Intensive Cognitive and Physical Rehabilitation Program
Condition: Cognitive Rehabilitation; Physical Rehabilitation
Study type: Observational

Summary: 
      This will be a feasibility study. Individuals that have undergone an evaluation day at the
      center for successful aging with diabetes with a Glycosylated hemoglobin (A1C) of >=7.5 and a
      Montreal Cognitive Assessment (MoCA)<26 will be approached and invited to participate. The
      participants will be divided into 2 groups: 1) information communication technology (ICT)
      group - an intervention based on weekly SMS that will remind the individual to implement his
      personal treatment plan and will raise the awareness to the importance of self-care in
      diabetes; 2) intensive cognitive-physical rehabilitation group that will include a 2 phase
      multi-disciplinary intervention. The 2 phases: a) Intensive phase: weekly 4 hour group
      meeting which will include computerized cognitive training, aerobic, balance and strength
      exercise and group discussion that will be dedicated to cognitive rehabilitation strategies
      development and implementation with emphasis on disease management and physical activity as
      well as psycho-education on various disease management aspects (medical and nutritional) b) a
      consolidation phase: monthly 2 hour group discussions on challenges of implementation and
      coping strategies. Outcomes will include change in A1C (primary), change in strength, aerobic
      capacity as well as quality of life and cognitive function (secondary). Additionally, team
      members and participants will fill out a structured questionnaire regarding their evaluation
      of the program aiming at refinement of the intervention.
    

Detailed description: 
      Intensive cognitive-physical rehabilitation intervention. The intervention will include two
      phases:

        1. Intensive phase: 12 weekly group meeting 4 hours each. Each meeting will be composed of:

             -  2 hours guided by a neuropsychologist each dedicated to a different cognitive
                domain for example memory, concentration, planning, information processing, problem
                solving (with special emphasis on diabetes issues). Each session will be composed
                of: 1) introduction- homework from previous session will be checked and the
                cognitive domain that will be discussed on that day will be introduced; 2)
                cognitive training using a computerized system (hour); 3) group discussion on
                compensatory strategies and training to be conducted at home

             -  2 hours guided by a certified physical trainer. These will include strength,
                balance and aerobic elements conducted in a group but individualized according to
                the capabilities and targets of the individual as assessed during the evaluation
                day. These sessions will also include formulation of a plan for exercise to be
                conducted by the individual on a daily basis. Additionally, 30 minutes of each
                session will be dedicated to psycho-education on various disease management aspects
                guided by a diabetes nurse educator or a dietitian (alternating).

        2. Consolidation phase: 9 months of monthly group meetings. The consolidation group
           sessions will include monthly 2 hour group discussions on challenges of implementation
           and coping strategies Medical surveillance will take place every 2 months with
           monitoring of glucose, blood pressure lipid control as well as follow-up on other
           recommendations given during the feed-back sessions this will be conducted by the
           Diabetes nurse educator who will be work together with a diabetes specialist an
           Endocrinologist (study physician) on maximal risk factor reduction.
    

Intervention name(s): intensive cognitive physical rehabilitation program
Intervention type(s): Behavioral
Intervention description(s): include 2 phases: a) Intensive phase: weekly 4 hour group meeting which will include computerized cognitive training, aerobic, balance and strength exercise and group discussion that will be dedicated to cognitive rehabilitation strategies development and implementation with emphasis on disease management and physical activity as well as psycho-education on various disease management aspects (medical and nutritional) b) a consolidation phase: monthly 2 hour group discussions on challenges of implementation and coping strategies.
Observational model: Other
Time perspective: Prospective
Sampling method: Non-Probability Sample
Study population: 
        people with type 2 diabetes with below the norm cognitive function
      
Keywords: Diabetes; Cognitive-physical rehabilitation; Self care management