Improving the Rehabilitation Process

NCT03865758 | Completed

• 1 other identifier: 00007754
• Study Type: interventional
• Target: 98
• Locations: 1 country
• Sites: 2

Brief Summary

A major challenge in care of persons with dementia is that illness and hospitalizations can lead to significant decreases in functional abilities. Maintaining functional abilities as high as possible is a key goal in dementia care, because persons are able to function optimally despite cognitive problems and engage in more preferred and enjoyable activities. Functional decline can be ameliorated through rehabilitation, building strength, balance and functional competencies. People with dementia, however, may not able to engage fully in rehabilitation due to their cognitive problems. They may not understand the therapist's instructions and may be fearful of what the therapist is trying to do. The proposed study will test the efficacy of a multifunctional interactive computer system, the IN2L, that uses video and audio to engage people more fully in rehabilitation. Music and videos elicit and sustain responses that contribute to rehabilitation goals such as increasing balance or strength. With the IN2L, audio and video material that matches the preferences and past experience of the person in rehabilitation can be selected. While this approach shows promise with rehabilitation patients generally, it has particular potential for application with persons with dementia. Specifically, when Physical or Occupational Therapists (PT and OT) are not able to engage a person with dementia in rehabilitation tasks using verbal instructions and explanations, they may be able to involve the person using audio and video stimuli that draw upon abilities that have remained intact despite the disease. To determine the efficacy of IN2L, the study will use a quasi-experimental design that compares rehabilitation patients with dementia seen at two comparable facilities operated by Presbyterian Senior Care Network. In one facility, the Willows, OT and PT currently use IN2L. In the comparison facility, (Southmont), OT and PT do not currently have access to IN2L. This type of design is optimal, because it prevents contamination effects that could occur with random assignment within the same facility. In that case, therapists in the control condition who were working side-by-side with therapists using IN2L would be likely to incorporate IN2L techniques in their therapy sessions if they perceived it to be useful. The study will use observational and self-report by patients and their therapists measures to determine if persons with dementia in rehabilitation show greater participation in rehabilitation activities, better attainment of rehabilitation goals and functional improvement when therapists use the IN2L compared to usual therapy approaches.

Conditions

Dementia

Keywords

Dementia; Rehabilitation

Outcome Measures

Primary Outcomes (3)

• Pittsburgh Rehabilitation Participation Scale (PRPS)

  Measures change in engagement in therapy from the beginning to the end of rehabilitation. Scores range from 0--no engagement to 5--excellent engagement. Higher scores indicate a better outcome. There are no subscales.

  The PRPS is scored on multiple occasions for each subject following completion of OT and PT sessions from the time of enrollment in the study until treatment completion (on average 10 days).

• Functional Independence Scale

  Measures change in functioning independence of patients from beginning to end of treatment. The scale consists of 42 items that are each rated using a reliable 10 point rating system. Scores on each function range from completely dependent (score of 0) to independent (score of 10). There are 2 subscales: items rated by physical therapists (13, range 0 to 130) and items rated by occupational therapists (29, range 0 to 290). Higher scores indicated better functioning.

  The Functional Independence Scale is administered two times: prior to treatment and again at the completion of treatment (on average 10 days later)

• Goal Attainment: Percent of Rehabilitation Goals Attained.

  The measure assesses the percent of rehabilitation goals attained by patients. Goals are set by OT and PT at initial assessment. Attainment is determined based on comparison of Functional Independent scores at baseline and completion of treatment. Scores for goal attainment are: (1) did not attain goal; (2) attained goal; and (3) exceeded goal. The number of goals set initially varies across patients. For that reason, goal attainment scores will be summed for each person and the sum then divided by the number of goals that were initially set. This creates a comparable score across persons, which has a range from 1 to 3. Analyses will be conducted using this mean-item score for goals. Secondary analyses will look at the mean-item score for goals set by PTs and by OTs separately.

  Scored at the completion of treatment, usually 10 days to two weeks after subjects enter the study.

Study Arms (2)

IN2L enhanced therapy

EXPERIMENTAL

The intervention to be delivered is the use of the IN2L computer system to deliver video, music, and exercises to patients receiving physical and occupational therapy. Therapists will select the specific IN2L that will be most appropriate given each person's rehabilitation goals and personal preferences.

Device: IN2L computer system

Usual OT and PT services without IN2L

NO INTERVENTION

The intervention to be delivered is physical therapy and occupational therapy to improve functioning.

Interventions

IN2L computer system DEVICE

Therapists will use the IN2L computer system to choose videos, music, games and exercise specific to the rehabilitation needs and personal preferences of patients.

IN2L enhanced therapy

Eligibility Criteria

• Sex: all
• Healthy Volunteers: No
• Age Groups: Child (0-17), Adult (18-64), Older Adult (65+)

You may qualify if:

• Probable dementia indicated by prior diagnosis and/or a score of 23 or less on the Brief Alzheimer Screen.

You may not qualify if:

• No evidence of dementia

Sponsors & Collaborators

• Penn State University: lead
• Presbyterian SeniorCare Network: collaborator

Study Sites (2)

Presbytyerian SeniorCare

Oakmont, Pennsylvania, 15139, United States

Location

Presbyterian SeniorCare Southmont

Washington, Pennsylvania, 15301, United States

Location

Related Publications (3)

• Lenze EJ, Munin MC, Quear T, Dew MA, Rogers JC, Begley AE, Reynolds CF 3rd. The Pittsburgh Rehabilitation Participation Scale: reliability and validity of a clinician-rated measure of participation in acute rehabilitation. Arch Phys Med Rehabil. 2004 Mar;85(3):380-4. doi: 10.1016/j.apmr.2003.06.001.

  PMID: 15031821 BACKGROUND

• Morghen S, Morandi A, Guccione AA, Bozzini M, Guerini F, Gatti R, Del Santo F, Gentile S, Trabucchi M, Bellelli G. The association between patient participation and functional gain following inpatient rehabilitation. Aging Clin Exp Res. 2017 Aug;29(4):729-736. doi: 10.1007/s40520-016-0625-3. Epub 2016 Sep 2.

  PMID: 27590904 BACKGROUND

• Zarit SH, Chiusano C, Harrison AS, Sewell L, Krause C, Liu Y. Rehabilitation of persons with dementia: using technology to improve participation. Aging Ment Health. 2021 Mar;25(3):543-550. doi: 10.1080/13607863.2020.1711864. Epub 2020 Jan 16.

  PMID: 31941356 RESULT

MeSH Terms

Conditions

Dementia

Condition Hierarchy (Ancestors)

Brain Diseases; Central Nervous System Diseases; Nervous System Diseases; Neurocognitive Disorders; Mental Disorders

Study Design

• Study Type: interventional
• Phase: not applicable
• Allocation: NON RANDOMIZED
• Masking: NONE
• Purpose: TREATMENT
• Intervention Model: PARALLEL
• Sponsor Type: OTHER
• Responsible Party: PRINCIPAL INVESTIGATOR
• PI Title: Principal Investigator and Distinguished Professor Emeritus

Model Details: The study will use a quasi-experimental design, comparing patients from two similar rehabilitation units operated by the same organization who have similar patient populations.

Study Record Dates

• First Submitted: February 28, 2019
• First Posted: March 7, 2019
• Study Start: March 31, 2018
• Primary Completion: May 31, 2019
• Study Completion: June 30, 2019
• Last Updated: August 28, 2020

Record last verified: 2020-08

Data Sharing

• IPD Sharing: Will not share

Locations

US (2)