Reablement of Instrumental Activities of Daily Living for Patients With Stroke: A Randomized Crossover Trial

Abstract

Abstract Importance: Reablement is a person-centered and goal-oriented rehabilitative intervention to optimize people’s chances to live independently. Objective: To investigate the effects of a reablement intervention on performance of instrumental activities of daily living (IADLs) in three aspects (i.e., actual performance, ability, and self-perceived difficulty) for patients with stroke. Design: A single-blinded, randomized crossover study. Setting: Participants’ home and community. Participants: Twenty-seven patients with stroke. Interventions: Each participant received two interventions (IADL reablement and health education). Each intervention was administered for 6 wk. All participants were randomly assigned to one intervention and then received the other intervention after a 4-wk washout period. Outcomes and Measures: Outcomes of actual performance and self-perceived difficulty were derived from the Frenchay Activities Index (FAI) and the difficulty dimension of the Participation Measure–3 Domains, 4 Dimensions (PM–3D4D), respectively. Outcomes of ability were measured with the Lawton Instrumental Activities of Daily Living Scale (LIADL) and the Canadian Occupational Performance Measure Performance score (COPM Performance). Results: No statistically significant differences were found in the three aspects between the IADL reablement and health education (ps = .148–.570). Compared with the health education, the IADL reablement showed better improvements on the FAI, LIADL, COPM Performance, and difficulty dimension of the PM–3D4D with trivial to small effect sizes (ds = 0.17–0.45). Conclusions and Relevance: Our results reveal that the IADL reablement has the potential to increase the frequency of IADL administration, enhancing the capability to perform IADLs and reducing the self-perceived difficulty of carrying out IADLs. Plain-Language Summary: The results of this study showed positive outcomes for a reablement intervention that focuses on goal-oriented instrumental activities of daily living for patients with stroke. An IADL reablement intervention may be useful for improving the ability to carry out IADL tasks at home and in the community.