Miho Asano

Background: Elder orphans have been described as a growing vulnerable population of isolated older adults with limited social and caregiving support. There is a lack of consistency in the terminology and definitions of elder orphans. This lack of consistency impedes research and implementation of services for elder orphans, who are predisposed to isolation, loneliness, unmet care needs, and a decline in health outcomes. It is imperative for elder orphans to plan for their health and well-being as they age in the community. Objective: The objectives of the scoping review are (1) to document the definitions and settings surrounding terms used to describe elder orphans, (2) to explore the determinants of isolation and loneliness in elder orphans, and (3) to understand the barriers to and facilitators of planning to age well in elder orphans. Methods: This review follows the JBI methodology for scoping reviews and the PRISMA-ScR (Preferred Reporting Items for Systematic Reviews and Meta-Analyses Extension for Scoping Reviews) guidelines. The search strategy was first developed and piloted in the Scopus database on October 16, 2025, to identify initial articles on the topic. The following databases were searched: Scopus, MEDLINE ALL (Ovid), CINAHL Complete (EBSCOhost), APA PsycINFO (EBSCOhost), Social Work Abstracts (EBSCOhost), Web of Science (Clarivate), Sociological Abstracts (ProQuest), Sociology Database (ProQuest), and Applied Social Sciences Index & Abstracts (ASSIA; ProQuest). Gray literature was searched using Google (incognito) and ClinicalTrials.gov. Only literature in English was considered due to staff constraints. Two reviewers will screen and extract data independently using piloted screening and data extraction tools. Descriptive analysis will include narrative summaries, tables, and charts and deductive thematic analysis using appropriate frameworks. Results: This protocol has been registered on the Open Science Framework. As of October 2026, the final search and abstract citation screening has been completed. We expect screening, data extraction, and synthesis to be completed by February 2027, with the manuscript of the scoping review submitted thereafter. Conclusions: This review explores both peer-reviewed and gray literature using rigorous and reproducible methods. It will support researchers in streamlining future work on elder orphans and will identify directions for future research and services for elder orphans.

Purpose Well-designed vocational rehabilitation programs (VRPs) are needed to ensure that people with acquired physical disabilities (PAPD) receive the optimal support to return to work. The aim of our scoping review was to summarize the literature on both international and local VRPs that support PAPD to return to work. Methods We conducted a scoping review based on Arksey and O’Malley’s framework. We searched databases (PubMed, CINAHL, and PsycINFO) throughout March 2023. To be included, studies must have been published in a peer-reviewed scientific journal, be available in the English language, and describe a VRP for PAPD. We added a grey literature search to better understand local VRPs. We summarized the VRPs’ characteristics and services narratively. Results We screened 2894 citations and included 20 in our review. These 20 articles discussed 16 VRPs. We identified 46 unique service components and categorized them into six domains – vocational, physical, financial, social, psychological, and others. The vocational domain comprised the majority of components identified (n = 18, 40%). However, no VRPs were exactly alike. Conclusion VRPs facilitate PAPD to return to work via a range of services. Our review is useful for vocational rehabilitation providers to enhance existing VRPs or to design new ones. We recommend that VRPs offer a set of standardized services with the option of expanding services based on emerging needs of service users. Our scoping review provides a valuable evidence synthesis of the services offered within the field of vocational rehabilitation. Future research to better understand the effectiveness of VRPs is warranted.

The purposes of this study were to (i) describe the lived experiences of participating in a Singaporean vocational rehabilitation (VR) program among individuals with stroke and spinal cord injury a...

Purpose Strongly framed research questions are clear as to the population (P), the exposures or interventions (E/I), comparison groups (C), outcomes (O), time when relevant (T), and what the investigator wants to know. A solid framework sets up the measurement model, analysis, and anticipated results. The purpose of this study was to estimate the extent to which research questions in journals that focused on patient-reported outcome measures (PROM) and quality of life (QOL) are clear. Methods All 440 research articles published in four PROM journals in 2020. excluding reviews, psychometric, and qualitative papers, were reviewed. Research questions were classified as: (i) adequately framed (ii) poorly framed; or (iii) unframed based on clarity criteria. Examples from each journal were presented and reframed to match results in the article. Results Of 440 articles, 195 (44.3%) were classified as adequately framed; 230 (52.2%) as poorly framed; and 15 (3.4%) as unframed. There was heterogeneity across journals (Chi-square: 20.8; 6 df; p = 0.002). Only 29% were framed according to what the investigators wanted to know; 72% were framed like a “to do” list; and 6% were framed as a research agenda. Conclusion Almost half of the questions were poorly framed or unframed a practice that could contribute to research wastage. Even “adequately framed” questions rarely stated what they wanted to know a priori, increasing the risk of biased reporting. Researchers, reviewers, and editors should encourage the use established frameworks for research questions.

Background: Breast cancer is the leading cancer affecting women in Singapore. Its survivors commonly experience decline in physical function and quality of life post-mastectomy, due to their upper limb morbidity and wound issues. Rehabilitation can address the aforementioned issues. When rehabilitation is accessible and easy to adhere, it can optimize recovery.Home-based tele-rehabilitation guided by healthcare professionals and self-managed by patients can potentially optimize the patients’ adherence to rehabilitation and recovery. With that in mind, a team of breast cancer specialists (oncologists, nurses, and therapists) in Singapore has developed one of the first tele-rehabilitation systems for local women undergoing a unilateral mastectomy. To our knowledge, no such systems have been evaluated or proven effective as a treatment option among local breast cancer patients with acute disabilities.Methods: This is a pilot quasi-experimental trial that aims to evaluate the feasibility of tele-rehabilitation and tele-drain care compared to usual care. Up to 40 patients (20 per group) will be recruited for this trial. They will be assigned to an intervention group that receives rehabilitation via a tele-rehabilitation system or a control group that receives rehabilitation in person at their clinic. The primary outcome of this trial is rehabilitation participation (i.e., the time spent on rehabilitation). The secondary outcomes are upper extremity functioning, perceived health, and quality of life.Discussion: As part of this pilot trial, patients who opt in for the tele-rehabilitation will be asked to share their experience with and thoughts on the tele-rehabilitation system. With the evidence obtained from the tele-rehabilitation patients of this trial, we will be able to improve the current system for our future trial. Further, our additional data on rehabilitation participation, physical function, and quality of life will help us design a sufficiently powered future main trial.Trial registration: The trial was approved by the National Healthcare Group’s Domain Specific Review Board (#2019/00283) and registered withwww.ClinicalTrials.gov(#NCT04269967) in February 2020.

Importance: Return to work after stroke is an important rehabilitation outcome. Vocational rehabilitation may support people with stroke to return to work. Objective: To report the return-to-work rate of people with stroke who completed a local community-based vocational rehabilitation program and to describe the program’s impact on their community reintegration. Design: Retrospective database study. Setting: Community-based voluntary welfare organization. Participants: Fifty-eight men and women ages 21 to 55 yr, formally diagnosed with stroke, with no significant cognitive impairment, and fit to undergo rehabilitation. Intervention: A pilot community-based interdisciplinary vocational rehabilitation program implemented between 2014 and 2017. The program included physical rehabilitation, psychosocial support, employment support, and caregiver support services. Outcomes and Measures: Return-to-work rate and community reintegration as measured by the Community Integration Questionnaire (CIQ). Results: Fifty participants completed the program. Their median age was 44 yr, and most were male (n = 37; 74%). Forty-four participants (88%) returned to work after completing the program. Statistically significant differences (p < .001) were found between their CIQ scores at program enrollment and at completion. Conclusions and Relevance: The program appeared to benefit people with stroke in their return-to-work process. Future studies are recommended to determine the effectiveness of such programs and identify features contributing to their success. Potential implications for occupational therapy practice are that vocational rehabilitation interventions can be initiated earlier, comprehensive return-to-work programs can better address the unique needs of people with stroke, and interdisciplinary evaluations are needed to assess suitability for return to work. What This Article Adds: One of occupational therapy’s unique goals is to facilitate performance and participation in valued activities such as work. Occupational therapists can play a pivotal role across the continuum of care to support their clients to explore and achieve their vocational goals after stroke.

Study design Retrospective analysis of data collected as part of a pilot program. Objectives The primary objective of our study was to document the return-to-work rate of individuals with SCI who participated in a community-based interdisciplinary vocational rehabilitation program. The secondary objectives were to assess changes in their levels of community integration and functional independence. Setting A community-based rehabilitation center in Singapore. Methods Participants were individuals with SCI between 21 and 55 years. They identified return to work as a rehabilitation goal, and were certified fit to undergo rehabilitation by their physicians. Primary outcome was the return-to-work rate at discharge from the program. Secondary outcomes were community integration and functional independence, measured by the Community Integration Questionnaire (CIQ) and the Spinal Cord Independence Measure III (SCIM-III), respectively. We summarized participants’ clinical and socio-demographic characteristics descriptively, and used inferential statistics to compare pre- and postprogram scores for secondary outcome measures. Results Thirty-nine participants were included for this study. Thirty-two completed the program, of which 84% (n = 27) reported returning to work. Participants who completed the program had mean change in total CIQ and SCIM-III scores of 7 (95% CI, 5–8) and 11 (95% CI, 7–15), respectively. There were differences (p < 0.05) between pre- and postprogram scores for both secondary outcome measures. Conclusions Our findings suggest that our vocational rehabilitation program facilitated participants with SCI in Singapore to return to work and was beneficial to enhance their levels of community integration and functional independence. Future interventional studies are recommended to estimate the efficacy of such programs.

Childhood obesity is a growing concern worldwide. Though multifactorial, the family environment exerts significant influence on children’s eating habits. Grandparents are increasingly involved as caregivers and they can significantly influence their grandchildren’s eating habits. Yet, literature on this topic is lacking. This exploratory sequential mixed methods study (qualitative interview and interviewer-administered questionnaire) aims to understand grandparents’ knowledge, attitudes, and practices on the feeding of their grandchildren in Singapore. A total of 11 interview participants and 396 questionnaire respondents with at least one grandchild, aged 12 years and below were included. Qualitative interviews informed the questionnaire development. Responses to interview questions about knowledge, attitudes, and practices revealed sub-themes such as knowledge on the impact of feeding, attitude toward feeding role, and challenges to feeding. Of the 396 participants, 35% were primary caregivers (defined as the person who spends the most time with the grandchild and performs most of the caregiving tasks). Nutritional knowledge was fair (median score 5/8), with misconceptions centered around healthy feeding practices. Grandparents who were primary caregivers, female, Malay, and younger than 70 years old believed that they played an important role in feeding their grandchild (p < 0.05). Overall, 47.2% of the grandparents rarely or never set a maximum limit on the amount of unhealthy food eaten, of which 77.1% are non-primary caregivers. In comparison, primary caregivers tend to set a maximum limit to the amount of unhealthy food their grandchildren eat and choose a wide variety of food (p < 0.05). These findings support the need for further improvement of grandparents’ feeding knowledge and practices as part of tackling childhood obesity.