Performing One-Session Cognitive Stimulation to Interact with Patients with Dementia in a Hospital for Mood Improvement: A Retrospective Single-Arm Cohort Study

Round 1

Reviewer 1 Report

Authors in this manuscript wanted to present that developing support and environment for patients with dementia in hospitals is crucial. they wanted to assess the immediate effect of one-session cognitive stimulation intervention on the mood of patients with dementia at the hospital. 

1. Please explain why the study group is very small and includes only females. It would be great if the group is varied and includes both sexes.
2. The discussion is very poor and it requires more insightful and detailed.

Author Response

Response to Reviewer 1 Comments

 

TO REVIEWER 1

 

We thank the reviewer for carefully reading our manuscript and providing useful comments.

 

Point 1: Please explain why the study group is very small and includes only females. It would be great if the group is varied and includes both sexes.

 

Response 1: We thank you for pointing it out. The study’s sample size was determined via a specific analysis. Because the explanation was lacking, we have revised sentences in the Methods section (eg, lines 87-92, page 2) as follows:

 

“Calculating an appropriate sample size is an essential step before conducting a study, as samples that are too small or too large may result in type I (α) or II (β) errors, respectively. For this study, the type I error was fixed at a maximum value of 5%, the type II error was fixed at a maximum value of 20%, and the effect size was fixed as medium (r = 0.5) (Martínez-Mesa et al., 2014). Using this method and calculating software (R2. 8. 1.), we determined that this study required a sample size of 33.4.”

 

< Reference >

Martínez-Mesa, J.; González-Chica, D.A.; Bastos, J.L.; Bonamigo, R.R.; Duquia, R.P. Sample size: How many participants do i need in my research? An. Bras. Dermatol. 2014, 89, 609–615, doi:10.1590/abd1806-4841.20143705.

                                 

To address the reason for the female-only sample, we revised sentences in the Limitation section (eg, lines 227-231, page 6) as follows:

 

“… all patients were female, as only females were willing to participate in this voluntary CS intervention. The men chose not to participate. Therefore, it is unclear whether the CS intervention would have a similar impact on other populations, specifically hospitalized men with dementia. Consequently, it is necessary to study the effects of the CS intervention in both genders.”

 

Point 2: The discussion is very poor and it requires more insightful and detailed.

 

Response 2: Thank you very much for your suggestion. In order for the Discussion section to be more insightful and detailed, we have added details regarding two analyses and interpreted the overall study according to the characteristics of early research (eg, lines 164-173, page 5, lines 194-209, pages 5-6).

Author Response File: Author Response.pdf

Reviewer 2 Report

I this manuscript, the authors performed a retrospective study to investigate the one-session cognitive stimulation on the mood of patients affected by dementia in a hospital. Although the manuscript may be of potential interest, the size of population is relatively small and not homogeneous (different kinds of dementia). It would be interesting stratifying patients according to the dementia types. The results are quite weak (only two tables).
In this form, the manuscript is not suitable for publication.

Comments for author File: Comments.pdf

Author Response

Response to Reviewer 2 Comments

 

TO REVIEWER 2

 

We thank the reviewer for carefully reading our manuscript and providing useful comments.

 

Point 1: Although the manuscript may be of potential interest, the size of population is relatively small and not homogeneous (different kinds of dementia). It would be interesting stratifying patients according to the dementia types.

 

Response 1: Thank you very much for your advice. Regarding sample size, please refer to the response above for reviewer 1, comment 1.

 

Regarding the homogeneous sample, we conducted this study based on many previous studies on CS programs for people with dementia (Lobbia et al., 2019; Yamanaka et al., 2013), which did not stratify subjects according to the dementia types. However, such stratification is important to evaluate the differences in the effectiveness of the CS intervention among patients with different types of dementia. Therefore, we stratified the subjects according to dementia types and analyzed mood changes. However, since the sample size of the study was small, the results may show a type II error. Therefore, we got only some indications of trends from results in the effect size (Supplemental table). These details have been added to the Discussion (eg, lines 200-204, page 5) and limitation (eg, lines 233-235, page 6) sections and a supplemental table.

 

< Reference >

Lobbia, A.; Carbone, E.; Faggian, S.; Gardini, S.; Piras, F.; Spector, A.; Borella, E. The Efficacy of Cognitive Stimulation Therapy (CST) for People with Mild-to-Moderate Dementia: A Review. Eur. Psychol. 2019, 24, 257–277, doi:10.1027/1016-9040/a000342.

Yamanaka, K.; Kawano, Y.; Noguchi, D.; Nakaaki, S.; Watanabe, N.; Amano, T.; Spector, A. Effects of cognitive stimulation therapy Japanese version (CST-J) for people with dementia: A single-blind, controlled clinical trial. Aging Ment. Heal. 2013, 17, 579–586, doi:10.1080/13607863.2013.777395.

 

 

Point 2: The results are quite weak (only two tables).

 

Response 2: We thank you for pointing it out. To address the weak results, we made two modifications. First, we added another analysis to compensate for the reliability of the results. Second, we added an explanation addressing how this study is a part of the initial clinical research phase for this topic.

 

First, we considered the data of patients who were able to participate in multiple sessions due to the length of their hospital stay. Then, we analyzed the average scores of these patients’ moods. Because a single measurement was unreliable and may cause a measurement error, an average of multiple measurements was used to reduce the measurement error (Kaiser & Knight, 1979; Shrout & Fleiss, 1979). The average value of multiple measurements gave high reliability (Koppenhaver et al., 2009). The results of the average score showed the improvement effect of the Pleasure (Table 3), which supported the single measurement results as Table 2. We have added these details to the Abstract (eg, line 20, lines 24-26, page 1), Methods (eg, lines 102-104, lines 131-137, page 3), Results (eg, lines 142-144, lines 146-151, page 4, lines 156-160 pages 4-5), and Discussion sections (eg, lines 164-173, page 5).

 

Second, we added an explanation of how this study is a part of the initial clinical research phase for this topic. This study provides preliminary evidence on the clinical efficacy of a CS intervention. Studies are routinely performed in the early phases of clinical research to provide preliminary evidence in many clinical areas. “Feasibility” or “vanguard” studies are designed to assess the safety and efficacy of interventions (Thabane et al., 2010). Despite the weakness of the results in this study, we believe that this study is beneficial for the development of clinical trials in this rehabilitation area. We have revised the Abstract (eg, line 18, page 1), Discussion section accordingly (eg, lines 194-200, page 5, lines 204-209, pages 5-6).

 

< Reference >

Kaiser, R.; Knight, W.R. Digital signal averaging. J. Magn. Reson. 1979, 36, 215–220, doi:10.1016/0022-2364(79)90096-9.

Shrout, P.E.; Fleiss, J.L. Intraclass correlations: uses in assessing rater reliability. Psychol. Bull. 1979, 86, 420–8.

Koppenhaver, S.L.; Parent, E.C.; Teyhen, D.S.; Hebert, J.J.; Fritz, J.M. The effect of averaging multiple trials on measurement error during ultrasound imaging of transversus abdominis and lumbar multifidus muscles in individuals with low back pain. J. Orthop. Sports Phys. Ther. 2009, 39, 604–611, doi:10.2519/jospt.2009.3088.

Thabane, L.; Ma, J.; Chu, R.; Cheng, J.; Ismaila, A.; Rios, L.P.; Robson, R.; Thabane, M.; Giangregorio, L.; Goldsmith, C.H. Pilot Study Article Need To Rename. BMC Med. Res. Methodol. 2010, 10, 1–10.

 

Round 2

Reviewer 1 Report

Dear Authors,

thank you for your answers. The manuscript is improved and my questions are answered. I am satisfied with your responses and recommend to publish this paper now.

Reviewer 2 Report

I really appreciated the efforts for the authors to address my concerns. Now I think that it is suitable for publication.