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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.

PURPOSE Individuals with a diagnosis of primary immunodeficiency disease (PID) have poorer health-related quality of life (HRQoL) compared with healthy individuals. Regular moderate exercise enhances immune function and wellbeing. Whether exercise at recommended levels for the general population is tolerated by individuals diagnosed with PID, without adverse effects, is unknown and warrants investigation. METHODS A prospective randomized preliminary pilot investigation with individuals diagnosed with PID was undertaken; participants were assigned to either an exercise (n = 18) or control group (n = 16). The exercise group completed an eight-week, semi-customized, home-based, moderate intensity exercise program, while the control group engaged in routine activities. Participants completed recall surveys assessing infection rates and non-routine medical care over 8 weeks prior to the eight-week intervention. RESULTS Given recruitment issues, the study was underpowered. Thus, as expected, no difference between groups was observed. CONCLUSION This preliminary pilot investigation provides the foundation for a large scale, appropriately powered, randomized controlled trial to investigate the effect of moderate exercise on infection rates and non-routine medical care for individuals with PID. Recommendations are made to strengthen the methodology of future investigations on the effects of exercise on the immune function and quality of life for individuals diagnosed with PID.

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.

Chemotherapy-induced peripheral neuropathy (CIPN) causes significant pain and is an adverse effect of treatment with chemotherapeutic agents. We explored a somatic yoga and meditation intervention in a predominantly minority population. Goals included describing strategies for minority inclusion and testing feasibility and effectiveness. Eight individuals with CIPN enrolled in a single-arm feasibility trial. Somatic yoga and meditation were provided weekly for 8 weeks, with an additional home program component. The primary outcomes were Sit and Reach, Functional Reach, and Timed Up and Go. Secondary outcomes were Patient Neurotoxicity Questionnaire, FACT-GOG-Ntx (for addressing patient concerns associated with neurological symptoms), Brief Pain Inventory, Perceived Stress Scale, Pittsburgh Sleep Quality Index, and Falls Efficacy Scale. Sensitivity to vibration was measured via biothesiometer. Participants with a mean age of 65 (49–73) years self-reported as 63% African-American and 37% Caucasian. They attended 81% of the sessions, and no adverse events we re re p o rted. CIPN symptoms (FAC T- G O G - N t x ) improved significantly (from 88.88 to 106.88, standard deviation = 20.03; p = 0.039). Fear of falling improved, approaching significance (from 39.26 to 34.38, standard deviation = 6.081; p = 0.058). Other measures showed improvement trends, with a slight increase in Brief Pain Inventory pain severity (from 3.50 to 3.75, p = 0.041) possibly reflecting comorbidities. Four qualitative themes emerged: (1) CIPN symptom variability, with musculoskeletal comorbidities; (2) utility of learned skills; (3) improvement in self-confidence, balance, and stability; and (4) social support, with CIPN experience validation and increasing health literacy. Challenges of recruitment and retention require specific outreach, community trust, and health literacy. Preliminary data suggest that somatic yoga and meditation may affect fear of falling and quality of life in cancer survivors with CIPN. A randomized controlled trial using inclusive recruitment and retention methods is indicated to establish the intervention’s efficacy.

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

Recent calls from oncology providers and cancer policy forums advocate for improved connections between rehabilitation services and cancer care delivery. Traditionally, this intersection has occurred when patients present with overt disability related to cancer treatment and is driven by reactive approaches to care. A growing body of evidence suggests that a proactive approach to functional screening and assessment encourages the identification and management of functional impairment and morbidity earlier in the cancer care continuum and contributes to better outcomes. A clinical pathway that prompts screening and referral to rehabilitation services in an expedited manner is needed. Cancer patient navigators provide care coordination through the duration of medical treatment, survivorship, and end-of-life. This article presents a framework for navigation workflows to support functional assessment and provide early triage pathways to the rehabilitation system of care. We provide a case example of novel approach to patient navigation from a Southeastern United States community cancer center that uses a patient navigator with a rehabilitation background to serve in this role. An overview of the position skills, functional assessment and referral pathways, and perspective on quality improvements related to this approach are described. The use of rehabilitation providers beyond traditional clinical roles should be further explored. Their expertise in functional assessment and interpretation could foster improvements in cancer care delivery and outcomes for survivors in both the short and long term.

Objectives The purpose of this study was to investigate the construct validity and overall appropriateness of test score interpretation of 4 shoulder-related patient-reported outcome (PRO) measures for use in a population of patients with head and neck cancer using Rasch analysis. Methods One hundred eighty-two individuals who had received a neck dissection procedure within the past 2 weeks to 18 months were recruited for this cross-sectional psychometric study. Rasch methodologies were used to investigate scale dimensionality, scale hierarchy, response scale structure, and reliability of Disabilities of the Arm, Shoulder and Hand (DASH), QuickDASH, Shoulder Pain and Disability Index (SPADI), and Neck Dissection Impairment Index (NDII). Results DASH did not meet criteria for unidimensionality and was deemed inappropriate for use in this sample. The QuickDASH, SPADI, and NDII were all determined to be unidimensional. All scales had varying issues with person and item misfit, differential item functioning, coverage of ability levels, and optimal rating scale requirements. The NDII met most requirements. All measures were found to meet thresholds for person and item separation as well as reliability statistics. Conclusions Rasch analysis indicates the NDII is the most appropriate measure studied for this population. The QuickDASH and SPADI are recommended with reservation, whereas the DASH is not recommended. Impact This study demonstrates the use of objective methodologies, using Rasch analysis, to validate PRO recommendations provided by clinical experts in forums such as the Evaluation Database to Guide Effectiveness (EDGE) TaskForce, which are based upon a comprehensive literature review, consideration of published psychometric properties, and expert consensus. Use of Rasch methodologies demonstrates weaknesses in this model and provides opportunities to strengthen recommendations for clinicians.

Purpose: In the United States, there are almost 17 million cancer survivors who often have poorer health outcomes and an increased risk for developing a second cancer and other chronic illnesses. Evidence suggests substantial cancer burden may be prevented through lifestyle modifications. The purpose of this study was to determine the feasibility of health coaching for the improvement of health, fitness, and overall well-being of cancer survivors in a community setting. Methods: Participants were recruited from community-based cancer agency locations. Health coaching was provided to people diagnosed with cancer anywhere along the cancer survivorship continuum. Coaches provided six individual sessions to each participant. Surveys were sent pre- and post-intervention on topics including fitness, eating habits, perceived stress, anxiety, depression, and quality of life. Results were analyzed using repeated measures multilevel modeling. Results: 48 participants completed an average of 85% of health coaching sessions. Coaching participants noted significant improvements in weekly physical activity, including moderate-vigorous physical activity. Small significant increases were found in healthy eating behavior. Participants reported moderate change in the quality of their sleep and smaller significant changes in sleep duration and sleep efficiency. Moderate significant reductions were found in perceived stress and anxiety, with small but significant decreases in depression. Importantly, participants reported improved quality of life, particularly in areas of physical and emotional well-being. Smaller increases were found in functional and total well-being. Conclusion: Preliminary findings indicate real behavior change in the measured outcomes and suggests health coaching may be an important tool for cancer survivorship.

Individuals with Primary Immunodeficiency Disease (PID) have increased risk for infection, autoimmune conditions, and inflammatory disorders. Cognitive impairment, also referred to as brain fog, has been recognized in other medical conditions and as a side-effect of treatments; however, it has not been previously reported in individuals with PID. The phenomenon of brain fog is recognized in other autoimmune or inflammatory conditions, including lupus, multiple sclerosis, chronic fatigue syndrome, and has resulted from chemotherapy treatment for cancer. This research investigates the self-reported memory function of individuals with a diagnosis of PID. Respondents completed a survey which used reliable and valid questionnaires: Memory Functioning Questionnaire, Beck's Depression Inventory II, and Beck's Anxiety Inventory. Of the 292 completed surveys, 133 did not report any comorbid neurological diagnosis or incident of concussion (both of which could influence perceived memory function). When compared to normative scores, the respondents in this study were found to have significantly greater perceived memory impairment. The respondents had a significant higher score for anxiety and depression as compared to non-anxious and non-depressed normative values. This study finds that individuals with a diagnosis of PID have a greater degree of perceived memory impairment, or brain fog, in addition to greater levels of anxiety and depression. Individuals with a diagnosis of PID would benefit from prospective surveillance through a comprehensive neuropsychological assessment to track cognitive status and implement corrective measures, should any decline be identified.

Objective The purpose of this study was to compare disability in people with HIV and peripheral neuropathy with those without neuropathy and explore how neuropathy and other relevant factors are associated with disability. Methods In this cross-sectional study, participants completed the Brief pain inventory, Beck Depression Inventory II, World Health Organization Disability Assessment Schedule (WHODAS 2.0), and a health and demographic questionnaire. Additional data were extracted from the medical record. A raw score of ≥1 on the Subjective Peripheral Neuropathy Screen questions about lower extremity numbness or paresthesia was used to identify peripheral neuropathy. Predictors of disability (as determined by association with World Health Organization Disability Assessment Schedule 2.0 scores) were evaluated bivariately and in a multivariable model. Path modeling was used to identify a parsimonious model to elucidate the mediated effects of peripheral neuropathy on disability. Results Participants with peripheral neuropathy had more depression symptoms, more pain (severity and interference), and higher disability scores compared with participants without neuropathy. The relationship between neuropathy and disability was mediated by pain interference and depression (standardized root mean residual = .056). Conclusion In this sample of people with HIV, those with lower extremity peripheral neuropathy reported more severe disability, worse pain, and more depression symptoms than those without neuropathy. The relationship between peripheral neuropathy and disability may be mediated though pain interference and depression. Impact Distal sensory polyneuropathy is a common comorbidity experienced by people living with HIV and frequently causes pain. This study can help providers direct care toward lessening disability experienced among people with HIV and peripheral neuropathy by targeting interventions for treatment of pain and depression. Lay Summary People living with HIV may experience disabling painful neuropathy. Treatment for pain and depression may help reduce the disability associated with painful neuropathy.

Background Chemotherapy-induced peripheral neuropathy (CIPN) is a common, debilitating side effect that worsens quality of life and increases the risk of falls in cancer survivors. Evidence of yoga’s safety and efficacy in treating CIPN is lacking. Methods In a randomized controlled study, we assigned breast and gynecological cancer survivors with persistent moderate-to-severe CIPN pain, numbness, or tingling with a score of 4 or greater (0-10 numeric rating scale [NRS]) for at least 3 months after chemotherapy to 8 weeks of usual care or yoga focused on breathwork and musculoskeletal conditioning. Primary endpoint was treatment arm differences for NRS, and secondary endpoints were Functional Assessment of Cancer Therapy/Gynecologic Oncology Group-Neurotoxicity subscale (FACT/GOG-Ntx), and Functional Reach Test after week 8. We tested treatment arm differences for each outcome measure using linear mixed models with treatment-by-time interactions. All statistical tests were two-sided. Results We randomly assigned 41 participants into yoga (n = 21) or usual care (n = 20). At week 8, mean NRS pain decreased by 1.95 points (95% confidence interval [CI] = -3.20 to -0.70) in yoga vs 0.65 (95% CI = -1.81 to 0.51) in usual care (P = .14). FACT/GOG-Ntx improved by 4.25 (95% CI = 2.29 to 6.20) in yoga vs 1.36 (95% CI = -0.47 to 3.19) in usual care (P = .035). Functional reach, an objective functional measure predicting the risk of falls, improved by 7.14 cm (95% CI = 3.68 to 10.59) in yoga and decreased by 1.65 cm (95% CI = -5.00 to 1.72) in usual care (P = .001). Four grade 1 adverse events were observed in the yoga arm. Conclusion Among breast and gynecological cancer survivors with moderate-to-severe CIPN, yoga was safe and showed promising efficacy in improving CIPN symptoms.

Purpose: Substantial cancer burden may be prevented through lifestyle modifications. The purpose of this study was to determine the preliminary effectiveness of health coaching for the improvement of health, fitness, and overall well-being of cancer survivors in a community setting. Methods: Participants were recruited from Cancer Support Community Delaware locations. Health coaching was provided to people diagnosed with cancer anywhere along the survivorship continuum. Coaches provided 6 individual sessions. Surveys were sent pre- and post-intervention on topics including fitness, eating habits, sleep, perceived stress, anxiety, depression, and quality of life. Results were analyzed using multilevel modeling. Results: 48 participants completed an average of 85% of health coaching sessions. Coaching participants noted improvements in weekly physical activity frequency, including moderate–vigorous physical activity. Increases were found in healthy eating behavior. Participants reported improvements in the quality of their sleep, including changes in sleep duration and sleep efficiency. Significant reductions were found in perceived stress, anxiety, and depression. Importantly, participants reported improved quality of life, particularly in areas of physical and emotional well-being, as well as functional and total well-being. Conclusion: Preliminary findings indicate significant behavior change in measured outcomes and suggest health coaching may be an important tool for cancer survivorship.

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.

It has been suggested that yoga may be an effective adjunct intervention in the management of substance use disorders (SUD). Additionally, women with SUD require different treatment approaches than men. The objective of this study was to critically evaluate the evidence for the effectiveness of yoga, specifically for women, as part of treatment for SUD. Nine electronic databases were searched from inception to January 2020. Randomized controlled trials (RCT) that evaluated any type of yoga, including yoga as a component of mindfulness-based treatment, against any type of control in individuals with any type of addiction were eligible. Using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) Checklist and Statement, methodological quality was appraised using Physiotherapy Evidence Database (PE Dro) criteria. Ten RC Ts (eight mixed-gender and two female-focused) met the eligibility criteria. Most of these RCTs were small to medium-sized, with various methodological and analytical flaws and deficits. The types of addictions included in these studies were alcohol, drug, and nicotine addiction. Most RCTs suggested that various types of yoga, primarily Hatha Yoga and its components, led to favorable or equivalent results for SUD as an adjunct to control or treatment-as-usual interventions. There are limited results on the impact of yoga for SUD specifically focused on women and their unique needs. Although the results of mixed-gender articles are encouraging, large RCTs with gender-specific subanalyses are required to better determine the benefits specific to women incorporating yoga for SUD.

A Common Reading was used as an Interprofessional Education (IPE) strategy to engage students from varied pre-professional undergraduate and graduate professional programs. This IPE activity, combined with an interprofessional panel presentation, provided students and faculty with shared ground on which to model selected Core Competencies of Interprofessional Collaborative Practice. Successful achievement of student learning outcomes was demonstrated via a post program evaluation by rating achievement of four IPEC Core Competencies using a 5-point Likert Scale. Responses to open-ended questions provided qualitative data to further support the effectiveness of this IPE strategy. The Common Reading was a feasible and effective strategy to meet IPE learning outcomes while overcoming commonly cited logistical barriers.

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: Patients with head and neck cancer (HNC) often experience significant postoperative limitations in temporomandibular joint (TMJ) function, facial pain, reduced nutritional intake, speech impairments, and compromised activities of daily living due to side effects of cancer treatment. Physical therapists treating these individuals must use valid and reliable patientreported outcome measures to quantify change related to physical therapy intervention for the TMJ. Purpose: As part of the activities of the Oncology Section EDGE Task Force on Head and Neck Cancer Outcomes, we report evidence-based recommendations for patient-reported outcome measures for individuals with HNC-related temporomandibular dysfunction (TMD). Methods: A systematic literature review of TMD-related patient-reported outcome measures that are clinically feasible and relevant to the HNC patient population was conducted using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) model. Recommendations are based on the quality of psychometric properties, clinical utility, and previous use in HNC-related research. Twenty-two outcome measures were selected for review; 4 received a rating of 3, “recommended” for use in the HNC population. Conclusions: A variety of outcome measures have been reported in the literature for individuals with HNC-related TMD. Four measures, the Graded Chronic Pain Scale, 8 and 20-item Jaw Functional Limitation Scale and TMD Pain Screener, are recommended for clinical use by the researchers on this task force although it is important to note psychometric properties specific to the HNC population are lacking. Systematic Review Registration Number: PROSPERO CRD42013004898

Background: Human immunodeficiency virus (HIV) negatively impacts muscle strength and function. This study aimed to establish the relationship between lower limb muscle strength and lower extremity function in HIV disease. Method: A cross-sectional study was undertaken with a sample of 113 HIV-positive participants. Lower limb muscle strength and self-reported function were established using dynamometry and the Lower Extremity Functional Scale (LEFS), respectively. Muscle strength and functional status were established in a subset of 30 HIV-negative participants to determine normative values. Results: Muscle strength for participants with HIV ranged from an ankle dorsiflexion mean of 9.33 kg/m 2 to 15.79 kg/m 2 in hip extensors. In the HIV-negative group, ankle dorsiflexors recorded 11.17 kg/m 2 , whereas hip extensors were the strongest, generating 17.68 kg/m 2 . In the HIV-positive group, linear regression showed a positive relationship between lower limb muscle strength and lower extremity function ( r = 0.71, p = 0.00). Fifty per cent of the changes in lower extremity function were attributable to lower limb muscle strength. A simple linear regression model showed that lower limb ankle plantar flexors contributed the most to lower extremity function in this cohort, contrary to the literature which states that hip and trunk muscles are the most active in lower limb functional activities. Conclusion: Lower extremity strength impacts perceived function in individuals stabilised on antiretroviral therapy for HIV disease. These findings demonstrate that ankle plantar flexors produce more force over hip flexors. Careful attention should be paid to the implications for strength training in this population.

Study Design Observational study. Introduction The brachial plexus neurodynamic test (BPNT), based on previous neurodynamic tests, is considered a clinically meaningful tool to objectively assess brachial plexus extensibility. This novel test's psychometric properties have yet to be determined. Purpose of the Study The primary study aim was to assess the inter- and intrarater reliability and accuracy of the BPNT, which biases the median nerve and brachial plexus, among clinicians of various professional experience levels and geographic US regions. The secondary study aim was to determine if professional experience or geographic region affects the accuracy levels of this test. Methods In phase 1, inter-rater reliability and accuracy was determined. About 307 participants attending neural mobilization conferences and courses were instructed in the BPNT and asked to score 7 different videos of 14 possible test levels. In phase 2, intrarater reliability was determined via scoring the same test videos twice. Results High inter-rater intraclass correlation coefficient (range, 0.98-0.99) and accuracy (range, 0.88-0.94) levels were determined for all clinical experience levels and geographic regions. Intrarater intraclass correlation coefficient values were high (range, 0.96-1.0) among all participants. One-way analysis of variance indicated no significant differences on test accuracy based on professional clinical experience (F = 0.104; P = .958) and geographic region (F = 0.416; P = .416) among all 307 participants. Discussion Excellent inter- and intrarater reliability and accuracy levels may allow clinicians to correctly identify BPNT positions regardless of their professional experience or geographic location. Conclusion The BPNT can reliably and accurately quantify outcomes in neural mobility scoring.

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.

Objective. Chemotherapy-induced peripheral neuropathy (CIPN) syndrome causes significant pain as an adverse effect of treatment, with few nonpharmacological interventions tested. A somatic yoga and meditation (SYM) intervention on functional outcomes and quality of life (QOL) was investigated. Design and methods. Individuals diagnosed with CIPN were enrolled in an open-label, single-arm, mixed-methods feasibility trial. Participants and Setting. In an outpatient rehabilitation center, ten participants with median age 64.4 years (47-81) attended 61% of the sessions with no adverse events. Intervention. SYM twice a week for 8 weeks for 1.5 hours, with home program and journaling. Main outcome measures. Primary functional outcomes included Sit and Reach (SR), Functional Reach (FR), and Timed Up and Go (TUG). Self-reported Patient Neurotoxicity Questionnaire (PNQ) and Functional Assessment of Cancer Therapy—Neurotoxicity (FACT-GOG-NTX) were secondary CIPN outcomes. Biomarkers included salivary cortisol (stress) and bioesthesiometer (vibration). Results: Quantitative findings. Significant improvements were found in flexibility (SR; P = .006); balance (FR; P = .001) and fall risk (TUG; P = .004). PNQ improved significantly ( P = .003) with other measures improving non-significantly. Qualitative findings. Five themes emerged: (1) vacillation of CIPN pain perception over time; (2) transferability of skills to daily activities; (3) improvement in physical function; (4) perceived relaxation as an effect of SYM; and (5) group engagement provided a social context for not feeling isolated with CIPN. Conclusion. Preliminary data suggest SYM may improve QOL, flexibility, and balance in cancer survivors with CIPN, with a fully powered randomized controlled trial indicated. Trial registration: NCT03786055

The prevalence of prehypertension and Stage 1 hypertension continues to increase despite being amenable to non-pharmacologic interventions. Iyengar yoga (IY) has been purported to reduce blood pressure (BP) though evidence from randomized trials is lacking. We conducted a randomized controlled trial to assess the effects of 12 weeks of IY versus enhanced usual care (EUC) (based on individual dietary adjustment) on 24-h ambulatory BP in yoga-naïve adults with untreated prehypertension or Stage 1 hypertension. In total, 26 and 31 subjects in the IY and EUC arms, respectively, completed the study. There were no differences in BP between the groups at 6 and 12 weeks. In the EUC group, 24-h systolic BP (SBP), diastolic BP (DBP) and mean arterial pressure (MAP) significantly decreased by 5, 3 and 3 mmHg, respectively, from baseline at 6 weeks (P< .05), but were no longer significant at 12 weeks. In the IY group, 24 h SBP was reduced by 6 mmHg at 12 weeks compared to baseline (P= .05). 24 h DBP (P< .01) and MAP (P< .05) decreased significantly each by 5 mmHg. No differences were observed in catecholamine or cortisol metabolism to explain the decrease in BP in the IY group at 12 weeks. Twelve weeks of IY produces clinically meaningful improvements in 24 h SBP and DBP. Larger studies are needed to establish the long term efficacy, acceptability, utility and potential mechanisms of IY to control BP.