THU0727-HPR FOLLOW-UP CARE AND SELF-MANAGEMENT ACTIVITIES AFTER SPECIALIZED REHABILITATION FOR PATIENTS WITH RHEUMATIC AND MUSCULOSKELETAL DISEASES
Authors: Helene Lindtvedt Valaas, Mari Klokkerud, Ingvild Kjeken
Journal: Annals of the Rheumatic Diseases (2019)

<h3>Background</h3> Patients with rheumatic and musculoskeletal diseases (RMDs) benefit from rehabilitation in specialized care, but the effect seems to decline over time. Implementation of healthy self-management strategies and support over an extended period may prolong the effect. Rehabilitation trajectories with planned follow-up interventions and support in primary health care are therefore recommended. Still, evidence is not clear concerning what constitutes an optimal design of supportive follow-up interventions, and to which degree such follow-up care are planned and delivered. <h3>Objectives</h3> To describe current follow-up care practice and self-management after specialized rehabilitation for patients with RMDs. <h3>Methods</h3> This is a multicentre cohort study, including 523 participants with RMDs who received rehabilitation in specialized care in Norway. Participants completed a core set of outcome measures for rehabilitation in musculoskeletal diseases covering nine aspects of health and function in a web based data collection system [1]. At rehabilitation discharge, they additionally reported needed and planned follow-up care (FU-care) from listed professions and services in primary health care and plans for self-management activities (SMA). Received FU-care and adherence to SMA were reported at 4, 8 and 12 months follow-up. A multiple logistic regression analysis was performed to explore predictors for acceptable adherence to SMA. <h3>Results</h3> A total of 436 participants completed all assessments at discharge, of which 429 (98%) reported a need for FU-care. A need for FU-care by primary physician was most frequently registered, followed by physiotherapist and the Norwegian Labour and Welfare Service. However, only 239 (56%) reported that FU-care was planned at discharge. Of those reporting a need for FU-care, 201 (47%) participants reported receiving such care during the follow-up year, and these participants more often had a specific follow-up plan at discharge compared to those who did not receive the FU-care they reported needing (p=0.06). Hundred and sixty-four (38%) participants were adhering to their SMA throughout the follow-up year. Higher age (OR=1.04, [CI 95% 1.02, 1.06], p&lt;0.001), lower degree of depression and anxiety (OR=0.73, [CI 95% 0.58, 0.94], p=0.01), and performing physical activity on a regular basis (OR=3.35, [CI 95% 2.08, 5.39], p&lt;0.001) at baseline were predictors for acceptable adherence. Participants with acceptable adherence reported more often a need for FU-care (p&lt;0.001), and had more frequently received the FU-care they needed (p&lt;0.001) than those without acceptable adherence. <h3>Conclusion</h3> Participants with plans were more likely to receive the FU-care they reported needing, indicating that discussing and planning follow-up should be an integral part of rehabilitation in specialized health care. The results further indicate that having structure and routines in one's daily life enhance adherence to SMA, and that patients with anxiety and depression and a sedentary life style may need more support over a longer period to be able to implement behavioural changes for healthy self-management. <h3>References</h3> [1] Klokkerud, M., et al., Developing and testing a consensus-based core set of outcome measures for rehabilitation in musculoskeletal diseases. Scandinavian Journal of Rheumatology, 2017: p. 1-10. <h3>Acknowledgement</h3> The authors want to inform that members in the Rehabilitation Trajectories Research group are co-authors of this abstract. Their names are listed in the following link: http://diakonhjemmetsykehus.no/#!/diakon/forside/Helsepersonell/nasjonal-kompetansetjeneste-for-revmatologisk-rehabilitering-nkrr/nkrr/pagaende-prosjekter-nkrr/_5479|5495 <h3>Disclosure of Interests</h3> None declared