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It is a steep challenge to fully implement the wide range of evidence that supports rehabilitation interventions for the prevention of chronic disease. Proactive physical activity (PA) promotion can lead to increased PA levels to improve and maintain physical function. Higher levels of PA throughout the lifespan lead to better overall population health, wellness, aging, disease prevention, and chronic condition management. This article introduces the Wellness Aging Model related to Inactivity, Illness, and Injury (WAMI-3) as a simple visual tool to educate patients on the importance of PA and exercise for primary, secondary, and tertiary prevention. As a clinical construct, the WAMI-3 can be applied to all body systems affected by aging, inactivity, illness, and/or injury and exemplifies the concept of Exercise is Medicine®. The WAMI-3 framework is intended for easy integration into clinical practice; a clinician-friendly resource, based on health promotion, is provided to serve as a catalyst for enhancing the patient interview and education on the importance of PA and exercise. Video Abstract available: For more insight from the authors, see Supplemental Digital Content 1 (available at: http://links.lww.com/JGPT/A115).

Background Yoga is a meditative movement therapy focused on mind‐body awareness. The impact of yoga on health‐related quality of life (HRQOL) outcomes in patients with chemotherapy‐induced peripheral neuropathy (CIPN) is unclear. Methods We conducted a pilot randomized wait‐list controlled trial of 8 weeks of yoga (n = 21) versus wait‐list control (n = 20) for CIPN in 41 breast and gynecological cancer survivors with persistent moderate to severe CIPN. HRQOL endpoints were Hospital Anxiety and Depression Scale (HADS), Brief Fatigue Inventory (BFI), and Insomnia Severity Index (ISI). The Treatment Expectancy Scale (TES) was administered at baseline. We estimated mean changes and 95% confidence intervals (CIs) from baseline to weeks 8 and 12 and compared arms using constrained linear mixed models. Results At week 8, HADS anxiety scores decreased −1.61 (−2.75, −0.46) in the yoga arm and −0.32 (−1.38, 0.75) points in the wait‐list control arm (p = 0.099). At week 12, HADS anxiety scores decreased −1.42 (−2.57, −0.28) in yoga compared to an increase of 0.46 (−0.60, 1.53) in wait‐list control (p = 0.017). There were no significant differences in HADS depression, BFI, or ISI scores between yoga and wait‐list control. Baseline TES was significantly higher in yoga than in wait‐list control (14.9 vs. 12.7, p = 0.019). TES was not associated with HADS anxiety reduction and HADS anxiety reduction was not associated with CIPN pain reduction. Conclusions Yoga may reduce anxiety in patients with CIPN. Future studies are needed to confirm these findings. Clinical Trial Registration Number: ClinicalTrials.gov Identifier: NCT03292328., The impact of yoga on health‐related quality of life (HRQOL) outcomes in patients with chemotherapy‐induced peripheral neuropathy (CIPN) is unclear. We conducted a pilot randomized wait‐list controlled trial of 8 weeks of yoga versus wait‐list control for CIPN in breast and gynecological cancer survivors with persistent moderate to severe CIPN. Our results showed a trend for yoga to decrease anxiety, but not Hospital Anxiety and Depression Scale depression scores, Brief Fatigue Inventory, or the Insomnia Severity Index, at weeks 8 and 12 compared to wait‐list control; future studies are needed to confirm these findings.

Background Women with substance use disorders (SUD) receive medication-assisted treatment (MAT) with behavioral interventions and counseling for recovery. Evidence supports the use of yoga for SUD; however few studies specifically feature women. Objectives Community-based yoga may add to health promotion through preferable physical activity for women in recovery. The aims of this study are to explore demographics and quantitative measures relevant to recovery and capture and understand the subjective experience of one session of yoga. Study design The study design involves Descriptive/Cross-sectional. Methodology Women in an inpatient SUD center attending weekly optional off-site yoga for recovery were recruited to capture first-time attendance. Survey data included Medical Outcomes Survey 12-item short-form (SF-12), Toronto Mindfulness Scale (TMS), and Brief Resilience Scale (BRS), demographics, and narrative reflections. Recruitment opportunities occurred weekly during ongoing hour-long classes. Results Twenty-nine women (average age 36.6) with primarily opiate-based addictions completed surveys. SF-12 was below the normative value of 50 for both subscales. BRS scores showed averages on the low end of normal resiliency. The frequency of responses to writing prompts confirmed physical and mental well-being through yoga intervention. Women shared potential relapse prevention specifically attributed to the mindfulness component of the intervention. Conclusion The SF-12, BRS, and TMS are brief, valid, and reliable and can be easily incorporated in clinical practice or future research. Suboptimal SF-12 scores were found in women with SUD and, therefore important to note in the context of recovery to optimize treatment. Subjective reports from the participants find community-based yoga an enjoyable and beneficial type of physical activity. Yoga may be a viable option for comprehensive mind-body intervention for this population.

Using a Survey to Characterize Rehabilitation Professionals' Perceptions and Use of Complementary, Integrative, and Alternative Medicine

Purpose Nationwide, upward trends exist in student issues with anxiety, stress, depression, and lowered classroom performance. As emotional awareness and emotional regulation skills are typically not addressed in professional discipline-specific courses, students experience challenges in their academic performance. This pilot research explored the effect of brief targeted classroom practices within an empowerment-based framework on domains of emotional intelligence. Method Twenty-two students in an undergraduate speech-language pathology class received a 13-week, biweekly, 15-min session of empowerment-based worksheet exercises to develop increased self-esteem, emotional awareness and regulation, and communication. Assessments of self-esteem, emotional intelligence, communication competence, and communication apprehension were conducted using validated scales, namely, the Rosenberg Self-Esteem Scale ( Rosenberg, 1965 ), the Quick Emotional Intelligence Self-Assessment ( Mohapel, 2015 ), the Self-Perceived Communication Competence Scale ( McCroskey & McCroskey, 2013 ), and the Personal Report of Communication Apprehension ( McCroskey, 1982 ), respectively. Midsemester and semester-end student reflections were collected. Results Paired t tests were significant in self-esteem and emotional quotient, including subdomains of emotional awareness, emotional management, social emotional awareness, and relational management. Significance was noted in communication competence in the subdomains of dyad interaction, stranger interaction, and acquaintance. Students' reflection showed significant improvement in empowerment and self-rated improvements in confidence, communication, connections with peers, and trust with instructor. Conclusion Preliminary evidence demonstrates positive outcomes with integration of intentional classroom exercises to build emotional intelligence (including emotional awareness and regulation), self-esteem, and communication. This empowerment model may assist faculty in developing effective pedagogical strategies to build students' self-resiliency.

BACKGROUND Health coaching promotes healthy lifestyles and may be particularly helpful for employees with chronic disease. OBJECTIVE Evaluate the effects of a health coaching program that targeted health-system employees with at least one cardiovascular disease (CVD) risk factor. METHODS Fifty-four employees volunteered for a health coaching program (6-session, 12-week program, at least one cycle). 40 (74%) completed (mean age [SD] = 53.3 [10.3] years, Female = 95%, Caucasian = 83%). A certified and integrative health coach/nutritionist provided coaching. Self-reported outcomes were collected using a pre-post design. RESULTS Participants reported high rates of obesity (75%), hypertension (52.5%), diabetes/prediabetes (47.5%), and hyperlipidemia (40%). In addition, 20% reported chronic pain/rehabilitation needs, 17.5% seasonal depression, and 30% other significant co-morbidities. Following coaching, participants reported significant weight loss (mean [SD] 7.2 [6.6] pounds, p

The purpose of this interdisciplinary educational experience was to explore dynamic interaction between student dancers and graduate physical therapy students in a structured learning environment ...

Routine exercise has been established as an effective way to improve overall health. The value of exercise has been established in many diseases, however, there are no studies investigating the impact of exercise for individuals with primary immunodeficiency disease (PID). The purpose of this study was to investigate exercise perceptions and behaviors in individuals diagnosed with PID. An online survey was distributed over a four-week period. Of the 264 responses collected, most were females, 45–54 years old. Respondents reported a measurable loss of function impairing their daily activities due to loss of mobility/physical activity (41.32%), or loss of lung/pulmonary function (40.08%,). They felt exercise decreased stress level and improved their mental well-being (46.25%). Some indicated they participate in exercise (33.20%), while 36.84% had not participated in exercise for at least 1 year. Exercise was limited primarily due to fatigue (86.97%). Exercise is important for those with chronic medical conditions. Most individuals living with PID can participate in low/moderate physical activity, but struggle with vigorous physical activity, since fatigue is the greatest barrier. Respondents view exercise as beneficial, and would like to increase participation in an exercise program.

Women at elevated risk for breast cancer are motivated to reduce their risk. Current approaches rely primarily on hormonal intervention. A preventive exercise intervention might address the same hormonal issues, yet have fewer serious side effects and less negative impact on quality of life as compared to prophylactic mastectomy. WISER Sister was a randomized controlled trial which examined effects of two doses of exercise training on endogenous sex hormone exposure, hormonally active breast tissue, and other breast cancer risk factors.Subjects for this single site trial were recruited from across the U.S., in collaboration with organizations that serve women at elevated risk, via emails, flyers, and letters. Eligibility criteria included age ≥ 18, eumenorrheic, and at elevated risk for breast cancer (e.g. BRCA1 or BRCA2 mutation and/or ≥ 18% lifetime risk according to prediction models). A 1:1:1 randomization scheme was used to allocate participants into: control, low dose (150 min/week), or high dose (300 min/week) home based treadmill exercise. Participants provided first morning urine samples daily for two menstrual cycles at study beginning and end for calculation of endogenous hormone exposure. In addition, women completed breast dynamic contrast enhanced magnetic resonance imaging, a fasting blood draw, a treadmill exercise test, and surveys at baseline and follow-up.WISER Sister randomized 139 women, 122 of whom completed the study. The overall drop-out rate was 12%. Findings will be useful in understanding the potential for exercise to assist with reducing risk for breast cancer among women at elevated risk.

Background Distal sensory polyneuropathy (DSP) is a common complication of HIV disease. Its effects on quality of life (QOL) and function have not been well described. Objective The study objectives were: (1) to compare QOL and lower extremity function in people with HIV-related DSP and people with HIV disease who do not have DSP, (2) to determine the extent to which function predicts QOL, (3) to evaluate the agreement of 2 function scales, and (4) to describe the use of pain management resources. Design This was a cross-sectional survey study with predictive modeling and measurement tool concordant validation. Methods A demographic questionnaire, the Medical Outcomes Study HIV Health Survey, the Lower Extremity Functional Scale (LEFS), the Lower Limb Functional Index (LLFI), and a review of medical records were used. General linear modeling was used to assess group differences in QOL and the relationship between function and QOL. Bland-Altman procedures were used to assess the agreement of the LEFS and the LLFI. Results Usable data for analyses were available for 82 of the 94 participants enrolled. The 67% of participants who reported DSP symptoms tended to be older, had HIV disease longer, and were more likely to receive disability benefits. Participants without DSP had better LLFI, LEFS, and physical health summary scores. In multivariate models, lower limb function predicted physical and mental health summary scores. The LLFI identified participants with a lower level of function more often than the LEFS. Participants with DSP were more likely to use medical treatment, physical therapy, and complementary or alternative treatments. Limitations A sample of convenience was used; the sample size resulted in a low power for the mental health summary score of the Medical Outcomes Study HIV Health Survey. Conclusions Quality of life and function were more impaired in participants with HIV disease and DSP. The LLFI was more likely to capture limitations in function than the LEFS. Participants with DSP reported more frequent use of pain management resources.

Background:Patients with head and neck cancer (HNC) often experience significant postoperative limitations in shoulder function and ability to participate in daily activities due to spinal accessory nerve (SAN) damage. Physical therapists must use valid and reliable outcome measures to quant

This excerpt was created in the absence of an abstract . highlights the findings and application of Cochrane reviews and other evidence pertinent to the practice ofphysical therapy. The Cochrane Library is a respected source of reliable evidence related to health care. Cochrane systematic reviews explore the evidence for and against the effectiveness and appropriateness of interventions—medication, surgery, education, nutrition, exercise—and the evidence for and against the use of diagnostic tests for specific conditions. Cochrane reviews are designed to facilitate the decisions of clinicians, patients, and others in health care by providing a careful review and interpretation of research studies published in the scientific literature.1 Each article in this PTJ series summarizes a Cochrane review or other scientific evidence on a single topic and presents clinical scenarios based on real patients or programs to illustrate how the results of the review can be used to directly inform clinical decisions. This article focuses on a woman with a diagnosis of breast cancer who underwent a modified radical mastectomy with a sentinel lymph node biopsy. She subsequently received chemotherapy and radiation therapy and required episodic physical therapy to decrease impairments and improve functional limitations. Could an exercise program for the upper limb delivered preoperatively and postoperatively and along the trajectory of adjuvant chemotherapy and radiation therapy help reduce shoulder and upper extremity impairments?

Neuromuscular electrical stimulation (NMES) has been shown to be an eff ective technique to strengthen muscle following musculoskeletal injury or surgery. A limitation of NMES is the discomfort caused by the strong electrical contractions required for eff ective strength gains. This article explores whether the application of cryotherapy over muscle aff ects the ability of the muscle to contract in response to NMES and whether the reduction in discomfort of the stimulus enables greater force production. Eleven studies that met the inclusion criteria were reviewed. This review found that short-duration application of cryotherapy can improve tolerance to strong contractions elicited by NMES for muscle strengthening; however, longerduration applications may aff ect muscle force production. More studies are needed to determine the eff ect of cryotherapy on force production of muscle during NMES and whether greater increases in strength can be achieved. Neuromuscular electrical stimulation (NMES) is a widely used intervention for rehabilitation of weak or damaged muscle. Studies support the use of this technique for strengthening muscle following ligament repairs of the knee and total knee joint arthroplasties.1-4 The typical clinical approach is to place electrodes on the skin overlying the motor points of the muscle, which are usually defi ned as the location over the muscle where the motor nerve to the muscle is most accessible. The intensity of the stimulation depends on the amplitude, duration, and frequency of the electrical pulses, or bursts. A high-amplitude, longpulse duration stimulus is required to achieve a contraction that is at least 50% of maximal voluntary contraction (MVC). This stimulus may not be tolerated by the patient. Farquhar and Snyder-Mackler5 identifi ed patient discomfort as the limiting factor in using NMES in clinical settings, especially “when high contractile forces are sought for strength training regimens.” Most clinical uses of NMES are for strengthening of weak or injured muscle. The use of NMES for uninjured individuals is uncommon because strength gains can be achieved by exercise programs without the use of NMES. Patient tolerance to NMES for muscle strengthening depends primarily on the type of electrical current chosen for the treatment and the patient’s pain coping style.5 Some patients can tolerate burst mode alternating current (Russian stimulation) NMES, whereas other patients prefer biphasic pulsed NMES. Pain coping style varies from those patients who focus on the discomfort of NMES and those who focus on the benefi ts of the treatment and are willing to tolerate discomfort. Patients who focus on the discomfort of NMES require a blunting strategy to decrease their perception of pain. Strategies for blunting the perception of pain can include distraction by listening to music or interventions that interrupt nociception to the central nervous system. Modalities such as cryotherapy applied during or prior to NMES may be an effective blunting strategy; however, decreasing the temperature of tissues overlying a muscle or of the muscle itself may affect the ability of NMES to achieve a muscle contraction. The effect of Dr Nolan and Dr Galantino are from the Physical Therapy Program, School of Health Sciences, The Richard Stockton College of New Jersey, Galloway; and Dr Buccafurni is from Fox Rehabilitation, Northfi eld, New Jersey. Received: January 4, 2011 Accepted: June 12, 2012 Posted Online: January 2, 2013 The authors have no fi nancial or proprietary interest in the materials presented

Purpose Adjuvant chemotherapy for women with breast cancer has significantly improved the cure rate; however, it has been associated with chemotherapy-related cognitive impact (CRCI). The literature provides preliminary support for the feasibility and efficacy of yoga interventions for the general cancer population, however, controlled trials are scarce and no studies have examined the effect of yoga on cognition for women with breast cancer during chemotherapy. This case series aims to identify the impact of yoga on measures of cognition, functional outcomes, and quality of life (QOL) for breast cancer survivors (BCS). Methods Four women with a diagnosis of early-stage breast cancer prior to chemotherapy treatment were administered the following physiologic measures at baseline, 6, and 12 weeks during chemotherapy, and at one and three months after the conclusion of the study: Functional Reach test (balance) and Sit and Reach test (flexibility), and QOL, POMS (Mood) and FACT-B (QOL), at baseline. Primary outcomes of cognition were measured with the Perceived Cognition Questionnaire (PCQ) and CogState, a computerized measurement of cognition. Women attended an Iyengar-inspired yoga program twice a week for 12 weeks. Qualitative questionnaires were administered after the completion of the study to determine perceived benefits and challenges of the yoga program. Results Four women with Stage II breast cancer ranged in age from 44-65 years. CogState computerized testing showed changes in varying domains of cognition through treatment and follow-up. Improved balance, flexibility, and QOL were also noted over time. No adverse events were observed. Analysis of qualitative data revealed the yoga classes were helpful and subjects continued the practice elements of yoga including relaxation, breathing, and stretching. The most challenging aspect of the study was physical limitations due to various medical complications and included fatigue, decreased range of motion, and pain. Conclusion This case series suggests that yoga may impact various aspects of cognition during and after chemotherapy administration as noted through quantitative measures. Women describe yoga as improving various domains of QOL through the treatment trajectory. This mind-body intervention may stave off CRCI; however, further investigation is needed for additional randomized controlled trials on the effects of yoga on cognition for women with breast cancer undergoing adjuvant chemotherapy treatment.

Purpose. The purpose of this study was to determine the current prevalence, and at what level, complementary and alternative medicine (CAM) content is included in physical therapist (PT) education in the United States. This survey study provides self-report data regarding reasons why faculty members choose to include or not include CAM into programme content. Background/Significance. This study investigates the current prevalence of CAM content, and what level of inclusion (minimal, moderate, advanced) in PT curricula will assist programmes as they modify existing curricula and develop new programmes. Subjects. All 196 US-accredited programmes were included in our survey. Materials and Methods. An IRB-approved (Investigational Review Board), pilot-tested, two-page survey was emailed to all programme chairpersons of accredited PT programmes. A hard copy survey was mailed to non-responding programmes. Analyses. Returned surveys were analyzed descriptively to characterize the data shape, tendency and variability. Data were summarized in a frequency distribution and graphically depicted in a histogram for each category. In addition, qualitative analysis was completed for the explanatory data. Results. Forty-seven per cent (92) of all accredited PT programmes (196) responded. Most commonly included CAM areas were: manipulative and body-based methods, alternative medical systems and biologically based therapies. Most frequent responses to limitations to including CAM in PT curriculum were: limited curriculum time, lack of evidence supporting CAM practices and trouble locating qualified CAM presenters. Conclusions. This survey suggests the following: CAM techniques are included in entry-level PT education in the United States; the majority of these techniques are offered at the minimum or exposure level; manipulative and body-based methods, alternative medical systems and biologically based therapies are the most frequently included CAM techniques. Copyright © 2009 John Wiley & Sons, Ltd.

The potential for recurrence causes considerable distress for breast cancer survivors. Major information sources for survivors and providers offer few clear recommendations for postdiagnosis lifestyle change related to recurrence. To design interventions to improve long-term survivors' care and quality of life, we must know what survivors are doing to prevent recurrence in the absence of solid evidence, whether survivors' perceptions and behaviors correspond to hypothesized modifiable risk factors for recurrence, and whether survivors are adopting behaviors that could otherwise be harmful to their health. Our review first addresses the general lack of consensus on the impact of specific lifestyle factors on breast cancer recurrence and the resulting equivocal lifestyle recommendations for survivors. Second, we describe inadequacies of the studies of survivors' lifestyle changes related to recurrence. Because much of the existing knowledge about modifiable risk factors for recurrence comes from studies of survivors whose participation and behavior change were potentially influenced by their concern about recurrence, we need large, population-based observational studies of randomly selected breast cancer survivors, adequately representing the target population. Critical are data on lifestyle change from prediagnosis to postdiagnosis and changes over time after diagnosis, extensive data on conventional and nonconventional treatments, and the temporal relationship between behaviors and treatments, and inclusion of the full complement of potential lifestyle risk factors for recurrence. Understanding in detail the current status of survivors' perceptions and behaviors related to modifiable risk factors for recurrence can provide considerable practical information to inform future interventions and communication strategies for breast cancer survivors.

In the next few years, biotechnology will continue to develop a wide variety of functional foods, foods whose benefits go well beyond basic nutrition. Minors are a major potential market for bioengineered foods that are promoted not as sustaining health but rather as supporting desired lifestyles through the enhancement of physical, athletic, intellectual, or social performance. The experience of other industries suggests that such biomarketing is likely to create a variety of highly public ethical controversies. After a discussion of some of these potential issues, suggestions on how companies and industries can work with marketing ethicists and child advocates to limitnegative impacts on children and youth are presented. That discussion includes a preliminarily analysis of some of the considerations that should be involved in the initial development of a model of biomarketing ethics and in the use of that model to prevent ethical abuses.

Article Overview. Service learning is a teaching methodology that combines community service with explicit academic learning objectives, preparation, and reflection. It is a formal program that fosters student service in the local community and coincides with the theme of a course or specific topic of discussion. Much of the research in service learning, however, has been conducted on undergraduate students. Despite educators' eagerness to incorporate service learning throughout university health professions education programs, there is a paucity of graduate-level outcomes research in evaluating the effectiveness of personal and professional development. This article synthesizes the available instruments to measure outcomes of service learning. It presents strategies for the use of qualitative and quantitative analyses in measuring the effectiveness of service learning within a physical therapist education program curriculum. Key Words: Service learning, Physical therapy, Graduate, Outcome assessment. INTRODUCTION A dynamic physical therapist (PT) interacts daily with people of all backgrounds, age groups, and heritages. To prepare students for this reality, educators are often challenged to design for them engaging cross-cultural experiences. Service learning is a pedagogy that combines community service with explicit academic objectives, preparation, and reflection,1 and it is an effective tool for linking academic learning with practical experience.2 Before adopting service learning as a mandatory experience within the curriculum, it is important to assess its effectiveness in promoting the skills necessary for successful physical therapist-patient/client interaction. This article will present our initial attempt to assess the benefits of service learning through quantitative and qualitative data collection. It will conclude with a discussion of strategies for assessment that include practical tools for implementation in planning for successful service-learning outcomes. Introduction to Lessons Learned in Assessment Our research exploring the use of various assessment strategies was conducted in 1999, when few instruments were available to measure service learning for graduate students. Therefore, both qualitative and quantitative research methods were used to analyze the integration of service learning into the curriculum of a graduate physical therapist education program. We hypothesized that graduate PT students who were educated using a service-learning model would demonstrate increased levels of civic responsibility when compared with graduate-level PT students who had not participated in a service-learning course. Ninety-two Master of Physical Therapy (MPT) students participated in the study at the initiation of the fall semester (1999) and at the completion of the spring semester (2000). All students were given a survey at the beginning of the fall semester and again in the spring, at the end of the academic year. They were also instructed to keep journals of their experiences on a regular basis and to write in them immediately after their service. Upon completion of the 30 hours, students were asked to write summaries of their entire service-learning experience. Faculty members teaching in the program were responsible for discussing service learning as it related to physical therapy interventions and physical therapist practice, thereby guiding students toward making connections between learning in the community and in the classroom or clinic. The Data Collection Instruments The guiding questions for this study included: 1. How does your experience affect the way you view service learning in the community? 2. How does service learning shape your role as a PT? 3 . Do you have a greater understanding of yourself as a result of service learning? The data were both quantitative and qualitative in nature. Qualitative data included journal entries and summary statements. …

Work stress, burnout, and diminished empathy are prevalent issues for health-care professionals. Mindfulness meditation (MM) is one commonly used strategy to manage stress. Measuring salivary cortisol allows for the assessment of serum cortisol level, a known stress level indicator. This study evaluated the association of subject-reported stress symptoms and salivary cortisol in health-care professionals, in an 8-week MM program, with data collected prospectively at baseline and 8 weeks after program completion. Questionnaires [Profile of Mood States—Short Form (POMS-SF), Maslach Burnout Inventory (MBI), and Interpersonal Reactivity Index (IRI)] measured mood, burnout and empathy. A paired t-test between groups for pre/post-salivary cortisol yielded no significant change. The POMS-SF was most sensitive to change (mean increase 12.4; p = 0.020). Emotional exhaustion, measured in the MBI, was also affected by MM (mean decrease 4.54; p = 0.001). Changes in empathy may not have been captured due to either absence of effect of MM on empathy, subject number or scale sensitivity. Baseline and 8-week correlations between salivary cortisol and survey results, and correlations between changes in these measures, were weak and not statistically significant. Nevertheless, psychometric results present a strong case for additional clinical trials of MM to reduce stress for health-care professionals. Copyright © 2005 John Wiley & Sons, Ltd.

Arthralgia is common and debilitating for a significant proportion of breast cancer survivors (BCSs) and leads to poor adherence to aromatase inhibitors (AIs). Despite increased recognition of the negative impact of arthralgia on function and the poor adherence that results, very few interventions have been developed to target this side effect.This study aimed to determine the feasibility of tai chi to improve well-being for women experiencing AI-associated arthralgias (AIAAs).The study was a pilot to (1) demonstrate the feasibility of recruitment and retention for a tai chi trial, (2) determine the safety of tai chi, and (3) identify the outcomes (function, pain, and quality of life[QOL]) that tai chi may impact.The study took place at the Gilda's Club South Jersey in Linwood, NJ, USA.Postmenopausal women with a history of stage I-III breast cancer reporting AIAA were enrolled.Group tai chi was practiced for 1 h 2 ×/wk for 8 wks.Functional outcomes included (1) sit-and-reach (SR), (2) functional reach (FR), (3) the Berg Balance Scale (BBS), and (4) timed up-and-go (TUG). The following patient-reported outcomes (PROs) were evaluated pre- and postintervention: (1) the Hospital Anxiety and Depression Scale (HADS), (2) the Functional Assessment of Cancer Therapy-Breast (FACT-B), (3) the Functional Assessment of Chronic Illness Therapy Fatigue (FACIT-Fatigue), (4) the Brief Pain Inventory (BPI), (5) the Functional Assessment of Cancer Therapy/Gynecologic Oncology Group-Neurotoxicity (FACT-GOG-Ntx), and (6) the Functional Assessment of Chronic Illness Therapy- Spiritual Well-being Scale (FACIT-Sp). Participants also recorded their tai chi experiences in a journal.For the 12 participants, adherence to the classes was 75%, with no adverse events reported. Participants experienced significant improvement from baseline to follow-up for the HADS anxiety (P = .003) and depression (P = .020) scales, the emotional well-being scale of the FACT-B (P = .027), the FACIT-Fatigue (P = .030), and the sit-and-teach test (P = .016). The BBS (P = .090), TUG (P = .241), BPI severity subscale (P = .058), and physical well-being subscale of the FACT-B (P = .052) showed no significant improvement. Participants reported increased relaxation, reduced stress, and enhanced sleep quality and duration. They valued the group's and the instructor's support.The research team demonstrated the feasibility of a tai chi intervention for improving wellbeing for breast cancer patients with AIAA and identified measures that may be sensitive to the impact of a tai chi intervention in this population.

Persons with HIV infection and AIDS and their caregivers in the home environment often encounter difficulties with daily life-task management. Physical and psychosocial challenges secondary to HIV disease include deficits in mobility, activities of daily living, work, and leisure performance. Chronic pain, fatigue, central and peripheral nervous system damage, cognitive impairments, and psychosocial difficulties that impair function require adaptive and physical strategies to prevent further dysfunction and to improve or restore function. This article presents a strategy for occupational and physical therapy for the HIV patient in home care, emphasizing strategies to improve function. The need for other health care team members to involve rehabilitation specialists in HIV disease management is stressed.

As a multisystem chronic illness, two areas come to the forefront for management by the rehabilitation specialist. Pain and neuromuscular deficits may be a result of direct insult by the human immunodeficiency virus (HIV) or opportunistic infections affecting functional abilities. A brief overview of pathologic findings reveals that the types of pain experiences is based upon the disease processes that are occurring secondary to HIV. The management of pain and resultant functional changes depends on the source, symptoms and signs of pain. Physical and Occupational therapists are key health care professionals to conduct pain assessments and evaluate functional impairment to better employ non-invasive techniques for management of HIV complications. This article presents various modalities and modes of therapeutic intervention to enhance full participation of the person with HIV in activities of daily living.

This case series describes the impact of various forms of exercise on symptoms associated with osteoarthritis of the knee. A group of 15 women and men performed one of the following: traditional stretching and strengthening exercises, Iyengar yoga, or no structured group exercise. Low back and hamstring flexibility and quadriceps strength and function were monitored before and after the program. The Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) was used to assess subjective change after the six-week intervention period. A global assessment questionnaire was also completed by each participant and each instructor at the exit sessions to measure perceived changes in improvements since the initiation of the intervention. This study found functional changes and improvement in quality of life in traditional exercise and a yoga based approach that should encourage further comprehensive and carefully designed studies of yoga in osteoarthritis.

The purpose of this randomized pilot study was to evaluate a possible design for a 6-week modified hatha yoga protocol to study the effects on participants with chronic low back pain.Twenty-two participants (M = 4; F = 17), between the ages of 30 and 65, with chronic low back pain (CLBP) were randomized to either an immediate yoga based intervention, or to a control group with no treatment during the observation period but received later yoga training.A specific CLBP yoga protocol designed and modified for this population by a certified yoga instructor was administered for one hour, twice a week for 6 weeks. Primary functional outcome measures included the forward reach (FR) and sit and reach (SR) tests. All participants completed Oswestry Disability Index (ODI) and Beck Depression Inventory (BDI) questionnaires. Guiding questions were used for qualitative data analysis to ascertain how yoga participants perceived the instructor, group dynamics, and the impact of yoga on their life.To account for drop outs, the data were divided into better or not categories, and analyzed using chi-square to examine differences between the groups. Qualitative data were analyzed through frequency of positive responses.Potentially important trends in the functional measurement scores showed improved balance and flexibility and decreased disability and depression for the yoga group but this pilot was not powered to reach statistical significance. Significant limitations included a high dropout rate in the control group and large baseline differences in the secondary measures. In addition, analysis of the qualitative data revealed the following frequency of responses (1) group intervention motivated the participants and (2) yoga fostered relaxation and new awareness/learning.A modified yoga-based intervention may benefit individuals with CLB, but a larger study is necessary to provide definitive evidence. Also, the impact on depression and disability could be considered as important outcomes for further study. Additional functional outcome measures should be explored. This pilot study supports the need for more research investigating the effect of yoga for this population.