Determinants of Depressive Symptoms at 1 Year Following ICU Discharge in Survivors of $ 7 Days of Mechanical Ventilation : Results From the RECOVER Program, a Secondary Analysis of a Prospective Multicenter Cohort Study

Abstract : Background: Moderate to severe depressive symptoms occur in up to one-third of patients at 1 year following ICU discharge, negatively affecting patient outcomes. This study evaluated patient and caregiver factors associated with the development of these symptoms. Methods: This study used the Rehabilitation and Recovery in Patients after Critical Illness and Their Family Caregivers (RECOVER) Program (Phase 1) cohort of 391 patients from 10 medical/surgical university-affiliated ICUs across Canada. We determined the association between patient depressive symptoms (captured by using the Beck Depression Inventory II [BDI-II]), patient characteristics (age, sex, socioeconomic status, Charlson score, and ICU length of stay [LOS]), functional independence measure (FIM) motor subscale score, and caregiver characteristics (Caregiver Assistance Scale and Center for Epidemiologic Studies-Depression Scale) by using linear mixed models at time points 3, 6, and 12 months. Results: BDI-II data were available for 246 patients. Median age at ICU admission was 56 years (interquartile range, 45-65 years), 143 (58%) were male, and median ICU LOS was 19 days (interquartile range, 13-32 days). During the 12-month follow-up, 67 of 246 (27.2%) patients had a BDI-II score ≥ 20, indicating moderate to severe depressive symptoms. Mixed models showed worse depressive symptoms in patients with lower FIM motor subscale scores (1.1 BDI-II points per 10 FIM points), lower income status (by 3.7 BDI-II points; P = .007), and incomplete secondary education (by 3.8 BDI-II points; P = .009); a curvilinear relation with age (P = .001) was also reported, with highest BDI-II at ages 45 to 50 years. No associations were found between patient BDI-II and comorbidities (P = .92), sex (P = .25), ICU LOS (P = .51), or caregiver variables (Caregiver Assistance Scale [P = .28] and Center for Epidemiologic Studies Depression Scale [P = .74]). Conclusions: Increased functional dependence, lower income, and lower education are associated with increased severity of post-ICU depressive symptoms, whereas age has a curvilinear relation with symptom severity. Knowledge of risk factors may inform surveillance and targeted mental health follow-up. Early mobilization and rehabilitation aiming to improve function may serve to modify mood disorders

Réadaptation à base communautaire versus interventions communautaires de réadaptation et réadaptation dans la communauté : comparaison des concepts, et enjeux québécois et internationaux

Les situations de crise humanitaire touchent fréquemment les pays en voie de développement, pays où l’organisation des services de réadaptation s’appuie couramment sur la réadaptation à base communautaire (RBC). Parallèlement, la RBC est de plus en plus utilisée dans les pays industrialisés. La RBC est officiellement une stratégie de développement communautaire inclusif qui vise à favoriser la participation sociale des personnes en situations de handicap. Il existe cependant un flou conceptuel dans les écrits scientifiques sur la RBC et deux autres formes de collaboration avec la communauté, soit les interventions communautaires de réadaptation et la réadaptation dans la communauté. Les objectifs de cet article conceptuel sont : 1) de comparer ces trois formes de collaboration et 2) d’identifier quelques enjeux associés au travail en collaboration avec la communauté, et ce, pour le Québec, les pays industrialisés, les pays en voie de développement et les situations de crise. Les comparaisons mettent en évidence le fait que la RBC est une forme de collaboration avec la communauté qui demande une approche plus systémique, pouvant inclure les interventions communautaires de réadaptation (qui renvoient surtout à un type de services) et la réadaptation dans la communauté (qui renvoie principalement à un lieu d’intervention). Quelques enjeux sont propres à la RBC (ex. : le renforcement des liens avec les services spécialisés en comparaison avec les services communautaires) alors que d’autres sont communs aux trois formes de collaboration (ex. : les déplacements). De plus, la majorité des enjeux présentent des défis différents selon le contexte. La RBC est une stratégie globale de réadaptation qui est intéressante dans l’optique de favoriser, notamment en situation de crise, la participation sociale des membres de la communauté. D’autres recherches sont toutefois nécessaires afin de préciser les formes de collaboration avec la communauté les plus efficientes dans divers contextes.Humanitarian crisis situations frequently affect developing countries that have adopted Community Based Rehabilitation (CBR) to organize rehabilitation services at the community level. At the same time, CBR has increasingly been used in industrialized countries. CBR should be understood as an inclusive community development strategy aiming to promote the social participation of persons living in disabling situations. However, there is conceptual confusion in the scientific literature about CBR and two other forms of community collaboration, either the community-based rehabilitation interventions or community rehabilitation. The objectives of this conceptual article are: 1) to compare these three forms of collaboration, and 2) to identify some of the issues associated with the work in partnership with communities of the province of Québec (Canada), industrialized countries, developing countries, as well as in the context of humanitarian crisis situations. Comparisons put into evidence that CBR is a form of community collaboration that calls for a more systemic approach that may include community-based rehabilitation interventions (mainly referring to a certain type of services) and rehabilitation in the community (mainly referring to the location where services are delivered). Some issues are specific to RBC (e.g. strengthening of partnerships with specialized services compared to community services), while the others are common to the three forms of community collaboration (e.g. transportation). In addition, the majority of the issues present challenges that are different depending on the context. CBR is a global rehabilitation strategy that might be of interest to those wishing to promote, notably in crisis situations, the social participation of all community members. However, further research is needed to identify the forms of community collaboration that are the most efficient in various settings

Caregiver Well-Being Is Dependent On Caregiver Mastery, Social Support And Participation In Valued Activities: Towards Recover Study

Abstract : Rationale and Objective: Individuals who survive a long-stay in the intensive care unit (ICU) often experience ICU Acquired weakness, neuropsychological dysfunction and poor quality of life outcomes. Many need assistance from a family caregiver with everyday activities and medical care from the ICU through to community re-integration. As family caregivers take on this new and unfamiliar role, many will experience negative health outcomes. The objective of this research was to identify patient and caregiver related factors that influenced caregiver emotional health and quality of life during the first year post-ICU discharge. Method: We enrolled patients (mechanically ventilated for over one week) and family caregivers (who provide and/or coordinate post-hospital care) at 10 hospitals across Canada. Caregivers were assessed 7 days and 3, 6, and 12 months after survivors’ ICU discharge and completed the following assessments: Centre for Epidemiological Studies Depression scale (CES-D), Positive Affect Scale (PAS), SF-36, Caregiver Assistance Scale, Care-giving Impact Scale, Personal Gain Scale, Mastery Scale, and Social Support Survey. Patients completed a variety of assessments including the Functional Independence Measure (FIM) and the Beck Depression Inventory II (BDI). Results: Caregivers (n=330) were female (69.5%), caring for a spouse (56.9%), and 53 (SD 13.4) years of age. Modeling the dependent variables over the one year follow-up period suggests caregivers’ mental health outcomes (CES-D and the mental component of the SF-36 (MCS) improve between 7-days and 3-months post-ICU discharge and then remain relatively stable. Psychological well-being (PAS) and the physical component score from the SF-36 (PCS) are stable over time. Multivariable longitudinal modeling identified variables related to positive caregiver outcomes. Caregivers with more social support report better scores on all outcomes. More mastery and less of an impact on lifestyle are associated with better mental health outcomes. Caregivers who gain more personally as a result of providing care also report more psychological well-being. Patient age, ICU length-of-stay, FIM and BDI were not related to any caregiver outcomes. Conclusions: Programs to support caregivers should begin within the first 3-months post-ICU discharge and continue as survivors’ reintegrate into community living. Interventions should assist caregivers to access social support, maintain participation in valued activities, gain positive experiences from providing care, and contribute to their mastery

Réflexion sur l’utilisation de l’Outil d’évaluation Multiclientèle (OÉMC) pour identifier les besoins de participation sociale des aînés ayant des incapacités

Le maintien à domicile et la participation sociale des aînés ayant des incapacités sollicitent une concertation appropriée de diverses ressources de la communauté, dont celles du soutien à domicile (SAD) des Centres de santé et de services sociaux (CSSS). Malgré leur importance, les interventions actuellement offertes par les CSSS aux aînés ayant des incapacités sont limitées et portent principalement sur la sécurité et l’indépendance lors de l’hygiène, de l’habillage, des transferts et de l’alimentation, au détriment des activités sociales et de loisir. Cette offre limitée pourrait en partie être expliquée par une évaluation qui ne permet pas de bien couvrir toutes les dimensions des besoins des aînés et d’en cerner adéquatement la complexité. Cet article présente une réflexion sur l’utilisation de l’Évaluation de l’autonomie de l’Outil d’évaluation Multiclientèle (OÉMC), incluant le Système de mesure de l’autonomie fonctionnelle (SMAF), pour identifier les besoins de participation sociale des aînés ayant des incapacités. Cette réflexion est appuyée par une comparaison entre l’OÉMC, la Mesure des habitudes de vie (MHAVIE 4.0) et la Mesure canadienne du rendement occupationnel (MCRO; 5e édition). Les résultats de cette comparaison démontrent que l’OÉMC ne permet pas d’identifier de façon exhaustive les besoins de participation sociale des aînés ayant des incapacités. Spécifiquement, les activités les moins couvertes sont en lien avec la santé et le bien-être, dont notamment la pratique régulière d’activité physique, ainsi que les activités sociales, de relaxation et de détente, de stimulation cognitive et de loisir. L’OÉMC présente quelques ambigüités et chevauchements, ainsi que des éléments qui ne font pas partie des dimensions de la participation sociale. L’approche et le langage utilisés dans l’OÉMC pourraient impliquer davantage l’aîné et être orientés vers ses capacités et les interventions de prévention. En bref, en révisant l’OÉMC ou en le complétant à l’aide d’un autre outil tel que la MHAVIE ou la MCRO, les interventions pourraient contribuer davantage à améliorer et à maintenir la participation sociale et la santé des aînés ayant des incapacités.The home support and social participation of seniors with disabilities require the appropriate coordination of various community resources, including home support within health and social service centers. Despite their importance, interventions currently offered by health and social service centers for seniors with disabilities are limited and focus mainly on safety and independence in hygiene, dressing, transfers and nutrition, at the detriment of social and leisure activities. This can be partly explained by an evaluation that does not thoroughly cover all aspects, nor adequately capture the complexity of seniors’ needs. This article presents a reflection on the use of the Autonomy Assessment in the Multiclientele Assessment Tool, including the Functional Autonomy Measurement System (SMAF), to identify the social participation needs of seniors with disabilities. This reflection is supported by a comparison between the Multiclientele Assessment Tool, the Assessment of Life Habits (LIFE-H, 4.0) and the Canadian Occupational Performance Measure (COPM, 5th edition). The results of this comparison show that the Multiclientele Assessment Tool does not allow for a comprehensive evaluation of the social participation needs of seniors with disabilities. The least covered activities are those related to health and well-being, including regular physical social and relaxation activities as well as cognitive stimulation and entertainment. The Multiclient Assessment Tool contains some ambiguities and overlap, as well as items that do not pertain to the dimensions of social participation. The approach and language used in the Multiclientele Assessment Tool could involve seniors more and be more focused on their abilities and preventative activities. In short, by revisiting the Multiclientele Assessment Tool or supplementing it with another tool such as the LIFE-H or the COPM, interventions could potentially improve and maintain the health and social participation of seniors with disabilities

Effect of High Intensity Interval Training Compared to Continuous Training on Cognitive Performance in Young Healthy Adults: A Pilot Study

To improve cognitive function, moving the body is strongly recommended; however, evidence regarding the proper training modality is still lacking. The purpose of this study was therefore to assess the effects of high intensity interval training (HIIT) compared to moderate intensity continuous exercise (MICE), representing the same total training load, on improving cognitive function in healthy adults. It was hypothesized that after 6 weeks (3 days/week) of stationary bike training, HIIT would improve executive functions more than MICE. Twenty-five participants exercised three times a week for 6 weeks after randomization to the HIIT or MICE training groups. Target intensity was 60% of peak power output (PPO) in the MICE group and 100% PPO in the HIIT group. After training, PPO significantly increased in both the HIIT and MICE groups (9% and 15%, p < 0.01). HIIT was mainly associated with a greater improvement in overall reaction time in the executive components of the computerized Stroop task (980.43 ± 135.27 ms vs. 860.04 ± 75.63 ms, p < 0.01) and the trail making test (42.35 ± 14.86 s vs. 30.35 ± 4.13 s, p < 0.01). T exercise protocol was clearly an important factor in improving executive functions in young adults