Implementing a home-based personalised cognitive rehabilitation intervention for people with mild-to-moderate dementia: GREAT into Practice
Abstract Background Evidence-based rehabilitative interventions, if widely implemented, could equip people with dementia and their families to manage life with the condition and reduce the need for health and care services. The aim of this translational study, building on evidence from the GREAT ran...
| Main Authors: | , , , , , , , , , |
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| Format: | Article |
| Language: | English |
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BMC
2023-02-01
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| Series: | BMC Geriatrics |
| Subjects: | |
| Online Access: | https://doi.org/10.1186/s12877-022-03705-0 |
| _version_ | 1797863603134529536 |
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| author | Linda Clare Aleksandra Kudlicka Rachel Collins Suzannah Evans Jackie Pool Catherine Henderson Martin Knapp Rachael Litherland Jan Oyebode Robert Woods |
| author_facet | Linda Clare Aleksandra Kudlicka Rachel Collins Suzannah Evans Jackie Pool Catherine Henderson Martin Knapp Rachael Litherland Jan Oyebode Robert Woods |
| author_sort | Linda Clare |
| collection | DOAJ |
| description | Abstract Background Evidence-based rehabilitative interventions, if widely implemented, could equip people with dementia and their families to manage life with the condition and reduce the need for health and care services. The aim of this translational study, building on evidence from the GREAT randomised controlled trial, was to develop a foundation for implementing the GREAT Cognitive Rehabilitation intervention in community-based services for people with mild-to-moderate dementia. Methods Key elements of the implementation strategy were identifying and supporting managerial and clinical leadership, conducting collaborative planning and target-setting, training and supporting practitioners, and providing external facilitation. We developed implementation plans with, and trained staff in, 14 organisations. We subsequently worked closely with 11 of these, 10 National Health Service organisations and one private home care provider, to support practitioners to deliver GREAT Cognitive Rehabilitation over a 12-month period. Outcome evaluation examined the perspectives of local steering group members, practitioners and service users, and the reach, effectiveness and cost of the intervention. Results Implementation was disrupted by the COVID-19 pandemic, but six organisations completed at least six months of intervention delivery. Forty-one practitioners, mainly occupational therapists, provided the intervention, and 54 people with dementia completed a course of GREAT Cognitive Rehabilitation. Goal attainment by people with dementia exceeded levels of improvement seen in the original trial. People with dementia, carers, practitioners and steering group members all evaluated the intervention positively, and economic analysis indicated that the intervention could be provided at modest cost. However, we identified a range of mainly organisational barriers that impeded implementation and limited the potential for sustainability. Conclusions GREAT Cognitive Rehabilitation benefits people with dementia, can be delivered effectively at modest cost in routine services, and is viewed positively by people with dementia, family carers and practitioners. To fully realise these benefits and achieve widespread and sustainable implementation, however, requires sufficient resources and a reorientation of service priorities towards preventive and rehabilitative approaches. Trial Registration National Institute for Health Research (NIHR) Central Portfolio Management System, registration number 38994. |
| first_indexed | 2024-04-09T22:38:06Z |
| format | Article |
| id | doaj.art-5539d17dfc6b490389e0b4a2730dfc9a |
| institution | Directory Open Access Journal |
| issn | 1471-2318 |
| language | English |
| last_indexed | 2024-04-09T22:38:06Z |
| publishDate | 2023-02-01 |
| publisher | BMC |
| record_format | Article |
| series | BMC Geriatrics |
| spelling | doaj.art-5539d17dfc6b490389e0b4a2730dfc9a2023-03-22T12:19:08ZengBMCBMC Geriatrics1471-23182023-02-0123111710.1186/s12877-022-03705-0Implementing a home-based personalised cognitive rehabilitation intervention for people with mild-to-moderate dementia: GREAT into PracticeLinda Clare0Aleksandra Kudlicka1Rachel Collins2Suzannah Evans3Jackie Pool4Catherine Henderson5Martin Knapp6Rachael Litherland7Jan Oyebode8Robert Woods9University of Exeter Medical SchoolUniversity of Exeter Medical SchoolUniversity of Exeter Medical SchoolBetsi Cadwaladr University Health BoardQCS Quality Compliance SystemsCare Policy and Evaluation Centre, London School of Economics and Political ScienceCare Policy and Evaluation Centre, London School of Economics and Political ScienceInnovations in Dementia CICCentre for Applied Dementia Studies, Bradford UniversityDementia Services Development Centre, Bangor UniversityAbstract Background Evidence-based rehabilitative interventions, if widely implemented, could equip people with dementia and their families to manage life with the condition and reduce the need for health and care services. The aim of this translational study, building on evidence from the GREAT randomised controlled trial, was to develop a foundation for implementing the GREAT Cognitive Rehabilitation intervention in community-based services for people with mild-to-moderate dementia. Methods Key elements of the implementation strategy were identifying and supporting managerial and clinical leadership, conducting collaborative planning and target-setting, training and supporting practitioners, and providing external facilitation. We developed implementation plans with, and trained staff in, 14 organisations. We subsequently worked closely with 11 of these, 10 National Health Service organisations and one private home care provider, to support practitioners to deliver GREAT Cognitive Rehabilitation over a 12-month period. Outcome evaluation examined the perspectives of local steering group members, practitioners and service users, and the reach, effectiveness and cost of the intervention. Results Implementation was disrupted by the COVID-19 pandemic, but six organisations completed at least six months of intervention delivery. Forty-one practitioners, mainly occupational therapists, provided the intervention, and 54 people with dementia completed a course of GREAT Cognitive Rehabilitation. Goal attainment by people with dementia exceeded levels of improvement seen in the original trial. People with dementia, carers, practitioners and steering group members all evaluated the intervention positively, and economic analysis indicated that the intervention could be provided at modest cost. However, we identified a range of mainly organisational barriers that impeded implementation and limited the potential for sustainability. Conclusions GREAT Cognitive Rehabilitation benefits people with dementia, can be delivered effectively at modest cost in routine services, and is viewed positively by people with dementia, family carers and practitioners. To fully realise these benefits and achieve widespread and sustainable implementation, however, requires sufficient resources and a reorientation of service priorities towards preventive and rehabilitative approaches. Trial Registration National Institute for Health Research (NIHR) Central Portfolio Management System, registration number 38994.https://doi.org/10.1186/s12877-022-03705-0Alzheimer’s diseaseVascular dementiaParkinson’s diseaseDementia with Lewy bodiesActivities of daily livingFunctional ability |
| spellingShingle | Linda Clare Aleksandra Kudlicka Rachel Collins Suzannah Evans Jackie Pool Catherine Henderson Martin Knapp Rachael Litherland Jan Oyebode Robert Woods Implementing a home-based personalised cognitive rehabilitation intervention for people with mild-to-moderate dementia: GREAT into Practice BMC Geriatrics Alzheimer’s disease Vascular dementia Parkinson’s disease Dementia with Lewy bodies Activities of daily living Functional ability |
| title | Implementing a home-based personalised cognitive rehabilitation intervention for people with mild-to-moderate dementia: GREAT into Practice |
| title_full | Implementing a home-based personalised cognitive rehabilitation intervention for people with mild-to-moderate dementia: GREAT into Practice |
| title_fullStr | Implementing a home-based personalised cognitive rehabilitation intervention for people with mild-to-moderate dementia: GREAT into Practice |
| title_full_unstemmed | Implementing a home-based personalised cognitive rehabilitation intervention for people with mild-to-moderate dementia: GREAT into Practice |
| title_short | Implementing a home-based personalised cognitive rehabilitation intervention for people with mild-to-moderate dementia: GREAT into Practice |
| title_sort | implementing a home based personalised cognitive rehabilitation intervention for people with mild to moderate dementia great into practice |
| topic | Alzheimer’s disease Vascular dementia Parkinson’s disease Dementia with Lewy bodies Activities of daily living Functional ability |
| url | https://doi.org/10.1186/s12877-022-03705-0 |
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