The impact of rehabilitative interventions on quality of life: a qualitative evidence synthesis of personal experiences of individuals with amyotrophic lateral sclerosis

Background

The nature of amyotrophic lateral sclerosis (ALS) is progressive and degenerative, thus influencing individuals physically, emotionally, and socially. A broad review of qualitative studies that describe the personal experiences of people with ALS with physiotherapy, occupational therapy and speech and language pathology interventions, and how those affect QoL is warranted.

Purpose

This study synthesizes qualitative research regarding the potential that rehabilitation interventions have to maintain and/or improve QoL from the perspective of people with ALS.

Methods

The SPIDER search strategy was applied and five articles met inclusion criteria addressing the perceived impact of rehabilitation on QoL for individuals with ALS.

Results

Four themes emerged: the concept of control; adapting interventions to disease stage; struggles with interventions; and barriers between healthcare providers and patients.

Conclusions

Rehabilitation interventions were perceived to have potential to support QoL by people with ALS. Advantages and limitations of rehabilitation services within this population were identified.

     

Resilienzförderung

Background

Nearly every second person suffers from mental illness at some point in their life. In this regard, stress-induced illnesses play a central role. Stress cannot be avoided; thus, interventions that promote resilience in the face of stress are particularly significant.

Objective

The paper gives a short overview of the current status quo in the development of evidence-based resilience interventions.

Materials and methods

The chosen method is a narrative review that takes into account papers with relational resilience constructs such as concept analysis, systematic reviews, and empirical studies of international resilience research.

Results

Currently, the main challenge for program developers is to identify valid protective factors within resilience research which match the target and target group of a special intervention.

Conclusion

There is a need for systematic reviews to systematize heterogeneous resilience studies. Based on such reviews, the selection of protective factors that should be promoted in an intervention can be justified.

     

Perceived benefits of the hepatitis C peer educators: a qualitative investigation

Background

Although opioid-dependent patients are disproportionately impacted by hepatitis C (HCV), many do not receive treatment. In addition to HCV treatment-access barriers, substance-using patients may be reluctant to pursue treatment because of wariness of the medical system, lack of knowledge, or stigma related to HCV treatment. Implementation of a formal peer education program is one model of reducing provider- and patient-level barriers to HCV treatment, by enhancing mutual trust and reducing stigma.

Methods

We used thematic qualitative analysis to explore how 30 HCV patients and peer educators perceived a HCV peer program within an established methadone maintenance program in the USA.

Results

Participants unanimously described the program as beneficial. Participants described the peer educators’ normalization and dispelling of myths and fears around HCV treatment, and their exemplification of HCV treatment success, and reductions in perceived stigma. Peer educators described personal benefits.

Conclusions

These findings indicate that HCV peer educators can enhance HCV treatment initiation and engagement within opioid substitution programs.

     

Suicide Prevention Among High School Students: Evaluation of a Nonrandomized Trial of a Multi-stage Suicide Screening Program

Background

Suicide is a leading cause of death among youth. Suicide screening programs aim to identify mental health issues and prevent death by suicide.

Objective

The present study evaluated outcomes of a multi-stage screening program implemented over 3 school years in a moderately-sized Midwestern high school.

Methods

One hundred ninety-three 9th-grade students were screened in the program. Students who screened positive were referred to mental health services and followed. Suicide-related thoughts and behaviors among 9th-grade students in the school with screening were compared to those of students in a similar school without screening.

Results

There was a significant increase in utilization of mental health services among students who screened positive and a decrease in rates of suicidal ideation and attempts among 9th-grade students at the school with screening.

Conclusions

This multi-stage screening program shows promise in addressing suicide-related behaviors in schools. Randomized trials are needed to confirm program efficacy.

     

Clarifying questions about “risk factors”: predictors versus explanation

Background

In biomedical research much effort is thought to be wasted. Recommendations for improvement have largely focused on processes and procedures. Here, we additionally suggest less ambiguity concerning the questions addressed.

Methods

We clarify the distinction between two conflated concepts, prediction and explanation, both encompassed by the term “risk factor”, and give methods and presentation appropriate for each.

Results

Risk prediction studies use statistical techniques to generate contextually specific data-driven models requiring a representative sample that identify people at risk of health conditions efficiently (target populations for interventions). Risk prediction studies do not necessarily include causes (targets of intervention), but may include cheap and easy to measure surrogates or biomarkers of causes. Explanatory studies, ideally embedded within an informative model of reality, assess the role of causal factors which if targeted for interventions, are likely to improve outcomes. Predictive models allow identification of people or populations at elevated disease risk enabling targeting of proven interventions acting on causal factors. Explanatory models allow identification of causal factors to target across populations to prevent disease.

Conclusion

Ensuring a clear match of question to methods and interpretation will reduce research waste due to misinterpretation.

     

Peer-delivered harm reduction and recovery support services: initial evaluation from a hybrid recovery community drop-in center and syringe exchange program

Background

Recovery from substance use disorder (SUD) is often considered at odds with harm reduction strategies. More recently, harm reduction has been categorized as both a pathway to recovery and a series of services to reduce the harmful consequences of substance use. Peer recovery support services (PRSS) are effective in improving SUD outcomes, as well as improving the engagement and effectiveness of harm reduction programs.

Methods

This study provides an initial evaluation of a hybrid recovery community organization providing PRSS as well as peer-based harm reduction services via a syringe exchange program. Administrative data collected during normal operations of the Missouri Network for Opiate Reform and Recovery were analyzed using Pearson chi-square tests and Monte Carlo chi-square tests.

Results

Intravenous substance-using participants (N?=?417) had an average of 2.14 engagements (SD?=?2.59) with the program. Over the evaluation period, a range of 5345–8995 sterile syringes were provided, with a range of 600–1530 used syringes collected. Participant housing status, criminal justice status, and previous health diagnosis were all significantly related to whether they had multiple engagements.

Conclusions

Results suggest that recovery community organizations are well situated and staffed to also provide harm reduction services, such as syringe exchange programs. Given the relationship between engagement and participant housing, criminal justice status, and previous health diagnosis, recommendations for service delivery include additional education and outreach for homeless, justice-involved, LatinX, and LGBTQ+ identifying individuals.

     

Defining rehabilitation success in older adults with dementia–results from an inpatient geriatric rehabilitation unit

Objective

To quantify the magnitude of functional recovery in older adults with and without dementia admitted to an inpatient geriatric rehabilitation program by measuring change in measures of global physical function and physical therapy treatment outcomes.

Design

Retrospective cohort study.

Setting

Rehabilitation academic hospital.

Participants

Consecutive subjects, with (N=65, age 81.9±6.0 y) and without (N=157, age 82.8±7.2 y) a dementia diagnosis, had assessment data at admission and discharge from inpatient geriatric rehabilitation unit.

Interventions

Not applicable.

Measurements

The Functional Independence Measure (FIM) was used to estimate level of independence on activities of daily living. The Berg Balance Scale (BBS), Timed Up & Go Test (TUG) and 2 Minute Walk Test (2MWT) were used to estimate functional mobility and endurance. The FIM (total, motor subscale, cognitive subscale scores) were used to calculate rehabilitation efficacy and efficiency scores.

Results

After controlling for confounding, there was no group difference for gains on the BBS, TUG, 2MWT; there was no group difference on rehabilitation efficacy and efficiency values based on the FIM motor subscale. The magnitude of the rehabilitation gain using the total FIM score was statistically different between groups, people with dementia having smaller gains.

Conclusion

Older adults with a diagnosis of dementia are capable of making motor function recovery during inpatient sub-acute rehabilitation comparable to their peers without a dementia diagnosis. The metric used to evaluate functional recovery influences the determination of rehabilitation success between groups. Rehabilitation success should be defined among people with a dementia diagnosis by a change in the motor subscale of the FIM, rather than the total FIM score or the gain relative to the maximal FIM score.

     

Herausforderungen von Präventionsarbeit an Grundschulen

Background

There is relatively little research investigating prevention activities at schools and how these interventions are conducted and implemented in the school setting. Therefore, the aim of the study was to investigate prevention activities and to assess factors that affect the implementation process in the setting of primary schools in Thuringia, Germany.

Methods

In total, 164 principals and 106 teachers and pedagogical staff participated in the survey. Besides assessing the preventive interventions at primary schools, we investigated factors that are associated with implementation success such as characteristics of the programm itself and fidelity, characteristics of the program providers and the principals, and the school setting.

Results

Most of the schools conducted prevention programs, but there was a high diversity of interventions. With regard to the implementation factors, we found a positive attitude toward the prevention programs, but most of the programs were modified to fit the needs of the school setting. Furthermore, especially the characteristics of the school setting (e.g. time, money) were criticized.

Conclusions

Although most of the schools conducted prevention programs, more attention should be paid to the transfer of evaluated preventive interventions with long-term effects to the school setting. Furthermore, the implementation of successful prevention programs within the community care system is needed.

     

Effect of a 6-month brisk walking program on walking endurance in sedentary and physically deconditioned women aged 60 or older: A randomized trial

Background

Walking endurance is a predictor of healthy ageing.

Objective

To examine if a 6-month brisk walking program can increase walking endurance in sedentary and physically deconditioned older women.

Trial design

Randomized controlled trial.

Setting

Women recruited from public meetings aimed at promoting physical activity in women aged 60 or older.

Subjects

121 women aged 65.7 ± 4.3 years, with sedentary lifestyle (Physical Activity Questionnaire for the Elderly score < 9.4), and a 6-minute walking distance (6MWD) below normal value based on their gender, age, and body weight, and weight.

Methods

Women were randomly assigned to a 150 min/week brisk walking program (two supervised sessions and one session on their own per week) for six months (exercisers) (n=61) or a control group with physical activity allowed freely (n=60).

Outcome

The primary outcome was relative change in 6MWD.

Results

54/61 exercisers and 55/60 control subjects completed the program and data analysis was possible for 51 exercisers and 47 controls. At baseline, 6MWD was on average 23.1% and 22.5% below age-matched norms in exercisers and controls, respectively. Attendance rate for supervised sessions was 92% in exercisers. The 6MWD increased more significantly in exercisers than in controls (mean increase of 41.5% vs 11.0 %; p<0.0001). Over the 6-month program, 38 exercisers (74.5%) vs 5 controls (10.6%) had a 6MWD over the age-matched norm (p<0.0001). Exercisers with the highest tertile of 6MWD improvement (>46%) were those with baseline lowest values of 6MWD (p=0.001) and highest values of body mass index (BMI) (p<0.01).

Conclusion

Present results support recommendation that brisk walking programs should be encouraged to improve walking endurance in physically deconditioned women aged 60 or older, especially in those with high BMI.

     

Barriers and enablers in the use of respite interventions by caregivers of people with dementia: an integrative review

Background

Due to the increase in the number of people with dementia, relatives often provide in-home care. This care constitutes a cornerstone of the healthcare system, and maintaining these caregivers’ well-being is therefore of paramount importance. Although respite interventions are generally considered an effective support system, they tend to be underutilized. The aim of this integrative literature review is to highlight the factors that promote and impede the use of respite interventions.

Methods

Searches were conducted on the PubMed and CINAHL databases for studies of respite interventions from 1980 to 2016, and they yielded 51 articles of relevance.

Results

Analysis of these articles revealed modifiable and immutable factors that influence the use of respite. The most cited topic categories in the literature were attributes of respite services and workload managed by caregivers, which is characterized by the onset of burden.

Conclusion

The factors promoting or impeding the use of respite interventions identified by our analysis highlight the need to adapt respite service attributes and use caregivers’ skills to foster the partnership between healthcare teams and caregivers and to ensure the accompanying dyad’s quality and safety.

     

Interventions for Young Bereaved Children: A Systematic Review and Implications for School Mental Health Providers

Background

Many young children experience the death of a family member and they may be at risk for developing psychological and behavioral problems, but not much is known about how to help young children cope with such a stressful and painful experience.

Objective

The purposes of this study are to identify the interventions for bereaved young children and examine the effectiveness of the interventions.

Methods

A systematic review of the literature was performed to investigate the effects of interventions for preschool-age children (3–5 years) who experience the death of a family member.

Results

Seventeen studies that met the inclusion criteria for the purpose of this review were identified. All of the studies involved a small sample, and majority of the studies mixed preschool children with other older children in the sample. Play-based therapies were the most common interventions for grieving young children. Involving parents in the interventions, regardless of their therapeutic orientation, was a critical ingredient.

Conclusions

Limited empirical evidence of positive intervention outcomes for preschool-age bereaved children was available. Surviving parents were seen as an important agent to help young children grieve and cope with the experience of loss. Implications for school mental health practice and research are provided.

     

Cost-effectiveness analysis of the diarrhea alleviation through zinc and oral rehydration therapy (DAZT) program in rural Gujarat India: an application of the net-benefit regression framework

Background

This study evaluates the cost-effectiveness of the DAZT program for scaling up treatment of acute child diarrhea in Gujarat India using a net-benefit regression framework.

Methods

Costs were calculated from societal and caregivers’ perspectives and effectiveness was assessed in terms of coverage of zinc and both zinc and Oral Rehydration Salt. Regression models were tested in simple linear regression, with a specified set of covariates, and with a specified set of covariates and interaction terms using linear regression with endogenous treatment effects was used as the reference case.

Results

The DAZT program was cost-effective with over 95% certainty above $5.50 and $7.50 per appropriately treated child in the unadjusted and adjusted models respectively, with specifications including interaction terms being cost-effective with 85–97% certainty.

Discussion

Findings from this study should be combined with other evidence when considering decisions to scale up programs such as the DAZT program to promote the use of ORS and zinc to treat child diarrhea.

     

Prävention sexualisierter Gewalt. Zur Implementierung des IGEL-Programms in Grundschulen

Background

A large variety of interventions have been developed and implemented to prevent child sexual abuse in schools and other educational institutions. With regard to school-based prevention programs, little is known about their effectiveness and feasibility.

Objectives

The goal of this work was to identify conditions conducive to successful implementation of a school-based program for the prevention of sexual violence.

Methods

To analyze the implementation fidelity, feasibility, and acceptability of a German school-based program for the prevention of sexual violence (IGEL program), documentation sheets with prestructured contents were used, and (group) interviews with participating teachers were conducted as part of a process evaluation.

Results

The results suggest that the implementation of the IGEL program under practical everyday conditions in elementary schools could be realized as planned. The acceptance of the program by teachers and children was high. The flexibility of the program, the elaborateness of the IGEL sessions and materials, as well as the continuous offer of advice and support during the program implementation emerged as important conditions conducive to successful implementation.

Conclusions

Successful implementation of a school-based program for the prevention of sexual violence depends on various factors at different levels. On the one hand, there are specific characteristics of the program itself (e.g., practicality of the IGEL materials). On the other hand, there are characteristics of teachers and children (e.g., trust-based relationship) as well as of the school curriculum or school organization (e.g., linking of the program with the sexual education).

     

A Multilevel Model to Examine Adolescent Outcomes in Outdoor Behavioral Healthcare: The Parent Perspective

Background

Outdoor Behavioral Healthcare (OBH) has arisen to fill a gap in mental health treatment. While research shows large positive changes in adolescent self-reports, little is known about predictors of change, longitudinal outcomes, and parent-reports of change.

Objective

This study sought to identify treatment outcomes up to 18 months post-discharge and predictors of change for parents of adolescent clients in OBH treatment.

Methods

Parents of 659 adolescents from four OBH programs were invited to complete questionnaires at intake, discharge, and 6 and 18 months post-discharge. A regression was conducted to examine change during treatment, and a multilevel model to examine trajectories of change post-treatment.

Results

OBH participants entered treatment with clinically significant levels of emotional and behavioral dysfunction, made significant change during the program, and discharged within the “normal” range of functioning. Post-discharge scores indicated that clients remained in the “normal” range of functioning 6 and 18 months post-discharge. The regression analysis found that parent intake scores and attachment disorders were predictive of in-treatment change. The MLM found that parent perceptions of treatment gains and adoption status were significant predictors of functioning post-discharge.

Conclusions

Results are in-line with previous research suggesting that OBH may be helpful to adolescents experiencing a wide range of presenting problems, and adds new insights as well. Parent-reports parallel the dramatic changes in adolescent self-reports documented throughout OBH literature; data up to 18 months post-treatment shows healthy functioning per the parent perspective; and adoption and attachment appear to play a role in outcome trajectories.

     

Single-arm resistance training study to determine the relationship between training outcomes and muscle growth factor mRNAs in older adults consuming numerous medications and supplements

Objectives

Determine if the muscle mRNA levels of three growth factors (insulin-like growth factor-1 [IGF1], ciliary neurotropic factor [CNTF], and vascular endothelial growth factor-D [VEGFD]) are correlated with muscle size and strength gains from resistance exercise while piloting a training program in older adults taking medications and supplements for age-associated problems.

Design

Single-arm prospective study.

Setting

US Veterans Affairs hospital.

Participants

Older (70±6 yrs) male Veterans (N=14) of US military service.

Intervention

Thirty-five sessions of high-intensity (80% one-rep max) resistance training including leg press, knee curl, and knee extension to target the thigh muscles.

Measurements

Vastus lateralis biopsies were collected and body composition (DEXA) was determined pre- and post-training. Simple Pearson correlations were used to compare training outcomes to growth factor mRNA levels and other independent variables such as medication and supplement use.

Results

Average strength increase for the group was ≥ 25% for each exercise. Subjects averaged taking numerous medications (N=5±3) and supplements (N=2±2). Of the growth factors, a significant correlation (R>0.7, P≤0.003) was only found between pre-training VEGFD and gains in lean thigh mass and extension strength. Mass and strength gains were also correlated with use of α-1 antagonists (R=0.55, P=0.04) and pre-training lean mass (R=0.56, P=0.04), respectively.

Conclusions

Muscle VEGFD, muscle mass, and use of α-1 antagonists may be predisposing factors that influence the response to training in this population of older adults but additional investigation is required to determine if these relationships are due to muscle angiogenesis and blood supply.