Clinical trial NCT03733847: Rehabilitation Trajectories
Official title: Rehabilitation Trajectories. A Study of Rehabilitation Processes Across Health Care Levels in Patients With Rheumatic and Musculoskeletal Diseases
Study type: OBSERVATIONAL
Overall status: COMPLETED
Conditions: Musculoskeletal Disease
Lead sponsor: National Resource Center for Rehabilitation in Rheumatology
Sponsor class: OTHER
Collaborators: name: Haugesund Rheumatism Hosptial AS
name: Betanien Hospital
name: Vikersund Rehabilitation Center AS
name: Meråker Rehabilitation Center
name: North Norway Rehabilitation Center
name: UniCare Jeløy
name: Sørlandet Hospital
name: Innlandet HF Konsvinger Hospital
name: Rehab Vest Rehabilitation Hospital
First posted: 2018-11-07
Enrollment: 524
Sex: ALL
Minimum age (years): 18
Maximum age (years): 100
Standard ages: ADULT
OLDER_ADULT
Accepts healthy volunteers: no
Observational model: COHORT
Time perspective: PROSPECTIVE
Sampling method: NON_PROBABILITY_SAMPLE
Study population: Patients with rheumatic and musculoskeletal diseases from Norway admitted to rehabilitation at one of the nine participating rehabilitation centres.

Brief summary: The main aim of this multicentre cohort study is to provide evidence that can be used to improve continuity and quality in rehabilitation practice and rehabilitation processes across health care levels for patients with rheumatic and musculoskeletal diseases (RMDs).

Detailed description: There is an urgent need to develop rehabilitation trajectories that ensure coordination and communication between health care levels, support of self-management and self-monitoring, and follow-up tailored to patients' needs. Such trajectories should be based on evidence from current practice. The "Rehabilitation trajectories" project will systematically explore and describe current practice of planned and implemented follow-up and self-management strategies in primary health care during the first year after rehabilitation for patients with musculoskeletal diseases. Further, a newly developed core set of PROMs designed for evaluation of rehabilitation in RMDs and a self-monitoring web-based system will be tested for feasibility. Knowledge of patients' experiences and use of this self-monitoring system as a self-management and communication tool is needed in order to improve and integrate such e-technology in future care.

The Rehabilitation Trajectory study is a multi-centre study, led by the National Unit on Rehabilitation in Rheumatology and including participants at four rheumatology hospital departments and five specialized rehabilitation institutions. Participants will thus be included from all four health regions in Norway.

The study has five points of assessment. In an electronic portal, delivered by CheckWare, patients will log in with their Bank ID and complete the core set of PROMs at admission, discharge, and 4, 8 and 12 months following discharge.

Eligibility criteria: Inclusion Criteria:

* Admitted to rehabilitation at one of the nine participating rehabilitation centres with one of the following groups of diagnosis: Inflammatory rheumatic disease, Osteoarthritis, Low back pain, Neck/shoulder pain, Generalized pain syndromes (including fibromyalgia), Osteoporosis, Connective tissue diseases (SLE, Lupus, Myositis etc.), Fractures with need of rehabilitation, or Rehabilitation after orthopaedic surgery. Good proficiency in oral and written Norwegian language. Access to internet and BankID.

Exclusion Criteria:

* Cognitive impairment or severe mental illness.

Primary outcomes:
measure: Goal attainment
timeFrame: One year
Secondary outcomes:
measure: Health-realted quality of life
timeFrame: One year
measure: Physical function
timeFrame: One year
Other outcomes:
measure: General Pain
timeFrame: One year
measure: Fatigue
timeFrame: One year
measure: Motivation for goal attainment
timeFrame: One year
measure: Function in daily acitvities
timeFrame: One year
measure: Coping
timeFrame: One year
measure: Mental health
timeFrame: One year
measure: Participation
timeFrame: One year
Locations:
Study officials:
affiliation: Diakonhjemmet Hospital
name: Tore K Kvien, PhD
role: STUDY_DIRECTOR
References: