Reablement in community-dwelling older adults: a randomised controlled trial

BMC Geriatrics

Ingvild Kjeken¹  Oddvar Førland²  Birgitte Espehaug⁴  Mona Kristin Aaslund⁵  Hanne Tuntland³ 

[1] Oslo and Akershus University College of Applied Sciences, Program of Occupational Therapy, Prosthetics and Orthotics, P.O. Box 4, St. Olavs plass, Oslo, 0130, Norway;Haraldsplass Institute of Nursing, Deaconess University College, Ulriksdal 10, Bergen, 5009, Norway;Bergen University College, Centre for Care Research Western Norway, Bergen, 5020, Norway;Bergen University College, Centre for Evidence-based Practice, Bergen, 5020, Norway;Department of Global Public Health and Primary Care, University of Bergen, Faculty of Medicine and Dentistry, Bergen, 5018, Norway

关键词: Randomised controlled trial;    COPM;    Older adults;    Activities of daily living;    Rehabilitation;   

Others  :  1231059
DOI  :  10.1186/s12877-015-0142-9

 received in 2015-05-13, accepted in 2015-10-30,  发布年份 2015

【 摘 要 】

Background

There has been an increasing interest in reablement in Norway recently and many municipalities have implemented this form of rehabilitation despite a lack of robust evidence of its effectiveness. The aim of this study was to investigate the effectiveness of reablement in home-dwelling older adults compared with usual care in relation to daily activities, physical functioning, and health-related quality of life.

Methods

This is a parallel-group randomised controlled trial conducted in a rural municipality in Norway. Sixty-one home-dwelling older adults with functional decline were randomised to an intervention group (n = 31) or a control group (n = 30). The intervention group received ten weeks of multicomponent home-based rehabilitation. The Canadian Occupational Performance Measure (COPM) was used to measure self-perceived activity performance and satisfaction with performance. In addition, physical capacity and health-related quality of life were measured. The participants were assessed at baseline and at 3- and 9-month follow-ups.

Results

There were significant improvements in mean scores favouring reablement in COPM performance at 3 months with a score of 1.5 points (p = 0.02), at 9 months 1.4 points (p = 0.03) and overall treatment 1.5 points (p = 0.01), and for COPM satisfaction at 9 months 1.4 points (p = 0.03) and overall treatment 1.2 points (p = 0.04). No significant group differences were found concerning COPM satisfaction at 3 months, physical capacity or health-related quality of life.

Conclusion

A 10-week reablement program resulted in better activity performance and satisfaction with performance on a long-term basis, but not the other outcomes measured.

Trial registration

The trial was registered in ClinicalTrials.gov November 20, 2012, identifier NCT02043262.

【 授权许可】

   
2015 Tuntland et al.

【 图 表 】

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【 参考文献 】

• [1]OECD. Health at a glance 2013: OECD indicators. Paris: OECD Publishing; 2013.
• [2]Cochrane A, McGilloway S, Furlong M, Molloy DW, Stevenson M, Donnoly M. Home-care “re-ablement” services for maintaining and improving older adults’ functional independence (Protocol). Cochrane Database Syst Rev. 2013(11):Art.No.:CD010825
• [3]Allen K, Glasby J. ‘The billion dollar question’: embedding prevention in older people’s services—ten ‘High-Impact’ Changes. Br J Soc Work. 2012;18(3):bcs024.
• [4]Glendinning C, Jones K, Baxter K, Curtis LA, Wilde A, et al.: Home Care Re-ablement Services: Investigating the longer-term impacts (prospective longitudinal study). Social Policy Research Unit (SPRU)/Personal Social Service Research Unit (PSSRU), York/Canterburry; 2010.
• [5]Winkel A, Langberg H, Wæhrens EE. Reablement in a community setting. Disabil Rehabil 2014;37(preprint):1–6.
• [6]Baker DI, Gottschalk M, Eng C, Weber S, Tinetti ME: The design and implementation of a restorative care model for home care. Gerontol 2001, 41(2):257-63.
• [7]Lewin G, Vandermeulen S: A non-randomised controlled trial of the Home Independence Program (HIP): an Australian restorative programme for older home-care clients. Health Soc Care Com 2010, 18(1):91-9.
• [8]Parsons JGM, Sheridan N, Rouse P, Robinson E, Connolly M: A randomized controlled trial to determine the effect of a model of restorative home care on physical function and social support among older people. Arch Phys Med Rehab 2013, 94(6):1015-22.
• [9]Francis JFM, Rutter D. Research Briefing 36: Reablement. A cost-effective route to better outcomes. London: SCI (Social Care Institute for Excellence); 2011.
• [10]Lewin G, Allan J, Patterson C, Knuiman M, Boldy D, Hendrie D: A comparison of the home-care and healthcare service use and costs of older Australians randomised to receive a restorative or a conventional home-care service. Health Soc Care Com 2014, 22(3):328-36.
• [11]Lewin G, De San MK, Knuiman M, Alan J, Boldy D, Hendrie D: A randomised controlled trial of the Home Independence Program, an Australian restorative home-care programme for older adults. Health Soc Care Com 2013, 21(Jan):69-78.
• [12]Tinetti ME, Charpentier P, Gottschalk M, Baker DI: Effect of a restorative model of posthospital home care on hospital readmissions. J Am Geriatr Soc 2012, 60(8):1521-6.
• [13]Whitehead PJ, Worthington EJ, Parry RH, Walker MF, Drummond AE. Interventions to reduce dependency in personal activities of daily living in community dwelling adults who use homecare services: A systematic review. Clin Rehabil. 2015;1–13.
• [14]Parsons J, Rouse P, Robinson EM, Sheridan N, Connolly MJ: Goal setting as a feature of homecare services for older People: does it makes a difference? Age Ageing 2012, 41:24-9.
• [15]Moher D, Schulz KF, Altman DG: The CONSORT statement: revised recommendations for improving the quality of reports of parallel group randomized trials. BMC Med Res Methodol 2001, 1(1):2. BioMed Central Full Text
• [16]Tuntland H, Espehaug B, Forland O, Hole AD, Kjerstad E, Kjeken I: Reablement in community-dwelling adults: study protocol for a randomised controlled trial. BMC Geriatr 2014, 14(1):139. BioMed Central Full Text
• [17]Law M, Baptiste S, Carswell A, McColl M, Polatajko H, Pollock N: COPM Canadian Occupational Performance Measure (Norwegian version). 5th edition. NKRR National advisory unit on rehabilitation in rheumatology, Oslo; 2015.
• [18]Podsiadlo D, Richardson S: The timed “Up & Go”: a test of basic functional mobility for frail elderly persons. J Am Geriatr Soc 1991, 39(2):142-8.
• [19]Steffen TM, Hacker TA, Mollinger L: Age-and gender-related test performance in community-dwelling elderly people: Six-Minute Walk Test, Berg Balance Scale, Timed Up & Go Test, and gait speeds. Phys Ther 2002, 82(2):128-37.
• [20]Bohannon RW, Bear-Lehman J, Desrosiers J, Massy-Westropp N, Mathiowetz V: Average grip strength: a meta-analysis of data obtained with a Jamar dynamometer from individuals 75 years or more of age. J Geriatr Phys Ther 2007, 30(1):28-30.
• [21]Desrosiers J, Bravo G, Hebert R, Dutil E: Normative data for grip strength of elderly men and women. Am J Occup Ther 1995, 49(7):637-44.
• [22]Weel C: Functional status in primary care: COOP/Wonka charts. Disabil Rehabil 1993, 15(2):96-101.
• [23]Holm IRM, Steen H: Outpatient physical therapy influences the patient’s health-related quality of life. Adv Physiother 2005, 7:40-7.
• [24]Richardson J, Law M, Wishart L, Guyatt G: The use of a simulated environment (Easy Street) to retrain independent living skills in elderly persons: A randomized controlled trial. J Gerontol a-Biol 2000, 55(10):M578-84.
• [25]Pinheiro JC, Bates DM: Mixed-Effects Models in S and S-Plus. Spring-Verlag New York Inc., New York; 2000.
• [26]The R Project for Statistical Computing. Accessed 15 May 2015. http://www.r-project.org/ webcite
• [27]Eyssen IC, Steultjens MP, Oud TA, Bolt EM, Maasdam A, Dekker J: Responsiveness of the Canadian occupational performance measure. J Rehabil Res Dev 2011, 48(5):517-28.
• [28]Sturkenboom IH, Graff MJ, Hendriks JC, Veenhuizen Y, Munneke M, Bloem BR, et al. Efficacy of occupational therapy for patients with Parkinson’s disease: a randomised controlled trial. Lancet Neurol. 2014;13(6557).
• [29]Tuntland H, Ness NE: Reablement. (In Norwegian: Hverdagsrehabilitering), 1 edn. Oslo, Gyldendal Akademisk; 2014.
• [30]VanLeit B, Crowe TK: Outcomes of an occupational therapy program for mothers of children with disabilities: impact on satisfaction with time use and occupational performance. Am J Occup Ther 2002, 56(4):402-10.
• [31]WHO: International classification of functioning, disability and health. World Health Organization, Geneva; 2001.
• [32]Giné-Garriga M, Roqué-Fíguls M, Coll-Planas L, Sitja-Rabert M, Salvà A: Physical exercise interventions for improving performance-based measures of physical function in community-dwelling, frail older adults: A systematic review and meta-analysis. Arch Phys Med Rehab 2014, 95(4):753-69.
• [33]Bellg AJ, Borrelli B, Resnick B, Hecht J, Minicucci DS, Ory M, et al.: Enhancing treatment fidelity in health behavior change studies: best practices and recommendations from the NIH Behavior Change Consortium. Health Psychol 2004, 23(5):443-51.