Effectiveness of Implementing a Reablement Model in Community-Based Long-Term Care Centers
试验速览
- 阶段
- 不适用
- 状态
- 招募中
- 入组人数
- 300
- 试验地点
- 8
- 主要终点
- BPSD - Neuropsychiatric Inventory-Questionnaire (NPI-Q)
研究概览
简要总结
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.
详细描述
This study adopts a mixed-methods design, incorporating both quantitative and qualitative components. The quantitative component employs a quasi-experimental design and is expected to recruit approximately 300 adults aged 18 years or older with long-term care needs from eight community-based long-term care facilities across northern, central, and southern Taiwan. Facilities will be assigned to either an experimental group or a wait-list control group. The experimental group will receive a 12-week reablement intervention, while the control group will initially receive usual care and subsequently receive the same intervention. The reablement intervention consists of group activities (once weekly, 30 minutes per session) and individualized activities (at least twice weekly, 15-30 minutes per session), addressing mobility, cognitive function, activities of daily living, and social participation. Outcomes will be assessed before and after the intervention, including mobility (SPPB), cognitive function (BHT-7), activities of daily living (Barthel Index and IADL), depressive symptoms (GDS-5), neuropsychiatric symptoms (NPI-Q), quality of life (SF-12, EQ-VAS, and Life Satisfaction Scale), and individualized goal attainment, to evaluate the effectiveness of the reablement model.
The qualitative component will employ the extended case method, with the eight day care facilities serving as the research settings. Through field observations, document analysis, and semi-structured interviews with approximately 50 facility staff members, service users, and family caregivers, the study will explore in depth the implementation process, influencing factors, and practical strategies associated with introducing the reablement model into real-world care settings. Qualitative data will be analyzed using thematic analysis to develop a reablement service model and practical implementation principles tailored to the context of community-based long-term care in Taiwan.
This study is expected to establish a locally applicable reablement service model for community-based long-term care and provide empirical evidence to support policy development and improvements in service quality. The findings may also serve as a practical reference for long-term care facilities seeking to implement reablement-oriented care, thereby promoting the maintenance of functional abilities, improving quality of life, and supporting healthy aging among older adults.
研究设计
- 研究类型
- Interventional
- 分配方式
- Non Randomized
- 干预模型
- Crossover
- 主要目的
- Treatment
- 盲法
- None
入排标准
- 年龄范围
- 18 Years 至 —（Adult, Older Adult）
- 性别
- All
- 接受健康志愿者
- 是
入选标准
- •Aged 18 years or older and assessed as CMS Level 2 or above.
- •Regularly receiving adult day care services and attending at least two days per week.
- •Able to understand simple instructions and participate in activities with assistance.
排除标准
- •Severe cognitive impairment or severe visual or hearing impairment that interferes with participation in activities or assessments.
- •A major fall within the past three months or acute symptoms that prevent participation in assessments or study procedures.
- •Concurrent participation in another intensive rehabilitation program or research intervention.
- •Clear unwillingness to participate in the study intervention or inability to complete the three-month intervention period.
研究组 & 干预措施
Reablement Group
The experimental group will first receive a 12-week reablement intervention, consisting of both group and individualized activities.
干预措施: Reablement intervention (Behavioral)
Waiting List Control Group
The control group (wait-list control group) will first receive 12 weeks of usual care, followed by the same reablement intervention provided to the experimental group. Usual care will consist of routine activities provided by the adult day care centers, including stretching and muscle-strengthening exercises, group-based cognitive and craft activities, individualized activities, lunch, and scheduled rest periods.
结局指标
主要结局
BPSD - Neuropsychiatric Inventory-Questionnaire (NPI-Q)
时间窗: 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.
Mobility - Short Physical Performance Battery (SPPB)
时间窗: 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)
时间窗: 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)
时间窗: 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)
时间窗: 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.
Depression - Geriatric Depression Scale 5 (GDS-5)
时间窗: 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)
时间窗: 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)
时间窗: 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.
次要结局
未报告次要终点