Design and analysis of pilot studies: recommendations for good practice

Progression of Pilot Trials to Completed Randomized Controlled Trials in Plastic Surgery: A Systematic Review

PURPOSE

Well-designed pilot trials are essential in determining feasibility prior to initiating definitive randomized controlled trials (RCTs) and their implementation into clinical practice. The primary outcome of this study was to identify the number of pilot or feasibility studies in Plastic Surgery that progressed to a definitive RCT. Secondary outcomes included a) number of pilot studies expressing feasibility statements and outcomes and b) reporting quality.

METHODS

MEDLINE, Embase, Web of Science, and clinicaltrials.gov were searched for all pilot RCTs and definitive RCTs in plastic surgery between 2012-2023. Pilot trials were matched to definitive RCTs by keyword, author, and citation report. Feasibility outcomes were presented using descriptive statistics. Reporting quality was evaluated using the Consolidated Standards of Reporting Trials 2010 randomized pilot and feasibility trials extension.

RESULTS

Among 11,540 and 6035 citations screened in 2 separate literature searches, 171 pilot studies and 779 definitive RCTS were included, respectively. Ten (5.8%) pilot studies were associated with a completed RCT, 4 (2.3%) were in progress, and 2 (1.2%) were stopped. For studies that did not progress to a definitive RCT, "inadequate funding" (n = 11, 41.4%) was the most cited reason followed by "insufficient efficacy to justify study progression" (n = 5, 17.3%). The average reporting adherence to the Consolidated Standards of Reporting Trials items was 65.6% (SD 16). Fifty (29.2%) pilot RCTs reported a feasibility statement and 30 (17.5%) reported feasibility outcomes.

CONCLUSIONS

Few pilot trials in plastic surgery progressed to a definitive RCT, and most did not present feasibility statements or outcomes. Pilot studies should precede RCTs and include clear feasibility statements and outcomes.

A pilot randomized controlled double-blind trial of intermittent theta burst stimulation (iTBS) repetitive transcranial magnetic stimulation (rTMS) to improve memory in mild cognitive impairment (MCI): a study protocol

BACKGROUND

Mild cognitive impairment (MCI), prevalent among older adults, often precedes Alzheimer's disease (AD) or Alzheimer's disease-related dementias (ADRD), emphasizing the need for effective interventions. Early intervention in MCI is crucial, not only to alleviate symptoms but to potentially delay the progression of cognitive decline. The lack of definitive treatments for MCI has prompted the exploration into alternative non-pharmacological therapeutic approaches. Specifically, noninvasive brain stimulation using repetitive transcranial magnetic stimulation (rTMS) has demonstrated promise in improving cognition in MCI and AD.

OBJECTIVES

Our study will test the feasibility of using intermittent theta burst stimulation (iTBS) technique of rTMS in MCI, pilot test the study design, and collect pilot data on the effect of iTBS over three different brain regions on working memory, new learning, and executive function in MCI. Exploratory objectives are to assess the feasibility and usefulness of functional magnetic resonance imaging (fMRI), high-density electroencephalography (HD-EEG), and sleep architecture as potential biomarkers in response to iTBS.

METHODS

A pilot randomized double-blind controlled cross-over trial of iTBS on 20 MCI participants randomized to 10 days of active iTBS (left dorsolateral prefrontal cortex or left lateral parietal cortex) or control (vertex). After 4-6-week washout period, they cross over to the alternative treatment arm for another 10 days. Each participant will undergo a total of 20 iTBS sessions. Pre- and post-iTBS assessments include neuropsychological tests, fMRI, HD-EEG, and sleep architecture.

DISCUSSION

This innovative study aims to test the feasibility of iTBS as a cognitive enhancement strategy in MCI. If our study is feasible, it could lead to a future larger trial to further test whether iTBS can modulate underlying neurobiology and offer a therapeutic avenue to remediate cognitive decline in MCI or ultimately delay progression to dementia.

TRIAL REGISTRATION

ClinicalTrials.gov, NCT05327257. Registered 04 April 2022.

Optimising error rates in programmes of pilot and definitive trials using Bayesian statistical decision theory

Pilot trials are often conducted in advance of definitive trials to assess their feasibility and to inform their design. Although pilot trials typically collect primary endpoint data, preliminary tests of effectiveness have been discouraged given their typically low power. Power could be increased at the cost of a higher type I error rate, but there is little methodological guidance on how to determine the optimal balance between these operating characteristics. We consider a Bayesian decision-theoretic approach to this problem, introducing a utility function and defining an optimal pilot and definitive trial programme as that which maximises expected utility. We base utility on changes in average primary outcome, the cost of sampling, treatment costs, and the decision-maker's attitude to risk. We apply this approach to re-design OK-Diabetes, a pilot trial of a complex intervention with a continuous primary outcome with known standard deviation. We then examine how optimal programme characteristics vary with the parameters of the utility function. We find that the conventional approach of not testing for effectiveness in pilot trials can be considerably sub-optimal.

Diet therapy (The 8×5 Diet) for adults living with bile acid diarrhoea: protocol for a feasibility randomised controlled trial

INTRODUCTION

A national research priority for people living with bile acid diarrhoea (BAD) is effective treatment options to improve their quality of life. This study aims to evaluate the feasibility of conducting a randomised controlled trial (RCT) of a novel healthy dietary pattern (The 8×5 Diet) to inform a future, larger trial.

METHODS AND ANALYSIS

We plan to enrol 76 UK adults living with BAD and ongoing diarrhoea using self-selection sampling and digital technologies. Eligible participants will be assigned to groups using permuted block randomisation using 1:1 allocation to receive either 8 weeks of usual care or The 8×5 Diet using one-to-one, dietitian counselling via a video-conferencing platform and developed digital resources. Randomisation, consent, recruitment, retention and acceptability will be evaluated using data from the RCT and post-trial interviews conducted with those in the intervention group. Secondary outcome exploratory assessment will include health-related quality of life, symptom relief, diarrhoea, diet quality, nutrient intakes and diet satisfaction.

ETHICS AND DISSEMINATION

Ethical approval was granted by the University of Manchester Research Ethics Committee (2024-19094-33261; V1.7, last updated: 24/02/2025).Findings will be disseminated through peer-reviewed publication, conference presentation and social media.

TRIAL REGISTRATION NUMBER

NCT06259396.

Home-based hypnosis: a feasibility study for end-of-life patients and their relatives

CONTEXT

Palliative care patients facing the end of their life often experience severe symptoms and seek complementary therapies for relief and improved well-being. Clinical hypnosis is a promising mind-body therapy in palliative settings, benefiting both patients and their relatives. Nevertheless, access at the end-of-life can be limited due to symptom severity and restricted mobility.

OBJECTIVES

This study aimed to assess the feasibility and acceptability of a home-based hypnosis intervention for end-of-life patients to alleviate symptoms and for their relatives to enhance coping resources.

METHODS

A mixed-method observational feasibility study was conducted from February 2022 to January 2023 in French-speaking Switzerland. Participants included 32 end-of-life patients and 14 relatives, receiving weekly 20-25-minute hypnosis sessions over four weeks. Quantitative data on symptom intensity and well-being were collected using numeric rating scales, while qualitative data were gathered through semi-structured interviews with those who completed the intervention.

RESULTS

Eighteen patients and eight relatives completed the four-sessions. Significant reductions were observed in patient anxiety (median 6.5 to 2.0, p=.001) and pain (median 5.0 to 3.0, p=.001). Patient well-being improved across all sessions (median 5 to 7, p=.001). Relatives reported increased well-being (median 5.0 to 8.0, p=.001), serenity (median 5.0 to 8.0, p=.001), and energy levels (median 5.0 to 7.5, p=.042). High levels of satisfaction and frequent use of self-hypnosis recordings were noted.

CONCLUSION

A home-based hypnosis intervention was feasible and seemed beneficial for both end-of-life patients and their relatives, reducing symptoms and enhancing coping resources. Future research should build upon these findings to further support the integration of complementary therapies into standard palliative care practices.

Open-label placebo for non-specific pain in the emergency department (OLP EM): study protocol for a mixed-method randomised control feasibility study in Switzerland

INTRODUCTION

Non-specific pain (NSP), defined as pain without a clear pathological cause, is a common presentation in the emergency department (ED). There is no universally accepted analgesic strategy, but non-steroidal anti-inflammatory drugs (NSAIDs) such as ibuprofen are often prescribed. However, the established efficacy of NSAIDs for NSP is limited. Additionally, NSAIDs are associated with an increased risk of upper gastrointestinal bleeding, acute kidney injury and cardiovascular events, such as myocardial infarction and stroke. There is increasing evidence supporting the analgesic effects of open-label placebo (OLP), defined as placebo administered to patients without deception, in a broad variety of settings. Accordingly, OLP could be a safer, effective analgesic treatment option for NSP. To our knowledge, this is the first study investigating the feasibility of OLP for NSP in the ED. Therefore, our primary objective is to assess whether OLP is a feasible treatment option in this setting.

METHODS AND ANALYSIS

Patients diagnosed with acute NSP will be prospectively recruited at discharge in the ED at the University Hospital of Basel, Switzerland. Patients treated with pain medication for >7 days prior to ED visit or with chronic pain will be excluded. Patients will be randomised to receive either OLP (intervention) or ibuprofen (control). Rescue medication will be ibuprofen in both groups. Daily online self-assessment will take place during the first 7 days after the baseline visit as well as on day 30. A qualitative interview will be conducted on day 30. The primary outcome is feasibility, consisting of acceptability, adherence to the protocol and patient satisfaction. Clinical outcomes will focus on pain intensity and interference according to the Brief Pain Inventory Short Form as well as adverse events.

ETHICS AND DISSEMINATION

The study protocol has received approval from the ethics committee for Northwestern and central Switzerland (EKNZ; project ID 2024-00089). The results will be disseminated in peer-reviewed journals and at scientific conferences.

TRIAL REGISTRATION NUMBER

Swiss National Clinical Trials Portal (SNCTP000005852); Clinicaltrial.gov (NCT06408519).

Supervised and self-directed technology-based dual-task exercise training programme for older adults at risk of falling - Protocol for a feasibility study

Falls among older adults pose a significant public health challenge, as they lead to severe outcomes such as fractures and loss of independence. Research has shown that training cognitive function and balance simultaneously, termed Dual-Task (DT) training, improves mobility and reduces fall risks in older adults. This study aims to evaluate the feasibility and acceptability of a blended supervised and self-directed technology-based DT training programme for older adults who have high risk of falling. This is a single-arm, non-randomised feasibility study employing quantitative and qualitative methods. Fifty healthy adults aged 65 years or above will be recruited from the NHS primary and secondary care pathways and from the community. Participants will undergo supervised cognitive and balance DT training for 12 weeks, followed by self-directed DT training for an additional 12 weeks. The cognitive training will be delivered using a commercial mobile application (app) available from the AppStore or Google Play. The balance training will involve static (Marching on the spot, Tandem Stand, Hip Abduction & Extension, Squats, Tiptoe Stand, and Pendulum/Sideways Sway) and dynamic (Figure of Eight Walk, Walking Forwards and Backwards, Lunges, Functional Reach, Toe Tapping, Upper Limb Strength Exercises, and Side-Steps/Simple Grapevine) exercises focused on improving balance, postural stability and strength. Feasibility outcomes will be recruitment, adherence, usage of the app, and attrition. Outcomes measure data, that will be collected at baseline and at 24 weeks, includes the Timed- Up and Go (TUG) test (likely primary outcome in any future trial), along with self-reported questionnaires assessing cognition, fear of falling, quality of life, healthcare service usage, and the self-reported number of falls. Focus group interviews will be conducted with thirty participants and thirty healthcare professionals for in-depth exploration of the feasibility and acceptability of the DT training programme.

Virtual reality for MRI preparation: Participant perceptions from a feasibility study

INTRODUCTION

Undergoing a Magnetic Resonance Imaging (MRI) procedure remains a source of fear and concern for many. Providing adequate information beforehand is essential to ease concerns, yet traditional methods have limitations, often hindered by time constraints. The aim of this study is to explore the acceptability of a Virtual Experience (VE) as an alternative method to prepare patients, with a focus on participant feedback to inform future development.

METHODS

Feedback metrics and qualitative responses were captured as part of a wider experimental mixed methods feasibility study. Feedback scores were collated and described, whilst qualitative data underwent a process of thematic analysis.

RESULTS

15 participants underwent two exposures to the VE. The majority were female with an average age of 50, and a third having experienced virtual reality before. Feedback obtained supported perception of the VE to have been engaging, safe, and of benefit, with a willingness to use in the future. From the emerging themes, the experience was considered realistic, fostering acceptance and tolerance of the tool with a number of suggestions for improvement made. Participants would prefer use in a clinical setting with staff support, rather than at home, highlighting its potential to build trust with imaging staff away from pressurised scanning lists ahead of an actual scan.

CONCLUSION

Participants viewed the VE as a valuable preparatory tool, providing a realistic and acceptable means to familiarise themselves with the process. Their feedback highlights areas for improvement and supports its potential use in practice, underscoring the importance of the public's role in shaping acceptance and future enhancements.

IMPLICATIONS FOR PRACTICE

VR could become a commonplace means of patient preparation and help facilitate coping strategies before an actual scan.

Delivering guideline-directed medical therapy for heart failure with reduced ejection fraction as an over-encapsulated polypill: rationale and protocol for the COMBO-HF-X pilot crossover randomised clinical trial

INTRODUCTION

A four-drug regimen of guideline-directed medical therapy (GDMT) for heart failure with reduced ejection fraction (HFrEF) is underused, in part due to prescriber inertia and low patient adherence. Although fixed-dose combination pills ('polypills') have improved adherence and clinical outcomes for other conditions, there are no polypills available that combine multiple classes of GDMT for HFrEF. Pharmacy-level over-encapsulation, in which several tablets are combined into one capsule, offers an opportunity to create customised HFrEF polypills with the goal of improving delivery of HFrEF therapies.

METHODS AND ANALYSIS

In the COMBO-HF-X pilot crossover randomised clinical trial, we will enrol 30-40 patients with HFrEF in a safety-net public healthcare system in San Francisco, California. Participants will be randomised 1:1 to receive GDMT as individual tablets or as a customised, over-encapsulated HFrEF polypill. After 1 month, participants will cross over to the other formulation (individual tablets or a HFrEF polypill). Participants will attend in-person visits at 0, 4 and 8 weeks. GDMT will be initiated and titrated by study physicians as clinically indicated in accordance with HFrEF treatment guidelines. The primary outcome will be adherence to GDMT by pill count. Key feasibility outcomes will include the successful recruitment of 30-40 participants and completion of study procedures for at least 20 participants. Implementation outcomes will include the cost and time required for HFrEF polypill preparation, which will be performed by a community pharmacy partner. Exploratory clinical outcomes will include change in N-terminal pro-B-type natriuretic peptide (NT-proBNP) level and Kansas City Cardiomyopathy Questionnaire. Acceptability will be assessed through a patient exit survey and semistructured exit interviews with patients, their primary care and cardiology providers, and pharmacy staff.

ETHICS AND DISSEMINATION

Study findings will be published in peer-reviewed journals. The protocol of this study was approved by the Institutional Review Board of the University of California, San Francisco. Written informed consent for COMBO-HF-X was obtained from all participants.

TRIAL REGISTRATION NUMBER

NCT06029712.

Emotional awareness and expression therapy (EAET) for chronic pain following traumatic orthopaedic injury and surgery: study protocol for a single-arm feasibility clinical trial

BACKGROUND

Nearly half of individuals who sustain orthopaedic trauma develop chronic pain and experience significant levels of depression and anxiety. Emotional awareness and expression therapy (EAET) is a newly developed psychological intervention designed to treat chronic pain by helping patients process psychological trauma and conflict to reduce pain. The purpose of this study is to examine the feasibility of delivering EAET to individuals who sustained traumatic orthopaedic injuries requiring surgery and who have chronic pain 6 months after hospital discharge.

METHODS AND ANALYSIS

The study will consist of a single-arm design. Thirty individuals who sustained traumatic orthopaedic injuries requiring surgery and who reported chronic pain 6 months after hospital discharge will be recruited. Participants will receive eight sessions of individually administered EAET delivered via telehealth and complete self-report questionnaires at three timepoints (pretreatment, post-treatment and 3-month follow-up). Quantitative sensory testing will also be done before and after treatment. The primary outcome of the study is feasibility (eg, per cent of eligible patients recruited and per cent of study completers) and acceptability as reported by responses to a self-report questionnaire.

ETHICS AND DISSEMINATION

This study has been approved by the Johns Hopkins Institutional Review Board. All data are expected to be collected by 2026, with results of this study to be disseminated via relevant peer-reviewed journals and scientific conferences.

TRIAL REGISTRATION NUMBER

ClinicalTrials.gov NCT05989230. Registered on 14 August 2023.

Detection of potential complications in cancer survivors after chemotherapy and development of a regional care network: the PASCA feasibility study

Complications are often poorly identified and managed in cancer survivors after treatment and restoring their initial quality of life remains a challenge, particularly in a context of unequal access to care nationwide. The PASCA "Parcours de Santé au cours du Cancer [in English: healthcare pathways with cancer]" feasibility study was conducted in the Léon Bérard Comprehensive Cancer Center (Lyon, France) to assess the feasibility of a complications detection program, in cancer survivors who have received intensive chemotherapy. An initial network of physicians and healthcare professionals was also set up to facilitate medical referrals after detection. The study had a high recruitment rate (83.8%) and an adherence rate of 43%. In our analysis population (n = 98), 8% presented de novo dermatological, cardiological, and pneumological complications. Of these, 42 completed all program visits. Among them, the number of patients who developed a ≥ grade 2 complication increased between the first and last visits in: nephrology (+13.9%), overweight/obesity (+12.5%), endocrinology (+8.3%) and cardiology (+5.6%). Patient satisfaction was high (68%). The results supported the feasibility of a complication detection program and highlighted the presence of de novo complications at the first visit, as well as an increase in the number of patients developing complication in four areas between the first and last visit. In the future, after-treatment programs could be improved by increasing the motivation of the referring oncologists and patients, improving communication and by adapting the follow-up visits to take into consideration the constraints and profiles of the cancer survivors.

Development of the Team Evaluation and Assessment Measure Quality Improvement (TEAM-QI) and Proof-Of-Concept Testing in Maternity Teams

Poor teamwork is often implicated in serious healthcare delivery failings, leading to calls for effective team improvement interventions. Taking a complex, adaptive systems perspective, we adapted an oncology team quality improvement program to make it appropriate for other areas of clinical care. Study phases included: (1) meetings with National Health Service, policy and service user representatives (n = 19), a rapid review of existing maternity teamwork interventions, and mapping of the proposed program content to an evidence-based model of team effectiveness; (2) feasibility and acceptability testing of the team questionnaire component, and content analysis of free-text responses with four maternity teams within two NHS Trusts (n = 26). Meetings with representatives highlighted the importance of non-punitive, continuous team-led assessment, and the ability to compare performance to similar teams while enabling adaptability to different team types. Program content mapped well to known components of team effectiveness. Internal consistency of the questionnaire was acceptable (Cronbach alpha = 0.79-0.92). Most team members (76.9%) reported benefits in identifying priorities for improvement. Preliminary proof of concept was supported but larger-scale evaluation including testing in other clinical areas is warranted.

Cultural adaptation of a self-help app for grieving Syrian refugees in Switzerland. A feasibility and acceptability pilot-RCT

Background

The global refugee population has significantly increased, with Syrian refugees being one of the largest displaced groups. Bereavement represents a major challenge. However, access to mental health care is limited by structural and cultural barriers. Internet-based interventions (IBIs) offer a promising solution, but most are developed in Western contexts, limiting their cultural relevance. This study aimed to evaluate the acceptability, feasibility, and preliminary efficacy of a culturally adapted self-help IBI for bereaved Syrian refugees in Switzerland.

Methods

In a mixed-methods pilot randomized controlled trial (RCT), 30 bereaved Syrian refugees were randomly assigned to a 5-week app-based intervention or a waitlist control group. Semi-structured interviews with the intervention group provided qualitative insights on feasibility and acceptability and were analyzed with framework analysis. Quantitative data assessed treatment satisfaction, adherence, and preliminary efficacy on grief, depression, posttraumatic stress disorder (PTSD), anxiety, well-being, disability, post-migration difficulties, and social support. Descriptive statistics were used for feasibility and acceptability, while linear mixed-effects models assessed efficacy.

Results

High treatment satisfaction, a low dropout rate and adherence of 40 % were found. Qualitative interviews indicated the intervention was relevant and beneficial, further adaptations were suggested. No significant group differences were found on bereavement or secondary outcomes. However, trends indicated reduced grief, anxiety, PTSD, and depression, with improved well-being and social support in the intervention group.

Conclusions

The results suggest that this culturally adapted IBI is both feasible and acceptable for Syrian refugees. While trends are promising, a larger RCT is needed to investigate efficacy. This intervention shows potential as meaningful support for bereaved Syrian refugees.

The role of early orthotic intervention in the management of post-traumatic elbow contractures: Study protocol for phase II double-blinded randomised controlled trial

Background

Restoration of full elbow extension following trauma is difficult and influenced by the injury profile, surgeon preference, patient and environmental factors. The literature suggests that orthotic interventions are effective in improving contractures when movement plateaus despite normal therapeutic interventions. It is not known if extension orthotic intervention is more superior to standard treatment regardless of when it is commenced. The literature lacks patient-reported considerations to contracture management using elbow orthoses.

Methods and analysis

This protocol describes a Phase II double blinded randomised controlled feasibility trial (RCT) and mixed methods study, aimed to examine outcome with extension in an orthotic intervention group (OG) versus control (CG). All participants will undergo six weekly therapy sessions, which include a standardised therapeutic program. OG participants will be provided with an additional extension orthosis and the outcome is assessed according to the change in elbow extension motion after 6 weeks of intervention. Data will be collected via questionnaires, logbooks, feedback forms, and semi-structured interviews at baseline and final assessments for descriptive statistical analysis. Under the guidance of a statistician, all quantitative data will be evaluated using the appropriate parametric or non-parametric analyses to evaluate for systematic differences between groups. Preliminary extension gains are used to determine the final sample size required to achieve adequate power for a full-scaled RCT. Interview data on OG participants will be qualitatively analysed using the "five-factorial dimensions of adherence" framework to identify key differences in the influencers between adherent or non-adherent groups.

Trial registration number

ANZCTR ACTRN12619001402134p.

Evaluating Feasibility of an Exercise Intervention Including Physical Assessment During the First 6 Months of Cancer Treatment in Children and Adolescents in a Randomized Controlled Trial

PURPOSE

The aim was to assess the feasibility of a randomized controlled exercise intervention, including physical assessments, in children and adolescents during the first 6 months of cancer treatment.

MATERIALS AND METHODS

A sample of children and adolescents (n = 84, 6‒17.9 years) from an ongoing trial (INTERACT: NCT04706676) was randomly assigned to an integrative neuromuscular training (INT) intervention or active control intervention during treatment. The following inter-related feasibility domains were assessed: availability, acceptance, and attrition. Further, we assessed adherence to INT and physical assessments. Adverse events related to exercise and physical assessments were also reported.

RESULTS

We found feasible rates within the availability and attrition domains. While the INT group demonstrated feasible group-level adherence rates, individual adherence to prescribed intervention demands was suboptimal. Physical assessments after 6 months of cancer treatment showed feasible rates.

CONCLUSION

This study offers insights into the feasibility of an early-initiated INT intervention designed for children and adolescents undergoing cancer treatment. To ensure an optimal frequency of exercise in future studies, a flexible approach to hospital-based INT and a structured strategy for home-based exercise should be considered. Future trials should prioritize outcomes to minimize the length and timing of assessment.

Feasibility of a Cinematic-Virtual Reality Program Educating Health Professional Students About the Complexity of Geriatric Care: Pilot Pre-Post Study

Background

The US population is aging. With this demographic shift, more older adults will be living with chronic conditions and geriatric syndromes. To prepare the next generation of health care professionals for this aging population, we need to provide training that captures the complexity of geriatric care.

Objective

This pilot study aimed to assess the feasibility of the cinematic-virtual reality (cine-VR) training in the complexity of geriatric care. We measured changes in attitudes to disability, self-efficacy to identify and manage elder abuse and neglect, and empathy before and after participating in the training program.

Methods

We conducted a single-arm, pretest-posttest pilot study to assess the feasibility of a cine-VR training and measure changes in attitudes to disability, self-efficacy to identify and manage elder abuse and neglect, and empathy. Health professional students from a large university in the Midwest were invited to participate in 1 of 4 cine-VR trainings. Participants completed 3 surveys before and after the cine-VR training. We performed paired t tests to examine changes in these constructs before and after the training.

Results

A total of 65 health professional students participated in and completed the full cine-VR training for 100% retention. Participants did not report any technological difficulties or adverse effects from wearing the head-mounted displays or viewing the 360-degree video. Out of the 65 participants, 48 completed the pre- and postassessments. We observed an increase in awareness of discrimination towards people with disability (t47=-3.97; P<.001). In addition, we observed significant improvements in self-efficacy to identify and manage elder abuse and neglect (t47=-3.36; P=.002). Finally, we observed an increase in participants' empathy (t47=-2.33; P=.02).

Conclusions

We demonstrated that our cine-VR training program was feasible and acceptable to health professional students at our Midwestern university. Findings suggest that the cine-VR training increased awareness of discrimination towards people with disabilities, improved self-efficacy to identify and manage elder abuse and neglect, and increased empathy. Future research using a randomized controlled trial design with a larger, more diverse sample and a proper control condition is needed to confirm the effectiveness of our cine-VR training.

Protocol development and feasibility of the PEACH in Asia study: A pilot study on PEri-anesthetic morbidity in CHildren in Asia

BACKGROUND

Comprehensive data on pediatric anesthesia outcomes, particularly severe critical events (SCEs), are scarce in Asia. This highlights the need for standardized research to assess anesthesia safety and quality in the diverse settings.

AIMS

The PEACH in Asia pilot study aimed to test the feasibility of a standardized protocol for investigating SCEs in anesthesia practices across Asia, evaluate the data acquisition processes, and determine the sample size for a main study.

METHODS

This multicenter pilot study involved ten institutions across nine Asian countries, including children from birth to 15 years undergoing diagnostic or surgical procedures. Data on SCEs were collected using standardized definitions. The study assessed the feasibility and estimated the sample size needed for the main study.

RESULTS

The pilot study enrolled 330 patients, with a SCE incidence of 12.4% (95% CI: 9.2-16.4%). Respiratory events were observed in 7.0% of cases, cardiovascular instability in 4.9%, and drug errors in 0.6%. Based on the SCE incidence observed in the pilot study, the estimated sample size required for the main study is at least 10 958 patients. The pilot study demonstrated the feasibility of the study protocol but identified several challenges, particularly in resource-limited settings. These challenges included a significant burden associated with data collection, technical issues with electronic case report forms (e-CRFs), variability in patient enrollment across institutions (ranging from 4 to 86 patients per site), and incomplete data acquisition (24.8% of height data and 9.7% of disposition data were missing).

CONCLUSIONS

The PEACH in Asia pilot study successfully validated a protocol for investigating SCEs in pediatric anesthesia across Asia. Addressing the challenges identified in the pilot study will be crucial for generating robust data to improve pediatric anesthesia safety in the region. Key issues to address include improving data collection methods, resolving e-CRF technical difficulties, and ensuring consistent institutional support.

A Randomized Feasibility Study of Rehabilitation Targeting Upper Extremity Function and Participation Using Hippotherapy and the Equine Environment for Children with Cerebral Palsy and Autism Spectrum Disorder

Introduction: Children with upper extremity neuromotor impairments often have decreased participation in life activities. Hippotherapy and rehabilitation in the equine environment might be effective in targeting participation, given the community context and natural activity involvement. This randomized controlled feasibility trial assessed recruitment, retention, treatment fidelity, and acceptability of rehabilitation using hippotherapy and the equine environment, targeting upper extremity function and participation for children with neuromotor impairments to inform a larger trial. Methods: This 6-month trial occurred in Ohio, June-December 2021. Participants were 6-17 years old with upper extremity neuromotor impairment (and primary diagnosis of cerebral palsy and/or autism). Participants were randomized into treatment or waitlist control using REDCap. Treatment was 16 h (4 h/week/4 weeks) of rehabilitation using hippotherapy and the equine environment. Control participants completed a 4-week waiting period, then received the treatment. Recruitment, screening, enrollment, attendance, and retention were tracked. Nonblinded assessments of body structures and functions, activity, and participation were administered pre- and postcontrol and treatment. Assessment measure completion, treatment fidelity, and acceptability were recorded. Results: Twenty-six participants were screened between July and October 2021; 77% (20/26) met inclusion criteria; 70% (14/20) enrolled and randomized: 6 control and 8 treatment. Two withdrew after randomization and one was excluded for fear of horses. In total, n = 5 control and n = 6 treatment completed initial assessment. Retention was 80% (4/5) control and 83% (5/6) treatment, just below the a priori criteria (85%). Assessment measure completion was variable (77%-100%) and replacement of some should be considered before advancing to a clinical trial. Treatment fidelity and acceptability were moderate to high. There were no adverse events from study participation. Conclusions: Results demonstrated preliminary evidence of fidelity and acceptability of rehabilitation using hippotherapy and the equine environment for children with upper extremity neuromotor impairments. Some changes should be made to improve enrollment, retention, and outcome measure completion before advancing to a definitive trial. Trial registration: ClinicalTrials.gov identifier: NCT0653068. Trial funding: Eunice Kennedy Shriver National Institute of Child Health and Human Development, Foundation for Physical Therapy Research, American Academy of Cerebral Palsy and Developmental Medicine, and Pedal With Pete Foundation.

Family-Led Coaching of Patients During Weaning From Sedation and Mechanical Ventilation in the ICU

Background: ICU patients are weaned from sedation and mechanical ventilation through spontaneous awakening trials (SATs) and spontaneous breathing trials (SBTs). Weaning can be distressing for patients and their families. Family-led coaching could reassure patients and reduce stress for families by engaging them in patient care. This study developed and piloted a family-led coaching tool to support patients undergoing SATs/SBTs. Methods: Patient and family member dyads were recruited from 2 medical-surgical ICUs in Calgary, Canada (February 3-August 1, 2023). Surveys were administered to collect family (1) demographics, (2) anxiety and satisfaction with ICU care, (3) feedback on the tool, and (4) attitudes about family presence during SATs/SBTs (also collected from clinicians). Tool feasibility was determined by calculating the proportions of (1) eligible patients who were recommended for participation in the study by clinicians and (2) families approached who consented to participate in the study. Results: One thousand one hundred fifty patients were admitted to the study ICUs during the study period of which 819 received mechanical ventilation, and 42 were recommended by bedside clinicians for participation in the study. Twenty-five dyads were approached, 21 dyads consented to participate, and one withdrew consent before data collection. Of the enrolled families, 12 (60%) reported the coaching tool to be useful, and 5 (25%) recommended minor suggestions such as "shortening" the tool. Fourteen (70%) families reported positive experiences (through open-ended feedback) with being present for the SAT/SBT. State-Trait Anxiety Inventory (Y1) scores (scale range 20-80 points) significantly decreased in families from the first (pre coaching) to the second (post coaching) measures (mean decrease 8.2 points, SD 10.3, P = .001). All clinicians indicated they were comfortable with family presence and/or coaching during SATs/SBTs. Conclusion: Family-led coaching of patients during SATs/SBTs appears to be feasible, favorably perceived by families and clinicians, and potentially associated with lower family anxiety.

Interventions for subjective and objective social isolation among people living with HIV: A scoping review

Subjective and objective social isolation has been a globally significant public health issue for people living with HIV, yet little is known about the characteristics, effectiveness, and acceptability of available interventions. The purpose of this scoping review was to systematically identify and map the available evidence on interventions for subjective and objective social isolation among people living with HIV. We searched PubMed, Cochrane Library, Embase, Scopus, Social Sciences Citation Index, PsycArticles, CINAHL, ProQuest Dissertation & Theses Global, OpenGrey, Google Scholar, international trial registers, and websites for eligible studies from their inception to June 1, 2024. We included any studies that identified subjective or objective social isolation as a primary goal or outcome of an intervention for people living with HIV (≥18 years old). Two researchers independently conducted study selection, data extraction, and data analysis. A 'basic qualitative content analysis' approach was used to analyze the findings of the included studies. Of the 12762 records identified, 19 full-text studies involving 961 participants were included in this scoping review. Overall, we identified seven interventions for subjective and objective social isolation among people living with HIV, as well as their characteristics, including psychological therapy, support group intervention, online support community, peer mentorship, navigation-type intervention, activity intervention, and knowledge/skills development intervention. However, there was limited, mixed evidence on the effectiveness and acceptability of different interventions for subjective and objective social isolation among people living with HIV. More rigorously designed and large-scale randomized control trials are needed to support and enrich existing evidence further.

Perceptions of stigma associated with chronic knee pain: voices of selected women in Thailand and Malaysia

INTRODUCTION

A higher prevalence of knee pain in Southeast Asian countries, compared with non-Asian countries, is an established fact. This article hypothesizes that this fact, combined with personal, cultural, and environmental factors, may influence attitudes toward illness and treatment-seeking behavior and adherence.

OBJECTIVE

This study aimed to determine current attitudes, stigma, and barriers of women to the management of chronic knee pain and treatment in two Southeast Asian countries.

METHODS

Fourteen semi-structured interviews explored female lived perceptions of chronic knee pain in Southeast Asia. Using a phenomenological reduction process, open-ended questions allowed participants to voice their perceptions of their experience of this knee condition. Particular foci were potential stigma associated with the perceptions of others, health-seeking attitudes, and attitudes toward exercise.

RESULTS

The shared experiences of managing chronic knee pain revealed the impact of their condition on participants' normality of life and their struggles with pain, limitations, and fear for the future. Key individual, interpersonal, organizational and community barriers and facilitators impacted the health seeking attitudes and engagement with conservative rehabilitation programmes.

CONCLUSION

Improved socio-cultural competency and consideration for an individuals' intersectional identity and interpersonal relationships are key to designing rehabilitation and conservative management solutions. Co-creating alternative pathways for rehabilitation for individuals that are more distant from health facilities may help reduce socio-cultural barriers at a community level.

Women's experiences and needs in the use of digital technologies for the management of gestational diabetes: An integrative systematic review

INTRODUCTION

Gestational diabetes mellitus (GDM) represents a widespread complication occurring during pregnancy, posing potential risks to both expectant mothers and their babies. Evidence shows that digital technologies provide comparable levels of care to conventional methods for GDM self-management, which help to improve maternal and neonatal outcomes. This systematic review aimed to explore women's experiences in using digital technologies, inform future technology design for gestational diabetes and potentially help improve usability.

METHODS

An integrative systematic review including quantitative, qualitative and mixed-method studies. The search was conducted in five databases including CINAHL, Web of Science, Medline, Embase, and PsycInfo. Studies were eligible when including the experience of using digital technologies for GDM self-management from the women's perspective. The screening processes were conducted by two independent reviewers and reached an overall moderate agreement on inter-rater reliability. Quality appraisal was conducted using the Mixed Method Appraisal Tool version 2018.

RESULTS

Thirty peer-reviewed articles were included, with a predominant or partial focus on five types of digital technologies including mobile applications, virtual care services, webpages, digital devices, and online communities. Women's experiences and needs of using GDM digital technologies were synthesised into five overarching themes: (1) sufficient and straightforward GDM-relevant educational information; (2) advanced personalisation and broader commitments in coaching components; (3) easy data recording and advanced data visualisation in data management; (4) improved healthcare professionals' engagement; (5) development of online community interfaces.

CONCLUSION

This integrative systematic review gives information on the types of available features across technologies and specific preferences for features by women with GDM. According to the inferred gaps, efforts should be made to facilitate women's self-monitoring using data and feedback, provide personalised information corresponding to women's condition, meet different behaviour change needs using customised coaching features, and enable wider access to information and support.

The first AI-based Chatbot to promote HIV self-management: A mixed methods usability study

BACKGROUND

We developed MARVIN, an artificial intelligence (AI)-based chatbot that provides 24/7 expert-validated information on self-management-related topics for people with HIV. This study assessed (1) the feasibility of using MARVIN, (2) its usability and acceptability, and (3) four usability subconstructs (perceived ease of use, perceived usefulness, attitude towards use, and behavioural intention to use).

METHODS

In a mixed-methods study conducted at the McGill University Health Centre, enrolled participants were asked to have 20 conversations within 3 weeks with MARVIN on predetermined topics and to complete a usability questionnaire. Feasibility, usability, acceptability, and usability subconstructs were examined against predetermined success thresholds. Qualitatively, randomly selected participants were invited to semi-structured focus groups/interviews to discuss their experiences with MARVIN. Barriers and facilitators were identified according to the four usability subconstructs.

RESULTS

From March 2021 to April 2022, 28 participants were surveyed after a 3-week testing period, and nine were interviewed. Study retention was 70% (28/40). Mean usability exceeded the threshold (69.9/68), whereas mean acceptability was very close to target (23.8/24). Ratings of attitude towards MARVIN's use were positive (+14%), with the remaining subconstructs exceeding the target (5/7). Facilitators included MARVIN's reliable and useful real-time information support, its easy accessibility, provision of convivial conversations, confidentiality, and perception as being emotionally safe. However, MARVIN's limited comprehension and the use of Facebook as an implementation platform were identified as barriers, along with the need for more conversation topics and new features (e.g., memorization).

CONCLUSIONS

The study demonstrated MARVIN's global usability. Our findings show its potential for HIV self-management and provide direction for further development.

Exercise-based cardiac rehabilitation for patients with atrial fibrillation receiving catheter ablation: protocol for a feasibility randomised controlled trial (RCT) with embedded process evaluation

INTRODUCTION

Atrial fibrillation (AF) affects approximately 2.5% of the UK population, with a risk of 1 in 3-5 individuals after the age of 45 years. The global prevalence has risen sharply in the past two decades, from 33.3 million to 59 million individuals living with AF, and is associated with stroke, heart failure and mortality. Catheter ablation is commonly used for symptomatic patients to restore normal rhythm. A recent Cochrane review of randomised clinical trials (RCTs) has demonstrated that exercise training may induce positive effects on AF burden, AF severity, exercise capacity, and quality of life. The aim was therefore to investigate the feasibility of delivering exercise-based cardiac rehabilitation for patients with AF receiving catheter ablation within usual care in the UK.

METHODS AND ANALYSIS

A two-armed feasibility RCT with embedded process evaluation will be undertaken as a phased programme of work. Patients on a waiting list for catheter ablation will be offered a referral to cardiac rehabilitation. The intervention consists of supervised exercise sessions run by a clinical exercise physiologist and psychoeducation sessions. The trial (n=60) will involve one National Health Service (NHS) research site enrolling patients to assess intervention and study design processes. Primary outcomes are recruitment rate, adherence to exercise-based cardiac rehabilitation and loss to follow-up. Semistructured interviews and focus groups with patients and clinicians will be used to gather data on the acceptability of the intervention and study procedures. Secondary outcome measures will be taken at baseline (pre-intervention), post-intervention and at 6-month follow-up and will consist of AF burden, AF recurrence, quality of life, exercise capacity measured by peak oxygen consumption and echocardiographic parameters.

ETHICS AND DISSEMINATION

The trial was approved in the UK by the Northwest-Preston Research Ethics Committee (24/NW/0061; IRAS project ID: 330155). Results will be published in peer-reviewed journals and presented at national and international scientific meetings, and summaries will be communicated to participants.

TRIAL REGISTRATION NUMBER

Clinicaltrials.gov identifier: NCT06401148.

The acceptability of a novel seismocardiography device for measuring VO2 max in a workplace setting: a mixed methods approach

BACKGROUND

Workplace health screening rarely includes measures of cardiorespiratory fitness, despite it being a greater predictor of cardiovascular disease and all-cause mortality than other routinely measured risk factors. This study aimed to determine the comparative acceptability of using a novel seismocardiography device to measure cardiorespiratory fitness via VO2 max during a workplace health check.

METHODS

Participants were invited to participate in workplace health screening sessions where VO2 max was assessed by both seismocardiography at rest and sub-maximal exercise testing, in order for acceptability of both to be compared across multiple domains. Questionnaires and focus group guides for participants and practitioners were developed based on the Theoretical Framework of Acceptability. Data were analysed using t-tests and deductive thematic analysis.

RESULTS

There was a significant difference in the acceptability domain of 'affective attitude' between the novel SCG device (M = 9.06 ± 1.14) and the sub-maximal exercise testing (M = 7.94 ± 1.79); t = 3.296, p = .001, d = 0.50, and in the domain of 'burden' between the novel SCG device (M = 9.16, ± 0.55) and the sub-maximal exercise testing (M = 7.41 ± 1.45); t = 7.033, p = < 0.001, d = 1.45. Practitioners and employees highlighted the potential of seismocardiography to create a more inclusive and accessible workplace offer, allowing those with restricted mobility or those with differing physical or emotional needs to participate in wellness testing; yet there was a lack of understanding in both groups around intervention effectiveness and coherence.

CONCLUSIONS

Seismocardiography may offer an acceptable route to cardiorespiratory fitness testing in the workplace, due to the low effort requirement and simplicity of administration. This study suggests that practitioners delivering such services have a critical role to play in acceptability of health interventions at work, as employees will be heavily influenced by practitioner beliefs around coherence and effectiveness. Comprehensive delivery training is important for the adoption of new health-related technologies such as seismocardiography into workplace health screening.

Telehomecare Monitoring for Patients Receiving Anticancer Oral Therapy: Protocol for a Mixed Methods Evaluability Study

BACKGROUND

Telehomecare monitoring (TM) in patients with cancer is a complex intervention. Research shows variations in the benefits and challenges TM brings to equitable access to care, the therapeutic relationship, self-management, and practice transformation. Further investigation into these variations factors will improve implementation processes and produce effective outcomes.

OBJECTIVE

This study aims to concurrently analyze implementation and evaluate the effectiveness of TM for patients receiving anticancer oral therapy. The objectives are to (1) contextualize how and why TM is implemented according to (a) site characteristics, (b) team characteristics, and (c) characteristics of patients receiving anticancer oral therapy; (2) assess TM effectiveness for recording electronic patient-reported outcome measures (ePROMs) and patient-reported experience measures (ePREMs) according to the site, implementation process, and patient characteristics; (3) describe the acceptability and feasibility of TM from the perspectives of the people directly or indirectly involved and provide evidence-based actionable guidance in anticipation of provincewide implementation.

METHODS

This type II hybrid effectiveness-implementation study uses a concurrent mixed methods design. Evaluability assessment is integrated into an emerging practice in 3 participating sites to enable the evaluation of implementation strategies on TM clinical outcomes. Quantitative data for ePROMs and ePREMs will be collected using validated oncology questionnaire. Descriptive statistics and repeated measures using multiple linear mixed models and generalized estimating equations analyses will be undertaken alongside interpretive descriptive coding of qualitative data. Qualitative data will be gathered from key informants guided by the RE-AIM (reach, efficacy, adoption, implementation, maintenance) framework and its extension, PRISM (practical robust implementation and sustainability model). The concurrent approach allows results at multiple stages of this study to be integrated iteratively. The methodological choice aims to provide real-world data that are rigorous, rapidly usable in practice, and transferable to other settings.

RESULTS

Questionnaires were pretested and the technological platform was codeveloped with members of the cancer care team and patients. Preparatory work was carried out to configure the TM platform and activate coordinating mechanisms between members of the cancer care team, patients, information technology experts, and the research team. A steering committee with 3 working groups was established to oversee the technological, clinical, and evaluation aspects of this study. Recruitment of patients for ePROMs started in February 2024, and data collection is expected to continue until March 2025. Interviews with members of the cancer care team began in November 2024. Full analysis should be completed by September 2025.

CONCLUSIONS

This study will clarify how, why, for whom, and under what conditions TM can complement current care models. Our evaluability assessment will help to address implementation complexities and better understand intervention-to-practice operationalization so that implementation might be adapted to contextual factors without potentially harmful or inequitable impacts on patients.

INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID)

DERR1-10.2196/63099.

The Effects of Motivational Interviewing on Promoting Human Papillomavirus Vaccination Initiation and Completion Among South Asian Mother/Daughter Dyads: A Pilot Randomised Controlled Trial

BACKGROUND

Vaccination against HPV is an effective strategy for the prevention of HPV infection and cervical cancer. Nevertheless, the HPV vaccine uptake rate is low among ethnic minorities in Hong Kong. This study sought to assess the feasibility and acceptability of motivational interviewing among South Asian mother-daughter dyads and to preliminarily examine its effects on knowledge of HPV infection and vaccination, health beliefs, intention to have the daughters vaccinated, and initiation and completion of HPV vaccine series.

METHODS

This was a pilot randomised controlled trial. Forty South Asian mothers with at least one daughter aged 9 to 17 years were recruited. The intervention group received a motivational interviewing intervention whereas the control group received usual care. Structured questionnaires were used to collect data on the participants' characteristics and selected outcome variables. Bias-corrected Hedges' g and rate difference together with their 95% confidence intervals were calculated to estimate the effect sizes of the intervention on the outcomes The acceptability was assessed via semi-structured interviews.

RESULTS

A larger proportion of the daughters of the intervention group participants had received the first dose of HPV vaccine (95% [19 out of 20]) vs 0% [0 out of 20]). The intervention group showed greater improvement in knowledge at 3 months after the intervention (Hedges' g = 0.77 (95%CI:0.13-1.41)). Most interviewees were satisfied with the intervention.

CONCLUSION

The intervention was feasible and acceptable. The intervention can help to increase South Asian mothers' knowledge and to increase the initiation of HPV vaccine series by their daughters.

TRIAL REGISTRATION

This study was registered at the Chinese Clinical Trial Registry (ChiCTR2100052751) on 5 November 2021.

Supporting community translation of lung cancer screening: A web-based decision aid to support informed decision making

BACKGROUND

Results of the National Lung Screening Trial create the potential to reduce lung cancer mortality, but community translation of lung cancer screening (LCS) has been challenging. Subsequent policies have endorsed informed and shared decision-making and using decision support tools to support person-centered choices about screening to facilitate implementation. This study evaluated the feasibility and acceptability of LuCaS CHOICES, a web-based decision aid to support delivery of accurate information, facilitate communication skill development, and clarify personal preferences regarding LCS-a key component of high-quality LCS implementation.

METHODS

Using a parallel groups randomized trial, the study investigated the feasibility and acceptability of LuCaS CHOICES decision aid in comparison to the National Cancer Institute's Lung Cancer Screening website. Three waves of self-report data were collected: baseline (PRE), 2 weeks post-baseline (POST), and 4 months post-baseline (FOL). Participant accrual and intervention access data were also collected to evaluate methodological feasibility for conducting a larger subsequent trial.

RESULTS

Participants assigned to LuCaS CHOICES (n = 25) and the NCI website (n = 25) interventions reported similar, favorable levels of intervention feasibility and acceptability that exceeded a priori criteria. Methodological feasibility was partially supported for the proposed accrual and retention goals, but accrual was slower than hypothesized, and documented exposure to the digital interventions was suboptimal per a priori standards.

CONCLUSIONS

Overall, both interventions demonstrated intervention feasibility and acceptability. In addition, the proposed methods achieved desired levels of retention and overall data collection. Modifications to enhance intervention engagement should be explored prior to further testing. Subsequent steps involve conducting a randomized clinical trial to evaluate the effect of LuCaS CHOICES on informed decision making and preference-concordant screening behavior, supporting LCS translation into community settings.

Japi 2.0, a gaming platform to stimulate cognitive and non-cognitive skills in early childhood: protocol for a pilot randomized controlled trial

BACKGROUND

Mental health disorders are one of the leading causes of illness globally. The importance of psychosocial skills acquired in early childhood, such as executive functions, inhibitory control, emotional regulation, and social problem-solving, in preventing mental disorders has been reported. Furthermore, mental health care delivery is evolving, and mobile technology is becoming the medium for assessment and intervention. We have developed Japi 2.0, the second iteration of a gaming platform, to stimulate cognitive and non-cognitive skills in early childhood, supported by early years educators using a web-based dashboard integrated into one system. This study aims to assess the acceptability and feasibility of this gaming platform and web-based dashboards.

METHODS

This is a pilot randomized controlled trial, parallel-group type, where the school-based implementation of "Japi 2.0" training is compared to standard school curricula in control schools. A total of six schools with low socio-economic status located in the city of Santiago, Chile, are expected to be recruited and randomized with 1:1 allocation. Japi 2.0 has 24 sessions, and 2 sessions of 15 min per week are delivered for 12 weeks. Measures will be conducted using different instruments with children, parents, and early years educators to gain insight into their acceptance of the intervention and the development of cognitive and non-cognitive skills.

DISCUSSION

This is a randomized control trial to assess the acceptability and feasibility of a gaming platform called "Japi 2.0" among preschoolers in Chile. This platform stimulates cognitive and non-cognitive skills with the final objective of reducing emotional and behavioral problems in early childhood. Evaluating the acceptability and feasibility of this technological solution for children is expected to produce relevant information about these novel designs. It may help guide future studies, such as a randomized controlled trial on a larger scale.

TRIAL REGISTRATION

Clinical Trials NCT06420544, May 20, 2024 [ https://www.

CLINICALTRIALS

gov/study/NCT06420544 ].

Effect of a Novel Food Rich in Miraculin on the Intestinal Microbiome of Malnourished Patients with Cancer and Dysgeusia

BACKGROUND/OBJECTIVES

Dysgeusia contributes to malnutrition and worsens the quality of life of patients with cancer. Despite the different strategies, there is no effective treatment for patients suffering from taste disorders provided by the pharmaceutical industry. Therefore, we developed a novel strategy for reducing side effects in cancer patients by providing a novel food supplement with the taste-modifying glycoprotein miraculin, which is approved by the European Union, as an adjuvant to medical-nutritional therapy.

METHODS

A pilot randomized, parallel, triple-blind, and placebo-controlled intervention clinical trial was carried out in which 31 malnourished patients with cancer and dysgeusia receiving antineoplastic treatment were randomized into three arms-standard dose of dried miracle berries (DMBs) (150 mg DMB/tablet), high dose of DMBs (300 mg DMB/tablet), or placebo (300 mg freeze-dried strawberry)-for three months. Patients consumed a DMB or placebo tablet before each main meal (breakfast, lunch, and dinner). Using stool samples from patients with cancer, we analyzed the intestinal microbiome via nanopore methodology.

RESULTS

We detected differences in the relative abundances of genera Phocaeicola and Escherichia depending on the treatment. Nevertheless, only the Solibaculum genus was more abundant in the standard-dose DMB group after 3 months. At the species level, Bacteroides sp. PHL 2737 presented a relatively low abundance in both DMB groups, whereas Vescimonas coprocola presented a relatively high abundance in both treatment groups after 3 months. Furthermore, a standard dose of DMB was positively associated with TNF-α levels and Lachnoclostridium and Mediterraneibacter abundances, and a high dose of DMB was negatively associated with TNF-α levels and the relative abundance of Phocaeicola. Following the administration of a high dose of DMB, a positive correlation was observed between erythrocyte polyunsaturated fatty acids and the presence of Lachnoclostridium and Roseburia. Additionally, a positive association was identified between Phocaeicola and the acetic acid concentration of feces. There was a negative association between the relative abundance of Phocaeicola and taste perception in the high-dose DMB group.

CONCLUSIONS

The combination of DMB intake with nutritional treatment and individualized dietary guidance results in positive changes in the intestinal microbiome of patients with cancer and dysgeusia. Changes observed in the intestinal microbiome might contribute to maintaining an appropriate immune response in cancer patients. As the current pilot study included a limited number of participants, further clinical trials on a larger group of patients are needed to draw robust findings.

Development and Validation of a Survey on Inclusive Judo: Judo Teachers' Attitudes Towards Including Participants with Intellectual Developmental Disorders (J-TAID)

This study developed and refined the Judo Teachers' Attitudes Towards Including Participants with Intellectual Developmental Disorders (J-TAID) survey, addressing the need to assess attitudes, subjective norms, perceived behavioral control, and intention regarding inclusion, and grounded in the Theory of Planned Behavior. The survey, translated into English, Portuguese, French, and Slovenian, was administered to 163 participants in order to assess its reliability and validity using Cronbach's alpha, Principal Component Analysis (PCA), Confirmatory Factor Analysis (CFA), and Exploratory Factor Analysis (EFA). Internal consistency regarding attitudes, subjective norms, and perceived behavioral Constructs ranged from 0,79 to 0.80, with test-retest reliability improving, demonstrating moderate to strong temporal stability (α = 0.679-0.813). The PCA and CFA identified a robust three-factor structure explaining 74% of the variance, with good model fit (RMSEA = 0.048, CFI = 0.978). Pearson correlations supported the TPB constructs. The refined J-TAID demonstrates validity and reliability for its intended purpose, although the results are still preliminary, and the limitations that were observed suggest a need for further validation.

Social media-based Health Education plus Exercise Program (SHEEP) to improve muscle function among young-old adults with possible sarcopenia in the community: A feasibility study protocol

BACKGROUND

Despite the comparatively high prevalence of possible sarcopenia among young-old adults in the community, there is currently no available and effective social media-based intervention to increase the awareness and change the behavior of the target population to prevent sarcopenia. Using co-design methodology, we developed a multicomponent intervention strategy of health education and exercise for sarcopenia prevention utilizing the TikTok platform.

OBJECTIVES

The primary purpose of this study is to examine the feasibility and acceptability of the social media-based intervention to enhance muscle function in community-dwelling young-old adults with possible sarcopenia.

METHODS

This protocol outlines the entire research procedure for a prospective single-arm pre-post feasibility study employing a mixed-method design, which will be conducted between May 2024 and September 2024. Thirty-five older adults aged 60-69 years with possible sarcopenia will be recruited from two communities in Changsha, China. Using the TikTok platform, participants will be required to view a total of seven health education videos in the first week, and each video lasts four to six minutes. Then, participants will receive six-week multi-component exercise through TikTok, with at least three sessions/week, 30 minutes/session, and moderate intensity. Data collection will be conducted in baseline, week 1, 4, 7, 10 and 13. The primary outcomes will include evaluating recruitment capability, data collection procedure, outcome measurement, intervention procedures' acceptability, researchers' ability to manage and implement the study, among others. The secondary outcome is to compare standard measures for muscle function (e.g. handgrip strength, skeletal muscle mass, physical performance), body composition (e.g. body fat, body mass index, bone mineral), and other measures (e.g. perceived knowledge, personal motivation, behavioral skills). Finally, all participants will be offered a semi-structured interview to assess their in-depth experiences with the intervention and research process.

DISCUSSION

This study will be the first social-media based multicomponent intervention program for community young-old adults with possible sarcopenia to improve their muscle function, awareness and behavior of preventing sarcopenia. Findings will generate new evidence regarding the use of social media in health education for improving awareness of sarcopenia prevention, as well as the feasibility of using social media to influence participants' behavioral changes through exercise. This may help researchers identify ways to optimize acceptability and efficacy of the SHEEP intervention for the targeted population.

TRIAL REGISTRATION

ISRCTN registry, ISRCTN17269170, Registered 14 September 2023.

Oral ketamine for acute postoperative analgesia (OKAPA) trial: A randomized controlled, single center pilot study

STUDY OBJECTIVE

Although opioids represent the mainstay of treating surgical pain, their use is associated with significant side effects. There is an urgent need to find new pain relievers with safer side effect profiles. One drug that has been receiving increasing attention is ketamine. By using the oral route of administration, ketamine could potentially be used by patients in a less resource-intensive manner with similar efficacy. This study aims to examine the role of oral ketamine in improving recovery after major spine surgery.

DESIGN

A prospective, single-center, double blinded parallel arm, placebo controlled randomized feasibility trial.

SETTING

Toronto Western Hospital (TWH), UHN, Toronto, Canada.

PATIENTS

Adult patients (aged 18-75) undergoing multi-level lumbar spine decompression and fusion with planned overnight admission in hospital.

INTERVENTIONS

Study treatment (oral ketamine 30 mg) or matching placebo for three days (nine doses total) or until hospital discharge.

MEASUREMENTS

The primary outcome was the patient-reported Quality of Recovery-15 score (QoR-15). Secondary outcomes were opioid use, pain intensity, pain interference (PROMIS-pain interference questionnaire), mood (PHQ-9) and, side-effects (Generic Assessment of Side Effects Scale).

MAIN RESULTS

Data from 35 patients were analyzed, of which 18 patients in the ketamine group and 17 patients in the placebo group. There were no significant differences identified in QoR-15 scores at postoperative days 1,3,7, and 30. There were also no significant differences found in pain intensity scale scores at postoperative days 1, 3, 7, and 30, and PROMIS and PHQ-9 scores at postoperative days 7 and 30. Significantly less oral opioids were used in the ketamine group compared to the placebo group on postoperative day 3 and by postoperative day 7. In addition, patients in the ketamine group spent significantly less days on oral opioids and trended to be discharged from hospital earlier.

CONCLUSION

This pilot study demonstrated that low dose oral ketamine can be safely used as an adjunct in postoperative pain treatment to help reduce opioid consumption after major spine surgery.

Improvement in Gait Abnormality Following Minimally Invasive Posterior Sacroiliac Joint Fusion

Background Sacroiliac joint (SIJ) dysfunction is a common cause of low back pain and associated gait disturbances that result from aberrant muscle activity and symmetry. This study evaluated the magnitude of improvement in gait characteristics in patients with chronic SIJ pain followed for six months after minimally invasive posterior SIJ fusion. Methods This was a single-arm, prospective, pilot study at two private practice orthopedic pain clinics. Gait characteristics were quantitated using a wireless wearable sensor. Ten patients (mean age: 63 ± 12 years) with abnormal SIJ-associated gait impairment were enrolled and underwent posterior SIJ fusion. Results Average gait velocity improved significantly from 69 ± 28.5 cm/sec at baseline to 99.9 ± 31.5 cm/sec at six months, reflecting an overall average improvement of 30.93 cm/sec or 55.4% (p=0.003). Gait speed, variability, and symmetry impairment parameters also improved with corresponding mean percentage improvements at six months of 27.8% (p=0.02), 19.7% (p=0.17), and 11% (p=0.27). A significant decrease in fall risk and increased timed-up-and-go assessments were noted, with improvements of 32.3% and 24.7%, respectively (p=0.004 for both comparisons). Conclusion These pilot findings demonstrate the first objective assessment of gait characteristics in patients with SIJ dysfunction undergoing minimally invasive posterior SIJ fusion.

Management of Glucocorticoid-Induced Hyperglycemia in Cancer Patients: A Feasibility Study

Glucocorticoids are commonly used in the management of patients with hematological and solid malignancies. However, their use may be associated with impaired glycemic metabolism and increased treatment-related morbidity and mortality. This study aimed to examine the feasibility and acceptability of a nurse-led model of care (MOC) for screening and managing glucocorticoid-induced hyperglycemia (GIH) in non-diabetic patients requiring high-dose glucocorticoid (HDG) therapies, as well as patients' and health professionals' experiences with the MOC. This study was a single-site feasibility study. Patients with hematological or oncological malignancies who were >18 years of age, receiving a chemotherapy regimen including HDGs, had no prior diagnosis of diabetes or prediabetes, and were not at the end of life were considered eligible for this study. Participants were recruited from a district hospital's Cancer Centre in Australia. All consenting participants were screened for diabetes and were provided with a blood glucose meter to monitor their blood glucose levels (BGLs) four times a day on the days of glucocorticoid therapy (GT) plus one extra day following GT, for the first four cycles of their treatment, to screen for the presence of GIH. Feasibility and acceptability were assessed using rates of consent, study completion, and staff and patient surveys. Forty-eight percent (35/74) of patients approached consented to participate in the study and had screening tests for preexisting diabetes. None were diagnosed with diabetes. Six out of 35 patients withdrew, and 10/29 patients did not complete the recommended BGL monitoring. Thirteen percent (4/29) of patients developed GIH. The most common reasons for non-participation and study withdrawal were related to the self-monitoring of BGLs. While clinical stakeholders found the MOC feasible and acceptable, the results of this study suggest that alternative methods for encouraging self-monitoring of BGL and monitoring the presence of GIH during high-dose chemotherapy need to be explored to address issues associated with adherence and sustainability.

Seeing is believing: Patients' attitudes and information preferences towards robotic gynaecological surgery

OBJECTIVES

Robotic gynaecological surgery (RS) is reported to be associated with feelings of apprehension and anxiety pre-operatively in a proportion of patients. This study aimed to investigate patients' understanding and perceptions towards RS, and whether the format of RS information resources could improve acceptability of RS.

DESIGN

A two-phase, sequential, mixed methods study involving semi-structured interviews of patients who had previously undergone gynaecological RS and a block-randomised crossover study of women from the general public. Qualitative data from interviews were analysed using thematic analysis, quantitative data from questionnaires were summarised and analysed using Mann-Whitney U and Fisher's exact tests.

RESULTS

Interview participants reported very little background knowledge of RS prior to their surgery. Many participants stated that written information leaflets did not adequately describe the robotic set-up and procedure, leading to anxiety and information seeking from alternative sources. The use of videos or models to visually demonstrate how the surgery would be performed and the interaction between the surgeon and the robot were proposed to address patients' needs. Questionnaire data from 30 women demonstrated an increase in acceptability of RS following provision of information, with 73.3 % of the participants reporting that the video alone was an adequate source of information, compared to only 46.7 % for the printed leaflet.

CONCLUSION

This study gives new insights into the impact of information provision for patients undergoing RS. Availability of information resources in different modality formats, in particular an information video, may help address patients' information needs, reduce anxiety and hence increase acceptability of RS.

Perinatal emotional skills groups for women and birthing people with borderline personality disorder: outcomes from a feasibility randomised controlled trial

BACKGROUND

There is no clear evidence about how to support people with borderline personality disorder (BPD) during the perinatal period. Perinatal emotional skills groups (ESGs) may be helpful, but their efficacy has not been tested.

AIMS

To test the feasibility of conducting a randomised controlled trial (RCT) of perinatal ESGs for women and birthing people with BPD.

METHOD

Two-arm parallel-group feasibility RCT. We recruited people from two centres, aged over 18 years, meeting DSM-5 diagnostic criteria for BPD, who were pregnant or within 12 months of a live birth. Eligible individuals were randomly allocated on a 1:1 ratio to ESGs + treatment as usual (TAU), or to TAU. Outcomes were assessed at 4 months post randomisation.

RESULTS

A total of 100% of the pre-specified sample (n = 48) was recruited over 6 months, and we obtained 4-month outcome data on 92% of randomised participants. In all, 54% of participants allocated to perinatal ESGs attended 75% of the full group treatment (median number of sessions: 9 (interquartile range 6-11). At 4 months, levels of BPD symptoms (adjusted coefficient -2.0, 95% CI -6.2 to 2.1) and emotional distress (-2.4, 95% CI -6.2 to 1.5) were lower among those allocated to perinatal ESGs. The directionality of effect on well-being and social functioning also favoured the intervention. The cost of delivering perinatal ESGs was estimated to be £918 per person.

CONCLUSIONS

Perinatal ESGs may represent an effective intervention for perinatal women and birthing people with BPD. Their efficacy should be tested in a fully powered RCT, and this is a feasible undertaking.

TRIAL REGISTRATION

ISRCTN80470632.

Move to improve - Prescribing physical activity and deprescribing paracetamol for low back pain: Protocol for a hybrid type III feasibility study

INTRODUCTION

People experiencing low back pain (LBP) could potentially benefit from multimedia educational resources that integrate self-management strategies and improve awareness of the benefits of staying active and about medications that offer limited benefits, such as paracetamol. Primary care waiting rooms are potential spaces for presenting health promotion resources to improve health literacy through the dissemination of easily accessible health information. This feasibility study aims to explore the feasibility of conducting a large-scale trial to investigate the benefits of multimedia educational resources delivered at outpatient physiotherapy waiting rooms of public hospitals to support patients to participate in physical activity and reduce paracetamol intake for LBP.

METHODS AND ANALYSIS

A hybrid type III feasibility study will be conducted at a public hospital in Sydney, Australia, from March to September 2024. The multimedia strategy development (pre-implementation) involves collaborative planning among healthcare professionals, policymakers and community stakeholders in physiotherapy practice. Phase II (implementation) will evaluate the acceptability and implementation processes of delivering the multimedia educational resources in the physiotherapy waiting room following the RE-AIM (Reach, Effectiveness, Adoption, Implementation and Maintenance) framework. Findings from the quantitative data will be reported descriptively, and categorical data by counts and percentages. Qualitative (open-ended questions) will be integrated with the feasibility trial outcomes to inform the design of a full-scale randomised controlled trial.

ETHICS AND DISSEMINATION

This study has ethical approval from the Sydney Local Health District Human Research Ethics Committee (2023/ETH02683). The findings will be disseminated via peer-reviewed publications, articles in relevant newsletters and presentations at national and international conferences. Social media platforms including X will also be used to generate awareness.

Prehabilitation Exercise Training to Target Improved Muscle Strength in Pretransplant Patients Diagnosed With Multiple Myeloma: Protocol for a Pilot Randomized Controlled Trial

BACKGROUND

Muscle mass and strength are severely compromised in patients diagnosed with multiple myeloma, such that the risk of poor overall survival increases as the prevalence of low muscle mass, also known as sarcopenia, increases. Additionally, at the time of autologous stem cell transplant (ASCT), 51% of patients experience low muscle mass and strength, which can prolong hospitalization and lead to increased risk of obesity, insulin resistance, lowered physical function, and poor quality of life.

OBJECTIVE

The PROTECT (Prehabilitation Exercise Training in Multiple Myeloma Patients Undergoing Autologous Stem Cell Transplantation) trial will examine the preliminary effects of digitally supervised prehabilitative aerobic and resistance exercise on muscle strength in patients with multiple myeloma scheduled for ASCT.

METHODS

This prospective, 2-armed single-center randomized controlled trial will recruit 30 patients with multiple myeloma, aged 18 years and older, planning to receive ASCT. Individuals will be assigned to either the exercise or the waitlist control group. The 8-week exercise intervention is home-based and digitally supervised by a clinical exercise trainer. The frequency of the exercise intervention is 3 times per week consisting of aerobic exercise on a cycle ergometer and resistance exercises, which are individually tailored based on patient health status. The waitlist control group maintains normal daily activities of living and is offered the intervention within 6 months from ASCT. The primary outcome is lower limb muscle strength, measured using the 10-repetition maximum leg press or extensor strength. Additional outcomes include physical and cardiorespiratory function, patient-reported outcomes, cardiometabolic health outcomes, and clinical outcomes.

RESULTS

The trial was funded in the fall of 2022 and recruitment began in June 2023. As of August 2024, a total of 3 participants have consented and been randomized (n=1, exercise group; n=2, waitlist control group). Trial completion and start of data analysis is expected in July 2025 with expected results to be published in early winter of 2026.

CONCLUSIONS

We expect exercise to improve lower limb muscle strength and overall health outcomes compared to the waitlist control group. Results will contribute foundational knowledge needed to conduct larger-phase clinical trials testing the clinical benefits of prehabilitation exercise in this patient population. This study will provide insight into a prehabilitative exercise intervention designed to support patient prognosis.

TRIAL REGISTRATION

ClinicalTrials.gov NCT05706766; https://clinicaltrials.gov/study/NCT05706766.

INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID)

DERR1-10.2196/64905.

Evaluation of effect of cooled haemodialysis on cognition in patients with end-stage kidney disease (ECHECKED) feasibility randomised controlled trial results

BACKGROUND

Cognitive impairment is common in haemodialysis patients with no known beneficial interventions. Cooler dialysate slows brain white-matter changes, but its effect on cognition is unknown. This feasibility trial was performed to inform a fully-powered, randomised trial to assess this.

METHODS

We aimed to randomise (1:1) 90 haemodialysis patients to this double-blinded, randomised controlled feasibility trial to standard care (dialysate-temperature 36.5 °C) or intervention (35 °C). Eligible patients were adult chronic haemodialysis recipients with no established diagnosis of dementia or psychiatric disease. The primary outcome was change in Montreal Cognitive Assessment (MoCA) score at 12-months. Secondary outcomes included recruitment and attrition rates, reasons for non-recruitment, intradialytic hypotension, depression, patient burden, computerised cognition test battery, and quality of life.

FINDINGS

Of 334 patients screened, 160 were eligible. 99 declined mainly for the extra non-dialysis day study visits. Sixty-one patients consented, 43 randomised - 20 in standard care, 23 in intervention arms; 13 withdrew for non-dialysis day visits and 5 without reason before randomisation. 27 patients (12 standard care, 15 intervention) completed the trial - 5 died, 1 transplanted, 4 withdrew consent, and 6 could not attend due to the pandemic. Low temperature dialysis was well tolerated. There was no difference in change in MoCA from baseline to 12 months between the standard and intervention arms; 1.0 (-2.8-3.0, p = 0.755) and - 2.0 (-1.0 - -4.0, p = 0.047) respectively. There were no differences between groups on any secondary measures. There were no significant adverse events reported.

DISCUSSION

The trial was significantly affected by the COVID-19 pandemic contributing to an attrition rate of 27%. The non-dialysis day research visits were mainly responsible for low recruitment and consent withdrawal. There are several learning points, described in the article, which will inform design of definitive trials in this area in the future.

TRIAL REGISTRATION

ClinicalTrials.gov Identifier NCT03645733. Registration date 24/08/2018.

A Web-Based Mind-Body Intervention to Improve Resilience Among Patients With Nontraumatic Painful Upper-Extremity Conditions and Comorbid Risky Substance Use: Protocol for a Mixed Methods Study

BACKGROUND

Nontraumatic painful upper-extremity conditions (NPUCs) are largely age-related degenerations that affect the majority of adults. Most patients with NPUCs do not seek medical care and adjust on their own. Among those who do seek care, approximately 20% report risky substance use, defined as a consumption pattern that increases the risk of harm to physical or psychosocial health. In the context of NPUC, risky substance use is associated with more intense pain, emotional distress, disability, and opioid or other substance misuse (ie, cross-tolerance). Consequently, risky substance use is a significant modifiable risk factor for the progression and maintenance of chronic pain-related disability and comorbid psychopathology among patients with NPUCs.

OBJECTIVE

This study aims to develop, adapt, and test the feasibility of the Web-Based Toolkit for Resilient Life Beyond Pain and Substance Use (Web-TIRELESS), a novel, asynchronous, and web-based mind-body intervention aimed at modifying maladaptive pain-coping behaviors in patients with NPUC and comorbid risky substance use. This study illustrates the proposed study design, methodology, and intervention content.

METHODS

In aim 1, we will conduct live video qualitative interviews (n=20) with care-seeking adult patients with NPUC and comorbid risky substance use to inform the development and refinement of Web-TIRELESS and study procedures. In aim 2, we propose an open pilot study (n=12) of Web-TIRELESS with exit interviews and pre- and postintervention assessments to evaluate the feasibility, credibility, and acceptability of Web-TIRELESS and refine study procedures. Aim 3 consists of a pilot feasibility randomized controlled trial of Web-TIRELESS versus minimally enhanced usual care (n=50), both of which follow a web-based modality, to demonstrate the feasibility of recruitment procedures and data collection, as well as the feasibility, credibility, and acceptability of Web-TIRELESS and the control condition (adherence, retention, fidelity, and satisfaction), following prespecified benchmarks.

RESULTS

Patient interviews (aim 1) concluded in May 2024 and qualitative analysis is expected to be completed in September 2024. Completion of aim 2 (data collection and analysis) is expected by June 2025. The completion of aim 3 and other study-related operations is anticipated by June 2027.

CONCLUSIONS

We will develop and test Web-TIRELESS, the first asynchronous mind-body intervention specifically adapted to enhance resilience in response to chronic pain among individuals with NPUCs and comorbid risky substance use. Results from this 3-aim study (feasibility, acceptability, and satisfaction of Web-TIRELESS) will be leveraged to inform a future efficacy randomized controlled trial of Web-TIRELESS versus the minimally enhanced usual care.

TRIAL REGISTRATION

ClinicalTrials.gov NCT06366633; https://clinicaltrials.gov/study/NCT06366633.

INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID)

DERR1-10.2196/64547.

Continuum: A Postdischarge Supportive Care Intervention for Hospitalized Patients With Advanced Cancer

CONTEXT

Patients with advanced cancer are at increased risk for multiple hospitalizations and often have considerable needs postdischarge. Interventions to address patients' needs after transitioning home are lacking.

OBJECTIVES

We sought to demonstrate the feasibility and acceptability of a postdischarge intervention for this population.

METHODS

We conducted a single-arm pilot trial (n = 54) of a postdischarge intervention, consisting of a video visit with an oncology nurse practitioner (NP) within three days of discharge to address symptoms, medications, hospitalization-related issues, and care coordination. We enrolled English-speaking adults with advanced breast, gastrointestinal, genitourinary, or thoracic cancers experiencing an unplanned hospitalization and preparing for discharge home. The intervention was deemed feasible if ≥70% of approached patients enrolled and ≥70% of enrolled patients completed the intervention within three days of discharge. Two weeks after discharge, patients rated the ease and usefulness of the video technology on a 0-10 scale (higher scores indicate greater ease of use). NPs completed postintervention surveys to assess protocol adherence.

RESULTS

We enrolled 54 of 75 approached patients (77.3%). Of enrolled patients (median age = 65.0 years), 83.3% participated in the intervention within three days of discharge. The median ease of participating in the intervention was 9.0 (IQR: 6.0-10.0) and the median usefulness of the intervention was 7.0 (IQR: 4.5-8.0). The majority of visits focused on symptom management (85.7%), followed by posthospital medical issues (69.0%).

CONCLUSION

An oncology NP-delivered intervention immediately after hospital discharge is a feasible and acceptable approach to providing postdischarge care for hospitalized patients with advanced cancer.

SIFT IT: A feasibility and preliminary efficacy randomized controlled trial of a social cognition group treatment programme for people with acquired brain injury

Making sense of social situations requires social cognitive skills, which can be impaired after acquired brain injury (ABI), yet few evidence-based treatment options are available. This study aimed to evaluate the feasibility of a multi-faceted social cognition group treatment programme, SIFT IT, for people after ABI using an RCT design. Twenty-eight participants were recruited, and 23 were randomized into either Treatment or Waitlist. SIFT IT consisted of 14 weekly 90-minute small group sessions facilitated by a Clinical Psychologist. Topics included: emotion self-awareness, emotion perception, perspective taking, and choosing adaptive social responses. Preliminary efficacy outcomes were assessed at baseline, post-treatment, and three-month follow-up. Demand for treatment was evident with 61% recruitment and 91% post-treatment retention rates, with 63% attending at least 13/14 sessions. Large between-group treatment effects (with non-zero 95% confidence intervals) were observed for emotion perception, detecting hints, and informant ratings of social cognitive deficits. Implementation challenges recruiting to groups and maintaining group allocation fidelity, with a small sample size does, however, raise questions about the appropriateness of an RCT design in a future efficacy trial. Overall, this study showed there is demand for social cognitive interventions after ABI and the SIFT IT programme was practicable and acceptable to participants.Trial registration: Australian New Zealand Clinical Trials Registry identifier: ACTRN12617000405314.

Healthy Eating and Active Lifestyle after Bowel Cancer (HEAL ABC)-feasibility randomised controlled trial

BACKGROUND

Evidence from cohort studies indicates that a healthy lifestyle can improve cancer survival but evidence from randomised controlled trials (RCT) is lacking. Thus, this study tested the feasibility of conducting a lifestyle intervention in patients after colorectal cancer (CRC) treatment.

METHODS

An intervention was developed based on World Cancer Research Fund and American Institute for Cancer Research (WCRF/AICR) recommendations, the Health Action Process Approach, Motivational Interviewing and tested a feasibility, mixed-methods RCT. Participants were allocated to a three-month telephone-based intervention versus standard care control group. The follow up period was six months. Data on feasibility and secondary outcomes were collected and analysed using Stata (V15, StataCorp LLC) and NVivo 12 (QSR International Pty Ltd., Doncaster, VIC).

RESULTS

Recruitment was challenging (31 ineligible, 37 declined; recruitment rate = 48.6%.). In total, 34/35 participants completed the intervention, and 31 (89%) completed follow up; all 31 completers participated in six telephone calls during intervention and six months follow up. Study retention was 97% (34/35) and 89% (31/35) at three and six months, respectively. Data completion rates were high (>90%). Intervention was acceptable to participants, met their needs and kept them accountable towards their goals. Participants in the intervention group showed significant improvement in WCRF/AICR, Diet Quality Index-International score and a 10% reduction in ultra-processed food consumption.

CONCLUSIONS

The HEAL ABC intervention was feasible for 87% of intervention participants, supporting them in healthy lifestyle changes. However, alternative recruitment strategies are needed for a fully powered RCT to determine the effectiveness of the intervention.

Rationale and Design of a Study to Assess the Engagement and Usefulness of the Care4Today Connect Digital Health Application for Disease Management in Coronary Artery Disease and Peripheral Artery Disease (iPACE-CVD Study)

INTRODUCTION

Coronary artery disease (CAD) and peripheral artery disease (PAD) increase the risks of cardiovascular events and death. Digital health technologies are rapidly expanding to improve healthcare quality and access. The Care4Today Connect (C4T CAD-PAD) mobile application is designed to help patients with CAD and/or PAD improve medication adherence, learn about their disease, make lifestyle modifications, and enhance healthcare provider (HCP) connection via an HCP-facing portal.

HYPOTHESIS & METHODS

The prospective, single-arm, multicenter, noninterventional iPACE-CVD (innovative Patient compAnion impaCting health outcomEs: a CardioVascular Digital health program) study (ClinicalTrials.gov identifier: NCT06052319) is evaluating engagement and usefulness of the application for patients with CAD and/or PAD in clinical settings. Application access is provided with a code from patients' HCPs. Key features include medication and health experience tracking. The application is available in English and Spanish and for iOS and Android devices. Engagement is defined as the proportion of patients who use the application for ≥ 10 weeks during the 3-month study period. Application use is defined as the number of patients using ≥ 1 application feature(s) each week. Usefulness is determined by the percentage of engaged patients who complete the My Feedback Matters survey with a satisfaction response score of > 2 (on a 5-point scale, where 1 = strongly disagree and 5 = strongly agree) for at least three of the six questions.

RESULTS

A total of 271 participants were enrolled between November 29, 2023, and May 15, 2024. The study concluded on August 15, 2024.

CONCLUSION

This study will help enhance the application for subsequent studies.

TRIAL REGISTRATION

NCT06052319.

Exploring environmental modifiers of LRRK2-associated Parkinson's disease penetrance: An exposomics and metagenomics pilot study on household dust

Pathogenic variants in the Leucine-rich repeat kinase 2 (LRRK2) gene are a primary monogenic cause of Parkinson's disease (PD). However, the likelihood of developing PD with inherited LRRK2 pathogenic variants differs (a phenomenon known as "reduced penetrance"), with factors including age and geographic region, highlighting a potential role for lifestyle and environmental factors in disease onset. To investigate this, household dust samples from four different groups of individuals were analyzed using metabolomics/exposomics and metagenomics approaches: PD+/LRRK2+ (PD patients with pathogenic LRRK2 variants; n = 11), PD-/LRRK2+ (individuals with pathogenic LRRK2 variants but without PD diagnosis; n = 8), iPD (PD of unknown cause; n = 11), and a matched, healthy control group (n = 11). The dust was complemented with metabolomics and lipidomics of matched serum samples, where available. A total of 1,003 chemicals and 163 metagenomic operational taxonomic units (mOTUs) were identified in the dust samples, of which ninety chemicals and ten mOTUs were statistically significant (ANOVA p-value < 0.05). Reduced levels of 2-benzothiazolesulfonic acid (BThSO3) were found in the PD-/LRRK2+ group compared to the PD+/LRRK2+ . Among the significant chemicals tentatively identified in dust, two are hazardous chemical replacements: Bisphenol S (BPS), and perfluorobutane sulfonic acid (PFBuS). Furthermore, various lipids were found altered in serum including different lysophosphatidylethanolamines (LPEs), and lysophosphatidylcholines (LPCs), some with higher levels in the PD+/LRRK2+ group compared to the control group. A cellular study on isogenic neurons generated from a PD+/LRRK2+ patient demonstrated that BPS negatively impacts mitochondrial function, which is implicated in PD pathogenesis. This pilot study demonstrates how non-target metabolomics/exposomics analysis of indoor dust samples complemented with metagenomics can prioritize relevant chemicals that may be potential modifiers of LRRK2 penetrance.

A methodology to evaluate the effectiveness of interprofessional education strategies based on the Medical Research Council (MRC) framework among vocational healthcare students in China

Interprofessional education (IPE) is rapidly becoming a core element of health professions preparation programs worldwide, but the effectiveness of different IPE strategies and their impacts in different regions and populations remain unclear, especially in the vocational education setting. This article describes the overall research design including the development, testing and preliminary evaluation of the IPE education interventions for Chinese vocational healthcare students, following the procedure outlined in the UK Medical Research Council (MRC) framework for developing and implementing complex interventions in healthcare. The objective is to develop and adapt role-based IPE strategies and evaluate their feasibility and effectiveness on interprofessional competencies of vocational healthcare students in China, with nursing students being our focus.•This study adopts a mixed-methods approach to develop two IPE strategies related to role interaction (role-taking and role-playing) in comparison to one conventional IPE strategy (pure group discussion) and investigate the different effectiveness in vocational healthcare students' attitudes to IPE, perception of professional roles, and interprofessional collaborative competencies by three valid scales.•The study is divided into four stages: development, feasibility testing, evaluation and final experimental verification.•This study helps provide scientific and appropriate IPE strategies for vocational healthcare educators, so as to improve the interprofessional learning and collaborative ability of vocational healthcare students.

A Mindfulness-Based Lifestyle Intervention for Dementia Risk Reduction: Protocol for the My Healthy Brain Feasibility Randomized Controlled Trial

BACKGROUND

Lifestyle behavior change and mindfulness have direct and synergistic effects on cognitive functioning and may prevent Alzheimer disease and Alzheimer disease-related dementias (AD/ADRD). We are iteratively developing and testing My Healthy Brain (MHB), the first mindfulness-based lifestyle group program targeting AD/ADRD risk factors in older adults with subjective cognitive decline. Our pilot studies (National Institutes of Health [NIH] stage 1A) have shown that MHB is feasible, acceptable, and associated with improvement in lifestyle behavior and cognitive outcomes.

OBJECTIVE

We will compare the feasibility of MHB versus an education control (health enhancement program [HEP]) in 50 older adults (aged ≥60 y) with subjective cognitive decline and AD/ADRD risk factors. In an NIH stage 1B randomized controlled trial (RCT), we will evaluate feasibility benchmarks, improvements in cognitive and lifestyle outcomes, and engagement of hypothesized mechanisms.

METHODS

We are recruiting through clinics, flyers, web-based research platforms, and community partnerships. Participants are randomized to MHB or the HEP, both delivered in telehealth groups over 8 weeks. MHB participants learn behavior modification and mindfulness skills to achieve individualized lifestyle goals. HEP participants receive lifestyle education and group support. Assessments are repeated after the intervention and at a 6-month follow-up. Our primary outcomes are feasibility, acceptability, appropriateness, credibility, satisfaction, and fidelity benchmarks. The secondary outcomes are cognitive function and lifestyle (physical activity, sleep, nutrition, alcohol and tobacco use, and mental and social activity) behaviors. Data analyses will include the proportion of MHB and HEP participants who meet each benchmark (primary outcome) and paired samples 2-tailed t tests, Cohen d effect sizes, and the minimal clinically important difference for each measure (secondary outcomes).

RESULTS

Recruitment began in January 2024. We received 225 inquiries. Of these 225 individuals, 40 (17.8%) were eligible. Of the 40 eligible participants, 21 (52.5%) were enrolled in 2 group cohorts, 17 (42.5%) were on hold for future group cohorts, and 2 (5%) withdrew before enrollment. All participants have completed before the intervention assessments. All cohort 1 participants (9/21, 43%) have completed either MHB or the HEP (≥6 of 8 sessions) and after the intervention assessments. The intervention for cohort 2 (12/21, 57%) is ongoing. Adherence rates for the Garmin Vivosmart 5 (128/147, 87.1% weeks) and daily surveys (105/122, 86.1% weeks) are high. No enrolled participants have dropped out. Enrollment is projected to be completed by December 2024.

CONCLUSIONS

The RCT will inform the development of a larger efficacy RCT (NIH stage 2) of MHB versus the HEP in a more diverse sample of older adults, testing mechanisms of improvements through theoretically driven mediators and moderators. The integration of mindfulness with lifestyle behavior change in MHB has the potential to be an effective and sustainable approach for increasing the uptake of AD/ADRD risk reduction strategies among older adults.

TRIAL REGISTRATION

ClinicalTrials.gov NCT05934136; https://www.clinicaltrials.gov/study/NCT05934136.

INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID)

DERR1-10.2196/64149.

Reducing stigma and improving access to care for people with mental health conditions in the community: protocol for a multi-site feasibility intervention study (Indigo-Local)

BACKGROUND

Stigma and discrimination towards people with mental health conditions by their communities are common worldwide. This can result in a range of negative outcomes for affected persons, including poor access to health care. However, evidence is still patchy from low- and middle-income countries (LMICs) on affordable, community-based interventions to reduce mental health-related stigma and to improve access to mental health care.

METHODS

This study aims to conduct a feasibility (proof-of-principle) pilot study that involves developing, implementing and evaluating a community-based, multi-component, awareness-raising intervention (titled Indigo-Local), designed to reduce stigma and discrimination and to increase referrals of people with mental health conditions for assessment and treatment. It is being piloted in seven sites in five LMICs-China, Ethiopia, India, Nepal and Tunisia-and includes several key components: a stakeholder group workshop; a stepped training programme (using a 'Training of Trainers' approach) of community health workers (or similar cadres of workers) and service users that includes repeated supervision and booster sessions; community engagement activities; and a media campaign. Social contact and service user involvement are instrumental to all components. The intervention is being evaluated through a mixed-methods pre-post study design that involves quantitative assessment of stigma outcomes measuring knowledge, attitudes and (discriminatory) behaviour; quantitative evaluation of mental health service utilization rates (optional, where feasible in sites); qualitative exploration of the potential effectiveness and impact of the Indigo-Local intervention; a process evaluation; implementation evaluation; and an evaluation of implementation costs.

DISCUSSION

The output of this study will be a contextually adapted, evidence-based intervention to reduce mental health-related stigma in local communities in five LMICs to achieve improved access to healthcare. We will have replicable models of how to involve people with lived experience as an integral part of the intervention and will produce knowledge of how intervention content and implementation strategies vary across settings. The intervention and its delivery will be refined to be feasible and ready for larger-scale implementation and evaluation. This study thereby has the potential to make an important contribution to the evidence base on what works to reduce mental health-related stigma and discrimination and improve access to health care.