Hverdagsrehabilitering for hjemmeboende personer: en oppfølgings- og effektstudie

The main purpose with the present study is to increase the knowledge about the effect of reablement by investigating whether the paticipants strenghten their activity and participaction, coping, physical function, health-related quality of life and mental health in the short and long term and whether reablement gives economic effects for the municipalities. 

Background: Health promotion and prevention of functional decline among home dwelling adults and immediate onset of rehabilitation, can improve function, and reduce or delay need for home-based assistance and institution placement. In the coming years there will be a significant increase in number of persons in Norway that need interventions aiming at coping with everyday activities. Therefore there is a call for new models for early intervention and rehabilitation in order to give service to a larger amount of home living people. Reablement is a new and promising rehabilitation model which many Norwegian municipalities are implementing in order to meet current and future needs for municipal home-based services. However, very little research has been performed regarding the effectiveness of this intervention including clinical and economic outcomes.

Purpose: This study aims at assessing the effectiveness of reablement in terms of daily functioning, health-related quality of life, coping, mental health and economic municipal costs. 

Sample: The study will be conducted in 46 municipalities in Norway. The sample consists of home-dwelling adults with an initial functional decline in daily activities.

A total of approximately 500 participants will be recruited, including approximately 100 participants in the control group.

Inclusion Criteria:1. Home-dwelling person 2. Applicant of home-based services. 3. Above 18 years old. 4. Functional decline in at least one activity 5. Able to understand written and oral Norwegian.

In addition a sample of the participants will be interviewed to get knowledge about their experiences with participating in reablement. A sample of employees will also be interviewed to reveal their assessments and organisation of implementation of reablement.

Intervention: Reablement is an intensive, multidisciplinary, client-centered, home-based type of rehabilitation, where ordinary activities of daily living are used for rehabilitative purposes. The intervention lasts between 4 and 8 weeks.  

An occupational therapist and physical therapist, or nurse, constitutes the key personal, while home helpers, assistants and others with lower education, are the ones who work rehabilitative with the person on a daily basis focusing on self-help.

The control intervention is standard home-based treatment and care.

Data analyses will be performed according to intention to treat. Univariate analysis of covariance will be used to investigate differences between the groups from baseline to the end of intervention. The working hour data is panel data and will be analyzed accordingly; a random or a mixed effect regression model will be employed. Also, descriptive statistics and simpler tests will be carried out.

Method: The study will be conducted in 46 municipalities in Norway. It is a quasi-experimental intervention trial. The participants will be assessed at baseline, and at 10 weeks, 6-, and 12 months follow-up. Primary outcomes will be participation and activity and will be measured by using Canadian Occupational Performance Measure (COPM).  The COPM is a measure of a client`s self-perception of occupational performance in the areas of self-care, productivity and leisure. Outcome measures for the COPM are: the client`s most important problems in occupational performance and a total score of performance and a total score of satisfaction for these problems. Short Physical Performance Battery (SPPB) investigates balance, walking function and muscle strength in the lower limbs. Health-related Quality of Life (EQ-5D) measures health-related quality of life states consisting of five dimensions (mobility, self-care, usual activities, pain/discomfort, anxiety/depression). Sense of coherence (SOC) measures comprehensibility, manageability and meaning.

Mental Health Continuum Short Form (MHC-SF) measures emotional, psychological  and social well-being.

Municipal expenditures will be recorded weekly for six months. Costs will be recorded in accordance with the operating hours of the different health care professions in the private homes of the participants.