Implementation of Peer-Assisted Physical Activity Via Telehealth for Adults on the Autism Spectrum: A Mixed Methods Feasibility Study.

OBJECTIVE: Adults on the autism spectrum are at risk for physical inactivity, obesity, and related health conditions. Physical activity provides physical, social, and mental health benefits across the lifespan. Previous research examined feasibility and effectiveness of physical activity intervention in autistic children, but very few studies target autistic adults. This study examined the feasibility and acceptability of Physical Activity Connections via Telehealth, implemented during the coronavirus disease 2019 (COVID-19) pandemic lockdown as an alternative to in-person programming for autistic adults aged 18 to 32. METHODS: The 10-week intervention utilized telehealth and remote technologies to deliver a theoretically grounded program to improve physical activity. Strategies included peer-guidance, coaching, individualized wellness goals, customized exercise programs, and wearable activity trackers. Feasibility and acceptability were examined using a mixed-methods design including observational and survey data collection, as well as participant interviews. Data were analyzed using descriptive statistics and content analysis. RESULTS: Findings support feasibility and acceptability of telehealth to promote physical activity among autistic adults who have cognitive capacity and ability to utilize remote technology, with applicability beyond pandemic-imposed challenges. CONCLUSION: Telehealth delivery of physical activity interventions is a viable alternative to in-person programs and may enable autistic adults to overcome barriers to physical activity participation and access. IMPACT: As the rate of autism continues to rise globally, rehabilitation professionals will play a significant role in promoting health and wellness for autistic individuals across the lifespan. Findings promote informed practice based on the health needs of this growing segment of society.

Systematic Development of Standards for Mixed Methods Reporting in Rehabilitation Health Sciences Research.

OBJECTIVE: Mixed methods research (MMR) integrates quantitative and qualitative methods throughout the research process to answer complex research questions. MMR designs align with the guiding frameworks of patient-centered care and social determinants of health by effectively examining the role of contextual factors and human experiences in influencing health and rehabilitation outcomes. Reporting standards and critical appraisal tools ensure the quality and transparency of the research process. MMR standards exist; yet, there is a need for reporting guidelines and an appraisal tool that meets field standards, is applicable across rehabilitation fields of study, and can accommodate the range of possibilities for combining research approaches and methods. METHODS: Mixed Methods Reporting in Rehabilitation & Health Sciences (MMR-RHS) was developed using a systematic consensus-building process in accordance with published guidance and was preregistered with the Enhancing the Quality and Transparency of Health Research Network. MMR-RHS evolved through a sequence of steps, including extensive literature review, expert consultation, stakeholder feedback, pilot testing, and tool refinement. RESULTS: MMR-RHS consists of 20 criteria that align with field standards for rigor and transparency, with an emphasis on integration throughout the research process, a key component of MMR. CONCLUSIONS: A systematic process was utilized to develop the reporting standards and an appraisal tool for MMR in rehabilitation and health science. The tool is comprehensive, includes a set of criteria grounded in MMR literature, and is flexible for application to a range of MMR designs commonly seen in rehabilitation research. IMPACT: The MMR-RHS may improve the quality and transparency of MMR by supporting investigators, authors, reviewers, and editors during project development, manuscript preparation, and critical review. The tool may assist readers in critical appraisal, knowledge translation, and application of published MMR findings. Ultimately, the MMR-RHS may help legitimize mixed methods in rehabilitation and health research, an important step toward understanding the complexities of health care, patient outcomes, and evolving societal health needs.

Understanding the Lived Experience of Caring for a Child With Severe Cerebral Palsy: A Critical Step Toward Psychologically Informed Family-Centered Care.

OBJECTIVE: The purpose of this study was to explore the lived experience of parents who care for children with cerebral palsy who function at a Gross Motor Function Classification System Level V, their beliefs about pain and non-pain-related emotional distress, and what it means to provide care and comfort. METHODS: A phenomenological research design was used. Eleven participants were involved in this study. Pilot interviews informed the interview guide. Data were collected via participant journals and semi-structured interviews and analyzed using van Manen's framework for understanding experience. Trustworthiness criteria were met through a variety of strategies to ensure a rigorous research process. RESULTS: Four themes were revealed in this study: "life is hard, heavy with burden, worry, and love," "remarkable," "identity transformation and empowerment," and "living a life that is planned, forced with structure and without spontaneity." CONCLUSION: Caring for a child with lifelong needs is complex and requires a sensitive awareness of the contextual factors that impact daily decisions and routines. Understanding the lived experiences of parents who care for children with cerebral palsy Gross Motor Function Classification System Level V is necessary to provide psychologically informed, family-centered care. Comfort theory is presented as a framework for understanding what factors influence comfort and well-being. Understanding the complex nature of comfort for an individual can lead to greater understanding and empathy-driven care. These results will provide a foundation for future studies that aim to enhance pediatric physical therapist care through provider empathy and understanding. IMPACT: Caregiving parent experiences are impactful and play a large role in the life of children with developmental disabilities. Research exploring the lived experience of caregivers may enhance empathy-driven, psychologically informed, family-centered physical therapist care throughout the life course. LAY SUMMARY: If you are a parent who cares for a child with severe cerebral palsy, you have unique experiences that impact day-to-day activities and lifelong planning for your family and child.

Students' perspectives of core value development in a modified problem-based learning program.

Physical therapy educational programs are tasked to develop core values in their students as the foundation of professionalism. Problem-based learning (PBL) is an approach that intends to enrich exploration of issues in clinical decision making, understand how patient care is supported by other aspects of professional practice, and develop examination, intervention and communication skills. This qualitative study aimed to understand, interpret, and describe doctoral physical therapy students' perspectives of core value development in a modified PBL program. Twenty-seven of 49 students from a single class participated in the study at the time of graduation. Phenomenological methods via semi-structured focus group interviews were used to foster an in-depth understanding of students' experiences. Interviews were thematically organized by the constant comparison method and several strategies were used to establish trustworthiness. Eleven emerging themes represented the adjustment to PBL and essence of core value development from the students' perspective. An additional overarching theme "transformation" was also identified as students described a process of "transformation" from student to professional, supported by the curricular elements of the modified PBL process. These findings inform faculty on educational methods and curricular strategies, which may enhance the development of professional core values, regardless of curricular format.

Clinical instructors' perspectives: what should we be teaching in pediatrics?

PURPOSE: This study explored clinical instructors' perspectives regarding specific aspects of pediatric content that should be included in the curricula of entry-level physical therapist education programs. METHODS: This mixed methods sequential explanatory study was conducted using 2 groups of participants. The survey-only group consisted of 278 participants who anonymously completed a Web-based survey. The mixed-data group consisted of 9 purposively selected participants who completed the Web-based survey and participated in a one-on-one qualitative interview that explored their survey responses. RESULTS: Participants provided recommendations pertaining to the depth and breadth of pediatric content in entry-level curricula. A diagram was created to depict the participants' perspectives on how pediatric content in the entry-level curricula should be structured. CONCLUSION: Clinical instructors offer valuable insights that can be used to guide entry-level curricular content in pediatrics. The results of this study may assist physical therapist faculty in preparing students for entry-level practice in pediatrics.

Sport-specific fitness testing and intervention for an adolescent with cerebral palsy: a case report.

BACKGROUND AND PURPOSE: This case report describes the development, implementation, and outcomes of a fitness-related intervention program that addressed the sport-specific goals of an adolescent with cerebral palsy. CASE DESCRIPTION: The participant in this case was a 16-year-old African American male with spastic diplegia. The participant joined his high school wrestling team and asked to focus his physical therapy on interventions that would improve his wrestling performance. An examination was performed using the muscle power sprint test, the 10 x 5-m sprint test, strength tests, the 10-m shuttle run test, and the Gross Motor Function Measure. The intervention consisted of interval training, which focused on the demands of wrestling. OUTCOMES: Scores on all tests and measures were higher after the intervention. DISCUSSION: The outcomes of this case report seem to support the use of a fitness-related intervention program for addressing the sport-specific goals of an adolescent with cerebral palsy.