Development and Pilot Testing of the Disability Awareness Training and Education Program Among Community-Based Group Fitness Instructors.

Lack of disability awareness of fitness professionals is a well-established barrier to exercise participation among people with disabilities that is likely related to the lack of disability awareness training for group fitness instructors. The purposes of this study were to develop, implement, and evaluate a disability awareness training for group fitness instructors. A 90-min video training and resource manual were developed. We recruited 10 group fitness instructors from one recreation center to participate. Participants completed baseline, posttraining, and 2-month follow-up testing on survey-based outcomes including disability attitudes, confidence in exercise adaptations, and training satisfaction. Participants' confidence to adapt fitness classes was significantly improved; however, disability attitudes were high in the pretest and not significantly different posttraining. Semistructured interviews were conducted posttraining and revealed three themes: Formal disability training is needed, Managing inclusive class dynamics, and Training suggestions and satisfaction. This training demonstrated a feasible intervention for increasing disability awareness among community-based group fitness instructors.

Pain intensity and mental health quality of life in veterans with mental illnesses: the intermediary role of physical health and the ability to participate in activities.

PURPOSE: The purpose of this study was to examine the intermediary role of physical health quality of life and ability to participate social roles and activities in the relationship between pain intensity and mental health quality of life in veterans with mental illnesses. METHODS: This is a cross-sectional correlational design study. Our participants are 156 veterans with self-reported mental illness (Mage = 37.85; SDage = 10.74). Descriptive, correlation, and mediation analyses were conducted for the current study. RESULTS: Pain intensity was negatively correlated with physical health QOL, ability to participate in social roles and activities, and mental health QOL. Physical health QOL and ability to participate in social roles and activities were positively associated with mental health QOL, respectively. Physical health QOL was positively correlated with a ability to participate in social roles and activities. Study results indicate that the effect of pain intensity on mental health QOL can be explained by physical health QOL and ability to participate. CONCLUSIONS: Specific recommendations for practitioners include implementing treatment goals that simultaneously focus on physical health and ability to participate in social roles and activities for clients who present with both physical pain and low mental health QOL.

Preliminary Outcomes of an Older Peer and Clinician co-Facilitated Pain Rehabilitation Intervention among Adults Aged 50 Years and Older with Comorbid Chronic Pain and Mental Health Conditions.

The present study aimed to examine the acceptability, feasibility, and preliminary effectiveness of an older peer and clinician co-facilitated Behavioral Activation for Pain Rehabilitation (BA-PR) intervention among adults aged 50 years and older with comorbid chronic pain and mental health conditions. This was a mixed-methods research design with eight participants aged 55 to 62 years old with mental health conditions including schizophrenia spectrum disorder, bipolar disorder, major depressive disorder, personality disorder, and adjustment disorder. The quantitative data were assessed from observational methods, a pain rating scale and related measures. We used semi-structured interviews for qualitative feedback on experiences with the BA-PR intervention after participation. Overall, the participants had positive experiences following receipt of the BA-PR intervention. The recruitment and adherence rates for participants were 72.7% and 100%, respectively. Approximately 75% of the participants remained enrolled in the study. Findings from a paired t-test showed the BA-PR intervention was linked to significantly reduced prescription opioid misuse risk, t (7) = 2.42, p < 0.05. There were also non-significant reductions in pain intensity and depression severity, in addition to improvements in active and passive pain coping strategies and behavioral activation.The BA-PR intervention is the first pain rehabilitation intervention specifically designed for middle-aged and older adults with comorbid chronic pain and mental health conditions. Our findings indicate promise for the BA-PR intervention to potentially reduce prescription opioid misuse risk, pain, and depressive symptoms. However, a quasi-experimental study is needed before rigorous effectiveness testing.

Working on Wellness: Impact of a Pilot Workplace Wellness Program in a Hemodialysis Center.

This article describes the impact of a 12-week workplace wellness program on staff (n = 14) of an outpatient hemodialysis center. The program focused on decreasing dietary sodium and increasing habitual physical activity. The average systolic and diastolic blood pressure of participants decreased by 16.9±21.6 mmHg (p < 0.05) and 4.1±14.0 mmHg (p < 0.05), and body weight decreased by 2.7±1.9kg (p < 0.05). The mean step count at baseline was 7,052±3,278 but increased to 10,388±2,882 (p < 0.05) during a walking challenge. There was a reduction in self-reported barriers to making healthy nutritional changes (p < 0.05) and engaging in habitual physical activity (p < 0.05). Our pilot findings suggest that workplace wellness programs in hemodialysis centers are feasible and effective.

Mindfulness as a protective factor against depressive symptoms in people with fibromyalgia.

Background: Depressive symptoms complicate pain management for people with FM, with adverse consequences such as a greater need for pain medications and limited pain coping strategies. Determining risks and protective factors associated with depressive symptoms in persons with FM could inform the development and implementation of mental health interventions.Aims: To formulate and test a behavioral activation model of depression with mindfulness as a protective factor for people with FM.Methods: We conducted an online cross-sectional survey with 117 adults with FM from community and clinic networks. Path analysis was used to assess the relationships of pain intensity, perceived stress, activity interference, pain catastrophizing and mindfulness with depressive symptoms.Results: Mindfulness has a negative direct association with depressive symptoms and a negative indirect association with depressive symptoms through perceived stress, activity interference and pain catastrophizing. Perceived stress, activity interference and pain catastrophizing had direct associations with depressive symptoms. Finally, perceived stress, activity interference and pain catastrophizing had indirect associations with depressive symptoms through pain intensity.Conclusions: Mindfulness seems to play an important role as a protective factor against the negative effects of stress and depression among people with FM and should be included in mental health interventions for chronic pain.

Doctor-Diagnosed Arthritis and Self-Reported Physical Health Function Among Middle-Aged and Older Adults With Serious Mental Illness.

Arthritis is one of the most common chronic conditions in aging adults, with both physical and mental health issues and consequences. However, there is insufficient arthritis research among aging adults with serious mental illness (SMI). This study examined rates of doctor-diagnosed arthritis and its cross-sectional associations with self-reported physical health function among adults aged 50 years and older with SMI. Community-based mental health center participants (n = 176) reported clinical and sociodemographic data (e.g., physical health function, sex), whereas diagnostic information (i.e., arthritis, psychiatric, and medical diagnoses) was retrieved from medical records. Arthritis prevalence was high (43.8%) and had an independent, negative association with physical health function. Findings suggest that arthritis evaluations and intervention services need to be prioritized in middle-aged and older adults with SMI. Future research should focus on further testing arthritis self-management programs and other nonpharmacological psychosocial approaches for arthritis in aging adults with SMI.

Perceived Mindfulness and Depressive Symptoms Among People with Chronic Pain.

The study purpose was to evaluate pain catastrophizing and psychological distress as mediators for the relationship between perceived mindfulness and depressive symptoms in people with chronic pain. We conducted an online cross-sectional survey with 211 adults with chronic musculoskeletal pain recruited from U.S. clinics and community networks. A serial multiple mediation analysis was performed using ordinary least-squares regressions and a bootstrap testing approach. Pain catastrophizing and psychological distress, independently and jointly, mediated the relationship between mindfulness and depressive symptoms. Rehabilitation counseling professionals should consider targeting mindfulness, pain catastrophizing, and psychological distress in psychosocial treatment for people with chronic pain.

Differences in Self-Reported Physical Activity, Exercise Self-Efficacy and Outcome Expectancies, and Health Status by Body Mass Index Groups in People with Chronic Pain.

The study purpose was to determine how self-reported lifestyle physical activity levels, exercise self-efficacy and outcome expectancies, and health status differ by body mass index for persons with chronic pain. From U.S. clinics and community networks, 209 adults reporting chronic musculoskeletal pain were recruited for the cross-sectional survey. Data were analyzed using analysis of variance. Participants with self-described obesity reported the lowest physical activity, reduced exercise self-efficacy and positive outcome expectancies, and poorer health status. Promoting graded activity while addressing motivational factors from health behavior theory for people with chronic pain and obesity should be encouraged in rehabilitation programs.

Multiple sclerosis patients need and want information on exercise promotion from healthcare providers: a qualitative study.

BACKGROUND: There is growing recognition of the benefits and safety of exercise and its importance in the comprehensive care of persons with multiple sclerosis (MS), yet uptake is low. OBJECTIVE: We explored the needs and wants of patients with MS regarding exercise promotion through healthcare providers. SETTING AND PARTICIPANTS: Participants were adults with MS who had mild-or-moderate disability and a range of exercise levels. All participants lived in the Midwest of the United States. METHODS: Fifty semi-structured interviews were conducted and analysed using thematic analysis. Two themes emerged, namely interactions between patients and healthcare providers and needs and wants of patients. RESULTS: Analysis of participant accounts illustrate that current exercise promotion by healthcare providers does not meet patient needs and wants. The identified needs and wants of persons with MS involved (i) information and knowledge on the benefits of exercise and exercise prescription, (ii) materials to allow home and community exercise and (iii) tools for initiating and maintaining exercise behaviour. DISCUSSION AND CONCLUSION: Patients with MS frequently interact with healthcare providers and are generally unsatisfied with exercise promotion during interactions. Healthcare providers can address the low uptake of exercise among persons with MS by acting upon the identified unmet needs involving materials, knowledge and behaviour change strategies for exercise.

Identifying preferred format and source of exercise information in persons with multiple sclerosis that can be delivered by health-care providers.

BACKGROUND: There is increasing recognition of the benefits of exercise in individuals with multiple sclerosis (MS), yet the MS population does not engage in sufficient amounts of exercise to accrue health benefits. There has been little qualitative inquiry to establish the preferred format and source for receiving exercise information from health-care providers among persons with MS. OBJECTIVE: We sought to identify the desired and preferred format and source of exercise information for persons with MS that can be delivered through health-care providers. SETTING AND PARTICIPANTS: Participants were adults with MS who had mild or moderate disability and participated in a range of exercise levels. All participants lived in the Midwest of the United States. METHODS: Fifty semi-structured interviews were conducted and analysed using thematic analysis. RESULTS: Two themes emerged, (i) approach for receiving exercise promotion and (ii) ideal person for promoting exercise. Persons with MS want to receive exercise information through in-person consultations with health-care providers, print media and electronic media. Persons with MS want to receive exercise promotion from health-care providers with expertise in MS (ie neurologists) and with expertise in exercise (eg physical therapists). CONCLUSIONS: These data support the importance of understanding how to provide exercise information to persons with MS and identifying that health-care providers including neurologists and physical therapists should be involved in exercise promotion.

Relationships between self-determination theory and theory of planned behavior applied to physical activity and exercise behavior in chronic pain.

This study examined the relationships between self-determination theory (SDT) and theory of planned behavior (TpB) applied to physical activity and exercise behavior (PA&E) in people with chronic pain. Two hundred and eleven adults with chronic musculoskeletal pain (28 males and 183 females, age range 18 to 82 years, mean age 43 years) were recruited from online support groups and clinic networks in the United States. Participants completed SDT measures relevant to PA&E on perceived autonomy support, autonomy, competence, and relatedness, as well as TpB measures relevant to PA&E on intention, attitudes, subjective norms, and perceived behavioral control. Correlational techniques and canonical correlation analysis were performed to examine the relationships and variance within and between theoretical dimensions. Overall, the SDT set accounted for 37% of the TpB variance and the TpB set accounted for 32% of the SDT set variance. The results indicate there are statistical similarities and differences between concepts in SDT and TpB models for PA&E. Using both empirical guidance and clinical expertise, researchers and practitioners should attempt to select and integrate non-redundant and complementary components from SDT, TpB, and other related health behavior theories.

State rehabilitation services tailored to employment status among cancer survivors.

PURPOSE: Previous analyses of vocational rehabilitation services for unemployed cancer survivors indicated that counseling and guidance, job search assistance, and job placement services are significantly associated with increased odds for employment. However, many cancer survivors with jobs to return to may require vocational interventions that are different from unemployed cancer survivors. It is unclear whether the public rehabilitation system provides vocational services that are based on the work status of cancer survivors rather than providing the same set of services for all cancer survivors. This study examined whether differences in the types of services were indeed based on the employment status of those with a history of cancer at the time of application. METHODS: Administrative data on 1,460 cancer survivors were obtained through the US Rehabilitation Services Administration Case Service Report (RSA-911) dataset for fiscal year 2007. Data on demographic characteristics and vocational service patterns were extracted and analyzed. Multiple discriminant analysis was used to identify differential services received by cancer survivors based on employment status at time of application for vocational rehabilitation services. RESULTS: Results of the multiple discriminant analysis indicated one significant canonical discriminant function, with Wilks's λ = .92, χ (2)(19, N = 1,456) = 114.87, p < .001. The correlations between the discriminating variables and the significant canonical discriminant function were highest for diagnoses and treatment (-.526), job placement (.487), transportation (.419), job search (.403), vocational training (.384), job readiness (.344), university training (.307), and rehabilitation technology (-.287). The group centroids along the significant discriminant function (the distance of each group from the center of the canonical function) indicated that the employed applicant group (-.542) and the unemployed applicant group (.153) can be differentiated based on vocational rehabilitation services received, with the employed applicant group receiving primarily diagnostic and treatment services and rehabilitation technology/job accommodation services, while the unemployed applicant group received more vocational training, job seeking skills training, and job placement services. CONCLUSIONS: Employed cancer survivors who are at risk of losing their job and unemployed cancer survivors who are looking for a job receive different vocational services tailored to needs, suggesting that state vocational rehabilitation services for cancer survivors is responsive to individual client needs.

Validation of an eight-item resilience scale for inpatients with spinal cord injuries in a rehabilitation hospital: exploratory factor analyses and item response theory.

PURPOSE: People with spinal cord injury (PwSCI) can experience life changes, including impacts on their physical and mental health. PwSCI often report less life satisfaction and lower subjective well-being than peers without SCI. These challenges and adversities increase the demand on them to be more resilient. Healthcare providers need quick and valid instruments to assess adult patients' resilience in clinical settings. We aimed to validate the factor validity and discrimination ability of a resilience scale, CD-RISC-10, for clinical usage in adults with SCI during hospitalization. MATERIALS AND METHODS: 93 adults with SCI responded to the self-reported survey, including CD-RISC-10, the Patient Health Questionnaire-9 Scale (PHQ-9), the Satisfaction with Life Scale (SWLS), and the Intrinsic Spirituality Scale. We conducted descriptive statistics, exploratory factor analysis (EFA), and item response theory (IRT). RESULTS: Two items were deleted from CD-RISC-10 after EFA, forming CD-RISC-8. The item discriminations of the remaining eight items from the unconstrained IRT model ranged from a high of 3.071 to a relatively low 1.433. CD-RISC-8 is significantly related to PHQ-9 and SWLS. CONCLUSIONS: The factor validity of the CD-RISC-8 was improved. Significantly, the CD-RISC-8 has excellent potential for clinical usage due to its discriminant ability between low and intermediate resilience.

Spinal Cord InjuryPeople with spinal cord injury (PwSCI) experience unique challenges and adversities that can negatively affect physical, mental, social, and financial health and life satisfaction.PwSCI with higher resilience adapt to challenges quicker, and have better mental health outcomes and improved quality of life.The CD-RISC-8 is useful for screening PwSCI who need resilience intervention and it is sensitive enough to evaluate resilience improvement within two minutes.

State vocational rehabilitation services and employment in multiple sclerosis.

BACKGROUND: Obtaining and maintaining suitable employment can be a significant challenge for people with multiple sclerosis (MS). OBJECTIVE: The objective of this article is to identify what vocational rehabilitation (VR) services helped MS clients obtain and maintain employment, after controlling for the effect of demographic covariates and disability-related government benefits. METHODS: We retrieved data from the Rehabilitation Services Administration (RSA) 911 database in the fiscal year (FY) 2009, and used VR services as predictors to predict employment outcomes of people with MS by hierarchical logistic regression. RESULTS: A total of 924 out of 1920 MS clients (48.1%) were successfully employed after receiving VR services. Logistic regression analysis results indicated that cash benefits (OR =0.51, p < 0.001) and public medical benefits (OR =0.76, p < 0.01) were negatively associated with employment outcomes, whereas counseling and guidance (OR = 1.68, p < 0.001), job placement assistance (OR = 2.43, p < 0.001), on-the-job supports (OR = 1.62, p < 0.01), maintenance services (OR = 1.59, p < 0.01), and assistive technology services (OR =2.09, p < 0.001) were significant predictors of positive employment outcomes. CONCLUSION: VR services were found to be associated with employment status. MS patients experiencing problems obtaining or maintaining employment should be encouraged to pursue services from state VR agencies.

Mental Health Pandemic During the COVID-19 Outbreak: Social Media As a Window to Public Mental Health.

Intensified preventive measures during the COVID-19 pandemic, such as lockdown and social distancing, heavily increased the perception of social isolation (i.e., a discrepancy between one's social needs and the provisions of the social environment) among young adults. Social isolation is closely associated with situational loneliness (i.e., loneliness emerging from environmental change), a risk factor for depressive symptoms. Prior research suggested vulnerable young adults are likely to seek support from an online social platform such as Reddit, a perceived comfortable environment for lonely individuals to seek mental health help through anonymous communication with a broad social network. Therefore, this study aims to identify and analyze depression-related dialogues on loneliness subreddits during the COVID-19 outbreak, with the implications on depression-related infoveillance during the pandemic. Our study utilized logistic regression and topic modeling to classify and examine depression-related discussions on loneliness subreddits before and during the pandemic. Our results showed significant increases in the volume of depression-related discussions (i.e., topics related to mental health, social interaction, family, and emotion) where challenges were reported during the pandemic. We also found a switch in dominant topics emerging from depression-related discussions on loneliness subreddits, from dating (prepandemic) to online interaction and community (pandemic), suggesting the increased expressions or need of online social support during the pandemic. The current findings suggest the potential of social media to serve as a window for monitoring public mental health. Our future study will clinically validate the current approach, which has implications for designing a surveillance system during the crisis.

Community Partners' Perspectives on Partnering With an Academic Research Team to Promote Disability-inclusive Fitness Programming.

BACKGROUND: Community-based fitness programs can support public health by providing access to physical activity opportunities for a vulnerable population with significant barriers. Unfortunately, programs specifically designed for people with disabilities (PWD) and staff training to promote inclusion for PWD in general population programs is limited. The current study aimed to review an on-going partnership that had formed to address this need. OBJECTIVES: The purpose of this study was to assess community partners' experiences with a community-academic partnership designed to implement a fitness program for people with multiple sclerosis and also to promote inclusion for PWD in community-based fitness programming. METHODS: Semi-structured interviews were conducted with six community partners who had been engaged in a formal partnership with the academic institution for 2 or more years to understand partners' experiences and perspectives about the partnership. Interviews were audio/video recorded, transcribed verbatim, and analyzed thematically. RESULTS: Participants described their experiences as falling into four main areas. Pre-partnership experiences (or lack thereof) shaped participants views on entering into academic partnerships. Communication and planning for mutual benefit were key to getting the partnership started. Partners identified challenges and factors for success while they were in the thick of partnership activities. Finally, evaluation allowed for assessment and improvement of the partnership itself and its ultimate goals. CONCLUSIONS: Findings suggest that academic-community partnerships can be ideal for promoting inclusion for PWD and highlight insights that can be used in the development of future partnerships.

Massage therapy as a complementary and alternative approach for people with multiple sclerosis: a systematic review.

PURPOSE: Multiple sclerosis (MS) causes a range of different symptoms. Patients with MS (PwMS) have looked for alternative therapies to control their MS progress and treat their symptoms. Non-invasive therapeutic approaches such as massage can have benefits to mitigate some of these symptoms. However, there is no rigorous review of massage effectiveness for PwMS. The present systematic review aims to examine the effectiveness of different massage approaches on common MS symptoms, including fatigue, pain, anxiety, depression, and spasticity. MATERIALS AND METHODS: A systematic search of related trials was conducted in electronic databases including Cochrane Library, PubMed, Scopus, Web of Science, and Google Scholar, using search terms related to Multiple Sclerosis and massage therapy. The PEDro scale was used to evaluate the methodological quality of reviewed studies. RESULTS: A total of 12 studies met the inclusion criteria. We rated 5 studies as fair and 7 studies as good. Fatigue was improved by different massage styles, such as reflexology, nonspecific therapeutic massage, and Swedish massage. Pain, anxiety, and depression were effectively improved by reflexology techniques. Spasticity was reduced by Swedish massage and reflexology techniques. CONCLUSIONS: Different massage approaches effectively improved MS symptoms such as fatigue, pain, anxiety, depression, and spasticity.Implications for rehabilitationThe present review results indicate that massage may have beneficial effects on motor and non-motor symptoms in MS.Massage could be considered a complementary and alternative treatment combined with conventional medicine in people with MS.Pain and fatigue are best improved by Swedish massage, while anxiety and depression are effectively improved by reflexology.

Qualitatively Exploring Mental Health Attitude Changes among Emerging Adult Motivational Interviewing after One Motivational Enhanced Interview.

Emerging adult military members and veterans (MMV) are experiencing many transitions (e.g., adulthood, military). The sum of these changes can cause stress, anxiety, and mental health challenges. Stigma of mental health and treatment exists, and military populations are often not seeking or engaging in appropriate care. Recent research emphasizes the need to uncover mental health attitudes and self-stigma barriers regarding help seeking. We evaluated the impact of a single motivational-interviewing enhanced interview with 26 MMV, all who reported high risk substance use. In 75-minute interviews with the primary focus of discussing their experiences regarding mental health, substance use, and identity development, the interviewer incorporated motivational interviewing strategies (e.g., affirmations, complex reflections). Participants shared their developmental experiences, stressors transitioning, and barriers and stigma around mental health treatment. Participants completed a survey which included a variety of standardized measures and open-ended questions two weeks before and after the interview. Qualitative follow-up data via open ended questions shows the session was well received by participants as they could share their stories, think critically about their military experiences, and brainstorm solutions for mental health care. We conclude that using individual, confidential interviews to discuss sensitive topics for data collection with MMV is an area to continue developing. Conducting qualitative research with motivational interviewing strategies has the potential to be twofold: advance scholarship and inform practitioners, but also serve as a therapeutic platform for some participants. Supplementary Information: The online version contains supplementary material available at 10.1007/s10615-022-00837-z.

Communication between persons with multiple sclerosis and their health care providers: A scoping review.

OBJECTIVES: This study undertakes a scoping review of research about communication between persons with MS and their health care providers. DESIGN: PubMed, PsycInfo, Communication Source, Socindex, Sociological Abstracts, Cinahl, and Proquest Dissertations and Theses were used to identify studies since each database's inception. Research team members engaged in study selection, coding for communication issues, and data extraction for descriptive information. RESULTS: Of the 419 empirical articles identified, 175 were included. Codes represented all elements of ecological and pathway models, emphasizing emerging technologies for facilitating communication, uncertainty and anxiety for persons with MS, and communication issues surrounding diagnosis, information seeking, and decision making. CONCLUSION: This review synthesizes and organizes influences on communication, communication processes, and health outcomes of communication for persons with MS and their providers. Findings extend the ecological model with illness context and the pathway model with communication breakdowns and provider outcomes. PRACTICE IMPLICATIONS: Health care providers should consider the complexity of communication when interacting with persons with MS, including the larger context in which it occurs, communication processes and their purposes, and short-term and long-term consequences of interactions. Ecological and pathway models can be frameworks for developing educational materials, as they succinctly capture key communication issues and outcomes.