The TRACER Study- TRansition to Adulthood through Coaching and Empowerment in Rheumatology - A Multicentre Randomized-Controlled Feasibility Study

Abstract

Transition to adult healthcare is a vulnerable time for adolescents with chronic disease, with risks of disengagement and complications of inadequately managed disease. This comes when other transitions in life occur, including changes to vocation and social support. The TRACER (Transition to Adulthood through Coaching and Empowerment in Rheumatology) study assessed the feasibility of conducting a multi-centred RCT of a virtual Transition Coaching Intervention (TCI) in youth transferring to adult rheumatology care. The TCI aimed to help patients gain the knowledge, skills, and confidence to become active in their care and reach their health goals. Participants were recruited at their last pediatric rheumatology appointment at McMaster Children's Hospital or Children's Hospital in London and randomized to the TCI or control group. Control participants received standard care, while TCI participants received eight additional virtual one-on-one coaching sessions with an advanced practice physiotherapist (APP) and social worker. Sessions covered health management, future planning, and self-advocacy topics. Primary feasibility outcomes were overall consent rate (≥85%), enrollment from the non-primary site (>30%), coaching session attendance (≥90%), and data collection completion (≥90%). Secondary clinical outcomes included transition readiness, global functional assessment, and self-efficacy measures. Of 65 patients approached, 30 (46.2%) consented, and 16 (53.3%) were enrolled from London. TCI sessions had a 95.8% attendance rate. Participants completed 90.7% of assessments. At eight months, TCI participants appeared to have higher levels of transition readiness, PROMIS scores were higher in certain domains, and the TCI was well accepted by participants and coaches. Our study met all feasibility outcomes except the consent rate, which indicates that a virtual TCI could be feasible. This study's findings will shape a future multi-centred RCT of a virtual TCI, with the ultimate goal of enhancing the physical, mental, and social well-being of adolescents with rheumatic disease transitioning into adult care.