Occupational therapy for people with dementia and their family carers provided at home: A systematic review and meta-analysis

Sally Bennett; Kate Laver; Sebastian Voigt-Radloff; Lori Letts; Lindy Clemson; Maud Graff; Jodie Wiseman; Laura Gitlin

doi:10.1136/bmjopen-2018-026308

Occupational therapy for people with dementia and their family carers provided at home: A systematic review and meta-analysis

Sally Bennett^*, Kate Laver, Sebastian Voigt-Radloff, Lori Letts, Lindy Clemson, Maud Graff, Jodie Wiseman, Laura Gitlin

^*Corresponding author for this work

Research output: Contribution to journal › Article › Research › peer-review

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Abstract

Objective

To determine the effect of occupational therapy provided at home on activities of daily living, behavioural and psychological symptoms of dementia (BPSD) and quality of life (QOL) for people with dementia, and the effect on family carer burden, depression and QOL.

Design

Systematic review and meta-analysis.

Methods

Eight databases were searched to February 2018. Randomised controlled trials of occupational therapy delivered at home for people with dementia and their family carers that measured ADL, and/or BPSD were included. Two independent reviewers determined eligibility, risk of bias and extracted data.

Results

Fifteen trials were included (n=2063). Occupational therapy comprised multiple components (median=8 sessions). Compared with usual care or attention control occupational therapy resulted in improvements in the following outcomes for people with dementia: Overall ADL after intervention (standardised means difference (SMD) 0.61, 95% CI 0.16 to 1.05); instrumental ADL alone (SMD 0.22, 95% CI 0.07 to 0.37; moderate quality); number of behavioural and psychological symptoms (SMD-0.32, 95% CI-0.57 to-0.08; moderate quality); and QOL (SMD 0.76, 95% CI 0.28 to 1.24) after the intervention and at follow-up (SMD 1.07, 95% CI 0.58 to 1.55). Carers reported less hours assisting the person with dementia (SMD-0.33, 95% CI-0.58 to-0.07); had less distress with behaviours (SMD-0.23, 95% CI-0.42 to-0.05; moderate quality) and improved QOL (SMD 0.99, 95% CI 0.66 to 1.33; moderate quality). Two studies compared occupational therapy with a comparison intervention and found no statistically significant results. GRADE ratings indicated evidence was very low to moderate quality.

Conclusions

Findings suggest that occupational therapy provided at home may improve a range of important outcomes for people with dementia and their family carers. Health professionals could consider referring them for occupational therapy.

Original language	English
Article number	e026308
Journal	BMJ Open
Volume	9
Issue number	11
DOIs	https://doi.org/10.1136/bmjopen-2018-026308
Publication status	Published - 1 Nov 2019
Externally published	Yes

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Occupational therapy for people with dementia and their family carers provided at home: a systematic review and meta-analysisFinal published version, 981 KBLicence: CC BY-NC

Cite this

@article{b14392baf78540e3a170f9b92c78242f,

title = "Occupational therapy for people with dementia and their family carers provided at home: A systematic review and meta-analysis",

abstract = "ObjectiveTo determine the effect of occupational therapy provided at home on activities of daily living, behavioural and psychological symptoms of dementia (BPSD) and quality of life (QOL) for people with dementia, and the effect on family carer burden, depression and QOL. Design Systematic review and meta-analysis. Methods Eight databases were searched to February 2018. Randomised controlled trials of occupational therapy delivered at home for people with dementia and their family carers that measured ADL, and/or BPSD were included. Two independent reviewers determined eligibility, risk of bias and extracted data. Results Fifteen trials were included (n=2063). Occupational therapy comprised multiple components (median=8 sessions). Compared with usual care or attention control occupational therapy resulted in improvements in the following outcomes for people with dementia: Overall ADL after intervention (standardised means difference (SMD) 0.61, 95% CI 0.16 to 1.05); instrumental ADL alone (SMD 0.22, 95% CI 0.07 to 0.37; moderate quality); number of behavioural and psychological symptoms (SMD-0.32, 95% CI-0.57 to-0.08; moderate quality); and QOL (SMD 0.76, 95% CI 0.28 to 1.24) after the intervention and at follow-up (SMD 1.07, 95% CI 0.58 to 1.55). Carers reported less hours assisting the person with dementia (SMD-0.33, 95% CI-0.58 to-0.07); had less distress with behaviours (SMD-0.23, 95% CI-0.42 to-0.05; moderate quality) and improved QOL (SMD 0.99, 95% CI 0.66 to 1.33; moderate quality). Two studies compared occupational therapy with a comparison intervention and found no statistically significant results. GRADE ratings indicated evidence was very low to moderate quality. Conclusions Findings suggest that occupational therapy provided at home may improve a range of important outcomes for people with dementia and their family carers. Health professionals could consider referring them for occupational therapy.",

author = "Sally Bennett and Kate Laver and Sebastian Voigt-Radloff and Lori Letts and Lindy Clemson and Maud Graff and Jodie Wiseman and Laura Gitlin",

note = "Funding Information: Funding The first author{\textquoteright}s contribution was partially supported by The University of Queensland, Australia. Grant number: 2007000387. Publisher Copyright: {\textcopyright} 2019 Author(s). Copyright: Copyright 2019 Elsevier B.V., All rights reserved.",

year = "2019",

month = nov,

day = "1",

doi = "10.1136/bmjopen-2018-026308",

language = "English",

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AU - Bennett, Sally

AU - Laver, Kate

AU - Voigt-Radloff, Sebastian

AU - Letts, Lori

AU - Clemson, Lindy

AU - Graff, Maud

AU - Wiseman, Jodie

AU - Gitlin, Laura

N1 - Funding Information: Funding The first author’s contribution was partially supported by The University of Queensland, Australia. Grant number: 2007000387. Publisher Copyright: © 2019 Author(s). Copyright: Copyright 2019 Elsevier B.V., All rights reserved.

PY - 2019/11/1

Y1 - 2019/11/1

N2 - ObjectiveTo determine the effect of occupational therapy provided at home on activities of daily living, behavioural and psychological symptoms of dementia (BPSD) and quality of life (QOL) for people with dementia, and the effect on family carer burden, depression and QOL. Design Systematic review and meta-analysis. Methods Eight databases were searched to February 2018. Randomised controlled trials of occupational therapy delivered at home for people with dementia and their family carers that measured ADL, and/or BPSD were included. Two independent reviewers determined eligibility, risk of bias and extracted data. Results Fifteen trials were included (n=2063). Occupational therapy comprised multiple components (median=8 sessions). Compared with usual care or attention control occupational therapy resulted in improvements in the following outcomes for people with dementia: Overall ADL after intervention (standardised means difference (SMD) 0.61, 95% CI 0.16 to 1.05); instrumental ADL alone (SMD 0.22, 95% CI 0.07 to 0.37; moderate quality); number of behavioural and psychological symptoms (SMD-0.32, 95% CI-0.57 to-0.08; moderate quality); and QOL (SMD 0.76, 95% CI 0.28 to 1.24) after the intervention and at follow-up (SMD 1.07, 95% CI 0.58 to 1.55). Carers reported less hours assisting the person with dementia (SMD-0.33, 95% CI-0.58 to-0.07); had less distress with behaviours (SMD-0.23, 95% CI-0.42 to-0.05; moderate quality) and improved QOL (SMD 0.99, 95% CI 0.66 to 1.33; moderate quality). Two studies compared occupational therapy with a comparison intervention and found no statistically significant results. GRADE ratings indicated evidence was very low to moderate quality. Conclusions Findings suggest that occupational therapy provided at home may improve a range of important outcomes for people with dementia and their family carers. Health professionals could consider referring them for occupational therapy.

AB - ObjectiveTo determine the effect of occupational therapy provided at home on activities of daily living, behavioural and psychological symptoms of dementia (BPSD) and quality of life (QOL) for people with dementia, and the effect on family carer burden, depression and QOL. Design Systematic review and meta-analysis. Methods Eight databases were searched to February 2018. Randomised controlled trials of occupational therapy delivered at home for people with dementia and their family carers that measured ADL, and/or BPSD were included. Two independent reviewers determined eligibility, risk of bias and extracted data. Results Fifteen trials were included (n=2063). Occupational therapy comprised multiple components (median=8 sessions). Compared with usual care or attention control occupational therapy resulted in improvements in the following outcomes for people with dementia: Overall ADL after intervention (standardised means difference (SMD) 0.61, 95% CI 0.16 to 1.05); instrumental ADL alone (SMD 0.22, 95% CI 0.07 to 0.37; moderate quality); number of behavioural and psychological symptoms (SMD-0.32, 95% CI-0.57 to-0.08; moderate quality); and QOL (SMD 0.76, 95% CI 0.28 to 1.24) after the intervention and at follow-up (SMD 1.07, 95% CI 0.58 to 1.55). Carers reported less hours assisting the person with dementia (SMD-0.33, 95% CI-0.58 to-0.07); had less distress with behaviours (SMD-0.23, 95% CI-0.42 to-0.05; moderate quality) and improved QOL (SMD 0.99, 95% CI 0.66 to 1.33; moderate quality). Two studies compared occupational therapy with a comparison intervention and found no statistically significant results. GRADE ratings indicated evidence was very low to moderate quality. Conclusions Findings suggest that occupational therapy provided at home may improve a range of important outcomes for people with dementia and their family carers. Health professionals could consider referring them for occupational therapy.

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Occupational therapy for people with dementia and their family carers provided at home: A systematic review and meta-analysis

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