title: A new combined strategy to implement a community occupational therapy intervention: designing a cluster randomized controlled trial.
abstract: BACKGROUND
  Even effective interventions for people with dementia and their caregivers require specific implementation efforts. A pilot study showed that the highly effective community occupational therapy in dementia (COTiD) program was not implemented optimally due to various barriers. To decrease these barriers and make implementation of the program more effective a combined implementation (CI) strategy was developed. In our study we will compare the effectiveness of this CI strategy with the usual educational (ED) strategy.
  
  
  METHODS
  In this cluster randomized, single-blinded, controlled trial, each cluster consists of at least two occupational therapists, a manager, and a physician working at Dutch healthcare organizations that deliver community occupational therapy. Forty-five clusters, stratified by healthcare setting (nursing home, hospital, mental health service), have been allocated randomly to either the intervention group (CI strategy) or the control group (ED strategy). The study population consists of the professionals included in each cluster and community-dwelling people with dementia and their caregivers. The primary outcome measures are the use of community OT, the adherence of OTs to the COTiD program, and the cost effectiveness of implementing the COTiD program in outpatient care. Secondary outcome measures are patient and caregiver outcomes and knowledge of managers, physicians and OTs about the COTiD program.
  
  
  CONCLUSIONS
  Implementation research is fairly new in the field of occupational therapy, making this a unique study. This study does not only evaluate the effects of the CI-strategy on professionals, but also the effects of professionals' degree of implementation on client and caregiver outcomes.
  
  
  BACKGROUND
  NCT01117285.
authors: Scientific Institute for Quality of Healthcare (IQ healthcare), Radboud University, Nijmegen Medical Centre, Nijmegen, The Netherlands. cme_dopp@hotmail.com
authors: Carola M E
authors: CM
authors: Döpp
authors: Maud J L
authors: MJ
authors: Graff
authors: Steven
authors: S
authors: Teerenstra
authors: Eddy
authors: E
authors: Adang
authors: Ria W G
authors: RW
authors: Nijhuis-van der Sanden
authors: Marcel G M
authors: MG
authors: Olderikkert
authors: Myrra J F J
authors: MJ
authors: Vernooij-Dassen
mesh_terms: D016000:Cluster Analysis; D003704:Dementia / Q000523:psychology / Q000628:therapy*; D006801:Humans; D009788:Occupational Therapy / Q000379:methods*; D010348:Patient Care Team; D012111:Residence Characteristics; D016037:Single-Blind Method