A non-randomised feasibility study of the Rehabilitation Potential Assessment Tool (RePAT) in frail older people in the acute healthcare setting

Abstract

Background Rehabilitation potential involves predicting who will benefit from rehabilitation. Decisions about rehabilitation potential must take into account personal, clinical and contextual factors, a process which is complicated in the presence of acute ill-health and frailty. This study aimed to evaluate the feasibility and acceptability of the Rehabilitation Potential Assessment Tool (RePAT) – a 15 item holistic, person-centred assessment tool and training package – in the acute hospital setting. Methods A non-randomised feasibility study with nested semi-structured interviews explored whether RePAT was feasible and acceptable. Feasibility was tested by recruiting physiotherapy and occupational therapy participants delivering the RePAT intervention to patients alongside usual clinical care. Acceptability was tested by conducting semi-structured interviews with staff, patient and carer participants. Staff and patient characteristics were analysed using descriptive statistics. Interview data were analysed thematically. Fidelity of completed RePAT items was assessed against a priori criteria on how closely they matched tool guidance by two researchers. Mean values of the two scores were calculated. RePAT content was analysed and supported with verbatim quotes. Results Six staff participants were recruited and trained. They assessed 26 patient participants using RePAT. Mean (SD) patient age was 86.16 (±6.39) years. 32% were vulnerable or mildly frail, 42% moderately frail and 26% severely or very severely frail using the Clinical Frailty Scale. Mean (SD) time to complete RePAT was 32.7 (±9.6) minutes. RePAT fidelity was good where 13 out of 15 items achieved a priori fidelity. RePAT was acceptable and tolerated by staff and patients. Staff participants reported RePAT enabled them to consider rehabilitation decisions in a more structured and consistent way. Patients and carer participants, although unable to comment directly on RePAT, reported being satisfied with their rehabilitation assessments which were found to embrace a person-centred approach. Conclusions RePAT was found to be acceptable and feasible by staff, carers and patients. It allowed clinicians to make explicit their reasoning behind rehabilitation assessments and encouraged them to become more cognisant of factors which affected their clinical decision-making. Trial registration ID ISRCTN31938453. Registered 05/10/2021.

Development and usability of a hospital standardized ADL ratio (HSAR) for elderly patients with cerebral infarction: a retrospective observational study using administrative claim data from 2012 to 2019 in Japan

“…Second, other risk factors for deterioration of ADL, such as medical history or socioeconomic status were not considered in this study [37][38][39]. The risk of requiring rehabilitation during hospitalization and whether rehabilitation was planned at the time of admission should have been accounted [40]. Third, we could not include the information of discharge destination, which may be a reason for discharging patients in a poor condition, such as those with comorbidities or chronic diseases.…”

Rehabilitation potential: A critical review of its meaning and validity

“…A recently developed tool for assessing rehabilitation potential, the Rehabilitation Potential Assessment Tool, illustrates the almost exclusive focus on patient characteristics. 18 The 15 items include setting SMART goals, a list of reasons for not accepting a patient, such as ‘underlying psychological issues which may affect an individual’s motivation or participation with rehabilitation’, and one non-specific question about the home environment. It is not measuring the likelihood of gaining a better outcome if transferred to a rehabilitation service.…”