Effectiveness of a reablement training program for homecare staff on older adults' sedentary behavior: A cluster randomized controlled trial

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] À22.4, 59.3), p = 0.374) and as

Effects on clients' daily functioning and common features of reablement interventions: a systematic literature review

“…The most common measure, used in six studies, was the (unmodified) Barthel Index (Galik et al 2014 , 2015 ; Henskens et al 2017 ; Powell et al 2002 ; Resnick et al 2011 ; Sackley et al 2009 ). Six studies used a separate outcome measure concerning iADL (Gitlin et al 2006 , 2010 ; Lewin and Vandermeulen 2010 ; Rooijackers et al 2021 ; Szanton et al 2019 ; Tinetti et al 2002 ). In five studies, ADL was a secondary outcome measure (King et al 2012 ; Lewin et al 2013 ; Parsons et al 2020 , 2017 ; Rooijackers et al 2021 ).…”

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

“…Dropouts’ characteristics were comparable between groups; however, at baseline, dropouts were significantly more sedentary, had worse daily, physical, and psychological functioning, and fell more often than study completers. 33 …”

“…More information on the effectiveness of SAaH compared to usual care has been published elsewhere. 33 …”

“…The current findings show that SAaH was not cost-effective compared to usual care. Based on these and previous findings, 33 wider implementation of the training program in its current form cannot be recommended. Future studies should investigate how the training program could be improved.…”

“… 32 However, the effect evaluation found no differences between the study groups for sedentary behavior in older adults (primary care), implying that SAaH was as effective as usual care. 33 SAaH may still be cost-effective, as no effect difference can be justified by lower costs. 34 The current paper therefore describes the findings of the economic evaluation comparing SAaH with usual care in Dutch older adults from a societal perspective.…”