Integration of Physical Activity in Reablement for Community Dwelling Older Adults: A Systematic Scoping Review

Figures & data

Figure 1 Prisma Flow diagram. (Adapted with permission from the PRISMA Group) Moher D, Liberati A, Tetzlaff J, Altman DG, The PRISMA Group (2009). Preferred Reporting Items for Systematic Reviews and Meta-Analyses: The PRISMA Statement. PLoS Med 6(7): e1000097. doi:10.1371/journal.pmed1000097.The PRISMA Statement and the PRISMA Explanation and Elaboration document are distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited. (http://prisma-statement.org/PRISMAStatement/CitingAndUsingPRISMA.aspx).76

Table 1 Intervention Studies with PA Characteristics and Assessment Methods for Physical Fitness and PA Levels

Author, Year, Country	Design	Intervention	Control Intervention	Duration of Intervention	HCPs	Sample Size (Each Group)	Characteristics of General PA Facilitation	Exercise Characteristics	Assessment of Physical Fitness	Assessment of PA Levels
Intervention studies – RCTs (n=8)
Burton et al,^Citation30 2013, Australia	Parallel pragmatic RCT	Restorative care + LIFE (lifestyle functional exercise program)	Restorative care + standard exercise program	8 weeks	OTs PTs RNs Aides	80 (40, 40)	Include promotion of active engagement in activities of daily living.	Yes. Detailed descriptions provided (elaborated in text)	Functional reach Sit-to stand TUG Tandem walk	Exercise diary
Burton et al,^Citation45 2014, Australia	Pragmatic RCT long-term follow-up	Restorative care + LIFE (lifestyle exercise program)	Restorative care + standard exercise program	8 weeks	OTs PTs RNs Aides	80 (40, 40)	Refers to Burton 2013	Same as Burton 2013	Same as Burton 2013	Exercise diary
Tuntland et al,^Citation33 2015, Norway	Parallel-group superiority RCT	Reablement	Usual care	Max 3 months (average: 10 weeks)	OT PT Nurses Auxiliary nurses Assistants/students Social educator	61 (31,30)	Training in daily activities such as dressing, food preparation, vacuuming, bus transport, visiting friends at a club, or being able to knit	Exercise programs were recommended as individual features, such as indoor or outdoor walking with or without walking aids, climbing stairs, transferring and performing exercises to improve strength, balance, or fine motor skills	TUG Grip strength	No
Lewin et al,^Citation31 2013, Australia	RCT	HIP (the home independence program). A restorative home-care program	Usual home care	Max 12 weeks	RNs OTs PTs Support workers*	750 (375, 375)	Promotion of active engagement in daily activities	Strength, balance, and endurance programs for improving or maintaining mobility	TUG (results for TUG not reported)	No
Whitehead et al,^Citation34 2016, UK	Feasibility parallel group RCT	Reablement + OT intervention	Reablement	6 weeks ±	Social care workers Reablement team leader OT	30 (15/15)	Practicing ADL-activities was part of the intervention	Not reported	No	No
Parsons et al,^Citation32 2018, New Zealand	RCT	Supported discharge team	Usual care	Max 6 weeks	Healthcare assistants Registered nurses PTs OTs Geriatrician	183 (97,86)	Utilize functional rehabilitation principles to maximize recovery through incorporating exercises within ADL tasks	Exercises progressively incorporated within ADL tasks	No	No
Hattori et al,^Citation35 2019, Japan	Parallel, two-arm superiority RCT	Reablement + Usual care	Usual care	5 months	PTs OTs Care managers	375 (190/185)	Encouraged to regain physical activities and participation in ADL/IADL, based on motivational interviewing. Aimed to improve body function, activities and participation (ICF)	(See characteristics of general PA facilitation)	No	No
Jeon et al,^Citation36 2019, Australia	Parallel-group pilot RCT + interviews	I-HARP (Interdisciplinary Home-bAsed Reablement Program)	Usual care	4 months (up to 12 visits by HCPs)	OTs RNs Neuropsychologist.	18 (9/9)	Not reported	Balance and strength exercises were included as needed	No	No
Intervention studies – Not RCTs (n=8)
Lewin et al,^Citation38 2010, Australia	Non-randomized controlled trial	HIP (the home independence program). A restorative home-care program	Usual care	Up to 12 weeks. Average 62 days	Nurses PTs OTs	200 (100/100)	Interventions included promotion of active engagement in a range of daily living activities	Interventions included strength, balance, and endurance programs for improving or maintaining mobility	TUG	No
Whitney et al,^Citation41 2015, US	Retrospective quasi-experimental two-group design	Usual home care rehabilitation service specially trained in falls identification and prevention (Safe Strides)	Usual home care rehabilitation service	Mean duration in intervention group was 52.6 days	Nurses PTs OTs	3902 (2121/1781)	Not specifically reported	Targeted exercise programs focused on improving mobility and safety in the home were mentioned in discussion section	No	No
Winkel et al,^Citation43 2015, Denmark	Non-randomized pilot study	Reablement	(No comparison)	12 weeks	Home carer OT	91	The role of the home carer was to verbally and physically support and motivate the participant to perform the ADL tasks	Not mentioned	No	No
Tinetti et al,^Citation39 2002, US	Controlled clinical trial	Restorative care	Usual home care	3 months	Nurses PTs OTs Home health staff	1382 (691,691)	Not reported	The treatment plan included various combinations of exercises and training (not further elaborated, refers to Baker 2001)	No	No
Tinetti et al,^Citation40 2012, US	Quasi-experi-mental; matched and unmatched	Restorative care	Usual home care	Mean duration 20.3 days ± 14.8 days	Nurses PTs OTs Home health staff	770 (410/360)	Treatment plans targeted physical impairments and tasks of daily living. Included training and counseling of participant, family and caregivers (content of training not specified)	Treatment plan included various combinations of exercise (Refers to Baker 2001 for further description of intervention)	No	No
Langeland et al,^Citation37 2019, Norway	Clinical controlled trial in 36 municipalities	Reablement	Standard care	Maximum 10 weeks; mean 5.7 weeks	OTs PTs Nurses Auxiliary nurses Home helpers	849 (707/121)	Intensive attention was given to encourage participation and stimulate daily training for the participants, including performing their daily tasks themselves.	Exercise programs such as performing exercises to improve strength, balance, or fine motor skills. The exercises were incorporated into daily routines and the participants were encouraged to train on their own.	SPPB	No
Slater et al,^Citation42 2018, UK	A retrospective cohort design	Reablement	No comparison	6 weeks*	OTs Healthcare assistants	416	Not reported	Not reported	No	No
Beresford et al,^Citation44 2019, UK	Prospective cohort study	Three different reablement services	No comparison	Planned duration was typically 6 weeks, average duration was 3.9 weeks	OTs Healthcare assistants	186	Not reported	Not reported	No	No

Note: *Information from personal contact with author.

Abbreviations: PA, physical activity; OT, occupational therapist; PT, physiotherapist; RN, registered nurse TUG, timed up and go; RCT, randomized controlled trial; ADL, activities of daily living; SPPB, short physical performance battery.

Table 2 Other Studies Providing Information of PA Experiences and PA Characteristics

Author	Aim	Method	Duration of Intervention	HCPs Involved	Informants	PA Characteristics	PA Experiences
Perspectives of older adults
Burton et al,^Citation46 2013, Australia	To identify the motivators and barriers to being physically active for older people receiving either restorative or “usual” home care services	Cross-sectional mixed method study using questionnaire and interviews	Minimum 4 weeks, generally 6–12 weeks*	RNs OTs PTs Aides*	Questionnaire: 506 Older adults Interviews: 20 older adults	Not reported	Facilitators/barriers for PA among previous reablement receivers are reported
Hjelle et al,^Citation73 2017, Norway	To describe older adults experience of reablement	Qualitative Interviews (part of larger research program; Tuntland 2015)	Max 3 months	OT PT Nurses Auxiliary nurses Assistants/students Social educator	8 older adults	Same as Tuntland 2015	Own will-power and responsibility is considered important. Encouragement and motivation from HCPs Home environment stimulated to activity Understanding of PA-related terms
Wilde et al,^Citation77 2012, UK	Not clearly stated, but the title informs that the perceptions and experience of users of home-care reablement services are in focus	Interviews	Normally up to 6 weeks, with some flexibility*	Homecare staff with additional training. OTs regarded as essential members of the team*	34 service users 10 carers	Focuses on increasing service users ability to perform tasks such as getting up, washing, bathing, moving around the home and other daily living activities such as preparing drinks and light meals	Expressed frustration at lack of professional expertise to improve/maintain outdoor mobility
Moe & Brinchmann,^Citation75 2016, Norway	To generate a grounded theory of service users’ and their caregivers’ experiences of reablement	Grounded theory; focus groups, interviews and observation	Average duration of 6 weeks, maximal duration of 6 months*	Nurse OTs PTs Nurse assistants	17 services users, 10 carers	Includes doing repetitive practice of activities of daily life at home and in the neighborhood. Exercises included based on a detailed screening that identifies activity goals and functional impairments, with a focus on physical strengthening	Values/knowledge of PA are considered. Physical strengthening could boost participation in other activities. Experiences of insecurity for injury and overload. Self-confidence for PA was build during the reablement. Encouragement and motivation from HCPs was important. Reducing environmental barriers (indoors/outdoors)
Tuntland et al,^Citation51 2019, Norway	To explore which occupations/activities older people with functional decline find important to improve, which of these they prioritize as their rehabilitation goals, and what factors are associated with these priorities	A cross-sectional study based on data from a nationwide trial (Langeland 2019)	Mean 5.7 weeks (majority between 4 and 6 weeks)	OTs PTs Nurses Auxiliary nurse Home helpers	738 reablement receivers	Same as Langeland 2019	Goals related to functional mobility was most often prioritized, followed by goals related to personal care and household activities
Whitehead et al,^Citation48 2018, UK	To provide a detailed description of the content of the occupational therapy intervention that was provided in the OTHERS trial, and to evaluate whether the intervention was acceptable to the participants who received it	Feasibility/evaluation study (Part of a feasibility RCT); questionnaire and interviews	Median length of reablement episode was 56 days (range: 20–126 days)	OT Social care reablement workers	Interviews: 5 older adults Questionnaire: 8 older adults	Practicing ADL activities was included in intervention	Outdoor mobility goals were difficult to reach due to fluctuations of health condition or weather
Magne et al,^Citation78 2020, Norway	To describe how older adults engage in daily activities within the context of receiving reablement and to explore participation in daily activities	Interviews	6 weeks or less, with some exceptions*	OTs PTs Homecare workers	10 Older adults.	Not reported	Describes and explores older adults’ experiences of engaging in daily activities and exercises when receiving reablement
Perspectives of HCPs
Hjelle et al,^Citation62 2018, Norway	To explore and describe the roles of interdisciplinary teams in reablement services in a Norwegian setting	Focus groups + interviews	Max 3 months in the rural setting, 4 weeks duration in the city	OTs PTs Social educators Nurses Auxiliary nurses Assistants	27 HCPs (PTs, OTs, Nurses, Auxiliary nurses)	Same as Tuntland 2015	HCPs considered the reablement organization to be beneficial for reaching more users
Jakobsen et al,^Citation64 2018, Norway	To describe HCPs perspectives of next of kin in the context of reablement	Focus groups	Often 4–6 weeks	PTs OTs RNs Social educators Other employees of the home care services	49 HCPs (RNs, Health workers, OTs, students, PTs, Social educators)	HCPs assisted the older adults with practicing everyday activities and an individual physical training program	Values/knowledge of PA are considered. Relatives as a facilitator/barrier for PA.
Meldgaard Hansen,^Citation65 2016, Denmark	To analyze and discuss how the bodywork of homecare develops and is framed as clean, non-dirty work in the context of rehabilitative homecare	Ethnographic fieldwork	Average of 8 weeks in one unit, not specified in the other unit*	PTs OTs Nurses Social and healthcare workers	Two homecare units; 30 interviews with homecare workers, managers and administrators, shadow observations of 20 homecare workers	Not reported	HCPs experienced transformation of roles
Eliassen et al,^Citation58 2018, Norway	To explore how physiotherapy practice is performed in reablement settings and the content of the service provided to reablement users	Field study	4–6 weeks (with some exceptions)*	PTs OTs Nurses Allied health personnel*	7 PTs and 7 allied health personnel (+ 7 clients)	Daily activities were included in reablement plans and could involve getting dressed, showering, and walking to the grocery store. Exercises were provided in all teams, either as mainly standardized exercises or individual adapted exercises. The exercises mainly targeted balance, leg strength, and gait endurance	Experienced beneficial organization for reaching more users Competencies of allied health personnel was considered an important factor. Simple exercises were considered beneficial
Eliassen et al,^Citation57 2018, Norway	To explore how the allied health personnel follow-up instructions and supervision by PTs in reablement	Field study	4–6 weeks (with some exceptions)*	PTs OTs Nurses Allied health personnel*	7 PTs and 7 allied health personnel (+ 7 clients)	Same as Eliassen 2018a	Competencies of allied health personnel was considered an important factor. Individually targeted exercises were preferred in some teams
Eliassen et al,^Citation59 2018, Norway	To explore the content of PTs’ supervision of home trainers in reablement teams	Field study	4–6 weeks (with some exceptions) *	PTs OTs Nurses Allied health personnel*	7 PTs and 7 allied health personnel (+ 7 clients)	Same as Eliassen 2018a	Competencies of allied health personnel was considered an important factor
Eliassen et al,^Citation70 2020, Norway	To investigate and discuss how PTs on reablement teams plan and adapt training interventions to enhance users’ functional abilities	Field study	4–6 weeks (with some exceptions) *	PTs OTs Nurses Allied health personnel*	7 PTs and 7 allied health personnel (+ 7 clients)	Identified three main categories of interventions: (i) exercise-based training, (ii) activity-based training, or (iii) a combination of both exercise and activity-based training	Not reported
Bodker et al,^Citation8 2019, Denmark	To explore how transitioning from compensatory care to reablement care is not merely a practical process, but also a deeply normative one	Ethnographic field work	8 weeks	OTs RNs PTs Allied health personnel	One municipality, involving 31 older people (of which 8 received reablement) Interviews with 13 HCPs	Individualized reablement program includes reablement training. Allied health personnel (upon instruction by health professionals) works to re-enable the older person to manage ADLs	Experienced transformation of roles and mindsets Values/knowledge of PA influenced practice
Baker et al,^Citation49 2001, USA	To describe the development of a restorative model of home care designed to integrate medical treatments for acute conditions with personal care and rehabilitation for chronic disabilities in order to improve older adults’ functional outcomes	Description of design and implementation of a restorative care model	Mean duration of the Restorative care was 24.8 days*	Nurses PTs OT Allied health personnel	Model development within a branch of a homecare agency. Work group included two researchers (RN, PT), two RNs, 2 PTs, two allied health personnel. Staff and six older adults participated in focus groups	Supporting older adults to perform activities themselves. Help patients safely practice regaining function. Prevention of sedentary behavior. Allied health personnel were trained to help patients follow through on prescribed exercises and gait and transfer training	Competencies of allied health personnel was considered an important factor. Simple exercises were considered beneficial. Values/knowledge of PA influenced practice
Burton et al,^Citation47 2014, Australia	To determine whether a lifestyle and functional exercise program (LiFE) was suitable for delivery in a restorative home care service	Feasibility study; Pilot intervention study, including interviews with clients and care managers	Average 7–8 weeks	RNs OTs PTs Aides*	9 clients	Exercises incorporated into daily activities. An individually targeted Lifestyle exercise program as intervention, including strength and balance activities; a standardized exercise program as comparative intervention. Manual delivered, including guidance on how to progress exercises	Simple exercises were considered beneficial. Beneficial with written instructions
Liaanen et al,^Citation69 2019, Norway	To provide knowledge regarding how home care service providers working with reablement in the home care setting describe their experiences	Focus groups, grounded theory approach	Time-limited within 6–8 weeks, with some exceptions*	OTs PTs RNs Other home care staff	25 HCPs (2 OTs, 11, RNs, 4 Health workers, 1 Specialist auxiliary nurse, 4 auxiliary nurses, 1 student nurse, 1 Trainee health worker and 1 social educator)	Not reported	HCPs experienced a shift of care focus from caring to enabling. HCPs emphasized that reablement tended to focus on activities of daily living related to personal hygiene and food preparation, but questioned a lack of focus on outdoor and social activities
Zingmark et al,^Citation53 2020, Sweden	To explore the characteristics and differences of occupational therapy and physiotherapy in terms of focus (what the intervention was aimed to improve), content (what actions were implemented) and duration within the context of reablement in Swedish municipalities	Surveys	In most cases the duration was within a period of 6 weeks	OTs PTs home care staff Collaboration with other professionals, eg, district nurses, social workers, managers	1393 OTs 1005 PTs	OTs focused mostly on activities such as walking indoors and self-care. PTs focused mainly on walking indoors and body function	Not reported
Perspectives of family members
Hjelle et al,^Citation47 2017, Norway	To explore and describe how family members experience participation in the reablement process	Qualitative; Interviews (part of larger research program; Tuntland 2015)	Max 3 months	OT PT Nurses Allied health personnel Social educator	Six family members (spouse, child or other kinship)	Same as Tuntland 2015	Wanted information about how to support for PA. Some relatives missed follow-ups
Jakobsen et al,^Citation51 2019, Norway	To identify how adult children perceive the collaboration between older parents, family members, and HCPs in reablement services	In-depth interviews	4–6 weeks	PTs OTs RNs Allied health personnel	Eight daughters, six sons and a daughter-in-law of older adults receiving reablement	Not reported	Some family members wanted information about how to support for PA. Some family members found this responsibility problematic. Difficult to facilitate PA as a relative

Note: *Information from personal contact with author.

Abbreviations: PA, physical activity; OT, occupational therapist; PT, physiotherapist; RN, registered nurses; ADL, activities of daily living.

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