Validation therapy for dementia
Editorial Group: Cochrane Dementia and Cognitive Improvement Group
Published Online: 21 JUL 2003
Assessed as up-to-date: 4 AUG 2005
Copyright © 2009 The Cochrane Collaboration. Published by John Wiley & Sons, Ltd.
How to Cite
Neal M, Barton Wright P. Validation therapy for dementia. Cochrane Database of Systematic Reviews 2003, Issue 3. Art. No.: CD001394. DOI: 10.1002/14651858.CD001394.
- Publication Status: Edited (no change to conclusions)
- Published Online: 21 JUL 2003
Validation therapy was developed by Naomi Feil between 1963 and 1980 for older people with cognitive impairments. Initially, this did not include those with organically-based dementia, but the approach has subsequently been applied in work with people who have a dementia diagnosis. Feil's own approach classifies individuals with cognitive impairment as having one of four stages in a continuum of dementia: these stages are Mal orientation, Time Confusion, Repetitive Motion and Vegetation. The therapy is based on the general principle of validation, the acceptance of the reality and personal truth of another's experience, and incorporates a range of specific techniques. Validation therapy has attracted a good deal of criticism from researchers who dispute the evidence for some of the beliefs and values of validation therapy, and the appropriateness of the techniques. Feil, however, argues strongly for the effectiveness of validation therapy.
To evaluate the effectiveness of validation therapy for people diagnosed as having dementia of any type, or cognitive impairment
The trials were identified from the Specialized Register of the Cochrane Dementia and Cognitive Improvement Group (CDCIG) on 5 August 2005 using the terms validation therapy, VTD and emotion-oriented care. The Specialized Register at that time contained records from the following databases: MEDLINE, EMBASE, CINAHL, PSYCLIT, and SIGLE plus many ongoing trials databases.
All randomised controlled trials (RCTs) examining validation therapy as an intervention for dementia were considered for inclusion in the review. The criteria for inclusion comprised systematic assessment of the quality of study design and the risk of bias.
Data collection and analysis
Data were extracted independently by both reviewers. Authors were contacted for data not provided in the papers. Psychological scales measuring cognition, behaviour, emotional state and activities of daily living were examined.
Three studies were identified that met the inclusion criteria (Peoples 1982; Robb 1986; Toseland 1997) incorporating data on a total of 116 patients (42 in experimental groups, and 74 in the control groups (usual care 43 and social contact 21, 10 in reality orientation). It was not possible to pool the data from the 3 included studies, either because of the different lengths of treatment or choice of different control treatments, or because the outcome measures were not comparable.
Two significant results were found:
Peoples 1982 - Validation versus usual care. Behaviour at 6 weeks [MD --5.97, 95% CI (-9.43 to -2.51) P=0.0007, completers analysis] favours validation therapy.
Toseland 1997 - Validation versus social contact. Depression at 12 months (MOSES) [MD -4.01, 95% CI (-7.74 to - 0.28) P=0.04, completers analysis] favours validation. There were no statistically significant differences between validation and social contact or between validation and usual therapy. There were no assessments of carers.
There is insufficient evidence from randomised trials to allow any conclusion about the efficacy of validation therapy for people with dementia or cognitive impairment.
Plain language summary
No new evidence of the efficacy of validation therapy for people with dementia or cognitive impairment has been identified. The new study identified Schrijnemaekers 2002 was excluded because it was not deemed to be validation therapy.
Validation therapy is based on the general principle of validation, the acceptance of the reality and personal truth of another's experience. The specific interventions and techniques used within the validation approach bring together behavioural and psychotherapeutic methods to meet the needs of individuals with different stages of dementia. Three studies were identified that met the inclusion criteria. It was not possible to pool the data from the 3 included studies, either because of the different lengths of treatment or choice of different control treatments, or because the outcome measures were not comparable. Two significant results were found but there were no statistically significant differences between validation and social contact or between validation and usual therapy. There were no assessments of carers. All in all there is insufficient evidence from randomised trials to allow any conclusion about the efficacy of validation therapy for people with dementia or cognitive impairment.
由Naomi Feil於1963至1980年間所發展的確認療法 (validation therapy)，適用於認知缺損 (cognitive impairment) 的老年患者。起初確認療法並未包含器質性失智症 (organically-based dementia)，但後來也應用於失智症患者。Feil將有認知缺損的患者，歸類於失智症連續病程的4個階段之一，分別為定向感不佳 (Mal orientation)、時間混亂 (Time Confusion)、反覆性動作 (Repetitive Motion) 與呆板單調 (Vegetation)。確認療法依據確認的一般原則、接受患者經驗對其個人的現實與真實性，且併用一系列特殊技巧。確認療法引起研究者相當多的批評，認為有些確認療法的信念和價值證據，以及技術的適切性具有爭議。無論如何，Feil強烈主張確認療法具有療效。
我們於2005年8月5日，使用確認療法（validation therapy）、VTD與情緒導向照護（emotion-oriented care）等關鍵字，搜尋於考科藍失智與認知促進小組（the Cochrane Dementia and Cognitive Improvement Group，CDCIG）註冊之相關試驗，包含以下資料庫：MEDLINE、EMBASE、CINAHL、PSYCLIT與SIGLE以及許多進行中之試驗的資料庫。
我們找到3項符合納入條件的試驗（Peoples 1982, Robb 1986, Toseland 1997），總共納入116位受試者的資料（實驗組42人，對照組74人[一般照護者43人，社會接觸者21人，現實定向療法[reality orientation]10人]。因為治療持續時間不一、有不同的對照療法，或評估指標不同，所以無法將所將納入之3項試驗資料合併進行比較。
Peoples 1982：相較於一般照護，接受確認療法者在第6週時的行為（MD -5.97，95% CI：-9.43--2.51，P=0.0007）較佳。
Toseland 1997：相較於社會接觸，確認療法在第12個月時的憂鬱症（MOSES）（MD -4.01；95% CI：(-7.74-- 0.28) P=0.04，完成者的分析[completers analysis]）效果較佳。確認療法與社會接觸之間，或確認療法與一般照護之間皆無具統計顯著性的差異，且未針對照護者進行評估。
由 East Asian Cochrane Alliance 翻譯
翻譯由 台灣衛生福利部/台北醫學大學實證醫學研究中心 資助