Intervention Protocol Research Articles

Effect of an oral stimulation protocol on breastfeeding among preterm infants: a randomised controlled trial

ObjectivesThe objectives are to assess the effectiveness of a modified and adapted oral sensorimotor intervention (MA-OSMI) protocol for infants in India on the rate and performance of breastfeeding among preterm...

Widely Integrated Services in Home (WISH) for homebound older adults: a study protocol for a randomized encouragement trial.

Home-based primary care (HBPC) is an emerging patient-centered, interprofessional healthcare service model that can address unmet medical needs and care burdens for homebound older adults. In December 2022, the Ministry of Health and Welfare in South Korea launched the Home-Based Medical Center Demonstration project to provide a new bundle payment for physician home visits. In this study, we seek to determine whether the recently introduced HBPC services in South Korea have been associated with a reduction in long-term care (LTC) facility admissions and acute hospitalizations among homebound older adults. The study is a community-based, multicenter, two-arm, randomized encouragement design trial with a 12-month follow-up period (n = 600). Eligible study participants are community-dwelling LTC recipients with multimorbidity and functional deterioration. Study participants are recruited from five HBPC centers located in urban areas (Northeast Seoul, West Seoul, Daejeon, Wonju, and Paju). The study participants are randomly assigned to either the HBPC group or the usual care group with a 1:1 allocation ratio. Those assigned to the HBPC group receive longitudinal home visits at least once a month by an interprofessional HBPC team according to the Widely Integrated Services in Home (WISH) intervention protocol. This protocol adheres to the Integrated Care for Older People principles, which call for a person-centered assessment and broader integration of health and LTC services at the micro-, meso- and macro-levels. Primary outcomes of the trial are 1) between-group community survival days and 2) between-group potentially avoidable hospitalizations. Results of the treatment are estimated by both modified intention-to-treat and complier average causal effect analytic methods. This study aims to investigate the real-world effectiveness of HBPC on the reduction of LTC facility admissions and acute care hospitalizations in the community setting. The findings may inform healthcare policy decisions to expand HBPC services in South Korea and other countries. CRIS KCT0007921.

Leveraging Implementation Science at the Early-Stage Development of a Novel Telehealth-Delivered Fear of Exercise Program to Understand Intervention Feasibility and Implementation Potential: Feasibility Behavioral Intervention Study.

To increase real-world adoption of effective telehealth-delivered behavioral health interventions among midlife and older adults with cardiovascular disease, incorporating implementation science (IS) methods at earlier stages of intervention development may be needed. This study aims to describe how IS can be incorporated into the design and interpretation of a study assessing the feasibility and implementation potential of a technology-delivered behavioral health intervention. We assessed the feasibility and implementation potential of a 2-session, remotely delivered, home-based behavioral intervention composed of psychoeducation, interoceptive exposure through low-to-moderate intensity walking, interoceptive counseling, and homework (Reducing Exercise Sensitivity with Exposure Training; RESET) among patients with recent acute coronary syndrome (ACS) and some fear of exercise. To assess intervention feasibility, we measured patient protocol adherence, intervention delivery fidelity, and completion of intervention outcome assessments using direct observations, fidelity checklists, surveys, and device-measured physical activity. To assess implementation potential, we measured implementation outcomes (feasibility, acceptability, and appropriateness) using 4-item measures, each rated from the patient perspective on a 1 to 5 Likert scale (1=completely disagree and 5=completely agree; criteria: ≥4=agree or completely agree), and patient-perceived implementation determinants and design feedback using survey and interview data. Interview data underwent thematic analysis to identify implementation determinant themes, which were then categorized into Consolidated Framework for Implementation Research (CFIR) domains and constructs. Of 31 patients approached during recruitment, 3 (10%) were eligible, enrolled, and completed the study (mean age 46.3, SD 14.0 y; 2/3, 67% male; 1/3, 33% Black; and 1/3, 33% Asian). The intervention was delivered with fidelity for all participants, and all participants completed the entire intervention protocol and outcome assessments. On average, participants agreed that the RESET intervention was feasible and acceptable, while appropriateness ratings did not meet implementation criteria (feasibility: mean 4.2, SD 0.4; acceptability: mean 4.3, SD 0.7; and appropriateness: mean 3.7, SD 0.4). Key patient-perceived implementation determinants were related to constructs in the innovation (design, adaptability, and complexity), inner setting (available resources [physical space, funding, materials, and equipment] and access to knowledge and information), and innovation recipient characteristics (motivation, capability, opportunity, and need) domains of the CFIR, with key barriers related to innovation design. Design feedback indicated that the areas requiring the most revisions were the interoceptive exposure design and the virtual delivery modality, and reasons why included low dose and poor usability. The RESET intervention was feasible but not implementable in a small sample of patients with ACS. Our theory-informed, mixed methods approach aided our understanding of what, how, and why RESET was not perceived as implementable; this information will guide intervention refinement. This study demonstrated how integrating IS methods early in intervention development can guide decisions regarding readiness to advance interventions along the translational research pipeline.

Suicide prevention via telemental health services: insights from a randomized control trial of crisis response plan and self-guided safety planning approaches.

Although telemental health can make suicide prevention treatments more scalable and accessible, limited evidence demonstrates successful reductions in suicidality when interventions are administered through telehealth platforms. To address this limitation, the current work investigated the effects of two suicide prevention treatments - a clinician-guided Crisis Response Plan and a self-guided Safety Planning approach. After completing the screening process, 82 participants with high suicide ideation and/or a lifetime history of suicidal behavior were randomly assigned across the two groups. Trained research clinicians administered the interventions using a videoconferencing platform. After the intervention delivery was complete, participants reported the therapeutic alliance they experienced with their clinician using an online survey. Participants also reported their overall suicidality 45 days after receiving the intervention. In addition, participants' perceived usefulness of the received intervention and actual use of the plan were recorded. Linear and logistic regression models predicted how suicidality, perceived utility, and actual use of their intervention protocols varied depending on the high (Crisis Response Plan) versus low (self-guided Safety Planning) level of clinician-led collaboration the two treatments entailed. Both Crisis Response Plan and self-guided Safety Planning were found to lower suicidality after receiving them via telehealth services. At the same time, those who received the Crisis Response Plan (the more collaborative form of therapy) reported experiencing a stronger therapeutic alliance with the clinician, utilizing the plan more often and perceiving it as more useful. These findings demonstrate the additional benefits of adopting a more collaborative approach because of its effectiveness and perceived utility, which has implications for suicide-related distress reduction in the short and long term. Evidence from this randomized control trial suggests that Crisis Response Plan is a suitable candidate for delivering suicide prevention via telehealth platform because of its effectiveness in reducing suicidality and its collaborative approach to building a strong therapeutic alliance, perceived usefulness, and actual utility in everyday life. This paper was part of a registered RCT: https://clinicaltrials.gov/study/NCT04888845 . Registration date: Date: 2021-04-22.

Case report: Multicomponent intervention for severe food selectivity in autism spectrum disorder: a single case study

Food selectivity is common in children with Autism Spectrum Disorder (ASD). The treatment used can be invasive and difficult to implement, necessitating the exploration of multicomponent approaches. This study presents the case of a 9-year-old autistic girl with severe food selectivity, who ate exclusively liquid and semi-solid foods. A multicomponent intervention protocol was developed, including stimulus fading and positive reinforcement techniques, to increase acceptance of new textures and foods. Treatment sessions showed significant improvement in acceptance of semi-solid and novel foods, with a reduction in problem behaviors associated with mealtime. This study suggests that a multicomponent intervention can significantly improve food acceptance and reduce mealtime distress, proving to be a practical and effective treatment strategy in an autistic child. The intervention led to an increase in food acceptance and a reduction in mealtime-related distress, potentially improving the child and family’s quality of life.

Voluntary musical imagery in music practice: contextual meaning, neuroscientific mechanisms and practical applications

Practice is acknowledged as a crucial facilitator for musicians to achieve performance excellence. Despite the rich literature on incorporating musical imagery intentionally to improve one’s practice efficacy, limitations remain in the understanding of voluntary musical imagery (VMI) in the context of musical practice. Therefore, our aims in this review are threefold. First, we enriched the interpretation of VMI in the context of music practice through the lens of embodied cognition. Second, we integrated neuroscientific findings to elucidate how the deliberate use of musical imagery parallels physical practice in effectiveness. Third, we synthesize work on the application of VMI in enhancing musical learning from both theoretical and practical perspectives. By providing an integrated overview of voluntary musical imagery, we highlight gaps in the literature and encourage further research on (1) the impact of embodied experiences on VMI formation, (2) optimal imagery content and ratio combination to establish a personalized intervention protocol for more effective musical pedagogy, and (3) on physiological measures to access VMI effectiveness. Additionally, we highlight the crucial implications of VMI for researchers, performers, and music educators.

Technology-Based Interventions for Autism Spectrum Disorder: A Systematic Review

Introduction: Autism Spectrum Disorder (ASD) is a neurodevelopmental disorder characterized by deficits in social communication and repetitive behaviors. Its prevalence has steadily increased, with the CDC reporting a rise from 1 in 100 children in 2006 to 1 in 44 in the United States by 2021. ASD manifests in a spectrum of symptoms, requiring tailored interventions to address each child's unique needs. Recent advancements in technology have shown promise in aiding children with ASD, particularly through robotics and socially assistive robots (SARs). This systematic review explores the impact of technology-based interventions on children with ASD, assessing their efficacy in enhancing social skills, communication, and behavior regulation. Methodology: This review followed PRISMA guidelines, screening 46,580 articles across databases such as PubMed, Cochrane, Science Direct, Google Scholar, and PsychInfo. After applying inclusion and exclusion criteria, 254 studies were selected for in-depth review. The review focused on technology-based interventions, including robotics and socially assistive robots, with MeSH terms such as "Technology," "Artificial Intelligence," "Autism Spectrum Disorder," and "ASD." Results: Technology-based interventions, particularly SARs, demonstrated significant improvements in social interaction, emotional regulation, and communication for children with ASD. Robots such as LEGO Mindstorms and "Kaspar" were effective in enhancing eye contact, cooperation, and emotional recognition. However, results varied depending on the type of technology used, study design, and participant characteristics. Conclusion: While technology-based interventions hold promise for children with ASD, further research is needed to standardize intervention protocols, dosage, and long-term outcomes. These tools offer a non-invasive, scalable solution for enhancing social and cognitive skills, but variability in study designs limits definitive conclusions. Keywords: Autism Spectrum Disorder, Technology, Robotics, Socially Assistive Robots, Communication, Cognitive Skills, Applied Behavioral Analysis

Effect of Alternate Nostril Breathing Exercise on Cardiorespiratory Functions in Hypertensive Adults: A Systematic Review

Background: Cardiovascular diseases (CVDs), primarily driven by hypertension (HTN), are a leading global health concern. While medication is commonly used to manage HTN, non-pharmacological approaches like ANB are gaining interest. ANB is a yogic breathing technique believed to modulate the autonomic nervous system, influencing heart rate and blood pressure. Methods: A systematic review adhering to PRISMA guidelines assessed studies published between 2015 and 2022 that investigated the effects of ANB on blood pressure in human subjects. Results: Six studies were included, with findings suggesting a potential benefit of ANB for reducing blood pressure. All studies, except one, reported significant reductions in systolic and/or diastolic blood pressure after ANB practice. Intervention duration varied across studies, ranging from single sessions to six weeks of daily practice. Some studies also observed a decrease in heart rate and improved vascular function following ANB. However, limitations exist: unclear control groups in some studies and varying intervention protocols. Discussion: Despite promising preliminary evidence, further well-designed, randomized controlled trials with larger sample sizes and standardized protocols are needed. Future research should compare ANB with sham interventions or standard medical management, and explore the underlying mechanisms of how ANB might influence blood pressure. Conclusion: While the current evidence requires further confirmation, ANB appears to be a safe and potentially beneficial non-pharmacological intervention for managing blood pressure, potentially as an adjunct to medication. Healthcare professionals may consider suggesting ANB to hypertensive patients, alongside lifestyle modifications and medication, but emphasize the importance of consulting a healthcare provider before starting any new practice.

The Future of Artificial Intelligence and Genetic Insights in Precision Cardiovascular Medicine: A Comprehensive Review

Abstract A medical condition called cardiovascular disease (CVD) affects the heart or blood vessels, and about 40% of its causes can be attributed to genetic factors. The pathophysiology of CVD is still unknown despite numerous studies identifying important environmental and genetic factors. Genetic data research has significantly increased due to the application of genome-wide association studies. The utilization of artificial intelligence (AI) technology demonstrates clear advantages in managing intricate projects, outperforming traditional statistical methods in processing such data. The use of AI in the status of genetic research on CVD and medicine is briefly reviewed in the opening section of this article. Then, it gives a complete picture of how AI is used in genetic CVD research, including genetic data-driven diagnosis and prognosis, genetic variation analysis, gene expression profiles, gene interactions, and analysis of genes using knowledge bases. Even though much research has yielded significant findings, it is still early. The main disadvantages are database limitations, the underuse of AI in systematic biology analysis, and the lack of a theoretical framework for interpreting analysis results. The paper concludes with future directions and the significance of creating comprehensive, high-quality, large-sample-size data-sharing resources. Much research is going into how to use AI analysis techniques to help with development. Being creative with computers can help make new CVD intervention protocols and develop and test theoretical models.

O IMPACTO DO PILATES NO TRATAMENTO DA FIBROMIALGIA

Fibromyalgia is a chronic syndrome that causes diffuse muscle pain and increased sensitivity in specific points on the body. It mainly affects women between the ages of 30 and 60, but can occur in men and at younger ages. Symptoms include chronic pain, fatigue, sleep disturbances and cognitive difficulties. Pilates is adaptable to different populations and health conditions and can be customized to meet individual needs. This adaptability makes Pilates a versatile and inclusive therapeutic option, suitable for rehabilitation and health promotion programs. The objective, therefore, was to investigate the impact of the Pilates method in the treatment of fibromyalgia, evaluating its effects on reducing pain, improving physical function and quality of life for patients. Methodologically, a systematic review of the literature was incorporated, with a search for articles carried out in the PubMed and Google Scholar databases, starting from a period of 5 years (2019-2024). It was concluded, based on the available evidence, that Pilates can be considered as a complementary treatment option for patients with fibromyalgia. It is recommended that healthcare professionals consider including Pilates in multidisciplinary treatment programs for fibromyalgia, adapting intervention protocols as necessary to meet each patient’s specific needs. Even more so, the implementation of Pilates programs supervised by qualified professionals can guarantee the safety and effectiveness of this therapeutic intervention for patients with fibromyalgia.

Associations among psychological health problems, intimate-relationship problems, and suicidal ideation among United States Air Force active-duty personnel

ABSTRACT Linkages among psychological health problems, intimate relationship distress, and suicide risk have been widely studied, but less is known about how these factors interact, especially in military populations. With steady increases in suicide rates among active military and post-service members (SMs), it is critical to better understand the relation among known risk factors. The current study addresses this gap by testing a model hypothesizing that the association between intimate-relationship problems and suicidal ideation is mediated by individual mental health symptoms. We tested this model on a sample of 862 active-duty Air Force members in committed relationships. The sample consisted of 35.0% women and 64.8% men, with an average age of 21.9 years and a mean relationship length of 2.8 years. Findings supported the hypothesized statistical mediation model. Results indicated that relationship problems contribute to psychological health problems, which, in turn, are related to suicidal ideation. These findings may help direct suicide intervention and prevention protocols that consider intimate relationship distress as a significant risk factor. Limitations and further implications for policies regarding suicide prevention in the armed forces are discussed.

The efficacy of cognitive stimulation, cognitive training, and cognitive rehabilitation for people living with dementia: a systematic review and meta-analysis.

Cognition-oriented treatments (COTs) are a group of non-pharmacological treatments aimed at maintaining or improving cognitive functioning. Specific recommendations on the use of these interventions in people living with dementia (PLwD) are included in the Italian Guideline on the Diagnosis and Treatment of Dementia and Mild Cognitive Impairment, developed by the Italian National Institute of Health. This systematic review and meta-analysis, based on the GRADE methodology, is part of the guideline. Considered outcomes included the cognitive functions, quality of life, and functional abilities of PLwD, taking into account disease severity, modality and system of delivery, and form of the intervention. The effectiveness of these interventions on caregivers' outcomes was also assessed. Both group and individual cognitive stimulation were reported as effective in supporting cognitive functions in PLwD at any degree of severity. Individual cognitive training and group cognitive training were reported as effective in improving global cognitive functions in people with mild dementia. Cognitive rehabilitation appeared to be effective only in improving the functional abilities of people with mild dementia. Cognitive rehabilitation appeared to be the most effective in improving caregivers' outcomes, with results suggesting a reduction in care burden. The observed differences in the effectiveness of these interventions in people with different disease severity can be explained by the intrinsic characteristics of each intervention. Despite the large number of available studies, a high clinical, statistical, and methodological heterogeneity was observed. More methodologically rigorous studies are needed to clarify the effectiveness of each protocol and modality of intervention.

The effectiveness and safety of botulinum toxin injections for managing motor disorders of patients with Parkinson's disease: A meta-analysis of randomized controlled trials.

This study aimed to assess the effectiveness and safety of botulinum toxin (BTX) injections for managing motor disorders in patients with Parkinson's disease (PD). An electronic search was conducted based on Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Data from available randomized controlled trials (RCTs) assessing BTX injections for motor disorders in PD patients were extracted for meta-analysis. Ultimately, 215 patients from eight RCTs were enrolled. Pooled analyses indicated that BTX was more effective than placebo in improving tremor (standardized mean difference [SMD] = 0.96, 95% CI [0.34, 1.58], p < 0.01), whereas no notable differences were observed between BTX and placebo regarding freezing of gait (SMD = 0.66, 95% CI [-0.26, 1.58], p = 0.162), United Parkinson's Disease Rate Scale (UPDRS) III score (SMD = -0.20, 95% CI [-1.17, 0.76], p = 0.68) and clinical global impression (CGI) score (SMD = 0.84, 95% CI [-0.74, 2.42], p = 0.298). Adverse events related to BTX injections were comparable to placebo (OR = 1.74, 95% CI [0.59, 5.14], p = 0.32). The current evidence suggests that BTX is effective and safe in treating PD tremor but fails to provide therapeutic benefits for freezing of gait and motor functional scores in PD patients. Furthermore, the limited number of included studies and heterogeneity in BTX intervention protocols suggest more research is needed, with additional standardized RCTs, to better understand and optimize BTX injections for motor disorders in PD.

Frequency of Asymptomatic Spontaneous Bacterial Peritonitis in Patients with Chronic Liver Disease and Ascites

Chronic liver disease (CLD) contributes significantly to morbidity and mortality around the world. In Pakistan, it is due mainly to infections of Hepatitis B and C. One of the complications of CLD, which is often important for such patients, involves an infection of spontaneous bacterial peritonitis. Asymptomatic spontaneous bacterial peritonitis commonly develops in asymptomatic patients with ascites and is therefore preventable when it develops early. This study will determine the incidence of asymptomatic SBP in patients with CLD and ascites, providing potentially valuable data to support screening protocols for early intervention and improved outcomes. It was a cross-sectional study carried out for six months in the Gastroenterology Department of Sheikh Zayed Hospital, Lahore. A total of 121 CLD patients with ascites, meeting particular inclusion criteria, were assessed. The cases were categorized as asymptomatic SBP if the cultures were positive with more than 10⁵ colonies or more than 250/mm³ polymorphonuclear cells, without fever, pain, or tenderness. The patients were stratified according to age, gender, and Child-Pugh classification. The data were analyzed using SPSS version 24, along with the Chi-square test for correlation between the Child-Pugh class and SBP.The proportion of asymptomatic SBP was at 14.8 % among 121 patients. The patients were older: 66.1%, were mostly more than 50 years old, with a fair sex distribution ratio of 52.1 females against 47.9 males. Patients classified into Child-Pugh Class C constituted the highest proportions of patients with SBP cases of 14.8 % and significant association at p=0.000. Asymptomatic SBP in 14.8% of the patients with CLD and ascites forms the justification for routine screening on hospital admission. Critical importance is placed on detecting asymptomatic SBP because this leads to earlier intervention and a potential reduction in the risk of major complications, particularly in patients classified as Child Class C. Keywords- Frequency, Asymptomatic, Spontaneous Bacterial Peritonitis, Patients Chronic Liver Disease, Ascites

Effectiveness of a Need-based Interventional Tracheostomy Care Protocol on Knowledge and Practice of Tracheostomy Care among Nurses

Effectiveness of a Need-based Interventional Tracheostomy Care Protocol on Knowledge and Practice of Tracheostomy Care among Nurses

Impact of caregiving stressors on elder abuse—examining the mediating role of caregiver coping strategies

Objectives Based on the Caregiving Stress Theory and Cognitive Theory of Stress and Coping, this study examined whether increase in caregiving stressors had an impact on subsequent increase in different forms of elder abuse. Additionally, this study evaluated how these relationships were influenced by caregiver (CG) coping strategies. Method A group of 800 Chinese primary family CGs and their care recipients (CRs) with mild cognitive impairment or mild-to-moderate dementia were analyzed. Participatory dyads were assessed and followed for 2 years. Structural Equation Models were used to test the associations among caregiving stressors, CG coping strategies, and elder abuse. Results Increase in caregiving stressors (ie CR decreased cognitive function, neuropsychiatric symptoms, and functional impairment) significantly increased the level of subsequent physical abuse, psychological abuse, and neglect. In addition, the associations between caregiving stressors and different forms of elder abuse as stated above was mediated by CG dysfunctional coping strategies. Conclusion This study highlights the varying impact of caregiving stressors on different types of elder abuse and emphasizes the role of CG coping strategies in mediating these relationships. The findings provide valuable insights for the development of intervention protocols targeting both caregiving stressors and CG coping strategies to prevent elder abuse.

Implementing acceptance and commitment therapy for adherence to antiretroviral therapy: a randomized study

The objective of the research was to evaluate the effectiveness of ACT in optimizing adherence to ART. A quantitative study was conducted with a Solomon experimental design and follow-up. The sample comprised 84 seropositive patients randomly selected and distributed into four groups, two experimental and two controls. Symptoms of anxiety and depression (Hospital Anxiety and Depression Scale), level of treatment adherence (Questionnaire for Adherence to Treatment for HIV / AIDS) and experiential avoidance (Acceptance and Action Questionnaire) were measured. An ACT-based group intervention protocol was applied to the experimental groups, consisting of eight sessions. The results showed negative correlation between adherence and experiential avoidance, anxiety and depression. They also showed positive effects of ACT-based intervention on adherence to ART, with increase in adherence in the experimental groups and statistical difference in adherence in comparison with the control groups, according to the ANOVA test. It is concluded conclude that ACT is effective in optimising adherence to ART, allowing for behavioural changes that promote adaptation to diagnosis and treatment and reducing the presence of avoidance behaviours and emotional involvement.

Spondylolysis in Adolescent Athletes: A Descriptive Study of 533 Patients.

The objective of this descriptive study was to evaluate spondylolysis in adolescent athletes, including age at time of injury, sport associated with injury, examination findings, site of injury, studies used for diagnosis, treatments, duration of treatment, and outcomes. This was a retrospective chart review of patients who presented with a diagnosis of spondylolysis over a 17-year period. Community primary care sports medicine practice. All patients between 10 and 20 years of age diagnosed with spondylolysis. There was no set intervention protocol. A variety of interventions and combination of interventions were used and determined by the treating physician on a case-by-case basis. Clearance for return to sport activity. Males comprised 317 of the 533 patients. Soccer, gymnastics/cheer, football, and basketball were the most common sports associated with spondylolysis. Bilateral injuries were most common. L5 was the most common level for injury. Bracing and formal physical therapy as treatments were associated with longer duration of care. Most patients were treated successfully with nonoperative treatment. Recurrence of injury was rare. Spondylolysis is a common cause of back pain in adolescent athletes. Males are more likely to experience these injuries and are older at presentation compared than females. Spondylosis may be encountered in many sports. Nonoperative treatment leads to successful outcomes in most patients.

Combined exercise Intervention protocol validation in sedentary workers health risk with Nonspecific Chronic low back pain People

Background: Most chronic low back pain is nonspecific as the cause of the pain is unknown. Hence exercise protocol focussing on one area of fitness is not appropriate. A general exercise programme that combines muscular strength, flexibility and aerobic fitness would benefit the rehabilitation of Nonspecific Chronic Low Back Pain and its health risk. The present study aimed to validate the content of the combined exercise intervention protocol. Methods: The development and expert judgement stages are part of the content validation process. The development of the exercise protocol was based on a comprehensive literature review. The protocol was created in a step-by-step progressive manner. Exercises for flexibility (20 minutes), stabilisation and strengthening (20 minutes), and aerobic (20 minutes) make up the three main parts of the exercise protocol. 12 independent professionals with a minimum of 10 years of experience were invited. Ten of the twelve specialists consented to take part in the study. In India, all of the professionals were engaged in orthopaedic and musculoskeletal physical therapy. There are two professors, three associate professors, and five senior physiotherapists among the experts. Responses were gathered by mail. During the validation phase, The Exercise protocol was graded by the experts on relevance and ease of performance using a 5-point scale. After collecting the responses content validity index and kappa values were calculated. Results: 37 out of 39 items in the combined exercise intervention protocol showed good agreement. Treadmill walking with 60-75% and 80% and above target heart rate showed a kappa value of 0.66 for relevance and 0.50 for ease of performance. Conclusions: The designed exercise protocol exhibited good content validity.

Introduction to Adaptive Sports: An Intervention Protocol for Youth

Certified therapeutic recreation specialists (CTRS®s) within pediatric rehabilitation inpatient (PR-I) units use a variety of treatment modalities. One such modality is adaptive sports. Positive emotions that can be generated when participating in an adaptive sports activity include enjoyment and gratification. CTRSs are able to provide youth in the PR-I unit with a unique experience that teaches them about adaptive sports while introducing a potential new leisure pursuit. Thus, the Introduction to Adaptive Sports program was developed with the intent of documenting youths' knowledge related to adaptive sports following brief exposure, their enjoyment of ac-tivities associated with four different adaptive sports, and their interest in future participation. The youth involved in the piloting of this protocol were asked to complete a Knowledge and Future Participation Quiz as well as an Enjoyment Scale to measure their level of knowledge about each adaptive sport presented, how much they enjoyed participating in each ses-sion, and if they would be interested in future participation. The results showed that the youth demonstrated strong knowledge about each adaptive sport (average scores of 5.06 out of 6). The scores on the Enjoyment Scale indicated that youth on the PR-I unit enjoyed the adaptive sports sessions (average scores of 8.38 out of 10). Addition-ally, participant responses indicated 78.13% overall interest in future participation in the four presented adaptive sports. Though the preliminary results from the trial of this protocol are encouraging, recommendations for revision and future study by CTRS professionals on PR-I units are included.