Periodic Reporting for period 4 - MOBILIZE (Improving health in people with multimorbidity: a paradigm shift in health care from disease-based curative models to personalized exercise therapy and self-management)
Reporting period: 2024-02-01 to 2024-07-31
Multimorbidity, commonly defined as the co-occurrence of two or more chronic medical conditions in an individual, is associated with poorer function and quality of life, depression, intake of multiple drugs and increased healthcare utilization, and people with multimorbidity account for approximately 78% of all consultations in primary care. Compared to people with only one chronic condition, people with multimorbidity are more likely to die prematurely, to be admitted to hospital and have an increased length of stay in hospital. Multimorbidity affects millions of people around the world and is considered the number one challenge for the healthcare system in the years to come due to the enormous associated personal and societal consequences.
The healthcare system and most research focus on one medical condition at a time, and treatment plans often fail to take a holistic perspective. We know from qualitative research that treating one condition at a time is inconvenient, inefficient and unsatisfactory for the person with the chronic conditions as well as his or her healthcare provider. Research on effective treatment of multimorbidity is lacking. The results of the MOBILIZE project are helping change that.
The aim of the MOBILIZE project is to empower patients with multimorbidity to take a more active role in their healthcare so that they may increase quality of life and physical function, reduce symptoms of the individual conditions, and prevent development of other chronic conditions. In a meticulous process following state-of-the art methods and guidelines recommended internationally, the project has developed and evaluated the effects of a tailored exercise therapy and self-management support program in addition to current best practice on quality of life and a range of other outcomes in people with multimorbidity (i.e. at least two of the following conditions: knee or hip osteoarthritis, chronic obstructive pulmonary disease, heart disease (heart failure or coronary heart disease), hypertension, type 2 diabetes mellitus, depression). As hypothesized, we found that personalized exercise therapy and self-management program in addition to current best practice is superior to current best practice alone on quality of life at 12 months.
The project has thus provided new insight into which treatment is the most effective and how to support and manage people with multimorbidity to live a life with higher quality of life and wellbeing. To ensure that the results will reach the end-users and be applicable in research and clinical practice in the future, we have developed a communication and dissemination plan as well as a plan for implementation in Denmark, which can later be upscaled to other countries as described in WP4 of the original ERC proposal.
The healthcare system and most research focus on one medical condition at a time, and treatment plans often fail to take a holistic perspective. We know from qualitative research that treating one condition at a time is inconvenient, inefficient and unsatisfactory for the person with the chronic conditions as well as his or her healthcare provider. Research on effective treatment of multimorbidity is lacking. The results of the MOBILIZE project are helping change that.
The aim of the MOBILIZE project is to empower patients with multimorbidity to take a more active role in their healthcare so that they may increase quality of life and physical function, reduce symptoms of the individual conditions, and prevent development of other chronic conditions. In a meticulous process following state-of-the art methods and guidelines recommended internationally, the project has developed and evaluated the effects of a tailored exercise therapy and self-management support program in addition to current best practice on quality of life and a range of other outcomes in people with multimorbidity (i.e. at least two of the following conditions: knee or hip osteoarthritis, chronic obstructive pulmonary disease, heart disease (heart failure or coronary heart disease), hypertension, type 2 diabetes mellitus, depression). As hypothesized, we found that personalized exercise therapy and self-management program in addition to current best practice is superior to current best practice alone on quality of life at 12 months.
The project has thus provided new insight into which treatment is the most effective and how to support and manage people with multimorbidity to live a life with higher quality of life and wellbeing. To ensure that the results will reach the end-users and be applicable in research and clinical practice in the future, we have developed a communication and dissemination plan as well as a plan for implementation in Denmark, which can later be upscaled to other countries as described in WP4 of the original ERC proposal.
During the first part of the project, we identified factors and biomarkers that predict better health outcome from exercise therapy and exercise characteristics associated with a better outcome in people with different combinations of chronic conditions through two exploratory observational cohort studies of people with osteoarthritis as well as evaluated outcomes and predictors of outcome from exercise therapy and other behavioral interventions in people with multimorbidity in two systematic reviews and meta-analyses. Furthermore, a scoping review was conducted investigating the behavior change techniques that underlie trials that have a patient education or self-management component designed for people who live with multimorbidity. The project also quantified recruitment and retention rates and factors associated with better recruitment and retention in exercise trials including people with multimorbidity and, finally, assessed the quality of apps available on Google and Apple store for self-management of multiple chronic conditions. By a unique integration of state-of-the art quantitative and qualitative approaches, a novel 12-week exercise therapy and self-management program was subsequently developed based on existing recommendations for exercise, strategies to facilitate behavioral changes as well as focus group interviews with patients, healthcare providers and other relevant stakeholders to ensure that patient and provider priorities and perspectives are reflected in research outcomes. The co-created exercise therapy and self-management program was subsequently successfully tested in a feasibility study (using a mixed methods design) that led to some important adaptations of the intervention and study design to evaluate in the randomized controlled trial. The aim of the randomized controlled trial was to investigate the effects of the tailored exercise therapy and self-management program in addition to current best practice on quality of life (primary outcome) and a range of other self-reported, objectively measured and physiological outcomes in people with multimorbidity. We successfully recruited all of the 228 patients that we needed to evaluate the effects of the intervention. All baseline, 4-month and 12-month follow-up tests were completed with only a small delay due to Covid-19. In the randomized, controlled trial, we found that the personalized exercise therapy and self-management program in addition to current best practice is superior to current best practice alone on quality of life at 12 months, which supports our pre-defined, primary hypothesis. We are currently writing the primary report from the study, which we expect to submit to a leading, multiprofessional peer-reviewed journal followed by a range of other planned publications from the study.
An ambitious dissemination plan has been specified, and project results will be disseminated through a variety of channels in the coming months to academic and non-academic audiences. At least 20 peer-reviewed publications are expected to result from this study (i.e. 13 more than we expected and described in the original ERC proposal). The results will be communicated at no less than five relevant conferences in 2024 and 2025, two of which will be organized by the MOBILIZE project group. Moreover, 3 workshops will be held together with the different stakeholders in the summer of 2025 informing them of the application of the results.
An ambitious dissemination plan has been specified, and project results will be disseminated through a variety of channels in the coming months to academic and non-academic audiences. At least 20 peer-reviewed publications are expected to result from this study (i.e. 13 more than we expected and described in the original ERC proposal). The results will be communicated at no less than five relevant conferences in 2024 and 2025, two of which will be organized by the MOBILIZE project group. Moreover, 3 workshops will be held together with the different stakeholders in the summer of 2025 informing them of the application of the results.
Our established MOBILIZE research program uniquely combines novel holistic approaches and state-of-the-art experiments, collectively aimed at providing new information on how to effectively treat patients with more chronic conditions in a healthcare system that is primarily geared towards single conditions. It is envisioned that our new holistic approach will enable a clearer understanding of how to develop future interventions for people with multimorbidity. Based on the extensive scientific work and publications and the dissemination plan, as well as the implementation plan, we expect that the results of the research program will have the potential to significantly impact, not only research, but also clinical practice in Denmark and the rest of Europe.