Self-managed occupational therapy and physiotherapy for adults receiving inpatient rehabilitation (‘My Therapy’): protocol for a stepped-wedge cluster randomised trial

BMC Health Services Research

AnnemarieL.Lee¹  RaniaAbdelmotaleb²  LisaSomerville³  NatashaA. Lannin⁴  NicholasF.Taylor⁵  Meg E.Morris⁶  DerickWade⁷  Sara L. Whittaker⁸  KeithD.Hill⁸  Christina L. Ekegren⁹  Natasha K. Brusco^1,10  LibbyCallaway^1,11 

[1]Cabrini Health, 154 Wattletree Rd, 3144, Malvern, Australia

[2]School of Physiotherapy, Monash University, 47-49 Moorooduc Hwy, 3199, Frankston, VIC, Australia

[3]Eastern Health, 5 Arnold St, 3128, Box Hill, Australia

[4]La Trobe University Centre for Sport and Exercise Medicine Research, Plenty Road & Kingsbury Drive, 3086, Bundoora, Australia

[5]Alfred Health, 55 Commercial Rd, 3004, Melbourne, Australia

[6]La Trobe University Centre for Sport and Exercise Medicine Research, Plenty Road & Kingsbury Drive, 3086, Bundoora, Australia

[7]Alfred Health, 55 Commercial Rd, 3004, Melbourne, Australia

[8]Department of Neuroscience, Monash University, Central Clinical School, 99 Commercial Rd, 3004, Melbourne, Australia

[9]La Trobe University Centre for Sport and Exercise Medicine Research, Plenty Road & Kingsbury Drive, 3086, Bundoora, Australia

[10]Eastern Health, 5 Arnold St, 3128, Box Hill, Australia

[11]La Trobe University Centre for Sport and Exercise Medicine Research, Plenty Road & Kingsbury Drive, 3086, Bundoora, Australia

[12]Healthscope ARCH, The Victorian Rehabilitation Centre, 499 Springvale Road, 3150, Glen Waverley, Australia

[13]Physiotherapy and Rehabilitation, Faculty of Health and Life Sciences, Oxford Brookes University, Headington Campus, OX3 0BP, Oxford, United Kingdom

[14]Rehabilitation, Ageing and Independent Living (RAIL) Research Centre, School of Primary and Allied Health Care, Monash University, 47-49 Moorooduc Hwy, 3199, Frankston, VIC, Australia

[15]Rehabilitation, Ageing and Independent Living (RAIL) Research Centre, School of Primary and Allied Health Care, Monash University, 47-49 Moorooduc Hwy, 3199, Frankston, VIC, Australia

[16]Alfred Health, 55 Commercial Rd, 3004, Melbourne, Australia

[17]Rehabilitation, Ageing and Independent Living (RAIL) Research Centre, School of Primary and Allied Health Care, Monash University, 47-49 Moorooduc Hwy, 3199, Frankston, VIC, Australia

[18]La Trobe University Centre for Sport and Exercise Medicine Research, Plenty Road & Kingsbury Drive, 3086, Bundoora, Australia

[19]Rehabilitation, Ageing and Independent Living (RAIL) Research Centre, School of Primary and Allied Health Care, Monash University, 47-49 Moorooduc Hwy, 3199, Frankston, VIC, Australia

[20]School of Occupational Therapy, Monash University, 47-49 Moorooduc Hwy, 3199, Frankston, VIC, Australia

关键词: Rehabilitation;    Occupational Therapy;    Physiotherapy;    Physical Therapy;    Intensity;    Self-management;    Implementation;    Economic;    Independence;    Exercise;   

DOI  :  10.1186/s12913-021-06462-9

来源: Springer

【 摘 要 】

BackgroundEnsuring patients receive an effective dose of therapeutic exercises and activities is a significant challenge for inpatient rehabilitation. My Therapy is a self-management program which encourages independent practice of occupational therapy and physiotherapy exercises and activities, outside of supervised therapy sessions.MethodsThis implementation trial aims to determine both the clinical effectiveness of My Therapy on the outcomes of function and health-related quality of life, and cost-effectiveness per minimal clinically important difference (MCID) in functional independence achieved and per quality adjusted life year (QALY) gained, compared to usual care. Using a stepped-wedge cluster randomised design, My Therapy will be implemented across eight rehabilitation wards (inpatient and home-based) within two public and two private Australian health networks, over 54-weeks. We will include 2,160 patients aged 18 + years receiving rehabilitation for any diagnosis. Each ward will transition from the usual care condition (control group receiving usual care) to the experimental condition (intervention group receiving My Therapy in addition to usual care) sequentially at six-week intervals. The primary clinical outcome is achievement of a MCID in the Functional Independence Measure (FIM™) at discharge. Secondary outcomes include improvement in quality of life (EQ-5D-5L) at discharge, length of stay, 30-day re-admissions, discharge accommodation, follow-up rehabilitation services and adverse events (falls). The economic outcomes are the cost-effectiveness per MCID in functional independence (FIM™) achieved and per QALY gained, for My Therapy compared to usual care, from a health-care sector perspective. Cost of implementation will also be reported. Clinical outcomes will be analysed via mixed-effects linear or logistic regression models, and economic outcomes will be analysed via incremental cost-effectiveness ratios.DiscussionThe My Therapy implementation trial will determine the effect of adding self-management within inpatient rehabilitation care. The results may influence health service models of rehabilitation including recommendations for systemic change to the inpatient rehabilitation model of care to include self-management. Findings have the potential to improve patient function and quality of life, and the ability to participate in self-management. Potential health service benefits include reduced hospital length of stay, improved access to rehabilitation and reduced health service costs.Trial registrationThis study was prospectively registered with the Australian and New Zealand Clinical Trials Registry (ACTRN12621000313831; registered 22/03/2021, http://www.anzctr.org.au/Trial/Registration/TrialReview.aspx?id=380828&isReview=true).

【 授权许可】

CC BY