Emplacing reablement co-creating an outdoor recreation model in the rural Arctic

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.

The importance of context-a qualitative study exploring healthcare practitioners' experiences of working with patients at home after a stroke

BACKGROUND

Stroke significantly impacts individuals, leading to the need for long-lasting rehabilitation and adaptation to environmental demands. Rehabilitation after stroke is increasingly performed in patients' homes, and it is argued that rehabilitation in this context is more person-centred and positively impacts client outcomes. However, the role of environmental factors in this process is largely unknown. The aim of this study was to explore how multidisciplinary healthcare practitioners working with rehabilitation in the home after stroke consider possibilities and challenges in the environment and how environmental factors are documented in patients' records.

METHODS

Eight multidisciplinary healthcare practitioners working with home-based rehabilitation after stroke participated in two semistructured focus group sessions. Thematic analysis was used to analyse the transcripts of recorded focus group discussions. Data were also collected from patient history records (N = 14) to identify interventions to increase patients' opportunities to participate in activities inside and outside the home. These records were analysed using life-space mobility as a conceptual framework.

RESULTS

The analysis generated four overarching themes concerning possibilities and challenges in the environment: (1) the image of rehabilitation conflicts with place, (2) the person in the home reveals individual needs and capabilities, (3) environmental characteristics influence the rehabilitation practice, and (4) the person is integrated within a social context. The patient record analysis showed that most patients were discharged from hospital to home within four days. Assessments at the hospital mainly focused on basic activities of daily living, such as the patient's self-care and walking ability. Also at home, the assessments and actions primarily focused on basic activities with little focus on participation in meaningful activities performed in different life situations outside the home.

CONCLUSIONS

Our research suggests that one way to improve practice is to include the environment in the rehabilitation and consider the person´s life space. Interventions should focus on supporting out-of-home mobility and activities as part of person-centred stroke rehabilitation. This must be supported by clear documentation in the patient records to strengthen clinical practice as well as the communication between stakeholders.

Feasibility of a reablement-program in a Swedish municipality

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.

Enabling social participation for older people: The content of reablement by age, gender, and level of functioning in occupational therapists' interventions

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.

Patterns of occupational engagement among community-dwelling older adults in Singapore: An exploratory mixed method study

Introduction

The aim of this study is to understand the patterns of occupations among community-dwelling older adults in Singapore. The objectives are to describe their occupational engagement using the Activity Card Sort Singapore, understand their occupational preferences and perceived barriers and facilitators to engagement.

Methods

A convergent parallel mixed-method study was conducted over a 5-month period in 2018. Purposive and snowball sampling were used to recruit the participants. Individual 1-h interviews were conducted at participants’ homes. Quantitative data collected include demographic information, Modified Barthel Index scores and activity engagement based on the Activity Card Sort Singapore. Qualitative data was collected using semi-structured interviews.

Results

105 participants were enrolled in the study. Overall, older adults engaged mostly in instrumental and social activities. However, leisure and social activities were most preferred. Gender, educational level and age were found to influence occupational engagement. Overall, six main themes relating to perceived barriers and facilitators to occupational engagement were identified: cognition and physical status, self-efficacy, resources, affect and meaningfulness, social influence and environmental factors.

Conclusion

The findings from this study provided insights into the occupational patterns of community-dwelling older adults in Singapore and their perceived barriers and facilitators to engagement. Recommendations for practice were identified.

Leisure and Productivity in Older Adults with Cancer: A Systematic Review

Introduction

Self-care, leisure, and productivity are important occupational domains for older adults' quality of life, which might be affected by cancer and its treatment. A great number of publications about older adults focus on function or self-care, so we aimed to analyse how cancer and its treatments affect leisure and productivity. Secondary objectives were to identify whether particular clinical and/or sociodemographic factors were associated with occupational disruptions and to assess the impact of rehabilitation approaches on leisure and productivity in this population.

Methods

A systematic review of the 2009-2019 literature performed on Medline, Embase, and the Cochrane Central Register of Controlled Trials.

Results

1471 publications were retrieved: 48 full texts were assessed; seven of these (four cross-sectional studies, two cohort studies, and a case report) were reviewed, including data on 16668 people (12649 healthy controls, 3918 cancer survivors, and 101 ill patients). Older adults with comorbidities and a low level of activity before cancer diagnosis may be more at risk of occupational disruptions. However, studies focused more on physical activity than leisure and productivity. Two studies mentioned occupational therapy. Discussion. As cancer can become a chronic disease, it appears important to also offer occupation-centred assessments and follow-up.

Conclusion

An occupation-centred approach could be developed; its effectiveness must be assessed.

Characteristics of occupational therapy and physiotherapy within the context of reablement in Swedish municipalities: A national survey

Reablement is a multidisciplinary, home-based intervention implemented for people at risk of functional decline and losing independence aiming to optimise functioning and independence in activities of daily living. There is limited knowledge about what characterises the intervention and the role of different professionals. The purpose of this study was to explore the characteristics and differences of occupational therapy and physiotherapy interventions in terms of focus, content and duration within the context of reablement in Swedish municipalities. Web-based surveys were used to collect data from 43 municipalities representing 25% of the population in Sweden. Data on intervention characteristics were reported for all cases receiving occupational therapy (n = 1,395) and physiotherapy (n = 1,006) over a 15-week period. Data were presented descriptively, and differences between occupational therapy and physiotherapy were analysed using Chi-square tests. The results indicated that reablement in Sweden was implemented for adults in all ages (19-103 years, median 81.0 years); 72% had home help. For both professions, a baseline assessment was made in fewer than half of all cases. There were significant differences between occupational therapists and physiotherapists regarding the focus and content as well as the number of contacts and duration of the intervention. For occupational therapists, walking indoors and self-care were the largest focus areas, whereas for physiotherapists walking indoors and body function were the largest focus areas. For most cases, the intervention was completed within five sessions over a 6-week period. This study provides the first picture of occupational therapy and physiotherapy within Swedish reablement contexts. In relation to the results, the focus of interventions, how assessments are made and how the intervention is implemented over time are issues that can be further elaborated.

Everyday occupations prioritised by older adults participating in reablement. A cross-sectional study

Background: Little knowledge exists regarding which occupations older adults prioritize as rehabilitation goals in reablement and what factors are associated with their preferences.Objectives: To explore which occupations older people with functional decline find important to improve, which of these they prioritize as their rehabilitation goals, and what factors are associated with these priorities.Materials and methods: A cross-sectional study was undertaken with a sample of 738 older adults from a nationwide trial evaluating the effects of reablement in Norway. The nine occupational sub-areas of the Canadian Occupational Performance Measure were used as a framework for analyses.Results: Participants identified a multitude of occupations as challenging. Functional mobility was the most frequently identified and prioritized sub-area. Significant associations were found between prioritized occupations and health condition, sex, living status, education, walking speed and motivation.Conclusions: This study found both abundance and diversity in the occupational problems and prioritized goals of older adults, with mobility being a key priority regardless of health condition.Significance: It is important that reablement continues to be a person-centered intervention embracing the possibility to choose meaningful occupations. Occupational Therapists and other health professionals should address mobility when improving occupational performance in older adults.

Evidence-based interventions involving occupational therapists are needed in re-ablement for older community-living people: A systematic review

Introduction

Re-ablement services are in a period of strong development, but the terms and definitions used remain unclear, and the scientific evidence is still weak. The aim of this systematic review was to obtain an overview of the scientific literature in this evolving research area, and investigate whether there is scientific evidence for positive effects of re-ablement services for older community-living people.

Method

The systematic literature search was conducted in the databases CINAHL, PubMed and Svemed+(Swemed) and covered the years 2000–2014. Owing to the heterogeneity in the included studies, a narrative synthesis was performed.

Results

Eight original publications were found eligible and included in the systematic review. When addressed, terms and definitions varied among the papers. Effects such as less use of home care, higher likelihood to live at home, improved activities of daily living (ADL) skills, quality of life and physical health, increased physical activity and lower costs compared to conventional home care were reported.

Conclusion

More high-quality research is needed to strengthen the evidence-base regarding re-ablement services. The specific roles of various professional and staff groups are often insufficiently described, as are the interventions as such, and there is a lack of attention to person-centered aspects such as the meaningfulness of the specific activities.