The effect of twice-weekly versus once-weekly sessions of either imagery rescripting or eye movement desensitization and reprocessing for adults with PTSD from childhood trauma (IREM-Freq): a study protocol for an international randomized clinical trial

Background Trauma-focused treatments for posttraumatic stress disorder (PTSD) are commonly delivered either once or twice a week. Initial evidence suggests that session frequency affects treatment response, but very few trials have investigated the effect of session frequency. The present study’s aim is to compare treatment outcomes of twice-weekly versus once-weekly sessions of two treatments for PTSD related to childhood trauma, imagery rescripting (ImRs) and eye movement desensitization and reprocessing (EMDR). We hypothesize that both treatments will be more effective when delivered twice than once a week. How session frequency impacts treatment response, whether treatment type moderates the frequency effect, and which treatment type and frequency works best for whom will also be investigated. Methods The IREM-Freq trial is an international multicenter randomized clinical trial conducted in mental healthcare centers across Australia, Germany, and the Netherlands. We aim to recruit 220 participants, who will be randomized to one of four conditions: (1) EMDR once a week, (2) EMDR twice a week, (3) ImRs once a week, or (4) ImRs twice a week. Treatment consists of 12 sessions. Data are collected at baseline until one-year follow-up. The primary outcome measure is clinician-rated PTSD symptom severity. Secondary outcome measures include self-reported PTSD symptom severity, complex PTSD symptoms, trauma-related cognitions and emotions, depressive symptoms, dissociation, quality of life, and functioning. Process measures include memory, learning, therapeutic alliance, motivation, reluctance, and avoidance. Additional investigations will focus on predictors of treatment outcome and PTSD severity, change mechanisms of EMDR and ImRs, the role of emotions, cognitions, and memory, the optimization of treatment selection, learned helplessness, perspectives of patients and therapists, the network structure of PTSD symptoms, and sudden treatment gains. Discussion This study will extend our knowledge on trauma-focused treatments for PTSD related to childhood trauma and, more specifically, the importance of session frequency. More insight into the optimal session frequency could lead to improved treatment outcomes and less dropout, and in turn, to a reduction of healthcare costs. Moreover, the additional investigations will broaden our understanding of how the treatments work and variables that affect treatment outcome. Trial registration Netherlands Trial Register NL6965, registered 25/04/2018

After the honeymoon: The Obama effect on political attitudes and participation

My dissertation takes a mixed-methods approach to investigating the possibility of a lasting Obama Effect on the political attitudes and behaviors of Obama supporters from 2008. Defining the Obama Effect as the extraordinary enthusiasm surrounding Barack Obama’s 2008 campaign, I argue that a short term Obama Effect was clearly present in 2008 based on Obama’s electoral success, fundraising prowess, and ability to inspire volunteerism, as well as on the historic nature of his candidacy. But I ask, was it a lasting effect? My quantitative analyses—built upon panel survey data from the American National Election Studies—suggest little evidence of a lasting campaign effect that was positive and/or unique to Obama supporters. With regard to attitudes and behaviors such as political interest, political efficacy, or attendance of political events, Obama supporters often showed relative declines or stagnation over time when compared to nonsupporters or supporters of previous presidents. My qualitative analysis—based upon interviews with 30 former volunteers from the 2008 Obama campaign—does, however, indicated that the Obama Effect had a deep and lasting impact on his most enthusiastic support base, those who volunteered for his campaign. Many former Obama volunteers remained highly interested, civically engaged, and continually inspired as a result of their activism for the 2008 Obama campaign. In sum, I conclude that while that campaign may not have had its desired transformational effect on the broader American electorate, it did produce a positive and indeed a lasting impact on its most enthusiastic supporters

Minimising impairment: Protocol for a multicentre randomised controlled trial of upper limb orthoses for children with cerebral palsy.

BACKGROUND: Upper limb orthoses are frequently prescribed for children with cerebral palsy (CP) who have muscle overactivity predominantly due to spasticity, with little evidence of long-term effectiveness. Clinical consensus is that orthoses help to preserve range of movement: nevertheless, they can be complex to construct, expensive, uncomfortable and require commitment from parents and children to wear. This protocol paper describes a randomised controlled trial to evaluate whether long-term use of rigid wrist/hand orthoses (WHO) in children with CP, combined with usual multidisciplinary care, can prevent or reduce musculoskeletal impairments, including muscle stiffness/tone and loss of movement range, compared to usual multidisciplinary care alone. METHODS/DESIGN: This pragmatic, multicentre, assessor-blinded randomised controlled trial with economic analysis will recruit 194 children with CP, aged 5-15 years, who present with flexor muscle stiffness of the wrist and/or fingers/thumb (Modified Ashworth Scale score =1). Children, recruited from treatment centres in Victoria, New South Wales and Western Australia, will be randomised to groups (1:1 allocation) using concealed procedures. All children will receive care typically provided by their treating organisation. The treatment group will receive a custom-made serially adjustable rigid WHO, prescribed for 6 h nightly (or daily) to wear for 3 years. An application developed for mobile devices will monitor WHO wearing time and adverse events. The control group will not receive a WHO, and will cease wearing one if previously prescribed. Outcomes will be measured 6 monthly over a period of 3 years. The primary outcome is passive range of wrist extension, measured with fingers extended using a goniometer at 3 years. Secondary outcomes include muscle stiffness, spasticity, pain, grip strength and hand deformity. Activity, participation, quality of life, cost and cost-effectiveness will also be assessed. DISCUSSION: This study will provide evidence to inform clinicians, services, funding agencies and parents/carers of children with CP whether the provision of a rigid WHO to reduce upper limb impairment, in combination with usual multidisciplinary care, is worth the effort and costs. TRIAL REGISTRATION: ANZ Clinical Trials Registry: U1111-1164-0572

Exploring relevant parameters and investigating their reproducibility of task-oriented unimanual strength measurement in children with unilateral cerebral palsy

PurposeTo explore relevant parameters and investigate their test-retest reliability within the scope of the push button task of the Task-oriented Arm-hAnd Capacity (TAAC) measured in children with unilateral Cerebral Palsy (CP).Methods118 children diagnosed with unilateral CP, aged between 6 and 18 years, participated in this study. Thetest-retest reliability of the force generated during the push button task of the TAAC was investigated using an intraclass correlation (ICC) two-way random model with absolute agreement. The ICCs were calculated across the whole age group and for two separate age subgroups (6-12 and 13-18 years).ResultsTest-retest reliability of the parameters "mean peak force of all attempts", "overshoot of force", "number of successful attempts" and "time to complete four successful attempts" were moderate to good (ICC range 0.667-0.865; 0.721-0.908; 0.733-0.817, respectively).ConclusionsThe results showed moderate to good test-retest reliability for all parameters. The parameters "mean peak force" and "number of successful attempts" are the most relevant parameters, as these parameters are task-specific and the most functional for clinical practice