Multimorbidity rehabilitation versus disease-specific rehabilitation in people with chronic diseases: a pilot randomized controlled trial

Kathryn Barker, Anne E. Holland, Annemarie L. Lee, Terry Haines, Kathryn Ritchie, Claire Boote, Joanne Saliba, Stephanie Lowe, Fiona Pazsa, Lee Thomas, Monica Turczyniak, Elizabeth H. Skinner

Research output: Contribution to journalArticleResearchpeer-review

Abstract

Background
Multimorbidity (the co-existence of two or more chronic conditions in an individual) is a growing healthcare burden internationally; however, healthcare and disease management, including rehabilitation, is often delivered in single-disease siloes. The aims of this study were to (1) evaluate the safety and feasibility of multimorbidity rehabilitation compared to a disease-specific rehabilitation program in people with multimorbidity and (2) gather preliminary data regarding clinical outcomes and resource utilization to inform the design of future trials.
Methods
A pilot feasibility randomized controlled trial with concealed allocation, assessor blinding, and intention-to-treat analysis. Seventeen individuals with a chronic disease eligible for disease-specific rehabilitation (pulmonary, cardiac, heart failure rehabilitation) and at least one other chronic condition were recruited. The intervention group attended multimorbidity exercise rehabilitation and the control group attended disease-specific exercise rehabilitation. Participants attended twice-weekly exercise training and weekly education for 8 weeks. Feasibility measures included numbers screened, recruited, and completed. Other outcome measures were change in functional exercise capacity (6-minute walk test (6MWT)), health-related quality of life (HRQoL), activities of daily living (ADL), and resource utilization.
Results
Sixty-one people were screened to recruit seventeen participants (nine intervention, eight control); one withdrew prior to rehabilitation. Participants were mostly male (63%) with a mean (SD) age of 69 (9) years and body mass index of 29 (6). The intervention group attended a mean (SD) of 12 (6) sessions, and the control group attended 11 (4) sessions. One participant (6%) withdrew after commencing; two (12%) were lost to follow-up. The intervention group 6MWT distance increased by mean (SD) of 22 (45) meters (95% confidence interval − 16 to 60) compared to 22 (57) meters (95% confidence interval − 69 to 114) (control).
Conclusions
It was feasible to recruit people with multimorbidity to a randomized controlled trial of rehabilitation. A large RCT with the power to make significant conclusions about the impact on the primary and secondary outcomes is now required.
Trial registration
The trial was registered with the Australian and New Zealand Clinical Trials Registry available at http://www.anzctr.org.au ACTRN12614001186640. Registered 12/11/2014.
Original languageEnglish
Article number181
Number of pages12
JournalPilot and Feasibility Studies
Volume4
DOIs
Publication statusPublished - 29 Nov 2018

Cite this

@article{33f9289a6146451e987f28fdf3923972,
title = "Multimorbidity rehabilitation versus disease-specific rehabilitation in people with chronic diseases: a pilot randomized controlled trial",
abstract = "BackgroundMultimorbidity (the co-existence of two or more chronic conditions in an individual) is a growing healthcare burden internationally; however, healthcare and disease management, including rehabilitation, is often delivered in single-disease siloes. The aims of this study were to (1) evaluate the safety and feasibility of multimorbidity rehabilitation compared to a disease-specific rehabilitation program in people with multimorbidity and (2) gather preliminary data regarding clinical outcomes and resource utilization to inform the design of future trials.MethodsA pilot feasibility randomized controlled trial with concealed allocation, assessor blinding, and intention-to-treat analysis. Seventeen individuals with a chronic disease eligible for disease-specific rehabilitation (pulmonary, cardiac, heart failure rehabilitation) and at least one other chronic condition were recruited. The intervention group attended multimorbidity exercise rehabilitation and the control group attended disease-specific exercise rehabilitation. Participants attended twice-weekly exercise training and weekly education for 8 weeks. Feasibility measures included numbers screened, recruited, and completed. Other outcome measures were change in functional exercise capacity (6-minute walk test (6MWT)), health-related quality of life (HRQoL), activities of daily living (ADL), and resource utilization.ResultsSixty-one people were screened to recruit seventeen participants (nine intervention, eight control); one withdrew prior to rehabilitation. Participants were mostly male (63{\%}) with a mean (SD) age of 69 (9) years and body mass index of 29 (6). The intervention group attended a mean (SD) of 12 (6) sessions, and the control group attended 11 (4) sessions. One participant (6{\%}) withdrew after commencing; two (12{\%}) were lost to follow-up. The intervention group 6MWT distance increased by mean (SD) of 22 (45) meters (95{\%} confidence interval − 16 to 60) compared to 22 (57) meters (95{\%} confidence interval − 69 to 114) (control).ConclusionsIt was feasible to recruit people with multimorbidity to a randomized controlled trial of rehabilitation. A large RCT with the power to make significant conclusions about the impact on the primary and secondary outcomes is now required.Trial registrationThe trial was registered with the Australian and New Zealand Clinical Trials Registry available at http://www.anzctr.org.au ACTRN12614001186640. Registered 12/11/2014.",
author = "Kathryn Barker and Holland, {Anne E.} and Lee, {Annemarie L.} and Terry Haines and Kathryn Ritchie and Claire Boote and Joanne Saliba and Stephanie Lowe and Fiona Pazsa and Lee Thomas and Monica Turczyniak and Skinner, {Elizabeth H.}",
year = "2018",
month = "11",
day = "29",
doi = "10.1186/s40814-018-0369-2",
language = "English",
volume = "4",
journal = "Pilot and Feasibility Studies",
issn = "2055-5784",
publisher = "BioMed Central",

}

Multimorbidity rehabilitation versus disease-specific rehabilitation in people with chronic diseases : a pilot randomized controlled trial. / Barker, Kathryn; Holland, Anne E.; Lee, Annemarie L.; Haines, Terry; Ritchie, Kathryn; Boote, Claire; Saliba, Joanne; Lowe, Stephanie; Pazsa, Fiona; Thomas, Lee; Turczyniak, Monica; Skinner, Elizabeth H.

In: Pilot and Feasibility Studies, Vol. 4, 181, 29.11.2018.

Research output: Contribution to journalArticleResearchpeer-review

TY - JOUR

T1 - Multimorbidity rehabilitation versus disease-specific rehabilitation in people with chronic diseases

T2 - a pilot randomized controlled trial

AU - Barker, Kathryn

AU - Holland, Anne E.

AU - Lee, Annemarie L.

AU - Haines, Terry

AU - Ritchie, Kathryn

AU - Boote, Claire

AU - Saliba, Joanne

AU - Lowe, Stephanie

AU - Pazsa, Fiona

AU - Thomas, Lee

AU - Turczyniak, Monica

AU - Skinner, Elizabeth H.

PY - 2018/11/29

Y1 - 2018/11/29

N2 - BackgroundMultimorbidity (the co-existence of two or more chronic conditions in an individual) is a growing healthcare burden internationally; however, healthcare and disease management, including rehabilitation, is often delivered in single-disease siloes. The aims of this study were to (1) evaluate the safety and feasibility of multimorbidity rehabilitation compared to a disease-specific rehabilitation program in people with multimorbidity and (2) gather preliminary data regarding clinical outcomes and resource utilization to inform the design of future trials.MethodsA pilot feasibility randomized controlled trial with concealed allocation, assessor blinding, and intention-to-treat analysis. Seventeen individuals with a chronic disease eligible for disease-specific rehabilitation (pulmonary, cardiac, heart failure rehabilitation) and at least one other chronic condition were recruited. The intervention group attended multimorbidity exercise rehabilitation and the control group attended disease-specific exercise rehabilitation. Participants attended twice-weekly exercise training and weekly education for 8 weeks. Feasibility measures included numbers screened, recruited, and completed. Other outcome measures were change in functional exercise capacity (6-minute walk test (6MWT)), health-related quality of life (HRQoL), activities of daily living (ADL), and resource utilization.ResultsSixty-one people were screened to recruit seventeen participants (nine intervention, eight control); one withdrew prior to rehabilitation. Participants were mostly male (63%) with a mean (SD) age of 69 (9) years and body mass index of 29 (6). The intervention group attended a mean (SD) of 12 (6) sessions, and the control group attended 11 (4) sessions. One participant (6%) withdrew after commencing; two (12%) were lost to follow-up. The intervention group 6MWT distance increased by mean (SD) of 22 (45) meters (95% confidence interval − 16 to 60) compared to 22 (57) meters (95% confidence interval − 69 to 114) (control).ConclusionsIt was feasible to recruit people with multimorbidity to a randomized controlled trial of rehabilitation. A large RCT with the power to make significant conclusions about the impact on the primary and secondary outcomes is now required.Trial registrationThe trial was registered with the Australian and New Zealand Clinical Trials Registry available at http://www.anzctr.org.au ACTRN12614001186640. Registered 12/11/2014.

AB - BackgroundMultimorbidity (the co-existence of two or more chronic conditions in an individual) is a growing healthcare burden internationally; however, healthcare and disease management, including rehabilitation, is often delivered in single-disease siloes. The aims of this study were to (1) evaluate the safety and feasibility of multimorbidity rehabilitation compared to a disease-specific rehabilitation program in people with multimorbidity and (2) gather preliminary data regarding clinical outcomes and resource utilization to inform the design of future trials.MethodsA pilot feasibility randomized controlled trial with concealed allocation, assessor blinding, and intention-to-treat analysis. Seventeen individuals with a chronic disease eligible for disease-specific rehabilitation (pulmonary, cardiac, heart failure rehabilitation) and at least one other chronic condition were recruited. The intervention group attended multimorbidity exercise rehabilitation and the control group attended disease-specific exercise rehabilitation. Participants attended twice-weekly exercise training and weekly education for 8 weeks. Feasibility measures included numbers screened, recruited, and completed. Other outcome measures were change in functional exercise capacity (6-minute walk test (6MWT)), health-related quality of life (HRQoL), activities of daily living (ADL), and resource utilization.ResultsSixty-one people were screened to recruit seventeen participants (nine intervention, eight control); one withdrew prior to rehabilitation. Participants were mostly male (63%) with a mean (SD) age of 69 (9) years and body mass index of 29 (6). The intervention group attended a mean (SD) of 12 (6) sessions, and the control group attended 11 (4) sessions. One participant (6%) withdrew after commencing; two (12%) were lost to follow-up. The intervention group 6MWT distance increased by mean (SD) of 22 (45) meters (95% confidence interval − 16 to 60) compared to 22 (57) meters (95% confidence interval − 69 to 114) (control).ConclusionsIt was feasible to recruit people with multimorbidity to a randomized controlled trial of rehabilitation. A large RCT with the power to make significant conclusions about the impact on the primary and secondary outcomes is now required.Trial registrationThe trial was registered with the Australian and New Zealand Clinical Trials Registry available at http://www.anzctr.org.au ACTRN12614001186640. Registered 12/11/2014.

U2 - 10.1186/s40814-018-0369-2

DO - 10.1186/s40814-018-0369-2

M3 - Article

C2 - 30519483

VL - 4

JO - Pilot and Feasibility Studies

JF - Pilot and Feasibility Studies

SN - 2055-5784

M1 - 181

ER -