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OPTIMAL, a promising intervention to improve outcomes for people with multimorbidity

By Jess Garvey, Deirdre Connolly and Susan Smith

We investigated the effectiveness of an occupational therapy led self-management support programme, OPTIMAL, designed to address the challenges of living with multiple chronic conditions or multimorbidity in a primary care setting. We conducted a pragmatic feasibility randomised controlled trial including fifty participants with multimorbidity recruited from family practice and primary care settings in Dublin in Ireland. OPTIMAL is a six-week community-based programme, led by occupational therapy facilitators and focuses on problems associated with managing multimorbidity. The primary outcome was frequency of activity participation. Secondary outcomes included self-perception of, satisfaction with and ability to perform daily activities, independence in activities of daily living, anxiety and depression, self-efficacy, health-related quality of life, self-management support, healthcare utilisation and individualised goal attainment. Outcomes were collected within two weeks of intervention completion.
At immediate post intervention follow-up we found significant improvements in frequency of activity participation, measured using the Frenchay Activities Index, for the intervention group compared to the control group (Adjusted Mean Difference at follow up 4.22. 95% Confidence Interval 1.59-6.85). There were also significant improvements in perceptions of activity performance and satisfaction, self-efficacy, independence in daily activities and quality of life. Additionally, the intervention group demonstrated significantly higher levels of goal achievement, following the intervention. No significant differences were found between the two groups in anxiety, depression, self-management scores or healthcare utilisation.
OPTIMAL significantly improved frequency of activity participation, self-efficacy and quality of life for patients with multimorbidity. Further work is required to test the sustainability of these effects over time but this study indicates that it is a promising intervention that can be delivered in primary care and community settings.
Full details of this article can be found at http://www.biomedcentral.com/1471-2296/16/59/abstract
We would welcome contact and collaboration with other researchers looking to test the feasibility and effectiveness of the OPTIMAL programme in other healthcare settings.

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