The Impact of Transitions, a Mental Health Literacy Intervention With Embedded Life Skills for Postsecondary Students: Preliminary Findings From a Naturalistic Cohort Study.

OBJECTIVE: Mental illness is a common medical condition to onset during adolescence. Young people who leave for postsecondary life are at an especially challenging period of lifetime when many will leave home and familiar environments for prolonged periods of time. These new circumstances may put young people at risk of developing mental health problems or disorders or exacerbate existing mental disorders. Alternatively, some young people may misinterpret the normal negative emotional states occurring as a result of these new challenges as a mental disorder requiring professional intervention. We conducted a quasiexperimental cohort study to investigate the effectiveness of a mental health literacy intervention Transitions with blended life skills to address these challenges for first-year postsecondary students. METHODS: Students (n = 2,397) from five Canadian postsecondary institutions were assigned to the intervention or the control group and were administered a survey at baseline, postintervention, and at 2-month follow-up (September 2017 to February 2018). We applied generalized linear mixed effects (PROC Mixed procedure) to test the between-group difference in the post-pre/follow-up-pre and to determine the predicted least-square mean values. RESULTS: The findings showed that students who were exposed to the Transitions intervention significantly improved their mental health knowledge, decreased stigma against mental illness, improved help-seeking attitudes and behaviours, and decreased perceived stress when compared to students who had not been exposed to the intervention. However, we did not identify significant changes in general health. This may be due to the relatively short follow-up time (2 months) to determine participants' general health status. CONCLUSIONS: Transitions delivered to first-year postsecondary students may be a beneficial intervention to help young people adjust to their new postsecondary life and improve their mental health.

Pain Complaints and Intubation Risk in COVID-19: A Retrospective Cohort Study.

Background Since coronavirus disease 2019 (COVID-19) emerged, increasing cases have been identified worldwide. COVID-19 continues to lead to significant morbidity and mortality, despite developing a vaccination for the disease. While much has been studied regarding the initial presentation and treatment of patients with COVID-19, to our knowledge, no study has uncovered that COVID-19-positive patients with abdominal pain are at a higher risk of requiring intubation. Methodology In this retrospective cohort study, we identified 104 patients who presented to the emergency room of a single tertiary care center with laboratory-confirmed COVID-19 between February 1, 2020, and April 27, 2020, and collected data on reported pain complaints. Results In this retrospective cohort study, the most common pain complaints were chest pain (25.5%), myalgia (23.4%), and abdominal pain (17.0%). Less common pain complaints included headaches (14.9%) and neck/back pain (6.3%). Of these pain complaints, only patients who reported having abdominal pain were more likely to be intubated (37.5% of patients with abdominal pain were intubated compared to 8.3% of patients without abdominal pain, with a p-value of 0.001). Conclusions Abdominal pain in a patient with COVID-19 infection significantly increases their chances of requiring intubation based on the results of this study.

Virtual and Augmented Reality-based Treatments for Phantom Limb Pain: A Systematic Review.

Objective: To evaluate the literature on the effectiveness of virtual reality (VR)- and augmented reality (AR)-based treatments for phantom limb pain (PLP) in postamputation or brachial plexus avulsion (BPA) populations. Methods: Multiple databases were queried in July 2021 with the keywords "virtual reality," "augmented reality," and "phantom limb pain." Included studies utilized VR or AR to treat PLP with outcome measurement. Two independent reviewers assessed methodological quality using the Physiotherapy Evidence Databsae (PEDro) Scale and the Methodological Index for Nonrandomized Studies (MINORS) scoring. Studies were separated into immersive and nonimmersive AR/VR systems, with further categorization according to the specific methodologies used. Results: Of 110 results from the database queries, 20 publications met the inclusion criteria. There was one unblinded, randomized, control trial (RCT), one single-blinded, randomized, crossover trial (RCxT), three comparative case series, 13 noncomparative case series, and two case reports. Seven of the 20 studies were classified as nonimmersive. Six studies reported decreased PLP after AR/VR treatments, of which four reported significant reductions. One study reported a reduction in PLP with no significant difference from control conditions. Thirteen of the 20 studies were classified as immersive AR/VR. Twelve studies reported decreased PLP after AR/VR treatments, of which eight reported significant reductions. One study found no change in PLP, compared to baseline. Conclusion: The number of studies using AR/VR in PLP treatment has expanded since a 2017 review on the topic. The majority of these studies offer support for the efficacy of treating PLP with AR/VR-based treatments. Research has expanded on the customization, outcome measurements, and statistical analysis of AR/VR treatments. While results are promising, most publications remain at the case series level, and clinical indications should be cautioned. With improvements in the quality of evidence, there remain avenues for further investigations, including increased sampling, randomization, optimization of treatment duration, and comparisons to alternative therapies.

Immersive Virtual Reality for Pain Relief in Upper Limb Complex Regional Pain Syndrome: A Pilot Study.

Objective: This pilot study explored the effects of therapeutic immersive virtual reality (VR) on pain in upper limb complex regional pain syndrome (CRPS). While acute pain relief with VR has been studied in multiple populations, there is little data on the use of this modality in treating chronic pain, especially CRPS. Participants: Volunteer participants were recruited from outpatient rehabilitation services. Inclusion criteria required the diagnosis of CRPS in at least one upper limb and the ability to communicate in English to receive instructions from study personnel. A total of eight participants were recruited, with six fully completing the study. Interventions: An immersive virtual three-dimensional interactive kitchen environment was designed that allowed visualization of and object manipulation with virtual hands. Participants performed tasks representative of daily activities, as well as guided visualization exercises for a total of 10 sessions. Main Outcome Measure: Preand post-session pain scale measurements (Short Form McGill Pain Questionnaire, Visual Analog Scale, and Wong-Baker FACES) and subjective feedback were collected with each session. Results: Four of the six participants that completed the study reported subjective improvement of their pain and daily function. However, objective pain scales had limited correlation to reported subjective relief. Conclusions: Immersive virtual reality might provide subjective analgesia and functional improvement in select patients with upper limb complex regional pain syndrome, but objective data is lacking.

Virtual Reality Neurorehabilitation for Mobility in Spinal Cord Injury: A Structured Review.

Objective: The goal of this review was to evaluate the evidence regarding the use of virtual reality (VR) therapy for improvement of mobility in patients with spinal cord injury (SCI). Methods: A comprehensive literature search was conducted utilizing PubMed, CINAHL, EMBASE, and PsycINFO databases in April 2018. The phrase "virtual reality" and a combination of "spinal cord injury," "tetraplegia," "quadriplegia," or "paraplegia" were used as search terms. References included selected articles were reviewed as well. Articles were filtered based on the following inclusion criteria: 1) written in English, 2) peer-reviewed, 3) VR used for patients with SCI, and 4) changes in motor function evaluated. Main outcome measurements: Common outcomes of mobility assessment used in the studies included the Functional Reach Test (FRT), Functional Independence Measure (FIM), Limit of Stability (LOS), Berg Balance Scale (BBS), Timed Up and Go (TUG) test, and Walking Index for Spinal Cord Injury II (WISCI II) scale. Results: Seven of the nine reviewed articles were case series, while two were randomized, controlled trials. Reviewed literature demonstrated significant benefit in FRT, BBS, gait speed, muscle strength, SCIM, and WISCI-II using VR therapy. Voluntary muscle control improvement was also observed. However, no significant differences were found with regard to finehand motor movement. Conclusion: This literature review demonstrated mostly positive outcomes for the use of VR for SCI rehabilitation but were limited in quality and scope. Larger, multicenter trials are still needed.

Virtual and augmented reality in the treatment of phantom limb pain: A literature review.

BACKGROUND: Phantom limb pain (PLP), the perception of discomfort in a limb no longer present, commonly occurs following amputation. A variety of interventions have been employed for PLP, including mirror therapy. Virtual Reality (VR) and augmented reality (AR) mirror therapy treatments have also been utilized and have the potential to provide an even greater immersive experience for the amputee. However, there is not currently a consensus on the efficacy of VR and AR therapy. OBJECTIVE: The aim of this review is to evaluate and summarize the current research on the effect of immersive VR and AR in the treatment of PLP. METHODS: A comprehensive literature search was conducted utilizing PubMed and Google Scholar in order to collect all available studies concerning the use of VR and/or AR in the treatment of PLP using the search terms "virtual reality," "augmented reality," and "phantom limb pain." Eight studies in total were evaluated, with six of those reporting quantitative data and the other two reporting qualitative findings. RESULTS: All studies located were of low-level evidence. Each noted improved pain with VR and AR treatment for phantom limb pain, through quantitative or qualitative reporting. Additionally, adverse effects were limited only to simulator sickness occurring in one trial for one patient. CONCLUSIONS: Despite the positive findings, all of the studies were confined purely to case studies and case report series. No studies of higher evidence have been conducted, thus considerably limiting the strength of the findings. As such, the current use of VR and AR for PLP management, while attractive due to the increasing levels of immersion, customizable environments, and decreasing cost, is yet to be fully proven and continues to need further research with higher quality studies to fully explore its benefits.