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      The effects of in-home rehabilitation on task self-efficacy in mobility-impaired adults: A randomized clinical trial.

      Journal of the American Geriatrics Society
      Activities of Daily Living, Aged, Dependent Ambulation, Disabled Persons, rehabilitation, Female, Home Care Services, Humans, Male, Middle Aged, Mobility Limitation, Occupational Therapy, Physical Therapy Modalities, Self Efficacy, Self-Help Devices, Telemedicine

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          Abstract

          To examine the effect on mobility self-efficacy of a multifactorial, individualized, occupational/physical therapy (OT/PT) intervention delivered via teletechnology or in-home visits. Randomized, clinical trial. One Department of Veterans Affairs and one private rehabilitation hospital. Sixty-five community-dwelling adults with new mobility devices. Thirty-three were randomized to the control or usual care group (UCG), 32 to the intervention group (IG). Four, once-weekly, 1-hour OT/PT sessions targeting three mobility and three transfer tasks. A therapist delivered the intervention in the traditional home setting (trad group n = 16) or remotely via teletechnology (tele group n = 16). Ten-item Likert-scale measure of mobility self-efficacy. The IG had a statistically significantly greater increase in overall self-efficacy over the study period than the UCG (mean change: IG 8.8, 95% confidence interval (CI) = 3.8-13.7; UCG 1.2, 95% CI = -5.8-8.2). Descriptively, the IG exhibited positive changes in self-efficacy for all tasks and greater positive change than the UCG on all items with the exception of getting in and out of a chair. Comparisons of the two treatment delivery methods showed a medium standardized effect size (SES) in both the tele and trad groups, although it did not reach statistical significance for the tele group (SES: tele = 0.35, 95% CI = -2.5-0.95; trad = 0.54, 95% CI = 0.06-1.14). A multifactorial, individualized, home-based OT/PT intervention can improve self-efficacy in mobility-impaired adults. The trend toward increased self-efficacy irrespective of the mode of rehabilitation delivery suggests that telerehabilitation can be a viable alternative to or can augment traditional in-home therapy.

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