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Self-Efficacy and Pressure Ulcer Prevention After Spinal Cord Injury-Results From a Nationwide Community Survey in Switzerland (SwiSCI).
Hug, K, Stumm, C, Debecker, I, Fellinghauer, CS, Peter, C, Hund-Georgiadis, M
PM & R : the journal of injury, function, and rehabilitation. 2018;(6):573-586
Abstract
BACKGROUND Pressure ulcers (PUs) are a common and severe health condition in persons with spinal cord injury (SCI). Skin-care strategies for PU prevention are usually provided during initial rehabilitation. However, individuals with SCI often do not perform these strategies continuously, especially after discharge. The influence of psychological factors such as general self-efficacy (GSE) on the performance of PU prevention behavior has not yet been sufficiently explored. OBJECTIVE To investigate whether persons with greater levels of GSE are more likely to perform skin-care strategies for PU prevention regularly. DESIGN Nationwide cross-sectional survey within the Swiss Spinal Cord Injury Cohort Study. SETTING Community setting, data collection between 2011 and 2013. PARTICIPANTS A total of 456 subjects with a traumatic or nontraumatic SCI living in Switzerland. METHODS Associations between GSE and PU prevention behavior were analyzed by multivariate proportional odds regression models, including potential sociodemographic, lesion-related, and lifestyle-related confounders without and with interaction terms between GSE and potential effect modifiers. MAIN OUTCOME MEASUREMENTS Self-efficacy was assessed by the GSE scale comprising 10 items. PU preventive behavior was operationalized using 5 items of an adapted version of the Spinal Cord Injury Lifestyle scale. Both measurements were components of a self-administered questionnaire. RESULTS Based on the regression model without interaction terms, GSE levels were not associated with skin-care PU prevention. After we included interaction terms, the final model showed statistically significant associations between GSE and 3 skin-care items with odds ratios ranging from 1.09 to 1.17 (all P < .001). The slightly positive effect of GSE on PU prevention behavior was restricted to persons who sustained their SCI at a younger age. CONCLUSIONS GSE was generally not associated with skin-care PU prevention behavior among persons with SCI in this study. In further research, it might be of interest to assess SCI-specific concepts of self-efficacy. LEVEL OF EVIDENCE III.
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Randomized Controlled Trial of E-Counseling for Hypertension: REACH.
Nolan, RP, Feldman, R, Dawes, M, Kaczorowski, J, Lynn, H, Barr, SI, MacPhail, C, Thomas, S, Goodman, J, Eysenbach, G, et al
Circulation. Cardiovascular quality and outcomes. 2018;(7):e004420
Abstract
BACKGROUND The efficacy of internet-based interventions to improve hypertension management is not established. We evaluated the therapeutic benefit of e-counseling by adapting best evidence guidelines for behavioral counseling. METHODS AND RESULTS This multicenter double-blind randomized controlled trial included assessments at baseline, 4 months, and 12 months. Participants were 35 to 74 years of age and diagnosed with hypertension: systolic/diastolic blood pressure (BP) 130 to 180/85 to 110 mm Hg. BP was assessed by automated office measurement. E-Counseling used multimedia and interactive tools to increase motivation and skill for self-care (exercise, diet, medication adherence, and smoking cessation). Control used self-care education. Frequency of contact by our e-platform was equal for both trial arms. Primary end points were change at 4 and 12 months in systolic BP, diastolic BP, pulse pressure, total lipoprotein cholesterol, low-density lipoprotein cholesterol, total lipoprotein cholesterol/high-density lipoprotein cholesterol ratio, non-high-density lipoprotein cholesterol, and Framingham 10-year cardiovascular risk index. Intention-to-treat analysis used generalized linear models adjusted for baseline measures, sex, and medications. Among 264 participants, mean age was 57.6 years (SE, 0.6), 58% were women, with 83% on antihypertensive medications. At 12 months, e-counseling versus control evoked greater reduction in systolic BP (-10.1 mm Hg [95% confidence interval (CI), -12.5, -7.6] versus -6.0 mm Hg [95% CI, -8.5, -3.5]; P=0.02); pulse pressure (-5.2 mm Hg [95% CI, -6.9, -3.5] versus -2.7 mm Hg [95% CI, -4.5, -0.9]; P=0.04), and Framingham risk index (-1.9% [95% CI, -3.3, -0.5] versus -0.02% [95% CI, -1.2, 1.7]; P=0.02), respectively. Among males in e-counseling versus control, 12-month end points included lower diastolic BP (P=0.01), non-high-density lipoprotein cholesterol (P=0.04), total lipoprotein cholesterol (P=0.03), and a trend for total lipoprotein cholesterol/high-density lipoprotein cholesterol ratio (P=0.07). CONCLUSIONS To our knowledge, this is the first double-blind randomized trial of e-counseling for hypertension. Added benefit for medical therapy was achieved by combining available technology with a clinically organized protocol of motivational and cognitive-behavioral counseling. CLINICAL TRIAL REGISTRATION https://www.clinicaltrials.gov; Unique identifier: NCT01541540.
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Patients' and therapists' experiences with a new treatment programme for eating disorders that combines physical exercise and dietary therapy: the PED-t trial. A qualitative study protocol.
Pettersen, G, Rosenvinge, JH, Bakland, M, Wynn, R, Mathisen, TF, Sundgot-Borgen, J
BMJ open. 2018;(1):e018708
Abstract
INTRODUCTION Women with bulimia nervosa and binge eating disorder often suffer for many years before they seek professional help. Evidence-based treatments like cognitive-behavioural therapy (CBT) might be poorly accessible, and about 50% of those who receive CBT respond to it. Such outcome may reflect the heterogeneous nature of eating disorders, and addressing this heterogeneity calls for expanding the portfolio of treatment options. In particular, it is important to explore such options' acceptability, tolerability and affordability expressed through experiences with the treatment. This protocol outlines the rationale and design of a qualitative study. It captures experiences from patients and therapists who were involved in a randomised controlled trial (RCT) exploring the efficacy of a new group-based treatment programme combining physical exercise and dietary therapy. METHODS AND ANALYSIS 15 patients with bulimia nervosa or binge eating disorder, 10 therapists (physical trainers and dietitians) and 6-10 patients who dropped out of the RCT will be semistructurally interviewed. All interviews will be analysed using a systematic text condensation approach. ETHICS AND DISSEMINATION Results will be presented in peer-reviewed international journals, and at relevant international conferences. Key findings will be available to study participants as well as to patient organisations and health authorities. The overall study meets the intent and requirements of the Health Research Act and the Declaration of Helsinki. It is approved by the regional committee for medical research ethics (2013/1871). TRIAL REGISTRATION NUMBER NCT02079935; Pre-results.
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Which interventions work for dementia family carers?: an updated systematic review of randomized controlled trials of carer interventions.
Kishita, N, Hammond, L, Dietrich, CM, Mioshi, E
International psychogeriatrics. 2018;(11):1679-1696
Abstract
UNLABELLED ABSTRACTObjective:The aim of this study was to update the literature on interventions for carers of people with dementia published between 2006 and 2016 and evaluate the efficacy of psychoeducational programs and psychotherapeutic interventions on key mental health outcomes (depression, anxiety, burden, and quality of life). METHODS A meta-analysis was carried out of randomized controlled trials of carer interventions using MEDLINE, PsycINFO, Scopus, and Cochrane Central Register of Controlled Trials. RESULTS The majority of studies were conducted in Western and Southern Europe or the United States and recruited carers of people with Alzheimer's disease or dementia grouped as a whole. The most commonly used outcome measures were depression and burden across studies. The updated evidence suggested that psychoeducation-skill building interventions delivered face-to-face can better impact on burden. Psychotherapeutic interventions underpinned by Cognitive Behavior Therapy (CBT) models demonstrated strong empirical support for treating anxiety and depression and these effects were not affected by the mode of delivery (i.e. face-to-face vs. technology). A modern CBT approach, Acceptance and Commitment Therapy (ACT), seemed to be particularly beneficial for carers experiencing high levels of anxiety. CONCLUSIONS Future research needs to explore the efficacy of interventions on multiple clinical outcomes and which combination of interventions (components) would have the most significant effects when using CBT. The generalization of treatment effects in different countries and carers of different types of dementia also need to be addressed. More research is needed to test the efficacy of modern forms of CBT, such as ACT.
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Development and effect of a rational-emotive-behaviour-therapy-based self-management programme for early renal dialysis patients.
Kim, ES
Journal of clinical nursing. 2018;(21-22):4179-4191
Abstract
AIMS AND OBJECTIVES This study attempts to develop and determine the effect a rational-emotive-behaviour-therapy-based self-management programme can have on the self-efficacy, self-care, depression and dyssomnia of patients undergoing early renal dialysis. BACKGROUND When renal dialysis is initiated, changes in everyday life are inevitable, and patients can suffer from both psychological and physical symptoms. Hence, to obtain the best results from renal dialysis, active self-management is required. DESIGN Quasi-experimental and longitudinal. METHODS Forty-eight early-stage renal dialysis patients registered for and undergoing renal dialysis at a hospital located in S city participated in this study. These individuals were divided into an experimental and control group. The former group engaged in a self-management programme consisting of eight weekly sessions of 50 min in duration, while the latter received traditional nursing care. Data were collected from June 2012-May 2014 through the use of a preliminary survey, a postsurvey that was distributed after the eight sessions of the self-management programme had been completed, and a follow-up survey allocated 4 weeks after the postsurvey. Data collection was conducted using the Self-efficacy Scale, Self-care Practice Scale, Beck Depression Inventory, and Korean Sleep Scale, and a repeated-measures ANOVA was used to perform analysis. RESULTS The experimental group significantly differed from the control group in regard to self-efficacy (p = 0.006) and self-care (p = 0.031), but differences in terms of depression (p = 0.492) and dyssomnia (p = 0.141) were nonsignificant. In the experimental group, the depression decreased but then increased again, while the dyssomnia gradually decreased. CONCLUSIONS The provision of a rational-emotive-behaviour-therapy-based self-management programme that involves lectures, discussions, teach-backs, demonstrations and posters explaining diet choices improves the self-efficacy and self-care of patients receiving renal dialysis. RELEVANCE TO CLINICAL PRACTICE Rational-emotive-behaviour-therapy-based self-management programmes can be used in clinical nursing sites to improve the self-efficacy and self-care of early renal dialysis patients.
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Pilot test of brief instructions to improve the self-management of general food cravings.
Chapman, J, Zientara, J, Wilson, C
Eating behaviors. 2018;:88-92
Abstract
OBJECTIVE To provide a preliminary investigation into the impact of brief online acceptance-based vs. control-based techniques to self-manage food cravings in women. METHOD Female participants (N = 151) were randomised to 'acceptance' or 'control' groups. Measures of general food cravings (primary outcome), and depression, anxiety and stress (secondary outcomes) were taken at baseline, two weeks and four weeks. RESULTS Linear mixed models showed a significant group × time interaction, with food cravings significantly reduced in the thought-control group compared to the acceptance group over four weeks, along with a reduction in food consumption. Levels of depression, anxiety and stress decreased over the course of the study, but did not differ by group. CONCLUSION These findings provide preliminary support for the acceptability of a minimal technique to self-manage food cravings without deleterious effects, and suggest that simple control-based techniques may be useful in non-clinical, real-world settings.
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Modern approaches to the treatment of anorexia nervosa. "The third wave" of cognitive behavioral therapy.
Starzomska, M, Wilkos, E, Kucharska, K
Psychiatria polska. 2018;(4):651-662
Abstract
Anorexia nervosa (AN) is being considered one of the most difficult mental disorders to treat. The ego-syntonic nature of this mental disorder makes patients particularly reluctant to engage in or consent to treatment with relatively high drop-out rate. For all these reasons the treatment often takes a very long time, and the illness progresses to the chronic form, increasing the suffering of patients. Researchers have been discussing for many years how to provide these patients with measurable aid. Recent years have seen the emergence of arange of new treatment methods for eating disorders, including AN, that provide evidence of their effectiveness, especially in adults. Among them, of special note are those belonging to the third wave of cognitive therapy, mostly offered in the form of training programs. They are discussed in this paper in conjunction with evidence based therapy. This knowledge may help clinicians to decide how to complement traditional forms of treatment in outpatient and inpatient settings.
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Comparison of multiple interventions for older adults with Alzheimer disease or mild cognitive impairment: A PRISMA-compliant network meta-analysis.
Liang, JH, Xu, Y, Lin, L, Jia, RX, Zhang, HB, Hang, L
Medicine. 2018;(20):e10744
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Abstract
BACKGROUND The increasing prevalence of Alzheimer disease (AD) emphasizes the need for effective treatments. Both pharmacological therapies such as nutrition therapy (NT) and nonpharmacologic therapies including traditional treatment or personalized treatment (e.g., physical exercise, music therapy, computerized cognitive training) have been approved for the treatment of AD or mild cognitive impairment (MCI) in numerous areas. METHODS The aim of this study was to compare 4 types of interventions, physical exercise (PE), music therapy (MT), computerized cognitive training (CCT), and NT, in older adults with mild to moderate AD or MCI and identify the most effective intervention for their cognitive function. We used a system of search strategies to identify relevant studies and include randomized controlled trials (RCTs), placebo-controlled trials evaluating the efficacy and safety of 4 interventions in patients with AD or MCI. We updated the relevant studies which were published before March 2017 as a full-text article. Using Bayesian network meta-analysis (NMA), we ranked cognitive ability based objectively on Mini-Mental State Examination (MMSE), and assessed neuropsychiatric symptoms based on Neuropsychiatric Inventory (NPI). Pairwise and network meta-analyses were sequentially performed for efficacy and safety of intervention compared to control group through RCTs included. RESULTS We included 17 RCTs. Fifteen trials (n = 1747) were pooled for cognition and no obvious heterogeneity was found (I = 21.7%, P = .212) in NMA, the mean difference (MD) of PE (MD = 2.1, confidence interval [CI]: 0.44-3.8) revealed that PE was significantly efficacious in the treatment group in terms of MMSE. Five trials (n = 660) assessed neuropsychiatric symptoms with an obvious heterogeneity (I = 61.6%, P = .034), the MD of CCT (MD = -7.7, CI: -14 to -2.4), revealing that CCT was significantly efficacious in NPI. CONCLUSIONS As the first NMA comparing different interventions for AD and MCI, our study suggests that PE and CCT might have a significant improvement in cognition and neuropsychiatric symptoms respectively. Moreover, nonpharmacological therapies might be better than pharmacological therapies.
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Intervention for childhood obesity based on parents only or parents and child compared with follow-up alone.
Yackobovitch-Gavan, M, Wolf Linhard, D, Nagelberg, N, Poraz, I, Shalitin, S, Phillip, M, Meyerovitch, J
Pediatric obesity. 2018;(11):647-655
Abstract
OBJECTIVES The study aims to assess the effects of family-based interventions targeted to parents only or to parents-and-child for the prevention and treatment of childhood obesity. METHOD An open-label randomized study was conducted in 247 children (166 girls, 5-11 years) with body mass index (BMI) in the 85-98th percentile. Participants were allocated to three groups: parents-only (n = 89), parents-and-child (n = 84) and follow-up alone (n = 74). The intervention consisted of 12 once-weekly meetings with a dietician and psychologist. All children were followed for 2 years. Changes in anthropometric, clinical and lifestyle outcomes were assessed. RESULTS The 3-month intervention was completed by 58 (65.2%) in the parents-only, 61 (72.6%) in the parents-child and 49 (66.2%) in the control group (P = .554). BMI-standard deviation score (SDS) decreased from baseline to 3 months in both intervention groups (parents-only: from 1.74 ± 0.31 to 1.66 ± 0.36, P < .001; parents-child, 1.83 ± 0.33 to 1.76 ± 0.36, P = .012), with no significant change in the controls (1.73 ± 0.32 to 1.70 ± 0.31, P = .301). The 2-year follow-up was completed by 45 in each of the intervention groups (50.5% and 53.5%, respectively) and 37 controls (50%) (P = .896). Compared with baseline, only the parents-child group showed a significant decrease in BMI-SDS (1.56 ± 0.46, P = .006). The rate of children who met the criteria for metabolic syndrome tended to drop from 6.0% at baseline (14/232) to 1.5% at 3 months (12/137) (P = .109), with no significant between-group differences in the rate of metabolic syndrome at baseline or at completion of the intervention. CONCLUSIONS An intervention programme that focuses on both parents and children was found to have positive short-term and long-term effects on BMI-SDS.
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Treatment of premenstrual syndrome: Appraising the effectiveness of cognitive behavioral therapy in addition to calcium supplement plus vitamin D.
Karimi, Z, Dehkordi, MA, Alipour, A, Mohtashami, T
PsyCh journal. 2018;(1):41-50
Abstract
Premenstrual syndrome (PMS) consists of repetitious physical and psychological symptoms. The symptoms occur during the luteal phase of the menstrual period and cease when the menstrual period starts. This study included pre-test and post-test experiments between a control group and a test group. The statistical population involved 40 females, chosen based on multistage cluster sampling. The participants were then divided into four groups to undergo treatment with calcium supplement plus vitamin D together with cognitive behavioral therapy (CBT), and were screened with the Premenstrual Syndrome Screening Test (PSST). The pre-test and post-test scores in the PSST, the General Health Questionnaire (GHQ-28), and Bell's Adjustment Inventory (BAI) were used as assessment tools (p < .05). According to the parameters of PMS symptoms, when evaluating the pre-test and post-test scores, the overall score of each individual in the experimental group was improved and a significant effect for the combination of calcium supplement plus vitamin D together with CBT was observed in comparison to the post-test control group. A comparison of multivariate analysis of covariance (MANCOVA) results collected from the pre-test and post-test scores revealed that the method of treatment was beneficial for PMS, adjustment, and general health.