Community Rehabilitation Services Research Articles

Te Vaerua Community Rehabilitation Service: A Participation Action Research study of community based rehabilitation in the Cook Islands

Te Vaerua Community Rehabilitation Service: A Participation Action Research study of community based rehabilitation in the Cook Islands

Impact of a person-centred community rehabilitation service on outcomes for individuals with a neurological condition

Purpose: To evaluate the impact of a person-centred, community rehabilitation service on outcomes for people with a neurological condition, in the first year of service.Method: A prospective, observational, pre-post study was conducted with 206 people who had a neurological condition and attended the rehabilitation service to restore function (e.g., Stroke); maximize recovery in an ongoing situation (e.g., Spina Bifida); or maximize function and independence while preparing for inevitable decline (e.g., Parkinson’s Disease). Outcomes were measured via self-report questionnaires, prior to, and following three months of rehabilitation. The primary outcome was achievement of self-identified goals, measured by the Patient-Specific Functional scale. Secondary outcomes included the Lawton Instrumental Activities of Daily Living (IADL) scale, EQ-5D-5L European Quality of Life scale, and ICECAP-O – Index of Capability for Older Adults and health and medical resource use.Results: Participants demonstrated significant goal achievement and a significant reduction in health and medical resource use. There were small positive changes in the Lawton IADL, EQ-5D-5L, and ICECAP-O however these changes were not significant.Conclusions: In the first year of operation, the community rehabilitation service made a significant impact on outcomes for individuals with a neurological condition. Further research is required to identify appropriate measures of activities of daily living and quality of life that reflect person-centred rehabilitation outcomes for restoring function, maximizing function, or preparing for functional decline.Implications for RehabilitationSelf-identified goals are an important guide for achievement of meaningful outcomes for individuals with a neurological condition.Person-centred outcome measures are required to evaluate the benefits of a person-centred community rehabilitation service for individuals with a neurological condition.

Access to Rehabilitation at Six Months Post Stroke: A Profile from the Action on Secondary Prevention Interventions and Rehabilitation in Stroke (ASPIRE-S) Study

Background and Purpose: Stroke is the third leading cause of death and disability. Few studies have assessed the profile and adequacy of access to rehabilitation services after ischaemic stroke both in the inpatient and community setting. The objectives of the Action on Secondary Prevention Interventions and Rehabilitation in Stroke (ASPIRE-S) study were to assess the disability and rehabilitation profile, adherence with rehabilitation recommendations and needs of patients 6 months following hospital admission for stroke. Methods: A rehabilitation prescription was completed before hospital discharge for each participant, and adherence to this prescription was assessed at 6 months to determine whether patients received their recommended rehabilitation needs. Results: Two hundred and fifty six patients were recruited to ASPIRE-S. The average age was 69 (SD 12.8). A majority (n = 221, 86%) were referred to the hospital multidisciplinary team, 59% (n = 132) were referred to all services (physiotherapy (PT), occupational therapy (OT), speech and language therapy (SLT)). Fifty-four percent (n = 119) of patients (seen by the multidisciplinary team) were referred for further rehabilitation in the community on discharge. Of these 119 patients, 112 (95%) recalled receiving community rehabilitation services. However, while most (68%) patients were referred for several disciplines (PT, OT, SLT), the most commonly recalled therapy (55%) was from a single discipline. The most commonly recommended frequency of therapy required was on a weekly basis. Sixty-one patients (51%) reported a delay in services, with some still awaiting services at 6 months. Conclusion: Results from this prospective study revealed that a significant number of patients (57%) did not receive the therapy recommended on discharge. Future initiatives should include the development of policies, which support more effective, equitable multidisciplinary rehabilitation for stroke patients in the community.

Heart Wellness Programme: a pilot community-based cardiac rehabilitation programme in a multiethnic society.

Community-based exercise programmes have been shown to be effective in the Western world. However, there is a dearth of literature on their effectiveness in Asia. This pilot study aims to assess the effectiveness of the Asian community-based Health Wellness Programme (HWP) in Singapore. The HWP provides community cardiac rehabilitation services. A retrospective database analysis was conducted on cardiac rehabilitation patients who had completed the one-year wellness programme from 2010 to 2011. Patients were included in the programme if they had an underlying cardiac disease such as ischaemic heart disease and were deemed as stable by their cardiologist. Patients with New York Heart Association Class III or IV heart failure were excluded from this programme. Sociodemographic, anthropometric, clinical and laboratory data was recorded. Changes between the baseline and final measurements were analysed. Complete data from a total of 136 patients was analysed. Improvements were noted in body fat percentage (change [Δ] -1.3%, p < 0.01), distance walked (Δ 9.7 m, p = 0.01), total cholesterol (Δ -7.8 mg/dL, p = 0.03), low-density lipoprotein (Δ -7.8 mg/dL, p = 0.03) and triglyceride (Δ -17.8 mg/dL, p < 0.01). The low-to-moderate intensity HWP seems to be effective in a multiethnic community setting. To confirm the quality and effectiveness of such a programme in secondary cardiovascular prevention, more evidence from prospective controlled trials with suitable controls is needed.

COMPREHENSIVE GERIATRIC CARE VERSUS STANDARD CARE FOR ELDERLY REFERRED TO A REHABILITATION UNIT – A RANDOMIZED CONTROLLED TRIAL

Objective: To investigate the effect of comprehensive geriatric care (CGC) in elderly referred to a rehabilitation unit. This article describes the considerations behind the study. Design: Participants were randomized to either CGC or standard care. Setting: Participants were recruited from two community care rehabilitation units in Aarhus Municipality, Denmark, in the period between 2012 and 2015. Participants: Inclusion: Elderly patients aged 65 and older admitted from home or hospital. Exclusion: Persons receiving palliative care or assessed by a geriatrician during the past month. Intervention: Medical history, physical examination, blood tests, medication adjustment and follow-up by a geriatrician. The control group received standard care with the general practitioners (GPs) as back-up. Outcomes: Primary outcome: Hospital contacts drawn from national registers. Secondary outcomes: GPs contacts, institutionalization, medication status and mortality collected from national registers, activities of daily living (ADL), physical and cognitive function and quality of life measures collected by a blinded occupational therapist. All outcomes were assessed at day 10, 30 and 90 after arrival at the rehabilitation unit. Conclusion: A new model of care for elderly referred to community rehabilitation was developed and implemented. The potential benefits of this model were compared with usual care in a community rehabilitation unit in a pragmatic randomized clinical trial. We hypothesized that the geriatrician-performed CGC in elderly referred to a rehabilitation unit will reduce the hospital contacts by 25 % without increase in mortality and in contacts to GPs and home care services. We expect that this model will prevent deterioration in ADL, physical and cognitive functioning, and reduce the risk of institutionalization. If the results are positive, community rehabilitation services should be encouraged to change their routines for treatment of this population accordingly.

Understanding factors influencing the choice of discharge destination by older patients post total lower limb replacement: A qualitative study

Background: In Singapore, the clinical pathway for total knee replacement was introduced in 1997 to streamline multidisciplinary care and reduce length of stay for patients in acute hospitals. However, patients who chose to be discharged to a community hospital for rehabilitation currently have a longer length of stay due to the higher demand and longer waiting time for beds in these step-down care facilities. To our knowledge, no qualitative studies have been done in Singapore to investigate the post-discharge issues faced by these patients. This study aims to understand how decisions about discharge were being made among elderly patients post-discharge. Design: Grounded theory qualitative methodology was applied. Method: Data was collected from nine inpatients who recently underwent total knee replacement or total hip replacement surgery in a tertiary hospital in Singapore by in-depth interviews conducted between October 2012 and July 2013. Data was analyzed using thematic analysis. Findings: Three major themes emerged from the interviews when participants were asked about the reasons for choosing a community hospital instead of going home after discharge. The themes were: perceived lack of caregiver; lack of confidence; and services provided in the community hospitals. Conclusion: This study showed that factors related to perceived unavailability of caregivers, low level of confidence and accessibility of comprehensive community rehabilitation services were important considerations among elderly patients when choosing their discharge destinations and care. Relevant stakeholders can then explore solutions to these problems so as to correctly site patients.

Community reintegration following spinal cord injury: Insights for health professionals in community rehabilitation services in New Zealand

When returning home following a spinal cord injury (SCI), individuals will be in contact with a range of health professionals who will be involved in their ongoing rehabilitation. This study explored the qualitative literature to determine what individuals with SCI perceive to be the barriers or facilitators to community reintegration to provide insights for health professionals working in community rehabilitation services in New Zealand. The databases of Ovid Medline, CINAHL, the Allied and Complementary Medicine Database (AMED), Cochrane Database of Systematic Reviews and PEDro were searched for relevant articles. Barriers and facilitators to community reintegration were classified into the International Classification of Functioning, Disability and Health (ICF) framework with the addition of self-management factors to further define personal factors. Of the 381 studies uncovered in the search, seven met the inclusion criteria. Findings revealed that accessibility of the environment, re-establishing self, support and connections were strong themes for reintegration. The challenge for health professionals working in the community with individuals with SCI is to be client-centred and ensure the individual’s needs are suitably met to support them to re-connect with their work and community life.

Home Telehealth Video Conferencing: Perceptions and Performance.

BackgroundThe Flinders Telehealth in the Home trial (FTH trial), conducted in South Australia, was an action research initiative to test and evaluate the inclusion of telehealth services and broadband access technologies for palliative care patients living in the community and home-based rehabilitation services for the elderly at home. Telehealth services at home were supported by video conferencing between a therapist, nurse or doctor, and a patient using the iPad tablet.ObjectiveThe aims of this study are to identify which technical factors influence the quality of video conferencing in the home setting and to assess the impact of these factors on the clinical perceptions and acceptance of video conferencing for health care delivery into the home. Finally, we aim to identify any relationships between technical factors and clinical acceptance of this technology.MethodsAn action research process developed several quantitative and qualitative procedures during the FTH trial to investigate technology performance and users perceptions of the technology including measurements of signal power, data transmission throughput, objective assessment of user perceptions of videoconference quality, and questionnaires administered to clinical users.ResultsThe effectiveness of telehealth was judged by clinicians as equivalent to or better than a home visit on 192 (71.6%, 192/268) occasions, and clinicians rated the experience of conducting a telehealth session compared with a home visit as equivalent or better in 90.3% (489/540) of the sessions. It was found that the quality of video conferencing when using a third generation mobile data service (3G) in comparison to broadband fiber-based services was concerning as 23.5% (220/936) of the calls failed during the telehealth sessions. The experimental field tests indicated that video conferencing audio and video quality was worse when using mobile data services compared with fiber to the home services. As well, statistically significant associations were found between audio/video quality and patient comfort with the technology as well as the clinician ratings for effectiveness of telehealth.ConclusionsThese results showed that the quality of video conferencing when using 3G-based mobile data services instead of broadband fiber-based services was less due to failed calls, audio/ video jitter, and video pixilation during the telehealth sessions. Nevertheless, clinicians felt able to deliver effective services to patients at home using 3G-based mobile data services.

Streamlining clinical practice in an Australian community rehabilitation service using The Calderdale Framework

Background/Aims: With increased budgetary demands, pressure exists to create a flexible workforce and ensure efficient service delivery within health care services. This study investigated the impact of using The Calderdale Framework on team dynamics, client focus and communication, and resource use in an existing community rehabilitation service. Methods: The Calderdale Framework provided a structured process where clinicians were able to determine relevant tasks that could be shared with other health professionals to develop a streamlined transprofessional screening tool. Associated risks were reviewed and the resulting training and governance structures were embedded into practice. Staff views and resource usage costs were collected at three time points during the implementation process. Findings: Qualitative data from staff suggest a positive impact of The Calderdale Framework on team dynamics, understanding each other's roles, and client focus. Resource usage analysis revealed an increase in the number of client services provided, as well a reduction in cost per client appointment. Conclusions: This study provides further insight into the processes, resource usage outcomes and staff reflections of using The Calderdale Framework. This structured tool appears beneficial to develop a flexible workforce and an efficient service within this community rehabilitation context.

Barriers and Facilitators in Physical Rehabilitation for Parkinson's Disease in the Arabian World.

Barriers and Facilitators in Physical Rehabilitation for Parkinson's Disease in the Arabian World.

Integrating telehealth services into a remote allied health service: A pilot study.

The continuity of care for people with neurological conditions in a remote northwest Queensland town as services are currently only available intermittently. Mixed methods design using questionnaires and staff review of the program and processes. Intermittent community rehabilitation service for clients with neurological conditions has been offered in Mount Isa and is supported by a similar fulltime service in Townsville. Both services use a unique client-centred, student-assisted, interprofessional model of care. Understanding participant experiences by obtaining feedback from clients, students and allied health professionals (AHPs) regarding their experiences of using telehealth in this setting. Previous clients of the North West Community Rehabilitation service were offered a review assessment using telehealth by an interprofessional team. Using telehealth enabled the client, remote AHP and students in Mount Isa to be connected to expert assistance in Townsville. The findings suggest that telehealth was useful in a community rehabilitation setting to provide review services for clients. This improved continuity of care for these clients because without this telehealth assessment, the clients would have had to wait up to 12 months for the next service period in Mount Isa or travel to a major urban centre to access a similar service. Feedback from clients, students and AHPs was positive; however, some challenges were identified. Recommendations for future service delivery using telehealth are outlined in the paper.

Nutrition Module Intervention to Improve Nutrition Knowledge, Attitude and Practice of Trainers for Persons with Disabilities in Rehabilitation Centers in Malaysia

Introduction: Other than parents, primary care providers such as community workers and rehabilitation service personnel are also important nutritional gatekeepers for persons with disabilities (PWD). Good nutrition management for PWD by joint efforts is most desirable to prevent further disablement in later years. This study aimed to evaluate the effectiveness of a nutrition module intervention on improving trainers' knowledge, attitude and practice in nutrition management for PWD in rehabilitation centres. Methods: This quasi-experimental study which employed mixed methods design recruited 45 trainers as intervention group and another 42 trainers as comparison group. Intervention group participated in a three-consecutive-day nutrition inter- vention while comparison group was trained on general health care services for PWD. Nutrition knowledge, attitude and practice scores for both groups were assessed using a validated questionnaire at baseline (T0), 1-month (T1) and 6-month (T2) intervals after intervention. Intervention trainer's on-the-job nutrition practice was further assessed by qualitative interviews. Results: Repeated measures ANCOVA demonstrated that intervention group attained significantly higher nutrition knowl - edge (p<0.001) and practice (p=0.001) scores than comparison group at T1 (mean difference for knowledge= 6.95; mean difference for practice= 2.93) and T2 (mean difference for knowledge= 10.30; mean difference for practice= 4.78). Signifi - cant higher nutrition attitude (p=0.004) score for intervention group was observed at T2 (mean difference= 3.08). Conclusion: This program produced favourable outcome on improving nutrition knowledge, attitude and practice of rehabilitation service personnel. The nutrition module is certainly relevant to serve as an educational or reference material for care providers of PWD in Malaysia.

Utilisation of existing community rehabilitation services by critical care survivors

Patients recovering from critical illness suffer many physical and psychological problems during their recovery, including muscle weakness, fatigue, signs and symptoms of PTSD, anxiety and depression [1]. At present, specialist intensive care follow-up and rehabilitation is inconsistent and in many geographical areas is nonexistent. As a result, many survivors of critical illness will require using existing community rehabilitation services [2]. The aim of this present service evaluation was to understand the utilisation of community rehabilitation services by critical care survivors.

Rehabilitation needs of the survivors of the 2013 Ya'an earthquake in China.

To determine the physical, functional and psychosocial rehabilitation needs of the injured survivors of the 2013 earthquake in Ya'an, China. Cross-sectional survey. A total of 143 injured survivors (80 males, 63 females, mean age 41.4 years (standard deviation (SD) 20.2)) were recruited for the study. A questionnaire was designed to collect their demographic and environmental information. Manual muscle testing and active range of motion (AROM) were used to assess physical function. The Modified Barthel Index was used to assess activities of daily living (ADL) and the Post-Traumatic Stress Disorder - Self Rating Scale was used to assess psychological status. The rehabilitation needs of the injured survivors were identified based on the assessment results. Physical problems of the back and lower limbs were more severe than those of the upper limbs, as measured by MMT and AROM. Various degrees of dependence in ADL were measured in 74.2% of subjects, and psychological distress was present in more than 50% of subjects. Rehabilitation training prescribed by local therapists included functional training (74.8%), exercises (49.0%), provision of splints (44.8%), etc. Psychological interventions were re-commended to most of the patients. There were high levels of need for assistive devices, and home and community modifications. There is a high level of need for early rehabilitation in hospital, followed by continued home and community rehabilitation services, particularly for injured survivors who are returning to villages with very limited resources.

Developing and validating with foot‐care abilities questionnaire (F‐CAQ) in a low risk population

Background A validated instrument for measuring client’s perceived problems with their abilities for foot-care was required to measure outcomes of the Meet Your Feet (MYF) program. The MYF pilot program is a component of the demand management strategy and linked with the Active Service Model (ASM) at Barwon Health Community Health and Rehabilitation Services. A literature search revealed no such instrument was available. We developed a questionnaire and tested it with a small sample group.

A qualitative study of views on disability and expectations from community rehabilitation service users.

Conceptualisations of disability influence perspectives in clinical rehabilitation. The individual model and the social model framing of disability offer differing interpretations of the causality of problems and suggested actions to achieve improvement. Current rehabilitation practice centres on a problem-solving goal-oriented approach. How clients and professionals think about disability will invariably influence reasoning and suggestions for action. We explored these issues in a convenience sample of 10 community rehabilitation service users in London, United Kingdom. We took a phenomenological approach, aiming to discover interviewees' individual experiences and conceptualisations of disability, and expectations from community rehabilitation. Semi-structured qualitative interviews were conducted from June to August 2011. Interview transcripts were analysed through open coding, constant comparison and thematic analysis. Participants constituted a group of older adults with acquired impairments and diverse medical background. Participants generally understood disability according to the individual model. There was a lack of self-identification as disabled and of explicit socio-political views on disability. This seemed to correlate with participants' life course and the experience of impairments and increasing vulnerability with old age. However, accounts of interviewees' current difficulties in life provided examples of the applicability and relevance of social model thinking. Participants' expectations from community rehabilitation ranged from those who had no clear expectations and took a passive service user role to those who had concrete wishes and were actively engaged with the service. Our interpretation of these findings is that it may be necessary to raise the public profile of community rehabilitation as a service; and that there is scope for conceptual work to actively develop and incorporate alternative ways of looking at disability into clinical rehabilitation practice.

Patients with long-term neurological conditions: delivering best practice in the community.

British Journal of Community NursingVol. 19, No. 12 Long-Term ConditionsPatients with long-term neurological conditions: delivering best practice in the communityAysha MendesAysha MendesSearch for more papers by this authorAysha MendesPublished Online:5 Dec 2014https://doi.org/10.12968/bjcn.2014.19.12.616AboutSectionsView articleView Full TextPDF/EPUB ToolsAdd to favoritesDownload CitationsTrack CitationsPermissions ShareShare onFacebookTwitterLinked InEmail View article References Department of Health (2005) National Service Framework for Long Term Conditions. DH, London. http://tinyurl.com/o3llaxh (accessed 12 November 2014) Google ScholarDudley Group NHS Foundation Trust (2014) Understanding long-term neurological conditions. http://tinyurl.com/pnnd4ke (accessed 12 November 2014) Google ScholarHealth Foundation (2013) Self-management support. http://tinyurl.com/ouyqas3 (accessed 12 November 2014) Google ScholarHouse of Commons (2012) Services for people with neurological conditions. Seventy-second Report of Session. http://tinyurl.com/8ax3u2t (accessed 12 November 2014) Google ScholarKing's Fund (2014) Active support for self-management. http://tinyurl.com/np5j4uo (accessed 12 November 2014) Google ScholarNational Audit Office (2011) Services for people with neurological conditions. Report by the Comptroller and Auditor General. http://tinyurl.com/bws-vyqf (accessed 12 November 2014) Google ScholarNeurological Alliance (2012) Consultation on the Commissioning Outcomes Framework indicators: Neurological Alliance response. http://tinyurl.com/pbbcppd (accessed 12 November 2014) Google ScholarSiegert RJ, Jackson DM, Playford ED, Fleminger S, Turner-Stokes L (2014) A longitudinal, multicentre, cohort study of community rehabilitation service delivery in long-term neurological conditions. BMJ Open 4: e004231. doi: https://doi.org/10.1136/bmjopen-2013-004231 Crossref, Google Scholar FiguresReferencesRelatedDetails 2 December 2014Volume 19Issue 12ISSN (print): 1462-4753ISSN (online): 2052-2215 Metrics History Published online 5 December 2014 Published in print 2 December 2014 Information© MA Healthcare LimitedPDF download

Transformation and training for a mobile workforce: Sharing lessons learnt

The use of mobile technology has become more prevalent in the National Health Service as a sought after tool to improve quality and enable more efficient working. Across England, mobile working has been trialed with out of hours GPs, community nurses, midwives and emergency care providers. However, research has shown that many mobile working projects fail to fully realise the potential benefits or progress past pilot stage. This is often due to factors such as lack of appropriate strategy, business leadership or clinical engagement in the project. In December of 2013, Central London Community Healthcare (CLCH) Community Rehabilitation Services in Westminster and Kensington & Chelsea piloted a mobile working solution. The App provided the community clinicians with real time access to clinical data and the ability to document information at the point of care. CLCH promoted close collaboration between internal Information Management and Technology, the Transformation Team and frontline clinicians to overcome previously identified barriers. The project was unique, as it had to meet the user needs of multiple rehabilitation teams that work across different geographic areas. In addition, the teams were made up of multidisciplinary allied health professionals such as occupational therapists, physiotherapists and rehabilitation assistants. At times the project was challenged by issues of user skill, compliance, and technical support and was faced with a further complexity of high turnover of staff due to rotational programmes. The aim of this presentation is to share valuable lessons learnt in the form of ten top transformation tips. The presentation will provide practical, useful strategies for transformation projects utilising mobile working technology. The following strategies will be discussed: 1. Clinician centred transformation 2. Evaluate current work practice – ‘ As is’ process International Journal of Integrated Care – Volume 14, 01 November – URN:NBN:NL:UI:10-1-116522– http://www.ijic.org/ International Digital Health and Care Congress, The King’s Fund, London, September 10-12 2014. 3. Collaborate to develop new ‘To be’ working process 4. Analyse user digital and technological skills 5. Appoint mobile working champions 6. Timely distribute devices and kit to encourage self-directed learning 7. Multi-dimensional training 8. Dynamic IT support 9. Monitor and measure 10. Capture creativity and evolution The onset of the digital age with advances in care technology has provided great opportunities to improve the outcomes and experience for patients whilst making the jobs of clinicians easier. At CLCH, an innovative mobile working project identified that smart deployment, training and IT support to use new technology is essential in order fully achieve such benefits. At present there is a significant gap in documented guidance on how to actually carry this out. This presentation highlights some of the effective methods used by CLCH to embed a mobile working solution. We hope that this presentation will influence other services to explore, consolidate and share their core principles for successful digital and technology transformations.

Enhancing Community-Based Rehabilitation for Stroke Survivors: Creating a Discharge Link

Background and Objective: Intensive poststroke rehabilitation is critical to maximizing outcomes, improving inpatient flow, and decreasing long-term costs. This regional initiative investigated the impact of improving access to timely intensive home-based stroke rehabilitation follow-up care on hospital length of stay (LOS) and readmission rates. The enhanced service was made available across the region’s rural geography to new stroke survivors transitioning home who were unable to access outpatient care. Methods: All new stroke survivors with ongoing rehabilitation needs being discharged from the hospital and eligible for home care received timely enhanced intensity of home-based rehabilitation services from existing community rehabilitation providers for 2 months after discharge. Five hundred twenty-four stroke survivors received this service over a 3-year period. The service priority rating was increased to reduce wait times to less than 5 days. Collaborative planning across sectors occurred through discharge link meetings. Comparative analysis was used to investigate health system measures before and after service implementation. Results: A 15.7-day decrease in hospital LOS and decreased hospital readmission rates were observed after enhanced service implementation. Functional Independence Measure (FIM) efficiency improved for those discharged from inpatient rehabilitation. Average wait time for community rehabilitation services decreased from 44 days to 4.4 days. The mean total number of community therapy visits more than doubled to an average of 12 per client. Conclusion: The provision of timely more intensive home-based rehabilitation services for new stroke survivors transitioning home and unable to access outpatient care was associated with decreased hospital LOS and decreased readmission rates.

Age is no barrier to using healthcare technology: A mobile working demonstration of cognitive assessment and training for the elderly

Sustaining independence as we age is highly dependent on good cognitive health. Cognitive impairment, especially memory impairment, is often the earliest feature of dementia. According to the Alzheimer's Society (2014), one in three people over 65 in the United Kingdom will develop dementia. The Department of Health (2013) has stressed that raising the diagnosis rates of dementia is key to helping support this group of people, their families and carers. There is a critical role for care technology to help improve the timely access to cognitive assessment and treatment for the aging population. For Central London Community Healthcare (CLCH), care technology is a key part of our out of hospital care. We provide community and in-patient services to almost one million people across the London boroughs of Barnet, Hammersmith & Fulham, Kensington & Chelsea, and Westminster. In December of 2013, Westminster and Kensington & Chelsea Community Rehabilitation Services piloted a mobile working solution. Mobile working is the ability to work anywhere, irrespective of time and place. In the context of community health services, mobile devices provide our community clinicians with real time access to valuable patient information and to document at the point of care. The mobile working solution provided the clinicians with a range of multidisciplinary assessment tools including the Montreal Cognitive Assessment (MoCA). The MoCA is a rapid screening instrument for mild cognitive dysfunction. The aim of the presentation is to showcase the unique interaction between client, clinician and technology by providing a demonstration of the mobile working solution that supports cognitive assessment and retraining. A client’s different cognitive domains such as attention and concentration, executive functions, memory, language, visuoconstructional skills, conceptual thinking, calculations, and orientation will be assessed on a tablet. Following the assessment, an example of a treatment activity using a cognitive retraining App will be given. A case study will also be discussed to illustrate how technology and mobile working is facilitating new ways to shape cognitive goal setting and treatment planning for older clients. At CLCH, the mobile working project has demonstrated that age does not have to be a barrier to the use of new technology. Care technology can play an important role in the future of community healthcare to be able to assess and treat cognitive impairment. Furthermore, this type of care International Journal of Integrated Care – Volume 14, 01 November – URN:NBN:NL:UI:10-1-116521– http://www.ijic.org/ International Digital Health and Care Congress, The King’s Fund, London, September 10-12 2014. technology may contribute to improved communication about the cognitive needs of older clients and in turn, facilitate better personalised care by making timely onward referrals to specialist memory services for rapid diagnosis and management of dementia.