Movement through Active Personalised engagement (MAP) — a self-management programme designed to promote physical activity in people with multimorbidity: study protocol for a randomised controlled trial

Abstract

BackgroundMultimorbidity, defined as two or more concurrent chronic diseases within the same individual, is becoming the clinical norm within primary care. Given the burden of multimorbidity on individuals, carers and health care systems, there is a need for effective self-management programmes. Promoting active participation within their clinical care and following a healthy lifestyle will help empower patients and target lifestyle factors that are exacerbating their conditions. The aim of this study is to establish whether a tailored, structured self-management programme can improve levels of physical activity at 12 months, in people with multimorbidity.Methods/designThis study is a single-centre randomised controlled trial, with follow-up at 6 and 12 months. The primary outcome is change in objectively assessed average daily physical activity at 12 months. Secondary outcomes include medication adherence, lifestyle behaviours, quality of life, chronic disease self-efficacy and self-efficacy for exercise. Anthropometric and clinical measurements include blood pressure, muscle strength, lipid profile, kidney function and glycated haemoglobin (HbA1c). Participants are recruited from primary care. Those between 40 and 85 years of age with multimorbidity, with a good understanding of written and verbal English, who are able to give informed consent, have access to a mobile phone for use in study activities and are able to walk independently will be invited to participate. Multimorbidity is defined as two or more of the chronic conditions listed in the Quality and Outcomes Framework. A total of 338 participants will be randomly assigned, with stratification for gender and ethnicity, to either the control group, receiving usual care, or the intervention group, who are invited to the Movement through Active Personalised engagement programme. This involves attending four group-based self-management sessions aimed at increasing physical activity, mastering emotions, managing treatments and using effective communication. The sessions are delivered by trained facilitators, and regular text messages during the study period provide ongoing support. Changes in primary and secondary outcomes will be assessed, and an economic evaluation of the intervention undertaken.DiscussionThis study will provide new evidence on whether physical activity can be promoted alongside other self-management strategies in a multimorbid population and whether this leads to improvements in clinical, biomedical, psychological and quality of life outcomes.Trial registrationISRCTN, ISRCTN 42791781. Registered on 14 March 2017.Electronic supplementary materialThe online version of this article (10.1186/s13063-018-2939-2) contains supplementary material, which is available to authorized users.

Promoting physical activity with self-management support for those with multimorbidity: a randomised controlled trial

“…A detailed study protocol (ISRCTN42791781) has been published elsewhere. 23 The study was a single-site, two-arm, parallel-group, open-label, 12-month randomised controlled trial (RCT) testing the effectiveness of a structured, self-management programme in participants with multimorbidity who were recruited from primary care practices in Leicestershire, UK. Potential participants were identified from a search of each practice’s healthcare records.…”

“…The Movement through Active Personalised engagement (MAP) programme 23 was iteratively developed, tested, and refined using literature reviews, patient and public coproduction, and focus groups with people with multimorbidity, their relatives, and primary care clinicians and nurses. The focus groups informed the programme content to include both a focus on PA and to cover generic self-management challenges.…”

“…Allowing for 20% loss to follow-up and 20% non-compliance of accelerometer/intervention attendance meant that at least 338 participants were required (169 per group). 23 The value of 2.1 m g was chosen as it represents an increase in PA that is equivalent to walking at the threshold between light intensity and moderate intensity (for example, 4 km per hour) for 30 min per day or 10–15 min of brisk walking per day. 34 , 43…”

Carotid Intima-Media Thickness is a Predictor of Subclinical Myocardial Damage in Men with Type 2 Diabetes Mellitus

“…The study was conducted at the Department of Internal Medicine of the University Hospital Tübingen. Data were obtained from inpatients taking part at a diabetes mellitus education program according to recent guidelines [26]. Patients with type 1 diabetes mellitus and those who had a record of diabetes secondary to other causes (e. g. genetic defects of beta cell function, monogenic forms of diabetes, diabetes mellitus due to other pancreatic diseases) were excluded from the study.…”

Clustering of comorbidities

“…75 Currently, the ongoing Movement through Active Personalised engagement (MAP) study aims to assess the effectiveness of a structured self-management education programme with the primary goal of increasing daily physical activity in patients with multimorbidity. 76 Although, the follow-up for the study is short (12 months), which will not allow the evaluation of long-term mortality benefits. Therefore, further interventional research in this area is also required.…”