Adapting an evidence-based physical activity questionnaire for people with physical disabilities: A methodological process.

BACKGROUND: Practitioners and researchers often adapt tools, practices, and programs to meet the needs of culturally diverse population groups, but do not consider populations with disability. While there is some research on guidelines for adapting evidence-based programs, there is no systematic process for adapting survey instruments. Rather than creating separate instruments for people with physical disabilities (PWD), it is critical that instruments are designed to capture data on people with and without disabilities for comparison purposes. Given the disproportionately high rates of physical inactivity and obesity in PWD, we developed a methodology to adapt an evidence-based physical activity instrument. OBJECTIVE: To create a methodology to adapt surveys to be inclusive of PWD and use the methodology to adapt an evidence-based physical activity survey. METHODS: A framework was developed to adapt a physical activity survey instrument (International Physical Activity Questionnaire, IPAQ) to be inclusive of PWD. The framework, referred to as SAVe-IT, includes five steps: Step 1) Select survey instrument to adapt; Step 2) Adapt the survey instrument; Step 3) Verify adaptations with experts; Step 4) Implement pilot test; Step 5) Test the tool to confirm reliability. RESULTS: The adapted IPAQ passed review by the expert panels and the pilot test (n = 20). Assessment of test-retest reliability (n = 30) yielded strong intraclass correlation coefficients of 0.950 for the total score for the whole sample, 0.950 for PWD (n = 15) and 0.952 for people without disability (n = 15). CONCLUSIONS: The SAVe-IT framework resulted in the successful adaptation of the IPAQ and can be used in populations with and without physical disabilities.

"I never really thought that a virtual ride would be that good!": Experiences of participants with disabilities in online leisure-time physical activity during COVID-19.

BACKGROUND: The COVID-19 pandemic has exacerbated the sedentary behavior and inactivity of people, including individuals with disability, who were already less active than their able-bodied counterparts. Therefore, it is particularly important to think about how to maintain and increase their leisure-time physical activity (LTPA). Online adaptive programs may represent a useful tool to do so. However, there is a little research focused on the health impacts of online LTPA. OBJECTIVE: This mixed-methods study aimed to explore the experiences of people with disabilities who participated in online adaptive LTPA along with the factors contributing to or limiting participation. METHOD: First, semi-structured interviews were conducted with 10 individuals participating in online adaptive LTPA offered by a community organization. Based on these interviews, a survey was developed and completed by 104 participants. RESULTS: The results of the study suggested that people with disabilities can get a variety of physical and emotional health benefits when participating in adaptive online LTPA, including a strong social benefit. Staff attitude and knowledge as well as the staff's ability to adapt to participant needs played important roles in facilitating participation. Greater access to equipment was needed. CONCLUSION: This study offers insights into how online LTPA could support the health-promoting behavior of people with disabilities during the pandemic and beyond.

Feasibility of Implementing Disability Inclusive Evidence-Based Health Promotion.

People with disabilities face a number of barriers to accessing and participating in evidence-based health promotion programs offered within the community. To address these barriers, the program implementation process needs to integrate disability inclusion throughout planning and implementation. The National Center on Health, Physical Activity and Disability's inclusive Community Implementation Process (NiCIP) provides a framework for implementers to systematically integrate strategies into their health promotion programs that increase inclusion while maintaining the fidelity the program. The NiCIP is a community-engaged process that brings key stakeholders together to guide the selection and implementation of data-driven solutions that promote inclusion in, and access to, health promotion programs. In this article, we first provide an overview of the NiCIP. Then, we present a case study exploring one community's experience using the NiCIP to implement a disability inclusive nutrition program within their community.

The Effects of a Movement-to-Music (M2M) Intervention on Physical and Psychosocial Outcomes in People Poststroke: A Randomized Controlled Trial.

OBJECTIVE: To investigate the effects of a 12-week movement-to-music (M2M) intervention on physical and psychosocial outcomes in people poststroke. DESIGN: Two-arm randomized controlled trial. SETTING: A community-based fitness facility. PARTICIPANTS: Participants (N=47) with stroke between 18 and 65 years old were randomized to M2M (n=23) or waitlist control (n=24). INTERVENTIONS: Participants in M2M completed 3 60-minute exercise sessions per week for 12 weeks. Controls received biweekly educational newsletters via mail. MAIN OUTCOME MEASURES: Primary outcomes included Six-Minute Walk Test (6MWT, in meters), Five Times Sit-to-Stand Test (FTSST, in seconds) and Timed Up and Go (TUG, in seconds). Secondary outcomes were self-reported measures using Patient-Reported Outcomes Measurement Information System Fatigue and Pain Interference Short Form 8a. Outcomes were collected at baseline and postintervention. Analyses involved descriptive statistics and adjusted linear mixed models. RESULTS: Mixed models adjusted for the respective baseline values and demographic variables showed that M2M participants had longer 6MWT distance (least square mean difference [LSM], 14.5; 95% confidence interval [CI], -12.9 to 42.0), more FTSST time (LSM, 2.0; 95% CI, -4.5 to 8.5), and less fatigue (LSM, -3.0; 95% CI, -7.2 to 1.2) compared with controls postintervention. When controlling for baseline TUG and demographic variables, there was a larger increase in 6MWT distance (LSM, 37.9; 95% CI, -22.7 to 98.6), lower FTSST time (LSM, -6.1; 95% CI, -18.5 to 6.2), and decrease in fatigue (LSM, -6.5; 95% CI, -13.1 to 0.2) in the M2M group compared with controls. Moderate effect sizes were observed for improving 6MWT (d=0.6), FTSST (d=-0.6), and fatigue (d=-0.6). There was no group difference in change in TUG time and pain interference, with trivial effect sizes (d=-0.1). CONCLUSION: M2M may be a valuable exercise form for adults with stroke. Future studies are needed to determine optimal exercise doses for improving health and function in this population.

Resilience Among Caregivers of Injured Service Members: Finding the Strengths in Caregiving.

OBJECTIVE: To examine the relationships between caregiver resilience and a comprehensive set of sociodemographic and health-related quality of life (HRQOL) predictors among both caregivers and injured service members. DESIGN: Cross-sectional analysis of an observational cohort. SETTING: Community dwelling. PARTICIPANTS: Caregivers (n=87) who provide instrumental or emotional support to injured service members (n=73)(N=160). INTERVENTIONS: Not applicable. MAIN OUTCOME MEASURE: The Connor-Davidson Resilience Scale 25-item version. RESULTS: Higher caregiver resilience scores were related to lower depressive symptom severity, greater health responsibility, physical activity, nutrition, spiritual growth, interpersonal relations, stress management, and problem-solving orientation. A multivariable regression model showed that spiritual growth and aspects of problem-solving orientation were significantly related to resilience. CONCLUSIONS: Results highlight the relationships between resilience and spirituality, problem-solving orientation, and aspects of HRQOL among caregivers of injured service members. These findings have important implications for caregiver behavioral health programs designed to promote resilience and draw upon caregiver strengths when taking on a caregiver role. Approaches that include a more integrative medicine or strengths-based emphasis may be particularly beneficial when working with families of injured military.

The Effects of M2M and Adapted Yoga on Physical and Psychosocial Outcomes in People With Multiple Sclerosis.

OBJECTIVE: To investigate the effects of two 12-week exercise training interventions, movement-to-music (M2M) and adapted yoga (AY), on physical and psychosocial outcomes in people with multiple sclerosis (MS). DESIGN: Three-arm randomized controlled proof-of-concept trial. SETTING: A community-based fitness facility. PARTICIPANTS: Participants (N=81) with MS (Patient Determined Disease Steps [PDDS] self-reported disease status scores: 0-6) between ages of 18 and 65 years were randomized to M2M (n=27), AY (n=26), or waitlist control (n=28). INTERVENTIONS: Both M2M and AY completed three 60-minute exercise sessions per week for 12 weeks. Waitlist controls received biweekly newsletters via mail that contained educational information on living with MS. MAIN OUTCOME MEASURES: Primary measures were timed Up and Go (TUG, s) test, 6-minute walk test (6MWT, m), and 5 times sit-to-stand test (FTSST, s). Secondary measures were self-reported outcomes assessed using Patient-Reported Outcomes Measurement Information System Fatigue and Pain Interference Short Form 8a. Participants were evaluated at baseline and postintervention. Primary analyses were performed using an intent-to-treat mixed model analysis of covariance. RESULTS: Comparisons across all 3 groups revealed significant group differences in TUG and 6MWT. Post hoc analyses indicated significant improvements in TUG (least square mean difference [95% confidence interval] = -1.9s [-3.3 to -0.5], P=.01, d=0.7) and 6MWT (41.0m [2.2-80.0], P=.04, d=0.6; controlled for PDDS) in M2M compared to controls, while no significant differences were observed when compared AY to controls. No significant group differences were found in FTSST, fatigue, and pain interference. CONCLUSIONS: M2M may be a useful and enjoyable exercise form for people with MS in improving mobility and walking endurance and merits long-term study in larger study populations.

Methodological and clinical implications of a three-in-one Russian doll design for tracking health trajectories and improving health and function through innovative exercise treatments in adults with disability.

BACKGROUND: Hybrid research designs targeting adults with neurologic disability are critical for improving the efficiency of models that can identify, track and intervene on identified health issues. METHODS: Our Russian doll framework encompasses three study phases. Phase 1 involves prospectively following a cohort of participants with disability to examine the relationships between rates of health and functional deficits (e.g., pain, fatigue, deconditioning), functional measures (e.g., cardiorespiratory endurance, strength, balance), and environmental and sociocultural factors. In Phase 2, eligible participants with neurologic disability from Phase 1 (in our example, individuals with multiple sclerosis) are screened and randomized to a clinical exercise efficacy trial. In Phase 3, study participants are enrolled in a home-based teleexercise trial to test the feasibility and replicability of delivering the clinical exercise study in the home. DISCUSSION: This unique three-in-one Russian doll framework serves as a foundation for informing and guiding researchers and clinicians in treating certain health and functional deficits in people with neurologic disability using exercise as a primary treatment modality in both the clinical and home settings. It offers a unique perspective for understanding the critical issues of functioning, health maintenance and quality of life for people with neurologic disability across a longitudinal framework. TRIAL REGISTRATION: Study 2 ClinicalTrials.gov identifier NCT02533882 (retroactively registered 03/06/2015). Study 3 ClinicalTrials.gov identifier NCT03108950 (retroactively registered 04/05/2017).