Supporting daily functioning of persons with a neurological disorder: (cost)effectiveness of Occupational Therapy at Home E-Rehabilitation (OTHER) for persons post-stroke
Mensen revalideren na een beroerte vaak kort in een verpleeghuis om daarna thuis verder te revalideren, waar ze pas echt de gevolgen van de beroerte ervaren.
Ondersteuning door de ergotherapeut
Ergotherapie thuis met activiteitenmonitoring en (online)coaching (OTHER) ondersteunt het zelfmanagement en de uitvoer van dagelijkse activiteiten. De activiteitenmonitor registreert de bewegingen tijdens de dagelijkse activiteiten en informeert via een tablet de revalidant en ergotherapeut. Deze informatie ondersteunt mensen bij het realiseren van de eigen doelen gericht op de dagelijkse activiteiten. Daarbij geven ergotherapeuten coaching thuis en online via beeldbellen.
Wij onderzoeken of OTHER leidt tot verbetering van de uitvoering van dagelijkse activiteiten en het zelfmanagement thuis. Revalidanten uit 5 zorgorganisaties (Limburg, Gelderland, Noord- en Zuid-Holland) krijgen OTHER. Het effect op dagelijks functioneren, zelfmanagement en zorgkosten vergelijken we met een groep revalidanten die reguliere ergotherapie krijgt.
Margriet Pol, senior onderzoeker bij lectoraat Ergotherapie - Participatie en Omgeving bij de Hogeschool van Amsterdam, vertelt op welke manier e-health ergotherapeuten ondersteunt bij geriatrische revalidatie.
• OBJECTIVE(S)/RESEARCH QUESTION(S) To study the effectiveness and cost-effectiveness of Occupational Therapy (OT) at Home E-Rehabilitation (OTHER) to improve performance and self-management in daily activities of community-dwelling persons post-stroke, 6 months after start OTHER compared to usual care. • STUDY DESIGN Mixed methods design based on the Medical Research Council Framework (MRC) for the further development, feasibility, and (cost-) effectiveness of the OTHER. In the Developing phase, OTHER is further developed and an exploratory study will be conducted in which other smart technologies can be used to support daily functioning at home. Accordingly, the feasibility of the intervention, implementation, and research protocol will be evaluated by a mixed-methods feasibility study in one of the five participating centres with 20 participants post-stroke and the involved occupational therapists. The (cost-)effectiveness of OTHER will be evaluated in a 2-armed stepped-wedge randomized controlled trial in four centres of geriatric rehabilitation. The participating centres that are situated in the west, south, and east of the Netherlands, will include 192 patients, 96 in each group. Alongside the (cost-)effect study, we will conduct a process evaluation using mixed methods, a quantitative approach for investigating treatment fidelity and adherence to the intervention, and a qualitative approach for evaluating experiences and satisfaction with the intervention. During the four-year project, a Community of Practice (CoP) is active and runs parallel to all the research and implementation activities whereby persons post-stroke representatives, their partners and occupational therapists (OTs) of each GRC will participate, besides researchers and students. • RESEARCH POPULATION Persons post-stroke who are admitted to a geriatric rehabilitation centre with an indication for follow-up geriatric rehabilitation and OT at home. Persons post-stroke are included when they can walk and when they feel they have sufficient communication skills for participating in an interview. • OUTCOME MEASURES The primary outcome measure is ‘perceived daily performance’ six months after the start of the intervention, compared to baseline functioning, measured by the Canadian Occupational Performance Measure. Secondary outcomes are patient’s satisfaction with their daily performance, self-management, patient’s quality of life, satisfaction with occupational therapy, and cost-effectiveness. Process evaluation outcomes are the impact of OTHER on the transition from a geriatric rehabilitation centre to home, treatment fidelity and adherence to OTHER, and the facilitators and barriers persons post-stroke and the OTs experience. • RELEVANCE OTHER provides the right care in the right place with the application of technology (activity monitoring, visualizations on a tablet, videoconferencing) and occupational performance coaching, to support persons post-stroke to be more physically active, to increase performance in daily activities, and to support their post-stroke self-management, resulting in decreasing clinical days. This project provides a new intervention and tools for OTs based on scientific research to support persons post-stroke at home. This is of great relevance for the OT-profession because 42% of the Dutch OTs are working in an interprofessional team with persons in GR with persons post-stroke accounting for 14% of the GR population. Moreover, it supports the implementation of eHealth and Occupational Performance Coaching in OT in the Netherlands. This project will deliver in total four international peer-reviewed publications, two professional publications, a postgraduate course to train OTs in the implementation of OTHER, and classes for the initial OT bachelor and OT/interprofessional master programs of the four participating universities of applied sciences. • TIME SCHEDULE Year 1 Development & feasibility study, Year 2/3 Stepped wedge Randomized Controlled Trial and evaluation cost-effectiveness OTHER, Year 4 Implementation follow up, reporting and dissemination of the results. • KEYWORDS Occupational therapy, Post-Stroke, Sensor activity monitoring, Videoconferencing, Daily performance, Self-management, Neurological disorders.