Clinical effectiveness of music interventions for dementia and depression in elderly care (MIDDEL): Australian cohort of an international pragmatic cluster-randomised controlled trial.
Clinical effectiveness of music interventions for dementia and depression in elderly care (MIDDEL): Australian cohort of an international pragmatic cluster-randomised controlled trial.
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DOI：
10.1016/s2666-7568(22)00027-7
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发表时间：
2022-03-01
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影响因子：
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通讯作者：
Gold, Christian
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作者：
Baker, Felicity A;Lee, Young-Eun C;Gold, Christian
背景技术背景：痴呆症和抑郁症在生活在养老院的老年人中非常普遍和共病，并与个人痛苦和社会成本上升有关。需要有效、可扩展和可行的干预措施。音乐干预已经显示出有希望的效果，但目前的证据基础是不确定的。本研究旨在确定两种不同的音乐干预措施对老年痴呆症患者的抑郁症状的有效性，这些老年痴呆症患者生活在住宅老年护理机构。方法：我们实施了一项2 * 2析因聚类随机对照试验，以确定团体音乐治疗（GMT）是否比没有GMT的标准护理更有效，或娱乐合唱团唱歌（RCS）是否比没有RCS的标准护理更有效，用于减少居住在老年护理中的轻度至重度抑郁症状的痴呆症患者的抑郁症状和其他次要结局。使用计算机生成的列表和区组随机化（区组大小为4），将至少有10名居民的护理之家单位分配至GMT、RCS、GMT + RCS或标准护理。由音乐治疗师（GMT）和社区音乐家（RCS）提供协议干预。主要结局是6个月时的蒙哥马利-阿斯伯格抑郁评定量表评分，由盲法评估者评估，并使用线性混合效应模型在意向治疗基础上进行分析，该模型检查了GMT与无GMT和RCS与无RCS的效应，以及GMT和RCS的相互作用效应。我们报告了一项国际试验的澳大利亚队列。该试验在ClinicalTrials.gov，NCT 03496675和anzctr.org.au，ACTRN 12618000156280上注册。结果：在2018年6月15日至2020年2月18日期间，我们接触了12个RAC设施，其中有26个合格的护理之家，不包括因COVID-19封锁而无法入组的6个单位，我们筛选了818名居民。在2018年7月18日至2019年11月26日期间，随机分配了20个护理之家单位（318名居民）。由于COVID-19，招聘于二零二零年三月十七日停止。主要终点来自20个护理之家单位（214名居民），表明RCS的有益效果（平均差异-4 statist 25，95%CI-7 statist 89至-0 statist 62; p=0·0221），但不是GMT（平均差异-0 statist 44，-4 statist 32至3·43; p=0·8224）。没有相关的严重不良事件发生。解释：我们的研究支持实施娱乐合唱团唱歌作为一个临床相关的治疗干预，在减少抑郁症状的人与痴呆症在澳大利亚护理家庭context.FUNDING：国家卫生和医学研究理事会，澳大利亚。
BACKGROUND: Dementia and depression are highly prevalent and comorbid conditions among older adults living in care homes and are associated with individual distress and rising societal costs. Effective, scalable, and feasible interventions are needed. Music interventions have shown promising effects, but the current evidence base is inconclusive. The present study aimed to determine the effectiveness of two different music interventions on the depressive symptoms of people with dementia living in residential aged care.METHODS: We implemented a 2 * 2 factorial cluster-randomised controlled trial to determine whether group music therapy (GMT) is more effective than no GMT with standard care, or recreational choir singing (RCS) is more effective than no RCS with standard care, for reducing depressive symptoms and other secondary outcomes in people with dementia with mild to severe depressive symptoms living in residential aged care. Care home units with at least ten residents were allocated to GMT, RCS, GMT plus RCS, or standard care, using a computer-generated list with block randomisation (block size four). The protocolised interventions were delivered by music therapists (GMT) and community musicians (RCS). The primary outcome was Montgomery-Asberg Depression Rating Scale score at 6 months, assessed by a masked assessor and analysed on an intention-to-treat basis using linear mixed-effects models, which examined the effects of GMT versus no-GMT and RCS versus no-RCS, as well as interaction effects of GMT and RCS. We report on the Australian cohort of an international trial. This trial is registered with ClinicalTrials.gov, NCT03496675, and anzctr.org.au, ACTRN12618000156280.FINDINGS: Between June 15, 2018, and Feb 18, 2020, we approached 12 RAC facilities with 26 eligible care home units and, excluding six units who could not be enrolled due to COVID-19 lockdowns, we screened 818 residents. Between July 18, 2018, and Nov 26, 2019, 20 care home units were randomised (318 residents). Recruitment ceased on March 17, 2020, due to COVID-19. The primary endpoint, available from 20 care home units (214 residents), suggested beneficial effects of RCS (mean difference -4·25, 95% CI -7·89 to -0·62; p=0·0221) but not GMT (mean difference -0·44, -4·32 to 3·43; p=0·8224). No related serious adverse events occurred.INTERPRETATION: Our study supports implementing recreational choir singing as a clinically relevant therapeutic intervention in reducing depressive symptoms for people with dementia in the Australian care home context.FUNDING: National Health and Medical Research Council, Australia.