Feasibility of a community-based structured exercise program for persons with spinal cord injury.

OBJECTIVES: (1) Examine the feasibility of a community-based exercise intervention for persons with spinal cord injury and (2) compare the cardiorespiratory fitness, skeletal muscle strength, and psychosocial well-being of participants in the intervention group versus control group. DESIGN: Community-based pilot randomized controlled trial. Setting: Accessible community-based health and wellness center. Participants: Thirty-two sedentary community-dwelling adults with any level of spinal cord injury. Interventions: Participants were randomized to a 36-session/12-week community-based exercise program (intervention; EG) or to a 36-session/12-week physical activity education group (control; CG). Outcome measures: Primary outcome measures included cardiorespiratory fitness measured by a VO2peak test, a composite score of four upper extremity musculoskeletal strength 1-repetition maximum exercises, and feasibility measured by EG participants' adherence and exercise intensity achieved during the program. EG participants' acceptance of the program was also evaluated using a self-reported satisfaction scale. Self-efficacy, motivation, pain, and goal performance and satisfaction were secondary outcome measures. Adherence and acceptability were also measured. RESULTS: Fifteen participants (n = 15) completed the community-based exercise intervention and seventeen (n = 17) completed the education program. While no statistically significant differences were found, the EG experienced changes of moderate effect size in cardiorespiratory fitness, strength, motivation, and satisfaction with their goals. The EG attended, on average, two sessions per week. The community-based exercise intervention was highly accepted by and satisfying for participants to engage in. CONCLUSIONS: The EG had improvements in the two primary measures, cardiorespiratory fitness and musculoskeletal strength, following the intervention. The community-based exercise intervention was feasible and accepted by participants.

Training Medical Students to Recognize, Understand, and Mitigate the Impact of Racism in a Service-Learning Course.

The Morehouse School of Medicine's Community Health Course (CHC) trains first-year medical students to work with people of racial and ethnic minorities and economically and medically disadvantaged communities. This service-learning course includes the diagnosis/assessment of the health of a community and the development, implementation, and evaluation of a plan to improve some aspect of the community's health. The CHC teaches about the impact of racism on the health of communities through lectures, educational games, and videos focused on social determinants of health, cultural competence, and effective community engagement. Students complete small group assessments, interventions, and service activities at assigned sites. This pedagogical approach integrates the Association of Medical Colleges' Diversity, Equity, and Inclusion competencies and engages many community partners. The course's strengths include a multidisciplinary faculty, a culturally and educationally diverse student body, and community partners with varied backgrounds and resources. Opportunities exist for collaborations with other degree programs to sustain and increase the impact of community interventions and link this community-based educational activity to clinical training years. Course evaluations, exams, and short essays assess students' awareness of racism and the extent to which unconscious bias affects students' completion and interpretation of community assessment data and their engagement with community partners.

Perspectives of inpatient rehabilitation clinicians on the state of manual wheelchair training: a qualitative analysis.

PURPOSE: The purpose of this study was to identify clinician knowledge regarding manual wheelchair (MWC) training in an inpatient rehabilitation (IPR) setting, identify current MWC education provided to new manual wheelchair users (MWUs), and determine how MWC training resources can be developed or modified to promote use among IPR clinicians. METHODS: Semi-structured interviews were conducted with 20 licenced IPR clinicians who work with MWUs. Using a traditional qualitative research design, researchers completed open, data-driven coding of interview transcripts. Overarching themes were determined through content analysis. RESULTS: Participants included 12 physical therapists, six occupational therapists, one physical therapy assistant, and one occupational therapy assistant. Five themes emerged from the interviews: (1) clinician knowledge, education, and experience (2) current training content (3) training environment, (4) desired programme components (5) barriers to implementation. Participants reported receiving minimal education in school and from their employers on training MWUs. While clinicians expressed the importance of MWU education, they used varying training approaches with little standardization. Participants identified that training protocols for IPR are beneficial if they are quick, straightforward, and flexible. CONCLUSIONS: While MWC training occurs during IPR stays, it appears to be inconsistent across facilities, clinicians, and patients, with varying degrees of adherence to evidence-based practices. This is likely due to limited feasibility and awareness of existing MWC training resources. Clinician input gathered from these interviews provides information for how to best integrate MWC training programmes into the rehabilitative process. Findings may inform the development and assessment of more clinically feasible MWC training protocols. Implications for RehabilitationNew manual wheelchair users must learn numerous wheelchair-related skills in order to participate in everyday life activities.Manual wheelchair education for new users during inpatient rehabilitation is often inconsistent across facilities, clinicians, and patients, with varying degrees of adherence to existing evidence-based practices.Systematic challenges often act as a barrier to the implementation of more comprehensive, structured manual wheelchair training protocols.Manual wheelchair training resources must be concise, flexible, customisable, and easy to follow in order to promote increased implementation among inpatient rehabilitation clinicians.

Mobility Disability and Exercise: Health Outcomes of an Accessible Community-Based Center.

Objective: The purpose of this study was to determine how support and guidance provided by trained professionals during a 12-week, community-based transition exercise program, impact health outcomes and continued engagement in physical activity for persons with a mobility disability (PwMD). Design: A single arm pre-post design was used. Setting: Accessible community-based health and wellness center. Participants: The study included 244 PwMD using a mobility device. Interventions: Participants completed a 12-week transition exercise program provided through an accessible community facility that provided education and support to complete endurance and strength related exercises as well as programming to encourage transition to self-directed engagement in exercise. Main Outcome Measures: Bodyweight, BMI, pain, perceived exertion, speed, and distance during cardiovascular fitness testing, and strength were measured pre and post exercise program. The number of participants that signed up for a monthly membership after the program was also monitored. Results: For the total group, average pain reported over previous 30 days decreased significantly (p < 0.01), current daily pain decreased significantly (p < 0.05), perceived exertion at the end of the 9-min endurance test decreased significantly (p < 0.05), and the four upper extremity strength exercises showed large, significant strength gains (p < 0.01) after the program. There was no significant change in bodyweight, BMI, or speed and distance completed during endurance testing. At the completion of the program, 76% of participants enrolled in a monthly membership at the facility with the intentions to continue to exercise regularly. Conclusions: This study provides evidence that an accessible community-based exercise program, with a transitional component supported by trained professionals, can support the exercise goals of PwMD and improve strength, decrease pain, and may promote regular exercise adoption for PwMD.

Availability of Naloxone in 2 Underserved Urban Communities in Georgia.

In 2016, unintentional injuries became the third leading cause of death in the United States. In 2018, 54% of 103 672 unintentional injury deaths were due to drug overdoses among adults 19 to 64 years of age. In Georgia, opioid overdose deaths continued to increase, despite a 2014 state law for naloxone use to prevent deaths, and a 2017 amendment for more widespread community use without a prescription. Given these policies, naloxone availability in pharmacies in underserved communities remains unclear. Our objective is to explore naloxone availability in such communities. Three Public Health and Preventive Medicine residents during a social-cultural-behavioral longitudinal rotation conducted interviews of 9 community pharmacists. Several themes emerged: more education was needed, and naloxone was available only by prescription in certain pharmacies or in limited amounts. Additional assessments among community members and sectors can examine the extent to which policies to expand naloxone availability and accessibility are implemented, including reduced naloxone costs.

Pilot Study of a Self-Management Program for Parents With Spinal Cord Injury or Disease.

IMPORTANCE: This study lays the groundwork for a self-management program run by occupational therapy practitioners for parents with spinal cord injury or disease (SCI/D). OBJECTIVE: To develop and implement the Parenting Self-Management Program with people with SCI/D and evaluate the potential impact on knowledge, self-efficacy, and participation. DESIGN: A mixed-methods approach was used to develop (Phase 1) and implement and evaluate (Phase 2) a pilot group intervention for parents with SCI/D. SETTING: Community-based occupational therapy settings. PARTICIPANTS: Phase 1 participants were professionals working in the field of disability and SCI/D (n = 11) and experienced parents with SCI/D (n = 9). Phase 2 participants were people with SCI/D who were newly injured or inexperienced in parenting (n = 10). All participants were paid volunteers. INTERVENTION: The 4-wk Parenting Self-Management Program was piloted with 10 parents with SCI/D. Participants attended a weekly program with other parents with SCI/D led by occupational therapists in which they received parenting resources and presentations and set weekly goals. OUTCOMES AND MEASURES: The General Self-Efficacy Scale, a modified version of the Participation Survey/Mobility, and open-ended questions regarding parents' participation in parenting tasks were administered during Phase 2. RESULTS: Significant increases (p < .05) in perceived knowledge were found for the topics of emergency preparedness, home modifications, adapted equipment, fatigue management, pain management, and community resources among Phase 2 participants. CONCLUSIONS AND RELEVANCE: A self-management approach combined with pertinent resources for parents with SCI/D yielded positive outcomes. WHAT THIS ARTICLE ADDS: This research demonstrates that a self-management structure for a specific population (people with SCI/D) in combination with a targeted occupation (parenting) and delivered through group occupational therapy services, improved client outcomes.

Training residents to address cancer health disparities.

INTRODUCTION: Cancer is the source of significant morbidity and mortality in the United States, and eliminating cancer-related racial and ethnic disparities has become an ever-increasing focus of public health efforts. Increasing workforce diversity plays a major role in the reduction of health disparities, and a well-trained professional workforce is essential for the prevention, control, and ultimate elimination of this disease. METHODS: To help address this need, the Public Health/General Preventive Medicine residency program at Morehouse School of Medicine (MSM) developed an innovative Cancer Prevention and Control Track (CPCT). We describe the structure of the track, funding, examples of resident activities, and program successes. RESULTS: Since the development of the track in 2007, there have been 3 graduates, and 2 residents are currently enrolled. Residents have conducted research projects and have engaged in longitudinal community-based activities, cancer-focused academic experiences, and practicum rotations. There have been 3 presentations at national meetings, 1 research grant submitted, and 1 research award. CONCLUSION: The CPCT provides residents with comprehensive cancer prevention and control training with emphasis in community engagement, service, and research. It builds on the strengths of the diversity training already offered at MSM and combines resources from academia, the private sector, and the community at large.

Faith-based partnerships in graduate medical education: the experience of the Morehouse School of Medicine Public Health/Preventive Medicine Residency Program.

Faith-based organizations can be strategic partners in addressing the needs of low-income and underserved individuals and communities. The Morehouse School of Medicine (MSM) Public Health/Preventive Medicine Residency Program (PH/PMR) collaborates with faith-based organizations for the purpose of resident education, community engagement, and service. These partners provide guidance for the program's community initiatives and health promotion activities designed to address health inequities. Residents complete a longitudinal community practicum experience with a faith-based organization over the 2-year training period. Residents conduct a community health needs assessment at the organization and design a health intervention that addresses the identified needs. The faith-based community practicum also serves as a vehicle for achieving skills in all eight domains of the Public Health Competencies developed by the Council on Linkages and all six Accreditation Council for Graduate Medical Education (ACGME) Core Competencies. The MSM PH/PMR Program has engaged in faith-based partnerships for 7 years. This article discusses the structure of these partnerships, how partners are identified, funding sources for supporting resident projects, and examples of resident health needs assessment and intervention activities. The MSM PH/PMR Program may serve as a model to other residency and fellowship programs that may have an interest in developing partnerships with faith-based organizations.