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Neurology
Research
A multicentre RCT on community occupational therapy in Alzheimer's disease: 10 sessions are not better than one consultation
  1. Sebastian Voigt-Radloff1,
  2. Maud Graff2,
  3. Rainer Leonhart3,
  4. Katrin Schornstein3,
  5. Frank Jessen4,
  6. Jens Bohlken5,
  7. Brigitte Metz6,
  8. Andreas Fellgiebel7,
  9. Richard Dodel8,
  10. Gerhard Eschweiler9,
  11. Myrra Vernooij-Dassen10,
  12. Marcel Olde Rikkert11,
  13. Michael Hüll12
  1. 1Department of Occupational Therapy, Centre of Geriatric Medicine and Gerontology Freiburg, University Hospital Freiburg, Freiburg, Germany
  2. 2Alzheimer Centre Nijmegen, Scientific Institute for Quality in Health Care and Department of Rehabilitation–Occupational Therapy, Radboud University Nijmegen Medical Centre, Nijmegen, The Netherlands
  3. 3Department of Social Psychology and Methodology, University of Freiburg, Freiburg, Germany
  4. 4Department of Psychiatry and Psychotherapy, University of Bonn, Bonn, Germany
  5. 5Private Practice for Neurology, Psychiatry and Psychotherapy, Berlin, Germany
  6. 6Centre of Geriatric Medicine and Geriatric Clinic at Diakonissenkrankenhaus Karlsruhe-Rüppurr, Karlsruhe, Germany
  7. 7Department of Psychiatry and Psychotherapy, University Medical Center Mainz, Mainz, Germany
  8. 8Department of Neurology, Philipps-University Marburg, Marburg, Germany
  9. 9Department of Psychiatry and Psychotherapy, Eberhard-Karls University Tuebingen, Tübingen, Germany
  10. 10Alzheimer Centre Nijmegen, Scientific Institute for Quality in Health Care, Radboud University Nijmegen Medical Centre, Nijmegen, The Netherlands
  11. 11Department of Geriatrics, Alzheimer Centre Nijmegen, Radboud University Nijmegen Medical Centre, Nijmegen, The Netherlands
  12. 12Section of Gerontopsychiatry and Neuropsychology, Centre of Geriatric Medicine and Gerontology Freiburg, University Hospital Freiburg, Freiburg, Germany
  1. Correspondence to Dr Sebastian Voigt-Radloff; sebastian.voigt{at}uniklinik-freiburg.de

Abstract

Objective To compare the benefits and harms of a Dutch 10-session Community Occupational Therapy programme for patients with Alzheimer's disease with the impact of a one session consultation at home in German routine healthcare.

Design A seven-centre, parallel group, active controlled randomised controlled trial. Patients and carers were not masked. Assessors were fully blind for treatment allocation for one of two primary-outcome measurements.

Setting Patients' homes.

Participants Patients with mild to moderate Alzheimer's disease (Mini-Mental State Examination 14–24), living in the community with primary carer available and without severe depression or behavioural symptoms, were eligible.

Interventions Experimental 10 home visits within 5 weeks by an occupational therapist, educating patients in the performance of simplified daily activities and in the use of aids to compensate for cognitive decline; and educating carers in coping with behaviour of the patient and in giving supervision to the patient. Control one home visit including individual counselling of patient and carer and explanation of a leaflet on coping with dementia in daily life.

Outcome measures The primary outcome was the patient's daily functioning measured with the Interview of Deterioration in Daily activities in Dementia and the Perceive, Recall, Plan and Perform System of Task Analysis. Assessments were at baseline, 6, 16 and 26 weeks, with a postal assessment at 52 weeks.

Results 141 patients were 1:1 randomised to the experimental (N=71) and control group (N=70). Data for 54 and 50 participants were analysed. Patients' daily functioning did not differ significantly between the experimental and control group at week 6, 16, 26 or 52 and remained stable over 26 weeks in both groups. No adverse events were associated with the interventions.

Conclusions In German healthcare, a Dutch 10-session community occupational therapy was not better than a one-session consultation for the daily functioning of patients with Alzheimer's disease. Further research on the transfer of complex psychosocial is needed.

International Clinical Trials Registry Platform DRKS00000053; Funded by the German Federal Ministry of Health.

  • Alzheimer's disease
  • occupational therapy
  • randomised controlled trial
  • dementia
  • geriatric medicine
  • internal medicine
  • palliative care

This is an open-access article distributed under the terms of the Creative Commons Attribution Non-commercial License, which permits use, distribution, and reproduction in any medium, provided the original work is properly cited, the use is non commercial and is otherwise in compliance with the license. See: http://creativecommons.org/licenses/by-nc/2.0/ and http://creativecommons.org/licenses/by-nc/2.0/legalcode.

https://doi.org/10.1136/bmjopen-2011-000096

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    Footnotes

    • To cite: Voigt-Radloff S, Graff M, Leonhart R, et al. A multicentre RCT on community occupational therapy in Alzheimer's disease: 10 sessions are not better than one consultation. BMJ Open 2011;1:e000096. doi:10.1136/bmjopen-2011-000096

    • Funding German Federal Ministry of Health, Reference Number: IIA5-2508FSB111/44-004.

    • Competing interests FJ: membership in DSMB of AC-immune; payment for lectures from Pfizer, Esai and Novartis. BM: payment for lectures from various pharmaceutical companies. RD: consultancy, grants, payment for lectures, patents and meeting expenses from various pharmaceutical companies; royalties and patents from University of Marburg. GE: grants from AC-immune and Janssen-AL. MOR: consultancy for Jansen-Cilag and Numico. MH: grants from Wyeth, Pfizer and Medivation; payment for lectures from Wyeth, Pfizer and Merz.

    • Ethics approval Ethics approval was provided by the Medical Ethics Committee of the University Hospital Freiburg (no 110/08).

    • Contributors SVR, MG, RL, GE and MH contributed to the study conception and design. FJ, JB, BM, AF, RD, GE and MH acquired the data. SVR and KS participated in data and study management, and prepared the statistical analysis. RL performed the statistical analysis. SVR drafted the manuscript. RL, MG, FJ, JB, BM, AF, RD, GE, MOR, MVD and MH revised the manuscript critically for important intellectual content. All authors read and approved the final manuscript.

    • Provenance and peer review Not commissioned; externally peer reviewed.

    • Data sharing statement Complete data sets can be provided on request for fellow researchers in the context of collaborative projects and publications.