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Warner KN, Poulos RG, Cole AM, Nguyen TA, Un FC, Faux SG, Kohler F, Alexander T, Capell JT, Hilvert DR, O'Connor CMC, Poulos CJ. Re/connecting with "home": a mixed methods study of service provider and patient perspectives to facilitate implementing rehabilitation in the home for reconditioning. Disabil Rehabil 2024:1-11. [PMID: 39105538 DOI: 10.1080/09638288.2024.2386157] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2023] [Revised: 07/20/2024] [Accepted: 07/25/2024] [Indexed: 08/07/2024]
Abstract
PURPOSE To explore the views of healthcare professionals and patients about the advantages and disadvantages of rehabilitation in the home (RITH) for reconditioning, and identify factors that should contribute to the successful implementation of a consensus-based RITH model for reconditioning. MATERIALS AND METHODS Interviews with 24 healthcare professionals and 21 surveys (comprising Likert scale and free text responses) of inpatients undergoing rehabilitation for reconditioning provided study data. Interpretive thematic analysis was used to analyse interview data; descriptive statistics analysed Likert scale responses; patient written responses assisted with the interpretation of themes developed from the interview data. RESULTS Two major themes were elicited in this study: the home is a physical setting and the home is a lived space. Advantages and disadvantages of RITH for patients, carers and healthcare professionals were identified within these themes. Appropriate patient selection; effective communication with patients and carers, and within RITH teams; adequate patient and carer support; ensuring the safety of patients and staff; and education of patients, carers and healthcare professionals are essential for the satisfactory implementation of RITH. CONCLUSION The concept of home shapes the delivery of RITH. Recognising the advantages and disadvantages of RITH highlights important considerations needed to successfully implement RITH for reconditioning.
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Affiliation(s)
- Kerry N Warner
- HammondCare, Sydney, Australia
- School of Population Health, University of New South Wales, Sydney, Australia
| | - Roslyn G Poulos
- HammondCare, Sydney, Australia
- School of Population Health, University of New South Wales, Sydney, Australia
| | - Andrew M Cole
- HammondCare, Sydney, Australia
- School of Clinical Medicine, University of New South Wales, Sydney, Australia
| | - Tuan-Anh Nguyen
- South Western Sydney Local Health District, Sydney, Australia
| | | | - Steven G Faux
- School of Clinical Medicine, University of New South Wales, Sydney, Australia
- St Vincent's Hospital, Sydney, Australia
| | - Friedbert Kohler
- HammondCare, Sydney, Australia
- School of Clinical Medicine, University of New South Wales, Sydney, Australia
| | - Tara Alexander
- Australasian Rehabilitation Outcomes Centre, University of Wollongong, Wollongong, Australia
| | - Jacquelin T Capell
- Australasian Rehabilitation Outcomes Centre, University of Wollongong, Wollongong, Australia
| | | | - Claire M C O'Connor
- HammondCare, Sydney, Australia
- School of Psychology, University of New South Wales, Sydney, Australia
- Neuroscience Research Australia, Sydney, Australia
| | - Christopher J Poulos
- HammondCare, Sydney, Australia
- School of Population Health, University of New South Wales, Sydney, Australia
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Ozsoy G, Aksoy K. Intra- and inter- rater reliability of the face‑to‑face assessment and tele‑assessment of performance-based tests in older adults. Eur Geriatr Med 2024; 15:601-607. [PMID: 38383819 DOI: 10.1007/s41999-024-00946-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2023] [Accepted: 01/17/2024] [Indexed: 02/23/2024]
Abstract
PURPOSE This study aimed to assess Timed-Up and Go (TUG), Five Times Sit-to-Stand Test (5xSST), and 4-Meter Walk Test (4MWT) intra- and inter-rater reliability between face-to-face and tele-assessment tools in older adults. METHODS A total of 54 older adults (aged ≥ 65 years) were included in the study. Measurements (TUG, 5xSST, and 4MWT) were carried out face-to-face and tele-assessment. The intraclass correlation coefficients (ICCs), and Bland-Altman plots was used determine intra- and inter-rater reliability. RESULTS The mean age of the participants, 53% of whom were female, was 69.59 years. Inter-rater reliability between face-to-face and tele-assessment was as following: excellent for TUG (ICC = 0.931) and 5STS (ICC = 0.908), and good for 4MWT (ICC = 0.803). In addition, intra-rater reliability between the two tele-assessments was excellent for all tests. The ICC values for TUG, 5STS, and 4MWT were 0.973, 0.948, and 0.934, respectively. CONCLUSION To conclude, the TUG, 5xSST, and 4MWT seem to be reliable tools of tele-assessment in older adults. These practical assessment tools can be used in home settings for older adults as tele-health interventions.
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Affiliation(s)
- Gulsah Ozsoy
- Department of Physiotherapy and Rehabilitation, Faculty of Health Sciences, Selçuk University, Konya, Turkey.
| | - Kevser Aksoy
- Department of Physiotherapy and Rehabilitation, Faculty of Health Sciences, Selçuk University, Konya, Turkey
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Kattouw CE, Aase K, Viksveen P. Stakeholder perspectives on the preferred service ecosystem for senior citizens living at home: a qualitative interview study. BMC Geriatr 2023; 23:576. [PMID: 37726648 PMCID: PMC10508029 DOI: 10.1186/s12877-023-04303-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2023] [Accepted: 09/09/2023] [Indexed: 09/21/2023] Open
Abstract
BACKGROUND Most senior citizens want to live independently at home as long as possible. The World Health Organization recommends an age-friendly community approach by transforming the service ecosystem for senior citizens and basing it on the question "What matters to you?". However, there is limited research-based knowledge to determine the characteristics of the preferred service ecosystem from the perspectives of multiple stakeholders. Therefore, the aim of the study was to gain a deeper understanding of multiple stakeholder perspectives on the preferred service ecosystem for senior citizens living at home. METHODS Four stakeholder groups (n = 57) from a Norwegian municipality participated in an interview study in 2019 and 2020: senior citizens, carers, healthcare professionals, and managers. Data were analysed according to qualitative content analysis. RESULTS Overall, there was considerable correspondence between the four stakeholder groups' perspectives on the preferred service ecosystem for senior citizens. Six themes were developed: (1) "self-reliance - living independently at home as long as possible"; (2) "remaining active and social within the community"; (3) "support for living at home as long as possible"; (4) "accessible information and services"; (5) "continuity of services"; and (6) "compassionate and competent healthcare professionals". CONCLUSIONS In order to adapt and meet changing needs, the preferred service ecosystem should support senior citizens' autonomy through interpersonal relationships and involvement. Healthcare managers and decision makers should consider a broader range of practical and social support services. Municipalities should plan for and develop age-friendly infrastructures, while healthcare professionals should rely on their compassion and competence to meet senior citizens' needs.
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Affiliation(s)
- Christophe Eward Kattouw
- Department of Quality and Health Technology, Faculty of Health Sciences, SHARE - Centre for Resilience in Healthcare, University of Stavanger, Post Box 8600, Forus, Stavanger, 4036, Norway.
| | - Karina Aase
- Department of Quality and Health Technology, Faculty of Health Sciences, SHARE - Centre for Resilience in Healthcare, University of Stavanger, Post Box 8600, Forus, Stavanger, 4036, Norway
| | - Petter Viksveen
- Department of Quality and Health Technology, Faculty of Health Sciences, SHARE - Centre for Resilience in Healthcare, University of Stavanger, Post Box 8600, Forus, Stavanger, 4036, Norway
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Wang H, Zhang Y, Yue S. Exploring barriers to and facilitators of the implementation of home rehabilitation care for older adults with disabilities using the Consolidated Framework for Implementation Research (CFIR). BMC Geriatr 2023; 23:292. [PMID: 37179304 PMCID: PMC10183114 DOI: 10.1186/s12877-023-03976-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2022] [Accepted: 04/16/2023] [Indexed: 05/15/2023] Open
Abstract
BACKGROUND With global aging on the rise, the number of older adults with disabilities was also increasing exponentially. There has been growing international interest in home rehabilitation care as a new method for older adults with disabilities. METHOD The current study is a descriptive qualitative study. Guided by the Consolidated Framework for Implementation Research (CFIR), semistructured face-to-face interviews were performed to collect data. The interview data were analyzed using a qualitative content analysis method. RESULT Sixteen nurses with different characteristics from 16 cities participated in the interviews. The findings highlighted 29 implementation determinants of home-based rehabilitation care for older adults with disabilities, including 16 barriers, and 13 facilitators. These influencing factors aligned with all four CFIR domains that were used to guide the analysis and 15 of the 26 CFIR constructs. More barriers were identified in the CFIR domain of characteristics of individuals, intervention characteristics, and the outer setting, while fewer barriers were identified in the inner setting. CONCLUSION Nurses from the rehabilitation department reported many barriers related to the implementation of home rehabilitation care. They reported facilitators to the implementation of home rehabilitation care despite the barriers, which provided practical recommendations for directions to be explored by researchers in China and elsewhere.
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Affiliation(s)
- Haixia Wang
- School of Nursing and Rehabilitation, Cheeloo College of Medicine, Shandong University, Jinan, China
- University of Health and Rehabilitation Sciences, Qingdao, China
| | - Yanyan Zhang
- Rehabilitation Center, Qilu Hospital of Shandong University, Jinan, China.
| | - Shouwei Yue
- School of Nursing and Rehabilitation, Cheeloo College of Medicine, Shandong University, Jinan, China.
- University of Health and Rehabilitation Sciences, Qingdao, China.
- Rehabilitation Center, Qilu Hospital of Shandong University, Jinan, China.
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Poulos RG, Cole AM, Warner KN, Faux SG, Nguyen TA, Kohler F, Un FC, Alexander T, Capell JT, Hilvert DR, O’Connor CMC, Poulos CJ. Developing a model for rehabilitation in the home as hospital substitution for patients requiring reconditioning: a Delphi survey in Australia. BMC Health Serv Res 2023; 23:113. [PMID: 36737750 PMCID: PMC9895972 DOI: 10.1186/s12913-023-09068-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2022] [Accepted: 01/16/2023] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND Reconditioning for patients who have experienced functional decline following medical illness, surgery or treatment for cancer accounts for approximately 26% of all reported inpatient rehabilitation episodes in Australia. Rehabilitation in the home (RITH) has the potential to offer a cost-effective, high-quality alternative for appropriate patients, helping to reduce pressure on the acute care sector. This study sought to gain consensus on a model for RITH as hospital substitution for patients requiring reconditioning. METHODS A multidisciplinary group of health professionals working in the rehabilitation field was identified from across Australia and invited to participate in a three-round online Delphi survey. Survey items followed the patient journey, and also included items on practitioner roles, clinical governance, and budgetary considerations. Survey items mostly comprised statements seeking agreement on 5-point Likert scales (strongly agree to strongly disagree). Free text boxes allowed participants to qualify item answers or make comments. Analysis of quantitative data used descriptive statistics; qualitative data informed question content in subsequent survey rounds or were used in understanding item responses. RESULTS One-hundred and ninety-eight health professionals received an invitation to participate. Of these, 131/198 (66%) completed round 1, 101/131 (77%) completed round 2, and 78/101 (77%) completed round 3. Consensus (defined as ≥ 70% agreement or disagreement) was achieved on over 130 statements. These related to the RITH patient journey (including patient assessment and development of the care plan, case management and program provision, and patient and program outcomes); clinical governance and budgetary considerations; and included items for initial patient screening, patient eligibility and case manager roles. A consensus-based model for RITH was developed, comprising five key steps and the actions within each. CONCLUSIONS Strong support amongst survey participants was found for RITH as hospital substitution to be widely available for appropriate patients needing reconditioning. Supportive legislative and payment systems, mechanisms that allow for the integration of primary care, and appropriate clinical governance frameworks for RITH are required, if broad implementation is to be achieved. Studies comparing clinical outcomes and cost-benefit of RITH to inpatient rehabilitation for patients requiring reconditioning are also needed.
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Affiliation(s)
- Roslyn G Poulos
- HammondCare, Sydney, Australia ,grid.1005.40000 0004 4902 0432School of Population Health, UNSW, Sydney, Australia
| | - Andrew M Cole
- HammondCare, Sydney, Australia ,grid.1005.40000 0004 4902 0432School of Population Health, UNSW, Sydney, Australia
| | - Kerry N Warner
- HammondCare, Sydney, Australia ,grid.1005.40000 0004 4902 0432School of Population Health, UNSW, Sydney, Australia
| | - Steven G Faux
- grid.1005.40000 0004 4902 0432School of Population Health, UNSW, Sydney, Australia ,grid.437825.f0000 0000 9119 2677St Vincent’s Hospital, Sydney, Australia
| | - Tuan-Anh Nguyen
- grid.410692.80000 0001 2105 7653South Western Sydney Local Health District, Sydney, Australia
| | - Friedbert Kohler
- HammondCare, Sydney, Australia ,grid.1005.40000 0004 4902 0432School of Population Health, UNSW, Sydney, Australia
| | | | - Tara Alexander
- grid.1007.60000 0004 0486 528XAustralasian Rehabilitation Outcomes Centre, University of Wollongong, Wollongong, Australia
| | - Jacquelin T Capell
- grid.1007.60000 0004 0486 528XAustralasian Rehabilitation Outcomes Centre, University of Wollongong, Wollongong, Australia
| | | | - Claire MC O’Connor
- HammondCare, Sydney, Australia ,grid.1005.40000 0004 4902 0432School of Population Health, UNSW, Sydney, Australia
| | - Christopher J Poulos
- HammondCare, Sydney, Australia. .,School of Population Health, UNSW, Sydney, Australia.
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Johansson A, Torgé CJ, Fristedt S, Bravell ME. Relationships and gender differences within and between assessments used in Swedish home rehabilitation - a cross-sectional study. BMC Health Serv Res 2022; 22:807. [PMID: 35729529 PMCID: PMC9215038 DOI: 10.1186/s12913-022-08177-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2022] [Accepted: 06/06/2022] [Indexed: 11/16/2022] Open
Abstract
Background Home rehabilitation programmes are increasingly implemented in many countries to promote independent living. Home rehabilitation should include a comprehensive assessment of functioning, but the scientific knowledge about the assessment instruments used in this context is limited. The aim of this study was to explore relationships between standardised tests and a self-reported questionnaire used in a home rehabilitation programme. We specifically studied whether there were gender differences within and between assessments. Method De-identified data from 302 community-dwelling citizens that participated in a municipal home rehabilitation project in Sweden was analysed. A Mann Whitney test and an independent t-test were used to analyse differences within the following assessment instruments: the Sunnaas Activity of Daily Living Index, the General Motor Function assessment scale and the European Quality of Life Five Dimension Five Level Scale. Spearman’s bivariate correlation test was used to analyse relationships between the instruments, and a Fischer’s Z test was performed to compare the strengths of the correlation coefficients. Result Gender differences were found both within and between the assessment instruments. Women were more independent in instrumental activities of daily living than men. The ability to reach down and touch one’s toes while performing personal activities of daily living was stronger for men. There was a difference between men’s self-reported performance of usual activities that included instrumental activities of daily living and the standardised assessment in performing instrumental activities of daily living. The result also showed an overall difference between the self-reported assessment and the standardised test of motor function for the total group. Conclusion The results indicate that a comprehensive assessment with the combination of standardised tests, questionnaires and patient-specific instruments should be considered in a home rehabilitation context in order to capture different dimensions of functioning. Assessment instruments that facilitate a person-centred home rehabilitation supporting personally meaningful activities for both men and women should be applied in daily practice. Further research about gender-biased instruments is needed to facilitate agreement on which specific instruments to use at both individual and organisation levels to promote gender-neutral practice. Supplementary Information The online version contains supplementary material available at 10.1186/s12913-022-08177-x.
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Affiliation(s)
- Anette Johansson
- Health Care Administration, Jönköping Municipality, Jönköping University, School of Health and Welfare, SE 551 11, Jönköping, Sweden.
| | | | - Sofi Fristedt
- Jönköping University, School of Health and Welfare, Jönköping, Sweden
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