The effects of in-home rehabilitation on task self-efficacy in mobility-impaired adults: A randomized clinical trial.
OBJECTIVE
To examine the effect on mobility self-efficacy of a multifactorial, individualized, occupational/physical therapy (OT/PT) intervention delivered via teletechnology or in-home visits.


METHODS
Randomized, clinical trial.


METHODS
One Department of Veterans Affairs and one private rehabilitation hospital.


METHODS
Sixty-five community-dwelling adults with new mobility devices. Thirty-three were randomized to the control or usual care group (UCG), 32 to the intervention group (IG).


METHODS
Four, once-weekly, 1-hour OT/PT sessions targeting three mobility and three transfer tasks. A therapist delivered the intervention in the traditional home setting (trad group n = 16) or remotely via teletechnology (tele group n = 16).


METHODS
Ten-item Likert-scale measure of mobility self-efficacy.


RESULTS
The IG had a statistically significantly greater increase in overall self-efficacy over the study period than the UCG (mean change: IG 8.8, 95% confidence interval (CI) = 3.8-13.7; UCG 1.2, 95% CI = -5.8-8.2). Descriptively, the IG exhibited positive changes in self-efficacy for all tasks and greater positive change than the UCG on all items with the exception of getting in and out of a chair. Comparisons of the two treatment delivery methods showed a medium standardized effect size (SES) in both the tele and trad groups, although it did not reach statistical significance for the tele group (SES: tele = 0.35, 95% CI = -2.5-0.95; trad = 0.54, 95% CI = 0.06-1.14).


CONCLUSIONS
A multifactorial, individualized, home-based OT/PT intervention can improve self-efficacy in mobility-impaired adults. The trend toward increased self-efficacy irrespective of the mode of rehabilitation delivery suggests that telerehabilitation can be a viable alternative to or can augment traditional in-home therapy.
Sanford
Jon A
JA
Rehabilitation Research and Development Center, Atlanta Veterans Affairs Medical Center, Decatur, Georgia, USA. jon.sanford@med.va.gov
Griffiths
Patricia C
PC
Richardson
Peg
P
Hargraves
Katina
K
Butterfield
Tina
T
Hoenig
Helen
H
D000203:Activities of Daily Living; D000368:Aged; D051341:Dependent Ambulation; D006233:Persons with Disabilities / Q000534:rehabilitation*; D005260:Female; D006699:Home Care Services; D006801:Humans; D008297:Male; D008875:Middle Aged; D051346:Mobility Limitation; D009788:Occupational Therapy; D026741:Physical Therapy Modalities; D020377:Self Efficacy; D012656:Self-Help Devices; D017216:Telemedicine