Periodic Reporting for period 3 - 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)
Periodo di rendicontazione: 2022-08-01 al 2024-01-31
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 MOBILIZE project is going to 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. The project is going to develop and evaluate the effects of a tailored exercise therapy and self-management support program in addition to current best practice on self-reported, objectively measured and physiological 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). The project will provide new insight into which treatment is the most effective and develop a plan for implementation. This will be essential to ensure the best possible treatment for this large and growing group of patients and can potentially have a large societal impact.
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 MOBILIZE project is going to 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. The project is going to develop and evaluate the effects of a tailored exercise therapy and self-management support program in addition to current best practice on self-reported, objectively measured and physiological 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). The project will provide new insight into which treatment is the most effective and develop a plan for implementation. This will be essential to ensure the best possible treatment for this large and growing group of patients and can potentially have a large societal impact.
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 is to investigate the effects of the tailored exercise therapy and self-management program in addition to current best practice on self-reported, objectively measured and physiological outcomes in people with multimorbidity. At this point of the project, we have successfully recruited all of the 228 patients that we need to evaluate the effects of the intervention. All baseline and 4-month follow-up tests have been completed, and now we wait for the last 12-month follow-up tests to be performed. The full results of the randomized controlled trial are anticipated to be available in the summer/fall of 2024, providing valuable insights on how to treat multimorbidity effectively.
Our established 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.