Self-management goal setting: identifying the practice patterns of community-based physical therapists

Home care rehabilitation therapy services for individuals with multimorbidity: A rapid review

Multimorbidity refers to the co-occurrence of two or more chronic conditions, where no one disease is considered the central disease. Individuals with multimorbidity experience increased patient health complexity, increased disability and functional decline, and increased health care utilization. Rehabilitation therapists are well positioned to address the complex functional needs that can contribute to disability for people living with multimorbidity; however, it is not well understood how they address these needs within the home care setting. A rapid review was conducted to identify and synthesize the existing literature on home care rehabilitation services for clients with multimorbidity and the effect of those services. Two electronic databases (Medline and CINAHL) were searched. The Journal of Comorbidity was hand-searched for thoroughness because this journal focuses on populations with multiple chronic conditions. This rapid review included observational and experimental studies that focused on rehabilitation therapy interventions embedded within existing home care systems for adults with multimorbidity. Four studies were included in the final review. The results revealed that therapists delivered interventions aimed towards improving functional outcomes related to activities of daily living and instrumental activities of daily living. Physical therapy interventions were the only therapy delivered in three of the four studies included. Furthermore, 50% of these studies explicitly included people with chronic conditions impacting the musculoskeletal system only. This review offers an important perspective on how home care rehabilitation therapy interventions and outcomes are operationalized for individuals with multimorbidity. Despite the varying definitions of multimorbidity, therapeutic intervention supported functional improvements.

Shifting mindsets: a realist synthesis of evidence from self-management support training

CONTEXT

Accompanying the growing expectation of patient self-management is the need to ensure health care professionals (HCPs) have the required attitudes and skills to provide effective self-management support (SMS). Results from existing training interventions for HCPs in SMS have been mixed and the evidence base is weaker for certain settings, including supporting people with progressive neurological conditions (PNCs). We set out to understand how training operates, and to identify barriers and facilitators to training designed to support shifts in attitudes amongst HCPs.

METHODS

We undertook a realist literature synthesis focused on: (i) the influence of how HCPs, teams and organisations view and adopt self-management; and (ii) how SMS needs to be tailored for people with PNCs. A traditional database search strategy was used alongside citation tracking, grey literature searching and stakeholder recommendations. We supplemented PNC-specific literature with data from other long-term conditions. Key informant interviews and stakeholder advisory group meetings informed the synthesis process. Realist context-mechanism-outcome configurations were generated and mapped onto the stages described in Mezirow's Transformative Learning Theory.

RESULTS

Forty-four original articles were included (19 relating to PNCs), from which seven refined theories were developed. The theories identified important training elements (evidence provision, building skills and confidence, facilitating reflection and generating empathy). The significant influence of workplace factors as possible barriers or facilitators was highlighted. Embracing SMS often required challenging traditional professional role boundaries.

CONCLUSION

The integration of SMS into routine care is not an automatic outcome from training. A transformative learning process is often required to trigger the necessary mindset shift. Training should focus on how individual HCPs define and value SMS and how their work context (patient group and organisational constraints) influences this process. Proactively addressing potential contextual barriers may facilitate implementation. These findings could be applied to other types of training designed to shift attitudes amongst HCPs.

Appetite for change: a multidisciplinary team approach to behavioral modification for weight management in a community health group setting

PURPOSE

Obesity is a growing issue in Australia with limited evidence for brief community based intervention. This preliminary study aimed to investigate the long term effects of a 4-week group based multidisciplinary behavior management program for weight loss in the community health setting.

METHOD

A quasi-experimental study design was employed recruiting patients referred to two Community Health Centers. Participants completed a 4-week Appetite for change program, comprising four 2-h group sessions co-facilitated by a multidisciplinary team. The mindfulness self efficacy scale (MSES), quality of life scale (QoL), and self-reported knowledge and stages of change were measured pre-treatment, immediately post-treatment and, 6 and 12 months post-treatment. Weight and waist circumference were additionally measured at baseline, 6 and 12 months post-treatment.

RESULTS

Eighty participants (mean age 63 ± 12.1 years) comprising 73 % women consented to participate. Statistically significant improvements (p ≤ 0.01) from pre-treatment were found at both 6 and 12 months, with a clinically significant mean percentage weight loss of approximately 4 %, and a mean improvement of 8.5 point on QoL at 12 months follow-up. Self-reported improvements in stages of change and knowledge were also maintained at 12 months.

CONCLUSION

Clinically and statistically significant long term improvements in all outcomes were found following a multidisciplinary brief intervention program for overweight/obese adults in the community health setting. The promising results following the Appetite for Change program warrant further controlled investigation.