Lannin Natasha Anne, Clemson Lindy, McCluskey Annie, Lin Chung-Wei Christine, Cameron Ian D, Barras Sarah
Rehabilitation Studies Unit, The University of Sydney, PO Box 6, Ryde, New South Wales 2112, Australia.
BMC Health Serv Res. 2007 Mar 14;7:42. doi: 10.1186/1472-6963-7-42.
Pre-discharge home visits aim to maximise independence in the community. These visits involve assessment of a person in their own home prior to discharge from hospital, typically by an occupational therapist. The therapist may provide equipment, adapt the home environment and/or provide education. The aims of this study were to investigate the feasibility of a randomised controlled trial in a clinical setting and the effect of pre-discharge home visits on functional performance in older people undergoing rehabilitation.
Ten patients participating in an inpatient rehabilitation program were randomly assigned to receive either a pre-discharge home visit (intervention), or standard practice in-hospital assessment and education (control), both conducted by an occupational therapist. The pre-discharge home visit involved assessment of the older person's function and environment, and education, and took an average of 1.5 hours. The hospital-based interview took an average of 40 minutes. Outcome data were collected by a blinded assessor at 0, 2, 4, 8 and 12 weeks. Outcomes included performance of activities of daily living, reintegration to community living, quality of life, readmission and fall rates.
Recruitment of 10 participants was slow and took three months. Observed performance of functional abilities did not differ between groups due to the small sample size. Difference in activities of daily living participation, as recorded by the Nottingham Extended Activities of Daily Living scale, was statistically significant but wide confidence intervals and low statistical power limit interpretation of results.
Evaluation of pre-discharge home visits by occupational therapists in a rehabilitation setting is feasible, but a more effective recruitment strategy for a main study is favored by application of a multi-centre setting.
出院前家访旨在最大限度地提高患者在社区中的独立性。这些家访通常由职业治疗师在患者出院前对其家中情况进行评估。治疗师可能会提供设备、调整家庭环境和/或提供教育。本研究的目的是调查在临床环境中进行随机对照试验的可行性，以及出院前家访对接受康复治疗的老年人功能表现的影响。
10名参加住院康复计划的患者被随机分配，分别接受出院前家访（干预组）或标准的院内评估和教育（对照组），两者均由职业治疗师进行。出院前家访包括对老年人的功能和环境进行评估以及提供教育，平均耗时1.5小时。基于医院的访谈平均耗时40分钟。结果数据由一名盲法评估者在0、2、4、8和12周时收集。结果包括日常生活活动表现、重新融入社区生活、生活质量、再入院率和跌倒率。
招募10名参与者的过程缓慢，耗时三个月。由于样本量小，两组之间观察到的功能能力表现没有差异。根据诺丁汉扩展日常生活活动量表记录，日常生活活动参与度的差异具有统计学意义，但置信区间较宽且统计效力较低，限制了对结果的解释。
在康复环境中由职业治疗师对出院前家访进行评估是可行的，但采用多中心设置更有利于为主研究制定更有效的招募策略。
