Engaging carers in neuropsychological rehabilitation for brain cancer survivors: The "I'm aware: Patients And Carers Together" (ImPACT) program

BACKGROUND

Cognitive impairment is a common late effect in child and adult brain cancer survivors (BCS). Still, there is a dearth of research aimed at therapeutic interventions and no standard treatment options for most BCS.

OBJECTIVE

To describe 1) a novel neuropsychological rehabilitation program for BCS - the "I'm aware: Patients And Carers Together" (ImPACT) program, and 2) two studies that aim to assess the feasibility of the ImPACT program in child and adult BCS, respectively. The program adapts the holistic neuropsychological approach pioneered by Leonard Diller and Yehuda Ben-Yishay to an outpatient setting.

METHODS

Two feasibility studies are described: 1) A single-armed study with 15 child BCS (10-17 years) (ImPACT Child); and 2) a randomized waitlist-controlled trial with 26 adult BCS (>17 years) (ImPACT Adult). In both studies, patients will undergo an 8-week program together with a cohabiting carer. Primary outcomes (i.e., cognitive and neurobehavioral symptoms), and secondary outcomes (i.e., behavioral and psychological symptoms, e.g., quality of life, fatigue) will be assessed at four time points: pre-, mid-, and post intervention, and 8 weeks follow-up. Adult waitlist controls will be assessed at equivalent time points and will be included in the intervention group after all study assessments. Semi-structured interviews will be conducted at follow-up.

EXPECTED OUTCOMES

Results will provide feasibility data in support of future larger scale trials.

DISCUSSION

The findings could potentially improve the management of cognitive impairment in BCS and transform available services. The program can be delivered in-person or remotely and harnesses existing resources in patients' lives.

Efficacy of evidence-based comprehensive psycho-social intervention in patients with irritable bowel syndrome

BACKGROUND

With the rapid development of society, the incidence of irritable bowel syndrome (IBS) in China is increasing year by year. IBS is a chronic physical and mental disease for which there is no specific drug to cure; however, the efficacy of the drugs can be strengthened through psychological cognition and social intervention. However, there are few reports on the psycho-social intervention of IBS patients in China.

AIM

To explore the efficacy of comprehensive evidence-based psycho-social intervention in patients with IBS.

METHODS

A total of 140 patients with IBS who were admitted to Beijing Rehabilitation Hospital of Capital Medical University from March 2019 to September 2021 were included as the research subjects, and they were randomly divided into either a control group or a research group, with 70 cases in each. The control group was given routine outpatient follow-up and nursing intervention, while the research group was given comprehensive evidence-based psycho-social intervention. Both groups were followed for 3 mo. The gastrointestinal symptom rating scale (GSRS), irritable bowel syndrome-quality of life questionnaire (IBS-QOL), multi-gastrointestinal function tester, medication compliance scale, self-rating anxiety scale (SAS), and self-rating depression scale (SDS) were used to evaluate and compare gastrointestinal symptoms, rectal function, medication compliance, quality of life, and negative psychology in the two groups before and after intervention to evaluate the intervention effect.

RESULTS

There were five dropout cases in the control group and three in the research group. Finally, 65 cases in the control group and 67 in the research group completed the study. Before intervention, there were no significant differences in GSRS score, rectal sensation threshold, rectal defecation threshold, rectal pain threshold, rectal motor index, medication compliance scale score, IBS-QOL score, SAS score, or SDS score between the two groups (P > 0.05). After intervention, the GSRS scores, SAS scores, and SDS scores of the two groups were significantly lower than those before intervention, and these scores were significantly lower in the research group than in the control group (P < 0.05). After intervention, rectal sensory threshold, rectal defecation threshold, rectal pain threshold, and rectal motor index were significantly improved in both groups (P < 0.05); the improvements were significantly better in the research group than in the control group (P < 0.05). After intervention, the medication compliance score and IBS-QOL score of the control group were not significantly different from those before intervention (P > 0.05), and the medication compliance score, IBS-QOL score, and curative effect of the research group were significantly higher than those of the control group.

CONCLUSION

Evidence-based comprehensive psycho-social intervention program can effectively improve medication compliance of IBS patients, reduce patients' negative psychology, and improve patients' gastrointestinal function and quality of life.

Effectiveness of psychosocial intervention for internalizing behavior problems among children of parents with alcohol dependence: Randomized controlled trial

BACKGROUND

Parental drinking has a direct bearing on children. Behavioral problems such as anxiety and depression are common problems among children whose parents drink heavily. Psychosocial interventions have shown promising results for anxiety and depression among children; however, few studies have been conducted in the context of children of parents with alcohol dependence in India.

AIM

To evaluate the efficacy of psychosocial intervention for internalizing behavioral problems among children of parents with alcohol dependence.

METHODS

A randomized controlled trial with a 2 × 4 factorial design was adopted with longitudinal measurement of outcomes for 6 mo. Two-hundred and eleven children who met the eligibility criteria (at least one parent with alcohol dependence) at government high schools in Bangalore, India, were randomized to the experimental (n = 97) or control group (n = 98). The psychosocial intervention was administered to the experimental group in eight sessions (biweekly) over 4 wk after baseline assessment. The intervention focused on identifying and modifying negative thoughts, replacing thinking errors with realistic alternatives, modification of maladaptive behavior, developing adaptive coping skills and building self-esteem. The data was collected pre-intervention and at 1, 3 and 6 mo after the intervention. Data were analyzed using SPSS 28.0 version.

RESULTS

Mean age of the children was 14.68 ± 0.58 years, 60.5% were male, 56% were studying in 9th standard, 70.75% were from nuclear families, and mean family monthly income was 9588.1 ± 3135.2 INR. Mean duration of parental alcohol dependence was 7.52 ± 2.94 years and the father was the alcohol-consuming parent. The findings showed that there were significant psychosocial intervention effects in terms of decreasing anxiety and depression scores, and increasing self-esteem level among experimental group subjects over the 6-mo interval, when compared with the control group (P < 0.001).

CONCLUSION

The present study demonstrated that the psychosocial intervention was effective in reducing anxiety and depression, and increasing self-esteem among children of parents with alcohol dependence. The study recommends the need for ongoing psychosocial intervention for these children.

The effect of special educational assistance in early childhood education and care on psycho-social difficulties in elementary school children

BACKGROUND

Three to seven percent of pre-schoolers have developmental problems or child psychiatric disorders. Randomized controlled trials (RCTs) indicate that interventions in early childhood education and care (ECEC) improve long-term outcomes of children from disadvantaged backgrounds. It is unknown if such effects generalize beyond the well-structured context of RCTs and to children who may not have a disadvantaged background but have developmental problems or psychiatric disorders.

METHODS

We used data from the population-based Norwegian Mother, Father and Child Cohort Study, recruiting pregnant women from 1999 to 2009, with child follow-up from ages 6, 18, and 36 months to ages 5, 7, and 8 years. This sub-study included 2499 children with developmental problems or psychiatric disorders at age five. We investigated the effects of special educational assistance at age five on mother-reported internalizing, externalizing, and communication problems at age eight. We analysed bias due to treatment by indication with directed acyclic graphs, adjusted for treatment predictors to reduce bias, and estimated effects in different patient groups and outcome domains with a hierarchical Bayesian model.

RESULTS

In the adjusted analysis, pre-schoolers who received special educational assistance had on average by 0.1 (0.04-0.16) standardised mean deviation fewer psycho-social difficulties in elementary school.

CONCLUSION

In a sample of children from mostly higher socioeconomic backgrounds we estimate a positive effects of special educational assistance during the transition from preschool to the school years. It may therefore be considered as an intervention for pre-schoolers with developmental or behaviour problems. More research with improved measurements of treatment and outcomes is needed to solidify the findings and identify success factors for the implementation of special educational assistance in ECEC.

Telephone-based aftercare groups for family carers of people with dementia: study protocol of the Talking Time - REHAB project

Background

More than one million people in Germany live with dementia. Most of these people are cared for at home in the family setting. Supporting and caring for people with dementia is time-consuming, and family carers often have high stress levels and are at an increased risk of becoming physically and mentally ill. Medical rehabilitation (rehab) helps to relieve family carers and provide them with strategies to cope with stress. The aim of this study is to improve the sustainability of a multimodal rehab program for family carers of people with dementia. Research question: can the effects of this rehab be maintained through telephone-based aftercare groups following the rehab program?

Methods

A prospective randomized controlled longitudinal trial is performed. The intervention group (IG) participates in telephone-based aftercare groups; the control group (CG) receives treatment as usual. For evaluation, a mixed-methods approach is used. The effects of the intervention are quantitatively evaluated by written questionnaires at four measuring points (pre- and post-rehab, as well as 6 and 12 months after the end of rehab). Primary outcome: participation (IMET). Secondary outcomes: Depressive Mood State CES-D, General Complaints SCL-90-R, Subjective Quality of Life WHOQUOL-BREF, Social Support F-SozU, performance in different areas of life, single scales, and support offers (single items). The intervention process is evaluated through qualitative interviews and focus groups with regard to the acceptance of and satisfaction with the aftercare offered; in addition, a health economic evaluation is performed using the EQ-5D questionnaire. Rehabilitants are included in the study (N = 103 each in the IG and CG) who, accompanied by their family members with dementia, participate in the rehab measure in Ratzeburg. The IG participates monthly in 6 telephone aftercare groups over a period of 6 months. Typical stress situations are discussed and worked on.

Discussion

Upon successful evaluation, the offer to participate in telephone-based aftercare groups can be firmly established in the participating rehab clinic. Through minor adjustments, the offer would also be suitable for carers of physically ill people and for non-nursing-specific rehabilitation indications.

Trial registration

German Clinical Trials Register: DRKS00013736, May 14, 2018.

Mental health impact of social capital interventions: a systematic review

PURPOSE

Mental disorders are a major contributor to the global burden of disease and disability, and can be extremely costly at both individual and community level. Social capital, (SC) defined as an individual's social relationships and participation in community networks, may lower the risk of mental disorders while increasing resilience capacity, adaptation and recovery. SC interventions may be a cost-effective way of preventing and ameliorating these conditions. However, the impact of these SC interventions on mental health still needs research.

METHODS

We conducted a systematic review of SC-based interventions to investigate their effect on mental health outcomes from controlled, quasi-experimental studies or pilot trials. We searched twelve academic databases, three clinical trials registries, hand-searched references and contacted field experts. Studies' quality was assessed with the Cochrane Risk of Bias tools for randomized and non-randomized studies.

RESULTS

Seven studies were included in the review, published between 2006 and 2016. There was substantial heterogeneity in the definitions of both SC and mental disorders among the studies, preventing us from calculating pooled effect sizes. The interventions included community engagement and educative programs, cognitive processing therapy and sociotherapy for trauma survivors, and neighbourhood projects.

CONCLUSIONS

There are paucity of SC interventions investigating the effect on mental health outcomes. This study showed that both SC scores and mental health outcomes improved over time but there was little evidence of benefit compared to control groups in the long term. Further high-quality trials are needed, especially among adverse populations to assess sustainability of effect.

Feasibility and effectiveness of a telephone-based social support intervention for informal caregivers of people with dementia: Study protocol of the TALKING TIME project

Background

Caring for people with dementia at home requires a significant amount of time, organization, and commitment. Therefore, informal caregivers, mainly relatives, of people with dementia often feel a high burden. Although on-site support groups are known to have positive effects on the subjective well-being (SWB) and perceived social support of informal caregivers, there are cases in which relatives have either no time or no opportunity to leave the person alone or in which there are no support groups nearby. The TALKING TIME project aims to close this supply gap by providing structured telephone-based support groups in Germany for the first time. International studies have shown benefits for informal caregivers.

Methods

The TALKING TIME study is a randomized controlled trial. The effects of the 3-month TALKING TIME intervention will be compared with those of a control group without intervention at two time points (baseline = T₀, after 3 months = T₁). The control group will receive the TALKING TIME intervention after T₁. With a planned sample size of 88 participants, the study is powered to detect an estimated effect size of 0.70 for psychological quality of life, considering an α of 0.05 (two-sided), a power of 80%. Caregivers are informal caregivers who are eligible if they are 18 years of age or older and have cared for a person with diagnosed dementia for at least four hours, four days per week, in the past six months. The exclusion criteria are psychiatric disorders of the informal caregiver. The primary outcome is the mental component summary of the SF-12 rated by informal caregivers. The secondary outcomes for informal caregivers are the physical component summary of the SF-12, the Perceived Social Support Caregiver Scale (SSCS) score, and the Caregiver Reaction Scale (CRS) score. The secondary outcome for care recipients is the Neuropsychiatric Inventory (NPI-Q). For the process evaluation, different quantitative and qualitative data sources will be collected to address reach, fidelity, dosage and context.

Discussion

The results will provide further information on the effectiveness and optimization of telephone-based support groups for informal caregivers of people with dementia, which can help guide the further development of effective telephone-based social support group interventions.

Trial registration

Clinical Trials: NCT02806583, June 9, 2016