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Item Trajectory Analysis for Identifying Classes of Attention Deficit Hyperactivity Disorder (ADHD) in Children of the United States(Bentham Open, 2024-05-21) Lee, Yu-Sheng; Sprong, Matthew Evan; Shrestha, Junu; Smeltzer, Matthew P.; Hollender, Heaven; Health Sciences, School of Health and Human SciencesBackground: Attention Deficit Hyperactivity Disorder (ADHD) is a mental health disorder that affects attention and behavior. People with ADHD frequently encounter challenges in social interactions, facing issues, like social rejection and difficulties in interpersonal relationships, due to their inattention, impulsivity, and hyperactivity. Methods: A National Longitudinal Survey of Youth (NLSY) database was employed to identify patterns of ADHD symptoms. The children who were born to women in the NLSY study between 1986 and 2014 were included. A total of 1,847 children in the NLSY 1979 cohort whose hyperactivity/inattention score was calculated when they were four years old were eligible for this study. A trajectory modeling method was used to evaluate the trajectory classes. Sex, baseline antisocial score, baseline anxiety score, and baseline depression score were adjusted to build the trajectory model. We used stepwise multivariate logistic regression models to select the risk factors for the identified trajectories. Results: The trajectory analysis identified six classes for ADHD, including (1) no sign class, (2) few signs since preschool being persistent class, (3) few signs in preschool but no signs later class, (4) few signs in preschool that magnified in elementary school class, (5) few signs in preschool that diminished later class, and (6) many signs since preschool being persistent class. The sensitivity analysis resulted in a similar trajectory pattern, except for the few signs since preschool that magnified later class. Children's race, breastfeeding status, headstrong score, immature dependent score, peer conflict score, educational level of the mother, baseline antisocial score, baseline anxious/depressed score, and smoking status 12 months prior to the birth of the child were found to be risk factors in the ADHD trajectory classes. Conclusion: The trajectory classes findings obtained in the current study can (a) assist a researcher in evaluating an intervention (or combination of interventions) that best decreases the long-term impact of ADHD symptoms and (b) allow clinicians to better assess as to which class a child with ADHD belongs so that appropriate intervention can be employed.Item The Best of Two Worlds to Promote Healthy Cognitive Aging: Definition and Classification Approach of Hybrid Physical Training Interventions(JMIR, 2024-07-31) Herold, Fabian; Theobald, Paula; Gronwald, Thomas; Kaushal, Navin; Zou, Liye; de Bruin, Eling D.; Bherer, Louis; Müller, Notger G.; Health Sciences, School of Health and Human SciencesA healthy lifestyle can be an important prerequisite to prevent or at least delay the onset of dementia. However, the large number of physically inactive adults underscores the need for developing and evaluating intervention approaches aimed at improving adherence to a physically active lifestyle. In this regard, hybrid physical training, which usually combines center- and home-based physical exercise sessions and has proven successful in rehabilitative settings, could offer a promising approach to preserving cognitive health in the aging population. Despite its potential, research in this area is limited as hybrid physical training interventions have been underused in promoting healthy cognitive aging. Furthermore, the absence of a universally accepted definition or a classification framework for hybrid physical training interventions poses a challenge to future progress in this direction. To address this gap, this article informs the reader about hybrid physical training by providing a definition and classification approach of different types, discussing their specific advantages and disadvantages, and offering recommendations for future research. Specifically, we focus on applying digital technologies to deliver home-based exercises, as their use holds significant potential for reaching underserved and marginalized groups, such as older adults with mobility impairments living in rural areas.Item Use of Practice-Based Research Networks in Massage Therapy Research(Massage Therapy Foundation, 2024) Zabel, Samantha; Munk, Niki; Health Sciences, School of Health and Human SciencesMassage therapy is a profession, not simply an intervention, and pathways are needed to connect all key massage therapy profession components—clinicians, patient/clients, and the work—to the scholarship and research that describes, investigates, and shapes practice. While the volume of massage-related research has grown over the past few decades, much of the growing massage evidence base is not reflective of real-world massage therapy, nor is research typically conducted through the clinical lens of the massage therapy discipline. This situation reflects the unfortunate disconnect between massage therapy research and massage therapy practice, while magnifying a key research infrastructure deficiency within the massage therapy discipline: the who and where research is conducted is disconnected from the who and where massage therapy is practiced. Practice-based research networks (PBRNs) are a staple of primary care and other health professions research reflecting real life, discipline-focused practice that seeks to address the needs of the discipline’s practitioners and patients. The PBRN model fits well with the directional need of massage therapy research. This paper presents a commentary on the use of PBRNs in massage therapy research, and the current state of PBRN research within the field of massage therapy, namely the recently launched MassageNet PBRN.Item Care ally-assisted massage for Veterans with chronic neck pain: TOMCATT results(Elsevier, 2024-07) Munk, N.; Daggy, J. K.; Slaven, J. E.; Evans, E.; Foote, T.; Laws, B.; Matthias, M. S.; Bair, M. J.; Health Sciences, School of Health and Human SciencesPurpose Chronic neck pain (CNP) is prevalent and challenging to treat. Despite evidence of massage's effectiveness for CNP, multiple accessibility barriers exist. The Trial Outcomes for Massage: Care Ally-Assisted vs. Therapist Treated (TOMCATT) study examined a care ally-assisted massage (CA-M) approach compared to a waitlist control prior to a study design modification (WL-C0). Methods CA-M consisted of in-person training for veteran/care-ally dyads to learn a standardized 30-minue massage routine, instructional DVD, and printed treatment manual. Participants were to complete three care ally-assisted massage sessions weekly for 12-weeks. Outcomes collected at baseline, 1-, 3-, and 6-months included validated measures of neck pain severity and associated disability. Linear mixed-model approaches were used for analysis with 3-months as the primary outcome timepoint. Results Participants (N = 203) were 56.7 ± 14 years old, 75% White, 15% female, and 75% married/partnered. Among 102 CA-M participants, 45% did not attend the in-person training and subsequently withdrew from the study and were more likely to be younger (p = .016) and employed (p = .004). Compared to WL-C0, CA-M participants had statistically significant reductions in pain-related disability at 3-months (−3.4, 95%CI = [−5.8, −1.0]; p = .006) and 6-months (−4.6, 95%CI = [−7.0, −2.1]; p < .001) and pain severity at 3-months (−1.3, 95%CI = [−1.9, −0.8]; p < .001) and 6-months (−1.0, 95%CI = [−1.6, −0.4]; p = .007), respectively. Conclusion In this analysis, CA-M led to greater reductions in CNP with disability and pain severity compared to WL-C0, despite treatment engagement and retention challenges. Future work is needed to determine how to better engage Veterans and their care-allies to attend CA-M training.Item The MassageNet revival: join this network and contribute to the future of your field(2023-01) Zabel, Samantha; Munk, Niki; Health Sciences, School of Health and Human SciencesItem Massage therapy in palliative care populations: a narrative review of literature from 2012 to 2022(AME, 2023-09) Cates, Cal; Jordan, Kerry; Munk, Niki; Farrand, Rory; Kennedy, Ann Blair; Groninger, Hunter; Health Sciences, School of Health and Human SciencesBackground and Objective: Patients living with serious illness are often eligible for palliative care and experience physical symptoms including pain or dyspnea and psychological distress that negatively impacts health-related quality of life and other outcomes. Such patients often benefit from massage therapy to reduce symptom burden and improve quality of life when such treatment is available. At present, no synthesis or review exists exploring massage therapy specifically provided with palliative care patient populations. This review is needed because those with serious illness are a growing and important vulnerable population. Massage therapy is used frequently and in many healthcare delivery contexts, but the body of research has not led to its systematic integration or broad acceptance. Methods: PubMed search for clinical research focused on massage therapy for palliative care-eligible populations from 2012 and 2022. Search terms included keywords: massage, massage therapy, serious illness, advanced illness, and palliative care. Key Content and Findings: Thirteen unique articles were identified through the PubMed database search and from a manual review of references. Study designs of included articles were one pilot, one quasi-experimental single-arm study, one mixed-methods study, two qualitative (both with hospital-based palliative care populations), seven randomized controlled trials, and one retrospective cohort analysis in a major Veterans Health Administration health care facility. Conclusions: Variability was found in study design, scope, sample size, and outcomes for related articles published in the last ten years. Few eligible interventions reflected real-world massage therapy delivery suggesting more clinical research is needed to examine massage provided by massage therapists trained to work with palliative care populations. Gaps in the current body of existing evidence supports the need for this review and recommendations for the direction of future related research.Item Latin Dance and Working Memory: The Mediating Effects of Physical Activity Among Middle-Aged and Older Latinos(Frontiers, 2022-04-15) Aguiñaga, Susan; Kaushal, Navin; Balbim, Guilherme M.; Wilson, Robert S.; Wilbur, JoEllen E.; Hughes, Susan; Buchner, David M.; Berbaum, Michael; McAuley, Edward; Vásquez, Priscilla M.; Marques, Isabela G.; Wang, Tianxiu; Marquez, David X.; Health Sciences, School of Health and Human SciencesBackground Physical activity (PA) is a promising method to improve cognition among middle-aged and older adults. Latinos are at high risk for cognitive decline and engaging in low levels of PA. Culturally relevant PA interventions for middle-aged and older Latinos are critically needed to reduce risk of cognitive decline. We examined changes in cognitive performance among middle-aged and older Latinos participating in the BAILAMOS™ dance program or a health education group and compared the mediating effects of PA between group assignment and change in cognitive domains. Methods Our 8-month randomized controlled trial tested BAILAMOS™, a 4-month Latin dance program followed by a 4-month maintenance phase. A total of 333 older Latinos aged 55+ were randomized to either BAILAMOS™, or to a health education control group. Neuropsychological tests were administered, scores were converted to z-scores, and specific domains (i.e., executive function, episodic memory, and working memory) were derived. Self-reported PA was assessed, and we reported categories of total PA, total leisure PA, and moderate-to-vigorous PA as minutes/week. A series of ANCOVAs tested changes in cognitive domains at 4 and 8 months. A mediation analysis tested the mediating effects of each PA category between group assignment and a significant change in cognition score. Results The ANCOVAs found significant improvement in working memory scores among participants in the dance group at month 8 [F(1,328) = 5.79, p = 0.017, d = 0.20], but not in executive functioning [F(2,328) = 0.229, p = 0.80, Cohen’s d = 0.07] or episodic memory [F(2,328) = 0.241, p = 0.78, Cohen’s d = 0.05]. Follow-up mediation models found that total PA mediated the relationship between group assignment and working memory, in favor of the dance group (β = 0.027, 95% CI [0.0000, 0.0705]). Similarly, total leisure PA was found to mediate this relationship [β = 0.035, 95% CI (0.0041, 0.0807)]. Conclusion A 4-month Latin dance program followed by a 4-month maintenance phase improved working memory among middle-aged and older Latinos. Improvements in working memory were mediated by participation in leisure PA. Our results support the current literature that leisure time PA influences cognition and highlight the importance of culturally relevant PA modalities for Latinos. Clinical Trial Registration [www.ClinicalTrials.gov], identifier [NCT01988233].Item Benefits of Higher Cardiovascular and Motor Coordinative Fitness on Driving Behavior Are Mediated by Cognitive Functioning: A Path Analysis(Frontiers Media, 2021-06-29) Stojan, Robert; Kaushal, Navin; Bock, Otmar Leo; Hudl, Nicole; Voelcker-Rehage, Claudia; Health Sciences, School of Health and Human SciencesDriving is an important skill for older adults to maintain an independent lifestyle, and to preserve the quality of life. However, the ability to drive safely in older adults can be compromised by age-related cognitive decline. Performing an additional task during driving (e.g., adjusting the radio) increases cognitive demands and thus might additionally impair driving performance. Cognitive functioning has been shown to be positively related to physical activity/fitness such as cardiovascular and motor coordinative fitness. As such, a higher fitness level might be associated with higher cognitive resources and may therefore benefit driving performance under dual-task conditions. For the first time, the present study investigated whether this association of physical fitness and cognitive functioning causes an indirect relationship between physical fitness and dual-task driving performance through cognitive functions. Data from 120 healthy older adults (age: 69.56 ± 3.62, 53 female) were analyzed. Participants completed tests on cardiovascular fitness (cardiorespiratory capacity), motor coordinative fitness (composite score: static balance, psychomotor speed, bimanual dexterity), and cognitive functions (updating, inhibition, shifting, cognitive processing speed). Further, they performed a virtual car driving scenario where they additionally engaged in cognitively demanding tasks that were modeled after typical real-life activities during driving (typing or reasoning). Structural equation modeling (path analysis) was used to investigate whether cardiovascular and motor coordinative fitness were indirectly associated with lane keeping (i.e., variability in lateral position) and speed control (i.e., average velocity) while dual-task driving via cognitive functions. Both cardiovascular and motor coordinative fitness demonstrated the hypothesized indirect effects on dual-task driving. Motor coordinative fitness showed a significant indirect effect on lane keeping, while cardiovascular fitness demonstrated a trend-level indirect effect on speed control. Moreover, both fitness domains were positively related to different cognitive functions (processing speed and/or updating), and cognitive functions (updating or inhibition), in turn, were related to dual-task driving. These findings indicate that cognitive benefits associated with higher fitness may facilitate driving performance. Given that driving with lower cognitive capacity can result in serious consequences, this study emphasizes the importance for older adults to engage in a physically active lifestyle as it might serve as a preventive measure for driving safety.Item Therapist-Delivered Versus Care Ally–Assisted Massage for Veterans With Chronic Neck Pain: Protocol for a Randomized Controlled Trial(JMIR, 2022-09-27) Munk, Niki; Daggy, Joanne K.; Evans, Erica; Kline, Matthew; Slaven, James E.; Laws, Brian; Foote, Trevor; Matthias, Marianne S.; Bair, Matthew J.; Health Sciences, School of Health and Human SciencesBackground: Chronic neck pain (CNP) is prevalent, and it reduces functional status and quality of life and is associated with deleterious psychological outcomes in affected individuals. Despite the desirability of massage and its demonstrated effectiveness in CNP treatment, multiple accessibility barriers exist. Caregiver-applied massage has demonstrated feasibility in various populations but has not been examined in Veterans with CNP or compared in parallel to therapist-delivered massage. Objective: This manuscript described the original study design, lessons learned, and resultant design modifications for the Trial Outcomes for Massage: Care Ally-Assisted Versus Therapist-Treated (TOMCATT) study. Methods: TOMCATT began as a 3-arm, randomized controlled trial of 2 massage delivery approaches for Veterans with CNP with measures collected at baseline, 1 and 3 months after intervention, and 6 months (follow-up). Arm I, care ally-assisted massage, consisted of an in-person, 3.5-hour training workshop, an instructional DVD, a printed treatment manual, and three 30-minute at-home care ally-assisted massage sessions weekly for 3 months. Arm II, therapist-treated massage, consisted of two 60-minute sessions tailored to individual pain experiences and treatments per week for 3 months. The treatments followed a standardized Swedish massage approach. Arm III consisted of wait-list control. Results: Retention and engagement challenges in the first 30 months were significant in the care ally-assisted massage study arm (63% attrition between randomization and treatment initiation) and prompted modification to a 2-arm trial, that is, removing arm I. Conclusions: The modified TOMCATT study successfully launched and exceeded recruitment goals 2.5 months before the necessary COVID-19 pause and is expected to be completed by early 2023.Item How and Why Patients Adhere to a Prescribed Cardiac Rehabilitation Program: A Longitudinal Phenomenological Study of Patients with Acute Coronary Syndrome(MDPI, 2022-01-28) Kaushal, Navin; Nemati, Donya; Gauthier-Bisaillon, Raphaëlle; Payer, Marie; Bérubé, Béatrice; Juneau, Martin; Bherer, Louis; Health Sciences, School of Health and Human SciencesBackground: Adherence to cardiac rehabilitation remains a challenge despite established evidence that engaging in regular exercise is a strong preventive measure to experiencing a second cardiac event. A recent study found a six-month cardiac rehabilitation program to be effective for facilitating regular exercise behavior among patients diagnosed with acute coronary syndrome. The purpose of this study was to conduct a phenomenological investigation using Colaizzi’s descriptive technique to understand mechanisms responsible for behavior change. Methods: Data were collected and analyzed among patients with acute coronary syndrome at a cardiac rehabilitation using semi-structured interviews that were conducted over the phone across three months. Conclusion: Thematic analysis of 15 semi-structured interviews resulted in 124 statements that were analyzed. The data yielded seven themes that included “motivation to follow prescribed exercise program”, “volitional decision”, “capability of performing exercise”, “connectedness to peers”, “planning”, “habit formation”, and “adopting healthy behaviors beyond exercise”. The emerged themes align with construct definitions of the self-determination theory, which include the three psychological needs (autonomy, competence, and relatedness), in addition to autonomous motivation, which represents internally driven reasons to participate in exercise. Planning and habit formation themes support contemporary research that identifies these constructs responsible for behavioral maintenance. While these themes help explain exercise participation, the final theme, adopting healthy behaviors beyond exercise, reflects the impact of the program on having a change towards a healthier lifestyle. The findings highlight the complexity of exercise behavior, and that long-term participation is likely explained by amalgamating the self-determination theory.