Standardized Intervention Protocol Research Articles

PENGARUH CIRCULO MASSAGE TERHADAP TEKANAN DARAH PADA PENDERITA HIPERTENSI DI DESA SUKOWONO KABUPATEN JEMBER

Circulo Massage is one of massage or massage with the main target of lymph blood circulation. This study aims to determine the effect of circulo massage on blood pressure in hypertensive patients in Sukowono Village, Jember Regency Research using Pre-experimental design with Pretest – Post test Group design. The population of this study were hypertensive patients in Sukowono Village, Jember Regency with a population of 152 respondents divided into 30. The sampling technique used Simple Random Sampling. The intervention process uses a standardized intervention protocol for circulo massage procedures. The results of the study with the Paired Sample T-Test test (α < 0.05) showed a significant effect between the results of giving circulo massage with pre and post intervention systolic blood pressure measurements in hypertensive patients. The results of the study on the measurement of systolic blood pressure before the intervention obtained an average value of 154.67 mmHg and after the intervention obtained an average value of 146 mmHg. The effect of circulo massage on systolic blood pressure with the Paired Sample T-Test statistical test obtained a p value of 0.0001. The conclusion of this study is that there is a significant effect on blood pressure in hypertensive patients before and after being given circulo massage. Researcher recommendations, it is hoped that future researchers will better control other variables outside the study so as to avoid bias in research.

An investigation of the clinical nutritional practices of oncologists and the management of cancer-related malnutrition in inpatient care.

Malnutrition in oncology patients has been consistently associated with poor clinical outcomes. Despite the existence of nutrition guidelines and recommendations that emphasize the role of nutrition in cancer care and despite the prevalence of nutrition care needs in oncology units, nutrition interventions are not always implemented. As a result, malnutrition is not adequately assessed or managed. The aims of this study were to investigate current nutrition practice and management, determine the awareness of cancer-related malnutrition among oncologists and healthcare professionals and identify the barriers that prevent proper nutrition management. A total of 141 medical health professionals working in hospitals with cancer care units in Saudi Arabia were recruited using an online questionnaire. Most of the participants (65%) rated the role of nutrition in cancer treatment as crucial. The most common diagnostic criterion for cachexia was weight loss. 33% responded that they did not know how to conduct nutritional assessments. Only 14% evaluated patients' nutritional status by using validated screening tools. In most institutions (72%), nutritional support was delivered by clinical nutritionists or dieticians. The most frequent barrier preventing oncologists' from including nutritional care was a lack of clear guidelines. Our survey highlights a high level of awareness among oncologists regarding the critical role of nutrition management in cancer care. However, there is a need for applicative, and reliable nutrition guidelines. The integration of standardized nutrition assessments and intervention protocols is essential for better implementation. A key step forward is improving the communication and referral processes between dietitians and oncologists within cancer units, thereby promoting a more cooperative and effective approach to patient care.

Pearls and pitfalls in contemporary management of marginal velopharyngeal inadequacy among children with cleft palate.

Marginal velopharyngeal inadequacy (MVPI) is a particular status of velopharyngeal closure after cleft palate repair. The physiological and phonological characteristics of patients with MVPI are significantly different from those with typical velopharyngeal insufficiency. The pathological mechanisms and diagnostic criteria of MVPI are still controversial, and there is limited evidence to guide the selection of surgical and non- surgical management options and a lack of recognized standards for treatment protocols. Based on a systematic study of the relevant literatures, this review identifies specific problems that are currently under-recognized in the diagnosis and treatment of MVPI and provides guidelines for further exploration of standardized and reasonable intervention protocols for MVPI.

PSYCHOLOGICAL TREATMENT VARIANT WITH EYE MOVEMENT DESENSITIZATION AND REPROCESSING: A CASE REPORT

Background: EMDR (eye movement desensitization and reprocessing) is a structured psychotherapy method that facilitates the treatment of various psychopathologies and problems related to both traumatic events and more common but emotionally stressful experiences.1 Due to the confinement due to the COVID-19 (Coronavirus Disease 2019) pandemic, people have developed a mixture of anticipatory anxiety, stress, tiredness, misunderstanding and fear, a psychological and emotional mixture that does not fit into any of the existing boxes in the classification of mental disorders.2 Eye Movement Desensitization and Reprocessing (EMDR) has abundant evidence of efficacy in trauma spectrum disorders. Its efficacy in anxious and depressive disorders in children and adolescents has been scarcely studied.3 Objective: To evaluate the efficacy of an alternative EMDR protocol. Methods: It is about a 13-year-old female adolescent who seeks care after having made her second suicide attempt after 9 months of failed psychological and psychiatric therapy, the standard EMDR protocol is executed in a first unsuccessful session and a variant of the EMDR protocol that occurred incidentally achieving the therapeutic goal. Results: This is an adolescent with a history of failed mental health treatment, the standard intervention protocol with EMDR was executed without success, however; In a second attempt, the patient spontaneously proceeds with desensitization from positive experiences without ever directly addressing the traumatic event. In this case, the reprocessing of the events occurred through positive experiences for the patient instead of what is indicated in the standard protocol where the trauma is reprocessed through the negative event. Conclusion: Psychological treatment using EMDR was effective despite its atypical execution, therefore variations to the original protocol can be applied.

Interventions improving well-being of adult cancer patients' caregivers: A systematic review.

The aim of this study was to determine what kind of psychosocial interventions aimed at improving the well-being of adult cancer patient caregivers were developed, and to describe the methodological characteristics and clinical effectiveness of the interventions which could be included in the nursing care plans. Systematic review DATA SOURCES: A systematic search of three databases (PubMed, CINAHL, and PsycINFO) was conducted to identify peer-reviewed papers published between years 2004-2019. The review was guided by the Joanna Briggs Institute manual for systematic reviews. Data were extracted and appraised by three reviewers using standardized checklists. Narrative synthesis was used to analyse the data. A total of 37 studies underwent analysis. Most of the studies described psychoeducational interventions, designed for patient-caregiver dyads, delivered face-to-face. There was a great variety in caregiver outcomes and measurement tools used. Even though most studies used a randomized controlled design and standardized intervention protocols, many reported problems with recruitment and attrition. Most studies reported that the intervention improved caregiver outcomes, yet the majority of them failed to report effect sizes. There are currently a plethora of successful interventions available for cancer patient caregivers which can be included to the nursing care plan. Psychoeducational online interventions which include a social support component may have the best potential in supporting caregivers. It is important to address specific caregiver needs at different cancer stages rather than general needs of caregivers in future interventions. This review suggests that despite a large number of different interventions which can be included in the nursing care plan to improve the support offered to caregivers, some issues should be addressed while designing an intervention study. The emphasis should be placed on reporting effect sizes, focusing on specific caregiver needs and improving recruitment, retention strategies and sustainability of caregiver interventions.

Effect of Low-Load Blood Flow Restriction Training After Anterior Cruciate Ligament Reconstruction: A Systematic Review.

BackgroundQuadriceps strength and mass deficits are common after anterior cruciate ligament (ACL) reconstruction. Postoperatively, heavy load resistance training can have detrimental effects on knee joint pain and ACL graft laxity. Therefore, low-load blood flow restriction (LL-BFR) training has been suggested as an alternative to traditional strength rehabilitation.PurposeThe present systematic review aimed to investigate the effect of LL-BFR training on quadriceps strength, quadriceps mass, knee joint pain, and ACL graft laxity after ACL reconstruction compared to non-BFR training.Study designSystematic reviewMethodsA systematic literature search of PubMed, EMBASE.com, Cochrane Library/Wiley, CINAHL/Ebsco and Web of Science/Clarivate Analytics was performed on 19 February 2021. Studies were included if they compared LL-BFR and non-BFR training after ACL reconstruction with pre- and post-intervention quadriceps strength, quadriceps mass, knee joint pain or ACL graft laxity measurement. Systematic reviews, editorials, case reports and studies not published in a scientific peer reviewed journal were excluded. The risk of bias of randomized studies was assessed with the use of the Cochrane Risk of Bias Tool.ResultsA total of six randomized controlled trials were included. Random sequence generation and allocation concealment was defined as high risk in two of the six studies. In all studies blinding of participants and personnel was unclear or could not be performed. The included studies used different LL-BFR and non-BFR protocols with heterogeneous outcome measurements. Therefore, a qualitative analysis was performed. Two of the six studies assessed quadriceps strength and demonstrated significant greater quadriceps strength after LL-BFR compared to non-BFR training. Quadriceps mass was evaluated in four studies. Two studies observed significant greater quadriceps mass after LL-BFR compared to non-BFR training, while two studies observed no significant difference in quadriceps mass. Knee joint pain was assessed in three studies with significantly less knee joint pain after LL-BFR compared to non-BFR training. Two studies evaluated ACL graft laxity and observed no significant difference in ACL graft laxity between LL-BFR and non-BFR training.ConclusionThe results of this systematic review indicate that LL-BFR training after ACL reconstruction may be beneficial on quadriceps strength, quadriceps mass, and knee joint pain compared to non-BFR training with non-detrimental effects on ACL graft laxity. However, more randomized controlled trials with standardized intervention protocols and outcome measurements are needed to add evidence on the clinical value of LL-BFR training.Level of evidence2a

Pharmacological and Nonpharmacological Management of Chemotherapy-Induced Peripheral Neuropathy: A Scoping Review of Randomized Controlled Trials.

Background: Chemotherapy-induced peripheral neuropathy (CIPN) is a common and debilitating side effect of cancer treatment with no effective preventative strategy or definitive treatment. Purpose: To synthesize empiric literature from randomized controlled trials (RCTs) of pharmacological and nonpharmacological management of CIPN. Data Sources: Articles published between January 1, 2010, and February 28, 2021, were identified using keywords searching Medline, PubMed, CINAHL, Web of Science, Cochrane Library, and Embase. Study Selection: RCTs that recruited individuals who were post-chemotherapy and experienced persistent CIPN symptoms. Data Extraction and Synthesis: Three independent reviewers screened a total of 2023 abstracts. After screening, full-text review, and quality appraisal, 22 articles were included in this review. Data related to study design, participant characteristics, interventions, controls, outcome measures, and relevant findings were extracted from full texts. Descriptive quantitative summaries were calculated and narrative analysis was performed. Results: Of the 22 studies, 4 investigated pharmacologic treatments, 2 compared acupuncture to pharmacologic treatments, and 16 studies examined nonpharmacologic treatments. Pharmacologic studies reported mixed results with evidence of participant response varying by history of chemotherapeutic agent. Acupuncture, exercise/physical therapy, and neurofeedback appear to be effective treatments for CIPN. Evidence regarding biophysical agents and cognitive-behavioral therapy is equivocal. Scrambler therapy is not supported. Limitations: Studies included in this review share several limitations, including widely variable outcome measures, small and demographically homogenous samples, and nonstandardized treatment protocols. Conclusion: This scoping review summarized the current body of high-quality RCTs investigating treatment for CIPN. The majority of studies in this review reports benefits of pharmacologic and nonpharmacologic interventions, although management may require a multipronged approach and should be tailored to the individual. Clinical implications are proposed and suggestions made for future research include implementation of standardized intervention protocols, use of outcome measures representative of the spectrum of CIPN symptoms, and stratification by the chemotherapeutic agent.

Covid-19-associated fungal osteomyelitis of jaws and sinuses: An experience-driven management protocol.

Invasive fungal co-infections with COVID-19 are currently being reported at an alarming rate. Our study explores the importance of early identification of the disease, probable etiopathogenesis, clinical and radiological features and a treatment protocol for COVID-19 Associated Fungal Osteomyelitis of Jaws and Sinuses (CAFOJS). A one-year prospective study from June 2020 to May 2021 was conducted among CAFOJS diagnosed patients at a tertiary care center in South India. Demographic details, COVID-19 infection and treatment history, time taken for initiation of symptoms after COVID-19 diagnosis, medical history and clinical features were recorded. All patients were managed with a standard diagnostic and intervention protocol which included pre-operative and post-operative administration of Inj. Amphotericin B 50 mg (liposomal), early aggressive surgical debridement and tab. Posaconazole GR 300 mg OD for 90 days after discharge. Thirty-nine (78%) patients were diagnosed with CAFOJS out of 50 osteomyelitis patients. 35 patients (90%) were diabetic and 21 patients (54%) were known to receive steroids during the COVID-19 treatment. Sole existence of Mucorales spp. was seen in 30 patients (77%), Aspergillus fumigatus in 2 patients (5%), Curvularia spp. in 2 patients (5%). Concomitant existence of Mucorales and Aspergillus fumigatus was reported in two patients (5%) and Candida albicans in three patients (8%). Patients underwent treatment with standard protocol and no recurrence noted. CAFOJS is a clinical entity with aggressive presentation and warrants early diagnosis and treatment.Lay summaryInvasive fungal infections of head and neck region cause necrosis of bones affected by it, especially maxilla. Early diagnosis and treatment are advocated in such infections due to its aggressive clinical presentation compared to similar infections before COVID-19 pandemic.

When the non-sharing of therapeutic goals becomes the problem: The story of a consumer and his addiction to methadone.

Accessible SummaryWhat is known on the subject? It is well known that psychotropic drugs, besides having beneficial effects, may become a source of addiction.Drug therapy involving methadone is traditionally considered an essential medicine in the treatment for heroin dependence since it significantly reduces drug injecting and death rates associated with opioid dependence. What the paper adds to existing knowledge? This paper investigates a paradoxical situation: the use of methadone therapy to maintain a condition of addiction rather than to overcome it. The story is told jointly by the head of a rehab centre and a young man who has developed a methadone addiction and kept it hidden for years from the operators of the addiction centre, who supplied him with the substance. What are the implications for mental‐health nursing? The young man's story offers a key example which can be of interest not only for addiction centres but also for all mental‐health services that supply drugs as therapy. This study examines what happens when a person taken over by a service pursues goals that are in contrast to the service mission.Specific communication strategies have to be implemented to update and negotiate goals in continuity with the personal live project of the service user.This story is a warning to not rely on consolidated operational practices, ignoring the investigation of personal meanings and aims of those who experience them. IntroductionMental health services typically follow standardized intervention protocols and systematic operating practices.Aim/QuestionThis paper explores what happens when a service relies exclusively on fixed practices rather than on the negotiation of objectives and the differentiation of procedures according to the needs of the user.MethodThe analysis of the narratives produced in first person by Oliver, a former substance user, emphasizes the need of constructing a therapeutic plan in close cooperation, promoting an user active role and strengthening his affiliation in the change process.Results and DiscussionIn this specific case, the involvement of the user meant the identification of the peculiar meanings he attributed to the “substance of use,” which paradoxically coincided with the “therapeutic substance” (methadone).Implications for PracticeOliver's story is an effective mirror for rethinking staff conduct when it assumes that the drug is therapeutic in itself, regardless of the way the person experiences and means it, it also offers a description of the interactive ways in which the relationship between a young person and service staff proved to be effectively therapeutic.

Implementation and evaluation of a standardized performance profile intervention with collegiate athletes: A comparison of the original and revised techniques

Performance profiling is a theory-driven technique commonly employed by sport psychology professionals to enhance various psychological outcomes within athletes and teams. Over time, empirical and anecdotal evidence have advocated the applied use of this technique and several adaptations of the original profiling procedure have emerged. The purpose of this study was to examine the impact of the original and revised performance profile (PP) techniques compared to a didactic active control condition on self-awareness, intrinsic motivation, basic psychological need satisfaction, and commitment. A standardized intervention protocol was developed for each performance profiling procedure and utilized to guide implementation of the interventions. Using a randomized design, 117 collegiate athletes from different sports were allocated to a(n) original PP (n = 41), revised PP (n = 42), or didactic PP (n = 34) condition to examine the pre-post impacts of a single session delivered in a team setting. Two-way mixed ANOVAs and MANOVAs were used to analyze the pre to post changes across intervention conditions for the outcome variables. Paired comparisons using two-way mixed ANOVAs were used to determine which intervention was most effective. Results revealed that self-awareness significantly increased for the original and revised condition, however, no differences in improvement were seen between the groups. Furthermore, those in the original group reported significantly higher scores on numerous intrinsic motivation subscales from pre to post intervention, while significantly elevated scores for commitment were reported in the revised condition.

Intervenção e manejo de ansiedade em estudantes do ensino médio integrado

Os Institutos Federais de Educação, Ciência e Tecnologia, implementados em 2008, integram o ensino profissional e o ensino médio com base no ideal de Formação Humana Integral dos sujeitos. Nesse sentido, o presente trabalho tem como objeto de estudo a ansiedade em estudantes do Ensino Médio Integrado de um Instituto Federal de Ensino. Pesquisas recentes abordam sobre as metodologias, carga horária extensa e estrutura curricular como possíveis contribuintes para transtornos de ansiedade em adolescentes estudantes do Ensino Médio Integrado. Deste modo, esta pesquisa buscou identificar os resultados de um Grupo de Intervenção, baseado em Terapia Cognitivo-Comportamental (TCC), para o Manejo da ansiedade em estudantes do Ensino Médio Integrado. Trata-se de uma pesquisa transversal, de caráter quantitativo. Utilizou-se a escala de avaliação da ansiedade de Hamilton – HAM- A como instrumento de coleta de dados e de avaliação da intervenção realizada. Doze estudantes do Ensino Médio Integrado do IFNMG - Campus Januária participaram das atividades psicoeducativas, de reestruturação cognitiva e de mudanças comportamentais. Como resultados desta pesquisa, concluiu-se que o Grupo de Intervenção e Manejo da Ansiedade foi eficiente ao reduzir o nível de ansiedade de 92% das participantes. Como sugestão para trabalhos futuros, sugere-se a criação de um protocolo padrão de intervenção para os transtornos da ansiedade em estudantes do EMI, a ser utilizado por psicólogos escolares, a fim de promover o suporte emocional a estudantes desta modalidade de ensino e, consequentemente, contribuir com o bem-estar, com a aprendizagem, com a saúde mental e com a Formação Humana Integral desses estudantes.

Pill-Swallowing Training in Very Young Children With Cancer: A Case Series and Developmental Considerations.

Pill-swallowing training (PST) is a promising behavioral intervention. However, previous studies of PST have largely reported outcomes only in children aged 6 years and older. In the pediatric oncology setting, younger children may benefit from learning to swallow pills, with motivators such as avoiding bad-tasting liquid medications, simplifying oral medication routines, and accessing trials for patients with poor prognoses. Here, we briefly describe the standard PST intervention protocol and report success with very young patients experiencing a variety of medical, emotional, behavioral, and developmental complications. The current case series illustrates the utility of traditional behavioral PST interventions with novel supplements, such as intervention to increase general compliance or decrease anxiety, in four young children with cancer. These cases highlight the effectiveness of PST and describe the positive impact reported by each family. Developmental considerations for using PST with young children with cancer are offered.

Assessment of the effects of the “Active Neonates” technique (AN-t) on premature neonates in NICU during afive-day physiotherapy intervention period

Aim: To record the effects of AN-t on the body growth and function of the cardiovascular and respiratory system of preterm infants during the first 5 days period of the study. Material - Method: 24 preterm infant, with gestational age ≤ 32 weeks(after parental consent) were grouped equally into the Intervention (IG) (n = 12) and Control (CG) (n = 12) group with 1: 1 representation for gestational age and birth weight. On the IG an original standardized intervention protocol (AN-t), specifically designed for the study,was appliedbeyond the daily conventional clinical care. Results: There was a twofold change in the daily weight gain rate between the intervals (I1) and (I2) , before and during the intervention period respectively, with p = 0.033 in favor of IG. Statistical significance was also observed in the reduction of heart rate at the end of each session compared to the start in both morning (p = 0.006) and afternoon (p = 0.002) sessions. Similar significance was recorded to the increase in O2 saturation at the end of each session (morning- afternoon) with p = 0.003. Conclusions: The intervention protocol (AN-t) seems to be safe as an intervention protocol in order to promote active motion in premature medically stable neonates, since no disturbing signs from the respiratorycardiovascular system were presented. Furthermore A.N-t seems to favor neonatal growth but the responsiblemechanisms for this observation are not yet elucidated. keywords : Preterm neonates, kinesthetic stimuli, compressions, daily weight gain rate,

Comparison of a home-based (multi) systemic intervention to promoting Medication AdheRence and Self-management among kidney transplant recipients with care-as-usual: the MARS randomized controlled trial protocol

BackgroundAfter kidney transplantation non-adherence and inadequate self-management undermine clinical outcomes and quality of life. Both have been demonstrated to be substantial in all age groups. However, interventions promoting adherence and self-management among kidney transplant recipients that have proven to be effective are scarce. In this study we aim to develop and test an intervention to optimize adherence and self-management. In this article we describe the background and design of the trial entitled ‘promoting Medication AdheRence and Self-management among kidney transplant recipients’ (MARS-trial)’.Methods/designThis is a single-center, parallel arm randomized controlled trial. Nonadherent kidney transplant recipients aged 12 years or older are eligible for inclusion. Patients will be randomly assigned to either the experimental or a control group. The control group will receive care-as-usual. The experimental group will receive care-as-usual plus the MARS-intervention. The MARS-intervention is an outreaching intervention, based on the principles of (multi) systemic therapy which means involving the social network. A standardized intervention protocol is used for consistency but we will tailor the behavior change techniques used to the specific needs and determinants of each patient. The primary outcome of medication adherence will be measured using electronic monitoring. Secondary outcome measures regarding medication adherence and self-management are also assessed. Data is collected at baseline (T0), after a run-in period (T1), at six months post-baseline/end of treatment (T2) and after a six month follow-up period (T3).DiscussionWe combined elements of (multi) systemic therapy and evidence-based behavior change techniques to create an outreaching and highly individualized intervention. In this trial we will investigate the impact on medication adherence and self-management after kidney transplantation.Trial registrationNetherlands Trial Register,trial number NTR7462. Registered 7th September 2018, https://www.trialregister.nl/trial/7264

Psychotherapeutic interventions for LGBTQ + youth: a systematic review

LGBTQ + youth are at elevated risk for suicidality, substance use, and other mental health concerns. Evidence-based psychotherapeutic interventions are often the first line treatment for mental health concerns. However, there is limited research examining the effectiveness of such interventions among LGBTQ + adolescents. This systematic review synthesizes extant literature examining psychotherapeutic interventions for LGBTQ + adolescents with mental illness and/or substance use. Using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses, studies were assessed for inclusion eligibility. Researchers consulted three electronic databases, yielding a total of 666 results. Ten studies, with interventions ranging from drug use prevention to school-counseling, met inclusion criteria. Seven studies implemented adaptations to standard intervention protocol to make intervention content more accessible to LGBTQ + clients. Outcomes included decreased depressive symptoms, substance use, and social isolation. Significant design and methodological limitations were present across most studies, with four using a case study design and only two using a randomized controlled trial design. The review highlights preliminary evidence supporting the use of mental health interventions for LGBTQ + youth. However, more rigorous research is needed to determine if adapted interventions that include population-specific concerns of minority stress are more effective than treatment as usual.

Educational interventions for primary care providers to improve clinical skin examination for skin cancer

Skin cancer, the most commonly diagnosed cancer in the United States, is a serious health care concern. Early skin cancer detection improves prognosis; most common early detection approach is a comprehensive clinical skin examination (CSE). A CSE consists of skin cancer risk assessment, head-to-toe skin examination, and skin lesion assessment. Nurse practitioners (NPs) currently lack adequate training and confidence to conduct CSE. The goal of this systematic review was to learn more about published interventions targeting CSE training for primary care NPs and/or other primary care providers. The findings were categorized based on the established procedures for intervention development. The databases PubMed, Google Scholar, CINAHL, and Web of Science were searched. Using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines, 10 articles were selected for data extraction. There is a paucity of articles that report rigorously developed interventions aimed at educating primary care NPs to conduct CSE. Existing CSE interventions were not tested for efficacy or effectiveness, and the implementation methods were weak or not reported. A synthesis of the review findings revealed inadequately reported sample characteristics, vague intervention goals, unspecified frequency or duration of interventions, and lack of standardized intervention protocols. This review builds a foundation for more rigorously developed interventions to improve CSE and provides guidance for NPs to select education on CSE and other clinical foci. Future research will guide the development and evaluate the effectiveness of CSE education, which ultimately could improve skin cancer prognosis interventions and lack of standardized intervention protocols.

Design, Development, and Testing of an App for Dual-Task Assessment and Training Regarding Cognitive-Motor Interference (CMI-APP) in People With Multiple Sclerosis: Multicenter Pilot Study.

BackgroundDual tasking constitutes a large portion of most activities of daily living; in real-life situations, people need to not only maintain balance and mobility skills, but also perform other cognitive or motor tasks at the same time. Interest toward dual-task training (DTT) is increasing as traditional interventions may not prepare patients to adequately face the challenges of most activities of daily living. These usually involve simultaneous cognitive and motor tasks, and they often show a decline in performance. Cognitive-motor interference (CMI) has been investigated in different neurological populations, but limited evidence is present for people with multiple sclerosis (MS). The use of computerized tools is mandatory to allow the application of more standardized assessment and rehabilitation intervention protocols and easier implementation of multicenter and multilanguage studies.ObjectiveTo describe the design and development of CMI-APP, an adaptive and interactive technology tablet-based app, and to present the preliminary results of a multicenter pilot study involving people with MS performed in several European centers for evaluating the feasibility of and adherence to a rehabilitation program based on CMI-APP.MethodsCMI-APP includes user-friendly interfaces for personal data input and management, assessment of CMI, and DTT. A dedicated team developed CMI-APP for Android tablets above API level 14 (version 4.0), using C# as the programming language and Unity and Visual Studio as development tools. Three cognitive assessment tests for working memory, information processing speed, and sustained attention and four motor assessment tests for walking at different difficulty levels were implemented. Dual cognitive-motor tasks were performed by combining single cognitive and motor tasks. CMI-APP implements exercises for DTT involving the following 12 cognitive functions: sustained attention, text comprehension, verbal fluency, auditory discrimination, visual discrimination, working memory, information processing speed, auditory memory, visual memory, verbal analog reasoning, visual analog reasoning, and visual spatial planning, which can be performed during walking or stepping on the spot. Fifteen people with MS (mean age 52.6, SD 8.6 years; mean disease duration 9.4, SD 8.4 years; mean Expanded Disability Status Scale score 3.6, SD 1.1) underwent DTT (20 sessions). Adherence to the rehabilitation program was evaluated according to the percentage of performed sessions, perceived exertion during the training (Borg 15-point Ratings of Perceived Exertion [RPE] Scale), and subjective experience of the training (Intrinsic Motivation Inventory [IMI]).ResultsThe adherence rate was 91%. DTT was perceived as “somewhat difficult” (mean RPE Scale score 12.6, SD 1.9). IMI revealed that participants enjoyed the training and felt that it was valuable and, to some extent, important, without feelings of pressure. They felt competent, although they did not always feel they could choose the exercises, probably because the therapist chose the exercises and many exercises had few difficulty levels.ConclusionsCMI-APP is safe, highly usable, motivating, and well accepted for DTT by people with MS. The findings are fundamental for the preparation of future large-sample studies examining CMI and the effectiveness of DTT interventions with CMI-APP in people with MS.

Somatic Acupoint Stimulation for Cancer-Related Sleep Disturbance: A Systematic Review of Randomized Controlled Trials.

Aim The aim of this systematic review was to analyze and synthesize available evidence for the effects of somatic acupoint stimulation (SAS) on cancer-related sleep disturbance in adults with cancer. Methods Nine databases and four clinical trial registries were searched from their inception to July 2019 to identify potential articles and registered trials. Two authors independently extracted data and appraised the methodological quality of the included studies. The included studies could not be subjected to meta-analysis due to the significant variations in SAS intervention protocols and outcome measurement instruments. This systematic review therefore reported the results of the included trials narratively. Results Seven studies were identified, which involved 906 cancer patients. SAS protocols varied across trials without an optimal evidence-based standard intervention protocol to manage cancer-related sleep disturbance. Sanyinjiao (SP6) was the most commonly selected acupoint. Manual acupuncture was typically 15–30 min in duration and was conducted once a day or once a week for a period of 1–5 weeks, whereas self-administered acupressure was typically 1–3 min in duration per point and was conducted once a day, such as during night time before going to bed, for a period of 1–5 months. The results indicated that SAS could potentially relieve cancer-related sleep disturbance and improve quality of life. Mild adverse effects were reported in three of the included studies, but none of them performed a causality analysis to clarify the association between the reported adverse events and the intervention. Conclusions This systematic review showed that SAS is a useful approach to relieving cancer-related sleep disturbance. However, research evidence on SAS for managing cancer-related sleep disturbance has not been fully conclusive due to the limited number of existing clinical studies with relatively small sample size and suboptimal methodological quality. Clinical trials with large sample size and robust methodology are warranted in future research.

Group format rehabilitation is equally effective as individual therapy in patients with surgically repaired rotator cuff tears.

Does group physiotherapy methods produce different results when compared with individual physiotherapy in persons with surgically repaired rotator cuff tears? No studies to date have examined the feasibility or effectiveness of such therapy formats. Given the prevalence of rotator cuff tears, a study examining group format therapy is warranted and can produce evidence to transform care for rotator cuff tear rehabilitation. We analyzed the electronic medical records of persons that underwent rotator cuff repair surgery followed by the prescribedpost-surgical physiotherapy at Southlake Regional Health Centre. Both groups were provided standard physiotherapy intervention protocol for post-operative rotator cuff tear. Active range of motion (AROM), quick disabilities of the arm, shoulder and hand (Q-DASH) measures, and efficiency measures were examined for differences between groups. No significant differences between AROM (abduction p=.92, lateral rotation p=.64, and flexion p=1.00) and Q-DASH (p=.62) measures between groups were observed at discharge. Overall, group therapy participants required a greater number of visits (p=.000); however, when separated by age groups, only the 60- to 69-year-old participants significantly differed in number of visits between groups (p=.000), whereas no difference was observed in the 50- to 59-year-old participants (p=.14). Group format physiotherapy may be equally effective as individual formats in improving AROM and functional outcomes of participants with surgically repaired rotator cuff tears. Further research is needed to determine the optimal age range for group therapy interventions in this population.

Abstract WP20: Tandem Occlusions; Does Pretreatment With Thrombolytics Matter

Introduction: Tandem occlusions are a significant treatment challenge for which no standard intervention protocol has been determined. IV tPA alone generally has a poor outcome for tandem occlusions while endovascular therapy (EVT) is thought to produce the best possible outcome. The purpose of this study was to evaluate the safety and efficacy of IV tPA used prior to EVT for tandem occlusions. Hypothesis: IV tPA plus EVT may improve clinical outcome over EVT alone without more adverse events. Methods: There were 56 patients with tandem occlusions over a 3 year period out of 309 (18%) patients with an LVO. The primary clinical outcome was National Institutes of Health (NIH) stroke scale and modified Rankin Scale (mRS) at discharge. Secondary outcomes were discharge disposition (Good: home or acute rehabilitation, Poor: all others), recanalization (Good: TICI ≥ 2B), and mortality. T-test was used to compare outcomes between the group that received EVT plus tPA versus EVT alone. Reasons patients did not receive tPA included recent surgery, therapeutic anticoagulation, or outside treatment window. Results: 23/ 56 (41%) tandem occlusion patients received EVT; 15 (65%) also received tPA. NIH scores on presentation were the same between the group receiving EVT plus tPA and EVT alone (17.13, p = 0.9984), and there was no significant difference between the two groups in respect to discharge NIH (no tPA: 5.0, yes tPA: 6.0; p = 0.7487), discharge mRS (no tPA: 4.25, yes tPA: 3.67; p = 0.4349), TICI scores (63% as compared to 80% with tPA), mortality ( no tPA: 37.5%, yes tPA: 13%; p =0.419), or good discharge disposition (no tPA: 50%, yes tPA 60% p = 0.432). Conclusion: Although not statistically significant, the group that received EVT plus tPA had lower mRS scores, lower mortality rates, increased reperfusion and a higher percentage of discharge to home or acute rehab as compared to the group receiving EVT alone. This suggests that tPA plus EVT may be more effective in treating tandem occlusions without accruing additional adverse effects. Limitations of this study include the small sample size and retrospective nature, demonstrating the need for larger and prospective studies in the future.