Development and short-term effectiveness of a theory-informed, nurse-led structured rehabilitation consultation in primary care asthma management.

People undergoing revision total hip replacement (THR) typically experience slower recovery and greater functional limitations than those undergoing primary procedures. Rehabilitation practices following revision THR are inconsistent and often adapted from protocols for primary THR, despite limited specific evidence supporting their effectiveness. To compare the effectiveness of an exercise intervention targeting hip strengthening (NEMEX-STR) on functional performance at 4 months with the standard community-based rehabilitation (Usual care) in participants undergoing revision THR. This multicenter, randomized, controlled, parallel-group, assessor-blinded superiority trial included participants undergoing revision THR who were randomized to NEMEX-STR or Usual care. The NEMEX-STR group underwent a 16-week intervention targeting hip strengthening, while the Usual care group received standard rehabilitation. The primary outcome was the between-group difference in functional performance assessed by the 30-second Chair Stand Test (30s-CST), from baseline (ie, prior to surgery) to 4 months after the start of the intervention. Secondary outcomes included the Hip Disability and Osteoarthritis Outcome Score (HOOS), the 40-meter Fast-Paced Walk Test (40m-FPWT), the 9-step Timed Stair Climb Test (9-step TSCT), and unilateral leg extensor muscle power. A total of 84 participants were recruited between November 2022 and June 2024 and were allocated to either NEMEX-STR (n = 43) or Usual care (n = 41). The mean changes from baseline to 4-month follow-up in the 30s-CST were 1.9 (95 % CI 0.8 to 3.0) in NEMEX-STR and 1.2 (95 % CI 0.6 to 2.3) chair stands in Usual care, with a between-group difference of 0.7 (95 % CI -0.8 to 2.3). Secondary outcomes showed no clinically relevant between-group differences in change for HOOS subscales, 40m-FPWT, 9-step TSCT, or unilateral leg extensor muscle power. An exercise intervention targeting hip strengthening was not superior to standard community-based rehabilitation for improving functional performance at 4 months in participants undergoing revision THR. GOV: NCT05657054.

A functional medicine approach to diabetes control and quality of life: an open-label randomized pilot study.

Efficacy of nonsurgical interventions for the management of adults with cervicogenic headache: a systematic review and meta-analyses.

Design and rationale of the SPARC trial: a phase II, single-system randomized controlled trial of immediate transfer to specialty post-arrest care.

Deprescribing Psychotropic Medications and Falls in Older Adults: A Setting-Stratified Systematic Review and Meta-Analysis.

Patients, particularly those at the end of their lives, frequently receive goal-discordant care, and their surrogate decision-makers suffer long-term psychological injury. Contributors to these issues may include infrequent communication between clinicians and surrogates, failure to discuss prognosis, values, and treatment options that include comfort-focused care, and surrogates facing high-stakes decision-making while underprepared and overwhelmed psychologically and emotionally. This is a multicenter, patient-randomized efficacy trial of a multi-component intervention, versus usual care, for 370 incapacitated, critically ill adults at high risk of death or severe disability, and their surrogate decision-makers, from 7 hospitals across the United States. The intervention combines surrogate utilization of a digital Family Support Tool (FST) in real-time during their loved one's hospitalization with proactively scheduled family meetings, for which both surrogates and clinicians receive additional preparation, at set intervals during the ICU hospitalization. Those in the control arm will receive usual ICU care. Our primary outcome is patient-centeredness of care, measured using the modified Patient Perceived Patient-Centeredness of Care (PPPC) scale. Secondary outcomes include surrogates' psychological symptom burden, communication and decision quality, and patients' health resource utilization and clinical outcomes. This trial will provide robust evidence about the impact of combining the FST with increased and intentional communication, on patient, family, and health system outcomes for those hospitalized in the ICU.

Effectiveness of a nurse-led, mHealth-based cardiac rehabilitation program on cardiorespiratory fitness and physical activity in youth with congenital heart disease: A randomized controlled trial.

Efficacy of non-pharmacological therapies on depression, anxiety, and glycemic control in type 2 diabetes: A systematic review and network meta-analysis.

Psychoeducational intervention against support groups for caregivers: A randomised controlled trial of its effectiveness.

Assessing and Listening to Individual Goals and Needs (ALIGN) versus enhanced usual care for hospitalized older patients with cancer discharged to skilled nursing facilities: Protocol for a pilot randomized controlled trial.

Nursing and interdisciplinary interventions to support people with advanced cancer at the end of life in emergency departments: A systematic review.

The prevalence of gestational diabetes mellitus (GDM) in Malaysia is estimated at 9-18%. Although GDM is associated with increased and potentially modifiable risk of developing type 2 diabetes, the effectiveness of diabetes prevention interventions (DPI) post-GDM in this setting is unclear. To evaluate the feasibility of conducting a future full-scale, two-arm, parallel, randomised controlled trial (RCT) of a DPI in women with GDM set in Malaysia. Women in both arms received usual GDM care. Women in the intervention arm also received modules on diet, physical activity, and mental health via a mobile application, over six months post-partum, plus dietitian-led group sessions and motivational text messages. The primary feasibility outcomes included the proportion of women who consented, were eligible and randomised and provided outcome data. We measured biomedical and mental health outcomes for a full-scale RCT at four time points: baseline before randomisation (approximately 30 weeks' gestation), 36 weeks' gestation and 3- and 6-months postpartum. We screened 660 women with GDM, 294 (45%) consented for eligibility screening, of whom 164 (24.9%) were eligible and 60 (9%) consented and were randomised. The proportion who completed biomedical outcomes was 85% at each follow-up. There was no treatment effect on any other biomedical outcomes or secondary outcomes. The participation rate was in keeping with previous DPI trials and the attrition rate was low, suggesting it is feasible to conduct a full-scale RCT.

Chronic Obstructive Pulmonary Disease (COPD) is a major cause of healthcare system use and related cost. While pulmonary rehabilitation (PR) is efficient, maintenance programs (PR-MA) can maintain the benefits over time. Yet, the long-term impact (>36 months) of PR-MA on healthcare resource and cost has never been assessed. Recently, a PR-MA program based on self-help associations has shown a clinical efficacy beyond 36 months, Thus, we aimed to assess the effect of this PR-MA program on long-term hospitalizations and costs versus usual care (PR-UC). We performed an ancillary analysis of the post-rehabilitation LTAir+R cohort study, which compared a PR-MA group (n=144) to a matched PR-UC group (n=137) of COPD patients. Data were collected in 82 PR-MA and 93 PR-UC patients, from the Montpellier University Hospital database and patient records over 60 months, including hospitalizations, consultations, emergency visits, and associated costs. In PR-AM vs. PR-UC group, the hospitalization probability reduction almost reached significance (hazard ratio: 1.68; p=0.05). The costs of each hospitalization day (867±116 vs. 1213±138 euros/day; p<0.05), emergency visits (8±5 euros/year vs. 12±3 euros/year) and medical consultations (110±3 vs. 174±3 euros/year; p<0.01) were significantly lower in the PR-AM vs. PR-UC group. Last, PR-MA mitigated the increase in total hospitalizations (p<0.001) associated with the follow-up duration. In addition to its long-term clinical efficacy, this PR-MA program showed a positive impact on hospitalization and healthcare use costs. The effect on hospitalization number and costs could be larger in patients with the longest PR-MA adherence.

The effect of a brief audio-guided self-hypnosis intervention on fear of childbirth during normal delivery: A non-randomised controlled trial.

We conducted the diet and diabetes remission (DIREM) study to assess whether an integrated lifestyle intervention would lead to achieving remission in type 2 diabetes. Patients with type 2 diabetes were randomly assigned to calorie-carbohydrate restriction (CCR) group, intermittent fasting with calorie-carbohydrate restriction (IFCCR), or usual care group (control). The total study duration was 6 months, consisting of two phases: a 12-week integrated lifestyle intervention (ILI) phase, followed by a 12-week maintenance and structured monitoring (MSM) phase. The intervention was presented in the form of a structured behavioural model and also emphasised physical activity. One hundred and twenty participants were randomly assigned to the study. Diabetes remission occurred in 9 (22.5%) of 40 participants in the CCR group (OR (CCR vs. Control) = 11.7, 95% CI: 1.4-98.3; p = 0.024), 12 (30.0%) of 40 participants in the IFCCR group (OR (IFCCR vs. Control) = 18.1, 95% CI: 2.2-151.0; p = 0.007) and 1 (2.5%) of 40 participants in the control group. The odds of remission were higher in the IFCCR group compared to the CCR group, but it was not significant (OR (IFCCR vs. CCR) = 1.5, 95% CI: 0.6-4.3; p = 0.4). Both calorie-carbohydrate restriction alone and in combination with intermittent fasting significantly improved glycemic control and induced diabetes remission compared with the control group. No significant difference was found between the two interventions. Larger long-term studies are needed to confirm these findings. This trial was registered in the Iranian Registry of Clinical Trials (IRCT), IRCT20240418061519N1 (https://trialsearch.who.int/Trial2.aspx?TrialID=IRCT20240418061519N1).

Safety and efficacy of Nordic walking training in adult patients with asthma: A pilot randomised controlled trial with a mixed-methods approach.

Contemporary cardiac rehabilitation (CR) has amoderate effect on physical activity (PA), whereas novel technologies offer promise for enhancing PA levels. Therefore, we assessed the effect of ahome-based smartphone training program in addition to center-based CR on PA levels in patients with coronary artery disease (CAD). CAD patients participating in CR were included in this randomized controlled trial (1:1, stratified for index diagnosis). The control group received usual care CR, whereas the intervention group additionally received a6-week remote smartphone program. The primary outcome was the change in accelerometer-derived moderate-to-vigorous PA (MVPA) from baseline to post-CR. Secondary outcomes included changes in light intensity PA, step count, sedentary time, functional parameters, quality of life, and cardiac anxiety. Abaseline-adjusted linear mixed model was used. Participants (16% female, intervention n = 44, control n = 49) were 63 [56-69] years old and had abaseline MVPA of1.0 (95% Confidence interval (CI):0.9;1.1) h/day. Changes in MVPA did not differ between the intervention (0.1 (95% CI: -0.0; 0.2) h/day) and control group post-CR (0.1 (95% CI: -0.0; 0.2) h/day, p-interaction = 0.75). Also, no differences between the groups were observed for light intensity PA (0.5 (95% CI: 0.2; 0.8) versus 0.4 (95% CI: 0.1; 0.8) h/day, p-interaction = 0.79). Similarly, changes in other secondary outcomes did not differ among groups. Asmartphone training program on top of the usual CR did not yield additional benefits. Amore elaborate mHealth intervention seems needed to change PA during CR in active patients with CAD.

Chronic pain is highly prevalent, disabling, and difficult to treat in people with spinal cord injury (SCI). Our objective was to determine whether hypnotic cognitive therapy (HYP-CT) significantly reduces average pain intensity. This single-blind, randomized, parallel-group trial investigated the efficacy of HYP-CT in treating moderate-to-severe chronic pain in community-residing adults with SCI. Participants were recruited nationwide through SCI organizations and randomized 1:1 to HYP-CT vs usual care (UC). We used computerized permuted block randomization with variable block sizes and stratified by sex and worst pain type. HYP-CT was delivered by a psychologist over the telephone or through Zoom and consisted of 6 weekly 60-minute sessions plus instructions to practice self-hypnosis daily independently by listening to session recordings. Controls were encouraged to continue current treatments or seek additional pain treatments. The primary outcome was average pain intensity assessed 4 times per week on a 0-10 numerical rating scale and averaged. The primary end point was at 6 weeks after randomization, with a follow-up assessment at 12 weeks. All outcomes were assessed through structured telephone interviews performed by blinded assessors. A total of 127 participants were randomized to HYP-CT (n = 64) vs UC (n = 63). Forty-eight percent were treated over the telephone and 52% through Zoom. The group was 42% female, had a mean age of 51.3 years (15.4 years after SCI), and had a mean baseline pain intensity of 5.93. The worst pain was neuropathic in 57% of cases. The primary outcome, average pain intensity, decreased more in the HYP-CT group compared with UC controls at 6 (-0.55, 95% CI -1.04 to -0.06) and 12 (-0.79, 95% CI -1.28 to -0.29) weeks. Depression declined significantly more in the HYP-CT vs UC groups at 6 and 12 weeks. Planned exploratory analyses suggested that the effect of HYP-CT on pain intensity was similar when delivered over the telephone vs through Zoom, and that pain intensity decreased more in those with all neuropathic pain vs those with mixed pain at 12 weeks. The study suggests that HYP-CT is an effective adjunctive treatment for SCI-related pain. Replication studies are needed. The study was registered on ClinicalTrials.gov (NCT03857672) on February 28, 2019 and study enrollment commenced on April 24, 2019. This study provides Class III evidence that, in patients with SCI, HYP-CT improves average pain intensity at 6 weeks compared with UC.

Effect of Integrated Care Management Interventions on Post-hospitalization Utilization and Cost Outcomes for Adults with Multiple Chronic Conditions