Effects of reablement on home-dwelling older adults’ physical functioning: A follow-up study in primary healthcare

doi:10.21203/rs.3.rs-6503891/v1

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Effects of reablement on home-dwelling older adults’ physical functioning: A follow-up study in primary healthcare

https://doi.org/10.21203/rs.3.rs-6503891/v1

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published 23 Dec, 2025

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Background: Reablement at home takes place in health and social care services globally to support older adults in achieving independent and meaningful daily living and reducing the need for long-term care. However, research into reablement at home is scarce and the results are partly conflicting.

Objective: To describe the characteristics of reablement participants and evaluate the effects of reablement on their physical functioning at six-month follow-up.

Design: A quantitative longitudinal study with physical functioning assessment at baseline, post-test and six-month follow-up in a primary healthcare setting in Finland.

Subjects: Home-dwelling older adults (n=55) receiving interdisciplinary reablement care who met the inclusion criteria.

Methods: Primary outcomes are the Short Physical Performance Battery test and hand grip strength. Data collection was carried out during reablement visits by physiotherapists and occupational therapists. Results are described by mean, standard deviation and maximum and minimum values at baseline. Overall effects are estimated with linear mixed-effects model repeated measure analysis.

Results: The mean age of participants was 80.6 (SD 7.2) years. Physical functioning improved between baseline and post-test and between baseline and six-month follow-up. Improvement was shown especially in lower limb performance, in which the changes between baseline and post-test were statistically significant (p>0.05).

Conclusion: The results indicate that reablement increases the physical functioning of home-dwelling older adults with functional decline at six-month follow-up. Reablement is therefore recommended for the corresponding target groups.

reablement

older adult

physical functioning

Short Physical Performance Battery (SPPB)

hand grip strength

There is global concern about the world’s ageing population and how to enable age-friendly environments that support older adults in healthy and functional ageing to maximise their competences and manage their daily lives independently. It is suggested that nations should provide an integrated person-centred continuum of care that focuses on supporting individuals to meet their needs and fulfil their goals (World Health Organization, 2023). Older adults often experience unmet health and social care(Barber et al., 2024) and frailty is common among this population (da Cruz et al., 2017).

Reablement is one possible and potentially useful approach to meeting the health and social care needs of older adults at risk of functional decline and frailty. The conceptual understanding of this reablement varies between, and even within, countries. In a recent Delphi study, reablement was defined as a person-centred, holistic approach that aims to enhance an individual’s functioning in order to increase or maintain their independence in meaningful activities of daily living (ADL) at their place of residence and to reduce their need for long-term services (Metzelthin et al., 2022). This particular study also describes reablement as including multiple visits delivered by a coordinated interdisciplinary team, comprehensive assessments and individual goal-oriented plans. In earlier work, reablement has been described as a person-centred and home-based approach, which is time limited (usually six to 12 weeks) and provided by an interdisciplinary team of health and social care professionals (Aspinal et al., 2016; Cochrane et al., 2016).

Reablement primarily aims to enhance functioning, and this is determined by the individual’s physical and mental capacities in the environment in which they live, as well as the interactions between them (World Health Organization 2015). The International Classification of Functioning, Disability and Health offers a common language to support the understanding that functioning and disability are the results of the interaction between someone’s health conditions and their environment (World Health Organization, 2013). Physical functioning is one indicator of a healthy and functional ageing progress and this refers to a person’s physical ability to cope with the everyday tasks that are important to them, usually manifested as the ability to move oneself (World Health Organization, 2013).

Coping in everyday tasks is crucial for independent living at home, and this requires sufficient lower limb muscle strength, balance and speed (Rikli & Jones, 2013). Age-related loss in muscle strength can jeopardize this ability and lead to physical disability (Hairi et al., 2010). Annual muscle loss after the age of 65 varies from 1% to 2%, reaching 3.4% after the age of 75 (Milanović et al., 2013). Moderate and severe mobility limitations lead to significantly more falls and an increased need for social and healthcare services (Musich et al., 2018). Functional training can be used to improve functional performance in older adults (Liu et al., 2014).

Physical functioning assessment helps predict future health issues, such as mortality, healthcare costs and the need for long-term care. This kind of assessment helps to identify an individual’s needs and to plan an effective rehabilitation strategy. Additionally, it provides a means to monitor the effects of rehabilitation and ensure that interventions meet the individual’s needs and capabilities (Wales et al. 2012). The Short Physical Performance Battery (SPPB) is an assessment tool that provides a reliable snapshot of an individual’s physical performance in comparison to the broader population, although it is not particularly sensitive to small changes over time. The SPPB evaluates balance, walking speed and lower-body strength with a sit-to-stand subtest (Kameniar et al., 2024). Hand grip strength has been shown to have predictive validity for assessing muscle strength and physical capability, especially in the aging population. It is linked to various health parameters, such as morbidity and mortality among older adults (Vaishya et al., 2024). Hand grip strength is a strong predictor for dependency in ADL and instrumental activities of daily living (IADL) among community-dwelling older adults (Meskers et al., 2019). Limitations in physical functioning and ADL are the most relevant characteristics for predicting the need for homecare (van den Bulck et al. 2019). “ADL” is used to collectively describe the fundamental skills that are required to independently care for oneself, such as eating, bathing and moving (Edemekong, 2023). “IADL” is used to collectively describe skills such as completing household chores, shopping, and managing finances. Difficulties with completing IADL may impact on a person’s ability to independently live at home and in the community. (Tulliani et al., 2022)

Research on reablement is limited (Chen et al., 2022), but there has been growth in relevant studies over the past two decades, reflecting an increasing interest in reablement in both clinical practice and academia. A recent scoping review identified reablement articles from 14 countries, predominantly in the West and particularly from Norway (Guadaña et al., 2023). The effectiveness of reablement needs more robust evidence to be supported (Cochrane et al., 2016), and additional research with more rigorous methodological quality is required (Chen et al., 2022). A recent systematic review took account of the definition of reablement (Metzelthin et al., 2022) to develop an overview of its effects on ADL. Of the 20 studies reviewed, 10 found it to be effective in improving ADL functioning (Buma et al. 2022).

There is a risk of bias in many earlier studies because of the lack of a common definition. Some of the evidence indicates improvement in independence, functioning and quality of life. For example, seven of the 15 studies reported in one systematic review found improvement in functional abilities that lasted from several months to a year (Sims-Gould et al., 2017a). Improvements were also found in total SPPB scores and gait speed (Meisingset et al., 2021; Parsons et al., 2013a, 2013b) and in the walking and transferring elements of mobility (Tinetti, Baker, Gallo, et al., 2002). However, some studies did not find any significant effects on the SPPB scores or gait speed of reablement participants compared to a control group (Rooijackers et al., 2021).

The objectives of this study were to describe the characteristics of reablement participants and to evaluate the effects of reablement on their physical functioning at six-month follow-up. The aim was to add new knowledge about the effects of reablement on the physical functioning of older adults to support service development and healthy ageing. Consequently, the study addresses the scarcity of international literature in the field with novel quantitative follow-up information that takes into account the recent common definition of reablement. To the best of our knowledge, this is the first reablement follow-up study conducted in the Finnish healthcare context.

Study Design and Setting

This study is a quantitative follow-up study in a public healthcare setting. The time points used are baseline (T0) during the first week of reablement, post-test (T1) during the last week of reablement and follow-up (T2) at six months after post-test. The study was conducted in 2022–2023 in a midsize Finnish city where interdisciplinary reablement has operated since 2019. In this context, reablement is a person-centred, time-limited (typically two to eight weeks) and goal-oriented service provided by a specifically trained interdisciplinary team. This approach to reablement corresponds well with the new Delphi definition outlined above. The service is targeted at older adults with functional decline to help postpone the need for regular homecare services, aiming to prevent further functional decline and increase ADL independence.

The interdisciplinary team consisted of multiple health and social care professionals, namely a practice nurse, registered nurse, physiotherapist (PT), occupational therapist (OT), consultative doctor, and service coordinator. Each reablement programme included two to 28 person-centred, individually tailored visits per week by these professionals who assisted with ADL and supported the participants in achieving their personal goals. The service also consisted of tailored exercises, based on the individual’s goals and supported by the reablement team in the participant’s home or living environment. The PT and OT focused especially on comprehensive assessment, supporting the participants’ goal setting and devising the individual reablement plans, as well as the rehabilitative visits. The nurses concentrated on the participants’ medical needs and carried out visits to support their independency in for example eating, bathing or completing household chores. The health and social care professionals worked together in an interdisciplinary manner to deliver reablement.

The general ethical principles of data protection and information security were considered when processing the data, and the study itself was conducted according to the Declaration of Helsinki (World Medical Association 2004). The study protocol was reviewed by the ethical committee at the University of Oulu in 2021.

Participants

The participants were 60 home-dwelling older adults living in a midsized city in northern Finland. The inclusion criteria were: participation in the reablement service; written consent to participate in the study; aged over 65 years; home-dwelling; no homecare services history; and no significant cognitive impairment. Cognitive function was assessed by the Mini Mental State Examination (MMSE) (Salis et al., 2023) or the Resident Assessment Instrument (RAI) Cognitive Performance Scale (CPS) (Wellens et al., 2013). The exclusion criteria were an MMSE score lower than 22 (our of 30) or an RAI CPS score over two (scale from two to six). Potential participants who met the inclusion criteria were asked to participate in the study by the PT or OT on the reablement team. Five reablement programmes were discontinued due to hospitalization, with only baseline measurements completed, and these data were not included so that the total number of participants for analysis was 55.

Instruments and Data Collection

Data were collected from January 2022 to June 2023 by the PT or OT during planned reablement visits. Gender, age and length of reablement were recorded as the underlying variables. The repeated outcomes in this study were SPPB scores and hand grip strength. PT and OT were trained to collect and retain the data. The baseline data were collected during the first week of reablement, post-test during the last week of reablement and follow-up (T2) at six months after post-test. The length of each reablement plan was individualized, as was the timing of the post-test. The final tests were conducted six months after the completion of the programme as part of a follow-up visit.

The SPPB is recommended for screening and aims to identify older adults at risk of functional decline. The assessment includes a standing balance test, a timed 4-metre walking test and a timed sit-to-stand test repeated five times. Each subtest is scored on a scale from 0 to 4, and the total maximum is therefore 12. The lower the total, the greater the risk of functional impairment in the future (Guralnik et al. 1995). The SPPB is a well-established and widely used tool for assessing lower limb function. An SPPB score lower than 10 is predictive of all-cause mortality (de Fátima Ribeiro Silva et al. 2021), and the cut-off point between frail and non-frail older adults has been reported to be nine points (Aires de Câmara et al., 2013). The SPPB can be used in trials aiming to quantify the benefits and health improvements of specific treatments or rehabilitation programmes (Pavasini et al., 2016).

The hand grip strength test is a reliable and useful tool to identify the risk of mobility limitation. In this study, grip strength was assessed in both the dominant and non-dominant hands using a calibrated measuring tool in a sitting position. The overall cut-off points for the likelihood of mobility issues are 37 kg for men and 21 kg for women (Sallinen et al., 2010). Poor grip strength predicts accelerated dependency in ADL performance and cognitive decline (Taekema et al., 2010) and can be used as a reliable marker of future ADL disability (Dai et al., 2023). Grip strength and SPPB have been used as predictors of physical functioning in previous studies related to reablement (Langeland et al., 2019; Meisingset et al., 2021).

Statistical analysis

Analyses were performed using IBM SPSS Statistics 29, and data are described by mean, standard deviation and range at baseline in Table 1. Estimated mean differences between baseline, post-test and six-month follow-up in physical functioning were analyzed by linear mixed-effects models. The linear mixed-effects procedure enables the fitting of models to data sampled from normal distributions and encompasses all models in the variance components procedure. This approach is able to handle correlated data and unequal variances. The fixed effects in this study are age, gender and length of reablement, and the random effects are the measured physical functioning variables. A linear mixed-effects model allows for missing values, and the repeated measures mixed model allows for the analysis of unbalanced datasets without imputation (Kortekangas et al., 2019).

For this analysis, age and reablement length were bucketed in three same-sized groups using the visual binning tool in SPSS: age as group 1 (65-77 years), group 2 (78-84 years) and group 3 (85-94 years) and reablement length as group A (10-21 days), group B (22-36 days) and group C (36-117 days). The analysis model presented estimated means and mean differences with 95% confidence intervals (CI) for the total group. The effects and compound effects of gender, age and reablement length were tested, and p-values of less than 0.05 were considered statistically significant.

Participant Characteristics at Baseline

The participants were home-dwelling older adults (n=55) in receipt of an interdisciplinary reablement service. The mean age of the participants was 80.6 years (IOR 65–94 years), and 60% of participants were female. The mean length of the reablement programmes was 32 days (IOR 10–117 days). The mean length of reablement was 4.7 days shorter for female participants than for male participants. Participant characteristics by gender at baseline are described in Table 1.

Participant Physical Functioning at Baseline

The physical functioning of participants at baseline is described in Table 1. At baseline, the mean hand grip strength (dominant) of male participants was 29.4 kg (SD 8.7 kg), and 78% scored below the cut-off point of 37 kg, indicating mobility limitations. Among the female participants, the mean grip strength (dominant) was 17.7 kg (SD 8.4 kg), and 58% scored below the cut-off point of 21 kg. A prediction of mobility limitations according to grip strength was therefore more common among the male participants.

The baseline mean of the participants’ SPPB totals was 6.8 (SD 3.1). According to this assessment, the lower the score, the greater the risk of functional impairment and frailty, and a score under nine indicates frailty. In this study, 71% of the participants scored lower than nine points, and gender showed no statistically significant difference. The mean results for walking speed were 1.50 m/s and 1.78 m/s for male and female participants, respectively, although this difference between genders was not statistically significant. The overall mean score in standing balance was 2.8. Score suggests that participants had some difficulties maintaining balance in more challenging positions but were not severely impaired. This score can indicate a moderate risk of falls and may suggest the need for balance training or other interventions to improve stability and reduce risk of fall. The overall mean walking speed was 1.68 m/s, but 38% of participants demonstrated a speed under the 1.2 m/s required for safe signalized pedestrian crossing. The mean score in sit-to-stand test was 1.2. A score of 1 means that the participant is able to complete five chair rises in 16.70 seconds or more. This result indicates reduced lower limb muscle strength and functional capacity.

In summary, there was a statistically significant (p<0.001) difference in hand grip strength by gender at baseline, but other statistically significant differences according to any of the fixed effects (gender, age, length of reablement) were not found.

Table 1. Participant characteristics and outcome measures by gender at baseline (T0).

Baseline by Gender	Male	Female	Total
n (%)	22 (40)	33 (60)	55 (100)
Age (years)
Mean (SD)	80.2 (7.4)	80.9 (7.1)	80.6 (7.2)
Minimum	65	66	65
Maximum	93	94	94
Length of reablement (days)
Mean (SD)	34.8 (25.6)	30.1 (14.2)	32.0 (19.9)
Minimum	10	10	10
Maximum	117	67	117
Hand grip strength, n	21	33	54
Dominant, kg, mean (SD)	29.4 (8.7)*	17.7 (8.4)*	22.8 (10.2)
Non-dominant, kg, mean (SD)	26.8 (8.4)*	17.3 (7.2)*	20.8 (9.0)
SPPB, n	22	33	55
Total, mean (SD)	6.7 (3.0)	6.8 (3.1)	6.8 (3.1)
Standing balance, mean (SD)	2.7 (1.4)	2.8 (1.2)	2.8 (1.3)
4-metre walking, mean (SD)	3.0 (1.0)	2.6 (1.2)	2.8 (1.1)
Sit-to-stand x5, mean (SD)	1.1 (1.2)	1.4 (1.4)	1.2 (1.3)
SPPB subtests, n	20	33	53
4-metre walking, secs, mean (SD)	6.0 (3.0)	7.1 (3.9)	6.7 (3.6)
m/s, mean	1.5	1.8	1.7
* p-value < 0.001

Changes to Physical Functioning

There were positive changes in the participants’ physical functioning over time. The analysis model was adjusted for the covariates of gender, age and reablement length, but these did not have a significant effect on the results between the three time points on any of the outcome measures. Further analysis was made with the total participant group, with covariates not taken into account. Changes in physical functioning between the baseline (T0), post-test (T1) and six-month follow-up (T2) assessments are described in Table 2.

Changes in hand grip strength between T0, T1 and T2 were positive but not statistically significant. There was improvement in grip strength in both hands between T0 and T1, and this was greater in the dominant hand (-1.1; 95% CI: -4.0, 2.7). Between T1 and T2, grip strength weakened (0.4; 95% CI: -3.6, 4.3) but was still higher than at baseline.

Changes to the SPPB total and subtest scores across the assessments were positive, and physical functioning improved during reablement. In particular, statistically significant changes between T0 and T1 was found in the SPPB total score (-1.4; 95% CI: -2.6, 0.2; p = 0.023), in the 4-metre walking score (-0.5; 95% CI: -0.9; -0.1, p = 0.028) and in the 4-metre walking time in seconds (-1.4; 95% CI: 0.2, 2.6; p = 0.024). An increase was also seen between T0 and T2 in all outcomes, although the change was not statistically significant. All scores decreased from T1 to T2, apart from the sit-to-stand results which remained at the same level (-0.0; 95% CI: -0.6, 0).

Table 2. Participant characteristics at baseline (T0), post-test (T1) and six-month follow-up (T2).

Outcome

Baseline (T0)

mean(SD)

Post-test (T1)

mean(SD)

Follow-up (T2)

mean(SD)

Difference

T0 to T1

(95% CI)

Difference

T0 to T2

(95% CI)

Difference

T1 to T2

(95% CI)

Hand grip strength

Dominant, kg

22.2 (10.2)

23.4 (9.6)

23.0 (9.0)

-1.1 (-4.9; 2.7)

p = 0.555

-0.8 (-4.6; 3.0)

p = 0.688

0.4 (-3.6; 4.3)

p = 0.859

Non-dominant, kg

20.8 (9.0)

21.7 (8.9)

21.3 (8.5)

-0.6 (-3.4; 2.3)

p = 0.693

-0.4 (-3.3; 2.5)

p = 0.783

0.2 (-2.8 ;3.1)

p = 0.911

SPPB

Total

6.8 (3.1)

8.1 (2.9)

7.8 (3.5)

-1.4 (-2.6; 0.2)

*p = 0.023

-1.0 (-2.2; 0.3)

p = 0.133

0.5 (-0.8; 1.7)

p = 0.484

Standing balance, score

2.8 (1.3)

3.2 (1.1)

3.0 (1.4)

-0.5 (-1.0; 0.0)

p = 0.068

-0.2 (-0.7; 0.3)

p = 0.462

0.3 (-0.2; 0.8)

p = 0.305

4-metre walking, score

2.8 (1.1)

3.2 (1.0)

3.0 (1.1)

-0.5 (-0.9; -0.1)

*p = 0.028

-0.3 (-0.7; 0.1)

p = 0.171

0.2 (-0.3; 0.6)

p = 0.444

Sit-to-stand x5, score

1.2 (1.3)

1.7 (1.3)

1.7 (1.5)

-0.5 (-1.0; 0.1)

p = 0.084

-0.5 (-1.0; 0.1)

p = 0.086

-0.0 (-0.6; 0.5)

p = 0.968

4-metre walking, secs

6.7 (3.6)

5.3 (2.6)

6.0 (3.0)

-1.4 (0.2;2.6)

*p = 0.024

0.7 (-0.6; 2.0)

p = 0.272

-0.7(-2.0; 0.6)

p = 0.279

*The mean difference is significant at the p-value < 0.05. Differences T0-T2 based on estimated marginal mean. Adjustment for multiple comparisons: least significant difference.

The purpose of this study was to describe the characteristics of reablement participants and evaluate the effects of reablement on physical functioning at six-month follow-up. The participants in this study were older adults at some risk of functional disability with diminished lower limb performance and grip strength. These characteristics correspond well to the expected target group of reablement services and are in line with earlier studies (Kjernsholen et al., 2024; Parsons et al., 2013b; Tessier et al., 2016). This six-month follow-up study supports and strengthens existing evidence that reablement has positive effects on the physical functioning of older adults (Tinetti et al. 2002b; Lewin et al. 2013; Parsons et al. 2013b; Cochrane et al. 2016; Sims-Gould et al. 2017b; Beresford et al. 2019; Langeland et al. 2019).

The preservation of physical functioning is a core element of healthy ageing (World Health Organization 2015). Outcomes related to physical functioning are inversely associated with the risk of major health outcomes in older adults, such as hospitalization, institutionalization or mortality (Valenzuela et al., 2023). Walking and transferring are essential abilities for individuals to achieve various daily tasks, both indoors and outdoors, and to participate socially in their living environment (Mjøsund et al., 2020). Low muscle strength and gait speed have been associated with an impaired ability to perform ADL and IADL (Wang et al., 2020), and ability in these areas is essential for older adults to continue living independently (Vaughan et al., 2016).

In this study, physical performance improved by at least one SPPB point from baseline but remained below the cut-off score for frailty at follow-up (Aires de Câmara et al., 2013). However, an increase of one SPPB point is associated with a decrease in mobility impairment and reduced ADL limitations, as well as a lower risk of falls (Western & Malkowski, 2022). Increased muscle strength in the lower limbs leads to better ADL performance (Liao et al., 2024). Strengthening these muscles promotes independence in the daily lives of older adults (Bårdstu et al., 2022) and is positively associated with functional independence among individuals with different levels of functional decline (Batista et al., 2014). Improvements in physical strength can lead to increased participation in other activities, greater self-confidence and more freedom to plan daily routines (Mjøsund et al., 2020).

At baseline, the walking speed of the participants in this study was lower than existing reference values for 80-year-olds in Norway, which are 0.99 m/s and 0.96 m/s for males and females, respectively . For safe signalized pedestrian crossing, the reference walking speed is 1.2 m/s, with as many as 61% of adults over 75 walking slower than this (Wilmut & Purcell, 2021). In this study, walking speed was found to have improved by 0.4 m/s from baseline to post-test and by 0.2 m/s from baseline to follow-up. An increase of 0.1 m/s has been related to an increase in predicted survival of 10 years (Studenski et al., 2011).

Improvement in the sit-to-stand SPPB subtest was positive but not statistically significant. It is worth noting that the positive change in the sit-to-stand assessment lasted until the six-month follow-up, while improvements in other areas started to decrease slowly. As outlined above, the strength of the lower limbs is important in preventing functional decline and maintaining independence among older adults (Löppönen et al., 2024). The results of this study indicate that improvements in sit-to-stand performance last longer than those gained in balance, walking speed or grip strength. This kind of persistent improvement during the study period perhaps predicts its continued longevity, and lower limb exercises should therefore be considered a central component of reablement programmes.

Hand grip strength plays a critical role in basic self-care tasks. Weak grip is associated with ADL disability and functional limitations (Bohannon, 2019) and with ADL restrictions and all-cause mortality in older adults (McGrath et al., 2018). Moreover, weak grip strength predicts the development of ADL disability (Dai et al., 2023) and dependency on others for assistance (Wang et al., 2020). It is also related to lower quality of life, especially in the social and environmental domains (Kaczorowska et al., 2025). Maintaining or improving grip strength is crucial for preserving independence among older adults, and it is a good indicator of physical functioning; therefore, it should be both measured and strengthened as an essential element of reablement.

The severity of functional limitation impacts reablement strategy, whereas gender or age do not (Pettersson, Zingmark and Haak 2022). Interdisciplinary reablement teams should therefore focus on the personal capabilities and opportunities of an individual over their diagnoses, age or dependency (Langeland et al., 2019). Personal goal setting plays a central role in the effective implementation of reablement by helping tailor each programme to the needs of the individual. It can also strengthen interdisciplinary collaboration with the service user by fostering trust, a shared vision and the exchange of expertise (Buma et al. 2024). Gender, age and reablement length had no statistically significant effect on the changes in physical functioning over the six-month follow-up of this study, indicating that the more individual aspects of reablement services, such as being person centred, variable in length and goal oriented, are crucial to their effects.

The support roles available to older adults, played by family members, informal caregivers or other professionals, are an important part of successful reablement outcomes. To foster participation, self-maintenance and independence, evidence-based practice must be supported by health and social care professionals and by the individual’s immediate environment (Salminen, 2022). In the context of reablement, the person-centred approach promotes older adults’ motivation to set and achieve meaningful goals (Pettersson et al., 2022), and such personal goals have an important influence on life satisfaction. Health professionals should use different methods to support this kind of goal setting to potentially produce improved health outcomes (Burton et al., 2024). Setting personalized and meaningful goals for older adults beyond the reablement period is essential for sustaining an individual’s physical function over time, and it would therefore be beneficial to establish support from their immediate environment and network to maintain physical function.

The findings of this study suggest that reablement teams should prioritize the assessment of individual functioning over demographic factors such as age and gender when tailoring programmes. During reablement, special attention should be paid to muscle strength training of the lower limbs. Regular physical exercise can enhance muscle strength and slow the decline of working memory, thereby maintaining or improving ADL among older adults (Liao et al., 2024). To maintain functional abilities in strength, balance and endurance, physical activity must be undertaken regularly, especially in older age (Li et al., 2023), and it is important to find effective ways for older adults to maintain and improve their physical performance after reablement, either by themselves or with support, for the positive effects to continue. The benefits of physical exercise partly disappear after three to six months (Rodriguez-Larrad et al. 2021), and so the long-term maintenance of such programmes should be recommended (Valenzuela et al., 2023).

In this study, the observed improvements started to decline after the reablement programme. Health and social care professionals should therefore ensure that such services include plans for maintaining functional capacity after completion of the programme and identify all effective methods for doing so. It is also important to ensure that information about the plan is available and transferable between the different health and social services. To maintain physical function, it is essential to find innovative solutions that address the individual needs of older adults and integrate them seamlessly into their daily lives. Follow-up visits after reablement seem important in identifying any decreases in functional performance. Physical function should be assessed by validated tools during follow-up visits to identify changes.

The importance of healthy ageing and the enabling role played by physical activity and the environment have been widely advocated (World Health Organization 2015). Pedestrian-friendly infrastructure and neighbourhood walkability are positively associated with physical activity and total walking among older adults (Barnett et al., 2017). More broadly, regular exercise slows down age-related decline in physical function (Manning et al., 2024), and home-based digital health exercises have been found to improve lower limb strength and reduce the number of falls (Solis-Navarro et al., 2022). According to the literature, digital exercise groups have a higher attendance rate compared to in-person sessions, and older adults have demonstrated a generally positive attitude towards digital groups (Fernandez et al., 2023). As such, eHealth solutions should be considered during and after reablement to support the continued physical function of older adults.

Further research into the long-term effects of reablement and how interdisciplinary collaboration or an individual’s own motivation influences these effects is required. It would be particularly useful to explore the influence of environment, motivation and self-sustained exercise on reablement.

Study Limitations

There are some methodological challenges to note. Participant recruitment was more difficult than expected, and the sample size was smaller than the target. Because of the COVID-19 pandemic, the reablement service in question was paused twice during data collection. There were no baseline differences in characteristics between those who completed all time points and those who did not. The statistical power is lower than expected, but the mixed-methods analysis is robust in relation to missing values because of the estimated means and the use of all time data, even where a time point is missing.

Measurements were performed securely, with standardized procedures and instruments that have good validity and reliability ((Aires de Câmara et al., 2013; McGrath et al., 2018; Pavasini et al., 2016; Vaishya et al., 2024). The assessments were conducted by healthcare professionals experienced in such tests during reablement visits, so no inter-rater reliability bias was expected. Desirability bias is, however, possible because the measurements were non-blinded.

This six-month follow-up study strengthens the evidence that reablement has a positive effect on older adults’ physical functioning, with some of the differences between baseline and post-test being statistically significant. The improvements started to decline after post-test but remained better than at baseline six months later. To ensure that the achieved positive outcomes are sustained, reablement programmes should include plans for maintaining physical activity after the programme’s conclusion. In addition, the participant’s personal motivations, along with the opportunities provided by the environment, technology and their immediate surroundings, should be considered. Reablement services should prioritize personal capabilities over demographic factors such as age and gender when tailoring interventions. This study aligns with the recent Delphi definition of reablement and supplements earlier research with the first known primary healthcare perspective in the Finnish context. These findings can be used to improve existing and design new reablement services with the understanding that age-related changes in physical functioning are individual and so must be the actions to maintain and improve healthy ageing.

No funds, grants, or other support was received. The authors have no competing interests to declare that are relevant to the content of this article.

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Effects of reablement on home-dwelling older adults’ physical functioning: A follow-up study in primary healthcare

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