REMCARE: Pragmatic Multi-Centre Randomised Trial of Reminiscence Groups for People with Dementia and their Family Carers: Effectiveness and Economic Analysis.
BACKGROUND
Joint reminiscence groups, involving people with dementia and family carers together, are popular, but the evidence-base is limited. This study aimed to assess the effectiveness and cost-effectiveness of joint reminiscence groups as compared to usual care.


METHODS
This multi-centre, pragmatic randomised controlled trial had two parallel arms: intervention group and usual-care control group. A restricted dynamic method of randomisation was used, with an overall allocation ratio of 1:1, restricted to ensure viable sized intervention groups. Assessments, blind to treatment allocation, were carried out at baseline, three months and ten months (primary end-point), usually in the person's home. Participants were recruited in eight centres, mainly through NHS Memory Clinics and NHS community mental health teams. Included participants were community resident people with mild to moderate dementia (DSM-IV), who had a relative or other care-giver in regular contact, to act as informant and willing and able to participate in intervention. 71% carers were spouses. 488 people with dementia (mean age 77.5)were randomised: 268 intervention, 220 control; 350 dyads completed the study (206 intervention, 144 control). The intervention evaluated was joint reminiscence groups (with up to 12 dyads) weekly for twelve weeks; monthly maintenance sessions for further seven months. Sessions followed a published treatment manual and were held in a variety of community settings. Two trained facilitators in each centre were supported by volunteers. Primary outcome measures were self-reported quality of life for the person with dementia (QoL-AD), psychological distress for the carer (General Health Questionnaire, GHQ-28). Secondary outcome measures included: autobiographical memory and activities of daily living for the person with dementia; carer stress for the carer; mood, relationship quality and service use and costs for both.


RESULTS
The intention to treat analysis (ANCOVA) identified no differences in outcome between the intervention and control conditions on primary or secondary outcomes (self-reported QoL-AD mean difference 0.07 (-1.21 to 1.35), F = 0.48, p = 0.53). Carers of people with dementia allocated to the reminiscence intervention reported a significant increase in anxiety on a General Health Questionnaire-28 sub-scale at the ten month end-point (mean difference 1.25 (0.25 to 2.26), F = 8.28, p = 0.04). Compliance analyses suggested improved autobiographical memory, quality of life and relationship quality for people with dementia attending more reminiscence sessions, however carers attending more groups showed increased care-giving stress. Economic analyses from a public sector perspective indicated that joint reminiscence groups are unlikely to be cost-effective. There were no significant adverse effects attributed to the intervention. Potential limitations of the study include less than optimal attendance at the group sessions--only 57% of participants attended at least half of the intervention sessions over the 10 month period, and a higher rate of study withdrawal in the control group.


CONCLUSIONS
This trial does not support the clinical effectiveness or cost-effectiveness of joint reminiscence groups. Possible beneficial effects for people with dementia who attend sessions as planned are offset by raised anxiety and stress in their carers. The reasons for these discrepant outcomes need to be explored further, and may necessitate reappraisal of the movement towards joint interventions.


BACKGROUND
ISRCTN Registry ISRCTN42430123.
Dementia Services Development Centre Wales, Bangor University, Bangor, Gwynedd, United Kingdom.
Robert T
http://orcid.org/0000-0002-6781-651X
RT
Woods
Institute of Mental Health, University of Nottingham, Nottingham, United Kingdom.
Martin
M
Orrell
Bradford Dementia Group, University of Bradford, Bradford, United Kingdom.
Errollyn
E
Bruce
Centre for Economics and Policy in Health, Bangor University, Bangor, Gwynedd, United Kingdom.
Rhiannon T
RT
Edwards
North Wales Organisation for Randomised Trials in Health and Social Care, Bangor University, Bangor, Gwynedd, United Kingdom.
Zoe
http://orcid.org/0000-0003-1803-5482
Z
Hoare
Centre for Economics and Policy in Health, Bangor University, Bangor, Gwynedd, United Kingdom.
Barry
B
Hounsome
School of Nursing, Midwifery and Social Work, University of Manchester, Manchester, United Kingdom.
John
J
Keady
Dementia Care Research, Faculty of Health & Social Care, University of Hull, Hull, United Kingdom.
Esme
http://orcid.org/0000-0002-7232-4632
E
Moniz-Cook
Division of Psychiatry, University College London, London, United Kingdom.
Vasiliki
V
Orgeta
Clinical Psychology, Aneurin Bevan Health Board, Ystrad Mynach Hospital, Ystrad Mynach, Caerphilly, United Kingdom.
Janice
J
Rees
West Wales Organisation for Rigorous Trials in Health, Centre for Health Information Research and Evaluation, Swansea University, Swansea, United Kingdom.
Ian
http://orcid.org/0000-0002-0069-479X
I
Russell
D000203:Activities of Daily Living / Q000523:psychology; D000223:Adaptation, Psychological / Q000502:physiology; D000339:Affect / Q000502:physiology; D000368:Aged; D001008:Anxiety Disorders / Q000191:economics / Q000523:psychology; D017028:Caregivers / Q000191:economics* / Q000523:psychology; D003362:Cost-Benefit Analysis / Q000191:economics*; D003704:Dementia / Q000191:economics* / Q000628:therapy*; D039721:Diagnostic and Statistical Manual of Mental Disorders; D005260:Female; D006801:Humans; D008297:Male; D008568:Memory / Q000502:physiology; D011581:Psychological Tests; D011788:Quality of Life / Q000523:psychology; D019057:Quality-Adjusted Life Years; D011795:Surveys and Questionnaires