认知症患者及其配偶参与自我管理小组的效果-随机对照试验。
Effects of Self-Management Groups for People with Dementia and Their Spouses--Randomized Controlled Trial.
机构信息
Geriatric Clinic, Department of Social Services and Health Care, Laakso Hospital, Helsinki, Finland.
Department of General Practice, University of Helsinki, Helsinki, Finland.
出版信息
J Am Geriatr Soc. 2016 Apr;64(4):752-60. doi: 10.1111/jgs.14055. Epub 2016 Apr 5.
OBJECTIVES
To investigate the effect of self-management group rehabilitation for persons with dementia (PwD) and their spouses on their health-related quality of life (HRQoL), the cognition of the PwD, and the costs of health and social services.
DESIGN
A randomized controlled trial.
SETTING
Primary care and memory clinics in the Helsinki metropolitan area, Finland.
PARTICIPANTS
PwD (N = 136) and their spouses (N = 136).
INTERVENTION
Couples were randomized to usual care or eight-session self-management groups for PwD and concurrently for their spouses. Sessions aim to enhance self-efficacy and problem-solving skills and to provide peer support.
MEASUREMENTS
The primary outcome measures were the HRQoL of PwD (measured using a generic, comprehensive (15-dimensional), self-administered instrument (15D)) and spouses (measured using the RAND-36) and the spousal Sense of Competence Questionnaire (SCQ). Secondary outcome measures were PwD cognition (Verbal Fluency (VF), Clock Drawing Test (CDT)) and costs of health and social services during 24 months.
RESULTS
At 3 months, the spouse physical component of the RAND-36 improved (mean change 1.0, 95% confidence interval (CI) = -0.5 to 2.4) for those undergoing the intervention and worsened for controls (mean change -2.0, 95% CI = -3.5 to -0.4) (P = .006 adjusted for age, sex, baseline value of the physical component of the RAND-36). There were no differences between the groups on the mental component of the RAND-36, the SCQ, or the 15D. At 9 months, PwD change in VF was -0.38 (95% CI = -1.03 to 0.27) in intervention group and -1.60 (95% CI = -2.26 to -0.94) for controls (P = .011 adjusted for age, sex, baseline MMSE score). CDT changes were similar to VF changes. Differences in incremental costs between the groups was -436 € per person per year (95% CI = -4,986 to 4,115) for PwD (P = .35 adjusted for age, CDR) and -896 € per person per year (95% CI = -3,657 to 1,864) for spouses (P = .51 adjusted for PwD age, CDR).
CONCLUSIONS
The intervention had beneficial effects on the HRQoL of spouses and the cognitive function of PwD without increasing total costs.
TRIAL REGISTRATION
anzctr.org.au Identifier: ACTRN12611001173987.
目的
调查针对痴呆症患者（PwD）及其配偶的自我管理小组康复对其健康相关生活质量（HRQoL）、PwD 的认知以及健康和社会服务成本的影响。
设计
随机对照试验。
地点
芬兰赫尔辛基大都市区的初级保健和记忆诊所。
参与者
PwD（N=136）及其配偶（N=136）。
干预措施
夫妇被随机分配到常规护理或针对 PwD 的八节自我管理小组，同时针对他们的配偶。课程旨在增强自我效能感和解决问题的能力，并提供同伴支持。
测量
主要结果指标是 PwD（使用通用的、全面的（15 维）、自我管理的工具（15D）测量）和配偶（使用 RAND-36 测量）以及配偶的感知能力问卷（SCQ）的 HRQoL。次要结果指标是 PwD 的认知（言语流畅性（VF）、画钟测验（CDT））和 24 个月期间的健康和社会服务成本。
结果
在 3 个月时，接受干预的配偶的 RAND-36 生理成分得到改善（平均变化 1.0，95%置信区间（CI）= -0.5 至 2.4），而对照组则恶化（平均变化 -2.0，95% CI = -3.5 至 -0.4）（P=.006 调整了年龄、性别、RAND-36 生理成分的基线值）。RAND-36 的心理成分、SCQ 或 15D 组间无差异。在 9 个月时，干预组的 PwD 的 VF 变化为 -0.38（95% CI = -1.03 至 0.27），对照组为 -1.60（95% CI = -2.26 至 -0.94）（P=.011 调整了年龄、性别、基线 MMSE 评分）。CDT 变化与 VF 变化相似。组间增量成本的差异为每人每年 436 欧元（95% CI = -4986 至 4115）（P=.35 调整了 PwD 的年龄、CDR）和每人每年 896 欧元（95% CI = -3657 至 1864）（P=.51 调整了配偶的 PwD 年龄、CDR）。
结论
该干预措施对配偶的 HRQoL 和 PwD 的认知功能产生了有益的影响，而没有增加总成本。
试验注册
anzctr.org.au 标识符：ACTRN12611001173987。
Zotero 插件