***TASK*** the task is to summarize an input biomedical literature in six sentences 
    ***INPUT*** the input is a biomedical literature 
    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
    ***DOCUMENTATION*** 
    ***EXAMPLES*** 
    Input: Background There is a growing dem and 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 aim ed 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 design ed to reduce dependency in personal activities of daily living with routine input or usual care as the control . We will include r and omised controlled trials , nonr and omised controlled trials , and controlled before and after studies . We will also include interrupted time series studies .We shall search electronic data bases in addition to search ing for ongoing and unpublished studies , and where appropriate will contact key authors . Two review ers 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 review er 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 . Systematic review registration This review protocol has been registered on the PROSPERO data base ( CRD42013004163 ) OBJECTIVES To test the efficacy of a multicomponent intervention to reduce functional difficulties , fear of falling , and home hazards and enhance self-efficacy and adaptive coping in older adults with chronic conditions . DESIGN A prospect i ve , two-group , r and omized trial . Participants were r and omized to a treatment group or no-treatment group . SETTING Urban community-living older people . PARTICIPANTS Three hundred nineteen community-living adults aged 70 and older who reported difficulty with one or more activities of daily living . INTERVENTION Occupational and physical therapy sessions involving home modifications and training in their use ; instruction in strategies of problem-solving , energy conservation , safe performance , and fall recovery techniques ; and balance and muscle strength training . MEASUREMENTS Outcome measures included self-rated functional difficulties with ambulation , instrumental activities of daily living , activities of daily living , fear of falling , confidence performing daily tasks , and use of adaptive strategies . Observations of home hazards were also conducted . RESULTS At 6 months , intervention participants had less difficulty than controls with instrumental activities of daily living ( P=.04 , 95 % confidence interval (CI)=-0.28 - 0.00 ) and activities of daily living ( P=.03 , 95 % CI=-0.24 to -0.01 ) , with largest reductions in bathing ( P=.02 , 95 % CI=-0.52 to -0.06 ) and toileting ( P=.049 , 95 % CI=-0.35 - 0.00 ) . They also had greater self-efficacy ( P=.03 , 95 % CI=0.02 - 0.27 ) , less fear of falling ( P=.001 , 95 % CI=0.26 - 0.96 ) , fewer home hazards ( P=.05 , 95 % CI=-3.06 - 0.00 ) , and greater use of adaptive strategies ( P=.009 , 95 % CI=0.03 - 0.22 ) . Benefits were sustained at 12 months for most outcomes . CONCLUSION A multicomponent intervention targeting modifiable environmental and behavioral factors results in life quality improvements in community-dwelling older people who had functional difficulties , with most benefits retained over a year INTRODUCTION Health services delivered in an older person 's home are often implemented at a critical juncture in an individual 's functional status . Although homecare has potential to improve this situation , it often focuses on treating disease and ' taking care ' of the patient rather than promoting independence . The aim of restorative homecare is to change the philosophy from one where delivery of care may create dependency to provision of care which maximises independence , self-esteem , self-image and quality of life , and reduces the care required . AIMS To assess impact of a design ated goal facilitation tool on health-related quality of life ( HRQoL ) , social support and physical function among community-dwelling older people referred for homecare . METHODS A total of 205 participants [ mean age 79.1 years , 71.3 % female ( intervention group ) and 76.9 years with 60.8 % female ( control group ) ] were cluster r and omised to an intervention or control assessor . The intervention arm involved participants completing a goal facilitation tool with assessors . This established rehabilitation aims . Control participants received a st and ard needs assessment . Clients from both groups were then referred to a homecare organisation for service delivery . RESULTS There was greater change over time in HRQoL [ measured by Short Form 36 Survey ( SF-36 ) ] in the intervention group ( P = 0.0001 ) . There was a marked variation across homecare providers in types of services provided ( P < 0.001 ) . Identification of a goal did not predict completion of a formalised review of participants ' needs by the homecare organisation . CONCLUSIONS Use of a goal facilitation tool in assessment of an older person 's needs on referral for homecare leads to significant improvements in HRQoL. This may be through a higher proportion of individualised activities tailored to a successful identification of the person 's goals . The findings contribute to greater underst and ing of factors necessary to implement improvements in homecare services for older people OBJECTIVE To compare a specialized interprofessional team approach to community-based stroke rehabilitation with usual home care for stroke survivors using home care services . METHODS R and omized controlled trial of 101 community-living stroke survivors ( < 18 months post-stroke ) using home care services . Subjects were r and omized to intervention ( n=52 ) or control ( n=49 ) groups . The intervention was a 12-month specialized , evidence -based rehabilitation strategy involving an interprofessional team . The primary outcome was change in health-related quality of life and functioning ( SF-36 ) from baseline to 12 months . Secondary outcomes were number of strokes during the 12-month follow-up , and changes in community reintegration ( RNLI ) , perceived social support ( PRQ85-Part 2 ) , anxiety and depressive symptoms ( Kessler-10 ) , cognitive function ( SPMSQ ) , and costs of use of health services from baseline to 12 months . RESULTS A total of 82 subjects completed the 12-month follow-up . Compared with the usual care group , stroke survivors in the intervention group showed clinical ly important ( although not statistically significant ) greater improvements from baseline in mean SF-36 physical functioning score ( 5.87 , 95 % CI -3.98 to 15.7 ; p=0.24 ) and social functioning score ( 9.03 , CI-7.50 to 25.6 ; p=0.28 ) . The groups did not differ for any of the secondary effectiveness outcomes . There was a higher total per-person costs of use of health services in the intervention group compared to usual home care although the difference was not statistically significant ( p=0.76 ) . CONCLUSIONS A 12-month specialized , interprofessional team is a feasible and acceptable approach to community-based stroke rehabilitation that produced greater improvements in quality of life compared to usual home care . Clinical trials.gov identifier : NCT00463229 The Home Independence Program ( HIP ) is a short-term restorative programme targeted at older home-care clients , who do not have a diagnosis of dementia , when they are first referred for assistance or when they are referred for additional services because their needs have increased . This study compared the outcomes for individuals who participated in HIP with those of individuals who received ' usual ' home-care services .  The study was conducted in metropolitan Perth , Western Australia , between 2001 and 2003 , when HIP was being trialled as a service in just one region . One hundred clients were recruited into each group and were visited at home on three occasions -- service start and at 3 months and 1 year . St and ardised outcome measures were used to measure functional dependency , morale , confidence in performing everyday activities without falling and functional mobility . Service outcomes were also examined at 3 months and 1 year . The HIP group showed improvements on all personal outcome measures compared with the control group . These improvements were , except for the morale scale , significantly associated with group assignment even when baseline differences between the groups were adjusted for . As regards service outcomes , the odds of the individuals who received HIP still requiring services was 0.07 ( 95 % CI = 0.03 - 0.15 , P < 0.001 ) times those for the individuals in the control group at 3 months and 0.14 times at 12 months ( 95 % CI = 0.07 - 0.29 , P < 0.001 ) . The results of this study supported the hypothesis that older individuals referred for home care who participated in a programme to promote their independence had better individual and service outcomes than individuals who received usual home care PURPOSE To evaluate the clinical outcomes of a nurse care coordination program for people receiving services from a state-funded home and community-based waiver program called Missouri Care Options ( MCO ) . DESIGN A quasi-experimental design was used to compare 55 MCO clients who received nurse care coordination ( NCC ) and 30 clients who received MCO services but no nurse care coordination .  METHODS Nurse care coordination consists of the assignment of a  registered nurse who provides home care services for both the MCO program and Medicare home health services .  Two st and ardized data sets , the Minimum Data Set ( MDS ) for resident care and planning and the Outcome Assessment Instrument and Data Set ( OASIS ) were collected at baseline , 6 months , and 12 months on both groups . Cognition was measured with the MDS Cognitive Performance Scale ( CPS ) , activities of daily living ( ADL ) as the sum of five MDS ADL items , depression with the MDS-Depression Rating Scale , and incontinence and pressure ulcers with specific MDS items . Three OASIS items were used to measure pain , dyspnea , and medication management . The Cochran-Mantel-Haenszel ( CMH ) method was used to test the association between the NCC intervention and clinical outcomes . FINDINGS At 12 months the NCC group scored significantly better statistically in the clinical outcomes of pain , dyspnea , and ADLs . No significant differences between groups were found in eight clinical outcome measures at 6 months . CONCLUSIONS Use of nurse care coordination for acute and chronic home care warrants further evaluation as a treatment approach for chronically ill older adults A r and omised controlled trial was conducted to test the effectiveness of the Home Independence Program ( HIP ) , a restorative home-care programme for older adults , in reducing the need for ongoing services .  Between June 2005 and August 2007 , 750 older adults referred to a home-care service for assistance with their personal care participated in the study and received HIP or ' usual ' home-care services .  Service outcomes were compared at 3 and 12 months . Subgroups of 150 from each group were also compared on functional and quality of life measures . Data were analysed by ' intention-to-treat ' and ' as-treated ' . The intention-to-treat analysis showed at 3 and 12 months that the HIP group was significantly less likely to need ongoing personal care [ Odds ratio ( OR ) = 0.18 , 95 % CI = 0.13 - 0.26 , P < 0.001 ; OR = 0.22 , 95 % CI = 0.15 - 0.32 , P < 0.001 ] . Both subgroups showed improvements on the individual outcome measures over time with the only significant differences being found at 12 months for Instrumental Activities of Daily Living ( IADL ) in the as-treated analysis . Contamination of the control group by an increased emphasis on independence across the home-care agency involved , together with other method ological problems encountered , is thought to account for the few differences between groups in individual outcomes . Despite no difference between the groups over time in their overall ADL scores , a significantly smaller proportion of the HIP group required assistance with bathing/showering , the most common reason for referral , at 3 and 12 months . The results support earlier findings that participating in a short-term restorative programme appears to reduce the need for ongoing home care . The implementation of such programmes more broadly throughout Australia could substantially offset the projected increase in dem and for home care associated with the five-fold projected increase in numbers of the oldest old expected over the next 40 years Due to the ageing population , there is an increased dem and for home care services . Restorative care is one approach to improving home care services , although there is little evidence to support its use in the community setting . The objective of this trial was to evaluate the impact of a restorative home care service for community-dwelling older people . The study was a cluster r and omised controlled trial undertaken at a home care agency in New Zeal and . The study period was from December 2005 to May 2007 . Older people were interviewed face-to-face at baseline , four and 7 months . A total of 186 older people who received assistance from a home care agency participated in the study , 93 received restorative home care and 93 older people received usual home care .  The primary outcome measure was change in health-related quality of life ( measured by the Short Form 36 [ SF36 ] Health Survey ) . Secondary outcomes were the physical , mental , and social well-being of older people ( Nottingham Extended Activities of Daily Living , Timed Up and Go , Mastery scale , Duke Social Support Index ) . Findings revealed that compared with usual care , the intervention demonstrated a statistically significant benefit in health-related quality of life 
    Output:
    
Occupational therapy : there was insufficient evidence to determine whether involvement of qualified occupational therapists influenced effectiveness .
Conclusion : There is limited evidence that interventions targeted at personal ADL can reduce homecare service users ’  dependency with activities , the content of evaluated interventions varies greatly