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Sakuma Y, Miller MLE, Babalis DS, Baker A, Reddi M, Anjum A, Bruton J, Jones KN, Mulla UZ, Taddese H. Shining a spotlight on the inclusion of disabled participants in clinical trials: a mixed methods study. Trials 2024; 25:281. [PMID: 38671497 PMCID: PMC11046956 DOI: 10.1186/s13063-024-08108-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2023] [Accepted: 04/12/2024] [Indexed: 04/28/2024] Open
Abstract
BACKGROUND It is crucial to include a wide range of the population in clinical trials for the outcome to be applicable in real-world settings. Existing literature indicates that under-served groups, including disabled people, have been excluded from participating in clinical trials without justification. Exclusion from clinical trials exacerbates disparities in healthcare and diminishes the benefits for excluded populations. Therefore, this study was conducted to investigate potential obstacles that prevent disabled people from participating in clinical trials in the United Kingdom (UK). METHODS The study was carried out through an explanatory sequential mixed methods design. The Imperial Clinical Trials Unit devised and implemented an online questionnaire-based survey (with open/closed-ended questions) and an online focus group discussion. The target population were disabled people, family members/carers of disabled people and staff involved in clinical trials, whereupon the sample was recruited by convenience sampling methods via posters and emails through various networks. The Qualtrics XM survey system was used as the host platform for the online survey, and Microsoft Teams was used for an online focus group discussion. The focus group discussion was conducted to gain a deeper understanding of the themes identified from the survey responses. We analysed responses to the survey via descriptive analysis and used thematic analysis to synthesise the free-text answers from the survey and focus group discussion. RESULTS We received 45 responses to the survey questionnaire and 5 disabled people took part in a focus group discussion. Our findings highlighted the differences between the perspectives of researchers and those "being researched" and different types of barriers experienced by disabled people: opportunity barriers (inadequate recruitment strategy and ambiguous eligibility criteria), awareness barriers (perception of disability) and acceptance/refusal barriers (available support and adjustment, and sharing of trial results). CONCLUSION Our findings support perspectives drawn from the Ford Framework regarding the need to consider all barriers, not just up to the point of enrolment into trials but also beyond the point of inclusion in clinical trials. We support calls for the introduction of legislation on including disabled people in clinical trials, implementation of industry/community-wide participatory approaches and the development of guidelines, a combined public-private approach.
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Affiliation(s)
- Yoshiko Sakuma
- Faculty of Medicine, School of Public Health, Imperial College London, South Kensington Campus, London, SW7 2AZ, UK.
| | - Marie L E Miller
- Imperial Clinical Trials Unit, School of Public Health, Imperial College London, Stadium House, 68 Wood Ln, London, W12 7RH, UK
| | - Daphne S Babalis
- Imperial Clinical Trials Unit, School of Public Health, Imperial College London, Stadium House, 68 Wood Ln, London, W12 7RH, UK
| | - Alex Baker
- Imperial Clinical Trials Unit - Cancer, Department of Surgery and Cancer, Convergence Science Centre, Imperial College London, South Kensington Campus, London, Cancer Research, SW7 2AZ, UK
| | - Meena Reddi
- Imperial Clinical Trials Unit - Cancer, Department of Surgery and Cancer, Convergence Science Centre, Imperial College London, South Kensington Campus, London, Cancer Research, SW7 2AZ, UK
| | - Aisha Anjum
- Imperial Clinical Trials Unit, School of Public Health, Imperial College London, Stadium House, 68 Wood Ln, London, W12 7RH, UK
| | - Jane Bruton
- Patient Experience Research Centre, Imperial College London, South Kensington Campus, London, SW7 2AZ, UK
| | - Kathryn N Jones
- Patient Experience Research Centre, Imperial College London, South Kensington Campus, London, SW7 2AZ, UK
| | - Umm Zeinab Mulla
- Faculty of Medicine, School of Public Health, Medical School, Imperial College London, St Mary's Campus, 167, Praed Street, London, W2 1NY, UK
| | - Henock Taddese
- Faculty of Medicine, School of Public Health, Medical School, Imperial College London, St Mary's Campus, 167, Praed Street, London, W2 1NY, UK
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Smeets G, Volkers K, Scherder E, Moonen X. An Individual Music Intervention for Adults With Intellectual Disabilities and Challenging Behavior: Protocol for a Randomized Controlled Trial. JMIR Res Protoc 2024; 13:e52497. [PMID: 38324357 PMCID: PMC10882479 DOI: 10.2196/52497] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2023] [Revised: 12/22/2023] [Accepted: 12/24/2023] [Indexed: 02/08/2024] Open
Abstract
BACKGROUND Individuals with intellectual disabilities (ID) are more likely to have problems with executive functioning (EF) and challenging behavior (CB), which are negatively linked to well-being. Among clinical populations, music interventions have been shown to improve various outcome measures, such as CB and EF. Until now, no randomized controlled trials (RCTs) have been conducted to examine the effectiveness of an individual music intervention for adults with ID and CB. OBJECTIVE The study aims to identify the effect and feasibility of an individual music intervention compared with care-as-usual for people with ID and CB. METHODS In this study, a 2-group RCT with a pretest, posttest, and follow-up assessment after 8 weeks is presented. Participants of the music intervention condition will receive 16 individual music sessions within 8 to 10 weeks. The music intervention will be guided by a manual for music workers, in which every session will have a different focus (introduction, emotions, different EF, and end performance). Participants receiving care as usual will function as a control group. After the research is finished, they will be offered a budget, which they can spend on musical activities or musical instruments as they wish. Assessments will include caregiver rating scales and self-report questionnaires and tests, which will assess outcome measures of CB, well-being, depression, anxiety, self-esteem, and 4 domains of EF. A process evaluation will be conducted after the completion of the study, which entails the analysis of data on multiple aspects of the intervention and the study overall. RESULTS Enrollment commenced in July 2021, and data collection ended in May 2023. A total of 97 participants were recruited, with 44 participants allocated to the intervention group and 53 allocated to the control group. Data will be analyzed after this protocol has been accepted for publication. CONCLUSIONS Because there are currently no published RCTs of an individual music intervention for adults with ID and CB, this study will provide insight into the effectiveness and experiences of an individual music intervention for this target group. TRIAL REGISTRATION International Clinical Trials Registry Platform NL8482; http://tinyurl.com/4565s5pd. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID) DERR1-10.2196/52497.
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Affiliation(s)
| | - Karin Volkers
- Philadelphia Care Foundation, Amersfoort, Netherlands
| | - Erik Scherder
- Department of Clinical Neuropsychology, VU University Amsterdam, Amsterdam, Netherlands
| | - Xavier Moonen
- Research Institute of Child Development and Education, University of Amsterdam, Amsterdam, Netherlands
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Hecker J, Conecker G, Chapman C, Hommer R, Ludwig NN, Sevinc G, Te S, Wojnaroski M, Downs J, Berg AT. Patient-advocate-led global coalition adapting fit-for-purpose outcomes measures to assure meaningful inclusion of DEEs in clinical trials. THERAPEUTIC ADVANCES IN RARE DISEASE 2024; 18:26330040241249762. [PMID: 38911512 PMCID: PMC11193340 DOI: 10.1177/26330040241249762] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/03/2024] [Accepted: 04/02/2024] [Indexed: 06/25/2024]
Abstract
Existing clinical tools that measure non-seizure outcomes lack the range and granularity needed to capture skills in developmental and epileptic encephalopathy (DEE)-affected individuals who also fall in the severe to profound range of intellectual disability. This effectively excludes those with severe impairments from clinical trials, impeding the ability of sponsors to evaluate disease-modifying therapies (DMTs). The Inchstone Project, an international, patient advocate-led collaboration, brings together leading researchers, clinicians, pharmaceutical companies, and advocates to develop an adapted, validated assessment battery within 5 years. The goal is to support trials of DMTs for the DEEs by providing sufficiently sensitive measurement tools to demonstrate therapeutic efficacy. An initial pilot study administered 7 established assessments to 10 individuals affected by SCN2A-DEE, identifying specific limitations of existing measures and areas for improvement. It was clear that most tools do not account for challenges throughout the DEE population, including vision impairments, significant motor impairments and profound intellectual disability, which need to be accounted for in creating a 'fit-for-purpose' battery for the DEE population. Several novel assessments, including two measures of responsivity developed for use in monitoring recovery after acquired brain injury as well as individualized Goal Attainment Scaling, showed promise in this group. The team also completed a DEE-wide survey with over 270 caregivers documenting their children's abilities and priorities for their improvement from new treatments. The Inchstone team is using this information to evaluate how existing tools might be updated to better capture what is most important to families and measure their child's small but important improvements over time. These efforts are building a coherent picture across multiple DEEs of what domains, or concepts of interest, have the greatest impact on most patients and families. The Inchstone team is on course to adapt non-seizure outcome measures that are (1) sufficiently sensitive to measure small increments of meaningful change ('Inchstones') and (2) applicable to multiple DEE conditions.
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Affiliation(s)
- JayEtta Hecker
- DEE-P Connections, a project of Decoding Developmental Epilepsies, 1234 Crittenden St NW, Washington, DC 20011, USA
| | - Gabrielle Conecker
- DEE-P Connections, a project of Decoding Developmental Epilepsies, Washington, DC, USA
| | | | - Rebecca Hommer
- Maryland Deaf and Blind Project, University of Maryland, College Park, MD, USA
| | - Natasha N. Ludwig
- Kennedy-Krieger Institute, Johns Hopkins School of Medicine, Baltimore, MD, USA
| | | | - Sara Te
- DEE-P Connections, a project of Decoding Developmental Epilepsies, Washington, DC, USA
| | - Mary Wojnaroski
- Nationwide Children’s Hospital, The Ohio State University, Columbus, OH, USA
| | - Jenny Downs
- Telethon Kids Institute Centre for Child Health Research, Perth, WA, Australia
| | - Anne T. Berg
- Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
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Cordier R, Parsons L, Wilkes-Gillan S, Cook M, McCloskey-Martinez M, Graham P, Littlefair D, Kent C, Speyer R. Friendship interventions for children with neurodevelopmental needs: A systematic review and meta-analysis. PLoS One 2023; 18:e0295917. [PMID: 38096327 PMCID: PMC10721178 DOI: 10.1371/journal.pone.0295917] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2023] [Accepted: 11/30/2023] [Indexed: 12/18/2023] Open
Abstract
RATIONALE Children with neurodevelopmental disorders such as attention-deficit hyperactivity disorder (ADHD), autism, developmental language disorder (DLD), intellectual disability (ID), and social (pragmatic) communication disorder (SPCD) experience difficulties with social functioning due to differences in their social, emotional and cognitive skills. Previous systematic reviews have focussed on specific aspects of social functioning rather than broader peer functioning and friendships. OBJECTIVE To systematically review and methodologically appraise the quality and effectiveness of existing intervention studies that measured friendship outcomes for children with ADHD, autism, DLD, ID, and SPCD. METHOD Following PRISMA guidelines, we searched five electronic databases: CINAHL, Embase, Eric, PsycINFO, and PubMed. Two independent researchers screened all abstracts and disagreements were discussed with a third researcher to reach consensus. The methodological quality of studies was assessed using the Cochrane Risk of Bias Tool for Randomised Trials. RESULTS Twelve studies involving 15 interventions were included. Studies included 683 children with a neurodevelopmental disorder and 190 typically-developing children and diagnosed with either autism or ADHD. Within-group meta-analysis showed that the pooled intervention effects for friendship across all interventions were small to moderate (z = 2.761, p = 0.006, g = 0.485). The pooled intervention effect between intervention and comparison groups was not significant (z = 1.206, p = 0.400, g = 0.215). CONCLUSION Findings provide evidence that some individual interventions are effective in improving social functioning and fostering more meaningful friendships between children with neurodevelopmental disorders and their peers. Effective interventions involved educators, targeted child characteristics known to moderate peer functioning, actively involved peers, and incorporated techniques to facilitate positive peer perceptions and strategies to support peers. Future research should evaluate the effectiveness of friendship interventions for children with DLD, ID and SPCD, more comprehensively assess peer functioning, include child self-report measures of friendship, and longitudinally evaluate downstream effects on friendship.
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Affiliation(s)
- Reinie Cordier
- Department of Social Work, Education and Community Wellbeing, Northumbria University, Newcastle upon Tyne, United Kingdom
- Faculty of Health Sciences, Curtin School of Allied Health, Curtin University, Perth, Australia
- Faculty of Health Sciences, Department of Health & Rehabilitation Sciences, University of Cape Town, University of Cape Town, Cape Town, South Africa
| | - Lauren Parsons
- Faculty of Health Sciences, Curtin School of Allied Health, Curtin University, Perth, Australia
| | - Sarah Wilkes-Gillan
- Faculty of Medicine and Health, Sydney School of Health Sciences, The University of Sydney, Sydney, NSW, Australia
| | - Matthew Cook
- Department of Social Work, Education and Community Wellbeing, Northumbria University, Newcastle upon Tyne, United Kingdom
| | - Matthew McCloskey-Martinez
- Department of Social Work, Education and Community Wellbeing, Northumbria University, Newcastle upon Tyne, United Kingdom
| | - Pamela Graham
- Department of Social Work, Education and Community Wellbeing, Northumbria University, Newcastle upon Tyne, United Kingdom
| | - David Littlefair
- Department of Social Work, Education and Community Wellbeing, Northumbria University, Newcastle upon Tyne, United Kingdom
| | - Cally Kent
- Faculty of Health Sciences, Curtin School of Allied Health, Curtin University, Perth, Australia
| | - Renée Speyer
- Faculty of Health Sciences, Curtin School of Allied Health, Curtin University, Perth, Australia
- Department Special Needs Education, University of Oslo, Oslo, Norway
- Department of Otorhinolaryngology and Head and Neck Surgery, Leiden University Medical Centre, Leiden, The Netherlands
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Smeets GJJ, Volkers KM, Scherder EJA, Moonen XMH. Active music making and leisure activities for people with intellectual disabilities: A cluster randomized pilot study. RESEARCH IN DEVELOPMENTAL DISABILITIES 2023; 142:104606. [PMID: 37827006 DOI: 10.1016/j.ridd.2023.104606] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/23/2022] [Revised: 07/23/2023] [Accepted: 09/28/2023] [Indexed: 10/14/2023]
Abstract
AIM A pilot cluster randomized controlled trial was performed to evaluate the effects of a music group intervention and a leisure activities group intervention on well-being, self-esteem, social acceptance, challenging behaviour and three components of executive functions (inhibitory control, cognitive flexibility and visual working memory) of adults with intellectual disabilities (ID). METHOD Twenty-nine participants living in four residential facilities for people with ID were randomized into a music or a leisure activities group intervention. Sixteen weekly sessions of one hour were performed with six to eight participants per group. Measurements were carried out at baseline, post-intervention and 11 weeks follow- up. Results were analysed with linear mixed models. RESULTS The leisure activities group intervention improved more than the music group intervention on internalizing behaviour overall and on inhibitory control at post-intervention. However, further analyses showed that this improvement was only significant in one of the two leisure activities facilities. CONCLUSION A leisure activities group intervention seems a promising intervention to improve internalizing behaviour and inhibitory control of younger adults with mild ID. Implications for the delivery of leisure activities group interventions and especially music group interventions are discussed. WHAT THIS PAPER ADDS Involvement in leisure activities of people with ID is associated with better well-being, an improvement in social skills and a reduction in emotional and behavioural problems. Active music making, as a specific form of leisure activities, seems to improve well-being, social acceptance and challenging behaviour (CB) as well. Moreover, in different (non-clinical) groups a significant effect of active music making has been found on self-esteem and executive functioning (EF). So far, little attention has been paid to the possible positive effects of active music making on adults with ID. In the current paper, a randomized controlled trial (RCT) was conducted to compare the post-intervention and follow-up measurements with baseline measurements between a music group intervention and a leisure activities group intervention on well-being, self-esteem, social acceptance, CB and EF in adults with ID. Multilevel models were used to detect possible intervention effects of 16 weekly sessions. Overall, inhibitory control and internalizing behaviour improved more amongst the participants of the leisure activities group than amongst the participants of the music group. This was mainly the case for younger participants who had mild ID. These effects are discussed and recommendations regarding the improvement of a music intervention for people with ID are presented.
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Affiliation(s)
- Gerianne J J Smeets
- Philadelphia Care Foundation, PO box 1255, 3800 BG Amersfoort, the Netherlands.
| | - Karin M Volkers
- Philadelphia Care Foundation, PO box 1255, 3800 BG Amersfoort, the Netherlands
| | - Erik J A Scherder
- Department of Clinical Neuropsychology, VU University Amsterdam, van der Boechorstraat 7, 1081 BT Amsterdam, the Netherlands
| | - Xavier M H Moonen
- Research Institute of Child Development and Education, University of Amsterdam, Postbus 15776, 1001 NG Amsterdam, the Netherlands
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Brotherton M, Stancliffe RJ, O'Loughlin K, Wilson NJ. From mainstream employment to mainstream retirement: A randomised controlled trial of a transition to retirement intervention for adults with intellectual disability. JOURNAL OF APPLIED RESEARCH IN INTELLECTUAL DISABILITIES 2023; 36:1013-1024. [PMID: 37106266 DOI: 10.1111/jar.13111] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2022] [Revised: 03/23/2023] [Accepted: 04/11/2023] [Indexed: 04/29/2023]
Abstract
BACKGROUND We evaluated a transition to retirement intervention that adapted strategies used to support employment of people with intellectual disability in mainstream workplaces. The intervention facilitated their independent participation in mainstream community groups and volunteering. METHODS We randomised 29 older Australians who currently/previously worked in mainstream employment into an intervention group or wait-list control group. Hours of independent participation in target activities were collected before and after the 13-week initial intervention/waiting period, and at 52 weeks for intervention participants. RESULTS Six of the 12 intervention participants selected an activity and increased hours of independent participation following 13 weeks in the Keeping Active (KA) program and eight were independently accessing their selected activity at 52-week follow-up. None of the 19 wait-list participants increased their independent participation after 13 weeks. CONCLUSIONS The intervention was effective and highlighted the need to account for factors such as participant choice in evaluation of individualised programs.
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Affiliation(s)
| | | | - Kate O'Loughlin
- Faculty of Medicine and Health, University of Sydney, Sydney, Australia
| | - Nathan J Wilson
- School of Nursing and Midwifery, Western Sydney University, Sydney, Australia
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Baker FA, Blauth L, Bloska J, Bukowska AA, Flynn L, Hsu MH, Janus E, Johansson K, Odell-Miller H, Miller H, Petrowitz C, Pool J, Stensæth K, Tamplin J, Teggelove K, Wosch T, Sousa TV. Recruitment approaches and profiles of consenting family caregivers and people living with dementia: A recruitment study within a trial. Contemp Clin Trials Commun 2023; 32:101079. [PMID: 36949849 PMCID: PMC10025412 DOI: 10.1016/j.conctc.2023.101079] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2022] [Revised: 01/04/2023] [Accepted: 01/28/2023] [Indexed: 02/01/2023] Open
Abstract
Background While studies have identified strategies that are useful for recruiting people living with dementia, none have focused on psychosocial interventions involving arts therapies, or have examined the profiles of older people living in the community who consent or decline participation, particularly during a global pandemic. We aimed to identify the most effective recruitment strategies according to participant characteristics and transnational differences and develop a profile of consenting and non-consenting participants. Methods Recruitment teams in Australia, Norway, Germany, Poland, and the United Kingdom, recorded participants' source of study awareness and characteristics of consenting and non-consenting participants. Distributions of participants 'consenting to participate' were compared and logistic regressions were used to estimate the odds ratios. Results Consenting female caregivers were disproportionally represented. Study awareness differed between countries but overall, most expressions of interest to participate were derived from referrals from professionals or organisations, or from databases of people wanting to participate in research. Troughs in recruitment rates occurred during Northern Hemisphere summer vacation periods, and during Christmas periods. Conclusions This study found that recruiting for a trial with community-dwelling family caregivers and people living with dementia is challenging, especially during a global pandemic. While spousal caregivers comprised the highest proportion of dyads recruited, overall spousal caregivers were more reluctant to consent to participate than adult child caregivers. More targeted recruitment strategies designed for minority groups are also needed to ensure broader representation in dementia treatment studies.
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Affiliation(s)
- Felicity A. Baker
- Faculty of Fine Arts and Music, The University of Melbourne, Melbourne, Victoria, Australia
- Centre for Research in Music and Health, Norwegian Academy of Music, Oslo, Norway
- Corresponding author. The University of Melbourne, The Conservatorium of Music, Gate 12, Royal Parade, Parkville, Melbourne, Victoria, 3010, Australia.
| | - Laura Blauth
- Hochschule für Angewandte Wissenschaften Würzburg-Schweinfurt, Würzburg, Germany
| | - Jodie Bloska
- Cambridge Institute for Music Therapy Research, Anglia Ruskin University, Cambridge, UK
| | - Anna A. Bukowska
- Institute for Applied Science, University of Physical Education, Kraków, Poland
| | - Libby Flynn
- Faculty of Fine Arts and Music, The University of Melbourne, Melbourne, Victoria, Australia
| | - Ming-Hung Hsu
- Cambridge Institute for Music Therapy Research, Anglia Ruskin University, Cambridge, UK
| | - Edyta Janus
- Institute for Applied Science, University of Physical Education, Kraków, Poland
| | - Kjersti Johansson
- Centre for Research in Music and Health, Norwegian Academy of Music, Oslo, Norway
| | - Helen Odell-Miller
- Cambridge Institute for Music Therapy Research, Anglia Ruskin University, Cambridge, UK
| | - Hayley Miller
- Faculty of Fine Arts and Music, The University of Melbourne, Melbourne, Victoria, Australia
| | - Carina Petrowitz
- Hochschule für Angewandte Wissenschaften Würzburg-Schweinfurt, Würzburg, Germany
| | - Jonathan Pool
- Cambridge Institute for Music Therapy Research, Anglia Ruskin University, Cambridge, UK
| | - Karette Stensæth
- Centre for Research in Music and Health, Norwegian Academy of Music, Oslo, Norway
| | - Jeanette Tamplin
- Faculty of Fine Arts and Music, The University of Melbourne, Melbourne, Victoria, Australia
| | - Kate Teggelove
- Faculty of Fine Arts and Music, The University of Melbourne, Melbourne, Victoria, Australia
| | - Thomas Wosch
- Hochschule für Angewandte Wissenschaften Würzburg-Schweinfurt, Würzburg, Germany
| | - Tanara Vieira Sousa
- Faculty of Fine Arts and Music, The University of Melbourne, Melbourne, Victoria, Australia
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Prior D, Win S, Hassiotis A, Hall I, Martiello MA, Ali AK. Behavioural and cognitive-behavioural interventions for outwardly directed aggressive behaviour in people with intellectual disabilities. Cochrane Database Syst Rev 2023; 2:CD003406. [PMID: 36745863 PMCID: PMC9901280 DOI: 10.1002/14651858.cd003406.pub5] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
BACKGROUND Outwardly directed aggressive behaviour in people with intellectual disabilities is a significant issue that may lead to poor quality of life, social exclusion and inpatient psychiatric admissions. Cognitive and behavioural approaches have been developed to manage aggressive behaviour but the effectiveness of these interventions on reducing aggressive behaviour and other outcomes are unclear. This is the third update of this review and adds nine new studies, resulting in a total of 15 studies in this review. OBJECTIVES To evaluate the efficacy of behavioural and cognitive-behavioural interventions on outwardly directed aggressive behaviour compared to usual care, wait-list controls or no treatment in people with intellectual disability. We also evaluated enhanced interventions compared to non-enhanced interventions. SEARCH METHODS We used standard, extensive Cochrane search methods. The latest search date was March 2022. We revised the search terms to include positive behaviour support (PBS). SELECTION CRITERIA We included randomised and quasi-randomised trials of children and adults with intellectual disability of any duration, setting and any eligible comparator. DATA COLLECTION AND ANALYSIS We used standard Cochrane methods. Our primary outcomes were change in 1. aggressive behaviour, 2. ability to control anger, and 3. adaptive functioning, and 4. ADVERSE EFFECTS Our secondary outcomes were change in 5. mental state, 6. medication, 7. care needs and 8. quality of life, and 9. frequency of service utilisation and 10. user satisfaction data. We used GRADE to assess certainty of evidence for each outcome. We expressed treatment effects as mean differences (MD) or odds ratios (OR), with 95% confidence intervals (CI). Where possible, we pooled data using a fixed-effect model. MAIN RESULTS This updated version comprises nine new studies giving 15 included studies and 921 participants. The update also adds new interventions including parent training (two studies), mindfulness-based positive behaviour support (MBPBS) (two studies), reciprocal imitation training (RIT; one study) and dialectical behavioural therapy (DBT; one study). It also adds two new studies on PBS. Most studies were based in the community (14 studies), and one was in an inpatient forensic service. Eleven studies involved adults only. The remaining studies involved children (one study), children and adolescents (one study), adolescents (one study), and adolescents and adults (one study). One study included boys with fragile X syndrome. Six studies were conducted in the UK, seven in the USA, one in Canada and one in Germany. Only five studies described sources of funding. Four studies compared anger management based on cognitive behaviour therapy to a wait-list or no treatment control group (n = 263); two studies compared PBS with treatment as usual (TAU) (n = 308); two studies compared carer training on mindfulness and PBS with PBS only (n = 128); two studies involving parent training on behavioural approaches compared to wait-list control or TAU (n = 99); one study of mindfulness to a wait-list control (n = 34); one study of adapted dialectal behavioural therapy compared to wait-list control (n = 21); one study of RIT compared to an active control (n = 20) and one study of modified relaxation compared to an active control group (n = 12). There was moderate-certainty evidence that anger management may improve severity of aggressive behaviour post-treatment (MD -3.50, 95% CI -6.21 to -0.79; P = 0.01; 1 study, 158 participants); very low-certainty evidence that it might improve self-reported ability to control anger (MD -8.38, 95% CI -14.05 to -2.71; P = 0.004, I2 = 2%; 3 studies, 212 participants), adaptive functioning (MD -21.73, 95% CI -36.44 to -7.02; P = 0.004; 1 study, 28 participants) and psychiatric symptoms (MD -0.48, 95% CI -0.79 to -0.17; P = 0.002; 1 study, 28 participants) post-treatment; and very low-certainty evidence that it does not improve quality of life post-treatment (MD -5.60, 95% CI -18.11 to 6.91; P = 0.38; 1 study, 129 participants) or reduce service utilisation and costs at 10 months (MD 102.99 British pounds, 95% CI -117.16 to 323.14; P = 0.36; 1 study, 133 participants). There was moderate-certainty evidence that PBS may reduce aggressive behaviour post-treatment (MD -7.78, 95% CI -15.23 to -0.32; P = 0.04, I2 = 0%; 2 studies, 275 participants) and low-certainty evidence that it probably does not reduce aggressive behaviour at 12 months (MD -5.20, 95% CI -13.27 to 2.87; P = 0.21; 1 study, 225 participants). There was low-certainty evidence that PBS does not improve mental state post-treatment (OR 1.44, 95% CI 0.83 to 2.49; P = 1.21; 1 study, 214 participants) and very low-certainty evidence that it might not reduce service utilisation at 12 months (MD -448.00 British pounds, 95% CI -1660.83 to 764.83; P = 0.47; 1 study, 225 participants). There was very low-certainty evidence that mindfulness may reduce incidents of physical aggression (MD -2.80, 95% CI -4.37 to -1.23; P < 0.001; 1 study; 34 participants) and low-certainty evidence that MBPBS may reduce incidents of aggression post-treatment (MD -10.27, 95% CI -14.86 to -5.67; P < 0.001, I2 = 87%; 2 studies, 128 participants). Reasons for downgrading the certainty of evidence were risk of bias (particularly selection and performance bias); imprecision (results from single, often small studies, wide CIs, and CIs crossing the null effect); and inconsistency (statistical heterogeneity). AUTHORS' CONCLUSIONS There is moderate-certainty evidence that cognitive-behavioural approaches such as anger management and PBS may reduce outwardly directed aggressive behaviour in the short term but there is less certainty about the evidence in the medium and long term, particularly in relation to other outcomes such as quality of life. There is some evidence to suggest that combining more than one intervention may have cumulative benefits. Most studies were small and there is a need for larger, robust randomised controlled trials, particularly for interventions where the certainty of evidence is very low. More trials are needed that focus on children and whether psychological interventions lead to reductions in the use of psychotropic medications.
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Affiliation(s)
- David Prior
- Forensic Intellectual and Neurodevelopmental Disabilities (FIND) Community Team South London Partnership, Oxleas NHS Foundation Trust, London, UK
| | - Soe Win
- Services for People with Learning Disabilities (Luton), East London NHS Foundation Trust, London, UK
| | | | - Ian Hall
- Hackney Integrated Learning Disability Service, East London NHS Foundation Trust, London, UK
| | - Michele A Martiello
- More Ward, Goodmayes Hospital, North East London NHS Foundation Trust, London, UK
| | - Afia K Ali
- Unit for Social and Community Psychiatry, East London NHS Foundation Trust, London, UK
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Shields N, Bennell KL, Southby A, Rice LJ, Markovic T, Bigby C, Prendergast L, Watts JJ, Schofield C, Loughnan G, Franklin J, Levitt D, Chikani V, McCallum Z, Blair S, Proietto J, Taylor NF. Progressive resistance training in young people with Prader-Willi syndrome: protocol for a randomised trial (PRESTO). BMJ Open 2022; 12:e060306. [PMID: 36549735 PMCID: PMC9791392 DOI: 10.1136/bmjopen-2021-060306] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Abstract
INTRODUCTION Preliminary evidence suggests that progressive resistance training may be beneficial for people with Prader-Willi Syndrome (PWS), a rare genetic condition that results in muscle weakness and low muscle tone.To establish whether community-based progressive resistance training is effective in improving the muscle strength of people with PWS; to determine cost-effectiveness; and, to complete a process evaluation assessing intervention fidelity, exploring mechanisms of impact, understanding participant experiences and identifying contextual factors affecting implementation. METHODS AND ANALYSIS A multisite, randomised controlled trial will be completed. Sixty participants with PWS will be randomised to receive either progressive resistance training (experimental) or non-progressive exercise (placebo control). Participants will be aged 13 to 60 years, be able to follow simple instructions in English and have no contraindications to performing progressive resistance training. The experimental group will complete progressive resistance training two times weekly for 24 weeks supervised by an exercise professional at a community gym. The control group will receive all aspects of the intervention except progressive overload. Outcomes will be assessed at week 25 (primary endpoint) and week 52 by a blinded assessor. The primary outcome is muscle strength assessed using one repetition maximum for upper limb and lower limb. Secondary outcomes are muscle mass, functional strength, physical activity, community participation, health-related quality of life and behaviour. Health economic analysis will evaluate cost-effectiveness. Process evaluation will assess safety and intervention fidelity, investigate mechanism of impact, explore participant experiences and identify contextual factors affecting implementation. Data collection commenced in February 2020 and will conclude in September 2023. ETHICS AND DISSEMINATION Ethical approval was obtained from The Royal Children's Hospital Human Research Ethics Committee (HREC/50874/RCHM-2019) under the National Mutual Acceptance initiative. Research governance approvals were obtained from five clinical sites. Results will be disseminated through published manuscripts, conference presentations, public seminars and practical resources for stakeholder groups. TRIAL REGISTRATION NUMBER ACTRN12620000416998; Australian and New Zealand Clinical Trial Registry.
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Affiliation(s)
- Nora Shields
- Department of Physiothearpy, Podiatry and Prosthetics and Orthotics, La Trobe University, Melbourne, Victoria, Australia
| | - Kim L Bennell
- Centre for Health, Exercise & Sports Medicine, University of Melbourne, Parkville, Victoria, Australia
| | - Alesha Southby
- Department of Physiothearpy, Podiatry and Prosthetics and Orthotics, La Trobe University, Melbourne, Victoria, Australia
| | - Lauren J Rice
- Westmead Clinical School (Child & Adolescent Health), University of Sydney, Sydney, New South Wales, Australia
| | - Tania Markovic
- Boden Collaboration, University of Sydney, Sydney, New South Wales, Australia
- Metabolism & Obesity Services, Royal Prince Alfred Hospital, Camperdown, New South Wales, Australia
| | - Christine Bigby
- Living with Disability Research Centre, La Trobe University, Bundoora, Victoria, Australia
| | - Luke Prendergast
- Department of Mathematics and Statistics, La Trobe University, Bundoora, Victoria, Australia
| | - Jennifer J Watts
- School of Health & Social Development, Faculty of Health, Deakin University, Burwood, Victoria, Australia
| | - Cara Schofield
- Department of Physiothearpy, Podiatry and Prosthetics and Orthotics, La Trobe University, Melbourne, Victoria, Australia
| | - Georgina Loughnan
- Metabolism & Obesity Services, Royal Prince Alfred Hospital, Camperdown, New South Wales, Australia
| | - Janet Franklin
- Metabolism & Obesity Services, Royal Prince Alfred Hospital, Camperdown, New South Wales, Australia
| | - David Levitt
- Department of Paediatric Medicine and Dermatology, Queensland Children's Hospital, South Brisbane, Queensland, Australia
| | - Viral Chikani
- Department of Endocrinology, Princess Alexandra Hospital, Woolloongabba, Queensland, Australia
| | - Zoe McCallum
- Department of Neurodevelopment and Disability, Royal Children's Hospital, Melbourne, Victoria, Australia
| | - Susan Blair
- Prader-Willi Research Foundation of Australia, Heidelberg, Melbourne, Australia
| | - Joseph Proietto
- Faculty of Medicine, Dentistry and Health Sciences, University of Melbourne, Melbourne, Victoria, Australia
| | - Nicholas F Taylor
- Department of Physiothearpy, Podiatry and Prosthetics and Orthotics, La Trobe University, Melbourne, Victoria, Australia
- Allied Health Clinical Research Office, Eastern Health, Box Hill, Victoria, Australia
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10
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Elbers RG, de Oude KI, Kastanidis T, Maes-Festen DAM, Oppewal A. The Effect of Progressive Resistance Exercise Training on Cardiovascular Risk Factors in People with Intellectual Disabilities: A Study Protocol. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:16438. [PMID: 36554319 PMCID: PMC9778210 DOI: 10.3390/ijerph192416438] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 10/24/2022] [Revised: 12/01/2022] [Accepted: 12/06/2022] [Indexed: 06/17/2023]
Abstract
Progressive resistance exercise training (PRET) reduces cardiovascular risk factors (CVRF) in the general population. It is unknown if PRET also reduces these risk factors in adults with intellectual disabilities (ID). The aim is to present the protocol of an intervention study that investigates the effect of PRET on CVRF in adults with ID. We will use a repeated time series design with one study group. Adults with mild-to-moderate ID and at least two CVRF are eligible (Netherlands Trial Register, NL8382). During a 12-week baseline period, measurements take place at a 6-week interval. After this, the PRET programme starts for 24 weeks, after which all measurements will be repeated. We will use hierarchical regression models, adjusted for sport activity and medication use, to estimate the effect of PRET. After the intervention, the participants will be followed-up for 12 weeks. We will evaluate factors for successful implementation of exercise in daily life. Primary outcomes are: hypertension, obesity, hypercholesterolemia, diabetes, metabolic syndrome. Secondary outcomes are: physical fitness, sarcopenia, physical activity, activities of daily living, falls, challenging behaviour. If our results show that the PRET programme is effective, it may be a promising non-pharmacological intervention to reduce CVRF in adults with ID.
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11
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McDonald KE, Schwartz AE, Sabatello M. Eligibility criteria in NIH-funded clinical trials: Can adults with intellectual disability get in? Disabil Health J 2022; 15:101368. [PMID: 36123292 DOI: 10.1016/j.dhjo.2022.101368] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2022] [Revised: 08/04/2022] [Accepted: 08/14/2022] [Indexed: 01/21/2023]
Abstract
BACKGROUND Although scientific breakthroughs can promote health equity, there is concern that adults with intellectual disability, a health disparities population, may be excluded from clinical trials. OBJECTIVE To determine the extent to which adults with intellectual disability are subject to exclusion from National Institutes of Health (NIH)-funded clinical trials. METHODS We studied recent NIH-funded Phase 2/3, 3, and 4 clinical trials of United States-based working-age adults (>18 < 55 years of age) listed in ClinicalTrials.gov. We coded eligibility criteria for inclusion, direct exclusion, and indirect exclusion of adults with intellectual disability. RESULTS We rarely identified studies that directly include adults with intellectual disability. Most studies (74.6%) had eligibility criteria that directly and/or indirectly exclude adults with intellectual disability. Approximately one-third of studies had direct exclusion criteria based on cognitive impairment or diagnosis of intellectual disability. Nearly 65% of studies indirectly excluded adults with intellectual disability based on factors likely associated with intellectual disability (e.g., functional capacity, inability to read/write, and/or research staff discretion). CONCLUSIONS We found less exclusion based on diagnosis of intellectual disability than anticipated. Nonetheless, about three-fourths of studies had eligibility criteria which would likely lead to the direct and/or indirect exclusion of adults with intellectual disability. Our findings suggest substantial cause for concern that adults with intellectual disability experience widespread exclusion from NIH-funded clinical trials-exclusion that may lack appropriate justification and assessment. Consequently, this group is denied equal access to the potential benefits of scientific discovery. We provide recommendations for approaches to include adults with intellectual disability.
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Affiliation(s)
- Katherine E McDonald
- Department of Public Health, David B. Falk College of Sport and Human Dynamics, Syracuse University. 344 White Hall, Syracuse University, Syracuse, NY 13210, USA.
| | - Ariel E Schwartz
- Department of Occupational Therapy, School of Health and Rehabilitation Sciences, Mass General Brigham Institute of Health Professions, MA, USA.
| | - Maya Sabatello
- Department of Medicine, Center for Precision Medicine and Genomics, and Department of Medical Humanities and Ethics, Columbia University, NY, USA.
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12
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DeCormier Plosky W, Ne’eman A, Silverman BC, Strauss DH, Francis LP, Stein MA, Bierer BE. Excluding People With Disabilities From Clinical Research: Eligibility Criteria Lack Clarity And Justification. Health Aff (Millwood) 2022; 41:1423-1432. [DOI: 10.1377/hlthaff.2022.00520] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Affiliation(s)
| | - Ari Ne’eman
- Ari Ne’eman, Harvard University, Cambridge, Massachusetts
| | | | | | | | | | - Barbara E. Bierer
- Barbara E. Bierer , Brigham and Women’s Hospital and Harvard University
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13
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Zhou Y, Qi J. Effectiveness of Interventions on Improving Balance in Children and Adolescents With Hearing Impairment: A Systematic Review. Front Physiol 2022; 13:876974. [PMID: 35651874 PMCID: PMC9150273 DOI: 10.3389/fphys.2022.876974] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2022] [Accepted: 04/26/2022] [Indexed: 11/29/2022] Open
Abstract
Although children and adolescents with hearing impairment are at risks of falls from balance problems, reliable information on effects of interventions are scare. Therefore, the purpose of this review is to systematically summarize studies on the evidence of interventions to improve balance ability in children and adolescents with hearing impairment. A systematic literature search was conducted on five major electronic databases. Studies were included if: 1) interventions or trials focusing on improving balance in children and adolescents with hearing impairment; 2) research targeting children with hearing impairment (samples with a mean age below 18 years); 3) studies were published in English peer-reviewed journals due to language barriers and resource limitations; and 4) study designs were randomized controlled trial or quasi-experiment. A nine-item tool adapted from the Consolidated Standards of Reporting Trials Statement was used to assess the quality of the studies. Through the search strategy, 373 articles were identified, and 15 studies published between 1981 and 2021 met the inclusion criteria. Most of the studies reviewed were categorized as medium or low quality, and only three were identified as high quality. Exercise interventions were adopted in 80% of the included studies, whereas studies that employed music + vibration, motor, and game as the intervention modalities accounted for the remaining 20.0%. The results of this review showed that the included trials with exercise interventions had a positive influence on the balance among children and adolescents with hearing impairment (the post-intervention scores were significantly higher than the pre-intervention or the control group scores). In addition, the interventions with duration of 8–16 weeks were more effective than those with less than 8 weeks. However, due to most of the reviewed studies were of low methodological quality, the trials results analyzed by this systematic review should be interpreted with caution. Further investigations of high-quality studies are therefore needed to prove the effectiveness of interventions on improving balance performance in children and adolescents with hearing impairment. Systematic Review Registration: [https://www.crd.york.ac.uk/PROSPERO/], PROSPERO [308803].
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Affiliation(s)
- Yan Zhou
- Xingzhi College, Zhejiang Normal University, Jinhua, China
| | - Jing Qi
- College of Physical Education and Health Sciences, Zhejiang Normal University, Jinhua, China
- *Correspondence: Jing Qi,
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14
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Michalsen H, Wangberg SC, Hartvigsen G, Henriksen A, Pettersen G, Jaccheri L, Jahnsen RB, Thrane G, Arntzen C, Anke A. Mobile health support to stimulate physical activity in individuals with intellectual disability: Protocol for mixed methods pilot study (Preprint). JMIR Res Protoc 2022; 11:e37849. [PMID: 36107473 PMCID: PMC9523523 DOI: 10.2196/37849] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2022] [Revised: 06/21/2022] [Accepted: 06/27/2022] [Indexed: 11/24/2022] Open
Abstract
Background Several studies have shown that individuals with intellectual disabilities (IDs) have low levels of physical activity (PA), and intervention studies on PA suggest inconsistent evidence. The use of technology as a means of motivation for PA has yet to be extensively explored and needs to be further investigated. Objective We aim to assess the feasibility and acceptability of procedures for an intervention arm in a future trial on mobile health (mHealth) to support PA for individuals with IDs. In addition, we aim to examine how the use of technology can influence motivation for PA among participants, their caregivers, and staff members. Methods A mixed methods pilot study of an intervention arm will be carried out in a planned randomized controlled trial (RCT). Ten participants with ID and their caregivers or a staff member will be included. Information will always be provided by a caregiver or a staff member, or participants with ID if possible. Assessments will be carried out at baseline, follow-up after 4 weeks, and 12 weeks, and include questionnaires on PA, social support, self-efficacy, and challenging behavior. PA will be measured with 2 different activity trackers (Fitbit and Axivity) for 1 week at all assessments. Feasibility will be assessed as recruitment and adherence rate, missing data, usability of the motivational mHealth tool, and estimates of effectiveness. Acceptability of study procedures, activity measures, and motivation for participation in PA will be additionally assessed with qualitative methods at the end of the intervention. Results Enrollment commenced in May 2021. Data collection was completed in March 2022. Conclusions This pilot study will evaluate the feasibility and acceptability of study procedures of the intervention arm of a planned RCT to address feasibility issues, improve study procedures, and estimate effectiveness of the study measures. How the use of technology can influence motivation for PA will also be examined, which can help guide and improve future PA interventions involving the use of technology. Trial Registration ClinicalTrials.gov NCT04929106; https://clinicaltrials.gov/ct2/show/NCT04929106 International Registered Report Identifier (IRRID) DERR1-10.2196/37849
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Affiliation(s)
- Henriette Michalsen
- Department of Rehabilitation, University Hospital of North Norway, Tromsø, Norway
| | - Silje C Wangberg
- Department of Health and Care Sciences, Faculty of Health Sciences, UiT - The Arctic University of Norway, Narvik, Norway
| | - Gunnar Hartvigsen
- Department of Computer Science, Faculty of Science and Technology, UiT - The Artic University of Norway, Tromsø, Norway
| | - André Henriksen
- Department of Computer Science, Faculty of Science and Technology, UiT - The Artic University of Norway, Tromsø, Norway
| | - Gunn Pettersen
- Department of Health and Care Sciences, Faculty of Health Sciences, UiT - The Arctic University of Norway, Tromsø, Norway
| | - Letizia Jaccheri
- Department of Computer Science, Faculty of Information Technology and Electrical Engineering, NTNU, Trondheim, Norway
| | - Reidun Birgitta Jahnsen
- Institute of Health and Society, Research Centre for Habilitation and Rehabilitation Models and Services (CHARM), Faculty of Medicine, University of Oslo, Oslo, Norway
| | - Gyrd Thrane
- Department of Health and Care Sciences, Faculty of Health Sciences, UiT - The Arctic University of Norway, Tromsø, Norway
| | - Cathrine Arntzen
- Department of Health and Care Sciences, Faculty of Health Sciences, UiT - The Arctic University of Norway, Tromsø, Norway
| | - Audny Anke
- Department of Rehabilitation, University Hospital of North Norway, Tromsø, Norway
- Institute of Health and Society, Research Centre for Habilitation and Rehabilitation Models and Services (CHARM), Faculty of Medicine, University of Oslo, Oslo, Norway
- Department of Clinical Medicine, Faculty of Health Sciences, UIT - The Arctic University of Norway, Tromsø, Norway
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15
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Taggart L, Mulhall P, Kelly R, Trip H, Sullivan B, Walgrave E. Preventing, mitigating, and managing future pandemics for people with an intellectual and developmental disability ‐ Learnings from
COVID
‐19: A scoping review. JOURNAL OF POLICY AND PRACTICE IN INTELLECTUAL DISABILITIES 2022. [DOI: 10.1111/jppi.12408] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Affiliation(s)
| | | | - Rosie Kelly
- Ulster University Newtownabbey Northern Ireland
| | | | | | - Eva Walgrave
- Academic Primary Health Care Centre Stockholm Sweden
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16
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Hassiotis A, Langdon P, Courtenay K, Hall I, Lloyd-Evans B, Romeo R, Kouroupa A, Crossey V, Taggart L. Expanding capacity in mental health research in intellectual disabilities. BJPsych Bull 2021; 45:317-320. [PMID: 33208218 PMCID: PMC8727378 DOI: 10.1192/bjb.2020.117] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Although the research base on mental health in intellectual disabilities is advancing, there are long-standing barriers that hinder successful completion of funded studies. A variety of stakeholders hold the key to mitigating the challenges and arriving at sustainable solutions that involve researchers, experts by experience, clinicians and many others in the research pathway. Lessons learned during the COVID-19 pandemic can also contribute to improvements in the conduct of research in the medium to long term. People with an intellectual disability and mental health conditions deserve high standards of evidence-based care.
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Affiliation(s)
| | | | | | - Ian Hall
- East London NHS Foundation Trust, UK
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17
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Olsen MI, Halvorsen MB, Søndenaa E, Strand BH, Langballe EM, Årnes A, Michalsen H, Larsen FK, Gamst W, Bautz-Holter E, Anke A. Factors associated with non-completion of and scores on physical capability tests in health surveys: The North Health in Intellectual Disability Study. JOURNAL OF APPLIED RESEARCH IN INTELLECTUAL DISABILITIES 2021; 35:231-242. [PMID: 34643025 DOI: 10.1111/jar.12942] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2020] [Revised: 06/25/2021] [Accepted: 09/15/2021] [Indexed: 01/14/2023]
Abstract
BACKGROUND This study investigated the completion rates, scores and factors associated with non-completion and low scores on physical capability tests in a health survey administered to adults with intellectual disabilities. METHOD Assessment comprised body mass index (BMI), the Short Physical Performance Battery (SPPB), the timed up-and-go (TUG) test, the one-legged stance (OLS) test; and gross motor, communication and behavioural functioning tests. RESULTS The completion rates among 93 participants (aged 17-78) were 46% for the SPPB, 42% for the TUG, and 31% for the OLS. More severe intellectual disability (OR = 3.12, p < .001) and lower BMI (OR = 0.859, p = .001) were related to test non-completion. The SPPB scores were below the reference values from the general population. Lower scores were associated with older age, motor disabilities and intellectual disability severity. CONCLUSIONS Including physical capability tests in health surveys among adults with intellectual disabilities is important to monitor functional status and guide prevention strategies.
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Affiliation(s)
- Monica Isabel Olsen
- Department of Rehabilitation, University Hospital of North Norway, Tromsø, Norway.,Faculty of Health Sciences, Department of Clinical Medicine, UiT The Arctic University of Norway, Tromsø, Norway
| | - Marianne Berg Halvorsen
- Department of Paediatric Rehabilitation, University Hospital of North Norway, Tromsø, Norway
| | - Erik Søndenaa
- Faculty of Medicine, Institute of Mental Health, Norwegian University of Science and Technology, Trondheim, Norway.,Department of Brøset, St. Olavs University Hospital, Trondheim, Norway
| | - Bjørn Heine Strand
- Norwegian National Advisory Unit on Ageing and Health, Vestfold County Hospital Trust, Tønsberg, Norway.,Department of Geriatric Medicine, Oslo University Hospital, Oslo, Norway.,Department of Chronic Diseases and Ageing, Norwegian Institute of Public Health, Oslo, Norway
| | - Ellen Melbye Langballe
- Norwegian National Advisory Unit on Ageing and Health, Vestfold County Hospital Trust, Tønsberg, Norway.,Department of Geriatric Medicine, Oslo University Hospital, Oslo, Norway
| | - Anders Årnes
- Department of Pain, University Hospital of North Norway, Tromsø, Norway
| | - Henriette Michalsen
- Department of Rehabilitation, University Hospital of North Norway, Tromsø, Norway.,Faculty of Health Sciences, Department of Clinical Medicine, UiT The Arctic University of Norway, Tromsø, Norway
| | - Frode Kibsgaard Larsen
- Norwegian National Advisory Unit on Ageing and Health, Vestfold County Hospital Trust, Tønsberg, Norway
| | - Wenche Gamst
- Department of Clinical Research, University Hospital of North Norway, Tromsø, Norway
| | - Erik Bautz-Holter
- Faculty of Medicine, Institute of Health and Society, Research Centre for Habilitation and Rehabilitation Model and Services (CHARM), University of Oslo, Oslo, Norway
| | - Audny Anke
- Department of Rehabilitation, University Hospital of North Norway, Tromsø, Norway.,Faculty of Health Sciences, Department of Clinical Medicine, UiT The Arctic University of Norway, Tromsø, Norway.,Faculty of Medicine, Institute of Health and Society, Research Centre for Habilitation and Rehabilitation Model and Services (CHARM), University of Oslo, Oslo, Norway
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18
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Lally P, Beeken RJ, Wilson R, Omar R, Hunter R, Fovargue S, Anderson D, King M, Hassiotis A, Croker H. A manualised weight management programme for adults with mild-moderate intellectual disabilities affected by excess weight: A randomised controlled feasibility trial (Shape Up-LD). JOURNAL OF APPLIED RESEARCH IN INTELLECTUAL DISABILITIES 2021; 35:112-122. [PMID: 34297441 DOI: 10.1111/jar.12922] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2020] [Revised: 05/11/2021] [Accepted: 05/16/2021] [Indexed: 11/27/2022]
Abstract
BACKGROUND The aim was to pilot an adapted manualised weight management programme for persons with mild-moderate intellectual disabilities affected by overweight or obesity ('Shape Up-LD'). METHOD Adults with intellectual disabilities were enrolled in a 6-month trial (3-month active intervention and 3-month follow-up) and were individually randomised to Shape Up-LD or a usual care control. Feasibility outcomes included recruitment, retention, initial effectiveness and cost. RESULTS Fifty people were enrolled. Follow-up rates were 78% at 3 months and 74% at 6 months. At 3 and 6 months, controlling for baseline weight, no difference was observed between groups (3 months: β: -0.34, 95% confidence interval [CI]: -2.38, 1.69, 6 months: β: -0.55, 95%CI -4.34, 3.24). CONCLUSION It may be possible to carry out a trial of Shape Up-LD, although barriers to recruitment, carer engagement and questionnaire completion need to be addressed, alongside refinements to the intervention.
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Affiliation(s)
- Phillippa Lally
- Department of Behavioural Science and Health, University College London, London, UK
| | - Rebecca J Beeken
- Department of Behavioural Science and Health, University College London, London, UK.,Leeds Institute of Health Sciences, London, UK
| | - Rose Wilson
- Department of Behavioural Science and Health, University College London, London, UK
| | - Rumana Omar
- Department of Statistical Science, University College London, London, UK
| | - Rachael Hunter
- Department of Primary Care & Population Health, University College London, London, UK.,Priment Clinical Trials Unit, London, UK
| | | | | | - Michael King
- Division of Psychiatry, University College London, London, UK
| | | | - Helen Croker
- Department of Behavioural Science and Health, University College London, London, UK
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19
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Mac Giolla Phadraig C, Ishak NS, van Harten M, Al Mutairi W, Duane B, Donnelly-Swift E, Nunn J. The Oral Status Survey Tool: construction, validity, reliability and feasibility among people with mild and moderate intellectual disabilities. JOURNAL OF INTELLECTUAL DISABILITY RESEARCH : JIDR 2021; 65:437-451. [PMID: 33719155 DOI: 10.1111/jir.12820] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/05/2020] [Revised: 01/06/2021] [Accepted: 01/07/2021] [Indexed: 06/12/2023]
Abstract
BACKGROUND A lack of robust data about the oral health of people with intellectual disabilities (IDs) contributes to health disparities. Appropriate research tools are therefore needed. This study reports the construction and evaluation of the Oral Status Survey Tool (OSST), designed to be administered with people with disabilities by non-dental personnel. METHOD Oral Status Survey Tool construction and evaluation was achieved adopting a non-clinical construction and content validation phase and a clinical phase to test concurrent validity, reliability and feasibility. Final refinements were also made. RESULTS The OSST conceptual framework covered oral function (tooth count, denture wear and opposing pairs of teeth) and oral disease/treatment need (soft tissue status, oral cleanliness, gum condition, carious teeth and oral pain). A systematic literature review identified no existing suitable indices. Candidate items were identified and validated by experts generating content validation ratios. This framework was modified later to expand the function construct. In the initial clinical phase, 49 out of 60 participants underwent examination with OSST and standard dental assessments. All had mild to moderate IDs. Mean age was 43 years (SD = 16), and mean number of teeth was 22.1 (SD = 8.6). Data collectors included two dentists and three non-dentists. Later, a further 17 adults (nine female and eight male) with mild/moderate IDs were included for refinement. At this stage, data collectors included two dentists and five non-dentists. Concurrent validity was established for tooth count [intraclass correlation coefficient = 0.99 (95% confidence interval, CI: 0.99-0.99)], carious teeth [Gwet's AC2 = 0.94 (95% CI: 0.89-0.99)] and gum condition [Gwet's AC1 = 0.84 (95% CI: 0.64-1)]. For all final OSST items, inter-rater reliability ranged from moderate to very good; median test-retest reliability ranged from moderate to good. Acceptability was demonstrated for data collectors and participants. Mean time to complete the OSST was 7 min. CONCLUSIONS The OSST is a novel tool that can record a range of clinical oral features including tooth count, denture wear, occluding pairs of teeth and functional dentition, oral cleanliness, gum condition, carious cavitation and oral pain that will be useful within health surveys of people with mild-moderate IDs and similarly neglected populations. The tool demonstrates promising attributes and acceptability. From this study, the OSST appears to be a robust tool that can be incorporated into general data collection for people with mild-moderate IDs and similar populations. A key feature is that it can be administered by well-trained non-dentists.
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Affiliation(s)
- C Mac Giolla Phadraig
- School of Dental Science, Trinity College Dublin, Dublin 2, Ireland
- Division of Child and Public Dental Health, Dublin Dental University Hospital, Dublin 2, Ireland
| | - N S Ishak
- School of Dental Science, Trinity College Dublin, Dublin 2, Ireland
- Division of Child and Public Dental Health, Dublin Dental University Hospital, Dublin 2, Ireland
| | - M van Harten
- School of Dental Science, Trinity College Dublin, Dublin 2, Ireland
- Division of Child and Public Dental Health, Dublin Dental University Hospital, Dublin 2, Ireland
| | - W Al Mutairi
- School of Dental Science, Trinity College Dublin, Dublin 2, Ireland
- Division of Child and Public Dental Health, Dublin Dental University Hospital, Dublin 2, Ireland
| | - B Duane
- School of Dental Science, Trinity College Dublin, Dublin 2, Ireland
- Division of Child and Public Dental Health, Dublin Dental University Hospital, Dublin 2, Ireland
| | - E Donnelly-Swift
- School of Dental Science, Trinity College Dublin, Dublin 2, Ireland
- Division of Child and Public Dental Health, Dublin Dental University Hospital, Dublin 2, Ireland
| | - J Nunn
- School of Dental Science, Trinity College Dublin, Dublin 2, Ireland
- Division of Child and Public Dental Health, Dublin Dental University Hospital, Dublin 2, Ireland
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20
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Mulhall P, Taggart L, McAloon T, Coates V. Challenges to conducting randomised controlled trials with adults with intellectual disabilities: Experiences of international experts. JOURNAL OF APPLIED RESEARCH IN INTELLECTUAL DISABILITIES 2020; 34:891-904. [PMID: 33277777 DOI: 10.1111/jar.12838] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2018] [Revised: 11/09/2020] [Accepted: 11/12/2020] [Indexed: 01/24/2023]
Abstract
BACKGROUND Globally, conducting randomised controlled trials can be a complex endeavour. The complexity increases when including participants with cognitive or intellectual disabilities. A fuller understanding of the barriers and challenges that can be expected in such trials may help researchers to make their trials more inclusive for people with disabilities. METHOD Semi-structured interviews were conducted with twelve international trial experts. RESULTS Eight themes emerged relating to challenges linked to: 1) participant co-morbidities, 2) participant ability levels, 3) ethics and consent, 4) the RCT methodology, 5) gatekeeping, 6) staff turnover, 7) lack of technical understanding and 8) attitudes and perceptions. CONCLUSION Conducting trials with cognitively disabled participants can pose unique challenges although many can be overcome with 'reasonable adjustments'. Challenges that are harder to overcome are attitudes and perceptions that people (professional staff, funding bodies, carers or fellow researchers) hold towards the utility of conducting trials with cognitively disabled populations.
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Affiliation(s)
- Peter Mulhall
- School of Nursing, Ulster University, Newtownabbey, Northern Ireland
| | - Laurence Taggart
- School of Nursing, Ulster University, Newtownabbey, Northern Ireland
| | - Toni McAloon
- School of Nursing, Ulster University, Newtownabbey, Northern Ireland
| | - Vivien Coates
- School of Nursing, Ulster University, Newtownabbey, Northern Ireland
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Paterson RE, Taggart L, Hoyle L, Brown M. Characteristics of diabetes medication-taking in people with mild to moderate intellectual disability compared to those without: a mixed-methods study. Diabet Med 2020; 37:2035-2043. [PMID: 32632926 DOI: 10.1111/dme.14365] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/01/2019] [Revised: 06/14/2020] [Accepted: 07/01/2020] [Indexed: 01/25/2023]
Abstract
AIM To compare the frequency and factors associated with diabetes medication-taking (depression, perceived side effects, self-efficacy and social support) in people with mild to moderate intellectual disability and those without intellectual disability. METHODS In stage 1 of this study, we collated information on diabetes medication-taking and associated factors in 111 people with diabetes: 33 adults with mild to moderate intellectual disability and 78 adults without intellectual disability. Validated instruments measuring medicine-taking, self efficacy, depressive symptoms, perceived level of social support and perceived side effects were administered in both groups. In stage 2, we used an abductive qualitative approach to triangulate stage 1 findings with carers responses (n = 12). RESULTS The instruments showed good internal reliability (Cronbach's α = 0.7-0.9). Comparisons between people with intellectual disabilities and those without revealed similar frequency of medication-taking (70% vs 62%; P = 0.41). People with intellectual disabilities and diabetes had significantly higher depressive symptoms, as measured by the Glasgow Depression Scale for people with a Learning Disability (P = 0.04), higher levels of perceived side effects (P = 0.01), and lower confidence levels, as measured by the Perceived Confidence Scale (P = 0.01). The results of stage 2 showed how carers of people with intellectual disabilities and diabetes optimized medication-taking yet infrequently discussed the side effects of medicines. CONCLUSIONS Further investigation of medication-taking and side effects may result in the development of an evidence-informed intervention to improve medicines safety in people with intellectual disabilities.
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Affiliation(s)
- R E Paterson
- School of Health and Social Care, Edinburgh Napier University, Edinburgh
| | - L Taggart
- School of Nursing, University of Ulster, Belfast
| | - L Hoyle
- School of Health Sciences, University of Stirling, Stirling
| | - M Brown
- School of Nursing and Midwifery, Queens University, Belfast, UK
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Wass S, Safari MC. Photovoice-Towards Engaging and Empowering People with Intellectual Disabilities in Innovation. Life (Basel) 2020; 10:life10110272. [PMID: 33167330 PMCID: PMC7694372 DOI: 10.3390/life10110272] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2020] [Revised: 10/28/2020] [Accepted: 11/03/2020] [Indexed: 11/29/2022] Open
Abstract
E-health and welfare technology offer new ways to support health and social care delivery. While initiatives are made to engage disadvantaged user groups in innovation, people with intellectual disabilities tend to be excluded from design activities. This is a concern as this group can benefit from the use of assistive technology. However, it can be time-consuming and challenging to involve end-users in the design of technology. This calls for processes that are creative, empowering and that facilitate user involvement. In this study, we report and reflect on the process of using photovoice to understand user needs and to empower participants with intellectual disability in an innovation process. Nine persons with intellectual disability participated in photovoice to identify user needs connected to the design of assistive technology. The findings in our study suggest that the use of photovoice can contribute to the sharing of contextual and individual needs and an empowerment process that includes coping, self-determination and ownership. Photovoice can be a tool to reduce or remove some of the challenges that are faced when identifying user needs and is a way to strengthen the individual’s capacity to cope with the demands of participating in an innovation process.
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Affiliation(s)
- Sofie Wass
- Centre for eHealth, University of Agder, 4879 Grimstad, Norway
- Correspondence:
| | - Mugula Chris Safari
- Department of Psychosocial Health, University of Agder, 4879 Grimstad, Norway;
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Thurm A, Kelleher B, Wheeler A. Outcome Measures for Core Symptoms of Intellectual Disability: State of the Field. AMERICAN JOURNAL ON INTELLECTUAL AND DEVELOPMENTAL DISABILITIES 2020; 125:418-433. [PMID: 33211819 DOI: 10.1352/1944-7558-125.6.418] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/15/2019] [Accepted: 07/28/2020] [Indexed: 06/11/2023]
Abstract
Intellectual disability (ID) is defined by impairments in intellectual and adaptive functioning. As such, tools designed to assess these domains would theoretically be ideal outcome measures for treatment trials targeting core symptoms of ID. However, measures of intellectual and adaptive functioning have rarely been used as primary outcome measures to date and further study is needed regarding their usefulness to measure change. This area of inquiry is important because promising, mechanism-modifying treatments for conditions leading to ID are being initiated. To show efficacy, these treatments need to demonstrate an impact on core features of ID. After reviewing literature on this topic, we suggest solutions to several problems outlined, including use of out-of-age-range testing, alternative metrics, and development of new measures.
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Affiliation(s)
- Audrey Thurm
- Audrey Thurm, National Institute of Mental Health
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Owens R, Earle S, McNulty C, Tilley E. What works in community health education for adults with learning disabilities: A scoping review of the literature. JOURNAL OF APPLIED RESEARCH IN INTELLECTUAL DISABILITIES 2020; 33:1268-1283. [PMID: 32346968 DOI: 10.1111/jar.12746] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2019] [Revised: 03/05/2020] [Accepted: 04/06/2020] [Indexed: 02/06/2023]
Abstract
BACKGROUND Research suggests there is insufficient good quality information regarding the effectiveness of health education aimed at adults with intellectual disabilities. By analysing the literature, this review aimed to identify what constituted effectiveness in this context. METHOD Relevant evaluations were extracted from bibliographic databases according to pre-specified criteria. Papers were analysed using QSR NVivo 11 by developing a narrative synthesis and analytic framework that identified and explored text addressing the research question. RESULTS Twenty-two studies were included. The review identified two broad components of effective health education: mechanisms and context. Mechanisms included embedded programme flexibility, appropriate and accessible resources, and motivational delivery. An effective context included an accessible and supportive environment and longer term opportunities for reinforcement of learning. CONCLUSIONS Important gaps in the literature highlighted a need for further research addressing community learning experiences of adults with intellectual disabilities as well as the effectiveness of infection prevention programmes.
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Mulhall P, Taggart L, Coates V, McAloon T. Using a Delphi survey to gain an international consensus on the challenges of conducting trials with adults with intellectual disabilities. Clin Trials 2019; 17:138-146. [PMID: 31856601 DOI: 10.1177/1740774519887168] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
BACKGROUND/AIMS People with intellectual disability experience higher rates of multi-morbidity and health inequalities, they are frequently prescribed medications and more likely to have an avoidable or premature death. There is a recognised lack of randomised controlled trials, and subsequently a lack of evidence base, for many of the interventions and treatments provided to people with intellectual disabilities. Very few disability-specific trials are conducted, and people with intellectual, and other cognitive, disabilities are routinely excluded from mainstream trials. There is an urgent need to facilitate more disability-specific trials or to encourage mainstream trialists to include people with disabilities in their studies. Obtaining a thorough understanding of the challenges inherent in these trials, and sharing this knowledge within the research community, may contribute significantly towards addressing this need. The aim of this study was to explore the practical and methodological challenges to conducting trials with adults with intellectual disabilities and to reach a consensus regarding which are the most important challenges for researchers for inclusion in a resource toolkit. METHODS A three-round modified Delphi survey was conducted with a panel of international trials researchers within the intellectual disability field. Items were assessed in terms of the consensus level and stability of responses. RESULTS A total of 64 challenges and barriers were agreed upon, across all aspects of the trial pathway, from planning through to reporting. Some challenges and barriers had been noted in the literature previously, but many previously uncited barriers (both systemic and attitudinal) were identified. CONCLUSION This is the first international survey exploring the experiences of researchers conducting randomised controlled trials with adults with intellectual disabilities. Many of the barriers and challenges reported can be overcome with creativity and some additional resources. Other challenges, including attitudes towards conducting trials with disabled populations, maybe harder to overcome. These findings have implications for conducting trials with other populations with cognitive or communication difficulties. Implications for disability researchers, funding bodies and ethical review panels are discussed.
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Affiliation(s)
- Peter Mulhall
- School of Nursing, Ulster University, Newtownabbey, Northern Ireland
| | - Laurence Taggart
- School of Nursing, Ulster University, Newtownabbey, Northern Ireland
| | - Vivien Coates
- School of Nursing, Ulster University, Newtownabbey, Northern Ireland
| | - Toni McAloon
- School of Nursing, Ulster University, Newtownabbey, Northern Ireland
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Sheehan R, Strydom A, Marston L, Morant N, Fiori F, Santosh P, Hassiotis A. A structured medication review tool to promote psychotropic medication optimisation for adults with intellectual disability: feasibility study. BMJ Open 2019; 9:e033827. [PMID: 31843854 PMCID: PMC6924735 DOI: 10.1136/bmjopen-2019-033827] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
OBJECTIVES To investigate the feasibility of delivering structured psychotropic medication review in community services for adults with intellectual disability (ID). DESIGN Single-arm feasibility study conducted over a 6-month period. SETTING Specialist community ID teams in England. PARTICIPANTS Psychiatrists working with adults with ID and adults with ID who had been prescribed psychotropic medication. INTERVENTION A structured web-based psychotropic medication review tool (the HealthTracker-based structured medication review) comprising measures of therapeutic benefit and adverse side-effects was made available for use by psychiatrists in routine clinic appointments. A summary measure of medication effectiveness was graphically presented to aid discussion and decision-making. MAIN OUTCOME MEASURES Feasibility metrics including number of people with ID referred, eligible and recruited, and uptake of the medication review tool in naturalistic clinical settings. Psychiatrist and patient feedback was collected to assess acceptability of the intervention and suggestions for development. RESULTS Fifteen psychiatrists from five clinical teams took part. In total 94 potentially eligible people with ID were referred, of whom 79 (84%) were recruited and together underwent 97 medication reviews over the 6-month study period. Feedback from participants with ID was favourable. Psychiatrists indicated that the HealthTracker-based structured medication review was broadly acceptable and suggested adaptations to improve integration with existing information technology systems and to enhance patient involvement in the review. CONCLUSIONS Structured psychotropic medication review can be used in community services for adults with ID as part of a programme of medication optimisation. It would be feasible to test clinical and patient outcomes of the HealthTracker-based medication review in a randomised clinical trial.
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Affiliation(s)
- Rory Sheehan
- Division of Psychiatry, University College London, London, UK
| | - André Strydom
- Department of Forensic and Neurodevelopmental Science, Institute of Psychiatry, Psychology & Neuroscience, London, UK
| | - Louise Marston
- Research Department of Primary Care and Population Health, University College London, London, UK
| | - Nicola Morant
- Division of Psychiatry, University College London, London, UK
| | - Federico Fiori
- Department of Child and Adolescent Psychiatry, Institute of Psychiatry, Psychology & Neuroscience, London, UK
| | - Paramala Santosh
- Department of Child and Adolescent Psychiatry, King's College London, London, UK
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Marquis SM, McGrail K, Hayes M. Mental health of parents of children with a developmental disability in British Columbia, Canada. J Epidemiol Community Health 2019; 74:173-178. [PMID: 31744849 PMCID: PMC6993017 DOI: 10.1136/jech-2018-211698] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2018] [Revised: 09/26/2019] [Accepted: 11/08/2019] [Indexed: 01/23/2023]
Abstract
Background There is evidence in the literature that parents of children who have a developmental disability experience an increased risk of mental health problems. Methods This study used population-level administrative data from the Ministry of Health, British Columbia, Canada, to assess the mental health of parents of children who have a developmental disability compared with the mental health of parents of children who do not have a developmental disability. Population-level and individual explanatory variables available in the data were included in the models. Results At a population level, the study found strong evidence that parents of children who have a developmental disability experience higher odds of depression or other mental health diagnoses compared with parents of children who do not have a developmental disability. Age of the parent at birth of the child, income and location of healthcare services were all associated with outcomes. Conclusion Parents of children who have a developmental disability may be in need of programmes and services that support their mental health.
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Affiliation(s)
- Sandra Maureen Marquis
- School of Public Health and Social Policy, University of Victoria, Victoria, British Columbia, Canada
| | - Kimberlyn McGrail
- Centre for Health Services and Policy Research, University of British Columbia, Vancouver, British Columbia, Canada
| | - Michael Hayes
- School of Public Health and Social Policy, University of Victoria, Victoria, British Columbia, Canada
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28
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Derks S, van Wijngaarden S, Wouda M, Schuengel C, Sterkenburg PS. Effectiveness of the serious game 'You & I' in changing mentalizing abilities of adults with mild to borderline intellectual disabilities: a parallel superiority randomized controlled trial. Trials 2019; 20:500. [PMID: 31412913 PMCID: PMC6694494 DOI: 10.1186/s13063-019-3608-9] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2019] [Accepted: 07/20/2019] [Indexed: 01/25/2023] Open
Abstract
Background Persons with mild to borderline intellectual disabilities generally show dysfunctions in mentalization and stress regulation, resulting in problematic social relationships and personal distress. Intervention programs may improve mentalizing abilities. The aim of this study is to examine the effectiveness of the serious game ‘You & I’ in changing mentalizing abilities and stress regulation in adults with mild to borderline intellectual disabilities. Methods A two-arm, parallel, superiority randomized controlled trial will be used with 172 adults with mild to borderline intellectual disabilities. Participants will be randomly assigned to either the experimental group to play the serious game ‘You & I’ or a waitlist control group. Participants will be assessed at baseline, post intervention (5 weeks after baseline), and follow-up (6–8 weeks after post intervention). They also will fill in questionnaires for personal factors, personal development, personal well-being, social validity, autism spectrum quotient (demographic variables), mentalizing abilities (primary outcome measure), and stress regulation (secondary outcome measure). Discussion The serious game ‘You & I’ aims to improve mentalizing abilities in adults with mild to borderline intellectual disabilities, which is expected to lead to improved regulation of stress in social relationships. The study’s unique feature is the use of a serious game to improve mentalizing abilities. If the intervention is effective, the serious game can be implemented on a broad scale in Dutch care organizations for people with intellectual disabilities as an effective preventive tool to improve mentalizing abilities. Trial registration Netherlands Trial Register, NTR7418. Registered on 2 August 2018. Electronic supplementary material The online version of this article (10.1186/s13063-019-3608-9) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Suzanne Derks
- Department of Clinical Child and Family Studies, Amsterdam Public Health, Vrije Universiteit Amsterdam, Van der Boechorstraat 7, 1081 BT, Amsterdam, the Netherlands
| | | | - Mirjam Wouda
- Ons Tweede Thuis, Veteranenlaan 7, 1183 DL, Amstelveen, the Netherlands
| | - Carlo Schuengel
- Department of Clinical Child and Family Studies, Amsterdam Public Health, Vrije Universiteit Amsterdam, Van der Boechorstraat 7, 1081 BT, Amsterdam, the Netherlands
| | - Paula S Sterkenburg
- Department of Clinical Child and Family Studies, Amsterdam Public Health, Vrije Universiteit Amsterdam, Van der Boechorstraat 7, 1081 BT, Amsterdam, the Netherlands. .,Bartiméus, Oude Arnhemse Bovenweg 3, 3941 XM, Doorn, the Netherlands.
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Russell G, Mandy W, Elliott D, White R, Pittwood T, Ford T. Selection bias on intellectual ability in autism research: a cross-sectional review and meta-analysis. Mol Autism 2019; 10:9. [PMID: 30867896 PMCID: PMC6397505 DOI: 10.1186/s13229-019-0260-x] [Citation(s) in RCA: 145] [Impact Index Per Article: 29.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2018] [Accepted: 02/12/2019] [Indexed: 01/05/2023] Open
Abstract
Background Current global estimates suggest the proportion of the population with autism spectrum disorder (ASD) who have intellectual disability (ID) is approximately 50%. Our objective was to ascertain the existence of selection bias due to under-inclusion of populations with ID across all fields of autism research. A sub-goal was to evaluate inconsistencies in reporting of findings. Methods This review covers all original research published in 2016 in autism-specific journals with an impact factor greater than 3. Across 301 included studies, 100,245 participants had ASD. A random effects meta-analysis was used to estimate the proportion of participants without ID. Selection bias was defined as where more than 75% of participants did not have ID. Results Meta-analysis estimated 94% of all participants identified as being on the autism spectrum in the studies reviewed did not have ID (95% CI 0.91–0.97). Eight out of ten studies demonstrated selection bias against participants with ID. The reporting of participant characteristics was generally poor: information about participants’ intellectual ability was absent in 38% of studies (n = 114). Where there was selection bias on ID, only 31% of studies mentioned lack of generalisability as a limitation. Conclusions We found selection bias against ID throughout all fields of autism research. We recommend transparent reporting about ID and strategies for inclusion for this much marginalised group. Electronic supplementary material The online version of this article (10.1186/s13229-019-0260-x) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Ginny Russell
- 1College House, University of Exeter Medical School, University of Exeter, Exeter, EX1 2LU UK
| | - William Mandy
- 2UCL Research Department of Clinical, Educational and Health Psychology, Gower Street, London, WC1E 6BT UK
| | - Daisy Elliott
- 3College of Social Science and International Studies, Byrne House, University of Exeter, Exeter, EX4 4PJ UK
| | - Rhianna White
- 3College of Social Science and International Studies, Byrne House, University of Exeter, Exeter, EX4 4PJ UK
| | - Tom Pittwood
- 4Brain in Hand, Innovations Centre, University of Exeter, Exeter, EX4 4QJ UK
| | - Tamsin Ford
- 1College House, University of Exeter Medical School, University of Exeter, Exeter, EX1 2LU UK
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The Importance of Nidotherapy and Environmental Change in the Management of People with Complex Mental Disorders. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2018; 15:ijerph15050972. [PMID: 29757254 PMCID: PMC5982011 DOI: 10.3390/ijerph15050972] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/12/2018] [Revised: 05/10/2018] [Accepted: 05/10/2018] [Indexed: 01/15/2023]
Abstract
Much has been done in the last 50 years to achieve a better understanding of the psychosocial causes and other factors influencing the manifestation of mental illness, but there has been a conspicuous omission. Although gross environmental deficiencies were exposed in old mental institutions, 70 years ago the more subtle maladaptive settings that reinforce chronicity in mental illness have often been forgotten. In this review, the potential of systematic environmental manipulation as a treatment (nidotherapy) and other similar forms of management, used many times in the past but now mainly in forensic settings, is examined. There is now accumulating evidence, reinforced by controlled trials, that planned environmental change, preferably carried out with the full cooperation of the patient, can be a major contributor to therapeutic benefit. It is also very cost-effective. All forms of the environment, physical, social and personal, can be addressed in making assessments, and once a planned way forward has been chosen, progress can be monitored by personnel with limited mental health experience. These interventions have applications in general mental health and occupational health services and deserve much wider use.
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