Reablement is an emerging approach in rehabilitation services, but evidence for its efficacy is rather weak and inconsistent. The purpose of the present study is therefore to investigate the health ...effects of reablement in home-dwelling adults.
A multicenter, clinical controlled trial involving 47 municipalities in Norway, with assessments at baseline, and after 10 weeks and at 6 and 12 months. The sample consisted of 707 persons that received a 4-10 week reablement program and 121 underwent treatment as usual. Primary outcomes were activity performance and satisfaction with performance measured by the Canadian Occupational Performance Measure (COPM, 1-10). Secondary outcomes included the Short Physical Performance Measure Battery (SPPB), the European Quality of Life Scale (EQ-5D-5 L), and the Sense of Coherence Questionnaire (SOC). Overall treatment effects were estimated with mixed-model repeated measures analyses.
Significant treatment effects in the rehabilitation group compared with the control group were found in COPM-Performance and COPM-Satisfaction scores at 10 weeks (mean differences between groups (MD), 1.61, 95% confidence interval (CI), 1.13, 2.10 and MD 1.47, CI 0.98, 1.97, respectively), and at 6 months (MD 1.42; CI 0.82,2.02 and MD 1.37; CI 0.77,1.98, respectively). There were also significant treatment effects in the SPPB-subscales for balance and walking after 6 months, in the total SPPB score and in the subscale for sit-to-stand after 12 months. In the EQ-5D-5 L assessment, significant treatment effects were found in the subscales for mobility, and for usual activities and health after 6 months. There was a significant difference in the SOC after six months.
Reablement seems to be a more effective rehabilitation service for persons with functional decline than traditional home-based services after six months. After 12 months, the differences between the groups decreased.
The trial was registered at ClinicalTrials.gov on October 24, 2014, (retrospectively registered) identifier: NCT02273934 .
This study examines the effects of the COPD-specific health promoting self-management intervention "Better living with COPD" on different self-management-related domains, self-efficacy, and sense of ...coherence (SOC).
In a randomized controlled design, 182 people with COPD were allocated to either an intervention group (offered Better living with COPD in addition to usual care) or a control group (usual care). Self-management-related domains were measured by the Health Education Impact Questionnaire (heiQ) before and after intervention. Self-efficacy was measured by the General Self-Efficacy Scale (GSE) and SOC was measured by the 13-item Sense of Coherence Scale (SOC-13). Effects were assessed by ANCOVA, using intention-to-treat (ITT) analysis and per-protocol analysis (PPA).
The PPA and the ITT analysis showed significant positive changes on Constructive attitudes and approaches (heiQ) (ITT:
=0.0069; PPA:
=0.0021) and Skill and technique acquisition (heiQ) (ITT:
=0.0405; PPA:
=0.0356). Self-monitoring and insight (heiQ) showed significant positive change in the PPA (
=0.0494). No significant changes were found on the other self-management domains (heiQ), self-efficacy (GSE), or SOC (SOC-13).
Better living with COPD had a significant positive short-term effect on some self-management-related domains, and could be an intervention contributing to the support of self-management in people with COPD. However, further work is needed to establish the clinical relevance of the findings and to evaluate the long-term effects.
Self-management is crucial for effective COPD management. This study aimed at identifying associations between self-management and sociodemographic characteristics, clinical characteristics, and ...symptom burden in people with COPD.
In this cross-sectional study with 225 participants diagnosed with COPD grades II-IV, multiple linear regression analysis was conducted, using sociodemographic and clinical characteristics and symptom burden (COPD Assessment Test) as the independent variables and the eight self-management domains of the Health Education Impact Questionnaire (heiQ) as the outcome variables.
Higher symptom burden was significantly associated with worse scores in all self-management domains (
<0.003), except for self-monitoring and insight (
=0.012). Higher disease severity (
=0.004) and numbers of comorbidities (
<0.001) were associated with more emotional distress, and women scored higher than men on positive and active engagement in life (
=0.001). Higher score in pack-years smoking was associated with lower score in health-directed activities (
=0.006) and self-monitoring and insight (
<0.001), and participation in organized physical training was associated with higher score in health-directed activities (
<0.001). The final models explained 3.7%-31.7% of variance (adjusted
) across the eight heiQ scales.
A notable finding of this study was that higher symptom burden was associated with worse scores in all self-management domains, except for self-monitoring and insight. In addition, sex, disease severity, comorbidity, pack-years smoking, and participation in organized physical training were associated with one or two self-management domains. The study contributes to improved understanding of self-management in COPD. However, the explained variance levels indicate that more research needs to be done to uncover what else explains self-management domains in COPD.
This study investigated the mental health of people with psoriasis undergoing patient education in climate therapy. A prospective design included a baseline assessment and two follow‐ups after a ...3‐week patient education program. Participants were 254 adults. Positive mental health was measured by the mental health continuum short form (0–70), and negative mental health by the emotional distress subscale (1–4) of the health education impact questionnaire. Paired‐samples t‐tests were used to evaluate changes in mental health from baseline to follow‐up. Multiple linear regression was used to analyse the ability of socio‐demographic and clinical variables and emotional distress to predict changes in positive mental health. To predict change in negative mental health we repeated the same analysis but with a change in negative mental health as a dependent variable and positive mental health as an independent variable. The results show that positive mental health and health‐related emotional distress improved significantly from before to after the intervention by 7.1 points, p < 0.001 and 0.21 points, p < 0.001) respectively. At the second follow‐up, health‐related emotional distress remained significantly improved compared with baseline levels by 0.11 points, p = 0.004. The longer participants had lived with psoriasis ( β = 146, p = 0.027), and the presence of co‐morbid health problems (β = 111, p = 0.051) the greater the improvement in the positive mental health immediately after the intervention. No predictors were identified for negative mental health. This study indicates that the promotion of positive mental health needs to be integrated into the climate therapy program, and sustained in their home context.
Abstract
Background
The Norwegian guidelines for postnatal care strongly recommend that families are offered home visit by a midwife within the first week after early discharge from maternity clinic, ...in addition to home visit by health visitor 7-10 days after delivery. Due to lack of midwifery resources out of hospital, Bergen municipality has started a project where selected groups such as first time mothers, minority families and women who during pregnancy are defined as being in need of extra follow up, receive a home visit by their antenatal midwives. The main purpose of the study is to explore user satisfaction with the home visit by the midwife, and the parents’ experience of security and coping the first week after the delivery.
Methods
The design is a mixed method design including a clinical controlled trial. In addition to questions about the home visit, Parents’ Postnatal Sense of Security is used to measure safety, and by The Orientation to Life Questionnaire, coping as a Sense of Coherence is measured. The trial includes an intervention group who receive home visit by midwife, and a control group who met the inclusion criteria, but of different reasons do not receive home visit by midwife. The data collection started in November 2018 and is in progress.
Results
Preliminary results shows that the families consider home visit by midwife as useful, and as a good support the first week after delivery. Results from comparing the two groups regarding Sense of Security and Sense of Coherence will be presented.
Conclusions
Implications for better postpartum care will be presented.
Key messages
Investigate parents’ satisfaction with postpartum care at home, and ‘sense of security’ and ‘coping as a sense of coherence’.
Contribute with suggestions for how to improve the postnatal care in a health promoting perspective.
Background: Although older people often have challenges with fractures and dizziness/balance problems, knowledge concerning the impact of reablement of people with these conditions is limited. Aim: ...To explore functional changes in reablement for older home-dwelling people with fractures and dizziness/balance problems regarding 1) occupational performance and satisfaction with performance, 2) physical function and 3) health-related quality of life, and 4) which occupations they prioritize as rehabilitation goals. Material and Methods: The sample is derived from a nationwide clinically controlled trial in Norway consisting of 149 participants with fractures and 113 with dizziness/balance problems who participated in a four to 10-week reablement program. Data were collected at baseline and at 10-week, 6-month, and 12-month follow-up and were analyzed with paired f-tests and analysis of covariance. Occupational priorities were categorized into sub-areas of occupation. Results: Both groups had significant short-, mid-, and long-term improvements in occupational performance and satisfaction with performance. Except for balance from baseline to 12-month follow-up, the fracture group showed significant improvements in physical function and health-related quality of life at all follow-ups. The results varied more in the group with dizziness/balance problems in physical function and health-related quality of life. Functional mobility was the highest prioritized occupational sub-area in both groups. Conclusion: The findings of this study provide extended knowledge about goals and functional changes in people with fractures and dizziness/balance problems following a reablement program. Significance: Tailoring and individual adjustments according to diagnosis may be important in person-centered care in reablement. Keywords: activities of daily living, Canadian occupational performance measure, diagnosis, occupation, health related quality of life, physical function, rehabilitation
Background
Previous research has suggested empirically based gambling loss limits, with the goal of preventing gambling related harm in the population. However, there is a lack of studies relating ...gambling loss limits to individual factors such as income. The current study examines whether gambling loss limits should be income-specific.
Materials and methods
The dataset was derived from three representative cross-sectional surveys of the Norwegian population and consisted of 14,630 gamblers. Four income groups, based on a quartile approximation, were formed. Gambling related harm was measured with the Problem Gambling Severity Index (PGSI), and precision-recall (PR) analyses were used to identify loss limits for the different income groups at two levels of gambling severity: moderate-risk gambling and problem gambling.
Results
For both levels of gambling severity, we found the lowest income group to have the lowest gambling loss limits, and the highest income group to have the highest loss limits, which compared to the loss limits for the total sample, were lower and higher, respectively. Calculating the cut-offs for moderate-risk gamblers, we found a consistently ascending pattern from the lowest to the highest income group. Calculating the cut-offs for problem gamblers, we found a similar pattern except for the two middle income groups.
Conclusion
The results suggest that income moderates empirically derived gambling loss limits. Although replication is required, income-based gambling loss limits may have higher applied value for preventing gambling related harm, compared to general loss limits aimed at the entire population.
Reablement is a rehabilitation intervention for community-dwelling older adults, which has recently been implemented in several countries. Its purpose is to improve functional ability in daily ...occupations (everyday activities) perceived as important by the older person. Performance and satisfaction with performance in everyday life are the major outcomes of reablement. However, the evidence base concerning which factors predict better outcomes and who receives the greatest benefit in reablement is lacking.
The objective of this study was to determine the potential factors that predict occupational performance and satisfaction with that performance at 10 weeks follow-up.
The sample in this study was derived from a nationwide clinical controlled trial evaluating the effects of reablement in Norway and consisted of 712 participants living in 34 municipalities. Multiple linear regression was used to investigate possible predictors of occupational performance (COPM-P) and satisfaction with that performance (COPM-S) at 10 weeks follow-up based on the Canadian Occupational Performance Measure (COPM).
The results indicate that the factors that significantly predicted better COPM-P and COPM-S outcomes at 10 weeks follow-up were higher baseline scores of COPM-P and COPM-S respectively, female sex, having a fracture as the major health condition and high motivation for rehabilitation. Conversely, the factors that significantly predicted poorer COPM-P and COPM-S outcomes were having a neurological disease other than stroke, having dizziness/balance problems as the major health condition and having pain/discomfort. In addition, having anxiety/depression was a predictor of poorer COPM-P outcomes. The two regression models explained 38.3% and 38.8% of the total variance of the dependent variables of occupational performance and satisfaction with that performance, respectively.
The results indicate that diagnosis, functional level, sex and motivation are significant predictors of outcomes following reablement.
In-depth knowledge regarding interdisciplinary collaboration, a key feature in reablement, is scarce.
To elucidate how the interdisciplinary collaboration in reablement worked in a Norwegian context.
...Seven focus group interviews were conducted with 33 health care providers working in interdisciplinary reablement teams in seven municipalities across the country. The focus group interviews were transcribed and an hermeneutical analysis was conducted.
The analysis resulted in four main themes: "participant's own goals as a common interdisciplinary platform", "a positive professional community", "learning from each other's skills and competencies" and "new roles and joint efforts but specific competencies". The results show that interdisciplinary collaboration in reablement depends on participants defining their own rehabilitation goals, which function as a professional unifying platform for the interdisciplinary collaboration. The challenges for participants in reablement are often complex and include assessments, effort and a need for close collaboration between several different professionals. A tight interdisciplinary collaboration causes major changes in roles, often from a particular role to a more general role with broader job tasks. Although different professionals perform the same rehabilitation tasks, it is important that each professional contributes their unique competence and thus together they complete each other's competencies.
Factors that have a positive impact on interdisciplinary collaboration in reablement are participants' definitions of their goals, number and variety of professionals involved, how closely these professionals collaborate, the amount of time for communication and shared planning and decision making.
Social support is a crucial coping resource in the development of a strong sense of coherence. However, little is known about which components of social support are most important for the positive ...development of sense of coherence.
The aim of this study is to investigate the ability of the six social provisions in Weiss's theory of social support to predict the positive development of sense of coherence among people with mental health problems.
The study has a prospective design including a baseline assessment and one-year follow-up.
The community mental health care system in a large city in Norway.
The sample comprised 107 people with mental health problems. The inclusion criteria were: 18–80 years of age, living at home, mental health problems considered relatively stable, able to engage in dialogue, reliant on the mental health services and/or an activity centre, good orientation, mastery of the Norwegian language and no alcohol and/or drug problems. A total of 92 completed both measures.
Sense of coherence was measured by the Sense of Coherence questionnaire, mental symptoms by the revised Symptom Checklist-90-R and social support by The Social Provision Scale (all Norwegian versions).
The results show that while social support predicted change in sense of coherence (standardized beta coefficient for social support was 0.32,
P
=
0.016), mental symptoms did not (standardized beta coefficient −0.07,
P
=
0.621). The social provision of opportunity for nurturance contributed most to the prediction (standardized beta coefficient 0.24,
P
=
0.019).
The results indicate that improving social support with special emphasis on opportunity for nurturance might provide important opportunities for increasing sense of coherence among people with mental health problems.
PDF
