Journal of Medical Internet Research - International Scientific Journal for Medical Research, Information and Communication on the Internet #Preprint #PeerReviewMe: Warning: This is a unreviewed preprint. Readers are warned that the document has not been peer-reviewed by expert/patient reviewers or an academic editor, may contain misleading claims, and is likely to undergo changes before final publication, if accepted, or may have been rejected/withdrawn. Readers with interest and expertise are encouraged to sign up as peer-reviewer, if the paper is within an open peer-review period. Please cite this preprint only for review purposes or for grant applications and CVs (if you are the author). Background: People with Multiple Sclerosis (MS) face varying levels of disability and symptoms, thus requiring highly trained therapists and/or exercise trainers to design personalized exercise programs. However, for people living in geographically isolated communities, access to such trained professionals can be challenging due to a number of barriers associated with cost, access to transportation and travel distance. Generic mHealth exercise apps often fall short of what people with MS need to become physically active (i.e., exercise content that has been adapted to accommodate a wide range of functional limitations). Objective: This usability study describes the development process of the TEAMS (Tele-Exercise and Multiple Sclerosis) app, which is being used by people with MS in a large randomized controlled trial (RCT) to engage in home-based telerehabilitation. Methods: Twenty-one participants with disabilities (10 people with MS) were involved in the double iterative design, which included the simultaneous development of the app features and exercise content (exercise videos and articles). Framed within a user-centered design (UCD) approach, the development process included two stages: ground-level creation (focus group followed by early stage evaluations and developments), and proof of concept through two usability tests. Usability (effectiveness, usefulness, and satisfaction) was evaluated through a mixed methods approach. Results: Regarding app effectiveness, the second usability test resulted in an average of one problem per participant, a decrease of 53% compared to the initial usability test. Five themes were constructed from the qualitative data that related to usefulness and satisfaction: high perceived confidence for app usability, positive perceptions of exercise videos, viable exercise option at home, orientation and familiarity required for successful participation, and app issues. Participants acknowledged that the final app was ready to be delivered to the public after minor revisions. After including these revisions, the project team released the final app that is being used in the RCT. Conclusions: A multi-level user-centered development process resulted in an inclusive exercise program for people with MS operated through an easy-to-use app. The promotion of exercise through self-regulated mHealth programs requires a stakeholder-driven approach to app development. This ensures that app and content match the preferences and functional abilities of the end user (i.e., people with varying levels of MS).

Background: This review explored the sustainability of health and physical activity-based outcomes following exercise trials that were conducted for people with disabilities, and characterised the influence of technology and behaviour change strategies. Methods: A total of 132 studies were screened from an existing database. Results: Only 22 studies featured follow-up periods and met eligibility criteria. At follow-up, studies typically reported at least one significant health outcome that was maintained (n = 18/21; 86%). However, significant health outcomes accounted for only 32% of the total volume of outcomes that were measured at follow-up. For physical activity-based outcomes, six studies (n = 6/8; 75%) reported that intervention gains were maintained throughout follow-up. The incorporation of technology or behaviour change strategies appeared to be linked with sustainable intervention effects. Conclusions: Overall, some evidence demonstrated that post-intervention effects were sustainable. However, the strength of the evidence was weak and several existing gaps in knowledge were identified. Moreover, most studies did not focus on sustainability, but instead emphasised short-term effects of exercise participation on health and physical activity outcomes. Study findings call for greater research and programme efforts to maintain health, function, and physical activity behaviour after supports provided by research studies are removed.

Context:Previous literature has theorized that alterations in shoulder physical characteristics are present in wheelchair athletes and contribute to shoulder pain and injury. Limited empirical evidence is present that evaluates the effectiveness of a shoulder injury prevention program focusing on improving these altered characteristics.Objective:To evaluate the effectiveness of a 6-week intervention program at improving characteristics that increases the risk of developing pain or shoulder injury.Design:Pretest and posttest.Setting:Home-based and controlled laboratory.Participants:Seven college wheelchair athletes.Interventions:Shoulder range of motion (ROM) and scapular muscle strength were assessed, and a 5-minute injury prevention program was taught to participants. Participants completed the intervention 3 times per week for 6 weeks. Following completion of the program, a postintervention screening was performed.Main OutcomeMeasures:Internal rotation (IR)/external rotation (ER) ROM, retraction strength, and IR/ER strength.Results:Participants experienced a significant improvement in dominant limb shoulder IR ROM (t₆ = 3.56,P = .01) with an average increase of 11.4° of IR ROM and a significant improvement in dominant limb shoulder ER ROM (t₆ = 2.79,P = .03) with an average increase of 8.0° of ER ROM. There were no significant increases in shoulder IR or ER strength and scapular retraction strength (P > .05).Conclusions:Improvements in ROM have previously been linked to decreases in shoulder pain and injury in other upper-extremity dominant sports by improving scapular kinematics. These results provide evidence that a 6-week strengthening and stretching intervention program may decrease risk factors for shoulder injury in wheelchair basketball athletes.

The unmet need for dental care is one of the greatest public health problems facing U.S. children. This issue is particularly concerning for children with special health care needs (CSHCN), who experience higher prevalence of unmet dental care needs. The primary purpose of this study was to investigate regional differences in unmet dental care needs for CSHCN. Using the Social Ecological Model as a framework, additional variables were analyzed for regional differences. It was hypothesized that (H1) unmet dental care needs would be high in the CSHCN population, (H2) there would be regional differences in unmet dental care needs in CSHCN, and (H3) there would be differences in specific individual, interpersonal (family), community (state), and policy level factors by region. Data were obtained from the 2009-2010 National Survey of CSHCN. SPSS was used for data management and analysis. Each of the study hypotheses was supported for the sample of 40,242 CSHCN. The West region was more likely to have more unmet needs for preventive and specialized dental care in CSHCN than the reference region (Northeast). The South region followed the West region in unmet dental care needs. Statistically significant differences in individual, interpersonal (family), community (state) and policy factors were found by region. Further research is recommended. Effective strategies that include policy to address unmet dental care needs at multiple levels of intervention are suggested.

People with physical disabilities (PWD) experience several unique challenges that prevent them from participating in onsite exercise programs. Although mobile apps can provide a ubiquitous channel for delivering convenient exercise services within the community, no exercise apps have been designed for people with disabilities who experience certain functional limitations. The aim of this study was to examine the usability of a mobile exercise app in PWD. A sequential explanatory mixed-method design was used to holistically test usability in 4 core areas: effectiveness (ie, ease of use), efficiency (ie, operation speed), perceived satisfaction, and usefulness. Participants completed 7 face-to-face usability tasks and 1 structured interview. Equipment included a computer tablet that came preinstalled with the exercise app. The app included exercise videos that focused on several components of fitness: aerobic capacity, muscular strength, functional strength or balance, and range of motion. The app contained 3 different versions of the exercise program: (1) a program for people with the ability to use the upper and lower limbs, (2) a seated program for people with the ability to use only upper limbs, and (3) a program designed for people with hemiparesis. The app also included educational resources in the form of infographics aimed at addressing key social cognitive theory constructs included social support, outcome expectancies, self-efficacy, and barriers or facilitators to exercising. Participant characteristics and quantitative usability data were descriptively reported. Qualitative data were analyzed using thematic analysis. A total of 12 PWD tested the usability of the exercise app and completed 96% (69/72) of the usability tasks on the first attempt. Operation speed varied among users, which prompted the development team to make minor revisions to the app. Qualitative results demonstrated 3 overarching themes: facilitates exercise adoption, positive experiences of videos, and easy to learn. Participants noted that the app circumvented several barriers to exercise associated with leaving the home (eg, inclement weather conditions, exacerbations of health conditions or disability symptoms, difficulties with transportation, and social support). The mobile exercise app provided a simple platform that was effective, useful, and appreciated by PWD. Participants also perceived the app as easy to use and felt it was a valuable tool for assisting PWD to obtain regular exercise. Study findings also offered insight into the participants' preferences for mobile exercise apps that can aid future research and development projects. Future exercise trials are needed to determine the true impact of mobile app technology on lifestyle physical activity in people with disabilities. Clinicaltrials.gov NCT03024320; https://clinicaltrials.gov/ct2/show/NCT03024320 (Archived by WebCite at http://www.webcitation.org/75hNLgRFH).