The impact of prehabilitation interventions on affective and functional outcomes for young to midlife adult cancer patients: A systematic review.

OBJECTIVE: Cancer remains one of the most enduring health crises of the modern world. Prehabilitation is a relatively new intervention aimed at preparing individuals for the stresses associated with treatment from diagnosis. Prehabilitation can include exercise, psychological and nutrition-based interventions. The present systematic review aimed to assess the efficacy of prehabilitation on affective and functional outcomes for young to midlife adult cancer patients (18-55 years). Outcomes of interest included prehabilitation programme composition, duration, mode of delivery and measures used to determine impact on affective and functional outcomes. METHODS: The following databases were searched with controlled and free text vocabulary; Psychological Information database (PsychINFO), Culmunated Index to Nursing and Allied Health Literature (CINAHL), Medical Literature Analysis and Retrieval System Online (MEDLINE), Excerpta Medica Database (EMBASE) and Public MEDLINE (PubMed). Abstract and full-text screening was conducted with a secondary reviewer and final texts were subject to risk of bias analysis. RESULTS: Thirteen texts were included at full-text. These included data of 797 prehabilitation participants (mean age 53 years) and a large representation of female participants (71% average). Evidence was found for the efficacy of psychological prehabilitation for anxiety reduction. Prehabilitation did not significantly affect health related quality of life. Findings moderately supported the therapeutic validity of exercise prehabilitation for functional outcomes, both in terms of clinical and experimental improvement with respect to the quality of evidence. Variation between all prehabilitation types was observed. There was insufficient evidence to support the efficacy of psychological prehabilitation on stress, distress or depression. CONCLUSION: Implications for future research are highlighted and then discussed with respect to this young to midlife age group.

Virtual reality distraction for acute pain in children.

BACKGROUND: Virtual reality (VR) computer technology creates a simulated environment, perceived as comparable to the real world, with which users can actively interact. The effectiveness of VR distraction on acute pain intensity in children is uncertain. OBJECTIVES: To assess the effectiveness and adverse effects of virtual reality (VR) distraction interventions for children (0 to 18 years) with acute pain in any healthcare setting. SEARCH METHODS: We searched CENTRAL, MEDLINE, Embase, CINAHL, PsycINFO and four trial registries to October 2019. We also searched reference lists of eligible studies, handsearched relevant journals and contacted study authors. SELECTION CRITERIA: Randomised controlled trials (RCTs), including cross-over and cluster-RCTs, comparing VR distraction to no distraction, non-VR distraction or other VR distraction. DATA COLLECTION AND ANALYSIS: We used standard Cochrane methodological processes. Two reviewers assessed risk of bias and extracted data independently. The primary outcome was acute pain intensity (during procedure, and up to one hour post-procedure). Secondary outcomes were adverse effects, child satisfaction with VR, pain-related distress, parent anxiety, rescue analgesia and cost. We used GRADE and created 'Summary of findings' tables. MAIN RESULTS: We included 17 RCTs (1008 participants aged four to 18 years) undergoing various procedures in healthcare settings. We did not pool data because the heterogeneity in population (i.e. diverse ages and developmental stages of children and their different perceptions and reactions to pain) and variations in procedural conditions (e.g. phlebotomy, burn wound dressings, physical therapy sessions), and consequent level of pain experienced, made statistical pooling of data impossible. We narratively describe results. We judged most studies to be at unclear risk of selection bias, high risk of performance and detection bias, and high risk of bias for small sample sizes. Across all comparisons and outcomes, we downgraded the certainty of evidence to low or very low due to serious study limitations and serious or very serious indirectness. We also downgraded some of the evidence for very serious imprecision. 1: VR distraction versus no distraction Acute pain intensity: during procedure Self-report: one study (42 participants) found no beneficial effect of non-immersive VR (very low-certainty evidence). Observer-report: no data. Behavioural measurements (observer-report): two studies, 62 participants; low-certainty evidence. One study (n = 42) found no beneficial effect of non-immersive VR. One study (n = 20) found a beneficial effect favouring immersive VR. Acute pain intensity: post-procedure Self-report: 10 studies, 461 participants; very low-certainty evidence. Four studies (n = 95) found no beneficial effect of immersive and semi-immersive or non-immersive VR. Five studies (n = 357) found a beneficial effect favouring immersive VR. Another study (n = 9) reported less pain in the VR group. Observer-report: two studies (216 participants; low-certainty evidence) found a beneficial effect of immersive VR, as reported by primary caregiver/parents or nurses. One study (n = 80) found a beneficial effect of immersive VR, as reported by researchers. Behavioural measurements (observer-report): one study (42 participants) found no beneficial effect of non-immersive VR (very low-certainty evidence). Adverse effects: five studies, 154 participants; very low-certainty evidence. Three studies (n = 53) reported no adverse effects. Two studies (n = 101) reported mild adverse effects (e.g. nausea) in the VR group. 2: VR distraction versus other non-VR distraction Acute pain intensity: during procedure Self-report, observer-report and behavioural measurements (observer-report): two studies, 106 participants: Self-report: one study (n = 65) found a beneficial effect favouring immersive VR and one (n = 41) found no evidence of a difference in mean pain change scores (very low-certainty evidence). Observer-report: one study (n = 65) found a beneficial effect favouring immersive VR and one (n = 41) found no evidence of a difference in mean pain change scores (low-certainty evidence). Behavioural measurements (observer-report): one study (n = 65) found a beneficial effect favouring immersive VR and one (n = 41) reported a difference in mean pain change scores with fewer pain behaviours in VR group (low-certainty evidence). Acute pain intensity: post-procedure Self-report: eight studies, 575 participants; very low-certainty evidence. Two studies (n = 146) found a beneficial effect favouring immersive VR. Two studies (n = 252) reported a between-group difference favouring immersive VR. One study (n = 59) found no beneficial effect of immersive VR versus television and Child Life non-VR distraction. One study (n = 18) found no beneficial effect of semi-immersive VR. Two studies (n = 100) reported no between-group difference. Observer-report: three studies, 187 participants; low-certainty evidence. One study (n = 81) found a beneficial effect favouring immersive VR for parent, nurse and researcher reports. One study (n = 65) found a beneficial effect favouring immersive VR for caregiver reports. Another study (n = 41) reported no evidence of a difference in mean pain change scores. Behavioural measurements (observer-report): two studies, 106 participants; low-certainty evidence. One study (n = 65) found a beneficial effect favouring immersive VR. Another study (n = 41) reported no evidence of a difference in mean pain change scores. Adverse effects: six studies, 429 participants; very low-certainty evidence. Three studies (n = 229) found no evidence of a difference between groups. Two studies (n = 141) reported no adverse effects in VR group. One study (n = 59) reported no beneficial effect in reducing estimated cyber-sickness before and after VR immersion. 3: VR distraction versus other VR distraction We did not identify any studies for this comparison. AUTHORS' CONCLUSIONS: We found low-certainty and very low-certainty evidence of the effectiveness of VR distraction compared to no distraction or other non-VR distraction in reducing acute pain intensity in children in any healthcare setting. This level of uncertainty makes it difficult to interpret the benefits or lack of benefits of VR distraction for acute pain in children. Most of the review primary outcomes were assessed by only two or three small studies. We found limited data for adverse effects and other secondary outcomes. Future well-designed, large, high-quality trials may have an important impact on our confidence in the results.

The effect of participating in MedEx Wellness, a community-based chronic disease exercise rehabilitation programme, on physical, clinical and psychological health: A study protocol for a cohort trial.

BACKGROUND: Community-based exercise rehabilitation programmes for chronic disease are an effective alternative to traditional hospital-based programmes. MedEx Wellness is a novel community-based exercise rehabilitation programme that integrates a range of chronic diseases. The aim of this trial was to investigate the effect of participating in MedEx Wellness on physical, clinical and psychological health. METHODS: A prospective cohort study was conducted. Participants were recruited at induction to the MedEx Wellness programme following referral from healthcare professionals. Participants underwent a baseline assessment before commencing the exercise programme and repeat assessments at 3, 6 and 12 months. The primary outcome was cardiorespiratory fitness (6 minute- time trial) at 12 months. Secondary outcomes included health-related quality of life (EuroQoL-5D, Satisfaction with Life Scale, Warwick Edinburgh Mental Wellbeing Scale, Patient Health Questionnaire8, Functional Assessment of Cancer Therapy Questionnaire), free living activity behavior (accelerometer) and healthcare utilization (recall questionnaire). Tertiary outcomes included blood pressure (24 h), biomarkers (lipids, glucose and C-reactive protein), other components of physical fitness, including strength (handgrip test, sit-to-stand test), flexibility (sit-and-reach test), body composition (body mass index and waist-to-hip ratio), and falls risk (timed up and go test), and claudication time (incremental treadmill walking test), cognitive function, including attention (Attention Network Task), memory (Luck & Vogel Visual Working Memory Task) and cognitive reserve. Exploratory outcomes included psychosocial determinants of physical activity (self-efficacy, social support, intentions). DISCUSSION: This trial will evaluate whether participation in the MedEx Wellness programme has positive effects on physical, clinical and psychological health in individuals with a range of chronic diseases. TRIAL REGISTRATION: ISRCTN Registry ISRCTN10351412.

Cognitive Reserve Capacity: Exploring and Validating a Theoretical Model in Healthy Ageing.

OBJECTIVE: Cognitive reserve (CR) capacity can be viewed as the maximum processing potential of neural systems that support adaptive cognitive performance in age-related cognitive decline. CR is a complex construct that can only be measured indirectly. Proxy measures (e.g., psychosocial/lifestyle variables) are traditionally used to reflect CR. However, strong relationships have been observed between these measures and cognitive functions (e.g., executive function [EF], processing resources [PR], fluid/crystallized abilities); therefore, the organizational structure of indicators implicated in CR remains unclear. The objective of this study was to test a hypothetical, theoretical model of CR capacity that includes both traditional CR proxy indicators and measures of cognitive function [Satz et al. (2011). Journal of Clinical and Experimental Neuropsychology, 33(1), 121-130], which remain, as yet, untested. METHOD: Construct validity of the model was investigated in healthy older adults through exploratory and confirmatory factor analysis (EFA and CFA) using data from the Maastricht Ageing Study (MAAS). A secondary CFA was conducted to validate the model using data from the Irish Longitudinal Study on Ageing (TILDA). RESULTS: EFA and CFA in MAAS established a two-factor model comprising EF/PR and cumulative cognitive enrichment (CCE), which was further validated in a secondary analysis in TILDA. Convergent and discriminant validity was supported in MAAS (range of R2 = .228-.635; factor correlation confidence interval (CI) = .622, .740) and TILDA (range of R2 = .172-.899; factor correlation CI = .559, .624). CONCLUSIONS: A dual model of CR elucidated the relationships between hypothesized indicators of CR capacity and revealed a two-factor structure suggesting that both control (EF/PR) and representational processes (CCE) are involved in CR capacity.

Inhibition and Updating, but Not Switching, Predict Developmental Dyslexia and Individual Variation in Reading Ability.

To elucidate the core executive function profile (strengths and weaknesses in inhibition, updating, and switching) associated with dyslexia, this study explored executive function in 27 children with dyslexia and 29 age matched controls using sensitive z-mean measures of each ability and controlled for individual differences in processing speed. This study found that developmental dyslexia is associated with inhibition and updating, but not switching impairments, at the error z-mean composite level, whilst controlling for processing speed. Inhibition and updating (but not switching) error composites predicted both dyslexia likelihood and reading ability across the full range of variation from typical to atypical. The predictive relationships were such that those with poorer performance on inhibition and updating measures were significantly more likely to have a diagnosis of developmental dyslexia and also demonstrate poorer reading ability. These findings suggest that inhibition and updating abilities are associated with developmental dyslexia and predict reading ability. Future studies should explore executive function training as an intervention for children with dyslexia as core executive functions appear to be modifiable with training and may transfer to improved reading ability.

Identification of Resting State Networks Involved in Executive Function.

The structural networks in the human brain are consistent across subjects, and this is reflected also in that functional networks across subjects are relatively consistent. These findings are not only present during performance of a goal oriented task but there are also consistent functional networks during resting state. It suggests that goal oriented activation patterns may be a function of component networks identified using resting state. The current study examines the relationship between resting state networks measured and patterns of neural activation elicited during a Stroop task. The association between the Stroop-activated networks and the resting state networks was quantified using spatial linear regression. In addition, we investigated if the degree of spatial association of resting state networks with the Stroop task may predict performance on the Stroop task. The results of this investigation demonstrated that the Stroop activated network can be decomposed into a number of resting state networks, which were primarily associated with attention, executive function, visual perception, and the default mode network. The close spatial correspondence between the functional organization of the resting brain and task-evoked patterns supports the relevance of resting state networks in cognitive function.

Neural Patterns of the Implicit Association Test.

The Implicit Association Test (IAT) is a reaction time based categorization task that measures the differential associative strength between bipolar targets and evaluative attribute concepts as an approach to indexing implicit beliefs or biases. An open question exists as to what exactly the IAT measures, and here EEG (Electroencephalography) has been used to investigate the time course of ERPs (Event-related Potential) indices and implicated brain regions in the IAT. IAT-EEG research identifies a number of early (250-450 ms) negative ERPs indexing early-(pre-response) processing stages of the IAT. ERP activity in this time range is known to index processes related to cognitive control and semantic processing. A central focus of these efforts has been to use IAT-ERPs to delineate the implicit and explicit factors contributing to measured IAT effects. Increasing evidence indicates that cognitive control (and related top-down modulation of attention/perceptual processing) may be components in the effective measurement of IAT effects, as factors such as physical setting or task instruction can change an IAT measurement. In this study we further implicate the role of proactive cognitive control and top-down modulation of attention/perceptual processing in the IAT-EEG. We find statistically significant relationships between D-score (a reaction-time based measure of the IAT-effect) and early ERP-time windows, indicating where more rapid word categorizations driving the IAT effect are present, they are at least partly explainable by neural activity not significantly correlated with the IAT measurement itself. Using LORETA, we identify a number of brain regions driving these ERP-IAT relationships notably involving left-temporal, insular, cingulate, medial frontal and parietal cortex in time regions corresponding to the N2- and P3-related activity. The identified brain regions involved with reduced reaction times on congruent blocks coincide with those of previous studies.