Marja-Liisa Laakkonen1,2,3, Hannu Kautiainen2,3, Eeva Hölttä2,3,4, Niina Savikko2,3,5, Reijo S Tilvis6,7,8, Timo E Strandberg6,7,8,9,10, Kaisu H Pitkälä2,3. 1. Geriatric Clinic, Department of Social Services and Health Care, Laakso Hospital, Helsinki, Finland. 2. Department of General Practice, University of Helsinki, Helsinki, Finland. 3. Unit of Primary Health Care, Helsinki University Central Hospital, Helsinki, Finland. 4. Geriatric Psychiatric Clinics, Department of Social Services and Health Care, Laakso Hospital, Helsinki, Finland. 5. Department of Home Care, Espoo, Finland. 6. Department of General Internal Medicine and Geriatrics, University of Helsinki, Helsinki, Finland. 7. General Internal Medicine, Helsinki University Central Hospital, Helsinki, Finland. 8. Geriatrics Clinics, Helsinki University Central Hospital, Helsinki, Finland. 9. Division of Geriatrics, Institute of Health Sciences, University of Oulu, Oulu, Finland. 10. Unit of General Practice, Oulu University Hospital, Oulu, Finland.
Abstract
OBJECTIVES: To investigate the effect of self-management group rehabilitation for persons with dementia (PwD) and their spouses on their health-related quality of life (HRQoL), the cognition of the PwD, and the costs of health and social services. DESIGN: A randomized controlled trial. SETTING:Primary care and memory clinics in the Helsinki metropolitan area, Finland. PARTICIPANTS: PwD (N = 136) and their spouses (N = 136). INTERVENTION: Couples were randomized to usual care or eight-session self-management groups for PwD and concurrently for their spouses. Sessions aim to enhance self-efficacy and problem-solving skills and to provide peer support. MEASUREMENTS: The primary outcome measures were the HRQoL of PwD (measured using a generic, comprehensive (15-dimensional), self-administered instrument (15D)) and spouses (measured using the RAND-36) and the spousal Sense of Competence Questionnaire (SCQ). Secondary outcome measures were PwD cognition (Verbal Fluency (VF), Clock Drawing Test (CDT)) and costs of health and social services during 24 months. RESULTS: At 3 months, the spouse physical component of the RAND-36 improved (mean change 1.0, 95% confidence interval (CI) = -0.5 to 2.4) for those undergoing the intervention and worsened for controls (mean change -2.0, 95% CI = -3.5 to -0.4) (P = .006 adjusted for age, sex, baseline value of the physical component of the RAND-36). There were no differences between the groups on the mental component of the RAND-36, the SCQ, or the 15D. At 9 months, PwD change in VF was -0.38 (95% CI = -1.03 to 0.27) in intervention group and -1.60 (95% CI = -2.26 to -0.94) for controls (P = .011 adjusted for age, sex, baseline MMSE score). CDT changes were similar to VF changes. Differences in incremental costs between the groups was -436 € per person per year (95% CI = -4,986 to 4,115) for PwD (P = .35 adjusted for age, CDR) and -896 € per person per year (95% CI = -3,657 to 1,864) for spouses (P = .51 adjusted for PwD age, CDR). CONCLUSIONS: The intervention had beneficial effects on the HRQoL of spouses and the cognitive function of PwD without increasing total costs. TRIAL REGISTRATION: anzctr.org.au Identifier: ACTRN12611001173987.
RCT Entities:
OBJECTIVES: To investigate the effect of self-management group rehabilitation for persons with dementia (PwD) and their spouses on their health-related quality of life (HRQoL), the cognition of the PwD, and the costs of health and social services. DESIGN: A randomized controlled trial. SETTING: Primary care and memory clinics in the Helsinki metropolitan area, Finland. PARTICIPANTS: PwD (N = 136) and their spouses (N = 136). INTERVENTION: Couples were randomized to usual care or eight-session self-management groups for PwD and concurrently for their spouses. Sessions aim to enhance self-efficacy and problem-solving skills and to provide peer support. MEASUREMENTS: The primary outcome measures were the HRQoL of PwD (measured using a generic, comprehensive (15-dimensional), self-administered instrument (15D)) and spouses (measured using the RAND-36) and the spousal Sense of Competence Questionnaire (SCQ). Secondary outcome measures were PwD cognition (Verbal Fluency (VF), Clock Drawing Test (CDT)) and costs of health and social services during 24 months. RESULTS: At 3 months, the spouse physical component of the RAND-36 improved (mean change 1.0, 95% confidence interval (CI) = -0.5 to 2.4) for those undergoing the intervention and worsened for controls (mean change -2.0, 95% CI = -3.5 to -0.4) (P = .006 adjusted for age, sex, baseline value of the physical component of the RAND-36). There were no differences between the groups on the mental component of the RAND-36, the SCQ, or the 15D. At 9 months, PwD change in VF was -0.38 (95% CI = -1.03 to 0.27) in intervention group and -1.60 (95% CI = -2.26 to -0.94) for controls (P = .011 adjusted for age, sex, baseline MMSE score). CDT changes were similar to VF changes. Differences in incremental costs between the groups was -436 € per person per year (95% CI = -4,986 to 4,115) for PwD (P = .35 adjusted for age, CDR) and -896 € per person per year (95% CI = -3,657 to 1,864) for spouses (P = .51 adjusted for PwD age, CDR). CONCLUSIONS: The intervention had beneficial effects on the HRQoL of spouses and the cognitive function of PwD without increasing total costs. TRIAL REGISTRATION: anzctr.org.au Identifier: ACTRN12611001173987.
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