OP0153-HPR BRIDGING GAPS ACROSS LEVELS OF CARE IN REHABILITATION OF PATIENTS WITH RHEUMATIC - AND MUSCULOSKELETAL DISEASES: RESULTS FROM A STEPPED WEDGE CLUSTER RANDOMISED CONTROLLED TRIAL
Authors: G. Berdal, A. L. Sand-Svartrud, M. Azimi, I. Bø, T. Nygaard Dager, S. Eppeland, G. Ohldieck Fredheim, A. Sirnes Hagland, A. Klokkeide, A. D. Linge, K. Tennebø, H. Lindtvedt Valaas, A. M. Aasvold, J. Sexton, I. Kjeken
Journal: Annals of the Rheumatic Diseases (2021)

Background: Previous research show that patients with rheumatic and musculoskeletal diseases (RMDs) benefit from rehabilitation, but the health effects are small and decline over time. Later reports reveal that the quality of rehabilitation services varies largely, with lack of coordination and continuity across levels of care. This may weaken the effect on patients’ long-lasting health, ability to self-manage their conditions and achieve their goals. We therefore developed a new, evidence-based rehabilitation program to strengthen the quality and bridge the gaps in rehabilitation services for this patient group. Objectives: To evaluate if a new rehabilitation program (the BRIDGE program) designed to improve the quality and continuity of rehabilitation across levels of care, was more effective than traditional rehabilitation in improving goal achievement, function, self-assessed health and health related quality of life (HR-QoL) in patients with RMDs. Methods: In a stepped wedge cluster randomised controlled trial 8 rehabilitation centres organised in secondary health care and located across all health regions of Norway recruited a total of 374 patients with rheumatic and musculoskeletal diseases. These patients received either traditional rehabilitation (control) (n=206), or traditional rehabilitation extended with an individually adapted complex intervention consisting of structured goal setting, plans for self-management, motivational interviewing, self-monitored digital feedback, and tailored follow-up support after discharge according to patients’ needs and available resources in primary healthcare (the BRIDGE program) (n=168). Patient-reported data were collected electronically on admission and discharge from rehabilitation, and after 2, 7, and 12 months. The primary outcome measure was patients’ goal achievement measured by the Patient Specific Functional Scale (PSFS) (0-10, 10=best) seven months after rehabilitation stay. Secondary outcome measures were function measured by the 30-seconds Sit-To-Stand Test (30secSTS), self-assessed health and HR-QoL measured by the EuroQol instruments EQ-5D-5L-VAS (0-100, 100=best) and EQ 5D-5L-index (-1 to 1, 1=best). The main comparative analysis was performed on the intention to treat population, using all available data, by linear mixed models adjusted for the baseline scores and for the potentially confounding effects of calendar time and data clustering. Sensitivity analyses were performed on data provided by the per protocol population according to predefined criteria, in addition to centerwise comparisons of the control and intervention groups. Results: No significant treatment effects of the BRIDGE-program were demonstrated either for patients’ goal achievement (mean difference 0.1 [95% CI: -0.5, 0.8], p=0.70) (Figure 1), function (mean difference 0.9 [95% CI: - 0.4, 2.2], p=0.18), self-assessed health (mean difference -0.1 [95% CI: -4.1, 3.9], p=0.98), or HR-QoL (mean difference 0.0 [95% CI: -0.0, 0.0], p=0.99) seven months after rehabilitation. Sensitivity analyses confirmed the findings from the primary analysis. A significant proportion of missing data for the primary outcome measure (29% in the control and 41% in the intervention group), caused by errors in the digital data collection system, may impair the reliability of the results. Conclusion: The BRIDGE program was not shown to be more effective than traditional rehabilitation in terms of improving goal achievement, function, self-assessed health and HR-QoL in patients with RMDs. There is still a need for more knowledge about factors that can improve the quality, continuity and long-term health effects of rehabilitation for this patient group. Disclosure of Interests: None declared