Download Cognitive Stimulation Therapy

Occupational therapy perspectives
on Cognitive Stimulation Therapy:
outcomes in relation to
Activities of Daily Living
T Rehling*, J Sixsmith*, S Corr*, G Chard⁺
University of Northampton*; AMPS UK and Ireland⁺
Objectives
1. To demonstrate the ‘added value’ when
occupational therapists deliver Cognitive
Stimulation Therapy (CST)
2. To demonstrate the importance of using
outcome measures that focus on
occupational therapy specific objectives
DEMENTIA
‘One of the most important
health and care issues
facing the world’
(DOH 2015, p.10)
Recommended for people with mild to moderate dementia
(NICE 2006;2016)
Stimulation of global cognitive function rather than the
individual components of cognition
(Breuil et al. 1994)
Cognitive Stimulation Therapy
(Spector et al. 2003;2006)
Evidence of benefits for cognition and quality of life
(Spector et al. 2003)
Delivered by occupational therapists
(British Psychological Society 2014; College of Occupational Therapists 2011)
Effect of cognitive stimulation
upon Activities of Daily Living
No evidence of significant benefits
Trend to positive
effects noted
Slower rate of decline
in functional ability
Benefits evident
8 months
post-intervention
Evidence of
significant benefits
Functional outcomes not reported
Research questions
1. Can occupational therapists deliver CST in a way that
specifically targets ADL/ occupational performance?
2. What are the benefits of CST for people with
dementia in relation to their ongoing performance of
activities of daily living, when it is delivered by
occupational therapists?
3. Are there ADL benefits
that are measurable ?
Theoretical underpinnings
Methodology
Mixed methods: Sequential embedded design
(Adapted from Cresswell and Plano Clarke 2011)
Ethical
East of Scotland Research Ethics Service - Ref 15/ES/0062 IRAS ID:163729
Exploring CST from an
occupational therapy perspective
Survey
(n=71)
MOHOST
Interviews
(n=10)
CST
Case Study
(n=6)
AMPS; OPHI-II; PAL
Development of OT-CSTdem
What elements were delivered by
occupational therapists during the
CST Case Study, in addition to
cognitive stimulation ?
A focus on facilitating the dynamic interaction
between
the person, the environment and CST activity
OT-CSTdem
Delivers the standardised CST programme
Within the framework of an occupational therapy
approach
Enabling the benefits of the evidence-based CST
intervention to be delivered
(cognition and quality of life)
Focusing on occupational performance and
engagement
As an additional outcome
OT-CSTdem Case Study
Participants
(n=7)
• Dementia
• Age: 78 yrs
• MMSE: 25
Family carer
Intervention
OT-CSTdem
• 14 weekly sessions
• Trained occupational
therapists
• Adherence measures
• Occupational profiles
& personalised goals
• Average 12 sessions
Outcome
Measures
Primary: AMPS
Secondary:
OPHI-II / PAL
• Pre and post
• 17.5 weeks
Data Analysis: Wilcoxon Signed Rank Test
Results
A statistically significant increase
In ADL motor ability
with a large effect size
(z = - 2.214, p = 0.027, r = 0.639)
An increase in ADL process ability
that was close to significance
with a large effect size
(z = - 1.184, p = 0.066, r = 0.531)
Self-reported changes
Original contribution of this study
to the CST evidence base
• Targeting ADL outcomes with an adapted
version of CST (OT-CSTdem)
• ‘Adding value’ for people with dementia
participating in CST, in terms of potential ADL
benefits
• Evidencing measurable benefits of CST upon
ADL performance using an occupational therapy
outcome measure (AMPS)
Take home message
• There is potential ‘added value’ for people
with dementia when CST is delivered within
an occupation-centred framework (ADL
performance outcomes)
• It is the occupational therapy paradigm that
represents the added value of an occupational
therapist delivering the intervention
Acknowledgements
This study is supported by the UK Occupational
Therapy Research Foundation, a division of the
Royal College of Occupational Therapists (RCOT)
Email: [email protected]
Twitter: @ergo_tr
LinkedIn: Tracey Rehling
Time for questions
(All images courtesy of Pixabay. Creative Commons CC0: Public Domain Dedication)