Maartje M. E. de Werd

Errorless learning (EL) is a method for optimizing learning, which uses feed-forward instructions in order to prevent people from making mistakes during the learning process. The majority of previous studies on EL taught patients with dementia artificial tasks of little or no relevance for their daily lives. Furthermore, only a few controlled studies on EL have so far been performed and just a handful of studies have examined the long-term effects of EL. Tasks were not always trained in the patients’ natural or home environment, limiting the external validity of these studies. This multicenter parallel randomized controlled trial examines the effects of EL compared with trial and error learning (TEL) on the performance of activities of daily living in persons with Alzheimer’s or mixed-type dementia living at home. Patients received nine 1-hour task training sessions over eight weeks using EL or TEL. Task performance was measured using video observations at week 16. Secondary outcome measures were task performance measured at week 26, satisfaction with treatment, need for assistance, challenging behavior, adverse events, resource utilization and treatment costs. A total of 161 participants were randomized, of whom 71 completed the EL and 74 the TEL arm at week 11. Sixty-nine EL patients and 71 TEL patients were assessed at the 16-week follow-up (the primary measurement endpoint). Intention-to-treat analysis showed a significantly improved task performance in both groups. No significant differences between the treatment groups were found for primary or secondary outcomes. Structured relearning improved the performance of activities of daily living. Improvements were maintained for 6 months. EL had no additional effect over TEL. German Register of Clinical Trials DRKS00003117 . Registered 31 May 2011.

Errorless learning (EL) is an instructional procedure involving error reduction during learning. Errorless learning is mostly examined by counting correctly executed task steps or by rating them using a Task Performance Scale (TPS). Here, we explore the validity and reliability of a new assessment procedure, the core elements method (CEM), which rates essential building blocks of activities rather than individual steps. Task performance was assessed in 35 patients with Alzheimer’s dementia recruited from the Relearning methods on Daily Living task performance of persons with Dementia (REDALI-DEM) study using TPS and CEM independently. Results showed excellent interrater reliabilities for both measure methods (CEM: intraclass coefficient [ICC] = .85; TPS: ICC = .97). Also, both methods showed a high agreement (CEM: mean of measurement difference [MD] = −3.44, standard deviation [SD] = 14.72; TPS: MD = −0.41, SD = 7.89) and correlated highly (>.75). Based on these results, TPS and CEM are both valid for assessing task performance. However, since TPS is more complicated and time consuming, CEM may be the preferred method for future research projects.

Various studies have shown the efficacy of errorless learning (EL) in teaching patients with dementia a wide variety of skills and everyday tasks, with some studies showing beneficial effects and others reporting limited or no advantage. However, EL procedures vary greatly and, to date, no clinical guidelines or manuals are available. Here, we present a nationwide survey exploring the interest in, and feasibility of, EL in dementia care in The Netherlands. Based on the survey results and available evidence in the literature, we subsequently drafted an EL manual and had this concept manual evaluated in a Delphi round using the AGREE instrument. Forty-five health professionals associated with 22 dementia care facilities in The Netherlands, including those survey respondents who had piloted an EL intervention in accordance with the concept manual and an eight-strong expert panel representing various disciplines, deemed EL to be meaningful and feasible for use in dementia care and their residential facilities. Although our manual was favourably received, future studies are required to examine how EL can best be implemented in clinical practice and to determine the optimal outcome measures and quality indicators to reliably evaluate intervention outcomes and to consider the cost-effectiveness of the approach.