Structured relearning of activities of daily living in dementia: the randomized controlled REDALI-DEM trial on errorless learning.
BACKGROUND
Errorless learning (EL) is a method for optimizing learning, which uses feed-forward instructions in order to prevent people from making mistakes during the learning process. The majority of previous studies on EL taught patients with dementia artificial tasks of little or no relevance for their daily lives. Furthermore, only a few controlled studies on EL have so far been performed and just a handful of studies have examined the long-term effects of EL. Tasks were not always trained in the patients' natural or home environment, limiting the external validity of these studies. This multicenter parallel randomized controlled trial examines the effects of EL compared with trial and error learning (TEL) on the performance of activities of daily living in persons with Alzheimer's or mixed-type dementia living at home.


METHODS
Patients received nine 1-hour task training sessions over eight weeks using EL or TEL. Task performance was measured using video observations at week 16. Secondary outcome measures were task performance measured at week 26, satisfaction with treatment, need for assistance, challenging behavior, adverse events, resource utilization and treatment costs.


RESULTS
A total of 161 participants were randomized, of whom 71 completed the EL and 74 the TEL arm at week 11. Sixty-nine EL patients and 71 TEL patients were assessed at the 16-week follow-up (the primary measurement endpoint). Intention-to-treat analysis showed a significantly improved task performance in both groups. No significant differences between the treatment groups were found for primary or secondary outcomes.


CONCLUSIONS
Structured relearning improved the performance of activities of daily living. Improvements were maintained for 6 months. EL had no additional effect over TEL.


BACKGROUND
German Register of Clinical Trials DRKS00003117 . Registered 31 May 2011.
Center for Geriatric Medicine and Gerontology, University Medical Center Freiburg, Freiburg, Germany.
Sebastian
S
Voigt-Radloff
Department of Medical Psychology & Radboudumc Alzheimer Center, Radboud University Medical Center, P.O. Box 9101 (internal post 925), 6500 HB, Nijmegen, The Netherlands.
Maartje M E
MM
de Werd
Department of Social Psychology & Methodology, University of Freiburg, Psychological Institute, Freiburg, Germany.
Rainer
R
Leonhart
Department of Medical Psychology & Radboudumc Alzheimer Center, Radboud University Medical Center, P.O. Box 9101 (internal post 925), 6500 HB, Nijmegen, The Netherlands.|Rehabilitation Center Klimmendaal, Arnhem, The Netherlands.
Danielle H E
DH
Boelen
Department of Geriatric Medicine & Radboudumc Alzheimer Center, Radboud University Medical Center, Nijmegen, The Netherlands.
Marcel G M
MG
Olde Rikkert
Department of Psychiatry and Psychotherapy, University Medical Center Bonn, Bonn, Germany.|German Center for Neurodegenerative Diseases (DZNE), Bonn, Germany.
Klaus
K
Fliessbach
Center for Geriatric Medicine and Gerontology, University Medical Center Freiburg, Freiburg, Germany.|Department of Psychiatry and Psychotherapy, University Medical Centre Freiburg, Freiburg, Germany.
Stefan
S
Klöppel
Center for Geriatric Medicine and Gerontology, University Medical Center Freiburg, Freiburg, Germany.
Bernhard
B
Heimbach
Department of Psychiatry and Psychotherapy, University Medical Center Mainz, Mainz, Germany.
Andreas
A
Fellgiebel
Department of Neurology, Philipps University Marburg, Marburg, Germany.|Department of Geriatrics, University Clinic Essen, Essen, Germany.
Richard
R
Dodel
Geriatric Center, University Hospital Tübingen, Tübingen, Germany.
Gerhard W
GW
Eschweiler
Department of Gerontopsychiatry, Central Institute of Mental Health, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany.
Lucrezia
L
Hausner
Department of Medical Psychology & Radboudumc Alzheimer Center, Radboud University Medical Center, P.O. Box 9101 (internal post 925), 6500 HB, Nijmegen, The Netherlands. Roy.Kessels@radboudumc.nl.|Donders Institute for Brain, Cognition and Behaviour, Radboud University, Nijmegen, The Netherlands. Roy.Kessels@radboudumc.nl.
Roy P C
http://orcid.org/0000-0001-9500-9793
RP
Kessels
Center for Geriatric Medicine and Gerontology, University Medical Center Freiburg, Freiburg, Germany.|Department of Psychiatry and Psychotherapy, University Medical Centre Freiburg, Freiburg, Germany.
Michael
M
Hüll
D000203:Activities of Daily Living; D000368:Aged; D001676:Biofeedback, Psychology / Q000379:methods*; D003704:Dementia / Q000175:diagnosis* / Q000534:rehabilitation*; D005260:Female; D006801:Humans; D007858:Learning; D008297:Male; D009426:Netherlands; D000066530:Neurological Rehabilitation / Q000379:methods*; D011597:Psychomotor Performance; D016037:Single-Blind Method; D016896:Treatment Outcome
Activities of daily living; Alzheimer’s dementia; Cognitive rehabilitation; Dementia; Errorless learning; Randomized controlled trial