title: OPTIMAL, an occupational therapy led self-management support programme for people with multimorbidity in primary care: a randomized controlled trial.
abstract: BACKGROUND
  We investigated the effectiveness of an occupational therapy led self-management support programme, OPTIMAL, designed to address the challenges of living with multiple chronic conditions or multimorbidity in a primary care setting.
  
  
  METHODS
  Pragmatic feasibility randomised controlled trial including fifty participants with multimorbidity recruited from family practice and primary care settings. OPTIMAL is a six-week community-based programme, led by occupational therapy facilitators and focuses on problems associated with managing multimorbidity. The primary outcome was frequency of activity participation. Secondary outcomes included self-perception of, satisfaction with and ability to perform daily activities, independence in activities of daily living, anxiety and depression, self-efficacy, health-related quality of life, self-management support, healthcare utilisation and individualised goal attainment. Outcomes were collected within two weeks of intervention completion.
  
  
  RESULTS
  There was a significant improvement in frequency of activity participation, measured using the Frenchay Activities Index, for the intervention group compared to the control group (Adjusted Mean Difference at follow up 4.22. 95% Confidence Interval 1.59-6.85). There were also significant improvements in perceptions of activity performance and satisfaction, self-efficacy, independence in daily activities and quality of life. Additionally, the intervention group demonstrated significantly higher levels of goal achievement, following the intervention. No significant differences were found between the two groups in anxiety, depression, self-management scores or healthcare utilisation.
  
  
  CONCLUSIONS
  OPTIMAL significantly improved frequency of activity participation, self-efficacy and quality of life for patients with multimorbidity. Further work is required to test the sustainability of these effects over time but this study indicates that it is a promising intervention that can be delivered in primary care and community settings.
  
  
  BACKGROUND
  
  
  
  BACKGROUND
  ISRCTN67235963.
authors.affiliation: Department of Occupational Therapy, Trinity College Dublin, Trinity Centre, St James's Hospital, Dublin 8, Ireland. garveyjm@tcd.ie.
authors.forename: Jess
authors.initials: J
authors.lastname: Garvey
authors.affiliation: Department of Occupational Therapy, Trinity College Dublin, Trinity Centre, St James's Hospital, Dublin 8, Ireland. connoldm@tcd.ie.
authors.forename: Deirdre
authors.initials: D
authors.lastname: Connolly
authors.affiliation: HRB Centre for Primary Care Research, Department of General Practice, Royal College of Surgeon's in Ireland, Beaux Lane House, Lower Mercer Street, 2, 123 St Stephen's Green, Dublin 2, Ireland. fionaboland@rcsi.ie.
authors.forename: Fiona
authors.initials: F
authors.lastname: Boland
authors.affiliation: HRB Centre for Primary Care Research, Department of General Practice, Royal College of Surgeon's in Ireland, Beaux Lane House, Lower Mercer Street, 2, 123 St Stephen's Green, Dublin 2, Ireland. susansmith@rcsi.ie.
authors.forename: Susan M
authors.initials: SM
authors.lastname: Smith
mesh_terms: D000203:Activities of Daily Living; D002908:Chronic Disease / Q000453:epidemiology / Q000523:psychology / Q000534:rehabilitation; D055812:Community-Based Participatory Research / Q000379:methods; D015897:Comorbidity; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009788:Occupational Therapy / Q000379:methods / Q000523:psychology; D010043:Outcome and Process Assessment, Health Care; D011320:Primary Health Care / Q000379:methods / Q000706:statistics & numerical data; D011788:Quality of Life; D012648:Self Care / Q000379:methods / Q000523:psychology; D012649:Self Concept