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Effectiveness of a nurse-supported self-management programme for dual sensory impaired older adults in long-term care: a cluster randomised controlled trial
  1. Lieve M Roets-Merken1,2,
  2. Sytse U Zuidema3,
  3. Myrra J F J Vernooij-Dassen1,4,
  4. Steven Teerenstra5,
  5. Pieter G J M Hermsen6,
  6. Gertrudis I J M Kempen7,
  7. Maud J L Graff1,4
  1. 1 Radboud University Medical Center, Donders Center for Cognition, Brain and Behavior, Scientific Institute for Quality of Healthcare, Nijmegen, The Netherlands
  2. 2 Kalorama Foundation, Beek-Ubbergen, The Netherlands
  3. 3 Department of General Practice and Elderly Care Medicine, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
  4. 4 Radboud University Medical Center, IQ Healthcare, Scientific Institute for Quality of Healthcare, Nijmegen, The Netherlands
  5. 5 Department for Health Evidence, Radboud University Medical Center, Nijmegen, The Netherlands
  6. 6 Severinus Foundation, Veldhoven, The Netherlands
  7. 7 Department of Health Services Research, CAPHRI School for Public Health and Primary Care, Maastricht University, Maastricht, The Netherlands
  1. Correspondence to Lieve M Roets-Merken; lieve.roets-merken{at}


Objective To evaluate the effectiveness of a nurse-supported self-management programme to improve social participation of dual sensory impaired older adults in long-term care homes.

Design Cluster randomised controlled trial.

Setting Thirty long-term care homes across the Netherlands.

Participants Long-term care homes were randomised into intervention clusters (n=17) and control clusters (n=13), involving 89 dual sensory impaired older adults and 56 licensed practical nurses.

Intervention Nurse-supported self-management programme.

Measurements Effectiveness was evaluated by the primary outcome social participation using a participation scale adapted for visually impaired older adults distinguishing four domains: instrumental activities of daily living, social-cultural activities, high-physical-demand and low-physical-demand leisure activities. A questionnaire assessing hearing-related participation problems was added as supportive outcome. Secondary outcomes were autonomy, control, mood and quality of life and nurses’ job satisfaction. For effectiveness analyses, linear mixed models were used. Sampling and intervention quality were analysed using descriptive statistics.

Results Self-management did not affect all four domains of social participation; however. the domain ‘instrumental activities of daily living’ had a significant effect in favour of the intervention group (P=0.04; 95% CI 0.12 to 8.5). Sampling and intervention quality was adequate.

Conclusions A nurse-supported self-management programme was effective in empowering the dual sensory impaired older adults to address the domain ‘instrumental activities of daily living’, but no differences were found in addressing the other three participation domains. Self-management showed to be beneficial for managing practical problems, but not for those problems requiring behavioural adaptations of other persons.

Trial registration number NCT01217502; Results.

  • dual sensory loss
  • long-term care
  • licensed practical nurses
  • self-management
  • social participation
  • geriatric nursing

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  • Contributors LMR-M, SUZ, MJFJV-D, GIJMK and MJLG performed the study concept and design, LMR-M and PGJMH the acquisition of participants and ST and LMR-M the data analysis. All authors were involved in revising the manuscript and read and approved the final version of the manuscript. The corresponding author and all coauthors had full access to the study data and had final responsibility for the decision to submit for publication.

  • Funding This study was financially supported by the Joannes de Deo Foundation and the Mother Catharina Fund, the Netherlands.

  • Disclaimer The sponsors had no role in the design, methods, subject recruitment, data collections, analysis or preparation of the report.

  • Competing interests None declared.

  • Patient consent Obtained.

  • Ethics approval The study design and protocol has been approved by the Dutch Committee on Research involving Human Subjects region Arnhem-Nijmegen, ABR 26192.091.08. Informed consent was completed by all participants before starting the assessments and interventions.

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

  • Data sharing statement The dataset and statistical code are available from the Data Archiving and Networking Service (DANS).

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