Effectiveness of biofeedback on blood pressure in patients with hypertension: systematic review and meta-analysis.

Hypertension is the leading modifiable risk factor for cardiovascular disease, but less than 50% have their blood pressure controlled. A possible avenue to support hypertension management is a holistic approach, using non-pharmacological interventions. Since hypertension is mediated in part by dysregulation of the autonomic nervous system (ANS), biofeedback may help improve hypertension management by targeted self-regulation and self-awareness of parameters that regulate the ANS. This systematic review aimed to assess the effectiveness of biofeedback on blood pressure in hypertensive patients. The review was pre-registered on PROSPERO and followed the PICO strategy. A total of 1782 articles were retrieved, 20 met the inclusion criteria. Sample sizes ranged from 15 to 301 participants; with a median age of 49.3 (43.3-55.0) years and 45% were female. There was a significant effect of biofeedback on systolic (-4.52, Z = 2.31, P = 0.02, CI [-8.35, -0.69]) and diastolic blood pressure (-5.19, Z = 3.54, P = 0.0004, CI [-8.07, -2.32]). Six different biofeedback modalities were used, with biofeedback delivered by psychologists, trained therapists and research assistants. There was no publication bias, heterogeneity was rated as substantial and data quality was rated to be poor. This review demonstrated that biofeedback had a significant effect on blood pressure. However, this should be viewed in the context of included studies being limited by heterogeneity and dated literature, meaning the research does not reflect the current biofeedback technology such as wearable devices. Future research should incorporate these technologies with robust methodology to fully understand the effect of biofeedback on hypertension.

Characteristics of people who have received treatment for late-onset problem drinking and alcohol use disorder: A systematic review and narrative synthesis.

Aims: The current review investigated the psychosocial characteristics of late-onset problem drinkers, an under-researched area of alcohol harm that accounts for one-third of older problem drinkers. Method: Following the PRISMA model, the protocol and search strategy included a scoping search and main search of nine databases. A total of 1,595 papers were identified; after screening, 26 papers were considered eligible and were included in the review. The review used an investigative framework comprising three categories: standardising age of onset; gender differences; and psychosocial and mental health characteristics. The review also investigated how meaning and purpose in life, and treatment have been reported in relation to this cohort. Findings/Conclusions: The combined onset ages of the reviews' 26 papers (mean age = 52.69 years) and the participants' self-reported age at onset (mean age = 56.79 years), suggest that late-onset alcohol use disorder (AUD)/problem drinking is likely to emerge at the age of 55 years and older. Moreover, there is a high prevalence of co-morbid mental health disorders among elderly, late-onset drinkers. Retirement was reported as the most prevalent psychosocial risk factor for late-onset problematic drinking; other late-life events included bereavement, loneliness and social isolation, and boredom. In the context of gender, women are at greater risk of developing late-onset problem drinking than men. Furthermore, late-onset problem drinkers, particularly women, are more treatment compliant than their early-onset counterparts, highlighting the case for bespoke treatments/interventions for late-onset problem drinkers. Finally, the role that meaning and purpose in life plays in late-onset problem drinking has been under-reported and requires further investigation.

'People don't get cancer, families do': Co-development of a social physical activity intervention for people recently affected by a cancer diagnosis.

OBJECTIVE: This research took a co-design approach to develop a social intervention to support people affected by a cancer diagnosis to be physically active. METHODS: We conducted semi-structured interviews with five key stakeholder groups: (1) adults with a recent breast or prostate cancer diagnosis; (2) family and friends of cancer patients; (3) healthcare professionals; (4) physical activity providers; and (5) cancer charity representatives. Inductive content analysis was used to identify themes in the data. We then worked with a subset of participants to co-develop the intervention. RESULTS: Participants welcomed the idea of a social approach to a physical activity intervention. Input was received on the timing and format of delivery, how to communicate about physical activity to cancer patients and their family and friends and the types of physical activity that would be appropriate. Our findings suggest that interventions need to be flexible in terms of timing and delivery and offer a wide range of physical activity options. These findings directly informed the co-development of 'All Together Active'. CONCLUSION: All Together Active is designed to support cancer patients and their family and friends to be active throughout treatment and beyond, benefiting their physical and mental health.

Evaluation of the Psychometric Properties of PainChek® in UK Aged Care Residents with advanced dementia.

BACKGROUND: The aim of this study was to further validate PainChek®, an electronic pain assessment instrument, with a population living with dementia in a UK care home. METHOD: This study utilised a correlational design to evaluate the psychometric properties of PainChek® when compared to the Abbey Pain Scale (APS). Blinded paired pain assessments were completed at rest and immediately post-movement by a researcher and a nurse. A total of 22 participants with a diagnosis of moderate-to-severe dementia and a painful condition were recruited using opportunity sampling. RESULTS: Overall, 302 paired assessments were collected for 22 participants. Out of these 179 were conducted during rest and 123 were immediately post-movement. The results demonstrated a positive significant correlation between overall PainChek® pain scores and overall APS pain scores (r = 0.818, N = 302, p < .001, one-tailed), satisfactory internal consistency (α = 0.810), moderate single measure intraclass correlation (ICC = 0.680) and substantial inter-rater agreement (κ = 0.719). CONCLUSIONS: PainChek® has demonstrated to be a valid and reliable instrument to assess the presence and severity of pain in people with moderate-to-severe dementia living in aged care.

What is the role of stress cardiovascular reactivity in health behaviour change? A systematic review, meta-analysis and research agenda.

OBJECTIVE: The stress reactivity hypothesis posits that the extremes of exaggerated and low or blunted cardiovascular reactivity (CVR) to stress may lead to adverse health outcomes via psychophysiological pathways. A potential indirect pathway between CVR and disease outcomes is through health-related behaviour and behaviour change. However, this is a less well understood pathway. Design: A registered systematic review was undertaken to determine the association between cardiovascular reactivity (CVR) and health behaviour change, as well as identify mediators and moderators. Eight papers that met the inclusion criteria, focused on smoking cessation and weight loss, were identified. Results: Pooling data from studies exploring the prospective relationship between CVR (as systolic blood pressure) and smoking cessation found that exaggerated CVR was associated with smoking relapse (Hedges' g = 0.39, SE = 0.00, 95% CI 0.38 - 0.40, p < .001; I2 = 0%; N = 257) but did not find evidence that CVR responses were associated with changes in weight. In order to advance our understanding of reactivity as a modifiable determinant of health behaviour change, our review recommends exploring the association between CVR and other health behaviours, to determine the influence of blunted reactivity versus low motivational effort identify mediators and moderators and determine the focus of interventions.

An integrative systematic review of creative arts interventions for older informal caregivers of people with neurological conditions.

OBJECTIVE: We aimed to assess and synthesise the current state of quantitative and qualitative research concerning creative arts interventions for older informal caregivers of people with neurological conditions. METHODS: A systematic search was employed to identify studies that examined creative arts interventions for older informal caregivers, which were synthesised in this integrative review. We searched the following databases: MEDLINE, PubMed, EBSCO, CINAHL, EMBASE, PsycINFO, Cochrane Library, Scopus, Web of Science, and Google Scholar. We also backwards searched references of all relevant studies and inspected trials registers. RESULTS: Of the 516 studies identified, 17 were included: one was quantitative, nine were qualitative and seven used mixed methods. All included quantitative studies were pilot or feasibility studies employing pre- and post-test design with small sample sizes. Studies varied in relation to the type of creative intervention and evaluation methods, which precluded meta-analysis. Large effect sizes were detected in wellbeing measures following singing and art interventions. The qualitative synthesis highlighted that interventions created space for caregivers to make sense of, accept and adapt to their identity as a caregiver. Personal developments, such as learning new skills, were viewed positively by caregivers as well as welcoming the opportunity to gain cognitive and behavioural skills, and having opportunities to unload emotions in a safe space were important to caregivers. Group creative interventions were particularly helpful in creating social connections with their care-recipients and other caregivers. CONCLUSIONS: The current review revealed all creative interventions focused on caregivers of people living with dementia; subsequently, this identified gaps in the evidence of creative interventions for informal caregivers of other neurological conditions. There are encouraging preliminary data on music and art interventions, however, little data exists on other art forms, e.g., drama, dance. Creative interventions may appeal to many caregivers, offering a range of psycho-social benefits. The findings of the current review open the way for future research to develop appropriate and creative arts programmes and to test their efficacy with robust tools.

Social ecological interventions to increase physical activity in children and young people living with and beyond cancer: a systematic review.

Objective: To identify the behaviour change techniques and intervention components associated with the promotion of physical activity (PA) for children and young people living with and beyond cancer. Design and main outcome measures: A systematic review and narrative synthesis was conducted on the evidence on PA interventions for children and young people (up to 30 years of age) living with and beyond cancer using a social ecological framework. Results: Out of 12 studies, 8 were shown to change PA. Intervention components included (1) behavioural (Instruction on how to perform the behaviour, credible source, behavioural demonstration and rehearsal), (2) cognitive-emotional (targeting attitude, perceived behavioural control, intentions, resilience and achievement) (3) socio-cultural (family and peer support for PA), (4) environmental (providing access to resources, environmental restructuring, safety), (5) demographic (child, adolescent, young adult or mixed) and (6) medical (tailored exercise depending on age and cancer stage). Conclusions: Interventions designed to increase physical activity participation and adherence during and beyond cancer treatment for young people should integrate psychosocial (behavioural, cognitive-emotional, social), environmental and medical intervention components. Our conceptual model can be used to inform the development of interventions and guides future research objectives and priorities.

Mindfulness for pain, depression, anxiety, and quality of life in people with spinal cord injury: a systematic review.

BACKGROUND: Populations with reduced sensory and motor function, such as spinal cord injury (SCI) are at increased risk of depression, anxiety, pain, and poorer quality of life (QoL). Mindfulness-Based Interventions (MBIs) have been developed with the aim of improving outcomes for people with SCI. To understand the value of MBIs, a systematic review was conducted pertaining to the use of MBIs, and interventions including elements of mindfulness, with people with SCI. METHODS: Databases were reviewed from 1996 to October 2018 (updated January 2020). Eligibility criteria included the assessment of at least one of the common secondary consequences of SCI (i.e. risk of depression, anxiety, pain, and QoL), describe the use of mindfulness training as a component part of an intervention, or as the whole intervention. The Cochrane Collaboration Risk of Bias and The Effective Public Health Practice Project Quality Assessment Tools were utilised for quality appraisals. Two assessors appraised the studies and demonstrated good agreement (Cohen's k = .848, p < .001). RESULTS: Five papers met the inclusion criteria, and demonstrated a range of results of interventions delivered individually, in a group format, in person, and online. Only one study reported significant reductions in pain-related outcomes (with moderate effect sizes), with the remaining studies (n = 4) demonstrating no change. Four studies described reductions in depressive symptoms and three reported reductions in anxiety. Despite the importance of good QoL as a goal for people with SCI, few studies (n = 2) assessed this as an outcome with no improvements reported. Study quality ranged from high to low/weak. CONCLUSIONS: The findings in this review provide mixed support for the use of mindfulness to improve outcomes after SCI. In particular, findings indicate that mindfulness may be particularly effective for improving symptoms of depression and anxiety. This review highlights the requirement for more rigorous, high-quality research, particularly larger randomised-controlled trials with long-term follow-up, in this area. The small number of studies included in the present review mean that conclusions drawn are preliminary and thus reflects the paucity of the research in the area to date.

Mental contrasting for health behaviour change: a systematic review and meta-analysis of effects and moderator variables.

Mental contrasting is a self-regulation imagery strategy that involves imagining a desired future and mentally contrasting it with the present reality, which is assumed to prompt the individual to realise that action is required to achieve the desired future. Research has combined mental contrasting with implementation intentions (MCII) ('if-then' plans), which is hypothesised to strengthen the effects. A systematic review was conducted to evaluate the effectiveness of mental contrasting for improving health-related behaviours. A meta-analysis (N = 1528) using random effects modelling found a main effect of mental contrasting on health outcomes, adjusted Hedges' g = 0.28 (SE = .07), 95% CI [0.13-0.43], p < .001 at up to four weeks, and an increased effect at up to three months (k = 5), g = 0.38 (SE = 0.6), CI [0.20-0.55], p < .001. The combination of mental contrasting with implementation intentions (MCII; k = 7) showed a similar effect, g = 0.28, CI [0.14-0.42], p < .001. Mental contrasting shows promise as a brief behaviour change strategy with a significant small to moderate-sized effect on changing health behaviour in the short-term. Analysis on a small subset of studies suggested that the addition of implementation intentions (MCII) did not further strengthen the effects of mental contrasting on health behaviours, although additional studies are needed.

'A new normal with chemobrain': Experiences of the impact of chemotherapy-related cognitive deficits in long-term breast cancer survivors.

Chemobrain is one of the most commonly reported side-effects of cancer treatment. However, there is limited research into its psychosocial concomitants. This study aimed to explore the long-term lived experience of chemobrain. Interpretative phenomenological analysis allowed an in-depth investigation of 12 breast cancer survivors suffering from perceived cognitive deficits at least 1-year post-treatment. Themes were organised around the illness representations framework. Commonly reported cognitive deficits related to memory, language and processing speed, which affected participants' sense of identity and their interactions with others. Individual experiences were mediated by health beliefs regarding controllability, validation and impairment trajectory.

Experiences of Integrated Care for Dementia from Family and Carer Perspectives: A Framework Analysis of Massive Open Online Course Discussion Board Posts.

BACKGROUND: Integrated Care for dementia is an increasingly popular approach to supporting people with dementia, bringing services together to form a single cohesive provision for service users. This approach is still in its infancy but has the potential to improve the management of dementia, social care and to enhance the patient experience. AIMS: To understand views and experiences of integrated health and social care for dementia from the perspective of carers, families, healthcare professionals and researchers. METHODS: Crowdsourcing views and experiences from 'Bridging the Dementia Divide', a massive open online course at the University of Derby, provide a rich source of qualitative data from carers, families and healthcare professionals. We analysed 847 massive open online course discussion board posts using a Framework Analysis approach. RESULTS: Participants described how Integrated Care for dementia should be person-centred and holistic, involving a multidisciplinary team of health and social care practitioners, as well as the patient, the family and the wider community. The establishment of Integrated Care for dementia was viewed positively.

The psychosocial impact of caregiving in dementia and quality of life: a systematic review and meta-synthesis of qualitative research.

OBJECTIVE: A systematic meta-synthesis of qualitative studies was conducted to interpret and synthesise findings from studies investigating the experiences, quality of life, and psychosocial impact of caregiving on adult informal caregivers of people with dementia. DESIGN: The meta-synthesis was conducted according to the principles of meta-ethnography. RESULTS: Fourteen studies describing the experiences of 265 informal caregivers were reviewed. The meta-synthesis elicited the following themes: (1) understanding and making sense of the dementia diagnosis, changing symptoms, and the caregiver role; (2) coping strategies, psychological facilitators and rewards of caregiver role; (3) challenges of caring for a person with dementia and their behaviour; (4) caregivers' relationships with care-recipient and other informal caregivers; and (5) caregivers' experiences of formal support services and material resources. CONCLUSION: Our findings highlight the need for a person-centred approach to care planning that also accounts for the needs of the informal caregiver to promote better caregiver well-being and quality of life. Caregivers' emotional support, coping, resilience, need for information and respite care and adjustment to caregiver identity should be reviewed as part of the care package for the person with dementia.

Mental contrasting as a behaviour change technique: a systematic review protocol paper of effects, mediators and moderators on health.

BACKGROUND: Mental contrasting is a self-regulation strategy that is required for strong goal commitment. In mental contrasting, individuals firstly imagine a desired future or health goal that contrasted with the reality proceeding the goal state, which after reflection is viewed as an obstacle (Oettingen et al. J Pers Soc Psychol 80:736-753, 2001). Mentally contrasting a positive future with reality enables individuals to translate positive attitudes and high efficacy into strong goal commitment. METHODS: A systematic review of the literature is proposed to explore the efficacy of mental contrasting as a behaviour change technique (Michie et al., Ann Behav Med 46: 81-95, 2013) for health. The review also aims to identify the effects of mental contrasting on health-related behaviour, as well as identifying mediator and moderator variables. DISCUSSION: This will be the first systematic review of mental contrasting as a health behaviour change technique. With sufficient studies, a meta-analysis will be conducted with sensitivity and sub group analyses. If meta-analysis is not appropriate, a narrative synthesis of the reviewed studies will be conducted. SYSTEMATIC REVIEW REGISTRATION: Review protocol registered on PROSPERO reference CRD42016034202 .