Occupational Therapy in HomEcare Re-ablement Services (OTHERS): study protocol for a randomized controlled trial

Abstract

BackgroundHomecare re-ablement services have been developed by local authorities in England in response to the government agenda for health and social care. These services aim to optimize users’ independence and ability to cope at home, and reduce the need for ongoing health and social care services. However, there is currently limited evidence and guidance regarding the optimum configuration and delivery of re-ablement services. In particular, the impact of occupational therapy input on service user outcomes has been highlighted as a specific research priority.Methods/DesignThis feasibility randomized controlled trial (RCT) will recruit 50 people from one local authority led homecare re-ablement service in England. Those who provide informed consent will be randomized to receive either usual homecare re-ablement (without routine occupational therapy input) or usual homecare re-ablement plus an enhanced program targeted at activities of daily living (ADL), delivered by an occupational therapist. The primary aim of this study is to assess the feasibility of conducting a further, powered study. The participant outcomes assessed will be independence in personal and extended ADL, health and social care-related quality of life, number of care support hours, falls, acute and residential admissions and use of health and social care services. These will be assessed at two weeks, three months and six months post-discharge from the re-ablement service.DiscussionTo our knowledge, this is the first RCT of occupational therapy in homecare re-ablement services. The results of this study will lay the foundations for a further powered study. The findings will be relevant to researchers, clinicians, commissioners and users of adult social care services.Trial registrationCurrent Controlled Trials registration number: ISRCTN21710246 (registered on 31March 2014)

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

“…Thus, occupational therapist has much to offer in the development and implementation of novel interventions in the emerging service context labelled re-ablement. This was highlighted in a study protocol (Whitehead et al, 2014). However, although occupational therapist in several studies was mentioned as a component in the interventions, overall the evidence for effects attributed to specific professional intervention facets is not possible to confirm.…”

“…Accordingly, in order to demonstrate the usefulness of occupational therapist, there is a need for high-quality research that demonstrates the effectiveness of such programs (Boniface et al, 2013;Langland et al, 2015;Petch, 2008;Tuntland et al, 2015;Whitehead et al, 2015). For example, Whitehead et al (2014) are planning for a randomized controlled trial with specific focus on input from occupational therapists. During the time elapsed after the period covered by our review, several promising studies have been published (see e.g.…”

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

“…In particular, the Department of Health in the United Kingdom highlighted its commitment to reablement services in a white paper, Caring for Our Future: Reforming Care and Support. This document "outlines the government's vision that the provision of these services should support people to remain living independently in their homes after a crisis event" (Whitehead et al, 2014). Although the emphasis in the UK remained on providing services to adults of all ages (not specifically elderly citizens), this paper provides a definition of reablement in which "users receive home-care but are supported to increase their ability to manage tasks independently, in order to reduce the amount of homecare they will require in the longer term" (Whitehead et al, 2014), and further distinguishes reablement from rehabilitation, stating that reablement services "adopt a social model of recovery rather than a medical model" (Whitehead et al, 2014).…”

“…This document "outlines the government's vision that the provision of these services should support people to remain living independently in their homes after a crisis event" (Whitehead et al, 2014). Although the emphasis in the UK remained on providing services to adults of all ages (not specifically elderly citizens), this paper provides a definition of reablement in which "users receive home-care but are supported to increase their ability to manage tasks independently, in order to reduce the amount of homecare they will require in the longer term" (Whitehead et al, 2014), and further distinguishes reablement from rehabilitation, stating that reablement services "adopt a social model of recovery rather than a medical model" (Whitehead et al, 2014). During this time, there is also increased emphasis on developing professional practice; e.g., a 2013 critical literature review analysed evidence on the effectiveness and cost-effectiveness of occupational therapy interventions for older people in social-care services.…”

Home care: An opportunity for physiotherapy?

“…In addition, intensive and time limited supported discharge teams, that are based on the key principles shown in (Baker et al 2001, Nadash and Feldman 2003, Parsons et al 2013, Tinetti et al 2012a. Allied health (physiotherapy and occupational therapy) can teach and implement plans of treatment in cooperation with coordinators to allow individuals to maintain the maximum amount of independence that their physical condition allows (Baker et al 2001, Nadash and Feldman 2003, Tinetti et al 2002, Tinetti et al 1997, Whitehead et al 2014. In addition, there is a role for physiotherapy within the model in the application of key competencies associated with goal facilitation, task analysis and breakdown, fitness and function, strength, balance / proprioception, motor control and adaptation and in the use of skills related to exercise prescription; maximisation of mobility; falls prevention advice and education for support workers, family, patient and home care coordinators.…”