title: Evaluation of a structured goal planning and tailored follow-up programme in rehabilitation for patients with rheumatic diseases: protocol for a pragmatic, stepped-wedge cluster randomized trial.
abstract: BACKGROUND
  Comprehensive rehabilitation, involving health professionals from various disciplines, is widely used as an adjunct to pharmacological and surgical treatment in people with rheumatic diseases. However, the evidence for the clinical- and cost-effectiveness of such interventions is limited, and the majority of those who receive rehabilitation are back to their initial health status six to 12 months after discharge.
  
  
  METHODS
  To evaluate the goal attainment, health effects and cost-effectiveness of a new rehabilitation programme compared to current traditional rehabilitation programmes for people with rheumatic diseases, a stepped-wedge cluster randomized trial will be performed. Patients admitted for rehabilitation at six centres in the south-eastern part of Norway will be invited to participate. In the trial, six participating centres will switch from a control (current rehabilitation programme) to an intervention phase (the new rehabilitation programme) in a randomized order. Supported by recent research, the new programme will be a supplement to the existing programme at each centre, and will comprise four elements designed to enhance and support lifestyle changes introduced in the rehabilitation period: structured goal-planning, motivational interviewing, a self-help booklet and four follow-up telephone calls during the first five months following discharge. The primary outcome will be health-related quality of life and goal attainment, as measured by the Patient Generated Index directly before and after the rehabilitation stay, as well as after six and 12 months. Secondary outcomes will include self-reported pain, fatigue, a global assessment of disease activity and motivation for change (measured on 11-point numeric ratings scales), health-related quality of life as measured by the Short Form 36 Health Survey (SF-36) and utility assessed by the SF6D utility index.The main analysis will be on an intention to treat basis and will assess the clinical- and cost-effectiveness of the structured goal planning and tailored follow-up rehabilitation programme for patients with rheumatic diseases.
  
  
  CONCLUSIONS
  The findings will constitute an important contribution to more cost-effective- and evidence-based rehabilitation services for people with rheumatic diseases.
  
  
  BACKGROUND
  ISRCTN91433175.
authors.affiliation: National Advisory Unit on Rehabilitation in Rheumatology, Department of Rheumatology, Diakonhjemmet Hospital, PO Box 23 Vinderen, N-0319 Oslo, Norway. ingvild.kjeken@diakonsyk.no.
authors.forename: Ingvild
authors.initials: I
authors.lastname: Kjeken
authors.forename: Gunnhild
authors.initials: G
authors.lastname: Berdal
authors.forename: Ingvild
authors.initials: I
authors.lastname: Bø
authors.forename: Turid
authors.initials: T
authors.lastname: Dager
authors.forename: Anne
authors.initials: A
authors.lastname: Dingsør
authors.forename: Jon
authors.initials: J
authors.lastname: Hagfors
authors.forename: Bente
authors.initials: B
authors.lastname: Hamnes
authors.forename: Siv G
authors.initials: SG
authors.lastname: Eppeland
authors.forename: Elin
authors.initials: E
authors.lastname: Fjerstad
authors.forename: Petter
authors.initials: P
authors.lastname: Mowinckel
authors.forename: Merete
authors.initials: M
authors.lastname: Nielsen
authors.forename: Randi W
authors.initials: RW
authors.lastname: Rørstad
authors.forename: Anne-Lene
authors.initials: AL
authors.lastname: Sand-Svartrud
authors.forename: Bente
authors.initials: B
authors.lastname: Slungaard
authors.forename: Sigrid H
authors.initials: SH
authors.lastname: Wigers
authors.forename: Kåre Birger
authors.initials: KB
authors.lastname: Hagen
mesh_terms: D000359:Aftercare / Q000379:methods; D017281:Cost of Illness; D006040:Goals; D006801:Humans; D008019:Life Style; D009042:Motivation; D015337:Multicenter Studies as Topic / Q000379:methods*; D009664:Norway; D010353:Patient Education as Topic; D011788:Quality of Life; D012107:Research Design; D012216:Rheumatic Diseases / Q000191:economics / Q000534:rehabilitation*; D012648:Self Care; D020377:Self Efficacy; D016037:Single-Blind Method; D013689:Telephone; D016896:Treatment Outcome