bergen, Bergen, Norway.
BMC Med. 2024 Jan 11;22(1):12. doi: 10.1186/s12916-023-03237-3.
The health care is likely to break down unless we are able to increase the level of functioning for the growing number of patients with complex, chronic illnesses. Hence, novel high-capacity and cost-effective treatments with trans-diagnostic effects are warranted. In accordance with the protocol paper, we aimed to examine the acceptability, satisfaction, and effectiveness of an interdisciplinary micro-choice based concentrated group rehabilitation for patients with chronic low back pain, long COVID, and type 2 diabetes.
Patients with low back pain > 4 months sick-leave, long COVID, or type 2 diabetes were included in this clinical trial with pre-post design and 3-month follow-up. The treatment consisted of three phases: (1) preparing for change, (2) the concentrated intervention for 3-4 days, and (3) integrating change into everyday life. Patients were taught and practiced how to monitor and target seemingly insignificant everyday micro-choices, in order to break the patterns where symptoms or habits contributed to decreased levels of functioning or increased health problems. The treatment was delivered to groups (max 10 people) with similar illnesses. Client Satisfaction Questionnaire (CSQ-8)) (1 week), Work and Social Adjustment Scale (WSAS), Brief Illness Perception Questionnaire (BIPQ), and self-rated health status (EQ-5D-5L) were registered at baseline and 3-month follow-up.
Of the 241 included participants (57% women, mean age 48 years, range 19-84), 99% completed the concentrated treatment. Treatment satisfaction was high with a 28.9 (3.2) mean CSQ-8-score. WSAS improved significantly from baseline to follow-up across diagnoses 20.59 (0.56) to 15.76 (0.56). BIPQ improved from: 22.30 (0.43) to 14.88 (0.47) and EQ-5D-5L: 0.715 (0.01) to 0.779 (0.01)), all P<0.001.
Across disorders, the novel approach was associated with high acceptability and clinically important improvements in functional levels, illness perception, and health status. As the concentrated micro-choice based treatment format might have the potential to change the way we deliver rehabilitation across diagnoses, we suggest to proceed with a controlled trial.
ClinicalTrials.gov NCT05234281.
如果我们不能提高患有复杂慢性疾病的患者的功能水平，医疗保健系统可能会崩溃。因此，需要新的、具有大容量和成本效益的、具有跨诊断效果的治疗方法。根据方案文件，我们旨在检验一种基于跨学科的集中小组康复治疗方案对慢性腰痛、长新冠和 2 型糖尿病患者的可接受性、满意度和有效性。
本临床试验采用预前后测设计和 3 个月随访，纳入腰痛时间>4 个月请病假、长新冠或 2 型糖尿病患者。治疗包括三个阶段：（1）改变准备，（2）为期 3-4 天的集中干预，（3）将改变融入日常生活。向患者传授和练习如何监测和针对看似微不足道的日常微观选择，以打破导致功能水平下降或增加健康问题的症状或习惯模式。治疗以类似疾病的小组（最多 10 人）形式提供。在基线和 3 个月随访时登记客户满意度问卷（CSQ-8）（1 周）、工作和社会适应量表（WSAS）、简要疾病感知问卷（BIPQ）和自我评估健康状况（EQ-5D-5L）。
在纳入的 241 名参与者中（57%为女性，平均年龄 48 岁，范围 19-84 岁），99%完成了集中治疗。治疗满意度很高，CSQ-8 平均得分为 28.9（3.2）。WSAS 在不同诊断中从基线到随访均显著改善，从 20.59（0.56）降至 15.76（0.56）。BIPQ 从 22.30（0.43）改善至 14.88（0.47），EQ-5D-5L 从 0.715（0.01）改善至 0.779（0.01），所有 P<0.001。
在不同疾病中，这种新方法与功能水平、疾病认知和健康状况的显著改善相关，具有较高的可接受性。由于集中的基于微观选择的治疗模式有可能改变我们跨诊断提供康复治疗的方式，因此我们建议进行对照试验。
ClinicalTrials.gov NCT05234281。
