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JMIR Human Factors Dec 2023Telerehabilitation has gained significance as a tool to deliver and supervise therapy and training as effective as traditional rehabilitation methods yet more accessible... (Clinical Trial)
Clinical Trial
BACKGROUND
Telerehabilitation has gained significance as a tool to deliver and supervise therapy and training as effective as traditional rehabilitation methods yet more accessible and affordable. An exergame-based telerehabilitation system has recently been developed within the scope of the international Continuum-of-Care (COCARE) project. The system comprises training devices for use in clinics (Dividat Senso) and at home (Dividat Senso Flex), an assessment system, and a rehabilitation cockpit, and its focus lies on home-based motor-cognitive training, which is remotely managed by health care professionals (HPs).
OBJECTIVE
This study aims to analyze the usability, acceptance, and enjoyment of the COCARE system from the perspective of primary (older adults [OAs]) and secondary (HPs) end users.
METHODS
At 3 trial sites (located in Switzerland, Italy, and Cyprus), participants engaged in a single-session trial of the COCARE system, including testing of exergames and assessments. Mixed methods encompassing qualitative approaches (eg, think aloud) and quantitative measures (eg, Exergame Enjoyment Questionnaire [EEQ], System Usability Scale [SUS], and Unified Theory of Acceptance and Use of Technology [UTAUT] questionnaire) were used to analyze participants' perceptions of the system and identify potential barriers to its implementation in a home setting. In addition, the associations of performance during gameplay and assessments, demographics, and training motivation (Behavioral Regulation in Exercise Questionnaire-3 [BREQ-3]) with usability, acceptance, and enjoyment were explored.
RESULTS
A total of 45 OAs and 15 HPs participated in this study. The COCARE system achieved good acceptance ratings (OAs: 83%, range 36%-100% and HPs: 81%, range 63.8%-93.3% of the maximum score), and OAs indicated high enjoyment (mean 73.3, SD 12.7 out of 100 points in the EEQ) during the exergame session. The system's usability, assessed with the SUS, received scores of 68.1 (SD 18.8; OAs) and 70.7 (SD 12.3; HPs) out of 100 points, with substantial differences observed between the trial sites. Several requirements for improvement were identified. Commonly mentioned barriers to adoption included the movement-recognition sensitivity of the Senso Flex, its limited markings, and difficulties in understanding certain instructions for assessments and games. Performance in games and assessments showed the highest significant correlations with the SUS (Spearman ρ=0.35, P=.02 to ρ=0.52, P<.001). The BREQ-3 had significant correlations with all usability measures, thereby even large significant correlations with enjoyment (Spearman ρ=0.58; P<.001). Age had moderately significant correlations with the SUS (Spearman ρ=-0.35; P=.02) and the UTAUT total score (ρ=-0.35; P=.02) but no significant correlation with the EEQ. Concerning sex and years of education, no significant correlations were found.
CONCLUSIONS
The study's findings will inform the further development of the COCARE system toward a user-friendly and widely accepted version, enhancing cognitive and physical functions in OAs. Future randomized controlled trials should evaluate the system's feasibility and effectiveness.
Topics: Aged; Humans; Exercise; Exercise Therapy; Exergaming; Pleasure; Telerehabilitation
PubMed: 38060283
DOI: 10.2196/48845 -
Comprehensive Psychiatry Jan 2024The negative symptoms of schizophrenia are strong prognostic factors but remain poorly understood and treated. Five negative symptom domains are frequently clustered...
BACKGROUND AND HYPOTHESIS
The negative symptoms of schizophrenia are strong prognostic factors but remain poorly understood and treated. Five negative symptom domains are frequently clustered into the motivation and pleasure (MAP) and emotional expression (EE) 'dimensions', but whether this structure remains stable and behaves as a single entity or not remains unclear.
STUDY DESIGN
We examined a cohort of 153 patients taking clozapine for treatment-resistant schizophrenia in a regional mental health clinic. Patients were assessed longitudinally over a mean period of 45 months using validated scales for positive, negative and mood symptoms. Network analyses were performed to identify symptom 'communities' and their stability over time. The influence of common causes of secondary negative symptoms as well as centrality measures were also examined.
STUDY RESULTS
Across patients at baseline, two distinct communities matching the clinical domains of MAP and EE were found. These communities remained highly stable and independent over time. The communities remained stabled when considering psychosis, depression, and sedation severity, and these causes of secondary negative symptoms were clustered into the MAP community. Centrality measures also remained stable over time, with similar centrality measures across symptoms.
CONCLUSIONS
Our results suggest that MAP and EE are independent dimensions that remain highly stable over time in chronic schizophrenia patients treated with clozapine. Common causes of secondary negative symptoms mapped onto the MAP dimension. Our results emphasise the need for clinical trials to address either MAP or EE, and that treating causes of secondary negative symptoms may improve MAP.
Topics: Humans; Schizophrenia; Schizophrenia, Treatment-Resistant; Clozapine; Psychiatric Status Rating Scales; Psychotic Disorders
PubMed: 38039918
DOI: 10.1016/j.comppsych.2023.152440 -
BJPsych Open May 2024Few previous studies have established Snaith-Hamilton Pleasure Scale (SHAPS) cut-off values using receiver operating characteristic curve analysis and applied these...
BACKGROUND
Few previous studies have established Snaith-Hamilton Pleasure Scale (SHAPS) cut-off values using receiver operating characteristic curve analysis and applied these values to compare predictors of anhedonia between clinical and nonclinical groups.
AIMS
To determine the optimal cut-off values for the SHAPS and use them to identify predictors of anhedonia in clinical and nonclinical groups in Taiwan.
METHOD
This cross-sectional and correlational study used convenience sampling to recruit 160 patients from three hospitals and 412 students from two universities in northern Taiwan. Data analysis included receiver operating characteristic curve, univariate and multivariate analyses.
RESULTS
The optimal SHAPS cut-off values were 29.5 and 23.5 for the clinical and nonclinical groups, respectively. Moreover, two-stage analysis revealed that participants in the clinical group who perceived themselves as nondepressed, and participants in the nonclinical group who did not skip classes and whose fathers exhibited higher levels of care and protection were less likely to attain the cut-off values. Conversely, participants in the nonclinical group who reported lower academic satisfaction and were unwilling to seek help from family or friends were more likely to attain the cut-off values.
CONCLUSIONS
Our findings highlight the importance of optimal cut-off values in screening for depression risk within clinical and nonclinical groups. Accordingly, the development of comprehensive, individualised programmes to monitor variation trends in SHAPS scores and relevant predictors of anhedonia across different target populations is crucial.
PubMed: 38721787
DOI: 10.1192/bjo.2024.35 -
PloS One 2024Groove, or the pleasurable urge to move to music, offers unique insight into the relationship between emotion and action. The predictive coding of music model posits...
Groove, or the pleasurable urge to move to music, offers unique insight into the relationship between emotion and action. The predictive coding of music model posits that groove is linked to predictions of music formed over time, with stimuli of moderate complexity rated as most pleasurable and likely to engender movement. At the same time, listeners vary in the pleasure they derive from music listening: individuals with musical anhedonia report reduced pleasure during music listening despite no impairments in music perception and no general anhedonia. Little is known about musical anhedonics' subjective experience of groove. Here we examined the relationship between groove and music reward sensitivity. Participants (n = 287) heard drum-breaks that varied in perceived complexity, and rated each for pleasure and wanting to move. Musical anhedonics (n = 13) had significantly lower ratings compared to controls (n = 13) matched on music perception abilities and general anhedonia. However, both groups demonstrated the classic inverted-U relationship between ratings of pleasure & move and stimulus complexity, with ratings peaking for intermediately complex stimuli. Across our entire sample, pleasure ratings were most strongly related with music reward sensitivity for highly complex stimuli (i.e., there was an interaction between music reward sensitivity and stimulus complexity). Finally, the sensorimotor subscale of music reward was uniquely associated with move, but not pleasure, ratings above and beyond the five other dimensions of musical reward. Results highlight the multidimensional nature of reward sensitivity and suggest that pleasure and wanting to move are driven by overlapping but separable mechanisms.
Topics: Humans; Music; Anhedonia; Female; Male; Adult; Pleasure; Reward; Young Adult; Auditory Perception; Emotions; Adolescent; Acoustic Stimulation
PubMed: 38652721
DOI: 10.1371/journal.pone.0301478 -
Psychological Reports Aug 2023This paper describes the evaluation of the Happiness through Goal-Setting Training, a multiple intervention approach which helps participants to reflect on, and modify...
This paper describes the evaluation of the Happiness through Goal-Setting Training, a multiple intervention approach which helps participants to reflect on, and modify their reasons for goal pursuit. The training is theoretically grounded in the goal-striving reasons framework. This framework captures four important reasons for goal pursuit and has received a substantial amount of empirical support for its predictive power in relation to positive psychological functioning. The four goal-striving reasons are the pursuit of goals out of pleasure, altruism, fear of self-esteem loss or necessity. The evaluation of the training, employing a before-and-after study design, is based on two data sets comprising data from a face-to-face delivery of the training ( 41) and an online delivery of the training ( 40). Overall, the findings from both studies, using paired sample t-tests, show that the Happiness through Goal-Setting Training significantly improves the quality of people's reasons for goal pursuit as well as their positive psychological functioning measured through life satisfaction, positive affect, negative affect and work-engagement. Thus, the Happiness through Goal-Setting Training complements the existing suite of well-being interventions by providing a happiness training that focusses specifically on improving people's reasons for goal-pursuit.
Topics: Humans; Happiness; Goals; Pleasure; Motivation; Self Concept
PubMed: 35084260
DOI: 10.1177/00332941211071007 -
Social Cognitive and Affective... May 2024The smell of the own baby is a salient cue for human kin recognition and bonding. We hypothesized that infant body odors function like other cues of the Kindchenschema...
The smell of the own baby is a salient cue for human kin recognition and bonding. We hypothesized that infant body odors function like other cues of the Kindchenschema by recruiting neural circuits of pleasure and reward. In two functional magnetic resonance imaging studies, we presented infantile and post-pubertal body odors to nulliparae and mothers (N = 78). All body odors increased blood-oxygen-level-dependent (BOLD) response and functional connectivity in circuits related to olfactory perception, pleasure and reward. Neural activation strength in pleasure and reward areas positively correlated with perceptual ratings across all participants. Compared to body odor of post-pubertal children, infant body odors specifically enhanced BOLD signal and functional connectivity in reward and pleasure circuits, suggesting that infantile body odors prime the brain for prosocial interaction. This supports the idea that infant body odors are part of the Kindchenschema. The additional observation of functional connectivity being related to maternal and kin state speaks for experience-dependent priming.
Topics: Humans; Odorants; Female; Magnetic Resonance Imaging; Male; Infant; Adult; Smell; Brain; Olfactory Perception; Brain Mapping; Oxygen; Young Adult; Child; Reward; Pleasure
PubMed: 38850226
DOI: 10.1093/scan/nsae038 -
Frontiers in Sports and Active Living 2023Extrinsic strategies affect the exercise experience but fall outside the frequency, intensity, time, and type (i.e., ) principles. To our knowledge, no systematic review... (Review)
Review
BACKGROUND
Extrinsic strategies affect the exercise experience but fall outside the frequency, intensity, time, and type (i.e., ) principles. To our knowledge, no systematic review has focused on extrinsic strategies to influence the affective responses to exercise. The objective was to identify extrinsic strategies that seek to influence affective responses during exercise and other motivationally relevant variables including post-exercise momentary affective valence, remembered and forecasted pleasure, and enjoyment.
METHODS
For inclusion, eligible articles reported peer-reviewed original research, used acute bouts of exercise, and used a dimensional approach for measuring affective responses or measured enjoyment post-exercise. Web of Science, PubMed, and PsychINFO databases were last searched on 10th September 2021. Quality assessment was completed following the Effective Public Health Practice Project approach. Results were presented using a narrative synthesis.
RESULTS
125 studies were included with sample descriptions, study design (extrinsic strategies, mode, type, intensity, and duration), measurement details, and results summarised for each study.
CONCLUSIONS
71% of studies were categorised as Weak according to the quality assessment tool with sampling practices (self-referred participants) and poor reporting of participant withdrawals/drop-outs the predominant reasons for Weak ratings. A wide variety of extrinsic strategies were reported with music, music videos, immersive virtual reality, outdoor exercise, caffeine, high-to-low pattern of exercise intensity, self-selected exercise intensity, and manipulation of self-efficacy offering promise as suitable strategies to positively change how people feel during exercise.
SYSTEMATIC REVIEW REGISTRATION
https://osf.io/jbh8v/.
PubMed: 37496882
DOI: 10.3389/fspor.2023.1186986 -
The Patient's Perspective on the Effects of Intranasal Esketamine in Treatment-Resistant Depression.Brain Sciences Oct 2023The effectiveness of the esketamine nasal spray (ESK-NS) for treatment-resistant depression (TRD) has been confirmed by real-world studies. Available evidence derived...
The effectiveness of the esketamine nasal spray (ESK-NS) for treatment-resistant depression (TRD) has been confirmed by real-world studies. Available evidence derived from clinician-rated assessments might differ from patients' perceptions about the helpfulness of treatments. We aimed to verify the effect of ESK-NS from patients' view in 25 TRD patients (56% males, 55.1 ± 10.9 years) treated with ESK-NS (mean dose: 78.4 ± 11.43 mg) for three months and evaluated at different time-points through clinician-rated and self-administered scales, assessing changes in depression, anhedonia, sleep, cognition, suicidality, and anxiety. We observed an overall early improvement that lasted over time (endpoint total score reduction in Montgomery-Åsberg Depression Rating Scale, < 0.001, Beck Depression Inventory, = 0.003). Patients reported a significant self-rated decrease in anhedonia at two months (Snaith-Hamilton Pleasure Scale, = 0.04) and in suicide ideation at endpoint (BDI subitem 9, = 0.039) vs. earlier improvements detected by clinicians (one-month reduction in MADRS subitem 8, = 0.005, and subitem 10, = 0.007). These findings confirm the effectiveness of a three-month treatment with ESK-NS in TRD patients, highlighting an overall overlapping response from patients' and clinicians' perspectives, although with some differential effects on specific symptoms at given time-points. Including patients' viewpoints in routine assessments could inform clinical practice, ensuring a better characterization of clinical phenotypes to deliver personalized interventions.
PubMed: 37891860
DOI: 10.3390/brainsci13101494 -
BMC Pharmacology & Toxicology Dec 2023Feminizing gender-affirming hormone therapy (GAHT) for transgender individuals traditionally includes estradiol and androgen deprivation. Research has demonstrated that... (Randomized Controlled Trial)
Randomized Controlled Trial
BACKGROUND
Feminizing gender-affirming hormone therapy (GAHT) for transgender individuals traditionally includes estradiol and androgen deprivation. Research has demonstrated that breast size as a result of GAHT in transgender women is often limited. Therefore, transgender women often choose to undergo breast augmentation surgery. Progesterone is important for breast development in cisgender women during puberty. A potential role for progesterone in breast development in transgender women has not been investigated in a randomized controlled experimental set-up. The primary objective of this study is to explore the effects on breast volume of addition of oral progesterone to GAHT with estradiol in transgender women after vaginoplasty or orchiectomy. Secondary objectives include assessment of safety, satisfaction, mood, sleep and sexual pleasure.
METHODS
This is a non-blinded, non-placebo, randomized controlled trial using a factorial design in adult transgender individuals assigned male sex at birth who have undergone GAHT for at least one year and underwent vaginoplasty or orchiectomy. The study design allows for rapid assessment of potential synergistic effects of various dose combinations of estradiol and progesterone on breast volume change: Ninety participants will be randomized into six groups of 15 subjects each, receiving either the baseline dose of estradiol, the baseline dose of estradiol and progesterone 200 mg daily, the baseline dose of estradiol and progesterone 400 mg daily, twice the baseline dose of estradiol, twice the baseline dose of estradiol and progesterone 200 mg daily or twice the baseline dose of estradiol and progesterone 400 mg daily, all for a duration of 12 months. The main study parameters include changes in breast volume as determined by 3D measurements. Participants will be followed-up with laboratory testing including serum progesterone concentrations as well as surveys for satisfaction, mood, sleep quality and sexual pleasure.
DISCUSSION
This study will indicate whether progesterone is safe and of additional value with regard to breast volume change in transgender individuals receiving feminizing GAHT. The results of this study will be useful for innovation of feminizing GAHT.
TRIAL REGISTRATION
WHO International Clinical Trials Registry Platform: EUCTR2020-001952-16-NL; date of registration: 12 December 2020 https://trialsearch.who.int/Trial2.aspx?TrialID=EUCTR2020-001952-16-NL .
Topics: Adult; Humans; Male; Androgen Antagonists; Estradiol; Progesterone; Transgender Persons; Female
PubMed: 38124194
DOI: 10.1186/s40360-023-00724-4