Implementing a home-based personalised cognitive rehabilitation intervention for people with mild-to-moderate dementia: GREAT into practice

Clare, Linda, Kudlicka, Aleksandra, Collins, Rachel, Evans, Suzannah, Pool, Jackie, Henderson, Catherine ORCID: 0000-0003-4340-4702, Knapp, Martin ORCID: 0000-0003-1427-0215, Litherland, Rachael, Oyebode, Jan R. and Woods, Robert T (2023) Implementing a home-based personalised cognitive rehabilitation intervention for people with mild-to-moderate dementia: GREAT into practice. BMC Geriatrics, 23 (1). ISSN 1471-2318

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Abstract

Background Evidence-based rehabilitative interventions, if widely implemented, could equip people with dementia and their families to manage life with the condition and reduce the need for health and care services. The aim of this translational study, building on evidence from the GREAT randomised controlled trial, was to develop a foundation for implementing the GREAT Cognitive Rehabilitation intervention in community-based services for people with mild-to-moderate dementia. Methods Key elements of the implementation strategy were identifying and supporting managerial and clinical leadership, conducting collaborative planning and target-setting, training and supporting practitioners, and providing external facilitation. We developed implementation plans with, and trained staff in, 14 organisations. We subsequently worked closely with 11 of these, 10 National Health Service organisations and one private home care provider, to support practitioners to deliver GREAT Cognitive Rehabilitation over a 12-month period. Outcome evaluation examined the perspectives of local steering group members, practitioners and service users, and the reach, effectiveness and cost of the intervention. Results Implementation was disrupted by the COVID-19 pandemic, but six organisations completed at least six months of intervention delivery. Forty-one practitioners, mainly occupational therapists, provided the intervention, and 54 people with dementia completed a course of GREAT Cognitive Rehabilitation. Goal attainment by people with dementia exceeded levels of improvement seen in the original trial. People with dementia, carers, practitioners and steering group members all evaluated the intervention positively, and economic analysis indicated that the intervention could be provided at modest cost. However, we identified a range of mainly organisational barriers that impeded implementation and limited the potential for sustainability. Conclusions GREAT Cognitive Rehabilitation benefits people with dementia, can be delivered effectively at modest cost in routine services, and is viewed positively by people with dementia, family carers and practitioners. To fully realise these benefits and achieve widespread and sustainable implementation, however, requires sufficient resources and a reorientation of service priorities towards preventive and rehabilitative approaches.

Item Type:	Article
Official URL:	https://bmcgeriatr.biomedcentral.com/
Additional Information:	© 2023 The Authors
Divisions:	Care Policy and Evaluation Centre Health Policy
Subjects:	R Medicine > RA Public aspects of medicine > RA0421 Public health. Hygiene. Preventive Medicine H Social Sciences
Date Deposited:	16 Dec 2022 10:03
Last Modified:	18 Nov 2024 08:21
URI:	http://eprints.lse.ac.uk/id/eprint/117624

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