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developing complex interventions such as comprehensive OR “Alzheimer Disease” [Mesh] OR “Dementia” [Mesh: rehabilitation requires the identiﬁcation of evidence, iden- NoExp] OR dementia [Title/Abstract] OR senile) AND tifying or developing theory, and modelling processes and (Rehabilitation [Mesh:NoExp] OR rehabilitation [Title/ outcome . Providing evidence in rehabilitation for Abstract] OR reable ) NOT (brain injury OR stroke PLWD is challenged by a lack of conceptual consensus [MESH Major Topic] OR surgery NOT down syndrome OR [16–18] and by heterogeneity regarding samples, re- postoperative OR “Postoperative Period”[Mesh:NoExp]). habilitative techniques, and the processes and outcome e search was adopted to the individual databases. e measures used in intervention studies [18, 20]. Several search terms “Dementia” and “Alzheimer Disease” are broad studies indicate that multimodal nonpharmacological in- MESH terms including “Lewy Body Disease,” “Vascular terventions are promising [18, 20–23]. However, evidence Dementia,” and “Frontotemporal Dementia.” e search concerning which modalities should be integrated into a strategy was developed in cooperation with an experienced comprehensive rehabilitation intervention in dementia is librarian and through inspiration from previous systematic poor [16, 18, 20]. Evidence for speciﬁc modalities has been reviews [24, 39, 40]. identiﬁed: physical training [24, 25], memory training Mendeley Desktop Version 1.17.8 was used to manage [26, 27], occupational therapy , dyadic interventions the retrieved articles and remove duplicates. Furthermore, , and cognitive stimulation therapy . Moreover, experts within the ﬁeld of dementia and rehabilitation re- there is a small but growing evidence base regarding the search were consulted regarding the research strategy and eﬀectiveness of cognitive rehabilitation (CR) [12, 31–33]. CR the preliminary ﬁndings. includes a variety of psychosocial interventions aiming to support functioning, participation, and family carers 2.2. Inclusion and Exclusion Criteria. e eligible studies [12, 31–33]. were screened based on the type of article, population, in- In accordance with the MRC guidance, this review will tervention, outcome, and study design. Studies were ex- focus on selected aspects regarding modelling processes and cluded if not all eight criteria were applied: (1) peer-reviewed outcomes in dementia rehabilitation for PLWD. e re- articles in English, Danish, Swedish, or Norwegian, (2) the search literature concerning processes and outcomes seems term “rehabilitation” used in title/abstract/keywords, (3) to be heterogeneous. Professor Linda Clare and colleagues dementia (Alzheimer’s disease or not speciﬁed) being the emphasise the signiﬁcance of a person-centred approach primary diagnosis, (4) mild to moderate dementia, (5) tailored in accordance with individually meaningful goals participants were home-dwelling, inpatients, or in- and further emphasise the signiﬁcance of the setting in termediate care patients, (6) the intervention addressed rehabilitation. According to Clare, CR aims to support as- more than one International Classiﬁcation of Functioning, pects of everyday functioning and well-being . Clare Disability and Health (ICF) component: body system and does not clearly address whether CR should be organised by function, activities and participation, and environmental a multidisciplinary approach. is is stressed by other re- factors , (7) intervention studies with a statistically searchers in rehabilitation for PLWD  and further signiﬁcant eﬀect on one or more outcome measures, and (8) supported in generic rehabilitation literature [34, 35]. high level of evidence intervention studies (prospective e aim of this scoping review is to map intervention cohort and randomised controlled trials) . studies of rehabilitation for PLWD regarding processes and Rehabilitation is, in this review, deﬁned according to the outcomes with a particular focus on whether the in- biopsychosocial model [5, 6]. Hence, interventions targeting tervention is person-centred, home-based, adopts a multi- only one ICF component was not considered as re- disciplinary approach, and measures the outcome on habilitation and thereby excluded. By including only in- everyday functioning and well-being. tervention studies with a high level of evidence and a statistically signiﬁcant eﬀect on one or more outcome 2. Materials and Methods measures, this review aimed to map the most promising intervention studies in rehabilitation for PLWD. e scoping review was undertaken to identify the nature and extent of rehabilitation interventions targeting PLWD 2.3. Study Selection. e ﬁrst screening of title and abstract and further analyse processes and outcomes . e was undertaken by the ﬁrst author and, if in doubt, articles screening process followed the PRISMA Statement and were included and discussed with the other reviewers. e Guidelines [37, 38]. main reason for exclusion was dementia (Alzheimer’s dis- ease or not speciﬁed) not being the primary diagnosis. In- 2.1. Search Strategy. Relevant articles were retrieved from cluded studies were screened for eligibility; the full-text PubMed, CINAHL, PsycINFO, Embase, and Cochrane articles were read and analysed by all authors. When in electronic databases from 2005 until the 11th of November doubt, a consensus was reached by discussion. e main 2018. e year 2005 was chosen because a Cochrane review reasons for exclusion were studies in which interventions found no studies regarding cognitive rehabilitation in 2003 addressed only one ICF component and/or the setting and diagnostic criteria were ambiguous. e ﬂowchart of the , and two books indicated an emerging focus on re- habilitation in dementia in 2005  and 2007 . Search search and screening process is presented in Figure 1. Journal of Aging Research 3 Records identified through database searching (n = 2186) Records after duplicates removed Records excluded with reasons: (n = 1525) Nondementia or multiple diseases, e.g., Parkinson’s disease, nonrehabilitation intervention, reviews Records screened by title/abstract (n = 1081) (n = 1525) Full-text assessed for eligibility Records excluded with reasons: (n = 444) eligibility, single component interventions, ambiguous setting and diagnostic criteria, no statistically significant outcomes, prospective Studies included in the review cohort, and randomised controlled trials (n = 26) (n = 418) Figure 1: PRISMA œow diagram, identi�cation including inclusion and exclusion of studies. 2.4. Quality Assessment. A quality assessment of the in- merging duplicates. Following the �rst screening of title and cluded studies was performed using CONSORT for rand- abstract, 1,081 abstracts did not meet the inclusion criteria. omised control trials and CASP for prospective cohort Full-text reading was undertaken with the remaining eligible studies. e assessment of included studies did not result in 444 studies, of which 26 studies met the inclusion criteria further exclusion. and were included in this review. Nineteen of the 26 interventions were person-centred, 2.5. Analytic Framework for Mapping. e interventions in two were not speci�ed, and �ve were not considered to be person-centred. Nine of the 26 interventions were home- the included studies were mapped by all authors according to the study’s aim. e following aspects of the included based, six were not speci�ed, and 11 were not home-based. Fourteen of the 26 interventions reported a multidisciplinary studies were prede�ned: person-centred is de�ned as in- terventions that are either tailor-made, individualised, or approach towards rehabilitation, and 12 did not. Twelve involving the participants’ own goals as person-centred studies had ADL as an outcome measure. Fourteen studies had QoL as an outcome measure. rehabilitation involves both organisation and delivery [12, 34]; home-based interventions are interventions taking As an additional �nding, we realised that the 13 studies termed as “cognitive rehabilitation” di™ered on several of the place in the homes of people living with dementia; multi- disciplinary is considered as interventions that include two mapped aspects. For example, seven were multidisciplinary, six were not; four were home-based, six were not home- or more professions; everyday functioning is de�ned as activities of daily living (ADL) as an outcome measure, based, and three were not speci�ed; 11 were person-centred, one was not person-centred, and one did not specify person- according to the Danish Dementia Research Centre’s list of ADL-scales relevant in dementia research and scales ex- centredness. Details regarding the mapping of the 26 studies are presented in Table 1. plicitly termed as activities of daily living ; and well-being is de�ned as quality of life (QoL) as an outcome measure, according to JPND research’s list of QoL-scales, and scales 4. Discussion explicitly described as quality of life . Two authors independently mapped and compared their e aim of this scoping review is to map intervention studies assessment of the interventions reported in the included of rehabilitation for PLWD regarding processes and out- studies. In the event of any disagreements, a third author was comes, with a particular focus on whether interventions are consulted until consensus was reached. person-centred, home-based, adopt a multidisciplinary approach, and measure outcomes relating to everyday functioning and well-being. e �ndings provide an over- 2.5.1. Patient and Public Involvement. No patients were view of the current evidence base in which these speci�c involved in the review process. Peers were involved in aspects are presented in statistically signi�cant intervention planning the review via discussions with fellow researchers studies of rehabilitation for PLWD. Nineteen of the 26 in a research network. interventions were person-centred, that is, tailor-made, individualised interventions or interventions involving the 3. Results participants’ own goals. is aligns with generic re- habilitation literature: a person-centredgoal-orientated re- e systematic bibliographic database search identi�ed 2,186 potentially relevant abstracts, a total of 1,525 after habilitation has been recommended by several well-cited Included Eligibility Screening Identification 4 Journal of Aging Research Table 1: Mapping of the included studies. Processes Outcome Intervention and reference a b Multidisciplinary Home-based Person-centred ADL QoL Brain-activating rehabilitation  Yes No Yes No No Brain-activating rehabilitation  No No Yes No Yes Cognitive rehabilitation and cognitive-behavioural No No Yes No No treatment  Cognitive rehabilitation  Yes No Yes Yes Yes Cognitive rehabilitation  Yes No Yes Yes Yes Cognitive rehabilitation  No No Not speciﬁed No No Cognitive rehabilitation  Yes Yes Yes Yes Yes Cognitive rehabilitation  Yes Yes Yes No No Cognitive rehabilitation  No Not speciﬁed Yes No No Cognitive rehabilitation  No Yes Yes No Yes Cognitive rehabilitation  No Not speciﬁed Yes Yes Yes Collaborative memory intervention  No Yes No No No Computer errorless learning-based memory training No Not speciﬁed Yes Yes No program  Dual-task rehabilitation  No Not speciﬁed No No No Individualised cognitive rehabilitation therapy  Yes Not speciﬁed Yes Yes Yes Individualised face-to-face cognitive rehabilitation No Yes Yes Yes Yes  Intensive rehabilitation  Yes Not speciﬁed Yes Yes No MINDVital rehabilitation  Yes No Yes Yes No Multicomponent cognitive stimulation program  No Yes Yes No No Multidisciplinary cognitive rehabilitation  Yes No No No Yes Multidisciplinary rehabilitation  Yes No Not speciﬁed No Yes Multimodal cognitive and physical rehabilitation  Yes No Yes Yes Yes Multimodal rehabilitation  No Yes No Yes No Music rehabilitation  Yes Yes No No Yes Self-management group rehabilitation  Yes No Yes No Yes Short-term inpatient rehabilitation  Yes Yes Yes Yes Yes a b Activities of daily living, according to the Danish Dementia Research Centre . Quality of life, according to JPND research . Statistically signiﬁcant eﬀect (p≥ 0.05). researchers [71, 72]. Moreover, person-centredness is a well- on rehabilitation in dementia [15, 17]. However, the results known principle in dementia care . However, the review in the review illustrate that 12 intervention studies did not identiﬁed a few eﬀective interventions which did not address undertake a multidisciplinary approach; hence, the review person-centredness [56, 58, 64, 67, 68]. us, the results of does not clearly support multidisciplinarity as an organising this review support person-centredness as a dominant aspect principle in rehabilitation in dementia. Fewer than half of the studies measured the impact on within rehabilitation in PLWD. Regarding the setting of the interventions, in nine of the ADL, and more than half of them measured the impact on 26 included studies, the intervention was home-based. QoL. Dementia being an incurable and progressing disease Within generic rehabilitation literature, Professor Derick aﬀecting everyday life [79, 80], outcome measures related to T. Wade emphasises the importance of the environment ADL and QoL seem relevant in rehabilitation for PLWD. without stating that rehabilitation should be restricted to one Furthermore, diﬃculties in performing ADL are associated speciﬁc setting . Home-based rehabilitation provides the with diminished QoL and poor self-eﬃcacy . Still, the opportunity for PLWD to engage in rehabilitation in their impact on ADL and QoL is measured only in about half of everyday setting where they spend most of their time . It the intervention studies. ereby, the results of this review has been suggested that home-based rehabilitation in- concur with the ﬁndings from Kroll and Naue indicating terventions may reduce the demands and pressures on the that there is a heterogeneous use of outcome measures in intervention studies within rehabilitation for PLWD . participants . Despite this beneﬁt, the results of this review indicate that a home-based setting is not commonly Like the overall results, interventions termed as “cog- used in rehabilitation for PLWD. According to our ﬁndings, nitive rehabilitation” did not have consistency regarding rehabilitation of PLWD may take place either at home or at a whether those intervention studies for PLWD were person- centre. centred, home-based, or multidisciplinary. us, the results A multidisciplinary approach was present in 14 of the 26 of our review support and expand the critique referred to in interventions studied. Studies from geriatric rehabilitation the introduction, illustrating that studies in rehabilitation for  and rehabilitation in other areas support a multidis- PLWD suﬀer from a conceptual inconsistency [16–18] and ciplinary approach . is is reﬂected in other literature substantial heterogeneity in terms of processes [18, 20]. Journal of Aging Research 5 e review has both methodological strengths and Conflicts of Interest limitations. e strength of the ﬁndings from the review is e authors have no conﬂicts interest to declare. the provision of an overview of the processes and outcomes in studies of high evidence in the rehabilitation of PLWD. However, the study also has some limitations. Using Authors’ Contributions search terms other than “rehabilitation” and “reable ,” for MBR conducted the literature search, and all authors con- example, “restorative care,” might have resulted in more tributed to the screening and mapping of the studies. MBR relevant studies. However, the rationale behind this decision and JT prepared the initial draft of the manuscript after was to include studies constituted as rehabilitation. Fur- sparring with KSP and completed the manuscript. thermore, we do not expect that including more studies would have resulted in a clearer picture of processes and Acknowledgments outcomes in dementia intervention studies. Only studies with a high level of evidence and a sta- We would like to thank Mette Buje Grundsøe, MLISc, tistically signiﬁcant eﬀect on more than one outcome Aalborg University Library, for specialised knowledge and measure were included in this review. In accordance with the support regarding the systematic searches for this review. aim, these studies were assessed to be the most reasonable. We would also like to thank experts within the ﬁeld of However, it can be argued that including studies with no dementia and rehabilitation research for assisting with ex- statistically signiﬁcant eﬀects might have been just as rea- pert consultation. is research was supported by Velux sonable. Also including studies with no statistically signif- Fonden (grant no. 11637). icant eﬀect might have provided us with a more comprehensive picture of current evidence. Results from References studies with no statistically signiﬁcant eﬀect are more dif- ﬁcult to publish, so risk of publication bias should be  Nationalt videnscenter for demens, Vaskulær Demens, 2017, considered . Considering the aim, we however do not http://www.videnscenterfordemens.dk/viden-om-demens/ expect this would have resulted in a clearer picture of demenssygdomme/vaskulaer-demens/. processes and outcomes in dementia intervention studies.  K. R. Scott and A. M. 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