ABSTRACT
Domestic marine and coastal tourism has increased in importance over the last number of years due to the impacts of environmental concerns connected with international travel, the associated health benefits and COVID-19 related travel restrictions. Consequently, this paper analyses the determinants of demand for domestic day trips and overnight stays by Irish residents to marine and coastal areas. Two logit models examine the factors that influence participation in the coastal day trip and overnight stay markets, respectively. Two truncated travel cost models are employed to explore trip duration, one analysing the number of day trips taken and the other examining the number of nights spent in marine and coastal areas. The results suggest a division amongst those who can and cannot access marine and coastal tourism. In particular, those who are financially better off have a greater level of access to Irish marine and coastal tourism. Additionally, although generally disregarded in tourism policy and marketing, the results indicate a vibrant day trip market that commands high per person consumer surplus. © 2022 Economic Society of Australia, Queensland
ABSTRACT
Introduction: Cognitive difficulties experienced in MS impact areas such as work, socialising, self-care and many activities of daily living. There is a high prevalence of cognitive difficulties in MS, but despite this there are few programmes targeting cognition that focus on the ability to function well in everyday life. The COB-MS programme, an occupation-focused cognitive intervention, was developed to address this. It focuses on both the functional difficulties and the wide-ranging symptoms that present in MS, including the ability to maintain employment, social activities, home management and self-care. Objective(s): Here we report on the results of feasibility and initial efficacy of the COB-MS as a cognitive intervention for people with MS. Method(s): Although initially designed for in-person delivery, the COB-MS was adapted for online delivery due to the COVID-19 pandemic. Data was collected from people with MS experiencing cognitive difficulties at baseline, post-intervention, 12-weeks, and 6-month follow-up. The primary outcome measure was the Goal Attainment Scaling at 12 weeks. Data was also collected in cognition, quality of life, and mood. Result(s): One hundred and twenty-five people with MS and cognitive difficulties were randomised to either usual care or COB-MS intervention. Ninety-four participants were retained at 6-month follow-up. Fidelity data was collected and analysed for occupational therapist conducting the intervention. A qualitative evaluation of the COB-MS from the perspective of participants also took place. All feasibility results will be presented- preliminary efficacy, participant experiences, intervention fidelity, and overall outcomes from the trial. Conclusion(s):The results provide recommendations for a future definitive trial of COB-MS, with respect to both feasibility and preliminary, clinical efficacy.
ABSTRACT
Approximately 43-70% of people living with multiple sclerosis (MS) experience cognitive impairment. This study-within-a-trial (SWAT) takes place within a host trial investigating the feasibility of the Cognitive-Occupation-Based programme for people with MS (COB-MS), a holistic therapy on the management of cognitive symptoms in MS. Reliable remote cognitive testing could provide safer and more convenient care for MS patients, during the COVID-19 pandemic and thereafter. The SWAT examines the reliability of delivering the Brief International Cognitive Assessment for MS (BICAMS) and the Trail-Making Test (TMT) remotely to people to 68 people with MS experiencing cognitive difficulties. Group 1 (N=34) were tested in-person pre-pandemic. Group 2 were tested remotely. No significant differences between virtual and in-person administrations of the CVLT-II and SDMT were detected. BVMT-R scores were significantly higher for virtual administrations, possibly indicating inter-rater differences. Strong positive correlations were found for in-person and virtual scores within Group 1 on the CVLT-II. The findings support the reliability of remote administration of BICAMS and the TMT in people living with MS. Future research with larger samples could investigate performance on BVMT-R with regards to screen size of device used.
ABSTRACT
Introduction: The COVID-19 pandemic has had a significant impact on research and health care in MS. This study-within-atrial (SWAT) takes place within a host trial investigating the feasibility of the Cognitive-Occupation-Based programme for people with MS (COB-MS) that was originally designed to be delivered in-person but was amended to an online environment. As such, reliable remote cognitive testing could provide safer and more convenient care for MS patients. Aims: The SWAT examines the reliability of delivering the Brief International Cognitive Assessment for MS (BICAMS) and the Trail-Making Test (TMT) remotely to people with MS. Objectives: Performance on BICAMS measures and the TMT administered remotely are compared with performance on tests administered in-person. BICAMS measures include the California Verbal Learning Test, Second Edition (CVLT-II), the Symbol Digit Modality Test (SDMT) and the Brief Visuospatial Memory Test-Revised (BVMT-R). Method: Independent samples t-tests were conducted on a sample of 68 participants to investigate differences in performance between Group 1 (11 males, 23 females), who were visited by a research assistant in their homes before the pandemic and Group 2 (10 males, 24 females) who received online testing only via teleconference platform Zoom. Within-group differences for Group 1 who also received virtual testing after a six-month interval were also examined. Results: The analysis revealed no significant differences in scores between virtual and in-person administrations of the CVLT-II, TMT and SDMT. Strong positive correlations were found for inperson and virtual tests within Group 1 after a six-month interval on the CVLT-II, SDMT, TMT-A and TMT-B. BVMT-R scores were significantly higher for virtual testing (M = 20.59, SD = 6.65) compared to in-person testing (M = 16.35, SD = 6.05). However, this discrepancy may be attributed to inter-rater differences, rather than enhanced performance for online testing. In-person and virtual assessments within Group 1 were also strongly correlated (r = .72). Conclusions: The findings support the reliability of remote administration of BICAMS and the TMT in people living with MS.
ABSTRACT
Introduction: Traditionally, public and patient involvement (PPI) in research has included people with MS in consultation roles rather than deeper levels of 'involvement'. There has also been limited evidence regarding the impact that such involvement has on the person living with MS or on trials which employ people living with MS, as part of the research team. Here we report on the experiences of a person living with MS who is embedded in a clinical trial throughout the lifetime of the project- an embedded patient researcher (EPR). Aims & Objectives: The aim of this research is to explore and present an embedded patient researcher's (EPR) perspective on PPI integration within a feasibility trial of a Cognitive Occupation- Based programme for people living with MS (COB-MS), with respect to the PPI impact on trial feasibility and potential success. Methods: This presentation is focused on three specific examples of EPR impact, participant recruitment, trial materials and adapting to the impact of the SARS-Cov-2 pandemic on the trial. Due to the high level of PPI integration within COB-MS, significant amendments were made. Results: As a result of a high level of PPI integration, the research team identified the recruitment of between 34% - 62% of participants as a result EPR involvement, which also influenced the decision to extend the role of the EPR to include Patient Advocacy. The EPR's involvement facilitated the development of more accessible trial materials for participants with MS and the development of online protocols for the treatment and assessment of participants. Conclusion: When fully integrated into a trial, PPI - along with the inclusion of an EPR - has the potential to improve participant recruitment, trial material development and adaptability as a result of external factors impacting the trial (with respect to being more suitable for participants with MS.) It has also encouraged the EPR to develop further as a Patient Advocate, by sharing their experience with patients wanting to become more involved in research as well as researchers and educators who want to incorporate PPI in their research or training.