Monitoring physical functioning as the sixth vital sign: evaluating patient and practice engagement in chronic illness care in a primary care setting--a quasi-experimental design

Abstract

Background In Canada, one in three adults or almost 9 million people report having a chronic condition. Over two thirds of total deaths result from cardiovascular disease, diabetes, cancer and respiratory illness and 77% of persons ≥65 years have at least one chronic condition. Persons with chronic disease are at risk for functional decline; as a result, there is an increased awareness of the significance of functional status as an important health outcome. The purpose of this study was to determine whether patients who receive a multi-component rehabilitation intervention, including online monitoring of function with feedback and self-management workshops, showed less functional decline than case matched controls who did not receive this intervention. In addition, we wanted to determine whether capacity building initiatives within the Family Health Team promote a collaborative approach to Chronic Disease Management. Methods A population-based multi-component rehabilitation intervention delivered to persons with chronic illnesses (≥ 44 yrs) (n = 60) was compared to a group of age and sex matched controls (n = 60) with chronic illnesses receiving usual care within a primary healthcare setting. The population-based intervention consisted of four main components: (1) function-based individual assessment and action planning, (2) rehabilitation self-management workshops, (3) on-line self-assessment of function and (4) organizational capacity building. T-tests and chi-square tests were used for continuous and categorical variables respectively in baseline comparison between groups. Results Two MANOVA showed significant between group differences in patient reported physical functioning (Λ = 0.88, F = (2.86) = 5.97. p = 0.004) and for the physical performance measures collectively as the dependent variable (Λ = 0.80, F = (6.93) = 3.68. p = 0.0025). There were no within group differences for the capacity measures. Conclusion It is feasible to monitor physical functioning as a health outcome for persons with chronic illness in primary care. The timeline for this study was not sufficient to show an increase in the capacity within the team; however there were some differences in patient outcomes. The short timeline was likely not sufficient to build the capacity required to support this approach. Trial registration NCT00859638

Is self‐reported physical functioning associated with incident cardiometabolic abnormalities or the metabolic syndrome?

“…Given the potential prognostic utility of our findings, future studies should determine if self‐reported physical functioning is a proxy marker of overall health burden, or if improving physical functioning directly through interventions will result in better health outcomes and prevention of cardiovascular abnormalities. Nevertheless, the need for simple screening tools for future cardiometabolic risk in clinical settings cannot be overlooked, and physical functioning has been posited as the ‘sixth vital sign’ . We observed a significant association between self‐reported physical functioning and incident metabolic syndrome, which suggests potential utility in evaluating self‐reported physical functioning by clinicians.…”

“…Several chronic conditions have been associated with poor physical functioning , and the association between cardiometabolic factors and physical functioning is established . Thus, physical functioning has been suggested as an important pre‐clinical marker of chronic disease . While physical functioning has been shown to predict major health events including new disease onset , hospitalizations and mortality , physical functioning would have greater clinical utility if it was also a predictor of the metabolic syndrome and could be used to identify patients at high risk for this collection of sub‐clinical risk factors.…”

Overcoming Barriers to Weight Loss Practice Guidelines in Primary Care

“…This measurement collectively can monitor LWPF status and patient engagement in maintaining a healthy lifestyle. 10 In a review of studies exploring successes in overcoming lifestyle change barriers, the 5A's has been identified as effective for smoking cessation. This guideline, from the CS2day (Cease Smoking Today) national smoking cessation initiative, has been translated into models addressing obesity and modifiable risk factors as a lifestyle counseling outline in the PC setting.…”

Self-management of Function in Older Adults: The Contribution of Physical Therapy

“…Increasing evidence suggests that function should be considered as a sixth vital sign and should be assessed as a primary health outcome [19][20][21]. Functional status as an outcome of care is a major concern for persons with chronic illness, regardless of age, who are trying to self-manage their condition.…”

“…Physical function and mobility issues in the context of an individual's overall health status will supersede impairment issues because the former are predictive of independence and autonomy for the older person. An initial step in making assessments in primary care more salient to appropriate health outcomes in the elderly would be to implement tests of function [21]. Min and Shekelle (2012) have recently called for a globally accepted measure of functional decline, as the lack of a universal model to categorize older persons into functional subgroups acts as a barrier to empirically driven decisionmaking about prognosis and treatment interventions [22•].…”