Enhancing functional improvement in reablement – a qualitative study

Abstract

Background and purpose Reablement is aimed to enable people to remain independent in their lives and is based on users’ own goals. Interventions are described to involve both physical exercises and guidance in everyday activities. However, descriptions of the content of reablement practices are sparse. This study aims to investigate and discuss how physiotherapists (PTs) on reablement teams plan and adapt training interventions to enhance users’ functional abilities. Methods We conducted fieldwork with seven Norwegian reablement teams, including video observations of interventions and interviews with PTs and home trainers. The results were analysed through thematic content analyses in which we used motor learning theory to interpret the results. Results The analyses revealed that reablement practices typically involved either (i) exercise-based training, (ii) activity-based training, or (iii) a combination of both exercise- and activity-based training. Discussion Reablement interventions are described as individually tailored and goal oriented. However, in practice, it is challenging to implement training that emphasises both physical function- and goal-oriented activities. Motor learning and relearning depend on several principles and require both exercise-based and activity-based training. Standardised approaches emphasising physical exercises may neglect a particular activity that is important to the user. On the other hand, exclusively activity-based approaches may omit individual, specific aspects of bodily movement and physical constraints. The use of only one aspect of training may limit the potential for functional improvement, while a combination of the two is more likely to meet the principles of motor learning theories.