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BEHANDLING-God og treffsikker diagnostikk, behandling og rehabilitering

The BRIDGE trial: A multicenter RCT to improve continuity and quality in rehabilitation of people with rheumatic & musculoskeletal diseases

Alternative title: BRObygging i rehabilitering: En multisenter RCT for å bedre kvalitet og kontinuitet i rehabilitering av personer med muskelskjelettsykdommer

Awarded: NOK 12.0 mill.

Many people with rheumatic and musculoskeletal diseases (RMDs) need rehabilitation to reach and maintain optimal functioning, independence and participation in society. Such rehabilitation is usually delivered at hospital departments and rehabilitation institutions in specialist health care. Previous research shows that even if these patients benefit from rehabilitation, the effect seems to reduce over time. One reason may be that they need support over a longer period to be able to implement new habits in their daily life. Planned strategies for self-management and follow-up in primary health care may promote such implementation. However, several reports conclude that the quality of rehabilitation in general is low, characterized by a lack of coordination across levels of care, and with large variations in content and quality, especially in primary health care. Further, research on which elements that is essential to ensure good quality in rehabilitation is warranted. The main goals of the BRIDGE trial are to develop and test the efficacy of a new program aimed at bridging gaps and improve communication across levels of care, and to use a newly developed set of quality indicators to describe and compare the content and organization of rehabilitation across different centers. Eight centers in specialist health care participate in the study. All centers started the trial simultaneously and delivered their current rehabilitation program (control intervention) before they, one after another in randomized order, switched to the intervention phase and added the BRIDGE program to the current program in a stepped wedge randomised controlled trial design. A total of 379 participants have been included and followed for one year. The primary outcome is goal attainment seven months after rehabilitation discharge. Other important outcomes are health-related quality of life and physical function. As for September 2021, the PhD student has published her first article. The results show that the quality indicator set is responsive when applied in rehabilitation services for adults with various RMD conditions. We therefore recommend this quality indicator set as a timely method for establishing quality of rehabilitation benchmarks, promoting important progress toward high-quality rehabilitation, and tracking trends over time. The PhD-student is now working on her second article, exploring whether higher quality, measured by patients' responses to process indicators from the quality indicator set for rehabilitation, is associated with better patient-reported outcomes in terms of goal attainment, physical function and health related quality of life. She completed her mid-term evaluation at Oslo Metropolitan University in October 2020 and plans to hand in her thesis in spring of 2022. The post doc candidate is working on her first article, where the main aim is to evaluate the effectiveness of the BRIDGE program in patients with RMDs, compared to traditional rehabilitation. She won an award for best abstract at the European Congress of Rheumatology for this work, and will submit the article in fall 2021.

The goal of rehabilitation is to help people to reach and maintain their optimal functioning and coping capabilities, and to promote independence and participation in society. According to current political documents, there are large variation in the content and quality of rehabiliation in Norway, and systems to improve coordination and communication are needed. This application presents a collaborative project between 8 centres across Norway, investigating whether a new program aimed at bridging gaps in rehabilitation across levels of care increase and/or prolong the effect of rehabilitation for people with rheumatic & musculoskeletal diseases. Additionally, we will use a newly developed set of quality indicators to monitor and compare the quality of rehabilitation across different centres, and explore relationships between adherence to structure and process indicators and the outcomes of rehabilitation. The effects will be evaluated in a multi-centre stepped wedge randomized controlled trial, where participating centres switch from control (current rehabilitation program) to intervention phase (adding the BRIDGE program to the current program) in a randomized order. Primary outcome is goal attainment after seven months, and secondary outcomes are health related quality of life and function. The results will give insight in the content and organisation of current rehabilitation programs, what follow up people want and receive in primary care, their planned and completed efforts to implement and maintain life style changes, and predictors for improvement following rehabilitation in specialist health care. Results will also have consequences on how rehabilitation is to be organized in the future regarding follow-up and coordination across levels of care. The study has been developed in close collaboration with patient research partners, clinicians and international experts, who will also contribute in the process of integrating study results in clinical practice.

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BEHANDLING-God og treffsikker diagnostikk, behandling og rehabilitering