Trial reportBMJ open2021
Implementation processes in a cognitive rehabilitation intervention for people with dementia: a complexity-informed qualitative analysis.
Trial report in BMJ open, 2021. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 8 papers, 2 of them syntheses that pooled it.
What it found
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The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
The trial behind it
Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.
Who cites it
8 citing papers in PubMed, 2 syntheses or guidelines pooled it, 9 citations in OpenAlex.
- Carer Involvement in Rehabilitation for People Living With Dementia: A Systematic Review.Journal of advanced nursing · 2025Pooled it
- Cognitive rehabilitation for people with mild to moderate dementia.The Cochrane database of systematic reviews · 2023Pooled it
- Perspectives and Experiences of People Receiving Care on a De-escalation Intervention to Reduce Restrictive Practices in Acute Mental Health Units.International journal of mental health nursing · 2026Article
- Mapping factors associated with health system resilience against large-scale infectious disease outbreaks: a qualitative study in China.BMC public health · 2026Article
- Implementation of Cognitive (Neuropsychological) Interventions for Older Adults in Clinical or Community Settings: A Scoping Review.Neuropsychology review · 2025Article
- Case Reports in the Integration of Technology with Cognitive Rehabilitation for Individuals with Memory Concerns and Their Care Partners.Archives of clinical neuropsychology : the official journal of the National Academy of Neuropsychologists · 2025Article
- Real-world occupational therapy interventions for early-stage dementia: Characteristics and contextual barriers.Dementia (London, England) · 2025Article
- Strengthening the connection between clinical research and clinical practice of cognitive rehabilitation.Frontiers in rehabilitation sciences · 2023Article
Corrections and comments
PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.
Authors and funding
8 authors at 6 institutions in 2 countries.
Funding
No grant is acknowledged in the PubMed record.
Abstract
objectivesHealthcare is often delivered through complex interventions. Understanding how to implement these successfully is important for optimising services. This article demonstrates how the complexity theory concept of 'self-organisation' can inform implementation, drawing on a process evaluation within a randomised controlled trial of the GREAT (
designA process evaluation examined experiences of GREAT therapists and participants receiving the intervention, through thematic analysis of a focus group with therapists and interviews with participants and their carers. Therapy records of participants receiving the intervention were also analysed using adapted framework analysis. Analysis adopted a critical realist perspective and a deductive-inductive approach to identify patterns in how the intervention operated.
settingThe GREAT intervention was delivered through home visits by therapists, in eight regions in the UK.
participantsSix therapists took part in a focus group, interviews were conducted with 25 participants and 26 carers, and therapy logs for 50 participants were analysed.
interventionA 16-week cognitive rehabilitation programme for people with mild-to-moderate dementia.
results'Self-organisation' of the intervention occurred through adaptations made by therapists. Adaptations included simplifying the intervention for people with greater cognitive impairment, and extending it to meet additional needs. Relational work by therapists produced an emergent outcome of 'social support'. Self-organised aspects of the intervention were less visible than formal components, but were important aspects of how it operated during the trial. This understanding can help to inform future implementation.
conclusionsResearchers are increasingly adopting complexity theory to understand interventions. This study extends the application of complexity theory by demonstrating how 'self-organisation' was a useful concept for understanding aspects of the intervention that would have been missed by focusing on formal intervention components. Analysis of self-organisation could enhance future process evaluations and implementation studies. TRIAL REGISTRATION NUMBER: ISRCTN21027481.
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Registered trials
Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.