Summary
Development, evaluation, and implementation of an occupational therapy intervention programme (ABLE) for people living with chronic conditions
The “A Better everyday Life” research programme was founded on the idea of developing an occupational therapy intervention programme addressing problems related to performance of Activities of Daily Living (ADL) tasks in people with chronic conditions. Since the establishment of the research programme in 2015 several studies have been conducted, inspired by the United Kingdom’s Medical Research Council framework on how to develop and evaluate complex interventions in four phases (development, feasibility/piloting, evaluation, implementation).
The development of the programme was initiated in 2015 and was based on a literature search to identify existing knowledge on ADL interventions, a study aiming at identifying, organizing and prioritizing ideas on how to enhance ADL ability according to both persons living with chronic conditions and occupational therapists and a study on selv-reported ADL ability in four diagnostic groups living with chronic conditions. Thus, resulting in the first version of the ABLE program (ABLE 1.0). Next, in 2017 a feasibility study was conducted to evaluate content and delivery in a Danish municipality. This study revealed that ABLE 1.0 was feasible. However minor adjustments were needed before proceeding to a pilot RCT.
Based on the results of the feasibility study the ABLE 1.0 was revised, resulting in ABLE 2.0; a systematic, individualised, home-based, and problem-solving occupational therapy intervention programme, using adaptational strategies, to address ADL task performance problems in people with chronic conditions. It was developed to be applicable across diagnoses, age, and sex, representing an occupation-centered intervention programme, applying occupation-based and/or occupation-focused approached during evaluation of ADL ability, goal setting, application of intervention components and re-evaluation of ADL ability to finalise the intervention.
In 2019-2022 the ABLE 2.0 was evaluated applying several evaluation models, including a pilot RCT, followed by a full-scale randomised controlled trial, process evaluation, realist evaluation, and evaluation of cost-effectiveness.
Currently implementation studies are being planned, aiming to implement ABLE 2.0 as part of community-based rehabilitation services in Denmark. Furthermore, in cooperation with researchers from Lund University, studies are being planned to adapt and feasibility evaluate the ABLE programme in Sweden.
Project registration:
https://classic.clinicaltrials.gov/ct2/show/NCT03335709
https://classic.clinicaltrials.gov/ct2/show/NCT04295837
Publications related to the ABLE programme:
Guidetti S, Nielsen KT, von Bülow C, Pilegaard MS, Klokker L & Wæhrens EE. Evaluation of an intervention programme addressing ability to perform activities of daily living among persons with chronic conditions: study protocol for a feasibility trial (ABLE). BMJ Open. 2018;8:e020812. https://bmjopen.bmj.com/content/8/5/e020812
Nielsen KT, Klokker L, Guidetti S, & Wæhrens EE. Identifying, organizing and prioritizing ideas on how to enhance ADL ability, Scandinavian Journal of Occupational Therapy. 2019; 26:5, 382-393https://doi.org/10.1080/11038128.2018.1424235
Nielsen KT, Klokker L & Wæhrens EE. Self-reported quality of activities of daily living task performance in four diagnostic groups with chronic conditions. International Journal of Therapy and Rehabilitation. 2021; 28:4, 1-10https://doi.org/10.12968/ijtr.2020.0025
Nielsen KT, Guidetti S, von Bülow C, Klokker L & Wæhrens EE. Feasibility of ABLE 1.0—a program aiming at enhancing the ability to perform activities of daily living in persons with chronic conditions. Pilot Feasibility Stud. 2021; 7:52. https://doi.org/10.1186/s40814-021-00790-7
Hagelskjær V, Nielsen KT, von Bülow C, Graff M & Wæhrens EE. Occupational therapy addressing the ability to perform activities of daily living among persons living with chronic conditions: a randomised controlled pilot study of ABLE 2.0. Pilot Feasibility Stud. 2021; 7:122. https://doi.org/10.1186/s40814-021-00861-9
Hagelskjær V, Nielsen KT, von Bulow C, Oestergaard LG, Graff M & Wæhrens EE. Evaluating a complex intervention addressing ability to perform activities of daily living among persons with chronic conditions: study protocol for a randomised controlled trial (ABLE). BMJ Open 2021;11:e051722. https://bmjopen.bmj.com/content/11/11/e051722.info
Hagelskjær V, Bülow CV, Nielsen KT, Henriksen M, Wæhrens EE. Effectiveness of an individualised occupational therapy intervention programme (ABLE) using adaptational strategies on activities of daily living among persons with chronic conditions: A randomised controlled trial (RCT). Clin Rehabil. 2023 Jun 12:2692155231180720. https://journals.sagepub.com/doi/10.1177/02692155231180720 Epub ahead of print. PMID: 37309135.
Thesis related to the ABLE programme:
Nielsen KT. Occupational therapy for persons living with chronic conditions - Development and feasibility of the ABLE program. Syddansk Universitet, 2018.
Hagelskjær V. Occupational therapy for persons with chronic conditions – Effectiveness and process evaluation of the ABLE programme. Syddansk Universitet, 2022.