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- Effectiveness of multisensory stimulation in managing neuropsychiatric symptoms in older adults with major neurocognitive disorder: a systematic reviewPublication . Silva, Rosa Carla; Abrunheiro, Sérgio; Cardoso, Daniela; Costa, Paulo; Couto, Filipa; Agrenha, Cátia; Apóstolo, JoãoObjective: The objective of the review was to synthesize the effectiveness of multisensory stimulation in managing neuropsychiatric symptoms (NPS) in older adults with major neurocognitive disorder (NCD). Introduction: Major neurocognitive disorder is characterized by changes in specific cognitive domains with a progressive deterioration in cognitive ability and capacity for independent living. Most older adults with this condition have one or more concomitant symptoms known as NPS. Evidence shows that nonpharmacological therapies have been effective in controlling these symptoms, with multisensory stimulation attracting further investigation. Inclusion criteria: The review considered studies on older adults aged 65 years or over with major NCD. The intervention of interest was multisensory stimulation, and the comparator was usual care (e.g. no occupational therapy, no cognitive training, and no art therapy, but with possible control of activities such as looking at photographs or doing quizzes), or another intervention (e.g. occupational therapy, cognitive training and art therapy). Primary outcomes were NPS (agitation, aggression, motor disturbances, mood liability, anxiety, apathy, night-time behaviour, eating disorders, delusion and hallucination). Secondary outcomes were quality of life, functional status in activities of daily living, cognitive status and caregiver burden. Experimental study designs were considered. Methods: A broad range of keywords and a three-step search strategy were used to identify potentially eligible published and unpublished studies from January 1990 to June 2016 in major healthcare-related online databases. Studies in English, Spanish and Portuguese were included. Two independent reviewers assessed the methodological quality of eight included studies using the Joanna Briggs Institute (JBI) Critical Appraisal Checklists for Randomized Controlled Trials and Quasi-Experimental Studies. Data were extracted using the standardized data extraction tool from the JBI System for the Unified Management, Assessment and Review of Information (JBI SUMARI) and included details about the interventions, populations, study methods and outcomes of interest. Significant differences were found between participants, interventions, outcome measures (clinical heterogeneity), and designs (methodological heterogeneity). For these reasons, a meta-analysis could not be performed. Therefore, the results have been described in a narrative format. Results: Eight studies (seven randomized controlled trials and one quasi-experimental study) were included, with a total sample of 238 participants (pre-intervention). Four studies confirmed the effectiveness of multisensory stimulation in domains such as physically nonaggressive behavior, verbally agitated behavior and agitation. However, these effects did not always persist in the long-term. Six studies showed poorly consistent results on the effects of multisensory stimulation in improving mood, with only one displaying significant effects. Similarly, despite poor results, two studies showed benefits concerning anxiety. Participants reported significantly decreased levels of anxiety over the course of the intervention, and this improvement persisted in the long-term. In regard to functional status in activities of daily living, two studies reported an improvement in the short-term. Moreover, the effectiveness in cognitive domains such as memory and attention to surroundings also showed inconsistent results across the seven studies that analyzed this outcome. Two studies reflected an improvement during the intervention, but also reported a gradual decline in the long-term. Only one study observed significantly better results during the intervention that persisted until the follow-up assessment. Apathy, night-time behavior, eating disorders, delusion and hallucination were NPS that were not explored in the studies that met the criteria to be included in this review. Conclusions: These findings suggest that multisensory stimulation could be an effective intervention for managing NPS in older adults with major NCD in a mild to severe stage, particularly for managing behavioral symptoms such as agitation. This research provides an indication of the likely effect of the multisensory stimulation on NPS such as agitation and anxiety, as well on cognitive status.
- Estimulação cognitiva em pessoas idosas : intervenção individual na fragilidade cognitivaPublication . Silva, Rosa Carla Gomes da; Apóstolo, João Luís AlvesÉ uma prioridade societal disponibilizar condições que promovam o envelhecimento da população na comunidade. A par do envelhecimento temos o aumento da prevalência de doenças crónicas, como é o caso das Perturbações Neurocognitivas (PNC). Neste contexto, viver na comunidade, pelo maior tempo possível, inclui a prestação de cuidados multimodais pelo cuidador familiar/informal. Este estudo centra-se na estimulação cognitiva (EC) individual, como uma intervenção a ser promovida pelo cuidador, em ambiente familiar. Objetivo: avaliar a aceitabilidade, aplicabilidade e o impacto de um programa de EC individual (PECI) em pessoas com PNC (PcPNC), implementado pelo cuidador em contexto domiciliário. Metodologia: O PECI testado foi o Making a Difference 3 - Individual Cognitive Stimulation Therapy (MD3), em português Fazer a Diferença 3 - Intervenção Individual de Estimulação Cognitiva (FD3). Metodologicamente o trabalho foi organizado em seis tarefas. As duas primeiras tarefas foram duas revisões sistemáticas da literatura (RSL) sobre a evidência de eficácia, segundo a metodologia do Joanna Briggs Institute. Estas duas RSL serviram de fundamentação conceptual para o presente trabalho. A primeira centra-se na eficácia das intervenções cognitivas promovidas pelo cuidador na cognição e a segunda sobre a eficácia da estimulação multissensorial (EM) na gestão dos sintomas neuropsiquiátricos (SNP). As três tarefas seguintes (Tarefa III, IV e V) consistiram na preparação do estudo piloto: a Tarefa III corresponde à tradução e adaptação para cultura e língua portuguesa do PECI-MD3, que metodologicamente segui as orientações do Formative Method For Adapting Psychotherapy; na Tarefa IV identifica-se o ponto de corte e as propriedade psicométrica do Teste de Declínio Cognitivo de Seis Itens (6CIT, instrumento de rasteio cognitivo); a Tarefa V corresponde à tradução e validação para a língua e cultura portuguesa da escala Quality of the Carer-Patient Relationship, que decorreu em quatro etapas (tradução, síntese, retroversão e criação da versão consensual). Por fim, na Tarefa VI, apresenta-se o estudo piloto que metodologicamente foi um ensaio clínico randomizado controlado (RCT). Resultados: A RSL sobre de eficácia das intervenções cognitivas promovida pelos cuidadores identifica efeitos benéficos a favor desta abordagem, em vários domínios cognitivos como memória, atenção, fluência verbal e resolução de problemas. Na segunda RSL (sobre a eficácia da EM) os resultados, dos estudos primários incluídos, apoiam o uso desta intervenção no controlo do comportamento fisicamente não agressivo, como agitação comportamental e verbal, do humor e da ansiedade. Pelo desenvolvimento da Tarefa III, obteve-se a versão pré-final do PECI-FD3 (versão β) que permitiu a condução do estudo piloto (Tarefa VI). Pela Tarefa V afere-se que o 6-CIT, pelas suas propriedades psicométricas e de precisão, é um instrumento de rastreio robusto; e também adequados pontos de corte, ajustados à população portuguesa, para o 6CIT são aferidos. A escala QCPR versão portuguesa apresenta propriedades psicométricas consistentes para uma das suas duas subescalas. É necessário o desenvolvimento de trabalhos futuros que permitam a continuidade deste processo de validação. Por último, na Tarefa VI, verifica-se pelo desenvolvimento do RCT, que grupo que recebeu a EC pelo programa FD3 apresenta ganhos na cognição, em comparação com o grupo controlo, mais especificamente na orientação e compreensão de ordens. Discussão/Conclusão: A evidência identificada pelas RSL e pelo RCT apoiam as intervenções não farmacológicas na gestão dos domínios cognitivos e SNP. Este trabalho colocou à disposição para a população portuguesa um PECI, com 75 sessões de EC, que permite ao cuidador familiar/informal ter um papel mais ativo no cuidado à PcPNC. Considera-se que, no global, este trabalho fornece instrumentos essenciais para o cuidado à PcPNC/cuidador, como o 6CIT (rastreio cognitivo) e a escala QCPR (que avalia da qualidade da relação entre a díade).
- Midwifery interventions to reduce fear of childbirth in pregnant women: a scoping review protocolPublication . Souto, Sandra Patrícia Arantes do; Albuquerque, Rosemeire Sartori de; Silva, Rosa Carla Gomes da; Guerra, Maria João; Prata, Ana PaulaObjective: The objective of the review is to map and analyze midwifery interventions to reduce fear of childbirth in pregnant women. Introduction: Fear of childbirth is a phenomenon negatively affecting women's health and well-being before and during pregnancy, as well as after childbirth. During the previous few decades, there has been a growing interest in research into interventions to reduce the fear of childbirth in childbearing women. Currently, providing an appropriate model of care for pregnant women with fear of childbirth is a challenge in midwifery care. Therefore, further efforts are needed to identify and examine the characteristics of different midwifery interventions to reduce fear of childbirth in pregnant women. Inclusion criteria: This scoping review will consider studies that include interventions to reduce fear of childbirth in pregnant women, led and implemented by midwives, during the antenatal period, in all possible birth scenarios. Quantitative, qualitative, and mixed methods studies will be included. Methods: The JBI methodology for conducting scoping reviews will be employed. Published and unpublished literature in English, Portuguese, and Spanish, from 1981 to the present, will be included. MEDLINE, CINAHL Complete, Scopus, Web of Science, Embase, and Cochrane Library databases will be searched. Searches for gray literature will be performed. Data will be extracted using a tool developed specifically for the scoping review objectives.
- Use of innovative technologies in group-based reminiscence interventions in older adults’ with dementia: a scoping reviewPublication . Gil, Isabel; Santos-Costa, Paulo; Bobrowicz-Campos, Elzbieta; Santos, Eduardo; Silva, Rosa Carla; Sousa, Liliana B.; Almeida, Maria de Lurdes; Apóstolo, JoãoBackground: Reminiscence therapy (RT) emerges in the literature as a non-pharmacological intervention commonly implemented in groups of older adults with dementia, and which has significant positive results in outcomes such as cognition and depressive symptomatology. Simultaneously, we witness the gradual addition of innovative technologies in non-pharmacological interventions in this population segment. However, no studies have synthesized the main contributions of the use of technology in group-based RT sessions. Aim: To map the available evidence on group-based RT sessions/activities aided by technological innovations, and critically discussed the potentialities and weaknesses of its use. Methods: Scoping review following the Joanna Briggs Institute methodology. Two independent reviewers analyzed the relevance of the studies, extracted and synthesized data. Results: Seven studies were included. Overall, the use of technological aids potentiates the interaction and communication between older adults with dementia, staff, and relatives. Nevertheless, issues related to ergonomics, connectivity, and intention of use emerge as recurrent pitfalls. Conclusion: While technological aids can foster a more personalized and dynamic group-based RT session, the development of such innovations must follow an user-centered approach that involves older adults with different stages of dementia in order to create solutions with significance and applicability to its end-users.