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Evans E, Zengul A, Subhash Chilke T, Knight A, Willig A, Cherrington A, Mehta T, Thirumalai M. Telehealth Behavioral Intervention for Chronic Disease Self-Management in Adults With Physical Disabilities (My Health, My Life, My Way): Protocol for Intervention Fidelity and Dashboard Design for a Randomized Controlled Trial. JMIR Res Protoc 2024; 13:e53410. [PMID: 38345845 PMCID: PMC10897788 DOI: 10.2196/53410] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2023] [Revised: 11/13/2023] [Accepted: 11/23/2023] [Indexed: 03/01/2024] Open
Abstract
BACKGROUND Individuals with physical disabilities experience higher rates of chronic health conditions than individuals without physical disabilities. Self-management programs that use health coaching are effective at eliciting health behavior change in health outcomes such as goal setting, adherence, and health care use. Additionally, web-based resources such as telehealth-based technologies, including SMSS text messaging, web-based applications, and educational multimedia content, can complement health coaching to improve health-related behaviors and the use of health services. The complexity of studies using these resources requires a fidelity protocol to ensure that health behavior studies are administered properly. OBJECTIVE The My Health, My Life, My Way fidelity protocol provides methods, strategies, and procedures of a multifaceted telehealth program for individuals with permanent physical disabilities and chronic health conditions. This health behavior study is a randomized controlled trial with four study arms: (1) scheduled coaching calls with gamified rewards, (2) no scheduled coaching calls with gamified rewards, (3) scheduled coaching calls with fixed rewards, and (4) no scheduled coaching calls with fixed rewards. To guide the fidelity protocol developed, we used the National Institutes of Health Behavior Change Consortium framework (NIH BCC). METHODS The fidelity intervention protocol was developed by using the 5 primary domains provided by the NIH BCC: study design, provider training, treatment delivery, treatment receipt, and enactment of treatment skills. Following the NIH BCC guidelines and implementing social cognitive theory, this study is designed to ensure that all study arms receive equal treatment across conditions and groups. Health coaches and providers will be trained to deliver consistent health coaching, and thus participants will receive appropriate attention. Educational content will be developed to account for health literacy and comprehension of the material. Multiple fidelity intervention steps such as coaching call logs, regular content review, and participant progress monitoring will translate to participants using the skills learned in their daily lives. Different monitoring steps will be implemented to minimize differences among the 4 treatment groups. RESULTS My Health, My Life, My Way has been approved by the institutional review board and will begin enrollment in January 2024 and end in December 2024, with results reported in early 2025. CONCLUSIONS Intervention fidelity protocols are necessary to ensure that health behavior change studies can be implemented in larger real-world settings. The My Health, My Life, My Way fidelity protocol has used the guidelines by the NIH BCC to administer a telehealth intervention combined with health coaching for individuals with physical disabilities and chronic health conditions. This fidelity protocol can be used as a complementary resource for other researchers who conduct similar research using telehealth technologies and health coaching in real-world settings. TRIAL REGISTRATION ClinicalTrials NCT05481593; https://clinicaltrials.gov/study/NCT05481593. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID) PRR1-10.2196/53410.
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Affiliation(s)
- Eric Evans
- Department of Health Services Administration, School of Health Professions, University of Alabama at Birmingham, Birmingham, AL, United States
| | - Ayse Zengul
- Department of Nutrition Sciences, School of Health Professions, University of Alabama at Birmingham, Birmingham, AL, United States
| | - Tejaswini Subhash Chilke
- UAB Research Collaborative, School of Health Professions, University of Alabama at Birmingham, Birmingham, AL, United States
| | - Amy Knight
- Department of Neuroology, Heersink School of Medicine, University of Alabama at Birmingham, Birmingham, AL, United States
| | - Amanda Willig
- Division of Infectious Disease, Heersink School of Medicine, University of Alabama at Birmingham, Birmingham, AL, United States
| | - Andrea Cherrington
- Division of Preventive Medicine, Heersink School of Medicine, University of Alabama at Birmingham, Birmingham, AL, United States
| | - Tapan Mehta
- Department of Family and Community Medicine, Heersink School of Medicine, University of Alabama at Birmingham, Birmingham, AL, United States
| | - Mohanraj Thirumalai
- Department of Health Services Administration, School of Health Professions, University of Alabama at Birmingham, Birmingham, AL, United States
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Evans E, Zengul A, Knight A, Willig A, Cherrington A, Mehta T, Thirumalai M. Stakeholders' Perspectives, Needs, and Barriers to Self-Management for People With Physical Disabilities Experiencing Chronic Conditions: Focus Group Study. JMIR Rehabil Assist Technol 2023; 10:e43309. [PMID: 38109170 PMCID: PMC10758937 DOI: 10.2196/43309] [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: 10/07/2022] [Revised: 09/28/2023] [Accepted: 10/19/2023] [Indexed: 12/19/2023] Open
Abstract
BACKGROUND While self-management programs have had significant improvements for individuals with chronic conditions, less is known about the impact of self-management programs for individuals with physical disabilities who experience chronic conditions, as no holistic self-management programs exist for this population. Similarly, there is limited knowledge of how other stakeholders, such as caregivers, health experts, and researchers, view self-management programs in the context of disability, chronic health conditions, and assistive technologies. OBJECTIVE This study aimed to obtain insight into how stakeholders perceive self-management relating to physical disability, chronic conditions, and assistive technologies. METHODS Nine focus groups were conducted by 2 trained facilitators using semistructured interview guides. Each guide contained questions relating to stakeholders' experiences, challenges with self-management programs, and perceptions of assistive technologies. Focus groups were audio recorded and transcribed. Thematic analysis was conducted on the focus group data. RESULTS A total of 47 individuals participated in the focus groups. By using a constructivist grounded approach and inductive data collection, three main themes emerged from the focus groups: (1) perspectives, (2) needs, and (3) barriers of stakeholders. Stakeholders emphasized the importance of physical activity, mental health, symptom management, medication management, participant centeredness, and chronic disease and disability education. Participants viewed technology as a beneficial aide to their daily self-management and expressed their desire to have peer-to-peer support in web-based self-management programs. Additional views of technology included the ability to access individualized, educational content and connect with other individuals who experience similar health conditions or struggle with caregiving duties. CONCLUSIONS The findings suggest that the development of any web-based self-management program should include mental health education and resources in addition to physical activity content and symptom management and be cost-effective. Beyond the inclusion of educational resources, stakeholders desired customization or patient centeredness in the program to meet the overall needs of individuals with physical disabilities and caregivers. The development of web-based self-management programs should be holistic in meeting the needs of all stakeholders. TRIAL REGISTRATION ClinicalTrials.gov NCT05481593; https://clinicaltrials.gov/study/NCT05481593.
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Affiliation(s)
- Eric Evans
- Department of Family and Community Medicine, Heersink School of Medicine, University of Alabama at Birmingham, Birmingham, AL, United States
| | - Ayse Zengul
- Department of Family and Community Medicine, Heersink School of Medicine, University of Alabama at Birmingham, Birmingham, AL, United States
| | - Amy Knight
- Department of Health Services Administration, School of Health Professions, University of Alabama at Birmingham, Birmingham, AL, United States
| | - Amanda Willig
- Department of Family and Community Medicine, Heersink School of Medicine, University of Alabama at Birmingham, Birmingham, AL, United States
| | - Andrea Cherrington
- Department of Health Services Administration, School of Health Professions, University of Alabama at Birmingham, Birmingham, AL, United States
| | - Tapan Mehta
- Department of Family and Community Medicine, Heersink School of Medicine, University of Alabama at Birmingham, Birmingham, AL, United States
| | - Mohanraj Thirumalai
- Department of Health Services Administration, School of Health Professions, University of Alabama at Birmingham, Birmingham, AL, United States
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Neal WN, Schleicher EA, Baron K, Oster RA, Brown NI, Demark-Wahnefried W, Pisu M, Baskin ML, Parrish KB, Cole WW, Thirumalai M, Pekmezi DW. Impact of the COVID-19 Pandemic on Physical Activity among Mostly Older, Overweight Black Women Living in the Rural Alabama Black Belt. Int J Environ Res Public Health 2023; 20:7180. [PMID: 38131731 PMCID: PMC10743260 DOI: 10.3390/ijerph20247180] [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] [Subscribe] [Scholar Register] [Received: 10/26/2023] [Revised: 12/08/2023] [Accepted: 12/13/2023] [Indexed: 12/23/2023]
Abstract
Despite well-documented global declines in physical activity (PA) during the COVID-19 pandemic, little is known regarding the specific impact among underserved, rural Alabama counties. This is concerning as this region was already disproportionately burdened by inactivity and related chronic diseases and was among the hardest hit by COVID-19. Thus, the current study examined the effect of COVID-19 on PA in four rural Alabama counties. An ancillary survey was administered between March 2020 and August 2021 to the first cohort (N = 171) of participants enrolled in a larger PA trial. Main outcomes of this survey included the perceived impact of COVID-19 on PA, leisure-time PA, and social cognitive theory (SCT) constructs at 3 months. Almost half of the participants reported being less active during the pandemic (49.7%) and endorsed that COVID-19 made PA more difficult (47.4%), citing concerns such as getting sick from exercising outside of the home (70.4%) and discomfort wearing a face mask while exercising (58%). Perceived COVID-19 impact on PA was significantly associated with education, household dependents, and gender (p's < 0.05). More women, parents, and college graduates reported that the COVID-19 pandemic made PA more difficult. Overall, there were no significant associations between PA, SCT constructs, or perceived COVID-19 impact on PA scores at 3 months. While the pandemic made PA difficult for many participants, these barriers were not associated with leisure-time PA levels or related theoretical mechanisms of action, which bodes well for the success of our ongoing intervention efforts and the resiliency of these communities.
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Affiliation(s)
- Whitney N. Neal
- Department of Health Behavior, University of Alabama at Birmingham, Birmingham, AL 35294, USA; (E.A.S.); (K.B.P.); (W.W.C.); (D.W.P.)
| | - Erica A. Schleicher
- Department of Health Behavior, University of Alabama at Birmingham, Birmingham, AL 35294, USA; (E.A.S.); (K.B.P.); (W.W.C.); (D.W.P.)
- O’Neal Comprehensive Cancer Center, University of Alabama at Birmingham, Birmingham, AL 35294, USA; (R.A.O.); (M.P.)
| | - Kerri Baron
- Capstone College of Nursing, University of Alabama, Tuscaloosa, AL 35487, USA;
| | - Robert A. Oster
- O’Neal Comprehensive Cancer Center, University of Alabama at Birmingham, Birmingham, AL 35294, USA; (R.A.O.); (M.P.)
- Department of Medicine, Division of Preventive Medicine, University of Alabama at Birmingham, Birmingham, AL 35294, USA;
| | - Nashira I. Brown
- Department of Health Outcomes and Behavior, Moffitt Cancer Center, Tampa, FL 33612, USA;
| | - Wendy Demark-Wahnefried
- Department of Medicine, Division of Preventive Medicine, University of Alabama at Birmingham, Birmingham, AL 35294, USA;
- Department of Nutrition Sciences, University of Alabama at Birmingham, Birmingham, AL 35294, USA
| | - Maria Pisu
- O’Neal Comprehensive Cancer Center, University of Alabama at Birmingham, Birmingham, AL 35294, USA; (R.A.O.); (M.P.)
- Department of Medicine, Division of Preventive Medicine, University of Alabama at Birmingham, Birmingham, AL 35294, USA;
| | - Monica L. Baskin
- Department of Medicine, Division of Hematology/Oncology, University of Pittsburgh, Pittsburgh, PA 15260, USA;
| | - Kelsey B. Parrish
- Department of Health Behavior, University of Alabama at Birmingham, Birmingham, AL 35294, USA; (E.A.S.); (K.B.P.); (W.W.C.); (D.W.P.)
| | - William Walker Cole
- Department of Health Behavior, University of Alabama at Birmingham, Birmingham, AL 35294, USA; (E.A.S.); (K.B.P.); (W.W.C.); (D.W.P.)
| | - Mohanraj Thirumalai
- Health Services Administration, University of Alabama at Birmingham, Birmingham, AL 35294, USA;
| | - Dori W. Pekmezi
- Department of Health Behavior, University of Alabama at Birmingham, Birmingham, AL 35294, USA; (E.A.S.); (K.B.P.); (W.W.C.); (D.W.P.)
- O’Neal Comprehensive Cancer Center, University of Alabama at Birmingham, Birmingham, AL 35294, USA; (R.A.O.); (M.P.)
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Mohanraj S, Malone LA, Mendonca CJ, Thirumalai M. Development and Formative Evaluation of a Virtual Exercise Platform for a Community Fitness Center Serving Individuals With Physical Disabilities: Mixed Methods Study. JMIR Form Res 2023; 7:e49685. [PMID: 38100173 PMCID: PMC10757225 DOI: 10.2196/49685] [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: 06/05/2023] [Revised: 07/31/2023] [Accepted: 08/04/2023] [Indexed: 12/17/2023] Open
Abstract
BACKGROUND People with disabilities experience numerous barriers to being physically active, such as transportation issues, a lack of trained exercise professionals who understand disabilities, and facility access. The use of a virtual exercise platform (VEP) may provide an alternative and limit certain barriers. OBJECTIVE The aim of this mixed method study was to evaluate user interaction (effectiveness, efficiency, and satisfaction), the strengths and weaknesses of the user interface, and the user experience with a VEP. METHODS Participants were recruited from a community fitness facility that offers programs for people with disabilities. Inclusion criteria were being older than 18 years, fluent in English, and availability of internet access. Features of the VEP included articles, prerecorded videos, live Zoom classes, web-based class registration, weekly progress tracking, incentives, and surveys. A one-on-one Zoom session was scheduled with each participant, during which they completed certain tasks: (1) create an account or login, (2) register for class, (3) join class, (4) add to calendar, and (5) complete surveys. As participants completed tasks, quantitative observations (time on task, task success, rate of task completion, and number of errors by users, which determined task difficulty), qualitative observations were made and interviews were conducted at the end of the session. The "concurrent think-aloud" method was encouraged by the moderator to gauge participants' thoughts as they worked through testing. Participants also completed the System Usability Scale (SUS) and Questionnaire for User Interface Satisfaction (QUIS). RESULTS A total of 5 people with disabilities (3 male, 2 female), aged 36-78 (mean 54) years, with education levels from high school to PhD, were recruited. Devices used for testing included a laptop (n=3), a Chromebook (n=1), and a desktop (n=1). All participants completed tasks #1 and #2 without errors but could not complete task #4. One participant completed task #5 with difficulty and another completed task #3 with difficulty. The average time to complete each task was: (1) 82 seconds (55-110), (2) 11 seconds (4-21), (3) 9 seconds (5-27), and (4) 921.5 seconds (840-958). The mean SUS score was 86.5/100, and the mean user QUIS score was 8.08 out of 10. Qualitative observations indicated that the system was simple, user-friendly, and accessible. CONCLUSIONS People with disabilities reported high usability and user satisfaction with the web-based exercise platform, and the system appears to be an efficient and effective physical activity option.
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Affiliation(s)
- Sangeetha Mohanraj
- School of Health Professions, The University of Alabama at Birmingham, Birmingham, AL, United States
| | - Laurie A Malone
- Department of Occupational Therapy, School of Health Professions, The University of Alabama at Birmingham, Birmingham, AL, United States
| | - Christen J Mendonca
- School of Health Professions, The University of Alabama at Birmingham, Birmingham, AL, United States
| | - Mohanraj Thirumalai
- Department of Health Services Administration, School of Health Professions, The University of Alabama at Birmingham, Birmingham, AL, United States
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Mendonca CJ, Malone LA, Mohanraj S, Thirumalai M. The Usability of a Touchpad Active Video Game Controller for Individuals With Impaired Mobility: Observational Study. JMIR Rehabil Assist Technol 2023; 10:e41993. [PMID: 37535411 PMCID: PMC10436121 DOI: 10.2196/41993] [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: 08/17/2022] [Revised: 03/07/2023] [Accepted: 05/15/2023] [Indexed: 08/04/2023] Open
Abstract
BACKGROUND Video games are a popular sedentary activity among people with impaired mobility; however, active video game hardware typically lacks accessibility and customization options for individuals with mobility impairments. A touchpad video game system can elicit moderate physical activity in healthy adults; however, it is unclear if this system is usable by adults with impaired mobility. OBJECTIVE The purpose of this study was to assess the usability of a touchpad video game controller system adapted for adults with impaired mobility. Additional outcomes explored were enjoyment, perceived exertion, self-efficacy, participant feedback, and researcher observations of gameplay. METHODS Participants played several video game titles for 20 minutes with a touchpad video game controller as they stood or sat in a chair or their wheelchair. Usability was assessed with the System Usability Scale (SUS) and the Health Information Technology Usability Evaluation Scale (Health-ITUES) surveys after gameplay. After each video game, participants reported enjoyment using a visual analog scale (0 to 100 mm) and a rating of perceived exertion using the OMNI 0 to 10 scale. Self-efficacy was measured before and after gameplay. Participants provided feedback at the end of their session. RESULTS In total, 21 adults (6 females and 15 males) with a mean age of 48.8 (SD 13.8) years with various mobility impairments participated in this study. The touchpads received mean usability scores on the SUS 80.1 (SD 18.5) and Health-ITUES 4.23 (SD 0.67). CONCLUSIONS The SUS scores reported suggest the touchpad system is "usable"; however, the Health-ITUES scores were slightly below a suggested benchmark. Participants reported moderate to high enjoyment but perceived the exertion as "somewhat easy." Self-efficacy was moderate to high and did not differ pre- to postgame play. The participants regarded the touchpads as novel, fun, and entertaining. The generalizability of our results is limited due to the heterogenous sample; however, our participants identified several areas of improvement for future iteration.
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Affiliation(s)
- Christen J Mendonca
- School of Health Professions, The University of Alabama at Birmingham, Birmingham, AL, United States
| | - Laurie A Malone
- School of Health Professions, The University of Alabama at Birmingham, Birmingham, AL, United States
| | - Sangeetha Mohanraj
- School of Health Professions, The University of Alabama at Birmingham, Birmingham, AL, United States
| | - Mohanraj Thirumalai
- School of Health Professions, The University of Alabama at Birmingham, Birmingham, AL, United States
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Wilroy J, Kim Y, Lai B, Young HJ, Giannone J, Powell D, Thirumalai M, Mehta T, Rimmer J. Increasing Physical Activity in Persons With Spinal Cord Injury With an eHealth-Based Adaptive Exercise Intervention: Protocol for a Sequential Multiple Assignment Randomized Trial. JMIR Res Protoc 2023; 12:e47665. [PMID: 37498650 PMCID: PMC10415946 DOI: 10.2196/47665] [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: 05/26/2023] [Revised: 06/07/2023] [Accepted: 06/08/2023] [Indexed: 07/28/2023] Open
Abstract
BACKGROUND Participating in an adequate amount of physical activity to acquire health benefits is challenging for people with spinal cord injury (SCI) due to personal and logistic barriers. Barriers in the built and social environments may include lack of transportation, lack of accessible facilities or programs, and lack of training among fitness personnel. Low self-efficacy, lack of self-regulation skills, and improper outcome expectations are examples of personal barriers. Current approaches to investigating physical activity programs in people with SCI have been limited to traditional "one-size-fits-all" design, which has yielded low adherence rates, high dropout rates, and participants not maintaining physical activity levels at follow-up. OBJECTIVE The primary aim of this study is to test the feasibility of a tele-exercise program that applies an adaptive intervention design for 30 adults with SCI, targeting increases in adherence to the exercise program and physical activity participation. METHODS The Sequential Multiple Assignment Randomized Trial for Home-based Exercise and Lifestyle Tele-Health (SMART-HEALTH) is a 12-week, home-based, movement-to-music (M2M) program. The goal of a SMART-designed study is to develop an adaptive intervention that modifies support provisions based on response levels. In SMART-HEALTH, 2 groups of participants will undergo 3-week and 6-week asynchronous M2M interventions in the first phase. Participants who did not achieve the desired adherence rate (≥95% of video watch minutes) will be rerandomized into M2M Live (switch) or individualized behavioral coaching (augmented with the asynchronous M2M program). The study will primarily assess rates of recruitment or enrollment, adherence and retention, timing to identify nonresponders, and scientific outcomes (eg, physical activity and exercise self-efficacy). The study will qualitatively evaluate the acceptability of the study using semistructured interviews among participants who complete the 12-week intervention. RESULTS Recruitment procedures started in June 2022. All data are expected to be collected by September 2023. Full trial results are expected to be published by March 2024. Secondary analyses of data will be subsequently published. Results will include exercise adherence rates; changes in self-reported physical activity levels and blood pressure; and changes in secondary conditions including pain, sleep, and fatigue. Thematic analysis of semistructured interviews will include results on participant enjoyment and acceptability of SMART-HEALTH and inform modifications for future delivery of the program. CONCLUSIONS This study will strengthen our understanding of the potential benefits of the tele-exercise intervention for people with SCI and build upon adaptive intervention design and its delivery strategies that aim to increase adoption and sustainable exercise behavior. This pilot trial will inform future SMART-designed studies and provide new and innovative strategies for investigating intervention effects on physical activity behavior in the SCI population. TRIAL REGISTRATION ClinicalTrials.gov NCT04726891; https://classic.clinicaltrials.gov/ct2/show/NCT04726891. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID) DERR1-10.2196/47665.
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Affiliation(s)
- 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
| | - Byron Lai
- Division of Pediatric Rehabilitation Medicine, University of Alabama at Birmingham, Birmingham, AL, United States
| | - Hui-Ju Young
- Research Collaborative, University of Alabama at Birmingham, Birmingham, AL, United States
| | - John Giannone
- Research Collaborative, University of Alabama at Birmingham, Birmingham, AL, United States
| | - Danielle Powell
- Department of Physical Medicine and Rehabilitation, 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
| | - Tapan Mehta
- Department of Family and Community Medicine, University of Alabama at Birmingham, Birmingham, AL, United States
| | - James Rimmer
- Research Collaborative, University of Alabama at Birmingham, Birmingham, AL, United States
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Evans E, Zengul A, Knight A, Willig A, Cherrington A, Mehta T, Thirumalai M. My Health, My Life, My Way-An Inclusive Web-Based Self-management Program for People With Disabilities Living With Chronic Conditions: Protocol for a Multiphase Optimization Strategy Study. JMIR Res Protoc 2023; 12:e31694. [PMID: 37115620 PMCID: PMC10182470 DOI: 10.2196/31694] [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: 12/14/2022] [Revised: 02/13/2023] [Accepted: 02/16/2023] [Indexed: 04/29/2023] Open
Abstract
BACKGROUND Individuals with disabilities living with chronic health conditions require self-management programs that are accessible, sustainable, inclusive, and adaptable. Health coaching is an effective approach to promoting behavior change in self-management. Health coaching combined with telehealth technology has the potential to improve the overall quality of, and access to, health services. OBJECTIVE This protocol outlines the study design for implementing the My Health, My Life, My Way intervention. The study will assess the feasibility, acceptability, and preliminary efficacy of the intervention for people with disabilities and optimize it. METHODS The My Health, My Life, My Way study is a 4-arm randomized controlled trial evaluating the delivery of a 6-month intervention involving telecoaching, inclusive educational content, and technology access for 200 individuals with chronic conditions and physical disabilities. This study uses the engineering-inspired multiphase optimization strategy (MOST) framework to evaluate intervention components and assess whether a combination or lack of individual elements influences behavior. Participants will be randomized to 1 of 4 study arms: scheduled coaching calls and gamified rewards, no scheduled coaching calls and gamified rewards, scheduled coaching calls and flat rewards, and no scheduled coaching calls and flat rewards. RESULTS The My Health, My Life, My Way study was approved by the institutional review board of the University of Alabama at Birmingham, and recruitment and enrollment will begin in May 2023. Data analysis is expected to be completed within 6 months of ending data collection. This clinical trial protocol was developed based on the SPIRIT (Standard Protocol Items: Recommendations for Interventional Trials) 2013 statement. CONCLUSIONS The My Health, My Life, My Way study will help to optimize and improve our understanding of the feasibility and efficacy of a web-based self-management program for people with physical disabilities and chronic conditions. More specifically, My Health, My Life, My Way will determine which combination of interventions (coaching calls and gamification) will result in increased participation in self-management programming. The My Health, My Life, My Way intervention has the potential to become a scalable and novel method to successfully manage chronic conditions in people with disabilities. TRIAL REGISTRATION ClinicalTrials.gov NCT05481593; https://clinicaltrials.gov/ct2/show/NCT05481593. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID) PRR1-10.2196/31694.
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Affiliation(s)
- Eric Evans
- Department of Health Services Administration, School of Health Professions, University of Alabama at Birmingham, Birmingham, AL, United States
| | - Ayse Zengul
- Department of Nutrition Sciences, School of Health Professions, University of Alabama at Birmingham, Birmingham, AL, United States
| | - Amy Knight
- Department of Neurology, Heersink School of Medicine, University of Alabama at Birmingham, Birmingham, AL, United States
| | - Amanda Willig
- Division of Infectious Disease, Heersink School of Medicine, University of Alabama at Birmingham, Birmingham, AL, United States
| | - Andrea Cherrington
- Division of Preventive Medicine, Heersink School of Medicine, University of Alabama at Birmingham, Birmingham, AL, United States
| | | | - Mohanraj Thirumalai
- Department of Health Services Administration, School of Health Professions, University of Alabama at Birmingham, Birmingham, AL, United States
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Zary N, Mendonca CJ, Mohanraj S, Misko SR, Moore J, Brascome JM, Thirumalai M. Usability of the GAIMplank Video Game Controller for People With Mobility Impairments: Observational Study. JMIR Serious Games 2023; 11:e38484. [PMID: 36626195 PMCID: PMC9947916 DOI: 10.2196/38484] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2022] [Revised: 07/02/2022] [Accepted: 10/11/2022] [Indexed: 01/11/2023] Open
Abstract
BACKGROUND Replacing sedentary behaviors during leisure time with active video gaming has been shown to be an enjoyable option for increasing physical activity. However, most off-the-shelf active video gaming controllers are not accessible or usable for individuals with mobility impairments. To address this requirement, a universal video game controller (called the GAIMplank) was designed and developed. OBJECTIVE This study aimed to assess the usability of the GAIMplank video game controller for playing PC video games among individuals with mobility impairments. Measures of enjoyment, perceived exertion, and qualitative data on the user experience were also examined. METHODS Adults (aged 18-75 years) with a mobility impairment were recruited to participate in a single testing session in the laboratory. Before testing began, basic demographic information, along with minutes of weekday and weekend physical activity, minutes of weekday and weekend video game play, and video game play experience were collected. The GAIMplank was mapped to operate as a typical joystick controller. Depending on their comfort and functional ability, participants chose to play seated in a chair, standing, or in their own manual wheelchair. Leaning movements of the trunk created corresponding action in the game (ie, lean right to move right). The participants played a total of 5 preselected video games for approximately 5 minutes each. Data were collected to assess the usability of the GAIMplank, along with self-efficacy regarding execution of game play actions, rating of perceived exertion and enjoyment for each game, and overall qualitative feedback. RESULTS A total of 21 adults (n=15, 71% men; n=6, 29% women) completed the usability testing, with a mean age of 48.8 (SD 13.8; range 21-73) years. Overall, 38% (8/21) of adults played while standing, 33% (7/21) of adults played while seated in a chair, and 29% (6/21) played in their own manual wheelchair. Scores from the System Usability Scale indicated above average (74.8, SD 14.5) usability, with scores best for those who played seated in a chair, followed by those standing, and then individuals who played seated in their own wheelchairs. Inconsistencies in the responsiveness of the controller and general feedback for minor improvements were documented. Rating of perceived exertion scores ranged from light to moderate intensity, with the highest scores for those who played seated in a chair. Participants rated their experience with playing each game from above average to very enjoyable. CONCLUSIONS The GAIMplank video game controller was found to be usable and accessible, providing an enjoyable option for light-to-moderate intensity exercise among adults with mobility impairments. Minor issues with inconsistencies in controller responsiveness were also recorded. Following further development and refinement, the next phase will include a pilot exercise intervention using the GAIMplank system.
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Affiliation(s)
| | - Christen J Mendonca
- School of Health Professions, The University of Alabama at Birmingham, Birmingham, AL, United States
| | - Sangeetha Mohanraj
- School of Health Professions, The University of Alabama at Birmingham, Birmingham, AL, United States
| | - Samuel R Misko
- Engineering and Innovative Technology Development, The University of Alabama at Birmingham, Birmingham, AL, United States
| | - Joseph Moore
- Engineering and Innovative Technology Development, The University of Alabama at Birmingham, Birmingham, AL, United States
| | - James Michael Brascome
- Engineering and Innovative Technology Development, The University of Alabama at Birmingham, Birmingham, AL, United States
| | - Mohanraj Thirumalai
- School of Health Professions, The University of Alabama at Birmingham, Birmingham, AL, United States
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9
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Wilroy J, Kim Y, Lai B, Mehta T, Thirumalai M, Mintz M, Rimmer J. Scale Up Project Evaluating Responsiveness to Home Exercise And Lifestyle Tele-Health (SUPER-HEALTH): Preliminary Findings. Arch Phys Med Rehabil 2022. [DOI: 10.1016/j.apmr.2022.08.752] [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: 12/03/2022]
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10
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Thirumalai M, Brown N, Niranjan S, Townsend S, Powell MA, Neal W, Schleicher E, Raparla V, Oster R, Demark-Wahnefried W, Pekmezi D. An Interactive Voice Response System to Increase Physical Activity and Prevent Cancer in the Rural Alabama Black Belt: Design and Usability Study. JMIR Hum Factors 2022; 9:e29494. [PMID: 34982714 PMCID: PMC8767466 DOI: 10.2196/29494] [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: 04/08/2021] [Revised: 08/29/2021] [Accepted: 09/11/2021] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Increased physical activity (PA) levels are associated with reduced risk and improved survival for several cancers; however, most Americans engage in less than the recommended levels of PA. Using interactive voice response (IVR) systems to provide personalized health education and counseling may represent a high-reach, low-cost strategy for addressing physical inactivity and cancer disparities in disproportionately burdened rural regions. However, there has been a paucity of research conducted in this area to date. OBJECTIVE The aim of this study is to design, develop, and test the usability of an IVR system aimed at increasing PA levels in the rural Alabama Black Belt. METHODS A pilot version of the IVR system was used to assess initial feasibility and acceptability. Detailed exit interviews were conducted to elicit participant feedback, which helped inform the development of a substantially upgraded in-house IVR system. This refined IVR system was then subjected to a sequential explanatory mixed methods evaluation. Participating rural county coordinators and research staff (N=10) tested the usability of the IVR system features for 2 weeks and then completed the System Usability Scale and qualitative semistructured interviews. RESULTS The study sample comprised mostly African American people, women, rural county coordinators, and research staff (N=10). Participants rated the IVR system with a mean score of 81 (SD 5) on the System Usability Scale, implying excellent usability. In total, 5 overarching themes emerged from the qualitative interviews: likes or dislikes of the intervention, barriers to or facilitators of PA, technical difficulties, quality of calls, and suggestions for intervention improvement. Message framing on step feedback, call completion incentives, and incremental goal-setting challenges were areas identified for improvement. The positive areas highlighted in the interviews included the personalized call schedules, flexibility to call in or receive a call, ability to make up for missed calls, narration, and PA tips. CONCLUSIONS The usability testing and feedback received from the rural county coordinators and research staff helped inform a final round of refinement to the IVR system before use in a large randomized controlled trial. This study stresses the importance of usability testing of all digital health interventions and the benefits it can offer to the intervention.
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Affiliation(s)
- Mohanraj Thirumalai
- Department of Health Services Administration, School of Health Professions, University of Birmingham at Alabama, Birmingham, AL, United States
| | - Nashira Brown
- Department of Nutrition Sciences, School of Health Professions, University of Birmingham at Alabama, Birmingham, AL, United States
| | - Soumya Niranjan
- Department of Health Services Administration, School of Health Professions, University of Birmingham at Alabama, Birmingham, AL, United States
| | - Sh'Nese Townsend
- Department of Health Behavior, School of Public Health, University of Alabama at Birmingham, Birmingham, AL, United States
| | - Mary Anne Powell
- Department of Health Behavior, School of Public Health, University of Alabama at Birmingham, Birmingham, AL, United States
| | - Whitney Neal
- Department of Health Behavior, School of Public Health, University of Alabama at Birmingham, Birmingham, AL, United States
| | - Erica Schleicher
- Department of Health Behavior, School of Public Health, University of Alabama at Birmingham, Birmingham, AL, United States
| | - Venkatadri Raparla
- University of Alabama at Birmingham/Lakeshore Research Collaborative, School of Health Professions, University of Alabama at Birmingham, Birmingham, AL, United States
| | - Robert Oster
- Division of Preventive Medicine, Heersink School of Medicine, University of Alabama at Birmingham, Birmingham, AL, United States
| | - Wendy Demark-Wahnefried
- Department of Nutrition Sciences, School of Health Professions, University of Birmingham at Alabama, Birmingham, AL, United States
| | - Dori Pekmezi
- Department of Health Behavior, School of Public Health, University of Alabama at Birmingham, Birmingham, AL, United States
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11
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Wilroy J, Lai B, Currie M, Young HJ, Thirumalai M, Mehta T, Giannone J, Rimmer J. Teleassessments for Enrollment of Adults With Physical or Mobility Disability in a Home-Based Exercise Trial in Response to COVID-19: Usability Study. JMIR Form Res 2021; 5:e29799. [PMID: 34792477 PMCID: PMC8663535 DOI: 10.2196/29799] [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] [Received: 04/21/2021] [Revised: 07/01/2021] [Accepted: 09/18/2021] [Indexed: 11/20/2022] Open
Abstract
Background The Scale-Up Project Evaluating Responsiveness to Home Exercise And Lifestyle Tele-Health (SUPER-HEALTH) initiative is a large randomized controlled study that aims to overcome logistical barriers to exercise via telehealth for people with physical disabilities. However, at the start of the COVID-19 pandemic, enrollment was halted due to limited operations at the testing site, which included no onsite visits that involved participant data collection. In response to the limited operations, a modified data collection protocol was developed for virtual enrollment of study participants. Objective This paper presents feasibility data on using teleassessments to enroll people with mobility impairment into a home-based exercise trial. Methods The modified protocol replaced onsite enrollment and data collection visits with teleassessments using a computer tablet and testing equipment that was shipped to the participants’ home address prior to the synchronous teleassessments conducted by an exercise physiologist through Zoom. The participants were mailed a teleassessment toolkit that included a digital blood pressure cuff, spirometer, hand dynamometer, mini disc cone, and measuring tape (to complete standardized testing). The teleassessment measures included resting blood pressure and heart rate, forced vital capacity, grip strength, Five Times Sit to Stand, and Timed Up and Go. Feasibility metrics included technological effectiveness, efficiency, and safety. The technological effectiveness of the telehealth assessment was determined by the percentage of sessions completed without technical issues with ≥90% criteria set a priori. Efficiency was measured by a session duration of ≤2 hours. Safety was measured by the number of adverse events related to the teleassessments reported. Results Data from 36 participants were included in this feasibility study, and 34 (94%) participants completed all teleassessments without technical issues. For efficiency, the teleassessment sessions were completed in a mean time of 65 minutes and a maximum session length of 110 minutes. There were no adverse events reported to indicate concerns with the safety of teleassessments. Conclusions The modified teleassessment protocol, in response to COVID-19 restrictions, may be a feasible process for enrolling adults with mobility impairment into a home exercise trial who otherwise would have not been able to participate. Trial Registration ClinicalTrials.gov NCT03024320; https://clinicaltrials.gov/ct2/show/NCT03024320
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Affiliation(s)
- Jereme Wilroy
- University of Alabama at Birmingham, Birmingham, AL, United States
| | - Byron Lai
- University of Alabama at Birmingham, Birmingham, AL, United States
| | - Madison Currie
- University of Alabama at Birmingham, Birmingham, AL, United States
| | - Hui-Ju Young
- University of Alabama at Birmingham, Birmingham, AL, United States
| | | | - Tapan Mehta
- University of Alabama at Birmingham, Birmingham, AL, United States
| | - John Giannone
- University of Alabama at Birmingham, Birmingham, AL, United States
| | - James Rimmer
- University of Alabama at Birmingham, Birmingham, AL, 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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14
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Evans E, Zengul A, Hall A, Qu H, Willig A, Cherrington A, Thirumalai M. Disability-Inclusive Diabetes Self-management Telehealth Program: Protocol for a Pilot and Feasibility Study. JMIR Res Protoc 2021; 10:e31689. [PMID: 34505831 PMCID: PMC8463947 DOI: 10.2196/31689] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2021] [Accepted: 07/06/2021] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND Individuals with disabilities and type 2 diabetes require self-management programs that are accessible, sustainable, inclusive, and adaptable. Health coaching has been shown to be an effective approach for improving behavioral changes in self-management. Health coaching combined with telehealth technology has the potential to improve the overall quality of and access to health services. OBJECTIVE This protocol outlines the study design for implementing the Artificial Intelligence for Diabetes Management (AI4DM) intervention. The protocol will assess the feasibility, acceptability, and preliminary efficacy of the AI4DM telehealth platform for people with disabilities. METHODS The AI4DM study is a 2-arm randomized controlled trial for evaluating the delivery of a 12-month intervention, which will involve telecoaching, diabetes educational content, and technology access, to 90 individuals with diabetes and physical disabilities. The hypothesis is that this pilot project is feasible and acceptable for adults with permanently impaired mobility and type 2 diabetes. We also hypothesize that adults in the AI4DM intervention groups will have significantly better glycemic control (glycated hemoglobin) and psychosocial and psychological measures than the attention control group at the 3-, 6-, and 12-month follow-ups. RESULTS The AI4DM study was approved by the university's institutional review board, and recruitment and enrollment will begin in October 2021. CONCLUSIONS The AI4DM study will improve our understanding of the feasibility and efficacy of a web-based diabetes self-management program for people with disabilities. The AI4DM intervention has the potential to become a scalable and novel method for successfully managing type 2 diabetes in people with disabilities. TRIAL REGISTRATION ClinicalTrials.gov NCT04927377; https://clinicaltrials.gov/ct2/show/NCT04927377. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID) PRR1-10.2196/31689.
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Affiliation(s)
- Eric Evans
- Department of Health Services Administration, University of Alabama at Birmingham, Birmingham, AL, United States
| | - Ayse Zengul
- Department of Nutrition Sciences, University of Alabama at Birmingham, Birmingham, AL, United States
| | - Allyson Hall
- Department of Health Services Administration, University of Alabama at Birmingham, Birmingham, AL, United States
| | - Haiyan Qu
- Department of Health Services Administration, University of Alabama at Birmingham, Birmingham, AL, United States
| | - Amanda Willig
- Department of Medicine, University of Alabama at Birmingham, Birmingham, AL, United States
| | - Andrea Cherrington
- Department of Medicine, 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
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15
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Zengul A, Evans E, Hall A, Qu H, Willig A, Cherrington A, Thirumalai M. Telehealth Behavioral Intervention for Diabetes Management in Adults With Physical Disabilities: Intervention Fidelity Protocol for a Randomized Controlled Trial. JMIR Res Protoc 2021; 10:e31695. [PMID: 34505835 PMCID: PMC8463946 DOI: 10.2196/31695] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2021] [Accepted: 07/06/2021] [Indexed: 01/29/2023] Open
Abstract
BACKGROUND Diabetes mellitus is a major health problem among people with physical disabilities. Health coaching has been proven to be an effective approach in terms of behavioral changes, patient self-efficacy, adherence to treatment, health service use, and health outcomes. Telehealth systems combined with health coaching have the potential to improve the quality of health care by increasing access to services. Treatment fidelity is particularly important for behavior change studies; however, fidelity protocols are inadequately administered and reported in the literature. OBJECTIVE The aim of this study is to outline all the intervention fidelity strategies and procedures of a telecoaching intervention-artificial intelligence for diabetes management (AI4DM)-which is a randomized controlled trial to evaluate the feasibility, acceptability, and preliminary efficacy of a telehealth platform in adults with type 2 diabetes and permanent impaired mobility. AI4DM aims to create a web-based disability-inclusive diabetes self-management program. We selected the National Institutes of Health Behavior Change Consortium (NIH BCC) fidelity framework to describe strategies to ensure intervention fidelity in our research. METHODS We have developed fidelity strategies based on the five fidelity domains outlined by the NIH BCC-focusing on study design, provider training, treatment delivery, treatment receipt, and enactment of treatment skills. The design of the study is grounded in the social cognitive theory and is intended to ensure that both arms would receive the same amount of attention from the intervention. All providers will receive standardized training to deliver consistent health coaching to the participants. The intervention will be delivered through various controlling and monitoring strategies to reduce differences within and between treatment groups. The content and structure of the study are delivered to ensure comprehension and participation among individuals with low health literacy. By constantly reviewing and monitoring participant progress and protocol adherence, we intend to ensure that participants use cognitive and behavioral skills in real-world settings to engage in health behavior. RESULTS Enrollment for AI4DM will begin in October 2021 and end in October 2022. The results of this study will be reported in late 2022. CONCLUSIONS Developing and using fidelity protocols in behavior change studies is essential to ensure the internal and external validity of interventions. This study incorporates NIH BCC recommendations into an artificial intelligence embedded telecoaching platform for diabetes management designed for people with physical disabilities. The developed fidelity protocol can provide guidance for other researchers conducting telehealth interventions within behavioral health settings to present more consistent and reproducible research. TRIAL REGISTRATION ClinicalTrials.gov NCT04927377; http://clinicaltrials.gov/ct2/show/NCT04927377. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID) PRR1-10.2196/31695.
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Affiliation(s)
- Ayse Zengul
- Department of Nutrition Sciences, University of Alabama at Birmingham, Birmingham, AL, United States
| | - Eric Evans
- Department of Health Services Administration, University of Alabama at Birmingham, Birmingham, AL, United States
| | - Allyson Hall
- Department of Health Services Administration, University of Alabama at Birmingham, Birmingham, AL, United States
| | - Haiyan Qu
- Department of Health Services Administration, University of Alabama at Birmingham, Birmingham, AL, United States
| | - Amanda Willig
- Department of Medicine, University of Alabama at Birmingham, Birmingham, AL, United States
| | - Andrea Cherrington
- Department of Medicine, 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
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16
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Malone LA, Davlyatov GK, Padalabalanarayanan S, Thirumalai M. Active Video Gaming Using an Adapted Gaming Mat in Youth and Adults With Physical Disabilities: Observational Study. JMIR Serious Games 2021; 9:e30672. [PMID: 34435962 PMCID: PMC8430845 DOI: 10.2196/30672] [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] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2021] [Revised: 06/21/2021] [Accepted: 07/02/2021] [Indexed: 11/23/2022] Open
Abstract
Background A common leisure-time activity amongst youth and adults in the United States is video gameplay. Playing video games is typically a sedentary endeavor; however, to encourage an increased level of physical activity in an engaging and enjoyable way, active video gaming has become popular. Unfortunately, the accessibility of gaming controllers is often an issue for persons with disabilities. A commercial off-the-shelf (OTS) gaming mat was adapted to facilitate use by individuals with mobility impairments to address this issue. Objective Our study aimed to examine energy expenditure, enjoyment, and gameplay experience in youth and adults with mobility impairment during active video gaming using an OTS and adapted versions of a gaming mat. Methods The study used an observational design. During visit 1, physical function was assessed, and participants were given a familiarization period with the gaming system. For visit 2, based on observation during the physical function tests and discussion with the participant, it was decided whether the participant would play in a standing or seated position. For standing gameplay, the mat was placed on the floor, and for seated play, the mat was placed on a height-adjustable and tilt-adjustable tabletop. Metabolic data were collected during a 20-minute baseline and four 10-minute bouts of Wii Fit Plus gameplay, with 2 bouts on each of the mats (adapted and OTS). During gameplay, the research staff observed and rated participants’ ability to use the game controller (mat) and the quality of gameplay. At the end of each game set, participants reported their rating of perceived exertion on a scale from 0 to 10. During rest, participants completed the physical activity enjoyment scale. Participants also answered additional questions regarding the system's usability with each controller (adapted mat and OTS mat). Statistical analyses were computed using Stata 16 (version 16.1; StataCorp). Linear mixed-effects maximum likelihood regression was performed separately for individuals who could play standing and for those who played seated. Results A convenience sample of 78 individuals with mobility impairments between the ages of 12 and 60 years (mean 39.6, SD 15.8) participated in the study. Of the sample, 48 participants played the video games in a seated position, while 30 played the games standing. Energy expenditure and heart rate tended to be higher in the OTS mat condition for seated players, while values were similar for both conditions among standing players. However, seated participants reported greater gameplay experience, and both groups exhibited a higher quality of gameplay during the adapted mat condition. Conclusions Active video gaming using an adapted gaming mat provided an enjoyable exercise activity for individuals with mobility impairments. The use of the adapted controller provides a means by which this population can engage in light to moderate intensity active video gaming, thereby reducing sedentary leisure time. Trial Registration ClinicalTrials.gov NCT02994199; https://clinicaltrials.gov/ct2/show/NCT02994199
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Affiliation(s)
- Laurie A Malone
- University of Alabama at Birmingham/Lakeshore Research Collaborative, School of Health Professions, University of Alabama at Birmingham, Birmingham, AL, United States
| | - Ganisher K Davlyatov
- Department of Health Administration and Policy, Hudson College of Public Health, University of Oklahoma Health Sciences Center, Oklahoma City, OK, United States
| | - Sangeetha Padalabalanarayanan
- University of Alabama at Birmingham/Lakeshore Research Collaborative, 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
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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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Thirumalai M, Zengul AG, Evans E. Challenges and Lessons Learned From a Telehealth Community Paramedicine Program for the Prevention of Hypoglycemia: Pre-Post Pilot Feasibility Study. JMIR Diabetes 2021; 6:e26941. [PMID: 34342593 PMCID: PMC8371490 DOI: 10.2196/26941] [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: 01/04/2021] [Revised: 03/26/2021] [Accepted: 06/17/2021] [Indexed: 12/03/2022] Open
Abstract
Background Prevention through Intervention is a community paramedicine program developed by Birmingham Fire and Rescue Services in Alabama. This program aims to reduce dependency on emergency medical services (EMS) for nonemergency-related events through education and to lower the frequency of emergency calls in underserved populations. A telehealth intervention with an emphasis on hypoglycemia was implemented to (1) tailor the intervention to meet the educational needs of participants and (2) facilitate follow-ups. A pre-post pilot feasibility evaluation of the telehealth intervention was conducted. Objective This paper describes the results of the feasibility evaluation, implementation challenges, and the lessons learned about the deployment of a hypoglycemia prevention program in an underserved area and its evaluation. Methods This single-arm pretest-posttest intervention included (1) an initial in-person visit (week 1), (2) 3 weekly telecoaching calls (weeks 2-4), (3) 1 biweekly call (week 6), and (4) a final in-person visit (week 8) for collecting posttest data from individuals who called EMS due to hypoglycemic events. In-person visits included educational sessions conducted by EMS personnel. Participants’ education included tailored content related to hypoglycemia. Weekly telecoaching calls focused on hypoglycemia symptom monitoring and education reinforcement via a telehealth dashboard. The primary measures focused on feasibility measures, and exploratory measures focused on the fear of hypoglycemia, self-efficacy, and a knowledge of diabetes. Results A total of 40 participants participated in the intervention. However, the study was marred with high attrition. The various factors behind the low retention rate were discussed. There was a decreasing trend in all three subdomains of the fear of hypoglycemia from pretest to posttest. There was also a significant increase in participants’ self-efficacy in hypoglycemia self-management (P=.03). Conclusions This study shows preliminary and promising results for a community-based intervention specifically for hypoglycemia. However, the socioeconomic setting in which the intervention was delivered may have resulted in high dropout rates and low attendance during the intervention, which are considerations for future telehealth studies. Trial Registration ClinicalTrials.gov NCT03665870; https://clinicaltrials.gov/ct2/show/NCT03665870
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Affiliation(s)
- Mohanraj Thirumalai
- Department of Health Services Administration, University of Alabama at Birmingham, Birmingham, AL, United States
| | - Ayse G Zengul
- Department of Health Services Administration, University of Alabama at Birmingham, Birmingham, AL, United States
| | - Eric Evans
- Department of Health Services Administration, University of Alabama at Birmingham, Birmingham, AL, United States
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Brown NI, Powell MA, Baskin M, Oster R, Demark-Wahnefried W, Hardy C, Pisu M, Thirumalai M, Townsend S, Neal WN, Rogers LQ, Pekmezi D. Design and Rationale for the Deep South Interactive Voice Response System-Supported Active Lifestyle Study: Protocol for a Randomized Controlled Trial. JMIR Res Protoc 2021; 10:e29245. [PMID: 34032575 PMCID: PMC8188314 DOI: 10.2196/29245] [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] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2021] [Revised: 04/14/2021] [Accepted: 04/15/2021] [Indexed: 12/24/2022] Open
Abstract
BACKGROUND The rates of physical inactivity and related cancer incidence and mortality are disproportionately high in the Deep South region in the United States, a rural, medically underserved region with a large African American population compared with the rest of the nation. Given this region's lower rates of literacy and internet access, interactive voice response (IVR) system-automated telephone-based interventions have the potential to help overcome physical activity intervention barriers (literacy, internet access, costs, and transportation) but have yet to be extended to rural, underserved populations, such as in the Deep South. Thus, extensive formative research is being conducted to develop and beta test the Deep South IVR System-Supported Active Lifestyle intervention in preparation for dissemination in rural Alabama counties. OBJECTIVE This paper aims to describe the design and rationale of an ongoing efficacy trial of the Deep South IVR System-Supported Active Lifestyle intervention. METHODS A two-arm randomized controlled trial will be conducted to compare a 12-month physical activity intervention versus a wait-list control condition in 240 underactive adults from 6 rural Alabama counties. The Deep South IVR System-Supported Active Lifestyle intervention is based on the Social Cognitive Theory and includes IVR-automated physical activity-related phone counseling (daily in months 0-3, twice weekly in months 4-6, and weekly in months 7-12) and support from local rural county coordinators with the University of Alabama O'Neal Comprehensive Cancer Center Community Outreach and Engagement Office. The primary outcome is weekly minutes of moderate- to vigorous-intensity physical activity (7-day physical activity recall; accelerometry) at baseline, 6 months, 12 months, and 18 months. Rural Active Living Assessments will be conducted in each rural county to assess walkability, assess recreational amenities, and inform future environment and policy efforts. RESULTS This study was funded in March 2019 and approved by the institutional review board of the University of Alabama at Birmingham in April 2019. As of February 2020, start-up activities (hiring and training staff and purchasing supplies) were completed. Study recruitment and assessments began in September 2020 and are ongoing. As of February 2021, a total of 43 participants have been enrolled in Dallas County, 42 in Sumter County, and 51 in Greene County. CONCLUSIONS IVR-supported phone counseling has great potential for addressing physical activity barriers (eg, culture, literacy, cost, or transportation) and reducing related rural health disparities in this region. TRIAL REGISTRATION ClinicalTrials.gov NCT03903874; https://clinicaltrials.gov/ct2/show/NCT03903874. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID) DERR1-10.2196/29245.
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Affiliation(s)
- Nashira I Brown
- Department of Health Behavior, University of Alabama at Birmingham, Birmingham, AL, United States
| | - Mary Anne Powell
- Department of Health Behavior, University of Alabama at Birmingham, Birmingham, AL, United States
| | - Monica Baskin
- Department of Medicine, Division of Preventive Medicine, University of Alabama at Birmingham, Birmingham, AL, United States
- O'Neal Comprehensive Cancer Center at UAB, Birmingham, AL, United States
| | - Robert Oster
- Department of Medicine, Division of Preventive Medicine, University of Alabama at Birmingham, Birmingham, AL, United States
- O'Neal Comprehensive Cancer Center at UAB, Birmingham, AL, United States
| | - Wendy Demark-Wahnefried
- O'Neal Comprehensive Cancer Center at UAB, Birmingham, AL, United States
- Department of Nutrition Sciences, University of Alabama at Birmingham, Birmingham, AL, United States
| | - Claudia Hardy
- O'Neal Comprehensive Cancer Center at UAB, Birmingham, AL, United States
| | - Maria Pisu
- Department of Medicine, Division of Preventive Medicine, University of Alabama at Birmingham, Birmingham, AL, United States
- O'Neal Comprehensive Cancer Center at UAB, Birmingham, AL, United States
| | - Mohanraj Thirumalai
- Health Services Administration, University of Alabama at Birmingham, Birmingham, AL, United States
| | - Sh'Nese Townsend
- Department of Health Behavior, University of Alabama at Birmingham, Birmingham, AL, United States
| | - Whitney N Neal
- Department of Health Behavior, University of Alabama at Birmingham, Birmingham, AL, United States
| | - Laura Q Rogers
- Department of Medicine, Division of Preventive Medicine, University of Alabama at Birmingham, Birmingham, AL, United States
- O'Neal Comprehensive Cancer Center at UAB, Birmingham, AL, United States
| | - Dori Pekmezi
- Department of Health Behavior, University of Alabama at Birmingham, Birmingham, AL, United States
- O'Neal Comprehensive Cancer Center at UAB, Birmingham, AL, United States
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20
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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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21
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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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22
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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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23
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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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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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Ainsworth MC, Perumean-Chaney SE, Fontaine KR, Thirumalai M, Rogers LQ, Pekmezi D. Sedentary Adult Characteristics and Exercise Benefits and Barriers: Associations in an Interactive Voice Response Study. Med Sci Sports Exerc 2019. [DOI: 10.1249/01.mss.0000562665.77048.83] [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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Malone LA, Padalabalanarayanan S, Thirumalai M. Comparison of Energy Expenditure in Wheelchair Users During Active Video Gaming with Adapted Game Controllers. Med Sci Sports Exerc 2019. [DOI: 10.1249/01.mss.0000561001.83474.cc] [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, 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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Malone LA, Thirumalai M, Padalabalanarayanan S, Neal WN, Bowman S, Mehta T. Energy Expenditure and Enjoyment During Active Video Gaming Using an Adapted Wii Fit Balance Board in Adults with Physical Disabilities: Observational Study. JMIR Serious Games 2019; 7:e11326. [PMID: 30707098 PMCID: PMC6376329 DOI: 10.2196/11326] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [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: 06/18/2018] [Revised: 12/10/2018] [Accepted: 12/30/2018] [Indexed: 01/18/2023] Open
Abstract
Background Individuals with physical disabilities have fewer opportunities to participate in enjoyable physical activity. One option for increasing physical activity is playing active video games (AVGs); however, many AVGs are inaccessible or offer limited play options. Objective This study aimed to examine energy expenditure and enjoyment in adults with mobility impairment during AVG play using off-the-shelf (OTS) and adapted versions of the Wii Fit balance board (Nintendo). Methods During visit 1, participants completed a functional assessment and the familiarization period. During visit 2, metabolic data were collected during a 20-minute baseline and four 10-minute bouts of Wii Fit Plus game play, with two bouts on each of the boards. During the resting period, participants completed the Physical Activity Enjoyment Scale (PACES). Statistical analyses were computed using SPSS software. Data were analyzed separately for individuals who were able to play while standing on both boards (StdStd); those who could not play while standing on the OTS board, but were able to play while standing on the adapted board (aStd); and those who could only play while sitting on the adapted board (aSit). Results Data were collected for 58 participants (StdStd, n=17; aStd, n=10; aSit, n=31). The sample included 31 men and 27 women with a mean age of 41.21 (SD 12.70) years. Energy expenditure (metabolic equivalent [MET]) during game play was significantly greater than that during rest for all players. Only 17 participants (StdStd group) were able to play using the OTS board. During game play on the adapted board, the average MET values for the two game sets were 2.261 (SD 0.718) kcal/kg/hour and 2.233 (SD 0.751) kcal/kg/hour for the aSit group, 3.151 (SD 1.034) and 2.990 (SD 1.121) for the aStd group, and 2.732 (SD 0.655) and 2.777 (SD 0.803) for the StdStd group. For game play on the adapted board, self-reported ratings of perceived exertion on a 0-10 scale suggested greater exercise intensity levels, with median scores ranging from moderate (3) to very hard (7). The PACES scores indicated that all players enjoyed using the adapted board, with a median score of 4 on a 5-point scale. Conclusions The adapted Wii Fit balance board provided an opportunity for individuals with mobility impairments, including wheelchair users, to engage in AVG. All participants were able to utilize the adapted controller and enjoyed the AVG activity. Although the average MET values achieved during AVG represented light-intensity exercise (<3 METs), 16% of sitting participants and 41% of standing participants achieved moderate-intensity exercise (3-6 METs) in at least one of the games. Factors not accounted for, which may have influenced the intensity of exercise, include game selection, limited familiarization period, and discomfort wearing the COSMED portable metabolic system for measurement of oxygen consumption. Accessible AVG controllers offer an innovative approach to overcome various barriers to participation in physical activity. The next steps include assessment of an AVG intervention using an adapted board gaming controller on health and fitness outcomes. Trial Registration ClinicalTrials.gov NCT02994199; https://clinicaltrials.gov/ct2/show/NCT02994199 (Archived by Webcite at http://www.webcitation.org/75fc0mN39).
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Affiliation(s)
- Laurie A Malone
- University of Alabama at Birmingham/Lakeshore Foundation Research Collaborative, Birmingham, AL, United States
| | - Mohanraj Thirumalai
- University of Alabama at Birmingham/Lakeshore Foundation Research Collaborative, Birmingham, AL, United States
| | | | - Whitney N Neal
- University of Alabama at Birmingham/Lakeshore Foundation Research Collaborative, Birmingham, AL, United States
| | - Sean Bowman
- University of Alabama at Birmingham/Lakeshore Foundation Research Collaborative, Birmingham, AL, United States
| | - Tapan Mehta
- University of Alabama at Birmingham/Lakeshore Foundation Research Collaborative, Birmingham, AL, United States
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Thirumalai M, Lai B, Wilroy J, Young HJ, Mehta T, Rimmer JH. User-Centered Design of mHealth Apps to Promote Physical Activity Behavior Change in People With Disabilities. Arch Phys Med Rehabil 2018. [DOI: 10.1016/j.apmr.2018.07.313] [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: 10/28/2022]
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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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Malone LA, Padalabalanarayanan S, Thirumalai M. Adapted Wii Fit Controller for Active Videogaming in Individuals with Mobility Impairments. Med Sci Sports Exerc 2018. [DOI: 10.1249/01.mss.0000538215.92367.0e] [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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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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Thirumalai M, Kirkland WB, Misko SR, Padalabalanarayanan S, Malone LA. Adapting the Wii Fit Balance Board to Enable Active Video Game Play by Wheelchair Users: User-Centered Design and Usability Evaluation. JMIR Rehabil Assist Technol 2018; 5:e2. [PMID: 29510972 PMCID: PMC5861301 DOI: 10.2196/rehab.8003] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [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: 05/31/2017] [Revised: 10/24/2017] [Accepted: 01/17/2018] [Indexed: 12/30/2022] Open
Abstract
Background Active video game (AVG) playing, also known as “exergaming,” is increasingly employed to promote physical activity across all age groups. The Wii Fit Balance Board is a popular gaming controller for AVGs and is used in a variety of settings. However, the commercial off-the-shelf (OTS) design poses several limitations. It is inaccessible to wheelchair users, does not support the use of stabilization assistive devices, and requires the ability to shift the center of balance (COB) in all directions to fully engage in game play. Objective The aim of this study was to design an adapted version of the Wii Fit Balance Board to overcome the identified limitations and to evaluate the usability of the newly designed adapted Wii Fit Balance Board in persons with mobility impairments. Methods In a previous study, 16 participants tried the OTS version of the Wii Fit Balance Board. On the basis of observed limitations, a team of engineers developed and adapted the design of the Wii Fit Balance Board, which was then subjected to multiple iterations of user feedback and design tweaks. On design completion, we recruited a new pool of participants with mobility impairments for a larger study. During their first visit, we assessed lower-extremity function using selected mobility tasks from the International Classification of Functioning, Disability and Health. During a subsequent session, participants played 2 sets of games on both the OTS and adapted versions of the Wii Fit Balance Board. Order of controller version played first was randomized. After participants played each version, we administered the System Usability Scale (SUS) to examine the participants’ perceived usability. Results The adapted version of the Wii Fit Balance Board resulting from the user-centered design approach met the needs of a variety of users. The adapted controller (1) allowed manual wheelchair users to engage in game play, which was previously not possible; (2) included Americans with Disabilities Act-compliant handrails as part of the controller, enabling stable and safe game play; and (3) included a sensitivity control feature, allowing users to fine-tune the controller to match the users’ range of COB motion. More than half the sample could not use the OTS version of the Wii Fit Balance Board, while all participants were able to use the adapted version. All participants rated the adapted Wii Fit Balance Board at a minimum as “good,” while those who could not use the OTS Wii Fit Balance Board rated the adapted Wii Fit Balance Board as “excellent.” We found a significant negative correlation between lower-extremity function and differences between OTS and adapted SUS scores, indicating that as lower-extremity function decreased, participants perceived the adapted Wii Fit Balance Board as more usable. Conclusions This study demonstrated a successful adaptation of a widely used AVG controller. The adapted controller’s potential to increase physical activity levels among people with mobility impairments will be evaluated in a subsequent trial. Trial Registration ClinicalTrials.gov NCT02994199; https://clinicaltrials.gov/ct2/show/NCT02994199 (Archived by WebCite at http://www.webcitation.org/6xWTyiJWf)
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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
| | - William B Kirkland
- Engineering and Innovative Technology Department, University of Alabama at Birmingham, Birmingham, AL, United States
| | - Samuel R Misko
- Engineering and Innovative Technology Department, University of Alabama at Birmingham, Birmingham, AL, United States
| | - Sangeetha Padalabalanarayanan
- UAB/Lakeshore Research Collaborative, School of Health Professions, University of Alabama at Birmingham, Birmingham, AL, United States
| | - Laurie A Malone
- UAB/Lakeshore Research Collaborative, School of Health Professions, University of Alabama at Birmingham, Birmingham, AL, United States
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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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Neal W, Young HJ, Mehta T, Thirumalai M, Tracy T, Riser E, Rimmer J. Comparative Effectiveness Trial between a Clinic- and Home-Based Exercise Intervention for Multiple Sclerosis. Arch Phys Med Rehabil 2017. [DOI: 10.1016/j.apmr.2017.08.142] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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Malone LA, Padalabalanarayanan S, McCroskey J, Thirumalai M. Assessment of Active Video Gaming Using Adapted Controllers by Individuals With Physical Disabilities: A Protocol. JMIR Res Protoc 2017. [PMID: 28623186 PMCID: PMC5493786 DOI: 10.2196/resprot.7621] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023] Open
Abstract
Background Individuals with disabilities are typically more sedentary and less fit compared to their peers without disabilities. Furthermore, engaging in physical activity can be extremely challenging due to physical impairments associated with disability and fewer opportunities to participate. One option for increasing physical activity is playing active video games (AVG), a category of video games that requires much more body movement for successful play than conventional push-button or joystick actions. However, many current AVGs are inaccessible or offer limited play options for individuals who are unable to stand, have balance issues, poor motor control, or cannot use their lower body to perform game activities. Making AVGs accessible to people with disabilities offers an innovative approach to overcoming various barriers to participation in physical activity. Objective Our aim was to compare the effect of off-the-shelf and adapted game controllers on quality of game play, enjoyment, and energy expenditure during active video gaming in persons with physical disabilities, specifically those with mobility impairments (ie, unable to stand, balance issues, poor motor control, unable to use lower extremity for gameplay). The gaming controllers to be evaluated include off-the-shelf and adapted versions of the Wii Fit balance board and gaming mat. Methods Participants (10-60 years old) came to the laboratory a total of three times. During the first visit, participants completed a functional assessment and became familiar with the equipment and games to be played. For the functional assessment, participants performed 18 functional movement tasks from the International Classification of Functioning, Disability, and Health. They also answered a series of questions from the Patient Reported Outcomes Measurement Information System and Quality of Life in Neurological Conditions measurement tools, to provide a personal perspective regarding their own functional ability. For Visit 2, metabolic data were collected during an initial 20-minute baseline, followed by 40 minutes of game play. The controller (balance board or gaming mat) played was randomly selected. A set of games was played for 10 minutes, followed by 5 minutes of rest, and then another set of games was played for 10 minutes, followed by rest. Quality of game play was observed and documented for each set. During rest, the participant completed questions regarding enjoyment. Following the same procedures, the participant then played the two sets of games using the other version (off-the-shelf or adapted) of the controller. The entire procedure was repeated during Visit 3 with the controller that was not played. Results Enrollment began in February 2016 and ended in September 2016. Study results will be reported in late 2017. Conclusions We hypothesized that the adapted versions of the Wii Fit balance board and gaming mat would produce greater quality of game play, enjoyment, and energy expenditure in persons with mobility impairments compared to off-the-shelf versions. Trial Registration ClinicalTrials.gov NCT02994199; https://clinicaltrials.gov/ct2/show/NCT02994199 (Archived by WebCite at http://www.webcitation.org/6qpPszPJ7)
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Affiliation(s)
- Laurie A Malone
- University of Alabama at Birmingham/Lakeshore Foundation Research Collaborative, Birmingham, AL, United States
| | | | - Justin McCroskey
- University of Alabama at Birmingham/Lakeshore Foundation Research Collaborative, Birmingham, AL, United States
| | - Mohanraj Thirumalai
- University of Alabama at Birmingham/Lakeshore Foundation Research Collaborative, Birmingham, AL, United States
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Malone LA, Rowland JL, Rogers R, Mehta T, Padalabalanarayanan S, Thirumalai M, Rimmer JH. Active Videogaming in Youth with Physical Disability: Gameplay and Enjoyment. Games Health J 2016; 5:333-341. [PMID: 27696899 DOI: 10.1089/g4h.2015.0105] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
OBJECTIVE For active videogaming (AVG) to be a meaningful, health-enhancing physical activity option for youth with physical disability, factors related to game performance and enjoyment must be understood. The objective was to explore associations between quality of gameplay, controller usage, heart rate (HR), physical function, and enjoyment during AVG play in youth with physical disability. METHODS Participants (5 girls, 11 boys, mean age 13.8 ± 2.7 years) played four AVGs on three platforms (Nintendo® Wii™, Sony PlayStation3 Move, and Microsoft Xbox® Kinect), across three sessions. Participants' primary means of mobility were manual (n = 13) and power (n = 3) wheelchairs; majority were diagnosed with cerebral palsy or spina bifida. Functional level was assessed using 17 International Classification of Functioning, Disability and Health mobility items. Participants played each AVG for 8 minutes with a 5-minute rest. Quality of gameplay and ability to use controller were recorded on a five-point Likert scale. HR was recorded immediately following each game and participants completed the Physical Activity Enjoyment Scale (PACES). PACES scores were compared across games and correlations were examined among the variables. RESULTS PACES scores were significantly greater for Wii Punch-Out compared to Xbox Fitness, Sports Rivals, and Zumba, and for PS3 Sports Champions compared to Xbox Zumba. Higher HR was associated with higher quality of gameplay and a higher PACES score. As quality of gameplay increased, the PACES score increased. CONCLUSION Game performance and exercise intensity were positively correlated with AVG enjoyment in youth with physical disability, specifically mobility impairments. Further research is warranted to examine the capacity of AVG play to be an enjoyable health-enhancing activity for individuals with physical disability.
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Affiliation(s)
- Laurie A Malone
- 1 UAB/Lakeshore Research Collaborative , Birmingham, Alabama
| | - Jennifer L Rowland
- 2 Department of Physical Medicine and Rehabilitation, Baylor College of Medicine , Houston, Texas.,3 TIRR-Memorial Hermann Spinal Cord Injury and Disability Research Center , Houston, Texas
| | - Rebecca Rogers
- 4 Department of Kinesiology, Samford University , Birmingham, Alabama
| | - Tapan Mehta
- 1 UAB/Lakeshore Research Collaborative , Birmingham, Alabama.,5 Department of Health Services Administration, University of Alabama at Birmingham , Birmingham, Alabama
| | | | | | - James H Rimmer
- 1 UAB/Lakeshore Research Collaborative , Birmingham, Alabama
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Prakash V, Kumar PA, Anandaraj M, Thirumalai M, Anandbabu C, Rajan K. Flow induced vibration studies on PFBR control plug components. Nuclear Engineering and Design 2012. [DOI: 10.1016/j.nucengdes.2012.05.033] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
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Prakash V, Thirumalai M, Anandaraj M, Kumar PA, Ramdasu D, Pandey G, Padmakumar G, Anandbabu C, Kalyanasundaram P. Experimental qualification of subassembly design for Prototype Fast Breeder Reactor. Nuclear Engineering and Design 2011. [DOI: 10.1016/j.nucengdes.2011.04.040] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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Thirumalai M, Anandaraj M, Kumar PA, Prakash V, Anandbabu C, Kalyanasundaram P, Vaidyanathan G. Experimental investigation of weir instability in main vessel cooling system of 1/4 FBR model. Nuclear Engineering and Design 2010. [DOI: 10.1016/j.nucengdes.2009.10.012] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Prakash V, Thirumalai M, Prabhakar R, Vaidyanathan G. Assessment of flow induced vibration in a sodium–sodium heat exchanger. Nuclear Engineering and Design 2009. [DOI: 10.1016/j.nucengdes.2008.10.007] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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Abstract
We describe a system for multiattribute drug product searching. We then demonstrate the system's performance on sample queries, and evaluate the name-based similarity searching component. Ten drug names were used to query a database of existing drug names using five different retrieval methods. Retrieved names were merged into master lists and presented to 15 pharmacists. Pharmacists rated the similarity between the query name and each retrieved names on a scale of 1-5. We report the precision of our five different retrieval methods at 11 levels of recall. The best single measure was editex, with a precision of 17.4% averaged across 11 levels of recall. A regression model using four objective measures of similarity as predictors accounted for 40.6% of the variance in observed mean similarity ratings. Automated, multiattribute drug product searching may improve the effectiveness and efficiency of preapproval screening processes and thereby prevent medication errors.
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Affiliation(s)
- Bruce L Lambert
- Department of Pharmacy Administration, Department of Pharmacy Practice, University of Illinois at Chicago, 833 S. Wood Street (M/C 871), Chicago, Illinois 60612-7231, USA.
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