***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: CONTEXT Illness and hospitalization often trigger functional decline among older persons .  Home care services implemented for functional decline provide an opportunity to intervene to improve outcomes . OBJECTIVE To compare functional status and the likelihood of remaining at home for persons receiving restorative care vs usual home care .  DESIGN AND SETTING Intervention using prospect i ve individual matching conducted between November 1 , 1998 , and April 30 , 2000 . Six offices of a home care agency in Connecticut were used . One branch office served as the restorative care unit and the other 5 served as usual care offices . PARTICIPANTS Patients receiving home care through the restorative care office who were 65 years or older ; in receipt of Medicare-covered home care lasting at least 7 days ; with absence of severe cognitive impairment ; and not terminal , bedridden , or requiring total care were matched with patients from 1 of the usual care offices  . The matching factors included age , sex , race , baseline self-care function , cognitive status , whether hospitalization preceded the home care episode , and date of the home care episode . Of the 712 eligible restorative care patients , 691 ( 97 % ) were matched with a usual care patient . INTERVENTION Restorative care , provided by the home care agency nursing , therapy , and home health aide staff , was based on principles from geriatric medicine , nursing , rehabilitation , and goal attainment . MAIN OUTCOME MEASURES Remaining at home , functional status at completion of the home care episode , and duration and intensity of home care episode . RESULTS Compared with usual care , and after adjusting for baseline characteristics and other factors , restorative care was associated with a greater likelihood of remaining at home ( 82 % vs 71 % ; odds ratio [ OR ] , 1.99 ; 95 % confidence interval [ CI ] , 1.47 - 2.69 ) and a reduced likelihood of visiting an emergency department ( 10 % vs 20 % ; OR , 0.44 ; 95 % CI , 0.32 - 0.61 ) . Home care episodes were shorter ( mean [ SD ] , 24.8 [ 26.8 ] days vs 34.3 [ 44.2 ] days ; S = -17 821 ; P<.001 ) . Restorative care patients had better mean ( SD ) scores than usual care patients in self-care ( 11.0 [ 2.1 ] vs 10.7 [ 2.5 ] ; P = .07 after adjustment ) , home management ( 9.5 [ 2.9 ] vs 9.2 [ 3.0 ] ; P = .05 after adjustment ) , and mobility ( 3.3 [ 0.8 ] vs 3.2 [ 0.9 ] ; P = .02 after adjustment ) . CONCLUSIONS This trial suggests that reorganizing the structure and goals of home care can enhance health outcomes of older patients without increasing health care utilization Background As a result of the ageing population , there is an urgent need for innovation in community health-care in order to achieve sustainability . Reablement is implemented in primary care in some Western countries to help meet these challenges . However , evidence to support the use of such home-based rehabilitation is limited . Reablement focuses on early , time-intensive , multidisciplinary , multi-component and individualised home-based rehabilitation for older adults with functional decline . The aim of this study is to investigate the effectiveness of reablement in home-dwelling adults compared with st and ard treatment in relation to daily activities , physical functioning , health-related quality of life , use of health-care services , and costs . Methods / Design The study will be a 1:1 parallel-group r and omised controlled superiority trial conducted in a rural municipality in Norway . The experimental group will be offered reablement and the control group offered st and ard treatment . A computer-generated permuted block r and omisation sequence , with r and omly selected block sizes , will be used for allocation . Neither participants nor health-care providers will be blinded , however all research assistants and research ers will be blinded . The sample size will consist of 60 participants . People will be eligible if they are home-dwelling , over 18 years of age , underst and Norwegian and have functional decline . The exclusion criteria will be people in need of institution-based rehabilitation or nursing home placement , and people who are terminally ill or cognitively reduced . The primary outcome will be self-perceived performance , and satisfaction with performance of daily activities , assessed with the Canadian Occupational Performance Measure . In addition , physical capacity , health-related quality of life , use of health-care services , and cost data will be collected at baseline , and after 3 and 9 months in both groups , and again after 15 months in the intervention group . Data will be analysed on an intention-to-treat basis using a linear mixed model for repeated measures . Discussion The findings will make an important contribution to evaluating cost-effective and evidence -based rehabilitation approaches for community-dwelling adults . Trial registration The trial was registered in Clinical Trials.gov November 20 , 2012 , identifier : NCT02043262 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 Background Restorative home care services help older people maximise their independence using a multi-dimensional approach . They usually include an exercise program design ed to improve the older person ’s strength , balance and function . The types of programs currently offered require allocation of time during the day to complete specific exercises . This is not how the majority of home care clients prefer to be active and may be one of the reasons that few older people do the exercises regularly and continue the exercises post discharge . This paper describes the study protocol to test whether a Lifestyle Functional Exercise ( LiFE ) program : 1 ) is undertaken more often ; 2 ) is more likely to be continued over the longer term ; and , 3 ) will result in greater functional gains compared to a st and ard exercise program for older people receiving a restorative home care service . Methods / Design Design : A pragmatic r and omised controlled trial ( RCT ) design was employed with two study arms : LiFE program ( intervention ) and the current exercise program ( control ) . Setting : Silver Chain , a health and community care organisation in Perth , Western Australia . Participants : One hundred and fifty restorative home care clients , aged 65 years and older . Measurements : The primary outcome is a composite measure incorporating balance , strength and mobility . Other outcome measures include : physical functioning , falls efficacy , and levels of disability and functioning . Discussion If LiFE is more effective than the current exercise program , the evidence will be presented to the service management accompanied by the recommendation that it be adopted as the generic exercise program to be used within the restorative home care service . Trial registration Australian and New Zeal and Clinical Trials Registry ACTRN12611000788976 BACKGROUND frail older people often require tailored rehabilitation in order to remain at home , especially following a period of hospitalisation . Restorative care services aim to enhance an older person 's ability to remain improve physical functioning , either at home or in residential care but evidence of their effectiveness is limited . OBJECTIVE to evaluate the effectiveness of a restorative care service on institutional-free survival and health outcomes in frail older people referred for needs assessment in New Zeal and . METHODS a r and omised controlled trial of restorative care or usual care in 105 older people at risk of permanent residential who were follow-up over 24 months . The restorative care service was delivered in short-stay residential care facilities and at participants ' residences with the aim of reducing the requirement for permanent residential care . It included a comprehensive geriatric assessment and care plan developed and delivered , initially by a multi-disciplinary team and subsequently by home care assistants . RESULTS compared with usual care , there was a non-significant absolute risk reduction of 14.3 % for death or permanent residential care ( 8.8 % for residential care and 7.2 % for death alone ) for the restorative care approach . There was no difference in levels of burden among caregivers . CONCLUSIONS restorative care models that utilise case management and multi-disciplinary care may positively impact on institutional-free survival for frail older people without adversely impacting on the health of caregivers 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 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 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 
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We did note the lack of an agreed underst and ing of the nature of reablement .
Conclusions : Reablement is an ill-defined intervention targeted towards an ill-defined and potentially highly heterogeneous population /patient group .
There is no evidence to suggest it is effective at either of its goals ; increasing personal independence or reducing use of personal care services