School of Psychology and Public Health, La Trobe University, Melbourne, Australia.
John Richards Centre for Rural Ageing Research, La Trobe University, Wodonga, Australia.
J Med Internet Res. 2023 Apr 20;25:e41712. doi: 10.2196/41712.
Memory strategy training for older adults helps maintain and improve cognitive health but is traditionally offered face-to-face, which is resource intensive, limits accessibility, and is challenging during a pandemic. Web-based interventions, such as the Online Personalised Training in Memory Strategies for Everyday (OPTIMiSE) program, may overcome such barriers.
We report on OPTIMiSE's feasibility, acceptability, and efficacy.
Australians aged ≥60 years reporting subjective cognitive decline participated in this single-arm pre-post web-based intervention. OPTIMiSE is a 6-module web-based program offered over 8-weeks with a 3-month booster. It has a problem-solving approach to memory issues, focusing on psychoeducation about memory and aging, knowledge and practice of compensatory memory strategies, and personalized content related to individual priorities. We examined the feasibility (recruitment, attrition, and data collection), acceptability (recommendation to others, suggestions for improvement, and withdrawal reasons), and efficacy (change in goal satisfaction, strategy knowledge and use, self-reported memory, memory satisfaction and knowledge, and mood; thematic content analysis of the most significant change; and the application of knowledge and strategies in daily life) of OPTIMiSE.
OPTIMiSE was feasible, demonstrated by strong interest (633 individuals screened), a satisfactory level of attrition (158/312, 50.6%), and minimal missing data from those completing the intervention. It was acceptable, with 97.4% (150/154) of participants agreeing they would recommend OPTIMiSE, the main suggestion for improvement being more time to complete modules, and withdrawal reasons similar to those in in-person interventions. OPTIMiSE was also efficacious, with linear mixed-effects analyses revealing improvements, of moderate to large effect sizes, across all primary outcomes (all P<.001): memory goal satisfaction (Cohen d after course=1.24; Cohen d at 3-month booster=1.64), strategy knowledge (Cohen d after course=0.67; Cohen d at 3-month booster=0.72) and use (Cohen d after course=0.79; Cohen d at 3-month booster=0.90), self-reported memory (Cohen d after course=0.80; Cohen d at 3-month booster=0.83), memory satisfaction (Cohen d after course=1.25; Cohen d at 3-month booster=1.29) and knowledge (Cohen d after course=0.96; Cohen d at 3-month booster=0.26), and mood (Cohen d after course=-0.35; nonsignificant Cohen d at booster). Furthermore, the most significant changes reported by participants (strategy use, improvements in daily life, reduced concern about memory, confidence and self-efficacy, and sharing and shame busting with others) reflected the course objectives and were consistent with themes arising from previous in-person interventions. At the 3-month booster, many participants reported continued implementation of knowledge and strategies in their daily lives.
This feasible, acceptable, and efficacious web-based program has the potential to enable access to evidence-based memory interventions for older adults worldwide. Notably, the changes in knowledge, beliefs, and strategy use continued beyond the initial program. This is particularly important for supporting the growing number of older adults living with cognitive concerns.
Australian New Zealand Clinical Trials Registry ACTRN12620000979954; https://tinyurl.com/34cdantv.
INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID): RR2-10.3233/ADR-200251.
针对老年人的记忆策略训练有助于维持和改善认知健康，但传统上是面对面进行的，这种方式资源密集、限制了可及性，并且在大流行期间具有挑战性。基于网络的干预措施，如在线个性化记忆策略培训日常应用（OPTIMiSE）计划，可能克服这些障碍。
我们报告 OPTIMiSE 的可行性、可接受性和疗效。
报告主观认知能力下降的澳大利亚年龄≥60 岁的参与者参加了这项基于网络的单臂前后预试验。OPTIMiSE 是一个为期 8 周的 6 个模块的基于网络的程序，有 3 个月的强化期。它采用解决记忆问题的方法，重点是关于记忆和衰老的心理教育、补偿记忆策略的知识和实践，以及与个人优先事项相关的个性化内容。我们检查了 OPTIMiSE 的可行性（招募、流失和数据收集）、可接受性（向他人推荐、改进建议和退出原因）以及疗效（目标满意度、策略知识和使用、自我报告的记忆、记忆满意度和知识、情绪的变化；最显著变化的主题内容分析；以及知识和策略在日常生活中的应用）。
OPTIMiSE 是可行的，表现为强烈的兴趣（312 人中有 633 人进行了筛选）、令人满意的流失率（158/312，50.6%）和从完成干预的参与者中获得的最小缺失数据。它是可以接受的，97.4%（150/154）的参与者同意推荐 OPTIMiSE，主要的改进建议是有更多的时间来完成模块，退出的原因与面对面干预相似。OPTIMiSE 也是有效的，线性混合效应分析显示，所有主要结果都有改善，效果大小从中等到较大（所有 P<.001）：记忆目标满意度（课程结束后的 Cohen d=1.24；3 个月强化期后的 Cohen d=1.64）、策略知识（课程结束后的 Cohen d=0.67；3 个月强化期后的 Cohen d=0.72）和使用（课程结束后的 Cohen d=0.79；3 个月强化期后的 Cohen d=0.90）、自我报告的记忆（课程结束后的 Cohen d=0.80；3 个月强化期后的 Cohen d=0.83）、记忆满意度（课程结束后的 Cohen d=1.25；3 个月强化期后的 Cohen d=1.29）和知识（课程结束后的 Cohen d=0.96；3 个月强化期后的 Cohen d=0.26）、情绪（课程结束后的 Cohen d=-0.35；非显著的 Cohen d 在强化期）。此外，参与者报告的最显著变化（策略使用、日常生活中的改善、对记忆的担忧减少、信心和自我效能感以及与他人分享和打破羞耻感）反映了课程目标，与之前的面对面干预中出现的主题一致。在 3 个月强化期，许多参与者报告继续在日常生活中实施知识和策略。
这种可行的、可接受的、有效的基于网络的计划有可能使世界各地的老年人都能获得基于证据的记忆干预措施。值得注意的是，知识、信念和策略使用的变化在初始课程结束后仍在继续。这对于支持越来越多的老年人的认知能力下降尤其重要。
