The BRIDGE Rehabilitation Trial
Condition: Musculoskeletal Disease
MeSH terms: Musculoskeletal Diseases
Study type: Interventional

Summary: 
      The main aim of this multi-centre stepped wedge randomized controlled trial is to improve the
      quality, professional practice and cost-effective utilization of health care resources by
      evaluating if a new rehabilitation program aimed at bridging gaps in rehabilitation across
      levels of care may increase and/or prolong the effect of rehabilitation.
    

Detailed description: 
      The goal of rehabilitation is to help people to reach and maintain their optimal functioning
      and coping capabilities, and to promote independence and participation in society. According
      to current political documents, there are large variation in the content and quality of
      rehabilitation in Norway, and systems to improve coordination and communication are needed.

      This trial is a collaborative project between eight centres across Norway, investigating
      whether a new program aimed at bridging gaps in rehabilitation across levels of care increase
      and/or prolong the effect of rehabilitation for people with rheumatic and musculoskeletal
      diseases. Additionally, we will use a newly developed set of quality indicators to monitor
      and compare the quality of rehabilitation across different centres, and explore relationships
      between adherence to structure and process indicators and the outcomes of rehabilitation.

      The effects will be evaluated in a multi-centre stepped wedge randomized controlled trial,
      where participating centres switch from control (current rehabilitation program) to
      intervention phase (adding the BRIDGE program to the current program) in a randomized order.
      Primary outcome is goal attainment after seven months, and secondary outcomes are health
      related quality of life and function.

      The results will give insight in the content and organisation of current rehabilitation
      programs, what follow-up people want and receive in primary care, their planned and completed
      efforts to implement and maintain life style changes, and predictors for improvement
      following rehabilitation in specialist health care. Results will also have consequences on
      how rehabilitation is to be organized in the future regarding follow-up and coordination
      across levels of care.

      The study has been developed in close collaboration with patient research partners,
      clinicians and international experts, who will also contribute in the process of integrating
      study results in clinical practice.
    

Intervention name(s): Current rehabilitation; The BRIDGE program
Intervention type(s): Behavioral; Behavioral
Intervention description(s): The control group will receive the rehabilitation currently offered at each of the participating centers.; The experimental group will additionally receive the BRIDGE program, which comprises motivational interviewing, structured goal-setting, tailored follow-up, plans for self-management, and individualised written feedback that participants can use to monitor their progress and share with important care givers.
Allocation: Randomized
Intervention model: Sequential Assignment
Intervention model description: In order to evaluate the effects of the BRIDGE program, a stepped wedge cluster randomized controlled trial will be conducted. In the trial, participating centres switch from control (current rehabilitation program) to intervention phase (adding the BRIDGE program to the current program) in a randomized order. All centres start the trial simultaneously and act as controls until the point in time they are randomized to crossover from control to intervention, and all centres deliver the intervention by the end of inclusion.
The stepped wedge design is suitable for a phased evaluation approach, where it is difficult to deliver two parallel interventions.
Masking: Single (Investigator)
Primary purpose: Treatment