Different Aspects of municipal Rehabilitation and the Use of a Capability Measure: the importance of outcome measures

The burden of chronic illness is increasing in Denmark and across the globe, and we live longer. As populations age, the amount of time that people spend living with a disability and with the consequences of chronic illness increases. This increase affects the healthcare and social care systems. Therefore, a societal focus on the, health, quality of life and well-being are essential, and as the Danish population ages and seriously ill individuals survive with disabilities and lower health status levels, the field of rehabilitation becomes increasingly important. Rehabilitation programmes for people with a chronic illness will become increasingly important over the upcoming decades. Therefore it is crucial to continually assess, evaluate, adjust and develop the programmes offered today so that people with a chronic illness can master their disease and live a meaningful life with good quality of life. This thesis is an attempt to highlight the importance of broad measurement in public health interventions such as rehabilitation programmes. Furthermore, to highlight some of the less explored aspects of municipal rehabilitation. Hence the research questions of interest are: is the capability approach and the ICECAP-A a potential outcome measure in rehabilitation, and is ICECAP-A a substitute or supplement to the health-related quality of life outcome measures. Lastly, what are the different non-quality of life aspects of municipal rehabilitation in terms of participation and effects of the programme? Based on the results of four scientific papers, this thesis finds the capability approach and the ICECAP-A to be potential outcome measures for use in public health intervention. A reliable, valid and responsive Danish version of ICECAP-A is now available for use in chronically ill populations. The thesis also demonstrated the different reasons for attendance, non-attendance and dropping out of municipal rehabilitation programmes, resulting in different ‘profiles’ and focus areas for use in everyday work at the healthcare centre. Furthermore, the patients change in health-related quality of life, calculated as quality-adjusted life-years was investigated before and after rehabilitation, and found small positive net effects, with differences across socioeconomic status. In conclusion, the results from this thesis highlight the necessity for a broader view of outcome measurements of public health interventions, where the aim is broader than health. Based on the findings of this thesis, the recommendation is to draw up standardised guidelines for measuring effects and broaden the view on effects. Furthermore, the healthcare centre should continue to focus on the individual characteristics, possible comorbidities and personal objectives with the presented ‘profiles’ in mind.