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Randomized Controlled Trial
. 2017 Mar 23;9(1):22.
doi: 10.1186/s13195-017-0247-9.

Structured relearning of activities of daily living in dementia: the randomized controlled REDALI-DEM trial on errorless learning

Sebastian Voigt-Radloff  1 , Maartje M E de Werd  2 , Rainer Leonhart  3 , Danielle H E Boelen  2   4 , Marcel G M Olde Rikkert  5 , Klaus Fliessbach  6   7 , Stefan Klöppel  1   8 , Bernhard Heimbach  1 , Andreas Fellgiebel  9 , Richard Dodel  10   11 , Gerhard W Eschweiler  12 , Lucrezia Hausner  13 , Roy P C Kessels  14   15 , Michael Hüll  1   8
Affiliations
Randomized Controlled Trial

Structured relearning of activities of daily living in dementia: the randomized controlled REDALI-DEM trial on errorless learning

Sebastian Voigt-Radloff et al. Alzheimers Res Ther. .

Abstract

Background: Errorless learning (EL) is a method for optimizing learning, which uses feed-forward instructions in order to prevent people from making mistakes during the learning process. The majority of previous studies on EL taught patients with dementia artificial tasks of little or no relevance for their daily lives. Furthermore, only a few controlled studies on EL have so far been performed and just a handful of studies have examined the long-term effects of EL. Tasks were not always trained in the patients' natural or home environment, limiting the external validity of these studies. This multicenter parallel randomized controlled trial examines the effects of EL compared with trial and error learning (TEL) on the performance of activities of daily living in persons with Alzheimer's or mixed-type dementia living at home.

Methods: Patients received nine 1-hour task training sessions over eight weeks using EL or TEL. Task performance was measured using video observations at week 16. Secondary outcome measures were task performance measured at week 26, satisfaction with treatment, need for assistance, challenging behavior, adverse events, resource utilization and treatment costs.

Results: A total of 161 participants were randomized, of whom 71 completed the EL and 74 the TEL arm at week 11. Sixty-nine EL patients and 71 TEL patients were assessed at the 16-week follow-up (the primary measurement endpoint). Intention-to-treat analysis showed a significantly improved task performance in both groups. No significant differences between the treatment groups were found for primary or secondary outcomes.

Conclusions: Structured relearning improved the performance of activities of daily living. Improvements were maintained for 6 months. EL had no additional effect over TEL.

Trial registration: German Register of Clinical Trials DRKS00003117 . Registered 31 May 2011.

Keywords: Activities of daily living; Alzheimer’s dementia; Cognitive rehabilitation; Dementia; Errorless learning; Randomized controlled trial.

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Figures

Fig. 1
Fig. 1
Flow of participants through the trial. IDDD Interview for Deterioration in Daily Living Activities, MMSE Mini Mental State Examination
Fig. 2
Fig. 2
Primary outcome measure (performance on task A and task B; mean + SEM) for the errorless (EL) and trial and error (TEL) treatment arms at baseline and weeks 11, 16 and 26
See this image and copyright information in PMC

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