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BackgroundCognitive frailty refers to the coexistence of physical frailty and cognitive impairment, and is associated with many adverse health outcomes. Although cognitive frailty is prevalent in older people, motor-cognitive training is effective at enhancing cognitive and physical function. We proposed a virtual reality (VR) simultaneous motor-cognitive training program, which allowed older people to perform daily activities in a virtual space mimicking real environments. ObjectiveWe aimed to (1) explore the feasibility of offering VR simultaneous motor-cognitive training to older people with cognitive frailty and (2) compare its effects with an existing motor-cognitive training program in the community on the cognitive function and physical function of older people with cognitive frailty. MethodsA two-arm (1:1), assessor-blinded, parallel design, randomized controlled trial was employed. The eligibility criteria for participants were: (1) aged ≥60 years, (2) community dwelling, and (3) with cognitive frailty. Those in the intervention group received cognitive training (ie, cognitive games) and motor training (ie, cycling on an ergometer) simultaneously on a VR platform, mimicking the daily living activities of older people. Those in the control group received cognitive training (ie, cognitive games) on tablet computers and motor training (ie, cycling on the ergometer) sequentially on a non-VR platform. Both groups received a 30-minute session twice a week for 8 weeks. Feasibility was measured by adherence, adverse outcomes, and successful learning. The outcomes were cognitive function, physical frailty level, and walking speed. ResultsSeventeen participants were recruited and randomized to either the control group (n=8) or intervention group (n=9). At baseline, the median age was 74.0 years (IQR 9.5) and the median Montreal Cognitive Assessment score was 20.0 (IQR 4.0). No significant between-group differences were found in baseline characteristics except in the number of chronic illnesses (P=.04). At postintervention, the intervention group (Z=–2.67, P=.01) showed a significantly larger improvement in cognitive function than the control group (Z=–1.19, P=.24). The reduction in physical frailty in the intervention group (Z=–1.73, P=.08) was similar to that in the control group (Z=–1.89, P=.06). Improvement in walking speed based on the Timed Up-and-Go test was moderate in the intervention group (Z=–0.16, P=.11) and greater in the control group (Z=–2.52, P=.01). The recruitment rate was acceptable (17/33, 52%). Both groups had a 100% attendance rate. The intervention group had a higher completion rate than the control group. Training was terminated for one participant (1/9, 11%) due to minimal VR sickness (Virtual Reality Sickness Questionnaire score=18.3/100). Two participants (2/8, 25%) in the control group withdrew due to moderate leg pain. No injuries were observed in either group. ConclusionsThis study provides preliminary evidence that the VR simultaneous motor-cognitive training is effective at enhancing the cognitive function of older people with cognitive frailty. The effect size on frailty was close to reaching a level of significance and was similar to that observed in the control group. VR training is feasible and safe for older people with cognitive frailty. Trial RegistrationClinicalTrials.gov NCT04467216; https://clinicaltrials.gov/ct2/show/NCT04467216

Few studies have explored the experiences of family caregivers of persons living with dementia (PLWD) in acceptance and commitment therapy (ACT). This study aimed for in-depth exploration on experiences of family caregivers of PLWD in ACT. Individual interviews were conducted with eight family caregivers of PLWD who were women and participated in an eight-week video conferencing ACT program. Data were analysed using interpretative phenomenological analysis. Two overarching themes emerged, including improved strategies in responding to emotions and thoughts in challenging caregiving situations and taking better care of myself. Participants perceived that ACT skills training improved their coping strategies and, subsequently, their daily emotions and relationship with their relatives with dementia. Participants also perceived ACT strategies and exercises as helpful and applicable resources for daily use in challenging caregiving situations. In addition, ACT helped participants feel comfortable taking the time to take care of themselves without feeling guilty and acknowledge that they must take care of themselves first to take better care of their relatives with dementia. These changes helped caregivers increase their participation in valued activities. This study contributes to the literature by exploring experiences of family caregivers of PLWD in ACT, including its perceived benefits on themselves. Trial registration: ClinicalTrials.gov ID: NCT04847986 () What is already known about this topic: Adverse mental health outcomes in family caregivers of persons living with dementia (PLWD) can result from caregivers' difficulties in accepting challenges and emotions and the lack of strategies for managing their own emotions and balancing care demands with other important aspects of life. Acceptance and commitment therapy (ACT) is an evidence-based practice that can promote mental health and engagement in personally valued activities through acceptance and mindfulness processes and behaviour change processes for valued living. There have been only two studies that involved a qualitative approach to explore the experiences of family caregivers of PLWD in ACT. These feasibility studies found that contents covered and the online delivery formats for ACT were acceptable to family caregivers of PLWD. What this topic adds: The present study contributes to the literature with in-depth exploration on experiences of family caregivers of PLWD in ACT with thick descriptions, including the benefits of ACT from the perspectives of family caregivers of PLWD. ACT helped family caregivers of PLWD improve strategies for responding to their emotions and thoughts that arise from challenging caregiving situations. Caregivers also perceived ACT as helpful and applicable for daily use in challenging caregiving situations. ACT helped these caregivers feel comfortable taking the time they needed to take care of themselves without feeling guilty and acknowledge that they must take care of themselves first to take better care of their relatives with dementia; these changes helped caregivers increase their participation in valued activities. [ABSTRACT FROM AUTHOR]

Background/Purpose: Minimally invasive surgery (MIS) has become popular in every specialty. Different distal metatarsal osteotomy methods using minimally invasive percutaneous approach with or without fixation have been proposed to treat mild to moderate degrees of hallux valgus. Methods: From June 2010 to May 2012, we performed 23 percutaneous chevron osteotomies with screw fixation in 20 patients. Results: At 18 months postoperatively, the mean hallux valgus angle (HVA) was corrected from 31.68° to 14.39°, mean intermetatarsal angle (IMA) from 13.77° to 7.98° and mean American Orthopaedic Foot and Ankle Society (AOFAS) score from 59.26 to 88.35. There were four cases of medial plication stitch impingement and four cases with screw impingement but no other complications such as joint stiffness, avascular necrosis of metatarsal head, union complication, wound infection or deep vein thrombosis. Conclusion: The mid-term results are encouraging, indicating that this is an effective method in the treatment of mild to moderate hallux valgus with advantages of percutaneous technique. Further study with longer-term results and larger sample size is needed in order to compare with other percutaneous or open techniques.

This study examined effects of coach-guided videoconferencing acceptance and commitment therapy (ACT) accompanied by psychoeducation on distressed individuals with spinal cord injury (SCI) and explored participants' experiences in the intervention. Ten people with SCI participated in 8 individual videoconferencing sessions delivered by trained coaches. Data using self-reported questionnaires and individual interviews was collected at pretest and posttest and analyzing using Wilcoxon signed-rank tests and interpretative phenomenological analysis (ClinicalTrials.gov ID: NCT04670406). Statistically significant improvements were found in depression, anxiety, stress, grief, engagement in meaningful activities, and self-compassion with medium to large effect sizes. There was no significant change in quality of life, resilience, and ACT processes. Participants gained a new way of thinking by: being aware of thoughts and emotions; exploring perceptions of others; and focusing on the present. Also, the intervention equipped participants to deal with challenges by: improving coping with SCI-related conditions; practicing self-compassion, acceptance, and meditation; and acquiring skills of value-based decision making and committed action. Findings contribute to the limited evidence as the first study that measured effects of videoconferencing ACT on people with SCI. Future randomized controlled trials are needed to measure efficacy of internet-delivered ACT for people with SCI. Guided videoconferencing ACT may reduce depressive symptoms, anxiety, stress, and grief and increase engagement in meaningful activities and self-compassion in people with SCI. Professionals may consider ACT as a supportive or adjunct service for people with SCI who experience psychological distress. [ABSTRACT FROM AUTHOR]

The purpose of this study is to explore physiological and psychological changes immediately after a short-term visit to urban parks in an uncontrolled condition. Sixty park visitors completed a short questionnaire evaluating their subjective well-being (SWB) and donated a saliva sample immediately before and after their park visit. In addition, participants wore a pedometer to track their physical activity level during the park visit. Results indicated the levels of all biomarkers (cortisol, dehydroepiandrosterone [DHEA], and cortisol/DHEA ratio) decreased while SWB scores increased after the park visit. The duration of park visit was identified as a key variable significantly associated with cortisol reduction, and changes in SWB scores after the park visit were significantly associated with changes in cortisol level. A park visit duration of 21.8 min has the predictive ability to discriminate park visitors who exhibit reductions in cortisol levels after the park visit from those who do not. [ABSTRACT FROM AUTHOR]

This qualitative study explored ex-offender's community reintegration experiences following a prison sentence. Fourteen ex-offenders from the Offender Alumni Association participated in an in-person in-depth individual interview regarding their current roles, daily routines, living situation, activity participation, and current and future plans. A phenomenological approach using thematic analysis was employed for data collection and interpretation. The emerged themes were categorized under facilitators and barriers that influence healthy community reintegration. The facilitators included visualizing and committing to an ideal future, establishing a daily routine, upholding life balance, and discovering and connecting to external supports. The barriers included impediments to employment opportunities, lack of financial resources, social stigma, regulations imposed by the judicial system, disconnection from social advancements, and addiction to drugs and alcohol. The themes identified from the interviews suggest that current reintegration strategies and programs need to be improved in order to benefit ex-offenders seeking these services. [ABSTRACT FROM AUTHOR]

This study seeks to examine the effect of the characteristics of park users, park characteristics, and the neighborhood environment on park visits and the resultant perceived health status of residents living in Alabama, US. One hundred and eighty-nine participants, representing residents from 49 counties in Alabama, were recruited via a random-digit dial method to complete a telephone survey related to park visits. Data collection spanned 11 months. Results from the path analysis indicated a few significant direct effects: park location and body mass index (BMI) were the only two factors significantly associated with park visits, with race being marginally significant; and work status was significantly associated with perceived health. Our findings suggest park proximity, and high BMI are related to park visits and work status is related to perceived health among Alabamians. It is recommended that more neighborhood parks are needed for promoting Alabamians to visit them more frequently. [ABSTRACT FROM AUTHOR]

This study examined the effects of a guided online acceptance and commitment therapy (ACT) intervention on distressed family caregivers of persons living with dementia and explored the experiences of these caregivers in the ACT intervention. Seven family caregivers experiencing psychological distress individually participated in 10 ACT videoconference sessions guided by a trained coach. Quantitative data, such as psychological distress, burden, and ACT processes, were collected at pretest and posttest and analyzed using the Wilcoxon signed-rank test. Individual interviews were conducted at posttest and analyzed using interpretative phenomenological analysis. Statistically significant reductions were found in depressive symptoms, anxiety, stress, and burden (p <.05) with medium effect sizes. ACT sessions helped caregivers gain renewed strength by: being equipped with resources to use under distress throughout the caregiving journey; being more self-compassionate and taking care of one's self; and being more patient with relatives with dementia. Findings contribute to the limited evidence in guided online ACT for caregivers of persons living with dementia. Further studies with a larger sample size are needed to evaluate the efficacy of guided online ACT. Guided online ACT may reduce depressive symptoms, anxiety, stress, and burden of family caregivers of persons living with dementia. [ABSTRACT FROM AUTHOR]