Effects of creative expression therapy on Chinese elderly patients with dementia: an exploratory randomized controlled trial

Figures & data

Figure 1 Study flow chart.

Abbreviations: CE, creative expression; SC, standard cognitive.

Table 1 Baseline demographic and neuropsychological evaluations of participants

Characteristics	Overall (n=91)	CE program (n=43)	SC training (n=48)	P-value
Age, mean (SD)	84.33 (7.17)	85.3 (5.89)	83.46 (8.11)	0.222^a
Gender (%)				0.203^b
Male	34 (37.4)	19 (44.2)	15 (31.3)
Female	57 (62.6)	24 (55.8)	33 (68.8)
Marital status (%)				0.431^b
Married	14 (15.4)	10 (23.3)	8 (16.7)
Single/divorced	77 (84.6)	33 (76.7)	40 (83.3)
Education level (%)				0.288^b
No schooling/Primary	26 (28.6)	10 (23.3)	16 (33.3)
Secondary/Tertiary	65 (71.4)	33 (76.7)	32 (66.7)
Self-care (%)				0.614^b
Fully self-care	28 (30.8)	13 (30.2)	13 (27.1)
Partially self-care	53 (58.2)	22 (51.2)	29 (60.4)
Totally incapacitated	10 (11.0)	8 (18.6)	6 (12.5)
MMSE score, mean (SD)	18.55 (4.97)	18.72 (4.85)	18.40 (5.13)	0.758^a
QOL-AD scores, mean (SD)	30.11 (5.44)	29.14 (5.63)	30.98 (5.16)	0.108^a
CSDD score, mean (SD)	4.45 (3.46)	3.79 (2.57)	5.04 (4.03)	0.085^a
FACS score, mean (SD)
Social Communication	5.85 (0.90)	5.88 (0.96)	5.83 (0.85)	0.802^a
Communication of Basic Needs	6.04 (1.08)	5.82 (1.10)	6.23 (1.05)	0.073^a

Notes: ^aIndependent sample t-test. ^bChi-square test.

Abbreviations: MMSE, Mini-Mental State Examination; QOL-AD, Quality of Life–Alzheimer’s Disease; CSDD, Cornell Scale for Depression in Dementia; FACS, Functional Assessment of Communication Skills; CE, creative expression; SC, standard cognitive.

Table 2 Outcome at baseline, postintervention, and 1 month follow-up

Measures	Groups CE (n=43) or SC (n=48)	Baseline mean (SD)	Postintervention mean (SD)	Follow-up mean (SD)	Postintervention			Follow-up
					P-value (group)	P-value (time)	Effect size (95% CI)	P-value (group)	P-value (time)	Effect size (95% CI)
MMSE	CE	18.72 (4.85)	20.47 (5.75)	19.77 (5.57)	0.344	0.001^a	d=−1.74 (−2.68, -0.81)	0.247	0.017^a	d=−1.05 (−1.90, -0.20)
	SC	18.40 (5.13)	19.29 (6.00)	18.35 (5.96)		0.066	d=−0.90 (−1.86, 0.06)		0.943	d=−0.04 (−1.13, -1.21)
QOL-AD	CE	29.14 (5.63)	32.33 (6.47)	31.33 (5.48)	0.110	0.001^a	d=−3.186 (−4.99, −1.38)	0.030^a	0.010^a	d=2.19 (−3.81, −0.56)
	SC	30.98 (5.16)	30.13 (5.96)	28.65 (6.25)		0.181	d=0.854 (−0.41, 2.12)		0.004^a	d=0.854 (−0.79, 3.87)
CSDD	CE	3.79 (2.57)	2.26 (2.49)	2.86 (2.22)	0.060	0.001^a	d=1.535 (0.70, 2.37)	0.047^a	0.012^a	d=0.930 (0.22, 1.64)
	SC	5.04 (4.03)	3.44 (3.26)	4.90 (6.24)		0.015^a	d=1.60 (0.33, 2.88)		0.872	d=0.146 (−1.67, 1.96)
FACS
Social Communication	CE	5.88 (0.96)	6.38 (0.77)	6.41 (0.77)	0.010^a	0.003^a	d=−0.50 (−0.82, −0.18)	0.001^a	<0.001^a	d=−0.53 (−0.75, −0.31)
	SC	5.83 (0.85)	5.94 (0.81)	5.86 (0.69)		0.151	d=−0.11 (−0.27, 0.04)		0.810	d=−0.03 (−0.27, 0.21)
Communication of Basic Needs	CE	5.82 (1.10)	6.35 (0.79)	6.17 (1.06)	0.150	0.003^a	d=−0.53 (−0.86, −0.20)	0.240	0.069	d=−0.36 (−0.74, 0.03)
	SC	6.23 (1.05)	6.56 (0.62)	6.42 (0.86)		0.036^a	d=−0.34 (−0.65, −0.02)		0.259	d=−0.19 (−0.52, 0.14)

Notes: Effect size was defined as Cohen’s d of the CE group compared with the CG. Mean= adjusted mean after Bonferroni correction. ^aP<0.05.

Abbreviations: MMSE, Mini-Mental State Examination; QOL-AD, Quality of Life–Alzheimer’s Disease; CSDD, Cornell Scale for Depression in Dementia; FACS, Functional Assessment of Communication Skills; CE, creative expression; SC, standard cognitive; CI, confidence interval.

Table 3 The result of OERS

Measures		Group CE (n=43) or SC (n=48)	Week 3			Week 6
			Mean (SD)	95% CI	P	Mean (SD)	95% CI	P
Positive emotions	Pleasure	CE	3.23 (1.65)	0.309–1.740	0.006^a	3.77 (1.445)	0.191–1.635	0.014^a
		SC	2.21 (1.77)			2.85 (2.000)
	General alertness	CE	5.00 (0.00)	0.154–0.930	0.007^a	4.95 (0.21)	0.099–0.558	0.006^a
		SC	4.46 (1.34)			4.63 (0.76)
Negative emotions	Anger	CE	1.07 (0.46)	−0.130–0.186	0.724	1.00 (0.00)	−0.134–0.009	0.083
		SC	1.04 (0.29)			1.06 (0.25)
	Anxiety/Fear	CE	1.00 (0.00)	−0.100–0.017	0.159	1.02 (0.15)	−0.024–0.070	0.323
		SC	1.04 (0.20)			1.00 (0.00)
	Sadness	CE	1.00 (0.00)	−0.194–0.069	0.347	1.02 (0.15)	−0.059–0.064	0.938
		SC	1.06 (0.43)			1.02 (0.14)

Notes: P-value by independent t-test. ^aP<0.05.

Abbreviations: OERS, Observed Emotion Rating Scale; CE, creative expression; SC, standard cognitive; CI, confidence interval.