1
|
Inoue T, Shinba T, Itokawa M, Sun G, Nishikawa M, Miyashita M, Suzuki K, Kariya N, Arai M, Matsui T. The development and clinical application of a novel schizophrenia screening system using yoga-induced autonomic nervous system responses. Front Physiol 2022; 13:902979. [PMID: 36277195 PMCID: PMC9581289 DOI: 10.3389/fphys.2022.902979] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2022] [Accepted: 09/16/2022] [Indexed: 11/13/2022] Open
Abstract
Background: In severe cases, schizophrenia can result in suicide and social isolation. Diagnosis delay can lead to worsening symptoms, and often results in prolonged therapy. An estimated 50%–80% of patients with schizophrenia are unaware of their condition. Biomarkers for schizophrenia are important for receiving a diagnosis from a psychiatrist at an early stage. Although previous studies have investigated near-infrared spectroscopy as a biomarker for schizophrenia, the required equipment is expensive and not designed for home use. Hence, we developed a novel home-use schizophrenia screening system that uses a wearable device to measure autonomic nervous system responses induced by yoga, which is frequently adopted in rehabilitation for schizophrenia.Materials and methods: The schizophrenia screening system automatically distinguishes patients with schizophrenia from healthy subjects via yoga-induced transient autonomic responses measured with a wearable wireless electrocardiograph (ECG) using linear discriminant analysis (LDA; Z score ≥ 0 → suspected schizophrenia, Z-score < 0 → healthy). The explanatory variables of LDA are averages of four indicators: components of heart rate variability (HRV): the very low-frequency (VLF), the low-frequency (LF), HR, and standard deviation of the NN intervals (SDNN). In the current study, HRV is defined as frequency domain HRV, which is determined by integrating RRI power spectrum densities from 0.0033 to 0.04 Hz (VLF) and 0.04–0.15 Hz (LF), and as time domain HRV, SDNN of which is calculated as the mean of the standard deviations of the RR intervals. These variables were measured before (5 min), during (15 min), and after (5 min) yoga in a 15-min mindfulness-based yoga program for schizophrenia (MYS). The General Health Questionnaire-28 (GHQ28) score was used to assess the severity of mental disorders for patients with schizophrenia and healthy volunteers. Twelve patients with schizophrenia (eight female and four male, 23–60 years old) and 16 healthy volunteers (seven female and nine male, 22–54 years old) were recruited.Results: The schizophrenia screening system achieved sensitivity of 91% and specificity of 81%. Z-scores of LDA were significantly correlated with GHQ28 scores (r = 0.45, p = 0.01).Conclusion: Our proposed system appears to be promising for future automated preliminary schizophrenia screening at home.
Collapse
Affiliation(s)
- Tomoko Inoue
- Graduate School of Systems Design, Tokyo Metropolitan University, Hachioji, Japan
- Schizophrenia Research Project, Department of Psychiatry and Behavioral Sciences, Tokyo Metropolitan Institute of Medical Science, Tokyo, Japan
- Department of Psychiatry, Tokyo Metropolitan Matsuzawa Hospital, Tokyo, Japan
| | - Toshikazu Shinba
- Graduate School of Systems Design, Tokyo Metropolitan University, Hachioji, Japan
- Department of Psychiatry, Shizuoka Saiseikai General Hospital, Shizuoka, Japan
| | - Masanari Itokawa
- Schizophrenia Research Project, Department of Psychiatry and Behavioral Sciences, Tokyo Metropolitan Institute of Medical Science, Tokyo, Japan
- Department of Psychiatry, Tokyo Metropolitan Matsuzawa Hospital, Tokyo, Japan
| | - Guanghao Sun
- Graduate School of Systems Design, Tokyo Metropolitan University, Hachioji, Japan
- Graduate School of Informatic and Engineering, The University of Electro-Communications, Chofu, Japan
| | - Maho Nishikawa
- Graduate School of Informatic and Engineering, The University of Electro-Communications, Chofu, Japan
| | - Mitsuhiro Miyashita
- Schizophrenia Research Project, Department of Psychiatry and Behavioral Sciences, Tokyo Metropolitan Institute of Medical Science, Tokyo, Japan
- Department of Psychiatry, Tokyo Metropolitan Matsuzawa Hospital, Tokyo, Japan
- Department of Psychiatry, Takatsuki Clinic, Akishima, Japan
| | - Kazuhiro Suzuki
- Schizophrenia Research Project, Department of Psychiatry and Behavioral Sciences, Tokyo Metropolitan Institute of Medical Science, Tokyo, Japan
- Department of Psychiatry, Takatsuki Clinic, Akishima, Japan
- Kokoro-no Home Clinic, Tokyo, Japan
| | | | - Makoto Arai
- Schizophrenia Research Project, Department of Psychiatry and Behavioral Sciences, Tokyo Metropolitan Institute of Medical Science, Tokyo, Japan
| | - Takemi Matsui
- Graduate School of Systems Design, Tokyo Metropolitan University, Hachioji, Japan
- *Correspondence: Takemi Matsui,
| |
Collapse
|
2
|
Provancha-Romeo AF, Hoffman AL, Malcolm MP, Coatsworth JD, Laxton LR, Freeman KM, Schmid AA. Mind-body interventions utilized by an occupational therapist in a medical intensive care unit: An exploratory case study. Work 2019; 63:191-197. [DOI: 10.3233/wor-192920] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Affiliation(s)
- Alexa F. Provancha-Romeo
- Department of Occupational Therapy, Colorado State University, Integrative Rehabilitation Lab, Fort Collins, CO, USA
| | - Amanda L. Hoffman
- Department of Occupational Therapy, University of Colorado Hospital, Aurora, CO, USA
| | - Matt P. Malcolm
- Colorado School of Public Health, Colorado State University, Fort Collins, CO, USA
| | - J. Douglas Coatsworth
- Department of Human Development and Family Studies, Colorado State University, Fort Collins, CO, USA
| | - Lyndsay R. Laxton
- Department of Occupational Therapy, University of Colorado Hospital, Aurora, CO, USA
| | - Katherine M. Freeman
- Department of Occupational Therapy, University of Colorado Hospital, Aurora, CO, USA
| | - Arlene A. Schmid
- Department of Occupational Therapy, Colorado State University, Integrative Rehabilitation Lab, Fort Collins, CO, USA
| |
Collapse
|
3
|
Lorenc A, Feder G, MacPherson H, Little P, Mercer SW, Sharp D. Scoping review of systematic reviews of complementary medicine for musculoskeletal and mental health conditions. BMJ Open 2018; 8:e020222. [PMID: 30327397 PMCID: PMC6196876 DOI: 10.1136/bmjopen-2017-020222] [Citation(s) in RCA: 41] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
OBJECTIVE To identify potentially effective complementary approaches for musculoskeletal (MSK)-mental health (MH) comorbidity, by synthesising evidence on effectiveness, cost-effectiveness and safety from systematic reviews (SRs). DESIGN Scoping review of SRs. METHODS We searched literature databases, registries and reference lists, and contacted key authors and professional organisations to identify SRs of randomised controlled trials for complementary medicine for MSK or MH. Inclusion criteria were: published after 2004, studying adults, in English and scoring >50% on Assessing the Methodological Quality of Systematic Reviews (AMSTAR); quality appraisal checklist). SRs were synthesised to identify research priorities, based on moderate/good quality evidence, sample size and indication of cost-effectiveness and safety. RESULTS We included 84 MSK SRs and 27 MH SRs. Only one focused on MSK-MH comorbidity. Meditative approaches and yoga may improve MH outcomes in MSK populations. Yoga and tai chi had moderate/good evidence for MSK and MH conditions. SRs reported moderate/good quality evidence (any comparator) in a moderate/large population for: low back pain (LBP) (yoga, acupuncture, spinal manipulation/mobilisation, osteopathy), osteoarthritis (OA) (acupuncture, tai chi), neck pain (acupuncture, manipulation/manual therapy), myofascial trigger point pain (acupuncture), depression (mindfulness-based stress reduction (MBSR), meditation, tai chi, relaxation), anxiety (meditation/MBSR, moving meditation, yoga), sleep disorders (meditative/mind-body movement) and stress/distress (mindfulness). The majority of these complementary approaches had some evidence of safety-only three had evidence of harm. There was some evidence of cost-effectiveness for spinal manipulation/mobilisation and acupuncture for LBP, and manual therapy/manipulation for neck pain, but few SRs reviewed cost-effectiveness and many found no data. CONCLUSIONS Only one SR studied MSK-MH comorbidity. Research priorities for complementary medicine for both MSK and MH (LBP, OA, depression, anxiety and sleep problems) are yoga, mindfulness and tai chi. Despite the large number of SRs and the prevalence of comorbidity, more high-quality, large randomised controlled trials in comorbid populations are needed.
Collapse
Affiliation(s)
- Ava Lorenc
- Population Health Sciences, Bristol Medical School, Bristol, UK
| | - Gene Feder
- Population Health Sciences, Bristol Medical School, Bristol, UK
| | | | - Paul Little
- Primary Care and Population Science Unit, University of Southampton, Southampton, UK
| | - Stewart W Mercer
- General Practice and Primary Care, Institute of Health and Wellbeing, University of Glasgow, Glasgow, UK
| | - Deborah Sharp
- Population Health Sciences, Bristol Medical School, Bristol, UK
| |
Collapse
|
4
|
Goodman V, Wardrope B, Myers S, Cohen S, McCorquodale L, Kinsella EA. Mindfulness and human occupation: A scoping review. Scand J Occup Ther 2018; 26:157-170. [PMID: 29952233 DOI: 10.1080/11038128.2018.1483422] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Abstract
BACKGROUND Mindfulness is an emergent construct with implications for our understanding of approaches to engagement in human occupation. Little is known about how mindfulness is being applied and what its possibilities are in the occupation-based disciplines. OBJECTIVE The purpose of this scoping review was to summarize, describe, and identify gaps in the existing literature on mindfulness in relation to human occupation. MATERIAL AND METHOD A scoping review, guided by Arksey and O'Malley's methodological framework was undertaken. The initial search yielded 929 articles; 20 articles met the criteria for inclusion. Articles included peer review and gray literature published in English between 2006-2016. Articles addressed mindfulness in OT or OS and included the terms 'human occupation', 'occupational therapy' and/or 'occupational therapist', and 'mindfulness' and/or 'meditation' or 'yoga'. FINDINGS The qualitative thematic analysis identified an overarching theme of mindful occupation, with 5 sub-themes including occupational presence; occupational awareness; occupational engagement; occupational well-being; and occupational fulfillment. CONCLUSIONS AND SIGNIFICANCE The findings have important implications for practice, education, theory and research. Future directions should focus on more depth and breadth of empirical research about mindful engagement in human occupation that can be used to implement and evaluate mindfulness in occupation-based theory and practice.
Collapse
Affiliation(s)
- Victoria Goodman
- a School of Occupational Therapy, Faculty of Health Sciences , Western University , London , Ontario , Canada
| | - Brooke Wardrope
- a School of Occupational Therapy, Faculty of Health Sciences , Western University , London , Ontario , Canada
| | - Suzanne Myers
- a School of Occupational Therapy, Faculty of Health Sciences , Western University , London , Ontario , Canada
| | - Shelly Cohen
- a School of Occupational Therapy, Faculty of Health Sciences , Western University , London , Ontario , Canada
| | - Lisa McCorquodale
- a School of Occupational Therapy, Faculty of Health Sciences , Western University , London , Ontario , Canada
| | - Elizabeth Anne Kinsella
- a School of Occupational Therapy, Faculty of Health Sciences , Western University , London , Ontario , Canada
| |
Collapse
|
5
|
Morgan AJ, Chittleborough P, Jorm AF. Self-help strategies for sub-threshold anxiety: A Delphi consensus study to find messages suitable for population-wide promotion. J Affect Disord 2016; 206:68-76. [PMID: 27466744 DOI: 10.1016/j.jad.2016.07.024] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/01/2016] [Revised: 06/10/2016] [Accepted: 07/16/2016] [Indexed: 10/21/2022]
Abstract
BACKGROUND Many self-help strategies have been recommended for anxiety, but it is not clear which strategies are most effective and could be encouraged as part of an early intervention approach. This study used the Delphi expert consensus method to identify which strategies for mild (sub-threshold) anxiety are thought to be helpful and feasible to implement for individuals without professional assistance. METHODS Participants were an international sample of 51 clinicians/researchers and 32 consumer advocates with expertise in anxiety. The scientific and lay literature was systematically searched for strategies claimed to be effective for anxiety. Participants rated the likely helpfulness of each strategy in reducing sub-threshold anxiety (related to generalised anxiety, social anxiety, or non-specific anxiety symptoms) and the feasibility of implementation in an iterative process across three questionnaire rounds. RESULTS 66 out of 324 candidate strategies were endorsed by at least 80% of both consumers and clinicians/researchers as likely to be helpful, and 18 were judged as feasible to carry out. Endorsed strategies were most frequently related to cognitive strategies and other psychological methods, interpersonal strategies, reducing physical tension, and lifestyle strategies. Few strategies were endorsed that were related to diet, supplements, or complementary medicine. LIMITATIONS Findings may not apply to other forms of mild anxiety related to panic attacks or specific phobias. CONCLUSIONS This study contributes to the evidence-base on strategies that individuals can use to improve mild anxiety symptoms. Research is now required to evaluate whether promoting the strategies can help reduce the overall community burden from anxiety disorders.
Collapse
Affiliation(s)
- Amy J Morgan
- School of Psychology and Public Health, La Trobe University, Victoria, Australia.
| | | | - Anthony F Jorm
- Centre for Mental Health, Melbourne School of Population and Global Health, The University of Melbourne, Victoria, Australia
| |
Collapse
|
6
|
Welch CD, Polatajko HJ. Applied Behavior Analysis, Autism, and Occupational Therapy: A Search for Understanding. Am J Occup Ther 2016; 70:7004360020p1-5. [PMID: 27295000 DOI: 10.5014/ajot.2016.018689] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Occupational therapists strive to be mindful, competent practitioners and continuously look for ways to improve practice. Applied behavior analysis (ABA) has strong evidence of effectiveness in helping people with autism achieve goals, yet it does not seem to be implemented in occupational therapy practice. To better understand whether ABA could be an evidence-based option to expand occupational therapy practice, the authors conducted an iterative, multiphase investigation of relevant literature. Findings suggest that occupational therapists apply developmental and sensory approaches to autism treatment. The occupational therapy literature does not reflect any use of ABA despite its strong evidence base. Occupational therapists may currently avoid using ABA principles because of a perception that ABA is not client centered. ABA principles and occupational therapy are compatible, and the two could work synergistically.
Collapse
Affiliation(s)
- Christie D Welch
- Christie D. Welch, OT Reg. (Ont.), is PhD Student, Rehabilitation Sciences Institute, Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada;
| | - H J Polatajko
- H. J. Polatajko, PhD, OT Reg. (Ont.), OT(C), FCAOT, FCAHS, is Editor-in-Chief, Canadian Journal of Occupational Therapy; Professor, Department of Occupational Science and Occupational Therapy, Rehabilitation Sciences Institute, Neuroscience Program, University of Toronto; and Program Affiliate, St. John's Rehab Hospital, Toronto, Ontario, Canada
| |
Collapse
|
7
|
Groessl EJ, Maiya M, Elwy AR, Riley KE, Sarkin AJ, Eisen SV, Braun T, Gutierrez I, Kidane L, Park CL. The Essential Properties of Yoga Questionnaire: Development and Methods. Int J Yoga Therap 2015; 25:51-9. [PMID: 26667289 PMCID: PMC6943820 DOI: 10.17761/1531-2054-25.1.51] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
Yoga interventions have considerable heterogeneity, are multi-dimensional, and may impact health in different ways. However, most research reports regarding the effects of yoga on health and wellbeing do not adequately describe the components of the yoga interventions being used. Thus, drawing comparisons across studies or understanding the relative effects of specific aspects of a yoga intervention are rarely possible. To address this problem, we created the Essential Properties of Yoga Questionnaire (EPYQ) Project, an NCCAM-funded set of studies to develop a translational tool for yoga researchers. Here we describe the methods and developmental processes used in the EPYQ Project in detail. The project consists of four main phases. Phase I was designed to gain a comprehensive understanding of the relevant aspects of yoga by conducting a comprehensive systematic literature review and conducting focus groups with stakeholders including a wide variety of yoga teachers and students. In Phase II, a pool of potential questionnaire items was developed for the prototypic questionnaire using information from Phase I. Cognitive interviews were conducted with the preliminary EPYQ items to assess the perceived clarity, meaning, and importance of each item. In Phase III, the prototypic questionnaire was administered to two large samples of yoga students and instructors. Military personnel and veterans who practiced or taught yoga (n = 329) were recruited to participate. Factor analysis and item response theory were used to identify factors and select the final questionnaire items. Phase IV is ongoing and will collect reliability and validity data on the final instrument. Results are expected to be available in 2016. The EPYQ will provide an objective tool for describing the amount of various components of yoga interventions, eventually allowing researchers to link specific yoga components to health benefits, and facilitating the design of yoga interventions for specific health conditions.
Collapse
Affiliation(s)
- Erik J Groessl
- University of California San Diego, Health Services Research Center, La Jolla, CA
- VA San Diego Healthcare System, San Diego, CA
| | - Meghan Maiya
- University of California San Diego, Health Services Research Center, La Jolla, CA
| | - A Rani Elwy
- Boston University School of Public Health, Department of Health Policy and Management, Boston, MA
- Center for Health Quality, Outcomes and Economic Research, Edith Nourse Rogers Memorial VA Hospital, Bedford, MA
| | - Kristen E Riley
- University of Connecticut, Department of Clinical Psychology, Storrs, CT
| | - Andrew J Sarkin
- University of California San Diego, Health Services Research Center, La Jolla, CA
| | - Susan V Eisen
- Boston University School of Public Health, Department of Health Policy and Management, Boston, MA
- Center for Health Quality, Outcomes and Economic Research, Edith Nourse Rogers Memorial VA Hospital, Bedford, MA
| | - Tosca Braun
- University of Connecticut, Department of Clinical Psychology, Storrs, CT
| | - Ian Gutierrez
- University of Connecticut, Department of Clinical Psychology, Storrs, CT
| | - Luwam Kidane
- University of California San Diego, Health Services Research Center, La Jolla, CA
| | - Crystal L Park
- University of Connecticut, Department of Clinical Psychology, Storrs, CT
| |
Collapse
|
8
|
Hofmann SG, Curtiss J, Khalsa SBS, Hoge E, Rosenfield D, Bui E, Keshaviah A, Simon N. Yoga for generalized anxiety disorder: design of a randomized controlled clinical trial. Contemp Clin Trials 2015; 44:70-76. [PMID: 26255236 PMCID: PMC4744580 DOI: 10.1016/j.cct.2015.08.003] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2015] [Revised: 07/31/2015] [Accepted: 08/03/2015] [Indexed: 10/23/2022]
Abstract
Generalized anxiety disorder (GAD) is a common disorder associated with significant distress and interference. Although cognitive behavioral therapy (CBT) has been shown to be the most effective form of psychotherapy, few patients receive or have access to this intervention. Yoga therapy offers another promising, yet under-researched, intervention that is gaining increasing popularity in the general public, as an anxiety reduction intervention. The purpose of this innovative clinical trial protocol is to investigate the efficacy of a Kundalini Yoga intervention, relative to CBT and a control condition. Kundalini yoga and CBT are compared with each other in a noninferiority test and both treatments are compared to stress education training, an attention control intervention, in superiority tests. The sample will consist of 230 individuals with a primary DSM-5 diagnosis of GAD. This randomized controlled trial will compare yoga (N=95) to both CBT for GAD (N=95) and stress education (N=40), a commonly used control condition. All three treatments will be administered by two instructors in a group format over 12 weekly sessions with four to six patients per group. Groups will be randomized using permuted block randomization, which will be stratified by site. Treatment outcome will be evaluated bi-weekly and at 6month follow-up. Furthermore, potential mediators of treatment outcome will be investigated. Given the individual and economic burden associated with GAD, identifying accessible alternative behavioral treatments will have substantive public health implications.
Collapse
Affiliation(s)
| | | | - Sat Bir S Khalsa
- Brigham and Women's Hospital, Harvard Medical School, United States
| | | | | | - Eric Bui
- Massachusetts General Hospital, United States
| | | | - Naomi Simon
- Massachusetts General Hospital, United States
| |
Collapse
|
9
|
Bradshaw ML. Knowledge, Attitudes, and Personal Use of Complementary and Alternative Medicine among Occupational Therapy Educators in the United States. Occup Ther Health Care 2014; 30:80-94. [PMID: 25427214 DOI: 10.3109/07380577.2014.982315] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
The purpose of this study was to establish a baseline description of American occupational therapy educators' knowledge, attitudes, and personal use of complementary and alternative medicine (CAM) as a first step in exploring the larger issue of future occupational therapy practitioners' preparedness for meeting clients' occupational needs in today's evolving healthcare environment. Results of this cross-sectional survey highlighted limitations of occupational therapy educators' knowledge of common CAM concepts and therapies across all demographic variables, varying attitudes towards CAM in general and its inclusion in occupational therapy education, and personal use of common CAM therapies. Without increased occupational therapy educator knowledge about CAM and engagement in the current healthcare practices, occupational therapy practitioners are at risk for having a limited role in integrative healthcare.
Collapse
|