Short-Term Weight Loss Patterns, Baseline Predictors, and Longer-Term Follow-Up Within a Randomized Controlled Trial.

Short-term weight loss patterns, baseline predictors, and longer-term follow-up within a randomized controlled trial.

Obesity (Silver Spring). 2013 Jun 6;
Yank V, Xiao L, Wilson SR, Stafford RS, Rosas LG, Ma J

OBJECTIVE: To examine weight loss patterns and predictors among participants in a primary care-based translation study of the Diabetes Prevention Program lifestyle intervention. DESIGN AND METHODS: Cluster analysis identified short-term (12-week) weight loss patterns among 72 intervention participants. Analysis of variance assessed cluster differences in weight loss maintenance at 15-month follow-up. Discriminant analysis identified baseline characteristics that best differentiated between clusters. RESULTS: Participants had baseline mean (SD) age of 55.0 (10.8) years and BMI of 31.9 (5.2) kg/m(2) . Cluster analysis identified three short-term weight loss patterns: modest (n=15; 21%), moderate-and-steady (n=43; 60%), and substantial-and-early (n=14; 19%). Only participants with the latter two patterns achieved clinically significant (? 5%) short-term weight loss and maintained it at 15 months. On discriminant analysis, the modest cluster was most differentiated from other clusters by high friend encouragement for dietary change, high obesity-related problems, and low physical well-being. The moderate-and-steady cluster was differentiated by lower physical activity, family encouragement, and depression symptoms. CONCLUSION: Results provide insight into the heterogeneity of response to an effective lifestyle intervention by identifying short-term weight loss patterns and their baseline predictors and relationship to 15-month success. If replicated, results may help tailor strategies for participant subgroups in weight loss programs. HubMed – depression

Environmental and behavioural interventions for reducing physical activity limitation in community-dwelling visually impaired older people.

Cochrane Database Syst Rev. 2013 Jun 5; 6: CD009233
Skelton DA, Howe TE, Ballinger C, Neil F, Palmer S, Gray L

BACKGROUND: Impairment of vision is associated with a loss of function in activities of daily living. Avoidance of physical activity and consequent reduced functional capacity is common in older people with visual impairment and an important risk factor for falls. Indeed, the rate of falls and fractures is higher in older people with visual impairment than age-matched visually normal older people. Depression and anxiety is common in older people with vision impairment and leads to further restriction of activity, reduced social contact and reduced quality of life. Possible mechanisms to reduce activity restriction and therefore improve mobility and activity include environmental and behavioural interventions delivered by a number of health professionals, including occupational therapists. OBJECTIVES: The objective of this review was to assess the effectiveness of environmental and behavioural interventions in reducing activity limitation and improving quality of life amongst visually impaired older people. SEARCH METHODS: We searched CENTRAL (which contains the Cochrane Eyes and Vision Group Trials Register) (The Cochrane Library 2012, Issue 10), Ovid MEDLINE, Ovid MEDLINE In-Process and Other Non-Indexed Citations, Ovid MEDLINE Daily, Ovid OLDMEDLINE, (January 1950 to November 2012), EMBASE (January 1980 to November 2012), Cumulative Index to Nursing and Allied Health Literature (CINAHL) (January 1937 to November 2012), Allied and Complementary Medicine Database (AMED) (January 1985 to November 2012), OT Seeker (inception to November 2012), the metaRegister of Controlled Trials (mRCT) (www.controlled-trials.com), ClinicalTrials.gov (www.clinicaltrials.gov) and the WHO International Clinical Trials Registry Platform (ICTRP) (www.who.int/ictrp/search/en). We did not use any date or language restrictions in the electronic searches for trials. We last searched the electronic databases on 9 November 2012. SELECTION CRITERIA: Randomised controlled trials (RCTs) and quasi-randomised controlled trials (Q-RCTs) that compared environmental interventions, behavioural interventions or both, versus control (placebo control or no intervention or usual care), and trials comparing different types of environmental or behavioural interventions, in older people (aged 60 and over) with irreversible visual impairment living independently or in residential settings. To be eligible for inclusion the primary aim of studies must be reducing physical activity limitation and must include a measure of physical activity. Secondary outcome measures included falls, fear of falling, quality of life. DATA COLLECTION AND ANALYSIS: Two authors independently read abstracts retrieved by the search to identify eligibility and study quality. We contacted study authors for additional information. MAIN RESULTS: Our searches found no RCTs or Q-RCTs that met the eligibility criteria for this review. AUTHORS’ CONCLUSIONS: We are unable to reach any conclusion about the effectiveness of environmental or behavioural interventions for reducing physical activity limitation in community-dwelling visually impaired older people, as no eligible studies were found. However a number of studies reviewed included only the secondary outcome measures of this review. Although behavioural interventions delivered by occupational therapists have been shown to reduce the rate of falls, we are unable to conclude if this is due to reduced activity restriction (increased mobility) or reduced activity (lessening exposure to risk). There are inconclusive and conflicting results from trials evaluating the effectiveness of behavioural and environmental interventions aimed at improving quality of life. Further research is necessary (such as ongoing Dutch and UK trials considering the effectiveness of orientation and mobility training on activity restriction, physical activity, falls, fear of falling and quality of life in older adults with low vision, and the effect of an occupational therapist delivering home safety modification, coping strategies and exercise with older people with low vision) before any conclusions can be reached. HubMed – depression

Occupational therapy for care home residents with stroke.

Cochrane Database Syst Rev. 2013 Jun 5; 6: CD010116
Fletcher-Smith JC, Walker MF, Cobley CS, Steultjens EM, Sackley CM

BACKGROUND: Stroke is a worldwide problem and is a leading cause of adult disability, resulting in dependency in activities of daily living (ADL) for around half of stroke survivors. It is estimated that up to 25% of all care home residents in the USA and in the UK have had a stroke. Stroke survivors who reside in care homes are likely to be more physically and cognitively impaired and therefore more dependent than those able to remain in their own home. Overall, 75% of care home residents are classified as severely disabled, and those with stroke are likely to have high levels of immobility, incontinence and confusion, as well as additional co-morbidities. It is not known whether this clinically complex population could benefit from occupational therapy in the same way as community-dwelling stroke survivors. The care home population with stroke differs from the general stroke population living at home, and a review was needed to examine the benefits of occupational therapy provided to this specific group. This review therefore focused on occupational therapy interventions for ADL for stroke survivors residing in care homes. OBJECTIVES: To measure the effects of occupational therapy interventions (provided directly by an occupational therapist or under the supervision of an occupational therapist) targeted at improving, restoring and maintaining independence in ADL among stroke survivors residing in long-term institutional care, termed collectively as ‘care homes’. As a secondary objective, we aimed to evaluate occupational therapy interventions for reducing complications such as depression and low mood. SEARCH METHODS: We searched the Cochrane Stroke Group Trials Register (August 2012), the Cochrane Central Register of Controlled Trials (CENTRAL) (The Cochrane Library, September 2012), MEDLINE (1948 to September 2012), EMBASE (1980 to September 2012), CINAHL (1982 to September 2012) and 10 additional bibliographic databases and six trials registers. We also handsearched seven journals, checked reference lists and obtained further information from individual trialists. SELECTION CRITERIA: Randomised controlled trials investigating the impact of an occupational therapy intervention for care home residents with stroke versus standard care. DATA COLLECTION AND ANALYSIS: The lead review author performed all searches. Two review authors then independently assessed all titles and abstracts of studies and selected trials for inclusion, with a third review author resolving any discrepancies. The same two review authors independently extracted data from all included published sources to ensure reliability. Primary outcomes were performance in ADL at the end of scheduled follow-up and death or a poor outcome. Secondary outcomes aimed to reflect the domains targeted by an occupational therapy intervention. MAIN RESULTS: We included in the review one study involving 118 participants. We found one ongoing study that also met the inclusion criteria for the review, but the data were not yet available. AUTHORS’ CONCLUSIONS: We found insufficient evidence to support or refute the efficacy of occupational therapy interventions for improving, restoring or maintaining independence in ADL for stroke survivors residing in care homes. The effectiveness of occupational therapy for the population of stroke survivors residing in care homes remains unclear, and further research in this area is warranted. HubMed – depression

Tolerance of intravenous methylprednisolone for relapse treatment in demyelinating CNS disease.

Swiss Med Wkly. 2013; 143: 0
Lienert C, Schawalder G, Findling O, Kamm C, Humpert S, Mugglin A, Mathis J, Sturzenegger M, Mattle H

In Switzerland, the first course of intravenous steroids for treatment of episodes of demyelinating CNS disease is usually administered in an inpatient setting. We prospectively evaluated short term tolerance of treatment with special emphasis on sleep quality.Patients with a first event of presumed demyelinating disease (CIS), multiple sclerosis relapses (MS) or sub-acute disease progression were treated with a 5-day regimen of intravenous methylprednisolone (IVMP) in our inpatient clinic. Patients’ experience was documented by self-report questionnaires including a standardised depression scale (ADSL). Laboratory tests were performed on a routine basis. Fasting glucose, blood pressure and pulse were measured before every infusion. Activity and sleep patterns were analysed by wrist actigraphs during the 5 day infusion period and at follow-up after 1-2 months.A total of 66 patients participated in the study. Of these, 55 were steroid treatment naïve, and 11 patients, who had received intravenous steroid relapse treatment before, were admitted because of disabling symptoms. Mood disturbances were reported before steroid treatment, however significantly less often at the end of the steroid pulse and during follow-up. Sleep efficiency as measured by wrist actimetry was high before, during and after steroid treatment.Therapy was well tolerated without severe side effects in CIS and MS patients. Sleep efficiency was not disturbed. In conclusion there are no obstacles to change from an inpatient to an outpatient setting for the steroid treatment of relapses in MS and CIS, but rare psychotic reactions to steroid treatment are not predictable. HubMed – depression