What is the effectiveness and cost-effectiveness of at-home time-limited reablement service for improving an individual’s independence and health outcomes and reducing the need for long term care: a rapid review

What is the effectiveness and cost-effectiveness of at-home time-limited reablement service for improving an individual’s independence and health outcomes and reducing the need for long term care: a rapid review | medRxiv /* */ /* */ <!-- <!-- /*! * yepnope1.5.4 * (c) WTFPL, GPLv2 */ (function(a,b,c){function d(a){return"[object Function]"==o.call(a)}function e(a){return"string"==typeof a}function f(){}function g(a){return!a||"loaded"==a||"complete"==a||"uninitialized"==a}function h(){var a=p.shift();q=1,a?a.t?m(function(){("c"==a.t?B.injectCss:B.injectJs)(a.s,0,a.a,a.x,a.e,1)},0):(a(),h()):q=0}function i(a,c,d,e,f,i,j){function k(b){if(!o&&g(l.readyState)&&(u.r=o=1,!q&&h(),l.onload=l.onreadystatechange=null,b)){"img"!=a&&m(function(){t.removeChild(l)},50);for(var d in y[c])y[c].hasOwnProperty(d)&&y[c][d].onload()}}var j=j||B.errorTimeout,l=b.createElement(a),o=0,r=0,u={t:d,s:c,e:f,a:i,x:j};1===y[c]&&(r=1,y[c]=[]),"object"==a?l.data=c:(l.src=c,l.type=a),l.width=l.height="0",l.onerror=l.onload=l.onreadystatechange=function(){k.call(this,r)},p.splice(e,0,u),"img"!=a&&(r||2===y[c]?(t.insertBefore(l,s?null:n),m(k,j)):y[c].push(l))}function j(a,b,c,d,f){return q=0,b=b||"j",e(a)?i("c"==b?v:u,a,b,this.i++,c,d,f):(p.splice(this.i++,0,a),1==p.length&&h()),this}function k(){var a=B;return a.loader={load:j,i:0},a}var l=b.documentElement,m=a.setTimeout,n=b.getElementsByTagName("script")[0],o={}.toString,p=[],q=0,r="MozAppearance"in l.style,s=r&&!!b.createRange().compareNode,t=s?l:n.parentNode,l=a.opera&&"[object Opera]"==o.call(a.opera),l=!!b.attachEvent&&!l,u=r?"object":l?"script":"img",v=l?"script":u,w=Array.isArray||function(a){return"[object Array]"==o.call(a)},x=[],y={},z={timeout:function(a,b){return b.length&&(a.timeout=b[0]),a}},A,B;B=function(a){function b(a){var a=a.split("!"),b=x.length,c=a.pop(),d=a.length,c={url:c,origUrl:c,prefixes:a},e,f,g;for(f=0;f<d;f++)g=a[f].split("="),(e=z[g.shift()])&&(c=e(c,g));for(f=0;f<b;f++)c=x[f](c);return c}function g(a,e,f,g,h){var i=b(a),j=i.autoCallback;i.url.split(".").pop().split("?").shift(),i.bypass||(e&&(e=d(e)?e:e[a]||e[g]||e[a.split("/").pop().split("?")[0]]),i.instead?i.instead(a,e,f,g,h):(y[i.url]?i.noexec=!0:y[i.url]=1,f.load(i.url,i.forceCSS||!i.forceJS&&"css"==i.url.split(".").pop().split("?").shift()?"c":c,i.noexec,i.attrs,i.timeout),(d(e)||d(j))&&f.load(function(){k(),e&&e(i.origUrl,h,g),j&&j(i.origUrl,h,g),y[i.url]=2})))}function h(a,b){function c(a,c){if(a){if(e(a))c||(j=function(){var a=[].slice.call(arguments);k.apply(this,a),l()}),g(a,j,b,0,h);else if(Object(a)===a)for(n in m=function(){var b=0,c;for(c in a)a.hasOwnProperty(c)&&b++;return b}(),a)a.hasOwnProperty(n)&&(!c&&!--m&&(d(j)?j=function(){var a=[].slice.call(arguments);k.apply(this,a),l()}:j[n]=function(a){return function(){var b=[].slice.call(arguments);a&&a.apply(this,b),l()}}(k[n])),g(a[n],j,b,n,h))}else!c&&l()}var h=!!a.test,i=a.load||a.both,j=a.callback||f,k=j,l=a.complete||f,m,n;c(h?a.yep:a.nope,!!i),i&&c(i)}var i,j,l=this.yepnope.loader;if(e(a))g(a,0,l,0);else if(w(a))for(i=0;i (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0];var j=d.createElement(s);var dl=l!='dataLayer'?'&l='+l:'';j.src='//www.googletagmanager.com/gtm.js?id='+i+dl;j.type='text/javascript';j.async=true;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-P4HH5NV'); Skip to main content Home About Submit ALERTS / RSS Search for this keyword Advanced Search What is the effectiveness and cost-effectiveness of at-home time-limited reablement service for improving an individual’s independence and health outcomes and reducing the need for long term care: a rapid review View ORCID Profile Bethany Anthony , View ORCID Profile Jacob Davies , View ORCID Profile Kalpa Pisavadia , Sofie Roberts , Greg Flynn , Limssy Varghese , Rachel Granger , Madison Montgomery , Rebecca Rosi , Elizabeth Gillen , Juliet Hounsome , View ORCID Profile Dyfrig Hughes , Jane Noyes , Deborah Fitzsimmons , Rhiannon Tudor Edwards , Adrian Edwards , Alison Cooper , View ORCID Profile Ruth Lewis doi: https://doi.org/10.1101/2025.06.13.25329562 Bethany Anthony 1 Centre for Health Economics and Medicines Evaluation, Bangor University , UK Find this author on Google Scholar Find this author on PubMed Search for this author on this site ORCID record for Bethany Anthony Jacob Davies 1 Centre for Health Economics and Medicines Evaluation, Bangor University , UK Find this author on Google Scholar Find this author on PubMed Search for this author on this site ORCID record for Jacob Davies For correspondence: jacob.davies{at}bangor.ac.uk Kalpa Pisavadia 1 Centre for Health Economics and Medicines Evaluation, Bangor University , UK Find this author on Google Scholar Find this author on PubMed Search for this author on this site ORCID record for Kalpa Pisavadia Sofie Roberts 1 Centre for Health Economics and Medicines Evaluation, Bangor University , UK Find this author on Google Scholar Find this author on PubMed Search for this author on this site Greg Flynn 1 Centre for Health Economics and Medicines Evaluation, Bangor University , UK Find this author on Google Scholar Find this author on PubMed Search for this author on this site Limssy Varghese 1 Centre for Health Economics and Medicines Evaluation, Bangor University , UK Find this author on Google Scholar Find this author on PubMed Search for this author on this site Rachel Granger 1 Centre for Health Economics and Medicines Evaluation, Bangor University , UK Find this author on Google Scholar Find this author on PubMed Search for this author on this site Madison Montgomery 1 Centre for Health Economics and Medicines Evaluation, Bangor University , UK Find this author on Google Scholar Find this author on PubMed Search for this author on this site Rebecca Rosi 1 Centre for Health Economics and Medicines Evaluation, Bangor University , UK Find this author on Google Scholar Find this author on PubMed Search for this author on this site Elizabeth Gillen 2 Wales Centre for Evidence Based Care, Cardiff University , UK Find this author on Google Scholar Find this author on PubMed Search for this author on this site Juliet Hounsome 3 Specialist Unit for Review Evidence, Cardiff University , UK Find this author on Google Scholar Find this author on PubMed Search for this author on this site Dyfrig Hughes 1 Centre for Health Economics and Medicines Evaluation, Bangor University , UK Find this author on Google Scholar Find this author on PubMed Search for this author on this site ORCID record for Dyfrig Hughes Jane Noyes 4 Bangor Institute for Medical and Health Research, Bangor University , UK Find this author on Google Scholar Find this author on PubMed Search for this author on this site Deborah Fitzsimmons 5 Swansea Centre for Health Economics, Swansea University , UK Find this author on Google Scholar Find this author on PubMed Search for this author on this site Rhiannon Tudor Edwards 1 Centre for Health Economics and Medicines Evaluation, Bangor University , UK Find this author on Google Scholar Find this author on PubMed Search for this author on this site Adrian Edwards 6 Health and Care Research Wales Evidence Centre, Cardiff University , UK Find this author on Google Scholar Find this author on PubMed Search for this author on this site Alison Cooper 6 Health and Care Research Wales Evidence Centre, Cardiff University , UK Find this author on Google Scholar Find this author on PubMed Search for this author on this site Ruth Lewis 4 Bangor Institute for Medical and Health Research, Bangor University , UK 7 Health and Care Research Wales Evidence Centre, Bangor University , UK Find this author on Google Scholar Find this author on PubMed Search for this author on this site ORCID record for Ruth Lewis Abstract Full Text Info/History Metrics Data/Code Preview PDF Abstract Local authorities and health services in Wales are tasked with reablement, to help individuals who are at risk of frailty maintain and improve independence. However, social care resource constraints, mean that the balance of funds and workforce may be focussed on acute health care and long-term care in the community. This review aimed to identify evidence on the effectiveness and cost-effectiveness of at-home time-limited reablement services for improving an individuals independence and health outcomes and reducing the need for long term care. Eighteen studies were included in the review: 16 reported on clinical effectiveness and three on cost-effectiveness (one study reported on both). Key clinical-effectiveness findings included person-related and service-level outcomes. Implications for practice There is international evidence that reablement led by an allied health professional (AHP), such as occupational therapists, or a multi-professional team that includes allied health professionals (AHPs) is effective in improving mobility including activities of daily living (ADL), quality of life and falls outcomes. There is also evidence that demonstrated that reablement led by AHPs can reduce the need for long term care in terms of the use of domiciliary care services and admissions to residential care. Three economic evaluations found reablement services to be cost-effective, although there were some methodological flaws that limited the certainty of findings. There is a need for more studies from a UK perspective - only three UK-based studies were identified, with the rest reflecting an international body of evidence. Review Team Bethany Anthony, Jacob Davies, Kalpa Pisavadia, Sofie Roberts, Greg Flynn, Limssy Varghese, Rachel Granger, Madison Montgomery, Rebecca Rosi, Elizabeth Gillen, Juliet Hounsome, Dyfrig Hughes, Jane Noyes, Deborah Fitzsimmons, Rhiannon Tudor Edwards. Methodological Advice Ruth Lewis Evidence Centre Team Adrian Edwards, Ruth Lewis, Alison Cooper, Elizabeth Doe and Micaela Gal involved in stakeholder engagement, review of report and editing. Public Partner Rashmi Kumar Stakeholder(s) Denise Moultrie, Ruth Crowder, Kerrie Phipps, and Rhian Matthews Disclaimer The views expressed in this publication are those of the authors, not necessarily Health and Care Research Wales. The Health and Care Research Wales Evidence Centre and authors of this work declare that they have no conflict of interest. What is a Rapid Review? Our rapid reviews use a variation of the systematic review approach, abbreviating or omitting some components to generate evidence to inform stakeholders promptly whilst maintaining attention to bias. Who is this Rapid Review for? The review question was suggested by Health, Social Care and Early Years, Welsh Government. Background / Aim of Rapid Review Reablement is defined by NICE (2017) as a community-based intervention that aims to increase a service user’s independence by helping them recover lost skills and confidence. Local authorities and health services in Wales are tasked with reablement, to help individuals who are at risk of frailty maintain and improve independence. However, social care resource constraints, mean that the balance of funds and workforce may be focussed on acute health care and long-term care in the community. The review aimed to identify evidence on the effectiveness and cost-effectiveness of at -home time-limited reablement services for improving an individual’s independence and health outcomes and reducing the need for long term care. The evidence base The review included evidence available up until December 2024. Eighteen studies were included: 16 reported on clinical effectiveness (11 were controlled trials, 4 uncontrolled before and after studies, and one controlled cohort study); and three on cost-effectiveness (one study reported on both). Ten studies evaluated a step-up reablement model, two studies focused on the step-down reablement, four studies evaluated a reablement both step-up and step-down reablement, whilst the focus was unclear for the remaining two studies. Step-up reablement is defined as early / preventative intervention when an aspect of functioning deteriorates, following injury (e.g. fall) or a period of ill health and mitigating risk of hospital admission. Step-down reablement is the intervention received immediately following discharge with a view to regaining function. Twelve studies evaluated a reablement model led by a multi-professional team, which included allied health professionals (AHPs). 1 Five studies evaluated an AHP-led reablement model. One study evaluated a reablement model led by a nurse case manager coordinator. The reablement intervention was delivered by a range of people including: an occupational therapist (n=1 study); a member of the multiprofessional team or multi-professional workforce (n=10); a multi-professional team consisting of a range of different AHPs only (n=1); or non-health professional such as care manager, homecare personnel, health care assistant, home care aid, or carer (n=6). Person-related outcomes A significant amount of evidence on the effectiveness of reablement interventions on person-related outcomes was identified. Reablement interventions were effective in improving people’s mobility and their ability to undertake activities of daily living (ADL), increasing quality of life, and reducing falls . Reablement interventions may be effective in improving individuals coping, in terms of sense of coherence (how individuals perceive life as comprehensible, manageable & meaningful). Reablement was not found to be effective for improving grip strength or increasing clients’ social support. Service-level outcomes A significant amount of evidence on the effectiveness of reablement interventions on service-level outcomes was identified. Reablement was effective in reducing the need for long term home care services and residential care admissions . Reablement was also effective in reducing the number of outpatient treatments compared with usual domiciliary care. There were contradictory findings on reablement’s effectiveness in reducing hospital admissions, community care service use, and social care service use. There were inconsistent findings on reablement’s effectiveness in reducing emergency department visits. Type of reablement model One study conducted in England found that a reablement model that was led and delivered by occupational therapists resulted in greater improvements in activities of daily living, quality of life, and falls, compared to reablement led and delivered by social care workers. Although the sample size was small and findings were not statistically significant, the Occupational Therapy-led model showed promising trends. In terms of community and social care resource use, participants in the Occupational Therapy-led reablement group were less likely to use health services, including GP visits and community support such as meals at home, suggesting potential efficiency benefits compared to the social care worker–led model. Key cost-effectiveness findings Three economic evaluations found reablement services to be cost-effective , although there were some methodological flaws in the studies, that limited the certainty of findings. Research Implications and Evidence Gaps There is a need for more studies from a UK perspective - only three UK-based studies were identified, with the rest reflecting an international body of evidence. While the international research is useful when it aligns with how reablement services are delivered in the UK, it is essential to consider the unique context of Wales where reablement services are often hosted within or delivered by local authorities. Noting there is currently significant challenge reported by occupational therapists in local authority in undertaking research activity. The economic evaluations had methodological flaws that limited the certainty of review findings, evidencing a need for future economic evaluations on the topic. Policy and Practice Implications There is international evidence that reablement led by a multi-professional team that includes allied health professionals (AHPs) 1 , such as occupational therapists, is effective in improving mobility including activities of daily living, quality of life and falls outcomes. There is also evidence that demonstrated that reablement led by AHPs can reduce the need for long term care in terms of the use of domiciliary care services and admissions to residential care. While not all reablement services currently utilise AHPs, the evidence from this review makes a strong case for their inclusion in Wales. AHP-led reablement has been shown to improve person-centred outcomes and reduce the need for long-term care, supporting the case for targeted investment in AHP roles within reablement services. Three economic evaluations identified reablement as a cost-effective alternative to domiciliary care services. Given UK’s ageing population, the evidence from the Science Evidence Advice (SEA) 2023 report of the future prevalence and impact of frailty, and the high costs associated with ongoing care needs for people at risk of frailty, our findings make the case for investing in time-limited reablement interventions in Wales. Economic considerations Reablement programmes may provide cost savings to commissioners and the health and social care systems through prevention of or reduced length of hospital admission, reductions in hospital readmission and preventing or reducing domiciliary and residential care demand. Frailty has a sizeable impact on healthcare resource use in the UK. Total additional costs of frailty-related healthcare resource use are £8 billion per year when adjusted to 2025 prices. 1. BACKGROUND 1.1 Who is this review for? This Rapid Review was conducted as part of the Health and Care Research Wales Evidence Centre Work Programme. The above question was suggested by Health, Social Services and Early Years, Welsh Government. The intended audience is Welsh Government, health boards and local authorities. This research will be used to help underpin the possible funding decisions and process developments and priorities. It will also be used to guide Welsh Government policy decisions regarding the provisions for reablement services. 1.2 Background and purpose of this review Local authorities and health services in Wales are tasked with reablement, aimed at helping individuals regain independence when their functioning decreases and/or as a result of a hospital admission. However, due to social care resource constraints, funds often shift toward post-hospitalisation reablement only and/or toward long-term care, reducing resources for reablement. Traditional reablement research has focused on ‘step down’ reablement (support after hospital discharge). However, a growing interest in ‘step up’ preventative reablement has emerged. This involves proactive intervention for individuals at risk of deteriorating, aiming to prevent hospital admissions, improve health outcomes, and reduce long-term care costs. Many health boards and local authorities, stretched for resources, prioritise discharge support over preventative care at present, often caused by financial and staffing constraints. Identifying the financial benefits of reablement may help make a case for increased investment, aligning with community-based health strategies and reducing hospital admissions. An agreed all Wales definition of reablement refers to an enabling approach with services that provide rehabilitation for all people with physical or mental disabilities. It helps them adapt to their condition by learning or re-learning the skills needed to function in everyday life. The focus is on promoting and optimising functional independence by practicing activities, rather than interventions aimed at improving underlying impairments (All Wales Rehabilitation Framework, 2022). Reablement typically lasts for up to six weeks, with a focus on achieving specific goals within that timeframe. Delivered in the individual’s own home, wherever that may be, allowing for practical application of skills in familiar surroundings. A personalised plan is created with the individual, focusing on restoring function and independence and improving their ability to perform daily tasks that matter to them. Helping individuals become more self-sufficient and confident in their abilities, rather than relying on ongoing support. A multi-professional approach is required to provide a holistic approach to care, usually comprising of allied health professional-led (AHP-led) delivery, occupational therapists, reablement assessors (if not the occupational therapist), physiotherapists, social workers, reablement support workers and rehabilitation or therapy support workers. In some areas, other workforce may be included such as home care or domiciliary care workers. The reablement service is often hosted within or delivered by local authorities, however there are currently different models of reablement service provision in Wales and not all include allied health professionals (AHPs). The aim of this review was to identify evidence on the effectiveness and cost-effectiveness of at-home time-limited reablement services for improving an individual’s independence and health outcomes and reducing the need for long term care. 1.3 NICE guidance on reablement services This section summarises the NICE 2017 guidance (NG74) on intermediate care, including reablement. The NICE guidelines referring specifically to reablement will be the primary focus of this summary and will be considered throughout this rapid review. ‘Reablement’ is referred to by NICE (2017) as a community-based intervention that aims to increase a service user’s independence by helping them recover lost skills and confidence. NICE guideline NG74 concentrates on the referral, assessment and delivery of intermediate care (NICE, 2017). The term ‘intermediate care’ refers to multi-professional services that aim to increase a service user’s independence and support rehabilitation while minimising unnecessary hospitalisation and admissions to long-term care facilities. Intermediate care is comprised of four service models, which include reablement. In most cases, the intervention lasts up to 6 weeks and is delivered by a multidisciplinary team and social care practitioners. Referral to the service can be arranged through either health or social care practitioners. The NICE guidance recommends that reablement is offered as the first line intervention for service users requiring home care, provided that an assessment has established that reablement could help the service user regain independence (NICE, 2017). As one of the service models, reablement follows the core principles of intermediate care; therefore, the service is goal-driven, focusing on maximising independence and overall wellbeing in addition to taking a person-centred approach to account for varying needs and preferences. The delivery of the service is flexible and individualised to the requirements of the service user. Regular goal reviews are recommended to manage the progression towards set goals and to adjust the duration of the reablement service (NICE, 2017). NICE (2017) states that there is no evidence on the effectiveness and cost-effectiveness of repeated periods of reablement, or reablement that lasts longer than 6 weeks. Moreover, the data for costs, outcomes and the optimal duration of reablement for different population groups is limited. Therefore, NICE (2017) recommends that further research is conducted to fill the research gaps around reablement. 2. RESULTS 2.1 Overview of the evidence base This section summarises the results of the rapid review, which involved reviewing the international literature of reablement interventions. Evidence from studies reporting on clinical effectiveness including person-related outcomes and service-level outcomes is presented in Section 2.2 . Evidence from studies reporting on cost-effectiveness is reported in Section 2.3 . Section 2.4 provides an overview of other relevant outcomes including costs and implementation outcomes reported in the included studies. This report also includes a summary of the findings of a previously identified qualitative evidence synthesis exploring older people and their carers’ experiences and perceptions of reablement services, which is is provided in Section 3 . A detailed summary of the criteria used for selecting studies for inclusion in the review along with the methods used for conducting the review are presented in Section 6. The rapid review search strategies are presented in Appendix 1. After the removal of duplicates, the database searches identified 4,344 records (see Figure 1 in Section 6.1 for an outline of the study selection process). Following title and abstract screening, 46 papers were retrieved for full text screening. Eighteen studies that evaluated 11 specific rehabilitation interventions were included in this rapid review. Download figure Open in new tab Figure 1. PRISMA 2020 flow diagram of included records ( Page et al., 2021 ) Of the 18 included studies, 15 reported on the clinical effectiveness of reablement service, two reported on cost-effectiveness, and one reported on both clinical and cost-effectiveness. Hence, the total number of studies reporting on clinical effectiveness was 16. Two studies ( Glendinning et al., 2010 ; Kjerstad and Tuntland, 2016 ) reporting on cost-effectiveness were trial based economic evaluations. The clinical-effectiveness data from the comparative trial was reported in the same publication for the economic evaluation by Glendinning et al. (2010) and in a sperate publication for the economic evaluation by Kjerstad and Tuntland (2016) . This means that Glendinning et al. (2010) is included in both Section 2.2 (on clinical effectiveness) and Section 2.3 (on cost-effectiveness). The clinical-effectiveness data from the RCT used in the economic evaluation reported by Kjerstad and Tuntland (2016) is reported by Tuntland et al., 2015 , which is included in Section 2.2 . In terms of other relevant outcomes, relating to intervention delivery, reported by included studies, five studies reported on service level costs ( Lewin et al., 2014 ; Lewin et al., 2013b ; Beresford et al., 2019 ; Glendinning et al., 2010 ; Kjerstad and Tuntland 2016 ), and three studies reported on implementation outcomes ( Beresford et al., 2019 ; Glendinning et al., 2010 ; Whitehead et al., 2016 ). Our eligibility criteria for reablement interventions were developed with input from stakeholders and based on inclusion of the following common key components ( Cochrane et al., 2016 ; Clotworthy et al., 2021 ): Targeting participants who are aged 65+ or suffering from frailty Include a time-limited (typically 6-12 weeks) intensive (multiple visits) programme Delivered at the person’s home Developed or managed by an allied health professional (such as physical/occupational therapists) and involve a multi-professional team. (But does not have to be delivered by a health professional.) Focused on maximising independence, functional ability and social participation Person-centred and goal directed Some interventions included in this review did not strictly comply with all of the criteria listed above. These are highlighted in Table 1 . Six studies did not report on the duration of the programme, or the involvement of a multi-professional team. However, stakeholders deemed these studies relevant for inclusion in the review, as they contribute to the development of a comprehensive definition of what could constitute a reablement service for Wales. A summary of the interventions included in the review is also provided in Table 2 , which outlines the characteristics of included studies reporting on clinical effectiveness. A more detailed summary of interventions described in the included studies is available in the appendices ( section 9.4 ). View this table: View inline View popup Table 1: Reablement interventions and studies included in the review and their assessment against key intervention components View this table: View inline View popup Table 2: Study characteristics of included primary studies reporting on clinical effectiveness (person-related outcomes and service level outcomes) (n=16). 2.2 Clinical effectiveness of reablement interventions 2.2.1 Overview of the evidence on effectiveness of reablement interventions A summary of the characteristics of included studies reporting on the clinical effectiveness of reablement interventions is presented in Table 2 . Of the 16 studies that reported on clinical effectiveness, six were randomised controlled trials (RCTs), five were non-randomised controlled trials, one was a (controlled) cohort study, and four were uncontrolled before and after studies. Eight studies evaluated a step-up reablement model to support individuals at risk of deteriorating and help prevent hospital admissions or the need to move to a care home. Two studies focused on the step-down reablement model to support someone’s recovery after hospital discharge and help prevent readmission. Four studies evaluated a reablement model that covered both step-up and step-down, whilst the focus was unclear for the remaining two studies. Four studies evaluated a therapist-led reablement model. Two studies evaluated a reablement intervention led by an occupational therapist or physiotherapist ( Tuntland et al., 2015 ; Langeland et al., 2019 ) (nurse-led was also an option in one of these studies; Langeland et al., 2019 ), and one was explicitly occupational therapist-led ( Winkel et al., 2015 ). The fourth study compared occupational therapist-led reablement with social care worker-led reablement ( Whitehead et al., 2016 ). Six studies evaluated a reablement model led by a multi-professional teams that included allied health professionals ( Tinetti et al., 2002 ; Tinetti et al., 2012 ; Parsons et al., 2013 ; Schmidt et al., 2024 ; Glendinning et al., 2010 ; Beresford et al., 2019 ). Five studies evaluated a reablement model that was led by muti-professional teams that included allied health professionals and nurses. These five studies evaluated the Home Independence Program (HIP) or an adaptation of this ( Lewin & Vandermeulen, 2010 ; Lewin et al., 2013a ; Lewin et al., 2014 ; Lewin et al., 2013b ; Lewin et al., 2016 ). One study evaluated a model led by a nurse case manager coordinator ( Parsons et al., 2017 ). Across the 16 studies, the reablement intervention was delivered by a range of personnel, including: an occupational therapist (1 study); a member of a multi-professional team or multi-professional workforce (9 studies); a multi-professional team consisting of range of different AHPs only (1 study) and non-health professionals such as homecare personnel, healthcare assistants, home care aides, or carers (5 studies). Six were conducted in Australia ( Lewin & Vandermeulen, 2010 ; Lewin et al., 2013a ; Lewin et al., 2013b ; Lewin et al., 2014 , Lewin et al., 2016 ; Schmidt et al., 2024 ), three in the UK ( Beresford et al., 2019 ; Glendinning et al., 2010 ; Whitehead et al., 2016 ), two in New Zealand ( Parsons et al., 2013 ; Parsons et al., 2017 ), two in Norway ( Tuntland et al., 2015 ; Langeland et al., 2019 ), two in the US ( Tinetti et al., 2002 ; Tinetti et al., 2012 ), and one was conducted in Denmark ( Winkel et al., 2015 ). Thirteen studies assessed the effectiveness of reablement interventions on person-related outcomes including mobility and activities of daily living (ADL) ( Lewin & Vandermeulen, 2010 ; Lewin et al., 2013a ; Lewin et al., 2016 ; Tuntland et al., 2015 ; Langeland et al., 2019 ; Parsons et al., 2013 ; Parsons et al., 2017 ; Schmidt et al., 2024 ; Winkel et al., 2015 ; Beresford et al., 2019 ; Whitehead et al., 2016 ; Glendinning et al., 2010 ; Tinetti et al., 2002 ), quality of life ( Lewin et al., 2013a ; Lewin et al., 2016 ; Tuntland et al., 2015 ; Langeland et al., 2019 ; Parsons et al., 2013 ; Beresford et al., 2019 ; Whitehead et al., 2016 ; Glendinning et al., 2010 ), falls outcomes ( Lewin & Vandermeulen, 2010 ; Lewin et al., 2016 ; Whitehead et al., 2016 ), grip strength ( Tuntland et al., 2015 ), coherence ( Langeland et al., 2019 ), social support ( Parsons et al., 2013 ), and mortality ( Parsons et al., 2017 ). Twelve studies assessed the effectiveness of reablement on service-level outcomes including the use of home care services ( Lewin & Vandermeulen, 2010 ; Lewin et al., 2013a ; Lewin et al., 2014 ; Lewin et al., 2013b ; Lewin et al., 2016 ; Beresford et al., 2019 ; Glendinning et al., 2010 ; Tinetti et al., 2012 ), hospital admissions ( Lewin et al., 2013a ; Lewin et al., 2014 ; Lewin et al., 2016 ; Parsons et al., 2017 ; Beresford et al., 2019 ; Whitehead et al., 2016 ; Glendinning et al., 2010 ; Tinetti et al., 2012 ), residential care admissions ( Lewin et al., 2013a ; Lewin et al., 2016 ; Parsons et al., 2017 ), and other health and social care service use outcomes ( Lewin et al., 2014 ; Tuntland et al., 2015 ; Parsons et al., 2017 ; Beresford et al., 2019 ; Whitehead et al., 2016 ; Glendinning et al., 2010 ; Tinetti et al., 2002 ). 2.2.2 Quality of studies evaluating the effectiveness of reablement on person-related and service-level outcomes The studies that evaluated the effectiveness of reablement on person-related and service-level outcomes were critically appraised using the Analytic Study Critical Appraisal Tool, which is part of the Critical Appraisal Toolkit (CAT) for assessing multiple types of evidence (Public Health Agency of Canada 2014). CAT provides a toolkit for evaluating the evidence base, which incorporates the assessment of individual studies and the overall body of evidence to inform practice and policy development (see section 6.6 for further details). A summary rating of the strength of the study design and quality of individual studies is provided in Table 2 . Following the results section and results summary tables for person-related outcomes ( Table 3 ) and service level outcomes ( Table 4 ), a summary of the rating of the certainty of the overall evidence for the effectiveness of reablement on person-related outcomes and service-level outcomes is presented at the end of Section 2.2 . in Table 5 . View this table: View inline View popup Table 3: Summary of main findings for person-related outcomes View this table: View inline View popup Table 4: Summary of main findings for service level outcomes View this table: View inline View popup Table 5. Summary of the rating of the certainty of the overall body of evidence for the effectiveness of reablement on person-related outcomes and service-level outcomes. The quality of included studies varied. All studies had a clear, focused research question. Most studies (fifteen) evidenced a study population representative of the target population, however one study did not describe recruitment sufficiently to conclude whether its study population was representative. Most studies (ten) did not use a random sampling methodology, contributing to selection bias. Five studies allocated participants to groups systematically, of which four used randomisation processes for group allocation, which allowed for the adjustment and control of potential confounders. Twelve studies went some way to controlling for misclassification bias, while three studies were at high risk of misclassification. Eight studies reported a lack of a control group or major differences between control and intervention groups. Five studies failed to adequately blind assessors and participants, thus were at risk of information bias. Most studies (nine) used validated and reliable data collection instruments and methods. Follow-up was poorly conducted across the studies, with seven studies that reported less than 80% completion rate at follow-up, which lead to significant missing data. However, the observed low completion rate at follow-up can likely be attributed to the sample characteristics, comprised of older individuals and consequently experienced higher levels of mortality. Follow-up periods were slightly different across the studies, with a mixture of short- and long-term follow-ups reported. Statistical testing was appropriate for the data used and hypotheses tested. Thirteen studies included sufficiently powered sample sizes to reliably detect statistically significant differences, while three studies failed to do so. This review rated the overall quality of studies evaluating the effectiveness of reablement on person-related and service-level outcomes, and a significant variation was observed. Only one study ( Tuntland et al., 2015 ) was rated as high quality. This study had a rigorous methodology and its results can be viewed as reliable. Most studies were rated as medium quality (11 studies), each with some limitations in their study designs. Four studies were rated as low quality, showing significant methodological weaknesses that failed to account for potential biases that could impact the reliability of the results. Detailed results from the critical appraisal of individual studies can be found in the appendices ( section 9.2.1 ). 2.2.3 The clinical effectiveness of reablement interventions on person-related outcomes Table 3 summarises the main findings of clinical effectiveness on person-related outcomes. The following sections present the evidence under respective outcome categories of person-related outcomes. Mobility including activities of daily living Thirteen studies assessed the effectiveness of reablement on improving mobility and ADLs ( Lewin & Vandermeulen, 2010 ; Lewin et al., 2013a ; Lewin et al., 2016 ; Tuntland et al., 2015 ; Langeland et al., 2019 ; Parsons et al., 2013 ; Parsons et al., 2017 ; Schmidt et al., 2024 ; Winkel et al., 2015 ; Beresford et al., 2019 ; Whitehead et al., 2016 ; Glendinning et al., 2010 ; Tinetti et al., 2002 ). The feasibility RCT (referred to as Occupational Therapy in HomEcare Re-ablement Services (OTHERS)) compared a model of reablement led and delivered by occupational therapists with a model of reablement led and delivered by social care workers ( Whitehead et al., 2016 ). Three Australian studies assessed the effectiveness of the Home Independence Program (HIP) on improving mobility and ADLs ( Lewin & Vandermeulen, 2010 ; Lewin et al., 2013a ; Lewin et al., 2016 ). HIP is an intensive reablement intervention including multiple home visits delivered for up to 12 weeks. Firstly, a small non-randomised controlled trial (NRCT) assessed the effectiveness of HIP delivered in one metropolitan area of Perth, Australia. Participants who received HIP included people first referred for home care or people in need of further home care assistance ( Lewin & Vandermeulen, 2010 ). The intervention was led by a multi-professional team of health professionals, including occupational therapists, physiotherapists and nurses, with one member of the team working as the care manager to implement assessments, goal setting and strategies relevant to the clients’ needs and goals. ADLs (basic activities required for survival), instrumental ADLs (IADLS) (complex activities necessary for independent living) and the Timed Sit Up and Go test score (measure of mobility) were compared between the intervention and the control group who received home and community care (HACC) services. Significant difference between the groups in terms of change in ADL (p<0.001), IADL (p<0.001) and Timed Sit Up and Go (TUG) (p<0.001) scores between baseline and 3 months, and at 12 months: ADL (p=0.04), IADL (p<0.001), and TUG (p<0.001) were reported in favour of the intervention group ( Lewin & Vandermeulen, 2010 ). The second study of HIP, a large randomised controlled trial (RCT) conducted across different areas of Perth, assessed the effectiveness of the HIP intervention for people who had no prior receipt of home care services before HIP, compared with usual domiciliary care services ( Lewin et al., 2013a ). Overall, ADL scores were similar for both groups with both groups reporting improvements over time. At 3-month follow-up, there was no difference in ADL scores between the HIP and usual domiciliary care groups, with both groups demonstrating improvements in ADLs and IADLs from baseline to 3-month follow-up. At 12-month follow-up, there was a significant difference (p=0.016) in IADLs between groups, favouring the intervention ( Lewin et al., 2013a ). The third study assessed the effectiveness of a new model of HIP whereby non-health professionals replaced health professionals as care managers to deliver the intervention under the new HIP-coordinator (HIPC) service model ( Lewin et al., 2016 ). This study was an uncontrolled before and after study and therefore did not include a comparator group. Between baseline and 3-months follow-up, HIPC was associated with statistically significant improvements in ADLs (p<0.0001) and IADLs (p<0.0001). There were also statistically significant improvements in ADLs (p=0.0003) and IADLs (p<0.0001) between baseline and 12 months, demonstrating a sustained improvement. A secondary analysis compared the results from HIPC with the results from the earlier RCT of HIP, where health professionals undertook the care manager role ( Lewin et al., 2013a ). The secondary analysis reported statistically significant differences in improvements in ADLs (p=0.0237) and IADLs (p=0.0159) between HIPC and HIP between baseline and 12 months, favouring HIPC when non-health professionals take on the role of care manager ( Lewin et al., 2016 ). Another study of a separate reablement intervention delivered in Australia assessed the effectiveness of a short-term restorative care programme ( Schmidt et al., 2024 ). The intervention was delivered by allied health professionals for 8 weeks and included multi-professional team involvement. This was a moderate quality uncontrolled before and after study (UCBA) that assessed the difference in ADL and functional outcomes between baseline and following the intervention. The study did not include a comparator group, but intervention demonstrated statistically significant improvements (p<0.0001) between baseline and 8-week follow-up in ADLs and functioning as measured by the Modified Barthel Index, Lower Extremity Functional Scale, Upper Extremity Functional Index and Berg Balance Scale tools ( Schmidt et al., 2024 ). In Norway, two studies assessed the clinical effectiveness of a 10-week multicomponent reablement programme on self-perceived activity performance and satisfaction with performance ( Tuntland et al., 2015 ; Langeland et al., 2019 ). Both studies used the Canadian Occupational Performance Measure (COPM) to assess self-perceived activity performance and satisfaction with performance. Firstly, Tuntland and colleagues conducted the first RCT of home-based reablement in Europe, conducted in one rural municipality in Norway. This was a high quality study, comparing a reablement programme where occupational therapists and physical therapists supervised home care personnel to deliver the intervention, to usual domiciliary care services. The reablement groups experienced statistically significant improvements in mean COPM performance scores at both 3 months (p=0.02) and 9 months (p=0.03). The reablement group also reported significantly higher COPM satisfaction scores at 9 months (p=0.03); however, no statistically significant differences in COPM satisfaction were found between groups at 3 months ( Tuntland et al., 2015 ). A large non-randomised controlled trial (NRCT) also compared a 10-week multicomponent reablement programme with usual domiciliary care services ( Langeland et al., 2019 ). This was a medium quality study conducted across 47 Norwegian municipalities. The intervention was delivered by homecare personnel and involved a multi-professional team who collaborated with the participants for the whole intervention period. The results reported significantly higher COPM performance (p<0.001) and COPM satisfaction (p<0.001) at 10 weeks and 6 months follow-up, compared to usual domiciliary care. There was no significant difference between groups for COPM performance and COPM satisfaction at 12 months. A medium quality cluster RCT compared a restorative home care intervention with standard home care in New Zealand ( Parsons et al., 2013 ). The intervention included allied health professional (AHP) involvement and was delivered by home care aids, but the study did not report on the duration of the intervention. A greater improvement in physical function scores between baseline and 6 months were reported for the intervention group (p=0.003). A second study conducted in New Zealand, a low quality RCT, compared the effectiveness of a Community Flexible Integrated Responsive Support Team (FIRST) intervention with usual domiciliary care ( Parsons et al., 2017 ). The intervention was coordinated by a nurse case manager and was delivered by unregulated support worker/healthcare assistant. The study did not report on the involvement of other healthcare professionals such as AHPs, nor did it provide information on the duration of the reablement, or any details about the comparator group. The findings reported similar functional outcome scores, ADLs or IADLs in both groups ( Parsons et al., 2017 ). In Denmark, a low quality UCBA study assessed the effectiveness of the Copenhagen Municipality Reablement Program for improving participants’ ability to perform ADLs ( Winkel et al., 2015 ). The study also explored whether the outcomes differed between participants who had already received home care services and had applied for more help (help group) and those who had not received home care services prior to the reablement program and had applied for home help (no help group). The results reported significant improvements in ADLs between baseline and the end of the reablement intervention (p=0.042) with improvements being maintained at 10 months post-intervention (p=0.042). There were no significant differences in ADL scores between the ‘help’ and ‘no help’ groups (p=0.120) ( Winkel et al., 2015 ). Two UK studies assessed the effectiveness of reablement on ADLs and mobility ( Beresford et al., 2019 ; Glendinning et al., 2010 ). Another UK study reporting on ADLs compared a model of reablement led and delivered by occupational therapists with a model of reablement led and delivered by social care workers ( Whitehead et al., 2016 ). A medium quality non-randomised controlled trial evaluated five models of reablement services in England (Glendinning et al., 2015). Each model included the involvement of multi-professional teams with management structures consisting of managers, multi-professional specialists (occupational therapists, physiotherapists and senior carers). Differences in effectiveness between the reablement models were not reported. At 12-month follow-up, participants in the standard care comparison group were less able to undertake all ADLs compared to participants in the reablement group. Results found statistically significant differences between the groups (in favour of the intervention group) for some outcomes, including being unable to get outdoors and walk down the road (p<0.001), and unable to bath, shower or wash all over (p<0.001) (Glendinning et al., 2015). Another study, a medium quality uncontrolled before and after (UCBA) study, assessed the effectiveness of models of English reablement ( Beresford et al., 2019 ). Descriptive statistics indicated in terms of improvements in ADL outcomes between baseline and 6 months follow-up, as measured by the Barthel Index and the Nottingham Extended Activities of Daily Living Scale (NEADL) scale ( Beresford et al., 2019 ). A medium quality feasibility RCT (referred to as OTHERS) conducted in England compared a model of reablement led and delivered by occupational therapists with a model of reablement led and delivered by social care workers under the direction of a reablement care team leader ( Whitehead et al., 2016 ). There were improvements in ADL outcomes (Barthel Index, Nottingham Extended Activities of Daily Living Scale (NEADL) scale) from baseline in both groups, although overall improvements were greater in the occupational therapist intervention group. This was a feasibility study with a small sample ( Whitehead et al., 2016 ). A non-randomised controlled study assessed the effectiveness of step-down restorative care in the US ( Tinetti et al., 2002 ). This study was of medium quality and compared restorative care delivered by home care agency staff (occupational therapists, nurses, physiotherapists and home health aides) with usual domiciliary care. The intervention group reported significantly higher mean mobility scores (p=0.02) and higher mean self-care ADLs (p=0.07) compared to usual domiciliary care) ( Tinetti et al., 2002 ). Quality of life Eight studies reported on the effectiveness of reablement services on Quality of Life (QoL) outcomes ( Glendinning et al., 2010 ; Lewin et al,. 2013a ; Parsons et al., 2013 ; Tuntland et al., 2015 ; Whitehead et al., 2016 ; Lewin et al., 2016 ; Langelend et al., 2019 and Beresford et al., 2019). Specifically, the study by Whitehead and colleagues compared a model of reablement led and delivered by occupational therapists with a model of reablement led and delivered by social care workers. A high-quality comparative before-after study assessing five models of reablement services provided by local authorities in England compared with standard home care ( Glendinning et al., 2010 ) found significant improvement in HRQoL (derived from the EQ-5D) between baseline and 12 months (p<0.001) in the intervention group and found no change within the comparison group. No statistically significant differences were identified in social care-related quality of life (derived through the ASCOT tool) between the reablement and comparison groups. The low quality RCT conducted in Australia ( Lewin et al., 2013a ) comparing the HIP reablement programme with HACC usual domiciliary care found similar QoL outcomes between groups. Both groups reported improvements in QoL, however no figures or statistical analysis are presented in the article. A medium quality cluster RCT compared a restorative home care intervention with standard home care in New Zealand ( Parsons et al., 2013 ). This study found improved QoL outcomes amongst individuals receiving the restorative home care intervention. Between baseline and 6 months, there was greater change in HRQoL (as measured by the SF-36) in the intervention group (p=0.0001) than the control group. A high quality RCT analysing a multicomponent home-based reablement programme in Norway ( Tuntland et al., 2015 ) reported similar HRQoL outcomes between intervention and control groups (as measured by the COOP/Wonka). People in both groups evidenced improvement in HRQoL across most domains up to 9-month follow-up. A medium quality feasibility RCT of OTHERS conducted in England compared a model of reablement led and delivered by occupational therapists with a model of reablement led and delivered by social care workers ( Whitehead et al., 2016 ) found non-statistically significant improvements in HRQoL (measured by the EQ-5D) and social care related QoL (measured by the ASCOT tool) from baseline in both groups, although overall improvements were greater in the occupational therapy intervention group (care provided by an occupational therapist). A moderate quality uncontrolled before-after study ( Lewin et al., 2016 ) assessing the impact of the HIPC and HIP services in Australia reported statistically significant improvements in QoL (as measured by the Assessment of Quality of Life outcome measure) in the single cohort group between baseline and 3 months (p< 0.0001) and between baseline and 12 months (p< 0.0001). This increase however was not statistically significant between the 3 and 12-month follow-up periods. A medium quality non-randomised controlled trial comparing a 10-week multicomponent reablement programme with usual domiciliary care services in Norway ( Langeland et al., 2019 ) found a positive significant difference (p<0.001) in some domains of the EQ-5D (mobility, personal care, usual activities and current health) at 6-month follow-up. No difference between groups for other domains or at other time points were evidenced. Falls outcomes Three studies reported on the effectiveness of reablement on falls outcomes ( Lewin & Vandermeulen, 2010 ; Lewin et al., 2016 ; Whitehead et al., 2016 ). Specifically, the study by Whitehead and colleagues compared a model of reablement led and delivered by occupational therapists with a model of reablement led and delivered by social care workers. In Australia, a medium quality non-randomised controlled trial reported the HIP programme, when delivered by health care professionals, had a positive impact on falls efficacy, defined as the perceived ability of individuals to perform activities without losing balance or falling. At 3 months, HIP scored significantly higher than the usual domiciliary care services control group on the modified falls efficacy scale (p=0.034) ( Lewin & Vandermeulen, 2010 ). In a later medium quality study assessing the effectiveness of HIPC, where non-health professionals acted as care managers to deliver the reablement instead of health care professionals, HIPC demonstrated statistically significant improvements in the modified falls efficacy scale between baseline and 3 months (p< 0.0001) and between baseline and 12 months (p< 0.0001) ( Lewin et al., 2016 ). In the UK, a medium quality feasibility RCT of OTHERS reported fewer falls in the occupational therapist reablement group compared to the social care worker reablement group in terms of the number of participants who reported a fall and the mean number of falls reported at both 3 and 6 month follow-up periods ( Whitehead et al., 2016 ). Other person-related outcomes Other person-related outcomes reported in the identified studies included grip strength ( Tuntland et al., 2015 ), sense of coherence ( Langeland et al., 2019 ), social support ( Parsons et al., 2013 ), and mortality ( Parsons et al., 2017 ). The first RCT of home-based reablement in Europe (a high quality RCT) conducted in one rural municipality in Norway compared grip strength between a 10-week reablement programme where occupational therapists and physical therapists supervised home care personnel to deliver the intervention, with usual domiciliary care services. Neither group reported any improvements in grip strength at 3 or 9 months follow-up ( Tuntland et al., 2015 ). Langeland and colleagues conducted a large non-randomised controlled trial (medium quality) comparing a 10-week multicomponent reablement programme with usual domiciliary care services in Norway. Coping related to experiences of coherence (comprehensibility, manageability and meaning) was assessed using the Sense of Coherence Questionnaire (SOC-13). This paper reported a statistically significant difference, in favour of the intervention group at 3-months (p=0.04), but no statistically significant differences between groups at 12-month follow-up (p=0.72) ( Langeland et al., 2019 ). In New Zealand, a medium quality cluster RCT compared a restorative home care intervention with standard home care ( Parsons et al., 2013 ). The intervention included allied health professional (AHP) involvement and was delivered by home care aides. No significant differences (p=0.09) in social support (measured using the Dukes Social Support Index) was reported between groups at 6-months follow-up ( Parsons et al, 2013 ). A second study conducted in New Zealand, a low quality RCT, compared the effectiveness of a Community Flexible Integrated Responsive Support Team (FIRST) intervention with usual domiciliary care ( Parsons et al., 2017 ). The intervention was coordinated by a nurse case manager and was delivered by an unregulated support worker/healthcare assistant. The outcome of death was lower in this intervention group, compared to the control group, but this was not statistically significant ( Parsons et al., 2017 ). A high quality prospective cohort study assessing models of reablement in England ( Beresford et al., 2019 ) found HRQoL improvements amongst those receiving reablement care. Outcomes were assessed at entry to the reablement services (T0), at discharge from the reablement service (T1), and at 6 months post discharge (T2). Descriptive statistics indicated improvements in HRQoL and social care related QoL outcomes (measured by the EQ-5D-5L and ASCOT, respectively) between timepoints. The differences in mean EQ-5D-5L and EQ-5D Visual Analogue Scale between baseline and 6 months follow up were 0.15 and 17.77, respectively. 2.2.4 Bottom line results for the effectiveness of reablement on person-related outcomes The identified evidence was conducted in six different countries, with Australia contributing the highest number of research studies (four). The evidence was mainly focused on mobility, including ADLs (13 studies). The second most commonly reported outcome assessed was QoL (8 studies). Falls outcomes, assessed in 3 studies, indicated a lack of evidence on the effectiveness of reablement to prevent falls. Of the 13 studies reporting person-related outcomes, 7 studies assessed step-up reablement interventions, 3 studies assessed step-up and step-down reablement interventions, 1 study assessed step-down only, and 2 studies were unclear due to insufficient information on recruitment strategies and participant characteristics reported. Findings for each person-related outcome were graded and are summarised below and shown in Table 5 . Grading was based on guidance by the Public Health Agency of Canada (2014) using the Critical Appraisal Toolkit (CAT). For more information see section 6.8 . Strong international evidence (grade AII) from 13 studies indicated that reablement was effective in improving mobility and activities of daily living . Eleven of the studies reported improvements in mobility and ADLs, of which, eight studies found statistically significant improvements. Two of the studies reported similar outcomes between groups. Strong international evidence (grade AII) from eight studies suggested that reablement interventions were effective for increasing quality of life among clients. Six of the studies reported improvements in quality of life outcomes, and of these, six studies found statistically significant improvements. Two studies reported similar quality of life scores between groups. Moderate evidence (grade BII) from three studies from Australia and the UK suggested that reablement may improve outcomes to prevent falls . All three studies reported improvements in outcomes, with two studies reporting statistically significant findings. Moderate evidence (grade BII) from one high quality Norwegian study reported no difference in grip strength between the reablement intervention and the usual domiciliary care group. Weak evidence (grade CI) from a study conducted in Norway reported statistically significant improvements in sense of coherence in the reablement intervention group. Weak evidence (grade CI) from one study conducted in New Zealand found that reablement had no effect on increasing clients’ social support . Weak evidence (grade CII) from one study from New Zealand reported that mortality was lower in the reablement intervention group compared with usual domiciliary care, but the results were not statistically significant. 2.2.5 Effectiveness of reablement on service-level outcomes Table 4 summarises the main findings of clinical effectiveness on service-related outcomes. The following sections present the evidence under respective categories of service-related outcomes. Admissions to residential care Three identified studies assessed the impact of reablement services on admissions to residential care. Two studies were RCTs, one conducted in Australia ( Lewin et al., 2013a ) and the other in New Zealand ( Parsons et al., 2017 ). The third was an uncontrolled before-after study conducted in Australia ( Lewin et al., 2016 ). One low quality RCT conducted in Australia compared the HIP reablement programme with home and community care (HACC) services ( Lewin et al., 2013a ). People receiving the HIP reablement programme were found to have a reduced rate of admissions to residential care compared to HACC. There was an equal number of participants in the reablement and HACC groups ( Table 2 ). At 3 months, there were 21 and 16 admissions to residential care in the control and intervention groups, respectively. At 12 months, there were 48 and 44 admissions in the control and intervention groups, respectively. Nevertheless, the paper did not provide information to determine whether the admissions reported related to multiple admissions for the same individual. A low quality RCT conducted in New Zealand compared the FIRST reablement intervention with usual domiciliary care (Parsons et a., 2017). People receiving the FIRST reablement intervention had a lower rate of placement in residential care than those receiving usual domiciliary care (17 in the FIRST intervention group, 22 in the usual domiciliary care group). However, this lower rate was not statistically significant. A moderate quality uncontrolled before-after study assessed the impact of a Home Independence Program Coordinator (HIPC) service in Australia compared to HIP ( Lewin et al., 2016 ). People who received the HIPC service were less likely to be admitted to residential care, however this was not statistically significant. A secondary comparison with the group of people who received the HIP programme in the RCT ( Lewin et al., 2013a ) reported slightly less transfers to residential care amongst people receiving HIPC. Long-term home care needs Eight identified studies evaluated the impact reablement services had on the requirement for future home care services: one RCT ( Lewin et al., 2013a ), one longitudinal study based on RCT data ( Lewin et al., 2014 ), two non-randomised RCTs (Lewin and Vendermeulen, 2010; Tinetti et al., 2012 ), one retrospective cohort study ( Lewin et al., 2013b ), one uncontrolled before-after study ( Lewin et al., 2016 ), one comparative before-after study ( Glendinning et al., 2010 ), and one prospective cohort study ( Beresford et al., 2019 ). A moderate quality non-randomised controlled trial conducted in Australia compared the HIP reablement programme with usual home-care services (Lewin and Vendermeulen, 2010). People who received HIP had statistically significantly lower odds of requiring home care services after the programme compared to people who received usual domiciliary care. Those who received HIP were 0.07 (p<0.001) times as likely to require home care services at 3 months and 0.14 (p<0.001) times at 12 months follow-up, compared to the control group. A low quality RCT conducted in Australia ( Lewin et al., 2013a ) also compared the HIP reablement programme, but in their study usual domiciliary care was represented by HACC usual domiciliary care. The HIP programme was found to substantially and significantly decrease the odds of having an ongoing home care service at both 3 months (Odds Ratio: 0.18, 95% CI: 0.13-0.26) and 12 months (Odds Ratio: 0.22, 95% CI: 0.15-0.32) (p<0.001 for both). Lewin et al. (2014) presented the long-term outcomes (2 year follow-up) of the low quality RCT conducted in Australia comparing the HIP reablement programme with HACC usual domiciliary care ( Lewin et al., 2013a ). Those in receipt of the HIP programme used significantly less home-care hours compared to the control group (p<0.001) during the first year (19.1 compared to 45.6, p<0.001) and second year (13.4 compared to 36.2, p<0.001), and overall after 24 months (29.8 compared to 74.4, p<0.001). A moderate quality retrospective cohort study conducted in Australia assessed the outcomes of people who received two models of reablement support: HIP and Personal Enablement Program (PEP) ( Lewin et al., 2013b ). HIP is a multi-component reablement service targeted at elderly people referred from the community, while PEP uses the HIP service model but is targeted at elderly people discharged from hospital. Compared to standard home care, both HIP and PEP groups used fewer home care services in the first 3 years, with HIP remaining lower in year 3. Both HIP and PEP used less services over 57 months, with HIP still lower in the final year. The moderate quality uncontrolled before-after study by Lewin et al. (2016) assessed the impact of the HIPC and HIP services in Australia. Secondary analysis found that both groups reported a reduction in people who required ongoing home care services at 3 and 12 months. However, outcomes for the HIPC groups were somewhat better than the HIP group with more people in the HIPC group no longer required home care services at 3 months (51.43% vs. 36.45%) and 12 months (65.71% vs. 39.68%). A high quality prospective cohort study assessed models of reablement in England ( Beresford et al., 2019 ). The study contained no comparator, but reablement services produced positive, but not statistically significant differences in outcome over the study period. A lower number of home care service hours required was reported between baseline (mean hours: 3.09) and 6 month follow-up (mean hours: 0.5). A high quality comparative before-after study assessed five models of reablement services provided by local authorities in England compared with standard home care ( Glendinning et al., 2010 ). The percentage of people who received independent home care was lower in the reablement group than the comparison group both within the first eight weeks (2% and 65%, respectively) and the remaining ten months (18% and 50%, respectively). A moderate quality non-randomised controlled trial from the US assessed restorative care models and usual domiciliary care ( Tinetti et al., 2012 ). The restorative care model that was evaluated was developed based on principles adapted from geriatric medicine, nursing, rehabilitation, goal attainment, chronic care management and behavioural change theory. The intervention team consisted of a multi-professional team of home care clinicians. Home care episodes were significantly lower for people in receipt of the restorative care group compared to usual domiciliary care. The mean length of home care episodes was 20.3 ± 14.8 days in the restorative care group and 29.1 ± 31.7 days in the usual domiciliary care group (p< 0.001). Hospital admissions Eight identified studies assessed the impact reablement services had on hospital admissions: two RCTs ( Parsons et al., 2017 ; Lewin et al., 2013a ), one longitudinal study based on RCT data ( Lewin et al., 2014 ), one uncontrolled before-after study ( Lewin et al., 2016 ), one prospective cohort study ( Beresford et al., 2019 ), one feasibility parallel group randomised controlled trial ( Whitehead et al., 2016 ), one comparative before-after study ( Glendinning et al., 2010 ), and one non-randomised controlled trial ( Tinetti et al., 2012 ). The study by Whitehead and colleagues compared a model of reablement led and delivered by an occupational therapist compared with a model of reablement delivered by social care workers. One low quality RCT conducted in Australia compared the HIP reablement programme with HACC usual domiciliary care ( Lewin et al., 2013a ). The study found an increased, but not statistically significant rate of hospital admission at 3 months for people who received the HIP programme when compared to usual domiciliary care. At 3 months, there were 6 and 24 hospital admissions in the control and intervention groups, respectively. At 12 months people who received usual domiciliary care were more likely to be admitted to hospital, with 3 hospital admissions recorded in the usual domiciliary care group and 1 recorded in the HIP group. Lewin et al. (2014) presented the long-term outcomes of the low quality RCT conducted in Australia comparing the HIP reablement programme with HACC usual domiciliary care ( Lewin et al., 2013a ). There were fewer hospitalisations in the intervention group compared with the control group during the first and second year, and overall at 24 months. A moderate quality uncontrolled before-after study ( Lewin et al., 2016 ) assessed the impact of the HIPC and HIP services in Australia. The study found lower hospitalisations in the HIPC group compared to HIP at 3 months (1 (1%) compared to 21 (7%)). As a proportion of each group, admissions increased in the HIPC group compared to HIP at 12 months (4 (6%) compared to 12 (4%)). These differences were not statistically significant. Secondary comparison reported slightly less hospitalisations than results from the previous RCT ( Lewin et al., 2013a ). A low quality RCT conducted in New Zealand compared the FIRST reablement intervention with usual domiciliary care ( Parsons et al., 2017 ). The RCT found no difference in hospitalisations between people who received the FIRST intervention and people who received usual domiciliary care. Both groups reported similar hospital admissions over 12 months. No numerical figures are offered in the paper. A high quality prospective cohort study assessed models of reablement in England ( Beresford et al., 2019 ). The study contained no comparator, but reablement services produced positive, but not statistically significant differences in the number of hospital admissions and hospital length of stay. Mean number of hospital visits without overnight stay fell between baseline (0.31) and 6-month follow up (0.18). Mean hospital length of stay at baseline was 2.32 days and reduced to 0.16 days at 6-month follow-up. A moderate quality feasibility parallel group randomised controlled trial compared a home care reablement service led and delivered by occupational therapists with reablement led and delivered by social care workers (control group) in England ( Whitehead et al., 2016 ). The trial found a higher number of hospital admissions in the group that received the OTHERS reablement service (27%) than in the control group (17%) at 3 months follow-up. The same trend held at 6-month follow-up, with (40%) of those in the intervention group admitted to hospital, compared to (17%) in the control group. A high quality comparative before-after study assessed five models of reablement services provided by local authorities in England compared with standard home care ( Glendinning et al., 2010 ) found higher hospital inpatient stays amongst people who received reablement services. At 10-month follow-up, the intervention group had higher hospital inpatient stays (237 days) compared with the comparison group (139 days). This difference was not statistically significant. A moderate quality non-randomised controlled trial from the US assessed restorative care models and usual domiciliary care ( Tinetti et al., 2012 ). The study found people who received restorative care were less likely to be readmitted to an acute hospital during their episode of home care. 13.2% of restorative model participants were readmitted to an acute hospital during the episode of home care, versus 17.6% of usual domiciliary care participants. Conditional regression analysis suggested participants who received the restorative model of home care were 32% less likely to be readmitted than those who received usual domiciliary care. Other health and social care resource use Seven identified studies assessed the impact reablement services had on other forms of health and social care resource use: one longitudinal study based on RCT data ( Lewin et al., 2014 ), two RCTs ( Parsons et al., 2017 ; Tuntland et al., 2015 ), one prospective cohort study ( Beresford et al., 2019 ), one feasibility parallel group randomised controlled trial ( Whitehead et al. 2016 ), and one comparative before-after study ( Tinetti et al., 2002 ). Lewin et al. (2014) presented the long-term outcomes of the low quality RCT conducted in Australia that compared the HIP reablement programme with HACC usual domiciliary care ( Lewin et al., 2013a ). The longer-term outcomes of the RCT were that fewer emergency department presentations were recorded in the intervention group (188 visits, 50% of group) compared to the usual domiciliary care group (208 visits, 58% of group) during the first year. There were also a lower number of emergency department visits among the HIP group (239 visits, 64% of the group) compared to the usual domiciliary care group (257 visits, 69% of group). However, these differences were not statistically significant. A high quality RCT analysed a multicomponent home-based reablement programme in Norway ( Tuntland et al., 2015 ). The study found a statistically significant difference (p=0.007) in outpatient treatments between the groups at 3-month follow-up: control group (12 treatments) vs intervention (3 treatments). A low quality RCT conducted in New Zealand that compared the FIRST reablement intervention with usual domiciliary care ( Parsons et al., 2017 ) found a non-significant difference in other social care resource use between control and intervention groups. Over 12 months, those in the intervention group used more day care, day centre, meals on wheels and transport and slightly more general practitioner (GP) visits. The number of emergency department presentations were similar in both groups. No data is shown in the paper to report figures. A high quality prospective cohort study assessed models of reablement in England ( Beresford et al., 2019 ). As a cohort study there was no comparator, but the intervention produced positive, but non-statistically significant differences in service outcomes between timepoints. There was a reduction in mean community care visits from entry to the reablement service (2.08 visits) to 6 month follow up (0.9 visits). There was also a reduction in mean social care service visits between entry to the reablement service (0.92 visits) and 6-month follow up (0.72 visits). A moderate quality feasibility parallel group randomised controlled trial compared a home care reablement service led and delivered by occupational therapists with a control group who received reablement which was led and delivered by social care workers ( Whitehead et al., 2016 ). Total resource use at 6 months follow-up was similar between groups. Those in the OTHERS group were less likely to use community and social care services (including GP services) (60% of participants in the intervention group used health services, compared to 100% of participants in the control group), an occupational therapist (0% of participants in the OTHERS group compared to 17% of participants in the control group) and accessed meals at home (10% of participants in the OTHERS group compared to 25% of participants in the control group). A high quality comparative before-after study assessed five models of reablement services in England compared with usual domiciliary care ( Glendinning et al., 2010 ). This study found those in receipt of reablement services used less other social care services than those receiving standard home care. Of 241 participants in the reablement group and 141 participants in the control group that completed follow-up assessments, six people in the comparison group and none in the reablement group used day care services during the 10-month follow-up period. For other social care services other than meals on wheels, more people receiving conventional home care services were in receipt of each service compared with those in the reablement group. A high quality non-randomised controlled trial compared restorative home care reablement with usual domiciliary care in the US ( Tinetti et al., 2002 ). Those in receipt of the reablement intervention evidenced a statistically significant difference (p<0.001) in emergency department visits between the intervention (10% utilisation rate) and control (20% utilisation rate) groups. 2.2.6 Bottom line results for the effectiveness of reablement on service level outcomes The identified evidence was conducted in five different countries, with Australia contributing the highest number of research studies (five studies). The evidence of service level outcomes was mainly focused on long-term home care needs (8 studies) and hospital admissions (8 studies). Other health and social care resource use (7 studies) and admissions to residential care (3 studies) were also reported. A lack of evidence in reporting the effectiveness of reablement services on reducing admissions to residential care was identified. Of the 12 studies that reported service level outcomes, 6 studies assessed step-up reablement interventions, 4 studies assessed step-up and step-down reablement interventions and 2 studies assessed step-down only. Findings for each person-related outcome were graded and are summarised below and are shown in Table 5 . Weak international evidence (grade CI) from eight studies reported contradictory evidence (see glossary of terms) on the effectiveness of reablement to reduce hospital admissions . Moderate international evidence (grade BII) from eight studies reported consistent findings demonstrating the effectiveness of reablement to reduce the use of ongoing home care services , with three studies reporting statistically significant findings. Weak international evidence (grade CII) from three studies from Australia (n=2) and New Zealand (n=1) suggested that reablement was effective in reducing residential care admissions , but none of the studies reported statistically significant findings. Weak international evidence (grade CII) from three studies reported inconsistent findings on the effectiveness of reablement to reduce emergency department visits , with two studies reporting favourable outcomes for the reablement group (one demonstrating statistically significant findings), and one study reporting similar outcomes in both groups. Moderate evidence (grade BII) from one Norwegian study found that reablement was effective in reducing the number of outpatient treatments compared with usual domiciliary care with statistically significant differences between groups. Weak evidence (grade CII) from three studies conducted in England (n=2) and New Zealand (n=1) reported contradictory findings on the effectiveness of reablement to reduce community care service use . Weak evidence (grade CII) from four studies conducted in England (n=3) and New Zealand (n=1) reported contradictory findings on the effectiveness of reablement to reduce social care service use . 2.3 Cost-effectiveness of reablement interventions 2.3.1 Overview of the evidence on the cost-effectiveness of reablement interventions Three economic evaluations reporting on the cost-effectiveness of reablement were included in this review. The study characteristics of the included economic evaluations are presented in Table 6 . The first economic evaluation was a cost-effectiveness analysis (CEA) of five English reablement services ( Glendinning et al., 2010 ). The second economic evaluation was a model-based cost-minimisation analysis (CMA) conducted in England (Bauer et al., 218) and was based on differences in service-use outcomes reported in a RCT of the Home Independence Program in Australia ( Lewin et al., 2013a ). The final economic evaluation, a trial-based CEA, assessed the cost-effectiveness of a 10-week multicomponent reablement intervention in Norway ( Kjerstad and Tuntland, 2016 ). View this table: View inline View popup Table 6: Study characteristics of economic evaluation studies assessing cost-effectiveness (n=3) 2.3.2 Quality of studies evaluating the cost-effectiveness of reablement interventions Two of the included economic evaluation studies were deemed to be of moderate quality when critically appraised by the Joanna Briggs Institute (JBI) checklist for economic evaluations (Bauer et al., 2018; Glendinning et al., 2010 ), see the appendices ( Section 9.2.2 ). The economic evaluation conducted by Kjerstad and Tuntland (2016) was deemed to be of strong quality. The CEA conducted by Glendinning et al. (2010) contained key methodological flaws as it included improper application of the NICE threshold (using non-parameterised measures) and did not calculate EQ-5D utility values or QALYs. The CMA by Bauer et al. (2018) used evidence from the moderate quality analyses by Glendinning et al. (2010) and Australian data from Lewin et al. (2013a) . The moderate quality evidence underpinning the model-based economic analysis by Bauer et al. (2018) restricted the quality and representativeness of the results. The authors did acknowledge the lack of quality evidence on which to base their model. The CEA undertaken by Kjerstad and Tuntland (2016) was conducted more rigorously and contained fewer methodological flaws. However, a key methodological flaw in this study was the lack of sensitivity analysis conducted in order to investigate uncertainty in their estimates. 2.3.3 The cost-effectiveness of reablement interventions Three studies conducted economic evaluations of home-based reablement services compared to standard home care only. Two evaluations took the form of trial-based cost-effectiveness analyses ( Kjerstad and Tuntland, 2016 ; Glendinning et al., 2010 ) and the other, a model-based cost-minimisation analysis (Bauer et al., 2018). Table 7 summarises the main findings on the cost-effectiveness of reablement interventions. View this table: View inline View popup Download powerpoint Table 7: Summary of main cost-effectiveness findings In their cost-effectiveness analysis, Kjerstad and Tuntland used the results from a high quality RCT that compared a multicomponent home-based reablement programme in Norway to usual domiciliary care ( Tuntland et al., 2015 ). The intervention group received the reablement programme for 10 weeks and were followed-up at 3- and 9-months post-intervention. The primary outcome measure used in the cost-effectiveness analysis was the Canadian Occupational Performance Measure (COPM). The COPM was used to measure self-perceived activity performance and satisfaction with performance of the programme. Costs in this evaluation were based on recorded patient contacts including the number and duration of home visits to each participant, the type of professional delivering the care and their associated wage costs. The reablement programme was found to be more cost-effective than usual domiciliary care. The incremental cost-effectiveness ratio (ICER) reported that the cost per one-point improvement in COPM-performance was 868.18 NOK lower on average for the intervention group compared to the control group. The cost per one-point improvement in the COPM-satisfaction was 666.30 NOK lower on average for the intervention group compared with the control group. The key driver of the lower costs amongst people who received the reablement programme was a lower average number of home visits in that group (88 visits compared to 158 in control group). The economic evaluation was deemed to be of high/strong quality when assessed by the JBI checklist for economic evaluations. The study did not conduct sensitivity analysis, which would further strengthen the findings. The cost-effectiveness analysis by Glendinning et al., 2010 used the findings from a large-scale non-randomised controlled trial (NRCT) that compared five unique home care reablement services provided by local councils in England with standard home care only. Each of the reablement services differed slightly but they each consisted of a multi-professional care team with a management team overseeing their delivery. The services ran for between 6 and 8 weeks. Health-related quality of life was assessed using the EQ-5D and social care-related quality of life was assessed using the Adult Social Care Outcomes Toolkit (ASCOT). Social care service use was captured by participants and care providers, while NHS and voluntary organisation service use was self-reported only. Relevant Personal Social Services Research Unit (PSSRU) and NHS unit costs were assigned to service utilisation figures to generate costs for the cost-effectiveness analysis from both NHS and social care and wider societal perspectives. All outcomes were assessed between 9- and 12-month follow-up. At a threshold of £30,000 per EQ-5D outcome gain, there was a 99% probability that reablement was cost-effective when both health and social care costs were included and just under 100% if social care costs only were included. At a more stringent threshold of £20,000 per EQ-5D outcome gain, in the case of health and social care costs, the probability of cost-effectiveness fell to around 98% but was still over 99% when only social care costs were considered. The probability that reablement was cost-effective when reablement health care costs were between 5% and 25% higher than reported, and where health care costs for the comparison group were unchanged, were 98.1% and 89.3% respectively. This study was deemed to be of moderate quality, with some key methodological issues. EQ-5D outcome gain was not clearly defined in this study. The authors did not calculate index values or QALYs from EQ-5D responses. Further, the authors compared changes in ASCOT score to the NICE threshold. Comparison with NICE threshold should be restricted to QALY outcomes only as other outcomes have not been parameterised to the threshold. Sensitivity analysis was completed, but the issues surrounding outcome measurement influenced these results also. The model-based cost-minimisation analysis by Bauer et al., 2018 examined whether home care reablement schemes for older people at home had the potential to reduce costs from NHS and Personal Social Services (PSS) perspectives in England. The authors developed a decision-analytic Markov model using evidence from previously published studies to run two synthetic cohorts of patients (n=1,000 in each) on which the cost-minimisation analysis was conducted. Cost-minimisation studies typically assume equivalence of outcomes, but this wasn’t stated by the authors, however the authors did acknowledge and arrive at a similar conclusion that the study by Glendinning et al., 2010 did not provide clear evidence on health outcomes from home care reablement services. Differences in service use between home care reablement services and standard home care were obtained from Lewin et al., 2013; 2014 . Lewin et al., 2013 was identified in our literature search and deemed to be of low quality and at risk of bias when assessed using the CAT. Costs of home care reablement service provision were based on Glendinning et al., 2010 ; Lewin 2014; and national audit estimates. Costs of hospital care were generated through assigning unit costs to resource use estimates. Outcomes used in the model included relative risk of hospital admission, probabilities of hospital admission in reablement during the first year, probabilities of hospital admission in reablement during the second year, relative risk of ongoing home care and probabilities of ongoing home care for each synthetic cohort. Mean cost in the reablement group was £56,499 per person, ranging from £55,690 to £57,307 at a 95% confidence interval (CI). Mean cost in the standard care group was £58,560 (95% CI 57,800 to 59,319). The mean difference was -£2,061 (95% CI 1,933 to 2,129). In both groups, most of the total costs (over 80%) were social care related: If reablement was counted as a cost to local authorities, mean costs to this sector were £46,894 in the reablement group and £48,887 in the standard care group. On the same basis, 97% (£1,993) of the net benefit was due to reductions in costs to local authorities, and only 3% (£68) was due to reductions in costs to the NHS. Costs in both reablement and standard care groups decreased with higher starting ages of cohorts, mean differences increased to - £3,244 (starting age 75) and -£3,844 (starting age 85). The decrease in costs was explained by the overall shorter period in which costs occurred, and the increase in mean differences reflected the relatively greater impact on hospital admission rates for older age groups (who have higher risks of hospital admission). The probability that reablement was cost-reducing increased to 99.9% (for starting age 75) and 100% (for starting age 85). The model parameters utilised evidence from primary studies deemed to be of poor to moderate quality, which influenced the quality of this study when assessed by the JBI checklist (moderate quality). Further, in the absence of high quality evidence from England, the model used Australian data. The authors noted expert opinion found both countries’ reablement systems to be similar, but the use of such data influenced generalisability to an English population. 2.3.4 Bottom line results for the cost-effectiveness of reablement interventions Two of the economic evaluations suggested at-home reablement services could be cost-effective when compared to standard at-home care. The quality of this evidence was mixed however, with one study being of high quality and the other being of moderate quality, with key methodological challenges concerning outcome measurement. The cost-minimisation analysis indicated that at-home reablement interventions can be less costly when compared to standard at-home care. This study used previously published evidence from Australia to inform model parameters which may influence generalisability to an English/UK care system. 2.4 Service-level costs and implementation outcomes of reablement interventions 2.4.1 Costs Five of the included studies reported on service-level costs as one of their outcomes ( Glendinning et al., 2010 ; Lewin et al., 2013b ; Lewin et al., 2014 ; Kjerstad and Tutland, 2016; Beresford et al., 2019 ). In England, a medium quality non-randomised controlled trial compared NHS health service use costs and social care service use costs between a reablement service group and a usual domiciliary care control group over a 12-month period ( Glendinning et al., 2010 ). During the first 8 weeks, reablement was associated with significantly higher NHS and social care service costs due to the cost of the reablement services themselves. At 10 months, NHS costs were similar between groups but the control group incurred significantly higher (p<0.0.001) mean social care service use costs compared to the reablement group including in-house home care (£270 reablement group vs. £590 control), independent home care (£450 reablement group vs. £1,660 control group), day care (£0 reablement group vs. £60 control) and meals on wheels (£60 reablement group vs £70 control). Overall, at 12 months, there was no significant difference between groups in total healthcare costs ( Glendinning et al., 2010 ). A medium quality UCBA study conducted in England reported an estimated cost of reablement per case of £1,700 (2016 prices) ( Beresford et al., 2019 ). The study reported that public sector health and social care costs were highest before the reablement, with a large reduction in the cost of hospital stays following the implementation of reablement. Informal care time was a main driver of cost before and during implementation ( Beresford et al., 2019 ). In a low quality RCT conducted in Australia, results reported lower total home care costs for home independence program (HIP) clients (AU$5570) compared to usual domiciliary care services (AU$8541) ( Lewin et al., 2013b ). Over the 24-month follow-up period, the mean home care and healthcare costs per client were AU$2869 lower for the HIP group compared to usual domiciliary care services ( Lewin et al., 2014 ). A separate study, a medium quality retrospective cohort study compared the costs between two reablement services (HIP and personal independence program (PEP)) with usual domiciliary care services ( Lewin et al., 2013b ). Both reablement groups (HIP and PEP) were less likely to use home care services compared with usual domiciliary care, which equated to an estimated median cost saving of AU $12,500 per person over 5 years ( Lewin et al., 2013b ). A high quality cost-effectiveness analysis used the results from a high quality RCT that compared a multicomponent home-based reablement programme in Norway to usual domiciliary care ( Tuntland et al., 2015 ). Kjerstad and Tutland, 2016 calculated costs of delivering the multicomponent home-based reablement programme investigated in the RCT. Over the ten-week programme, aggregate delivery costs were approximately 12,000 NOK lower for the intervention group than control. At 3-month follow-up, mean costs per participant was approximately 1,134 NOK lower for the intervention group compared with the control (Kjerstad and Tutland, 2016). 2.4.2 Implementation Three included studies reported on implementation outcomes: Beresford et al., (2019) , Whitehead et al., (2016) and Glendinning et al., (2010) . The prospective cohort study by Beresford et al., (2019) reported on the appropriateness of the models of English reablement interventions. The study mapped and created a typology of existing statutorily funded adult social care reablement service models in England, before evaluating three distinct models. Data was captured from staff and participants through questionnaires and interview at discharge and 6-month post-discharge. The results indicated that staff advocated reablement interventions over usual domiciliary care. Service users reported the acceptability of the intervention and cited six factors had an impact on outcomes (the service user–worker relationship; the workers’ reablement skills; the service user’s confidence in the worker; the duration of home visits; the service user’s willingness to accept support; and the service user being able to review progress). Beresford et al. reported acceptability issues of implementation, and that staff frequently reported that service users and family members had a poor understanding of reablement, including confusion about its difference from usual domiciliary care, and this acted as a barrier to engagement. The study also identified concerns with monitoring and review processes and with the sustainability of the intervention as staff caseload volume had increased. Whitehead et al., (2016) conducted a feasibility RCT that compared a model of reablement that was led and delivered by occupational therapists to a model of reablement that was led and delivered by social care workers (control group). In the feasibility outcomes, the authors reported that, overall, it was possible to deliver the intervention as planned and that it was delivered consistently with the protocol. Each participant received an average of 10 hours of occupational therapy time: 4 hours of direct contact, 3 hours of administration and liaison, and 3 hours of travel time. All participants were able to set one or more ADL-related goals. The intervention acceptability was evaluated using a questionnaire and semi structured interviews with five participants in the intervention group. The questionnaire and interviews revealed a high level of satisfaction with the intervention, and participants reported that they believed the intervention helped them to increase their ability to manage ADL. However, this was a feasibility RCT and further research is needed to ascertain whether intervention delivery could be standardised across sites. Glendinning et al., (2010) reported on the implementation of five English reablement services through the non-randomised controlled trial element of their study. The study captured qualitative and quantitative data from service users, carers and staff through validated and bespoke questionnaires, interviews and focus groups. Service users and their carers reported positive experiences of reablement, particularly the good relationships they were able to develop with the team of reablement workers. The reassurance provided by visits from reablement workers was particularly important for users living alone. Factors contributing to the successful delivery of five reablement services included not having highly selective intake policies, unsustainable levels of resourcing, or particularly highly motivated staff (often features of new or pilot services which are likely to enhance positive findings and outcomes). Thus, the authors concluded that the promotion of home care reablement was well-founded. However, the authors also noted that a number of service users and carers were disappointed that home care reablement had not been able to address two areas of importance to them, in this instance preparing meals and rebuilding confidence and improving mobility to walk outside the home. 3. SUMMARY OF THE FINDINGS OF A QUALITATIVE EVIDENCE SYNTHESIS EXPLORING OLDER PEOPLE AND THEIR CARERS’ EXPERIENCES AND PERCEPTIONS REABLEMENT SERVICES Our rapid review focused on the assessment of the clinical and cost-effectiveness of reablement service and was limited to comparative studies. However, we also acknowledge the value of qualitative research exploring older people and their carers’ experiences and perceptions of reablement, which is likely to provide important information on the barriers and enables for implementing the service. This section summarises the findings of a systematic review and qualitative evidence synthesis that was identified during the preliminary searches for this rapid review. A systematic review of qualitative studies investigated the experiences and perceptions of older individuals and their carers (formal and informal) regarding the reablement model used in community aged care ( Mulquiny and Oakman, 2022 ). The review encompassed 19 qualitative studies which highlighted the potential of reablement to foster independence, challenges associated with goal setting, and the necessity for enhanced engagement strategies. A prominent finding across the studies was that both older people and their carers viewed goals as crucial measures and motivators during the reablement process, with goal attainment positively influencing their experiences. Findings across studies demonstrated reablement improved the health and well-being of older individuals. However, the success of these improvements was closely tied to the level of engagement and understanding of the reablement process by the older individuals. Poor engagement in reablement services among older people was attributed to their limited understanding of their role in the process. Expectations often aligned with traditional aged care services, which contrasted with the more hands-off and rehabilitative approach of reablement. Enhanced collaboration in setting reablement goals between practitioners, older individuals, and their carers was found to be essential in improving understanding and engagement. While older individuals appreciated the principles of reablement, such as supporting people to remain independent within their usual place of residence, the short duration of reablement services were considered insufficient for the level of disability experienced by some individuals, who expressed a need for ongoing interventions. Additionally, older people felt that their reablement goals often overlooked their need for social connectedness, with leisure and social activities rarely included in the goals of reablement programmes ( Mulquiny and Oakman, 2022 ). 4. DISCUSSION 4.1 Summary of the findings This rapid review identified a significant amount of international evidence that reablement led by multi-professional teams that includes allied health professionals, or an allied health professional such as an occupational therapist is effective in improving person-related outcomes and reducing the need for long term care needs. Twelve studies evaluated reablement models led by multi-professional teams that included allied health professionals, while five studies specifically examined AHP-led models. Only one study involved no AHPs, evaluating a reablement model led by a nurse case manager. In response to the rapid review question, there was evidence to demonstrate that reablement interventions were effective for improving independence in terms of increasing mobility and activities of daily living outcomes. Other outcomes relating to clients’ health reported in the studies identified in this rapid review included quality of life, falls outcomes, grip strength, sense of coherence, mortality and social support. The rapid review findings suggest that reablement interventions were effective in improving quality of life and may have been effective in improving falls outcomes. The review also identified that reablement may have been effective in reducing the risk of mortality and improving clients’ coping in terms of sense of coherence. The review did not identify evidence to suggest that reablement was effective for improving grip strength or increasing clients’ social support. Another aim of this rapid review was to assess whether reablement was effective in reducing the need for long term care. Based on the available evidence identified in this rapid review, reablement was found to reduce the need for long term home care services. There was also evidence that reablement interventions were effective in reducing residential care admissions. In terms of other service-level outcomes, there were contradictory findings on the effectiveness of reablement to reduce hospital admissions and inconsistent findings on the effectiveness of reablement to reduce emergency department visits. One study found that reablement was effective in reducing the number of outpatient treatments compared with usual domiciliary care. The rapid review also found contradictory findings on the effectiveness of reablement to reduce community care service use and social care service use. This review also identified a medium-quality feasibility RCT conducted in England that compared a model of reablement that was led and delivered by occupational therapists to a standard model led and delivered by social care workers under the supervision of a reablement care team leader ( Whitehead et al., 2016 ). The study found greater improvements in person-related outcomes—including activities of daily living, health-related and social care-related quality of life, and a reduction in falls in the occupational therapy reablement group. Although the sample size was small (N=30) and findings were not statistically significant, the occupational therapy-led model showed promising trends. At the service level, participants in the occupational therapy-led reablement group were less likely to use community and social care services, including GP visits and community support such as meals at home, suggesting potential efficiency benefits compared to the social care worker–led model. In terms of the cost-effectiveness of reablement, this rapid review identified three economic evaluations. Two of the economic evaluations (one set in England, one set in Norway) found that at-home reablement services were cost-effective when compared to standard at-home care. The third economic evaluation, a cost-minimisation analysis (set in England but incorporated Australian data), reported that reablement was cost-effective compared to usual domiciliary care when the clinical effectiveness is assumed to be equal between the intervention and usual domiciliary care groups, due to lower health and social care resource use costs in the reablement intervention group. Some of the studies included in this rapid review also reported on other relevant outcomes, such as costs and implementation outcomes. Five studies reported on service-level costs. One UK study reported similar total healthcare costs for people who received a reablement intervention compared to people who received usual domiciliary care services at 10-month and 12-month study follow-up periods; however, the costs of social care services were significantly higher in the usual domiciliary care group compared with the reablement group at the 10-month follow-up. Another UK study reported that reablement was associated with a large reduction in hospital stay costs. Two studies reported service-level costs of reablement in Australia. Both studies reported lower home care service use costs for reablement compared with usual domiciliary care. One Norwegian study reported aggregate delivery costs were lower for the intervention group than control, and at 3-month follow-up, mean costs per participant was lower for the intervention group than control. Three studies reported on implementation outcomes in terms of the acceptability of reablement interventions. There were mixed findings in relation to the acceptability of reablement as noted by the experiences of service users, carers and staff. Some of the reported barriers to the acceptability of reablement included a poor understanding of reablement among service users, not addressing goals that were important to the service user, concerns with monitoring and review processes, and concerns around the sustainability of the intervention as staff caseload volume had increased. There was also some evidence that reablement interventions were feasible to deliver. 4.2 Strengths and limitations of the available evidence All evidence included in this review was from academic papers, with the exception of Glendinning et al., 2010 which was not published in an academic journal and did not go through peer review process. All included studies evaluated a form of reablement care. When assessed against key components of reablement (see Table 1 ), most interventions from included studies satisfied all five criterion [1) participants must have had an identified need for formal care and support or be at risk of functional decline 2) intervention must have been time-limited (up to 12 weeks) and intensive (e.g., multiple home visits) 3) intervention must have been delivered in the person’s own home, and provided by an interdisciplinary team 4) intervention must have been focused on maximising independence and 5) intervention must have been person-centred and goal-directed]. Of criterion not satisfied, we cannot be certain that four studies provided time-bound reablement as they did not report on duration. Most of the studies reported on reablement that appeared to be provided by healthcare providers, with fewer studies reporting on reablement that was hosted within or delivered by local authorities. It is important to note that occupational therapists working within local authorities currently face significant challenges in engaging in research activities. The evidence comprehensively covered both person-related and service-level outcomes, with evidence of key outcomes in each category identified. Only three economic evaluations were identified and had some methodological flaws, highlighting an evidence gap. Study designs were variable, with four studies using full RCTs. Some studies employed a single cohort design, which did not allow for comparisons of the effectiveness of reablement services to be made against a comparator. Most of the identified evidence was rated to be of moderate quality. Only one study was rated as high quality, the RCT by Tuntland et al., 2015 . The differences in quality highlights a limitation of the available evidence, affecting the overall strength and reliability of the review’s conclusions. Further research utilising strong study designs and robust methodologies are required to provide more definitive evidence of the effectiveness and cost-effectiveness of reablement services across the domains of person-centred and service-level outcomes. 4.3 Strengths and limitations of this Rapid Review This rapid review systematically searched five bibliographic databases and followed a rigorous and comprehensive search strategy that was co-produced with stakeholder and information scientist input. All results were dual-screened for relevance by two reviewers at title and abstract and full-text stages to ensure consistency and accuracy. Any conflicts were resolved by a third reviewer. Inclusion and exclusion criteria were co-produced by expert stakeholders to ensure suitable and appropriate study selection. This review reported not only on effectiveness and cost-effectiveness, but also on wider outcomes such as implementation. Included studies were critically appraised individually as well as a quality appraisal of the evidence base for included outcomes in this review. A generic critical appraisal tool was used for all studies of effectiveness, which facilitated the comparison of methodological quality across different study designs while also accounting for study design during the appraisal process. Due to the differences in terminology used to define reablement across countries, we cannot be certain we have not missed other relevant search terms to identify studies of reablement. Our search strategy was defined with input from the stakeholder team. 4.4 Implications for policy and practice There is international evidence that reablement (led by a multi-professional team that includes allied health professionals, or an allied health professional such as an occupational therapist) is effective in improving mobility including activities of daily living, quality of life and falls outcomes. There is also evidence that demonstrated reablement can reduce the need for long term care in terms of the use of home care services and admissions to residential care. While not all reablement services currently include allied health professionals (AHPs), the evidence from this review makes a strong case for their inclusion in Wales. AHP-led reablement has been shown to improve person-centred outcomes and reduce the need for long-term care, supporting the case for targeted investment in AHP roles within reablement services. From a UK and Norwegian context, three economic evaluations reported that reablement was a cost-effective alternative to usual domiciliary care services. Given the high costs associated with ongoing care needs for people at risk of frailty, our findings make the case for investing in time-limited reablement interventions in Wales. Wales currently has different models of reablement provision, guided by the All Wales Rehabilitation Framework (2022). This review makes the case for more focus on reablement services to provide better outcomes for people, with appropriate resource, support and prioritisation of allied health professional resource in order to achieve optimal systems impact. Future recommendations for policy and practice should also consider findings relating to the acceptability of reablement to service users and staff, and also the feasibility of implementing these interventions in practice. 4.5 Implications for future research There is a clear need for more UK-based studies on reablement, as this review identified only three from the UK, with the remainder drawn from international evidence. While international research can offer valuable insights—particularly where service models align—it is essential to consider the unique context of Wales, where reablement is often hosted within or delivered by local authorities. Most of the included studies identified in this review reported on interventions that appeared to be delivered by the healthcare sector. There is a need for high quality evidence on the clinical and cost-effectiveness of reablement services. The majority of included studies were deemed to be of moderate quality, limiting the certainty of the review findings. The three identified economic evaluations had some methodological flaws that limited the certainty of review findings, evidencing a need for future economic evaluations on the topic. Consider the challenges faced by professionals in undertaking research outside the field of Health, as reablement is often hosted within the remit of local authorities and could involve social care practitioners, such as occupational therapists. Future research should consider sub-group analyses to ensure equitable provision of reablement services across the whole of Wales for people from all socioeconomic backgrounds and ethnicities. 4.6 Economic considerations* Reablement programmes may provide cost savings to commissioners and the health and social care systems through prevention of or reduced length of hospital admission, reductions in hospital readmission and preventing or reducing domiciliary and residential care demand ( Deloitte, 2012 ). Frailty has a sizeable impact on healthcare resource use in the UK. Total additional costs of frailty-related healthcare resource use are £8 billion** per year. Healthcare resource use costs increase with severity of frailty. Additional per person costs from an NHS perspective were £773**, £1,666** and £2,904** for mild, moderate and severe frailty respectively ( Han et al., 2019 ). *This section has been completed by the Centre for Health Economics & Medicines Evaluation (CHEME), Bangor University **Inflated to April 2025 prices using Bank of England inflation calculator https://www.bankofengland.co.uk/monetary-policy/inflation/inflation-calculator Glossary Allied health professional-led (AHP-led): describes an intervention that is led, coordinated, or managed by an allied health professional (AHP), such as a physiotherapist, occupational therapist, or speech and language therapist, even if the intervention itself is delivered by other staff (e.g., support workers or care assistants). This is distinct from a multi-professional team approach, which involves active collaboration and shared decision-making among professionals from multiple disciplines (that could include AHPs). Economic evaluation: an assessment of the costs and effects of alternate healthcare interventions. The aim of an economic evaluation is to help decision makers maximise the level of health benefits relative to the finite resources available. Coherence : how people view life and their capacity to respond to stressful situations. It consists of three core components: Comprehensibility, Manageability, and Meaningfulness. Sense of coherence is measured using the Sense of Coherence Questionnaire. Cohort study: a type of observational study in which two or more groups of people—one with a particular exposure, treatment, or characteristic (e.g., smokers), and one without (e.g., non-smokers)—are followed over time to assess differences in the occurrence of a specific outcome. The inclusion of a comparison or “control” group allows researchers to examine the effect of the exposure by contrasting outcomes between the groups. Unlike randomised trials, participants are not randomly assigned, but observed in their natural exposure settings. Consistency of results: consistent results report findings from studies that found similar results, inconsistent results report some variation in results but overall trend related to the effect is clear, contradictory results report varying results with no clear overall trend related to the effect. Cost-effectiveness analysis: a type of economic evaluation whereby costs are compared with a treatment’s common therapeutic goal, expressed in terms of one main outcome measured in natural units (e.g., improvement in blood pressure or cholesterol level). These outcomes are typically condition-specific, meaning comparison within conditions is possible, but difficulty arises in comparing between conditions. Cost-minimisation analysis: is a form economic evaluation which compares the cost of alternative interventions or services that achieve the same outcomes. In the analysis, if the overall cost of new intervention is lower than the comparator intervention, the intervention of interest is considered cost-effective. This method aims to identify the least costly option. Directness of evidence: direct evidence comes from studies that specifically researched the association of interest, whereas extrapolation is inferences drawn from studies that researched a different but related research question or researched the same question but in an artificial setting. Health and social care resource use or utilisation: refers to the use of healthcare resources by end users (patients) and intervention deliverers. This can take the form of contacts with health professionals across health and social care, medicines or healthcare consumables used. In economic evaluations, resource use is collected, and costs are assigned to them to identify the costs an intervention places on the healthcare system. Intervention deliverer : personnel who deliver the intervention to participants. Intervention leads: individuals responsible for overseeing the design, coordination, and strategic implementation of an intervention. They guide the overall direction and support those delivering it, but are not necessarily involved in direct delivery to participants. Model-based economic evaluation: Model-based economic evaluations are often used especially when long term evidence is important but not available. It can extrapolate findings beyond the trial-based follow-up period (time horizon). Model-based economic evaluations use past knowledge and patterns to understand the performance of new and existing treatments. This can be performed alongside empirical studies or as standalone studies. The model can be used to synthesise evidence across multiple trials for decision making. The model types widely used are simple decision trees, Markov cohort, and Markov microsimulation models. Multi-professional team/ multi-disciplinary team: a group of healthcare professionals from different disciplines who come together to discuss cases, share expertise, and jointly develop coordinated management plans. Multi-professional workforce: the broader composition of personnel from various professional backgrounds who are employed within a service or system. Unlike a multi-professional team, this term refers to the overall staffing structure, not necessarily implying active collaboration or joint working, but rather the presence of diverse professional roles within the workforce. Non-randomised controlled trial: is a study design that participants are not randomly assigned into an experimental group or a control group. Participants may choose which group they want to be in, or they may be assigned to the groups by the researchers. Overall rating of the body of evidence: considers the strength of the study designs, quality of the studies, directness of evidence and consistency of results across the studies to draw a conclusion for each outcome. Please see section 6.8 of this report for further information about the grading criteria for rating the overall body of evidence. Randomised controlled trial: a study in which a number of similar people are randomly assigned to 2 (or more) groups to test a specific drug, treatment or other intervention. One group (the intervention group) has the intervention being tested, the other (the comparison or control group) has an alternative intervention, a dummy intervention (placebo) or no intervention at all. The groups are followed up at set time periods to see how effective the experimental intervention was. Outcomes are measured at specific times and any difference in response between the groups is assessed statistically. Randomised controlled trials are the highest standard of research trials as their design helps to reduce biases that may impact the findings. Reablement: referred to by NICE (2017) as a community-based intervention that aims to increase a service user’s independence by helping them recover lost skills and confidence. The All Wales Rehabilitation Framework (2022) refers to reablement as an enabling approach with services that provide rehabilitation for all people with physical or mental disabilities. It helps them adapt to their condition by learning or re-learning the skills needed to function in everyday life. The focus is on promoting and optimising functional independence by practicing activities, rather than interventions aimed at improving underlying impairments. Sample size range: presents the highest and lowest sample size across the studies for a given outcome of interest. Statistical significance: a statistically significant result is one that is deemed to be down to a true effect rather than random chance. It is a way to determine if a relationship between variables is caused by something other than chance. Strength of study designs: each analytical study design has particular strengths and limitations and are assigned a strength of study design available from the critical appraisal tool guidance. Step down reablement: support after hospital discharge. Step up reablement: proactive support for individuals at risk of deteriorating, aiming to prevent hospital admissions, improve health outcomes, and reduce long-term care costs Quality of studies: each analytical study is given a quality rating based on the scoring on the critical appraisal tool quality assessment for individual studies. Trial-based economic evaluation: an economic evaluation of the costs and effects of healthcare interventions that are being studied as part of a clinical trial. The primary aim of clinical trials is typically a measurement of clinical effect of administering an intervention (e.g., change in blood pressure). These clinical effects of the intervention are then assessed together with the costs of the intervention in the economic evaluation. Uncontrolled before-after study: is a study that evaluates the outcome of an intervention before and after implementation of the desired intervention. This method is known as an uncontrolled before-after study. It aims to assess whether the intervention has an effect on the measured outcome. The term ‘uncontrolled’ is used to distinguish this design from a controlled before-after study. In an uncontrolled before-and-after study, the effect of the intervention is not compared to a control group that did not receive the intervention. Data Availability All data produced in the present study are available upon reasonable request to the authors 6 RAPID REVIEW METHODS 6.1 Eligibility criteria An extended version of the Population, Intervention (exposure), Comparison, Outcomes (PICO) framework table is presented below detailing the inclusion and exclusion criteria of this review. View this table: View inline View popup Table 8: Eligibility criteria 6.2 Literature search A comprehensive search of bibliographic databases was conducted for publications from database inception to January 2025. The following databases were searched: On the OVID platform: Medline and EMBASE On the EBSCO platform: CINAHL Cochrane: CENTRAL & CDSR 6.3 Study selection process Four reviewers independently screened titles and abstracts using the Covidence review management software. Two reviewers independently screened 100% of the full text articles. Following the independent full text screening stage, discrepancies were resolved through discussion with the review team to come to an agreement on the final inclusions. 6.4 Data extraction Data extraction was based on the outlined eligibility criteria. For the economic evaluation studies, the review team extracted data on study country, type of intervention, study design, sample size, length of follow-up, type of economic evaluation, perspective of analysis, currency and cost year, details of discounting and sensitivity analysis, main costs and outcomes measures, and main health economics findings. For the remaining primary studies, the review team extracted data of study country, type of intervention, study design, sample size, participants and settings, intervention and comparator/control, outcomes that are relevant to the review question. Resource use, costs and implementation were also extracted if applicable to the study. 6.5 Study design classification Studies were classified using the algorithm supplemented in the Critical Appraisal Toolkit (CAT) designed by the Public Health Agency of Canada (Public Health Agency of Canada, 2014). An evidence summary table was utilised in order to extract further detail surrounding the outcomes of the intervention and the results specific to each individual outcome. 6.6 Quality appraisal The Critical Appraisal Toolkit (CAT) for assessing multiple types of evidence will be used to critically appraise the included studies ( Moralejo et al., 2017 ). 6.7 Synthesis Quantitative data from each study was narratively synthesised and analysed. Due to the heterogeneity of intervention type, study outcomes and outcome measures, it was not possible to conduct a meta-analysis. Following detailed extraction of interventions, outcomes, and outcome measures, a thematic approach was undertaken to synthesis findings. The review findings were presented under the following outcome categories: Person-related outcomes Mobility including ADLs QoL Falls outcomes Other person-related outcomes Service-level outcomes Admissions to residential care Long-term home care needs Hospital admissions Other health and social care resource use Cost-effectiveness Other relevant outcomes Costs Implementation Summary of findings from a previously identified qualitative evidence synthesis Evidence of any outcomes relating to acceptability, feasibility and implementation reported in the identified studies were summarised to highlight implementation issues and recommendations for policy and practice. 6.8 Assessment of body of evidence The CAT was used to assess the body of evidence identified in this rapid review ( Moralejo et al., 2017 ). This toolkit provides three main appraisal tools for analytical studies, descriptive studies, and literature reviews. The CAT facilitates a comprehensive assessment of the body of evidence for different study designs and was used to produce an evidence summary table detailing information on the relevant methods and outcome measures, results and conclusions from each study. The CAT was used to rank each study as ‘strong’, ‘moderate’ or ‘weak’ which is based on a number of variables such as the type of study design, assessment of the study population and sampling method, internal validity, control of confounding variables, ethics, control of analysis, assessment of applicability, and overall conclusions ( Moralejo et al., 2017 ). To assess the overall body evidence for each outcome, five outcomes suggested by Moralejo et al. (2017) were taking into account, including the CAT quality decisions; the number of studies evaluating the same population; directedness of the evidence; and consistency of results. Based on these items, a rating for the overall body of evidence for each outcome can be described as strong, moderate, or weak ( Moralejo et al. 2017 ). Grading criteria is presented below. View this table: View inline View popup Download powerpoint EVIDENCE 7.1 Search results and study selection Following the removal of duplicates, the search identified 4,316 records. Full texts (n=46) were reviewed, and eighteen studies were included in this rapid review: studies of clinical effectiveness (n=15), economic evaluations (n=2), study including both an evaluation of clinical effectiveness and an economic evaluation (n=1). Please see Section 9.3 of this report for further information on the reasons for the exclusion of records during the full text screening stage. 7.2 Data extraction View this table: View inline View popup Table 9. Summary of primary studies of clinical effectiveness View this table: View inline View popup Table 10. Summary of economic evaluation studies assessing cost-effectiveness 7.3 Quality appraisal The summary tables for the quality appraisals are presented in section 9.2 . 7.4 Information available on request The data that supports the findings of this study are available in the data extraction tables of this report. The search strategies conducted in the databases are available in section 9.1 . ADDITIONAL INFORMATION 8.1 Conflicts of interest The authors declare they have no conflicts of interest to report. APPENDICES 9.1 Search strategies conducted in databases Database: Ovid MEDLINE(R) ALL View this table: View inline View popup Database: Embase Classic+Embase View this table: View inline View popup Database: CINAHL (EBSCO) 15.01.2025 View this table: View inline View popup Database: CINAHL (EBSCO) 15.01.2025 View this table: View inline View popup View this table: View inline View popup Download powerpoint 9.2 Quality appraisal 9.2.1 Critical appraisal toolkit (CAT) Evidence Summary Table for outcomes of clinical effectiveness View this table: View inline View popup Download powerpoint 9.2.2 JBI critical appraisal checklist for economic evaluations View this table: View inline View popup Download powerpoint 9.3 Reasons for exclusion during full text screening View this table: View inline View popup 9.4 Summary of interventions described in the included studies using the TIDieR checklist (Hoffman et al., 2024) View this table: View inline View popup The Health and Care Research Wales Evidence Centre Our dedicated team works together with Welsh Government, the NHS, social care, research institutions and the public to deliver vital research to tackle health and social care challenges facing Wales. Funded by Welsh Government, through Health and Care Research Wales, the Evidence Centre answers key questions to improve health and social care policy and provision across Wales. Along with our collaborating partners, we conduct reviews of existing evidence and new research, to inform policy and practice needs, with a focus on ensuring real-world impact and public benefit that reaches everyone. Director: Professor Adrian Edwards Associate Directors: Dr Alison Cooper, Dr Natalie Joseph-Williams, Dr Ruth Lewis Acknowledgements The authors would like to thank Denise Moultrie, Ruth Crowder, Kerrie Phipps, Emily Clarke, Rhian Matthews and Rashmi Kumar for their time, expertise, and contributions during stakeholder meetings in guiding the focus of the review and interpretation of findings. We would also like to thank Elizabeth Gillen and Juliet Hounsome, Information Specialists at Cardiff University, for their expert contribution to the search strategy development and database searches. Footnotes Funding statement : The authors and their Institutions were funded for this work by the Health and Care Research Wales Evidence Centre, itself funded by Health and Care Research Wales on behalf of Welsh Government. To provide further clarity around the implications of the evidence found on policy and practice in health and social care in Wales, in relation to the potential benefits of involvement of allied health professionals in reablement service delivery ↵ 1 Allied Health Professions : include art therapists, drama therapists, music therapists, podiatrists, dietitians, occupational therapists, orthoptists, prosthetists and orthotists, paramedics, physiotherapists, speech and language therapists, psychologists. Abbreviations Acronym Full Description ADL Activities of Daily Living AHP Allied Health Professional ASCOT Adult Social Care Outcomes Toolkit AU $ Australian Dollar CAT Critical Appraisal Toolkit CEA Cost-Effectiveness Analysis CHEME Centre for Health Economics & Medicines Evaluation CI Confidence Interval CMA Cost-Minimisation Analysis COOP/Wonka (WONCA) The Dartmouth Co-op Functional Health Assessment Charts/WONCA (World Organization of Family Doctors) COPM Canadian Occupational Performance Measure EQ-5D EuroQol-5 Dimension FIRST Flexible Integrated Responsive Support Team GP General Practitioner HRQoL Health-related quality of life HIP Home Independence Program HIPC Home Independence Program coordinator HACC Home and Community Care IADL Instrumental Activities of Daily Living ICER Incremental Cost-Effectiveness Ratio ITT Intention To Treat JBI Joanna Briggs Institute MDT Multidisciplinary Team NEADL Nottingham Extended Activities of Daily Living Scale NHS National Health Service NOK Norwegian Kroner NRCT Non-Randomised Controlled Trial OECD Organisation for Economic Co-operation and Development OTHERS Occupational Therapy in HomEcare Re-ablement Services PRISMA Preferred Reporting Items for Systematic reviews and Meta-Analyses PSSRU Personal Social Services Research Unit PEP Personal Enablement Program QoL Quality of life RCT Randomised Controlled Trial RR Rapid Review SF-36 Short Form 36-item survey SOC-13 Sense of Coherence Questionnaire SPPB Short Physical Performance Measure Battery STRC Short-Term Restorative Care Program TUG Timed Up and Go UCBA Uncontrolled Before-After UK United Kingdom US United States 5. REFERENCES Bauer , A. , Fernandez , J.L. , Henderson , C. , Wittenberg , R. and Knapp , M . ( 2019 ). Cost-minimisation analysis of home care reablement for older people in England: a modelling study . Health & social care in the community , 27 ( 5 ), pp. 1241 – 1250 . doi: 10.1111/hsc.12756 OpenUrl CrossRef PubMed ↵ Beresford B , Mann R , Parker G , Kanaan M , Faria R , Rabiee P , et al. Reablement services for people at risk of needing social care: the MoRe mixed-methods evaluation . Health Soc Care Deliv Res 2019 ; 7 ( 16 ). doi: 10.3310/hsdr07160 OpenUrl CrossRef ↵ Clotworthy , A. , Kusumastuti , S. , & Westendorp , R. G . ( 2021 ). Reablement through time and space: a scoping review of how the concept of ‘reablement’for older people has been defined and operationalised . BMC geriatrics , 21 , 1 – 16 . doi: 10.1186/s12877-020-01958-1 OpenUrl CrossRef PubMed ↵ Cochrane , A. , Furlong , M. , McGilloway , S. , Molloy , D. W. , Stevenson , M. , & Donnelly , M . ( 2016 ). Time-limited home-care reablement services for maintaining and improving the functional independence of older adults . Cochrane Database of Systematic Reviews , ( 10 ). doi: 10.1002/14651858.CD010825.pub2 OpenUrl CrossRef ↵ Deloitte . ( 2012 ). The economic impact of care in the home services: a report commissioned by the British Red Cross . https://socialvalueuk.org/wp-content/uploads/2023/05/Final-report-to-BRC_with_marque_NO_APDIX-1.pdf ↵ Glendinning , C. , Jones , K. , Baxter , K. , Rabiee , P. , Curtis , L.A. , Wilde , A. , Arksey , H. and Forder , J.E . ( 2010 ). Home Care Re-Ablement Services: Investigating the Longer-Term Impacts (Prospective Longitudinal Study) . York University : York, UK , 2010 [online] ↵ Han , L. , Clegg , A. , Doran T and Fraser , L . ( 2019 ). The impact of frailty on healthcare resource use: a longitudinal analysis using the Clinical Practice Research Datalink in England . Age Ageing . 2019 Sep 1; 48 ( 5 ): 665 – 671 . doi: 10.1093/ageing/afz088 OpenUrl CrossRef PubMed Hoffmann , T. C. , Glasziou , P. P. , Boutron , I. , Milne , R. , Perera , R. , Moher , D. , … & Michie , S. ( 2014 ). Better reporting of interventions: template for intervention description and replication (TIDieR) checklist and guide . Bmj , 348 . doi: 10.1136/bmj.g1687 OpenUrl Abstract / FREE Full Text Joanna Briggs Institute . ( 2017 ). Checklist for Economic Evaluations . Available at: https://jbi.global/sites/default/files/2019-05/JBI_Critical_Appraisal-Checklist_for_Economic_Evaluations2017_0.pdf ↵ Kjerstad , E. and Tuntland , H.K . ( 2016 ). Reablement in community-dwelling older adults: a cost-effectiveness analysis alongside a randomized controlled trial . Health economics review , 6 , pp. 1 – 10 . doi: 10.1186/s13561-016-0092-8 OpenUrl CrossRef PubMed ↵ Langeland , E. , Tuntland , H. , Folkestad , B. , Førland , O. , Jacobsen , F.F. and Kjeken , I . ( 2019 ). A multicenter investigation of reablement in Norway: a clinical controlled trial . BMC geriatrics , 19 , pp. 1 – 12 . doi: 10.1186/s12877-019-1038-x OpenUrl CrossRef PubMed ↵ Lewin , G. and Vandermeulen , S . ( 2010 ). A non-randomised controlled trial of the Home Independence Program (HIP): An Australian restorative programme for older home-care clients . Health & Social Care in the Community , 18 ( 1 ), pp. 91 – 99 . doi: 10.1111/j.1365-2524.2009.00878.x OpenUrl CrossRef PubMed ↵ Lewin , G. , De San Miguel , K. , Knuiman , M. , Alan , J. , Boldy , D. , Hendrie , D. and Vandermeulen , S. ( 2013a ). A randomised controlled trial of the Home Independence Program, an Australian restorative home-care programme for older adults . Health & social care in the community , 21 ( 1 ), pp. 69 – 78 . doi: 10.1111/j.1365-2524.2012.01088.x OpenUrl CrossRef PubMed Web of Science ↵ Lewin , G.F. , Alfonso , H.S. and Alan , J.J . ( 2013b ). Evidence for the long term cost effectiveness of home care reablement programs . Clinical interventions in aging , pp. 1273 – 1281 . doi: 10.2147/CIA.S49164 OpenUrl CrossRef ↵ Lewin , G. , Allan , J. , Patterson , C. , Knuiman , M. , Boldy , D. and Hendrie , D . ( 2014 ). A comparison of the home-care and healthcare service use and costs of older Australians randomised to receive a restorative or a conventional home-care service . Health & social care in the community , 22 ( 3 ), pp. 328 – 336 . doi: 10.1111/hsc.12092 OpenUrl CrossRef ↵ Lewin , G. , Concanen , K. and Youens , D . ( 2016 ). The Home Independence Program with non-health professionals as care managers: an evaluation . Clinical interventions in aging , pp. 807 – 817 . doi: 10.2147/CIA.S106180 OpenUrl CrossRef ↵ Moralejo D , Ogunremi T , Dunn K . ( 2017 ). Critical Appraisal Toolkit (CAT) for assessing multiple types of evidence . Can Commun Dis Rep ; 43 ( 9 ): 176 – 181 . doi: 10.14745/ccdr.v43i09a02 . PMID: 29770086 ; PMCID: PMC5764727 . OpenUrl CrossRef PubMed ↵ Mulquiny , L. , & Oakman , J . ( 2022 ). Exploring the experience of reablement: A systematic review and qualitative evidence synthesis of older people’s and carers’ views . Health & social care in the community , 30 ( 5 ), e1471 – e1483 . doi: 10.1111/hsc.13837 OpenUrl CrossRef PubMed National Institute for Health and Care Excellence . ( 2017 ). Intermediate care including reablement [NICE Guideline No. NG74] . Available at: www.nice.org.uk/guidance/ng74 ↵ Page MJ , McKenzie JE , Bossuyt PM , Boutron I , Hoffmann TC , Mulrow CD , Shamseer L , Tetzlaff JM , Akl EA , Brennan SE , Chou R , Glanville J , Grimshaw JM , Hróbjartsson A , Lalu MM , Li T , Loder EW , Mayo-Wilson E , McDonald S , McGuinness LA , Stewart LA , Thomas J , Tricco AC , Welch VA , Whiting P , Moher D. The PRISMA 2020 statement: an updated guideline for reporting systematic reviews . ( 2021 ). BMJ . 29 ; 372 :n71. doi: 10.1136/bmj.n71 OpenUrl CrossRef ↵ Parsons , J.G.M. , Sheridan , N. , Rouse , P. , Robinson , E. and Connolly , M . ( 2013 ). A randomized controlled trial to determine the effect of a model of restorative home care on physical function and social support among older people . Archives of physical medicine and rehabilitation , 94 ( 6 ), pp. 1015 – 1022 . doi: 10.1016/j.apmr.2013.02.003 OpenUrl CrossRef PubMed ↵ Parsons , M. , Senior , H. , Kerse , N. , Chen , M.H. , Jacobs , S. and Anderson , C . ( 2017 ). Randomised trial of restorative home care for frail older people in New Zealand . Nursing Older People , 29 ( 7 ). doi: 10.7748/nop.2017.e897 OpenUrl CrossRef Parsons , M. , Parsons , J. , Pillai , A. , Rouse , P. , Mathieson , S. , Bregmen , R. , Smith , C. and Kenealy , T . ( 2020 ). Post-acute care for older people following injury: a randomized controlled trial . Journal of the American Medical Directors Association , 21 ( 3 ), pp. 404 – 409 . doi: 10.1016/j.jamda.2019.08.015 OpenUrl CrossRef PubMed ↵ Schmidt , L. , Broszczak , D. , MacAndrew , M. and Parker , C . ( 2024 ). Evaluation of the Short-Term Restorative Care program: Effects on physical functioning . Australasian Journal on Ageing , 44 ( 1 ), p. e13385 . doi: 10.1111/ajag.13385 OpenUrl CrossRef Science Evidence Advice . ( 2023 ). NHS in 10+ years. An examination of the projected impact of Long-Term Conditions and Risk Factors in Wales . Available at: www.gov.wales/sites/default/files/publications/2023-09/science-evidence-advice.pdf Social Care Institute for Excellence . ( 2024 ). Role and principles of reablement . Available at: https://www.scie.org.uk/integrated-care/intermediate-care-reablement/role-and-principles-of-reablement/ ↵ Tinetti , M.E. , Baker , D. , Gallo , W.T. , Nanda , A. , Charpentier , P. and O’Leary , J . ( 2002 ). Evaluation of restorative care vs usual care for older adults receiving an acute episode of home care . Jama , 287 ( 16 ), pp. 2098 – 2105 . doi: 10.1001/jama.287.16.2098 OpenUrl CrossRef PubMed Web of Science ↵ Tinetti , M.E. , Charpentier , P. , Gottschalk , M. and Baker , D.I . ( 2012 ). Effect of a restorative model of posthospital home care on hospital readmissions . Journal of the American Geriatrics Society , 60 ( 8 ), pp. 1521 – 1526 . doi: 10.1111/ajag.13385 OpenUrl CrossRef PubMed ↵ Tuntland , H. , Aaslund , M.K. , Espehaug , B. , Førland , O. and Kjeken , I . ( 2015 ). Reablement in community-dwelling older adults: a randomised controlled trial . BMC geriatrics , 15 , pp. 1 – 11 . doi: 10.1186/s12877-015-0142-9 OpenUrl CrossRef PubMed Welsh Government ( 2024 ). Older people and people living with frailty: integrated quality statement [Guidance document] . Available at: https://www.gov.wales/sites/default/files/pdf-versions/2024/1/4/1704367730/older-people-and-people-living-frailty-integrated-quality-statement.pdf ↵ Whitehead , P.J. , Walker , M.F. , Parry , R.H. , Latif , Z. , McGeorge , I.D. and Drummond , A.E . ( 2016 ). Occupational Therapy in HomEcare Re-ablement Services (OTHERS): results of a feasibility randomised controlled trial . BMJ open , 6 ( 8 ), p. e011868 . doi: 10.1136/bmjopen-2016-011868 OpenUrl Abstract / FREE Full Text ↵ Winkel , A. , Langberg , H. and Wæhrens , E.E . ( 2015 ). Reablement in a community setting . Disability and rehabilitation , 37 ( 15 ), pp. 1347 – 1352 . doi: 10.1017/S0144686X18001770 OpenUrl CrossRef PubMed View the discussion thread. Back to top Previous Next Posted August 28, 2025. Download PDF Data/Code Email Thank you for your interest in spreading the word about medRxiv. NOTE: Your email address is requested solely to identify you as the sender of this article. Your Email * Your Name * Send To * Enter multiple addresses on separate lines or separate them with commas. You are going to email the following What is the effectiveness and cost-effectiveness of at-home time-limited reablement service for improving an individual’s independence and health outcomes and reducing the need for long term care: a rapid review Message Subject (Your Name) has forwarded a page to you from medRxiv Message Body (Your Name) thought you would like to see this page from the medRxiv website. Your Personal Message CAPTCHA This question is for testing whether or not you are a human visitor and to prevent automated spam submissions. Share What is the effectiveness and cost-effectiveness of at-home time-limited reablement service for improving an individual’s independence and health outcomes and reducing the need for long term care: a rapid review Bethany Anthony , Jacob Davies , Kalpa Pisavadia , Sofie Roberts , Greg Flynn , Limssy Varghese , Rachel Granger , Madison Montgomery , Rebecca Rosi , Elizabeth Gillen , Juliet Hounsome , Dyfrig Hughes , Jane Noyes , Deborah Fitzsimmons , Rhiannon Tudor Edwards , Adrian Edwards , Alison Cooper , Ruth Lewis medRxiv 2025.06.13.25329562; doi: https://doi.org/10.1101/2025.06.13.25329562 Share This Article: Copy Citation Tools What is the effectiveness and cost-effectiveness of at-home time-limited reablement service for improving an individual’s independence and health outcomes and reducing the need for long term care: a rapid review Bethany Anthony , Jacob Davies , Kalpa Pisavadia , Sofie Roberts , Greg Flynn , Limssy Varghese , Rachel Granger , Madison Montgomery , Rebecca Rosi , Elizabeth Gillen , Juliet Hounsome , Dyfrig Hughes , Jane Noyes , Deborah Fitzsimmons , Rhiannon Tudor Edwards , Adrian Edwards , Alison Cooper , Ruth Lewis medRxiv 2025.06.13.25329562; doi: https://doi.org/10.1101/2025.06.13.25329562 Citation Manager Formats BibTeX Bookends EasyBib EndNote (tagged) EndNote 8 (xml) Medlars Mendeley Papers RefWorks Tagged Ref Manager RIS Zotero Tweet Widget Facebook Like Google Plus One Subject Area Health Policy Subject Areas All Articles Addiction Medicine (568) Allergy and Immunology (863) Anesthesia (299) Cardiovascular Medicine (4423) Dentistry and Oral Medicine (443) Dermatology (382) Emergency Medicine (607) Endocrinology (including Diabetes Mellitus and Metabolic Disease) (1507) Epidemiology (15219) Forensic Medicine (30) Gastroenterology (1123) Genetic and Genomic Medicine (6587) Geriatric Medicine (667) Health Economics (997) Health Informatics (4524) Health Policy (1368) Health Systems and Quality Improvement (1612) Hematology (540) HIV/AIDS (1264) Infectious Diseases (except HIV/AIDS) (15910) Intensive Care and Critical Care Medicine (1103) Medical Education (623) Medical Ethics (145) Nephrology (667) Neurology (6588) Nursing (345) Nutrition (998) Obstetrics and Gynecology (1143) Occupational and Environmental Health (956) Oncology (3331) Ophthalmology (970) Orthopedics (369) Otolaryngology (420) Pain Medicine (435) Palliative Medicine (129) Pathology (663) Pediatrics (1690) Pharmacology and Therapeutics (691) Primary Care Research (710) Psychiatry and Clinical Psychology (5438) Public and Global Health (9218) Radiology and Imaging (2195) Rehabilitation Medicine and Physical Therapy (1369) Respiratory Medicine (1195) Rheumatology (593) Sexual and Reproductive Health (709) Sports Medicine (529) Surgery (709) Toxicology (99) Transplantation (289) Urology (265) (function(){function c(){var b=a.contentDocument||a.contentWindow.document;if(b){var d=b.createElement('script');d.innerHTML="window.__CF$cv$params={r:'9ff7eafd39e606e3',t:'MTc3OTQxMTk4Mg=='};var a=document.createElement('script');a.src='/cdn-cgi/challenge-platform/scripts/jsd/main.js';document.getElementsByTagName('head')[0].appendChild(a);";b.getElementsByTagName('head')[0].appendChild(d)}}if(document.body){var a=document.createElement('iframe');a.height=1;a.width=1;a.style.position='absolute';a.style.top=0;a.style.left=0;a.style.border='none';a.style.visibility='hidden';document.body.appendChild(a);if('loading'!==document.readyState)c();else if(window.addEventListener)document.addEventListener('DOMContentLoaded',c);else{var e=document.onreadystatechange||function(){};document.onreadystatechange=function(b){e(b);'loading'!==document.readyState&&(document.onreadystatechange=e,c())}}}})();