Psycho-Educational and Rehabilitative Intervention to Manage Cancer Cachexia (PRICC) for Advanced Patients and Their Caregivers: Lessons Learned from a Single-Arm Feasibility Trial

BACKGROUND

Key elements in cancer cachexia (CC) management are personalized and multimodal interventions, but it is hard for some patients to follow programs based on several components. We examined the feasibility of a bimodal intervention, including a psycho-educational component and exercises, to support patients and their caregivers in managing CC; Methods: Prospective mixed-methods pilot study explored feasibility data, changes in patient-reported outcomes, and performance outcomes over time in a convenient sample of 30 consecutive CC patients and their caregivers.

RESULTS

Twenty-four dyads consented to participate. Twenty dyads received at least two psycho-educational sessions, so the psycho-educational component was feasible for 83.3% of the sample. Six dyads participated in at least fourteen out of twenty-seven rehabilitation sessions, so the exercise program was feasible for 25.0% of the sample. Six dyads showed compliance greater than 50% for both components of the bimodal intervention.

CONCLUSIONS

While we did not meet our primary feasibility endpoint and had mixed acceptability, our experience provides insight into the challenges and lessons learned in implementing a primary palliative care intervention for CC. More robust studies are needed to help clinicians understand the best exercise program for CC patients, to be included in a multimodal intervention.

The comprehensive inventory of thriving: a systematic review of published validation studies and a replication study

In this study we sought to collect evidence regarding the validity of the Comprehensive Inventory of Thriving (CIT), systematically reviewing studies that tested its psychometric properties (Study 1) and trying to replicate validity evidence collected across previous validation studies (Study 2). We found five studies that tested the validity of CIT scores through the collection of different kinds of evidence (score structure validity, convergent validity, discriminant validity, criterion-related validity, incremental validity, internal consistency, test-retest reliability). Results were often inconsistent across studies (especially for the score structure validity evidence). Using a sample of 483 Italian participants (63.0% female; aged 18–71 years), we replicated the tests performed in the previous validation studies. Findings suggest that the best fitting model is the one that (1) adds the overarching latent construct of thriving, which can be measured using the total scale score; and (2) merges the Skills and Flow factors in just one factor, named “Skills for Flow”. At the same time, the different kinds of validity evidence collected both in previous validation studies and in the current replication study indicate high overlap among thriving sub-dimensions and poor validity evidence. We concluded that the CIT in its present form is not an adequate instrument to assess thriving, thus mono-dimensional scales (e.g. Brief Inventory of Thriving) should be currently preferred. Suggestions to develop a multi-dimensional scale measuring thriving (both using a theory-driven approach or a data-drive approach) are discussed.

The Self-Regulation of Learning - Self-Report Scale for Sport Practice: Validation of an Italian Version for Football

Self-regulation of learning (SRL) is a key psychological factor that supports young athletes aiming to reach the elite level by promoting their involvement in deliberate practice. We contributed to the validation of the Italian version of the Bartulovic et al. (2017) Self-Regulation of Learning - Self-Report Scale for Sport Practice by testing its factorial structure, reliability, and measurement invariance among elite and non-elite football players, involving 415 male professional, semi-professional, and amateur youth academy players (M age = 16.2, SD = 1.51). The original six-factor structure (planning, reflection, effort, self-efficacy, self-monitoring, and evaluation) did not fit the data well and a five-factor solution (where self-monitoring and evaluation items load on the same factor, named "self-supervision") was a better fit. This five-factor solution was measurement invariant across groups of elite and non-elite athletes. We found that elite athletes scored significantly higher than non-elite ones in each SRL subprocess. Implications for future validation studies and for the use of this tool are discussed.

Marital Stability and Quality of Couple Relationships after Acquired Brain Injury: A Two-Year Follow-Up Clinical Study

Couple relationships after acquired brain injury (ABI) could be vulnerable to emotional distress. Previous evidence has demonstrated significant marital dissatisfaction in the first period after a traumatic event, while long-term evaluations are lacking. In this study, we evaluated the impact of a series of demographic and clinical factors on marital stability after two years from the injury. Thirty-five patients (29% female) with mild/moderate ABI (57% vascular, 43% traumatic) and their partners were enrolled. The couples completed a series of psychological questionnaires assessing marital adjustment (Dyadic Adjustment Scale, DAS) and family functioning (Family Relationship Index, FRI) at discharge from the intensive rehabilitation unit and after 2 years. Demographics (i.e., educational level, job employment and religion commitment) and clinical variables (i.e., the Barthel index, aetiology and brain lesion localization) were considered as predictive factors. Regression analyses revealed that the DAS and FRI values are differently influenced by demographic and clinical factors in patients and caregivers. Indeed, the highest educational level corresponds to better DAS and FRI values for patients. In the spouses, the variability of the DAS values was explained by aetiology (the spouses of traumatic ABI patients had worse DAS values), whereas the variability in the FRI values was explained by religious commitment (spending much time on religious activities was associated with better FRI values). Our data suggest that some clinical and demographic variables might be important for protecting against marital dissatisfaction after an ABI.

Psychoeducational and rehabilitative intervention to manage cancer cachexia (PRICC) for patients and their caregivers: protocol for a single-arm feasibility trial

INTRODUCTION

Half of all patients with cancer experience cachexia, with the prevalence rising above 80% in the last weeks of life. Cancer cachexia (CC) is a complex relational experience that involves the patient-family dyad. There are no studies on the association between the psychoeducational component and the rehabilitative component of dyads for supporting more functional relationships in the management of CC.The primary objective of this study is to evaluate the feasibility of a psychoeducational intervention combined with a rehabilitative intervention on dyads.The secondary objective is to improve the quality of life (QoL) and acceptability of the intervention.

METHODS AND ANALYSIS

This mixed-methods study with a nonpharmacological interventional prospective includes 30 consecutive cancer patients with cachexia and refractory cachexia and their caregivers, assisted by the Specialised Palliative Care Team. The recruitment will last 1 year. The intervention involves two components: (1) psychoeducational intervention: 3 weekly face-to-face consultations between dyads and trained nurses to help the dyads cope with involuntary weight loss and strengthening dyadic coping resources and (2) rehabilitation intervention: 3 biweekly educational sessions between dyads and trained physiotherapists focused on self-management, goal-setting, physical activity with three home exercise sessions per week.The primary endpoint will be in adherence to the intervention, indicated by a level of completion greater than or equal to 50% in both components. The secondary endpoints will be QoL (Functional Assessment of Anorexia-Cachexia Therapy), caregiver burden (Zarit Burden), physical performance (Hand-Grip strength and 30 seconds sit-to-stand test), and the acceptability of the intervention (ad hoc semi-structured interviews with the dyads and the healthcare professionals).

ETHICS AND DISSEMINATION

The study was approved by the Ethics Committee Area Vasta Emilia Nord, Azienda USL-IRCSS Reggio Emilia, Italy, number: 73/2019/SPER/IRCCSRE. The authors will provide the dissemination of the results through publication in international scientific journals.

TRIAL REGISTRATION NUMBER

NCT04153019.

Cognitive-Behavioral Therapy for Relationship Distress: Meta-analysis of RCTs with Social Work Implications

PURPOSE

The purpose of the present meta-analysis is twofold: 1) determine the aggregated statistical effect of cognitive-behavioral couples therapy (CBCT) for relationship distress in randomized controlled trials and 2) use the findings to inform clinical social work practice and research.

METHODS

A systematic review was conducted using electronic databases and the reference lists of included studies. The random effects model meta-analysis used a hedges' g effect size.

RESULTS

After the removal of an outlier, a homogeneous (Q = 16.66, df = 12, p = .16, I ² = 27.96), significant, moderate effect favoring CBCT (Hedges' g summary effect = .421, Z = 4.51, p < .0001, 95% confidence interval: 0.238 to 0.604, standard error = .093, variance = .009, k =  13) was obtained.

DISCUSSION

It is anticipated that cognitive-behavioral/evidence-based social work clinicians and researchers will use the findings to support their clinical practice and advance their clinical research, respectively.

COVID-19-Related Disruptions and Increased mHealth Emergency Use Intention: Experience Sampling Method Study

BACKGROUND

The COVID-19 pandemic has become a global public health event, which has raised concerns regarding individuals' health. Individuals need to cope with the COVID-19 pandemic with guidelines on symptom recognition, home isolation, and maintain mental health. Besides routine use of mobile health (mHealth) such as accessing information to keep healthy, individuals can use mHealth services in situations requiring urgent medical care, which is defined as mHealth emergency use. It is not known whether individuals have increased their daily mHealth services emergency use as a result of disruptions caused by the COVID-19 pandemic.

OBJECTIVE

The purpose of this diary analysis study is to assess the influences of daily disruptions related to the COVID-19 pandemic on individuals' mHealth emergency use. The secondary purpose of this study is to explore the mediating role of COVID-19-induced strain and the moderating role of promotion regulatory focus in the relationship between daily disruptions of COVID-19 and mHealth emergency use. Drawing from the cognitive activation theory of stress, we investigated the underlying mechanism and boundary condition of the influence of COVID-19-related disruptions on daily mHealth emergency use.

METHODS

To test the proposed model, this study adopts the experience sampling method to collect daily data. The experience sampling method helps researchers to capture participants' fluctuations in emotions, mental engagement in an activity, and experienced stress. This study collected 550 cases nested in 110 samples in mainland China to test the conceptual model. In addition, we employed hierarchical linear modeling analysis to test the effect of COVID-19-related disruptions on mHealth emergency use.

RESULTS

We found that COVID-19-related disruptions increased COVID-19-induced strain (γ=0.24, P<.001) and mHealth emergency use on a daily basis (γ=0.28, P<.001). COVID-19-induced daily strain mediated this relationship (effect=0.09, 95% CI 0.05-0.14). Promotion regulatory focus moderated the relationship between COVID-19-induced strain and mHealth emergency use (γ=0.35, P=.02). In addition, the indirect relationship between disruptions and mHealth emergency use intentions through COVID-19-induced strain is contingent upon promotion regulatory focus: this relationship was stronger in those with high promotion regulatory focus (effect=0.12, 95% CI 0.06-0.19) than in those with low promotion regulatory focus (effect=0.06, 95% CI 0.02-0.11).

CONCLUSIONS

Event disruption of the COVID-19 pandemic induced mHealth emergency use intention through increased psychological strain. Furthermore, individuals' promotion regulatory focus amplified this indirect relationship. Our findings extend our understanding of the factors underlying mHealth emergency use intention and illustrate the potential contingent role of promotion regulatory focus in the cognitive activation theory of stress. This study also opens avenues for future research on mHealth emergency use intention in other countries and cultural settings.

Reliability and validity of the French adaptation of the Family Relationship Index-short form in patients' with chronic kidney disease

The Family Relationship Index (FRI) measures family cohesion, expressiveness and conflict. This study aimed to investigate its reliability and validity in patients with chronic kidney disease (CKD). Confirmatory factor analysis was performed on 1657 patients and on subgroups according to socio-demographics and medical variables. Two items with poor saturation were excluded. The indexes indicated an acceptable fit. Reliability was especially weak for expressiveness. Our results provide partial support for the use of the French-version of the FRI in patients with advanced CKD. The family relationship index should be used with caution, especially in certain subgroups and for the expressiveness subscale.

The correlation between family relationships and brain activity within the reward circuit in adolescents with Internet gaming disorder

Disrupted reward circuits and diminished behavioural control have been suggested as the pathophysiologies of Internet gaming disorder (IGD). Family functioning is thought to play an important role in reward-related control. We hypothesized that adolescents with IGD show disrupted patterns of family relationships, which are associated with brain activity within the reward circuit. 42 adolescents with IGD without comorbidities and 41 healthy controls were assessed for family function and psychological states using the Korean Wechsler Intelligence Scale for Children (K-WISC), Korean version of DuPaul's attention deficit hyperactivity disorder (ADHD) Rating Scale (K-ARS), Young Internet Addiction Scale (YIAS), Children's Depression Inventory (CDI), Beck Anxiety Inventory (BAI), and the relationship domain of the Family Environmental Scale (FES-R). Brain activity was assessed via resting-state fMRI. Adolescents with IGD showed increased K-ARS, BAI, and YIAS scores, but decreased FES-R and FES-cohesion subscale scores; YIAS scores were negatively correlated with FES-R scores. Brain connectivity from the cingulate to the striatum was decreased, positively correlated with FES-R scores, and negatively correlated with IGD severity. Adolescents with IGD showed disrupted family relationships, which was associated with the severity of the disorder, and dis-connectivity within the reward circuit.