Christina Bode

BACKGROUND Stroke aftercare often leaves patients with unmet needs that can negatively affect their well-being and recovery. Providing right care at the right time and place is essential during the transition from hospital to home. The STROKE eCoach is a new mHealth self-management mobile application, designed to support this transition by offering personalized care through health information, symptom self-monitoring, and communication with healthcare providers. OBJECTIVE This study assessed the acceptability and usability of stroke aftercare with the STROKE eCoach from the perspectives of patients, informal caregivers, and healthcare providers. METHODS Using a mixed-methods approach: acceptability was assessed quantitatively through discontinuation rates, adherence rates, and a satisfaction questionnaire; usability was explored qualitatively based on four themes - technical functionality, ease of use, ability to meet patient needs, and enhancement of standard aftercare - discussed in focus groups and individual interviews. RESULTS Acceptability was assessed in 189 patients of whom n = 7 (3.7% ) discontinued app use due to the chosen technology. Adherence was high with 154 participants (82%) completing the recommended usage time. Satisfaction was moderate. Regarding usability, patients (n = 9), informal caregivers (n = 3), and healthcare providers (n = 5) participated. Four key themes emerged: patient-centred care, health information, care coordination and support, practical and technical considerations. CONCLUSIONS The STROKE eCoach was generally well-accepted by a large group of patients, usability findings provided ideas for future improvements. Next steps involve exploring the (cost-)effectiveness of the STROKE eCoach and the role of informal caregivers in the aftercare process.

Objectives: The feasibility of a fatigue Cognitive Bias Modification training was evaluated in women on treatment for breast cancer in a multi-center waitlist-control design assessing feasibility criteria, such as recruitment, retention, and completion rates, as well as effects on fatigue bias. Methods: Five hospitals were each asked to recruit 30 patients, who were sequentially divided in active and delayed treatment groups. Fatigue bias and self-reported outcomes (fatigue, vitality, avoidance, and all-or-nothing behavior) were measured in baseline, training, and follow-up phases. Results: Feasibility results were mixed with recruitment and retention not meeting predetermined criteria, but completion and variability were judged positively. Training effects on fatigue bias compared to control were found. Conclusions: This study evaluated a promising novel fatigue intervention. Continuation with an RCT is encouraged with recruitment and retention strategies reconsidered. Trial registry: This study’s protocol (Geerts, et al., 2024) was preregistered at the Open Science Framework on October 31st, 2023.

This longitudinal pilot trial investigated the effects of novel Cognitive Bias Modification (CBM) training targeting fatigue on cognitive biases, fatigue, vitality, and fatigue-related behaviour in people with chronic kidney disease (CKD). Thirty patients were alternately allocated to a week of CBM training with either attentional bias modification (ABM) or self-identity bias modification (SIBM), followed by a second week with the trainings combined. Twenty-two participants (12 pre-dialysis, 10 dialysis) completed the study, where cognitive biases and self-reported outcomes were measured at baseline, post-training, and follow-up. Possible interaction effects between CBM focus and disease stage were explored. A significant effect of time was found on both cognitive biases; participants' attentional bias (Cohen's d = 0.88–0.99) and self-identity bias (Cohen's d = 1.16–1.28) were significantly more vitality oriented at post and follow-up compared to baseline. On the self-report outcomes, a small beneficial effect was found on vitality, but only for the ABM training. This is the first study to introduce CBM, which targets fatigue, to people with CKD. Despite the limitations in sample size and design, this study revealed strong effects on cognitive biases. It is recommended to replicate these findings in an adequately powered randomised controlled trial.

Lifestyle change is essential for managing chronic- or life-threatening somatic conditions. Virtual reality offers opportunities for designing immersive and engaging lifestyle interventions that enable patients to translate behavioural changes into daily living. This review maps the state-of-the-art to provide directions for future research and intervention development. A systematic scoping review was conducted by searching five bibliographic databases to explore the characteristics and feasibility of immersive virtual reality interventions for lifestyle change in people with chronic- or life-threatening somatic conditions. Forty-seven studies met inclusion criteria, and three different lifestyle behaviours were addressed in ten different conditions. Stress management (63.8%) was widespread, whereas physical exercise (19.1%), diet (4.3%), and combinations (12.8%) were less frequent. Gamification elements were often used (85.1%), unlike adaptation (27.7%) or personalisation (25.5%). Interventions focusing on the process of lifestyle change without performances of the target behaviour during immersion were scarce (8.5%). Feasibility-, acceptability-, and user experience outcomes were mainly positive despite some technical issues and side effects. Future directions revolve around combining adaptation and personalisation, improving user experience, exploring the role of gamification, and adjusting the focus on practising lifestyle behaviour based on individual goal-setting- and behaviour change stages.

Background: Fatigue is a common symptom occurring in individuals with visual impairment (VI). Feeling fatigued has a strong impact on an individual’s well-being, with profound consequences. Cognitive and emotional functioning, social roles, and participation are negatively affected in severely fatigued individuals with VI. Therefore, we developed E-nergEYEze, a blended vision-specific eHealth intervention based on cognitive behavioral therapy and self-management to reduce fatigue severity in adults with VI. Objective: We aimed to report the experience of patients and professionals with E-nergEYEze. To complement cost-effectiveness outcomes, the user experiences from both perspectives were considered relevant for a better understanding of the intervention uptake. Methods: E-nergEYEze was studied in a randomized controlled trial. User experiences of participants with VI and severe fatigue (51/98, 52%; median age 58.0, IQR 53.0-65.0 years; female participants: 32/51, 63%), who were randomized to the intervention group, and professionals (n=11), who provided blended support, were evaluated. The Dutch Mental Health Care Thermometer questionnaire and a therapist evaluation were used and analyzed using mixed methods. A focus group meeting with social workers (4/7, 57%), a computer trainer (1/7, 14%), and psychologists (2/7, 29%) was held for more in-depth information. The eHealth platform provided data on user engagement from both perspectives. Results: E-nergEYEze was completed by 63% (32/51) of patients for more than 80% of the module steps. Overall, results on user engagement showed that a median 89% (IQR 45%-100%) of all assigned module steps were completed, with all modules being completed by at least 50% (37/51) of the patients. Completion of the intervention was related to the presence of digital proficiency; having the appropriate expectations; content that matches personal preferences and life context; and the absence of impeding personal circumstances, mental health issues, or other concurrent rehabilitation programs. The intervention was given a median grade of 7.0 out of 10.0 (IQR 6.0-8.0), and 87% (39/45) of the patients reported that they would recommend E-nergEYEze to others. However, improvements in the frequency and quality of guidance were considered highly relevant. Professionals reported that E-nergEYEze required patients’ self-efficacy, motivation, and digital skills; therefore, preselection was seen as essential. Professionals’ affinity with eHealth was considered important to provide appropriate remote support. Conclusions: eHealth provides treatment opportunities for individuals with VI for which guidance is considered highly relevant. During participation in E-nergEYEze, patients were engaged, internalized personally relevant topics, and made use of the benefits of eHealth. More attention to the suitability of patients and training of professionals for providing remote support is considered essential. These user experiences underlined the potential of E-nergEYEze to reduce fatigue severity in adults with VI and provided valuable insights to learn from and optimize E-nergEYEze. Trial Registration: International Clinical Trials Registry Platform (ICTRP) NL7764; https://tinyurl.com/32b3xt74

Background: Cancer-related fatigue (CRF) is a frequent and impactful symptom for many people with breast cancer. Cognitive biases are believed to influence CRF and were explored in the current mixed methods pilot study investigating a preventive Cognitive Bias Modification (CBM) training. Methods: Two data sets were combined resulting in 31 people with recently diagnosed breast cancer (n = 18 intervention group, n = 13 control group). Both groups were measured on self-identity bias and weekly fatigue and vitality before and after the intervention. The intervention group also answered daily fatigue and vitality scales and was interviewed after training. Potential training effects were assessed by exploring time series graphs on self-identity bias, vitality and fatigue, and trajectories of change during training. Results: Some indications of potential training effects were found on self-identity bias, weekly fatigue, and daily fatigue and vitality. Participants were accepting about the training and app features. Conclusions: This is the first study to research a preventive CBM targeting fatigue. Although this is a pilot study with small sample size, promising results were found. These results need to be confirmed in an randomized controlled trial with longer follow-up, sufficient control conditions, and a sample size to detect small effect sizes. CBM is a promising intervention for targeting fatigue in patients with breast cancer who show translational potential for other symptoms and patient groups. This study adds the promising potential of CBM as a preventive intervention.

Purpose: A substantial number of people experience a persisting impact on health-related quality of life (HRQoL) after COVID-19. The current study aims to identify different trajectories of physical and mental HRQoL, fatigue severity, and dyspnoea severity following hospitalisation with COVID-19, and associated factors of these trajectories. Methods: 500 patients with COVID-19 were followed for one year in a longitudinal cohort study. Self-reported outcomes were measured at 3, 6, 9, and 12 months after hospitalisation. Distinct trajectories were characterised using Growth Mixture Modelling. Sociodemographic and clinical correlates of trajectories were investigated using multivariable (multinomial) logistic regression analyses. Results: Three trajectories (‘stable high’ (16%), ‘improving’ (40%), and ‘stable low’ (44%)) were found for physical HRQoL, and four (‘stable high’ (43%), ‘improving’ (14%), ‘middle declining’ (17%), and ‘low’ (26%)) for mental HRQoL. Older age, overweight and obesity, lower education, and comorbidities were associated with ‘low’ physical HRQoL. Younger age was associated with ‘low’ mental HRQoL. Four fatigue trajectories (‘no fatigue’ (15%), ‘improving’ (40%), ‘low-severe’ (27%), and ‘high-severe’ (18%)) were found. Participants either experienced almost never (‘no dyspnoea’, 75%) or almost always (‘severe’, 25%) dyspnoea. High co-occurrences between low HRQoL and severe fatigue and dyspnoea symptom trajectories were found. Conclusion: A substantial number of COVID-19 survivors continue to struggle with reduced HRQoL over time. However, large variations in these physical and mental HRQoL trajectories exist, and trajectories are associated with persisting COVID-19-related symptoms or pre-hospitalised health status. Regular measurement of HRQoL and post-COVID symptoms may help identify those that may benefit from timely interventions.