Contingency Management to Induce Exercise Among College Students

2013 ◽  
Vol 30 (2) ◽  
pp. 84-95 ◽  
Author(s):  
Jessica G. Irons ◽  
Derek A. Pope ◽  
Allyson E. Pierce ◽  
Ryan A. Van Patten ◽  
Brantley P. Jarvis
Keyword(s):  
Undergraduate Students ◽  
External Validity ◽  
Contingency Management ◽  
Multiple Baseline ◽  
Activity Levels ◽  
Post Intervention ◽  
Baseline Phase ◽  
Changing Criterion ◽  
Subsequent Intervention

Objective: The effects of contingency management to induce physical activity levels were examined in seven non-obese physically inactive undergraduate students by providing monetary payments using a multiple baseline, changing-criterion procedure. Methods: Participants attended a baseline phase, a subsequent intervention phase consisting of three exercise sessions per week for 4 weeks, and a follow-up session 2 weeks post intervention. A total of $145 was available for attendance and exercise contingency payments. Results: Results indicate that all participants significantly increased exercise during intervention from inactivity at baseline to exercising three 30-minute sessions per week. Participants maintained some gains during follow-up. Limitations: The study employed a small and homogenous sample size and required participants to exercise in a lab setting thus limiting external validity. Conclusions: These findings suggest that incentive-based interventions are an effective and viable means for inducing exercise.

scholarly journals 0695 Sleepwell24, A Smartphone Application To Promote PAP Therapy Adherence: Feasibility And Acceptability

SLEEP ◽  
2020 ◽  
Vol 43 (Supplement_1) ◽  
pp. A265-A265
Author(s):  
M E Petrov ◽  
K Hasanaj ◽  
C M Hoffmann ◽  
D R Epstein ◽  
L Krahn ◽  
...  
Keyword(s):  
Real Time ◽  
Smartphone Application ◽  
Sleep Medicine ◽  
Retention Rates ◽  
Activity Levels ◽  
Post Intervention ◽  
Personal Technology ◽  
Lost To Follow Up ◽  
First Time

Abstract Introduction We aimed to test the feasibility and acceptability of SleepWell24, a multicomponent, smartphone-delivered intervention to increase positive airway pressure (PAP) adherence among newly diagnosed OSA patients. Methods SleepWell24 targets PAP adherence along with other health behaviors through education, trouble-shooting, goal-setting, and near real-time biofeedback of PAP machine use, and sleep and physical activity levels (via Fitbit integration), and other chronic disease self-management components. Patients with a first-time diagnosis of OSA (AHI≥5) and prescribed PAP therapy were enrolled from the Centers for Sleep Medicine at Mayo Clinic in Rochester, MN and Phoenix, AZ. Patients were randomized to SleepWell24 or usual care (UC) and assessed for PAP use over 60 consecutive nights. UC patients received a Fitbit monitor to control for non-specific intervention effects related to the introduction of a new personal technology. Feasibility was assessed with recruitment and retention rates and acceptability was assessed post-intervention with the validated, 8-item Treatment Evaluation Questionnaire (TEQ; range:0-4). ANCOVA models, adjusting for age, sex, and AHI severity, compared intervention arms on acceptability ratings. Results OSA patients were consented and randomized (N=111). Before the intervention began 4 participants withdrew, 12 were lost to follow-up, and 5 could not start the trial due to durable medical equipment (DME) vendor barriers. Ninety OSA patients (n=41 SleepWell24, n=49 UC; age M±SD=57.2±12.2; 44.4% female, 61.1% AHI≥15) started the intervention, with 2 participants withdrawing, 1 becoming deceased (unrelated to treatment) and 7 with missing PAP data due to DME vendor barriers. There was no significant between-groups differences on post-treatment acceptability (SleepWell24 M±SD=2.7±1.1 vs. UC M±SD=3.1±0.9, F[1,73]=2.3, p=0.11), and 77% of SleepWell24 participants found the app to be moderately to totally acceptable. Conclusion Overall, SleepWell24 was found to be feasible for delivery in two large clinical sleep medicine centers, and patients found the app to be acceptable. A number of challenges in trial delivery were encountered that have implications for scaled-up efficacy testing: (a) partnerships with DME vendors for near real-time PAP data integration; (b) alignment with clinical practice (i.e., referral, medical record integration); and (c) patient engagement. Support National Institute of Nursing Research / National Institutes of Health: R21NR016046

“Hey Dad, Watch Me”: The Effects of Training a Child to Teach Pain Management Skills to a Parent With Recurrent Headaches

1993 ◽  
Vol 10 (4) ◽  
pp. 237-243 ◽  
Author(s):  
Grant J. Devilly ◽  
Matthew R. Sanders
Keyword(s):  
Pain Management ◽  
Relaxation Training ◽  
Contingency Management ◽  
Self Report ◽  
Multiple Baseline ◽  
Treatment Intervention ◽  
Management Skills ◽  
Cognitive Behavioural ◽  
Self Talk

This study examines the efficacy of a cognitive-behavioural program for recurrent headaches which was first implemented with an 8-year-old boy suffering from headaches. The child was subsequently trained to implement the same intervention with his father who also suffered from headaches. The treatment involved pain management skills, such as relaxation training, imagery, positive self-talk, and distraction techniques. In addition, a parent contingency management component involving the mother was employed. The treatment intervention was sequentially introduced to the child and father in a nonconcurrent multiple-baseline across-subjects design. Headache diaries and self-report measures were completed by both clients. From pre- to posttreatment there was respectively a 92.5% and 86.7% improvement in headache frequency, a 67% and 85% improvement in mean headache intensity and a 89.44% and 28% improvement in headache duration. Three-month follow-up data showed that both subjects had 100% improvement rates on all headache measures. The results highlight that some children can successfully teach their parents pain management skills. Possible implications of the results for the treatment of families, where multiple family members suffer from pain, are discussed.

Modifying Bedtime Disruptions in Children using Stimulus Control and Contingency Management Techniques

1984 ◽  
Vol 12 (2) ◽  
pp. 130-141 ◽  
Author(s):  
Matthew R. Sanders ◽  
Bill Bor ◽  
Mark Dadds
Keyword(s):  
Side Effects ◽  
Stimulus Control ◽  
Contingency Management ◽  
Management Program ◽  
Multiple Baseline ◽  
Negative Side ◽  
Management Procedures ◽  
Management Techniques ◽  
Negative Side Effects

The present study examined the effect of a bedtime management programme which incorporated both stimulus control and contingency management procedures on the level of bedtime disruption in children. Using a multiple baseline across subjects design each of four children (ranging in age from 2–5 years) were sequentially introduced to the treatment program, which was implemented by the child's parents each night. In addition the study sought to determine whether direct treatment of bedtime disruption would be associated with any negative side effects. Systematic observational data revealed that the Bedtime Management Program was effective in reducing bedtime disruptions in all subjects and the improvements sustained during a 2-month follow-up. No evidence suggests that treatment resulted in negative side effects. The implications of the results for behavioural parent training are discussed.

Effects of a Brief Behavioural Activation Treatment on Activities of Various Difficulty and Depression

2010 ◽  
Vol 27 (3) ◽  
pp. 184-197 ◽  
Author(s):  
Debra L. Bailey ◽  
Lucius Arco
Keyword(s):  
Depressive Symptoms ◽  
Depressive Symptomatology ◽  
Early Initiation ◽  
Multiple Baseline ◽  
Activity Levels ◽  
Behavioural Activation ◽  
Baseline Study ◽  
Difficult Sequence ◽  
The Relationship

AbstractThis study examined, first, effectiveness of a brief behavioural activation treatment for depression, in which participants engaged concurrently in activities of various difficulty instead of a standard least-to-most difficult sequence; and second, the relationship between behavioural self-observations of changes in activity levels and depressive symptomatology. Two adults with mild to moderate BDI-II depressive symptoms participated in a with-in participant multiple baseline study that contained 8 weekly conjoint sessions. Results showed that depression decreased to minimal levels at posttreatment and 1-month follow-up as a function of increases in activities of various difficulty. Results suggest early initiation of more difficult activities, and corroborate the relationship between increased activities and decreased depressive symptoms.

scholarly journals Protocol Based Standardized Endocrinological Evaluation of Children With Traumatic Brain Injury: A QI Initiative

2021 ◽  
Vol 5 (Supplement_1) ◽  
pp. A491-A492
Author(s):  
Jayalakshmi Narayan Bhat ◽  
Ricardo Gomez ◽  
Scott Schultz
Keyword(s):  
Traumatic Brain Injury ◽  
Brain Injury ◽  
Data Collection ◽  
Prevalence Rate ◽  
Motor Vehicle ◽  
Adherence Rate ◽  
Endocrine Dysfunction ◽  
Post Intervention ◽  
Baseline Phase

Abstract Introduction: Traumatic brain injury (TBI) can disrupt the hypothalamo-pituitary axis, causing central neuroendocrine dysfunction and hormone abnormalities (HPAD). As one-third of children can develop post-traumatic HPAD, a longitudinal and thorough follow up may be required to exclude the transient or late-onset HPAD. Objective: To implement a protocol for standardized evaluation of children with TBI for the diagnosis of HPAD and to effectively establish a regular inpatient endocrine consultation and outpatient longitudinal follow up. Method: The study was divided into pre-QI (baseline phase) and QI phase (post-intervention phase). During the pre-QI phase, retrospective data were collected on children admitted with TBI at our institution for 1 year. The prevalence of HPAD and the percentage of children longitudinally followed in endocrine clinic were estimated. A consensus-based guidance protocol, detailing clinical and hormonal assay-based evaluation at presentation and during the follow up were formulated and implemented. Prospective data collection will be performed to estimate outcome measures (prevalence of HPAD, rate of initial endocrine consultation and endocrine outpatient follow up) and process measure (protocol adherence rate). Result: During the baseline phase (pre-QI), a total of 27 children, aged ≤19 years were admitted in the year for TBI management. The median (IQR) age at TBI diagnosis was 9 (3, 15) years. Motor vehicle accident was the predominant cause, accounting for 60%. In 85% of patients, the TBI was classified as severe based on GCS. Overall, only 8 children (30%) underwent limited (non-consultation based) endocrine evaluation (7 for central DI and 1 for central hypothyroidism) and 1 patient had complete evaluation (endocrinologist consulted). During the baseline period, the prevalence rate of transient central DI was diagnosed in 1 patient (4%). Implementation of protocol and post-intervention data collection are pending. Conclusion: The lower prevalence rate of HPAD in the current cohort of TBI patients may be due to under evaluation for endocrine dysfunction. QI initiative incorporating standardized evaluation using guiadance protocol will improve identification follow up rates of patients with endocrine dysfunction following TBI.

Comparing the transfer effects of three nonpharmacological interventions in children with AD/HD: a single-case experimental design

2020 ◽  
Author(s):  
Da-Wei Zhang ◽  
Stuart J. Johnstone ◽  
Hui Li ◽  
Xiangsheng Li ◽  
Li Sun
Keyword(s):  
Experimental Design ◽  
Visual Analysis ◽  
Single Case ◽  
Multiple Baseline ◽  
Neurofeedback Training ◽  
Transfer Effects ◽  
Baseline Phase ◽  
Intervention Phase ◽  
Inhibitory Function ◽  
Home Training

The current study used behavioral and electroencephalograph measures to compare the transferability of cognitive training (CT), neurofeedback training (NFT), and CT combined with NFT in children with AD/HD. Following a multiple-baseline single-case experimental design, twelve children were randomized to a training condition. Each child completed a baseline phase, followed by an intervention phase. The intervention phase consisted of 20 sessions of at-home training. Tau-U analysis and standardized visual analysis were adopted to detect effects. CT improved inhibitory function, and NFT showed improved alpha activity and working memory. The combined condition, who was a reduced 'dose' of CT and NFT, did not show any improvements. The three conditions did not alleviate AD/HD symptoms. While CT and NFT may have near transfer effects, considering the lack of improvement in symptoms, this study does not support CT and NFT on their own as a treatment for children with AD/HD.

Association between multimodality measures of aortic stenosis severity and quality-of-life improvement outcomes after transcatheter aortic valve replacement

2021 ◽  
Author(s):  
Michael A Catalano ◽  
Shahryar G Saba ◽  
Bruce Rutkin ◽  
Greg Maurer ◽  
Jacinda Berg ◽  
...  
Keyword(s):  
Quality Of Life ◽  
Computed Tomography ◽  
Aortic Valve ◽  
Transcatheter Aortic Valve Replacement ◽  
Multivariable Analysis ◽  
Calcium Score ◽  
Post Intervention ◽  
Transcatheter Aortic Valve

Abstract Aims Up to 40% of patients with aortic stenosis (AS) present with discordant grading of AS severity based on common transthoracic echocardiography (TTE) measures. Our aim was to evaluate the utility of TTE and multi-detector computed tomography (MDCT) measures in predicting symptomatic improvement in patients with AS undergoing transcatheter aortic valve replacement (TAVR). Methods and results A retrospective review of 201 TAVR patients from January 2017 to November 2018 was performed. Pre- and post-intervention quality-of-life was measured using the Kansas City Cardiomyopathy Questionnaire (KCCQ-12). Pre-intervention measures including dimensionless index (DI), stroke volume index (SVI), mean transaortic gradient, peak transaortic velocity, indexed aortic valve area (AVA), aortic valve calcium score, and AVA based on hybrid MDCT-Doppler calculations were obtained and correlated with change in KCCQ-12 at 30-day follow-up. Among the 201 patients studied, median KCCQ-12 improved from 54.2 pre-intervention to 85.9 post-intervention. In multivariable analysis, patients with a mean gradient >40 mmHg experienced significantly greater improvement in KCCQ-12 at follow-up than those with mean gradient ≤40 mmHg (28.1 vs. 16.4, P = 0.015). Patients with MDCT-Doppler-calculated AVA of ≤1.2 cm2 had greater improvements in KCCQ-12 scores than those with computed tomography-measured AVA of >1.2 cm2 (23.4 vs. 14.1, P = 0.049) on univariate but not multivariable analysis. No association was detected between DI, SVI, peak velocity, calcium score, or AVA index and change in KCCQ-12. Conclusion Mean transaortic gradient is predictive of improvement in quality-of-life after TAVR. This measure of AS severity may warrant greater relative consideration when selecting the appropriateness of patients for TAVR.

scholarly journals An empirical example of analysis using a two-stage modeling approach: within-subject association of outdoor context and physical activity predicts future daily physical activity levels

2020 ◽  
Author(s):  
Chih-Hsiang Yang ◽  
Jaclyn P Maher ◽  
Aditya Ponnada ◽  
Eldin Dzubur ◽  
Rachel Nordgren ◽  
...  
Keyword(s):  
Physical Activity ◽  
Vigorous Physical Activity ◽  
Wearable Sensors ◽  
Activity Levels ◽  
Two Stage ◽  
Modeling Approach ◽  
Source Program ◽  
Modeling Strategy ◽  
Stage Modeling

Abstract People differ from each other to the extent to which momentary factors, such as context, mood, and cognitions, influence momentary health behaviors. However, statistical models to date are limited in their ability to test whether the association between two momentary variables (i.e., subject-level slopes) predicts a subject-level outcome. This study demonstrates a novel two-stage statistical modeling strategy that is capable of testing whether subject-level slopes between two momentary variables predict subject-level outcomes. An empirical case study application is presented to examine whether there are differences in momentary moderate-to-vigorous physical activity (MVPA) levels between the outdoor and indoor context in adults and whether these momentary differences predict mean daily MVPA levels 6 months later. One hundred and eight adults from a multiwave longitudinal study provided 4 days of ecological momentary assessment (during baseline) and accelerometry data (both at baseline and 6 month follow-up). Multilevel data were analyzed using an open-source program (MixWILD) to test whether momentary strength between outdoor context and MVPA during baseline was associated with average daily MVPA levels measured 6 months later. During baseline, momentary MVPA levels were higher in outdoor contexts as compared to indoor contexts (b = 0.07, p < .001). Participants who had more momentary MVPA when outdoors (vs. indoors) during baseline (i.e., a greater subject-level slope) had higher daily MVPA at the 6 month follow-up (b = 0.09, p < .05). This empirical example shows that the subject-level momentary association between specific context (i.e., outdoors) and health behavior (i.e., physical activity) may contribute to overall engagement in that behavior in the future. The demonstrated two-stage modeling approach has extensive applications in behavioral medicine to analyze intensive longitudinal data collected from wearable sensors and mobile devices.

scholarly journals Development and preliminary evaluation of EMPOWER for surrogate decision-makers of critically ill patients

2021 ◽  
pp. 1-11
Author(s):  
Wendy G. Lichtenthal ◽  
Martin Viola ◽  
Madeline Rogers ◽  
Kailey E. Roberts ◽  
Lindsay Lief ◽  
...  
Keyword(s):  
Critically Ill ◽  
Critically Ill Patients ◽  
Experiential Avoidance ◽  
Decision Makers ◽  
Post Intervention ◽  
Prolonged Grief ◽  
Surrogate Decision Makers ◽  
Surrogate Decision ◽  
Peritraumatic Distress

Abstract Objective The objectives of this study were to develop and refine EMPOWER (Enhancing and Mobilizing the POtential for Wellness and Resilience), a brief manualized cognitive-behavioral, acceptance-based intervention for surrogate decision-makers of critically ill patients and to evaluate its preliminary feasibility, acceptability, and promise in improving surrogates’ mental health and patient outcomes. Method Part 1 involved obtaining qualitative stakeholder feedback from 5 bereaved surrogates and 10 critical care and mental health clinicians. Stakeholders were provided with the manual and prompted for feedback on its content, format, and language. Feedback was organized and incorporated into the manual, which was then re-circulated until consensus. In Part 2, surrogates of critically ill patients admitted to an intensive care unit (ICU) reporting moderate anxiety or close attachment were enrolled in an open trial of EMPOWER. Surrogates completed six, 15–20 min modules, totaling 1.5–2 h. Surrogates were administered measures of peritraumatic distress, experiential avoidance, prolonged grief, distress tolerance, anxiety, and depression at pre-intervention, post-intervention, and at 1-month and 3-month follow-up assessments. Results Part 1 resulted in changes to the EMPOWER manual, including reducing jargon, improving navigability, making EMPOWER applicable for a range of illness scenarios, rearranging the modules, and adding further instructions and psychoeducation. Part 2 findings suggested that EMPOWER is feasible, with 100% of participants completing all modules. The acceptability of EMPOWER appeared strong, with high ratings of effectiveness and helpfulness (M = 8/10). Results showed immediate post-intervention improvements in anxiety (d = −0.41), peritraumatic distress (d = −0.24), and experiential avoidance (d = −0.23). At the 3-month follow-up assessments, surrogates exhibited improvements in prolonged grief symptoms (d = −0.94), depression (d = −0.23), anxiety (d = −0.29), and experiential avoidance (d = −0.30). Significance of results Preliminary data suggest that EMPOWER is feasible, acceptable, and associated with notable improvements in psychological symptoms among surrogates. Future research should examine EMPOWER with a larger sample in a randomized controlled trial.

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