Study protocol for a randomized controlled trial: Effect of an everyday cognition training program on cognitive function, emotional state, frailty and functioning in older adults without cognitive impairment.

BACKGROUND: Ageing entails changes in complex cognitive functions that lead to a decrease in autonomy and quality of life. Everyday cognition is the ability to solve cognitively complex problems in the everyday world, enabling instrumental activities of life. Benefits have been found in studies using everyday cognition-based assessment and intervention, as the results predict improvements in everyday performance, not just in specific cognitive functions. A study protocol is presented based on assessment and training in everyday cognition versus traditional cognitive stimulation for the improvement of functionality, emotional state, frailty and cognitive function. METHODS: A parallel randomised controlled clinical trial with two arms will be conducted. It will be carried out by the University of Salamanca (Spain) in eleven centres and associations for the elderly of the City Council of Salamanca. People aged 60 years or older without cognitive impairment will be recruited. Participants will be randomly distributed into two groups: the experimental group will undergo a training programme in everyday cognition and the control group a programme of traditional cognitive stimulation, completing 25 sessions over 7 months. All participants will be assessed at the beginning and at the end of the intervention, where socio-demographic data and the following scales will be collected: The Medical Outcomes Study (MOS), Questionnaire ARMS-e, Everyday Cognition Test (PECC), Scale Yesavage, Test Montreal Cognitive Assessment (MoCA), The Functional Independence Measure (FIM), Fragility Index and Lawton y Brody Scale. DISCUSSION: The present study aims to improve conventional clinical practice on cognitive function training by proposing a specific assessment and intervention of everyday cognition based on the importance of actual cognitive functioning during the resolution of complex tasks of daily life, giving priority to the improvement of autonomy. TRIAL REGISTRATION: ClinicalTrials.gov; ID: NCT05688163. Registered on: January 18, 2023.

Effectiveness of Different Neurocognitive Intervention Approaches on Functionality in Healthy Older Adults: A Systematic Review.

Subtle loss of functionality in healthy older adults is considered one of the most important predictors of cognitive decline. Neurocognitive interventions are increasingly being used, from a preventive maintenance approach to functional capacity. This study evaluates the effectiveness of different neurocognitive approaches on the functionality of healthy older adults. In this systematic review (CRD42023473944), an extensive search was conducted for articles published in the last 10 years (2013-2023) in the following databases: Medline, Scopus, and Web of Science. A total of 809 trials were identified, of which 18 were considered to be eligible for inclusion in the review. The data revealed heterogeneity in sample size, measures of functional assessment, neurocognitive interventions used, number of sessions, session duration, and time. Traditional cognitive stimulation is shown to have no significant functional benefit, while other less commonly used neurocognitive interventions, such as those based on everyday cognition, are associated with more significant benefits. Moreover, it is demonstrated that although the Instrumental Activities of Daily Living scale (IADL) is the most used test in similar studies, it is not sensitive enough to detect changes in functionality in healthy elderly individuals, with other tests such as the Timed Instrumental Activities of Daily Living (TIADL) being more advantageous. Therefore, a new guideline is proposed for its use in clinical practice and research, using homogeneous study protocols and neurocognitive interventions that allow for the transfer and generalization of results in daily life.

Multifactorial Study on the Impact of Educational Level, Employment Status, and the Need for Extraordinary Care on the Economic Impact of Cancer Patients.

Cancer is one of the major socio-health problems in the world. The level of education, the profession and/or employment status of the patient and the family can influence the amount of household income, the additional expenditure, and the possible socio-economic impact of the disease. The main objective of the study is to analyse and evaluate the influence of the level of education, the employment status of the patient, and the need for care and how these factors influence the additional expenditure and the possible socio-economic impact. METHODS: descriptive cross-sectional randomised observational epidemiological study without replacement at the Hospital Universitario de Salamanca (CAUSA). RESULTS: total sample (n = 365) comprised 53.2% of patients with no education or primary education, 25.8% with secondary education and 21.1% with higher education. Overall, 36.4% of patients were employed, 10.1% were self-employed, 53.0% were not employed, and 38.9% were experiencing other conditions. Significant statistics were found for educational level, employment status of the patient and main caregivers in terms of financial expenditure. CONCLUSIONS: Oncology patients with more education spend more on home help and/or accompanying the patient and transfers to the hospital for treatment. Higher incomes are not synonymous with higher expenditure in the sample. The patient's main caregivers are a fundamental pillar of the patient's household income and additional spending on orthopaedic material.

Efectividad de la robótica en terapia ocupacional para recuperación funcional del miembro superior: revisión sistemática / Effectiveness of robotics in occupational therapy for functional recovery of the upper limb: systematic review

Objetivos: revisar sistemáticamente la evidencia científica actual acerca de la efectividad de la terapia robótica, respecto a la terapia ocupacional convencional, para alcanzar la máxima recuperación funcional de un miembro hemiparético en pacientes que hayan sufrido un accidente cerebrovascular. Métodos: La revisión se llevó a cabo en mayo de 2022, siguiendo el protocolo definido de las normas de la declaración PRISMA. La búsqueda se realizó en las bases de datos y archivos electrónicos Pubmed, Cochrane Library, American Journal of Occupational Therapy, Journal of Neuroengineering and Rehabilitation (BMC), Archives of Physical Medicine and Rehabilitation, Wiley Online Library (Australian Journal of Occupational Therapy), SAGE journals, Journal of Neurologic Physical Therapy, International Journal of Stroke. Se seleccionaron 12 estudios de los 1920 registrados. Resultados: Los resultados mostraban todavía cierta controversia respecto al uso de dispositivos robóticos, determinando su utilidad para competencias concretas y apostando por su inclusión de manera combinada con la terapia ocupacional convencional. Conclusiones: diversos estudios recomiendan la rehabilitación combinada de la terapia ocupacional convencional y la terapia robótica para optimizar la funcionalidad e independencia de los pacientes.(AU)

Objective: Was to systematically review the current scientific evidence about the effectiveness of robotic therapy, compared to conventional occupational therapy, to achieve maximum functional recovery of a hemiparetic limb in patients who have suffered a cerebrovascular accident. Methods: The review was conducted in May 2022, following the defined protocol of the PRISMA statement guidelines. The databases and electronic archives used were Pubmed, Cochrane Library, American Journal of Occupational Therapy, Journal of Neuroengineering and Rehabilitation (BMC), Archives of Physical Medicine and Rehabilitation, Wiley Online Library (Australian Journal of Occupational Therapy), SAGE journals, Journal of Neurologic Physical Therapy, International Journal of Stroke. 12 studies were selected from the 1920 registered. Results: The results still showed some controversy regarding the use of robotic devices, determining their usefulness for specific competencies and advocating their inclusion in combination with conventional occupational therapy. Conclusions: Several studies recommend the combined rehabilitation of conventional occupational therapy and robotic therapy to optimize patients' functionality and independence.(AU)

Living Conditions and the Incidence and Risk of Falls in Community-Dwelling Older Adults: A Multifactorial Study.

Old age represents a social group that is undergoing continuous expansion. The aging population will be prone to chronic diseases and falls, which is a marker of frailty and a public health problem. This study aims to examine the relationship between living conditions and the prevalence of the risk of falls in older adults within the community. As an observational cross-sectional study, intentional sampling was carried out on residents of the metropolitan area over 75 years of age. The socio-demographic data of the subjects and their history of falls were collected. Additionally, the subjects were evaluated on the risk of falling, basic activities of daily living, such as walking and balance, fragility, and their fear of falling. The statistical analyses used were based on the Shapiro-Wilk test for normality, statistics of central tendency with description, mean (M) and dispersion, standard deviation (SD), bivariate contingency tables for studying the relationships between the variables, and the analysis of Pearson's relational statistics (χ2). The comparisons of means were resolved by parametric or non-parametric routes. We obtained the following results: 1. The socio-demographic profile of our sample consisted of adults over 75 years of age, the majority of whom were overweight or obese women living in an urban area, specifically in an apartment, and receiving care; 2. Older people in the studied community had mild dependency and frailty, and were also at severe risk of falls; 3. The prevalence of falls was higher in women than in men in this study. Through these results, we confirmed the relationship between living conditions and the prevalence of risk of falls in older adults within the community.

Multimodal Physical Exercise and Functional Rehabilitation Program in Oncological Patients with Cancer-Related Fatigue-A Randomized Clinical Trial.

The increase in life expectancy and survival time implies an increase in the possible side-effects of pharmacological treatments in patients. Cancer-related fatigue is one of these side-effects. The main objective of this study was to evaluate the effects of a multimodal program of physical exercise and functional rehabilitation on asthenia, pain, functional capacity, and quality of life in cancer patients with cancer-related fatigue. METHODS: This was a randomized, parallel-controlled clinical trial, with two arms (experimental and control group), and it was conducted over the course of a year in the Oncology Hospitalization Unit at the University Hospital of Salamanca, Spain. Participants (n = 48) were assessed at three points during the study. The first assessment was prior to hospital discharge, the second assessment was after 15 days, and the final assessment was at one month post-hospital follow-up. The intervention lasted one month. The main variables studied were the dependency levels (Barthel), cancer-related fatigue (FACT-An), health-related quality of life (EuroQoL-5D), functional capacity (SPPB), and kinesiophobia (TSK-F). RESULTS: Sample size (n = 44). Mean age 63.46 ± 12.36 years. Significant differences between control and experimental group participants in Barthel, FACT-An, TSK-F, and SPPB scores at follow-up and final assessment. CONCLUSIONS: There are beneficial effects of a multimodal physical exercise and functional rehabilitation program in improving the autonomy of cancer-related fatigue patients.

Study on the Socio-Economic Impact of Cancer Disease on Cancer Patients and Their Relatives.

BACKGROUND: Cancer is one of the most relevant social and health problems in the world. The disease entails additional costs for cancer patients and their families that are not covered by the public part of our welfare state, and which they assume themselves simply because they are ill. The main objective of this study is to identify and analyse the additional cost and socioeconomic impact of cancer disease on patients diagnosed with cancer disease and their families. METHODS: Descriptive cross-sectional randomised observational epidemiological study without replacement with prevalence of cancer disease in the study base, carried out in the Medical Oncology Service of the Complejo Asistencial Universitario de Salamanca (CAUSA), Spain. RESULTS: The study variable has been the additional cost of the cancer disease for cancer patients and their families that is not covered by our autonomous health system. CONCLUSIONS: Cancer disease entails an additional cost for the patient and family; more specifically, for 55% of the patients in the study sample, the diagnosis of cancer represents extra expenditure of between 8.38-9.67% of their annual income. Furthermore, the disability and dependence of patients does not represent an additional cost due to their levels of functionality, but it can have repercussions on the future cost of the evolution of the disease, in addition to the fact of having cancer.

Estudio sobre la autopercepción de calidad de vida en ictus mediante la escala CAVIDACE-AUTOINFORME: estudio descriptivo / Self-perception study of quality of life in stroke patients using the CAVIDACE-SELF-REPORT SCALE: descriptive study

Objetivos: analizar la autopercepción que tienen las personas con enfermedad cerebral vascular de cada una de las dimensiones de la calidad de vida. Métodos: estudio descriptivo observacional transversal, en el que se utilizó la escala CAVIDACE-Autoinforme para evaluar la calidad de vida de 24 personas con diagnóstico de enfermedad cerebral vascular. Resultados: los resultados mostraron diferencias significativas entre las diferentes dimensiones de la calidad de vida, destacando que la dimensión que los participantes percibieron como más satisfactoria fue las relaciones interpersonales, mientras que la dimensión que han considerado como menos satisfactoria ha sido la inclusión social. Además, no se ha podido determinar relación entre el grado de funcionalidad, el índice de calidad de vida y el tratamiento de terapia ocupacional. Conclusiones: se han obtenido diferencias significativas entre las puntuaciones obtenidas en las diferentes dimensiones de la calidad de vida por lo que sería interesante analizar el motivo de la discrepancia entre la puntuación obtenida en la dimensión de relaciones interpersonales e inclusión social, además de determinar si la relación entre la dimensión de desarrollo personal y el grado de independencia está influida o no por el tratamiento de terapia ocupacional. (AU)

Objective: The aim was to analyze stroke patients' self-perception of each dimension of quality of life. Methods: Cross-sectional observational descriptive study, in which the CAVIDACE-Self-report scale was used to assess the quality of life of 24 subjects with a diagnosis of stroke. Results: The results showed significant differences between the different dimensions of quality of life, highlighting that the dimension that the participants perceived as most satisfactory was interpersonal relationships, while social inclusion was the dimension, they considered least satisfactory. Furthermore, it was not possible to determine a relationship between the degree of functionality, the quality-of-life index and occupational therapy treatment. Conclusions: Significant differences were obtained between the scores obtained in the different dimensions of quality of life, so it would be interesting to analyse the reason for the discrepancy between the score obtained in the dimension of interpersonal relationships and social inclusion, as well as to determine whether the relationship between the dimension of personal development and degree of independence is influenced or not by the occupational therapy treatment. (AU)

Multimodal physical exercise and functional rehabilitation program in oncological patients with asthenia. study protocol.

BACKGROUND: The increase in the survival of oncology patients include multiple side effects as cancer-related asthenia and dyspnea, which represents a serious health problem. An implementation of the conventional clinical practice, developed through multimodal physical exercise and functional rehabilitation program intervention, may be useful in controlling dyspnoea. This study aims to evaluate the effects of a multimodal exercise and functional rehabilitation program on fatigue, pain, functional capacity, and quality of life in cancer patients with cancer-related asthenia. METHODS: This is a protocol for an experimental, prospective, randomised study using a parallel, fixed assignment scheme, with an experimental group and a control group in patients from the oncology hospitalisation unit at the Salamanca University Hospital Complex in Spain, using consecutive sampling to select 50 participants with oncological asthenia who are hospitalised at the time of inclusion. After the baseline evaluation, the participants will be randomised into two groups. Both groups will receive standard clinical practice care and the normal health education program at discharge, but in addition, the participants assigned to the experimental group will also complete a multimodal exercise and functional rehabilitation program lasting one month. The primary outcomes will be basic activities of daily living (Barthel Index) and degree of asthenia (FACT-An scale). Additionally, physical performance will be evaluated with the Short Physical Performance Battery (SPPB), as will the attention and executive functions (Trail-Making Test), fear/avoidance of movement (TAMPA scale), pain (VAS scale), and body composition (waist, hip, brachial, thigh, wrist, and ankle circumferences). DISCUSSION: The results of this study may be translated to clinical practice, incorporating a specific autonomy recovery programme into comprehensive rehabilitation programmes of care for cancer patients with asthenia. The current study addresses to improve the conventional clinical practice by proposing a multimodal physical exercise and functional rehabilitation program intervention, which will be implemented by an interdisciplinary team, to try to improve the autonomy of cancer patients with cancer-related asthenia. TRIAL REGISTRATION: ClinicalTrials.gov; ID: NCT04761289. (February 18, 2021).  https://clinicaltrials.gov/ct2/show/ NCT04761289.

Specific autonomy recovery programme in a comprehensive rehabilitation on functionality and respiratory parameters in oncological patients with dyspnoea. Study protocol.

BACKGROUND: Survival in cancer patients has increased exponentially in recent years, with multiple side effects caused by treatments. Cancer-related asthenia and dyspnea are among them, which represent a serious health problem, with considerable limitations and reduced quality of life. An implementation of the conventional clinical practice, developed through physical exercise, may be useful in controlling dyspnoea. This study aims to compare the effects of a comprehensive rehabilitation implementing a programme of multimodal physical exercise with a specific autonomy recovery programme, versus an isolated intervention using the physical exercise programme alone, on the functionality, physical performance and respiratory parameters in oncologycal patients with dyspnea. METHODS: This is a protocol por an experimental, prospective, randomized, parallel-controlled clinical trial, with two arms design of fixed assignment with an experimental and control groups. It will conduct in the Oncology Hospitalisation Unit at the University Hospital Complex of Salamanca, using consecutive sampling to select 50 participants with oncological dyspnoea who are hospitalised at the time of inclusion. After baseline assessment, participants will be randomised into the groups. Experimental group will complete Comprehensive Rehabilitation with the autonomy recovery and the multimodal exercise programmes, and in the control group, only the multimodal exercise programme will be carried out. The primary outcomes will be basic activities of daily living (Barthel Index) and degree of dyspnoea (MRC scale). Additionally, physical performance will be evaluated with the Short Physical Performance Battery (SPPB), as will the oxygen saturation in the blood using pulse oximetry, fear/avoidance of movement with the Tampa Scale of Kinesiophobia (TSK), and the quality of life of the oncology patient (ECOG performance scale). DISCUSSION: The results of this study may be translated to clinical practice, incorporating a specific autonomy recovery programme into comprehensive rehabilitation programmes of care for cancer patients with dyspnoea. Increase in the survival of patients with cancer includes multiple side effects as cancer-related asthenia and dyspnea, which represents a serious health problem. The current study addresses to improve the conventional clinical practice by proposing an integral, rehabilitative approach, to implement education and training for oncology patients with dyspnea to increase their quality of life. TRIAL REGISTRATION: ClinicalTrials.gov; ID: NCT04766593 . (February 23, 2021).

Estudio aleatorizado de un programa de entrenamiento de cognición cotidiana frente a estimulación cognitiva tradicional en adultos mayores / Randomized study of a everyday cognition training program versus traditional cognitive stimulation in elderly adults

La cognición cotidiana consiste en la aplicación de las habilidades cognitivas básicas y el conocimiento del dominio específico para la resolución de problemas que se integran dentro de los dominios instrumentales de funcionamiento. Para valorar la cognición cotidiana, existen evaluaciones que presentan problemas cotidianos cognitivamente desafiantes, pertenecientes a actividades instrumentales, cuyo objetivo es evaluar el funcionamiento cognitivo dentro de estos dominios en el mundo real. Objetivo principal: Analizar la diferencia existente entre la realización de programas de estimulación cognitiva tradicionales y programas de intervención directa en cognición cotidiana. Metodología: Estudio experimental, aleatorizado, estratificado, prospectivo, longitudinal mediante un esquema de asignación fija con grupo experimental y grupo control. La población a estudio fueron adultos mayores sanos de la ciudad de Salamanca que participaron en los programas de terapia ocupacional. La intervención constó de un programa específico de estimulación en cognición cotidiana. Para la evaluación se utilizó la ERFC (evaluación rápida de las funciones cognitivas) para medir la función cognitiva global y la ECB (Everyday Cognition Battery) para medir la cognición cotidiana. Resultados: Muestra total de pacientes (n = 147) compuesta por 19 hombres y 128 mujeres, con una edad media de 75 años. Se observaron diferencias estadísticamente significativas (p < 0,001) en la variable ECB, así como diferencias estadísticamente significativas (p < 0,05) en los ítems "total", "cálculo", "razonamiento", "comprensión" y "reconocimiento visual". Conclusiones: La utilización combinada de estimulación cognitiva tradicional y entrenamiento en cognición cotidiana presenta mayores beneficios en términos de cognición cotidiana que la utilización exclusiva de estimulación cognitiva en adultos mayores

Everyday cognition consists in the application of basic cognitive skills and the knowledge about a specific domain in problem solving which are integrated within the functional instrumental domains. In order to assess everyday cognition, there are assessments which include challenging cognitive tasks which are categorized as instrumental domains. The aim of these assessments is to assess cognition in the real world. Main objective: To analyze the difference among the implementation conventional of cognitive stimulation programs and the implementation of everyday cognition programs. Methods: Longitudinal prospective stratified randomized control trial. The population study will be older adults living in Salamanca who will participate in occupational therapy programs. The intervention will consist of a specific everyday cognition stimulation program. For the evaluation we used the ERFC (rapid assessment of cognitive functions) to measure global cognitive function and the ECB (everyday cognition battery) to measure daily cognition. Results: Sample size (n=147) composed of 19 males and 128 females with an average age of 75. Statistically significant difference is observed (p<0.001) in ECB variable (Everyday Cognition Battery), and in "total", "calculation", "reasoning", "comprehension" and "visual recognition" items as well (p<0.05). Conclusions: The combination of conventional cognitive stimulation and everyday cognition training has more benefits in terms of everyday cognition than the administration of cognitive stimulation by itself in older adults