Highlights
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Reablement is a more beneficial and sustainable approach with long lasting effects on physical function, quality of life, and ADL in home dwelling elderly, than usual home care services.
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The reablement group needed considerably less hours of home care services than the usual care group participants over time.
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The use of intermediate care in nursing homes is reduced in the reablement group.
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Reablement incorporates a systematic user-involvement by asking “What matters to you?” that includes communication emphasizing empowerment, encouragement, and support, as well as a hopeful and solution-oriented questioning in the context of the participants’ resources and challenges.
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The interdisciplinary team harmonizes and coordinates the rehabilitation plan according to the participants goals.
Keywords: Functional decline, Home care services, Interdisciplinary team, Reablement, Rehabilitation
Abstract
Objectives
To investigate the effect of a reablement intervention (a person-centered, interdisciplinary rehabilitation approach) compared with usual care services in home-dwelling elderly experiencing functional declines in activities of daily living.
Design
A non-randomized controlled trial comparing a reablement intervention with usual care; outcomes were measured at baseline, after intervention, and at a 6-month from baseline in both groups.
Setting
Municipal public health service.
Participants
Sixty-five home-dwelling elderly with functional decline were assigned by the participants home care service zone to a reablement group (n=35), or a usual care group (n=30). The mean participant age was 80±11 years in the reablement group and 78±12 in the usual care group.
Intervention
The reablement group received a person-centered and tailored reablement program provided by an interdisciplinary team, consisting of a physiotherapist, an occupational therapist, and a nurse. The usual care group received standard home care services.
Main Outcome Measures
The dimension “Your health today” from the European Quality of Life-Visual Analog Scale (HRQOL), the patient-specific functional scale for goals in ADL (PSFS), the short physical performance battery (SPPB), and home care services in hours per week.
Results
There were significant differences over time in favor of the reablement group with between-group effect sizes of Cohen h2=0.36 (P=.001) for HRQOL, h2=0.60 (P=.001) for PSFS, h2=0.30 (P=.001) for SPPB, and h2=0.10 (P=.013) for hours of home care services per week. The within-group effect size for PSFS was h2=0.15 (P=.010) in favor of the reablement group. The mean number of hours of home care services per week was mean 0.38±1.07 (P=.001) in the reablement group and mean 30.38±64.13 (P=.023) in the usual care group.
Conclusions
The participants in the reablement group achieved and maintained better physical function, a higher HRQOL and needed considerably less home care services than the usual care group participants. Thus, reablement appears to be a more beneficial and sustainable approach than the usual care services for the home-dwelling elderly with functional decline.
Graphical Abstact
Elderly wants to remain in their homes safely, independently, and comfortably for as long as possible, but cannot because they face health issues. The resources to fund care for the elderly are increasingly limited because the older population is growing.1 Most elderly persons want to have an effect on their own lives, be active, and participate in the social community. A previous study suggested that the elderly wish to remain at home because their quality of life can best be maintained by doing so.2 One of the solutions to meet this challenge is reablement, which is an alternative approach to the usual home care services for home-dwelling elderly.
The intervention of reablement is a person-centered, goal-, and resilience-oriented approach to increase independence in older people experiencing a functional decline of activities of daily living (ADL).3 The usual care medical model consisting of home care services are focusing on frailty and compensatory care, while reablement is a person-centered orientation helping individuals learn or relearn skills that are necessary to engage in activities and occupations in their communities.4 There has been some ambiguity regarding the concept of reablement. However, a Delphi study has recently been conducted among 81 international experts, wherein reablement was defined as follows: “Reablement is a person-centered, holistic approach that aims to enhance an individual's physical and/or other functioning, to increase or maintain their independence in meaningful ADL at their place of residence and to reduce their need for long-term services. Reablement consists of multiple home visits and delivered by a trained and coordinated interdisciplinary team. The intervention includes an initial comprehensive assessment followed by regular reassessments and the development of goal-oriented support plans. Reablement supports an individual to achieve their goals, if applicable, through participation in daily activities, home modifications, and assistive devices as well as involvement of their social network. Reablement is an inclusive approach irrespective of age, capacity, diagnosis, or setting”.3
An interdisciplinary team, usually consisting of a physiotherapist, occupational therapist, and a nurse within the home care service, assists the person. The reablement team asks, “What matters to you?” instead of the traditional question “What is the matter with you?”.5,6 This shifts from volume to value. Traditional, medical-oriented models in the public service often miss the opportunity to promote motivation and engagement in the elderly persons’ ADL.7 Unfortunately, this can lead to further increase of dependence and concomitant loss of functioning.7,8 Studies on reablement have indicated improvement in physical function, health-related quality of life (HRQOL) and self-maintenance in the home-dwelling elderly for as long as 6 months after intervention.9, 10, 11 However, the effect of reablement in ADL remains unclear because standardized assessments and measurements, as well as the level of self-care skills, differ across studies.12 Moreover, few reports have examined the sustainability and effectiveness of reablement compared with those of the usual care services.13 Knowledge of the numbers of hours used in home care services related to short- and long-term improvements in clinical outcomes is essential for evaluating the sustainability of the approach.
We hypothesized significant differences between and within the groups over time, in favor of the reablement group, for PSFS, SPPB, motivation, HRQOL, and hours of homecare services per week. Differences in the results between men and women were also explored. This study aimed to investigate the effect of a reablement intervention compared with home care services in public health care with home-dwelling elderly experiencing functional declines.
Methods
Study design and participants
This is a non-randomized control study in a public health home care services setting with an intervention group and a control group and the following 3 time points: baseline (T0) before study initiation, after intervention (T1), and at 6 months from baseline (T2). The participants consisted of 65 elderly persons living in a rural municipality in south-east Norway. The inclusion of the participants and data collection started in August 2017 and was completed in January 2019. The municipal health services office identified potential participants, and those who met the inclusion criteria were invited to participate in this study. Allocation to the reablement or usual care group was decided by the participant home care service zone. Nor the office, the participants, or the measurers were blinded to the allocation.
The inclusion criteria were as follows: home-dwelling elderly, experiencing functional decline in 1 or more daily activities, who applied for or were referred to home-based services and scored ≥1 on the motivation scale for reablement (numeric rating scale [NRS]: 0-10). The participants had previously been discharged from hospital or intermediate care because of an acute illness or having gradually developed functional decline at home. The participants had to be capable of collaborating because of the intervention plan. The exclusion criteria were as follows: persons with moderate to severe cognitive impairments. Cognitive impairments were identified by using the Mini Mental State Examination (MMSE).14 A score of 18-10 points is considered as moderate. Persons with a lower score than 18 points were not included, needing end-of-life care, applying for nursing-home or rehabilitation institution, needing psychiatric assistance or absence of motivation for reablement (a score of 0 on the motivation scale). Motivation scale may decide who is motivated for participation.
Interventions
The reablement group received a person-centered and tailored reablement program, which consisted of standardized exercises and practice of their preferred goals of ADL. The reablement sessions lasted for 45 minutes, 3 times a week for a maximum of 16 weeks. The interdisciplinary team consisted of a physical therapist, an occupational therapist, and a nurse. “What matters to you?” was asked at the first time point. The communication was based on the theory “humble consulting” of Edgar Schein, to minimize the professional distance and work with the patients in a more personal way, emphasizing authentic openness, curiosity, and humility.15 The communication also emphasizes empowerment including encouraging and supportive, as well as hopeful and solution-oriented questioning in the context of the participants’ resources and challenges. The participants’ goals were specific, measurable, achievable, realistic, and time-bounded.16,17 Furthermore, the reablement intervention consisted of individually tailored activities based on the respective participants’ interests and goals and made in collaboration with the team. The program included balance, strength, and walking exercises. Both the exercises and practice of the several types of ADL were performed in the participants’ homes and the nearby outdoor environments. The reablement intervention also aimed to understand the effectiveness of reablement on ADL with regard to the following 3 domains: basic, instrumental, and advanced ADL, referring to volitional, influenced by cultural and motivational factors, expressing a personal engagement in satisfying activities beyond what is needed to be independent.18 The ADL domains were identified and evaluated based on the participants goal setting. The program was coordinated and integrated with the home care services, because trained nurses from the home care service guided the participants through the intervention period.
The usual care group received medical model guides home care services which comprised nursing, housekeeping aid, occupational, and/or physical therapy, for 8 weeks. A traditional interview method was used focusing on the participant's limitations in ADL, and the need for home care services was decided based on their responses.
Ethical considerations
This study was approved and obtained (2017/1616) by the Regional Committee for Medical Health Research, Region South-East in Norway. The study conforms to the principles outlined in the Declaration of Helsinki.19 This study took place in the municipality primary care and the participants provided written informed consent. The usual care group participants were offered reablement after a 6-month follow-up in relation to the waiting list.
Measurements
The following demographic data were collected from the medical records: age, sex, marital status/cohabiting, education, and body mass index. Diagnosis and impairments (causes of functional decline) were categorized as follows: fall, orthopedic surgery, stroke, heart failure, respiratory impairments, and “other diagnoses” (such as pain, abdominal problems, and infections). The social activity factors were as follows: participation in organized walking groups, pensioner associations or volunteer groups, and activities inside and outside the residence, such as climbing stairs, gardening, and shoveling snow.
The patient-specific functional scale (PSFS) was used to evaluate participant-rated goals and assess their functional ability to complete specific activities and social participation. The goals within all the different ADL (basic, instrumental, and advanced) were based on the participants’ interests and preferences of activity, where 0 indicates “Cannot perform” and 10 indicates “Able to perform without problems”.20 A change of ≥2 points over time has been shown to be clinically and significantly relevant.21 The PSFS is commonly used in goal setting for reablement and has demonstrated high reliability and validity in elderly persons with musculoskeletal problems and patients with acquired brain injury.22, 23, 24
Physical functioning was evaluated using the short physical performance battery (SPPB), which is recommended for screening and aims to identify people at risk of functional decline.25 The SPPB includes a standing balance test, a timed 4-meter walking test, and a timed test of 5 repetitions rising from and sitting down on a chair (score 0-12 shows worst to best). A score of ≤8 points suggests the need for assistance in ADL, and a score of ≤6 points indicates an increased risk of falling and re-falling.26 An increase of 1 point over time has been shown to be clinically meaningful for the participant.27 The SPPB has demonstrated high reliability and good validity and responsiveness for home-dwelling older adults.27
Motivation was measured using an NRS (0-10) and the question “Are you motivated for rehabilitation?”, as commonly used in rehabilitation and reablement.28
The European Quality of Life Five Dimension Five Level Scale (EQ-5D-5L) is a generic HRQOL measurement tool that is used for evaluating physical, mental and social dimensions of health.29 In the present study, only the dimension “Your health today” (European Quality of Life-Visual Analog Scale (EQ-VAS) was used. The participants assessed their health status using an NRS (0-100), where 100 indicated “Excellent health”. The EQ-5D-5L has demonstrated high reliability and good validity in elderly persons.29,30
Hours of home care services, intermediate care in nursing home and reablement per week were registered in the medical records and collected at baseline, after intervention, and at the 6-month follow-up for both groups.
Statistical analysis
The statistical power calculation was provided by Oslo Centre of Biostatistics and Epidemiology, Research Support Services, Oslo University Hospital. The calculation was performed before data collection and based on an earlier study in Norway using the HRQOL (EQ-VAS) measurements.9 A sample size calculation based on a paired samples t test assuming a mean of 0.6 (SD 0.20) at baseline and a mean of 0.77 (SD 0.20) at follow-up with a correlation of 0.5 between the repeated measurements was conducted. Accepting an a risk of 0.05 and a b risk of 0.80 in a bilateral contrast, 13 participants were needed in each group.
Descriptive statistics are presented using mean and standard deviation for continuous data, and frequencies and percentages (%) for categorical data. Outcome data were analyzed on an intention to treat (ITT) basis using the last observation carry forward method and including all patients, non-compliers, and participants lost to follow-up. Differences between groups at baseline (T0) were analyzed using independent-sample t tests for continuous data and chi-square tests for categorical data. We compared the course of EQ-VAS, PSFS, SPPB, motivation for rehabilitation, and duration of home care utilization per week in the 2 groups between baseline (T0), end of intervention (T1), and 6 months follow-up (T2) using a general linear model with repeated-measures, to distinguish within group (intrasubject) effects (time effect and time-by-group interaction) and between group (intersubject) effects. Effect size (partial h square score (partial h2) was calculated according to Cohen (0.01 small, 0.06 moderate, and 0.14, large).31 Age was dichotomized at ≥70 years to provide significant results. Confounding factors were identified by the following method: relevant factors were analyzed using a univariate linear regression analysis; in cases where P was lower than .05 (2-tailed), the significant factors were included into a multivariate linear regression analysis with forward variable selection. They were identified as climbing stairs and gardening/shoveling snow for the within group analyses and age, marital status/living together with someone, and social activities for the between group analyses. Two-tailed tests were performed at a significance level of P<.05. IBM SPSS Statistics version 27 (Armonk, New York, NY, USA) was used for statistical analyses.
Results
Sixty-five participants were included in the present study: 35 were allocated to the reablement group and 30 to the usual care group (table 1). The mean participant age was 80±11 years in the reablement group and 78±12 years in the usual care group. A total of 63% and 50% of the participants in the reablement and usual care groups, respectively, had undergone a fall or orthopedic surgery (table 1). At baseline, the reablement group participants had a significantly (P<.02) higher number of men, social, and gardening activities as well as a higher number of stairs at their residence than the usual care group participant. There were no significant baseline differences for the outcome measures in the 2 groups, except for Motivation (P<.002), the mean score was 8.1±1.7 in Reablement group and 6.0 ±3.1 in Usual care group (table 1). Both groups scored <6 points at baseline on the SPPB, indicating an increased risk of falling and re-falling (table 1). The T0 to T1 (intervention) period lasted for a mean of 8.5±3.3 (min–max, 2-16) weeks.
Table 1.
Participants characteristics and outcome measures for the Reablement and Usual Care groups at baseline N 65
| Characteristics | Reablement n=35 |
Usual Care n=30 |
P |
|---|---|---|---|
| Age (min-max) SD | 80 (56-96)±11 | 78 (42-96)±12 | .51 |
| Men no (%) | 19 (54) | 10 (35) | .001 |
| Women no (%) | 16 (46) | 20 (65) | .16 |
| BMI kg/m × m mean SD | 27.3±4.7 | 26.5±7 | .59 |
| Care, hours* mean SD | 4.13±3.19 | 2.03±2.35 | .01 |
| Social activity factors | |||
| Living together no (%) | 12 (34) | 12 (40) | .46 |
| Education level primary <9 y no (%) | 22 (63) | 20 (67) | .79 |
| Higher education >9 y no (%) | 12 (37) | 10 (33) | .61 |
| Social activity outside residence no (%) | 20 (57) | 9 (30) | .02 |
| Gardening/Shoveling snow no (%) | 15 (43) | 4 (13) | .01 |
| Stairs in residence no (%) | 19 (54) | 7 (23) | .01 |
| Walking distance to grocery ≥3 km no (%) | 22 (63) | 21 (70) | .61 |
| Patient reported and observed outcome | |||
| EQ VAS mean SD (Your health today) NRS (0-100) | 51.7±17 | 50.4±20.2 | .77 |
| PSFS mean SD (Goals) NRS (0-10) | 3.7±1.3 | 3.9±1.7 | .50 |
| SPPB mean SD (Physical function.) (0-12) | 5.9±2.5 | 5.7±2.7 | .79 |
| Motivation mean SD NRS (0-10) | 8.0±1.7 | 6.0±3.1 | .002 |
| Diagnoses, medication, and care service | |||
| Diagnoses mean (min-max) | 5 (2-11) | 4 (1-8) | .52 |
| Medication mean (min-max) | 10 (2-16) | 10 (3-19) | .62 |
| Used antidepressants no (%) | 6 (17) | 7 (23) | .76 |
| Fall no (%) | 11 (31) | 9 (30) | .74 |
| Orthopedic surgery no (%) | 11 (31) | 6 (20) | .74 |
| Stroke no (%) | 6 (17) | 4 (14) | .74 |
| Heart failure no (%) | 3 (9) | 6 (20) | .74 |
| Respiratory no (%) | 1 (3) | 1 (3) | .74 |
| Pain, abdominal surgery, cancer, infection no (%) | 3 (9) | 4 (13) | .74 |
Hours of homecare services utilization per week.
The dropout rates were 3% and 23% in the reablement and usual care groups, respectively. One and 3 participants in the reablement and usual care groups, respectively, withdrew from the study. In addition, 3 participants died, and 1 moved elsewhere during the intervention in the usual care group (fig 1).
Fig 1.
Flow chart of participants throughout the intervention.
There were significant (P=.001) differences between the groups over time in favor of the reablement group, with between group effect sizes of h2=0.36 for the EQ-VAS, h2=0.60 for the PSFS and h2=0.30 for the SPPB (table 2 and fig 2). The model was adjusted for the following covariates: climbing stairs and gardening/shoveling snow for within-group analyses and age, marital status/living together with someone and social activities for between-groups analyses. The reablement group had significantly (P=.013) fewer hours of home care services per week at T1 and T2 compared with the usual care group (table 2, fig 3).
Table 2.
Between and within group differences for the Reablement and the Usual Care groups at baseline (T0), end of intervention (T1), and at 6 months follow-up (T2)
| Time |
Effect |
|||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|
| Reablement |
Usual Care |
Within Group × 3 Time |
Between Groups |
|||||||||
| T0 Mean SD |
T1 Mean SD |
T2 Mean SD |
T0 Mean SD |
T1 Mean SD |
T2 Mean SD |
F | P | ɳ2* | F | P | ɳ2* | |
| EQ VAS NRS (0-100) | 50.85±16.44 | 65.53±19.53 | 66.62±17.34 | 50.37±20.16 | 55.43±17.94 | 53.15±20.05 | .68 | .51 | .02 | 17.31 | .001 | .36 |
| PSFS NRS (1-10) | 3.70±1.29 | 7.64±2.09 | 7.53±2.09 | 3.92±1.72 | 5.03±2.11 | 5.15±2.45 | 4.67 | .01 | .15 | 43.48 | .001 | .60 |
| SPPB (0-12) | 5.94±2.56 | 8.06±2.51 | 7.19±2.58 | 5.73±2.73 | 5.93±2.72 | 6.33±2.72 | .24 | .79 | .01 | 11.97 | .001 | .30 |
| Motivation NRS (0-10) | 7.86±1.79 | 8.72±2.17 | 8.14±2.60 | 5.88±2.98 | 6.96±3.27 | 6.46±3.40 | .84 | .44 | .03 | .67 | .520 | .03 |
| Hours of homecare services | 4.13±3.19 | 2.57±2.20 | .38±1.07 | 2.03±2.35 | 24.29±59.08 | 30.38±64.13 | 3.03 | .06 | .09 | 6.61 | .013 | .10 |
NOTE. Within group analyses were adjusted for stairs and gardening/shovel snow, and between group analyses were adjusted for age, living together, and social activity.
ɳ2 Cohen 0.01=small; 0.06=moderate; 0.14=large effect size.
Fig 2.
Outcome for the reablement and the usual care groups over time; at the baseline (T0), end of intervention (T1), and the 6 months follow-up (T2). (A) EQ-VAS. (B) PSFS; ADL. (C) SPPB.
Fig 3.
Home care services (hours per week) for the reablement and the usual care groups over time; from baseline T0, to end of intervention T1, to 6 months follow-up T0-T2.
Physical function assessed using the PSFS (ADL) and SPPB improved significantly (P=.001) over time within the reablement group from T0 to T1. Small improvements were observed for the usual care group, but they were not significant (P>.05; table 3 and fig 2).
Table 3.
Changes over time for the Reablement and the Usual Care groups from baseline (T0), end of intervention (T1), and 6-month follow-up (T2)
| Reablement |
Usual Care |
|||||||
|---|---|---|---|---|---|---|---|---|
| Change T0 to T1 |
Change T0 to T2 |
Change T0 to T1 |
Change T0 to T2 |
|||||
| Mean SD | P | Mean SD | P | Mean SD | P | Mean SD | P | |
| PSFS | 3.94±2.45 | .001 | 3.83±2.37 | .001 | .96±1.96 | .010 | 1.07±1.86 | .004 |
| SPPB | 1.94±2.36 | .001 | 1.17±1.74 | .001 | .20±1.67 | .520 | .60±1.57 | .045 |
| Hours of homecare services | -1.56±2.50 | .001 | -4.16±3.28 | .001 | 22.26±57.37 | .046 | 28.36±63.47 | .023 |
NOTE. Minimal clinical important change for PSFS ≥2, SPPB ≥1.
Hours of homecare services: 4 participants at T1 and 5 participants at T2 admitted to intermediate care in the Usual Care group.
Duration of home care services decreased significantly (P=.001) in the reablement group over time (4.16 hours), but it showed a significant increase (P=.023) in the usual care group (28.36 hours). In the usual care group, 4 participants were admitted for intermediate care in nursing homes at T1 and 5 participants at T2. No participants were admitted for intermediate care in nursing homes in the reablement group (table 3 and fig 3).
Discussion
This study aimed to investigate the results of a reablement intervention, compared with those of usual care, in home-dwelling elderly receiving standard public health care services. Previous studies on rehabilitation in the elderly reported that physical function at baseline is an important factor for successful rehabilitation and is not related to sex.32,33 The higher number of men vs women in the reablement group in the present study did not significantly affect the results and was not identified as a confounding factor. The significantly higher motivation level in the reablement group might be due to the context of the reablement approach. The shared understanding and commitment to the intervention have previously been found to be essential factors and the driving forces related to successful reablement.34 Participants with higher motivation may be more likely to make changes to meet goals and do for self vs those with lower motivation. These factors were lacking in the usual care group and might have led to a decrease in the motivation of the participants. The higher drop-out rate in the usual care group might illustrate this lack of motivation, as 3 persons withdrew, but only 1 in the intervention group. The reablement approach has previously been shown to promote motivation.28,35 Moreover, there were no significant differences in the participants’ characteristics between the groups at baseline. Nevertheless, 3 persons died in the usual care group and non in the reablement group. The study design and sample size were not designed to explain if their deaths were random or due to the lack of the reablement intervention.
Favorable significant differences with large effect sizes were observed in the reablement group regarding the EQ-VAS, PSFS, SPPB, and duration of home care services per week. These results support previous findings that reablement is highly favorable for the quality of life because it enhances independence in ADL and self-maintenance as well as increases physical activity level and function in the home-dwelling elderly.9,36, 37, 38
All 3 ADL domains (basic, instrumental, and advanced)18 were identified and evaluated using the PSFS in the present study, because the functional task changed from the simplest self-care to participation in social settings and hobbies. A significant, positive change was observed in the PSFS scores in both groups. However, the results were only clinically relevant in the reablement group, because a change in the score of ≥2 points is recognized as a clinically relevant change.21 Moreover, Tuntland et al reported that after a sudden functional decline, for example a fall, the time to recover to a certain functional level is prolonged with usual home care services compared with the reablement approach.11 They also suggested that reablement improves a person's self-maintenance and motivation.11 The strong person-centered approach stimulates the participant's motivation to achieve self-maintenance and goals based on their personal interests and wishes.39 The aims of reablement are to learn or relearn the skills that are necessary for independent everyday living. The reablement process through empowerment can enhance commitment and thereby assisting people to live well with their impairments in the context of their environments.40 The reablement team contributes with interdisciplinary competence and focuses on capabilities and opportunities rather than diagnoses and dependency.8 The team's high competence and their relation with the participant combined with continuity in the services may be factors explaining the beneficial results in the reablement group compared with the usual care group with more lack of continuity and focusing more on compensating care.41,42
Both groups scored <6 points at baseline on the SPPB, indicating an increased risk of falling and re-falling, in addition to suggesting the need for assistance from home care services. Physical function significantly improved in the reablement group after the intervention and the participants of this group showed higher scores at the 6-month follow-up. Because the scores improved by >1 point at all time intervals, the improvements are considered clinically important changes. Although physical function significantly improved from the baseline to the 6-month follow-up in the usual care group, it was not considered a clinically important change and the participants were still at risk of falling with a score of ≤6 points.26 This finding demonstrates the positive effects of introducing motivation for regular physical activity using a reablement team approach to reduce the risk of falling and postpone the need for other home care services or intermediate care in nursing home. Such a finding was also observed by other investigators.43
In the usual care group, 4 participants after the intervention and 5 participants at the 6-month follow-up were temporarily admitted for intermediate care in nursing homes, while none were admitted for intermediate care in the reablement group. The number of home care service hours per week increased dramatically in the usual care group, with an increase of >28 hours per week from T0 to T2. In contrast, the number of home care service hours in the reablement group decreased from 4 to zero hours per week from baseline (T0) to end of study (T2) (tables 2 and 3). These findings demonstrate the better efficacy of the reablement approach compared with the traditional care services, although slightly more resources were used in the intervention period. These findings indicate that the reablement approach is more cost-effective over time than the traditional home care services. To our knowledge, this is the first study to report the effectiveness of reablement by less used hours of home care services per week compared with usual care services.
Study limitations
A randomized controlled study would probably been a better study design. However, a quasi-experimental design can often involve more providers and settings, making the results more generalizable to the home care service “real world” evidence. Furthermore, the sample size was small, which might have introduced a type II error. Nevertheless, power calculation suggested the requirement of 13 participants in each group. We included 35 participants in the reablement group and 30 in the usual care group. Even with 7 dropouts in the usual care group, the statistical power should be satisfactory with 23 participants at the 6-month follow-up. The high dropout rate in the usual care group might represent a possibility of selection bias. However, the intention-to-treat analyses did not reveal such error.
Conclusions
The reablement intervention enabled achievement and maintenance of better physical function in ADL and a higher quality of life in short and long term for both elderly men and women. Furthermore, the hours of home care services decreased for the reablement group and increased for the usual care group over time. None of the individuals in the reablement group were referred to intermediate care as compared with those in the in the usual care group. Thus, the reablement approach appears to be more beneficial and sustainable than the usual home care services in home-dwelling elderly with functional declines.
Acknowledgments
We are most grateful to all the participants and staff, as well as the managers of the health care organization who took part in this study.
Footnotes
This study was performed in the municipality of Aurskog-Holand, Norway, years 2018-2021.
This study was financially supported by the Norwegian Directorate of Health2017/1497-18H-KHT.
Disclosures: None.
References
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