Evaluating the impact of a home-based rehabilitation service on older people and their caregivers: a matched-control quasi-experimental study

Abstract

IntroductionPrevious studies evaluating home-based rehabilitation service (HBRS) merely focused on the period immediately after the patients’ discharge from hospitals. The present study focuses on HBRS that covers clients who have not been recently hospitalized. HBRS aims to meet older clients’ rehabilitation needs and support their caregivers in the community. This study intended to evaluate the impact of HBRS on the older clients’ health outcomes and hospital services utilization, and caregivers’ strain in providing care for clients.MethodsThis study used a matched-control quasi-experimental design with a 3-month follow-up to evaluate HBRS. The health outcome measures used for the older clients included Elderly Mobility Scale, Timed Up and Go test, Modified Barthel Index, Lawton’s Instrumental Activities of Daily Living Scale, Mini-Mental State Examination, and World Health Organization Quality of Life Scale, Short Form, Hong Kong version (WHOQOL-BREF [HK]). Meanwhile, the Caregiver Strain Index was used to measure the caregivers’ caregiving strain. Data on clients’ hospital services utilization 3 and 6 months before and after the study were also collected and evaluated.ResultsThe final sample consisted of 122 pairs of older clients and caregivers who live in a community in Hong Kong. In the follow-up after 3 months, the intervention group showed immensely substantial improvements across all the health outcome measures compared with the control group. The intervention group also demonstrated substantial reduction in the clients’ hospital services utilization compared with the control group. However, no significant differences in the clients’ hospital services utilization exist between the two groups in the follow-up after 6 months.ConclusionHBRS of this study is an effective intervention service to improve health outcomes and reduce hospital services utilization among older people living in the community. Moreover, HBRS of this study was effective in reducing the caregivers’ caregiving strain.

Giving voice to informal caregivers of community‐dwelling older adults: A systematic review of empowerment interventions

“…The other four NRQ studies were nonrandomized controlled trials in which the exposure to (an) empowerment‐oriented intervention(s) was contrasted with a control group. More specifically, two studies (Toseland & Smith, 1990; Toseland et al, 1990) applied a quasi‐experimental non‐equivalent control group design and two studies (Broekema et al, 2021; Lee et al, 2018) applied a matched control quasi‐experimental design. Furthermore, one study (Ducharme et al, 2006) used a concurrent mixed‐method study design, combining a qualitative research method and NRQ design, in which the qualitative and quantitative data were gathered in parallel and analysed together.…”

“…Among these RCTs, items referring to adherence of participants to the assigned interventions ( n = 6) and to the blinding of the outcome assessors in the studies ( n = 5) were most frequently scored negative. Of the five NRQ studies, one study (Boise et al, 2005) was evaluated as very low quality, two studies (Toseland & Smith, 1990; Toseland et al, 1990) were evaluated as low quality and two studies (Broekema et al, 2021; Lee et al, 2018) were evaluated as good. On item‐level, studies frequently scored low because there was no information on whether the intervention was administered as intended ( n = 4) or confounding variables predicting both the outcome and the intervention received were not controlled for or considered in the design and/or analysis ( n = 3).…”

“…In general, the intensity of the interventions varied from six (Boise et al, 2005; Ducharme et al, 2006) to 12 weeks (Broekema et al, 2021; Smith & Toseland, 2006). One quasi‐experimental study (Lee et al, 2018) described a non‐standardised duration varying between 3 and 6 months and one study (Sahar et al, 2003) described a 3‐day workshop followed by two home visits. Regarding the format of the interventions, seven studies (Baldwin et al, 1989; Boise et al, 2005; Gallagher‐Thompson et al, 2000; Sahar et al, 2003; Smith & Toseland, 2006; Toseland et al, 1989, 2004) used a group intervention format ( n = 7) and five studies (Broekema et al, 2021; Ducharme et al, 2006; Lee et al, 2018; López et al, 2007; Toseland & Smith, 1990) used an individual intervention format.…”

“…Overall, most interventions focused on different attributes of empowerment and across the included studies all attribute domains were represented. The number of empowerment attributes varied from 1 (Ducharme et al, 2006; Gallagher‐Thompson et al, 2000; Lee et al, 2018) to 5 (Broekema et al, 2021; Toseland et al, 2004). Although all components of empowerment (Sakanashi & Fujita, 2017) were found to be covered in this review, no intervention study represented all empowerment domains at the same time.…”

“…The other four NRQ studies were nonrandomized controlled trials in which the exposure to (an) empowerment-oriented intervention(s) was contrasted with a control group. More specifically, two studies ; ) applied a quasi-experimental non-equivalent control group design and two studies (Broekema et al, 2021;Lee et al, 2018) applied a matched control quasi-experimental design.…”