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多中心随机对照 REDALI-DEM 试验研究方案——结构化再学习方法对痴呆患者日常生活活动表现的影响。

Study protocol of the multi-site randomised controlled REDALI-DEM trial--the effects of structured relearning methods on daily living task performance of persons with dementia.

机构信息

Centre of Geriatric Medicine and Gerontology Freiburg, University Hospital Freiburg, Lehener Strasse 88, 79106 Freiburg, Germany.

出版信息

BMC Geriatr. 2011 Aug 18;11:44. doi: 10.1186/1471-2318-11-44.

Abstract

BACKGROUND

Evidence from pilot trials suggests that structured learning techniques may have positive effects on the performance of cognitive tasks, movement sequences or skills in patients with Alzheimer's disease. The purpose of this trial is to evaluate whether the usual method of learning by trial and error or the method of errorless learning demonstrate better effects on the performance of two selected daily living tasks six weeks after the intervention in people with mild to moderate dementia.

METHODS/DESIGN: A seven-centre single-blind, active-controlled design with a 1:1 randomisation for two parallel groups will include 175 persons diagnosed with Alzheimer's disease or mixed type dementia (MMSE 14-24), living at home, showing at least moderate need for assistance in instrumental activities of daily living; primary carer available and informed consent of patient and primary carer. Patients of both study arms will receive 15 one-hour-sessions at home by trained interventionists practising two daily living tasks individually selected. In one group the trial and error technique and in the other group the errorless learning method will be applied. Primary outcome is the task performance measured with the Task Performance Scale six weeks post treatment.

DISCUSSION

The trial results will inform us to improve guidelines for instructing individuals with memory impairments. A user-friendly practice guideline will allow an efficient implementation of structured relearning techniques for a wide range of service providers in dementia care.

TRIAL REGISTRATION

DRKS00003117.

摘要

背景

来自初步试验的证据表明,在患有阿尔茨海默病的患者中,结构化学习技术可能对认知任务、运动序列或技能的表现产生积极影响。本试验的目的是评估在干预后六周,对于两个选定的日常生活任务,通过试错法进行常规学习与无错误学习方法的效果是否更好。

方法/设计:本试验采用 1:1 随机分组的 7 中心单盲、主动对照设计,共纳入 175 名被诊断为阿尔茨海默病或混合型痴呆(MMSE 14-24)、居家生活、在工具性日常生活活动中至少有中度需要帮助、有主要照顾者且患者和主要照顾者均知情同意的患者。两组患者均将由经过培训的干预者在家中接受 15 次每次 1 小时的治疗,分别针对两个单独选择的日常生活任务进行练习。一组采用试错技术,另一组采用无错误学习方法。主要结局是治疗 6 周后使用任务表现量表(Task Performance Scale)测量的任务表现。

讨论

试验结果将为我们提供指导,以改善指导有记忆障碍个体的指南。一个用户友好的实践指南将允许在痴呆症护理中广泛的服务提供者中有效地实施结构化再学习技术。

试验注册

DRKS00003117。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/342c/3166897/fe0c7457be8a/1471-2318-11-44-1.jpg

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本文引用的文献

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Am J Alzheimers Dis Other Demen. 2011 Jun;26(4):273-81. doi: 10.1177/1533317511404394. Epub 2011 Apr 17.
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Last observation carried forward versus mixed models in the analysis of psychiatric clinical trials.
Am J Psychiatry. 2009 Jun;166(6):639-41. doi: 10.1176/appi.ajp.2009.09040458.
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Errorless-based techniques can improve route finding in early Alzheimer's disease: a case study.
Am J Alzheimers Dis Other Demen. 2008 Feb-Mar;23(1):47-56. doi: 10.1177/1533317507307228.
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Errorless learning in the rehabilitation of memory impairment: a critical review.
Neuropsychol Rev. 2008 Mar;18(1):1-23. doi: 10.1007/s11065-008-9051-4. Epub 2008 Feb 5.
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Alzheimer's disease in real life--the dementia carer's survey.
Int J Geriatr Psychiatry. 2008 May;23(5):546-51. doi: 10.1002/gps.1984.

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