Multiple Intervention Components Research Articles

Multiple-component interventions to increase rotavirus vaccine uptake in children: a randomised controlled trial

Rotavirus vaccine has not been included in the Hong Kong Government's Childhood Immunisation Programme. This randomised controlled trial examined whether a simple intervention package can increase rotavirus vaccine uptake in Hong Kong children. Postpartum mothers were recruited from two public hospitals in Hong Kong and randomly allocated into three groups using block randomisation, with block sizes kept unknown to investigators and research staff. Control-subjects received public rotavirus information. Subjects in intervention group 1 additionally received: key rotavirus information with a hyperlink to a webpage showing private clinics providing rotavirus vaccines and guidance on searching the clinics, and vaccination reminders. Subjects in intervention group 2 received the same intervention as group 1, plus tokens to receive free rotavirus vaccines at specific health centres. Rotavirus vaccination status was collected when children were approximately 8 months old. Maternal attitudes towards rotavirus vaccine were assessed at enrolment and at the end of the study. This trial has been registered in the Chinese Clinical Trial Register (Ref.:ChiCTR2000039791). From 16 February to 30 July 2021, 788 eligible mothers were recruited and randomly allocated to control group (n=263), intervention group 1 (n=263), and intervention group 2 (n=262). The full intervention package (intervention group 2 relative to control group) increased rotavirus vaccine uptake by 1.7 times (95% confidence interval [CI]=1.49-1.97) or by 33 percent-points (from 48% to 81% uptake). Provision of key rotavirus information with vaccination reminders (intervention group 1 relative to control group) and removal of financial barrier (intervention group 2 relative to intervention group 1) increased uptake by 1.17 times (95% CI=0.99-1.38) or 8 percent-points, and by 1.46 times (95% CI=1.29-1.66) or 25 percent-points, respectively. A multiple-component intervention package, and in particular providing free vaccine, could increase the uptake of rotavirus vaccine in Hong Kong children. The impact of the intervention package was greatest in low-income families, emphasising the importance of removing financial barriers to vaccination to promote equity. Incorporating rotavirus vaccine into the routine CIP could further protect more young children from rotavirus infection and improve equity. This work was supported by the Health and Medical Research Fund by the Health Bureau, Government of Hong Kong SAR [Ref.: 19180202].

Effectiveness of psychological interventions for reducing depressive symptomatology and overload and improving quality of life in informal caregivers of non-institutionalized dependent elderly: a systematic review.

The phenomenon of aging is distinguished by profound life transformations, with the most dependent group being constituted by elderly individuals. The responsibility for their care primarily falls on the figure of the informal caregiver. The scarcity of time, the stress associated with caregiving, the financial, work-related, and personal difficulties it entails, make it a collective with high probabilities of experiencing various psychological disorders. Interventions that have shown the best results are those of multiple components, composed of various techniques that seek to adapt to the reality of the informal caregiver. The purpose of this study is a systematic review of effective interventions on depressive symptoms, emotional wellbeing, burden, or quality of life in informal caregivers of non-institutionalized dependents from 2018 to the present. A search was conducted in November 2023, on Pubmed, Pubmed Central, Proquest, and Scielo. The final review was conducted on 11 articles. The results indicate that multiple component interventions including cognitive behavioral techniques and psychoeducation in combination with stress coping techniques and social support are more effective on depressive symptoms, burden, quality of life, and increasing the social support network. Results on web-based programs demonstrate their efficacy and effectiveness, but require a greater number of trials to adjust their methodological quality and content to the idiosyncrasies of the informal caregiver.

Evaluating Intensity, Complexity, and Potential for Causal Inference in Social Needs Interventions

Interventions that address needs such as low income, housing instability, and safety are increasingly appearing in the health care sector as part of multifaceted efforts to improve health and health equity, but evidence relevant to scaling these social needs interventions is limited. To summarize the intensity and complexity of social needs interventions included in randomized clinical trials (RCTs) and assess whether these RCTs were designed to measure the causal effects of intervention components on behavioral, health, or health care utilization outcomes. This review of a scoping review was based on a Patient-Centered Outcomes Research Institute-funded evidence map of English-language US-based RCTs of social needs interventions published between January 1, 1995, and April 6, 2023. Studies were assessed for features related to intensity (defined using modal values as providing as-needed interaction, 8 participant contacts or more, contacts occurring every 2 weeks or more often, encounters of 30 minutes or longer, contacts over 6 months or longer, or home visits), complexity (defined as addressing multiple social needs, having dedicated staff, involving multiple intervention components or practitioners, aiming to change multiple participant behaviors [knowledge, action, or practice], requiring or providing resources or active assistance with resources, and permitting tailoring), and the ability to assess causal inferences of components (assessing interventions, comparators, and context). This review of a scoping review of social needs interventions identified 77 RCTs in 93 publications with a total of 135 690 participants. Most articles (68 RCTs [88%]) reported 1 or more features of high intensity. All studies reported 1 or more features indicative of high complexity. Because most studies compared usual care with multicomponent interventions that were moderately or highly dependent on context and individual factors, their designs permitted causal inferences about overall effectiveness but not about individual components. Social needs interventions are complex, intense, and include multiple components. Our findings suggest that RCTs of these interventions address overall intervention effectiveness but are rarely designed to distinguish the causal effects of specific components despite being resource intensive. Future studies with hybrid effectiveness-implementation and sequential designs, and more standardized reporting of intervention intensity and complexity could help stakeholders assess the return on investment of these interventions.

EFFECTIVENESS OF COGNITIVE STIMULATION THERAPY(CST) AMONG PEOPLE WITH DEMENTIA - A NARRATIVE REVIEW

OBJECTIVE: This study explores the effectiveness of cognitive stimulation therapy to improve cognition in people with dementia. SELECTION METHOD: PubMed, Google Scholar, Science Direct, Cochrane from these databases, articles were searched using keywords. SELECTION CRITERIA: The articles were collected based on the inclusion criteria focusing on the cognition in people with dementia. RESULTS: The preliminary results suggested that the tasks like measuring attention, memory, speed processing, executive functions, and speed processing following the cognitive stimulation treatment (CST). Evidence shows that CST promisingly improves people’s cognitive functions as measured by the (MMSE) mini-mental state examination. This test investigates memory, orientation, language, and visuospatial abilities. CST has led to significant improvements in quality of life, along with care givers. Analyses suggests CST is equally effective as many dementia drugs. CONCLUSION: Cognitive stimulation therapy improves cognition in people with dementia and benefits the quality of life. Evidence from several studies indicates that cognitive stimulation therapy along with multiple component interventions improves not only cognition but also the language, behavior, and quality of life of people with dementia. Results from interviews of CST sessions found key themes, including positivity being in the groups, due to a supportive and good environment, improvements in confidence, mood, and concentration. KEY WORDS: Non-Pharmacological intervention, Cognitive stimulation therapy (CST), People with Dementia (PwD), Cognition, Older adults, assessment scales, Quality of life (QoL).

Run, hide, or fight? Considerations for young children with autism and lockdown drills

Lockdown drills have become a normal part of school activities for children across the United States. Despite the increase in drill practice and consistent prevalence of school shootings, little information exists to deem current practice effective, and little guidance exists to guide educators’ preparation efforts. As it stands, schools are planning and executing lockdown drills with variability with little to no planning dedicated to diverse learners such as young children with autism spectrum disorder (ASD). At the same time, a vast research base that supports evidence-based practices for learners with a diagnosis of ASD exists, yet these known supports are not being utilized to prepare them for these life-threatening emergencies. This article summarizes the current guidance and research surrounding lockdown drills and evidence-based practices used to teach children with ASD similar skills that could be applied to teach lockdown drills. Potential strategies for multiple component interventions are described for researchers to consider, individualize, and evaluate.

The barriers and enablers to providing healthy food in New Zealand secondary school canteens

Establishing healthy lifelong eating habits in young people is important for short and long-term health(1). Schools are ideal setting to improve diet. However, research shows that many school food environments are unhealthy(2). In New Zealand (NZ), the canteen is a popular food provision, particularly in secondary schools. This research aimed to explore the barriers and enablers to providing healthy food and beverages in NZ secondary school canteens. In 2022, 6 secondary schools were purposively selected to participate in semi-structured interviews about foods and beverages sold in schools’ canteens and the factors that influenced this. In total, 11 stakeholders representing six schools and one staff member of an external catering company completed interviews. The interviews were transcribed and analysed using a reflexive thematic analysis approach(3). Four themes were developed. Theme 1 Action-oriented school policies that are based on healthy eating principles can facilitate healthier canteens highlighted the use and characteristics of policies. The subtheme highlighted that Mandatory policies are more enforceable. Theme 2 Multiple component opt-in programs or interventions facilitate a healthier school food provision shows that opt-in government interventions (e.g. Ka Ora, Ka Ako, the NZ free school lunch initiative) with funding, monitoring, and incentives can improve food provision. The subtheme Health-enhancing changes inthe school environment has flow-on effect to canteens showed that these changes can affect the entire school food environment. Theme 3 Healthy canteens get lost in the “pecking order” of what’s important highlights that while schools and key stakeholders may believe healthy eating is important, other factors related to well-being and education were more important to prioritise within the school’s limited resources. Theme 4 People’s values, attitudes and beliefs may help and hinder the healthiness of canteens and explores the role champions have in influencing the healthiness of the canteen. Champions were those with a positive, proactive attitude, value healthy eating and are capable. Subtheme 1 Meet student preferences while providing healthy food was a common barrier many champions worked hard to overcome. The final subtheme identified how A collaborative approach within schools and their communities can overcome barriers to healthy canteens. Government mandates and interventions can positively impact the canteen and other food provisions. This research supports a recommendation for schools to create and implement school policies around food encompassing a whole-school approach.

Commentary: A nurturing care perspective on bundling interventions - a reflection on Jeong etal. (2023).

Bundling multiple interventions have been implemented and evaluated in response to global recognition that young children benefit from the multiple components of nurturing care. Engaging Fathers for Effective Child Nutrition and Development in Tanzania Study evaluated the impact of adding a parenting intervention to a nutrition program and involving fathers on children's development. The study found that the bundled nutrition-parenting intervention improved children's short-term cognitive and receptive language scores over the nutrition only intervention, with no difference between involving mother-father couples versus mothers only. This study adds to recommendations for future multiple component interventions, including to investigate the mechanisms driving interventions, to address the potential for both benefits and harms, to involve household and community caregivers, and to incorporate implementation research to transition evidence-based programs to scale. Expanding nurturing care through multiple component interventions has the potential to promote equity by ensuring that all children have opportunities for healthy growth and development.

Promoting healthy sleep in Chinese kindergarteners through a family-based intervention: protocol of the “Healthy Sleep” randomised controlled trial

BackgroundSleep is instrumental for growth and development in children, making it critical to establish healthy sleep habits from the earliest years of life. Many kindergarteners (3–6 years) in China have inadequate and poor sleep, necessitating targeted interventions. This research protocol details the “Healthy Sleep” intervention that was designed to promote healthy sleep among kindergarteners in China.MethodsThe “Healthy Sleep” intervention will be family-based and will support parents as change agents. The development of the intervention is based on evidence regarding correlates of sleep in young children and guided by Bandura’s social cognitive theory. A 12-month randomised controlled trial will be conducted to examine the efficacy of the intervention for promoting healthy sleep in Chinese kindergarteners and the intervention's effects on child development outcomes. A targeted sample of 160 kindergarteners and their parents will be recruited through social media. The intervention group (n = 80) will receive monthly webinars for one year that include multiple intervention components – including educational training, goal setting and planning, as well as follow-up support sessions. The control group (n = 80) will receive videos of the recorded educational sessions after the study end. For primary outcomes, child sleep behaviours will be examined using the Child Sleep Health Questionnaire. For secondary outcomes, communication, fine motor, gross motor, personal-social, and problem-solving development will be examined using the Ages and Stages Questionnaire; executive functions will be examined using the Head, Toes, Knees, and Shoulders Revised tasks. Potential intervention mediators and covariates will be measured using a parental questionnaire. Mixed models will be conducted.DiscussionThis intervention targets sleep behaviours among kindergarteners in China. It has the potential to inform programs to support parents in helping their child establish healthy sleep habits from the earliest years of life. The study will provide high-quality experimental evidence on sleep behaviours in relation to development outcomes in kindergarteners. This evidence will inform family-based strategies to optimise early childhood development and inform national and international updates of the sleep recommendations for young children.Trial registrationThe trial was registered prospectively at Chinese Clinical Trial Registry (ID: ChiCTR2300072105) on 2 June 2023.

Contextualizing evidence-based nurse-led interventions for reducing 30-day hospital readmissions using GRADE evidence to decision framework: A Delphi study.

High 30-day readmission rates increase hospital costs and negatively impact patient outcomes in many healthcare systems, including Hong Kong. Evidence-based and local adaptable nurse-led interventions have not been established for reducing 30-day hospital readmissions among general medical patients in Hong Kong's public healthcare system. The aim of this study was to select and refine evidence-based nurse-led interventions for reducing 30-day hospital readmissions among general medical patients in Hong Kong's public healthcare system using the Grading of Recommendations Assessment, Development and Evaluation (GRADE) Evidence to Decision (EtD) framework. Eighteen local healthcare stakeholders were recruited to carry out a two-step process. In step 1, stakeholders were invited to prioritize nurse-led interventions which were supported by existing evidence and suggest important combinations of different interventions. For all interventions prioritized in step 1, step 2 involved stakeholders performing a two-round Delphi questionnaire aiming to generate consensus-based interventions appropriate to the local context. GRADE EtD framework was applied to guide the decision-making process, taking into account certainty of evidence, benefits and harms, resource use, equity, acceptability, and feasibility. Four out of eight nurse-led interventions reached a positive consensus with percentage agreement ranging from 70.6% to 82.4%. GRADE EtD criteria ratings showed that over 70% of stakeholders agreed these four interventions were probably acceptable and feasible, though the certainty of evidence was low or moderate. Half of stakeholders believed their desirable effects compared to undesirable effects were large. However, the resources required and how these nurse-led interventions might affect health inequities when implemented were uncertain. Preliminary implementation issues included high complexity of delivering multiple nurse-led intervention components, and challenges of coordinating different involved parties in delivering the interventions. Appropriate resource allocation and training should be provided to address these potential problems, as suggested by stakeholders. Using the GRADE EtD framework, four nurse-led interventions were recommended by healthcare stakeholders as possible strategies for reducing 30-day hospital readmissions among general medical patients in Hong Kong. To address preliminary implementation issues, nurses' role as care coordinators should also be strengthened to ensure smooth delivery of nurse-led intervention components, and to facilitate multidisciplinary collaboration during service delivery.

Protocol for an evaluation of adherence monitoring and support interventions among people initiating antiretroviral therapy in Cape Town, South Africa—a multiphase optimization strategy (MOST) approach using a fractional factorial design

BackgroundSouth Africa bears a large HIV burden with 7.8 million people with HIV (PWH). However, due to suboptimal antiretroviral therapy (ART) adherence and retention in care, only 66% of PWH in South Africa are virally suppressed. Standard care only allows for suboptimal adherence detection when routine testing indicates unsuppressed virus. Several adherence interventions are known to improve HIV outcomes, yet few are implemented in routinely due to the resources required. Therefore, determining scalable evidence-based adherence support interventions for resource-limited settings (RLS) is a priority. The multiphase optimization strategy (MOST) framework allows for simultaneous evaluation of multiple intervention components and their interactions. We propose to use MOST to identify the intervention combination with the highest levels of efficacy and cost-effectiveness that is feasible and acceptable in primary care clinics in Cape Town.MethodsWe will employ a fractional factorial design to identify the most promising intervention components for inclusion in a multi-component intervention package to be tested in a future randomized controlled trial. We will recruit 512 participants initiating ART between March 2022 and February 2024 in three Cape Town clinics and evaluate acceptability, feasibility, and cost-effectiveness of intervention combinations. Participants will be randomized to one of 16 conditions with different combinations of three adherence monitoring components: rapid outreach following (1) unsuppressed virus, (2) missed pharmacy refill collection, and/or (3) missed doses as detected by an electronic adherence monitoring device; and two adherence support components: (1) weekly check-in texts and (2) enhanced peer support. We will assess viral suppression (<50 copies/mL) at 24 months as the primary outcome; acceptability, feasibility, fidelity, and other implementation outcomes; and cost-effectiveness. We will use logistic regression models to estimate intervention effects with an intention-to-treat approach, employ descriptive statistics to assess implementation outcomes, and determine an optimal intervention package.DiscussionTo our knowledge, ours will be the first study to use the MOST framework to determine the most effective combination of HIV adherence monitoring and support intervention components for implementation in clinics in a RLS. Our findings will provide direction for pragmatic, ongoing adherence support that will be key to ending the HIV epidemic.Trial registrationClinicalTrials.gov NCT05040841. Registered on 10 September 2021.

Changing prescribing practice for rapid tranquillization-a quality improvement project based on the Plan-Do-Study-Act method.

It is unclear how the evidence from clinical trials best translates into complex clinical settings. The aim of this quality improvement (QI) project was to change prescribing practice for rapid tranquillization in inpatient mental health care services examining the effectiveness of the Plan-Do-Study-Act (PDSA) method. A prospective QI project was conducted to ensure that intramuscular (IM) diazepam was substituted with IM lorazepam for benzodiazepine rapid tranquillization in inpatient mental health care. We monitored the prescription and administration of medication for rapid tranquillization before (N = 371), during (N = 1130) and after (N = 364) the QI intervention. Seven iterative PDSA cycles with a multiple-component intervention approach were conducted to gradually turn the prescribing practice in the desired direction. Simultaneously, a standard monitoring regimen was introduced to ensure patient safety. Lorazepam administrations gradually replaced diazepam during the intervention period which was sustained post-intervention where lorazepam comprised 96% of benzodiazepine administrations for rapid tranquillization. The mean dose of benzodiazepine administered remained stable from pre (14.40mg diazepam equivalents) to post (14.61mg) intervention phase. Close to full compliance (> 80%) with vital signs monitoring was achieved by the end of the observation period. It was possible to increase the quality of treatment of acute agitation in a large inpatient mental health care setting using a stepwise approach based on iterative PDSA cycles and continuous data feedback. This approach might be valuable in other prescribing practice scenarios with feedback from local stakeholders and opinion leaders.

Describing the nonsurgical, nonpharmacological interventions offered to adolescents with persistent back pain in randomized trials: A scoping review.

Persistent nonspecific back pain is now established as a biopsychosocial phenomenon that can be meaningfully affected by individuals' cognitions, emotions, lifestyle factors and family and social relationships. Recent guidelines for the treatment of adolescents with persistent nonspecific back pain, as well as those for youth with mixed chronic pain, strongly recommend interdisciplinary care in which adolescents receive treatment for both mind and body. The objective of this scoping review was to examine the interventions evaluated in randomized trials for adolescents with persistent back pain to determine whether they correspond to these guidelines and to reveal future research priorities. The review protocol was registered in March 2022. We followed the PRISMA guidelines for scoping reviews. Twelve electronic databases were searched for relevant study reports. Data were charted on study characteristics, participant characteristics and intervention details using the Template for Intervention Description and Replication (TIDieR) checklist. The search yielded 1952 records, of which eight reports representing seven randomized trials were eligible. The most common interventions were exercise therapy (n =6) and back education (n=4). Five studies employed multiple intervention components, but none was multidisciplinary. Studies primarily targeted posture or biomechanical factors. One study included an intervention addressing participants' fears and beliefs about pain. Randomized trials for adolescents with persistent back pain have primarily relied upon an outdated, biomechanical explanation of persisting pain. Future randomized trials should align with current treatment recommendations and measure outcomes across multiple biopsychosocial domains. This scoping review describes in detail the interventions included in randomized trials for adolescents with persistent, nonspecific back pain. The review is important because it reveals discrepancies between those interventions and the interventions recommended for this population.

Interventions for Picky Eaters among Typically Developed Children—A Scoping Review

Picky eating in children is often a major source of concern for many parents and caregivers. Picky eaters (PEs) consume limited foods, demonstrate food aversion, and have a limited food repertoire, which hinders their growth and health. These behaviours are common in children with special health care needs despite the rise in typically developing children. This leads to less attention being given to intervention programmes for typically developing children. Therefore, this scoping review aims to investigate the key concept of an existing intervention programme for PE among typically developing children, primarily on the types and approaches selected. A thorough literature search was conducted on three primary databases (PubMed, Emerald In-sight, and Web of Science) using predefined keywords. The literature was then appraised using the Joanna Briggs Institute's guidelines and protocols, and the PRISMScR checklist. Inclusion and exclusion criteria were also specified in the screening procedure. Results showed that the majority of the interventions in these studies were single-component interventions, with the sensory approach being the type that was most frequently utilised, followed by the nutrition approach and parenting approach. Single and multiple intervention components improved the assessed outcome, with a note that other components may or may not show a similar outcome, as they were not assessed in the single-component intervention. Given the evidence that picky eating is influenced by various factors, a multi-component intervention can provide a substantial impact on future programmes. In addition, defining picky eaters using standardised tools is also essential for a more inclusive subject selection.

Use of didactic training and feedback to improve quality and acceptability of progress notes written by direct‐care staff on a psychiatric inpatient unit

AbstractWriting progress notes represent a critical activity of practicing clinicians in a variety of settings. They provide a way for medical practitioners, insurance companies, and others to communicate in a timely fashion regarding ongoing clinical care. Previous research showed that intervention components like didactic training, using note templates, and feedback improved the quality of progress notes. At least two questions remain despite several studies already addressing progress note writing. First, previous research most often used multiple intervention components to improve progress notes. Thus, the relative impact of two common components of interventions, such as didactic training and feedback, is unclear. Second, previous research has not evaluated the acceptability of improved progress notes for the practitioners that actually utilize them. Thus, the purpose of the current study evaluated the components of didactic training and feedback on improved progress note writing for four direct staff employed by a psychiatric inpatient unit. A second purpose of this study was to evaluate the acceptability of the training procedures by both (a) the direct‐care staff participating in this study and (b) four members of the psychiatric treatment team that used direct‐care staff progress notes to inform their clinical care. Results showed that feedback was necessary to improve the accuracy of progress notes for three of four participants. The direct‐care staff reported the training procedures as acceptable and the treatment team noted improvements in the quality of the progress notes after intervention. These data will be discussed in terms of ways to arrange effective training programs to improve direct‐care staff's progress notes.

A Methodological Approach for Documenting Multi-Component Interventions Targeting Family Caregivers.

Managing the complex care needs of seriously ill patients transitioning from hospital to home can have detrimental effects on family caregivers (FCG). Multi-component interventions tailored to FCG needs are most effective at reducing caregiver burden, distress, and depression. However, gaps exist in determining best methods to assess, document, and analyze intervention components for FCGs. Common methods used to capture patient data during transitions in care may not be appropriate or allowed for FCG needs. As such, we present a methodological approach for electronically capturing, reporting, and analyzing multiple intervention components. This approach uses a standardized terminology and pathway for tailoring intervention components in real time while evaluating intervention effects across time. We use examples from a randomized controlled trial to illustrate the benefits of the current approach for analyzing the effectiveness of multi-component interventions in the context of caregiving research.

Effectiveness of lifestyle interventions for treatment of overweight/obesity among children in China: A systematic review and meta-analysis.

Pediatric obesity has become a global public health problem. China has the largest population of obese children in the world. It is important to develop effective interventions to control child obesity. This systematic review summarizes proof from randomized controlled trials to assess the efficacy of lifestyle intervention to reduce BMI and metabolic risk factors for overweight/obese Chinese children. We searched studies from five databases (PubMed, MEDLINE, EMBASE, Cochrane Database of Systematic Reviews, and CNKI). Research that meets the following requirements was included: randomized controlled trials, participants are overweight/obese Chinese children aged <18 years old, and the effectiveness of lifestyle interventions is evaluated. Eight randomized controlled trials were included. A significant difference was found between the intervention group and the control group for the BMI changes (mean difference = -1.49; 95% CI: -2.20 to -0.77; p < 0.001). Subgroup analyses consistently demonstrated that effects of lifestyle interventions on BMI change including multiple-component interventions (mean difference = -2.03 kg/m2; 95% CI: -3.62 to -0.43; p < 0.001) were stronger than those only with physical activities or health education; effects of lifestyle interventions on BMI change were also strengthened if duration of intervention last for more than 1 year (mean difference = -3.03 kg/m2; 95% CI: -4.00 to -2.06; p = 0.01) or with age during 12-18 years old (mean difference = -1.90 kg/m2; 95% CI: -3.37 to -0.43; p < 0.001). Lifestyle interventions are effective in reducing BMI in Chinese children with overweight/obesity, and the effectiveness is more profound when the lifestyle intervention includes multiple components, lasts longer than one year, and/or is conducted among teens. These findings provide an important evidence base for developing and implementing potentially effective lifestyle interventions for the treatment of overweight/obesity among Chinese children.

Interventions for improving mobility after hip fracture surgery in adults.

Interventions for improving mobility after hip fracture surgery in adults.

Social Cognitive Theory-based Interventions on Healthy Lifestyles for Hypertensive Patients: A Systematic Review

Abstract Effective strategies to promote a long-term healthy lifestyle among hypertensive patients remain unclear. Social cognitive theory (SCT)-based interventions have demonstrated some effectiveness in promoting sustainable lifestyle change in this population. This systematic review aims to synthesize randomized controlled trials (RCTs) examining the effect of SCT-based interventions on healthy lifestyles, including physical activity [PA] and/or diet adherence [DA], in hypertensive patients. Four electronic databases (CINAHL, PubMed, Scopus, and Web of Science) were searched to identify RCTs that: 1) targeted hypertensive patients; 2) reported PA and/or DA as proximal outcomes; and 3) included an intervention guided by the SCT. Narrative and tabulation synthesis were conducted to present the effects of the SCT-based interventions. Fifteen studies were included in this systematic review with 3,388 hypertensive patients (mean age = 52.21, 68.70% female). Findings were inconsistent for the SCT-based interventions targeting multiple behaviors, including DA and PA. Multiple-component interventions, including PA training and identification of PA barriers through group discussion, had a greater effect size on PA improvement (d = .93–.99) than interventions without these components (d = .29–.44). Interventions with a longer duration (&gt; 12 weeks), greater length of time for sessions (150 minutes/session), and higher session frequency (2 days/week) were more effective on DA change (d = .65) than interventions with a shorter duration (&lt; 12 weeks), shorter session length (60–90 minutes), or lesser session frequency (monthly meeting) (d = .09–.51). Keywords: Social cognitive theory, Hypertension, Physical activity, Diet adherence

MCMTC: A Pragmatic Framework for Selecting an Experimental Design to Inform the Development of Digital Interventions.

Advances in digital technologies have created unprecedented opportunities to deliver effective and scalable behavior change interventions. Many digital interventions include multiple components, namely several aspects of the intervention that can be differentiated for systematic investigation. Various types of experimental approaches have been developed in recent years to enable researchers to obtain the empirical evidence necessary for the development of effective multiple-component interventions. These include factorial designs, Sequential Multiple Assignment Randomized Trials (SMARTs), and Micro-Randomized Trials (MRTs). An important challenge facing researchers concerns selecting the right type of design to match their scientific questions. Here, we propose MCMTC – a pragmatic framework that can be used to guide investigators interested in developing digital interventions in deciding which experimental approach to select. This framework includes five questions that investigators are encouraged to answer in the process of selecting the most suitable design: (1) Multiple-component intervention: Is the goal to develop an intervention that includes multiple components; (2) Component selection: Are there open scientific questions about the selection of specific components for inclusion in the intervention; (3) More than a single component: Are there open scientific questions about the inclusion of more than a single component in the intervention; (4) Timing: Are there open scientific questions about the timing of component delivery, that is when to deliver specific components; and (5) Change: Are the components in question designed to address conditions that change relatively slowly (e.g., over months or weeks) or rapidly (e.g., every day, hours, minutes). Throughout we use examples of tobacco cessation digital interventions to illustrate the process of selecting a design by answering these questions. For simplicity we focus exclusively on four experimental approaches—standard two- or multi-arm randomized trials, classic factorial designs, SMARTs, and MRTs—acknowledging that the array of possible experimental approaches for developing digital interventions is not limited to these designs.

Rehabilitation of Cognitive Deficits Poststroke: Systematic Review and Meta-Analysis of Randomized Controlled Trials.

Despite the prevalence of cognitive impairment poststroke, there is uncertainty regarding interventions to improve cognitive function poststroke. This systematic review and meta-analysis evaluate the effectiveness of rehabilitation interventions across multiple domains of cognitive function. Five databases were searched from inception to August 2019. Eligible studies included randomized controlled trials of rehabilitation interventions for people with stroke when compared with other active interventions or standard care where cognitive function was an outcome. Sixty-four randomized controlled trials (n=4005 participants) were included. Multiple component interventions improved general cognitive functioning (MD, 1.56 [95% CI, 0.69-2.43]) and memory (standardized MD, 0.49 [95% CI, 0.27-0.72]) compared with standard care. Physical activity interventions improved neglect (MD, 13.99 [95% CI, 12.67-15.32]) and balance (MD, 2.97 [95% CI, 0.71-5.23]) compared with active controls. Noninvasive brain stimulation impacted neglect (MD, 20.79 [95% CI, 14.53-27.04) and functional status (MD, 14.02 [95% CI, 8.41-19.62]) compared with active controls. Neither cognitive rehabilitation (MD, 0.37 [95% CI, -0.94 to 1.69]) nor occupational-based interventions (MD, 0.45 [95% CI, -1.33 to 2.23]) had a significant effect on cognitive function compared with standard care. There is some evidence to support multiple component interventions, physical activity interventions, and noninvasive brain stimulation improving cognitive function poststroke. Findings must be interpreted with caution given the overall moderate to high risk of bias, heterogeneity of interventions, and outcome measures across studies.