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Knopp-Sihota JA, MacGregor T, Reeves JTH, Kennedy M, Saleem A. Management of Chronic Pain in Long-Term Care: A Systematic Review and Meta-Analysis. J Am Med Dir Assoc 2022; 23:1507-1516.e0. [PMID: 35594944 DOI: 10.1016/j.jamda.2022.04.008] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2021] [Revised: 04/07/2022] [Accepted: 04/11/2022] [Indexed: 11/25/2022]
Abstract
OBJECTIVES Pain, a complex subjective experience, is common in care home residents. Despite advances in pain management, optimal pain control remains a challenge. In this updated systematic review, we examined effectiveness of interventions for treating chronic pain in care home residents. DESIGN A Cochrane-style systematic review and meta-analysis using PRISMA guidelines. SETTING AND PARTICIPANTS Randomized and nonrandomized controlled trials and intervention studies included care home residents aged ≥60 years receiving interventions to reduce chronic pain. METHODS Six databases were searched to identify relevant studies. After duplicate removal, articles were screened by title and abstract. Full-text articles were reviewed and included if they implemented a pain management intervention and measured pain with a standardized quantitative pain scale. Meta-analyses calculated standardized mean differences (SMDs) using random-effect models. Risk of bias was assessed using the Cochrane Risk-of-Bias Tool 2.0. RESULTS We included 42 trials in the meta-analysis and described 13 more studies narratively. Studies included 26 nondrug alternative treatments, 8 education interventions, 7 system modifications, 3 nonanalgesic drug treatments, 2 analgesic treatments, and 9 combined interventions. Pooled results at trial completion revealed that, except for nonanalgesic drugs and health system modification interventions, all interventions were at least moderately effective in reducing pain. Analgesic treatments (SMD -0.80; 95% CI -1.47 to -0.12; P = .02) showed the greatest treatment effect, followed by nondrug alternative treatments (SMD -0.70; 95% CI -0.95 to -0.45; P < .001), combined interventions (SMD -0.37; 95% CI -0.60 to -0.13; P = .002), and education interventions (SMD -0.31; 95% CI -0.48 to -0.15; P < .001). CONCLUSIONS AND IMPLICATIONS Our findings suggest that analgesic drugs and nondrug alternative pain management strategies are the most effective in reducing pain among care home residents. Clinicians should also consider implementing nondrug alternative therapies in care homes, rather than relying solely on analgesic drug options.
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Affiliation(s)
- Jennifer A Knopp-Sihota
- Faculty of Health Disciplines, Athabasca University, Athabasca, Alberta, Canada; Faculty of Nursing, University of Alberta, Edmonton, Alberta, Canada.
| | - Tara MacGregor
- Faculty of Nursing, University of Alberta, Edmonton, Alberta, Canada
| | | | - Megan Kennedy
- Faculty of Nursing, University of Alberta, Edmonton, Alberta, Canada
| | - Ahsan Saleem
- Faculty of Nursing, University of Alberta, Edmonton, Alberta, Canada
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Liao YJ, Parajuli J, Jao YL, Kitko L, Berish D. Non-pharmacological interventions for pain in people with dementia: A systematic review. Int J Nurs Stud 2021; 124:104082. [PMID: 34607070 DOI: 10.1016/j.ijnurstu.2021.104082] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2021] [Revised: 08/23/2021] [Accepted: 08/26/2021] [Indexed: 10/20/2022]
Abstract
CONTEXT Pain commonly occurs in people living with dementia but is often undertreated. Non-pharmacological interventions are a safer first-line option for pain management, but evidence-based interventions for people living with dementia have not been established. An increasing number of studies have examined the effect of non-pharmacological interventions in pain management. However, the evidence that specifically focuses on people living with dementia has not been systematically reviewed. OBJECTIVES This review aimed to systematically synthesize current evidence on non-pharmacological interventions to manage pain in people living with dementia. METHODS A comprehensive search of the literature was conducted in PubMed, CINAHL, Scopus, and Web of Science databases. Studies were included if they were 1) peer-reviewed original quantitative research, 2) tested the effect of non-pharmacological interventions on pain in people with dementia, and 3) English language. Studies were excluded if they 1) included both pharmacological and non-pharmacological interventions and did not report separate results for the non-pharmacological interventions; 2) enrolled participants with and without dementia and did not have separate results reported for individuals with dementia; 3) tested dietary supplements as the intervention; and 4) were not original research, such as reviews, editorials, commentaries, or case studies. Title, abstract, and full text were screened. Quality assessment was conducted using the Cochrane Risk of Bias tool and Johns Hopkins Level of Evidence. Pain assessment tools, participant characteristics, study designs, intervention condition, and results were extracted. Results were synthesized through grouping the type of the interventions and weighting evidence based on quality and design of the studies. RESULTS A total of 11 articles and 12 interventions were identified. A total of 486 participants were included. Interventions that have shown a positive impact on pain include ear acupressure, music therapy, reflexology, tailored pain intervention, painting and singing, personal assistive robot, cognitive-behavioral therapy, play activity, and person-centered environment program. Nevertheless, a majority of the interventions were only evaluated once. Moreover, most studies had similar sample characteristics and setting. CONCLUSION Overall, the quality of included studies were mostly low to mixed quality and most participants only had mild to moderate baseline pain, which limits detection of the intervention's effect. Hence, these findings need to be duplicated in studies with a greater sample size, a more diverse population (race, gender, and settings), and a more rigorous design to validate the results.
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Affiliation(s)
- Yo-Jen Liao
- Pennsylvania State University, Ross and Carol Nese College of Nursing, 307 Nursing Sciences Building, University Park, PA, 16802, United States.
| | - Jyotsana Parajuli
- Assistant Professor, University of North Carolina at Charlotte, School of Nursing, 9201 University City Blvd, Charlotte, NC, 28223, United States.
| | - Ying-Ling Jao
- Assistant Professor, Pennsylvania State University, Ross and Carol Nese College of Nursing, 307B Nursing Sciences Building, University Park, PA, 16802, United States.
| | - Lisa Kitko
- Associate Professor, Pennsylvania State University, Ross and Carol Nese College of Nursing, 311 Nursing Sciences Building, University Park, PA, 16802, United States.
| | - Diane Berish
- Assistant Research Professor, Pennsylvania State University, Ross and Carol Nese College of Nursing, 304A Nursing Sciences Building, University Park, PA, 16802, United States.
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Welch V, Mathew CM, Babelmorad P, Li Y, Ghogomu ET, Borg J, Conde M, Kristjansson E, Lyddiatt A, Marcus S, Nickerson JW, Pottie K, Rogers M, Sadana R, Saran A, Shea B, Sheehy L, Sveistrup H, Tanuseputro P, Thompson‐Coon J, Walker P, Zhang W, Howe TE. Health, social care and technological interventions to improve functional ability of older adults living at home: An evidence and gap map. CAMPBELL SYSTEMATIC REVIEWS 2021; 17:e1175. [PMID: 37051456 PMCID: PMC8988637 DOI: 10.1002/cl2.1175] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/13/2023]
Abstract
Background By 2030, the global population of people older than 60 years is expected to be higher than the number of children under 10 years, resulting in major health and social care system implications worldwide. Without a supportive environment, whether social or built, diminished functional ability may arise in older people. Functional ability comprises an individual's intrinsic capacity and people's interaction with their environment enabling them to be and do what they value. Objectives This evidence and gap map aims to identify primary studies and systematic reviews of health and social support services as well as assistive devices designed to support functional ability among older adults living at home or in other places of residence. Search Methods We systematically searched from inception to August 2018 in: MEDLINE, EMBASE, Cochrane Database of Systematic Reviews, CENTRAL, CINAHL, PsycINFO, AgeLine, Campbell Library, ASSIA, Social Science Citation Index and Social Policy & Practice. We conducted a focused search for grey literature and protocols of studies (e.g., ProQuest Theses and Dissertation Global, conference abstract databases, Help Age, PROSPERO, Cochrane and Campbell libraries and ClinicalTrials.gov). Selection Criteria Screening and data extraction were performed independently in duplicate according to our intervention and outcome framework. We included completed and on-going systematic reviews and randomized controlled trials of effectiveness on health and social support services provided at home, assistive products and technology for personal indoor and outdoor mobility and transportation as well as design, construction and building products and technology of buildings for private use such as wheelchairs, and ramps. Data Collection and Analysis We coded interventions and outcomes, and the number of studies that assessed health inequities across equity factors. We mapped outcomes based on the International Classification of Function, Disability and Health (ICF) adapted categories: intrinsic capacities (body function and structures) and functional abilities (activities). We assessed methodological quality of systematic reviews using the AMSTAR II checklist. Main Results After de-duplication, 10,783 records were screened. The map includes 548 studies (120 systematic reviews and 428 randomized controlled trials). Interventions and outcomes were classified using domains from the International Classification of Function, Disability and Health (ICF) framework. Most systematic reviews (n = 71, 59%) were rated low or critically low for methodological quality.The most common interventions were home-based rehabilitation for older adults (n = 276) and home-based health services for disease prevention (n = 233), mostly delivered by visiting healthcare professionals (n = 474). There was a relative paucity of studies on personal mobility, building adaptations, family support, personal support and befriending or friendly visits. The most measured intrinsic capacity domains were mental function (n = 269) and neuromusculoskeletal function (n = 164). The most measured outcomes for functional ability were basic needs (n = 277) and mobility (n = 160). There were few studies which evaluated outcome domains of social participation, financial security, ability to maintain relationships and communication.There was a lack of studies in low- and middle-income countries (LMICs) and a gap in the assessment of health equity issues. Authors' Conclusions There is substantial evidence for interventions to promote functional ability in older adults at home including mostly home-based rehabilitation for older adults and home-based health services for disease prevention. Remotely delivered home-based services are of greater importance to policy-makers and practitioners in the context of the COVID-19 pandemic. This map of studies published prior to the pandemic provides an initial resource to identify relevant home-based services which may be of interest for policy-makers and practitioners, such as home-based rehabilitation and social support, although these interventions would likely require further adaptation for online delivery during the COVID-19 pandemic. There is a need to strengthen assessment of social support and mobility interventions and outcomes related to making decisions, building relationships, financial security, and communication in future studies. More studies are needed to assess LMIC contexts and health equity issues.
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Affiliation(s)
- Vivian Welch
- Methods CentreBruyère Research InstituteOttawaCanada
| | | | | | - Yanfei Li
- Evidence‐Based Social Science Research Center, School of Public HealthLanzhou UniversityLanzhouChina
| | | | | | - Monserrat Conde
- Cochrane Campbell Global Ageing Partnership FieldFaroPortugal
| | | | | | - Sue Marcus
- Radcliffe Department of MedicineUniversity of OxfordOxfordUK
| | | | | | - Morwenna Rogers
- NIHR ARC, South West Peninsula (PenARC)University of Exeter Medical SchoolExeterUK
| | | | | | - Beverly Shea
- Bruyère Research InstituteUniversity of OttawaOttawaCanada
| | - Lisa Sheehy
- Bruyère Research InstituteUniversity of OttawaOttawaCanada
| | - Heidi Sveistrup
- Bruyère Research InstituteUniversity of OttawaOttawaCanada
- Faculty of Health SciencesUniversity of OttawaOttawaCanada
| | | | - Joanna Thompson‐Coon
- NIHR ARC South West Peninsula (PenARC)University of Exeter Medical SchoolExeterUK
| | - Peter Walker
- Faculty of MedicineUniversity of OttawaOttawaCanada
| | - Wei Zhang
- Access to Medicines, Vaccines and Health ProductsWorld Health OrganizationGenevaSwitzerland
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Murukesu RR, Singh DKA, Shahar S, Subramaniam P. A Multi-Domain Intervention Protocol for the Potential Reversal of Cognitive Frailty: "WE-RISE" Randomized Controlled Trial. Front Public Health 2020; 8:471. [PMID: 33014971 PMCID: PMC7495818 DOI: 10.3389/fpubh.2020.00471] [Citation(s) in RCA: 23] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2020] [Accepted: 07/27/2020] [Indexed: 12/20/2022] Open
Abstract
Following the rapid increase of the aging population, health promotion and prevention of physical disability and dementia in older persons are essential for healthy aging. For example, there may be a potential to prevent or reverse cognitive frailty, the co-existence of both physical frailty and cognitive impairment in older persons. However, evidence-based interventions targeting the prevention or potential reversibility of cognitive frailty among community dwelling older adults are scarce. In this paper, we described the rationale, development and delivery of a multi-domain intervention comprising multi-component physical exercise prescription, cognitive training, dietary counseling and promotion of psychosocial support, called the WE-RISE trial. The aim of WE-RISE intervention is to potentially reverse cognitive frailty. This is a two-armed, single blinded, randomized controlled trial conducted over a duration of 6 months, at senior citizen activity centers within the Klang Valley, Malaysia. Ambulating, community dwelling older adults aged 60 years and above with cognitive frailty are randomized into two groups; (1) intervention group: which receives an instructor based "WE-RISE" intervention for the first 3 months, and then a home-based "WE-RISE at Home" intervention for the following 3 months; (2) control group: usual care with no modifications to their daily routine. Primary outcome is cognitive frailty status and secondary outcome include physical function, cognitive performance, nutritional status, psychosocial status and quality of life which are obtained during baseline screening and subsequent follow ups at 3rd and 6th month. Description of the intervention is done using the template for intervention description and replication (TIDieR) checklist. This trial protocol has received approval from Research Ethics Committee of Universiti Kebangsaan Malaysia (UKM PPI/111/8/JEP-2018-558) and the Department of Social Welfare Malaysia (MyResearch Reference: JKMM 100/12/5/2: 2018/405). Trial registration number: ACTRN12619001055190.
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Affiliation(s)
- Resshaya Roobini Murukesu
- Physiotherapy Programme and Centre for Healthy Aging and Wellness, Faculty of Health Sciences, Universiti Kebangsaan Malaysia, Kuala Lumpur, Malaysia
| | - Devinder Kaur Ajit Singh
- Physiotherapy Programme and Centre for Healthy Aging and Wellness, Faculty of Health Sciences, Universiti Kebangsaan Malaysia, Kuala Lumpur, Malaysia
| | - Suzana Shahar
- Dietetic Program and Centre for Healthy Aging and Wellness, Faculty of Health Sciences, Universiti Kebangsaan Malaysia, Kuala Lumpur, Malaysia
| | - Ponnusamy Subramaniam
- Health Psychology Programme and Centre for Healthy Aging and Wellness, Faculty of Health Sciences, Universiti Kebangsaan Malaysia, Kuala Lumpur, Malaysia
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Godino-Iáñez MJ, Martos-Cabrera MB, Suleiman-Martos N, Gómez-Urquiza JL, Vargas-Román K, Membrive-Jiménez MJ, Albendín-García L. Play Therapy as an Intervention in Hospitalized Children: A Systematic Review. Healthcare (Basel) 2020; 8:healthcare8030239. [PMID: 32751225 PMCID: PMC7551498 DOI: 10.3390/healthcare8030239] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2020] [Revised: 07/24/2020] [Accepted: 07/28/2020] [Indexed: 02/06/2023] Open
Abstract
Background: Hospitalization disrupts children’s lives and can produce feelings such as anxiety, fear, or pain. Playing is an important part of children’s lives. Thus, it is necessary to ensure holistic care during the process, including play therapy. The aim of this study was to analyze the effect of therapeutic play in hospitalized children. Methods: A systematic review was performed. The search was conducted in CINAHL (Cumulative Index of Nursing and Allied Health Literature), CUIDEN, and PubMed (Medline). The search equation was “pediatric nurs* AND play therapy”. The search was performed in March 2020. Results: n = 14 studies were included in the review. The studies reveal that the application of therapeutic play in hospitalized children decreases postoperative pain, improves behavior and attitude, and reduces anxiety during the hospital stay. Conclusions: play therapy has a beneficial impact on the care of hospitalized children and should be implemented in pediatric units after assessing the resources and training needed for pediatric nurses.
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Affiliation(s)
- María José Godino-Iáñez
- Faculty of Health Sciences, University of Granada, Avenida Ilustración 60, 18016 Granada, Spain; (M.J.G.-I.); (J.L.G.-U.)
| | - María Begoña Martos-Cabrera
- San Cecilio University Hospital, Andalusian Health Service, Avenida de la Ilustración s/n, 18016 Granada, Spain;
| | - Nora Suleiman-Martos
- Faculty of Health Sciences, University of Granada, Cortadura del Valle s/n, 51001 Ceuta, Spain
- Correspondence:
| | - José Luis Gómez-Urquiza
- Faculty of Health Sciences, University of Granada, Avenida Ilustración 60, 18016 Granada, Spain; (M.J.G.-I.); (J.L.G.-U.)
| | - Keyla Vargas-Román
- Faculty of Psychology, University of Granada, Campus Universitario de Cartuja s/n, 18071 Granada, Spain;
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Apóstolo J, Cooke R, Bobrowicz-Campos E, Santana S, Marcucci M, Cano A, Vollenbroek-Hutten M, Germini F, D'Avanzo B, Gwyther H, Holland C. Effectiveness of interventions to prevent pre-frailty and frailty progression in older adults: a systematic review. ACTA ACUST UNITED AC 2019; 16:140-232. [PMID: 29324562 PMCID: PMC5771690 DOI: 10.11124/jbisrir-2017-003382] [Citation(s) in RCA: 273] [Impact Index Per Article: 54.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Abstract
OBJECTIVE To summarize the best available evidence regarding the effectiveness of interventions for preventing frailty progression in older adults. INTRODUCTION Frailty is an age-related state of decreased physiological reserves characterized by an increased risk of poor clinical outcomes. Evidence supporting the malleability of frailty, its prevention and treatment, has been presented. INCLUSION CRITERIA The review considered studies on older adults aged 65 and over, explicitly identified as pre-frail or frail, who had been undergoing interventions focusing on the prevention of frailty progression. Participants selected on the basis of specific illness or with a terminal diagnosis were excluded. The comparator was usual care, alternative therapeutic interventions or no intervention. The primary outcome was frailty. Secondary outcomes included: (i) cognition, quality of life, activities of daily living, caregiver burden, functional capacity, depression and other mental health-related outcomes, self-perceived health and social engagement; (ii) drugs and prescriptions, analytical parameters, adverse outcomes and comorbidities; (iii) costs, and/or costs relative to benefits and/or savings associated with implementing the interventions for frailty. Experimental study designs, cost effectiveness, cost benefit, cost minimization and cost utility studies were considered for inclusion. METHODS Databases for published and unpublished studies, available in English, Portuguese, Spanish, Italian and Dutch, from January 2001 to November 2015, were searched. Critical appraisal was conducted using standardized instruments from the Joanna Briggs Institute. Data was extracted using the standardized tools designed for quantitative and economic studies. Data was presented in a narrative form due to the heterogeneity of included studies. RESULTS Twenty-one studies, all randomized controlled trials, with a total of 5275 older adults and describing 33 interventions, met the criteria for inclusion. Economic analyses were conducted in two studies. Physical exercise programs were shown to be generally effective for reducing or postponing frailty but only when conducted in groups. Favorable effects on frailty indicators were also observed after the interventions, based on physical exercise with supplementation, supplementation alone, cognitive training and combined treatment. Group meetings and home visits were not found to be universally effective. Lack of efficacy was evidenced for physical exercise performed individually or delivered one-to-one, hormone supplementation and problem solving therapy. Individually tailored management programs for clinical conditions had inconsistent effects on frailty prevalence. Economic studies demonstrated that this type of intervention, as compared to usual care, provided better value for money, particularly for very frail community-dwelling participants, and had favorable effects in some of the frailty-related outcomes in inpatient and outpatient management, without increasing costs. CONCLUSIONS This review found mixed results regarding the effectiveness of frailty interventions. However, there is clear evidence on the usefulness of such interventions in carefully chosen evidence-based circumstances, both for frailty itself and for secondary outcomes, supporting clinical investment of resources in frailty intervention. Further research is required to reinforce current evidence and examine the impact of the initial level of frailty on the benefits of different interventions. There is also a need for economic evaluation of frailty interventions.
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Affiliation(s)
- João Apóstolo
- Health Sciences Research Unit: Nursing, Nursing School of Coimbra, Portugal Centre for Evidence Based Practice: a Joanna Briggs Institute Centre of Excellence
| | - Richard Cooke
- Aston Research Centre for Healthy Ageing (ARCHA), Aston University, Birmingham, United Kingdom
| | - Elzbieta Bobrowicz-Campos
- Health Sciences Research Unit: Nursing, Nursing School of Coimbra, Portugal Centre for Evidence Based Practice: a Joanna Briggs Institute Centre of Excellence
| | - Silvina Santana
- Department of Economics, Management and Industrial Engineering, University of Aveiro, Aveiro, Portugal
| | - Maura Marcucci
- Geriatric Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy.,Department. of Clinical Science and Community Health, University of Milan, Milan, Italy
| | - Antonio Cano
- Department of Paediatrics, Obstetrics and Gynaecology, Universitat de Valência, Valência, Spain
| | | | - Federico Germini
- Department. of Clinical Science and Community Health, University of Milan, Milan, Italy
| | - Barbara D'Avanzo
- IRCCS Istituto di Ricerche Farmacologiche Mario Negri, Milan, Italy
| | - Holly Gwyther
- Aston Research Centre for Healthy Ageing (ARCHA), Aston University, Birmingham, United Kingdom
| | - Carol Holland
- Aston Research Centre for Healthy Ageing (ARCHA), Aston University, Birmingham, United Kingdom
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Tse MM, Lau JL, Kwan R, Cheung D, Tang AS, Ng SS, Lee PH, Yeung SS. Effects of play activities program for nursing home residents with dementia on pain and psychological well-being: Cluster randomized controlled trial. Geriatr Gerontol Int 2018; 18:1485-1490. [DOI: 10.1111/ggi.13509] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2017] [Revised: 07/05/2018] [Accepted: 07/14/2018] [Indexed: 12/18/2022]
Affiliation(s)
- Mimi M.Y. Tse
- School of Nursing, The Hong Kong Polytechnic University; Kowloon Hong Kong
| | - Joyce L. Lau
- School of Nursing, The Hong Kong Polytechnic University; Kowloon Hong Kong
| | - Rick Kwan
- School of Nursing, The Hong Kong Polytechnic University; Kowloon Hong Kong
| | - Daphne Cheung
- School of Nursing, The Hong Kong Polytechnic University; Kowloon Hong Kong
| | - Angel S.K. Tang
- School of Nursing, The Hong Kong Polytechnic University; Kowloon Hong Kong
| | - Shamay S.M. Ng
- Department of Rehabilitation Sciences; The Hong Kong Polytechnic University; Kowloon Hong Kong
| | - Paul H. Lee
- School of Nursing, The Hong Kong Polytechnic University; Kowloon Hong Kong
| | - Suey S.Y. Yeung
- Department of Human Movement Sciences, Faculty of Behavioural and Movement Sciences, Amsterdam Movement Sciences; Vrije Universiteit; Amsterdam The Netherlands
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