Session Duration Research Articles

The effectiveness of reminiscence therapy on anxiety, depression, and quality of life in adult cancer patients: a systematic review and meta-analysis.

To investigate the effectiveness of reminiscence therapy on anxiety, depression, and quality of life in adult cancer patients. This study is a systematic review and meta-analysis, including 16 randomized controlled trials (RCTs) and controlled clinical trials (CCTs), encompassing a total of 1948 participants. The sample sizes of the included studies ranged from 32 to 210, with results from 1852 participants being evaluated. Potential studies up to July 31, 2023, were searched across seven electronic literature databases, reference lists of similar reviews, gray literature, and the Clinical Trials Registry. Studies were required to meet the PICOS inclusion criteria. Two independent investigators assessed the risk of bias in the included studies using the Cochrane Collaboration Tool. Meta-analysis was conducted using RevMan 5.4 when data were available. This review is registered in the International Prospective Register of Systematic Reviews (PROSPERO) with the registration number CRD42024524176 (28/03/2024). This meta-analysis included 16 articles; nine studies found that reminiscence therapy significantly reduced the anxiety scores with a standardized mean difference (SMD) of 0.80 (95% CI - 1.15, - 0.44) and depression scores with an SMD of 0.67 (95% CI - 0.94, - 0.4) (p < 0.001). In four studies, reminiscence therapy significantly improved quality of life with an SMD of 0.37 (95% CI 0.18, 0.56) (p < 0.001). Reminiscence therapy can be used by nurses as a nonpharmacological intervention to reduce anxiety and depression and improve quality of life in cancer patients during treatment, rehabilitation, and end-of-life periods. Further studies are needed as there is no standard for the duration and frequency of sessions.

Screening for Systemic Diseases Associated with Dental Self-Care in Japanese Adolescents

Background: Toothbrushing is important for maintaining oral health and preventing periodontal disease. However, the association between toothbrushing and systemic diseases remains unclear in adolescence. In this study, the association between dental self-care (frequency and duration of toothbrushing) and systemic diseases/disorders in adolescents was examined. Methods: We conducted a retrospective review of mandatory medical questionnaires administered during legally mandated freshman medical checkups between 2017 and 2019 at the University of Tokyo, Japan. Out of 9376 total responses, 9098 cases involving individuals under the age of 20 were included in the analysis. Respondents were classified into three groups based on their daily toothbrushing frequency: “1 time or less”, “twice”, and “3 times or more”. For the duration of each toothbrushing session, they were classified into three groups: “1 min or less”, “2–3 min”, and “4 min or more”. A statistical analysis was performed by Pearson’s χ2 test and multinomial logistic regression analysis. Results: Regarding frequency of daily toothbrushing: The χ2 test showed no significant relationship between frequency of toothbrushing and 17 systemic diseases/disorders. A multivariate analysis found that gingival bleeding and sex were independent factors. The risk of gingival bleeding decreased dramatically with increased frequency of toothbrushing (odds ratio (OR): 0.428; 95% confidence interval (CI), 0.366–0.501; p &lt; 0.001). Regarding the amount of time spent on toothbrushing: The χ2 test showed atopic dermatitis and arrhythmia were significantly associated with the duration of toothbrushing (p = 0.032 and p = 0.016, respectively). In the multivariate analysis, atopic dermatitis, gingival bleeding, and sex were independent factors regarding the duration of toothbrushing; longer brushing time was associated with a lower risk of atopic dermatitis (OR: 0.731, 95% CI: 0.578–0.924, p = 0.009) and a lower risk of gingival bleeding (OR: 0.643, 95% CI: 0.567–0.729, p &lt; 0.001). Conclusions: Dental self-care was most strongly associated with gingival bleeding, while the risk of atopic dermatitis was found to increase with shorter toothbrushing times. The results suggest that dental self-care during adolescence is important not only for oral health but also for general health.

Dietary Habits and Nutritional Knowledge of Pregnant Women: The Importance of Nutrition Education.

A good diet during pregnancy is associated with improvements to maternal and fetal health. Nevertheless, excessive weight gain during pregnancy has been reported in several studies. The aim of this review is to determine the dietary habits of pregnant women (measured according to their degree of adherence to the Mediterranean diet, a reference in dietary quality), their knowledge of food and nutrition, and their perceptions of the nutritional education received during their pregnancy, in order to detect intervention needs within that group. The bibliographic search was conducted on three databases (Medline, PubMed central, and Web of Science), using the keywords "pregnancy", "Mediterranean diet", "nutrition knowledge", "nutritional education", and some synonyms. The final selection included 68 original articles. The available evidence indicated that, although pregnant women were aware of the importance of nutrition during pregnancy, their habits showed some room for improvement in terms of diet and physical exercise. Lack of adequate advice was the main barrier to the practice of healthy habits that pregnant women encountered; they considered that the information they received during pregnancy follow-up visits was inadequate. However, the success of interventions within different countries is a source of hope for well-structured nutrition education throughout pregnancy. The lack of nutrition-related knowledge among pregnant women could be originally related to poorly planned nutrition education from healthcare providers. Research focused on the consultations with these healthcare providers could be of help when proposing strategies to improve the content, the depth, and the duration of nutrition education sessions. It should, in any case, be noted that the available evidence in this field is limited to certain geographical origins. Therefore, research that uncovers evidence in different countries will be useful for learning about the factors that condition the habits of pregnant women and, in that way, guide strategies for the improvement of the health of expectant mothers during that stage in their lives.

Evaluating the effectiveness of a multi-component lifestyle therapy program versus psychological therapy for managing mood disorders (HARMON-E): protocol of a randomised non-inferiority trial

BackgroundMood disorders, including unipolar and bipolar depression, contribute significantly to the global burden of disease. Psychological therapy is considered a gold standard non-pharmacological treatment for managing these conditions; however, a growing body of evidence also supports the use of lifestyle therapies for these conditions. Despite some clinical guidelines endorsing the application of lifestyle therapies as a first-line treatment for individuals with mood disorders, there is limited evidence that this recommendation has been widely adopted into routine practice. A key obstacle is the insufficient evidence on whether lifestyle therapies match the clinical and cost effectiveness of psychological therapy, particularly for treating those with moderate to severe symptoms. The HARMON-E Trial seeks to address this gap by conducting a non-inferiority trial evaluating whether a multi-component lifestyle therapy program is non-inferior to psychological therapy on clinical and cost-effectiveness outcomes over 8-weeks for adults with major depressive disorder and bipolar affective disorder.MethodsThis trial uses an individually randomised group treatment design with computer generated block randomisation (1:1). Three hundred and seventy-eight adults with clinical depression or bipolar affective disorder, a recent major depressive episode, and moderate-to-severe depressive symptoms are randomised to receive either lifestyle therapy or psychological therapy (adjunctive to any existing treatments, including pharmacotherapies). Both therapy programs are delivered remotely, via a secure online video conferencing platform. The programs comprise an individual session and six subsequent group-based sessions over 8-weeks. All program aspects (e.g. session duration, time of day, and communications between participants and facilitators) are matched except for the content and program facilitators. Lifestyle therapy is provided by a dietitian and exercise physiologist focusing on four pillars of lifestyle (diet, physical activity, sleep, and substance use), and the psychological therapy program is provided by two psychologists using a cognitive behavioural therapy approach. Data collection occurs at baseline, 8-weeks, 16-weeks, and 6 months with research assistants blinded to allocation. The primary outcome is depressive symptoms at 8 weeks, measured using the Montgomery-Åsberg Depression Rating Scale (MADRS) (minimal clinically important difference = 1.6). A pre-specified within-trial economic evaluation will also be conducted.DiscussionShould lifestyle therapy be found to be as clinically and cost effective as psychological therapy for managing mood disorders, this approach has potential to be considered as an adjunctive treatment for those with moderate to severe depressive symptoms.Trial registrationAustralia and New Zealand Clinical Trials Register (ANZCTR): ACTRN12622001026718, registered 22nd July 2022.Protocol version: 4.14, 26/06/2024

The Evolvement of Session Design From Junior Age to Senior Peak Performance in World-Class Cross-Country Skiers.

To compare designs of training sessions applied by world-class cross-countryskiers during their most successful junior and senior season. Retrospective analysis of self-reported training characteristics (ie,training form, intensity, and exercise mode) among 8 male and 7 female world-class cross-country skiers was conducted. Total number of sessions (441 [71] vs 519 [34], P < .001, large effect) and mean duration (1.5 [0.1]h vs 1.7 [0.1]h, P < .001, moderate effect) increased from junior to senior age. More double-session days were performed at senior age (124 [50] vs 197 [29]d, P < .001, large). The number (310 [64] vs 393 [64], P < .001, large effect) and duration (1.3 [0.1]h vs 1.5 [0.1]h, P < .001, moderate effect) of low-intensity training sessions increased from junior to senior age. Regarding intensive training, most emphasis was put on high-intensity training sessions lasting 20 to 39minutes with <5-minute intervals at junior age, while 40 to 59minutes ofmoderate-intensity training with 5- to 9-minute intervals was predominant at senior age. More MIXED (combined moderate- and high-intensity) sessions (9 [7] vs 14 [7], P = .023, moderate effect) and longer races (0.5 [0.1]h vs 0.6 [0.1]h, P = 0.29, moderate effect) compensated for fewer high-intensity training sessions at senior age (36 [17] vs 25 [10], P = .027, moderate effect). Duration of strength-training sessions increased significantly (0.6 [0.1] vs 0.8 [0.2]h, P = 0.30, moderate effect), while other training forms remained unchanged. World-class cross-country skiers increased their training volume from junior to senior age primarily by more and longer low-intensity training sessions and more often training twice per day. Concurrently, the most frequent intensive sessions were modified from high- to moderate-intensity training, lasted longer, and contained longer intervals.

The Magnitude Of Exercise-induced Hypervolemia Following High-intensity Interval Exercise Depends On Session Duration

The Magnitude Of Exercise-induced Hypervolemia Following High-intensity Interval Exercise Depends On Session Duration

Evaluating ExpandED: Evaluating the effectiveness of a serious game expansion pack in teaching health professional students about interprofessional care.

The emergency department (ED) is a challenging fast-paced environment with high-acuity, undifferentiated patients who often require extensive interdisciplinary care. This paper introduces ExpandED, an expansion pack to the serious board game GridlockED, designed to enhance players' understanding of interprofessional collaboration in the ED and the diverse scope of practice of different ED professionals including physicians, residents, registered nurses, registered practical nurses, social workers, occupational therapists, and physiotherapists. This investigation evaluates the effectiveness of ExpandED as a teaching tool for medical and allied health professions students about interprofessional collaboration in the ED. A program evaluation harnessing a playtest framework was employed. Participants completed pre- and postgame surveys including quantitative measures (e.g., Likert scales) and qualitative free-text feedback that focused on participant familiarity with ED functioning, valuation of interprofessional collaboration before and after playing, and feedback on game usability and effectiveness. Recruitment was open to students in all health care and allied health professional programs at the institution. Forty-five participants were recruited from medical doctor, nursing, physiotherapy, and speech language pathology programs. ExpandED enhances participants' understanding of ED workflow (p < 0.001) and provides an enjoyable playing experience. However, participants' valuation of interdisciplinary teamwork did not change significantly before and after game play (p = 0.17). Participants expressed satisfaction with the game's accuracy in simulating the ED environment and appreciated the opportunity to collaborate with peers from different disciplines. Challenges reported included some tension among players, potential biases, and limitations of fidelity to a real-life ED. While this study has limitations regarding participant sampling and duration of gameplay sessions, it highlights the potential of ExpandED for teaching interprofessional collaboration in the ED. These findings will guide further development to optimize the expansion pack's effectiveness and its implementation into health care curricula.

Developing the optimal gross movement interventions to improve the physical fitness of 3-10 year-old children: a systematic review and meta-analysis.

To identify the optimal parameters of gross movement interventions to yield the strongest effects on physical fitness among children aged 3-10 years and to provide a reference for the development of gross movement interventions to improve the physical fitness of children. There has been a global decline in children's physical fitness. Previous studies have shown that gross movement interventions can improve children's physical fitness, but the optimal intervention parameters for achieving the strongest effects have yet to be determined. Therefore, we conducted this meta-analysis to determine the optimal intervention parameters for yielding the strongest effects on children's physical fitness. We searched the Web of Science, PubMed, China Biology Medicine, China National Knowledge Infrastructure, Wanfang Data, and China Science and Technology Journal databases to identify randomized controlled trials on the effects of gross movement interventions (walking, running, jumping, throwing, batting, rolling, spinning, catching, and leg lifting) on children's physical fitness (upper-body strength, lower-body strength, explosive power, speed, flexibility, and balance). We included studies published up to September 2023. The inclusion and exclusion criteria were developed based on the PICOS framework, and the quality of the included studies was evaluated. Subgroup analysis was performed using Review Manager 5.3, and the data were pooled using a random effects model to obtain the SMD (or WMD) and 95% confidence intervals (CIs). A total of 23 studies involving 2007 healthy children aged 3-10 years met the inclusion criteria. Gross movement interventions significantly improved the explosive power of children aged 3-10 years [WMD, 6.2]. The most effective intervention duration was 16-18 weeks [WMD, 0.45]. The most effective intervention frequency was one session per week [WMD, 1.06]. The optimal duration of single sessions was 60 min [WMD, 0.47]. Children aged 7-10 years [WMD, 1.41] showed the most significant improvements in physical fitness after gross movement interventions. Gross movement interventions had a positive effect on the physical fitness of children aged 3-10 years. The optimal intervention parameters include 60-min sessions once a week across a total duration of 16-18 weeks.

The Impact of Introducing Generic Therapy Assistants to an Acute Occupational Therapy Stroke Service

Abstract Background It has been recommended that patients post-Stroke should receive 45 minutes of Occupational Therapy (OT) input on at least five days per week to evoke meaningful and significant improvements in patient-centred outcomes. However, service capacity cannot always meet recommended levels. Generic Therapy Assistants (GTAs) offer opportunities to bolster staffing and increase intensity and quality of OT input. This pilot aims to investigate the impact of the recruitment of two GTAs upon OT services in an acute Stroke unit. Methods Two GTAs were recruited to the service and underwent tailored training, followed by in-service training and supervision support. Data was collected prior to their recruitment for a four-week period (Timepoint 1) and again following their appointment (Timepoint 2). Duration of OT sessions were categorised as High (&amp;gt;36 minutes), Moderate (23-36 minutes) and Low Intensity (&amp;lt;23 Minutes). Key metrics were the number of sessions that took place, the proportion of sessions deemed low, moderate and high intensity and a functional measure of included patients using the Functional Independence Measure (FIM). Results Total sessions increased from 113 to 184 from Timepoint 1 to 2, and sessions deprioritized reduced from 116 to 71, with greater contact time per day during Timepoint 2. The proportion of sessions described as High Intensity increased from 45% to 63%. Twelve patients from each cohort had functional changes measured, with scores recorded on initial assessment and on discharge. Average increases of 3.75 points were observed during Timepoint 1, and 8 points at Timepoint 2. Conclusion The addition of two GTAs to the Stroke service in this acute hospital facilitated positive changes to the OT service capacity and delivery. Increased numbers of sessions and session duration were observed, alongside a greater proportion of sessions being of High Intensity, and greater functional improvements when compared to similar data collection prior to their recruitment.

Implementation of A Blog-Based Journal Reading Strategy to Improve the Reading Comprehension Ability of UNIMED English Literature Students

This study explores the impact of a blog-based reading journal strategy on improving reading comprehension among English Literature students at Universitas Negeri Medan. Conducted over six months in 2024, the research involved 60 students who documented their reflections and analyses of assigned readings on blog platforms. The methodology included qualitative and quantitative approaches, with a rubric assessing comprehension, analytical skills, reflection depth, and coherence. Results showed significant improvement in reading comprehension, with 80% of students rating the overall experience highly and 100% finding the blog content very helpful. Critical and analytical thinking skills also improved, with 60% of students rating this aspect highest. Students were comfortable using the blog platform and suggested extending session durations and incorporating more visual aids. The study concludes that the blog-based strategy effectively enhances reading comprehension, engagement, and critical thinking, supporting its continued use and exploration in educational settings.

Effectiveness of interventions for informal caregivers of people with end-stage chronic illness: a systematic review

BackgroundPeople living with advanced, non-malignant chronic conditions often have extensive and complex care needs. Informal or family caregivers often provide the care and support needed by those with advanced chronic conditions at home. These informal caregivers experience many challenges associated with their caring role, which can impact their own wellbeing. Whilst there is growing evidence around the impact on carers, guidance on support for informal caregivers of patients with advanced, non-malignant, chronic conditions is lacking, with little evidence available on effective psychosocial carer interventions. This systematic review explored existing interventions for caregivers of those with advanced, non-malignant, chronic illness, in order to assess the effectiveness of these interventions in improving psychosocial outcomes.MethodsElectronic databases, Medline, CINAHL, EMBASE, and PsycINFO, were searched up to the end of March 2023. Studies meeting the inclusion criteria, focusing on interventions to improve psychosocial outcomes, such as depression, anxiety, quality of life, and caregiver burden, in this cohort of caregivers were included. Data were extracted regarding study setting, design, methods, intervention components, and outcomes. Risk of bias and quality assessment were conducted.ResultsA total of 5281 articles were screened, ultimately identifying 12 studies for inclusion, reported in 13 publications. A narrative synthesis revealed mixed results. Psychosocial interventions resulted in more significant improvements in psychosocial outcomes than psychoeducational or support interventions, with interventions for carer-patient dyads also reflecting more positive outcomes for caregivers. Evidence-based interventions, guided by an appropriate theoretical model, were reportedly more effective in improving caregiver outcomes. Differences in outcomes were related to intervention development, design, delivery, and outcome assessment.ConclusionsThis review, to our knowledge, is the first to explore the effectiveness of interventions in improving psychosocial outcomes for caregivers of those with advanced, non-malignant, chronic conditions. The review highlights the need for more robust, sufficiently powered, high-quality trials of evidence-based interventions for caregivers of people with advanced chronic illness. Optimal intervention duration and frequency of sessions are unclear and need further exploration.

Cognitive behavioural therapy for fatigue in patients with multiple sclerosis: A systematic review and meta-analysis

BackgroundTreatment of fatigue is important for many patients with multiple sclerosis (MS). While pharmacological options have not shown consistent benefit, psychological interventions offer another avenue of treatment. Cognitive behavioural therapy (CBT) involves strategies to change maladaptive cognition and illness behaviours that modulate how patients with MS respond to fatigue. The aim of this study was to perform a systematic review and meta-analysis to determine the effectiveness of CBT for the treatment of fatigue in patients with MS. MethodsFive databases (Cochrane Central Register of Controlled Trials, MEDLINE/PubMed, Embase, Emcare and PsycINFO) were searched up until 31 July 2023. Randomised controlled trials involving adult patients with MS and fatigue, comparing CBT with another intervention or usual treatment were included. Studies were required to measure fatigue severity and/or the impact of fatigue as the primary outcome(s). Each study was assessed for bias using the Cochrane Risk of Bias tool version 2. Studies with sufficient data were used for meta-analysis to quantify the short- and long-term effects of CBT on MS-related fatigue. The level of certainty provided by the body of evidence was evaluated using the Grading of Recommendations, Assessment, Development and Evaluations (GRADE) framework. ResultsEight studies were included in the review and six studies contributed to the meta-analysis. Most studies had a low overall risk of bias. CBT interventions differed in the number, duration and frequency of sessions, mode of delivery and therapist. There were significant short- (standardised mean difference (SMD) -0.58, 95% confidence interval (95%CI) -0.85 to -0.31, P-value < 0.0001) and long-term (SMD -0.36, 95%CI -0.52 to -0.19, P-value < 0.0001) effects supporting CBT. The evidence provided a low level of certainty for the short-term effect because of heterogeneity of results and possible publication bias, while there was high certainty for the long-term result. ConclusionThe study provides secondary evidence that CBT has moderate short-term and small long-term effects in reducing fatigue in patients with MS. CBT should be regarded as a viable evidence-based intervention, particularly in the absence of established alternatives. Future research should identify the ideal characteristics of a fatigue-specific CBT intervention, patient factors that predict treatment response and strategies to maintain initial improvements over time.

A Staff Educational Intervention to Increase the Time of Skin-to-Skin Care in a Swedish NICU: A Quality Improvement Project.

Skin-to-skin contact (SSC) is crucial in neonatal intensive care unit (NICU) care; yet, challenges exist in its implementation. This study addresses a knowledge gap by examining the most effective ways to introduce SSC in the NICU, emphasizing the need to seamlessly integrate this practice for optimal infant and parent care. One way, among many, to implement SSC is to increase staff's knowledge and awareness about SSC. To describe the effect of an educational intervention on SSC time, the number of SSC sessions per day, and the number of infants cared for with SSC within their first day of life. A pre- and postinterventional study design was used to determine the effect of an educational intervention on SSC time, the number of SSC sessions per day, and the number of infants cared for with SSC within their first day of life. The prevalence of infants receiving SSC during their first 24 hours of life, the number of SSC sessions per day, and the duration of each SSC session increased after the intervention, and these effects persisted over 2 years. Our study highlights the impact of staff education and reflective discussions on SSC in the NICU. Integrating these with practical training, parental education, and NICU environment modifications is pivotal for enhancing and sustaining optimal SSC practices, benefiting both infants and parents.

Quantifying the Training Loads and Corresponding Changes in Physical Qualities among Adolescent, Schoolboy Rugby League Players.

The adolescent development period is critical for rugby league athletes, given the physical growth, neuromuscular adaptation, and skill acquisition that occurs. Secondary schools play an important role in the development of adolescent rugby league players; however, players may be selected into rugby league academies and development programs outside of school, as well as participating in additional sports. In turn, the training loads these young athletes accrue and the implications of these loads are currently unknown. Our aim was to quantify the training loads and concomitant changes in physical qualities of schoolboy and adolescent rugby league players during mesocycles within the pre-season and in-season phases. This is a prospective experimental study. Twenty-one schoolboy rugby league players (16.2 ± 1.3 years) were monitored across separate 4-week mesocycles in the pre-season and in-season. Session frequency, duration, and the session rating of perceived exertion (sRPE) load were reported for all examples of training and match participation in the school rugby league program, as well as club and representative teams for any sport and personal strength and conditioning. Various physical qualities were assessed before and after each 4-week mesocycle. The sRPE load that accumulated across the 4-week mesocycles was higher in the pre-season than the in-season (8260 ± 2021 arbitrary units [AU] vs. 6148 ± 980 AU, p < 0.001), with non-significant differences in accumulated session frequency and duration between phases. Session frequency, duration, and sRPE load differed (p < 0.05) between some weeks in an inconsistent manner during the pre-season and in-season mesocycles. Regarding physical qualities, improvements (p < 0.05) in the 10 m sprint test, Multistage Fitness Test, medicine ball throw, and 1-repetition maximum back squat and bench press performances were evident across the pre-season mesocycle, with declines (p < 0.05) in the 505-Agility Test, L-run Test, and 1-repetition maximum back squat performances across the in-season mesocycle. Conclusions: These novel training load data show schoolboy rugby league players experience considerable demands that may be suitable in developing several physical qualities during the pre-season but detrimental to maintaining such qualities across the in-season.

Neuromuscular Electrical Stimulation for Dysphagia Treatment: Adoption, Perceived Barriers, and Clinical Practices.

This study aims to learn about the global adoption of neuromuscular electrical stimulation (NMES) in managing dysphagia, identify the barriers to its adoption, and describe the existing clinical practices. A total of 171 professionals from various international backgrounds initiated a specially developed online survey, and 122 responses were included in the final analysis. The survey consisted of 44 items related to NMES usage, perceived adoption barriers of NMES in dysphagia management, and clinical practices. The data were subjected to descriptive and correlational statistical analysis. NMES is adopted by 50% of the participants' workplaces when considering responses globally and 42.7% in the United States. Most respondents reported both high self-assessed knowledge level and high interest in learning about NMES. Among the 21 posed barriers to NMES adoption, 19 were agreed upon by over 50% of participants, with the most reported being insufficient academic coverage, lack of expert endorsement, and heterogeneity in stimulation parameters. There was considerable diversity in the clinical application of NMES, particularly regarding the duration, frequency, and total number of sessions typically completed when using NMES. NMES is adopted by half of the facilities and utilized by one third of dysphagia practitioners among the international respondents to this survey. The high interest expressed in NMES parallels the increasing volume of related research. Nonetheless, the widespread recognition of barriers and the substantial variability in clinical application underscore the need for international efforts to establish standardized protocols or guidelines, ensuring its effective and consistent use in clinical settings.

Feasibility of self-management for amputee rehabilitation using technology and peer support for improving walking and confidence in individuals with lower limb loss

Background: Individuals with lower limb loss (LLL) require self-management education for amputation adaptation. eHealth technologies, like online platforms, widen access to educational resources. We developed an online self-management program for individuals with LLL called Self-Management for Amputee Rehabilitation using Technology (SMART). Objective: To assess the feasibility of SMART for improving walking capacity and confidence for adults with recent LLL. Study Design: A single-group pre-post intervention design. Methods: We recruited community-dwelling adults, with unilateral, transtibial, or transfemoral amputation. Self-management for amputee rehabilitation using technology included 6 weekly online educational modules, for example, pain management, diet, and sock management, and 6 weekly online meetings with a peer mentor to discuss goal setting and action planning. Outcomes were assessed at baseline (before SMART) and after 6 weeks using SMART. Feasibility indicators included process (retention rate), resource (duration of training sessions), management (participant processing), and treatment issues (effect size). The primary clinical outcome was walking capacity measured using Timed Up and Go, and secondary outcome was walking confidence measured using the Ambulatory Self-Confidence Questionnaire. Results: Twelve participants were recruited. The median (range) age was 56.0 (26–79) years. The retention rate was 100%. All participants were trained in less than 15 min. Four participants had an enrollment delay of more than 10 days. Two participants reported noninjurious falls because of amputation comorbidities and increased activity. The effect sizes for walking capacity and confidence were 0.51 and 0.86, respectively. Conclusions: Only small intervention and protocol refinements are required to SMART. These will be incorporated for a future multisite randomized controlled trial. SMART is an eHealth education program for people with LLL. Self-management for amputee rehabilitation using technology with peer support is a feasible intervention. However, adjustments to the study protocol and intervention safety are necessary before proceeding with the evaluation of SMART in a larger study.

Exploring the impact of physiotherapy on health outcomes in older adults with chronic diseases: a cross-sectional analysis.

This study evaluates the impact of physiotherapy interventions on health outcomes and explores the correlation between physiotherapy session characteristics and improvements in health among older individuals. In a cross-sectional design, 384 older adults with chronic conditions such as arthritis, osteoporosis, Chronic Obstructive Pulmonary Disease (COPD), diabetes, and hypertension were recruited. The proportion of arthritis (39.1%) and hypertension (45.8%) was notably high. Participants receiving physiotherapy showed significant improvements in pain levels (mean reduction from 5.09 to 2.95), mobility scores (improvement from 3.0 to 3.96), and functional independence. A positive correlation was identified between the frequency of physiotherapy sessions and pain reduction (r = 0.26, p = 0.035), and a stronger correlation between session duration and both pain reduction (r = 0.38, p = 0.002) and mobility improvement (r = 0.43, p = 0.001). High satisfaction rates with physiotherapy were reported, and age was found to be a significant negative predictor of health outcomes (Coef. = -0.3402, p = 0.0009). Physiotherapy interventions significantly improve health outcomes in older adults with chronic diseases.

Differential analgesic effects of high-frequency or accelerated intermittent theta burst stimulation of M1 on experimental tonic pain: Correlations with cortical activity changes assessed by TMS-EEG

Accelerated intermittent theta burst stimulation (AiTBS) has attracted much attention in the past few years as a new form of brain stimulation paradigm. However, it is unclear the relative efficacy of AiTBS on cortical excitability compared to conventional high-frequency rTMS. Using concurrent TMS and electroencephalogram (TMS-EEG), this study systematically compared the efficacy on cortical excitability and a typical clinical application (i.e. pain), between AiTBS with different intersession interval (ISIs) and 10-Hz rTMS. Participants received 10-Hz rTMS, AiTBS-15 (3 iTBS sessions with a 15-min ISI), AiTBS-50 (3 iTBS sessions with a 50-min ISI), or Sham stimulation over the primary motor cortex on four separate days. All four protocols included a total of 1800 pulses but with different session durations (10-Hz rTMS ​= ​18, AiTBS-15 ​= ​40, and AiTBS-50 ​= ​110 ​min). AiTBS-50 and 10-Hz rTMS were more effective in pain reduction compared to AiTBS-15. Using single-pulse TMS-induced oscillation, our data revealed low gamma oscillation as a shared cortical excitability change across all three active rTMS protocols but demonstrated completely opposite directions. Changes in low gamma oscillation were further associated with changes in pain perception across the three active conditions. In contrast, a distinct pattern of TMS-evoked potentials (TEPs) was revealed, with 10-Hz rTMS decreasing inhibitory N100 amplitude and AiTBS-15 reducing excitatory P60 amplitude. These changes in TEPs were also covarying with low gamma power changes. Sham stimulation indicated no significant effect on either cortical excitability or pain perception. These results are relevant only for provoked experimental pain, without being predictive for chronic pain, and revealed a change in low gamma oscillation, particularly around the very particular frequency of 40 ​Hz, shared between AiTBS and high-frequency rTMS. Conversely, cortical excitability (balance between excitation and inhibition) assessed by TEP recording was modulated differently by AiTBS and high-frequency rTMS paradigms.

Effects of Traditional Chinese Exercises on Glycemic Control in Patients with Type 2 Diabetes Mellitus: A Systematic Review and Meta-Analysis of Randomized Controlled Trials.

Currently, most studies on the health benefits of traditional Chinese exercises on type 2 diabetes mellitus have explored the effects of a single type of traditional Chinese exercise on type 2 diabetes. Although a previous study evaluated the combined clinical effects of traditional Chinese exercises on type 2 diabetes, the studies included in that review were deficient in their study design. In addition, previous studies have not explored the ideal exercise dose that should be taken by patients with type 2 diabetes when performing traditional Chinese exercises. To understand whether the findings of previous systematic reviews and meta-analyses are still applicable and to try to address the deficiencies in the previous review, this review conducted a meta-analysis of existing randomized controlled trials to investigate the impact of traditional Chinese exercises on glycemic control with type 2 diabetes. The literature was searched in seven Chinese and English databases. Randomized controlled trials published in English and Chinese, from database inception to March 2023, were included in this review. Two reviewers independently reviewed the search results, extracted the data, and assessed the risk of bias. A meta-analysis of the included studies was conducted using Rev Man 5.4 and Stata 15.1 software. Heterogeneity was investigated using a sensitivity analysis, a subgroup analysis, and a meta-regression analysis. Pre-determined subgroups included the duration of the intervention, frequency of exercise, and duration of the single exercise session. A total of 31 randomized controlled trials (2077 subjects) were selected in this review. The meta-analysis revealed that traditional Chinese exercises were more effective than control groups in lowering glycated hemoglobin (Z = 6.06; mean difference [MD] = - 0.64, 95% confidence interval [CI] - 0.85, - 0.44; P < 0.00001), fasting blood glucose (Z = 7.81; MD = - 0.82, 95% CI - 1.03, - 0.62; P < 0.00001), 2-h plasma glucose (Z = 5.61;MD = - 1.03, 95% CI - 1.39, - 0.67; P < 0.00001), total cholesterol (Z = 4.23; MD = - 0.37, 95% CI - 0.54, - 0.20; P < 0.0001), high-density lipoprotein cholesterol (Z = 5.94; MD = 0.12, 95% CI 0.08, 0.16; P < 0.00001), low-density lipoprotein cholesterol (Z = 6.20; MD = - 0.34, 95% CI - 0.44, - 0.23; P < 0.00001), and triglyceride levels (Z = 3.74; MD = - 0.44, 95% CI - 0.67, - 0.21; P = 0.0002) among patients with type 2 diabetes. Traditional Chinese exercises can significantly improve blood glucose and lipid levels in patients with type 2 diabetes. When performing traditional Chinese exercise interventions for type 2 diabetes, it is recommended that exercise programs are designed for 30-50min/session, 4-5 sessions/week for at least 3months.

Dealing with rectum motion during radiotherapy: How can we anticipate it?

IntroductionIntra- and inter-fraction rectum motion is important for pelvic radiotherapy (RT). This study assesses how RT session duration, the presence or the absence of an intra-rectal tumour, and the distance from the anorectal junction (ARJd) impact rectal motion. Materials and methodsAnalyses used cone-beam computed tomographies (CBCTs) from RT patients treated for rectal and prostate cancer. Three structures were evaluated: (1) the entire rectum in patients without a rectal tumour (RectumProstate); (2) the non-invaded portion (RectumRectum) and (3) the tumour-invaded portion (RectumTumour) in rectal cancer patients.Intrafraction motion was assessed using the Hausdorff distance 95% and the Mean distance-to-agreement between structures delineated on the first CBCT and the 2 subsequent CBCTs within a same RT session. Interfraction motion was quantified by comparing structures delineated on the planning-CT and the first CBCT of each session.Linear mixed model evaluated rectum motion in relation to time, tumour presence, and ARJd, respectively. ResultsWe included 10 patients with and 10 without rectal cancer, collecting 385 CBCTs. A significant correlation (p < 0.05) between rectum motion and RT session duration was found. Intrafraction motion was significantly higher in prostate cancer patients (RectumProstate motion > RectumRectum and RectumTumour, p < 0.01). For interfraction motion, only the mean distance to agreement was significantly higher for RectumProstate (p < 0.05). Motion increased significantly with ARJd for all three structures (p < 0.001). ConclusionsSession duration, absence of a tumour, and ARJd are associated with larger intra- and interfraction rectal motion. This highlights the need for tailored RT treatment, including online-adaptive RT, to manage intra- and interfraction variations. Rectal motion should be handled differently for patients with prostate cancer and those with rectal cancer.