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多成分二元干预对痴呆症患者家庭照顾者心理困扰的影响:一项随机对照试验。

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.

作者信息

Prick Anna-Eva, de Lange Jacomine, Twisk Jos, Pot Anne Margriet

机构信息

Department of Clinical Psychology and the EMGO institute for Health and Care Research,Faculty of Psychology and Education,VU University,Van der Boechorststraat 1,1081 BT Amsterdam,the Netherlands.

Research Centre Innovations in Care,Rotterdam University of Applied Sciences,Rochussenstraat 198,3015 EK Rotterdam,the Netherlands.

出版信息

Int Psychogeriatr. 2015 Dec;27(12):2031-44. doi: 10.1017/S104161021500071X. Epub 2015 May 25.

Abstract

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.

摘要

背景

早期研究表明,多成分二元干预措施——包括干预策略的组合以及针对痴呆症患者及其照料者双方——对痴呆症患者及其家庭照料者的身心健康具有有益影响。开展了一项多成分二元干预的随机对照试验(RCT),该干预是Teri等人(2003年)在美国已证明有效的一种干预措施的翻译和改编版本。研究了其对照料者情绪(主要结局)、负担、总体健康状况和唾液皮质醇水平(次要结局)的影响。

方法

将社区居住的痴呆症患者及其家庭照料者(N = 111对)随机分组。实验组在三个月内接受八次家访,结合体育锻炼和支持(心理教育、沟通技巧培训以及愉快活动规划)。体育锻炼和支持部分均针对痴呆症患者及其照料者。对照组每月收到信息公告并接到电话。在基线期(干预前)、干预三个月时和干预六个月时进行了三次测量。基于对所有可用数据的意向性分析,使用广义估计方程(GEE)对数据进行分析。

结果

所有分析均表明,随着时间推移,干预措施对任何结局均无益处。

结论

负面结果可能是由于对在美国已证明有效的干预措施进行翻译和改编所致:干预措施被缩短且未包括认知重构。然而,在美国仅研究了对痴呆症患者的健康影响,而非对照料者的影响。其他几个因素可能也起到了作用,这对未来研究而言很重要,需要加以考虑。这些因素包括:实施国家或地区的常规医疗保健;参与者对特定干预成分的意愿和需求;这些成分的改进空间;纳入积极的结局指标,如愉悦感,以及关系质量。

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