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Effects of an Individualized Aerobic Exercise Program in Individuals With a Brain Tumor Undergoing Inpatient Rehabilitation: A Feasibility Study
e28 Research Poster 190 Peer-Led Wheelchair Training Improves Wheelchair Use Self-Efficacy and Wheelchair Skills: A Pilot Randomized Controlled Trial Krista Best (Center for Interdisciplinary Research in Rehabilitation and Social Integration (CIRRIS)), William C. Miller, Grant Huston, Francois Routhier, Janice J. Eng Research Objectives: To evaluate the effect of a peer-led wheelchair training program on manual wheelchair use self-efficacy. Influences of the intervention on manual wheelchair skill capacity, manual wheelchair skill performance, life-space mobility, and satisfaction with participation were explored as secondary outcomes. Design: Randomized controlled trial. Setting: Rehabilitation centre and community. Participants: 28 community-living, manual wheelchair users (49+/-17 years of age) were recruited on a volunteer basis. Participants were predominantly male (79%) with spinal cord injury (68%), and had 13+/-13 years of experience using a manual wheelchair. Ethics and informed consent were obtained. Interventions: The experimental group (nZ16) received 6, 1.5 hour sessions of a peer-led, self-efficacy enhanced wheelchair training program (WheelSee). A peer-trainer facilitated WheelSee to pairs of manual wheelchair users; however, individualized training was based on participants’ self-identified goals. The control group (nZ12) did not receive any intervention. Main Outcome Measure(s): The primary outcome, manual wheelchair use self-efficacy, was assessed using the Wheelchair Use Confidence Scale. Secondary outcomes included wheelchair skills capacity and performance (Wheelchair Skills Test-Questionnaire), life-space mobility (Life-space Assessment), and satisfaction with participation (Wheelchair Outcome Measure). Results: Intention-to-treat analysis using multiple imputation was performed (nZ1 drop-out). Controlling for baseline scores, analysis of covariance revealed that WheelSee had a large statistically significant effect on wheelchair use self-efficacy (Cohen’s dZ1.4, pZ0.002). WheelSee also had large statistically significant effects on wheelchair skills capacity (Cohen’s dZ1.3, pZ0.003) and performance (Cohen’s dZ1.0, pZ0.02), but no statistically significant effects on life-space mobility or satisfaction with participation. Conclusions: WheelSee is a novel approach to a health service dilemma that positively influenced manual wheelchair use self-efficacy and wheelchair skills. A peer-led, goal-oriented approach to wheelchair training may offer a promising intervention strategy to accommodate the training needs of community-living manual wheelchair users. Key Words: Wheelchairs, Self efficacy, Peer group Disclosures: None disclosed. Research Poster 191 Effects of an Individualized Aerobic Exercise Program in Individuals With a Brain Tumor Undergoing Inpatient Rehabilitation: A Feasibility Study Kelli Hudson (Mary Free Bed Rehabilitation Hospital), Cathy Harro, Sarah Ayotte Research Objectives: To investigate the feasibility of aerobic exercise training in patients with brain tumor and its effects on aerobic function, strength, fatigue and functional outcomes. Design: Prospective study-single cohort design. Setting: Phase 1: inpatient rehabilitation hospital, phase 2: outpatient. Participants: Brain oncology patients admitted over an 18 month period. Forty four patients were screened for the study; 20 qualified participants were enrolled. Sixteen of the 20 participants (9 men, 7 women; mean ageZ 56.6 years) completed phase one. Only one participant completed phase two. Interventions: Individualized aerobic training on a recumbent cycle ergometer. Phase 1: 5 days/week, phase 2: 3 days/week. Training goal was
Research Posters 20 minutes, continuous cycling at moderate intensity, 6 week duration with vitals closely monitored by a physical therapist. Main Outcome Measure(s): Outcome measures included Aerobic Capacity (graded submaximal cycling test), Six Minute Walk test (6MWT), Functional Independence Measure, lower extremity composite strength score, and the Functional Assessment of Chronic Illness Therapy-Fatigue. Measures were assessed pre-training, at inpatient discharge, and posttraining. Feasibility was determined by: 1) adherence to the training program, 2) training responsiveness, and 3) ability to achieve training goals; adverse events monitored throughout the study. Results: Statistically significant changes in all outcomes measures were found during phase one, with moderate gains found in aerobic capacity and 6MWT. All participants were able to reach the training goal of 20 minutes of continuous cycling, training intensity (40-60% HRmax), and adherence to 5 training sessions per week. There were no adverse events during the training sessions. Conclusions: Study supports the feasibility and effectiveness of an individualized aerobic exercise program for individuals with brain tumors. Key Words: brain tumor, aerobic training, rehabilitation Disclosures: None disclosed. Research Poster 195 Growth and Benefit Finding Post-Trauma: A Qualitative Study of Partners of Individuals with Multiple Sclerosis Sonya Kim (NYU School of Medicine Department of Neurology and Department of Rehabilitation), Frederick W. Foley, Marie Cavallo, Jonathon Howard, Joseph Rath, Koral Dadon, Zoe Rimler, Jennifer Tamar Kalina Research Objectives: To develop an instrument to measure posttraumatic growth/PTG in partners of individuals with multiple sclerosis/MS. Design: Cross-sectional design following a phenomenological qualitative methodology. Five focus groups with partners of patients with a definite diagnosis of MS were conducted and analyzed using qualitative inductive content analysis, combined with counts of the coded data[1-3]. Items for each theme were generated by consensus. Experts in the field and participants/enrolled partners - randomly selected - participated in an initial validation phase to verify that the content domain of the construct was adequately covered. Setting: Hospital-outpatient. Participants: 39 partners (22 males); age 32-64 (MZ45.68, SDZ9.31); education/yrs.,12-20 (MZ15.82, SDZ2.71). “Partnership” was defined as individuals in committed relationships, living together for >1 year. Interventions: Not Applicable. Main Outcome Measure(s): Descriptive examination of experiences of partners of individuals with MS[1,3,4]. Results: Participants’ experiences as caregivers and partners varied individually. Yet six dominant PTG and benefit finding themes emerged. Themes included perceived changes regarding sense of self within social and intimate relationships. Conclusions: Previous concepts of PTG[5] led to observations[6] that patients and their partners can undergo searches for meaning attendant to illness, with resulting discoveries of new possibilities, increased emotional strength, and greater life appreciation[7-9]. Results are consistent with theories of trauma[5,10-13] where crises spur positive growth, and have important implications for addressing positive affect in rehabilitation. A well-functioning family unit, headed by a closely bonded couple, can powerfully aid in the patient’s adjustment to chronic progressive illness. A PTG instrument that effectively measures the positive impact on the partner of an individual living with MS will enable clinicians to track the psychological effects of the disease on the partner. These characteristics could then be used to improve and guide treatment interventions. Future work needs to validate the psychometric properties of this preliminary instrument. Key Words: Caregivers, Multiple Sclerosis, Adjustment, Posttraumatc growth, Benefit finding Disclosures: None disclosed.
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Research Posters 20 minutes, continuous cycling at moderate intensity, 6 week duration with vitals closely monitored by a physical therapist. Main Outcome Measure(s): Outcome measures included Aerobic Capacity (graded submaximal cycling test), Six Minute Walk test (6MWT), Functional Independence Measure, lower extremity composite strength score, and the Functional Assessment of Chronic Illness Therapy-Fatigue. Measures were assessed pre-training, at inpatient discharge, and posttraining. Feasibility was determined by: 1) adherence to the training program, 2) training responsiveness, and 3) ability to achieve training goals; adverse events monitored throughout the study. Results: Statistically significant changes in all outcomes measures were found during phase one, with moderate gains found in aerobic capacity and 6MWT. All participants were able to reach the training goal of 20 minutes of continuous cycling, training intensity (40-60% HRmax), and adherence to 5 training sessions per week. There were no adverse events during the training sessions. Conclusions: Study supports the feasibility and effectiveness of an individualized aerobic exercise program for individuals with brain tumors. Key Words: brain tumor, aerobic training, rehabilitation Disclosures: None disclosed. Research Poster 195 Growth and Benefit Finding Post-Trauma: A Qualitative Study of Partners of Individuals with Multiple Sclerosis Sonya Kim (NYU School of Medicine Department of Neurology and Department of Rehabilitation), Frederick W. Foley, Marie Cavallo, Jonathon Howard, Joseph Rath, Koral Dadon, Zoe Rimler, Jennifer Tamar Kalina Research Objectives: To develop an instrument to measure posttraumatic growth/PTG in partners of individuals with multiple sclerosis/MS. Design: Cross-sectional design following a phenomenological qualitative methodology. Five focus groups with partners of patients with a definite diagnosis of MS were conducted and analyzed using qualitative inductive content analysis, combined with counts of the coded data[1-3]. Items for each theme were generated by consensus. Experts in the field and participants/enrolled partners - randomly selected - participated in an initial validation phase to verify that the content domain of the construct was adequately covered. Setting: Hospital-outpatient. Participants: 39 partners (22 males); age 32-64 (MZ45.68, SDZ9.31); education/yrs.,12-20 (MZ15.82, SDZ2.71). “Partnership” was defined as individuals in committed relationships, living together for >1 year. Interventions: Not Applicable. Main Outcome Measure(s): Descriptive examination of experiences of partners of individuals with MS[1,3,4]. Results: Participants’ experiences as caregivers and partners varied individually. Yet six dominant PTG and benefit finding themes emerged. Themes included perceived changes regarding sense of self within social and intimate relationships. Conclusions: Previous concepts of PTG[5] led to observations[6] that patients and their partners can undergo searches for meaning attendant to illness, with resulting discoveries of new possibilities, increased emotional strength, and greater life appreciation[7-9]. Results are consistent with theories of trauma[5,10-13] where crises spur positive growth, and have important implications for addressing positive affect in rehabilitation. A well-functioning family unit, headed by a closely bonded couple, can powerfully aid in the patient’s adjustment to chronic progressive illness. A PTG instrument that effectively measures the positive impact on the partner of an individual living with MS will enable clinicians to track the psychological effects of the disease on the partner. These characteristics could then be used to improve and guide treatment interventions. Future work needs to validate the psychometric properties of this preliminary instrument. Key Words: Caregivers, Multiple Sclerosis, Adjustment, Posttraumatc growth, Benefit finding Disclosures: None disclosed.
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