Background People on or at risk of sick leave from work due to obesity or obesity-related problems participated in a new vocational rehabilitation (VR). The study aimed to examine the outcome changes in the participants’ health-related quality of life (HRQoL), body mass index (BMI), return to work self-efficacy (RTWSE), work ability scale (WAS) and degree of work participation (DWP) after their participation in the 12-month VR programme. The secondary aim was to examine associations between the outcome changes and HRQoL at 12-month follow-up, measured with the HRQoL 15D instrument (15D). Methods This prospective observational study included 95 participants. The one-year multidisciplinary VR programme with an integrated work and lifestyle intervention included 4 weeks of inpatient stay followed-up by 5 meetings. A paired sample t-test was used to examine changes in HRQoL, BMI, RTWSE, WAS, and DWP between baseline and the 12-month follow-up. Multiple linear regression analyses explored associations between changes in HRQoL and the outcome variables. Results The participants achieved statistically significant changes in HRQoL (2.57, 95% CI: 1.35 to 3.79), BMI (− 2.33, 95% CI: − 3.10 to − 1.56), RTWSE (15.89, 95% CI: 4.07 to 27.71), WAS (1.51, 95% CI: 0.83 to 2.20) and DWP (18.69, 95% CI: 8.35 to 29.02). At 12 months, a significant association was found between HRQoL and BMI (B = − 0.34, 95% CI: − 0.65 to − 0.04), RTWSE (B = 0.02, 95% CI: 0.004 to 0.04), WAS (B = 0.91, 95% CI: 0.55 to 1.28), DWP (B = − 0.02, 95% CI: − 0.04 to 0.001) and work absence (B = − 0.01, 95% CI: − 0.02 to − 0.002). The regression model explained 71.8% of the HRQoL variance. Conclusion The results indicated positive changes in HRQoL, BMI, RTWSE, WAS and DWP from baseline to the 12-month follow-up. Factors associated with HRQoL at the 12-month follow-up were decreased BMI, increased RTWSE, improved WAS and reduced work absence. Future studies examining VR programmes with lifestyle interventions for people with obesity are recommended. Trial registration Norwegian Regional Committee for Medical and Health Research Ethics (REC) 2017/573, Clinical Trials NCT03286374, registered 18. September 2017. https://clinicaltrials.gov/ct2/results?cond=Obesity&term=Anita+Dyb+Linge&cntry=NO&state=&city=&dist=

Background Quality of care is gaining increasing attention in research, clinical practice, and health care planning. Methods for quality assessment and monitoring, such as quality indicators (QIs), are needed to ensure health services in line with norms and recommendations. The aim of this study was to assess the responsiveness of a newly developed QI set for rehabiliation for people with rheumatic and musculoskeletal diseases (RMDs). Methods We used two yes/no questionnaires to measure quality from both the provider and patient perspectives, scored in a range of 0–100% (best score, 100%). We collected QI data from a multicenter stepped-wedge cluster-randomized controlled trial (the BRIDGE trial) that compared traditional rehabilitation with a new BRIDGE program designed to improve quality and continuity in rehabilitation. Assessment of the responsiveness was performed as a pre–post evaluation: Providers at rehabilitation centers in Norway completed the center-reported QIs (n = 19 structure indicators) before (T1) and 6–8 weeks after (T2) adding the BRIDGE intervention. The patient-reported QIs comprised 14 process and outcomes indicators, measuring quality in health services from the patient perspective. Pre-intervention patient-reported data were collected from patients participating in the traditional program (T1), and post-intervention data were collected from patients participating in the BRIDGE program (T2). The patient groups were comparable. We used a construct approach, with a priori hypotheses regarding the expected direction and magnitude of PR changes between T1 and T2. For acceptable responsivess, at least 75% of the hypotheses needed to be confirmed. Results All eight participating centers and 82% of the patients (293/357) completed the QI questionnaires. Responsiveness was acceptable, with 44 of 53 hypotheses (83%) confirmed for single indicators and 3 of 4 hypotheses (75%) confirmed for the sum scores. Conclusion We found this QI set for rehabilitation to be responsive when applied in rehabilitation services for adults with various RMD conditions. We recommend this QI set as a timely method for establishing quality-of-rehabilitation benchmarks, promoting important progress toward high-quality rehabilitation, and tracking trends over time. Trial registration The study is part of the larger BRIDGE trial, registered at ClinicalTrials.gov (Identifier: NCT03102814).

Purpose We aimed to investigate which changes in the explanatory factors that were associated with positive change in the work ability score (WAS) and degree of work participation (DWP) for participants in a new 1-year vocational rehabilitation (VR) program for people on or at risk of sick leave due to obesity or obesity-related problems. Patients and Methods This prospective observational study included 95 participants with a body mass index (BMI) above 30 kg/m 2 . The 1-year multidisciplinary VR program with an integrated work and lifestyle intervention included 4 weeks of inpatient stay followed-up by five meetings. Differences between baseline and 12-month follow-up data were analyzed for the change in explanatory variables WAS, DWP, health-related quality of life (HRQoL), BMI, and return-to-work self-efficacy (RTWSE). The primary outcome was measured by multiple linear regression for predicting WAS and DWP. Results We found significant changes in WAS (1.51, 95% CI: 0.83 to 2.20, p<0.001), DWP (18.69, 95% CI: 8.35 to 29.02, p<0.001), HRQoL (2.57, 95% CI: 1.35 to 3.79, p<0.001), BMI (−2.33, 95% CI: −3.10 to −1.56, p<0.001), and in RTWSE (15.89, 95% CI: 4.07 to 27.71, p = 0.009). Regression analysis yielded a strong association between WAS at 12-month follow-up with an increase in HRQoL (β=0.27, 95% CI: 0.16 to 0.38, p<0.001) and WAS baseline (β=0.49, 95% CI: 0.28 to 0.71, p<0.001). Further, regression analysis demonstrated a strong association between DWP at 12-month follow-up with return-to-work expectancy (RTWEXP) (β=−10.62, 95% CI: −15.25 to −6.03, p<0.001). Conclusion The results indicate positive changes in WAS, DWP, HRQoL, BMI, and RTWSE from baseline to 12-month follow-up. For people with BMI above 30 kg/m 2 , changes in HRQoL are important for an increase in WAS, and a high RTWEXP is essential to achieve work participation. Future studies examining VR programs with lifestyle interventions for people with obesity are recommended.

Background:The prevalence of obesity has increased worldwide. Obesity affects the lungs and airways, limits peak oxygen uptake, and hampers physical performance; however, objective data are scarce. Does lifestyle modification for weight loss (LM) have an impact on cardiorespiratory capacity (CRC) in patients with class II and class III obesity?Method: This was a single-center prospective 2-year follow-up pilot study. Four separated stays in the inpatient specialized medical center Muritunet with an integrated approach to LM, including an individual plan on diet and physical activity (PA) goals. Furthermore, it included lectures and counseling on human anatomy and physiology, nutrition, physical exercise, and motivation, as well as daily PA.Cardiopulmonary and blood chemistry tests were conducted.Results: Seventy-seven participants were included; however, 47% (n = 36) dropped out during follow-up. Forty-one participants completed the study. At baseline (BL), the mean age was 45.4 (SD 10.2, range 23-62) years, with a mean body mass index (BMI) of 41.3 (SD 5.4) kg/m 2 , and 85% (n = 35) had one or more comorbidities, such as obstructive pulmonary disease (n = 15, 37%), obstructive sleep apnea (n = 19, 46%), type 2 diabetes (n = 20, 49%), and hypertension (n = 17, 41%). The mean functional residual capacity increased, significantly the second year (p = 0,037). CRC increased significantly the first year (p = 0.032). Weight and BMI declined, reaching statistical significance at 2 years for both males and females (p = 0.033 and p = 0.003, respectively). At BL, the participants reported lower health-related quality of life compared to the general Norwegian population. Across time the physical component summary score (quality of life) for both males and females (p = 0.011 and p = 0.049, respectively) increased significantly. Conclusion:Lifestyle modification for weight loss improves CRC in patients with class II and class III obesity.

Background:Previous research show that patients with rheumatic and musculoskeletal diseases (RMDs) benefit from rehabilitation, but the health effects are small and decline over time. Later reports reveal that the quality of rehabilitation services varies largely, with lack of coordination and continuity across levels of care. This may weaken the effect on patients’ long-lasting health, ability to self-manage their conditions and achieve their goals. We therefore developed a new, evidence-based rehabilitation program to strengthen the quality and bridge the gaps in rehabilitation services for this patient group.Objectives:To evaluate if a new rehabilitation program (the BRIDGE program) designed to improve the quality and continuity of rehabilitation across levels of care, was more effective than traditional rehabilitation in improving goal achievement, function, self-assessed health and health related quality of life (HR-QoL) in patients with RMDs.Methods:In a stepped wedge cluster randomised controlled trial 8 rehabilitation centres organised in secondary health care and located across all health regions of Norway recruited a total of 374 patients with rheumatic and musculoskeletal diseases. These patients received either traditional rehabilitation (control) (n=206), or traditional rehabilitation extended with an individually adapted complex intervention consisting of structured goal setting, plans for self-management, motivational interviewing, self-monitored digital feedback, and tailored follow-up support after discharge according to patients’ needs and available resources in primary healthcare (the BRIDGE program) (n=168). Patient-reported data were collected electronically on admission and discharge from rehabilitation, and after 2, 7, and 12 months. The primary outcome measure was patients’ goal achievement measured by the Patient Specific Functional Scale (PSFS) (0-10, 10=best) seven months after rehabilitation stay. Secondary outcome measures were function measured by the 30-seconds Sit-To-Stand Test (30secSTS), self-assessed health and HR-QoL measured by the EuroQol instruments EQ-5D-5L-VAS (0-100, 100=best) and EQ 5D-5L-index (-1 to 1, 1=best). The main comparative analysis was performed on the intention to treat population, using all available data, by linear mixed models adjusted for the baseline scores and for the potentially confounding effects of calendar time and data clustering. Sensitivity analyses were performed on data provided by the per protocol population according to predefined criteria, in addition to centerwise comparisons of the control and intervention groups.Results:No significant treatment effects of the BRIDGE-program were demonstrated either for patients’ goal achievement (mean difference 0.1 [95% CI: -0.5, 0.8], p=0.70) (Figure 1), function (mean difference 0.9 [95% CI: - 0.4, 2.2], p=0.18), self-assessed health (mean difference -0.1 [95% CI: -4.1, 3.9], p=0.98), or HR-QoL (mean difference 0.0 [95% CI: -0.0, 0.0], p=0.99) seven months after rehabilitation. Sensitivity analyses confirmed the findings from the primary analysis. A significant proportion of missing data for the primary outcome measure (29% in the control and 41% in the intervention group), caused by errors in the digital data collection system, may impair the reliability of the results.Conclusion:The BRIDGE program was not shown to be more effective than traditional rehabilitation in terms of improving goal achievement, function, self-assessed health and HR-QoL in patients with RMDs. There is still a need for more knowledge about factors that can improve the quality, continuity and long-term health effects of rehabilitation for this patient group.Disclosure of Interests:None declared