Time-limited home-care reablement services for maintaining and improving the functional independence of older adults

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dc.contributor.author Cochrane, Andy
dc.contributor.author Furlong, Mairead
dc.contributor.author McGilloway, Sinead
dc.contributor.author Molloy, D. William
dc.contributor.author Stevenson, Michael
dc.date.accessioned 2016-11-30T09:30:54Z
dc.date.available 2016-11-30T09:30:54Z
dc.date.issued 2016-10-11
dc.identifier.citation Cochrane, A., Furlong, M., McGilloway, S., Molloy, D.W., Stevenson, M. and Donnelly, M. (2016) ‘Time-limited home-care reablement services for maintaining and improving the functional independence of older adults’, Cochrane Database of Systematic Reviews 2016, 10, CD010825 (62pp). doi: 10.1002/14651858.CD010825.pub2 en
dc.identifier.issued 10 en
dc.identifier.issn 1469-493X
dc.identifier.uri http://hdl.handle.net/10468/3326
dc.identifier.doi 10.1002/14651858.CD010825.pub2
dc.description.abstract Background: Reablement, also known as restorative care, is one possible approach to home-care services for older adults at risk of functional decline. Unlike traditional home-care services, reablement is frequently time-limited (usually six to 12 weeks) and aims to maximise independence by offering an intensive multidisciplinary, person-centred and goal-directed intervention. Objectives: To assess the effects of time-limited home-care reablement services (up to 12 weeks) for maintaining and improving the functional independence of older adults (aged 65 years or more) when compared to usual home-care or wait-list control group. Search methods: We searched the following databases with no language restrictions during April to June 2015: the Cochrane Central Register of Controlled Trials (CENTRAL); MEDLINE (OvidSP); Embase (OvidSP); PsycINFO (OvidSP); ERIC; Sociological Abstracts; ProQuest Dissertations and Theses; CINAHL (EBSCOhost); SIGLE (OpenGrey); AgeLine and Social Care Online. We also searched the reference lists of relevant studies and reviews as well as contacting authors in the field. Selection criteria: We included randomised controlled trials (RCTs), cluster randomised or quasi-randomised trials of time-limited reablement services for older adults (aged 65 years or more) delivered in their home; and incorporated a usual home-care or wait-list control group. Data collection and analysis: Two authors independently assessed studies for inclusion, extracted data, assessed the risk of bias of individual studies and considered quality of the evidence using GRADE. We contacted study authors for additional information where needed. Main results: Two studies, comparing reablement with usual home-care services with 811 participants, met our eligibility criteria for inclusion; we also identified three potentially eligible studies, but findings were not yet available. One included study was conducted in Western Australia with 750 participants (mean age 82.29 years). The second study was conducted in Norway (61 participants; mean age 79 years). We are very uncertain as to the effects of reablement compared with usual care as the evidence was of very low quality for all of the outcomes reported. The main findings were as follows. Functional status: very low quality evidence suggested that reablement may be slightly more effective than usual care in improving function at nine to 12 months (lower scores reflect greater independence; standardised mean difference (SMD) -0.30; 95% confidence interval (CI) -0.53 to -0.06; 2 studies with 249 participants). Adverse events: reablement may make little or no difference to mortality at 12 months' follow-up (RR 0.97; 95% CI 0.74 to 1.29; 2 studies with 811 participants) or rates of unplanned hospital admission at 24 months (RR 0.94; 95% CI 0.85 to 1.03; 1 study with 750 participants). The very low quality evidence also means we are uncertain whether reablement may influence quality of life (SMD -0.23; 95% CI -0.48 to 0.02; 2 trials with 249 participants) or living arrangements (RR 0.92, 95% CI 0.62 to 1.34; 1 study with 750 participants) at time points up to 12 months. People receiving reablement may be slightly less likely to have been approved for a higher level of personal care than people receiving usual care over the 24 months' follow-up (RR 0.87; 95% CI 0.77 to 0.98; 1 trial, 750 participants). Similarly, although there may be a small reduction in total aggregated home and healthcare costs over the 24-month follow-up (reablement: AUD 19,888; usual care: AUD 22,757; 1 trial with 750 participants), we are uncertain about the size and importance of these effects as the results were based on very low quality evidence. Neither study reported user satisfaction with the service. Authors' conclusions: There is considerable uncertainty regarding the effects of reablement as the evidence was of very low quality according to our GRADE ratings. Therefore, the effectiveness of reablement services cannot be supported or refuted until more robust evidence becomes available. There is an urgent need for high quality trials across different health and social care systems due to the increasingly high profile of reablement services in policy and practice in several countries. en
dc.description.sponsorship Health Research Board (Cochrane Fellowship) en
dc.format.mimetype application/pdf en
dc.language.iso en en
dc.publisher John Wiley & Sons Ltd. en
dc.rights © 2016, The Cochrane Collaboration. Published by John Wiley & Sons, Ltd. This article may be used for non-commercial purposes in accordance with Wiley Terms and Conditions for Self-Archiving. en
dc.subject Reablement en
dc.subject Restorative care en
dc.subject Home-care services en
dc.subject Time-limited en
dc.title Time-limited home-care reablement services for maintaining and improving the functional independence of older adults en
dc.type Article (peer-reviewed) en
dc.internal.authorcontactother David Molloy, Medicine, University College Cork, Cork, Ireland. T: +353-21-490-3000 E: w.molloy@ucc.ie en
dc.internal.availability Full text available en
dc.check.info Access to this article is restricted until 12 months after publication by request of the publisher. en
dc.check.date 2017-10-11
dc.description.version Published Version en
dc.contributor.funder Health Research Board en
dc.description.status Peer reviewed en
dc.identifier.journaltitle Cochrane Database of Systematic Reviews en
dc.internal.IRISemailaddress w.molloy@ucc.ie
dc.internal.IRISemailaddress w.molloy@ucc.ie en
dc.identifier.articleid CD010825


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