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Scientific Reports Jun 2024While implementing communication interventions, practitioners follow diverse theoretical models. Different conceptual orientations influence the way professionals...
While implementing communication interventions, practitioners follow diverse theoretical models. Different conceptual orientations influence the way professionals embrace the subject of communication and its disorders. This research project explores the co-creation and validation of a new model and intervention program to analyze and improve communication between persons with Complex Communication Needs and their caregivers. The methodology incorporated a comprehensive narrative review, as foundation for the new model and intervention proposal. Succeeding this stage, the team implemented an online Delphi Panel to improve and validate these results, involving 17 international renowned experts. Following the Appropriateness Method, 25 indications were subject to scrutiny and rated as appropriate with minimal values of disagreement among the evaluators. Qualitative feedback was used to improve the research products. Quality assurance measures were taken to ensure quality and transparency of the results. A new conceptual framework of atypical interpersonal communication and intervention program result from the investigation. The new model is inspired by the Transactional model and principles of Dialogism. The intervention consists of consultations with caregivers, using video analysis and a dialogical methodology to enhance communication. The next research phase is to pilot-test the intervention program with clinicians supporting persons with disability at risk of social isolation.
Topics: Humans; Communication; Social Isolation; Caregivers; Delphi Technique; Female; Male; Disabled Persons
PubMed: 38830956
DOI: 10.1038/s41598-024-63519-5 -
JAMA Network Open Jun 2024Chronic pain after traumatic brain injury (TBI) is prevalent and associated with poor outcomes. By providing multidisciplinary care through expert consultation, a... (Randomized Controlled Trial)
Randomized Controlled Trial
IMPORTANCE
Chronic pain after traumatic brain injury (TBI) is prevalent and associated with poor outcomes. By providing multidisciplinary care through expert consultation, a collaborative care (CC) treatment approach may reduce pain interference.
OBJECTIVE
To compare CC with usual care (UC) in decreasing pain interference.
DESIGN, SETTING, AND PARTICIPANTS
This randomized clinical trial was conducted from July 2018 through April 2021 at 2 hospital-based academic rehabilitation medicine clinics in Seattle, Washington. Participants included adults with mild-to-severe TBI (at least 6 months before enrollment) and chronic pain. Data analysis was performed from March 30, 2022, to August 30, 2023.
INTERVENTION
The CC intervention (called TBI Care) included up to 12 in-person or telephone visits over 16 weeks with a care manager (CM) who provided person-centered cognitive behavioral treatment. The CM met weekly with members of the expert team to review participants and discuss recommendations to optimize treatment.
MAIN OUTCOMES AND MEASURES
The primary outcome was pain interference on the Brief Pain Inventory at treatment conclusion (4 months after randomization). Secondary outcomes included pain interference at 8 months; pain severity; symptoms of depression, anxiety, and sleep disturbance; pain-related emergency department visits; community participation; and participant satisfaction. Linear mixed-effects regression was used for analysis.
RESULTS
A total of 1379 individuals were screened for eligibility, and 158 were randomized (79 to CC and 79 to UC). The participants were mostly women (92 participants [58%]) with a mean (SD) age of 46.8 (13.2) years and a mean (SD) of 15.3 (3.0) years of education. TBI occurred a mean (SD) of 4.0 (5.9) years (median [IQR], 1.9 [0.8-4.5] years) before enrollment. All TBI severities were included, and of 149 participants for whom TBI severity was known, the majority (97 participants [65%]) had mild TBI. In the CC group, 71 participants (90%) completed at least 11 sessions, and, at 4 months, this group had significantly lower pain interference scores compared with the UC group (mean [SD], 3.46 [2.17] vs 5.03 [2.28]). This difference was maintained at 8 months after randomization, with mean (SD) TBI care pain interference scores of 3.61 (2.22) for CC vs 4.68 (2.51) for UC. At 4 months, there was significantly lower pain severity in the CC group vs UC group (mean [SD] score, 3.63 [1.95] vs 4.90 [1.96]), as well as symptoms of depression (mean [SD] score, 8.07 [5.34] vs 11.31 [6.37]) and anxiety (mean [SD], 6.20 [5.17] vs 9.58 [6.00]). Satisfaction with pain treatment (mean [SD] score, 2.99 [1.23] vs 2.52 [1.25]), clinical care (mean [SD] score, 3.28 [1.00] vs 2.84 [1.26]), and overall health care (mean [SD] score, 3.25 [0.88] vs 2.82 [1.00]) were significantly higher in the CC group vs the UC group; global impression of change was significantly lower in the CC group vs the UC group (mean [SD] score, 2.74 [1.02] vs 3.47 [1.26]) (lower scores denote a better impression of change).
CONCLUSIONS AND RELEVANCE
In this randomized clinical trial of CC compared with UC for patients with TBI, CC was effective at reducing pain interference and was sustained at 8-month follow-up. Further research is needed to examine the implementation and cost-effectiveness of CC for TBI in other health care settings.
TRIAL REGISTRATION
ClinicalTrials.gov Identifier: NCT03523923.
Topics: Humans; Brain Injuries, Traumatic; Female; Male; Chronic Pain; Middle Aged; Adult; Pain Management; Washington; Patient Care Team; Pain Measurement; Cognitive Behavioral Therapy
PubMed: 38829619
DOI: 10.1001/jamanetworkopen.2024.13459 -
Neurobiology of Disease Aug 2024The association between common neuroradiological markers of multiple sclerosis (MS) and clinical disability is weak. Given that the disability in patients with MS may...
BACKGROUND
The association between common neuroradiological markers of multiple sclerosis (MS) and clinical disability is weak. Given that the disability in patients with MS may depend on the underlying structural connectivity of the brain, our study aimed to examine the association between white matter tracts affected by MS and the patients' disability using a new tract density index (TDI).
METHOD
This study included 53 patients diagnosed with MS, examined between 2019 and 2020. Manual lesion segmentation was performed on fluid-attenuated inversion recovery (FLAIR) images, and the density of white matter tracts encompassing the lesion (i.e., TDI) was calculated. Correlation analysis was employed to assess the association between TDI and disability. Additionally, the relationship between disability, TDI, and lesion-derived network metrics was examined by computing a partial correlation network.
RESULTS
The TDI significantly correlated with the expanded disability status scale (EDSS) (r = 0.30, p = 0.03). Furthermore, the patient's disability is linked solely through TDI to lesion-derived network metrics -a key metric that 'bridges' the gap between the brain lesion and disability.
CONCLUSIONS
In this study, MS lesions encompassing regions with high white matter tract density were associated and linked with severe physical disability. These findings indicate that TDI may be an outcome predictor that may connect radiologic findings to clinical practice.
Topics: Humans; White Matter; Female; Male; Multiple Sclerosis; Adult; Middle Aged; Magnetic Resonance Imaging; Disability Evaluation; Diffusion Tensor Imaging; Brain; Disabled Persons
PubMed: 38825050
DOI: 10.1016/j.nbd.2024.106548 -
BMC Geriatrics Jun 2024Disability prior to death complicates end-of-life care. The present study aimed to explore the prior-to-death disability profiles of Chinese older adults, the profiles'...
BACKGROUND
Disability prior to death complicates end-of-life care. The present study aimed to explore the prior-to-death disability profiles of Chinese older adults, the profiles' links to end-of-life care arrangements and place of death, and predictors of the profiles.
METHODS
In total, data were extracted from the records of 10,529 deceased individuals from the Chinese Longitudinal Healthy Longevity Survey (CLHLS). Latent profile analyses, bivariate analysis, and multivariate logistic regression were applied to identify prior-to-death disability profiles, explore the profiles' links to end-of-life care arrangements and place of death, and examine predictors in the profiles, respectively.
RESULTS
Three prior-to-death disability profiles, namely, Disabled-Incontinent (37.6%), Disabled-Continent (34.6%), and Independent (27.8%), were identified. Those with the Independent profile were more likely to live alone or with a spouse and receive no care or care only from the spouse before death. Disabled-Continent older adults had a higher chance of dying at home. Being female, not "married and living with a spouse", suffering from hypertension, diabetes, stroke or cerebrovascular disease (CVD), bronchitis/emphysema/pneumonia, cancer, or dementia, and dying in a later year were associated with more severe prior-to-death disability patterns. Not having public old-age insurance predicted lower chances of having a Disabled-Incontinent profile, and advanced age increased the chance of having a Disabled-Continent profile.
CONCLUSIONS
Three prior-to-death disability patterns were identified for Chinese adults aged 65 years and older. These profiles were significantly linked with the end-of-life caregiving arrangements and place of death among older adults. Both demographic information and health status predicted prior-to-death disability profiles.
Topics: Aged; Aged, 80 and over; Female; Humans; Male; China; Death; Disabled Persons; East Asian People; Longitudinal Studies; Terminal Care
PubMed: 38824494
DOI: 10.1186/s12877-024-05105-y -
BMC Geriatrics May 2024Evidence of the optimal blood pressure (BP) target for older adults with disability in long-term care is limited. We aim to analyze the associations of BP with mortality...
BACKGROUND
Evidence of the optimal blood pressure (BP) target for older adults with disability in long-term care is limited. We aim to analyze the associations of BP with mortality in older adults in long-term care setting with different levels of disability.
METHODS
This prospective cohort study was based on the government-led long-term care programme in Chengdu, China, including 41,004 consecutive disabled adults aged ≥ 60 years. BP was measured during the baseline survey by trained medical personnel using electronic sphygmomanometers. Disability profile was assessed using the Barthel index. The association between blood pressure and mortality was analyzed with doubly robust estimation, which combined exposure model by inverse probability weighting and outcome model fitted with Cox regression. The non-linearity was examined by restricted cubic spline. The primary endpoint was all-cause mortality, and the secondary endpoints were cardiovascular and non-cardiovascular mortality.
RESULTS
The associations between systolic blood pressure (SBP) and all-cause mortality were close to a U-shaped curve in mild-moderate disability group (Barthel index ≥ 40), and a reversed J-shaped in severe disability group (Barthel index < 40). In mild-moderate disability group, SBP < 135 mmHg was associated with elevated all-cause mortality risks (HR 1.21, 95% CI, 1.10-1.33), compared to SBP between 135 and 150 mmHg. In severe disability group, SBP < 150 mmHg increased all-cause mortality risks (HR 1.21, 95% CI, 1.16-1.27), compared to SBP between 150 and 170 mmHg. The associations were robust in subgroup analyses in terms of age, gender, cardiovascular comorbidity and antihypertensive treatment. Diastolic blood pressure (DBP) < 67 mmHg (HR 1.29, 95% CI, 1.18-1.42) in mild-moderate disability group and < 79 mmHg (HR 1.15, 95% CI, 1.11-1.20) in severe disability group both demonstrated an increased all-cause mortality risk.
CONCLUSION
The optimal SBP range was found to be higher in older individuals in long-term care with severe disability (150-170mmHg) compared to those with mild to moderate disability (135-150mmHg). This study provides new evidence that antihypertensive treatment should be administered cautiously in severe disability group in long-term care setting. Additionally, assessment of disability using the Barthel index can serve as a valuable tool in customizing the optimal BP management strategy.
TRIAL REGISTRATION
Chinese Clinical Trial Registry (Registration Number: ChiCTR2100049973).
Topics: Humans; Male; Female; Aged; China; Prospective Studies; Disabled Persons; Long-Term Care; Blood Pressure; Middle Aged; Aged, 80 and over; Cohort Studies; Hypertension; Mortality; East Asian People
PubMed: 38822230
DOI: 10.1186/s12877-024-05094-y -
Research in Developmental Disabilities Jul 2024A disability service organization piloted a parent capacity-building intervention for parents of children with developmental disabilities in rural South India.
BACKGROUND
A disability service organization piloted a parent capacity-building intervention for parents of children with developmental disabilities in rural South India.
AIMS
To examine the impact of this parent capacity-building group intervention on parent empowerment, peer support, social inclusion, advocacy skills, and the factors influencing these outcomes.
METHODS AND PROCEDURES
A qualitative study recruited 37 participants from 17 parent groups through convenience sampling. Six focus groups occurred six months post the start of this intervention and explored these parents' experiences with the groups and their perceived impacts.
OUTCOMES AND RESULTS
Qualitative analysis yielded four main themes and corresponding sub-themes: peer support (feeling peaceful and supported, building self-efficacy), social inclusion (space to share, acceptance and identity), knowledge sharing (increasing awareness, accepting advice), and advocacy (building confidence, making requests). Participation in parent groups provided participants with opportunities to find peer support, utilize knowledge sharing, feel socially included, and build advocacy skills.
CONCLUSIONS AND IMPLICATIONS
This study provides a greater understanding of the impact and benefits of parent capacity-building interventions in low-resource settings. Results will improve this intervention and guide other organizations in creating similar programs.
WHAT THIS PAPER ADDS
This paper adds perspectives of parents who are caregivers of children with developmental disabilities in rural South India. More specifically, this paper highlights the impact of a parent-focused intervention in group settings in both rural and urban areas. Parent support group interventions are not common in India and low- and middle-income countries and there is a paucity of literature describing these interventions and their impact. In this study, parents described a need for multifaceted interventions to support their child in the community. These parent groups provided space for caregivers of children with developmental disabilities to make connections, feel validated, and grow confidence to utilize new knowledge or advice shared by other parents to further enhance their lives. Further, parent-group settings provide opportunities to build advocacy skills through timely discussions. Parents reported an increase in feelings of acceptance within the group itself but not within the wider community. This highlights the need for involving the wider community in interventions to promote integration for families with children with disabilities.
Topics: Humans; India; Rural Population; Parents; Male; Female; Capacity Building; Child; Social Support; Qualitative Research; Developmental Disabilities; Adult; Peer Group; Focus Groups; Disabled Children; Empowerment; Self Efficacy; Caregivers
PubMed: 38821012
DOI: 10.1016/j.ridd.2024.104766 -
PloS One 2024This study aims to observe the associated risk factors of lower back pain and the factors that increase the pain severity. So, the main objective of this research is to...
Assessing pain severity and treatment outcomes in patients with low back pain: A Structural equation modeling approach at the center for the rehabilitation of the Paralysed, Bangladesh.
OBJECTIVES
This study aims to observe the associated risk factors of lower back pain and the factors that increase the pain severity. So, the main objective of this research is to identify the factors which may cause the lower back pain and the causal effect on the pain severity and respective treatment. This study also tries to determine the demographical characteristics of the low back pain patients and determine the inter relationship of psychological health, work stress and treatment effect with the pain disability index.
STUDY DESIGN
In this cross-sectional study, 200 patients with lower back pain were interviewed who were taking treatments from the physiotherapy department at the Center for the Rehabilitation of the Paralysed, Savar, Dhaka, Bangladesh.
METHODS
A quantitative research model has been performed to observe the relationship between different causes of low back pain effects on the patients. Different statistical analysis including structural equation modeling have been performed to observe their pain severity and treatment effect.
RESULTS
The study found 64% (128) of the total participants as male and 36% (72) as female among 200 patients of low back pain. The study also observed the highest portion of the patients belong to the age group 39 to 45 years (21.5%). On the basis of BMI, obese weight respondents were 26.5% (53), overweight respondents were 37% (74), normal weight respondents were 33% (66), and underweight respondents were only 3.5% (7). Here, sex, body mass index (BMI), living place and educational status have significant association with pain disability index (PDI). On the other hand, smoking tendency of patients has insignificant relationship (p>0.05) with pain disability index (PDI). The path coefficients of the structural equation model identified that all the null hypotheses of no significant relationship have been rejected for 5% level of significance. The hypothesis of psychological health is positively related to pain severity of a patient has an acceptable strength (β = 0.745, p<0.001) and a positive direction. Another hypothesis (Psychological health is positively related to the treatment of a patient) shows an acceptable strength (β = 0.401, p <0.001) and a positive direction. Work stress is also found to be positively related to pain severity of a patient with an acceptable strength (β = 0.544, p < 0.001) and a positive direction. The hypothesis (Work stress is positively related to the treatment of a patient) has an acceptable strength (β = 0.322, p< 0.05) and a positive direction. The hypothesis (pain severity is positively related to the treatment of patients) shows an acceptable strength (β = 0.801, p < 0.001) and a positive direction.
CONCLUSION
The research found out the psychological health situation and work stress of patients are significantly related with pain severity with acceptable strength. Also, Pain severity is significantly associated with treatment scheme intensity.
Topics: Humans; Male; Female; Adult; Low Back Pain; Bangladesh; Middle Aged; Cross-Sectional Studies; Latent Class Analysis; Treatment Outcome; Pain Measurement; Severity of Illness Index; Young Adult; Disabled Persons; Risk Factors
PubMed: 38820450
DOI: 10.1371/journal.pone.0303939 -
Journal of Online Learning Research Apr 2024The COVID-19 pandemic impacted school-based delivery of special educational supports and therapeutic services. This study describes student receipt of school-based...
The COVID-19 pandemic impacted school-based delivery of special educational supports and therapeutic services. This study describes student receipt of school-based supports/services and parent satisfaction by instruction modalities during the 2020-2021 academic year in the United States. Data were collected through the COVID Experiences Survey from parents of children ages 5-12 years, administered using NORC's AmeriSpeak panel. Most parents reported satisfaction with supports (88.4%) and services (93.2%). Dissatisfaction with special education supports and therapeutic services was more common among parents whose children received supports/services virtually than in person (special educational supports: =12.00, 95% CI [1.49-96.89], =0.020; therapeutic services: =15.76, 95% CI [1.01-245.40], =0.049). These findings suggest opportunities to improve design and delivery of online special education supports and therapeutic services as well as emergency preparedness by considering the needs of students with disabilities and their families.
PubMed: 38817908
DOI: No ID Found -
Journal of Public Health Policy Jun 2024Understanding the relationship between disability and physical activity and whether it differs across local government jurisdictions may aid in the development of...
Understanding the relationship between disability and physical activity and whether it differs across local government jurisdictions may aid in the development of placed-based approaches to reducing disability-related inequalities in physical activity. The objectives of this study were to examine the association between disability and physical activity and assess whether this association varied between Australian Local Government Areas. The sample included 13,315 participants aged 18-64 years from the Household Income and Labour Dynamics Australia Survey, 2017. Participants self-reported disability and physical activity. Linear mixed-effects models estimated the association between disability and physical activity. People with disability reported less physical activity per week. We did not find evidence that this association varied across LGAs. Our findings do not add evidence towards local government-based approaches in Australia to reducing physical activity inequalities between people with and without a disability.
Topics: Humans; Adult; Disabled Persons; Australia; Middle Aged; Male; Female; Exercise; Local Government; Adolescent; Young Adult; Surveys and Questionnaires; Socioeconomic Factors
PubMed: 38816483
DOI: 10.1057/s41271-024-00487-0 -
BMJ Open May 2024Around the world, the disability rights movements and the social model of disability have placed emphasis on the importance of social participation for people with... (Review)
Review
INTRODUCTION
Around the world, the disability rights movements and the social model of disability have placed emphasis on the importance of social participation for people with disability. People with physical disability who have high and complex support needs often need support to access their communities, however, very little is known about the interaction between support and social participation for this population of people. Therefore, the aim of this scoping review is to explore the literature related to the interaction between support and social participation for adults with disability and understand any existing gaps in the literature where further research may be required in order to maximise quality support and social participation.
METHODS AND ANALYSIS
This scoping review will be conducted and reported according to scoping review guidelines outlined by Arksey and O'Malley and later modified by Levac , as well as the Preferred Reporting Items for Systematic Reviews and Meta-Analysis: Extension for Scoping Reviews. Thorough database searches will be conducted across MEDLINE, PsycINFO, CINAHL and Scopus. The search will be limited to papers published in English from 2013 onwards. Citations will be uploaded into Covidence and screened by two independent reviewers. Data extraction will extract data regarding participants, housing, support and study characteristics, as well as qualitative and quantitative data relevant to the research question. A narrative synthesis will be used to summarise findings. A minimum of three consultants with lived experience of disability will be engaged to review and contribute to the final scoping review paper.
ETHICS AND DISSEMINATION
It is anticipated that the findings of this scoping review will be made available in peer-reviewed publications and also in plain language formats to ensure accessibility to a wide range of audiences. Ethics will not be required for this scoping review.
Topics: Humans; Disabled Persons; Social Participation; Social Support; Research Design; Review Literature as Topic
PubMed: 38816056
DOI: 10.1136/bmjopen-2023-083102