Preferred Behavior Change Techniques for Physical Activity Interventions among Persons Newly Diagnosed with Multiple Sclerosis: A Qualitative Study.

There is increasing interest by researchers and clinicians in behavior change interventions for promoting physical activity in persons newly diagnosed with MS. Ideally, such interventions require the delivery of behavior change techniques (BCTs) based on theory and the selection of BCTs might further require tailoring for this MS subpopulation. The current study examined BCTs preferred by persons newly diagnosed with MS for informing the design and delivery of physical activity behavior change interventions in early-stages of MS. We recruited and interviewed 20 persons newly diagnosed with MS (i.e., disease duration ≤ 2 years). The interviews were conducted online via video conferencing platform and followed a semi-structured script. During the interviews, participants provided opinions regarding an ideal physical activity behavior change program, and the opinions of participants were mapped with the Intervention Functions of the Behavior Change Wheel, BCTs, and BCT groups. Ten frequently mentioned BCTs were identified as preferred strategies for a physical activity behavior change intervention among persons newly diagnosed with MS. These BCTs focused on providing social support, skills and strategies for physical activity performance and regulation, and knowledge on benefits of physical activity in MS. This research provides a refined list of BCTs that can be included when designing tailored physical activity behavior change interventions for persons newly diagnosed with MS.

Physical Activity in Individuals Newly Diagnosed With Multiple Sclerosis Through the Lens of the COM-B Model.

BACKGROUND: Physical activity (PA) is a promising intervention for disease modification and symptom management in multiple sclerosis (MS); however, there is a lack of research focusing on PA behavior change interventions for persons newly diagnosed with MS. Such PA behavior change interventions should be developed based on a strong empirical foundation of understanding the behavior and its determinants (ie, what to target for changes to occur). To that end, this qualitative study examined factors explaining PA in persons newly diagnosed with MS and identified potential targets for future behavior change intervention development based on the Capability-Opportunity-Motivation-Behavior (COM-B) model. METHODS: Twenty individuals diagnosed with MS within the past 2 years underwent one-on-one semistructured interviews using questions developed based on the COM-B model. Data were analyzed using reflective thematic analysis, and the identified themes were then mapped with the COM-B model. RESULTS: Factors explaining PA in the study sample were identified across the COM-B components. The typical factors include knowledge and skills to sufficiently engage in PA with appropriate approaches, ability to adapt and navigate through new environmental and social difficulties after diagnosis, and motivation resulting from a combination of factors, such as outcome expectation, belief of capabilities, role/identity, reinforcement, and emotions. CONCLUSIONS: The COM-B model was applied successfully in this study to understand PA behavior and identify potential targets for behavior change in individuals newly diagnosed with MS. Future behavior change interventions should consider addressing these factors to generate effective PA behavior change in this population.

Feasibility of a theory-based physical activity intervention for persons newly diagnosed with multiple sclerosis.

BACKGROUND: Physical activity (PA) is beneficial for rehabilitation and symptom management in multiple sclerosis (MS), yet persons newly diagnosed with MS are insufficiently active and have not been the focus of PA research. This is important as early initiation of lifestyle PA, alongside other disease modifying therapies, might maximize the lasting benefits of this behavior on health outcomes and health-related quality of life (HRQOL) in MS. PURPOSE: This single group, pre-post study examined the feasibility and initial efficacy of a 12-week remotely delivered COM-B-based behavior change intervention targeting lifestyle PA in persons newly diagnosed with MS. METHODS: Persons newly diagnosed with MS (diagnosis of 2 years or less) were recruited for the study. The intervention was designed based on COM-B and formative research, and included a program manual, newsletters, video coaching calls, pedometer, logbook, and calendar. Feasibility was assessed in four domains: process (e.g., recruitment, retention), resource (e.g., time and costs), management (e.g., data management), and scientific evidence (e.g., safety, treatment effects). RESULTS: Thirty-two persons newly diagnosed with MS underwent screening, 17 were eligible, and 14 started the intervention. Twelve participants completed the study (86 % retention rate). All participants in the intervention engaged in 100 % of video coaching calls and participants provided 73 % of online step count entries. Eighty-three percent of participants fully complied with reviewing the newsletters. No relapses were reported during the intervention. There were moderate-to-large increases in PA outcomes, as measured by the Godin Leisure-Time Exercise Questionnaire, International Physical Activity Questionnaire, and accelerometry (light PA) (d ≥ 0.5). There were no significant changes in other accelerometry outcomes, including step counts and moderate-to-vigorous PA (d = 0.2). There were large, positive effects of the intervention on physical and mental health-related quality of life with (d ≥ 1), but the change in fatigue severity was small and not statistically significant among the study participants (d = 0.3). CONCLUSIONS: This study provides evidence for feasibility and initial efficacy of a COM-B-based PA intervention for persons newly diagnosed with MS. The results indicate that this intervention was feasible, safe, acceptable, and promising for promoting lifestyle PA in persons newly diagnosed with MS.

An Evaluation of a Clinic-Based Low Vision Device Lending Library.

As the efficacy of low vision service provision is facilitated by clients' access to and proper use of low vision devices, the objective of this study was to evaluate an outpatient clinic-based low vision device lending library program and the functional and psychosocial impact that device use had upon clients. Twenty individuals borrowed portable video magnifiers during the study period. Line items from the Revised-Self-Report Assessment of Functional Visual Performance and the Reading Behavior Inventory were analyzed before and after device loan at two months. The Psychosocial Impact of Assistive Devices Scale-10 and a semi-structured interview were also completed at two months. Reported improvements in reading performance and satisfaction levels on the Reading Behavior Inventory were significant (p<.001). The Revised-Self-Report Assessment of Functional Visual Performance indicated improved independence in reading medications, bills and labels. Higher scores in happiness, independence, sense of control and adaptability on the Psychosocial Impact of Assistive Devices Scale-10 indicated device retention at two months. Qualitative themes included improved independence, time needed to acclimate to the device, personal appraisal impacting motivation and challenges specific to low vision. This article provides occupational therapists a model to facilitate access, person-device fit and successful use of low vision devices to promote therapy outcomes.

Models and materials for exercise promotion in comprehensive multiple sclerosis care: completion of the 'exercise in medicine' development process.

PURPOSE: Health care providers have highlighted the need for tools and resources that support promotion of exercise behavior within comprehensive multiple sclerosis (MS) care. This study involved a final quality improvement evaluation of exercise promotion models and materials for inclusion within this setting. METHODS AND MATERIALS: Our research team distributed a paper-based survey containing Likert scales, open answer questions, and copies of the models for editing. We distributed this survey among health care providers across the United States. We conducted a novel mixed-methods analysis evaluating quantitative, qualitative, and creative data. RESULTS: We received completed surveys from 13 health care providers who strongly rated the clarity and applicability of the models and materials, and reported that no major improvements were necessary. The minor improvements were specific per comprehensive MS care center. The feedback indicated that the "Exercise in Medicine" models and materials are guides such that the processes should be integrated into real world practice by amending roles and responsibilities with the team members and structure per comprehensive MS care center. CONCLUSION: This paper presents finalized models and materials for exercise promotion within comprehensive MS care that are ready to be tested for feasibility and efficacy in a clinical trial.IMPLICATIONS FOR REHABILITATIONHealth care providers require support to promote exercise within the context of comprehensive MS care.The practice models in this article provide guides regarding how to promote exercise in this context.Implementing these exercise promotion guides can reduce the burden of neurologists, and ensure patients receive exercise support from appropriate providers.These guides should be implemented within the context of each individual care center, and not as an explicit step by step guide as each care center is unique.

Using Quality Improvement for Refining Program Materials for Exercise Promotion in Comprehensive Multiple Sclerosis Care.

INTRODUCTION: There is a gap between evidence-based knowledge of exercise benefits and the translation of these benefits among persons with multiple sclerosis within clinical practice. This study represents the second cycle of a Plan-Do-Study-Act ramp to assess and improve three exercise promotion practice models and a screening process for use by healthcare providers to bridge the knowledge-translation gap within comprehensive multiple sclerosis care. METHODS: Using a quality improvement design, our research team created an online survey for evaluating program materials by healthcare providers (i.e., neurologists, nurses, physical therapists, and occupational therapists). Participants provided written comments and suggestions for improvement regarding roles and responsibilities and clarity and relatability of these tools within a real-world setting. RESULTS: Healthcare providers submitted 13 suggestions for improvement. Responses informed four specific improvements regarding program materials (i.e., patient screening, current exercise behavior, referrals, and provider checklists), thereby prompting the research team to adapt and further test the change idea. CONCLUSIONS: This article provides a step forward in a line of research focused on developing a systems-based process for integrating exercise promotion as part of comprehensive multiple sclerosis care.

The priorities of neurologists for exercise promotion in comprehensive multiple sclerosis care.

BACKGROUND: Fewer than 20% of persons with multiple sclerosis (MS) engage in sufficient amounts of exercise for experiencing health and wellness benefits. Neurologists have a powerful and influential relationship among patients, highlighting the potential for the patient-provider interaction to be a gateway for promoting exercise behavior. Neurologists, however, are under-supported and under-resourced for promoting exercise in comprehensive MS care. The purpose of this study was to determine the priorities of neurologists for exercise promotion among patients in comprehensive MS care and, where possible, provide suggestions for how each priority may be addressed in practice. METHODS: Priority areas were identified through deductive content analysis of 20 semi-structured interviews with practicing neurologists. RESULTS: Seven priority areas were identified regarding promotion of exercise among patients in comprehensive MS care. These included 1). How do I fit exercise promotion into a patient's appointment? 2). What resources should I give my patients about exercise? 3). What are the benefits of exercise for people with MS? 4). What training can I do to be better informed about exercise? 5). What are the prescriptions/guidelines for exercise among persons with MS? 6). What kind of services can I rely on to support me in promoting and supporting exercise behavior? 7). How do I negotiate reimbursement and insurance restrictions when I promote exercise? CONCLUSIONS: This research sets an agenda regarding approaches for exercise promotion among patients with MS through interactions with neurologists in comprehensive care settings.

Promotion of Exercise in Multiple Sclerosis Through Health Care Providers.

Participation in exercise yields meaningful benefits among persons with multiple sclerosis (MS), yet this population engages in low rates of health-promoting physical activity. The disconnect between evidence of benefits and rates of participation requires consideration of new opportunities for changing this health behavior. The current article hypothesizes that the patient-provider interaction offers a fertile opportunity for promoting exercise behavior in MS.

Investigating the needs and wants of healthcare providers for promoting exercise in persons with multiple sclerosis: a qualitative study.

PURPOSE: We undertook a qualitative study that explored the needs of healthcare providers for promoting exercise behaviour among persons with mild or moderate multiple sclerosis (MS). METHODS: We used interpretive description methodology, and conducted semi-structured interviews with Neurologists (n = 13), occupational therapists (n = 10), physical therapists (n = 11), and nurses (n = 10). The interviews were analysed using thematic analysis. RESULTS: We identified three themes with multiple subthemes regarding exercise promotion by healthcare providers. The first theme was "opportunities for exercise promotion" through the healthcare system, healthcare team, and clinical appointment. The second theme was "healthcare provider education" that included professional training, training among healthcare providers, and clear and defined exercise promotion protocols. The third theme was "patient tools/strategies" that should be delivered among persons with MS as part of the exercise prescription. CONCLUSIONS: Providers in MS healthcare consider the patient-provider interaction within the healthcare system, healthcare team, and clinical appointment as a novel opportunity for exercise promotion. Such an opportunity requires education of healthcare providers and provision of tools and strategies for exercise promotion among persons with MS. Implications for rehabilitation Healthcare providers are interested in and motivated for promoting exercise participation among persons with multiple sclerosis. Successful exercise promotion must consider opportunities at three different organisational levels, namely the healthcare system, the local healthcare team, and clinical appointment. Healthcare providers need further training for promoting exercise among persons with multiple sclerosis. The promotion of exercise among persons with multiple sclerosis will require resources and strategies that can be readily offered by providers.

Screening for sensory impairment in older adults: Training and practice of occupational therapists in Quebec.

BACKGROUND: The goal of occupational therapy education is to train generalists who can refine their knowledge after graduation according to the requirements of the professional environment. However, it is currently unclear to what extent sensory screening should be included in the educational curricula. PURPOSE: The purpose of this study was to examine the sensory screening education for and practice by occupational therapists working with older adults. METHOD: A cross-sectional survey was used to collect data from members of the Quebec Order of Occupational Therapists. Descriptive statistics were used in the analysis. FINDINGS: Data from 102 respondents indicated that training on sensory impairment-related topics was minimal and in stark contrast to the proportion who reported serving clients with a visual (92%), hearing (84%), or combined impairment (53%). IMPLICATIONS: Occupational therapy considers numerous aspects of physical, cognitive, and emotional well-being. The question remains as to what extent vision and hearing health should take their place among these priorities.

Survey of the low vision rehabilitation curricula in occupational therapy and occupational therapy assistant programs.

OBJECTIVE: We examined the preclinical curricular content pertaining to low vision rehabilitation (LVR) included in occupational therapy (OT) and occupational therapy assistant (OTA) programs. METHOD: An e-mail survey containing questions about program structure and the extent of course material related to LVR in the curriculum was sent to directors of all accredited OT and OTA programs in the United States. RESULTS: One hundred nineteen programs responded. The curricula of all but 1 program included LVR content. Twenty-four programs included a required course with a primary emphasis on LVR. Forty-four programs had faculty with advanced training in LVR or experience working in a LVR clinic. CONCLUSION: Given that almost all respondent programs integrate LVR content into their required preclinical coursework, we recommend that LVR be incorporated into the Accreditation Council for Occupational Therapy Education standards so as to ensure knowledge of LVR within existing programs and enhance the quality of education in LVR.