Celia Cassiani’s research while affiliated with SickKids and other places

Improving cognitive sequelae in children treated for brain tumours (CTBT) requires accessible interventions. While instructor-led exercise in a hospital setting is efficacious, it is not extended to communities. Objectives We aimed to (i) develop a website with educational resources/tools for community health and fitness professionals (HFP) to deliver exercise for CTBT in community settings to improve cognition and (ii) assess its usability by community HFP. It was hypothesized that the website would be learnable, clear, satisfactory and efficient to deliver exercise. Methods A scoping review determined the state of eHealth resources to support exercise for CTBT and identified knowledge and resource gaps. Three focus groups with HFP who served cancer survivors in hospital or community settings (n = 13) identified user needs; content analysis identified themes. Gaps from the scoping review and themes from focus groups informed website content. A questionnaire assessed its usability by community HFP (n = 4). Descriptive statistics inferred the website's learnability, clarity, satisfaction and efficiency. Open-ended responses identified issues. Results The scoping review revealed a lack of eHealth resources supporting exercise to improve cognition in CTBT and education for HFP to deliver exercise. Six themes were identified in the focus groups. HFP rated the website as sufficiently learnable, clear, satisfactory and efficient. Two minor issues were reported and addressed. Conclusion The website marks one of the first eHealth resources to increase accessibility of intervention to improve cognitive sequelae and ultimately quality of life in CTBT. HFP also gain access to education and tools to deliver exercise in community settings.

BACKGROUND It is crucial to develop effective and accessible interventions to improve cognitive sequelae in children treated for brain tumours (CTBT), as their impact on functional outcomes is significant. Instructor-led exercise training in a hospital setting is safe, feasible and efficacious to promote cognitive improvements in patients, however, most receive their post-treatment rehabilitative care in the community. eHealth is well positioned to support the delivery of community interventions. OBJECTIVE We aimed to i) develop a website that provides educational resources/tools for health and fitness professionals (HFP) to deliver exercise training to CTBT in the community with the goal of improving cognitive outcomes and ii) assess the website’s usability by community HFP. It was hypothesized that the website would be rated as learnable, clear, satisfactory and efficient to train on and deliver exercise training to CTBT in the community. METHODS A scoping review of academic literature, and publicly and commercially available eHealth resources was conducted. The scoping review determined the state of eHealth resources to support exercise training for CTBT and identify knowledge and resource gaps. Three focus groups were conducted with HFP with expertise serving cancer survivors in hospital (n=5) and community (n=8) settings to identify user needs and preferences. Content analysis identified themes. Gaps identified in the scoping review and themes from focus groups informed content that was integrated into the website build. Usability by community HFP (n=4) was assessed using a questionnaire (multiple choice, Likert-type, and open-ended questions). Descriptive statistics inferred elements of the website deemed sufficiently learnable, clear, satisfactory and efficient, and aspects with issues requiring modification. The mode of each multiple choice and Likert-type response was calculated to determine the value that appeared most often. Open ended responses identified issues. RESULTS The scoping review revealed a lack of eHealth resources to support exercise training to improve cognitive sequelae in CTBT and education for professionals to deliver training. Six themes were identified in the focus groups: instructor experience, instructor training, training on the intervention, venue considerations/suitability, exercise session planning and feedback. HFP reported the website to be sufficiently learnable, clear, satisfactory and efficient. Two minor issues were reported and addressed: a desire for discussion of appropriate language when instructing and correspondence between website activities and visual tools. CONCLUSIONS The development and usability testing of the website marks one of the first eHealth resources to increase accessibility of interventions typically delivered in a hospital setting to improve cognitive sequelae in CTBT. It also provides professionals the necessary education/tools for delivery in the community and provision of exercise intervention designed to improve cognitive outcomes. This website would afford an increase in the number of patients with access to interventions that promote cognitive improvement and ultimately enhance quality of life.

Objectives: First, we aimed to determine the feasibility of virtual reality (VR) distraction for children with cancer undergoing subcutaneous port (SCP) access. Second, we aimed to estimate preliminary treatment effects of VR compared to an active distraction control (iPad). Methods: A single-site pilot randomized controlled trial (RCT) comparing VR to iPad distraction was conducted. Eligible children were aged 8-18 years undergoing treatment for cancer with upcoming SCP needle insertions. Intervention acceptability was evaluated by child, parent, and nurse self-report. Preliminary effectiveness outcomes included child-reported pain intensity, distress, and fear. Preliminary effectiveness was determined using logistic regression models with outcomes compared between groups using pre-procedure scores as covariates. Results: Twenty participants (mean age 12▒y) were randomized to each group. The most common diagnosis was acute lymphocytic leukemia (n=23, 58%). Most eligible children (62%) participated, and one withdrew after randomization to the iPad group. Nurses, parents, and children reported the interventions in both groups to be acceptable, with the VR participants reporting significantly higher immersion in the distraction environment (P=0.0318). Although not statistically significant, more VR group participants indicated no pain (65% vs. 45%) and no distress (80% vs. 47%) during the procedure compared to the iPad group. Fear was similar across groups, with approximately 60% of the sample indicating no fear. Discussion: VR was feasible and acceptable to implement as an intervention during SCP access. Preliminary effectiveness results indicate that VR may reduce distress and distress compared to iPad distraction. These data will inform design of a future full-scale RCT.

Background: Peer-mentoring is a method of delivering support that may ameliorate some of the challenges that youth with physical disabilities experience when preparing for future employment. This qualitative study compared and described forum content of an employment-focused peer e-mentoring intervention for youth with physical disabilities with a focus on support provided within a mentored group (an experimental group) and a non-mentored group (a control group). Methods: Using a descriptive qualitative approach, textual data from discussion forums of two groups within a peer e-mentoring intervention were analyzed through a content analysis. This qualitative study was part of a larger mixed-method pilot-randomized control trial on peer e-mentoring. Results: The mentored group consisted of nine youth with physical disabilities, aged 15–21 (mean age, 17.8) and two paid-peer mentors, and the non-mentored group included seven youth with physical disabilities, aged 15–19 (mean age = 16.1). We analyzed 151 posts. The types of support exchanged differed between the two groups. Two overarching themes emerged: (1) solution-focused support and (2) catalysts for support Conclusion: Peer e-mentoring can offer youth unique forms of support to help them prepare for employment. Clinicians may explore the opportunity for peer e-mentoring to complement current practice in preparing youth with physical disabilities for future employment.

Introduction Pain negatively affects the health-related quality of life (HRQL) of adolescents with cancer. The Pain Squad+ smartphone-based application (app), has been developed to provide adolescents with real-time pain self-management support. The app uses a validated pain assessment and personalised pain treatment advice with centralised decision support via a registered nurse to enable real-time pain treatment in all settings. The algorithm informing pain treatment advice is evidence-based and expert-vetted. This trial will longitudinally evaluate the impact of Pain Squad+, with or without the addition of nurse support, on adolescent health and cost outcomes. Methods and analysis This will be a pragmatic, multicentre, waitlist controlled, 3-arm parallel-group superiority randomised trial with 1:1:1 allocation enrolling 74 adolescents with cancer per arm from nine cancer centres. Participants will be 12 to 18 years, English-speaking and with ≥3/10 pain. Exclusion criteria are significant comorbidities, end-of-life status or enrolment in a concurrent pain study. The primary aim is to determine the effect of Pain Squad+, with and without nurse support, on pain intensity in adolescents with cancer, when compared with a waitlist control group. The secondary aims are to determine the immediate and sustained effect over time of using Pain Squad+, with and without nurse support, as per prospective outcome measurements of pain interference, HRQL, pain self-efficacy and cost. Linear mixed models with baseline scores as a covariate will be used. Qualitative interviews with adolescents from all trial arms will be conducted and analysed. Ethics and dissemination This trial is approved by the Hospital for Sick Children Research Ethics Board. Results will provide data to guide adolescents with cancer and healthcare teams in treating pain. Dissemination will occur through partnerships with stakeholder groups, scientific meetings, publications, mass media releases and consumer detailing. Trial registration number NCT03632343 ( ClinicalTrials.gov ).

LEGO® therapy uses children's natural interest in play to help motivate behavioural change and may be an effective teaching tool to increase social competency and communication skills. Although the literature is growing it has not been synthesized. The objective was to review the literature on the role of LEGO therapy on social skills and inclusion among children and youth with autism spectrum disorder.A scoping review was conducted, involving comprehensive searches of international databases. Eligible articles included: (a) youth aged 19 or younger, with ASD; (b) empirical research on LEGO® therapy interventions; (c) published from 1996 to 2016 in a peer-reviewed journal, conference proceedings, or dissertation. Results: Of the 6964 studies identified, 15 articles—involving 293 participants, aged 5–16 (mean age 8.7 years), across five countries—met the inclusion criteria. Although the outcomes of the LEGO® therapy varied across the studies, 14 studies reported at least one improvement in social and communication skills (e.g., building friendships, improved social interactions and social competence), ASD-specific behaviors, belonging, family relationships, coping, and reductions in playing alone. Conclusions: Although LEGO® therapy shows promise as an intervention for children and youth with ASD, more rigorously designed studies are needed to fully understand its impact.