A Home-Based Dyadic Music-with-Movement Intervention for People with Dementia and Caregivers: A Hybrid Type 2 Cluster-Randomized Effectiveness-Implementation Design

Daphne Sze Ki Cheung, Lily Yuen Wah Ho, Liliane Chui King Chan, Robin Ka Ho Kwok, Claudia Kam Yuk Lai, Daphne Sze Ki Cheung, Lily Yuen Wah Ho, Liliane Chui King Chan, Robin Ka Ho Kwok, Claudia Kam Yuk Lai

Abstract

Background: Integrating evidence-based music-with-movement into routine practices for people with dementia requires effective implementation strategies. The objectives of this study were to evaluate the clinical efficacy of the intervention and to examine the effectiveness of the implementation strategies in promoting home-based adoption.

Methods: This was a cluster randomized controlled trial adopting a clinical effectiveness-implementation hybrid design. The 12-week music-with-movement intervention aims to promote the well-being of people with dementia and their caregivers. Clinical outcomes were assessed to evaluate the efficacy of the intervention. These included the symptoms of anxiety and depression of people with dementia; caregivers' perception of their stress and the positive aspects of caregiving; and the quality of the dyadic relationship. Caregivers, staff, and volunteers were interviewed and objective figures on reach and adoption were collected to reflect the outcomes of the implementation.

Results: Compared to the waitlist control, there was a significant reduction in the anxiety and the symptoms of depression of those in the intervention group. There was also a significant reduction in the perceived stress level of the caregivers. Six focus group interviews were conducted. The intervention and the appropriateness of the implementation strategies were perceived positively by the dyad participants, the staff of the centres, and volunteers. Of the collaborating centres, 57% continued to use the intervention and, after six months, served six times more people than were recruited in this study. Over half of the participating families continued to use the intervention for at least six more months.

Conclusion: Music-with-movement interventions showed promise for improving the well-being of people with dementia and their caregivers. Effective strategies facilitated the implementation process, such as integrating communication technology to provide instant support and involving volunteers in engaging the collaborating centres and families. This study sheds light on perceptions of the intervention, and on its scalability for a broader population.

Trial registration: NCT03575026, Registered 2 July 2018.

Keywords: acceptability; dementia; implementation; music; well-being.

Conflict of interest statement

Dr Daphne Sze Ki Cheung reports grants from Ho Cheung Shuk Yuen Charitable Foundation, during the conduct of the study. The authors declare that they have no other competing interests.

© 2022 Cheung et al.

Figures

Figure 1
Figure 1
Trial flowchart.

References

    1. Chang YS, Chu H, Yang CY., et al. The efficacy of music therapy for people with dementia: a meta‐analysis of randomised controlled trials. J Clin Nurs. 2015;24(23–24):3425–3440. doi:10.1111/jocn.12976
    1. Murrock CJ, Higgins PA. The theory of music, mood and movement to improve health outcomes. J Adv Nurs. 2009;65(10):2249–2257. doi:10.1111/j.1365-2648.2009.05108.x
    1. Vasionytė I, Madison G. Musical intervention for patients with dementia: a meta‐analysis. J Clin Nurs. 2013;22(9–10):1203–1216. doi:10.1111/jocn.12166
    1. Raglio A, Fonte C, Reani P, Varalta V, Bellandi D, Smania N. Active music therapy for persons with dementia and their family caregivers. Int J Geriatr Psychiatry. 2016;31(9):1085–1087. doi:10.1002/gps.4421
    1. Music & memory; 2022. Available from: . Accessed March 18, 2022.
    1. Kwak J, Ha J-H, O’Connell Valuch K. Lessons learned from the statewide implementation of the Music & Memory program in nursing homes in Wisconsin in the USA. Dementia. 2021;20(5):1617–1630. doi:10.1177/1471301220962234
    1. Lai CK, Lai DL, Ho JS, Wong KK, Cheung DS. Interdisciplinary collaboration in the use of a music‐with‐movement intervention to promote the wellbeing of people with dementia and their families: development of an evidence‐based intervention protocol. Nurs Health Sci. 2016;18(1):79–84. doi:10.1111/nhs.12238
    1. Cheung DSK, Lai CKY, Wong FKY, Leung MCP. The effects of the music-with-movement intervention on the cognitive functions of people with moderate dementia: a randomized controlled trial. Aging Ment Health. 2018;22(3):306–315. doi:10.1080/13607863.2016.1251571
    1. Cheung DSK, Lai CKY, Wong FKY, Leung MCP. Is music-with-movement intervention better than music listening and social activities in alleviating agitation of people with moderate dementia? A randomized controlled trial. Dementia. 2020;19(5):1413–1425. doi:10.1177/1471301218800195
    1. Lai CKY. Music intervention for people with dementia and their family caregivers. A final report submitted to the Ho Cheung Shek Yuen Charitable Foundation; 2016.
    1. Sung H-C, Chang S-M, Lee W-L, Lee M-S. The effects of group music with movement intervention on agitated behaviours of institutionalized elders with dementia in Taiwan. Complement Ther Med. 2006;14(2):113–119. doi:10.1016/j.ctim.2006.03.002
    1. Ray KD, Götell E. The use of music and music therapy in ameliorating depression symptoms and improving well-being in nursing home residents with dementia. Front Med. 2018;5:287. doi:10.3389/2Ffmed.2018.00287
    1. Van de Winckel A, Feys H, De Weerdt W, Dom R. Cognitive and behavioural effects of music-based exercises in patients with dementia. Clin Rehabil. 2004;18(3):253–260. doi:10.1191/0269215504cr750oa
    1. Cheung DS, Chien WT, Lai CK. Conceptual framework for cognitive function enhancement in people with dementia. J Clin Nurs. 2011;20(11‐12):1533–1541. doi:10.1111/j.1365-2702.2010.03584.x
    1. Damschroder LJ, Aron DC, Keith RE, Kirsh SR, Alexander JA, Lowery JC. Fostering implementation of health services research findings into practice: a consolidated framework for advancing implementation science. Implement Sci. 2009;4:1–15. doi:10.1186/1748-5908-4-50
    1. Waltz TJ, Powell BJ, Fernández ME, Abadie B, Damschroder LJ. Choosing implementation strategies to address contextual barriers: diversity in recommendations and future directions. Implement Sci. 2019;14:1–15. doi:10.1186/s13012-019-0892-4
    1. Powell BJ, McMillen JC, Proctor EK, et al. A compilation of strategies for implementing clinical innovations in health and mental health. Med Care Res Rev. 2012;69(2):123–157. doi:10.1177/1077558711430690
    1. Powell BJ, Waltz TJ, Chinman MJ, et al. A refined compilation of implementation strategies: results from the Expert Recommendations for Implementing Change (ERIC) project. Implement Sci. 2015;10:1–14. doi:10.1186/s13012-015-0209-1
    1. Curran GM, Bauer M, Mittman B, Pyne JM, Stetler C. Effectiveness-implementation hybrid designs: combining elements of clinical effectiveness and implementation research to enhance public health impact. Med Care. 2012;50(3):217–226. doi:10.1097/mlr.0b013e3182408812
    1. Pinnock H, Barwick M, Carpenter CR, et al. Standards for Reporting Implementation Studies (StaRI) statement. BMJ. 2017;356:1–9. doi:10.1136/bmj.i6795
    1. Reisberg B, Ferris SH, de Leon MJ, Crook T. The Global Deterioration Scale for assessment of primary degenerative dementia. Am J Psychiatry. 1982;139(9):1136–1139. doi:10.1176/ajp.139.9.1136
    1. Cohen J. Statistical Power Analysis for the Behavioral Sciences. 2nd ed. Lawrence Erlbaum Associates; 1988.
    1. Wong KKY. 欣悅樂韻健身心 - 早期認知障礙人仕的音樂活動手册 [Music-with-Movement - Music activities handbook for early dementia]. The Centre for Gerontological Nursing (CGN) under the School of Nursing of The Hong Kong Polytechnic University; 2017. Chinese.
    1. Cheung DSK, Ho LYW, Kwok RKH, Lai DLL, Lai CKY. The effects of involvement in training and volunteering with families of people with dementia on the knowledge and attitudes of volunteers towards dementia. BMC Public Health. 2022;22:1–12. doi:10.1186/s12889-022-12687-y
    1. Shankar K, Walker M, Frost D, Orrell M. The development of a valid and reliable scale for rating anxiety in dementia (RAID). Aging Ment Health. 1999;3(1):39–49. doi:10.1080/13607869956424
    1. Cheung DSK, Lai CKY, Leung MCP. The Chinese version rating anxiety in dementia scale: a validation study; 2018.
    1. Alexopoulos GS, Abrams RC, Young RC, Shamoian CA. Cornell scale for depression in dementia. Biol Psychiatry. 1988;23(3):271–284. doi:10.1016/0006-3223(88)90038-8
    1. Lin J-N, Wang -J-J. Psychometric evaluation of the Chinese version of the Cornell scale for depression in dementia. J Nurs Res. 2008;16(3):202–210. doi:10.1097/01.jnr.0000387307.34741.39
    1. Cohen S, Kamarck T, Mermelstein R. A global measure of perceived stress. J Health Soc Beh. 1983;24:285. doi:10.2307/2136404
    1. Leung DY, Lam T-H, Chan SS. Three versions of Perceived Stress Scale: validation in a sample of Chinese cardiac patients who smoke. BMC Public Health. 2010;10:1–7. doi:10.1186/1471-2458-10-513
    1. Tarlow BJ, Wisniewski SR, Belle SH, Rubert M, Ory MG, Gallagher-Thompson D. Positive aspects of caregiving: contributions of the REACH project to the development of new measures for Alzheimer’s caregiving. Res Aging. 2004;26(4):429–453. doi:10.1177/2F0164027504264493
    1. Lou VW, Lau BH-P, Cheung KS-L. Positive aspects of caregiving (PAC): scale validation among Chinese dementia caregivers (CG). Arch Gerontol Geriatr. 2015;60(2):299–306. doi:10.1016/j.archger.2014.10.019
    1. Lawrence RH, Tennstedt SL, Assmann SF. Quality of the caregiver–care recipient relationship: does it offset negative consequences of caregiving for family caregivers? Psychol Aging. 1998;13(1):150–158. doi:10.1037//0882-7974.13.1.150
    1. Cheung DSK, Tang SK, Ho KHM, et al. Strategies to engage people with dementia and their informal caregivers in dyadic intervention: a scoping review. Geriatr Nurs. 2021;42(2):412–420. doi:10.1016/j.gerinurse.2021.02.002
    1. Proctor E, Silmere H, Raghavan R, et al. Outcomes for implementation research: conceptual distinctions, measurement challenges, and research agenda. Adm Policy Ment Health. 2011;38(2):65–76. doi:10.1007/s10488-010-0319-7
    1. Gaglio B, Shoup JA, Glasgow RE. The RE-AIM framework: a systematic review of use over time. Am J Public Health. 2013;103(6):e38–46. doi:10.2105/AJPH.2013.301299
    1. Sakamoto M, Ando H, Tsutou A. Comparing the effects of different individualized music interventions for elderly individuals with severe dementia. Int Psychogeriatr. 2013;25(5):775–784. doi:10.1017/2FS1041610212002256
    1. Rapport F, Smith J, Hutchinson K, et al. Too much theory and not enough practice? The challenge of implementation science application in healthcare practice. J Eval Clin Pract. 2021:1–12. doi:10.1111/jep.13600
    1. Howson FFA, Robinson SM, Lin SX, et al. Can trained volunteers improve the mealtime care of older hospital patients? An implementation study in one English hospital. BMJ Open. 2018;8(8):1–10. doi:10.1136/bmjopen-2018-022285
    1. Bergmo TS, Ersdal G, Rødseth E, Berntsen G. Electronic messaging to improve information exchange in primary care; 2013:172–177.
    1. Steele Gray C, Barnsley J, Gagnon D, et al. Using information communication technology in models of integrated community-based primary health care: learning from the iCOACH case studies. Implement Sci. 2018;13:1–14. doi:10.1186/s13012-018-0780-3
    1. Bauer MS, Damschroder L, Hagedorn H, Smith J, Kilbourne AM. An introduction to implementation science for the non-specialist. BMC Psychol. 2015;3:1–12. doi:10.1186/s40359-015-0089-9
    1. Moses H 3rd, Matheson DH, Cairns-Smith S, George BP, Palisch C, Dorsey ER. The anatomy of medical research: US and international comparisons. JAMA. 2015;313(2):174–189. doi:10.1001/jama.2014.15939
    1. Geng EH, Peiris D, Kruk ME. Implementation science: relevance in the real world without sacrificing rigor. PLoS Med. 2017;14(4):1–5. doi:10.1371/journal.pmed.1002288

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