Abstract
BackgroundEffective primary care interventions for multimorbidity are needed.AimTo evaluate the effectiveness of a group-based, 6-week, occupational therapy-led self-management support programme (OPTIMAL) for patients with multimorbidity.Design and settingA pragmatic parallel randomised controlled trial across eight primary care teams in Eastern Ireland with 149 patients with multimorbidity, from November 2015 to December 2018. Intervention was OPTIMAL with a usual care comparison.MethodPrimary outcomes were health-related quality of life (EQ-5D-3L) and frequency of activity participation (Frenchay Activities Index [FAI]). Secondary outcomes included independence in activities of daily living, occupational performance and satisfaction, anxiety and depression, self-efficacy, and healthcare utilisation. Complete case linear regression analyses were conducted. Age (<65/≥65 years) and the number of chronic conditions (<4/≥4) were explored further.ResultsA total of 124 (83.2%) and 121 (81.2%) participants had complete data at immediate and 6-month post-intervention follow-up, respectively. Intervention participants had significant improvement in EQ-VAS (visual analogue scale) at immediate follow-up (adjusted mean difference [aMD] = 7.86; 95% confidence interval [CI] = 0.92 to 14.80) but no difference in index score (aMD = 0.04; 95% CI = −0.06 to 0.13) or FAI (aMD = 1.22; 95% CI = −0.84 to 3.29). At 6-month follow-up there were no differences in primary outcomes and mixed results for secondary outcomes. Pre-planned subgroup analyses suggested participants aged <65 years were more likely to benefit.ConclusionOPTIMAL was found to be ineffective in improving health-related quality of life or activity participation at 6-month follow-up. Existing multimorbidity interventions tend to focus on older adults; preplanned subgroup analyses results in the present study suggest that future research should target younger adults (<65 years) with multimorbidity.
Highlights
Individuals with multimorbidity, the presence of ≥2 chronic conditions, have poorer health outcomes, higher health service utilisation, and higher healthcare costs.[1,2] The 2016 updated Cochrane review of interventions for multimorbidity in primary care[3] found limited evidence on effectiveness
Intervention participants had significant improvement in EQ-VAS at immediate follow-up but no difference in index score or FAI
OPTIMAL was found to be ineffective in improving health-related quality of life or activity participation at 6-month follow-up
Summary
Individuals with multimorbidity, the presence of ≥2 chronic conditions, have poorer health outcomes, higher health service utilisation, and higher healthcare costs.[1,2] The 2016 updated Cochrane review of interventions for multimorbidity in primary care[3] found limited evidence on effectiveness. The review concluded that previous interventions focused predominantly on people with defined comorbid conditions or on multimorbidity in patients aged >65 years, and recommended a focus on risk factors common across comorbid conditions or generic outcomes such as daily functioning.[3] In 2018, the largest randomised controlled trial (RCT) of a multimorbidity intervention, the 3D study,[4] examined the effect of general practice-based 6-monthly patient multidisciplinary reviews of the dimensions of drugs, depression, and health, based on multimorbidity guidelines It found no effect on health-related quality of life (HRQoL) but did report significant improvements in patients’ experience of care.
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