RehabNytte - Spesialisert rehabilitering ved private rehabiliteringsinstitusjoner

Hovedmålet med RehabNytte er å bidra til bedre og mer effektive rehabiliteringstjenester. Dette skal gjøres ved å undersøke hvilken nytte pasienter har av rehabilitering, øke kunnskapen om grad og betydning av brukermedvirkning, kvalitetssikre måleinstrumenter til bruk i forskning, samt å undersøke hvilken effekt innføring av kvalitetsindikatorer har for pasienters helse, funksjon og livskvalitet etter rehabilitering og evaluering av rehabilitering i Norge.

De 17 spesialiserte rehabiliteringsinstitusjonene som deltar i prosjektet representerer alle helseregioner i Norge. Studien følger personer som har vært til rehabilitering over en periode på ett år.

Prosjektet vil se nærmere på følgende: 

• Hvilken nytte har brukerne av rehabilitering?
• Hvordan kan kvalitetsindikatorer hjelpe oss til å utvikle enda bedre rehabiliteringstjenester?
• Hva betyr brukermedvirkning i rehabilitering?
• Hvordan kan datakvalitet på innsamlede pasientdata og effektmål hjelpe oss i oppfølging etter rehabilitering?
• Hvordan fungerer pasientrapporterte utfallsmål på ulike rehabiliteringspopulasjoner?

The main objective of the project is to contribute to better and more effective rehabilitation services. This will lead to increasing knowledge about patient health, function and quality of life after rehabilitation, the degree and importance of user involvement, applicability of assessment instruments for use in rehabilitation research, as well as investigating the impact of the introduction of quality indicator, and evaluation of rehabilitation in Norway. The institutions participating in the project represent all health regions in Norway.

Background

Use of rehabilitation

It is pointed out that within the rehabilitation field, little is known about the quality and long-term effects of rehabilitation [1-3]. One method of measuring quality of a service is to use quality indicators. These are measurable variables that indicate if specific requirements or standards are met [3]. The National Advisory Unit on Rehabilitation in Rheumatology (NKRR) has developed a set of quality indicators for rehabilitation in musculoskeletal diseases, injuries and complaints that will be used as quality objectives in the project.

Work participation is an important goal for rehabilitation

Norway has a well-functioning labour market where most people are in work, yet around 17 percent of the population today is on health-related benefits. There is a strong correlation between workforce, sickness absence and health-related quality of life [4] and good working ability along with good working conditions affect the person's desire to be at work [2]. Questions about current work ability, compared to when it was at its best [4], are included together with register data from NAV (sickness benefit, unemployment benefit and disability pension).

Common outcomes and reliable results in rehabilitation

The Directorate of Health has, on behalf of the Ministry of Health and Care Services, recently proposed a set of functional assessment instruments with the main aim to be used as a common national tool for the evaluation of rehabilitation in specialist health service [2]. The set soely consists of patient-reported outcomes (PROMS); Patient Specific Functional Scale [5-8], EuroQuol 5D-5L (EQ-5D-5L) [9-11] and PROMIS Profile 29 [12] and, in addition to the Barthel Index Observation and Sunnaas ADL Index. The project will provide knowledge about the applicability, validity, responsiveness, and feasibility of instruments in relevant populations [13].

Patient involvement

Patient involvement is an important goal for today's healthcare and in the rehabilitation services. In this study we want to use the quality indicator set to quantitatively measure user involvement at both system and structure level. Furthermore, we will investigate whether patients' experience of participation, and control over their own rehabilitation process increases the benefits of rehabilitation over time.

Goals

The overall goals of the project are to contribute to better and more effective rehabilitation services by examining the benefit patients have from rehabilitation, increasing knowledge about the degree and importance of user intervention in the rehabilitation services, and quality assurance instruments for use in research and evaluation of rehabilitation in Norway.

Study Design The study is a longitudinal multicentre study of a cohort where we use different study designs; a randomized controlled study (RCT) and an interrupted time series and qualitative interviews.

All participants who wish to participate in the study complete the questionnaire at the start and end of the rehabilitation stay, and 3, 6 and 12 months after rehabilitation start. All reporting is done on a web portal that participants log in via email link with short message service (SMS) login code. The digital solution for data collection and storage will be provided by Check Ware that has security level 4.

Participants

In this study, people admitted to rehabilitation in the specialist health service are followed in the period 01.01.2019-31.03.20. Participants are included at 17 rehabilitation centres in the specialist health service in the health regions South-East, West and Central and North. If one assumes that 80% of the referenced patients are inquiring about participation in the study and that 50% of them agree to participate, one will be in a 15-month inclusion period to include more than 4000 participants. A local project coordinator at each participating unit is responsible for recruiting and registering participants in the study.

Inclusion criteria: Participates in rehabilitation on day or day stays at one of the participating institutions, age over 18 years, good Norwegian language understanding, internet access.

Exclusion criteria: Severe cognitive failure, severe mental illness with inadequate consent competence / ability to participate, outpatient rehabilitation.

Ethics

All participants in the study receive oral and written information about the study, and sign an informed consent. They also consent to retrieving registry data on work participation from NAV. Participation is not associated with any known inconvenience, discomfort or risk, except from the time required to complete the questionnaires (5-20 mins per session). All participants receive rehabilitation as usual. The study adheres to the ethical principles of the Helsinki Declaration. Participants in the project are covered by Norwegian Patient Injury Compensation while staying at the Rehabilitation Institution to which they are referred. The study is recommended by the local data protection office dated 17.10.2018. 

Organization

The project is organized in collaboration with the research and development network in the private rehabilitation institutes, Virke Rehab, user representatives, the National Competition Service for Rheumatological Rehabilitation (NKRR), the National Competition Service for Work-Based Rehabilitation (NKARR) and Regional Competence Service for rehabilitation in South-Eastern Norway Regional Health Authority (RKR-HSØ).