Evaluation of a home-based physical exercise and support intervention for people living with dementia and their informal caregivers: a randomised controlled trial

Pot, A.M. [Promotor]Scherder, E.J.A. [Promotor]Lange, J. de [Copromotor

Process evaluation of a multicomponent dyadic intervention study with exercise and support for people with dementia and their family caregivers

BACKGROUND: A randomized controlled trial of a multicomponent dyadic intervention (a translated and adapted version of an intervention that has been shown to be effective for people with dementia in the USA) was performed. The exercise and support intervention was intended to reduce depressive symptoms of people with dementia and their caregivers. The purpose of this process evaluation is to create in-depth insight into the delivery of the intervention and the effect analysis, to prevent drawing inappropriate conclusions on the efficacy or effectiveness of the intervention, and to formulate recommendations for future studies on complex geriatric interventions. METHODS: Qualitative and quantitative data were collected. The process evaluation was performed according to the model presented by Reelick and colleagues, which encompasses the following three process components: (1) success rate of recruitment and quality of the study population; (2) the quality of execution of the complex intervention; and (3) the process of acquisition of the data. RESULTS: The study design met high research standards and the intervention was carefully delivered. Evaluation of the study population quality revealed a profound recruitment process resulting in a reasonable sample size. Attrition rate during follow-up was acceptable. With regard to the evaluation of the intervention quality, most interviewed participants experienced benefits of the intervention. Attendance at the home visits was high and attrition to homework was moderate. Evaluation of the data acquisition showed the positive value of the use of a mixed design; qualitative analysis of the intervention revealed outcomes not measured in the quantitative analysis. CONCLUSIONS: The process evaluation revealed a carefully and soundly performed study. The mixed design contributed to valuable insights. However, there were some restrictions worth considering. The intervention components may have a different feasibility by moderate attrition to homework and some negative experiences of participants, which may be an indication of too intensive an intervention for this frail population in this specific country. As a result, the results of the statistical effect analysis should be interpreted with caution. TRIAL REGISTRATION: The study has been registered at the Netherlands National Trial Register: NTR1802, registration date 6 May 2009

De CRDL als muziektherapeutische interventie in het stimuleren van contact bij ouderen met gevorderde dementie en apathie: Een pilot-onderzoek

De CRDL is een interactief zorginstrument dat multisensorische stimulatie aanbiedt door fysieke aanraking tussen mensen te vertalen in geluid, om nieuw contact mogelijk te maken voor mensen die moeite hebben met communicatie en sociale interactie, zoals mensen met dementie (CRDL, z.d.; CRDL, 2016). In dit kwalitatief pilot-onderzoek is een interventieopzet ontwikkeld voor mensen met gevorderde dementie en apathie, middels het toepassen van de Delphi-methode bij muziektherapeuten en het afnemen van half-gestructureerde interviews bij CRDLdeskundigen. Tevens is de interventie uitgevoerd en geëvalueerd met behulp van de PRS (Perrin, 1997) bij twee ouderen met gevorderde dementie en apathie. Uit de evaluatie kwam naar voren dat alle gebruikte Bruscia-technieken potentie hebben om contact te stimuleren, aangezien de deelnemers op alle toegepaste technieken overwegend positief reageerden. Het pilot-onderzoek laat daarmee zien dat de ontwikkelde consensus-based interventieopzet potentie heeft om contact te stimuleren bij ouderen met gevorderde dementie en apathie. Voor gevalideerde toepassing van deze interventie is verdere theoretische onderbouwing, zoals de uitwerking tot een micro-interventie, en uitgebreider evaluatie- en/of effectonderzoek naar de effecten en ervaringen met de interventie noodzakelijk

The CRDL as a music therapy intervention in stimulating contact in elderly with advanced dementia and apathy:Pilot Study

De CRDL is een interactief zorginstrument dat multisensorische stimulatie aanbiedt door fysieke aanraking tussen mensen te vertalen in geluid, om nieuwcontact mogelijk te maken voor mensen die moeite hebben met communicatie en sociale interactie, zoals mensen met dementie (CRDL, z.d.; CRDL, 2016). In dit kwalitatief pilot-onderzoek is een interventieopzet ontwikkeld voor mensen met gevorderde dementie en apathie, middels het toepassen van de Delphi-methode bij muziektherapeuten en het afnemen van half-gestructureerde interviews bij CRDLdeskundigen. Tevens is de interventie uitgevoerd en geëvalueerd met behulp van de PRS (Perrin, 1997) bij twee ouderen met gevorderde dementie en apathie. Uit de evaluatie kwam naar voren dat alle gebruikte Bruscia-technieken potentie hebben om contact te stimuleren, aangezien de deelnemers op alle toegepaste technieken overwegend positief reageerden. Het pilot-onderzoek laat daarmee zien dat de ontwikkelde consensus-based interventieopzet potentie heeft om contact te stimuleren bij ouderen met gevorderde dementie en apathie. Voor gevalideerde toepassing van deze interventie is verdere theoretische onderbouwing, zoals de uitwerking tot een micro-interventie, en uitgebreider evaluatie- en/of effectonderzoek naar de effecten en ervaringen met de interventie noodzakelijk

The effects of a multi-component dyadic intervention on the psychological distress of family caregivers providing care to people with dementia: a randomized controlled trial

Background: Earlier research showed that multi-component dyadic interventions - including a combination of intervention strategies and addressing both the person with dementia and caregiver - have a beneficial impact on the mental and physical health of people with dementia and their family caregivers. A randomized controlled trial (RCT) of a multi-component dyadic intervention, which is a translated and adapted version of an intervention that has been shown to be effective in the US by Teri et al. (2003), was performed. The effects on caregivers' mood (primary outcome), burden, general health, and salivary cortisol levels (secondary outcomes) were studied. Methods: Community-dwelling people with dementia and their family caregivers (N = 111 dyads) were randomly assigned. The experimental group received eight home visits during three months, combining physical exercise and support (psycho-education, communication skills training, and planning of pleasant activities). Both the physical exercise and support component were directed at both the person with dementia and the caregiver. The comparison group received monthly information bulletins and phone calls. There were three measurements at baseline (prior to the intervention), at three months, and at six months into the intervention. Data were analyzed with Generalized Estimating Equations (GEE) based on an intention-to-treat analysis of all available data. Results: All analyses showed no benefits of the intervention over time on any of the outcomes. Conclusion: The negative results might be explained by the translation and adaptation of the intervention that has been shown to be effective in the US: the intervention was shortened and did not include cognitive reframing. However, only the health effects on people with dementia and not on caregivers were studied in the US. Several other factors might also have played a role, which are important for future studies to take into account. These are: the usual health care in the country or region of implementation; the wishes and needs of participants for specific intervention components; the room for improvement regarding these components; the inclusion of positive outcome measures, such as pleasure, and the quality of the relationship