Occupational therapy in HomEcare Re-ablement Services (OTHERS): study protocol for a randomized controlled trial

Background: Homecare re-ablement services have been developed by local authorities in England in response to the government agenda for health and social care. These services aim to optimize users’ independence and ability to cope at home, and reduce the need for ongoing health and social care services. However, there is currently limited evidence and guidance regarding the optimum configuration and delivery of re-ablement services. In particular, the impact of occupational therapy input on service user outcomes has been highlighted as a specific research priority. Methods/Design: This feasibility randomized controlled trial (RCT) will recruit 50 people from one local authority led homecare re-ablement service in England. Those who provide informed consent will be randomized to receive either usual homecare re-ablement (without routine occupational therapy input) or usual homecare re-ablement plus an enhanced program targeted at activities of daily living (ADL), delivered by an occupational therapist. The primary aim of this study is to assess the feasibility of conducting a further, powered study. The participant outcomes assessed will be independence in personal and extended ADL, health and social care-related quality of life, number of care support hours, falls, acute and residential admissions and use of health and social care services. These will be assessed at two weeks, three months and six months post-discharge from the re-ablement service. Discussion: To our knowledge, this is the first RCT of occupational therapy in homecare re-ablement services. The results of this study will lay the foundations for a further powered study. The findings will be relevant to researchers, clinicians, commissioners and users of adult social care services

Cross-country analyses of technological innovations and labor demand based on harmonized, multi-linked and micro-aggregated firm-level data

This chapter illustrates how the relationship between technological innovations and labor demand can be analyzed in a cross-country setting by use of harmonized, multilinked, and microaggregated firm-level data. An investigation of the relationship between new market product (market novelty) sales and labor demand (employment) derived from a two-output cost function is used as an example. The example is embedded in recent literature and discussions on data availability, data limitations, and possible estimation methods. Fixed effects estimations reveal that the sales of market novelties have a significant impact on relative employment in the representative manufacturing firm. In contrast, employment in the representative service firm does not benefit from new market products but rather from the intensity with which information and communication technology innovations are used (in this case the proportion of broadband internet connected employees). The results coincide with those in the firm-level literature, but the approach allows inclusion of a broader variety of firm characteristics, such as firm size, international experience, and ICT intensity.acceptedVersio

Interventions to reduce dependency in personal activities of daily living in community-dwelling adults who use homecare services: protocol for a systematic review

Background There is a growing demand for services whereby individuals receive assistance from care workers for personal care within the home. This has led to the development of re-ablement or restorative homecare services that provide time-limited input aimed at reducing dependency in personal activities of daily living, and preventing or delaying the need for further homecare support. However, little is currently known about how such interventions are configured, or how they may affect individuals’ ability to carry out personal care independently. Methods/Design We will seek to identify studies that compare an intervention designed to reduce dependency in personal activities of daily living with routine input or usual care as the control. We will include randomised controlled trials, nonrandomised controlled trials, and controlled before and after studies. We will also include interrupted time series studies. We shall search electronic databases in addition to searching for ongoing and unpublished studies, and where appropriate will contact key authors. Two reviewers will independently screen articles for inclusion; will assess risk of bias using quality assessment tools; and will carry out data extraction using pre-prepared forms. Any disagreements, at any stage, will be resolved by discussion and the involvement of a third reviewer if needed. We will produce a narrative summary of the results. A meta-analysis will be conducted if sufficient data are available of appropriate quality and comparability. Discussion The findings from this review will inform future practice within homecare re-ablement services; will inform policy decisions about the structure, organisation and content of such services; and will identify areas where further research is warranted