Increase Activity Engagement Research Articles

Couples’ Cognition, Intimacy, and Activity Engagement: An Actor-Partner Interdependence Model Analysis

ABSTRACT Objectives: This study examines the actor and partner effects of cognition on activity engagement and the potential mediating role of intimate relationship in older couple dyadic context. Methods: Data for this study were obtained from heterosexual couples who participated in the 2020 wave of the Health and Retirement Study. Constructing a dyadic model of couples’ cognitions, activity engagement, and intimacy using structural equation modeling to analyze the relationship between variables and mediating effects. Results: At the actor level, cognition was positively correlated with their activity participation. At the partner level, wives’ cognition and husbands’ activity engagement were positively correlated. Husband’s cognitive score affect wife’s subjective feelings about intimacy. The mediation effect of Wife’s intimacy on the relationship between husband’s cognition and wife’s activity engagement was significant. Conclusions: In older couples, cognition influences activity engagement at a binary level, and this association is influenced by the level of intimacy. Improving intimacy can help increase activity engagement in older couples, which in turn promotes health. Clinical Implications Maintaining cognition helps older people enjoy good marriage and participation in activities. For women, the closer the partnership, the higher the frequency of participating in various activities.

Preliminary Outcomes from an Intensive Multidisciplinary Pain Program in a Veteran’s Administration Hospital: A Pilot Study

Chronic pain is a leading cause of lost productivity, disability payments, and health care utilization among the Veteran population. As such, there is interest in chronic pain treatments that address not only physical functioning and pain, but also psychological functioning and pain-related beliefs. One such treatment that has been explored is multidisciplinary team treatments. This pilot study aimed to determine whether a multidisciplinary treatment program for chronic pain would be effective in a sample of primarily rural-based Veterans. Seventy Veterans completed multidisciplinary chronic pain treatment, which consisted of 3–5 hours of pain related services per week for twelve weeks with providers from seven different disciplines. Veterans took standardized pre- and post-test measures of functioning, pain, pain-related beliefs, and mood. The program was highly acceptable and feasible to both Veterans and medical providers. Participants reported statistically significant improvements in average pain level following the intervention and improvements in pain related beliefs, pain-related catastrophizing, pain-related self-efficacy, mood symptoms and increased activity engagement. The program was highly acceptable to participants and feasible to a rural VA medical center, as evidenced by high completion rates. Future research is needed for cost-benefit analysis of the multidisciplinary program compared to less time-intensive pain related services (e.g. CBT-CP), post-intervention pain-related health care utilization, and the role of pain-related beliefs in treatment outcomes.

The Effect of Behavioral Activation on Older Adults' Engagement and Wellbeing: A Randomized Control Trial Protocol

Meaningful activity engagement in later life is widely recognized as crucial for ageing well, but age-related changes and transitions can impede such participation. A behavioral activation framework can provide a person-centred, value-consistent therapeutic approach to increasing activity engagement that is both easy to administer, cost effective and accessible to a broad audience. Although there is evidence supporting the utility of behavioral activation as a treatment for depression in older adults, this study will be the first to examine whether a behavioral activation is more effective in increasing activity engagement and psychological wellbeing among a non-clinical sample of older adults, compared to a multi component positive psychology intervention. This randomized controlled trial will examine the impact of two therapeutic approaches on activity engagement and wellbeing among older adults. One hundred and fifty adults aged 65+ who have relatively lower scores on a measure of engagement with life will be randomized to either a behavioral activation-based intervention, or a multi-component positive psychology intervention. The interventions will involve six individual weekly sessions conducted via telephone or video conference. Participants will be assessed pre-, post-intervention, and at three months follow-up. Outcome measures will include activity engagement, positive affect, and psychological wellbeing. Intra-individual variability will also be assessed via micro-longitudinal data in the behavioral activation condition. This study will be the first to provide evidence to the effectiveness of behavioral activation as an intervention to increase activity engagement and wellbeing among older adults, compared to other therapeutic approaches to increase psychological wellbeing.

The Effect of Home- and Community-Based Services on Activity Engagement

Nurses and social workers in acute care settings have unique perspectives about providing care to persons living with dementia (PLwD) who experience behavioral and psychological symptoms of dementia (BPSD). Their distinctive roles and training have important implications for the recovery and well-being of PLwDs during hospital stays. This study utilized the "rigorous and accelerated data reduction" (RADaR) technique to compare perspectives of social workers (n=12) and nurses (n=5) in a Midwestern tertiary care facility about their caring for PLwds with BPSD. Three major themes were identified: 1) patient engagement and coordination with family and professionals, 2) treatment and medical management, and 3) barriers to care. Similarities between social workers and nurses emerged within the themes, including the importance of family involvement and providing person centered care. Differences emerged particularly within the treatment and medical management theme, as nurses utilize medications to treat BPSD and social workers were more likely to use redirection. While there is distinctive training for nurses and social workers, both identified similar barriers to providing care to PLwDs with BPSD, including time constraints, competing demands, and lack of training on BPSD management. Results demonstrate how an understanding of the critical and complementary roles that nurses and social workers play in dementia care and work together to build a care team can inform best practices to support symptom management and quality of life in PLwDs. Continuing education and training could be beneficial for both professionals to improve the quality of care for PlwDs.

The Effect of Home- and Community-Based Services on Activity Engagement

This study examined the association between home- and community-based services (HCBS) and social, cognitive, and physical engagement among community-dwelling older adults in the U.S. Data were drawn from the 2012 Health and Retirement Study (HRS). The sample consisted of respondents ages 50 and over who answered questions on HCBS utilization and activity engagement (n = 567). Genetic matching and propensity score weighting were used to mimic randomized control and treatment groups, in order to estimate the population average treatment effect on the treated (PATT). HCBS utilization was found to be significantly associated with social engagement (PATT = 0.17, SE = 0.05, p < 0.05) and physical (PATT = -0.20, SE = 0.07, p < 0.05) engagement but not significantly associated with cognitive engagement (PATT = -0.04, SE = 0.12, p > 0.05). Sensitivity analyses found that the results were robust to the estimation model. These findings suggest that HCBS utilization is a promising model for increased activity engagement, and future policies aimed at targeting these outcomes are warranted.

Mood, Activity Participation, and Leisure Engagement Satisfaction (MAPLES): a randomised controlled pilot feasibility trial for low mood in acquired brain injury

BackgroundAcquired brain injury (ABI) affects approximately 79.3 million individuals annually and is linked with elevated rates of depression and low mood. Existing methods for treating depression in ABI have shown mixed efficacy. Behavioural activation (BA) is a potentially promising intervention. Its premise is that individuals with low mood avoid planning and engaging in activities due to low expectations of a positive outcome. Consequently, their exposure to positive reinforcement is reduced, exacerbating low mood. BA aims to break this cycle by encouraging activity planning and engagement. It is unknown whether cognitive demands of traditional BA may undermine efficacy in ABI. Here, we assess the feasibility and acceptability of two groups designed to increase activity engagement. In the activity planning group (traditional BA), the importance of meaningful and positive activity will be discussed and participants encouraged to plan/engage in activities in everyday life. The activity engagement group (experiential BA) instead focuses on engagement in positive experiences (crafts, games, discussion) within the group. The primary aims are to evaluate the feasibility and acceptability of the two groups in ABI. A secondary aim is to explore relative efficacy of the groups compared to an equivalent period of waitlist controls.MethodThis study outlines a parallel-arm pilot feasibility trial for individuals with low mood and ABI that compares a traditional vs experiential BA group vs waitlist controls. Adults (≥ 18 years) will be recruited from local ABI services and randomised to condition. Feasibility and acceptability will be assessed via recruitment, retention, attendance and participant feedback. Groups will be compared (pre- and post-intervention and 1 month follow-up) by assessing self-reported activity engagement. Secondary outcomes include self-report measures of depression, anxiety, post-traumatic distress related to the ABI, motivation, participation and sense of control over one’s life.Ethics and disseminationThe trial has been approved by the Health Research Authority of the NHS in the UK (East of England—Cambridge Central, REF 18/EE/0305). Results will inform future research on interventions for mood in ABI and be disseminated broadly via peer-reviewed journals, conference presentations and social media.Trial registrationClinicalTrials.gov, NCT03874650 pre-results. Protocol version 2.1, March 5, 2019

Promotion of Healthy Aging Within a Community Center Through Behavior Change: Health and Fitness Findings From the AgeWell Pilot Randomized Controlled Trial.

The purpose of this randomized controlled trial was to determine if behavior change through individual goal setting (GS) could promote healthy aging, including health and fitness benefits in older adults who attended a community "AgeWell" Center for 12 months. Seventy-five older adults were randomly allocated to either a control or a GS group. Health outcomes were measured at baseline and after 12 months of the participants' having access to the exception of Agewell Center facilities. The findings demonstrate that participation in the Center in itself was beneficial, with improved body composition and reduced cardiovascular risk in both groups (p < .05), and that this kind of community-based resource offers valuable potential for promoting protective behaviors and reducing health risk. However, a specific focus on identifying individual behavior change goals was required in order to achieve increased activity engagement (p < .05) and to bring about more substantial improvements in a range of health, diet, and physical function measures (p < .05).

Identity, civic engagement, and altruism: a phenomenological exploration of activity engagement in older adults

Background Older adults’ health and quality of life, proxies for aging well, are tied to activity engagement. Recent research indicates studying the perspective of older adults through their personal stories is key to understanding the phenomenon of occupational engagement as experienced day-to-day. Aim To uncover the lived experience of older adults within their natural settings to better understand the phenomenon of activity engagement. This new knowledge informs programming options suited to older adults’ wants and needs. Materials/methods Ten community-dwelling older adults (5 female, 5 male mean 79 years) were studied. Researchers performed phenomenological interpretive analysis (IPA) with multiple coders and member cheques to triangulate findings. Results Daily activities revolved around three themes: 1) Perspectives of self-identity are viewed as consistent throughout the lifespan; 2) Civic engagement is beneficial for social support and self-efficacy; and 3) Philosophical outlook influences activity choices and outlooks centred on altruism are critical to continued activity engagement. Seven of the ten participants expressed an overall positive outlook on aging. Three participants described a negative outlook on aging, expressed more difficulty with activity engagement, but reported desire to help others. Conclusions and significance These themes provide a basis for programming to increase activity engagement with older adults in the community.

Participation in Younger and Older Adults Post-stroke: Frequency, Importance, and Desirability of Engagement in Activities.

Purpose: To characterize and compare frequency and subjective dimensions of post-stroke participation in younger (<65) and older adults (>age 65), in social, productivity and leisure activities, 6 months post-inpatient rehabilitation. Secondary aims included exploration of demographic and clinical factors influencing desire for increased participation and comparison of two measures of participation.Methods: A prospective cohort study of people with stroke (n = 99) who were identified during their inpatient rehabilitation stay and followed-up 6 months post-discharge with telephone interviews using two self-report participation measures. The Stroke Impact Participation subscale (SIS-P) measured the frequency of perceived limitations in social, leisure, productive activities and extent of stroke recovery. The Community Participation Indicators (CPI) examined activity frequency, importance, and desire for increased activity engagement. Descriptive statistics were used to summarize demographic variables and characterize SIS-P and CPI items. Differences between age groups on individual items were examined. Associations between measures and demographic variables were explored.Results: Both groups reported a wide variation in participation restrictions that was not associated with stroke severity and weakly associated with discharge functional status (rho = 0.20–0.35). There were no significant differences between age groups in CPI frequency (for 18/19 items), or the SIS-P. However, there was a trend toward more participation restrictions on the SIS-P among those <65 (p = 0.07). Younger adults (n = 46; median age = 53) were significantly more likely to indicate that they were not doing selected activities enough on the CPI, compared with older adults (n = 56; median age = 76). While age and ethnicity were independently associated with some activities, it was not associated with other activities. The CPI and SIS-P were moderately related at a correlation of rho = 0.54, p < 0.001.Conclusion: The CPI demonstrated value and utility in examining subjective perspectives of activity importance and desire for change for people who are 6 months post-stroke. Although the CPI and SIS-P are moderately related, subjective appraisal of participation in selected individual activities (CPI) better distinguished between age groups and provided unique and distinct information from the SIS-P.

Yoga improves occupational performance, depression, and daily activities for people with chronic pain.

Chronic pain is a complex accumulation of physical, psychological, and social conditions, thus interventions that address pain and promote occupational performance are needed. A holistic intervention, with mind and body components, is likely necessary to best treat the complexities of chronic pain. Thus, we developed and tested a yoga intervention for people with chronic pain. In a randomized control trial (RCT), participants with chronic pain were randomized to a yoga intervention or usual care group. Between and within group differences for pre-and post-outcome measure scores were assessed for: occupational performance, completion of activities, and depression. Pilot RCT with participant allocation to 8 weeks of yoga or usual care. Both groups received ongoing monthly self-management programming. Data were collected before and after the 8-week intervention. Participants were randomized to yoga or usual care after baseline assessments. Demographics were collected and measures included: Canadian Occupational Performance Measure (COPM) to assess occupational performance; the 15-item Frenchay Activities Index (FAI)(activities); and the 9-item Patient Health Questionnaire (PHQ-9) for depression. Independent t-tests were used to assess differences between groups. Paired t-tests were used to assess differences between pre- and post 8-week intervention for both the yoga and the usual care groups. Percent change scores and effect sizes were calculated. 83 people were recruited for the study and completed baseline assessments; 44 individuals were randomized to yoga and 39 to the control group. The average age of all participants was 51.4±10.5 years, 68% were female; and 60% had at least some college education. There were no significant differences in demographics or outcome measures between groups at baseline or 8 weeks; however, the study was not powered to see such differences. Individuals randomized to the control group did not significantly improve in any outcome measure over the 8 weeks. There were significant improvements in COPM performance and COPM satisfaction scores for individuals randomized to the yoga group; both scores significantly improved. COPM performance improved by 27% with a moderate to large effect size (3.66±1.85 vs 4.66±1.93, p < 0.001, d = 0.76). COPM satisfaction significantly improved by 78% (2.14±2.31 vs. 3.80±2.50, p < 0.001) and had a large effects size (d = 1.02). FAI scores improved, indicating increased activity or engagement in daily occupation during the 8-week intervention. Scores increased by 5% (38.13±8.48 vs. 39.90±8.57, p = 0.024) with a small effect size (d = 0.37). Depression significantly decreased from 13.21±5.60 to 11.41±5.82, p = 0.041, with a small effect size. Data from this pilot RCT indicate yoga may be an effective therapeutic intervention with people in chronic pain to improve occupational performance, increase engagement in activities, and decrease depression. Occupational therapy practitioners may consider adding yoga as a treatment intervention to address the needs of people with pain.

A qualitative interview study comparing and contrasting resident and staff perspectives of engaging in meaningful activity in a UK care home

The provision of meaningful activities in care homes is essential for maintaining residents' mental and physical health, yet many do not get adequate opportunities to participate. This qualitative study explored resident and staff perceptions of engaging in meaningful activities in a residential care home for older people (aged over 65 years) in South London, UK. Nine residents and eleven staff members were recruited and their experiences explored through semi-structured interviews. Data were analysed thematically, and three themes emerged. (1) Appreciation of activity: both staff and residents were aware of the benefits of activity to physical and mental health, yet there was a lack of provision within the home. (2) Residents' desire for engagement: residents perceived themselves as active individuals who had previously enjoyed activities, and had goals that they wanted to achieve. This was in contrast to views of care staff, who perceived residents as inactive, lacking in motivation and sedentary due to intrinsic factors such as their age. (3) Impact of care home culture and physical space: staff and residents perceived different barriers to activity; staff reported they were often expected to take on multiple roles within the home leading to a lack of time to engage residents in activities, whilst residents perceived that the layout and design of the home hindered provision. It was concluded that comparing and contrasting views of residents and staff could assist residential homes to reach greater levels of shared understanding of activity provision and highlight particular areas to target for increasing activity engagement.

Video-Delivered Relaxation Intervention Reduces Late-Life Anxiety: A Pilot Randomized Controlled Trial

The study's aim was to demonstrate the feasibility and preliminary efficacy of a 4-week video-delivered relaxation program called Breathing, Relaxation, and Education for Anxiety Treatment in the Home Environment (BREATHE) for reducing anxiety and increasing activity engagement in older adults with anxiety disorders. This was an 8-week pilot randomized controlled trial performed as outpatient and self-directed learning at home among 40 community-dwelling adults aged 60years or older who met criteria for an anxiety disorder (generalized anxiety disorder, social anxiety disorder, panic disorder, agoraphobia, or anxiety disorder unspecified). The study looked at the BREATHE intervention compared with a wait list control condition. The primary outcome measure was anxiety symptoms (Geriatric Anxiety Scale). Secondary outcomes included activity engagement (modified Activity Card Sort), depressive symptoms (Patient Health Questionnaire), and somatic symptoms (Somatic Symptom Scale). In linear mixed-effects models, findings indicated a significant reduction in anxiety symptoms. There was no significant effect of group on activity engagement. Results also showed significant reductions in depressive and somatic symptoms associated with the BREATHE intervention compared with wait list. Our findings demonstrate feasibility and preliminary efficacy for this brief video-delivered relaxation intervention and suggest that older adults can benefit from technology-delivered interventions with minimal provider contact. Although activity engagement did not improve, lessons learned suggest that targeted coaching around activity goals may help target this outcome.

PBS Goes to Middle School: Building Capacity of Peer Buddies to Implement a PBS Intervention with Fidelity.

During adolescence, peer behavior is a strong stimulus that influences how students initiate and respond to their physical and social environment. Yet, the majority of school-based behavioral studies (Dunlap, Clarke, & Steiner, 1999) do not include peers as intervention agents. This study demonstrated how to include peers as contributing members of a Positive Behavior Support (PBS) team. Findings indicated that peers were able to implement a behavior support plan with fidelity, resulting in decreased challenging behavior and increased activity engagement in a middle school peer with Autism Spectrum Disorder (ASD).

Content Analysis of a Participant-Directed Intervention to Optimize Activity Engagement of Older Adult Cancer Survivors.

Many older adult cancer survivors reduce their activity level during and after cancer treatment. Occupational therapy interventions need to flexibly address various obstacles to occupational engagement that survivors may face. The aim of this analysis was to describe the content of a participant-directed occupational therapy intervention for older adults with cancer. Content analysis was used to describe the treatment session data from the experimental arm of a pilot randomized controlled trial in terms of activities addressed, obstacles reported, and treatment strategies utilized. Participants predominantly used the intervention to increase exercise engagement or address instrumental activities of daily living. The most common obstacles to occupational engagement included fatigue, finding time, weather, and pain. Regarding treatment strategies, 77% of participants chose to practice the activity with the occupational therapist, 42% requested a piece of equipment, and 11% modified the environment to increase activity engagement. Overall, the participant-directed intervention appears flexible enough to address various activities and obstacles to occupational engagement.

A technology-aided program for helping persons with Alzheimer’s disease perform daily activities

PurposePersons with mild and moderate Alzheimer’s disease experience increasing activity engagement failures, with consequent cognitive, social, and physical drawbacks. The purpose of this paper is to assess a technology-aided program to help these persons to independently start and carry out daily activities at the appropriate times.Design/methodology/approachThe program was implemented with eight participants according to an adapted non-concurrent multiple baseline design across participants. The program provided each participant with: timely reminders about the activities to carry out, verbal instructions about the activity steps, and brief encouragements and praise.FindingsAll participants showed improvement during the program, that is, they managed to independently start the activities at the scheduled times and perform those activities with satisfactory levels of accuracy (i.e. with mean percentages of correct steps nearing or exceeding 90).Originality/valueA technology-aided program, such as that used in this study, may help persons with mild and moderate Alzheimer disease engage in daily activities, with possible benefits for their cognitive functioning, social image, and physical condition.

Replication and extension of a check-in procedure to increase activity engagement among people with severe dementia.

Engelman, Altus, and Mathews (1999) evaluated a procedure to ensure that staff checked in with elderly residents in a nursing home and offered activity choices. We report findings of a replication, with some additional components, to increase appropriate activity engagement among 5 residents (aged 77 to 83 years) with severe dementia. Evaluated in a concurrent multiple baseline design across participants that incorporated partial withdrawal phases, activity engagement increased for 3 participants, with modest improvement for 1 other participant. The 4 responders all engaged in a wider variety of activities during intervention.

Determinants and Strategies for Physical Activity Maintenance in Chronic Health Conditions: A Qualitative Study.

Physical activity is promoted to help adults manage chronic health conditions, but evidence suggests that individuals relapse after intervention cessation. The objective of this study was to explore the determinants and strategies for successful and unsuccessful physical activity maintenance. A qualitative study using semistructured interviews was conducted with 32 participants. Purposive sampling was used to recruit 20 successful and 12 unsuccessful maintainers. Adults with chronic health conditions were recruited having completed a physical activity referral scheme 6 months before study commencement. The IPAQ and SPAQ were used to categorize participants according to physical activity status. Data were analyzed using framework analysis. Eleven main themes emerged: 1) outcome expectations, 2) experiences, 3) core values, 4) trial and error, 5) social and practical support, 6) attitudes toward physical activity, 7) environmental barriers, 8) psychological barriers, 9) physical barriers, 10) cognitive-behavioral strategies for physical activity self-management (eg, self-monitoring), and 11) condition management (eg, pacing). The findings identified determinants and strategies for successful maintenance and highlighted the processes involved in physical activity disengagement. Such findings can guide the development of physical activity maintenance interventions and increase activity engagement over the long-term in adults with chronic health conditions.

Pre-Session Satiation as a Treatment for Stereotypy During Group Activities

Individuals with developmental disabilities may engage in automatically reinforced behaviors that may interfere with learning opportunities. Manipulation of motivating operations has been shown to reduce automatically maintained behavior in some individuals. Considering behavioral indicators of satiation may assist in identifying the point at which an abolishing operation has begun to effect behavior. The purpose of this study was to evaluate the effects of pre-session satiation of automatic reinforcement on subsequent levels of stereotypy and activity engagement during group activities for three males ages 5 to 13 years with developmental disabilities. Following functional analyses with analogue conditions, an alternating treatment design compared a pre-session access to stereotypy condition with a no-pre-session access condition prior to group activity sessions. Results indicated that pre-session satiation of the putative reinforcer produced by stereotypy was effective in decreasing stereotypy and increasing activity engagement during subsequent group activities for all participants. These findings add to the literature supporting the effectiveness of abolishing operations to decrease automatically maintained stereotypy.

Pain coping and acceptance as longitudinal predictors of health‐related quality of life among people with haemophilia‐related joint pain

Interventions based on coping and acceptance can be adapted for people with different painful conditions. Evidence about baseline characteristics that predict improved outcomes is informative for matching people to interventions, whereas evidence about changes that predict improved outcomes is informative about the processes that interventions should target. Participants in a low-intensity programme to promote self-management of haemophilia-related chronic joint pain (n = 101) reported pain intensity, coping, acceptance and quality of life at baseline and 6-month follow-up. Baseline and change measures of pain intensity, coping and acceptance were used to predict follow-up quality of life, taking account of baseline quality of life. Changed (reduced) pain intensity predicted better physical quality of life, independently of age, haemophilia severity, baseline pain intensity and baseline physical quality of life. Lower baseline passive coping and changed (increased) pain acceptance predicted better mental quality of life, independently of age, severity and baseline mental quality of life. Increased activity engagement but not pain willingness predicted better mental quality of life when pain acceptance was decomposed. Changed (reduced) negative thoughts also predicted better mental quality of life when separate acceptance subscales were used. Active pain coping did not predict physical or mental quality of life. Initially high levels of passive coping may be an obstacle to improving mental quality of life. Acceptance rather than coping may be a more useful behavioural change target, but more research is needed about the meanings and therapeutic implications of different elements of pain acceptance.

Engagement in retirement: an evaluation of the effect of Active Mentoring on engagement of older adults with intellectual disability in mainstream community groups

As adults with intellectual disability age, retirement options need to be explored. One option is to attend a mainstream community group for retirees. Support within these groups could come from group members who are trained to act as mentors for the older adults with intellectual disability. This research evaluated a support training programme, Active Mentoring, which combines elements of Active Support and Co-worker Training. Three older women with intellectual disability participated in a non-concurrent multiple baseline design. Effect size analyses (Percentage of Non-overlapping Data) were used to evaluate observational data. Active Mentoring was effective in increasing most types of engagement in activities, but there was no observed effect for social engagement. Mentor help also increased. Active Mentoring was effective in eliciting support from mentors, and in increasing activity engagement of older adults with intellectual disability in mainstream community groups.