A meta-analysis of mindfulness-based interventions for improving mental health and burden among caregivers of persons living with dementia.

BACKGROUND: Mindfulness-based interventions are becoming increasingly popular and are effective in lowering depressive symptoms and caregiver burden. However, the overall efficacy of therapies in stress and anxiety management is unreported, and no study to date has performed a subgroup analysis to investigate the intervention dose response of outcomes. AIMS: To quantitatively identify the effectiveness of mindfulness-based interventions for caregivers of persons living with dementia. METHODS: A comprehensive literature search of six databases was undertaken from the date of inception to June 18, 2023. The DerSimonian-Laird model with random effects was used to examine the overall effect and its heterogeneity in the studies. Version 2 of the risk of bias (RoB 2) tool was employed to analyze the publication bias of each randomized study. Funnel and forest plots were created to represent the findings. RESULTS: Thirteen randomized trials were included in the meta-analysis. Mindfulness-based interventions significantly reduced stress and anxiety of caregivers of persons living with dementia. In addition, interventions provided for ≥8 weeks were beneficial in reducing depression in caregivers. However, mindfulness-based interventions did not offer significant benefits in reducing depression or caregiver burden immediately after the intervention. CONCLUSION: Mindfulness-based interventions have the potential to help caregivers of people living with dementia. This study could be used as a model for future research into and implementation of mindfulness-based therapies for caregivers. LINKING EVIDENCE TO ACTION: Mindfulness-based therapies appear to alleviate stress and anxiety but are ineffective in reducing depression and burden in caregivers of persons living with dementia. Well-designed RCTs with more rigorous methodology and a larger sample size should be conducted to firm the conclusion of the effectiveness of mindfulness-based interventions for caregivers of persons living with dementia.

Effects of art therapy for people with mild or major neurocognitive disorders: A systematic review and meta-analysis.

OBJECTIVES: The aim of this study was to analyze the efficacy of non-pharmacological, interactive, and emotional art therapy interventions for patients with mild neurocognitive disorder (mild NCD) or major neurocognitive disorder (MNCD). METHODS: A systematic review and meta-analysis assessed English-language literature published from January 1, 2001, to August 22, 2021, and indexed in CINAHL, EMBASE, MEDLINE, PubMed, Web of Science, and PsycINFO. People with mild NCD or MNCD who received art therapy were classified as the intervention group. Study quality was assessed using the Risk of Bias (RoB) 2 and the Joanna Briggs Institute tool. RESULTS: Among nine included studies, depression was significantly reduced as compared with control groups (Cohen's d = -0.52 [95 % CI = -0.99-0.05], p < 0.001, I2 = 62.90 %) but not cognitive function or quality of life. CONCLUSION: People with mild neurocognitive disorder or MNCD are encouraged to engage in art therapy delivered by art therapists collaborating with healthcare providers. The effects of specific types of art therapy should be explored. PRACTICAL IMPLICATION: Healthcare providers should be encouraged to provide art therapy designed to reduce depression in patients with mild NCD or MNCD.

Robotic arm use for upper limb rehabilitation after stroke: A systematic review and meta-analysis.

Several studies have reported the effects of robotic arms on improving upper limb function in patients with stroke. However, previous studies have reported inconsistent findings that may lead to incorrect applications of robotic arm use. Six databases were searched for relevant randomized controlled trials. Meta-analyses were performed for upper limb performance measures, including subgroup analysis of pooled upper limb rehabilitation data such as stroke stage and intervention delivery dose. Furthermore, the Cochrane risk-of-bias tool for randomized trials version 2 (RoB 2) and sensitivity analysis were used to assess methodology and determine publication bias. The final analysis included 18 studies. Robotic arms improved upper limb and hand function in patients with stroke. Subgroup analysis revealed that robotic arm interventions lasting 30-60 min per session significantly improved upper limb function. However, no significant improvement was observed in shoulder and elbow or wrist and hand movements. This review may help develop applicable rehabilitation robots and collaboration between clinicians.

Effects of telehealth-assisted interventions for secondary prevention of cardiovascular disease: A systematic review and meta-analysis.

BACKGROUND: Telehealth-assisted interventions have been used as secondary prevention measures in cardiac rehabilitation, especially for the delivery of information between healthcare service providers and patients. However, as the application of this intervention modality broadens, investigation of its effects in secondary prevention of cardiovascular disease (CVD) is necessary. AIMS: To identify the effectiveness of telehealth-assisted interventions for secondary prevention of CVD. DESIGN: Systematic review and meta-analysis. METHODS: The PRISMA protocol was used to conduct a systematic review and meta-analysis of randomised controlled trials. The full text of articles was obtained from six databases for the period from database establishment to 25 November 2021. To assess the methodological quality of the studies reviewed, the updated Cochrane risk-of-bias checklist for randomised trials was employed. A meta-analysis was performed using a random-effects model to calculate the pooled effects of telehealth-assisted interventions for secondary CVD prevention. RESULTS: The final analysis included 4012 individuals from 18 different trials. Telehealth-assisted interventions were shown to improve medication adherence (standardised mean difference [SMD]: 0.31; 95% confidence interval [CI]: 0.33-0.59) and reduce depression (SMD: -0.28; 95% CI: -0.46 to -0.10). CONCLUSIONS: Telehealth-assisted interventions appear to improve adherence to medication and reduce depression of individuals with CVD. These intervention strategies could be offered to both healthcare providers and individuals with CVD as an option in delivering and facilitating the use of health services to improve health behaviours and overall outcomes. Furthermore, this study may be used as guidance for future research to provide an appropriate plan of care for this population. RELEVANCE TO CLINICAL PRACTICE: The findings imply that the delivery of care remotely via telehealth-assisted interventions for secondary prevention of CVD is beneficial in improving CVD survivors' health and access to healthcare services. TRIAL REGISTRATION: The International Prospective Register of Systematic Review: (PROSPERO): CRD 42021290111.

Effects of technology-assisted interventions for people with dementia: A systematic review and meta-analysis.

PURPOSE: The use of technology-assisted interventions in dementia care contributes to increased communication, reduced burden on the caregivers, improved health outcomes, and improved expense management. Technology-assisted interventions can be provided remotely to monitor, improve, and enable home care, benefiting the health of both patients and caregivers. Despite increasing use, the effectiveness of technology-assisted interventions for dementia care remains uncertain, with studies reporting inconclusive findings subject to interpretation. Therefore, the current study investigated the available evidence to explore the efficacy of technology-assisted interventions for people with dementia. DESIGN: Systematic review and meta-analysis. METHODS: The study was preregistered with the PROSPERO international prospective register of systematic reviews using a Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA)-guided protocol. The primary search was conducted in eight databases from database inception to January 29, 2022. Using a random-effects model, the standardized mean differences (SMDs) with 95% confidence intervals (CIs) were synthesized to obtain pooled effect sizes (using Stata 16.0). The updated Cochrane Risk of Bias 2 tool (RoB-2) was used to evaluate the methodological quality of the studies. FINDINGS: A pooled analysis of 12 trials, including 584 people with dementia, showed more improvement associated with technology-assisted interventions compared with standard care, including in the domains of cognitive function (SMD = 0.39; 95% CI: 0.14 to 0.64; p < 0.001) and depression (SMD = -0.75; 95% CI: -1.33 to -0.17; p = 0.01). However, no significant effects were observed for activities of daily living (ADL) or quality of life. CONCLUSION: Technology-assisted interventions appear to improve cognitive function and reduce depression in people with dementia compared with standard care. CLINICAL RELEVANCE: This study may be used to demonstrate that interventions incorporating many modalities or technologies can be used to enhance dementia care, which may improve favorable outcomes when using technology-assisted interventions to remotely initiate appropriate activities for people with dementia. Because technology allows for simultaneous communication and access to shared multimedia, it removes environmental constraints and allows treatment to be administered remotely.

Effects of telehealth interventions on performing activities of daily living and maintaining balance in stroke survivors: A systematic review and meta-analysis of randomised controlled studies.

BACKGROUND: Stroke is one of the most common causes of disability worldwide. In recent years, diverse telehealth programmes for stroke survivors have suggested that this mode of rehabilitation could improve stroke survivors' abilities to perform activities of daily living (ADLs) and maintain balance. Although increasingly utilised in clinical and community settings, the effectiveness of telehealth interventions in stroke survivors remains inconclusive. This warrants investigation so that telehealth interventions are evidence-based and are not merely modalities of convenience. AIM: To identify the effects of telehealth interventions on the ability to perform ADLs and maintain balance in stroke survivors. DESIGN: A systematic literature review and meta-analysis were conducted in accordance with PRISMA guidelines. METHODS: A systematic literature search was performed using seven databases for literature dated up to April 25, 2021. The revised Cochrane risk of bias tool for randomised trials was used to assess the methodological quality of the included studies. A meta-analysis was performed using a random-effects model to calculate the pooled effects of telehealth interventions. Stata 16.0 was used for the statistical analyses. RESULTS: A total of 14 studies with 1,367 participants were included in the analysis. Overall, telehealth interventions were effective in improving stroke survivors' abilities to carry out their ADLs (standardised mean difference: .45; 95% confidence interval: .12 to .78); however, no significant effects were found on balance. CONCLUSION: Telehealth interventions are beneficial for improving stroke survivors' performance of their ADLs. Future telehealth intervention trials should focus on identifying essential intervention delivery components that facilitate intervention adoption by clinicians and stroke survivors and sustain the positive effects on stroke survivors' performance of their ADLs in different settings. RELEVANCE TO CLINICAL PRACTICE: It is essential to build flexibility in the telehealth-based intervention delivery protocol to meet individual stroke survivors' needs to motivate and enhance their ADL performance.

Effects of resistance bands exercise for frail older adults: A systematic review and meta-analysis of randomised controlled studies.

AIMS AND OBJECTIVES: Research examining the effectiveness of resistance band exercises for improving physical and psychological dimensions among frail older adults has been inconsistent. We aimed to examine the effects of resistance band exercises for improving outcomes in frail older adults. BACKGROUND: To provide robust evidence regarding the effectiveness of resistance band exercises and explore other potential outcomes in frail older adults, a systematic review of RCTs remains necessary. DESIGN: Systematic literature review and meta-analysis were conducted in accordance with the PRISMA guidelines. METHODS: Four databases were searched. English language papers were retrieved from 2006 to 2020. Three reviewers reviewed the methodology of the selected studies using the Joanna Briggs Institute tool for randomised controlled trials. The pooled standardised mean difference was calculated using a random-effects model. Heterogeneity among pooled studies was assessed using the τ2 , Q and I2 statistics, and publication bias was evaluated using Egger's test and the visual inspection of funnel plots. RESULTS: A total of 15 studies met the eligibility criteria for this study. Overall, resistance band exercise reduced frailty after 24 weeks (SMD: -0.29; 95% CI: -0.55 to -0.03) and reduced depression after both 12 weeks (SMD: -0.19; 95% CI: -0.38 to -0.01) and 24 weeks (SMD: -0.30; 95% CI: -0.52 to -0.09). However, no significant effects were observed for frailty after 12 weeks, and no significant effects were observed for grip strength, leg strength, activities of daily living or quality of life at any time. CONCLUSION: Resistance band exercise might be considered a viable strategy for frail older adults in the community or in long-term care facilities. More research implementing a standardised protocol remains necessary to identify the effects of different training volumes and the dose-response relationship for the very old and frail population. RELEVANCE TO CLINICAL PRACTICE: As a safe complementary intervention for frail older adults, health providers should consider resistance band exercises when caring for frail older adults because this intervention has clinical benefits.

Effects of animal-assisted interventions for people with dementia: A systematic review and meta-analysis.

Animal-assisted interventions (AAIs) are non-pharmacological, cost-effective interventions developed to improve outcomes in patients with dementia; however, the effects remain inconclusive. The purpose of this study was to analyze the efficacy of AAIs for people with dementia. A systematic review and meta-analysis was performed of English-language literature published from January 1, 2001, to July 3,2021, and indexed in the following databases: CINAHL, EMBASE, MEDLINE, PubMed, Web of Science, Cochrane, and PsycINFO. Intervention groups were people with dementia who received AAIs. Study quality was assessed using the Joanna Briggs Institute tool. Among 10 included studies, significant differences in depression levels were identified between the intervention and control groups (p < 0.001). No significant differences in cognitive function, neuropsychiatric syndrome, or independence in activities of daily living were observed between groups. Future research remains necessary to examine the effects of AAIs on depression during different stages of dementia. AAIs therapists may collaborate with healthcare workers to improve AAIs benefits.

Global prevalence of mental health problems among healthcare workers during the Covid-19 pandemic: A systematic review and meta-analysis.

BACKGROUND: Healthcare workers are at high risk of developing mental health issues during the coronavirus disease 2019 (COVID-19) pandemic. However, there is a need for a full picture of mental health problems with comprehensive analysis among healthcare workers during the COVID-19 pandemic. OBJECTIVE: This review aimed to systematically identify the mental health problems among healthcare workers in various countries during the COVID-19 pandemic. DESIGN: Systematic review and meta-analysis. METHODS: A systematic literature search was performed of the following databases: PubMed, Academic Search Complete, Cumulative Index to Nursing and Allied Health Literature (CINAHL), Web of Science, MEDLINE Complete, and SocINDEX. The last date of our search was November 2, 2020. We included all cohort, case-control and cross-sectional studies and used the Joanna Briggs Institute tool to assess their quality. A meta-analysis was performed to synthesize the pooled prevalence of mental health problems using a random-effects model. Heterogeneity was measured using the I2 statistic and Egger's test was used to assess publication bias. RESULTS: A total of 38 studies were identified that reported the mental health problems of healthcare workers during the COVID-19 pandemic. The distribution of healthcare workers analyzed in this review included 27.9% doctors, 43.7% nurses, and 7.0% allied health workers. The pooled prevalence of mental health problems for post-traumatic stress disorder, anxiety, depression, and distress was 49% (95% confidence interval [CI]: 22-75%), 40% (95% CI: 29-52%), 37% (95% CI: 29-45%), and 37% (95% CI: 25-50%), respectively. CONCLUSION: This review yielded evidence that estimated the global prevalence of mental health problems among healthcare workers during the COVID-19 pandemic. Post-traumatic stress disorder was the most common mental health disorder reported by healthcare workers during the COVID-19 pandemic, followed by anxiety, depression, and distress. Additional studies remain necessary to assess the appropriate management strategies for treating and preventing mental health disorders among healthcare workers during the pandemic.

Dementia as a mortality predictor among older adults with COVID-19: A systematic review and meta-analysis of observational study.

The purpose of this study was to systematically examine the association between dementia and mortality among older adults with COVID-19. To do so, we conducted a search of 7 databases for relevant full-text articles. A cohort study and case-control study were included. A meta-analysis was performed to synthesize the pooled odds ratio with a random-effects model. We identified studies that reported mortality among older adults with dementia and non-dementia who have COVID-19. The pooled mortality rates of dementia and non-dementia older adults infected with COVID-19 were 39% (95% CI: 0.23-0.54%, I2 = 83.48%) and 20% (95% CI: 0.16-0.25%, I2 = 83.48%), respectively. Overall, dementia was the main factor influencing poor health outcomes and high rates of mortality in older adults with COVID-19 infection (odds ratio 2.96; 95% CI 2.00-4.38, I2 = 29.7%), respectively. Our results show that older adults with dementia with COVID-19 infection have a higher risk of mortality compared with older adults without dementia. This current study further highlights the need to provide focused care to the older adults with dementia or cognitive impairment who have COVID-19.