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Ferguson CC, Clina JG, Young HJ, Gammon L, Jeter A, Abadie A, Rimmer JH. Improvements in nutrition knowledge among adults with physical disabilities: A program evaluation of the mindfulness, exercise, and nutrition to optimize resilience (MENTOR) program 2020-2021. Disabil Health J 2024; 17:101577. [PMID: 38184471 DOI: 10.1016/j.dhjo.2023.101577] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2023] [Revised: 12/18/2023] [Accepted: 12/20/2023] [Indexed: 01/08/2024]
Abstract
BACKGROUND The Centers for Disease Control and Prevention (CDC) funds a quality improvement (QI) health promotion telewellness program for adults with physical disabilities. OBJECTIVE The nutrition component of the parent program, Mindfulness, Exercise, and Nutrition to Optimize Resilience (MENTOR) program, from 2020 to 2021, was evaluated to assess changes in nutrition knowledge of people with physical disabilities. METHODS This was a quasi-experimental program evaluation by pre-post survey of participating adults with physical disabilities. Participants attended weekly nutrition classes for eight weeks with optional one-on-one counseling with a Registered Dietitian. Participants completed pre-post General Nutrition Knowledge Questionnaire Revised (GNKQ-R) that were analyzed using paired t-tests. Participants were grouped into quartiles by pre-program GNKQ-R scores for additional comparisons. Program attendance and post-program feedback were also evaluated. RESULTS A total of 286 participants completed the MENTOR program, and 31% (n = 89) completed pre-post questionnaires for data analysis. Mean pre-program GNKQ-R scores were 58.4 ± 15.1 and post scores were 64.4 ± 11.3, which demonstrated a statistically significant improvement in nutrition knowledge (p < .001). Ancillary analysis revealed that participants with the lowest quartile of pre-program nutrition knowledge had the greatest improvements in their post-GNKQ-R scores (Mean change 16.4 ± 13.9). Questionnaire data revealed participants' subjective knowledge changes and their feedback on the nutrition component of the program. CONCLUSIONS The eight-week MENTOR program effectively improved nutrition knowledge among people with physical disabilities. This demonstrates the impact the program can have on individual knowledge levels. Additionally, these results support the implementation of the program to the broader population of people with disabilities.
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Affiliation(s)
- Christine C Ferguson
- National Center on Health, Physical Activity and Disability, 3810 Ridgeway Dr., Birmingham, AL, 35209, USA; Dean's Office, School of Health Professions, University of Alabama at Birmingham, 3810 Ridgeway Dr., Birmingham, AL, 35209, USA.
| | - Julianne G Clina
- National Center on Health, Physical Activity and Disability, 3810 Ridgeway Dr., Birmingham, AL, 35209, USA; Department of Nutrition Sciences, School of Health Professions, University of Alabama at Birmingham, 1675 University Blvd., Birmingham, AL, 35233, USA
| | - Hui-Ju Young
- National Center on Health, Physical Activity and Disability, 3810 Ridgeway Dr., Birmingham, AL, 35209, USA; Dean's Office, School of Health Professions, University of Alabama at Birmingham, 3810 Ridgeway Dr., Birmingham, AL, 35209, USA
| | - Lacey Gammon
- National Center on Health, Physical Activity and Disability, 3810 Ridgeway Dr., Birmingham, AL, 35209, USA; Lakeshore Foundation, 4000 Ridgeway Dr., Homewood, AL, 35209, USA
| | - Amanda Jeter
- National Center on Health, Physical Activity and Disability, 3810 Ridgeway Dr., Birmingham, AL, 35209, USA; Dean's Office, School of Health Professions, University of Alabama at Birmingham, 3810 Ridgeway Dr., Birmingham, AL, 35209, USA
| | - Allyn Abadie
- National Center on Health, Physical Activity and Disability, 3810 Ridgeway Dr., Birmingham, AL, 35209, USA; Department of Nutrition Sciences, School of Health Professions, University of Alabama at Birmingham, 1675 University Blvd., Birmingham, AL, 35233, USA
| | - James H Rimmer
- National Center on Health, Physical Activity and Disability, 3810 Ridgeway Dr., Birmingham, AL, 35209, USA; Dean's Office, School of Health Professions, University of Alabama at Birmingham, 3810 Ridgeway Dr., Birmingham, AL, 35209, USA
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Clina JG, Wyatt HR, Hill JO, Ferguson CC, Young H, Rimmer JH. Pilot evaluation of a behavioral weight loss program for adults with physical disabilities: State of Slim Everybody usability and feasibility. Obes Sci Pract 2024; 10:e750. [PMID: 38618520 PMCID: PMC11009485 DOI: 10.1002/osp4.750] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2024] [Revised: 03/26/2024] [Accepted: 04/01/2024] [Indexed: 04/16/2024] Open
Abstract
Background People with physical disabilities (PWD) have a higher prevalence of obesity than populations without disability, but most evidence-based weight loss programs have not included this population. The State of Slim (SOS) program is an evidence-based weight loss program that has demonstrated success in producing weight loss in populations without disability, but it has not been adapted for or evaluated in PWD. Methods The SOS program was systematically adapted using the evidence-informed Guidelines, Recommendations, and Adaptations Including Disability (GRAIDs) framework. A total of 35 participants enrolled in the State of Slim Everybody program. The program was offered entirely online. Body weight, attendance, and food log completion were also tracked weekly. The program length was 16.5 h and included weekly group instruction, with optional one-on-one sessions provided upon request. Following completion, participants completed post-evaluation surveys on overall satisfaction with the program. The primary outcomes were program effectiveness (i.e., body weight), usability, and feasibility. Results Thirty-two out of 35 participants completed the program, representing a retention rate of 91.4%. Average weight loss was 10.9% (9.9 ± 0.7 kg (t (31) = -13.3, p =< 0.0001)). On a 1 (dissatisfied/completely useless) to 5 (very satisfied/completely helpful) Likert scale, the average score for overall program satisfaction was 4.8 ± 0.1 and program helpfulness 4.6 ± 0.1. Conclusion The State of Slim Everybody program demonstrated significant weight loss and good usability and feasibility in PWD. Existing adaptation frameworks can be used to create inclusive health promotion programs for adults with physical disabilities.
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Affiliation(s)
- Julianne G. Clina
- Department of Nutrition SciencesUniversity of Alabama at BirminghamBirminghamAlabamaUSA
- UAB Research CollaborativeUniversity of Alabama at BirminghamBirminghamAlabamaUSA
- University of Kansas Medical CenterKansas CityKansasUSA
| | - Holly R. Wyatt
- Department of Nutrition SciencesUniversity of Alabama at BirminghamBirminghamAlabamaUSA
| | - James O. Hill
- Department of Nutrition SciencesUniversity of Alabama at BirminghamBirminghamAlabamaUSA
| | - Christine C. Ferguson
- Department of Nutrition SciencesUniversity of Alabama at BirminghamBirminghamAlabamaUSA
- UAB Research CollaborativeUniversity of Alabama at BirminghamBirminghamAlabamaUSA
| | - Hui‐Ju Young
- UAB Research CollaborativeUniversity of Alabama at BirminghamBirminghamAlabamaUSA
| | - James H. Rimmer
- UAB Research CollaborativeUniversity of Alabama at BirminghamBirminghamAlabamaUSA
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Lai B, Oster RA, Davis D, Bright L, Fisher G, Wilroy J, Kim Y, Young R, Wright A, Sinha T, Rimmer JH. Telehealth Movement-to-Music With Arm-Based Sprint-Intensity Interval Training to Improve Cardiometabolic Health and Cardiorespiratory Fitness in Children With Cerebral Palsy: Protocol for a Pilot Randomized Controlled Trial. JMIR Res Protoc 2024; 13:e56499. [PMID: 38441939 PMCID: PMC10951837 DOI: 10.2196/56499] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2024] [Revised: 01/29/2024] [Accepted: 01/30/2024] [Indexed: 03/07/2024] Open
Abstract
BACKGROUND Children with mobility disabilities, including those with cerebral palsy, have limited options and limited time to exercise to manage their cardiometabolic health and cardiorespiratory fitness. Regular cardiovascular exercise during childhood is a critical health behavior for preventing health decline in adulthood. Thus, there is an urgent need for accessible, age-appropriate, convenient exercise modalities in this group. Sprint-intensity interval training (SIT), combined with telehealth procedures, may be ideal for children with disabilities. SIT includes repetitive bouts of maximal exercise effort combined with rest periods, which can be effective in eliciting comparable results to moderate-exercise training with very short training durations. OBJECTIVE This phase 1 pilot feasibility randomized controlled trial aims to investigate the potential effects of a 12-week SIT program on indicators of cardiorespiratory fitness and cardiometabolic health among children with cerebral palsy. An ancillary aim is to evaluate the feasibility of the program through several process feasibility metrics. METHODS This study uses a 2-armed parallel group design. A total of 50 physically inactive children with cerebral palsy (aged 6-17 years) will be randomly allocated into 1 of 2 groups: a 12-week SIT or a waitlist control group that continues habitual activity for 12 weeks. The SIT prescription includes 3 tele-supervised sessions per week with 30 repeated sequences of 4 seconds of maximal arm exercise, with active recovery, warm-up, and cooldown periods (for an approximately 20-minute total session). SIT includes guided videos with child-themed arm routines and music. The exercise sessions will be remotely supervised through a web-based videoconference application and include safety monitoring equipment. Outcomes are measured at pre- and postintervention (weeks 0 and 13, respectively). Health outcome measures include peak oxygen consumption (VO2 peak), measured by a graded exercise test; high-sensitivity C-reactive protein and blood insulin, hemoglobin A1c, triglycerides, and cholesterol using a finger stick dried blood spot test; blood pressure, using a sphygmomanometer; and body composition (total mass, total lean mass, tissue % lean, and tissue % fat) using dual x-ray absorptiometry. Feasibility will be evaluated by the following metrics: adverse events or problems experienced throughout the intervention related to participant safety; perceived enjoyment; and recruitment, enrollment, and attrition rates. RESULTS Recruitment procedures started in November 2023. All data are anticipated to be collected by February 2025. Full trial results are anticipated to be analyzed and submitted for publication by March 2025. Secondary analyses of data will be subsequently published. CONCLUSIONS This trial tests an accessible and low-cost exercise program that leverages principles of high-intensity exercise to provide a convenient program for children with physical disabilities. Knowledge obtained from this study will inform the development of a larger trial for improving the cardiometabolic health, cardiorespiratory fitness, and well-being of children with physical disabilities. TRIAL REGISTRATION ClinicalTrials.gov NCT05619211; https://clinicaltrials.gov/study/NCT05619211. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID) DERR1-10.2196/56499.
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Affiliation(s)
- Byron Lai
- Division of Pediatric Rehabilitation Medicine, Department of Pediatrics, University of Alabama at Birmingham, Birmingham, AL, United States
| | - Robert A Oster
- Division of Preventive Medicine, Department of Medicine, University of Alabama at Birmingham, Birmingham, AL, United States
| | - Drew Davis
- Division of Pediatric Rehabilitation Medicine, Department of Pediatrics, University of Alabama at Birmingham, Birmingham, AL, United States
| | - Larsen Bright
- Division of Pediatric Rehabilitation Medicine, Department of Pediatrics, University of Alabama at Birmingham, Birmingham, AL, United States
| | - Gordon Fisher
- Department of Human Studies, University of Alabama at Birmingham, Birmingham, AL, United States
| | - Jereme Wilroy
- Department of Physical Medicine and Rehabilitation, University of Alabama at Birmingham, Birmingham, AL, United States
| | - Yumi Kim
- Department of Physical Medicine and Rehabilitation, University of Alabama at Birmingham, Birmingham, AL, United States
| | - Raven Young
- Division of Pediatric Rehabilitation Medicine, Department of Pediatrics, University of Alabama at Birmingham, Birmingham, AL, United States
| | - Ashley Wright
- Division of Pediatric Rehabilitation Medicine, Department of Pediatrics, University of Alabama at Birmingham, Birmingham, AL, United States
| | - Tanvee Sinha
- Department of Physical Medicine and Rehabilitation, University of Alabama at Birmingham, Birmingham, AL, United States
| | - James H Rimmer
- Dean's Office, School of Health Professions, National Center on Health, Physical Activity and Disability, Birmingham, AL, United States
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Clina JG, Sayer RD, Friedman JE, Chui TK, Mehta T, Rimmer JH, Hill JO. Reliability and Validity of the International Physical Activity Questionnaire Adapted to Include Adults With Physical Disability. J Phys Act Health 2024; 21:189-196. [PMID: 38056440 PMCID: PMC10875625 DOI: 10.1123/jpah.2023-0504] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2023] [Revised: 10/12/2023] [Accepted: 10/31/2023] [Indexed: 12/08/2023]
Abstract
BACKGROUND People with physical disabilities (PWD) participate in less physical activity than people without physical disabilities (PWoD), which increases the risk for several negative health consequences. Comparing physical activity between PWD and PWoD remains a challenge since no reliable and valid survey exists to measure physical activity in both populations. The International Physical Activity Questionnaire (IPAQ) was adapted to be inclusive of PWD using a recently developed survey adaption framework; however, the adapted IPAQ has not been assessed for reliability and validity. The objective of this study was to assess the reliability and validity of the adapted IPAQ. METHODS To assess test-retest reliability, the adapted IPAQ was completed twice within a 72-hour period by 172 individuals (PWD: n = 102, PWoD: n = 70) and compared using intraclass correlation coefficients. Using Spearman rho, convergent validity and construct validity were assessed in 62 individuals by comparing the adapted IPAQ against the original instrument and activity monitor measured step count, respectively. RESULTS The adapted IPAQ demonstrated moderate test-retest reliability, with intraclass correlation coefficients of total scores for the total sample of .690 (95% confidence interval [CI] .581-.770) and among subgroup analysis (PWD, .640, 95% CI, .457-.761; PWoD, .758, 95% CI, .610-.850). Correlation coefficients were also good for the assessment of convergent validity of total score (.727; 95% CI, .579-.829; P < .001). Construct validity assessment yielded moderate coefficient (.406; 95% CI, .166-.596; P = .001). CONCLUSIONS The adapted IPAQ demonstrated acceptable reliability and validity and is appropriate for use in PWD and PWoD.
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Affiliation(s)
- Julianne G Clina
- Department of Nutrition Sciences, University of Alabama at Birmingham, Birmingham, AL, USA
| | - R Drew Sayer
- Department of Family and Community Medicine, University of Alabama at Birmingham, Birmingham, AL, USA
| | - James E Friedman
- Department of Nutrition Sciences, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Tsz Kiu Chui
- Department of Nutrition Sciences, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Tapan Mehta
- Department of Family and Community Medicine, University of Alabama at Birmingham, Birmingham, AL, USA
| | - James H Rimmer
- UAB Research Collaborative, University of Alabama at Birmingham, Birmingham, AL, USA
| | - James O Hill
- Department of Nutrition Sciences, University of Alabama at Birmingham, Birmingham, AL, USA
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Rimmer JH, Young HJ, Bachiashvili V, Baidwan NK, Mehta T. Enhancements to a Telewellness Program for People With Physical Disabilities: Mindfulness, Exercise, and Nutrition To Optimize Resilience (MENTOR 2.0). Prev Chronic Dis 2024; 21:E02. [PMID: 38176696 PMCID: PMC10805275 DOI: 10.5888/pcd21.230181] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2024] Open
Abstract
Introduction This study evaluated the National Center on Health, Physical Activity and Disability (NCHPAD) Mindfulness, Exercise, and Nutrition To Optimize Resilience (MENTOR) program for people with physical disabilities. Methods This retrospective evaluation of MENTOR 2.0, an 8-week online group health promotion program, was based on improvements from its first implementation (MENTOR 1.0). Baseline and postassessments included the Godin Leisure-Time Exercise Questionnaire (GLTEQ), NCHPAD Wellness Assessment (NWA), Connor-Davidson Resilience Scale, and Mindfulness Attention Awareness Scale. Estimates and corresponding 95% CIs from linear mixed models were provided to compare baseline and postassessment scores and effect sizes using Cohen d. Results Among 116 participants (mean age, 53 y; 63% female), postassessment scores increased significantly in the overall NWA and in all 15 NWA domains (effect size, 0.30-0.69). The overall NWA score was 7.59 (95% CI, 5.63-9.56) units higher at postassessment compared with baseline. Scores for GLTEQ health contribution increased significantly among participants with low baseline scores (31.37 [95% CI, 12.97-49.77]) (effect size, 0.50). Mindfulness and resilience scores both showed improvement (0.16 [95% CI, 0.01-0.31]; effect size, 0.15) and (0.72 [95% CI, -0.25 to 1.68]; effect size 0.09), respectively, but only the change in mindfulness was significant. Conclusion MENTOR 2.0 advanced the evaluation of this online telewellness program for people with physical disabilities by demonstrating consistent results with MENTOR 1.0. We reported improvements in GLTEQ, especially among those with lower baseline scores; in multiple areas of wellness, including physical, mental, and emotional/spiritual health; and in mindfulness and resilience, although the improvements in these 2 constructs were small.
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Affiliation(s)
- James H Rimmer
- School of Health Professions, The University of Alabama at Birmingham, National Center on Health, Physical Activity and Disability
- The University of Alabama at Birmingham, School of Health Professions, 3810 Ridgeway Dr, Birmingham, AL 35294
| | - Hui-Ju Young
- School of Health Professions, The University of Alabama at Birmingham, National Center on Health, Physical Activity and Disability
| | - Vasil Bachiashvili
- Department of Family and Community Medicine, The University of Alabama at Birmingham
| | - Navneet Kaur Baidwan
- Department of Family and Community Medicine, The University of Alabama at Birmingham
| | - Tapan Mehta
- Department of Family and Community Medicine, The University of Alabama at Birmingham
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Lai B, Young R, Craig M, Chaviano K, Swanson-Kimani E, Wozow C, Davis D, Rimmer JH. Improving Social Isolation and Loneliness Among Adolescents With Physical Disabilities Through Group-Based Virtual Reality Gaming: Feasibility Pre-Post Trial Study. JMIR Form Res 2023; 7:e47630. [PMID: 38055309 PMCID: PMC10733831 DOI: 10.2196/47630] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2023] [Revised: 11/09/2023] [Accepted: 11/20/2023] [Indexed: 12/07/2023] Open
Abstract
BACKGROUND Adolescents with disabilities experience alarmingly higher rates of depression and isolation than peers without disabilities. There is a need to identify interventions that can improve mental health and isolation among this underserved population. Innovations in virtual reality (VR) gaming "standalone" headsets allow greater access to immersive high-quality digital experiences, due to their relatively low cost. OBJECTIVE This study had three purposes, which were to (1) examine the preliminary effects of a low-cost, home-based VR multiplayer recreation and socialization on depression, socialization, and loneliness; (2) quantify the acceptability of the program as measured by participant adherence, total play time, and exercise time; and (3) identify and describe behavioral mechanisms that affected participant engagement. METHODS This was a single-group, pre- to postdesign trial. The intervention was conducted at home. Participants were recruited from a children's hospital. The intervention lasted 4 weeks and included 2×1-hour sessions per week of supervised peer-to-peer gaming. Participants used the Meta Quest 2 headset to meet peers and 2 coaches in a private party held digitally. Aim 1 was evaluated with the Children's Depression Inventory 2 Short Form and the University of California, Los Angeles Loneliness Scale 20 items, which are measures of social isolation and loneliness, respectively. Aim 2 was evaluated through the following metrics: participant adherence, the types of games played, friendship building and playtime, and program satisfaction and enjoyment. RESULTS In total, 12 people enrolled (mean age 16.6, SD 1.8 years; male: n=9 and female: n=3), and 8 people completed the program. Mean attendance for the 8 participants was 77% (49 sessions of 64 total possible sessions; mean 6, SD 2 sessions). A trend was observed for improved Children's Depression Inventory 2 Short Form scores (mean preintervention score 7.25, SD 4.2; mean postintervention score 5.38, SD 4.1; P=.06; effect size=0.45, 95% CI -0.15 to 3.9), but this was not statistically significant; no difference was observed for University of California, Los Angeles Loneliness Scale 20 items scores. Most participants (7/8, 88%) stated that they became friends with a peer in class; 50% (4/8) reported that they played with other people. Participants reported high levels of enjoyment and satisfaction with how the program was implemented. Qualitative analysis resulted in 4 qualitative themes that explained behavioral mechanisms that determined engagement in the program. CONCLUSIONS The study findings demonstrated that a brief VR group program could be valuable for potentially improving mental health among adolescents with physical disabilities. Participants built friendships with peers and other players on the web, using low-cost consumer equipment that provided easy access and strong scale-up potential. Study findings identified factors that can be addressed to enhance the program within a larger clinical trial. TRIAL REGISTRATION ClinicalTrials.gov NCT05259462; https://clinicaltrials.gov/study/NCT05259462. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID) RR2-10.2196/42651.
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Affiliation(s)
- Byron Lai
- Division of Pediatric Rehabilitation Medicine, Department of Pediatrics, University of Alabama at Birmingham, Birmingham, AL, United States
| | - Raven Young
- Division of Pediatric Rehabilitation Medicine, Department of Pediatrics, University of Alabama at Birmingham, Birmingham, AL, United States
| | - Mary Craig
- Division of Pediatric Rehabilitation Medicine, Department of Pediatrics, University of Alabama at Birmingham, Birmingham, AL, United States
| | - Kelli Chaviano
- Division of Pediatric Rehabilitation Medicine, Department of Pediatrics, University of Alabama at Birmingham, Birmingham, AL, United States
| | - Erin Swanson-Kimani
- Division of Pediatric Rehabilitation Medicine, Department of Pediatrics, University of Alabama at Birmingham, Birmingham, AL, United States
| | - Cynthia Wozow
- Division of Pediatric Rehabilitation Medicine, Department of Pediatrics, University of Alabama at Birmingham, Birmingham, AL, United States
| | - Drew Davis
- Division of Pediatric Rehabilitation Medicine, Department of Pediatrics, University of Alabama at Birmingham, Birmingham, AL, United States
| | - James H Rimmer
- Dean's Office, School of Health Professions, University of Alabama at Birmingham, Birmingham, AL, United States
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Clina JG, Herman C, Ferguson CC, Rimmer JH. Adapting an evidence-based physical activity questionnaire for people with physical disabilities: A methodological process. Disabil Health J 2023:101447. [PMID: 36841678 DOI: 10.1016/j.dhjo.2023.101447] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2022] [Revised: 01/24/2023] [Accepted: 01/24/2023] [Indexed: 02/05/2023]
Abstract
BACKGROUND Practitioners and researchers often adapt tools, practices, and programs to meet the needs of culturally diverse population groups, but do not consider populations with disability. While there is some research on guidelines for adapting evidence-based programs, there is no systematic process for adapting survey instruments. Rather than creating separate instruments for people with physical disabilities (PWD), it is critical that instruments are designed to capture data on people with and without disabilities for comparison purposes. Given the disproportionately high rates of physical inactivity and obesity in PWD, we developed a methodology to adapt an evidence-based physical activity instrument. OBJECTIVE To create a methodology to adapt surveys to be inclusive of PWD and use the methodology to adapt an evidence-based physical activity survey. METHODS A framework was developed to adapt a physical activity survey instrument (International Physical Activity Questionnaire, IPAQ) to be inclusive of PWD. The framework, referred to as SAVe-IT, includes five steps: Step 1) Select survey instrument to adapt; Step 2) Adapt the survey instrument; Step 3) Verify adaptations with experts; Step 4) Implement pilot test; Step 5) Test the tool to confirm reliability. RESULTS The adapted IPAQ passed review by the expert panels and the pilot test (n = 20). Assessment of test-retest reliability (n = 30) yielded strong intraclass correlation coefficients of 0.950 for the total score for the whole sample, 0.950 for PWD (n = 15) and 0.952 for people without disability (n = 15). CONCLUSIONS The SAVe-IT framework resulted in the successful adaptation of the IPAQ and can be used in populations with and without physical disabilities.
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Affiliation(s)
- Julianne G Clina
- Department of Nutrition Sciences, University of Alabama at Birmingham, 1675 University Blvd, Birmingham, AL, 35233, USA.
| | - Cassandra Herman
- Department of Disability and Human Development, University of Illinois Chicago, 1675 W. Roosevelt Rd, Chicago, IL, 60608, USA
| | - Christine C Ferguson
- UAB Research Collaborative, University of Alabama at Birmingham, 3810 Ridgeway Dr, Homewood, AL, 35209, USA
| | - James H Rimmer
- UAB Research Collaborative, University of Alabama at Birmingham, 3810 Ridgeway Dr, Homewood, AL, 35209, USA
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Kim Y, Mehta T, Tracy T, Young HJ, Pekmezi DW, Rimmer JH, Niranjan SJ. A qualitative evaluation of a clinic versus home exercise rehabilitation program for adults with multiple sclerosis: The tele-exercise and multiple sclerosis (TEAMS) study. Disabil Health J 2022:101437. [PMID: 36658077 DOI: 10.1016/j.dhjo.2022.101437] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2022] [Revised: 12/13/2022] [Accepted: 12/15/2022] [Indexed: 12/24/2022]
Abstract
BACKGROUND Substantial evidence supports therapeutic exercise for improving health and function in people with multiple sclerosis (MS). However, few studies have considered the patients' perspective. OBJECTIVE This study explored perspectives of adults with MS following participation in a 3-month clinic- and home-based exercise rehabilitation program. METHODS Twenty participants with MS were interviewed using a semi-structured interview guide on the design and implementation processes of the exercise programs as well as any perceived facilitators or barriers to exercise. Data analysis was conducted using a thematic analysis approach to generate themes from the transcribed interviews. RESULTS Key facilitators of exercise for people with MS included perceived improvements in physical health and function, activity participation, and psychosocial health. Mismatched level of exercise with their stage of post-diagnosis and/or functional ability and limited human interaction emerged as barriers to exercise. CONCLUSIONS Participation in the exercise program was a positive experience for people with MS. Despite the provision of a high level of adaptation and tailored exercise plan and delivery, self-directed exercise continued to present challenges for people with MS. Additionally, the importance of seeking cost-effective ways to maintain motivational support was implicit in participant responses. The findings provided an improved understanding of personal experiences and exercise perspectives that can inform future intervention strategies aimed at promoting sustained exercise participation.
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Affiliation(s)
- Yumi Kim
- Department of Physical Medicine and Rehabilitation, Heersink School of Medicine, University of Alabama at Birmingham, Birmingham, AL, USA; Dean's Office, School of Health Professions, University of Alabama at Birmingham, Birmingham, AL, USA.
| | - Tapan Mehta
- Department of Family and Community Medicine, Heersink School of Medicine, University of Alabama at Birmingham, Birmingham, Birmingham, AL, USA; Dean's Office, School of Health Professions, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Tracy Tracy
- Tanner Foundation for Neurological Disease, Birmingham, AL, USA
| | - Hui-Ju Young
- Dean's Office, School of Health Professions, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Dorothy W Pekmezi
- Department of Health Behavior, School of Public Health, University of Alabama at Birmingham, Birmingham, AL, USA
| | - James H Rimmer
- Dean's Office, School of Health Professions, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Soumya J Niranjan
- Department of Health Services Administration, School of Health Professions, University of Alabama at Birmingham, Birmingham, AL, USA
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Lai B, Davis D, Young R, Swanson-Kimani E, Wozow C, Chaviano K, Rimmer JH. Group tele-gaming through immersive virtual reality to improve mental health among adolescents with physical disabilities: pre and post trial protocol. JMIR Res Protoc 2022; 11:e42651. [PMID: 36194864 PMCID: PMC9614625 DOI: 10.2196/42651] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2022] [Revised: 09/29/2022] [Accepted: 09/30/2022] [Indexed: 11/13/2022] Open
Abstract
Background Adolescents with physical disabilities have higher rates of mental health conditions and issues than adolescents without disabilities, and this disparity was exacerbated by the onset of the COVID-19 pandemic. They also have limited access to on-site programs and nearby peers. Objective This pilot aims to investigate the potential effects of a low-dose multiplayer virtual reality telegaming program on depression, socialization, and loneliness among a cohort of children with physical disabilities. A secondary aim is to describe feasibility metrics, namely, recruitment and adherence rates and perceived program enjoyment and satisfaction. The tertiary aim is to describe behavioral mechanisms that affect participant adherence and social participation in the classes. Methods This study is a single-group pre- and posttest–designed trial. A single cohort of 12 children with physical disabilities will pilot a 1-month program that includes 2 supervised 1-hour sessions per week of group-based exergaming. Participants will complete questionnaires before and after the program. The primary aim measures will include the Children’s Depression Inventory 2 Short Form, a measure of feelings of depression, and the UCLA Loneliness Scale, a measure of both loneliness and social isolation. Secondary aim measures will include three posttest Likert scale questionnaires: perceived program enjoyment, program satisfaction, and satisfaction with multiplayer experiences. At postintervention or dropout, participants will undergo semistructured interviews to identify behavioral mechanisms that underlie participation. Data will be reported descriptively and be supported by t tests as appropriate. Results Recruitment procedures started in July 2022. All data are expected to be collected by January 2023. Full trial results are expected to be published by March 2023. Secondary analyses of data will be subsequently published. Conclusions This trial tests a peer-to-peer virtual reality telegaming program that includes a completely remote enrollment, assessment, and intervention protocol. This program is accessible and short in duration and frequency, allowing it to be integrated into other interventions. Knowledge obtained from this study will inform the development of a larger trial for improving the mental health and well-being of adolescents with physical disabilities. Trial Registration ClinicalTrials.gov NCT05259462; https://clinicaltrials.gov/ct2/show/NCT05259462 International Registered Report Identifier (IRRID) PRR1-10.2196/42651
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Affiliation(s)
- Byron Lai
- Division of Pediatric Rehabilitation Medicine, Department of Pediatrics, University of Alabama at Birmingham, 1720 University Blvd, Birmingham, US
| | - Drew Davis
- Division of Pediatric Rehabilitation Medicine, Department of Pediatrics, University of Alabama at Birmingham, 1720 University Blvd, Birmingham, US
| | - Raven Young
- Division of Pediatric Rehabilitation Medicine, Department of Pediatrics, University of Alabama at Birmingham, 1720 University Blvd, Birmingham, US
| | - Erin Swanson-Kimani
- Division of Pediatric Rehabilitation Medicine, Department of Pediatrics, University of Alabama at Birmingham, 1720 University Blvd, Birmingham, US
| | - Cynthia Wozow
- Division of Pediatric Rehabilitation Medicine, Department of Pediatrics, University of Alabama at Birmingham, 1720 University Blvd, Birmingham, US
| | - Kelli Chaviano
- Division of Pediatric Rehabilitation Medicine, Department of Pediatrics, University of Alabama at Birmingham, 1720 University Blvd, Birmingham, US
| | - James H Rimmer
- Dean's Office, School of Health Professions, University of Alabama at Birmingham, Birmingham, US
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Rimmer JH. Addressing Disability Inequities: Let's Stop Admiring the Problem and Do Something about It. Int J Environ Res Public Health 2022; 19:11886. [PMID: 36231189 PMCID: PMC9565910 DOI: 10.3390/ijerph191911886] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/06/2022] [Revised: 09/11/2022] [Accepted: 09/15/2022] [Indexed: 06/16/2023]
Abstract
The healthcare system and public health community are often underprepared to support the needs of people with disabilities and to include them equitably in wellness programs (e.g., exercise, leisure, nutrition, stress management) offered to the general community. Consequently, the vast majority of people with disabilities are unable to make the transition from "patient" to "participant," which contributes to many of the health disparities reported in this population. People with disabilities have a disproportionately higher rate of acquiring secondary conditions such as obesity, cardiovascular comorbidity, pain, fatigue, depression, deconditioning, and type 2 diabetes, often resulting from poor access to home and community-based health promotion/wellness programs that include physical activity, nutrition, stress reduction, and sleep hygiene, among others. Achieving health equity in people with disabilities requires a multi-stage approach that includes person-centered referral to wellness programs, empowering people with disabilities to become self-managers of their own health and ensuring that community-based programs and services are inclusive. A three-stage model for addressing health and wellness needs across the home and community settings is described, which is currently being used in a large federally funded center in the US with potential generalizability across the world.
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Affiliation(s)
- James H Rimmer
- School of Health Professions, Lakeshore Foundation Research Collaborative, University of Alabama, Birmingham, AL 35206, USA
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Wilroy JD, Kim Y, Lai B, Ivankova N, Herbey I, Sinha T, Rimmer JH. How do people with physical/mobility disabilities benefit from a telehealth exercise program? A qualitative analysis. Front Rehabil Sci 2022; 3:932470. [PMID: 36189049 PMCID: PMC9397826 DOI: 10.3389/fresc.2022.932470] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 04/29/2022] [Accepted: 06/23/2022] [Indexed: 06/16/2023]
Abstract
People with neurological and physical disabilities (PWD) experience a myriad of secondary and chronic health conditions, thus, reducing their participation and quality of life. A telehealth exercise program could provide a convenient opportunity for improving health in this population. To describe participants' perceived benefits of a telehealth physical activity program among PWD, we conducted semi-structured interviews with 30 study participants after completing the 24-week program SUPER-HEALTH (Scale-Up Project Evaluating Responsiveness to Home Exercise and Lifestyle TeleHealth). Interview data were recorded, transcribed verbatim, and analyzed using inductive thematic analysis. The mean age of the sample was 51 ± 13 years, the primary disability was Multiple Sclerosis, and there were nine men (30%) and 21 (70%) women. Inductive thematic analysis resulted in four themes that include the following: (1) improved health and function, (2) increased activity participation, (3) improved psychosocial health, and (4) optimized performance and benefits. These preliminary findings provided support for the use of a home exercise program and recommendations to improve it to enhance benefits among PWD.
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Affiliation(s)
- Jereme D. Wilroy
- Department of Physical Medicine and Rehabilitation, The University of Alabama at Birmingham, Birmingham, AL, United States
- UAB-Lakeshore Foundation Research Collaborative, Birmingham, AL, United States
| | - Yumi Kim
- Department of Physical Medicine and Rehabilitation, The University of Alabama at Birmingham, Birmingham, AL, United States
- UAB-Lakeshore Foundation Research Collaborative, Birmingham, AL, United States
| | - Byron Lai
- UAB-Lakeshore Foundation Research Collaborative, Birmingham, AL, United States
- Division of Pediatric Rehabilitation Medicine, Department of Pediatrics, The University of Alabama at Birmingham, Birmingham, AL, United States
| | - Nataliya Ivankova
- Department of Health Services Administration, The University of Alabama at Birmingham, Birmingham, AL, United States
| | - Ivan Herbey
- Department of Surgery, The University of Alabama at Birmingham, Birmingham, AL, United States
| | - Tanvee Sinha
- Department of Physical Medicine and Rehabilitation, The University of Alabama at Birmingham, Birmingham, AL, United States
| | - James H. Rimmer
- UAB-Lakeshore Foundation Research Collaborative, Birmingham, AL, United States
- Dean's Office, The University of Alabama at Birmingham, Birmingham, AL, United States
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Rimmer JH, Wilroy J, Young HJ, Young R, Sinha T, Currie M, Lima CR, Lai B. Qualitative Evaluation of a Comprehensive Online Wellness Program (MENTOR) Among People With Spinal Cord Injury. Front Rehabil Sci 2022; 3:917898. [PMID: 36189027 PMCID: PMC9397963 DOI: 10.3389/fresc.2022.917898] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 04/11/2022] [Accepted: 05/16/2022] [Indexed: 11/20/2022]
Abstract
People with spinal cord injury (SCI) experience a plethora of health conditions that hinder their health and wellness. This qualitative retrospective evaluation describes the perceptions of 14 peoples with SCI, several months after they completed an eight-week telewellness community program (MENTOR-Mindfulness, Exercise and Nutrition To Optimize Resilience). The program offered daily online classes that covered three core wellness domains (mindfulness, exercise, nutrition) and one health coaching session to introduce participants to eight other wellness domains (sleep, self-care, core values, arts & leisure, outdoor time in nature; spiritual practice, relationships, contribution to others). Qualitative analysis resulted in 4 themes related to program benefits, likes, and improvement recommendations. First, participants valued the program for the social support provided by a sense of community and relationship building with peers. Second, self-regulation was facilitated by the comprehensiveness of the program components, easy online access, and shared lifestyle goals for self-improvement among peers. Third, participants reported improved psychological wellbeing and adopted healthy behaviors that were maintained long after the program. Last, future programs should include flexible class times, post-program support, specific exercise adaptations for people with limited arm function, and supplementary in-person meetings. These preliminary findings demonstrate that MENTOR may benefit the wellbeing of people with SCI and warrant further study.
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Affiliation(s)
- James H. Rimmer
- Dean's Office, University of Alabama at Birmingham, Birmingham, AL, United States
- University of Alabama at Birmingham-Lakeshore Foundation Research Collaborative, Birmingham, AL, United States
| | - Jereme Wilroy
- University of Alabama at Birmingham-Lakeshore Foundation Research Collaborative, Birmingham, AL, United States
- Department of Physical Medicine and Rehabilitation, University of Alabama at Birmingham, Birmingham, AL, United States
| | - Hui-Ju Young
- Dean's Office, University of Alabama at Birmingham, Birmingham, AL, United States
- University of Alabama at Birmingham-Lakeshore Foundation Research Collaborative, Birmingham, AL, United States
| | - Raven Young
- University of Alabama at Birmingham-Lakeshore Foundation Research Collaborative, Birmingham, AL, United States
- Division of Pediatric Rehabilitation Medicine, Department of Pediatrics, University of Alabama at Birmingham, Birmingham, AL, United States
| | - Tanvee Sinha
- Department of Physical Medicine and Rehabilitation, University of Alabama at Birmingham, Birmingham, AL, United States
| | - Madison Currie
- University of Alabama at Birmingham-Lakeshore Foundation Research Collaborative, Birmingham, AL, United States
- Physical and Occupational Therapy Department, Rehabilitation Science Program, University of Alabama at Birmingham, Birmingham, AL, United States
| | - Carla Rigo Lima
- University of Alabama at Birmingham-Lakeshore Foundation Research Collaborative, Birmingham, AL, United States
- Physical and Occupational Therapy Department, Rehabilitation Science Program, University of Alabama at Birmingham, Birmingham, AL, United States
| | - Byron Lai
- University of Alabama at Birmingham-Lakeshore Foundation Research Collaborative, Birmingham, AL, United States
- Division of Pediatric Rehabilitation Medicine, Department of Pediatrics, University of Alabama at Birmingham, Birmingham, AL, United States
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Rimmer JH, Wilroy J, Galea P, Jeter A, Lai BW. Retrospective evaluation of a pilot eHealth/mHealth telewellness program for people with disabilities: Mindfulness, Exercise, and Nutrition To Optimize Resilience (MENTOR). Mhealth 2022; 8:15. [PMID: 35449508 PMCID: PMC9014229 DOI: 10.21037/mhealth-21-34] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/31/2021] [Accepted: 12/23/2021] [Indexed: 11/06/2022] Open
Abstract
BACKGROUND People with disabilities have few options to participate in wellness programs that are tailored to their health, functional level, specific interests/needs, and available in the comfort of their home. To address this need, we evaluated a mobile health wellness program for people with physical disabilities. METHODS Retrospective pilot evaluation of MENTOR (Mindfulness, Exercise, and Nutrition To Optimize Resilience), an 8-week, 40-hour online telewellness program adapted from the peer reviewed literature on wellness. The three core wellness domains-mindfulness, exercise, and nutrition-were delivered via Zoom to groups of participants with a disability. Each group met weekly with an assigned health coach who responded to Q&A about the program and presented new material on several additional wellness domains that could impact their health (e.g., relationships, contribution to society/community, spending outdoor time in nature). Pre/post measures included the Godin Leisure-Time Exercise Questionnaire (GLTEQ) and the UAB/Lakeshore Wellness Assessment (LWA). Participants were also interviewed and provided feedback after the program, which was thematically analyzed. RESULTS A total of 154 people from 15 states enrolled in the MENTOR program and 135 completed it (87.7% completers). Data were analyzed from a subset of participants (n=53) who were asked to complete a pre/post assessment and had complete data. Participants who were physically inactive at baseline improved their GLTEQ total activity (P=0.002; effect size =0.56) and moderate-to-vigorous activity scores (P=0.005; effect size =0.53). LWA results demonstrated that participants increased their exercise behavior (P=0.006; effect sizes =0.39) and contribution to society/community (P=0.013; effect size =0.37). Participants with low overall wellness (mental, physical & emotional health) at baseline had statistically significant improvements in exercise, nutrition, sleep, core values, self-care, hobbies, contribution to society/community, relationships, and overall wellness (all P<0.05 with effect sizes ranging from 0.43 to 1.07). Resultant qualitative themes were: (I) lifestyle transformation occurred through new positive experiences, physical and mental health benefits, and adoption of healthy behaviors; and (II) engagement through accessible online bonding through enjoyable and professional experiences. CONCLUSIONS A pilot telewellness program for people with disabilities is feasible and potentially effective in improving several domains of wellness. There is a need for precision-based mobile health (mHealth) programs that are tailored for people with disabilities and that can be accessed from various portable devices including their phone and/or tablet.
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Affiliation(s)
- James H. Rimmer
- Dean’s Office, School of Health Professions, University of Alabama at Birmingham, Birmingham, AL, USA
- Lakeshore Foundation, Homewood, AL, USA
| | - Jereme Wilroy
- Lakeshore Foundation, Homewood, AL, USA
- Department of Physical Medicine and Rehabilitation, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Pierre Galea
- Department of Physical Medicine and Rehabilitation, University of Alabama at Birmingham, Birmingham, AL, USA
| | | | - Byron W. Lai
- Lakeshore Foundation, Homewood, AL, USA
- Division of Pediatric Rehabilitation Medicine, Department of Pediatrics, University of Alabama at Birmingham, Birmingham, AL, USA
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Lai B, Vogtle L, Young R, Craig M, Kim Y, Gowey M, Swanson-Kimani E, Davis D, Rimmer JH. A home-based telehealth Movement-to-Music program can increase physical activity participation among adolescents with cerebral palsy: pilot randomized controlled trial (Preprint). JMIR Form Res 2021; 6:e36049. [PMID: 36306154 PMCID: PMC9652735 DOI: 10.2196/36049] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2021] [Revised: 08/24/2022] [Accepted: 09/12/2022] [Indexed: 11/22/2022] Open
Abstract
Background Adolescents with cerebral palsy (CP) who have mobility limitations have almost no access to inexpensive and enjoyable home-based programs that can be disseminated on a large scale to help them independently manage their health through participation in leisure-time physical activity (LTPA). Objective The primary aim of this study was to determine the preliminary efficacy of the early adoption phase of an adult Movement-to-Music (M2M) program with behavioral telecoaching for increasing LTPA and activity participation compared with a waitlist control group in adolescents with CP. The secondary aim was to explore the effects of the program on perceived levels of pain and fatigue. The tertiary aim was to qualitatively evaluate the factors that influenced adherence and develop a theory that would inform the development of a more targeted M2M telehealth program for this group. Methods This randomized controlled trial piloted a 4-week M2M program with weekly behavioral telecoaching among 58 adolescents with CP who walked or used wheelchairs. The participants were randomized into one of 2 groups: M2M or control, which maintained their daily activities. M2M included videos that participants were asked to complete 3 times each week at home (asynchronous training). Adherence to video minutes was objectively measured using cloud-based analytics. Changes in activity and LTPA participation were measured before and after the intervention using the Children’s Assessment of Participation and Enjoyment total domain scores and active physical recreation domain scores, respectively. Perceived pain and fatigue were measured using the National Institutes of Health Neuro-QoL short forms. The changes in scores were compared between the groups using analysis of covariance. A grounded theory approach was used to analyze one-on-one interviews, coaching notes, and feedback surveys. Results A total of 58 people were enrolled, of which 49 (84%) completed the primary outcome follow-up assessment. The mean adherence to the prescribed exercise video minutes across all 4 weeks was 68%, starting from 90% in week 1 and gradually declining to 43% in week 4. Mean adherence to coaching calls was 91%. Analysis of covariance revealed a statistically significant difference between the pre- to postchange scores for Children’s Assessment of Participation and Enjoyment Active Physical Recreation–Intensity domain scores in favor of the intervention group (F1,47=8.76; P=.005; effect size=0.17, also known as volume of LTPA). The qualitative findings highlighted 5 critical factors that influenced participants’ adherence to the program: caregiver support, video elements, suitable exercises, music, and behavioral coaching. Conclusions This project determined that adolescents with CP responded well to an M2M telehealth program that could enhance their LTPA levels. This paper describes a theory in which adherence to a telehealth LTPA program can be optimized through functional and age-specific modifications for adolescents with CP. Trial Registration ClinicalTrials.gov NCT04264390; https://clinicaltrials.gov/ct2/show/NCT04264390
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Affiliation(s)
- Byron Lai
- Division of Pediatric Rehabilitation Medicine, Department of Pediatrics, University of Alabama at Birmingham, Birmingham, AL, United States
| | - Laura Vogtle
- Department of Occupational Therapy, University of Alabama at Birmingham, Birmingham, AL, United States
| | - Raven Young
- Division of Pediatric Rehabilitation Medicine, Department of Pediatrics, University of Alabama at Birmingham, Birmingham, AL, United States
| | - Mary Craig
- Division of Pediatric Rehabilitation Medicine, Department of Pediatrics, University of Alabama at Birmingham, Birmingham, AL, United States
| | - Yumi Kim
- Department of Physical Medicine and Rehabilitation, University of Alabama at Birmingham, Birmingham, AL, United States
| | - Marissa Gowey
- Division of Pediatric Gastroenterology, Hepatology and Nutrition, Department of Pediatrics, University of Alabama at Birmingham, Birmingham, AL, United States
| | - Erin Swanson-Kimani
- Division of Pediatric Rehabilitation Medicine, Department of Pediatrics, University of Alabama at Birmingham, Birmingham, AL, United States
| | - Drew Davis
- Division of Pediatric Rehabilitation Medicine, Department of Pediatrics, University of Alabama at Birmingham, Birmingham, AL, United States
| | - James H Rimmer
- Dean's Office, University of Alabama at Birmingham, Birmingham, AL, United States
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Lai B, Wen H, Sinha T, Davis D, Swanson-Kimani E, Wozow C, Young R, Powell D, Rimmer JH. The impact of COVID-19 on the lifestyles of adolescents with cerebral palsy in the Southeast United States. Disabil Health J 2021; 15:101263. [PMID: 35000878 PMCID: PMC8677427 DOI: 10.1016/j.dhjo.2021.101263] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2021] [Revised: 12/01/2021] [Accepted: 12/13/2021] [Indexed: 11/26/2022]
Abstract
Background The impact of COVID-19 on adolescents with cerebral palsy (CP) and their families is underinvestigated, particularly in the Southeastern United States. Objective/Hypothesis The objective of this study was to examine the impact of COVID-19 on lifestyle activities, general and mental health, and basic needs among a cohort of adolescents with CP in the Southeast U.S. The second purpose was to identify key factors that impacted their lifestyles. Methods This was a cross-sectional survey of adolescents with CP (aged 10–19 years) who completed a child-modified version of the Coronavirus Disability Survey. Health and behavior items were associated with the perceived lifestyle impact of COVID-19. Results A total of 101 respondents completed the survey (mean age: 14 ± 2 years). Respondents reported minimal to no change in general health since the COVID-19 outbreak. Basic needs were met for most families. Nearly all participants (94.1%) reported a mental health concern that resulted from COVID-19: 32.7% felt down or depressed; 47.5% felt little pleasure in doing things; and 64.4% felt isolated. Moreover, 74.3% reported decreased socialization, 51.5% reported reduced exercise participation, and 43.6% reported difficulties in obtaining medical care. Most participants (90.1%) were negatively affected by COVID-19, and key associated factors were reduced interactions with friends and family (p = 0.001), exercise participation (p = 0.016), interest in doing things (p = 0.005), worsened depression (p = 0.015), increased isolation from others (p = 0.02) and at home (p = 0.006), technological communication (p = 0.00), and virus exposure (p = 0.008). Conclusions Study findings highlight problem areas that warrant urgent intervention among adolescents with CP located within the Southeast U.S.
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Affiliation(s)
- Byron Lai
- Department of Pediatrics, Division of Pediatric Rehabilitation Medicine, School of Medicine, University of Alabama at Birmingham, Birmingham, USA.
| | - Huacong Wen
- Department of Physical Medicine and Rehabilitation, School of Medicine, University of Alabama at Birmingham, Birmingham, USA
| | - Tanvee Sinha
- Department of Physical Medicine and Rehabilitation, School of Medicine, University of Alabama at Birmingham, Birmingham, USA
| | - Drew Davis
- Department of Pediatrics, Division of Pediatric Rehabilitation Medicine, School of Medicine, University of Alabama at Birmingham, Birmingham, USA
| | - Erin Swanson-Kimani
- Department of Pediatrics, Division of Pediatric Rehabilitation Medicine, School of Medicine, University of Alabama at Birmingham, Birmingham, USA
| | - Cynthia Wozow
- Department of Pediatrics, Division of Pediatric Rehabilitation Medicine, School of Medicine, University of Alabama at Birmingham, Birmingham, USA
| | - Raven Young
- Department of Pediatrics, Division of Pediatric Rehabilitation Medicine, School of Medicine, University of Alabama at Birmingham, Birmingham, USA
| | - Danielle Powell
- Department of Physical Medicine and Rehabilitation, School of Medicine, University of Alabama at Birmingham, Birmingham, USA
| | - James H Rimmer
- School of Health Professions, Dean's Office, University of Alabama at Birmingham, Birmingham, USA
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Young HJ, Mehta T, Herman C, Baidwan NK, Lai B, Rimmer JH. The Effects of a Movement-to-Music (M2M) Intervention on Physical and Psychosocial Outcomes in People Poststroke: A Randomized Controlled Trial. Arch Rehabil Res Clin Transl 2021; 3:100160. [PMID: 34977542 PMCID: PMC8683867 DOI: 10.1016/j.arrct.2021.100160] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
OBJECTIVE To investigate the effects of a 12-week movement-to-music (M2M) intervention on physical and psychosocial outcomes in people poststroke. DESIGN Two-arm randomized controlled trial. SETTING A community-based fitness facility. PARTICIPANTS Participants (N=47) with stroke between 18 and 65 years old were randomized to M2M (n=23) or waitlist control (n=24). INTERVENTIONS Participants in M2M completed 3 60-minute exercise sessions per week for 12 weeks. Controls received biweekly educational newsletters via mail. MAIN OUTCOME MEASURES Primary outcomes included Six-Minute Walk Test (6MWT, in meters), Five Times Sit-to-Stand Test (FTSST, in seconds) and Timed Up and Go (TUG, in seconds). Secondary outcomes were self-reported measures using Patient-Reported Outcomes Measurement Information System Fatigue and Pain Interference Short Form 8a. Outcomes were collected at baseline and postintervention. Analyses involved descriptive statistics and adjusted linear mixed models. RESULTS Mixed models adjusted for the respective baseline values and demographic variables showed that M2M participants had longer 6MWT distance (least square mean difference [LSM], 14.5; 95% confidence interval [CI], -12.9 to 42.0), more FTSST time (LSM, 2.0; 95% CI, -4.5 to 8.5), and less fatigue (LSM, -3.0; 95% CI, -7.2 to 1.2) compared with controls postintervention. When controlling for baseline TUG and demographic variables, there was a larger increase in 6MWT distance (LSM, 37.9; 95% CI, -22.7 to 98.6), lower FTSST time (LSM, -6.1; 95% CI, -18.5 to 6.2), and decrease in fatigue (LSM, -6.5; 95% CI, -13.1 to 0.2) in the M2M group compared with controls. Moderate effect sizes were observed for improving 6MWT (d=0.6), FTSST (d=-0.6), and fatigue (d=-0.6). There was no group difference in change in TUG time and pain interference, with trivial effect sizes (d=-0.1). CONCLUSION M2M may be a valuable exercise form for adults with stroke. Future studies are needed to determine optimal exercise doses for improving health and function in this population.
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Key Words
- 6MWT, Six-Minute Walk Test
- AEs, adverse events
- BMI, body mass index
- CI, confidence interval
- Dance
- Exercise
- FTSST, Five Times Sit to Stand Test
- ICC, intraclass correlation coefficient
- LSM, least square means
- M2M, movement-to-music
- MCID, minimally clinically important difference
- PROMIS, Patient-Reported Outcomes Measurement Information System
- Physical performance
- Quality of life
- RPE, Rating of Perceived Exertion
- Rehabilitation
- Stroke
- TUG, Timed Up and Go
- WC, waitlist control
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Affiliation(s)
- Hui-Ju Young
- UAB/Lakeshore Research Collaborative, School of Health Professions, University of Alabama at Birmingham, Birmingham, Alabama, United States
| | - Tapan Mehta
- UAB/Lakeshore Research Collaborative, School of Health Professions, University of Alabama at Birmingham, Birmingham, Alabama, United States
- Department of Health Services Administration, School of Health Professions, University of Alabama at Birmingham, Birmingham, Alabama, United States
| | - Cassandra Herman
- UAB/Lakeshore Research Collaborative, School of Health Professions, University of Alabama at Birmingham, Birmingham, Alabama, United States
| | - Navneet Kaur Baidwan
- Department of Health Services Administration, School of Health Professions, University of Alabama at Birmingham, Birmingham, Alabama, United States
| | - Byron Lai
- UAB/Lakeshore Research Collaborative, School of Health Professions, University of Alabama at Birmingham, Birmingham, Alabama, United States
- Division of Pediatric and Rehabilitation Medicine, School of University of Alabama at Birmingham, Birmingham, Alabama, United States
| | - James H. Rimmer
- UAB/Lakeshore Research Collaborative, School of Health Professions, University of Alabama at Birmingham, Birmingham, Alabama, United States
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Young HJ, Lai B, Mehta T, Thirumalai M, Wilroy J, Yates A, Kane B, Rimmer JH. The movement-to-music (M2M) study: study protocol for a randomized controlled efficacy trial examining a rhythmic teleexercise intervention for people with physical disabilities. Trials 2021; 22:779. [PMID: 34743701 PMCID: PMC8574035 DOI: 10.1186/s13063-021-05751-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2021] [Accepted: 10/25/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND People with physical disabilities need exercise routines that are enjoyable, readily available in the home, adapted to their functional level, and eliminate common barriers to exercise participation related to transportation and time commitment. The purpose of the movement-to-music (M2M) study is to address these issues by establishing a remotely delivered, rhythmic exercise program for people with physical disabilities. METHODS The study is a two-arm randomized controlled efficacy trial examining a 12-week remotely delivered M2M intervention (eM2M) in 108 people with physical disabilities. The primary outcomes are changes in cardiorespiratory fitness and muscle strength at post 12-week intervention. DISCUSSION The eM2M study will enhance our understanding of an alternative intervention design and delivery mode that removes common barriers to exercise participation experienced by people with physical disabilities. The eM2M intervention may be an alternative option for people with physical disabilities to obtain regular exercise, especially during a pandemic when exercising in indoor facilities may be problematic. TRIAL REGISTRATION ClinicalTrials.gov NCT03797378. Registered on January 9, 2019, with the trial name "Movement-to-Music: Lakeshore Examination of Activity, Disability, and Exercise Response Study (M2M LEADERS)".
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Affiliation(s)
- Hui-Ju Young
- UAB/Lakeshore Research Collaborative, School of Health Professions, University of Alabama at Birmingham, Birmingham, AL, USA.
| | - Byron Lai
- UAB/Lakeshore Research Collaborative, School of Health Professions, University of Alabama at Birmingham, Birmingham, AL, USA.,Division of Pediatric and Rehabilitation Medicine, School of Medicine, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Tapan Mehta
- UAB/Lakeshore Research Collaborative, School of Health Professions, University of Alabama at Birmingham, Birmingham, AL, USA.,Department of Health Services Administration, School of Health Professions, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Mohanraj Thirumalai
- UAB/Lakeshore Research Collaborative, School of Health Professions, University of Alabama at Birmingham, Birmingham, AL, USA.,Department of Health Services Administration, School of Health Professions, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Jereme Wilroy
- UAB/Lakeshore Research Collaborative, School of Health Professions, University of Alabama at Birmingham, Birmingham, AL, USA.,Department of Physical Medicine and Rehabilitation, School of Medicine, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Alex Yates
- UAB/Lakeshore Research Collaborative, School of Health Professions, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Brandon Kane
- UAB/Lakeshore Research Collaborative, School of Health Professions, University of Alabama at Birmingham, Birmingham, AL, USA
| | - James H Rimmer
- UAB/Lakeshore Research Collaborative, School of Health Professions, University of Alabama at Birmingham, Birmingham, AL, USA
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Neumeier WH, Guerra N, Hsieh K, Thirumalai M, Ervin D, Rimmer JH. POWERSforID: Personalized online weight and exercise response system for individuals with intellectual disability: A randomized controlled trial. Disabil Health J 2021; 14:101111. [PMID: 33965364 PMCID: PMC8448903 DOI: 10.1016/j.dhjo.2021.101111] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2020] [Revised: 04/19/2021] [Accepted: 04/22/2021] [Indexed: 12/20/2022]
Abstract
BACKGROUND Obesity is associated with early mortality and chronic disease among adults with intellectual disability (ID), yet there is a paucity of effective weight management interventions for this population. OBJECTIVE/HYPOTHESIS This pilot study examined a tailored intervention on weight loss, waist circumference, A1c, and lipid profile among adults with ID. METHODS Obese adults (BMI ≥ 30 kg/m2) with mild to moderate ID were randomized to an intervention (n = 17) or comparison group (n = 18) for a 24-week trial. All participants completed health-related questionnaires and clinic visits. Participants in the intervention group received access to an online weight management platform that assisted them in monitoring their diet and physical activity along with weekly coaching calls (weeks 1-12) that were tapered off to calls every other week (weeks 12-24). The comparison group completed questionnaires and clinic visits, but did not receive access to the online platform or calls. Differences in weight, waist circumference, percent body fat, A1c, lipid profile were assessed at baseline and at week 24. RESULTS The intervention group reduced body weight by an average of 2.7% (-2.6 kg; p = 0.02) and waist circumference by 3.4% (-3.89 cm; p = 0.02) versus the comparison. There were no statistically significant group by time interactions observed among other variables. CONCLUSION Adults with ID who received the intervention were able to maintain or slightly reduce their body weight and waist circumference after the 24-week intervention. Despite not achieving the targeted sample size, the pilot study findings serve as a basis for developing accessible weight management interventions for people with ID.
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Affiliation(s)
- William H Neumeier
- University of Alabama at Birmingham | Lakeshore Foundation Research Collaborative, 331 School of Health Professions Bldg, 1705 University Blvd, Birmingham, AL, 35294-1212, USA.
| | - Nichole Guerra
- The Resource Exchange, 6385 Corporate Drive, Suite 301, Colorado Springs, CO, 80919, USA.
| | - Kelly Hsieh
- University of Illinois at Chicago, Department of Disability and Human Development, 1640 W. Roosevelt Rd., Suite 708, Chicago, IL, 60608, USA.
| | - Mohanraj Thirumalai
- University of Alabama at Birmingham | Lakeshore Foundation Research Collaborative, 331 School of Health Professions Bldg, 1705 University Blvd, Birmingham, AL, 35294-1212, USA
| | - David Ervin
- Jewish Foundation for Group Homes, 1500 East Jefferson Street, Rockville, MD, 20852, USA.
| | - James H Rimmer
- University of Alabama at Birmingham | Lakeshore Foundation Research Collaborative, 331 School of Health Professions Bldg, 1705 University Blvd, Birmingham, AL, 35294-1212, USA.
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Young HJ, Mehta T, Kim Y, Padalabalanarayanan S, Chiu CY, Rimmer JH, Thirumalai M. The Spinal Cord Injury Program in Exercise (SCIPE) study: study protocol for a randomized controlled trial evaluating teleexercise programs for people with spinal cord injury. Trials 2021; 22:551. [PMID: 34412653 PMCID: PMC8377865 DOI: 10.1186/s13063-021-05474-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2020] [Accepted: 07/21/2021] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND Many people with spinal cord injury (SCI) have limited access to tailored, readily available exercise resources. As a result, exercise remains an underutilized treatment strategy for improving health and function in people with SCI. The purpose of this study is to test the effectiveness of two remotely delivered exercise programs for people with SCI. METHODS The Spinal Cord Injury Program in Exercise (SCIPE) study is a three-arm adaptive randomized controlled trial examining two 8-week teleexercise interventions: Movement-to-Music (M2M) and Standard Exercise Training (SET), compared to Attention Control (AC) in 327 adults with SCI. The primary outcome is change in physical activity level at post 8-week intervention. The study contains two interim analyses. The first interim analysis will assess feasibility metrics of the protocol after 36 participants complete the 8-week intervention period. The second interim analysis will examine two effectiveness comparisons: SET vs. AC and M2M vs AC, after 165 participants complete the intervention period. Early termination of the intervention arm(s) will take place when non-significant findings are found in the corresponding intervention(s). Incorporation of such interim analysis enhances trial efficiency by dropping the intervention(s) that deemed ineffective. It provides ethical benefits and allows allocation of additional resources to explore the effective intervention(s). DISCUSSION Delivery of teleexercise programs may be an effective strategy for addressing transportation barrier to exercise resources and increasing physical activity level and quality of life in people with SCI. TRIAL REGISTRATION ClinicalTrials.gov Identifier NCT03925077 . Registered trial name: Spinal Cord Injury Program in Exercise (SCIPE). Registered on April 23rd, 2019.
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Affiliation(s)
- Hui-Ju Young
- UAB/Lakeshore Research Collaborative, School of Health Professions, University of Alabama at Birmingham, Birmingham, AL, USA.
| | - Tapan Mehta
- UAB/Lakeshore Research Collaborative, School of Health Professions, University of Alabama at Birmingham, Birmingham, AL, USA
- Department of Health Services Administration, School of Health Professions, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Yumi Kim
- UAB/Lakeshore Research Collaborative, School of Health Professions, University of Alabama at Birmingham, Birmingham, AL, USA
- Department of Physical Therapy, School of Health Professions, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Sangeetha Padalabalanarayanan
- UAB/Lakeshore Research Collaborative, School of Health Professions, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Chia-Ying Chiu
- Department of Health Services Administration, School of Health Professions, University of Alabama at Birmingham, Birmingham, AL, USA
| | - James H Rimmer
- UAB/Lakeshore Research Collaborative, School of Health Professions, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Mohanraj Thirumalai
- UAB/Lakeshore Research Collaborative, School of Health Professions, University of Alabama at Birmingham, Birmingham, AL, USA
- Department of Health Services Administration, School of Health Professions, University of Alabama at Birmingham, Birmingham, AL, USA
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Lai B, Lee E, Kim Y, Matthews C, Swanson-Kimani E, Davis D, Vogtle L, Rimmer JH. Leisure-time physical activity interventions for children and adults with cerebral palsy: a scoping review. Dev Med Child Neurol 2021; 63:162-171. [PMID: 33241561 DOI: 10.1111/dmcn.14751] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 10/27/2020] [Indexed: 01/08/2023]
Abstract
AIM To summarize current evidence on the effects and reach of leisure-time physical activity (LTPA) interventions among children and adults with cerebral palsy (CP). METHOD Systematic searches were conducted in PubMed, CINAHL, and Google Scholar to identify randomized controlled trials (RCTs) of LTPA interventions in CP. Data from eligible studies were extracted for qualitative synthesis. RESULTS Forty-nine studies enrolled a total of 1513 participants (mean [SD] age 13y [7y], range 5-43y; 818 males, 655 females, 40 not reported) and primarily included ambulatory children. RCTs underrepresented adults and people in Gross Motor Function Classification System (GMFCS) levels IV and V. Forty-one studies reported at least one favorable benefit from LTPA. Benefits included improvements to musculoskeletal strength, cardiorespiratory fitness, quality of life, spasticity, participation, and core aspects of physical function. Regarding reach, only 34% of people that were contacted to participate enrolled within a study. A smaller percentage of participants dropped out from intervention (8%) and follow-up periods (3%). INTERPRETATION Study findings highlight effective interventions to improve health, fitness, and function. To enhance the reach and generalizability of LTPA trials for CP, future studies should examine how to increase study sample sizes and aim to include a better representation of adults and people in GMFCS levels IV and V. WHAT THIS PAPER ADDS People with cerebral palsy (CP) may experience improvements in health, fitness, and physical function from leisure-time physical activity (LTPA) interventions. Effective interventions include exercise training, active video games, recreation activities, behavioral coaching, and motor skills training. Interventions that incorporate telehealth technology, behavioral coaching, and community resources may enhance LTPA. Interventions primarily include children in Gross Motor Functional Classification System (GMFCS) levels I to III. Adults, wheelchair users, and those in GMFCS levels IV and V are underrepresented.
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Affiliation(s)
- Byron Lai
- Division of Pediatric Rehabilitation Medicine, School of Medicine, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Eunbi Lee
- The Rehabilitation Science Program, School of Health Professions, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Yumi Kim
- The Rehabilitation Science Program, School of Health Professions, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Coke Matthews
- Department of Mechanical and Aerospace Engineering, University of Virginia, Charlottesville, VI, USA
| | - Erin Swanson-Kimani
- Division of Pediatric Rehabilitation Medicine, School of Medicine, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Drew Davis
- Division of Pediatric Rehabilitation Medicine, School of Medicine, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Laura Vogtle
- Department of Occupational Therapy, School of Health Professions, University of Alabama at Birmingham, Birmingham, AL, USA
| | - James H Rimmer
- School of Health Professions, Dean's Office, University of Alabama at Birmingham, Birmingham, AL, USA
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21
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Lai B, Davis D, Narasaki-Jara M, Hopson B, Powell D, Gowey M, Rocque BG, Rimmer JH. Feasibility of a Commercially Available Virtual Reality System to Achieve Exercise Guidelines in Youth With Spina Bifida: Mixed Methods Case Study. JMIR Serious Games 2020; 8:e20667. [PMID: 32880577 PMCID: PMC7499165 DOI: 10.2196/20667] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2020] [Revised: 07/20/2020] [Accepted: 08/11/2020] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Access to physical activity among youth with spina bifida (SB) is much lower than it is for children without disability. Enjoyable home-based exercise programs are greatly needed. OBJECTIVE Our objective is to examine the feasibility of a virtual reality (VR) active video gaming system (ie, bundle of consumer-available equipment) to meet US physical activity guidelines in two youth with SB. METHODS Two youth with SB-a 12-year-old female and a 13-year-old male; both full-time wheelchair users-participated in a brief, 4-week exercise program using a popular VR head-mounted display: Oculus Quest (Facebook Technologies). The system included a Polar H10 (Polar Canada) Bluetooth heart rate monitor, a no-cost mobile phone app (VR Health Exercise Tracker [Virtual Reality Institute of Health and Exercise]), and 13 games. The intervention protocol was conducted entirely in the homes of the participants due to the coronavirus disease 2019 (COVID-19) pandemic. The VR system was shipped to participants and they were instructed to do their best to complete 60 minutes of moderate-intensity VR exercise per day. Exercise duration, intensity, and calories expended were objectively monitored and recorded during exercise using the heart rate monitor and a mobile app. Fatigue and depression were measured via self-report questionnaires at pre- and postintervention. Participants underwent a semistructured interview with research staff at postintervention. RESULTS Across the intervention period, the total average minutes of all exercise performed each week for participants 1 and 2 were 281 (SD 93) and 262 (SD 55) minutes, respectively. The total average minutes of moderate-intensity exercise performed per week for participants 1 and 2 were 184 (SD 103) (184/281, 65.4%) and 215 (SD 90) (215/262, 82.1%) minutes, respectively. One participant had a reduction in their depression score, using the Quality of Life in Neurological Disorders (Neuro-QoL) test, from baseline to postintervention, but no other changes were observed for fatigue and depression scores. Participants reported that the amount of exercise they completed was far higher than what was objectively recorded, due to usability issues with the chest-worn heart rate monitor. Participants noted that they were motivated to exercise due to the enjoyment of the games and VR headset as well as support from a caregiver. CONCLUSIONS This study demonstrated that two youth with SB who used wheelchairs could use a VR system to independently and safely achieve exercise guidelines at home. Study findings identified a promising protocol for promoting exercise in this population and this warrants further examination in future studies with larger samples.
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Affiliation(s)
- Byron Lai
- Division of Pediatric Rehabilitation Medicine, School of Medicine, University of Alabama at Birmingham, Birmingham, AL, United States
| | - Drew Davis
- Division of Pediatric Rehabilitation Medicine, School of Medicine, University of Alabama at Birmingham, Birmingham, AL, United States
| | - Mai Narasaki-Jara
- Department of Kinesiology, California Polytechnic State University Pomona, Pomona, CA, United States
| | - Betsy Hopson
- Division of Pediatric Neurosurgery, School of Medicine, University of Alabama at Birmingham, Birmingham, AL, United States
| | - Danielle Powell
- Department of Physical Medicine and Rehabilitation, School of Medicine, University of Alabama at Birmingham, Birmingham, AL, United States
| | - Marissa Gowey
- Division of Pediatric Gastroenterology, Hepatology, and Nutrition, School of Medicine, University of Alabama at Birmingham, Birmingham, AL, United States
| | - Brandon G Rocque
- Division of Pediatric Neurosurgery, School of Medicine, University of Alabama at Birmingham, Birmingham, AL, United States
| | - James H Rimmer
- Dean's Office, School of Health Professions, University of Alabama at Birmingham, Birmingham, AL, United States
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Lai BW, Rimmer JH, Yates A, Jeter A, Young HJ, Thirumalai M, Mehta T, Wilroy J. Critical factors influencing the decision to enroll in a physical activity intervention among a predominant group of adults with spinal cord injury: a grounded theory study. Spinal Cord 2020; 59:17-25. [PMID: 32747672 PMCID: PMC7397960 DOI: 10.1038/s41393-020-0530-7] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2020] [Revised: 07/17/2020] [Accepted: 07/20/2020] [Indexed: 11/09/2022]
Abstract
Study design Grounded theory qualitative approach. Objectives To examine critical factors associated with interest in enrolling in a physical activity (PA) research intervention among a predominant group of adults with spinal cord injury (SCI) and develop a theory that can enhance future recruitment success. Setting Participants were recruited through the network of a community exercise facility for people with physical disabilities. Methods Interviews were conducted with 22 wheelchair users (mean age 46 ± 13 years; SCI [n = 19], cerebral palsy [n = 1]; multiple sclerosis [n = 1]; and bilateral limb loss [n = 1]) in either a one-on-one format or focus group. Interview data were coded, and these codes were organized into conceptual categories using a constructivist grounded theory framework. Results Adults with SCI conceive three core concerns with enrolling into a PA trial: (1) capability to participate in the program due to scheduling, transportation, and secondary health conditions; (2) mental balancing of anticipated benefits versus the difficulty of starting the program; and (3) desirability of the program characteristics based on their preferences and needs. Concerns were organized into a theory that may enhance future recruitment success. Conclusions Recruitment is often overlooked in PA research for people with SCI despite it being a primary rate-limiting factor that severely limits the external validity of published studies. Study findings identified core recruitment concerns that are likely similar with general barriers to PA participation. This paper proposed a 3-step decision-making process that can serve as a starting point for overcoming recruitment issues in PA research with people with SCI.
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Affiliation(s)
- Byron W Lai
- Division of Pediatric Rehabilitation Medicine, University of Alabama at Birmingham/Lakeshore Foundation Research Collaborative, Birmingham, AL, USA. .,Lakeshore Foundation, University of Alabama at Birmingham/Lakeshore Foundation Research Collaborative, Homewood, AL, USA.
| | - James H Rimmer
- Lakeshore Foundation, University of Alabama at Birmingham/Lakeshore Foundation Research Collaborative, Homewood, AL, USA.,Dean's Office, University of Alabama at Birmingham/Lakeshore Foundation Research Collaborative, Birmingham, AL, USA
| | - Alex Yates
- Lakeshore Foundation, University of Alabama at Birmingham/Lakeshore Foundation Research Collaborative, Homewood, AL, USA
| | - Amanda Jeter
- Lakeshore Foundation, University of Alabama at Birmingham/Lakeshore Foundation Research Collaborative, Homewood, AL, USA
| | - Hui-Ju Young
- Department of Physical Therapy, University of Alabama at Birmingham/Lakeshore Foundation Research Collaborative, Birmingham, AL, USA
| | - Mohanraj Thirumalai
- Department of Health Services Administration, University of Alabama at Birmingham/Lakeshore Foundation Research Collaborative, Birmingham, AL, USA
| | - Tapan Mehta
- Department of Health Services Administration, University of Alabama at Birmingham/Lakeshore Foundation Research Collaborative, Birmingham, AL, USA
| | - Jereme Wilroy
- Department of Physical Medicine and Rehabilitation, University of Alabama at Birmingham/Lakeshore Foundation Research Collaborative, Birmingham, AL, USA
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23
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Wilroy JD, Lai B, Davlyatov G, Mehta T, Thirumalai M, Rimmer JH. Correlates of adherence in a home-based, self-managed exercise program tailored to wheelchair users with spinal cord injury. Spinal Cord 2020; 59:55-62. [PMID: 32541883 DOI: 10.1038/s41393-020-0497-4] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2020] [Revised: 05/22/2020] [Accepted: 05/26/2020] [Indexed: 11/09/2022]
Abstract
STUDY DESIGN Cross-sectional design. OBJECTIVES To examine personal factors, secondary health conditions, and environmental factors as potential correlates of adherence to a 12-week home-based exercise trial in people with spinal cord injury. SETTING Home METHODS: Participants (n = 28) were prescribed a set of exercise videos that they were asked to complete three times each week for 12 weeks (36 total sessions). The videos were accessible through a custom-designed mobile application and included movements targeting strength, cardiorespiratory fitness, and balance that were accompanied with music. Watched video minutes were automatically recorded on the web-based platform. At baseline, participants completed self-report questionnaires that measured personal (e.g., age, self-efficacy) and environmental (e.g., barriers) factors and secondary health conditions (e.g., depression). Data were analyzed using quantile (median) regression analysis. RESULTS Race (African American; β = -65.62, p = 0.004), community barriers (β = -9.12, p = 0.026), anxiety (β = -3.84, p = <0.001), depression (β = -1.42, p = 0.038), physical function (β = -1.35, p = 0.048), and self-efficacy (β = -0.61, p = 0.007) were associated with a lower number of exercise video minutes. Pain intensity (β = 2.03, p = 0.032), pain interference (β = 1.84, p = 0.012), and age (β = 1.13, p = 0.013) were associated with a higher number of exercise video minutes. Total variance explained by the model was 77% (pseudo R2 = 0.77). CONCLUSIONS Factors associated with lower and higher adherence to home-based exercise should guide future research efforts in creating more precision-based approaches for self-managed home exercise.
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Affiliation(s)
- Jereme D Wilroy
- School of Medicine, University of Alabama at Birmingham, Birmingham, AL, 35233, USA.
| | - Byron Lai
- Division of Pediatric Rehabilitation Medicine, Children's of Alabama Hospital, Birmingham, AL, 35233, USA
| | - Ganisher Davlyatov
- School of Health Professions, University of Alabama at Birmingham, Birmingham, AL, 35233, USA
| | - Tapan Mehta
- School of Health Professions, University of Alabama at Birmingham, Birmingham, AL, 35233, USA
| | - Mohanraj Thirumalai
- School of Health Professions, University of Alabama at Birmingham, Birmingham, AL, 35233, USA
| | - James H Rimmer
- School of Health Professions, University of Alabama at Birmingham, Birmingham, AL, 35233, USA
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24
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Carroll NW, Hall AG, Feldman S, Thirumalai M, Wade JT, Rimmer JH. Enhancing Transitions From Rehabilitation Patient to Wellness Participant for People With Disabilities: An Opportunity for Hospital Community Benefit. Front Public Health 2020; 8:105. [PMID: 32322569 PMCID: PMC7156537 DOI: 10.3389/fpubh.2020.00105] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2019] [Accepted: 03/17/2020] [Indexed: 11/13/2022] Open
Abstract
Pressure is increasing on not-for-profit hospitals to demonstrate that they provide sufficient benefit to the community to justify their tax-exempt status. Many industry observers have suggested that this community benefit should address unmet medical needs within the community, deficits in the social determinants of health, or health disparities within communities. We argue that one area of clear unmet need is assistance in helping bridge the transition that people with disabilities (PWD) must make from rehabilitation patient to wellness participant. Programs to bridge this transition are necessary because many PWD struggle to identify strategies to maintain and maximize their own well-being after discharge from the healthcare system. As a result, PWD have worse health outcomes than non-disabled individuals. To address these needs, we propose hospitals take a leading role in establishing new, community-based efforts to provide PWD with benefits that will support their effort to self-manage health. Hospitals are well-suited to lead the creation of these programs because of the important role they play in providing services to PWD and because of their ability to bring together multiple stakeholders required to make supportive programs sustainable.
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Affiliation(s)
- Nathan W Carroll
- Department of Health Services Administration, University of Alabama at Birmingham, Birmingham, AL, United States.,School of Health Professions, University of Alabama at Birmingham, Birmingham, AL, United States
| | - Allyson G Hall
- Department of Health Services Administration, University of Alabama at Birmingham, Birmingham, AL, United States.,School of Health Professions, University of Alabama at Birmingham, Birmingham, AL, United States
| | - Sue Feldman
- Department of Health Services Administration, University of Alabama at Birmingham, Birmingham, AL, United States.,School of Health Professions, University of Alabama at Birmingham, Birmingham, AL, United States
| | - Mohanraj Thirumalai
- Department of Health Services Administration, University of Alabama at Birmingham, Birmingham, AL, United States.,School of Health Professions, University of Alabama at Birmingham, Birmingham, AL, United States
| | - Jamie Tinker Wade
- Spain Rehabilitation Center, University of Alabama at Birmingham Hospital, Birmingham, AL, United States
| | - James H Rimmer
- School of Health Professions, University of Alabama at Birmingham, Birmingham, AL, United States
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25
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Wingo BC, Yang D, Davis D, Padalabalanarayanan S, Hopson B, Thirumalai M, Rimmer JH. Lessons learned from a blended telephone/e-health platform for caregivers in promoting physical activity and nutrition in children with a mobility disability. Disabil Health J 2020; 13:100826. [PMID: 31416771 PMCID: PMC6901757 DOI: 10.1016/j.dhjo.2019.100826] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2019] [Revised: 07/16/2019] [Accepted: 07/26/2019] [Indexed: 11/18/2022]
Abstract
BACKGROUND Children with physical disabilities report higher rates of sedentary lifestyle and unhealthy dietary patterns than non-disabled peers. These behaviors can increase comorbidities, caregiver burden, and healthcare costs. Innovative interventions are needed to assist caregivers of children with physical disabilities improve health behaviors. OBJECTIVE /Hypothesis: The purpose of this pilot study was to test the usability and preliminary efficacy of an e-health and telecoaching intervention compared to telecoaching alone. METHODS Parent/child dyads (n = 65) were randomized into either the e-health and telephone group (e-HT) or the telephone only group (TO). All participants received regular calls from a telecoach, and the e-HT group received access to a website with personalized weekly goals for diet and physical activity, and access to resources to meet these goals. At the conclusion of the intervention, participants in the e-HT group were asked to complete a semi-structured interview to discuss the usability of the e-health platform. RESULTS Fifty of the 65 randomized dyads (77%) completed all baseline measures and had at least one intervention call. Forty families (80% of those that started the intervention) completed the study (50% spina bifida, 24% mobility limitation, diagnosis not reported). Age of the children ranged from 6 to 17 years old. Both groups had high adherence to scheduled phone calls (e-HT (n = 17): 81%, TO (n = 23): 86%); however no significant differences in dietary intake or physical activity were seen within or between groups. Primary themes to emerge from qualitative interviewers were: the platform should target children rather than parents, parents valued the calls more than the website, and schools need to be involved in interventions. CONCLUSIONS E-health interventions are a promising way to promote healthy behaviors in children with physical disability, but technology must be balanced with ease of use for parents while also engaging the child.
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Affiliation(s)
- Brooks C Wingo
- Department of Occupational Therapy, University of Alabama at Birmingham, SHPB 353, 1720 2nd, Ave South, Birmingham, AL, 35294, USA; UAB/Lakeshore Research Collaborative, SHPB 331, 1720 2nd Ave South, Birmingham, AL, 35294, USA.
| | - Dershung Yang
- BrightOutcome, Inc, 1110 Lake Cook Road, Suite 167, Buffalo Grove, IL, 60089, USA.
| | - Drew Davis
- University of Alabama at Birmingham, Department of Pediatrics, Division of Pediatric Rehabilitation Medicine, Dearth Tower, 5601 McWane, 1600 7th Ave South, Birmingham, AL, 35233-1711, USA.
| | | | - Betsy Hopson
- University of Alabama at Birmingham, Department of Pediatrics, Division of Pediatric Rehabilitation Medicine, Dearth Tower, 5601 McWane, 1600 7th Ave South, Birmingham, AL, 35233-1711, USA.
| | - Mohanraj Thirumalai
- UAB/Lakeshore Research Collaborative, SHPB 331, 1720 2nd Ave South, Birmingham, AL, 35294, USA; Department of Health Services Administration, University of Alabama at Birmingham, SHPB 590E, 1720 2nd, Ave South, Birmingham, AL, 35294, USA.
| | - James H Rimmer
- UAB/Lakeshore Research Collaborative, SHPB 331, 1720 2nd Ave South, Birmingham, AL, 35294, USA.
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Guerra N, Neumeier WH, Breslin L, Geer B, Thirumalai M, Ervin DA, Rimmer JH. Feedback and Strategies From People With Intellectual Disability Completing a Personalized Online Weight Loss Intervention: A Qualitative Analysis. Intellect Dev Disabil 2019; 57:527-544. [PMID: 31751170 PMCID: PMC9105760 DOI: 10.1352/1934-9556-57.6.527] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
Coaching log notes for 15 participants from a 24-week blended online and telehealth randomized controlled trial were analyzed using thematic analysis and analyst triangulation to determine the factors that facilitated participant adherence to weight loss strategies, use of technology, and motivational interviewing. Several participants reported that restricting processed carbohydrates, limiting portion size, and maintaining healthy substitutions were effective nutritional strategies. Participants were less successful with adherence to their exercise goals, often due to time constraints and a lack of support. Results suggested consistent caregiver support improved participants' adherence to weight loss strategies and use of technology. Future programs should address obesity among people with intellectual and developmental disabilities by offering a range of interventions that are customized to their specific weight loss needs.
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Affiliation(s)
- Nichole Guerra
- Nichole Guerra, The Resource Exchange; William H. Neumeier, University of Alabama at Birmingham and Lakeshore Foundation; Lauren Breslin, Mayo Clinic Alix School of Medicine; Betty Geer, The Resource Exchange; Mohanraj Thirumalai, University of Alabama at Birmingham; David A. Ervin, Jewish Foundation for Group Homes, Inc.; and James H. Rimmer, University of Alabama at Birmingham and The Lakeshore Foundation
| | - William H Neumeier
- Nichole Guerra, The Resource Exchange; William H. Neumeier, University of Alabama at Birmingham and Lakeshore Foundation; Lauren Breslin, Mayo Clinic Alix School of Medicine; Betty Geer, The Resource Exchange; Mohanraj Thirumalai, University of Alabama at Birmingham; David A. Ervin, Jewish Foundation for Group Homes, Inc.; and James H. Rimmer, University of Alabama at Birmingham and The Lakeshore Foundation
| | - Lauren Breslin
- Nichole Guerra, The Resource Exchange; William H. Neumeier, University of Alabama at Birmingham and Lakeshore Foundation; Lauren Breslin, Mayo Clinic Alix School of Medicine; Betty Geer, The Resource Exchange; Mohanraj Thirumalai, University of Alabama at Birmingham; David A. Ervin, Jewish Foundation for Group Homes, Inc.; and James H. Rimmer, University of Alabama at Birmingham and The Lakeshore Foundation
| | - Betty Geer
- Nichole Guerra, The Resource Exchange; William H. Neumeier, University of Alabama at Birmingham and Lakeshore Foundation; Lauren Breslin, Mayo Clinic Alix School of Medicine; Betty Geer, The Resource Exchange; Mohanraj Thirumalai, University of Alabama at Birmingham; David A. Ervin, Jewish Foundation for Group Homes, Inc.; and James H. Rimmer, University of Alabama at Birmingham and The Lakeshore Foundation
| | - Mohanraj Thirumalai
- Nichole Guerra, The Resource Exchange; William H. Neumeier, University of Alabama at Birmingham and Lakeshore Foundation; Lauren Breslin, Mayo Clinic Alix School of Medicine; Betty Geer, The Resource Exchange; Mohanraj Thirumalai, University of Alabama at Birmingham; David A. Ervin, Jewish Foundation for Group Homes, Inc.; and James H. Rimmer, University of Alabama at Birmingham and The Lakeshore Foundation
| | - David A Ervin
- Nichole Guerra, The Resource Exchange; William H. Neumeier, University of Alabama at Birmingham and Lakeshore Foundation; Lauren Breslin, Mayo Clinic Alix School of Medicine; Betty Geer, The Resource Exchange; Mohanraj Thirumalai, University of Alabama at Birmingham; David A. Ervin, Jewish Foundation for Group Homes, Inc.; and James H. Rimmer, University of Alabama at Birmingham and The Lakeshore Foundation
| | - James H Rimmer
- Nichole Guerra, The Resource Exchange; William H. Neumeier, University of Alabama at Birmingham and Lakeshore Foundation; Lauren Breslin, Mayo Clinic Alix School of Medicine; Betty Geer, The Resource Exchange; Mohanraj Thirumalai, University of Alabama at Birmingham; David A. Ervin, Jewish Foundation for Group Homes, Inc.; and James H. Rimmer, University of Alabama at Birmingham and The Lakeshore Foundation
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Wilroy JD, Martin Ginis KA, Rimmer JH, Wen H, Howell J, Lai B. An E-Learning Program for Increasing Physical Activity Associated Behaviors Among People with Spinal Cord Injury: Usability Study. JMIR Form Res 2019; 3:e14788. [PMID: 31436161 PMCID: PMC6724499 DOI: 10.2196/14788] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2019] [Revised: 07/16/2019] [Accepted: 07/17/2019] [Indexed: 11/25/2022] Open
Abstract
Background The majority of people with spinal cord injury (SCI) in the United States are not meeting the recommended guidelines for regular physical activity. Behavior change techniques (eg, goal setting and action planning) that are framed within the principles of the social cognitive theory (self-efficacy and self-regulation) have the potential to enhance physical activity behavior. Objective The aim of the study was to develop and test the usability of an electronic learning (e-learning) program for improving social cognitive factors related to physical activity behavior among people with SCI. Methods The program was created through an iterative process of development and refinement, using a modification of a similar methodology used to develop evidence-informed guidelines in health promotion for people with disabilities (Guidelines, Recommendations, and Adaptations Including Disability; GRAIDs framework). The study included 4 phases: (1) initial product creation, (2) national survey, (3) expert review, and (4) usability testing. Usability testing included both quantitative and qualitative data collection and analyses. Results The review of the program by an expert panel (n=5) and the results from a national survey (n=142) led to several refinements. Usability testing demonstrated that the program could be completed in a timely manner (<30 min). Participants reported 5 themes: (1) the program improves social cognitions related to physical activity participation; (2) reflection of physical activity behavior; (3) positive perceptions of the quality of the program; (4) positive perceptions of the program operation and effectiveness; and (5) recommendations for improvement. Each item was incorporated into a revised program version 1.0. Conclusions This study incorporated an evidence-based framework for developing a brief 30-min e-learning program for increasing the physical activity behavior among people with SCI. The Exercise Strategies Through Optimized Relevant Interactive E-learning Storytelling (e-STORIES) program could be completed in a timely manner and was reported by participants as valuable and useful for enhancing intent-to-perform physical activity in individuals with SCI. The program has the potential to be applied in a variety of settings, but feasibility testing is required before implementing in a larger trial.
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Affiliation(s)
- Jereme D Wilroy
- Department of Physical Medicine & Rehabilitation, University of Alabama at Birmingham, Birmingham, AL, United States.,UAB/Lakeshore Research Collaborative, School of Health Professions, University of Alabama at Birmingham, Birmingham, AL, United States
| | - Kathleen A Martin Ginis
- Department of Medicine, Division of Physical Medicine & Rehabilitation, University of British Columbia, Vancouver, BC, Canada.,School of Health & Exercise Sciences, University of British Columbia, Kelowna, BC, Canada.,International Collaboration on Repair Discoveries, University of British Columbia, Vancouver, BC, Canada.,Centre for Chronic Disease Prevention and Management, University of British Columbia, Kelowna, BC, Canada
| | - James H Rimmer
- UAB/Lakeshore Research Collaborative, School of Health Professions, University of Alabama at Birmingham, Birmingham, AL, United States
| | - Huacong Wen
- Department of Physical Medicine & Rehabilitation, University of Alabama at Birmingham, Birmingham, AL, United States.,Department of Physical Therapy, School of Health Professions, University of Alabama at Birmingham, Birmingham, AL, United States
| | - Jennifer Howell
- UAB/Lakeshore Research Collaborative, School of Health Professions, University of Alabama at Birmingham, Birmingham, AL, United States
| | - Byron Lai
- UAB/Lakeshore Research Collaborative, School of Health Professions, University of Alabama at Birmingham, Birmingham, AL, United States
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Kim Y, Lai B, Mehta T, Thirumalai M, Padalabalanarayanan S, Rimmer JH, Motl RW. Exercise Training Guidelines for Multiple Sclerosis, Stroke, and Parkinson Disease: Rapid Review and Synthesis. Am J Phys Med Rehabil 2019; 98:613-621. [PMID: 30844920 PMCID: PMC6586489 DOI: 10.1097/phm.0000000000001174] [Citation(s) in RCA: 105] [Impact Index Per Article: 21.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
The translation of knowledge from exercise training research into the clinical management of multiple sclerosis, stroke, and Parkinson disease requires evidence-based guidelines that are uniformly recognizable by healthcare practitioners and patients/clients. This article synthesized resources that reported aerobic and resistance training guidelines for people with multiple sclerosis, stroke, and Parkinson disease. Systematic searches yielded 25 eligible resources from electronic databases and Web sites or textbooks of major organizations. Data were extracted (exercise frequency, intensity, time, and type) and synthesized into three sets of recommendations. Exercise guidelines for multiple sclerosis consistently recommended 2-3 d/wk of aerobic training (10-30 mins at moderate intensity) and 2-3 d/wk of resistance training (1-3 sets between 8 and 15 repetition maximum). Exercise guidelines for stroke recommended 3-5 d/wk of aerobic training (20-40 mins at moderate intensity) and 2-3 d/wk of resistance training (1-3 sets of 8-15 repetitions between 30% and 50% 1 repetition maximum). Exercise guidelines for Parkinson disease recommended 3-5 d/wk of aerobic training (20-60 mins at moderate intensity) and 2-3 d/wk of resistance training (1-3 sets of 8-12 repetitions between 40% and 50% of 1 repetition maximum). This harmonization of exercise guidelines provides a prescriptive basis for healthcare providers, exercise professionals, and people with multiple sclerosis, stroke, and Parkinson disease regarding exercise programming.
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Affiliation(s)
- Yumi Kim
- Rehabilitation Science, School of Health Professions, University of Alabama at Birmingham, Birmingham, AL, USA
- University of Alabama at Birmingham/Lakeshore Foundation Research Collaborative, Birmingham, AL, USA
| | - Byron Lai
- Department of Physical Therapy, School of Health Professions, University of Alabama at Birmingham, Birmingham, AL, USA
- University of Alabama at Birmingham/Lakeshore Foundation Research Collaborative, Birmingham, AL, USA
| | - Tapan Mehta
- Department of Health Services Administration, School of Health Professions, University of Alabama at Birmingham, Birmingham, AL, USA
- University of Alabama at Birmingham/Lakeshore Foundation Research Collaborative, Birmingham, AL, USA
| | - Mohanraj Thirumalai
- Department of Health Services Administration, School of Health Professions, University of Alabama at Birmingham, Birmingham, AL, USA
- University of Alabama at Birmingham/Lakeshore Foundation Research Collaborative, Birmingham, AL, USA
| | | | - James H. Rimmer
- University of Alabama at Birmingham/Lakeshore Foundation Research Collaborative, Birmingham, AL, USA
| | - Robert W. Motl
- Department of Physical Therapy, School of Health Professions, University of Alabama at Birmingham, Birmingham, AL, USA
- University of Alabama at Birmingham/Lakeshore Foundation Research Collaborative, Birmingham, AL, USA
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Graham K, Yarar-Fisher C, Li J, McCully KM, Rimmer JH, Powell D, Bickel CS, Fisher G. Effects of High-Intensity Interval Training Versus Moderate-Intensity Training on Cardiometabolic Health Markers in Individuals With Spinal Cord Injury: A Pilot Study. Top Spinal Cord Inj Rehabil 2019; 25:248-259. [PMID: 31548792 PMCID: PMC6743747 DOI: 10.1310/sci19-00042] [Citation(s) in RCA: 27] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
Background: Recent studies in nondisabled individuals have demonstrated that low-volume high-intensity interval training (HIIT) can improve cardiometabolic health similar to moderate-intensity training (MIT) despite requiring 20% of the overall time commitment. To date, there have been no studies assessing the effects of HIIT for improving cardiometabolic health in individuals with SCI. Objectives: The primary purpose of this pilot study was to compare the effects of 6 weeks of low-volume HIIT vs MIT using arm crank ergometer exercise to improve body composition, cardiovascular fitness, glucose tolerance, blood lipids, and blood pressure in a cohort of individuals with longstanding SCI. Methods: Participants were randomized to 6 weeks of HIIT or MIT arm crank exercise training. Aerobic capacity, muscular strength, blood lipids, glucose tolerance, blood pressure, and body composition were assessed at baseline and 6 weeks post training. Results: Seven individuals (6 male, 1 female; n = 3 in MIT and n = 4 in HIIT; mean age 51.3 ± 10.5 years) with longstanding SCI completed the study. The preliminary findings from this pilot study demonstrated that individuals with SCI randomized to either 6 weeks of HIIT or MIT displayed improvements in (a) insulin sensitivity, (b) cardiovascular fitness, and (c) muscular strength (p < .05). However, MIT led to greater improvements in arm fat percent and chest press strength compared to HIIT (p < .05). Conclusion: No differences between MIT and HIIT were observed. Both conditions led to improvements in insulin sensitivity, aerobic capacity, muscle strength, and blood lipids in individuals with SCI. Future larger cohort studies are needed to determine if the shorter amount of time required from HIIT is preferable to current MIT exercise recommendations.
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Affiliation(s)
- Kyle Graham
- Department of Human Studies, University of Alabama at Birmingham, Birmingham, Alabama
| | - Ceren Yarar-Fisher
- Department of Physical Medicine and Rehabilitation Science, University of Alabama at Birmingham, Birmingham, Alabama
| | - Jia Li
- Department of Physical Medicine and Rehabilitation Science, University of Alabama at Birmingham, Birmingham, Alabama
| | - Kevin M McCully
- Department of Kinesiology, University of Georgia, Athens, Georgia
| | - James H Rimmer
- UAB/Lakeshore Foundation Research Collaborative, Birmingham, Alabama
| | - Danille Powell
- Department of Physical Medicine and Rehabilitation Science, University of Alabama at Birmingham, Birmingham, Alabama
| | - C Scott Bickel
- Department of Physical Therapy, Samford University, Birmingham, Alabama
| | - Gordon Fisher
- Department of Human Studies, University of Alabama at Birmingham, Birmingham, Alabama
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Affiliation(s)
- James H. Rimmer
- Center on Health Promotion Research for Persons with Disabilities, director, National Center on Physical Activity and Disability, Department of Disability and Human Development, University of Illinois at Chicago, 1640 West Roosevelt Road, Chicago, IL 60608
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Rimmer JH, Mehta T, Wilroy J, Lai B, Young HJ, Kim Y, Pekmezi D, Thirumalai M. Rationale and design of a Scale-Up Project Evaluating Responsiveness to Home Exercise And Lifestyle Tele-Health (SUPER-HEALTH) in people with physical/mobility disabilities: a type 1 hybrid design effectiveness trial. BMJ Open 2019; 9:e023538. [PMID: 30928927 PMCID: PMC6475257 DOI: 10.1136/bmjopen-2018-023538] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Abstract
INTRODUCTION Rates of physical inactivity among people with physical disabilities are substantially higher than in the general population and access to home-based tailored exercise programmes is almost non-existent. Using a theory-driven eHealth platform, an innovative exercise programme referred to as movement-to-music (M2M) will be delivered as a customised, home-based exercise intervention for adults with mobility disabilities. METHODS AND ANALYSIS Participants are being recruited for this type 1 hybrid design based effectiveness trial through outpatient clinics at a large rehabilitation centre and randomised to one of three groups: (1) M2M, (2) M2M plus social networking (M2Mplus) and (3) attention control (AC). The intervention includes a 12-week adoption phase, 12-week transition phase and 24-week maintenance phase, at which the collection of objective measures on exercise, fitness and self-reported measures on health will be obtained at the start of each phase and at follow-up. The study compares the effectiveness of M2M and M2Mplus in increasing physical activity (primary outcome), adherence, fitness and physical functioning compared with the AC group and examines the mediators and moderators of the treatment effect. ETHICS AND DISSEMINATION The Institutional Review Board of The University of Alabama at Birmingham granted full approval: (IRB-160923002). Dissemination of findings will include publication in peer-reviewed journals, presentations at regional, national and/or international meetings, and the National Center on Health, Physical Activity and Disability (NCHPAD, www.nchpad.org). This study will strengthen our understanding of the potential benefits of eHealth exercise interventions for people with physical disabilities and build on strategies that aim to recruit larger samples in exercise trials. TRIAL REGISTRATION NUMBER NCT03024320; Pre-results.
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Affiliation(s)
- James H Rimmer
- UAB/Lakeshore Research Collaborative, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Tapan Mehta
- Department of Health Services Administration, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Jereme Wilroy
- UAB/Lakeshore Research Collaborative, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Byron Lai
- UAB/Lakeshore Research Collaborative, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Hui-Ju Young
- UAB/Lakeshore Research Collaborative, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Yumi Kim
- UAB/Lakeshore Research Collaborative, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Dorothy Pekmezi
- Department of Health Behavior, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Mohanraj Thirumalai
- Department of Health Services Administration, University of Alabama at Birmingham, Birmingham, Alabama, USA
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Lai B, Wilroy J, Young HJ, Howell J, Rimmer JH, Mehta T, Thirumalai M. A Mobile App to Promote Adapted Exercise and Social Networking for People With Physical Disabilities: Usability Study. JMIR Form Res 2019; 3:e11689. [PMID: 30888325 PMCID: PMC6444218 DOI: 10.2196/11689] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2018] [Revised: 10/31/2018] [Accepted: 12/09/2018] [Indexed: 12/16/2022] Open
Abstract
BACKGROUND People with physical disabilities (PWD) experience several unique challenges that prevent them from participating in onsite exercise programs. Although mobile apps can provide a ubiquitous channel for delivering convenient exercise services within the community, no exercise apps have been designed for people with disabilities who experience certain functional limitations. OBJECTIVE The aim of this study was to examine the usability of a mobile exercise app in PWD. METHODS A sequential explanatory mixed-method design was used to holistically test usability in 4 core areas: effectiveness (ie, ease of use), efficiency (ie, operation speed), perceived satisfaction, and usefulness. Participants completed 7 face-to-face usability tasks and 1 structured interview. Equipment included a computer tablet that came preinstalled with the exercise app. The app included exercise videos that focused on several components of fitness: aerobic capacity, muscular strength, functional strength or balance, and range of motion. The app contained 3 different versions of the exercise program: (1) a program for people with the ability to use the upper and lower limbs, (2) a seated program for people with the ability to use only upper limbs, and (3) a program designed for people with hemiparesis. The app also included educational resources in the form of infographics aimed at addressing key social cognitive theory constructs included social support, outcome expectancies, self-efficacy, and barriers or facilitators to exercising. Participant characteristics and quantitative usability data were descriptively reported. Qualitative data were analyzed using thematic analysis. RESULTS A total of 12 PWD tested the usability of the exercise app and completed 96% (69/72) of the usability tasks on the first attempt. Operation speed varied among users, which prompted the development team to make minor revisions to the app. Qualitative results demonstrated 3 overarching themes: facilitates exercise adoption, positive experiences of videos, and easy to learn. Participants noted that the app circumvented several barriers to exercise associated with leaving the home (eg, inclement weather conditions, exacerbations of health conditions or disability symptoms, difficulties with transportation, and social support). CONCLUSIONS The mobile exercise app provided a simple platform that was effective, useful, and appreciated by PWD. Participants also perceived the app as easy to use and felt it was a valuable tool for assisting PWD to obtain regular exercise. Study findings also offered insight into the participants' preferences for mobile exercise apps that can aid future research and development projects. Future exercise trials are needed to determine the true impact of mobile app technology on lifestyle physical activity in people with disabilities. TRIAL REGISTRATION Clinicaltrials.gov NCT03024320; https://clinicaltrials.gov/ct2/show/NCT03024320 (Archived by WebCite at http://www.webcitation.org/75hNLgRFH).
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Affiliation(s)
- Byron Lai
- UAB/Lakeshore Research Collaborative, School of Health Professions, University of Alabama at Birmingham, Birmingham, AL, United States
| | - Jereme Wilroy
- UAB/Lakeshore Research Collaborative, School of Health Professions, University of Alabama at Birmingham, Birmingham, AL, United States
| | - Hui-Ju Young
- UAB/Lakeshore Research Collaborative, School of Health Professions, University of Alabama at Birmingham, Birmingham, AL, United States
| | - Jennifer Howell
- UAB/Lakeshore Research Collaborative, School of Health Professions, University of Alabama at Birmingham, Birmingham, AL, United States
| | - James H Rimmer
- UAB/Lakeshore Research Collaborative, School of Health Professions, University of Alabama at Birmingham, Birmingham, AL, United States
| | - Tapan Mehta
- UAB/Lakeshore Research Collaborative, School of Health Professions, University of Alabama at Birmingham, Birmingham, AL, United States.,Department of Health Services Administration, University of Alabama at Birmingham, Birmingham, AL, United States
| | - Mohanraj Thirumalai
- UAB/Lakeshore Research Collaborative, School of Health Professions, University of Alabama at Birmingham, Birmingham, AL, United States.,Department of Health Services Administration, University of Alabama at Birmingham, Birmingham, AL, United States
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Young HJ, Mehta TS, Herman C, Wang F, Rimmer JH. The Effects of M2M and Adapted Yoga on Physical and Psychosocial Outcomes in People With Multiple Sclerosis. Arch Phys Med Rehabil 2019; 100:391-400. [DOI: 10.1016/j.apmr.2018.06.032] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2018] [Revised: 06/15/2018] [Accepted: 06/25/2018] [Indexed: 11/29/2022]
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Ginis KAM, van der Scheer JW, Latimer-Cheung AE, Barrow A, Bourne C, Carruthers P, Bernardi M, Ditor DS, Gaudet S, de Groot S, Hayes KC, Hicks AL, Leicht CA, Lexell J, Macaluso S, Manns PJ, McBride CB, Noonan VK, Pomerleau P, Rimmer JH, Shaw RB, Smith B, Smith KM, Steeves JD, Tussler D, West CR, Wolfe DL, Goosey-Tolfrey VL. Correction: Evidence-based scientific exercise guidelines for adults with spinal cord injury: an update and a new guideline. Spinal Cord 2018; 56:1114. [DOI: 10.1038/s41393-018-0194-8] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
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Lai B, Cederberg K, Vanderbom KA, Bickel CS, Rimmer JH, Motl RW. Characteristics of Adults With Neurologic Disability Recruited for Exercise Trials: A Secondary Analysis. Adapt Phys Activ Q 2018; 35:476-497. [PMID: 30382753 DOI: 10.1123/apaq.2017-0109] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
This review examined demographic and clinical characteristics of participants from exercise trials in 3 neurologic disability conditions (multiple sclerosis, spinal cord injury, and traumatic brain injury) and compared these data with population-based statistics. The authors included 75 published studies from 2006 to 2016: 53 studies for multiple sclerosis (n = 2,034), 14 for spinal cord injury (n = 302), and 8 for traumatic brain injury (n = 272). Pooled data resembled some heterogeneous aspects of population data sets. However, many characteristics were not reported; samples were small and predominantly White, and 48.1% of the people screened were excluded. Thus, findings from these studies may not be translatable across the range of people with these three conditions, which warrant efforts to target the inclusion of underrepresented subgroups in future exercise trials.
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Affiliation(s)
- Byron Lai
- University of Alabama at Birmingham/Lakeshore Research Collaborative
| | - Katie Cederberg
- University of Alabama at Birmingham/Lakeshore Research Collaborative
| | - Kerri A Vanderbom
- University of Alabama at Birmingham/Lakeshore Research Collaborative
| | | | - James H Rimmer
- University of Alabama at Birmingham/Lakeshore Research Collaborative
| | - Robert W Motl
- University of Alabama at Birmingham/Lakeshore Research Collaborative
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Thirumalai M, Rimmer JH, Johnson G, Wilroy J, Young HJ, Mehta T, Lai B. TEAMS (Tele-Exercise and Multiple Sclerosis), a Tailored Telerehabilitation mHealth App: Participant-Centered Development and Usability Study. JMIR Mhealth Uhealth 2018; 6:e10181. [PMID: 29798832 PMCID: PMC5992455 DOI: 10.2196/10181] [Citation(s) in RCA: 26] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2018] [Revised: 04/15/2018] [Accepted: 05/08/2018] [Indexed: 01/30/2023] Open
Abstract
Background People with multiple sclerosis face varying levels of disability and symptoms, thus requiring highly trained therapists and/or exercise trainers to design personalized exercise programs. However, for people living in geographically isolated communities, access to such trained professionals can be challenging due to a number of barriers associated with cost, access to transportation, and travel distance. Generic mobile health exercise apps often fall short of what people with multiple sclerosis need to become physically active (ie, exercise content that has been adapted to accommodate a wide range of functional limitations). Objective This usability study describes the development process of the TEAMS (Tele-Exercise and Multiple Sclerosis) app, which is being used by people with multiple sclerosis in a large randomized controlled trial to engage in home-based telerehabilitation. Methods Twenty-one participants with disabilities (10 people with multiple sclerosis) were involved in the double iterative design, which included the simultaneous development of the app features and exercise content (exercise videos and articles). Framed within a user-centered design approach, the development process included 2 stages: ground-level creation (focus group followed by early stage evaluations and developments), and proof of concept through 2 usability tests. Usability (effectiveness, usefulness, and satisfaction) was evaluated using a mixed-methods approach. Results During testing of the app’s effectiveness, the second usability test resulted in an average of 1 problem per participant, a decrease of 53% compared to the initial usability test. Five themes were constructed from the qualitative data that related to app usefulness and satisfaction, namely: high perceived confidence for app usability, positive perceptions of exercise videos, viable exercise option at home, orientation and familiarity required for successful participation, and app issues. Participants acknowledged that the final app was ready to be delivered to the public after minor revisions. After including these revisions, the project team released the final app that is being used in the randomized controlled trial. Conclusions A multi-level user-centered development process resulted in the development of an inclusive exercise program for people with multiple sclerosis operated through an easy-to-use app. The promotion of exercise through self-regulated mHealth programs requires a stakeholder-driven approach to app development. This ensures that app and content match the preferences and functional abilities of the end user (ie, people with varying levels of multiple sclerosis).
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Affiliation(s)
- Mohanraj Thirumalai
- Department of Health Services Administration, University of Alabama at Birmingham, Birmingham, AL, United States.,UAB/Lakeshore Research Collaborative, School of Health Professions, University of Alabama at Birmingham, Birmingham, AL, United States
| | - James H Rimmer
- UAB/Lakeshore Research Collaborative, School of Health Professions, University of Alabama at Birmingham, Birmingham, AL, United States
| | - George Johnson
- Department of Health Services Administration, University of Alabama at Birmingham, Birmingham, AL, United States
| | - Jereme Wilroy
- UAB/Lakeshore Research Collaborative, School of Health Professions, University of Alabama at Birmingham, Birmingham, AL, United States
| | - Hui-Ju Young
- UAB/Lakeshore Research Collaborative, School of Health Professions, University of Alabama at Birmingham, Birmingham, AL, United States
| | - Tapan Mehta
- Department of Health Services Administration, University of Alabama at Birmingham, Birmingham, AL, United States.,UAB/Lakeshore Research Collaborative, School of Health Professions, University of Alabama at Birmingham, Birmingham, AL, United States
| | - Byron Lai
- UAB/Lakeshore Research Collaborative, School of Health Professions, University of Alabama at Birmingham, Birmingham, AL, United States
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Goodner ES, Neal W, Tracy T, Mehta T, Thirumalai M, Neumeier WH, Young HJ, Rimmer JH. A Multilevel Patient Engagement Model for Recruiting Hard-to-Reach Populations into Exercise Training Studies. Med Sci Sports Exerc 2018. [DOI: 10.1249/01.mss.0000536550.39397.0d] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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Rimmer JH, Herman C, Wingo B, Fontaine K, Mehta T. Methodological and clinical implications of a three-in-one Russian doll design for tracking health trajectories and improving health and function through innovative exercise treatments in adults with disability. BMC Med Res Methodol 2018. [PMID: 29540164 PMCID: PMC5853027 DOI: 10.1186/s12874-018-0480-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Hybrid research designs targeting adults with neurologic disability are critical for improving the efficiency of models that can identify, track and intervene on identified health issues. METHODS Our Russian doll framework encompasses three study phases. Phase 1 involves prospectively following a cohort of participants with disability to examine the relationships between rates of health and functional deficits (e.g., pain, fatigue, deconditioning), functional measures (e.g., cardiorespiratory endurance, strength, balance), and environmental and sociocultural factors. In Phase 2, eligible participants with neurologic disability from Phase 1 (in our example, individuals with multiple sclerosis) are screened and randomized to a clinical exercise efficacy trial. In Phase 3, study participants are enrolled in a home-based teleexercise trial to test the feasibility and replicability of delivering the clinical exercise study in the home. DISCUSSION This unique three-in-one Russian doll framework serves as a foundation for informing and guiding researchers and clinicians in treating certain health and functional deficits in people with neurologic disability using exercise as a primary treatment modality in both the clinical and home settings. It offers a unique perspective for understanding the critical issues of functioning, health maintenance and quality of life for people with neurologic disability across a longitudinal framework. TRIAL REGISTRATION Study 2 ClinicalTrials.gov identifier NCT02533882 (retroactively registered 03/06/2015). Study 3 ClinicalTrials.gov identifier NCT03108950 (retroactively registered 04/05/2017).
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Affiliation(s)
- James H Rimmer
- Department of Occupational Therapy, School of Health Professions, University of Alabama at Birmingham, 1716 9th Ave. South, Birmingham, AL, 35294-1212, USA.,UAB-Lakeshore Research Collaborative, School of Health Professions, University of Alabama at Birmingham, 1716 9th Ave. South, Birmingham, AL, 35294-1212, USA
| | - Cassandra Herman
- Department of Health Behavior, School of Public Health, University of Alabama at Birmingham, 1665 University Boulevard, Birmingham, AL, 35294-0022, USA.,UAB-Lakeshore Research Collaborative, School of Health Professions, University of Alabama at Birmingham, 1716 9th Ave. South, Birmingham, AL, 35294-1212, USA
| | - Brooks Wingo
- Department of Occupational Therapy, School of Health Professions, University of Alabama at Birmingham, 1716 9th Ave. South, Birmingham, AL, 35294-1212, USA
| | - Kevin Fontaine
- Department of Health Behavior, School of Public Health, University of Alabama at Birmingham, 1665 University Boulevard, Birmingham, AL, 35294-0022, USA
| | - Tapan Mehta
- Department of Health Services Administration, School of Health Professions, University of Alabama at Birmingham, 1716 9th Ave. South, Birmingham, AL, 35294-1212, USA. .,UAB-Lakeshore Research Collaborative, School of Health Professions, University of Alabama at Birmingham, 1716 9th Ave. South, Birmingham, AL, 35294-1212, USA.
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Hsieh K, Murthy S, Heller T, Rimmer JH, Yen G. Reported gum disease as a cardiovascular risk factor in adults with intellectual disabilities. J Intellect Disabil Res 2018; 62:187-198. [PMID: 29114946 DOI: 10.1111/jir.12438] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/16/2017] [Revised: 08/26/2017] [Accepted: 09/28/2017] [Indexed: 06/07/2023]
Abstract
BACKGROUND Several risk factors for cardiovascular disease (CVD) have been identified among adults with intellectual disabilities (ID). Periodontitis has been reported to increase the risk of developing a CVD in the general population. Given that individuals with ID have been reported to have a higher prevalence of poor oral health than the general population, the purpose of this study was to determine whether adults with ID with informant reported gum disease present greater reported CVD than those who do not have reported gum disease and whether gum disease can be considered a risk factor for CVD. METHODS Using baseline data from the Longitudinal Health and Intellectual Disability Study from which informant survey data were collected, 128 participants with reported gum disease and 1252 subjects without reported gum disease were identified. A series of univariate logistic regressions was conducted to identify potential confounding factors for a multiple logistic regression. RESULTS The series of univariate logistic regressions identified age, Down syndrome, hypercholesterolemia, hypertension, reported gum disease, daily consumption of fruits and vegetables and the addition of table salt as significant risk factors for reported CVD. When the significant factors from the univariate logistic regression were included in the multiple logistic analysis, reported gum disease remained as an independent risk factor for reported CVD after adjusting for the remaining risk factors. Compared with the adults with ID without reported gum disease, adults in the gum disease group demonstrated a significantly higher prevalence of reported CVD (19.5% vs. 9.7%; P = .001). CONCLUSION After controlling for other risk factors, reported gum disease among adults with ID may be associated with a higher risk of CVD. However, further research that also includes clinical indices of periodontal disease and CVD for this population is needed to determine if there is a causal relationship between gum disease and CVD.
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Affiliation(s)
- K Hsieh
- Department of Disability and Human Development, University of Illinois at Chicago, Chicago, IL, USA
| | - S Murthy
- Department of Disability and Human Development, University of Illinois at Chicago, Chicago, IL, USA
| | - T Heller
- Department of Disability and Human Development, University of Illinois at Chicago, Chicago, IL, USA
| | - J H Rimmer
- School of Health Professions, University of Alabama at Birmingham, Birmingham, AL, USA
| | - G Yen
- Department of Disability and Human Development, University of Illinois at Chicago, Chicago, IL, USA
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40
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Lai B, Kim Y, Wilroy J, Bickel CS, Rimmer JH, Motl RW. Sustainability of exercise intervention outcomes among people with disabilities: a secondary review. Disabil Rehabil 2018; 41:1584-1595. [PMID: 29409367 DOI: 10.1080/09638288.2018.1432704] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
BACKGROUND This review explored the sustainability of health and physical activity-based outcomes following exercise trials that were conducted for people with disabilities, and characterised the influence of technology and behaviour change strategies. METHODS A total of 132 studies were screened from an existing database. RESULTS Only 22 studies featured follow-up periods and met eligibility criteria. At follow-up, studies typically reported at least one significant health outcome that was maintained (n = 18/21; 86%). However, significant health outcomes accounted for only 32% of the total volume of outcomes that were measured at follow-up. For physical activity-based outcomes, six studies (n = 6/8; 75%) reported that intervention gains were maintained throughout follow-up. The incorporation of technology or behaviour change strategies appeared to be linked with sustainable intervention effects. CONCLUSIONS Overall, some evidence demonstrated that post-intervention effects were sustainable. However, the strength of the evidence was weak and several existing gaps in knowledge were identified. Moreover, most studies did not focus on sustainability, but instead emphasised short-term effects of exercise participation on health and physical activity outcomes. Study findings call for greater research and programme efforts to maintain health, function, and physical activity behaviour after supports provided by research studies are removed. Implications for rehabilitation Short-term exercise programmes may require additional strategies designed specifically to enhance the sustainability of exercise outcomes and physical activity participation. Incorporating technology within exercise interventions may enhance the likelihood of sustaining health and function outcomes. Exercise programmes framed within behaviour change theory can equip individuals with the appropriate strategies necessary to maintain their physical activity participation.
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Affiliation(s)
- Byron Lai
- a Department of Physical and Occupational Therapy , School of Health Professions, University of Alabama at Birmingham , Birmingham , AL , USA
| | - Yumi Kim
- a Department of Physical and Occupational Therapy , School of Health Professions, University of Alabama at Birmingham , Birmingham , AL , USA
| | - Jereme Wilroy
- b Department of Physical Medicine and Rehabilitation , University of Alabama at Birmingham , Birmingham , AL , USA
| | - C Scott Bickel
- c Department of Physical Therapy , Samford University , Birmingham , AL , USA
| | - James H Rimmer
- d Department of Occupational Therapy, School of Health Professions , University of Alabama at Birmingham , Birmingham , AL , USA
| | - Robert W Motl
- e Department of Physical Therapy, School of Health Professions , University of Alabama at Birmingham , Birmingham , AL , USA
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41
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Martin Ginis KA, van der Scheer JW, Latimer-Cheung AE, Barrow A, Bourne C, Carruthers P, Bernardi M, Ditor DS, Gaudet S, de Groot S, Hayes KC, Hicks AL, Leicht CA, Lexell J, Macaluso S, Manns PJ, McBride CB, Noonan V, Pomerleau P, Rimmer JH, Shaw RB, Smith B, Smith KM, Steeves J, Tussler D, West CR, Wolfe DL, Goosey-Tolfrey VL. Response to correspondence from the ESSA Statement authors. Spinal Cord 2018; 56:409-411. [PMID: 29348688 DOI: 10.1038/s41393-017-0051-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2017] [Revised: 12/10/2017] [Accepted: 12/13/2017] [Indexed: 11/09/2022]
Affiliation(s)
| | | | | | - Andy Barrow
- Paralympian and Inspirational Speaker, London, UK
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | - Pierre Pomerleau
- Institut de Réadaptation en Déficience Physique de Québec, Ville de Québec, Canada
| | | | - Robert B Shaw
- University of British Columbia, British Columbia, Canada
| | | | | | - John Steeves
- ICORD University of British Columbia, Vancouver, Canada
| | - Dot Tussler
- National Spinal Injuries Centre, Stoke Mandeville Hospital, Aylesbury, UK
| | | | - Dalton L Wolfe
- Parkwood Institute, Lawson Health Research Institute, Ontario, Canada
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42
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Hsieh K, Hilgenkamp TIM, Murthy S, Heller T, Rimmer JH. Low Levels of Physical Activity and Sedentary Behavior in Adults with Intellectual Disabilities. Int J Environ Res Public Health 2017; 14:E1503. [PMID: 29207570 PMCID: PMC5750921 DOI: 10.3390/ijerph14121503] [Citation(s) in RCA: 35] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 10/20/2017] [Revised: 11/26/2017] [Accepted: 11/29/2017] [Indexed: 11/30/2022]
Abstract
Adults with intellectual disabilities (ID) are more likely to lead sedentary lifestyles and have low levels of physical activity (LLPA). The present study investigated the prevalence of reported LLPA and time spent watching TV in adults with ID and identified the associated factors for these behaviors. The proxy informants of 1618 adults with ID completed the surveys regarding their health behaviors. Multiple logistic regressions were employed for LLPA and multiple linear regressions for time spent watching TV. About 60% of adults with ID had LLPA and average time spent watching TV was 3.4 h a day. Some characteristics and health and function variables were identified as associated factors. While engaging in community activities and involvement in Special Olympics were inversely associated with LLPA, they were not associated with time spent watching TV. Attending day/educational programs or being employed were associated with spending less time watching TV. Findings highlight differential factors associated with LLPA versus TV-watching behavior in adults with ID. Hence, a key strategy aimed at increasing physical activity includes promoting participation in social and community activities, while targeted activities for reducing sedentary behavior might focus on providing day programs or employment opportunities for adults with ID.
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Affiliation(s)
- Kelly Hsieh
- Department of Disability and Human Development, University of Illinois at Chicago, Chicago, IL 60609, USA.
| | - Thessa I M Hilgenkamp
- Department of Kinesiology and Nutrition, University of Illinois at Chicago, Chicago, IL 60612, USA.
| | - Sumithra Murthy
- Department of Disability and Human Development, University of Illinois at Chicago, Chicago, IL 60609, USA.
| | - Tamar Heller
- Department of Disability and Human Development, University of Illinois at Chicago, Chicago, IL 60609, USA.
| | - James H Rimmer
- School of Health Professions, University of Alabama at Birmingham, SHPB 331, Birmingham, AL 35294, USA.
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43
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Reinkensmeyer DJ, Blackstone S, Bodine C, Brabyn J, Brienza D, Caves K, DeRuyter F, Durfee E, Fatone S, Fernie G, Gard S, Karg P, Kuiken TA, Harris GF, Jones M, Li Y, Maisel J, McCue M, Meade MA, Mitchell H, Mitzner TL, Patton JL, Requejo PS, Rimmer JH, Rogers WA, Zev Rymer W, Sanford JA, Schneider L, Sliker L, Sprigle S, Steinfeld A, Steinfeld E, Vanderheiden G, Winstein C, Zhang LQ, Corfman T. How a diverse research ecosystem has generated new rehabilitation technologies: Review of NIDILRR's Rehabilitation Engineering Research Centers. J Neuroeng Rehabil 2017; 14:109. [PMID: 29110728 PMCID: PMC5674748 DOI: 10.1186/s12984-017-0321-3] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2016] [Accepted: 10/26/2017] [Indexed: 01/14/2023] Open
Abstract
Over 50 million United States citizens (1 in 6 people in the US) have a developmental, acquired, or degenerative disability. The average US citizen can expect to live 20% of his or her life with a disability. Rehabilitation technologies play a major role in improving the quality of life for people with a disability, yet widespread and highly challenging needs remain. Within the US, a major effort aimed at the creation and evaluation of rehabilitation technology has been the Rehabilitation Engineering Research Centers (RERCs) sponsored by the National Institute on Disability, Independent Living, and Rehabilitation Research. As envisioned at their conception by a panel of the National Academy of Science in 1970, these centers were intended to take a "total approach to rehabilitation", combining medicine, engineering, and related science, to improve the quality of life of individuals with a disability. Here, we review the scope, achievements, and ongoing projects of an unbiased sample of 19 currently active or recently terminated RERCs. Specifically, for each center, we briefly explain the needs it targets, summarize key historical advances, identify emerging innovations, and consider future directions. Our assessment from this review is that the RERC program indeed involves a multidisciplinary approach, with 36 professional fields involved, although 70% of research and development staff are in engineering fields, 23% in clinical fields, and only 7% in basic science fields; significantly, 11% of the professional staff have a disability related to their research. We observe that the RERC program has substantially diversified the scope of its work since the 1970's, addressing more types of disabilities using more technologies, and, in particular, often now focusing on information technologies. RERC work also now often views users as integrated into an interdependent society through technologies that both people with and without disabilities co-use (such as the internet, wireless communication, and architecture). In addition, RERC research has evolved to view users as able at improving outcomes through learning, exercise, and plasticity (rather than being static), which can be optimally timed. We provide examples of rehabilitation technology innovation produced by the RERCs that illustrate this increasingly diversifying scope and evolving perspective. We conclude by discussing growth opportunities and possible future directions of the RERC program.
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Affiliation(s)
| | | | | | - John Brabyn
- The Smith-Kettlewell Eye Research Institute, San Francesco, USA
| | | | | | | | | | - Stefania Fatone
- Northwestern University Prosthetics-Orthotics Center, Evanston, USA
| | - Geoff Fernie
- Toronto Rehabilitation Institute, Toronto, Canada
| | - Steven Gard
- Northwestern University Prosthetics-Orthotics Center, Evanston, USA
| | | | | | | | | | - Yue Li
- Toronto Rehabilitation Institute, Toronto, Canada
| | | | | | | | | | | | - James L. Patton
- Rehabilitation Institute of Chicago, University of Illinois at Chicago, Chicago, USA
| | | | - James H. Rimmer
- Lakeshore FoundationUniversity of Alabama-Birmingham, Birmingham, USA
| | | | - W. Zev Rymer
- Rehabilitation Institute of Chicago, Chicago, USA
| | | | | | | | | | - Aaron Steinfeld
- Robotics Institute, Carnegie Mellon University, Pittsburgh, USA
| | | | | | | | | | - Thomas Corfman
- National Institute on Disability, Independent Living, and Rehabilitation Research, Washington, DC, USA
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44
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Martin Ginis KA, van der Scheer JW, Latimer-Cheung AE, Barrow A, Bourne C, Carruthers P, Bernardi M, Ditor DS, Gaudet S, de Groot S, Hayes KC, Hicks AL, Leicht CA, Lexell J, Macaluso S, Manns PJ, McBride CB, Noonan VK, Pomerleau P, Rimmer JH, Shaw RB, Smith B, Smith KM, Steeves JD, Tussler D, West CR, Wolfe DL, Goosey-Tolfrey VL. Evidence-based scientific exercise guidelines for adults with spinal cord injury: an update and a new guideline. Spinal Cord 2017; 56:308-321. [PMID: 29070812 DOI: 10.1038/s41393-017-0017-3] [Citation(s) in RCA: 231] [Impact Index Per Article: 33.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2017] [Revised: 09/14/2017] [Accepted: 09/20/2017] [Indexed: 01/03/2023]
Abstract
OBJECTIVES To describe the process and outcomes of using a new evidence base to develop scientific guidelines that specify the type and minimum dose of exercise necessary to improve fitness and cardiometabolic health in adults with spinal cord injury (SCI). SETTING International. METHODS Using Appraisal of Guidelines, Research and Evaluation (AGREE) II reporting criteria, steps included (a) determining the guidelines' scope; (b) conducting a systematic review of relevant literature; (c) holding three consensus panel meetings (European, Canadian and International) to formulate the guidelines; (d) obtaining stakeholder feedback; and (e) process evaluation by an AGREE II consultant. Stakeholders were actively involved in steps (c) and (d). RESULTS For cardiorespiratory fitness and muscle strength benefits, adults with a SCI should engage in at least 20 min of moderate to vigorous intensity aerobic exercise 2 times per week AND 3 sets of strength exercises for each major functioning muscle group, at a moderate to vigorous intensity, 2 times per week (strong recommendation). For cardiometabolic health benefits, adults with a SCI are suggested to engage in at least 30 min of moderate to vigorous intensity aerobic exercise 3 times per week (conditional recommendation). CONCLUSIONS Through a systematic, rigorous, and participatory process involving international scientists and stakeholders, a new exercise guideline was formulated for cardiometabolic health benefits. A previously published SCI guideline was endorsed for achieving fitness benefits. These guidelines represent an important step toward international harmonization of exercise guidelines for adults with SCI, and a foundation for developing exercise policies and programs for people with SCI around the world.
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Affiliation(s)
| | | | | | - Andy Barrow
- Paralympian and Inspirational Speaker, London, UK
| | | | | | | | | | - Sonja Gaudet
- Spinal Cord Injury British Columbia, Vancouver, Canada
| | | | | | | | | | | | | | | | | | | | - Pierre Pomerleau
- Institut de Réadaptation en Déficience Physique de Québec, Ville de Québec, Canada
| | | | | | | | | | | | - Dot Tussler
- National Spinal Injuries Centre, Stoke Mandeville Hospital, Aylesbury, UK
| | | | - Dalton L Wolfe
- Parkwood Institute, Lawson Health Research Institute, London, Canada
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45
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Neumeier WH, Guerra N, Thirumalai M, Geer B, Ervin D, Rimmer JH. POWERS forID: Personalized Online Weight and Exercise Response System for Individuals with Intellectual Disability: study protocol for a randomized controlled trial. Trials 2017; 18:487. [PMID: 29058620 PMCID: PMC5653469 DOI: 10.1186/s13063-017-2239-2] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2017] [Accepted: 10/04/2017] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND Intellectual disability (ID) is characterized by limitations in intellectual functioning and adaptive behavior. Adults with ID exhibit higher rates of obesity and poorer health status compared to the general population. Continuity of care and barriers to health-related activities may contribute to the poorer health status observed in this population. To address this problem, a tailored weight management online health information and communication technology platform, known as POWERSforID, was developed and is being tested to determine if this delivery mechanism can improve weight maintenance/weight loss in adults with ID. METHODS Obese adults with mild-to-moderate ID (n = 70) are randomized to the POWERS forID intervention or control group for a 24-week trial. Each group undergoes an assessment that includes body weight, waist circumference, and percent body fat at baseline and at weeks 6, 12, and 24. Physical activity barriers, healthy eating barriers, food frequency, and psychosocial wellbeing are measured at baseline and at weeks 12 and 24. Blood lipids are assessed at baseline and 24 weeks. Participants randomized to POWERS forID receive access to the POWERS forID website and calls from a health coach (weekly during weeks 1-12, biweekly during weeks 13-24). The health coach employs motivational interviewing techniques adapted for individuals with ID to promote behavior change. Participants randomized to the control group receive standard clinical weight-loss care. Differences in weight, waist circumference, blood lipids, percent body fat, and psychosocial self-report will be assessed. Barriers and facilitators of implementation as well as perception of study outcomes will be conducted via qualitative analysis. DISCUSSION POWERS forID is a novel information and communication technology platform designed to address health needs for adults with ID. This article describes the development and components of POWERS forID. The overall aim is to assess usability and feasibility of POWERS forID for promoting weight loss for obese adults with ID over the course of a 24-week randomized control trial. TRIAL REGISTRATION Clinicaltrials.gov, NCT03139760 . Registered on XXX.
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Affiliation(s)
- William H. Neumeier
- University of Alabama at Birmingham/Lakeshore Foundation Research Collaborative, 331 School of Health Professions Bldg. 1705 University Blvd, Birmingham, AL 35294-1212 USA
| | - Nichole Guerra
- The Resource Exchange, 6385 Corporate Drive, Suite 301, Colorado Springs, CO 80919 USA
| | - Mohanraj Thirumalai
- University of Alabama at Birmingham/Lakeshore Foundation Research Collaborative, 331 School of Health Professions Bldg. 1705 University Blvd, Birmingham, AL 35294-1212 USA
| | - Betty Geer
- The Resource Exchange, 6385 Corporate Drive, Suite 301, Colorado Springs, CO 80919 USA
| | - David Ervin
- The Resource Exchange, 6385 Corporate Drive, Suite 301, Colorado Springs, CO 80919 USA
| | - James H. Rimmer
- University of Alabama at Birmingham/Lakeshore Foundation Research Collaborative, 331 School of Health Professions Bldg. 1705 University Blvd, Birmingham, AL 35294-1212 USA
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Rimmer JH, Padalabalanarayanan S, Malone LA, Mehta T. Fitness facilities still lack accessibility for people with disabilities. Disabil Health J 2017; 10:214-221. [DOI: 10.1016/j.dhjo.2016.12.011] [Citation(s) in RCA: 49] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2015] [Revised: 12/05/2016] [Accepted: 12/23/2016] [Indexed: 11/25/2022]
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47
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Affiliation(s)
- James H Rimmer
- Lakeshore Foundation Endowed Chair in Health Promotion and Rehabilitation Sciences, University of Alabama at Birmingham/Lakeshore Foundation Research Collaborative, 331 School of Health Professions Building, 1705 University Blvd., Birmingham, AL 35292-1212, USA.
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48
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Martin Ginis KA, Ma JK, Latimer-Cheung AE, Rimmer JH. A systematic review of review articles addressing factors related to physical activity participation among children and adults with physical disabilities. Health Psychol Rev 2016; 10:478-494. [PMID: 27265062 DOI: 10.1080/17437199.2016.1198240] [Citation(s) in RCA: 199] [Impact Index Per Article: 24.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
Dozens of published papers cite factors related to leisure-time physical activity (LTPA) participation among people with physical disabilities. Unfortunately, there has been little effort to synthesise this literature in a manner that is accessible and useful to the sectors (e.g., health care, recreation) responsible for LTPA promotion in disability populations. In this systematic review, over 200 factors were extracted from 22 review articles addressing barriers and facilitators to LTPA in children and adults with physical disabilities. Factors were grouped according to common themes, classified into five levels of a social ecological model, and coded according to whether they could be affected by the health-care and/or recreation sectors. Findings are discussed with regard to key factors to target in LTPA-enhancing interventions, relevant theories and models in which to frame interventions, the levels at which the interventions can be implemented, and intervention priorities. The synthesis provides a blueprint and a catalyst for researchers and practitioners to shift focus from conducting studies that merely describe LTPA barriers and facilitators, to developing and delivering strategies to increase LTPA among persons with physical disabilities.
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Affiliation(s)
| | - Jasmin K Ma
- a Department of Kinesiology , McMaster University , Hamilton , Ontario , Canada L8S 4K1
| | - Amy E Latimer-Cheung
- b Queen's University, School of Kinesiology and Health Studies , Kingston , Ontario , Canada K7L 3N6
| | - James H Rimmer
- c University of Alabama at Birmingham and Lakeshore Foundation , Birmingham , AL , USA
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49
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Wingo B, Herman C, Rimmer JH. An Exploration of Dietary Intake Among Adults With Physical Disabilities. Arch Phys Med Rehabil 2016. [DOI: 10.1016/j.apmr.2016.09.078] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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50
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Papas MA, Trabulsi JC, Axe M, Rimmer JH. Predictors of Obesity in a US Sample of High School Adolescents With and Without Disabilities. J Sch Health 2016; 86:803-812. [PMID: 27714868 PMCID: PMC5621740 DOI: 10.1111/josh.12436] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/08/2015] [Revised: 03/05/2016] [Accepted: 05/10/2016] [Indexed: 06/06/2023]
Abstract
BACKGROUND Childhood obesity is a major public health concern. Children with disabilities have a higher prevalence of obesity. OBJECTIVE We examined factors associated with obesity within a cross-sectional study of US adolescents with and without disabilities. METHODS Data were obtained from the 2011 Youth Risk Behavior Survey. Logistic regression models were fitted to assess effects of dietary habits, physical activity, and unhealthy weight control behaviors on obesity. Effect modification by disability status was examined. RESULTS Twenty percent (1986 of 9775 participants) reported a disability. Adolescents with disabilities were more likely to be obese (odds ratio [OR] = 1.7; 95% confidence interval [CI]: 1.3-2.1) and have at least 1 unhealthy weight control behavior (OR = 2.0; 95% CI: 1.6-2.5), and were less likely to be physically active (OR = 0.5; 95% CI: 0.4-0.6). Lack of physical activity, increased television watching/video game playing, and unhealthy weight loss behaviors were significantly associated with obesity regardless of disability status (p-for-interaction >.05). CONCLUSIONS Successful obesity interventions should target diet, physical activity, and weight control among adolescents with disabilities. Understanding barriers to healthier diet and physical activity for this population is critical to developing effective obesity prevention programs and reducing the prevalence of unhealthy weight control behaviors.
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Affiliation(s)
- Mia A Papas
- Department of Behavioral Health and Nutrition, College of Health Sciences, University of Delaware, 26 North College Avenue, Newark, DE 19716.
| | - Jillian C Trabulsi
- Department of Behavioral Health and Nutrition, College of Health Sciences, University of Delaware, 26 North College Avenue, Newark, DE 19716.
| | - Michelle Axe
- Department of Behavioral Health and Nutrition, College of Health Sciences, University of Delaware, 26 North College Avenue, Newark, DE 19716.
| | - James H Rimmer
- School of Health Professions, University of Alabama at Birmingham, SHPB 331, 1530 S. 3rd Avenue, Birmingham, AL 35294-3361.
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