Psychometric Evaluation of the Traditional Chinese Version of the Self-Care of Heart Failure Index Version 7.2.

BACKGROUND: The Self-Care of Heart Failure Index (SCHFI) is a widely used instrument used to measure self-care in both research and clinical settings. The lack of a psychometric evaluation of the traditional Chinese version of the SCHFI (SCHFI-C) might limit its utilization in non-Mainland Chinese populations such as Hong Kong, Macau, and Taiwan. OBJECTIVE: This study aimed to evaluate the psychometric properties of the SCHFI-C v.7.2. METHODS: Participants included 365 adults with heart failure. Breslin's method of translation was used to translate the SCHFI v.7.2 into traditional Chinese. Exploratory factor analysis was conducted to examine the dimensionality structure of each scale. Then, composite reliability was calculated to assess the reliability of 3 scales. Construct validity was examined by hypothesis testing and known-group comparisons. RESULTS: The results of exploratory factor analysis suggest its multidimensionality of each scale. More specifically, the findings indicated a unique internal structure of the self-care maintenance ("lifestyle-related behaviors" and "consulting behaviors") and self-care management ("self-reliance behaviors" and "help-seeking behaviors") scales. The composite reliability of 3 scales were 0.81, 0.88, and 0.82, respectively, reaching adequate level. As for construct validity, the significant associations between the 3 SCHFI domains and self-care confidence as well as significant group difference among patients of different ages and educational backgrounds supported good construct validity. CONCLUSIONS: This study provides evidence of the reliability and validity of the SCHFI-C v.7.2. The traditional SCHFI-C v.7.2 can serve as a valid and reliable outcome measure to evaluate the effects of self-care-promoting interventions.

The effects of a salutogenic strength-based intervention on sense of coherence and health outcomes of dementia family carers: A randomized controlled trial.

INTRODUCTION: Dementia caregiving is associated with notable impacts on the health of family carers. Although sense of coherence (SOC), as a core dimension of inner strength, has been found to have health-protecting effects in stressful encounters, few studies have designed a strength-based intervention to optimise SOC and thereby the health of carers. OBJECTIVES: To identify the effects of a strength-based intervention on SOC, coping, health-related quality of life (HRQoL), perceived burden and depression among Chinese family carers of people with dementia and to examine whether the health effects, if any, are mediated through an enhanced SOC and effective coping. DESIGN: A double-blind randomised controlled trial comparing a strengths-based intervention with a general education control. INTERVENTION: A 14-session strengths-based intervention which combined the use of narrative and empowerment strategies to support the carers of people with dementia to optimise the use of their generalised resistance resources in coping with the caregiving situation. SETTING: Older people community centres in Hong Kong. RESULTS: A total of 350 family carers participated in the study (mean age: 65.0 (SD = 12.3); female: 84.6%). Participants who received the strength-based intervention reported significantly greater improvements in their SOC, mental health, perceived burden and depression, than those in the education group, over a 22-week evaluation period. Path analysis models revealed that an SOC wholly mediated the relationship between the strength-based intervention and mental HRQoL (covering energy/vitality and psychosocial functioning) and partially mediated the relationship between the strength-based intervention and depression. We did not identify any harm from the intervention. CONCLUSION: A strength-based intervention is effective in improving the perceived burden and mental health of family caregivers of persons with dementia, and an SOC plays an important role in accounting for the mental health benefits. TRIAL REGISTRATION: The trial was registered in the World Health Organization International Clinical Trials Registry Platform (Main ID: ChiCTR-IIC-17011097).

The prognostic impact of symptom clusters in patients with heart failure: A systematic review and meta-analysis.

AIM: To determine the impact of symptom clusters on clinical outcomes among heart failure patients. DESIGN: Systematic review and meta-analysis. DATA SOURCES: Peer-reviewed articles were searched from 12 English and Chinese language databases from inception to August 2021. REVIEW METHODS: Narrative syntheses were first conducted to integrate symptom clusters reported in the identified studies. This was followed by meta-analysis to synthesize the evidence on the association or predictive effects of symptom clusters on clinical outcomes. RESULTS: Twelve studies were identified. Among studies which identified highly correlated symptoms as in a cluster, meta-analysis indicated that severe congestive (r = .45, 95% CI = 0.38-0.52), weary (r = .41, 95% CI = 0.33-0.50), ischaemic (r = .29, 95% CI = 0.04-0.51) and stress-related (r = .62, 95% CI = 0.31-0.81) symptom clusters were correlated with a poorer health-related quality of life. As for studies used latent class to identified patient cohorts of similar symptom pattern, high symptom cohorts (hazard ratio = 1.86, 95% CI = 1.39-2.48) and incongruent physical and psycho-cognitive symptom cohorts was associated with a significantly higher risk (hazard ratio = 2.10, 95% CI = 1.44-3.07) of combined event rate relative to low symptom presentation. CONCLUSIONS: This review has identified the impact of symptom clusters on clinical outcomes in heart failure patients. In addition to the classical physical symptoms highlighted in the clinical management guidelines, our findings suggested the important predictive role of psycho-cognitive and weary symptoms in determining the clinical outcomes of HF patients. IMPACT: This review concluded the promising prospect of symptom clusters in shaping clinical outcomes of heart failure. The findings highlighted the importance of integrating care to minimize the disease impact on psycho-cognitive function and weary symptoms among this clinical cohort. The review also inform the direction on how to advance the knowledge on symptom clusters among this clinical cohort.

Effects of a culturally adapted group based Montessori based activities on engagement and affect in Chinese older people with dementia: a randomized controlled trial.

BACKGROUND: The Montessori Method underpinned by the principle of person-centered care has been widely adopted to design activities for people with dementia. However, the methodological quality of the existing evidence is fair. The objectives of this study are to examine the feasibility and effects of a culturally adapted group-based Montessori Method for Dementia program in Chinese community on engagement and affect in community-dwelling people with dementia. METHODS: This was a two-arm randomized controlled trial. People who were aged 60 years or over and with mild to moderate dementia were recruited and randomly assigned to the intervention group to receive Montessori-based activities or the comparison group to receive conventional group activities over eight weeks. The attendance rates were recorded for evaluating the feasibility. The Menorah Park Engagement Scale and the Apparent Affect Rating Scale were used to assess the engagement and affect during the activities based on observations. Generalized Estimating Equation model was used to examine the intervention effect on the outcomes across the sessions. RESULTS: A total of 108 people with dementia were recruited. The average attendance rate of the intervention group (81.5%) was higher than that of the comparison group (76.3%). There was a significant time-by-group intervention effect on constructive engagement in the first 10 minutes of the sessions (Wald χ2 = 15.21-19.93, ps = 0.006-0.033), as well as on pleasure (Wald χ2 = 25.37-25.73, ps ≤ 0.001) and interest (Wald χ2 = 19.14-21.11, ps = 0.004-0.008) in the first and the middle 10 minutes of the sessions, adjusted for cognitive functioning. CONCLUSIONS: This study provide evidence that Montessori-based group activities adapted to the local cultural context could effectively engage community-dwelling Chinese older people with mild to moderate dementia in social interactions and meaningful activities and significantly increase their positive affect. TRIAL REGISTRATION: ClinicalTrials.gov, NCT04352387. Registered 20 April 2020. Retrospectively registered.

Cross-cultural applicability of the Self-Care Self-Efficacy Scale in a multi-national study.

AIM: The Self-Care Self-Efficacy Scale (SCSES) was newly developed as a self-report measure for self-care self-efficacy for chronic illness. This study investigated its measurement equivalence (ME) in different cultural groups, including United States, China (Hong Kong), Italy, and Brazil. DESIGN: A multi-national study for cross-cultural validation of the Scale. METHODS: From January 2015 - December 2018, investigators recruited 957 patients (United State: 200; Hong Kong: 300; Italy: 285; and Brazil: 142) with chronic illness from inpatient and outpatient settings. The SCSES was administered and clinical and demographic data were collected from participants. Based on the Meredith framework, multi-group confirmatory factor analysis evaluated the configural, metric, scalar, and strict invariance of the scale across the four populations through a series of nested models, with evaluation of reliability and coherence of the factor solution. RESULTS: The mean ages of the groups ranged from 65-77 years, 56.4% was male. The Cronbach's alpha coefficients of the single-factor SCSES were 0.93, 0.89, 0.92, and 0.90 for the United States, China (Hong Kong), Italy, and Brazil, respectively. Three of the four levels of ME were partially or totally supported. The highest level achieved was partial scalar invariance level (χ2 [52] = 313.4, p < 0.001; RMSEA = 0.067; 95% CI = 0.056-0.077; CFI = 0.966; TLI = 0.960, SRMR = 0.080). CONCLUSION: Patients from the four countries shared the same philosophical orientation towards scale items, although some of the items contributed differently to represent the concept and participants shared the same schemata for score interpretation. IMPACT: Self-efficacy is important in producing effective and sustainable self-care behavioural changes. Cultural ideation shapes the ways individuals interpret and report their self-care self-efficacy. The study findings support cross-cultural and cross-national utility of the SCSES for research on self-care across United States, China (Hong Kong), Italy, and Brazil.

A mixed methods study to evaluate the effects of a teamwork enhancement and quality improvement initiative on nurses' work environment.

AIMS: To test the effect of a teamwork enhancement and quality improvement program named 'Nurturing Effective Teams and Continuous Quality Improvement' on nurses' work environments in the hospital setting. DESIGN: Mixed-method study with quasi-experimental controlled trial and focus group interviews. METHODS: Twelve units from two Philippine tertiary government hospitals will be matched and allocated to have 72 nurses receiving the teamwork enhancement and quality improvement program, or no intervention. The program focuses on enhancing the nurse autonomy, leadership and management support, teamwork, and workload management, delivered in two phases: (a) teamwork enhancement training using team strategies and tools to enhance the performance and patient safety; and (b) implementation of quality improvement projects using the model for improvement to identify priority unit issues and change ideas and tested using the Plan-Do-Study-Act cycle. The 6-month implementation includes two trainings and seven mentoring sessions with a quality improvement facilitator. Primary outcome is the nurses' work environment and secondary outcomes are job satisfaction, burnout risk, turnover intention, and perceived quality of care provided measured at the nurse-level using self-administered survey and measured at 0, 3, and 6 months. Focus group interviews will be conducted among 14-16 nurse subjects to explore their experience during the program, while other stakeholders will be interviewed to reflect the program effects. Generalized equation modelling will be used to identify the program effects on the quantitative outcomes and content analysis will be used for qualitative data. DISCUSSION: Establishing measures to improve the nurses' work environments can be used to address poor nurse outcomes in high workload and low-resource settings. IMPACT: A favourable nurse work environment is the cornerstone to sustainable nursing workforce and positive outcomes. This study will provide explicit evidence to inform the effect of a structured evidence-based protocol in improving nurses' work environment given resource-limited context. TRIAL REGISTRATION: China Clinical Trial Registration Center (CciCTR), Registration number ChiCTR1900021754 (March 8, 2019).

Systematic review of interventions to improve nurses' work environments.

AIMS: To evaluate the current evidence that examined the effects of nurses' work environment interventions on nurse, patient, and hospital outcomes; and the key intervention characteristics. DESIGN: Quantitative systematic review without meta-analysis. DATA SOURCES: Nine databases (British Nursing Index, CINAHL, EMBASE, Global Health, Global Health Archives, MEDLINE, Ovid Nursing, PubMed, and Web of Science) were searched following Systematic review Without Meta-analysis guideline to elicit studies that examined effects of interventions aimed at improving nurses' work environments among peer-reviewed publications from inception to April 2019. METHODS: Database search used the following keywords: nurs*, patient, hospital, healthcare intervention, organizational improvement, nurs*adj4 outcome, patient adj4 outcome*, hospital adj4 outcome*, and their MeSH terms. The Cochrane's Risk of Bias in Non-Randomized Studies of Intervention (ROBINS-I) was used for quality appraisal. Donabedian model of Quality of Care was used as the framework to categorize interventions components focusing on structure and process aspects of the nurse work environments. RESULTS: The interventions included the use of accreditation process, educational strategies, and participatory approach. By defining the interventions which demonstrated positive effects on the nurse, patient, and hospital outcomes as effective, it appears that they are more consistently characterized as focusing on process improvement, adopting participatory approach, with greater involvement of frontline and nurse executives and at unit-level implementation. CONCLUSION: Although the heterogeneity in the design of the review studies precludes making conclusive insights on the best evidence to improve nurses' work environments, the review informs the major research gaps in the topic area and the ways to design better interventions to enhance the outcomes. IMPACT: The study provides insights on intervention components and strategies that can contribute to healthy nurse work environments. By adapting unit-level process improvements that actively involve frontline and nurse executives, nurse leaders may provide a more directed approach towards achieving favourable outcomes.

Effect of eHealth cardiac rehabilitation on health outcomes of coronary heart disease patients: A systematic review and meta-analysis.

AIMS: To evaluate the effects of eHealth cardiac rehabilitation (CR) on health outcomes of coronary heart disease patients and to identify programme design, which may lead to more effective health benefits. DESIGN: A systematic review and meta-analysis following Cochrane Handbook for Systematic Reviews of Interventions. DATA SOURCES: Medline, EMBASE, CLNAHL, Web of Science, Scopus, PsycINFO, Cochrane Central Register of Controlled Trails, PubMed and CNKI were searched over the period from 1806 to April 2019. REVIEW METHODS: A systematic review and meta-analysis of randomized controlled trials to examine the effect of eHealth CR on health outcomes of coronary heart disease patients. We used RevMan 5.3 for risk of bias assessment and meta-analysis and GRADE software for generating findings. RESULTS: In all, 14 trials with 1,783 participants were included. eHealth CR has significantly promoted duration of physical activity, daily steps, quality of life (QoL) and re-hospitalization. Using comparative analysis of programme design elements, including mode of delivery, intervention content, motivational strategies and social support, between the effective and ineffective eHealth CR, it was found that comprehensive empowerment strategies and follow-up care by tele-monitoring may be the crucial characteristics leading to more favourable treatment effect. CONCLUSION: eHealth CR is effective in engaging patients in active lifestyle, improving QoL and reducing re-hospitalization. Future research needs to test the effects of comprehensive CR programmes by incorporating empowerment strategies and tele-monitoring as active components. IMPACT: eHealth has been increasingly applied to increase accessibility and uptake of CR. Integrative evidence to indicate its effects on health outcomes is lacking. This review identified its positive effects on some behavioural, psychosocial and health service use outcomes. Together with insights about which programme design elements may positively shape the outcomes, this review informs the role and practice of cardiovascular nurses in promoting evidence-based eHealth CR.

The relationship between sleep-wake disturbances and frailty among older adults: A systematic review.

AIM: To examine the relationship between sleep-wake disturbances and frailty among older adults. DESIGN: A systematic review. DATA SOURCES: Peer-reviewed and English-written studies were sourced in CINAHL Complete, PsycINFO, Ovid-Medline, and by hand searching from inception to December 2018. REVIEW METHODS: This review was conducted following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses. The Cochrane Collaboration Risk of Bias Tool was used to appraise the methodological quality. A quantitative meta-analysis was not conducted due to the heterogeneous effect estimates statistics and measurements of sleep-wake disturbances. Instead, a narrative synthesis was carried out conforming to the Centre for Reviews and Dissemination's guidance. RESULTS: Six cross-sectional studies and one longitudinal study were included in this review. There was consistent evidence on the association between perceived sleep quality and frailty among older adults; whereas the results for insomnia symptoms, excessive daytime sleepiness, and sleep-wake pattern were inconclusive. CONCLUSION: Despite a comprehensive search, this review has identified limited research in this field of study. Nevertheless, this review has identified consistent evidence on the relationship between perceived sleep quality and frailty. Future rigorous research with more validated use of measurement tools are needed to explore whether insomnia symptoms, excessive daytime sleepiness, and sleep-wake pattern are related to frailty. IMPACT: Due to the indefinite role of sleep-wake disturbances in the pathophysiology of frailty, nearly all nurse-led care programmes for frail older adults did not include any sleep-related screening and interventions. Nevertheless, the consistent evidence on the association between poor sleep quality and higher risk of frailty shows the need of incorporating assessments and interventions for improving sleep quality in nurse-led care programmes for frail older adults. Moreover, such evidence also generates casual hypothesis for future prospective longitudinal studies that explore the causality of this relationship.

An information-motivation-behavioural-based model and adherence to inhalation therapy and other health outcomes in patients with chronic obstructive pulmonary disease: A pilot randomized controlled trial.

AIMS: To explore the feasibility and effects of the programme based on information-motivation-behavioural skills (IMB) model (IMB programme) on adherence to inhalation therapy and other health outcomes in chronic obstructive pulmonary disease (COPD) patients. BACKGROUND: Poor adherence to inhalation therapy is common among COPD patients. The IMB model is supported by previous studies as useful in promoting adherence to health behaviours. METHODS: This pilot randomized controlled trial randomized 35 COPD patients to receive either the IMB-based programme or usual care. The 4-week IMB programme consisted of a face-to-face and two telephone sessions to empower patients with skills and knowledge on using inhalation therapy and support their goal attainment for treatment compliance. Outcome evaluation including adherence to inhalation therapy, inhalation techniques, disease impact, and quality of life was conducted at baseline and at 6 weeks after randomization. Feasibility of the IMB programme was evaluated by a satisfaction survey and implementation experience. RESULTS: Thirty patients completed the study, with an attrition rate of 14.3%. The intervention group (n = 15) had significant improvements in inhalation adherence, inhalation techniques, and quality of life than the control group over the evaluation period. Patient satisfaction survey results and observations on programme implementation suggested the feasibility of the IMB programme. CONCLUSION: A IMB model is a feasible and potentially effective intervention for improving COPD patients' adherence to inhalation therapy.

Effectiveness of eHealth cardiac rehabilitation on health outcomes of coronary heart disease patients: a randomized controlled trial protocol.

BACKGROUND: Cardiac rehabilitation (CR) uptake and adherence remain sub-optimal despite the apparent health benefits of modifying healthy behavior and slowing disease progression. eHealth is the use of information and communication technology (ICT) for health. eHealth lifestyle interventions and disease management have emerged as modalities to enhance CR accessibility, enable an individualized progress page, and enrich real-time contact, video-based information, and technology monitored functionality. This study aims to develop a nurse-led eHealth cardiac rehabilitation (NeCR) intervention and investigate its effectiveness on coronary heart disease (CHD) patients' health outcomes. METHODS: This single-blinded two-arm parallel randomized controlled trial will randomize 146 patients from the inpatient cardiovascular units of a hospital in Wuhan, China to receive either the NeCR or the usual care. The NeCR intervention uses a hybrid approach consisting of a brief face-to-face preparatory phase and an empowerment phase delivered by health technology. The preparatory phase aims at identifying self-care needs, developing a goal-oriented patient centered action plan, incorporating a peer support network and orientation to the use of the e-platform. The empowerment phase includes use of the multi-media interactive NeCR for promoting symptom management, monitoring lifestyle changes and offering psychological support. A tele-care platform is also integrated to enhance health care dialogue with health professionals and peer groups. The control group will receive the usual care. An evaluation of lifestyle behavioral changes, self-efficacy, health-related quality of life, anxiety and depression, cardiovascular risk parameters, and unplanned health services use will be conducted at baseline, 6 weeks and 12 weeks post-intervention. DISCUSSION: This protocol proposes an individualized, comprehensive, and interactive NeCR delivered using a hybrid approach and guided by an empowerment model to optimize health outcomes of CHD patients. The intervention content and web-design is based on international health guidelines to improve credibility, comprehensibility and implementation. This study also proposes a new method of peer support in which the researcher shares participants' progress toward goal attainment with the peer group. Results of this research have the potential to increase accessibility and availability of CR, improve cardiac rehabilitation service development in China, and inform eHealth lifestyle interventions. TRIAL REGISTRATION: Chinese Clinical Trial Registry: ChiCTR1800020411; Date of registration: December 28, 2018.

Self-administered acupressure for symptom management among Chinese family caregivers with caregiver stress: a randomized, wait-list controlled trial.

BACKGROUND: Caregiving can be stressful, potentially creating physical and psychological strain. Substantial evidence has shown that family caregivers suffer from significant health problems arising from the demands of caregiving. Although there are programs supporting caregivers, there is little evidence regarding their effectiveness. Acupressure is an ancient Chinese healing method designed to restore the flow of Qi (vital energy) by applying external pressure to acupoints. A randomized, wait-list controlled trial was developed to evaluate the effectiveness of a self-administered acupressure intervention on caregiver stress (primary objective) and stress-related symptoms of fatigue, insomnia, depression, and health-related quality of life (secondary objectives) in Chinese caregivers of older family members. METHODS: Two hundred Chinese participants, aged ≥ 21 years, who are the primary caregivers of an older family member and screen positive for caregiver stress and symptoms of fatigue/insomnia/depression will be recruited from a community setting in Hong Kong. Subjects will be randomized to receive either an immediate treatment condition (self-administered acupressure intervention) or a wait-list control condition. The self-administered acupressure intervention will include (i) an individual learning and practice session twice a week for 2 weeks, (ii) a home follow-up visit once a week for 2 weeks, and (iii) 15-min self-practice twice a day for 6 weeks. The wait-list control group will receive the same acupressure training after the intervention group has completed the intervention. We hypothesize that Chinese family caregivers in the intervention group will have lower levels of caregiver stress, fatigue, insomnia, depression, and higher health-related quality of life after completion of the intervention than participants in the wait-list control group. DISCUSSION: This study will provide evidence for the effectiveness of self-administered acupressure in reducing stress and improving symptoms of fatigue, insomnia, depression, and health-related quality of life in Chinese family caregivers. The findings will inform the design of interventions to relieve negative health effects of caregiving. Furthermore, the results can raise community awareness and serve as a basis for policymaking, planning, and allocation of resources regarding empowerment of family caregivers for self-care. TRIAL REGISTRATION: Current Controlled Trials NCT02526446 . Registered August 10, 2015.

Effects of dyadic care interventions for heart failure on patients' and caregivers' outcomes: A systematic review, meta-analysis and meta-regression.

BACKGROUND: The contemporary model for managing heart failure has been extended to a patient-family caregiver dyadic context. However, the key characteristics of the model that can optimise health outcomes for both patients and caregivers remain to be investigated. OBJECTIVES: This study aimed to identify the effects of dyadic care interventions on the behavioural, health, and health-service utilisation outcomes of patients with heart failure and their family caregivers and to explore how the intervention design characteristics influence these outcomes. DESIGN: This study involved systematic review, meta-analysis, and meta-regression techniques. METHODS: We performed a systematic review and meta-analysis, using 12 databases to identify randomised controlled trials or quasi-experimental studies published in English or Chinese between database inception and 31 December 2022. The considered interventions included those targeting patients with heart failure and their family caregivers to enhance disease management. Data synthesis was performed on various patient- and caregiver-related outcomes. The identified interventions were categorised according to their design characteristics for subgroup analysis. Meta-regression was performed to explore the relationship between care delivery methods and their effectiveness. RESULTS: We identified 48 studies representing 9171 patient-caregiver dyads. Meta-analyses suggested the positive effects of dyadic care interventions on patients' health outcomes [Hedges' g (95 % confidence interval {CI}): heart failure knowledge = 1.0 (0.26, 1.75), p = 0.008; self-care confidence = 0.45 (0.08, 0.83), p = 0.02; self-care maintenance = 1.12 (0.55, 1.70), p < 0.001; self-care management = 1.01 (0.54, 1.49), p < 0.001; anxiety = -0.18 (-0.34, -0.02), p = 0.03; health-related quality of life = 0.30 (0.08, 0.51), p < 0.001; hospital admission (risk ratio {95 % CI}: hospital admission = 0.79 (0.65, 0.97), p = 0.007; and mortality = 0.58 (0.36, 0.93), p = 0.02)]. Dyadic care interventions also improved the caregivers' outcomes [Hedges' g (95 % CI): social support = 0.67 (0.01, 1.32), p = 0.05; perceived burden = -1.43 (-2.27, -0.59), p < 0.001]. Although the design of the identified care interventions was heterogeneous, the core care components included enabling and motivational strategies to improve self-care, measures to promote collaborative coping within the care dyads, and nurse-caregiver collaborative practice. Incorporating the first two core components appeared to enhance the behavioural and health outcomes of the patients, and the addition of the last component reduced readmission. Interventions that engaged both patients and caregivers in care provision, offered access to nurses, and optimised continuity of care led to better patient outcomes. CONCLUSIONS: These findings demonstrate that dyadic care interventions can effectively improve disease management in a family context, resulting in better health outcomes for both patients and caregivers. Additionally, this study provides important insights into the more-effective design characteristics of these interventions. REGISTRATION NUMBER: The review protocol was registered in the PROSPERO International Prospective Register of Systematic Reviews (CRD42022322492).

Screening for Frailty Using the FRAIL Scale in Older Cancer Survivors: A Cross-sectional Comparison With the Fried Phenotype.

OBJECTIVES: To examine the diagnostic performance of the FRAIL Scale for frailty screening with reference to the Fried phenotype and investigate its association with health outcomes in older cancer survivors. DATA SOURCE: In this cross-sectional quantitative study, participants were post-treatment cancer survivors aged 65 or above. Measurements included the FRAIL Scale, Fried phenotype, Geriatric Depression Scale-15 item, Modified Barthel Inventory, and EORTC Core Quality of Life Questionnaire. Receiver operating characteristic curve analysis was performed to evaluate the diagnostic performance of the FRAIL Scale with reference to the Fried phenotype. Health outcomes associated with being frail as estimated by the FRAIL Scale and Fried phenotype were also examined using regressions. RESULTS: Based on 293 older cancer survivors, the area under curve (AUC) of the FRAIL Scale was 0.79, and the optimal cut-off of 1 yielded a sensitivity of 92% and specificity of 41%. According to regression results, the FRAIL Scale was modified by adding an item on time since cancer treatment completion (AUC = 0.81), and using a cut-off of 2 for older cancer survivors, which yielded a sensitivity of 74% and specificity of 67%. The modified FRAIL Scale was associated with depressive symptoms, functional independence, fatigue, dyspnea, physical functioning, and role functioning. CONCLUSIONS: The modified FRAIL Scale is proposed for use in older cancer survivors, and a cut-off of 2 should be used. IMPLICATIONS FOR NURSING PRACTICE: The modified FRAIL Scale can serve as a brief screening tool for identifying frailty among older cancer survivors in practice.

Acceptance and Commitment Therapy Among Informal Caregivers of People With Chronic Health Conditions: A Systematic Review and Meta-Analysis.

Importance: Although there is substantial evidence to suggest the health benefits of acceptance and commitment therapy (ACT) among informal caregivers of people with chronic health conditions, the great variation in intervention designs among published studies limits its application. Objectives: To identify intervention characteristics of ACT that are associated with improved psychological health and to assess the acceptability of ACT among informal caregivers. Data Sources: Seven English- and 3 Chinese-language databases without limits on publication dates, the reference lists of previous reviews, and gray literature were searched up to February 2023. Study Selection: Randomized clinical trials comparing the effect of ACT vs control groups on improving psychological health among informal caregivers. Data Extraction and Synthesis: Two reviewers independently screened searched records and extracted data from eligible studies. Random-effects meta-analysis and mixed-effects metaregression were performed. The Preferred Reporting Items for Systematic Reviews and Meta-Analyses guideline was followed. Main Outcomes and Measures: Psychological health outcomes (eg, depressive symptoms) measured by valid measurements and the acceptability of ACT based on identified parameters. Results: A total of 29 studies with 2010 participants, published between 2015 and 2023, were identified. ACT showed moderate to large effect sizes for improving psychological health at postintervention assessments (Hedges g range, -0.55 [95% CI, -0.98 to -0.12] to -1.14 [95% CI, -1.83 to -0.45]) and at 1-to-3-month and 4-to-6-month follow-ups (Hedges g range, -0.47 [95% CI, -0.69 to -0.25] to -1.29 [95% CI, -2.33 to -0.24]). Multivariable metaregression analysis regarding intervention characteristics found that ACT delivered in a mixed individual- and group-based format, face-to-face, or through more intervention sessions was associated with greater improvements for experiential avoidance (face-to-face: ß = -1.170 [95% CI, -2.020 to -0.319]; number of sessions: ß = -0.242 [95% CI, -0.353 to -0.130]), depressive symptoms (mixed delivery format: ß = -2.583 [95% CI, -4.845 to -0.321]; face-to-face: ß = -1.555 [95% CI, -3.002 to -0.108]), or anxiety symptoms (face-to-face: ß = -1.241 [95% CI, -2.337 to -0.146]). In general, ACT had low attrition rates (11%), and participants' adherence (51%-80%) and satisfactory ratings (72%-95%) lend support to its acceptability. Conclusions and Relevance: This systematic review and meta-analysis found that ACT was consistently associated with improvements in psychological health, supporting its application to improve informal care for chronic disease management. This review provides specific details on the design parameters of ACT for achieving greater efficacy.

Effects of an empowerment-based educative psycho-behavioral program on neuropsychiatric symptoms among persons with mild cognitive impairment: A mixed methods study.

BACKGROUND: Mild cognitive impairment refers to the transitional stage between normal aging and dementia. While managing the cognitive symptoms receives most research attention, neuropsychiatric symptoms, particularly depression and anxiety, affect up to 80% of this cohort and detrimentally impact disease progression. Evidence-based interventions to support this preclinical cohort to cope with the neuropsychiatric symptoms are yet to be developed. OBJECTIVES: To test the effects of an empowerment-based educative psycho-behavioral program on neuropsychiatric symptoms, cognitive function, and health-related quality of life among older adults with mild cognitive impairment and explore the engagement experience and perceived effects of the program. DESIGN: An explanatory sequential mixed methods design comprises a single-blinded randomized controlled trial and a descriptive qualitative study. SETTING AND PARTICIPANTS: This study was conducted in five social facilities in three major geographic districts in Hong Kong from August 2020 to November 2021. Community-dwelling adults aged ≥50 with mild cognitive impairment were included. METHODS: A total of 171 participants were randomly assigned to either a 13-week empowerment-based educative psycho-behavioral program on stress adaptation, cognitive coping and knowledge enhancement (intervention group; n = 86), or a generic health education program (control group; n = 85). Mild Behavioral Impairment Checklist, Geriatric Depression Scale Short Form, Apathy Evaluation Scale, Kessler Psychological Distress Scale, Montreal Cognitive Assessment, Memory Inventory for Chinese, and Short Form Health Survey were administered at baseline, immediately after the program completion, and four weeks thereafter. Individual, semi-structured interviews were conducted to explore the engagement experience and perceived effects of the program. RESULTS: The mean age of the participants was 69.1 years (SD = 8.1), and 87.7% were female. Using generalized estimating equation, the intervention group had significantly greater improvement in overall neuropsychiatric symptoms (ß = -1.49, p = 0.044), apathy (ß = 2.14, p = 0.018), anxiety (ß = -0.53, p = 0.009), and subjective memory complaints (ß = -1.97, p = 0.003) than the control group upon completion of the intervention, such positive effects lasted to four weeks thereafter. Delayed effects were also shown on depression (ß = 0.86, p = 0.008) and global cognitive function (ß = 0.86, p = 0.008). The qualitative data converges with the quantitative evaluation; the participants indicated that the increased coping for daily hassles and emotional arousal, together with a more positive orientation towards living a fulfilling life and the future, may explain such encouraging effects. CONCLUSIONS: This study revealed the beneficial effects of the empowerment-based educative psycho-behavioral program on improving neuropsychiatric symptoms and cognitive function of older adults with mild cognitive impairment. The findings support the application of a comprehensive empowerment approach to enhance psychological well-being of this cohort. REGISTRATION NUMBER: HKUCTR-2915 (HKU Clinical Trial Registry). TWEETABLE ABSTRACT: Neuropsychiatric symptoms received less attention in the management of mild cognitive impairment. An empowerment-based educative psycho-behavioral program shows benefits on these prevalent manifestations.

Effects of non-pharmacological interventions on loneliness among community-dwelling older adults: A systematic review, network meta-analysis, and meta-regression.

BACKGROUND: The highly prevalent late-life loneliness, together with its deleterious health impacts, calls for increasing attention to the need for effective interventions targeting on this growing public health problem. With the increasing evidence on interventions for combating loneliness, it is timely to identify their comparative effectiveness. OBJECTIVE: This systematic review, meta-analysis and network meta-analysis was to identify and compare the effects of various non-pharmacological interventions on loneliness in community-dwelling older adults. METHODS: Systematic search was conducted in nine electronic databases from inception to 30th March 2023 for studies investigating the effects of non-pharmacological interventions on loneliness among community-dwelling older adults. The interventions were categorized according to the nature and purpose of use. Pairwise meta-analysis and network meta-analyses were sequentially performed to identify the effects of each category of interventions and their comparative intervention effectiveness, respectively. Meta-regression was performed to examine any influence of study design and participants' characteristics on the intervention effectiveness. The study protocol was registered at PROSPERO (CRD42022307621). RESULTS: A total of 60 studies with 13,295 participants were included. The interventions were categorized as psychological interventions, social support interventions (by digital and non-digital means), behavioral activation, exercise intervention with and without social engagement, multi-component intervention and health promotion. Pairwise meta-analysis identified the positive effect of psychological interventions (Hedges' g = -2.33; 95%CI [-4.40, -0.25]; Z = -2.20, p = 0.003), non-digital social support interventions (Hedges' g = -0.63; 95%CI [-1.16, -0.10]; Z = 2.33, p = 0.02) and multi-component interventions (Hedges' g = -0.28 95%CI [-0.54, -0.03]; Z = -2.15, p = 0.03) on reducing loneliness. Subgroup analysis provided additional insights: i) social support and exercise interventions which integrated active strategies to optimize the social engagement demonstrated more promising intervention effects; ii) behavioral activation and multicomponent interventions worked better for older adults who were male or reported loneliness, respectively, and iii) counseling-based psychological interventions was more effective than mind-body practice. Network meta-analysis consistently pointed to the greatest therapeutic benefits of psychological interventions, and this was followed by exercise-based interventions, non-digital social support interventions and behavioral activation. Meta-regression further suggested that the therapeutic effects of the tested interventions were independent of the various factors relating to study design and participants' characteristics. CONCLUSIONS: This review highlights the more superior effects of psychological interventions in improving loneliness among older adults. Interventions which have an attribute to optimize social dynamic and connectivity may also be effective. TWEETABLE ABSTRACT: Psychological intervention is the best to beat late-life loneliness, but increasing social dynamic and connectivity may add an impact.

A randomized controlled trial on the effects and acceptability of individual mindfulness techniques - meditation and yoga - on anxiety and depression in people with Parkinson's disease: a study protocol.

BACKGROUND: Between 40 and 50% of patients with Parkinson's disease (PD) experience anxiety and depression, associated with impaired physical function, high care dependency and mortality. Recently, the United States National Institutes of Health has urged the implementation of mindfulness practices in chronic illness care. Most research to date has examined the effects on chronically ill patients of complex interventions using a combination of mindfulness techniques. In PD patients, however, such complex modalities appear to hinder the technique mastery. Hence, the aim of this trial is to investigate the effects and underlying mechanism of individual mindfulness techniques among PD patients, as well as exploring participants' experience in using individual mindfulness techniques as a lifestyle intervention for stress and symptom management. METHODS: We will conduct an assessor-blind three-arm randomized waitlist-controlled trial with a descriptive qualitative evaluation. Up to 168 PD patients will be recruited from community settings and out-patient clinics, and randomized to meditation, yoga, or usual care group. Meditation and yoga sessions of 90-minute are held weekly for 8 weeks. Primary outcomes include anxiety and depression. Secondary outcomes include PD-related motor and non-motor symptoms and quality-of-life; and level of mindfulness and biomarkers of stress and inflammatory responses will be measured as mediating variables. All outcome evaluations will be assessed at baseline, 8 weeks, and 24 weeks. Following the intention-to-treat principle, generalized estimating equation models and path analysis will be used to identify the treatment effects and the mediating mechanisms. A subsample of 30 participants from each intervention group will be invited for qualitative interviews. DISCUSSION: The study would also generate important insights to enhance the patients' adaptation to debilitating disease. More specifically, symptom management and stress adaptation are highly prioritized healthcare agenda in managing PD. The research evidence will further inform the development of community-based, nurse-led compassionate care models for neurodegenerative conditions, which is complementary to existing health services. TRIAL REGISTRATION: WHO Primary Registry - Chinese Clinical Trials Registry number: ChiCTR2100045939; registered on 2021/04/29 ( https://www.chictr.org.cn/showproj.html?proj=125878 ).

The effects of low-impact moderate-intensity stepping exercise on fatigue and other functional outcomes in older adults with multimorbidity: A randomized controlled trial.

OBJECTIVES: Fatigue is highly prevalent among older adults with multimorbidity. As the World Health Organization advocates for strategies that improve the functional status of this aged cohort, this study examined the effects of a low-impact moderate-intensity exercise program on their fatigue levels and related functional health outcomes. METHODS AND MATERIALS: A multi-site clinical trial randomized 124 community-dwelling older adults with multimorbidity [mean age: 78.1 years (SD: 7.0); female: 83.8%] to a low-impact exercise program (intervention) group or a health education (control) group. The exercise program was designed to address fatigue-associated low energy levels, and consisted of thrice-weekly low-impact stepping exercises that were progressively increased from low intensity to moderate intensity over a 12-week period, using group-based practice to encourage engagement. The Multidimensional Fatigue Inventory, FRAIL Scale, International Physical Activity Questionnaire, the two-minute walking test, and Profile of Mood States (short-from) were administered at baseline, post-intervention, and 12 weeks thereafter. RESULTS: Generalized estimating equation showed that the intervention group reported greater decreases in fatigue and frailty, and greater improvements in physical activity level, exercise tolerance, and mood status than the control group. The positive effects of the intervention on most of these outcomes were sustained over the two post-test endpoints. DISCUSSION AND IMPLICATIONS: The low-impact stepping-based moderate-intensity exercise program is effective to improve fatigue and functional outcomes in older adults with multimorbidity. As it can be challenging to engage the fatigued older adults in exercise training, this study adds insights to inform community-based care approach for multimorbidity management.