Session Attendance Research Articles

Hybrid Evaluation of a Lifestyle Change Program to Prevent the Development of Type 2 Diabetes Among Individuals With Prediabetes: Intended and Observed Changes in Intervening Mechanisms.

Lifestyle interventions can prevent type 2 diabetes (T2D) by successfully inducing behavioral changes (eg, avoiding physical inactivity and sedentariness, increasing physical activity and/or healthy eating) that reduce body weight and normalize metabolic levels (eg, HbA1c). For interventions to be successful, it is important to influence "behavioral mechanisms" such as self-efficacy, which motivate behavioral changes. Theory-based expectations of how self-efficacy, chronic stress, and mood changed over time were investigated through a group-based behavior change intervention (PREMIT). At 8 intervention sites, PREMIT was offered by trained primary care providers in 18 group-sessions over a period of 36 months, divided into 4 intervention phases. Adherence to the intervention protocol was assessed. Participants (n = 962) with overweight and prediabetes who had achieved ≥8% weight loss during a diet reduction period and completed the intervention were categorized into 3 groups: infrequent, frequent, or very frequent group sessions attendance. The interactions between participation in the group sessions and changes in self-efficacy, stress, and mood were multivariate tested. Intervention sites were regularly asked where and how they deviated from the intervention protocol. There was no increase in the participants' self-efficacy in any group. However, the level of self-efficacy was maintained among those who attended the group sessions frequently, while it decreased in the other groups. For all participants, chronic stress and the frequency of attending group sessions were inversely related. Significant differences in mood were found for all groups. All intervention centers reported specific activities, additional to intervention protocol, to promote participation in the group sessions. The results suggest that the behavioral changes sought by trained primary care providers are related to attendance frequency and follow complex trajectories. The findings also suggest that group-based interventions in naturalistic primary care settings aimed at preventing T2D require formats and strategies that encourage participants to attend group sessions regularly.

EMPOWER@HOME:CONNECTED - TESTING A PILOT GROUP INTERVENTION FOR DEPRESSION AND LONELINESS IN OLDER ADULTS

Abstract Homebound older adults experience high rates of depression, social isolation, and loneliness, which adversely impacts physical and mental well-being. Accessing psychotherapy to address these concerns can be logistically challenging and cost prohibitive. This study examined the feasibility and preliminary effect of a novel group-based internet cognitive-behavioral therapy program called Empower@Home:Connected. The intervention was implemented over nine consecutive weekly sessions in small virtual groups (4-6 participants). These sessions were facilitated by trained mental health professionals and incorporated psychoeducational material, cognitive-behavioral therapy exercises, and socialization. Measurements on primary and secondary outcomes were gathered before and after completion of the intervention. In this preliminary pilot trial (NCT05732740), participants averaged 68 years and of those that attended the first session (n = 25), nearly all completed the program (n = 24). Session attendance was high, with an average session attendance rate of 94.70%. Following program completion, participants had statistically significant reductions in depressive symptoms (Cohen’s d = 1.01). Participants also had reductions in loneliness that trended towards statistical significance (p = 0.07); changes in social isolation were not statistically significant. Of the participants, 21 out of 23 expressed satisfaction with the program and would recommend it to peers. For secondary outcomes, analyses revealed significant improvements in anxiety and health-related quality-of-life. In this pilot feasibility trial, Empower@Home:Connected reduced depressive symptoms among older adults. The high adherence and satisfaction rates suggest acceptability. While the intervention produced improvements on several measures, further exploration is warranted to determine long-term impact and efficacy relative to other existing interventions.

ADDRESSING COMORBID CHRONIC PAIN AND EARLY COGNITIVE DECLINE IN OLDER ADULTS: THE ACTIVE BRAINS EFFICACY TRIAL

Abstract Chronic pain (CP) and early cognitive decline (ECD) are costly, highly prevalent, and challenging to treat among community-dwelling older adults. CP and ECD commonly co-occur, exacerbate each other, and can accelerate dementia. Our interdisciplinary team has developed Active Brains (AB), a virtual group mind-body walking program aided by Fitbit, to address this comorbidity. We are conducting a single-blinded, NIH stage 2 RCT to establish the efficacy of AB versus a time- and dose-matched education control (Health Enhancement Program; HEP) in 260 older adults with CP and ECD. In this symposium, we will describe the study design, recruitment numbers, and maximizing the inclusion of racial and ethnic minoritized older adults (38% benchmark). Participants are recruited through providers, social media, and community partnerships. Participants wear an ActiGraph to monitor steps and are randomized to 8 weeks of AB or HEP delivered via Zoom by an MGH psychologist. The AB group receives a Fitbit to reinforce activity goals. Primary (multimodal physical function) and secondary (cognitive and emotional function, pain) outcomes are collected at baseline, post-intervention, and 6 months. We have recruited 37 participants (4 cohorts). All 37 completed the baseline, 26 completed the post-test, and 9 are currently enrolled (total dropout = 5%). Session attendance (92.8%) and watch adherence (93.5%) have been excellent. The trial will establish efficacy, test mechanisms, and inform a future multi-site effectiveness-implementation trial. Consistent with the GSA 2023 theme, AB has the potential to catalyze non-pharmacological interventions for CP–ECD and empower older adults to maintain active and meaningful lives.

Cost-utility of a multicomponent intervention for fibromyalgia versus usual care: a pragmatic randomised controlled trial.

To perform an economic evaluation on a multicomponent intervention programme for patients with fibromyalgia syndrome compared with usual clinical practice in primary care. A cost-utility analysis was conducted alongside a pragmatic randomised controlled trial (ClinicalTrials.gov: https://clinicaltrials.gov/ct2/show/record/NCT04049006) from a societal perspective, a human capital approach, and a 1-year time horizon. Patients diagnosed with fibromyalgia syndrome from the public health system in south Catalonia, Spain. Crude and adjusted incremental cost- utility ratios were estimated to compare the treatment strategies based on cost estimations (direct medical costs and productivity losses) and quality-adjusted life years. One-way and 2-way deterministic sensitivity analyses were performed. The final analysed sample comprised 297 individuals, 161 in the intervention group and 136 in the control group. A crude incremental cost-utility ratio of € 1,780.75 and an adjusted ratio of € 851.67 were obtained, indicating that the programme significantly improved patients' quality of life with a cost-increasing outcome that fell below the cost-effectiveness threshold. The sensitivity analysis confirmed these findings when varying large cost components, and showed dominance when increasing session attendance. The proposed multicomponent intervention programme was cost-effective compared with usual care for fibromyalgia, which supports its addition to standard practice in the regional primary care service.

Light-Dark and Activity Rhythm Therapy (L-DART) to Improve Sleep in People with Schizophrenia Spectrum Disorders: A Single-Group Mixed Methods Study of Feasibility, Acceptability and Adherence.

People with a diagnosis of schizophrenia often have poor sleep, even when their psychotic symptoms are relatively well managed. This includes insomnia, sleep apnoea, hypersomnia, and irregular or non-24 h sleep-wake timing. Improving sleep would better support recovery, yet few evidence-based sleep treatments are offered to this group. This paper presents a mixed methods feasibility and acceptability study of Light-Dark and Activity Rhythm Therapy (L-DART). L-DART is delivered by an occupational therapist over 12 weeks. It is highly personalisable to sleep phenotypes and circumstances. Ten participants with schizophrenia spectrum diagnoses and sleep problems received L-DART; their sleep problems and therapy goals were diverse. We measured recruitment, attrition, session attendance, and adverse effects, and qualitatively explored acceptability, engagement, component delivery, adherence, activity patterns, dynamic light exposure, self-reported sleep, wellbeing, and functioning. Recruitment was ahead of target, there was no attrition, and all participants received the minimum 'dose' of sessions. Acceptability assessed via qualitative reports and satisfaction ratings was good. Adherence to individual intervention components varied, despite high participant motivation. All made some potentially helpful behaviour changes. Positive sleep and functioning outcomes were reported qualitatively as well as in outcome measures. The findings above support testing the intervention in a larger randomised trial ISRCTN11998005.

The value of peer contributions and different forms of social support in rare dementia bereaved caregiver groups

AbstractBackgroundPeer support has a key role to play in national and local health services worldwide given growing need, pressure on resources, and strategic drives towards supporting people to manage their own health. Yet evaluation of peer‐only and multi‐component peer and professional group services is held back by research methodology gaps, including the absence of direct, within‐session evaluation tools. The current study evaluates the relationship between participation and conversational characteristics using linguistic analysis of a series of online bereaved support groups.MethodParticipants were bereaved family caregivers (N = 102) attending Rare Dementia Support bereaved support group meetings between March 2017 and March 2022. Attendance rates and (virtual) travel distance were compared for in person meetings (N = 9 sessions; 2017‐2019) and online meetings (N = 26 sessions; 2020‐2022). During each online session, notable phrases & contributions were recorded using a verbatim note‐making process and shared with participants post‐session as a reminder of the experiences shared by group members. These text files (660 phrases comprised of 9,600 words) were analysed using Linguistic Inquiry and Word Count (LIWC; Pennebaker et al., 2015) software, automatically classifying words into LIWC categories of analytical thinking, clout, authenticity and affect variables.ResultThe switch to online sessions increased accessibility to bereaved support in terms of attendance rates (Figure 1A), geographical proximity (Figure 1B) and group consistency (Figure 1C, e.g. higher proportion of online attendees returned for further sessions [in person 42%, online 69%; McNemar χ2 = 3.84, p = 0.0001]). Linear regression analyses with robust standard errors revealed that greater session attendance (mean number of sessions attended by participants present) was associated with conversations that were more authentic and less emotional and definitive (i.e. more reflective) over time (regression coefficients: Authentic: 0.111 [0.073, 0.149]; Affect: ‐0.637 [‐1.089, ‐0.185]; Clout: ‐0.066 [‐0.112, ‐0.020]; see Figures 2A‐C). The level of analytical thinking was maintained across sessions (Analytic: ‐0.012 [‐0.086, 0.061]; see Figure 2D).ConclusionOnline peer groups offer a practical and effective medium for bereavement support. Shifting the focus of evaluation to the processes of social support – how it is delivered and received – rather than just the outcomes, offers insights into the mechanisms of peer support.

Feasibility of a Synchronous, Remoted‐Delivered, Aerobic Exercise Training Program in Rural‐Dwelling Adults with Subjective Cognitive Decline ‐ The MN RIDE Pilot

AbstractBackgroundSubjective cognitive decline (SCD), the subjective experience of worsening memory or cognition, is one of the earliest noticeable symptoms of Alzheimer’s disease and related dementias (ADRD), and offers a therapeutic window where interventions have strong potential to prevent or delay the progression to the ADRD. Out of all the modifiable risk factors for ADRD, physical inactivity is the strongest; therefore, it is no surprise that exercise is linked to a 30‐40% risk reduction for ADRD, with moderate intensity being the most beneficial. Rural communities have greater barriers in participating in exercise due to lack of social support, travel/weather problems, and lack of facilities/equipment. The purpose of this pilot study was to implement and evaluate the feasibility of a synchronous, remoted‐delivered, aerobic exercise (AEx) training program in persons with SCD living in rural areas.MethodThe MN RIDE Pilot Study employed a single group, pre‐posttest design. Participants were shipped all needed equipment to complete the intervention (cycle, heart rate monitors, etc.). All AEx sessions were supervised remotely via smart devices and Zoom® by an exercise physiologist. AEx was prescribed as progressive, moderate‐intensity cycling for 20‐50 minutes, 3 times/week for 3 months (36 sessions). Intensity was evaluated using the Borg Rating of Perceived Exertion (RPE) 6‐20 scale and heart rate max (HRmax) methods. Moderate intensity was defined as RPE 13 and HRmax 64‐76%. Feasibility was assessed by session attendance, intensity adherence, and presence of adverse events.ResultThe average age of the study sample (n = 9) was 57.44±7.16 years old (average age of SCD onset 53.44 [7.47] years old) with 14.00±5.57 years of education and 77.8% female. Out of the possible 324 sessions scheduled, 276 were attended (86% session adherence). Average intensity metrics achieved over the AEx sessions were 13.2 (0.5) and 72.0 (7.9) for RPE and HRmax respectively. No adverse events were reported.ConclusionOur study provides preliminary evidence of the feasibility of AEx telerehabilitation program designed to reduced ADRD risk in persons with SCD living in underserved rural communities. AEx telerehabilitation in rural communities should be further explored given AEx’s potential to reduce ADRD risk.

Abstract A023: Outcomes for breast cancer survivors with metastatic disease in a physical activity program for medically underserved cancer survivors

Abstract Background: Physical activity (PA) improves cancer survivors’ health outcomes including physical functioning, fatigue, and health-related quality of life (HRQOL), but the feasibility and effectiveness of PA programs for survivors with metastatic breast cancer (MBC) are still unclear. The purpose of this study was to examine the effects of the Active Living After Cancer (ALAC) program on breast cancer survivors with metastatic disease. ALAC is an evidence-based community program for underrepresented and medically underserved cancer survivors that aims to improve HRQOL and physical functioning through increasing PA. This presentation will analyze program effects on HRQOL and physical functioning as well as program satisfaction and retention among survivors with MBC compared to those with early stage breast cancer. Methods: This study is a secondary analysis of data from the ALAC program. ALAC is offered in the community in both English and Spanish and consists of 12 group sessions provided weekly. Among ALAC participants, we identified those with MBC (stage IV and with metastasis) and compared them to survivors with early stage breast cancer (stage I and II). The International Physical Activity Questionnaire (IPAQ), 30-second sit to stand test, and PROMIS Global Short Form-Physical and Mental Health T-scores were measured at baseline and follow-up. Program satisfaction and retention were assessed at the end of program. Repeated measure mixed models were used to compare changes in outcomes between patients with early stage breast cancer and MBC and Pearson’s chi-squared tests were used to examine differences in program satisfaction and attendance. Results: A total of 248 women (60 yr ±10.4), mostly Hispanic (50.6%) or non-Hispanic Black (19.7%), were included in the analyses (early stage: n=226; MBC: n=22). After the ALAC program, there were significant increases in PA (p<.001) and improvement of physical HRQOL (p=.011) and 30-second sit-to-stand (p<.001), but no significant between-group differences in these outcomes. Although session attendance was similar between groups, women with early stage breast cancer showed significantly higher program satisfaction compared to those with MBC (χ2=4.24, p=.039). Conclusions: The ALAC program effectively increases PA and improves physical HRQOL and physical functioning among breast cancer survivors with both metastatic and early stage disease. More research is needed to identify program changes needed to improve mental HRQOL and program satisfaction among women with MBC. Citation Format: Che Young Lee, Scherezade M. Mama, Yue Liao, Abenaa Brewster, Meagan Whisenant, Kylee Laffoon, Stacy J. Mitchell, Patricia V. Tracy, Giselle M Garza, Karen M. Basen-Engquist. Outcomes for breast cancer survivors with metastatic disease in a physical activity program for medically underserved cancer survivors [abstract]. In: Proceedings of the 16th AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2023 Sep 29-Oct 2;Orlando, FL. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2023;32(12 Suppl):Abstract nr A023.

Implementation of Exergame Telehealth in Subjective Cognitive Decline

ABSTRACT Background The purpose of this pilot study was to evaluate the feasibility and safety of a synchronous, remotely delivered, simultaneous aerobic exercise (AEx) and cognitive training program (Exergame) via BrainFitRx® in persons at risk for Alzheimer’s disease (AD) dementia. Methods In this pilot study, we employed a randomized controlled trial design in which participants were randomized to 1 of 3 groups: Exergame, AEx only, or stretching control on a 2:1:1 allocation ratio, 3 times a week for 12 weeks. Sessions were supervised in a synchronous audiovisual telehealth format by a clinical exercise physiologist. Feasibility and safety outcomes were assessed as session attendance, intensity adherence, and study-related adverse events. Usability for the Exergame was assessed by the Systems Usability Survey. Results The average age of the study sample (n = 39) was 74.6 ± 7.2 years old with 17.7 ± 2.3 years of education and 69.0% female. Overall participants in the Exergame and AEx groups attended on average 83.8% of possible sessions over the course of the 12-week study (85.6% attendance overall). Attendance was significantly higher for the AEx group (P = 0.02). Of the total training sessions completed collectively, 87.7% of sessions achieved the prescribed moderate intensity rating of perceived exertion targets (84.3% and 94.9% of sessions, respectively, for the Exergame and AEx groups). Overall, there were 2 study-related adverse events, both in the Exergames group. The Systems Usability Survey score was considered acceptable for the BrainFitRx. Conclusions In this study, we provide preliminary evidence of the feasibility of a simultaneous AEx + cognitive training (Exergame) program delivered through a synchronous telehealth format.

Predictors of Voice Therapy Attendance in an Interdisciplinary Care Model

The purpose of this study is to elucidate factors associated with voice therapy attendance within the interdisciplinary care model. This was a retrospective review. Patients referred for voice therapy following interdisciplinary evaluation involving speech language pathology and laryngology were included. Independent variables were (1) duration between interdisciplinary voice evaluation and first voice therapy session, (2) plan of care determined at the time of evaluation, (3) mode of voice therapy delivery, and (4) stimulability for improvement during evaluation. Voice therapy attendance was measured as (1) attendance to the first voice therapy session and (2) overall voice therapy attendance. Of 272 patients referred for voice therapy, 69.12% attended the first session, 17.28% canceled/no-showed (C/NS), and 13.6% did not schedule the first session. Of 235 patients who scheduled voice therapy, 48.94% attended all their scheduled sessions, and 51.06% C/NS at least one session. Patients with a plan of care including voice therapy+surgery were 86% less likely (risk ratio [RR]=0.14, P=0.0014) to C/NS any of their voice therapy sessions. In contrast, patients with plan of care including voice therapy+medication were more likely to C/NS at least one voice therapy session (RR=1.27, P=0.1419), although this finding was not significant. No other covariates had a significant impact on voice therapy initiation or overall attendance. This study provides further support for the positive impact of interdisciplinary evaluation on voice therapy initiation. However, once voice therapy is initiated, overall C/NS rates are persistently high, consistent with previous investigations of voice therapy dropout. Our findings suggest that plan of care determined at the time of evaluation may have an impact on voice therapy attendance.

Dementia Caregiving 101: The effect of a pilot virtual dementia caregiving course on caregiver role preparedness and self‐efficacy

AbstractBackgroundDementia affects approximately 6.5 million people over the age of 65 in the US, most of whom are cared for at home by family members. Dementia caregivers (CGs) have reported inadequate perceived role preparedness and self‐efficacy, in addition to burden, depression, and anxiety that is disproportionate to CGs of those without dementia. We created a virtual Dementia Caregiving 101 course offering psychoeducation and skills training through an immersive structured program. The virtual platform was designed to improve access to dementia caregiving education for the rural CGs we serve. Goals of this course were to increase CG role preparedness and self‐efficacy by providing information about dementia and an overview of the caregiving experience.MethodPrior to the first class, CGs were administered questionnaires to assess role preparedness and self‐efficacy. Two intervention groups were then conducted simultaneously for ten weeks. Post‐intervention data regarding role preparedness, self‐efficacy, and course feedback were collected.ResultFifteen CGs enrolled in the course. Four CGs were lost to follow up by the time of post‐group data collection, and one CG’s data was excluded whose scores were significantly discrepant from the overall pattern (this person joined by phone instead of by video). CGs included spouses/significant others (n = 5), former spouses (n = 1), siblings (n = 2), and adult children (n = 2). CGs ranged in age from 58‐76 (age M = 69.2; SD = 6.4). Diagnoses of CG’s loved ones included vascular dementia (n = 4), Alzheimer’s disease (n = 2), and unspecified dementia/no diagnosis given (n = 4). Total session attendance was high (M = 7.8; SD = 1.9; range = 5‐10). Following course completion, CGs reported an overall increase in role preparedness (Pre‐course score = 175; Post‐course score = 198) and self‐efficacy (Pre‐course score = 417; Post‐course score = 482). Qualitative analysis of CG feedback revealed high satisfaction with the course overall, with particular emphasis on usefulness of the manual, convenience of the virtual platform, and the opportunity to learn from other CGs.ConclusionThe Dementia Caregiving 101 virtual course appears to be an accessible and effective program for improving CG role preparedness and self‐efficacy, which are important factors in reducing negative CG outcomes. Our preliminary results are encouraging and underscore the benefits of virtual skills‐based interventions for dementia CGs.

Building Adaptive Coping and Knowledge to Improve Daily Life (Back2Life): A Pilot Feasibility Trial for Youth with Chronic Sickle Cell Pain

Introduction: Cognitive-behavioral therapy (CBT) for pain is an effective non-pharmacological treatment for chronic pain management, yet can have limited generalizability, access, and reach for underrepresented populations like youth with sickle cell disease (SCD). We aimed to conduct a single-arm proof-of-concept clinical trial to evaluate the feasibility, acceptability, and preliminary efficacy of Back2Life, an adapted, culturally congruent CBT intervention for youth with chronic SCD pain and their parents. We hypothesized that Back2Life would be feasible and acceptable as demonstrated by high levels of treatment engagement (≥80% attendance of treatment sessions) and satisfaction. We also expected clinically significant reductions in pain and pain interference and improvements in pain coping efficacy from baseline to 3-month follow-up (primary endpoint) and 6-month follow-up (maintenance endpoint). Methods: Youth receiving care at comprehensive SCD clinics at 3 tertiary care locations within a southeast children's hospital were included if they were aged 10-18 years, any SCD genotype, reported chronic pain (i.e., pain on most days per month for at least 3 months), had English fluency, and had stable disease-modifying treatments in the past 3 months. Youth were excluded if they had comorbid medical conditions typically associated with pain but unrelated to SCD, had significant cognitive or developmental limitations that would interfere with study procedures, or received ≥ 3 sessions of outpatient psychological therapy for pain management in the preceding 6 months. Patients completed assessments at baseline, post-treatment, 3-month follow-up, and 6-month follow-up. Primary outcomes included pain characteristics (i.e., intensity, frequency, burden), pain interference, and coping self-efficacy. Secondary outcomes included depressive symptoms, pain catastrophizing, and sleep quality. The Back2Life program included evidence-based CBT treatment manuals that were adapted based on qualitative feedback from patient and parent stakeholders to optimize the cultural congruence and relevance to chronic SCD pain. Back2Life was an adaptive treatment comprised of 6-10 module-based sessions delivered by a behavioral health coach via telehealth. All participants received 6 core sessions and up to 4 additional sessions were included to optimize tailored treatment components to address individual family needs. Tailored sessions targeted common co-morbidities associated with chronic pain and were identified based on findings of the baseline assessment. Families also could opt-in to tailored sessions based on interest. Descriptive statistics were conducted to evaluate feasibility and acceptability metrics as well as clinically significant changes in primary and secondary clinical outcomes. Results: Youth (n=20) were on average 15.9 years old (SD=1.6), 50% female, 100% Black or African American, and 95% Non-Hispanic/Latinx. Most (80%) had hemoglobin types HbSS or HbSβ 0. Feasibility and acceptability ratings were high, including 85% consent rate, 80% initiated study procedures, 100% treatment session completion, 93% intervention fidelity, 100% reported moderate-high treatment satisfaction, and strong qualitative feedback suggested treatment acceptance. Patients reported clinically significant changes from baseline to 6-month follow-up in pain frequency (>35% reduction), worst and typical pain intensities (>30% reduction), SCD pain burden (>30% reduction), pain interference (moderate to mild severity), and improvement in pain coping self-efficacy (see Table 1). Patients also reported changes in pain catastrophizing (high to moderate severity), depressive symptoms (mild severity to within normal limits), and no change in sleep quality. Conclusions: The Back2Life treatment program demonstrated high feasibility and acceptability, participant engagement, participant retention, and meaningful changes in patient-reported outcomes. An adapted, culturally congruent, telehealth-delivered CBT for pain intervention tailored to meet the unique needs experienced by youth with chronic SCD pain can promote increased access, reach, and health equity in SCD.

Process evaluation of the Invictus Pathways Program.

UniSA's Invictus Pathways Program (IPP), a service program, was originally developed to assist veterans to train for and participate in the Invictus Games. More recently, the scope of the IPP has widened to support and improve wellbeing and facilitate post traumatic growth and recovery among participants who are living with physical and mental health injuries and conditions. This paper describes the components of the IPP and reports its process evaluation. Underpinned by a pragmatic approach, data related to participant and student involvement in the IPP, the number of participant training sessions, session attendance, program activities and events, and program fidelity were compiled from process documentation that had been collected between 2017 and 2020, inclusive. Following ethics approval, semi-structured interviews were conducted with participants of the IPP, members of their family support network, and university staff to understand the operations of the IPP and satisfaction with the program. There was high fidelity for the student-led exercise training aspects of IPP; however, data collection relevant to participants' psychological outcomes, and non-training IPP events and activities did not always occur as intended. Between 2017 and 2020, 53 veterans had participated in or were still participating in the IPP, and 63 allied health students had completed placements as student trainers. Fifty-three individual training sessions were delivered in 2017, increasing to 1,024 in 2020. Seventy-one interviews were completed with key IPP stakeholders. The qualitative analysis identified four higher order themes: Implementation and fidelity of the IPP, Satisfaction with the IPP, Areas of the IPP requiring improvement and suggestions for change, and Sustainability of the IPP. Satisfaction was generally high for the IPP, although there were factors that negatively impacted the experience for some participants and their family support network. Suggestions for improvement to program components and delivery aspects were made during the interviews, and the precariousness of IPP funding and sustainability was raised as an ongoing concern. This process evaluation has demonstrated that the physical activity training components of the IPP were delivered with high levels of fidelity, and that satisfaction with the IPP is mostly high, although there are areas that could be improved. There is a need for a more structured approach to the ongoing evaluation of the IPP. This includes ensuring that program staff have a shared understanding of the purpose of evaluation activities and that these activities occur as intended. Beyond this is the need to secure funding to support the sustainability of the IPP, so that it can continue to contribute to the wellbeing of veterans living with physical and mental health conditions, and their families.

Applying RE-AIM to examine the impact of an implementation facilitation package to scale up a program for Veterans with chronic obstructive pulmonary disease

BackgroundUS Veterans are four times more likely to be diagnosed with chronic obstructive pulmonary disease (COPD) compared to the civilian population with no care model that consistently improves Veteran outcomes when scaled. COPD Coordinated Access to Reduce Exacerbations (CARE) is a care bundle intended to improve the delivery of evidence-based practices to Veterans. To address challenges to scaling this program in the Veterans’ Health Administration (VA), the COPD CARE Academy (Academy), an implementation facilitation package comprised of five implementation strategies was designed and implemented.MethodsThis evaluation utilized a mixed-methods approach to assess the impact of the Academy’s implementation strategies on the RE-AIM framework implementation outcomes and the extent to which they were effective at increasing clinicians’ perceived capability to implement COPD CARE. A survey was administered one week after Academy participation and a semi-structured interview conducted 8 to 12 months later. Descriptive statistics were calculated for quantitative items and thematic analysis was used to analyze open-ended items.ResultsThirty-six clinicians from 13 VA medical centers (VAMCs) participated in the Academy in 2020 and 2021 and 264 front-line clinicians completed COPD CARE training. Adoption of the Academy was indicated by high rates of Academy session attendance (90%) and high utilization of Academy resources. Clinicians reported the Academy to be acceptable and appropriate as an implementation package and clinicians from 92% of VAMCs reported long-term utilization of Academy resources. Effectiveness of the Academy was represented by clinicians’ significant increases (p < 0.05) in their capability to complete ten implementation tasks after Academy participation.ConclusionsThis evaluation found that the use of implementation facilitation paired with additional strategies enhanced the capacity of clinicians to implement COPD CARE. Future assessments are needed to explore post-academy resources that would help VAMCs to strategize localized approaches to overcome barriers.

Differences in injury and concussion rates in a cohort of Canadian female and male youth Rugby Union: a step towards targeted prevention strategies

ObjectiveTo examine differences in match and training musculoskeletal injury and concussion rates and describe mechanisms of concussion while considering previous playing experience in female and male Canadian high school Rugby...

QOL-12. NEURO-ONCOLOGY INCLUSION IN PSYCHOTHERAPEUTIC INTERVENTION TRIALS: LEARNING WHICH COGNITIVE ADAPTATIONS COULD SUPPORT PATIENT ENGAGEMENT?

Abstract BACKGROUND Many patients with brain tumors experience double vulnerability—significant emotional distress coupled with cognitive decline—however, these cognitive changes often prohibit their inclusion in psychotherapeutic interventions that might otherwise improve their wellbeing. The primary goal of this analysis was to understand how best to accommodate the neurocognitive needs of patients with brain tumors so that they may effectively participate in future psychotherapeutic interventions. Our secondary goal was to assess potential differences in desired cognitive adaptations between patients with primary compared to metastatic brain tumors. METHODS In two recently completed Phase 2 proof-of-concept trials, patients with both primary and metastatic brain tumors (N = 27) participated in a 3-month psychotherapeutic intervention, Managing Cancer and Living Meaningfully (CALM). During exit interviews, participants reported whether evidence-informed accommodations would support their cognitive limitations and enhance engagement in future trials. Additionally, trial interventionists identified which accommodations were used in each session. RESULTS Participants recommended several accommodations: appointment reminders (100%), topic refreshers (94%), prior session summaries (88%), visual handouts (82%), time for consolidation (71%), transcription notepads (65%), and questionnaire completion assistance (24%). Interventionists documented using appointment reminders (66%), topic refreshers (53%), prior session summaries (60%), and time for consolidation (60%) in more than half of sessions. Visual handouts (2%), notepads (0%), and questionnaire assistance (17%) were rarely or never used. CONCLUSIONS: RESULTS were similar across the two brain tumor populations surveyed: primary and metastatic brain tumors. Accommodations that were recommended by patients and used by interventionists included: (1) appointment reminders to support session attendance, (2) topic refreshers and prior session summaries to support memory, and (3) additional time to assist with slower processing and support comprehension. Implementing supportive cognitive strategies is vital when promoting neuro-oncology inclusion in psychotherapeutic interventions and meeting the needs of this underserved population.

Home- versus clinic-based exercise intervention in patients with heart failure (EXIT-HF trial): a pragmatic randomized controlled trial

Abstract Background The limited accessibility partially explains the low uptake of cardiac rehabilitation (ExCR) for heart failure (HF). Home-based programs might address those obstacles but few data from randomized trials are available. Purpose To compare the effectiveness of a home-based versus clinic-based ExCR intervention in HF patients. Methods Single-center, single-blind, parallel groups, non-inferiority pragmatic randomized control trial (1:1 and after COVID-19 2:1 home- vs clinic-based). Adult HF patients referred to our cardiac rehabilitation (CR) unit were randomized to either a clinic-based (24 supervised sessions at a CR unit of a tertiary hospital over 12 weeks) or home-based (4 supervised ExT sessions to familiarize with the training protocol and the remaining sessions continued at home) over 12 weeks. Exercise training protocol consisted of a combination of endurance (at 60%-80% of peak oxygen uptake [VO2peak] and resistance training (elastic bands). The primary endpoint was the change in VO2peak at the end of the 12-week program. Secondary outcomes included adherence (&amp;gt;80% of sessions attendance) and change of Minnesota Living with HF Questionnaire (MLHFQ) scores. Results 120 patients (mean age 64±11 years; 64% men) were randomized: 44 to clinic- and to 76 home-based intervention. 41% had an ischemic cardiomyopathy, 27% had an ICD/CRT, the mean LVEF was 36±11% (62% had LVEF &amp;lt;40%), 73% were on NYHA class II, and the median NT-proBNP was 361 [IQR 170-1008] ng/mL. Intervention groups were well balanced, including basal VO2peak that was similar between groups (17.8±4.8 vs 18.1±5.2 mL/min/Kg; p=0.75). Adherence was similar between groups (87.5% vs 82.5%; p=0.50). At week 12, on average, patients increased VO2 peak by 0.9±2.5 mL/min/Kg compared to baseline (p&amp;lt;0.001). No significant differences were found between clinic- and home-based interventions (p=0.25). Consistently, the MLHFQ total score decreased significantly overall (-10.3±1.7 points; p&amp;lt;0.001), with no significant differences between groups (p=0.91). The drop-out rate was 14% and 17% in clinic- and home-based groups, respectively. Conclusions The clinical impact of home-based CR program on peakVO2 and health-related quality of life of HF patients was similar to a standard supervised clinic-based one. Our data support the home-based program as an effective alternative way of delivering CR in HF.

Exploring the experiences of staff conducting psychology consultations via telehealth in an oncology hospital

Purpose During the COVID-19 pandemic, telehealth delivery of psychological care services expanded to meet the needs of people with cancer. This study examined psychologists’ attitudes toward using telehealth during the pandemic peak in a tertiary oncology hospital. Methods Semi-structured interviews were conducted with ten psychologists who used telehealth to deliver psychological services. Thematic analysis was conducted to identify themes in the interview data. Results Themes identified: (1) increased uptake and attendance of psychology sessions was due to greater accessibility of services; (2) clinicians reported ease of communication and building of rapport when using telehealth; and (3) clinicians perceived differences in the psychotherapeutic process when sessions were delivered via telehealth compared to in-person. Conclusions Clinicians expressed high satisfaction with delivering telehealth psychological support for oncology patients. Implications for Psychosocial Providers: Oncology services that are considering developing or expanding a telehealth psychology service can facilitate this by ensuring a reliable technological platform and providing training and/or support to staff and patients. Clinicians should also use their clinical judgment to decide if a patient is appropriate for telehealth-delivered psychological care or if a mix of modalities is more ideal.

What matters for weight loss in behavioral trials in the Latinx community: Learnings from three randomized controlled trials

BackgroundNearly half of Latinx adults in the US are obese, making effective weight loss interventions crucial to prevent associated chronic conditions. ObjectiveTo identify factors associated with increased session attendance and clinically significant weight loss among Latinx adults. ParticipantsLatinx participants from the Vivamos Activos (n = 207), Vida Sana (n = 191), and HOMBRE (n = 424 Latinx men) randomized clinical trials. DesignPost-hoc analysis of randomized controlled trial data. InterventionCulturally-adapted behavioral weight loss interventions based on the Diabetes Prevention Program among Latinx adults over 12 months. Main outcome measureDemographic, clinical, and psychosocial predictors of session attendance and 5% weight loss at 12-months. Statistical analysis performedBi-variable associations between baseline characteristics and outcomes were tested with chi-square and t-tests. Those with p-value< 0.15 were then included in stepwise logistic regressions. ResultsParticipants (N = 822) were middle age with diverse socioeconomic backgrounds. Older age in the Vivamos Activos and Vida Sana trials, and lower acculturation in the HOMBRE trial were significant predictors of increased session attendance. Factors associated with 5% weight loss varied by trials. These included younger age (OR 0.96 95% CI 0.92, 0.99) in Vivamos Activos, higher acculturation (OR 1.88 95% CI 1.05, 3.37) in Vida Sana, and higher education (OR 3.20 95% CI 1.3, 7.03) and greater body image dissatisfaction (OR 1.29, 95% CI 1.04, 1.6), and lower acculturation (0.69 95% CI 0.5, 0.96) in HOMBRE. ConclusionsFew and conflicting baseline characteristics were associated with session attendance and clinically significant weight loss, suggesting that alternative approaches to optimizing interventions are needed.

Yoga-based supportive care for patients with head and neck cancer undergoing radiotherapy: Results of a three-arm randomized controlled trial.

292 Background: Radiotherapy (RT) to treat head and neck cancer (HNC) may result in debilitating toxicities and functional problems. Targeted yoga therapy delivered concurrently to RT may buffer against treatment-related sequelae. Given the high distress rates in spouses and interdependence of distress in couples, involving a spousal caregiver in the intervention may have additional benefits. Thus, we randomized patient-caregiver dyads to either a dyadic yoga (DY), patient yoga (PY) or usual care (UC) control arm. We hypothesized that both yoga arms are better than the UC arm regarding functional outcomes and healthcare utilization (i.e., feeding tube (FT) placements, emergency department (ED) and hospital admissions (HA) across the standard RT period. The comparison between the DY vs PY group was considered exploratory. Methods: HNC patients planned to receive ≥25 fractions of RT and their caregivers completed baseline assessments and were then randomized to the DY, PY or UC arm. Both yoga programs consisted of 15 sessions delivered parallel to the RT schedule. Sessions were either in person or via videoconference. Patients completed the self-report part of the PG-SGA on a weekly basis during the RT period (5-6 weeks). We extracted FT, ED and HA as healthcare utilization metrics from patients’ electronic medical records as binary variables (yes/no). Results: 100 patients (mean age: 60.3 yrs., 85% male, 79% NHW, 67% early stage, 54% chemo-RT) and caregivers (mean age: 54.9 yrs., 83% female, 78% NHW) were randomized (DY: n=34; PY: n=33, UC: n=33). Session attendance was high for both yoga arms (88% attended ≥ 10 session) with mean of 13.13 sessions in the DY and 13.30 sessions in the PY group. Intent to treat analyses using multi-level modeling controlling for patient age, sex, disease stage and treatment (RT vs CRT) revealed a significant effect between the DY and UC group for the physical function (F=5.27, p=.03) and the nutrition intake (F=4.97, p=.03) PG-SGA subscales favoring the DY group. The other comparisons (PY vs UC and DY vs PY) were not significant. None of the comparisons for the symptom and weight subscales were significant. Logistic regression analyses revealed a significant effect for FT placement so that both DY (p=.05) and PY (p=.02) groups had significantly fewer FTs than the UC group. The effect for ED visits was marginally significant and the effect for HA was not significant. Conclusions: Yoga therapy, particularly when delivered to patient-caregiver dyads, appears to be a beneficial behavioral supportive care strategy for HNC patients undergoing RT. We revealed significantly improved physical function and nutrition intake and fewer FTs relative to a UC comparison group. A larger comparative effectiveness trial is warranted. Clinical trial information: NCT04607590 .