Reablement teams' roles: a qualitative study of interdisciplinary teams' experiences

Conceptualizing the Facilitators and Barriers of Successful Multidisciplinary Teamwork Within the Reablement Process: A Scoping Review

Background

As the global population ages, there is increasing pressure on health systems to provide high-quality and cost-effective care for this growing segment of the population. Reablement, primarily a strategic home-based rehabilitation approach, has been demonstrated to be a cost-effective, multidisciplinary, holistic, and person-centred approach to maintaining functional independence as one ages. Given that care delivery in the home setting for older persons is complex, a key feature of effective implementation of reablement is the integration of a multidisciplinary team.

Objective

The primary objective of this study was to identify the facilitators and barriers that lead to successful teamwork in a multidisciplinary reablement team setting.

Methods

Scoping review approach was used in this study to determine trends, and mapping themes prevalent in the peer-reviewed literature. Eligible articles were sourced from four electronic databases, and data were extracted, coded, analyzed and chartered in February 2024.

Results

Twenty studies were included in this study. Six main themes were identified: (1) multidisciplinary teamwork for quality service development, (2) dynamics of multidisciplinary collaboration, (3) professional autonomy and reflective practice, (4) towards a flat organizational structure and shared goals, (5) openness and flexibility of developing new cultures, and (6) open and frequent communication for success. Each of the themes can exert a facilitating or/and inhibiting effect depending on the context.

Conclusion

The findings indicate that multidisciplinary teamwork in reablement settings is diverse, complex, and situational. In this paper, we propose a conceptual model that integrates each theme as a way to understand the complexity and interconnectedness of the themes along the quest for greater multidisciplinary teamwork in reablement. Given the positive outcomes of both service consumers and providers, amplification of multidisciplinary teamwork within reablement holds the promise of effective care for older persons in a time of growing service demands.

Aging in (a meaningful) place - appropriateness and feasibility of Outdoor Reablement in a rural Arctic setting

BACKGROUND

As populations age in the Western world, interventions aiming for 'aging in place', such as reablement, have gained prominence. Reablement programs have focused on enabling older people to maintain independence in their home environment. However, while a growing body of research points to the considerable benefits of engaging in outdoor environments, reablement rarely addresses outdoor activities. People living in rural Arctic areas often tend to have strong cultural, social, and emotional attachments to outdoor places, emphasizing the outdoors as a meaningful arena for engagement. Concurrently, rural Arctic communities face unique obstacles in facilitating outdoor activities, such as geographic isolation, limited access to services, harsh climate conditions, and seasonal variations. Recognizing these challenges, our study sought to tailor an outdoor reablement model that is appropriate and feasible for the context of a rural Arctic setting.

METHODS

The study design was inspired by a co-design methodology, incorporating data creation through workshops, focus groups, and individual interviews conducted over an eleven-month period. Three municipalities in rural Arctic Norway were involved, with a total of 35 participants, including older people receiving reablement services and healthcare professionals. A socioecological theory supported the thematic data analysis.

RESULTS

The study yielded experiences that generated a comprehensive model for implementing outdoor reablement that meet the specific needs that the participants experienced in the rural Arctic setting. The model includes the individual level, accounting for physical and mental functioning; the organizational level, necessitating access to aids and equipment and cross-sectorial collaboration; and the environmental level, adapting to climatic, seasonal, and geographic challenges.

CONCLUSION

This study contributes with knowledge that broadens the scope of reablement as an initiative to support aging in place to include outdoor environments. The tailored outdoor reablement model developed in this study addresses the complexity of aging in place in rural Arctic settings. The study underscores the importance of context-specific strategies that support older people in maintaining a healthy and meaningful life through active engagement with the outdoors.

Barriers and facilitators for reducing low-value home-based nursing care: A qualitative exploratory study among homecare professionals

AIM

To explore barriers and facilitators for reducing low-value home-based nursing care.

DESIGN

Qualitative exploratory study.

METHOD

Seven focus group interviews and two individual interviews were conducted with homecare professionals, managers and quality improvement staff members within seven homecare organizations. Data were deductively analysed using the Tailored Implementation for Chronic Diseases checklist.

RESULTS

Barriers perceived by homecare professionals included lack of knowledge and skills, such as using care aids, interactions between healthcare professionals and general practitioners creating expectations among clients. Facilitators perceived included reflecting on provided care together with colleagues, clearly communicating agreements and expectations towards clients. Additionally, clients' and relatives' behaviour could potentially hinder reduction. In contrast, clients' motivation to be independent and involving relatives can promote reduction. Lastly, non-reimbursement and additional costs of care aids were perceived as barriers. Support from organization and management for the reduction of care was considered as facilitator.

CONCLUSION

Understanding barriers and facilitators experienced by homecare professionals in reducing low-value home-based nursing care is crucial. Enhancing knowledge and skills, fostering cross-professional collaboration, involving relatives and motivating clients' self-care can facilitate reduction of low-value home-based nursing care. Implications for profession and patient care: De-implementing low-value home-based nursing care offers opportunities for more appropriate care and inclusion of clients on waitlists.

IMPACT

Addressing barriers with tailored strategies can successfully de-implement low-value home-based nursing care.

REPORTING METHOD

The Consolidated Criteria for Reporting Qualitative Research checklist was used. No patient or public contribution.

Interprofessional supervision among allied health professionals: a systematic scoping review

Clinical supervision typically occurs between clinicians who are trained in the same discipline, and this assumption is present across much of the relevant literature. However, the use of interprofessional supervision (IPS), wherein clinicians do not share the same discipline, has increased in recent years. As IPS increases in usage, it is key that the implications of this approach are explored. In order to map the existing evidence, a scoping review was conducted to explore what is known about the use of IPS across five allied health professions (psychology, speech and language therapy, occupational therapy, physiotherapy and social work). A systematic literature search of four electronic databases was conducted, with 27 articles meeting the inclusion criteria. The data were analyzed using thematic synthesis. Six key themes were identified relating to factors impacting the appropriateness of IPS, necessary steps in the IPS process, and impacts of IPS for clinicians. Limited application of standardized tools and theoretical frameworks within the existing research was highlighted. The findings identified within this review present a broad overview of the existing research relating to IPS, which can be used to inform future research in this area.

A qualitative exploration of professionals' perspectives on the implementation of reablement intervention programs in community care

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.

Are two occupational therapists better than one? Occupational therapists' perspectives of intra-disciplinary practice within community health

INTRODUCTION

Intra-disciplinary practice is rarely discussed in occupational therapy and the broader health-care literature. Community-based occupational therapists often work autonomously in clients' homes and consequently have limited access to routine intra-disciplinary practices. Additionally, the community-based role covers a large scope of practice requiring comprehensive expertise. This study aimed to describe occupational therapists' perspectives on intra-disciplinary practice within community health settings.

METHODS

This study utilised an online cross-sectional survey design, collecting quantitative and qualitative data to explore perspectives of occupational therapists working within Australian community health services. Quantitative data were analysed using descriptive statistics. Qualitative data were analysed using thematic analysis. Both forms of data were compared and contrasted.

RESULTS/FINDINGS

Eighty occupational therapists completed the survey. Seventy-eight participants (97%) previously used or currently use intra-disciplinary practice in their workplace. Participants predominantly consult their peers when client needs are perceived as complex. Participants indicated that intra-disciplinary practice can benefit the client, therapist, and workplace. Enablers and barriers to the use of intra-disciplinary practice had overlapping themes, including access to therapists, attitudes towards intra-disciplinary practice, management support, and funding influences. Most participants expressed a desire to utilise intra-disciplinary practices (n = 70, 87%) and were also likely or extremely likely to incorporate it into their clinical work (n = 73, 91%). Participants who did not want to utilise intra-disciplinary practices or who were unsure provided reasons related to cost, practice inefficiencies, and being uncertain of the benefit.

CONCLUSIONS

Occupational therapists perceive intra-disciplinary practice as beneficial for problem-solving and an opportunity for knowledge sharing that supports therapist confidence with clinical reasoning. Conversely, some therapists believe its use may lead to client confusion, a greater need for communication and coordination among therapists, and that power differentials between therapists may discourage equal collaboration. Greater understanding of intra-disciplinary practice will help guide how it is used and supported in community health settings.

The Content of Physiotherapy and Factors Impacting on Reablement - A National Study

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.

Boundary work in task-shifting practices - a qualitative study of reablement teams

BACKGROUND

Health services worldwide have provided incentives for establishing teams to accommodate complex health care tasks, enhance patient outcomes and organizational efficiency, and compensate for shortages of health care professionals. Parallel to and partly due to the increased focus on teamwork, task shifting has become a health policy. Task shifting involves new tasks and responsibilities, which may result in social negotiations about occupational boundaries.

OBJECTIVE

The aim of this study was to explore how the division of tasks, responsibilities, and roles in reablement practices can appear as boundary work between physiotherapists (PTs) and home trainers (HTs).

METHODS

The study drew on data from fieldwork with seven Norwegian reablement teams, including observations and individual interviews with PTs and HTs. We conducted thematic analysis informed by a theoretical framework on professional boundaries.

RESULTS

We identified two different practices, which we labeled as: i) "The engine and the assistant" and ii) "The symbiotic team." We drew on these practices and theory of boundary making and boundary blurring to interpret the results.

CONCLUSION

The findings indicate that boundary-making processes may generate asymmetric power relations that may constrain autonomous work and job satisfaction in teams, whereas boundary-blurring processes may promote collaborative practices that enhance holistic approaches and mutual learning on reablement teams.

Publication Trends in Reablement - A Scoping Review

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.

Factors Impacting User Engagement in Reablement: A Qualitative Study of User, Family Member and Practitioners' Views

Background

The challenges of population aging have fostered the adoption of reablement as a core pillar of older people's care in many developed economies. Aligning with wider literature on the association between "patient" engagement and outcomes, emerging evidence points to the impact user engagement may have on reablement outcomes. To date, existing research on the factors implicated in engagement with reablement is rather limited.

Objective

To identify and describe factors which impact user engagement in reablement from the perspectives of reablement staff, staff in interfacing services, service users and family members.

Sample and Methods

A total of 78 staff were recruited from five sites across England and Wales. Twelve service users and five family members were recruited from three of these sites. Data were collected via focus groups with staff and interviews with service users and families, and subject to thematic analysis.

Results

The data revealed a complex picture of factors potentially impacting user engagement, ranging from user-, family-, and staff-centered factors, the nature of the relationship between staff and users, and aspects of service organization and delivery across referral and intervention pathways. Many are amenable to intervention. As well as offering a more fine-grained understanding of factors reported by previous research, new factors impacting engagement were identified. These included staff morale, equipment provision systems, assessment and reviewing processes, and attention to social reablement needs. Aspects of the wider service context (eg, degree of integration of health and social care) played a role in determining which factors were pertinent.

Conclusion

Findings highlight the complexity of factors influencing engagement with reablement, and the need to ensure features of the wider service context (eg delivery models, referral pathways) do not work against securing and sustaining older people's engagement with reablement.

An exploratory study on the role of occupational therapists in home-based rehabilitation team in South Korea

Introduction: Cooperation among rehabilitation team members is essential in the home-based rehabilitation setting. Q-methodology that can quantitatively analyze the subjectivity of members of the rehabilitation team was used to explore the role of occupational therapists (OTs) in home-based rehabilitation. Methods: The Q-methodology process was implemented in five steps: Step 1 - Representative statements about the role of OTs were collected through in-depth interviews, open questionnaires, and literature reviews (Q-sample); Step 2 - A total of 34 rehabilitation team members (physical therapists, OTs, social workers, nutritionists) were recruited (P-sample); Step 3 - The statements were classified according to their subjective perspective (Q-sort); Step 4 - Factor analysis was performed based on the correlation among the responses from the participants (Q-factor analysis); Step 5 - The awareness factor for roles was interpreted (Interpretation of awareness factors). Results: The roles of OTs perceived by members of the home-based rehabilitation team were formed into five factors (A) Adaptation within home environments; (B) Professional development; (C) Reliable service execution; (D) Client needs resolution; and (E) Focus on activity participation. In all factors, perspectives on the role of OTs in helping clients participate in their roles and activities at home were included. These factors included issues and directions addressed in prior literature on the development of occupational therapy. Conclusions: In home-based rehabilitation, OTs must play a professional role in ensuring clients live fully at home, and cooperate with team members for an effective rehabilitation approach.

Individual and organisational factors in the psychosocial work environment are associated with home care staffs' job strain: a Swedish cross-sectional study

BACKGROUND

Home care staff (HCS) provide essential service to enable older adults to age in place. However, unreasonable demands in the work environment to deliver a safe, effective service with high quality has a negative impact on the individual employee's well-being and the care provided to the older adults. The psychosocial work environment is associated with employees´ well-being, although, knowledge regarding which individual and organisational factors that contribute to job strain for HCS is limited. These factors need to be identified to develop targeted interventions and create sustainable work situations for HCS. This study aimed to explore how HCS´s perceived job strain is associated with, and to what extent can be explained by, individual and organisational factors of the psychosocial work environment and psychosomatic health.

METHOD

An explorative cross-sectional questionnaire survey design was used in a large Swedish county. Five home care agencies with a total of 481 HCS were asked to respond to a questionnaire regarding their perceived level of job strain (Strain in Dementia Care Scale), psychosocial work environment (QPS_Nordic³⁴⁺), and psychosomatic health (Satisfaction with Work Questionnaire). Multiple linear regression (MLR) analyses were conducted to explore the association between job strain and individual and organisational factors.

RESULTS

In total, 226 (46%) HCS responded to the questionnaire. Both individual and organisational factors were significant predictors of job strain and explained a variance ranging between 39 to 51% (p = 0.001). The organisational factor job demand and the individual factor feeling worried and restless was most frequently represented in these MRL models. A higher job strain was also associated with adverse outcomes regarding leadership, organisational culture and climate, and control at work.

CONCLUSION

This study indicates that there is an intertwined complexity of individual and organisational factors that are associated with the HCS´s perception of job strain. Implementation of new multidimensional work strategies, such as a reablement approach, could support the development of efficient strategies for HCS and reduce the level of job strain. Policy changes for the provision of home care are also needed to support the development of a sustainable and healthy psychosocial work environment.

Promotion of physical activity in older adults: facilitators and barriers experienced by healthcare personnel in the context of reablement

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.

ASSIST: a reablement program for older adults in Sweden - a feasibility study

Background

Western countries emphasise the provision of assistive home care by implementing reablement services. Reablement services are offered to a limited degree in Sweden, and systematic research regarding outcomes and how reablement can be tailored to maximize benefits for older adults has been lacking. This study aimed to evaluate the feasibility of a novel reablement program (ASSIST 1.0) regarding study design and outcome measures, as well as fidelity, adherence, and acceptability of the program in a Swedish context.

Method

A non-randomised, quasi-experimental, mixed-method, pre/post-test design was applied with an intervention group receiving ASSIST 1.0 (n = 7) and a control group receiving regular home care (n = 10). ASSIST 1.0 was developed to empower older adults to increase their perceived performance and satisfaction of performing activities in everyday life as well as increase their perceived health, self-efficacy, and well-being. ASSIST 1.0 was founded on the concept of reablement and included three components: i) goal setting with The Canadian Occupational Performance Measure (COPM), ii) provided support to home care staff to enhance their provision of reablement, and iii) explored the incorporation and use of an information- and communication technology (ICT) to facilitate information transfer.

Results

Using COPM for goal setting with older adults and providing support to the staff via workshops were valuable components in the delivery of ASSIST 1.0. The ICT product encountered several challenges and could not be evaluated. COPM and EQ-5D were deemed the most important instruments. Organisational and political barriers affected the feasibility. Although, the fidelity and adherence were complied the staff perceived the program to be acceptable.

Conclusion

The ASSIST 1.0 program was feasible in regard of study design, delivering the intervention, and evaluating instruments that detected a change. A logical progression would be to conduct a full-scale trial. In addition, a usability study to evaluate the technological component is also recommended. With minor improvements, the ASSIST 1.0 program has the potential to contribute to the development of a home care organisation that could enhance older adults possibility to age in place at home.

Trial registration number

NCT03505619

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

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.

A qualitative study on promoting reablement among older people living at home in Norway: opportunities and constraints

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.

Exploring behavior change techniques for reablement: A scoping review

BACKGROUND

Reablement is a team-based person-centered health and social care model, most commonly available for community-dwelling older adults. Understanding the components of reablement and how it is delivered, received, and enacted facilitates best evidence and practice. Determining behavior change techniques (BCTs) or strategies is an important step to operationalize implementation of reablement.

OBJECTIVE

We conducted a scoping review of peer-reviewed literature to identify BCTs used within reablement studies.

METHODS

We registered our study with the Joanna Briggs Institute and conducted five database searches. Inclusion criteria were peer-reviewed studies focused on adults and older adults without significant cognitive impairment or dementia receiving reablement, and all study designs, years, and languages. We excluded studies focused on reablement for people with dementia or reablement training programs. The last search was on April 8, 2021. Two authors screened independently at Level 1 (title and abstract) and 2 (full text). Two authors adjudicated BCTs for each study, and a third author confirmed the final list.

RESULTS

We identified 567 studies (591 publications) and included 21 studies (44 publications) from six global locations. We identified 27 different BCTs across all studies. The three most common BCTs for reablement were goal setting (behavior), social support (unspecified), and instruction on how to perform a behavior.

CONCLUSIONS

We highlight some behavioral components of reablement and encourage detailed reporting to increase transparency and replication of the intervention. Future research should explore effective BCTs (or combinations of) to include within reablement to support health behavior adoption and maintenance.

Reablement professionals' perspectives on client characteristics and factors associated with successful home-based reablement: a qualitative study

BACKGROUND

To understand what is needed to achieve a successful Danish home-based reablement service from the perspective of reablement professionals.

METHODS

Semi-structured interviews and observations were conducted with nine professionals within a municipal visitation unit in the Northern Denmark Region. Thematic analysis was used to analyze the interviews.

RESULTS

Four major themes emerged during this study: "Heterogeneity of clients and mixed attitudes towards the reablement intervention", "Shared understanding and acknowledging the need for help as the first step in reablement", "Commitment and motivation are essential for successful reablement", and "Homecare helpers as most important team players". The findings indicate that the clients had both mixed characteristics and attitudes about participating in the reablement intervention. Essential factors for successful reablement included a shared understanding of the reablement intervention, commitment, and motivation in terms of client involvement and staff group collaboration.

CONCLUSIONS

Shared understanding of the reablement intervention, commitment, and motivation was found to be essential factors and the driving forces in relation to successful reablement.

Promotion of Physical Activity Through Reablement for Older Adults: Exploring Healthcare Professionals' Clinical Reasoning

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.

Staff experiences of a reablement approach to care for older people in a regional Australian community: A qualitative study

Reablement is described as a person-centred, goal-directed intervention with a view to regain, maintain or improve the independence of older clients. Although evidence to support the use of reablement as a multidisciplinary, home-based intervention for community-dwelling older adults is increasing, there is limited knowledge about what it means for care staff who provide client-based services. This study, which was nested in a larger program evaluation, used a descriptive qualitative approach to explore direct care staff and care coordinator experiences of translating a reablement training program into practice for older people in a regional Australian community. Two months after the training program four focus groups were conducted with 13 care coordinators to assimilate staff experiences with development of care plans, systems, processes and practices of reablement. In addition, four direct care staff took part in individual interviews, which centred on eliciting their experience using the reablement approach with clients. Results from the care coordinator focus groups and the direct care staff interviews highlight the importance of reablement staff training and the involvement of staff in the development and delivery of a reablement approach to client-centred care. A number of organisational and client-centred challenges such as communication, functional partnerships, staff education and resourcing are also uncovered in this research into the development of a reablement-focused care service in a regional setting. Overall there is support for the dominating discourse around healthy ageing and the policy approach of ageing in place to support wellness.

Reablement through time and space: a scoping review of how the concept of 'reablement' for older people has been defined and operationalised

BACKGROUND

While the field of rehabilitation has determined a common definition of professional practice, legislators and healthcare professionals in various Western countries have struggled to reach consensus about how the newer offer of 'reablement' should be organised, operationalised, and understood as a health service for older adults. International research indicates that there is confusion, ambiguity, and disagreement about the terminology and the structure of these programmes, and they may not be adequately supporting older people's self-identified goals. Could an analysis of the concept's genealogy illuminate how reablement can be more effective and beneficial in theory and in practice?

METHODS

We conducted a qualitative and quantitative scoping review to determine how reablement has developed through time and space. Eligible articles (N=86) had to focus on any of the defined features of current reablement programmes; there were no restrictions on study designs or publication dates. In articles published from 1947 to 2019, we identified themes and patterns, commonalities, and differences in how various countries described and defined reablement. We also performed an analysis using computer software to construct and visualise term maps based on significant words extracted from the article abstracts.

RESULTS

The fundamental principles of reablement have a long history. However, these programmes have undergone a widespread expansion since the mid-2000s with an intention to reduce costs related to providing long-term care services and in-home assistance to growing older populations. Despite theoretical aspirations to offer person-centred and goal-directed reablement, few countries have been able to implement programmes that adequately promote older people's goals, social involvement, or participation in their local community in a safe, culturally sensitive and adaptable way.

CONCLUSIONS

Reablement is meant to support older people in attaining their self-defined goals to be both more physically independent at home and socially involved in their communities. However, until legislators, health professionals, and older people can collectively reach consensus about how person-centred reablement can be more effectively implemented and supported in professional home-care practice, it will be difficult to determine a conceptual description of reablement as a service that is unique, separate, and distinct from standard rehabilitation.

Developing an assessment scale for long-term care reablement literacy in home care workers in Taiwan using a modified Delphi method

Background

Reablement is a philosophy of change in long-term care (LTC). Assessing the knowledge and competence of LTC professionals who provide reablement services is vital in LTC research. This study aimed to develop a scale for the assessment of long-term care reablement literacy (LTCRL) and employ this scale to assess the performance of home care workers in Taiwan.

Methods

To develop this scale, we employed the modified Delphi technique based on the theoretical framework of health literacy and the content of service delivery in reablement. Home care workers from northern, central, and southern Taiwan were selected through purposive sampling (N = 119). Participants answered a self-administered questionnaire that included items related to basic demographic characteristics and questions to assess LTCRL.

Results

Based on the experts’ consensus on the procedure of the modified Delphi technique, the LTCRL assessment sale consists of 29 questions on four aspects of knowledge acquisition: the abilities to access/obtain, understand, process/appraise, and apply/use. The results revealed that higher education levels and better Chinese language proficiency are associated with higher LTCRL outcomes among home care workers.

Conclusions

The LTCRL assessment scale based on a modified Delphi technique is useful and feasible for evaluating LTCRL in home care workers who provide reablement services in Taiwan.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12877-020-01854-8.

Integration of Physical Activity in Reablement for Community Dwelling Older Adults: A Systematic Scoping Review

Background

Reablement is a rehabilitative intervention provided to homecare receivers with the aim of improving function and independence. There is limited evidence of the effectiveness of reablement, and the content of these interventions is variable. Physical activity (PA) is known to be important for improving and maintaining function among older adults, but it is unclear how PA is integrated in reablement.

Purpose

To map existing evidence of how PA strategies are integrated and explored in studies of reablement for community dwelling older adults and to identify knowledge gaps.

Methods

An a priori protocol was published. Studies of time-limited, interdisciplinary reablement for community-dwelling older adults were considered for inclusion. Eight databases were searched for studies published between 1996 and June 2020, in addition to reference and citation searches. Study selection and data extraction were made independently by two reviewers.

Results

Fifty-one studies were included. Exercise strategies and practice of daily activities were included in the majority of intervention studies, but, in most cases, little information was provided about the intensity of PA. Interventions aiming to increase general PA levels or reduce sedentary behavior were rarely described. None of the studies explored older adults’, healthcare providers’ or family members’ experiences with PA in a reablement setting, but some of the studies touched upon themes related to PA experiences. Some studies reported outcomes of physical fitness, including mobility, strength, and balance, but there was insufficient evidence for any synthesis of these results. None of the studies reported PA levels among older adults receiving reablement.

Conclusion

There is limited evidence of how PA is integrated and targeted to older adults’ individual needs and preferences in a reablement setting. The feasibility and effectiveness of PA interventions, as well as experiences or barriers related to PA in a reablement setting, should be further investigated.

Discourses of service recipients in the context of reablement in Norway

BACKGROUND

Reablement is a shift from reactive home care to a more preventive model based on active engagement. In this shift, it is interesting to uncover and understand potential discourses that may exist amongst service providers regarding their views of service recipients.

AIM

to explore and describe discourses of the view of service recipients in the context of reablement, from the service providers' perspective.

METHOD

Participants were service providers working in reablement, with the analysis being retrieved from 13 focus groups. A critical discourse analysis was used in order to gain a broader understanding and to capture service providers' views.

FINDINGS

Five discourses were constructed. Three discourses indicated the way participants perceived service recipients included in reablement, namely the competent service recipient, the conventional service recipient, and the perfect service recipient. Two discourses categorised recipients related to whether or not they were included in reablement: the suitable service recipient who was excluded and the unsuitable service recipient who was included.

CONCLUSION

Service providers use a variety of different discourses when they talk about service recipients.

SIGNIFICANCE

Service providers, including occupational therapists, must be aware of how unconscious discourses can affect those to whom they provide services.