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dc.contributor.authorGathercole, Rebecca
dc.contributor.authorBradley, Rosie
dc.contributor.authorHarper, Emma
dc.contributor.authorDavies, Lucy
dc.contributor.authorPank, Lynn
dc.contributor.authorLam, Natalie
dc.contributor.authorDavies, Anna
dc.contributor.authorTalbot, Emma
dc.contributor.authorHooper, Emma
dc.contributor.authorWinson, Rachel
dc.contributor.authorScutt, Bethany
dc.contributor.authorMontano, Victoria Ordonez
dc.contributor.authorNunn, Samantha
dc.contributor.authorLavelle, Grace
dc.contributor.authorLariviere, Matthew
dc.contributor.authorHirani, Shashivadan
dc.contributor.authorBrini, Stefano
dc.contributor.authorBateman, Andrew
dc.contributor.authorBentham, Peter
dc.contributor.authorBurns, Alistair
dc.contributor.authorDunk, Barbara
dc.contributor.authorForsyth, Kirsty
dc.contributor.authorFox, Chris
dc.contributor.authorHenderson, Catherine
dc.contributor.authorKnapp, Martin
dc.contributor.authorLeroi, Iracema
dc.contributor.authorNewman, Stanton
dc.contributor.authorO'Brien, John
dc.contributor.authorPoland, Fiona
dc.contributor.authorWoolham, John
dc.contributor.authorGray, Richard
dc.contributor.authorHoward, Robert
dc.identifier.citationGathercole, R., Bradley, R., Harper, E., Davies, L., Pank, L., Lam, N., Davies, A., Talbot, E., Hooper, E., Winson, R., Scutt, B., Montano, V. O., Nunn, S., Lavelle, G., Lariviere, M., Hirani, S., Brini, S., Bateman, A., Bentham, P., Burns, A., Dunk, B., Forsyth, K., Fox, C., Henderson, C., Knapp, M., Leroi, I., Newman, S., O’Brien, J., Poland, F., Woolham, J., Gray, R. & Howard, R. (2021) Assistive technology and telecare to maintain independent living at home for people with dementia: The ATTILA RCT. Health Technology Assessment, 25(19).
dc.descriptionFrom PubMed via Jisc Publications Router
dc.descriptionPublication status: ppublish
dc.description.abstractAssistive technology and telecare have been promoted to manage the risks associated with independent living for people with dementia, but there is limited evidence of their effectiveness. This trial aimed to establish whether or not assistive technology and telecare assessments and interventions extend the time that people with dementia can continue to live independently at home and whether or not they are cost-effective. Caregiver burden, the quality of life of caregivers and of people with dementia and whether or not assistive technology and telecare reduce safety risks were also investigated. This was a pragmatic, randomised controlled trial. Blinding was not undertaken as it was not feasible to do so. All consenting participants were included in an intention-to-treat analysis. This trial was set in 12 councils in England with adult social services responsibilities. Participants were people with dementia living in the community who had an identified need that might benefit from assistive technology and telecare. Participants were randomly assigned to receive either assistive technology and telecare recommended by a health or social care professional to meet their assessed needs (a full assistive technology and telecare package) or a pendant alarm, non-monitored smoke and carbon monoxide detectors and a key safe (a basic assistive technology and telecare package). The primary outcomes were time to admission to care and cost-effectiveness. Secondary outcomes assessed caregivers using the 10-item Center for Epidemiological Studies Depression Scale, the State-Trait Anxiety Inventory 6-item scale and the Zarit Burden Interview. Of 495 participants, 248 were randomised to receive full assistive technology and telecare and 247 received the limited control. Comparing the assistive technology and telecare group with the control group, the hazard ratio for institutionalisation was 0.76 (95% confidence interval 0.58 to 1.01;  = 0.054). After adjusting for an imbalance in the baseline activities of daily living score between trial arms, the hazard ratio was 0.84 (95% confidence interval 0.63 to 1.12;  = 0.20). At 104 weeks, there were no significant differences between groups in health and social care resource use costs (intervention group - control group difference: mean -£909, 95% confidence interval -£5336 to £3345) or in societal costs (intervention group - control group difference: mean -£3545; 95% confidence interval -£13,914 to £6581). At 104 weeks, based on quality-adjusted life-years derived from the participant-rated EuroQol-5 Dimensions questionnaire, the intervention group had 0.105 (95% confidence interval -0.204 to -0.007) fewer quality-adjusted life-years than the control group. The number of quality-adjusted life-years derived from the proxy-rated EuroQol-5 Dimensions questionnaire did not differ between groups. Caregiver outcomes did not differ between groups over 24 weeks. Compliance with the assigned trial arm was variable, as was the quality of assistive technology and telecare needs assessments. Attrition from assessments led to data loss additional to that attributable to care home admission and censoring events. A full package of assistive technology and telecare did not increase the length of time that participants with dementia remained in the community, and nor did it decrease caregiver burden, depression or anxiety, relative to a basic package of assistive technology and telecare. Use of the full assistive technology and telecare package did not increase participants' health and social care or societal costs. Quality-adjusted life-years based on participants' EuroQol-5 Dimensions questionnaire responses were reduced in the intervention group compared with the control group; groups did not differ in the number of quality-adjusted life-years based on the proxy-rated EuroQol-5 Dimensions questionnaire. Future work could examine whether or not improved assessment that is more personalised to an individual is beneficial. Current Controlled Trials ISRCTN86537017.
dc.description.sponsorshipThe research reported in this issue of the journal was funded by the HTA programme as project number 10/50/02. The contractual start date was in January 2013. The draft report began editorial review in September 2019 and was accepted for publication in December 2019. The authors have been wholly responsible for all data collection, analysis and interpretation, and for writing up their work. The HTA editors and publisher have tried to ensure the accuracy of the authors’ report and would like to thank the reviewers for their constructive comments on the draft document. However, they do not accept liability for damages or losses arising from material published in this report. This report presents independent research funded by the National Institute for Health Research (NIHR). The views and opinions expressed by authors in this publication are those of the authors and do not necessarily reflect those of the NHS, the NIHR, NETSCC, the HTA programme or the Department of Health and Social Care. If there are verbatim quotations included in this publication the views and opinions expressed by the interviewees are those of the interviewees and do not necessarily reflect those of the authors, those of the NHS, the NIHR, NETSCC, the HTA programme or the Department of Health and Social Care.
dc.relation.ispartofHealth Technology Assessment
dc.rightsCopyright © 2021 Gathercole et al. This work was produced by Gathercole et al. under the terms of a commissioning contract issued by the Secretary of State for Health and Social Care
dc.subjectActivities Of Daily Living
dc.subjectCost–Benefit Analysis
dc.subjectIndependent Living
dc.subjectQuality Of Life
dc.subjectQuality-Adjusted Life-Years
dc.subjectTechnology Assessment
dc.titleAssistive technology and telecare to maintain independent living at home for people with dementia: The ATTILA RCT
qmu.authorForsyth, Kirsty

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