Feasibility and potential effects of interdisciplinary home-based reablement program (I-HARP) for people with cognitive and functional decline: a pilot trial

Abstract

Objectives: To test feasibility and potential effects of the interdisciplinary Home-bAsed Reablement Program (I-HARP) that integrates evidence-based strategies and cognitive rehabilitation techniques into a dementia-specific, bio-behavioural-environmental intervention.

Methods: A parallel-group randomised controlled pilot trial was conducted in Sydney, Australia, targeting community-dwelling people with amnestic mild cognitive impairment or mild/moderate stages of dementia and their carer (n = 18 dyads). I-HARP comprised: up to 12 home visits by registered nurse, occupational therapist, and psychologist, tailored to the individual client’s needs; <A$1000 for home modification/assistive devices; and individual carer support, all provided over four months. Additional allied health services were recommended when necessary. Clients’ daily activities, mobility, mood, caregiver burden, and quality of life were assessed at baseline, four months and 12 months. Semi-structured interviews were conducted with I-HARP participants post intervention.

Results: Of 51 dyads who expressed interest in participation, 25 were eligible, with 76% consent rate (19/25 eligible dyads consented), and high adherence to the program (all nine intervention group participants completed and complied). Challenges included: need for better carer and allied health support, with more targeted recruitment points to speed up the process. The I-HARP group showed favourable effects across most outcomes at short-term (4 months) and longer-term (12 months) assessments. However, wide Confidence Intervals (CIs) point to the degree of uncertainty around interpretation of these results.

Conclusion: The delivery of I-HARP, a dementia-specific reablement program and the trial design concerning randomisation, screening and consent procedures, were deemed feasible, acceptable and appropriate for the target population group. Building on the success and lessons from the pilot, a larger trial is currently underway.

Keywords:

• Dementia
• interdisciplinary teamwork
• community care
• reablement
• cognitive rehabilitation

Author contributions

Y.-H. Jeon, S.L. Szanton, J. Simpson, L.-F. Low, L. Clemson, S.L. Naismith, R. Norman, L. Gitlin, H. Brodaty contributed to the design of the pilot. Y.-H. Jeon oversaw the study recruitment, data collection, and drafted the paper. J.M. Simpson, Y.-H. Jeon and L. Krein carried out data analysis. Y.-H. Jeon, L. Clemson, S.L. Naismith, L. Mowszowski and S.L. Szanton contributed to developing the I-HARP intervention protocol. Y.-H. Jeon and L. Mowszowski provided carer support, and L. Mowszowski also supported cognitive rehabilitation techniques. L. Krein coordinated I-HARP, conducted the interviews with the participants, and contributed to drafting of the paper. All authors contributed to revisions and the finalisation of the paper.

Acknowledgements

We thank I-HARP pilot clinical assessor, Kim Burns, and health service use assessor, Dr. Tonia Crawford, and interventionists, Caitlin Dawes (Psychologist), Niki McDonough (Occupational Therapist), Helen McIntosh and Margeret Mackenzie (Registered Nurses) who also contributed to the protocol development. We are grateful for the support provided by the CAPABLE Team, especially Jill Roth and Allyson Evelyn-Gustave, at Johns Hopkins University, MD, USA.

Disclosure statement

No potential conflict of interest was reported by the authors.

Additional information

Funding

This study was funded by the Dementia Collaborative Research Centre – Assessment and Better Care, University of New South Wales as part of an Australian Government Initiative.