Associations Between Adherence to Self-Management Activities and Change in Function and Health Outcomes in the Rehabilitation of Patients with Rheumatic and Musculoskeletal Diseases

Abstract

Objectives: To explore the content of, and adherence to, self-management activities reported by patients with rheumatic and musculoskeletal diseases (RMDs), and whether adherence to self-management activities is associated with changes in self-reported health and function over a 1-year period following rehabilitation in specialized healthcare. Methods: Participants (n = 523) reported function and health outcomes at admission, discharge, and 4, 8 and 12 months post-rehabilitation. Self-management activities reported at discharge were self-evaluated as adherence level at home. Self-management activity content was linked to the International Classification of Functioning, Disability and Health coding system, and summarized as high or low adherence. Associations between adherence to self-management activities and change in outcomes were investigated using a linear mixed model approach with repeated measures. Results: Self-management activities focused mainly on enhanced physical health and managing everyday routines, and seldom addressed work participation. Adherence to self-management activities was challenging with regard to structure and daily life routines, mental health, and the application of knowledge and coping strategies. Adherence to self-management activities was significantly associated with improvements in all outcomes, except for mental health and activities of daily living. Conclusion: Adherence to self-management activities, and creating structure and setting everyday routines at home, appear to be important for maintaining health and function over time. Rehabilitation should include a greater focus on mental health challenges and work participation. LAY ABSTRACT The aim of this study is to explore the self-management plans reported by patients with rheumatic and musculoskeletal diseases, and whether these plans influenced patients’ health and function after rehabilitation. The participants were followed for 1 year after undergoing rehabilitation and into their home settings. They self-reported their self-management plans, and self-evaluated their adherence to these plans at home. The plans focused mainly on physical health and managing everyday routines. It appears that creating structure and setting routines at home are important for maintaining health and function over time. It was notable that mental health challenges and plans for work participation were seldom prioritized or improved, suggesting a need for greater focus on these issues by healthcare professionals during rehabilitation and in the community.

Keywords

• rheumatic and musculoskeletal diseases
• rehabilitation trajectories
• self-management
• adherence
• function and health outcomes
• International Classification of Functioning