Intervention Review

Validation therapy for dementia

  1. Martin Neal1,*,
  2. Philip Barton Wright2

Editorial Group: Cochrane Dementia and Cognitive Improvement Group

Published Online: 21 JUL 2003

Assessed as up-to-date: 4 AUG 2005

DOI: 10.1002/14651858.CD001394

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.

Author Information

  1. 1

    Leeds Mental Health Trust, Research and Development, Leeds, UK

  2. 2

    Bradford District Care Trust, Older Peoples Mental Health Service, Bradford, West Yorkshire, UK

*Martin Neal, Research and Development, Leeds Mental Health Trust, Room 109 QSH, Leeds, LS7 3JX, UK. M.Neal@leedsmet.ac.uk.

Publication History

  1. Publication Status: Edited (no change to conclusions)
  2. Published Online: 21 JUL 2003

SEARCH

 

Abstract

  1. Top of page
  2. Abstract
  3. Plain language summary
  4. 摘要
  5. 一般語言總結

Background

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.

Objectives

To evaluate the effectiveness of validation therapy for people diagnosed as having dementia of any type, or cognitive impairment

Search methods

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.

Selection criteria

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.

Main results

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.

Authors' conclusions

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

  1. Top of page
  2. Abstract
  3. Plain language summary
  4. 摘要
  5. 一般語言總結

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.

 

摘要

  1. Top of page
  2. Abstract
  3. Plain language summary
  4. 摘要
  5. 一般語言總結

失智症的確認療法(validation therapy)

背景

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。

目標

評估確認療法(validation therapy)對任何類型之失智症或認知功能受損病人的功效。

搜尋策略

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。

選擇標準

所有針對確認療法作為治療失智症的隨機對照試驗(RCT)均考慮納入本拚文獻回顧。納入標準上包括檢視該試驗的品質及偏差風險評估。

資料收集與分析

由兩位回顧文獻作者獨立萃取資料,若該資料在該試驗中未被提及,則進一步與原作者聯繫。我們檢視了評量認知功能、行為、情緒狀態與日常活動的心理量表。

主要結論

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。

有兩項重要的結果發現:
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。

作者結論

確認療法對失智症病人或認知功能受損者是否具有功效,目前的隨機對照試驗尚無足夠的證據可供做出任何結論。

 

一般語言總結

  1. Top of page
  2. Abstract
  3. Plain language summary
  4. 摘要
  5. 一般語言總結

失智症的確認療法(validation therapy)

確認療法是基於確認的一般原則,接受及體驗個人及他人經驗的一種治療。此療法使用的介入措施與技巧為綜合運用行為療法與心理療法,以符合各失智階段病人的需要,我們找到了3項符合納入條件的試驗,但是無法合併分析這3項試驗的數據,因為其治療的時間長短不同或其使用不同的對照療法,或使用的評估指標無法互相比較。我們發現了兩個重要結果,但是在確認療法與社交療法之間,不具統計上顯著性的差異,而確認療法與一般療法之間,同樣也無差異。本文未針對提供照護者進行評估。總而言之,目前隨機試驗的證據尚不足夠可以做出其對失智或有認知障礙病人治療功效方面的結論。

譯註

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