Table of Contents:

Introduction

Missouri Foundation for Health Protocol

Exercise Programs and Health Promotion for Unserved and Underserved People with Mobility Impairments Grant

Missouri Foundation for Health

INTRODUCTION

Individuals who use mobility devices are in poorer health than individuals who do not use mobility devices and they do not receive health services relevant to their specific needs. People with mobility impairments (PWMI) are more vulnerable to secondary conditions by virtue of an underlying condition.1,2 Secondary conditions are those physical, medical, cognitive, emotional, or psychosocial conditions that often result in adverse outcomes in health, wellness, participation, and quality of life. For PWMI early detection and treatment of secondary conditions is essential for their participation in everyday life. Yet, access to healthcare and providers trained to prevent and treat secondary conditions are major problems for people with disabilities.3,4 The lack of access to healthcare promotion opportunities and inaccessible healthcare and exercise facilities are major barriers to health maintenance for people with disabilities.5,6

Few community based health promotion programs focus directly on the overall health and prevention of the secondary conditions experienced by PWMI. Several community based programs have been established to target the causes of some secondary conditions (including exercise and nutrition health promotion programs). However, these programs “often present physical, attitudinal and knowledge barriers that limit participation by those with disabilities” that greatly reduce individuals with disabilities ability to engage in health-promoting behaviors.7,8,9 In addition, mobility impairments and limitations are often related to a difficulty in maintaining good health due to a lack of exercise and health information.

Paraquad and Washington University are collaborating together on a project funded by the Missouri Foundation for Health entitled, “Exercise Programs and Health Promotion for Unserved and Underserved People with Mobility Impairments”. The Enabling Mobility Center (EMC) located in University City is a community facility where seminars, Health Handbook education and an accessible fitness program will be offered. The programs are free of charge to participants and transportation to and from the EMC will be provided to qualified participants.

Participants

Recruitment:

The Enabling Mobility Center (EMC) will work directly with 400 people with mobility impairments (PWMI) who use mobility devices to develop health management handbooks and exercise programs. The program participants will be drawn from the greater St. Louis metropolitan area (targeted areas include University City, North County, and South County) which is estimated to have between 40,000 to 50,000 PWMI who use mobility devices. Project participants will be referred from Paraquad (serving approximately 4,000 people with disabilities), Family Care Health Centers, Health Protection and Education Services program, private physicians and other allied healthcare professionals. Clients of the Enabling Mobility Center will be invited to participate as well. New participants will be recruited through Paraquad newsletter, mailings and events such as vendor demonstrations at the Enabling Mobility Center.

Inclusion Criteria:

To be included in the study, the person must have a mobility impairment and limitation requiring the use of a power wheelchair, manual wheelchair, scooter, or a cane(s), crutch(s), or walker. Persons must be over the age of 18. The person must live in St. Louis City or the surrounding areas.

Exclusion Criteria:

Individuals who do not meet the inclusion criteria or who are currently institutionalized will be excluded. The presence of serious cognitive impairments (e.g., severe traumatic brain injury, dementia) that prohibit the individual from giving consent or serious health conditions (e.g., cardiovascular disease or heart disease) that would confound responses with regard to mobility limitations will also be excluded.

Participant Payment:

Participants will not receive any financial compensation. Qualified participants that request assistance with transportation to and from our facility will receive assistance.
Each assessment period will include completing a survey and fitness tests. Participants will have the option to participate in a 12 week EMC Exercise or In Home Exercise program free of charge.

Procedures

Initial Health and Exercise Education Session:

Participants in groups of six to twelve will attend a 1-2 hour workshop in which they will be oriented to the services of the EMC and Paraquad and will be educated on the benefits and importance of monitoring their own health and wellness. Participants will hear from a peer that has prior experience and knowledge about accessible exercise and will be able to ask questions related to exercise, health and wellness. At the initial Health and Exercise Education Session, participants will fill out a survey, be assisted with filling out health history forms that will go into their own personal health handbook and be given a tour of the EMC. The health history forms and survey will be used to establish a baseline measure of secondary conditions. Health handbooks with general health information and specific information materials on relevant secondary conditions have been developed in conjunction with Washington University’s residents in physical medicine and rehabilitation, exercise peers and project collaborators. Participants will receive education on how to utilize the health handbooks and an orientation to the materials in the health handbook. Project participants will be trained to record the number and severity of secondary conditions in their individualized health handbooks. The type and duration of treatment for any occurrence of secondary conditions and the health related expenses will be requested from both the participant and their healthcare providers for entry into their handbook. Participants will be educated on the benefits of preventing secondary conditions, maintaining healthy behaviors and the benefits of regular exercise. Participants will be given opportunities to ask questions regarding the project and handbook at the workshop. The participants will also be weighed on an accessible scale and when applicable will receive pressure mapping and/or a short assessment with a SmartWheel which is a computerized wheel that goes on a manual wheelchair in place of one of the participant’s usual wheels and gives computer readouts of push forces and speed while the participant does various tasks. See Table 1 for detailed breakdown of Health and Education Session.

when appropriate to condition - @

Selection of type of participation in programs offered:

Participants may choose between 3 options: a) Health Handbook education only (no exercise), b) Health Handbook education and EMC Exercise or c) Health Handbook education and In Home Exercise. All participants will receive Health Handbook education and complete a survey during their first visit to the EMC. Participants who indicate interest in exercise will have an option to select either a 12-week exercise program offered at the EMC or a personalized In Home Exercise Program. Participants involved in either exercise program will complete an initial baseline exercise assessment. During this initial assessment, 1-2 members of the research staff will be present to ensure the participant’s safety. Participants will be given the option to begin the exercise programs following completion of the Missouri Foundation for Health (MFH) health conditions survey and Health Handbook education. While the participant is at the EMC, a member of the research staff will perform a short screening to verify the participant’s ability to perform the exercises.

Surveys and evaluations:

All participants will complete a survey prior to or on their visit to the EMC for the Initial Health and Exercise Education Session. Participants will be asked questions about demographics, frequency of visiting healthcare providers, frequency and severity of secondary conditions, health status (physical and mental), exercise habits and questions about participation and mobility. Participants will be monitored every 3 months for 1 year via telephone survey or web based survey. These follow up surveys will be administered to participants for the purpose of measuring change over time in secondary conditions, health status, exercise habits and participation and mobility. See Table 2 for detailed breakdown of the EMC MFH Health Survey.
Participants will also be surveyed every 3 months for 1 year regarding their usage of health handbooks via telephone or Internet based survey.