Reforming allied health service provision in residential aged care to improve the rehabilitation reach: a feasibility study
Natasha Brusco
A * , Christina Ekegren A , Helen Rawson B , Nicholas F. Taylor C D , Julia Morphet B , Keith Hill A , Jennifer Anderson E , Kelly Stephen E , Amelia Crabtree F G H , Pazit Levinger I , Sara L. Whittaker A , Sze-Ee Soh J , Fiona Dulfer K and Katherine Lawler D L
A
B
C
D
E
F
G
H
I
J
K
L
Abstract
My Therapy is an allied health guided, co-designed rehabilitation self-management program for residents of aged care facilities. This study aimed to determine the feasibility of implementing My Therapy in a residential aged care setting.
This observational study was conducted on a 30-bed wing, within a 90-bed metropolitan residential aged care facility, attached to a public health service, in Victoria, Australia. Staff and resident data were collected prospectively over 6 weeks (staff focus groups, patient surveys, and audits) to evaluate the feasibility domains of acceptability, reach and demand, practicality, integration, limited efficacy testing and adaptations.
Twenty-six residents and five allied health staff (physiotherapy and occupational therapy) participated. My Therapy was acceptable to residents (survey) and staff (focus groups). Via initial My Therapy discussions between the resident and the therapists, to determine goals and resident preferences, My Therapy reached 26 residents (n = 26/26, 100% program reach), with 15 residents subsequently receiving a rehabilitation program (n = 15/26, 58% program demand). The remaining 11 residents did not participate due to resident preference or safety issues (n = 11/26, 42%). Collecting physical function outcome measures for limited efficacy testing was practical, and the cost of My Therapy was AUD$6 per resident per day, suggesting financial integration may be possible. Several adaptations were required, due to limited allied health staff, complex resident goal setting and program co-design.
My Therapy has the potential to improve the rehabilitation reach of allied health services in residential aged care. While introducing this low-cost intervention is feasible, adaptations were required for successful implementation.
Keywords: aged care, allied health, co-design, empowering, physical activity, rehabilitation, residential aged care, self-management, self-practice.
References
1 Australian Government. Royal Commission into Aged Care Quality and Safety. 2021. Available at https://www.royalcommission.gov.au/aged-care/final-report.
2 Benjamin K, Edwards N, Ploeg J, et al. Barriers to physical activity and restorative care for residents in long-term care: a review of the literature. J Aging Phys Act 2014; 22: 154-165.
| Crossref | Google Scholar | PubMed |
3 World Health Organization. Rehabilitation. 2023. Available at https://www.who.int/news-room/fact-sheets/detail/rehabilitation.
4 Huglin J, Whelan L, McLean S, et al. Exploring utilisation of the allied health assistant workforce in the Victorian health, aged care and disability sectors. BMC Health Serv Res 2021; 21: 1144.
| Crossref | Google Scholar | PubMed |
5 Meulenbroeks I, Raban MZ, Seaman K, et al. Therapy-based allied health delivery in residential aged care, trends, factors, and outcomes: a systematic review. BMC Geriatr 2022; 22: 712.
| Crossref | Google Scholar | PubMed |
6 Meulenbroeks I, Seaman K, Raban MZ, et al. Allied health in residential aged care: Using routinely collected data to improve funding opportunities. Australas J Ageing 2023; 42: 221-224.
| Crossref | Google Scholar | PubMed |
7 Cichocki M, Quehenberger V, Zeiler M, et al. Effectiveness of a low-threshold physical activity intervention in residential aged care–results of a randomized controlled trial. Clin Interv Aging 2015; 10: 885-895.
| Crossref | Google Scholar | PubMed |
8 Parry S, Chow M, Batchelor F, et al. Physical activity and sedentary behaviour in a residential aged care facility. Australas J Ageing 2019; 38: E12-E18.
| Crossref | Google Scholar | PubMed |
9 Quehenberger V, Cichocki M, Krajic K. Sustainable effects of a low-threshold physical activity intervention on health-related quality of life in residential aged care. Clin Interv Aging 2014; 9: 1853-1864.
| Crossref | Google Scholar | PubMed |
10 Brusco NK, Tilley L, Walpole B, et al. Feasibility of increasing the dosage of inpatient occupational therapy and physiotherapy rehabilitation via independent tasks and exercises:‘My Therapy’. Aust Occup Ther J 2019; 66: 739-752.
| Crossref | Google Scholar | PubMed |
11 Brusco NK, Kugler H, Dulfer F, et al. Including exercise self-management as part of inpatient rehabilitation is feasible, safe and effective for patients with cognitive impairment. J Rehabil Med Clin Commun 2022; 5: 1000076.
| Crossref | Google Scholar | PubMed |
12 Lancaster GA, Thabane L. Guidelines for reporting non-randomised pilot and feasibility studies. Pilot Feasibility Stud 2019; 5: 114.
| Crossref | Google Scholar |
13 Eldridge SM, Chan CL, Campbell MJ, et al. CONSORT 2010 statement: extension to randomised pilot and feasibility trials. BMJ 2016; 355: 5239.
| Crossref | Google Scholar | PubMed |
14 Brusco NK, Ekegren CL, Taylor NF, et al. Self-managed occupational therapy and physiotherapy for adults receiving inpatient rehabilitation (‘My Therapy’): protocol for a stepped-wedge cluster randomised trial. BMC Health Serv Res 2021; 21: 811.
| Crossref | Google Scholar | PubMed |
15 Hoffmann TC, Glasziou PP, Boutron I, et al. Better reporting of interventions: template for intervention description and replication (TIDieR) checklist and guide. Gesundheitswesen 2016; 78: 175-188.
| Crossref | Google Scholar | PubMed |
16 Bowen DJ, Kreuter M, Spring B, et al. How we design feasibility studies. Am J Prev Med 2009; 36: 452-457.
| Crossref | Google Scholar | PubMed |
17 De Morton NA, Brusco NK, Wood L, et al. The de Morton Mobility Index (DEMMI) provides a valid method for measuring and monitoring the mobility of patients making the transition from hospital to the community: an observational study. J Physiother 2011; 57: 109-116.
| Crossref | Google Scholar | PubMed |
18 Eagar K, Gordon R, Snoek MF, et al. The Australian National Aged Care Classification (AN‐ACC): a new casemix classification for residential aged care. Med J Aust 2020; 213: 359-363.
| Crossref | Google Scholar | PubMed |
19 Wesson J, du Toit SHJ, Wales K, et al. Australian National Aged Care Classification behaviour assessment and people living with dementia in residential aged care: Inclusive language for reform? Australas J Ageing 2023; 42: 234-240.
| Crossref | Google Scholar | PubMed |
20 Hsieh H-F, Shannon SE. Three approaches to qualitative content analysis. Qual Health Res 2005; 15: 1277-1288.
| Crossref | Google Scholar | PubMed |
21 Brett L, Stapley P, Meedya S, et al. Sufficient exercise for Australians living with dementia in residential aged care facilities is lacking: An exploration of policy incoherence. Aust N Z J Public Health 2018; 42: 427-429.
| Crossref | Google Scholar | PubMed |
22 Sexton BP, Taylor NF. To sit or not to sit? A systematic review and meta‐analysis of seated exercise for older adults. Australas J Ageing 2019; 38: 15-27.
| Crossref | Google Scholar | PubMed |
23 Brett L, Ilhan E. The type and scope of physiotherapy is under-utilised in Australian residential aged care facilities: a national, cross-sectional survey of physiotherapists. BMC Geriatr 2022; 22: 625.
| Crossref | Google Scholar | PubMed |
24 Australian Government. Aged Care Quality Standards. 2023. Available at https://www.health.gov.au/topics/aged-care/aged-care-reforms-and-reviews/royal-commission-into-aged-care-quality-and-safety/the-aged-care-quality-standards
25 Brusco NK, Walpole B, Kugler H, et al. Barriers and facilitators to implementing self-directed therapy activities in inpatient rehabilitation settings. Aust Occup Ther J 2023; 70: 617-626.
| Crossref | Google Scholar |
26 Whittaker SL, Taylor NF, Hill KD, et al. Self-managed occupational therapy and physiotherapy for adults receiving inpatient rehabilitation (‘My Therapy’): protocol for a mixed-methods process evaluation. BMC Health Serv Res 2021; 21: 810.
| Crossref | Google Scholar | PubMed |
