Health behavior change models and theories: contributions to rehabilitation

Improving balance in community-dwelling elders using trained volunteers within faith-based institutions: a mixed methods feasibility study

PURPOSE

To investigate the feasibility and acceptability of a volunteer-led balance programme for older adults.

METHODS

A feasibility cluster RCT with focus groups were conducted in faith-based institutions. Eligibility criteria were: participants were ≥65 years, able to do five times sit -to-stand, had no falls in the previous six months and had good mental capacity. The intervention included supervised group exercises and exercise booklets for six months, education and a fall poster. Assessments included, TUG, MCTSiB, FTST, FES, mABC, OPQoL and DGLS at baseline, 6 weeks, and 6 months. Feasibility measures included numbers of volunteers, sessions, and volunteers" time commitment, views of participants about sustainability of program using qualitative focus groups and volunteers' ability to deliver programme.

RESULTS

Three churches participated with 31 participants in each group. Participants had a mean age of 77.3 years, were 100% British, and 79% female. The sample size estimate for a future trial using TUG, was 79 per group. Focus groups showed perceived social and physical improvements in participants, need to extend the programme to the wider community, and increased confidence, participation and socialisation.

CONCLUSION

The community-based balance training in faith-based institutions, was feasible and acceptable in one geographical area and requires evaluation in cohesive diverse communities.Implications for RehabilitationIf an institution or a community is united through faith, culture, national roots, or tradition, then these groups are ideal for such balance rehabilitation programmes, because of the familiarity of the location and people, cohesive culture or their ideology to help their communities.Participants and volunteers perceived improved participation, confidence and socialisation and were keen to continue programme.It is important to develop community-based falls prevention programmes that the National Health Service (NHS) can partially support using volunteers to reduce the burden of falls in the community and for the NHS.

Breaking barriers to rehabilitation: the role of behavior change theories in overcoming the challenge of exercise-related behavior change

BACKGROUND

Promoting exercise-related behavior change in rehabilitation is a challenge. The lack of integration between rehabilitation program prescriptions, behavior change interventions, and behavioral change theories is profound. Using behavior change theories properly is crucial for better adherence and promoting positive outcomes. Therefore, it is essential to bring theories that support the understanding of exercise-related behavioral change to the attention of rehabilitation practitioners.

OBJECTIVE

This masterclass article aims to provide the theoretical background of theories and strategies for exercise behavior change within the physical therapy context based on acknowledged behavioral change theoretical models.

METHODS

This is a narrative review that examines six behavior theories; five of them well-established, and a new (and promising) theory that has exhibited the most favorable outcomes in rehabilitation settings. The development process for this masterclass included conversations between authors, reviewing behavior theories, summarizing and discussing the theories' concepts and strategies for physical therapy.

RESULTS

The included theories were self-determination theory, social-cognitive theory, the transtheoretical model, the theory of planned behavior, the health belief model, and the unifying theory of physical activity. Each theory offers a unique perspective on exercise behavior change within rehabilitation, exploring constructs such as motivation, self-efficacy, stages of change, behavioral intention, perceived threat, and the core elements of physical activity expression.

CONCLUSION

These theoretical models provide a foundation for understanding and developing strategies for promoting exercise behavior change in rehabilitation. Knowing and using these theories is important for respecting the patient's individuality.

Mobile health to promote physical activity in people post stroke or transient ischemic attack - study protocol for a feasibility randomised controlled trial

BACKGROUND

Physical activity is essential to improve health and reduce the risk of recurrence of stroke or transient ischemic attack (TIA). Still, people post stroke or TIA are often physically inactive and the availability of physical activity promotion services are often limited. This study builds on an existing Australian telehealth-delivered programme (i-REBOUND- Let's get moving) which provides support for home-based physical activity for people post stroke or TIA. The aim of this study is to test the feasibility, acceptability, and preliminary effects of a mobile Health (mHealth) version of the i-REBOUND programme for the promotion of physical activity in people post stroke or TIA living in Sweden.

METHODS

One hundred and twenty participants with stroke or TIA will be recruited via advertisement. A parallel-group feasibility randomised controlled trial design with a 1:1 allocation ratio to 1) i-REBOUND programme receiving physical exercise and support for sustained engagement in physical activity through behavioural change techniques, or 2) behavioural change techniques for physical activity. Both interventions will proceed for six months and be delivered digitally through a mobile app. The feasibility outcomes (i.e., reach, adherence, safety and fidelity) will be monitored throughout the study. Acceptability will be assessed using the Telehealth Usability Questionnaire and further explored through qualitative interviews with a subset of both study participants and the physiotherapists delivering the intervention. Clinical outcomes on preliminary effects of the intervention will include blood pressure, engagement in physical activity, self-perceived exercise self-efficacy, fatigue, depression, anxiety, stress and health-related quality of life and will be measured at baseline and at 3, 6 and 12 months after the baseline assessments.

DISCUSSION

We hypothesise that the mHealth delivery of the i-REBOUND programme will be feasible and acceptable in people post stroke/TIA living in rural and urban regions of Sweden. The results of this feasibility trial will inform the development of full-scale and appropriately powered trial to test the effects and costs of mHealth delivered physical activity for people after stroke or TIA.

TRIAL REGISTRATION

ClinicalTrials.gov Identifier: NCT05111951. Registered November 8, 2021.

Motivation Theory and Practice in Aphasia Rehabilitation: A Scoping Review

PURPOSE

In the aphasia literature, motivation has been described as potentially influencing rehabilitation outcomes, and there are reports that researchers and clinicians have acted to promote it. However, studies directly investigating the range of beliefs and practices surrounding motivation do not exist currently. The purpose of this scoping review is to develop themes related to the beliefs and practices appearing in the recent aphasia literature.

METHOD

Four databases (CINAHL, PsycINFO, PubMed, and Google Scholar) were searched using keywords aphasia and motivation (including derivatives such as motiv*) for articles published between 2009 and 2020. Searches returned 19,731 articles; after deleting duplicates and applying inclusionary criteria, 365 articles remained. In each article, text surrounding the term motivation was highlighted and thematic analysis was applied to these quotations.

RESULTS

Sixteen themes were developed through thematic analysis and placed into two groups. The first group contained five themes suggesting that researchers believed that motivation should be studied and recognized the value of motivation in person(s) with aphasia when participating in research or clinical activities. The second group contained 11 themes reporting diverse beliefs and practices in how motivation is incorporated in research and clinical activities.

CONCLUSIONS

Results from this scoping review suggest that aphasia researchers, clinicians, and persons with aphasia hold beliefs about motivation that can influence clinical and research decisions. In general, beliefs and decisions related to motivation appeared to be guided by intuition rather than theories of motivation. These themes are discussed within the context of three psychological needs proposed by self-determination theory: competency, autonomy, and relatedness. Applying theories of motivation to future study in aphasia rehabilitation will guide work that can provide empirical support for these beliefs.

From expert to coach: health coaching to support behavior change within physical therapist practice

Background: Negative health behaviors are a significant risk factor for non-communicable diseases (NCDs) and are responsible for 40-50% of the burden of disease in the US population. Physical therapists (PTs) have the capacity to effect behavior change in their patients to reduce their risk of disease and promote health. Competence in health behavior change is recommended for physical therapists. One way to achieve this competence is by learning and adopting a health coaching approach. Objectives: To provide a theoretical and practical approach to applying a health coaching approach in physical therapist clinical practice. Methods: 1) Describe a health coaching approach to facilitating behavior change; 2) present behavior change theories, communication strategies, and models underpinning health coaching; and 3) provide suggestions for ways PTs can integrate health coaching in clinical practice. Results: Health coaching is a dynamic and collaborative approach to health behavior change that harnesses the patient's or client's values and strengths to realize their goals for health. Conclusion: Adopting a health coaching approach may enhance adherence to physical therapists' recommendations as well as improve health outcomes.

Noninvasive Brain Stimulation & Space Exploration: Opportunities and Challenges

As NASA prepares for longer space missions aiming for the Moon and Mars, astronauts' health and performance are becoming a central concern due to the threats associated with galactic cosmic radiation, unnatural gravity fields, and life in extreme environments. In space, the human brain undergoes functional and structural changes related to fluid shift and changes in intracranial pressure. Behavioral abnormalities, such as cognitive deficits, sleep disruption, and visuomotor difficulties, as well as psychological effects, are also an issue. We discuss opportunities and challenges of noninvasive brain stimulation (NiBS) methods - including transcranial magnetic stimulation (TMS) and transcranial electrical stimulation (tES) - to support space exploration in several ways. NiBS includes safe and portable techniques already applied in a wide range of cognitive and motor domains, as well as therapeutically. NiBS could be used to enhance in-flight performance, supporting astronauts during pre-flight Earth-based training, as well as to identify biomarkers of post-flight brain changes for optimization of rehabilitation/compensatory strategies. We review these NiBS techniques and their effects on brain physiology, psychology, and cognition.

Motivation and Barriers to Maintaining Lifestyle Changes in Patients with Type 2 Diabetes after an Intensive Lifestyle Intervention (The U-TURN Trial): A Longitudinal Qualitative Study

The purpose of this study was to explore and identify factors that influence motivation for and barriers to adopting and maintaining lifestyle changes in patients with type 2 diabetes, following participation in an intensive multiple-lifestyle intervention. Participants were recruited from the U-TURN trial, a one-year, intensive lifestyle intervention for type 2 diabetes patients. This study was conducted over time; informants were interviewed twice after the trial ended with a six-month interval between interviews. The qualitative data from these individual interviews were analysed using systematic text condensation with an inductive approach. Five themes emerged: Social support and relatedness, Achievement of results, Support from healthcare professionals, Identification with and acceptance of the new lifestyle and Coping with ongoing challenges. These are all important for maintaining lifestyle changes and diabetes self-management. Changing one’s lifestyle can be a constant, difficult struggle. For sustainable progress after an intensive intervention, the changes must be adopted and endorsed by patients and co-opted into their social setting. Belonging to an exercise group, confidence in managing the lifestyle adjustments and handling of challenges through continual support and professional diabetes treatment are crucial in maintaining and adhering to the new lifestyle.

Development of Rasch-based short screenings for the assessment of treatment motivation in patients with cardiovascular diseases

Purpose: The aim of the study was to develop unidimensional test-fair and economic short screenings to assess treatment motivation in patients with cardiovascular diseases using the Rasch analysis.Materials and methods: After pretesting for relevance and comprehension, a pool of 132 items on treatment motivation was completed by a sample consisting of 1168 patients with cardiovascular diseases recruited in two German cardiological rehabilitation centers. Confirmatory factor analyses and the Rasch analyses were conducted.Results: The confirmatory factor analyses confirmed a three-factor structure of the treatment motivation construct with task self-efficacy, outcome expectancies and intention as factors. Using the Rasch analysis for each of the three factors and removing items with misfit, differential item functioning and local response dependency reduced the initial item pool to the three short screenings. The short screenings fit to the Rasch model with a root mean square error of approximation (RMSEA = 0.021 (task self-efficacy; seven items); RMSEA = 0.024 (outcome expectancies; 12 items), RMSEA = 0.027 (intention; nine items). Person-separation reliability was 0.81, 0.82, and 0.73. Unidimensionality could be verified.Conclusions: The calibrated, unidimensional short screenings provide a psychometrically sound option for an initial- and follow-up assessment of treatment motivation in rehabilitation patients with cardiovascular diseases. Further testing in other cardiovascular diseases populations is needed to increase generalizability.Implications for rehabilitationNew short screenings for the assessment of treatment motivation: task self-efficacy, outcome expectancies, intention in rehabilitation patients with cardiovascular diseases are available.Treatment motivation short screenings_{self-efficacy/outcome expectancies/intention} consist of seven items (treatment motivation short screening_{self-efficacy}), 12 items (treatment motivation short screening_{outcome expectancies}), nine items (treatment motivation short screening_intention) and are therefore especially timesaving.The short screenings demonstrate good psychometric properties, cover a wide spectrum of task self-efficacy, outcome expectancies and intention, and are free of local dependencies and of differential item functioning regarding to gender, age and cardiovascular diagnoses.Using a Rasch based unidimensional short screening is a test-fair and economic method to assess patients' treatment motivation, which might help to improve rehabilitation health care tailored to patients' needs.

Evaluation of an Outpatient Rehabilitative Program to Address Mobility Limitations Among Older Adults

Supplemental digital content is available in the text.

Live Long Walk Strong is a clinical demonstration program for community-dwelling older patients. It was designed to be consistent with current fall prevention guidelines and reimbursed under the Medicare model. Patients were screened within primary care and referred to a physiatrist followed by systematic assessment and treatment within an outpatient rehabilitative care setting. The treatment included behavioral modification, fall prevention education, community/home exercise integration, and exercise targeting strength, power, flexibility, balance, and endurance. Treatment duration and frequency varied with each patient based on baseline presentation, clinical judgment, and patient preference. Program feasibility and preliminary effectiveness were evaluated by assessing participation and changes in physical performance, respectively. There were 266 patients referred to the program, and 147 were willing to participate. Of these, 116 patients completed all scheduled visits (10.8 ± 3.9 visits). The noncompleters (n = 31) had a higher rate of falls in the previous 6 months and lower baseline Short Physical Performance Battery composite score. At the completion of care, the adjusted mean change in Short Physical Performance Battery was 1.66 units, surpassing a large clinically meaningful threshold (1 unit). The Live Long Walk Strong program appears to be feasible to implement and demonstrates preliminary effectiveness in enhancing mobility among older adults.

Does a Combination of Virtual Reality, Neuromodulation and Neuroimaging Provide a Comprehensive Platform for Neurorehabilitation? - A Narrative Review of the Literature

In the last decade, virtual reality (VR) training has been used extensively in video games and military training to provide a sense of realism and environmental interaction to its users. More recently, VR training has been explored as a possible adjunct therapy for people with motor and mental health dysfunctions. The concept underlying VR therapy as a treatment for motor and cognitive dysfunction is to improve neuroplasticity of the brain by engaging users in multisensory training. In this review, we discuss the theoretical framework underlying the use of VR as a therapeutic intervention for neurorehabilitation and provide evidence for its use in treating motor and mental disorders such as cerebral palsy, Parkinson’s disease, stroke, schizophrenia, anxiety disorders, and other related clinical areas. While this review provides some insights into the efficacy of VR in clinical rehabilitation and its complimentary use with neuroimaging (e.g., fNIRS and EEG) and neuromodulation (e.g., tDCS and rTMS), more research is needed to understand how different clinical conditions are affected by VR therapies (e.g., stimulus presentation, interactivity, control and types of VR). Future studies should consider large, longitudinal randomized controlled trials to determine the true potential of VR therapies in various clinical populations.

Self-appraisal: Estimates of intellectual performance for persons with Acquired Brain Injury

BACKGROUND

Acquired Brain Injury (ABI) limits a survivor's ability to appraise their task performance. There are, however, few measures of self-appraisal.

OBJECTIVE

This study developed a technique for measuring self-appraisal originally proposed by Wilbur, Wilk, Silver, and Parente (2008).

METHODS

A multivariate model of self-appraisal that includes measures of predicted performance as well as measures of over- and under-estimation of performance was evaluated with ABI survivors, participants with diagnosed learning disabilities, and others with emotional impairments to determine which measures were the most sensitive to the differences among the groups.

RESULTS

This model provided a more accurate assessment of self-appraisal than the one previously proposed by Wilbur et al. (2008). The two measures of self-appraisal measure different psychological processes, and the overall model measures aspects of performance that are unrelated to an individual's IQ. A measure of over- or under-estimation of performance was the most sensitive component of the model.

CONCLUSIONS

Self-appraisal is a multi-dimensional concept, with at least two main components. The findings corroborate previous literature suggesting that persons with ABI have difficulty accurately assessing their task performance resulting in inflated performance judgments. This self-appraisal technique can be applied to most assessments of performance.

Systematic Review of Correlates and Determinants of Physical Activity in Persons With Multiple Sclerosis

OBJECTIVE

To review the current evidence regarding correlates and determinants of physical activity (PA) in persons with multiple sclerosis (pwMS).

DATA SOURCES

PubMed and Scopus (1980 to January 2015) and reference lists of eligible studies.

STUDY SELECTION

Eligible studies include adults with multiple sclerosis; have a cross-sectional or prospective observational design; or examine the effect of a theory-based intervention trial on PA, including a mediation analysis. Eligible studies also apply a quantitative assessment of PA and correlates or proposed mediators and are published in English or German language.

DATA EXTRACTION

Two reviewers independently evaluated the risk of bias, extracted data, and categorized variables according to the International Classification of Functioning, Disability and Health.

DATA SYNTHESIS

Consistency and the direction of associations were evaluated with a semiquantitative approach. Fifty-six publications with data from observational studies and 2 interventional studies provided evidence for 86 different variables. Consistent correlates of PA were the disability level, walking limitations in particular, PA-related self-efficacy, self-regulation constructs, employment status, and educational level. One interventional study provided evidence for a causal relation between self-regulation and PA. However, 59 of the 86 investigated variables in observational studies are based on 1 or 2 study findings, and most results stem from cross-sectional designs.

CONCLUSIONS

Beside the importance of the general disability level and walking limitations, the results highlight the importance of personal factors (eg, PA-related self-efficacy, self-regulatory constructs, sociodemographic factors). Limitations and implications of the current review are discussed. Research that is more rigorous is needed to better understand what affects PA in pwMS.

Promoting Health and Wellness: Implications for Physical Therapist Practice

The leading cause of morbidity and mortality in the United States is chronic, or noncommunicable, diseases. The impact of chronic diseases on health and wellness can be significantly altered by individual health and behavior choices or modifications. Furthermore, the burden of chronic disease goes beyond health and the health care system and may influence an individual's wellness. The purposes of this article are: (1) to provide a basis for understanding the terms "health" and "wellness," (2) to identify the knowledge and skills physical therapists need to address behaviors that promote health and wellness and treat and protect against chronic disease, and (3) to discuss barriers and opportunities associated with integrating the promotion of health and wellness into physical therapist practice.

Development and feasibility of an automated call monitoring intervention for older wheelchair users: the MOvIT project

Background

Recent advances in wheeled mobility technology are multiplying opportunities for community integration and improved quality of life. The mobility needs of older wheelchair users are particularly complex due to a constellation of chronic conditions and comorbidities that may compromise optimal use of the device. The purpose of the Mobility Outcomes via Information Technologies (MOvIT) project is to examine the feasibility of automated calls for the systematic monitoring for adverse outcomes associated with wheelchair use.

Methods

A two-phase mixed methods approach was used. Phase I involved user-centered development and face validation of a monitoring questionnaire with end-users (seven wheelchair users and five healthcare providers). Phase II tested the feasibility of monitoring outcomes using automated calls to administer the MOvIT questionnaire 1 and 3 months after wheelchair delivery with a prospective cohort of older adults (50–84 years of age). When problems were identified, the computer monitoring system notified a clinical coordinator who followed up with respondents requiring interventions. Feasibility data were extracted from the web database and from individual interviews covering perceived ease of use, usefulness and intention to use the MOvIT questionnaire in the future.

Results

The MOvIT monitoring questionnaire developed in phase I tracks nine potential wheelchair-related adverse outcomes considered important for end-users: 1) non-use of wheelchair, 2) pain, 3) skin condition, 4) positioning, 5) wheelchair incidents, 6) psychosocial issues, 7) restricted wheelchair participation, 8) limited wheelchair skills and knowledge, and 9) technical problems. In phase II, 92 individuals who received a wheelchair were eligible, 71 out of 92 accepted (77 %) and 65 out of 71 (92 %) completed the 3-month follow-up. In the sample of 65 participants, a wheelchair-related adverse outcome was confirmed by a rehabilitation professional for 58.5 %, and at least one recommendation was given to 66.2 % during the 3-month monitoring period. A majority of participants found the intervention useful (82.8 %) and said they intended to use the MOvIT monitoring questionnaire in the future (81.5 %). Participants made suggestions to make the calls more adaptive to various ability profiles.

Conclusions

Automated calls tailored for individuals with mobility limitations and associated comorbidities are a promising approach to reach clients who need post-rehabilitation support.

Stages of Change Profiles among Adults Experiencing Hearing Difficulties Who Have Not Taken Any Action: A Cross-Sectional Study

The aim of the current study was to test the hypothesis that adults experiencing hearing difficulties who are aware of their difficulties but have not taken any action would fall under contemplation and preparation stages based on the transtheoretical stages-of-change model. The study employed a cross-sectional design. The study was conducted in United Kingdom and 90 participants completed University of Rhode Island Change Assessment (URICA) scale as well as measures of self-reported hearing disability, self-reported anxiety and depression, self-reported hearing disability acceptance, and provided additional demographic details online. As predicted, the results indicate that a high percentage of participants (over 90%) were in the contemplation and preparation stages. No statistically significant differences were observed among groups of stage with highest URICA scores and factors such as: years since hearing disability, self-reported hearing disability, self-reported anxiety and depression, and self-reported hearing disability acceptance. Cluster analysis identified three stages-of-change clusters, which were named as: decision making (53% of sample), participation (28% of sample), and disinterest (19% of sample). Study results support the stages-of-change model. In addition, implications of the current study and areas for future research are discussed.

Health behaviour change theories: contributions to an ICF-based behavioural exercise therapy for individuals with chronic diseases

PURPOSE

The purpose of this perspective is (1) to incorporate recent psychological health behaviour change (HBC) theories into exercise therapeutic programmes, and (2) to introduce the International Classification of Functioning (ICF)-based concept of a behavioural exercise therapy (BET).

METHODS

Relevant personal modifiable factors of physical activity (PA) were identified based on three recent psychological HBC theories. Following the principles of intervention mapping, a matrix of proximal programme objectives specifies desirable parameter values for each personal factor. As a result of analysing reviews on behavioural techniques and intervention programmes of the German rehabilitation setting, we identified exercise-related techniques that impact the personal determinants. Finally, the techniques were integrated into an ICF-based BET concept.

RESULTS

Individuals' attitudes, skills, emotions, beliefs and knowledge are important personal factors of PA behaviour. BET systematically addresses these personal factors by a systematic combination of adequate exercise contents with related behavioural techniques. The presented 28 intervention techniques serve as a theory-driven "tool box" for designing complex BET programmes to promote PA.

CONCLUSION

The current paper highlights the usefulness of theory-based integrative research in the field of exercise therapy, offers explicit methods and contents for physical therapists to promote PA behaviour, and introduces the ICF-based conceptual idea of a BET. Implications for Rehabilitation Irrespective of the clients' indication, therapeutic exercise programmes should incorporate effective, theory-based approaches to promote physical activity. Central determinants of physical activity behaviour are a number of personal factors: individuals' attitudes, skills, emotions, beliefs and knowledge. Clinicians implementing exercise therapy should set it within a wider theoretical framework including the personal factors that influence physical activity. To increase exercise-adherence and promote long-term physical activity behaviour change, the concept of a behavioural exercise therapy (BET) offers a theory-based approach to systematically address relevant personal factors with a combination of adequate contents of exercise with exercise-related techniques of behaviour change.

Severity of psychological distress among adults with and without disabilities

The aim of this study is to examine psychological distress and its individual symptoms between adults with and without disabilities, and among adults with disabilities, to examine whether an association exists between severity of distress and health-related factors. Cross-sectional data from the 2007 Behavioral Risk Factor Surveillance System were used for this study. Severity of psychological distress was assessed using the Kessler 6 scale of nonspecific psychological distress. Logistic regression analyses were performed to estimate predicted marginals and prevalence ratios. Nine percent of adults had mild to moderate psychological distress and 3.9% had serious psychological distress. The adjusted mean Kessler 6 total scores and individual item scores were higher for adults with disabilities, as was the average number of days that a mental health condition interfered with activities in the past 30 days. Among adults with disabilities, mild to moderate and serious psychological distress were particularly high among those who were unemployed or unable to work. Those who had either mild to moderate or serious psychological distress were significantly more likely than those with no psychological distress to be physically inactive, to smoke, and to report fair or poor health, life dissatisfaction, and inadequate social support. A dose-response relationship exists between categorical severity of psychological distress and examined health-related factors. These findings may inform the design of targeted public health strategies that aim to eliminate health disparities between people with and without disabilities.

Health behaviour change interventions for the promotion of physical activity in rheumatoid arthritis: a systematic review

BACKGROUND

Rheumatoid arthritis (RA) is a chronic, inflammatory, autoimmune disease with typical onset between the ages of 40 and 50 years. Increasing levels of physical activity (PA) have been shown to decrease inflammation, reduce pain, increase functional ability and improve self-esteem in people with RA. Health behaviour change (HBC) interventions have recently shown promise in facilitating the promotion of PA within a range of long-term conditions. There is currently no evidence synthesis relating to HBC interventions to increase PA in the RA population.

OBJECTIVES

The aim of the present study was to determine whether HBC interventions can increase PA in people with RA and identify optimal interventions or promising constituent components of the HBC interventions.

METHODS

A systematic literature search was conducted to identify randomized, controlled trials investigating the effect of HBC interventions on PA level in adults with RA. Four review authors independently assessed the methodological quality of studies and extracted data based upon predefined criteria.

RESULTS

Following the application of inclusion/exclusion criteria, three studies remained for inclusion. Two studies reported significant short-term (<9 months) beneficial effects of HBC upon PA (p < 0.05). Individualized interventions were significantly more effective (p < 0.05).

CONCLUSIONS

Due to methodological flaws and a lack of comparison with usual care, it is not possible to conclude whether HBC interventions can increase PA in the RA population. Although it is possible to highlight promising elements of HBC interventions, such as goal setting and feedback on performance, further research on all specific components, including information provision, behaviour contracts and problem solving, is required to establish conclusive clinical guidelines.

A health and wellness intervention for those with moderate to severe traumatic brain injury: a randomized controlled trial

OBJECTIVES

To assess the efficacy of a standardized 12-week health and wellness group intervention for those with moderate to severe traumatic brain injury (TBI).

STUDY DESIGN

Randomized controlled trial.

PARTICIPANTS

Seventy-four individuals with moderate to severe TBI recruited from the outpatient program at a rehabilitation hospital, a Veterans Affairs Medical Center, and the community.

METHOD

Eligible participants were randomized to treatment (health and wellness therapy group) or wait-list control (treatment, n = 37; wait-list, n = 37). The primary outcome was the Health Promoting Lifestyle Profile-II.

RESULTS

The results of the mixed-model repeated-measures analysis indicated no differences between treatment and control groups engaging in activities to increase their health and well-being.

CONCLUSIONS

Findings did not support the efficacy of the intervention. Results may have been impacted by the wide variability of individualized health and wellness goals selected by group members, the structure and/or content of the group, and/or the outcome measures selected.

Health behavior change in hearing healthcare: a discussion paper

Health behavior change (HBC) refers to facilitating changes to habits and/or behavior related to health. In healthcare practice, it is quite common that the interactions between practitioner and patient involve conversations related to HBC. This could be mainly in relation to the practitioner trying to directly persuade the patients to make some changes in their health behavior. However, the patients may not be motivated to do so as they do not see this change as important. For this reason, direct persuasion may result in a breakdown of communication. In such instances, alternative approaches and means of indirect persuasion, such as empowering the patient and their family members, could be helpful. Furthermore, there are several models and/or theories proposed which explain the health behavior and also provide a structured framework for health behavior change. Many such models/approaches have been proven effective in facilitating HBC and health promotion in areas such as cessation of smoking, weight loss and so on. This paper provides an overview of main models/theories related to HBC and some insights into how these models/approaches could be adapted to facilitate behavior change in hearing healthcare, mainly in relation to: i) hearing help-seeking and hearing-aid uptake; and ii) hearing conservation in relation to music-induced hearing loss (MIHL). In addition, elements of current research related to this area and future directions are highlighted.

Exercise perceptions among people with stroke: Barriers and facilitators to participation

BACKGROUND/AIMS: People with stroke continue to lead sedentary lives despite the multiple benefits of exercise. Knowledge regarding stroke survivors' conception of exercise, which is essential for a thorough understanding of the barriers and facilitators to exercise, is lacking. This study aims to explore the perceptions of exercise among stroke survivors, including their concepts and definitions of exercise, as well as their perceptions of barriers and facilitators to exercise. METHODS: This study utilized a qualitative exploratory design. Focus groups were conducted with 11 community dwelling participants with stroke (mean 8 ± 3 years post stroke). Data was analysed using content analysis methods. FINDINGS: Six themes that provided information regarding participants' perceptions of exercise were identified: mobility, balance, self-efficacy, outcomes, support, and exercise as part of an active or healthy lifestyle. Although participants internalized specific benefits of exercise, they did not demonstrate an internalized link between exercise and stroke risk. Low self-efficacy was identified as a barrier to participating in exercise, whereas, support to exercise (e.g., external encouragement, qualified personnel) was identified as a facilitator. CONCLUSION: These findings may provide insight when developing exercise interventions which optimize adherence for people with stroke.

Disability and health behavior change

OBJECTIVE/HYPOTHESIS

We conducted a review of four health behavior change (HBC) theories (Health Belief, Theory of Planned Behavior, Social Cognitive, and Transtheoretical) to consider how these theories conceptually apply to people with disabilities.

METHODS

We identified five common constructs across HBC theories and examined how these commonalities fit within the International Classification of Function (ICF).

RESULTS

Four of the HBC constructs appear to be Personal Factors within the ICF, while the fifth represents Environmental Factors.

CONCLUSIONS

Using the ICF framework to understand disability and HBC, we propose that including a sense of meaning as another personal factor will further develop HBC theories that lead to more effective HBC interventions for people with disabilities.

Exploring physical activity behaviour of persons with multiple sclerosis: a qualitative pilot study

PURPOSE

Identify facilitators and barriers to physical activity (PA), and explore the utility of Social Cognitive Theory (SCT) and Transactional Model of Stress and Coping (TMSC) in understanding PA behaviour among persons with multiple sclerosis (MS).

METHODS

Thirteen participants from a clinical trial were interviewed and classified as physically active, sometimes active or inactive based on the Health-Promoting Lifestyle Profile-II. Interviews were analysed using analytical induction, which consisted of coding data into pre-established categories and then exploring similarities and differences between groups. Pre-established coding categories were constructs from SCT (i.e. environment, expectations, self-efficacy and self-regulation) and TMSC (i.e. stress appraisal and coping style).

RESULTS

Inactive and active participants differed in their self-regulation skills, self-efficacy and coping styles. Common barriers to PA included symptoms and the physical and social environment. Facilitators of PA included strong self-regulation skills, confidence to overcome symptoms to engage in PA (i.e. barrier self-efficacy) and positive coping styles.

CONCLUSION

Results from this pilot study suggest that PA interventions will need to implement multiple strategies that target self-efficacy, social environment and coping styles. We found SCT and TMSC useful in understanding PA behaviour among persons with MS; however, a limitation to these theories is that they are not explicit in the relationship between health and cognitions. Future research will need to explore how to incorporate models of health and function into existing behaviour change theories.

Health promotion and education: application of the ICF in the US and Canada using an ecological perspective

Health promotion is an issue comprised of complex and multi-layered concepts that involves a process of enabling people to increase control over and improve their health. The aims and applications of the World Health Organization's International Classification of Functioning, Disability and Health (ICF), with its focus on components of functioning, activities and participation, and environmental factors are salient to health promotion and health education efforts. For individuals with or without disabilities, health promotion occurs within the community in which they reside and is influenced by a complex interaction of personal and environmental factors. The aim of this paper is to discuss how the ICF can be useful in enhancing social change through health promotion and health education for all people, in particular those with disabilities and chronic conditions. In doing so health promotion concepts and the ecological approach linked with the ICF, the relationship of social change and social support to the ICF, the potential role of the ICF for national and local (city) policies, and the role of health professionals in this process will be examined. Building on this body of knowledge, the authors recommend that future research should focus on the relationship between policies and the social participation of people with disabilities in the community, the use of ICF measurement tools to improve the indicators established by the National Organization on Disability, the development of a new ICF core set for community accessibility and inclusion, better interventions to enhance social support, and enhancing the role of professionals in health promotion for people with disabilities or chronic health conditions.

Views on exercise maintenance: variations among patients with rheumatoid arthritis

BACKGROUND AND PURPOSE

Individuals with rheumatoid arthritis (RA) often have to make changes in exercise behavior in order to gain and sustain health benefits. The purpose of this study was to explore and describe ways of understanding exercise maintenance among individuals with RA who had already started to exercise.

PARTICIPANTS

Fourteen women and 4 men with RA of at least 2 years' duration, selected from 4 hospitals or primary health care physical therapy clinics, participated. They had exercised regularly at least twice weekly during the previous 2 months with various levels of support from a physical therapist, and they had attempted to exercise without support outside of the health care environment during the previous year.

METHOD

A phenomenographic approach was used to analyze semistructured interviews. A pattern of categories of descriptions was constructed based on the participants' conceptions and ways of understanding the phenomenon of exercise maintenance.

RESULTS

Five categories were identified: "external control," "sticks and carrots," "a joint venture," "the easy way," and "on one's own terms." The categories became clear by elucidating 2 aspects related to exercise maintenance: (1) the way the participants talked about and experienced the type of support needed and (2) personal factors.

DISCUSSION AND CONCLUSION

The results highlight the importance of finding the proper context and support for each patient's needs. Furthermore, preparing for exercise maintenance by strengthening the patient's beliefs in his or her ability to exercise in different settings, by discussing pros and cons of exercise, and by exploiting the patient's ability to adapt and continue exercise outside of the health care environment might be valuable.

The role of patient education in the rehabilitation of people with spinal cord injuries

Individuals with newly acquired spinal cord injuries need to be educated to manage the consequences of their neurological impairment and disability. However, to enable individuals with long-term conditions to manage their own care, they need to be provided with more than simply information about their condition. Critical to independence and self-management are empowerment and self-efficacy. As part of the process of rehabilitation, patient education programmes need to incorporate teaching strategies that develop these key skills to facilitate a successful outcome of rehabilitation for the patient.

This article will explore these strategies, and the theories behind them, from a nursing perspective; highlighting how the rehabilitation professional can use these to improve patient outcomes.

Perceptions of issues associated with the maintenance and improvement of long-term health in people with SCI

STUDY DESIGN

Qualitative design using focus groups.

OBJECTIVE

To explore the perceptions of people with SCI and their caregivers about information needs and service delivery options that may assist them to maintain or improve their long-term health.

SETTING

Province wide project in Alberta, Canada.

METHODS

Eight focus groups were conducted; five with community dwelling people with SCI and three with unpaid caregivers (family and friends). Content analysis was used to identify categories and themes arising from the data.

RESULTS

The findings from the study are broader than the original objective to explore information needs and service delivery options to promote long-term health. The participants more globally discussed factors that contribute to or provide barriers to their long-term health. Those factors are captured in five categories, including readiness, information pathways, community health care, health promotion, and contextual factors. A framework that illustrates the relationships between categories was constructed.

CONCLUSION

The framework identifies areas to target in programmes designed to reduce or prevent secondary conditions in people with SCI.

SPONSORSHIP

This study was funded by the Alberta Paraplegic Foundation and the Glenrose Rehabilitation Hospital Foundation.