Components of community rehabilitation programme for adults with chronic conditions: A systematic review

Background: Health services for individuals with chronic conditions often include a disease specific community rehabilitation programme to assist these individuals to maintain physical function and develop self-management skills. Nurses are often involved in the delivery of such programmes. Many individuals however live with more than one chronic condition and find it difficult to manage the rehabilitation demands for their different diagnoses. Objective: To identify core programme components and clinically meaningful measures for a generic rehabilitation programme. Data sources: Full text English language journal articles identified from CINAHL, MEDLINE (Ovid), AMED and PubMed, plus reference lists of included articles. Review method: A systematic search of databases using keywords and MeSH terms for randomised controlled trials detailing a group based community programme for adults with chronic conditions. Study quality was appraised using the Cochrane Collaboration Tool for assessing risk of bias for randomised controlled trials. Data summarising characteristics of the studies such as participant numbers, programme components and the questionnaires, scales and measures were extracted and tabulated. An additional search of wider literature was undertaken to identify the minimal clinically important difference for each questionnaire, scale or measure used within the included studies. Results: Fifteen good quality studies were identified. At baseline, there were 3856 participants (age range 42-84 years), with 642 participants lost to follow-up. Programmes were led by health professionals and/ or lay leaders. Programme duration ranged from four to 12 weeks and included educational components targeting symptom management, and development of self-efficacy. Only three programmes included a supervised exercise component. Although many of the 64 outcomes measured across the programmes demonstrated statistically significant results, only three measures demonstrated clinically meaningful change for study participants and these measures were used in only two studies. Conclusions and recommendations: The findings suggest community rehabilitation programmes for individuals with chronic conditions be a minimum of 4-6 weeks to cover necessary education for management of symptoms, be led by a health professionals in combination with lay leaders, and include development of self-management skills. We recommend consideration be given to health literacy level of the programme, and that because of the known positive benefit of exercise on physical functioning, quality of life and in slowing progression of chronic conditions, an exercise time should be included. Lastly, we recommend that reporting and interpreting effect sizes of interventions within studies would facilitate more useful choice of outcome measures to be able to demonstrate clinically meaningful change. (C) 2019 Elsevier Ltd. All rights reserved.