Use of a robotic seal as a therapeutic tool to improve dementia symptoms: A cluster-randomized controlled trial

Wendy Moyle, Cindy J. Jones, Jenny E. Murfield, Lukman Thalib, Elizabeth R.A. Beattie, David K.H. Shum, Siobhan T. O'Dwyer, M. Cindy Mervin, Brian M. Draper

Research output: Contribution to journalArticleResearchpeer-review

32 Citations (Scopus)

Abstract

Objectives To test the effects of individual, nonfacilitated sessions with PARO (version 9), when compared against a look-alike plush toy and usual care, on the emotional and behavioral symptoms of dementia for people living in long-term care facilities. Design Parallel, 3-group, cluster-randomized controlled trial conducted between June 14, 2014, and May 16, 2015. Setting Twenty-eight long-term care facilities operated by 20 care organizations located in South-East Queensland, Australia. Participants Four hundred fifteen participants aged ≥60 years, with a documented diagnosis of dementia. Intervention Stratified by private/not-for-profit status and randomized using a computer-generated sequence, 9 facilities were randomized to the PARO group (individual, nonfacilitated, 15-minute sessions 3 times per week for 10 weeks); 10 to plush toy (same, but given PARO with robotic features disabled); and 9 to usual care. Treatment allocation was masked to assessors. Measurements Primary outcomes were changes in levels of engagement, mood states, and agitation after a 10-week intervention, assessed by coded video observations (baseline, weeks 1, 5, 10, and 15) and Cohen-Mansfield Agitation Inventory–Short Form (baseline, weeks 10 and 15). Analyses followed intention-to-treat, using repeated measures mixed effects models. Australian New Zealand Clinical Trials Registry (ACTRN12614000508673). Results Video data showed that participants in the PARO group were more verbally [3.61, 95% confidence interval (CI): 6.40–0.81, P =.011] and visually engaged (13.06, 95% CI: 17.05–9.06, P <.0001) than participants in plush toy. Both PARO (−3.09, 95% CI: −0.45 to −5.72, P =.022) and plush toy (−3.58, 95% CI: −1.26 to −5.91, P =.002) had significantly greater reduced neutral affect compared with usual care, whilst PARO was more effective than usual care in improving pleasure (1.12, 95% CI: 1.94–0.29, P =.008). Videos showed that PARO was more effective than usual care in improving agitation (3.33, 95% CI: 5.79–0.86, P =.008). When measured using the CMAI-SF, there was no difference between groups. Conclusions Although more effective than usual care in improving mood states and agitation, PARO was only more effective than a plush toy in encouraging engagement.

Original languageEnglish
Pages (from-to)766-773
Number of pages8
JournalJournal of the American Medical Directors Association
Volume18
Issue number9
DOIs
Publication statusPublished - 1 Sep 2017
Externally publishedYes

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Robotics
Play and Playthings
Dementia
Randomized Controlled Trials
Confidence Intervals
Long-Term Care
Therapeutics
Behavioral Symptoms
Intention to Treat Analysis
Queensland
Pleasure
New Zealand
Registries
Clinical Trials

Cite this

Moyle, Wendy ; Jones, Cindy J. ; Murfield, Jenny E. ; Thalib, Lukman ; Beattie, Elizabeth R.A. ; Shum, David K.H. ; O'Dwyer, Siobhan T. ; Mervin, M. Cindy ; Draper, Brian M. / Use of a robotic seal as a therapeutic tool to improve dementia symptoms : A cluster-randomized controlled trial. In: Journal of the American Medical Directors Association. 2017 ; Vol. 18, No. 9. pp. 766-773.
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abstract = "Objectives To test the effects of individual, nonfacilitated sessions with PARO (version 9), when compared against a look-alike plush toy and usual care, on the emotional and behavioral symptoms of dementia for people living in long-term care facilities. Design Parallel, 3-group, cluster-randomized controlled trial conducted between June 14, 2014, and May 16, 2015. Setting Twenty-eight long-term care facilities operated by 20 care organizations located in South-East Queensland, Australia. Participants Four hundred fifteen participants aged ≥60 years, with a documented diagnosis of dementia. Intervention Stratified by private/not-for-profit status and randomized using a computer-generated sequence, 9 facilities were randomized to the PARO group (individual, nonfacilitated, 15-minute sessions 3 times per week for 10 weeks); 10 to plush toy (same, but given PARO with robotic features disabled); and 9 to usual care. Treatment allocation was masked to assessors. Measurements Primary outcomes were changes in levels of engagement, mood states, and agitation after a 10-week intervention, assessed by coded video observations (baseline, weeks 1, 5, 10, and 15) and Cohen-Mansfield Agitation Inventory–Short Form (baseline, weeks 10 and 15). Analyses followed intention-to-treat, using repeated measures mixed effects models. Australian New Zealand Clinical Trials Registry (ACTRN12614000508673). Results Video data showed that participants in the PARO group were more verbally [3.61, 95{\%} confidence interval (CI): 6.40–0.81, P =.011] and visually engaged (13.06, 95{\%} CI: 17.05–9.06, P <.0001) than participants in plush toy. Both PARO (−3.09, 95{\%} CI: −0.45 to −5.72, P =.022) and plush toy (−3.58, 95{\%} CI: −1.26 to −5.91, P =.002) had significantly greater reduced neutral affect compared with usual care, whilst PARO was more effective than usual care in improving pleasure (1.12, 95{\%} CI: 1.94–0.29, P =.008). Videos showed that PARO was more effective than usual care in improving agitation (3.33, 95{\%} CI: 5.79–0.86, P =.008). When measured using the CMAI-SF, there was no difference between groups. Conclusions Although more effective than usual care in improving mood states and agitation, PARO was only more effective than a plush toy in encouraging engagement.",
author = "Wendy Moyle and Jones, {Cindy J.} and Murfield, {Jenny E.} and Lukman Thalib and Beattie, {Elizabeth R.A.} and Shum, {David K.H.} and O'Dwyer, {Siobhan T.} and Mervin, {M. Cindy} and Draper, {Brian M.}",
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Use of a robotic seal as a therapeutic tool to improve dementia symptoms : A cluster-randomized controlled trial. / Moyle, Wendy; Jones, Cindy J.; Murfield, Jenny E.; Thalib, Lukman; Beattie, Elizabeth R.A.; Shum, David K.H.; O'Dwyer, Siobhan T.; Mervin, M. Cindy; Draper, Brian M.

In: Journal of the American Medical Directors Association, Vol. 18, No. 9, 01.09.2017, p. 766-773.

Research output: Contribution to journalArticleResearchpeer-review

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T1 - Use of a robotic seal as a therapeutic tool to improve dementia symptoms

T2 - A cluster-randomized controlled trial

AU - Moyle, Wendy

AU - Jones, Cindy J.

AU - Murfield, Jenny E.

AU - Thalib, Lukman

AU - Beattie, Elizabeth R.A.

AU - Shum, David K.H.

AU - O'Dwyer, Siobhan T.

AU - Mervin, M. Cindy

AU - Draper, Brian M.

PY - 2017/9/1

Y1 - 2017/9/1

N2 - Objectives To test the effects of individual, nonfacilitated sessions with PARO (version 9), when compared against a look-alike plush toy and usual care, on the emotional and behavioral symptoms of dementia for people living in long-term care facilities. Design Parallel, 3-group, cluster-randomized controlled trial conducted between June 14, 2014, and May 16, 2015. Setting Twenty-eight long-term care facilities operated by 20 care organizations located in South-East Queensland, Australia. Participants Four hundred fifteen participants aged ≥60 years, with a documented diagnosis of dementia. Intervention Stratified by private/not-for-profit status and randomized using a computer-generated sequence, 9 facilities were randomized to the PARO group (individual, nonfacilitated, 15-minute sessions 3 times per week for 10 weeks); 10 to plush toy (same, but given PARO with robotic features disabled); and 9 to usual care. Treatment allocation was masked to assessors. Measurements Primary outcomes were changes in levels of engagement, mood states, and agitation after a 10-week intervention, assessed by coded video observations (baseline, weeks 1, 5, 10, and 15) and Cohen-Mansfield Agitation Inventory–Short Form (baseline, weeks 10 and 15). Analyses followed intention-to-treat, using repeated measures mixed effects models. Australian New Zealand Clinical Trials Registry (ACTRN12614000508673). Results Video data showed that participants in the PARO group were more verbally [3.61, 95% confidence interval (CI): 6.40–0.81, P =.011] and visually engaged (13.06, 95% CI: 17.05–9.06, P <.0001) than participants in plush toy. Both PARO (−3.09, 95% CI: −0.45 to −5.72, P =.022) and plush toy (−3.58, 95% CI: −1.26 to −5.91, P =.002) had significantly greater reduced neutral affect compared with usual care, whilst PARO was more effective than usual care in improving pleasure (1.12, 95% CI: 1.94–0.29, P =.008). Videos showed that PARO was more effective than usual care in improving agitation (3.33, 95% CI: 5.79–0.86, P =.008). When measured using the CMAI-SF, there was no difference between groups. Conclusions Although more effective than usual care in improving mood states and agitation, PARO was only more effective than a plush toy in encouraging engagement.

AB - Objectives To test the effects of individual, nonfacilitated sessions with PARO (version 9), when compared against a look-alike plush toy and usual care, on the emotional and behavioral symptoms of dementia for people living in long-term care facilities. Design Parallel, 3-group, cluster-randomized controlled trial conducted between June 14, 2014, and May 16, 2015. Setting Twenty-eight long-term care facilities operated by 20 care organizations located in South-East Queensland, Australia. Participants Four hundred fifteen participants aged ≥60 years, with a documented diagnosis of dementia. Intervention Stratified by private/not-for-profit status and randomized using a computer-generated sequence, 9 facilities were randomized to the PARO group (individual, nonfacilitated, 15-minute sessions 3 times per week for 10 weeks); 10 to plush toy (same, but given PARO with robotic features disabled); and 9 to usual care. Treatment allocation was masked to assessors. Measurements Primary outcomes were changes in levels of engagement, mood states, and agitation after a 10-week intervention, assessed by coded video observations (baseline, weeks 1, 5, 10, and 15) and Cohen-Mansfield Agitation Inventory–Short Form (baseline, weeks 10 and 15). Analyses followed intention-to-treat, using repeated measures mixed effects models. Australian New Zealand Clinical Trials Registry (ACTRN12614000508673). Results Video data showed that participants in the PARO group were more verbally [3.61, 95% confidence interval (CI): 6.40–0.81, P =.011] and visually engaged (13.06, 95% CI: 17.05–9.06, P <.0001) than participants in plush toy. Both PARO (−3.09, 95% CI: −0.45 to −5.72, P =.022) and plush toy (−3.58, 95% CI: −1.26 to −5.91, P =.002) had significantly greater reduced neutral affect compared with usual care, whilst PARO was more effective than usual care in improving pleasure (1.12, 95% CI: 1.94–0.29, P =.008). Videos showed that PARO was more effective than usual care in improving agitation (3.33, 95% CI: 5.79–0.86, P =.008). When measured using the CMAI-SF, there was no difference between groups. Conclusions Although more effective than usual care in improving mood states and agitation, PARO was only more effective than a plush toy in encouraging engagement.

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JO - Journal of the American Medical Directors Association

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