ANZCTR search results

In Australia, accidental injury represents the most common type of traumatic event experienced by children under the age of 6 years. Recent research has shown that around 10-30% of young injured children will go on to develop chronic posttraumatic stress disorder (PTSD). Parents of injured children are also at risk of PTSD and this is associated with short and long-term consequences for their child’s physical and psychological recovery. PTSD is a complex and serious disorder that is associated with a range of adverse psychiatric and health outcomes; poorer adherence to medical treatment; reduced wound healing; diminished health-related quality of life; impaired parent-child relationships; and can significantly impact psychological, cognitive, social and neurobiological development. Despite the significance of this problem, to date, the mental health needs of injured young children have been neglected. One reason for this is due to the uncertainty and considerable debate around how to best provide early psychological intervention to traumatised children and adults. In particular, there are currently no published studies on early intervention for young traumatised children. The proposed research therefore aims to evaluate the effectiveness and feasibility of a screening and indicated prevention program for injured young children (1-6 years) and their parents. The study will employ a randomised control trial design and children who are screened as ‘high-risk’ for PTSD and their parents will be randomised to either (1) 2-session face-to-face child and family focused intervention or (2) treatment as usual. Assessment will be completed at baseline (2 weeks), 3 and 6 months post injury. The development, evaluation and dissemination of effective indicated prevention programs for young children and parents have the potential for enormous national and international benefit.

This study aims to examine whether feedback regarding mental health symptoms encourages increased help-seeking or service use. The research group will be initially running a national survey of an estimated 105,000 people. The survey will contain screening questionnaires for common mental health issues. At the end of this survey, participants will be asked whether they would like to be included in a randomised controlled trial (RCT). If yes, participants will be asked to provide their email addresses only. The national survey (already completed by participants) will serve as baseline data. They will then be randomised into one of two conditions: 'Feedback' or 'No Feedback' (control condition). Those who are randomised into the 'Feedback' condition will immediately be provided with feedback regarding their mental health symptomology, based on screening results . All RCT participants will then be assessed in a post-intervention survey, 3 months after the initial survey regarding their help-seeking or service use for mental health problems, quality of life, disability (days out of role) and mental health symptoms.

Fractures of the distal radius,: a randomised controlled trial comparing the volar locking plate and routine current surgical treatment

Fixation of the femoral stem and acetabular shell in their respective bones can be with cement, specialised coatings or a combination of the two (i.e. stem in cement, acetabulum with porous coating), known as hybrid fixation. The cemented Absolut hip stem with the non-cemented Global acetabular cup will be evaluated following primary total hip replacement surgery.

The aim of this study is to evaluate the efficacy of resistance exercise training and nutritional supplementation in prostate cancer survivors treated with androgen deprivation therapy. Who is it for? You may be eligible to join this study if you are a male aged 50-85 years and are currently undergoing treatment for prostate cancer with androgen deprivation therapy which is expected to continue for at least 52 weeks. Study details Participants in this study will be randomly (by chance) allocated to one of two groups. Participants in one group will participate in an individually tailored progressive resistance exercise training program three times a week and receive daily supplementation of calcium, vitamin D and protein over a period of 52 weeks. Participants in the other group will receive the usual care administered to men undergoing androgen deprivation therapy. Participants will be assessed at baseline, 26 weeks and 52 weeks in order to determine any changes in musculoskeletal health, cardiometabolic risk factors, and health-related quality of life. Assessment is by bone scans, blood tests, and questionnaires. The results of this study may contribute to the development of exercise and nutritional guidelines for optimising overall health in men treated with androgen deprivation therapy.

Using Randomised Controlled Trial methodology, this study investigates the effectiveness of a universal prevention intervention for depression in adolescents prior to the Higher School Certificate (HSC). Students in 30 schools across New South Wales (NSW) will be randomly allocated to receive an online, automated, preventative Cognitive Behavioral Therapy (CBT) program or an online control program focused on health and wellbeing. Students will participate in the intervention in February of Year 12, and will complete assessment measures pre- and post-intervention, approximately 6 months later (prior to the Trial HSC) and at 18-month follow-up. The primary outcome measure will be symptom levels of depression. Secondary outcomes include academic performance, incidence/recurrence of depression, suicidal ideation and behaviour. Cost effectiveness, as well as predictors of treatment response and adherence will also be measured. Additionally, the effect of the intervention on parental mental health and wellbeing will be examined.

Low back pain is one of the most common health problems and affects 80 – 85% of people over their life time. Low back-related leg pain or sciatica is a common variation of low back pain. Although the prognosis for sciatica is good in most patients, up to 30% of patients continue to have pain for 1 year or longer. People with sciatica may or may not present with signs of nerve damage and associated nerve-related pain (neuropathic pain). It is important to determine the presence of altered nerve function as this (i) may contribute to people having persistent pain and/or disability and both are associated with greater health costs and poorer patient outcomes; (ii) will help direct more targeted treatment for the underlying condition such as specific pharmaceutical intervention for the treatment of neuropathic pain or surgical intervention in case of nerve root compromise. Targeted treatment may prevent the transition to persistent pain and associated poorer health outcomes and greater health economic burden. This study will investigate responses to various sensory stimuli (to heat and cold, to light touch and pressure, to pin-prick and vibration) that can be used to assess nerve fibre dysfunction. We will explore the correspondence of quantitative laboratory sensory testing with simple bedside sensory testing in patients with sciatica and compare findings with a healthy population that is age and gender matched. Should the bedside examination findings match the laboratory findings, then bedside examination may potentially replace time-consuming laboratory testing in the future. We will also investigate if sensory examination findings may be associated with the persistency of pain and functional status at 3 and 12 months follow-up in patients with sciatica. It is anticipated that there will be sub-groups of patients with differing sensory profiles. Sensory profiles of enhanced pain sensitivity will be associated with pain persistency and functional status at 3 and 12 months follow-up. The outcome of the study will inform clinical pathways to optimise time and cost efficient health outcomes for this patient cohort.

This study aims to find out if a sensory discrimination training method that is effective in reducing sensory impairment in adults who have had a stroke is also effective in reducing impairments in sensation for children with cerebral palsy. We hypothesise that sensory discrimination training will improve sensory discrimination for children with hemiplegic cerebral palsy and result in improvements in function, activity and quality of life. Additionally we hypothesis that central changes will be evident on fMRI following intervention. We hypothesise that changes will be sustained at 6 months post intervention.

Anxiety and depression co-occur highly with each other, with 69% of anxious youth being diagnosed with depression and up to 75% of depressed youth meeting criteria for an anxiety disorder (Angold, Costello, & Erkanli, 1999). When different classes of disorders co-occur at such high rates, selecting an appropriate treatment approach can be challenging. Traditional CBT for anxiety or depression are mostly single-target approaches focusing specifically on either anxiety or depression. Evidence-based interventions for multiple problems required a therapist to prioritise treatment goals and treat one problem at a time (Barlow, Allen, & Choate, 2004). However, this approach risks client drop out before he or she receives essential treatment for co-occurring difficulties (Rohde, 2012). In addition, multiple interventions are often costly to the public health care system (Jacobson, Martell, & Dimidjian, 2001). Given that the high comorbidity rates complicate the conceptualisation and provision of treatment and are generally associated with higher dropout, lower recovery, and poorer maintenance of gains (Rohde, 2012), treatment strategies that are flexible enough to accommodate diverse problems are needed. Recent development in unified treatments suggests that a transdiag-nostic approach appears to be more efficient and effective than treating disorders in a serial manner (Barlow et al., 2004). Unlike most traditional disorder specific treatments, transdiagnostic approaches target common features underlying symptoms in comorbid disorders (Barlow et al., 2004). They are more time-efficient and cost effective, simplifying treatment for both the client and therapist, which could improve the quality of care and satisfy a great need in public health (Rohde, 2012). Recent research (Barlow, et al., 2004) has identified that one of the common features in anxiety and depression is worry, a repetitive negative valanced process that reflects an unsuccessful attempt to prevent the occurrence of negative events or to devise coping strategies in case such events occur. Worry is an essential feature of Generalised Anxiety Disorder (GAD) and is a presenting characteristic across all anxiety disorders and depressive disorders (Starcevic, et al., 2007). Worry is characterised by the repeated experience of thoughts about potential negative events, and reported proneness to worry varies continuously across the normal population (Ruscio, Borkovec, & Ruscio, 2001). According to the most widely recognized model of GAD (Borkovec, Alcaine, & Behar, 2004), worry functions as a cognitive avoidance response, suppressing images and somatic activation and preventing the individual from emotional processing of fear that is important for successful habituation and extinction (Foa, Huppert, & Cahill, 2006). Such avoidance brings initial relief but results in anxiety maintenance. The repetitive negative thoughts involving anticipating future threat in worriers may disrupt the implementation of effective strategies to solve problems, resulting in maintained or exacerbated levels of distress. Resent data has also highlighted the importance of behavioural avoidance in worry such as reassurance seeking, procrastinating, or over-preparing, aimed at reducing distress in the short term but contributing to the long term maintenance of symptoms (Beesdo-Baum et al., 2012). Therefore, an approach targeting such avoidance strategies in worriers is warranted. Drawing from findings by Borkovec and colleagues (2004), Roemer and Orsillo (2005, 2007) argued that cognitive avoidance in worry may be experiential. That is, excessive worriers may be actively and/or automatically avoiding unpleasant internal experiences (thoughts, feelings, or bodily sensations) by focusing on future events and such avoidance is paradoxically associated with increased distress. Accordingly, training in the skill of mindfulness (i.e., paying attention, on purpose, in the present moment in a non-evaluative and expanded way to both internal and external sensations) may help to break this habitual anxious cycle of worry. An acceptance-based behaviour therapy (ABBT) was developed to specifically target the experiential avoidance in people with generalized anxiety disorder (Roemer & Orsillo, 2005; Roemer & Orsillo, 2007). The principles of the ABBT include (1) expanding present-moment awareness, (2) encouraging acceptance (a willingness to have one’s internal responses in order to participate in meaningful experiences) rather than judgment and avoidance of internal experiences, and (3) promoting action in areas of importance to the individual. A recent meta-analysis has revealed that ABBT is effective at reducing worry and that gains are largely maintained at follow-up (Hanrahan, Field, Jones, & Davey, 2013). Further, Hayes, Orsillo, & Roemer (2010) found that both acceptance of internal experiences and engagement in meaningful activities were related to treatment responder’s status at post-treatment and predicted treatment outcome. Specifically, change in acceptance was related to quality of life at post-treatment. Based on these findings, the current study will emphasise the acceptance component and investigate whether such acceptance approach is effective at improving excessive worry in a sample of community populations. Specifically, we investigate the effect of a mindfulness and acceptance-based group therapy (MABGT) for excessive worry by comparing it with a waitlist control.

We will directly target young people with comorbid depression and binge drinking behaviours and, for the first time, evaluate an internet-based psychological treatment program, augmented with peer-driven social networking. This program can easily be translated into primary care, clinical and real world settings for use by young people experiencing these conditions. Via this study, we aim to: (1) Demonstrate that young people, aged 18-30 years, who are experiencing low mood and are binge drinking will engage with web-based treatments that target their multiple problems simultaneously; (2) Demonstrate that young people with these problems will benefit from web-based treatment targeting low mood and binge drinking simultaneously; and (3) Demonstrate the additional benefit of peer-led social influence on engagement and mood and binge drinking outcomes for young people, when offered in conjunction with a web-based treatment for these conditions. We will examine the relative impact of: (a) Monthly online self-assessment (OSA) for 12 months; OSA (b) OSA + 12-months of access to a 4-week. program of web-based intervention for binge drinking and depressed mood (DEpression ALcohol - DEAL); OSA + DEAL (c) OSA + DEAL + 12-months of access to Breathing Space.