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Silveira SL, Kidwell-Chandler A, Huynh TLT, Cederberg KLJ, Jeng B, Sikes EM, Motl RW. Randomized Controlled Trial of the Behavioral Intervention for Increasing Physical Activity in Multiple Sclerosis Project: Fidelity Monitoring and Outcomes. Behav Med 2024:1-8. [PMID: 39287190 DOI: 10.1080/08964289.2024.2398414] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/08/2023] [Revised: 05/05/2024] [Accepted: 08/23/2024] [Indexed: 09/19/2024]
Abstract
Treatment fidelity is a key component for assessing the reliability and validity of clinical trials in behavioral medicine. This manuscript reports on the outcomes of a pre-planned fidelity monitoring protocol for a Phase-III clinical trial, project Behavioral Intervention for Physical Activity in Multiple Sclerosis (BIPAMS). The fidelity monitoring protocol included the five areas of the National Institutes of Health Behavior Change Consortium with primary data sources including: coaching call checklists, coaching logs, auditing of coaching calls by experts, behavioral resource bank within the treatment group, review of participant website log-ins, review of participant self-monitoring, and team meetings for discussing participant progress and protocol adherence. The fidelity monitoring protocol was implemented across six waves of participants, and a final sample of 269 participants (i.e., n = 135 in BIPAMS intervention and n = 134 in WellMS control) completed the 24-week study. Ten coaches were comprehensively trained to implement the study protocol, which included an orientation call and one-on-one behavioral coaching calls. Among BIPAMS participants, an average of 11.81/13 scheduled calls were completed, and 96 (62% of planned) were audited by an expert. Among WellMS participants, an average of 8.19/9 calls were completed, and 54 (55% of planned) audits were completed. Unplanned protocol deviations included inability to complete live call audits during the COVID-19 pandemic lockdown and changes in coaching criteria to accommodate unanticipated medical conditions and graduations. This manuscript provides an example and insights for demystifying treatment fidelity monitoring to help facilitate wide-spread use of standard protocols.
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Affiliation(s)
- Stephanie L Silveira
- Department of Management, Policy, and Community Health, University of Texas Health Science Center at Houston, Houston, TX, USA
| | - Ariel Kidwell-Chandler
- Department of Kinesiology and Nutrition, University of Illinois Chicago, Chicago, IL, USA
| | - Trinh L T Huynh
- Department of Kinesiology and Nutrition, University of Illinois Chicago, Chicago, IL, USA
| | - Katie L J Cederberg
- Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, Palo Alto, CA, USA
| | - Brenda Jeng
- Department of Kinesiology and Nutrition, University of Illinois Chicago, Chicago, IL, USA
| | - E Morghen Sikes
- Division of Occupational Therapy, Shenandoah University, Winchester, VA, USA
| | - Robert W Motl
- Department of Kinesiology and Nutrition, University of Illinois Chicago, Chicago, IL, USA
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Zheng P, Phillips SA, Duffecy J, DeJonge SR, DuBose NG, Motl RW. Remotely-delivered exercise training program for improving physical and cognitive functions among older adults with multiple sclerosis: Protocol for an NIH stage-I randomized controlled trial. Contemp Clin Trials 2024; 144:107636. [PMID: 39038700 DOI: 10.1016/j.cct.2024.107636] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2023] [Revised: 04/14/2024] [Accepted: 07/17/2024] [Indexed: 07/24/2024]
Abstract
BACKGROUND Older adults with multiple sclerosis (MS) present with low physical activity participation, cognitive and ambulatory dysfunctions, and compromised quality of life (QOL). OBJECTIVE We propose a NIH Stage-I, randomized controlled trial (RCT) that examines the feasibility and efficacy of a 16-week theory-based, remotely-delivered, exercise training program for improving cognitive and physical functions in older adults with MS who have moderate mobility disability without severe cognitive impairment. METHODS This Stage-I study utilizes a parallel-group RCT design. Participants (N = 50; age ≥ 50 years) will be randomly assigned into exercise training (combined aerobic and resistance exercise) or active control (flexibility and stretching) conditions. The conditions will be undertaken within a participant's home/community over a 16-week period, and monitored remotely and supported by Zoom-based chats guided by social cognitive theory (SCT) via a behavioral coach. Participants will receive training manuals and equipment, one-on-one behavioral coaching, action-planning calendars, self-monitoring logs, and SCT-based newsletters. The primary outcomes include feasibility (e.g., recruitment and retention rates), exercise behavior and physical activity; other outcomes include physical function (lower-extremity function, mobility, walking), cognition (processing speed, learning and memory, executive function), MS symptoms, QOL, and vascular function. We will collect outcome data at baseline (Week 0), post-intervention (Week 16), and follow-up (Week-32). Data analysis will follow intent-to-treat principles using linear mixed-effects models. DISCUSSION This Stage-I trial adopts an innovative approach for exercise training via telerehabilitation and is convenient and accessible for older adults with MS. If successful, the study will provide foundations for future research using remotely-delivered exercise intervention for managing the consequences of aging with MS. TRIAL REGISTRATION NUMBER NCT05930821.
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Affiliation(s)
- Peixuan Zheng
- Department of Kinesiology and Nutrition, University of Illinois Chicago, Chicago, IL, United States.
| | - Shane A Phillips
- Department of Physical Therapy, University of Illinois Chicago, Chicago, IL, United States
| | - Jennifer Duffecy
- Department of Psychiatry, University of Illinois Chicago, Chicago, IL, United States
| | - Sydney R DeJonge
- Department of Kinesiology and Nutrition, University of Illinois Chicago, Chicago, IL, United States
| | - Noah G DuBose
- Department of Kinesiology and Nutrition, University of Illinois Chicago, Chicago, IL, United States
| | - Robert W Motl
- Department of Kinesiology and Nutrition, University of Illinois Chicago, Chicago, IL, United States
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Prigent G, Aminian K, Gonzenbach RR, April R, Paraschiv-Ionescu A. Effects of multidisciplinary inpatient rehabilitation on everyday life physical activity and gait in patients with multiple sclerosis. J Neuroeng Rehabil 2024; 21:88. [PMID: 38807215 PMCID: PMC11131212 DOI: 10.1186/s12984-024-01383-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2023] [Accepted: 05/14/2024] [Indexed: 05/30/2024] Open
Abstract
BACKGROUND Multiple sclerosis is a progressive neurological disease that affects the central nervous system, resulting in various symptoms. Among these, impaired mobility and fatigue stand out as the most prevalent. The progressive worsening of symptoms adversely alters quality of life, social interactions and participation in activities of daily living. The main objective of this study is to bring new insights into the impact of a multidisciplinary inpatient rehabilitation on supervised walking tests, physical activity (PA) behavior and everyday gait patterns. METHODS A total of 52 patients, diagnosed with multiple sclerosis, were evaluated before and after 3 weeks of inpatient rehabilitation. Each measurement period consisted of clinical assessments and 7 days home monitoring using foot-mounted sensors. In addition, we considered two subgroups based on the Expanded Disability Status Scale (EDSS) scores: 'mild' (EDSS < 5) and 'severe' (EDSS ≥ 5) disability levels. RESULTS Significant improvements in fatigue, quality of life and perceived mobility were reported. In addition, walking capacity, as assessed by the 10-m walking test, two-minute walk test and timed-up-and-go test, improved significantly after rehabilitation. Regarding the home assessment, mildly disabled patients significantly increased their locomotion per day and complexity of daily PA pattern after rehabilitation, while severely disabled patients did not significantly change. There were distinct and significant differences in gait metrics (i.e., gait speed, stride length, cadence) between mildly and severely disabled patients, but the statistical models did not show a significant overall rehabilitation effect on these gait metrics. CONCLUSION Inpatient rehabilitation showed beneficial effects on self-reported mobility, self-rated health questionnaires, and walking capacity in both mildly and severely disabled patients. However, these improvements do not necessarily translate to home performance in severely disabled patients, or only marginally in mildly disabled patients. Motivational and behavioral factors should also be considered and incorporated into treatment strategies.
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Affiliation(s)
- Gaëlle Prigent
- Laboratory of Movement Analysis and Measurement, École Polytechnique Fédérale de Lausanne (EPFL), Lausanne, Switzerland
| | - Kamiar Aminian
- Laboratory of Movement Analysis and Measurement, École Polytechnique Fédérale de Lausanne (EPFL), Lausanne, Switzerland
| | - Roman Rudolf Gonzenbach
- Department of Neurological Rehabilitation, Rehabilitation Centre Valens, Valens, Switzerland
| | - Roger April
- Department of Neurological Rehabilitation, Rehabilitation Centre Valens, Valens, Switzerland
| | - Anisoara Paraschiv-Ionescu
- Laboratory of Movement Analysis and Measurement, École Polytechnique Fédérale de Lausanne (EPFL), Lausanne, Switzerland.
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Motl RW, Bombardier CH, Duffecy J, Hibner B, Wathen A, Carrithers M, Cutter G. Study protocol: exercise training for treating major depressive disorder in multiple sclerosis. BMC Neurol 2024; 24:131. [PMID: 38632556 PMCID: PMC11022372 DOI: 10.1186/s12883-024-03634-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2024] [Accepted: 04/10/2024] [Indexed: 04/19/2024] Open
Abstract
BACKGROUND Major depressive disorder (MDD) is prevalent, yet sub-optimally treated among persons with multiple sclerosis (MS). We propose that exercise training may be a promising approach for treating depression in persons with MS who have MDD. Our primary hypothesis predicts a reduction in depression severity immediately after an exercise training intervention compared with minimal change in an attention control condition, and the reduction will be maintained during a follow-up period. METHODS This study involves a parallel-group, assessor-blinded RCT that examines the effect of a 4-month home-based exercise training intervention on depression severity in a sample of persons with MS who have MDD based on the MINI International Neuropsychiatric Interview. The primary outcomes of depression severity are the Patient Health Questionnaire-9 and Hamilton Depression Rating Scale. Participants (N = 146) will be recruited from within 200 miles of the University of Illinois at Chicago and randomized (1:1) into either a home-based exercise training condition or control condition with concealed allocation. The exercise training and social-contact, attention control (i.e., stretching) conditions will be delivered remotely over a 4-month period and supported through eight, 1:1 Zoom-based behavioral coaching sessions guided by social-cognitive theory and conducted by persons who are uninvolved in screening, recruitment, random assignment, and outcome assessment. We will collect outcome data at 0, 4 and 8 months using treatment-blinded assessors, and data analyses will involve intent-to-treat principles. DISCUSSION If successful, the proposed study will provide the first Class I evidence supporting a home-based exercise training program for treating MDD in persons with MS. This is critical as exercise training would likely have positive secondary effects on symptoms, cognition, and quality of life, and provide a powerful, behavioral approach for managing the many negative outcomes of MDD in MS. The program in the proposed research is accessible and scalable for broad treatment of depression in MS, and provides the potential for integration in the clinical management of MS. TRIAL REGISTRATION The trial was registered on September 10, 2021 at clinicaltrials.gov with the identifier NCT05051618. The registration occurred before we initiated recruitment on June 2, 2023.
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Affiliation(s)
- Robert W Motl
- Department of Kinesiology and Nutrition, University of Illinois at Chicago, Chicago, IL, 60612, USA.
| | - Charles H Bombardier
- Department of Rehabilitation Medicine, University of Washington, Seattle, WA, USA
| | - Jennifer Duffecy
- Department of Psychiatry, University of Illinois at Chicago, Chicago, IL, USA
| | - Brooks Hibner
- Department of Kinesiology and Nutrition, University of Illinois at Chicago, Chicago, IL, 60612, USA
| | - Alison Wathen
- Department of Kinesiology and Nutrition, University of Illinois at Chicago, Chicago, IL, 60612, USA
| | - Michael Carrithers
- Department of Neurology and Rehabilitation, University of Illinois at Chicago, Chicago, IL, USA
| | - Gary Cutter
- Department of Biostatistics, University of Alabama at Birmingham, Birmingham, AL, USA
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Silveira SL, Motl RW, Froehlich-Grobe K, Kay M. Feasibility, acceptability, and initial efficacy of a wheelchair exercise training program in persons with multiple sclerosis: study protocol for a parallel group randomized controlled trial. Disabil Rehabil Assist Technol 2024:1-8. [PMID: 38520055 DOI: 10.1080/17483107.2024.2332322] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2023] [Accepted: 03/13/2024] [Indexed: 03/25/2024]
Abstract
Purpose: This study is a randomized controlled trial (RCT) that examines the feasibility, acceptability, and initial efficacy of a home-based, remotely supported and supervised exercise training program that was developed using a three-step community engaged research process for persons with multiple sclerosis (MS) who are wheelchair users.Materials and Methods: The study design is a parallel group RCT (NCT05888727). We aim to enroll 24 wheelchair users with MS who will be randomly assigned using REDCap randomization module into exercise training or attention/contact wellness control conditions. The conditions will be delivered remotely over 16 weeks and supported using online, one-onone behavioral coaching. The feasibility outcomes of interest include recruitment and retention rates, and safety outcomes collected throughout the study period. The acceptability outcomes include participant satisfaction and perceptions measured using formative surveys and interviews following the 16-week period. Efficacy outcomes include metabolic health, MS symptoms, and exercise behavior measured before and after the 16-week period. The data analysis will follow intent-to-treat principles using 2 group by 2 time mixed factor ANOVA with estimation of Cohen's d values as effect sizes.Conclusions: The results will guide future research targeting health outcomes using exercise training among wheelchair users with MS who have largely been absent from health promotion research.
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Affiliation(s)
- Stephanie L Silveira
- Department of Kinesiology, Health Promotion, and Recreation, University of North TX, Denton, TX, USA
- Department of Management, Policy, and Community Health, University of Texas Health Science Center at Houston, Houston, TX, USA
| | - Robert W Motl
- Department of Kinesiology and Nutrition, University of IL Chicago, Chicago, IL, USA
| | | | - Mitch Kay
- Department of Kinesiology, Health Promotion, and Recreation, University of North TX, Denton, TX, USA
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Silveira SL, Motl RW, Sandroff BM, Pilutti LA, Cutter GR. Randomized Controlled Trial of the Behavioral Intervention for Physical Activity in Multiple Sclerosis Project: Response Heterogeneity and Predictors of Change. Int J Behav Med 2024:10.1007/s12529-024-10265-7. [PMID: 38326673 DOI: 10.1007/s12529-024-10265-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/29/2024] [Indexed: 02/09/2024]
Abstract
BACKGROUND We reported that a social cognitive theory-based (SCT), Internet-delivered behavioral intervention increased device-measured minutes/day of moderate-to-vigorous physical activity (MVPA) over a 6-month period among persons with multiple sclerosis (MS). This paper examined the pattern and predictors of heterogeneity in change for MVPA. Based on previous research, we hypothesized that mild MS disability, fewer MS symptoms, lower baseline MVPA, and positive SCT characteristics (e.g., high exercise self-efficacy) would be associated with greater change in MVPA. METHOD Persons with MS (N = 318) were randomized into behavioral intervention (n = 159) or attention/social contact control (n = 159) conditions that were administered via Internet websites and supported with behavioral coaching. Demographic, clinical, symptom, behavioral, and SCT data were from before the 6-month period of delivering the conditions, and MVPA data were from before and after the 6-month period. We examined heterogeneity based on waterfall plots, box plots, and the Levene statistic. We identified predictors of MVPA change using bivariate correlation and multiple, linear regression analyses per condition. RESULTS The Levene statistic indicated statistically significant heterogeneity of variances for MVPA change between conditions (p = .003), and the waterfall plots and box plots indicated greater heterogeneity in MVPA change for the behavioral intervention. MVPA change score was correlated with baseline MVPA (r = - .33 and r = - .34, p = .0004 and p = .0001) in both conditions and walking impairment (r = - .188, p = .047) and race (r = .233, p = .014) in the behavioral intervention condition. The regression analysis indicated that baseline MVPA (Standardized B = - .449, p = .000002), self-reported walking impairment (Standardized B = - .310, p = .0008), and race (Standardized B = .215, p = .012) explained 25.6% of variance in MVPA change for the behavioral intervention condition. CONCLUSION We provide evidence for walking impairment, baseline MVPA, and race as predictors of the heterogeneity in the pattern of MVPA change with a behavioral intervention.
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Affiliation(s)
- Stephanie L Silveira
- Department of Management, Policy, and Community Health, University of Texas Health Science Center at Houston, 1200 Pressler Street, Houston, TX, 77030, USA.
| | - Robert W Motl
- Department of Kinesiology and Nutrition, University of Illinois Chicago, Chicago, USA
| | - Brian M Sandroff
- Center for Neuropsychology and Neuroscience Research, Kessler Foundation, East Hanover, USA
| | - Lara A Pilutti
- Interdisciplinary School of Health Sciences, University of Ottawa, Ottawa, Canada
| | - Gary R Cutter
- Department of Biostatistics, University of Alabama at Birmingham, Birmingham, USA
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Motl RW, Kidwell-Chandler A, Sandroff BM, Pilutti LA, Cutter GR, Aldunate R, Bollaert RE. Randomized controlled trial of the behavioral intervention for physical activity in multiple sclerosis project: Social cognitive theory variables as mediators. Mult Scler Relat Disord 2023; 78:104933. [PMID: 37586313 DOI: 10.1016/j.msard.2023.104933] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2023] [Revised: 08/05/2023] [Accepted: 08/08/2023] [Indexed: 08/18/2023]
Abstract
BACKGROUND We recently reported in a phase-III, randomized controlled trial that a behavioral intervention based on social cognitive theory (SCT) and delivered through the Internet using e-learning approaches increased device-measured minutes/day of moderate-to-vigorous physical activity (MVPA) over a 6-month period among persons with multiple sclerosis (MS). OBJECTIVE This planned tertiary outcome paper examined SCT variables as mediators of the behavioral intervention effect on change in device-measured minutes/day of MVPA. METHOD Persons with MS (N = 318) were randomized into behavioral intervention (n = 159) or attention/social contact control (n = 159) conditions. The conditions were administered over a 6-month period via an Internet website and supported with behavioral coaching by persons who were uninvolved in screening, recruitment, random assignment, and outcome assessments. We collected MVPA and SCT data before and after the 6-month period. The data analysis involved linear mixed modeling on MVPA and SCT outcomes followed by latent change score modeling for examining SCT variables as mediators of the intervention effect on change in MVPA. RESULTS The linear mixed model indicated statistically significant group by time interactions on device-measured minutes/day of MVPA and scores from SCT measures of exercise self-efficacy, barriers self-efficacy, goal setting, and planning. The effect of the intervention on device-measured minutes/day of MVPA was mediated by the SCT variable of exercise self-efficacy based on the statistical significance of the Wald z-score for the indirect effect in the latent change score model. CONCLUSIONS This study provides evidence for exercise self-efficacy as a SCT mediator of the behavioral intervention effect on device-measured minutes/day of MVPA in persons with MS.
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Affiliation(s)
- Robert W Motl
- Department of Kinesiology and Nutrition, University of Illinois Chicago, 506 J AHSB, Chicago, IL 60612, USA.
| | | | - Brian M Sandroff
- Center for Neuropsychology and Neuroscience Research, Kessler Foundation, USA
| | - Lara A Pilutti
- Interdisciplinary School of Health Sciences, University of Ottawa, Canada
| | - Gary R Cutter
- Department of Biostatistics, University of Alabama at Birmingham, USA
| | | | - Rachel E Bollaert
- Program in Exercise Science, Department of Physical Therapy, Marquette University, USA
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Reece JC, Yu M, Bevens W, Simpson-Yap S, Jelinek G, Jelinek P, Davenport R, Nag N, Gray K, Neate S. Study protocol for an online lifestyle modification education course for people living with multiple sclerosis: the multiple sclerosis online course (MSOC). BMC Neurol 2023; 23:249. [PMID: 37386385 DOI: 10.1186/s12883-023-03298-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2023] [Accepted: 06/20/2023] [Indexed: 07/01/2023] Open
Abstract
BACKGROUND People living with multiple sclerosis (plwMS) seek access to information on evidence-based lifestyle-related risk factors associated with multiple sclerosis (MS). As the internet has made delivery of lifestyle information increasingly accessible and cost-effective, we designed the Multiple Sclerosis Online Course (MSOC) to deliver a multimodal lifestyle modification program for plwMS. Two MS online courses were developed: the intervention course based on lifestyle recommendations of the Overcoming Multiple Sclerosis (OMS) program and the standard-care course representing standard lifestyle recommendations from other MS websites. We examined for feasibility in a pilot randomised controlled trial (RCT), where satisfactory completion and accessibility were achieved across both study arms. From this success, a protocol for a larger RCT was developed to examine the effectiveness of MSOC in improving health-related quality of life (HRQoL) and other health outcomes in plwMS. METHODS/DESIGN This single-blinded RCT will recruit n = 1,054 plwMS. Participants in the intervention arm will receive access to a MSOC with seven modules providing evidence-based information on the OMS program. Participants in the control group will receive access to a MSOC of identical format, with seven modules providing general MS-related information and lifestyle recommendations sourced from popular MS websites, e.g. MS societies. Participants will complete questionnaires at baseline and at 6, 12, and 30 months after course completion. The primary endpoint is HRQoL, as measured by MSQOL-54 (both physical and mental health domains) at 12 months following course completion. Secondary outcomes are changes to depression, anxiety, fatigue, disability, and self-efficacy as measured by Hospital Anxiety and Depression Scale, Patient-Determined Disease Steps and University of Washington Self-Efficacy Scale, respectively, assessed at each timepoint. Further assessments will include quantitative post-course evaluation, adoption and maintenance of behaviour change from follow-up survey data, and qualitative analysis of participants' outcomes and reasons for course completion or non-completion. DISCUSSION This RCT aims to determine whether an online intervention course delivering evidence-based lifestyle modification recommendations based on the Overcoming Multiple Sclerosis program to plwMS is more effective at improving HRQoL, and other health outcomes post-intervention, compared with an online standard-care course. TRIAL REGISTRATION This trial was registered prospectively with the Australian New Zealand Clinical Trials Registry, www.anzctr.org.au , identifier ACTRN12621001605886. DATE OF REGISTRATION 25 November 2021.
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Affiliation(s)
- Jeanette C Reece
- Neuroepidemiology Unit, Centre for Epidemiology and Biostatistics, Melbourne School of Population & Global Health, The University of Melbourne, Level 3, 207 Bouverie St Carlton, Melbourne, VIC, 3053, Australia
| | - Maggie Yu
- Neuroepidemiology Unit, Centre for Epidemiology and Biostatistics, Melbourne School of Population & Global Health, The University of Melbourne, Level 3, 207 Bouverie St Carlton, Melbourne, VIC, 3053, Australia
| | - William Bevens
- Neuroepidemiology Unit, Centre for Epidemiology and Biostatistics, Melbourne School of Population & Global Health, The University of Melbourne, Level 3, 207 Bouverie St Carlton, Melbourne, VIC, 3053, Australia
| | - Steve Simpson-Yap
- Neuroepidemiology Unit, Centre for Epidemiology and Biostatistics, Melbourne School of Population & Global Health, The University of Melbourne, Level 3, 207 Bouverie St Carlton, Melbourne, VIC, 3053, Australia
- Menzies Institute for Medical Research, University of Tasmania, Hobart, Australia
| | - George Jelinek
- Neuroepidemiology Unit, Centre for Epidemiology and Biostatistics, Melbourne School of Population & Global Health, The University of Melbourne, Level 3, 207 Bouverie St Carlton, Melbourne, VIC, 3053, Australia
| | - Pia Jelinek
- Neuroepidemiology Unit, Centre for Epidemiology and Biostatistics, Melbourne School of Population & Global Health, The University of Melbourne, Level 3, 207 Bouverie St Carlton, Melbourne, VIC, 3053, Australia
| | - Rebekah Davenport
- Melbourne School of Psychological Sciences, The University of Melbourne, Melbourne, Australia
| | - Nupur Nag
- Neuroepidemiology Unit, Centre for Epidemiology and Biostatistics, Melbourne School of Population & Global Health, The University of Melbourne, Level 3, 207 Bouverie St Carlton, Melbourne, VIC, 3053, Australia
| | - Kathleen Gray
- Centre for Digital Transformation of Health, The University of Melbourne, Melbourne, Australia
| | - Sandra Neate
- Neuroepidemiology Unit, Centre for Epidemiology and Biostatistics, Melbourne School of Population & Global Health, The University of Melbourne, Level 3, 207 Bouverie St Carlton, Melbourne, VIC, 3053, Australia.
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Motl RW, Kidwell-Chandler A, Sandroff BM, Pilutti LA, Cutter GR, Aldunate R, Bollaert RE. Primary results of a phase-III, randomized controlled trial of the Behavioral Intervention for increasing Physical Activity in Multiple Sclerosis project. Mult Scler 2023; 29:415-426. [PMID: 36843446 DOI: 10.1177/13524585221146430] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/28/2023]
Abstract
BACKGROUND We undertook a phase-III, randomized controlled trial (RCT) that examined the effectiveness of a behavioral intervention based on social cognitive theory (SCT) and delivered through the Internet using e-learning approaches for immediate and sustained increases in physical activity among persons with multiple sclerosis (MS). METHOD The study followed a parallel group RCT design. Persons with MS (N = 318) were randomized into either behavioral intervention (n = 159) or attention/social contact control (n = 159) conditions. The conditions were administered over a 6-month period by persons who were uninvolved in screening, recruitment, random assignment, and outcome assessment. There was a 6-month follow-up period without access of conditions. We collected outcome data every 6 months over the 12-month period. The primary outcome was device-measured minutes/day of moderate-to-vigorous physical activity (MVPA). The data analysis involved a modified intent-to-treat approach (i.e. those who received the allocated conditions) using a linear mixed model. RESULTS There was a significant group by time interaction on the primary outcome of device-measured minutes/day of MVPA (p < 0.005). MVPA was increased immediately after the 6-month period in the behavioral intervention compared with control, and this difference was sustained over the 6-month follow-up. CONCLUSION This study provides evidence for the effectiveness of a widely scalable approach for increasing MVPA in persons with MS.
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Affiliation(s)
- Robert W Motl
- Department of Kinesiology and Nutrition, University of Illinois Chicago, Chicago, IL, USA
| | | | | | - Lara A Pilutti
- Interdisciplinary School of Health Sciences, University of Ottawa, Ottawa, ON, Canada
| | - Gary R Cutter
- Department of Biostatistics, University of Alabama at Birmingham, Birmingham, AL, USA
| | | | - Rachel E Bollaert
- Program in Exercise Science, Department of Physical Therapy, Marquette University, Milwaukee, WI, USA
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Randomized controlled trial of the behavioral intervention for increasing physical activity in multiple sclerosis project: Secondary, patient-reported outcomes. Contemp Clin Trials 2023; 125:107056. [PMID: 36535606 DOI: 10.1016/j.cct.2022.107056] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2022] [Revised: 12/09/2022] [Accepted: 12/14/2022] [Indexed: 12/23/2022]
Abstract
BACKGROUND We undertook a randomized controlled trial (RCT) that investigated the effectiveness of a theory-based, Internet-delivered, behavioral intervention focusing on physical activity promotion for immediate and sustained improvements in secondary, patient-reported outcomes (PROs) of function, symptoms, and quality of life (QOL) in multiple sclerosis (MS). METHOD Persons with MS (N = 318) were recruited from throughout the United States and randomized into behavioral intervention (n = 159) or attention/social contact control (n = 159) conditions. The conditions were administered over a 6-month period by persons who were uninvolved in screening, recruitment, random assignment, and outcome assessment. There was a 6-month follow-up period without intervention access/content. We collected PROs data every 6 months over the 12-month period. The PROs included validated measures of walking and cognitive function, symptoms of fatigue, depression, anxiety, pain, and sleep quality, and QOL. The data analysis involved a modified intent-to-treat approach using a linear mixed model in JMP Pro 16.0. RESULTS There was a significant group by time interaction on Fatigue Severity Scale scores (p < .01) and physical subscale scores of the Modified Fatigue Impact Scale (p < .05). Scores on both measures decreased immediately after the 6-month period in the behavioral intervention compared with no change in the control condition, and this differential pattern of change was sustained over the 6-month follow-up. There were no group by time interactions on the other PROs. DISCUSSION This study provides evidence for the effectiveness of a novel, widely scalable approach for physical activity promotion and fatigue management in persons with MS, yet this must be contextualized with the absence of improvements in the other PROs.
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Polhemus A, Haag C, Sieber C, Sylvester R, Kool J, Gonzenbach R, von Wyl V. Methodological heterogeneity biases physical activity metrics derived from the Actigraph GT3X in multiple sclerosis: A rapid review and comparative study. FRONTIERS IN REHABILITATION SCIENCES 2022; 3:989658. [PMID: 36518351 PMCID: PMC9742246 DOI: 10.3389/fresc.2022.989658] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/08/2022] [Accepted: 11/01/2022] [Indexed: 11/10/2023]
Abstract
BACKGROUND Physical activity (PA) is reduced in persons with multiple sclerosis (MS), though it is known to aid in symptom and fatigue management. Methods for measuring PA are diverse and the impact of this heterogeneity on study outcomes is unclear. We aimed to clarify this impact by comparing common methods for deriving PA metrics in MS populations. METHODS First, a rapid review of existing literature identified methods for calculating PA in studies which used the Actigraph GT3X in populations with MS. We then compared methods in a prospective study on 42 persons with MS [EDSS 4.5 (3.5-6)] during a voluntary course of inpatient neurorehabilitation. Mixed-effects linear regression identified methodological factors which influenced PA measurements. Non-parametric hypothesis tests, correlations, and agreement statistics assessed overall and pairwise differences between methods. RESULTS In the rapid review, searches identified 421 unique records. Sixty-nine records representing 51 eligible studies exhibited substantial heterogeneity in methodology and reporting practices. In a subsequent comparative study, multiple methods for deriving six PA metrics (step count, activity counts, total time in PA, sedentary time, time in light PA, time in moderate to vigorous PA), were identified and directly compared. All metrics were sensitive to methodological factors such as the selected preprocessing filter, data source (vertical vs. vector magnitude counts), and cutpoint. Additionally, sedentary time was sensitive to wear time definitions. Pairwise correlation and agreement between methods varied from weak (minimum correlation: 0.15, minimum agreement: 0.03) to perfect (maximum correlation: 1.00, maximum agreement: 1.00). Methodological factors biased both point estimates of PA and correlations between PA and clinical assessments. CONCLUSIONS Methodological heterogeneity of existing literature is high, and this heterogeneity may confound studies which use the Actigraph GT3X. Step counts were highly sensitive to the filter used to process raw accelerometer data. Sedentary time was particularly sensitive to methodology, and we recommend using total time in PA instead. Several, though not all, methods for deriving light PA and moderate to vigorous PA yielded nearly identical results. PA metrics based on vertical axis counts tended to outperform those based on vector magnitude counts. Additional research is needed to establish the relative validity of existing methods.
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Affiliation(s)
- Ashley Polhemus
- Epidemiology and Biostatistics and Prevention Institute, University of Zürich, Zürich, Switzerland
| | - Christina Haag
- Epidemiology and Biostatistics and Prevention Institute, University of Zürich, Zürich, Switzerland
- Institute for Implementation Science in Health Care, University of Zürich, Zürich, Switzerland
| | - Chloé Sieber
- Epidemiology and Biostatistics and Prevention Institute, University of Zürich, Zürich, Switzerland
- Institute for Implementation Science in Health Care, University of Zürich, Zürich, Switzerland
| | - Ramona Sylvester
- Research Department Physiotherapy, Rehabilitation Centre, Valens, Switzerland
| | - Jan Kool
- Research Department Physiotherapy, Rehabilitation Centre, Valens, Switzerland
| | - Roman Gonzenbach
- Research Department Physiotherapy, Rehabilitation Centre, Valens, Switzerland
| | - Viktor von Wyl
- Epidemiology and Biostatistics and Prevention Institute, University of Zürich, Zürich, Switzerland
- Institute for Implementation Science in Health Care, University of Zürich, Zürich, Switzerland
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12
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Huynh TLT, Silveira SL, Motl RW. Systematic review of participant characteristics in theory-based behavior change interventions for physical activity in multiple sclerosis: are we missing those with the greatest potential for lifelong benefits? Disabil Rehabil 2022; 44:5784-5803. [PMID: 34334057 DOI: 10.1080/09638288.2021.1954705] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2020] [Revised: 06/24/2021] [Accepted: 07/06/2021] [Indexed: 10/20/2022]
Abstract
PURPOSE This study examined participant characteristics, particularly disease duration, in theory-based physical activity behavior change trials in multiple sclerosis (MS) and summarized theoretical frameworks and changes in physical activity outcomes. MATERIALS AND METHODS PubMed, CINAHL, Embase, and Scopus were searched to identify potential trials. One reviewer screened titles and abstracts, and two reviewers then independently screened full-text articles based on predetermined eligibility criteria. Data were extracted by one reviewer and checked by a second reviewer. RESULTS Among 33 trials reviewed, only one trial reported a mean disease duration of less than five years (i.e., 4.5 years) for the sample. The remaining trials included samples with a mean disease duration of 6.7 years or longer. The most common theories used were Social Cognitive Theory, Trans-theoretical Model, and Motivational Interviewing. The effects on physical activity were heterogeneous; device-measured outcomes increased in 41.4% of studies, self-reported outcomes improved in 72.4%. Adherence (≥80%) was reported in 34.5% of studies. CONCLUSIONS There is little focus on persons with MS in the early disease course in physical activity behavior change interventions. Future research should include comprehensive theoretical approaches for more homogeneous effects across outcome measures when targeting those in the early stage and all MS populations.IMPLICATIONS FOR REHABILITATIONTheory-based physical activity behavior change interventions have not included persons with multiple sclerosis (MS) in the early disease course (<5 years since diagnosis).Disease duration has not been a criterion used to include or exclude participants in the reviewed theory-based behavior change interventions for physical activity in people with MS.The theory-based behavior change interventions in this review positively affected short-term physical activity levels in people with MS.
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Affiliation(s)
- Trinh L T Huynh
- Physical Therapy, University of Alabama at Birmingham, Birmingham, AL, USA
| | | | - Robert W Motl
- Physical Therapy, University of Alabama at Birmingham, Birmingham, AL, USA
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Kinnett-Hopkins D, Motl R. Social cognitive correlates of device-measured and self-reported physical activity in Black and White individuals with multiple sclerosis. Disabil Health J 2022; 15:101344. [PMID: 35725690 DOI: 10.1016/j.dhjo.2022.101344] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2022] [Revised: 05/09/2022] [Accepted: 05/18/2022] [Indexed: 11/03/2022]
Abstract
BACKGROUND There is increasing research interest regarding physical activity behavior among persons with multiple sclerosis (MS), yet there is little known about physical activity and its correlates in Black persons with MS. OBJECTIVE This cross-sectional study assessed associations among social cognitive theory (SCT) variables and device-measured and self-reported physical activity in samples of Black and White persons with MS. METHODS Participants included 67 Black and 141 White persons with MS who wore an ActiGraph accelerometer on a belt around the waist measuring moderate-to-vigorous physical activity (MVPA) for seven days and completed a battery of questionnaires. Questionnaires included demographic and clinical characteristics, leisure-time exercise, exercise self-efficacy, overcoming barriers self-efficacy, function, social support, exercise outcome expectations, and goal setting and planning. RESULTS Black participants with MS engaged in significantly less MVPA, but not sedentary behavior or light physical activity, than the White participants with MS. Black participants further had significantly lower levels of exercise self-efficacy and outcome expectations than the White sample. All SCT correlates were significantly correlated with self-reported physical activity, but only exercise and barriers self-efficacy, perceived function, and exercise goal setting were associated with device-measured MVPA. The difference in physical activity between Black and White participants with MS was accounted for by differences in exercise self-efficacy and outcome expectations. CONCLUSIONS Researchers should consider developing behavioral interventions that target exercise self-efficacy and outcome expectations as SCT variables for increasing physical activity in Black persons with MS.
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Affiliation(s)
| | - Robert Motl
- Department of Physical Therapy, The University of Alabama at Birmingham, Birmingham, AL, USA
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14
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Kuendig S, Kool J, Polhemus A, Schallert W, Bansi J, Gonzenbach RR. Three weeks of rehabilitation improves walking capacity but not daily physical activity in patients with multiple sclerosis with moderate to severe walking disability. PLoS One 2022; 17:e0274348. [PMID: 36121792 PMCID: PMC9484681 DOI: 10.1371/journal.pone.0274348] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2022] [Accepted: 08/25/2022] [Indexed: 11/19/2022] Open
Abstract
Background Patients with multiple sclerosis have low levels of physical activity. This is of concern because low activity levels are related to cardiovascular disease, poor walking ability, and reduced quality of life. The aim of this study was to evaluate the impact of rehabilitation on daily physical activity and walking capacity in patients with multiple sclerosis who have moderate to severe walking disability. Methods This exploratory, observational study of 24 patients with multiple sclerosis examined daily physical activity, walking capacity and fatigue before and after 3 weeks of inpatient rehabilitation. Inpatient rehabilitation included physiotherapy (30–60 min, 5 times/week), strength and endurance training (30–45 min, 3–5 times/week), occupational therapy (30 min, 2–3 times/week), and neuropsychological training (30 min, 2 times/week). There were no specific interventions to target daily levels of physical activity. Results Daily physical activity did not change after rehabilitation (physical activity: effect size = –0.23, 95% confidence interval (95% CI) 0.02‒0.62). There were significant improvements in walking capacity (Two-Minute Walk Test: effect size = 0.74, 95% CI 0.31‒1.16, +17 m, 20.2%) and mobility (Timed Up and Go Test: effect size = 0.65, 95% CI 0.22‒1.07, ‒2.1 s, 14.9%). Motor and cognitive fatigue (Fatigue Scale for Motor: effect size = 0.56, 95% CI 0.14‒0.99 and Cognitive Functions: effect size = 0.44, 95% CI 0.01‒0.86) improved significantly after rehabilitation. Conclusion Three weeks of rehabilitation improved walking capacity, but not daily physical activity, in patients with multiple sclerosis with moderate to severe walking disability. To increase physical activity, it may be necessary to add specific behavioural interventions to the rehabilitation programme. The intervention plan should include strategies to overcome personal and environmental barriers.
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Affiliation(s)
- Sandra Kuendig
- Research Department Physiotherapy, Rehabilitation Centre, Valens, Switzerland
- Zurich University of Applied Sciences, School of Health Professions, Institute of Physiotherapy, Winterthur, Switzerland
| | - Jan Kool
- Research Department Physiotherapy, Rehabilitation Centre, Valens, Switzerland
| | - Ashley Polhemus
- Epidemiology, Biostatistics, and Prevention Institute, University of Zürich, Zürich, Switzerland
| | - Wolfgang Schallert
- Research Department Physiotherapy, Rehabilitation Centre, Valens, Switzerland
- * E-mail:
| | - Jens Bansi
- Research Department Physiotherapy, Rehabilitation Centre, Valens, Switzerland
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15
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Social cognitive theory variables are stronger correlates of moderate-to-vigorous physical activity than light physical activity in older adults with multiple sclerosis. SPORT SCIENCES FOR HEALTH 2022. [DOI: 10.1007/s11332-021-00845-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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16
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Leavitt VM, Aguerre IM, Lee N, Riley CS, De Jager PL, Bloom S. RCT of a Telehealth Group-Based Intervention to Increase Physical Activity in Multiple Sclerosis: eFIT. Neurol Clin Pract 2021; 11:291-297. [PMID: 34484928 DOI: 10.1212/cpj.0000000000001039] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2020] [Accepted: 12/07/2020] [Indexed: 11/15/2022]
Abstract
Objective To conduct a pilot randomized controlled trial to determine whether participation in a group-based structured telehealth intervention increases physical activity in people with multiple sclerosis (MS). Methods In this parallel-arms trial, all study procedures were administered remotely. Adults diagnosed with MS (any subtype) were randomized to one of two 12-week (1 h/wk) active conditions: eFIT, online moderated structured groups; or eJournal, online independent journaling. For comparison, a treatment-as-usual (TAU; i.e., no eFIT/eJournal) group was enrolled. The primary outcome was feasibility (completion and adherence). The secondary efficacy outcomes included self-reported physical activity level (International Physical Activity Questionnaire, IPAQ). Results Participants were 37 adults with MS. The sample was diverse: 66.7% female; age range 23-64 years; 17.5% Hispanic, 12.5% Black; and progressive and relapsing-remitting disease subtypes. Regarding feasibility, 70.7% completed; average adherence was 74.9%. Physical activity in active groups increased by 34.2% (baseline IPAQ = 2,406.8 ± 1,959.7, follow-up = 3,229.4 ± 2,575.2) and decreased in the TAU group by 17.4% (baseline = 2,519.9 ± 1,500.1, follow-up = 2,081.2 ± 1,814.9); group × time interaction was not statistically significant [F(2,25) = 1.467, p = 0.250; partial η2 = 0.105]. Conclusions Telehealth represents an accessible, acceptable vehicle to deliver targeted behavioral treatments to a neurologic population. eFIT may be an effective intervention for increasing physical activity, a historically intractable treatment target, in individuals with MS. In addition, these results provide evidence for feasibility of conducting fully remote clinical trial research. Classification of Evidence This study provides Class II evidence that for people with MS, participation in a group-based structured telehealth intervention compared with TAU resulted in a (non-significant) increase in self-reported physical activity level. The percentage of participants who completed follow-up questionnaires did not differ between groups. The trial was registered at ClinicalTrials.gov (NCT03829267).
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Affiliation(s)
- Victoria M Leavitt
- Translational Cognitive Neuroscience Laboratory (VML), Multiple Sclerosis Center (VML, IMA, CSR, PLDJ, SB), Center for Translational & Computational Neuroimmunology (IMA, CSR, PLDJ), Department of Neurology, Columbia University Irving Medical Center; and Department of Rehabilitation and Regenerative Medicine (NL), Columbia University Vagelos College of Physicians and Surgeons, New York
| | - Ines M Aguerre
- Translational Cognitive Neuroscience Laboratory (VML), Multiple Sclerosis Center (VML, IMA, CSR, PLDJ, SB), Center for Translational & Computational Neuroimmunology (IMA, CSR, PLDJ), Department of Neurology, Columbia University Irving Medical Center; and Department of Rehabilitation and Regenerative Medicine (NL), Columbia University Vagelos College of Physicians and Surgeons, New York
| | - Nancy Lee
- Translational Cognitive Neuroscience Laboratory (VML), Multiple Sclerosis Center (VML, IMA, CSR, PLDJ, SB), Center for Translational & Computational Neuroimmunology (IMA, CSR, PLDJ), Department of Neurology, Columbia University Irving Medical Center; and Department of Rehabilitation and Regenerative Medicine (NL), Columbia University Vagelos College of Physicians and Surgeons, New York
| | - Claire S Riley
- Translational Cognitive Neuroscience Laboratory (VML), Multiple Sclerosis Center (VML, IMA, CSR, PLDJ, SB), Center for Translational & Computational Neuroimmunology (IMA, CSR, PLDJ), Department of Neurology, Columbia University Irving Medical Center; and Department of Rehabilitation and Regenerative Medicine (NL), Columbia University Vagelos College of Physicians and Surgeons, New York
| | - Philip L De Jager
- Translational Cognitive Neuroscience Laboratory (VML), Multiple Sclerosis Center (VML, IMA, CSR, PLDJ, SB), Center for Translational & Computational Neuroimmunology (IMA, CSR, PLDJ), Department of Neurology, Columbia University Irving Medical Center; and Department of Rehabilitation and Regenerative Medicine (NL), Columbia University Vagelos College of Physicians and Surgeons, New York
| | - Sharonna Bloom
- Translational Cognitive Neuroscience Laboratory (VML), Multiple Sclerosis Center (VML, IMA, CSR, PLDJ, SB), Center for Translational & Computational Neuroimmunology (IMA, CSR, PLDJ), Department of Neurology, Columbia University Irving Medical Center; and Department of Rehabilitation and Regenerative Medicine (NL), Columbia University Vagelos College of Physicians and Surgeons, New York
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17
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Leavitt VM, Aguerre IM, Lee N, Riley CS, De Jager PL, Bloom S. RCT of a Telehealth Group-Based Intervention to Increase Physical Activity in Multiple Sclerosis: eFIT. Neurol Clin Pract 2021. [PMID: 34484928 DOI: 10.1212/cpj.0000000000001039.] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Objective To conduct a pilot randomized controlled trial to determine whether participation in a group-based structured telehealth intervention increases physical activity in people with multiple sclerosis (MS). Methods In this parallel-arms trial, all study procedures were administered remotely. Adults diagnosed with MS (any subtype) were randomized to one of two 12-week (1 h/wk) active conditions: eFIT, online moderated structured groups; or eJournal, online independent journaling. For comparison, a treatment-as-usual (TAU; i.e., no eFIT/eJournal) group was enrolled. The primary outcome was feasibility (completion and adherence). The secondary efficacy outcomes included self-reported physical activity level (International Physical Activity Questionnaire, IPAQ). Results Participants were 37 adults with MS. The sample was diverse: 66.7% female; age range 23-64 years; 17.5% Hispanic, 12.5% Black; and progressive and relapsing-remitting disease subtypes. Regarding feasibility, 70.7% completed; average adherence was 74.9%. Physical activity in active groups increased by 34.2% (baseline IPAQ = 2,406.8 ± 1,959.7, follow-up = 3,229.4 ± 2,575.2) and decreased in the TAU group by 17.4% (baseline = 2,519.9 ± 1,500.1, follow-up = 2,081.2 ± 1,814.9); group × time interaction was not statistically significant [F(2,25) = 1.467, p = 0.250; partial η2 = 0.105]. Conclusions Telehealth represents an accessible, acceptable vehicle to deliver targeted behavioral treatments to a neurologic population. eFIT may be an effective intervention for increasing physical activity, a historically intractable treatment target, in individuals with MS. In addition, these results provide evidence for feasibility of conducting fully remote clinical trial research. Classification of Evidence This study provides Class II evidence that for people with MS, participation in a group-based structured telehealth intervention compared with TAU resulted in a (non-significant) increase in self-reported physical activity level. The percentage of participants who completed follow-up questionnaires did not differ between groups. The trial was registered at ClinicalTrials.gov (NCT03829267).
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Affiliation(s)
- Victoria M Leavitt
- Translational Cognitive Neuroscience Laboratory (VML), Multiple Sclerosis Center (VML, IMA, CSR, PLDJ, SB), Center for Translational & Computational Neuroimmunology (IMA, CSR, PLDJ), Department of Neurology, Columbia University Irving Medical Center; and Department of Rehabilitation and Regenerative Medicine (NL), Columbia University Vagelos College of Physicians and Surgeons, New York
| | - Ines M Aguerre
- Translational Cognitive Neuroscience Laboratory (VML), Multiple Sclerosis Center (VML, IMA, CSR, PLDJ, SB), Center for Translational & Computational Neuroimmunology (IMA, CSR, PLDJ), Department of Neurology, Columbia University Irving Medical Center; and Department of Rehabilitation and Regenerative Medicine (NL), Columbia University Vagelos College of Physicians and Surgeons, New York
| | - Nancy Lee
- Translational Cognitive Neuroscience Laboratory (VML), Multiple Sclerosis Center (VML, IMA, CSR, PLDJ, SB), Center for Translational & Computational Neuroimmunology (IMA, CSR, PLDJ), Department of Neurology, Columbia University Irving Medical Center; and Department of Rehabilitation and Regenerative Medicine (NL), Columbia University Vagelos College of Physicians and Surgeons, New York
| | - Claire S Riley
- Translational Cognitive Neuroscience Laboratory (VML), Multiple Sclerosis Center (VML, IMA, CSR, PLDJ, SB), Center for Translational & Computational Neuroimmunology (IMA, CSR, PLDJ), Department of Neurology, Columbia University Irving Medical Center; and Department of Rehabilitation and Regenerative Medicine (NL), Columbia University Vagelos College of Physicians and Surgeons, New York
| | - Philip L De Jager
- Translational Cognitive Neuroscience Laboratory (VML), Multiple Sclerosis Center (VML, IMA, CSR, PLDJ, SB), Center for Translational & Computational Neuroimmunology (IMA, CSR, PLDJ), Department of Neurology, Columbia University Irving Medical Center; and Department of Rehabilitation and Regenerative Medicine (NL), Columbia University Vagelos College of Physicians and Surgeons, New York
| | - Sharonna Bloom
- Translational Cognitive Neuroscience Laboratory (VML), Multiple Sclerosis Center (VML, IMA, CSR, PLDJ, SB), Center for Translational & Computational Neuroimmunology (IMA, CSR, PLDJ), Department of Neurology, Columbia University Irving Medical Center; and Department of Rehabilitation and Regenerative Medicine (NL), Columbia University Vagelos College of Physicians and Surgeons, New York
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Latchem-Hastings J, Randell E, Button K, Jones F, Lowe R, Dawes H, Wood F, Davies F, Poile V, O'Halloran R, Stensland B, Tallantyre E, Playle R, Edwards A, Busse M. Lifestyle, exercise and activity package for people living with progressive multiple sclerosis (LEAP-MS): protocol for a single-arm feasibility study. Pilot Feasibility Stud 2021; 7:111. [PMID: 34022955 PMCID: PMC8140324 DOI: 10.1186/s40814-021-00852-w] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2020] [Accepted: 05/11/2021] [Indexed: 01/03/2023] Open
Abstract
BACKGROUND We have co-designed a tailored blended physiotherapy intervention for people with progressive multiple sclerosis (PwPMS) who often struggle to access support for physical activity. Underpinned by self-management principles, the Lifestyle, Exercise and Activity Package for people with Multiple Sclerosis (LEAP-MS) intervention incorporates face-to-face or online physiotherapy coaching sessions with an accompanying online physical activity platform. The LEAP-MS platform is a multi-user system enabling user and physiotherapist to co-create activity plans. The LEAP-MS platform consists of an information and activity suite, interactive components enabling selection of exercises into an activity programme, goal setting and activity logging. The platform also facilitates online remote support from a physiotherapist through an embedded online messaging function. We aim to evaluate the LEAP-MS platform in a feasibility trial. METHODS LEAP-MS will be evaluated within a single-arm feasibility study with embedded process evaluation. After registration and initial eligible screening, 21 participants will be required to complete baseline self-completion measures. This will be followed by an initial home-based or online coaching session with a physiotherapist (who has received tailored self-management and digital resource training) and access to the online intervention for an initial 3-month period. During this period, participants are given the option to request up to five further home-based or online physiotherapy coaching sessions. Follow-up questionnaires and semi-structured interviews will be administered 3 months after baseline with participants and intervention physiotherapists. The LEAP-MS platform will be available to participants for a further 3 months. Usage of the LEAP-MS platform will be tracked during the full 6-month period and final follow-up will be conducted 6 months after baseline. DISCUSSION Feasibility outcomes (recruitment, retention, intervention uptake and safety) will be reported. The process evaluation will be undertaken to identify possible mechanisms for any observed effects. The data will inform full-scale evaluations of this co-produced, blended physiotherapy intervention. TRIAL REGISTRATION ClinicalTrials.gov , NCT03951181 . Registered 15 May 2019.
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Affiliation(s)
- Julie Latchem-Hastings
- Centre for Trials Research, Cardiff University, 4th floor Neuadd Meirionnydd, Heath Park, Cardiff, UK
| | - Elizabeth Randell
- Centre for Trials Research, Cardiff University, 4th floor Neuadd Meirionnydd, Heath Park, Cardiff, UK
| | - Kate Button
- School of Healthcare Sciences, Cardiff University, Ty Dewi Sant, Heath Park, Cardiff, UK
| | - Fiona Jones
- Faculty of Health and Social Care Science, St George's University of London and Kingston University, London, UK
| | - Rachel Lowe
- Centre for Trials Research, Cardiff University, 4th floor Neuadd Meirionnydd, Heath Park, Cardiff, UK
| | - Helen Dawes
- Movement Science Group, Oxford Brookes University, Gipsy Lane, Headington, Oxford, UK
| | - Fiona Wood
- Division of Population Medicine and PRIME Centre Wales, School of Medicine, Cardiff University, Heath Park, Cardiff, UK
| | - Freya Davies
- Division of Population Medicine and PRIME Centre Wales, School of Medicine, Cardiff University, Heath Park, Cardiff, UK
| | - Vincent Poile
- Centre for Trials Research, Cardiff University, 4th floor Neuadd Meirionnydd, Heath Park, Cardiff, UK
| | - Rhian O'Halloran
- Helen Durham Neuro-Inflammatory Centre, University Hospital of Wales, Heath Park, Cardiff, UK
| | - Barbara Stensland
- Centre for Trials Research, Cardiff University, 4th floor Neuadd Meirionnydd, Heath Park, Cardiff, UK
| | - Emma Tallantyre
- Helen Durham Neuro-Inflammatory Centre, University Hospital of Wales, Heath Park, Cardiff, UK
| | - Rebecca Playle
- Centre for Trials Research, Cardiff University, 4th floor Neuadd Meirionnydd, Heath Park, Cardiff, UK
| | - Adrian Edwards
- Division of Population Medicine and PRIME Centre Wales, School of Medicine, Cardiff University, Heath Park, Cardiff, UK
| | - Monica Busse
- Centre for Trials Research, Cardiff University, 4th floor Neuadd Meirionnydd, Heath Park, Cardiff, UK.
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Busse M, Latchem-Hastings J, Button K, Poile V, Davies F, O' Halloran R, Stensland B, Tallantyre E, Lowe R, Wood F, Dawes H, Edwards A, Jones F. Web-based physical activity intervention for people with progressive multiple sclerosis: application of consensus-based intervention development guidance. BMJ Open 2021; 11:e045378. [PMID: 33727274 PMCID: PMC7970218 DOI: 10.1136/bmjopen-2020-045378] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/30/2020] [Revised: 02/15/2021] [Accepted: 03/07/2021] [Indexed: 02/06/2023] Open
Abstract
OBJECTIVES People with progressive multiple sclerosis (PwPMS) report that they recognise the benefits of activity on their physical and psychological health but need support to achieve their physical activity goals. We aimed to systematically develop a theoretically informed intervention that would enable PwPMS to more readily engage in regular physical activity. DESIGN We used an intervention mapping approach to inform intervention development. SETTING We conducted semistructured interviews with PwPMS and their families/carers and physiotherapists recruited from secondary care settings. PARTICIPANTS Fourteen PwPMS with an Expanded Disability Status Scale score of between 6 and 8 and 7 of their families/carers and 13 physiotherapists and 1 physiotherapy technician participated. RESULTS Interview data suggested that the development of supportive coaching relationships with physiotherapists could promote the ability of PwPMS to achieve a desirable and achievable physical activity plan. These interview data informed the prototype 'Lifestyle Exercise and Activity Package for Multiple Sclerosis' (LEAP-MS) consisting of a secure multiuser web-based platform (with an education and activity suite, interactive components enabling selection of exercises, goal setting and activity logging), up to six flexible face-to-face or web-based physiotherapy coaching sessions and remote support via an embedded web-based messaging function that all together draw on specific theory-based methods to achieve physical activity behaviour change, namely active learning, reinforcement, modelling, feedback, facilitation, goal setting and guided practice. Implementation is within a multiuser platform accessible to participants, trained physiotherapists and researchers. CONCLUSIONS We have followed an inclusive, systematic and transparent process to develop the LEAP-MS intervention that enables detailed description of components, context and guiding principles to inform ongoing evaluation. Importantly, PwPMS expressed the need for autonomy in developing physical activity plans. This has been achieved through the embedding of self-management principles in the design and delivery of the LEAP-MS intervention.
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Affiliation(s)
- Monica Busse
- Centre for Trials Research, Cardiff University, Cardiff, UK
| | | | - Kate Button
- School of Healthcare Sciences, Cardiff University, Cardiff, UK
| | - Vince Poile
- Centre for Trials Research, Cardiff University, Cardiff, UK
| | - Freya Davies
- Division of Population Medicine, Cardiff University, Cardiff, UK
| | | | | | - Emma Tallantyre
- Division of Psychological Medicine and Clinical Neuroscience, Cardiff University, Cardiff, UK
| | - Rachel Lowe
- Centre for Trials Research, Cardiff University, Cardiff, UK
| | - Fiona Wood
- Division of Population Medicine, Cardiff University, Cardiff, UK
| | - Helen Dawes
- Department of Sport and Health Sciences, Oxford Brookes University, Oxford, UK
| | - Adrian Edwards
- Division of Population Medicine, Cardiff University, Cardiff, UK
| | - Fiona Jones
- Centre for Health and Social Care Research, St George's University of London and Kingston University, London, UK
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Feasibility and efficacy of a physical activity intervention for managing restless legs syndrome in multiple sclerosis: Results of a pilot randomized controlled trial. Mult Scler Relat Disord 2021; 50:102836. [PMID: 33618120 DOI: 10.1016/j.msard.2021.102836] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2020] [Revised: 01/26/2021] [Accepted: 02/06/2021] [Indexed: 11/24/2022]
Abstract
BACKGROUND This pilot randomized controlled trial examined the feasibility and efficacy of a physical activity behavior change intervention for improving restless legs syndrome (RLS) severity and secondary sleep outcomes among a sample of adults with multiple sclerosis (MS). METHODS Participants with MS(N=15) were randomly assigned into intervention(n=8) or waitlist control(n=7) conditions. The physical activity intervention was delivered over a 16-week period and outcomes were assessed at baseline and immediately following the 16-week period in both conditions. RESULTS There was a significant, positive effect of the intervention on overall RLS severity (p=.01;ηρ2=.43), severity during the night(p=.03,ηρ2=.35), severity during the day while resting(p=.01,ηρ2=.44), and severity during the day while active(p<.01,ηρ2=.61), and non-significant improvements in RLS severity while falling asleep (p=.33,ηρ2=.09). There were significant positive effects on sleep satisfaction(p<.01,ηρ2=.49) and non-significant improvements in self-reported global sleep quality(p=.35,ηρ2=.08). There was a significant intervention effect on self-reported time in bed(p=.03,ηρ2=.37) and total sleep time(p=.03,ηρ2=.36), and non-significant improvements in self-reported sleep latency (p=.08,ηρ2=.25), sleep efficiency(p=.27,ηρ2=.11), and daytime sleepiness (p=.52,ηρ2=.04;p=.35,ηρ2=.08;p=.51,ηρ2=.04). There was no significant effect of the intervention on device-measured sleep quality. CONCLUSIONS We provide preliminary evidence for the feasibility and efficacy of a physical activity intervention for reducing RLS severity and potentially improving self-reported sleep outcomes in adults with MS. CLINICALTRIALS. GOV IDENTIFICATION NUMBER NCT04061681.
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Silveira SL, Huynh T, Kidwell A, Sadeghi-Bahmani D, Motl RW. Behavior Change Techniques in Physical Activity Interventions for Multiple Sclerosis. Arch Phys Med Rehabil 2021; 102:1788-1800. [PMID: 33549545 DOI: 10.1016/j.apmr.2021.01.071] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2020] [Revised: 01/06/2021] [Accepted: 01/07/2021] [Indexed: 10/22/2022]
Abstract
OBJECTIVE To identify and summarize the behavior change techniques (BCTs) included in behavior change interventions for promoting physical activity in persons with multiple sclerosis (MS). DATA SOURCES PubMed, PsycINFO, Cumulative Index to Nursing and Allied Health Complete, Scopus, and Embase were initially searched in November 2019, and data extraction began in June 2020. STUDY SELECTION The inclusion criteria for studies were: adults older than 18 years with diagnosed MS, English language, clinical trial designs (ie, pre-post or randomized controlled trials), group or individual interventions, and home or community-based settings wherein physical activity was defined as a primary or secondary outcome. Exclusion criteria for studies included protocol manuscripts pending results, case studies, studies focused on populations with multiple chronic diseases, and interventions targeting multiple behaviors. Two researchers completed screening for study selection, and a third researcher served as a referee. Of the initially identified 8681 studies, 54 studies met selection criteria. DATA EXTRACTION Data extraction was completed by 3 researchers. Each article was coded by 2 of the 3 researchers, and a fourth researcher resolved discrepancies. Data extracted from each paper included study title, authors, country, year, sample size, study design, intervention details, physical activity outcomes, and BCTs. DATA SYNTHESIS Thirty-eight unique behavior change interventions were identified, and 53 of the 93 possible BCTs were included across the studies. The mean number of BCTs per study was 15, and studies and effect sizes across studies ranged from 0.04-1.49. CONCLUSIONS This review provides a comprehensive overview of BCTs as the active ingredients in behavior change interventions targeting physical activity in MS. Results from this study provide a compendium for future intervention development for increasing physical activity and improving overall health in MS.
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Affiliation(s)
- Stephanie L Silveira
- Department of Physical Therapy, University of Alabama at Birmingham, Birmingham, AL.
| | - Trinh Huynh
- Department of Physical Therapy, University of Alabama at Birmingham, Birmingham, AL
| | - Ariel Kidwell
- Department of Physical Therapy, University of Alabama at Birmingham, Birmingham, AL
| | - Dena Sadeghi-Bahmani
- Department of Physical Therapy, University of Alabama at Birmingham, Birmingham, AL
| | - Robert W Motl
- Department of Physical Therapy, University of Alabama at Birmingham, Birmingham, AL
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Motl RW, Sandroff BM. Current perspectives on exercise training in the management of multiple sclerosis. Expert Rev Neurother 2020; 20:855-865. [DOI: 10.1080/14737175.2020.1796640] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Affiliation(s)
- Robert W. Motl
- Department of Physical Therapy, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Brian M. Sandroff
- Department of Physical Therapy, University of Alabama at Birmingham, Birmingham, AL, USA
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Silveira SL, Richardson EV, Motl RW. Social cognitive theory as a guide for exercise engagement in persons with multiple sclerosis who use wheelchairs for mobility. HEALTH EDUCATION RESEARCH 2020; 35:270-282. [PMID: 32535626 DOI: 10.1093/her/cyaa013] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/17/2019] [Accepted: 04/26/2020] [Indexed: 06/11/2023]
Abstract
Multiple sclerosis (MS) is an immune-mediated neurodegenerative disease of the brain, optic nerves and spinal cord. Among persons with MS, 30% experience significant mobility impairment that requires use of a wheelchair for mobility. Exercise is an evidence-based second-line therapy that can improve mobility; however, little research has focused on individuals that use wheelchairs for mobility. Framed by social cognitive theory (SCT), we conducted a formative qualitative study examining exercise status and perceptions among 20 persons with MS who use wheelchairs for mobility. Using deductive, semantic thematic analysis, we coded for SCT variables (i.e. self-efficacy, knowledge, outcome expectations, barriers and facilitators) and identified participants as regular or inconsistent exercisers. In total, 12 participants were classified as regular exercisers and 8 inconsistent exercisers. Regular exercisers more frequently reported high self-efficacy, consistent exercise knowledge and numerous facilitators. All participants reported some positive outcome expectations and several barriers and facilitators. These findings can inform future intervention studies supporting exercise behavior change through SCT. Strategies such as increasing self-efficacy, imparting instructional materials, shaping realistic outcome expectations and providing tools directed toward overcoming barriers and identifying facilitators may work to support the exercise endeavor of persons with MS who use wheelchairs for mobility.
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Affiliation(s)
- Stephanie L Silveira
- Physical Therapy, University of Alabama at Birmingham, 3810 Ridgeway Drive, Birmingham, AL 35209, USA
| | - Emma V Richardson
- Physical Therapy, University of Alabama at Birmingham, 3810 Ridgeway Drive, Birmingham, AL 35209, USA
| | - Robert W Motl
- Physical Therapy, University of Alabama at Birmingham, 3810 Ridgeway Drive, Birmingham, AL 35209, USA
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Baird JF, Sasaki JE, Sandroff BM, Cutter GR, Motl RW. Feasibility of "Sit Less, Move More": An intervention for reducing sedentary behavior Among African Americans with MS. Mult Scler J Exp Transl Clin 2020; 6:2055217320932341. [PMID: 32577298 PMCID: PMC7288826 DOI: 10.1177/2055217320932341] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2020] [Accepted: 05/08/2020] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND Sedentary behavior is a major concern in multiple sclerosis, as it may accelerate disease progression and physical disability. This is especially concerning in African Americans, who present with greater neurological disability than Caucasians. OBJECTIVE We conducted a feasibility trial on an intervention targeting sedentary behavior in African Americans with multiple sclerosis. METHODS We examined the feasibility of the Sit Less, Move More program, a 12-week behavioral intervention that used text messaging along with theory-driven newsletters and behavioral coaching for managing sedentary behavior. We recruited ambulatory, inactive, African Americans with multiple sclerosis, and assessed feasibility on process, resource, management, and scientific outcomes. RESULTS Of the 64 people initially contacted, 45 were assessed for eligibility, 31 were sent the informed consent document, and 30 returned a signed document and were included in the study. Study costs were US$7242.38. Personnel time to complete the study was 130 h. There was a small effect on both device-measured (d = -0.19) and self-reported (d = -0.39) sedentary behavior. CONCLUSIONS The Sit Less, Move More intervention is safe and feasible for African Americans with multiple sclerosis, and yielded a small reduction in sedentary behavior. The intervention was low cost and well received. Our results suggest the Sit Less, Move More program should progress towards a Phase II trial to determine its efficacy.
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Affiliation(s)
- Jessica F. Baird
- Department of Physical Therapy, University of Alabama at Birmingham, USA
| | - Jeffer E. Sasaki
- Department of Physical Therapy, University of Alabama at Birmingham, USA
| | - Brian M. Sandroff
- Department of Physical Therapy, University of Alabama at Birmingham, USA
| | - Gary R. Cutter
- Department of Physical Therapy, University of Alabama at Birmingham, USA
| | - Robert W. Motl
- Department of Physical Therapy, University of Alabama at Birmingham, USA
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Silveira SL, Richardson EV, Motl RW. Informing the design of exercise programs for persons with multiple sclerosis who use wheelchairs: a qualitative inquiry of perceived components. Disabil Rehabil 2019; 43:1838-1848. [PMID: 31615284 DOI: 10.1080/09638288.2019.1678073] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
PURPOSE We investigated the perceptions of persons with multiple sclerosis (MS) who use wheelchairs regarding preferences for the design of exercise programs. MATERIALS AND METHODS We conducted online, semi-structured interviews with 20 persons with MS who use wheelchairs regarding preferences for exercise programs. We identified perceived necessary and desired components of exercise programs through deductive content analysis. RESULTS Participants articulated preferences for "what", "when", "where", and "who" of exercise programs for persons with MS who use wheelchairs. The majority of participants expressed an interest in aerobic and strength training, possibly supported by rehabilitation therapies (what). The frequency was 2-7 times per week with a duration of 15-30 minutes (when). The locations included home-, Internet-, or community-based exercise (where), supported through autonomous, one-on-one, and group delivery (who). CONCLUSIONS Persons with MS who use wheelchairs were interested in exercise, but need resources for engagement in regular exercise programs that yield meaningful health benefits. This study provided guidance for creating personalized, structured exercise programs for persons with MS who use wheelchairs that may improve overall wellness, independence, and quality of life.Implications for rehabilitationExercise training programs often do not account for the unique needs and wants of persons with multiple sclerosis (MS) who use a wheelchair.Personalized, structured exercise programs for persons with MS who use wheelchairs may improve outcomes including independence and quality of life.The proposed exercise guidelines provide initial guidance for persons with MS who use wheelchairs regarding engagement in exercise for improving MS symptoms and quality of life.
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Affiliation(s)
| | - Emma V Richardson
- Physical Therapy, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Robert W Motl
- Physical Therapy, University of Alabama at Birmingham, Birmingham, AL, USA
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Silveira SL, Motl RW. Do Social Cognitive Theory constructs explain response heterogeneity with a physical activity behavioral intervention in multiple sclerosis? Contemp Clin Trials Commun 2019; 15:100366. [PMID: 31193266 PMCID: PMC6525323 DOI: 10.1016/j.conctc.2019.100366] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2018] [Revised: 04/10/2019] [Accepted: 04/17/2019] [Indexed: 11/22/2022] Open
Abstract
Background Behavioral interventions based on Social Cognitive Theory (SCT) are efficacious for increasing both objectively-measured and self-reported physical activity in people with multiple sclerosis (MS). Purpose This study involved a secondary analysis of data focused on SCT constructs as correlates of individual-level changes (i.e., response heterogeneity) following a behavioral intervention. Method Twenty-two persons with MS who completed a 6-month SCT-based behavioral intervention for increasing physical activity were included in analyses. The intervention consisted of two primary components, namely a dedicated Internet website and one-on-one video chats with a behavioral coach. Outcomes included objectively-measured moderate-vigorous physical activity (MVPA) using Actigraph model GT3X+ accelerometers and self-reported physical activity using the Godin Leisure-Time Exercise Questionnaire (GLTEQ) as well as SCT variables of exercise self-efficacy, barriers self-efficacy, outcome expectations, goal setting and planning and facilitators/impediments. Results There was individual variability in physical activity change following the intervention. For example, 4/22 participants demonstrated a reduction in MVPA, 1/22 participants had no change, 9/22 participants had less than 0.5 standard deviation (SD) increase in MVPA, and 8/22 participants had an increase in MVPA of more than 0.5 SD. Baseline SCT variables, particularly outcome expectations, goal setting, planning, and barriers self-efficacy, correlated with increased physical activity. Conclusions This study indicates that SCT variables correlate with the response heterogeneity associated with physical activity behavioral interventions, and this might inform the delivery of interventions consistent with Bandura's stepwise implementation model for optimizing the “fit” of an intervention based on SCT for maximizing treatment efficacy in MS.
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Affiliation(s)
- Stephanie L Silveira
- Department of Physical Therapy, University of Alabama at Birmingham, Birmingham, USA
| | - Robert W Motl
- Department of Physical Therapy, University of Alabama at Birmingham, Birmingham, USA
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Silveira SL, McCroskey J, Wingo BC, Motl RW. eHealth-Based Behavioral Intervention for Increasing Physical Activity in Persons With Multiple Sclerosis: Fidelity Protocol for a Randomized Controlled Trial. JMIR Res Protoc 2019; 8:e12319. [PMID: 30821692 PMCID: PMC6418483 DOI: 10.2196/12319] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2018] [Revised: 11/21/2018] [Accepted: 11/22/2018] [Indexed: 11/30/2022] Open
Abstract
Background The rate of physical activity is substantially lower in persons with multiple sclerosis (MS) than in the general population. This problem can be reversed through rigorous and reproducible delivery of behavioral interventions that target lifestyle physical activity in MS. These interventions are, in part, based on a series of phase II randomized controlled trials (RCTs) supporting the efficacy of an internet-delivered behavioral intervention, which is based on social cognitive theory (SCT) for increasing physical activity in MS. Objective This paper outlines the strategies and monitoring plan developed based on the National Institutes of Health Behavior Change Consortium (NIH BCC) treatment fidelity workgroup that will be implemented in a phase III RCT. Methods The Behavioral Intervention for Physical Activity in Multiple Sclerosis (BIPAMS) study is a phase III RCT that examines the effectiveness of an internet-delivered behavioral intervention based on SCT and is supported by video calls with a behavioral coach for increasing physical activity in MS. BIPAMS includes a 6-month treatment condition and 6-month follow-up. The BIPAMS fidelity protocol includes the five areas outlined by the NIH BCC. The study design draws on the SCT behavior-change strategy, ensures a consistent dose within groups, and plans for implementation setbacks. Provider training in theory and content will be consistent between groups with monitoring plans in place such as expert auditing of calls to ensure potential drift is addressed. Delivery of treatment will be monitored through the study website and training will focus on avoiding cross-contamination between conditions. Receipt of treatment will be monitored via coaching call notes and website monitoring. Lastly, enactment of treatment for behavioral and cognitive skills will be monitored through coaching call notes among other strategies. The specific strategies and monitoring plans will be consistent between conditions within the constraints of utilizing existing evidence-based interventions. Results Enrollment began in February 2018 and will end in September 2019. The study results will be reported in late 2020. Conclusions Fidelity-reporting guidelines provided by the NIH BCC were published in 2004, but protocols are scarce. This is the first fidelity-monitoring plan involving an electronic health behavioral intervention for increasing physical activity in MS. This paper provides a model for other researchers utilizing the NIH BCC recommendations to optimize the rigor and reproducibility of behavioral interventions in MS. Trial Registration ClinicalTrials.gov NCT03490240; https://www.clinicaltrials.gov/ct2/show/NCT03490240. International Registered Report Identifier (IRRID) DERR1-10.2196/12319
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Affiliation(s)
- Stephanie L Silveira
- Exercise Neuroscience Research Lab, Department of Physical Therapy, University of Alabama at Birmingham, Birmingham, AL, United States
| | - Justin McCroskey
- Exercise Neuroscience Research Lab, Department of Physical Therapy, University of Alabama at Birmingham, Birmingham, AL, United States
| | - Brooks C Wingo
- Department of Occupational Therapy, University of Alabama at Birmingham, Birmingham, AL, United States
| | - Robert W Motl
- Exercise Neuroscience Research Lab, Department of Physical Therapy, University of Alabama at Birmingham, Birmingham, AL, United States
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Baird JF, Motl RW. Response Heterogeneity With Exercise Training and Physical Activity Interventions Among Persons With Multiple Sclerosis. Neurorehabil Neural Repair 2018; 33:3-14. [PMID: 30585528 DOI: 10.1177/1545968318818904] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/16/2023]
Abstract
Multiple sclerosis (MS) is a heterogeneous disease, both in its pathology and symptomology. This poses a challenge for the medical management and rehabilitation of MS; however, physical activity and exercise training are rehabilitation approaches that have demonstrated beneficial effects on many of the burdensome consequences of MS such as mobility impairment and fatigue. Given the heterogeneous course of MS, it is possible that outcomes of physical activity and exercise training interventions demonstrate heterogeneity both in the magnitude and pattern of change, but there has been little focus on response heterogeneity with these interventions among persons with MS. In this narrative review, a search of the existing literature was performed to identify studies that reported individual participant data, which was used to describe the variability in the response to physical activity and exercise training interventions among persons with MS. Inter-individual variability seemingly occurs across outcomes and modalities, which underscores the consideration of factors that might influence response heterogeneity. Factors related to MS disease characteristics, nervous system damage, and the degree of MS-related disability might influence individual responsiveness. Large-scale studies that permit the examination of heterogeneity and its predictors will inform future research on the area of physical activity and exercise training in MS, and lead to the development of individually tailored rehabilitation approaches that will more effectively elicit change.
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Affiliation(s)
| | - Robert W Motl
- 1 University of Alabama at Birmingham, Birmingham, AL, USA
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