Associations between adherence to self-management activities and change in function and health outcomes in the rehabilitation of patients with rheumatic and musculoskeletal diseases

Objectives: To explore the content of, and adherence to, self-management activities reported by patients with rheumatic and musculoskeletal diseases (RMDs), and whether adherence to self -manage-ment activities is associated with changes in self -reported health and function over a 1-year period following rehabilitation in specialized healthcare.Methods: Participants (n = 523) reported function and health outcomes at admission, discharge, and 4, 8 and 12 months post-rehabilitation. Self-management activities reported at discharge were self-evaluated as adherence level at home. Self-management activity content was linked to the International Classification of Functioning, Disability and Health coding system, and summarized as high or low adherence. Associa-tions between adherence to self-management activi-ties and change in outcomes were investigated using a linear mixed model approach with repeated measures. Results: Self-management activities focused mainly on enhanced physical health and managing every-day routines, and seldom addressed work partici-pation. Adherence to self-management activities was challenging with regard to structure and daily life routines, mental health, and the application of knowledge and coping strategies. Adherence to self -management activities was significantly associated with improvements in all outcomes, except for men-tal health and activities of daily living.Conclusion: Adherence to self-management acti-vities, and creating structure and setting everyday routines at home, appear to be important for main-taining health and function over time. Rehabilitation should include a greater focus on mental health chal-lenges and work participation.