Community Occupational Therapy in Dementia intervention for people with mild to moderate dementia and their family carers in the UK: the VALID research programme including RCT

Jennifer, Wenborn; Gail, Mountain; Esme, Moniz-Cook; Fiona, Poland; Michael, King; Rumana, Omar; Aidan, O’Keeffe; Stephen, Morris; Elena, Pizzo; Susan, Michie; Myrra, Vernooij-Dassen; Maud, Graff; Jane, Hill; David, Challis; Ian, Russell; Catherine, Sackley; Sinéad, Hynes; Nadia, Crellin; Jacqueline, Mundy; Jane, Burgess; Tom, Swinson; Laura, Di Bona; Becky, Field; Cathryn, Hart; Jacki, Stansfeld; Holly, Walton; Sally, Rooks; Ritchard, Ledgerd; Martin, Orrell · 2023 · DOAJ

DOI: 10.3310/RGTJ7429

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Summary

The VALID research programme addressed the need to translate and evaluate the Community Occupational Therapy in Dementia (COTiD) intervention for people with mild to moderate dementia and their family carers in the UK. Motivated by evidence that the original Dutch COTiD intervention was clinically and cost-effective, the study aimed to adapt the intervention for UK practice and estimate its effectiveness compared to treatment as usual. The programme sought to determine whether this activity-based, goal-setting approach could improve daily living activities and quality of life within the UK’s community service framework. The study employed a mixed-methods design comprising a development phase, an internal pilot, and a multicentre, two-arm, parallel-group, single-blind pragmatic randomised controlled trial (RCT). The development phase involved translating and adapting the COTiD manual and training materials through expert review, focus groups with patients and carers, a consensus conference, and a survey of 197 occupational therapists to scope current UK practice. The resulting COTiD-UK intervention was delivered at home by occupational therapists over 10 weeks. In the RCT, 468 pairs (people with dementia and their carers) were randomised to receive either COTiD-UK or treatment as usual. Data were collected at baseline and at 12, 26, 52, and 78 weeks post-randomisation. The primary outcome was the Bristol Activities of Daily Living Scale at 26 weeks, with secondary outcomes including cognition, mood, quality of life, and carer competence. The study also included a cost-utility analysis, a fidelity study, and qualitative interviews. The results indicated no statistically significant difference between the COTiD-UK and treatment as usual groups on the primary outcome at 26 weeks (adjusted mean difference 0.35, 95% CI –0.81 to 1.51; p = 0.55). There were no significant differences in secondary outcomes, and findings remained consistent at 52 and 78 weeks. The cost-utility analysis showed a very low probability (0.02%) that COTiD-UK was cost-effective at a willingness-to-pay threshold of £20,000 per quality-adjusted life-year. However, qualitative data revealed positive participant experiences, with 90.8% of the 920 goals set being fully or partially achieved. Fidelity to the intervention was moderate, with variation across sites and therapists. The study concluded that while COTiD-UK was successfully adapted for the UK context, it did not demonstrate statistical evidence of clinical or cost-effectiveness compared to usual care. The authors suggest this may be due to differences in UK service models or the need for better outcome measures that capture meaningful goals and activity participation rather than relying on proxy data. The findings highlight the importance of developing tools that reflect the lived experiences of people with dementia and suggest that future research should focus on measuring goal achievement and the quality of activity participation.

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• mci dementia driving