Rehabilitation of persons living with dementia: Using technology to improve participation: Mapping dementia: Technological methods to identify and interpret cognitive function. (7th December 2020) - Chiusano, Carrie
Abstract: Background: Rehabilitation following an illness or injury can improve functioning for persons living with dementia (PLWD) and help them remain as independent in daily life as possible. Gains, however, may be limited, because PLWD are often not able to engage fully in treatment. This study examined how a technology system, "It's Never 2 Late" (iN2L), may help augment traditional rehabilitation approaches for PLWD by improving engagement in therapy sessions and achieving better functional outcomes. Method: The study used a two group quasi‐experimental design. Older adults living with dementia (N= 96) were recruited from two rehabilitation departments housed within residential care communities operated by the same organization. Participants received daily occupational and physical therapy sessions using treatment as usual (TAU) at one site (n = 49) or treatment augmented with iN2L (n = 47) at the other site. A goal attainment approach was used to assess functional outcomes. As part of standard procedures at each site, initial and final functioning was assessed across 23 measures of functioning, mobility, and activities of daily living. Therapists selected goals from these items and specified levels of function that would indicate goal attainment. Goal attainment was scored comparing functioning at completion of treatment against initial goals. Engagement was rated from observations of treatment sessions by research assistants using the Pittsburgh Rehabilitation Participation Scale. It was hypothesized that patients at the iN2L site will show greater attainment of therapy goals and greater engagement during therapy sessions than patients receiving TAU and that improvement in engagement will mediate the association of treatment type (iN2L or TAU) with greater goal attainment. Result: Participants in the iN2L treatment had significantly higher goal attainment than TAU, significantly higher levels of engagement at baseline, and significantly steeper increases in engagement over the course of therapy. A multilevel regression model in MPLUS was used to estimate total and indirect (i.e. mediation) effects. Results showed that the effects of treatment on goal attainment was significantly mediated by increases in engagement. Conclusion: Findings suggest that iN2L technology has the potential to increase treatment engagement and enhance rehabilitation outcomes among older adults living with dementia.