POWERSforID: Personalized online weight and exercise response system for individuals with intellectual disability: A randomized controlled trial.

BACKGROUND: Obesity is associated with early mortality and chronic disease among adults with intellectual disability (ID), yet there is a paucity of effective weight management interventions for this population. OBJECTIVE/HYPOTHESIS: This pilot study examined a tailored intervention on weight loss, waist circumference, A1c, and lipid profile among adults with ID. METHODS: Obese adults (BMI ≥ 30 kg/m2) with mild to moderate ID were randomized to an intervention (n = 17) or comparison group (n = 18) for a 24-week trial. All participants completed health-related questionnaires and clinic visits. Participants in the intervention group received access to an online weight management platform that assisted them in monitoring their diet and physical activity along with weekly coaching calls (weeks 1-12) that were tapered off to calls every other week (weeks 12-24). The comparison group completed questionnaires and clinic visits, but did not receive access to the online platform or calls. Differences in weight, waist circumference, percent body fat, A1c, lipid profile were assessed at baseline and at week 24. RESULTS: The intervention group reduced body weight by an average of 2.7% (-2.6 kg; p = 0.02) and waist circumference by 3.4% (-3.89 cm; p = 0.02) versus the comparison. There were no statistically significant group by time interactions observed among other variables. CONCLUSION: Adults with ID who received the intervention were able to maintain or slightly reduce their body weight and waist circumference after the 24-week intervention. Despite not achieving the targeted sample size, the pilot study findings serve as a basis for developing accessible weight management interventions for people with ID.

Psychometric properties of a brief self-reported health-related quality of life measure (HRQoL-IDD) for persons with intellectual and developmental disabilities.

BACKGROUND: To encourage self-determination and address health disparities among persons with intellectual and developmental disabilities, clinicians and researchers rely on self-reported measures like health-related quality of life (HRQoL). This study evaluated the psychometric properties of a theory-driven self-reported HRQoL measure for adults requiring mild to moderate support related to intellectual and developmental disabilities. METHOD: 224 volunteers completed 42 quality of life items developed with extensive input from persons with intellectual and developmental disabilities, family members/caregivers, and providers. The 5-point Likert scale format with visual images of fluid-filled cups represented the range of responses. RESULTS: Exploratory and Unrestricted Factor Analyses yielded 16 HRQoL items with 4 subscales: Functional Well-Being, Emotional Well-Being, Social Well-Being, and Healthy Decision-making. The HRQoL-IDD explained 62.8% of variance, had satisfactory internal consistency (0.73-0.83), stability of reponses, and reading level (2nd grade, ages 7-8). CONCLUSIONS: The HRQoL-IDD is a promising measure of self-reported HRQoL for use in community-based settings for persons requiring mild to moderate support related to intellectual and developmental disabilities.

Cross-Systems Care Integration Impact on Adults With Intellectual Disability Utilizing Risk Weight and Comorbidity Data: A Comparative Effectiveness Study, 2014-2017.

Health disparities are documented between adults with intellectual and developmental disabilities (IDD) and neurotypical peers. As progress has been slow in improving health outcomes in people with IDD, the aim of this retrospective study was to compare effectiveness of a new Cross-Systems Care Integration (CSCI) model of care coordination to standard care coordination for 927 adults with IDD receiving Medicaid services in central Colorado from 2014 through 2017. Health care cost risk weight decreased (not statistically significant) only in individuals receiving the CSCI intervention. Depression diagnoses remained statistically unchanged, while both hypertension and hyperlipidemia significantly improved in patients receiving CSCI. Further study is warranted to extend duration of study and to examine additional study variables such as health-related quality of life.

Clinical Utility of Multisensory Environments for People With Intellectual and Developmental Disabilities: A Scoping Review.

IMPORTANCE: Adults with intellectual and developmental disabilities (IDD) are twice as likely as their peers without disabilities to have had a physical exam in the past year; however, as a result of challenging behavior during office visits, they are significantly less likely to have received recommended health screenings. Challenging behaviors in clinical settings have been identified as a barrier to providing adequate care for this population. OBJECTIVE: This scoping review examined the within-session effects of multisensory environments (MSEs) on people with IDD to determine the clinical utility of MSEs for this population. DATA SOURCES: Studies published between January 1, 2000, and August 1, 2018, were identified using Summon and Google Scholar. STUDY SELECTION: Studies were included in the review if they systematically collected and reported data on within-session effects of an MSE intervention on people with IDD. FINDINGS: Thirteen studies met criteria for this review: 4 with Level I evidence, 2 with Level II evidence, 3 with Level III evidence, and 4 with Level IV evidence. Studies examined the effects of MSEs on maladaptive behaviors, positive behaviors, distress and discomfort, activity and alertness states, and cost of care for people with IDD. CONCLUSION AND RELEVANCE: Preliminary support was found for the use of MSEs in clinical settings to reduce anxiety and challenging behaviors in patients with IDD during clinical care. Further research is needed to determine the efficacy of MSEs for producing the effects described in this review. WHAT THIS ARTICLE ADDS: The findings support the potential of MSEs as a tool that occupational therapy practitioners can use to support their clients with IDD who have sensory sensitivities in clinical settings. This article also highlights a multidisciplinary approach whereby medical providers and occupational therapy practitioners could work together in nontraditional ways to support this population.

Feedback and Strategies From People With Intellectual Disability Completing a Personalized Online Weight Loss Intervention: A Qualitative Analysis.

Coaching log notes for 15 participants from a 24-week blended online and telehealth randomized controlled trial were analyzed using thematic analysis and analyst triangulation to determine the factors that facilitated participant adherence to weight loss strategies, use of technology, and motivational interviewing. Several participants reported that restricting processed carbohydrates, limiting portion size, and maintaining healthy substitutions were effective nutritional strategies. Participants were less successful with adherence to their exercise goals, often due to time constraints and a lack of support. Results suggested consistent caregiver support improved participants' adherence to weight loss strategies and use of technology. Future programs should address obesity among people with intellectual and developmental disabilities by offering a range of interventions that are customized to their specific weight loss needs.

POWERS forID: Personalized Online Weight and Exercise Response System for Individuals with Intellectual Disability: study protocol for a randomized controlled trial.

BACKGROUND: Intellectual disability (ID) is characterized by limitations in intellectual functioning and adaptive behavior. Adults with ID exhibit higher rates of obesity and poorer health status compared to the general population. Continuity of care and barriers to health-related activities may contribute to the poorer health status observed in this population. To address this problem, a tailored weight management online health information and communication technology platform, known as POWERSforID, was developed and is being tested to determine if this delivery mechanism can improve weight maintenance/weight loss in adults with ID. METHODS: Obese adults with mild-to-moderate ID (n = 70) are randomized to the POWERS forID intervention or control group for a 24-week trial. Each group undergoes an assessment that includes body weight, waist circumference, and percent body fat at baseline and at weeks 6, 12, and 24. Physical activity barriers, healthy eating barriers, food frequency, and psychosocial wellbeing are measured at baseline and at weeks 12 and 24. Blood lipids are assessed at baseline and 24 weeks. Participants randomized to POWERS forID receive access to the POWERS forID website and calls from a health coach (weekly during weeks 1-12, biweekly during weeks 13-24). The health coach employs motivational interviewing techniques adapted for individuals with ID to promote behavior change. Participants randomized to the control group receive standard clinical weight-loss care. Differences in weight, waist circumference, blood lipids, percent body fat, and psychosocial self-report will be assessed. Barriers and facilitators of implementation as well as perception of study outcomes will be conducted via qualitative analysis. DISCUSSION: POWERS forID is a novel information and communication technology platform designed to address health needs for adults with ID. This article describes the development and components of POWERS forID. The overall aim is to assess usability and feasibility of POWERS forID for promoting weight loss for obese adults with ID over the course of a 24-week randomized control trial. TRIAL REGISTRATION: Clinicaltrials.gov, NCT03139760 . Registered on XXX.