Bridging gaps across levels of care in rehabilitation of patients with rheumatic and musculoskeletal diseases: Results from a stepped-wedge cluster randomized controlled trial.
Gunnhild Berdal, Anne-Lene Sand-Svartrud, Anita Dyb Linge and 12 others
PMID 36862585WHAT IT FOUND
Adding a complex support package to usual rehabilitation did not improve patients' goal attainment or health outcomes compared to usual care alone.
Only 31% of the intervention group received the intended post-discharge follow-up, suggesting implementation failures rather than lack of efficacy.
Key findings
01The intervention showed no significant effect on the primary outcome of goal attainment at 7 months, or on secondary outcomes of physical function and quality of life.
02Implementation was poor, with only 31% of patients in the intervention group receiving the follow-up services intended by the study protocol.
03There was a significant improvement in functioning in daily activities for the intervention group at 7 months, but this effect was not maintained at 12 months.
STILL TO COME
How it was doneWhat they foundWhat it means for PTsWhat it means for OTs
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What it does not show
High attrition and missing data (29% control, 41% intervention at 7 months) reduced statistical power and representativeness. Only 31% of the intervention group received the full intervention as intended, making it difficult to distinguish between an ineffective intervention and poor implementation. The stepped-wedge design with only eight clusters carries risks of bias and may have been underpowered for some outcomes. Intervention providers were not blinded, which could influence delivery, although patients may have been partially blinded to allocation.
Declared interests
The study was funded by the Research Council of Norway. The authors declared no conflicts of interest.
The easy way to misread this
Do not conclude that goal setting and follow-up support are ineffective. The trial failed to deliver the follow-up component to nearly 70% of the intervention group, so the null result likely reflects an implementation failure rather than a lack of therapeutic value.