Aging With Long Term Physical Disabilities

Study Overview
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Brief Summary
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The purpose of this study is to determine the feasibility and efficacy of an adapted evidence-based program (REBIL) to reduce barriers to community participation and remove fall hazards at home for adults aging with physical disabilities.

Detailed Description
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Investigators will test the working hypothesis that the adapted program, focused on resolving environmental barriers, removing fall hazards, and building self-management skills in the home and community, will be feasible and superior to usual care for daily activity performance and participation outcomes in adults aging with physical disabilities.

Official Title
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Building Capacity to Improve Community Participation for People Aging With Long-Term Disability Through Evidence-Based Strategies

Conditions
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Physical Disability

Intervention / Treatment
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* Behavioral: Removing Environmental Barriers to Independent Living (REBIL)
* Behavioral: Waitlist Attentional Control


Participation Criteria
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Eligibility Criteria
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Inclusion Criteria: Age 45-65 years Self-report of difficulty with at least 2 daily activities using the Older Adult Retirement Survey Activities of Daily Living (OARS ADL) scale onset of a physical disability 5 years prior to participation (e.g., spinal cord injury (SCI), cerebral palsy, post-polio syndrome, stroke, amputation). live within 60 miles of the research lab Exclusion Criteria: Currently institutionalized.

Ages Eligible for Study
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Minimum Age: 45 Years
Maximum Age: 65 Years

Sexes Eligible for Study
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All

Accepts Healthy Volunteers
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No

Study Plan
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How is the study designed?
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Design Details

Primary Purpose: Treatment
Allocation: Randomized
Intervention Model: Parallel Assignment
Interventional Model Description: Parallel-group, randomized control, participants in the waitlist control group will receive the intervention after 6-month follow up is completed
Masking: Single


Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| Experimental: REBIL- Intervention arm<br>Participants in this arm will receive the Removing Environmental Barriers to Independent Living (REBIL) intervention. | Behavioral: Removing Environmental Barriers to Independent Living (REBIL)<br>* REBIL is a complex intervention with two essential components: (1) removing environmental barriers and home hazards in the home tailored to the participant's unique abilities and limitations and (2) strategy training with the participant to help participant to be able to identify barriers in the home and community and identify potential resources and strategies to remove the barriers. Treatment includes one assessment session and four 75-minute visits in the home with an occupational therapist over 8 weeks, followed by a 6 -month assessment session by a blinded rater.<br>|
| Other: Waitlist Attentional control<br>Participants in this arm will receive life interview visits provided by a trained occupational therapist (OT) or OT student remotely for an equivalent amount of time to the treatment group. The waitlist control group will be offered the REBIL intervention after the 6-month follow-up is completed. | Behavioral: Waitlist Attentional Control<br>* The waitlist attentional control group will receive an initial assessment session then four 75 minute interview visits from an occupational therapy graduate assistant, followed by a 6-month assessment session by a blinded rater. After the 6-month follow-up is completed this group will receive the REBIL intervention.<br>|

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| In-Home Occupational Performance Evaluation (I-HOPE) | The In-Home Occupational Performance Evaluation will be used to measure current activity patterns of participants, identify activities that are difficult but important to them, and identify the environmental barriers that influence those activities (person-environment fit). Activity score: minimum value .5, maximum value 1, where a higher score indicates fewer problematic activities. Barrier scores: minimum value 0, maximum value 5, with higher scores indicating greater influence of barriers on activity. | Change from baseline to 6-month follow up | 
| Reintegration to Normal Living Index (RNLI) | The Reintegration to Normal Living Index is a disability-related quality-of life-instrument that will be used to measure participants' satisfaction with their home and community participation and has been validated on a population of community-dwelling individuals with chronic conditions. It uses an 11-item, 10 point visual analog scale with higher scores indicating greater reintegration to normal living. | Change from baseline and 6-month follow-up | 
| Westmead Home Safety Assessment (WeHSA) Short Form | Environmental fall hazards | Change from baseline to 6-month follow up | 

Secondary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Fall Prevention Strategy Survey (FPSS) | The Fall Prevention Strategy Survey is a self-report instrument addressing protective behaviors related to fall risk among adults. It is an 11-item survey, scores range from 0 to 22 with higher scores indicating use of more fall prevention strategies. | Change from baseline and 6-month follow-up | 
| Nine Participation Domain Measures | Descriptive information on activity participation and types of help needed; activities in four areas of participation (routines, recreation, responsibilities, and relationships) | Change from baseline and 6-month follow-up | 
| Falls | Participants will report monthly on the number of falls they had. | 6 months | 

 Terms related to the study
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Keywords Provided by Centre Hospitalier Valida
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community participation, environmental modifications, home modifications, fall prevention