Abstract
BackgroundDespite the well-known importance of cognitive deficits for everyday functioning in patients with severe mental illness (SMI), evidence-based interventions directed at these problems are especially scarce for SMI patients in long-term clinical facilities. Cognitive adaptation Training (CAT) is a compensatory approach that aims at creating new routines in patients’ living environments through the use of environmental supports. Previous studies on CAT showed that CAT is effective in improving everyday functioning in outpatients with schizophrenia. The aim of this study is to evaluate the effect of CAT as a nursing intervention in SMI patients who reside in long-term clinical facilities.Methods/DesignThis is a multicenter cluster randomized controlled trial comparing CAT (intervention group) as a nursing intervention to treatment as usual (control group). The primary goal is to evaluate the effectiveness of CAT on everyday functioning. Secondary outcomes are quality of life, empowerment and apathy. Further, an economic evaluation will be performed. The study has a duration of one year, with four follow-up assessments at 15, 18, 21 and 24 months for the intervention group.DiscussionThere is a need for evidence-based interventions that contribute to the improvement of the functional recovery of long-term residential patients. If our hypotheses are confirmed, it may be recommended to include CAT in the guidelines for SMI care and to implement the method in standardized care.Trial registrationNederlands Trial Register (identifier: NTR3308). Date registered: 12 February 2012.
Highlights
Despite the well-known importance of cognitive deficits for everyday functioning in patients with severe mental illness (SMI), evidence-based interventions directed at these problems are especially scarce for SMI patients in long-term clinical facilities
In SMI care, especially in the chronic stage of the disease, there is a necessity for practical hands-on interventions that target the functional impairments resulting from cognitive deficits in such a way that functional improvements are made, and can be sustained after a study period
The current, multicenter, cluster randomized controlled trial meets with these needs by assessing the efficacy of Cognitive adaptation Training (CAT) as a nursing intervention on everyday functioning in residential patients with SMI
Summary
Despite the well-known importance of cognitive deficits for everyday functioning in patients with severe mental illness (SMI), evidence-based interventions directed at these problems are especially scarce for SMI patients in long-term clinical facilities. The aim of this study is to evaluate the effect of CAT as a nursing intervention in SMI patients who reside in long-term clinical facilities. The term severe mental illness (SMI) defines a range of psychiatric disorders, characterized by serious mental, social and vocational problems that influence each other and create a need for long-term continuous care by mental health professionals [1]. Despite the strong relationship between cognition and everyday functioning, evidence-based interventions are scarce, especially for those who reside in long-stay clinical facilities. Two main approaches can be distinguished with regard to interventions for cognitive problems in SMI: restorative and compensatory
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