Intervention Mediators in a Randomized Controlled Trial to Increase Physical Activity and Fatigue Self-management Behaviors Among Adults With Multiple Sclerosis

2019 ◽  
Author(s):  
Matthew Plow ◽  
Robert W Motl ◽  
Marcia Finlayson ◽  
Francois Bethoux
Keyword(s):  
Physical Activity ◽  
Multiple Sclerosis ◽  
Goal Setting ◽  
Self Efficacy ◽  
Outcome Expectations ◽  
Step Count ◽  
Self Management ◽  
Post Test ◽  
The Impact

Abstract Background People with multiple sclerosis (MS) often experience fatigue, which is aggravated by inactivity. Identifying mediators of changes in physical activity (PA) and fatigue self-management (FSM) behaviors could optimize future interventions that reduce the impact of MS fatigue. Purpose To examine the effects of telephone-delivered interventions on Social Cognitive Theory constructs and test whether these constructs mediated secondary outcomes of PA and FSM behaviors. Methods Participants with MS (n = 208; Mean age = 52.1; Female = 84.6%) were randomized into contact–control intervention (CC), PA-only intervention, and PA+FSM intervention. Step count (Actigraphy) and FSM behaviors as well as self-efficacy, outcome expectations, and goal setting for PA and FSM were measured at baseline, post-test (12 weeks), and follow-up (24 weeks). Path analyses using bias-corrected bootstrapped 95% confidence intervals (CI) determined whether constructs at post-test mediated behaviors at follow-up when adjusting for baseline measures. Results Path analysis indicated that PA-only (β = 0.50, p < .001) and PA+FSM interventions (β = 0.42, p < .010) had an effect on goal setting for PA, and that PA + FSM intervention had an effect on self-efficacy for FSM (β = 0.48, p = .011) and outcome expectations for FSM (β = 0.42, p = .029). Goal setting for PA at post-test mediated the effects of PA-only (β = 159.45, CI = 5.399, 371.996) and PA + FSM interventions (β = 133.17, CI = 3.104, 355.349) on step count at follow-up. Outcome expectations for FSM at post-test mediated the effects of PA + FSM intervention on FSM behaviors at follow-up (β = 0.02, CI = 0.001, 0.058). Conclusions Goal setting for PA and outcome expectations for FSM may be important constructs to target in telephone-delivered interventions designed to reduce the impact of MS fatigue. Trial registration Clinicaltrials.gov (NCT01572714)

Response heterogeneity in a randomized controlled trial of telerehabilitation interventions among adults with multiple sclerosis

2020 ◽  
pp. 1357633X2096469
Author(s):  
Matthew Plow ◽  
Robert W Motl ◽  
Marcia Finlayson ◽  
Francois Bethoux
Keyword(s):  
Physical Activity ◽  
Multiple Sclerosis ◽  
Goal Setting ◽  
Controlled Trial ◽  
Self Management ◽  
Mental Function ◽  
Randomized Controlled ◽  
Responder Analysis ◽  
Post Test ◽  
Baseline Characteristics

Introduction Telerehabilitation may be effective on average but is not equally effective among all people with multiple sclerosis (MS). Thus, the purpose of this secondary analysis of a randomized controlled trial was to explore whether baseline characteristics of participants with MS influence fatigue and physical activity outcomes of three telerehabilitation interventions. Methods Participants were randomized to contact-control intervention (CC), physical activity-only intervention (PA-only), and physical activity plus fatigue self-management intervention (FM+). The 12-week interventions were delivered over the phone. Sociodemographic (age and income), clinical (comorbidities, mental function and physical function), psychosocial (self-efficacy, outcome expectations and goal-setting), and behavioural baseline characteristics (step count and fatigue self-management behaviors) were used in a moderated regression analysis and a responder analysis to examine their influence on the Fatigue Impact Scale (FIS) and Godin Leisure-Time Exercise Questionnaire (GLTEQ) at post-test (i.e. immediately post-interventions). Results No interactions terms were statistically significant in the moderation analysis. However, the responder analysis showed that baseline psychosocial characteristics and mental function were significantly different ( p < 0.05) between responders and non-responders. Specifically, non-responders on the FIS at post-test in the PA-only intervention had significantly lower baseline scores in goal setting for engaging in fatigue self-management behaviours. Also, non-responders on the GLTEQ at post-test in the FM+ intervention had significantly worse baseline scores in mental function. Discussion Further research is needed to understand the complex relationship among baseline characteristics, telerehabilitation and response heterogeneity. We discuss how research on examining response heterogeneity may be advanced by conducting mega-clinical trials, secondary analyses of big data, meta-analyses and employing non-traditional research designs. Trial registration Clinicaltrials.gov (NCT01572714).

scholarly journals Predictors of fatigue self-management behaviors in adults with multiple sclerosis

2021 ◽  
pp. 1-13
Author(s):  
Emily Wang ◽  
Julia H.C. Chang ◽  
Matthew Plow
Keyword(s):  
Multiple Sclerosis ◽  
Health Status ◽  
Symptom Severity ◽  
Self Efficacy ◽  
Outcome Expectations ◽  
Self Management ◽  
Management Behavior ◽  
Management Processes ◽  
The Impact ◽  
Management Behaviors

BACKGROUND: Fatigue is one of the most common and disabling symptoms in people with multiple sclerosis (MS). Fatigue self-management behaviors may be effective in reducing the impact of fatigue in people with MS. However, few studies have examined the factors that influence engagement in fatigue self-management behaviors. OBJECTIVE: Identify factors that directly and indirectly influence fatigue self-management behaviors. METHODS: Participants with MS (n = 300) completed online questionnaires at baseline and 6-weeks. Using the Self- and Family Management Framework, we examined the influence of health status, resources and environment, healthcare utilization, and self-management processes on fatigue self-management behaviors at 6-weeks. Multiple regression and path analyses were conducted. RESULTS: The final regression model variables accounted for 41.58% of the variance in fatigue self-management behavior, which included outcome expectation (β= 0.287), disability (β= 0.265), environmental barriers (β= 0.188), self-efficacy (β= 0.153), symptom severity (β= 0.113), living in a rural community (β= –0.108), and living alone (β= 0.103). Path analysis indicated that outcome expectations may mediate the relationship between disability levels and fatigue self-management behavior. CONCLUSIONS: Health status (i.e., disability and symptom severity), environmental factors (e.g., living situation), and self-management processes (i.e., self-efficacy and outcome expectations) may play an important role in influencing engagement in fatigue self-management behaviors.

scholarly journals Exercise is medicine Canada workshop training improves physical activity practices of physicians across Canada, independent of initial confidence level

2020 ◽  
Author(s):  
Myles William O'Brien ◽  
Chris Shields ◽  
Kara Solmundson ◽  
Jonathon Fowles
Keyword(s):  
Physical Activity ◽  
Self Efficacy ◽  
Relative Increase ◽  
High Confidence ◽  
Lifestyle Management ◽  
Self Reflection ◽  
Self Confidence ◽  
Workshop Training ◽  
The Impact

Background: Educational workshops help physicians (MDs) include physical activity and exercise (PAE) content in more patient appointments. It is unclear if MDs with varying degrees of self-confidence discussing PAE with their patients equally benefit from such training. We evaluated whether MDs’ initial self-confidence affects the impact of an educational PAE workshop. Methods: MDs (n = 63) across Canada completed self-reflection questionnaires initially and 3-months following a PAE workshop. MDs were divided into low-confidence [self-efficacy score (out of 100%): <40%; n = 21], medium-confidence (40-60%; n = 19) and high-confidence (>60%; n = 23). Results: PAE counselling self-efficacy increased in all groups (relative increase: Low=~40%, Medium=~20%, High=~10%). Training increased the low-confidence group’s knowledge, awareness of guidance/resources and perception of their patients’ interest in lifestyle management (~30% change; all p < 0.001). Compared to baseline, a greater proportion (all p < 0.001) of MDs reported prescribing exercise at 3-month follow-up in each of the low-confidence (10% to 62%) medium-confidence (16% to 89%) and high-confidence (57% to 87%) groups.  Conclusion: PAE training favorably improved MDs’ self-confidence, perceived impact of many barriers and the proportion of MDs prescribing exercise, at each level of confidence. An educational workshop particularly assisted MDs with low-confidence (i.e., those who needed it the most) integrate PAE into their practice.

scholarly journals Lifestyle, exercise and activity package for people living with progressive multiple sclerosis (LEAP-MS): Protocol for a Single-Arm Feasibility Study.

2020 ◽  
Author(s):  
Julie Latchem-Hastings ◽  
Elizabeth Randell ◽  
Kate Button ◽  
Fiona Jones ◽  
Rachel Lowe ◽  
...  
Keyword(s):  
Physical Activity ◽  
Multiple Sclerosis ◽  
Process Evaluation ◽  
Feasibility Study ◽  
Progressive Multiple Sclerosis ◽  
Feasibility Trial ◽  
Self Management ◽  
Physiotherapy Intervention ◽  
Home Based

Abstract Background. We have co-designed a tailored blended physiotherapy intervention for people with Progressive Multiple Sclerosis (MS) who often struggle to access support for physical activity. Underpinned by self-management principles, the Lifestyle, Exercise and Activity Package for people with MS intervention, which we call the LEAP-MS intervention, incorporates face-to-face or online physiotherapy coaching sessions with an accompanying online physical activity platform. The LEAP-MS platform is a multi-user system enabling user and physiotherapist to co-create activity plans. The LEAP-MS platform consists of an information and activity suite, interactive components enabling selection of exercises into an activity programme, goal setting, and activity logging. The platform also facilitates online remote support from a physiotherapist through an embedded online messaging function. We aim to evaluate the LEAP-MS platform in a feasibility trial. Methods. LEAP-MS will be evaluated within a single arm feasibility study with embedded process evaluation. After registration and initial eligible screening, 21 participants will be required to complete baseline self-completion measures. This will be followed by an initial home-based or online coaching session with a physiotherapist (who has received tailored self-management and digital resource training) and access to the online intervention for an initial three-month period. During this period participants are given the option to request up to five further home-based or online physiotherapy coaching sessions. Follow-up questionnaires and semi-structured interviews will be administered three months after baseline with participants and intervention physiotherapists. The LEAP-MS platform will be available to participants for a further three months. Usage of the LEAP-MS platform will be tracked during the full six-month period and final follow up will be conducted six months after baseline. Discussion. Feasibility outcomes (recruitment, retention, intervention uptake and safety) will be reported. The process evaluation will be undertaken to identify possible mechanisms for any observed effects. The data here will inform full scale evaluations of this co-produced, blended physiotherapy intervention. Trial registration: ClinicalTrials.gov NCT03951181. Registered 15th May 2019 https://clinicaltrials.gov/ct2/show/NCT03951181

scholarly journals Social Cognitive Theory and Physical Activity in Older Adults with Multiple Sclerosis

2020 ◽  
pp. 0000-0000
Author(s):  
Jessica F. Baird ◽  
Stephanie L. Silveira ◽  
Robert W. Motl
Keyword(s):  
Physical Activity ◽  
Multiple Sclerosis ◽  
Older Adults ◽  
Social Cognitive Theory ◽  
Goal Setting ◽  
Self Efficacy ◽  
Behavioral Interventions ◽  
Social Cognitive ◽  
Cognitive Theory ◽  
Bivariate Correlation

Abstract Background: The expanding population of older adults with multiple sclerosis (MS) likely experience many of the same benefits of physical activity as younger and middle-aged adults with MS. However, participation in physical activity is exceedingly low in this particular segment of the MS population. This study examined variables from social cognitive theory (SCT) as correlates of physical activity in older adults with MS, as this might inform the subsequent development of behavioral interventions. Methods: Older adults with MS (≥60 years, N = 180) completed an online survey including demographics and clinical characteristics, SCT variables (exercise self-efficacy, exercise goal setting, social support, and outcome expectations), and physical activity (total physical activity (PA) and moderate-to-vigorous physical activity (MVPA)). Results: Bivariate correlation analyses indicated that all SCT variables were significantly associated with both PA and MVPA (all P values ≤ .001). Hierarchical linear regression analyses indicated that disability status was a significant correlate of PA (β = −0.48; R2 = 0.23) and MVPA (β = −0.44; R2 = 0.19) in Step 1; disability and self-efficacy were significant correlates of PA (disability β = −0.20; self-efficacy β = 0.59; R2 = 0.50) and MVPA (disability β = −0.16; self-efficacy β = 0.60; R2 = 0.47) in Step 2; and disability, self-efficacy, and exercise goal setting were significant correlates of PA (disability β = −0.21; self-efficacy β = 0.50; exercise goal setting β = 0.14; R2 = 0.55) and MVPA (disability β = −0.17; self-efficacy β = 0.51; exercise goal setting β = 0.15; R2 = 0.51) in Step 3. Conclusions: Our results suggest that behavioral interventions targeting self-efficacy and exercise goal setting as targets from SCT may be appropriate for increasing physical activity in older adults with MS.

scholarly journals Evaluating psychosocial and physical activity outcomes following an intervention among Filipino Americans

2021 ◽  
Vol 11 (2) ◽  
pp. 210-218
Author(s):  
Aisha Bhimla ◽  
Ksenia Power ◽  
Michael Sachs ◽  
Allegra Bermudez ◽  
Jessica Dinh ◽  
...  
Keyword(s):  
Physical Activity ◽  
Social Support ◽  
Goal Setting ◽  
Self Efficacy ◽  
Health Workers ◽  
Minority Group ◽  
Self Regulation ◽  
Outcome Expectations ◽  
Rank Test ◽  
Filipino Americans

Background: Physical activity (PA) is a strong contributor to enhancing a healthy lifestyle and preventing numerous chronic diseases. As ethnic minorities engage in low levels of PA, psychosocial and activity-based interventions for sustaining PA are crucial. Methods: The 6-month intervention incorporated culturally tailored educational workshops and weekly PA classes at a community center. Educational workshops were led by six trained community health workers (CHWs). Participants (n=37) completed pre- and post-intervention questionnaires regarding PA related self-efficacy, outcome expectations, social support, enjoyment, self-regulation, goal setting, and overall PA. Results: Following the intervention, study participants exhibited increases in weekly PA levels. Wilcoxon Signed-Rank test revealed higher median scores for Exercise Self-Efficacy Scale (ESES), Identified Regulation, and Intrinsic Motivation. Positive changes were observed for Physical Outcome Expectations, Social Outcome Expectations, Self-Evaluative Outcome Expectations, Physical Activity Enjoyment, Social Support for Exercise Scale – Family, Social Support for Exercise – Friends, and Exercise Goal-Setting. Conclusion: Community-based PA interventions may provide potential benefits to Filipino Americans, an ethnic Asian minority group, in identifying exercise benefits, developing proper exercise goals, increasing motivation, promoting PA behavior, and facilitating long-term PA adherence.

scholarly journals Lifestyle, exercise and activity package for people living with progressive multiple sclerosis (LEAP-MS): protocol for a single-arm feasibility study

2021 ◽  
Vol 7 (1) ◽  
Author(s):  
Julie Latchem-Hastings ◽  
Elizabeth Randell ◽  
Kate Button ◽  
Fiona Jones ◽  
Rachel Lowe ◽  
...  
Keyword(s):  
Physical Activity ◽  
Multiple Sclerosis ◽  
Process Evaluation ◽  
Feasibility Study ◽  
Progressive Multiple Sclerosis ◽  
Self Management ◽  
Link Type ◽  
Physiotherapy Intervention ◽  
Home Based

Abstract Background We have co-designed a tailored blended physiotherapy intervention for people with progressive multiple sclerosis (PwPMS) who often struggle to access support for physical activity. Underpinned by self-management principles, the Lifestyle, Exercise and Activity Package for people with Multiple Sclerosis (LEAP-MS) intervention incorporates face-to-face or online physiotherapy coaching sessions with an accompanying online physical activity platform. The LEAP-MS platform is a multi-user system enabling user and physiotherapist to co-create activity plans. The LEAP-MS platform consists of an information and activity suite, interactive components enabling selection of exercises into an activity programme, goal setting and activity logging. The platform also facilitates online remote support from a physiotherapist through an embedded online messaging function. We aim to evaluate the LEAP-MS platform in a feasibility trial. Methods LEAP-MS will be evaluated within a single-arm feasibility study with embedded process evaluation. After registration and initial eligible screening, 21 participants will be required to complete baseline self-completion measures. This will be followed by an initial home-based or online coaching session with a physiotherapist (who has received tailored self-management and digital resource training) and access to the online intervention for an initial 3-month period. During this period, participants are given the option to request up to five further home-based or online physiotherapy coaching sessions. Follow-up questionnaires and semi-structured interviews will be administered 3 months after baseline with participants and intervention physiotherapists. The LEAP-MS platform will be available to participants for a further 3 months. Usage of the LEAP-MS platform will be tracked during the full 6-month period and final follow-up will be conducted 6 months after baseline. Discussion Feasibility outcomes (recruitment, retention, intervention uptake and safety) will be reported. The process evaluation will be undertaken to identify possible mechanisms for any observed effects. The data will inform full-scale evaluations of this co-produced, blended physiotherapy intervention. Trial registration ClinicalTrials.gov, NCT03951181. Registered 15 May 2019

scholarly journals The impact of self-assessment, planning and goal setting, and reflection before and after revision on student self-efficacy and writing performance

2021 ◽  
Author(s):  
Huy Q. Chung ◽  
Vicky Chen ◽  
Carol Booth Olson
Keyword(s):  
Academic Success ◽  
Goal Setting ◽  
Self Efficacy ◽  
Writing Assessment ◽  
Self Assessment ◽  
Revision Process ◽  
Writing Project ◽  
On Demand ◽  
Post Test ◽  
The Impact

AbstractWriting on-demand, text-based analytical essays is a challenging skill to master. Novice writers, such as the sixth grade US students in this study, may lack background knowledge of how to compose an effective essay, the self-efficacy skills, and the goal setting skills that will help with completing this task in accomplished ways. This sequential mixed-method study explored the impact of guiding a predominantly Redesignated English Learner group of students in a large, urban, low-SES school district in a timed, on-demand essay into a multiple draft process paper through a self-assessment, planning and goal setting, and reflection process as they revised this process paper over a three week period. Both treatment and comparison students completed a pre-test on demand writing assessment, a pre and post self-efficacy in writing survey, and a post-test on demand writing assessment. Students in both conditions were participating in a year-long writing intervention called The Pathway to Academic Success, developed and implemented by the UC Irvine site of the National Writing Project (UCI Writing Project), during the 2017–2018 school year and received identical training from their teachers on how to revise a pre-test essay. However, only the treatment group engaged in self-assessment, planning and goal setting, and reflection during this revision process. Students in the treatment condition demonstrated improved self-efficacy in the writing sub-domain of revision (p < .05) and had statistically significant greater gains on the post-test writing assessment (r = .57; p < .001). These results suggest that engaging students in a planned revision process that includes student reflection, planning, and goal setting before revision, and reflection and self-assessment after revision, positively impacts self-efficacy and writing outcomes.

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