Primary Health Care Research & Development

Research

Rehabilitation in a primary care setting for persons with chronic illness – a randomized controlled trial

Julie Richardsona1 c1, Lori Lettsa1, David Chana2, Paul Stratforda1, Carri Handa1, David Pricea2, Linda Hiltsa2, Liliana Comana1, Mary Edwardsa1, Sue Baptistea1 and Mary Lawa1

a1 School of Rehabilitation, McMaster University, Hamilton, Ontario, Canada

a2 Department of Family Medicine, McMaster University, Hamilton, Ontario, Canada

Abstract

Aim The primary objective of this study was to determine whether adults with a chronic illness within a primary care setting who received a rehabilitation intervention in this setting showed greater improvement in health status and had fewer hospital admissions and emergency room visits compared with adults who do not receive the intervention.

Background More than half of Canadians (16 million people) live with chronic illness. Persons with chronic illness in primary care, especially older persons who are most at risk for functional decline, are currently not receiving effective management.

Methods A randomized controlled trial was used. A rehabilitation multi-component intervention was delivered by a physiotherapist (PT) and occupational therapist in a primary care setting and included collaborative goal setting for rehabilitation needs, a six-week chronic disease self-management (SM) workshop, referral to community programs and a web-based education programme.

Findings Three hundred and three patients participated, n = 152 intervention group and n = 151 in the control group. There was a significant difference between the groups for planned hospital days (F = 6.3, P = 0.00) with an adjusted difference 0.60 day per person, and increased satisfaction with rehabilitation services however no difference on health status or emergency room visits. This rehabilitation intervention which had a strong SM component prevented planned hospitalizations that resulted in a conservative estimated cost saving from reduced hospitalizations of $65 000. Future research needs to examine which patient groups with chronic illness show positive responses to rehabilitation and self-management.

(Received May 14 2009)

(Accepted March 15 2010)

(Online publication June 22 2010)

Key words

  • chronic illness;
  • primary care;
  • randomized controlled trial;
  • rehabilitation

Correspondence:

c1 Correspondence to: Dr Julie Richardson, Associate Professor, School of Rehabilitation Science, McMaster University, IAHS 403, 1400 Main Street West, Hamilton, ON L8S 1C7, Canada. Email: jrichard@mcmaster.ca

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