Training Trials Research Articles

The superiority trial of Baduanjin training on patients chronic low back pain: a study protocol for a randomized controlled trial

The superiority trial of Baduanjin training on patients chronic low back pain: a study protocol for a randomized controlled trial

The Wolf Spider Tigrosa helluo Uses Visual Associative and Beacon Landmarks During Water Maze Navigation Tasks

ABSTRACTWolf spiders can learn simple spatial navigation tasks. Previous studies have shown that the wolf spider Tigrosa helluo can use environmental edge features (reference frame landmarks) to learn the location of a dry target in flooded T‐mazes; however, the relative importance of different types or numbers of landmark cues to spatial learning remains unknown. We used a modified open arena water maze and recorded the ability of adult female T. helluo to find a target reward (a dark and dry cup) among cups that were identical to the target but flooded. We measured variation in spatial learning by measuring time to target with no landmark (control), with a beacon (a landmark that is part of the target), with an associative cue (a landmark associated with a specific navigational action), and with both a beacon and an associative cue (N = 92 subjects, n = 23 per landmark cue treatment). For each treatment, we tested females for five trials each on four consecutive days, with the last trial on the fourth day having an altered target location, totaling 19 training trials and one reversal trial (1840 trials). We found that spiders took significantly less time to find the target over subsequent trials within a day and learned more quickly when landmark cues were present, but we found no difference in the type or number of landmark features in the meantime to target entrance. After learning a target location, moving the landmark significantly increased the mean time to target entrance in the combined beacon and associative cue treatment relative to other treatments. Our results indicate that wolf spiders use visual beacons and associative cue landmarks alone or in combination and that performance improves across trials when landmarks are present and deteriorates more when multiple landmarks are moved.

A Pilot Controlled Trial of Relaxation Training Combined with a Video Game Reinforcing Emotional Regulation to Improve Anger Management in Children and Adolescents.

Untreated anger and aggression in youth confer heightened risk for subsequent psychosocial problems. However, engaging youth in treatment for anger can be difficult given barriers to accessing care and high rates of attrition. This study examined whether learning relaxation skills and practicing them using a videogame, whose operation was contingent upon keeping heart rate close to baseline levels, could help children learn to manage anger and aggression. Youth ages 7-17 with elevated levels of anger (N = 39) were randomized to receive the active video game condition or a control game that displayed heart rate but did not stop the game if heart rate became elevated. Youth underwent baseline screening, 6 treatment sessions, and follow-up assessments at 2-weeks and 3-months. Compared to the control condition, children in the active condition demonstrated significantly greater improvements in clinician-rated aggression severity (d = 1.48) and youth-rated emotion dysregulation (d = 3.46) at 2-weeks post-treatment. The active group maintained these improvements at 3-month follow-up, but no longer significantly differed from the control group. Intervention effects were nonsignificant for parent-reported emotion dysregulation and aggression. In addition, the intervention group youth, but not control group, experienced increased time with heart rate below baseline over the course of the 6 sessions. Findings suggest a promising brief intervention for reducing aggression and emotion dysregulation in children while they are waiting for longer-term outpatient therapy. Clinical Trial Registration Number: NCT03270813.

Changing Landscape of Randomized Clinical Trials in Stroke: Explaining Contemporary Trial Designs and Methods.

Evidence generated from randomized clinical trials (RCTs) plays an indispensable role in advancing clinical stroke care. Although the number of stroke-related RCTs published every year has grown exponentially over the past 25 years, the execution and completion of RCTs, particularly those conducted in a hyperacute setting, have grown more complicated and challenging over the years. In addition to the practical challenges associated with conducting a clinical trial, like obtaining human subjects approval, identifying clinical sites, training trial personnel, and enrolling the target number of patients within the available funding and timeline, the complexity of contemporary RCT designs and analyses has become much more exacting. It is no longer sufficient to have a decent understanding of the 2-arm, placebo-controlled RCT, combined with a rudimentary grasp of the P value; things are now much more complicated. Innovations in trial design and analysis, including adaptive, Bayesian, platform, and noninferiority designs, have occurred to address the problems of poor trial efficiency. However, these advances require the end user to have a much greater level of understanding regarding the rationale, conduct, analysis, and interpretation of each design. While these newer designs seek greater efficiency, there are inevitably tradeoffs that need to be understood. In this month's edition of Stroke, we introduce a new series designed to help fill in these knowledge gaps. Over the next few months, 4 papers will be published that address major design innovations (adaptive, Bayesian, platform, and noninferiority) with the aim of illustrating how these approaches can make trials more efficient (where efficiency is defined as getting to the right answer, sooner, with a potentially lower sample size). In addition to introducing this series, this current article also reviews traditional hypothesis testing and the common misinterpretations of the P value; fortunately, new philosophical schools of inference are beginning to vanquish the overreliance on the P value. We are excited about the opportunity to educate the Stroke readership about these new trial designs and the profound implications that they bring.

Combinations of physical and cognitive training for subcortical neurodegenerative diseases with physical, cognitive and behavioral symptoms: a systematic review.

The onset of the symptoms of subcortical NDs is due to a unique part of the brain which strengthens the idea of reciprocal influence of physical activity and cognitive training in improving clinical symptoms. Consequently, protocols combining the two stimulations are becoming increasingly popular in NDs. Our threefold aim was to (A) describe the different combinations of physical and cognitive training used to alleviate the motor and cognitive symptoms of patients with subcortical neurodegenerative disorders, (B) compare the effects of these different combinations (sequential, dual tasking, synergical) on symptoms, and (C) recommend approaches for further studies. We conducted literature searches of PubMed, BASE and ACM, to carry out a systematic review of randomized controlled trials and controlled trials of combined physical and cognitive training among patients with Huntington's disease, Parkinson's disease, amyotrophic lateral sclerosis, Lewy body dementia, spinocerebellar ataxia, Friedreich's ataxia, and progressive supranuclear palsy. Physical, neuropsychological, behavioral outcomes were considered. The Cochrane risk-of-bias tool was used to verify the critical appraisal. Twenty-one studies focused on Parkinson's disease with 940 participants were included. Despites promising benefits on cognitive and physical function, our results revealed discrepant findings for research on combined training. Inconsistencies were linked to the choice of tests, the functions that were targeted, disease progression, and trainings. There was a dearth of follow-up data. Differences between combined training are unclear, particularly regarding the role of cognitive load. Future studies should focus on comparing the feasibility, tolerability, and effectiveness of different combinations of motor-cognitive training.

Views and experiences of older people taking part in a safe-falling training program: Lessons learned from the FAlling Safely Training (FAST) trial

BackgroundWhile falls are the leading cause of accidental injury among older people, the current fall prevention strategies have not resulted in a remarkable reduction in fall rates. An alternative novel approach, teaching older adults how to fall safely to prevent injury, has been recently implemented in the FAlling Safely Training (FAST) trial. The current study aimed to explore the views and perceptions of older people about their participation in the safe-falling training program.MethodsFocus groups were conducted with eight community-dwelling older adults (age range: 66 to 76 years, five females) at risk of falling who completed the FAST program. Two focus groups involving four participants each were conducted. Recordings were transcribed verbatim and analyzed using thematic analysis.ResultsThree themes were identified following the analysis: (1) Before the training; with subthemes: Previous fall prevention strategies and Motivation to participate. Motivations to take part in the training included worries about falling, an awareness of an increased risk of falling, and a desire to decrease the chances of sustaining an injury. (2) Training itself; with subthemes: General impressions of the training and Learning the techniques. Older people highlighted that the training was well-designed and executed. (3) Going forward; with subthemes: Training increased confidence, Incorporating in a community setting, and Proposing improvements to the study. It was reported that the training enhanced participants’ confidence about falling without injury. Incorporating the training into a community context was discussed, and suggestions for program enhancements were made. The individual nature of the training was valued, but participants also provided suggestions for how they would see the program taking place successfully in small groups.ConclusionsThe results indicated that the safe-falling training was acceptable to older adults. The perceived ability to fall without injury was reported to have increased. Individuals who experienced a fall after the training ended reported being able to use the techniques learned in their daily life. The findings have implications for the training to be refined and implemented in the community.Trial registrationThe article is linked to a randomized controlled trial registered at http://ClinicalTrials.gov (NCT05260034).

Physiological and Performance Adaptations to Varying Rest Distributions During Short Sprint Interval Training Trials in Female Volleyball Players: A Comparative Analysis of Interindividual Variability.

This study aimed to examine the impact of different rest periods between short sprint interval training (SSIT) trials on the physiological and performance adaptations of female volleyball players. Twenty-four trained collegeathletes volunteered to participate in this study and were randomly assigned to 3 SSIT groups with different work-to-rest ratios (1:2 [5-s run:10-s rest], 1:4 [5-s run:20-s rest], and 1:6 [5-s work:30-s rest]). Before and after 6-week training, physiological parameters (maximum oxygen uptake, first and second ventilatory thresholds, and peak and mean power output) and physical performance measures (ie,countermovement vertical jump, 10-m sprint, and T-test change-of-direction speed) were evaluated. After the training period, all groups improved (P = .001) their sport-related performance and physiological parameters, ranging from moderate to very large effect sizes. Comparative analysis of the magnitude of training effects indicated thatthe 1:6 SSIT group had in a significantly greater change in countermovement vertical jump (P = .007), 10-m sprint (P = .014), peak power output (P = .019), and mean power output (P = .05) compared with 1:2 SSIT group. By contrast, the 1:2 SSIT group demonstrated significantly (P = .022) greater changes in maximum oxygen uptake than the 1:6 SSIT group. However, the change-of-direction speed and changes infirst and second ventilatory thresholds were the same among the groups (P > .05). When performing SSIT, longer rest intervals are suitable for physical and anaerobic performance, and shorter rest periods are appropriate for enhancing the cardiorespiratory fitness of female volleyball players' performance.

Inducing select/reject control in a matching-to-sample procedure with observing response: Effects on stimulus equivalence.

This study investigated a three-choice matching-to-sample procedure with an observing-response requirement to induce select and reject control during baseline training and examined their effects on the formation of equivalence classes. The study involved four girls, aged 8 to 10 years, who participated in a computer-based task that alternated between conditions designed to induce select and reject control by requiring observing responses to display the stimuli. In the select-control condition, the correct stimulus was revealed first on at least 75% of the trials, increasing the likelihood of selecting the correct stimulus without seeing the incorrect ones. In contrast, in the reject-control condition, the correct stimulus was revealed third on at least 75% of the trials, forcing the display of both incorrect stimuli. This procedure successfully generated both select and reject control, which increased progressively with the accuracy during baseline training trials. Select control was more prominent than reject control, but both led to the formation of equivalence classes. This finding suggests that reject control does not hinder control by the correct stimulus.

Geographic inequality in funding by National Institutes of Health negatively impacts almost one-half of the states in the United States.

The National Institutes of Health (NIH) is the primary federal agency in the United States (US) that supports biomedical research, training, and clinical trials. NIH funding creates patents and jobs and thus helps the regional and national economy grow. Therefore, NIH funding would be expected to flow equitably to all 50 US states. However, there is a significant geographic disparity in the level of NIH funding received by various states. To that end, in 1993, authorized by Congress, NIH initiated a funding program called the Institutional Development Award (IDeA) to support states, called IDeA states, which received low levels of NIH funding. However, whether this approach has helped reduce the geographic disparity in NIH funding is unclear. In the current study, we analyzed data on various NIH funding mechanisms awarded to 23 IDeA states vs. 27 non-IDeA states, as identified by NIH. We compared these data to the population size, federal taxes paid, and the number of PhDs and Post-doctoral Fellows(PDFs) trained in IDeA vs. non-IDeA states. The non-IDeA states received 93.6% of the total NIH funding, whereas IDeA states received only 6.4%. On average, one Institutional Training Grant was received for every 24 PhDs trained in non-IDeA states, while IDeA states received one such grant for every 46 PhDs trained. The non-IDeA states comprised 84.3% of the US population, whereas IDeA states comprised 15.7%. Thus, on a per capita basis, non-IDeA states received $120 from NIH, whereas IDeA states received $45 per person. For every million dollars contributed by the non-IDeA states toward federal taxes, they received $7,903 in NIH funding, while the IDeA States received only $4,617. For FY 2022, the NIH funding created an economic activity of $90.6 Billion in non-IDeA states and only $6.3 billion in IDeA states. When total NIH funding to the states was analyzed for the years 1992, 2002, 2012, and 2022, IDeA states received 4.7% of the total NIH funding in 1992, which increased to 7.2% in 2002 but dropped to 6.8% in 2012 and 6.5% in 2022. This demonstrated that IDeA states' share of NIH funding remained relatively unchanged for the past 20 years. Eliminating the geographic disparity in NIH funding is crucial for achieving equitable health outcomes across the US, and for the IDeA states to successfully train future generations of physicians and scientists, as well as grow the regional economy. Although the NIH IDeA programs have helped enhance the research capacity in IDeA states, the funding currently constitutes less than 1% of the total NIH budget. Thus, it is critical to increase NIH funding to IDeA states to improve health outcomes for all Americans.

Personality may modulate learning and memory differences in two taxa of the African striped mouse genus Rhabdomys

AbstractDifferent environments place different cognitive demands on constituent taxa. Learning and memory involve cognitive processes with associated costs, and it is expected that different levels of learning will occur in taxa from different environments. Greater memory loads linked to increased environmental complexity require greater learning and memory capacities. We investigated the variation in learning and memory in sister taxa of striped mice (genus Rhabdomys). We studied two populations each of the mesic grassland‐occurring R. d. chakae and the mostly arid‐occurring R. pumilio. We conducted two sets of experiments. (1) In a novel object recognition (NOR) test, we assessed memory by recording the duration of exploration of similar and novel objects by test mice. (2) In an associative learning task, we assessed whether mice could associate specific scents with or without a food incentive or with different quantities of the food incentive in previous training phases. We measured the latency of mice to contact scents in a two‐sample choice in the test phase. In the NOR test, R. pumilio spent less time investigating similar objects in a training trial than R. d. chakae but increased absolute exploration of the novel object when presented with a novel and a familiar object in the retention trial, suggesting a sensitization to the novel object by R. pumilio. In the associative learning experiments, R. pumilio approached the stimuli faster than R. d. chakae, whereas mice from both taxa preferred scents associated with a seed versus no seed and scents associated with 5 seeds versus 1 seed. The data provide evidence of taxon‐level differences in learning and memory, likely related to environmentally modulated personality differences between the taxa.

Decoding working-memory load during n-back task performance from high channel fNIRS data

Objective.Functional near-infrared spectroscopy (fNIRS) can measure neural activity through blood oxygenation changes in the brain in a wearable form factor, enabling unique applications for research in and outside the lab and in practical occupational settings. fNIRS has proven capable of measuring cognitive states such as mental workload, often using machine learning (ML) based brain-computer interfaces (BCIs). To date, this research has largely relied on probes with channel counts from under ten to several hundred, although recently a new class of wearable NIRS devices featuring thousands of channels has emerged. This poses unique challenges for ML classification, as fNIRS is typically limited by few training trials which results in severely under-determined estimation problems. So far, it is not well understood how such high-resolution data is best leveraged in practical BCIs and whether state-of-the-art or better performance can be achieved.Approach.To address these questions, we propose an ML strategy to classify working-memory load that relies on spatio-temporal regularization and transfer learning from other subjects in a combination that, to our knowledge, has not been used in previous fNIRS BCIs. The approach can be interpreted as an end-to-end generalized linear model and allows for a high degree of interpretability using channel-level or cortical imaging approaches.Main results.We show that using the proposed methodology, it is possible to achieve state-of-the-art decoding performance with high-resolution fNIRS data. We also replicated several state-of-the-art approaches on our dataset of 43 participants wearing a 3198 dual-channel NIRS device while performing then-Back task and show that these existing methodologies struggle in the high-channel regime and are largely outperformed by the proposed pipeline.Significance.Our approach helps establish high-channel NIRS devices as a viable platform for state-of-the-art BCI and opens new applications using this class of headset while also enabling high-resolution model imaging and interpretation.

A mixed-method randomised controlled feasibility trial of digital CBT and emotion regulation skills training for employees in the workplace (REST)

Background and aimDigital interventions for depression and anxiety can be as effective as face-to-face therapy. One in six workers experience some form of mental health problems, making the workplace a potential avenue to deliver mental health interventions as part of a stepped care model. This study aimed to assess the acceptability, feasibility, and preliminary efficacy of a digital cognitive behavioural therapy (dCBT) on depression and anxiety for employees in the workplace.MethodsA mixed-methods evaluation of employees allocated to dCBT (n=25), or a waitlist control group (n=27) was used to assess five feasibility objectives related to recruitment of employers and employees, engagement, study procedure and preliminary efficacy of the intervention. Quantitative outcome measures and qualitative interviews at 8 weeks post-randomisation were used. Quantitative outcomes were also assessed within subject at 3-, 6-, and 12-month follow-up. Qualitative data was analysed using thematic and framework analysis in Nvivo, whilst quantitative outcomes were analysed using mixed effect linear models between and within subject in R and SPSS.ResultsThirty-Three businesses agreed to facilitate the delivery of three trials run by the University of Warwick in their workplaces. 52 participants consented into the REST trial. Adherence/usage of participants of the treatment platform was just over 50% across the whole sample. There was a reduction in depression and anxiety symptoms post-intervention and at follow-up timepoints across all participants and over time although there were no statistically significant between group differences. High acceptability and satisfaction of the intervention were reported by participants based on qualitative interview data at post-intervention.ConclusionsResults from this feasibility study suggests that the dCBT programme (REST) was acceptable and shows improvement in depression and anxiety symptoms, albeit not over and above the treatment effects in the control group. Recruitment of participants and engagement with the intervention made the feasibility of the delivery somewhat challenging. With better recruitment promotion and engagement strategies, as well as implementing the learnings from the feasibility trial, a fully powered study can inform the efficacy of the REST intervention.Trial registrationThe study is registered in the BMC Springer Nature ISRCTN registry ISRCTN31161020 (registered on 08/06/2021).

Vestibular perceptual learning improves self-motion perception, posture, and gait in older adults

Vestibular motion perception declines with age, increasing the risk of falling substantially. We performed a two-week perceptual learning intervention using a self-motion direction discrimination task (2800 training trials per person) on a 6 degrees of freedom motion platform in healthy older adults (n = 40, aged 70–88 yr). Linear inter-aural and angular roll tilt vestibular thresholds improved with training (95% credible interval for pre/post difference), suggesting altered sensitivity post-training. Moreover, improved perceptual abilities transfer to actual posture (reduced sway) and gait parameters. Passive self-motion discrimination training provides a new and promising way to counteract age-related sensory decline. It can reduce the risk of falling, and thereby maintain individual autonomy and quality of life.

Improved motor imagery training for subject's self-modulation in EEG-based brain-computer interface.

For the electroencephalogram- (EEG-) based motor imagery (MI) brain-computer interface (BCI) system, more attention has been paid to the advanced machine learning algorithms rather than the effective MI training protocols over past two decades. However, it is crucial to assist the subjects in modulating their active brains to fulfill the endogenous MI tasks during the calibration process, which will facilitate signal processing using various machine learning algorithms. Therefore, we propose a trial-feedback paradigm to improve MI training and introduce a non-feedback paradigm for comparison. Each paradigm corresponds to one session. Two paradigms are applied to the calibration runs of corresponding sessions. And their effectiveness is verified in the subsequent testing runs of respective sessions. Different from the non-feedback paradigm, the trial-feedback paradigm presents a topographic map and its qualitative evaluation in real time after each MI training trial, so the subjects can timely realize whether the current trial successfully induces the event-related desynchronization/event-related synchronization (ERD/ERS) phenomenon, and then they can adjust their brain rhythm in the next MI trial. Moreover, after each calibration run of the trial-feedback session, a feature distribution is visualized and quantified to show the subjects' abilities to distinguish different MI tasks and promote their self-modulation in the next calibration run. Additionally, if the subjects feel distracted during the training processes of the non-feedback and trial-feedback sessions, they can execute the blinking movement which will be captured by the electrooculogram (EOG) signals, and the corresponding MI training trial will be abandoned. Ten healthy participants sequentially performed the non-feedback and trial-feedback sessions on the different days. The experiment results showed that the trial-feedback session had better spatial filter visualization, more beneficiaries, higher average off-line and on-line classification accuracies than the non-feedback session, suggesting the trial-feedback paradigm's usefulness in subject's self-modulation and good ability to perform MI tasks.

Protocol for a randomized controlled trial of moderate intensity interval training in individuals with chronic obstructive pulmonary disease and obstructive sleep apnea overlap syndrome who have excessive daytime sleepiness

BackgroundThe term “Overlap Syndrome” (OS) describes the presence of both chronic obstructive pulmonary disease (COPD) and obstructive sleep apnea (OSA) in a single individual. Excessive daytime sleepiness (EDS) is a common symptom of OS shown to be associated with an increased risk of cardiovascular disease (CVD) that could be reduced through exercise. Thus, we propose to investigate a novel exercise intervention in individuals with the EDS-OS phenotype as they are at highest risk of CVD yet have the greatest barriers to exercise. MethodsWe will conduct a single-site, randomized, two-arm, parallel group-controlled exercise trial in individuals with EDS-OS. The Epworth Sleepiness Scale (ESS) will be assessed at baseline. Individuals with OS and the EDS-OS phenotype (ESS >10) (n = 46) will be randomized to a moderate intensity interval training (MIIT, i.e. intervals of 5 min at 50% VO2peak followed by 3 min of active recovery at 10% VO2peak) or a control group of standard of care. We will investigate if MIIT intervention decreases the risk of CVD in EDS-OS, which will be assessed by: 1) quality of life, measured by the 36-Item Short Form Health Survey; 2) physical activity, measured by daily step counts; and 3) cardiovascular health, assessed as VO2peak, flow-mediated dilation and serum high sensitivity C-reactive protein, lipids, and glucose. ConclusionOur findings will guide future development and implementation of exercise interventions that could reduce the risk of CVD in the understudied EDS-OS phenotype.

Implementation outcomes from a multi-site stepped wedge cluster randomized family caregiver skills training trial.

To assess whether a team collaboration strategy (CONNECT) improves implementation outcomes of a family caregiver skills training program (iHI-FIVES). iHI-FIVES was delivered to caregivers at eight Veterans Affairs (VA) medical centers. Data sources were electronic health records, staff surveys, and interviews. In a stepped wedge cluster randomized trial, sites were randomized to a 6-month time interval start date for iHI-FIVES launch. Sites were then randomized 1:1 to either (i) CONNECT, a team collaboration training strategy plus Replicating Effective Programs (REP), brief technical support training for staff, or (ii) REP only (non-CONNECT arm). Implementation outcomes included reach (proportion of eligible caregivers enrolled) and fidelity (proportion of expected trainings delivered). Staff interviews and surveys assessed team function including communication, implementation experience, and their relation to CONNECT and iHI-FIVES implementation outcomes. The sample for assessing implementation outcomes included 571 Veterans referred to VA home- and community-based services and their family caregivers eligible for iHI-FIVES. Prior to iHI-FIVES launch, staff completed 65 surveys and 62 interviews. After the start of iHI-FIVES, staff completed 52 surveys and 38 interviews. Mixed methods evaluated reach and fidelity by arm. Fidelity was high overall with 88% of expected iHI-FIVES trainings delivered, and higher among REP only (non-CONNECT) compared with CONNECT sites (95% vs. 80%). Reach was 18% (average proportion of reach across eight sites) and higher among non-CONNECT compared with CONNECT sites (22% vs. 14%). Qualitative interviews revealed strong leadership support at high-reach sites. CONNECT did not influence self-reported team function. A team collaboration strategy (CONNECT), added to REP, required more resources to implement iHI-FIVES than REP only and did not substantially enhance reach or fidelity. Leadership support was a key condition of implementation success and may be an important factor for improving iHI-FIVES reach with national expansion.

Teaching Turkish children to mand for information in the context of tact instruction

AbstractThis study explores the efficacy of mand for information (MFI) training in individuals with autism, with a particular focus on the extension of this training to non‐native English speakers and the promotion of generalization across various contexts. The “What is this?” MFI was taught to four native Turkish‐speaking participants under various establishing operations (EOs). Notably, these MFIs were effectively embedded within tact training trials and delivered in a language other than English, thereby extending the research on MFI to a different language. Furthermore, the generalization of the MFIs was observed as participants maintained their proficiency across individuals, settings, and novel stimuli. Social validity data confirmed the acceptability of MFI training among parents, highlighting its potential to enhance communication skills. Follow‐up assessments were conducted 4 weeks post‐training indicating maintenance of the MFIs.

A Randomized Trial of Virtual Reality Training to Improve Firearm Safety Counseling Skills

ObjectiveTo evaluate the efficacy of Resident Education And Counseling on Household (REACH) Firearm Safety, a novel virtual reality (VR) intervention. MethodsWe conducted a single-center, randomized controlled trial among pediatric residents in a Midwestern academic primary care center comparing REACH Firearm Safety with didactic training (intervention) to didactic training alone (control). In the intervention arm, participants practiced firearm safety counseling with virtual characters and received immediate feedback. All residents completed audio-recorded standardized patient (SP) encounters before and after the training as well as a retrospective pre-post survey. Two reviewers, blinded to the allocation arm, used a standardized assessment tool to generate performance scores. Outcomes of interest included the difference between groups in SP performance scores and self-reported confidence. ResultsFrom March to July 2023, 62% of eligible pediatric residents (n = 47/76) completed the allocated study tasks (intervention 19, control 28). In both groups, SP performance scores and self-reported confidence improved. Compared to the control group, the intervention group demonstrated improvement in sharing information on secure storage devices (P = 0.009) and increased confidence in providing information on secure storage (P = 0.002). ConclusionsCompared with didactic training alone, a VR intervention using deliberate practice improved residents’ skills and confidence related to firearm safety counseling.

Motor learning alters vision, but vision does not alter motor learning.

During visuomotor learning, improvements in motor performance accompany changes in how people use vision. However, the dependencies between altered visual reliance and improvements in motor skill is unclear. The present studies used an online sequence learning task to quantify how changing the availability of visual information affected motor skill learning (study 1) and how changing motor skill affected visual reliance (study 2). Participants used their keyboard to respond to targets falling vertically down a game screen. In study 1 (n = 49), the availability of visual information was altered by manipulating where the targets were visible on the screen. Three experimental groups practiced the task during full or limited vision conditions (when the targets were only visible in specific areas). We hypothesized that limiting visual information would reduce motor learning (i.e., the rate of improvement during training trial blocks). Instead, although participants performed worse during limited vision trials (P < 0.001), there was no difference in learning rate (P = 0.87). In study 2 (n = 119), all participants practiced the task with full vision and their visual reliance (i.e., their performance change between full and limited vision conditions) was quantified before and after training. We hypothesized that with motor learning, visual reliance on future targets would increase, whereas visual reliance on the current targets would decrease. The results of study 2 partially support our hypotheses with visual reliance decreasing for all visual areas (P < 0.001). Together, the results suggest changing motor skill alters how people use vision, but changing visual availability does not affect motor learning.NEW & NOTEWORTHY Previous research has established how people use visual information changes with motor learning. However, the dependencies of these two processes on each other are unclear. We find that limiting the availability of visual information degrades motor performance but not motor learning. We also find that motor learning reduces the impact of limiting the availability of visual information on motor performance. Together, these results suggest that how people use visual information depends on their motor skill.

Reflections on the challenges of conducting an international multicentre randomized controlled trial of balance training in addition to pulmonary rehabilitation and its impact on fall incidence in people with COPD

BackgroundPulmonary rehabilitation (PR) is accepted as standard care for individuals with COPD. We conducted an international, multi-centred randomized controlled trial (RCT) to determine if adding balance training to PR would reduce the incidence of falls in people with COPD. While there have been many trials investigating the effectiveness of PR, few have involved international collaboration. Successful execution of rehabilitation trials requires a significant investment of time, staffing, and resources. With the recent completion of the Balance Training for Fall Reduction in COPD RCT, we report on the design, implementation, and execution of our trial using project management phases. We also highlight our lessons learned for consideration in future multi-centre rehabilitation trials.MethodsThis was a retrospective review of the planning, preparation, timelines, and personnel training involved in the execution of this study using four of the five project management phases described by Farrell et al. in 2010: (1) initiation, (2) planning, (3) execution, and (4) monitoring and controlling. We report descriptive statistics as percentages and counts and summarize our lessons learned.ResultsTen outpatient PR programs in three continents participated. Thirty-one personnel worked on the trial across all sites. Enrolment began in January 2017 and was suspended in March 2020 due to the COVID-19 pandemic. Approximately 1275 patients were screened, 455 (36%) were eligible, 258 (57%) consented, 243 (53%) participated, and 130 (61%) completed the 12-month follow-up assessment. Lessons learned through our experience included (1) ensuring awareness of funder policies and considering the impact on collaborating sites; (2) preparing for the possibility of human resource and program disruptions; (3) anticipating site dropout and having a contingency plan in place; (4) planning and monitoring process measure data before, during, and after trial initiation; (5) ensuring frequent and consistent communication with and between collaborating sites; (6) maximizing features of database platform to ensure data set completeness and controlled data access; and (7) identifying strategies for increasing patient engagement in a high-demand study.ConclusionsWe identify seven lessons learned through our experience conducting an international, multicentre rehabilitation-based RCT. These lessons can provide guidance to other trialists conducting studies with similar logistics and may assist with future trial planning and implementation.