Multimodal Intervention Program Research Articles

Incremental versus saturation hypotheses for behavioral nudge in reducing sugar consumption.

This field experiment examined the efficacy of a behavioral nudge intervention towards lowering sugar intake in Indonesia. Specifically, two competing hypotheses were tested as to whether behavioral nudge played an additive role (i.e., the Incremental Hypothesis) or contributed to a ceiling effect (i.e., the Saturation Hypothesis) alongside social context and competition in a multimodal intervention program. This field experiment used a three-factorial mixed design involving 403 Indonesian participants based on power statistical analysis: 2 (sugar content nudge: lower sugar tea vs. regular sugar tea default) × 2 (social context: individual vs. group) × 2 (competition: absent vs. present). Nudging was the most powerful intervention in reducing sugar intake, but its effectiveness might be attenuated by social loafing even within Indonesia's collectivist culture. Competition did not work synergistically with nudging but was effective under the nonnudge condition. Our results are consistent with those of previous research showing that behavioral nudging has a stronger impact on behavioral change than nonnudge strategies. Contrary to some previous research, people in collectivist Indonesia did engage in social loafing: achievement motivation is not necessarily enhanced in a team of people in a collectivist culture. The Nudge × Competition interaction supports the saturation hypothesis in favor of behavioral nudging: using more than one intervention, when a potent strategy such as nudging is present, might result in diminishing returns that could reduce the overall benefit-cost profile of such multimodal intervention programs. (PsycInfo Database Record (c) 2024 APA, all rights reserved).

Implementation of a multimodal home-based rehabilitation intervention after discharge from inpatient geriatric rehabilitation (GeRas): an early qualitative process evaluation

BackgroundGeriatric rehabilitation aims at increasing physical and social activity and maintaining the functional reserve of older people. However, the continuity of geriatric rehabilitation in the outpatient setting is limited due to a lack of structured aftercare programs. In order to overcome this, a three-month multimodal home-based intervention program (GeRas) was implemented. The aim of this early qualitative process evaluation was to assess GeRas in terms of perceived reach, effectiveness/efficacy, adoption/uptake, implementation, and maintenance/sustainability (Domains within the RE-AIM Framework) from the perspective of patients who received the intervention and healthcare providers who were involved in the delivery of the intervention.MethodsIn a qualitative process evaluation, 13 healthcare providers and 10 patients were interviewed throughout the beginning of the implementation period of GeRas to capture early experiences using a semi-structured interview guide. The interview guide and qualitative content analysis was guided by the RE-AIM Framework.ResultsThe GeRas program was perceived to be largely well implemented and beneficial by healthcare providers and patients. According to healthcare providers, GeRas showed more advantages compared to usual care. Additionally, outcome expectations were mainly met (Domain 1: Effectiveness). However, the implementation of the intervention delivered via the eHealth system was perceived as challenging (Domain 2: Adoption). Nevertheless, the outpatient physical exercise, the outpatient counselling, and the continuous care after discharge improved perceived well-being regardless of the intervention type (Domain 3: Implementation). To facilitate the continued use of GeRas, technical requirements should be created to increase user-friendliness and to motivate patients to continue the training in the long term (Domain 4: Maintenance).ConclusionAlthough initial experiences with the implementation and effectiveness of GeRas were positive in general, organisational and technical issues need to be resolved to enhance sustainable and successful implementation of the GeRas program.Trial registrationGerman Clinical Trials Register (DRKS00029559). Registered 5/10/2022.

A multimodal cancer rehabilitation programme promoting sense of coherence for women treated for female reproductive cancers: a pilot randomised controlled trial.

To investigate the feasibility, acceptability, and preliminary effects of a theory-driven multimodal cancer rehabilitation intervention (MCRI) programme among Hong Kong Chinese women treated for female reproductive cancers (FRC). A single-blinded randomised controlled trial was conducted in two regional hospitals in Hong Kong involving 35 women treated for FRC. The intervention group (n = 18) received a 12-week MCRI which included 30 modules of app-based health education and three nurse-led individual counselling sessions. The control group (n = 17) received attention from the research nurse through telephone calls. Sense of coherence, health-related quality of life, and cancer-specific distress were measured at baseline (T0), immediately after completion of the intervention (T1) and 12weeks post-intervention (T2). Twelve intervention completers were interviewed to explore the acceptability of the programme. Recruitment, consent, and retention rates, counselling session attendance rate, and app usage were satisfactory. The intervention participants reported to have significant improvement in physical well-being at T1 (Cohen's d effect size (d) = 1.04, 95% CI 0.24, 1.83), sense of coherence (d = 0.76, 95% CI - 0.03, 1.54), and cancer-specific distress (d = 1.03, 95% CI - 1.83, - 0.21) at T2. Interviewed participants acknowledged the benefits of the programme and provided comments for improvement. The MCRI is found to be feasible and acceptable and may improve their sense of coherence, distress, and physical health. A full-scale trial using a larger and more representative sample is warranted to confirm the effects of the programme. Women treated for FRC may be benefited from the MCRI in improving sense of coherence, physical well-being, and distress. This trial was registered on ISRCTN registry with ID ISRCTN73177277.

Multimodal therapeutic intervention program associated with photobiomodulation therapy for individuals with chronic nonspecific neck pain: protocol for a clinical trial

BackgroundNeck pain is a prevalent global musculoskeletal issue, significantly contributing to the loss of years of healthy life due to disability. Chronic nonspecific neck pain (CNNP) involves diverse symptoms impacting mobility and quality of life. While therapeutic exercises demonstrate efficacy, the role of photobiomodulation therapy (PBMT) remains uncertain. This study aims to assess the additional effects of PBMT within a multimodal therapeutic intervention for CNNP.MethodsA randomized, two-arm, controlled, blind clinical trial follows CONSORT and SPIRIT guidelines. Participants diagnosed with CNNP will receive a stand-alone multimodal therapeutic intervention or the same program with additional PBMT. The primary outcomes will be assessed by the functional disability identified through applying the NDI (Neck Disability Index). Secondary outcomes will be pain intensity during rest and active neck movement, catastrophizing and kinesiophobia, functionality, and disability assessed at baseline, after 8 weeks, and at a 4-week follow-up. Both groups receive pain education before personalized interventions, including resistance exercises, neuromuscular activities, mobility, and body balance. The PBMT group undergoes low-level light therapy. Intention-to-treat analysis, using linear mixed models, employs data presented as mean, standard deviation, and differences with a 95% confidence interval. Non-normally distributed variables transform. Statistical significance is set at 5%.DiscussionThis study addresses a critical gap in understanding the combined effects of PBMT and therapeutic exercises for CNNP. The findings aim to guide clinicians, researchers, and CNNP sufferers through rigorous methodology and diverse outcome assessments, offering valuable insights into evidence-based practices for CNNP management. Data confidentiality is maintained throughout, ensuring participant privacy during statistical analysis.Trial registrationEffects of adding photobiomodulation to a specific therapeutic exercise program for the treatment of individuals with chronic nonspecific neck pain, registration number: NCT05400473, on 2022-05-27.

Efficacy of a non-pharmaceutical multimodal intervention program in a group setting for patients with mild cognitive impairment: A single-arm interventional study with pre-post and external control analyses

AimThis study aimed to evaluate the efficacy of a non-pharmaceutical multimodal intervention program consisting of physical exercise, cognitive stimulation, and health education in a group setting to slow the progression of mild cognitive impairment (MCI). MethodsA single-arm interventional study was conducted on 27 patients with MCI. To evaluate the efficacy of the intervention program, a pre-post analysis was performed using EuroQol-5 Dimension (EQ-5D), Mini-Mental State Examination (MMSE), Cognitive Function Instrument (CFI), 5 Cog test, depression, and physical performance before and after the 8-month intervention. Additionally, propensity score and the semi-Bayes analyses were performed to compare the intervention program with standard medical care, using the external control patients’ data for MMSE scores. ResultsTwenty-four patients completed the intervention program. During the study period, although EQ-5D and MMSE scores remained unchanged (mean change 0.02 [95 % confidence interval (CI): −0.004, 0.04], 0.5 [-0.2, 1.3]), CFI and the subcategories of 5Cog (attention and reasoning) improved (mean change −1.23 [-2.24, −0.21], 4.3 [0.9, 7.7], 3.0 [0.4, 5.6]). In the additional analysis comparing changes in MMSE scores, patients who underwent the intervention program had less decline than the external control patients (mean change −1.7 [-2.1, −1.3]) with an observed mean difference of 2.25 [1.46, 3.03], and propensity score-adjusted difference of 2.26 [1.46, 3.05]. The semi-Bayesian approach also suggested that the intervention slowed the progression of MCI. ConclusionA non-pharmaceutical multimodal intervention program could contribute to slowing cognitive decline in patients with MCI.

Effects on physical activity, physical fitness and well-being in a 36-months randomized controlled study, comparing a multimodal hospital-based intervention programme for primary cardiovascular prevention with usual care

BackgroundCardiovascular disease is a major cause of mortality and morbidity worldwide, and primary prevention efforts are poorly developed in people at high cardiovascular risk. On this background, we performed the Hjerteløftet Study and demonstrated that participation over 36 months in a multimodal primary prevention programme, significantly reduced validated cardiovascular risk scores. In the current substudy we aimed to further explore several elements and effects following the intervention programme.MethodsA random sample from the original Hjerteløftet Study was included for further examinations (n = 255, 40% women), and these patients were already randomized to an intervention group (IG) (n = 127), or a control group (CG) (n = 128). We compared changes from baseline to 36-months follow-up in physical activity, cardiorespiratory fitness, psychological well-being (WHO-5), cardiovascular medication use, smoking habits, and cardiometabolic risk factors (blood pressure, lipids, blood glucose, HbA1c, Apolipoprotein A-I, Apolipoprotein B and high-sensitive C-reactive protein).ResultsSelf-reported physical activity increased significantly with absolute difference in mean delta Physical Activity Index score in the IG compared to the CG: 0.90, 95% CI: 0.10 to 1.70, p = 0.028 (ANCOVA). There were no corresponding differences in cardiorespiratory fitness. The participation resulted in psychological well-being improvement in both groups with a larger increase in the IG compared to the CG. The mean difference in delta WHO-5 score was 5.06, 95% CI: 0.68 to 9.45, p = 0.024, and 3.28, 95% CI: -0.69 to 5.25, p = 0.104 when controlled for baseline values (ANCOVA). The use of antihypertensive medication increased significantly more in the CG (p = 0.044). Only minor, nonsignificant changes were observed for traditional risk factors and cardiometabolic variables.ConclusionsParticipation in the Hjerteløftet Study intervention programme resulted in an improved physical activity level, but without changing cardiorespiratory fitness. Participation in the programme also tended to improve psychological well-being, possibly related to increased physical activity, less smoking and less use of cardiovascular medication. Concerning the metabolic status, no major differences were observed, but minor changes may have been concealed by a larger increase in cardiovascular medication use in the control group.Trial registrationClinicalTrials.gov (NCT01741428), 04/12/2012.

Effects of nurses-led multidisciplinary-based psychological management in spinal surgery: a retrospective, propensity-score-matching comparative study

BackgroundPatients in spine surgery often have emotional disorders which is caused by multi-factors. Therefore, a multidisciplinary and multimodal intervention program is required to improve emotional disorders during the perioperative period. However, related studies were rare. This study aimed to confirm that the multidisciplinary-based psychological management leading by nurses was effective in treating emotional disorders and show the assignments of the members of the multidisciplinary team with the orientations of nurses.DesignA retrospective, comparative study.MethodThis study was a retrospective cohort research and compared the results between the intervention group and control group using the Huaxi Emotional Distress Index (HEI) which was used to evaluate emotional disorders. The intervention group consisted of patients who underwent surgery between January 2018 and December 2020 after psychological management was implemented. The control group consisted of patients with regular care who underwent surgery between January 2015 and December 2017. To improve comparability between the two groups, baseline data from the recruited patients were analyzed using propensity-score-matching (PSM) based on age, sex, marital status, education, and disease region.ResultsA total of 539 (11.5%) people developed emotional disorders, of which 319 (6.8%), 151 (3.2%) and 69 (1.5%) had mild, moderate mood and severe emotional disorders, respectively. 2107 pairs of patients were matched after PSM. Scores of HEI in the intervention group were heightened compared with those in the control group (P<0.001) after matching. Moreover, the incidence of emotional disorders in patients decreased after implementing psychological management (P = 0.001). The severity of emotional disorders was alleviated with statistical significance as well (P = 0.010).ConclusionsNurses-led Multidisciplinary-Based psychological management was able to reduce the incidence of emotional disorders and improve the severity of these in spine surgery patients.

Effects of Multimodal Exercise With Augmented Reality on Cognition in Community-Dwelling Older Adults

ObjectivesThis study aims to investigate the effects of an exercise intervention using multimodal exercise with augmented reality and multimodal exercise-only on cognitive function in older adults living in a community dwelling. DesignQuasi-experimental research study. Setting and ParticipantsIn this control study, 78 participants were divided into 2 experimental groups (with sessions 3 times a week for 12 weeks) and a control group (CG). MethodsEG1 participated in a multimodal exercise-only intervention program, EG2 participated in a multimodal exercise program with augmented reality exergames, and CG continued its usual activities. Participants were assessed at baseline and postintervention after 12 weeks. ResultsComparison between baseline and postintervention at 12 weeks showed significant improvements in executive functions, verbal fluency, choice reaction time, and dual task in EG1, whereas there were improvements in general cognition, executive functions, verbal fluency, discrimination reaction time, and depression in EG2 (P ≤ .05). The clinical effect sizes of the interventions were large for overall cognition, executive functions, and reaction time on single- and dual-task reaction time in EG1 and for overall cognition, executive functions, and verbal fluency in EG2. Conclusion and ImplicationsThe intervention programs showed significant improvements in several cognitive domains. The multimodal exercise-only showed improvements in more variables than the multimodal exercise with augmented reality, but the augmented reality group showed greater changes between baseline and postintervention.

Intensive lifestyle intervention positively affects nonalcoholic fatty liver fibrosis score (NFS) and key metabolic parameters: A retrospective study

To date lifestyle intervention is the only proven therapy to treat nonalcoholic fatty liver disease (NAFLD). In this study, we retrospectively analyze the influence of a structured, multimodal 52-week lifestyle intervention program on NAFLD fibrosis score (NFS) as a marker for liver fibrosis. At baseline, 16/47 subjects (34.0%) in our cohort displayed elevated NFS levels suggestive for advanced stages of liver fibrosis. Already after the initial 12-week hypocaloric fasting phase with a formula diet, this number decreased significantly and continued to decrease until the end of the program to 10/47 (21.3%). At baseline, 48.9% of the participants had impaired glucose metabolism, as defined by impaired fasting glucose, elevated HbA1c, or overt type 2 diabetes mellitus. This proportion reduced markedly to 31.9% by the end of the program. The proportion of advanced stages of liver fibrosis was especially high in the subgroup of participants with impaired glucose metabolism. This group particularly benefited from the lifestyle intervention program in terms of their NFS. The present study demonstrates that participants of structured multimodal lifestyle intervention programs with formula diets can significantly improve their metabolic parameters, such as body weight, fasting glucose, HbA1c, and lipids, and substantially reduce their risk of advanced liver fibrosis. Primary care providers must be aware of the close link between impaired glucose metabolism and increased liver-related risk and refer their metabolically ill patients to effective programs.

Efficacy of an app-based multimodal lifestyle intervention on body weight in persons with obesity: results from a randomized controlled trial

BackgroundDespite an increasing number of smartphone applications (apps) addressing weight management, data on the effect of app-based multimodal obesity treatment approaches on weight loss is limited. This study aimed to examine the effect of a digital multimodal weight loss intervention program delivered by an app on body weight in persons with obesity.MethodsFor this single-centre randomized controlled study, 168 adults with a body mass index (BMI) between 30.0 and 40.0 kg/m2 without severe comorbidities were recruited in the region of Munich and randomized into two intervention groups. The ADHOC group received an app-based multimodal weight loss program from baseline on for 12 weeks plus 12 weeks of follow-up. The EXPECT group received the app-based intervention for 12 weeks after 12 weeks of “waiting” (no intervention). Anthropometric data, data on quality of life (EuroQol, EQ-5D-5L), and app usage data were collected.Results64.3% of study participants were women, mean age was 46.8 ± 11.0 years, and mean BMI was 34.2 ± 2.8 kg/m2. The completers analysis resulted in a weight loss of 3.2 ± 3.2 kg (3.2 ± 3.0%) in the ADHOC group and 0.4 ± 2.6 kg (0.3 ± 2.6%) in the EXPECT group after 12 weeks, with a significant difference between the groups (β [95% CI] = −2.9 [−3.8; −1.9], p < 0.001). Completers in the ADHOC group showed weight maintenance after 24 weeks. The time spent on the app was associated with weight reduction (β [95% CI] = −0.10 [−0.18; −0.01], p = 0.03).ConclusionsApplication of a multimodal app-based weight loss program results in moderate weight loss in persons with obesity.Trial registrationThis study was registered in the German Clinical Trials Register (Registration number: DRKS00025291).

Effectiveness of a 5-Week Virtual Reality Telerehabilitation Program for Children With Duchenne and Becker Muscular Dystrophy: Prospective Quasi-Experimental Study.

Duchenne muscular dystrophy (DMD) and Becker muscular dystrophy (BMD) are neuromuscular diseases. DMD is the most prevalent in children. It affects dystrophin production, reducing the patient's mobility and quality of life. New technologies have become a part of physical therapy in DMD and BMD. During the COVID-19 pandemic, conducting telerehabilitation through virtual reality-based games could help these children maintain their physical abilities. This study examined if the use of a virtual platform in a multimodal intervention program changes the results of the 6-minute walk test (6MWT) in children with DMD and BMD. The main objective was to test whether children with DMD and BMD obtain different results on the 6MWT after completing 10 telerehabilitation treatment sessions. The secondary objective was to measure whether other specific motor scales also produce different results after the 10 defined sessions. This was a descriptive, open, and quasi-experimental study with a prospective A-B (control-intervention) design. A sample of 12 participants who fulfilled the inclusion criteria followed the program for 5 weeks with 10 telerehabilitation sessions. During the sessions, the participants used virtual reality glasses to train for the treatment goals. All participants were assessed in person before and after the intervention. Analysis was performed using R software according to the different functional assessments performed for each test. The participants showed a 19.55-meter increase in the 6MWT. Motor function also remained stable according to other scales used to assess it. The North Start Ambulatory Assessment scores were stable in both treatment conditions (P=.20). Furthermore, the timed up and go test results were 0.1 seconds faster in the telerehabilitation condition, and the Motor Function Measure in all of the 3 dimensions showed no significant differences (P=.08). Finally, the Effort Perception Infant scale showed that during the training, fatigue increased in the middle and decreased by the end of the sessions, but the perception throughout the sessions was lower even as the exercise intensity increased. There were no differences between conventional and telerehabilitation treatments, so the telerehabilitation tool could be used without harming children with DMD and BMD, facilitating their access to therapies and stimulating learning to maintain their functional capacity. Therefore, telerehabilitation in general may be helpful in maintaining motor function in children with DMD and BMD. The learning effect helped reduce the feeling of fatigue in the children during the program.

Effectiveness of Bidirectional Multimodal Intervention Program on Nocturnal Enuresis Reduction among School Age Children in Mansoura City, Egypt

Effectiveness of Bidirectional Multimodal Intervention Program on Nocturnal Enuresis Reduction among School Age Children in Mansoura City, Egypt

The impact of an intervention program on abusive intimate behaviors, self-esteem, and self-concept of male perpetrators of intimate partner violence

This study examines the effectiveness of a multimodal perpetrator intervention program (PIP) on intimate partner violence (IPV) perpetrators’ self-reported abusive behaviors, self-esteem, and self-concept. A sample of 53 male IPV perpetrators, both court- and self-referred to a community-based PIP, were assigned to one of two conditions: intervention condition (IC; n = 38) and waiting list control condition (WLCC; n = 15). Data on self-reported intimate violence, self-esteem, and self-concept were collected at baseline, post-test, and 6-month follow-up. The Reliable Change Index (RCI) was also computed. A considerable percentage of IC participants end or substantially reduce their abusive behavior (reoffending self-reported rates were 10.7% at post-treatment and 12.5% at follow-up). IC participants increase self-esteem and self-concept. Changes were maintained at follow-up. Significant differences were found between the groups, with IC participants reporting reductions in abusive behaviors, scoring higher on self-esteem and self-concept, and revealing greater clinical changes than WLCC participants. These findings suggest that multimodal interventions improve self-esteem and self-concept and reduce IPV perpetration.

Self-perception and anticipated efficacy of the anti-dementia multimodal program in 100 older adults with mild cognitive impairment.

Effective and sustainable interventions are clearly needed for mild cognitive impairment (MCI) patients. Despite the clinical importance of the multimodal intervention approach, only one study using a multimodal approach demonstrated promising improvements in memory, attention, and executive functions, which also correlated with functional magnetic resonance imaging (MRI) blood oxygenation level dependent (BOLD) changes in cerebral activation in 50 MCI patients. To investigate the self-perception and anticipated efficacy of each element of the BRAIN-FIT multimodal intervention program (robotic-assisted gait training (RAGT), computerized cognitive therapy, music, light, transcranial direct current stimulation (tDCS), and diaphragmatic breathing exercises) and the correlation between memory, concentration, depression, and sleep in older adults with MCI. One hundred participants (mean±standard deviation: 8.63±78.4 years; 47 women) with MCI were recruited from a major university medical center and community dementia relief center. The survey questionnaire comprised four domains with 21 questions, including four pertaining to general demographic characteristics, eight related to exercise and activity, three related to sleep, and nine related to the BRAIN-FIT program. Chi-squared test was used to analyze the Likert scale data. The descriptive frequencies were calculated. Additionally, Spearman's rho statistics measure the rank-order association. The statistical significance was at P < 0.05. A strong correlation was observed between memory and concentration (r = 0.850, P = 0.000), memory and depression (r = 0.540, P = 0.000), memory and sleep (r = 0.502, P = 0.000), concentration and depression (r = 0.602, P = 0.000), concentration and sleep (r = 0.529, P = 0.000) and sleep and depression (r = 0.497, P = 0.000). The correlation between medical services and sleep (r = 0.249, P = 0.012) was moderate. The chi-square test revealed a significant difference in memory and low-intensity duration of exercise (χ2[3,N = 100] = 11.69, P = 0.01), concentration and high-intensity exercise duration (χ2[3,N = 100] = 10.08, P = 0.02), concentration with low-intensity exercise duration (χ2[3,N = 100] = 21.11, P = 0.00), depression with high-intensity (χ2[3,N = 100] = 10.36, P = 0.02), high-intensity duration of exercise (χ2[3,N = 100] = 10.48, P = 0.02); low-intensity (χ2[3,N = 100] = 7.90, P = 0.48), and low-intensity duration of exercise (χ2[3,N = 100] = 9.69, P = 0.02). Additionally, significant differences were observed between sleep and high-intensity (χ2[3, N = 100] = 10.36, P = 0.02), low-intensity (χ2[3, N = 100] = 18.14, P = 0.00), and low-intensity duration of exercise (χ2[3, N = 100] = 18.30, P = 0.00). Among the participants 5% answered RAGT, and 20% responded that they had experienced computerized cognitive therapy. Music therapy (20 %), diaphragmatic breathing exercises (45 %), and light therapy (10 %) were used. No patient had experienced tDCS. Conversely, 11% of the participants answered RAGT for programs they wanted to experience and 21% responded to computerized cognitive therapy. 25% of music therapy, 22% of diaphragmatic breathing exercises, 5% of light therapy, and 16% of tDCS participants said they wanted to experience it. Finally, 63% of the participants wanted to participate in the BRAIN-FIT program. The present study's results provide clinical evidence-based insights into the utilization of BRAIN-FIT in MCI to maximize cognitive score improvement of memory, concentration, depression, and sleep. Therefore, when designing the BRAIN-FIT, six intervention items were set in proportion to the preference based on the survey, to reduce participants' feeling of repulsion. The program was configured according to exercise intensity.

The effect of a multimodal intervention program on cognitive and daily function of older persons residing in rural communities: A pilot study.

This pilot study aimed to explore the effects of a 12-week multimodal intervention program, comprising cognitive training and cognitive-stimulation, on cognitive performance and daily function of older adults in rural communities. Fifty-one participants were equally assigned to the multimodal intervention, cognitive-stimulation, and no-intervention control groups. Cognition and daily function were assessed using the Korean version of neuropsychological test battery and instrumental activities of daily living at baseline and at the 12-week follow-up assessment, respectively. Compared with the two other groups, the multimodal intervention group showed significant improvement in global cognitive function, attention, and executive function. A significant group-by-time interaction in instrumental activities of daily living was observed among the groups, with a greater improvement observed in the multimodal intervention group and little changes or decreases over time in the other groups. This study suggested the beneficial effects of a multimodal intervention on cognitive and behavioral improvement in older adults.

Improvement of Balance, Motor Aspects, and Activities of Daily Living in Parkinson's Disease after a Sequential Multimodal Aquatic- and Land-Based Intervention Program.

Parkinson's disease (PD) is a neurodegenerative, with heterogeneous clinical conditions and motor changes that reduce functioning. Postural instability is one of the motor aspects of disease progression, with a potential increase in the risk of falls, consequently affecting the activities of daily living (ADL). The objective of this study was to verify the influence of a multimodal intervention program (MIP) sequentially applied in aquatic- (AEs) and land-based environments (LEs) on balance, postural control, motor activities, and ADL in people with PD. It is an interventional clinical study with patients in stages 1 to 4 in the Hoehn and Yahr scale, assessed with Berg Balance Scale (BBS), Mini-Balance Evaluation System Test (Mini-BESTest), Unified Parkinson's Disease Rating Scale (UPDRS) II and III, Dynamic Gait Index (DGI), and quiet stance (QS) analysis in a force platform. The MIP was conducted sequentially with aquatic- (AIs) and land-based interventions (LIs) for 12 weeks each, twice a week, each session lasting 1 hour, and a 12-week interval between interventions. The comparison analysis was made with Friedman ANOVA, and the multiple comparisons with Wilcoxon signed-rank, Bonferroni correction, and effect size (r). The sample comprised 18 people with PD (66.83 ± 11.74 years). The AI and the full intervention (FI) had a large effect according to BBS. With Mini-BESTest, the LI and FI had a large effect. According to UPDRS II, the MIP improved ADL after LI, with a medium effect, and the motor aspects of UPDRS III improved after LI and FI, with a large effect. DGI was not sensitive in the analyses, with a ceiling effect after FI. No differences were identified in QS analyses. This research identified improved balance, ADL, and motor aspects in people with PD after sequential MIP in AI and LI, indicating that land-based and aquatic interventions are complementary and advantageous to people with PD.

Childrens’ behaviour problems’ and parents’ parenting behaviour changes after participation in a modified multimodal early intervention program “STOP 4–7”

The aim of this study was to examine reported changes in children’s behaviour after the children, parents and teachers had participated in the modified early intervention program “STOP 4–7”, which has been developed for children 4 to 7 years old. The aim was also to examine if there are changes in the parents’ parenting behaviour, and if there are differences in the degree of behavioural change ratings between the original and modified “STOP 4–7” groups. For purposes of this study 31 children participated in the first group and 48 children in the second group, as well as at least one of the child’s parents and their teacher. Before and after participation in the program, one of the child’s parents and their teacher completed questionnaires about the child’s behaviour. Parents also completed the Ghent Parental Behaviour Scale. Results show that after participation in the program, in both groups there was a decrease in the child’s externalizing behaviour problems, according to both the parents’ and teachers’ report. After participation in the modified program there was an increase in the parents’ report of discipline strategies and material reward ratings.

Improving language disorders in children with Down syndrome by applying a multimodal intervention program structured in accordance with the Theory of Multiple Intelligences

Down syndrome can cause disorders of both cognitive abilities, but also, most often, cause a deficit in language development, and their speech and language develop later and more slowly, hence the importance of finding optimal ways to improve. The purpose of the research is the development, implementation, and validation of the effectiveness of the speech therapy intervention program structured in accordance with the Theory of Multiple Intelligences (Howard Gardner). Participants with Down syndrome in this study obtained significant improvements in the areas of language and communication assessed after receiving the systematized speech therapy intervention, based on the theory of multiple intelligences.

Early interventions to promote healthy lifestyle and risk factor control in subjects with elevated cardiovascular risk. A 3-year randomized clinical trial

Abstract Background Cardiovascular risk factor control is suboptimal in Europe, including Norway. The present study examined the efficacy of a multimodal primary prevention intervention program based on the existing Norwegian health care system. Methods In this open-label randomized controlled trial, adult patients with elevated cardiovascular risk were randomly assigned to an intervention program including a hospital-based lifestyle course and primary care follow-up or to a control group. The participants were recruited between 2011 and 2015. Primary outcome was change in validated cardiovascular risk scores (NORRISK, NORRISK2, Framingham, PROCAM) between baseline and follow-up. Secondary outcomes included major cardiovascular risk factors. Results After 36 months the NORRISK score was significantly improved in patients assigned to the intervention group (IG) compared to patients assigned to the control group (CG); absolute difference in mean delta score in the IG (n=305) compared to mean delta score in the CG (n=296): −0.92, 95% CI: −1.48 to −0.36, p=0.001. The results for NORRISK2, Framingham and PROCAM showed similar significant effects. The secondary endpoints including total cholesterol and blood pressure were only minimally, and non-significantly, reduced in the IG, but the proportion of smokers (p=0.0028) and with metabolic syndrome (p&amp;lt;0.0001) were significantly reduced. A limited number of cardiovascular events were observed, IG (n=9), CG (n=16). Conclusions In subjects with elevated cardiovascular risk, a newly developed prevention program, combining a hospital-based lifestyle course and primary care follow-up, significantly reduced cardiovascular risk scores after 36 months. This benefit appeared achievable primarily through improvements in metabolic syndrome characteristics and smoking habits as prominent contributors to the positive results. Funding Acknowledgement Type of funding sources: Public grant(s) – National budget only. Main funding source(s): The trial is funded in a grant from the Norwegian healthdepartment.

Case Series of an ICT-Based Multimodal Intervention Program for People with Major Neurocognitive Disorders: The SENSE-GARDEN Project

There are an increasing number of older persons living with major Neurocognitive Disorders (NCDs). Psychosocial interventions are effective in the management of cognition, mood disorders, behavioural and psychological symptoms.