A Contemporary Approach to Patellofemoral Pain in Runners.

Patellofemoral pain (PFP) is among the most common injuries in recreational runners. Current evidence does not identify alignment, muscle weakness, and patellar maltracking or a combination of these as causes of PFP. Rather than solely investigating biomechanics, we suggest a holistic approach to address the causes of PFP. Both external loads, such as changes in training parameters and biomechanics, and internal loads, such as sleep and psychological stress, should be considered. As for the management of runners with PFP, recent research suggested that various interventions can be considered to help symptoms, even if these interventions target biomechanical factors that may not have caused the injury in the first place. In this Current Concepts article, we describe how the latest evidence on education about training modifications, strengthening exercises, gait and footwear modifications, and psychosocial factors can be applied when treating runners with PFP. The importance of maintaining relative homeostasis between load and capacity will be emphasized. Recommendations for temporary or longer-term interventions will be discussed. A holistic, evidence-based approach should consist of a graded exposure to load, including movement, exercise, and running, while considering the capacity of the individual, including sleep and psychosocial factors. Cost, accessibility, and the personal preferences of patients should also be considered.

Optimized Sleep After Brain Injury (OSABI): A Pilot Study of a Sleep Hygiene Intervention for Individuals With Moderate to Severe Traumatic Brain Injury.

Background. Disrupted sleep is common after traumatic brain injury (TBI) particularly in the inpatient rehabilitation setting where it may affect participation in therapy and outcomes. Treatment of sleep disruption in this setting is varied and largely unexamined. Objective. To study the feasibility of instituting a sleep hygiene intervention on a rehabilitation unit. Methods. Twenty-two individuals admitted to a brain injury unit were enrolled and allocated, using minimization, to either a sleep hygiene protocol (SHP) or standard of care (SOC). All participants wore actigraphs, underwent serial cognitive testing, and had light monitors placed in their hospital rooms for 4 weeks. Additionally, participants in the SHP received 30 minutes of blue-light therapy each morning, had restricted caffeine intake after noon, and were limited to 30-minute naps during the day. SHP participants had their lights out time set according to preinjury sleep time preference. Both groups were treated with the same restricted formulary of centrally acting medications. Results. Of 258 patients screened, 27 met all study inclusion criteria of whom 22 were enrolled. Nine participants in each group who had at least 21 days of treatment were retained for analysis. The protocol was rated favorably by participants, families, and staff. Actigraph sleep metrics improved in both groups during the 4-week intervention; however, only in the SHP was the change significant. Conclusions. Sleep hygiene is a feasible, nonpharmacologic intervention to treat disrupted sleep in a TBI inpatient rehabilitation setting. A larger study is warranted to examine treatment efficacy. ClinicalTrials.gov Identifier: NCT02838082.

The Effects of the COMMASH-E Intervention on the Fatigue, Sleep Quality and Functional Status of Children with Cancer in Indonesia.

This study aimed to investigate the effects of the combined music and sleep hygiene education (COMMASH-E) intervention on the fatigue, sleep quality and functional status of children with cancer residing in temporary lodges in Indonesia. The design of this study was a quasi-experimental pre-post test with a control group. We recruited children with cancer aged 7-18 years (n = 58) using a consecutive sampling method and assigned them to intervention and control groups (n = 29 in each group). The intervention group had the COMMASH-E intervention while the control group received routine care. Fatigue, sleep quality and functional status were measured on days 1 and 4 using Allen's Fatigue in Childhood Cancer Scale, the Sleep Problem in Children Scale and the Barthel Index, respectively. T-dependent and independent tests and Multivariate Analysis of Covariance (MANCOVA) tests were performed for the data analysis. There were significant differences in fatigue, sleep quality and functional status between the intervention and control groups after the COMMASH-E intervention. Nonetheless, chemotherapy drugs contributed to the children's sleep quality. COMMASH-E was found to be more effective than routine care in the reducing fatigue and increasing the sleep quality and functional status of children with cancer.

The insomnia of Franz Kafka.

OBJECTIVE: To characterize the insomnia suffered by Franz Kafka (1883-1924), one of the most important literary figures of the 20th century. METHODS: We read Kafka's diaries and private correspondence to his fiancée, friends, editors and relatives looking for references to his insomnia. RESULTS: We found 292 references to insomnia indicating that Kafka suffered from chronic insomnia disorder that originated from and was maintained by the following predisposing and precipitating factors: (1) a complex personality predisposing to an increased arousal level, (2) intrusive thoughts and ruminations at bedtime, (3) excessive worrying about sleep loss and its daytime consequences, and (4) an extraordinary intolerance to noise. Since he could not sleep at night and felt the necessity to compose his literary works in an absolutely quiet environment, Kafka deliberately changed his sleep-wake schedule so he could write at night and nap in the afternoon. These maladaptive sleep habits perpetuated his insomnia and led to chronic sleep deprivation resulting in fatigue, lack of concentration and sleep-related auditory, tactile and visual hallucinations. Kafka sought help in alternative medicine however this was ineffective in improving his insomnia. CONCLUSIONS: Kafka suffered from chronic insomnia disorder and had inadequate sleep hygiene resulting in chronic sleep deprivation. These sleep problems impaired Kafka's quality of life.

Let's talk about sleep: a systematic review of psychological interventions to improve sleep in college students.

Sleep problems are a common occurrence in college students. Insomnia, nightmares and impaired sleep quality lead to several mental health issues, as well as impaired academic performance. Although different sleep programmes exist, a systematic overview comparing their effectiveness is still missing. This systematic review aims to provide an overview of psychological interventions to improve sleep in college students. Seven databases were searched from November to December 2016 (MEDLINE, EMBASE, PsycINFO, Cinahl, Cochrane Library, PubMed, OpenSigle). The search string included search terms from three different topics: sleep, intervention and college students. Outcome measures included subjective as well as objective measures and focused on sleep, sleep-related and mental health variables. Twenty-seven studies met the inclusion criteria. They were assigned to four intervention categories: (1) sleep hygiene, (2) cognitive-behavioural therapy (CBT), (3) relaxation, mindfulness and hypnotherapy and (4) other psychotherapeutic interventions. Fifteen studies were randomized controlled trials. While sleep hygiene interventions provided small to medium effects, the CBTs showed large effects. The variability of the effect sizes was especially large in the relaxation category, ranging from very small to very large effect sizes. Other psychotherapeutic interventions showed medium effects. CBT approaches provided the best effects for the improvement of different sleep variables in college students. Five studies included insomnia patients. The other three intervention categories also showed promising results with overall medium effects. In the future, CBT should be combined with relaxation techniques, mindfulness and hypnotherapy. Furthermore, the interventions should broaden their target group and include more sleep disorders.

Self-administered acupressure for insomnia disorder: a pilot randomized controlled trial.

Self-administered acupressure has potential as a low-cost alternative treatment for insomnia. To evaluate the short-term effects of self-administered acupressure for alleviating insomnia, a pilot randomized controlled trial was conducted. Thirty-one subjects (mean age: 53.2 years; 77.4% female) with insomnia disorder were recruited from a community. The participants were randomized to receive two lessons on either self-administered acupressure or sleep hygiene education. The subjects in the self-administered acupressure group (n = 15) were taught to practise self-administered acupressure daily for 4 weeks. The subjects in the comparison group (n = 16) were advised to follow sleep hygiene education. The primary outcome was the Insomnia Severity Index (ISI). Other measures included a sleep diary, Hospital Anxiety and Depression Scale and Short-form Six-Dimension. The subjects in the self-administered acupressure group had a significantly lower ISI score than the subjects in the sleep hygiene education group at week 8 (effect size = 0.56, P = 0.03). However, this observed group difference did not reach a statistically significant level after Bonferroni correction. With regard to the secondary outcomes, moderate between-group effect sizes were observed in sleep onset latency and wake after sleep onset based on the sleep diary, although the differences were not significant. The adherence to self-administered acupressure practice was satisfactory, with 92.3% of the subjects who completed the lessons still practising acupressure at week 8. In conclusion, self-administered acupressure taught in a short training course may be a feasible approach to improve insomnia. Further fully powered confirmatory trials are warranted.

Non-pharmacological interventions for sleep and quality of life: a randomized pilot study / Intervenções não farmacológicas no sono e qualidade de vida: estudo piloto aleatorizado / Intervenciones no farmacológicas en el sueño y calidad de vida: estudio piloto aleatorizado

ABSTRACT Objective: to estimate the effects of non-pharmacological interventions to improve the quality of sleep and quality of life of patients with heart failure. Method: pilot study of a randomized controlled trial with 32 individuals assigned to four groups. Sleep was assessed using the Pittsburgh Sleep Quality Inventory, while health-related quality of life was assessed using the Minnesota Living with Heart Failure Questionnaire, at the baseline and at the 12th and 24th weeks. The means of the outcomes according to intervention groups were compared using analysis of covariance; effect sizes were calculated per group. Results: all groups experienced improved quality of sleep and health-related quality of life at the end of the intervention (week 12) and at follow-up (week 24), though differences were not statistically significant (p between 0.22 and 0.40). The effects of the interventions at the 12th week ranged between -2.1 and -3.8 for the quality of sleep and between -0.8 and -1.7 for quality of life, with similar values at the 24th week. Conclusion: the effects found in this study provide information for sample size calculations and statistical power for confirmatory studies. Brazilian Clinical Trials Registry - RBR 7jd2mm

RESUMO Objetivo: estimar os efeitos de intervenções não farmacológicas para melhora da qualidade de sono e de vida de pacientes com insuficiência cardíaca. Método: estudo piloto de um ensaio controlado aleatorizado com 32 indivíduos alocados em quatro grupos. Sono foi avaliado pelo Pittsburgh Sleep Quality Inventory e qualidade de vida relacionada à saúde avaliada pelo Minnessota Living with Heart Failure Questionnaire, no início e nas semanas 12 e 24 do estudo. As médias dos desfechos por grupo de intervenção foram comparadas por análise de covariância, e os tamanhos dos efeitos calculados para cada grupo. Resultados: todos os grupos apresentaram melhora na qualidade de sono e de vida relacionada à saúde no final do período de intervenção (12 semanas) e no seguimento de 24 semanas, mas as diferenças não foram estatisticamente significantes (p entre 0,22 e 0,40). Em 12 semanas, os efeitos das intervenções variaram entre -2,1 e -3,8 na qualidade de sono e de -0,8 e -1,7 na qualidade de vida, com valores similares em 24 semanas. Conclusão: os efeitos obtidos neste estudo podem servir de base para cálculos de tamanho amostral e poder estatístico em estudos confirmatórios. Registro Brasileiro de Ensaios Clínicos - RBR 7jd2mm

RESUMEN Objetivo: estimar los efectos de intervenciones no farmacológicas para mejoría de la calidad de sueño y de vida de pacientes con insuficiencia cardíaca. Método: estudio piloto de un ensayo controlado aleatorizado con 32 individuos asignados a cuatro grupos. El sueño fue evaluado por el Pittsburgh Sleep Quality Inventory y la calidad de vida relacionada a la salud fue evaluada por el Minnessota Living with Heart Failure Questionnaire, en el inicio y en las semanas 12 y 24 del estudio. Las medias de los resultados por grupo de intervención fueron comparadas con análisis de covariancia y los tamaños de los efectos fueron calculados para cada grupo. Resultados: todos los grupos presentaron mejoría en la calidad de sueño y de vida relacionada a la salud al final del período de intervención (12 semanas) y en el seguimiento de 24 semanas; sin embargo, las diferencias no fueron estadísticamente significativas (p entre 0,22 y 0,40). En 12 semanas, los efectos de las intervenciones variaron entre -2,1 y -3,8 en la calidad de sueño y de -0,8 a -1,7 en la calidad de vida, con valores similares en 24 semanas. Conclusión: los efectos obtenidos en este estudio pueden servir de base para calcular el tamaño de la muestra y del poder estadístico en estudios confirmatorios. Registro Brasileño de Ensayos Clínicos - RBR 7jd2mm.

The management of sleep disorders in dementia: an update.

PURPOSE OF REVIEW: Sleep disorders in dementia cause distress and may lead to families being unable to care for someone with dementia at home. Recent Cochrane reviews found no interventions of proven effectiveness. There was no effect of light therapy and moderate evidence that melatonin was ineffective both given without knowledge of the patient's circadian rhythm. The current article updates this review by considering newer publications on interventions for sleep disorders or abnormalities of the sleep-wake cycle in people with dementia living in the community. RECENT FINDINGS: We searched electronically for new primary research, reviews and meta-analyses and identified 258 articles published between 15/12/2015 and 14/06/2017 on sleep and dementia; 43 of them on nonpharmacological or pharmacological treatments. Fifteen articles reported on the management of sleep disturbances in people with dementia, living at home. Those using pharmacological treatments (melatonin, psychotropic medications, donepezil, memantine) encompassed a meta-analysis, two double-blind RCTs, two uncontrolled trials, two population-based studies, and one case report. The studies of behavioural interventions comprised five uncontrolled trials, one case series, and one qualitative study. We also included three recent reviews on the management of sleep disturbances in Alzheimer's disease; pharmacotherapies for sleep disturbances in dementia, and dementia prevention, intervention and care. None of these found a treatment that showed definitive effectiveness, although there is preliminary work about nonpharmacological interventions, which can be built on. SUMMARY: Clinically effective, safe treatment of sleep disturbances in dementia remains an unresolved challenge. Given the importance of sleep and the many consequences of its disruption, well designed controlled trials are needed to determine acceptable and cost-effective treatment strategies that work for sleep disturbances.

Sleep outcomes following sleep-hygiene-related interventions for individuals with traumatic brain injury: A systematic review.

BACKGROUND: Sleep disturbance is commonly reported following traumatic brain injury (TBI) and can adversely impact health and wellbeing and interfere with the rehabilitation process. As such, effective treatment of sleep disturbance is critical for overall recovery. Sleep hygiene, which is non-invasive, low cost, and low risk, could serve as a suitable first line of treatment for individuals experiencing sleep disturbance post-TBI. OBJECTIVE: To assess the efficacy of sleep hygiene on sleep outcomes post-TBI. DESIGN: PsycINFO, Medline and EMBASE databases were systematically searched using mesh terms and keywords related to 'traumatic brain injury', 'sleep' and 'treatment'. Studies that met inclusion criteria were assessed on their methodological quality using validated assessment tools. RESULTS: Ten studies met inclusion criteria, none of which contained a child or adolescent population. Their methodological quality varied. The following interventions were shown to improve sleep outcomes amongst adults with TBI: Cognitive Behaviour Therapy for Insomnia, blue light therapy, Problem Solving Treatment and combined sleep hygiene and Prazosin. There was mixed evidence for the efficacy of exercise on sleep outcomes. CONCLUSION: Preliminary findings suggest that some sleep-hygiene-related interventions, either in isolation or in combination with other treatments, may reduce sleep difficulties post-TBI.

A Sleep Hygiene and Relaxation Intervention for Children With Acute Lymphoblastic Leukemia: A Pilot Randomized Controlled Trial.

BACKGROUND: Sleep disturbance and fatigue are common and distressing pediatric cancer-related outcomes. Sleep hygiene education and relaxation techniques are recommended to improve sleep in healthy children and adult cancer survivors. No studies have tested these interventions to improve sleep and fatigue for children with acute lymphoblastic leukemia (ALL) in the home setting. OBJECTIVES: The aim of this study is to establish the feasibility and acceptability of a sleep hygiene and relaxation intervention to improve sleep and fatigue for children receiving maintenance chemotherapy for ALL. The child's fatigue and sleep data were collected to inform sample size calculations for a future trial. METHODS: In this pilot randomized controlled trial, 20 children were allocated randomly to the sleep intervention or control group. The sleep intervention group received a 60-minute educational session to discuss sleep and fatigue in children with cancer and strategies to improve sleep, including use of 2 storybooks to teach deep breathing and progressive muscle relaxation. Objective sleep data were collected using actigraphy and fatigue was measured using the Childhood Cancer Fatigue Scale. RESULTS: The intervention was acceptable to families, and feasibility of the intervention and data collection was clearly established. Although not statistically significant, increases in mean nighttime sleep and decreases in mean wake time after sleep onset in the sleep intervention group represented clinically important improvements. CONCLUSIONS: This pilot study demonstrated the feasibility and acceptability of a sleep hygiene and relaxation intervention for children undergoing maintenance chemotherapy for ALL. IMPLICATIONS FOR PRACTICE: Given the clinically important improvements in sleep observed, replication in a larger, adequately powered randomized controlled trial is merited.