Jeon Yun-Hee, Simpson Judy, Fethney Judith, Krein Luisa, Shin Mirim, Low Lee-Fay, Woods Robert T, Mowszowski Loren, Hilmer Sarah, Naismith Sharon L, Clemson Lindy, Brodaty Henry, Naganathan Vasi, Miller Amberber Amanda, Kenny Danelle, Gitlin Laura, Szanton Sarah
Susan Wakil School of Nursing and Midwifery, Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia
School of Public Health, Faculty of Medicine and Health, University of Sydney, Sydney, New South Wales, Australia.
J Neurol Neurosurg Psychiatry. 2025 Jun 12;96(7):705-715. doi: 10.1136/jnnp-2024-334514.
We investigated the effectiveness of an Interdisciplinary Home-bAsed Reablement Programme (I-HARP) on improving functional independence, health and well-being of people with dementia, family carer outcomes and costs.
A multicentre pragmatic parallel-arm randomised controlled trial compared I-HARP to usual care in community-dwelling people with mild to moderate dementia and their family carers in Sydney, Australia (2018-2022). I-HARP is a 4-month, home-based, dementia rehabilitation model delivered by an interdisciplinary team. Assessments were conducted at baseline (time-1), 4-month (time-2) and 12-month (time-3) follow-up. The primary outcome measure was the client's functional independence using the Disability Assessment for Dementia (DAD) scale at time-2, based on intention-to-treat analyses.
Of 130 recruited client-carer dyads, 116 dyads (58/group) completed the trial. The I-HARP group were not significantly better in most outcome measures than usual care at both time-2 and time-3; with the only statistically significant difference being a reduction in home environment hazards at time-2. Post hoc subgroup analysis of 66 clients with mild dementia found significantly better functional independence in the intervention group compared with those in usual care: difference 8.99 on DAD (95% CI 1.21, 16.79) at time-2 and difference 12.16 (95% CI 1.93, 22.38) at time-3. Economic evaluation suggests potentially lower resource use in I-HARP compared with usual care, but the cost-effectiveness is uncertain.
Primary outcomes were not met for a population of people with dementia, with severity ranging from mild to moderate and severe. The I-HARP model appeared to benefit functional independence of participants with mild dementia, with potential cost savings.
ACTRN12618000600246.
我们调查了跨学科居家康复计划（I-HARP）对改善痴呆症患者的功能独立性、健康和幸福感、家庭护理人员的结局及成本的有效性。
一项多中心实用平行组随机对照试验，将I-HARP与澳大利亚悉尼社区中患有轻度至中度痴呆症的居民及其家庭护理人员的常规护理进行比较（2018 - 2022年）。I-HARP是一个由跨学科团队提供的为期4个月的居家痴呆症康复模式。在基线（时间1）、4个月（时间2）和12个月（时间3）随访时进行评估。主要结局指标是在时间2时，基于意向性分析，使用痴呆症残疾评估（DAD）量表评估患者的功能独立性。
在招募的130对患者-护理人员二元组中，116对（每组58对）完成了试验。在时间2和时间3时，I-HARP组在大多数结局指标上并不比常规护理显著更好；唯一具有统计学显著差异的是在时间2时家庭环境危害有所减少。对66名轻度痴呆患者进行的事后亚组分析发现，干预组的功能独立性明显优于常规护理组：在时间2时，DAD量表上的差异为8.99（95%可信区间1.21, 16.79），在时间3时差异为12.16（95%可信区间1.93, 22.38）。经济评估表明，与常规护理相比，I-HARP可能使用的资源更少，但成本效益尚不确定。
对于轻度、中度和重度痴呆症患者群体，主要结局未达成。I-HARP模式似乎使轻度痴呆参与者的功能独立性受益，并可能节省成本。
ACTRN12618000600246。
