Supporting discharge planning in frail older adults with mild cognitive impairment: lessons learned from a feasibility pilot randomized control trial (RCT)

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The HOME intervention—based on collaborative discharge planning with patients and caregivers— has demonstrated promise in reducing unplanned rehospitalizations among older adults with mild cognitive impairment, as shown by a randomized controlled trial (RCT). Before implementing the intervention in Canada, it was essential to first assess the feasibility of conducting a large-scale mixed-methods RCT of the culturally adapted version, targeting the subgroup of frail older adults and incorporating patient-centered outcomes. The study aims to (1) document feasibility outcomes; (2) assess its preliminary effectiveness in real-world conditions. Methods: A mixed-method pilot RCT was conducted, with eligible patients randomized to either the HOME intervention or usual care group. Feasibility outcomes included recruitment and retention, as well as the acceptability and applicability of both the intervention and the data‑collection procedures. The primary outcome was functional autonomy, including its social component. Secondary outcomes included goal attainment scaling, perceived discharge preparedness, and hospital readmissions or emergency visits. Semi-structured interviews with older adults, family members, and clinicians were planned. Qualitative data were thematically analyzed and then compared to quantitative data. Results: Seven participants were recruited, of whom five completed all outcome measures. Two main themes emerged from the interviews: (1) the value of real-time communication between hospital and community-based clinicians, as simple pre-discharge phone calls facilitated the exchange of relevant patient information and supported smoother transitions home; and (2) challenges in establishing patient-oriented goals and conducting pre-discharge home visits. Although the sample size was small, quantitative data suggested potential benefits on both primary and secondary outcomes, while qualitative findings underscored how the intervention legitimized the exploration of leisure activities as a means of identifying functional goals. Conclusion: Significant recruitment challenges were encountered, leading to the conclusion that a large-scale pragmatic RCT would not be feasible. These barriers hinder the evaluation of the HOME intervention’s effectiveness in a Canadian context and highlight the need for revised or innovative research engagement strategies—particularly for hospitalized older adults facing complex discharge transitions. Trial registration: Registered on November 7, 2019 at https://clinicaltrials.gov/study/NCT04154917. Hospital-to-home transition Mild cognitive impairment Person-centered intervention Mixed-method Pilot randomized trial Feasibility study Figures Figure 1 Figure 2 Key messages regarding feasibility 1) What uncertainties existed regarding the feasibility? Uncertainties existed about how to effectively recruit older adults living with frailty, while evaluating an intervention they could benefit from, when the very characteristic that makes them ideal candidates – frailty— also renders them difficult to recruit. This challenge created a conundrum with the study’s implementation. Among the components of the Australian-based discharge intervention called HOME, a collaborative goal setting and pre-discharge home visits were the most difficult to implement in a Canadian context. 2) What are the key feasibility findings? The feasibility of a large-scale randomized controlled trial (RCT) using the Canadian adaptation of the HOME intervention—designed to support hospital-to-home transitions for older adults with mild cognitive impairment—was not demonstrated, mainly due to significant recruitment challenges. Indeed, the initial study aimed to enroll 36 participants per group (experimental and control), for a total of 72. However, only seven participants were recruited, and five completed all outcome measures. Pre-discharge communication between hospital and community clinicians improved information exchange and eased transitions. Moreover, despite the small sample size, results indicated potential benefits for functional autonomy, highlighting the value of integrating patient-centered goals such as leisure activities during discharge planning—even within the constraints of hospital settings. 3) What are the implications of the feasibility findings for the design of the main study? The significant recruitment challenges encountered led to the conclusion that a large-scale pragmatic RCT would not be feasible, and the contributing factors extend beyond the pandemic. These barriers hinder the evaluation of the HOME intervention’s effectiveness and highlight the need for revised or innovative research recruitment strategies—particularly for hospitalized older adults facing complex discharge transitions. Background After hospitalization, most older adults wish to return home, resume their life roles, and engage in meaningful activities 1 , 2 . However, hospitalization often leads to deconditioning and difficulties performing activities of daily living (ADLs) 3 , 4 . Combined with illness‑related functional decline, these challenges increase the risk of emergency department (ED) visits and unplanned hospital readmissions in the months following discharge, especially for older adults living with frailty 5 , 6 . Reviews 7 – 9 and empirical studies 10 – 12 have shown that comprehensive, patient-centered discharge-planning interventions, characterized by personalized care across hospital-community interfaces and active involvement of patients and families in decision-making, can improve post-discharge functional autonomy in ADLs as well as reduce ED visit and hospital readmissions among older adults living with frailty. To operationalize best practices in occupational therapy (OT) discharge planning for older adults, an Australian research team developed the “HOME” intervention 13 . HOME uses collaborative goal setting 14 and joint problem solving 15 with patients and family members to support safe, sustainable discharges. This collaborative process—focused on the fit between the person and their environment—encourages older adults to take ownership of their discharge goals and the strategies needed to achieve them. HOME also provides post-discharge support, enabling patients and families to build independence and access necessary services. The HOME intervention was assessed in a randomized control trial (RCT) involving 400 older patients across five Australian hospitals 16 . Secondary analyses showed that HOME significantly reduced unplanned rehospitalizations among participants with mild cognitive impairment and improved participation in life roles among those without social support, although the latter was not statistically significant 17 . Building on these findings, our team sought to implement HOME in a Canadian context with this subgroup of older adults. A Canadian adaptation of the intervention was therefore developed using an integrated knowledge-transfer approach to ensure that it met the needs of knowledge users and could be implemented within local health-care structures. This was particularly important given that, in Canada—and especially in Québec—functional goal identification is not routinely performed in hospital settings, pre-discharge OT home visits are uncommon, and waiting times for home visits vary widely. Adaptation of HOME to the Canadian context (preliminary study) The Canadian adaptation of HOME was developed in May 2017 through a one-day workshop and two online sessions, guided by an Expert Advisory Committee of researchers, decision makers, clinicians, and a patient/family representative 18 . These consultations revealed participants’ overall agreement with HOME’s goals, values and philosophy. However, the Expert Advisory Committee made the following recommendations about its procedural aspect: 1) involve community-based clinicians in the intervention, as they are typically responsible for post-discharge home visits, in order to (a) ensure that pre-discharge recommendations align with available community resources, (b) avoid duplication of in-home assessments, and (c) support long-term follow-up if new needs arise after discharge; and 2) increase flexibility in the intervention, to respond more individually to patients and family needs. For example, in consultation with the patient and family, the HOME clinician may decide not to conduct a pre-discharge home visit for a patient living with frailty or may opt to provide additional follow-up calls. Given the adaptations made to the HOME intervention for the Canadian context and the focus on frail older adults, it was necessary to reconsider the study design. The inclusion of patient-centered outcome measures—recommended by the Australian research team—also supported the need to first assess the feasibility of a large-scale randomized controlled trial (RCT). This design was well suited to examine issues specific to this population (e.g., recruitment pace, respondent burden) and to organizational factors influencing implementation in Canada (e.g., short hospital stays, prevailing care culture). A pragmatic approach 19 was adopted to capture the real-world benefits of the revised HOME intervention 20 . Finally, recognizing that measurable effects may not fully reflect perceived benefits, the feasibility and pragmatic components were integrated within a mixed-methods design—a robust way to understand what works, what does not, and why 21 . The purpose of this study was therefore to evaluate the feasibility of conducting a future large-scale RCT comparing the Canadian adaptation of the HOME intervention—designed to support the transition from hospital to home for frail older adults living with mild cognitive impairment—with customary care. To this end, a pragmatic pilot RCT was conducted to (1) document both quantitative and qualitative feasibility data related to recruitment, retention, as well as the acceptability and applicability of both the intervention and data collection procedures (2) evaluate the intervention’s preliminary effectiveness on functional autonomy ( primary outcome ), patient-centered outcomes—specifically discharge-related goal attainment and perceived preparedness— and hospital or ED readmissions rates ( secondary outcomes ). Methods Following the launch of the pilot trial, substantial methodological adjustments were required. This section presents the final study protocol, outlining the elements retained from the original version as well as the modifications introduced, all of which were approved by the principal investigator (VP). The study was guided by the CONSORT extension for pilot and feasibility trials 22 (checklist in additional file 1) and the CONSERVE-CONSORT guidelines for COVID-19–related modifications 23 (checklist in additional file 2). The research complies with the GRAMMS guideline 24 (checklist in additional file 3). Ethical approval was obtained from the CIUSSSE-CHUS Research Ethics Board (2020–2894). Study design A three-year feasibility study (2019–2022) was conducted using a pragmatic pilot RCT to inform a future full-scale study. The design followed a mixed-methods sequential explanatory approach, with qualitative data from clinicians used to help interpret quantitative findings 25 , 26 . Eligibility criteria and setting To be eligible, patients had to: 1) be aged 70 years or older (as in the original HOME study); 2) have mild cognitive impairment (Montreal Cognitive Assessment (MoCA) 20-26 27 , or Mini-Mental State Examination (MMSE) 18-23 28 or based on clinical judgment); 3) be expected to return to the community after discharge; 4) be conversant in French or English. The MoCA and MMSE were routinely used screening tools in the targeted wards. An expected hospital stay of ≥ 5 days was also required to allow implementation of HOME without prolonging hospitalization; this longer stay served as a pragmatic proxy for frailty 29 . Family members were invited to participate, although they were not part of the formal inclusion criteria. During the study, eligibility was expanded to include younger older adults (65–74 years) and individuals living alone or with limited social support—a subgroup previously shown to benefit from HOME 17 . This change aimed to increase the pool of potentially eligible participants and mitigate COVID-19–related recruitment challenges. Patients were excluded if significant physical or mental conditions were judged likely to interfere with the intervention or data collection, or if they were unable to provide consent according to Nova Scotia criteria 30 . Participants were recruited from two medical units in a semi-urban hospital in Sherbrooke, Quebec: a geriatric unit specializing in assessment and discharge planning for older adults with complex needs, and a general medical unit. Enrollment and randomization Recruitment was planned from October 2019 to October 2021 but was interrupted for 18 months (March 2020–September 2021) due to the COVID-19 suspension of research activities. It resumed until October 2022, when the study was stopped early because of persistent recruitment challenges, timeline constraints, and limited funding. Initial screening and verbal consent were conducted by occupational therapists (OTs) not involved in data collection. Eligible patients were then referred to research assistants (AG or NO). After the pandemic, a research assistant (NO) also contributed to screening to reduce clinicians’ workload. Weekly meetings with clinicians helped identify potential participants and refine recruitment procedures. After confirming eligibility and obtaining consent, participants were randomized in blocks to the intervention or control group, a method suited to maintaining allocation balance in small samples 31 . Randomization was initially stratified by prior use of community-based services, a factor expected to reduce delays in accessing such services. Allocation was performed by a statistician and a research staff member (MD) independent of study design, recruitment, and data collection. Intervention HOME intervention HOME was delivered to the experimental group. The OTs received three hours of training from the principal investigator and a research assistant (AG), including two sessions on assessing functional ability, goal setting, and home safety 16 . The intervention consisted of four phases. Phase 1 (hospital) : Hospital-based and community-based OTs jointly established a therapeutic relationship with the patient and family. OTs exchanged information about the participant’s home environment, discharge goals, functional abilities, and safety concerns in preparation for the pre-discharge home assessment. Phase 2 (at hospital) : A community-based clinician conducted a pre-discharge home assessment approximately five days before expected discharge with the patient and family, when possible, to evaluate the environment, identify potential issues, and propose solutions. A deviation from the original protocol was introduced: when an in-person home visit with the patient was not feasible, the hospital-based OT conducted a virtual home visit using a tablet in collaboration with a family member. Phase 3 (at home) : The community-based OT completed a post-discharge home assessment within one week of discharge to provide additional home training and address any unmet needs. Independence was promoted by reinforcing pre-discharge goals and addressing post-discharge goals aimed at improving functional autonomy and supporting the resumption of meaningful activities, including leisure. Phase 4 (at home): Follow-up telephone calls 2- and 3-weeks post-discharge provided ongoing support to participants and families, encouraging independent problem-solving and progress toward planned goals. Customary discharge planning Participants in the control group received the customary discharge-planning assessment from an OT who was not involved in the HOME intervention. As part of usual care, the OT gathered information on the participant’s ability to perform ADLs and on the home environment to support discharge planning. OT home assessments were not routinely provided, as they are not part of standard practice. When needs for assistive equipment or home modifications were identified, patients were referred to community-based home-care services. However, waiting times for a home visit by a community OT were typically several weeks—and often several months. All other medical and allied health services were delivered according to usual care in both groups. Outcomes Feasibility data Beyond protocol deviations, feasibility data included (1) recruitment and retention rates (e.g., proportion screened, eligible, refusing; dropout rates and profiles) and (2) measures of acceptability and applicability related to both the intervention and the data-collection procedures. Primary outcomes The primary planned outcome was functional autonomy, assessed with the Functional Autonomy Measurement System (SMAF) 32 – 34 . The SMAF is a 29-item scale based on the WHO classification of functioning and evaluates five domains: ADLs (7 items), mobility (6), communication (3), mental functions (5), and Instrumental ADLs (8). Each item is scored from 0 (independent) to − 3 (dependent), for a total score ranging from 0 to − 87; a ≥5-point change is considered clinically meaningful. SMAF is administered by questioning the older adult and proxies, observing performance, and conducting brief tests. Its test–retest and interrater reliability are high (ICCs: 0.95) 32 , 35 . Its validity and sensitivity to change have been demonstrated 36 , and SMAF scores correlate with service-use levels 37 . The Social Functional Autonomy Measure (Social-SMAF) 38 is a 6-item scale covering social participation, relationships, social roles, use of social services, and the expression of needs and limitations. Increased scores reflect greater social autonomy. Its measurement properties have been validated in older adults. The SMAF and Social-SMAF are pragmatic tools embedded in routine care and familiar to most hospital-based clinicians in Quebec. Secondary outcomes To document older adults’ perceived attainment of discharge-related goals, the Goal Attainment Scaling (GAS) 39 , 40 was administered with the patient and a family member. GAS is a personalized outcome measure that involves: (i) setting goals based on individual needs before the intervention, (ii) implementing the intervention, and (iii) evaluating progress afterward. Each goal is weighted by the older adult according to its priority. Progress is rated on a 5-point scale: −2 (worst expected outcome), − 1 (less than expected), 0 (expected), + 1 (better than expected), and + 2 (best expected outcome). Raw scores are then calculated to determine overall goal attainment. To support administration with older adults with cognitive impairment, previously validated strategies—such as using pictures or describing daily routines—were employed 41 , 42 . Perceived preparedness for hospital discharge was assessed for both patients and family members using B-PREPARED, an 11-item questionnaire evaluating discharge-planning processes and outcomes from their perspective. The tool has been validated in adults aged 65 and older and demonstrates acceptable construct and predictive validity 43 . Clinical outcomes included the dates and number of unplanned rehospitalizations and ED visits, obtained from the hospital database 44 . Readmissions were classified as unplanned (avoidable) when they were not related to routine patient care 45 . Because the study was conducted in a semi‑urban area, the likelihood that patients would be readmitted to the same hospital was high. Qualitative data Individual semi-structured interviews were conducted by a trained research assistant (not involved in the intervention). Interviews with OTs delivering the HOME intervention explored the acceptability and applicability of both the study procedures (including data collection) and the intervention itself, as well as perceived implementation barriers and facilitators. OTs also shared their impressions of the intervention’s benefits compared with standard care. Additional interviews were conducted with OTs involved in the study who did not deliver the HOME intervention to highlight differences between the HOME and control conditions. Finally, we aimed to interview dyads of older adults living with frailty and their family members to explore (a) how they manage daily life (e.g., perceived risks and caregiving burden) and (b) how they experienced discharge planning (HOME or usual care), including aspects such as fatigue and anxiety. Data collection Baseline demographic and health data for older adults were collected first. Although randomization should minimize group differences, these variables may influence outcomes and were therefore considered as potential covariates if important baseline imbalances emerged. Demographic data for family members (age, gender, self-reported health problems) were also planned for collection. To support hospital- and community-based OTs in data collection, standardized workbooks were developed and completed for each participant in both the experimental and control groups. The primary and secondary outcome measures, assessed with the SMAF and GAS respectively, were collected in hospital at baseline (T1) and at the patient’s home at 1 month (T2) and 3 months (T3) post-discharge. B-PREPARED was also administered at T2 (Fig. 1 ). Each assessment session required approximately one hour. A research assistant with a relevant clinical background, trained in the study tools and blinded to group allocation (AG), administered all measures except those collected before discharge. Due to pragmatic constraints related to short hospital stays, baseline functional measures (T1) were collected by a research assistant (NO) rather than the hospital-based OT after the COVID-19 pandemic. Unplanned rehospitalizations and ED visits were recorded through chart reviews by the blinded research assistant from 1 to 6 months post-discharge. Interviews with older adults and their caregivers were scheduled at T2 and T3, while clinician interviews were conducted once quantitative data collection was completed. Sample size We aimed to recruit 36 participants per group (experimental and control), for a total of 72 participants. This sample size was calculated to detect a large effect size (i.e., a 30% difference between groups in the proportion of patients showing a clinically significant change), based on the primary outcomes (α = 0.05; power = 80%) 46 and the expected dropout rate (≈ 16–20%) 16,47,48 . For the qualitative component, we aimed to recruit 16 dyads of older adults living with frailty and their family members (8 per group) 49 , 50 . We planned to interview the first four dyads recruited in each group (n = 8), followed by an additional eight dyads (four per group) three months later to explore potential cohort effects. Data analysis Quantitative data Descriptive statistics were used to characterize the HOME and control groups. Recruitment and follow-up rates were compared with thresholds literature to assess study feasibility 51 . The study design initially included an intention-to-treat approach to estimate effect sizes for the functional measures. We originally planned to use generalized linear mixed models to account for repeated measures over time and to compare the proportion of patients showing a clinically significant change (e.g., SMAF ≥ 5) 33 between groups. Chi-square and exact tests were planned to assess potential baseline imbalances (possible confounders) and compare the proportion of patients readmitted or visiting the ED at 1, 3, and 6 months. A survival analysis was also planned to examine time to readmission. However, these analyses could not be conducted due to the small sample size. Qualitative data Interviews conducted before the COVID-19 suspension were analyzed from transcripts, whereas post-pandemic interviews with OTs who did not implement the intervention were analyzed from audio files using a combination of the Rigorous and Accelerated Data Reduction (RADaR) technique 52 and the Rapid Identification of Themes from Audio 53 , 54 . RADaR enabled systematic data organization while preserving the integrity of the material and was well suited to exploring unexpected implementation challenges 55 . Data reduction was performed using a structured Excel matrix. Codes were grouped under the following themes: feasibility of the intervention and data-collection procedures (e.g., target population, recruitment); acceptability and applicability of the HOME intervention (e.g., facilitators, obstacles); and perceived benefits (for patients, families, and clinical practice). Audio summaries were entered into the same matrix, and findings were reviewed collaboratively (NO, VP) to ensure alignment with study objectives. Mixed data NO and VP used a matrix to identify and clarify areas of agreement and disagreement between the two data sets (QUANT→ qual) and to further explore how the qualitative findings contextualized and interpreted the quantitative results—for example, whether positive experiences reported by patients, families, or clinicians were reflected in favorable quantitative outcomes, or whether new insights emerged regarding feasibility challenges. Results Characteristics of participants Table 1 presents the sociodemographic and health characteristics of participants in each trial group. The mean age was 85.3 years (± 5.2). The experimental group included two men and two women, while the control group consisted of three participants (one man and two women). Despite the small sample size, the two groups showed comparable sociodemographic and health profiles. Throughout the study, five clinicians and two research assistants received training due to staff turnover. Table 1 Sociodemographic and health profile of participants (older adults) CHARACTERISTIC EXPERIMENTAL n = 4 CONTROL n = 3 CONTINUOUS Mean (± SD; Range) Age (years) 83.3 (± 6.1;78–89) 88.0 (± 2.6;86–91) MMSE score (/30) 25.7 (± 3.5;22–29) a 23.5 (± 5.0;20–27) a MoCA score 20.1 (± 1.5;19–22) a 21.0 (± 4.2;18–24) a Length of hospital stay (n days) 19.0 (± 6.3;11–25) 21.3 (± 8.5;15–31) CATEGORICAL Frequency (%) Gender - women 2 (50.0) 2 (66.7) Highest level of education High school or less 2 (50.0) 2 (66.7) Post high school 2 (50.0) 1 (33.3) Annual income < $ 19,000 1 (25.0) 0 $ 19,000–39,000 3 (75.0) 2 (66.7) Refusal 0 1 (33.3) Dwelling type Home/apartment 2 (50.0) 1 (33.3) Seniors’ residence 2 (50.0) 2 (66.7) Living situation - alone 2 (50.0) 0 (0) Main reason for hospital admission Fall 3 (75.0) 2 (66.7) Pneumonia and chronic deconditioning 1 (25.0) - Delirium (fall history) - 1 (33.3) Perceived health b Good 1 (25.0) 1 (33.3) Average 3 (75.0) 2 (66.7) Previous use of community services (yes) 0 2 (66.7) a One missing data; b Based on this question: “ Compared to people your age, in general, how would you rate your health? ” Feasibility data - Recruitment and retention of participants Quantitative data Figure 2 presents the CONSORT diagram illustrating participant flow. Because recruitment was suspended for 18 months, the numbers for the steps preceding allocation are shown separately for the pre-pandemic and pandemic/post-pandemic periods. During the first period, although planned, clinicians did not collect formal data on eligibility or refusal rates in order to reduce their data-collection burden. The involvement of the research assistant in the screening process during the second period (see Methods) subsequently made it possible to document these indicators. Before the pandemic, nine participants were randomized. Despite adaptations to procedures and eligibility criteria, recruitment remained challenging during and after the COVID-19 period. Of the 22 potentially eligible patients screened during this second phase, only two (9%) were randomized. Seventeen patients (81%) did not meet inclusion criteria: most were discharged too early (n = 10) or were not expected to return to the community (n = 4). Three were excluded due to medical instability (n = 1), absence of suspected cognitive impairment (n = 1), or uncertainty regarding consent (n = 1). Three other patients were excluded because recruiters anticipated refusal based on prior declines of services (n = 2) or the patient wished to sign in the presence of a family member—a requirement that could not be met under COVID-19 restrictions. Among the 11 randomized participants, six were allocated to the HOME intervention group and five to the control group. Data were analyzed for seven participants, with only five completing the data collection process. Of the four excluded participants, two dropped out, one deceased post T1 and one was admitted to long-term care. Two participants did not complete the study (deceased and pandemic issues) but were considered in the analysis since the issues arose after T2, thus providing interesting insight. Qualitative data Four individual semi-structured interviews were conducted with hospital- and community-based clinicians. Hospital-based clinicians reported difficulties identifying and recruiting “suitable” candidates, that is patients with mild cognitive impairment who were still able to understand and complete the required assessments. As one clinician noted: We had patients who looked great on paper, but ultimately in person, it was a “no” (laughs)...-P1_Hospital Additionally, one clinician excluded individuals whose only community follow-up need was equipment provision, even though they were potentially eligible. While clinical judgment was meant to guide recruitment, this approach may have further narrowed the pool of candidates. Recruitment efforts were further hindered by the fast-paced hospital environment and increased long-term care relocations during the COVID-19 pandemic. All hospital-based clinicians reported that potential participants were often discharged too quickly to be enrolled: (…) the turnover is so fast (…) there's a patient: "Oh, he doesn't look too bad [for the study]! Then in the end, he doesn't stay long enough. -P1_Hospital Feasibility data - Acceptability / applicability of the intervention and data collection Quantitative data Intervention The intervention was conducted with three participants. Among these, the “predischarge visit” was conducted only once—and in fact, took place at the time of discharge. The virtual visit was pretested but none was performed in a real-world context during the study. Data collection While socio-demographic data were collected for all participants, family member-related data were available for only two. For five of the seven participants, the caregiver relationship was identified (one sibling, one spouse, and three children). Complete SMAF and Goal Attainment Scaling (GAS) data were available for five participants, with missing data due to illness (COVID-19) and death. Social-SMAF data were collected at all three measurement points for one participant, and at two time points for the remaining six. B-PREPARED scores and hospitalization/emergency visit data were collected for all seven participants (three in the control group, four in the experimental group). Only one participant agreed to an interview, and no interviews could be conducted with their family members—despite four of them consenting to be contacted—due to COVID-19 constraints. Qualitative data Subtheme 1: Appreciating the principles of the HOME intervention and real-time communication Hospital-based clinicians appreciated the opportunity to communicate directly with the community-based clinician responsible for the follow-up. This communication supported timely information exchange, especially since written reports are sometimes sent after discharge and may not be available to the community-based clinician when needed. One clinician noted that: . […] being able to talk to the person and tell her: “I observed this, I’m considering this and I’m sending you the reference, can you take a look? My report is on its way.” For me, it was really helpful because I didn’t know if I would have the time to produce the report in time. - P1_Hospital Furthermore, some information—such as interpersonal dynamics or family considerations—was seen as easier to convey through real-time conversations. Although such details are not always included in written reports, they were viewed as “important to know to approach the intervention more effectively,” allowing clinicians “to have a more comprehensive picture [of the person]” (P4SAD). For this clinician, who participated in the study but did not deliver the intervention, creating a bridge between hospital and community-based services could help reduce duplication, particularly when cognitive issues are present: (…) when the clinicians have been able to spend time with that person, they have developed strategies (…). So, it is this source of information that prevents a duplication (…) the fact that the hospital has already gone through these steps allows us to start with a head start, and to know where to look (…). It improves my assessment, and it guides my reflection …- P4_Community Timely follow-ups between hospital- and home-based clinicians were described as reassuring, particularly for patients considered higher risk. However, effective collaborative communication required some adjustments. One strategy tested was scheduling weekly calls at a fixed time, but coordinating schedules proved difficult. Brief, frequent interactions were ultimately viewed as the most effective approach: (…)You have to be able to talk to each other more often, and a lot of times, I had a [home] visit, and I just wasn't there, you know. I think it requires discussion, even if they are very brief, but more often." - P2_Community Subtheme 2: Challenges Establishing Goals with Participants and Predischarge Visits Collaboratively establishing patient goals and conducting a pre-discharge home visit were identified as the most difficult HOME components to implement. Clinicians noted that the intervention aligns with OTs’ core values by helping them refocus on clients’ personal goals and integrate goal-attainment evaluation within the hospital context. A key challenge, however, was aligning patient-defined goals with discharge priorities and reconciling the multidisciplinary team’s perspective with HOME principles: HOME has a philosophy that's not our hospital philosophy… We don't talk about leisure activities… we think about getting them as functional as possible so they can leave. There are things I wouldn't have normally addressed as a goal because it's not in my scope of practice. Since I was the only one to really bring it up—the rest of the team (...) move on to something else, and then they [patients] have to leave! P1_Hospital Furthermore, because many patients had difficulty identifying personal goals, the research team developed a list of example goals with images. However, this remained challenging for individuals with cognitive impairments, especially when options were not sufficiently concrete. Implementation was further complicated for those who struggled to recall their functional goals, creating difficulties when reviewing goals before discharge: We address them [goals], but more broadly and not in such detail (…) the way patients formulated their goals wasn’t always clear. The people that were targeted didn’t always have a good memory. It’s not easy (…) it’s not something that I usually do. I didn’t find that easy (…) like quantifying those goals…-P1_Community Some defined goals, particularly leisure-related ones, were viewed as unrealistic given patients’ functional autonomy and the clinical team’s discharge priorities and often required reframing. Planning discharge from patient-defined goals was considered difficult to implement, though relevant, as the clinician explained: The advantages are that it allows us to highlight things I would never have thought were so important for the patient (…) but our reality means that I can’t dedicate time to that goal to plan the discharge, well, I have to dedicate time to another goal that is less important for the patient, but very important for me, for the discharge. -P1_Hospital The pre-discharge home visit, conducted twice during the pilot, proved difficult to operationalize due to short hospital stays, concerns about medical instability and transportation, and the risk of confusing patients who might expect to remain home afterward. Reluctance from families or care teams to authorize such visits further limited feasibility. Well, there's the aspect that I don't think it's at all part of the culture of an acute care hospital setting to conduct pre-discharge visits. And the people at [unit], they're not there that long, and they're very ill medically, I find. So that makes it logistically very complicated to discharge them, and they don't see the point. - P2_Community A hospital‑based clinician noted that earlier introduction of the HOME intervention’s core concepts could have supported more cohesive implementation and eased recruitment. Although she viewed the intervention as feasible, she emphasized the need for a gradual, phased rollout and a shift in institutional culture supported by team engagement. Nonetheless, experimenting with the HOME intervention influenced the hospital‑based clinician’s practice: Well, it’s a bit how I will check with them their expectations that has changed. And like a bit when I ask them about how they used to function, what their routine was like… I go into more detail than I usually do, with HOME. -P1_Hospital Even though clinicians feared redundancy during telephone follow-up, the older adult interviewed reported being satisfied with the post-discharge phone calls and found them helpful, noting that they made her feel that clinicians cared about her. Preliminary effectiveness of the HOME intervention The quantitative outcomes of the HOME preliminary effectiveness are presented in Table 2 (scores by participant) and Table 3 (mean assessment scores). Although the quantitative data must be interpreted with caution given the small sample size, participants in the experimental group showed a clinically meaningful improvement in functional autonomy one month after the intervention, as reflected in their SMAF scores, whereas the control group experienced a clinically significant decline during the same period. The mean T2–T1 SMAF delta was 1.3 (0.5–2) for the experimental group compared with − 13.5 (− 27.5 to − 5.5) for the control group, indicating a clinically important difference between groups (improvement in the experimental group and deterioration in the control group). SMAF-Social results are less conclusive due to missing T1 data for four participants. Among the partial data available, scores for four participants across both groups remained stable between T2 and T3 (± 1), while one participant in the experimental group showed improved social functioning (− 3 to 0). Qualitative findings also supported the perceived functional benefits of the HOME intervention, particularly by confirming whether functional needs identified in hospital were truly problematic at home through a more accurate understanding of the individual’s living environment. It allowed me to have a slightly more accurate view of the environment, to ensure that the equipment would work properly, that follow-up would be done quickly: that's what I appreciated about the project. It was a fast track for my patients, especially those I considered to be at higher risk, compared to the usual track. P1_Hospital Table 2 HOME preliminary effectiveness — Quantitative outcomes by participant Outcome measures Experimental group Control group P1 P3 P7 P9 P2 P4 P8 SMAF a T1 -23.5 -24 -19.5 -35 -25 -14 -25.5 T2 -21.5 -22.5 -19 . -32.5 -19.5 -53 T3 -18 -16.5 -18.5 -35 -31 -19.5 n.a. Social-SMAF b T1 -3 . . -4 . . -2 T2 -1 -3 -1 . -5 -1 -9 T3 -1 0 -1 -7 -4 0 n.a. B-PREPARED c 11 20 20 17 9 16 10 GAS d Goal 1 – T2 2 0 0 . -2 1 -1 Goal 1 – T3 2 0 0 0 -2 1 n.a. Goal 2 – T2 1 0 -1 . -2 0 -2 Goal 2 – T3 2 0 -1 2 -2 1 n.a. Goal 3 – T2 2 1 1 . -1 1 1 Goal 3 – T3 2 1 2 1 0 1 n.a. Readmissions (n) Emergency-post 1 month 0 0 0 0 0 0 0 Hospital-post 1 month 0 0 1 0 0 0 0 Emergency-post 3 months 0 0 0 0 0 0 2 Hospital-post 3 months 0 0 0 0 0 0 2 a. Functional autonomy: score ranging from 0 (maximum independence) to -87 (maximum dependence); b. Social functional autonomy: score ranging from 0 (maximum independence) to -18 (maximum dependence); c. Perceived preparedness for hospital discharge: score ranging from 0 (not prepared – lower level) to 33 (very prepared – higher level); d. Goal Attaintment Scale. Levels: -2 Significantly below expectations, -1 Below expectations, 0 As expected, 1 Above expectations, 2 Significantly above expectations. Bold : Clinically significant difference (SMAF ≥ 5 or ≤ 5) compared to T1; Underlined : Clinically significant difference (SMAF ≥ 5 or ≤ 5) compared to T2; n.a.: non applicable (deceased participant post T2);. : missing data Table 3 Home Preliminary Effectiveness — Mean Assessment Scores OUTCOMES EXPERIMENTAL n = 4 CONTROL n = 3 Mean (± SD; Range) SMAF a T1 -25.5 (6.6;[-35]-[-19.5]) -21.5 (6.5;[-25.5]-[-14]) T2 -21(1.8;[-22.5]-[-19]) -35 (16.9;[-53]-[-19.5]) T3 -22 (8.7;[-35]-[-16.5]) -25.3 (8.1;[-31]-[-19.5]) T2-T1 1.3 (0.8;0.5-2.0) -13.5 (12.2;[-27.5]-[-5.5]) T3-T2 3.3 (0.5-6.0) 0.75 (1.1;0.0-1.5) B-PREPARED b 17.0 (4.2;11–20) 11.7 (3.8;9–16) GAS c Goal 1 T2 0.67 (1.16;0–2) -0.67 (1.53;[-2]-1) Goal 1-T3 0.50 (1.00;0–2) -0.50 (2.12; [-2]-1) Goal 2-T2 0.00 (1.00;[-1]-1) -1.33 (1.16;[-2]-0) Goal 2-T3 0.75 (1.50;[-1]-2) -0.50 (2.12;[-2]-1) Goal 3-T2 1.33 (0.58;1–2) 0.33 (1.16; [-1]-1) Goal 3-T3 1.50 (0.58;1–2) 0.50 (0.71;0–1) a. Functional autonomy: score ranging from 0 (maximum independence) to -87 (maximum dependence); b. Perceived preparedness for hospital discharge: score ranging from 0 (not prepared – lower level) to 33 (very prepared – higher level); c. Goal Attainment Scale. Levels: -2 Significantly below expectations, -1 Below expectations, 0 As expected, 1 Above expectations, 2 Significantly above expectations. Both hospital- and community-based clinicians reported that communicating with each other helped them better understand their respective practice contexts. This contact was also seen as beneficial for older adults by ensuring a timely response to their needs after discharge: Well, I think it can help the client get what they need more efficiently, and most of the time, what they need is equipment. Well, the right equipment at the right time.-P2_Community Despite these perceived benefits of the HOME intervention, both clinicians deemed that it was unnecessary for some patients, mainly relating to the pre-discharge visit component: 'Let's say taking on patient care one week after discharge, yes, that makes sense. But on the same day, or even before discharge, for this clientele, I don't know. [...] But there are probably benefits, but I don't know if it's necessary... And you know, I don't know if it's a wise use of our resources. - P2_Community Regarding participants’ goals, quantitative results indicate that they were most often achieved at least as expected among those in the experimental group (Table 2 ). This aligns with clinicians’ interviews suggesting that integrating older adults’ goals effectively fostered engagement; notably, one patient even began acquiring assistive devices during the hospital stay: Like one of our patients, after we set the goals together…he made calls himself [from the hospital]to get the assistive devices … but I think that with my usual practice it might not have gone that far. So that, I found that it was beautiful… -P1_Hospital The HOME intervention also supported clinicians in adopting a patient-centered approach by emphasizing individual expectations, daily routines, and personal preferences—particularly regarding leisure activities after discharge. Its focus on patient-centered goals was viewed as essential to quality of life and added meaningfulness for patients, while contributing to a more reassuring continuum of care. As one clinician noted: “I find that HOME helps us refocus our priorities on that [the clients’ goals], when the reality [of the hospital setting] would lead us elsewhere.” (P1_Hospital) Questionnaires (B-PREPARED) completed by participants in the experimental group indicated greater satisfaction with their involvement in discharge planning compared with those in the control group (Table 2 ). The three lowest scores (9–11/22) were all observed in the control group. This quantitative finding was reinforced by qualitative data from the sole older adult interviewed, who reported feeling included in the decision-making process surrounding care recommendations. Discussion The overarching objective of this mixed‑methods pilot RCT was to assess the feasibility of conducting a larger trial of the Canadian adaptation of the HOME intervention for frail older adults with mild cognitive impairment. However, major recruitment and implementation challenges led to early study termination, indicating that a large‑scale RCT—even with a pragmatic design—was not feasible. Although preliminary effectiveness results remain tentative due to the small sample, quantitative trends were encouraging and qualitative findings provided valuable insight into the unexpected barriers encountered. Overall, the feasibility issues identified point to important considerations for future research in hospital settings. Participation demands were high for older adults, and clinicians found the intervention difficult to implement in its current form. This reflects a broader paradox: individuals most likely to benefit from such interventions are often the hardest to recruit or most at risk of attrition 56 , which may lead to underestimating intervention effects and ultimately depriving older adults of support that could be beneficial. Beyond the limited time available to screen for eligibility and clinicians’ reluctance to approach patients perceived as less suitable for research, the low enrollment rate was also likely influenced by challenges in obtaining written consent during discharge planning. Hospitalization constitutes a physically and emotionally demanding period for older adults and their families 57 – 59 , during which decision-making about research participation may be particularly difficult. Age-related declines in vision 60 and information-processing speed 61 , combined with heightened vulnerability and often limited health literacy 62 , 63 , may further contribute to apprehension about signing consent documents. Obtaining written consent from older adults is a well-recognized challenge 64 . The legalistic structure, language, and complexity of consent forms 65 , 66 may reinforce perceptions of high-stakes commitment, thereby increasing reluctance to participate. This challenge invites reconsideration of whether formal written consent is necessary in studies posing risks comparable to standard care. Marshall 66 argues that verbal consent may be appropriate for low-risk studies, noting that the legalistic nature of written consent forms can inhibit relational ease during the consent process. Although some ethics committees waive formal consent requirements in such contexts 67 , this practice remains uncommon in Canada. Nonetheless, strategies such as obtaining preauthorization for research teams to contact patients at their initial interaction with the health system 68 , combined with verbal consent for a specific study, may help reduce barriers. In addition, supportive tools—such as a visual timeline and photographs of the evaluators—may help reassure participants by clarifying what will be expected of them and who they will interact with. Despite challenges in jointly defining patients’ goals, OTs reported that this component of the HOME intervention benefited both patients and their practice. It legitimized the exploration of leisure activities to identify meaningful goals and supported negotiating realistic, patient-centered objectives. This collaborative process—requiring clarification and reformulation of goals—is already recognized for improving patient satisfaction and motivating them to take action to achieve their goals 69 . However, given the limited time before discharge and the hospital mandate to expedite patient flow, clinicians often feel compelled to prioritize goals related to safety (e.g., bath transfers) over those that support quality of life (e.g., gardening)—a pattern also observed in our study. Encouraging patients to be proactive may also raise concerns about increased post-discharge risks when discussing the resumption of leisure activities. Yet, one study 70 shows that involving patients and families in these conversations can help manage such risks through positive risk-taking , an important pathway for fostering resilience, whereas avoiding such discussions may exacerbate negative outcomes. These ethical tensions echo Atwal & Caldwell’s observations 71 , highlighting how OTs may face dilemmas during discharge planning that challenge principles such as autonomy, beneficence, non-maleficence, and justice. However, given the challenges encountered during the administration of the goal-attainment evaluation, future studies could explore developing a version tailored to individuals with mild cognitive impairments. Another perceived benefit of the HOME intervention was the involvement of a community-based OT during discharge planning. The study underscores the value of real-time pre-discharge communication between hospital- and community-based clinicians; simple strategies such as weekly phone calls supported timely information exchange and strengthened the relevance of recommendations. These practices align with literature emphasizing efficient, patient-responsive coordination across care settings 72 – 73 . Recent provincial government directives promoting intensified post-discharge home care and the involvement of home-care professionals in discharge planning 74 – 75 suggest that components of the HOME intervention are now more embedded in routine practice than when the study was conducted. Future research could also examine other simple strategies to strengthen communication between hospital‑ and community‑based OTs, such as creating shared environments that facilitate pre‑discharge discussions. Beyond the actions promoted by the HOME intervention, it would be valuable to document how its underlying values are enacted in practice—for example, prioritizing services based on patient‑defined goals and negotiating acceptable compromises. Such an approach reinforces person‑centered care while promoting efficient resource use by avoiding recommendations misaligned with patients’ values or priorities 76 . Despite the adaptations made to the HOME program, several implementation challenges persisted. In the Québec professional context, expanding the intervention to include additional professionals could have facilitated practice changes, as interprofessional involvement is known to support the adoption and sustainability of new clinical practices 77 . Ensuring feasibility may also require preparing and supporting the team to view patient-identified goals as central to effective discharge planning, and to recognize the value of having the OT conduct the pre-discharge home visit - at minimum in a virtual format. Virtual home assessments were perceived as beneficial in our previous study 78 with clinicians reporting improved applicability of recommendations and caregivers expressing a greater sense of engagement in the discharge-planning process. Strengths and limitations Although pragmatic trials combined with mixed methods are recommended to support the integration of research into clinical practice, few studies have used this design to inform best practices in discharge planning. Balancing flexibility with methodological rigor remains a central challenge, particularly in maintaining internal validity. For example, to improve recruitment, we broadened inclusion criteria to individuals with low social support. This adjustment, introduced after recruitment resumed, did not ultimately increase enrollment. Such adaptations, however, must be carefully weighed to avoid compromising methodological consistency. This study has several limitations. First, recruitment challenges among older adults and their families were amplified by the COVID-19 context (2020–2021), particularly within this patient population, which was frailer than the one targeted in the original HOME study 16 . Clinicians reported shorter hospital stays and more frequent relocations during this period, factors that likely affected recruitment and limited the application of a person-centered approach. This is consistent with studies showing reduced length of stay 79 , 80 and increased transfers 79 , 81 during the pandemic. The missing refusal‑rate data also reflects the documentation burden reported by clinicians, who noted the difficulty of systematically recording such information in hospital settings. Second, despite recruitment across two units, the single-site design limits generalizability, as discharge-planning practices vary across settings. Finally, the study was not grounded in a conceptual framework—such as the Consolidated Framework for Implementation Research 82 —which could have offered a more nuanced understanding of barriers and facilitators influencing the implementation of the HOME intervention in a Canadian context. Conclusion Persistent gaps in care coordination and clinical communication underscore the importance of implementing promising interventions like HOME, which help bridge hospital-to-home priorities by improving continuity of care and aligning services with patients’ meaningful goals. Our findings further highlight the need for clinicians to prioritize patients’ goals and quality of life, despite time constraints and reluctance to engage in ethically sensitive discussions about risk. However, substantial recruitment challenges limit our ability to assess the intervention’s effectiveness. These challenges point to the need for revised or innovative strategies to address barriers to participation. Implementing such strategies within hospital discharge planning could enhance research engagement, particularly among older adults living with frailty and cognitive decline during complex care transitions. Special consideration should also be given to the context in which consent is obtained, as hospitalization often coincides with periods of cognitive and emotional vulnerability. Abbreviations ADLs: Activities of Daily Living CIUSSSE-CHUS: Centre intégré universitaire de santé et de services sociaux de l’Estrie-Centre hospitalier universitaire de Sherbrooke CONSERVE: CONSORT and SPIRIT Extension for RCTs Revised in Extenuating Circumstances CONSORT: Consolidated Standards of Reporting Trials ED: Emergency Department GAS: Goat Attainment Scale GRAMMS: Good Reporting of A Mixed Methods Study MMSE: Mini-Mental State Examination MoCA: Montreal Cognitive Assessment OT: Occupational Therapist RADaR: Rigorous and Accelerated Data Reduction RCT: Randomized Clinical Trial SMAF: Functional Autonomy Measurement System Declarations Acknowledgements The authors are grateful to clinicians Annie-Claude Lemieux-Courchesne, Vanessa Roy and Frédérick Roy for their collaboration in the preliminary conceptual phases. We are also grateful to the five clinicians for their collaboration in the recruitment process, as well as those that experienced the HOME intervention and were involved in data collection. To preserve anonymity (confidentiality) due to the limited number of participants, individual names were not included, but we are truly grateful for their contribution. Finally, we would like to thank Natasha Lannin and Lindy Clemson, who developed the initial HOME approach, for their invaluable collaboration during the Canadian adaptation of the intervention. Ethics approval and consent to participate This research received ethics approval from the CIUSSSE-CHUS Research Ethics Board (2020‑2894). All participants signed a written consent form prior to the first interview and received a copy of the form. Consent for publication Not applicable. Availability of data and materials The datasets used during the current study are available from the corresponding author on reasonable request. Competing interests The authors declare that they have no competing interests. Funding This study was supported by the Canadian Institute of Health Research, under grant #PJT-156231. Authors' contributions VPr, BM, NV, MJK, NDC, VD, DG, VPo, MJS and ME contributed to the conceptual and methodological design of the study. NO, AG, MD and VP analyzed and interpreted the data. AG and NO collected the data. NO, VP and MD wrote the first draft of the manuscript. All authors reviewed and edited the manuscript, and approved the final version. References Karlsson V, Bergbom I, Ringdal M, Jonsson A. After discharge home: a qualitative analysis of older ICU patients' experiences and care needs. Scand J Caring Sci. 2016;30(4):749-756. https://doi.org/10.1111/scs.12301. Hestevik CH, Molin M, Debesay J, Bergland A, Bye A. Older persons' experiences of adapting to daily life at home after hospital discharge: a qualitative metasummary. BMC Health Serv Res. 2019;19(1):224. https://doi.org/10.1186/s12913-019-4035-z. O'Brien MW, Mallery K, Rockwood K, Theou O. Impact of hospitalization on patients ability to perform basic activities of daily living. Can Geriatr J. 2023;26(4):524-529. https://doi.org/10.5770/cgj.26.664. Jonckers M, Van Grootven B, Willemyns E, et al. Hospitalization-associated disability in older adults with valvular heart disease: incidence, risk factors and its association with care processes. Acta Cardiol. 2018;73(6):566-572. https://doi.org/10.1080/00015385.2017.1421300. Hao Q, Zhou L, Dong B, Yang M, Dong B, Weil Y. The role of frailty in predicting mortality and readmission in older adults in acute care wards: a prospective study. Sci Rep. 2019;9(1):1207. https://doi.org/10.1038/s41598-018-38072-7. Zheng PP, Yao SM, He W, Wan YH, Wang H, Yang JF. Frailty related all-cause mortality or hospital readmission among adults aged 65 and older with stage-B heart failure inpatients. BMC Geriatr. 2021;21(1):125. https://doi.org/10.1186/s12877-021-02072-6. Xu Y, Ji T, Li X, et al. The effectiveness of the comprehensive geriatric assessment for older adults with frailty in hospital settings: A systematic review and meta-analysis. Int J Nurs Stud. 2024;159:104849. https://doi.org/10.1016/j.ijnurstu.2024.104849. Parker KJ, Mcdonagh J, Ferguson C, Hickman LD. Clinical outcomes of nurse-coordinated interventions for frail older adults discharged from hospital: A systematic review and meta-analysis. J Clin Nurs. 2024;33(11):4184-4206. https://doi.org/10.1111/jocn.17345. Steiner LM, Osmancevic S, Hahn S, Bonetti L, Zwakhalen S. The effectiveness of interventions on clinical and patient-reported outcomes in hospital-to-home transitions of older adults: a systematic review. Eur J Ageing. 2025;22(1):58. https://doi.org/10.1007/s10433-025-00890-w. Sum G, Sim SYH, Chay J, et al. An Integrated Patient-Centred Medical Home (PCMH) Care Model Reduces Prospective Healthcare Utilisation for Community-Dwelling Older Adults with Complex Needs: A Matched Observational Study in Singapore. Int J Environ Res Public Health. 2023;20(19):6848. https://doi.org/10.3390/ijerph20196848. Wilhelmson K, Andersson Hammar I, Westgård T, Holmquist Henrikson L, Dahlin-Ivanoff S. Positive effects on activities of daily living one year after receiving comprehensive geriatric assessment - results from the randomised controlled study CGA-Swed. BMC Geriatr. 2022;22(1):180. https://doi.org/10.1186/s12877-022-02862-6. Schapira M, Outumuro MB, Giber F, et al. Geriatric co-management and interdisciplinary transitional care reduced hospital readmissions in frail older patients in Argentina: results from a randomized controlled trial. Aging Clin Exp Res. 2022;34(1):85-93. https://doi.org/10.1007/s40520-021-01893-0. Wales K, Clemson L, Lannin NA, Cameron ID, Salked G, Gitlin L, Rubenstein L, Barras S, Mackenzie L, Davies C. Occupational therapy discharge planning for older adults: a protocol for a randomized trial and economic evaluation. BMC Geriatr. 2012;12:34. https://doi.org/10.1186/1471-2318-12-34. Turner-Stokes L. Goal attainment scaling (GAS) in rehabilitation: a practical guide. Clin Rehabil. 2009;23(4):362-370. https://doi.org/10.1177/0269215508101742. Gitlin LN. Environmental adaptations for older adults and their families in the home and community. In Söderback I, editor. International handbook of occupational therapy interventions. Dordrecht:Springer; 2009.p.53-62. Clemson L, Lannin N, Wales K, Salkeld G, Rubenstein L, Gitlin L, Barris S, Mackenzie L, Cameron ID. Occupational therapy predischarge home visits in acute hospital care: A randomized trial. J Am Geriatr Soc. 2016;64(10):2019-2026. https://doi.org/10.1111/jgs.14287. Provencher V, Clemson L, Wales K, et al. Supporting at-risk older adults transitioning from hospital to home: who benefits from an evidence-based patient-centered discharge planning intervention? Post-hoc analysis from a randomized trial. BMC Geriatr. 2020;20(1):84. https://doi.org/10.1186/s12877-020-1494-3. Provencher V. Meilleures pratiques pour soutenir la planification du congé hospitalier des personnes âgées. Interactive webinar workshop: Continuum for Seniors. Knowledge transfer service, libraries and best practices. Sherbrooke, Québec, Canada. 2017. June 12 and 29. Ford I, Norrie J. Pragmatic Trials. N Engl J Med. 2016;375(5):454-463. https://doi.org/10.1056/NEJMra1510059. Anderson ML. Ethical and regulatory issues of pragmatic cluster randomized trials in contemporary health systems. Clin Trials. 2015;12(3):276-286. https://doi.org/10.1177/1740774515571140. Albright K, Gechter K, Kempe A. Importance of mixed methods in pragmatic trials and dissemination and implementation research. Acad Pediatr. 2013;13(5):400-407. https://doi.org/10.1016/j.acap.2013.06.010. Eldridge SM, Chan CL, Campbell MJ, et al. CONSORT 2010 statement: extension to randomised pilot and feasibility trials. Pilot Feasibility Stud. 2016;2:64. https://doi.org/10.1186/s40814-016-0105-8. Orkin AM, Gill PJ, Ghersi D, et al. Guidelines for reporting trial protocols and completed trials modified due to the COVID-19 pandemic and other extenuating circumstances: The CONSERVE 2021 Statement. JAMA. 2021;326(3):257-265. https://doi.org/10.1001/jama.2021.9941. O’Cathain A, Murphy E, Nicholl J. The quality of mixed methods studies in health services research. J Health Serv Res Policy. 2008;13(2):92-98. https://doi.org/10.1258/jhsrp.2007.007074. Creswell JW, Plano Clark VL. Designing and conducting mixed methods research. Third Edition, SAGE Publications. 2017. Tashakkori A, Teddlie C. SAGE Handbook of mixed methods in social & behavioral research. SAGE Publications. Second Edition 2010. Nasreddine ZS, Phillips NA, Bédirian V, et al. The Montreal Cognitive Assessment, MoCA: a brief screening tool for mild cognitive impairment. J Am Geriatr Soc. 2005;53(4):695-699. https://doi.org/10.1111/j.1532-5415.2005.53221.x. Folstein MF, Folstein SE, McHugh PR. "Mini-mental state". A practical method for grading the cognitive state of patients for the clinician. J Psychiatr Res. 1975;12(3):189-198. https://doi.org/10.1016/0022-3956(75)90026-6. Nguyen TN, Cumming RG, Hilmer SN. The impact of frailty on mortality, length of stay and re-hospitalisation in older patients with atrial fibrillation. Heart Lung Circ. 2016;25(6):551-557. https://doi.org/10.1016/j.hlc.2015.12.002. Government of Nova Scotia. Hospitals Act, Halifax. 2015 Efird J. Blocked randomization with randomly selected block sizes. Int J Environ Res Public Health. 2011;8(1):15-20. https://doi.org/10.3390/ijerph8010015. Hébert R, Carrier R, Bilodeau A. The Functional Autonomy Measurement System (SMAF): description and validation of an instrument for the measurement of handicaps. Age Ageing. 1988;17(5):293-302. https://doi.org/10.1093/ageing/17.5.293. Hébert R, Guilbault J, Desrosiers J, Dubuc N. The functional autonomy measurement system (SMAF): a clinical-based instrument for measuring disabilities and handicaps in older people. Geriatrics Today. 2001;4:141-144. Hébert R, Desrosiers J, Dubuc N, Tousignant M, Guilbeault J, Pinsonnault E. Le système de mesure de l'autonomie fonctionnelle (SMAF). La Revue de Gériatrie. 2003;28(4):323-336. Desrosiers J, Bravo G, Hébert R, Dubuc N. Reliability of the revised functional autonomy measurement system (SMAF) for epidemiological research. Age Ageing. 1995;24(5):402-406. https://doi.org/10.1093/ageing/24.5.402. Langlais ME. Estimation et comparaison de la sensibilité au changement de trois échelles d’indépendance fonctionnelle couramment utilisées en réadaptation gériatrique. Master’s Thesis. Université de Sherbrooke. 1998. Hébert R, Dubuc N, Buteau M, et al. Resources and Costs Associated with Disabilities of Elderly People Living at Home and in Institutions. Canadian Journal on Aging / La Revue canadienne du vieillissement. 2001;20(1):1-22. https://doi.org/10.1017/S0714980800012113. Pinsonnault E, Desrosiers J, Dubuc N, Kalfat H, Colvez A, Delli-Colli N. Functional autonomy measurement system: development of a social subscale. Arch Gerontol Geriatr. 2003;37(3):223-233. https://doi.org/10.1016/s0167-4943(03)00049-9. Kiresuk TJ, Sherman RE. Goal attainment scaling: A general method for evaluating comprehensive community mental health programs. Community Ment Health J . 1968;4(6):443-453. https://doi.org/10.1007/BF01530764. Kiresuk TJ, Smith A, Cardillo JE, editors. Goal Attainment Scaling: Applications, Theory, and Measurement (1st ed.). New York:Psychology Press. 1994. 336 p. https://doi.org/10.4324/9781315801933. Provencher V, D'Amours M, Viscogliosi C, et al. Risks perceived by frail male patients, family caregivers and clinicians in hospital: Do they change after discharge? A multiple case study. Int J Integr Care. 2019;19(1):4. https://doi.org/10.5334/ijic.4166. Provencher V, Viscogliosi C, Lacerte J, et al. Risk management during the transition from hospital to home: A multiple case study documenting the experience of patients living with a major neurocognitive disorder, their caregivers, and healthcare professionals. J Patient Exp. 2024;11:23743735241259553. https://doi.org/10.1177/23743735241259553. Graumlich JF, Novotny NL, Aldag JC. Brief scale measuring patient preparedness for hospital discharge to home: Psychometric properties. J Hosp Med. 2008;3(6):446-454. https://doi.org/10.1002/jhm.316. Centre de recherche – CHUS. DORISE. Données Organisées du Réseau Informatique de Santé de l’Estrie. https://www.crchus.ca/en/services-outils/autres-services-et-outils/infocentre. Australian Commission on Safety and Quality in Care. Avoidable hospital readmissions . 2022. https://www.safetyandquality.gov.au/our-work/indicators/avoidable-hospital-readmissions.. Hébert R, Spiegelhalter DJ, Brayne C. Setting the minimal metrically detectable change on disability rating scales. Arch Phys Med Rehabil. 1997;78(12):1305-1308. https://doi.org/10.1016/s0003-9993(97)90301-4. Lannin NA, Clemson L, McCluskey A. Survey of current pre-discharge home visiting practices of occupational therapists. Aust Occup Ther J. 2011;58(3):172-177. https://doi.org/10.1111/j.1440-1630.2010.00911.x. Desrosiers J, Rochette A, Noreau L, Bravo G, Hébert R, Boutin C. Comparison of two functional independence scales with a participation measure in post-stroke rehabilitation. Arch Gerontol Geriatr. 2003;37(2):157-172. https://doi.org/10.1016/s0167-4943(03)00044-x. Hennink M, Kaiser BN. Sample sizes for saturation in qualitative research: A systematic review of empirical tests. Soc Sci Med. 2022;292:114523. https://doi.org/10.1016/j.socscimed.2021.114523. Malterud K, Siersma VD, Guassora AD. Sample Size in Qualitative Interview Studies: Guided by Information Power. Qual Health Res . 2016;26(13):1753-1760. https://doi.org/10.1177/1049732315617444. Thabane L, Ma J, Chu R, et al. A tutorial on pilot studies: the what, why and how. BMC Med Res Methodol. 2010;10:1. https://doi.org/10.1186/1471-2288-10-1. Watkins DC. Rapid and Rigorous Qualitative Data Analysis: The “RADaR” technique for applied research. Int. J. Qual. Methods. 2017;16(1):1-9. https://doi.org/10.1177/1609406917712131. Farley J, Duppong Hurley K, Aitken AA. Monitoring implementation in program evaluation with direct audio coding. Eval Program Plann. 2020;83:101854. https://doi.org/10.1016/j.evalprogplan.2020.101854. Neal JW, Neal ZP, VanDyke E, Kornbluh M. Expediting the analysis of qualitative data in evaluation: A procedure for the rapid identification of themes from audio recordings (RITA). Am J Eval. 2015;36(1):118–132. https://doi.org/10.1177/1098214014536601. Kowalski CP, Nevedal AL, Finley EP, et al. Planning for and Assessing Rigor in Rapid Qualitative Analysis (PARRQA): a consensus-based framework for designing, conducting, and reporting. Implement Sci. 2024;19(1):71. https://doi.org/10.1186/s13012-024-01397-1. Pitkala KH, Strandberg TE. Clinical trials in older people. Age Ageing. 2022;51(5):afab282. https://doi.org/10.1093/ageing/afab282. Schattner A. The spectrum of hospitalization-associated harm in the elderly. Eur J Intern Med. 2023;115:29-33. https://doi.org/10.1016/j.ejim.2023.05.025. Olsson A, Berglöv A, Sjölund BM. "Longing to be independent again" - A qualitative study on older adults' experiences of life after hospitalization. Geriatr Nurs. 2020;41(6):942-948. https://doi.org/10.1016/j.gerinurse.2020.07.007. Alzahrani N. The effect of hospitalization on patients' emotional and psychological well-being among adult patients: An integrative review. Appl Nurs Res. 2021;61:151488. https://doi.org/10.1016/j.apnr.2021.151488. Murman DL. The Impact of Age on Cognition. Semin Hear. 2015;36(3):111-121. https://doi.org/10.1055/s-0035-1555115. Kirova AM, Bays RB, Lagalwar S. Working memory and executive function decline across normal aging, mild cognitive impairment, and Alzheimer's disease. Biomed Res Int. 2015;2015:748212. https://doi.org/10.1155/2015/748212. Gouvernement du Québec. Étude exploratoire sur l'analphabétisme en lien avec la santé et le vieillissement. 2008-2009. Rapport de recherche. 2008. 59p. https://collections.banq.qc.ca/ark:/52327/bs1871380. Institut de la statistique du Québec. Développer nos compétences en littératie : un défi porteur d'avenir. Rapport québécois de l’Enquête internationale sur l’alphabétisation et les compétences des adultes, 2003. 2006. https://statistique.quebec.ca/fr/document/developper-competences-litteratie-defi-porteur-avenir. Altawalbeh SM, Alkhateeb FM, Attarabeen OF. Ethical Issues in Consenting Older Adults: Academic Researchers and Community Perspectives. J Pharm Health Serv Res. 2020;11(1):25-32. https://doi.org/10.1111/jphs.12327. Shannon J. Informed consent: documenting the intersection of bureaucratic regulation and ethnographic practice. Polit Leg Anthropol Rev:PoLAR. 2007;30(2):229-248. https://doi.org/10.1525/pol.2007.30.2.229. Marshall PA. Informed consent in international health research. J Empir Res Hum Res Ethics. 2006;1(1):25-42. https://doi.org/10.1525/jer.2006.1.1.25. University of Virginia. When consent is not required. Institutional Review Board for the Social and Behavioral Sciences (IRB-SBS). 2024. https://sites.research.virginia.edu/irb-sbs/when-consent-not-required. McHugh KR, Swamy GK, Hernandez AF. Engaging patients throughout the health system: A landscape analysis of cold-call policies and recommendations for future policy change. J Clin Transl Sci. 2018;2(6):384-392. https://doi.org/10.1017/cts.2019.1. Poulin V, Korner-Bitensky N, Bherer L, Lussier M, Dawson DR. Comparison of two cognitive interventions for adults experiencing executive dysfunction post-stroke: a pilot study. Disabil Rehabil. 2017;39(1):1-13. https://doi.org/10.3109/09638288.2015.1123303. MacLeod H, Veillette N, Klein J, et al. Shifting the narrative from living at risk to living with risk: validating and pilot-testing a clinical decision support tool: a mixed methods study. BMC Geriatr. 2023;23(1):338. https://doi.org/10.1186/s12877-023-04068-w. Atwal A, Caldwell K. Ethics, occupational therapy and discharge planning: Four broken principles. Aust Occup Ther J. 2003;50(4):244 251. https://doi.org/10.1046/j.1440-1630.2003.00374.x. Ifrim RA, Klugarová J, Măguriță D, Zazu M, Mazilu DC, Klugar M. Communication, an important link between healthcare providers: a best practice implementation project. JBI Evid Implement. 2022;20(S1):S41-S48. https://doi.org/10.1097/XEB.0000000000000319. Foronda C, MacWilliams B, McArthur E. Interprofessional communication in healthcare: An integrative review. Nurse Educ Pract. 2016;19:36-40. https://doi.org/10.1016/j.nepr.2016.04.005. Ministère de la santé et des services sociaux. Plan stratégique 2023-2027. Gouvernement du Québec. 2023. https://publications.msss.gouv.qc.ca/msss/document-003663/. Fleury F, Trépanier M. Soins intensifiés à domicile – Recension exploratoire. Consortium InterS4. 2018. https://consortiuminters4.uqar.ca/bibliotheque/soins-intensifies-a-domicile/. Tuzzio L, Berry AL, Gleason K, et al. Aligning care with the personal values of patients with complex care needs. Health Serv Res. 2021;56(Suppl 1):1037-1044. https://doi.org/10.1111/1475-6773.13862. Kanno NP, Peduzzi M, Germani ACCG, Soárez PC, Silva ATCD. Interprofessional collaboration in primary health care from the perspective of implementation science. A colaboração interprofissional na atenção primária à saúde na perspectiva da ciência da implementação. Cad Saude Publica. 2023;39(10):e00213322. https://doi.org/10.1590/0102-311XPT213322. Latulippe K, Giroux D, Guay M, et al. Mobile Videoconferencing for Occupational Therapists' Assessments of Patients' Home Environments Prior to Hospital Discharge: Mixed Methods Feasibility and Comparative Study. JMIR Aging. 2022;5(3):e24376. https://doi.org/10.2196/24376. Juang WC, Chiou SM, Chen HC, Li YC. Differences in characteristics and length of stay of elderly emergency patients before and after the outbreak of COVID-19. Int J Environ Res Public Health. 2023;20(2):1162. https://doi.org/10.3390/ijerph20021162. Butt AA, Kartha AB, Masoodi NA, et al. Hospital admission rates, length of stay, and in-hospital mortality for common acute care conditions in COVID-19 vs. pre-COVID-19 era. Public Health. 2020;189:6-11. https://doi.org/10.1016/j.puhe.2020.09.010. Denninger NE, Brefka S, Dallmeier D, Denkinger M, Müller M. Impacts of COVID-19-related measures on older non-COVID-19 patients, their caregivers, and healthcare professionals in acute care settings: A secondary analysis of real-time qualitative data from the TRADE study. Geriatr Nurs. 2025;66(Part A):1-15. https://doi.org/10.1016/j.gerinurse.2025.103679. Damschroder LJ, Aron DC, Keith RE, Kirsh SR, Alexander JA, Lowery JC. Fostering implementation of health services research findings into practice: a consolidated framework for advancing implementation science. Implement Sci. 2009;4:50. https://doi.org/10.1186/1748-5908-4-50. Additional Declarations No competing interests reported. Supplementary Files Additionalfile1CONSORTextensionPilotandFeasibilityTrialsChecklist.pdf Additionalfile2CONSERVECONSORTchecklist.pdf Additionalfile3GRAMMSchecklist.pdf Cite Share Download PDF Status: Posted Version 1 posted You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. We do this by developing innovative software and high quality services for the global research community. Our growing team is made up of researchers and industry professionals working together to solve the most critical problems facing scientific publishing. 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Laval","correspondingAuthor":false,"prefix":"","firstName":"Marie-Josée","middleName":"","lastName":"Sirois","suffix":""},{"id":637191603,"identity":"c18d1b49-1e7b-4ea5-9a3f-6834d32470c3","order_by":11,"name":"Mary Egan","email":"","orcid":"","institution":"University of Ottawa","correspondingAuthor":false,"prefix":"","firstName":"Mary","middleName":"","lastName":"Egan","suffix":""},{"id":637191604,"identity":"48c1888b-0f36-4383-ae35-562dfb522f18","order_by":12,"name":"Véronique 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21:53:30","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-9635148/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-9635148/v1","draftVersion":[],"editorialEvents":[],"editorialNote":"","failedWorkflow":false,"files":[{"id":109296634,"identity":"cb4bde2e-760d-400c-bbd6-7fa536d1a2e3","added_by":"auto","created_at":"2026-05-15 08:48:40","extension":"png","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":89071,"visible":true,"origin":"","legend":"\u003cp\u003eStudy procedures: outcome measures and data collection from participants\u003c/p\u003e","description":"","filename":"floatimage1.png","url":"https://assets-eu.researchsquare.com/files/rs-9635148/v1/f6ce38732302027308f6a291.png"},{"id":109269389,"identity":"e420376c-1583-4df0-aece-af776acf4022","added_by":"auto","created_at":"2026-05-14 13:28:27","extension":"png","order_by":2,"title":"Figure 2","display":"","copyAsset":false,"role":"figure","size":54027,"visible":true,"origin":"","legend":"\u003cp\u003eCONSORT Diagram: Flowchart of Participants\u003c/p\u003e","description":"","filename":"floatimage2.png","url":"https://assets-eu.researchsquare.com/files/rs-9635148/v1/dc50b5fbc80a5bc19399509a.png"},{"id":109296185,"identity":"02c81af2-a305-4c52-9853-a43ed1f93d81","added_by":"auto","created_at":"2026-05-15 08:45:58","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":501779,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-9635148/v1/d5c51744-13e7-4054-ba04-009c2f68b1eb.pdf"},{"id":109269387,"identity":"ed31ffaa-6631-44dd-8c1c-a9375daa20a0","added_by":"auto","created_at":"2026-05-14 13:28:27","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"supplement","size":96386,"visible":true,"origin":"","legend":"","description":"","filename":"Additionalfile1CONSORTextensionPilotandFeasibilityTrialsChecklist.pdf","url":"https://assets-eu.researchsquare.com/files/rs-9635148/v1/4408ca23d9f22401f92ea611.pdf"},{"id":109405678,"identity":"0393935f-29c7-463b-b5f4-d83389c9111d","added_by":"auto","created_at":"2026-05-17 13:19:40","extension":"pdf","order_by":1,"title":"","display":"","copyAsset":false,"role":"supplement","size":154415,"visible":true,"origin":"","legend":"","description":"","filename":"Additionalfile2CONSERVECONSORTchecklist.pdf","url":"https://assets-eu.researchsquare.com/files/rs-9635148/v1/7637a2a7044eb6df88303538.pdf"},{"id":109296907,"identity":"d54cc2e9-3a7c-44d6-8469-f35e7e4b35d6","added_by":"auto","created_at":"2026-05-15 08:52:05","extension":"pdf","order_by":2,"title":"","display":"","copyAsset":false,"role":"supplement","size":149145,"visible":true,"origin":"","legend":"","description":"","filename":"Additionalfile3GRAMMSchecklist.pdf","url":"https://assets-eu.researchsquare.com/files/rs-9635148/v1/b6c773bf01be7333131af2d7.pdf"}],"financialInterests":"No competing interests reported.","formattedTitle":"Supporting discharge planning in frail older adults with mild cognitive impairment: lessons learned from a feasibility pilot randomized control trial (RCT)","fulltext":[{"header":"Key messages regarding feasibility","content":"\u003cp\u003e\u003cstrong\u003e1) What uncertainties existed regarding the feasibility?\u003c/strong\u003e\u003c/p\u003e\n\u003cul\u003e\n \u003cli\u003eUncertainties existed about how to effectively recruit older adults living with frailty, while evaluating an intervention they could benefit from, when the very characteristic that makes them ideal candidates \u0026ndash; frailty\u0026mdash; also renders them difficult to recruit. This challenge created a conundrum with the study\u0026rsquo;s implementation. Among the components of the Australian-based discharge intervention called HOME, a collaborative goal setting and pre-discharge home visits were the most difficult to implement in a Canadian context.\u0026nbsp;\u003c/li\u003e\n\u003c/ul\u003e\n\u003cp\u003e\u003cstrong\u003e2) What are the key feasibility findings?\u003c/strong\u003e\u003c/p\u003e\n\u003cul\u003e\n \u003cli\u003eThe feasibility of a large-scale randomized controlled trial (RCT) using the Canadian adaptation of the HOME intervention\u0026mdash;designed to support hospital-to-home transitions for older adults with mild cognitive impairment\u0026mdash;was not demonstrated, mainly due to significant recruitment challenges. Indeed, the initial study aimed to enroll 36 participants per group (experimental and control), for a total of 72. However, only seven participants were recruited, and five completed all outcome measures. Pre-discharge communication between hospital and community clinicians improved information exchange and eased transitions. Moreover, despite the small sample size, results indicated potential benefits for functional autonomy, highlighting the value of integrating patient-centered goals such as leisure activities during discharge planning\u0026mdash;even within the constraints of hospital settings.\u0026nbsp;\u003c/li\u003e\n\u003c/ul\u003e\n\u003cp\u003e\u003cstrong\u003e3) What are the implications of the feasibility findings for the design of the main study?\u003c/strong\u003e\u003c/p\u003e\n\u003cul\u003e\n \u003cli\u003eThe significant recruitment challenges encountered led to the conclusion that a large-scale pragmatic RCT would not be feasible, and the contributing factors extend beyond the pandemic. These barriers hinder the evaluation of the HOME intervention\u0026rsquo;s effectiveness and highlight the need for revised or innovative research recruitment strategies\u0026mdash;particularly for hospitalized older adults facing complex discharge transitions.\u003c/li\u003e\n\u003c/ul\u003e"},{"header":"Background","content":"\u003cp\u003eAfter hospitalization, most older adults wish to return home, resume their life roles, and engage in meaningful activities\u003csup\u003e\u003cspan class=\"CitationRef\"\u003e1\u003c/span\u003e,\u003cspan class=\"CitationRef\"\u003e2\u003c/span\u003e\u003c/sup\u003e. However, hospitalization often leads to deconditioning and difficulties performing activities of daily living (ADLs)\u003csup\u003e\u003cspan class=\"CitationRef\"\u003e3\u003c/span\u003e,\u003cspan class=\"CitationRef\"\u003e4\u003c/span\u003e\u003c/sup\u003e. Combined with illness‑related functional decline, these challenges increase the risk of emergency department (ED) visits and unplanned hospital readmissions in the months following discharge, especially for older adults living with frailty\u003csup\u003e\u003cspan class=\"CitationRef\"\u003e5\u003c/span\u003e,\u003cspan class=\"CitationRef\"\u003e6\u003c/span\u003e\u003c/sup\u003e. Reviews\u003csup\u003e\u003cspan class=\"CitationRef\"\u003e7\u003c/span\u003e–\u003cspan class=\"CitationRef\"\u003e9\u003c/span\u003e\u003c/sup\u003e and empirical studies\u003csup\u003e\u003cspan class=\"CitationRef\"\u003e10\u003c/span\u003e–\u003cspan class=\"CitationRef\"\u003e12\u003c/span\u003e\u003c/sup\u003e have shown that comprehensive, patient-centered discharge-planning interventions, characterized by personalized care across hospital-community interfaces and active involvement of patients and families in decision-making, can improve post-discharge functional autonomy in ADLs as well as reduce ED visit and hospital readmissions among older adults living with frailty.\u003c/p\u003e \u003cp\u003eTo operationalize best practices in occupational therapy (OT) discharge planning for older adults, an Australian research team developed the “HOME” intervention\u003csup\u003e\u003cspan class=\"CitationRef\"\u003e13\u003c/span\u003e\u003c/sup\u003e. HOME uses collaborative goal setting\u003csup\u003e\u003cspan class=\"CitationRef\"\u003e14\u003c/span\u003e\u003c/sup\u003e and joint problem solving\u003csup\u003e\u003cspan class=\"CitationRef\"\u003e15\u003c/span\u003e\u003c/sup\u003e with patients and family members to support safe, sustainable discharges. This collaborative process—focused on the fit between the person and their environment—encourages older adults to take ownership of their discharge goals and the strategies needed to achieve them. HOME also provides post-discharge support, enabling patients and families to build independence and access necessary services.\u003c/p\u003e \u003cp\u003eThe HOME intervention was assessed in a randomized control trial (RCT) involving 400 older patients across five Australian hospitals\u003csup\u003e\u003cspan class=\"CitationRef\"\u003e16\u003c/span\u003e\u003c/sup\u003e. Secondary analyses showed that HOME significantly reduced unplanned rehospitalizations among participants with mild cognitive impairment and improved participation in life roles among those without social support, although the latter was not statistically significant\u003csup\u003e\u003cspan class=\"CitationRef\"\u003e17\u003c/span\u003e\u003c/sup\u003e. Building on these findings, our team sought to implement HOME in a Canadian context with this subgroup of older adults. A Canadian adaptation of the intervention was therefore developed using an integrated knowledge-transfer approach to ensure that it met the needs of knowledge users and could be implemented within local health-care structures. This was particularly important given that, in Canada—and especially in Québec—functional goal identification is not routinely performed in hospital settings, pre-discharge OT home visits are uncommon, and waiting times for home visits vary widely.\u003c/p\u003e\n\u003ch3\u003eAdaptation of HOME to the Canadian context (preliminary study)\u003c/h3\u003e\n\u003cp\u003eThe Canadian adaptation of HOME was developed in May 2017 through a one-day workshop and two online sessions, guided by an Expert Advisory Committee of researchers, decision makers, clinicians, and a patient/family representative\u003csup\u003e\u003cspan class=\"CitationRef\"\u003e18\u003c/span\u003e\u003c/sup\u003e. These consultations revealed participants’ overall agreement with HOME’s goals, values and philosophy. However, the Expert Advisory Committee made the following recommendations about its procedural aspect: 1) involve community-based clinicians in the intervention, as they are typically responsible for post-discharge home visits, in order to (a) ensure that pre-discharge recommendations align with available community resources, (b) avoid duplication of in-home assessments, and (c) support long-term follow-up if new needs arise after discharge; and 2) increase flexibility in the intervention, to respond more individually to patients and family needs. For example, in consultation with the patient and family, the HOME clinician may decide not to conduct a pre-discharge home visit for a patient living with frailty or may opt to provide additional follow-up calls.\u003c/p\u003e \u003cp\u003eGiven the adaptations made to the HOME intervention for the Canadian context and the focus on frail older adults, it was necessary to reconsider the study design. The inclusion of patient-centered outcome measures—recommended by the Australian research team—also supported the need to first assess the feasibility of a large-scale randomized controlled trial (RCT). This design was well suited to examine issues specific to this population (e.g., recruitment pace, respondent burden) and to organizational factors influencing implementation in Canada (e.g., short hospital stays, prevailing care culture). A pragmatic approach\u003csup\u003e\u003cspan class=\"CitationRef\"\u003e19\u003c/span\u003e\u003c/sup\u003e was adopted to capture the real-world benefits of the revised HOME intervention\u003csup\u003e\u003cspan class=\"CitationRef\"\u003e20\u003c/span\u003e\u003c/sup\u003e. Finally, recognizing that measurable effects may not fully reflect perceived benefits, the feasibility and pragmatic components were integrated within a mixed-methods design—a robust way to understand what works, what does not, and why\u003csup\u003e\u003cspan class=\"CitationRef\"\u003e21\u003c/span\u003e\u003c/sup\u003e.\u003c/p\u003e \u003cp\u003eThe purpose of this study was therefore to evaluate the feasibility of conducting a future large-scale RCT comparing the Canadian adaptation of the HOME intervention—designed to support the transition from hospital to home for frail older adults living with mild cognitive impairment—with customary care. To this end, a pragmatic pilot RCT was conducted to (1) document both quantitative and qualitative feasibility data related to recruitment, retention, as well as the acceptability and applicability of both the intervention and data collection procedures (2) evaluate the intervention’s preliminary effectiveness on functional autonomy (\u003cem\u003eprimary outcome\u003c/em\u003e), patient-centered outcomes—specifically discharge-related goal attainment and perceived preparedness— and hospital or ED readmissions rates (\u003cem\u003esecondary outcomes\u003c/em\u003e).\u003c/p\u003e "},{"header":"Methods","content":"\u003cp\u003eFollowing the launch of the pilot trial, substantial methodological adjustments were required. This section presents the final study protocol, outlining the elements retained from the original version as well as the modifications introduced, all of which were approved by the principal investigator (VP). The study was guided by the CONSORT extension for pilot and feasibility trials\u003csup\u003e\u003cspan class=\"CitationRef\"\u003e22\u003c/span\u003e\u003c/sup\u003e (checklist in additional file 1) and the CONSERVE-CONSORT guidelines for COVID-19–related modifications\u003csup\u003e\u003cspan class=\"CitationRef\"\u003e23\u003c/span\u003e\u003c/sup\u003e (checklist in additional file 2). The research complies with the GRAMMS guideline\u003csup\u003e\u003cspan class=\"CitationRef\"\u003e24\u003c/span\u003e\u003c/sup\u003e (checklist in additional file 3). Ethical approval was obtained from the CIUSSSE-CHUS Research Ethics Board (2020–2894).\u003c/p\u003e\u003ch3\u003eStudy design\u003c/h3\u003e\u003cp\u003eA three-year feasibility study (2019–2022) was conducted using a pragmatic pilot RCT to inform a future full-scale study. The design followed a mixed-methods sequential explanatory approach, with qualitative data from clinicians used to help interpret quantitative findings\u003csup\u003e\u003cspan class=\"CitationRef\"\u003e25\u003c/span\u003e,\u003cspan class=\"CitationRef\"\u003e26\u003c/span\u003e\u003c/sup\u003e.\u003c/p\u003e\u003ch3\u003eEligibility criteria and setting\u003c/h3\u003e\u003cp\u003eTo be eligible, patients had to: 1) be aged 70 years or older (as in the original HOME study); 2) have mild cognitive impairment (Montreal Cognitive Assessment (MoCA) 20-26\u003csup\u003e27\u003c/sup\u003e, or Mini-Mental State Examination (MMSE) 18-23\u003csup\u003e28\u003c/sup\u003e or based on clinical judgment); 3) be expected to return to the community after discharge; 4) be conversant in French or English. The MoCA and MMSE were routinely used screening tools in the targeted wards. An expected hospital stay of ≥ 5 days was also required to allow implementation of HOME without prolonging hospitalization; this longer stay served as a pragmatic proxy for frailty\u003csup\u003e\u003cspan class=\"CitationRef\"\u003e29\u003c/span\u003e\u003c/sup\u003e. Family members were invited to participate, although they were not part of the formal inclusion criteria. During the study, eligibility was expanded to include younger older adults (65–74 years) and individuals living alone or with limited social support—a subgroup previously shown to benefit from HOME\u003csup\u003e\u003cspan class=\"CitationRef\"\u003e17\u003c/span\u003e\u003c/sup\u003e. This change aimed to increase the pool of potentially eligible participants and mitigate COVID-19–related recruitment challenges. Patients were excluded if significant physical or mental conditions were judged likely to interfere with the intervention or data collection, or if they were unable to provide consent according to Nova Scotia criteria\u003csup\u003e\u003cspan class=\"CitationRef\"\u003e30\u003c/span\u003e\u003c/sup\u003e. Participants were recruited from two medical units in a semi-urban hospital in Sherbrooke, Quebec: a geriatric unit specializing in assessment and discharge planning for older adults with complex needs, and a general medical unit.\u003c/p\u003e\u003ch3\u003eEnrollment and randomization\u003c/h3\u003e\u003cp\u003eRecruitment was planned from October 2019 to October 2021 but was interrupted for 18 months (March 2020–September 2021) due to the COVID-19 suspension of research activities. It resumed until October 2022, when the study was stopped early because of persistent recruitment challenges, timeline constraints, and limited funding. Initial screening and verbal consent were conducted by occupational therapists (OTs) not involved in data collection. Eligible patients were then referred to research assistants (AG or NO). After the pandemic, a research assistant (NO) also contributed to screening to reduce clinicians’ workload. Weekly meetings with clinicians helped identify potential participants and refine recruitment procedures. After confirming eligibility and obtaining consent, participants were randomized in blocks to the intervention or control group, a method suited to maintaining allocation balance in small samples\u003csup\u003e\u003cspan class=\"CitationRef\"\u003e31\u003c/span\u003e\u003c/sup\u003e. Randomization was initially stratified by prior use of community-based services, a factor expected to reduce delays in accessing such services. Allocation was performed by a statistician and a research staff member (MD) independent of study design, recruitment, and data collection.\u003c/p\u003e\u003ch3\u003eIntervention\u003c/h3\u003e\u003ch2\u003eHOME intervention\u003c/h2\u003e\u003cp\u003eHOME was delivered to the experimental group. The OTs received three hours of training from the principal investigator and a research assistant (AG), including two sessions on assessing functional ability, goal setting, and home safety\u003csup\u003e\u003cspan class=\"CitationRef\"\u003e16\u003c/span\u003e\u003c/sup\u003e. The intervention consisted of four phases. \u003cb\u003ePhase 1 (hospital)\u003c/b\u003e: Hospital-based and community-based OTs jointly established a therapeutic relationship with the patient and family. OTs exchanged information about the participant’s home environment, discharge goals, functional abilities, and safety concerns in preparation for the pre-discharge home assessment. \u003cb\u003ePhase 2 (at hospital)\u003c/b\u003e: A community-based clinician conducted a \u003cb\u003epre-discharge home assessment\u003c/b\u003e approximately five days before expected discharge with the patient and family, when possible, to evaluate the environment, identify potential issues, and propose solutions. A deviation from the original protocol was introduced: when an in-person home visit with the patient was not feasible, the hospital-based OT conducted a virtual home visit using a tablet in collaboration with a family member. \u003cb\u003ePhase 3 (at home)\u003c/b\u003e: The community-based OT completed a \u003cb\u003epost-discharge home assessment\u003c/b\u003e within one week of discharge to provide additional home training and address any unmet needs. Independence was promoted by reinforcing pre-discharge goals and addressing post-discharge goals aimed at improving functional autonomy and supporting the resumption of meaningful activities, including leisure. \u003cb\u003ePhase 4 (at home): Follow-up telephone calls\u003c/b\u003e 2- and 3-weeks post-discharge provided ongoing support to participants and families, encouraging independent problem-solving and progress toward planned goals.\u003c/p\u003e\u003ch3\u003eCustomary discharge planning\u003c/h3\u003e\u003cp\u003eParticipants in the control group received the customary discharge-planning assessment from an OT who was not involved in the HOME intervention. As part of usual care, the OT gathered information on the participant’s ability to perform ADLs and on the home environment to support discharge planning. OT home assessments were not routinely provided, as they are not part of standard practice. When needs for assistive equipment or home modifications were identified, patients were referred to community-based home-care services. However, waiting times for a home visit by a community OT were typically several weeks—and often several months. All other medical and allied health services were delivered according to usual care in both groups.\u003c/p\u003e\u003ch3\u003eOutcomes\u003c/h3\u003e\u003ch2\u003eFeasibility data\u003c/h2\u003e\u003cp\u003eBeyond protocol deviations, feasibility data included (1) recruitment and retention rates (e.g., proportion screened, eligible, refusing; dropout rates and profiles) and (2) measures of acceptability and applicability related to both the intervention and the data-collection procedures.\u003c/p\u003e\u003ch2\u003ePrimary outcomes\u003c/h2\u003e\u003cp\u003eThe primary planned outcome was functional autonomy, assessed with the Functional Autonomy Measurement System (SMAF)\u003csup\u003e\u003cspan class=\"CitationRef\"\u003e32\u003c/span\u003e–\u003cspan class=\"CitationRef\"\u003e34\u003c/span\u003e\u003c/sup\u003e. The SMAF is a 29-item scale based on the WHO classification of functioning and evaluates five domains: ADLs (7 items), mobility (6), communication (3), mental functions (5), and Instrumental ADLs (8). Each item is scored from 0 (independent) to − 3 (dependent), for a total score ranging from 0 to − 87; a ≥5-point change is considered clinically meaningful. SMAF is administered by questioning the older adult and proxies, observing performance, and conducting brief tests. Its test–retest and interrater reliability are high (ICCs: 0.95)\u003csup\u003e\u003cspan class=\"CitationRef\"\u003e32\u003c/span\u003e,\u003cspan class=\"CitationRef\"\u003e35\u003c/span\u003e\u003c/sup\u003e. Its validity and sensitivity to change have been demonstrated\u003csup\u003e\u003cspan class=\"CitationRef\"\u003e36\u003c/span\u003e\u003c/sup\u003e, and SMAF scores correlate with service-use levels\u003csup\u003e\u003cspan class=\"CitationRef\"\u003e37\u003c/span\u003e\u003c/sup\u003e. The Social Functional Autonomy Measure (Social-SMAF)\u003csup\u003e\u003cspan class=\"CitationRef\"\u003e38\u003c/span\u003e\u003c/sup\u003e is a 6-item scale covering social participation, relationships, social roles, use of social services, and the expression of needs and limitations. Increased scores reflect greater social autonomy. Its measurement properties have been validated in older adults. The SMAF and Social-SMAF are pragmatic tools embedded in routine care and familiar to most hospital-based clinicians in Quebec.\u003c/p\u003e\u003ch2\u003eSecondary outcomes\u003c/h2\u003e\u003cp\u003eTo document older adults’ perceived attainment of discharge-related goals, the Goal Attainment Scaling (GAS)\u003csup\u003e\u003cspan class=\"CitationRef\"\u003e39\u003c/span\u003e,\u003cspan class=\"CitationRef\"\u003e40\u003c/span\u003e\u003c/sup\u003e was administered with the patient and a family member. GAS is a personalized outcome measure that involves: (i) setting goals based on individual needs before the intervention, (ii) implementing the intervention, and (iii) evaluating progress afterward. Each goal is weighted by the older adult according to its priority. Progress is rated on a 5-point scale: −2 (worst expected outcome), − 1 (less than expected), 0 (expected), + 1 (better than expected), and + 2 (best expected outcome). Raw scores are then calculated to determine overall goal attainment. To support administration with older adults with cognitive impairment, previously validated strategies—such as using pictures or describing daily routines—were employed\u003csup\u003e\u003cspan class=\"CitationRef\"\u003e41\u003c/span\u003e,\u003cspan class=\"CitationRef\"\u003e42\u003c/span\u003e\u003c/sup\u003e.\u003c/p\u003e\u003cp\u003ePerceived preparedness for hospital discharge was assessed for both patients and family members using B-PREPARED, an 11-item questionnaire evaluating discharge-planning processes and outcomes from their perspective. The tool has been validated in adults aged 65 and older and demonstrates acceptable construct and predictive validity\u003csup\u003e\u003cspan class=\"CitationRef\"\u003e43\u003c/span\u003e\u003c/sup\u003e.\u003c/p\u003e\u003cp\u003eClinical outcomes included the dates and number of unplanned rehospitalizations and ED visits, obtained from the hospital database\u003csup\u003e\u003cspan class=\"CitationRef\"\u003e44\u003c/span\u003e\u003c/sup\u003e. Readmissions were classified as unplanned (avoidable) when they were not related to routine patient care\u003csup\u003e\u003cspan class=\"CitationRef\"\u003e45\u003c/span\u003e\u003c/sup\u003e. Because the study was conducted in a semi‑urban area, the likelihood that patients would be readmitted to the same hospital was high.\u003c/p\u003e\u003ch2\u003eQualitative data\u003c/h2\u003e\u003cp\u003eIndividual semi-structured interviews were conducted by a trained research assistant (not involved in the intervention). Interviews with OTs delivering the HOME intervention explored the acceptability and applicability of both the study procedures (including data collection) and the intervention itself, as well as perceived implementation barriers and facilitators. OTs also shared their impressions of the intervention’s benefits compared with standard care. Additional interviews were conducted with OTs involved in the study who did not deliver the HOME intervention to highlight differences between the HOME and control conditions. Finally, we aimed to interview dyads of older adults living with frailty and their family members to explore (a) how they manage daily life (e.g., perceived risks and caregiving burden) and (b) how they experienced discharge planning (HOME or usual care), including aspects such as fatigue and anxiety.\u003c/p\u003e\u003ch2\u003eData collection\u003c/h2\u003e\u003cp\u003eBaseline demographic and health data for older adults were collected first. Although randomization should minimize group differences, these variables may influence outcomes and were therefore considered as potential covariates if important baseline imbalances emerged. Demographic data for family members (age, gender, self-reported health problems) were also planned for collection. To support hospital- and community-based OTs in data collection, standardized workbooks were developed and completed for each participant in both the experimental and control groups.\u003c/p\u003e\u003cp\u003eThe primary and secondary outcome measures, assessed with the SMAF and GAS respectively, were collected in hospital at baseline (T1) and at the patient’s home at 1 month (T2) and 3 months (T3) post-discharge. B-PREPARED was also administered at T2 (Fig.\u0026nbsp;\u003cspan class=\"InternalRef\"\u003e1\u003c/span\u003e). Each assessment session required approximately one hour. A research assistant with a relevant clinical background, trained in the study tools and blinded to group allocation (AG), administered all measures except those collected before discharge. Due to pragmatic constraints related to short hospital stays, baseline functional measures (T1) were collected by a research assistant (NO) rather than the hospital-based OT after the COVID-19 pandemic. Unplanned rehospitalizations and ED visits were recorded through chart reviews by the blinded research assistant from 1 to 6 months post-discharge. Interviews with older adults and their caregivers were scheduled at T2 and T3, while clinician interviews were conducted once quantitative data collection was completed.\u003c/p\u003e\u003ch2\u003eSample size\u003c/h2\u003e\u003cp\u003e We aimed to recruit 36 participants per group (experimental and control), for a total of 72 participants. This sample size was calculated to detect a large effect size (i.e., a 30% difference between groups in the proportion of patients showing a clinically significant change), based on the primary outcomes (α = 0.05; power = 80%)\u003csup\u003e46\u003c/sup\u003e and the expected dropout rate (≈ 16–20%)\u003csup\u003e16,47,48\u003c/sup\u003e. For the qualitative component, we aimed to recruit 16 dyads of older adults living with frailty and their family members (8 per group)\u003csup\u003e\u003cspan class=\"CitationRef\"\u003e49\u003c/span\u003e,\u003cspan class=\"CitationRef\"\u003e50\u003c/span\u003e\u003c/sup\u003e. We planned to interview the first four dyads recruited in each group (n = 8), followed by an additional eight dyads (four per group) three months later to explore potential cohort effects.\u003c/p\u003e\u003ch2\u003eData analysis\u003c/h2\u003e\u003ch2\u003eQuantitative data\u003c/h2\u003e\u003cp\u003eDescriptive statistics were used to characterize the HOME and control groups. Recruitment and follow-up rates were compared with thresholds literature to assess study feasibility\u003csup\u003e\u003cspan class=\"CitationRef\"\u003e51\u003c/span\u003e\u003c/sup\u003e. The study design initially included an intention-to-treat approach to estimate effect sizes for the functional measures. We originally planned to use generalized linear mixed models to account for repeated measures over time and to compare the proportion of patients showing a clinically significant change (e.g., SMAF ≥ 5)\u003csup\u003e33\u003c/sup\u003e between groups. Chi-square and exact tests were planned to assess potential baseline imbalances (possible confounders) and compare the proportion of patients readmitted or visiting the ED at 1, 3, and 6 months. A survival analysis was also planned to examine time to readmission. However, these analyses could not be conducted due to the small sample size.\u003c/p\u003e\u003ch2\u003eQualitative data\u003c/h2\u003e\u003cp\u003eInterviews conducted before the COVID-19 suspension were analyzed from transcripts, whereas post-pandemic interviews with OTs who did not implement the intervention were analyzed from audio files using a combination of the Rigorous and Accelerated Data Reduction (RADaR) technique\u003csup\u003e\u003cspan class=\"CitationRef\"\u003e52\u003c/span\u003e\u003c/sup\u003e and the Rapid Identification of Themes from Audio\u003csup\u003e\u003cspan class=\"CitationRef\"\u003e53\u003c/span\u003e,\u003cspan class=\"CitationRef\"\u003e54\u003c/span\u003e\u003c/sup\u003e. RADaR enabled systematic data organization while preserving the integrity of the material and was well suited to exploring unexpected implementation challenges\u003csup\u003e\u003cspan class=\"CitationRef\"\u003e55\u003c/span\u003e\u003c/sup\u003e. Data reduction was performed using a structured Excel matrix. Codes were grouped under the following themes: feasibility of the intervention and data-collection procedures (e.g., target population, recruitment); acceptability and applicability of the HOME intervention (e.g., facilitators, obstacles); and perceived benefits (for patients, families, and clinical practice). Audio summaries were entered into the same matrix, and findings were reviewed collaboratively (NO, VP) to ensure alignment with study objectives.\u003c/p\u003e\u003ch2\u003eMixed data\u003c/h2\u003e\u003cp\u003e NO and VP used a matrix to identify and clarify areas of agreement and disagreement between the two data sets (QUANT→ qual) and to further explore how the qualitative findings contextualized and interpreted the quantitative results—for example, whether positive experiences reported by patients, families, or clinicians were reflected in favorable quantitative outcomes, or whether new insights emerged regarding feasibility challenges.\u003c/p\u003e"},{"header":"Results","content":"\u003cdiv id=\"Sec22\" class=\"Section2\"\u003e \u003ch2\u003eCharacteristics of participants\u003c/h2\u003e \u003cp\u003eTable\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e presents the sociodemographic and health characteristics of participants in each trial group. The mean age was 85.3 years (\u0026plusmn;\u0026thinsp;5.2). The experimental group included two men and two women, while the control group consisted of three participants (one man and two women). Despite the small sample size, the two groups showed comparable sociodemographic and health profiles. Throughout the study, five clinicians and two research assistants received training due to staff turnover.\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab1\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 1\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eSociodemographic and health profile of participants (older adults)\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"3\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eCHARACTERISTIC\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eEXPERIMENTAL\u003c/p\u003e \u003cp\u003e\u003cem\u003en\u0026thinsp;=\u0026thinsp;4\u003c/em\u003e\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eCONTROL\u003c/p\u003e \u003cp\u003e\u003cem\u003en\u0026thinsp;=\u0026thinsp;3\u003c/em\u003e\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eCONTINUOUS\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e \u003cp\u003eMean (\u0026plusmn;\u0026thinsp;SD; Range)\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAge (years)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e83.3 (\u0026plusmn;\u0026thinsp;6.1;78\u0026ndash;89)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e88.0 (\u0026plusmn;\u0026thinsp;2.6;86\u0026ndash;91)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMMSE score (/30)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e25.7 (\u0026plusmn;\u0026thinsp;3.5;22\u0026ndash;29)\u003csup\u003ea\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e23.5 (\u0026plusmn;\u0026thinsp;5.0;20\u0026ndash;27)\u003csup\u003ea\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMoCA score\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e20.1 (\u0026plusmn;\u0026thinsp;1.5;19\u0026ndash;22)\u003csup\u003ea\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e21.0 (\u0026plusmn;\u0026thinsp;4.2;18\u0026ndash;24)\u003csup\u003ea\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eLength of hospital stay (n days)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e19.0 (\u0026plusmn;\u0026thinsp;6.3;11\u0026ndash;25)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e21.3 (\u0026plusmn;\u0026thinsp;8.5;15\u0026ndash;31)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eCATEGORICAL\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e \u003cp\u003e\u003cb\u003eFrequency (%)\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eGender - women\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e2 (50.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e2 (66.7)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eHighest level of education\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eHigh school or less\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e2 (50.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e2 (66.7)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePost high school\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e2 (50.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e1 (33.3)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAnnual income\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u0026lt; \u003cspan\u003e$\u003c/span\u003e19,000\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1 (25.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cspan\u003e$\u003c/span\u003e19,000\u0026ndash;39,000\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e3 (75.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e2 (66.7)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eRefusal\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e1 (33.3)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eDwelling type\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eHome/apartment\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e2 (50.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e1 (33.3)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSeniors\u0026rsquo; residence\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e2 (50.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e2 (66.7)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eLiving situation - alone\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e2 (50.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0 (0)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMain reason for hospital admission\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eFall\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e3 (75.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e2 (66.7)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePneumonia and chronic deconditioning\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1 (25.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e-\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eDelirium (fall history)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e-\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e1 (33.3)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePerceived health\u003csup\u003eb\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eGood\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1 (25.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e1 (33.3)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAverage\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e3 (75.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e2 (66.7)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePrevious use of community services (yes)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e2 (66.7)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003ctfoot\u003e \u003ctr\u003e\u003ctd colspan=\"3\"\u003e\u003csup\u003ea\u003c/sup\u003e One missing data; \u003csup\u003eb\u003c/sup\u003eBased on this question: \u0026ldquo;\u003cem\u003eCompared to people your age, in general, how would you rate your health?\u003c/em\u003e\u0026rdquo;\u003c/td\u003e\u003c/tr\u003e \u003c/tfoot\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cdiv id=\"Sec23\" class=\"Section3\"\u003e \u003ch2\u003eFeasibility data - Recruitment and retention of participants\u003c/h2\u003e \u003cdiv id=\"Sec24\" class=\"Section4\"\u003e \u003ch2\u003eQuantitative data\u003c/h2\u003e \u003cp\u003eFigure \u003cspan refid=\"Fig2\" class=\"InternalRef\"\u003e2\u003c/span\u003e presents the CONSORT diagram illustrating participant flow. Because recruitment was suspended for 18 months, the numbers for the steps preceding allocation are shown separately for the pre-pandemic and pandemic/post-pandemic periods. During the first period, although planned, clinicians did not collect formal data on eligibility or refusal rates in order to reduce their data-collection burden. The involvement of the research assistant in the screening process during the second period (see Methods) subsequently made it possible to document these indicators.\u003c/p\u003e \u003cp\u003eBefore the pandemic, nine participants were randomized. Despite adaptations to procedures and eligibility criteria, recruitment remained challenging during and after the COVID-19 period. Of the 22 potentially eligible patients screened during this second phase, only two (9%) were randomized. Seventeen patients (81%) did not meet inclusion criteria: most were discharged too early (n\u0026thinsp;=\u0026thinsp;10) or were not expected to return to the community (n\u0026thinsp;=\u0026thinsp;4). Three were excluded due to medical instability (n\u0026thinsp;=\u0026thinsp;1), absence of suspected cognitive impairment (n\u0026thinsp;=\u0026thinsp;1), or uncertainty regarding consent (n\u0026thinsp;=\u0026thinsp;1). Three other patients were excluded because recruiters anticipated refusal based on prior declines of services (n\u0026thinsp;=\u0026thinsp;2) or the patient wished to sign in the presence of a family member\u0026mdash;a requirement that could not be met under COVID-19 restrictions.\u003c/p\u003e \u003cp\u003eAmong the 11 randomized participants, six were allocated to the HOME intervention group and five to the control group. Data were analyzed for seven participants, with only five completing the data collection process. Of the four excluded participants, two dropped out, one deceased post T1 and one was admitted to long-term care. Two participants did not complete the study (deceased and pandemic issues) but were considered in the analysis since the issues arose after T2, thus providing interesting insight.\u003c/p\u003e \u003cp\u003e \u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv id=\"Sec25\" class=\"Section3\"\u003e \u003ch2\u003eQualitative data\u003c/h2\u003e \u003cp\u003eFour individual semi-structured interviews were conducted with hospital- and community-based clinicians. Hospital-based clinicians reported difficulties identifying and recruiting \u0026ldquo;suitable\u0026rdquo; candidates, that is patients with mild cognitive impairment who were still able to understand and complete the required assessments. As one clinician noted:\u003cdiv class=\"BlockQuote\"\u003e\u003cp\u003e \u003cem\u003eWe had patients who looked great on paper, but ultimately in person, it was a \u0026ldquo;no\u0026rdquo; (laughs)...-P1_Hospital\u003c/em\u003e \u003c/p\u003e\u003c/div\u003e\u003c/p\u003e \u003cp\u003eAdditionally, one clinician excluded individuals whose only community follow-up need was equipment provision, even though they were potentially eligible. While clinical judgment was meant to guide recruitment, this approach may have further narrowed the pool of candidates.\u003c/p\u003e \u003cp\u003eRecruitment efforts were further hindered by the fast-paced hospital environment and increased long-term care relocations during the COVID-19 pandemic. All hospital-based clinicians reported that potential participants were often discharged too quickly to be enrolled:\u003cdiv class=\"BlockQuote\"\u003e\u003cp\u003e \u003cem\u003e(\u0026hellip;) the turnover is so fast (\u0026hellip;) there's a patient: \"Oh, he doesn't look too bad [for the study]! Then in the end, he doesn't stay long enough. -P1_Hospital\u003c/em\u003e \u003c/p\u003e\u003c/div\u003e\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec26\" class=\"Section3\"\u003e \u003ch2\u003eFeasibility data - Acceptability / applicability of the intervention and data collection\u003c/h2\u003e \u003cdiv id=\"Sec27\" class=\"Section4\"\u003e \u003ch2\u003eQuantitative data\u003c/h2\u003e \u003cp\u003e \u003cem\u003eIntervention\u003c/em\u003e \u003c/p\u003e \u003cp\u003eThe intervention was conducted with three participants. Among these, the \u0026ldquo;predischarge visit\u0026rdquo; was conducted only once\u0026mdash;and in fact, took place at the time of discharge. The virtual visit was pretested but none was performed in a real-world context during the study.\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv id=\"Sec28\" class=\"Section2\"\u003e \u003ch2\u003eData collection\u003c/h2\u003e \u003cp\u003eWhile socio-demographic data were collected for all participants, family member-related data were available for only two. For five of the seven participants, the caregiver relationship was identified (one sibling, one spouse, and three children). Complete SMAF and Goal Attainment Scaling (GAS) data were available for five participants, with missing data due to illness (COVID-19) and death. Social-SMAF data were collected at all three measurement points for one participant, and at two time points for the remaining six. B-PREPARED scores and hospitalization/emergency visit data were collected for all seven participants (three in the control group, four in the experimental group). Only one participant agreed to an interview, and no interviews could be conducted with their family members\u0026mdash;despite four of them consenting to be contacted\u0026mdash;due to COVID-19 constraints.\u003c/p\u003e \u003c/div\u003e\n\u003ch3\u003eQualitative data\u003c/h3\u003e\n\u003cdiv id=\"Sec30\" class=\"Section2\"\u003e \u003ch2\u003eSubtheme 1: Appreciating the principles of the HOME intervention and real-time communication\u003c/h2\u003e \u003cp\u003eHospital-based clinicians appreciated the opportunity to communicate directly with the community-based clinician responsible for the follow-up. This communication supported timely information exchange, especially since written reports are sometimes sent after discharge and may not be available to the community-based clinician when needed. One clinician noted that:\u003cdiv class=\"BlockQuote\"\u003e\u003cp\u003e. \u003cem\u003e[\u0026hellip;] being able to talk to the person and tell her: \u0026ldquo;I observed this, I\u0026rsquo;m considering this and I\u0026rsquo;m sending you the reference, can you take a look? My report is on its way.\u0026rdquo; For me, it was really helpful because I didn\u0026rsquo;t know if I would have the time to produce the report in time. - P1_Hospital\u003c/em\u003e\u003c/p\u003e\u003c/div\u003e\u003c/p\u003e \u003cp\u003eFurthermore, some information\u0026mdash;such as interpersonal dynamics or family considerations\u0026mdash;was seen as easier to convey through real-time conversations. Although such details are not always included in written reports, they were viewed as \u0026ldquo;important to know to approach the intervention more effectively,\u0026rdquo; allowing clinicians \u0026ldquo;to have a more comprehensive picture [of the person]\u0026rdquo; (P4SAD). For this clinician, who participated in the study but did not deliver the intervention, creating a bridge between hospital and community-based services could help reduce duplication, particularly when cognitive issues are present:\u003cdiv class=\"BlockQuote\"\u003e\u003cp\u003e \u003cem\u003e(\u0026hellip;) when the clinicians have been able to spend time with that person, they have developed strategies (\u0026hellip;). So, it is this source of information that prevents a duplication (\u0026hellip;) the fact that the hospital has already gone through these steps allows us to start with a head start, and to know where to look (\u0026hellip;). It improves my assessment, and it guides my reflection \u0026hellip;- P4_Community\u003c/em\u003e \u003c/p\u003e\u003c/div\u003e\u003c/p\u003e \u003cp\u003eTimely follow-ups between hospital- and home-based clinicians were described as reassuring, particularly for patients considered higher risk. However, effective collaborative communication required some adjustments. One strategy tested was scheduling weekly calls at a fixed time, but coordinating schedules proved difficult. Brief, frequent interactions were ultimately viewed as the most effective approach:\u003cdiv class=\"BlockQuote\"\u003e\u003cp\u003e \u003cem\u003e(\u0026hellip;)You have to be able to talk to each other more often, and a lot of times, I had a [home] visit, and I just wasn't there, you know. I think it requires discussion, even if they are very brief, but more often.\" - P2_Community\u003c/em\u003e \u003c/p\u003e\u003c/div\u003e\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec31\" class=\"Section2\"\u003e \u003ch2\u003eSubtheme 2: Challenges Establishing Goals with Participants and Predischarge Visits\u003c/h2\u003e \u003cp\u003eCollaboratively establishing patient goals and conducting a pre-discharge home visit were identified as the most difficult HOME components to implement. Clinicians noted that the intervention aligns with OTs\u0026rsquo; core values by helping them refocus on clients\u0026rsquo; personal goals and integrate goal-attainment evaluation within the hospital context. A key challenge, however, was aligning patient-defined goals with discharge priorities and reconciling the multidisciplinary team\u0026rsquo;s perspective with HOME principles:\u003cdiv class=\"BlockQuote\"\u003e\u003cp\u003e \u003cem\u003eHOME has a philosophy that's not our hospital philosophy\u0026hellip; We don't talk about leisure activities\u0026hellip; we think about getting them as functional as possible so they can leave. There are things I wouldn't have normally addressed as a goal because it's not in my scope of practice. Since I was the only one to really bring it up\u0026mdash;the rest of the team (...) move on to something else, and then they [patients] have to leave! P1_Hospital\u003c/em\u003e \u003c/p\u003e\u003c/div\u003e\u003c/p\u003e \u003cp\u003eFurthermore, because many patients had difficulty identifying personal goals, the research team developed a list of example goals with images. However, this remained challenging for individuals with cognitive impairments, especially when options were not sufficiently concrete. Implementation was further complicated for those who struggled to recall their functional goals, creating difficulties when reviewing goals before discharge:\u003cdiv class=\"BlockQuote\"\u003e\u003cp\u003e \u003cem\u003eWe address them [goals], but more broadly and not in such detail (\u0026hellip;) the way patients formulated their goals wasn\u0026rsquo;t always clear. The people that were targeted didn\u0026rsquo;t always have a good memory. It\u0026rsquo;s not easy (\u0026hellip;) it\u0026rsquo;s not something that I usually do. I didn\u0026rsquo;t find that easy (\u0026hellip;) like quantifying those goals\u0026hellip;-P1_Community\u003c/em\u003e \u003c/p\u003e\u003c/div\u003e\u003c/p\u003e \u003cp\u003eSome defined goals, particularly leisure-related ones, were viewed as unrealistic given patients\u0026rsquo; functional autonomy and the clinical team\u0026rsquo;s discharge priorities and often required reframing. Planning discharge from patient-defined goals was considered difficult to implement, though relevant, as the clinician explained:\u003cdiv class=\"BlockQuote\"\u003e\u003cp\u003e \u003cem\u003eThe advantages are that it allows us to highlight things I would never have thought were so important for the patient (\u0026hellip;) but our reality means that I can\u0026rsquo;t dedicate time to that goal to plan the discharge, well, I have to dedicate time to another goal that is less important for the patient, but very important for me, for the discharge. -P1_Hospital\u003c/em\u003e \u003c/p\u003e\u003c/div\u003e\u003c/p\u003e \u003cp\u003eThe pre-discharge home visit, conducted twice during the pilot, proved difficult to operationalize due to short hospital stays, concerns about medical instability and transportation, and the risk of confusing patients who might expect to remain home afterward. Reluctance from families or care teams to authorize such visits further limited feasibility.\u003cdiv class=\"BlockQuote\"\u003e\u003cp\u003e \u003cem\u003eWell, there's the aspect that I don't think it's at all part of the culture of an acute care hospital setting to conduct pre-discharge visits. And the people at [unit], they're not there that long, and they're very ill medically, I find. So that makes it logistically very complicated to discharge them, and they don't see the point. - P2_Community\u003c/em\u003e \u003c/p\u003e\u003c/div\u003e\u003c/p\u003e \u003cp\u003eA hospital‑based clinician noted that earlier introduction of the HOME intervention\u0026rsquo;s core concepts could have supported more cohesive implementation and eased recruitment. Although she viewed the intervention as feasible, she emphasized the need for a gradual, phased rollout and a shift in institutional culture supported by team engagement. Nonetheless, experimenting with the HOME intervention influenced the hospital‑based clinician\u0026rsquo;s practice:\u003cdiv class=\"BlockQuote\"\u003e\u003cp\u003e \u003cem\u003eWell, it\u0026rsquo;s a bit how I will check with them their expectations that has changed. And like a bit when I ask them about how they used to function, what their routine was like\u0026hellip; I go into more detail than I usually do, with HOME. -P1_Hospital\u003c/em\u003e \u003c/p\u003e\u003c/div\u003e\u003c/p\u003e \u003cp\u003e Even though clinicians feared redundancy during telephone follow-up, the older adult interviewed reported being satisfied with the post-discharge phone calls and found them helpful, noting that they made her feel that clinicians cared about her.\u003c/p\u003e \u003cdiv id=\"Sec32\" class=\"Section3\"\u003e \u003ch2\u003ePreliminary effectiveness of the HOME intervention\u003c/h2\u003e \u003cp\u003eThe quantitative outcomes of the HOME preliminary effectiveness are presented in Table\u0026nbsp;\u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e2\u003c/span\u003e (scores by participant) and Table\u0026nbsp;\u003cspan refid=\"Tab3\" class=\"InternalRef\"\u003e3\u003c/span\u003e (mean assessment scores). Although the quantitative data must be interpreted with caution given the small sample size, participants in the experimental group showed a clinically meaningful improvement in functional autonomy one month after the intervention, as reflected in their SMAF scores, whereas the control group experienced a clinically significant decline during the same period. The mean T2\u0026ndash;T1 SMAF delta was 1.3 (0.5\u0026ndash;2) for the experimental group compared with \u0026minus;\u0026thinsp;13.5 (\u0026minus;\u0026thinsp;27.5 to \u0026minus;\u0026thinsp;5.5) for the control group, indicating a clinically important difference between groups (improvement in the experimental group and deterioration in the control group). SMAF-Social results are less conclusive due to missing T1 data for four participants. Among the partial data available, scores for four participants across both groups remained stable between T2 and T3 (\u0026plusmn;\u0026thinsp;1), while one participant in the experimental group showed improved social functioning (\u0026minus;\u0026thinsp;3 to 0). Qualitative findings also supported the perceived functional benefits of the HOME intervention, particularly by confirming whether functional needs identified in hospital were truly problematic at home through a more accurate understanding of the individual\u0026rsquo;s living environment.\u003cdiv class=\"BlockQuote\"\u003e\u003cp\u003e \u003cem\u003eIt allowed me to have a slightly more accurate view of the environment, to ensure that the equipment would work properly, that follow-up would be done quickly: that's what I appreciated about the project. It was a fast track for my patients, especially those I considered to be at higher risk, compared to the usual track. P1_Hospital\u003c/em\u003e \u003c/p\u003e\u003c/div\u003e\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab2\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 2\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eHOME preliminary effectiveness \u0026mdash; Quantitative outcomes by participant\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"11\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c7\" colnum=\"7\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c8\" colnum=\"8\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c9\" colnum=\"9\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c10\" colnum=\"10\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c11\" colnum=\"11\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eOutcome measures\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colspan=\"5\" nameend=\"c6\" namest=\"c2\"\u003e \u003cp\u003eExperimental group\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colspan=\"3\" nameend=\"c10\" namest=\"c8\"\u003e \u003cp\u003eControl group\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colspan=\"1\" nameend=\"c11\" namest=\"c11\"\u003e\u0026nbsp;\u003c/th\u003e \u003c/tr\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eP1\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eP3\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003eP7\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e \u003cp\u003eP9\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colspan=\"2\" nameend=\"c8\" namest=\"c7\"\u003e \u003cp\u003eP2\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c9\"\u003e \u003cp\u003eP4\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colspan=\"2\" nameend=\"c11\" namest=\"c10\"\u003e \u003cp\u003eP8\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eSMAF\u003c/b\u003e\u003csup\u003e\u003cb\u003ea\u003c/b\u003e\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c8\" namest=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colspan=\"1\" nameend=\"c11\" namest=\"c11\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eT1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e-23.5\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e-24\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e-19.5\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e-35\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c8\" namest=\"c7\"\u003e \u003cp\u003e-25\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e-14\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003e-25.5\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"1\" nameend=\"c11\" namest=\"c11\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eT2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e-21.5\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e-22.5\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e-19\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e.\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c8\" namest=\"c7\"\u003e \u003cp\u003e\u003cb\u003e-32.5\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e\u003cb\u003e-19.5\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003e\u003cb\u003e-53\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"1\" nameend=\"c11\" namest=\"c11\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eT3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u003cb\u003e-18\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e\u003cspan type=\"BoldUnderline\" class=\"BoldUnderline\" name=\"Emphasis\"\u003e-16.5\u003c/span\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e-18.5\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e-35\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c8\" namest=\"c7\"\u003e \u003cp\u003e\u003cb\u003e-31\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e\u003cb\u003e-19.5\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003en.a.\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"1\" nameend=\"c11\" namest=\"c11\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eSocial-SMAF\u003c/b\u003e\u003csup\u003e\u003cb\u003eb\u003c/b\u003e\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c8\" namest=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colspan=\"1\" nameend=\"c11\" namest=\"c11\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eT1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e-3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e.\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e.\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e-4\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c8\" namest=\"c7\"\u003e \u003cp\u003e.\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e.\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003e-2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"1\" nameend=\"c11\" namest=\"c11\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eT2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e-1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e-3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e-1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e.\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c8\" namest=\"c7\"\u003e \u003cp\u003e-5\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e-1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003e-9\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"1\" nameend=\"c11\" namest=\"c11\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eT3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e-1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e-1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e-7\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c8\" namest=\"c7\"\u003e \u003cp\u003e-4\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003en.a.\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"1\" nameend=\"c11\" namest=\"c11\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eB-PREPARED\u003c/b\u003e\u003csup\u003e\u003cb\u003ec\u003c/b\u003e\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e11\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e20\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e20\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e17\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c8\" namest=\"c7\"\u003e \u003cp\u003e9\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e16\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003e10\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"1\" nameend=\"c11\" namest=\"c11\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eGAS\u003c/b\u003e\u003csup\u003e\u003cb\u003ed\u003c/b\u003e\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c8\" namest=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colspan=\"1\" nameend=\"c11\" namest=\"c11\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eGoal 1 \u0026ndash; T2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e.\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c8\" namest=\"c7\"\u003e \u003cp\u003e-2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003e-1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"1\" nameend=\"c11\" namest=\"c11\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eGoal 1 \u0026ndash; T3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c8\" namest=\"c7\"\u003e \u003cp\u003e-2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003en.a.\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"1\" nameend=\"c11\" namest=\"c11\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eGoal 2 \u0026ndash; T2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e-1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e.\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c8\" namest=\"c7\"\u003e \u003cp\u003e-2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003e-2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"1\" nameend=\"c11\" namest=\"c11\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eGoal 2 \u0026ndash; T3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e-1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c8\" namest=\"c7\"\u003e \u003cp\u003e-2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003en.a.\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"1\" nameend=\"c11\" namest=\"c11\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eGoal 3 \u0026ndash; T2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e.\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c8\" namest=\"c7\"\u003e \u003cp\u003e-1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"1\" nameend=\"c11\" namest=\"c11\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eGoal 3 \u0026ndash; T3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c8\" namest=\"c7\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003en.a.\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"1\" nameend=\"c11\" namest=\"c11\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eReadmissions (n)\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c8\" namest=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colspan=\"1\" nameend=\"c11\" namest=\"c11\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eEmergency-post 1 month\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c8\" namest=\"c7\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"1\" nameend=\"c11\" namest=\"c11\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eHospital-post 1 month\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c8\" namest=\"c7\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"1\" nameend=\"c11\" namest=\"c11\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eEmergency-post 3 months\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c8\" namest=\"c7\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003e2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"1\" nameend=\"c11\" namest=\"c11\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eHospital-post 3 months\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c8\" namest=\"c7\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003e2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"1\" nameend=\"c11\" namest=\"c11\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003ea. Functional autonomy: score ranging from 0 (maximum independence) to -87 (maximum dependence); b. Social functional autonomy: score ranging from 0 (maximum independence) to -18 (maximum dependence); c. Perceived preparedness for hospital discharge: score ranging from 0 (not prepared \u0026ndash; lower level) to 33 (very prepared \u0026ndash; higher level); d. Goal Attaintment Scale. Levels: -2 Significantly below expectations, -1 Below expectations, 0 As expected, 1 Above expectations, 2 Significantly above expectations.\u003c/p\u003e \u003cp\u003e \u003cb\u003eBold\u003c/b\u003e: Clinically significant difference (SMAF\u0026thinsp;\u0026ge;\u0026thinsp;5 or \u0026le;\u0026thinsp;5) compared to T1; \u003cspan type=\"Underline\" class=\"Underline\" name=\"Emphasis\"\u003eUnderlined\u003c/span\u003e: Clinically significant difference (SMAF\u0026thinsp;\u0026ge;\u0026thinsp;5 or \u0026le;\u0026thinsp;5) compared to T2; n.a.: non applicable (deceased participant post T2);. : missing data\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab3\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 3\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eHome Preliminary Effectiveness \u0026mdash; Mean Assessment Scores\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"3\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eOUTCOMES\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eEXPERIMENTAL\u003c/p\u003e \u003cp\u003e\u003cem\u003en\u0026thinsp;=\u0026thinsp;4\u003c/em\u003e\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eCONTROL\u003c/p\u003e \u003cp\u003e\u003cem\u003en\u0026thinsp;=\u0026thinsp;3\u003c/em\u003e\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003ctr\u003e \u003cth align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e \u003cp\u003eMean (\u0026plusmn;\u0026thinsp;SD; Range)\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSMAF\u003csup\u003ea\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eT1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e-25.5 (6.6;[-35]-[-19.5])\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e-21.5 (6.5;[-25.5]-[-14])\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eT2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e-21(1.8;[-22.5]-[-19])\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e-35 (16.9;[-53]-[-19.5])\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eT3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e-22 (8.7;[-35]-[-16.5])\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e-25.3 (8.1;[-31]-[-19.5])\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eT2-T1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u003cb\u003e1.3\u003c/b\u003e (0.8;0.5-2.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e\u003cb\u003e-13.5\u003c/b\u003e (12.2;[-27.5]-[-5.5])\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eT3-T2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e3.3 (0.5-6.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.75 (1.1;0.0-1.5)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eB-PREPARED\u003csup\u003eb\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u003cb\u003e17.0\u003c/b\u003e (4.2;11\u0026ndash;20)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e\u003cb\u003e11.7\u003c/b\u003e (3.8;9\u0026ndash;16)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eGAS\u003csup\u003ec\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eGoal 1 T2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0.67 (1.16;0\u0026ndash;2)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e-0.67 (1.53;[-2]-1)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eGoal 1-T3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0.50 (1.00;0\u0026ndash;2)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e-0.50 (2.12; [-2]-1)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eGoal 2-T2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0.00 (1.00;[-1]-1)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e-1.33 (1.16;[-2]-0)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eGoal 2-T3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0.75 (1.50;[-1]-2)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e-0.50 (2.12;[-2]-1)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eGoal 3-T2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1.33 (0.58;1\u0026ndash;2)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.33 (1.16; [-1]-1)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eGoal 3-T3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1.50 (0.58;1\u0026ndash;2)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.50 (0.71;0\u0026ndash;1)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003ctfoot\u003e \u003ctr\u003e\u003ctd colspan=\"3\"\u003ea.\u0026nbsp;Functional autonomy: score ranging from 0 (maximum independence) to -87 (maximum dependence); b.\u0026nbsp;Perceived preparedness for hospital discharge: score ranging from 0 (not prepared \u0026ndash; lower level) to 33 (very prepared \u0026ndash; higher level); c.\u0026nbsp;Goal Attainment Scale. Levels: -2 Significantly below expectations, -1 Below expectations, 0 As expected, 1 Above expectations, 2 Significantly above expectations.\u003c/td\u003e\u003c/tr\u003e \u003c/tfoot\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003eBoth hospital- and community-based clinicians reported that communicating with each other helped them better understand their respective practice contexts. This contact was also seen as beneficial for older adults by ensuring a timely response to their needs after discharge:\u003cdiv class=\"BlockQuote\"\u003e\u003cp\u003e \u003cem\u003eWell, I think it can help the client get what they need more efficiently, and most of the time, what they need is equipment. Well, the right equipment at the right time.-P2_Community\u003c/em\u003e \u003c/p\u003e\u003c/div\u003e\u003c/p\u003e \u003cp\u003eDespite these perceived benefits of the HOME intervention, both clinicians deemed that it was unnecessary for some patients, mainly relating to the pre-discharge visit component:\u003cdiv class=\"BlockQuote\"\u003e\u003cp\u003e \u003cem\u003e'Let's say taking on patient care one week after discharge, yes, that makes sense. But on the same day, or even before discharge, for this clientele, I don't know. [...] But there are probably benefits, but I don't know if it's necessary... And you know, I don't know if it's a wise use of our resources. - P2_Community\u003c/em\u003e \u003c/p\u003e\u003c/div\u003e\u003c/p\u003e \u003cp\u003eRegarding participants\u0026rsquo; goals, quantitative results indicate that they were most often achieved at least \u003cem\u003eas expected\u003c/em\u003e among those in the experimental group (Table\u0026nbsp;\u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e2\u003c/span\u003e). This aligns with clinicians\u0026rsquo; interviews suggesting that integrating older adults\u0026rsquo; goals effectively fostered engagement; notably, one patient even began acquiring assistive devices during the hospital stay:\u003cdiv class=\"BlockQuote\"\u003e\u003cp\u003e \u003cem\u003eLike one of our patients, after we set the goals together\u0026hellip;he made calls himself [from the hospital]to get the assistive devices \u0026hellip; but I think that with my usual practice it might not have gone that far. So that, I found that it was beautiful\u0026hellip; -P1_Hospital\u003c/em\u003e \u003c/p\u003e\u003c/div\u003e\u003c/p\u003e \u003cp\u003eThe HOME intervention also supported clinicians in adopting a patient-centered approach by emphasizing individual expectations, daily routines, and personal preferences\u0026mdash;particularly regarding leisure activities after discharge. Its focus on patient-centered goals was viewed as essential to quality of life and added meaningfulness for patients, while contributing to a more reassuring continuum of care. As one clinician noted: \u0026ldquo;I find that HOME helps us refocus our priorities on that [the clients\u0026rsquo; goals], when the reality [of the hospital setting] would lead us elsewhere.\u0026rdquo; (P1_Hospital)\u003c/p\u003e \u003cp\u003eQuestionnaires (B-PREPARED) completed by participants in the experimental group indicated greater satisfaction with their involvement in discharge planning compared with those in the control group (Table\u0026nbsp;\u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e2\u003c/span\u003e). The three lowest scores (9\u0026ndash;11/22) were all observed in the control group. This quantitative finding was reinforced by qualitative data from the sole older adult interviewed, who reported feeling included in the decision-making process surrounding care recommendations.\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e"},{"header":"Discussion","content":"\u003cp\u003eThe overarching objective of this mixed‑methods pilot RCT was to assess the feasibility of conducting a larger trial of the Canadian adaptation of the HOME intervention for frail older adults with mild cognitive impairment. However, major recruitment and implementation challenges led to early study termination, indicating that a large‑scale RCT\u0026mdash;even with a pragmatic design\u0026mdash;was not feasible. Although preliminary effectiveness results remain tentative due to the small sample, quantitative trends were encouraging and qualitative findings provided valuable insight into the unexpected barriers encountered.\u003c/p\u003e \u003cp\u003eOverall, the feasibility issues identified point to important considerations for future research in hospital settings. Participation demands were high for older adults, and clinicians found the intervention difficult to implement in its current form. This reflects a broader paradox: individuals most likely to benefit from such interventions are often the hardest to recruit or most at risk of attrition\u003csup\u003e\u003cspan citationid=\"CR56\" class=\"CitationRef\"\u003e56\u003c/span\u003e\u003c/sup\u003e, which may lead to underestimating intervention effects and ultimately depriving older adults of support that could be beneficial. Beyond the limited time available to screen for eligibility and clinicians\u0026rsquo; reluctance to approach patients perceived as less suitable for research, the low enrollment rate was also likely influenced by challenges in obtaining written consent during discharge planning. Hospitalization constitutes a physically and emotionally demanding period for older adults and their families\u003csup\u003e\u003cspan additionalcitationids=\"CR58\" citationid=\"CR57\" class=\"CitationRef\"\u003e57\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR59\" class=\"CitationRef\"\u003e59\u003c/span\u003e\u003c/sup\u003e, during which decision-making about research participation may be particularly difficult. Age-related declines in vision\u003csup\u003e\u003cspan citationid=\"CR60\" class=\"CitationRef\"\u003e60\u003c/span\u003e\u003c/sup\u003e and information-processing speed\u003csup\u003e\u003cspan citationid=\"CR61\" class=\"CitationRef\"\u003e61\u003c/span\u003e\u003c/sup\u003e, combined with heightened vulnerability and often limited health literacy\u003csup\u003e\u003cspan citationid=\"CR62\" class=\"CitationRef\"\u003e62\u003c/span\u003e,\u003cspan citationid=\"CR63\" class=\"CitationRef\"\u003e63\u003c/span\u003e\u003c/sup\u003e, may further contribute to apprehension about signing consent documents. Obtaining written consent from older adults is a well-recognized challenge\u003csup\u003e\u003cspan citationid=\"CR64\" class=\"CitationRef\"\u003e64\u003c/span\u003e\u003c/sup\u003e. The legalistic structure, language, and complexity of consent forms\u003csup\u003e\u003cspan citationid=\"CR65\" class=\"CitationRef\"\u003e65\u003c/span\u003e,\u003cspan citationid=\"CR66\" class=\"CitationRef\"\u003e66\u003c/span\u003e\u003c/sup\u003e may reinforce perceptions of high-stakes commitment, thereby increasing reluctance to participate. This challenge invites reconsideration of whether formal written consent is necessary in studies posing risks comparable to standard care. Marshall\u003csup\u003e\u003cspan citationid=\"CR66\" class=\"CitationRef\"\u003e66\u003c/span\u003e\u003c/sup\u003e argues that verbal consent may be appropriate for low-risk studies, noting that the legalistic nature of written consent forms can inhibit relational ease during the consent process. Although some ethics committees waive formal consent requirements in such contexts\u003csup\u003e\u003cspan citationid=\"CR67\" class=\"CitationRef\"\u003e67\u003c/span\u003e\u003c/sup\u003e, this practice remains uncommon in Canada. Nonetheless, strategies such as obtaining preauthorization for research teams to contact patients at their initial interaction with the health system\u003csup\u003e\u003cspan citationid=\"CR68\" class=\"CitationRef\"\u003e68\u003c/span\u003e\u003c/sup\u003e, combined with verbal consent for a specific study, may help reduce barriers. In addition, supportive tools\u0026mdash;such as a visual timeline and photographs of the evaluators\u0026mdash;may help reassure participants by clarifying what will be expected of them and who they will interact with.\u003c/p\u003e \u003cp\u003eDespite challenges in jointly defining patients\u0026rsquo; goals, OTs reported that this component of the HOME intervention benefited both patients and their practice. It legitimized the exploration of leisure activities to identify meaningful goals and supported negotiating realistic, patient-centered objectives. This collaborative process\u0026mdash;requiring clarification and reformulation of goals\u0026mdash;is already recognized for improving patient satisfaction and motivating them to take action to achieve their goals\u003csup\u003e\u003cspan citationid=\"CR69\" class=\"CitationRef\"\u003e69\u003c/span\u003e\u003c/sup\u003e. However, given the limited time before discharge and the hospital mandate to expedite patient flow, clinicians often feel compelled to prioritize goals related to \u003cem\u003esafety\u003c/em\u003e (e.g., bath transfers) over those that support \u003cem\u003equality of life\u003c/em\u003e (e.g., gardening)\u0026mdash;a pattern also observed in our study. Encouraging patients to be proactive may also raise concerns about increased post-discharge risks when discussing the resumption of leisure activities. Yet, one study\u003csup\u003e\u003cspan citationid=\"CR70\" class=\"CitationRef\"\u003e70\u003c/span\u003e\u003c/sup\u003e shows that involving patients and families in these conversations can help manage such risks through \u003cem\u003epositive risk-taking\u003c/em\u003e, an important pathway for fostering resilience, whereas avoiding such discussions may exacerbate negative outcomes. These ethical tensions echo Atwal \u0026amp; Caldwell\u0026rsquo;s observations\u003csup\u003e\u003cspan citationid=\"CR71\" class=\"CitationRef\"\u003e71\u003c/span\u003e\u003c/sup\u003e, highlighting how OTs may face dilemmas during discharge planning that challenge principles such as autonomy, beneficence, non-maleficence, and justice. However, given the challenges encountered during the administration of the goal-attainment evaluation, future studies could explore developing a version tailored to individuals with mild cognitive impairments.\u003c/p\u003e \u003cp\u003eAnother perceived benefit of the HOME intervention was the involvement of a community-based OT during discharge planning. The study underscores the value of real-time pre-discharge communication between hospital- and community-based clinicians; simple strategies such as weekly phone calls supported timely information exchange and strengthened the relevance of recommendations. These practices align with literature emphasizing efficient, patient-responsive coordination across care settings\u003csup\u003e\u003cspan citationid=\"CR72\" class=\"CitationRef\"\u003e72\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR73\" class=\"CitationRef\"\u003e73\u003c/span\u003e\u003c/sup\u003e. Recent provincial government directives promoting intensified post-discharge home care and the involvement of home-care professionals in discharge planning\u003csup\u003e\u003cspan citationid=\"CR74\" class=\"CitationRef\"\u003e74\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR75\" class=\"CitationRef\"\u003e75\u003c/span\u003e\u003c/sup\u003e suggest that components of the HOME intervention are now more embedded in routine practice than when the study was conducted. Future research could also examine other simple strategies to strengthen communication between hospital‑ and community‑based OTs, such as creating shared environments that facilitate pre‑discharge discussions. Beyond the actions promoted by the HOME intervention, it would be valuable to document how its underlying values are enacted in practice\u0026mdash;for example, prioritizing services based on patient‑defined goals and negotiating acceptable compromises. Such an approach reinforces person‑centered care while promoting efficient resource use by avoiding recommendations misaligned with patients\u0026rsquo; values or priorities\u003csup\u003e\u003cspan citationid=\"CR76\" class=\"CitationRef\"\u003e76\u003c/span\u003e\u003c/sup\u003e.\u003c/p\u003e \u003cp\u003eDespite the adaptations made to the HOME program, several implementation challenges persisted. In the Qu\u0026eacute;bec professional context, expanding the intervention to include additional professionals could have facilitated practice changes, as interprofessional involvement is known to support the adoption and sustainability of new clinical practices\u003csup\u003e\u003cspan citationid=\"CR77\" class=\"CitationRef\"\u003e77\u003c/span\u003e\u003c/sup\u003e. Ensuring feasibility may also require preparing and supporting the team to view patient-identified goals as central to effective discharge planning, and to recognize the value of having the OT conduct the pre-discharge home visit - at minimum in a virtual format. Virtual home assessments were perceived as beneficial in our previous study\u003csup\u003e\u003cspan citationid=\"CR78\" class=\"CitationRef\"\u003e78\u003c/span\u003e\u003c/sup\u003e with clinicians reporting improved applicability of recommendations and caregivers expressing a greater sense of engagement in the discharge-planning process.\u003c/p\u003e\n\u003ch3\u003eStrengths and limitations\u003c/h3\u003e\n\u003cp\u003eAlthough pragmatic trials combined with mixed methods are recommended to support the integration of research into clinical practice, few studies have used this design to inform best practices in discharge planning. Balancing flexibility with methodological rigor remains a central challenge, particularly in maintaining internal validity. For example, to improve recruitment, we broadened inclusion criteria to individuals with low social support. This adjustment, introduced after recruitment resumed, did not ultimately increase enrollment. Such adaptations, however, must be carefully weighed to avoid compromising methodological consistency.\u003c/p\u003e \u003cp\u003eThis study has several limitations. First, recruitment challenges among older adults and their families were amplified by the COVID-19 context (2020\u0026ndash;2021), particularly within this patient population, which was frailer than the one targeted in the original HOME study\u003csup\u003e\u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e\u003c/sup\u003e. Clinicians reported shorter hospital stays and more frequent relocations during this period, factors that likely affected recruitment and limited the application of a person-centered approach. This is consistent with studies showing reduced length of stay\u003csup\u003e\u003cspan citationid=\"CR79\" class=\"CitationRef\"\u003e79\u003c/span\u003e,\u003cspan citationid=\"CR80\" class=\"CitationRef\"\u003e80\u003c/span\u003e\u003c/sup\u003e and increased transfers\u003csup\u003e\u003cspan citationid=\"CR79\" class=\"CitationRef\"\u003e79\u003c/span\u003e,\u003cspan citationid=\"CR81\" class=\"CitationRef\"\u003e81\u003c/span\u003e\u003c/sup\u003e during the pandemic. The missing refusal‑rate data also reflects the documentation burden reported by clinicians, who noted the difficulty of systematically recording such information in hospital settings. Second, despite recruitment across two units, the single-site design limits generalizability, as discharge-planning practices vary across settings. Finally, the study was not grounded in a conceptual framework\u0026mdash;such as the Consolidated Framework for Implementation Research\u003csup\u003e\u003cspan citationid=\"CR82\" class=\"CitationRef\"\u003e82\u003c/span\u003e\u003c/sup\u003e \u0026mdash;which could have offered a more nuanced understanding of barriers and facilitators influencing the implementation of the HOME intervention in a Canadian context.\u003c/p\u003e"},{"header":"Conclusion","content":"\u003cp\u003ePersistent gaps in care coordination and clinical communication underscore the importance of implementing promising interventions like HOME, which help bridge hospital-to-home priorities by improving continuity of care and aligning services with patients\u0026rsquo; meaningful goals. Our findings further highlight the need for clinicians to prioritize patients\u0026rsquo; goals and quality of life, despite time constraints and reluctance to engage in ethically sensitive discussions about risk. However, substantial recruitment challenges limit our ability to assess the intervention\u0026rsquo;s effectiveness. These challenges point to the need for revised or innovative strategies to address barriers to participation. Implementing such strategies within hospital discharge planning could enhance research engagement, particularly among older adults living with frailty and cognitive decline during complex care transitions. Special consideration should also be given to the context in which consent is obtained, as hospitalization often coincides with periods of cognitive and emotional vulnerability.\u003c/p\u003e"},{"header":"Abbreviations","content":"\u003cp\u003eADLs: Activities of Daily Living\u003c/p\u003e\n\u003cp\u003eCIUSSSE-CHUS: Centre int\u0026eacute;gr\u0026eacute; universitaire de sant\u0026eacute; et de services sociaux de l\u0026rsquo;Estrie-Centre hospitalier universitaire de Sherbrooke\u003c/p\u003e\n\u003cp\u003eCONSERVE:\u0026nbsp;CONSORT and SPIRIT Extension for RCTs Revised in Extenuating Circumstances\u003c/p\u003e\n\u003cp\u003eCONSORT:\u0026nbsp;Consolidated Standards of Reporting Trials\u003c/p\u003e\n\u003cp\u003eED: Emergency Department\u003c/p\u003e\n\u003cp\u003eGAS: Goat Attainment Scale\u003c/p\u003e\n\u003cp\u003eGRAMMS: Good Reporting of A Mixed Methods Study\u003c/p\u003e\n\u003cp\u003eMMSE: Mini-Mental State Examination\u003c/p\u003e\n\u003cp\u003eMoCA: Montreal Cognitive Assessment\u003c/p\u003e\n\u003cp\u003eOT: Occupational Therapist\u003c/p\u003e\n\u003cp\u003eRADaR: \u0026nbsp;Rigorous and Accelerated Data Reduction\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eRCT: Randomized Clinical Trial\u003c/p\u003e\n\u003cp\u003eSMAF: Functional Autonomy Measurement System\u0026nbsp;\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eAcknowledgements\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe authors are grateful to clinicians Annie-Claude Lemieux-Courchesne, Vanessa Roy and Frédérick Roy for their collaboration in the preliminary conceptual phases. We are also grateful to the five clinicians for their collaboration in the recruitment process, as well as those that experienced the HOME intervention and were involved in data collection. To preserve anonymity (confidentiality) due to the limited number of participants, individual names were not included, but we are truly grateful for their contribution.\u0026nbsp;Finally, we would like to thank Natasha Lannin and Lindy Clemson, who developed the initial HOME approach, for their invaluable collaboration during the Canadian adaptation of the intervention.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eEthics approval and consent to participate\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThis research received ethics approval from the CIUSSSE-CHUS Research Ethics Board (2020‑2894).\u0026nbsp;All participants signed a written consent form prior to the first interview and received a copy of the form.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConsent for publication\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eNot applicable.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAvailability of data and materials\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe datasets used during the current study are available from the corresponding author on reasonable request.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eCompeting interests\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe authors declare that they have no competing interests.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eFunding\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThis study was supported by the Canadian Institute of Health Research, under grant #PJT-156231.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAuthors' contributions\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eVPr, BM, NV, MJK, NDC, VD, DG, VPo, MJS and ME contributed to the conceptual and methodological design of the study. NO, AG, MD and VP analyzed and interpreted the data. AG and NO collected the data. NO, VP and MD wrote the first draft of the manuscript. All authors reviewed and edited the manuscript, and approved the final version.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\n\u003cli\u003eKarlsson V, Bergbom I, Ringdal M, Jonsson A. After discharge home: a qualitative analysis of older ICU patients\u0026apos; experiences and care needs. Scand J Caring Sci. 2016;30(4):749-756. https://doi.org/10.1111/scs.12301.\u003c/li\u003e\n\u003cli\u003eHestevik CH, Molin M, Debesay J, Bergland A, Bye A. Older persons\u0026apos; experiences of adapting to daily life at home after hospital discharge: a qualitative metasummary. BMC Health Serv Res. 2019;19(1):224. https://doi.org/10.1186/s12913-019-4035-z.\u003c/li\u003e\n\u003cli\u003eO\u0026apos;Brien MW, Mallery K, Rockwood K, Theou O. Impact of hospitalization on patients ability to perform basic activities of daily living. Can Geriatr J. 2023;26(4):524-529. https://doi.org/10.5770/cgj.26.664.\u003c/li\u003e\n\u003cli\u003eJonckers M, Van Grootven B, Willemyns E, et al. Hospitalization-associated disability in older adults with valvular heart disease: incidence, risk factors and its association with care processes. Acta Cardiol. 2018;73(6):566-572. https://doi.org/10.1080/00015385.2017.1421300.\u003c/li\u003e\n\u003cli\u003eHao Q, Zhou L, Dong B, Yang M, Dong B, Weil Y. The role of frailty in predicting mortality and readmission in older adults in acute care wards: a prospective study. Sci Rep. 2019;9(1):1207. https://doi.org/10.1038/s41598-018-38072-7.\u003c/li\u003e\n\u003cli\u003eZheng PP, Yao SM, He W, Wan YH, Wang H, Yang JF. Frailty related all-cause mortality or hospital readmission among adults aged 65 and older with stage-B heart failure inpatients. BMC Geriatr. 2021;21(1):125. https://doi.org/10.1186/s12877-021-02072-6.\u003c/li\u003e\n\u003cli\u003eXu Y, Ji T, Li X, et al. The effectiveness of the comprehensive geriatric assessment for older adults with frailty in hospital settings: A systematic review and meta-analysis. Int J Nurs Stud. 2024;159:104849. https://doi.org/10.1016/j.ijnurstu.2024.104849.\u003c/li\u003e\n\u003cli\u003eParker KJ, Mcdonagh J, Ferguson C, Hickman LD. Clinical outcomes of nurse-coordinated interventions for frail older adults discharged from hospital: A systematic review and meta-analysis. J Clin Nurs. 2024;33(11):4184-4206. https://doi.org/10.1111/jocn.17345.\u003c/li\u003e\n\u003cli\u003eSteiner LM, Osmancevic S, Hahn S, Bonetti L, Zwakhalen S. The effectiveness of interventions on clinical and patient-reported outcomes in hospital-to-home transitions of older adults: a systematic review. Eur J Ageing. 2025;22(1):58. https://doi.org/10.1007/s10433-025-00890-w.\u003c/li\u003e\n\u003cli\u003eSum G, Sim SYH, Chay J, et al. An Integrated Patient-Centred Medical Home (PCMH) Care Model Reduces Prospective Healthcare Utilisation for Community-Dwelling Older Adults with Complex Needs: A Matched Observational Study in Singapore. Int J Environ Res Public Health. 2023;20(19):6848. https://doi.org/10.3390/ijerph20196848.\u003c/li\u003e\n\u003cli\u003eWilhelmson K, Andersson Hammar I, Westg\u0026aring;rd T, Holmquist Henrikson L, Dahlin-Ivanoff S. Positive effects on activities of daily living one year after receiving comprehensive geriatric assessment - results from the randomised controlled study CGA-Swed. BMC Geriatr. 2022;22(1):180. https://doi.org/10.1186/s12877-022-02862-6.\u003c/li\u003e\n\u003cli\u003eSchapira M, Outumuro MB, Giber F, et al. Geriatric co-management and interdisciplinary transitional care reduced hospital readmissions in frail older patients in Argentina: results from a randomized controlled trial. Aging Clin Exp Res. 2022;34(1):85-93. https://doi.org/10.1007/s40520-021-01893-0.\u003c/li\u003e\n\u003cli\u003eWales K, Clemson L, Lannin NA, Cameron ID, Salked G, Gitlin L, Rubenstein L, Barras S, Mackenzie L, Davies C. Occupational therapy discharge planning for older adults: a protocol for a randomized trial and economic evaluation. BMC Geriatr. 2012;12:34. https://doi.org/10.1186/1471-2318-12-34.\u003c/li\u003e\n\u003cli\u003eTurner-Stokes L. Goal attainment scaling (GAS) in rehabilitation: a practical guide. Clin Rehabil. 2009;23(4):362-370. https://doi.org/10.1177/0269215508101742.\u003c/li\u003e\n\u003cli\u003eGitlin LN. Environmental adaptations for older adults and their families in the home and community. In S\u0026ouml;derback I, editor. International handbook of occupational therapy interventions. Dordrecht:Springer; 2009.p.53-62.\u003c/li\u003e\n\u003cli\u003eClemson L, Lannin N, Wales K, Salkeld G, Rubenstein L, Gitlin L, Barris S, Mackenzie L, Cameron ID. Occupational therapy predischarge home visits in acute hospital care: A randomized trial. J Am Geriatr Soc. 2016;64(10):2019-2026. https://doi.org/10.1111/jgs.14287.\u003c/li\u003e\n\u003cli\u003eProvencher V, Clemson L, Wales K, et al. Supporting at-risk older adults transitioning from hospital to home: who benefits from an evidence-based patient-centered discharge planning intervention? Post-hoc analysis from a randomized trial. BMC Geriatr. 2020;20(1):84. https://doi.org/10.1186/s12877-020-1494-3.\u003c/li\u003e\n\u003cli\u003eProvencher V. Meilleures pratiques pour soutenir la planification du cong\u0026eacute; hospitalier des personnes \u0026acirc;g\u0026eacute;es. Interactive webinar workshop: Continuum for Seniors. Knowledge transfer service, libraries and best practices. Sherbrooke, Qu\u0026eacute;bec, Canada. 2017. June 12 and 29. \u003c/li\u003e\n\u003cli\u003eFord I, Norrie J. Pragmatic Trials. N Engl J Med. 2016;375(5):454-463. https://doi.org/10.1056/NEJMra1510059.\u003c/li\u003e\n\u003cli\u003eAnderson ML. Ethical and regulatory issues of pragmatic cluster randomized trials in contemporary health systems. Clin Trials. 2015;12(3):276-286. https://doi.org/10.1177/1740774515571140.\u003c/li\u003e\n\u003cli\u003eAlbright K, Gechter K, Kempe A. Importance of mixed methods in pragmatic trials and dissemination and implementation research. Acad Pediatr. 2013;13(5):400-407. https://doi.org/10.1016/j.acap.2013.06.010.\u003c/li\u003e\n\u003cli\u003eEldridge SM, Chan CL, Campbell MJ, et al. CONSORT 2010 statement: extension to randomised pilot and feasibility trials. Pilot Feasibility Stud. 2016;2:64. https://doi.org/10.1186/s40814-016-0105-8.\u003c/li\u003e\n\u003cli\u003eOrkin AM, Gill PJ, Ghersi D, et al. Guidelines for reporting trial protocols and completed trials modified due to the COVID-19 pandemic and other extenuating circumstances: The CONSERVE 2021 Statement. JAMA. 2021;326(3):257-265. https://doi.org/10.1001/jama.2021.9941.\u003c/li\u003e\n\u003cli\u003eO\u0026rsquo;Cathain A, Murphy E, Nicholl J. The quality of mixed methods studies in health services research. J Health Serv Res Policy. 2008;13(2):92-98. https://doi.org/10.1258/jhsrp.2007.007074.\u003c/li\u003e\n\u003cli\u003eCreswell JW, Plano Clark VL. Designing and conducting mixed methods research. Third Edition, SAGE Publications. 2017. \u003c/li\u003e\n\u003cli\u003eTashakkori A, Teddlie C. SAGE Handbook of mixed methods in social \u0026amp; behavioral research. SAGE Publications. Second Edition 2010. \u003c/li\u003e\n\u003cli\u003eNasreddine ZS, Phillips NA, B\u0026eacute;dirian V, et al. The Montreal Cognitive Assessment, MoCA: a brief screening tool for mild cognitive impairment. J Am Geriatr Soc. 2005;53(4):695-699. https://doi.org/10.1111/j.1532-5415.2005.53221.x.\u003c/li\u003e\n\u003cli\u003eFolstein MF, Folstein SE, McHugh PR. \u0026quot;Mini-mental state\u0026quot;. A practical method for grading the cognitive state of patients for the clinician. J Psychiatr Res. 1975;12(3):189-198. https://doi.org/10.1016/0022-3956(75)90026-6.\u003c/li\u003e\n\u003cli\u003eNguyen TN, Cumming RG, Hilmer SN. The impact of frailty on mortality, length of stay and re-hospitalisation in older patients with atrial fibrillation. Heart Lung Circ. 2016;25(6):551-557. https://doi.org/10.1016/j.hlc.2015.12.002.\u003c/li\u003e\n\u003cli\u003eGovernment of Nova Scotia. Hospitals Act, Halifax. 2015\u003c/li\u003e\n\u003cli\u003eEfird J. Blocked randomization with randomly selected block sizes. Int J Environ Res Public Health. 2011;8(1):15-20. https://doi.org/10.3390/ijerph8010015.\u003c/li\u003e\n\u003cli\u003eH\u0026eacute;bert R, Carrier R, Bilodeau A. The Functional Autonomy Measurement System (SMAF): description and validation of an instrument for the measurement of handicaps. Age Ageing. 1988;17(5):293-302. https://doi.org/10.1093/ageing/17.5.293.\u003c/li\u003e\n\u003cli\u003eH\u0026eacute;bert R, Guilbault J, Desrosiers J, Dubuc N. The functional autonomy measurement system (SMAF): a clinical-based instrument for measuring disabilities and handicaps in older people. Geriatrics Today. 2001;4:141-144.\u003c/li\u003e\n\u003cli\u003eH\u0026eacute;bert R, Desrosiers J, Dubuc N, Tousignant M, Guilbeault J, Pinsonnault E. Le syst\u0026egrave;me de mesure de l\u0026apos;autonomie fonctionnelle (SMAF). La Revue de G\u0026eacute;riatrie. 2003;28(4):323-336.\u003c/li\u003e\n\u003cli\u003eDesrosiers J, Bravo G, H\u0026eacute;bert R, Dubuc N. Reliability of the revised functional autonomy measurement system (SMAF) for epidemiological research. Age Ageing. 1995;24(5):402-406. https://doi.org/10.1093/ageing/24.5.402.\u003c/li\u003e\n\u003cli\u003eLanglais ME. Estimation et comparaison de la sensibilit\u0026eacute; au changement de trois \u0026eacute;chelles d\u0026rsquo;ind\u0026eacute;pendance fonctionnelle couramment utilis\u0026eacute;es en r\u0026eacute;adaptation g\u0026eacute;riatrique. Master\u0026rsquo;s Thesis. Universit\u0026eacute; de Sherbrooke. 1998.\u003c/li\u003e\n\u003cli\u003eH\u0026eacute;bert R, Dubuc N, Buteau M, et al. Resources and Costs Associated with Disabilities of Elderly People Living at Home and in Institutions. Canadian Journal on Aging / La Revue canadienne du vieillissement. 2001;20(1):1-22. https://doi.org/10.1017/S0714980800012113.\u003c/li\u003e\n\u003cli\u003ePinsonnault E, Desrosiers J, Dubuc N, Kalfat H, Colvez A, Delli-Colli N. Functional autonomy measurement system: development of a social subscale. Arch Gerontol Geriatr. 2003;37(3):223-233. https://doi.org/10.1016/s0167-4943(03)00049-9.\u003c/li\u003e\n\u003cli\u003eKiresuk TJ, Sherman RE. Goal attainment scaling: A general method for evaluating comprehensive community mental health programs. \u003cem\u003eCommunity Ment Health J\u003c/em\u003e. 1968;4(6):443-453. https://doi.org/10.1007/BF01530764.\u003c/li\u003e\n\u003cli\u003eKiresuk TJ, Smith A, Cardillo JE, editors. Goal Attainment Scaling: Applications, Theory, and Measurement (1st ed.). New York:Psychology Press. 1994. 336 p. https://doi.org/10.4324/9781315801933.\u003c/li\u003e\n\u003cli\u003eProvencher V, D\u0026apos;Amours M, Viscogliosi C, et al. Risks perceived by frail male patients, family caregivers and clinicians in hospital: Do they change after discharge? A multiple case study. Int J Integr Care. 2019;19(1):4. https://doi.org/10.5334/ijic.4166.\u003c/li\u003e\n\u003cli\u003eProvencher V, Viscogliosi C, Lacerte J, et al. Risk management during the transition from hospital to home: A multiple case study documenting the experience of patients living with a major neurocognitive disorder, their caregivers, and healthcare professionals. J Patient Exp. 2024;11:23743735241259553. https://doi.org/10.1177/23743735241259553. \u003c/li\u003e\n\u003cli\u003eGraumlich JF, Novotny NL, Aldag JC. Brief scale measuring patient preparedness for hospital discharge to home: Psychometric properties. J Hosp Med. 2008;3(6):446-454. https://doi.org/10.1002/jhm.316.\u003c/li\u003e\n\u003cli\u003eCentre de recherche \u0026ndash; CHUS. DORISE. Donn\u0026eacute;es Organis\u0026eacute;es du R\u0026eacute;seau Informatique de Sant\u0026eacute; de l\u0026rsquo;Estrie. https://www.crchus.ca/en/services-outils/autres-services-et-outils/infocentre.\u003c/li\u003e\n\u003cli\u003eAustralian Commission on Safety and Quality in Care. \u003cem\u003eAvoidable hospital readmissions\u003c/em\u003e. 2022. https://www.safetyandquality.gov.au/our-work/indicators/avoidable-hospital-readmissions..\u003c/li\u003e\n\u003cli\u003eH\u0026eacute;bert R, Spiegelhalter DJ, Brayne C. Setting the minimal metrically detectable change on disability rating scales. Arch Phys Med Rehabil. 1997;78(12):1305-1308. https://doi.org/10.1016/s0003-9993(97)90301-4. \u003c/li\u003e\n\u003cli\u003eLannin NA, Clemson L, McCluskey A. Survey of current pre-discharge home visiting practices of occupational therapists. Aust Occup Ther J. 2011;58(3):172-177. https://doi.org/10.1111/j.1440-1630.2010.00911.x.\u003c/li\u003e\n\u003cli\u003eDesrosiers J, Rochette A, Noreau L, Bravo G, H\u0026eacute;bert R, Boutin C. Comparison of two functional independence scales with a participation measure in post-stroke rehabilitation. Arch Gerontol Geriatr. 2003;37(2):157-172. https://doi.org/10.1016/s0167-4943(03)00044-x.\u003c/li\u003e\n\u003cli\u003eHennink M, Kaiser BN. Sample sizes for saturation in qualitative research: A systematic review of empirical tests. Soc Sci Med. 2022;292:114523. https://doi.org/10.1016/j.socscimed.2021.114523.\u003c/li\u003e\n\u003cli\u003eMalterud K, Siersma VD, Guassora AD. Sample Size in Qualitative Interview Studies: Guided by Information Power. \u003cem\u003eQual Health Res\u003c/em\u003e. 2016;26(13):1753-1760. https://doi.org/10.1177/1049732315617444.\u003c/li\u003e\n\u003cli\u003eThabane L, Ma J, Chu R, et al. A tutorial on pilot studies: the what, why and how. BMC Med Res Methodol. 2010;10:1. https://doi.org/10.1186/1471-2288-10-1.\u003c/li\u003e\n\u003cli\u003eWatkins DC. Rapid and Rigorous Qualitative Data Analysis: The \u0026ldquo;RADaR\u0026rdquo; technique for applied research. Int. J. Qual. Methods. 2017;16(1):1-9. https://doi.org/10.1177/1609406917712131.\u003c/li\u003e\n\u003cli\u003eFarley J, Duppong Hurley K, Aitken AA. Monitoring implementation in program evaluation with direct audio coding. Eval Program Plann. 2020;83:101854. https://doi.org/10.1016/j.evalprogplan.2020.101854.\u003c/li\u003e\n\u003cli\u003eNeal JW, Neal ZP, VanDyke E, Kornbluh M. Expediting the analysis of qualitative data in evaluation: A procedure for the rapid identification of themes from audio recordings (RITA). Am J Eval. 2015;36(1):118\u0026ndash;132. https://doi.org/10.1177/1098214014536601.\u003c/li\u003e\n\u003cli\u003eKowalski CP, Nevedal AL, Finley EP, et al. Planning for and Assessing Rigor in Rapid Qualitative Analysis (PARRQA): a consensus-based framework for designing, conducting, and reporting. Implement Sci. 2024;19(1):71. https://doi.org/10.1186/s13012-024-01397-1.\u003c/li\u003e\n\u003cli\u003ePitkala KH, Strandberg TE. Clinical trials in older people. Age Ageing. 2022;51(5):afab282. https://doi.org/10.1093/ageing/afab282. \u003c/li\u003e\n\u003cli\u003eSchattner A. The spectrum of hospitalization-associated harm in the elderly. Eur J Intern Med. 2023;115:29-33. https://doi.org/10.1016/j.ejim.2023.05.025.\u003c/li\u003e\n\u003cli\u003eOlsson A, Bergl\u0026ouml;v A, Sj\u0026ouml;lund BM. \u0026quot;Longing to be independent again\u0026quot; - A qualitative study on older adults\u0026apos; experiences of life after hospitalization. Geriatr Nurs. 2020;41(6):942-948. https://doi.org/10.1016/j.gerinurse.2020.07.007.\u003c/li\u003e\n\u003cli\u003eAlzahrani N. The effect of hospitalization on patients\u0026apos; emotional and psychological well-being among adult patients: An integrative review. Appl Nurs Res. 2021;61:151488. https://doi.org/10.1016/j.apnr.2021.151488.\u003c/li\u003e\n\u003cli\u003eMurman DL. The Impact of Age on Cognition. Semin Hear. 2015;36(3):111-121. https://doi.org/10.1055/s-0035-1555115. \u003c/li\u003e\n\u003cli\u003eKirova AM, Bays RB, Lagalwar S. Working memory and executive function decline across normal aging, mild cognitive impairment, and Alzheimer\u0026apos;s disease. Biomed Res Int. 2015;2015:748212. https://doi.org/10.1155/2015/748212. \u003c/li\u003e\n\u003cli\u003eGouvernement du Qu\u0026eacute;bec. \u0026Eacute;tude exploratoire sur l\u0026apos;analphab\u0026eacute;tisme en lien avec la sant\u0026eacute; et le vieillissement. 2008-2009. Rapport de recherche. 2008. 59p. https://collections.banq.qc.ca/ark:/52327/bs1871380.\u003c/li\u003e\n\u003cli\u003eInstitut de la statistique du Qu\u0026eacute;bec. D\u0026eacute;velopper nos comp\u0026eacute;tences en litt\u0026eacute;ratie : un d\u0026eacute;fi porteur d\u0026apos;avenir. Rapport qu\u0026eacute;b\u0026eacute;cois de l\u0026rsquo;Enqu\u0026ecirc;te internationale sur l\u0026rsquo;alphab\u0026eacute;tisation et les comp\u0026eacute;tences des adultes, 2003. 2006. https://statistique.quebec.ca/fr/document/developper-competences-litteratie-defi-porteur-avenir. \u003c/li\u003e\n\u003cli\u003eAltawalbeh SM, Alkhateeb FM, Attarabeen OF. Ethical Issues in Consenting Older Adults: Academic Researchers and Community Perspectives. J Pharm Health Serv Res. 2020;11(1):25-32. https://doi.org/10.1111/jphs.12327.\u003c/li\u003e\n\u003cli\u003eShannon J. Informed consent: documenting the intersection of bureaucratic regulation and ethnographic practice. Polit Leg Anthropol Rev:PoLAR. 2007;30(2):229-248. https://doi.org/10.1525/pol.2007.30.2.229.\u003c/li\u003e\n\u003cli\u003eMarshall PA. Informed consent in international health research. J Empir Res Hum Res Ethics. 2006;1(1):25-42. https://doi.org/10.1525/jer.2006.1.1.25.\u003c/li\u003e\n\u003cli\u003eUniversity of Virginia. When consent is not required. Institutional Review Board for the Social and Behavioral Sciences (IRB-SBS). 2024. https://sites.research.virginia.edu/irb-sbs/when-consent-not-required.\u003c/li\u003e\n\u003cli\u003eMcHugh KR, Swamy GK, Hernandez AF. Engaging patients throughout the health system: A landscape analysis of cold-call policies and recommendations for future policy change. J Clin Transl Sci. 2018;2(6):384-392. https://doi.org/10.1017/cts.2019.1. \u003c/li\u003e\n\u003cli\u003ePoulin V, Korner-Bitensky N, Bherer L, Lussier M, Dawson DR. Comparison of two cognitive interventions for adults experiencing executive dysfunction post-stroke: a pilot study. Disabil Rehabil. 2017;39(1):1-13. https://doi.org/10.3109/09638288.2015.1123303.\u003c/li\u003e\n\u003cli\u003eMacLeod H, Veillette N, Klein J, et al. Shifting the narrative from living at risk to living with risk: validating and pilot-testing a clinical decision support tool: a mixed methods study. BMC Geriatr. 2023;23(1):338. https://doi.org/10.1186/s12877-023-04068-w. \u003c/li\u003e\n\u003cli\u003eAtwal A, Caldwell K. Ethics, occupational therapy and discharge planning: Four broken principles. Aust Occup Ther J. 2003;50(4):244 251. https://doi.org/10.1046/j.1440-1630.2003.00374.x.\u003c/li\u003e\n\u003cli\u003eIfrim RA, Klugarov\u0026aacute; J, Măguriță D, Zazu M, Mazilu DC, Klugar M. Communication, an important link between healthcare providers: a best practice implementation project. JBI Evid Implement. 2022;20(S1):S41-S48. https://doi.org/10.1097/XEB.0000000000000319. \u003c/li\u003e\n\u003cli\u003eForonda C, MacWilliams B, McArthur E. Interprofessional communication in healthcare: An integrative review. Nurse Educ Pract. 2016;19:36-40. https://doi.org/10.1016/j.nepr.2016.04.005. \u003c/li\u003e\n\u003cli\u003eMinist\u0026egrave;re de la sant\u0026eacute; et des services sociaux. Plan strat\u0026eacute;gique 2023-2027. Gouvernement du Qu\u0026eacute;bec. 2023. https://publications.msss.gouv.qc.ca/msss/document-003663/.\u003c/li\u003e\n\u003cli\u003eFleury F, Tr\u0026eacute;panier M. Soins intensifi\u0026eacute;s \u0026agrave; domicile \u0026ndash; Recension exploratoire. Consortium InterS4. 2018. https://consortiuminters4.uqar.ca/bibliotheque/soins-intensifies-a-domicile/.\u003c/li\u003e\n\u003cli\u003eTuzzio L, Berry AL, Gleason K, et al. Aligning care with the personal values of patients with complex care needs. Health Serv Res. 2021;56(Suppl 1):1037-1044. https://doi.org/10.1111/1475-6773.13862.\u003c/li\u003e\n\u003cli\u003eKanno NP, Peduzzi M, Germani ACCG, So\u0026aacute;rez PC, Silva ATCD. Interprofessional collaboration in primary health care from the perspective of implementation science. A colabora\u0026ccedil;\u0026atilde;o interprofissional na aten\u0026ccedil;\u0026atilde;o prim\u0026aacute;ria \u0026agrave; sa\u0026uacute;de na perspectiva da ci\u0026ecirc;ncia da implementa\u0026ccedil;\u0026atilde;o. Cad Saude Publica. 2023;39(10):e00213322. https://doi.org/10.1590/0102-311XPT213322. \u003c/li\u003e\n\u003cli\u003eLatulippe K, Giroux D, Guay M, et al. Mobile Videoconferencing for Occupational Therapists\u0026apos; Assessments of Patients\u0026apos; Home Environments Prior to Hospital Discharge: Mixed Methods Feasibility and Comparative Study. JMIR Aging. 2022;5(3):e24376. https://doi.org/10.2196/24376.\u003c/li\u003e\n\u003cli\u003eJuang WC, Chiou SM, Chen HC, Li YC. Differences in characteristics and length of stay of elderly emergency patients before and after the outbreak of COVID-19. Int J Environ Res Public Health. 2023;20(2):1162. https://doi.org/10.3390/ijerph20021162. \u003c/li\u003e\n\u003cli\u003eButt AA, Kartha AB, Masoodi NA, et al. Hospital admission rates, length of stay, and in-hospital mortality for common acute care conditions in COVID-19 vs. pre-COVID-19 era. Public Health. 2020;189:6-11. https://doi.org/10.1016/j.puhe.2020.09.010. \u003c/li\u003e\n\u003cli\u003eDenninger NE, Brefka S, Dallmeier D, Denkinger M, M\u0026uuml;ller M. Impacts of COVID-19-related measures on older non-COVID-19 patients, their caregivers, and healthcare professionals in acute care settings: A secondary analysis of real-time qualitative data from the TRADE study. Geriatr Nurs. 2025;66(Part A):1-15. https://doi.org/10.1016/j.gerinurse.2025.103679.\u003c/li\u003e\n\u003cli\u003eDamschroder LJ, Aron DC, Keith RE, Kirsh SR, Alexander JA, Lowery JC. Fostering implementation of health services research findings into practice: a consolidated framework for advancing implementation science. Implement Sci. 2009;4:50. https://doi.org/10.1186/1748-5908-4-50.\u003c/li\u003e\n\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":true,"hideJournal":true,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true},"keywords":"Hospital-to-home transition, Mild cognitive impairment, Person-centered intervention, Mixed-method, Pilot randomized trial, Feasibility study","lastPublishedDoi":"10.21203/rs.3.rs-9635148/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-9635148/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003e\u003cstrong\u003eIntroduction:\u003c/strong\u003e Older adults living with frailty often face challenges with daily activities after hospital discharge, increasing their risk of emergency department visits and rehospitalization. The HOME intervention—based on collaborative discharge planning with patients and caregivers— has demonstrated promise in reducing unplanned rehospitalizations among older adults with mild cognitive impairment, as shown by a randomized controlled trial (RCT). Before implementing the intervention in Canada, it was essential to first assess the feasibility of conducting a large-scale mixed-methods RCT of the culturally adapted version, targeting the subgroup of frail older adults and incorporating patient-centered outcomes. The study aims to (1) document feasibility outcomes; (2) assess its preliminary effectiveness in real-world conditions.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eMethods:\u003c/strong\u003e A mixed-method pilot RCT was conducted, with eligible patients randomized to either the HOME intervention or usual care group. Feasibility outcomes included recruitment and retention, as well as the acceptability and applicability of both the intervention and the data‑collection procedures. The primary outcome was functional autonomy, including its social component. Secondary outcomes included goal attainment scaling, perceived discharge preparedness, and hospital readmissions or emergency visits. Semi-structured interviews with older adults, family members, and clinicians were planned. Qualitative data were thematically analyzed and then compared to quantitative data.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eResults:\u003c/strong\u003e Seven participants were recruited, of whom five completed all outcome measures. Two main themes emerged from the interviews: (1) the value of real-time communication between hospital and community-based clinicians, as simple pre-discharge phone calls facilitated the exchange of relevant patient information and supported smoother transitions home; and (2) challenges in establishing patient-oriented goals and conducting pre-discharge home visits. Although the sample size was small, quantitative data suggested potential benefits on both primary and secondary outcomes, while qualitative findings underscored how the intervention legitimized the exploration of leisure activities as a means of identifying functional goals.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConclusion:\u003c/strong\u003e Significant recruitment challenges were encountered, leading to the conclusion that a large-scale pragmatic RCT would not be feasible. These barriers hinder the evaluation of the HOME intervention’s effectiveness in a Canadian context and highlight the need for revised or innovative research engagement strategies—particularly for hospitalized older adults facing complex discharge transitions.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eTrial registration:\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eRegistered on November 7, 2019 at https://clinicaltrials.gov/study/NCT04154917.\u003c/p\u003e","manuscriptTitle":"Supporting discharge planning in frail older adults with mild cognitive impairment: lessons learned from a feasibility pilot randomized control trial (RCT)","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2026-05-14 13:28:18","doi":"10.21203/rs.3.rs-9635148/v1","editorialEvents":[{"type":"communityComments","content":0}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"ace17de4-c8a0-45eb-bcce-74c9acfa64b2","owner":[],"postedDate":"May 14th, 2026","published":true,"recentEditorialEvents":[{"type":"editorAssigned","content":"","date":"2026-05-09T03:54:44+00:00","index":"","fulltext":""},{"type":"checksComplete","content":"","date":"2026-05-09T03:54:20+00:00","index":"","fulltext":""},{"type":"submitted","content":"Pilot and Feasibility Studies","date":"2026-05-06T21:46:07+00:00","index":"","fulltext":""}],"rejectedJournal":[],"revision":"","amendment":"","status":"posted","subjectAreas":[],"tags":[],"updatedAt":"2026-05-14T13:28:18+00:00","versionOfRecord":[],"versionCreatedAt":"2026-05-14 13:28:18","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-9635148","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-9635148","identity":"rs-9635148","version":["v1"]},"buildId":"XKTyCvWXoU3ODBz1xrDgd","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}