TY - JOUR
T1 - Facilitating Recovery of Daily Functioning in People With a Severe Mental Illness Who Need Longer-Term Intensive Psychiatric Services
T2 - Results From a Cluster Randomized Controlled Trial on Cognitive Adaptation Training Delivered by Nurses
AU - Stiekema, Annemarie P. M.
AU - van Dam, Michelle T.
AU - Bruggeman, Richard
AU - Redmeijer, Jeroen E.
AU - Swart, Marte
AU - Dethmers, Marian
AU - Rietberg, Kees
AU - Wekking, Ellie M.
AU - Velligan, Dawn
AU - Timmerman, Marieke E.
AU - Aleman, Andre
AU - Castelein, Stynke
AU - van Weeghel, Jaap
AU - Pijnenborg, Gerdina M. H.
AU - van der Meer, Lisette
N1 - Funding Information:
NutsOhra grant (1303-041). We gratefully acknowledge Lentis, GGz Drenthe and Parnassia Noord-Holland for their participation. We thank the participants and nurses for their participation, time and effort. We also thank all students and mental health workers who assisted in organizing the study and collecting the data. The authors have declared that there are no conflicts of interest in relation to the subject of this study.
Publisher Copyright:
© The Author(s) 2020. Published by Oxford University Press on behalf of the Maryland Psychiatric Research Center. This is an Open Access article distributed under the terms of the Creative Commons Attribution-NonCommercial-NoDerivs licence (http://creativecommons. org/licenses/by-nc-nd/4.0/)
PY - 2020/9
Y1 - 2020/9
N2 - Background: Feasible and effective interventions to improve daily functioning in people with a severe mental illness (SMI), such as schizophrenia, in need of longerterm rehabilitation are scarce. Aims: We assessed the effectiveness of Cognitive Adaptation Training (CAT), a compensatory intervention to improve daily functioning, modified into a nursing intervention. Method: In this cluster randomized controlled trial, 12 nursing teams were randomized to CAT in addition to treatment as usual (CAT; n = 42) or TAU (n = 47). Daily functioning (primary outcome) was assessed every 3 months for 1 year. Additional follow-up assessments were performed for the CAT group in the second year. Secondary outcomes were assessed every 6 months. Data were analyzed using multilevel modeling. Results: CAT participants improved significantly on daily functioning, executive functioning, and visual attention after 12 months compared to TAU. Improvements were maintained after 24 months. Improved executive functioning was related to improved daily functioning. Other secondary outcomes (quality of life, empowerment, negative symptoms) showed no significant effects. Conclusions: As a nursing intervention, CAT leads to maintained improvements in daily functioning, and may improve executive functioning and visual attention in people with SMI in need of longer-term intensive psychiatric care. Given the paucity of evidence-based interventions in this population, CAT can become a valuable addition to recovery-oriented care.
AB - Background: Feasible and effective interventions to improve daily functioning in people with a severe mental illness (SMI), such as schizophrenia, in need of longerterm rehabilitation are scarce. Aims: We assessed the effectiveness of Cognitive Adaptation Training (CAT), a compensatory intervention to improve daily functioning, modified into a nursing intervention. Method: In this cluster randomized controlled trial, 12 nursing teams were randomized to CAT in addition to treatment as usual (CAT; n = 42) or TAU (n = 47). Daily functioning (primary outcome) was assessed every 3 months for 1 year. Additional follow-up assessments were performed for the CAT group in the second year. Secondary outcomes were assessed every 6 months. Data were analyzed using multilevel modeling. Results: CAT participants improved significantly on daily functioning, executive functioning, and visual attention after 12 months compared to TAU. Improvements were maintained after 24 months. Improved executive functioning was related to improved daily functioning. Other secondary outcomes (quality of life, empowerment, negative symptoms) showed no significant effects. Conclusions: As a nursing intervention, CAT leads to maintained improvements in daily functioning, and may improve executive functioning and visual attention in people with SMI in need of longer-term intensive psychiatric care. Given the paucity of evidence-based interventions in this population, CAT can become a valuable addition to recovery-oriented care.
KW - outcome
KW - cognitive remediation
KW - cognition
KW - treatment
KW - schizophrenia
KW - COMMUNITY ABILITY SCALE
KW - LIFE SKILLS PROFILE
KW - ENVIRONMENTAL SUPPORTS
KW - COMPENSATORY STRATEGIES
KW - NURSING INTERVENTION
KW - SCHIZOPHRENIA
KW - OUTCOMES
KW - RELIABILITY
KW - VALIDATION
KW - DISABILITY
U2 - 10.1093/schbul/sbz135
DO - 10.1093/schbul/sbz135
M3 - Article
C2 - 32144418
SN - 0586-7614
VL - 46
SP - 1259
EP - 1268
JO - Schizophrenia Bulletin
JF - Schizophrenia Bulletin
IS - 5
ER -