Department of Health Services Research, Care and Public Health Research Institute, Maastricht University, Maastricht, The Netherlands.
Living Lab in Ageing and Long-Term Care, Maastricht, The Netherlands.
J Am Geriatr Soc. 2021 Sep;69(9):2566-2578. doi: 10.1111/jgs.17286. Epub 2021 Jun 7.
BACKGROUND/OBJECTIVES: Homecare staff often take over activities instead of "doing activities with" clients, thereby hampering clients from remaining active in daily life. Training and supporting staff to integrate reablement into their working practices may reduce clients' sedentary behavior and improve their independence. This study evaluated the effectiveness of the "Stay Active at Home" (SAaH) reablement training program for homecare staff on older homecare clients' sedentary behavior.
Cluster randomized controlled trial (c-RCT).
Dutch homecare (10 nursing teams comprising a total of 313 staff members).
264 clients (aged ≥65 years).
SAaH seeks to equip staff with knowledge, attitude, and skills on reablement, and to provide social and organizational support to implement reablement in homecare practice. SAaH consists of program meetings, practical assignments, and weekly newsletters over a 9-month period. The control group received no additional training and delivered care as usual.
Sedentary behavior (primary outcome) was measured using tri-axial wrist-worn accelerometers. Secondary outcomes included daily functioning (GARS), physical functioning (SPPB), psychological functioning (PHQ-9), and falls. Data were collected at baseline and at 12 months; data on falls were also collected at 6 months. Intention-to-treat analyses using mixed-effects linear and logistic regression were performed.
We found no statistically significant differences between the study groups for sedentary time expressed as daily minutes (adjusted mean difference: β 18.5 (95% confidence interval [CI] -22.4, 59.3), p = 0.374) and as proportion of wake/wear time (β 0.6 [95% CI -1.5, 2.6], p = 0.589) or for most secondary outcomes.
Our c-RCT showed no evidence for the effectiveness of SAaH for all client outcomes. Refining SAaH, by adding components that intervene directly on homecare clients, may optimize the program and require further research. Additional research should explore the effectiveness of SAaH on behavioral determinants of clients and staff and cost-effectiveness.
背景/目的：家庭护理人员经常接管活动，而不是“与”客户一起开展活动，从而阻碍客户在日常生活中保持活跃。培训和支持员工将再适应纳入其工作实践中，可以减少客户的久坐行为并提高他们的独立性。本研究评估了“在家保持活跃”（SAaH）再适应培训计划对家庭护理人员对老年家庭护理客户久坐行为的影响。
集群随机对照试验（c-RCT）。
荷兰家庭护理（由 10 个护理团队组成，共计 313 名员工）。
264 名客户（年龄≥65 岁）。
SAaH 旨在使员工具备有关再适应的知识、态度和技能，并为实施家庭护理实践中的再适应提供社会和组织支持。SAaH 由计划会议、实际作业和每周通讯组成，持续 9 个月。对照组未接受额外培训，按常规提供护理。
使用三轴腕戴式加速度计测量久坐行为（主要结果）。次要结果包括日常功能（GARS）、身体功能（SPPB）、心理功能（PHQ-9）和跌倒。在基线和 12 个月时收集数据；在 6 个月时还收集了跌倒数据。使用混合效应线性和逻辑回归进行意向治疗分析。
我们发现研究组之间在以每天分钟表示的久坐时间（调整后的平均差异：β 18.5（95%置信区间[CI] -22.4，59.3），p=0.374）和以清醒/佩戴时间的比例表示的久坐时间（β 0.6（95% CI -1.5，2.6），p=0.589）方面均无统计学显著差异，或在大多数次要结果方面。
我们的 c-RCT 表明，SAaH 对所有客户结果均无效。通过添加直接干预家庭护理客户的组件来改进 SAaH，可以优化该计划，并需要进一步研究。进一步的研究应探讨 SAaH 对客户和员工的行为决定因素以及成本效益的有效性。
