Effects of a culturally adapted group based Montessori based activities on engagement and affect in Chinese older people with dementia: a randomized controlled trial.

BACKGROUND: The Montessori Method underpinned by the principle of person-centered care has been widely adopted to design activities for people with dementia. However, the methodological quality of the existing evidence is fair. The objectives of this study are to examine the feasibility and effects of a culturally adapted group-based Montessori Method for Dementia program in Chinese community on engagement and affect in community-dwelling people with dementia. METHODS: This was a two-arm randomized controlled trial. People who were aged 60 years or over and with mild to moderate dementia were recruited and randomly assigned to the intervention group to receive Montessori-based activities or the comparison group to receive conventional group activities over eight weeks. The attendance rates were recorded for evaluating the feasibility. The Menorah Park Engagement Scale and the Apparent Affect Rating Scale were used to assess the engagement and affect during the activities based on observations. Generalized Estimating Equation model was used to examine the intervention effect on the outcomes across the sessions. RESULTS: A total of 108 people with dementia were recruited. The average attendance rate of the intervention group (81.5%) was higher than that of the comparison group (76.3%). There was a significant time-by-group intervention effect on constructive engagement in the first 10 minutes of the sessions (Wald χ2 = 15.21-19.93, ps = 0.006-0.033), as well as on pleasure (Wald χ2 = 25.37-25.73, ps ≤ 0.001) and interest (Wald χ2 = 19.14-21.11, ps = 0.004-0.008) in the first and the middle 10 minutes of the sessions, adjusted for cognitive functioning. CONCLUSIONS: This study provide evidence that Montessori-based group activities adapted to the local cultural context could effectively engage community-dwelling Chinese older people with mild to moderate dementia in social interactions and meaningful activities and significantly increase their positive affect. TRIAL REGISTRATION: ClinicalTrials.gov, NCT04352387. Registered 20 April 2020. Retrospectively registered.

An information-motivation-behavioural-based model and adherence to inhalation therapy and other health outcomes in patients with chronic obstructive pulmonary disease: A pilot randomized controlled trial.

AIMS: To explore the feasibility and effects of the programme based on information-motivation-behavioural skills (IMB) model (IMB programme) on adherence to inhalation therapy and other health outcomes in chronic obstructive pulmonary disease (COPD) patients. BACKGROUND: Poor adherence to inhalation therapy is common among COPD patients. The IMB model is supported by previous studies as useful in promoting adherence to health behaviours. METHODS: This pilot randomized controlled trial randomized 35 COPD patients to receive either the IMB-based programme or usual care. The 4-week IMB programme consisted of a face-to-face and two telephone sessions to empower patients with skills and knowledge on using inhalation therapy and support their goal attainment for treatment compliance. Outcome evaluation including adherence to inhalation therapy, inhalation techniques, disease impact, and quality of life was conducted at baseline and at 6 weeks after randomization. Feasibility of the IMB programme was evaluated by a satisfaction survey and implementation experience. RESULTS: Thirty patients completed the study, with an attrition rate of 14.3%. The intervention group (n = 15) had significant improvements in inhalation adherence, inhalation techniques, and quality of life than the control group over the evaluation period. Patient satisfaction survey results and observations on programme implementation suggested the feasibility of the IMB programme. CONCLUSION: A IMB model is a feasible and potentially effective intervention for improving COPD patients' adherence to inhalation therapy.

Effects of Lifestyle Intervention on Physiological Outcomes in Chinese Adults With, or at High Risk of, Metabolic Syndrome.

BACKGROUND: Metabolic syndrome (MS) increases the risk of cardiovascular events and the development of diabetes. This article reports the effects of lifestyle intervention on the physiological outcomes of people with or at high risk of MS in the community setting of Hong Kong. METHODS: Chinese adults with 2 or more MS components were recruited from 13 community centers, which were cluster-randomized to the intervention or control group. The intervention group received a low-intensity lifestyle intervention program for people with MS consisting of group sessions, individual counseling, and telephone follow-ups over 3 months. The control group received standard care plus an attention placebo. The primary outcomes were body weight and waist circumference, whereas the secondary outcomes included blood pressure, lipids, glucose, and number of MS components. Linear mixed-effects models were used to compare the effects of the program between the 2 groups. RESULTS: The final sample consisted of 183 adults (19.1% male) with a mean (SD) age of 54.0 (7.8) years. At 3 months, overall MS prevalence was reduced to 13.8%. Compared with the control group, subjects in the intervention group exhibited a reduced waist circumference (ß = -.146, P = .008) when the interaction effects of time and group were considered simultaneously. However, no significant differences were found for changes in the other measured outcomes. CONCLUSION: A low-intensity lifestyle intervention program for people with MS can reduce central obesity among people with or at high risk for MS. Further research is necessary to confirm the long-term physiological effects of the intervention.

Anxiety, depression and pain intensity in patients with low back pain who are admitted to acute care hospitals.

AIM: This study examines the relationship between anxiety, depression and pain intensity in patients with low back pain who are newly admitted to an acute care hospital setting. BACKGROUND: Previous studies have supported the idea that anxiety and depression play a significant role in chronic low back pain, but the relationship between anxiety, depression and pain intensity in patients with low back pain who are newly admitted to hospital has not been adequately explored. METHOD: The study reported here was descriptive correlational in design. The sample was 102 Chinese patients with low back pain who were newly admitted to an acute care hospital in Hong Kong. Data were collected through individual interviews, using an 11-point numerical pain rating scale and the Hospital Anxiety and Depression Scale. In addition, demographic data were identified from the medical record. RESULTS: There were 48 male and 54 female adult participants in the study. The average anxiety and depression level of the participants was 19.46 (SD 9.02) on a scale of 0-42, which is higher than the normal level. The level of anxiety and depression was significantly positively correlated with pain intensity (r = 0.471, p < 0.0005) and was also a significant predictor of pain intensity (t = 3.918, p < 0.0005, 95% CI 0.050-0.154). CONCLUSION: The results of this study showed that anxiety and depression are not only associated with pain intensity but that they also, partly, predict pain intensity in patients with low back pain who are newly admitted to an acute care hospital. Relevance to clinical practice. The results of this study support the assessment of and intervention in anxiety and depression symptoms in the provision of pain-relief nursing treatment in patients with low back pain who are admitted to acute care hospitals.

Evaluating the impact of a home-based rehabilitation service on older people and their caregivers: a matched-control quasi-experimental study.

INTRODUCTION: Previous studies evaluating home-based rehabilitation service (HBRS) merely focused on the period immediately after the patients' discharge from hospitals. The present study focuses on HBRS that covers clients who have not been recently hospitalized. HBRS aims to meet older clients' rehabilitation needs and support their caregivers in the community. This study intended to evaluate the impact of HBRS on the older clients' health outcomes and hospital services utilization, and caregivers' strain in providing care for clients. METHODS: This study used a matched-control quasi-experimental design with a 3-month follow-up to evaluate HBRS. The health outcome measures used for the older clients included Elderly Mobility Scale, Timed Up and Go test, Modified Barthel Index, Lawton's Instrumental Activities of Daily Living Scale, Mini-Mental State Examination, and World Health Organization Quality of Life Scale, Short Form, Hong Kong version (WHOQOL-BREF [HK]). Meanwhile, the Caregiver Strain Index was used to measure the caregivers' caregiving strain. Data on clients' hospital services utilization 3 and 6 months before and after the study were also collected and evaluated. RESULTS: The final sample consisted of 122 pairs of older clients and caregivers who live in a community in Hong Kong. In the follow-up after 3 months, the intervention group showed immensely substantial improvements across all the health outcome measures compared with the control group. The intervention group also demonstrated substantial reduction in the clients' hospital services utilization compared with the control group. However, no significant differences in the clients' hospital services utilization exist between the two groups in the follow-up after 6 months. CONCLUSION: HBRS of this study is an effective intervention service to improve health outcomes and reduce hospital services utilization among older people living in the community. Moreover, HBRS of this study was effective in reducing the caregivers' caregiving strain.

Effects of a nurse-led post-discharge advance care planning programme for community-dwelling patients nearing the end of life and their family members: A randomised controlled trial.

BACKGROUND: Although evidence increasingly demonstrates the effects of advance care planning, the relevant studies are of questionable quality, and lack consensus regarding when and with whom to initiate the conversation. OBJECTIVE: To examine the effects of a structured, nurse-led post-discharge advance care planning programme on congruence between the end-of-life care preferences of the patient and family members, decisional conflicts and the documentation of care preferences. DESIGN: A two-arm parallel-group randomised controlled trial. PARTICIPANTS: A total of 230 dyads comprising community-dwelling patients screened by the Gold Standards Framework Prognostic Indicator Guidance and their designated family members. METHODS: Patients in the experimental group participated in a structured advance care planning programme administered by a trained nurse during three weekly home visits following hospital discharge. In contrast, the post-discharge home visits provided to the control group focused on self-care management as attention control. The study outcomes were the dyadic congruence regarding end-of-life care preferences, the patients' level of decisional conflict regarding end-of-life decision-making and the documentation of these preferences at baseline and 1 and 6 months after enrolment. Generalised estimating equation models were used to compare changes in the outcomes between the groups across time. RESULTS: At baseline, few participants had ever heard of advance directives (12/460, 2.6%) and few patients had ever discussed end-of-life issues with family members (34/230, 14.8%). After six months, the experimental group exhibited a greater increase in dyadic congruence regarding various end-of-life care preferences than the control group (Ps < 0.04). The experimental group also exhibited a greater improvement in decisional conflict at 6 months relative to the control group (P = 0.003). However, the groups did not differ significantly in terms of changes in any outcomes after one month. The experimental group had significantly higher rates of completion of advance directives and electronic medical record documentation of do-not-attempt cardiopulmonary resuscitation orders than the control group. CONCLUSIONS: This study showed that a nurse-led structured advance care planning programme could effectively improve dyadic congruence regarding end-of-life care preferences, reduce patients' decisional conflict and increase the documentation of care preferences. The findings underscored the importance of supporting nurses to introduce advance care planning at an earlier time that enable patients with sufficient time to contemplate end-of-life issues, empower patients to deliberate their choices and engage patients and their family members in open discussion.