Ask an answerable question (PICO)：
Dementia is a crucial issue in an aging society. The progression of dementia leads to cognitive, emotional, or behavioral disorders, among which behavior problems mostly often increase the caregivers’ stress. Nonpharmacological treatments become an alternative option in handling those behavior problems. Clinical evidence suggested that doll therapy can be applied to reduce behavioral abnormalities of patients with dementia. However, caregivers and family members of such patients question the therapy. Therefore, this study aimed to review and realize whether the doll therapy as an intervention improves behavior problems of patients with dementia.
The Method and Analysis of Literature Review：
PICO (patients/problem, intervention, comparison, and outcomes) was used to create a researchable question based on the clinical situation. Based on the PICO question, keywords were identified to use in database searches. In this study, the “P” was dementia; the “I” was doll therapy; the “C” was usual care or other care; and the “O” was behavior problems. Literature search was conducted in electronic databases of Cochrane Library, PubMed, Cumulative Index to Nursing and Allied Health Literature (CINAHL) Plus with Full Text, PsycINFO, and Airiti Library for the period of 2018-2022. Studies that published in English language and involved participants who aged 65 and older were deemed to meet the inclusion criteria. Accordingly, a total of 30 studies were identified. Subsequently, studies that were randomized controlled trials (RCTs), systematic reviews, and meta-analyses were selected. After the removal of duplicates and examinations of the relevance of titles and abstracts, five studies were included for methodological quality appraisal.
Critical Appraisal：
All of the five studies were RCTs and they were classified as Level 1c in the Joanna Briggs Institute (JBI) Levels of Evidence. Therefore, the Critical Appraisal Skills Programme (CASP) Randomized Controlled Trial Checklist was used to appraise the articles. Results indicated that the precision of four of the five included studies might be compromised because of their small sample size. Study 2, 3, and 4 did not indicate blinding. All of the five studies presented adequate quality that could be references for clinical applications.
Results, Conclusions and Recommendations：
The results of this study showed that doll therapy improved the behavior problems of older adults with moderate to severe dementia and reduced the burden of caregivers. It is recommended to provide lifelike dolls or empathy dolls during the day and when agitation occurs to reduce the frequency and severity of behavior problems. It is also recommended to assess case status and enhance caregivers’ knowledge of doll therapy before implementing the therapy.
