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Community Occupational Therapy for people with dementia and family carers (COTiD-UK) versus treatment as usual (Valuing Active Life in Dementia [VALID]) study: A single-blind, randomised controlled trial

Research output: Contribution to journalArticlepeer-review

Standard

Community Occupational Therapy for people with dementia and family carers (COTiD-UK) versus treatment as usual (Valuing Active Life in Dementia [VALID]) study : A single-blind, randomised controlled trial. / Wenborn, Jennifer; O’Keeffe, Aidan G.; Mountain, Gail; Moniz-Cook, Esme; King, Michael; Omar, Rumana Z.; Mundy, Jacqueline; Burgess, Jane; Poland, Fiona; Morris, Stephen; Pizzo, Elena; Vernooij-Dassen, Myrra; Challis, David; Michie, Susan; Russell, Ian; Sackley, Catherine; Graff, Maud; Swinson, Tom; Crellin, Nadia; Hynes, Sinéad; Stansfeld, Jacki; Orrell, Martin.

In: PLoS Medicine, Vol. 18, No. 1, e1003433, 04.01.2021.

Research output: Contribution to journalArticlepeer-review

Harvard

Wenborn, J, O’Keeffe, AG, Mountain, G, Moniz-Cook, E, King, M, Omar, RZ, Mundy, J, Burgess, J, Poland, F, Morris, S, Pizzo, E, Vernooij-Dassen, M, Challis, D, Michie, S, Russell, I, Sackley, C, Graff, M, Swinson, T, Crellin, N, Hynes, S, Stansfeld, J & Orrell, M 2021, 'Community Occupational Therapy for people with dementia and family carers (COTiD-UK) versus treatment as usual (Valuing Active Life in Dementia [VALID]) study: A single-blind, randomised controlled trial', PLoS Medicine, vol. 18, no. 1, e1003433. https://doi.org/10.1371/journal.pmed.1003433

APA

Wenborn, J., O’Keeffe, A. G., Mountain, G., Moniz-Cook, E., King, M., Omar, R. Z., Mundy, J., Burgess, J., Poland, F., Morris, S., Pizzo, E., Vernooij-Dassen, M., Challis, D., Michie, S., Russell, I., Sackley, C., Graff, M., Swinson, T., Crellin, N., ... Orrell, M. (2021). Community Occupational Therapy for people with dementia and family carers (COTiD-UK) versus treatment as usual (Valuing Active Life in Dementia [VALID]) study: A single-blind, randomised controlled trial. PLoS Medicine, 18(1), [e1003433]. https://doi.org/10.1371/journal.pmed.1003433

Vancouver

Wenborn J, O’Keeffe AG, Mountain G, Moniz-Cook E, King M, Omar RZ et al. Community Occupational Therapy for people with dementia and family carers (COTiD-UK) versus treatment as usual (Valuing Active Life in Dementia [VALID]) study: A single-blind, randomised controlled trial. PLoS Medicine. 2021 Jan 4;18(1). e1003433. https://doi.org/10.1371/journal.pmed.1003433

Author

Wenborn, Jennifer ; O’Keeffe, Aidan G. ; Mountain, Gail ; Moniz-Cook, Esme ; King, Michael ; Omar, Rumana Z. ; Mundy, Jacqueline ; Burgess, Jane ; Poland, Fiona ; Morris, Stephen ; Pizzo, Elena ; Vernooij-Dassen, Myrra ; Challis, David ; Michie, Susan ; Russell, Ian ; Sackley, Catherine ; Graff, Maud ; Swinson, Tom ; Crellin, Nadia ; Hynes, Sinéad ; Stansfeld, Jacki ; Orrell, Martin. / Community Occupational Therapy for people with dementia and family carers (COTiD-UK) versus treatment as usual (Valuing Active Life in Dementia [VALID]) study : A single-blind, randomised controlled trial. In: PLoS Medicine. 2021 ; Vol. 18, No. 1.

Bibtex Download

@article{f8511e3a5e0640b7a2ec34ad990255df,
title = "Community Occupational Therapy for people with dementia and family carers (COTiD-UK) versus treatment as usual (Valuing Active Life in Dementia [VALID]) study: A single-blind, randomised controlled trial",
abstract = "Background We aimed to estimate the clinical effectiveness of Community Occupational Therapy for people with dementia and family carers–UK version (Community Occupational Therapy in Dementia–UK version [COTiD-UK]) relative to treatment as usual (TAU). We hypothesised that COTiD-UK would improve the ability of people with dementia to perform activities of daily living (ADL), and family carers{\textquoteright} sense of competence, compared with TAU. Methods and findings The study design was a multicentre, 2-arm, parallel-group, assessor-masked, individually randomised controlled trial (RCT) with internal pilot. It was conducted in 15 sites across England from September 2014 to January 2018. People with a diagnosis of mild to moderate dementia living in their own home were recruited in pairs with a family carer who provided domestic or personal support for at least 4 hours per week. Pairs were randomised to either receive COTiD-UK, which comprised 10 hours of occupational therapy delivered over 10 weeks in the person with dementia{\textquoteright}s home or TAU, which comprised the usual local service provision that may or may not include standard occupational therapy. The primary outcome was the Bristol Activities of Daily Living Scale (BADLS) score at 26 weeks. Secondary outcomes for the person with dementia included the following: the BADLS scores at 52 and 78 weeks, cognition, quality of life, and mood; and for the family carer: sense of competence and mood; plus the number of social contacts and leisure activities for both partners. Participants were analysed by treatment allocated. A total of 468 pairs were recruited: people with dementia ranged from 55 to 97 years with a mean age of 78.6 and family carers ranged from 29 to 94 with a mean of 69.1 years. Of the people with dementia, 74.8% were married and 19.2% lived alone. Of the family carers, 72.6% were spouses, and 22.2% were adult children. On randomisation, 249 pairs were assigned to COTiD-UK (62% people with dementia and 23% carers were male) and 219 to TAU (52% people with dementia and 32% carers were male). At the 26 weeks follow-up, data were available for 364 pairs (77.8%). The BADLS score at 26 weeks did not differ significantly between groups (adjusted mean difference estimate 0.35, 95% CI −0.81 to 1.51; p = 0.55). Secondary outcomes did not differ between the groups. In total, 91% of the activity-based goals set by the pairs taking part in the COTiD-UK intervention were fully or partially achieved by the final COTiD-UK session. Study limitations include the following: Intervention fidelity was moderate but varied across and within sites, and the reliance on primarily proxy data focused on measuring the level of functional or cognitive impairment which may not truly reflect the actual performance and views of the person living with dementia. Conclusions Providing community occupational therapy as delivered in this study did not improve ADL performance, cognition, quality of life, or mood in people with dementia nor sense of competence or mood in family carers. Future research should consider measuring person-centred outcomes that are more meaningful and closely aligned to participants{\textquoteright} priorities, such as goal achievement or the quantity and quality of activity engagement and participation.",
author = "Jennifer Wenborn and O{\textquoteright}Keeffe, {Aidan G.} and Gail Mountain and Esme Moniz-Cook and Michael King and Omar, {Rumana Z.} and Jacqueline Mundy and Jane Burgess and Fiona Poland and Stephen Morris and Elena Pizzo and Myrra Vernooij-Dassen and David Challis and Susan Michie and Ian Russell and Catherine Sackley and Maud Graff and Tom Swinson and Nadia Crellin and Sin{\'e}ad Hynes and Jacki Stansfeld and Martin Orrell",
year = "2021",
month = jan,
day = "4",
doi = "10.1371/journal.pmed.1003433",
language = "English",
volume = "18",
journal = "PL o S Medicine",
issn = "1549-1277",
publisher = "Public Library of Science",
number = "1",

}

RIS (suitable for import to EndNote) Download

TY - JOUR

T1 - Community Occupational Therapy for people with dementia and family carers (COTiD-UK) versus treatment as usual (Valuing Active Life in Dementia [VALID]) study

T2 - A single-blind, randomised controlled trial

AU - Wenborn, Jennifer

AU - O’Keeffe, Aidan G.

AU - Mountain, Gail

AU - Moniz-Cook, Esme

AU - King, Michael

AU - Omar, Rumana Z.

AU - Mundy, Jacqueline

AU - Burgess, Jane

AU - Poland, Fiona

AU - Morris, Stephen

AU - Pizzo, Elena

AU - Vernooij-Dassen, Myrra

AU - Challis, David

AU - Michie, Susan

AU - Russell, Ian

AU - Sackley, Catherine

AU - Graff, Maud

AU - Swinson, Tom

AU - Crellin, Nadia

AU - Hynes, Sinéad

AU - Stansfeld, Jacki

AU - Orrell, Martin

PY - 2021/1/4

Y1 - 2021/1/4

N2 - Background We aimed to estimate the clinical effectiveness of Community Occupational Therapy for people with dementia and family carers–UK version (Community Occupational Therapy in Dementia–UK version [COTiD-UK]) relative to treatment as usual (TAU). We hypothesised that COTiD-UK would improve the ability of people with dementia to perform activities of daily living (ADL), and family carers’ sense of competence, compared with TAU. Methods and findings The study design was a multicentre, 2-arm, parallel-group, assessor-masked, individually randomised controlled trial (RCT) with internal pilot. It was conducted in 15 sites across England from September 2014 to January 2018. People with a diagnosis of mild to moderate dementia living in their own home were recruited in pairs with a family carer who provided domestic or personal support for at least 4 hours per week. Pairs were randomised to either receive COTiD-UK, which comprised 10 hours of occupational therapy delivered over 10 weeks in the person with dementia’s home or TAU, which comprised the usual local service provision that may or may not include standard occupational therapy. The primary outcome was the Bristol Activities of Daily Living Scale (BADLS) score at 26 weeks. Secondary outcomes for the person with dementia included the following: the BADLS scores at 52 and 78 weeks, cognition, quality of life, and mood; and for the family carer: sense of competence and mood; plus the number of social contacts and leisure activities for both partners. Participants were analysed by treatment allocated. A total of 468 pairs were recruited: people with dementia ranged from 55 to 97 years with a mean age of 78.6 and family carers ranged from 29 to 94 with a mean of 69.1 years. Of the people with dementia, 74.8% were married and 19.2% lived alone. Of the family carers, 72.6% were spouses, and 22.2% were adult children. On randomisation, 249 pairs were assigned to COTiD-UK (62% people with dementia and 23% carers were male) and 219 to TAU (52% people with dementia and 32% carers were male). At the 26 weeks follow-up, data were available for 364 pairs (77.8%). The BADLS score at 26 weeks did not differ significantly between groups (adjusted mean difference estimate 0.35, 95% CI −0.81 to 1.51; p = 0.55). Secondary outcomes did not differ between the groups. In total, 91% of the activity-based goals set by the pairs taking part in the COTiD-UK intervention were fully or partially achieved by the final COTiD-UK session. Study limitations include the following: Intervention fidelity was moderate but varied across and within sites, and the reliance on primarily proxy data focused on measuring the level of functional or cognitive impairment which may not truly reflect the actual performance and views of the person living with dementia. Conclusions Providing community occupational therapy as delivered in this study did not improve ADL performance, cognition, quality of life, or mood in people with dementia nor sense of competence or mood in family carers. Future research should consider measuring person-centred outcomes that are more meaningful and closely aligned to participants’ priorities, such as goal achievement or the quantity and quality of activity engagement and participation.

AB - Background We aimed to estimate the clinical effectiveness of Community Occupational Therapy for people with dementia and family carers–UK version (Community Occupational Therapy in Dementia–UK version [COTiD-UK]) relative to treatment as usual (TAU). We hypothesised that COTiD-UK would improve the ability of people with dementia to perform activities of daily living (ADL), and family carers’ sense of competence, compared with TAU. Methods and findings The study design was a multicentre, 2-arm, parallel-group, assessor-masked, individually randomised controlled trial (RCT) with internal pilot. It was conducted in 15 sites across England from September 2014 to January 2018. People with a diagnosis of mild to moderate dementia living in their own home were recruited in pairs with a family carer who provided domestic or personal support for at least 4 hours per week. Pairs were randomised to either receive COTiD-UK, which comprised 10 hours of occupational therapy delivered over 10 weeks in the person with dementia’s home or TAU, which comprised the usual local service provision that may or may not include standard occupational therapy. The primary outcome was the Bristol Activities of Daily Living Scale (BADLS) score at 26 weeks. Secondary outcomes for the person with dementia included the following: the BADLS scores at 52 and 78 weeks, cognition, quality of life, and mood; and for the family carer: sense of competence and mood; plus the number of social contacts and leisure activities for both partners. Participants were analysed by treatment allocated. A total of 468 pairs were recruited: people with dementia ranged from 55 to 97 years with a mean age of 78.6 and family carers ranged from 29 to 94 with a mean of 69.1 years. Of the people with dementia, 74.8% were married and 19.2% lived alone. Of the family carers, 72.6% were spouses, and 22.2% were adult children. On randomisation, 249 pairs were assigned to COTiD-UK (62% people with dementia and 23% carers were male) and 219 to TAU (52% people with dementia and 32% carers were male). At the 26 weeks follow-up, data were available for 364 pairs (77.8%). The BADLS score at 26 weeks did not differ significantly between groups (adjusted mean difference estimate 0.35, 95% CI −0.81 to 1.51; p = 0.55). Secondary outcomes did not differ between the groups. In total, 91% of the activity-based goals set by the pairs taking part in the COTiD-UK intervention were fully or partially achieved by the final COTiD-UK session. Study limitations include the following: Intervention fidelity was moderate but varied across and within sites, and the reliance on primarily proxy data focused on measuring the level of functional or cognitive impairment which may not truly reflect the actual performance and views of the person living with dementia. Conclusions Providing community occupational therapy as delivered in this study did not improve ADL performance, cognition, quality of life, or mood in people with dementia nor sense of competence or mood in family carers. Future research should consider measuring person-centred outcomes that are more meaningful and closely aligned to participants’ priorities, such as goal achievement or the quantity and quality of activity engagement and participation.

UR - http://www.scopus.com/inward/record.url?scp=85099332253&partnerID=8YFLogxK

U2 - 10.1371/journal.pmed.1003433

DO - 10.1371/journal.pmed.1003433

M3 - Article

C2 - 33395437

AN - SCOPUS:85099332253

VL - 18

JO - PL o S Medicine

JF - PL o S Medicine

SN - 1549-1277

IS - 1

M1 - e1003433

ER -

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