Enhancing self-management of multimorbidity in primary care: A randomised controlled trial

Abstract

Abstract Background: Effective primary care interventions for multimorbidity are needed. Aim: To evaluate the effectiveness of a group-based six-week occupational therapy led self-management support programme (OPTIMAL) for patients with multimorbidity. Design and Setting: A pragmatic parallel randomised trial across eight primary care teams in Eastern Ireland with 149 patients with multimorbidity. The intervention was OPTIMAL with a usual care comparison. Methods: Primary outcomes were health-related quality of life (EQ5D) and frequency of activity participation (FAI). Secondary outcomes included independence in activities of daily living, occupational performance and satisfaction, anxiety and depression, self-efficacy and healthcare utilisation. Complete case linear regression analyses were conducted. Age (<65/ ≥65 years) and the number of chronic conditions (<4/ ≥4) were explored further. Results: 124 participants (83%) and 121 (81%) participants had complete data at immediate and six-month post-intervention follow-up. Intervention participants had a significant improvement in EQ-VAS at immediate follow-up (Adjusted MD=7.86; 95% CI 0.92 to 14.80) but no difference in the index score (Adjusted MD= 0.04; 95% CI -0.06 to 0.01) or FAI (Adjusted MD = 1.22; 95% CI -0.84 to 3.29). At six-month follow-up there were no differences in primary outcomes. There were mixed results for secondary outcomes. Pre-planned sub-group analyses suggested participants aged <65 years were more likely to benefit. Conclusions: OPTIMAL was not effective in improving health related quality of life or activity participation at six-month follow up. Pre-planned sub-group analyses results suggest that future research should target younger adults (age <65 years) with multimorbidity.