Characteristics of self-care interventions for patients with a chronic condition: A scoping review

Background: Self-care is a fundamental element of treatment for patients with a chronic condition and a major focus of many interventions. A large body of research exists describing different types of self-care interventions, but these studies have never been compared across conditions. Examination of heterogeneous interventions could provide insights into effective approaches that should be used in diverse patient populations. Objectives: To provide a comprehensive and standardized cross-condition overview of interventions to enhance self-care in patients with a chronic condition. Specific aims were to: 1) identify what self-care concepts and behaviors are evaluated in self-care interventions; 2) classify and quantify heterogeneity in mode and type of delivery; 3) quantify the behavior change techniques used to enhance self-care behavior; and 4) assess the dose of self-care interventions delivered. Design: Scoping review DATA SOURCES: Four electronic databases - PubMed, EMBASE, PsychINFO and CINAHL - were searched from January 2008 through January 2019. Eligibility criteria for study selection: Randomized controlled trials (RCTs) with concealed allocation to the intervention were included if they compared a behavioral or educational self- care intervention to usual care or another self-care intervention and were conducted in adults. Nine common chronic conditions were included: hypertension, coronary artery disease, arthritis, chronic kidney disease, heart failure, stroke, asthma, chronic obstructive lung disease, and type 2 diabetes mellitus. Diagnoses that are psychiatric (e.g. schizophrenia), acute rather than chronic, or benefitting little from self-care (e.g. dementia) were excluded. Studies had to be reported in English with full-text available. Results: 9309 citations were considered and 233 studies were included in the final review. Most studies addressed type 2 diabetes mellitus (n = 85; 36%), hypertension (n = 32; 14%) or heart failure (n = 27; 12%). The majority (97%) focused on healthy behaviors like physical activity (70%), dietary intake (59%), and medication management (52%). Major deficits found in self-care interventions included a lack of attention to the psychological consequences of chronic illness, technology and behavior change techniques were rarely used, few studies focused on helping patients manage signs and symptoms, and the interventions were rarely innovative. Research reporting was generally poor. Conclusions: Major gaps in targeted areas of self-care were identified. Opportunities exist to improve the quality and reporting of future self-care intervention research. Registration: The study was registered in the PROSPERO database (#123,719)

RehabMove 2018: IMMEDIATE EFFECTS OF WEARING A SOFT ANKLE BRACE ON PROPRIOCEPTION AND DYNAMIC POSTURAL CONTROL

PURPOSE: The purpose of this study was to investigate the effect of ankle bracing on proprioception of the ankle and dynamic postural control in participants with chronic ankle instability (CAI). With this knowledge, current brace methods can be optimized and compliance towards the use of braces in athletes who are at risk for an ankle sprain can be improved. METHODS: A cross-sectional observational study was conducted. Proprioception of the ankle and dynamic postural control were measured with and without a soft ankle brace in each participant in randomized order. Males and females with CAI aged 18-35 years were included in this study. Joint position sense (JPS) was measured with an Angle Reproduction Test on an isokinetic device for plantarflexion and inversion. Dynamic postural control was measured with the Y-balance TestTM (YBT). Paired t-tests were used to compare test results with and without ankle brace for both JPS and dynamic postural control. RESULTS: When participants wore the ankle brace, JPS absolute error scores were significantly lower for plantar flexion (p=0.03), in comparison without ankle brace. No significant difference was found in JPS absolute error scores for inversion (p=0.20). The YBT normalized reach distances did not significantly differ when performed with or without brace (p>0.50). CONCLUSION: Wearing a soft ankle brace has statistically significant, but small, effect on the JPS in plantar flexion of the chronically unstable ankle. Ankle bracing has no effect on JPS in inversion and dynamic postural control in participants with CAI. When advising athletes on using an ankle brace, it should be explained that the effect of bracing is probably not caused by improving proprioception, but through other mechanisms. However, athletes should still be encouraged to use an ankle brace during sports due to the preventive effect that is shown in other studies

Quality of life issues identified by palliative care clients using two tools

Reported are issues impacting upon the Quality of Life (QoL) of 59 palliative care clients within a district nursing service. These issues reinforce the emerging conceptualisation of QoL as being subjective and multidimensional. The issues were identified during a trial of two QoL assessment and measurement tools, the Client Generated Index (CGI) and the McGill Quality of Life (MQOL). In this era of considerable concern about QoL for the terminally ill, the article's intent is to present the QoL issues identified, the grades of impact and priority for improvement of the issues according to the clients, and to discuss these aspects. This information can inform the assessment of palliative care clients (the CGI tool was found ideal for such an assessment), and may also inform further research on the QoL of palliative care clients

Using caregivers-as-proxies to retrospectively assess and measure quality of dying of palliative care clients

This study evaluated two quality-of-life assessment and measurement tools, the Client Generated Index and the McGill Quality of Life questionnaire, within palliative care nursing. Primarily tested was the feasibility of the tools to assess clients’ QOL at admission and, if necessary, when their condition altered. The reliability of the tools has previously been ascertained. Additionally, quality of dying during the last two days of life for 14 participants who died during the study was assessed and measured retrospectively by these tools, using the client’s nominated care-giver as proxy for the client. It is this second focus that we report on here. The reasons why proxy assessment and measurement of client QOD was not useful or feasible are discussed