Measuring older adults' wellbeing when transitioning into assisted living facilities: a confirmatory factor analysis of the Mueller assessment of transition (MAT).

OBJECTIVES: Older adults' wellbeing during the transition into an assisted living facility (ALF) is not well understood and may influence their wellbeing. The Mueller Assessment of Transition (MAT) was created to measure the impact of transition on older adults' wellbeing. Early developmental testing of the MAT revealed a hypothesized model with two constructs (adjustment strategies and constraints to wellbeing). Therefore, the purpose of this study was to confirm the factor structure of the MAT with a representative sample of older adults transitioning into ALFs. METHODS: In a nationwide sample, 108 older adult participants completed the MAT to measure wellbeing when relocating into ALFs. Confirmatory factor analysis (CFA) assessed the structural validity of the MAT. Internal consistency was evaluated, and chi-square tests of association for regional differences in MAT scores were also conducted. RESULTS: The CFA produced strong fit indices to confirm the hypothesized 2-factor (constraints to wellbeing and adjustment strategies) model of the MAT. Cronbach's alpha for the internal consistency was 0.784 and chi-square test indicated no significant regional differences. CONCLUSION: The MAT was established as a valid and reliable standardized assessment. Implications for using the MAT as a tool to measure older adults' wellbeing and future research are discussed.

Matching Exercise Volume in Active Control Groups for Yoga Interventions.

Context: The selection of a control group should foremost be determined by the study's primary intended outcome and trial design. When examining the effects of the physical movements that comprise yoga postures, an active control group, with physical exercise as the control, is often recommended. Objective: The current study aimed to define an active control group that participates in physical exercise, emphasizing the importance of matching the exercise's volume to that of an intervention group's yoga, and to provide a tangible example from a federally funded, recently completed, randomized controlled trial. Design: The research team designed a control group, providing a case study as a example of it. Setting: The study took place at Colorado State University. Intervention: The exercise component for the control group included 60 minutes of low-intensity exercise, matched with 60 minutes of Hatha yoga for the intervention group. Because the intervention included chronic pain self-management in addition to the exercise component, the education component for the control group included 45 minutes of group-based, general health-and-wellness education and discussion. Conclusions: Future randomized trials for yoga and other complementary or integrative health interventions should continue to use appropriate active control groups, which will serve to enhance the scientific rigor of conclusions that can be drawn with respect to the effectiveness of these interventions.

The Lived Experience of Siblings of Children With Cancer Who Attended a Peer Support Camp in the United States.

Childhood cancer has a profound and negative impact on siblings, yet there are limited studies exploring lived experiences from their perspective. This qualitative study examined the perceptions and experiences of siblings of children with cancer who attended a peer support camp. Semi-structured interviews were conducted three to six weeks after the weeklong peer support camp with a stratified random sample of 10 siblings (six non-bereaved and four bereaved) ages 8 to 16 years. The qualitative data were analyzed using conventional content analysis and an inductive data-driven approach. Four themes emerged: social connection (subthemes: support/feeling of belonging, mentorship, and expressing feelings), personal growth, identity, and freedom to have fun and relax. These findings add to the scant body of research by providing enhanced understanding of the siblings' experiences and new insights into their perceptions of meaning and outcomes associated with participation in a peer support camp. These findings have implications for peer support camp programs and the well-being of siblings of children with cancer.

Influence of 8-Week Horseback Riding Activity on Balance and Pelvic Movements in an Older Adult Population.

The biomechanical relationship between horse and rider in equine-assisted activities and therapies has been largely unexplored. The three-dimensional stimulation of the horse's gait has potential to improve rider musculature and coordination, especially in an older adult population. This study utilized dual-axis goniometers and video motion capture tracking to simultaneously track horse and rider hip flexion and extension. Ten older adult riders participated in 8 weeks of horseback riding lessons, where pelvis kinematics and balance assessments were compared between Weeks 1 and 8. Pelvic roll of the rider and horses' hip flexion and extension were successfully tracked and summed improvements in balance assessments were also evident after 8 weeks of horseback riding lessons. Future research will assess deeper kinematic relationships between a horse's gait and rider biomechanical responses.

Multidimensional risk score to stratify community-dwelling older adults by future fall risk using the Stopping Elderly Accidents, Deaths and Injuries (STEADI) framework.

BACKGROUND: The Stopping Elderly Accidents, Deaths and Injuries (STEADI) screening algorithm aligns with current fall prevention guidelines and is easy to administer within clinical practice. However, the stratification into low, moderate and high risk categories limits the meaningful interpretation of the fall-related risk factors. METHODS: Baseline measures from a modified STEADI were used to predict self-reported falls over 4 years in 3170 respondents who participated in the 2011-2015 National Health and Aging Trends Study. A point method was then applied to find coefficient-based integers and 4-year fall risk estimates from the predictive model. Sensitivity and specificity estimates from the point method and the combined moderate and high fall risk STEADI categories were compared. RESULTS: There were 886 (27.95%) and 387 (12.21%) respondents who were classified as moderate and high risk, respectively, when applying the stratification method. Falls in the past year (OR: 2.16; 95% CI: 1.61 to 2.89), multiple falls (OR: 2.94; 95% CI: 1.89 to 4.55) and a fear of falling (OR: 1.77; 95% CI: 1.45 to 2.16) were among the significant predictors of 4-year falls in older adults. The point method revealed integers that ranged from 0 (risk: 27.21%) to 44 (risk: 99.71%) and a score of 10 points had comparable discriminatory capacity to the combined moderate and high STEADI categories. CONCLUSION: Coefficient-based integers and their risk estimates can provide an alternative interpretation of a predictive model that may be useful in determining fall risk within a clinical setting, tracking changes longitudinally and defining the effectiveness of an intervention.

Yoga for symptom management in oncology: A review of the evidence base and future directions for research.

Because yoga is increasingly recognized as a complementary approach to cancer symptom management, patients/survivors and providers need to understand its potential benefits and limitations both during and after treatment. The authors reviewed randomized controlled trials (RCTs) of yoga conducted at these points in the cancer continuum (N = 29; n = 13 during treatment, n = 12 post-treatment, and n = 4 with mixed samples). Findings both during and after treatment demonstrated the efficacy of yoga to improve overall quality of life (QOL), with improvement in subdomains of QOL varying across studies. Fatigue was the most commonly measured outcome, and most RCTs conducted during or after cancer treatment reported improvements in fatigue. Results also suggested that yoga can improve stress/distress during treatment and post-treatment disturbances in sleep and cognition. Several RCTs provided evidence that yoga may improve biomarkers of stress, inflammation, and immune function. Outcomes with limited or mixed findings (eg, anxiety, depression, pain, cancer-specific symptoms, such as lymphedema) and positive psychological outcomes (such as benefit-finding and life satisfaction) warrant further study. Important future directions for yoga research in oncology include: enrolling participants with cancer types other than breast, standardizing self-report assessments, increasing the use of active control groups and objective measures, and addressing the heterogeneity of yoga interventions, which vary in type, key components (movement, meditation, breathing), dose, and delivery mode.

Self-Management and Yoga for Older Adults with Chronic Stroke: A Mixed-Methods Study of Physical Fitness and Physical Activity.

OBJECTIVE: This study investigated changes in physical fitness and physical activity among older patients with chronic stroke (stroke ≥ 6 months previous) after participation in a yoga infused self-management intervention. METHODS: A mixed-methods secondary data analysis examined quantitative measures of endurance, strength, and gait speed and qualitative perspectives of intervention participants. RESULTS: Based on Wilcoxon analysis, physical fitness outcome measures including endurance and lower and upper body strength significantly (p < .02) improved. Based on qualitative results of 2 focus groups and 14 individual interviews, participants expressed positive changes in endurance, strength, gait speed, flexibility, and balance. They also reported improvements in walking ability and duration, and expressed a desire to continue yoga and increase levels of exercise. CONCLUSIONS: With the objective of improving physical fitness and exercise for older adults with chronic stroke, it is important for self-management interventions to provide specific safe and feasible physical activity components, such as yoga. CLINICAL IMPLICATIONS: Health professionals may improve offered chronic stroke self-management interventions by incorporating yoga.

Outcomes of a Therapeutic Fly-Fishing Program for Veterans with Combat-Related Disabilities: A Community-Based Rehabilitation Initiative.

The purpose of this study was to examine the outcomes of a therapeutic fly-fishing program for veterans with combat-related disabilities. A total of 40 veterans participated in the 4-day therapeutic fly-fishing program and this study. The outcomes examined included reducing symptoms of posttraumatic stress (PTS), depression, perceived stress, functional impairment (i.e., work, relationships, physical, and everyday life), increasing self-determination, and leisure satisfaction. Each research participant completed pretest, posttest, and 3-month follow-up questionnaires. Repeated measures MANOVA and ANOVA were conducted to examine the differences between the three time points on each outcomes. The results indicated significant decreases from the pretest to posttest for symptoms of PTS, depression, perceived stress, and functional impairment, and an increase in leisure satisfaction from pretest to 3-month follow-up. These results highlight the use of therapeutic recreation programming for veterans with disabilities as a holistic approach to treatment and recovery.

The Effects of Yoga Participation on Women's Quality of Life and Symptom Management During the Menopausal Transition: A Pilot Study.

Typically lasting 5-10 years, the menopausal transition is associated with symptoms including hot flashes, night sweats, and labile mood. As these symptoms often hinder a woman's successful functioning in everyday life, hormone therapy is commonly prescribed as a means to diminish symptoms. Many women, however, are seeking complementary and alternative treatments due to side effects and/or detrimental health-risks associated with conventional therapies. We completed a mixed methods study to determine changes in physiological symptoms associated with menopause and changes in women's quality of life, as a result of participation in a 10-week yoga intervention.

Examination of sustained gait speed during extended walking in individuals with chronic stroke.

OBJECTIVES: To determine if individuals with chronic stroke were able to sustain their peak gait speed during the 6-minute walk test (6MWT), and to explore this sustainability across community ambulation potential subgroups. DESIGN: Prospective cross-sectional study. SETTING: University-based research laboratory, hospitals, and stroke support groups. PARTICIPANTS: A sample of individuals with chronic stroke (N=48) completed a series of questionnaires and physical outcome measures, including gait mat assessment, during a single visit. INTERVENTIONS: Not applicable; 1-time cross-sectional data collection. MAIN OUTCOME MEASURES: During the 6MWT, we measured peak gait speed and end gait speed to assess sustainability, along with beginning gait speed, total distance walked, and rating of perceived exertion. We also assessed maximum gait speed during the 10-meter walk test (10MWT). Finally, we examined these gait outcomes across the subgroups. RESULTS: During the 6MWT, peak gait speed declined from .89m/s (SD=.38) to an end speed of .82m/s (SD=.36), whereas perceived exertion increased from 7.7 (SD=2.6) to 11.8 (SD=3.6). This peak gait speed was slower than the 10MWT maximum speed of 1.06m/s (SD=.51), but faster than the 6MWT beginning speed of .81m/s (SD=.34). The unlimited community ambulator subgroup was the primary contributor to sustainability differences. CONCLUSIONS: Predicting community ambulation potential based on the discrete gait speed from the 10MWT and endurance based on the average from the 6MWT might be incomplete if gait speed sustainability is not also assessed.

Balance is associated with quality of life in chronic stroke.

OBJECTIVE: To investigate the association between balance and quality of life (QOL) in chronic stroke survivors by (1) examining the associations between balance and QOL scores; (2) identifying the frequency of balance impairment and poststroke falls; and (3) determining the differences in QOL scores between persons with and those without balance impairment. METHODS: This is a secondary analysis of a cross-sectional study. People who had a stroke more than 6 months earlier from 3 Midwest states were included in the study if they met the following criteria: were referred to occupational or physical therapy for poststroke physical deficits; had self-reported stroke-related physical deficits; completed all stroke-related rehabilitation; had residual functional disability; had a score of ≥4 out of 6 on the short 6-item Mini-Mental State Examination; and were between 50 and 85 years old (n = 59). The main outcome measures included the Berg Balance Scale (BBS) to assess balance and the Stroke Specific Quality of Life Scale (SS-QOL) to assess QOL. Number of falls since stroke was self-reported. RESULTS: Mean BBS score was 44 ± 8 and mean SS-QOL score was 46 ± 8; these scores were significantly correlated (r = .394, P = .002). Seventy-six percent of the sample reported a fall since stroke. Persons with balance impairment (BBS score ≤46; n = 29; 49%) had an average BBS score of 39 ± 7 and significantly worse SS-QOL scores than those without balance impairment (42 ± 8 vs 49 ± 7; P = .001). CONCLUSION: In the chronic stroke population, balance impairment and fall risk are associated with lower QOL scores. If balance can be improved and maintained into the chronic phases of stroke, it is likely that individuals will benefit with improved QOL.

Fatigue and pain: relationships with physical performance and patient beliefs after stroke.

BACKGROUND: Fatigue and pain are common after stroke, potentially impacting stroke recovery. OBJECTIVE: This study examines the frequency and impact of fatigue and pain in people with chronic stroke. METHOD: Seventy-seven people with chronic stroke completed a one-time assessment consisting of a battery of self-report and performance tools to describe and quantify mobility issues post stroke. We assessed the proportion of individuals with fatigue and pain and the relationship between fatigue and pain and other variables including gait (10-meter walk and 6-minute walk test), balance (Berg Balance Scale), activity and participation (ICF Measure of Participation and Activities), chronic disease self-efficacy (Chronic Disease Self-Efficacy Scale), and balance self-efficacy (Activity-Specific Balance Confidence Scale). Additionally, subgroup comparisons were made between participants with and without coexisting fatigue and pain. RESULTS: Fatigue and pain were reported by 66% and 45% of study participants, respectively. Thirty-four percent of the sample reported co-existing fatigue and pain. Participants with coexisting fatigue and pain demonstrated significantly lower chronic disease and balance self-efficacy and decreased activity than participants without coexisting fatigue and pain. Individually, fatigue correlated with balance, chronic disease self-efficacy, balance self-efficacy, activity, and participation, whereas pain correlated with chronic disease self-efficacy, balance self-efficacy, and activity. CONCLUSION: Fatigue and pain are common after stroke and are negatively correlated with outcomes important to rehabilitation. Efforts focused on examining the impact of interventions on fatigue and pain are warranted. It is possible that changes to these body structure limitations could positively impact functional recovery and community re-entry after stroke.

Correlates of moderate-to-vigorous physical activity participation in adults with intellectual disabilities.

Adults with intellectual disabilities (ID) have low levels of physical activity and higher than average rates of related chronic health conditions. Understanding correlates of their physical activity participation may improve health promoting interventions. Forty-two adults with ID participated in a physical activity study. Physical activity knowledge and skills, awareness of recommendations and demographic characteristics were analyzed for their association with moderate-to-vigorous physical activity (MVPA) participation measured by accelerometers. Five variables were significantly correlated with MVPA. Body mass index was inversely correlated with MVPA, and gender, job location, job tasks, and place of residence were all significantly associated with MVPA. Understanding correlates of physical activity in this population will help inform disability service and health promotion professionals in future research and health intervention design.

Exploring Constraints to Well-Being for Older Adults in Transition Into an Assisted Living Home: A Qualitative Study.

Transitions into an assisted living home (ALH) are difficult and may impact the well-being of older adults. A thematic analysis guided by grounded theory was employed to better understand how a transition into an ALH influenced older adults' overall well-being. Individual, face-to-face interviews were conducted with a convenience sample of 14 participants at an ALH in the rural, southeastern U.S. Two central findings that influenced well-being during the transition process were revealed: loss of independence (sub-themes include loss of physical and mental health and loss of driving) and downsizing in space and possessions. The themes support and broaden the Hierarchical Leisure Constraints Theory, a Modified Constraints to Wellbeing model is proposed, and implications for older adult health care practitioners in ALHs are recommended. Further research is needed on the Modified Constraints to Wellbeing model and how to better describe these constraints to older adults' well-being when relocating into ALHs.

Acceptability of Online Yoga Among Individuals With Chronic Conditions and Their Caregivers: Qualitative Study.

BACKGROUND: The online delivery of yoga interventions rapidly expanded during the COVID-19 pandemic, and preliminary studies indicate that online yoga is feasible across multiple chronic conditions. However, few yoga studies provide synchronous online yoga sessions and rarely target the caregiving dyad. Online chronic disease management interventions have been evaluated across conditions, life spans, and diverse samples. However, the perceived acceptability of online yoga, including self-reported satisfaction and online delivery preferences, is underexplored among individuals with chronic conditions and their caregivers. Understanding user preferences is essential for successful and safe online yoga implementation. OBJECTIVE: We aimed to qualitatively examine the perceived acceptability of online yoga among individuals with chronic conditions and their caregivers who participated in an online dyadic intervention that merged yoga and self-management education to develop skills (MY-Skills) to manage persistent pain. METHODS: We conducted a qualitative study among 9 dyads (>18 years of age; individuals experiencing persistent moderate pain) who participated in MY-Skills online during the COVID-19 pandemic. The intervention consisted of 16 online, synchronous yoga sessions over 8 weeks for both dyad members. After the completion of the intervention, participants (N=18) participated in semistructured telephone interviews for around 20 minutes, discussing their preferences, challenges, and recommendations for improved online delivery. Interviews were analyzed by using a rapid analytic approach. RESULTS: MY-Skills participants were, on average, aged 62.7 (SD 19) years; were primarily women; were primarily White; and had a mean of 5.5 (SD 3) chronic conditions. Both participants and caregivers reported moderate pain severity scores (mean 6.02, SD 1.3) on the Brief Pain Inventory. The following three themes were identified related to online delivery: (1) participants indicated a preference for the intervention to be in person rather than online because they were distracted in the home setting, because they felt that in-person yoga would be more engaging, because the yoga therapist could physically correct positions, and because of safety concerns (eg, fear of falling); (2) participants indicated good acceptability of online MY-Skills delivery due to convenience, access, and comfort with being in their home; and (3) recommendations for improving online delivery highlighted a need for additional and accessible technical support. CONCLUSIONS: Both individuals with chronic conditions and their caregivers find online yoga to be an acceptable intervention. Participants who preferred in-person yoga did so due to distractions in the home and group dynamics. Some participants preferred in-person corrections to ensure correct positioning, while others felt safe with verbal modifications in their homes. Convenience and access were the primary reasons for preferring online delivery. To improve online delivery, future yoga studies should include specific activities for fostering group engagement, enhancing safety protocols, and increasing technical support. TRIAL REGISTRATION: ClinicalTrials.gov NCT03440320; https://clinicaltrials.gov/ct2/show/NCT03440320.

An Exploration of Yoga in Occupational Therapy Practice for Multiple Sclerosis.

The purpose of this exploratory qualitative study was to provide insight on the use of yoga in occupational therapy (OT) for people with multiple sclerosis (PwMS). This study aimed to answer how and why OT practitioners (OTPs) integrate yoga into clinical practice for PwMS. Eight OTPs, half of whom have also completed yoga teacher training, participated in a semi-structured telephone interview. Interviews were transcribed verbatim, inductively open-coded, and analyzed using thematic data analysis. Themes that emerged were: (a) OT and yoga are a natural fit; (b) improved performance and participation; (c) leveraging personal ties to yoga; and (d) influenced by client factors and clinical environment. The qualitative data provide valuable information about OTPs' justification for, and unique application of, yoga in clinical practice for PwMS. Future researchers should further explore the use of yoga for OT-related outcomes and the experience of PwMS.

Poststroke balance improves with yoga: a pilot study.

BACKGROUND AND PURPOSE: Balance impairment is common after stroke; modified yoga may be able to improve balance and other important poststroke variables. Scientific-evidence is needed to support such treatment interventions. The purpose of this study was to assess the impact of a yoga-based rehabilitation intervention on balance, balance self-efficacy, fear of falling (FoF), and quality of life after stroke. METHODS: This was a prospective, randomized, pilot study of yoga-based rehabilitation for people with chronic stroke. All yoga sessions were taught by a registered yoga therapist, occurred twice per week for 8 weeks and included seated, standing, and floor postures with relaxation and meditation. Balance was assessed with the Berg Balance Scale, balance self-efficacy with the Activities-specific Balance Confidence Scale, FoF with a dichotomous yes/no question, and quality of life with the Stroke Specific Quality of Life scale. RESULTS: There were no significant differences between wait-list control (n=10) and yoga (n=37) groups in baseline or follow-up scores. However, using within-group comparisons, yoga group data demonstrated significant improvement in balance (Berg Balance Scale, 41.3±11.7 vs 46.3±9.1; P<0.001) and FoF (51% vs 46% with FoF; P<0.001). CONCLUSIONS: A group yoga-based rehabilitation intervention for people with chronic stroke has potential in improving multiple poststroke variables. Group yoga may be complementary to rehabilitation, may be possible in medical-based and community-based settings, and may be cost-effective. Further testing of group yoga-based rehabilitation interventions is warranted. Clinical Trial Registration- URL: http://clinicaltrials.gov. Unique Identifier: NCT01109602.

Balance and balance self-efficacy are associated with activity and participation after stroke: a cross-sectional study in people with chronic stroke.

OBJECTIVES: To (1) examine the relationships between multiple poststroke mobility variables (gait speed, walking capacity, balance, balance self-efficacy, and falls self-efficacy) and activity and participation; and (2) determine which poststroke mobility variables are independently associated with activity and participation. DESIGN: This is the primary analysis of a prospective cross-sectional study completed to understand the impact of mobility on activity and participation in people with chronic stroke. SETTING: University-based research laboratory, hospitals, and stroke support groups. PARTICIPANTS: People (N=77) with stroke greater than 6 months ago were included in the study if they were referred to occupational or physical therapy for physical deficits as a result of the stroke, completed all stroke related inpatient rehabilitation, had residual functional disability, scored a ≥4 out of 6 on the short, 6-item Mini-Mental State Examination, and were between the ages of 50 and 85. INTERVENTIONS: Not applicable, this is a cross-sectional data collection of 1 timepoint. MAIN OUTCOME MEASURES: We measured activity and participation with the validated International Classification of Functioning, Disability and Health Measure of Participation and Activities. Other variables included gait speed (10-meter walk), walking capacity (6-minute walk), balance (Berg Balance Scale), balance self-efficacy (Activities Specific Balance Confidence Scale), and falls self-efficacy (Modified Falls Efficacy Scale). RESULTS: Only balance self-efficacy was found to be independently associated with poststroke activity (ß=-.430, P<.022, 95% confidence interval [CI], -.247 to -.021) and participation (ß=-.439, P<.032, 95% CI, -.210 to -.010). CONCLUSIONS: Among people with chronic stroke, balance self-efficacy, not physical aspects of gait, was independently associated with activity and participation. While gait training continues to be important, this study indicates a need to further evaluate and address the psychological factors of balance and falls self-efficacy to obtain the best stroke recovery.

Developing a physical activity education curriculum for adults with intellectual disabilities.

Adults with intellectual disabilities have high rates of physical inactivity and related chronic diseases. Researchers have called for an increase in the development and evaluation of health education programs adapted to the unique needs of this population. Formative and process evaluation strategies were applied to develop a physical activity education program. The first phase of formative evaluation included a comprehensive literature review to select educational strategies and curriculum content. The theory of planned behavior was selected as a guiding framework, and meetings with stakeholders were held to assess feasibility. The second phase of formative evaluation included an assessment of materials by an expert panel and the priority population, and pilot testing. Next, field testing was implemented, followed by process evaluation and an assessment of implementation fidelity. The final curriculum was developed as a result of the completion of the aforementioned steps and led to a successful physical activity intervention.

Catalyzing transdisciplinary studies in public health: a college health survey and data platform.

Researchers, educators, and service providers recognize that health behaviors and conditions are interdependent, yet they are too often addressed compartmentally. This "silo" approach is unfortunate because it leads to inefficiencies and less effective approaches to prevention. This article describes a process designed to promote better understanding of the interrelatedness of health behaviors and outcomes through a multidimensional Internet-based health survey aimed at undergraduate college students. In addition, we describe a data-sharing platform whereby faculty and students from across disciplines may access the raw data for a variety of uses. An analysis is performed illustrating a syndemic between binge drinking, sexually transmitted diseases, and using alcohol or drugs prior to sexual intercourse. Potential applications of the multidomain survey are discussed, as well as lessons learned and limitations of this approach.