Videoconference Sessions Research Articles

Protocol for a randomized controlled trial to evaluate the effectiveness of a telehealth group intervention to reduce perinatal depressive symptoms

BackgroundPerinatal depression and anxiety (PDA) affect approximately 20 % of individuals and are associated with adverse outcomes, including preterm birth, low birth weight, and impaired cognitive development of the child. Telehealth may reduce access barriers to needed mental health services. However, lack of disseminated, standardized study protocols aimed at investigating the role of telehealth in reducing PDA symptoms limits the ability to compare findings across studies. The purpose of this paper is to provide a conceptual framework and a randomized controlled trial protocol (RCT) for use in future studies. Methods and analysisAn RCT was designed to evaluate the effectiveness of a group videoconference intervention (VCI) to reduce PDA symptoms across pregnancy and postpartum period. Participants are randomly assigned to study groups: VCI + standard of care, or attention control (AC) + standard of care. Both groups have weekly one-hour group videoconference sessions for 9 weeks. The VCI groups are facilitated by a mental health professional using a manualized program based on mindfulness-based practices and cognitive behavioral therapy (MBCT). The AC groups are facilitated by a registered nurse using a manualized program for childbirth and parenting education. The primary outcomes are depressive symptoms as measured by the Edinburgh Postnatal Depression Scale (EPDS) and anxiety symptoms as measured by the Generalized Anxiety Disorder (GAD-7). ConclusionThis RCT study protocol can be used as a standard approach to improve the ability to compare findings across studies, applied in any setting (e.g., rural or urban), and adapted to diverse communities.Trial Registration:ClinicalTrials.govNCT03932760

Sleep Treatment Education Program for Cancer Survivors: Protocol for an Efficacy Trial.

Cancer survivors are at increased risk for chronic insomnia, even years after treatment completion. As insomnia is associated with a variety of long-term health consequences, access to insomnia treatment is critically important for the survivor population. Cognitive behavioral therapy for insomnia (CBTI) is the recommended first-line treatment for insomnia but remains largely unavailable to survivors. Treatment barriers include geographic limitations, a shortage of trained providers, and demanding treatment regimens. Designed with these limitations in mind, the Sleep Treatment Education Program (STEP-1) delivers components of CBTI in a low-intensity educational intervention delivered online. This is a phase II pilot randomized controlled trial. The primary aims are to test the efficacy of STEP-1 to improve (1) insomnia symptoms and (2) mood in cancer survivors compared to a control condition. The secondary aims will (1) explore participant factors associated with clinically significant response, (2) evaluate acceptability of the control intervention, (3) explore feasibility of delivering individualized coaching sessions for participants who do not have a significant response to STEP-1, and (4) describe participants' satisfaction with STEP-1 and suggestions for improvement. This 2-arm randomized controlled trial enrolled 70 off-treatment cancer survivors aged 40-89 years with clinically significant insomnia. Participants are randomized to receive either the STEP-1 intervention or control condition (relaxation education); interventions are delivered in one-on-one, synchronous, virtual videoconference sessions by trained interventionists. The STEP-1 intervention presents educational information on the development of insomnia after cancer and offers suggestions for improving insomnia symptoms based on the CBTI elements of sleep hygiene, stimulus control, and cognitive restructuring. With the interventionist, participants review the suggestions and develop a personalized sleep action plan for implementation. The relaxation education session provides information on the potential benefits of relaxation and how to independently access online relaxation exercises. The Insomnia Severity Index is used to measure insomnia symptoms, and the Profile of Mood States Short Form is used to measure mood at baseline and 4 and 8 weeks after intervention. The primary end point is change in the Insomnia Severity Index score at 8 weeks, and the secondary end point is change in mood symptoms (Profile of Mood States Short Form) at 8 weeks. This trial was funded in July 2022. Enrollment and data collection began in February 2023 and concluded in October 2024, with 70 participants enrolled. The analysis will begin in fall 2024, and the results are expected in winter 2025. Trial results will determine if STEP-1 effects go beyond those that could be attributed to placebo and other nonspecific treatment factors. Should results support the efficacy of STEP-1 to improve mood and insomnia symptoms, we anticipate developing efficacy and implementation trials of STEP-1 in larger and more diverse samples. ClinicalTrials.gov NCT05519982; https://clinicaltrials.gov/study/NCT05519982. DERR1-10.2196/60762.

MATHEMATICAL MODELING OF SECURE MULTIPOINT VIDEO CONFERENCE SESSIONS USING MULTILAYER GRAPHS

The article describes a multilayer graph model for multipoint videoconference sessions. The model presented in this study allows to specify requirements for quality of video capture quality when transferred between terminals and multipoint control unit at the service layer, as well as assessing bandwidth performance and delay of datalink channels at the secure and transport network layer. The given multilayer graph model for videoconference system is designed taking into account the features of secure network configuration, in which several overlay network layers are distinguished over transportation networks. This model specifies a structure of multipoint videoconference session at service layer, at which videoconferencing terminals interoperate through server. Traffic flows generated during session are distributed according to routing rules at the secure network layer. A purpose to select the most optimal route configuration for the entire session includes a number of alternative methods to distribute traffic for each pair of client-server communication seems to be rather complicated. The study proposes an algorithm for searching the shortest path in the graph of a secure overlay network with a step-by-step projection fer each individual route section onto the underlying level of the transport network to find the shortest path within its boundaries. An example for solving a problem on finding route in regard to the overlay network requirements and the actual traffic flow through the transportation network is given. Minimization of the capacity usage of leased channels was chosen as the optimality criterion. Experiments were conducted to evaluate the session quality based on the objective methods for various video-stream parameters, and corresponding quantitative estimates of the required bandwidth in order to organize a session.

Pilot feasibility randomised controlled trial of cognitive–behavioural therapy for functional cognitive disorder after concussion

BackgroundFunctional cognitive disorder (FCD) may be common after a concussion, and no evidence-based treatment options are available. The current study evaluated the feasibility of a novel cognitive–behavioural therapy (CBT) protocol...

Graded exposure therapy for adults with persistent symptoms after mTBI: A historical comparison study

ABSTRACT Fear avoidance behaviour is associated with slow recovery from mild traumatic brain injury (mTBI). This study is a preliminary evaluation of graded exposure therapy (GET), which directly targets fear avoidance behaviour, for reducing post-concussion symptoms (PCS) and disability following mTBI. In a historical comparison design, we compared two groups from independent randomized trials. The GET + UC group (N = 34) received GET (delivered over 16 videoconference sessions) in addition to usual care (UC). The historical comparison group (N = 71) received UC only. PCS severity (Rivermead Post Concussion Symptoms Questionnaire; RPQ) and disability (World Health Organization Disability Assessment Schedule; WHODAS 2.0 12-item) were measured at clinic intake (M = 2.7, SD = 1.1 months after injury) and again at M = 4.9 (SD = 1.1) months after injury. Between-group differences were estimated using linear mixed effects regression, with a sensitivity analysis controlling for injury-to-assessment intervals. The estimated average change on the RPQ was −14.3 in the GET + UC group and −5.3 in the UC group. The estimated average change on the WHODAS was −5.3 in the GET + UC group and −3.2 in the UC group. Between-group differences post-treatment were −5.3 on the RPQ and −1.5 on the WHODAS. Treatment effects were larger in sensitivity analyses. Findings suggest that a randomized controlled trial is warranted.

Inside the Black Box of Deliberate Practice: How do Coaches Coach to Improve Trauma Triage

IntroductionDeliberate practice, goal-oriented training with feedback from a coach, is a common tool for improving physicians’ performance. However, little is known about how coaches foster performance improvement. MethodsA content analysis of video-recorded training sessions was performed to analyze the coaches’ behaviors during a pilot randomized trial of deliberate practice in trauma triage. The intervention consisted of three video-conference sessions during which trial physicians, under the supervision of a coach, played a customized video game designed to review trauma triage principles. A multidisciplinary team specified tasks (e.g., create collaborative learning environment) that coaches should complete, and suggested 19 coaching strategies (e.g., encourage culture of error) to allow execution of these tasks. Two independent raters translated those strategies into a coding framework and applied it deductively to the recorded sessions. The frequencies of the coaching strategies were summarized, and tested for variation across coaches and time. ResultsThirty physicians received the intervention across two 1-mo blocks. Most (28 [93%]) completed three sessions, each covering two (interquartile range 1-2) triage principles. Coaches used coaching strategies 18 (interquartile range 14.5-22) times per triage principle, using some often (2-3 times/principle) and others infrequently (<1 time/principle). The three coaches used similar numbers (20 versus 16 versus 18.5, P = 0.07) and types of strategies. However, use increased over time (16.8 [Block 1] versus 20 [Block 2] P = 0.018). ConclusionsCoaches used 19 coaching strategies to deliver this deliberate practice intervention, with behavior that evolved over time. Future trials should isolate the most potent strategies and should assess the best method of standardizing coaching.

Alternative models to support weight loss in chronic musculoskeletal conditions: effectiveness of a physiotherapist-delivered intensive diet programme for knee osteoarthritis, the POWER randomised controlled trial

ObjectivesTo determine if physiotherapists can deliver a clinically effective very low energy diet (VLED) supplementary to exercise in people with knee osteoarthritis (OA) and overweight or obesity.Methods88 participants with knee...

The Transition from Face-to-Face Counseling to Videoconferencing Following the Onset of the COVID-19 Pandemic in Taiwan: The Client's Perspective

&lt;p&gt;COVID-19疫情嚴重威脅人們的身心健康，也加速通訊諮商的發展。原進行實體諮商的當事人，面對突發疫情須轉為視訊晤談，這轉換過程的經驗、對諮商關係的知覺，是本研究探究焦點。本研究以發現式研究取向，針對九位大學生當事人，透過半結構式深度訪談蒐集資料，並採紮根理論研究的資料分析方法。研究結果發現，當事人在轉換過程的經驗有四個主題，一是對視訊晤談的預想，正面期待與擔憂參半；二是視訊晤談過程實際困境，包含溝通品質不佳影響投入、虛擬空間療癒氛圍難以營造、情緒表達與覺察受限等，此一主題也是敘說最豐富的；三是有助持續視訊晤談的因素，包含當事人務實的考量、視訊困境的應對與調適；四是視訊晤談的正向經驗，包含省時便利、降低社交接觸的負擔。當事人對於轉換過程諮商關係的知覺有兩個主題，一是轉換對諮商關係的影響，包含情感連結的減損、諮商關係更親近；二是有助諮商關係維繫的因素，包含原有實體諮商基礎的加持、心理師即時的支持與回應。本研究認為在視訊晤談前準備度不足，是導致當事人衝擊經驗的主因之一，而當事人與心理師因應視訊形式的雙向調整有助於當事人調適視訊困境，此外，當事人在轉換過程普遍經歷情感連結的弱化，然原有實體諮商關係的基礎有助於調節轉換過程的不適。最後，依研究結果，提供相關實務與未來研究之建議。&lt;/p&gt; &lt;p&gt;&amp;nbsp;&lt;/p&gt;&lt;p&gt;The global COVID-19 pandemic was a serious threat to the physical and mental health of individuals. Due to social distancing measures, psychological counseling sessions that were previously held face-to-face had to be conducted through videoconferencing. In Taiwan, the two COVID-19 outbreaks in early 2020 and May 2021 necessitated the imposition of social restrictions. This study focuses on the experiences and views of college student clients who initially received counseling for mental health issues through face-to-face sessions but had to transition to online video counseling due to the epidemic.&lt;/p&gt; &lt;p&gt;In this study, a qualitative research method with discovery orientation was adopted. The recruitment of study participants was carried out in two phases. The first phase targeted two universities in central Taiwan, while the second phase was expanded to include universities in northern and southern Taiwan. Both recruitments were promoted online on the school pages of several universities. Over 20 college students signed up in the two stages. After screening by the researchers through telephone and email, only 9 college students (female = 6), all sophomores or juniors, met the study criteria. Data collection was conducted through semi-structured, in-depth interviews conducted through videoconferencing due to social distancing constraints. Open coding, axial coding, and selective coding based on grounded theory research were used for data analysis.&lt;/p&gt; &lt;p&gt;The analysis extracted four themes in the participants&amp;rsquo; experiences of transition to videoconferencing. The first theme is the anticipation of the videoconference, which includes three sub-themes: feeling a sense of similarity to previous experiences of online social communication or distance learning, having positive expectations due to novelty and convenience, and worrying about the possible limitations of the videoconference or interfering distractions. The second theme addresses the challenges of videoconferences, encompassing three sub-themes: the adverse effects of poor dialogue quality on engagement, difficulties in establishing a comforting atmosphere in virtual spaces, and limitations on emotional expression and awareness. The participants discussed this theme frequently in the interviews. The third theme is related to the elements that enable the success of continuous videoconference interviews, including two sub-themes: pragmatic considerations of the client and coping with and adjusting to videoconferencing difficulties. Fourth, the positive experience of videoconferencing includes two sub-themes: time-saving and convenience, which reduce the burden of social contact. Two themes were identified in the participants&amp;rsquo; perception of the counseling relationship during the transition process. One aspect to consider is the impact of transition on the counseling relationship, which includes two sub-themes: loss of emotional connection and a strengthened counseling relationship. The second theme pertains to the factors that contribute to maintaining the consultation relationship, encompassing two sub-themes: the support of an existing face-to-face counseling relationship and the immediate support and response from the counseling psychologist.&lt;/p&gt; &lt;p&gt;This study suggests that the absence of proper informed consent by psychological counseling professionals before the videoconference is one of the main factors affecting the client’s experience. The quality of the videoconference session is significantly influenced by communication equipment and the environment. In addition, participants typically spoke of a weakening of the emotional connection in the counseling relationship during the transition process. The original face-to-face counseling relationship foundation helped to alleviate the discomfort of the transition process. Finally, based on the study results, recommendations for practice related to telecounseling and suggestions for future research directions are provided.&lt;/p&gt; &lt;p&gt;&amp;nbsp;&lt;/p&gt;

Feasibility and acceptability of a family navigator program to support foster parents of youth with mental health concerns

This pilot study assessed the acceptability and feasibility of the PROviding ACcess To InnoVative &Evidence-Based Intervention (PROACTIVE) Family Navigator Program for foster parents of children with mental health needs. Foster parents (n = 7) participated in four video conference sessions with a family navigator over the course of one month. In this study, family navigators were psychology doctoral students with mental health training. Feasibility and acceptability were measured with post-session surveys completed by family navigators and participants as well as a participant-completed survey following completion of the program. Feasibility and acceptability were both found to be excellent. Foster parents provided very positive satisfaction ratings for all aspects of the program. This pilot study provided preliminary support for the feasibility and acceptability of the PROACTIVE Family Navigator Program. With the experienced gained in this pilot work, we will design a randomized controlled trial with a fully powered sample to evaluate the efficacy of this program on building foster parent capacity to manage their child’s mental health needs.

Abstract P371: The Retrain Your Brain for Healthy Eating Study: Promising Results in Reducing Cravings and Supporting Healthier Eating Habits Among Diverse Patients With Obesity

Introduction: Adopting healthy eating habits can improve cardiovascular health. However, following dietary guidelines can be challenging, partly due to neural pathways that influence cravings and appetite. While medications exist to reduce appetite and cravings, behavioral interventions targeting cravings are less common. The innovative Food Trainer mobile application, FoodT, employs a go no-go paradigm, where participants learn to respond to healthy foods presented in green circles (go-trials) and withhold their response to unhealthy foods presented in red circles (no-go trials). Growing evidence suggests that this training can reduce food cravings and energy intake. Nonetheless, its feasibility in clinical and at-home settings and among diverse populations remains underexplored. To address this gap, this study investigates the feasibility of the FoodT application for a diverse patient population with obesity. Hypothesis: Food response training is feasible to decrease food cravings (scores: 15-75) and energy intake (kcal). Methods: The Retrain Your Brain for Healthy Eating trial is a single-group feasibility study of participants with obesity from diverse racial and ethnic backgrounds. Participants engage in a food response training intervention, with a video-conference introduction session, followed by a self-guided training regimen of three or more sessions weekly for 12 weeks. Study staff conduct weekly meetings to monitor adherence and offer support. Assessments include weekly food craving reports via a validated survey (Food Craving Questionnaire - State) and energy intake (kcal) via weekly self-guided ASA-24 dietary recalls. We averaged reports in cravings and kcal for Month 1, Month 2, and Month 3 and used linear mixed-effect models. Results: Of 17 participants, 87% self-identified as female, 42% as non-Hispanic Black, and 23% as Hispanic (age: 50.0±13.4, BMI: 36.53±4.59). On average, participants used FoodT 4.22±2.91 times per week. We observed significant reductions in cravings (Month 1: 37.59±10.42, Month 2: 32.43±10.22, Month 3: 31.36±9.80), P = .001, and kcal (Month 1: 1872.54 ±740.22, Month 2: 1818.05 ±724.43, Month 3: 1563.14 ±682.78), P = .046. Conclusion: Preliminary findings from this feasibility study suggest that FoodT has the potential to decrease food cravings and energy intake among a diverse population with obesity. However, this study is limited by a small sample size, gender imbalance, and reliance on self-reported data. This mobile app offers a low-cost scalable tool to support patients with obesity in adopting healthier diets, and improve cardiovascular health, needing further research to confirm these findings and assess its long-term sustainability and clinical implications.

Group, Blended and Individual, Unguided Online Delivery of Mindfulness-Based Cognitive Therapy for People With Cancer: Feasibility Uncontrolled Trial.

Online mindfulness based cognitive therapy (eMBCT) has been shown to reduce psychological distress in people with cancer. However, this population has reported lack of support and asynchronous communication as barriers to eMBCT, resulting in higher nonadherence rates than with face-to-face MBCT. Using a co-creation process, we developed 2 formats of eMBCT: group, blended (combination of therapist-guided group and individual online sessions) and individual, unguided (individual, unguided online sessions only). Group, blended eMBCT offers peer support and guidance, whereas individual, unguided eMBCT offers flexibility and the possibility of large-scale implementation. The objective of this nonrandomized feasibility study was to assess aspects of feasibility of the group, blended and individual, unguided eMBCT interventions. Participants were people with cancer who chose between group, blended and individual, unguided eMBCT. Both intervention conditions followed the same 8-week eMBCT program, including an introductory session and a silent day (10 sessions total). All sessions for individual, unguided eMBCT occurred via the platform Minddistrict, whereas group, blended eMBCT consisted of 3 online videoconference sessions guided by a mindfulness teacher and 5 sessions via Minddistrict. We assessed the feasibility of the intervention quantitatively and qualitatively by evaluating its acceptability among participants. Additionally, we assessed limited efficacy by looking at the number of questionnaires participants completed pre- and postintervention. We included 12 participants for each eMBCT condition. Participants in group, blended eMBCT completed, on average, 9.7 of 10 sessions, compared with an average 8.3 sessions for individual, unguided eMBCT (excluding dropouts). Of the 24 participants, 13 (54%) agreed to be interviewed (5 unguided and 8 blended). Participants in both conditions reported positive experiences, including the convenience of not having to travel and the flexibility to choose when and where to participate. However, among the barriers for participation, participants in the group, blended condition reported a preference for more group sessions, and participants in the individual, unguided condition reported a lack of guidance. Additionally, for the group, blended condition, the effect sizes were small for all outcome measures (Hedges g range=0.01-0.36), except for fatigue, which had a moderate effect size (Hedges g=0.57). For the individual, unguided condition, the effect sizes were small for all outcome measures (Hedges g range=0.24-0.46), except for mindfulness skills (Hedges g=0.52) and engagement with the intervention (Hedges g=1.53). Participants in this study had a positive experience with group, blended and individual, unguided eMBCT. Based on the results from this study, we will adjust the intervention prior to conducting a full-scale randomized controlled trial to evaluate effectiveness; we will add 1 group session to the group, blended eMBCT using Zoom as the platform for the group sessions; and we will send reminders to participants to complete questionnaires. ClinicalTrials.gov NCT05336916; https://clinicaltrials.gov/ct2/show/NCT05336916.

A blended intervention for adjustment disorder: Study protocol for a feasibility trial

IntroductionAdjustment disorder (AjD) is a maladaptive response to one or more psychosocial stressors. In many cases, the symptomatology of this disorder disappears once the stressor or its consequences are no longer present. However, in some cases, if left untreated, the symptoms may worsen and develop into a more severe mental disorder. In this regard, different authors propose that a low-intensity intervention may be suitable for this disorder. Previous studies with other mental disorders and with patients with AjD found that blended interventions can be a viable and effective option. The aim of this study is to analyze the feasibility (the participants' expectations and preferences, the satisfaction and acceptance, the appropriateness of different methods of recruitment and data collection, and the reasons for dropping out) of a blended cognitive-behavioral intervention (CBT) for AjD that combines the use of a self-applied Internet-based program with videoconference sessions with a therapist. As a secondary objective, the potential efficacy of this intervention will be tested. Method and analysisA feasibility trial with a single-group and open-trial design will be conducted. A total of 41 participants will be assigned to the single treatment group. All the participants will be assessed for eligibility and respond at four measurement points: pre-treatment, post-treatment, and 3- and 12-month follow-ups. The treatment combines the use of an Internet-based intervention through a web platform with videoconference sessions with a therapist every 10–12 days. The intervention contains seven modules and is based on CBT. The main outcome measures are related to the feasibility of the intervention (adherence, treatment satisfaction and expectations, participants' opinions, preferences, therapeutic alliance, and usability). Clinical measures will also be assessed. DiscussionTo the best of our knowledge, this is the first study to test a blended intervention for AjD in the Spanish language. We expect this intervention to be feasible, and that a future Randomized Controlled Trial will be able to show its efficacy. Potential limitations include difficulties in recruiting the sample, failures in the computer systems, or a high dropout rate. Measures have been taken to try to reduce the impact of these limitations. This study received the approval of the Ethics committee of Universitat Jaume I in March 2022 (CD/42/2022). Trial registrationClinicalTrials.gov Identifier: NCT05464121. Registered 19 July 2022, https://clinicaltrials.gov/ct2/show/NCT05464121.

Comparing remote versus in-person assessment of learning skills in children with specific learning disabilities.

Interactive telemedicine applications have been progressively introduced in the assessment of cognitive and literacy skills. However, there is still a lack of research focusing on the validity of this methodology for the neuropsychological assessment of children with Specific Learning Disorder (SLD). Seventy-nine children including 40 typically developing children (18 males, age 11.5 ± 1.06) and 39 children with SLD (24 males, age 12.3 ± 1.28) were recruited. Each participant underwent the same neuropsychological battery assessing reading accuracy, speed, and comprehension, writing, numerical processing, computation, and semantic numerical sense, twice (once during an in-person session (I) and once during a remote (R) home-based videoconference session). Four groups were subsequently defined based on the administration order. Repeated-measure-ANOVAs with assessment type (R vs. I testing) as within-subject factor and diagnosis (SLD vs. TR) and administration order (R-I vs. I-R) as between-subject factors, and between-group t-tests comparing the two assessment types within each time of administration, were run. No differences emerged between I and R assessments of reading accuracy and speed, numerical processing, and computation; on the contrary, potential biases against R assessment emerged when evaluating skills in writing, reading comprehension, and semantic numerical sense. However, regardless of the assessment type, the scores obtained with I and R assessments within the same administration time point overlapped. These results partially support the validity and reliability of the assessment of children's learning skills via a remote home-based videoconferencing system. Implementing telemedicine as an assessment tool may increase timely access to primary health care and to support research activity.

A perspective on the scope of videoconferencing-based telemedicine in respiratory diseases outpatient clinic.

Telemedicine is rapidly expanding across various fields worldwide. While it finds application in respiratory diseases due to the imperative need for protection against the risk of transmission and the close monitoring of patients with chronic diseases, there is a scarcity of publications detailing telemedicine experiences in respiratory diseases. This study aims to retrospectively evaluate the prospective management of patients with respiratory diseases through videoconference-based telemedicine, intending to establish a foundation for its judicious application in pulmonology cases. In this descriptive study, anonymized medical records of all 478 patients assessed via videoconference-based telemedicine over an eight-month period from June 2020 to February 2021 were reviewed. The analysis included demographic characteristics, disease history, attendance methods, the necessity for in-person physical examination after the initial videoconference (VC) session, the inclusion of investigations, pre-diagnosis, diagnosis processes, follow-up period, and outcomes. Follow-up data for all patients included in the study were reviewed at the end of June 2021. Median age of the patients was 55 (44-67), with a male predominance of 55%. Approximately 30% resided in a city other than the one in which the physician offering telemedicine was situated. Seventy-nine (16.7%) individuals received telemedicine via VC sessions without the requirement for any in-person examinations. The most prevalent disease among those who applied for telemedicine was asthma. Median duration of the initial VC session was 13 (8-18) minutes. At least half of the individuals seeking videoconference-based telemedicine for chronic respiratory disorders, such as asthma, COPD, and interstitial lung disease, had previously been followed by either the telemedicine provider or another physician in the same hospital. However, the vast majority of telemedicine applications in disease categories such as COVID, post-COVID, pulmonary nodules, and lung cancer were submitted by first-time applicants. This pioneering study suggests that videoconference-based telemedicine may be an alternative/complementary tool for patients, particularly those with chronic respiratory diseases.

THE READYR PROGRAM FOR WELL-BEING IN DEMENTIA: PILOT STUDY AND SIX-MONTH FOLLOW-UP RESULTS AMONG SPOUSE–PARTNER DYADS

Abstract The READyR Program assesses and targets everyday routines of care dyads (older adults with cognitive impairment and their co-habiting partners) using in-home sensors and video-conference sessions in order to understand future care needs, and promote greater well-being. This study aimed to evaluate the feasibility, acceptability, and pilot test of efficacy for READyR. Fifteen dyads (96% married) were enrolled in the 6-month study, and randomized to immediately join READyR (n=8 dyads) or to complete READyR after an educational control condition (n=7 dyads). Feasibility was high: 100% of enrolled dyads completed ≥1 session; 80% completed all sessions. Acceptability was also high: responding participants (n=26) reported that READyR helped them express their care values and understand their care needs (92%), that they were comfortable sharing their views (92%) and doing so with their partner present (96%). Hearing and visual impairments were reported to interfere with online sessions for 4 and 6 participants, respectively, but 93% of participants reported that the digital components were easy to use and understand. After receiving the READyR sessions, awareness of future care needs among care partners increased (d = 0.85) and relationship strain for both dyad members decreased (d = 0.58–0.82), when compared to changes among participants in the active control group. No effect was observed on participants’ quality of life, mood, or care-related strain at post-test or at 6 month follow-up. As a remote dyadic intervention, READyR is feasible, acceptable, and may help dyads decrease strain in the care relationship and prepare for future care needs.

Acceptance and Commitment Therapy is feasible for people with acquired brain injury: A process evaluation of the BrainACT treatment

Objective To evaluate the feasibility of Acceptance and Commitment Therapy for people with acquired brain injury. Design A process evaluation of the BrainACT treatment was conducted alongside a randomised controlled trial. Setting Psychology departments of hospitals and rehabilitation centres. Subjects Tweny-seven participants with acquired brain injury and 11 therapists. Intervention BrainACT is an Acceptance and Commitment Therapy adapted for the needs and possible cognitive deficits of people with acquired brain injury, provided in eight one-hour face-to-face or video-conference sessions. Measurements The attendance and compliance rates, engagement, satisfaction, and perceived barriers and facilitators for delivery in clinical practice were investigated using semi-structured interviews with participants and therapists and therapy logs. Results 212 of the 216 sessions in total were attended and 534 of the 715 protocol elements across participants and sessions were delivered. Participants were motivated and engaged. Participants and therapists were satisfied with the intervention and participants reported to have implemented skills in their daily routines acquired during therapy. Key strengths are the structure provided with the bus of life metaphor, the experiential nature of the intervention, and the materials and homework. Participants and therapists often preferred face-to-face sessions, however, when needed video-conferencing is a good alternative. Conclusion BrainACT is a feasible intervention for people with anxiety and depressive symptoms following acquired brain injury. However, when the content of the intervention is too extensive, we recommend adding two extra sessions.

A health-social service partnership programme for improving the health self-management of community-dwelling older adults: a hybrid effectiveness-implementation pilot study protocol

BackgroundThe ageing population requires seamless, integrated health and social care services in the community to promote the health of older adults. However, inadequate financial resources, a lack of clear operational guidelines, and various organisational work cultures may affect the implementation quality and sustainability of these services. As a unique approach, this study seeks to examine the preliminary effects of a health-social partnership programme on the health self-management of community-dwelling older adults in Hong Kong. Additionally, the study seeks to ascertain key insights into the mechanisms and processes required to implement and sustain a self-care management programme in broader practice in community settings.MethodsThis study will use a hybrid effectiveness-implementation design. During the 3-month programme, subjects in the intervention group will receive four Zoom video conference sessions and four telephone calls conducted by a health-social service team that will include a nurse case manager, community workers, general practitioners, a Chinese medicine practitioner, and social workers. Subjects in the control group will receive a monthly social telephone call from a trained research assistant to rule out the possible social effect of the intervention. The reach, effectiveness, adoption, implementation, and maintenance framework (i.e. RE-AIM framework) will be used to evaluate the implementation and effectiveness outcomes. Of the five dimensions included in the RE-AIM framework, only effectiveness and maintenance outcomes will be collected from both the intervention and control groups. The outcomes of the other three dimensions—reach, adoption, and implementation—will only be collected from subjects in the intervention group. Data will be collected pre-intervention, immediately post-intervention, and 3 months after the intervention is completed to evaluate the maintenance effect of the programme.DiscussionThis programme will aim to enhance health-promoting self-care management behaviours in older adults dwelling in the community. This will be the first study in Hong Kong to use the hybrid effectiveness-implementation design and involve key stakeholders in the evaluation and implementation of a health self-management programme using a health-social service partnership approach. The programme, which will be rooted in the community, may be used as a model, if proven successful, for similar types of services.Trial registrationClinicaltrials.gov, NCT04442867. Submitted 19 June 2020

Effects of Introvision, a self-regulation method with a mindfulness-based perception technique in migraine prevention: a monocentric randomized waiting-list controlled study (IntroMig Study)

BackgroundMigraine is a brain disorder with recurrent headache attacks and altered sensory processing. Introvision is a self-regulation method based on mindfulness-like perception techniques, developed at the University of Hamburg. Here, we examined the effect of Introvision in migraine prevention.MethodsMigraineurs with at least five headache days per month were block-randomized to the experimental group (EG) or waiting list group (WL), the latter starting Introvision training six weeks after the EG. Participants learned Introvision in six weekly on-site group sessions with video-conference support followed by three individual video-conference sessions. Headache diaries and questionnaires were obtained before Introvision training and three months after the last individual Introvision session.ResultsFifty-one patients completed the study. The primary outcome, headache days of the EG after Introvision training compared to those of the WL before the training, showed no significant effect (10.6 ± 7.7, n = 22; vs. 10.9 ± 6.3, n = 29, p = 0.63; Mann–Whitney-U-Test). The secondary outcome, comparing pooled EG and WL data before and after Introvision training, revealed a significant reduction of headache days (from 11.7 ± 6.5 to 9.8 ± 7.0; p = 0.003; Wilcoxon-paired-Test) as well as of acute medication intake and Headache-Impact-Test 6 (HIT-6) scores and increased self-efficacy as quantified by increased FKMS-scores (FKMS: german short form of the Headache Management Self-Efficacy Scale (HMSE)).ConclusionAlthough the study did not reach its primary endpoint, several secondary outcome parameters in the pooled (non-controlled) pre-post analysis showed an improvement with a decrease in monthly headache days by 1.9 days/ month. A larger randomized controlled trial has to corroborate these preliminary findings.Trial registrationNCT03507400, Registration date 09.03.2018.

Assessing real-world implementability of a multimodal group-based tele-prehabilitation program in cancer care: a pragmatic feasibility study.

Multimodal prehabilitation is intended to optimize a patient's mental and physical health prior to surgery. Most multimodal prehabilitation interventions are delivered on a one-on-one format, which may limit benefits associated with social interactions that can be achieved in a group context, and are delivered in-person, which may limit the accessibility. The purpose of this study was to develop a group-based, multimodal, tele-prehabilitation intervention for individuals diagnosed with cancer (iACTIF) and assess its implementability in a "real-world" clinical setting by measuring feasibility, acceptability, fidelity, and preliminary effects. A prospective, single-group, pragmatic feasibility study was conducted with assessments at baseline, pre-surgery, and 12-weeks post-surgery. iACTIF consisted of three 90-min live videoconference sessions per week, including exercise and educational components. Descriptive statistics were used to document feasibility, acceptability, and fidelity indicators. Paired t-test, Wilcoxon test, and Cohen's D-test were conducted to assess changes in health-related outcomes. A total of 25 participants (mean age ± SD= 60.2 ± 14.0) were recruited. The feasibility assessment revealed a low referral rate (31.4%) and a high study retention (98%) and program attendance [session attended/possible session] (70.2%), with a prehabilitation window of 32.7 days (SD= 20.9, median= 28). Acceptability was high (84%-100%) according to satisfaction, utility and safety, delivery modality, and intention to continue physical activity and to recommend iACTIF to a relative. Pre-post-intervention assessments suggest positive changes on physical functional capacity based on the 2-min step test (mean difference= +18.9 steps, p=0.005), the 30-s sit-to-stand (mean difference= +1.1 repetition, p=0.011), and volume of moderate intensity physical activity per week (mean difference= +104.8 min, p<0.001). Fidelity was supported by conformity and coherence, with only minimal adjustments required to meet participants' needs. iACTIF implementability in a "real-world" clinical setting is promising, and preliminary outcomes suggest moderate benefits on physical health and small increase in mental health indicators.

Pelvic floor muscle training delivered via telehealth to treat urinary and/or faecal incontinence after gynaecological cancer surgery: a single cohort feasibility study

PurposeTo assess the feasibility and clinical outcomes of telehealth-delivered pelvic floor muscle training (PFMT) for urinary incontinence (UI) and/or faecal incontinence (FI) after gynaecological cancer surgery.MethodsIn this pre-post cohort clinical trial, patients with incontinence after gynaecological cancer surgery underwent a 12-week physiotherapist-supervised telehealth-delivered PFMT program. The intervention involved seven videoconference sessions with real-time feedback from an intra-vaginal biofeedback device and a daily home PFMT program. Feasibility outcomes included recruitment, retention, engagement and adherence rates. Clinical outcomes were assessed at baseline, immediately post-intervention and a 3-month post-intervention using International Consultation on Incontinence questionnaires for UI (ICIQ-UI-SF) and Bowel function (ICIQ-B) and the intra-vaginal biofeedback device. Means and 95%CIs for all time points were analysed using bootstrapping methods.ResultsOf the 63 eligible patients, 39 (62%) consented to the study. Three participants did not complete baseline assessment and were not enrolled in the trial. Of the 36 participants who were enrolled, 32 (89%) received the intervention. Retention was 89% (n=32/36). The majority of participants (n=30, 94%) demonstrated high engagement, attending at least six videoconference sessions. Adherence to the daily PFMT program was moderate, with 24 participants (75%) completing five-to-seven PFMT sessions per week during the intervention. All clinical outcomes improved immediately post-intervention; however, the magnitude of these improvements was small.ConclusionTelehealth-delivered PFMT may be feasible to treat incontinence after gynaecological cancer surgery.Trial registrationClinicalTrials.gov Identifier: ACTRN12621000880842)