Associations Between Eating, Mobility, and Toileting Functional Dependence and COVID-19 Symptoms.

OBJECTIVES: The first goal of this study was to explore associations between functional dependence levels during activities of daily living (eg, functional mobility, eating, and toileting) before COVID-19 and presence of COVID-19 symptoms (eg, fever, dehydration, lethargy, and shortness of breath) during illness. The second goal of this study was to explore associations between presence of specific COVID-19 symptoms and level of functional decline from before to after illness. DESIGN: Retrospective cohort study. SETTING AND PARTICIPANTS: A total of 375 residents at a single skilled nursing facility in New York City. METHODS: Data were extracted from the Minimum Data Set 3.0 and chart reviews. Multiple linear regressions analyzed relationships between baseline functional dependence in eating, functional mobility, and toileting and presence of dehydration, lethargy, shortness of breath, and fever. Ordinal linear regressions analyzed associations between COVID-19 symptom presence and changes in functional dependence from before to after illness. RESULTS: Pre-COVID-19 eating dependence was significantly associated with dehydration during COVID-19. Dehydration during COVID-19 was significantly associated with greater functional declines in functional mobility from before to after illness. Shortness of breath was significantly associated with increased functional declines in eating and functional mobility. CONCLUSIONS AND IMPLICATIONS: Patients with COVID-19 should be monitored for shortness of breath and dehydration, as these symptoms are associated with functional decline. Individuals experiencing functional decline before COVID-19 onset are especially vulnerable to these symptoms. Future research should further explore the relationship between functional status and COVID-19 symptoms.

Reductions in Depression and Anxiety Among Autistic Adults Participating in an Intervention to Promote Healthy Relationships.

IMPORTANCE: Some autistic adults experience depression and anxiety related to their social relationships. There is a need for evidence-based occupational therapy interventions that decrease depression and anxiety and improve the health of social relationships for autistic adults. OBJECTIVE: To determine the feasibility and preliminary effectiveness of the Healthy Relationships on the Autism Spectrum (HEARTS) intervention, a six-session, group-based psychoeducational intervention for the improvement of relationship health. DESIGN: One-group pretest-posttest design with a 3-mo follow-up after baseline. SETTING: United States; online intervention through community organization. PARTICIPANTS: Fifty-five adults, ages 20 to 43 yr, with a professional or self-diagnosis of autism and the capacity to independently participate in an online, group-based, participatory class. INTERVENTION: Participants received 6 90-min weekly sessions that addressed healthy relationship topics, including recognizing abuse, meeting people, maintaining relationships, setting interpersonal boundaries, neurohealth for relationships, and ending relationships. A psychoeducational approach that provided education and involved guided discovery and strategy acquisition was used. OUTCOMES AND MEASURES: All measures were self-administered through an online survey. Depression and anxiety were assessed using instruments from the Patient-Reported Outcomes Measurement Information System. RESULTS: Fifty-five participants completed the intervention. Postintervention scores revealed statistically significant improvements in depression and anxiety. CONCLUSIONS AND RELEVANCE: HEARTS is a promising intervention for improving depression and anxiety among autistic adults and should be investigated further. What This Article Adds: HEARTS offers a potentially effective, nonpharmacological, psychoeducational group-based intervention option to promote healthy relationships for autistic adults. Positionality Statement: This article uses identity-first language (autistic person) in accordance with the preference of autistic self-advocates (Autistic Self Advocacy Network, 2020; Kenny et al., 2016; Lord et al., 2022).

A systematic review and meta-analysis of neuromodulators to treat chronic airway hypersensitivity.

OBJECTIVES: Chronic laryngitis can present with numerous symptoms, including chronic cough. Patients who do not respond to standard treatment are sometimes diagnosed with chronic airway hypersensitivity (CAH). In many centers, neuromodulators are prescribed off-label despite limited evidence of efficacy. A previous meta-analysis suggested neuromodulator therapy improved cough-related quality-of-life (QoL). This current updated and expanded meta-analysis examined whether neuromodulators reduced cough frequency, reduced cough severity, and/or improved QoL in CAH patients. DATA SOURCES: PubMed, Embase, Medline, Cochrane Review, and publication bibliographies were searched from 01/01/2000 to 07/31/2021 using MESH terms. REVIEW METHODS: PRISMA guidelines were followed. 999 abstracts were identified/screened, 28 studies were fully reviewed, and 3 met inclusion criteria. Only randomized controlled trials (RCT) investigating CAH patients with comparable cough-related outcomes were included. Three authors reviewed potentially eligible papers. Fixed-effect models and calculated pooled estimates using the Inverse-Variance method were used. RESULTS: The estimated difference in change in log coughs per hour (from baseline to intervention end) between treatment and control groups was -0.46, 95%CI [-0.97; 0.05]. Estimated change-from-baseline in VAS scores was -12.24, 95 % CI [-17.84; -6.65] lower for patients who received treatment vs placebo. Estimated change-from-baseline for LCQ scores was 2.15, 95 % CI [1.49-2.80] higher for patients who receive treatment vs placebo. Only change in LCQ score was clinically significant. CONCLUSIONS: This study tentatively suggests that neuromodulators have the potential to reduce cough symptoms associated with CAH. However, high-quality evidence is lacking. This could be due to limited treatment effect or significant limitations in the design and comparability of existing trials. A well-designed and properly powered RCT is needed to authoritatively test the efficacy of neuromodulators for the treatment of CAH. LEVEL OF EVIDENCE: Level I, evidence from a systematic review or meta-analysis of all relevant RCTs (randomized controlled trial) or evidence-based clinical practice guidelines based on systematic reviews of RCTs or three or more RCTs of good quality that have similar results.