Effectiveness of Implementing a Reablement Model in Community-Based Long-Term Care Centers

Condition(s) studied

Investigational drug(s) / intervention(s)

Reablement intervention: Reablement intervention consists group activities and individualized activities. Group activities will be conducted once a week for 30 minutes per session. The activities will focus on mobility, cognition and emotional well-being, independence in activities of daily living, and social participation. Healthcare professionals will design practical and engaging activities based on everyday life situations. Individualized activities will be conducted for 15-30 minutes per session, at least twice a week. Healthcare professionals will develop individualized activities that can be incorporated into participants' daily routines based on their functional abilities, personal interests, and available facility resources.

Study summary

This study will examine whether a reablement approach can help people receiving community-based long-term care maintain or improve their independence, daily functioning, and quality of life. Approximately 300 adults from eight long-term care facilities across Taiwan will participate. The 12-week reablement program includes group and individualized activities designed to support mobility, cognitive function, daily activities, and social participation. Participants' physical and cognitive function, daily living abilities, emotional well-being, quality of life, and personal goals will be assessed before and after the program.

The study will also include observations and interviews with care providers, participants, and family members to understand their experiences with the program and identify factors that support successful implementation. The findings are expected to help develop a practical reablement model for community-based long-term care in Taiwan and provide guidance for improving care quality, independence, and healthy aging.

Eligibility

Primary outcome measure(s)

• Mobility - Short Physical Performance Battery (SPPB) — For intervention group: from enrollment to the end of treatment at 12 weeks For control group: from enrollment to the end of treatment at 24 weeks
  The SPPB assesses lower-extremity physical performance in older adults and comprises three major components: static balance, gait speed, and lower-extremity strength. Total scores range from 0 to 12, with higher scores indicating better physical function.
• Cognition - Brain Health Test-7 (BHT-7) — For intervention group: from enrollment to the end of treatment at 12 weeks For control group: from enrollment to the end of treatment at 24 weeks
  The BHT-7 was developed from the cognitive assessment component of the original BHT-cog. It includes assessments of time orientation, five-item immediate and delayed recall, categorical verbal fluency, cube copying, clock drawing, and the three-step Luria test, with a total score of 23 points. The BHT-7 can be used to identify individuals with mild cognitive impairment and dementia, with cutoff scores of 17/18 and 14/15, respectively. The BHT-7 also maintains good screening performance among individuals with higher levels of education.
• Basic Activities of Daily Living - Barthel Index (BI) — For intervention group: from enrollment to the end of treatment at 12 weeks For control group: from enrollment to the end of treatment at 24 weeks
  The Barthel Index measures functional independence in performing basic activities of daily living. It comprises 10 items covering feeding, bathing, grooming, dressing, bowel control, bladder control, toileting, transfers, mobility, and stair climbing. Items are scored according to the participant's level of independence, typically as 0, 5, 10, or 15 points. Total scores range from 0 to 100, with higher scores indicating greater functional independence.
• Instrumental Activities of Daily Living - Lawton Instrumental Activities of Daily Living Scale (Lawton IADL Scale) — For intervention group: from enrollment to the end of treatment at 12 weeks For control group: from enrollment to the end of treatment at 24 weeks
  The Lawton IADL Scale assesses independence in instrumental activities of daily living (IADL) among older adults. The scale includes eight activities: telephone use, shopping, food preparation, housekeeping, laundry, transportation, medication management, and financial management. The traditional version uses dichotomous scoring (0-8 points); however, modified versions employ three- or four-level scoring systems according to the degree of independence, with each item scored from 0 to 4 and total scores ranging from 0 to 24. Higher scores indicate better functional performance. The present study will use the 24-point version to provide greater sensitivity in detecting intervention effects.
• BPSD - Neuropsychiatric Inventory-Questionnaire (NPI-Q) — For intervention group: from enrollment to the end of treatment at 12 weeks For control group: from enrollment to the end of treatment at 24 weeks
  The NPI-Q is used to assess the severity of neuropsychiatric symptoms experienced by individuals with dementia during the previous month, as well as the level of distress these symptoms cause their caregivers. It covers 12 neuropsychiatric symptoms, including delusions, hallucinations, agitation/aggression, depression/dysphoria, anxiety, elation/euphoria, apathy/indifference, disinhibition, irritability/lability, aberrant motor behavior, nighttime behavioral disturbances, and appetite/eating disturbances. Each symptom is rated for severity on a 0-3 scale, with higher scores indicating greater symptom severity, and for caregiver distress on a 0-5 scale, with higher scores indicating greater caregiver distress.
• Depression - Geriatric Depression Scale 5 (GDS-5) — For intervention group: from enrollment to the end of treatment at 12 weeks For control group: from enrollment to the end of treatment at 24 weeks
  The GDS-5 is used to assess the severity of depressive symptoms in participants. It consists of five items, with a total score ranging from 0 to 5. Higher scores indicate greater severity of depressive symptoms.
• Quality of Life - World Health Organization-Five Well-Being Index (WHO-5) — For intervention group: from enrollment to the end of treatment at 12 weeks For control group: from enrollment to the end of treatment at 24 weeks
  The WHO-5 is a self-report instrument measuring mental well-being. It consists of five statements relating to the past two weeks. Each statement is rated on a 6-point scale, with higher scores indicating better mental well-being.
• Quality of Life - EurolQoL (VAS) — For intervention group: from enrollment to the end of treatment at 12 weeks For control group: from enrollment to the end of treatment at 24 weeks
  The EQ-VAS is used to assess participants' self-rated health status. It consists of a vertical scale with endpoints labeled "the best health you can imagine" and "the worst health you can imagine." Participants are asked to mark an "X" on the scale to indicate their health status on the day of assessment. Higher scores indicate better perceived health status.

Trial sites (8)

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