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Saranti A, Dragoumi P, Papavasiliou A, Zafeiriou D. Current approach to cerebral palsy. Eur J Paediatr Neurol 2024; 51:49-57. [PMID: 38824721 DOI: 10.1016/j.ejpn.2024.05.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/23/2024] [Revised: 05/26/2024] [Accepted: 05/28/2024] [Indexed: 06/04/2024]
Abstract
This teaching review aims to provide an overview of the current approach to children with cerebral palsy (CP), retrieving the best available evidence and summarizing existing knowledge in the field of CP in children. We also highlight areas where more research is needed and novel strategies for diagnosing and treating cerebral palsy. CP includes a group of permanent disorders of movement and posture that cause activity limitation. Multiple risk factors, occurring preconceptionally, prenatally, perinatally, or postneonatally, are involved in the pathogenesis of CP, with the prenatal ones accounting for 80-90 % of cases. Due to its heterogeneity, CP has various classifications, but usually is classified based on clinical findings and motor impairment. Standardized function classification systems have been developed to address inconsistencies in previous classifications. The combination of clinical assessment and validated predictive tools is recommended for an early diagnosis, which is important for early intervention and prevention of secondary impairments. The therapeutic regimen in CP involves prevention and management of the motor and associated problems. It includes the enhancement of motor performance, the enrichment of cognition and communication skills, the prevention of secondary impairments, and the support of parents and caregivers. The care of CP children demands a multidisciplinary approach focused on improving motor skills, reducing comorbidities, enhancing the quality of life, and prolonging survival.
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Affiliation(s)
- Anna Saranti
- 1th Department of Pediatrics, Aristotle University of Thessaloniki, G. Hippokration Hospital, Thessaloniki, Greece
| | - Pinelopi Dragoumi
- 1th Department of Pediatrics, Aristotle University of Thessaloniki, G. Hippokration Hospital, Thessaloniki, Greece
| | | | - Dimitrios Zafeiriou
- 1th Department of Pediatrics, Aristotle University of Thessaloniki, G. Hippokration Hospital, Thessaloniki, Greece.
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Poojari DP, Umakanth S, Maiya GA, Rao BK, Khurana S, Kumaran D S, Attal R, Brien M. Effect of family-centered care interventions on well-being of caregivers of children with cerebral palsy: a systematic review. F1000Res 2024; 12:790. [PMID: 38911944 PMCID: PMC11193087 DOI: 10.12688/f1000research.133314.2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 04/30/2024] [Indexed: 06/25/2024] Open
Abstract
Background Caring for a child with long-term functional limitations can have a negative impact on the physical and psychological well-being of the caregiver. Family-centered care (FCC) interventions have the potential to empower caregivers and contribute to their well-being. This systematic review aimed to synthesize existing evidence on the effectiveness of FCC interventions in improving the well-being of caregivers of children with cerebral palsy (CP), and identify the key components of such interventions that are most commonly practiced and deemed effective. Methods This review systematically searched seven databases for randomized controlled trials that evaluated the effectiveness of any FCC intervention on the well-being of caregivers of children with or at risk of CP. We used the Cochrane RoB 2.0 tool to assess risk of bias and Critical Appraisal Skills Programme (CASP) checklist for critical appraisal. Due to high heterogeneity of studies, narrative synthesis was used to summarize the data. Results The review consists of 11 studies which were categorized into five sections based on the components of FCC intervention provided in each individual study: 1. Information provision, and Enabling and partnership (n= 5); 2. Information provision, and Respectful and supportive care (n= 1); 3. Enabling and partnership (n= 2); 4. Enabling and partnership, and Respectful and supportive care (n= 2); 5. Information provision, Enabling and partnership and Respectful and supportive care (n= 1). Risk of bias was low in four studies, unclear in two studies, and high in five studies. Conclusion FCC interventions were found to be effective in improving caregivers' satisfaction with attainment of child and caregiver goals. Evidence from multiple studies does not strongly support the effectiveness of FCC interventions on caregiver's mental health, parenting and personal outcomes. Limited evidence precludes a conclusion on the effectiveness of the components of FCC on well-being of caregivers of children with CP.
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Affiliation(s)
- Deepalaxmi Paresh Poojari
- Department of Physiotherapy, Manipal College of Health Professions, Manipal Academy of Higher Education, Manipal, Karnataka, 576104, India
| | - Shashikiran Umakanth
- Department of Medicine, Dr TMA Pai Hospital, Udupi, Manipal Academy of Higher Education, Manipal, Karnataka, 576101, India
| | - G. Arun Maiya
- Department of Physiotherapy, Manipal College of Health Professions, Manipal Academy of Higher Education, Manipal, Karnataka, 576104, India
| | - Bhamini Krishna Rao
- Department of Physiotherapy, Manipal College of Health Professions, Manipal Academy of Higher Education, Manipal, Karnataka, 576104, India
| | - Sonia Khurana
- Department of Physical therapy, College of Health Sciences, Old Dominion University, Norfolk, Virginia, USA
| | - Senthil Kumaran D
- Department of Physiotherapy, Manipal College of Health Professions, Manipal Academy of Higher Education, Manipal, Karnataka, 576104, India
| | - Radhika Attal
- Department of Physiotherapy, Manipal College of Health Professions, Manipal Academy of Higher Education, Manipal, Karnataka, 576104, India
| | - Marie Brien
- Enabling Inclusion Program, Amar Seva Sangam, Ayikudi, Tamil Nadu, India
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Benfer KA, Whittingham K, Ware RS, Ghosh AK, Chowdhury S, Moula G, Samanta S, Khan NZ, Bell KL, Oftedal S, Bandaranayake S, Salt AT, Bhattacharya A, Maiti P, Tripathi SK, Morgan C, Novak I, Boyd RN. Efficacy of Early Intervention for Infants With Cerebral Palsy in an LMIC: An RCT. Pediatrics 2024; 153:e2023063854. [PMID: 38516717 DOI: 10.1542/peds.2023-063854] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 12/13/2023] [Indexed: 03/23/2024] Open
Abstract
OBJECTIVE To test efficacy of a parent-delivered multidomain early intervention (Learning through Everyday Activities with Parents [LEAP-CP]) for infants with cerebral palsy (CP) compared with equal-dose of health advice (HA), on (1) infant development; and (2) caregiver mental health. It was hypothesized that infants receiving LEAP-CP would have better motor function, and caregivers better mental health. METHODS This was a multisite single-blind randomized control trial of infants aged 12 to 40 weeks corrected age (CA) at risk for CP (General Movements or Hammersmith Infant Neurologic Examination). Both LEAP-CP and HA groups received 15 fortnightly home-visits by a peer trainer. LEAP-CP is a multidomain active goal-directed intervention. HA is based on Key Family Practices, World Health Organization. Primary outcomes: (1) infants at 18 months CA: Pediatric Evaluation of Disability Inventory-Computer Adaptive Test (PEDI-CAT mobility); and (2) caregiver: Depression Anxiety and Stress Scale. RESULTS Of eligible infants, 153 of 165 (92.7%) were recruited (86 males, mean age 7.1±2.7 months CA, Gross Motor Function Classification System at 18 m CA: I = 12, II = 25, III = 9, IV = 18, V = 32). Final data were available for 118 (77.1%). Primary (PEDI-CAT mobility mean difference = 0.8 (95% CI -1.9 to 3.6) P = .54) and secondary outcomes were similar between-groups. Modified-Intention-To-Treat analysis on n = 96 infants with confirmed CP showed Gross Motor Function Classification System I and IIs allocated to LEAP-CP had significantly better scores on PEDI-CAT mobility domain (mean difference 4.0 (95% CI = 1.4 to 6.5), P = .003) compared with HA. CONCLUSIONS Although there was no overall effect of LEAP-CP compared with dose-matched HA, LEAP-CP lead to superior improvements in motor skills in ambulant children with CP, consistent with what is known about targeted goal-directed training.
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Affiliation(s)
- Katherine A Benfer
- Queensland Cerebral Palsy and Rehabilitation Research Centre, Child Health Research Centre, The University of Queensland, Brisbane, Australia
| | - Koa Whittingham
- Queensland Cerebral Palsy and Rehabilitation Research Centre, Child Health Research Centre, The University of Queensland, Brisbane, Australia
| | - Robert S Ware
- Menzies Health Institute Queensland, Griffith University, Brisbane, Australia
| | | | - Sayak Chowdhury
- Indian Institute of Cerebral Palsy, Kolkata, India
- SSKM Postgraduate Institute of Medical Education and Research, Kolkata, India
| | | | - Sandip Samanta
- Dr B.C. Roy Post Graduate Institute of Paediatric Sciences, Kolkata, India
| | | | - Kristie L Bell
- Children's Nutrition Research Centre, Child Health Research Centre, The University of Queensland, Brisbane, Australia
| | - Stina Oftedal
- Queensland Cerebral Palsy and Rehabilitation Research Centre, Child Health Research Centre, The University of Queensland, Brisbane, Australia
| | - Sasaka Bandaranayake
- Queensland Paediatric Rehabilitation Service, Queensland Children's Hospital, Brisbane, Australia
| | | | | | - Pradip Maiti
- Dr B.C. Roy Post Graduate Institute of Paediatric Sciences, Kolkata, India
| | | | - Cathy Morgan
- Cerebral Palsy Alliance Research Institute, Specialty of Child and Adolescent Health, Sydney Medical School, Faculty of Medicine and Health, The University of Sydney, Sydney, Australia
| | - Iona Novak
- Cerebral Palsy Alliance Research Institute, Specialty of Child and Adolescent Health, Sydney Medical School, Faculty of Medicine and Health, The University of Sydney, Sydney, Australia
| | - Roslyn N Boyd
- Queensland Cerebral Palsy and Rehabilitation Research Centre, Child Health Research Centre, The University of Queensland, Brisbane, Australia
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Maughan AL, Lunsky Y, Lake J, Mills JS, Fung K, Steel L, Weiss JA. Parent, child, and family outcomes following Acceptance And Commitment Therapy for parents of autistic children: A randomized controlled trial. AUTISM : THE INTERNATIONAL JOURNAL OF RESEARCH AND PRACTICE 2024; 28:367-380. [PMID: 37165863 PMCID: PMC10851654 DOI: 10.1177/13623613231172241] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/12/2023]
Abstract
LAY ABSTRACT Parents of autistic children commonly experience difficulties with their own mental health. This study looked at the effects of a brief group-based Acceptance and Commitment Therapy program, developed for parents of autistic children, youth, and adults. ACT focuses on increasing psychological flexibility, which is the ability to be mindful and accepting of difficult thoughts and experiences, shown to be important for mental wellness. Participants included 54 parents of autistic people, ages 3-34. Parents were randomly divided into two groups: a Treatment group that received the intervention right away, and a Waitlist group that completed the program after the Treatment group completed the trial. All parents filled out questionnaires right before the program began, and at 3, 7, and 17 weeks after randomization. Compared to the group that was waiting to participate in the program, parents in the Treatment group reported greater improvements in depression and family distress, and these improvements were still present 4 months later. Parents in the Treatment group also reported short-term improvements in their positive feelings and personal goals, compared to those waiting. Results showed that ACT may help improve some aspects of mental health for parents of autistic children, but further research is recommended.
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Affiliation(s)
| | - Yona Lunsky
- Centre for Addiction and Mental Health, Canada
| | | | | | | | - Lee Steel
- Centre for Addiction and Mental Health, Canada
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Schlebusch L, Chambers N, Rosenstein D, Erasmus P, de Vries PJ. Supporting caregivers of children with developmental disabilities: Findings from a brief caregiver well-being programme in South Africa. AUTISM : THE INTERNATIONAL JOURNAL OF RESEARCH AND PRACTICE 2024; 28:199-214. [PMID: 36352758 DOI: 10.1177/13623613221133182] [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] [Indexed: 11/11/2022]
Abstract
LAY ABSTRACT Young children with developmental disabilities and delays who live in low- and middle-income countries are at significant risk of not reaching their full potential. We know that daily interactions with their caregivers (parents or other people taking care of them) play an important role in promoting their development. However, having a child with developmental disabilities can have a negative impact on carers' mental health and well-being, which in turn can influence their capacity to care for their children. To date, very little attention has been given to the caregivers' capacity to care. The World Health Organization developed a Caregiver Skills Training programme which includes a brief, three-session module that focuses on improving caregivers' well-being and mental health. This well-being programme is based on acceptance and commitment therapy. Acceptance and commitment therapy shows increasing evidence of helping people respond to their stressors, thoughts, feelings and experiences a little differently and commit to small changes that are in line with their personal values. Acceptance and commitment therapy has shown promise in improving feelings of well-being in caregivers of children with developmental disabilities. We adapted the World Health Organization Caregiver Skills Training Caregiver well-being module to suit the South African context. The resultant 'Well Beans for Caregivers' was then delivered to caregivers from a rural, low-resource setting in South Africa. We found the intervention easy to implement, highly acceptable to caregivers and showed promising impacts on caregivers' well-being and mental health. This intervention has the potential to be implemented widely and sustainably to build caregivers' capacity to care for their children.
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Ye F, Lee JJ, Xue D, Yu DSF. Acceptance and Commitment Therapy Among Informal Caregivers of People With Chronic Health Conditions: A Systematic Review and Meta-Analysis. JAMA Netw Open 2023; 6:e2346216. [PMID: 38051530 DOI: 10.1001/jamanetworkopen.2023.46216] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/07/2023] Open
Abstract
Importance Although there is substantial evidence to suggest the health benefits of acceptance and commitment therapy (ACT) among informal caregivers of people with chronic health conditions, the great variation in intervention designs among published studies limits its application. Objectives To identify intervention characteristics of ACT that are associated with improved psychological health and to assess the acceptability of ACT among informal caregivers. Data Sources Seven English- and 3 Chinese-language databases without limits on publication dates, the reference lists of previous reviews, and gray literature were searched up to February 2023. Study Selection Randomized clinical trials comparing the effect of ACT vs control groups on improving psychological health among informal caregivers. Data Extraction and Synthesis Two reviewers independently screened searched records and extracted data from eligible studies. Random-effects meta-analysis and mixed-effects metaregression were performed. The Preferred Reporting Items for Systematic Reviews and Meta-Analyses guideline was followed. Main Outcomes and Measures Psychological health outcomes (eg, depressive symptoms) measured by valid measurements and the acceptability of ACT based on identified parameters. Results A total of 29 studies with 2010 participants, published between 2015 and 2023, were identified. ACT showed moderate to large effect sizes for improving psychological health at postintervention assessments (Hedges g range, -0.55 [95% CI, -0.98 to -0.12] to -1.14 [95% CI, -1.83 to -0.45]) and at 1-to-3-month and 4-to-6-month follow-ups (Hedges g range, -0.47 [95% CI, -0.69 to -0.25] to -1.29 [95% CI, -2.33 to -0.24]). Multivariable metaregression analysis regarding intervention characteristics found that ACT delivered in a mixed individual- and group-based format, face-to-face, or through more intervention sessions was associated with greater improvements for experiential avoidance (face-to-face: β = -1.170 [95% CI, -2.020 to -0.319]; number of sessions: β = -0.242 [95% CI, -0.353 to -0.130]), depressive symptoms (mixed delivery format: β = -2.583 [95% CI, -4.845 to -0.321]; face-to-face: β = -1.555 [95% CI, -3.002 to -0.108]), or anxiety symptoms (face-to-face: β = -1.241 [95% CI, -2.337 to -0.146]). In general, ACT had low attrition rates (11%), and participants' adherence (51%-80%) and satisfactory ratings (72%-95%) lend support to its acceptability. Conclusions and Relevance This systematic review and meta-analysis found that ACT was consistently associated with improvements in psychological health, supporting its application to improve informal care for chronic disease management. This review provides specific details on the design parameters of ACT for achieving greater efficacy.
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Affiliation(s)
- Fen Ye
- School of Nursing, LKS Faculty of Medicine, The University of Hong Kong, Hong Kong, China
| | - Jung Jae Lee
- School of Nursing, LKS Faculty of Medicine, The University of Hong Kong, Hong Kong, China
| | - Dandan Xue
- School of Nursing, LKS Faculty of Medicine, The University of Hong Kong, Hong Kong, China
| | - Doris Sau-Fung Yu
- School of Nursing, LKS Faculty of Medicine, The University of Hong Kong, Hong Kong, China
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Li S, Chen Z, Yong Y, Xie J, Li Y. Effectiveness of acceptance and commitment therapy-based interventions for improving the psychological health of parents of children with special health care needs: A systematic review and meta-analysis. Compr Psychiatry 2023; 127:152426. [PMID: 37757593 DOI: 10.1016/j.comppsych.2023.152426] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/03/2023] [Revised: 09/18/2023] [Accepted: 09/19/2023] [Indexed: 09/29/2023] Open
Abstract
PURPOSE To evaluate the effectiveness of ACT-based interventions on improving the mental health of parents of children with SHCN compared to active/inactive controls and to investigate the characteristics/components of the effective interventions in the included studies. METHODS Eight databases were searched from inception to 14 February 2023. We included all randomized controlled trials (RCTs) of ACT-based interventions for parents of children with SHCN published in English or Chinese journals and dissertations reporting at least one parental mental health outcome postintervention. RESULTS Fourteen RCTs were included. The results indicated significant improvements of ACT-based interventions in the stress (Hedges' g = -0.36), depressive symptoms (g = -0.32), anxiety (g = -0.29), distress (g = -0.29), psychological flexibility (g = 0.51), mindful awareness/mindfulness abilities (g = 0.41), and confidence/self-efficacy (g = 0.30) of parents, as well as in the emotional and behavioural problems (EBP; g = -0.39) of their children with SHCN postintervention, with moderate to high certainty of evidence. Furthermore, the optimal components of ACT-based interventions, including the intervention approaches (ACT combined with another parenting technique/program), active participants (only involving parents), delivery mode (in-person) and format (group-based format), and desirable number of sessions (4-8 sessions), were identified to inform the design of future interventions/studies. CONCLUSION This review highlights the positive effects of ACT-based interventions on mental health, psychological flexibility, mindful awareness/mindfulness abilities, and confidence/self-efficacy in parents and EBP in children with SHCN. Since group-based ACT combined with a parenting technique/program was identified as the optimal effective strategy, its effects could be further examined in larger-scale RCTs with parents and children with SHCN with diverse ethnic and sociodemographic characteristics.
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Affiliation(s)
- Sini Li
- Clinical Nursing Teaching and Research Section, The Second Xiangya Hospital, Central South University, Changsha, Hunan, China; The Nethersole School of Nursing, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong
| | - Zengyu Chen
- The Xiangya Nursing School, Central South University, Changsha, Hunan, China
| | - Yijing Yong
- Cognition and Human Behaviour Key Laboratory of Hunan Province, Hunan Normal University, Changsha, Hunan, China
| | - Jiao Xie
- Department of Otolaryngology-Head and Neck Surgery, The Second Xiangya Hospital, Central South University, Changsha, Hunan, China..
| | - Yamin Li
- Clinical Nursing Teaching and Research Section, The Second Xiangya Hospital, Central South University, Changsha, Hunan, China; The Xiangya Nursing School, Central South University, Changsha, Hunan, China.
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Chong YY, Kwan JYM, Yau PT, Cheng HY, Chien WT. Roles of Parental Psychological Flexibility, Self-Compassion, and Self-Efficacy in Affecting Mental Health and Quality of Life in Parents of Children with Eczema. Healthcare (Basel) 2023; 11:2708. [PMID: 37893783 PMCID: PMC10606052 DOI: 10.3390/healthcare11202708] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2023] [Revised: 10/02/2023] [Accepted: 10/07/2023] [Indexed: 10/29/2023] Open
Abstract
Parents of young children with eczema often experience adverse mental health consequences, including depression, anxiety, stress, and a reduced health-related quality of life (HRQoL), due to the unpredictable nature of flare-ups and exacerbations. This study investigated the roles of psychological flexibility, self-compassion, and self-efficacy in fostering parental mental health outcomes and HRQoL while caring for children diagnosed with eczema. Baseline data from an ongoing clinical trial examining the effects of a family acceptance-and-commitment-therapy-based eczema management program (FACT-EMP) on parent-child dyads affected by eczema (N = 110 dyads, 75.5% mothers; 66.4% boys) were analyzed using adjusted hierarchical regression analyses. The findings indicate that psychological inflexibility was significantly associated with symptoms of anxiety, depression, stress, and HRQoL. Self-compassion was significantly linked to all assessed mental health outcomes, whereas self-efficacy showed a significant association only with symptoms of depression. These results underscore the significance of promoting parental psychological flexibility and self-compassion through acceptance and commitment therapy and compassion-based approaches to enhance mental health and quality of life while managing children's eczema.
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Affiliation(s)
- Yuen Yu Chong
- The Nethersole School of Nursing, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong SAR, China; (J.Y.M.K.); (P.T.Y.); (H.Y.C.); (W.T.C.)
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Alirahmi M, Aibod S, Azizifar A, Kikhavani S. Effectiveness of behavioral activation therapy and acceptance and commitment therapy on depression and rumination as a tool for health promotion on mothers with cerebral palsy children. JOURNAL OF EDUCATION AND HEALTH PROMOTION 2023; 12:290. [PMID: 37849873 PMCID: PMC10578540 DOI: 10.4103/jehp.jehp_1552_22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 10/27/2022] [Accepted: 12/24/2022] [Indexed: 10/19/2023]
Abstract
BACKGROUND Since in most families, mothers are more responsible for taking care of children and they have more responsibility than fathers for monitoring the child; taking care of a disabled child can have a more negative effect on the psychological state of mothers. The purpose of the present study is to investigate the effectiveness of behavioral activation therapy (BAT) and acceptance and commitment therapy (ACT) on depression and rumination on mothers with children with cerebral palsy in the city of Ilam. MATERIALS AND METHODS The design of this research was pretest and post-test quasi-experimental with a control group. The research sample was 60 mothers who referred to occupational therapy centers in the city of Ilam in 2022, who were randomly divided into two experimental groups (N = 40 for each) and a control group (N = 20). One of the experimental groups, received behavioral activation group therapy method; and the other received the group therapy method based on acceptance and commitment for eight sessions lasted for 90 minutes in week. Data were collected using the Beck depression questionnaire (BDI-II) and the rumination questionnaire in two stages before the intervention and after the intervention. In this research, covariance analysis was used for data analysis. RESULTS The results of covariance analysis showed that behavioral activation therapy and acceptance and commitment-based therapy reduced depression (P < 0.01) and rumination (P < 0.01), and the two experimental groups were compared with the control group in the post-test phase. CONCLUSION It seems that behavioral activation therapy and acceptance and commitment therapy are effective in reducing depression and rumination in the subjects of the present study. Therefore, these treatments are suggested as complementary treatments along with drug treatments to improve psychological symptoms.
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Affiliation(s)
- Mostafa Alirahmi
- Department of Psychology, Faculty of Human Sciences, Islamic Azad University, Ilam Branch, Ilam, Iran
| | - Sehat Aibod
- Psychosocial Injuries Research Center, Ilam University of Medical Sciences, Ilam, Iran
| | - Akbar Azizifar
- Department of Psycholinguistics, School of Medicine, Ilam University of Medical Sciences, Ilam, Iran
| | - Sattar Kikhavani
- Department of Psychology, Faculty of Human Sciences, Islamic Azad University, Ilam Branch, Ilam, Iran
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Sheng N, Ouyang N, Zhou P, Ge B, Cheng F, Lv H. Caregiver engagement interventions on reducing the anxiety and depression of children with chronic health conditions and their caregivers: A meta-analysis of randomized controlled trials. J Pediatr Nurs 2023:S0882-5963(23)00104-5. [PMID: 37164784 DOI: 10.1016/j.pedn.2023.04.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/20/2022] [Revised: 04/21/2023] [Accepted: 04/22/2023] [Indexed: 05/12/2023]
Abstract
BACKGROUND Anxiety and depression are common debilitating mental health issues in families of children with chronic health conditions. It is essential to consider the mediating role of caregivers between children and healthcare workers. Previous research has evaluated the effectiveness of caregiver engagement interventions in reducing anxiety and depression in chronically ill children and their caregivers, but their overall impact awaits a synthesis of the available evidence. METHODS We performed a comprehensive search using PubMed, Embase, Web of Science, Cochrane Library, Ovid, PsycINFO, APA PsycArticles, and Cumulative Index of Nursing and Allied Health Literature (CINAHL). RESULTS Twenty-nine studies were included. The results demonstrated that caregiver engagement interventions significantly decreased anxiety (standardized mean difference [SMD] = -0.49; 95% confidence interval [CI], -0.77 to -0.22; P < 0.001) and depression (SMD = -0.37; 95% CI, -0.55 to -0.18; P < 0.001) among caregivers, particularly in developing countries. However, no improvements in the anxiety (SMD = 0.00; 95% CI, -0.46 to 0.46; P = 0.99) and depression (SMD = -0.14; 95% CI, -0.32 to 0.04; P = 0.14) of children were observed. CONCLUSIONS Significant evidence exists regarding the positive effects of caregiver engagement interventions on caregivers' anxiety and depression. Further recommendations for future research should focus on engagement interventions that reduce the anxiety and depression for children with chronic conditions. IMPLICATIONS Clinicians should concentrate on the mental health of chronically ill children and their caregivers and extend caregiver engagement therapies to improve anxiety and depression resulting from managing the disease.
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Affiliation(s)
- Nan Sheng
- School of Nursing, Suzhou Vocational Health College, Suzhou, China
| | - Na Ouyang
- School of Nursing, Yale University, CT, USA.
| | - Ping Zhou
- School of Nursing, Suzhou Vocational Health College, Suzhou, China
| | - Binqian Ge
- School of Nursing, Suzhou Vocational Health College, Suzhou, China
| | - Fangman Cheng
- School of Nursing, Suzhou Vocational Health College, Suzhou, China
| | - Han Lv
- School of Nursing, Suzhou Vocational Health College, Suzhou, China
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Lobato D, Montesinos F, Polín E, Cáliz S. Third-Generation Behavioural Therapies in the Context of Neurodevelopmental Problems and Intellectual Disabilities: A Randomised Clinical Trial with Parents. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:4406. [PMID: 36901415 PMCID: PMC10002330 DOI: 10.3390/ijerph20054406] [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: 01/20/2023] [Revised: 02/23/2023] [Accepted: 02/28/2023] [Indexed: 06/18/2023]
Abstract
The purpose of this study was to examine how 14 parents of children with autism and intellectual impairments responded to an Acceptance and Commitment Therapy (ACT)-based psychological flexibility intervention programme. A randomised clinical trial was conducted. Parents were randomly assigned to the training programme group (n = 8) or waiting list group (n = 6). The treatment effect was measured using the 6-PAQ, PSS-14, GHQ-12, and WBSI questionnaires. Changes in interactions were assessed through self-recording, including a baseline to observe the previous functioning. Measures were taken before and after the application of the intervention programme and three months later. After that, the control group was switched to the psychological flexibility programme condition. After the programme's implementation, we could see a reduction in stress and the tendency to suppress unwanted private events. The impacts also appeared to apply to family interactions, resulting in a rise in positive interactions and a decrease in unfavourable ones. The results led us to think about the importance of psychological flexibility for the parents of children with chronic conditions, facilitating a reduction in the emotional impact derived from parenting and the emission of behaviours that promote the harmonious development of the diagnosed child.
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Affiliation(s)
- David Lobato
- Department of Psychology, Universidad Europea de Madrid, 28670 Madrid, Spain
| | - Francisco Montesinos
- Department of Psychology, Universidad Europea de Madrid, 28670 Madrid, Spain
- Instituto ACT, 28036 Madrid, Spain
| | - Eduardo Polín
- Department of Psychology, Universidad Europea de Madrid, 28670 Madrid, Spain
| | - Saray Cáliz
- Department of Psychology, Universidad Europea de Madrid, 28670 Madrid, Spain
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Akyurek G, Gurlek S, Ozturk LK, Bumin G. The effect of parent-based occupational therapy on parents of children with cerebral palsy: a randomised controlled trial. INTERNATIONAL JOURNAL OF THERAPY AND REHABILITATION 2023. [DOI: 10.12968/ijtr.2022.0074] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
Background/Aims Parents of children with cerebral palsy face higher levels of stress, anxiety and depression, sadness, exhaustion and burnout. Parent-based therapies have been found to increase parents' satisfaction with therapy, parent–child interactions and reduced parental stress. This study examined the effects of parent-based occupational therapy on stress levels, coping skills, and emotional skills and competencies of parents of children with cerebral palsy. Methods A total of 15 children and their parents who were admitted to the paediatric rehabilitation unit for occupational therapy were divided into two groups (control group: n=7, study group: n=8) using the coin toss randomisation method. The control group received standard occupational therapy, while the study group received parent-based occupational therapy for 45 minutes a session, twice a week, until 10 sessions had been completed. Participants were evaluated before and after the intervention. Results The study group showed a decrease in stress levels (P=0.034) and increases in coping skills (P=0.016), and emotional skills and competencies (P=0.036). In addition, only an improvement in parents' stress levels (P=0.046) was observed in the control group. Conclusions The parent-based occupational therapy programme was more effective regarding stress levels, coping skills, emotional skills and competencies of the families of children with cerebral palsy compared to classical occupational therapy. This study is important in terms of demonstrating the benefits of parent-based occupational therapy for parents of children with cerebral palsy.
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Affiliation(s)
- Gokcen Akyurek
- Department of Occupational Therapy, Faculty of Health Sciences, Hacettepe University, Ankara, Turkey
| | - Sedanur Gurlek
- Department of Occupational Therapy, Afyonkarahisar State Hospital, Afyonkarahisar, Turkey
| | - Leyla Kaya Ozturk
- Department of Occupational Therapy, Diskapi Yildirim Beyazit Training and Research Hospital, Ankara, Turkey
| | - Gonca Bumin
- Department of Occupational Therapy, Faculty of Health Sciences, Hacettepe University, Ankara, Turkey
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Wright SR, Graham CD, Houghton R, Ghiglieri C, Berry E. Acceptance and commitment therapy (ACT) for caregivers of children with chronic conditions: A mixed methods systematic review (MMSR) of efficacy, process, and acceptance. JOURNAL OF CONTEXTUAL BEHAVIORAL SCIENCE 2023. [DOI: 10.1016/j.jcbs.2022.12.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
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14
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Çiçek Gümüş E, Öncel S. Effects of Acceptance and Commitment Therapy-based interventions on the mental states of parents with special needs children: Randomized controlled trial. CURRENT PSYCHOLOGY 2022. [DOI: 10.1007/s12144-022-03760-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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15
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Leadbitter K, Smallman R, James K, Shields G, Ellis C, Langhorne S, Harrison L, Hackett L, Dunkerley A, Kroll L, Davies L, Emsley R, Bee P, Green J. REACH-ASD: a UK randomised controlled trial of a new post-diagnostic psycho-education and acceptance and commitment therapy programme against treatment-as-usual for improving the mental health and adjustment of caregivers of children recently diagnosed with autism spectrum disorder. Trials 2022; 23:585. [PMID: 35869533 PMCID: PMC9306249 DOI: 10.1186/s13063-022-06524-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2022] [Accepted: 07/06/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Autism is a neurodevelopmental disability affecting over 1% of UK children. The period following a child's autism diagnosis can present real challenges in adaptation for families. Twenty to 50% of caregivers show clinically significant levels of mental health need within the post-diagnostic period and on an ongoing basis. Best practice guidelines recommend timely post-diagnostic family support. Current provision is patchy, largely unevidenced, and a source of dissatisfaction for both families and professionals. There is a pressing need for an evidenced programme of post-diagnostic support focusing on caregiver mental health and adjustment, alongside autism psycho-education. This trial tests the clinical and cost-effectiveness of a new brief manualised psychosocial intervention designed to address this gap. METHODS This is a multi-centre two-parallel-group single (researcher)-blinded randomised controlled trial of the Empower-Autism programme plus treatment-as-usual versus usual local post-diagnostic offer plus treatment-as-usual. Caregivers of children aged 2-15 years with a recent autism diagnosis will be recruited from North West England NHS or local authority centres. Randomisation is individually by child, with one "index" caregiver per child, stratified by centre, using 2:1 randomisation ratio to assist recruitment and timely intervention. Empower-Autism is a group-based, manualised, post-diagnostic programme that combines autism psycho-education and psychotherapeutic components based on Acceptance and Commitment Therapy to support caregiver mental health, stress management and adjustment to their child's diagnosis. The comparator is any usual local group-based post-diagnostic psycho-education offer. Receipt of services will be specified through health economic data. PRIMARY OUTCOME caregiver mental health (General Health Questionnaire-30) at 52-week follow-up. SECONDARY OUTCOMES key caregiver measures (wellbeing, self-efficacy, adjustment, autism knowledge) at 12-, 26- and 52-week follow-up and family and child outcomes (wellbeing and functioning) at 52-week endpoint. SAMPLE N=380 (approximately 253 intervention/127 treatment-as-usual). Primary analysis will follow intention-to-treat principles using linear mixed models with random intercepts for group membership and repeated measures. Cost-effectiveness acceptability analyses will be over 52 weeks, with decision modelling to extrapolate to longer time periods. DISCUSSION If effective, this new approach will fill a key gap in the provision of evidence-based care pathways for autistic children and their families. TRIAL REGISTRATION ISRCTN 45412843 . Prospectively registered on 11 September 2019.
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Affiliation(s)
- Kathy Leadbitter
- Division of Neuroscience and Experimental Psychology, University of Manchester, Manchester, UK.
| | - Richard Smallman
- Division of Neuroscience and Experimental Psychology, University of Manchester, Manchester, UK
| | - Kirsty James
- Department of Biostatistics and Health Informatics, Institute of Psychiatry, Psychology and Neuroscience, Kings College London, London, UK
| | - Gemma Shields
- Division of Neuroscience and Experimental Psychology, University of Manchester, Manchester, UK
| | - Ceri Ellis
- Division of Neuroscience and Experimental Psychology, University of Manchester, Manchester, UK
| | - Sophie Langhorne
- Division of Neuroscience and Experimental Psychology, University of Manchester, Manchester, UK
| | - Louisa Harrison
- Division of Neuroscience and Experimental Psychology, University of Manchester, Manchester, UK
| | - Latha Hackett
- Manchester University NHS Foundation Trust, Manchester, UK
| | | | - Leo Kroll
- Pennine Care NHS Foundation Trust, Ashton-under-Lyne, UK
| | - Linda Davies
- Division of Neuroscience and Experimental Psychology, University of Manchester, Manchester, UK
| | - Richard Emsley
- Department of Biostatistics and Health Informatics, Institute of Psychiatry, Psychology and Neuroscience, Kings College London, London, UK
| | - Penny Bee
- Division of Neuroscience and Experimental Psychology, University of Manchester, Manchester, UK
| | - Jonathan Green
- Division of Neuroscience and Experimental Psychology, University of Manchester, Manchester, UK
- Manchester University NHS Foundation Trust, Manchester, UK
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16
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Ferreira MG, Mariano LI, Rezende JVD, Caramelli P, Kishita N. Effects of group Acceptance and Commitment Therapy (ACT) on anxiety and depressive symptoms in adults: A meta-analysis. J Affect Disord 2022; 309:297-308. [PMID: 35489560 DOI: 10.1016/j.jad.2022.04.134] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/22/2022] [Revised: 04/04/2022] [Accepted: 04/21/2022] [Indexed: 11/30/2022]
Abstract
BACKGROUND A comprehensive meta-analysis quantitatively examining the effects of group Acceptance and Commitment Therapy (ACT) on anxiety and depressive symptoms is required to advance our understanding of its efficacy and moderating factors. METHODS Four electronic databases were searched in August 2018. An update search was conducted in November 2021. Forty-eight randomised controlled trials (RCTs) were included in this review (3292 participants: anxiety = 34 RCTs, depression = 40 RCTs). RESULTS The overall effect size for anxiety symptoms was medium-to-large (g = 0.52, p < 0.001; 95% CI = 0.30-0.73), while the overall effect size was small-to-medium for depressive symptoms (g = 0.47, p < 0.001; 95% CI = 0.31-0.64). Subgroup analyses demonstrated that group ACT was significantly superior to non-active controls (e.g., waiting list) in reducing anxiety and depressive symptoms. Group ACT was only significantly superior to active controls (e.g., CBT) in reducing depressive symptoms. Subgroup analyses also demonstrated that the effect size can vary depending on the number of sessions provided and the primary condition of participants recruited. LIMITATIONS The number of studies included in each category of subgroup analyses was small and the risk of bias varied across studies. There was high heterogeneity among the included studies, and this might have affected the results. CONCLUSION The current evidence suggests that group ACT may be effective in treating anxiety and depressive symptoms, perhaps more so for depressive symptoms when compared to other well-established treatments. The intensity of treatment and the targeted population may need to be considered when delivering group ACT.
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Affiliation(s)
- Michele Gomes Ferreira
- Programa de Pós-Graduação em Ciências Aplicadas à Saúde do Adulto, Faculdade de Medicina da Universidade Federal de Minas Gerais, Av. Prof. Alfredo Balena, 190 - Santa Efigênia, CEP: 30130-100 Belo Horizonte, MG, Brazil
| | - Luciano Inácio Mariano
- Programa de Pós-Graduação em Neurociências, Universidade Federal de Minas Gerais, Av. Antônio Carlos, 6.627, CEP: 31270-901 Belo Horizonte, MG, Brazil
| | - Junio Vieira de Rezende
- Programa de Pós-Graduação em Psicologia, Faculdade de Filosofia e Ciências Humanas, Universidade Federal de Minas Gerais, Av. Antônio Carlos, 6.627, Caixa Postal N° 253, CEP: 31270-901 Belo Horizonte, MG, Brazil
| | - Paulo Caramelli
- Programa de Pós-Graduação em Ciências Aplicadas à Saúde do Adulto, Faculdade de Medicina da Universidade Federal de Minas Gerais, Av. Prof. Alfredo Balena, 190 - Santa Efigênia, CEP: 30130-100 Belo Horizonte, MG, Brazil; Departamento de Clínica Médica, Faculdade de Medicina da Universidade Federal de Minas Gerais. Av. Prof. Alfredo Balena, 190 - Santa Efigênia, CEP: 30130-100 Belo Horizonte, MG, Brazil.
| | - Naoko Kishita
- School of Health Science, University of East Anglia, Norwich Research Park, Norwich NR4 7TJ, United Kingdom.
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17
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Whittingham K, Sheffield J, Mak C, Wright A, Boyd RN. Parenting Acceptance and Commitment Therapy: An RCT of an online course with families of children with CP. Behav Res Ther 2022; 155:104129. [DOI: 10.1016/j.brat.2022.104129] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2021] [Revised: 05/09/2022] [Accepted: 05/21/2022] [Indexed: 11/02/2022]
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18
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Lamond B, Roberts SD, Miller SP, Wade SL, Williams TS. Psychosocial Intervention Outcomes for Children with Congenital and Neonatal Conditions: Systematic Review. J Pediatr Psychol 2022; 47:1003-1018. [PMID: 35472174 DOI: 10.1093/jpepsy/jsac038] [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: 12/10/2021] [Revised: 03/28/2022] [Accepted: 03/30/2022] [Indexed: 11/14/2022] Open
Abstract
There has been a historic lack of psychosocially geared treatment studies for congenital and neonatal conditions that impact brain development, despite well-established knowledge that these conditions impact cognitive development, quality of life (QoL), mental health, and academic success. OBJECTIVE The aim of the present study was to systematically investigate the research literature focusing on the effects of interventions in psychosocially geared programs for children with neonatal brain injury on school and psychological outcomes. METHODS Psychosocially geared programs broadly refer to interventions to improve parenting and school functioning, or child behavior, as well as other interventions that have a psychological component but may be more physically oriented, such as goal-directed physiotherapy. A comprehensive search of PubMed, Medline, PsychINFO, and Embase was completed between June and July 2020. The methodological quality of included articles was assessed using the Cochrane Risk of Bias Tool for Randomized Trials (RoB-2). RESULTS AND CONCLUSION Twenty studies met the inclusion criteria and demonstrated adequate risk of bias (i.e., low risk of bias or some concerns). The studies included family (n = 2), parenting (n = 7), and child (n = 10) interventions. There is some evidence supporting the effectiveness of psychosocial interventions for children with neonatal brain injury and their families on academic outcomes, behavior, and QoL, indicated by positive intervention effects in 65% (n = 13) of studies.
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Affiliation(s)
- Bronwyn Lamond
- Department of Psychology, Division of Neurology, The Hospital for Sick Children, Canada.,Department of Applied Psychology and Human Development, The University of Toronto, Canada
| | - Samantha D Roberts
- Department of Psychology, Division of Neurology, The Hospital for Sick Children, Canada.,Department of Psychology, York University, Canada
| | - Steven P Miller
- Department of Pediatrics, Faculty of Medicine, University of British Columbia, Canada.,BC Children's Hospital & Sunny Hill Health Centre, Canada
| | - Shari L Wade
- Department of Pediatrics, Cincinnati Children's Hospital Medical Center, USA.,Department of Pediatrics, University of Cincinnati College of Medicine, USA
| | - Tricia S Williams
- Department of Psychology, Division of Neurology, The Hospital for Sick Children, Canada.,Department of Pediatrics, The University of Toronto, Canada
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19
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Holmberg Bergman T, Renhorn E, Berg B, Lappalainen P, Ghaderi A, Hirvikoski T. Acceptance and Commitment Therapy Group Intervention for Parents of Children with Disabilities (Navigator ACT): An Open Feasibility Trial. J Autism Dev Disord 2022; 53:1834-1849. [PMID: 35239083 PMCID: PMC10123046 DOI: 10.1007/s10803-022-05490-6] [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] [Accepted: 02/14/2022] [Indexed: 10/19/2022]
Abstract
Parents of children with autism spectrum disorder and other disabilities report high levels of distress, but systematically evaluated interventions are few. This study aimed to evaluate the feasibility of a novel, manualized Acceptance and Commitment Therapy group intervention (Navigator ACT) in a sample of 94 parents of children with disabilities. Feasibility was measured by treatment completion, credibility, and satisfaction, and preliminary outcomes by using self-rating scales administered at the baseline, post-intervention, and follow-up. The results imply the intervention is feasible in the context of Swedish outpatient habilitation services. A preliminary analysis of the outcome measures suggests that parents experienced significant improvements in well-being. The results indicate that the treatment is feasible and should be evaluated in a randomized controlled trial.
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Affiliation(s)
- T Holmberg Bergman
- Department of Women's and Children's Health, Pediatric Neuropsychiatry Unit, Center for Neurodevelopmental Disorders at Karolinska Institutet (KIND), Gävlegatan 22B, 11330, Stockholm, Sweden. .,Habilitation and Health, Region Stockholm, Stockholm, Sweden. .,Center for Psychiatry Research, Stockholm, Sweden.
| | - E Renhorn
- Department of Women's and Children's Health, Pediatric Neuropsychiatry Unit, Center for Neurodevelopmental Disorders at Karolinska Institutet (KIND), Gävlegatan 22B, 11330, Stockholm, Sweden.,Habilitation and Health, Region Stockholm, Stockholm, Sweden.,Center for Psychiatry Research, Stockholm, Sweden
| | - B Berg
- Habilitation and Health, Region Stockholm, Stockholm, Sweden
| | - P Lappalainen
- Department of Psychology, University of Jyväskylä, PO Box 35, 40014, Jyväskylä, Finland
| | - A Ghaderi
- Department of Clinical Neuroscience, Karolinska Institutet, Nobels väg 9, 17165, Stockholm, Sweden
| | - T Hirvikoski
- Department of Women's and Children's Health, Pediatric Neuropsychiatry Unit, Center for Neurodevelopmental Disorders at Karolinska Institutet (KIND), Gävlegatan 22B, 11330, Stockholm, Sweden.,Habilitation and Health, Region Stockholm, Stockholm, Sweden.,Center for Psychiatry Research, Stockholm, Sweden
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20
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Andrews ML, Garcia YA, Catagnus RM, Gould ER. Effects of Acceptance and Commitment Training Plus Behavior Parent Training on Parental Implementation of Autism Treatment. PSYCHOLOGICAL RECORD 2021; 72:601-617. [PMID: 34866659 PMCID: PMC8628834 DOI: 10.1007/s40732-021-00496-5] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/02/2021] [Indexed: 11/27/2022]
Abstract
The objective of this study was to examine the effects of acceptance and commitment training (ACT) plus behavior parent training (BPT), when delivered via telehealth, on parental implementation of behavioral strategies, experiential avoidance (EA), and stress. The study also examined the subsequent effects on the parents’ autistic children’s behaviors. A multiple baseline design was implemented across four parent-child dyads who participated in the online training. The findings showed that ACT+BPT resulted in parental implementation reaching and maintaining high levels. The training also decreased EA and stress in three parents. Moreover, the parents’ ratings of their children’s challenging behaviors decreased. However, such a trend was not as clearly depicted by direct measures of the children’s behaviors. A social validity interview revealed parents found ACT beneficial in assisting them to learn and use the BPT strategies. Implications and suggestions for future research are discussed.
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Affiliation(s)
- Meredith L. Andrews
- Applied Behavior Analysis Online Program, The Chicago School of Professional Psychology, 325 North Wells Street, Chicago, IL USA
| | | | - Robyn M. Catagnus
- Applied Behavior Analysis Online Program, The Chicago School of Professional Psychology, 325 North Wells Street, Chicago, IL USA
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21
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Effective Interventions to Support Self-management for Parents of Children with a Chronic Condition: A Systematic Review. Matern Child Health J 2021; 25:1842-1865. [PMID: 34655426 DOI: 10.1007/s10995-021-03244-x] [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] [Accepted: 09/24/2021] [Indexed: 10/20/2022]
Abstract
INTRODUCTION This systematic review aims to determine the efficacy of interventions to support the self-management for parents of children with a chronic condition. An overview of prior research, regardless of the children's diagnosis, is lacking. Therefore, this systematic review provides an overview of the most recent available scientific literature that describes interventions to support self-management for parents of children with a chronic condition. METHODS A systematic search of Randomised Controlled Trials (RCTs) was conducted in CENTRAL, CINAHL, EMBASE, MEDLINE and PsychInfo. Studies that describe any type of self-management intervention or a combination of self-management interventions that support parents of children with a chronic condition between 0 and 18 years were included. The interventions and results were reported, hence categorized in the four areas of self-management: medical management, adjustment of lifestyle, shared decision-making and managing the consequences of a chronic condition. RESULTS The study included 23 RCTs. Due to the heterogeneity of the included studies a meta-analysis was impossible. Twenty studies showed statistically significant effects in favour of the intervention on at least one of the outcomes. Twenty-two studies showed risk of bias. The results indicate that disease management, (parent) group training, psycho-education and the Triple P intervention are effective interventions to support self-management. There were limited studies found in the areas lifestyle adjustment and shared decision making. DISCUSSION Effective interventions to support self-management for parents of children with a chronic condition are described, but the moderate quality of the studies hampers firm conclusions.
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22
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Marlow N, Shankaran S, Rogers EE, Maitre NL, Smyser CD. Neurological and developmental outcomes following neonatal encephalopathy treated with therapeutic hypothermia. Semin Fetal Neonatal Med 2021; 26:101274. [PMID: 34330680 DOI: 10.1016/j.siny.2021.101274] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
In randomized trials, therapeutic hypothermia (TH) is associated with reduced prevalence of the composite outcome mortality or neurodevelopmental morbidity in infants with neonatal encephalopathy (NE). Following systematic review, the reduction in prevalence of both mortality and infant neuromorbidity is clear. Among three trials reporting school age outcomes, the effects of NE and TH suggest that such benefit persists into middle childhood, but none of the major trials were powered to detect differences in these outcomes. Cognitive, educational and behavioural outcomes are all adversely affected by NE in children without moderate or severe neuromorbidity. High-quality longitudinal studies of neurocognitive and educational outcomes following NE in the era of TH, including studies incorporating multimodal neuroimaging assessments, are required to characterise deficits more precisely so that robust interventional targets may be developed, and resource planning can occur. Understanding the impact of NE on families and important educational, social, and behavioural outcomes in childhood is critical to attempts to optimise outcomes through interventions.
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Affiliation(s)
| | | | | | - Nathalie L Maitre
- Nationwide Children's Hospital, Columbus, OH, USA; Vanderbilt University, Nashville, TN, USA
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23
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Provenzi L, Grumi S, Rinaldi E, Giusti L. The porridge-like framework: A multidimensional guidance to support parents of children with developmental disabilities. RESEARCH IN DEVELOPMENTAL DISABILITIES 2021; 117:104048. [PMID: 34375793 DOI: 10.1016/j.ridd.2021.104048] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/21/2021] [Revised: 07/21/2021] [Accepted: 07/26/2021] [Indexed: 06/13/2023]
Abstract
Parents of children with developmental disabilities face many daily challenges that can lead to emotional and affective problems, difficulties in caregiving, and partial mental representations about themselves and their children. The multi-faceted nature of these parents' needs requires a multi-component approach that should include the analysis of priority support goals and the planning of tailored therapeutic actions. Despite different types of validated interventions are available, the choice of the most appropriate strategy to pursue a family-centered approach to support parents of infants with developmental disabilities is not obvious. In this scenario, we propose a multi-dimensional model, the porridge-like framework of parenting. It considers three interrelated domains in parents' experience - affective (A), behavioral (B), and cognitive (C) aspects - that are intertwined with the specific degree of the child's impairment (D). This ABCD model may provide professionals with pragmatically valid guidance to plan and deliver family-centered healthcare interventions. By covering the multi-dimensional nature of parenting challenges, it provides clinicians with conceptual categories to recognize the specific needs and to choose the most suitable therapeutic action to address them. In addition, it aims to promote an ethical approach to family-centered rehabilitation for children with developmental disabilities, maximizing the potentials of a collaborative assessment approach.
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Affiliation(s)
- Livio Provenzi
- Child Neurology and Psychiatry Unit, IRCCS Mondino Foundation, Pavia, Italy.
| | - Serena Grumi
- Child Neurology and Psychiatry Unit, IRCCS Mondino Foundation, Pavia, Italy
| | - Elisa Rinaldi
- Child Neurology and Psychiatry Unit, IRCCS Mondino Foundation, Pavia, Italy
| | - Lorenzo Giusti
- Faculty of Psychology, Università Cattolica del Sacro Cuore, Milan, Italy
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Early Intervention in Unilateral Cerebral Palsy: Let's Listen to the Families! What Are Their Desires and Perspectives? A Preliminary Family-Researcher Co-Design Study. CHILDREN-BASEL 2021; 8:children8090750. [PMID: 34572182 PMCID: PMC8467316 DOI: 10.3390/children8090750] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/08/2021] [Revised: 08/26/2021] [Accepted: 08/27/2021] [Indexed: 11/17/2022]
Abstract
Cerebral palsy (CP) is a clinical diagnosis based on a combination of clinical and neurological signs, which occurs between the ages of 12 and 24 months. Cerebral palsy or a high risk of cerebral palsy can be accurately predicted before 5–6 months, which is the corrected age. This would allow the initiation of intervention at an early stage. Parents must be more involved in the development and implementation of the early therapy, increasing opportunities for parent–child interaction. The aim of this study was to learn from the perspectives of families with children under 12 months with unilateral cerebral palsy (UCP), what ingredients (barriers and facilitators) should be involved in early intervention so that we could co-design (researchers and families) a multidisciplinary guideline for a global intervention addressed to the needs of the child and the family. Semi-structured interviews were conducted at a time and venue convenient for the families. A total of ten families with experience in early intervention were invited to attend the interview with open questions: (1) What components should early intervention have for a baby diagnosed with UCP? (2) What components should early intervention have for the family? (3) What should the involvement of the family be in early intervention? (4) What barriers included in early intervention should be removed? From the data analysis, three key topics emerged and were subsequently named by focus group participants: (1) UCP early intervention components, (2) family involvement in early intervention of UCP, and (3) removing barriers and creating facilitators within early intervention. The participation of the families (mothers) in the co-design of the necessary ingredients within the scope of a multidisciplinary early intervention guide aimed at children with UCP under 12 months allows learning about their reality and not that of the therapist. The following list highlights the present barriers as perceived by the parents: intervention as spectators, therapeutic goals, clinic environment, and lack of empathy, and the possible facilitators determined by the parents during the implementation comprised teamwork, the family’s goals, motivation during the intervention, and learning at home. Thus, an early intervention program to improve global functionality should address family involvement through multidisciplinary coaching and the modification of the environment, encouraging family goals and family support through the family–therapist team.
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Magnacca C, Thomson K, Marcinkiewicz A, Davis S, Steel L, Lunsky Y, Fung K, Vause T, Redquest B. A Telecommunication Model to Teach Facilitator to Deliver Acceptance and Commitment Training. Behav Anal Pract 2021; 15:730-751. [PMID: 34422238 PMCID: PMC8366160 DOI: 10.1007/s40617-021-00628-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/12/2021] [Indexed: 12/01/2022] Open
Abstract
Providing mediator training using a telecommunication format increases access to training by reducing geographical and financial barriers, while maintaining or increasing efficiency. Limited research has implemented this format to train facilitators in acceptance and commitment training (ACT), an empirically supported intervention. The aim of this research was to examine the efficacy of behavioral skills training via telecommunication for training novice facilitators to provide ACT to caregivers of individuals with neurodevelopmental disabilities. This two-part study involved concurrent multiple-baseline designs, each across four participants. Quantitative data on fidelity and confidence were collected at baseline, posttraining, and at 1-month follow-up. The results from this study provide preliminary support for the use of behavioral skills training via telecommunication to train ACT facilitators. Increasing the number of competently trained facilitators will help build capacity to increase access to ACT across geographical regions. Supplementary Information The online version contains supplementary material available at 10.1007/s40617-021-00628-x.
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Affiliation(s)
- Carly Magnacca
- Department of Applied Disability Studies, Brock University, St. Catharines, ON L2S 3A1 Canada
| | - Kendra Thomson
- Department of Applied Disability Studies, Brock University, St. Catharines, ON L2S 3A1 Canada.,Azrieli Adult Neuordevelopmental Centre (Centre for Addiction and Mental Health), Toronto, ON Canada
| | - Amanda Marcinkiewicz
- Azrieli Adult Neuordevelopmental Centre (Centre for Addiction and Mental Health), Toronto, ON Canada.,Department of Child and Youth Studies, Brock University, St. Catharines, ON Canada
| | - Sarah Davis
- Department of Child and Youth Studies, Brock University, St. Catharines, ON Canada
| | - Lee Steel
- Azrieli Adult Neuordevelopmental Centre (Centre for Addiction and Mental Health), Toronto, ON Canada
| | - Yona Lunsky
- Azrieli Adult Neuordevelopmental Centre (Centre for Addiction and Mental Health), Toronto, ON Canada
| | - Kenneth Fung
- Department of Psychiatry, University of Toronto, Toronto, ON Canada
| | - Tricia Vause
- Department of Child and Youth Studies, Brock University, St. Catharines, ON Canada
| | - Brianne Redquest
- Azrieli Adult Neuordevelopmental Centre (Centre for Addiction and Mental Health), Toronto, ON Canada
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Morgan C, Fetters L, Adde L, Badawi N, Bancale A, Boyd RN, Chorna O, Cioni G, Damiano DL, Darrah J, de Vries LS, Dusing S, Einspieler C, Eliasson AC, Ferriero D, Fehlings D, Forssberg H, Gordon AM, Greaves S, Guzzetta A, Hadders-Algra M, Harbourne R, Karlsson P, Krumlinde-Sundholm L, Latal B, Loughran-Fowlds A, Mak C, Maitre N, McIntyre S, Mei C, Morgan A, Kakooza-Mwesige A, Romeo DM, Sanchez K, Spittle A, Shepherd R, Thornton M, Valentine J, Ward R, Whittingham K, Zamany A, Novak I. Early Intervention for Children Aged 0 to 2 Years With or at High Risk of Cerebral Palsy: International Clinical Practice Guideline Based on Systematic Reviews. JAMA Pediatr 2021; 175:846-858. [PMID: 33999106 PMCID: PMC9677545 DOI: 10.1001/jamapediatrics.2021.0878] [Citation(s) in RCA: 142] [Impact Index Per Article: 47.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
Abstract
IMPORTANCE Cerebral palsy (CP) is the most common childhood physical disability. Early intervention for children younger than 2 years with or at risk of CP is critical. Now that an evidence-based guideline for early accurate diagnosis of CP exists, there is a need to summarize effective, CP-specific early intervention and conduct new trials that harness plasticity to improve function and increase participation. Our recommendations apply primarily to children at high risk of CP or with a diagnosis of CP, aged 0 to 2 years. OBJECTIVE To systematically review the best available evidence about CP-specific early interventions across 9 domains promoting motor function, cognitive skills, communication, eating and drinking, vision, sleep, managing muscle tone, musculoskeletal health, and parental support. EVIDENCE REVIEW The literature was systematically searched for the best available evidence for intervention for children aged 0 to 2 years at high risk of or with CP. Databases included CINAHL, Cochrane, Embase, MEDLINE, PsycInfo, and Scopus. Systematic reviews and randomized clinical trials (RCTs) were appraised by A Measurement Tool to Assess Systematic Reviews (AMSTAR) or Cochrane Risk of Bias tools. Recommendations were formed using the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) framework and reported according to the Appraisal of Guidelines, Research, and Evaluation (AGREE) II instrument. FINDINGS Sixteen systematic reviews and 27 RCTs met inclusion criteria. Quality varied. Three best-practice principles were supported for the 9 domains: (1) immediate referral for intervention after a diagnosis of high risk of CP, (2) building parental capacity for attachment, and (3) parental goal-setting at the commencement of intervention. Twenty-eight recommendations (24 for and 4 against) specific to the 9 domains are supported with key evidence: motor function (4 recommendations), cognitive skills (2), communication (7), eating and drinking (2), vision (4), sleep (7), tone (1), musculoskeletal health (2), and parent support (5). CONCLUSIONS AND RELEVANCE When a child meets the criteria of high risk of CP, intervention should start as soon as possible. Parents want an early diagnosis and treatment and support implementation as soon as possible. Early intervention builds on a critical developmental time for plasticity of developing systems. Referrals for intervention across the 9 domains should be specific as per recommendations in this guideline.
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Affiliation(s)
- Catherine Morgan
- Cerebral Palsy Alliance Research Institute, Brain Mind Centre, Discipline of Child and Adolescent Health, The University of Sydney, Sydney, New South Wales, Australia
| | | | - Lars Adde
- Department of Clinical and Molecular Medicine, Norwegian University of Science and Technology, Trondheim, Norway
- Clinic and Clinical Services, St Olavs Hospital, Trondheim University Hospital, Trondheim, Norway
| | - Nadia Badawi
- Cerebral Palsy Alliance Research Institute, Brain Mind Centre, Discipline of Child and Adolescent Health, The University of Sydney, Sydney, New South Wales, Australia
- Grace Centre for Newborn Care, Children’s Hospital at Westmead, Westmead, New South Wales, Australia
| | | | - Roslyn N. Boyd
- The University of Queensland, St Lucia, Queensland, Australia
| | | | - Giovanni Cioni
- IRCCS Fondazione Stella Maris, Pisa, Italy
- University of Pisa, Pisa, Italy
| | | | - Johanna Darrah
- Faculty of Rehabilitation Medicine, University of Alberta, Edmonton, Alberta, Canada
| | - Linda S. de Vries
- University Medical Center Utrecht, Utrecht University, Utrecht, the Netherlands
| | | | | | | | | | - Darcy Fehlings
- Holland Bloorview Kids Rehabilitation Hospital, Department of Paediatrics, University of Toronto, Toronto, Ontario, Canada
| | - Hans Forssberg
- Department of Women’s and Children’s Health, Karolinska Institutet, Stockholm, Sweden
| | | | | | - Andrea Guzzetta
- IRCCS Fondazione Stella Maris, Pisa, Italy
- University of Pisa, Pisa, Italy
| | - Mijna Hadders-Algra
- Department of Pediatrics, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands
| | | | - Petra Karlsson
- Cerebral Palsy Alliance Research Institute, Brain Mind Centre, Discipline of Child and Adolescent Health, The University of Sydney, Sydney, New South Wales, Australia
| | | | - Beatrice Latal
- University Children’s Hospital Zurich, Zurich, Switzerland
| | - Alison Loughran-Fowlds
- Grace Centre for Newborn Care, Children’s Hospital at Westmead, Westmead, New South Wales, Australia
| | - Catherine Mak
- The University of Queensland, St Lucia, Queensland, Australia
| | - Nathalie Maitre
- Nationwide Children’s Hospital, The Ohio State University, Columbus
| | - Sarah McIntyre
- Cerebral Palsy Alliance Research Institute, Brain Mind Centre, Discipline of Child and Adolescent Health, The University of Sydney, Sydney, New South Wales, Australia
| | - Cristina Mei
- Orygen, Parkville, Victoria, Australia
- University of Melbourne, Parkville, Victoria, Australia
- Murdoch Children’s Research Institute, Melbourne, Victoria, Australia
| | - Angela Morgan
- The Royal Children’s Hospital, Melbourne, Australia
- University of Melbourne, Parkville, Victoria, Australia
- Murdoch Children’s Research Institute, Melbourne, Victoria, Australia
| | | | - Domenico M. Romeo
- Pediatric Neurology Unit, Fondazione Policlinico Universitario A. Gemelli, Universitá Cattolica del Sacro Cuore, Rome, Italy
| | - Katherine Sanchez
- Murdoch Children’s Research Institute, Melbourne, Victoria, Australia
| | - Alicia Spittle
- Murdoch Children’s Research Institute, Melbourne, Victoria, Australia
- Department of Physiotherapy, University of Melbourne, Parkville, Victoria, Australia
| | | | - Marelle Thornton
- Cerebral Palsy Alliance Research Institute, Brain Mind Centre, Discipline of Child and Adolescent Health, The University of Sydney, Sydney, New South Wales, Australia
| | - Jane Valentine
- Perth Children’s Hospital, Nedlands, Western Australia, Australia
| | | | - Koa Whittingham
- The University of Queensland, St Lucia, Queensland, Australia
| | - Alieh Zamany
- Eugene Child Development and Rehabilitation Center, Oregon Health and Science University, Eugene
| | - Iona Novak
- The University of Sydney, Sydney, Australia
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Effect of Psychological Intervention Combined with Family Cooperation on the Perioperative Quality of Life and Psychological States of Elderly Patients with Prostate Cancer Treated with Compound Kushen Injection. EVIDENCE-BASED COMPLEMENTARY AND ALTERNATIVE MEDICINE 2021; 2021:2971644. [PMID: 34335804 PMCID: PMC8315856 DOI: 10.1155/2021/2971644] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/04/2021] [Accepted: 07/13/2021] [Indexed: 11/17/2022]
Abstract
Objective The purpose of the study was to investigate the nursing effect of psychological intervention combined with family cooperation on elderly patients with prostate cancer treated with compound kushen injection and put forward effective suggestions. Methods 122 elderly patients with prostate cancer admitted to our hospital from June 2018 to June 2019 were selected and randomly divided into a control group (n = 61) and experimental group (n = 61). The patients in the control group received routine nursing intervention during the perioperative period, while the patients in the experimental group were treated with psychological intervention combined with family cooperation on the basis of routine nursing. The quality of life and psychological states of patients in the two groups were statistically analyzed. Results The evaluation of psychological states at 24 hours before surgery and 24 hours before discharge in the experimental group was significantly better than that in the control group (P < 0.05), with statistical significance. On comparing the basic conditions between the two groups in the perioperative period, the length of hospitalization, length of catheter retention after surgery, and incidence of complications in the experimental group were all significantly better than those in the control group (P < 0.05), with statistical significance. The satisfaction of patients with the nursing process in both groups was recorded and statistically analyzed through questionnaires. The satisfaction with nursing process in the experimental group was significantly higher than that in the control group (P < 0.05), with statistical significance. The quality of life of the patients was followed up at three months after discharge. The quality of life of the experimental group was significantly better than that of the control group (P < 0.05), with statistical significance. Conclusion Psychological intervention combined with family cooperation for the elderly patients with prostate cancer treated with compound kushen injection is beneficial to improve their psychological states, encourage them to face the disease in a more positive manner, effectively improve the quality of life after intervention, ensure the therapeutic effect during perioperative period, increase happiness index, and enhance their satisfaction with the nursing process, which is worthy of clinical application and popularization.
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Chua JYX, Shorey S. The Effect of Mindfulness-Based and Acceptance Commitment Therapy-Based Interventions to Improve the Mental Well-Being Among Parents of Children with Developmental Disabilities: A Systematic Review and Meta-Analysis. J Autism Dev Disord 2021; 52:2770-2783. [PMID: 34181139 PMCID: PMC8237545 DOI: 10.1007/s10803-021-04893-1] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/21/2021] [Indexed: 12/17/2022]
Abstract
Parents of children with developmental disabilities are susceptible to mental health problems. Mindfulness-based and acceptance and commitment therapy (ACT)-based interventions can improve their mental well-being. This review examined the effectiveness of mindfulness-based and ACT-based interventions in improving mental well-being and mindfulness among parents of children with developmental disabilities. Six electronic databases were searched, resulting in the inclusion of ten studies published between 2014 and 2020. Meta-analysis was conducted using the random-effect model. The results suggest that mindfulness-based and ACT-based interventions were effective in decreasing parental stress, anxiety and depression, however, the effectiveness of these interventions in increasing parental mindfulness was inconclusive. Based on these findings, we discussed considerations for implementing interventions and identified areas which warrant further research.
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Affiliation(s)
| | - Shefaly Shorey
- Alice Lee Centre for Nursing Studies, Yong Loo Lin School of Medicine, National University of Singapore, Level 2, Clinical Research Centre, Block MD11, 10 Medical Drive, Singapore, 117597, Singapore.
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Acceptance and Commitment Therapy for Caregivers of Children with Neurodevelopmental Disabilities: a Systematic Review. CURRENT DEVELOPMENTAL DISORDERS REPORTS 2021. [DOI: 10.1007/s40474-021-00228-y] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Byrne G, Ghráda ÁN, O'Mahony T, Brennan E. A systematic review of the use of acceptance and commitment therapy in supporting parents. Psychol Psychother 2021; 94 Suppl 2:378-407. [PMID: 32406169 DOI: 10.1111/papt.12282] [Citation(s) in RCA: 26] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/27/2019] [Revised: 04/03/2020] [Indexed: 12/16/2022]
Abstract
OBJECTIVES Acceptance and commitment therapy (ACT) has accrued a growing evidence-base for a wide variety of psychological difficulties. Given that ACT promotes broad and flexible repertoires of behaviour as well as neutralizing the ubiquitous psychological processes theorized to be responsible for much human suffering, such an approach may hold promise. The use of ACT-informed parenting interventions offers another alternative to solely behavioural approaches but it remains relatively understudied and in need of further exploration. DESIGN The current systematic review, which searched four databases, aimed to collate all ACT interventions that included parental therapeutic components in the treatment of various child presenting difficulties. The review also rated the methodological rigour of the ACT evidence-base for this type of treatment format. RESULTS Twenty-seven individual studies covering a broad spectrum of presenting problems were included, comprising of 1,155 participants. A large proportion of studies were within-group designs with a smaller number using randomized controlled trials. The majority of studies reported improvements on either parent report symptoms regarding child physical or psychological functioning as well as parent-reported measures of stress, depression, and anxiety. Similar improvements were noted on a number of ACT mechanisms of change outcomes, including mindfulness, acceptance, and cognitive fusing. These gains were evident for parents of children with neurodevelopmental disorders, chronic pain, and significant physical health difficulties. Maintenance or further treatment gains were often reported at follow-up. These positive findings are tempered by low levels of methodological rigour common in some of the studies included. CONCLUSIONS Despite these limitations, ACT holds promise as a transdiagnostic intervention that can help with the parenting of children with a range of psychological and physical difficulties. PRACTITIONER POINTS ACT has accrued a relatively strong evidence base for a range of psychological difficulties. Despite some methodological shortcomings, ACT shows promise as an intervention to help parents manage stress and difficulties especially in relation to children with autism, chronic pain, and physical health needs. Further research is required in comparing ACT to more established treatments and helping consolidate initial positive findings.
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Affiliation(s)
- Gary Byrne
- Health Service Executive, Dublin, Ireland
| | | | | | - Emma Brennan
- School of Psychology, Trinity College, Dublin, Ireland
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Supporting parents of children with chronic conditions: A randomized controlled trial of web-based and self-help ACT interventions. Internet Interv 2021; 24:100382. [PMID: 33816128 PMCID: PMC8010620 DOI: 10.1016/j.invent.2021.100382] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/08/2021] [Revised: 03/09/2021] [Accepted: 03/10/2021] [Indexed: 12/30/2022] Open
Abstract
OBJECTIVE Many parents of children with chronic conditions and developmental disabilities experience high rates of burnout and psychological distress. The aim of the current study was to examine the effects of two differently delivered interventions based on acceptance and commitment therapy (ACT) on symptoms of burnout, depression, quality of life, psychological flexibility, and mindfulness skills. METHOD A total of 110 parents of children aged 0.8 to 17 years with chronic conditions and developmental disabilities participated in a randomized controlled trial lasting 13 weeks with two intervention groups: (1) an iACT intervention, including three psychologist-led video conferencing sessions, and (2) a self-help ACT, which received self-help material: an ACT-based booklet with the possibility of using ACT-based online exercises. RESULTS For the main outcome measure burnout, a similar decrease was found in both groups. The supported iACT intervention produced significantly larger improvements in depressive symptoms (d = 0.49), psychological flexibility (d = 0.64), and mindfulness (d = 0.55) compared to the self-help ACT intervention. For health-related quality of life, only the dimension of role limitations caused by emotional problems showed a significant difference in favor of the supported iACT (d = 0.58). CONCLUSIONS The results suggest that the iACT intervention including three video conferencing sessions with a psychologist produced broader improvements in parents' psychological well-being than the self-help ACT. Overall, Internet-delivered interventions and video conferencing technology may offer a feasible alternative to psychological support and self-care for parents of children with chronic conditions. Further research is needed to investigate the long-term effects of the current delivery models.
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Ying K, Rostenberghe HV, Kuan G, Mohd Yusoff MHA, Ali SH, Yaacob NS. Health-Related Quality of Life and Family Functioning of Primary Caregivers of Children with Cerebral Palsy in Malaysia. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18052351. [PMID: 33670850 PMCID: PMC7957778 DOI: 10.3390/ijerph18052351] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 01/12/2021] [Revised: 02/18/2021] [Accepted: 02/24/2021] [Indexed: 11/16/2022]
Abstract
Caregiving for children with cerebral palsy (CP) has proved to negatively impact on the physical and psychological well-being of their primary caregivers. The aim of the current study was to examine the overall impact of caregiving for children with CP on the primary caregivers' health-related quality of life (HRQOL) and family functioning, and to identify potential factors associated with primary caregivers' HRQOL and family functioning. The cross-sectional study involved a total of 159 primary caregivers of children with CP with a mean age of 42.8 ± 8.4 years. Demographic data and information on the physical and leisure activities of the primary caregivers were collected, and their quality of life (QOL) was measured based on the self-reported Pediatric Quality of Life Inventory Family Impact Module (PedsQL FIM). Primary caregivers in the current study have shown good HRQOL and family functioning, with scores of 82.4 and 85.3 out of 100, respectively. Through multiple linear regression analyses, the mother's level of education, family monthly income, sleeping problems in children with CP, and the existence of children with other types of disability have been identified as factors contributing to HRQOL and family functioning. The findings help set out the course for stakeholders to establish action to enhance the QOL of primary caregivers.
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Affiliation(s)
- Kelvin Ying
- Interdisciplinary Health Sciences Unit, School of Health Sciences, Universiti Sains Malaysia, Kubang Kerian 16150, Kelantan, Malaysia;
- Cerebral Palsy Research Cluster, Universiti Sains Malaysia, Kubang Kerian 16150, Kelantan, Malaysia; (H.V.R.); (G.K.); (M.H.A.M.Y.)
| | - Hans Van Rostenberghe
- Cerebral Palsy Research Cluster, Universiti Sains Malaysia, Kubang Kerian 16150, Kelantan, Malaysia; (H.V.R.); (G.K.); (M.H.A.M.Y.)
- Department of Paediatrics, School of Medical Sciences, Universiti Sains Malaysia, Kubang Kerian 16150, Kelantan, Malaysia
| | - Garry Kuan
- Cerebral Palsy Research Cluster, Universiti Sains Malaysia, Kubang Kerian 16150, Kelantan, Malaysia; (H.V.R.); (G.K.); (M.H.A.M.Y.)
- Exercise and Sports Science, School of Health Sciences, Universiti Sains Malaysia, Kubang Kerian 16150, Kelantan, Malaysia
| | - Mohammad Haris Amirul Mohd Yusoff
- Cerebral Palsy Research Cluster, Universiti Sains Malaysia, Kubang Kerian 16150, Kelantan, Malaysia; (H.V.R.); (G.K.); (M.H.A.M.Y.)
- Department of Chemical Pathology, School of Medical Sciences, Universiti Sains Malaysia, Kubang Kerian 16150, Kelantan, Malaysia
| | - Siti Hawa Ali
- Interdisciplinary Health Sciences Unit, School of Health Sciences, Universiti Sains Malaysia, Kubang Kerian 16150, Kelantan, Malaysia;
- Cerebral Palsy Research Cluster, Universiti Sains Malaysia, Kubang Kerian 16150, Kelantan, Malaysia; (H.V.R.); (G.K.); (M.H.A.M.Y.)
- Correspondence: (S.H.A.); (N.S.Y.)
| | - Nik Soriani Yaacob
- Cerebral Palsy Research Cluster, Universiti Sains Malaysia, Kubang Kerian 16150, Kelantan, Malaysia; (H.V.R.); (G.K.); (M.H.A.M.Y.)
- Department of Chemical Pathology, School of Medical Sciences, Universiti Sains Malaysia, Kubang Kerian 16150, Kelantan, Malaysia
- Correspondence: (S.H.A.); (N.S.Y.)
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Stuyvenberg CL, Brown SE, Inamdar K, Evans M, Hsu LY, Rolin O, Harbourne RT, Westcott McCoy S, Lobo MA, Koziol NA, Dusing SC. Targeted Physical Therapy Combined with Spasticity Management Changes Motor Development Trajectory for a 2-Year-Old with Cerebral Palsy. J Pers Med 2021; 11:jpm11030163. [PMID: 33673573 PMCID: PMC7997196 DOI: 10.3390/jpm11030163] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2021] [Revised: 02/13/2021] [Accepted: 02/19/2021] [Indexed: 01/09/2023] Open
Abstract
Therapies for children with cerebral palsy (CP) often fail to address essential components of early rehabilitation: intensity, child initiation, and an embodied approach. Sitting Together And Reaching To Play (START-Play) addresses these issues while incorporating intensive family involvement to maximize therapeutic dosage. While START-Play was developed and tested on children aged 7–16 months with motor delays, the theoretical construct can be applied to intervention in children of broader ages and skills levels. This study quantifies the impact of a broader START-Play intervention combined with Botulinum toxin-A (BoNT-A) and phenol on the developmental trajectory of a 24 month-old child with bilateral spastic CP. In this AB +1 study, A consisted of multiple baseline assessments with the Gross Motor Function Measure-66 and the Assessment of Problem Solving in Play. The research participant demonstrated a stable baseline during A and changes in response to the combination of BoNT-A/phenol and 12 START-Play sessions during B, surpassing the minimal clinically important difference on the Gross Motor Function Measure-66. The follow-up data point (+1) was completed after a second round of BoNT-A/phenol injections. While the findings suggest the participant improved his gross motor skills with BoNT-A/phenol and START-Play, further research is needed to generalize these findings.
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Affiliation(s)
- Corri L. Stuyvenberg
- Rehabilitation Science Graduate Program, University of Minnesota Medical School, MMC 388, 420 Delaware St. SE, Minneapolis, MN 55455, USA;
| | - Shaaron E. Brown
- Department of Physical Therapy, Virginia Commonwealth University Health System, 1300 East Marshall Street, P.O. Box 980419, Richmond, VA 23298, USA;
| | - Ketaki Inamdar
- Rehabilitation and Movement Science Program, College of Health Professions, Virginia Commonwealth University, 900 E. Leigh Street, Richmond, VA 23298, USA;
| | - Megan Evans
- College of Health Professions, Virginia Commonwealth University, 900 E. Leigh Street, Richmond, VA 23298, USA;
| | - Lin-ya Hsu
- Department of Rehabilitation Medicine, Division of Physical Therapy, University of Washington, 1959 NE Pacific Street, P.O. Box 356490, Seattle, WA 98195, USA; (L.-y.H.); (S.W.M.)
| | - Olivier Rolin
- Department of Physical Medicine and Rehabilitation, Virginia Commonwealth University Health Sciences, 1223 E. Marshall Street, P.O. Box 980677, Richmond, VA 23298, USA;
| | - Regina T. Harbourne
- Rangos School of Health Sciences, Physical Therapy, Duquesne University, 600 Forbes Ave., Pittsburgh, PA 15282, USA;
| | - Sarah Westcott McCoy
- Department of Rehabilitation Medicine, Division of Physical Therapy, University of Washington, 1959 NE Pacific Street, P.O. Box 356490, Seattle, WA 98195, USA; (L.-y.H.); (S.W.M.)
| | - Michele A. Lobo
- Department of Physical Therapy and Biomechanics & Movement Science Program, University of Delaware, 540 S. College Ave., Newark, DE 19711, USA;
| | - Natalie A. Koziol
- Nebraska Center for Research on Children, Youth, Families & Schools, University of Nebraska Lincoln, 160 Prem S. Paul Research Center at Whittier School, Lincoln, NE 68583, USA;
| | - Stacey C. Dusing
- Division of Biokinesiology and Physical Therapy, University of Southern California, 1540 E Alcazar Street, CHP 155, Los Angeles, CA 90033, USA
- Correspondence:
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Jin X, Wong CL, Li H, Chen J, Chong YY, Bai Y. Acceptance and Commitment Therapy for psychological and behavioural changes among parents of children with chronic health conditions: A systematic review. J Adv Nurs 2021; 77:3020-3033. [PMID: 33626192 DOI: 10.1111/jan.14798] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2020] [Revised: 12/12/2020] [Accepted: 01/25/2021] [Indexed: 12/13/2022]
Abstract
AIMS To systematically identify the application of Acceptance and Commitment Therapy among parents of children with chronic health conditions and determine its effectiveness in parental psychological flexibility, psychological distress and parenting behaviour. DESIGN Systematic review. DATA SOURCES Nine databases (i.e. MEDLINE, PubMed, Embase, Cochrane Library, CINAHL, PsychINFO, Web of Science, China National Knowledge Infrastructure and WanFang Data) were systematically searched from inception to October 2019. REVIEW METHODS Quality of studies was appraised by using the Joanna Briggs Institute critical appraisal checklist. Findings were synthesized narratively. This work was conducted following the Preferred Reporting Items for Systematic Reviews and Meta-Analysis statement. RESULTS Eight studies involving 485 parents were included. Results indicated that Acceptance and Commitment Therapy significantly improved parental psychological flexibility and reduced psychological distress compared with usual care and waitlist, but was not significantly different from active treatments. Limited studies have provided very preliminary evidence that Acceptance and Commitment Therapy can significantly improve dysfunctional parenting behaviour than usual care and waitlist. High attrition rate at follow-up made the overall confidence of maintained effect relatively low. CONCLUSION This review provides preliminary evidence that Acceptance and Commitment Therapy is beneficial for improving psychological flexibility, psychological distress and parenting behaviour among parents of children with chronic health conditions. Future studies with rigorous designs and large sample sizes are warranted to verify the evidence and explore its long-term efficacy. IMPACT Acceptance and Commitment Therapy has been increasingly applied to parents of children with chronic health conditions. This review provides positive evidence of its effects on psychological and behavioural outcomes among these parents. This work will help healthcare professionals and researchers with their practice and further research.
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Affiliation(s)
- Xiaohuan Jin
- The Nethersole School of Nursing, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong SAR, China
| | - Cho Lee Wong
- The Nethersole School of Nursing, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong SAR, China
| | - Huiyuan Li
- The Nethersole School of Nursing, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong SAR, China
| | - Jieling Chen
- The Nethersole School of Nursing, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong SAR, China
| | - Yuen Yu Chong
- The Nethersole School of Nursing, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong SAR, China
| | - Yang Bai
- The Nethersole School of Nursing, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong SAR, China
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Vyas SS, Ford MK, Tam EWY, Westmacott R, Sananes R, Beck R, Williams TS. Intervention experiences among children with congenital and neonatal conditions impacting brain development: patterns of service utilization, barriers and future directions. Clin Neuropsychol 2021; 35:1009-1029. [DOI: 10.1080/13854046.2020.1871516] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Affiliation(s)
- Shruti S. Vyas
- Division of Neurology, Department of Psychology, The Hospital for Sick Children, Toronto, ON, Canada
- Department of Psychology, Ryerson University, Toronto, ON, Canada
| | - Meghan K. Ford
- Division of Neurology, Department of Psychology, The Hospital for Sick Children, Toronto, ON, Canada
| | - Emily W. Y. Tam
- Department of Pediatrics, The University of Toronto, Toronto, ON, Canada
- Division of Neurology, Department of Pediatrics, The Hospital for Sick Children, Toronto, ON, Canada
| | - Robyn Westmacott
- Division of Neurology, Department of Psychology, The Hospital for Sick Children, Toronto, ON, Canada
- Department of Pediatrics, The University of Toronto, Toronto, ON, Canada
| | - Renee Sananes
- Department of Pediatrics, The University of Toronto, Toronto, ON, Canada
- Division of Cardiology, Department of Psychology, The Hospital for Sick Children, Toronto, ON, Canada
| | - Ranit Beck
- Division of Neonatology, Department of Pediatrics, The Hospital for Sick Children, Toronto, ON, Canada
| | - Tricia S. Williams
- Division of Neurology, Department of Psychology, The Hospital for Sick Children, Toronto, ON, Canada
- Department of Pediatrics, The University of Toronto, Toronto, ON, Canada
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Examining the correlates of psychological flexibility in romantic relationship and family dynamics: A meta-analysis. JOURNAL OF CONTEXTUAL BEHAVIORAL SCIENCE 2020. [DOI: 10.1016/j.jcbs.2020.09.010] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
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Pietruszewski L, Burkhardt S, Yoder PJ, Heathcock J, Lewandowski DJ, Maitre NL. Protocol and Feasibility-Randomized Trial of Telehealth Delivery for a Multicomponent Upper Extremity Intervention in Infants With Asymmetric Cerebral Palsy. Child Neurol Open 2020; 7:2329048X20946214. [PMID: 33015220 PMCID: PMC7517997 DOI: 10.1177/2329048x20946214] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2020] [Revised: 06/19/2020] [Accepted: 07/02/2020] [Indexed: 11/15/2022] Open
Abstract
Background: Past work showed that an in-person, therapist-guided, parent-implemented multicomponent intervention increased the motor functioning of the more affected upper extremity (UE) in infants with asymmetric cerebral palsy. The authors document treatment fidelity and provide initial testing of telehealth intervention delivery in a new subject sample. Methods: The authors adapted the intervention manual used in the previous trial for telehealth. Infants (6-24 months) were randomly assigned to intervention (n = 7) or waitlist (n = 6). The intervention prescribed soft-constraint wear on the less affected UE for 6 hours, 5 d/wk, and exercises. After an initial in-person training session, three 15- to 45-minute telehealth sessions were performed. Results: Median weekly constraint wear was 21 hours (interquartile range = 10.3-29.7); average parent-treatment fidelity was 95.7% (SD 11.2). A significant large (Cohen d = 0.92) between-group differences occurred on fine motor functioning of more affected UEs. Conclusion: The telehealth intervention was feasible and potentially effective, but a larger trial is needed to evaluate efficacy.
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Affiliation(s)
- Lindsay Pietruszewski
- Center for Perinatal Research at the Abigail Wexner Research Institute, Nationwide Children's Hospital, Columbus, OH, USA
| | - Stephanie Burkhardt
- Center for Perinatal Research at the Abigail Wexner Research Institute, Nationwide Children's Hospital, Columbus, OH, USA
| | - Paul J Yoder
- Department of Special Education, Peabody College of Education, Vanderbilt University, Nashville, TN, USA
| | - Jill Heathcock
- School of Health and Rehabilitation Sciences, The Ohio State University, Columbus, OH, USA
| | - Dennis J Lewandowski
- Center for Perinatal Research at the Abigail Wexner Research Institute, Nationwide Children's Hospital, Columbus, OH, USA
| | - Nathalie L Maitre
- Center for Perinatal Research at the Abigail Wexner Research Institute, Nationwide Children's Hospital, Columbus, OH, USA.,Department of Pediatrics, Nationwide Children's Hospital, Columbus, OH, USA
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Moore DA, Nunns M, Shaw L, Rogers M, Walker E, Ford T, Garside R, Ukoumunne O, Titman P, Shafran R, Heyman I, Anderson R, Dickens C, Viner R, Bennett S, Logan S, Lockhart F, Thompson Coon J. Interventions to improve the mental health of children and young people with long-term physical conditions: linked evidence syntheses. Health Technol Assess 2020; 23:1-164. [PMID: 31122334 DOI: 10.3310/hta23220] [Citation(s) in RCA: 34] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2023] Open
Abstract
BACKGROUND Although mental health difficulties can severely complicate the lives of children and young people (CYP) with long-term physical conditions (LTCs), there is a lack of evidence about the effectiveness of interventions to treat them. OBJECTIVES To evaluate the clinical effectiveness and cost-effectiveness of interventions aiming to improve the mental health of CYP with LTCs (review 1) and explore the factors that may enhance or limit their delivery (review 2). DATA SOURCES For review 1, 13 electronic databases were searched, including MEDLINE, EMBASE, PsycINFO, Cochrane Central Register of Controlled Trials (CENTRAL), Cumulative Index to Nursing and Allied Health Literature (CINAHL) and Science Citation Index. For review 2, MEDLINE, PsycINFO and CINAHL were searched. Supplementary searches, author contact and grey literature searches were also conducted. REVIEW METHODS The first systematic review sought randomised controlled trials (RCTs) and economic evaluations of interventions to improve elevated symptoms of mental ill health in CYP with LTCs. Effect sizes for each outcome were calculated post intervention (Cohen's d). When appropriate, random-effects meta-analyses produced pooled effect sizes (d). Review 2 located primary qualitative studies exploring experiences of CYP with LTCs, their families and/or practitioners, regarding interventions aiming to improve the mental health and well-being of CYP with LTCs. Synthesis followed the principles of metaethnography. An overarching synthesis integrated the findings from review 1 and review 2 using a deductive approach. End-user involvement, including topic experts and CYP with LTCs and their parents, was a feature throughout the project. RESULTS Review 1 synthesised 25 RCTs evaluating 11 types of intervention, sampling 12 different LTCs. Tentative evidence from seven studies suggests that cognitive-behavioural therapy interventions could improve the mental health of CYP with certain LTCs. Intervention-LTC dyads were diverse, with few opportunities to meta-analyse. No economic evaluations were located. Review 2 synthesised 57 studies evaluating 21 types of intervention. Most studies were of individuals with cancer, a human immunodeficiency virus (HIV) infection or mixed LTCs. Interventions often aimed to improve broader mental health and well-being, rather than symptoms of mental health disorder. The metaethnography identified five main constructs, described in an explanatory line of argument model of the experience of interventions. Nine overarching synthesis categories emerged from the integrated evidence, raising implications for future research. LIMITATIONS Review 1 conclusions were limited by the lack of evidence about intervention effectiveness. No relevant economic evaluations were located. There were no UK studies included in review 1, limiting the applicability of findings. The mental health status of participants in review 2 was usually unknown, limiting comparability with review 1. The different evidence identified by the two systematic reviews challenged the overarching synthesis. CONCLUSIONS There is a relatively small amount of comparable evidence for the effectiveness of interventions for the mental health of CYP with LTCs. Qualitative evidence provided insight into the experiences that intervention deliverers and recipients valued. Future research should evaluate potentially effective intervention components in high-quality RCTs integrating process evaluations. End-user involvement enriched the project. STUDY REGISTRATION This study is registered as PROSPERO CRD42011001716. FUNDING The National Institute for Health Research (NIHR) Health Technology Assessment programme and the NIHR Collaboration for Leadership in Applied Health Research and Care South West Peninsula.
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Affiliation(s)
- Darren A Moore
- Evidence Synthesis & Modelling for Health Improvement, University of Exeter Medical School, Exeter, UK
| | - Michael Nunns
- Evidence Synthesis & Modelling for Health Improvement, University of Exeter Medical School, Exeter, UK
| | - Liz Shaw
- Evidence Synthesis & Modelling for Health Improvement, University of Exeter Medical School, Exeter, UK
| | - Morwenna Rogers
- National Institute for Health Research Collaboration for Leadership in Applied Health Research and Care South West Peninsula, University of Exeter Medical School, Exeter, UK
| | - Erin Walker
- Great Ormond Street Hospital for Children NHS Foundation Trust, London, UK
| | - Tamsin Ford
- Child Mental Health Group, University of Exeter Medical School, Exeter, UK
| | - Ruth Garside
- The European Centre for Environment and Human Health, University of Exeter Medical School, Exeter, UK
| | - Obi Ukoumunne
- National Institute for Health Research Collaboration for Leadership in Applied Health Research and Care South West Peninsula, University of Exeter Medical School, Exeter, UK
| | - Penny Titman
- Great Ormond Street Hospital for Children NHS Foundation Trust, London, UK
| | - Roz Shafran
- University College London Institute of Child Health, London, UK
| | - Isobel Heyman
- Great Ormond Street Hospital for Children NHS Foundation Trust, London, UK
| | - Rob Anderson
- Evidence Synthesis & Modelling for Health Improvement, University of Exeter Medical School, Exeter, UK
| | - Chris Dickens
- National Institute for Health Research Collaboration for Leadership in Applied Health Research and Care South West Peninsula, University of Exeter Medical School, Exeter, UK
| | - Russell Viner
- University College London Institute of Child Health, London, UK
| | - Sophie Bennett
- University College London Institute of Child Health, London, UK
| | - Stuart Logan
- National Institute for Health Research Collaboration for Leadership in Applied Health Research and Care South West Peninsula, University of Exeter Medical School, Exeter, UK
| | - Fiona Lockhart
- Biomedical Research Centre Patient & Public Involvement Group, University College London Hospitals, London, UK
| | - Jo Thompson Coon
- National Institute for Health Research Collaboration for Leadership in Applied Health Research and Care South West Peninsula, University of Exeter Medical School, Exeter, UK
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Whittingham K, McGlade A, Kulasinghe K, Mitchell AE, Heussler H, Boyd RN. ENACT (ENvironmental enrichment for infants; parenting with Acceptance and Commitment Therapy): a randomised controlled trial of an innovative intervention for infants at risk of autism spectrum disorder. BMJ Open 2020; 10:e034315. [PMID: 32819928 PMCID: PMC7440709 DOI: 10.1136/bmjopen-2019-034315] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/14/2019] [Revised: 05/04/2020] [Accepted: 06/08/2020] [Indexed: 11/03/2022] Open
Abstract
INTRODUCTION Autism spectrum disorder (ASD) is a heterogeneous neurodevelopmental condition with impacts on behaviour, cognition, communication, social interaction and family mental health. This paper reports the protocol of a randomised controlled trial (RCT) of a very early intervention, ENACT (ENvironmental enrichment for infants; parenting with Acceptance and Commitment Therapy), for families of infants at risk of ASD. METHODS AND ANALYSIS We aim to recruit 66 mothers of infants at risk of ASD (ie, infants with a sibling or parent diagnosed with ASD) to this RCT. Families will be randomly assigned to care-as-usual or ENACT. ENACT is a very early intervention, leveraging parent-child interactions to improve early social reciprocity, while supporting parental mental health and the parent-child relationship through Acceptance and Commitment Therapy. Intervention content is delivered online (approximately 8 hours) and supported by more than 7 consultations with a clinician. Parents will perform the social reciprocity intervention with their child (30 min per day). Assessments at four time points (baseline, 3 months, 6 months, and 12 months corrected age) will assess parent-infant interaction, parental mental health, infant development and early ASD markers. Analysis will be by intention to treat using general linear models for RCTs. ETHICS AND DISSEMINATION This protocol has been approved by the Children's Health Queensland Hospital and Health Service Human Research Ethics Committee (HREC/19/QCHQ/50131) and the University of Queensland Human Research Ethics Committee (2019000558). If efficacy is demonstrated, the intervention has the potential for wide and accessible dissemination. TRIAL REGISTRATION NUMBER Australian New Zealand Clinical Trials Registry (ACTRN12618002046280).
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Affiliation(s)
- Koa Whittingham
- Queensland Cerebral Palsy and Rehabilitation Research Centre, UQ Child Health Research Centre, Faculty of Medicine, The University of Queensland, Brisbane, Queensland, Australia
| | - Andrea McGlade
- Queensland Cerebral Palsy and Rehabilitation Research Centre, UQ Child Health Research Centre, Faculty of Medicine, The University of Queensland, Brisbane, Queensland, Australia
| | - Kavindri Kulasinghe
- Queensland Cerebral Palsy and Rehabilitation Research Centre, UQ Child Health Research Centre, Faculty of Medicine, The University of Queensland, Brisbane, Queensland, Australia
| | - Amy E Mitchell
- Queensland Cerebral Palsy and Rehabilitation Research Centre, UQ Child Health Research Centre, Faculty of Medicine, The University of Queensland, Brisbane, Queensland, Australia
| | - Honey Heussler
- Mater Medical Research Institute, South Brisbane, Queensland, Australia
| | - Roslyn N Boyd
- Queensland Cerebral Palsy and Rehabilitation Research Centre, UQ Child Health Research Centre, Faculty of Medicine, The University of Queensland, Brisbane, Queensland, Australia
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Kinematic and Somatosensory Gains in Infants with Cerebral Palsy After a Multi-Component Upper-Extremity Intervention: A Randomized Controlled Trial. Brain Topogr 2020; 33:751-766. [DOI: 10.1007/s10548-020-00790-5] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2020] [Accepted: 07/24/2020] [Indexed: 02/06/2023]
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Chong YY, Mak YW, Loke AY. The role of parental psychological flexibility in childhood asthma management: An analysis of cross-lagged panel models. J Psychosom Res 2020; 137:110208. [PMID: 32798834 DOI: 10.1016/j.jpsychores.2020.110208] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/04/2020] [Revised: 06/24/2020] [Accepted: 07/26/2020] [Indexed: 11/26/2022]
Abstract
OBJECTIVE This is a secondary analysis of a previously reported randomized controlled trial, aimed at examining the mediating role of parental psychological flexibility (PF) in an Acceptance and Commitment Therapy (ACT)-based childhood asthma management program for parents. METHODS The participants were 168 parents (mean age (SD) = 38.40 (5.90) years; 88.1% mothers) and their children who had been diagnosed with asthma (mean age (SD) = 6.81 (2.50) years; 62% boys). They were randomly allocated to either the program composed of a four-session, group-based ACT plus asthma education (ACT Group) or to a group-based asthma education talk plus three telephone follow-ups (Control Group). The parents underwent assessments at baseline, and immediately, 3-months, and 6-months after the intervention for the following outcomes: PF (Acceptance and Action Questionnaire-II), psychological distress of the parents (Depression Anxiety Stress Scale-21); and the asthma symptoms and use of inhaled bronchodilators of their children. RESULTS Cross-lagged panel models showed that the improvement in parental PF at post-intervention mediated the effect of ACT on reducing parental psychological distress (all beta coefficients (βs) ranged from -2.20 to - 2.30, all Ps < 0.01) and childhood asthma symptoms in terms of daytime symptoms (β = -0.22, 95% CI [-0.52, -0.02], P = 0.04), nighttime symptoms (β = -0.17, 95% CI [-0.33, -0.02], P = 0.04), and the use of bronchodilators (β = -0.22, 95% CI [-0.48, -0.02], P = 0.03) at 6-months post-intervention. CONCLUSION ACT makes a unique contribution to improving the health outcomes of parents and their children diagnosed with asthma through fostering parental PF.
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Affiliation(s)
- Yuen Yu Chong
- The Nethersole School of Nursing, The Chinese University of Hong Kong, Shatin, New Territories, Hong Kong.
| | - Yim Wah Mak
- School of Nursing, The Hong Kong Polytechnic University, Hung Hom, Kowloon, Hong Kong
| | - Alice Yuen Loke
- School of Nursing, The Hong Kong Polytechnic University, Hung Hom, Kowloon, Hong Kong
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Han A, Yuen HK, Jenkins J. Acceptance and commitment therapy for family caregivers: A systematic review and meta-analysis. J Health Psychol 2020; 26:82-102. [PMID: 32659142 DOI: 10.1177/1359105320941217] [Citation(s) in RCA: 32] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Acceptance and commitment therapy is an emerging evidenced-based practice, but no systematic review regarding the effects of ACT on family caregivers has been conducted. This article examined the effects of ACT on family caregivers by conducting meta-analysis with a random effects model. Twenty-four articles were identified from four electronic databases searched up to 30 March 2020. Meta-analyses found moderate effects of ACT on depressive symptoms and quality of life, small effects on anxiety, and small to moderate effects on stress. Further ACT studies should be conducted to measure effects on different outcomes for various family caregiver populations.
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Affiliation(s)
- Areum Han
- University of Alabama at Birmingham, Birmingham, AL, USA
| | - Hon K Yuen
- University of Alabama at Birmingham, Birmingham, AL, USA
| | - Jeremy Jenkins
- Telehealth Private Practice: jeremyjenkins.icouch.me, Montana, USA
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Daily parenting of children with cerebral palsy: The role of daily child behavior, parents' daily psychological needs, and mindful parenting. Dev Psychopathol 2020; 33:184-200. [PMID: 32381132 DOI: 10.1017/s0954579419001688] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
The purpose of this study was to advance the current understanding of the daily dynamics that are involved in raising a child with Cerebral Palsy (CP). Specifically, we examined the role of mindful parenting and of day-to-day variation in parents' psychological needs and child behavior in explaining day-to-day variation in parents' autonomy-supportive, psychologically controlling, and responsive parenting behavior. Parents (N = 58) of children with CP (Mage = 12.68 years) participated in a 7-day diary study. Multilevel analyses indicated that parents' autonomy-supportive, psychologically controlling, and responsive behaviors fluctuate considerably between days. Further, daily fluctuations in both child behavior and parents' own psychological needs were found to be associated with this daily variability in parenting. In addition, interindividual differences in mindful parenting were associated positively with parents' responsiveness and negatively with psychologically controlling parenting across the week. These findings point towards the changeability of parenting behavior among parents of a child with CP and suggest that interventions targeting parenting behavior in the context of CP will be most effective when taking into account both the parents' and the child's functioning.
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44
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Novak I, Morgan C, Fahey M, Finch-Edmondson M, Galea C, Hines A, Langdon K, Namara MM, Paton MC, Popat H, Shore B, Khamis A, Stanton E, Finemore OP, Tricks A, Te Velde A, Dark L, Morton N, Badawi N. State of the Evidence Traffic Lights 2019: Systematic Review of Interventions for Preventing and Treating Children with Cerebral Palsy. Curr Neurol Neurosci Rep 2020; 20:3. [PMID: 32086598 PMCID: PMC7035308 DOI: 10.1007/s11910-020-1022-z] [Citation(s) in RCA: 431] [Impact Index Per Article: 107.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
PURPOSE OF REVIEW Cerebral palsy is the most common physical disability of childhood, but the rate is falling, and severity is lessening. We conducted a systematic overview of best available evidence (2012-2019), appraising evidence using GRADE and the Evidence Alert Traffic Light System and then aggregated the new findings with our previous 2013 findings. This article summarizes the best available evidence interventions for preventing and managing cerebral palsy in 2019. RECENT FINDINGS Effective prevention strategies include antenatal corticosteroids, magnesium sulfate, caffeine, and neonatal hypothermia. Effective allied health interventions include acceptance and commitment therapy, action observations, bimanual training, casting, constraint-induced movement therapy, environmental enrichment, fitness training, goal-directed training, hippotherapy, home programs, literacy interventions, mobility training, oral sensorimotor, oral sensorimotor plus electrical stimulation, pressure care, stepping stones triple P, strength training, task-specific training, treadmill training, partial body weight support treadmill training, and weight-bearing. Effective medical and surgical interventions include anti-convulsants, bisphosphonates, botulinum toxin, botulinum toxin plus occupational therapy, botulinum toxin plus casting, diazepam, dentistry, hip surveillance, intrathecal baclofen, scoliosis correction, selective dorsal rhizotomy, and umbilical cord blood cell therapy. We have provided guidance about what works and what does not to inform decision-making, and highlighted areas for more research.
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Affiliation(s)
- Iona Novak
- Cerebral Palsy Alliance Research Institute, Discipline of Child & Adolescent Health, Faculty of Medicine & Health, The University of Sydney, PO Box 6427, Frenchs Forest, Sydney, NSW, 2086, Australia.
| | - Catherine Morgan
- Cerebral Palsy Alliance Research Institute, Discipline of Child & Adolescent Health, Faculty of Medicine & Health, The University of Sydney, PO Box 6427, Frenchs Forest, Sydney, NSW, 2086, Australia
| | - Michael Fahey
- Department of Paediatric Neurology, Monash Health, Clayton, Victoria, Australia
- Department of Paediatrics, Monash University, Clayton, Victoria, Australia
| | - Megan Finch-Edmondson
- Cerebral Palsy Alliance Research Institute, Discipline of Child & Adolescent Health, Faculty of Medicine & Health, The University of Sydney, PO Box 6427, Frenchs Forest, Sydney, NSW, 2086, Australia
| | - Claire Galea
- Cerebral Palsy Alliance Research Institute, Discipline of Child & Adolescent Health, Faculty of Medicine & Health, The University of Sydney, PO Box 6427, Frenchs Forest, Sydney, NSW, 2086, Australia
- Grace Centre for Newborn Care, Children's Hospital at Westmead, Westmead, New South Wales, Australia
| | - Ashleigh Hines
- Cerebral Palsy Alliance Research Institute, Discipline of Child & Adolescent Health, Faculty of Medicine & Health, The University of Sydney, PO Box 6427, Frenchs Forest, Sydney, NSW, 2086, Australia
| | - Katherine Langdon
- Department of Paediatric Rehabilitation, Kids Rehab WA, Perth Children's Hospital, Perth, Australia
| | - Maria Mc Namara
- Cerebral Palsy Alliance Research Institute, Discipline of Child & Adolescent Health, Faculty of Medicine & Health, The University of Sydney, PO Box 6427, Frenchs Forest, Sydney, NSW, 2086, Australia
| | - Madison Cb Paton
- Cerebral Palsy Alliance Research Institute, Discipline of Child & Adolescent Health, Faculty of Medicine & Health, The University of Sydney, PO Box 6427, Frenchs Forest, Sydney, NSW, 2086, Australia
| | - Himanshu Popat
- Cerebral Palsy Alliance Research Institute, Discipline of Child & Adolescent Health, Faculty of Medicine & Health, The University of Sydney, PO Box 6427, Frenchs Forest, Sydney, NSW, 2086, Australia
- Grace Centre for Newborn Care, Children's Hospital at Westmead, Westmead, New South Wales, Australia
| | - Benjamin Shore
- Department of Orthopedic Surgery, Boston Children's Hospital, Harvard Medical School, Boston, MA, USA
| | - Amanda Khamis
- Cerebral Palsy Alliance Research Institute, Discipline of Child & Adolescent Health, Faculty of Medicine & Health, The University of Sydney, PO Box 6427, Frenchs Forest, Sydney, NSW, 2086, Australia
| | - Emma Stanton
- Cerebral Palsy Alliance Research Institute, Discipline of Child & Adolescent Health, Faculty of Medicine & Health, The University of Sydney, PO Box 6427, Frenchs Forest, Sydney, NSW, 2086, Australia
| | - Olivia P Finemore
- Cerebral Palsy Alliance Research Institute, Discipline of Child & Adolescent Health, Faculty of Medicine & Health, The University of Sydney, PO Box 6427, Frenchs Forest, Sydney, NSW, 2086, Australia
| | - Alice Tricks
- Cerebral Palsy Alliance Research Institute, Discipline of Child & Adolescent Health, Faculty of Medicine & Health, The University of Sydney, PO Box 6427, Frenchs Forest, Sydney, NSW, 2086, Australia
| | - Anna Te Velde
- Cerebral Palsy Alliance Research Institute, Discipline of Child & Adolescent Health, Faculty of Medicine & Health, The University of Sydney, PO Box 6427, Frenchs Forest, Sydney, NSW, 2086, Australia
| | - Leigha Dark
- Allied and Public Helath, Faculty of Health Sciences, Western Sydney University, Sydney, New South Wales, Australia
| | - Natalie Morton
- Allied and Public Helath, Faculty of Health Sciences, Western Sydney University, Sydney, New South Wales, Australia
- School of Allied Health, Australian Catholic University, North Sydney, New South Wales, Australia
| | - Nadia Badawi
- Cerebral Palsy Alliance Research Institute, Discipline of Child & Adolescent Health, Faculty of Medicine & Health, The University of Sydney, PO Box 6427, Frenchs Forest, Sydney, NSW, 2086, Australia
- Grace Centre for Newborn Care, Children's Hospital at Westmead, Westmead, New South Wales, Australia
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Meuret AE, Tunnell N, Roque A. Anxiety Disorders and Medical Comorbidity: Treatment Implications. ADVANCES IN EXPERIMENTAL MEDICINE AND BIOLOGY 2020; 1191:237-261. [PMID: 32002933 DOI: 10.1007/978-981-32-9705-0_15] [Citation(s) in RCA: 28] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
Anxiety disorders are debilitating psychological disorders characterized by a wide range of cognitive and somatic symptoms. Anxiety sufferers have a higher lifetime prevalence of various medical problems. Chronic medical conditions furthermore increase the likelihood of psychiatric disorders and overall dysfunction. Lifetime rates of cardiovascular, respiratory, gastrointestinal, and other medical problems are disproportionately high in anxiety and panic/fear sufferers. The heightened comorbidity is not surprising as many symptoms of anxiety and panic/fear mimic symptoms of medical conditions. Panic disorder specifically is strongly linked to medical conditions due to its salient somatic symptoms, such as dyspnea, dizziness, numbness, chest pain, and heart palpitations, all of which can signal danger and deterioration for chronic disease sufferers. This chapter identifies shared correlates of medical illness and anxiety disorders and evidence for misinterpretation of symptoms as medically relevant and offers an analysis of implications for treatment of both types of conditions. We will concentrate on medical conditions with high associations for anxiety and panic by aspects of symptomatology, specifically neurological disorders (fibromyalgia, epilepsy, cerebral palsy), diabetes, gastrointestinal illness (irritable bowel syndrome, gastroesophageal reflux disease), and cardiovascular and respiratory illnesses (asthma).
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Affiliation(s)
- Alicia E Meuret
- Department of Psychology, Southern Methodist University, Dallas, TX, USA.
| | - Natalie Tunnell
- Department of Psychology, Southern Methodist University, Dallas, TX, USA
| | - Andres Roque
- Department of Psychology, Southern Methodist University, Dallas, TX, USA
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Becoming flexible: Increase in parent psychological flexibility uniquely predicts better well-being following participation in a pediatric interdisciplinary pain rehabilitation program. JOURNAL OF CONTEXTUAL BEHAVIORAL SCIENCE 2020. [DOI: 10.1016/j.jcbs.2020.01.003] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
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Sairanen E, Lappalainen R, Lappalainen P, Hiltunen A. Mediators of change in online acceptance and commitment therapy for psychological symptoms of parents of children with chronic conditions: An investigation of change processes. JOURNAL OF CONTEXTUAL BEHAVIORAL SCIENCE 2020. [DOI: 10.1016/j.jcbs.2019.11.010] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Irwin L, Jesmont C, Basu A. A systematic review and meta-analysis of the effectiveness of interventions to improve psychological wellbeing in the parents of children with cerebral palsy. RESEARCH IN DEVELOPMENTAL DISABILITIES 2019; 95:103511. [PMID: 31670025 DOI: 10.1016/j.ridd.2019.103511] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/12/2018] [Revised: 07/01/2019] [Accepted: 10/01/2019] [Indexed: 06/10/2023]
Abstract
BACKGROUND Caregivers of children with cerebral palsy (CP) face unique demands and challenges, with potential negative impact on psychological wellbeing and consequences for both caregiver and child. Timely support could improve parental wellbeing. AIM To evaluate the effectiveness of interventions aimed at improving the psychological wellbeing of caregivers of children with CP. METHODS AND PROCEDURES Systematic review and meta-analysis of randomised controlled trials of interventions to improve the psychological well-being of caregivers of children with cerebral palsy. Databases (including MEDLINE, EMBASE, PsycINFO, Cochrane) were searched for relevant English language publications between January 1990 and December 2017. Risk of bias was assessed including randomization, allocation concealment, incomplete outcome data and selective outcome reporting. OUTCOME AND RESULTS We included 13 studies (1293 participants, 1/3 with CP). Six studies investigated a positive parenting intervention; the other seven studies covered a range of other interventions. Meta-analysis of 7 studies (662 participants) showed that interventions significantly improved parental wellbeing (standardised mean difference -0.61, 95% CI -0.92 to -0.30, z = 3.84, p = 0.0001). CONCLUSIONS AND IMPLICATIONS Limitations include small sample sizes and heterogeneity in study design; however, our results indicate that interventions can improve the wellbeing of parents of children with CP and should be made available.
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Affiliation(s)
- Louise Irwin
- School of Psychology/Institute of Neuroscience, Newcastle University, Newcastle upon Tyne, UK.
| | - Ceit Jesmont
- Institute of Neuroscience, Newcastle University, Newcastle upon Tyne, UK.
| | - Anna Basu
- Institute of Health and Society, Newcastle University and Department of Paediatric Neurology, Newcastle upon Tyne Hospitals NHS Foundation Trust, UK.
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te Velde A, Morgan C, Novak I, Tantsis E, Badawi N. Early Diagnosis and Classification of Cerebral Palsy: An Historical Perspective and Barriers to an Early Diagnosis. J Clin Med 2019; 8:E1599. [PMID: 31623303 PMCID: PMC6832653 DOI: 10.3390/jcm8101599] [Citation(s) in RCA: 50] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2019] [Revised: 09/24/2019] [Accepted: 09/25/2019] [Indexed: 12/18/2022] Open
Abstract
Since the 1800s, there have been calls in the literature for the early diagnosis of cerebral palsy (CP). However, diagnosis still often occurs late, from 12 to 24 months in high income countries and as late as 5 years in low resource settings. This is after the optimal timeframe for applying interventions which could harness neuroplastic potential in the developing brain. Multiple barriers exist which affect clinicians' confidence in diagnosing CP early. These range from the lack of definitive biomarkers to a lack of curative treatments for CP. Further barriers to diagnosis are proposed including; (a) difficulty finding a congruent fit with the definition of CP in an infant, where expected activity limitations might not yet be apparent; and (b) differences in the presentation of motor type and topography classifications between infants and children. These barriers may affect a clinicians' confidence using "pattern recognition" in the differential diagnosis process. One of the central tenets of this paper is that diagnosis and classification are different, involving different instruments, and are more accurately conducted separately in infants, whereas they are fundamentally interconnected in older children and inform therapeutic decisions. Furthermore, we need to be careful not to delay early diagnosis because of the low reliability of early classification, but instead uncouple these two processes. Ongoing implementation of best practice for early detection requires creative solutions which might include universal screening for CP. Implementation and accompanying knowledge translation studies are underway to decrease the average age of diagnosis in CP.
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Affiliation(s)
- Anna te Velde
- Cerebral Palsy Alliance, Discipline of Child and Adolescent Health, Faculty of Medicine and Health, The University of Sydney, New South Wales 2050, Australia.
- Discipline of Child and Adolescent Health, Faculty of Medicine and Health, The University of Sydney, New South Wales 2145, Australia.
| | - Catherine Morgan
- Cerebral Palsy Alliance, Discipline of Child and Adolescent Health, Faculty of Medicine and Health, The University of Sydney, New South Wales 2050, Australia.
- Discipline of Child and Adolescent Health, Faculty of Medicine and Health, The University of Sydney, New South Wales 2145, Australia.
| | - Iona Novak
- Cerebral Palsy Alliance, Discipline of Child and Adolescent Health, Faculty of Medicine and Health, The University of Sydney, New South Wales 2050, Australia.
- Discipline of Child and Adolescent Health, Faculty of Medicine and Health, The University of Sydney, New South Wales 2145, Australia.
| | - Esther Tantsis
- TJ Nelson Department of Neurology & Neurosurgery, The Children's Hospital at Westmead, New South Wales 2145, Australia.
| | - Nadia Badawi
- Cerebral Palsy Alliance, Discipline of Child and Adolescent Health, Faculty of Medicine and Health, The University of Sydney, New South Wales 2050, Australia.
- Discipline of Child and Adolescent Health, Faculty of Medicine and Health, The University of Sydney, New South Wales 2145, Australia.
- The Grace Centre for Newborn Intensive Care, The Children's Hospital at Westmead, Hawkesbury Road, Westmead NSW 2145, Australia.
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Benscoter D, Borschuk A, Hart C, Voos K. Preparing families to care for ventilated infants at home. Semin Fetal Neonatal Med 2019; 24:101042. [PMID: 31648918 DOI: 10.1016/j.siny.2019.101042] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
Advances in neonatal care have led to increased survival of infants with complex medical needs and technology dependence. Transition of the ventilator-dependent infant from hospital to home is a complex process that requires extensive coordination between the medical team and family. Home caregivers must be prepared to provide routine care for the ventilator-dependent child and respond to life-threatening emergencies. Families should be counseled on the need for home nursing, medical equipment and an adequate home environment to ensure a safe transition to home. Throughout the process, the family may require financial, social and psychological support. A structured education and transition process that is clearly communicated to parents is necessary to have an effective partnership with families.
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Affiliation(s)
- Dan Benscoter
- Department of Pediatrics, University of Cincinnati, College of Medicine, 3333 Burnet Ave, Cincinnati, 45229, OH, USA; Division of Pulmonary Medicine, Cincinnati Children's Hospital Medical Center, 3333 Burnet Ave, Cincinnati, 45229, OH, USA.
| | - Adrienne Borschuk
- Department of Pediatrics, University of Cincinnati, College of Medicine, 3333 Burnet Ave, Cincinnati, 45229, OH, USA; Division of Behavioral Medicine and Clinical Psychology, Cincinnati Children's Hospital Medical Center, 3333 Burnet Ave, Cincinnati, 45229, OH, USA.
| | - Catherine Hart
- Department of Otolaryngology, University of Cincinnati, College of Medicine, 231 Albert Sabin Way, Cincinnati, 45267, OH, USA.
| | - Kristin Voos
- Department of Pediatrics, Case Western Reserve University School of Medicine, 11100 Euclid Ave, Cleveland, 44106, OH, USA; Division of Neonatology, University Hospitals Cleveland Medical Center Rainbow Babies and Children's Hospital, 11100 Euclid Ave, Cleveland, 44106, OH, USA.
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