Yun-Hee Jeon, Judy Simpson, Judith Fethney, Luisa Krein, Mirim Shin, Lee-Fay Low, Robert T Woods, Loren Mowszowski, Sarah Hilmer, Sharon L Naismith, Lindy Clemson, Henry Brodaty, Vasi Naganathan, Amanda Miller Amberber, Danelle Kenny, Laura Gitlin, Sarah Szanton
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I-HARP is a 4-month, home-based, dementia rehabilitation model delivered by an interdisciplinary team. Assessments were conducted at baseline (time-1), 4-month (time-2) and 12-month (time-3) follow-up. The primary outcome measure was the client's functional independence using the Disability Assessment for Dementia (DAD) scale at time-2, based on intention-to-treat analyses.</p><p><strong>Result: </strong>Of 130 recruited client-carer dyads, 116 dyads (58/group) completed the trial. The I-HARP group were not significantly better in most outcome measures than usual care at both time-2 and time-3; with the only statistically significant difference being a reduction in home environment hazards at time-2. Post hoc subgroup analysis of 66 clients with mild dementia found significantly better functional independence in the intervention group compared with those in usual care: difference 8.99 on DAD (95% CI 1.21, 16.79) at time-2 and difference 12.16 (95% CI 1.93, 22.38) at time-3. Economic evaluation suggests potentially lower resource use in I-HARP compared with usual care, but the cost-effectiveness is uncertain.</p><p><strong>Conclusion: </strong>Primary outcomes were not met for a population of people with dementia, with severity ranging from mild to moderate and severe. 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引用次数: 0
摘要
背景：我们调查了跨学科家庭康复计划（I-HARP）在改善痴呆患者的功能独立性、健康和福祉、家庭护理结果和成本方面的有效性。方法：一项多中心实用平行组随机对照试验比较了I-HARP与澳大利亚悉尼社区居住的轻度至中度痴呆患者及其家庭护理人员的常规护理（2018-2022）。I-HARP是一个跨学科团队提供的为期4个月、以家庭为基础的痴呆症康复模式。在基线（时间-1）、4个月（时间-2）和12个月（时间-3）随访时进行评估。主要结局指标是基于意向治疗分析，使用时间-2时痴呆残疾评估（DAD）量表评估患者的功能独立性。结果：在招募的130对客户-护理者中，116对（58/组）完成了试验。在时间-2和时间-3时，I-HARP组在大多数结局指标上都没有明显优于常规护理；唯一有统计学意义的区别是家庭环境危害在时间2上的减少。对66名轻度痴呆患者进行的事后亚组分析发现，干预组的功能独立性明显优于常规护理组：在第2次时，DAD差异为8.99 (95% CI 1.21, 16.79)；在第3次时，差异为12.16 （95% CI 1.93, 22.38）。经济评价表明，与常规护理相比，I-HARP的资源使用可能更低，但成本效益尚不确定。结论：痴呆患者的主要结局未达到，其严重程度从轻度到中度到重度不等。I-HARP模型似乎有利于轻度痴呆参与者的功能独立性，具有潜在的成本节约。试验注册号：ACTRN12618000600246。
Effectiveness of the Interdisciplinary Home-bAsed Reablement Programme (I-HARP) on improving functional independence of people living with dementia: a multicentre, pragmatic, randomised, open-label, controlled trial.
Background: We investigated the effectiveness of an Interdisciplinary Home-bAsed Reablement Programme (I-HARP) on improving functional independence, health and well-being of people with dementia, family carer outcomes and costs.
Method: A multicentre pragmatic parallel-arm randomised controlled trial compared I-HARP to usual care in community-dwelling people with mild to moderate dementia and their family carers in Sydney, Australia (2018-2022). I-HARP is a 4-month, home-based, dementia rehabilitation model delivered by an interdisciplinary team. Assessments were conducted at baseline (time-1), 4-month (time-2) and 12-month (time-3) follow-up. The primary outcome measure was the client's functional independence using the Disability Assessment for Dementia (DAD) scale at time-2, based on intention-to-treat analyses.
Result: Of 130 recruited client-carer dyads, 116 dyads (58/group) completed the trial. The I-HARP group were not significantly better in most outcome measures than usual care at both time-2 and time-3; with the only statistically significant difference being a reduction in home environment hazards at time-2. Post hoc subgroup analysis of 66 clients with mild dementia found significantly better functional independence in the intervention group compared with those in usual care: difference 8.99 on DAD (95% CI 1.21, 16.79) at time-2 and difference 12.16 (95% CI 1.93, 22.38) at time-3. Economic evaluation suggests potentially lower resource use in I-HARP compared with usual care, but the cost-effectiveness is uncertain.
Conclusion: Primary outcomes were not met for a population of people with dementia, with severity ranging from mild to moderate and severe. The I-HARP model appeared to benefit functional independence of participants with mild dementia, with potential cost savings.
期刊介绍：
The Journal of Neurology, Neurosurgery & Psychiatry (JNNP) aspires to publish groundbreaking and cutting-edge research worldwide. Covering the entire spectrum of neurological sciences, the journal focuses on common disorders like stroke, multiple sclerosis, Parkinson’s disease, epilepsy, peripheral neuropathy, subarachnoid haemorrhage, and neuropsychiatry, while also addressing complex challenges such as ALS. With early online publication, regular podcasts, and an extensive archive collection boasting the longest half-life in clinical neuroscience journals, JNNP aims to be a trailblazer in the field.
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