Do occupational therapy interventions improve quality of life in persons with dementia? A meta‐analysis with implications for future directions

Occupational therapy (OT) interventions have shown positive effects on physical functioning in persons with dementia (PwD). However, their effect on quality of life (QoL) has been inconsistent in individual clinical trials. The present review appraises current evidence for the use of OT interventions in improving QoL of PwD. Records in the Cochrane Database, MEDLINE, EMBASE, PsycINFO, and Cumulative Index to Nursing and Allied Health Literature were searched for relevant citations, and PubMed was searched for in‐process articles. Additional searches of the reference lists of retrieved articles were undertaken. Ten studies involving 1002 PwD met the criteria for syntheses. OT intervention produced small non‐significant improvements in overall QoL. The evidence from the present review does not support the specific use of OT interventions for the improvement of QoL in PwD under pragmatic clinical conditions at this time. They may be best used as part of a comprehensive range of interventions for PwD. Recommendations are made for future design of OT interventions focusing on the improvement of QoL, which is central to the well‐being of PwD.     

Innovations in Practice: Empowering Parents,Empowering Communities: A pilot evaluation of a peer‐led parenting programme

Background: Efficacious parenting interventions are under‐utilised in mainstream services. Empowering Parents, Empowering Communities (EPEC) aims to increase community access to effective parenting support through a peer‐led manualised intervention. Method: Training outcomes, clinical effectiveness and acceptability of EPEC were evaluated using a pre‐post cohort design. Data were collected from trained peer facilitators (n=31) and parenting group participants (n=73). Results: Peer facilitators demonstrated significantly increased knowledge of and confidence in delivering parenting groups. Parents attending groups reported improvements in child behaviour and parenting stress, and high satisfaction. Conclusions: Early evidence suggests that EPEC may be an effective and acceptable service model in socially disadvantaged communities.     

Non‐pharmacological interventions for adults with intellectual disabilities and depression: a systematic review

Background

Although high rates of depression symptoms are reported in adults with intellectual disabilities (IDs), there is a lack of knowledge about non‐pharmacological treatment options for depression in this population. The first research question of this paper is: Which non‐pharmacological interventions have been studied in adults with ID and depression? The second research question is: What were the results of these non‐pharmacological interventions?

Method

Systematic review of the literature with an electronic search in six databases has been completed with hand searches. Preferred Reporting Items for Systematic Reviews and Meta‐analyses guidelines have been followed. Selected studies met predefined inclusion criteria.

Results

Literature search resulted in 4267 papers of which 15 met the inclusion criteria. Five different types of non‐pharmacological interventions have been studied: cognitive behavioural therapy, behavioural therapy, exercise intervention, social problem‐solving skills programme and bright light therapy.

Conclusion

There are only a few studies of good quality evaluating non‐pharmacological interventions for adults with ID and depression. Some of these studies, especially studies on cognitive behavioural therapy, show good results in decreasing depressive symptoms. High‐quality randomised controlled trials evaluating non‐pharmacological interventions with follow‐up are needed.

     

Evaluation of the implementation of the Meeting Centres Support Program in Italy,Poland, and the UK; exploration of the effects on people with dementia

Objectives

MEETINGDEM investigated whether the Dutch Meeting Centres Support Programme (MCSP) could be implemented in Italy, Poland, and the UK with comparable benefits. This paper reports on the impact on people living with dementia attending pilot Meeting Centres in the 3 countries.

Methods

Nine pilot Meeting Centres (MCs) participated (Italy—5, Poland—2, UK—2). Effectiveness of MCSP was compared with Usual Care (UC) on outcomes measuring behavioural and psychological symptoms (NPI), depression (CSDD), and quality of life (DQoL, QOL‐AD), analysed by ANCOVAs in a 6‐month pre‐test/post‐test controlled trial.

Results

Pre/post data were collected for 85 people with dementia and 93 carers (MCSP) and 74 people with dementia /carer dyads' receiving UC. MCSP showed significant positive effects for DQoL [Self‐esteem (F = 4.8, P = 0.03); Positive Affect (F = 14.93, P < 0.00); Feelings of Belonging (F = 7.77, P = 0.01)] with medium and large effect sizes. Higher attendance levels correlated with greater neuropsychiatric symptom reduction (rho = 0.24, P = 0.03) and a greater increase in feelings of support (rho = 0.36, P = 0.001).

Conclusions

MCSPs showed significant wellbeing and health benefits compared with UC, building on the evidence of effectiveness from the Netherlands. In addition to the previously reported successful implementation of MCSP in Italy, Poland, and the UK, these findings suggest that further international dissemination of MCSP is recommended.     

Editorial: Evidence‐guided interventions and optimising outcomes in routine clinical care of children and young people's mental health

This Editorial reflects on several articles in this issue of the journal that focus on evidence‐based interventions in routine clinical care. In particular, it highlights the approaches advocated in the review by Bearman & Weisz into overcoming barriers to the implementation of research findings into routine clinical care: conceptually unified treatments that acknowledge the overlap and comorbidity between presenting problems; modular approaches to co‐ordinate and combine treatment approaches to improve the fit for young people presenting with multiple problems; and approaches to monitoring and feedback of progress and outcomes to aid clinical review and decision‐making. Issues of access, stigma and measurement of meaningful outcomes in routine clinical practice are also considered.     

Editorial: Looked‐after children – a perspective into a more resilient future

Looked after children (LAC) are among the most vulnerable group in our society in terms of their risk of a range of poor outcomes including mental health, educational attainments and social wellbeing. Over the past decade, it has become increasingly clear that LAC have a higher prevalence of mental health problems than the general population, including children living with their families in “high‐risk” populations. These children present with high rates of, both emotional and behavioural problems, and also neurodevelopmental problems. This Editorial highlights a collection of 10 articles and accompanying Introduction for a Virtual Issue on LAC, published as a free resource at: http://onlinelibrary.wiley.com/journal/10.1111/(ISSN)1475-3588/homepage/LAC.htm .     

A systematic review of economic evaluations of treatments for patients with epilepsy

The increasing number of treatment options and the high costs associated with epilepsy have fostered the development of economic evaluations in epilepsy. It is important to examine the availability and quality of these economic evaluations and to identify potential research gaps. As well as looking at both pharmacologic (antiepileptic drugs [AEDs]) and nonpharmacologic (e.g., epilepsy surgery, ketogenic diet, vagus nerve stimulation) therapies, this review examines the methodologic quality of the full economic evaluations included. Literature search was performed in MEDLINE, EMBASE, NHS Economic Evaluation Database (NHS EED), Econlit, Web of Science, and CEA Registry. In addition, Cochrane Reviews, Cochrane DARE and Cochrane Health Technology Assessment Databases were used. To identify relevant studies, predefined clinical search strategies were combined with a search filter designed to identify health economic studies. Specific search strategies were devised for the following topics: (1) AEDs, (2) patients with cognitive deficits, (3) elderly patients, (4) epilepsy surgery, (5) ketogenic diet, (6) vagus nerve stimulation, and (7) treatment of (non)convulsive status epilepticus. A total of 40 publications were included in this review, 29 (73%) of which were articles about pharmacologic interventions. Mean quality score of all articles on the Consensus Health Economic Criteria (CHEC)‐extended was 81.8%, the lowest quality score being 21.05%, whereas five studies had a score of 100%. Looking at the Consolidated Health Economic Evaluation Reporting Standards (CHEERS), the average quality score was 77.0%, the lowest being 22.7%, and four studies rated as 100%. There was a substantial difference in methodology in all included articles, which hampered the attempt to combine information meaningfully. Overall, the methodologic quality was acceptable; however, some studies performed significantly worse than others. The heterogeneity between the studies stresses the need to define a reference case (e.g., how should an economic evaluation within epilepsy be performed) and to derive consensus on what constitutes “standard optimal care.”     

Meaning of psychoses as perceived by patients,their relatives and clinicians

Making sense of psychoses supports insight and personal recovery. Relatives' and clinicians' different perspectives on psychoses might impede such processes e.g., in family interventions. This study compares the meaning of psychosis as perceived by patients, their relatives and clinicians and investigates factors associated with discrepancies between them. Meaning of psychosis was assessed in 70 interrelated patients, relatives and clinicians with the SUSE-questionnaire. Severity of disorder, therapeutic relationship and other clinical variables were analysed in patient groups with deviant SUSE-ratings compared to their relative or clinician respectively. The majority of patient–relative- and patient–clinician-dyads made equal ratings of meaning of psychosis. Relatives and clinicians tended to have a less optimistic view on long-term-effects than patients. Discrepancy in ratings between patients and relatives was best explained by the family relationship (i.e. not being a parent) and between patients and clinicians by the severity of positive symptoms. Strong consensus was found among patients, relatives and clinicians about a relatively positive, meaningful picture of psychosis. Sufficient opportunities to discuss experiences and understanding of psychosis help to make sense of it consensually. If clinicians' attitudes towards psychosis are negatively biased by symptomatology, they will struggle to see and support personal recovery.     

The structure of risk factors and outcomes for family caregivers: Implications for assessment and treatment

Purpose: We examined the associations among risk factors (e.g., behavioral problems, family conflict) and outcomes (e.g., overload, depression) commonly used in the research literature in order to inform the design of caregiver assessment and interventions.

Methods: A sample of 67 caregivers caring for a family member in the middle stages of dementia were assessed on 15 risk factors and six outcome measures.

Results: Risk factors were at best only moderately correlated with one another, suggesting their relative independence. Outcome measures showed somewhat higher correlations with one another, but participants varied in terms of the number and type of outcomes that were elevated. Multivariate results showed that risk factors differed in their contribution to models, predicting various outcomes.

Implications: Caregivers possess unique combinations of risk factors and outcomes that suggest the need for individualized or tailored interventions. Designing an effective caregiver assessment and corresponding targeted intervention requires careful planning and selection of appropriate risk factors and outcomes.