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Group-based music intervention in Parkinson's disease - findings from a mixed-methods study.

ABSTRACT: OBJECTIVE:To evaluate a group-based music intervention in patients with Parkinson's disease. DESIGN:Parallel group randomized controlled trial with qualitative triangulation. SETTING:Neurorehabilitation in primary care. SUBJECTS:Forty-six patients with Parkinson's disease were randomized into intervention group (n?=?26), which received training with the music-based intervention, and control group (n?=?20) without training. INTERVENTIONS:The intervention was delivered twice weekly for 12?weeks. MAIN MEASURES:Primary outcome was Timed-Up-and-Go subtracting serial 7's (dual-task ability). Secondary outcomes were cognition, balance, concerns about falling, freezing of gait, and quality of life. All outcomes were evaluated at baseline, post-intervention, and three months post-intervention. Focus groups and individual interviews were conducted with the intervention group and with the delivering physiotherapists. RESULTS:No between-group differences were observed for dual-task ability. Between-group differences were observed for Falls Efficacy Scale (mean difference (MD)?=?6.5 points; 95% confidence interval (CI)?=?3.0 to 10.0, P?=?0.001) and for Parkinson Disease Questionnaire-39 items (MD?=?8.3; 95% CI?=?2.7 to 13.8, P?=?0.005) when compared to the control group post-intervention, but these were not maintained at three months post-intervention. Three themes were derived from the interviews: Expectations versus Results, Perspectives on Treatment Contents, and Key Factors for Success. CONCLUSION:Patient-reported outcomes and interviews suggest that the group-based music intervention adds value to mood, alertness, and quality of life in patients with Parkinson's disease. The study does not support the efficacy in producing immediate or lasting gains in dual-tasking, cognition, balance, or freezing of gait.

SUBMITTER: Pohl P

PROVIDER: S-EPMC7132435 | biostudies-literature | 2020 Apr

REPOSITORIES: biostudies-literature

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Group-based music intervention in Parkinson's disease - findings from a mixed-methods study.

Pohl Petra P Wressle Ewa E Lundin Fredrik F Enthoven Paul P Dizdar Nil N

Clinical rehabilitation 20200219 4

<h4>Objective</h4>To evaluate a group-based music intervention in patients with Parkinson's disease.<h4>Design</h4>Parallel group randomized controlled trial with qualitative triangulation.<h4>Setting</h4>Neurorehabilitation in primary care.<h4>Subjects</h4>Forty-six patients with Parkinson's disease were randomized into intervention group (<i>n</i> = 26), which received training with the music-based intervention, and control group (<i>n</i> = 20) without training.<h4>Interventions</h4>The inter ...[more]

PMID: 32070122

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Project description:IntroductionParkinson's disease (PD) is the second most common neurodegenerative disorder in developed countries. There is an increasing interest in the use of mindfulness-related interventions in the management of patients with a chronic disease. In addition, interventions that promote personal control, stress-management and other lifestyle factors, such as diet and exercise, assist in reducing disability and improving quality of life in people with chronic illnesses. There has been little research in this area for people with PD.MethodsA prospective mixed-method randomised clinical trial involving community living adults with PD aged <76 years and with moderate disease severity (Hoehn and Yahr stage 2) PD. Participants will be randomised into the ESSENCE 6-week programme or a matched wait list control group. ESSENCE is a multifaceted, healthy lifestyle and mindfulness programme designed to improve quality of life. We aim to determine whether participation in a mindfulness and lifestyle programme could improve PD-related function and explore self-management related experiences and changing attitudes towards self-management. The outcome measures will include 5 self-administered questionnaires: PD function and well-being questionnaire (PDQ39), Health Behaviours, Mental health, Multidimensional locus of control, and Freiburg mindfulness inventory. An embedded qualitative protocol will include in-depth interviews with 12 participants before and after participation in the 6-week programme and a researcher will observe the programme and take notes.AnalysisRepeated measures of Analysis of Variance (ANOVA) will examine the outcome measures for any significant effects from the group allocation, age, sex, adherence score and attendance. Qualitative data will be analysed thematically. We will outline the benefits of, and barriers to, the uptake of the intervention.EthicsThis protocol has received ethics approval from the Monash University Human Research Ethics Committee project number CF11/2662-2011001553.DisseminationThis is the first research of its kind in Australia involving a comprehensive, lifestyle-based programme for people with PD and has the potential to involve a broader range of providers than standard care. The findings will be disseminated through peer reviewed journals, primary care conferences in Australia as well as abroad and through the Parkinson's community.Registration detailsAustralian New Zealand Clinical Trials Registry (ANZCTR) ACTRN12612000440820.

Project description:BACKGROUND:eHealth interventions show stronger effects when informed by solid behavioral change theories; for example, self-regulation models supporting people in translating vague intentions to specific actions have shown to be effective in altering health behaviors. Although these theories inform developers about which behavioral change techniques should be included, they provide limited information about how these techniques can be engagingly implemented in Web-based interventions. Considering the high levels of attrition in eHealth, investigating users' experience about the implementation of behavior change techniques might be a fruitful avenue. OBJECTIVE:The objective of our study was to investigate how users experience the implementation of self-regulation techniques in a Web-based intervention targeting physical activity and sedentary behavior in the general population. METHODS:In this study, 20 adults from the general population used the intervention for 5 weeks. Users' website data were explored, and semistructured interviews with each of the users were performed. A directed content analysis was performed using NVivo Software. RESULTS:The techniques "providing feedback on performance," "action planning," and "prompting review of behavioral goals" were appreciated by users. However, the implementation of "barrier identification/problem solving" appeared to frustrate users; this was also reflected by the users' website data-many coping plans were of poor quality. Most users were well aware of the benefits of adopting a more active way of living and stated not to have learned novel information. However, they appreciated the provided information because it reminded them about the importance of having an active lifestyle. Furthermore, prompting users to self-monitor their behavioral change was not sufficiently stimulating to make users actually monitor their behavior. CONCLUSIONS:Iteratively involving potential end users offers guidance to optimally adapt the implementation of various behavior change techniques to the target population. We recommend creating short interventions with a straightforward layout that support users in creating and evaluating specific plans for action.

Project description:BackgroundLimited access to mental health care services due to provider shortages, geographic limitations, and cost has driven the area of mobile health (mHealth) care to address these access gaps. Reports from the Cohen Veterans Network and National Council for Behavioral Health show that in states where mental health care is more accessible, 38% of people still do not receive the care they need. mHealth strategies help to provide care to individuals experiencing these barriers at lower cost and greater convenience, making mHealth a great resource to bridge the gaps.ObjectiveWe present a mixed methods study to evaluate user experiences with the mental mHealth service, Cope Notes. Specifically, we aimed to investigate the following research questions: How do users perceive the service in relation to stigma, impact of the intervention, and perceived usefulness? How do users rate the Cope Notes service and SMS text messaging along various dimensions of acceptability? What is the relationship between Cope Notes SMS text message ratings, user personality, and coping strategies? What are user perspectives of leveraging ubiquitous sensing technologies to improve delivery and provide tailored content?MethodsWe performed qualitative interviews with Cope Notes users (N=14) who have used the service for at least 30 days to evaluate their experiences and usefulness of the service. These interviews were coded by 2 raters (SLK and JL), and the interrater reliability was calculated with SPSS (IBM Corp) at 61.8%. In addition, participants completed quantitative measures, including a user experiences survey, personality inventory (Big Five Inventory-10), and coping assessment (Brief Coping Orientation to Problems Experienced).ResultsWe derived 7 themes from our qualitative interviews: Likes or Perceived Benefits, Dislikes or Limitations, Suggested Changes, Stigma or Help Seeking, Perceptions of Ubiquitous Sensing, Cultural Sensitivity, and Alternative mHealth Resources. Exploratory analyses between acceptability ratings of Cope Notes and personality factors showed statistically significant positive relationships between seeing oneself as someone who is generally trusting and acceptability items, the most significant being item 7 (I fully understood the sentiment behind Cope Notes Messages) with (rs(10)=0.82, P=.001). We also found statistically significant relationships between acceptability and Brief Coping Orientation to Problems Experienced items, with the strongest positive correlation between participants strongly endorsing coping by accepting the reality that an event has happened and acceptability item 7 (rs(8)=0.86, P=.001).ConclusionsOur study found that Cope Notes subscribers appreciate the service for reframing their mental wellness with statistically significant correlations between personality and acceptability of the service. We found that some users prefer a more personalized experience with neutral to positive reactions to a potential companion app that continuously monitors user behavior via smartphone sensors to provide just-in-time interventions when users need it most.

Project description:BackgroundHaemodialysis can negatively impact quality of life and mental health. Arts-based interventions used successfully in other settings to improve health and well-being, could help address the impact of haemodialysis. This study aimed to evaluate the feasibility and acceptability of conducting a randomised controlled trial (RCT) of an arts-based intervention for patients receiving haemodialysis.MethodsA parallel convergent mixed-methods design was used, including a pilot cluster RCT and qualitative process evaluation. Phase 1 evaluated recruitment and retention rates through a pilot cluster RCT at a single haemodialysis unit in Northern Ireland. Participants included patients who received haemodialysis for ESKD, were over the age of 18 and had the capacity to consent. These participants were randomised to the intervention or control group according to their haemodialysis shift. The intervention involved six one-hour, one-to-one facilitated arts sessions during haemodialysis. Phase 2 explored intervention and trial acceptability through a qualitative process evaluation using semi-structured interviews based on the RE-AIM framework. Participants included 13 patients who participated in phase 1 of the study, including 9 participants from the experimental group and four participants from the control group, and nine healthcare professionals who were present on the unit during implementation.ResultsOut of 122 outpatient haemodialysis patients, 94 were assessed as eligible for participation. Twenty-four participants were randomised, meaning 80% of the target sample size was recruited and the attrition rate at 3 months was 12.5% (n = 3). Participants viewed the arts as more accessible and enjoyable than anticipated following implementation. All participants who started the intervention (n = 11) completed the full six sessions. Qualitative benefits of the intervention suggest improvements in mental well-being. Patient choice and facilitation were important factors for successful implementation.ConclusionAn arts-based intervention for patients receiving haemodialysis is acceptable for both patients and healthcare professionals, and a definitive trial is feasible. The intervention may help improve mental-wellbeing in patients receiving haemodialysis, but this requires further investigation in a definitive trial.Trial registrationThe trial was prospectively registered on clinicaltrials.gov on 14/8/2018, registration number NCT03629496 .

Project description:PurposeTo investigate the feasibility, acceptability, and preliminary efficacy of a 6-session music therapy protocol on self-efficacy, quality of life, and coping skills in adults with sickle cell disease (SCD).Patients and methodsUsing a mixed-methods intervention design, adults with SCD (ages 21-57; mean age 32.33) were randomized (1:1) to either 1) a 6-session music therapy (MT) intervention (n = 12) or 2) waitlist control (WLC) (n = 12) using stratified randomization where factors were age in years (≤30 vs >30), and sex (male, female). All participants completed two weeks of daily electronic pain diary entries and self-efficacy, quality of life, and coping skills measures before and after their assigned study condition to explore preliminary efficacy. MT participants were taught music exercises accessed via smartphone and subsequently interviewed to determine feasibility and acceptability.ResultsThe enrollment rate was 89%. All study measures were completed, with high rates of electronic pain diary completion at baseline (70%) and 2-week follow-up (66%). Interviews revealed two overall themes related to MT participants' experience: 1) participants learned new self-management skills and 2) MT improved participants' ability to cope with pain. MT participants demonstrated 100% attendance. In preliminary analyses, MT participants demonstrated significant improvements (means ± SD) in self-efficacy (5.42 ± 5.43, p = 0.008, d = 1.20), PROMIS sleep disturbance (-1.49 ± 6.68, p = 0.023, d = -0.99), PROMIS pain interference (-2.10 ± 4.68, p = 0.016, d = -1.06), and ASCQ-Me social functioning impact scores (2.97 ± 6.91, p = 0.018, d = 1.05) compared to WLC participants.ConclusionPreliminary findings support the feasibility and acceptability of music therapy for home use in adults with SCD. While music therapy may assist adults with SCD in improving self-efficacy and quality of life, subsequent, fully-powered clinical research is needed to determine its efficacy.

Project description:Group psychotherapy is a useful clinical practice for adolescents with mental health issues. Groups typically consist of young people of similar ages but with different personalities, and this results in a complex communication network. The goal of group psychoanalytic psychotherapy is to improve participants' mentalization abilities, facilitating interactions between peers and their therapist in a safe, containing environment. The main aim of this study was to analyze conversation turn-taking between a lead therapist, a co-therapist, and six adolescents over the course of 24 treatment sessions divided into four blocks over 8 months. We employed a mixed-methods design based on systematic observation, which we consider to be a mixed method itself, as the qualitative data collected in the initial observation phase is transformed into quantitative data and subsequently interpreted qualitatively with the aid of clinical vignettes. The observational methodology design was nomothetic, follow-up, and multidimensional. The choice of methodology is justified as we used an ad-hoc observation instrument combining a field format and a category system. Interobserver agreement was analyzed quantitatively by Cohen's kappa using the free QSEQ5 software program. Once we had confirmed the reliability of the data, these were analyzed by polar coordinate analysis, which is a powerful data reduction technique that provides a vector representation of relationships between categories. The results show significant relationships between the therapist and (1) the activation of turn-taking by the participants and the co-therapist and silence and (2) conversation-facilitating interventions and interventions designed to improve mentalization abilities. Detailed analysis of questions demonstrating interest in others showed how the communication changed from radial interactions stemming from the therapist at the beginning of therapy to circular interactions half way through. Repetition was found to be a powerful conversation facilitator. The results also illustrate the role of the therapist, who (1) did not facilitate interventions by all participants equally, (2) encouraged turn-taking from more inhibited members of the group, (3) stimulated conversation from the early stages of therapy, and (4) favored mentalization toward the end. Despite its complexity, polar coordinate analysis produces easy-to-interpret results in the form of vector maps.

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Group-based music intervention in Parkinson's disease - findings from a mixed-methods study.

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Group-based music intervention in Parkinson's disease - findings from a mixed-methods study.

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