title: Effectiveness and cost-effectiveness of cognitive adaptation training as a nursing intervention in long-term residential patients with severe mental illness: study protocol for a randomized controlled trial.
abstract: BACKGROUND
  Despite the well-known importance of cognitive deficits for everyday functioning in patients with severe mental illness (SMI), evidence-based interventions directed at these problems are especially scarce for SMI patients in long-term clinical facilities. Cognitive adaptation Training (CAT) is a compensatory approach that aims at creating new routines in patients' living environments through the use of environmental supports. Previous studies on CAT showed that CAT is effective in improving everyday functioning in outpatients with schizophrenia. The aim of this study is to evaluate the effect of CAT as a nursing intervention in SMI patients who reside in long-term clinical facilities.
  
  
  METHODS
  This is a multicenter cluster randomized controlled trial comparing CAT (intervention group) as a nursing intervention to treatment as usual (control group). The primary goal is to evaluate the effectiveness of CAT on everyday functioning. Secondary outcomes are quality of life, empowerment and apathy. Further, an economic evaluation will be performed. The study has a duration of one year, with four follow-up assessments at 15, 18, 21 and 24 months for the intervention group.
  
  
  CONCLUSIONS
  There is a need for evidence-based interventions that contribute to the improvement of the functional recovery of long-term residential patients. If our hypotheses are confirmed, it may be recommended to include CAT in the guidelines for SMI care and to implement the method in standardized care.
  
  
  BACKGROUND
  Nederlands Trial Register (identifier: NTR3308 ). Date registered: 12 February 2012.
authors.affiliation: Department of Rehabilitation, Lentis Center for Mental Health, Lentis Psychiatric Institute, Lagerhout E35, 9741 KE, Zuidlaren, The Netherlands. a.stiekema@lentis.nl.|Rob Giel Research Center, University of Groningen, University Medical Center Groningen, Hanzeplein 1, 9713 GZ, Groningen, The Netherlands. a.stiekema@lentis.nl.
authors.forename: Annemarie Pm
authors.initials: AP
authors.lastname: Stiekema
authors.affiliation: Department of Depression, PsyQ, Lentis Psychiatric Institute, Hereweg 76, 9725 AG, Groningen, The Netherlands. pj.quee@lentis.nl.
authors.forename: Piotr J
authors.initials: PJ
authors.lastname: Quee
authors.affiliation: Department of Rehabilitation, Lentis Center for Mental Health, Lentis Psychiatric Institute, Lagerhout E35, 9741 KE, Zuidlaren, The Netherlands. am.dethmers@lentis.nl.
authors.forename: Marian
authors.initials: M
authors.lastname: Dethmers
authors.affiliation: Department of Epidemiology, University of Groningen, University Medical Center Groningen, Hanzeplein 1, 9713 GZ, Groningen, The Netherlands. e.r.van.den.heuvel@umcg.nl.
authors.forename: Edwin R
authors.initials: ER
authors.lastname: van den Heuvel
authors.affiliation: Department of Rehabilitation, Lentis Center for Mental Health, Lentis Psychiatric Institute, Lagerhout E35, 9741 KE, Zuidlaren, The Netherlands. je.redmeyer@lentis.nl.
authors.forename: Jeroen E
authors.initials: JE
authors.lastname: Redmeijer
authors.affiliation: Department of Rehabilitation, Lentis Center for Mental Health, Lentis Psychiatric Institute, Lagerhout E35, 9741 KE, Zuidlaren, The Netherlands. cm.rietberg@lentis.nl.
authors.forename: Kees
authors.initials: K
authors.lastname: Rietberg
authors.affiliation: Department of Epidemiology, University of Groningen, University Medical Center Groningen, Hanzeplein 1, 9713 GZ, Groningen, The Netherlands. a.d.stant@umcg.nl.
authors.forename: A Dennis
authors.initials: AD
authors.lastname: Stant
authors.affiliation: Research Department, Lentis Psychiatric Institute, Hereweg 80, 9725 AG, Groningen, The Netherlands. m.swart@lentis.nl.
authors.forename: Marte
authors.initials: M
authors.lastname: Swart
authors.affiliation: Department of TRANZO, Tilburg School of Social and Behavioral Sciences, Dijk en Duin Psychiatric Institute, Tilburg University, Warandelaan 2, 5037 AB, Tilburg, The Netherlands. J.vanWeeghel@uvt.nl.
authors.forename: Jaap
authors.initials: J
authors.lastname: van Weeghel
authors.affiliation: Department of Neuroscience, University of Groningen, University Medical Center Groningen, Antonius Deusinglaan 2, 9713 AW, Groningen, The Netherlands. a.aleman@umcg.nl.|Department of Clinical Psychology and Experimental Psychopathology, University of Groningen, Grote Kruisstraat 2/1, 9712 TS, Groningen, The Netherlands. a.aleman@umcg.nl.
authors.forename: André
authors.initials: A
authors.lastname: Aleman
authors.affiliation: Division of Schizophrenia and Related Disorders, Department of Psychiatry, University of Texas, 7703 Floyd Curl Drive, San Antonio, TX, USA. velligand@uthscsa.edu.
authors.forename: Dawn I
authors.initials: DI
authors.lastname: Velligan
authors.affiliation: Rob Giel Research Center, University of Groningen, University Medical Center Groningen, Hanzeplein 1, 9713 GZ, Groningen, The Netherlands. r.a.schoevers@umcg.nl.|University of Groningen, University Medical Center Groningen, University Center of Psychiatry, Hanzeplein 1, 9713 GZ, Groningen, The Netherlands. r.a.schoevers@umcg.nl.
authors.forename: Robert A
authors.initials: RA
authors.lastname: Schoevers
authors.affiliation: Rob Giel Research Center, University of Groningen, University Medical Center Groningen, Hanzeplein 1, 9713 GZ, Groningen, The Netherlands. r.bruggeman@umcg.nl.|University of Groningen, University Medical Center Groningen, University Center of Psychiatry, Hanzeplein 1, 9713 GZ, Groningen, The Netherlands. r.bruggeman@umcg.nl.
authors.forename: Richard
authors.initials: R
authors.lastname: Bruggeman
authors.affiliation: Department of Rehabilitation, Lentis Center for Mental Health, Lentis Psychiatric Institute, Lagerhout E35, 9741 KE, Zuidlaren, The Netherlands. l.vandermeer@lentis.nl.|Rob Giel Research Center, University of Groningen, University Medical Center Groningen, Hanzeplein 1, 9713 GZ, Groningen, The Netherlands. l.vandermeer@lentis.nl.|Department of Neuroscience, University of Groningen, University Medical Center Groningen, Antonius Deusinglaan 2, 9713 AW, Groningen, The Netherlands. l.vandermeer@lentis.nl.
authors.forename: Lisette
authors.initials: L
authors.lastname: van der Meer
mesh_terms: D002985:Clinical Protocols; D003072:Cognition Disorders / Q000451:nursing*; D003362:Cost-Benefit Analysis; D056344:Executive Function; D017048:Health Care Costs; D006801:Humans; D011788:Quality of Life; D018401:Sample Size; D012559:Schizophrenia / Q000451:nursing*