Occupational therapist-led mindfulness-based stress reduction for older adults living with subjective cognitive decline or mild cognitive impairment in primary care: a feasibility randomised control trial protocol

Wright

British Journal of Occupational Therapy

2021

Introduction Occupational therapy (OT) has a rich history of integrating physical and mental health care services, however, there is a limited evidence base regarding the effectiveness of OT interventions for mental health disorders in primary care. Methods A comprehensive systematic review was conducted from database inception through 31 January 2021. Eligible studies had to include: (1) an intervention that involved an occupational therapist in design and/or implementation; (2) a quantitative outcome assessing symptoms related to a mental health disorder; (3) a comparison group; and (4) primary care or community dwelling patients and/or primary care clinical settings. Results The researchers identified five studies and there was heterogeneity in the OT interventions. There were no significant differences between intervention and control groups in depression symptoms at different time intervals. Several trials employed interventions that involved interprofessional team members, including OTs, to provide training in specific strategies that promoted functioning. Other studies utilized only OTs within the intervention arm. OT interventions demonstrated no significant difference in anxiety in one study, however, another indicated a reduction in symptoms. The overall risk of bias was considered low in three studies and unclear in two studies. Conclusion There is limited evidence demonstrating the impact of OT interventions in primary care settings on quantitative outcomes measuring symptoms related to a mental health disorder. Given the heterogeneity of interventions and variation in reported findings, there is need for further pragmatic trials in this area.

Section: Discussion and Implicationmentioning

confidence: 99%

Section: Discussion and Implicationmentioning

confidence: 99%

The effectiveness of occupational therapy for mental health disorders in primary care: A systematic review

Wright

British Journal of Occupational Therapy

2021

“…The wait-list control group received the MBSR intervention post-three-months when the experimental group was completed. Our study protocol has been published previously [41]. All original study data, from focus group interviews to feasibility data such as attendance and field notes, were all kept under lock and key in a secure location within the clinic.…”

Section: Treatment Allocation and Randomizationmentioning

confidence: 99%

“…As previously described, feasibility outcomes included the following objectives: 1(a) patient recruitment, study retention, intervention adherence, and follow-up rates; and 1(b) acceptability of technology [41]. Data were collected from attendance records, home practice duration and completion, and computer tablet logins; attrition throughout the MBSR program was also tracked.…”

Section: Feasibility Outcome Measures and Acceptability Of Technologymentioning

confidence: 99%

Mindfulness-based stress reduction for community-dwelling older adults with subjective cognitive decline (SCD) and mild cognitive impairment (MCI) in primary care: a mixed-methods feasibility randomized control trial

et al. 2023

Self Cite

Background Primary care is often the first point of contact when community-dwelling older adults experience subjective cognitive decline (SCD) or mild cognitive impairment (MCI). Living with SCD or MCI can be life-altering, resulting in low mood and increased anxiety, further exacerbating cognitive decline. However, there is scant literature on interventions that interprofessional primary care providers can provide to support those living with SCD or MCI. Practicing mindfulness-based stress reduction (MBSR) in an interprofessional primary care setting may support emotional health and well-being for those with cognitive decline, but it has not been studied in an interprofessional primary care context. Objectives This study’s primary aim was to determine the feasibility of, and perceived benefits to and satisfaction with, a 9-Week MBSR program delivered in a team-based primary care setting. The secondary aim was to examine the acceptability of using technology (computer tablet and App Insight Timer®) for program delivery and home practice. Methods A convergent mixed-methods, single-blind pilot randomized controlled trial (RCT) study design was used. A quantitative strand was used to evaluate the feasibility of the MBSR program. The qualitative strand used a focus group with older adult participants with SCD or MCI. Individual semi-structured interviews with occupational therapists who are qualified-MBSR teachers were conducted to explore the acceptability of using computer tablets for program delivery and home practice. Results 27 participants were randomized (14 MBSR; 13 Control) with retention rates of 64.3% (9/14 completed ≥6 sessions), true adherence rates of 50% (7/14 met ≥19.5 hrs of home practice), 21.4% attrition rates, and 100% post-intervention follow-up. No participants who used computer tablets at the beginning of the intervention switched to low technology. Older adult participants found the use of computer tablets in the MBSR course acceptable and appreciated the portability of the tablets. Conclusions Based on the lower-than-expected rates of recruitment, retention, and adherence, our study, as designed, did not meet the feasibility benchmarks that were set. However, with minor modifications to the design, including changing how participants who drop-out are analyzed, extending recruitment, and adding multiple sites, this intervention would be well suited to further study using a full-scale RCT. However, we found that embedding MBSR in an interprofessional primary care setting was feasible in practice and qualitative data highlighted the satisfaction and perceived benefits based on the intervention. The use of technology was acceptable and portable, as participants utilized their computer tablets consistently until the study’s end. Our study showed that older adults living with SCD or MCI were highly receptive to learning how to use technology, and future group intervention programs in interprofessional primary care settings may also incorporate tablet use. Trial registration This study was reviewed and approved by the Research Ethics Board in Toronto, Ontario, Canada (REB# 2017–0056-E); Queen’s University (REB# 6026418) in Kingston, Ontario, Canada, and Clinicaltrials.gov (08/03/2019; NCT03867474).

“…A three-phase enriched environment protocol matching a multistage rehabilitation program applied post-head trauma or stroke, was found to improve cerebral blood flow, reducing cortical cellular loss (Zhan et al, 2020). Specific examples of implementation include encouraging end-user patients to identify new ways to deepen their experience of naturally occurring sound (Welch et al, 2022), incorporating mindfulness (Tran et al, 2020(Tran et al, , 2023 that may engage tinnitus core inhibitory systems and reduce stress. Multisensory novel stimuli, such as visual-auditory (experiencing unexpected or new sights and sounds) or motionauditory stimuli (such as singing and dancing), may activate similar limbic structures to narrow-band noise.…”

Section: End-user Patient-driven Experience Is Encouragedmentioning

confidence: 99%

An implementation science systematic review of neurophysiological evidence indicates the tinnitus core network as a therapeutic target

Burton-Harris,

Sanders,

Searchfield

2023

Front. Audiol. Otol.

Identifying and implementing an effective tinnitus treatment has been a challenge. Despite efforts over many decades, there is no definitive cure for tinnitus yet. Implementation science may assist audiology practitioners and end-user patients in their pursuit of a cure by identifying ways to maximize the use of research findings. Within the context of therapeutic interventions, implementation science is the study of a successful treatment–system fit evidenced by use. Research evidence for tinnitus treatment efficacy is dominated by behavioral questionnaires as they are a pragmatic source of patient-driven data. Neurophysiological evidence of the underlying neural network change correlated with these behavioral findings enhances research conclusions and potential use. This implementation science review systematically sourced and analyzed neurophysiological evidence from 29 studies to find that targeting tinnitus core network neuroplasticity may be the most effective tinnitus treatment. Narrow-band sound treatment has the greatest body of correlated neurophysiological-behavioral evidence. This is the first tinnitus implementation science systematic review. It is hoped that new or improved treatments may emerge from pivoting the evidential lens toward the pragmatic use of neurophysiological evidence.Systematic Review Registrationhttps://www.crd.york.ac.uk/PROSPERO/, identifier: CRD42022335201.