Döpp Carola M E, Graff Maud J L, Teerenstra Steven, Olde Rikkert Marcel G M, Nijhuis-van der Sanden Maria W G, Vernooij-Dassen Myrra J F J
Radboud University Medical Center, Scientific Institute for Quality of Healthcare (IQ healthcare), Nijmegen, The Netherlands The Nijmegen Alzheimer Centre, Nijmegen, The Netherlands
Radboud University Medical Center, Scientific Institute for Quality of Healthcare (IQ healthcare), Nijmegen, The Netherlands The Nijmegen Alzheimer Centre, Nijmegen, The Netherlands Department of Rehabilitation, Radboud University Medical Center, Nijmegen, The Netherlands.
Clin Rehabil. 2015 Oct;29(10):974-86. doi: 10.1177/0269215514564699. Epub 2014 Dec 28.
Evaluate the effectiveness of a training package to implement a community occupational therapy program for people with dementia and their caregiver (COTiD).
Cluster randomized controlled trial.
A total of 45 service units including 94 occupational therapists, 48 managers, 80 physicians, treating 71 client-caregiver couples.
Control intervention: A postgraduate course for occupational therapists only.
A training package including the usual postgraduate course, additional training days, outreach visits, regional meetings, and access to a reporting system for occupational therapists. Physicians and managers received newsletters, had access to a website, and were approached by telephone.
The intended adherence of therapists to the COTiD program. This was assessed using vignettes.
clients' daily functioning, caregivers' sense of competence, quality of life, and self-perceived performance of daily activities of both clients and caregivers. Between-group differences were assessed using multilevel analyses with therapist and intervention factors as covariates.
No significant between-group differences between baseline and 12 months were found for adherence (1.58, 95% CI -0.10 to 3.25), nor for any client or caregiver outcome. A higher number of coaching sessions and higher self-perceived knowledge of dementia at baseline positively correlated with adherence scores. In contrast, experiencing more support from occupational therapy colleagues or having conducted more COTiD treatments at baseline negatively affected adherence scores.
The training package was not effective in increasing therapist adherence and client-caregiver outcomes. This study suggests that coaching sessions and increasing therapist knowledge on dementia positively affect adherence.
NCT01117285.
评估一套培训方案在为痴呆症患者及其照护者实施社区职业治疗项目（COTiD）方面的有效性。
整群随机对照试验。
共45个服务单位，包括94名职业治疗师、48名管理人员、80名医生，治疗71对患者-照护者夫妇。
对照干预：仅为职业治疗师提供的研究生课程。
一套培训方案，包括常规研究生课程、额外培训日、外展访问、区域会议，以及职业治疗师可使用的报告系统。医生和管理人员收到时事通讯，可访问网站，并通过电话与他们联系。
治疗师对COTiD项目的预期依从性。使用案例 vignettes进行评估。
患者的日常功能、照护者的胜任感、生活质量，以及患者和照护者日常活动的自我感知表现。使用以治疗师和干预因素作为协变量的多水平分析评估组间差异。
在依从性方面（1.58，95%可信区间 -0.10至3.25），以及任何患者或照护者结局方面，均未发现基线与12个月之间存在显著组间差异。基线时更多的辅导课程和更高的痴呆症自我感知知识与依从性得分呈正相关。相比之下，在基线时从职业治疗同事那里获得更多支持或进行更多COTiD治疗对依从性得分有负面影响。
该培训方案在提高治疗师依从性和患者-照护者结局方面无效。本研究表明，辅导课程和增加治疗师对痴呆症的知识对依从性有积极影响。
NCT01117285。
