OPTIMAL, an occupational therapy led self-management support programme for people with multimorbidity in primary care: a randomized controlled trial.

Jess Garvey,Deirdre Connolly,Susan M Smith,Fiona Boland

doi:10.1186/s12875-015-0267-0

Abstract

BackgroundWe investigated the effectiveness of an occupational therapy led self-management support programme, OPTIMAL, designed to address the challenges of living with multiple chronic conditions or multimorbidity in a primary care setting.MethodsPragmatic feasibility randomised controlled trial including fifty participants with multimorbidity recruited from family practice and primary care settings. OPTIMAL is a six-week community-based programme, led by occupational therapy facilitators and focuses on problems associated with managing multimorbidity. The primary outcome was frequency of activity participation. Secondary outcomes included self-perception of, satisfaction with and ability to perform daily activities, independence in activities of daily living, anxiety and depression, self-efficacy, health-related quality of life, self-management support, healthcare utilisation and individualised goal attainment. Outcomes were collected within two weeks of intervention completion.ResultsThere was a significant improvement in frequency of activity participation, measured using the Frenchay Activities Index, for the intervention group compared to the control group (Adjusted Mean Difference at follow up 4.22. 95% Confidence Interval 1.59-6.85). There were also significant improvements in perceptions of activity performance and satisfaction, self-efficacy, independence in daily activities and quality of life. Additionally, the intervention group demonstrated significantly higher levels of goal achievement, following the intervention. No significant differences were found between the two groups in anxiety, depression, self-management scores or healthcare utilisation.ConclusionsOPTIMAL significantly improved frequency of activity participation, self-efficacy and quality of life for patients with multimorbidity. Further work is required to test the sustainability of these effects over time but this study indicates that it is a promising intervention that can be delivered in primary care and community settings.Trial registrationTrial Number: ISRCTN67235963

Highlights

We investigated the effectiveness of an occupational therapy led self-management support programme, OPTIMAL, designed to address the challenges of living with multiple chronic conditions or multimorbidity in a primary care setting
The review suggested that interventions targeting functional limitations that are common across conditions had potential to improve outcomes [9]
Patient flow and characteristics Sixty-three individuals were referred to the programme within the study time frame, which was limited as this work was undertaken as part of a postgraduate Research Masters degree (JG)

Summary

Introduction

We investigated the effectiveness of an occupational therapy led self-management support programme, OPTIMAL, designed to address the challenges of living with multiple chronic conditions or multimorbidity in a primary care setting. Multimorbidity is considered the norm, rather than the exception, in primary care settings [1,2]. It is an independent predictor of adverse outcomes, including poor quality of life (QoL), mortality and disability [3]. There is limited evidence regarding the potential effectiveness of interventions designed to improve outcomes in multimorbidity. The review suggested that interventions targeting functional limitations that are common across conditions had potential to improve outcomes [9].

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