Chemotherapy-induced neuropathy (CIN) is a persistent condition that impairs function and quality of life. Auricular point acupressure (APA) has shown short-term benefit for CIN, but the durability of these effects after treatment completion is unknown. This study evaluated the sustainability of symptom improvements for 3 months following a 4-week APA intervention. This prespecified secondary analysis of a randomized wait-list controlled trial compared mobile-supported APA (mAPA) and virtual APA (vAPA) in adults with moderate or greater CIN who received APA during the initial treatment phase (mAPA, n = 80; vAPA, n = 75). Outcomes at 1, 2, and 3 months post-intervention were analyzed using generalized estimating equations with multiple imputation. The primary outcome was CIN severity, measured with an individualized composite outcome (ICO); the secondary outcome was CIN interference. Reductions in CIN severity and interference were maintained throughout follow-up in both groups (all p < .001). ICO scores decreased by 3.10, 3.36, and 3.61 points in mAPA and by 2.88, 2.90, and 3.21 points in vAPA at 1, 2, and 3 months, respectively. Benefits were maintained post-treatment, with higher retention in the mAPA group. Improvements in CIN severity and interference after APA were sustained for up to 3 months post-treatment, suggesting a durable benefit as a self-management strategy. Larger studies with longer follow-up and untreated comparison groups are needed. APA may offer survivors a durable, self-administered, nonpharmacologic option for managing CIN well beyond active treatment, without requiring ongoing clinical visits. ClinicalTrials.gov, ID NCT04920097 registered on 3 June 2021.

BackgroundChronic low back pain (cLBP) is a prevalent and disabling condition in older adults. Auricular point acupressure (APA), a nonpharmacologic intervention, has shown promise in managing cLBP. However, its impact on daily symptom fluctuations remains unclear. Ecological momentary assessment (EMA), which collects real-time data, offers a method to capture these fluctuations. ObjectiveThis secondary analysis evaluated the effects of APA on EMA-reported pain intensity and pain interference among older adults with cLBP and examined associations among APA practice patterns, recall-based assessments, and EMA engagement. MethodsData were drawn from a published 3-arm randomized controlled trial of 272 adults aged ≥60 years with cLBP, randomized to targeted auricular point acupressure (T-APA), nontargeted auricular point acupressure (NT-APA), or education control. For this analysis, only participants who completed at least one EMA entry during the 4-week intervention were included. A total of 61 participants were excluded due to missing EMA data, resulting in a final analytic sample of 211 (T-APA: 72; NT-APA: 74; and control: 65). EMA-reported pain intensity and interference were collected using a smartphone app 3 times daily over 29 days. Linear mixed-effects models assessed the effects of group assignment and APA practice behaviors on EMA outcomes, adjusting for demographics, smoking, opioid use, and baseline recall-based pain. Spearman correlations assessed associations between EMA and 7-day recall measures. ResultsThe overall compliance rate was 44.8%, with an attrition rate of 54%. There were no significant differences in compliance or attrition across treatment groups. Older participants showed significantly lower compliance, though attrition was not associated with age. Pain intensity reported via EMA was significantly lower than recall-based pain, while EMA-reported pain interference was higher. EMA and 7-day recall pain outcomes were strongly correlated (Spearman =0.53–0.95; P<.001). Both T-APA and NT-APA, analyzed as separate randomized groups, significantly reduced EMA-reported pain and interference compared to the control. T-APA reduced worst pain (β=–0.98, SE 0.33; P<.001), average pain (β=–0.93, SE 0.30; P<.001), and current pain (β=–1.01, SE 0.36; P=.006). NT-APA also reduced worst (β=–0.74, SE 0.12; P<.001), average (β=–1.02, SE 0.30; P=.001), and current pain (β=–1.26, SE 0.37; P=.001). For interference, T-APA significantly reduced interference with enjoyment of life (β=–1.72, SE 0.37; P<.001) and daily activity (β=–1.41, SE 0.34; P=.001), with similar reductions seen in NT-APA. ConclusionsAPA significantly reduced daily pain and interference among older adults with cLBP. EMA provided valuable insights into treatment response and symptom variability. Future research should enhance EMA adherence and explore sustained APA use for self-management. Trial RegistrationClinicalTrials.gov NCT03589703; https://clinicaltrials.gov/study/NCT03589703 International Registered Report Identifier (IRRID)RR2-10.1186/s13063-019-4016-x

Purpose Chronic postoperative pain (CPOP) is a potential outcome of otherwise successful surgery that can persist for months, with its prevalence varied by surgical type, genetic predispositions, and psychosocial factors. Pain acceptance offers better outcomes to these patient populations by fostering a willingness to experience pain without resistance. This analysis examines how pain acceptance contributes to psychological well-being, helps reduce opioid misuse, and enhances quality of life, even in the presence of CPOP. Design The concept analysis approach follows Walker and Avant's framework (2019). Methods A literature search across PubMed, Web of Science, and CINAHL yielded 276 articles, of which 16 met the inclusion criteria for adult-centered studies published from 2009 to 2024. Results Sixteen publications identified through the literature search guided the development of the concept analysis and delineated the essential attributes such as open-mindedness/receptivity, present orientation, self-acceptance, and endurance. Conclusions Identifying key attributes, antecedents, and consequences of pain acceptance enables healthcare providers to tailor interventions that enhance postoperative recovery in patients with the risk of CPOP. Clinical Implications Findings from the concept analysis support future research on pain acceptance in postoperative populations, guiding healthcare practitioners on developing evidence-based interventions to improve quality of life for individuals with CPOP.

Introduction:Insomnia is highly prevalent among older adults with chronic low back pain (cLBP), contributing to a cycle of heightened pain sensitivity, impaired physical function, and reduced quality of life. Auricular Point Acupressure (APA), a nonpharmacologic intervention for pain, has shown emerging evidence of improving sleep. We compared the effectiveness of targeted APA (T-APA) versus non-targeted APA (NT-APA) on insomnia in older adults with cLBP. Methods:This secondary analysis used data from a parent RCT, including 99 adults aged 60 or older with cLBP and clinical insomnia (Insomnia Severity Index [ISI]>7). Participants received four weeks of T-APA or NT-APA. Sleep outcomes (ISI, PROMIS-29 sleep disturbance) and pain outcomes (intensity, interference) were assessed at baseline and post-intervention, with pain examined as a mediator of sleep change. Results:The T-APA (n = 45) and NT-APA (n = 54) groups had similar baseline characteristics. Both groups showed significant reductions in sleep disturbance, pain interference, and pain intensity (p < 0.05). However, only the NT-APA group demonstrated significant improvement in ISI scores (p < 0.001, d = 0.50). No significant mediation effect of pain on sleep outcomes was found. Conclusions:APA may be an effective nonpharmacologic approach for improving sleep among older adults with cLBP. Unexpectedly, NT-APA showed greater improvements in insomnia compared to T-APA, suggesting mechanisms beyond traditional somatotopic theory. Further research is warranted to confirm these findings and explore the potential of point-specific versus non-specific APA protocols in treating insomnia. Trial ID:NCT03589703 (registration date: May 22, 2018). URL:https://clinicaltrials.gov/ct2/show/record/NCT03589703.

Background:Chronic low back pain (cLBP) is a major cause of disability, with varied patient responses to treatments. Auricular point acupressure (APA) has shown potential as a non-pharmacological intervention, but individual responses may differ significantly. Objective:This study aimed to determine the predictability of baseline characteristics, including functional disability, symptom severity, and treatment expectancy, on clinically significant responses to APA in reducing pain and improving function. Methods:A secondary analysis was performed using data from a randomized controlled trial with 263 cLBP patients. Participants were randomly assigned to targeted APA (T-APA), non-targeted APA (NT-APA), or to a control group. APA responders were defined as those with at least a 1.5-point reduction in pain intensity or a 2.5-point improvement in the Roland-Morris Disability Questionnaire (RMDQ). Predictors of response were assessed using logistic regression and machine learning models, including the Random Forest and Support Vector Machine (SVM). Results:Baseline pain, physical function, sleep disturbance, and treatment expectancy were key predictors. The Random Forest model had the highest accuracy for T-APA; however, logistic regression performed best in NT-APA. SVM was most accurate in the control group, with predictive accuracy varying by group (AUC 60.9%-80%). The Least Absolute Shrinkage and Selection Operator (LASSO) method was found to be overly aggressive, often eliminating important variables. Conclusion:This study highlights the variability in APA treatment responses for cLBP. While predictive models provide useful insights, further research with larger datasets is needed to improve prediction accuracy and generalizability, enhancing personalized treatment approaches for cLBP.

OBJECTIVES:South Asian individuals (SAs) may have heightened levels of inflammatory markers, such as C reactive protein (CRP), Tumor Necrosis Factor-α (TNF-α), leptin, and resistin, and decreased levels of anti-inflammatory adiponectin, contributing to higher cardiovascular disease (CVD) incidence. Social determinants of health, like discrimination, are also associated with risks for CVD in SAs. This study examined the associations between discrimination and inflammation and whether coping styles moderated the association between discrimination and self-rated health (SRH) among SAs in the United States. DESIGN:Secondary analysis of data obtained from 1164 SAs (mean age = 57 years, SD = 9.4, 48% women) enrolled in the Mediators of Atherosclerosis in South Asians Living in America (MASALA) study was conducted. Discrimination was measured using the Everyday Discrimination Scale (EDS). Inflammatory markers (CRP, TNF-α, leptin, resistin) and anti-inflammatory adiponectin were measured from blood samples. SRH was self-reported by participants. Coping styles were defined as problem-focused or emotion-focused. Multiple regression with bootstrapping was used to examine associations between discrimination and inflammatory markers and adiponectin. Moderation analysis assessed whether coping styles moderated the association between discrimination and SRH. RESULTS:No significant associations were found between discrimination and inflammation. Discrimination was inversely associated with SRH (OR = 0.969, p = 0.005). Emotion-focused coping moderated the association between discrimination and SRH (OR = 0.969, 95% CI = 0.940-0.999, p = 0.044). Among participants who used emotion-focused coping strategies, an increase in self-reported discriminatory experiences was associated with lower odds of having good or excellent SRH. Problem-focused coping did not moderate the association between discrimination and SRH. CONCLUSION:The unknown magnitude and duration, and the lack of variability in discrimination among participants could explain the null findings between discrimination and inflammation. Gaining a better understanding of the ways in which SAs appraise and cope with discriminatory experiences may help to develop future interventions targeted to reduce the adverse health consequences of discrimination among SAs.

Auricular point acupressure (APA) has shown promise for pain relief, but its biological mechanisms remain unclear. This study examined the effects of APA on inflammatory cytokines and explored the relationships between changes in inflammatory markers and clinical outcomes in older adults with chronic low back pain (cLBP). This secondary analysis utilized plasma samples from a three-arm randomized controlled trial (RCT) (NCT03589703) with 272 participants aged 65 years and older with cLBP. The participants were randomly assigned (1:1:1) to the targeted APA (T-APA), nontargeted APA (NT-APA), or education control (CG) groups for four weeks. Cytokine levels were measured at baseline, post-intervention, and at the one- and three-month follow-ups using multiplex assays. RNA sequencing and quantitative PCR (qPCR) were performed to assess changes in inflammatory gene expression. The primary outcome was the change in inflammatory cytokine levels, and the secondary outcomes included self-reported pain and physical function. A total of 272 participants were randomized (T-APA: 92, NT-APA: 91, CG: 89), with 43.4

Aims and ObjectivesThis paper aims to inform nursing and other healthcare disciplines by clearly defining patient competence and the skills required to improve self-care behaviours.BackgroundCompetence has been defined in education and leadership. However, competence in persons with chronic disease has not been expanded upon since one publication in 1983. Patient competence needs to be developed and defined so that healthcare disciplines can understand the attributes necessary for a patient to be deemed competent to promote self-care behaviours.DesignA concept derivation.MethodsWalker and Avant's approach to concept derivation was used to identify a base concept (competence) that is well-defined in another field, define the concepts associated with the parent field, and transpose that definition to a new field to formulate a redefined concept. PsycINFO, Scopus, Web of Science and Medline were searched, and 21 articles were included.ResultsPatient competence is defined as the ability of a person with a chronic illness to reach skill mastery, achieve knowledge, maintain a positive attitude and develop trust in themselves and in healthcare providers that will facilitate active engagement to improve self-care behaviours.ConclusionsDefining patient competence is important in assisting nurses and other healthcare providers in understanding the attributes needed to deem a patient competent, especially those living with chronic illnesses requiring lifelong self-care behaviours. More research is needed to aid in the designing of a precise instrument for measuring this phenomenon.Relevance to Clinical PracticeConcept derivation of patient competence provides a framework for nurses and other members of the healthcare profession to understand the attributes needed to determine patient competence.

Background Sexual minority men with HIV are at an increased risk of cardiovascular disease (CVD) and have been underrepresented in behavioral research and clinical trials. Objective This study aims to explore perceptions of HIV-related comorbidities and assess the interest in and usability of a virtual environment for CVD prevention education in Black and Latinx sexual minority men with HIV. Methods This is a 3-phase pilot behavioral randomized controlled trial. We report on formative phases 1 and 2 that informed virtual environment content and features using qualitative interviews, usability testing, and beta testing with a total of 25 individuals. In phase 1, a total of 15 participants completed interviews exploring HIV-related illnesses of concern that would be used to tailor the virtual environment. In phase 2, usability testing and beta testing were conducted with 10 participants to assess interest, features, and content. Results In phase 1, we found that CVD risk factors included high blood pressure, myocardial infarction, stroke, and diabetes. Cancer (prostate, colon, and others) was a common concern, as were mental health conditions. In phase 2, all participants completed the 12-item usability checklist with favorable feedback within 30 to 60 minutes. Beta-testing interviews suggested (1) mixed perceptions of health and HIV, (2) high risk for comorbid conditions, (3) virtual environment features were promising, and (4) the need for diverse avatar representations. Conclusions We identified several comorbid conditions of concern, and findings carry significant implications for mitigating barriers to preventive health screenings, given the shared risk factors between HIV and related comorbidities. Highly rated aspects of the virtual environment were anonymity; meeting others with HIV who identify as gay or bisexual; validating lesbian, gay, bisexual, transgender, queer, and others (LGBTQ+) images and content; and accessibility to CVD prevention education. Critical end-user feedback from beta testing suggested more options for avatar customization in skin, hair, and body representation. Our next phase will test the virtual environment as a new approach to advancing cardiovascular health equity in ethnic and racial sexual minority men with HIV. Trial Registration ClinicalTrials.gov NCT04061915; https://clinicaltrials.gov/study/NCT05242952 International Registered Report Identifier (IRRID) RR2-10.2196/38348

BACKGROUND: A multitude of variables influence an individual's decision to seek care in emergency situations. By recognizing these variables and their impact on the timeline of an individual seeking care for a stroke, nurses have an opportunity to positively affect the outcomes of stroke within the community. The purpose of this narrative review was to develop a research framework describing the variables involved in care seeking during an acute stroke. METHODS: Using a theory synthesis methodology that included variable identification and the establishment of relationships between variables based on existing literature, a framework describing variables relevant to acute stroke care seeking behavior was developed. RESULTS: Fourteen recently published studies reported significant variables related to seeking emergency medical care during the hyperacute phase of a stroke. Eight variables were identified and characterized as either promoters or distractors. Promoters led an individual to seek acute stroke care earlier, such as perceived symptom severity, stroke knowledge, and the presence of others. Distractors led an individual to delay seeking acute stroke care and resulted in later hospital arrival times, such as a lack of social network or resources, comorbid conditions, and incongruity with the local health system. CONCLUSION: Although individual decision making is exceedingly complex and varies by individual and situation, the developed acute stroke care seeking framework may provide a basis on which to develop stroke awareness programs and interventions targeted at individuals at risk for delayed acute stroke care.

Background: Black and Latinx sexual minority men with HIV are at increased risk of CVD and have been underrepresented in clinical trials. The American Heart Association has called for an increase in interventions that focus on enhancing cardiovascular health in underserved communities by addressing social determinants and modifiable risk factors of CVD. Objective: To explore patient and HIV care experts’ perceptions about HIV comorbidities and assess usability of a virtual environment as CVD prevention education in Black and Latinx sexual minority men with HIV. Methods: This two-phase study is part of a pilot behavioral clinical trial informed by the American Heart Association’s metrics for cardiovascular health. Qualitative Phase 1 data were collected June 2021 to May 2022. Phase 2 data were collected August 2022 to October 2022. Using convenience sampling, we recruited a) Black and Latinx sexual minority men with HIV, and b) interdisciplinary HIV care experts. Eligibility criteria for non-HIV care experts were: 1) self-identify as gay or bisexual; 2) HIV serostatus positive; 3) ages 30 to 65; 4) access to a laptop or desktop. We explored HIV comorbidities of concern and conducted usability testing of the virtual environment. Eighty-four pages of interview data were analyzed using NVivo 12. Results: Phase 1 themes included: Mixed Perceptions about Health, High Risk for Comorbidities, and Virtual Environment Features. CVD risk factors were consistently expressed in relation to HIV, including hypertension, heart attack, stroke, and diabetes. Additionally, kidney, and liver disease were identified as important. Cancer was a common concern and so were the development of mental health conditions. All participants in Phase 2 completed the usability checklist with favorable feedback. Conclusions: We identified hypertension, diabetes, asthma, and cancer were comorbidities of concern. These findings carry significant implications for mitigating barriers to preventative health screenings in Black and Latinx sexual minority men with HIV, given shared risk factors between HIV, CVD, and cancer. We also found that usability of a virtual environment as CVD prevention education was promising as it offered anonymity and access to reliable health information that traverses geography. A virtual environment may serve as a novel modality for extending the reach of prevention education and clinical trials into the hands of ethnic and racial, sexual minoritized individuals that have been underrepresented in advancements in health equity.

Background: Sexual minority men with HIV are at increased risk of cardiovascular disease (CVD) and have been underrepresented in intervention research and in clinical trials.Objective: To explore patient's and HIV care experts' perceptions about HIV-related comorbidities and assess the usability and functionality of a virtual environment as CVD prevention education in Black and Latinx sexual minority men with HIV.Methods: This two-phase study is part of a pilot clinical trial to test acceptability and feasibility of a virtual environment as CVD prevention education in Black and Latinx sexual minority men with HIV.We qualitatively explored HIV comorbidities of concern and conducted usability and beta testing of the virtual environment. Results:In Phase 1, we found CVD risk factors included high blood pressure, heart attack, stroke, and diabetes.Cancer (prostate, colon, and others) was a common concern and so were the development of mental health conditions.In Phase 2, all participants completed the 12-item usability checklist with favorable feedback.Several themes emerged: 1) Mixed perceptions about health and HIV, 2) High risk for comorbid conditions, and 3) Virtual environment features.Sentiment resulting from betatesting was favorable, but included constructive feedback for refinements that include diverse avatar representations. Conclusions:We identified several comorbid conditions of concern and findings carry significant implications for mitigating barriers to preventative health screenings in Black and Latinx sexual minority men with HIV given the shared risk factors between HIV and related comorbidities.Highly rated aspects of the virtual environment were anonymity, the ability to meet other patients who identify as gay or bisexual with HIV, and accessibility to CVD prevention education.Critical end-user feedback from beta-testing suggested more options for avatar customization in skin, hair, body representation.We will apply these recommendations and others in our next step to formally test the virtual environment as a novel modality to extend the reach of CVD prevention education to minoritized individuals that have been underrepresented in advancements in health equity and in clinical trials.Clinical Trial: clinical trial (NCT04061915)

OBJECTIVES:The advent of immune checkpoint inhibitor (ICI) therapy has vastly improved outcomes for patients with advanced melanoma. However, the symptom burden and intensity with their impact on quality-of-life (HRQoL) and functionality are heterogeneous and unpredictable. We used descriptive exploratory content analysis from interviews to capture the patient experience after they had completed quantitative data collection of their symptom burden and interference with the use of two patient-reported outcome (PRO) instruments. DATA SOURCES:Participants from a single center with advanced melanoma (n = 19) who are undergoing ICI therapy completed the Modified MD Anderson Symptom Inventory and Functional Assessment of Cancer Therapy-Melanoma and recorded semistructured interviews. Interpretive description informed the inductive and iterative analysis approach. CONCLUSION:Participants had a heterogenous experience of ICI and melanoma-related symptoms: distress (84%), fatigue (68%), rash or skin changes (53%), pain (30%), diarrhea (30%), itching (26%), and shortness of breath (21%), with varying interference within HRQoL domains, mood (47%), relations with other people (26%), and activity (21%). Some noted a lack of physical interference (79%). Uncertainty was a pervasive theme in the interviews (68%) despite the majority having positive thoughts about ICI therapy (58%) and expectations of the success of therapy (53%). The physical and emotional burden of a melanoma diagnosis, undergoing therapy, and the uncertainty of the outcomes are pervasive for patients. IMPLICATIONS FOR NURSING PRACTICE:Communication surrounding the diagnosis, prognosis, treatment options, and outcomes need to be clear and acknowledge there are unknowns. Nurses may benefit from using a validated PRO instrument to help document and understand the patient's symptom experience while undergoing ICI therapy.

This research explored baby boomer gay men's experiences with primary healthcare and their perspectives of future long-term care. Baby boomer gay men's perspectives about primary healthcare remain understudied in the United States. A descriptive qualitative study was conducted with 30 baby boomer men in the Southwest USA. We used semi-structured interviews to assess participants' initiation and maintenance of primary healthcare, disclosure of sexual orientation to providers, and perspectives about future healthcare needs, including long-term care. Data were analyzed with a latent thematic analysis. We found baby boomer gay men anticipate discrimination because of their sexual orientation whenever they establish healthcare with new providers. Participants identified circumstantial comfort in the new healthcare setting as a key motivator to disclose their sexual orientation. Thus, baby boomer gay men specifically sought gay or gay-friendly healthcare providers to ease the burden of managing disclosure and to permit free discussion of their sexual orientation and healthcare needs. Participants faced recurring anticipation of rejection and discrimination from healthcare providers, which extends to their perceptions of current healthcare encounters and future long-term care placement. Healthcare providers would benefit from understanding the practice implications of this dynamic. Future research on primary healthcare inclusivity is needed.

Background:People with diabetes are susceptible to serious and disabling foot complications, which increase their morbidity and mortality rates. Examining the perspectives of people with diabetes on their foot care routines could help elucidate their beliefs and offer practical ways to prevent foot problems.Purpose:We explored the perspectives of adults with diabetes on their foot care practices to identify and enhance foot care education and support strategies.Methodology:Using the Zoom platform, 29 adults with diabetes completed a 3-month telehealth educational program, during which interviews were conducted. This article reports the results of thematic content analysis of the qualitative data. Coded participant statements were organized into categories and reexamined to identify emergent themes.Results:Analysis of participants' perceptions revealed four main themes of influences that facilitated and/or hindered their foot care practices. Foot care behaviors were facilitated by patients' personal knowledge of others with diabetes-related foot consequences (theme 1). Foot care practices were hindered by the emotional impact of living with diabetes (theme 2), and the physical, social, and lifestyle limitations associated with foot care (theme 3). Finally, patients noted that interactions with family could be either a facilitator or hindrance to their foot care routines (theme 4).Conclusions:These findings highlight multiple patient-centered factors related to personal, physical, psychosocial, and cultural influences that affect foot care behaviors.Implications:An understanding of how patients manage diabetes-related foot care can help nurse practitioners enhance foot care education and support strategies in this population.

Purpose: Self-management and lifestyle interventions are a key factor in treatment outcomes for persons with bipolar disorder (BD). A virtual environment (VE), due to it's ability to provide flexibility of involvement in its platform, may be an alternative to face-to-face treatment to provide support for self-management. The purpose of this study is to explore how a VE, developed for chronic illness self-management, may be modified to promote self-management and lifestyle changes in those with BD. Method: This study used a qualitative description design with focus groups. Data were collected via minimally structured interviews and analyzed using thematic content analysis. A total of seven focus groups were conducted, and the sample consisted of 30 adults with BD. Age range was 21-77 years with 21 females, seven males, and two non-binary individuals. Results: Five themes emerged from the findings: Self-management and lifestyle interventions with regards to (1) mental health; (2) holistic health; (3) role of peers; (4) involvement of the family; (5) technological aspects of the VE. Conclusions: Focus group participants suggested that the VE may be an efficacious way to enhance selfmanagement and promote lifestyle interventions in those with BD. Research is needed to adapt such platforms to the need of the patients and examine its' effect on health outcomes.

Objectives: To evaluate the feasibility and usability of stroke survivor participation in an 8-week virtual environment intervention that provides opportunities for social support exchanges, social network interactions, and recovery education. Materials and methods: A single-group, pre- and post-test measure design was used. Descriptive statistics were used to examine enrollment and retention rates, proportion of questionnaires completed, and virtual environment process data (e.g., number of log-ins) and usability scores. Changes in pre- and post-intervention questionnaire (e.g., usability, social support, depression, anxiety, loneliness, and self-efficacy) scores were explored using Wilcoxon signed-rank tests and paired t-test. Results: Fifteen (65 %) of the eligible stroke survivors enrolled (60 % white, 27 % black), 12 (80 %) had an ischemic stroke, ages ranged from 33 to 74 years (mean 44 years), and mean months since stroke was 33 +/- 23. Retention and questionnaire completion rates were both 93 % (n = 14). Survivors logged into the virtual environment a total of 122 times, logged an average of 49 min/log-in, and 12 (80 %) attended support groups and social activities. Median usability score indicated lower than average usability. Improvement trends in social support, loneliness, and depressive symptoms were found, but significant changes in mean questionnaire scores were not found. Conclusions: Overall, the results suggest that using a virtual environment to foster social support exchanges, social network interactions, and recovery education after stroke is feasible. Similar to other chronic disease populations, stroke survivor adoption of a virtual environment likely requires ongoing technical assistance, repetition of instructions, and opportunities for practice to reinforce engagement. Trial registration: NCT05487144.

ObjectiveChemotherapy-induced neuropathy (CIN) significantly impacts cancer patients, leading to functional disability, diminished quality of life, and increased healthcare costs amid the ongoing opioid crisis. Auricular point acupressure (APA), a non-invasive and non-pharmacological alternative, has shown potential for alleviating the pain, numbness, and tingling associated with CIN. This study aims to assess the efficacy of APA for CIN symptoms and physical function and to examine the mechanisms underlying APA’s effects on CIN.MethodsThis is a three-arm randomized controlled clinical trial protocol. Patients aged 18 and older who are experiencing CIN are randomly assigned to one of the three groups: an APA group (in-person APA; mAPA), a sham control group (virtual APA; vAPA), and a wait-list usual care control group (UC). During the four-week program, participants in the mAPA receive an in-person APA treatment and training; the sham control participants (vAPA) receive a self-guided smartphone APA application with APA demonstration videos; and the UC participants will continue with the usual care and be re-randomized into one of the APA groups. The primary outcomes are changes in CIN symptoms and physical function. Secondary outcomes include evaluating pain sensory thresholds, motor and cognitive functioning, inflammatory signaling, brain connectivity, opioid use, and quality of life. The outcomes are measured at baseline, program completion (4 weeks), and at monthly follow-up for 3 months post-intervention.DiscussionThis study will provide evidence supporting the potential viability of APA as an intervention for CIN.Trial registrationClinicalTrials.gov, IDNCT04920097registered on 3 June 2021.