Structured relearning of activities of daily living in dementia: the randomized controlled REDALI-DEM trial on errorless learning

Abstract

BackgroundErrorless learning (EL) is a method for optimizing learning, which uses feed-forward instructions in order to prevent people from making mistakes during the learning process. The majority of previous studies on EL taught patients with dementia artificial tasks of little or no relevance for their daily lives. Furthermore, only a few controlled studies on EL have so far been performed and just a handful of studies have examined the long-term effects of EL. Tasks were not always trained in the patients’ natural or home environment, limiting the external validity of these studies. This multicenter parallel randomized controlled trial examines the effects of EL compared with trial and error learning (TEL) on the performance of activities of daily living in persons with Alzheimer’s or mixed-type dementia living at home.MethodsPatients received nine 1-hour task training sessions over eight weeks using EL or TEL. Task performance was measured using video observations at week 16. Secondary outcome measures were task performance measured at week 26, satisfaction with treatment, need for assistance, challenging behavior, adverse events, resource utilization and treatment costs.ResultsA total of 161 participants were randomized, of whom 71 completed the EL and 74 the TEL arm at week 11. Sixty-nine EL patients and 71 TEL patients were assessed at the 16-week follow-up (the primary measurement endpoint). Intention-to-treat analysis showed a significantly improved task performance in both groups. No significant differences between the treatment groups were found for primary or secondary outcomes.ConclusionsStructured relearning improved the performance of activities of daily living. Improvements were maintained for 6 months. EL had no additional effect over TEL.Trial registrationGerman Register of Clinical Trials DRKS00003117. Registered 31 May 2011.Electronic supplementary materialThe online version of this article (doi:10.1186/s13195-017-0247-9) contains supplementary material, which is available to authorized users.

Individual goal‐oriented cognitive rehabilitation to improve everyday functioning for people with early‐stage dementia: A multicentre randomised controlled trial (the GREAT trial)

“…A different, but related, approach to improving everyday functioning involves structured training in completing selected activities of daily living. Two recent trials 35,36 found that performance on trained tasks improved, although there was no evidence of generalisation to everyday situations 35 of CR 37 reported that, compared with usual treatment, CR participants showed less functional decline at 24 months, a 6-month delay in institutionalisation and lower overall rates of institutionalisation, but no significant differences mood or quality of life. The CR intervention in that trial was poorly described, and goal attainment was not directly measured.…”

Effects of nonpharmacological interventions on functioning of people living with dementia at home: A systematic review of randomised controlled trials

“…The 13 studies with lower ROB were conducted in the United Kingdom, 26,30,[37][38][39] United States, 29,31 Netherlands, 34,56 Finland, 27,28,33 Germany, 32,36 Denmark, 25 and France. 35 .…”

“…35 . They evaluated functional ability using informant or self-report scales that measured patient performance and dependency on others to perform ADLs, [25][26][27][28][29][30][31][32][33][35][36][37][38][39]56 activity-specific goal setting, 56 and physical role function. 34 We divided the included studies into four groups: physical exercise therapies, OT interventions, multicomponent interventions, and cognitionoriented or reminiscence therapies.…”

Nichtpharmakologische Therapie der Demenzen

“…"geführte Lernen" (vorsagen, vormachen, korrigieren) dem sog. "aktiven Lernen" (ausprobieren lassen) in der Begleitung von Personen mit Alzheimer-oder gemischter Demenz in der eigenen Häuslichkeit überlegen ist [11]. Hintergrund ist die Überlegung, dass geführtes Lernen (errorless learning) mehr prozedurale Lernsysteme anspricht, wogegen aktives Lernen (trial and error) mehr auf explizite, hippokampale Gedächtnisleistungen angewiesen ist.…”

“…In beiden Gruppen verbesserte sich die Performance der Aktivitäten des täglichen Lebens. Im Ergebnis zeigte sich jedoch kein Unterschied zwischen geführtem und aktivem Lernen [11].…”