Development of a Coaching Protocol to Enhance Self-efficacy Within Outpatient Physical Therapy.

Objective: To describe the development of the Specific, Measurable, Action-Oriented, Realistic, and Timed (SMART) Coaching Protocol to increase exercise self-efficacy in middle-aged and older adults participating in Live Long Walk Strong (LLWS) Rehabilitation Program. LLWS Rehabilitation Program is an innovative physical therapist (PT) delivered outpatient intervention for middle- and older-aged adults with slow gait speed. Design: Phase II randomized controlled trial (RCT) with masked outcome assessment. We applied the Knowledge to Action Framework to develop and implement the LLWS SMART Coaching Protocol within an RCT for the LLWS Rehabilitation Program. Data will be collected at baseline and post intervention at 2, 8 and 16 weeks. Setting: Outpatient; VA Boston Healthcare System. Participants: Community-dwelling veterans (N=198) (older than 50 years) with slow gait speed (<1.0 m/s). Interventions: Participants will be randomized to the LLWS Rehabilitation Program, an 8-week (10-session) PT-delivered intervention, or wait-list control group. Each study visit will introduce a new SMART Coaching module focused on goal setting, exercise adherence, and addressing internal and external barriers to meeting exercise goals. Main Outcome Measures: Primary outcome is gait speed and secondary outcome is the Self-Efficacy for Exercise Scale. Conclusions: Incorporating cognitive behavioral tools in physical therapy intervention research is critical for targeting motivational processes needed for exercise behavior change.

Activity Level and Intensity of Older Adults in Skilled Nursing Rehabilitation Measured via Actigraphy.

BACKGROUND AND PURPOSE: Increasing activity has been shown to improve outcomes in patients receiving post-acute rehabilitation, but little is known about the activity duration and intensity that are actually occurring throughout the rehabilitative stay for older adults in skilled nursing facilities. The purpose of this study was to quantify duration and intensity of movement in older adults receiving rehabilitation in a skilled nursing facility, using 4-limb actigraphy. METHODS: Observational study of 92 older adults admitted for rehabilitation services at 2 skilled nursing facilities. All participants wore actigraph accelerometers (wGT3X+) on bilateral wrists and ankles for 24 hours, inclusive of 1 session each of physical and occupational therapy. Using actigraphy data, we calculated (a) movement duration (time the dominant or noninvolved upper or lower limb was active) and (b) movement intensity (sum of activity counts per minute for the dominant or noninvolved upper or lower limb). RESULTS: Over the 24-hour period, the lower limb moved a total median [interquartile range] of 01:10 (hours:minutes) [01:01] and the upper limb moved a total average (SD) of 04:45 (02:00). When participants did move, it was at low intensities with 61 [87] and 610 [623] activity counts per minute for lower limb out-of-therapy time and during physical therapy, respectively. For the upper limb, activity counts per minute were 689 (388) for out-of-therapy movement and 1359 (695) during physical therapy. However, neither the lower or upper limb reached a moderate-intensity level (2690-6166 counts per minute). DISCUSSION: Older adults receiving rehabilitation in 2 skilled nursing facilities had low movement duration and movement intensity both in and out of therapy. CONCLUSION: Rehabilitation interventions for older adults should target and increase movement duration and intensity, during and after skilled nursing facility care.

Is subclinical gambling really subclinical?

Gambling disorder and substance use disorders (SUD) overlap in terms of etiology and diagnostic constructs (e.g., preoccupation, loss of control), yet diagnostic thresholds for the disorders are different. Currently, endorsing 2-3 gambling disorder criteria does not warrant a diagnosis while endorsing 2-3 SUD criteria does. The aim of this study was to examine whether subclinical gamblers (i.e., endorsing 2-3 gambling disorder criteria) experience psychosocial dysfunction equivalent to individuals who are diagnosed with mild severity SUD (i.e., 2-3 SUD criteria) and whether this level of dysfunction is significantly different from individuals with no psychopathology. Data are from the first wave of Quinte Longitudinal Study, a large epidemiological sample (N=4121). Psychometrically supported measures assessed for psychosocial functioning and the presence of Axis-I psychiatric disorders. Cross-sectional analysis examined 7 domains of psychosocial functioning using ANCOVA, which allowed for the inclusion of covariates, to test for difference between subclinical gamblers and individuals with no psychopathology and individuals with mild severity SUD. Equivalency testing compared subclinical gamblers in relation to mild severity SUD. Subclinical gamblers reported significantly poorer psychosocial functioning in relation to individuals endorsing no current psychopathology. Subclinical gamblers were also equivalent to and not significantly different from individuals with mild severity SUD. Subclinical gamblers experience similar psychosocial impairment to those individuals who endorse mild severity SUD, and this significantly differed from healthy individuals. The threshold for diagnosis of gambling disorder therefore warrants re-examination.