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Table 1 Concept of Reablement in Various Geographic Regions between 2015 and 2019

From: Reablement through time and space: a scoping review of how the concept of ‘reablement’ for older people has been defined and operationalised

Region (Country)

Concept of reablement between 2015 and 2019

Australasia

(Australia/New Zealand)

• Australian research mentions that ‘reablement’, developed and formalised since the 1990s, has focused on goal-oriented cognitive rehabilitation to improve everyday functioning for people with dementia. Such interventions have been described as a form of reablement [7, 48,49,50,51,52,53].

• The book Ageing in Australia included a chapter “Care and Support for Older People” with a section on the more ‘typical’ reablement, defined as “(short-term) services for people with poor physical or mental health to help them accommodate their illness by learning or relearning the skills necessary for daily living” [54]. It was discussed as a person-centred service and emphasised the necessity to develop an aged-care workforce of professionals capable to do things with older persons and find optimal ways to engage family carers.

• While restorative home care / reablement services for older adults have been “shown to be effective in reducing functional dependency and increasing functional mobility, confidence in everyday activities, and quality of life” [55], the literature often focuses on support workers and non-health professionals; e.g. to receive better training and improve collaboration [55], to promote health-behaviour change [56], and to develop the skills to work with complexity in community aged care [57].

• A trend towards developing better collaboration is evident in a paper about the feasibility of LifeFul, a relationship and reablement-focused “culture change program” in residential aged care [58]. However, the authors stated that one of the main challenges to successfully implementing reablement has been compliance by staff.

• A critical review described reablement as “an emerging global practice model in community- and home-based care for older people” [59] and, although it is gaining acceptance worldwide, researchers and policy makers still have questions about what reablement means and how it is used in practice. They found nine essential features, the most predominant being the wish to improve the functionality of clients so they can continue to live in their own homes; the authors concluded that the under-representation of social connectivity for clients was regrettable [59].

• A New Zealand paper discussed benchmarking to assist the improvement of service quality in home support services for older people and stated that the country “has developed restorative home support services, very close to what in the United Kingdom are called reablement services, involving elements of goal facilitation, functional and repetitive ADL exercises, support worker training and enhanced supervision, health professional training, care management and comprehensive geriatric assessment” [60].

Continental Europe (Netherlands)

• A Dutch study protocol for a randomised controlled trial (RCT) on the effects, costs, and feasibility of the ‘Stay Active at Home’ reablement training programme for homecare professionals described reablement as home-care services that are “goal-oriented, holistic and person-centred taking into account the capabilities and opportunities of older adults” [61].

North America

(Canada/United States)

• Despite the early implementation of reablement in the United States, our search did not result in any articles from this country during this time period.

• A Canadian systematic review explored the effectiveness of reablement and factors that contribute to successful implementation [62].

• Another Canadian systematic review described “the 4R interventions” (reablement, reactivation, rehabilitation, and restorative) with older adults receiving home care to improve “functional abilities, strength, gait speed, social support, loneliness, and the execution of activities of daily living (ADL) and instrumental ADL (IADL)” [63].

Scandinavia

(Denmark/Norway/Sweden)

• Although Denmark and Sweden were the earliest adopters of reablement programmes in this region, it was typically referred to as “everyday rehabilitation” or “home rehabilitation”. The first Scandinavian paper to use the term ‘reablement’ discussed a Danish pilot study on whether a home-based reablement programme influenced the ADL ability of older adults [64].

• A Swedish systematic review stated that “re-ablement services are in a period of strong development, but the terms and definitions used remain unclear, and the scientific evidence is still weak” [65].

• A Swedish study was conducted to illuminate older adults’ perceptions of a multi-professional team’s caring skills as success factors for health support in short-term goal-directed reablement [66], and concluded that health professionals’ caring skills need to be addressed as an evidence base in the area of homecare for older people.

• A Norwegian RCT on the effectiveness of reablement in home-dwelling older adults [67] and a study protocol for further investigation of the effects described reablement as “an intensive, multidisciplinary, multicomponent, person-centered, home-based type of rehabilitation, where ordinary activities of daily living are used for rehabilitative purposes” [68].

• A Norwegian study on the validity, interpretability, and feasibility of the Canadian Occupational Performance Measure described reablement as a “time limited, person-centered, and goal directed, delivered by a multidisciplinary team” [69]. The authors followed up with a cost-effectiveness analysis alongside an RCT [70].

• The same authors also investigated potential factors that predict an older person’s “occupational performance and satisfaction with that performance at 10 weeks follow-up” [71], and later conducted a clinical controlled trial in 47 Norwegian municipalities on the health effects of reablement in home-dwelling adults, writing that “reablement is an emerging approach in rehabilitation services, but evidence for its efficacy is rather weak and inconsistent” ([72]; emphasis added).

• A Norwegian qualitative study explored how an integrated multidisciplinary team experiences participation in reablement [73], followed by a study on how older adults experienced participation in reablement [74].

• Another Norwegian study examined interdisciplinary collaboration [75], and the same authors also described how relatives in a community setting experienced participation in the reablement process [76]. They then conducted a qualitative study on interdisciplinary reablement teams’ roles and experiences and described reablement as “a service for home-dwelling older people experiencing a decline in health and function” [77].

• Other qualitative research from Norway described reablement as an intervention “to provide necessary assistance to the client’s own efforts to achieve the best possible functioning coping ability and participation in social life” [78], as “an approach that aims to assist older adults, irrespective of diagnosis, to continue with their desired activities – as well as the activities of daily living – and to increase their independence” [79], and as “an interprofessional, home-based rehabilitation service that aims to enable senior residents to cope with everyday life and to prevent functional impairments” [80].

• Another Norwegian study wrote “many welfare states offer reablement, also known as restorative care, as an intervention to promote healthy ageing and support older adults in regaining or maintaining their independence in daily life” [81].

• The development of professional practice was the focus of a Norwegian study that presented a cross-sectional descriptive survey of community-working occupational therapists’ involvement in research and development projects [82], which included occupational therapy services and reablement. The authors wrote that “reablement is synonymous to the term ‘restorative care’, which is more commonly used in the USA, and describes home-based, goal-oriented intervention provided by a coordinated multidisciplinary team to home-dwelling elderly with functional decline” [83].

• Another study from Norway explored the content of physiotherapists’ supervision of ‘home trainers’ in reablement teams [83]; the lead author also published a paper that discussed variations in physiotherapy practices across reablement settings [84].

• In an article that examined the practice of support personnel supervised by physiotherapists (PTs) in Norwegian reablement services, the authors focused on PTs’ work, writing that “the key characteristics of the [reablement] service are the short-term and goal-oriented interventions provided by an interprofessional team” [85].

United Kingdom

(England/Scotland/Wales)

and Ireland

• In discussing a Patient Reported Experience Measure for use by older people in community services, the authors distinguished between social care re-ablement and healthcare hospital-at-home services [86].

• One British article examined ‘re-ablement’ or ‘restorative homecare’ interventions developed as an alternative to reduce dependency in ADLs in homecare to provide “time-limited, intensive input with the specific and explicit aim of enabling people to become independent in personal care activities wherever possible” [87].

• Another article described reablement as a “new paradigm to increase independence in the home amongst the ageing population” [88].

• A systematic review of the evidence on home-care reablement services “found no studies fulfilling our inclusion criteria that assessed the effectiveness of reablement interventions. We did note the lack of an agreed understanding of the nature of reablement” [89].

• In the UK’s first RCT of occupational therapy in homecare reablement, the authors state that The Care Act 2014 statutory guidance considers reablement to be “an example of prevention and has been identified as one of the ‘top-ten’ prevention services for older adults” [90], outlining that these services “aim to assist the person to maximise their ability to carry out activities independently with the aim of reducing the amount of paid care worker input required in the long term” [90].

• A formal examination of reablement stated that “there is limited evidence regarding the organisation and delivery of reablement services in England” [91].

• One study examined family-inclusive approaches to reablement in mental health, and defined reablement in terms of empowerment and social participation, particularly with regards to maximising users’ independence, choice, and quality of life [92].

• Evaluating three reablement services, researchers found a need for greater investment in research on user engagement [93].

• Another article studied goal-orientated cognitive rehabilitation in early-stage Alzheimer’s disease [48]; in a subsequent article, the authors stated that “rehabilitation (or reablement) is grounded in a philosophy of enablement reflecting a positive approach to finding solutions and encouraging optimal functioning. This philosophy emphasises a collaborative approach in service delivery, (…and) translates into specific individualised interventions aimed at optimising functioning [49].

• In a cost analysis of home care reablement for older people, reablement “actively engages the person in activities of daily living, thus improving their ability to perform those activities, which they might have lost after an episode of illness or other adverse life event” [94].

Cross-national studies

• A British–Irish systematic review assessed the effects of time-limited home-care reablement services for maintaining and improving the functional independence of older adults, and stated that “the reablement approach emphasises the active participation of an older person in working towards agreed goals that are designed to maximise independence and confidence” [95].

• British, Danish, Norwegian, and Dutch researchers comprehensively reviewed the reablement approach, describing it as “an intensive, time-limited intervention provided in people’s homes or in community settings, often multi- disciplinary in nature, focusing on supporting people to regain skills around daily activities. It is goal-orientated, holistic and person-centred irrespective of diagnosis, age and individual capacities” [96].