A multicenter investigation of reablement in Norway: a clinical controlled trial

BACKGROUND: 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. METHODS: 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. RESULTS: 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. CONCLUSION: 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. TRIAL REGISTRATION: The trial was registered at ClinicalTrials.gov on October 24, 2014, (retrospectively registered) identifier: NCT02273934.