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Randomized Controlled Trial
. 2016 Aug 16;6(8):e011868.
doi: 10.1136/bmjopen-2016-011868.

Occupational Therapy in HomEcare Re-ablement Services (OTHERS): results of a feasibility randomised controlled trial

Phillip J Whitehead  1 , Marion F Walker  1 , Ruth H Parry  2 , Zaid Latif  3 , Ian D McGeorge  4 , Avril E R Drummond  2
Affiliations
Randomized Controlled Trial

Occupational Therapy in HomEcare Re-ablement Services (OTHERS): results of a feasibility randomised controlled trial

Phillip J Whitehead et al. BMJ Open. .

Abstract

Objectives: The objective of this study was to test the feasibility of conducting a randomised controlled trial (RCT) of an intervention targeted at activities of daily living (ADL), delivered by an occupational therapist, in homecare reablement.

Design: Feasibility parallel group RCT.

Setting: Single-site local authority homecare reablement service.

Participants: People referred for homecare reablement with ability to consent. Exclusion criteria were as follows: inability to speak English, receiving other community therapy services, needing two or more to assist transfer and receiving end-of-life care.

Control: 'Usual care' was 6 weeks of homecare reablement delivered by social care workers (no routine health professional input).

Intervention: A targeted ADL programme, delivered by an occupational therapist incorporating goal setting, teaching/practising techniques, equipment/adaptations and provision of advice/support. This was in addition to usual care.

Outcome measures: Aspects of feasibility including eligibility, recruitment, intervention delivery, attrition and suitability and sensitivity of outcome measures. Participant outcomes were personal and extended ADL, quality of life, falls and use of health and social care services.

Results: 30 participants were recruited, 15 to each arm, which was 60% of those eligible. Data from 22 (73%) were analysed at 6 months. Of the 15 participants, 13 (86%) received the intervention and were able to set one or more ADL goals. There were improvements from baseline in both groups, although overall improvements were greater in the occupational therapy (OT) intervention group. The biggest threat to feasibility was a change in service configuration during the trial, involving additional occupational therapy input, affecting usual care and recruitment.

Conclusions: Despite the service reconfiguration, it was feasible to recruit and retain participants, deliver the intervention and collect outcome data that were responsive to change. The choice of primary outcome measure remains unclear. A further powered study is feasible and warranted; however, the design will require careful consideration because of ongoing national changes in service configurations.

Trial registration number: ISRCTN21710246; Results.

Keywords: Activities of Daily Living; Homecare Re-ablement; Occupational Therapy; Prevention; Social Care.

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Figures

Figure 1
Figure 1
Flow of participants.
See this image and copyright information in PMC

References

    1. Social Care Institute for Excellence. Maximising the potential for re-ablement. London: Social Care Institute for Excellence, 2013.
    1. Department of Health. Statutory guidance to support local authorities implement the Care Act 2014, 2016. https://www.gov.uk/guidance/care-and-support-statutory-guidance.
    1. Allen K, Glasby J. ‘The billion dollar question’: embedding prevention in older people's services—ten ‘high-impact’ changes. Br J Soc Work 2013;43:904–24. 10.1093/bjsw/bcs024 - DOI
    1. Pilkington G. Homecare re-ablement: why and how providers and commissioners can implement a service. J Care Serv Manag 2008;2:354–67. 10.1179/csm.2008.2.4.354 - DOI
    1. Lewin G, De San Miguel K, Knuiman M et al. . A randomised controlled trial of the Home Independence Program, an Australian restorative home-care programme for older adults. Health Soc Care Community 2013;21:69–78. 10.1111/j.1365-2524.2012.01088.x - DOI - PubMed

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