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Music‐with‐movement intervention for people with mild/early cognitive impairment: An effectiveness‐implementation hybrid cluster randomized controlled trial
Author(s) -
Cheung Daphne Sze Ki,
Lai Daniel Lok Lam,
Ho Lily Yuen Wah,
Lai Claudia KY
Publication year - 2020
Publication title -
alzheimer's and dementia
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 6.713
H-Index - 118
eISSN - 1552-5279
pISSN - 1552-5260
DOI - 10.1002/alz.039313
Subject(s) - psychosocial , intervention (counseling) , randomized controlled trial , fidelity , dementia , cluster randomised controlled trial , medicine , anxiety , psychology , physical therapy , nursing , psychiatry , surgery , disease , pathology , electrical engineering , engineering
Background A caregiver‐delivered, home‐based music‐with‐movement intervention (MM) for people with early dementia has been shown to reduce anxiety symptoms. Yet, caregivers reported their struggles when implementing the intervention, which reduced their motivation to sustain the intervention at home. This study is to evaluate the effectiveness of the strategies for overcoming the implementation challenges identified in the previous research and to investigate the efficacy of the intervention on psychosocial well‐being of people with mild/early cognitive impairment. Method This was a multi‐centre, two‐arm, cluster randomized controlled, effectiveness‐implementation hybrid trial. The program was designed to improve the psychosocial well‐being of people with mild/early dementia. Partnered centres were randomized into the intervention or wait‐list control groups, and the families recruited by them followed the group allocation correspondingly. Seven community partners recruited eighty families from different districts in Hong Kong. Intervention participants received a 12‐week MM intervention, delivered by trained family caregivers at home, and trained staff and volunteers in the centres. Participants in the control group received the identical programme after data collection. Implementation strategies included (1) partnering with different types of community service sectors for recruiting families; (2) training centre staff and volunteers for delivering the intervention and providing support; (3) using information and communication technology (ICT) for disseminating intervention materials, communication, and fidelity monitoring; and (4) introducing centre‐based activities for enhancing programme sustainability. To assess program efficacy (psychosocial well‐being) and implementation outcomes (acceptability, fidelity, practicality and sustainability), multi‐method and multi‐informant assessment strategies were used including clinical assessments, observation and interview. Result Caregivers, volunteers and staff of the centres welcomed the use of ICT, which facilitated the delivery of the intervention. Four elderly centres have continued to use the MM programme as their routine services. The findings showed that the programme was effective in improving anxiety and depressive symptoms of elderly participants and reducing stress level of family caregivers. Booster training may need to be introduced to ensure the fidelity of intervention delivery. Conclusion This study demonstrated that adaptive strategies were effective in overcoming the implementation challenges and the intervention helped the target population improve their emotional well‐being.