Introduction
Method
Model structure
Transition probabilities
Mild dependency | Moderate dependency | Severe dependency | Total dependency | Death | |
---|---|---|---|---|---|
Mild dependency |
0.79
| 0.13 | 0.03 | 0.02 | 0.03 |
Moderate dependency | 0.08 |
0.82
| 0.03 | 0.01 | 0.06 |
Severe dependency | 0.02 | 0.12 |
0.61
| 0.11 | 0.14 |
Total dependency | 0.00 | 0.03 | 0.18 |
0.63
| 0.16 |
Death |
1.00
|
Level of dependency | Iso-SMAF profiles | |
---|---|---|
Mild dependency | Independence in personal activities of daily living (PADL) (e.g. bathing, dressing). Dependence in no more than a single instrumental activity of daily living (IADL) (e.g. cleaning, shopping). Needs help no more than one time per week | Profile 1 includes independence in ADL and having difficulties with IADL |
Moderate dependency | Independence in PADL. Regularly dependent in more than one IADL. Needs help more than one time per week | Profiles 2–5 include levels of dependency ranging from a need for supervision in IADL (profile 2) to a need for supervision in ADL and dependency in IADL (profile 5) |
Severe dependency | Dependent in at least one PADL and more than one IADL. Needs help one or several times per day | Profiles 6–9 include levels of dependency ranging from difficulties in ADL and dependency in IADL (profile 6) to a need for help in ADL and dependency in IADL (profile 9) |
Total dependency | Dependent in PADLs and IADLs. Needs extensive help throughout the day and live in ordinary or special housing | Profiles 10–14 +LTCFb include levels of dependency ranging from extensive need for help in ADL and dependency in IADL to complete dependency. All profiles include severe cognitive impairment |
Quality of life
Societal Cost
Intervention effect
Markov state | QoL scores | Total costs |
---|---|---|
Mild dependency | 0.77 | 2864 |
Moderate dependency | 0.60 | 8593 |
Severe dependency | 0.47 | 22,915 |
Total dependency | 0.41 | 68,746 |
Dead | 0 | 0 |
Intervention cost
Statistical analysis
Sensitivity analysis
Results
Author, year (ref) | Sample | Follow-up | Recovery, n (%) | Increased probability for recovery |
---|---|---|---|---|
Chiu, 2004 (Chiu and Man 2004) | Intervention: 30 Control: 23 | 3 months | 25 (83) 9 (39) | 2.1 (bathing) |
Zingmark, 2011 (Zingmark and Bernspång 2011) | Intervention: 46 | 3 months | 32 (70) | 2.8 (bathing) |
Control: 28 | 7 (25) | |||
Lewin, 2013 (Lewin et al. 2013a) | Intervention: 375 | 3 months | 272 (73) | 2.0 (personal carea) |
Control: 375 | 137(37) | |||
Lewin, 2013 (Lewin et al. 2013a) | Intervention: 375 | 1 year | 308 (82) | 1.4 (personal carea) |
Control: 375 | 224 (60) | |||
Lewin, 2014 (Lewin et al. 2014) | Intervention: 201 | 2 years | 178 (89) | 1.4 (personal carea) |
Control: 246 | 161 (65) | |||
Intervention characteristics | ||||
Zingmark, 2011 (Zingmark and Bernspång 2011) | Older people who applied for home care with bathing. Interventions implemented by occupational therapists, on average 3 home visits. Focus on supporting the person to gradually increase her/his ability to safely and independently perform the tasks related to bathing. Seventy percent of the interventions focused on a modified task performance for example by the use of technical aids. | |||
Chiu, 2004 (Chiu and Man 2004) | Older stroke patients with an identified need of a bathing device. Additional support from occupational therapists in using prescribed assistive devices after discharge from the hospital (2–3 home visits). Interventions included demonstration, information and opportunity to practice how to use assistive devices. Information and support were given both to the older person and potential caregivers. | |||
Lewin, 2013 (Lewin et al. 2013a) | Older people referred to a home care service for help with personal care*. Multi-professional intervention aimed at enhancing engagement and independence in daily activities, implemented during a maximum of 12 weeks. Individually tailored intervention based on clients’ goals including, for example, use of assistive devices, exercise to enhance mobility, fall prevention, nutrition, disease self-management. | |||
Lewin, 2014 (Lewin et al. 2014) | Same as above. |
Sensitivity analysis
Analysis | No intervention | Occupational therapy | Incremental QALYs | Incremental costs (€) | ||
---|---|---|---|---|---|---|
QALYsa
| Costs (€) | QALYs | Costs (€) | |||
Main analysis | 2.211 | 94,982 | 2.263 | 92,572 | 0.052 | −2410 |
Sensitivity analysis | ||||||
Reduced intervention effect | 2.211 | 94,982 | 2.237 | 93,837 | 0.026 | −1145 |
Increased intervention cost | 2.211 | 94,982 | 2.263 | 92,969 | 0.052 | −2013 |
Combined sensitivity analysisb
| 2.211 | 94,982 | 2.237 | 94,235 | 0.026 | −747 |