Journal article
Effectiveness of the Interdisciplinary Home-bAsed Reablement Programme (I-HARP) on improving functional independence of people living with dementia: a multicentre, pragmatic, randomised, open-label, controlled trial
Journal of neurology, neurosurgery and psychiatry, v 96(7), pp 705-715
01 Jul 2025
PMID: 39824599
Featured in Collection : UN Sustainable Development Goals @ Drexel
Abstract
Background We investigated the effectiveness of an Interdisciplinary Home-bAsed Reablement Programme (I-HARP) on improving functional independence, health and well-being of people with dementia, family carer outcomes and costs.Method A multicentre pragmatic parallel-arm randomised controlled trial compared I-HARP to usual care in community-dwelling people with mild to moderate dementia and their family carers in Sydney, Australia (2018-2022). I-HARP is a 4-month, home-based, dementia rehabilitation model delivered by an interdisciplinary team. Assessments were conducted at baseline (time-1), 4-month (time-2) and 12-month (time-3) follow-up. The primary outcome measure was the client's functional independence using the Disability Assessment for Dementia (DAD) scale at time-2, based on intention-to-treat analyses.Result Of 130 recruited client-carer dyads, 116 dyads (58/group) completed the trial. The I-HARP group were not significantly better in most outcome measures than usual care at both time-2 and time-3; with the only statistically significant difference being a reduction in home environment hazards at time-2. Post hoc subgroup analysis of 66 clients with mild dementia found significantly better functional independence in the intervention group compared with those in usual care: difference 8.99 on DAD (95% CI 1.21, 16.79) at time-2 and difference 12.16 (95% CI 1.93, 22.38) at time-3. Economic evaluation suggests potentially lower resource use in I-HARP compared with usual care, but the cost-effectiveness is uncertain.Conclusion Primary outcomes were not met for a population of people with dementia, with severity ranging from mild to moderate and severe. The I-HARP model appeared to benefit functional independence of participants with mild dementia, with potential cost savings.Trial registration number ACTRN12618000600246.
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Details
- Title
- Effectiveness of the Interdisciplinary Home-bAsed Reablement Programme (I-HARP) on improving functional independence of people living with dementia: a multicentre, pragmatic, randomised, open-label, controlled trial
- Creators
- Yun-Hee Jeon - The University of SydneyJudy Simpson - The University of SydneyJudith Fethney - The University of SydneyLuisa Krein - The University of SydneyMirim Shin - The University of SydneyLee-Fay Low - Univ Sydney, Fac Med & Hlth, Sch Hlth Sci, Sydney, NSW, AustraliaRobert T. Woods - Bangor UniversityLoren Mowszowski - The University of SydneySarah Hilmer - The University of SydneySharon L. Naismith - The University of SydneyLindy Clemson - The University of SydneyHenry Brodaty - UNSW SydneyVasi Naganathan - The University of SydneyAmanda Miller Amberber - Macquarie UniversityDanelle Kenny - The University of QueenslandLaura Gitlin - Drexel University, College of Nursing and Health ProfessionsSarah Szanton - Johns Hopkins University
- Publication Details
- Journal of neurology, neurosurgery and psychiatry, v 96(7), pp 705-715
- Publisher
- Bmj Publishing Group
- Number of pages
- 11
- Grant note
- National Health and Medical Research Council; National Health & Medical Research Council (NHMRC) of Australia Royal North Shore Hospital
- Resource Type
- Journal article
- Language
- English
- Academic Unit
- College of Nursing and Health Professions
- Web of Science ID
- WOS:001406340800001
- Scopus ID
- 2-s2.0-85215372815
- Other Identifier
- 991022019600704721
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- Collaboration types
- Domestic collaboration
- International collaboration
- Web of Science research areas
- Clinical Neurology
- Psychiatry
- Surgery