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Jawad AM, Kadhum M, Evans J, Cubitt JJ, Martin N. Recovery of functional independence following major burn: A systematic review. Burns 2024; 50:1406-1423. [PMID: 38492981 DOI: 10.1016/j.burns.2024.02.017] [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: 09/29/2023] [Revised: 01/07/2024] [Accepted: 02/21/2024] [Indexed: 03/18/2024]
Abstract
BACKGROUND Major burn injury, despite advancements in care and prevention, can have a profound impact on long-term morbidity, affecting quality of life and socioeconomic standing. We aim to explore factors predicting recovery of independence, the expected rate and time in majorly burned patients, and the measures of progress used. METHOD A systematic search of four databases (MEDLINE, EMBASE, COCHRANE, CINAHL) was conducted for studies reporting outcomes pertaining to physical ability indicative of independent function in adult (>15 y) cohorts who had suffered a major burn (>20% TBSA) up to 30 years after treatment in a developed specialised burn service. Data extracted included factors affecting rate of and time to achievement of function in five independence domains, as well as the outcome measures used. RESULTS 21 eligible studies were included comprising 1298 major burns survivors with a combined mean age of 39.6 y and a mean TBSA of 25.8%. The most significant recurring factors impacting recovery of independent function were older age, female gender, burn severity, prolonged ICU and hospital admission, preceding mental health conditions, and post-acute psychological issues. Exercise-based rehabilitation conferred benefits on major burn patients even over 2 years following injury. Discharge to independent living from hospital occurred in 27% to 97% of patients, while reported return to work rates varied from 52% to 80%. Burns Specific Health Scale-Brief, Functional Independence Measure, and Physical Composite Score (SF-36) were the most widely used outcome scoring systems. CONCLUSION Major burn survivors have protracted recovery with potential for persistent chronic impairments, remaining consistently below baseline levels of function. Non-modifiable factors such as age and gender, and disease characteristics such as burn size with associated physical, physiological and psychosocial sequelae are contributory. Further research is required to explore achievement of specific milestones of major burn and polytrauma critical care patients, while early targeted rehabilitation addressing physical, psychological, and vocational needs has promising potential benefit.
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Affiliation(s)
- Ali M Jawad
- Centre for Trauma Sciences, Blizard Institute, Queen Mary University of London, UK; Welsh Centre for Burns and Plastic Surgery, Swansea, Wales, UK.
| | - Murtaza Kadhum
- Welsh Centre for Burns and Plastic Surgery, Swansea, Wales, UK
| | - Janine Evans
- Welsh Centre for Burns and Plastic Surgery, Swansea, Wales, UK
| | | | - Niall Martin
- Centre for Trauma Sciences, Blizard Institute, Queen Mary University of London, UK
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Burton E, Chonody J, Teater B, Alford S. Goal setting in later life: an international comparison of older adults' defined goals. BMC Geriatr 2024; 24:443. [PMID: 38773405 PMCID: PMC11110366 DOI: 10.1186/s12877-024-05017-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2024] [Accepted: 04/26/2024] [Indexed: 05/23/2024] Open
Abstract
BACKGROUND Studies of goal setting in later life tend to focus on health-related goal setting, are pre-determined by the researcher (i.e., tick box), and/or are focused on a specific geographical area (i.e., one country). This study sought to understand broader, long-term goals from the perspective of older adults (65 + years) from Australia, New Zealand (NZ), United Kingdom (UK), Ireland, Canada, and the United States of America (USA). METHODS Through a cross-sectional, online survey (N = 1,551), this exploratory study examined the qualitative goal content of older adults. Thematic analysis was used to analyze the qualitative data, and bivariate analyses were used to compare thematic differences between regions and by participants' sex. RESULTS Over 60% of the participants reported setting goals, and participants from the Australia-NZ and Canada-USA regions were more likely to set goals than the UK-Ireland region. The following six overarching themes were identified from the 946 goals reported: health and well-being; social connections and engagement; activities and experiences; finance and employment; home and lifestyle; and attitude to life. CONCLUSIONS This study supports previous research that demonstrates that older adults can and do set personal goals that are wide ranging. These findings support the need for health professionals to consider different methods for elucidating this important information from older adults that builds rapport and focuses on aspects viewed as more important by the older adult and therefore potentially produces improved health outcomes.
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Affiliation(s)
- Elissa Burton
- enAble Institute, Faculty of Health Sciences, Curtin University, GPO Box U1987, Perth, WA, Australia.
- Curtin School of Allied Health, Faculty of Health Sciences, Curtin University, Perth, WA, Australia.
| | - Jill Chonody
- College of Health Sciences, School of Social Work, Boise State University, Boise, ID, USA
| | - Barbra Teater
- College of Staten Island, Department of Social Work, City University of New York, Staten Island, NY, USA
| | - Sabretta Alford
- The Graduate Center, PhD in Social Welfare, City University of New York, New York, NY, USA
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3
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Mouchaers I, Buma LE, Verbeek H, Zwakhalen S, van Haastregt JCM, Vlaeyen E, Goderis G, Metzelthin SF. A qualitative exploration of professionals' perspectives on the implementation of reablement intervention programs in community care. Sci Rep 2024; 14:11391. [PMID: 38762551 PMCID: PMC11102453 DOI: 10.1038/s41598-024-62047-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2023] [Accepted: 05/09/2024] [Indexed: 05/20/2024] Open
Abstract
Reablement is considered a complex intervention due to its multicomponent, person-centered, holistic approach promoting older adults' active participation in daily activities. It is important to consider the unique context in which complex interventions are implemented, as contextual factors may interact and influence implementation outcomes. As part of the European TRANS-SENIOR project, this qualitative study aimed to gain insight into professionals' experiences with reablement implementation in Dutch community care. Using the Consolidated Framework for Implementation Research, four focus groups were conducted comprising 32 professionals. Two groups were formed: one at operational level, including therapists, nursing staff, social workers, and domestic support; and one at organizational/strategic level, including project leaders, managers, directors, municipality representatives and health insurers. Participating care organizations had at least 6 months of experience with deploying and implementing reablement. Findings reflected three themes: (1) strength of interdisciplinary collaboration; highlighting significance of sharing goals and beliefs, (2) integrating the reablement philosophy into the organization; underscoring managements role in fostering support across all organizational layers, and (3) achieving a culture change in the healthcare system; emphasizing current funding models impeding value-based care tailored to the individual's goals and needs. The results offer valuable insights for implementation of complex interventions, like reablement.
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Affiliation(s)
- Ines Mouchaers
- Department of Health Services Research, Faculty of Health Medicine and Life Sciences, CAPHRI Care and Public Health Research Institute, Maastricht University, P.O. Box 616, 6200 MD, Maastricht, The Netherlands.
- Living Lab of Ageing and Long Term Care, Maastricht, The Netherlands.
- Department of Public Health and Primary Care, Academic Centre for General Practice, KU Leuven, Leuven, Belgium.
| | - Lise E Buma
- Department of Health Services Research, Faculty of Health Medicine and Life Sciences, CAPHRI Care and Public Health Research Institute, Maastricht University, P.O. Box 616, 6200 MD, Maastricht, The Netherlands.
- Living Lab of Ageing and Long Term Care, Maastricht, The Netherlands.
- Cicero Zorggroep, Brunssum, The Netherlands.
| | - Hilde Verbeek
- Department of Health Services Research, Faculty of Health Medicine and Life Sciences, CAPHRI Care and Public Health Research Institute, Maastricht University, P.O. Box 616, 6200 MD, Maastricht, The Netherlands
- Living Lab of Ageing and Long Term Care, Maastricht, The Netherlands
| | - Sandra Zwakhalen
- Department of Health Services Research, Faculty of Health Medicine and Life Sciences, CAPHRI Care and Public Health Research Institute, Maastricht University, P.O. Box 616, 6200 MD, Maastricht, The Netherlands
- Living Lab of Ageing and Long Term Care, Maastricht, The Netherlands
| | - Jolanda C M van Haastregt
- Department of Health Services Research, Faculty of Health Medicine and Life Sciences, CAPHRI Care and Public Health Research Institute, Maastricht University, P.O. Box 616, 6200 MD, Maastricht, The Netherlands
- Living Lab of Ageing and Long Term Care, Maastricht, The Netherlands
| | - Ellen Vlaeyen
- Department of Public Health and Primary Care, Academic Centre for Nursing and Midwifery, KU Leuven, Leuven, Belgium
- Faculty of Medicine and Life Sciences, Hasselt University, Hasselt, Belgium
| | - Geert Goderis
- Department of Public Health and Primary Care, Academic Centre for General Practice, KU Leuven, Leuven, Belgium
| | - Silke F Metzelthin
- Department of Health Services Research, Faculty of Health Medicine and Life Sciences, CAPHRI Care and Public Health Research Institute, Maastricht University, P.O. Box 616, 6200 MD, Maastricht, The Netherlands
- Living Lab of Ageing and Long Term Care, Maastricht, The Netherlands
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Pedersen AKB, Skinner MS, Sogstad M. Needs assessment in long-term care: expression of national principles for priority setting in service allocation. BMC Health Serv Res 2024; 24:530. [PMID: 38671489 PMCID: PMC11046954 DOI: 10.1186/s12913-024-10889-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2023] [Accepted: 03/21/2024] [Indexed: 04/28/2024] Open
Abstract
BACKGROUND Long-term care services for older adults are characterised by increasing needs and scarce resources. Political strategies have led to the reorganisation of long-term care services, with an increased focus on "ageing in place" and efficient use of resources. There is currently limited research on the processes by which resource allocation decisions are made by service allocators of long-term care services for older adults. The aim of this study is to explore how three political principles for priority setting in long-term care, resource, severity and benefit, are expressed in service allocation to older adults. METHODS This qualitative study uses data from semi-structured individual interviews, focus groups and observations of service allocators who assess needs and assign long-term care services to older adults in Norway. The data were supplemented with individual decision letters from the allocation office, granting or denying long-term care services. The data were analysed using reflexive thematic analysis. RESULTS The allocators drew on all three principles for priority setting when assessing older adults' long-term care needs and allocating services. We found that the three principles pushed in different directions in the allocation process. We identified six themes related to service allocators' expression of the principles: (1) lowest effective level of care as a criterion for service allocation (resource), (2) blanket allocation of low-cost care services (resource), (3) severity of medical and rehabilitation needs (severity), (4) severity of care needs (severity), (5) benefit of generous service allocation (benefit) and (6) benefit of avoiding services (benefit). CONCLUSIONS The expressions of the three political principles for priority setting in long-term care allocation are in accordance with broader political trends and discourses regarding "ageing in place", active ageing, an investment ideology, and prioritising those who are "worse off". Increasing attention to the rehabilitation potential of older adults and expectations that they will take care of themselves increase the risk of not meeting frail older adults' care needs. Additionally, difficulties in defining the severity of older adults' complex needs lead to debates regarding "worse off" versus potentiality in future long-term care services allocation. TRIAL REGISTRATION Not applicable.
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Affiliation(s)
- Ann Katrin Blø Pedersen
- Centre for Care Research, Department of Health Sciences in Gjøvik, Faculty of Medicine and Health Sciences, NTNU - Norwegian University of Science and Technology, Teknologivegen 22, 2815, Gjøvik, Norway.
| | - Marianne Sundlisæter Skinner
- Centre for Care Research, Department of Health Sciences in Gjøvik, Faculty of Medicine and Health Sciences, NTNU - Norwegian University of Science and Technology, Teknologivegen 22, 2815, Gjøvik, Norway.
| | - Maren Sogstad
- Centre for Care Research, Department of Health Sciences in Gjøvik, Faculty of Medicine and Health Sciences, NTNU - Norwegian University of Science and Technology, Teknologivegen 22, 2815, Gjøvik, Norway.
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Down MJA, Picknoll D, Hoyne G, Piggott B, Bulsara C. e-Delphi in the outdoors: Stakeholder contributions to the development of a wellbeing-focused outdoor adventure education intervention program. Health Promot J Austr 2024; 35:470-480. [PMID: 37434344 DOI: 10.1002/hpja.777] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2023] [Revised: 06/02/2023] [Accepted: 06/29/2023] [Indexed: 07/13/2023] Open
Abstract
ISSUE ADDRESSED Outdoor adventure education (OAE) (programs involving outdoor activities such as rock climbing or white-water canoeing) that participants perceive as risky, conducted in a social support setting, can be utilised by practitioners to elicit changes in educational and psychosocial outcomes to support participant adolescent wellbeing. METHODS This study garnered the opinions of an expert OAE panel on the content of future programs aiming to impact adolescent wellbeing. The panel consisted of local (Western Australia, n = 7), national (Australia, n = 4), and international (Canada, Germany, New Zealand, United Kingdom, United States, n = 7) experts. A two-round, mixed-methods Delphi approach was employed. Extensive formative work led to the development of a series of open-ended questions requiring qualitative responses for round one. Panellists were also asked to respond to 17 statements using Likert scales in the second round. RESULTS After analysis, a consensus was reached for all statements, with five statements having high consensus and being considered important by panellists. CONCLUSIONS The statement 'Equity for all participants requires flexible delivery and facilitation' had the highest level of agreement amongst panellists. Connections, authentic experiences, and equitable experiences developed as key themes. SO WHAT?: Future OAE interventions focused on wellbeing impact could use the findings of this research as a basis for program design.
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Affiliation(s)
- Michael J A Down
- School of Health Sciences and Physiotherapy, The University of Notre Dame Australia, Fremantle, Australia
| | - Duncan Picknoll
- School of Health Sciences and Physiotherapy, The University of Notre Dame Australia, Fremantle, Australia
| | - Gerard Hoyne
- School of Health Sciences and Physiotherapy, The University of Notre Dame Australia, Fremantle, Australia
| | - Ben Piggott
- School of Health Sciences and Physiotherapy, The University of Notre Dame Australia, Fremantle, Australia
| | - Caroline Bulsara
- School of Nursing and Midwifery, The University of Notre Dame Australia, Fremantle, Australia
- Institute for Health Research, The University of Notre Dame Australia, Fremantle, Australia
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Kumar P, Umakanth S, Marzetti E, Kalra S, N G. Four-Step Co-Designing of the Reablement Strategies Targeting Sarcopenia (ReStart-S): An Exercise-Based Multicomponent Program for Older Adults Residing in Long-Term Care Settings. J Multidiscip Healthc 2024; 17:1415-1433. [PMID: 38563041 PMCID: PMC10984199 DOI: 10.2147/jmdh.s452269] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2023] [Accepted: 02/22/2024] [Indexed: 04/04/2024] Open
Abstract
Background The prevalence of sarcopenia is concerningly high in long-term care settings (LTCS); yet, no exercise programs specifically targeting older adults living in residential care are available. Objective The goal of the present study was to co-design and validate a program named Reablement Strategies targeting Sarcopenia (ReStart-S) for older long-term care residents. Design Cross-sectional study with an exploratory phase. Settings LTCS in Udupi, Karnataka, India. Participants Sarcopenic older adults diagnosed using Asian Working Group for Sarcopenia 2019 criteria. Material and Methods The program was designed using a four-step intervention mapping technique involving systematic progression after completing each step. The steps included 1) identifying the appropriate exercise-based intervention for sarcopenia, 2) determining objectives and expected outcomes, 3) seeking expert views through a Delphi consensus approach, and 4) assessing the feasibility of ReStart-S program among older adults living in LTCS. Results A comprehensive literature review appraised existing exercise programs for managing sarcopenia. A workshop held with six older adults and one caretaker, decided on morning exercise sessions, recommended 2-7 days/week. The results of the review and workshop were compiled for the Delphi process that had seven experts from 5 countries, achieving a 71% response rate after four rounds. In the last step, a pilot study on eight LTCS residents, two males and six females with a mean age of 78.3 ± 8.3 years, was conducted and the program was found to be feasible. Conclusion The ReStart-S program for managing sarcopenia among older adults residing in LTCS incorporates evidence from the literature and the engagement of older adults, caregivers, and experts, making it a contextually appropriate intervention. Our study also provides researchers and healthcare professionals insight into co-designing an intervention program for vulnerable older adults. Finally, the program evaluation indicates that a full-scale trial testing the efficacy of the ReStart-S program is feasible.
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Affiliation(s)
- Prabal Kumar
- Department of Physiotherapy, Manipal College of Health Professions, Manipal Academy of Higher Education, Manipal, Karnataka, India
| | - Shashikiran Umakanth
- Department of Medicine, Dr. TMA Pai Hospital, Manipal Academy of Higher Education, Manipal, Karnataka, India
| | - Emanuele Marzetti
- Fondazione Policlinico Universitario “Agostino Gemelli” IRCCS, Rome, Italy
- Department of Geriatrics, Orthopedics and Rheumatology, Università Cattolica Del Sacro Cuore, Rome, Italy
| | - Sanjay Kalra
- Department of Endocrinology, Bharti Hospital, Karnal, India
- University Center for Research & Development, Chandigarh University, Mohali, India
| | - Girish N
- Department of Physiotherapy, Manipal College of Health Professions, Manipal Academy of Higher Education, Manipal, Karnataka, India
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Buma LE, Tuntland H, Parsons M, Zwakhalen S, Metzelthin SF. Exploring Goal-Setting and Achievement Within Reablement: A Comparative Case Study of Three Countries. J Multidiscip Healthc 2024; 17:1203-1218. [PMID: 38524861 PMCID: PMC10960507 DOI: 10.2147/jmdh.s447606] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2023] [Accepted: 03/07/2024] [Indexed: 03/26/2024] Open
Abstract
Purpose Over the last two decades, reablement programs have been studied and implemented internationally. Goal-setting and multidisciplinary collaboration are central elements of reablement. Unfortunately, limited intervention descriptions leave questions on how they are applied in practice and how goals set by the user are achieved. As a consequence, healthcare providers and organizations often lack knowledge to implement and align reablement to their national and local context. This study aimed to collect data on goal-setting and achievement, and multidisciplinary collaboration within reablement services to provide insight into how these processes inform reablement practice as well as to explore the experiences of healthcare professionals in Norway, New Zealand, and the Netherlands. Material and Methods A qualitative exploratory design was used comprising three focus group interviews with 20 healthcare professionals (nursing and allied health) involved in reablement programs from the three countries. Purposive sampling was employed considering a mix of gender, age and educational level. Results Findings reflected healthcare professionals' experiences and reablement processes in three main themes: (1) Goal-setting processes; clearly demonstrating goal-setting as an essential part of reablement and contributing to better understanding of users' motives; (2) Impact of goal-setting on multidisciplinary collaboration; promoting a sense of community, learning climate, job satisfaction and task-shifting; and (3) Behavior change techniques used to reach users' goals, promoting self-reflection and changing users' perspectives. Conclusion This study offers valuable insights from three countries. Goal-setting serves a crucial role enabling effective reablement implementation across diverse contexts. More specifically, to facilitate tailoring of reablement programs to the user's needs as well as establish more effective multidisciplinary collaboration by promoting trust, shared vision, and utilizing each other's expertise. However, despite the acknowledgement of the significance of reablement, it was reported by all that a cultural shift is necessary for users, informal caregivers as well as healthcare professionals.
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Affiliation(s)
- Lise Elisabeth Buma
- Department of Health Services Research, Care and Public Health Research Institute, Maastricht University, Maastricht, the Netherlands
- Living Lab in Ageing and Long-Term Care, Maastricht, the Netherlands
- Cicero Zorggroep, Brunssum, the Netherlands
| | - Hanne Tuntland
- Faculty of Health and Social Sciences, Western Norway University of Applied Sciences, Bergen, Norway
| | - Matthew Parsons
- School of Health, University of Waikato, Hamilton, New Zealand
- Te Whatu Ora Health New Zealand Waikato District, Hamilton, New Zealand
| | - Sandra Zwakhalen
- Department of Health Services Research, Care and Public Health Research Institute, Maastricht University, Maastricht, the Netherlands
- Living Lab in Ageing and Long-Term Care, Maastricht, the Netherlands
| | - Silke F Metzelthin
- Department of Health Services Research, Care and Public Health Research Institute, Maastricht University, Maastricht, the Netherlands
- Living Lab in Ageing and Long-Term Care, Maastricht, the Netherlands
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Jensen MCF, Vabø M. Making assessment protocols workable: Navigating transparency and person-centredness in Norwegian reablement. SOCIOLOGY OF HEALTH & ILLNESS 2024; 46:333-350. [PMID: 37723881 DOI: 10.1111/1467-9566.13710] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/12/2022] [Accepted: 08/07/2023] [Indexed: 09/20/2023]
Abstract
Western welfare states are facing great challenges as they strive to optimise their health and social systems in response to the realities of an ageing population. Many countries put a stake on reablement services-short-term rehabilitative interventions aiming to help older people regain functional capacity. To ensure a person-centred approach and outcome measures, service providers are recommended to follow a protocol designed for the dual purpose. In this article, we explore how reablement staff perceive and work around these person-centred assessment protocols. Departing from the perspective that standards never operate in isolation, but in social settings already infused with values and interests, we explore the various kinds of work involved in aligning the protocol with ongoing day-to-day assessment practices. The article demonstrates that professionals continuously engage in processes of tinkering to navigate between different values and concerns: they tinker with workflows (articulation work), with clients (identity transformation work) and with protocols (editing work). Exploring the different forms and intensity of tinkering enables us to discuss the practical and moral difficulties inherent in making assessment protocols workable.
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Affiliation(s)
| | - Mia Vabø
- NOVA, Centre for Welfare and Labour Research, OsloMet - Oslo Metropolitan University, Oslo, Norway
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9
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Mouchaers I, Verbeek H, van Haaster S, van Haastregt JCM, Vlaeyen E, Goderis G, Metzelthin SF. What matters to you? A mixed-method evaluation of goal setting and attainment within reablement from a client perspective. Scand J Occup Ther 2024; 31:2356548. [PMID: 38804133 DOI: 10.1080/11038128.2024.2356548] [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: 10/23/2023] [Accepted: 05/14/2024] [Indexed: 05/29/2024]
Abstract
BACKGROUND Goal setting is an essential component of reablement programmes. At the same time it is also an important aspect in the evaluation of reablement from the perspective of clients. OBJECTIVES As part of the TRANS-SENIOR project, this research aims to get an in-depth insight of goal setting and goal attainment within reablement services from the perspective of the older person. MATERIAL AND METHODS A convergent mixed methods design was used, combining data from electronic care files, and completed Canadian Occupational Performance Measure (COPM) forms with individual interviews. RESULTS In total, 17 clients participated. Participants' meaningful goals mainly focused on self-care, rather than leisure or productivity. This mattered most to them, since being independent in performing self-care tasks increased clients' confidence and perseverance. Regarding goal attainment, a statistically significant and clinically relevant increase in self-perceived performance and satisfaction scores were observed. CONCLUSION Although most goals focused on self-care, it became apparent that these tasks matter to participants, especially because these often precede fundamental life goals. SIGNIFICANCE Reablement can positively contribute to goal setting and attainment of clients and may contribute to increased independence. However, effectiveness, and subsequently long-term effects, are not yet accomplished and should be evaluated in future research.
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Affiliation(s)
- Ines Mouchaers
- Department of Health Services Research, Faculty of Health Medicine and Life Sciences, CAPHRI Care and Public Health Research Institute, Maastricht University, Maastricht, the Netherlands
- Living Lab in Ageing and Long Term Care, Maastricht, the Netherlands
- Department of Public Health and Primary Care, Academic Centre for General Practice, KU Leuven, Leuven, Belgium
| | - Hilde Verbeek
- Department of Health Services Research, Faculty of Health Medicine and Life Sciences, CAPHRI Care and Public Health Research Institute, Maastricht University, Maastricht, the Netherlands
- Living Lab in Ageing and Long Term Care, Maastricht, the Netherlands
| | | | - Jolanda C M van Haastregt
- Department of Health Services Research, Faculty of Health Medicine and Life Sciences, CAPHRI Care and Public Health Research Institute, Maastricht University, Maastricht, the Netherlands
- Living Lab in Ageing and Long Term Care, Maastricht, the Netherlands
| | - Ellen Vlaeyen
- Department of Public Health and Primary Care, Academic Centre for Nursing and Midwifery, KU Leuven, Leuven, Belgium
- Faculty of Medicine and Life Sciences, Hasselt University, Hasselt, Belgium
| | - Geert Goderis
- Department of Public Health and Primary Care, Academic Centre for General Practice, KU Leuven, Leuven, Belgium
| | - Silke F Metzelthin
- Department of Health Services Research, Faculty of Health Medicine and Life Sciences, CAPHRI Care and Public Health Research Institute, Maastricht University, Maastricht, the Netherlands
- Living Lab in Ageing and Long Term Care, Maastricht, the Netherlands
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10
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Eliassen M, Sørensen BA, Hartviksen TA, Holm S, Zingmark M. Emplacing reablement co-creating an outdoor recreation model in the rural Arctic. Int J Circumpolar Health 2023; 82:2273013. [PMID: 37883476 PMCID: PMC10997308 DOI: 10.1080/22423982.2023.2273013] [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: 07/24/2023] [Accepted: 10/16/2023] [Indexed: 10/28/2023] Open
Abstract
Reablement aims to enable older persons with functional decline to re-engage in meaningful activities. The benefits of engagement in outdoor activities are significant; however, reablement services primarily target function in indoor environments whereas descriptions of outdoor activities are sparse. The aim of this study was to create a model that integrates outdoor recreation into reablement. We therefore elaborated on an experienced based co-design methodology to create a model that integrates outdoor recreation for older persons in reablement in an Arctic, rural context in northern Norway. Stakeholders (N = 35), including reablement participants, participated in workshops, focus groups, and individual interviews. Based on the results, we co-created a person-centred model for outdoor recreation in reablement, including an assessment tool that can guide reablement staff in goal-setting practices. Accordingly, we argue that cherished locations holds significant meaning in the lives of older people and warrant recognition in reablement programmes. There is a need to evaluate the effects and feasibility of the model and the possibility for its implementation in other health care settings.
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Affiliation(s)
- Marianne Eliassen
- Department of Health and Care Sciences, UiT, The Arctic University of Norway, Tromsø, Norway
| | - Bodil A. Sørensen
- Department of Research, Development and Innovation, Municipality of Vestvågøy. Postboks 203, Leknes, Norway
| | - Trude A. Hartviksen
- Department of Health and Care Sciences, UiT, The Arctic University of Norway, Municipality of Vestvågøy. Postboks 203, Leknes, Norway
| | - Solrun Holm
- Department of Research, Development and Innovation, Municipality of Vestvågøy. Postboks 203, Leknes, Norway
| | - Magnus Zingmark
- Department of Epidemiology and Global Health, Faculty of medicine, Umeå University, Umeå, Sweden
- Health and Social Care administration, Municipality of Östersund, Health and Social Care Administration, Östersund, Sweden
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11
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Olsson Möller U, Zingmark M, Ekstrand J, Haak M. The Content of Physiotherapy and Factors Impacting on Reablement - A National Study. J Multidiscip Healthc 2023; 16:3075-3088. [PMID: 37881528 PMCID: PMC10596052 DOI: 10.2147/jmdh.s415112] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2023] [Accepted: 09/14/2023] [Indexed: 10/27/2023] Open
Abstract
Purpose Reablement is a multidisciplinary intervention aimed at promoting function and independence for people with functional decline. Detailed descriptions of various professions' actions are needed for organization and evaluation of reablement services. This study describes physiotherapy practice in a reablement context in Swedish municipalities, focusing on the content and magnitude of interventions. Methods Physiotherapists (n=108) from 34 municipalities answered a web-based survey covering the target group, content and duration of their actions, and number of contacts initiated over a 3-week period. Data were analyzed with descriptive statistics and multiple logistic regression. Results Overall, 1005 cases were reported, with a mean age of 78.9 years (SD: 11.7); about 91% (n=912) were aged ≥65 and 61% (n=612) were women. About 70% were allocated to home care; 16% (n=160) of these had minor functional limitations (eg, needing safety alarms/help with domestic tasks), and 55% (n=550) had major functional limitations (eg, needing help with personal activities of daily living). The most reported actions were providing technical aids (60.8%, n=576), instructions/counseling (41.5%, n=393), walking/climbing stairs (27.6%, n=262), strength training (27.2%, n=258), and fall prevention (25.5%, n=242). Almost half of the cases included one action (n=494) and about 89% (n=890) targeted primary needs (body functions, walking indoors, self-care, or domestic life), mainly in clients with major functional limitations (odds ratio=2.96; 95% confidence interval: 1.95-4.49). About 50% (n=517) of the cases involved 1-2 contacts; about 55% (n=549) were completed within 3 weeks. Exercise was associated with ≥6 visits over ≥7 weeks. Supervision of home care staff was performed in 19.1% (n=181) of cases. Conclusion Reablement physiotherapy mostly comprises a few actions over a relatively short period. Whether this is a conscious strategy based on the purpose of home-based physiotherapy or clients' needs and wishes, or conversely an expression of limited resources, remains to be investigated.
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Affiliation(s)
- Ulrika Olsson Möller
- Department of Nursing and Health Sciences, Faculty of Health Science, Kristianstad University, Kristianstad, Sweden
- Department of Health Sciences, Faculty of Medicine, Lund University, Lund, Sweden
| | - Magnus Zingmark
- Department of Health Sciences, Faculty of Medicine, Lund University, Lund, Sweden
- Department of Epidemiology and Global Health, Faculty of Medicine, Umeå University, Umeå, Sweden
- Health and Social Care Administration, Municipality of Östersund, Östersund, Sweden
- Department of Community Medicine and Rehabilitation, Faculty of Medicine, Umeå University, Umeå, Sweden
| | - Joakim Ekstrand
- Department of Nursing and Health Sciences, Faculty of Health Science, Kristianstad University, Kristianstad, Sweden
| | - Maria Haak
- Department of Nursing and Health Sciences, Faculty of Health Science, Kristianstad University, Kristianstad, Sweden
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Mouchaers I, Metzelthin S, van Haastregt J, Vlaeyen E, Goderis G, Verbeek H. Exploring the Support and Involvement of Family Caregivers for Reablement Programs: A Qualitative Study. J Multidiscip Healthc 2023; 16:2993-3005. [PMID: 37849961 PMCID: PMC10577240 DOI: 10.2147/jmdh.s424147] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2023] [Accepted: 09/15/2023] [Indexed: 10/19/2023] Open
Abstract
Background Reablement is a person-centered, holistic approach promoting older adults' participation through social, leisure, and physical activities. Family caregivers are seldom involved in reablement services despite their wish to be an active member of the care team and expressing a need for more support and recognition. The voice of family caregivers is often forgotten when evaluating services such as reablement. Little is known how family caregivers can be involved and supported more effectively in reablement services, therefore the aim of our research is to investigate the perceived support and involvement of family caregivers. Methods As part of the TRANS-SENIOR project, we studied perceived support and involvement of family caregivers during and after geriatric rehabilitation, a setting in which principles of reablement, like goal setting and training of daily activities, are applied. In total, fourteen semi-structured interviews were conducted with family caregivers of people admitted to a geriatric rehabilitation facility. Thematic analysis was used. Results Results reflected four themes: (1) support for family caregivers, (2) involvement in care, (3) trusting care professionals, and (4) asking for and accepting support. Family caregivers' experiences with support from care professionals were mainly ambivalent. While caregivers expressing a lack of support and information whilst also indicating that they do not expect to be supported by care professionals. Regarding involvement, caregivers wanted to be involved; ie express their opinion and be involved in decision-making. However, more involvement could also lead to a higher burden. Conclusion There is a discrepancy between the perceived support and involvement of family caregivers, their expressed needs, and their expectations of care professionals. A personalized approach is needed to create room for the family caregiver to be an active participant in the care process while also providing the right amount of support, when preferred by the caregiver.
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Affiliation(s)
- Ines Mouchaers
- Department of Health Services Research, Faculty of Health Medicine and Life Sciences, CAPHRI Care and Public Health Research Institute, Maastricht University, Maastricht, the Netherlands
- Living Lab in Ageing and Long Term Care, Maastricht, the Netherlands
- Department of Public Health and Primary Care, Academic Centre for General Practice, KU Leuven, Leuven, Belgium
| | - Silke Metzelthin
- Department of Health Services Research, Faculty of Health Medicine and Life Sciences, CAPHRI Care and Public Health Research Institute, Maastricht University, Maastricht, the Netherlands
- Living Lab in Ageing and Long Term Care, Maastricht, the Netherlands
| | - Jolanda van Haastregt
- Department of Health Services Research, Faculty of Health Medicine and Life Sciences, CAPHRI Care and Public Health Research Institute, Maastricht University, Maastricht, the Netherlands
- Living Lab in Ageing and Long Term Care, Maastricht, the Netherlands
| | - Ellen Vlaeyen
- Department of Public Health and Primary Care, Academic Centre for Nursing and Midwifery, KU Leuven, Leuven, Belgium
- Faculty of Medicine and Life Sciences, Hasselt University, Hasselt, Belgium
| | - Geert Goderis
- Department of Public Health and Primary Care, Academic Centre for General Practice, KU Leuven, Leuven, Belgium
| | - Hilde Verbeek
- Department of Health Services Research, Faculty of Health Medicine and Life Sciences, CAPHRI Care and Public Health Research Institute, Maastricht University, Maastricht, the Netherlands
- Living Lab in Ageing and Long Term Care, Maastricht, the Netherlands
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13
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Mouchaers I, Verbeek H, Kempen GIJM, van Haastregt JCM, Vlaeyen E, Goderis G, Metzelthin SF. Development and content of a community-based reablement programme (I-MANAGE): a co-creation study. BMJ Open 2023; 13:e070890. [PMID: 37648386 PMCID: PMC10471872 DOI: 10.1136/bmjopen-2022-070890] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/07/2022] [Accepted: 07/19/2023] [Indexed: 09/01/2023] Open
Abstract
OBJECTIVES As age increases, people generally start experiencing problems related to independent living, resulting in an increased need for long-term care services. Investing in sustainable solutions to promote independent living is therefore essential. Subsequently, reablement is a concept attracting growing interest. Reablement is a person-centred, holistic approach promoting older adults' active participation through daily, social, leisure and physical activities. The aim of this paper is to describe the development and content of I-MANAGE, a model for a reablement programme for community-dwelling older adults. DESIGN The development of the programme was performed according to the Medical Research Council framework as part of the TRANS-SENIOR international training and research network. A co-creation design was used, including literature research, observations, interviews, and working group sessions with stakeholders. SETTING AND PARTICIPANTS The interviews and working group sessions took place in the Dutch long-term home care context. Stakeholders invited to the individual interviews and working group sessions included care professionals, policymakers, client representatives, informal caregiver representatives, informal caregivers, and scientific experts. RESULTS The co-creation process resulted in a 5-phase interdisciplinary primary care programme, called I-MANAGE. The programme focuses on improving the self-management and well-being of older adults by working towards their meaningful goals. During the programme, the person's physical and social environment will be put to optimal use, and sufficient support will be provided to informal caregivers to reduce their burden. Lastly, the programme aims for continuity of care and better communication and coordination. CONCLUSION The I-MANAGE programme can be tailored to the local practices and resources and is therefore suitable for the use in different settings, nationally and internationally. If the programme is implemented as described, it is important to closely monitor the process and results.
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Affiliation(s)
- Ines Mouchaers
- Department of Health Services Research, Faculty of Health Medicine and Life Sciences, CAPHRI Care and Public Health Research Institute, Maastricht University, Maastricht, The Netherlands
- Living Lab in Ageing and Long-Term Care, Maastricht, The Netherlands
- Department of Public Health and Primary Care, Academic Centre for General Practice, KU Leuven, Leuven, Belgium
| | - Hilde Verbeek
- Department of Health Services Research, Faculty of Health Medicine and Life Sciences, CAPHRI Care and Public Health Research Institute, Maastricht University, Maastricht, The Netherlands
- Living Lab in Ageing and Long-Term Care, Maastricht, The Netherlands
| | - Gertrudis I J M Kempen
- Department of Health Services Research, Faculty of Health Medicine and Life Sciences, CAPHRI Care and Public Health Research Institute, Maastricht University, Maastricht, The Netherlands
- Living Lab in Ageing and Long-Term Care, Maastricht, The Netherlands
| | - Jolanda C M van Haastregt
- Department of Health Services Research, Faculty of Health Medicine and Life Sciences, CAPHRI Care and Public Health Research Institute, Maastricht University, Maastricht, The Netherlands
- Living Lab in Ageing and Long-Term Care, Maastricht, The Netherlands
| | - Ellen Vlaeyen
- Department of Public Health and Primary Care, Academic Centre for Nursing and Midwifery, KU Leuven, Leuven, Belgium
- Faculty of Medicine and Life Sciences, UHasselt, Hasselt, Belgium
| | - Geert Goderis
- Department of Public Health and Primary Care, Academic Centre for General Practice, KU Leuven, Leuven, Belgium
| | - Silke F Metzelthin
- Department of Health Services Research, Faculty of Health Medicine and Life Sciences, CAPHRI Care and Public Health Research Institute, Maastricht University, Maastricht, The Netherlands
- Living Lab in Ageing and Long-Term Care, Maastricht, The Netherlands
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Licina S, Kjeken I, Førland O, Langeland E, Tuntland H. Exploring Goals and Functional Changes in Reablement for People with Fractures and People with Dizziness and Balance Problems. J Multidiscip Healthc 2023; 16:2323-2337. [PMID: 37601327 PMCID: PMC10439777 DOI: 10.2147/jmdh.s417883] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2023] [Accepted: 06/28/2023] [Indexed: 08/22/2023] Open
Abstract
Background Although older people often have challenges with fractures and dizziness/balance problems, knowledge concerning the impact of reablement of people with these conditions is limited. Aim To explore functional changes in reablement for older home-dwelling people with fractures and dizziness/balance problems regarding 1) occupational performance and satisfaction with performance, 2) physical function and 3) health-related quality of life, and 4) which occupations they prioritize as rehabilitation goals. Material and Methods The sample is derived from a nationwide clinically controlled trial in Norway consisting of 149 participants with fractures and 113 with dizziness/balance problems who participated in a four to 10-week reablement program. Data were collected at baseline and at 10-week, 6-month, and 12-month follow-up and were analyzed with paired t-tests and analysis of covariance. Occupational priorities were categorized into sub-areas of occupation. Results Both groups had significant short-, mid-, and long-term improvements in occupational performance and satisfaction with performance. Except for balance from baseline to 12-month follow-up, the fracture group showed significant improvements in physical function and health-related quality of life at all follow-ups. The results varied more in the group with dizziness/balance problems in physical function and health-related quality of life. Functional mobility was the highest prioritized occupational sub-area in both groups. Conclusion The findings of this study provide extended knowledge about goals and functional changes in people with fractures and dizziness/balance problems following a reablement program. Significance Tailoring and individual adjustments according to diagnosis may be important in person-centered care in reablement.
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Affiliation(s)
- Selma Licina
- Department of Occupational Therapy, Prosthetics and Orthotics, OsloMet - Oslo Metropolitan University, Oslo, Norway
| | - Ingvild Kjeken
- Department of Occupational Therapy, Prosthetics and Orthotics, OsloMet - Oslo Metropolitan University, Oslo, Norway
| | - Oddvar Førland
- Centre for Care Research Western Norway, Western Norway University of Applied Sciences, Bergen, Norway
| | - Eva Langeland
- Department of Health and Caring Sciences, Western Norway University of Applied Sciences, Bergen, Norway
| | - Hanne Tuntland
- Department of Occupational Therapy, Prosthetics and Orthotics, OsloMet - Oslo Metropolitan University, Oslo, Norway
- Department of Health and Functioning, Western Norway University of Applied Sciences, Bergen, Norway
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Muhl C, Mulligan K, Bayoumi I, Ashcroft R, Godfrey C. Establishing internationally accepted conceptual and operational definitions of social prescribing through expert consensus: a Delphi study. BMJ Open 2023; 13:e070184. [PMID: 37451718 PMCID: PMC10351285 DOI: 10.1136/bmjopen-2022-070184] [Citation(s) in RCA: 15] [Impact Index Per Article: 15.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/15/2022] [Accepted: 06/08/2023] [Indexed: 07/18/2023] Open
Abstract
OBJECTIVE The aim of this study was to establish internationally accepted conceptual and operational definitions of social prescribing. DESIGN A three-round Delphi study was conducted. SETTING This study was conducted virtually using an online survey platform. PARTICIPANTS This study involved an international, multidisciplinary panel of experts. The expert panel (n=48) represented 26 countries across five continents, numerous expert groups and a variety of years of experience with social prescribing, with the average being 5 years (range=1-20 years). RESULTS After three rounds, internationally accepted conceptual and operational definitions of social prescribing were established. The definitions were transformed into the Common Understanding of Social Prescribing (CUSP) conceptual framework. CONCLUSION This foundational work offers a common thread-a shared sense of what social prescribing is, which may be woven into social prescribing research, policy and practice to foster common understanding of this concept.
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Affiliation(s)
- Caitlin Muhl
- School of Nursing, Faculty of Health Sciences, Queen's University, Kingston, Ontario, Canada
| | - Kate Mulligan
- Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
| | - Imaan Bayoumi
- School of Medicine, Faculty of Health Sciences, Queen's University, Kingston, Ontario, Canada
| | - Rachelle Ashcroft
- Factor-Inwentash Faculty of Social Work, University of Toronto, Toronto, Ontario, Canada
| | - Christina Godfrey
- School of Nursing, Faculty of Health Sciences, Queen's University, Kingston, Ontario, Canada
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Darwich AS, Boström AM, Guidetti S, Raghothama J, Meijer S. Investigating the Connections Between Delivery of Care, Reablement, Workload, and Organizational Factors in Home Care Services: Mixed Methods Study. JMIR Hum Factors 2023; 10:e42283. [PMID: 37389904 PMCID: PMC10365606 DOI: 10.2196/42283] [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: 09/02/2022] [Revised: 04/27/2023] [Accepted: 04/29/2023] [Indexed: 07/01/2023] Open
Abstract
BACKGROUND Home care is facing increasing demand due to an aging population. Several challenges have been identified in the provision of home care, such as the need for support and tailoring support to individual needs. Goal-oriented interventions, such as reablement, may provide a solution to some of these challenges. The reablement approach targets adaptation to disease and relearning of everyday life skills and has been found to improve health-related quality of life while reducing service use. OBJECTIVE The objective of this study is to characterize home care system variables (elements) and their relationships (connections) relevant to home care staff workload, home care user needs and satisfaction, and the reablement approach. This is to examine the effects of improvement and interventions, such as the person-centered reablement approach, on the delivery of home care services, workload, work-related stress, home care user experience, and other organizational factors. The main focus was on Swedish home care and tax-funded universal welfare systems. METHODS The study used a mixed methods approach where a causal loop diagram was developed grounded in participatory methods with academic health care science research experts in nursing, occupational therapy, aging, and the reablement approach. The approach was supplemented with theoretical models and the scientific literature. The developed model was verified by the same group of experts and empirical evidence. Finally, the model was analyzed qualitatively and through simulation methods. RESULTS The final causal loop diagram included elements and connections across the categories: stress, home care staff, home care user, organization, social support network of the home care user, and societal level. The model was able to qualitatively describe observed intervention outcomes from the literature. The analysis suggested elements to target for improvement and the potential impact of relevant studied interventions. For example, the elements "workload" and "distress" were important determinants of home care staff health, provision, and quality of care. CONCLUSIONS The developed model may be of value for informing hypothesis formulation, study design, and discourse within the context of improvement in home care. Further work will include a broader group of stakeholders to reduce the risk of bias. Translation into a quantitative model will be explored.
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Affiliation(s)
- Adam S Darwich
- Division of Health Informatics and Logistics, Department of Biomedical Engineering and Health Systems, KTH Royal Institute of Technology, Huddinge, Stockholm, Sweden
| | - Anne-Marie Boström
- Division of Nursing, Department of Neurobiology, Care Science and Society, Karolinska Institutet, Huddinge, Sweden
- Theme Inflammation and Aging, Karolinska University Hospital, Huddinge, Sweden
- Research and Development Unit, Stockholms Sjukhem, Stockholm, Sweden
| | - Susanne Guidetti
- Division of Occupational Health, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Stockholm, Sweden
- Theme Women's Health and Allied Professionals, Medical Unit Occupational Therapy and Physiotherapy, Karolinska University Hospital, Stockholm, Sweden
| | - Jayanth Raghothama
- Division of Health Informatics and Logistics, Department of Biomedical Engineering and Health Systems, KTH Royal Institute of Technology, Huddinge, Stockholm, Sweden
| | - Sebastiaan Meijer
- Division of Health Informatics and Logistics, Department of Biomedical Engineering and Health Systems, KTH Royal Institute of Technology, Huddinge, Stockholm, Sweden
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Guadaña J, Oyeneyin B, Moe CF, Tuntland H. Publication Trends in Reablement - A Scoping Review. J Multidiscip Healthc 2023; 16:1641-1660. [PMID: 37333025 PMCID: PMC10276570 DOI: 10.2147/jmdh.s407802] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2023] [Accepted: 05/18/2023] [Indexed: 06/20/2023] Open
Abstract
Background Reablement is a holistic and multidisciplinary intervention that can facilitate achievement of service users' goals related to their independence in everyday activities. Reablement has been the subject of increasing scientific activity in recent years. Currently, no review has provided a broad overview of the extent and breadth of international publications in reablement. Objective The objectives were 1) to map the volume of reablement publications, how the publications had increased over time, and their geographical distribution, 2) to identify the publication types and designs, 3) to identify publication trends, and 4) to identify knowledge gaps in the current peer-reviewed literature. Methods The scoping review approach designed by Arksey and O'Malley was used to identify peer-reviewed articles on reablement. Information was obtained on scientific activity on reablement over a period of more than two decades from five electronic databases and without language restrictions. Data was extracted from the eligible articles and both descriptive analysis and thematic analysis of the data was performed. Results A total of 198 articles published from 1999 to August 2022 from 14 countries were identified. There is a continuous interest in the field from countries where reablement has been implemented. An international and historical overview among countries with peer-reviewed publications on reablement is presented, which also partly reflects the countries that have implemented reablement. Most of the research derives from Western countries, in particular from Norway. Varied approaches to publications in reablement were noted with the majority being empirical and quantitative in nature. Conclusion The scoping review confirms the continued expansion of the breadth of reablement-focused publications in terms of originating countries, target populations, and research designs. In addition, the scoping review contributes to the knowledge base regarding reablement's research front.
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Affiliation(s)
- Jean Guadaña
- Department for Health and Functioning, Western Norway University of Applied Sciences, Bergen, Norway
| | - Babatunde Oyeneyin
- Victoria Ward, Farnham Road Hospital, Surrey and Borders Partnership NHS Foundation Trust, Guildford, UK
| | | | - Hanne Tuntland
- Department for Health and Functioning, Western Norway University of Applied Sciences, Bergen, Norway
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Graff L, Timm H, Thuesen J. Organizational narratives in rehabilitation-focused dementia care - Negotiating identities, interventions and personhood. DEMENTIA 2023; 22:709-726. [PMID: 36919376 PMCID: PMC10088340 DOI: 10.1177/14713012231161487] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/16/2023]
Abstract
BACKGROUND Rehabilitation is increasingly being introduced in dementia care but studies highlight extensive heterogeneity in practices, conceptual confusion and divergent perceptions of its relevance across care organizations and national contexts. As this have implications for development of dementia care as well as for people with dementia's access to care it is important to study the organizational narratives and practices in rehabilitation-oriented dementia care organizations. METHODS The study build on qualitative interviews (individual and group interviews) with health professionals (N = 26) engaged with dementia care and rehabilitation in two Danish municipalities. The interviews were conducted in 2018-2019. The empirical data was analyzed using abductive analysis and theory-based narrative analysis, using Loseke's conceptualizations of and approach to analyzing formula stories. FINDINGS Four dominant organizational narratives were constructed from the data. Each narrative produced a specific organizational narrative of client identity: the active participant in individualized rehabilitation, the inactive individual benefitting from enhanced social environments, the disengaging self and the vulnerable self. CONCLUSION Introducing rehabilitation in dementia care may amplify the organizational polyphonic and provide a plurality of organizational identities each expressing different perceptions of personhood and agency for people with dementia. The organizational narratives were negotiated within a specific structural context where national regulation and dominant discourses on economic challenges and ageing gave precedence to some narratives more than others. In Danish elder care, the first narrative is the most influential but risks excluding people with dementia. Instead, rehabilitation in dementia care is positioned within a social and relational perspective, which may silence important discussion of agency and resistance.
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Affiliation(s)
- Lea Graff
- The Danish Center for Social Science Research
| | - Helle Timm
- The National Institute of Public Health, 74340University of Southern Denmark; UCSF - Center for Health Research, Rigshospitalet; University of the Faroe Islands
| | - Jette Thuesen
- University of Southern Denmark, Department of Public Health, Center for User Perspectives and Community-based Interventions; Absalon University College, Center for Nutrition and Rehabilitation; REHPA, The Danish Knowledge Centre for Rehabilitation and Palliative Care
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Huijsman R. Understanding and Balancing Generalist-Specialist Approaches in Dementia Research and Care Practice, Qualitative Research with 44 Dementia Professors in The Netherlands. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:3835. [PMID: 36900847 PMCID: PMC10000976 DOI: 10.3390/ijerph20053835] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 01/15/2023] [Revised: 02/18/2023] [Accepted: 02/20/2023] [Indexed: 06/18/2023]
Abstract
Dementia is one of the leading causes of death and disability among citizens and a societal challenge because of aging worldwide. As dementia has physical, psychological, social, material, and economic impacts, both research and care practice require many disciplines to develop and implement diagnostics, medical and psychosocial interventions, and support, crossing all domains of housing, public services, care, and cure. Notwithstanding large research efforts, much knowledge about mechanisms, interventions, and needs' based care pathways is still lacking. To cope with these challenges in research and practice, this paper is the first to question how generalist and specialist orientations can be unfolded. In the Netherlands, all dementia professors (N = 44) at eight Dutch academic centers have been interviewed. Qualitative analyses revealed three subgroups of dementia professors, one with a generalist orientation, one adhering to specialist approaches, and a third group that pleas for mixed orientations, with some differences between research and care practice. Each group has arguments for its generalist/specialist vision, but the synthesis suggests a paradigm of personalized and integrated dementia care, aimed at the individual in his own living environment. Sustainable strategies to cope with dementia require (inter)national programs and strong collaboration to build multi- and interdisciplinarity within and between research and practice.
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Affiliation(s)
- Robbert Huijsman
- Erasmus School of Health Policy & Management, Erasmus University Rotterdam, P.O. Box 1738, 3000 DR Rotterdam, The Netherlands
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Abstract
BACKGROUND While occupational therapists (OT) and physiotherapists (PT) have a central role in reablement, no structured approach for these professions has been described in Sweden. AIMS/OBJECTIVES The aim was to explore the feasibility of a reablement program developed to guide OTs and PTs in a Swedish municipality context. MATERIAL AND METHODS Eligible participants were OTs and PTs working with reablement. Feasibility was evaluated in terms of how OTs (n = 16) and PTs (n = 15) experienced the application of the program. Data were collected through web surveys during a pilot study over four months. RESULTS The program was implemented for 62 clients. Baseline assessments were conducted in 97% of all cases and follow-ups in 77%. The average duration of the program was 8 weeks and includeed 5 home visits and 3 contacts by phone. In 15 cases, a new goal was identified after follow-up. Collaboration was included with other professionals and relatives in 89% and 35% of the cases, respectively. The program was categorized as feasible to some extent in 34 cases and not feasible in 21 cases. CONCLUSIONS AND SIGNIFICANCE The program was feasible to some extent. To enhance feasibility, flexibility may be needed in order to tailor assessments according to the client's health status.
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Affiliation(s)
- Magnus Zingmark
- Health and Social Care Administration, Municipality of Östersund, Sweden.,Department of Epidemiology and Global Health, Faculty of Medicine, Umeå University, Umeå, Sweden.,Department of Health Sciences, Faculty of Medicine, Lund University, Sweden
| | - Maya Kylén
- Department of Health Sciences, Faculty of Medicine, Lund University, Sweden.,School of Education, Health and Social Studies, Dalarna University, Falun, Sweden
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Andersen P, Broman P, Tokolahi E, Yap JR, Brownie S. Determining a common understanding of interprofessional competencies for pre-registration health professionals in Aotearoa New Zealand: A Delphi study. Front Med (Lausanne) 2023; 10:1119556. [PMID: 37035298 PMCID: PMC10079912 DOI: 10.3389/fmed.2023.1119556] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2023] [Accepted: 03/13/2023] [Indexed: 04/11/2023] Open
Abstract
There is growing awareness that factors such as the growing incidence of co-morbidity and increasing complexity of patient health needs cannot be addressed by health professionals practicing in isolation. Given this, there is an increasing emphasis on preparing students in health-related programs for effective interprofessional practice. Less clear, however, are the specific skills and clinical or learning opportunities necessary for students to develop effectiveness in interprofessional practice. These factors drove a team associated with a tertiary health education provider in Hamilton, New Zealand to transform traditional clinical student experiences in the form of an interprofessional student-assisted clinic. The clinic was intended, in part, to provide students with opportunities to learn and experience interprofessionalism in practice but was hampered by limited information available regarding the specific skill requirements necessary for students in New Zealand to learn in this context. In this Delphi study, we synthesize national expert opinion on student competency indicators necessary for effective interprofessional practice. The resultant set of indicators is presented and opportunities for application and further research discussed. The paper offers guidance to others seeking to innovate health curricula, develop novel service-oriented learning experiences for students, and foster interprofessional practice competence in the future health workforce.
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Affiliation(s)
- Patrea Andersen
- Centre for Health and Social Practice, Waikato Institute of Technology–Te Pūkenga, Hamilton, New Zealand
- School of Nursing, Midwifery and Paramedicine, University of the Sunshine Coast, Sippy Downs, QLD, Australia
- School of Nursing, Midwifery and Social Science, Central Queensland University, Norman Gardens, QLD, Australia
| | - Patrick Broman
- Centre for Health and Social Practice, Waikato Institute of Technology–Te Pūkenga, Hamilton, New Zealand
- *Correspondence: Patrick Broman,
| | - Ema Tokolahi
- Otago Polytechnic–Te Pūkenga, Dunedin, New Zealand
| | - Jia Rong Yap
- Centre for Health and Social Practice, Waikato Institute of Technology–Te Pūkenga, Hamilton, New Zealand
| | - Sharon Brownie
- Centre for Health and Social Practice, Waikato Institute of Technology–Te Pūkenga, Hamilton, New Zealand
- School of Health Science, Swinburne University of Technology, Melbourne, VIC, Australia
- School of Medicine and Dentistry, Griffith University, Brisbane, QLD, Australia
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22
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Hartley P, Warmoth K, Gordon AL, Goodwin VA. Reablement interventions in care homes: the need for theory and process evaluation. Age Ageing 2022; 51:6834149. [PMID: 36413593 DOI: 10.1093/ageing/afac261] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Affiliation(s)
- Peter Hartley
- Department of Physiotherapy, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK.,Department of Public Health and Primary Care, University of Cambridge, Cambridge, UK
| | - Krystal Warmoth
- Centre for Research in Public Health and Community Care (CRIPACC), University of Hertfordshire, Hatfield, UK.,NIHR Applied Research Collaboration East of England, Cambridge, UK
| | - Adam L Gordon
- Academic Unit of Injury, Inflammation and Recovery Sciences, School of Medicine, University of Nottingham, Nottingham, UK.,NIHR Applied Research Collaboration-East Midlands (ARC-EM), Nottingham, UK
| | - Victoria A Goodwin
- Faculty of Health and Life Sciences, University of Exeter, Exeter, UK.,NIHR Applied Research Collaboration South West Peninsula, Exeter, UK
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Yu HW, Wu SC, Chen HH, Yeh YP, Chen YM. Relationships between reablement-embedded home- and community-based service use patterns and functional improvement among older adults in Taiwan. HEALTH & SOCIAL CARE IN THE COMMUNITY 2022; 30:e4321-e4331. [PMID: 35560740 DOI: 10.1111/hsc.13825] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/29/2021] [Revised: 03/29/2022] [Accepted: 04/22/2022] [Indexed: 06/15/2023]
Abstract
For its second decade, Taiwan's National 10-Year Long-Term Care Plan launched a policy of reinforcing home- and community-based services (HCBSs) with a focus on reablement. This study aimed to (1) identify the distinct service use patterns of reablement-embedded HCBS and (2) examine the effects of these service patterns on functional improvements among older care recipients, including among groups with different levels of care needs. We collected 2018 data from the Long-Term Care Service Management System for care recipients in one county located in central Taiwan (N = 4735). Three recipient groups were assigned based on level of care needs. We included data on use of the following services: reablement, home care, respite care, applications for assistive devices and home environmental modifications, transportation to medical appointments and community-based services. Outcome variables were measured by change scores between successive assessments of activities of daily living (ADL) and instrumental activities of daily living (IADL). Latent class analysis and multivariate linear regression analyses were used to analyse relationships between use patterns, participant subgroups and outcomes. Four subgroups of HCBS use patterns were found. Care recipients with low care needs had greater potential to improve their physical function in ADL through reablement-embedded HCBS. Care recipients in the groups with low and high care needs showed overall benefits in functional improvements in ADL and IADL from personal care-based HCBS. Care recipients in the community-based and multiple services-based use pattern subgroups showed the least improvement in physical function. Our study indicates that the effects of reablement-embedded HCBS use strategies may vary among older adults with different levels of care needs. We recommend further research to examine how to design HCBS with a reablement focus to better fit the needs of those with moderate and high levels of care needs.
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Affiliation(s)
- Hsiao-Wei Yu
- Department of Gerontological Care and Management, College of Nursing, Chang Gung University of Science and Technology, Taoyuan, Taiwan
- Geriatric and Long-term Care Research Center, Chang Gung University of Science and Technology, Taoyuan, Taiwan
- Department of Family Medicine, Keelung Chang Gung Memorial Hospital, Keelung City, Taiwan
| | - Shih-Cyuan Wu
- Institute of Health Policy and Management, College of Public Health, National Taiwan University, Taipei, Taiwan
| | - Hsiu-Hsi Chen
- Institute of Epidemiology and Preventive Medicine, College of Public Health, National Taiwan University, Taipei, Taiwan
| | - Yen-Po Yeh
- Changhua County Public Health Bureau, Changhua City, Taiwan
| | - Ya-Mei Chen
- Institute of Health Policy and Management, College of Public Health, National Taiwan University, Taipei, Taiwan
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24
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Bennett C, Allen F, Hodge S, Logan P. An investigation of Reablement or restorative homecare interventions and outcome effects: A systematic review of randomised control trials. HEALTH & SOCIAL CARE IN THE COMMUNITY 2022; 30:e6586-e6600. [PMID: 36461163 PMCID: PMC10107871 DOI: 10.1111/hsc.14108] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 01/14/2022] [Revised: 08/03/2022] [Accepted: 11/01/2022] [Indexed: 06/17/2023]
Abstract
The effect of Reablement, a multi-faceted intervention is unclear, specifically, which interventions improve outcomes. This Systematic Review evaluates randomised controlled trials (RCTs) describing Reablement investigating the population, interventions, who delivered them, the effect and sustainability of outcomes. Database search from inception to August 2021 included AMED, ASSIA, BNI, CINHALL, EMBASE, HMIC, MEDLINE, PUBMED, PsycINFO, Google Scholar, Web of Science, Clinicaltrials.gov. Two researchers undertook data collection and quality assessment, following the PRISMA (2020) statement. They measured effect by changed primary or secondary outcomes: no ongoing service, functional ability, quality of life and mobility. The reviewers reported the analysis narratively, due to heterogeneity of outcome measures, strengthened by the SWiM reporting guideline. The search criteria resulted in eight international studies, five studies had a risk of bias limitations in either design or method. Ongoing service requirement decreased in five studies, with improved effect at 3 months shown in studies with occupational therapist involvement. Functional ability increased statistically in four studies at 3 months. Increase in quality of life was statistically significant in three studies, at 6 and 7 months. None of the studies reported a statistically significant improvement in functional mobility. Reablement is effective in the context of Health and Social Care. The outcomes were sustained at 3 months, with less sustainability at 6 months. There was no statistical result for the professional role regarding assessment, delivery and evaluation of interventions, and further research is justified.
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Affiliation(s)
- Cate Bennett
- School of Medicine: Ageing and RehabilitationNottingham UniversityNottinghamUK
| | - Francis Allen
- School of Medicine: Ageing and RehabilitationNottingham UniversityNottinghamUK
| | - Sevim Hodge
- School of Medicine: Ageing and RehabilitationNottingham UniversityNottinghamUK
| | - Phillipa Logan
- School of Medicine: Ageing and RehabilitationNottingham UniversityNottinghamUK
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25
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Percival A, Newton C, Mulligan K, Petrella RJ, Ashe MC. Systematic review of social prescribing and older adults: where to from here? Fam Med Community Health 2022; 10:fmch-2022-001829. [PMID: 36207017 PMCID: PMC9557282 DOI: 10.1136/fmch-2022-001829] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
Abstract
OBJECTIVE Social prescribing is a person-centred model of care with emphases on lessening the impact of unmet social needs, supporting the delivery of personalised care, and reducing non-medical resource use in the primary care setting. The purpose of this systematic review was to synthesise the effect of social prescribing for older adults within primary care. DESIGN We followed standard systematic review guidelines, including protocol registration, screening studies (title/abstract and full text) and assessing the study quality. ELIGIBILITY AND INFORMATION SOURCES We searched multiple online databases for studies that included older adults 60+ years (group mean age), an intervention defined and called social prescribing (or social prescription) via health provider referrals to non-medical services, and quantitative physical and psychosocial outcomes and/or health resource use. We included experimental and observational studies from all years and languages and conducted a narrative synthesis. The date of the last search was 24 March 2022. RESULTS We screened 406 citations (after removing duplicates) and included seven studies. All studies except one were before-after design without a control group, and all except one study was conducted in the UK. Studies included 12-159 participants (baseline), there were more women than men, the group mean (SD) age was 76.1 (4.0) years and data collection (baseline to final) occurred on average 19.4 (14.0) weeks apart. Social prescribing referrals came from health and social providers. Studies had considerable risk of bias, programme implementation details were missing, and for studies that reported data (n=6) on average only 66% of participants completed studies (per-protocol). There were some positive effects of social prescribing on physical and psychosocial outcomes (eg, social participation, well-being). Findings varied for health resource use. These results may change with new evidence. CONCLUSIONS There were few peer-reviewed studies available for social prescribing and older adults. Next steps for social prescribing should include co-creating initiatives with providers, older people and communities to identify meaningful outcomes, and feasible and robust methods for uptake of the prescription and community programmes. This should be considered in advance or in parallel with determining its effectiveness for meaningful outcomes at multiple levels (person, provider and programme).
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Affiliation(s)
- Amanda Percival
- Department of Family Practice, The University of British Columbia, Vancouver, British Columbia, Canada
| | - Christie Newton
- Department of Family Practice, The University of British Columbia, Vancouver, British Columbia, Canada
| | - Kate Mulligan
- Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
| | - Robert J Petrella
- Department of Family Practice, The University of British Columbia, Vancouver, British Columbia, Canada,Department of Family Medicine, Western University, London, Ontario, Canada,School of Kinesiology, Western University, London, Ontario, Canada
| | - Maureen C Ashe
- Department of Family Practice, The University of British Columbia, Vancouver, British Columbia, Canada
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26
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Rahja M, Laver K, Whitehead C, Pietsch A, Oliver E, Crotty M. A systematic review and meta-analysis of reablement interventions for people in permanent residential aged care homes. Age Ageing 2022; 51:6754360. [PMID: 36215172 DOI: 10.1093/ageing/afac208] [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: 02/06/2022] [Indexed: 01/27/2023] Open
Abstract
BACKGROUND Most evidence for reablement comes from community-based interventions. OBJECTIVE To determine the effect of reablement interventions provided in permanent residential aged care (PRAC) homes on residents' level of function in activities of daily living (ADL) and quality of life (QoL). DESIGN Systematic review and meta-analysis. SETTING PRAC homes. SUBJECTS Residents in PRAC. METHODS Six databases and grey literature were searched until November 2021. Quantitative studies involving a control group or pre-post evaluation were included. Outcomes of interest were the effectiveness of the reablement intervention on overall ADL or QoL in the last available follow-up. RESULTS Twelve studies involving 2,620 residents were included. The reablement interventions varied; the primary focus areas were organisational approaches (e.g. educating staff; n = 10) and improving physical function (e.g. increasing physical activity; n = 9). Not all studies could be pooled in the meta-analysis due to reported data and heterogeneity. There was no significant effect of reablement intervention versus usual care on ADL function (five studies, standardised mean difference (SMD): 0.17, 95% confidence interval (CI): -0.25 to 0.59, very low quality evidence). Reablement appeared more beneficial than usual care in improving QoL; however, the overall effect was not statistically significant (four studies, SMD: 0.73, 95% CI: -0.07 to 1.52; very low quality evidence). CONCLUSIONS Few studies focus on reablement in PRAC homes and their clinical heterogeneity is considerable. There is insufficient evidence for reablement in terms of improving ADL or QoL for residents in PRAC. Tools that are more sensitive to change may be beneficial.
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Affiliation(s)
- Miia Rahja
- Division of Rehabilitation, Aged and Palliative Care, Flinders Health and Medical Research Institute, Flinders University, Bedford Park, 5042, South Australia, Australia
| | - Kate Laver
- Division of Rehabilitation, Aged and Palliative Care, Flinders Health and Medical Research Institute, Flinders University, Bedford Park, 5042, South Australia, Australia
| | - Craig Whitehead
- Division of Rehabilitation, Aged and Palliative Care, Southern Adelaide Local Health Network, Bedford Park, 5042, South Australia, Australia
| | | | - Eliza Oliver
- Division of Rehabilitation, Aged and Palliative Care, Flinders Health and Medical Research Institute, Flinders University, Bedford Park, 5042, South Australia, Australia
| | - Maria Crotty
- Division of Rehabilitation, Aged and Palliative Care, Flinders Health and Medical Research Institute, Flinders University, Bedford Park, 5042, South Australia, Australia
- Division of Rehabilitation, Aged and Palliative Care, Southern Adelaide Local Health Network, Bedford Park, 5042, South Australia, Australia
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27
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Mulquiny L, Oakman J. Exploring the experience of reablement: A systematic review and qualitative evidence synthesis of older people's and carers' views. HEALTH & SOCIAL CARE IN THE COMMUNITY 2022; 30:e1471-e1483. [PMID: 35581940 PMCID: PMC9540535 DOI: 10.1111/hsc.13837] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/07/2021] [Revised: 04/06/2022] [Accepted: 04/22/2022] [Indexed: 05/29/2023]
Abstract
Concerns from the worldwide ageing population and evidence of poor-quality aged care services have highlighted the need to develop innovative models of aged care which are acceptable to older people, economically sustainable and are safe. Reablement is a relatively new model for aged care that aims to support older people's desires to age independently in their usual place of residence and decrease dependency on aged care services. This qualitative evidence synthesis aimed to explore the experiences of older people and their carers (formal and informal) towards a reablement model of community aged care to ensure services are considerate of older people's needs. A systematic search was conducted across six electronic databases (Medline, Scopus, CINAHL, PsycINFO, Cochrane Library and Google Scholar) from 1990 to September 2021. Qualitative research exploring older people and their carers' experiences and perceptions of the reablement model used in community aged care services were identified. Nineteen articles were included in the synthesis following the screening of 668 abstracts and 56 full texts. Included articles were subject to quality assessment, and the data were synthesised using thematic synthesis. Three analytical themes were generated from the thematic synthesis; (i) reablement is a shift in approach to aged care, (ii) difficulties in developing tangible and meaningful reablement goals, (iii) reablement improves health and well-being. Reablement is generally well-received by older people and their informal carers. However, poor engagement from older people did occur when they had a poor understanding of their role in reablement and when they had not been fully consulted regarding their reablement goals. Current and future reablement services for older people should focus on ensuring an awareness of the processes and principles of reablement and collaboration between practitioner, the older person and their carer when developing goals to increase engagement.
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Affiliation(s)
- Lachlan Mulquiny
- Centre for Ergonomics and Human Factors, School of Psychology and Public HealthLa Trobe UniversityMelbourneVictoriaAustralia
| | - Jodi Oakman
- Centre for Ergonomics and Human Factors, School of Psychology and Public HealthLa Trobe UniversityMelbourneVictoriaAustralia
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28
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Mjøsund HL, Uhrenfeldt L, Burton E, Moe CF. Promotion of physical activity in older adults: facilitators and barriers experienced by healthcare personnel in the context of reablement. BMC Health Serv Res 2022; 22:956. [PMID: 35897061 PMCID: PMC9327260 DOI: 10.1186/s12913-022-08247-0] [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: 02/15/2022] [Accepted: 06/23/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Being physically active is important for maintaining function and independence in older age. However, there is insufficient knowledge about how to successfully promote physical activity (PA) among home-dwelling older adults with functional challenges in real-life healthcare settings. Reablement is an interdisciplinary, person-centered approach to restoring function and independence among older adults receiving home care services; it also may be an opportunity to promote PA. However, reablement occurs in many different contexts that influence how PA can be integrated within reablement. This study aimed to identify facilitators and barriers experienced by healthcare professionals (HCPs) that influence the promotion of PA within the context of reablement. METHODS This exploratory qualitative study is guided by a realist perspective and analyzed through inductive content analysis. Sixteen HCPs, including occupational therapists, physical therapists, registered nurses, and home care workers, participated in semi-structured interviews. The HCPs were recruited from four Norwegian municipalities with diverse sizes and different organizational models of reablement. RESULTS The HCPs experienced several facilitators and barriers at the participant, professional, organizational, and system levels that influenced how they promoted PA through reablement. Factors related to the individual person and their goals were considered key to how the HCPs promoted PA. However, there were substantial differences among reablement settings regarding the degree to which facilitators and barriers at other levels influenced how HCPs targeted individual factors. These facilitators and barriers influenced how the HCPs reached out to people who could benefit from being more physically active; targeted individual needs, desires and progression; and promoted continued PA habits after reablement. CONCLUSIONS These findings exemplify the complexity of facilitators and barriers that influence the promotion of PA within the reablement context. These factors are important to identify and consider to develop and organize healthcare services that facilitate older adults to be active. We recommend that future practice and research in reablement acknowledge the variations between settings and consider mechanisms on a participant and professional level and within an integrated care perspective.
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Affiliation(s)
- Hanne Leirbekk Mjøsund
- Faculty of Nursing and Health Sciences, Nord University, Universitetsallèen 11, 8026, Bodø, Norway.
| | - Lisbeth Uhrenfeldt
- Faculty of Nursing and Health Sciences, Nord University, Universitetsallèen 11, 8026, Bodø, Norway
| | - Elissa Burton
- Curtin School of Allied Health, Curtin University, Perth, Australia.,enAble Institute, Curtin University, Perth, Australia
| | - Cathrine Fredriksen Moe
- Faculty of Nursing and Health Sciences, Nord University, Universitetsallèen 11, 8026, Bodø, Norway
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29
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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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30
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Bergström A, Vik K, Haak M, Metzelthin S, Graff L, Hjelle KM. The jigsaw puzzle of activities for mastering daily life; service recipients and professionals' perceptions of gains and changes attributed to reablement-A qualitative meta-synthesis. Scand J Occup Ther 2022:1-12. [PMID: 35655362 DOI: 10.1080/11038128.2022.2081603] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
BACKGROUND Reablement services are intended to make a difference in the daily lives of older adults. Outcomes are often described in terms of independence, improving quality of life, improving ADL functioning, or reducing services. However, little is known if the older adults or next-of-kin experience these outcomes when talking about participating in reablement services. AIM This study aims to explore how older adults, next-of-kin, and professionals narrate the reablement recipients' possible outcomes as gains and changes in everyday life during and after the reablement period. MATERIALS AND METHODS This meta-synthesis included 13 studies. Data were analyzed with a meta-ethnographic approach, searching for overarching metaphors, in three stages. RESULTS The metaphor 'the jigsaw puzzle of activities for mastering daily life again' illustrates that re-assembling everyday life after reablement is not a straightforward process of gains and changes but includes several daily activities that must be organized and fit together. To obtain a deeper understanding of the participants' gains, and changes after reablement, we use the theoretical framework of 'doing, being, becoming, and belonging'. CONCLUSION The findings indicate the complexity of reablement services as well as the need for a holistic approach. SIGNIFICANCE Outcome measures should be meaningful for reablement recipients.
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Affiliation(s)
- Aileen Bergström
- Department of Neurobiology, Care Sciences and Society, Division of Occupational Therapy, Karolinska Institute, Huddinge, Sweden
| | - Kjersti Vik
- Department of Neuromedicine and Movement Science, Norwegian University of Science and Technology, Trondheim, Norway
| | - Maria Haak
- Department of Nursing and Health Science, Kristianstad University, Kristianstad, Sweden
| | - Silke Metzelthin
- Department of Medicine and Life Science, Maastricht University, Maastricht, Netherlands
| | - Lea Graff
- VIVE-The Danish Center for Social Science Research, Copenhagen, Denmark
| | - Kari Margrete Hjelle
- Department of Occupational Therapy, Western Norway University of Applied Science, Bergen, Norway
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31
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Effects on clients' daily functioning and common features of reablement interventions: a systematic literature review. Eur J Ageing 2022; 19:903-929. [PMID: 36692753 PMCID: PMC9729664 DOI: 10.1007/s10433-022-00693-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/03/2022] [Indexed: 01/26/2023] Open
Abstract
This systematic review aimed to provide an overview of reablement interventions according to the recently published ReAble definition and their effect on Activities of Daily Living (ADL). In addition, the most common and promising features of these reablement interventions were identified. Four electronic bibliographic databases were searched. Articles were included when published between 2002 and 2020, which described a Randomised or Clinical Controlled Trial of a reablement intervention matching the criteria of the ReAble definition, and had ADL functioning as an outcome. Snowball sampling and expert completion were used to detect additional publications. Two researchers screened and extracted the identified articles and assessed methodological quality; discrepancies were resolved by discussion and arbitration by a third researcher. Twenty relevant studies from eight countries were included. Ten of these studies were effective in improving ADL functioning. Identifying promising features was challenging as an equal amount of effective and non-effective interventions were included, content descriptions were often lacking, and study quality was moderate to low. However, there are indications that the use of more diverse interdisciplinary teams, a standardised assessment and goal-setting method and four or more intervention components (i.e. ADL-training, physical and/or functional exercise, education, management of functional disorders) can improve daily functioning. No conclusions could be drawn concerning the effectiveness on ADL functioning. The common elements identified can provide guidance when developing reablement programmes. Intervention protocols and process evaluations should be published more often using reporting guidelines. Collecting additional data from reablement experts could help to unpack the black box of reablement.
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Hasemann L, Lampe D, Nebling T, Thiem U, von Renteln-Kruse W, Greiner W. Effectiveness of a multi-component community-based care approach for older people at risk of care dependency - results of a prospective quasi-experimental study. BMC Geriatr 2022; 22:348. [PMID: 35448956 PMCID: PMC9022407 DOI: 10.1186/s12877-022-02923-w] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2021] [Accepted: 03/07/2022] [Indexed: 12/21/2022] Open
Abstract
Background Due to demographic changes, the elderly population in western countries is constantly growing. As the risk of functional decline and multimorbidity increases with age, health care systems need to face the challenge of high demand for health care services and related costs. Therefore, innovative health care approaches and geriatric screenings are needed to provide individualised care. This study aims to expand the state of research by investigating the effectiveness of a multi-component care approach for the elderly in a German community setting. Methods A prospective, quasi-experimental study was initiated by statutory health insurance (SHI) companies. The innovative care approach includes a geriatric assessment, a case and network management as well as digital supporting tools and was implemented at the Center for Geriatrics and Gerontology (Albertinen Haus, Hamburg-Eimsbuettel). Participants of the intervention were compared to matched controls recruited in comparable urban areas. The primary outcome measure was the progression in long-term care grade during the period of observation (21 months), which was analysed on the basis of SHI claims data. Secondary endpoints were morbidity, mortality and self-reported health-related quality of life (HRQoL) measured by SF-36. Results Overall, 2,670 patients (intervention group (IG) n=873; control group (CG) n=1,797) were analysed. Logistic regression analysis showed no statistically significant difference in progression of long-term care grade between IG and CG (Odds Ratio (OR)=1.054; 95% confidence interval (CI) 0.856-1.296; p-value=0.616). Differentiated analyses indicated an initial effect, which might be attributable to the geriatric assessment. However, an adapted regression model resulted in a reversed but even non-significant effect (OR=0.945; 95% CI 0.757-1.177; p-value=0.619). While secondary analyses of long-term care grade, mortality and HRQoL did not show intervention effects, a statistically significant relative change of 0.865 (95% CI 0.780, 0.960; p-value=0.006) in morbidity indicated a potential benefit for the IG. Conclusions The analyses did not reveal a significant effect of the community-based intervention on the primary outcome and thus we are not able to recommend a transfer into SHI standard care. Tendencies in secondary analyses need to be proved in further research. Trial registration German Clinical Trials Register, retrospective registration on February 01, 2022 (DRKS00027866). Supplementary Information The online version contains supplementary material available at 10.1186/s12877-022-02923-w.
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Affiliation(s)
- Lena Hasemann
- AG 5 - Department of Health Economics and Health Care Management, Bielefeld University, School of Public Health, Universitaetsstrasse 25, 33615, Bielefeld, Germany.
| | - David Lampe
- AG 5 - Department of Health Economics and Health Care Management, Bielefeld University, School of Public Health, Universitaetsstrasse 25, 33615, Bielefeld, Germany
| | - Thomas Nebling
- Department Care Management, Techniker Krankenkasse, Bramfelder Strasse 140, 22305, Hamburg, Germany
| | - Ulrich Thiem
- Center for Geriatrics and Gerontology, Albertinen-Haus, Sellhopsweg 18-22, 22459, Hamburg, Germany.,University Medical Center Hamburg, Martinistrasse 52, 20251, Hamburg, Germany
| | | | - Wolfgang Greiner
- AG 5 - Department of Health Economics and Health Care Management, Bielefeld University, School of Public Health, Universitaetsstrasse 25, 33615, Bielefeld, Germany
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van den Bulck AOE, Elissen AMJ, Metzelthin SF, de Korte MH, Verhoeven GS, de Witte-Breure TAT, van der Weij LC, Mikkers MC, Ruwaard D. Identifying client characteristics to predict homecare use more accurately: a Delphi-study involving nurses and homecare purchasing specialists. BMC Health Serv Res 2022; 22:394. [PMID: 35337315 PMCID: PMC8957197 DOI: 10.1186/s12913-022-07733-9] [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: 11/22/2021] [Accepted: 03/07/2022] [Indexed: 11/25/2022] Open
Abstract
Background Case-mix based prospective payment of homecare is being implemented in several countries to work towards more efficient and client-centred homecare. However, existing models can only explain a limited part of variance in homecare use, due to their reliance on health- and function-related client data. It is unclear which predictors could improve predictive power of existing case-mix models. The aim of this study was therefore to identify relevant predictors of homecare use by utilizing the expertise of district nurses and health insurers. Methods We conducted a two-round Delphi-study according to the RAND/UCLA Appropriateness Method. In the first round, participants assessed the relevance of eleven client characteristics that are commonly included in existing case-mix models for predicting homecare use, using a 9-Point Likert scale. Furthermore, participants were also allowed to suggest missing characteristics that they considered relevant. These items were grouped and a selection of the most relevant items was made. In the second round, after an expert panel meeting, participants re-assessed relevance of pre-existing characteristics that were assessed uncertain and of eleven suggested client characteristics. In both rounds, median and inter-quartile ranges were calculated to determine relevance. Results Twenty-two participants (16 district nurses and 6 insurers) suggested 53 unique client characteristics (grouped from 142 characteristics initially). In the second round, relevance of the client characteristics was assessed by 12 nurses and 5 health insurers. Of a total of 22 characteristics, 10 client characteristics were assessed as being relevant and 12 as uncertain. None was found irrelevant for predicting homecare use. Most of the client characteristics from the category ‘Daily functioning’ were assessed as uncertain. Client characteristics in other categories – i.e. ‘Physical health status’, ‘Mental health status and behaviour’, ‘Health literacy’, ‘Social environment and network’, and ‘Other’ – were more frequently considered relevant. Conclusion According to district nurses and health insurers, homecare use could be predicted better by including other more holistic predictors in case-mix classification, such as on mental functioning and social network. The challenge remains, however, to operationalize the new characteristics and keep stakeholders on board when developing and implementing case-mix classification for homecare prospective payment. Supplementary Information The online version contains supplementary material available at 10.1186/s12913-022-07733-9.
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Affiliation(s)
- Anne O E van den Bulck
- Faculty of Health, Medicine and Life Sciences, Department of Health Services Research, Maastricht University, Care and Public Health Research Institute (CAPHRI), P.O. Box 616, 6200 MD, Maastricht, The Netherlands.
| | - Arianne M J Elissen
- Faculty of Health, Medicine and Life Sciences, Department of Health Services Research, Maastricht University, Care and Public Health Research Institute (CAPHRI), P.O. Box 616, 6200 MD, Maastricht, The Netherlands
| | - Silke F Metzelthin
- Faculty of Health, Medicine and Life Sciences, Department of Health Services Research, Maastricht University, Care and Public Health Research Institute (CAPHRI), P.O. Box 616, 6200 MD, Maastricht, The Netherlands
| | - Maud H de Korte
- Department of Economics, Tilburg University, P.O. Box 90153, 5037 AB, Tilburg, The Netherlands.,Dutch Healthcare Authority (NZa), P.O. Box 3017, 3502 GA, Utrecht, The Netherlands
| | - Gertjan S Verhoeven
- Department of Economics, Tilburg University, P.O. Box 90153, 5037 AB, Tilburg, The Netherlands.,Dutch Healthcare Authority (NZa), P.O. Box 3017, 3502 GA, Utrecht, The Netherlands
| | | | | | - Misja C Mikkers
- Department of Economics, Tilburg University, P.O. Box 90153, 5037 AB, Tilburg, The Netherlands.,Dutch Healthcare Authority (NZa), P.O. Box 3017, 3502 GA, Utrecht, The Netherlands.,Tilburg Law and Economics Center (TILEC), Tilburg University, P.O. Box 90153, 5000 LE, Tilburg, The Netherlands
| | - Dirk Ruwaard
- Faculty of Health, Medicine and Life Sciences, Department of Health Services Research, Maastricht University, Care and Public Health Research Institute (CAPHRI), P.O. Box 616, 6200 MD, Maastricht, The Netherlands
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Ambugo EA, Dar I, Bikova MS, Førland O, Tjerbo T. A qualitative study on promoting reablement among older people living at home in Norway: opportunities and constraints. BMC Health Serv Res 2022; 22:150. [PMID: 35120512 PMCID: PMC8815167 DOI: 10.1186/s12913-022-07543-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2021] [Accepted: 01/20/2022] [Indexed: 11/21/2022] Open
Abstract
BACKGROUND Healthcare services that traditionally have been provided in long-term care institutions in Norway are increasingly being delivered at home to a growing population of older people with chronic conditions and functional limitations. Fostering reablement among older people is therefore important if they are to live safety at home for as long as possible. This study examines how healthcare professionals and managers (staff) in Norwegian municipalities promote reablement among community-dwelling older people. METHODS Face-to-face, semi-structured interviews lasting between 21 and 89 min were conducted between November 2018 and March 2019 with healthcare managers (N = 8) and professionals (N = 8 focus groups with 2-5 participants) in six municipalities in Norway. All interviews were audio-recorded, transcribed, and thematically coded inductively and analyzed with the aid of NVivo 12 software. RESULTS Overall, healthcare staff in this study used several strategies to promote reablement, including: carrying out assessments to evaluate older people's functional status and needs (including for safe home environments), and to identify older people's wishes and priorities with regard to reablement training. Staff designed care plans informed by the needs assessments, and worked with older people on reablement training at a suitable pace. They promoted among older people and staff (within and across care-units) the principle of 'showing/doing with' versus 'doing for' the older person so as to not enable disablement. Additionally, they supported older people in the safe and responsible use of welfare technology and equipment. Even so, staff also reported constraints to their efforts to foster reablement, such as: heavy workload, high turnover, insufficient training in reablement care, and poor collaboration across care-units. CONCLUSION Older people may be supported to live safely at home by meeting them as individuals with agency, identifying and tailoring services to their needs and wishes, and encouraging their functional abilities by 'showing/doing with' versus 'doing for them' when possible. The healthcare professionals and managers in this study were positive towards reablement care. However, meeting the resource demands of reablement care is a key challenge.
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Affiliation(s)
- Eliva Atieno Ambugo
- Department of Health, Social and Welfare Studies, Faculty of Health and Social Sciences, University of South-Eastern Norway in Vestfold, Postboks 235, 3603 Kongsberg, Norway
- Department of Health Management and Health Economics, Institute of Health and Society, University of Oslo, Postboks 1089 Blindern, 0317 Oslo, Norway
| | - Imran Dar
- Northern Norway Regional Health Authority (Helse Nord RHF), Postboks 1445, 8038 Bodø, Norway
| | - Mariya S. Bikova
- Centre for Care Research Western Norway, Western Norway University of Applied Sciences in Bergen, Årstadveien 17, 5009 Bergen, Norway
| | - Oddvar Førland
- Centre for Care Research Western Norway, Western Norway University of Applied Sciences in Bergen, Årstadveien 17, 5009 Bergen, Norway
| | - Trond Tjerbo
- Department of Health Management and Health Economics, Institute of Health and Society, University of Oslo, Postboks 1089 Blindern, 0317 Oslo, Norway
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Clemson L. Relevance, resilience, and ageism: A bright future for occupational therapy and healthy ageing, Sylvia Docker Lecture 2021. Aust Occup Ther J 2022; 69:3-14. [PMID: 34988989 DOI: 10.1111/1440-1630.12783] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2021] [Accepted: 12/09/2021] [Indexed: 11/28/2022]
Abstract
Our core professional values have been enduring and remarkably relevant to decades past and times present. Our values ensure the currency of our professional contribution, our resilience, readiness, and adaptability, to meet the challenges as we move into the next decade and beyond. In this Sylvia Docker lecture, I draw on my career experience from practice and academic research to examine this premise. The social isolation during the COVID-19 pandemic gave us all a picture of what our clients experience in an enduring way and the challenges of maintaining healthy lifestyles, meaningful occupations, and life roles. One of the greatest population challenges of this century is healthy ageing and the impact that ageism has on health. We live in a society that is ageist, and such cultural thinking impacts our beliefs and expectations as it does for older adults themselves. As occupational therapists, we strive to maintain our relevance, and we drive transformational change through using research-informed evidence-based approaches and adopting enablement programmes that meet the needs of people who are ageing. While prominent in enablement and therapeutic approaches, we are not immune to ageism. Being exposed to ageist views throughout our lives means, we internalise these and believe that ageing is a process of decline. Such self-perceptions and stereotyping impact the health of older people and influence the choices we make in our everyday practice. There are examples of emerging evidence and approaches that will meet these challenges and ways to re-frame ageist thinking. Occupational therapy values of working with people's strengths, what they can do, indicates we are well placed to engage and provide leadership in moving societal views. Addressing ageism requires self-reflection and action in order to be part of changing the narrative on ageing.
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Affiliation(s)
- Lindy Clemson
- Sydney School of Health Sciences, Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia
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Lampe D, Hasemann L, Nebling T, Thiem U, Greiner W. Health economic perspective on a community-based intervention for older people at risk of care dependency – results of a prospective quasi-experimental study. Gerontol Geriatr Med 2022; 8:23337214221140222. [DOI: 10.1177/23337214221140222] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2022] [Revised: 10/20/2022] [Accepted: 11/03/2022] [Indexed: 11/25/2022] Open
Abstract
This prospective, quasi-experimental study aims to compare healthcare resource utilization (HCRU) and costs of a multi-component care approach for older people in a community setting (intervention group (IG)) with usual care in a matched control group (CG) during a 21-month observation period. The reablement-oriented intervention included a geriatric assessment, a case and network management and digital supporting tools. Regression models were applied to determine intervention effects regarding hospitalization, total hospital length of stay (LOS), number of physician consultations, and healthcare costs using claims data. 872 subjects were included in the IG and 1,768 in the CG. The analyses showed that the intervention did not affect hospitalization ( OR = 1.153; 95% CI: 0.971–1.369, p = .105). However, participating in the IG lead to a small but significant increase of physician contacts by a factor of 1.078 (Exp( ß) = 1.078; 95% CI: 1.011–1.149; p = .022). A non-significant mean difference in costs of €1,183 (95% CI: €−261.6 to €2,627.6, p = .108) per participant was identified. Further research is needed to generate robust evidence on the optimal design of care approaches for older people and the health economic implications of such interventions to improve care and resource allocation decision-making. Trial registration: The study was registered at the German Clinical Trials Register (DRKS00027866).
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Affiliation(s)
| | - Lena Hasemann
- AG 5 - Department of Health Economics and Health Care Management, Bielefeld University, School of Public Health, Bielefeld, Germany
| | - Thomas Nebling
- Techniker Krankenkasse, Department Care Management, Hamburg, Germany
| | - Ulrich Thiem
- Centre for Geriatrics and Gerontology, Albertinen-Haus, Hamburg, Germany
- University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Wolfgang Greiner
- AG 5 - Department of Health Economics and Health Care Management, Bielefeld University, School of Public Health, Bielefeld, Germany
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Rooijackers TH, Metzelthin SF, van Rossum E, Kempen GIJM, Evers SMAA, Gabrio A, Zijlstra GAR. Economic Evaluation of a Reablement Training Program for Homecare Staff Targeting Sedentary Behavior in Community-Dwelling Older Adults Compared to Usual Care: A Cluster Randomized Controlled Trial. Clin Interv Aging 2021; 16:2095-2109. [PMID: 35221681 PMCID: PMC8866985 DOI: 10.2147/cia.s341221] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2021] [Accepted: 11/23/2021] [Indexed: 11/30/2022] Open
Abstract
Purpose Training and supporting homecare staff in reablement aims to change staff behavior from “doing for” to “doing with” older adults and is assumed to benefit the health and quality of life of older adults and reduce healthcare utilization and costs. This study evaluated the cost-effectiveness and cost-utility of the staff reablement training program “Stay Active at Home” (SAaH) from a societal perspective. Participants and Methods An economic evaluation was embedded in a 12-month cluster randomized controlled trial. Ten Dutch homecare nursing teams participated (n = 313 staff members), of which five teams were trained in reablement and the other five provided usual care. Cost and effect data were collected from 264 older adults at baseline, 6 and 12 months. Costs included “intervention,” “healthcare,” and “patient and family” costs (collectively, societal costs) and were assessed using questionnaires and client records or estimated by bottom-up micro-costing. Effects included sedentary behavior and quality-adjusted life years (QALYs). Multiple imputed bootstrapped data were used to generate cost-effectiveness planes and acceptability curves. Results No statistically significant differences were observed between the intervention and control group in terms of sedentary time (adjusted mean difference: \documentclass[12pt]{minimal}
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\end{document} €2216 [95% CI –459, 4895]), except lower costs for domestic help in the intervention group (\documentclass[12pt]{minimal}
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\end{document} €–173 [95% CI –299, –50]). The probability that SAaH was cost-effective compared to usual care ranged from 7.1% to 19.9%, depending on the willingness-to-pay (WTP) (€0‒€50,000)/minute of sedentary time averted and was 5.9% at a WTP of €20,000/QALY gained. Conclusion SAaH did not improve outcomes or reduce costs and was not cost-effective from a societal perspective compared to usual care in Dutch older adults receiving homecare. Consequently, there is insufficient evidence to justify widespread implementation of the training program in its current form. Trial Registration ClinicalTrials.gov: NCT03293303.
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Affiliation(s)
- Teuni H Rooijackers
- Department of Health Services Research, Care and Public Health Research Institute, Maastricht University, Maastricht, the Netherlands
- Living Lab in Ageing and Long-Term Care, Maastricht, the Netherlands
- Correspondence: Teuni H Rooijackers Department of Health Services Research, Care and Public Health Research Institute, Maastricht University, P.O. Box 616, Maastricht, 6200 MD, the NetherlandsTel +31 43-388-1711 Email
| | - Silke F Metzelthin
- Department of Health Services Research, Care and Public Health Research Institute, Maastricht University, Maastricht, the Netherlands
- Living Lab in Ageing and Long-Term Care, Maastricht, the Netherlands
| | - Erik van Rossum
- Department of Health Services Research, Care and Public Health Research Institute, Maastricht University, Maastricht, the Netherlands
- Living Lab in Ageing and Long-Term Care, Maastricht, the Netherlands
- Research Center for Community Care, Academy of Nursing, Zuyd University of Applied Sciences, Heerlen, the Netherlands
| | - Gertrudis I J M Kempen
- Department of Health Services Research, Care and Public Health Research Institute, Maastricht University, Maastricht, the Netherlands
- Living Lab in Ageing and Long-Term Care, Maastricht, the Netherlands
| | - Silvia M A A Evers
- Department of Health Services Research, Care and Public Health Research Institute, Maastricht University, Maastricht, the Netherlands
| | - Andrea Gabrio
- Department of Methodology and Statistics, Care and Public Health Research Institute, Maastricht University, Maastricht, the Netherlands
| | - G A Rixt Zijlstra
- Department of Health Services Research, Care and Public Health Research Institute, Maastricht University, Maastricht, the Netherlands
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Lewis LK, Henwood T, Boylan J, Hunter S, Lange B, Lawless M, Milte R, Petersen J. Re-thinking reablement strategies for older adults in residential aged care: a scoping review. BMC Geriatr 2021; 21:667. [PMID: 34847860 PMCID: PMC8638477 DOI: 10.1186/s12877-021-02627-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2021] [Accepted: 11/12/2021] [Indexed: 11/28/2022] Open
Abstract
BACKGROUND The number of older adults in residential aged care is increasing. Aged care residents have been shown to spend most of the day sedentary and have many co-morbidities. This review aimed to systematically explore the effectiveness of reablement strategies in residential aged care for older adults' physical function, quality of life and mental health, the features of effective interventions and feasibility (compliance, acceptability, adverse events and cost effectiveness). METHOD This scoping review was undertaken according to PRISMA guidelines (extension for scoping reviews). Five e-databases (Medline, Embase, Cochrane Central Register of Controlled Trials, Cochrane Database of Systematic Reviews and CINAHL) were searched from 2010 onwards. Randomised controlled trials investigating reablement strategies addressing physical deconditioning for older adults (mean age ≥ 65 yrs) in residential aged care on physical function, quality of life or mental health were included. Feasibility of the interventions (compliance, acceptability, satisfaction, adverse events and cost effectiveness) was explored. RESULTS Five thousand six hundred thirty-one citations were retrieved, and 63 studies included. Sample sizes ranged from 15 to 322 and intervention duration from one to 12 months. Exercise sessions were most often conducted two to three times per week (44 studies) and physiotherapist-led (27 studies). Interventions were predominately multi-component (28 studies, combinations of strength, balance, aerobic, functional exercises). Five interventions used technology. 60% of studies measuring physical function reported significant improvement in the intervention versus control, 40% of studies measuring quality of life reported significant improvements in favour of the intervention, and 26% of studies measuring mental health reported significant intervention benefits. Over half of the studies measured compliance and adverse events, four measured acceptability and none reported cost effectiveness. CONCLUSIONS There has been a research surge investigating reablement strategies in residential aged care with wide variability in the types and features of strategies and outcome measures. Few studies have measured acceptability, or cost effectiveness. Exploration of core outcomes, mapping stakeholders and co-designing a scalable intervention is warranted. TRIAL REGISTRATION Prospectively registered review protocol (Open Science Framework: DOI https://doi.org/10.17605/OSF.IO/7NX9M ).
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Affiliation(s)
- Lucy K Lewis
- Caring Futures Institute, College of Nursing and Health Sciences, Flinders University, GPO Box 2100, Adelaide, SA, 5001, Australia.
| | - Tim Henwood
- Southern Cross Care (SA, NT & Vic) Inc., PO Box 155, Glen Osmond, SA, 5064, Australia
| | - Jo Boylan
- Southern Cross Care (SA, NT & Vic) Inc., PO Box 155, Glen Osmond, SA, 5064, Australia
| | - Sarah Hunter
- Caring Futures Institute, College of Nursing and Health Sciences, Flinders University, GPO Box 2100, Adelaide, SA, 5001, Australia
| | - Belinda Lange
- Caring Futures Institute, College of Nursing and Health Sciences, Flinders University, GPO Box 2100, Adelaide, SA, 5001, Australia
| | - Michael Lawless
- Caring Futures Institute, College of Nursing and Health Sciences, Flinders University, GPO Box 2100, Adelaide, SA, 5001, Australia
| | - Rachel Milte
- Caring Futures Institute, College of Nursing and Health Sciences, Flinders University, GPO Box 2100, Adelaide, SA, 5001, Australia
| | - Jasmine Petersen
- Caring Futures Institute, College of Nursing and Health Sciences, Flinders University, GPO Box 2100, Adelaide, SA, 5001, Australia
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Rooijackers TH, Kempen GIJM, Zijlstra GAR, van Rossum E, Koster A, Lima Passos V, Metzelthin SF. Effectiveness of a reablement training program for homecare staff on older adults' sedentary behavior: A cluster randomized controlled trial. J Am Geriatr Soc 2021; 69:2566-2578. [PMID: 34097301 PMCID: PMC8518811 DOI: 10.1111/jgs.17286] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2021] [Revised: 04/28/2021] [Accepted: 05/05/2021] [Indexed: 12/05/2022]
Abstract
BACKGROUND/OBJECTIVES Homecare staff often take over activities instead of "doing activities with" clients, thereby hampering clients from remaining active in daily life. Training and supporting staff to integrate reablement into their working practices may reduce clients' sedentary behavior and improve their independence. This study evaluated the effectiveness of the "Stay Active at Home" (SAaH) reablement training program for homecare staff on older homecare clients' sedentary behavior. DESIGN Cluster randomized controlled trial (c-RCT). SETTING Dutch homecare (10 nursing teams comprising a total of 313 staff members). PARTICIPANTS 264 clients (aged ≥65 years). INTERVENTION SAaH seeks to equip staff with knowledge, attitude, and skills on reablement, and to provide social and organizational support to implement reablement in homecare practice. SAaH consists of program meetings, practical assignments, and weekly newsletters over a 9-month period. The control group received no additional training and delivered care as usual. MEASUREMENTS Sedentary behavior (primary outcome) was measured using tri-axial wrist-worn accelerometers. Secondary outcomes included daily functioning (GARS), physical functioning (SPPB), psychological functioning (PHQ-9), and falls. Data were collected at baseline and at 12 months; data on falls were also collected at 6 months. Intention-to-treat analyses using mixed-effects linear and logistic regression were performed. RESULTS We found no statistically significant differences between the study groups for sedentary time expressed as daily minutes (adjusted mean difference: β 18.5 (95% confidence interval [CI] -22.4, 59.3), p = 0.374) and as proportion of wake/wear time (β 0.6 [95% CI -1.5, 2.6], p = 0.589) or for most secondary outcomes. CONCLUSION Our c-RCT showed no evidence for the effectiveness of SAaH for all client outcomes. Refining SAaH, by adding components that intervene directly on homecare clients, may optimize the program and require further research. Additional research should explore the effectiveness of SAaH on behavioral determinants of clients and staff and cost-effectiveness.
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Affiliation(s)
- Teuni H. Rooijackers
- Department of Health Services Research, Care and Public Health Research InstituteMaastricht UniversityMaastrichtThe Netherlands
- Living Lab in Ageing and Long‐Term CareMaastrichtThe Netherlands
| | - Gertrudis I. J. M. Kempen
- Department of Health Services Research, Care and Public Health Research InstituteMaastricht UniversityMaastrichtThe Netherlands
- Living Lab in Ageing and Long‐Term CareMaastrichtThe Netherlands
| | - G. A. Rixt Zijlstra
- Department of Health Services Research, Care and Public Health Research InstituteMaastricht UniversityMaastrichtThe Netherlands
| | - Erik van Rossum
- Department of Health Services Research, Care and Public Health Research InstituteMaastricht UniversityMaastrichtThe Netherlands
- Living Lab in Ageing and Long‐Term CareMaastrichtThe Netherlands
- Research Center for Community Care, Academy of NursingZuyd University of Applied SciencesHeerlenThe Netherlands
| | - Annemarie Koster
- Department of Social Medicine, Care and Public Health Research InstituteMaastricht UniversityMaastrichtThe Netherlands
| | - Valéria Lima Passos
- Department of Methodology and Statistics, Care and Public Health Research InstituteMaastricht UniversityMaastrichtThe Netherlands
| | - Silke F. Metzelthin
- Department of Health Services Research, Care and Public Health Research InstituteMaastricht UniversityMaastrichtThe Netherlands
- Living Lab in Ageing and Long‐Term CareMaastrichtThe Netherlands
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Pettersson C, Zingmark M, Haak M. Enabling social participation for older people: The content of reablement by age, gender, and level of functioning in occupational therapists' interventions. Scand J Occup Ther 2021; 29:522-529. [PMID: 34463598 DOI: 10.1080/11038128.2021.1967442] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
BACKGROUND Social participation and the ability to build and maintain social relationships is emphasized as important for older people's health and well-being. AIM To explore if social participation is addressed and whether age, gender and level of functioning are associated with the composition of occupational therapy interventions within the context of reablement. METHOD In this cross-sectional study, invitations to participate were sent to 60 municipalities in Sweden. 318 occupational therapists participated and described the character of initiated interventions made during 3 weeks through web-based surveys. RESULT 1392 cases were reported in the age span of 19-103 years, 61.7% were women. A higher proportion of persons having no home care and minor functional dependency got interventions with a focus on social participation to a higher extent than persons with major functional dependency. Occupational therapists' interventions vary as related to functional limitation, age, and gender. CONCLUSION The results indicate that the severity of functional limitation impacts the focus of the intervention whereas age and gender do not. There is a need for social participation to be more clearly addressed within the context of reablement. SIGNIFICANCE To develop a person-centred intervention, one needs to consider aspects of age, gender, and functions.
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Affiliation(s)
| | - Magnus Zingmark
- Health and Social Care Administration, Municipality of Östersund, Östersund, Sweden.,Department of Epidemiology and Global Health, Umeå University, Umeå, Sweden
| | - Maria Haak
- Faculty of Health Sciences, Kristianstad University, Kristianstad, Sweden.,Faculty of Medicine, Department of Health Sciences, Lund University, Lund, Sweden
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Abstract
Abstract
The reablement approach is becoming a popular social and health-care model in many Western countries, providing support strategies for older people experiencing impairment. Reablement programmes have been criticised for a lack of theories, explicating the understanding of the problem that it is intended to address, i.e. ageing and impairment in old age. We need to discuss the inherent theories in intervention programmes to question taken-for-granted assumptions about not only what works, but also how these assumptions affect the sociocultural models of ageing. Theories on successful ageing have been suggested as underpinning reablement. This article aims to present and discuss theories of successful ageing compared to key principles, components and outcomes in reablement. A medical and epidemiological, a psychological and a sociocultural theoretical approach to successful ageing are included. Contemporary reablement programmes mirror medical and psychological theories of successful ageing, including models of ageing that are associated with continuity, optimisation, selection, individuality and goal orientation. Most reablement programmes do not address sociocultural perspectives on ageing. As older people experience impairment in a pertinent liminality within and between the sociocultural values of the third and fourth age, it is important for reablement programmes and practice to consider the theoretical assumptions and underpinning theories of ageing and how to help older people balance between optimising capacity and accepting losses in their everyday life.
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Ingstad K, Moe A, Brataas HV. Patient Involvement During a Pathway of Home-Based Reablement for Older Persons: A Longitudinal Single-Case Study. J Multidiscip Healthc 2021; 14:1911-1921. [PMID: 34321888 PMCID: PMC8313399 DOI: 10.2147/jmdh.s321760] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2021] [Accepted: 07/08/2021] [Indexed: 11/24/2022] Open
Abstract
Background In recent years, home-based reablement has become an increasingly popular way to provide rehabilitation services. This health care service aims to enable older persons to live longer at home while reducing the need for institutionalization. To ensure the provision of high-quality services, there is a continual need for research on issues of user involvement and co-creation during the pathway of the reablement process. Purpose This study focused on user involvement and participation with health care professionals during the reablement process. Methods This was a longitudinal, instrumental single-case study, in which one 85-year-old female patient was followed over the pathway of a six-week reablement process. Data were collected at three stages, including the goal-mapping phase, evaluation phase, and three weeks after completing reablement. Results Our analyses revealed two themes for the goal-mapping phase (dialogue led by the care provider and main goal), three themes for the implementation phase (the home as the preferred setting, little influence on organizational factors, and participation, influence, and motivation), and three themes for the evaluation phase (patient understanding as a precondition, motivated by weak paternalism, and self-determination requires clear communication). Conclusion The patient becomes involved through a partly co-creation process. During this time, they are involved, motivated, and influenced over the pathway of reablement. Health care providers must avoid implementing too much control during the pathway of home-based reablement, as patients have contextual knowledge that care providers do not possess.
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Affiliation(s)
- Kari Ingstad
- Faculty of Nursing and Health Sciences, Nord University, Campus Levanger, Levanger, Norway
| | - Aud Moe
- Faculty of Nursing and Health Sciences, Nord University, Campus Levanger, Levanger, Norway
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Johansson A, Ernsth Bravell M, Fransson EI, Fristedt S. Factors associated to functioning and health in relation to home rehabilitation in Sweden: a non-randomized pre-post intervention study. BMC Geriatr 2021; 21:416. [PMID: 34229616 PMCID: PMC8258925 DOI: 10.1186/s12877-021-02360-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2020] [Accepted: 06/23/2021] [Indexed: 11/20/2022] Open
Abstract
Background Home rehabilitation is a growing rehabilitation service in many countries, but scientific knowledge of its components and outcomes is still limited. The aim of this study was to investigate; 1) which changes in functioning and self-rated health could be identified in relation to a home rehabilitation program in a population of community-dwelling citizens, and 2) how socio-demographic factors, health conditions and home rehabilitation interventions were associated to change in functioning and self-rated health after the home rehabilitation program. Method The sample consisted of participants in a municipal home rehabilitation project in Sweden and consisted of 165 community-dwelling citizens. General Linear Models (ANOVA repeated measures) was used for identifying changes in rehabilitation outcomes. Logistic regressions analysis was used to investigate associations between rehabilitation outcomes and potential factors associated to outcome. Result Overall improvements in functioning and self-rated health were found after the home rehabilitation program. Higher frequencies of training sessions with occupational therapists, length of home rehabilitation, and orthopaedic conditions of upper extremities and spine as the main health condition, were associated with rehabilitation outcomes. Conclusion The result indicates that the duration of home rehabilitation interventions and intensity of occupational therapy, as well as the main medical condition may have an impact on the outcomes of home rehabilitation and needs to be considered when planning such programs. However, more research is needed to guide practice and policymaking.
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Affiliation(s)
- Anette Johansson
- Health Care Administration, Jönköping Municipality, Jönköping, Sweden. .,School of Health and Welfare, Jönköping University, Jönköping, Sweden.
| | | | | | - Sofi Fristedt
- School of Health and Welfare, Jönköping University, Jönköping, Sweden
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Mjøsund HL, Moe CF, Burton E, Uhrenfeldt L. Promotion of Physical Activity Through Reablement for Older Adults: Exploring Healthcare Professionals' Clinical Reasoning. J Multidiscip Healthc 2021; 14:1623-1635. [PMID: 34234450 PMCID: PMC8254412 DOI: 10.2147/jmdh.s315553] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2021] [Accepted: 05/31/2021] [Indexed: 11/23/2022] Open
Abstract
Introduction Reablement is an interdisciplinary, multifactorial, and individualized intervention aimed at improving function and maintaining the independence of community-dwelling older adults who receive home care services. Physical activity (PA) is important for functional ability in older adults, but it is unclear how PA is promoted through reablement. Healthcare professionals' (HCPs) clinical reasoning and decision-making are essential and determine how reablement is delivered to individuals. Exploring how HCPs integrate PA into their clinical reasoning is critical to understanding how PA is integrated within reablement. To gain knowledge of how PA is integrated within reablement, there is a need to explore how HCPs integrate PA into their clinical reasoning. Purpose The study aimed to explore how PA is integrated into HCPs' clinical reasoning in a Norwegian reablement setting. Methods Sixteen HCPs, including occupational and physical therapists, registered nurses, and other home care staff, were recruited from four Norwegian municipalities. They participated in semi-structured interviews that were transcribed verbatim, and an interpretive content analysis approach was used. Results PA was integrated into multifaceted clinical reasoning captured by the main theme: "Improving the person's ability to participate in meaningful activities." Within this overall theme, two sub-themes emerged with a primary focus on either i) increasing physical capacity or ii) improving activity performance. Each subtheme encompassed different aspects of clinical reasoning and diverse perspectives on how to integrate PA in reablement. Conclusion HCPs' decision-making in reablement builds upon complex clinical reasoning and incorporates diverse perspectives on integrating PA in the delivery of reablement. This broad approach may be useful in targeting different needs, preferences, and contexts. There is a need to further investigate how PA is appropriately promoted through reablement, how it meets the needs and preferences of participants, and which contextual factors influence PA promotion through reablement.
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Affiliation(s)
| | - Cathrine Fredriksen Moe
- Faculty of Nursing and Health Sciences, Nord University, Bodø, Norway.,Nordland Hospital Trust, Bodø, Norway
| | - Elissa Burton
- Curtin School of Allied Health, Curtin University, Perth, Australia
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Tuntland H, Ness NE. Hverdagsrehabilitering – ti år etter oppstart og veien videre. TIDSSKRIFT FOR OMSORGSFORSKNING 2021. [DOI: 10.18261/issn.2387-5984-2021-03-12] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
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Rooijackers TH, Zijlstra GAR, van Rossum E, Vogel RGM, Veenstra MY, Kempen GIJM, Metzelthin SF. Process evaluation of a reablement training program for homecare staff to encourage independence in community-dwelling older adults. BMC Geriatr 2021; 21:5. [PMID: 33407189 PMCID: PMC7789187 DOI: 10.1186/s12877-020-01936-7] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2020] [Accepted: 11/30/2020] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Many community-dwelling older adults experience limitations in (instrumental) activities of daily living, resulting in the need for homecare services. Whereas services should ideally aim at maintaining independence, homecare staff often take over activities, thereby undermining older adults' self-care skills and jeopardizing their ability to continue living at home. Reablement is an innovative care approach aimed at optimizing independence. The reablement training program 'Stay Active at Home' for homecare staff was designed to support the implementation of reablement in the delivery of homecare services. This study evaluated the implementation, mechanisms of impact and context of the program. METHODS We conducted a process evaluation alongside a 12-month cluster randomized controlled trial, using an embedded mixed-methods design. One hundred fifty-four homecare staff members (23 nurses, 34 nurse assistants, 8 nurse aides and 89 domestic workers) from five working areas received the program. Data on the implementation (reach, dose, fidelity, adaptations and acceptability), possible mechanisms of impact (homecare staff's knowledge, attitude, skills and support) and context were collected using logbooks, registration forms, checklists, log data and focus group interviews with homecare staff (n = 23) and program trainers (n = 4). RESULTS The program was largely implemented as intended. Homecare staff's average compliance to the program meetings was 73.4%; staff members accepted the program, and particularly valued its practical elements and team approach. They experienced positive changes in their knowledge, attitude and skills about reablement, and perceived social and organizational support from colleagues and team managers to implement reablement. However, the extent to which homecare staff implemented reablement in practice, varied. Perceived facilitators included digital care plans, the organization's lump sum funding and newly referred clients. Perceived barriers included resistance to change from clients or their social network, complex care situations, time pressure and staff shortages. CONCLUSIONS The program was feasible to implement in the Dutch homecare setting, and was perceived as useful in daily practice. Nevertheless, integrating reablement into homecare staff's working practices remained challenging due to various personal and contextual factors. Future implementation of the program may benefit from minor program adaptations and a more stimulating work environment. TRIAL REGISTRATION ClinicalTrials.gov (Identifier NCT03293303 ). Registered 26 September 2017.
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Affiliation(s)
- Teuni H Rooijackers
- Department of Health Services Research, Care and Public Health Research Institute, Maastricht University, P.O. Box 616, 6200 MD, Maastricht, The Netherlands.
- Living Lab in Ageing and Long-Term Care, Maastricht, The Netherlands.
| | - G A Rixt Zijlstra
- Department of Health Services Research, Care and Public Health Research Institute, Maastricht University, P.O. Box 616, 6200 MD, Maastricht, The Netherlands
| | - Erik van Rossum
- Department of Health Services Research, Care and Public Health Research Institute, Maastricht University, P.O. Box 616, 6200 MD, Maastricht, The Netherlands
- Living Lab in Ageing and Long-Term Care, Maastricht, The Netherlands
- Zuyd University of Applied Sciences, Research Center for Community Care, Academy of Nursing, P.O. Box 550, 6400 AN, Heerlen, The Netherlands
| | - Ruth G M Vogel
- Department of Health Services Research, Care and Public Health Research Institute, Maastricht University, P.O. Box 616, 6200 MD, Maastricht, The Netherlands
- Living Lab in Ageing and Long-Term Care, Maastricht, The Netherlands
| | - Marja Y Veenstra
- Burgerkracht Limburg, P.O. Box 5185, 6130 PD, Sittard, The Netherlands
| | - Gertrudis I J M Kempen
- Department of Health Services Research, Care and Public Health Research Institute, Maastricht University, P.O. Box 616, 6200 MD, Maastricht, The Netherlands
- Living Lab in Ageing and Long-Term Care, Maastricht, The Netherlands
| | - Silke F Metzelthin
- Department of Health Services Research, Care and Public Health Research Institute, Maastricht University, P.O. Box 616, 6200 MD, Maastricht, The Netherlands
- Living Lab in Ageing and Long-Term Care, Maastricht, The Netherlands
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