Personal information

My research is focused on 'The implementation of the Dutch Serial Trial Intervention (STA OP!) for Pain and Challenging behaviour in advanced dementia patients'.

Pain (physical discomfort) and challenging behaviour are highly prevalent in nursing home residents with dementia: at any given time 45-80% of nursing home residents are in pain and up to 80% have challenging behaviour.

To address the problems in assessment and management of pain and challenging behaviour in people with dementia, an innovative clinical protocol, the STI - Serial Trial Intervention was developed in the United States (first named: Assessment and treatment of Discomfort in Dementia /ADD-protocol; Kovach et al. 1999, 2001, 2002, 2006). It is a stepped care protocol, which means that if in one step the assessment is negative, or if targeted interventions fail to decrease symptoms, the move is made to the next step. The protocol is specifically designed for dementia patients with moderate to severe cognitive impairment, because they cannot clearly communicate in a verbal way, and consequently care professionals have to rely (at least partly) on behavioural symptoms. Since it is often unclear whether these symptoms are a result of pain or for instance of affective discomfort, a systematic approach for exploring and managing the symptoms is needed.

The effects of the protocol on patient outcomes and professionals' interventions have been investigated in several studies in the USA (Kovach et al. 1999, 2001, 2006). The most recent and well-designed study (Kovach et al., 2006) used a double-blinded randomized design and tested the effects of the protocol in subjects with moderate to severe dementia. The researchers established a significant decrease in the number of symptoms linked to pain and affective discomfort, measured with the DS-DAT.

Based on these positive findings we expect that this protocol will also be effective in Dutch patients with moderate to severe dementia. However, Dutch nursing homes are differently organized than those in the USA (Ribbe et al. 1997). This warranted some changes in the protocol. For example: in the original protocol nurses perform a physical examination, while in the Dutch nursing home this is a task of the nursing home physician. Also, in Dutch nursing homes, psychologist are available for the analysis and care planning for behavioural problems.

The present study will provide insight into the effects of implementation of the Dutch version of the STI-protocol (STA OP!) in comparison with a control intervention, not only on behavioural symptoms, but also on pain, depression, and quality of life.


Prof. W.P. (Wilco) Achterberg, MD, PhD
Prof. A.L. (Anneke) Francke, PhD

Prof. E.J.A. (Erik) Scherder, PhD

J.T. (Jenny) van der Steen, PhD