Tyrer P, Tarabi S A, Bassett P, Liedtka N, Hall R, Nagar J, Imrie A, Tyrer H
Centre for Psychiatry, Department of Medicine, Imperial College, London, UK.
Independent Statistical Consultant, Amersham, UK.
J Intellect Disabil Res. 2017 Jun;61(6):521-531. doi: 10.1111/jir.12360. Epub 2017 Jan 26.
Aggressive challenging behaviour is very common in care homes for people with intellectual disability, and better psychological treatments are needed. Nidotherapy aims to change the environment of people with mental illness and is an appropriate treatment for this group of disorders.
The design was a cluster randomised trial of 20 care homes in which the staff either received training in nidotherapy or the enhanced care programme approach (ECPA), with equivalent duration of treatment in each arm. Cluster randomisation of care homes was carried out at the beginning of the study by an independent statistician. Primary and secondary outcomes were not specified exactly in view of absence of previous study data, but changes over time in scores on two scales, the Modified Overt Aggression Scale and the Problem Behaviour Check List were the main outcome measures. Serious violent incidents were recorded using the Quantification of Violence Scale. All these measures were recorded monthly by research assistants who were carefully kept blind to the allocation of treatment.
A total of 200 residents entered the trial, 115 allocated to the ECPA arm and 85 to the nidotherapy one. Seven residents left the care homes in the course of the study, and six were replaced; these were included 79 in the analysis as the trial was a pragmatic one. There were no material reductions in challenging behaviour in the first 8 months of the trial in either group, but in the last 7 months, those allocated to nidotherapy had a 33% reduction in Modified Overt Aggression Scale (MOAS) scores and a 43% reduction in Problem Behaviour Check List scores compared with 5% and 13%, respectively, for the ECPA group, differences which for the MOAS were close to statistical significance.
Nidotherapy shows promise in the management of aggressive challenging behaviour in care homes, but a delay in its benefit might be expected if given to staff only. The treatment is worthy of further evaluation and development.
攻击性行为在智障人士护理院中非常常见，因此需要更好的心理治疗方法。巢式疗法旨在改变患有精神疾病者的环境，是针对这类疾病的一种合适治疗方法。
本研究为一项整群随机试验，涉及20家护理院，工作人员要么接受巢式疗法培训，要么接受强化护理计划方法（ECPA）培训，每组治疗时长相等。护理院的整群随机分组在研究开始时由一名独立统计学家进行。鉴于之前缺乏研究数据，未确切规定主要和次要结局，但两个量表（改良公开攻击量表和问题行为检查表）得分随时间的变化是主要结局指标。使用暴力量化量表记录严重暴力事件。所有这些测量均由研究助理每月记录一次，研究助理对治疗分配情况严格保密。
共有200名居民进入试验，115名分配至ECPA组，85名分配至巢式疗法组。7名居民在研究过程中离开护理院，6名被替换；由于该试验是一项务实试验，因此分析中纳入了79名居民。在试验的前8个月，两组的攻击性行为均未实质性减少，但在最后7个月，分配至巢式疗法组的居民改良公开攻击量表（MOAS）得分降低了33%，问题行为检查表得分降低了43%，而ECPA组分别为5%和13%，MOAS得分的差异接近统计学显著性。
巢式疗法在护理院中攻击性行为的管理方面显示出前景，但如果仅给予工作人员，可能会预期其益处出现延迟。该治疗方法值得进一步评估和开发。
