Correlates of adherence in a home-based, self-managed exercise program tailored to wheelchair users with spinal cord injury.

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; ß = -65.62, p = 0.004), community barriers (ß = -9.12, p = 0.026), anxiety (ß = -3.84, p = <0.001), depression (ß = -1.42, p = 0.038), physical function (ß = -1.35, p = 0.048), and self-efficacy (ß = -0.61, p = 0.007) were associated with a lower number of exercise video minutes. Pain intensity (ß = 2.03, p = 0.032), pain interference (ß = 1.84, p = 0.012), and age (ß = 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.

Parent health literacy and adherence-related outcomes in children with epilepsy.

BACKGROUND: The relationship between parent health literacy and adherence to treatment in children with epilepsy has not been fully explored. The purpose of this study was to determine whether parent health literacy and other variables predicted factors associated with adherence, such as missed medication doses, missed medical appointments, and seizure frequency, in children with epilepsy between 1 and 12 years old. METHODS: It was hypothesized that parents with adequate parent health literacy would report fewer missed doses, missed appointments, and seizure occurrences. Using a nonexperimental, cross-sectional study design, interviews were conducted with 146 parents and guardians of children with epilepsy who resided in rural communities. Univariate analyses, including ANOVA, and multiple linear regressions were conducted. RESULTS: Results indicated that parent health literacy was the strongest predictor of two of the adherence-related factors. Higher health literacy scores were associated with fewer missed medication doses and seizure occurrences. However, health literacy was not associated with missed medical appointments. Among other study variables, higher household income was also predictive of fewer missed doses. CONCLUSION: The study findings suggest that inadequate health literacy among parents may serve as an independent risk factor for adherence-related outcomes among children with epilepsy. Further research, as well as effective, targeted parent health literacy strategies used to improve epilepsy management and care in children, is recommended.

Effects of a coach-guided videoconferencing acceptance and commitment therapy intervention combined with psychoeducation on distressed individuals living with spinal cord injury: a preliminary mixed-methods study.

PURPOSE: This study examined effects of coach-guided videoconferencing acceptance and commitment therapy (ACT) accompanied by psychoeducation on distressed individuals with spinal cord injury (SCI) and explored participants' experiences in the intervention. MATERIALS AND METHODS: Ten people with SCI participated in 8 individual videoconferencing sessions delivered by trained coaches. Data using self-reported questionnaires and individual interviews was collected at pretest and posttest and analyzing using Wilcoxon signed-rank tests and interpretative phenomenological analysis (ClinicalTrials.gov ID: NCT04670406). RESULTS: Statistically significant improvements were found in depression, anxiety, stress, grief, engagement in meaningful activities, and self-compassion with medium to large effect sizes. There was no significant change in quality of life, resilience, and ACT processes. Participants gained a new way of thinking by: being aware of thoughts and emotions; exploring perceptions of others; and focusing on the present. Also, the intervention equipped participants to deal with challenges by: improving coping with SCI-related conditions; practicing self-compassion, acceptance, and meditation; and acquiring skills of value-based decision making and committed action. CONCLUSIONS: Findings contribute to the limited evidence as the first study that measured effects of videoconferencing ACT on people with SCI. Future randomized controlled trials are needed to measure efficacy of internet-delivered ACT for people with SCI.IMPLICATIONS FOR REHABILITATIONGuided videoconferencing ACT may reduce depressive symptoms, anxiety, stress, and grief and increase engagement in meaningful activities and self-compassion in people with SCI.Professionals may consider ACT as a supportive or adjunct service for people with SCI who experience psychological distress.

Exploring associations of psychological inflexibility with depressive symptoms, anxiety, and stress in individuals living with a spinal cord injury: A cross-sectional study.

PURPOSE/OBJECTIVE: This study explored associations of psychological inflexibility with depressive symptoms, anxiety, and stress in individuals living with spinal cord injuries (SCI). RESEARCH METHOD/DESIGN: The study used a cross-sectional design involving data of self-reported questionnaires collected from 92 adults with SCI in the United States. These questionnaires included measures of depressive symptoms, anxiety, and stress as the dependent variables and measures of potential independent variables, including demographic and SCI-related variables, psychological inflexibility, pain interference, independence, and ability to participate in and satisfaction with social roles and activities. Multivariable linear regression analyses were conducted. Stepwise method, forward selection, and backward elimination procedures, supplemented with the best subsets method, were used to obtain the most parsimonious set of independent variables for each of the depressive symptoms, anxiety, and stress scores. RESULTS: The current study showed that psychological inflexibility, employment status, and time since the injury were variables significantly associated with depressive symptoms, and that psychological inflexibility and ethnicity/race were variables significantly associated with anxiety. Psychological inflexibility was the only variable significantly associated with stress. CONCLUSIONS: Findings of the present study suggest the importance of psychological flexibility in depressive symptoms, anxiety, and stress in individuals with SCI by showing significant associations among these variables. This exploratory study informs the need for further studies involving interventions that aim to foster greater psychological flexibility, which may decrease mental health problems in individuals with SCI. (PsycInfo Database Record (c) 2022 APA, all rights reserved).

How do people with physical/mobility disabilities benefit from a telehealth exercise program? A qualitative analysis.

People with neurological and physical disabilities (PWD) experience a myriad of secondary and chronic health conditions, thus, reducing their participation and quality of life. A telehealth exercise program could provide a convenient opportunity for improving health in this population. To describe participants' perceived benefits of a telehealth physical activity program among PWD, we conducted semi-structured interviews with 30 study participants after completing the 24-week program SUPER-HEALTH (Scale-Up Project Evaluating Responsiveness to Home Exercise and Lifestyle TeleHealth). Interview data were recorded, transcribed verbatim, and analyzed using inductive thematic analysis. The mean age of the sample was 51 ± 13 years, the primary disability was Multiple Sclerosis, and there were nine men (30%) and 21 (70%) women. Inductive thematic analysis resulted in four themes that include the following: (1) improved health and function, (2) increased activity participation, (3) improved psychosocial health, and (4) optimized performance and benefits. These preliminary findings provided support for the use of a home exercise program and recommendations to improve it to enhance benefits among PWD.

An E-Learning Program for Increasing Physical Activity Associated Behaviors Among People with Spinal Cord Injury: Usability Study.

BACKGROUND: The majority of people with spinal cord injury (SCI) in the United States are not meeting the recommended guidelines for regular physical activity. Behavior change techniques (eg, goal setting and action planning) that are framed within the principles of the social cognitive theory (self-efficacy and self-regulation) have the potential to enhance physical activity behavior. OBJECTIVE: The aim of the study was to develop and test the usability of an electronic learning (e-learning) program for improving social cognitive factors related to physical activity behavior among people with SCI. METHODS: The program was created through an iterative process of development and refinement, using a modification of a similar methodology used to develop evidence-informed guidelines in health promotion for people with disabilities (Guidelines, Recommendations, and Adaptations Including Disability; GRAIDs framework). The study included 4 phases: (1) initial product creation, (2) national survey, (3) expert review, and (4) usability testing. Usability testing included both quantitative and qualitative data collection and analyses. RESULTS: The review of the program by an expert panel (n=5) and the results from a national survey (n=142) led to several refinements. Usability testing demonstrated that the program could be completed in a timely manner (<30 min). Participants reported 5 themes: (1) the program improves social cognitions related to physical activity participation; (2) reflection of physical activity behavior; (3) positive perceptions of the quality of the program; (4) positive perceptions of the program operation and effectiveness; and (5) recommendations for improvement. Each item was incorporated into a revised program version 1.0. CONCLUSIONS: This study incorporated an evidence-based framework for developing a brief 30-min e-learning program for increasing the physical activity behavior among people with SCI. The Exercise Strategies Through Optimized Relevant Interactive E-learning Storytelling (e-STORIES) program could be completed in a timely manner and was reported by participants as valuable and useful for enhancing intent-to-perform physical activity in individuals with SCI. The program has the potential to be applied in a variety of settings, but feasibility testing is required before implementing in a larger trial.

Unmet needs for dental care in children with special health care needs.

OBJECTIVE: The unmet need for dental care is one of the greatest public health problems facing U.S. children. This issue is particularly concerning for children with special health care needs (CSHCN), who experience higher prevalence of unmet dental care needs. The primary purpose of this study was to investigate regional differences in unmet dental care needs for CSHCN. Using the Social Ecological Model as a framework, additional variables were analyzed for regional differences. It was hypothesized that (H1) unmet dental care needs would be high in the CSHCN population, (H2) there would be regional differences in unmet dental care needs in CSHCN, and (H3) there would be differences in specific individual, interpersonal (family), community (state), and policy level factors by region. METHODS: Data were obtained from the 2009-2010 National Survey of CSHCN. SPSS was used for data management and analysis. RESULTS: Each of the study hypotheses was supported for the sample of 40,242 CSHCN. The West region was more likely to have more unmet needs for preventive and specialized dental care in CSHCN than the reference region (Northeast). The South region followed the West region in unmet dental care needs. Statistically significant differences in individual, interpersonal (family), community (state) and policy factors were found by region. CONCLUSION: Further research is recommended. Effective strategies that include policy to address unmet dental care needs at multiple levels of intervention are suggested.