I Am Able: Population Based Rehabilitation in a Family Health Team

Hamilton Health Sciences (HHS)

Status: Completed

Conditions: Chronic Conditions; Hypertension; Diabetes; Arthritis; Chronic Pain

Treatments: Behavioral: Occupational Therapy; Behavioral: Capacity Building; Behavioral: Physiotherapy

Study type: Interventional

Funder types: Other

Identifiers

NCT00859638

2007-ORRAN-IIA-568

08-177

Details and patient eligibility

About

People who have long-term conditions such as heart disease, diabetes, arthritis etc. face challenges in staying active and able to participate in activities that are important to them. There is some research that suggests that a care model that focuses on physical functioning and helping patients to manage their own conditions will assist them to stay active and healthy longer. In this project, the investigators are testing whether physiotherapy and occupational therapy offered to groups of patients and information about rehabilitation offered to other members of the health care team can help people with chronic conditions to maintain their physical abilities.

Full description

Participants older than 44, with at least one chronic disease, (n=60) will participate in a before-and-after study integrating a population based, rehabilitation-focused program targeting physical function into a Family Health Team. The program, delivered by a Physiotherapist and Occupational Therapist, will consist of comprehensive functional assessments and individualized self-management care plans; a rehabilitation based chronic disease self-management program; and on-line self-monitoring of physical function. Process and outcome measures will be administered at baseline and 4 months follow-up.

Enrollment: 124 patients

Sex: All

Ages: 44+ years old

Volunteers: No Healthy Volunteers

Inclusion criteria

• 44 years and older
• 1 or more chronic conditions
• 3 visits to physician in the past year
• access or willingness to access email

Exclusion criteria

• none

Trial design

Primary purpose: Supportive Care

Allocation: Non-Randomized

Interventional model: Parallel Assignment

Masking: None (Open label)

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124 participants in 2 patient groups

Intervention Group

Experimental group

Description:

Rehabilitation self-management group, on-line self monitoring of physical function, and organizational capacity building.

Treatment:

Behavioral: Occupational Therapy

Behavioral: Physiotherapy

Behavioral: Capacity Building

Case matched controls

No Intervention group

Description:

Usual care in primary health care.