title: Interventions to reduce dependency in personal activities of daily living in community dwelling adults who use homecare services: a systematic review.
abstract: OBJECTIVE
  To identify interventions that aim to reduce dependency in activities of daily living (ADL) in homecare service users. To determine: content; effectiveness in improving ability to perform ADL; and whether delivery by qualified occupational therapists influences effectiveness.
  
  
  METHODS
  The Cochrane Central Register of Controlled Trials, MEDLINE, EMBASE, AMED, CINAHL, PsycINFO, OTseeker, PEDro, Web of Science, CIRRIE, and ASSIA.
  
  
  METHODS
  We included: randomised controlled trials, non-randomised controlled trials and controlled before and after studies. Two reviewers independently screened studies for inclusion, assessed risk of bias and extracted data. A narrative synthesis of the findings was conducted.
  
  
  RESULTS
  Thirteen studies were included, totalling 4975 participants. Ten (77%) were judged to have risk of bias. Interventions were categorised as those termed 're-ablement' or 'restorative homecare' (n=5/13); and those involving separate components which were not described using this terminology (n=8/13). Content of the intervention and level of health professional input varied within and between studies. Effectiveness on ADL: eight studies included an ADL outcome, five favoured the intervention group, only two with statistical significance, both these were controlled before and after studies judged at high risk of bias. ADL outcome was reported using seven different measures. Occupational therapy: there was insufficient evidence to determine whether involvement of qualified occupational therapists influenced effectiveness.
  
  
  CONCLUSIONS
  There is limited evidence that interventions targeted at personal ADL can reduce homecare service users' dependency with activities, the content of evaluated interventions varies greatly.
authors.affiliation: Faculty of Medicine and Health Sciences, University of Nottingham, UK phillip.j.whitehead@nottingham.ac.uk.
authors.forename: Phillip J
authors.initials: PJ
authors.lastname: Whitehead
authors.affiliation: Faculty of Medicine and Health Sciences, University of Nottingham, UK.
authors.forename: Esme J
authors.initials: EJ
authors.lastname: Worthington
authors.affiliation: Faculty of Medicine and Health Sciences, University of Nottingham, UK.
authors.forename: Ruth H
authors.initials: RH
authors.lastname: Parry
authors.affiliation: Faculty of Medicine and Health Sciences, University of Nottingham, UK.
authors.forename: Marion F
authors.initials: MF
authors.lastname: Walker
authors.affiliation: Faculty of Medicine and Health Sciences, University of Nottingham, UK.
authors.forename: Avril E R
authors.initials: AE
authors.lastname: Drummond
mesh_terms: D000203:Activities of Daily Living; D000328:Adult; D000367:Age Factors; D000368:Aged; D016022:Case-Control Studies; D003858:Dependency, Psychological; D005081:Exercise Therapy / Q000379:methods*; D005260:Female; D006699:Home Care Services / Q000458:organization & administration*; D006801:Humans; D057187:Independent Living; D008297:Male; D008875:Middle Aged; D009788:Occupational Therapy / Q000379:methods*; D010348:Patient Care Team / Q000458:organization & administration; D011379:Prognosis; D016032:Randomized Controlled Trials as Topic; D020127:Recovery of Function; D018570:Risk Assessment; D016896:Treatment Outcome
keywords: Homecare services; occupational therapy; personal activities of daily living; re-ablement; restorative homecare