Do inpatient multidisciplinary rehabilitation programmes improve health status in people with long-term musculoskeletal conditions? A service evaluation

Background: Long-term musculoskeletal (MSK) conditions impair health and function. Guidelines recommend a multidisciplinary team (MDT) approach for the optimum management of people with long-term MSK conditions, but there is limited evidence for MDT care. This service evaluation investigates the short-term effectiveness of an inpatient MDT rehabilitation programme on self-reported function and disease status in people with long-term MSK conditions. Methods: A convenience sample of adults with rheumatoid arthritis (RA), osteoarthritis (OA), low back pain (LBP) and chronic widespread pain (CWP) participated in an inpatient MDT rehabilitation programme, consisting of needs assessment, collaborative goal setting and planning, exercise and self-management. The Routine Assessment of Patient Index Data (RAPID3) (primary outcome), the Multi-Dimensional Health Assessment Questionnaire (MDHAQ), Pain Visual Analogue Scale (VAS) and global well-being VAS were assessed at baseline and immediately following MDT rehabilitation. Results: A total of 183 people mean age 62 (standard deviation, 14.5) years, 145 females with RA, OA, LBP or CWP were evaluated before and after inpatient MDT rehabilitation (median duration, ten days). Overall, there was a 28% improvement in RAPID3 (mean difference 95% confidence intervals in effect size, 5.0 [4.3, 5.8],d=-0.98, p<0.05). Clinically relevant changes were found in people with RA (5.7 [4.4, 6.9], d=-1.08, p<0.05, 32%), OA 6.1 [3.4, 8.7], d=-1.07, p<0.05, 35%), LBP 4.0 [2.8, 5.2], d=-0.91, p<0.05, 22%), CWP 4.6 [2.7, 6.6], d=-0.84, p<0.05, 25%). These changes were reflected in all secondary outcomes. Conclusion: This inpatient MDT rehabilitation programme provides short-term evidence of improved function and disease status in people with long term MSK conditions.