Disability and RehabilitationResults. Thirty papers were found that met the inclusion criteria. The studies were characterised by heterogeneity of design, methodological quality, sample characteristics, assessment of cognitive functioning, and outcomes examined. The research published to date suggests that cognitive impairment is more prevalent among persons with lower limb amputations than in the general population, and is linked with a number of important outcomes in this patient group, including mobility, prosthesis use, and maintenance of independence following amputation.Conclusions. These findings highlight the importance of assessing the cognitive abilities of persons with lower limb amputations. An understanding of the cognitive profile of these patients could assist rehabilitation teams in determining their suitability for prosthetic or wheelchair rehabilitation, ascertaining appropriate and realistic goals for rehabilitation, and tailoring rehabilitation programmes to patients' strengths so that maximal mobility and independence is achieved. Individuals with lower limb amputations may be particularly susceptible to impairments in cognitive function for a number of reasons. Firstly, there has been a significant increase in the average age at which amputation occurs in recent years, due to improvements in the medical management of associated conditions such as diabetes and peripheral vascular disease [14]. Over half of all individuals referred to prosthetic centres in the U.K. every year are older than 65 years of age, and more than a quarter are aged over 75 years [15]. The rising age at which lower limb amputation is performed brings with it a 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32 33 34 35 36 37 38 39 40 41 42 43 44 45 46 47 48 49 50 51 52 53 54 55 56 57 58 59 [5,9,12,19]. These shared characteristics may leave individuals with dysvascular amputations susceptible to vascular cognitive impairment [20,21],which affects approximately five percent of all persons aged over 65 years [22] and is characterised by deficits in attentional and executive functioning (the ability to organise cognitive processes e.g. planning and sequencing of actions) in addition to slowing of motor performance and information processing, with episodic memory remaining relatively intact [8,20,23].Diabetes mellitus, which is present in almost half of all cases of lower limb amputation [24], is associated with increased incidence of dementia and accelerated decline in cognitive functioning [25][26][27].

Objectives This systematic review aimed to describe medication non-adherence among people living with multimorbidity according to the current literature, and synthesise predictors of non-adherence in this population. Methods A systematic review was conducted according to the Preferred Reporting Items for Systematic reviews and Meta-Analyses. PubMed, EMBASE, CINAHL and PsycINFO were searched for relevant articles published in English language between January 2009 and April 2019. Quantitative studies reporting medication non-adherence and/or predictors of non-adherence among people with two or more chronic conditions were included in the review. A meta-analysis was conducted with a subgroup of studies that used an inclusive definition of multimorbidity to recruit participants, rather than seeking people with specific conditions. Remaining studies reporting prevalence and predictors of non-adherence were narratively synthesised. Results The database search produced 10 998 records and a further 75 were identified through other sources. Following full-text screening, 178 studies were included in the review. The range of reported non-adherence differed by measurement method, at 76.5% for self-report, 69.4% for pharmacy data, and 44.1% for electronic monitoring. A meta-analysis was conducted with eight studies (n=8949) that used an inclusive definition of multimorbidity to recruit participants. The pooled prevalence of non-adherence was 42.6% (95% CI: 34.0 - 51.3%, k=8, I2=97%, p<0.01). The overall range of non-adherence was 7.0%–83.5%. Frequently reported correlates of non-adherence included previous non-adherence and treatment-related beliefs. Conclusions The review identified a heterogeneous literature in terms of conditions studied, and definitions and measures of non-adherence used. Results suggest that future attempts to improve adherence among people with multimorbidity should determine for which conditions individuals require most support. The variable levels of medication non-adherence highlight the need for more attention to be paid by healthcare providers to the impact of multimorbidity on chronic disease self-management. PROSPERO registration number CRD42019133849.

ObjectiveTo review systematically the evidence on how deinstitutionalisation affects quality of life (QoL) for adults with intellectual disabilities.DesignSystematic review.PopulationAdults (aged 18 years and over) with intellectual disabilities.InterventionsA move from residential to community setting.Primary and secondary outcome measuresStudies were eligible if evaluating effect on QoL or life quality, as defined by study authors.SearchWe searched MEDLINE, PsycINFO, CENTRAL, CINAHL, EconLit, Embase and Scopus to September 2017 and supplemented this with grey literature searches. We assessed study quality using the Critical Appraisal Skills Programme suite of tools, excluding those judged to be of poor methodological quality.ResultsThirteen studies were included; eight quantitative studies, two qualitative, two mixed methods studies and one case study. There was substantial agreement across quantitative and qualitative studies that a move to community living was associated with improved QoL. QoL for people with any level of intellectual disabilities who move from any type of institutional setting to any type of community setting was increased at up to 1 year postmove (standardised mean difference [SMD] 2.03; 95% CI [1.21 to 2.85], five studies, 246 participants) and beyond 1 year postmove (SMD 2.34. 95% CI [0.49 to 4.20], three studies, 160 participants), with total QoL change scores higher at 24 months comparative to 12 months, regardless of QoL measure used.ConclusionOur systematic review demonstrated a consistent pattern that moving to the community was associated with improved QoL compared with the institution. It is recommended that gaps in the evidence base, for example, with regard to growing populations of older people with intellectual disability and complex needs are addressed.PROSPERO registration numberCRD42018077406.

Augmented and virtual reality (AR/VR) technologies are regularly used in psychology research to complement psychological interventions and to enable an individual to feel as if they are in an environment other than that of their immediate surroundings. A scoping review was performed to identify how AR/VR was being used with older adult populations to impact their physical and mental health. The review also sought to determine whether the terminology used in AR/VR research was consistent. The results show that 65 studies have been published in the last 20 years that meet the inclusion criteria (virtual/augmented reality) technology to impact older adults’ physical/mental health and wellbeing. Participants included healthy, physically, and cognitively impaired, and emotionally vulnerable older adults. We argue that over 70% of the studies included in this review were mislabeled as VR and only six papers included fully immersive VR/AR. The remaining studies use less immersive variants of virtual reality with their populations, and only one study made use of AR, which prompted the suggestion of a new definition for virtual reality. This paper also calls for an updated taxonomy of augmented and virtual reality definitions to address the lack of consistency found in studies that identify themselves as AR/VR when they are using less immersive technical set-ups, including displaying non-interactive videos on 2D screens.

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