Evaluating adapted physical activity-based rehabilitation in people with chronic disabilities

Abstract

Purpose: To evaluate short- and long-term outcome of rehabilitation based on adapted physical activity (APA) on mental and physical functioning for people with chronic, mainly physical disabilities. In addition, to explore the goal-setting process in terms of content, achievement and influence on outcome. Research design: A randomized double-blind waiting list-controlled study followed by a 12- month prospective follow-up-study. Methods: The study included adults (18-73 years) with chronic disabilities who were admitted to a four-week APA-based rehabilitation stay at Beitostølen Healthsports Center. In the double-blind randomized controlled trial (Clinical Trial Gov number NCT01788397), subjects were randomized to intervention or control (waiting list). The waiting list-group received delayed intervention and subjects from both groups were followed for 12 months. The subjects completed written questionnaires eight and four weeks before rehabilitation, at admission and discharge, and again four weeks and 12 months after discharge. Mental and physical functioning was measured by the Physical and Mental Component Summaries (PCS and MCS) of The Medical Outcomes Study 12-item Short Form Health Survey (SF-12). Possible predictors included pain, fatigue, motivation, self-efficacy and goal achievement. Subjects set individual goals in the study admission questionnaire. Negotiated goals were part of the observed intervention, and were elaborated in a meeting with the rehabilitation team on the second day of the intervention. The goals were linked to categories in The International Classification of Functioning, Disability and Health (ICF) to ensure comparability. Goal achievement was measured at discharge. Results: Compared to waiting list, the intervention significantly improved the subjects’ physical and mental functioning four weeks after rehabilitation (p=0.001 and p=0.02, respectively). The SF-12 PCS and MCS improved with 3.76 and 3.79 points, respectively. Improvements were associated with increased self-efficacy for social and recreational activities during rehabilitation. Trajectories revealed that the detected improvement in physical and mental functioning sustained after one year (p<0.001). Mean improvement in SF-12 PCS and MCS from baseline to one year was 1.99 and 2.88 points. Long-term improvement was associated with low self-efficacy for managing chronic disease and high levels of fatigue at baseline, non-nervous system diseases and goal achievement. Rehabilitation goals set by the individuals were most frequently linked to the ICF-component. Body Functions. After goal negotiation with the rehabilitation team, the portion of goal codes that could be linked to the ICF increased by 7%. Conclusion: Individuals with chronic disabilities participating in an APA- and goal-settingbased intervention improved their physical and mental functioning both at short and long-term follow up. The improvement seemed to be particularly positive for subjects with fatigue and low self-efficacy, and for those who experienced goal achievement. Health professional’s involvement in goal-setting seemed to benefit more specific goals and a higher relative frequency of goals directed towards activities and participation.