Interventions For Subpopulations Research Articles

Developing a community-engaged wheelchair exercise program for persons with MS: community advisory board formation and feedback

Purpose Exercise is a safe, evidence-based approach for improving symptoms such as mobility impairment, cognitive dysfunction, and fatigue; however, persons with multiple sclerosis (MS) who use wheelchairs for mobility have been excluded from most research. This paper describes our approach for recruiting ten community advisor board (CAB) members and partnering with them on developing a novel home-based exercise training program for wheelchair users with MS. Materials and Methods The exercise training program, which was developed based on initial qualitative research, includes a progressive exercise prescription, equipment, and one-on-one behavioural coaching based on Social Cognitive Theory. The CAB members convened in groups of five people for five meetings online, using virtual conference software. The CAB meetings each lasted approximately 1-hour and notes were transcribed into digital format for data analyses. Results Content analysis identified elements that aligned with meeting foci (i.e., prescription, equipment, coaching, and outcomes). Feedback was divided into categories to refine the program, specifically modifying, adding, or retaining content and/or activities. CAB member feedback was very positive and emphasised potential additions to the materials presented. The research team proposed implementing modifications based on the CAB member feedback such as adding wrist weights to the equipment options for completing resistance training exercises. Conclusions The overall CAB feedback was invaluable for assessing the appropriateness of the proposed exercise training program before initiating feasibility testing. This report provides a model and guidance for researchers who seek community-engaged research approaches in creating products and interventions. Implication for Rehabilitation Community advisory board participation was invaluable in creating and modifying a novel exercise training programmes for wheelchair users with multiple sclerosis (MS). The current study provides a framework for the creation of exercise interventions for subpopulations of persons with MS that may provide substantial rehabilitation benefits such as improved symptoms and quality of life. Health behaviour interventists targeting individuals with disabilities may consider the benefits of recruiting stakeholders from the community in creation of novel programmes.

Interventions for addressing trauma among people with HIV: a narrative review

ABSTRACT Traumatic experiences are disproportionately prevalent among people with HIV and adversely affect HIV-related health outcomes. As part of a national cooperative agreement funded by the Health Resources and Services Administration’s HIV/AIDS Bureau, we searched the literature for interventions designed to address trauma among people with HIV in the U.S. Our search yielded 22 articles on 14 studies that fell into five intervention categories: expressive writing, prolonged exposure therapy, coping skills, cognitive–behavioral approaches integrated with other methods, and trauma-informed care. Thematic elements among the interventions included adaptating existing interventions for subpopulations with a high burden of trauma and HIV, such as transgender women and racial/ethnic minorities; addressing comorbid substance use disorders; and implementing organization-wide trauma-informed care approaches. Few studies measured the effect of the interventions on HIV-related health outcomes. To address the intersecting epidemics of HIV and trauma, it is critical to continue developing, piloting, and evaluating trauma interventions for people with HIV, with the goal of wide-scale replication of effective interventions in HIV settings.

Sociodemographic and clinical correlates of device-measured sedentary behaviour in multiple sclerosis

Purpose This study examined sociodemographic and clinical variables as correlates of device-measured volume and pattern of sedentary behaviour in persons with multiple sclerosis (MS). Materials and methods Participants were recruited through a standardised invitation letter distributed among 1000 persons randomly selected from the North American Research Committee on MS registry. Those who volunteered wore an accelerometer for 7 d and provided sociodemographic and clinical information. Results There were 233 persons with MS who were included in the analyses. Linear regression analyses indicated that age and MS type explained significant variance in total sedentary time per day as well as number of breaks in sedentary time. Only disability status explained significant variance in sedentary bout length, whereas age explained significant variance in both number of long sedentary bouts per day. Both age and disability status explained significant variance total time spent in long sedentary bouts per day. Conclusions Persons of older age, progressive MS, and higher disability status spend prolonged, uninterrupted periods of time sedentary. Such results highlight the need for targeted interventions in sub-populations of MS that reduce time spent sedentary and break up the pattern of sedentary behaviour. Implications for Rehabilitation Sedentary behaviour is highly prevalent in multiple sclerosis and may be associated with comorbid conditions. The majority of research on sedentary behaviour in multiple sclerosis has been derived from self-report instruments that only measure the volume of sitting time per day. This study indicates that persons with multiple sclerosis spend a significant amount of time sedentary, and those who are older, have progressive multiple sclerosis, and have higher disability status spend prolonged, uninterrupted periods of time sedentary. Such results highlight the need for targeted behavioural interventions in these sub-populations of multiple sclerosis to reduce time spent sedentary and break the pattern of sedentary behaviour to manage its consequences.

A Direct Method and ICER Tables for the Estimation of the Cost-Effectiveness of Smoking Cessation Interventions in General Populations: Application to a New Cytisine Trial and Other Examples

The popularity of smoking cost-effectiveness (CE) analysis has grown rapidly. Differences in models and inputs mean results may not be comparable, and researchers may have to take them on trust because the methods are beyond their expertise and not always transparent. We describe a direct method and tables of results for researchers without specialist knowledge. We estimate the health benefit to an individual attributed to an intervention and compute tables of incremental cost-effectiveness ratios (ICERs) for interventions with varying incremental intervention effects and costs. Estimates of life years gained come from the longest epidemiological study. After discounting, adjustments are made for future cessation and relapse. The method is described in simple steps, and conservative inputs are used throughout. To look up an ICER, the user needs only to know the cost of the intervention per smoker and the effect as measured by the percentage of ex-smokers attributable to the intervention at either 6- or 12-month follow-up. Reanalysis of authoritative reports indicates that these ICERs are comparable to those from decision-analytic simulation models. Researchers can now obtain immediate estimates of the CE of interventions in general populations. The method is easily programmed in a spreadsheet. ICERs are from the payer perspective and exclude offset and societal costs. Interventions in subpopulations will require inputs specific to those populations. Readers who wish to include an adjustment for quality of life can easily do so. The tables might promote a standard approach, with interventions compared on a consistent and transparent basis.