Planning and Implementation of COVID-19 Isolation and Quarantine Facilities in Hawaii: A Public Health Case Report.

In response to the second surge of COVID-19 cases in Hawaii in the fall of 2020, the Hawaii State Department of Health Behavioral Health Administration led and contracted a coalition of agencies to plan and implement an isolation and quarantine facility placement service that included food, testing, and transportation assistance for a state capitol and major urban center. The goal of the program was to provide safe isolation and quarantine options for individual residents at risk of not being able to comply with isolation and quarantine mandates. Drawing upon historical lived experiences in planning and implementing the system for isolation and quarantine facilities, this qualitative public health case study report applies the plan-do-study-act (PDSA) improvement model and framework to review and summarize the implementation of this system. This case study also offers lessons for a unique opportunity for collaboration led by a public behavioral health leadership that expands upon traditionally narrow infectious disease control, by developing a continuum of care that not only addresses immediate COVID-19 concerns but also longer-term supports and services including housing, access to mental health services, and other social services. This case study highlights the role of a state agency in building a coalition of agencies, including a public university, to respond to the pandemic. The case study also discusses how continuous learning was executed to improve delivery of care.

Mapping diabetes burden by school-district for school-based diabetes prevention interventions in selected cities in Michigan, USA.

To decrease diabetes morbidity and mortality rates, early interventions are needed to change lifestyles that are often cemented early, making school-based interventions important. However, with limited resources and lack of within-county diabetes data, it is difficult to determine which local areas require intervention. To identify at-risk school districts, this study mapped diabetes prevalence and related deaths by school district using geographic information systems (GIS). The 2010-2014 records of diabetes-related deaths were identified for 13 cities in Michigan, USA. Diabetes prevalence was estimated using the weighted average of population by school district from the '500 Cities Project' of the Centres of Disease Control and prevention (CDC). Prevalence and mortality rates were mapped by school district and the correlation between diabetes prevalence and mortality rate analysed using the Spearman's rank correlation. Years of potential life lost (YPLL) were calculated using a 75-year endpoint. The result indicated there were geographic variations in diabetes prevalence, mortality and YPLL across Michigan. Most census tracts in the cities of Detroit, Flint and downtown Grand Rapids had higher diabetes prevalence and mortality rate with rs (628)=0.52, P<0.005. School districts with high mortality rates also had high prevalence with rs (13)=0.72, P=0.002. Flint City School District showed a higher rate of diabetes prevalence, death and YPLL than others and should thus be considered a priority for diabetes prevention interventions. Using school districts as the geographic spatial unit of analysis, we identified local variation in diabetes burden for targeting school-based diabetes prevention interventions.

Prevalence and Risk Factors for Self-Reported Postpartum Depression Symptoms (SRPDS) in Hawai'i, 2012-2015.

Postpartum depression (PPD) affects an estimated 10% to 20% of women in the United States, but little is known about the risk factors for PPD in Hawai'i. This study sought to identify PPD risk factors and examine whether disparities exist in Hawai'i. Aggregated 2012-2015 Hawai'i Pregnancy Risk Assessment Monitoring System (PRAMS) data from 5572 women with a recent live birth were analyzed. Two questions on the PRAMS survey about mood and interest in activities were used to create a brief measure of Self-Reported Postpartum Depression Symptoms (SRPDS). Multivariate generalized logit analysis was conducted to identify risk factors associated with SRPDS or possible SRPDS, adjusting for maternal race and age, intimate partner violence (IPV), prenatal anxiety, prenatal depression, illicit drug use before pregnancy, and stressful life events (SLEs). About 10.0% of women surveyed had SRPDS and 27.7% had possible SRPDS. SRPDS was more common among Native Hawaiians (adjusted odds ratios=1.77; 95% confidence interval: 1.17-2.70), Filipinos (2.16; 1.33-3.50), Japanese (2.88; 1.67-4.98), and other Pacific Islanders (OPI; 3.22; 1.78-5.82), when compared to white. Women aged 20-29 years (0.39; 0.24-0.65) and 30-52 years (0.41; 0.24-0.69) were less likely to have SRPDS than those 19 years and younger. SRPDS was highest among women who experienced IPV (2.65; 1.37-5.13), prenatal anxiety (2.10; 1.28-3.42), prenatal depression (2.78; 1.47-5.25), or used illicit drugs before pregnancy (1.97; 1.21-3.20). There was an upward trend in SRPDS based on the number of SLEs. Possible SRPDS had similar but smaller effects, suggesting the importance of clinical screening and appropriate follow-up for these high-risk groups.

Assessing the association of diabetes self-management education centers with age-adjusted diabetes rates across U.S.: Aspatial cluster analysis approach.

The purpose of this study is to identify regions with diabetes health-service shortage. American Diabetes Association (ADA)-accredited diabetes self-management education (DSME) is recommended for all those with diabetes. In this study, we focus on demographic patterns and geographic regionalization of the disease by including accessibility and availability of diabetes education resources as a critical component in understanding and confronting differences in diabetes prevalence, as well as addressing regional or sub-regional differences in awareness, treatment and control. We conducted an ecological county-level study utilizing publicly available secondary data on 3,109 counties in the continental U.S. We used a Bayesian spatial cluster model that enabled spatial heterogeneities across the continental U.S. to be addressed. We used the American Diabetes Association (ADA) website to identify 2012 DSME locations and national 2010 county-level diabetes rates estimated by the Centers for Disease Control and Prevention and identified regions with low DSME program availability relative to their diabetes rates and population density. Only 39.8% of the U.S. counties had at least one ADA-accredited DSME program location. Based on our 95% credible intervals, age-adjusted diabetes rates and DSME program locations were associated in only seven out of thirty five identified clusters. Out of these seven, only two clusters had a positive association. We identified clusters that were above the 75th percentile of average diabetes rates, but below the 25th percentile of average DSME location counts and found that these clusters were all located in the Southeast portion of the country. Overall, there was a lack of relationship between diabetes rates and DSME center locations in the U.S., suggesting resources could be more efficiently placed according to need. Clusters that were high in diabetes rates and low in DSME placements, all in the southeast, should particularly be considered for additional DSME programming.

Modelling individual vulnerability to sexually transmitted infections to optimise intervention strategies: analysis of surveillance data from Kalamazoo County, Michigan, USA.

OBJECTIVE: We modelled individual vulnerability to STI using personal history of infection and neighbourhood characteristics. METHODS: Retrospective chlamydia and gonorrhoea data of reported confirmed cases from Kalamazoo County, Michigan for 2012 through 2014 were analysed. Unique IDs were generated from the surveillance data in collaboration with local health officials to track the individual STI histories. We then examine the concept that individuals with similar STI histories form a 'peer' group. These peer group include: (1) individuals with a single chlamydia; (2) individuals with single gonorrhoea; (3) individuals with repeated cases of one type of STI and (4) individuals that were diagnosed with both infections during the study period. Using Kernel density estimation, we generated densities for each peer group and assigned the intensity of the infection to the location of the individual. Finally, the individual vulnerability was characterised through ordinary least square regression (OLS) using demographics and socioeconomic variables. RESULTS: In an OLS regression adjusted for frequency of infection, individual vulnerability to STI was only consistently significant for race and neighbourhood-level socioeconomic status (SES) in all the models under consideration. In addition, we identified six areas in three townships in Kalamazoo County that could be considered for unique interventions based on overlap patterns among peer groups. CONCLUSIONS: The results provide evidence that individual vulnerability to STI has some dependency on individual contextual (race) and exogenous factors at the neighbourhood level such as SES, regardless of that individual's personal history of infection. We suggest place-based intervention strategies be adopted for planning STI interventions instead of current universal screening of at-risk populations.

The impact of multimorbidity on grip strength in adults age 50 and older: Data from the health and retirement survey (HRS).

BACKGROUND: Multimorbidity, the presence of two or more chronic diseases, is a public health concern. The measurement of grip strength has been proposed as a measure of overall body strength and is reliable and easy to measure. The purpose of this study was to investigate the relationship between the number of chronic diseases and common co-occurring chronic diseases with grip strength. METHODS: A cross-sectional analysis was conducted of 5877 respondents (2744=male, 3103=female) from the 2008 Health and Retirement Study (HRS) who completed grip strength measurements (kg). RESULTS: As the number of chronic diseases increased, an incremental decrease in grip strength occurred and became more pronounced with ≥3 chronic diseases present (b=3.1, 95% CI=2.3-3.9, p<0.001). No statistically significant relationship was identified between specific chronic diseases (except for stroke) and grip strength. CONCLUSION: Multimorbidity has a statistically significant negative relationship on grip strength. Grip strength should be considered as a physical performance measure to incorporate into the care of patients with multimorbidity.

Factors Influencing Choices of Contextualized Versus Traditional Practices With Children and Adolescents Who Have Traumatic Brain Injury.

PURPOSE: This preliminary investigation examined speech-language pathologists' (SLPs') use of contextualized practices (i.e., functional, personally relevant, nonhierarchical, and collaborative) compared with traditional practices (i.e., clinical, generic, hierarchical, and expert driven) with school-age children and adolescents with traumatic brain injury (TBI). METHODS: An electronic survey asked SLPs about their use of clinical activities described as more or less contextualized. Research questions focused on frequency of using contextualized practices and factors associated with their use or nonuse. RESULTS: Seventy responses met criteria for analysis; 98% of these participants reported using at least 1 contextualized practice. Higher use of contextualized practices was associated with working in schools compared to health care settings, access to experts, and greater experience with TBI. Most frequently cited reasons for not using contextualized practices included not fitting the student and scheduling issues. CONCLUSIONS: Factors associated with using contextualized practices suggest that access to experts and experience with TBI are critical components for facilitating contextualized practice recommendations. Reasons for not using certain contextualized practices highlight the need to address scheduling issues and to increase education about practices that may best meet the unique needs of students with TBI.

Grip strength values stratified by age, gender, and chronic disease status in adults aged 50 years and older.

BACKGROUND AND PURPOSE: Grip strength is a measure of overall muscle strength and has been found to be a predictor of disability and mortality. Almost 3 in 4 adults aged 65 years and older have multiple chronic conditions, known as multimorbidity. Normative data for grip strength have commonly been reported on healthy convenience samples that may not accurately represent the population of interest. Grip strength values of US adults, utilizing a nationally representative data set based on the number of chronic diseases, would be beneficial to health care providers who serve adults with multimorbidity. The purpose of this study was to describe grip strength values of adults in the United States, based on gender, age, and the number of chronic diseases. METHODS: A cross-sectional analysis was conducted using data collected from adults aged 50 years or older (n = 5877) from the Health and Retirement Study survey administered in 2008. Grip strength values (in kilograms) were determined and stratified on the basis of the number of self-reported chronic diseases (0, 1, 2, ≥3) and stratified by age (decades) and gender. RESULTS: Consistent with previously published values, males demonstrated higher mean hand grip strength than females and grip strength values decreased with age. Adults with multimorbidity demonstrated decreased grip strength as compared with those without chronic conditions (males/females with 0 chronic diseases right grip strength (Equation is included in full-text article.)= 44.2/26.8 kg as compared with males/females with 3 or more chronic disease right grip strength (Equation is included in full-text article.)= 36.1/21.7 kg). CONCLUSIONS: The grip strength values presented can serve as a standard of comparison for the large proportion of adults who have multimorbidity. Clinicians should consider grip strength as a component of a comprehensive physical assessment to identify decreased grip strength and recommend increased physical activity as an appropriate intervention.

Longitudinal follow-up of factors associated with food selectivity in children with autism spectrum disorders.

The objective of this study was to examine food selectivity in children with autism spectrum disorders longitudinally. Additionally explored were the stability of the relationship between food selectivity and sensory over-responsivity from time 1 to time 2 and the association between food selectivity and restricted and repetitive behavior at time 2. A total of 52 parents of children with autism were surveyed approximately 20 months after completing an initial questionnaire. First and second surveys each contained identical parent-response item to categorize food selectivity level and a scale to measure sensory over-responsivity. A new scale to measure restricted and repetitive behaviors was added at time 2. Results comparing time 1 to time 2 indicated no change in food selectivity level and a stable, significant relationship between food selectivity and sensory over-responsivity. The measure of restrictive and repetitive behavior (time 2) was found to significantly predict membership in the severe food selectivity group. However, when sensory over-responsivity and both restricted and repetitive behaviors were included in the regression model, only sensory over-responsivity significantly predicted severe food selectivity. These results support conclusions about the chronicity of food selectivity in young children with autism and the consistent relationship between food selectivity and sensory over-responsivity.

Clinically meaningful change estimates for the six-minute walk test and daily activity in individuals with chronic heart failure.

PURPOSE: The purpose of the present pilot study was to provide a preliminary estimate of the minimum detectable difference (MDD) and minimum clinically important difference (MCID) of the six-minute walk test (6MWT) and daily activity in outpatients with chronic heart failure (CHF). METHODS: A convenience sample of 22 adults with stable New York Heart Association Functional Class II and III CHF performed two baseline 6MWTs separated by 30 minutes of rest. Subjects then wore a triaxial accelerometer for 7 days to monitor daily activity. After 7 weeks of usual care, subjects again wore the accelerometer for 7 days and then returned to the clinic to complete the Global Rating of Change Scale (GRS) with regard to their heart disease and perform another set of 6MWTs. For the 6MWT, the MDD was calculated using the two baseline 6MWT distances. For daily activity, the MDD was calculated using two methods: (1) day-to-day test-retest reliability during baseline monitoring, and (2) baseline to follow-up test-retest reliability in those who reported no change on the GRS. The MCID for the 6MWT and daily activity was calculated using the mean and 95% confidence interval (CI95%) for those subjects who reported 'improvement' on the GRS. RESULTS: The MDD at the CI95% for the 6MWT was 32.4 meters. The MCID for the 6MWT was 30.1 (CI95% 20.8, 39.4) meters. The MDD for daily activity was 5,909 vector magnitude units (VMU·hr.(-1)) The MCID for daily activity was 1,337 VMU·hr.(-1) There was good alignment of the MDD and MCID for the 6MWT, suggesting that clinically meaningful change is approximately 32 meters. However, the calculated MCID was substantially less than measurement error as represented by the MDD, indicating that the MCID was underestimated in this sample or that daily activity may be robust to change in overall disease status.

Using GIS and secondary data to target diabetes-related public health efforts.

OBJECTIVES: To efficiently help communities prevent and manage diabetes, health departments need to be able to target populations with high risk but low resources. To aid in this process, we mapped county-level diabetes-related rates and resources/use using publicly available secondary data to identify Michigan counties with high diabetes prevalence and low or no medical and/or community resources. METHODS: We collected county-level diabetes-related rates and resources from Web-based sources and mapped them using geographic information systems (GIS) software. Data included age-adjusted county diabetes rates, diabetes-related medical resource and resource use (i.e., the number of endocrinologists and percentage of Medicare patients with diabetes who received hemoglobin A1c testing in the past year), community resources (i.e., the number of certified diabetes self-management education and diabetes support groups), as well as population estimates and demographics (e.g., rural residence, education, poverty, and race/ethnicity). We created GIS maps highlighting areas that had higher-than-median rates of disease and lower-than-median resources. We also conducted linear, logistic, and Poisson regression analyses to confirm GIS findings. RESULTS: There were clear regional trends in resource distribution across Michigan. The 15 counties in the Upper Peninsula were lacking in medical resources but higher in community resources compared with the 68 counties in the Lower Peninsula. There was little apparent association between need (diabetes prevalence) and diabetes-related resources/use. Specific counties with high diabetes prevalence and low resources were easily identified using GIS mapping. CONCLUSION: Using public data and mapping tools identified diabetes health-service shortage areas for targeted public health programming.

Bilateral coordination and gait symmetry after body-weight supported treadmill training for persons with chronic stroke.

BACKGROUND: Locomotor interventions are commonly assessed using functional outcomes, but these outcomes provide limited information about changes toward recovery or compensatory mechanisms. The study purposes were to examine changes in gait symmetry and bilateral coordination following body-weight supported treadmill training in individuals with chronic hemiparesis due to stroke and to compare findings to participants without disability. METHODS: Nineteen participants with stroke (>6 months) who ambulated between 0.4 and 0.8 m/s and 22 participants without disability were enrolled in this repeated-measures study. The stroke group completed 24 intervention sessions over 8 weeks with 20 minutes of walking/session. The non-disabled group served as a comparison for describing changes in symmetry and coordination. Bilateral 3-dimensional motion analysis and gait speed were assessed across 3 time points (pre-test, immediate post-test, and 6-month retention). Continuous relative phase was used to evaluate bilateral coordination (thigh-thigh, shank-shank, foot-foot) and gait symmetry was assessed with spatiotemporal ratios (step length, swing time, stance time). FINDINGS: Significant improvements in continuous relative phase (shank-shank and foot-foot couplings) were found at post-test and retention for the stroke group. Significant differences in spatiotemporal symmetry ratios were not found over time. Compared to the non-disabled group, changes in bilateral coordination moved in the direction of normal recovery. Most measures of continuous relative phase were more responsive to change after training than the spatiotemporal ratios. INTERPRETATIONS: After body-weight supported treadmill training, the stroke group made improvements toward recovery of normal bilateral coordination. Bilateral coordination and gait symmetry measures may assess different aspects of gait.

Triangulating Clinically Meaningful Change in the Six-minute Walk Test in Individuals with Chronic Heart Failure: A Systematic Review.

PURPOSE: The purpose of the present review was to use existing, published data to provide an estimate of the amount of change in six-minute walk test distance (Δ6MWT) that represents a clinically meaningful change in individuals with chronic heart failure (CHF). METHODS: THE PRESENT REVIEW INCLUDED TWO SEPARATE LITERATURE SEARCHES OF THE CINAHL AND MEDLINE DATABASES FOR ARTICLES THAT: (1) reported the intraclass correlation coefficient (ICC) of the 6MWT in individuals with CHF, and (2) used the 6MWT along with either aerobic capacity or health-related quality of life (HRQL) as study endpoints in randomized controlled trials (RCTs) of exercise-based intervention for individuals with CHF. The ICCs were used to calculate the minimum detectable difference (MDD) at the 95% confidence interval for each included study. The Δ6MWT associated with aerobic capacity and HRQL within-group effect sizes for the intervention and control groups in each included RCT was analyzed using receiver operating characteristic (ROC) curves. RESULTS: Thirteen articles reported the ICC for the 6MWT. The mean (standard deviation) MDD calculated based on these data was 43.1(16.8) m. Eighteen RCTs measured the 6MWT and either aerobic capacity and/or HRQL. A Δ6MWT of 40-45 m was associated with at least moderate aerobic capacity and HRQL effect sizes in the intervention groups. The Δ6MWT thresholds that discriminated between intervention and control groups using ROC curves revealed the following sensitivity/specificity for the respective thresholds: 19 m, 94.4/83.3%, 32 m, 83.3/94.4%, and 48 m 44.4/100% (AUC = .935, p = .009, CI(95%) .855, 1.015). CONCLUSIONS: A Δ6MWT of approximately 45 m appears to exceed measurement error and be associated with significant changes in either aerobic capacity and/or HRQL.

A multistate examination of partnership activity among local public health systems using the National Public Health Performance Standards.

This study examines whether partnership-related measures in the second version of the National Public Health Performance Standards (NPHPS) are useful in evaluating level of activity as well as identifying latent constructs that exist among local public health systems (LPHSs). In a sample of 110 LPHSs, descriptive analysis was conducted to determine frequency and percentage of 18 partnership-related NPHPS measures. Principal components factor analysis was conducted to identify unobserved characteristics that promote effective partnerships among LPHSs. Results revealed that 13 of the 18 measures were most frequently reported at the minimal-moderate level (conducted 1%-49% of the time). Coordination of personal health and social services to optimize access (74.6%) was the most frequently reported measure at minimal-moderate levels. Optimal levels (conducted >75% of the time) were reported most frequently in 2 activities: participation in emergency preparedness coalitions and local health departments ensuring service provision by working with state health departments (67% and 61% of respondents, respectively) and the least optimally reported activity was review partnership effectiveness (4% of respondents). Factor analysis revealed categories of partnership-related measures in 4 domains: resources and activities contributing to relationship building, evaluating community leadership activities, research, and state and local linkages to support public health activities. System-oriented public health assessments may have questions that serve as proxy measures to examine levels of interorganizational partnerships. Several measures from the NPHPS were useful in establishing a national baseline of minimal and optimal activity levels as well as identifying factors to enhance the delivery of the 10 essential public health services among organizations and individuals in public health systems.

Effects of body-weight supported treadmill training on kinetic symmetry in persons with chronic stroke.

BACKGROUND: The purpose was to examine changes in kinetic symmetry in persons with chronic stroke immediately and 6-months after body-weight supported treadmill training. METHODS: Fifteen participants at least six-months post stroke and able to ambulate between 0.4 and 0.8m/s and 20 participants without neurological conditions completed all phases of the study and were included in the analysis. The non-disabled group served as a comparison for describing changes in kinetic symmetry. The stroke group completed 24 sessions of body-weight supported treadmill training over 8-weeks with 20 minutes of total walking per session. Bilateral 3-dimensional motion analysis and gait speed were assessed 1-week before training (pre-test), 1-week after training (post-test) and 6-months after training (retention) in a repeated measures design. Relative propulsion of the paretic leg and relative positive work of the hip, knee and ankle joints of both legs were calculated to evaluate symmetry of kinetic forces. FINDINGS: Statistically significant differences in relative propulsion and positive joint work within the paretic and non-paretic legs were not found over time. The stroke group significantly improved gait speed from pre- to post-test (p=.001) and pre-test to retention (p=.008). In comparison to the non-disabled group, forces produced by the stroke group were asymmetrical demonstrating compensatory adaptation. INTERPRETATION: Although the participants with chronic stroke walked faster after body-weight supported treadmill training, the relative percentages of propulsion and positive work remained unchanged. These findings suggest that the increase in speed was likely due to strengthening existing compensatory strategies rather than through recovery of normal kinetic symmetry.

Exploration of commonalities and variations in health related beliefs across four Latino subgroups using focus group methodology: implications in care for Latinos with type 2 diabetes.

Latinos, now the largest U.S. ethnic minority, have a high risk for type 2 diabetes. The Latino population is a heterogeneous group of individuals from many countries with a variety of beliefs and cultures. The purpose of this study was to explore similarities and differences in beliefs and attitudes related to health and healthcare practices across our Latino subgroups (Mexican, Colombian, Puerto Rican, and Mayan). The study used a qualitative research design employing focus groups and participant questionnaires. Data analysis revealed four themes: 1) View of health; 2) Access to care; 3) Acculturation; and 4) Stress and worry.

Ergonomic factors related to drop-off detection with the long cane: effects of cane tips and techniques.

OBJECTIVE: This study examined the effect of cane tips and cane techniques on drop-off detection with the long cane. BACKGROUND: Blind pedestrians depend on a long cane to detect drop-offs. Missing a drop-off may result in falls or collision with moving vehicles in the street. Although cane tips appear to affect a cane user's ability to detect drop-offs, few experimental studies have examined such effect. METHOD: A repeated-measures design with block randomization was used for the study. Participants were 17 adults who were legally blind and had no other disabilities. Participants attempted to detect the drop-offs of varied depths using different cane tips and cane techniques. RESULTS: Drop-off detection rates were similar between the marshmallow tip (77.0%) and the marshmallow roller tip (79.4%) when both tips were used with the constant contact technique, p = .294. However, participants detected drop-offs at a significantly higher percentage when they used the constant contact technique with the marshmallow roller tip (79.4%) than when they used the two-point touch technique with the marshmallow tip (63.2%), p < .001. CONCLUSION: The constant contact technique used with a marshmallow roller tip (perceived as a less advantageous tip) was more effective than the two-point touch technique used with a marshmallow tip (perceived as a more advantageous tip) in detecting drop-offs. APPLICATION: The findings of the study may help cane users and orientation and mobility specialists select appropriate cane techniques and cane tips in accordance with the cane user's characteristics and the nature of the travel environment.

Balance, balance confidence, and health-related quality of life in persons with chronic stroke after body weight-supported treadmill training.

OBJECTIVES: To examine changes in balance, balance confidence, and health-related quality of life immediately and 6 months after body weight-supported treadmill training (BWSTT) for persons with chronic stroke (primary objective) and to determine whether changes in gait speed after BWSTT were associated with changes in these dimensions of health (secondary objective). DESIGN: Prospective pre-/posttest pilot study with 6 months retention. SETTING: University research laboratory settings. PARTICIPANTS: A convenience sample of participants (N=19; at least 6mo poststroke; able to ambulate 0.4-0.8m/s) were recruited. INTERVENTION: BWSTT was provided for 24 sessions over 8 weeks with 20 minutes of total walking each session. MAIN OUTCOME MEASURES: Berg Balance Scale (BBS), Activities-Specific Balance Confidence (ABC) Scale, Stroke Impact Scale (SIS), comfortable 10-m walk test (CWT), and fast 10-m walk test (FWT). Proportions of participants who achieved minimal detectable changes (MDCs) were examined for all measures. RESULTS: Statistically significant improvements were found from pre- to posttest for BBS, ABC, SIS mobility, SIS stroke recovery, and CWT scores (P<.05) and from pretest to retention on BBS, ABC, CWT, and FWT scores (P<.05). For most participants, improvements did not exceed MDCs. Changes in gait speed and BBS, ABC, and SIS scores were not associated. CONCLUSIONS: The findings of this study suggest that effects of BWSTT may transfer beyond gait to positively influence balance, balance confidence, and health-related quality of life. However, for most participants, BWSTT was not sufficient to induce improvements in balance and balance confidence beyond measurement error or long-term retention of enhanced perceptions of quality of life.