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Trial details imported from ClinicalTrials.gov
For full trial details, please see the original record at
https://clinicaltrials.gov/study/NCT03496675
Registration number
NCT03496675
Ethics application status
Date submitted
6/03/2018
Date registered
12/04/2018
Titles & IDs
Public title
Music Interventions for Dementia and Depression in Elderly Care
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Scientific title
Music Interventions for Dementia and Depression in Elderly Care: International Cluster-randomised Controlled Trial
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Secondary ID [1]
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MIDDEL
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Universal Trial Number (UTN)
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Trial acronym
MIDDEL
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Linked study record
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Health condition
Health condition(s) or problem(s) studied:
Dementia
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Depression
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Condition category
Condition code
Neurological
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Dementias
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Neurological
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Alzheimer's disease
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Mental Health
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Depression
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Intervention/exposure
Study type
Interventional
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Description of intervention(s) / exposure
BEHAVIORAL - Group Music Therapy
BEHAVIORAL - Recreational Choir Singing
Other interventions - Standard care
Other: Standard care - Participants receive standard care as locally available. The components of standard care are recorded.
Experimental: Group Music Therapy (GMT) - GMT is provided twice weekly for the first three months, followed by weekly sessions for the next three months, with possible extension after that period as desired and feasible. Sessions are 45 minutes each.
In line with usual practice, and as appropriate in local contexts, residents of a unit allocated to GMT may be divided into smaller groups (e.g. around 5 participants).
Experimental: Recreational Choir Singing (RCS) - RCS is provided twice weekly for the first three months, followed by weekly sessions for the next three months, with possible extension after that period as desired and feasible. Sessions are 45 minutes each.
RCS may be conducted in larger groups (e.g. with all residents of the unit in one group).
Experimental: GMT + RCS - Group Music Therapy and Recreational Choir Singing are both provided twice weekly for the first three months, followed by weekly sessions for the next three months, with possible extension after that period as desired and feasible. Sessions are 45 minutes each.
BEHAVIORAL: Group Music Therapy
The core intention of GMT is to meet the psychosocial needs of each person living with dementia, which in turn is thought to reduce depressive symptoms and anxiety and to stimulate overall social and emotional wellbeing. It includes active, reciprocal music making with the use of singing and musical instruments. GMT is provided by a trained music therapist, highly skilled as a musician, and registered with the appropriate professional association in his or her country.
BEHAVIORAL: Recreational Choir Singing
RCS is intended to foster connectedness in a group, wellbeing, and enjoyment of music making in a group. It includes singing familiar songs and providing a familiar musical environment for participants. RCS is provided by a musician with choir leading skills.
Other interventions: Standard care
May include pharmacological and non-pharmacological interventions as locally available
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Intervention code [1]
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BEHAVIORAL
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Intervention code [2]
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Other interventions
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Comparator / control treatment
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Control group
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Outcomes
Primary outcome [1]
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Montgomery-Åsberg Depression Rating Scale (MADRS)
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Assessment method [1]
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10-item scale where each item is rated from 0 to 6 ('no abnormality' to 'severe'), yielding a total sum score between 0 and 60, with higher values indicating more severe symptom levels.
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Timepoint [1]
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6 months
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Secondary outcome [1]
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Montgomery-Åsberg Depression Rating Scale (MADRS)
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Assessment method [1]
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10-item scale where each item is rated from 0 to 6 ('no abnormality' to 'severe'), yielding a total sum score between 0 and 60, with higher values indicating more severe symptom levels.
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Timepoint [1]
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up to 24 months
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Secondary outcome [2]
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Clinical Dementia Rating (CDR)
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Assessment method [2]
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Semi-structured interview with the person living with dementia and an appropriate caregiver/relative; rates impairment across 6 cognitive categories (memory, orientation, judgment and problem solving, community affairs, home and hobbies, and personal care). The CDR score can range from 0 (normal) to 3 (severe dementia); not used at all sites.
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Timepoint [2]
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12 months
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Secondary outcome [3]
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Neuropsychiatric Inventory - Questionnaire (NPI-Q): severity
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Assessment method [3]
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Includes 12 domains where if a symptom is present, its severity (from 1 = mild to 3 = severe) is assessed by a caregiver familiar with the participant's behaviour. Higher scores (sums of all items, range 0 to 36) represent higher severity.
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Timepoint [3]
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12 months
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Secondary outcome [4]
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Neuropsychiatric Inventory - Questionnaire (NPI-Q): distress
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Assessment method [4]
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Includes 12 domains where if a symptom is present, the associated distress on caregivers (from 0 = not distressing at all to 5 = extreme or very severe) is assessed by a caregiver familiar with the participant's behaviour. Higher scores (sums of all items, range 0 to 60) represent higher severity.
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Timepoint [4]
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12 months
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Secondary outcome [5]
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EuroQol (EQ-5D)
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Assessment method [5]
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Standardized, non-disease-specific instrument for evaluating health-related quality of life, defining health in five dimensions: mobility, self-care, usual activities, pain/discomfort, and anxiety/depression. Response categories range from "no problems" to "extreme problems". Scores are derived using a weighted scoring method and can range from 0 = worst possible to 1 = best possible quality of life.
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Timepoint [5]
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12 months
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Secondary outcome [6]
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Quality of Life in Alzheimer´s Dementia (QOL-AD)
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Assessment method [6]
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13-item scale with self-rating and proxy version. Each item ranges from 1 (poor) to 4 (excellent), yielding a total sum score of 13 to 52.
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Timepoint [6]
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12 months
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Secondary outcome [7]
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All-cause mortality (time to death)
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Assessment method [7]
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Data on participant deaths will be collected from care staff on a monthly basis.
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Timepoint [7]
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up 24 months
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Secondary outcome [8]
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Any increase in medication use (binary, yes/no)
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Assessment method [8]
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Data on type (ATC Codes N065, N06) of medication used and any increase or decrease over time will be collected from care staff using the 'medication profile' section of a tailored version of the Client Socio-Demographic and Service Receipt Inventory (CSSRI), or from available databases.
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Timepoint [8]
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12 months
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Secondary outcome [9]
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Costs
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Assessment method [9]
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Total and component costs of the interventions are assessed from a societal perspective, including the cost of the intervention as well as statutory health and social care services used, using a tailored version of the Client Socio-Demographic and Service Receipt Inventory (CSSRI). Total cost per participant will be calculated in Euros.
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Timepoint [9]
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12 months
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Secondary outcome [10]
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Any adverse event [Safety]
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Assessment method [10]
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All types of adverse events and serious adverse events (e.g. unexpected worsening of symptoms), whether related or unrelated to the interventions, are reported.
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Timepoint [10]
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12 months
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Secondary outcome [11]
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Professional Care Team Burden Scale
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Assessment method [11]
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10-item scale to obtain ratings of burden from formal care teams working in care homes. Items are scored on a 5-point scale from 0 (strongly disagree) to 4 (strongly agree), yielding a total sum score from 0 to 40, with higher scores indicating higher burden.
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Timepoint [11]
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12 months
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Secondary outcome [12]
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Days on sick leave of care staff
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Assessment method [12]
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(as recorded monthly by the employer)
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Timepoint [12]
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12 months
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Eligibility
Key inclusion criteria
* resident (full-time, 24h/day) at a participating care home;
* dementia as indicated by a Clinical Dementia Rating score of 0.5 or more and a Mini-Mental State Examination (MMSE) score of 26 or less;
* at least mild depressive symptoms, as indicated by a Montgomery-Åsberg Depression Rating Scale (MADRS) score of at least 8;
* a clinical diagnosis of dementia according to ICD-10 research criteria;
* have given written informed consent (may be assent by proxy for those unable to provide consent themselves).
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Minimum age
65
Years
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Maximum age
No limit
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Sex
Both males and females
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Can healthy volunteers participate?
No
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Key exclusion criteria
* diagnosis of schizophrenia or Parkinson's disease;
* severe hearing-impairment;
* in short-term care;
* unable to tolerate sitting in a chair for the duration of the sessions.
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Study design
Purpose of the study
Treatment
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Allocation to intervention
Randomised controlled trial
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Procedure for enrolling a subject and allocating the treatment (allocation concealment procedures)
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Methods used to generate the sequence in which subjects will be randomised (sequence generation)
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Masking / blinding
Blinded (masking used)
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Who is / are masked / blinded?
The people assessing the outcomes
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Intervention assignment
Factorial
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Other design features
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Phase
NA
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Type of endpoint/s
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Statistical methods / analysis
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Recruitment
Recruitment status
Active, not recruiting
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Data analysis
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Reason for early stopping/withdrawal
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Other reasons
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Date of first participant enrolment
Anticipated
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Actual
18/07/2018
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Date of last participant enrolment
Anticipated
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Actual
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Date of last data collection
Anticipated
1/01/2024
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Actual
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Sample size
Target
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Accrual to date
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Final
1021
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Recruitment in Australia
Recruitment state(s)
VIC
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Recruitment hospital [1]
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The University of Melbourne - Melbourne
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Recruitment postcode(s) [1]
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3010 - Melbourne
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Recruitment outside Australia
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Germany
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State/province [1]
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Oldenburg
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Country [2]
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Netherlands
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State/province [2]
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Groningen
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Country [3]
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Norway
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State/province [3]
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Vestland
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Country [4]
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Turkey
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State/province [4]
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Ankara
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Country [5]
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United Kingdom
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State/province [5]
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Nottingham
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Funding & Sponsors
Primary sponsor type
Other
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Name
NORCE Norwegian Research Centre AS
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Address
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Other collaborator category [1]
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Other
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Name [1]
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University of Melbourne
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Address [1]
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Other collaborator category [2]
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Other
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Name [2]
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University of Oldenburg
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Address [2]
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Country [2]
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Other collaborator category [3]
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Other
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Name [3]
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University Medical Center Groningen
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Address [3]
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Country [3]
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Other collaborator category [4]
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Other
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Name [4]
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Ankara Haci Bayram Veli University
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Address [4]
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Other collaborator category [5]
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Other
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Name [5]
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University of Nottingham
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Address [5]
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Ethics approval
Ethics application status
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Summary
Brief summary
This study evaluates the effectiveness of two music-based approaches - group music therapy and recreational choir singing - for reducing depression symptoms in people living with dementia. It also examines mechanisms and heterogeneity of treatment effects.
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Trial website
https://clinicaltrials.gov/study/NCT03496675
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Trial related presentations / publications
Gold C, Eickholt J, Assmus J, Stige B, Wake JD, Baker FA, Tamplin J, Clark I, Lee YC, Jacobsen SL, Ridder HMO, Kreutz G, Muthesius D, Wosch T, Ceccato E, Raglio A, Ruggeri M, Vink A, Zuidema S, Odell-Miller H, Orrell M, Schneider J, Kubiak C, Romeo R, Geretsegger M. Music Interventions for Dementia and Depression in ELderly care (MIDDEL): protocol and statistical analysis plan for a multinational cluster-randomised trial. BMJ Open. 2019 Mar 30;9(3):e023436. doi: 10.1136/bmjopen-2018-023436. Rasing NL, Janus SIM, Kreutz G, Sveinsdottir V, Gold C, Nater UM, Zuidema SU. The Impact of Music on Stress Biomarkers: Protocol of a Substudy of the Cluster-Randomized Controlled Trial Music Interventions for Dementia and Depression in ELderly Care (MIDDEL). Brain Sci. 2022 Apr 8;12(4):485. doi: 10.3390/brainsci12040485. Janus, S. I. M., Vink, A. C., Ridder, H. M., Geretsegger, M., Stige, B., Gold, C., & Zuidema, S. U. (2020). Developing consensus description of group music therapy characteristics for persons with dementia. Nordic Journal of Music Therapy, 1-17. Baker FA, Tamplin J, Clark IN, Lee YC, Geretsegger M, Gold C. Treatment Fidelity in a Music Therapy Multi-site Cluster Randomized Controlled Trial for People Living With Dementia: The MIDDEL Project Intervention Fidelity Protocol. J Music Ther. 2019 May 10;56(2):125-148. doi: 10.1093/jmt/thy023. Baker FA, Lee YC, Sousa TV, Stretton-Smith PA, Tamplin J, Sveinsdottir V, Geretsegger M, Wake JD, Assmus J, Gold C. Clinical effectiveness of music interventions for dementia and depression in elderly care (MIDDEL): Australian cohort of an international pragmatic cluster-randomised controlled trial. Lancet Healthy Longev. 2022 Mar;3(3):e153-e165. doi: 10.1016/S2666-7568(22)00027-7. Erratum In: Lancet Healthy Longev. 2022 Oct;3(10):e653. doi: 10.1016/S2666-7568(22)00227-6. Baker FA, Stretton-Smith PA, Sousa TV, Clark I, Cotton A, Gold C, Lee YC. Resource assessment in trials undertaken in residential care homes: Experiences from the Australian MIDDEL cluster randomised controlled trial research team. Contemp Clin Trials Commun. 2020 Nov 25;20:100675. doi: 10.1016/j.conctc.2020.100675. eCollection 2020 Dec. Lee YC, Sousa TV, Stretton-Smith PA, Gold C, Geretsegger M, Baker FA. Demographic and clinical profile of residents living with dementia and depressive symptoms in Australian private residential aged care: Data from the Music Interventions for Dementia and Depression in ELderly care (MIDDEL) cluster-randomised controlled trial. Australas J Ageing. 2022 Dec;41(4):e387-e396. doi: 10.1111/ajag.13104. Epub 2022 Jul 8.
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Public notes
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Contacts
Principal investigator
Name
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Vigdis Sveinsdottir, PhD
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Address
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GAMUT, NORCE Norwegian Research Centre, Bergen, Norway
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Contact person for public queries
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Contact person for scientific queries
Data sharing statement
Will individual participant data (IPD) for this trial be available (including data dictionaries)?
Yes
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What data in particular will be shared?
De-identified datasets (participant codes and outcome scores) generated during and/or analysed during the current study will be stored in a publically available repository (NSD - Norwegian Centre for Research Data, http://www.nsd.uib.no/nsd/english/index.html).
Supporting document/s available: Study protocol, Statistical analysis plan (SAP), Clinical study report (CSR)
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When will data be available (start and end dates)?
Data will become available upon publication of the primary outcome.
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Available to whom?
De-identified IPD will be publicly available at the Norwegian Centre for Research Data (http://www.nsd.uib.no/nsd/english/index.html).
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Available for what types of analyses?
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How or where can data be obtained?
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What supporting documents are/will be available?
No Supporting Document Provided
Results publications and other study-related documents
Type
Citations or Other Details
Journal
Janus, S. I. M., Vink, A. C., Ridder, H. M., Geret...
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Journal
Baker FA, Tamplin J, Clark IN, Lee YC, Geretsegger...
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Baker FA, Lee YC, Sousa TV, Stretton-Smith PA, Tam...
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Baker FA, Stretton-Smith PA, Sousa TV, Clark I, Co...
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Lee YC, Sousa TV, Stretton-Smith PA, Gold C, Geret...
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Results not provided in
https://clinicaltrials.gov/study/NCT03496675