Reablement is an intensive, person-centred service for people who have lost their independence and ability to carry out activities of daily living. It plays an important role in adult social care, helping people to meet their goals and remain independent as well as to reduce adult social care costs.
Local authorities use a variety of outcomes to measure the impact of reablement services, but there is a lack of agreement on which outcomes are the most important. This makes it difficult to determine how well services are working or to make comparisons between services or local authorities. It can also cause reporting challenges for commissioned providers of reablement.
This study is part of The ConnectED project, which aims to help decision-makers in Adult Social Care make better decisions by growing their ability to use research (https://tinyurl.com/ConnectED-ASC). The project is a collaboration between three Local Authority Adult Social Care Departments, two Universities and two service provider organisations. One of the ConnectED workstreams entailed the identification of small studies or pilot projects to answer questions important to the social care partners. Through a process of discussion and consensus involving all the partners and the ConnectED Service User and Carer Advisory Group, this project was identified as one of the ConnectED sub-projects.
A standardised set of outcomes for use in local reablement services, called a Core Outcome Set (COS), could help to improve the monitoring and evaluation of reablement services, facilitate evidence synthesis using meta analyses, and ensure that the outcomes reported are important and relevant for service users, carers and practitioners (Williamson et al. 2017). COS are widely used in health research and practice, however few areas of social care have a COS, and there is currently no COS for reablement (Crichton et al. 2024; Sugavanam et al. 2021).
RATIONALE
Staff managing reablement services in the partner local authorities within the ConnectED project have expressed a need for information about which are the most important outcomes to measure when evaluating reablement. Social care provider agencies have expressed the challenge of being required to report on different outcomes for different commissioning organisations. This explorative study will help to provide the information requested by carrying out a Delphi consensus approach with reablement stakeholders including service users, carers, local authority staff, reablement agency staff and researchers to create a Core Outcome Set for measuring the impact of reablement services.
We recognise that Reablement services vary widely across England, with different approaches taken between, and even within, different commissioning areas (Beresford et al. 2018). The intervention components, target population and goals of reablement are diverse, with some focused on activities of daily living and others encompassing a wider set of goals such as activities outside the home and social engagement (Beresford et al. 2018). In this exploratory study, we have taken the decision to focus the study on stakeholders in the four local authorities Bristol, North Somerset, South Gloucestershire and Wiltshire. We are also focusing on the study population on people aged over 65, since the outcomes for this age group may be less heterogeneous than those for adults aged 18 and over. We plan to use the findings from this study to create a funding application to carry out a larger, national reablement COS development study involving a broader range of stakeholders.
RESEARCH AIM
The aim of the Outcomes for Reablement study is to carry out an exploratory Delphi survey with stakeholders, in order to develop a COS for use in local reablement practice with older people aged over 65 years.
COMET database search
A search of the COMET database in January 2025, updated in April 2026, found no studies aiming to develop a Core Outcome Set (COS) for reablement, and 31 COS studies related to rehabilitation, a related field. Most of these studies relate to specific health conditions or patient groups, for example following major trauma, spinal cord injury or stroke.
Our study is taking a social care perspective, and focuses on developing a COS for reablement services. Reablement is a social care intervention, most commonly developed by social care practitioners, which seeks to assess and support people to regain or maintain independence in their daily lives (Beresford et al., 2019). People receiving reablement are a broad group, including those who have lost function due to an acute hospital stay, and individuals where there is evidence of declining independence or ability to cope with everyday living (Beresford et al., 2019. Our aim is to develop a COS that can be used in social care practice by local authorities and commissioned care providers in England to evaluate reablement services for older adults, aged 65 years and over.
Although no existing study closely fits the aims of our study, five studies are potentially relevant, either because they involve older adults who have lost function and/are adults who have been discharged from hospital. These studies (listed below) will be taken into account in the study literature review and, where appropriate, will feed into the study design.
1. Demers et al., Development of a conceptual framework for the assessment of geriatric rehabilitation outcomes. Like our study, Demers et al.’s study focuses on older adults who have lost function, although their study included adults who would receive specialist rehabilitation, such as older adults who have experienced stroke and lower limb amputation syndrome. Demers et al. provide valuable information on outcomes that were identified as important in qualitative work with older adults, in research and in clinical practice (Demers et al, 2004), which we will draw on in our literature review.
2. Connolly et al., Development of a core outcome set for trials of physical rehabilitation after critical illness This study focuses on patients aged 16-100 who have experienced a critical illness, whereas our study focuses on older adults aged 65 years and older who are supported by reablement services after a loss of function, perhaps due to an acute hospital stay, illness, injury or other causes. However, we will draw on the findings of Connolly et al. 2024 , where relevant, in our literature review.
3. Another relevant study, is Aarden et al.: An expert consensus statement on a post-discharge exercise intervention for acute hospitalized older adults. Both this study and our study are concerned with older adults, and both involve supporting an increase in physical function. However, the study by Aarden et al. is concerned with a different intervention, a physiotherapy-based exercise intervention programme, rather than a reablement study, and involves stakeholders from a range of countries apart from the UK, while our study focuses on reablement services in England. The most relevant aspect of this study is that it seeks to establish consensus on ‘which measurement tools are recommended to measure physical functioning and diagnostics’. The results of this, (Aarden et al. 2023), may be relevant to our study and will be considered in the literature review.
4. Lenny Vasanthan T., Core Outcome Sets for physiotherapy clinical trials and research: A systematic review. This is a study to appraise studies that report the development of core outcome sets for use in physiotherapy clinical trials and research.
5. Corbett et al., The National Rehabilitation Centre Dataset Development of a minimum dataset for multidisciplinary rehabilitation: A modified e-Delphi Study. This study seeks to develop a COS for patients treated at the National Rehabilitation Centre, an in-patient centre for people with complex rehabilitation needs including Major Trauma, Spinal, Neuro-Rehab (brain injury), musculoskeletal, and patients who are deconditioned after a long stay in an Intensive Care Unit. The patient group for this study is different from those who receive reablement, and the type of rehabilitation offered includes more specialist health care.
References
Aarden., J. J,, et al. (2023) Recommendations for an exercise intervention and core outcome set for older patients after hospital discharge: Results of an international Delphi study. PLoS ONE18(3): e0283545. https://doi.org/ 10.1371/journal.pone.0283545
Beresford, B. et al., 2019, Outcomes of reablement and their measurement: Findings from an evaluation of English reablement services, Health & Social Care in the Community 2019 Vol. 27 Issue 6 Pages 1438-1450. DOI: 10.1111/hsc.12814
Demers. L. et al., Development of a conceptual framework for the assessment of geriatric rehabilitation outcomes, COMET database https://www.cometinitiative.org/Studies/Details/2158
Demers, L. et al., 2004, Development of a conceptual framework for the assessment of geriatric rehabilitation outcomes, Archives of Gerontology and Geriatrics., 38: 221-237. doi:10.1016/j.archger.2003.10.003
Connolly., B.A. et al., Development of a core outcome set for trials of physical rehabilitation after critical illness, COMET database https://www.cometinitiative.org/Studies/Details/288
Connolly., B.A. et al. 2024, Development of a Core Outcome Set for Trials of Physical Rehabilitation in Critical Illness, Ann Am Thorac Soc, Vol 21(12):1742–1750
AnnalsATS.202406-581OC.pdf
Aarden et al. 2023, An expert consensus statement on a post-discharge exercise intervention for acute hospitalized older adults, COMET database https://www.cometinitiative.org/Studies/Details/1294
Aarden, J.J., 2023, Recommendations for an exercise intervention and core outcome set for older patients after hospital discharge: Results of an international Delphi study, PLoS ONE 18(3): https://doi.org/10.1371/journal.pone.0283545
Lenny Vasanthan T., Core Outcome Sets for physiotherapy clinical trials and research: A systematic review, COMET Database
https://www.cometinitiative.org/Studies/Details/3366
Corbett et al., The National Rehabilitation Centre Dataset Development of a minimum dataset for multidisciplinary rehabilitation: A modified e-Delphi Study, https://www.cometinitiative.org/Studies/Details/3290
Dr Jo Crichton
Professor Geraldine Macdonald
Disease Category: Health care of older people
Disease Name: N/A
Age Range: 65 - 120
Sex: Either
Nature of Intervention: Other
- Researchers
- Service commissioners
- Service providers
- Service users
- COS for clinical trials or clinical research
- COS for practice
- Consensus meeting
- Delphi process
- Literature review
- Semi structured discussion
- Survey
- Systematic review
Brief Summary of Methods
The first stage in the COMET COS development process will involve the collection of research evidence to develop a comprehensive long list of reablement outcomes used in research and practice (Williamson et al. 2017). We will carry out a review of systematic reviews, scoping reviews and grey literature, followed by a consultation with stakeholders to generate a long list of outcomes currently measured in reablement.
Two members of the research team will independently review the long list of outcomes, separating out multi-dimensional outcomes into their individual components as well as the overarching constructs, removing individual components not relevant to reablement and merging overlapping components.
We will then present the long list of outcomes to our stakeholder advisory group. The service users, carers and practitioners in the group will be asked to suggest any outcomes that have not been identified through the literature review.
Delphi survey
We will conduct a Delphi survey with the aim of achieving consensus among local reablement stakeholders about which of the outcomes identified in the long list should be included in the proposed Core Outcome Set.
Up to 250 participants will be recruited through ConnectED partners (Bristol City Council, North Somerset Council, South Gloucestershire Council) and Wiltshire Council. Participants will include the following stakeholder groups: service users, informal carers, local authority staff, commissioned agency staff, and researchers.
All service users aged 65 years and above using reablement services in these local authorities during a two-week eligibility period in April 2025 will be invited, together with their relative or carer.
All local authority and agency staff working in reablement service provision and commissioning will be invited. A small number of UK-based researchers with reablement expertise will be identified through research publications and invited to take part.
All eligible participants will be invited to complete two rounds of a survey. Each round will be open for four weeks. Service users and carers or relatives will be given the choice of completing postal or online questionnaires. All others will be invited to complete the survey online. The online version will be hosted within the University of Bristol using REDCap software.
Round 1: participants will rate how important a series of outcomes is for measuring the impact of reablement services. An open text question will capture missing outcomes.
Round 2: the second round of the survey will be distributed to those participants who completed Round 1 one month after Round 2 closes. Participants will be presented with their previous rating for each outcome, and average scores from each stakeholder group, and asked to rate each of the retained items again.
Each survey round will take around 20 minutes for participants to complete.
Round 1 of the survey
The Round 1 survey will ask participants for information on background characteristics including gender and ethnicity. Participants will be asked to rate the importance of each outcome on a scale of 1 to 9 according to how important each outcome is for measuring the impact of reablement services. Ratings will be grouped into the following categories: 1-3 ‘not important’, 4-6 ‘important but not essential’ and 7-9 ‘essential’. Participants will be able to respond ‘Unable to score’ the outcome. The order the outcomes appear in the survey will be randomised in the online version of the survey but not the paper version.
Pre-specified criteria will be used for defining consensus and for dropping or adding outcomes, based on methods used in other COS studies (Williamson et al. 2017). Consensus (and inclusion in the Reablement COS) will be defined as 70% or more of responses rating the outcome as essential for inclusion (score of 7-9) by service users and carers and by practitioners AND less than or equal to 15% of responses rating the outcome ‘not important’ (score of 1-3).
Dropping outcomes considered to be unimportant by the majority in all panels will help to keep Round 2 as short as possible, helping to reduce attrition. Outcomes that 70% or more of participants scored as ‘not important for inclusion’ (a score of 3 or less) and 15% or fewer of participants scored as ‘very important’ (a score of 7 or more) in every panel will be dropped at Round 2.
The survey will include one open question asking participants to name any outcomes that are important for measuring the impact of reablement that had not been included. Outcomes suggested by one or more participants that meet the criteria of being ‘changes a person may experience as a result of reablement’ will be included in Round 2 (Williamson et al. 2017).
Round 2 of the survey
The remaining outcomes will be retained in Round 2, as well as new outcomes suggested by 1 or more participants in Round 1.
For each outcome, participants will be presented with the previous rating they gave the outcome, and the average (median) scores from each broad stakeholder group. Participants will then be asked to rate the item again, and informed that they can keep their previous rating or change it if they wish. Participants will be asked their reasons for changing their ratings in Round 2, if they have done so.
Stakeholder meeting
The Delphi surveys will be followed by a consensus meeting of stakeholders drawn from the survey participants. The purpose of the consensus meeting will be to discuss the results of the Delphi process and agree a Core Outcome Set. The meeting may involve additional voting in the event that consensus has not been reached for some outcomes.
This meeting may be in-person or online. Participants will be randomly selected from those who agreed to be invited to the meeting during Round 2 of the survey.
COS development studies tend to involve another stage of data collection in order to agree core outcome measurement instruments. In this small, exploratory study, we may hold an additional meeting after the consensus meeting with the study Advisory Group to discuss potential measurement instruments for the COS from the long list of measurement instruments identified in the literature review described above.
4.2 Data analysis:
The background characteristics of participants completing Round 1 and Round 2 will be analysed using descriptive statistics including frequencies and percentages. Participants’ ratings of reablement outcomes in the surveys will be analysed with descriptive statistics as follows.
We will first determine summary scores for each outcome from each panel by calculating median scores (Williamson 2017).
The survey results will then be analysed according to the following pre-set criteria for dropping in Round 2 and inclusion in the Core Outcome Set:
• Outcomes that 70% or more of participants scored as ‘not important for inclusion’ (a score of 3 or less) and 15% or fewer of participants scored as ‘very important’ (a score of 7 or more) in every panel will be dropped at Round 2.
• Consensus (and therefore inclusion in the Core Outcome Set) will be defined as 70% or more of responses rating the outcome as essential for inclusion (score of 7-9) AND less than or equal to 15% of responses rating the outcome ‘not important’ (score of 1-3).
Attrition bias will be considered by comparing the median round 1 scores for each outcome measure between those who complete Round 1 only and those who complete both rounds (Williamson 2017). We will do this for all participants as well as separately for 1. service users and carers, and 2. people working in reablement.
References
Williamson, P.R., 2019, The COMET Handbook: version 1.0, Trials, Vol. 18. DOI: 10.1186/s13063-017-1978-4