The Dementia Early Stage Cognitive Aids New Trial (DESCANT) intervention: A goal attainment scaling approach to promote self‐management

The DESCANT (Dementia Early Stage Cognitive Aids New Trial) intervention provided a personalised care package to improve the cognitive abilities, function and well -being of people with early-stage dementia and their carers by providing a range of memory aids, with training and support for use. This presentation will explore findings from a goal attainment scaling exercise undertaken within a multi-site pragmatic randomised trial, part of a NIHR-funded research programme ‘Effective Home Support in Dementia Care: Components, Impacts and Costs of Tertiary Prevention.’The aim was to describe the Goal Attainment Scaling (GAS) approach developed; investigate the types of goals identified by people with dementia and their carers and subsequent attainment; and explore the role of Dementia Support Practitioners (DSPs) in the process. This GAS exercise was designed by researchers, a clinical psychologist, a clinician and a DSP. Goal setting and attainment were conducted with the person with dementia and their carer and recorded by DSPs. Data were obtained from 117 intervention records and semi-structured interviews with five DSPs delivering the intervention across seven NHS Trusts in England and Wales. The GAS exercise was conducted as planned with goals and extent of involvement in the exercise tailored to individual participants and engagement was high. Demographic characteristics from the trial baseline dataset were analysed. Measures were created from intervention records to permit quantification and descriptive analysis. Interviews were professionally transcribed and subject to thematic analysis to identify salient themes.A total of 293 goals were identified across the 117 participants. From these 17 goal types were distinguished across six domains: self -care; household tasks; daily occupation; orientation; communication; and well-being and safety. A measure of goal attainment appropriate to both the client group and a modest intervention was obtained. On average participants had evidenced some improvement regarding goals set. Qualitative findings suggested overall DSPs were positive about their experience of goal setting. Although several challenges were identified, if these were overcome, measuring goal attainment was generally viewed as straightforward. GAS can be used in the context of a psychosocial intervention for people with early-stage dementia to identify and measure attainment of personalised care goals.

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Development and Initial Evaluation of the Web-Based Self-Management Program “Partner in Balance” for Family Caregivers of People With Early Stage Dementia: An Exploratory Mixed-Methods Study

JMIR Research Protocols ◽

10.2196/resprot.5142 ◽

2016 ◽

Vol 5 (1) ◽

pp. e33 ◽

Cited By ~ 40

Author(s):

Lizzy MM Boots ◽

Marjolein E de Vugt ◽

Hanneke EJ Withagen ◽

Gertrudis IJM Kempen ◽

Frans RJ Verhey

Keyword(s):

Self Efficacy ◽

Goal Attainment ◽

Early Stage ◽

Management Program ◽

Self Management ◽

Dementia Caregivers ◽

System Failures ◽

Management Interventions ◽

Usability Tests ◽

Mrc Framework

BackgroundPeople with dementia increasingly depend on informal caregivers. Internet-based self-management interventions hold considerable promise for meeting the educational and support needs of early stage dementia caregivers (EDCs) at a reduced cost.ObjectiveThis study aimed to (1) develop an online self-management program for EDC to increase self-efficacy and goal attainment, and (2) evaluate the program’s feasibility and report preliminary data on effectiveness.MethodsBased on the Medical Research Council (MRC) framework for the development and evaluation of complex interventions, a stepwise approach was adopted to explore potential user needs and develop and validate the content by means of (1) focus group discussions with dementia caregivers (N=28), (2) interviews with dementia care professionals (N=11), and (3) individual think-aloud usability tests with EDC (N=2) and experts (N=2). A pilot evaluation was conducted with EDC (N=17) to test the feasibility and establish preliminary effects. Self-report measures of feasibility were completed after the completion of intervention. Self-efficacy and goal attainment were evaluated before and after the intervention.ResultsThe different steps provided useful information about the needs of potential users regarding the content and delivery of the program. This resulted in the newly developed “Partner in Balance” program. At the start, system failures resulted in a high noncompleter rate (7/17, 41%), but at the end, an acceptable feasibility score of 209 (range 54-234) was found. The convenience of completing the program at home, the tailored content, and the guidance (face-to-face and online) were appraised positively. Preliminary effects on caregiver self-efficacy (P<.05) and goal attainment (T>50) were promising.ConclusionsAdaptations were made to the program to limit the amount of system failures and prevent high noncompleter rates. As recommended by the MRC framework, confirming the feasibility and preliminary effectiveness is a valuable step toward examining the effectiveness of this newly developed intervention.Trial RegistrationDutch Trial Register (NTR): NTR4217; http://www.trialregister.nl/trialreg/admin/rctview.asp?TC=4217 (Archived by WebCite at http://www.webcitation.org/6f6B8lvRP).

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Feasibility of an integrated multidisciplinary geriatric rehabilitation programme for older stroke patients: a process evaluation

10.21203/rs.2.22563/v1 ◽

2020 ◽

Author(s):

Tom Vluggen ◽

Jolanda van Haastregt ◽

Jeanine Verbunt ◽

Caroline van Heugten ◽

Jos Schols

Keyword(s):

Process Evaluation ◽

Goal Attainment ◽

Informal Caregivers ◽

Management Training ◽

Rehabilitation Programme ◽

Self Management ◽

Geriatric Rehabilitation ◽

Goal Attainment Scaling ◽

Elderly Persons ◽

Stroke Patients

Abstract Background Almost half of the stroke patients admitted to geriatric rehabilitation has persisting problems after discharge. Currently, there is no evidence based geriatric rehabilitation programme available for older stroke patients, combining inpatient rehabilitation with adequate aftercare aimed at reducing the impact of persisting problems after discharge from a geriatric rehabilitation unit. Therefore, we developed an integrated multidisciplinary rehabilitation programme consisting of inpatient neurorehabilitation treatment using goal attainment scaling, home based self-management training, and group based stroke education for patients and informal caregivers. We performed a process evaluation to assess to what extent this programme was performed according to protocol. Furthermore, we assessed the participation of the patients in the programme, and the opinion of patients, informal caregivers and care professionals on the programme. Methods In this multimethod study, process data were collected by means of interviews, questionnaires, and registration forms among 97 older stroke patients, 89 informal caregivers, and 103 care professionals involved in the programme. Results A substantial part of patients and informal caregivers did not receive all key elements of the programme. Almost all patients formulated rehabilitation goals, but only among two thirds of the patients the goal attainment scaling method was used. Furthermore, the self-management training was considered rather complex and difficult to apply for frail elderly persons with stroke, and the percentage of therapy sessions performed in the patients’ home environment was lower than planned. In addition, only about a quarter of the patients and informal caregivers attended the education sessions. However, a large majority of patients, informal caregivers and care professionals indicated the beneficial aspects of the programme. Conclusion This study revealed that although the programme in general is perceived to be beneficial by patients, and informal and formal caregivers, the feasibility of the programme needs further attention. Because of persisting cognitive deficits and specific care needs in our frail and multimorbid target population, some widely used methods such as goal attainment scaling, and self-management training seemed not feasible in their current form. To optimize feasibility of the programme, it is recommended to tailor these elements more optimally to the population of frail older patients.

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Feasibility of an integrated multidisciplinary geriatric rehabilitation programme for older stroke patients: a process evaluation

10.21203/rs.2.22563/v2 ◽

2020 ◽

Author(s):

Tom Vluggen ◽

Jolanda van Haastregt ◽

Jeanine Verbunt ◽

Caroline van Heugten ◽

Jos Schols

Keyword(s):

Process Evaluation ◽

Goal Attainment ◽

Informal Caregivers ◽

Management Training ◽

Rehabilitation Programme ◽

Self Management ◽

Geriatric Rehabilitation ◽

Goal Attainment Scaling ◽

Stroke Patients ◽

Trial Register

Abstract Background: Almost half of the stroke patients admitted to geriatric rehabilitation has persisting problems after discharge. Currently, there is no evidence based geriatric rehabilitation programme available for older stroke patients, combining inpatient rehabilitation with adequate aftercare aimed at reducing the impact of persisting problems after discharge from a geriatric rehabilitation unit. Therefore, we developed an integrated multidisciplinary rehabilitation programme consisting of inpatient neurorehabilitation treatment using goal attainment scaling, home based self-management training, and group based stroke education for patients and informal caregivers. We performed a process evaluation to assess to what extent this programme was performed according to protocol. Furthermore, we assessed the participation of the patients in the programme, and the opinion of patients, informal caregivers and care professionals on the programme.Methods: In this multimethod study, process data were collected by means of interviews, questionnaires, and registration forms among 97 older stroke patients, 89 informal caregivers, and 103 care professionals involved in the programme.Results: A part of patients and informal caregivers did not receive all key elements of the programme. Almost all patients formulated rehabilitation goals, but among two thirds of the patients the goal attainment scaling method was used. Furthermore, the self-management training was considered rather complex and difficult to apply for frail elderly persons with stroke, and the percentage of therapy sessions performed in the patients’ home environment was lower than planned. In addition, about a quarter of the patients and informal caregivers attended the education sessions. However, a majority of patients, informal caregivers and care professionals indicated the beneficial aspects of the programme.Conclusion: This study revealed that although the programme in general is perceived to be beneficial by patients, and informal and formal caregivers, the feasibility of the programme needs further attention. Because of persisting cognitive deficits and specific care needs in our frail and multimorbid target population, some widely used methods such as goal attainment scaling, and self-management training seemed not feasible in their current form. To optimize feasibility of the programme, it is recommended to tailor these elements more optimally to the population of frail older patients. Trial registration: International Standard Randomized Controlled Trial Register Number (ISRCTN62286281), and The Dutch Trial Register (NTR2412).

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LRS-Elterngruppenprogramm: Teilnehmerzufriedenheit und subjektive Effektivität

Lernen und Lernstörungen ◽

10.1024/2235-0977/a000089 ◽

2016 ◽

Vol 5 (1) ◽

pp. 44-57

Author(s):

Anke Buschmann ◽

Bettina Multhauf

Keyword(s):

Goal Attainment ◽

Goal Attainment Scaling ◽

Eine Hohe ◽

Post Test

Zusammenfassung. Das Ziel vorliegender Studie bestand in einer Überprüfung der Akzeptanz und Teilnehmerzufriedenheit eines Gruppentrainings für Eltern von Kindern mit Lese- und/oder Rechtschreibschwierigkeiten. Zudem sollten erste Indikatoren bezüglich der Wirksamkeit des Programmes untersucht werden. Dazu wurden Daten von 25 Müttern zu 2 Messzeitpunkten (Post-Test, 3-Monats-Follow-up) analysiert. Die Probandinnen nahmen über einen Zeitraum von 3 Monaten an 5 Sitzungen des Programms «Mein Kind mit Lese- und Rechtschreibschwierigkeiten verstehen, stärken und unterstützen: Heidelberger Elterntraining zum Umgang mit LRS» teil. Ein Paper-Pencil-Fragebogen diente zum Post-Test der Erhebung von Teilnahmeparametern, der Zufriedenheit mit dem Training, der Relevanz einzelner Themen und der wahrgenommenen Veränderungen in wichtigen Zielbereichen. Zusätzlich kam eine für das Gruppensetting adaptierte Form des Goal Attainment Scaling zum Einsatz, um das Erreichen persönlich relevanter Ziele unmittelbar nach dem Training sowie 3 Monate später zu erfassen. Die Analyse des Fragebogens zeigte eine hohe Partizipationsbereitschaft der Mütter. Die Rahmenbedingungen des Trainings (Gruppengröße, Dauer des Trainings und der Sitzungen) sowie die didaktischen Methoden wurden als ideal und die Themen als relevant eingeschätzt. Die Mütter sahen sich in der Lage, die Inhalte im Alltag anzuwenden und nahmen positive Veränderungen hinsichtlich Einfühlungsvermögen, Unterstützung des Kindes, Hausaufgabensituation und Beziehung zum Kind wahr. Das Ausmaß des Erreichens individueller Ziele zum Post-Test variierte je nach Zielbereich: Einfühlen und Verstehen (75 %), Optimierung der Hausaufgabensituation (76 %), Unterstützung psychosozialer Entwicklung (86 %), Lese-Rechtschreibförderung (60 %) und war auch 3 Monate später noch vergleichbar hoch. Die Überprüfung der Wirksamkeit hinsichtlich einer Belastungsreduktion und Kompetenzstärkung seitens der Eltern erfolgt aktuell im Vergleich zu einer unbehandelten Kontrollgruppe.

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