Informal Caregivers' Perceptions of Facilitators of Successful Weight Management for People With Spinal Cord Injury.

IMPORTANCE: Informal caregivers have valuable insights that occupational therapists can use to prevent and manage problems that may arise in people with spinal cord injury (SCI) because of a lack of physical activity and poor nutrition. OBJECTIVE: To assess caregiver-identified facilitators of weight management in people with SCI. DESIGN: Descriptive qualitative design using semistructured interviews and thematic analysis. SETTING: Regional SCI Care Model System and Veterans Health Administration. PARTICIPANTS: Informal caregivers (n = 24) of people with SCI. OUTCOMES AND MEASURES: Facilitators of successful weight management in care recipients with SCI. RESULTS: Four themes were identified as weight management facilitators: healthy eating (subthemes: food content, self-control, self-management, and healthy preinjury lifestyle), exercise and therapy (subthemes: occupational and physical therapy, receiving assistance, and resources for exercise), accessibility, and leisure activity or activities of daily living, the latter described as a source of activity (because of required energy expenditure) to facilitate weight management for people with more severe injuries. CONCLUSIONS AND RELEVANCE: These findings can inform the development of successful weight management plans by occupational therapists by incorporating feedback from informal caregivers. Because caregivers are involved in many of the facilitators identified, occupational therapists should communicate with the dyad about sourcing accessible places to increase physical activity and assessing in-person assistance and assistive technology needs to promote healthy eating and physical activity. Occupational therapists can use informal caregiver-identified facilitators of weight management to help prevent and manage problems for people with SCI secondary to limited activity and poor nutrition. What This Article Adds: Occupational therapy practitioners provide therapeutic intervention to people with SCI; this includes attention to weight management from the time of initial injury throughout their lives. This article is novel in the presentation of informal caregivers' perceptions about successful facilitators of weight management among people with SCI, which is important because caregivers are intimately involved in the daily activities of people with SCI and can be a liaison for occupational therapists and other health care providers about ways to facilitate healthy eating and physical activity.

Development and evaluation of an educational curriculum for healthcare providers on overweight/obesity management in individuals with spinal cord injury based on diverse stakeholder engagement.

BACKGROUND: Spinal cord injury (SCI) healthcare providers are aware of the harmful consequences of overweight/obesity in persons with SCI, but many are unaware of available information and lack training to guide weight management care in the SCI population. OBJECTIVE: Describe the development and content of an educational curriculum for healthcare providers to help individuals with SCI prevent or manage overweight/obesity. METHODS: The biopsychoecological framework guided curriculum planning, data collection, and product development. Thematic analysis of interviews conducted with individuals with SCI, informal caregivers, and SCI healthcare providers pinpointed central educational curriculum topics. SCI healthcare providers evaluated the curriculum. RESULTS: Seven comprehensive topics were developed: 1. Scope and consequences of overweight/obesity in SCI; 2. Classifying and measuring overweight/obesity in SCI; 3. Guidelines related to weight management in SCI; 4. Identifying challenges (and solutions) to weight management in SCI; 5. Strategies for providers to facilitate weight management; 6. Understanding goals, motivators, and desired feedback for weight management; and 7. Knowing how informal caregivers are affected by weight and weight management of care recipients with SCI. High ratings (>80% strong agreement) were achieved on content, word choice, organization, relevance, and actionability. Modification needs were identified and subsequently made to layout, visual aids, and provision of tangible resources. Providers described the curriculum as a scientifically rigorous resource that addresses a knowledge gap, provides population-specific content, and is useful across interdisciplinary teams. CONCLUSION: We developed a self-directed learning educational curriculum addressing topics most salient to stakeholders involved in overweight/obesity management of persons with SCI.

What Are Personal Meanings of Healthy Eating and Physical Activity in Individuals Living With Spinal Cord Injury? A Qualitative Exploration.

Objectives: To explore the personal meanings of healthy eating and physical activity among individuals living with spinal cord injury (SCI) and the information and resources they find beneficial. Methods: We conducted in-depth semistructured individual interviews to understand the personal meanings of healthy eating and physical activity among individuals with SCI. We completed a thematic analysis of qualitative data. Results: Participants were 11 Veterans and 14 civilians, predominantly male, non-Hispanic White, and with paraplegia. Data were described across two categories, including the personal meaning of healthy eating and the personal meaning of physical activity/exercise. Individuals with SCI described their meaning of healthy eating around four themes: types of food, amounts/portions of food, conscious/mindful eating, and eating to enhance health. Individuals wanted information on tailored diets for individuals with paraplegia and tetraplegia and healthy foods that are easy to prepare by people with SCI. Their personal meaning of physical activity/exercise focused on four themes: types of physical activity and exercise, staying active, moving/movement, and differences from non-SCI. Desired information around physical activity included cardiovascular workouts that are effective and possible to do in a wheelchair so that people with SCI can burn enough of the calories they consume to lose or maintain weight. Conclusion: Results provide a better understanding of what healthy eating and physical activity mean to people with SCI and information they desire toward these goals, which can be used to guide patient-provider discussions, develop health promotion programs, and tailor interventions to capitalize on meaningful concepts and beliefs that facilitate healthy behaviors.

Motivators, goal setting, and helpful feedback for weight management among individuals with spinal cord injury.

Objective: To gain a fuller understanding, in the context of biopsychoecological factors, of drivers/motivators, goal setting, and feedback, individuals with spinal cord injury (SCI) find helpful to gauge their weight management progress. Research Method/Design: We conducted in-depth interviews around weight management in SCI. Participants included veterans and civilians with SCI. Thematic analysis methodology was used to categorize data into relevant recurrent and/or conceptually significant themes. Results: Twenty-five individuals identified three primary reasons they wanted to participate in weight management, including overall health and wellness, appearance, and functional mobility. Their self-identified weight management goals included reaching/maintaining a specific body weight and/or trimming a focused body part; engaging in any or more physical activity/exercise; gaining strength and endurance; participating in life and activities; and alleviating weight-related health symptoms (e.g., pain). Individuals identified progress assessments, recognition, regular check-ins, and encouragement as helpful feedback toward weight management achievement. Conclusions/Implications: Our work identified what drives weight management in individuals with SCI, what is important to them in terms of goal setting, and what feedback they would find helpful. These findings may be used in intervention planning and program development to facilitate participation and behavior modification. Weight management efforts and interventions are needed that 1) incorporate motivators for weight management that are important to individuals with SCI; 2) help them identify actionable process and performance goals to facilitate achievement of self-identified meaningful outcome goals; and 3) provide person-centered weight management progress feedback such as those identified in this study (progress assessments, recognition, regular check-ins, and encouragement). (PsycInfo Database Record (c) 2021 APA, all rights reserved).

Relationship Between Self-Reported Restless Sleep and Objectively Measured Physical Activity in Adults With Knee Osteoarthritis.

OBJECTIVE: Despite the numerous health benefits of physical activity, inactivity is endemic among adults with knee osteoarthritis (OA). Because sleep quality may be a target in order to improve physical activity behavior, we investigated the cross-sectional relationship between restless sleep and physical activity in participants with or at risk for knee OA. METHODS: We analyzed accelerometer-measured physical activity and clinical data of participants included in the Osteoarthritis Initiative (OAI). We used multiple regression analysis to evaluate physical activity for participants, who were grouped by the reported frequency of restless sleep, and adjusted for demographic and medical confounders. RESULTS: Of the 1,892 OAI participants for whom complete data were available, 300 participants (16%) reported restless sleep ≥3 days in the past week. Participants who reported restless sleep for much of the time (3-4 days/week) and most of the time (5-7 days/week) had 11.9% and 23.7% less weekly minutes of moderately vigorous activity, respectively, compared to participants who reported rarely restless sleep (<1 day/week) (P for trend 0.021). These differences persisted after accounting for age, sex, race, body mass index, medical comorbidity, and knee OA severity and pain (P for trend 0.023). Differences related to restless sleep were largely attenuated by the presence of high depressive symptoms and low energy levels. CONCLUSION: Poor sleep quality is associated with less physical activity in persons with or at risk for knee OA. Future studies are needed to determine the mechanisms of how poor sleep and physical activity are related, how energy and depression mediate these relationships, and whether interventions that improve sleep quality might result in increased physical activity.

Association Between Sedentary Time and Quality of Life From the Osteoarthritis Initiative: Who Might Benefit Most From Treatment?

OBJECTIVE: To investigate the relationship between sedentary behavior and quality-adjusted life years (QALYs) among participants in the Osteoarthritis Initiative. DESIGN: Longitudinal, observational design. SETTING: Osteoarthritis Initiative cohort. PARTICIPANTS: Individuals (N=1794) from a prospective, multicenter longitudinal cohort were classified into quantile groups based on average daily sedentary time (most sedentary, quartile 1 [Q1] ≥11.6h; 10.7h≤ Q2 <11.6h; 9.7h≤ Q3 <10.7h; least sedentary, Q4 <9.7h). INTERVENTIONS: Not applicable. MAIN OUTCOME MEASURES: Individual QALYs were estimated over 2 years from the area under the curve of health-related utility scores derived from the Medical Outcomes Study 12-Item Short-Form Health Survey versus time. The relationship between baseline sedentary behavior and median 2-year QALYs was estimated using quantile regression adjusted for socioeconomic factors and body mass index. RESULTS: Lower QALYs over 2 years were more frequently found among the most sedentary (Q1, median 1.59), and QALYs increased as time spent in baseline sedentary behavior decreased (median QALYs for Q2, 1.64; Q3, 1.65; Q4, 1.65). The relationship of sedentary time and median QALY change was only significant for the most sedentary Q1 group, where an additional hour of sedentary behavior significantly reduced QALYs by -.072 (95% confidence interval, -.121 to -.020). CONCLUSIONS: Our findings suggest that individuals with the most extreme sedentary profiles may be vulnerable to additional losses of quality of life if they become more sedentary. Targeting these individuals to decrease sedentary behavior has the potential to be cost-effective.

Do Inactive Older Adults Who Increase Physical Activity Experience Less Disability: Evidence From the Osteoarthritis Initiative.

BACKGROUND: Physical inactivity is a leading risk factor for developing disability. Although randomized clinical trials have demonstrated improving physical activity can reduce this risk in older adults with arthritis, these studies did not specifically evaluate inactive adults. OBJECTIVES: The aim of this study was to evaluate the relationship of changes in physical activity with disability changes among initially inactive adults with or at high risk of knee osteoarthritis from Osteoarthritis Initiative. METHODS: Inactive persons were identified at baseline based on the US Department of Health and Human Services classification (no [zero] 10-minute session of moderate-to-vigorous [MV] activity over 1 week) from objective accelerometer monitoring. Two years later, physical activity change status was classified as follows: (1) met Federal physical activity guidelines (≥150 MV minutes/week acquired in bouts ≥10 minutes), (2) insufficiently increased activity (some but <150 MV bout minutes/week), or (3) remained inactive. Disability at baseline and 2 years was assessed by Late Life Disability Instrument limitation and frequency scores. Multiple regression evaluated the relationship of physical activity change status with baseline-to-2-year changes in disability scores adjusting for socioeconomics, health factors, and baseline disability score. RESULTS: Increased physical activity showed a graded relationship with improved disability scores in Late Life Disability Instrument limitation (P < 0.001) and frequency scores (P = 0.027). While increasing MV activity to guideline levels showed the greatest reduction, even insufficiently increased physical activity was related to reduced disability. CONCLUSIONS: Findings support advice to increase MV physical activity to reduce disability among inactive adults with or at high risk of knee osteoarthritis, even when guidelines are not met.

Sedentary Behavior as a Risk Factor for Physical Frailty Independent of Moderate Activity: Results From the Osteoarthritis Initiative.

OBJECTIVES: This prospective longitudinal study investigated the association between baseline objectively measured sedentary time and 2-year onset of physical frailty. METHODS: We studied 1333 Osteoarthritis Initiative participants 55 to 83 years of age who were at risk for physical frailty, as assessed via low gait speed (< 0.6 m per second) or inability to perform a single chair stand. Baseline sedentary time was assessed through accelerometer monitoring. Hazard ratios (HRs) for physical frailty onset were estimated with discrete survival methods that controlled for moderate physical activity, sociodemographic characteristics, baseline gait and chair stand functioning, and health factors. RESULTS: The incidence of physical frailty in this high-risk group was 20.7 per 1000 person-years. Greater baseline sedentary time (adjusted HR = 1.36 per sedentary hour; 95% confidence interval [CI] = 1.02, 1.79) was significantly related to incident physical frailty after control for time spent in moderate-intensity activities and other covariates. CONCLUSIONS: Our prospective data demonstrated a strong relationship between daily sedentary time and development of physical frailty distinct from insufficient moderate activity. Interventions that promote reductions in sedentary behaviors in addition to increases in physical activity may help decrease physical frailty onset.

Accelerometer-monitored sedentary behavior and observed physical function loss.

OBJECTIVES: We examined whether objectively measured sedentary behavior is related to subsequent functional loss among community-dwelling adults with or at high risk for knee osteoarthritis. METHODS: We analyzed longitudinal data (2008-2012) from 1659 Osteoarthritis Initiative participants aged 49 to 83 years in 4 cities. Baseline sedentary time was assessed by accelerometer monitoring. Functional loss (gait speed and chair stand testing) was regressed on baseline sedentary time and covariates (baseline function; socioeconomics [age, gender, race/ethnicity, income, education], health factors [obesity, depression, comorbidities, knee symptoms, knee osteoarthritis severity, prior knee injury, other lower extremity pain, smoking], and moderate-to-vigorous activity). RESULTS: This cohort spent almost two thirds of their waking hours (average=9.8 h) in sedentary behaviors. Sedentary time was significantly positively associated with subsequent functional loss in both gait speed (-1.66 ft/min decrease per 10% increment sedentary percentage waking hours) and chair stand rate (-0.75 repetitions/min decrease), controlling for covariates. CONCLUSIONS: Being less sedentary was related to less future decline in function, independent of time spent in moderate-to-vigorous activity. Both limiting sedentary activities and promoting physical activity in adults with knee osteoarthritis may be important in maintaining function.