Multimorbidity rehabilitation in chronic disease: general rehabilitation compared to usual care

INTERVENTION: Multimorbidity (generic) rehabilitation Will be administered in small group sessions supervised by a physiotherapist and a nurse, twice‐weekly for 8 weeks, including aerobic exercise (walking and cycling for 15 minutes each) and resistance exercise (upper and lower limbs). Session duration will be 75 minutes twice weekly, with an education session duration of one hour once weekly. Education sessions will be delivered by health professionals including a physiotherapist, nursing, dietician to the class group of patients. Education topics will include general information on chronic disease and multimorbidity, risk factor management, exercise, dietary management, diabetes education, pharmacological and psychological support. Initial aerobic exercise prescription will be calculated at 80% of peak walking speed or distance (ALF & APA, 2009 and National Heart Foundation of Australia, 2011) and stationary cycling intensity will be calculated at 60‐80% of maximum work rate estimated from the 6‐minute walk test (Hill et al 2008). Exercise prescription will be progressed using a rating of perceived exertion (RPE) Borg scale (6‐20) and dyspnoea modified Borg scale, aiming for a RPE score of 12‐14 and a dyspnoea score of 3‐4. The aerobic component will include intermittent, incline, treadmill training in patients with peripheral vascular disease as their primary presenting complaint or who have a significant contribution from this as part of their presentation (Gardner et al, 1995). Initial resistance exercise load will correspond to 10‐12 RM (repetition maximum). A weight that can be lifted correctly and comfortably at least 10 times, but not more than 12 times (Kraemer et al 2004). Resistance exercise will be progressed using a rating of perceived exertion (RPE) Borg scale (6‐20) aiming for a RPE score of 12‐14. CONDITION: Bronchiectasis Chronic asthma Chronic disease Chronic heart failure Chronic kidney disease Chronic obstructive pulmonary disease Coronary artery disease Depression Diabetes Ischemic heart disease Multimorbidity Osteoarthritis PRIMARY OUTCOME: Change in functional exercise capacity (as measured by the 6‐minute walk test) ; SECONDARY OUTCOME: Catastrophic health events (calculated from diary); for example myocardial infarction, stroke, diabetic coma. Functional activities of daily living (as measured by the Katz ADL index) Health‐related quality of life (as measured by the SF‐36, AQoL‐4D, EQ‐5D‐5L) Participant daily diary including hospital admissions and medical consultations) Resource utilization (measured from the diary completed by participants, calculating costs of GP appointments, hospitalisations) INCLUSION CRITERIA: Adult patients (aged > 18) will be eligible to be enrolled if they have a physician diagnosis of two or more chronic conditions for which rehabilitation is indicated (as listed in the target conditions): Chronic obstructive pulmonary disease ‐ Bronchiectasis ‐ Chronic asthma ‐ Chronic heart failure ‐ Coronary artery disease ‐ Ischaemic heart disease ‐ Diabetes ‐ Chronic kidney disease ‐ Depression or anxiety ‐ New diagnosis of cancer in past 5 years ‐ Stroke and transient ischaemic attack ‐ Peripheral vascular disease ‐ Parkinson's disease ‐ Multiple sclerosis ‐ Chronic liver disease