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Aim: To investigate the effects of a multimodal couple-based sexual health intervention for premenopausal women treated for breast cancer and their partners to provide personalised psychosexual care, and to understand participants' experience of, and adherence to, the intervention., Methods: This is an assessor-blinded, randomised controlled trial. Premenopausal women treated for breast cancer (N = 160) and their partners will be recruited. Dyads will be randomised into an intervention (n = 80) or attention control (n = 80) group. The intervention group will receive the multimodal couple-based sexual health intervention over eight weeks. The intervention comprises five face-to-face and virtual individual couple counselling sessions combined with online reading, a chat-based discussion forum, and telephone calls. The intervention is based on level I-II evidence and a robust theoretical framework. The attention control group will receive usual care plus telephone calls comprising general greetings and reminders to complete follow-up surveys. Sexual adjustment, relationship quality and quality of life will be measured at baseline, after completion of the intervention, three months and six months post-intervention. The project will adhere to the CONSORT-EHEALTH checklist. Qualitative interviews will explore the participants' experience of, and adherence to, the intervention., Discussion: This study will provide the first pragmatic evidence of the effectiveness of a multimodal couple-coping intervention to support premenopausal women and their partners to improve sexuality, relationship quality and quality of life after treatment for breast cancer., Implications for the Profession and /or Patient Care: Sexual health is a neglected area in clinical practice, for patients and partners. The ever-growing population of women treated for breast cancer at younger age has created a more pressing need for the development of tailored sexual health interventions. If effective, this intervention could be incorporated into routine cancer care to provide better support and care for this patient population to enhance sexual health, intimacy and overall well-being., Trial Registration: ISRCTN35481498; prospectively registered on 08/05/2023., Competing Interests: The authors have declared that no competing interests exist., (Copyright: © 2024 Chow et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.)

Importance: Psychoeducational interventions (PEIs), which provide both information and emotional and psychosocial support, may address the unmet needs of the caregivers of adolescent and young adult patients with cancer., Objective: To explore the effects of an instant messaging-delivered PEI on anxiety, depression, quality of life (QOL), and coping and determine whether the intervention reduces caregivers' unmet needs., Design, Setting, and Participants: This randomized clinical trial using an intention-to-treat protocol was conducted from April 1 to September 14, 2022, in a tertiary cancer hospital in China and included caregivers of patients diagnosed with cancer at age 15 to 39 years recruited using convenience sampling., Intervention: Caregivers were allocated 1:1 using a randomized block scheme to the intervention or control group. The intervention group received a 5-week PEI and usual care, whereas the control group received only usual care. The PEI was delivered through articles and calls through an instant messaging application., Main Outcomes and Measures: The primary outcomes were changes in the levels of caregivers' anxiety and depression, measured using the 7-Item Generalized Anxiety Disorder Scale and the Patient Health Questionnaire 9, respectively. The secondary outcomes were changes in the levels of caregivers' QOL, coping, and unmet needs., Results: Of the 160 participants, 92 (57.5%) were male; mean (SD) age was 40.27 (8.33) years. Compared with the control group, the intervention group had significantly greater reduction in severity of anxiety (B = -3.231; 95% CI, -4.746 to -1.716; P < .001) and depression (B = -3.253; 95% CI, -5.052 to -1.454; P < .001), smaller reduction in QOL (B = 13.574; 95% CI, 0.488-26.661; P = .04), and greater reduction in unmet needs (B = -12.136; 95% CI, -18.307 to -5.965; P < .001) after the intervention. Twelve weeks after baseline, the intervention group demonstrated a significantly greater reduction only in severity of anxiety (B = -1.890; 95% CI, -3.382 to -0.397; P = .01)., Conclusions and Relevance: In this randomized clinical trial of a mobile instant messaging-delivered PEI, caregivers' unmet needs, anxiety, and depression decreased significantly and QOL declined at a significantly slower rate immediately after the intervention in the intervention group compared with the control group. A sustained effect on anxiety was observed 12 weeks after baseline., Trial Registration: Chinese Clinical Trial Registry identifier: ChiCTR2200055951.

Purpose: This study aimed to determine a cut-off for the simplified Chinese version of the COmprehensive Score for financial Toxicity (COST) that could identify cost-related treatment nonadherence among Chinese patients with cancer. The study also sought to validate this cut-off score by using it to assess impaired health-related quality of life (HRQoL) in the same population., Methods: A secondary analysis was conducted using data from a cross-sectional survey of 1208 Chinese patients with cancer who were recruited from 12 hospitals in six cities across three provinces of the Chinese mainland. Sociodemographic information and data on financial toxicity (FT), cost-related treatment nonadherence, and HRQoL were used in the analysis. Receiver operating characteristic (ROC) analysis was used to determine the optimal cut-off for the simplified Chinese version of the COST., Results: The ROC analysis identified a COST cut-off of 18.5 for identifying cost-related treatment nonadherence, yielding a sensitivity of 76.5% and specificity of 71.4%. In the validation study, this cut-off score yielded a sensitivity of 64.2% and a specificity of 67.1% for identifying impaired HRQoL., Conclusion: Early and dynamic assessment of cancer-related FT in routine clinical practice may play a crucial role in the early identification and management of FT. Accordingly, a COST cut-off of 18.5 was identified to indicate cost-related treatment nonadherence and impaired HRQoL in a population of patients with cancer from the Chinese mainland. This finding may facilitate the implementation of universal FT screening among patients with cancer in specific settings such as the Chinese mainland., (© 2024. The Author(s).)

Background: Childhood cancer negatively impacts a child's physical, mental, and behavioural health and significantly affects their health-related quality of life. The Pediatric Quality of Life Inventory 4.0 Generic Core Scale (PedsQL™ 4.0 GCS) is one of the most commonly used measures of the quality of life in children. However, the Amharic version of PedsQL™ 4.0 GCS has not been validated in a paediatric oncology population. This study aimed to translate and evaluate the psychometric properties of the Amharic PedsQL™ 4.0 GCS (PedsQL™ 4.0 GCS (A)) for Ethiopian children with cancer., Methods: A descriptive cross-sectional study was conducted among children aged 8-18 years with any type of cancer across the cancer trajectory. Cronbach's alpha and intraclass correlation coefficient were computed to determine the internal consistency and test-retest reliability of the scale. The convergent validity was established by examining the correlation of the PedsQL™ 4.0 GCS (A) with the Amharic version of the Revised Child Anxiety and Depression Scale (RCADS-25(A)). Factorial validity was evaluated by conducting a confirmatory factor analysis., Results: The study included 142 participants with childhood cancer. PedsQL™ 4.0 GCS (A) had good validity and reliability. It demonstrated high internal consistency with a Cronbach's alpha of 0.96 for the scale and 0.82-0.95 for the subscales. The intraclass correlation coefficient for the scale was 0.9 and that for the subscales was 0.76-0.90. The PedsQL™ 4.0 GCS (A) was highly correlated with RCADS-25 (A) (r = - 0.97, p < 0.001), supporting its convergent validity. The four-factor structure of the model fitted the data satisfactorily (χ 2 /df = 1.28; CFI = 0.97; TLI = 0.97; RMSEA = 0.05; SRMR = 0.05), supporting the factorial validity of the PedsQL™ 4.0 GCS (A)., Conclusion: The PedsQL™ 4.0 GCS (A) demonstrates desirable psychometric properties for assessing quality of life among Ethiopian children with cancer. The scale can be used in clinical settings for assessing and evaluating quality of life in children with cancer. The use of parent-report versions and studies in those with different health conditions and healthy populations are necessary to further establish the psychometric properties of the PedsQL™ 4.0 GCS (A)., (© 2023. The Author(s).)

Purpose: To identify a cut-off score for the COmprehensive Score for financial Toxicity (COST) to predict a clinical implication of a high level of financial toxicity (FT)., Methods: A total of 640 cancer patients were recruited from three regional hospitals in Hong Kong. They completed a questionnaire comprising the COST measure and the Functional Assessment of Cancer Therapy - General (FACT-G) instrument. The cut-off score for the COST that predicts the lowest quartile of the FACT-G total score was identified by receiver operating characteristic (ROC) analysis. The sample was then stratified by this cut-off score, and characteristics were compared using Fisher's exact, chi-squared or independent sample t-test., Results: The mean scores were 20.1 ± 8.8 for the COST and 71.6 ± 15.5 for the FACT-G. The ROC analysis suggested that the cut-off of 17.5 yielded an acceptable sensitivity and specificity. Characteristics of patients with a higher level of FT included being younger, having a monthly household income of < 10,000 HKD (approximately 1290 USD), being more likely not employed, having stage IV cancer and receiving targeted and/or immunotherapy. In terms of financial support, a higher proportion of these patients had discussed financial issues with health care professionals and had received financial assistance. In addition, fewer of them were covered by private health insurance., Conclusion: Our findings suggest a cut-off for the COST that can be used to screen for FT in clinical settings. In addition, while a considerable proportion of high-FT patients received targeted therapy, they often received financial assistance. There is a gap between financial hardship and assistance that warrants attention., (© 2021. The Author(s), under exclusive licence to Springer-Verlag GmbH Germany, part of Springer Nature.)

Background: The Trunk Impairment Scale (TIS) has been translated into Chinese, but the psychometric properties of the Chinese version of the TIS (TIS-C) have not yet been established. We aimed to examine the reliability and validity of the TIS-C for assessing sitting balance among Chinese people with a stroke., Methods: A descriptive, cross-sectional design was used. We recruited a convenience sample of 170 subacute stroke patients aged 18 years or over from the neurology departments of four traditional Chinese medicine hospitals in China. Patients completed the TIS-C, the Berg Balance Scale and the Modified Barthel Index. The psychometric properties of the TIS-C were examined to establish test-retest reliability, internal consistency, equivalence, and content, criterion, and construct validity., Results: Intraclass correlation coefficients for inter-rater and intra-rater reliability ranged from 0.75 to 0.89 and from 0.90 to 0.97, respectively. The TIS-C Cronbach α was 0.86. The strong correlation between the total score of the TIS-C and the Berg Balance Scale (r s = 0.81, p < 0.001) or Modified Barthel Index (r s = 0.84, p < 0.001) suggested good concurrent and convergent validity, respectively. Known-group validity was supported by the significant difference (p < 0.001) in TIS-C scores between participants with mild and moderate stroke., Conclusions: The TIS-C is a valid and reliable tool for assessing static and dynamic sitting balance as well as coordination of trunk movement among stroke survivors with mild and moderate stroke.

Context: Patients with end-stage renal disease undergoing dialysis experience multiple concurrent symptoms. These symptoms cluster together and have negative impacts on patient outcomes. However, information on changes in symptom clusters over time is limited., Objectives: This longitudinal study examined the stability of symptom clusters and their impacts on health-related quality of life and functional status over a period of one year., Methods: Eligibility criteria were patients diagnosed with end-stage renal disease; had received dialysis consecutively for at least three months; and had given written informed consent. Dialysis Symptom Index, Kidney Disease Quality of Life 36, and Karnofsky Performance Status Scale were used to evaluate the impacts of symptom clusters and outcomes. Exploratory factor analyses and multiple regression analyses were used to determine symptom clusters and their associations with patient outcomes., Results: Among the 354 recruited patients, 271 completed the 12-month assessment. Four symptom clusters were identified across the three assessments, namely, uremic, gastrointestinal, skin, and emotional. Within each cluster, the specific symptoms were varied. The uremic symptom cluster accounted for the largest amount of variability. Across the three assessments, a higher uremic cluster factor score was associated with poorer physical well-being, whereas a higher emotional cluster factor score was consistently associated with poorer mental well-being., Conclusion: Symptoms in patients on dialysis clustered in relatively stable patterns. The four symptom clusters identified had consistent negative effects on various aspects of patients' well-being. Our findings suggest the need for ongoing symptom assessment and early recognition of symptoms that may contribute to adverse patient outcomes., (Copyright © 2019 American Academy of Hospice and Palliative Medicine. Published by Elsevier Inc. All rights reserved.)

Aim: The aim of the study was to translate the Cancer Survivors' Unmet Needs (CaSUN) scale into Chinese, and then test its psychometric properties, for cancer survivors in Hong Kong., Methods: The original questionnaire was translated from English into traditional Chinese (CaSUN-Chi), following standardized procedures. An expert panel was invited to assess the items' content validity, and pilot test on 15 patients to evaluate its readability. The sample for psychometric evaluation was drawn from a large multinational study assessing unmet needs of cancer survivors, with a convenience sample of 300 was recruited. Cronbach's α coefficient was used to assess the internal consistency of the scale, and confirmatory factor analysis to evaluate its construct validity., Results: The CaSUN-Chi had good readability and high content validity (S-CVI 0.98). Cronbach's α for the entire scale was 0.93 and 0.71-0.91 for the five subscales. Confirmatory factor analysis indicated that the five-factor structure of the CaSUN-Chi was good fit to the data (CFI = 0.99, AGFI = 0.98, RMSEA = 0.054, SRMR = 0.071)., Conclusion: The CaSUN-Chi showed desirable psychometric properties for assessing unmet needs of cancer survivors in Hong Kong. Using the newly translated scale to identify individual supportive care unmet needs can bridge the gap between patients' experiences and expectations, and improve healthcare provision and resource allocation., (© 2019 John Wiley & Sons Australia, Ltd.)

Background: A life review is a promising intervention to enhance spiritual well-being in older people. Conventional life review interventions are lengthy and often led by psychologists., Objectives: This is the first randomised controlled trial study to examine the effectiveness and applicability of a nurse-led short term life-review intervention in people with life limiting diseases, the purpose being to enhance their spiritual well-being and lower their anxiety and depression., Design: A sequential mixed method approach, randomised controlled trial and qualitative evaluation, was adopted. The intervention group received the short version life review, and the control group attention placebo. Participants were randomly assigned to either intervention or control groups by computerised randomisation. Both participants and outcome assessors were blinded to the group assignment., Settings: The study was conducted in three publicly funded regional hospitals in Hong Kong., Participants: The target population were people suffering from life-limiting diseases, and receiving hospitalised, day hospice or outreach home care from the palliative care team., Methods: Two sets of questionnaires were used: the spiritual sub-scale of the McGill Quality of Life Questionnaire, Hong Kong version and the Hospital Anxiety and Depression Scale, Chinese version. The intervention process was assessed by means of observation log sheets and semi-structured interviews of 12 participants., Results: A total of 109 participants were recruited (54 in the intervention group, 55 in the control group). The intervention group showed significantly more improvement in spiritual well-being than the control group, with a Cohen's d-effect size of 0.65. Although there were improvements in both anxiety and depression levels in the intervention group, statistical significance in between-group comparisons was not reached. The process evaluation found that most participants were highly involved (92.6%), interested (77.8%) and participated in the intervention (79.6%). The participants described the intervention process as 'comfortable', 'relaxing' and 'interesting', and felt enlightened, with raised self-awareness, after it., Conclusion: The nurse-led short term life-review intervention demonstrated significant improvement effects in spiritual well-being. Participant feedback on nurses' performance was positive, finding the intervention acceptable and useful. The setting of the intervention has now been extended from bedside to home. It is recommended to incorporate life review into palliative nursing specialty training, empowering more nurses to deliver the intervention in their daily practice., (Copyright © 2019 Elsevier Ltd. All rights reserved.)

Background: Previous research has documented the negative impact of cancer treatment on body image and health-related quality of life among survivors, and the positive relationship between those factors. However, existing evidence is mainly based on Western studies of female survivors, and there is thus a huge knowledge gap in research on non-Western cancer survivors., Objectives: The aim of the study was to assess body image and health-related quality of life, and explore their relationship, among Chinese cancer survivors during transitional survivorship., Methods: Chinese cancer survivors with various diagnoses at the oncology outpatient clinic of a regional hospital in Hong Kong were invited to complete a self-reported survey on socio-demographic and clinical data, the instrument of Quality of Life in Adult Cancer Survivors and Body Image Scale., Results: A convenience sample of 402 Chinese cancer survivors was recruited, with a mean age of 54.4 years, the majority female (70.4%). In general, participants reported satisfactory body image but only fair health-related quality of life. Hierarchical multiple regression showed that body image was independently associated with both generic and cancer-specific health-related quality of life after controlling for socio-demographic and clinical characteristics (B = 9.572, P < 0.001; B = 5.165, P < 0.001)., Conclusions: Addressing body image may be an effective approach to enhancing Chinese cancer survivors' health-related quality of life during their transitional survivorship. Since there is a lack of attention given to body image in local clinical settings, early assessment and appropriate interventions should be considered., (© 2018 John Wiley & Sons, Ltd.)

Background: Disrupted sexual function is a prevalent and sustained side effect of gynaecological cancer and its related treatment. This problem may pose challenges to the survivors in the process of illness adjustment, leading to elevated psychological distress and impaired quality of life. However, care and interventions in this area have been neglected in most countries., Objectives: To investigate sexual function, psychosocial adjustment to illness, and quality of life among Chinese gynaecological cancer survivors in Hong Kong and to explore their associations., Methods: A cross-sectional design was adopted. Gynaecological cancer survivors were recruited from a gynaecological oncology outpatient clinic at a regional hospital in Hong Kong., Results: A total of 225 Chinese gynaecological cancer survivors were recruited. Their sexual function was found to be impaired. They had satisfactory performance in psychosocial adjustment to illness, but the worst domain was sexual relationships. Their quality of life was fair, with physical and social functioning performing best. Path analysis demonstrated that psychosocial adjustment to illness played a significant mediating role in the relationship between sexual function and quality of life among those who were married or had a regular sex partner., Conclusions: Impaired sexual function was prevalent among Chinese gynaecological cancer survivors, and psychosocial adjustment to illness mediates the relationship between sexual function and quality of life. In Chinese clinical settings without routine sexuality assessments, early sexual function and psychosocial adjustment assessment should be integrated into routine nursing practice. In addition, a culturally appropriate practice model should be developed to guide sexuality care delivery., (Copyright © 2018 John Wiley & Sons, Ltd.)

Background: Heart failure is an increasing public health problem globally. Interventions are imperative in managing the disease., Objective: To examine the effectiveness of a health education booklet and telephone follow-ups on patients' medication adherence, health-related quality of life, and psychological status., Methods: One hundred and sixty heart failure patients were assigned to either the experimental group (health education booklet and telephone follow-ups) or the control group (usual care). An independent t-test and the generalized estimating equation (GEE) model were used to compare the differences in the study outcomes. The statistical tests were two-sided and a p value below 0.05 was considered statistically significant., Results: The patients in the experimental group showed greater improvement throughout the study period compared with those in the control group regarding all the study outcomes., Conclusions: The study provided clues for healthcare professionals to develop interventions while undertaking clinical work with limited resources in China., (Copyright © 2015 Elsevier Inc. All rights reserved.)

Objectives: To determine the effect of nurse-implemented transitional care (TC) on readmission and mortality rates in Chinese individuals with chronic heart failure (CHF) in Hong Kong., Design: Single-center randomized controlled trial of TC versus usual care (UC)., Setting: University-affiliated hospital in Hong Kong., Participants: Hospitalized Chinese individuals with CHF (N = 178; aged 78.6 ± 6.9, 45% male)., Measurements: The TC group received a predischarge visit, two home visits, and then regular telephone calls over 9 months to provide self-care education and support, optimized health surveillance, and facilitation in use of community services. Primary endpoints were event-free survival, all-cause hospital readmission, and mortality during the 9-month follow-up. Secondary endpoints were length of hospital stay, self-care, and health-related quality of life (HRQL). Data were analyzed using survival analysis and generalized estimating equations, following an intention-to-treat principle., Results: Survival analysis indicated no significant differences in event-free survival, hospital readmission, or mortality between the TC and UC groups, although the TC group had a lower hospital readmission rate at 6 weeks (8.1% vs 16.3%, P = .048) and lower mortality at 9 months (4.1% vs 13.8%, P = .03). The TC group also had a shorter hospital stay (P = .006) and significantly better self-care and HRQL. Because of attrition, sensitivity analyses were conducted to examine whether the intention-to-treat assumption affected the results. Per-protocol population analyses (hazard ratio (HR) = 0.40, 95% confidence interval (CI) = 0.17-0.93) and worst-case-scenario analysis (HR = 0.44, 95% CI = 0.25-0.77) suggested a lower mortality risk in the TC group., Conclusion: The translation of individual-centered nurse-implemented TC to the Chinese culture and healthcare context of Hong Kong appears beneficial., (© 2015, Copyright the Authors Journal compilation © 2015, The American Geriatrics Society.)

Aim: To explore factors associated with health-related quality of life of patients with implantable cardioverter defibrillators., Background: Substantial evidence indicates that implantable cardioverter defibrillator is proven to increase survival rate by terminating life-threatening arrhythmia. However, this device can negatively affect health-related quality of life. Little is known about factors associated with health-related quality of life of patients with implantable cardioverter defibrillators, particularly in Asian population., Design: A transversal descriptive design was used., Methods: Data were collected from a convenience sample of 139 adult patients with implantable cardioverter defibrillators from 4 January-30 April 2012 using the structured questionnaires administered by the researcher and medical record reviews. The Short Form-36 Health Survey version 2 was used to measure health-related quality of life., Results: A total of 139 Chinese patients, including 107 (77·0%) males with a mean age of 63·0 (14·6) years, were selected. The physical component summary was relatively lower, whereas the mental component summary was relatively higher than that of the general Hong Kong Chinese population. Multivariable regression analysis revealed gender, self-care dependence, educational level, atrial fibrillation, diabetes mellitus, anxiety and depression significantly associated with physical or mental quality of life., Conclusions: Depression was a common factor affecting physical and mental quality of life. Self-care dependence, atrial fibrillation, diabetes mellitus, depression and anxiety could be improved. Our findings expand existing knowledge on identifying at-risk patients for having lower quality of life, thus allowing development of appropriate interventions targeting risk factors for improving health-related quality of life of patients with implantable cardioverter defibrillator., (© 2014 John Wiley & Sons Ltd.)

Purpose: This study aims to examine the supportive care needs of Chinese breast cancer survivors, and investigate the relationships with participant characteristics and quality of life., Methods: A total of 163 participants were recruited from a local public hospital and completed a self-administered questionnaire: the 34-item Supportive Care Needs Survey, the supplementary module of access to healthcare and ancillary support services, and the Functional Assessment of Cancer Therapy., Results: The five most commonly reported unmet needs were all in the health system information domain (range: 55-63%), and the majority (84%) reported at least one unmet need in relation to information on healthcare. Stepwise multivariable regression analyses revealed that the time spent on travelling from home to hospital, receiving hormonal therapy, and physical and psychological unmet needs were independently associated with poorer quality of life among the participants., Conclusions: Breast cancer survivors perceive various unmet needs, and health system information is the most common one. Those who have more unmet needs in the physical and psychological domains were more likely to perceive a poorer quality of life., (Copyright © 2014 Elsevier Ltd. All rights reserved.)

Background and Purpose: Previous literatures on young adult survivors of childhood cancer show inconsistent findings with regards to their psychological distress and health-related quality of life (HRQOL). Much of the available data focus on negative patient outcomes following cancer treatments prescribed from 1970 to 1990. In the present study, HRQOL and psychological distress of young adult survivors in Hong Kong was examined. It focused on subjects who had received cancer treatments prescribed in the last two decades., Methods: A structured telephone survey was conducted with 614 eligible survivors and 208 sibling controls in Hong Kong., Results: The survivors reported significantly lower mean scores in physical role and functioning, whereas their mental, social, and psychological well-being was similar to that of their sibling controls. Being female, older age, longer survival time, and specific cancer diagnoses were the factors associated with poorer physical and mental adaptation. HRQOL was negatively correlated with psychological distress., Conclusions: Findings of the study suggest that most survivors adjusted fairly well in mental, psychological, and social aspects. Survivors with a higher risk of poor HRQOL could benefit from appropriate screening and counseling at an early stage to mitigate their survivorship difficulties. Prospective follow-up studies on childhood cancer survivors are recommended to detect changes over longer survival periods., (Copyright © 2013 John Wiley & Sons, Ltd.)

Background: This study aimed to examine the mediating role of psychological distress in the relationship between the physical health component of health-related quality of life (HRQoL) of coronary heart disease patients and their socio-demographic and clinical characteristics., Methods: This was a cross-sectional study conducted from March 2009 to July 2010 with a total of 420 participants recruited from two hospital-based phase II cardiac rehabilitation centres. Participants' socio-demographic variables, self-reported medical history data, level of psychological distress, perceived social support, and HRQoL were collected by means of a structured questionnaire. Body weight and height, blood pressure and clinical data including fasting blood glucose, triglycerides, and low- and high-density lipoprotein cholesterol were also collected. Exploratory univariate analyses and multivariable regressions were conducted to identify socio-demographic and clinical determinants of the physical health component of HRQoL. Path analyses were then performed to examine the mediating role of psychological distress in the relationship between the physical health component of HRQoL and the determinants., Results: Path analysis revealed that age, sex, perceived social support, history of angina, and dyslipidaemia had both direct effect and indirect effect through psychological distress on the physical health component of HRQoL. Obesity and impaired left ventricular function only affected the physical health component of HRQoL directly, whereas household income only affected it indirectly, through psychological distress., Conclusion: Psychological distress mediates the effects of some socio-demographic and clinical variables of CHD patients on the physical health component of HRQoL. Our findings have important implications for rehabilitation care for people with CHD in order to enhance their HRQoL.

Background: Social support has been identified as a significant factor positively influencing quality of life (QOL) in breast cancer survivors. However, less is known about whether and how social support remains important among cancer survivors over the course of the survivorship trajectory., Aim: To explore social support and its relationship with QOL in breast cancer survivors in China., Methods: This was a sequential mixed methods study. In Phase I, 100 breast cancer survivors were surveyed using standardized questionnaires. A multivariate regression analysis was performed to examine the relationship between social support and QOL after controlling for annual household income and length of survivorship. In Phase II, individual in-depth interviews were conducted to understand social support experience from 29 survivors selected from Phase I. Interview data were transcribed and analyzed using qualitative content analysis., Results: Survivors reported a median support network size of 2.2 persons (interquartile range = 1.2-3.8) and a median support satisfaction score of 5.5 (interquartile range = 5-6). While support satisfaction was found to be associated with QOL, no association was found between support network size and QOL. Interview findings revealed that close family members and peer survivors constituted the major source of breast cancer survivors' support, especially in emotional and informational support aspects. Cultural factors played a role in the perception and utilization of support of the breast cancer survivors., Conclusions: This study has indicated that support satisfaction is more critical than support network size in influencing various aspects of survivors' QOL through the underlying different types of situation-specific support., (Copyright © 2013 Elsevier Ltd. All rights reserved.)

Objective: To investigate the long-term effects of motivational interviewing on clinical outcomes, psychological outcomes, health-related quality of life among cardiac rehabilitation patients with poor motivation., Design: A randomized controlled trial with blind data collectors., Setting: Cardiac rehabilitation centre., Subjects: A total of 146 cardiac rehabilitation patients with poor motivation., Intervention: All participants received usual care, including exercise and education, while those in the experimental group also received 10 sessions of motivational interviewing, each lasting 30-45 minutes., Main Measures: Clinical and psychological outcomes and health-related quality of life were assessed at baseline and at six, nine and 12 months for both groups., Result: There was no significant difference between the two groups at baseline on demographic and clinical outcomes except for monthly family income (p = 0.034). Patients in the experimental group had higher increases in health-related quality of life (SF-36) scores in bodily pain (88.7 SD 16.7 vs. 87.6 SD 18.7 at month 12, p = 0.044) and role limitation owing to emotional problems (86.9 SD 19.2 vs. 78.6 SD 21.8 at month 9, p = 0.019; 85.8 SD 18.9 vs. 76.9 SD 23.9 at month 12, p = 0.022). No statistically significant group difference was found among other outcomes., Conclusion: The long-term effect of motivational interviewing on clinical and psychological outcomes and health-related quality of life in studied patients is limited.

The purpose of this study is to compare health-related quality of life (HRQoL) and emotional distress among diverse cancer survivors who had completed all treatment within the previous year. A convenience sample of 353 cancers survivors (lung, head and neck, breast and prostate cancers) were recruited to complete a survey, which consisted of (i) Hospital Anxiety and Depression Scales; (ii) Chinese version of the Functional Assessment of Cancer Therapy-General version; and (iii) demographic and clinical data. The HRQoL scores were similar among the four types of survivors. Mild anxiety and depression levels were reported, but no significant difference was noted. Younger females with financial burdens and uncertain prognosis were particularly associated with HRQoL and emotional distress. Further studies are essential to identify specific problems that cancer patients experience after cancer diagnosis that might lead to the early detection of those most at risk of ongoing problems., (© 2013 Wiley Publishing Asia Pty Ltd.)

Background: Motivational interviewing (MI) is effective in promoting behavioural changes in patients with substance abuse and smoking. However, its effectiveness on health outcomes in cardiac rehabilitation patients is unclear., Design: A randomized controlled trial., Method: A total of 146 patients assessed as having poor motivation attended a cardiac rehabilitation programme from February 2008 to June 2010. Patients (n = 73) in the control group received usual care while those in the experimental group (n = 73) received usual care plus four sessions of MI, each lasting 30-45 min. Clinical and psychological outcomes and health-related quality of life were measured at baseline and 3 months after entering the programme. Descriptive statistics, independent t-test, Pearson Chi-squared test, and generalized estimating equations models were used to analyse the data., Results: There was no significant difference between the two groups on clinical outcomes (all p-values >0.05). Patients in the experimental group had higher increases in health-related quality of life (SF-36) scores in the aspects of general health (4.74, 95% CI 0.04-9.44; p = 0.048) and role limitation due to emotional problems (8.80, 95% CI 1.16-16.43; p = 0.024). However, they reported significantly higher increases in anxiety levels (Hospital Anxiety and Depression Scale) than those in the control group (0.96, 95% CI 0.09-1.83; p = 0.030)., Conclusion: The short-term effectiveness of MI on clinical outcomes and health-related quality of life in poorly motivated cardiac rehabilitation patients is limited. MI, however, was shown to increase anxiety levels of patients during the study period (3 months). More evidence is needed to better understand this phenomenon in the future studies.

A cross-sectional descriptive design was used in this study to compare the quality of life of younger (<60) and older (≥60) Chinese women undergoing adjuvant therapy for breast cancer. A total of 261 patients completed a self-report survey on their demographic and clinical characteristics, as well as the Functional Assessment of Cancer Therapy for Breast Cancer and the Medical Outcomes Study Social Support Survey-Chinese version. Stepwise regression was used for secondary analysis. Significant differences between the two groups were established in the total score (p = 0.049), and the physical well-being (p = 0.048), emotional well-being (p = 0.014), and breast cancer (p < 0.001) subscales after adjustment for potential confounding variables. The older group had better overall quality of life, physical and emotional well-being, and higher breast cancer subscale scores than the younger group. However, health care professionals need to be aware of the confounding factors identified and of certain cultural values, which may also influence the quality of life of these older patients., (Copyright 2011, SLACK Incorporated.)

Aim: To evaluate the acceptability, feasibility and potential effectiveness of a group‐based instrumental musical training programme in improving resilience, depressive symptoms, self‐esteem and quality of life among school‐aged children from low‐income families. Design: Assessor‐blinded pilot randomised waitlist controlled trial with process evaluation. Methods: This study was conducted in the community from January 2022 to July 2023. Sixty‐four children from low‐income families (aged 8–12 years) were randomised (1:1) to intervention and waitlist control groups. The intervention group (n = 32) received weekly 1‐hour instrumental musical training for 6 months in groups of four to five from professionally qualified musicians at a music centre. The participants in the waitlist control group (n = 32) received the same intervention as the participants in the intervention group after the completion of all outcome assessments. The primary outcome was the children's levels of resilience, measured using the Resilience Scale for Children – 10. The secondary outcomes were depressive symptoms, self‐esteem and quality of life. Assessments were conducted at baseline (T0) and immediately post‐intervention (T1). An intention‐to‐treat analysis was performed. Results: The 64 participants had a mean (SD) age of 9.5 (1.44) years, and 37 (57.8%) were boys. Compared with the waitlist control group, participants in the intervention group showed significantly greater improvements in resilience levels from baseline to T0 (group‐by‐time interaction coefficient β = 4.41; 95% CI, 1.82–6.99; p = 0.001), depressive symptoms (β = −6.42; 95% CI, −11.12 to −1.71; p = 0.008), self‐esteem (β = −2.60; 95% CI, 0.28–4.92; p = 0.028) and quality of life (β = 6.69; 95% CI, 0.18–13.2; p = 0.044). Conclusion: The group‐based instrumental musical training programme was feasible and acceptable for school‐aged underprivileged children and showed the potential to improve the resilience and quality of life of this vulnerable population. [ABSTRACT FROM AUTHOR]

Background: It is unknown whether financial well‐being mediates the impact of multimorbidity on the health‐related quality of life (HRQoL) of cancer patients. Methods: Participants were recruited from three outpatient oncology clinics of Hong Kong public hospitals. Multimorbidity was assessed using the Charlson Comorbidity Index. Financial well‐being, the mediator of the association between multimorbidity and HRQoL outcomes, was assessed using the Comprehensive Score for Financial Toxicity Functional Assessment of Chronic Illness Therapy. The HRQoL outcomes were assessed using the Functional Assessment of Cancer Therapy – General (FACT‐G) and its four sub‐dimensions. Mediation analyses were conducted using SPSS PROCESS v4.1. Results: Six‐hundred and forty cancer patients participated in the study. Multimorbidity had a direct effect on FACT‐G scores independent of financial well‐being (β for path c' = −0.752, p < 0.001). In addition, multimorbidity had an indirect effect on FACT‐G scores through its effect on financial well‐being (β for path a = −0.517, p < 0.05; β for path b = 0.785, p < 0.001). Even after adjustments were made for the covariates, the indirect effect of multimorbidity on FACT‐G via financial well‐being remained significant, accounting for 38.0% of the overall effect, indicating partial mediation. Although there were no statistically significant associations between multimorbidity, social well‐being, and emotional well‐being, the indirect effects of multimorbidity on physical and functional well‐being through financial well‐being remained significant. Conclusions: Poor financial well‐being attributable to multimorbidity partially mediates the direct impact of chronic conditions on HRQoL in Chinese cancer patients, particularly their physical and functional well‐being. [ABSTRACT FROM AUTHOR]

Background: Eczema is the most common childhood skin problem worldwide. Education that enhances parental self‐efficacy in carrying out appropriate eczema management is crucial to controlling eczema symptoms of their children. However, the lack of such a structured education program hinders everyday lives of eczematous children and their families. This study evaluated the effects of a self‐efficacy theory‐based parental eczema education program in controlling eczema of Chinese children at three months after commencement of intervention. Methods: An assessor‐blind, 2‐arm, randomized controlled trial was conducted at an outpatient clinic of a regional hospital. One hundred and thirty‐six Chinese children aged 3 months to 12 years with physician‐diagnosed eczema, and their parents were recruited. The intervention was underpinned by the Social Cognitive Theory. Children's disease severity, parental self‐efficacy, treatment adherence, and quality of life of family members were assessed by validated tools. Generalized estimating equation model was employed to compare differential change in each outcome across time between different groups. Results: Eczema severity of children and parental self‐efficacy in the intervention group were found to show greater improvement at 3‐month follow‐up with regression coefficient (β) −16.98 (95% CI, −21.04 to −12.92; P <.001) and β 29.39 (95% CI, 22.64‐36.14; P <.001), respectively. Nearly all parents (97%) receiving the intervention rated this program as useful and helpful. Conclusions: This program is effective in enhancing parents' self‐efficacy in managing their children's eczema and improving their adherence to eczema treatment and quality of life. [ABSTRACT FROM AUTHOR]

Aims: To explore the feasibility and effects of the programme based on information‐motivation‐behavioural skills (IMB) model (IMB programme) on adherence to inhalation therapy and other health outcomes in chronic obstructive pulmonary disease (COPD) patients. Background: Poor adherence to inhalation therapy is common among COPD patients. The IMB model is supported by previous studies as useful in promoting adherence to health behaviours. Methods: This pilot randomized controlled trial randomized 35 COPD patients to receive either the IMB‐based programme or usual care. The 4‐week IMB programme consisted of a face‐to‐face and two telephone sessions to empower patients with skills and knowledge on using inhalation therapy and support their goal attainment for treatment compliance. Outcome evaluation including adherence to inhalation therapy, inhalation techniques, disease impact, and quality of life was conducted at baseline and at 6 weeks after randomization. Feasibility of the IMB programme was evaluated by a satisfaction survey and implementation experience. Results: Thirty patients completed the study, with an attrition rate of 14.3%. The intervention group (n = 15) had significant improvements in inhalation adherence, inhalation techniques, and quality of life than the control group over the evaluation period. Patient satisfaction survey results and observations on programme implementation suggested the feasibility of the IMB programme. Conclusion: A IMB model is a feasible and potentially effective intervention for improving COPD patients' adherence to inhalation therapy. SUMMARY STATEMENT: What is already known about this topic? Information‐motivation‐behavioural skills (IMB) models have produced positive effects on adherence behaviour in patients with acquired immune deficiency syndrome, coronary heart disease, and diabetes. What this paper adds? No study has evaluated the effects of the IMB model on an intervention for adherence behaviour in patients with chronic obstructive pulmonary disease (COPD).The pilot randomized controlled trial (RCT) showed that the IMB model used in the intervention was effective in improving COPD patients' adherence to inhalation regimen and techniques.The pilot study found that the IMB intervention programme was feasible for implementation in outpatient settings and was highly accepted by COPD patients. The implications of this paper: This programme may be effective in improving COPD patients' adherence to inhalation regimen and inhalation techniques.The programme is feasible and acceptable.There is need to conduct an adequately powered multisite RCT to provide stringent outcome evaluation of the IMB intervention programme. [Correction added on 28 January 2020: 'The implications of this paper' section has been amended.] [ABSTRACT FROM AUTHOR]

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Background Despite establishment of advocacies centered on using patient-centered care to improve disease-related behavioral changes and health outcomes, studies have seldom discussed incorporation of patient-centered care concept in the design of secondary cardiac prevention. Objectives This review aimed to identify, appraise, and examine existing evidence on the effectiveness of nurse-led patient-centered care for secondary cardiac prevention in patients with coronary heart disease. Design A systematic review of randomized controlled trials focusing on nurse-led patient-centered care for secondary cardiac prevention was conducted. Primary outcomes were behavioral risks (e.g. smoking, physical activity), secondary outcomes were clinically relevant physiological parameters (e.g. body weight, blood pressure, blood glucose, blood lipoproteins), health-related quality of life, mortality, and self efficacy. Data sources Twenty-three English and seven Chinese electronic databases were searched to identify the trials. Review methods The studies’ eligibility and methodological quality were assessed by two reviewers independently according to the Joanna Briggs Institute guidelines. Statistical heterogeneities of the included studies were assessed by Higgins I2 and quantitative pooling was performed when studies showed sufficient comparability. Results 15 articles on 12 randomized controlled trials were included in this review. Methodological quality of the included studies was fair. Based on the Joanna Briggs Institute critical appraisal tool for experimental studies, the included studies had met a mean of six criteria out the ten in this appraisal tool. The meta-analyses of the included studies revealed that nurse-led patient-centered care had significantly improved patients' smoking habits, adherence toward physical activity advices, and total cholesterol level with medical regime optimization, in short- to medium-term. The intervention was also favorable in improving the patients' health-related quality of life in several domains of SF-36. Furthermore, from single-study results, the intervention was favorable in improving the patients' weight management and alcohol consumption. However, it did not show significant effects on improving the patient's dietary habits, certain cardiac physiological parameters, mortality and self-efficacy. Currently, no addition long-term benefit of the intervention on secondary cardiac prevention was identified. Conclusion This review has systematically analyzed the effects of nurse-led patient-centered care on patients’ behavioral risks, cardiac physiological parameters, mortality, health-related quality of life and self-efficacy. Given limited quantity of existing evidence regarding certain outcomes and long-term follow-up period; cross-trial heterogeneity of the interventions, measurement methods and statistical results; high or unclear risk of bias in some quality dimensions, the effectiveness of the intervention on secondary cardiac prevention remains inconclusive and subject to additional trials and evidences. [ABSTRACT FROM AUTHOR]

Aims/Introduction The present study applied the Wilson- Cleary model of health-related quality of life ( HRQOL) by using the structural equation modeling ( SEM) approach to understand the interrelationships among clinical, sociodemographic and psychological characteristics in older people with diabetes. Materials and Methods This was a cross-sectional study with 452 Chinese older people with diabetes recruited from three primary care clinics. A series of assessments were made, including four instruments: the Chinese version of the Short Form 36 Health Survey, Older American Resources and Services Multidimensional Functional Assessment Questionnaire, Rand Mental Health Inventory and Medical Outcomes Study Social Support Survey; and clinical outcomes (diabetes-related characteristics and physiological data). Results In the present study, we identified six patient individual and environmental characteristics, namely, age, sex, physical activity, psychological distress, social support and adequacy of income, that significantly influence HRQOL directly or by way of physical functional status and general health perception. Conclusions Improving social and financial support as well as providing interventions to promote physical activity and to cope with psychological distress in this patient population might be effective to eventually enhance their HRQOL. The present findings add to the literature the underlying complex biological and psychological processes of HRQOL, and take the body of knowledge in HRQOL of older people with diabetes to a theoretical level, and provide insights for development of appropriate strategies to optimize their HRQOL. [ABSTRACT FROM AUTHOR]

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Fatigue, sleep disturbance, and depression are frequent concurrent symptoms in patients with breast cancer. Exercise is a promising strategy for symptom management, but the effect of dance as an exercise modality for managing the fatigue–sleep disturbance–depression symptom cluster has not been evaluated yet. This study examined the effects of a 16-week dance program on reducing symptoms and improving the quality of life of patients with breast cancer who underwent adjuvant chemotherapy. A prospective, assessor-blinded, two-arm randomized controlled design was used. Adult female patients with breast cancer who were scheduled for adjuvant chemotherapy were recruited from two university-affiliated hospitals in a city in northwest China. Participants in the dance group received six sessions of hospital-based dance instruction and 16 weeks of home-based practice. The dance intervention was culturally adapted for the Chinese population. The control group received general health consultation. Outcomes including fatigue, sleep disturbance, depression, and quality of life were evaluated at baseline and after the third and sixth cycles of chemotherapy. The intention-to-treat principle and a generalized estimating equation were used to analyze data. A total of 279 individuals were assessed for eligibility, and 176 eligible participants were successfully recruited. The majority of the participants (n = 140, 79.6%) were diagnosed with stages I–II breast cancer and had undergone mastectomy (n = 155, 88.1%). The baseline characteristics were similar between the two groups. Participants in the intervention group reported less severe fatigue, sleep disturbance, and depression. In addition, a lower incidence of the symptom cluster (P = 0.003) and an increase in quality of life (P = 0.001) were found in the intervention group compared with the control group at week 17. A culturally specific dance intervention is a promising method for managing the fatigue-sleep disturbance-depression symptom cluster and promoting the quality of life in Chinese women with breast cancer receiving adjuvant chemotherapy. Given its acceptability and practicality, this program may be incorporated in routine cancer care. [ABSTRACT FROM AUTHOR]

There is considerable interest in advocating empowerment in diabetes care. Health professionals, however, often fail to realize empowerment in clinical practice, especially in patients with poorly controlled type 2 diabetes. To evaluate the effectiveness of an empowerment-based intervention on empowerment level, psychological distress, and quality of life among patients with poorly controlled type 2 diabetes. An analysis of secondary outcomes of a prospective multi-center, randomized, parallel, investigator-blinded controlled trial. A total of 242 adult patients with poorly controlled type 2 diabetes [Hemoglobin A1c (HbA1c)≥ 58 mmol/mol in the recent six months] were randomly allocated to either intervention (n = 121) or attentional control (n = 121) groups. The design of the intervention was based on the Empowerment Process Model. The intervention group received a 6-week empowerment-based transitional care program, with significant emphasis on establishing personally meaningful goals, facilitating collaborative partnership and shared decision-making, resolving life-disease conflicts via situational reflection. Participants in the attentional control group received two general health education classes and post-discharge social calls on top of routine care. Outcomes of interest include empowerment level, diabetes distress, and quality of life. Participants were invited to complete a set of questionnaires before randomization, one-week, and three-month post-intervention. Statistical analyses were performed using the generalized estimating equations based on the intention-to-treat principle. Comparing with the attention control group, participants in the intervention group showed significant improvements on empowerment level [(β = 0.163; 95% confidence interval (CI): 0.011 to 0.316, p = 0.036) at one-week post-intervention and (β = 0.176; 95% CI: 0.020 to 0.331, p = 0.027) at three-month post-intervention, respectively]. This group of patients also displayed significant reduction in terms of emotional-distress (β = −0.424, 95% CI: −0.798 to −0.049, p = 0.027) and regimen-distress (β = −0.397, 95% CI: −0.702 to −0.091, p = 0.011) at three-month post-intervention and physician-related distress (β = −0.236, 95% CI: −0.466 to −0.006, p = 0.044) at one-week post-intervention. Significant improvement in quality of life (β = 4.151, 95% CI: 1.291, 7.012, p = 0.004) at three-month post-intervention was also observed in the intervention group. Findings provide empirical evidence for the values of an empowerment-based intervention program for patients with poorly controlled type 2 diabetes in increasing the empowerment level and perceived quality of life and reducing diabetes distress. Long-term effects of the intervention and its underlying mechanisms need further investigation. [ABSTRACT FROM AUTHOR]

Heart failure self-care is crucial for sustainable heart failure management but its adherence remains poor worldwide. Despite having an intention to change, individuals often face difficulties in modifying existing lifestyle habits and sustaining change motivations. To examine the effectiveness of a novel theory-driven nurse-led self-regulation program on improving heart failure self-care behaviours, future-thinking and behavioural automaticity. A two-arm randomized controlled trial. 144 patients with heart failure were recruited from September 2018 to July 2019 at a tertiary hospital in Singapore. Participants were randomly assigned to a self-regulation intervention (n = 72) or usual care group (n = 72). The three-month intervention was developed based on the temporal self-regulation theory and consisted of one face-to-face session, a print booklet and three reinforcement telephone follow-ups at week 3, 6 and 9. Outcomes were measured at baseline (T0), immediate after a three-month intervention (T1) and a further three-month follow-up (T2). heart failure self-care was measured using the Self-Care of Heart Failure Index (SCHFI) maintenance subscale, future-thinking was measured using the Consideration of Future Consequences Scale (CFCS) and behaviour automaticity was measured using the Self-Reported Behavioural Automaticity Index (SRBAI). The outcomes were compared between groups by using generalized estimating equations (GEE) based on intention-to-treat principle. No significant differences were found between the groups at baseline except for age. Participants were on average 61 years old, men (79.2%), had mild heart failure symptoms (50.7%) and had three comorbidities (66.0% dyslipidaemia; 65.3% hypertension; 61.8% history of myocardial infarction). Baseline scores indicated poor heart failure self-care (52.9±17.2, cut off ≥70). GEE results showed significantly higher heart failure self-care improvements in intervention group than control group at both T1 (regression coefficient, B = 13.9, 95% CI: 8.02 to 19.9, p < 0.001) and T2 (B = 8.34, 95% CI: 1.68 to 15.0, p = 0.014) after adjusting for gender, living alone, education level, comorbidity and age. Results also showed significantly higher increase in future-thinking (B [95% CI]=0.694[.123, 1.26], p = 0.017) and behaviour automaticity (B [95% CI]=0.656[.085, 1.23], p = 0.024) at T1 and only increase in behaviour automaticity (B [95% CI]=0.674[.099, 1.25], p = 0.022) at T2. However, only the differences in self-care scores at T1 remained significant after Bonferroni correction. No significant differences were found for intention, quality of life and clinical biomarkers. The program was effective in improving heart failure self-care and has potential for clinical implementation and generalisation to other chronic illnesses. Longer follow-up study is needed to uncover its long-term benefits on clinical outcomes. [ABSTRACT FROM AUTHOR]

Impaired physical mobility refers to a limitation in independent and purposeful physical movement of the body or one or more extremities. Physical restrictions result in negative consequences on an individual's physical and psychosocial functions. Sitting Tai Chi, a derivative form of traditional Tai Chi, has been found to increase the flexibility of all joints involved and enhance the ability to perform physical activity. However, the evidence of sitting Tai Chi on physical and psychosocial health outcomes on individuals with impaired physical mobility is limited. To critically synthesize evidence that evaluates the effects of sitting Tai Chi on health outcomes among individuals with impaired physical mobility and to identify implementation strategies for the sitting Tai Chi intervention. Searches were performed across 11 English and two Chinese databases systematically from inception to January 2020. Randomised controlled trials and non-randomised controlled trials, written in English or Chinese were included. Two independent reviewers screened all eligible studies, appraised risk of bias, and extracted the data. Meta-analyses were conducted using Review Manager 5.4 and narrative syntheses were performed where meta-analysis was inappropriate. The certainty of evidence was assessed using Grades of Recommendation, Assessment, Development and Evaluation profiler Guideline Development Tool. This study was registered in PROSPERO. A total of 1,446 records were generated and 11 studies were eligible for inclusion. Meta-analysis reported a statistically significant effect size favouring sitting Tai Chi on depressive symptoms (SMD: -1.53, 95% CI: -2.81 to -0.21, 2 studies; very low quality), heart rate (MD: -5.72, 95% CI: -11.16 to -0.29, 2 studies; low quality) and social domain of quality of life (MD: 1.42, 95% CI: 0.66 to 2.19, 3 studies; low quality). Sitting Tai Chi was found to have favourable effects on depressive symptoms, heart rate, and social domain of quality of life of individuals with impaired physical mobility. Very low to low quality evidence does not support the effectiveness of sitting Tai Chi on dynamic sitting balance, handgrip strength, and the physical and psychological domains of quality of life. There was limited evidence to suggest the best implementation strategies for the sitting Tai Chi intervention. It is anticipated that more well-designed studies will continue developing high quality evidence in this field. [ABSTRACT FROM AUTHOR]