The Effect of Using PARO for People Living With Dementia and Chronic Pain: A Pilot Randomized Controlled Trial

ObjectivesTo evaluate the effect of interaction with a robotic seal (PARO) on pain and behavioral and psychological symptoms of people with dementia and chronic pain.DesignA parallel pilot randomized controlled trial conducted between January 2018 and January 2019.SettingThree long-term care facilities in Australia.ParticipantsForty-three participants aged ≥65 years living with dementia and chronic pain.InterventionParticipants were randomized to the PARO group (individual, nonfacilitated, 30-minute sessions, 5 days per week for 6 weeks) or a usual care group using a computer-generated random number.MeasurementsThe primary outcome was researcher-rated observational pain behaviors before and after each session. Secondary outcomes were staff-rated pain level, agitation, depression, and anxiety measured at baseline and the end of week 6. Medications regularly prescribed and as needed were recorded weekly. Analyses followed intention-to-treat, using the generalized estimating equation model. Australian New Zealand Clinical Trials Registry (ACTRN12618000082202).ResultsParticipants in the PARO group had a significantly lowered level of observed pain [−0.514, 95% confidence interval (CI) −0.774 to −0.254, P < .001] and used fewer pro re nata medications (−1.175, 95% CI −2.205 to −0.145, P = .025) than those in usual care after controlling for age, sex, cognitive function and medications. There were no significant differences in staff-rated pain, agitation, anxiety, and depression, nor regularly scheduled medications between intervention and control group.Conclusions and ImplicationsPARO shows promise in reducing pain and medications for individuals with dementia and chronic pain in long-term care facilities. This intervention might be incorporated into daily practice as an alternative to manage pain in people with dementia. Larger randomized controlled trials with longer time frames are needed to identify further and test the use of PARO in long-term care settings.     

Stress reduction intervention with mothers of children/adolescents with asthma: a randomized controlled study in Brazil

Abstract

Brazil has a high prevalence of pediatric asthma, which can be a stressor to parents/caretakers. Researchers aimed to assesses the efficacy of a stress reduction intervention for mothers of children/adolescents with asthma through a randomized controlled study. Stress, anxiety, and depression were evaluated in three moments. The intervention group (n?=?20), entailed 5-weekly sessions; the control group (n?=34) had waiting list format. There was a significant decrease in stress, anxiety, and depression in the intervention group. This study indicates that the intervention directed to mothers of children/adolescents with asthma was efficient not only in reducing stress but also anxiety and depression reduction.     

Reduction of Depressive Symptoms in an Elderly Mexican‐American Female with Type 2 Diabetes Mellitus: A Single‐Subject Study

The purpose of this study was to determine if occupation‐based activities improve diabetes self‐management and reduce depressive symptoms in an elderly Mexican‐American woman with type 2 diabetes mellitus (T2DM). There have been no known studies showing occupational therapy's role in self‐care management of T2DM in people with depressive symptoms. The individual in this single‐subject research was evaluated using glycosylated haemoglobin blood tests, four self‐reported standardized questionnaires, participant reflective logs and clinical observations following an 8‐week intervention. The participant improved on all measures, which were sustained 1 month after treatment ended. Clinical implications highlight a new role for occupational therapists providing early intervention in people with diabetes and depression for secondary prevention of complications of uncontrolled diabetes. Research suggestions include multiple single‐subject studies showing occupational therapy contributions. Copyright © 2012 John Wiley & Sons, Ltd.     

Effects of Dynavision Training as a Preparatory Intervention Status Postcerebrovascular Accident: A Case Report

ABSTRACT

Objective. This is a case study of a 67-year-old woman, status post right hemispheric ischemic lesion cerebrovascular accident (CVA), and her use of Dynavision training as a preparatory intervention to determine its influence on her performance skills and perceived occupational performance. Method. The participant engaged in 6 weeks of Dynavision intervention, 3 days per week. The participant was evaluated using a broad battery of assessments at pretest and posttest. Outcome measures included the Action Research Arm Test (ARAT), Canadian Occupational Performance Measure (COPM), and goniometric active range of motion (AROM) measurements for the upper extremity. Standing activity tolerance during engagement in occupations also was assessed. A qualitative interview was employed to ascertain the participant's perceptions of how Dynavision training influenced her performance in activities of daily living (ADL) and instrumental activities of daily living (IADL). Results. Improvements in performance skills, perceived occupational performance, and perceived satisfaction with engagement in occupation were noted. The participant demonstrated improved AROM, functional activity tolerance, and greater awareness of the neglected side. Qualitative interviews revealed that the participant's satisfaction and confidence with ADL and IADL tasks improved at the time of posttest. Conclusion. Data suggest positive effects of Dynavision intervention when used with an individual status post-CVA.     

Quality of life of community-residing persons with dementia based on self-rated and caregiver-rated measures

Purpose

To identify correlates of self-rated and caregiver-rated quality of life (QOL) in community-residing persons with dementia (PWD) for intervention development.

Methods

Cross-sectional data of 254 PWD and their caregivers participating in a clinical trial were derived from in-home assessments. Self-rated QOL was measured with the Quality of Life-Alzheimer Disease (QOL-AD) scale, and caregiver-rated QOL was measured using the QOL-AD and Alzheimer Disease-Related Quality of Life (ADRQL) scales. Multivariate modeling identified correlates of the PWD?? QOL.

Results

Self-rated QOL was related significantly to participant race, unmet needs, depression, and total medications. Caregiver-rated QOL-AD scores were significantly associated with participant function, unmet needs, depression, and health problems and with caregiver burden and self-rated health. Significant correlates of ADRQL scores included neuropsychiatric symptom severity, functional and cognitive impairment, and caregiver burden and depression.

Conclusions

Correlates of QOL in community-residing PWD depend on who rates the PWD??s QOL and which measure is used. Addressing health problems, medication use, and dementia-related unmet needs, reducing functional dependency, and treating neuropsychiatric symptoms in PWD, while reducing caregiver burden and depression, may maximize QOL in those with dementia.     

Promoting physical activity in an adolescent and a young adult with physical disabilities

BackgroundWe sought to describe the design of the Active Lifestyle and Sports Participation (ALSP) intervention for adolescents and young adults with physical disabilities, and to present the first 2 cases.MethodsA 17-year-old boy with myelomeningocele and hydrocephalus and a 23-year-old woman with unilateral cerebral palsy were enrolled into the ALSP intervention, a personalized intervention designed to improve physical activity and fitness levels. Main outcome measures were self-reported physical activity and aerobic fitness. Fitness was determined by submaximal 6-minute walk or wheel test and by maximal cycle or arm ergometer-exercise test. Participants rated satisfaction with the intervention on a Likert-type numeric scale from 1 to 10.ResultsImprovements in self-reported physical activity were 51% and 75% for the male and female participant, respectively. Respective improvements in submaximal exercise were 16% and 9%. Maximal exercise increased 39% in the male participant but did not increase in the female participant. Satisfaction with the intervention was rated moderate-good to excellent.ConclusionData for the first 2 cases suggested that ALSP intervention seemed feasible to offer in an outpatient rehabilitation department, and the effectiveness may be promising. Future studies should determine the short- and long-term effectiveness of the intervention.     

Enhanced Medical Rehabilitation Increases Therapy Intensity and Engagement and Improves Functional Outcomes in Postacute Rehabilitation of Older Adults: A Randomized-Controlled Trial

ObjectivesFor millions of disabled older adults each year, postacute care in skilled nursing facilities is a brief window of opportunity to regain enough function to return home and live independently. Too often this goal is not achieved, possibly because of therapy that is inadequately intense or engaging. This study tested Enhanced Medical Rehabilitation, an intervention designed to increase patient engagement in, and intensity of, daily physical and occupational therapy sessions in postacute-care rehabilitation.DesignRandomized controlled trial of Enhanced Medical Rehabilitation versus standard-of-care rehabilitation.SettingPostacute care unit of a skilled nursing facility in St Louis, MO.ParticipantsTwenty-six older adults admitted from a hospital for postacute rehabilitation.InterventionBased on models of motivation and behavior change, Enhanced Medical Rehabilitation is a set of behavioral skills for physical and occupational therapists that increase patient engagement and intensity, with the goal of improving functional outcome, through (1) a patient-directed, interactive approach, (2) increased rehabilitation intensity, and (3) frequent feedback to patients on their effort and progress.MeasurementsTherapy intensity: assessment of patient active time in therapy sessions. Therapy engagement: Rehabilitation Participation Scale. Functional and performance outcomes: Barthel Index, gait speed, and 6-minute walk.ResultsParticipants randomized to Enhanced Medical Rehabilitation had higher intensity therapy and were more engaged in their rehabilitation sessions; they had more improvement in gait speed (improving from 0.08 to 0.38 m/s versus 0.08 to 0.22 in standard of care, P = .003) and 6-minute walk (from 73 to 266 feet versus 40 to 94 feet in standard of care, P = .026), with a trend for better improvement of Barthel Index (+43 points versus 26 points in standard of care, P = .087), compared with participants randomized to standard-of-care rehabilitation.ConclusionHigher intensity and patient engagement in the postacute rehabilitation setting is achievable, with resultant better functional outcomes for older adults. Findings should be confirmed in a larger randomized controlled trial.     

Oral Motor Feeding in the Neonatal Intensive Care Unit: Exploring Perceptions of Parents and Occupational Therapists

The purpose of this qualitative study was to explore the perceptions of three occupational therapists and three parents regarding occupational therapy services provided in the neonatal intensive care unit. Data were obtained through participant interviews. Role of the occupational therapist, parent training, and time spent with parents were themes that emerged from the therapist interviews. Themes from the parent interviews included occupational therapy intervention and treatment, time spent with occupational therapist, and perceptions. A cross-case analysis addressed two common themes: amount of time spent in parent training and perceptions of training provided. Implications for occupational therapy practice in the neonatal intensive care unit are discussed.     

High intensity resistance training improves sleep quality and anxiety in individuals who screen positive for posttraumatic stress disorder: A randomized controlled feasibility trial

PurposePosttraumatic stress is disorder (PTSD) is a disabling psychological condition that often causes chronic sleep issues. Exercise has beneficial effects on sleep in healthy individuals. However, little is known about the effects exercise on sleep in individuals with PTSD. The purpose of this pilot study was to assess the feasibility of a resistance training intervention on sleep quality, PTSD, anxiety and depression symptoms in individuals who screened positive for PTSD.MethodsWhile blocking for gender participants were randomly assigned to either a 3-week resistance training intervention (i.e., 9 total sessions), or a time-matched attention control.ResultsA total of 22 participants were randomized into the study. The mean age was 33.0 years (SD = 13.3), 82% were women, and 77% identified as a racial minority. Over 90% of sessions were attended by both groups. Results demonstrated that the resistance training group reported significantly improved global sleep quality F(1, 16) = 12.04, p < 0.01, sleep latency F(1, 16) = 13.45, p < 0.01, and reduced anxiety F(1, 17) = 5.45, p = 0.03 relative to the control. However, PTSD and depression symptoms did not significantly differ between groups (p's > 0.05).ConclusionsThe findings of this study suggest that three weeks of high intensity resistance training can improve aspects of sleep and reduce anxiety in individuals who screen positive for PTSD. The results further support the safety, feasibility, and acceptability of resistance training for this population. These results are preliminary, and should be further verified by larger adequately powered trials.     

Effects of a hand training programme in five patients with myotonic dystrophy type 1

The aim of this study was to evaluate hand function and self-rated occupational performance before and after specific hand training in five participants with myotonic dystrophy (MD) type 1. MD is the commonest of the muscular dystrophies with adult onset and is associated with muscle weakness, wasting and myotonia. Compensatory techniques and strategies are mostly offered as the only intervention therapy. In the present study, the participants were their own controls using pre- and post-test measures. Each participant was tested at intervals a total of nine times before and nine times after hand training. A hand-held myometer (Microfet2), Grippit, Purdue Pegboard and self-rated myotonia were used as outcome measures. Occupational performance was assessed pre- and post-test using the Canadian Occupational Performance Measurement (COPM) in which the participants rated their own performance and satisfaction in five self-chosen occupational performance areas. The participants performed hand training for a total of three months, three times per week using a specific resistance training programme including Theraputty, a silicone-based putty. Hand function was significantly increased and a positive change in self-rated occupational performance was noted after the training period. This study indicates that hand training has a positive effect on hand function, i.e. motor function and occupational performance. The present results need to be replicated in a controlled study including a larger number of patients and over a longer period of time.     

Impact of STAR-VA on Staff Injury and Disruptive Behavior Reports in VA Nursing Homes

ObjectivesWorkplace disruptive behavior incidents can be costly for organizations, employees, and customers. Persons with dementia living in long-term care settings have a high risk of exhibiting distressed behaviors. We examined whether a resident-centered, behavioral intervention for residents with dementia led to a reduction in reported workplace disruptive behaviors and staff injury rate due to assault. Impactful interventions are important for quality of care.DesignWe examined whether a team-based behavioral program in community living centers (CLCs), where a nurse champion and behavioral coordinator were trained to work with the clinical team to understand and manage distressed behaviors commonly associated with dementia, was associated with reductions in behavior incidents.Setting and ParticipantsThe setting was Veterans Health Administration CLCs. The sample consisted of 120 aggregated CLCs operating between 2012 and 2017 with 62 completing training. CLCs were distributed across the United States.MethodsOutcomes included CLC-level rates of staff injury and number of workplace disruptive behavior incidents. Outcomes were regressed on measures of intervention completion, time since intervention, and several CLC characteristics.ResultsThe intervention was significantly associated with lower incidence of assault with staff injury rates overall, particularly following the first year of training, but not with other reported workplace disruptive behavior incident rates.Conclusions and ImplicationsA team-based behavioral intervention was associated with reduction of employee assaults, a critical repercussion of distressed behavior in dementia. Given rapid growth in patients with dementia in nursing homes, effective treatment practices, such as interdisciplinary behavioral management approaches may be impactful and valuable to implement.     

Orthostatic Hypotension is a Risk Factor for Falls Among Older Adults: 3-Year Follow-Up

ObjectivesTo assess the prevalence of orthostatic hypotension (OH) and the association of OH with the risk of falls among community-dwelling older adults with a previous fall.DesignLongitudinal study.Setting and ParticipantsThe subjects (n = 561) were participants in fall prevention conducted in western Finland.MethodsBlood pressure (BP) was measured in supine position and at 30 seconds and 3 minutes after standing. The participants were divided according to the consensus definition to an OH group (OHG) and a non-OH group (non-OHG). Falls were recorded by fall diaries during 12 months. Falls requiring treatment were gathered from health center and hospital registers during 12 and 36 months.ResultsThe prevalence of OH was 23.4% (30 seconds) and 7.3% (3 minutes). The 30-second measurement showed that the incidence of falls and that of falls requiring treatment were significantly higher in OHG compared with non-OHG during 12 months. After adjustments, the incidence of falls remained higher in all 5 adjusted models whereas that of falls requiring treatment remained higher only after adjustment for functional balance. The 3-minute measurement showed that the incidence of falls was higher in OHG compared with non-OHG during 12 months and remained higher after adjustments for functional balance and for age and functional balance. During the 36-month follow-up, OH measured at 30 seconds or 3 minutes after standing was not associated with the occurrence of falls leading to treatment.Conclusions and ImplicationsOH at 30 seconds or 3 minutes after standing is associated with a greater risk for falling within 12 months in older adults. The 30-second blood pressure measurement is more reliable to detect the risk than the 3-minute measurement. The results support the usability of 30-second measurement in determining OH and the risk for falling among older persons.     

Working conditions,psychosocial environmental factors,and depressive symptoms among wage workers in South Korea

Background: In South Korea, the number of workers suffering from mental illnesses, such as depression, has rapidly increased. There is growing concern about depressive symptoms being associated with both working conditions and psychosocial environmental factors.

Objectives: To investigate potential psychosocial environmental moderators in the relationship between working conditions and occupational depressive symptoms among wage workers.

Methods: Data were obtained from the wage worker respondents (n = 4,095) of the Korean National Health and Nutrition Examination Survey of 2009. First, chi-square tests confirmed the differences in working conditions and psychosocial characteristics between depressive and non-depressive groups. Second, multivariate logistic regression analysis was performed to examine the moderating effects of the psychosocial environmental factors between working conditions and depressive symptoms.

Results: After adjusting for potential covariates, the likelihood of depressive symptomatology was high among respondents who had dangerous jobs and flexible work hours compared to those who had standard jobs and fixed daytime work hours (OR = 1.66 and 1.59, respectively). Regarding psychosocial factors, respondents with high job demands, low job control, and low social support were more likely to have depressive symptoms (OR = 1.26, 1.58 and 1.61, respectively).

Conclusions: There is a need to develop non-occupational intervention programs, which provide workers with training about workplace depression and improve social support, and the programs should provide time for employees to have active communication. Additionally, companies should provide employees with support to access mental healthcare thereby decreasing the occurrence of workplace depression.     

Workplace exercise intervention to prevent depression: A pilot randomized controlled trial

ObjectiveThis study evaluates whether it is feasible to deliver an exercise program to inactive employees with minimal symptoms of depression, and the size of effects on the mental and physical health of employees.MethodIn the fall of 2008, 30 white-collar employees with minimal symptoms of depression (5 ≤ PHQ-9 ≤ 9) were randomly assigned to a 10-week in-company fitness program with two supervised training sessions per week or to a control group. Demographics, depression scores, and exercise behavior were determined by questionnaire, physical health variables were measured and company records were checked to calculate sickness absence data. Participants were measured at baseline and 10 weeks after (post-test).ResultsANCOVA showed that the difference between the groups on the average change in depression from baseline to post-test approached significance. Eighty-six percent of the participants in the exercise group were below the cut-off point for experiencing minimal symptoms of depression, compared with 31% of the control participants. Most physical measures improved significantly from baseline to post-test in the exercise group compared to the control group. The difference between the groups on average change in sickness absence was not significant.ConclusionsThis intervention was feasible and shows that exercise can reduce the risk of depression in employees with sedentary jobs, an inactive lifestyle, and a high-risk of depression. A large randomized controlled trial with a long-term follow-up is needed to establish the effectiveness and cost-effectiveness of exercise in the prevention of depression in a workplace setting.     

Response and Adherence of Nursing Home Residents to a Nutrition/Exercise Intervention

ObjectivesInterindividual response variability to nutrition and exercise interventions is extensive in older adults. A group of nursing home (NH) residents participated in a combined intervention. The objective of this post-hoc analysis was to identify factors associated with intervention response measured by change in physical function and body composition.DesignPost-hoc analyses in the Older Person's Exercise and Nutrition study, a 2-arm randomized trial. The primary outcomes were 30-second Chair Stand Test and composite scores combining physical function and fat-free mass. A secondary outcome was intervention adherence. A 12-week intervention of sit-to-stand exercises and protein-rich nutritional supplements did not improve chair-stand capacity vs control on intention-to-treat basis.Setting and ParticipantsResidents ≥75 years of age from dementia and somatic units in eight NHs in Sweden.MethodsLogistic regressions were performed to define factors associated with response (maintenance/improvement) or nonresponse (deterioration) in 30-second Chair Stand Test, and with intervention adherence. Linear regressions were performed to explore factors associated with response in composite scores.ResultsMean age of participants (n = 52 intervention, n = 49 control) was 85.8 years. Sarcopenia was occurring in 74%. Sarcopenia at baseline (P = .005) and high adherence to nutritional supplements (P = .002) increased the odds of response. Higher independence in daily activities increased the odds of adherence to sit-to-stand exercises (P = .027) and the combined intervention (P = .020). Allocation to the intervention group and higher self-perceived health were associated with higher composite scores.Conclusions and ImplicationsNH residents with baseline sarcopenia, better self-perceived health, and high adherence to nutritional supplements benefitted most from a combined nutrition and exercise intervention regarding chair-stand capacity and composite scores of function and fat-free mass. Adherence was related to higher grade of independence. Understanding factors associated with response and adherence to an intervention will help target susceptible residents in most need of support and to optimize the outcome.     

Trauma-Informed Financial Empowerment Programming Improves Food Security Among Families With Young Children

ObjectiveTo determine how trauma-informed programming affects household food insecurity (HFI) over 12 months.DesignChange was assessed in HFI from baseline to 12 months in response to a single-arm cohort intervention. Measures were taken at baseline and in every quarter. Two participant groups were compared: participation in ≥4 sessions (full participation) vs participation in <4 sessions (low/no participation).SettingCommunity-based setting in Philadelphia, Pennsylvania.ParticipantsA total of 372 parents of children aged <6 years, participating in Temporary Assistance for Needy Families and the Supplemental Nutrition Assistance Program, recruited from county assistance offices and community-based settings.InterventionTrauma-informed programming incorporates healing-centered approaches to address previous exposures to trauma. Sixteen sessions addressed emotional management, social and family dynamics related to violence exposure and childhood adversity, and financial skills.Main Outcome MeasuresHousehold food insecurity, as defined by the US Department of Agriculture Household Food Security Survey Module.AnalysisMixed-effects logistic regression models were used to compare groups from baseline to 12 months, controlling for adverse childhood experiences, depression, and public assistance.ResultsThose with full participation had 55% lower odds of facing HFI compared with the low/no participation group (adjusted odds ratio = 0.45; 95% confidence interval, 0.22–0.90).Conclusions and ImplicationsTrauma-informed programming can reduce the odds of HFI and may reduce trauma-related symptoms associated with depression and poverty.     

A Controlled Trial of an Intervention to Increase Resident Choice in Long Term Care

ObjectiveThe purpose of this study was to evaluate an intervention to improve staff offers of choice to nursing home residents during morning care.DesignA controlled trial with a delayed intervention design.SettingFour community, for-profit nursing homes.ParticipantsA total of 169 long-stay nursing home residents who required staff assistance with morning care and were able to express their care preferences.InterventionResearch staff held weekly training sessions with nurse aides (NAs) for 12 consecutive weeks focused on how to offer choice during four targeted morning care areas: when to get out of bed, when to get dressed/what to wear, incontinence care (changing and/or toileting), and where to dine. Training sessions consisted of brief video vignettes illustrating staff-resident interactions followed by weekly feedback about how often choice was being provided based on standardized observations of care conducted weekly by research staff.MeasurementsResearch staff conducted standardized observations during a minimum of 4 consecutive morning hours per participant per week for 12 weeks of baseline and 12 weeks of intervention.ResultsThere was a significant increase in the frequency that choice was offered for 3 of the 4 targeted morning care areas from baseline to intervention: (1) out of bed, 21% to 33% (P < .001); dressing, 20% to 32% (P < .001); incontinence care, 18% to 23%, (P < .014). Dining location (8% to 13%) was not significant. There was also a significant increase in the amount of NA staff time to provide care from baseline to intervention (8.01 ± 9.0 to 9.68 ± 9.9 minutes per person, P < .001).ConclusionA staff training intervention improved the frequency with which NAs offered choice during morning care but also required more time. Despite significant improvements, choice was still offered one-third or less of the time during morning care.