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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)
