Level 2: Mid-level evidence

The efficacy of occupational therapy for dementia was evaluated in a randomized trial (BMJ. 2006;333:1196; full-text available online without charge at: www.bmj.com/cgi/content/full/333/7580/1196. Accessed April 17, 2007). Community-dwelling patients older than 65 years with mild-to-moderate dementia (N=135) were randomized to occupational therapy vs. control.

Occupational therapy consisted of 10 sessions over five weeks and included cognitive and behavioral interventions. Patients and caregivers learned to choose and prioritize meaningful activities. They also received therapist support to improve their performance of daily chores.

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Intention-to-treat analysis included 132 patients (three dropped out before baseline), but only 105 patients (78%) were followed up at three months.

Comparing intervention vs. control at 12 weeks, 75% vs. 9% had clinically relevant improvement in process outcomes (NNT 1.5), 82% vs. 10% had clinically relevant improvement in performance interview outcomes (NNT 1.4), and 48% vs. 24% of caregivers felt more competent to provide care (NNT 4.2).