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弥合差距:为社区痴呆症患者制定循证支持的恢复性护理和康复实施策略的研究方案

Bridging the gap: Study protocol for development of an implementation strategy for evidence-informed reablement and rehabilitation for community-dwelling people with dementia.

作者信息

O'Connor Claire Mc, Poulos Christopher J, Kurrle Susan, Anstey Kaarin J

机构信息

University of New South Wales, School of Psychology, Sydney, Australia; HammondCare, Centre for Positive Ageing, Sydney, Australia; Neuroscience Research Australia, Sydney, Australia; University of New South Wales, Ageing Futures Institute, Sydney, Australia.

HammondCare, Centre for Positive Ageing, Sydney, Australia; University of New South Wales, School of Population Health, Sydney, Australia.

出版信息

Arch Gerontol Geriatr. 2023 May;108:104943. doi: 10.1016/j.archger.2023.104943. Epub 2023 Jan 21.

Abstract

BACKGROUND

Extensive research supports the use of goal-directed reablement and rehabilitation interventions to address a range of physical, functional, cognitive and behavioural needs of people living with dementia. Despite this, evidence-informed multidisciplinary reablement and rehabilitation interventions are not being offered in usual dementia care across Australia. An examination is needed of how best to implement reablement and rehabilitation interventions within the community-based dementia care sector.

METHODS

Drawing on implementation science, this study uses a four-phase mixed-methods retrospective and prospective approach: (1) clinical audit to evaluate current clinical practice, and through focus groups with practitioners, identify practitioner-led goals and targets for practice change; (2) Delphi survey to converge opinions from the diverse stakeholders involved in reablement in dementia, to reach national consensus around an implementation strategy; (3) hybrid pragmatic effectiveness-implementation pilot will facilitate testing of the implementation strategy in parallel with exploring effectiveness of the reablement intervention specifically within a real-world Australian community aged care context; (4) implementation capacity building.

DISCUSSION

This study will result in a freely available, nationally relevant implementation protocol, designed and tailored via input from key stakeholders over a series of iterative project activities. By testing this protocol via a pilot implementation-effectiveness study, we will generate national information about effectiveness of evidence-informed reablement programs for people living with dementia across various community aged care settings. Outcomes have potential to influence policy and drive widespread practice change, increasing access to evidence-informed reablement and rehabilitation for people living with dementia across Australia.

摘要

背景

广泛的研究支持采用目标导向的恢复和康复干预措施,以满足痴呆症患者在身体、功能、认知和行为方面的一系列需求。尽管如此,澳大利亚常规痴呆症护理中并未提供基于证据的多学科恢复和康复干预措施。需要研究如何在社区痴呆症护理部门中最佳地实施恢复和康复干预措施。

方法

本研究借鉴实施科学,采用四阶段混合方法,包括回顾性和前瞻性方法:(1)临床审计以评估当前临床实践,并通过与从业者的焦点小组,确定从业者主导的实践变革目标和指标;(2)德尔菲调查以汇集参与痴呆症恢复的不同利益相关者的意见,围绕实施策略达成全国共识;(3)混合务实有效性-实施试点将有助于在探索恢复干预措施在澳大利亚现实社区老年护理背景下的有效性的同时,对实施策略进行测试;(4)实施能力建设。

讨论

本研究将产生一个免费提供的、与全国相关的实施协议,该协议通过一系列迭代项目活动中关键利益相关者的投入进行设计和定制。通过试点实施-有效性研究对该协议进行测试,我们将生成关于循证恢复计划在澳大利亚各种社区老年护理环境中对痴呆症患者有效性的全国性信息。研究结果有可能影响政策并推动广泛的实践变革,增加澳大利亚痴呆症患者获得循证恢复和康复服务的机会。

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