Putting the pieces together: A qualitative study exploring perspectives on self-management and exercise behavior among people living with multimorbidity, healthcare professionals, relatives, and patient advocates

Jäger, Madalina; Lindhardt, Mathias Constantin; Pedersen, Julie Rønne; Dideriksen, Mette; Nyberg, Mette; Bødtger, Uffe; Midtgaard, Julie; Skou, Søren Thorgaard

doi:10.1177/26335565221100172

Cited by 12 publications

(14 citation statements)

References 39 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Given the demonstrated clinical effects of exercise on at least 26 chronic conditions 287 , it is promising both for treatment and prevention, especially when combined with other self-management supports. Importantly, barriers to participation need to be overcome to ensure adherence and effects in the long term 289 .…”

Section: Interventions For Multimorbiditymentioning

confidence: 99%

Multimorbidity

Skou

Mair

Fortin

et al. 2022

Nat Rev Dis Primers

376

283

View full text Add to dashboard Cite

Interest in multimorbidity -commonly defined as the co-occurrence of at least two chronic conditions in the same individual 1 -has increased in the past few years owing to its substantial effect on the individual and the individual's family, as well as on health systems and on society, particularly in resource-poor settings 2-4 . Multimorbidity is distinct from the related concept of comorbidity, which refers to the combined effects of additional conditions in relation to the index condition in an individual [5][6][7][8] . By contrast, care for multimorbidity is patient-centred and does not routinely give priority to any single condition, although in clinical care, patients and clinicians will usually focus on the most pressing problems that the patient is experiencing.People with multimorbidity are more likely to die prematurely, be admitted to hospital and have an increased length of stay than people with a single chronic condition 9,10 . Multimorbidity is also associated with poorer function and health-related quality of life (HRQOL), depression and intake of multiple drugs (polypharmacy) and greater socioeconomic costs [11][12][13][14][15][16][17][18] . Most health care is designed to treat individual conditions rather than providing comprehensive, person-centred care 2,19,20 , which often leads to fragmented and sometimes contradictory care for people with multimorbidity and increases their treatment burden 21 Moreover, treating one condition at a time is inefficient and unsatisfactory for both people with multimorbidity and their health-care providers [22][23][24] .Multimorbidity is increasingly common owing to changes in lifestyle risk factors, notably physical inactivity and obesity, and population ageing that in part reflects improvements in survival from acute and chronic conditions 2,19,25,26 . Multimorbidity is associated with socioeconomic status and age 3,19,25,27 . However, although age is the strongest driver of multimorbidity, in absolute numbers, more people <65 years of age have multimorbidity than people ≥65 years of age, partly because more people in the general population are in that age group. Moreover, this emphasizes that multimorbidity is not just a feature of ageing 19,26 .Multimorbidity is further complicated in low-income and middle-income countries (LMICs) by the overlap of compounding factors, including adverse environmental and early life stressors linked to poverty, limited social infrastructure and poorer family coping mechanisms, that translate into chronic diseases occurring at earlier ages [28][29][30][31] . LMICs also have a higher prevalence of multimorbidity-related financial burden 32,33 and have weaknesses in health systems including a greater focus Treatment burdenThe workload associated with managing treatments and health-care recommendations and the impact of this on an individual and their supporters.

show abstract

Section: Interventions For Multimorbiditymentioning

confidence: 99%

Multimorbidity

Skou

Mair

Fortin

et al. 2022

Nat Rev Dis Primers

376

283

View full text Add to dashboard Cite

show abstract

“…Overall, we performed one scoping review [35], five systematic reviews [27,[36][37][38][39][40], two registry-based studies [41,42], one qualitative interview study [43], and a mixed-methods feasibility study [34], to identify knowledge gaps and develop an exercise therapy and self-management intervention for people with multimorbidity (Table 1) and Fig. 1.…”

Section: Resultsmentioning

confidence: 99%

“…A qualitative approach is particularly useful in capturing how people are affected by a problem and their perspectives on it [33]. Therefore, the qualitative study we conducted aimed to explore the perspectives of people living with multimorbidity, health care professionals, relatives, and patient advocates concerning self-management with a particular focus on exercise behaviour [43]. We conducted 17 interviews (nine focus groups; eight key informants) with 48 informants from four groups (22 people living with multimorbidity, 17 health care professionals, five relatives, and five patient advocates).…”

Section: Qualitative Analysesmentioning

confidence: 99%

“…The interviews were carried out online, informed consent was provided by the participants; the interviews were audio recorded and then transcribed verbatim. For the qualitative and feasibility study [34], patients and relatives were recruited by healthcare professionals from one psychiatric hospital and four hospital departments in Region Zealand (one of five health care regions in Denmark) or via self-referral on the basis of a poster and flyers placed in the hospitals' waiting rooms or through posts on the hospitals' and patient organizations' Facebook pages [43]. The focus groups and interviews were audio-recorded, [27,36,37] To investigate the benefits and harms of exercise therapy for people with multimorbidity.…”

Section: Qualitative Analysesmentioning

confidence: 99%

See 1 more Smart Citation

Personalised exercise therapy and self-management support for people with multimorbidity: Development of the MOBILIZE intervention

Jäger

Dideriksen

Rasmussen

et al. 2022

Pilot Feasibility Stud

Self Cite

View full text Add to dashboard Cite

Background To our knowledge, there is no intervention which includes personalised exercise therapy and self-management support for people with multimorbidity, although these interventions may be as effective as for people with single chronic conditions. Therefore, we developed a novel intervention, including personalised exercise therapy and self-management support for people with multimorbidity. Methods We followed the Medical Research Council framework and conducted one scoping review, five systematic reviews, two registry-based studies, one qualitative interview study and a mixed-methods feasibility study. Following an iterative approach, together with feedback from people with multimorbidity and relevant stakeholders, we developed the MOBILIZE intervention. Results The intervention included 24 (60 minutes) sessions of personalised exercise therapy and 24 (30 minutes) sessions of self-management support twice a week for 12 weeks, delivered in small groups by specifically trained physiotherapists. The intervention targets physiological, psychosocial, behavioural, and contextual factors to improve health-related quality of life and physical function in people living with multimorbidity. Conclusions We developed a personalised exercise therapy and self-management support programme for people with multimorbidity. The intervention will be tested for its safety and effectiveness in a randomised controlled trial.

show abstract

“…Prior to planning the feasibility study and the RCT, several reviews on exercise therapy [ 24 ], behavioural interventions and behaviour change techniques (Jäger M, Zangger G, Bricca A, Dideriksen M, Smith SM, Midtgaard J, Taylor R, Skou ST: Mapping interventional components and behaviour change techniques used to promote self-management in people with multimorbidity: a scoping review, in review) [ 29 ], available apps for people with multimorbidity and recruitment and retention [ 30 ], cohort studies [ 31 , 32 ] were done. Furthermore, interviews with people with multimorbidity and their carers, health care providers and patient organisations [ 33 , 34 ] were conducted to inform the development of the intervention and study design. For more details on the MOBILIZE study, see www.mobilize-project.dk and the Open Science Framework website ( https://osf.io/qk6yg/ ).…”

Section: Methodsmentioning

confidence: 99%

Personalised exercise therapy and self-management support for people with multimorbidity: feasibility of the MOBILIZE intervention

Skou

Brødsgaard

Nyberg

et al. 2023

Pilot Feasibility Stud

Self Cite

View full text Add to dashboard Cite

Background Exercise therapy is safe and effective in people with single conditions, but the feasibility in people with two or more conditions is unclear. Therefore, the aim was to evaluate the feasibility of exercise therapy and self-management in people with multimorbidity prior to a randomised, controlled trial (RCT). Methods This was a mixed-methods feasibility study performed in two general hospitals and one psychiatric hospital. 20 adult patients (8 females; mean age (SD) 67 (6.9)) with at least two long-term conditions and a score of ≥ 3 on Disease Burden Impact Scale for at least one condition (at least moderate limitations of daily activities) and of ≥ 2 for at least one other condition. Patients with unstable health conditions, at risk of serious adverse events (SAE) or with terminal conditions were excluded. Participants received 12 weeks of exercise (18 60-min group-based and 6 home-based sessions) and self-management support (6 90-min group-based sessions) supervised by physiotherapists. Pre-defined progression to RCT criteria were the primary outcomes and included recruitment rate (acceptable 20 participants in 3 months), retention through follow-up (75% retention), compliance (75% complete > 9 of exercise and > 3 self-management sessions), outcome burden (80% do not find outcomes too burdensome), improvement in quality of life (EQ-5D-5L) and function (6-min walk test; ≥ 50% experience clinically relevant improvements) and intervention-related SAEs (No SAEs). Furthermore, a purposeful sample including eleven participants and two facilitators were interviewed about their experiences of participating/facilitating. Qualitative data was analysed using thematic analysis. Results Recruitment rate (20 in 49 days), retention (85%), outcome burden (95%), and SAEs (0 related to intervention) were acceptable, while compliance (70%) and improvements (35% in quality of life, 46% in function) were not (amendment needed before proceeding to RCT). The intervention was found acceptable by both participants and physiotherapists with some barriers among participants relating to managing multiple chronic conditions while caring for others or maintaining a job. Physiotherapists expressed a need for additional training. Conclusions Exercise therapy and self-management are feasible in people with multimorbidity. The subsequent RCT, amending the intervention according to progression criteria and feedback, will determine whether the intervention is superior to usual care alone. Trial registration ClinicalTrials.gov registration: NCT04645732 Open Science Framework https://osf.io/qk6yg/

show abstract

Putting the pieces together: A qualitative study exploring perspectives on self-management and exercise behavior among people living with multimorbidity, healthcare professionals, relatives, and patient advocates

Cited by 12 publications

References 39 publications

Multimorbidity

Multimorbidity

Personalised exercise therapy and self-management support for people with multimorbidity: Development of the MOBILIZE intervention

Personalised exercise therapy and self-management support for people with multimorbidity: feasibility of the MOBILIZE intervention

Contact Info

Product

Resources

About