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Christofferson J, Scheurich JA, Black WR, Hoffart CM, Wallace DP. Psychosocial Functioning of Parents of Youth Receiving Intensive Interdisciplinary Pain Treatment. J Pediatr Psychol 2024; 49:309-317. [PMID: 38092685 DOI: 10.1093/jpepsy/jsad092] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2023] [Revised: 11/21/2023] [Accepted: 11/21/2023] [Indexed: 05/18/2024] Open
Abstract
OBJECTIVE Parents of youth with chronic pain report psychosocial difficulties, yet treatment often focuses on improving their child's functioning and pain. This study evaluated changes in parents' social and emotional functioning and explored predictors of change, as they completed a parent-focused intervention while their child was enrolled in an intensive interdisciplinary pain treatment (IIPT) program. METHODS Parents (n = 69) completed questionnaires at baseline and weekly (average duration of 4 weeks) during their child's participation in IIPT. Parents engaged in 3 groups per week providing education, therapeutic art, and psychotherapy (3 hr/week total). RESULTS At baseline, 38% of parents reported scores in the clinically elevated range for at least 1 psychosocial variable. Linear mixed modeling for the full sample indicated reduced parent anxiety (t = -2.72, p <.01) and depression (t = -3.59, p <.001), but not increased emotional support (t = 1.86, p >. 05) or reduced social isolation (t = -1.20, p >.05). For parents with at least moderately elevated psychosocial concerns, statistically significant improvements were observed for all 4 outcomes (all p's<.01). Psychological flexibility, cognitive reappraisal, and emotional suppression were found to be related to changes in parent outcomes (anxiety, depression, isolation, and support). CONCLUSIONS Findings support the benefit of parent-focused interventions in addition to child-focused interventions. Many parents of youth participating in IIPT had elevated scores for at least 1 psychosocial concern at baseline. Brief, parent-focused intervention including psychoeducation, therapeutic art, and psychotherapy targeting mindfulness, acceptance, and values had a significant impact on these parents, particularly those with greater struggles at baseline.
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Affiliation(s)
- Jennifer Christofferson
- The Center for Children's Healthy Lifestyles & Nutrition, Children's Mercy Kansas City, USA
- Clinical Child Psychology Doctoral Program, University of Kansas, USA
| | - Jennifer A Scheurich
- Department of Psychiatry and Psychology, Mayo Clinic, USA
- Pain Management Clinic, Department of Pediatrics, Children's Mercy Kansas City, USA
- Department of Pediatrics, University of Missouri-Kansas City School of Medicine, USA
| | - William R Black
- The Center for Children's Healthy Lifestyles & Nutrition, Children's Mercy Kansas City, USA
- Department of Pediatrics, University of Kansas School of Medicine, USA
| | - Cara M Hoffart
- The Center for Children's Healthy Lifestyles & Nutrition, Children's Mercy Kansas City, USA
- Pain Management Clinic, Department of Pediatrics, Children's Mercy Kansas City, USA
- Department of Pediatrics, University of Missouri-Kansas City School of Medicine, USA
| | - Dustin P Wallace
- The Center for Children's Healthy Lifestyles & Nutrition, Children's Mercy Kansas City, USA
- Pain Management Clinic, Department of Pediatrics, Children's Mercy Kansas City, USA
- Department of Pediatrics, University of Missouri-Kansas City School of Medicine, USA
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2
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Chong ASS, Ahmad M, Harizan NBM, Alias H, Hussain RI, Lateh A, Chan CMH. Predictors of Post-traumatic Stress Symptoms (PTSS), Depression, and Anxiety among Caregivers of Children with Acute Lymphoblastic Leukaemia (ALL). Asian Pac J Cancer Prev 2023; 24:1923-1929. [PMID: 37378920 PMCID: PMC10505900 DOI: 10.31557/apjcp.2023.24.6.1923] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2022] [Accepted: 06/04/2023] [Indexed: 06/29/2023] Open
Abstract
OBJECTIVE The caregivers of children diagnosed with acute lymphoblastic leukaemia (ALL) are believed to experience post-traumatic stress symptoms (PTSS), depression and anxiety. This present study endeavoured to explore the prevalence and predictors of PTSS, depression, and anxiety among the caregivers of children with ALL. METHODS Purposive sampling was used to select the 73 caregivers of children with ALL who participated in this cross-sectional study. The Post-traumatic Stress Disorder Checklist for DSM-5 (PCL-5), Beck Depression Inventory (BDI), and Beck Anxiety Inventory (BAI) were used to measure psychological distress. RESULT There was a low prevalence (11%) of post-traumatic stress disorder (PTSD) among the participants. Although all the criteria for PTSD were not met, a few post-traumatic symptoms remained, suggesting that PTSS was likely present. Most of the participants reported minimal symptoms of depression (79.5%) and anxiety (65.8%). Anxiety, depression, and ethnicity predicted the PTSS scores (R2 = .77, p =.000). Subsequently, depression predicted the PTSS scores (R2 = 0.42, p =0.000). Participants of 'Other' or 'Indigenous' ethnicity had lower PTSS scores and higher anxiety scores (R2 = 0.75, p =0.000) than participants of Malay ethnicity. CONCLUSION The caregivers of children with ALL experience post-traumatic stress symptoms (PTSS), depression, and anxiety. These variables co-exist and may have different trajectories in different ethnic groups. Therefore, healthcare providers should take ethnicity and psychological distress into consideration when providing paediatric oncology treatment and care.
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Affiliation(s)
- Agnes Shu Sze Chong
- Centre for Community Health Studies (ReaCH)/Clinical Psychology & Behavioural Health Program, Faculty of Health Sciences, Universiti Kebangsaan Malaysia, Kuala Lumpur, Malaysia.
| | - Mahadir Ahmad
- Faculty of Health Science, Universiti Kebangsaan Malaysia, Kuala Lumpur, Federal Territory of Kuala Lumpur, Malaysia.
| | - Nurul Batrisyia Mohd Harizan
- Clinical Psychology and Behavioural Health Program, Faculty of Health Sciences, Universiti Kebangsaan Malaysia, Wilayah Persekutuan Kuala Lumpur, Malaysia.
| | - Hamidah Alias
- Department of Pediatrics, UKM Medical Centre, Wilayah Persekutuan Kuala Lumpur, Malaysia.
| | - Rizuana Iqbal Hussain
- Department of Radiology, UKM Medical Centre, Wilayah Persekutuan Kuala Lumpur, Malaysia.
| | - Afifi Lateh
- Department of Educational Evaluation and Research, Faculty of Education, Prince of Songkla University, Pattani Campus , Thailand.
| | - Caryn Mei Hsien Chan
- Centre for Community Health Studies (ReaCH)/Clinical Psychology & Behavioural Health Program, Faculty of Health Sciences, Universiti Kebangsaan Malaysia, Kuala Lumpur, Malaysia.
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Phenotyping peripheral neuropathic pain in male and female adolescents: pain descriptors, somatosensory profiles, conditioned pain modulation, and child-parent reported disability. Pain 2021; 162:1732-1748. [PMID: 33394878 DOI: 10.1097/j.pain.0000000000002172] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2020] [Accepted: 11/09/2020] [Indexed: 12/13/2022]
Abstract
ABSTRACT Neuropathic pain (NeuP) can be difficult to diagnose and manage in children. Data regarding prevalence and sex-dependent differences are limited, and more detailed phenotyping is needed. This observational cohort study recruited adolescents (10-17 years) with NeuP or complex regional pain syndrome (CRPS). After pain history and NeuP questionnaires, quantitative sensory testing was performed. Individual z-score plots were calculated with body-region control measures and matched to mechanism-related sensory profiles (sensory loss, thermal hyperalgesia, and mechanical hyperalgesia). Conditioned pain modulation was assessed with pressure pain threshold and a contralateral cold conditioning stimulus, and meaningful conditioned pain modulation defined as twice the standard error of measurement. Patients and parents completed validated questionnaires for child quality of life (QoL), pain catastrophizing, and self-reported anxiety/depression. Males (n = 23) and females (n = 43) with NeuP (n = 52) or CRPS (n = 14) reported moderate-severe pain with neuropathic sensory descriptors. Mixed patterns of sensory gain/loss at pain sites were not sex-dependent. Thermal hyperalgesia was common in both NeuP and CRPS, whereas sensory loss occurred only with NeuP and in a smaller proportion than adult cohorts. Conditioned pain modulation was inhibitory in 54%, facilitatory in 14%, and nonresponders had variable cold conditioning sensitivity. Males and females reported marked impairment of QoL, increased emotional distress, and pain catastrophising. Child-parent QoL scores correlated, but catastrophizing scores were discordant when parents or adolescents reported higher anxiety/depression. NeuP in adolescents is associated with significant pain, physical impairment, and psychosocial impairment. Quantifying alterations in somatosensory profiles, descending modulation, child and parent psychological function will inform individualized therapy and stratification for future clinical trials.
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Interpersonal Dyadic Influences of Pain Catastrophizing Between Caregivers and Children With Chronic Pain. Clin J Pain 2019; 36:61-67. [DOI: 10.1097/ajp.0000000000000773] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Kohler M, Strauss S, Horn U, Langner I, Usichenko T, Neumann N, Lotze M. Differences in Neuronal Representation of Mental Rotation in Patients With Complex Regional Pain Syndrome and Healthy Controls. THE JOURNAL OF PAIN 2019; 20:898-907. [PMID: 30710707 DOI: 10.1016/j.jpain.2019.01.330] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/04/2018] [Revised: 01/16/2019] [Accepted: 01/28/2019] [Indexed: 12/12/2022]
Abstract
Spatial integration of parts of the body is impaired in patients with complex regional pain syndrome (CRPS). Because the training of mental rotation (MR) has been shown to be among the effective therapy strategies for CRPS, impairment of MR is also important for the pathophysiological understanding of CRPS. The aim of this study was to evaluate whether differences in the neural representation of MR occur between patients with CRPS and healthy controls (HC). Therefore, we included 15 patients with chronic CRPS and 15 age- and gender-matched HC. We assessed behavioral (accuracy and reaction time for MR of both hands), clinical (Disabilities of Arm, Shoulder and Hand questionnaire) and magnetic resonance imaging (T1-weighted, function magnetic resonance imaging during MR) data. Reaction times in the patient group were delayed compared with HC without a lateralization effect for the affected hand side. Although both groups showed an activation pattern typical for MR, only HC showed a highly significant contrast for the rotated versus unrotated hands in the right intraparietal sulcus. Patients with CRPS showed a reduction of functional magnetic resonance imaging activation in areas including the subthalamic nucleus, nucleus accumbens, and putamen. Regression analysis for the CRPS group emphasized the importance of putamen and nucleus accumbens activation for MR performance. This study highlights the reduced access of patients with CRPS for mental resources modulating arousal, emotional response, and subcortical sensorimotor integration. PERSPECTIVE: This study localized the underlying neural responses for impaired mental rotation in patients with complex regional pain syndrome as a decrease in basal ganglia (putamen) and nucleus accumbens activation.
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Affiliation(s)
| | - Sebastian Strauss
- Functional Imaging Unit, Center for Diagnostic Radiology, and; Department of Neurology, University of Greifswald, Germany
| | - Ulrike Horn
- Functional Imaging Unit, Center for Diagnostic Radiology, and
| | - Inga Langner
- Division of Hand Surgery and Functional Microsurgery, Department of Trauma and Reconstructive Surgery, and
| | - Taras Usichenko
- Department of Anesthesiology, University Medicine Greifswald, Greifswald, Germany
| | - Nicola Neumann
- Functional Imaging Unit, Center for Diagnostic Radiology, and
| | - Martin Lotze
- Functional Imaging Unit, Center for Diagnostic Radiology, and.
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Timmers I, Park AL, Fischer MD, Kronman CA, Heathcote LC, Hernandez JM, Simons LE. Is Empathy for Pain Unique in Its Neural Correlates? A Meta-Analysis of Neuroimaging Studies of Empathy. Front Behav Neurosci 2018; 12:289. [PMID: 30542272 PMCID: PMC6277791 DOI: 10.3389/fnbeh.2018.00289] [Citation(s) in RCA: 73] [Impact Index Per Article: 12.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2018] [Accepted: 11/08/2018] [Indexed: 01/10/2023] Open
Abstract
Empathy is an essential component of our social lives, allowing us to understand and share other people's affective and sensory states, including pain. Evidence suggests a core neural network—including anterior insula (AI) and mid-cingulate cortex (MCC)—is involved in empathy for pain. However, a similar network is associated to empathy for non-pain affective states, raising the question whether empathy for pain is unique in its neural correlates. Furthermore, it is yet unclear whether neural correlates converge across different stimuli and paradigms that evoke pain-empathy. We performed a coordinate-based activation likelihood estimation (ALE) meta-analysis to identify neural correlates of empathy, assess commonalities and differences between empathy for pain and for non-pain negative affective states, and differences between pain-empathy evoking stimuli (i.e., facial pain expressions vs. acute pain inflictions) and paradigms (i.e., perceptual/affective vs. cognitive/evaluative paradigms). Following a systematic search, data from 128 functional brain imaging studies presenting whole-brain results of an empathy condition vs. baseline/neutral condition were extracted. Synthesizing neural correlates of empathy confirmed a core network comprising AI, MCC, postcentral gyrus, inferior parietal lobe, thalamus, amygdala, and brainstem. There was considerable overlap in networks for empathy for pain and empathy for non-pain negative affective states. Important differences also arose: empathy for pain uniquely activated bilateral mid-insula and more extensive MCC. Regarding stimuli, painful faces and acute pain inflictions both evoked the core empathy regions, although acute pain inflictions activated additional regions including medial frontal and parietal cortex. Regarding paradigms, both perceptual/affective and cognitive/evaluative paradigms recruited similar neural circuitry, although cognitive/evaluative paradigms activated more left MCC regions while perceptual/affective paradigms activated more right AI. Taken together, our findings reveal that empathy for pain and empathy for non-pain negative affective states share considerable neural correlates, particularly in core empathy regions AI and MCC. Beyond these regions, important differences emerged, limiting generalizability of findings across different affective/sensory states. Within pain-empathy studies, the core regions were recruited robustly irrespective of stimuli or instructions, allowing one to tailor designs according to specific needs to some extent, while ensuring activation of core regions.
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Affiliation(s)
- Inge Timmers
- Department of Anesthesiology, Perioperative, and Pain Medicine, Stanford University School of Medicine, Palo Alto, CA, United States
| | - Anna L Park
- Department of Anesthesiology, Perioperative, and Pain Medicine, Stanford University School of Medicine, Palo Alto, CA, United States
| | - Molly D Fischer
- Department of Anesthesiology, Perioperative, and Pain Medicine, Stanford University School of Medicine, Palo Alto, CA, United States
| | - Corey A Kronman
- Department of Anesthesiology, Perioperative, and Pain Medicine, Stanford University School of Medicine, Palo Alto, CA, United States
| | - Lauren C Heathcote
- Department of Anesthesiology, Perioperative, and Pain Medicine, Stanford University School of Medicine, Palo Alto, CA, United States
| | - J Maya Hernandez
- Department of Anesthesiology, Perioperative, and Pain Medicine, Stanford University School of Medicine, Palo Alto, CA, United States
| | - Laura E Simons
- Department of Anesthesiology, Perioperative, and Pain Medicine, Stanford University School of Medicine, Palo Alto, CA, United States
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Guite JW, Russell BS, Homan KJ, Tepe RM, Williams SE. Parenting in the Context of Children's Chronic Pain: Balancing Care and Burden. CHILDREN-BASEL 2018; 5:children5120161. [PMID: 30486470 PMCID: PMC6306930 DOI: 10.3390/children5120161] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 11/01/2018] [Revised: 11/21/2018] [Accepted: 11/23/2018] [Indexed: 01/06/2023]
Abstract
Parents of youth with chronic health conditions encounter numerous challenges in supporting their children across pediatric treatment contexts. Structural barriers to care, such as access issues and coordinating care across school, health, and family settings, can exacerbate challenges to daily functioning. Parents are often concomitantly managing their child’s chronic condition, their own health care needs, work and family demands. For these parents, accomplishing a manageable “work-life balance” feels elusive, if not impossible, when a chronic health condition is part of family life. Based on a recent symposium presentation, combined perspectives from the disciplines of pediatric psychology, parenting, and human development and family studies consider key challenges and opportunities to assist parent coping with stress associated with caregiving amidst pervasive changes in healthcare service delivery. Two innovative interventions to support parents in both an outpatient (“Parents as Coping Coaches”) and an inpatient (“Putting Parents FIRST”) context are described, with commonalities and unique aspects highlighted for each. These programs are considered in reference to a rapidly changing healthcare landscape, growing focus on the family as a core context for care, and importance of parent/caregiver self-care and crucial role in supporting children’s long-term health and resiliency.
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Affiliation(s)
- Jessica W Guite
- Connecticut Children's Medical Center, Hartford, CT 06106, USA.
- Department of Pediatrics, University of Connecticut School of Medicine, Farmington, CT 06030, USA.
| | - Beth S Russell
- Department of Human Development and Family Studies, The University of Connecticut, Storrs, CT 06269, USA.
| | - Kendra J Homan
- Division of Behavioral Medicine and Clinical Psychology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH 45229, USA.
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH 45267, USA.
| | - Rebecca M Tepe
- Division of Social Services, Cincinnati Children's Hospital and Medical Center, Cincinnati, OH 45229, USA.
| | - Sara E Williams
- Division of Behavioral Medicine and Clinical Psychology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH 45229, USA.
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH 45267, USA.
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Parental emotion and pain control behaviour when faced with child's pain: the emotion regulatory role of parental pain-related attention-set shifting and heart rate variability. Pain 2018; 160:322-333. [DOI: 10.1097/j.pain.0000000000001402] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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9
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Supporting Parent Caregivers of Children with Life-Limiting Illness. CHILDREN-BASEL 2018; 5:children5070085. [PMID: 29949926 PMCID: PMC6069074 DOI: 10.3390/children5070085] [Citation(s) in RCA: 41] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 06/06/2018] [Accepted: 06/20/2018] [Indexed: 11/17/2022]
Abstract
The well-being of parents is essential to the well-being of children with life-limiting illness. Parents are vulnerable to a range of negative financial, physical, and psychosocial issues due to caregiving tasks and other stressors related to the illness of their child. Pediatric palliative care practitioners provide good care to children by supporting their parents in decision-making and difficult conversations, by managing pain and other symptoms in the ill child, and by addressing parent and family needs for care coordination, respite, bereavement, and social and emotional support. No matter the design or setting of a pediatric palliative care team, practitioners can seek to provide for parent needs by referral or intervention by the care team.
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Rao-Gupta S, Kruger D, Leak LD, Tieman LA, Manworren RC. Leveraging Interactive Patient Care Technology to Improve Pain Management Engagement. Pain Manag Nurs 2018; 19:212-221. [DOI: 10.1016/j.pmn.2017.11.002] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2017] [Revised: 10/13/2017] [Accepted: 11/05/2017] [Indexed: 10/18/2022]
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Ratnamohan L, Kozlowska K. When things get complicated: At-risk attachment in children and adolescents with chronic pain. Clin Child Psychol Psychiatry 2017; 22:588-602. [PMID: 28994326 DOI: 10.1177/1359104517692850] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
Pain is a signal of danger, and danger activates the attachment system. When a parent responds to a child's pain with appropriate protection and comfort, more often than not, the pain resolves. But what happens in families when a child's pain becomes chronic and continues to signal a danger that has long passed? This study explored patterns of attachment in 48 children and adolescents with chronic functional pain and 48 healthy controls using structured attachment interviews. Patterns of attachment were identified using the Dynamic Maturational Model of Attachment. Compared to controls, children and adolescents with chronic functional pain were classified into at-risk patterns of attachment (χ2 = 76.4, df = 2, p < .001) and had higher rates of unresolved loss and trauma (χ2 = 10.8, df = 1, p = .001), suggesting a long-standing history of relational stress and the disruption of nurturing relationships. The findings suggest that the quality of attachment relationships contribute to the development and maintenance of chronic functional pain. Ongoing anxiety within the attachment relationship, combined with unresolved loss and trauma, may function much like catastrophising, contributing to chronic functional pain by activating the body's arousal systems. The assessment process for chronic functional pain should include a family assessment to identify ruptures in attachment relationships, as well as unresolved loss and trauma events that need to be addressed through family interventions or individual therapy.
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Affiliation(s)
- Lux Ratnamohan
- 1 Department of Psychological Medicine, The Children's Hospital at Westmead, Australia.,2 Psychiatry Research & Teaching Unit, Liverpool Hospital, Australia
| | - Kasia Kozlowska
- 1 Department of Psychological Medicine, The Children's Hospital at Westmead, Australia.,3 Discipline of Psychiatry and Discipline of Child and Adolescent Health, University of Sydney Medical School, Australia.,4 Brain Dynamics Centre, Westmead Institute of Medical Research, Australia
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Jütten LH, Mark RE, Maria Janssen BWJ, Rietsema J, Dröes RM, Sitskoorn MM. Testing the effectivity of the mixed virtual reality training Into D'mentia for informal caregivers of people with dementia: protocol for a longitudinal, quasi-experimental study. BMJ Open 2017; 7:e015702. [PMID: 28827242 PMCID: PMC5724167 DOI: 10.1136/bmjopen-2016-015702] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
INTRODUCTION Informal caregivers for people with dementia (hereafter: caregivers) often feel (over)burdened by the care for a loved one with dementia, and this can have various deleterious effects on both caregivers and patients. Support for caregivers is urgently needed, and for this reason, a dementia simulator (Into D'mentia) was developed in which caregivers experience what it is like to have dementia. The simulator attempts to heighten caregivers' empathy and understanding for the patient and, in turn, diminish their own caregiver burden. The current study evaluates whether the simulator is effective on a number of outcomes. METHODS AND ANALYSIS A longitudinal, quasi-experimental study is ongoing in the Netherlands. We aim to recruit 142 caregivers in total divided over two groups: 71 caregivers in the intervention group and 71 caregivers in the control group. All participants will complete interviews and questionnaires at four time points: at baseline, 1 week, 2.5 months and 15 months after the training. The primary outcomes include empathy, caregiver burden, caregiver's sense of competence, social reliance, anxiety, depression and caregivers' subjective and objective health. ETHICS AND DISSEMINATION This study is being carried out in agreement with the Declaration of Helsinki, and the protocol has been approved by the local ethics committees. REGISTRATION DETAILS This study is registered with The Netherlands National Trial Register (NNTR5856).
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Affiliation(s)
- Linda Helena Jütten
- Department of Cognitive Neuropsychology, Tilburg University, Tilburg, The Netherlands
| | - Ruth Elaine Mark
- Department of Cognitive Neuropsychology, Tilburg University, Tilburg, The Netherlands
| | | | | | - Rose-Marie Dröes
- Department of Psychiatry, VU University Medical Center, Amsterdam, The Netherlands
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