A pragmatic randomised controlled trial (RCT) and realist evaluation of the interdisciplinary home-bAsed Reablement program (I-HARP) for improving functional independence of community dwelling older people with dementia: an effectiveness-implementation hybrid design

BMC Geriatrics

Robert Woods¹  Loren Mowszowski²  Sharon L. Naismith³  Henry Brodaty⁴  Amanda Miller Amberber⁵  Laura N. Gitlin⁶  Richard Norman⁷  Lindy Clemson⁸  Lee-Fay Low⁸  Sarah Szanton⁹  Sarah Hilmer^1,10  Yun-Hee Jeon^1,11  Judy M. Simpson^1,12 

[1] Bangor University;Brain and Mind Centre and School of Psychology, The University of Sydney;Brain and Mind Centre, Charles Perkins Centre and School of Psychology, The University of Sydney;CHeBA (Centre for Healthy Brain Ageing), School of Psychiatry, UNSW;Charles Sturt University;College of Nursing and Health Professions, Drexel University;Curtin University;Faculty of Health Sciences, The University of Sydney;Johns Hopkins School of Nursing, Johns Hopkins School of Public Health;Kolling Institute, Northern Clinical School, Faculty of Medicine and Health, University of Sydney and Royal North Shore Hospital;Susan Wakil School of Nursing and Midwifery, The University of Sydney;Sydney School of Public Health, The University of Sydney;

关键词: Dementia;    Interdisciplinary teamwork;    Community care;    Reablement;    Cognitive rehabilitation;    Pragmatic trial;   

DOI  :  10.1186/s12877-019-1216-x

来源: DOAJ

【 摘 要 】

Abstract Background A major gap exists internationally in providing support to maintain functional and social independence of older people with dementia living at home. This project evaluates a model of care that integrates evidence-based strategies into a person-centred interdisciplinary rehabilitation package: Interdisciplinary Home-bAsed Reablement Program (I-HARP). Two central aims are: 1) to determine the effectiveness of I-HARP on functional independence, mobility, quality of life and depression among people with dementia, their home environmental safety, carer burden and quality of life, and I-HARP cost-effectiveness; and 2) to evaluate the processes, outcomes and influencing factors of the I-HARP implementation. Methods I-HARP is a 4-month model of care, integrated in community aged care services and hospital-based community geriatric services, and consists of: 1) 8–12 home visits, tailored to the individual client’s needs, by an occupational therapist, registered nurse, and other allied health staff; 2) minor home modifications/assistive devices to the value of  60 years with mild to moderate dementia and his/her carer). During Phase I, I-HARP advisory group is established and training of I-HARP interventionists is completed, and the effectiveness of I-HARP is examined using a pragmatic RCT. Phase II, conducted concurrently with Phase I, focuses on the process evaluation of the I-HARP implementation using a realist approach. Semi-structured interviews with participants and focus groups with I-HARP interventionists and participating site managers will provide insights into the contexts, mechanisms and outcomes of I-HARP. Discussion I-HARP is being evaluated within the real-world systems of hospital-based and community-based aged care services in Australia. Future directions and strategies for reablement approaches to care for community dwelling people living with dementia, will be developed. The study will provide evidence to inform key stakeholders in their decision making and the use/delivery of the program, as well as influence future systems-thinking and changes for dementia care. Trial registration Australian New Zealand Clinical Trial Registry ACTR N12618000600246 (approved 18/04/2018).

【 授权许可】

Unknown