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

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.

Study Overview

• Status: Completed
• Conditions: Hypertension; Obesity; Arthritis; Back Pain; Chronic Disease
• Intervention / Treatment: Behavioral: Self-management; Behavioral: Occupational therapy; Behavioral: Physiotherapy

Detailed Description

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.

• Study Type: Interventional
• Enrollment (Actual): 303
• Phase: Not Applicable

Contacts and Locations

Study Locations

• Canada
  • Ontario
    • Hamilton, Ontario, Canada, L8W 3L2
      • Stonechurch Family Health Centre, 549 Stonechurch Rd. E.

Participation Criteria

Eligibility Criteria

• Ages Eligible for Study: 44 years and older (Adult, Older Adult)
• Accepts Healthy Volunteers: No
• Genders Eligible for Study: All

Description

Inclusion Criteria:

• At least 1 chronic condition
• 3 visits to family physician in the past year

Exclusion Criteria:

• None

Study Plan

How is the study designed?

Design Details

• Primary Purpose: Treatment
• Allocation: Randomized
• Interventional Model: Parallel Assignment
• Masking: Single

Number of Arms

2

Arms and Interventions

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

What is the study measuring?

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

Collaborators and Investigators

• Sponsor: Hamilton Health Sciences Corporation
• Collaborators: Ontario Ministry of Health and Long Term Care
• Investigators: Principal Investigator: Julie Richardson, PhD, McMaster University; Principal Investigator: Lori Letts, PhD, McMaster University

Study record dates

Study Major Dates

• Study Start: June 1, 2004
• Primary Completion (Actual): August 1, 2006
• Study Completion (Actual): October 1, 2006

Study Registration Dates

• First Submitted: September 28, 2005
• First Submitted That Met QC Criteria: September 28, 2005
• First Posted (Estimate): September 30, 2005

Study Record Updates

• Last Update Posted (Estimate): July 20, 2010
• Last Update Submitted That Met QC Criteria: July 13, 2010
• Last Verified: September 1, 2009

More Information

Terms related to this study

• Keywords: Rehabilitation; Primary health care; Occupational therapy; Self care; Disease management; Chronic disease; Physical therapy techniques
• Additional Relevant MeSH Terms: Pathologic Processes; Disease Attributes; Chronic Disease
• Other Study ID Numbers: 04-052; G03-02572