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Table 6 RePAT intervention results

From: A non-randomised feasibility study of the Rehabilitation Potential Assessment Tool (RePAT) in frail older people in the acute healthcare setting

Item

Supporting Evidence

Mean fidelity score (%)

Are there any underlying physical issues which may affect or interfere with rehabilitation?

“Atrial fibrillation, previous stroke (left MCA infarct), hypertension, and poor vision. May cause difficulties in different environments.” SP1/PP19

“Hypertension, postural drop currently being investigated so patients’ mobility should improve once management is optimised.” SP4/PP6

100

Are there any unresolved physical issues which may affect or interfere with rehabilitation?

“Resolving urinary sepsis, functional decline following infection. CT lumbar spine showed L5/4/3 endplate collapse. Pain in lumbar spine limits activities.” SP1/PP25

“Nil of note, medically fit for discharge, no medical follow up.” SP5/PP7

100

Are there any underlying psychological issues which may affect an individual’s motivation or participation with rehabilitation?

“Mild hypoxic brain injury, patient requires clear step-by-step instructions and struggles with memory.” SP6/PP26

“Nil, very keen to progress.” SP3/PP3

100

Are there any unresolved psychological issues which may affect an individual’s motivation or participation with rehabilitation?

“Hallucinations settled during admission and had increased mood within inpatient progression.” SP3/PP1

“Nil, very motivated to participate in rehabilitation, nil evidence of delirium.” SP3/PP2

100

Has the individual been able to demonstrate participation in the rehabilitation assessment or rehabilitation programme during this current episode of care?

“Patient was motivated and engaged in all Occupational Therapy [OT] and physio assessments.” SP2/PP14

“Patient has been keen to participate, clear instructions required due to confusion. Pain has been limiting factor.” SP6/PP26

100

What are the individual’s current functional abilities and levels of independence?

“Independently mobile with wheeled frame, independent changing stoma. Assistance with washing and dressing, independent with all transfers.” SP4/PP13

“At best had assistance of 2 to mobilise 10m. Mostly handled 2 person step round transfer.” SP3/PP4

88.2

What were the individual’s pre-morbid (pre-admission) functional abilities and levels of independence?

“Pre-admission (3/52) independently mobile, unlimited exercise tolerance and driving. But 3/52 prior to admission a slow decline due to pain and difficulty with transfers.” SP3/PP3

“Lives alone, no care package. Has cleaner and support from family. Independent with shopping, meals and personal care. Mobilises with walking stick indoors and electric scooter outdoors.” SP4/ PP6

88.2

Do you have a thorough understanding of an individual’s environment in their usual place of residence?

“Yes, through discussion with patient.” SP1/PP19

“Patient lives in bungalow, 1 step access, all level inside, riser recliner chair, Mowbray toilet frame and double divan bed.” SP2/PP17

88.2

What support does the individual require to make decisions about their future?

“Wife supports with all ADL’s and decisions. Lacks capacity however, this is variable due to resolving delirium and UTIs.” SP5/PP15

“No concerns regarding capacity, patient has support from family.” SP6/PP23

73.5

Has the individual been asked, “What’s important to me?”

“I just want to go home [patient]. Go home with the right support and equipment so I can manage as much as I can on my own [husband].” SP5/PP8

“To return to previous baseline function so she is able to toilet independently.” SP3/PP2

97

Have goals been set and agreed which are SMART? (Short, Medium, Long Term)

“Short – transfer with wheeled frame in 2 days. Medium – go to rehab and mobilise with wheeled frame in 2 weeks. Long – return home independently mobile with wheeled frame in 3 weeks.” SP4/PP1

“To return to independence with personal care and cooking within 4 weeks.” SP6/PP24

55.9

Has the multi-disciplinary team been involved in the assessment or decision-making process?

“Review by OT, social services, medical review, liaised with daughter.” SP4/PP13

“Nurses report patient is becoming reliant and refusing certain medical interventions but keen for rehab. Integrated Discharge Team to review.” SP4/PP6

94

Has the individual's rehabilitation potential been assessed over multiple time points?

“Patient assessed every morning with nursing staff, OT and physio reviewed patient daily whilst on ward.” SP2/PP14

“Long admission of 41 days and has reduced motivation, fluctuating cognitive states have been seen.” SP3/PP4

88.2

Is the proposed rehabilitation programme likely to be effective?

“Given the right amount motivation and improved medical status I think residential rehabilitation would benefit the patient.” SP4/PP5

“Patient has already improved whilst on the ward and this is likely to continue at home with support.” SP6/PP23

94

Overall impression

“Patient is likely to regain independence and confidence with the reablement team.” SP2/PP14

“Patient has demonstrated determination with little encouragement needed to participate in therapy. Is dependent on medication timing and mental state, however has progressed with each session. I feel that will improve once back at home in familiar environment and once UTI’s and delirium have settled.” SP5/PP15

88.2

  1. Staff participants are referred to as SP plus their study number (for example SP1) and patient participants as PP plus their study number (for example PP1)