title: Reablement, Reactivation, Rehabilitation and Restorative Interventions With Older Adults in Receipt of Home Care: A Systematic Review.
abstract: OBJECTIVE
  To systematically review the impact of reablement, reactivation, rehabilitation, and restorative (4R) programs for older adults in receipt of home care services.
  
  
  METHODS
  Systematic review.
  
  
  METHODS
  We searched the following electronic bibliographic databases: MEDLINE, EMBASE, PsycINFO, CINAHL (Cumulative Index to Nursing and Allied Health), SPORTDiscus and The Cochrane Library and reference lists.
  
  
  METHODS
  Randomized controlled trials that describe original data on the impact of home-based rehabilitative care and were written in English.
  
  
  METHODS
  Fifteen studies were identified. Study details were recorded using a predefined data abstraction form. Methodological quality was assessed by 2 independent reviewers. If there were discrepancies, a third author resolved these.
  
  
  METHODS
  Given the tailored and personalized approach of the 4R interventions, a range of primary outcomes were assessed, including functional abilities, strength, gait speed, social support, loneliness, and the execution of activities of daily living (ADL) and instrumental ADL (IADL). 4R interventions are intended to reduce the long-term use of home care services. As such, health care resource utilization will be assessed as a secondary outcome.
  
  
  RESULTS
  There are 2 distinct clusters of interventions located in this systematic review (defined by hospitalizations): (1) "hospital to home" programs, in which participants are discharged from hospital wards with a 4R home care, and (2) those that focus on clients receiving home care without a hospital stay immediately preceding. Reflecting the highly tailored and personalized nature of 4R interventions, the studies included in this review assessed a wide range of outcomes, including survival, place of residence, health care service usage, functional abilities, strength, walking impairments, balance, falls efficacy and rates of falls, pain, quality of life, loneliness, mental state, and depression. The most commonly reported and statistically significant outcomes were those pertaining to the service usage and functional abilities of participants.
  
  
  CONCLUSIONS
  From cost savings to improvements in clinical outcomes, 4R interventions show some promise in the home care context. However, there are several key issues across studies, including questions surrounding the generalizability of the results, in particular with respect to the ineligibility criteria for most interventions; the lack of information provided on the interventions; and lack of information on staff training.
authors.affiliation: Faculty of Medicine, University of British Columbia, Vancouver, Canada; Centre for Hip Health & Mobility, Vancouver Coastal Health Research Institute & University of British Columbia, Vancouver, Canada. Electronic address: simsg@mail.ubc.ca.
authors.forename: Joanie
authors.initials: J
authors.lastname: Sims-Gould
authors.affiliation: Centre for Hip Health & Mobility, Vancouver Coastal Health Research Institute & University of British Columbia, Vancouver, Canada; Interdisciplinary Studies Graduate Program, University of British Columbia, Vancouver, Canada.
authors.forename: Catherine E
authors.initials: CE
authors.lastname: Tong
authors.affiliation: Centre for Hip Health & Mobility, Vancouver Coastal Health Research Institute & University of British Columbia, Vancouver, Canada.
authors.forename: Lutetia
authors.initials: L
authors.lastname: Wallis-Mayer
authors.affiliation: Faculty of Medicine, University of British Columbia, Vancouver, Canada; Centre for Hip Health & Mobility, Vancouver Coastal Health Research Institute & University of British Columbia, Vancouver, Canada.
authors.forename: Maureen C
authors.initials: MC
authors.lastname: Ashe
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D006801:Humans; D008297:Male; D020127:Recovery of Function / Q000502:physiology*; D012046:Rehabilitation
keywords: Home care; older adults; rehabilitation; restorative care