Centre for Psychiatry and Mental Health, Wolfson Institute of Population Health, Queen Mary University London, London E1 2AB, UK.
Age Ageing. 2024 Apr 1;53(4). doi: 10.1093/ageing/afae074.
In the first randomised controlled trial of a dementia training and support intervention in UK homecare agencies, we aimed to assess: acceptability of our co-designed, manualised training, delivered by non-clinical facilitators; outcome completion feasibility; and costs for a future trial.
This cluster-randomised (2:1) single-blind, feasibility trial involved English homecare agencies. Intervention arm agency staff were offered group videocall sessions: 6 over 3 months, then monthly for 3 months (NIDUS-professional). Family carers (henceforth carers) and clients with dementia (dyads) were offered six to eight complementary, individual intervention sessions (NIDUS-Family). We collected potential trial measures as secondary outcomes remotely at baseline and 6 months: HCW (homecare worker) Work-related Strain Inventory (WRSI), Sense of Competence (SoC); proxy-rated Quality of Life (QOL), Disability Assessment for Dementia scale (DAD), Neuropsychiatric Inventory (NPI) and Homecare Satisfaction (HCS).
From December 2021 to September 2022, we met agency (4 intervention, 2 control) and HCWs (n = 62) recruitment targets and recruited 16 carers and 16/60 planned clients. We met a priori progression criteria for adherence (≥4/6 sessions: 29/44 [65.9%,95% confidence interval (CI): 50.1,79.5]), HCW or carer proxy-outcome completion (15/16 (93.8% [69.8,99.8]) and proceeding with adaptation for HCWs outcome completion (46/63 (73.0% [CI: 60.3,83.4]). Delivery of NIDUS-Professional costs was £6,423 (£137 per eligible client). WRSI scores decreased and SoC increased at follow-up, with no significant between-group differences. For intervention arm proxy-rated outcomes, carer-rated QOL increased, HCW-rated was unchanged; carer and HCW-rated NPI decreased; DAD decreased (greater disability) and HCS was unchanged.
A pragmatic trial is warranted; we will consider using aggregated, agency-level client outcomes, including neuropsychiatric symptoms.
在英国家庭护理机构中进行的首次痴呆症培训和支持干预的随机对照试验中，我们旨在评估：我们共同设计的、由非临床促进者提供的培训的可接受性，通过非临床促进者提供培训；结果完成的可行性；以及未来试验的成本。
这是一项采用群组随机（2:1）、单盲、可行性试验，涉及英国的家庭护理机构。干预组的机构工作人员接受了六次为期三个月的小组视频通话，然后每月一次，持续三个月（NIDUS-专业版）。家庭护理员（以下简称护理员）和痴呆症患者（对）接受了六到八次补充的个人干预（NIDUS-家庭版）。我们在基线和 6 个月时远程收集了潜在的试验措施作为次要结果：家庭护理人员工作相关压力量表（WRSI）、护理人员感知能力量表（SoC）；代理评定的生活质量（QOL）、痴呆症残疾评估量表（DAD）、神经精神问卷（NPI）和家庭护理满意度（HCS）。
从 2021 年 12 月至 2022 年 9 月，我们达到了机构（4 个干预组，2 个对照组）和家庭护理人员（n=62）的招募目标，并招募了 16 名护理员和 16/60 名计划中的患者。我们达到了依从性（≥4/6 次：29/44[65.9%，95%置信区间（CI）：50.1,79.5]）和 HCW 或护理员代理结局完成（15/16[93.8%[69.8,99.8]）的预先规定的进展标准，并且正在为 HCW 结局完成进行调整（46/63[73.0%[CI：60.3,83.4]）。NIDUS-专业版的交付成本为 6423 英镑（每位符合条件的客户 137 英镑）。WRSI 评分在随访时下降，感知能力量表增加，组间无显著差异。对于干预组的代理评定结果，护理员评定的生活质量提高，HCW 评定不变；护理员和 HCW 评定的神经精神问卷减少；DAD 减少（残疾程度增加），HCS 不变。
需要进行一项实用的试验；我们将考虑使用聚合的、机构层面的客户结果，包括神经精神症状。
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