title: Fee-for-service cancer rehabilitation programs improve health-related quality of life.
abstract: BACKGROUND
  Rigorously applied exercise interventions undertaken in a research setting result in improved health-related quality of life (hrqol) in cancer survivors, but research to demonstrate effective translation of that research to practice is needed. The objective of the present study was to determine the effect of fee-for-service cancer rehabilitation programs in the community on hrqol and on self-reported physical activity and its correlates.
  
  
  METHODS
  After enrolment and 17 ± 4 weeks later, new clients (n = 48) to two fee-for-service cancer rehabilitation programs completed the 36-Item Short Form Health Survey (rand-36: rand Corporation, Santa Monica, CA, U.S.A.), the Godin Leisure-Time Exercise Questionnaire, and questions about physical activity correlates. Normal fee-for-service operations were maintained, including a fitness assessment and individualized exercise programs supervised in a group or one-on-one setting, with no minimum attendance required. Fees were associated with the assessment and with each exercise session.
  
  
  RESULTS
  Of the 48 participants, 36 (75%) completed both questionnaires. Improvements in the physical functioning, role physical, pain, and energy/fatigue scales on the rand-36 exceeded minimally important differences and were of a magnitude similar to improvements reported in structured, rigorously applied, and free research interventions. Self-reported levels of vigorous-intensity (p = 0.021), but not moderate-intensity (p = 0.831) physical activity increased. The number of perceived barriers to exercise (p = 0.035) and the prevalence of fatigue as a barrier (p = 0.003) decreased. Exercise self-efficacy improved only in participants who attended 11 or more sessions (p = 0.002). Exercise enjoyment did not change (p = 0.629).
  
  
  CONCLUSIONS
  Enrolment in fee-for-service cancer rehabilitation programs results in meaningful improvements in hrqol comparable to those reported by research interventions, among other benefits. The fee-for-service model could be an effective model for delivery of exercise to more cancer survivors.
authors.affiliation: Rehabilitation Sciences, University of British Columbia.
authors.forename: A A
authors.initials: AA
authors.lastname: Kirkham
authors.affiliation: School of Population and Public Health, University of British Columbia, Vancouver, BC;
authors.forename: S E
authors.initials: SE
authors.lastname: Neil-Sztramko
authors.affiliation: Back on Track Fitness, Vancouver, BC;
authors.forename: J
authors.initials: J
authors.lastname: Morgan
authors.affiliation: Live Well Exercise Clinic, White Rock, BC;
authors.forename: S
authors.initials: S
authors.lastname: Hodson
authors.affiliation: Back on Track Fitness, Vancouver, BC;
authors.forename: S
authors.initials: S
authors.lastname: Weller
authors.affiliation: Live Well Exercise Clinic, White Rock, BC;
authors.forename: T
authors.initials: T
authors.lastname: McRae
authors.affiliation: Rehabilitation Sciences, University of British Columbia; Physical Therapy, University of British Columbia, Vancouver, BC.
authors.forename: K L
authors.initials: KL
authors.lastname: Campbell
keywords: Physical activity; exercise therapy; fatigue; quality of life