Twenty-five studies (n=1,167, range 13 to 148 ) were included in the review: 10 randomised controlled trials (RCTs) or nested RCTs and 15 before-and-after (repeated measure) studies, 13 of which were randomised crossover trials. Quality scores ranged from 2 to 4. Six studies were rated as strong, 16 as moderate, three as weak and none as poor.
Eleven studies showed that psychosocial interventions were more effective than attention controls in reducing behavioural symptoms. Effect sizes were mostly small or moderate.
Interventions with large effect sizes were bed bath versus tub bath (ES 1.15; one crossover trial) and preferred music versus classical music (ES 1.19; one crossover trial) and versus usual bath (ES not computable; one repeated measures).
Interventions with moderate effect sizes were aromatherapy (ES 0.71; one nested RCT and ES 0.57; one crossover trial), carer education (ability-focused morning care versus usual morning care) (ES 0.62; one nested RCT). The review abstract reported that muscle relaxation therapy was more effective than attention control, but this was not supported by the results reported in the main body of the review and the results table.
Small effect sizes were shown for music/sound: natural sounds versus headphone only (ES 0.27; one crossover trial), preferred music during bath versus usual bath (ES 0.47; one crossover trial) and family audiotape versus neutral audiotape (ES 0.45; one crossover trial).