Development and Use of a Tech-Based Data Management System for a Cognitive Rehabilitation Randomized Controlled Trial for People With Type 2 Diabetes.

Successful technology-based interventions to improve patients' self-management are providing an incentive for researchers to develop and implement their own technology-based interventions. However, the literature lacks guidance on how to do this. In this article, we describe the electronic process with which we designed and implemented a technology-based data management system to implement a randomized controlled trial of a comprehensive cognitive rehabilitation intervention to improve cognitive function and diabetes self-management in people with type 2 diabetes. System development included feasibility assessment, interdisciplinary collaboration, design mapping, and use of institutionally and commercially available software. The resulting framework offers a template to support the development of technology-based interventions. Initial development may be time-consuming, but the benefits of the technology-based format surpass any drawbacks.

Selected health behaviors moderate the progression of functional limitations in persons with multiple sclerosis: Eleven years of annual follow-up.

BACKGROUND: Multiple sclerosis (MS), a chronic neurological disease typically diagnosed in young adulthood, presents with a wide variety of symptoms, impairments and functional limitations. Given the chronic, unpredictable and long-term nature of this disease, preserving function is essential. OBJECTIVE: The purpose of this study was to identify psychosocial and behavioral factors that might influence the trajectory of functional limitation through eleven years of longitudinal follow-up of a sample of persons with MS. METHODS: Participants (N = 606) completed measures of health behaviors, related constructs and functional limitations annually over eleven years. Longitudinal measures of functional limitations were analyzed using random-effects regression that allows for study of individual differences in the trajectories of a measure. Using the best fitting quadratic growth model, we tested the within and between-person effects of Nutrition, Interpersonal Relationships, Exercise, Stress Management, Health Responsibilities, Spiritual Growth, Self-rated Health and Barriers, controlling for Age, Year since Diagnosis and Year of Dropout, on Functional Limitations in the 11th year. RESULTS: After adjusting for covariates, higher mean scores for Exercise and Self-rated Health were related to lower levels of Functional Limitations in Year 11. Higher mean scores for Stress Management, Health Responsibilities and Barriers were related to higher levels of Functional Limitations in Year 11. Higher mean Exercise scores and lower mean Health Responsibilities scores were related to slower rates of progression of functional limitations in Year 11. CONCLUSION: Findings suggest that the highly variable trajectory of functional limitations in MS may be extended and shaped through health behavior strategies.

Correlates of body mass index in women with fibromyalgia.

BACKGROUND: Excess weight in women with fibromyalgia syndrome (FMS) may further contribute to joint pain and fatigue. However, there is little research addressing weight issues in this population. PURPOSE: This study examined the relationship of body mass index (BMI) to quality of life. METHODS: Quality of life was measured by the 36-Item Short Form Health Survey, severity of FMS, nutritional intake, Barriers to Health Promoting Behaviors for Disabled Persons Scale (BS), and self-efficacy for health-promoting behaviors (Self-Rated Abilities for Health Practices Scale) in women with FMS. Baseline data were collected on 179 women diagnosed with FMS. FINDINGS: Controlling for age, BMI was significantly (p < .05) correlated with 36-Item Short Form Health Survey subscales of physical functioning, bodily pain and vitality, severity of FMS using the Tender Point Index, calories, protein, fat, saturated fat, BS, and Self-Rated Abilities for Health Practices Scale subscale for exercise. The findings support a growing body of evidence that excess weight is negatively related to quality of life and pain in women with FMS.

Subjective and objective sleep difficulties in women with fibromyalgia syndrome.

PURPOSE: To explore differences in demographic and illness-related variables among women with fibromyalgia syndrome (FMS) with documented sleep problems and those without. DATA SOURCES: As part of the baseline assessments for a larger intervention study, 104 women with FMS wore an actigraph and completed a sleep log for 72 hours. Participants also completed a baseline questionnaire and a physical exam to quantify the Tender Point Index. CONCLUSIONS: Although almost half (44%) of the women rated their sleep as bad or fairly bad, only 22 of the 104 women (21%) had objective sleep deficits (less than 6 hours sleep duration). The women with objective sleep deficits had significantly higher pain scores on the tender point index, perceived their sleep as significantly worse, and reported significantly more depressive symptoms and more negative impact of FMS on functioning than those without deficits. Descriptive statements in the sleep logs revealed frequent problems with energy, fatigue, and functioning for women in the sleep deficits group. IMPLICATIONS FOR PRACTICE: Sleep problems are a major concern among women with FMS. Those with concurrent depressive symptoms, high pain, and limited functioning may be candidates for in-depth sleep assessment and behavioral programs to improve sleep.

Benefits of wellness interventions for persons with chronic and disabling conditions: a review of the evidence.

BACKGROUND: Persons living with the effects of chronic and disabling conditions are often at increased risk for the development of secondary conditions and disabilities that can lead to further decline in health status, independence, functional status, life satisfaction, and overall quality of life. OBJECTIVE: The purpose of this study was to review the evidence for the benefits of wellness/health promotion interventions for persons with chronic and disabling conditions. METHODS: The authors conducted a Medline search (1990-2007) using terms related to wellness and health promotion cross-referenced with general terms for chronic and disabling conditions, as well as 15 specific chronic and/or disabling conditions (e.g., multiple sclerosis, spinal cord injury). Selection of studies was limited to those published in English that reported randomized controlled trails or prospective studies that involved adult human subjects with a chronic and/or disabling condition. All selected studies focused on some aspect of a wellness or health promotion intervention and involved a comparison or control group. Of the 5,847 studies initially identified in the search using medical subject heading terms, 190 met the criteria for full review. Data were extracted from these publications and summarized using descriptive statistics. RESULTS: Almost all studies (95%) explored the effects of wellness intervention in a sample diagnosed with a single condition (e.g., cancer, stroke, arthritis). Although the mean sample size was 100, the range in sample size varied widely (6-688); 25% of the studies had sample of 30 or fewer. Almost all studies (89.5%) reported positive effects of the wellness intervention, although the delivery and content of interventions as well as the measurement of outcomes, varied greatly. CONCLUSIONS: Our findings support an immediate post-intervention positive impact of wellness interventions across persons with a wide variety of chronic and disabling conditions. Future research that clearly specifies primary study outcomes and follows the CONSORT guidelines will strengthen future reviews of the evidence and facilitate application of the evidence of practice.

A randomized controlled trial of a wellness intervention for women with fibromyalgia syndrome.

OBJECTIVE: To examine the effects of a wellness intervention, Lifestyle Counts, for women with fibromyalgia syndrome on the level of self-efficacy for health-promoting behaviours, health-promoting activity and perceived quality of life. DESIGN: A randomized controlled single-blinded trial with treatment and attention-control groups. SETTING: Community in the southwestern United States. SUBJECTS: Convenience sample of 187 women (98 treatment, 89 attention control) with fibromyalgia syndrome (mean age = 53.08 years, SD 9.86). INTERVENTION: The two-phase Lifestyle Counts intervention programme included lifestyle change classes for eight weeks, with goal-setting and telephone follow-up for three months. Participants in the attention-control group were offered an equivalent amount of contact in classes on general disease-related information and health education topics and unstructured follow-up phone calls. Participants were followed for a total of eight months after baseline. OUTCOME MEASURES: Self-report instruments measuring self-efficacy for health behaviours, health-promotion behaviours and health-related quality of life (SF-36 and the Fibromyalgia Impact Questionnaire) were completed at baseline, two months (after the classes), five months (after telephone follow-up) and at eight months. RESULTS: Both groups improved significantly (P<0.05) over time on the measures of self-efficacy, health behaviours, fibromyalgia impact and quality of life. There were significant group x time interactions for scores on the Health Promoting Lifestyle II subscales of physical activity and stress management. CONCLUSIONS: The Lifestyle Counts wellness intervention holds promise for improving health-promoting behaviours and quality of life of women with fibromyalgia syndrome.

The relevance of depressive symptoms and social support to disability in women with multiple sclerosis or fibromyalgia.

Multiple sclerosis and fibromyalgia syndrome may spur substantial disability for those affected. Using structural equation modeling, this secondary analysis examined predictors of disability in women with multiple sclerosis (n = 118) and fibromyalgia syndrome (n = 197) recruited for separate wellness studies. Greater functional limitations, lower economic adequacy, less social support, and higher depressive symptoms predicted greater disability in both groups. The final multigroup model showed good fit chi [(111, n = 315) = 135.92, comparative fit index = 0.99, root mean square error of approximation = 0.03] and identified similarities and differences across groups.

Predictors of a health promoting lifestyle in women with fibromyalgia syndrome.

The purpose of this study was to describe the health practices of women with fibromyalgia syndrome (FMS) and the predictors of an overall health promoting lifestyle in these individuals. The predictors of a health promoting lifestyle examined in this study were barriers, social support, self-efficacy, demographic characteristics and illness factors. The sample consisted of 198 women who participated in a randomised clinical trial to test the effectiveness of a health promotion intervention for women with FMS. The women in this sample engaged most frequently in health practices in the domains of interpersonal relations and spiritual growth and least frequently in the domain of physical activity. Self-efficacy and social support were significant predictors of an overall health promoting lifestyle.

Structural equation modeling of disability in women with fibromyalgia or multiple sclerosis.

Structural equation modeling (SEM), a popular statistical technique for analysis of multivariate data in the social sciences, is increasingly being used in the behavioral and clinical sciences. SEM is appropriate for posing complex models that evaluate the direct and indirect influence of several variables on one or more outcome variables. A biosocial model of disability, the Disablement Process Model, lends itself to evaluation by SEM. Using SEM, this study examined predictors of disability (Age, Education, Duration of Illness, and Economic Adequacy Functional Limitations, Depressive Symptoms, and Social Support) separately in women with multiple sclerosis (MS) and women with fibromyalgia syndrome (FMS) and compared the respective models across groups. Data were analyzed with Analysis of Moment Structures (Amos) 7.0. Problems identified in initial confirmatory model testing included collateral correlated errors, a negative error variance, and poor performance of the disability indicators. After specifying well-fitting confirmatory models for each group, a structural model for the larger FMS group was estimated. Model refinement resulted in the reversal of the path between Depressive Symptoms and Social Support. Further model revisions were based on comparative fit statistics and theoretical logic. The structural model developed from the FMS sample required minimal changes to fit the MS sample. The multisample model explained greater variance in disability in women with FMS than in women with MS. Social support and depressive symptoms mediated the effect of functional limitations on disability. Interventions that target modifiable characteristics, such as depression and social support, may improve outcomes such as disability.

Illness perceptions and related outcomes among women with fibromyalgia syndrome.

PURPOSE: Fibromyalgia syndrome (FMS) is characterized by widespread musculoskeletal pain, multiple tender points, and fatigue, and affects 3-6 million Americans, 75% of whom are female. The purpose of the present study was to examine the illness perceptions of women with FMS using Leventhal's common sense self-regulation model. DESIGN: Ninety-one women with FMS took part in this study. Pearson correlations and stepwise multiple regressions were used to assess relationships among variables and explanation of variance in the outcomes of health behaviors, FMS impact, and subjective physical and mental health. RESULTS: Participants viewed their FMS as chronic with a somewhat fluctuating course, having serious consequences in their lives, and difficult to understand in a coherent fashion. The women tended to find their FMS emotionally distressing and unamenable to personal control or efficacious treatment. Emotional representations explained 41% of the variance in mental health scores and 17% in reported health behaviors. CONCLUSIONS: Overall, this sample of women with FMS had fairly negative perceptions of their illness. As suggested by Leventhal's model, cognitive and emotional representations predicted different outcomes. Interventions that address psychological as well as the physical components of the illness experience may offer benefits for women with FMS.

Adaptation of a wellness intervention for women with chronic disabling conditions.

Women with chronic disabling conditions live with multiple symptoms that decrease their ability to function in society, and they may be at elevated risk for further morbidity with age. Despite research indicating that health-promoting behaviors decrease the risk for further morbidity, few interventions have been designed to help women with chronic disabling conditions promote their health. The purpose of this article is to present the results of a pilot study of a wellness intervention adapted for use with women with fibromyalgia syndrome (FMS). First, the development of the original wellness intervention for women with multiple sclerosis (MS) will be described. Next, the steps taken to adapt the intervention to the needs of women with FMS will be described. Finally, it wil be argued that commonalities in symptoms and social experiences and the universal need for health-promoting skills make this intervention adaptable to multiple groups of women with chronic disabling conditions.

The use of individualized goal setting to facilitate behavior change in women with multiple sclerosis.

Setting goals is a useful strategy for changing behavior. The purpose of this study was to examine the effectiveness of a wellness intervention for women with multiple sclerosis (MS) on achieving health-related goals set individually by each participant in the experimental group (N = 57) using goal attainment scaling. The two-phase intervention included lifestyle-change classes over 8 weeks, then telephone follow-up over 3 months. Participants were followed over an 8-month period. Goal achievement was assessed at baseline, 2 months (following class), 3 1/2 months (6 weeks after class), 5 months (following 3 months of telephone follow-up), and at 8 months. The majority of the women met or exceeded all their individualized goals for changing behavior at the 6-week postclass assessment. Achievement and maintenance of individual goals remained high (59%-84%) over the 5 months after class follow-ups. These data support the positive effects of wellness interventions for helping women with MS to meet their own individualized health goals. Setting goals with incremental steps helped participants to articulate their individual goals and monitor achievement over time.