RehabWire - Volume 7, Number 3, April 2005

RehabWire for April highlights projects researching health and wellness for people with disabilities. Can we prevent secondary conditions by focusing on good health practices?

NIDRR Projects: Research in the New Millennium.

Rehabilitation Research and Training Center on Secondary Prevention Through Exercise: A Participatory Approach for People with Spinal Cord Injury. National Rehabilitation Hospital/MedStar Research Institute, (H133B031114) led by Suzanne L. Groah, MD. Thomas Corfman, Project Officer.
Abstract: This project systematically and comprehensively addresses the role and impact of physical activity in the prevention of secondary conditions in people with spinal cord injury (SCI). The project develops exercise formats specifically designed according to severity of SCI and chronicity of SCI. In addition, the project determines whether regular exercise is related to fewer secondary conditions. These research findings feed into four training activities that include a peer mentoring program for newly injured people with SCI, a consumer-driven education curriculum for physical therapy and medical students, a state-of-science and training conference, and the development of a virtual resource network on exercise and prevention.
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Man in a wheelchair using a weight machine to exercise

Rehabilitation Research and Training Center in Neuromuscular Diseases. University of California, Davis, (H133B031118) led by Craig McDonald, MD. Theresa San Agustin, MD, Project Officer.
Abstract: The purpose of this project is to enhance the health, function, and quality of lives of persons with neuromuscular diseases. Two of the goals of this project are to: conduct research that continues to address rehabilitation needs, particularly related to exercise, nutrition, pain, secondary conditions, and the quality of life of individuals with neuromuscular diseases; and develop and evaluate appropriate health promotion and wellness programs that enhance the ability of individuals with neuromuscular disease to be physically active and participate in recreational activities.
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Rehabilitation Research and Training Center on Aging with Developmental Disabilities. University of Illinois at Chicago, (H133B031134) led by Tamar Heller, PhD. Margaret Campbell, PhD, Project Officer.
Abstract: The mission of the RRTCADD is to have a sustained beneficial impact on the health and community inclusion of adults with intellectual and developmental disabilities (I/DD) as they age through a coordinated set of research, training, and dissemination activities. Major goals are: (1) improving health and function of adults with I/DD, (2) enhancing caregiving supports and transition planning among older caregivers and other family members, and (3) promoting aging and disability friendly environments that enable adults with I/DD to participate in community life. Projects promoting health and functioning include: examination of age-related changes, epidemiological surveys, research on health care utilization, and development of community-based health promotion interventions.
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Rehabilitation Research and Training Center on Health and Wellness in Long Term Disability. Oregon Health and Science University, (H133B040034) led by Gloria Krahn, PhD, MPH. Theresa San Agustin, MD, Project Officer.
Abstract: The vision of the RRTC is to contribute to the reduction of health disparities for person with disabilities through an integrated program of research, training, technical assistance, and dissemination. The Center: (1) identifies strategies to overcome barriers that impede access to routine healthcare for individuals with disabilities; (2) identifies interventions in areas such as exercise, nutrition, pain management, or complementary and alternative therapies that promote health and wellness and minimize the occurrence of secondary conditions; and (3) develops improved status measurement tools to assess health and well-being of individuals with disabilities regardless of functional ability. The RRTC examines and evaluates the practices of exemplary generic and specialized health promotion programs for people with disabilities in order to create an evidence-based set of evaluation and planning criteria. The project organizes and uses panels to assess current health status measurement tools and develops or refines measures to more accurately reflect the health and well-being of people living with disabilities.
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The Efficacy of Computer and Sense Wear Technologies for Promoting Health in Adults with Fibromyalgia: A Randomized Clinical Trial. University of Pittsburgh, (H133G020159) led by Joan Rogers, PhD and Margo Holm, PhD. Carol Cohen, Project Officer.
Abstract: This study uses a cognitive-behavioral intervention to facilitate adoption of a wellness lifestyle in people with fibromyalgia. Specifically, researchers test the efficacy of an Internet-based health promotion computer program used in conjunction with a wearable sensor (SenseWear™) for developing a wellness lifestyle and improving the quality of life of adults with fibromyalgia. Consumers are assisted in: (1) establishing goals in the areas of physical activity, nutrition, participation in meaningful, productive activities, sleep, stress-reducing activities, and emotional state; (2) monitoring progress toward established goals; and (3) assessing the relationship between these areas in one’s daily life. In addition, based on consumer input, the program offers suggestions for developing a wellness lifestyle.

Healthy Lifestyles Evaluation Project. Oregon Health and Science University, (H133G020231) led by Charles Drum, JD, PhD. Constance Pledger, EdD, Project Officer.
Abstract: This project evaluates the effectiveness of the Healthy Lifestyles for People with Disabilities training curriculum. The project: (1) conducts ten Healthy Lifestyles training events for persons with disabilities through local Centers for Independent Living; (2) assesses the level of wellness and the healthy lifestyles attitudes, knowledge, and skills of participants over the course of the project ; (3) assesses participants’ completion of lifestyle change goals; and (4) compares participants’ wellness and healthy lifestyles attitudes, knowledge, and skills to that of controls.
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New Research: Selections from REHABDATA

Slater, D., Meade, M. (2004) Participation in recreation and sports for persons with spinal cord injury: Review and recommendations. NeuroRehabilitation, 19(2), 9. NARIC Accession Number: J45484.
Project Number: H133N000015.
Abstract: Article reviews research focused on participation in recreation and sports among individuals with spinal cord injury. The physiological and psychological benefits of participation, factors that influence participation, issues related to assistive technology, and safety concerns are discussed and recommendations are provided.

Humphries, K., Traci, M. (2004) A preliminary assessment of the nutrition and food-system environment of adults with intellectual disabilities living in supported arrangements in the community. Ecology of Food and Nutrition, 43(6), 16. NARIC Accession Number: J46951.
Project Number: H133B030501.
Abstract: Study analyzed the adequacy of planned diets in two community-based group homes for adults with intellectual/developmental disabilities in Montana. Adequacy of the diet was determined by comparing the planned menus to recommended servings from the Food Guide Pyramid. Results showed that the diets did not conform to the Food Guide Pyramid guidelines for adequacy and contained excessive amount of energy-dense, nutrient-poor foods and dietary fats. The diets had multiple deficits, putting residents at risk for chronic disease. Note: This research predates the new Food Pyramid.

Fruits and vegetables on display at a supermarket

Downs, A., Wile, N., Krahn. G. (2004) Wellness promotion in persons with disabilities: Physicians’ personal behaviors, attitudes, and practices. Rehabilitation Psychology, 49(4), 6. NARIC Accession Number: J47000.
Project Number: H133B990019.
Abstract: Survey examined physicians’ personal wellness behaviors, their attitudes toward various wellness-related behaviors, and the impact of those attitudes and behaviors on the amount and type of wellness promotion activities they engaged in with their patients with disabilities. Physicians who reported engaging in high levels of wellness promotion with their patients with disabilities rated wellness promotion as more important and reported feeling more competent and responsible. Several barriers and incentives to wellness promotion were also reported.

Heller, T., Hsieh, K., Rimmer, J. (2004) Attitudinal and psychosocial outcomes of a fitness and health education program on adults with Down syndrome. American Journal on Mental Retardation, 109(2), 11. NARIC Accession Number: J47662.
Project Number: H133B980046.
Abstract: Study examined the attitudinal and psychosocial outcomes of a fitness and health education program for 53 adults with Down syndrome. The 12-week training program consisted of cardiovascular and strength exercises and health education classes, 3 days a week for 2 hours per day. Outcome measures included attitudes towards exercise (cognitive-emotional barriers, outcomes expectations, and performance self-efficacy) and psychosocial well-being (community integration, depression, and life satisfaction). Compared to control subjects, the training group showed significant changes in attitudes towards exercise, more positive expected outcomes, fewer cognitive-emotional barriers, improved life satisfaction, and marginally lower depression. Authors discuss limitations of the study, implications of the findings, and directions for future research.

Rimmer, J. H. (2005) Exercise and physical activity in persons aging with a physical disability. Physical Medicine and Rehabilitation Clinics of North America, 16(1), 16. NARIC Accession Number: J48385.
Project Number: H133E020715.
Abstract: Article examines the relationship between health status and physical activity in older adults with physical disabilities. Author describes a cyclical relationship between disability and physical activity. Physical inactivity over a prolonged period results in the development of secondary conditions and further functional loss, which results in greater effort to participate in physical activity. Regular physical activity has the potential to offset aging- and disability-related losses in function. Guidelines are presented for implementing exercise programs for aging individuals with various types of physical disabilities.

Seekins, T. (2004) Living well with a disability: An update. Rural Disability and Rehabilitation Research Progress Report #19, 2. NARIC Accession Number: O15271.
Project Number: H133B030501. Abstract: Fact sheet describes efforts to promote and evaluate the “Living Well with a Disability” program, a health promotion and wellness program for adults with physical disabilities. To date, 202 facilitators from 72 community-based organizations have conducted an estimated 218 workshops, serving 1,585 consumers. These programs have shown improved health and cost-saving benefits.

Ravesloot, C. (2004) Living well and Medicaid: Better health for consumers - lower costs for states. Rural Disability and Rehabilitation Research Progress Report #23, 4. NARIC Accession Number: O15421.
Project Number: H133B030501. Abstract: Study examined the effects of the Living Well with a Disability program, a health promotion program for adults with physical disabilities, on the cost of providing health care to Medicaid beneficiaries. Results showed that participants’ secondary conditions decreased by 25 percent during the intervention period and the decrease was maintained for 4 months after the program. After accounting for implementation cost, the Living Well program saved Medicaid as much as $291,284 (in 1998 dollars).

(2004) Rehabilitation research and training center: Health and wellness consortium: Summary of studies and findings. NARIC Accession Number: O15911.
Project Number: H133B990019.
Abstract: Report summarizes the activities and findings of projects conducted by the Rehabilitation Research and Training Center (RRTC): Health and Wellness Consortium. This RRTC focuses on assessing the health maintenance and promotion practices of people with long-term disabilities such as cerebral palsy, spinal cord injury, multiple sclerosis, amputation, and post-polio. The RRTC identified three short-term outcomes to result from it outputs, activities, and dissemination. These outcomes focus on increasing knowledge and awareness of people living with disabilities, providers, and policymakers in three key areas: (1) holistic health and wellness definition, practices, and policies; (2) health disparities and contributors to secondary conditions affecting function, independence, and quality of life; and (3) best practices in health promotion for people living with disabilities.