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Community based occupational therapy for patients with dementia and their care givers: randomised controlled trial.

Abstract

OBJECTIVE

To determine the effectiveness of community based occupational therapy on daily functioning of patients with dementia and the sense of competence of their care givers.

DESIGN

Single blind randomised controlled trial. Assessors were blinded for treatment allocation.

SETTING

Memory clinic and day clinic of a geriatrics department and participants' homes.

PARTICIPANTS

135 patients aged > or =65 with mild to moderate dementia living in the community and their primary care givers.

INTERVENTIONS

10 sessions of occupational therapy over five weeks, including cognitive and behavioural interventions, to train patients in the use of aids to compensate for cognitive decline and care givers in coping behaviours and supervision.

MAIN OUTCOME MEASURES

Patients' daily functioning assessed with the assessment of motor and process skills (AMPS) and the performance scale of the interview of deterioration in daily activities in dementia (IDDD). Care giver burden assessed with the sense of competence questionnaire (SCQ). Participants were evaluated at baseline, six weeks, and three months.

RESULTS

Scores improved significantly relative to baseline in patients and care givers in the intervention group compared with the controls (differences were 1.5 (95% confidence interval 1.3 to 1.7) for the process scale; -11.7 (-13.6 to -9.7) for the performance scale; and (11.0; 9.2 to 12.8) for the competence scale). This improvement was still significant at three months. The number needed to treat to reach a clinically relevant improvement in motor and process skills score was 1.3 (1.2 to 1.4) at six weeks. Effect sizes were 2.5, 2.3, and 1.2, respectively, at six weeks and 2.7, 2.4, and 0.8, respectively, at 12 weeks.

CONCLUSIONS

Occupational therapy improved patients' daily functioning and reduced the burden on the care giver, despite the patients' limited learning ability. Effects were still present at 12 weeks, which justifies implementation of this intervention.

TRIAL REGISTRATION

Clinical Trials NCT00295152 [ClinicalTrials.gov].

Links

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  • Authors+Show Affiliations

    ,

    Research Group for Allied Health Care, Department of Allied Health Care Disciplines, Occupational Therapy, University Medical Center Nijmegen, PO Box 9101, 6500 HB Nijmegen, Netherlands. m.graff@ergo.umcn.nl

    , , , ,

    Source

    BMJ (Clinical research ed.) 333:7580 2006 Dec 9 pg 1196

    MeSH

    Activities of Daily Living
    Aged
    Ambulatory Care
    Caregivers
    Community Health Services
    Dementia
    Female
    Humans
    Male
    Occupational Therapy
    Single-Blind Method
    Treatment Outcome

    Pub Type(s)

    Journal Article
    Randomized Controlled Trial
    Research Support, Non-U.S. Gov't

    Language

    eng

    PubMed ID

    17114212

    Citation

    TY - JOUR T1 - Community based occupational therapy for patients with dementia and their care givers: randomised controlled trial. AU - Graff,Maud J L, AU - Vernooij-Dassen,Myrra J M, AU - Thijssen,Marjolein, AU - Dekker,Joost, AU - Hoefnagels,Willibrord H L, AU - Rikkert,Marcel G M Olde, Y1 - 2006/11/17/ PY - 2006/11/17/aheadofprint PY - 2006/11/23/pubmed PY - 2006/12/22/medline PY - 2006/11/23/entrez SP - 1196 EP - 1196 JF - BMJ (Clinical research ed.) JO - BMJ VL - 333 IS - 7580 N2 - OBJECTIVE: To determine the effectiveness of community based occupational therapy on daily functioning of patients with dementia and the sense of competence of their care givers. DESIGN: Single blind randomised controlled trial. Assessors were blinded for treatment allocation. SETTING: Memory clinic and day clinic of a geriatrics department and participants' homes. PARTICIPANTS: 135 patients aged > or =65 with mild to moderate dementia living in the community and their primary care givers. INTERVENTIONS: 10 sessions of occupational therapy over five weeks, including cognitive and behavioural interventions, to train patients in the use of aids to compensate for cognitive decline and care givers in coping behaviours and supervision. MAIN OUTCOME MEASURES: Patients' daily functioning assessed with the assessment of motor and process skills (AMPS) and the performance scale of the interview of deterioration in daily activities in dementia (IDDD). Care giver burden assessed with the sense of competence questionnaire (SCQ). Participants were evaluated at baseline, six weeks, and three months. RESULTS: Scores improved significantly relative to baseline in patients and care givers in the intervention group compared with the controls (differences were 1.5 (95% confidence interval 1.3 to 1.7) for the process scale; -11.7 (-13.6 to -9.7) for the performance scale; and (11.0; 9.2 to 12.8) for the competence scale). This improvement was still significant at three months. The number needed to treat to reach a clinically relevant improvement in motor and process skills score was 1.3 (1.2 to 1.4) at six weeks. Effect sizes were 2.5, 2.3, and 1.2, respectively, at six weeks and 2.7, 2.4, and 0.8, respectively, at 12 weeks. CONCLUSIONS: Occupational therapy improved patients' daily functioning and reduced the burden on the care giver, despite the patients' limited learning ability. Effects were still present at 12 weeks, which justifies implementation of this intervention. TRIAL REGISTRATION: Clinical Trials NCT00295152 [ClinicalTrials.gov]. SN - 1756-1833 UR - https://www.unboundmedicine.com/medline/citation/17114212/full_citation L2 - http://www.bmj.com/cgi/pmidlookup?view=long&pmid=17114212 ER -