Twelve month follow-up on a randomised controlled trial of relaxation training for post-stroke anxiety

© The Author(s) 2016. Objective: To follow up participants in a randomised controlled trial of relaxation training for anxiety after stroke at 12 months. Design: Twelve month follow-up to a randomised controlled trial, in which the control group also received treatment. Setting: Community. Participants: Fifteen of twenty one original participants with post-stroke anxiety participated in a one year follow-up study. Interventions: A self-help autogenic relaxation CD listened to five times a week for one month, immediately in the intervention group and after three months in the control group. Main measures: Hospital Anxiety and Depression Scale-Anxiety subscale and the Telephone Interview of Cognitive Status for inclusion. Hospital Anxiety and Depression Scale-Anxiety subscale for outcome. All measures were administered by phone. Results: Anxiety ratings reduced significantly between pre and post-intervention, and between pre-intervention and one year follow-up (‡2(2) = 22.29, p < 0.001). Conclusions: Reductions in anxiety in stroke survivors who received a self-help autogenic relaxation CD appear to be maintained after one year

A pilot randomized controlled trial of self-help relaxation to reduce post-stroke depression

© 2017, © The Author(s) 2017. Objective: To consider the potential of self-help relaxation training to treat depression after stroke. Design: Randomized controlled trial with cross-over at three months. Setting: Community. Participants: In total, 21 people with stroke, aged 49–82 years. Intervention: Autogenic relaxation CD. Main measure: Hospital Anxiety and Depression Scale–Depression (HADS-D) subscale. Results: No difference in depression change scores was identified between the treatment and control groups; however, on two follow-ups, significant positive differences relative to screening were found for the treatment group (at 2 months Z = −2.55, P =.011 and 12 months Z = −2.44, P =.015). A partial η2 =.07 was identified. Conclusion: Self-help relaxation holds promise as a self-help treatment for depression after stroke. Findings from this trial, considered with others of relaxation for depression, suggest that a study including a total of 80 participants would likely be sufficient to establish efficacy of the treatment, relative to controls, in those with stroke

The Behavioural Outcomes of Anxiety scale (BOA): A preliminary validation in stroke survivors

© 2014 The British Psychological Society. Objectives To determine the psychometric properties of an observational scale of anxiety.Design A cross-sectional and longitudinal survey with stroke survivor-carer dyads.Methods Eighty-nine dyads recruited in community stroke groups completed: a demographic questionnaire; the Behavioural Outcomes of Anxiety scale (BOA), survivor-rated (survivor BOA) and carer-rated (carer BOA) versions; the anxiety scale of the Hospital Anxiety and Depression Scales (HADS-A), also in carer and survivor versions. Twenty-seven survivors and carers repeated the BOA after 1 week.Results Correlations between the carer BOA and the survivor HADS-A (r =.55, p <.001) and the survivor BOA (r =.73, p <.001) demonstrated construct validity. Cronbach's alpha for the carer BOA was.81; item statistics did not identify any items for exclusion. The test-retest coefficient at 1 week was 0.83. Receiver operating characteristic analysis against the survivor HADS-A and BOA produced areas under the curve of 0.75 and 0.88, respectively. At a cut-off score of 13/14 sensitivity and specificity against the HADS-A were 0.77 and 0.58, respectively, and 0.86 and 0.68 against the survivor BOA. The impact of stroke on memory was associated with elevated anxiety. Scores for both BOA versions were independent of demographic variables.Conclusions The carer BOA has acceptable psychometric properties and is independent of survivor demographic variables such as age. It identifies self-reported cases with acceptable sensitivity and specificity. It has potential for use with persons unable to self-report anxiety. Further validation is recommended, but its continuing use is supported. © 2014 The British Psychological Society

Potential for children with intellectual disability to engage in cognitive behaviour therapy: the parent perspective.

BACKGROUND:This study aimed to obtain the opinions of parents and carers of children with intellectual disability (ID) as to whether cognitive behaviour therapy (CBT) could be useful for their children. METHODS:A mixed qualitative and quantitative method was employed. Twenty-one carers of children aged 10 to 17 having borderline to moderate intellectual functioning responded to an online questionnaire. Participants were provided with information about CBT and asked to respond to open-ended questions. Quantitative data pertained to questions about their child's ability to identify and describe thoughts, feelings and behaviours. Thematic analysis of responses was conducted using an inductive method of identifying themes from the qualitative data collected. RESULTS:Five themes emerged from the qualitative analysis: Emotional Attunement (i.e. parent's understanding and recognition of their child's emotions), Role of the Therapist (i.e. ways therapists could facilitate the intervention), Role of the Parent (i.e. ways parents could engage in the therapy process), Anticipated Obstacles (i.e. what may get in the way of the therapy) and Suggested Adaptations for Therapy (i.e. how CBT can be adapted to suit the needs of children with ID). Seventy-six per cent agreed that their child would be able to engage in CBT with assistance. CONCLUSIONS:The majority of parents believed that CBT is an intervention that children with ID could engage in, provided the therapy is adapted, and the therapist accommodates their needs

Accessibility and applicability of currently available e-mental health programs for depression for people with poststroke aphasia: Scoping review

© Stephanie Jane Clunne, Brooke Jade Ryan, Annie Jane Hill, Caitlin Brandenburg, Ian Kneebone. Background: Depression affects approximately 60% of people with aphasia 1 year post stroke and is associated with disability, lower quality of life, and mortality. Web-delivered mental health (e-mental health) programs are effective, convenient, and cost-effective for the general population and thus are increasingly used in the management of depression. However, it is unknown if such services are applicable and communicatively accessible to people with poststroke aphasia. Objective: The aim of this study was to identify freely available e-mental health programs for depression and determine their applicability and accessibility for people with poststroke aphasia. Methods: A Web-based search was conducted to identify and review freely available e-mental health programs for depression. These programs were then evaluated in terms of their (1) general features via a general evaluation tool, (2) communicative accessibility for people with aphasia via an aphasia-specific communicative accessibility evaluation tool, and (3) empirical evidence for the general population and stroke survivors with and without aphasia. The program that met the most general evaluation criteria and aphasia-specific communicative accessibility evaluation criteria was then trialed by a small subgroup of people with poststroke aphasia. Results: A total of 8 programs were identified. Of these, 4 had published evidence in support of their efficacy for use within the general population. However, no empirical evidence was identified that specifically supported any programs’ use for stroke survivors with or without aphasia. One evidence-based program scored at least 80% (16/19 and 16/20, respectively) on both the general and aphasia-specific communicative accessibility evaluation tools and was subject to a preliminary trial by 3 people with poststroke aphasia. During this trial, participants were either unable to independently use the program or gave it low usability scores on a post-trial satisfaction survey. On this basis, further evaluation was considered unwarranted. Conclusions: Despite fulfilling majority of the general evaluation and aphasia-specific evaluation criteria, the highest rated program was still found to be unsuitable for people with poststroke aphasia. Thus, e-mental health programs require substantial redevelopment if they are likely to be useful to people with poststroke aphasia

Online Resource to Promote Vocational Interests Among Job Seekers With Multiple Sclerosis: A Randomized Controlled Trial in Australia

© 2017 American Congress of Rehabilitation Medicine Objective: To provide a preliminary evaluation of the effectiveness of an online resource for job seekers with multiple sclerosis (MS). Design: Randomized controlled design. Setting: Community-dwelling cohort. Participants: Adults (N = 95) with relapsing-remitting or progressive MS were randomly assigned to one of two groups. Forty-five accessed an email delivered, 7 module resource, Work and MS, over a 4 week period. Waitlist control participants (n=50) were offered the opportunity to access Work and MS 4 weeks postenrollment. Main Outcome Measures: Primary outcomes focused on vocational interests (My Vocational Situation Scale) and self-efficacy in job-seeking activities (Job-Procurement Self Efficacy Scale). Secondary outcomes focused on perceived workplace difficulties (Multiple Sclerosis Work Difficulties Questionnaire [MSWDQ]), optimism (Life Orientation Test – Revised), and mood (Patient Health Questionnaire-9). Results: Intention-to-treat analyses revealed pre-post gains: participants who accessed Work and MS reported improved confidence in their career goals (My Vocational Situation Scale g=.55; 95% confidence interval [CI],.14–.96; P=.008) and positively reappraised potential workplace difficulties (MSWDQ g range,.42–.47; P range,.023–.042). The effect on job self-efficacy was not significant, but changed in the expected direction (g=.17; 95% CI, –.23 to.57; P=.409). Completer data revealed larger, significant effect estimates (g range,.52–.64; P range,.009–.035). Conclusions: Findings provide preliminary support for the utility of a job information resource, Work and MS, to augment existing employment services. The results also suggest the need to test employment-ready interventions in a larger study population. This might include the addition of online peer support to increase intervention compliance

Mindfulness Therapies for Improving Mental Health in Parents of Children with a Developmental Disability: a Systematic Review

© 2020, Springer Science+Business Media, LLC, part of Springer Nature. Mindfulness offers promise as a therapy approach for parents of children with developmental disabilities (DD), however its effectiveness in managing mental health symptoms remains unclear. This review quantitatively examines the comparative effectiveness of mindfulness-based and informed interventions, drawing on the evidence base from randomised controlled trials (RCTs). Eight RCTs were identified from the Embase, PsycINFO, PubMed and Scopus databases. Risk of bias was assessed using the Cochrane Collaboration tool and Hedges’ g effect sizes, with associated 95% confidence intervals and p values calculated. Parents who completed Mindful Parenting or Mindfulness-Based Stress Reduction programs reported immediate and large to very large reductions in psychological distress (gw range:.39–1.94), with some improvements maintained up to 6 months post-treatment. A single study reported short-term benefits with Acceptance and Commitment Therapy. Evidence for the mental health benefits of mindfulness for parents of children with DD is still at an early stage. Controlled trials are needed to determine the differential effects of specific mindfulness techniques and how to best adapt this approach to best meet the unique needs of a vulnerable caregiver population

Falls self-efficacy and falls incidence in community-dwelling older people: the mediating role of coping

Background: A cognitive behavioural model predicts that coping responses mediate the relationship between falls related psychological concerns and falls incidence, in community-dwelling older people. If empirical support could be found for this pathway then interventions could be developed to reduce falls risk by targeting coping strategies. Therefore, this study aimed to begin the process of testing whether coping responses mediate the association between falls self-efficacy (a principal element of falls related psychological concerns) and falls incidence, in community-dwelling older people. Method: In a cross-sectional design, 160 community–dwelling older people (31 male, 129 female; mean age 83.47 years) completed the Falls Efficacy Scale–International, the Revised-Ways of Coping Questionnaire, the Turning to Religion subscale of the COPE, and a falls questionnaire. Data were analysed via mediation analysis using a bootstrapping approach. Results: Lower falls self-efficacy was associated with higher falls incidence, and more self-controlling coping was found to be a partial mediator of this association, with a confidence interval for the indirect effect of (.003, .021) and an effect size of κ2 = .035. The association was not mediated by the other measured coping responses; namely, turning to religion, distancing, seeking social support, accepting responsibility, escape-avoidance, planful problem-solving and positive reappraisal. Conclusions: Self-controlling coping may mediate the association between falls self-efficacy and falling. If longitudinal studies confirm this finding then coping could be targeted in interventions to reduce falls

Automatic alignment of surgical videos using kinematic data

Over the past one hundred years, the classic teaching methodology of "see one, do one, teach one" has governed the surgical education systems worldwide. With the advent of Operation Room 2.0, recording video, kinematic and many other types of data during the surgery became an easy task, thus allowing artificial intelligence systems to be deployed and used in surgical and medical practice. Recently, surgical videos has been shown to provide a structure for peer coaching enabling novice trainees to learn from experienced surgeons by replaying those videos. However, the high inter-operator variability in surgical gesture duration and execution renders learning from comparing novice to expert surgical videos a very difficult task. In this paper, we propose a novel technique to align multiple videos based on the alignment of their corresponding kinematic multivariate time series data. By leveraging the Dynamic Time Warping measure, our algorithm synchronizes a set of videos in order to show the same gesture being performed at different speed. We believe that the proposed approach is a valuable addition to the existing learning tools for surgery.Comment: Accepted at AIME 201

Reducing the psychosocial impact of aphasia on mood and quality of life in people with aphasia and the impact of caregiving in family members through the Aphasia Action Success Knowledge (Aphasia ASK) program: Study protocol for a randomized controlled trial

© 2016 Worrall et al. Background: People with aphasia and their family members are at high risk of experiencing post stroke depression. The impact of early interventions on mood and quality of life for people with aphasia is unknown. Methods/design: This study will determine whether an early intervention for both the person with aphasia after stroke and their family members leads to better mood and quality of life outcomes for people with aphasia, and less caregiver burden and better mental health for their family members. This is a multicenter, cluster-randomized controlled trial. Clusters, which are represented by Health Service Districts, will be randomized to the experimental intervention (Aphasia Action Success Knowledge Program) or an attention control (Secondary Stroke Prevention Information Program). People with aphasia and their family members will be blinded to the study design and treatment allocation (that is, will not know there are two arms to the study). Both arms of the study will receive usual care in addition to either the experimental or the attention control intervention. A total of 344 people with aphasia and their family members will be recruited. Considering a cluster size of 20, the required sample size can be achieved from 18 clusters. However, 20 clusters will be recruited to account for the potential of cluster attrition during the study. Primary outcome measures will be mood and quality of life of people with aphasia at 12 months post stroke. Secondary measures will be family member outcomes assessing the impact of caregiving and mental health, and self-reported stroke risk-related behaviors of people with aphasia. Discussion: This is the first known program tailored for people with aphasia and their family members that aims to prevent depression in people with aphasia by providing intervention early after the stroke. Trial registration: This trial is registered in the Australian New Zealand Clinical Trials Registry (ANZCTR) as ACTRN12614000979651. Date registered: 11 September 2014