Promoting Activity, Independence and Stability in Early Dementia
Research type
Research Study
Full title
A programme of work to develop and evaluate an intervention to promote activity and independence, and prevent falls, for people with early dementia and mild cognitive impairment.
IRAS ID
195907
Contact name
Rowan Harwood
Contact email
Sponsor organisation
Nottingham University Hospitals NHS Trust
Duration of Study in the UK
6 years, 0 months, 0 days
Research summary
People with memory problems can struggle with everyday activities and may stop doing things they want to do. They are more prone to accidents and have a higher risk of falling. Occupational therapists can advise how to do daily activities more easily and safely. Physiotherapists can teach exercises which increase activity and improve balance, and may help maintain memory.
There is little research on how to make these interventions work for with people with memory problems. In this research programme we will finalise two activity and exercise programmes suitable for people with memory problems, and study them in a feasibility trial. One programme involves high-intensity supervision (50 visits over one year), the other moderate-intensity supervision (11 visits over three months). We will compare these with standard falls prevention assessment and advice (1-3 therapist visits). We will encourage participants to exercise by themselves or with family members over the year, and once the programme ends.
People with early dementia or memory problems will be eligible for this study. If possible, we will also recruit a family member. Participants will be recruited from memory clinics or the ‘Join Dementia Research’ register. The intervention will be delivered over a maximum of 1 year in their own homes. Researchers will visit to collect information at baseline and at 12 months. We will measure ability in activities of daily living, activity, quality of life, memory and health service use. Participants will complete weekly falls diaries. Intervention persistence will be measured for 24 months.
We will conduct interviews and discussion groups to help develop the programmes, and understand how they work in practice ('process evaluation'). We will also do initial work on health economic modelling, dissemination and implementation.
Study findings will be used to refine the intervention, and inform a planned definitive randomised controlled trial.
Lay summary of study results: Dementia causes deterioration in memory and thinking abilities. The Promoting Activity, Independence, and Stability in Early Dementia (PrAISED) programme aimed to develop and test a physical exercise and activity intervention to improve the ability to do daily activities among older people in the early stages of dementia.
We developed a therapy programme specifically designed for people with dementia. We paid particular attention to encouraging participation. Therapy was tailored to participants’ goals, preferences and abilities. We confirmed that we could deliver the intervention and do the research to test it in a small-scale feasibility study.
We tested PrAISED by recruiting 365 people with dementia and a family member from five English counties. We randomly assigned them to receive PrAISED therapy or to a control group, who were given advice on falls prevention. The PrAISED group received up to 50 therapy sessions, delivered by trained therapists, and were also encouraged to do exercises on their own. At the start and after 12 months, we measured ability to do everyday activities and other aspects of health, including falls, quality of life, activity and NHS and social care use. We did interviews and observations to explain the findings.
Those receiving PrAISED therapy did no better on any of our measurements than those in the control group. The therapy programme was popular, and participants described benefits to their lives. Professional supervision and family support were important. However, memory and physical health problems often prevented full participation. The study was disrupted by the COVID-19 pandemic.
An economic study showed that PrAISED was not cost-effective. A method which values social outcomes suggested that PrAISED gave a good return before the pandemic, but not during it.
We conclude that it might be more appropriate to help people manage problems associated with the inevitable decline seen in dementia rather than to try to change the course of the disease.REC name
Yorkshire & The Humber - Bradford Leeds Research Ethics Committee
REC reference
16/YH/0040
Date of REC Opinion
16 Mar 2016
REC opinion
Further Information Favourable Opinion