Jana J. Peterson

Exercise Intervention Research on Persons with Disabilities: What We Know and Where We Need to Go

Rimmer JH, Chen M-D, McCubbin JA, Drum C, Peterson J: Exercise intervention research on persons with disabilities: What we know and where we need to go. The purpose of this article was to provide a comprehensive review of the exercise intervention literature on persons with physical and cognitive disabilities. Electronic searches were conducted to identify research articles published from 1986 to 2006. Of the 80 physical activity/exercise interventions identified in the literature, only 32 were randomized controlled trials. The remaining studies were nonrandomized controlled trials with (n = 16) and without (n = 32) a control group. There was a mixture of exercise training modalities that involved aerobic (26%), strength (25%), and combined aerobic and strength (23%) exercises, but there were no overlapping studies using the same dose of exercise for any of the 11 disability groups. Almost half the studies targeted stroke (20%), multiple sclerosis (15%), and intellectual disability (13%), with significantly fewer studies targeting other disability groups. The current literature on exercise and disability is extremely broad in scope and has limited generalizability to any specific disability group. A new body of evidence is needed with stronger research designs that adhere to precise dosing characteristics for key health outcomes (e.g., pain/fatigue reduction, improved cardiorespiratory health). Multicenter trials will be needed for low-prevalence populations to strengthen research designs and increase generalizability of study findings.

Physical activity among adults with intellectual disabilities living in community settings

OBJECTIVE The aim was to objectively monitor steps accrued by a sample of adults with intellectual disabilities and to describe physical activity patterns by monitoring steps taken across weekdays, weekends, and hours of the day using time-stamped technology. METHOD This study used pedometers with time-stamped recording capabilities to measure physical activity behavior of 131 adults with mild to moderate levels of intellectual disabilities living in community-based supported living group settings in Iowa. Participants wore a pedometer for seven consecutive days. All data was collected in 2006 and analyzed in 2007. RESULTS The participants accrued 6508+/-3296 steps/day. Controlling for age, participants with mild intellectual disability were more active than participants with moderate intellectual disability (F=7.03, p<.01). A total of 14.1% accumulated 10,000 steps/day. Participants were more active on weekdays than on weekends (Z=-7.36, p<.01), and least active during the evening period compared to the morning and afternoon hours (F(r)=103.3, p<.01). CONCLUSION Physical activity (steps/day) achieved by the majority of this population is insufficient for health benefits, particularly among individuals with moderate intellectual disability. Evenings and weekends are especially inactive time periods.

Guidelines and Criteria for the Implementation of Community-Based Health Promotion Programs for Individuals with Disabilities:

Health promotion programs for people with disabilities are in the early stages of development. This critical review utilizes a credentialed expert panel to develop a set of guidelines for community-based health promotion programs for individuals with disabilities. The procedures include a review of background material, systematic literature review with drafted guidelines consisting of operational, participation and accessibility recommendations. The role that those with disabilities can play is addressed and includes program planning, implementation and evaluation, physical and programmatic accessibility of programs, and importance of evidence-based practices.

Paths to Leisure Physical Activity Among Adults With Intellectual Disabilities: Self-Efficacy and Social Support

Purpose. This study tested a path model that included perceptions of social support and self-efficacy for leisure physical activity and leisure physical activity participation among adults with intellectual disabilities. Design. A cross-sectional design was used. Data was collected via oral interview. Setting. Community-based group, supported-living settings in one Midwestern state. Sample. A total of 152 adults with mild to moderate intellectual disabilities, which provided a 39% response rate. Measures. Self-efficacy and social support (from family, residential staff, and peers with disabilities) for leisure physical activity were assessed using self-reported scales. Leisure physical activity participation was measured with a self-reported checklist of the frequency of leisure physical activity participation. Analysis. Path analysis was conducted for the entire sample and was repeated for younger and older age groups. Results. The hypothesized model fit the data from each group. Social support and self-efficacy predicted physical activity participation, and self-efficacy served as a mediator between social support and physical activity. Significant sources of social support differed between groups; among younger participants, social support from family predicted physical activity, whereas, for the older group, social support from staff and peers predicted physical activity. Conclusion. Self-efficacy and social support for leisure physical activity are related to leisure physical activity participation among adults with intellectual disabilities who are receiving supported-living services. The results provide information to guide health promotion programs for this group.

Differential Performance of SF-36 Items in Healthy Adults With and Without Functional Limitations

OBJECTIVE To determine whether Medical Outcomes Study 36-Item Short-Form Health Survey (SF-36) items show differential item functioning among healthy adults with various types of functional limitations as compared with a healthy sample with no identified limitations. DESIGN Survey responses were analyzed by using partial correlations. SETTING General community. PARTICIPANTS Participants (N=206) included (1) adults with spinal cord injury (SCI), (2) adults who were deaf or hard of hearing, (3) adults who were legally blind, (4) adults with psychiatric or emotional conditions, and (5) adults with no reported functional limitations. Participants were screened to ensure the absence of substantial health problems. INTERVENTIONS Not applicable. MAIN OUTCOME MEASURE SF-36. RESULTS Partial correlations showed a significant negative correlation, indicating differential item functioning (ie, apparent bias) for people with SCI on all 10 SF-36 Physical Functioning items. For people who were blind, 5 items showed a significant negative correlation. Two items had significant negative correlations for the deaf/hard-of-hearing group. One item showed significant negative performance for people with mental health conditions. CONCLUSIONS Our data indicated a possibility for measurement bias caused by the blending of health and function concepts in the SF-36.

Secondary analysis of a scoping review of health promotion interventions for persons with disabilities: Do health promotion interventions for people with mobility impairments address secondary condition reduction and increased community participation?

BACKGROUND Secondary conditions can have very serious outcomes for people with physical disabilities. Such consequences can range from immobility due to pressure sores to withdrawal and isolation due to depression, decreasing participation in the community. OBJECTIVE/HYPOTHESIS To further investigate these assumptions, we conducted a review of the literature on health promotion interventions that include physical activity for adults with disabilities to determine whether they have a positive effect on the reduction of secondary conditions and increased community participation. METHODS We conducted a secondary analysis of the results of a scoping review of health promotion programs containing physical activity for people with mobility impairments (N = 5). This secondary analysis examined the relationship between health promotion containing physical activity and prevention of secondary conditions among people with various physical disabilities. We further examined evidence and effects of independent variables on the outcome of increased community participation for study participants. RESULTS The outcomes from this investigation are varied, with 2 studies providing evidence of reducing secondary conditions while another shared anecdotal statements referencing a decrease in secondary conditions. Of the remaining 2 studies in this paper, 1 showed no intervention effect on reducing secondary conditions while the remaining study reported an increase in secondary conditions. Regarding increased participation in the community, 2 of 5 studies directly reported on these outcomes, while increased community participation was referenced in another 2 articles, but without any data presented. The final study did not report on any post intervention in the community. CONCLUSIONS This review demonstrates that research on health promotion interventions containing physical activity lack description about whether such interventions help reduce or prevent secondary conditions. Additionally, the review shows that further work is needed in terms of sustaining health programs effects beyond the initial proximal activity gains, with attention given toward more distal outcomes of increased participant participation in the community.

Improving cancer screening among women with mobility impairments: randomized controlled trial of a participatory workshop intervention.

Purpose. To assess the efficacy of an intervention to promote mammography and Papanicolaou (Pap) testing among women with mobility impairments overdue for screenings Design. Randomized controlled trial. Setting. Urban and suburban Oregon. Participants. Women aged 35 to 64 with mobility impairments who reported not receiving a Pap test in the past 3 years and/or mammogram (if age > 40 years) in the last 2 years were eligible. A total of 211 women were randomized, and 156 completed the study (26% attrition). The majority were not employed and reported annual income <

Rasch calibration of physical activity self-efficacy and social support scale for persons with intellectual disabilities

10,000. Intervention. The Promoting Access to Health Services (PATHS) program is a 90-minute, small-group, participatory workshop with 6 months of structured telephone support, based on the health belief model and social cognitive theory. Measures. Perceived susceptibility to breast and cervical cancer, perceived benefits of and self-efficacy for screening intention to be screened, and self-reported receipt of mammography and Pap testing. Analysis. Chi-square tests to examine the proportion of women obtaining screening; analysis of covariance to examine change in theoretical mediators. Results. The intervention group received more Pap tests than the control group at posttest (intervention 61 %, control 27%, n = 71, p < .01). No significant group effect was observed for mammography (intervention 49%, control 42%, n = 125, p = .45). Conclusion. Findings indicate that the PATHS intervention promotes Pap testing but not mammography among women with mobility impairments.

Using Intervention Mapping to Promote the Receipt of Clinical Preventive Services Among Women With Physical Disabilities

The purpose of this study was to investigate the construct validity of the Self-Efficacy/Social Support for Activity for persons with Intellectual Disability (SE/SS-AID) scales developed by Peterson, Peterson, Lowe, & Nothwehr (2009). A total of 146 participants with intellectual disabilities completed 6 self-efficacy (SE) items and 18 social support (SS) items. After applying the Rasch rating model, all SE items and 17 SS items fit the model and measured a single-construct. Thus, it was able to determine the item difficulty and persons level of SE and SS for physical activity by calculated logit scores. No items showed evidence for differential functioning by the level of intellectual disability. Model fit of SS subscales (e.g., staff, family, and peer) showed good-fit as well. In conclusion, SE and SS scales for physical activity can be measured more accurately for persons with intellectual disabilities by using the modified scales validated in this study.

Development and psychometric assessment of the function-neutral health-related quality of life measure.

This article describes the development of Promoting Access to Health Services (PATHS), an intervention to promote regular use of clinical preventive services by women with physical disabilities. The intervention was developed using intervention mapping (IM), a theory-based logical process that incorporates the six steps of assessment of need, preparation of matrices, selection of theoretical methods and strategies, program design, program implementation, and evaluation. The development process used methods and strategies aligned with the social cognitive theory and the health belief model. PATHS was adapted from the workbook Making Preventive Health Care Work for You, developed by a disability advocate, and was informed by participant input at five points: at inception through consultation by the workbook author, in conceptualization through a town hall meeting, in pilot testing with feedback, in revision of the curriculum through an advisory group, and in implementation by trainers with disabilities. The resulting PATHS program is a 90-min participatory small-group workshop, followed by structured telephone support for 6 months.