GREAT into Practice is an implementation project aiming to maintain independence in people with Alzheimer’s and related dementias through implementation of GREAT Cognitive Rehabilitation into Practice. Working alongside NHS Trusts, Councils and private providers, the goal is for everyone who can benefit from GREAT Cognitive Rehabilitation to have access to it locally.
GREAT Cognitive Rehabilitation is an evidence-based programme developed specifically to help people with mild and moderate dementia, and their families.. The aim is to enable people to function as well as possible in the everyday activities that are important to them. It is based on many years of research and cognitive rehabilitation has been recommended for people with dementia and their families in the NICE guidelines and by the MSNAP.
It has been adapted from a well-established approach for people who have cognitive impairment as a result of a brain injury and it is based on a large-scale clinical trial called GREAT which stands for “Goal-oriented cognitive Rehabilitation in Early-stage Alzheimer’s and related dementias: a multi-centre single-blind randomised controlled Trial”. The study involved nearly 500 people with dementia and care partners, and demonstrated the positive effects of the approach, showing that it enabled people to function better in relation to the goals targeted in therapy.
In this 3-year implementation (service improvement) project we aimed to have GREAT Cognitive Rehabilitation effectively implemented in at least 15 organisations, and a tried and tested strategy available for wider implementation throughout the UK and beyond. The implementation project aimed to provide the knowledge necessary to enable the broad rollout of GREAT Cognitive Rehabilitation to benefit as many people affected by dementia as possible.
The team worked with 11 NHS and private care providers, provided cognitive rehabilitation training to nearly100 practitioners and recorded intervention outcomes for 54 people with dementia. Despite a shorter 6-session protocol and the involvement of staff with diverse levels of experience, the observed intervention outcomes proved even better than in the original trial. In addition, people receiving cognitive rehabilitation expressed high levels of satisfaction with the intervention, and practitioners felt more positive about their work. A linked study in a group of 4 care homes showed that people living in residential care could equally benefit from GREAT Cognitive Rehabilitation.
The project team have developed an e-learning course designed to provide NHS staff with the skills to deliver GREAT Cognitive Rehabilitation to people with mild-to-moderate dementia. Working with a group of people with dementia, they have co-produced a self-help guide for people with dementia based on principles of cognitive rehabilitation, called My Life, My Goals. This offers hope that it is possible to find ways of managing difficulties and live a good life with dementia. It is available on the Living With Dementia Toolkit and on Alzheimer’s Society website.
GREAT Cognitive Rehabilitation could form a valuable component of post-diagnostic support offered by NHS memory services or social care providers and dementia care services should now increase their capacity to offer cognitive rehabilitation to people with dementia.
Birmingham and Solihull Mental Health NHS Foundation Trust,
Black Country NHS Foundation Trust,
Bristol Dementia Wellbeing Service,
Hertfordshire Partnership University NHS Foundation Trust,
Kent and Medway NHS and Social Care Partnership Trust,
Rotherham Doncaster and South Humber NHSFT,
West London NHS Foundation Trust
Universities of Bangor, Bradford, London School of Economics