Outcomes of the My Therapy self-management program in people admitted for rehabilitation: A stepped wedge cluster randomized clinical trial

IF 3.9 3区医学 Q1 REHABILITATION

Annals of Physical and Rehabilitation Medicine Pub Date : 2024-08-21 DOI:10.1016/j.rehab.2024.101867

Natasha K. Brusco , Christina L. Ekegren , Meg E. Morris , Keith D. Hill , Annemarie L. Lee , Lisa Somerville , Natasha A. Lannin , Rania Abdelmotaleb , Libby Callaway , Sara L. Whittaker , Nicholas F. Taylor , My Therapy Consortium

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引用次数: 0

Abstract

Background

Self-management programs can increase the time spent on prescribed therapeutic exercises and activities in rehabilitation inpatients, which has been associated with better functional outcomes and shorter hospital stays.

Objectives

To determine whether implementation of a self-management program (‘My Therapy’) improves functional independence relative to routine care in people admitted for physical rehabilitation.

Methods

This stepped wedge, cluster randomized trial was conducted over 54 weeks (9 periods of 6-week duration, April 2021 - April 2022) across 9 clusters (general rehabilitation wards) within 4 hospitals (Victoria, Australia). We included all adults (≥18 years) admitted for rehabilitation to participating wards. The intervention included routine care plus ‘My Therapy’, comprising a sub-set of exercises and activities from supervised sessions which could be performed safely, without supervision or assistance. The primary outcomes were the proportion of participants achieving a minimal clinically important difference (MCID) in the Functional Independence Measure, (FIM™) and change in total FIM™ score from admission to discharge.

Results

2550 participants (62 % women) were recruited (control: n = 1458, intervention: n = 1092), with mean (SD) age 77 (13) years and 37 % orthopedic diagnosis. Under intervention conditions, participants reported a mean (SD) of 29 (21) minutes/day of self-directed therapy, compared to 4 (SD 14) minutes/day, under control conditions. There was no evidence of a difference between control and intervention conditions in the odds of achieving an MCID in FIM™ (adjusted odds ratio 0.93, 95 % CI 0.65 to 1.31), or in the change in FIM™ score (adjusted mean difference: -0.27 units, 95 % CI -2.67 to 2.13).

Conclusions

My Therapy was delivered safely to a large, diverse sample of participants admitted for rehabilitation, with an increase in daily rehabilitation dosage. However, given the lack of difference in functional improvement with participation in My Therapy, self-management programs may need to be supplemented with other strategies to improve function in people admitted for rehabilitation.

Trial registration

Australian New Zealand Clinical Trials Registry (ACTRN12621000313831), https://www.anzctr.org.au/

查看原文本刊更多论文

我的治疗 "自我管理计划在康复患者中的效果：阶梯式楔形群组随机临床试验。

背景：自我管理计划可以增加康复住院病人用于规定的治疗锻炼和活动的时间，这与更好的功能结果和更短的住院时间有关：目的：确定与常规护理相比，实施自我管理计划（"我的疗法"）是否能提高物理康复住院患者的功能独立性：这项阶梯式楔形群组随机试验在4家医院（澳大利亚维多利亚州）的9个群组（普通康复病房）中进行，为期54周（9期，每期6周，2021年4月至2022年4月）。我们将所有入住参与病房进行康复治疗的成年人（≥18 岁）纳入其中。干预措施包括常规护理和 "我的疗法"，"我的疗法 "包括在没有监督或协助的情况下可以安全进行的运动和活动。结果：共招募了 2550 名参与者（62% 为女性）（对照组：n = 1458，干预组：n = 1092），平均（标清）年龄为 77（13）岁，37% 被诊断为骨科。在干预条件下，参与者平均（标清）每天进行 29（21）分钟的自我指导治疗，而在对照条件下，平均（标清）每天进行 4（标清）分钟的自我指导治疗。没有证据表明对照组和干预组在 FIM™ 达到 MCID 的几率（调整后的几率比 0.93，95 % CI 0.65 至 1.31）或 FIM™ 分数变化（调整后的平均差异：-0.27 个单位，95 % CI -2.67 至 2.13）方面存在差异：结论："我的疗法 "能安全地为大量不同的康复参与者提供康复治疗，并增加了每日康复治疗的用量。然而，鉴于参与 "我的疗法 "在功能改善方面缺乏差异，自我管理计划可能需要辅以其他策略，以改善接受康复治疗者的功能：澳大利亚-新西兰临床试验登记处（ACTRN12621000313831），https://www.anzctr.org.au/。

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来源期刊

Annals of Physical and Rehabilitation Medicine Medicine-Rehabilitation

CiteScore

7.80

自引率

4.30%

发文量

136

审稿时长

34 days

期刊介绍： Annals of Physical and Rehabilitation Medicine covers all areas of Rehabilitation and Physical Medicine; such as: methods of evaluation of motor, sensory, cognitive and visceral impairments; acute and chronic musculoskeletal disorders and pain; disabilities in adult and children ; processes of rehabilitation in orthopaedic, rhumatological, neurological, cardiovascular, pulmonary and urological diseases.