Integrated cognitive behavioral therapy and social skills training to reduce social isolation in schizophrenia: a quasi-experimental study

Malaysia's rapid population aging has intensified the need for dementia care systems that extend beyond hospital-based services. This qualitative study explored the experiences and support needs of family caregivers of persons living with dementia (PLWD) in Malaysia, with the aim of informing dementia workforce development and para-professional training. Semi-structured interviews were conducted with 67 caregivers attending the geriatric unit of a public hospital in Selangor. Responses to open-ended questions on social support, emotional impact, communication with health professionals, economic consequences, and unmet needs were analyzed using structured qualitative content analysis, supported by a human-large language model (LLM) parallel coding approach. Caregivers described substantial emotional burden, including exhaustion, anxiety, social isolation, and feelings of being trapped in a continuous caregiving role. Many reported fragmented information from healthcare professionals, limited awareness of available welfare schemes, and inadequate access to respite, home-based support, and caregiver education. Caregiving also produced major financial strain through lost employment, reduced working hours, depleted savings, and recurring out-of-pocket costs. Across domains, caregivers expressed a strong need for affordable day care, home-based therapy, psychological support, financial assistance, and practical training. These findings indicate that dementia care in Malaysia remains heavily dependent on family caregivers who are expected to absorb unmet system demands with limited formal support. Strengthening the dementia care workforce through structured para-professional roles may help bridge gaps in caregiver education, welfare navigation, post-discharge support, and community-based care. The study underscores the need to align national aging and dementia policies with workforce development strategies that better support both persons living with dementia and the families who care for them.

Graduate education and competency development in advanced practice provider roles: A scoping review.

Brain injuries can have a significant negative impact on marriages/partnerships. Available interventions either require specialists trained in relationship therapy (which most rehabilitation services have no access to) or offer more structured manualised approaches that are restricted in scope and have generally led to only small improvements. Continuity Therapy was developed to provide a manualised approach that can be delivered by brain injury clinicians without specialist training in relationship therapy, and that addresses a broader range of relationship issues. Study aims were to complete a preliminary evaluation of the benefits of the therapy to determine whether progression to a randomised controlled trial is justified; to obtain feedback that will be used to refine the therapy; and to evaluate selection criteria and patient-reported outcome measures. Fifteen couples living with brain injury received the therapy. They completed questionnaires about their relationship and psychological wellbeing before and after the therapy, and at 3-month follow-up, and rated how helpful they found the therapy. They and the therapists were also interviewed (or provided written feedback) about their experience of the therapy. Criteria about progression to an RCT were established in terms of numbers showing statistically reliable improvement on relationship questionnaires, ratings of helpfulness, and non-completion rates. Progression criteria were met. Although not everyone benefitted, participants showed a mean large effect improvement on post-therapy questionnaires about their relationship, and this was sustained at 3 months. They showed a mean moderate effect improvement in their psychological wellbeing, again sustained at 3 months. Couples and therapists made suggestions about improvements to the therapy, the circumstances of couples that may impact the effectiveness of the therapy (relevant to selection criteria), and the suitability of outcome measures. Effect sizes should be treated with caution because of the limitations of the study. Nevertheless, the therapy showed sufficient promise to support progression to an RCT. A broader range of outcome measures is required to capture the benefits of the therapy for the relationship. Refinement of the selection criteria is also needed. The study was registered with ISRCTN: The UK's Clinical Study Registry (registration number-93611293) on 6.6.2023.

Effective inhalation therapy is critical for managing chronic airway diseases, yet improper technique remains prevalent and contributes to poor clinical outcomes. In China, nurses play a central role in patient education. However, the relationship between nurses' own training and their competency in delivering inhalation therapy education remains underexplored. A cross-sectional online survey was conducted from September to October 2025 among 387 respiratory nurses from 32 hospitals across 25 provinces. A validated 61-item questionnaire assessed their knowledge, attitudes, practices (KAP), and training status regarding inhalation therapy. Mean scores were 33.78 ± 2.76 for knowledge, 35.01 ± 7.98 for attitude, and 61.37 ± 10.2 for practice. Only 50.13% achieved a "good" level of theoretical knowledge. Practice correlated more with attitudes (Rho = 0.57, P < 0.001) than knowledge. Years of experience in specialty nursing, practical workshops and specialist nurse training were markedly associated with the knowledge and practice of inhalation therapy, respectively (P < 0.05), while educational video utilization was significantly correlated with better performance in both areas (all P < 0.05). In summary, respiratory nurses demonstrate positive attitudes and practices but have insufficient theoretical knowledge towards inhalation therapy. Integrated learning strategies combining theoretical instruction with visual tools like educational videos are recommended.

To identify facilitators and barriers that influence psychological resilience among colorectal cancer (CRC) patients. Mixed-methods systematic review. Eight databases were searched (1987-2026): CINAHL Plus, Scopus, PubMed, PsycINFO, EMBASE, Cochrane Library, Web of Science, and Medline. A data-based convergent synthesis was conducted in accordance with Joanna Briggs Institute guidelines. Study selection and quality appraisal (using the MMAT tool) were completed in Covidence, and data extraction and transformation were managed in Covidence and NVivo. A total of 33 studies were included. Guided by the Society-to-Cells Resilience Framework, identified multilevel facilitators and barriers shaping resilience among CRC survivors. Six interventions demonstrated effectiveness in enhancing resilience among CRC survivors: the resilience-base prehabilitation program, the resilience and nutrition program, the narrative therapy and resilience training program, the Hospital-Family Holistic Care Model, Physiotherapy, and Attention and Interpretation Therapy (AIT). Resilience was supported by healthcare systems, family, positive cognitive and emotional resources, good self-management, and a lower symptom burden. Barriers included healthcare disparities, limited support, psychological distress, stigma, poor self-care, and increased fatigue. Notably, three factors (coping style, urban residence, employment) varied dynamically across contexts, acting as either facilitators or barriers. Psychological resilience in CRC care is multidimensional and context-dependent, shaped by the interplay of societal, community, family, individual, and physiological and cellular factors. These findings underscore the urgent need for multilevel, person-centred interventions to strengthen resilience across the cancer care continuum. Future research should focus on longitudinal and qualitative studies to inform targeted strategies. CRD42023470691.

From hands-on to family-on: Task-Shifting manual therapy techniques in post-stroke neuroplasticity - A retrospective comparative analysis of the Cogni-Famille protocol.

Nonverbal empathy and perceived therapist warmth and competence: An experimental video vignette study.

Cognitive dysfunction, characterized by memory impairment, attentional deficits, and executive dysfunction, represents a critical clinical manifestation in post-acute sequelae of COVID-19 that significantly compromises patients' quality of life. The lung-brain axis, as a bidirectional regulatory network connecting the respiratory system to the central nervous system, interacts through neural circuits, humoral pathways, and microbial pathways, and may play a central role in the cognitive impairments occurring in long COVID (LC). This paper systematically reviews the multidimensional pathways of the lung-brain axis and their pathological mechanisms in the cognitive impairment of LC, including direct viral neuroinvasion during the acute phase, chronic injury triggered by viral persistence, immune homeostasis dysregulation, hypoxaemia, microbiome disruption, and renin- angiotensin system imbalance. It then explores clinical intervention strategies based on the lungbrain axis, integrating supportive treatments, such as oxygen therapy, exercise therapy, and cognitive training, with treatments targeting the lung-brain axis, including antiviral drugs, immunomodulation, probiotics, and neuromodulation techniques. It is also suggested that future research should favour the integration of multi-omics technologies and the development of individualised therapeutic targets.

Statins' effects on cardiorespiratory fitness (CRF) and their interaction with exercise training remain unclear in older adults with dyslipidemia. This cohort study enrolled nine hundred and eighty-one older adults with dyslipidemia who underwent one of three interventions: (i) multicomponent exercise training (MEX; n = 298; 74% females), (ii) daily statin monotherapy (ST; n = 178; 65% females), or (iii) combined treatment with statins and multicomponent exercise training (STMEX; n = 505; 79% females). CRF, functional status, and lipid profile were assessed at baseline and after 24 months. After follow-up, statin therapy reduced CRF by 4% in women (p < 0.001), but not in men. The statin groups also showed reduced upper- and lower-limb strength in both sexes. Exercise alone significantly improved CRF (women: 27% vs. men: 21%, p < 0.001) and functional status, regardless of sex. The combined treatment significantly increased women's CRF, whereas men showed an attenuated CRF benefit (women: 27% vs. men: 1%, p < 0.001). Our findings suggest sex-specific patterns in the effects of statin therapy on CRF in older adults with dyslipidemia. Statin therapy was associated with lower CRF over time in women, but not in men, whereas multicomponent exercise training may reverse these effects.

Objective.Perinatal posttraumatic stress disorder (PTSD) is a highly prevalent and undertreated public health concern contributing to significant risk for maternal and neonatal outcomes. As treatment gaps for perinatal PTSD persist, so do gaps in training for professionals who regularly serve these individuals. This paper evaluates two approaches for delivering training in perinatal-focused Narrative Exposure Therapy (NET), offering a preliminary blueprint for expanding access to high-quality training for perinatal PTSD treatment.Method.Using a multi-cohort design, we examined training-related perceptions and outcomes. Study 1 included psychology trainees (n = 21) who participated in a clinical rotation embedded within an academic graduate training program and completed pre- and post-training evaluations. Study 2 included interdisciplinary professionals and trainees (n = 57) who participated in a 3-day professional development workshop and completed evaluations at pre-, immediately post-, 6-months post-, and 12-months post-training.ResultsTraining was rated favorably, and participants indicated perinatal-focused NET was acceptable, appropriate, and feasible across both studies. Participants in both studies indicated sustained improvements in perceived competence and abilities over time (ps < .05).ConclusionsBoth training approaches show promise for expanding training opportunities for perinatal PTSD. Findings have important preliminary implications for designing and delivering clinical training in various settings and populations.

To evaluate the effects of a short, structured multimodal day-clinic program on health-related quality of life and disability in patients with primary headache disorders. Although monoclonal antibodies targeting the calcitonin gene-related peptide (CGRP) pathway have substantially advanced migraine prophylaxis, a large proportion of patients remain insufficiently controlled. Residual disability, comorbidities, and contraindications highlight the need for complementary nonpharmacological approaches. Multimodal programs combining medical, psychological, and behavioral strategies have proven effective in chronic pain but remain insufficiently studied in primary headache populations, particularly in the context of modern pharmacological options. In this quasi-experimental pre-post study at the neurological day clinic of University of Greifswald, we investigated a 5-day multimodal treatment program delivered by an interdisciplinary team. Patients were recruited between January and July 2021. The intervention comprised medical consultations, psychological therapy, physiotherapy, occupational therapy, structured education, and relaxation training. Patient-reported outcomes were assessed with the Veterans RAND 12-Item Health Survey (VR-12; primary end points: mental component summary [MCS] and physical component summary [PCS]), the Depression Anxiety Stress Scales (DASS-21), the Headache Impact Test (HIT-6), and headache diaries. Assessments were performed during the pre-admission waiting period (V0), at admission (V1), and at 3, 6, and 9 months after treatment (V2-V4). Primary analyses focused on changes from baseline to 3 months, with exploratory analyses for extended follow-up. A total of 92 patients were included, most with migraine (83%). The VR-12 MCS improved significantly over time (F[2,162] = 3.23, p = 0.042; nominal), increasing from an estimated marginal mean of 36.9 (95% CI, 33.35-40.45) at baseline (V0) to 38.3 (95% CI, 35.54-41.06) at V1, and 41.5 (95% CI, 37.55-45.45) at 3 months (V2). Focusing on the pre-specified baseline-to-3-month contrast, MCS improved from V0 to V2 (mean difference, 4.63; 95% CI, 1.02-8.24; p = 0.012; Holm-Bonferroni padj = 0.024). PCS showed no significant changes (F[2,162] = 0.95, p = 0.387), with estimated marginal means of 38.3 (95% CI, 36.13-40.47) at V0, 37.7 (95% CI, 35.73-39.67) at V1, and 39.0 (95% CI, 36.24-41.76) at V2. Headache frequency did not change significantly across V0-V2 (F[2,148] = 0.49, p = 0.616). HIT-6 scores decreased significantly (64.7 ± 3.6 at V0, 64.8 ± 5.0 at V1, and 60.8 ± 5.4 at V2; F[2,148] = 5.63, p = 0.004). DASS-21 subscales showed nonsignificant reductions at 3 months, with exploratory analyses indicating gradual improvements at 6 and 9 months. A short, structured multimodal program in a day-clinic setting significantly improved the mental component of health-related quality of life and reduced headache-related disability in patients with primary headache disorders. Although physical functioning and headache frequency did not change significantly at 3 months, the program provided clinically relevant benefits in coping and mental health. These findings highlight multimodal day-clinic treatment as a valuable component of comprehensive headache care, even in the era of CGRP-targeted treatment options.

Background: Chronic low back pain (CLBP) and depression often co-occur. This study compared a fascia-focused physiotherapeutic program with a conventional physiotherapeutic and relaxation-based program in psychosomatic inpatients with CLBP and comorbid depression. Methods: In this exploratory quasi-randomized study, 41 inpatients were allocated to a fascia-focused intervention group (n = 23) or a conventional active control group (n = 18). Over six weeks, the intervention group received Bowen therapy and fascia circuit training, whereas the control group received progressive muscle relaxation and strength circuit training. Outcomes were assessed at baseline and after rehabilitation. NRS pain intensity and BDI-II depressive symptom severity were the main clinically relevant outcomes; spinal function, tissue stiffness, pressure pain threshold, and craniovertebral angle were secondary or exploratory outcomes. Results: Both groups improved over time in pain intensity and depressive symptom severity. NRS scores decreased by 3.21 ± 2.61 points in the fascia-focused group and by 2.17 ± 2.34 points in the control group; BDI-II scores decreased by 9.30 ± 13.42 and 7.22 ± 8.57 points, respectively. Repeated-measures ANOVA confirmed significant time effects for NRS and BDI-II, with no significant group differences or time × group interactions. Significant time effects were also observed for thoracic tissue stiffness, lumbar and pelvic posture, thoracic and lumbar mobility, and pelvic stability. Conclusions: Fascia-focused and conventional physiotherapy showed similar observed effects in this exploratory quasi-randomized study. The absence of significant between-group differences should be interpreted cautiously because the study was not designed or powered to establish formal equivalence.

ABSTRACT Introduction The COVID-19 pandemic thrust telehealth practices, education, and clinical training into the professional conversation. However, regulations for telehealth practice are lagging. We sought to assess how music therapy (MT) educators include telehealth training in their curriculum. Method We globally distributed a cross-sectional online survey with 32 questions to MT educators covering four sections: (a) demographic information, (b) Telehealth Music Therapy (TMT) education and training at participants’ institution, (c) educator training/perspectives/perceptions on TMT, (d) resources participants use to teach TMT. We used descriptive statistics and correlation analysis for quantitative data and thematic analysis for qualitative responses. Results Sixty-one music therapy educators responded to the survey. Most respondents (n = 51, 85%) do not require students to practice TMT as part of their training nor offer opportunities for telehealth placements (n = 36, 60%), yet the majority believe TMT should be taught in all programs and therapists should offer accessible services for clients in isolated contexts. Several respondents reported that technology was the largest challenge in teaching TMT. Respondents also noted the complexities of building online relationships, along with balancing a busy curriculum. Finally, culture was highlighted, with differing perceptions and relevancy of TMT across the globe. Discussion While the professional music therapy associations responded quickly with guidance for clinicians during the COVID-19 pandemic, we found that education and training vary between institutions and across countries, which points to the need for TMT to be formally included in music therapy training and education programs.

The aim of this study was to evaluate the efficacy of a smartphone-based rehabilitation method, Multimodal Acoustic Therapy (MAT), integrating linguistic and nonlinguistic auditory training in improving hearing outcomes in cochlear implant (CI) users. A double-blind, active-controlled randomized clinical trial was conducted at Seoul National University Hospital, South Korea. Thirty-three CI users aged 8-20 years with over 2 years of device use were randomized to MAT or control groups. Participants underwent 8 weeks of home-based training using a smartphone-based digital therapeutic. The MAT group received structured training designed to improve frequency and phoneme discrimination using both linguistic stimuli and nonlinguistic auditory stimuli with auditory-visual feedback. The control group listened to a curated playlist of various music genres through a smartphone application. The primary outcome was a change in melodic contour identification score for music perception. Secondary outcomes were changes in consonant, vowel, and monosyllabic word tests for speech perception. Outcomes were compared at baseline and after 8 weeks of training. Of 33 randomized participants, 28 completed the trial (MAT, n = 13; control, n = 15). Compared with the control group, the MAT group demonstrated greater improvements in melodic contour identification (mean change = +11.5 percentage points, 95% CI [+3.6, +19.4] vs. +0.1 percentage points, 95% CI [-2.8, +3.0]; p = .010) and consonant identification (+14.1 percentage points [+8.0, +20.2] vs. +5.9 percentage points [+2.3, +9.5]; p = .028). Vowel identification (median change = +7.1 percentage points, interquartile range [IQR, 0, +7.1]) and monosyllabic word recognition (median change = +5.6 percentage points, IQR [0, +11.1]) also showed significant gains in the MAT group (p = .016 and p = .007, respectively), whereas the control group showed minimal or no (p = .831 and p = .114, respectively) improvement. MAT improved hearing outcomes in experienced pediatric and adolescent CI users. These findings support the use of digital therapeutics as a feasible and practical approach to auditory rehabilitation. https://doi.org/10.23641/asha.32129725.

Background: Equine-assisted therapy (EAT) is a supportive intervention for children with autism spectrum disorder (ASD). Aim: This pilot study evaluated the feasibility of a cognitive–motor EAT intervention to explore its preliminary effects on motor coordination in children with ASD. Methods: A single-group pre-test–post-test design was adopted. Twelve children (mean age: 10.08 ± 1.51 years; ASD level 1–2) participated in a 16-week EAT program. The intervention integrated EAT with cognitive dual-task activities targeting attention and perceptual processing. Motor performance was assessed before and after the intervention using the Movement Assessment Battery for Children (MABC-2). Results: The RM-ANOVA examined pre–post changes. A significant improvement in the MABC-2 Total Test Score was observed (p = 0.036; ηp2 = 0.34; 95% CI [0.541, 13.792]), indicating a trend of improvement of global motor coordination. No significant improvements were observed in Manual Dexterity, Aiming and Catching, and Balance subscale scores. Conclusions: A cognitively enriched EAT program promoted improvements in overall motor competence in ASD children, even without measurable changes in specific motor skills. The intervention was feasible and well-tolerated, with high adherence and no adverse events. These preliminary findings support the feasibility and potential value of integrating cognitive–motor demands into EAT and provide a rationale for larger randomized controlled studies.

Specific phobias (SPs) in childhood are common, impairing, and treatable, yet access to gold-standard exposure therapy remains limited. Parent-led interventions delivered via telehealth may help overcome these barriers. This pilot study examined the feasibility, acceptability, and preliminary effectiveness of a co-designed, brief, group-based parent-training program in exposure therapy for SP of dogs, delivered via videoconference. Three families (children: M age = 7.33years, SD = 0.58) completed three parent group videoconference sessions plus two boosters, and outcomes were assessed at post-treatment and at a 1-month follow up. Feasibility was excellent, with 100% retention; acceptability was supported by high satisfaction ratings and positive qualitative feedback. Clinician severity ratings of SP decreased significantly across time-points, parent-rated target symptoms declined, and all children met reliable change at post-treatment and 1-month follow-up based on their primary SP CSR. In regards to diagnostic remission (CSR < 4), rates were 33% at post-treatment, increasing to 67% at 1-month follow-up. Preliminary outcome analyses using non-parametric tests, suggested large effects for increased global functioning (CGAS), decreased parent-reported anxiety (SCAS-P) and child dysfunctional phobic beliefs, with stable child self-report anxiety (SCAS-C). Parent confidence in managing their child's SP improved, but not significantly. Findings support further evaluation of this potentially scalable model in larger controlled trials to determine efficacy.

Abstract Limb-girdle muscular dystrophy (LGMD) is a progressive neuromuscular disorder characterised by proximal muscle weakness, often exacerbated by obesity-related deconditioning. We report the outcomes of an intensive, individualised inpatient rehabilitation programme in a 23-year-old male with genetically confirmed LGMD and Class II obesity (body mass index 37.58 kg/m 2 ) who presented with severe functional decline. The multidisciplinary intervention included tailored physiotherapy, ambulation training, respiratory exercises, occupational therapy, nutritional optimisation, psychological counselling and adaptive equipment training. Over 45 days, significant functional improvement was observed: The functional independence measure motor subscore increased from 78 to 91, 6-min walk distance improved from 120 m to 850 m and the Fatigue Severity Scale score decreased from 53 to 18. Muscle strength and endurance also improved, accompanied by a 13 kg weight reduction. This case highlights that intensive, individualised rehabilitation incorporating weight management can yield meaningful functional recovery in LGMD complicated by obesity, emphasising the value of early multidisciplinary intervention.

Context. In France, the Certificat de Compétences Cliniques (Clinical Competency Certificate) marks the completion of speech and language therapy training. To obtain this certificate, students must demonstrate the acquisition of knowledge, skills, and professional attitudes consistent with the level of autonomy required for clinical practice. However, assessment procedures vary considerably across university training centers. Current practices often lack explicit criteria, temporal indicators, and structured feedback mechanisms to support clinical reasoning and learner autonomy. Criterion-referenced formative assessment, grounded in authentic learning situations, provides a coherent framework to clarify expectations, monitor progress, and guide pedagogical adjustments. Objective. To design a criterion-referenced, longitudinal, and equitable assessment tool to monitor the development of clinical competencies during the second cycle of speech and language therapy education, and to support the attainment of the Clinical Competency Certificate. Method. The DÉveloppement CLInique Certificatif (DÉCLIC) tool was developed following the principles of criterion-referenced assessment and existing educational frameworks, aligned with the national competency reference framework. The development process comprised three stages: (1) the selection and hierarchical organization of core clinical competencies and their sub-competencies; (2) the design of a longitudinal grid (from semester 7 to semester 10) specifying expected levels of autonomy for each competency, with a visual cue system to identify students requiring additional support; and (3) the integration of this grid into a structured continuous assessment process organized around six evaluation points and five formative learning activities. Results. Eight core clinical competencies from the national framework were selected, and 24 sub-competencies were operationalized into measurable acquisition criteria with defined developmental trajectories. The hetero-assessment grid enables the documentation, at each of the six evaluation points of the level achieved for each sub-competency and the identification of gaps relative to expectations. The self-assessment grid, entitled J’ME DÉCLIC, reformulates items in the first person and provides structured guidance for self-evaluation and pedagogical adjustment. Conclusion. The DÉCLIC tool makes learning acquisition benchmarks explicit, supports targeted feedback, and enhances students’ reflexivity. It also facilitates the early identification of students who are struggling or who demonstrate high potential, thereby informing realistic pedagogical interventions.

Postnatal depression (PND) affects around one in 10 women in the UK within 12 months of giving birth. Despite current management, suicide remains the leading cause of maternal deaths between 6 weeks and 12 months, accounting for 39% of cases. This systematic review aimed to evaluate the effectiveness of non-pharmacological interventions for managing postnatal depression within a primary care setting. A systematic search was conducted in PubMed, Web of Science, and Scopus databases, following the Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) guidelines. English-language papers published between 2006 and 2019 that met the inclusion criteria were retrieved. Nine papers were deemed eligible and appraised using the Critical Appraisal Skills Programme (CASP). The study included four randomised controlled trials and five qualitative studies. The studies evaluated interventions including listening visits, cognitive behavioural approaches (CBA) and person-centred approaches, group therapy, peer support, and health visitor training. No single intervention emerged as the most effective. Listening visits were commonly used but insufficient to manage PND alone. CBA showed improvements, particularly for women with more severe symptoms. Peer support and group therapy were associated with improved outcomes, while health visitor training was effective in delivering psychologically informed approaches to reduce depressive symptomology. Integrating non-pharmacological interventions - such as a multimodal treatment approach, peer support, and group therapy programmes in the community, and delivering training packages for health visitors - can effectively manage postnatal depression in primary care and improve current practices.