Re@home - Evaluation of home rehabilitation for older people

Research problem and specific questions

Rehabilitation is fundamental to all health care, as good care and public health cannot be achieved without access to rehabilitation (WHO). Despite this, research on the effectiveness of home rehabilitation to improve older adults’ ability in performing activities of daily living (ADL) and health-related quality of life (HRQL) is scarce. This project aims to address this knowledge gap by evaluating the effects of a structured home rehabilitation intervention for older adults, called Re@home.

Research questions (RQ)

1. What is the effectiveness of the Re@home in comparison to usual rehabilitation among older on a) ability in ADL performance, b) HRQL, c) care utilization, and significant others’ d) perceived caregiver burden?

2. How do older adults and significant others experience their participation in the Re@home?

3. What facilitators and barriers influence the implementation process and the outcome of the Re@home?

Data and methods

This is a randomised controlled cluster trial that will be conducted in Stockholm, Jönköping and Luleå reflecting differences in population, urban and rural areas, and approaches to organize home rehabilitation. The project adheres to the Medical Research C ouncil framework for complex interventions. 

The intervention is based on several pre-studies funded by Forte (Dnr 2021-01791, PI Elisabeth Rydwik)(literature review, field observations, interviews, a feasibility evaluation, a concluded in a mixed-method synthesize of data from the pre-studies). 

180 participants over the age of 65 will be recruited from 12 home rehabilitation units (4 clusters /each site). 

The principles of Re@home consist of content (person-centred assessment and activities), strategies used to engage the older adults in a shared decision-making process, duration and context, taking the home environment into consideration. Occupational therapists and physiotherapists at the units will participate in a preparation training course and receive reminders about the intervention to ensure consistency in delivery.

Primary outcome; performance in ADL. 

Secondary outcomes; HRQL, satisfaction with the intervention, use of care and social services and caregiver burden (RQ1).

Interviews with the older adults and their significant others will be performed to grasp their experiences of Re@home (RQ2). 

Barriers and facilitators of the implementation will be evaluated with focus groups and questionnaires (RQ3).

Societal relevance and utilization

Rehabilitation is vital to improve performance in ADL and HRQL. Therefore, it is central that older adults are invited to shared decision-making throughout the intervention process in line with person-centred rehabilitation and integrated care (SOU 2019:29). This project addresses the importance of scientific-based home rehabilitation interventions to improve care and social services for older adults. Effective rehabilitation reducing costs for care and social services is important given the demographic challenges, including an increasing number of people over the age of 80 with potential health issues (SoU 2016: 2). This is combined with fewer people working and contributing taxes to society, as well as the shortage of and difficulties in recruiting staff. This project will contribute to address these societal challenges, and the results can be implemented to counteract these challenges.

Plan for project realization

The multi-professional project group (i.e. occupational therapists, physiotherapists, social worker, nurse, an implementation scientist), are all well experienced researchers in the design used in this project. The ongoing collaboration with rehabilitation units at all sites in the pre-studies will be further deepened, which is vital to proceed with the proposed project plan.