Promotion of Physical Activity Through Reablement for Older Adults: Exploring Healthcare Professionals’ Clinical Reasoning

Abstract

Introduction Reablement is an interdisciplinary, multifactorial, and individualized intervention aimed at improving function and maintaining the independence of community-dwelling older adults who receive home care services. Physical activity (PA) is important for functional ability in older adults, but it is unclear how PA is promoted through reablement. Healthcare professionals’ (HCPs) clinical reasoning and decision-making are essential and determine how reablement is delivered to individuals. Exploring how HCPs integrate PA into their clinical reasoning is critical to understanding how PA is integrated within reablement. To gain knowledge of how PA is integrated within reablement, there is a need to explore how HCPs integrate PA into their clinical reasoning. Purpose The study aimed to explore how PA is integrated into HCPs’ clinical reasoning in a Norwegian reablement setting. Methods Sixteen HCPs, including occupational and physical therapists, registered nurses, and other home care staff, were recruited from four Norwegian municipalities. They participated in semi-structured interviews that were transcribed verbatim, and an interpretive content analysis approach was used. Results PA was integrated into multifaceted clinical reasoning captured by the main theme: “Improving the person’s ability to participate in meaningful activities.” Within this overall theme, two sub-themes emerged with a primary focus on either i) increasing physical capacity or ii) improving activity performance. Each subtheme encompassed different aspects of clinical reasoning and diverse perspectives on how to integrate PA in reablement. Conclusion HCPs’ decision-making in reablement builds upon complex clinical reasoning and incorporates diverse perspectives on integrating PA in the delivery of reablement. This broad approach may be useful in targeting different needs, preferences, and contexts. There is a need to further investigate how PA is appropriately promoted through reablement, how it meets the needs and preferences of participants, and which contextual factors influence PA promotion through reablement.

Promotion of physical activity in older adults: facilitators and barriers experienced by healthcare personnel in the context of reablement

“…A recent Delphi study among international reablement experts found diverse perspectives on whether or not exercise or motivation to increase PA should be included in reablement, and fewer than half of the experts agreed that exercise and motivation to increase PA should be part of the reablement concept [ 13 ]. Similarly, a recent study by our research team, that built upon the same interviews as the current study, found that HCPs working in reablement in a Norwegian context had diverse perspectives on how PA should be integrated within reablement [ 19 ]. The HCPs had a shared overall perspective that PA involved all types of physical activities, and that daily activities were a core type of PA in reablement.…”

“…This study is a qualitative exploratory study based on individual interviews, from which one study has been published previously describing some of its methods [ 19 ]. The study design is inspired by a realist perspective, focusing on gaining an increased understanding of mechanisms that may explain why reality unfolds as it does in a particular context [ 25 ].…”

“…The HCPs had a shared overall perspective that PA involved all types of physical activities, and that daily activities were a core type of PA in reablement. However, while some HCPs considered PA a central part of reablement to improve the participants’ physical function, other HCPs did not focus on PA particularly; they rather saw it as a positive consequence of participating in meaningful activities in daily living [ 19 ]. To embrace the HCPs’ differing perspectives on PA, we will in the following consider promotion of PA to include general facilitation of activity in daily living, including both everyday activities and PA/exercises particularly targeted physical capacity.…”

“…To embrace the HCPs’ differing perspectives on PA, we will in the following consider promotion of PA to include general facilitation of activity in daily living, including both everyday activities and PA/exercises particularly targeted physical capacity. Although the HCPs’ differing perspectives on PA may complement each other in the delivery of interdisciplinary and person-centered reablement, several studies have found that the approaches and activities prioritized in reablement differ between settings [ 19 – 21 ]. It has been suggested that contextual differences between or within countries may explain the different perspectives and priorities in reablement [ 12 – 14 , 19 , 21 ].…”

“…Although the HCPs’ differing perspectives on PA may complement each other in the delivery of interdisciplinary and person-centered reablement, several studies have found that the approaches and activities prioritized in reablement differ between settings [ 19 – 21 ]. It has been suggested that contextual differences between or within countries may explain the different perspectives and priorities in reablement [ 12 – 14 , 19 , 21 ].…”