Does the content really matter? A study comparing structure, process, and outcome of team rehabilitation for patients with inflammatory arthritis in two different clinical settings

Abstract

Objectives: To provide a thorough description of team rehabilitation care and compare the structure, process, and outcomes in two specialized arthritis rehabilitation settings.

Methods: Patients with inflammatory arthritis scheduled for inpatient rehabilitation in seven specialized rehabilitation centres and three rheumatology hospital departments in Norway were included consecutively in a prospective cohort study. Patients completed questionnaires at admission, at discharge, and at a 6-month follow-up, and kept a diary regarding structure and process variables during the rehabilitation stay.

Results: Eighty patients in rehabilitation centres and 73 in hospital departments were included and 80% responded to the 6-month follow-up questionnaire. The two clinical settings differed significantly with regard to structure variables such as cost, referral of patients, length of stay, and number of health professionals involved, and most process variables reflecting treatment modalities. The most remarkable difference was in the amount of individual intervention compared with group intervention. Despite significant improvements in most outcomes at discharge, the scores deteriorated towards baseline level 6 months later. There was a trend towards more significant improvement during rehabilitation for patients at rehabilitation centres whereas patients at hospitals had more prolonged improvement.

Conclusions: Team rehabilitation for inflammatory arthritis in two different clinical settings differed across most variables for structure and process, but few significant differences in outcome were found. Considering the substantial differences in cost, there is an urgent need for consensus concerning which patients should receive rehabilitation in which setting. Future research on the development and evaluation of methods for prolonging the beneficial effects of rehabilitation is needed.

Acknowledgements

We also thank the SPOR (Structure Process and Outcome in Rehabilitation in Rheumatology) collaboration group and all the participating rehabilitation centres and rheumatology hospital departments for their contributions to this study. They are: Bakke, Skogli, Vikersund, Grande, Valnesfjord, Tonsåsen, Jeløy, and Ringen rehabilitation centres, and Diakonhjemmet, Martina Hansens, Østfold, and Lillehammer Hospitals for Rheumatic Diseases. We also than the Scandinavian Team Arthritis Register (STAR) and the European Team Initiative for Care Research (ETIC) collaboration for contributions regarding the development of a rehabilitation diary and for inspiring collaboration.

Notes

1 There is an out-of-pocket payment for a stay at a rehabilitation centre, averaging EUR15. However, there is a yearly upper limit for all out-of-pocket costs.