Table 3.
Results for effectiveness of activity-based interventions to improve experience of care outcomes for Plwd in hospital
| Study | Outcome (tool) | Comparison group (or pre-intervention) |
Intervention group (or post-intervention) |
Effect size d (95% CI) |
Mean difference (95% CI) |
p | Significant change | ||||
|---|---|---|---|---|---|---|---|---|---|---|---|
| N | Mean | SD | N | Mean | SD | ||||||
| DiNapoli et al. [36] (2016) | Quality of life (DQoL) | 13 | 3.27 | 0.72 | 21 | 3.64 | 0.66 | 0.53 (− 0.17 to 1.23) | 0.37 (− 0.12 to 0.86) | 0.13 | ↔ |
| BPSD (NRS-R) | 26 | 10.04 | 6.97 | 26 | 7.19 | 5.58 | −0.45 (− 0.99 to 0.11) | −2.85 (−6.37 to 0.67) | 0.11 | ↔ | |
| Gitlin et al. [37] (2016) | Emotional state (pleasure-AARS) | 10 | 9.9 | range 2–20 | 15 | 13.76 | range 0–57 | NA | (increase) | NA | NA |
| Mood (general alertness-AARS) | 10 | 88.7 | range 45–139 | 15 | 75.68 | range 17–174 | NA | (decrease) | NA | NA | |
| Mood (anxiety and anger-AARS) | 10 | 22.6 | range 0–34 | 15 | 5.3 | range 0–29 | NA | (decrease) | NA | NA | |
| Patient engagement (positive verbalisations) | 10 | 56.2 | range 15–126 | 15 | 40.67 | range 0–116 | NA | (decrease) | NA | NA | |
| Patient engagement (negative verbalisations) | 10 | 17.5 | range 0–84 | 15 | 5.58 | range 0–32 | NA | (decrease) | NA | NA | |
| Patient engagement (positive nonverbal) | 10 | 38.6 | range 9–65 | 15 | 41.87 | range 1–152 | NA | (increase) | NA | NA | |
| Patient engagement (negative nonverbal) | 10 | 11.6 | range 0–21 | 15 | 5.72 | range 0–36 | NA | (decrease) | NA | NA | |
| Weber et al. [38] (2009) | Patient engagement (therapeutic progress-GES) | 76 | NA | NA | 76 | NA | NA | NA | (increase, β = 2.01) | 0.04 | ↑ |
| Behaviour-Neuropsychiatric symptoms (NPI) | 76 | NA | NA | 76 | NA | NA | NA | (decrease, β = −4.21) | < 0.001 | ↑ | |
| Cheong et al. [39] (2016) | Mood (pleasure and general alertness-OERS) | 25 | 0.68 | NA | 25 | 3.12 | NA | NA | (increase) | 0.01 | ↑ |
| Mood (anger, anxiety and sadness-OERS) | 25 | 0.48 | NA | 25 | 0.32 | NA | NA | (decrease) | 0.05 | ↑ | |
| Patient engagement (Constructive & passive-MPES) | 25 | 6.26 | NA | 25 | 8.0 | NA | NA | (increase) | 0.01 | ↑ | |
| Patient engagement (self- and non-engagement-MPES) | 25 | 1.04 | NA | 25 | 0.72 | NA | NA | (decrease) | 0.01 | ↑ | |
| Daykin et al. [40] (2017) | Mood (happiness-ArtsObs) | 20 | NA | NA | 20 | NA | NA | NA | (increase) | NA | NA |
| Patient engagement (relaxation, distraction, engagement-ArtsObs) | 20 | NA | NA | 20 | NA | NA | NA | (positive impact) | NA | NA | |
| Behaviour (agitation-ArtsObs) | 20 | NA | NA | 20 | NA | NA | NA | (decrease) | NA | NA | |
| Windle et al. [41] (2018) | Quality of life (DEMQOL self-report, 3 months) | 15 | 91.5 | 14 | 13 | 92.5 | 10.7 | 0.08 (−0.67 to 0.82) | 1.0 (−8.80 to 10.80) | 0.84 | ↔ |
| Quality of life (DEMQOL self-report, 6 months) | 15 | 91.5 | 14 | 12 | 90.3 | 14.6 | − 0.08 (− 0.84 to 0.68) | −1.20 (− 12.58 to 10.18) | 0.83 | ↔ | |
| Quality of life (DEMQOL proxy, 3 months) | 19 | 86.7 | 12.6 | 9 | 96.3 | 10.2 | 0.78 (− 0.04 to 1.60) | 9.60 (− 0.31 to 19.51) | 0.06 | ↔ | |
| Quality of life (DEMQOL proxy, 6 months) | 19 | 86.7 | 12.6 | 4 | 85.5 | 15.6 | −0.09 (−1.17 to 0.99) | − 1.20 (− 16.15 to 13.75) | 0.87 | ↔ | |
| Patient engagement (communication*, 3 months) | 19 | 12.9 | 9.5 | 15 | 19.3 | 10 | 0.64 (−0.05 to 1.34) | 6.40 (−0.44 to 13.24) | 0.07 | ↔ | |
| Patient engagement (communication*, 6 months) | 19 | 12.9 | 9.5 | 9 | 20.7 | 10.9 | 0.76 (−0.06 to 1.58) | 7.80 (−0.48 to 16.08) | 0.06 | ↔ | |
| Wellbeing domains (GCCWBOT, 2 weeks) | |||||||||||
| Interest | 18 | 52.5 | 28.9 | 20 | 50.5 | 18.8 | −0.08 (−0.72 to 0.56) | −2.0 (−17.88 to 13.88) | 0.80 | ↔ | |
| Attention | 18 | 67.5 | 21 | 20 | 71.9 | 16.5 | 0.23 (−0.41 to 0.87) | 4.4 (−7.96 to 16.76) | 0.48 | ↔ | |
| Pleasure | 18 | 26 | 22.2 | 20 | 25.9 | 14.0 | −0.01 (−0.64 to 0.63) | −0.10 (−12.18 to 11.98) | 0.99 | ↔ | |
| Normalcy | 18 | 46.1 | 20.2 | 20 | 41.5 | 15.3 | −0.25 (−0.89 to 0.39) | −4.60 (−16.32 to 7.12) | 0.43 | ↔ | |
| Self-esteem | 18 | 29.2 | 5.5 | 20 | 27.9 | 6.4 | −0.21 (−0.85 to 0.43) | −1.30 (−5.25 to 2.65) | 0.51 | ↔ | |
| Disengagement | 18 | 19.8 | 25.0 | 20 | 19.0 | 24.0 | −0.03 (−0.67 to 0.60) | −0.80 (−16.93 to 15.33) | 0.92 | ↔ | |
| Sadness | 18 | 2.1 | 6.4 | 20 | 2.1 | 7.0 | 0.0 (−0.64 to 0.64) | 0.0 (−4.43 to 4.43) | 1.00 | ↔ | |
| Negative affect | 18 | 2.8 | 5.0 | 20 | 1.3 | 2.9 | −0.36 (−1.01 to 0.28) | −1.50 (−4.16 to 1.16) | 0.26 | ↔ | |
| Wellbeing domains (GCCWBOT, 3 months) | |||||||||||
| Interest | 18 | 52.5 | 28.9 | 12 | 47.9 | 18.3 | −0.18 (−0.91 to 0.55) | −4.6 (−23.89 to 14.69) | 0.63 | ↔ | |
| Attention | 18 | 67.5 | 21 | 12 | 69.5 | 20.4 | 0.09 (−0.64 to 0.82) | 2.00 (−13.85 to 17.85) | 0.80 | ↔ | |
| Pleasure | 18 | 26 | 22.2 | 12 | 25.5 | 18.9 | −0.02 (−0.75 to 0.71) | −0.50 (−16.51 to 15.51) | 0.95 | ↔ | |
| Normalcy | 18 | 46.1 | 20.2 | 12 | 44.3 | 13.8 | −0.10 (−0.83 to 0.63) | −1.80 (−15.51 to 11.91) | 0.79 | ↔ | |
| Self-esteem | 18 | 29.2 | 5.5 | 12 | 30 | 5.3 | 0.14 (−0.59 to 0.87) | 0.80 (−3.34 to 4.94) | 0.70 | ↔ | |
| Disengagement | 18 | 19.8 | 25.0 | 12 | 15.9 | 16 | −0.17 (−0.90 to 0.56) | −3.90 (−20.63 to 12.83) | 0.64 | ↔ | |
| Sadness | 18 | 2.1 | 6.4 | 12 | 0.4 | 1.3 | −0.33 (−1.06 to 0.41) | −1.70 (−5.56 to 2.16) | 0.37 | ↔ | |
| Negative affect | 18 | 2.8 | 5.0 | 12 | 1.7 | 2.6 | −0.25 (−0.99 to 0.48) | −1.10 (−4.32 to 2.12) | 0.49 | ↔ | |
AARS Apparent Affect Rating Scale, BPSD Behavioural and psychological symptoms of dementia, CI Confidence interval, d: Cohen’s d, DEMQOL Dementia Quality of Life, DQoL Dementia Quality of Life instrument, GCCWBOT Greater Cincinnati Chapter Well-Being Observation Tool, GES Group Evaluation Scale, MPES Menorah Park Engagement Scale, NRS-R Neurobehavioral Rating Scale-Revised, NA Indicates relevant data was not reported or calculable, OERS The Lawton Observed Emotion Rating Scale, SD Standard deviation, p-value: for the mean difference between groups/pre-post
*: higher scores indicating more communication difficulties, ↑: statistically significant difference for outcome in this comparison and direction of effect beneficial for intervention group or post-test, ↓: statistically significant difference for outcome in this comparison and direction of effect not beneficial for intervention group or post-test, ↔: no statistically significant difference for outcome in this comparison