Feasibility of a Co-designed Personalized Cognitive Reablement Program Delivered via Digital Voice Assistants for Older Adults Living with Early-Stage Dementia or Mild Cognitive Impairment: A Pilot Randomized Controlled Trial
ABSTRACT
Background:
Home-based reablement programs have improved everyday functioning for people living with early-stage dementia or mild cognitive impairment (MCI) but the substantial time commitment required for delivery by health professionals has created a barrier to widespread implementation. Digital technology could facilitate delivery, but traditional devices such as smartphones and tablets present usability challenges for this population. We have co-designed a cognitive reablement program, VOICE-COG, that can deliver personalized interventions broadcast via voice-controlled Digital Voice Assistants (DVAs).
Objective:
This pilot non-blinded randomized controlled trial (RCT) examined the feasibility and potential effectiveness of VOICE-COG for people living with dementia or MCI to guide design of a full-scale trial.
Methods:
Adults aged 60-85 years living with dementia or MCI (N=30) were recruited via Facebook or the Step-Up-for Dementia Research database and randomized to either a DVA intervention (n=15) or control (n=15) group for 12-weeks. Each participant randomized to the intervention group, and their care partner, met with a psychologist via Zoom to select two or three personalized goals from the VOICE-COG program which included i) Activities and Appointments, ii) Routine Reminders, iii) Family and Friends, iv) Mood Monitor, v) Active Minds and vi) Household Manager. The personalized program was input into software (“Buddy Link”: Great Australian Pty Ltd) by researchers for broadcast via a DVA (Amazon Alexa Show 8). Participants in the control group received enhanced usual care, consisting of treatment as usual plus weekly informational emails. Primary feasibility outcomes were recruitment, retention, and adherence. Secondary outcomes included goal attainment scale (GAS-Light), system usability scale (SUS), participant-reported changes in mood and cognition, and care partner reported changes in everyday functioning, cognition, and carer burden.
Results:
Recruitment rate was 86% (30/35) and retention rate 97% (29/30) with one participant in the intervention group lost to follow-up. Adherence to the VOICE-COG program ranged from 29% to 100% (mean 70%, SD 17%). After 12 weeks, 60% (9/15) of the intervention group reported having met or exceeded their goals (GAS-Light t-Score ≥ 50, mean 57.7, SD 15.3). The VOICE-COG program was rated as marginally acceptable (mean SUS score 56.3, SD 18.1). The intervention group had a significantly higher increase in Multifactorial Memory Questionnaire – Strategy subscale score compared to control, mean difference 5.0 (95% CI 0.03 to 10.1, P=.049)), representing a medium effect size (d=0.55). There were no other significant differences between groups.
Conclusions:
This co-designed VOICE-COG program delivered via DVAs was feasible for older adults living with early-stage dementia or MCI, resulting in most participants meeting their reablement goals and increases in the use of memory strategies. System usability issues should be addressed for future adequately powered trials. Clinical Trial: ACTRN12623000898651 https://anzctr.org.au/
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