Feasibility of a Co-Designed Personalized Cognitive Reablement Program Delivered via Digital Voice Assistants for Older Adults Living With Early-Stage Dementia or Mild Cognitive Impairment: Pilot Randomized Controlled Trial.
完整摘要 · 中文译文
背景：居家康复训练项目改善了早期痴呆或轻度认知障碍（MCI）患者的日常功能，但由卫生专业人员提供所需的大量时间投入已成为广泛实施的障碍。数字技术可以促进服务提供，但智能手机和平板电脑等传统设备对该人群存在可用性挑战。我们共同设计了一个认知康复训练项目VOICE-COG，可通过语音控制的数字语音助手（DVA）播送个性化干预。目的：本试点非盲随机对照试验考察了VOICE-COG对患有痴呆或MCI的老年人的可行性和潜在有效性，以指导全面试验的设计。方法：通过Facebook或StepUp-for Dementia Research数据库招募自我报告诊断为痴呆或MCI的老年人（年龄60-85岁）（N=30），并随机分为DVA干预组（n=15）或对照组（n=15），为期12周。随机分配到干预组的每位参与者及其照护伙伴通过Zoom与心理学家会面，从VOICE-COG项目中选择2或3个个性化目标。个性化项目由研究人员输入软件（BuddyLink），通过DVA（Amazon Alexa Show 8）播送。对照组参与者接受增强常规照护，包括照常治疗加每周信息电子邮件。主要可行性结局为招募、保留、设备记录的ad 以及系统可用性量表（SUS）。次要结局由参与者和照护伙伴通过基于网络的Qualtrics表单自我报告，包括目标达成量表-简易版（GAS）、参与者情绪、认知和日常功能的变化，以及照护者负担。 结果：招募率为86%（30/35），保留率为97%（29/30），干预组有1名参与者失访。对VOICE-COG项目的依从率为29%至100%（均值70%，SD 17%）。VOICE-COG项目被评为边缘可接受（SUS均分56.3，SD 18.1）。12周后，干预组60%（9/15）报告已达到或超过其目标（GAS-Light t分数≥50；均值57.6，SD 15.4）。与对照组相比，干预组的多因素记忆问卷-策略子量表评分增加显著更高，平均差异5.0（95% CI 0.03-10.1，P=.049），代表中等效应量（d=0.55）。组间无其他显著差异。 结论：这一共同设计的VOICE-COG项目通过数字语音助手（DVA）交付，对患有早期痴呆或轻度认知障碍（MCI）的老年人而言是可行的，使大多数参与者达到了其康复目标并增加了记忆策略的使用。系统可用性问题应在未来样本量充足的试验中加以解决。
完整摘要 · 英文原文
BACKGROUND: Home-based reablement programs have improved everyday functioning for people living with early-stage dementia or mild cognitive impairment (MCI), but the substantial time commitment required for delivery by health professionals has created a barrier to widespread implementation. Digital technology could facilitate delivery, but traditional devices such as smartphones and tablets present usability challenges for this population. We have co-designed a cognitive reablement program, VOICE-COG, that can deliver personalized interventions broadcast via voice-controlled digital voice assistants (DVAs). OBJECTIVE: This pilot nonblinded randomized controlled trial examined the feasibility and potential effectiveness of VOICE-COG for older adults living with dementia or MCI to guide the design of a full-scale trial. METHODS: Older adults (aged 60-85 years) with a self-reported diagnosis of dementia or MCI (N=30) were recruited via Facebook or the StepUp-for Dementia Research database and randomized to either a DVA intervention (n=15) or control (n=15) group for 12 weeks. Each participant randomized to the intervention group and their care partner met with a psychologist via Zoom to select 2 or 3 personalized goals from the VOICE-COG program. The personalized program was input into the software (BuddyLink) by researchers for broadcast via a DVA (Amazon Alexa Show 8). Participants in the control group received enhanced usual care, consisting of treatment as usual, plus weekly informational emails. Primary feasibility outcomes were recruitment, retention, device-recorded adherence, and the System Usability Scale (SUS). Secondary outcomes were self-reported by the participant and care partner via web-based Qualtrics forms and included the Goal Attainment Scale-Light (GAS), changes in participant mood, cognition, and everyday functioning, and carer burden. RESULTS: The recruitment rate was 86% (30/35) and the retention rate was 97% (29/30), with 1 participant in the intervention group lost to follow-up. Adherence to the VOICE-COG program ranged from 29% to 100% (mean 70%, SD 17%). The VOICE-COG program was rated as marginally acceptable (mean SUS score 56.3, SD 18.1). After 12 weeks, 60% (9/15) of the intervention group reported having met or exceeded their goals (GAS-Light t-score ≥50; mean 57.6, SD 15.4). The intervention group had a significantly higher increase in Multifactorial Memory Questionnaire-Strategy subscale score compared with control, mean difference 5.0 (95% CI 0.03-10.1, P=.049), representing a medium effect size (d=0.55). There were no other significant differences between groups. CONCLUSIONS: This co-designed VOICE-COG program, delivered via DVAs, was feasible for older adults living with early-stage dementia or MCI, resulting in most participants meeting their reablement goals and increases in the use of memory strategies. System usability issues should be addressed in future adequately powered trials.
摘要 待译
BACKGROUND: Home-based reablement programs have improved everyday functioning for people living with early-stage dementia or mild cognitive impairment (MCI), but the substantial time commitment required for delivery by health professionals has created a barrier to widespread implementation. Digital technology could facilitate delivery, but traditional devices such as smartphones and tablets present usability challenges for this population.…