Rehabilitation in Primary Care: A Project to Maximize the Health Status of Adults With Chronic Illness

Study Overview
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Brief Summary
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The purpose of the study is to determine whether occupational therapy and physiotherapy delivered in a primary care setting to adults with chronic illness is effective in improving health.

Detailed Description
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Primary health care is changing so that people receive the care that they need at the front line. Rehabilitation has been identified as one service that should be offered in primary care, to address the needs of adults who have or are at risk of poor health from chronic conditions such as arthritis, heart disease and depression. Two full time therapists (one physiotherapist and one occupational therapist) will offer rehabilitation to a sample of 170 adults with chronic illness over an 18 month period (170 people will also be enrolled in a control group) at the Stonechurch Family Health Centre. Key outcomes include health, hospital admissions and emergency room visits.

Official Title
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Rehabilitation in Primary Care: A Project to Maximize the Health Status of Adults With Chronic Illness

Conditions
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Chronic Disease, Hypertension, Back Pain, Obesity, Arthritis

Intervention / Treatment
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* Behavioral: Occupational therapy
* Behavioral: Physiotherapy
* Behavioral: Self-management


Participation Criteria
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Eligibility Criteria
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Inclusion Criteria: At least 1 chronic condition 3 visits to family physician in the past year Exclusion Criteria: None

Ages Eligible for Study
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Minimum Age: 44 Years

Sexes Eligible for Study
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All

Accepts Healthy Volunteers
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No

Study Plan
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How is the study designed?
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Design Details

Primary Purpose: Treatment
Allocation: Randomized
Intervention Model: Parallel Assignment
Masking: Single


Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| Experimental: Intervention<br>Intervention | Behavioral: Occupational therapy<br> <br> Behavioral: Physiotherapy<br> <br> Behavioral: Self-management<br> <br> |
| No Intervention: Control<br>Control group received usual care in primary care. | |

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| SF-36 Physical Component | health related quality of life. Minimum: 0; Maximum 100. | 15 months | 

Secondary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Use of Hospital Services | self report use of hospital service | baseline, 15 months | 
| Independence in Activities of Daily Living (ADLs) and Instrumental Activities of Daily Living (IADLs) | Late Life Function and Disability Instrument: A measure of disability and functional limitations in older adults. (Score range 0-100 with 100 representing better ability and less disability/functional limitation) | baseline, 15 months | 
| Functional Limitations | Late Life Function and Disability Instrument: A measure of functional limitations and disability in older adults. | baseline, 15 months | 
| Falls and Injuries | self-reported number of falls in last 6 months | baseline, 15 months | 
| HOME Falls and Accident Screening Tool (FAST) | This is a home assessment of safety hazards for falls present in the individual's home. This tool helps to identify seniors at risk of falls. Score 0-25. | baseline, 15 months | 
| Self-management and Self-efficacy | Individual's self-reported ability to carry out behaviours to self-manage their health condition, and their confidence level in being able to carry out these behaviours. (Score range 0= not confident at all, 10= totally confident). | baseline, 15 months | 
| Physical Abilities (Strength, Balance) | Grip strength was measured using a JAMAR hand grip dynamometer (in kilograms). The Lower Extremity Function test is a battery of three tests used to measure lower extremity function and balance: a balance test, 8 foot walk test, and repetitive standing from a chair. A performance summary score is created by adding the number of seconds achieved on the balance test, the number of seconds to walk 8 feet and the number of seconds it takes the person to stand up from a chair five times consecutively (no maximum score exists on this measure). | baseline, 15 months | 
| Patient Satisfaction Questionnaire - 18 (Modified) | Patient satisfaction with the care they received. (Score range 0-5) | 15 months | 

 Terms related to the study
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Keywords Provided by Centre Hospitalier Valida
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Occupational therapy, Physical therapy techniques, Primary health care, Chronic disease, Rehabilitation, Disease management, Self care