Community Occupational Therapy for people with dementia and family carers (COTiD-UK) versus treatment as usual (Valuing Active Life in Dementia [VALID]) study: A single-blind, randomised controlled trial

Autor: Martin Orrell, Nadia Crellin, Michael King, Maud Graff, Stephen Morris, Jane Burgess, Jacqueline Mundy, Esme Moniz-Cook, Jacki Stansfeld, Aidan G. O'Keeffe, Jennifer Wenborn, Ian Russell, Myrra Vernooij-Dassen, Tom Swinson, Elena Pizzo, Fiona Poland, Gail Mountain, Sinéad M. Hynes, Catherine Sackley, Rumana Z Omar, David Challis, Susan Michie
Přispěvatelé: Wenborn, Jennifer [0000-0001-7311-8972], Mountain, Gail [0000-0002-5417-7691], Moniz-Cook, Esme [0000-0002-7232-4632], King, Michael [0000-0003-4715-7171], Burgess, Jane [0000-0002-4626-6424], Poland, Fiona [0000-0003-0003-6911], Pizzo, Elena [0000-0003-0790-7505], Michie, Susan [0000-0003-0063-6378], Russell, Ian [0000-0002-0069-479X], Sackley, Catherine [0000-0002-8580-6622], Graff, Maud [0000-0003-4361-4291], Swinson, Tom [0000-0003-2314-9193], Crellin, Nadia [0000-0002-9497-5874], Hynes, Sinéad [0000-0002-3199-7355], Stansfeld, Jacki [0000-0002-4491-5523], Orrell, Martin [0000-0002-1169-3530], Apollo - University of Cambridge Repository, National Institute for Health Research
Jazyk: angličtina
Rok vydání: 2021
Předmět:
Male
Alzheimer`s disease Donders Center for Medical Neuroscience [Radboudumc 1]
Activities of daily living
Social Sciences
single-blind
randomised controlled trial
law.invention
0302 clinical medicine
Randomized controlled trial
Sociology
Occupational Therapy
law
Health care
Activities of Daily Living
Outcome Assessment
Health Care
Medicine and Health Sciences
Applied research
Single-Blind Method
030212 general & internal medicine
Human Families
Cognitive Impairment
Aged
80 and over
Measurement
Cognitive Neurology
Depression
family carers (COTiD-UK)
treatment as usual
FOS: Social sciences
General Medicine
Middle Aged
Home Care Services
Neurology
Caregivers
England
Valuing Active Life in Dementia [VALID]
Medicine
Engineering and Technology
Female
Research Article
Occupational therapy
Adult
medicine.medical_specialty
Drug Research and Development
Cognitive Neuroscience
MEDLINE
Research and Analysis Methods
Healthcare improvement science Radboud Institute for Health Sciences [Radboudumc 18]
03 medical and health sciences
All institutes and research themes of the Radboud University Medical Center
Quality of life (healthcare)
Mental Health and Psychiatry
medicine
Dementia
Humans
Clinical Trials
Family
Aged
Pharmacology
business.industry
Mood Disorders
Biology and Life Sciences
medicine.disease
FOS: Engineering and technology
Randomized Controlled Trials
Health Care
Family medicine
Quality of Life
Cognitive Science
Clinical Medicine
business
030217 neurology & neurosurgery
Neuroscience
Zdroj: PLoS Medicine
Plos Medicine, 18, 1
Plos Medicine, 18
PLoS Medicine, Vol 18, Iss 1, p e1003433 (2021)
ISSN: 1549-1676
1549-1277
Popis: Background We aimed to estimate the clinical effectiveness of Community Occupational Therapy for people with dementia and family carers–UK version (Community Occupational Therapy in Dementia–UK version [COTiD-UK]) relative to treatment as usual (TAU). We hypothesised that COTiD-UK would improve the ability of people with dementia to perform activities of daily living (ADL), and family carers’ sense of competence, compared with TAU. Methods and findings The study design was a multicentre, 2-arm, parallel-group, assessor-masked, individually randomised controlled trial (RCT) with internal pilot. It was conducted in 15 sites across England from September 2014 to January 2018. People with a diagnosis of mild to moderate dementia living in their own home were recruited in pairs with a family carer who provided domestic or personal support for at least 4 hours per week. Pairs were randomised to either receive COTiD-UK, which comprised 10 hours of occupational therapy delivered over 10 weeks in the person with dementia’s home or TAU, which comprised the usual local service provision that may or may not include standard occupational therapy. The primary outcome was the Bristol Activities of Daily Living Scale (BADLS) score at 26 weeks. Secondary outcomes for the person with dementia included the following: the BADLS scores at 52 and 78 weeks, cognition, quality of life, and mood; and for the family carer: sense of competence and mood; plus the number of social contacts and leisure activities for both partners. Participants were analysed by treatment allocated. A total of 468 pairs were recruited: people with dementia ranged from 55 to 97 years with a mean age of 78.6 and family carers ranged from 29 to 94 with a mean of 69.1 years. Of the people with dementia, 74.8% were married and 19.2% lived alone. Of the family carers, 72.6% were spouses, and 22.2% were adult children. On randomisation, 249 pairs were assigned to COTiD-UK (62% people with dementia and 23% carers were male) and 219 to TAU (52% people with dementia and 32% carers were male). At the 26 weeks follow-up, data were available for 364 pairs (77.8%). The BADLS score at 26 weeks did not differ significantly between groups (adjusted mean difference estimate 0.35, 95% CI −0.81 to 1.51; p = 0.55). Secondary outcomes did not differ between the groups. In total, 91% of the activity-based goals set by the pairs taking part in the COTiD-UK intervention were fully or partially achieved by the final COTiD-UK session. Study limitations include the following: Intervention fidelity was moderate but varied across and within sites, and the reliance on primarily proxy data focused on measuring the level of functional or cognitive impairment which may not truly reflect the actual performance and views of the person living with dementia. Conclusions Providing community occupational therapy as delivered in this study did not improve ADL performance, cognition, quality of life, or mood in people with dementia nor sense of competence or mood in family carers. Future research should consider measuring person-centred outcomes that are more meaningful and closely aligned to participants’ priorities, such as goal achievement or the quantity and quality of activity engagement and participation. Trial Registration Current Controlled Trials ISRCTN10748953.
Jennifer Wenborn and colleagues investigate the effectiveness of community occupational therapy program in improving activities of daily living, cognition, and mood for people with dementia.
Author summary Why was this study done? Maintaining everyday and pleasurable activities can be difficult for a person with dementia, as well as their family carer who often feels increasingly stressed as they need to give more and more support. Occupational therapists assist people to improve their health and well-being through carrying on with the activities they need and want to do. It is therefore important to develop effective strategies to deliver occupational therapy to people with dementia and their family carers who support them. What did the researchers do and find? We tested the effectiveness of the Community Occupational Therapy in Dementia–UK version (COTiD-UK) programme compared to the care that people with mild to moderate dementia and their family carers usually receive, through a clinical trial. We recruited 468 pairs comprising a person with dementia and a family carer across England who were randomly allocated to either take part in the COTiD-UK programme or to continue with their usual care. We found no statistical evidence that COTiD-UK gave more benefit to people with dementia or their carers than the usual care provided in terms of the people with dementia being able to carry out activities or their mood or quality of life nor their family carers’ sense of competence or mood. The pairs who took part in the COTiD-UK intervention set an average of 4.09 goals each, of which 91% were fully or partially achieved by the final COTiD-UK session. What do these findings mean? We did not find evidence to support commissioning the COTiD-UK intervention for people with mild to moderate dementia and their family carers. Future studies need to develop more realistic methods of measuring the effectiveness of programmes such as this, particularly to focus on the outcomes that most matter to the individuals taking part and to truly reflect the actual performance, experience, and views of the person living with dementia.
Databáze: OpenAIRE
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