title: Monitoring physical functioning as the sixth vital sign: evaluating patient and practice engagement in chronic illness care in a primary care setting--a quasi-experimental design.
abstract: BACKGROUND
  In Canada, one in three adults or almost 9 million people report having a chronic condition. Over two thirds of total deaths result from cardiovascular disease, diabetes, cancer and respiratory illness and 77% of persons ≥65 years have at least one chronic condition. Persons with chronic disease are at risk for functional decline; as a result, there is an increased awareness of the significance of functional status as an important health outcome. The purpose of this study was to determine whether patients who receive a multi-component rehabilitation intervention, including online monitoring of function with feedback and self-management workshops, showed less functional decline than case matched controls who did not receive this intervention. In addition, we wanted to determine whether capacity building initiatives within the Family Health Team promote a collaborative approach to Chronic Disease Management.
  
  
  METHODS
  A population-based multi-component rehabilitation intervention delivered to persons with chronic illnesses (≥ 44 yrs) (n = 60) was compared to a group of age and sex matched controls (n = 60) with chronic illnesses receiving usual care within a primary healthcare setting. The population-based intervention consisted of four main components: (1) function-based individual assessment and action planning, (2) rehabilitation self-management workshops, (3) on-line self-assessment of function and (4) organizational capacity building. T-tests and chi-square tests were used for continuous and categorical variables respectively in baseline comparison between groups.
  
  
  RESULTS
  Two MANOVA showed significant between group differences in patient reported physical functioning (Λ = 0.88, F = (2.86) = 5.97. p = 0.004) and for the physical performance measures collectively as the dependent variable (Λ = 0.80, F = (6.93) = 3.68. p = 0.0025). There were no within group differences for the capacity measures.
  
  
  CONCLUSIONS
  It is feasible to monitor physical functioning as a health outcome for persons with chronic illness in primary care. The timeline for this study was not sufficient to show an increase in the capacity within the team; however there were some differences in patient outcomes. The short timeline was likely not sufficient to build the capacity required to support this approach.
  
  
  BACKGROUND
  NCT00859638.
authors.affiliation: School of Rehabilitation Science, Faculty of Health Science, Institute of Applied Health Sciences, Room 403, 1400 Main Street West, Hamilton, ON L8S 1C7, Canada. jrichard@mcmaster.ca
authors.forename: Julie
authors.initials: J
authors.lastname: Richardson
authors.forename: Lori
authors.initials: L
authors.lastname: Letts
authors.forename: David
authors.initials: D
authors.lastname: Chan
authors.forename: Alexis
authors.initials: A
authors.lastname: Officer
authors.forename: Sarah
authors.initials: S
authors.lastname: Wojkowski
authors.forename: Doug
authors.initials: D
authors.lastname: Oliver
authors.forename: Ainsley
authors.initials: A
authors.lastname: Moore
authors.forename: Lisa
authors.initials: L
authors.lastname: McCarthy
authors.forename: David
authors.initials: D
authors.lastname: Price
authors.forename: Sarah
authors.initials: S
authors.lastname: Kinzie
mesh_terms: D000203:Activities of Daily Living; D000328:Adult; D017677:Age Distribution; D000368:Aged; D002170:Canada; D057191:Capacity Building; D002908:Chronic Disease / Q000534:rehabilitation*; D017076:Computer-Aided Design; D019468:Disease Management; D005194:Family Practice / Q000379:methods*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D018670:Monitoring, Ambulatory / Q000592:standards; D010043:Outcome and Process Assessment, Health Care; D010817:Physician-Patient Relations; D011320:Primary Health Care / Q000379:methods*; D015397:Program Evaluation; D036301:Qualitative Research; D020127:Recovery of Function; D012648:Self Care / Q000523:psychology / Q000592:standards; D017678:Sex Distribution