Objectives
Multimorbidity is commonly defined as two or more chronic conditions in an individual and affects more than 60% people over 50 years in Ireland. It is associated with reduced quality of life, an increased risk of mental health difficulties and increased healthcare utilisation (1). Multimorbidity has also been demonstrated to predict future functional decline with faster walking speed and stronger grip strength being shown to reduce the risk of developing new chronic conditions (2, 3). Research has thus highlighted the importance of considering physical functioning when designing interventions for patients with multimorbidity. The aim of this study was to identify the feasibility of an inter-agency physical activity and education programme for patients with multimorbidity in primary care.
Methods
Phase 1 and Phase 2 of the Medical Research Council Framework were used in the design of this study. The intervention combined exercise and education to help improve self-efficacy and physical function of patients with multimorbidity and was based in two Sport and Leisure Centre’s in Dublin City and County. Participants were recruited by HSE primary care Physiotherapists and six sessions were facilitated by a HSE primary care Physiotherapist and a city /county council Fitness Instructor. Gym based exercises targeted patient’s needs and preferences. Education sessions covered eight key topics: pacing and prioritising, pain, sleep, stress and emotional well-being, nutrition, physical activity, goal setting and signposting to additional supports. Sustainability, ongoing engagement and peer support were promoted by discounted leisure centre membership/ access fees on completion of the programme.
Results
Ten participants were recruited in both sites with six participants completing the programme in each site. The participants completed grip strength assessment, six minute walk tests, EQ-5D and Stanford questionnaires on commencement and completion of the programme. Focus groups were carried out with participants along with interviews with the Physiotherapists and Fitness Instructors at the end of the both six week interventions. Results of both quantitative data and qualitative data detailing the feasibility and acceptability of the programme will be completed by July 2017.
Conclusions
With an ageing population, the management of chronic medical conditions is at the forefront of healthcare planning and policy. Determining the feasibility of an interagency physical activity and exercise programme for patients with multimorbidity in the community is the first stage and will inform the design of a randomised controlled trial of the Activ8 programme. This programme aims to improve health outcomes and significantly reduce health care costs for this highly prevalent cohort of patients.
Acknowledgments
This study was funded by the Health Research Board(HRB) of Ireland as part of the HRB Structured PhD in Population Health and Health Services Research (SPHeRE) programme (SPHeRE/2013/01).
References
- WALLACE, E., SALISBURY, C., GUTHRIE, B., et al. 2015. Managing patients with multimorbidity in primary care. BMJ, 350,h176.
- RYAN, A., WALLACE, E., O'HARA, P. & SMITH, SM. 2015. Multimorbidity and functional decline in community-dwelling adults: a systematic review. Health Qual Life Outcomes, 13, 168.
- RYAN A., MURPHY C., BOLAND F., GALVIN R., & SMITH SM. 2017 What is the impact of physical activity and physical function on the development and worsening of Multimorbidity over time in older adults? Journals of Gerontology Series A –Under Review.
Ethical Approval
Approval was received for this study from Royal College of Surgeons Research Ethics Committee and the Health Service Executive Primary Care Research Committee.
