|Author, date and country||Patient group||Study type (level of evidence)||Outcomes||Key results||Study Weaknesses|
|Clare L, Woods B (Cochrane Database of Systematic Reviews)|
|Patients with a medical diagnosis of dementia residing at home, no age restriction, patients were excluded with a known diagnosis of fronto-temporal dementia. Patients receiving acetyl-cholinesterase inhibitors were included. -Systematic review of 9 RCT Total N = 433||Cochrane Review Level 1a||Participant scores on cognitive screening measures||NSS|
|Participant scores on neuropsychological tests||NSS|
|Participant self-report of functioning||NSS|
|Informant report of participant functioning||NSS|
|Informant reactions to memory and behaviour problems||NSS|
Unable to perform meta-analysis due to heterogeneity of outcome measures
|Zanetti et al|
|18 patients with mild and mild-moderate Alzheimer’s Disease|
Baseline and follow up assessments of patient's ability with 13 activities of daily living (ADL).
Follow up completed at 4 months post intervention
2 groups: 1) Treatment- Individual sessions -procedural memory stimulation for three consecutive weeks, one hour per day and five hours per week
2)Control – No Intervention
|RCT – Level 1b||Time required to complete ADLs.||Treatment group|
Control group – NSS
Between group differences were statistically significant p.<0.025
Statistical significant difference between the groups at baseline in forward digit span.
|Randomisation and treatment allocation not specified or concealed.|
Therapists and patients not blinded.
Small sample size.
Medication was a confounding variable.
|Graff et al|
|N=135 over 65yrs with mild to moderate dementia living in the community and their primary care givers.|
Day clinic of a geriatric department and in participant’s homes.
Treatment: 10 sessions of Occupational Therapy over 5 weeks.
Interventions: Cognitive and behavioural interventions, to train patients in the use of aids to compensate for cognitive decline and care givers in coping behaviours and supervision.
Assessed at baseline, 6 weeks and 3 months
|Assessor blind RCT||ADL function Assessment of Motor and Process Skills (AMPS) and interview of daily activities in dementia (IDDD).||ADL function- Differences were 1.5 (95 % confidence interval 1.3-1.7) for the AMPS (p<0.0001) and -11.7 (-13.6- -9.7) for the IDDD (p<0.0001)||Participants not blinded to treatment.|
Control group interventions not clear.
|Caregiver burden sense of competence questionnaire (SCQ).||Care giver burden - 11.0 (9.2 - 12.8) for the SCQ (p<0.0001)|
Treatment group > control group – there at 6 weeks (p<0.0001) and at 12weeks (p<0.0001)
|Clare et al|
|69 patients- mean age 77.78, with a diagnosis of Alzheimer’s Disease, or mixed Alzheimer’s Disease and Vascular Dementia.|
All subjects had a MMSE score of 18 or above and were receiving a stable dose of Acetyl cholinesterase-inhibiting medication.
Outcome measures were recorded pre-intervention, post-intervention and 6 months after intervention.
1)Treatment Group: N=23 (completed N=20)Intervention involved 8 weekly one hour individual cognitive rehab session in which individualised goals were set focusing on ADLs.
2)Relaxation Group: N=24 (completed N=23) Intervention involved 8 weekly one hour individual relaxation sessions.
3) Control Group: N=22 (completed N=21) No contact with the research team between initial and post intervention assessments.
|Single blind RCT||Outcome measures relevant to the three part question: Canadian Occupational Performance Measure (COPM) performance scale|| Group 1 – Group 2 1.175 95% CI (0.526-1.823)|
Group 1 – Group 3 0.908 95% CI (0.248-1.568)
|One therapist administered both the cognitive rehab for the treatment group and the relaxation group.|
No I.T.T analysis.
Sample size not justified.
Statistically significant results however these are not clinically significant when using the COPM as an outcome measure.
Additional care giver support was not consistent across the groups and this may have impacted on the results.
|Canadian Occupational Performance Measure (COPM) satisfaction scale|
|Group 1- Group 2 1.222 95% CI (0.569 -1.874)|
Group 1- Group 3 0.865 95% CI(0.208-1.521)
COPM only completed pre and post intervention as not reliable as a long term follow up measure.