Clinicians’ perceptions of a potential wearable device for capturing upper limb activity post-stroke: a qualitative focus group study

Background There is growing interest in the use of wearable devices that track upper limb activity after stroke to help determine and motivate the optimal dose of upper limb practice. The purpose of this study was to explore clinicians’ perceptions of a prospective wearable device that captures upper limb activity to assist in the design of devices for use in rehabilitation practice. Methods Four focus groups with 18 clinicians (occupational and physical therapists with stroke practice experience from a hospital or private practice setting) were conducted. Data were analyzed thematically. Results Our analysis revealed three themes: (1) “Quantity and quality is ideal” emphasized how an ideal device would capture both quantity and quality of movement; (2) “Most useful outside therapy sessions” described how therapists foresaw using the device outside of therapy sessions to monitor homework adherence, provide self-monitoring of use, motivate greater use and provide biofeedback on movement quality; (3) “User-friendly please” advocated for the creation of a device that was easy to use and customizable, which reflected the client-centered nature of their treatment. Conclusions Findings from this study suggest that clinicians support the development of wearable devices that capture upper limb activity outside of therapy for individuals with some reach to grasp ability. Devices that are easy to use and capture both quality and quantity may result in greater uptake in the clinical setting. Future studies examining acceptability of wearable devices for tracking upper limb activity from the perspective of individuals with stroke are needed.

Cognitive-Reminiscence Therapy for Young Adults with Depressive Symptoms: Clinical Observations, Challenges, and Recommendations

Cognitive-reminiscence therapy is a novel intervention for depression in young adults, and currently no specific clinical guidance exists for its use in this age group. The aim of this article is to disseminate our experiences from a recent clinical trial in which we engaged in cognitive-reminiscence therapy (CRT) with young adults for the purpose of treating depressive symptoms. Discussion is presented in terms of clinical observations that were made during treatment, specific challenges that arose, and recommendations for implementing this therapy with young adults. Firstly, a conceptual overview and rationale for CRT is provided along with an outline of the treatment protocol that was used. Then,a framework for undertaking therapeutic reminiscence work at different levels of analysis is presented, and comment is made on the rationale for, and the process of, elicitingspecific memories. Common life events and issues that emerged as the foci of reminiscence with young adults in our trial are reviewed. Following this, the process of orienting to the mechanisms of change in CRT is discussed. Finally, several clinical issues and insights that emerged during the provision of this therapy are presented: contextualising emerging adulthood as a time of transition, creating continuity acrossindividuals’ lives, the process of reflection on reminiscence, and homework adherence.

Mental Health Associations with Academic Performance and Education Behaviors in Canadian Secondary School Students

Course grades, as an indicator of academic performance, are a primary academic concern at the secondary school level and have been associated with various aspects of mental health status. The purpose of this study is to simultaneously assess whether symptoms of mental illness (depression and anxiety) and mental well-being (psychosocial well-being) are associated with self-reported grades (in their primary language [English or French] and math courses) and education behaviors (school days missed due to health, truancy, and frequency of incomplete homework) in a sample of secondary school students across Canada ( n = 57,394). Multivariate imputation by chained equations and multilevel proportional odds logistic regressions were used to assess associations between mental health scores, academic performance and education behaviors. Lower depression and higher psychosocial well-being scores were associated with better grade levels in both math and language courses, as well as better education behaviors. In turn, better education behaviors were associated with higher course grades. Depression scores and psychosocial well-being scores remained associated with higher grades after controlling for education behaviors, however the magnitude of association was diminished. Results indicate that the effects of mental health factors were partially attenuated by education behaviors, suggesting while reduced class attendance and poor homework adherence were associated with both academic outcomes and mental health, they do not account entirely for the association between lower grades and worse mental health.

Transdiagnostic group cognitive behaviour therapy for anxiety in bipolar disorder—a pilot feasibility and acceptability study

Objective Anxiety is prominent for many people living with bipolar disorder, yet the benefit of psychological interventions in treating this co-morbidity has been minimally explored and few studies have been conducted in a group format. This study aimed to assess the feasibility and acceptability of a transdiagnostic cognitive behaviour therapy group anxiety programme (CBTA-BD) for people living with bipolar disorder. Methods Participants were recruited to take part in a 9-week group therapy programme designed to treat anxiety in bipolar disorder using cognitive behaviour therapy. They were assessed by structured interview (SCID-5 RV) to confirm the diagnosis of bipolar disorder and assessed for anxiety disorders. Self-report questionnaires—DASS (depression, anxiety, stress), ASRM (mania), STAI (state and trait anxiety) and Brief QOL.BD (quality of life) pre- and post-treatment were administered. Results Fourteen participants enrolled in the programme, with 10 participants (5 male; 5 female) completing the follow-up assessments. Two groups (one during working hours, the other outside working hours) were conducted. The programme appeared acceptable and feasible with a mean of 6.9 (77%) sessions attended, though five (50%) participants completed less than 3 weeks homework. Conclusion The transdiagnostic cognitive behaviour therapy group anxiety programme (CBTA-BD) proved feasible and acceptable for participants; however, homework compliance was poor. A larger randomised pilot study is needed to assess the benefits of the intervention on symptom measures and address homework adherence, possibly through providing support between sessions or tailoring it more specifically to participant needs.

Tailored Text Message Prompts to Increase Therapy Homework Adherence: A Single-Case Randomised Controlled Study

Background:Psychotherapy homework completion is associated with positive treatment outcomes, but many patients show low adherence to prescribed assignments. Whether text-message prompts are effective in increasing adherence to assignments is unknown.Aims:To evaluate whether tailored daily text-message prompts can increase homework adherence in a stress/anxiety treatment.Method:This study used a randomised controlled single-case alternating treatment design with parallel replication in seven participants. Participants received a five-week relaxation program for stress and anxiety with daily exercises. The intervention consisted of daily text messages tailored for each participant. Phases with or without text messages were randomly alternated over the study course. Randomisation tests were used to statistically analyse differences in mean number of completed relaxation exercises between phases.Results:There was a significant (combinedp= .018) effect of daily text messages on homework adherence across participants with weak to medium effect size improvements. No negative effects of daily text messages were identified.Conclusions:Tailored text messages can marginally improve adherence to assignments for patients in CBT. Further studies may investigate how text messages can be made relevant for more patients and whether text messages can be used to increase homework quality rather than quantity.