Hostname: page-component-8448b6f56d-42gr6 Total loading time: 0 Render date: 2024-04-18T11:18:25.927Z Has data issue: false hasContentIssue false
  • English
  • Français

A pilot randomized controlled trial of a self-management group intervention for people with early-stage dementia (The SMART study)

Published online by Cambridge University Press:  17 December 2015

Catherine Quinn ,
Gill Toms ,
Carys Jones ,
Andrew Brand ,
Rhiannon Tudor Edwards ,
Fiona Sanders  and
Linda Clare
Catherine Quinn*
Affiliation:
REACH: The Centre for Research in Ageing and Cognitive Health, Department of Psychology, College of Life and Environmental Sciences, Exeter University, Exeter, EX4 4QG, UK
Gill Toms
Affiliation:
School of Psychology, Bangor University, Bangor, Gwynedd, LL57 2AS, UK
Carys Jones
Affiliation:
Centre for Health Economics and Medicines Evaluation, Bangor University, Bangor, Gwynedd, LL57 2PZ, UK
Andrew Brand
Affiliation:
North Wales Organization for Randomized Trials in Health, College of Health and Behavior Sciences (CoHABS), Bangor University, Bangor, Gwynedd, LL57 2PZ, UK
Rhiannon Tudor Edwards
Affiliation:
Centre for Health Economics and Medicines Evaluation, Bangor University, Bangor, Gwynedd, LL57 2PZ, UK
Fiona Sanders
Affiliation:
Glan Traeth Community Team, Glan Traeth CPN office, Royal Alexandra Hospital, Betsi Cadwaladr University Health Board, Denbighshire, LL18 3AS, UK
Linda Clare
Affiliation:
REACH: The Centre for Research in Ageing and Cognitive Health, Department of Psychology, College of Life and Environmental Sciences, Exeter University, Exeter, EX4 4QG, UK
*
Correspondence should be addressed to: Dr Catherine Quinn, Exeter University. REACH: The Centre for Research in Ageing and Cognitive Health, Department of Psychology, College of Life and Environmental Sciences, Washington Singer, Perry Road, Exeter, EX4 4QG, UK. Phone: +44 01392 726861. Email: C.Quinn@exeter.ac.uk.
Get access Rights & Permissions [Opens in a new window]

Abstract

Background:

Self-management equips people to manage the symptoms and lifestyle changes that occur in long-term health conditions; however, there is limited evidence about its effectiveness for people with early-stage dementia. This pilot randomized controlled trial (RCT) explored the feasibility of a self-management intervention for people with early-stage dementia.

Methods:

The participants were people with early-stage dementia (n = 24) and for each participant a caregiver also took part. Participants were randomly allocated to either an eight-week self-management group intervention or treatment as usual (TAU). Assessments were conducted at baseline, three months and six months post-randomization by a researcher blind to group allocation. The primary outcome measure was self-efficacy score at three months.

Results:

Thirteen people with dementia were randomized to the intervention and 11 to TAU. Two groups were run, the first consisting of six people with dementia and the second of seven people with dementia. There was a small positive effect on self-efficacy with the intervention group showing gains in self-efficacy compared to the TAU group at three months (d = 0.35), and this was maintained at six months (d = 0.23). In terms of intervention acceptability, attrition was minimal, adherence was good, and satisfaction ratings were high. Feedback from participants was analyzed with content analysis. The findings suggest the positive aspects of the intervention were that it fostered independence and reciprocity, promoted social support, offered information, and provided clinician support.

Conclusions:

This study has provided preliminary evidence that self-management may be beneficial for people with early-stage dementia.

Keywords

psychosocial interventionAlzheimer’s diseaseself-caresupport groupself-efficacy
Type
Research Article
Information
International Psychogeriatrics , Volume 28 , Issue 5 , May 2016 , pp. 787 - 800
Copyright
Copyright © International Psychogeriatric Association 2015 

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

Bandura, A. (1986). Social Foundations of Thought and Action: A Social Cognitive Theory. Englewood Cliffs NJ, USA: Prentice Hall.Google Scholar
Barlow, J., Wright, C., Sheasby, J., Turner, A. and Hainsworth, J. (2002). Self-management approaches for people with chronic conditions: a review. Patient Education and Counseling, 48, 177–187. doi: 10.1016/S0738-3991(02)00032-0.Google Scholar
Buszewicz, M. et al. (2006). Self-management of arthritis in primary care: a randomized controlled trial. BMJ, 333, 879–882. doi: 10.1136/bmj.38965.375718.80.CrossRefGoogle Scholar
Coast, J. et al. (2008). Valuing the ICECAP capability index for older people. Social Science & Medicine, 67, 874–882. doi: 10.1016/j.socscimed.2008.05.015.Google Scholar
de Silva, D. (2011). Helping People Help Themselves: A Review of the Evidence Considering Whether it is Worthwhile to Support Self-Management. London, UK: The Health Foundation.Google Scholar
Department of Health (2005). Self Care–A Real Choice. Self Care Support–A Practical Option. London, UK: Crown Copyright.Google Scholar
Dolan, P. (1997). Modeling valuations for EuroQol Health states. Medical Care, 35, 1095–1108. doi: 10.1097/00005650-199711000-00002.CrossRefGoogle ScholarPubMed
Evans, C. et al. (2002). Towards a standardised brief outcome measure: psychometric properties and utility of the CORE–OM. The British Journal of Psychiatry, 180, 51–60. doi: 10.1192/bjp.180.1.51.CrossRefGoogle ScholarPubMed
Folstein, M. F., Folstein, F. E. and McHugh, P. R. (1975). “Mini-mental state”: a practical method for grading the cognitive state of patients for the clinician. Journal of Psychiatric Research, 12, 189–198. doi: 10.1016/0022-3956(75) 900265-6.CrossRefGoogle ScholarPubMed
Laakkonen, M. L. et al. (2013). Self-management groups for people with dementia and their spousal caregivers. A randomized, controlled trial. Baseline findings and feasibility. European Geriatric Medicine, 4, 389–393. doi: 10.1016/j.eurger.2013.09.006.CrossRefGoogle Scholar
Leventhal, H., Brisette, I. and Leventhal, E. A. (2003). The common-sense model of self-regulation of health and illness. In Cameron, L. D. and Leventhal, H. (eds.), The Self-Regulation of Health and Illness Behavior (pp. 42–65). Oxon, UK: Psychology Press.Google Scholar
Lorig, K. R. et al. (1999). Evidence suggesting that a chronic disease self-management program can improve health status while reducing hospitalization: a randomized trial. Medical Care, 37, 5–14. doi: 10.1097/00005650-199901000-00003.Google Scholar
Luszczynska, A., Gutiérrez-Doňa, B. and Schwarzer, R. (2005). General self-efficacy in various domains of human functioning: evidence from five countries. International Journal of Psychology, 40, 80–89. doi: 10.1080/00207590444000041.Google Scholar
Marshall, A., Bucks, R. and Mander, H. (2005). A long-term support group for people with dementia. Journal of Dementia Care, 13, 36–37.Google Scholar
Martin, F., Turner, A., Wallace, L. M., Stanley, D., Jesuthasan, J. and Bradbury, N. (2015). Qualitative evaluation of a self-management intervention for people in the early stage of dementia. Dementia, 14, 418–435. doi: 10.1177/1471301213498387.CrossRefGoogle ScholarPubMed
Mason, E., Clare, L. and Pistrang, L. (2005). Processes and experiences of mutual support in professionally-led support groups for people with early-stage dementia. Dementia, 4, 87–112. doi: 10.1177/1471301205049192.Google Scholar
Mioshi, E., Dawson, K., Mitchell, J., Arnold, R. and Hodges, J. R. (2006). The addenbrooke's cognitive examination–revised (ACE-R): a brief cognitive test battery for dementia screening. International Journal of Geriatric Psychiatry, 21, 1078–1085. doi: 10.1002/gps.1610.Google Scholar
National Health Priority Action council (2006). National Chronic Disease Strategy. Canberra, Australia: Australian Government Department of Health and Ageing.Google Scholar
Prince, M., Bryce, R. and Ferri, C. (2011). World Alzheimer's Report 2011. The Benefits of Early Diagnosis and Intervention. London, UK: Alzheimer's Disease International.Google Scholar
Quinn, C., Toms, G., Anderson, D. and Clare, L. (2015). A review of self-management interventions for people with dementia and mild cognitive impairment. Journal of Applied Gerontology. Advanced Online Publication. doi: 10.1177/0733464814566852.Google ScholarPubMed
Quinn, C. et al. (2014). Self-management in early-stage dementia: a pilot randomised controlled trial of the efficacy and cost-effectiveness of a self-management group intervention (the SMART Study). Trials, 15, 74. doi:10.1186/1745-6215-15-74.CrossRefGoogle ScholarPubMed
Russell, D., Hoare, Z. S., Whitaker, R., Whitaker, C. J. and Russell, I. T. (2011). Generalized method for adaptive randomization in clinical trials. Statistics in Medicine, 30, 922–934. doi: 10.1002/sim.4175.CrossRefGoogle ScholarPubMed
Schwarzer, R. and Jerusalem, M. (1995). Generalized Self-efficacy Scale. Windsor, UK: NFER-NELSON.Google Scholar
Thabane, L. et al. (2010). A tutorial on pilot studies: the what, why and how. BMC Medical Research Methodology, 10, 1. doi: 10.1186/1471-2288-10-1.Google Scholar
The EuroQol group (1990). EuroQol - a new facility for the measurement of health-related quality of life. Health Policy, 16, 199–208. doi: 10.1016/0168-8510(90)90421-9.Google Scholar
Toms, G. R., Quinn, C., Anderson, D. E. and Clare, L. (2015). Help yourself: perspectives on self-management from people with dementia and their caregivers. Qualitative Health Research, 25, 87–98. doi: 10.1177/1049732314549604.CrossRefGoogle ScholarPubMed
Zigmond, A. S. and Snaith, R. P. (1983). The hospital anxiety and depression scale. Psychiatrica Scandinavia, 67, 361–370. doi: 10.1111/j.1600-0447.1983.tb09716.x.Google Scholar
World Health Organization (1992). The ICD-10 Classification of Mental and Behavioral Disorders: Clinical Descriptions and Diagnostic Guidelines. Geneva, Switzerland: World Health Organization Division of Mental Health.Google Scholar