title: Effectiveness of a training package for implementing a community-based occupational therapy program in dementia: a cluster randomized controlled trial.
abstract: OBJECTIVE
  Evaluate the effectiveness of a training package to implement a community occupational therapy program for people with dementia and their caregiver (COTiD).
  
  
  METHODS
  Cluster randomized controlled trial.
  
  
  METHODS
  A total of 45 service units including 94 occupational therapists, 48 managers, 80 physicians, treating 71 client-caregiver couples.
  
  
  METHODS
  Control intervention: A postgraduate course for occupational therapists only.
  
  
  METHODS
  A training package including the usual postgraduate course, additional training days, outreach visits, regional meetings, and access to a reporting system for occupational therapists. Physicians and managers received newsletters, had access to a website, and were approached by telephone.
  
  
  METHODS
  
  
  
  METHODS
  The intended adherence of therapists to the COTiD program. This was assessed using vignettes.
  
  
  RESULTS
  clients' daily functioning, caregivers' sense of competence, quality of life, and self-perceived performance of daily activities of both clients and caregivers. Between-group differences were assessed using multilevel analyses with therapist and intervention factors as covariates.
  
  
  RESULTS
  No significant between-group differences between baseline and 12 months were found for adherence (1.58, 95% CI -0.10 to 3.25), nor for any client or caregiver outcome. A higher number of coaching sessions and higher self-perceived knowledge of dementia at baseline positively correlated with adherence scores. In contrast, experiencing more support from occupational therapy colleagues or having conducted more COTiD treatments at baseline negatively affected adherence scores.
  
  
  CONCLUSIONS
  The training package was not effective in increasing therapist adherence and client-caregiver outcomes. This study suggests that coaching sessions and increasing therapist knowledge on dementia positively affect adherence.
  
  
  BACKGROUND
  NCT01117285.
authors.affiliation: Radboud University Medical Center, Scientific Institute for Quality of Healthcare (IQ healthcare), Nijmegen, The Netherlands The Nijmegen Alzheimer Centre, Nijmegen, The Netherlands carola.dopp@tno.nl.
authors.forename: Carola M E
authors.initials: CM
authors.lastname: Döpp
authors.affiliation: Radboud University Medical Center, Scientific Institute for Quality of Healthcare (IQ healthcare), Nijmegen, The Netherlands The Nijmegen Alzheimer Centre, Nijmegen, The Netherlands Department of Rehabilitation, Radboud University Medical Center, Nijmegen, The Netherlands.
authors.forename: Maud J L
authors.initials: MJ
authors.lastname: Graff
authors.affiliation: Department for Health Evidence (Biostatistics section), Radboud University Medical Center, Nijmegen, The Netherlands.
authors.forename: Steven
authors.initials: S
authors.lastname: Teerenstra
authors.affiliation: The Nijmegen Alzheimer Centre, Nijmegen, The Netherlands Department of Geriatrics, Radboud University Medical Center, Nijmegen, The Netherlands.
authors.forename: Marcel G M
authors.initials: MG
authors.lastname: Olde Rikkert
authors.affiliation: Radboud University Medical Center, Scientific Institute for Quality of Healthcare (IQ healthcare), Nijmegen, The Netherlands Department of Rehabilitation, Radboud University Medical Center, Nijmegen, The Netherlands.
authors.forename: Maria W G
authors.initials: MW
authors.lastname: Nijhuis-van der Sanden
authors.affiliation: Radboud University Medical Center, Scientific Institute for Quality of Healthcare (IQ healthcare), Nijmegen, The Netherlands The Nijmegen Alzheimer Centre, Nijmegen, The Netherlands Department of Primary and Community Care, Radboud University Medical Center, Nijmegen, The Netherlands Kalorama Foundation, Beek-Ubbergen, The Netherlands.
authors.forename: Myrra J F J
authors.initials: MJ
authors.lastname: Vernooij-Dassen
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D017028:Caregivers / Q000193:education*; D016000:Cluster Analysis; D003153:Community Health Services / Q000379:methods* / Q000458:organization & administration; D003704:Dementia / Q000534:rehabilitation*; D004500:Education, Graduate / Q000379:methods / Q000458:organization & administration; D005260:Female; D019983:Guideline Adherence / Q000706:statistics & numerical data; D006282:Health Personnel / Q000193:education*; D006801:Humans; D008297:Male; D008875:Middle Aged; D055361:Multilevel Analysis; D009426:Netherlands; D009788:Occupational Therapy / Q000193:education / Q000379:methods* / Q000458:organization & administration; D010348:Patient Care Team / Q000458:organization & administration / Q000592:standards; D011368:Professional-Family Relations
keywords: Adherence; caregiver; cost-effectiveness; dementia; implementation; manager; occupational therapy; physician