Evaluation of Housing Adaptations and Mobility Devices (FORMASEvid)

Housing Adaptations and Mobility Devices - Evaluation of a New Practice Strategy

The rationale underlying this project is the fact that HA is a very common compensatory interven¬tion within municipality health care, undertaken to support an independent living in the own home. In addition, MD are frequently prescribed and used among HA clients in order to compensate for declined body functions. In spite of this, knowledge of their effects for the individual and the society is still scarce. In particular, systematic, evidence-based strategies based on clear-cut conceptual definitions and descriptions of procedures are lacking. Such strategies are crucial in order to evaluate the effects of HA and MD. In addition, longterm cost-effectiveness evaluations are crucial for policy implementation.

The overarching aim is to investigate outcomes of HA on aspects of home and health for sub-groups of persons with disabilities.

The specific aims are to:

• Investigate the effects of HA on home and health related outcomes, i.e. usability, fear of falling, activity/participation and health-related quality of life for different subgroups of persons, e.g. MD users and non MD-users
• Investigate the use of a new practice strategy for HA on home and health related outcomes for subgroups of persons with disabilities in terms of differences between municipalities
• Investigate societal level outcomes of HA and MD, i.e. costs and quality adjusted life years
• Gain a deeper understanding of the processes behind changes in outcomes We hypothesise that using a structure strategy for housing adaptation and mobility devices case management in ordinary practice in Swedish municipalities increase activity, participation, the usability of the home, and reduces societal costs.

Study Overview

• Status: Completed
• Conditions: Activities of Daily Living; Cost Effectiveness; Housing
• Intervention / Treatment: Behavioral: New Practice Strategy

Detailed Description

The ultimate goal of the project is to improve the housing situation of older people and people with disabilities, by determining the long term effects of housing adaptations (HA) for clients and society, and transferring this knowledge into guidelines for practitioners in the housing and building planning sector.

Specific research questions are:

RQ1. What are the long-term effects of HA for clients (individual goals achievement, activity, participation, health-related quality of life, usability, falls, functional capacity and use of mobility devices (MD), mortality, health care and social services consumption, and relocation)? RQ2. What are the long-term effects of HA for society (costs and cost- effectiveness)? RQ3. What are the barriers and facilitators to knowledge transfer in the area of HA? RQ4. How can evidence based knowledge be transferred into practical guidelines for housing and building planning in Sweden?

• Study Type: Interventional
• Enrollment (Anticipated): 340
• Phase: Not Applicable

Contacts and Locations

Study Locations

• Sweden
  • Lund, Sweden, 221 00
    • Department of Health Sciences, Lund University

Participation Criteria

Eligibility Criteria

• Ages Eligible for Study: 20 years and older (Adult, Older Adult)
• Accepts Healthy Volunteers: No
• Genders Eligible for Study: All

Description

Inclusion Criteria:

• Persons receiving housing adaptation
• Above 20 years

Exclusion Criteria:

• Persons with language deficits and/or cognitive decline

Study Plan

How is the study designed?

Design Details

• Primary Purpose: Health Services Research
• Allocation: Non-Randomized
• Interventional Model: Parallel Assignment
• Masking: None (Open Label)

Number of Arms

2

Arms and Interventions

Participant Group / Arm	Intervention / Treatment
Experimental: New Practice Strategy; Structured strategy for assessment and evaluation before and after intervention	Behavioral: New Practice Strategy; Application of a structured case management strategy on housing adaptation cases
No Intervention: Ordinary practice; Ordinary practice, not structured

What is the study measuring?

Primary Outcome Measures

Outcome Measure	Measure Description	Time Frame
ADL Staircase	The ADL Staircase measures dependence on other persons in daily activities. Combined interview and observation	Differences in changes between intervention and control sites at baseline and 3, 6,12, 24 and 36 months after

Secondary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Falls Efficacy Scale- FES-I	FES-I measures perceived fear of falling	Differences in changes between intervention and control sites at baseline and 3, 6, 12, 24 and 36 months after

Other Outcome Measures

Outcome Measure	Measure Description	Time Frame
Usability of the home, UIMH	Self-rated assessment measuring the extent to which the person can perform Daily activities in the housing	Differences in changes between intervention and control sites between baseline and 3, 6,12,24 and 36 months after
Costs of housing adaptations	The actual costs for the housing adaptation, including costs for travel, work hours, and material will be calculated based on invoices benefit	3,6, 12, 24 and 36 months after, for the whole sample
Cost-benefit for client and society	The cost-benefit of the housing adaptation will be calculated based on health economic models utilising data from EQ-5D instrument	At 24 and 36 months after the housing adaptation, for the whole sample

Collaborators and Investigators

• Sponsor: Lund University
• Investigators: Principal Investigator: Agneta M Fänge, PhD, Lund University

Publications and helpful links

General Publications

• Malmgren Fange A, Carlsson G, Axmon A, Thordardottir B, Chiatti C, Nilsson MH, Ekstam L. Effects of applying a standardized assessment and evaluation protocol in housing adaptation implementation - results from a quasi-experimental study. BMC Public Health. 2019 Nov 4;19(1):1446. doi: 10.1186/s12889-019-7815-9.
• Ekstam L, Carlsson G, Chiatti C, Nilsson MH, Malmgren Fange A. A research-based strategy for managing housing adaptations: study protocol for a quasi-experimental trial. BMC Health Serv Res. 2014 Nov 29;14:602. doi: 10.1186/s12913-014-0602-5.

Study record dates

Study Major Dates

• Study Start (Actual): January 11, 2013
• Primary Completion (Actual): April 30, 2020
• Study Completion (Actual): April 30, 2020

Study Registration Dates

• First Submitted: September 27, 2013
• First Submitted That Met QC Criteria: October 9, 2013
• First Posted (Estimate): October 10, 2013

Study Record Updates

• Last Update Posted (Actual): October 9, 2020
• Last Update Submitted That Met QC Criteria: October 8, 2020
• Last Verified: October 1, 2020

More Information

Terms related to this study

• Keywords: Costs; Independence; Housing adaptation
• Other Study ID Numbers: FORMAS 2011-907