Objectives: This systematic review aimed to describe medication non-adherence among people living with multimorbidity according to the current literature, and synthesise predictors of non-adherence in this population. Methods: A systematic review was conducted according to the Preferred Reporting Items for Systematic reviews and Meta-Analyses. PubMed, EMBASE, CINAHL and PsycINFO were searched for relevant articles published in English language between January 2009 and April 2019. Quantitative studies reporting medication non-adherence and/or predictors of non-adherence among people with two or more chronic conditions were included in the review. A meta-analysis was conducted with a subgroup of studies that used an inclusive definition of multimorbidity to recruit participants, rather than seeking people with specific conditions. Remaining studies reporting prevalence and predictors of non-adherence were narratively synthesised. Results: The database search produced 10 998 records and a further 75 were identified through other sources. Following full-text screening, 178 studies were included in the review. The range of reported non-adherence differed by measurement method, at 76.5% for self-report, 69.4% for pharmacy data, and 44.1% for electronic monitoring. A meta-analysis was conducted with eight studies ( n =8949) that used an inclusive definition of multimorbidity to recruit participants. The pooled prevalence of non-adherence was 42.6% (95% CI: 34.0 - 51.3%, k =8, I ² =97%, p <0.01). The overall range of non-adherence was 7.0%–83.5%. Frequently reported correlates of non-adherence included previous non-adherence and treatment-related beliefs. Conclusions: The review identified a heterogeneous literature in terms of conditions studied, and definitions and measures of non-adherence used. Results suggest that future attempts to improve adherence among people with multimorbidity should determine for which conditions individuals require most support. The variable levels of medication non-adherence highlight the need for more attention to be paid by healthcare providers to the impact of multimorbidity on chronic disease self-management. PROSPERO registration number: CRD42019133849.

Objective To review systematically the evidence on how deinstitutionalisation affects quality of life (QoL) for adults with intellectual disabilities. Design Systematic review. Population Adults (aged 18 years and over) with intellectual disabilities. Interventions A move from residential to community setting. Primary and secondary outcome measures Studies were eligible if evaluating effect on QoL or life quality, as defined by study authors. Search We searched MEDLINE, PsycINFO, CENTRAL, CINAHL, EconLit, Embase and Scopus to September 2017 and supplemented this with grey literature searches. We assessed study quality using the Critical Appraisal Skills Programme suite of tools, excluding those judged to be of poor methodological quality. Results Thirteen studies were included; eight quantitative studies, two qualitative, two mixed methods studies and one case study. There was substantial agreement across quantitative and qualitative studies that a move to community living was associated with improved QoL. QoL for people with any level of intellectual disabilities who move from any type of institutional setting to any type of community setting was increased at up to 1 year postmove (standardised mean difference [SMD] 2.03; 95% CI [1.21 to 2.85], five studies, 246 participants) and beyond 1 year postmove (SMD 2.34. 95% CI [0.49 to 4.20], three studies, 160 participants), with total QoL change scores higher at 24 months comparative to 12 months, regardless of QoL measure used. Conclusion Our systematic review demonstrated a consistent pattern that moving to the community was associated with improved QoL compared with the institution. It is recommended that gaps in the evidence base, for example, with regard to growing populations of older people with intellectual disability and complex needs are addressed. PROSPERO registration number CRD42018077406.

Augmented and virtual reality (AR/VR) technologies are regularly used in psychology research to complement psychological interventions and to enable an individual to feel as if they are in an environment other than that of their immediate surroundings. A scoping review was performed to identify how AR/VR was being used with older adult populations to impact their physical and mental health. The review also sought to determine whether the terminology used in AR/VR research was consistent. The results show that 65 studies have been published in the last 20 years that meet the inclusion criteria (virtual/augmented reality) technology to impact older adults’ physical/mental health and wellbeing. Participants included healthy, physically, and cognitively impaired, and emotionally vulnerable older adults. We argue that over 70% of the studies included in this review were mislabeled as VR and only six papers included fully immersive VR/AR. The remaining studies use less immersive variants of virtual reality with their populations, and only one study made use of AR, which prompted the suggestion of a new definition for virtual reality. This paper also calls for an updated taxonomy of augmented and virtual reality definitions to address the lack of consistency found in studies that identify themselves as AR/VR when they are using less immersive technical set-ups, including displaying non-interactive videos on 2D screens.

Purpose: To review the literature on cognitive functioning in persons with lower limb amputations. Method: A search of the MEDLINE, PsycINFO and Web of Science databases was carried out. Results: Thirty papers were found that met the inclusion criteria. The studies were characterised by heterogeneity of design, methodological quality, sample characteristics, assessment of cognitive functioning, and outcomes examined. The research published to date suggests that cognitive impairment is more prevalent among persons with lower limb amputations than in the general population, and is linked with a number of important outcomes in this patient group, including mobility, prosthesis use, and maintenance of independence following amputation. Conclusions: These findings highlight the importance of assessing the cognitive abilities of persons with lower limb amputations. An understanding of the cognitive profile of these patients could assist rehabilitation teams in determining their suitability for prosthetic or wheelchair rehabilitation, ascertaining appropriate and realistic goals for rehabilitation, and tailoring rehabilitation programmes to patients’ strengths so that maximal mobility and independence is achieved.

Social anxiety is a prominent psychological concern within sexual minority populations. We systematically reviewed the related empirical literature in order to 1) describe the characteristics of studies assessing social anxiety among sexual minority individuals; 2) compare social anxiety levels across sexual orientation subgroups; 3) synthesise bivariate and multivariate associations related to social anxiety, and collate qualitative findings pertaining to social anxiety, among sexual minority populations; 4) identify psychological interventions that have been empirically tested to reduce social anxiety symptoms in sexual minority individuals. A search strategy was implemented across six databases, and 61 papers representing 46 unique studies were identified for inclusion. The vast majority of studies were cross-sectional, based in the USA, and more focused on sexual minority men than women. No included studies were qualitative in nature. Across studies, sexual minority individuals consistently appear at a higher risk for social anxiety symptoms than heterosexuals. Subgroup analyses within sexual minority subgroups are scarce; however, tentative evidence suggests that bisexual individuals are at greater risk for high social anxiety symptoms than gay/lesbian individuals. Minority stress processes, general social processes (e.g. social support), other internalising mental health symptoms, among other variables hold significant associations with social anxiety across the included studies. Empirical studies testing the efficacy of psychological interventions in this area are markedly lacking. Future studies should employ more diverse methodologies (i.e. experimental, longitudinal, and qualitative) to further elucidate the determinants and experience of social anxiety among sexual minority individuals and interventions to address them.

Objective: To review systematically the evidence on the costs and cost-effectiveness of deinstitutionalisation for adults with intellectual disabilities. Design: Systematic review. Population: Adults (aged 18 years and over) with intellectual disabilities. Intervention: Deinstitutionalisation, that is, the move from institutional to community settings. Primary and secondary outcome measures: Studies were eligible if evaluating within any cost-consequence framework (eg, cost-effectiveness analysis, cost–utility analysis) or resource use typically considered to fall within the societal viewpoint (eg, cost to payers, service-users, families and informal care costs). Search: We searched MEDLINE, PsycINFO, CENTRAL, CINAHL, EconLit, Embase and Scopus to September 2017 and supplemented this with grey literature searches and handsearching of the references of the eligible studies. We assessed study quality using the Critical Appraisals Skills Programme suite of tools, excluding those judged to be of poor methodological quality. Results: Two studies were included; both were cohort studies from the payer perspective of people leaving long-stay National Health Service hospitals in the UK between 1984 and 1992. One study found that deinstitutionalisation reduced costs, one study found an increase in costs. Conclusion: A wide-ranging literature review found limited evidence on costs associated with deinstitutionalisation for people with intellectual disabilities. From two studies included in the review, the results were conflicting. Significant gaps in the evidence base were observable, particularly with respect to priority populations in contemporary policy: older people with intellectual disabilities and serious medical illness, and younger people with very complex needs and challenging behaviours. PROSPERO registration number: CRD42018077406