Completion Of Session Research Articles

Effect of Robotic Delivery of Physical Activity and Fall Prevention Exercise in Older Adults: A Pilot Cohort Study.

Introduction The high prevalence of falls, lack of stability and balance, and general physical deconditioning are concerning issues for longevity and quality of life for adults aged 65 years and older. Although supervised delivery of the Otago Exercise Program (OEP) has demonstrated evidence of effectiveness in reducing fall risk of older adults, opportunities for ongoing unsupervised exercise performance are warranted. An option to facilitate exercise and performance of health behaviors may be via a social robot. The purpose of this study was to examine feasibility and initial outcomes of a robot-delivered fall prevention exercise program for community-dwelling older adults. Methods Five participants aged 65 years and older were recruited to receive robot-delivered modified OEP and walking program three times per week for four weeks. Outcomes of demographics, self-reported performance measures (Modified Falls Self-Efficacy Scale, Activities-specific Balance Confidence, and Almere Model assessing various constructs of acceptance of use of robotic technology), and physical performance measures (Timed Up and Go Test, Short Physical Performance Battery, Balance Tracking System [BTrackS] center of pressure sway) were collected. Data were analyzed descriptively and examined for trends in change. Measures of central tendency and distribution were used according to the distribution of the data. Results The mean age of the participants was 75 years (range: 66-83 years; four females and one male). The range of participant exercise session completion was 7-12 (mode=11, n=3). Constructs on the Almere Model that started and remained positive were Attitudes Toward Technology and Perceived Enjoyment with the robot. Anxiety improved from 3.80 to 4.68, while Social Presence of the robot improved from 2.80 to 3.56. The construct of Trust was somewhat negative among participants upon commencing the program and did not substantially change over time. Two participants improved their confidence on the Activities-specific Balance Confidence scale by more than 10%, while all participants showed some improvement in confidence in their balance. Mixed results were found with the Modified Falls Self-Efficacy Scale. Mean gait speed for the participants improved by 0.76 seconds over 3 meters. Improvement was also demonstrated for the Short Physical Performance Battery, with two participants improving scores by 2-3 points out of 12. No appreciable changes were found with the Timed Up and Go test and the BTrackS assessment. Conclusion Using a robot-led exercise program is an accessible and feasible way to deliver exercise to community-dwelling older adults in the home, but some technical constraints remain. Outcomes suggest that a four-week program is sufficient to elicit some positive trends in health outcomes and has the potential to reduce fall risk.

EFFECT OF ISOMETRIC SQUAT EXERCISE ON SPRINT PERFORMANCE OF FOOTBALL PLAYERS

A soccer match makes heavy demands on both aerobic and anaerobic metabolism. Elite players run 8–12 km during a game. Nevertheless, anaerobic metabolism is also crucial in sprints, jumps, and tackles. Many studies have stated that aerobic and anaerobic strength are significant features in soccer games. During a soccer match, soccer team members performed 60 to 70 runs from 12 to 15 m. Sprint running success, with or without the ball, is therefore a significant factor that can explain a winning team's supremacy. In essential ball duals, sprint could be key. In certain cases, the player should be quicker and more effective than the opponent to score goals or to avoid goals being scored. In addition, acceleration and speed can enhance skills vital to soccer, such as turning, sprinting, and changing tempo, by improving strength in appropriate muscles or muscle groups. The study was to evaluate the effect of isometric squat exercise on sprint performance of football players. The sample of 60 student were selected from the population of University of Lahore football team. Within 3 to 5 days after base training pre-test will be conducted in the morning by using 40-yard dash test. Post-test will be conducted after completion of Isometric Squat exercise training sessions. The results show that, differences between the two test 40 Yard Dash Test Post-Test of Experimental Group and 40 Yard Dash Test Post-Test of Control Group. This research study discovered that there was a statistically significant improvement in sprint performance by using Isometric Squat exercise Program.

Feasibility and Efficacy of the Newly Developed Robotic Hybrid Assistive Limb Shoulder Exercises in Patients with C5 Palsy during the Acute Postoperative Phase.

Background and Objectives: Although postoperative C5 palsy is a frequent complication of cervical spine surgery, no effective therapeutic rehabilitation approach has been established for postoperative C5 palsy. The purpose of this study was to find evidence confirming the effectiveness and feasibility of robotic Hybrid Assistive Limb (HAL) shoulder exercises for C5 palsy. Materials and Methods: In this before-after, uncontrolled case series clinical study, we performed a mean of 11.7 shoulder training sessions using a shoulder HAL immediately after the onset of C5 palsy in seven shoulders of six patients who developed postoperative C5 palsy and had difficulty raising their shoulder during the acute postoperative phase of cervical spine surgery. Shoulder HAL training was introduced as early as possible after evaluating the general condition of all inpatients who developed C5 palsy. Patients underwent shoulder abduction training using shoulder HAL on an inpatient and outpatient basis at 2-week or 1-month intervals. Adverse events associated with shoulder HAL training were investigated. The shoulder abduction angle and power without the shoulder HAL were evaluated before shoulder HAL usage, at every subsequent session, and upon completion of all sessions. Results: Severe adverse events due to shoulder HAL training were not reported. After completion of all shoulder HAL sessions, all patients showed improved shoulder elevation, while shoulder abduction angle and power improved over time. Conclusions: Shoulder elevation training with HAL in patients in the acute stage of postoperative C5 palsy has the potential to demonstrate improvement in shoulder joint function with a low risk of developing severe adverse events.

At-home use of parasacral transcutaneous electrical nerve stimulation for pediatric voiding dysfunction: a randomized controlled trial to assess its safety and feasibility.

Treating pediatric voiding dysfunction involves behavioral changes that require significant time or medications that are often avoided or discontinued due to side effects. Using parasacral transcutaneous electrical nerve stimulation (PTENS) has shown to have reasonable efficacy, but the safety and feasibility of its off-label use for pediatric voiding dysfunction are not well-established. Concerns have also been raised over treatment adherence. In-home therapy might improve adherence compared with office-based therapy; however, no studies have evaluated in-home feasibility to date. This study aims to assess the safety and feasibility of off-label use of PTENS for pediatric voiding dysfunction. A single-institution prospective, randomized controlled study was conducted from March 2019 to March 2020. Participants aged 6-18 years diagnosed with voiding dysfunction, overactive bladder, or urinary incontinence were eligible for the study. Those with known neurologic disorders, implanted electrical devices, anatomic lower urinary tract abnormality, and recurrent urinary tract infections and those taking bladder medications were excluded. Children with primary monosymptomatic nocturnal enuresis were also excluded due to previous work suggesting a lack of efficacy. Participants were randomly assigned to receive 12 weeks of urotherapy alone (control) or urotherapy plus at-home PTENS treatment. Families were contacted weekly to assess for adverse events (AEs) and treatment adherence. The primary and secondary outcomes were safety, defined as the absence of AEs and treatment adherence, respectively. A total of 30 eligible participants were divided into two groups, with 15 participants in each arm. The median age was 9.4 years (interquartile range: 7.7-10.6). In total, 60% were male. Baseline demographics and urotherapy compliance were similar between the two groups. With PTENS use, two AEs were reported, including mild pruritus at the pad site and discomfort when removing pads, while no AEs were noted in the control group. In total, 60% of patients completed three 30-min sessions per week, and all participants were able to complete treatment sessions for at least 10 weeks, involving 30 min of PTENS treatment each time. This randomized controlled study confirms that at-home use of PTENS is feasible with reasonable treatment adherence and minimal AEs. Future collaborative, multi-institutional studies may better determine the efficacy of this treatment modality.

Trends in Telepsychiatry and In-Person Psychiatric Care for Depression in an Academic Health System, 2017-2022.

The authors aimed to assess differences in appointment completion rates between telepsychiatry and in-person outpatient psychiatric care for patients with depression in an academic health system. Electronic health records of encounters for patients (ages ≥10) with a depression diagnosis and at least one scheduled outpatient psychiatric appointment (N=586,266 appointments; November 2017-October 2022) were assessed for appointment volume and completion of telepsychiatry versus in-person sessions. Telepsychiatry became the dominant care modality after the onset of the COVID-19 pandemic, although the number of telepsychiatry and in-person appointments nearly converged by October 2022. Logistic regression showed that telepsychiatry appointments (July 2020-October 2022) were more likely (OR=1.30, 95% CI=1.27-1.34) to be completed than in-person appointments. Telepsychiatry appointments were less likely to be canceled or missed than in-person appointments, suggesting that telepsychiatry improved efficiency and continuity of care. As in-person operations resume following the pandemic, maintaining telepsychiatry services may optimize hospital-level and patient outcomes.

An Educational Program for Remote Training and Supervision of Home-Based Transcranial Electrical Stimulation: Feasibility and Preliminary Effectiveness

ObjectivesThere has been recent interest in the administration of transcranial electrical stimulation (tES) by a caregiver, family member, or patient themselves while in their own homes (HB-tES). The need to properly train individuals in the administration of HB-tES is essential, and the lack of a uniform training approach across studies has come to light. The primary aim of this paper is to present the HB-tES training and supervision program, a tele-supervised, instructional, and evaluation program to teach laypersons how to administer HB-tES to a participant and to provide a standardized framework for remote monitoring of participants by teaching staff. The secondary aim is to present early pilot data on the feasibility and effectiveness of the training portion of the program based on its implementation in 379 sessions between two pilot clinical trials. Materials and MethodsThe program includes instructional materials, standardized tele-supervised hands-on practice sessions, and a system for remote supervision of participants by teaching staff. Nine laypersons completed the training program. Data on the feasibility and effectiveness of the program were collected. ResultsNo adverse events were reported during the training or any of the HB-tES sessions after the training. All laypersons successfully completed the training. The nine laypersons reported being satisfied with the training program and confident in their tES administration capabilities. This was consistent with laypersons requiring technical assistance from teaching staff very infrequently during the 379 completed sessions. The average adherence rate between all administrators was >98%, with seven of nine administrators having 100% adherence to the scheduled sessions. ConclusionsThese findings indicate that the HB-tES program is effective and is associated with participant satisfaction. SignificanceWe hope that the remote nature of this training program will facilitate increased accessibility to HB-tES research for participants of different demographics and locations. This program, designed for easy adaptation to different HB-tES research applications and devices, also is accessible online. The adoption of this program is expected to facilitate uniformity of study methods among future HB-tES studies and thereby accelerate the pace of tES intervention discovery.

Feasibility, Efficacy, and Safety of Peripheral Venous Access for Chronic Double-Filtration Plasmapheresis with Regional Citrate Anticoagulation

Introduction: Peripheral venous access (PVA) is recommended as a first-line vascular approach for therapeutic plasmapheresis with centrifugation methods but not filtration, which usually requires high blood flow. We evaluated the feasibility, efficacy, and safety of double-filtration plasmapheresis (DFPP) with PVA, using ultrasound guidance and regional citrate anticoagulation (RCA), i.e., PVA-RCA-DFPP in patients undergoing chronic DFPP. Secondly, we assessed the number of central venous catheters (CVCs) avoided. Methods: A single-center retrospective study evaluated 22 adult patients on chronic DFPP to perform PVA-RCA-DFPP. They were classified into 3 groups: successful (i.e., completion of sessions with PVA), primary failure (i.e., no sessions completed), secondary failure (i.e., ≥1 session with PVA completed but secondary return with CVC or arteriovenous fistula). Results: Among the 22 patients included (64% men), 7 patients (32%) were classified as primary failures (2 patient refusals, 5 inadequate PVAs), 1 patient (5%) as a secondary failure (due to uncomfortable venipunctures), and 14 patients (64%) as successful. In the successful group including 12 patients treated for chronic inflammatory demyelinating polyneuropathy (CIDP) and 2 patients for familial hypercholesterolemia (FH) (2 patients), 116 sessions were performed, with a median treated plasma volume of 4.3 L [IQR 3.6–4.6] (45 mL/kg) for a median duration of 134 min [IQR 122–144], and a median blood flow of 94 mL/min [IQR 87–103]. For the CIDP group, 90% of sessions achieved a plasma volume >1 TPV, and for the FH group 91% of sessions achieved an LDLc reduction >60%. Eleven sessions out of 116 (9%) were interrupted, mostly due to PVA dysfunction (5/11) and circuit clotting (4/11). Session interruptions decreased significantly between each patient’s first and following sessions (29% to 7%, p = 0.009). Conclusion: Chronic PVA-RCA-DFPP can be performed safely and efficiently, avoiding the use of CVCs.

Home practice for robotic surgery: a randomized controlled trial of a low-cost simulation model

Pre-operative simulated practice allows trainees to learn robotic surgery outside the operating room without risking patient safety. While simulation practice has shown efficacy, simulators are expensive and frequently inaccessible. Cruff (J Surg Educ 78(2): 379–381, 2021) described a low-cost simulation model to learn hand movements for robotic surgery. Our study evaluates whether practice with low-cost home simulation models can improve trainee performance on robotic surgery simulators. Home simulation kits were adapted from those described by Cruff (J Surg Educ 78(2): 379–381, 2021). Hand controllers were modified to mimic the master tool manipulators (MTMs) on the da Vinci Skills Simulator (dVSS). Medical students completed two da Vinci exercises: Sea Spikes 1 (SS1) and Big Dipper Needle Driving (BDND). They were subsequently assigned to either receive a home simulation kit or not. Students returned two weeks later and repeated SS1 and BDND. Overall score, economy of motion, time to completion, and penalty subtotal were collected, and analyses of covariance were performed. Semi-structured interviews assessed student perceptions of the robotic simulation experience. Thirty-three medical students entered the study. Twenty-nine completed both sessions. The difference in score improvement between the experimental and control groups was not significant. In interviews, students provided suggestions to increase fidelity and usefulness of low-cost robotic home simulation. Low-cost home simulation models did not improve student performance on dVSS after two weeks of at-home practice. Interview data highlighted areas to focus future simulation efforts. Ongoing work is necessary to develop low-cost solutions to facilitate practice for robotic surgery and foster more inclusive and accessible surgical education.

Feasibility and acceptability of ‘low-intensity mental health support via a telehealth-enabled network’ for adults with type 1 and type 2 diabetes: the LISTEN pilot study

BackgroundThis study examined the feasibility and acceptability of the low-intensity mental health support via telehealth-enabled network (LISTEN) intervention, for adults with diabetes, facilitated by diabetes health professionals (HPs).MethodsLISTEN training. Three HPs participated in three half-day online workshops and applied their learnings during training cases (maximum four). Competency was assessed with a validated tool and achieved ‘satisfactory’ ratings for three consecutive sessions. LISTEN pilot. A single-group, pre-post study (up to four LISTEN sessions) with online assessments at baseline, post-intervention, and 4-week follow-up. Eligible participants were adults with type 1 or type 2 diabetes, with diabetes distress, but excluded if they had moderate/severe depressive and/or anxiety symptoms. Feasibility was assessed via recruitment and session completion rates. Acceptability was assessed with post-intervention self-report data. Changes in diabetes distress and general emotional well-being from baseline (T1) were explored at post-intervention (T2) and at 4-week follow-up (T3).ResultsTwo HPs achieved competency (median training case sessions required: 7) and progressed to deliver LISTEN in the pilot study. In the pilot, N = 16 adults (Med [IQR] age: 60 [37–73] years; 13 women) with diabetes participated (median sessions per participant: 2). Twelve participants (75%) completed the post-intervention assessment (T2): 92% endorsed the number of sessions offered as ‘just right’, 75% felt comfortable talking with the HP, and 67% were satisfied with LISTEN. Perceived limitations were the structured format and narrow scope of problems addressed. Diabetes distress scores were lower post-intervention.ConclusionsThis pilot demonstrates the feasibility of training HPs to deliver LISTEN, and the acceptability and potential benefits of LISTEN for adults with diabetes. The findings highlight adaptations that may enhance the delivery of, and satisfaction with, LISTEN that will be tested in a hybrid type 1 effectiveness-implementation trial.

Electrocardiographic changes after balloon pulmonary angioplasty in chronic thromboembolic pulmonary hypertension: Data from the Hellenic Registry

BackgroundBalloon pulmonary angioplasty (BPA) has provided an effective invasive treatment for inoperable patients with chronic thromboembolic pulmonary hypertension (CTEPH). The hemodynamic improvement achieved by BPA has significantly increased the long-term prognosis of these patients, mostly by reversing the negative remodeling of the right ventricle (RV). Materials and methodsIn a cohort of 17 patients with symptomatic CTEPH hemodynamic data were collected before and after the completion of BPA sessions. After the confirmation of statistically significant hemodynamic improvement, we examined the changes in certain prespecified electrocardiographic (ECG) parameters (PR interval duration, QRS duration, QTc interval duration, R wave and S wave amplitude in lead I, R wave and S wave amplitude in precordial leads V1, V5 and V6) before the initiation and one month after the completion of BPA sessions. In addition, ECGs were qualitatively assessed before and after treatment for the presence of ECG abnormalities related to PH, proposed by the guidelines of the European Society of Cardiology (ESC). The term ESC criteria 1–6 was used for their description. ResultsStatistically significant correlation (p < 0.05) was found between the reduction in mean pulmonary artery pressure (mPAP) and the decrease of the depth of the S wave in leads I (p 0.0069), V5 (p 0.0003), V6 (p 0.0011) and in the R wave amplitude in leads V5 (p 0.0122) and V6 (p 0.0185). From the ESC criteria, RV strain pattern was the commonest in the initial cohort, with significant improvement after therapies. ConclusionHemodynamic improvement after BPA therapies is correlated with improved ECG amplitude parameters in leads I, V5 and V6. RV strain pattern is common among untreated patients with significant improvement after therapies.

Using virtual reality simulation for training practical skills in musculoskeletal wrist X-ray - A pilot study.

Using virtual reality (VR), students of radiography can practice acquisition and positioning of musculoskeletal radiographs and get immediate feedback on their performance within the simulator. The purpose of this study was to assess usability of a newly developed VR simulator and to explore self-perceived clinical readiness (SPCR) of radiography students before and after training acquisition of wrist radiographs in the VR simulator. A prospective methodology was applied where the students (n = 10) estimated their own SPCR in regard to acquisition of wrist radiographs pre- and post-VR training. A questionnaire on usability, realism, and educational value of the simulator was answered post-VR training. Usability and SPCR scores were calculated. The student's paired t-test was applied to explore the impact of VR training on SPCR. The students (90%) reported that the simulator was realistic and they thought that it could contribute to learning. The pre- and post-SPCR scores were 75 (95% confidence interval [CI]: 54-96) and 77 (95% CI: 59-95), respectively. There was no significant difference (P = 0.4574) between the pre- and post-SPCR scores. Results indicated that the concept of training acquisition and positioning of wrist radiographs in a VR simulator is feasible with positive feedback from the students. The SPCR scores improved slightly, although not statistically significant, after completion of the training session.

Can music and medicine be effective on anxiety, depression and chemotherapy-related nausea and vomiting? (PEGASUS study).

Music and medicine can be used in patients with cancer as a palliative complementary therapy. It is aimed to show the effect of music therapy performed on anxiety, depression, and chemotherapy-related nausea/vomiting. A total of 62 patients with colon cancer who previously experienced grade 1 or 2 chemotherapy-related nausea and vomiting were divided into two groups as intervention and control group based on the addition of music and medicine to infusion chemotherapies and 1:1 randomized. The groups were compared in terms of the effect of music and medicine on anxiety, depression, heart rate, blood pressure, and chemotherapy-related nausea-vomiting. Statistical analysis was done using SPSS Statistics for Windows, Version 19.0. A value of P < 0.05 was found statistically significant. The patients were evaluated in terms of study variables at the beginning and after the completion of a chemotherapy session. As a result, there was a significant decrease in systolic blood pressure (P = 0.042), diastolic blood pressure (P = 0.44), heart rate (P = 0.046), state and trait sections of the state-trait anxiety inventory scores (P = 0.047 and P = 0.046, respectively), as well as a significant decrease in anxiety degree (P = 0.036) and a significant improvement in chemotherapy-related nausea (P = 0.021) and vomiting (P = 0.038) experience in the intervention group. However, no significant effect of music and medicine on depression was detected (P = 0.218). Although it has not been shown to have an effect on depression, it was concluded that music and medicine with classical music integrated into the chemotherapy session can reduce the degree of nausea/vomiting and anxiety levels.

Smartphone-Based Wearable Gait Monitoring System Using Wireless Inertial Sensors

This paper presents a wearable virtual reality system with a wireless network of inertial sensors for lower limb monitoring. The system comprises seven sensor nodes sending data wirelessly to a master node. The information is then collected, organized, and sent to a screening device via a serial interface. An application executed either on a smartphone or a personal computer features an avatar which represents the received data and mimics the sensed movements of the patient, providing online feedback during and after the execution of a therapy. The data resulting from the therapy execution can be uploaded to a web server to facilitate the assessment and decision-making by health professionals. A pendulum featuring a rotary optical encoder is used for sensor functional behavior validation. In addition, the orientation angles measured by the proposed system are compared with respect to measurements from the motion analysis software Kinovea. The delay between the patient's body movement and the avatar is 33 ms, which is acceptable for visual feedback. This system is portable, inexpensive and enables a patient to complete physical therapy sessions at home or anywhere, with the advantage of enabling visual feedback through an avatar during rehabilitation therapy and allowing the reproduction of a therapy session for further analysis.

Feasibility of a positive psychology intervention (PATH) in allogeneic hematopoietic stem cell transplantation survivors: Randomized pilot trial design and methods

BackgroundAlthough patients undergoing allogeneic hematopoietic stem cell transplantation (HSCT) experience low levels of positive psychological well-being (PPWB), interventions that specifically boost PPWB in this population are lacking. ObjectiveTo describe the methods of a randomized controlled trial (RCT) designed to assess the feasibility, acceptability, and preliminary efficacy of a positive psychology intervention (PATH) tailored to the unique needs of HSCT survivors and aimed to decrease anxiety and depression symptoms and boost quality of life (QOL). MethodsWe will conduct a single-institution RCT of a novel nine-week phone-delivered manualized positive psychology intervention compared to usual transplant care in 70 HSCT survivors. Allogeneic HSCT survivors at 100 days post-HSCT are eligible for the study. The PATH intervention, tailored to the needs of HSCT survivors in the acute recovery phase, focuses on gratitude, strengths, and meaning. Our primary aims are to determine feasibility (e.g., session completion, rate of recruitment) and acceptability (e.g., weekly session ratings). Our secondary aim is to test the preliminary efficacy of the intervention on patient-reported outcomes (e.g., anxiety symptoms, QOL). DiscussionIf the PATH intervention is feasible, a larger randomized, controlled efficacy trial will be indicated. Additionally, we anticipate that the results from this RCT will guide the development of other clinical trials and larger efficacy studies of positive psychology interventions in vulnerable oncological populations beyond HSCT.

218-OR: Predictors of Young Adults’ (YAs) Engagement in a Type 1 Diabetes (T1D) Self-Management Intervention—The Resilient, Empowered, Active Living–Telehealth (REAL-T) Diabetes Study

Background: YAs with T1D have more complications and mental health challenges, and are less engaged in care, than other age groups. Few studies have examined factors predicting engagement in self-management interventions, which may support YAs’ T1D care and overall well-being. Methods: Using data from a T1D self-management RCT, we analyzed predictors of engagement among those randomized to the intervention who had reached the 6 month endpoint. Engagement was defined as the number of completed intervention sessions. Control variables were measured at baseline. Ordinary least-squares regression was used, entering categories of predictors in separate steps: 1) demographics: age, gender, race/ethnicity, insurance status, parental education; 2) clinical: A1c, duration of T1D, device use; 3) behavioral: medication adherence, diabetes self-management (DSMQ); 4) psychosocial: diabetes distress (DDS), self-efficacy (DES-SF), and autonomous motivation (TSRQ). Results: Participants (n=87) were 24 (±4) yrs old, 60% female, 49% Hispanic/Latinx and 43% White, and completed a mean of 9.5 intervention sessions (range: 0-24). In the final model (p=0.0003), engagement was associated with low parental education (parameter estimate -4.1 visits), being uninsured (+3.6 visits), and higher glucose monitoring (-1.1 visits) and physical activity (-0.6 visits) on the DSMQ. Discussion: Clinical and psychosocial variables were unrelated to OT visits; to an extent, poorer self-management predicted more visits. Indicators of SES were most predictive: low parental education decreased, and uninsured status increased, number of OT visits. Given that the factors most associated with engagement were indicators of SES, clinicians are encouraged to assess barriers and external factors that may impact access and participation as soon as possible in the therapeutic process, to facilitate engagement in services. Disclosure E.Pyatak: Research Support; Abbott Diabetes. J.Sideris: None. D.Fox: None. G.Granados: None. J.Diaz: None. J.Blanchard: None. A.R.Khurana: None. E.Salcedo-rodriguez: None. J.Raymond: None.

Cardiac Rehabilitation Facebook Intervention: Feasibility Randomized Controlled Trial.

The adherence to cardiac rehabilitation is low. Social media has been used to improve motivation and cardiac rehabilitation completion, but the authors did not find Facebook interventions for these purposes in the literature. The purpose of this study was to determine the feasibility of the Cardiac Rehabilitation Facebook Intervention (Chat) for affecting changes in exercise motivation and need satisfaction and adherence to cardiac rehabilitation. The Behavioral Regulation in Exercise Questionnaire-3 and Psychological Need Satisfaction for Exercise were used to measure motivation and need satisfaction (competence, autonomy, and relatedness) before and after the Chat intervention. To support need satisfaction, the intervention included educational posts, supportive posts, and interaction with peers. The feasibility measures included recruitment, engagement, and acceptability. Groups were compared using analysis of variance and Kruskal-Wallis tests. Paired t tests were used to assess motivation and need satisfaction change, and Pearson or Spearman correlations were used for continuous variables. A total of 32 participants were lost to follow-up and 22 were included in the analysis. Higher motivation at intake (relative autonomy index 0.53, 95% CI 0.14-0.78; P=.01) and change in need satisfaction-autonomy (relative autonomy index 0.61, 95% CI 0.09-0.87; P=.02) were associated with more completed sessions. No between-group differences were found. Engagement included "likes" (n=210) and "hits" (n=157). For acceptability, mean scores on a 1 (not at all) to 5 (quite a bit) Likert scale for feeling supported and in touch with providers were 4.6 and 4.4, respectively. Acceptability of the Chat group was high; however, intervention feasibility could not be determined due to the small sample size. Those with greater motivation at intake completed more sessions, indicating its importance in cardiac rehabilitation completion. Despite challenges with recruitment and engagement, important lessons were learned. ClinicalTrials.gov NCT02971813; https://clinicaltrials.gov/ct2/show/NCT02971813. RR2-10.2196/resprot.7554.

A novel non-word speech preparation task to increase stuttering frequency in experimental settings for longitudinal research

PurposeThe variable and intermittent nature of stuttering makes it difficult to consistently elicit a sufficient number of stuttered trials for longitudinal experimental research. This study tests the efficacy of using non-word pairs that phonetically mimic English words with no associated meaning, to reliably elicit balanced numbers of stuttering and fluent trials over multiple sessions. The study also evaluated the effect of non-word length on stuttering frequency, the consistency of stuttering frequency across sessions, and potential carry-over effects of increased stuttering frequency in the experimental task to conversational and reading speech after the task. MethodsTwelve adults who stutter completed multiple sessions (mean of 4.8 sessions) where they were video-recorded during pre-task reading and conversation, followed by an experimental task where they read 400 non-word pairs randomized for each session, and then a post-task reading and conversation sample. ResultsOn average, across sessions and participants, non-word pairs consistently yielded a balanced distribution of fluent (60.7%) and stuttered (39.3%) trials over five sessions. Non-word length had a positive effect on stuttering frequency. No carryover effects from experimental to post-task conversation and reading were found. ConclusionsNon-word pairs effectively and consistently elicited balanced proportions of stuttered and fluent trials. This approach can be used to gather longitudinal data to better understand the neurophysiological and behavioral correlates of stuttering.

Efficacy of an online communication skill training intervention on genetic counseling students’ performance during standardized patient sessions

ObjectiveTo examine the efficacy of a brief, online intervention designed to enhance genetic counseling students’ patient-centered communication. MethodsGenetic counseling students and recent graduates were randomized to two groups following a baseline standardized patient (SP) session: (1) immediate intervention exposure, which consisted of five modules that taught patient-centered communication skills followed by a second SP session, or (2) delayed intervention exposure following completion of the second session. Sessions were coded using the Roter Interaction Analysis System. Short-term efficacy was assessed by comparing communication during the second session between the delayed and immediate intervention exposure groups. Longer-term efficacy was assessed by comparing communication during a third session approximately five weeks later. ResultsDuring the second session, students in the immediate intervention exposure group (n = 18) used more emotionally responsive statements and were more likely to use teach-back than those in the delayed intervention exposure group (n = 23). Students’ emotionally responsive statements decreased among the immediate intervention exposure group during the third session. ConclusionExposure to the intervention was associated with multiple, positive changes to students’ patient-centered communication behavior. Practice implicationsThese time- and resource-efficient modules may be beneficial as an introduction to communication skills training or a supplement to existing training.

(432) Efficacy of Low-Intensity Shockwave Therapy on Hard Flaccid Syndrome: Initial Report of Three Cases

Abstract Introduction Hard flaccid syndrome (HFS) is characterized by chronic pain in the penis and perineum and firmness or rigidity of the penis even while not erect and may have a devastating impact on patient sexual quality of life. Although this syndrome has been discussed in myriad patient forums, there is no established evidence-based definition nor specific standard established treatment modalities in the literature. Current treatment options may include a combination of medical pain management, pelvic floor physical therapy, biofeedback, and stress reduction. In patients with other chronic pain conditions who fail traditional therapies, low-intensity shock wave therapy (LiSWT) has been increasingly utilized as management with positive response. We report a series of three patients with managed with LiSWT. Objective To report our initial experience of men with HFS managed with LiSWT. Methods Three patients, aged 36, 24, and 20 diagnosed with HFS were treated with LiSWT for a course of six sessions. In each session, LiSWT settings were: energy flux density of 0.13 mJ/mm2 and frequency of 3 Hz. While penis was held in stretched position, 600 shocks were delivered to each of the dorsum, left, ventral, and right aspects of penis along the shaft. The scrotum was then held up, and 600 shocks were delivered to each of the right and left crural areas, adding up to 3600 total number of shocks that were allocated evenly. All patients answered a questionnaire to assess improvement in symptoms after completion of the treatment sessions (Table 1). Results All patients reported initially alleviated symptoms after 3 treatment sessions, particularly with respect to penile rigidity in the flaccid state. Patient 1 elected for a combination of LiSWT and tadalafil. 5 months after treatment completion, Patient 1 has had complete resolution of HFS symptoms. Patient 2 had no response with tadalfil alone before he elected for LiSWT only, and patient 3 opted for LiSWT alone. After each LiSWT session, patient 2 reported relieved symptoms for 3-4 days, while patient 3 reported significant improvement lasting for 24 hours. Both patients 2 and 3 reported gradually returning to their pre-treatment baseline in 5 months’ follow-up. Conclusions While HFS is becoming increasingly recognized amongst sexual medicine clinicians, there are currently no established efficacious treatment options. LiSWT shows potential as a treatment modality and may have increased efficacy if used in combination with PDE5 inhibitors, as demonstrated in this pilot study. Nevertheless, a larger case series is necessary to establish LiSWT as a standardized treatment option and may require a more comprehensive approach to properly manage this condition. Disclosure Any of the authors act as a consultant, employee or shareholder of an industry for: Coloplast, Clarus Therapeutics, Antares Pharma, Acerus.

Nutrition, lifestyle, and cognitive performance in esport athletes.

Electronic sports, termed esports, is a growing athletic activity in which high levels of attention and cognitive performance are required. With its increasing popularity and competitiveness, interest in strategies to improve performance have emerged. Improving esports athlete performance, namely cognitive endurance, and resilience, may lie in nutritional or lifestyle factors. The Nutrition, Vision, and Cognition in Sport Studies (IONSport) investigated nutritional and behavioral factors that can influence cognition via 3-dimensional multiple objects tracking test (3DMOT) via Neurotracker X (NTx) software. The purpose of this study was to characterize the lifestyle of high level esports athletes with detailed nutrition, sleep, and physical activity assessments, and their association to gaming related cognitive performance. 103 male and 16 elite female esports athletes aged 16 to 35 years old completed surveys, food records, and cognitive testing sessions over 10 days. Participants were instructed to maintain their normal dietary and lifestyle habits. There were positive significant associations between average NTx scores and the following nutrients: magnesium, phosphorous, potassium, sodium, zinc, selenium, thiamin, niacin, vitamins B6 and B12, folate, cholesterol, saturated, polyunsaturated, and monounsaturated fats, omega-6 and omega-3 fatty acids, and choline. Majority of participants did not meet recommended dietary allowances (RDAs) for these micronutrients nor the recommended intakes for dairy, fruit, and vegetables. There was a significant (p = 0.003) positive (r = 0.272) association between total vegetable intake and average NTx score. There was a significant negative association (p = 0.015) with our final sustain session, which measured cognitive resilience, and the Stanford Sleepiness Scale score. Repeated measures analysis was done with these groups over the 18 core NTx sessions. There were significant (p = 0.018) differences between the two groups with those who consumed the recommended amount of protein or more performing significantly better on NTx over the 18 sessions than those that did not consume enough protein. Those who consumed the recommended intakes for riboflavin, phosphorous, vitamin B12, and selenium performed significantly better over the 18 core NTx sessions than those that did not meet the recommended amounts. The need for a nutrition intervention that is rich in protein, vitamins, and minerals is warranted in this population.