A systematic review of the effects of occupational therapy for persons with dementia: a meta-analysis of randomized controlled trials.

OBJECTIVE Meta-analysis was conducted to examine effects of OT interventions based on sensory stimulation, environmental modification and functional task activity on the behavioral problems and depression of individual with dementia. SEARCH STRATEGY An extensive search in database such as MEDLINE, CINAHL, ProQuest Medical Library, and Cochrane and OT related 11 journals was performed. SELECTION CRITERIA Potential studies were identified through the KEYWORDS dementia or Alzheimer, randomized controlled trials and occupational therapy or occupational therapist or ADL or sensory stimulation or Snoezelen or environmental modification or education for caregivers. DATA COLLECTION AND ANALYSIS Two reviewers independently identified studies, extracted data, assessed methodological quality of the studies. Effect size was estimated using standardized mean difference with 95% confidence intervals. Significant heterogeneity and publication bias were investigated. MAIN RESULTS Nine studies including 751 people were selected. Sensory stimulation was effective intervention in improving behavioral problems (0.32; 95% CI, 0.04 to 0.59). CONCLUSION This review identified that OT intervention based on sensory stimulation was effective intervention to improve behavioral problems. However, the number of studies included in this review is limited. More research is needed to enable evidence-based OT for dementia patients.

[1]  H. Wong,et al.  The impact of neuropsychiatric symptoms of dementia on distress in family and professional caregivers in Singapore , 2005, International Psychogeriatrics.

[2]  Nathan Herrmann,et al.  Clinical practice guidelines for severe Alzheimer’s disease , 2007, Alzheimer's & Dementia.

[3]  I. Frampton,et al.  AN EVALUATION OF THE EFFECTS OF SENSORY STIMULATION WITH PEOPLE WHO HAVE DEMENTIA , 1998, Behavioural and Cognitive Psychotherapy.

[4]  S. Baillon,et al.  Variability in Response of Older People with Dementia to Both Snoezelen and Reminiscence , 2005 .

[5]  R Goeree,et al.  Relation between severity of Alzheimer's disease and costs of caring. , 1998, CMAJ : Canadian Medical Association journal = journal de l'Association medicale canadienne.

[6]  S B Thacker,et al.  Meta-analysis. A quantitative approach to research integration. , 1988, JAMA.

[7]  W. Hauck,et al.  Tailored Activities to Manage Neuropsychiatric Behaviors in Persons With Dementia and Reduce Caregiver Burden: A Randomized Pilot Study , 2008 .

[8]  E. Mandelkow,et al.  Tau in Alzheimer's disease. , 1998, Trends in cell biology.

[9]  J. Cummings,et al.  Assessing the Impact of Neuropsychiatric Symptoms in Alzheimer's Disease: The Neuropsychiatric Inventory Caregiver Distress Scale , 1998, Journal of the American Geriatrics Society.

[10]  W W Hauck,et al.  A randomized, controlled trial of a home environmental intervention: effect on efficacy and upset in caregivers and on daily function of persons with dementia. , 2001, The Gerontologist.

[11]  Joost Dekker,et al.  Community occupational therapy for older patients with dementia and their care givers: cost effectiveness study , 2008, BMJ : British Medical Journal.

[12]  Dc Washington Diagnostic and Statistical Manual of Mental Disorders, 4th Ed. , 1994 .

[13]  Peter W Thomas,et al.  A randomized controlled trial of the effects of multi-sensory stimulation (MSS) for people with dementia. , 2001, The British journal of clinical psychology.

[14]  Matthew Owens,et al.  Effects of multi-sensory stimulation for people with dementia. , 2003, Journal of advanced nursing.

[15]  G. Glass Primary, Secondary, and Meta-Analysis of Research1 , 1976 .

[16]  G. Livingston,et al.  International Psychogeriatric Association consensus statement on defining and measuring treatment benefits in dementia , 2007, International Psychogeriatrics.

[17]  William R. Shadish,et al.  Combining estimates of effect size. , 1994 .

[18]  Gregg B. Jackson,et al.  Methods for Integrative Reviews , 1980 .

[19]  J. Desrosiers,et al.  Efficacy of a sensory integration program on behaviors of inpatients with dementia. , 1994, The American journal of occupational therapy : official publication of the American Occupational Therapy Association.

[20]  L. Schneider,et al.  Cholinergic deficiency in Alzheimer's disease. Pathogenic model. , 1998, The American journal of geriatric psychiatry : official journal of the American Association for Geriatric Psychiatry.

[21]  David R. Jones,et al.  Empirical assessment of effect of publication bias on meta-analyses , 2000, BMJ : British Medical Journal.

[22]  W. Hoefnagels,et al.  Effects of community occupational therapy on quality of life, mood, and health status in dementia patients and their caregivers: a randomized controlled trial. , 2007, The journals of gerontology. Series A, Biological sciences and medical sciences.

[23]  Rhiannon Whitaker,et al.  Goal-oriented cognitive rehabilitation for people with early-stage Alzheimer disease: a single-blind randomized controlled trial of clinical efficacy. , 2010, The American journal of geriatric psychiatry : official journal of the American Association for Geriatric Psychiatry.

[24]  R. Matheis,et al.  The Effects of Snoezelen (Multi-Sensory Behavior Therapy) and Psychiatric Care on Agitation, Apathy, and Activities of Daily Living in Dementia Patients on a Short Term Geriatric Psychiatric Inpatient Unit , 2007, International journal of psychiatry in medicine.

[25]  J. Cummings,et al.  Assessing the impact of neuropsychiatric symptoms on distress in professional caregivers , 1999 .

[26]  W. Hauck,et al.  Maintenance of effects of the home environmental skill-building program for family caregivers and individuals with Alzheimer's disease and related disorders. , 2005, The journals of gerontology. Series A, Biological sciences and medical sciences.

[27]  Joost Dekker,et al.  Occupational therapy for community dwelling elderly people: a systematic review. , 2004, Age and ageing.

[28]  P V Rabins,et al.  The impact of dementia on the family. , 1982, JAMA.

[29]  C. Mathers,et al.  Global prevalence of dementia: a Delphi consensus study , 2005, The Lancet.