Associations Between Adherence to Self-Management Activities and Change in Function and Health Outcomes in the Rehabilitation of Patients with Rheumatic and Musculoskeletal Diseases

Abstract

OBJECTIVES: To explore the content of, and adherence to, self-management activities reported by patients with rheumatic and musculoskeletal diseases (RMDs), and whether adherence to self-management activities is associated with changes in self-reported health and function over a 1-year period following rehabilitation in specialized healthcare. METHODS: Participants (n = 523) reported function and health outcomes at admission, discharge, and 4, 8 and 12 months post-rehabilitation. Self-management activities reported at discharge were self-evaluated as adherence level at home. Self-management activity content was linked to the International Classification of Functioning, Disability and Health coding system, and summarized as high or low adherence. Associations between adherence to self-management activities and change in outcomes were investigated using a linear mixed model approach with repeated measures. RESULTS: Self-management activities focused mainly on enhanced physical health and managing everyday routines, and seldom addressed work participation. Adherence to self-management activities was challenging with regard to structure and daily life routines, mental health, and the application of knowledge and coping strategies. Adherence to self-management activities was significantly associated with improvements in all outcomes, except for mental health and activities of daily living. CONCLUSION: Adherence to self-management activities, and creating structure and setting everyday routines at home, appear to be important for maintaining health and function over time. Rehabilitation should include a greater focus on mental health challenges and work participation.