Reality orientation therapy (RO) is a widely used non-pharmacological approach aimed at maintaining cognitive abilities and alleviate dementia-related symptoms. Although some evidence supports its beneficial effects on cognitive function, its impact on activities of daily living (ADL) and behavioral and psychological symptoms of dementia (BPSD, or neuropsychiatric symptoms) remains unclear. This systematic review and meta-analysis aims to evaluate the effects of RO on ADL, BPSD, and cognitive function. This review included individuals with dementia or cognitive impairment of neurodegenerative or vascular origin. Studies examining classroom-based or 24-hour RO interventions were included, with control groups receiving treatment as usual. Both randomized controlled trials (RCTs) and quasi-experimental studies were considered. In total, 16 studies were included in the systematic review, of which 13 were included in the meta-analysis; individual studies contributed to multiple outcomes (6 on ADL, 13 on cognitive function, 4 on depressive symptoms, and 4 on other BPSD). RO was associated with improvements in cognitive function (Standardized Mean Difference SMD = 0.60, 95% confidence interval CI = 0.43 to 0.77, p < 0.001) and reductions in depressive symptoms (SMD = -0.69, 95% CI = -1.37 to -0.00, p = 0.05). However, no significant effects were observed for ADL (SMD = -0.08, 95% CI = -0.45 to 0.30, p = 0.69) or other BPSD (SMD = -0.55, 95% CI = -1.96 to 0.87, p = 0.45). RO was associated with improvements in global cognitive function and depressive symptoms in individuals with dementia. However, no significant effects were observed on ADL or other BPSD. These results should be interpreted with caution given the methodological limitations, including study heterogeneity and potential biases. Future well-designed RCTs with larger sample sizes, longer intervention periods, and extended follow-up are needed to rigorously assess the clinical effectiveness of RO. Given its low cost and feasibility, RO may serve as a component of comprehensive dementia care. However, its role—particularly regarding functional outcomes and BPSD—warrants further evidence before it can be firmly defined. PROSPERO CRD42024572672.
Mikami et al. (Wed,) studied this question.