Physiotherapy supervision of home trainers in interprofessional reablement teams

Abstract

Physiotherapists (PTs) in reablement are responsible for the supervision of support personnel, referred to as home trainers (HTs), who carry out training and initiatives. There is a lack of knowledge about the significance of physiotherapy supervision in reablement. The aim of this study was to explore the content of PTs' supervision of HTs in reablement teams. We conducted fieldwork in seven reablement teams in Norwegian municipalities. The methods included observations of practice and individual in-depth interviews with PTs and HTs. We analysed data thematically through an iterative inductive-deductive process. The results were generated in a social constructionist perspective and situated learning theory guided the analyses. Analyses revealed that supervision included elements of instruction, demonstration and reflection. However, practices varied widely across different teams, especially regarding the reflection aspect, which was highlighted as essential for learning. Frequent meetings, both formal and informal, were essential to enable learning through reflection. This paper identifies and discusses fundamental elements of PTs' supervision practice in reablement teams, which is also relevant for similar interprofessional settings. Managers of reablement programs should be aware of the powerful impact that organizational conditions have on the practice of supervision.

Integration of physical activity in reablement for community dwelling older adults: a systematic scoping review

“…After screening 2,304 unique records, of which 236 were examined in full-text, 43 articles met our eligibility criteria and served as the overall data material for the scoping review (illustrated in Figure 1-Prisma Flow Diagram). Among these studies were 12 intervention studies, including ve RCTs (30)(31)(32)(33)(34), ve non-randomized controlled trials (35)(36)(37)(38)(39) and two non-controlled pre-post study (40,41), in addition to one RCT long-term follow up study (42); four studies with mixed design/other (43)(44)(45)(46); three studies based on quantitative research (47)(48)(49); and 23 qualitative studies, of which 15 focused on HCPs' perspectives (50)(51)(52)(53)(54)(55)(56)(57)(58)(59)(60)(61)(62)(63)(64), six on older adults' perspectives (65)(66)(67)(68)(69)(70) and two on family members perspectives (71,72).…”

“…In the two Norwegian intervention studies by Tuntland et al (2015) and Langeland et al (2019), it was described that daily training in activities was part of the general features of reablement, while exercise programs were recommended as individual features to improve strength, balance or ne motor skills (33,35,73,74). In the study by Eliassen et al (2018), they explored different perspectives of physiotherapy practice and supervision in reablement in Norwegian municipalities, and found that exercises were provided in all observed cases and that reablement plans contained elements of both exercises and daily activities (53)(54)(55). Though, while some of the teams mainly emphasized standardized exercises, other teams put more emphasis on daily activities in addition to targeted exercise strategies (53).…”

“…In the structured exercise program, it was reported that the participants were to progress to level two exercises on the back of the exercise sheet. In the eld study by , the researchers observed that the characteristics of the targeting processes of the exercises were mainly divided into two groups; i) standardized approaches and ii) individually tailored approaches (53)(54)(55). In the standardized approaches, allied health personnel conducted training sessions based on standardized exercise programs.…”

“…Fifteen qualitative studies and two mixed method/feasibility/implementation studies investigated inquiries based on HCPs experiences or perspectives on reablement (44,46,50,(52)(53)(54)(55)(56)(57)(58)(59)(60)(61)(62)(63)(64)76), but none of these speci cally aimed at investigating or exploring HCPs' experiences related to PA facilitation. However, some of the studies -of which ve were Norwegian (53-55, 58, 60), two were Danish (51, 62), one Australian (44) and one from the USA (46), brought up perspectives from HCPs related to activity training or exercises, which are presented in the following.…”

“…HCPs considered the organization of tasks between health professionals and allied health personnel to be bene cial for reaching out to a larger population and for giving more intensive training (54,58). However, it was also reported that the competencies of the allied health personnel and the team collaboration could have impact on the content of the training or exercises (46,(53)(54)(55). HCPs in several of the studies noted that it was advantageous to implement simple and recognizable exercises, that could easily be explained to both the allied health personnel and the older adults (44,46,54).…”