Implementation of exergaming for people with dementia: facilitators, barriers, and recommendations.

OBJECTIVES: To identify facilitators, barriers, and formulate recommendations for the implementation of exergames for people with dementia (PWD) in day-care centers (DCCs). METHODS: Within a randomized controlled trial into the effectiveness of exergaming, 73 PWD with their informal caregivers (IC) from 11 DCCs in the Netherlands and two exergame providers participated in a process evaluation. This was a mixed-methods study using focus groups, semi-structured interviews, the Measurement Instrument for Determinants of Innovations, forms for DCC staff, and a short satisfaction questionnaire. We used descriptive statistics for the quantitative outcomes, and thematic analysis for qualitative data. The Medical Research Council guidance for process evaluation was used to identify facilitators and barriers to the implementation, mechanisms of impact, and context. RESULTS: Implementation-related facilitators and barriers were the availability of budget, staff, equipment, instructions, location, and supervision. Mechanisms of impact-related facilitators were experienced positive effects on physical functioning and mobility, cognitive, emotional, and social functioning, and quality of life. Barriers were mainly linked to the need to customize the intervention for each participant. Contextual facilitators were support and enthusiasm from others; barriers were costs and planning. Recommendations by DCC staff involved technical support, instructions, responsibility, location, supervision, planning, and exergaming as a group or individually. CONCLUSION: Users, IC, and staff positively valued exergaming. We found various facilitators and barriers leading to recommendations for successful implementation. We recommend further research into tailoring exergaming to specific users and contexts, and into usability and cost-effectiveness. This may contribute to further dissemination and implementation of exergaming for PWD.

Are individual and group treatments equally effective in the treatment of depression in adults? A meta-analysis

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Background and Objectives: It is well-established that psychological interventions are effective in the treatment of depression. However, it is not yet clear what the optima format is in which psychological treatments should be delivered. Although several studies have examined whether individual and group treatments are equally effective in the treatment of depression, no comprehensive meta-analysis has examined this. Methods: We searched major bibliographical database and conducted a meta-analysis of 15 studies in which individual and group therapies were compared directly to each other. Results: The mean effect size indicating the difference between individual and group therapies in depressive symptomatology at post-test was 0.20 (95% CI: [0.05 0.35]; p < 0.01), in favor of individual therapies, with a lower drop-out rate in individual interventions (OR =0.56; 95% CI: [0.37, 0.86]; p < 0.01). At follow-up no significant differences were found. Conclusions: Although individual therapy seems to be somewhat more effective than group therapy at the short term, it is not clear whether this is relevant from a clinical point of view. Because of the small number of studies and the limited quality, more research is needed to examine whether the difference between individual and group treatment is clinically relevant (AU)