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      Individual goal‐oriented cognitive rehabilitation to improve everyday functioning for people with early‐stage dementia: A multicentre randomised controlled trial (the GREAT trial)

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          Abstract

          Objectives

          To determine whether individual goal‐oriented cognitive rehabilitation (CR) improves everyday functioning for people with mild‐to‐moderate dementia.

          Design and methods

          Parallel group multicentre single‐blind randomised controlled trial (RCT) comparing CR added to usual treatment (CR) with usual treatment alone (TAU) for people with an ICD‐10 diagnosis of Alzheimer, vascular or mixed dementia, and mild‐to‐moderate cognitive impairment (Mini‐Mental State Examination [MMSE] score ≥ 18), and with a family member willing to contribute. Participants allocated to CR received 10 weekly sessions over 3 months and four maintenance sessions over 6 months. Participants were followed up 3 and 9 months post randomisation by blinded researchers. The primary outcome was self‐reported goal attainment at 3 months. Secondary outcomes at 3 and 9 months included informant‐reported goal attainment, quality of life, mood, self‐efficacy, and cognition and study partner stress and quality of life.

          Results

          We randomised (1:1) 475 people with dementia; 445 (CR = 281) were included in the intention to treat analysis at 3 months and 426 (CR = 208) at 9 months. At 3 months, there were statistically significant large positive effects for participant‐rated goal attainment (d = 0.97; 95% CI, 0.75‐1.19), corroborated by informant ratings (d = 1.11; 95% CI, 0.89‐1.34). These effects were maintained at 9 months for both participant (d = 0.94; 95% CI, 0.71‐1.17) and informant (d = 0.96; 95% CI, 0.73‐1.2) ratings. The observed gains related to goals directly targeted in the therapy. There were no significant differences in secondary outcomes.

          Conclusions

          CR enables people with early‐stage dementia to improve their everyday functioning in relation to individual goals targeted in the therapy.

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          Most cited references17

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          The Canadian Occupational Performance Measure: A Research and Clinical Literature Review

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            Reliability and validity of the Canadian Occupational Performance Measure in stroke patients.

            To research test-retest reliability and discriminant validity of the Canadian Occupational Performance Measure (COPM), a client-centred outcome measure, in stroke patients. The COPM was administered twice with a mean interval of eight days (SD 2.5, range 5-16). On both occasions the patient identified a maximum of five problems in daily activities. The problems of both interviews were compared. The problems identified during the first COPM were rated by the patient on a performance and satisfaction rating scale on both occasions. The individually identified items with use of the client-centred COPM were compared with the fixed items of standardized measures (Barthel Index, Frenchay Activities Index, Stroke Adapted Sickness Impact Profile-30, Euroqol 5D and Rankin Scale). Patients were interviewed at their place of residence. Twenty-six stroke patients participated, 11 men and 15 women, aged from 26 to 83 years (mean 68, SD 15). Twenty-four patients were six months, two patients were two months post stroke. Of the 115 problems identified during the first COPM, 64 (56%) were also identified the second time. Correlation coefficients for the scores were 0.89 (p < 0.001) for performance and 0.88 (p < 0.001) for satisfaction. Of the individual problems identified with the COPM, 25% or less were present in the standardized measures. Correlations between the scores on the COPM and the standardized measures were low and nonsignificant, while all standardized measures correlated significantly with each other. Test-retest reliability of the COPM was moderate for the item pool but was good for the performance and satisfaction scores. Discriminant validity was confirmed. Many patient-unique problems identified with the COPM were not evaluated by standardized measures.
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              Towards a comprehensive model of cognitive rehabilitation

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                Author and article information

                Contributors
                l.clare@exeter.ac.uk
                Journal
                Int J Geriatr Psychiatry
                Int J Geriatr Psychiatry
                10.1002/(ISSN)1099-1166
                GPS
                International Journal of Geriatric Psychiatry
                John Wiley and Sons Inc. (Hoboken )
                0885-6230
                1099-1166
                01 March 2019
                May 2019
                : 34
                : 5 ( doiID: 10.1002/gps.v34.5 )
                : 709-721
                Affiliations
                [ 1 ] Centre for Research in Ageing and Cognitive Health University of Exeter Exeter UK
                [ 2 ] School of Dementia Studies University of Bradford Bradford UK
                [ 3 ] The RICE Centre Royal United Hospital Bath UK
                [ 4 ] Division of Population Medicine, Cardiff University University Llandough Hospital Penarth UK
                [ 5 ] Department of Neuroscience and Experimental Psychology, Jean McFarlane Building University of Manchester Manchester UK
                [ 6 ] Department of Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience, St Thomas' Hospital King's College London London UK
                [ 7 ] Centre of the Health of the Elderly Northumberland Tyne and Wear NHS Foundation Trust Newcastle upon Tyne UK
                [ 8 ] Kent and Medway NHS Partnership Trust St Martin's Hospital Canterbury UK
                [ 9 ] Dementia Pal Ltd. Southampton UK
                [ 10 ] North Wales Organisation for Randomised Trials in Health Bangor University Bangor UK
                [ 11 ] Personal Social Services Research Unit London School of Economics and Political Science London UK
                [ 12 ] Dementia Services Development Centre Bangor University Bangor UK
                Author notes
                [*] [* ] Correspondence

                L. Clare, Centre for Research in Ageing and Cognitive Health, University of Exeter, Exeter, EX1 2LU, UK.

                Email: l.clare@ 123456exeter.ac.uk

                Author information
                https://orcid.org/0000-0003-3989-5318
                https://orcid.org/0000-0002-6955-9043
                https://orcid.org/0000-0002-0263-8740
                https://orcid.org/0000-0002-7953-5985
                https://orcid.org/0000-0002-7514-248X
                https://orcid.org/0000-0003-1822-3643
                https://orcid.org/0000-0003-0526-3160
                https://orcid.org/0000-0003-2728-996X
                https://orcid.org/0000-0001-6950-5451
                https://orcid.org/0000-0001-6304-0753
                https://orcid.org/0000-0002-6942-0404
                https://orcid.org/0000-0003-4340-4702
                https://orcid.org/0000-0003-1803-5482
                https://orcid.org/0000-0003-1427-0215
                https://orcid.org/0000-0002-6781-651X
                Article
                GPS5076 GPS-18-0391.R1
                10.1002/gps.5076
                6593854
                30724405
                9fcd3907-2f5c-41f6-9c0a-1e4f18d17e0d
                © 2019 The Authors. International Journal of Geriatric Psychiatry Published by John Wiley & Sons Ltd.

                This is an open access article under the terms of the http://creativecommons.org/licenses/by-nc/4.0/ License, which permits use, distribution and reproduction in any medium, provided the original work is properly cited and is not used for commercial purposes.

                History
                : 12 September 2018
                : 28 January 2019
                Page count
                Figures: 1, Tables: 3, Pages: 13, Words: 4191
                Funding
                Funded by: National Institute for Health, Health Technology Assessment Programme
                Award ID: 11/15/04
                Categories
                Research Article
                Research Articles
                Custom metadata
                2.0
                gps5076
                May 2019
                Converter:WILEY_ML3GV2_TO_NLMPMC version:5.6.5 mode:remove_FC converted:26.06.2019

                Geriatric medicine
                activities of daily living,alzheimer disease,disability,goal‐setting,nonpharmacological intervention,person‐centred,problem‐solving,reablement,vascular dementia

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