Background As interest in non-pharmacologic treatments for migraine prevention increases, there is an urgent need to evaluate these treatments in well-designed randomized trials. However, designing a “control” for non-pharmacologic treatments is complex. One possible solution is to design credible educational programs to use as comparators which partially control for natural history, patient engagement, attention and positive expectancy. Objective To develop and validate through a modified Delphi process a “Headache Health Education” (HHE) program to be used as the control arm in a pilot study of multimodal chiropractic care for episodic migraine. Methods Leveraging existing patient educational materials, we drafted an initial HHE program with 14 modules, each covering a different migraine-related topic. Designed to be delivered by research personnel in a one-on-one video conference, each module provides education using a slide deck and guided conversation that is grounded in adult learning theory. Furthermore, to engage participants, the script-based sessions are informed by the psychological implications of polyvagal theory and motivational interviewing. The program was validated using a modified Delphi process. Modifications were made to the program based on the ratings and feedback, and a second round of review was then performed. Results Initial endorsement of the HHE program was generally supportive but included considerable variability. After program refinement, endorsement improved with much lower score variability. Key improvements included the addition of 2 topics, selection of new videos, and training for research assistants/associates in how to use conversational style and specific prompts to engage participants. Conclusion Initial development and validation of an HHE program to use as a comparator in trials of a non-pharmacological treatment for migraine has been completed. Future analysis will examine the fidelity and acceptability of the HHE program when used as a comparator in a randomized controlled trial of multimodal care for migraine.

Background:Neck pain presents a personal and socioeconomic burden globally. Despite increasing prevalence, research on chronic neck pain (CNP) is limited and management relies on generalized approaches. There is growing interest in non-pharmacological interventions, however their efficacy remains uncertain due to the multifactorial etiology of CNP. Two interventions, multimodal chiropractic care (MCC) and Tai Chi, have shown promise individually in managing CNP, and when combined may offer synergistic benefits. This pilot study aims to assess the feasibility of combining these interventions for CNP.Methods/design: Forty-eight adults, aged 18-65y, with CNP defined as occurring ≥5 days a week for ≥3 consecutive months, severity of ≥3 on the numeric rating scale, and a score of ≥5 on the Neck Disability Index will be recruited. Participants will be randomized 1:1:1 to one of the three treatment groups (MCC plus Tai Chi and Enhanced Usual Care (EUC), MCC plus EUC, or EUC alone). The MCC was validated using a modified Delphi approach. Primary outcomes relate to feasibility (recruitment, retention, and adherence) and secondary outcomes include clinical measures of neck pain severity and disability, health-related quality-of-life, psychosocial well-being, and physical function. Outcomes will be assessed at baseline, 16-weeks (post-intervention), and 24-weeks. Qualitative interviews will be conducted. Discussion:Results of this study will provide preliminary evidence regarding the feasibility and clinical evaluation of pragmatically delivered MCC, alone or in combination with Tai Chi, for individuals with CNP. These data will be used to inform the design of a fully powered, factorial trial evaluating two promising non-pharmacological therapies for CNP. Trial registration:This study is registered in ClinicalTrials.gov (NCT05726331).

Objectives: Chronic nonspecific neck pain (CNNP) is prevalent among health care workers, with particularly high rates among nurses. Nurses experiencing CNNP often report decreased job satisfaction, increased absenteeism, and reduced productivity. In recent years, nonpharmacologic approaches have gained attention as effective treatments for the management of CNNP, with exercise and manual therapies representing two of the most common. Early evidence shows that multimodal treatments may be more effective than unimodal strategies. The purpose of this current study was to assess the feasibility and observe the clinical outcomes of combined multimodal chiropractic care (MCC) and Tai Chi (TC) for CNNP in nurses.Methods: A single-arm mixed-methods pilot trial was conducted including 16 weeks of MCC and TC in nurses with self-reported CNNP. Feasibility outcomes were recruitment, retention, and adherence to the interventions. Clinical outcomes of interest included neck pain and related disabilities. Secondary outcomes of interest were functional, affective, and work-related performance. Qualitative interviews were also conducted.Results: Of the 59 screened, 36 met the eligibility criteria, and 21 were enrolled. The retention rate was 71.4%, and adherence rates were 85.3% for MCC and 62.5% for TC classes. Multiple pain and disability-related outcomes exhibited modest improvement from baseline to 16-week follow-up. Qualitative analysis identified six emergent themes: (1) neck pain being an inherent part of nursing, (2) nurses push through their pain, (3) MCC relieves pain and is instructive for preventing pain, (4) TC provides overall relaxation, (5) both interventions increased body awareness and improved posture, and (6) scheduling difficulties were a key obstacle for participating.Conclusions: Observed reductions in neck pain and disability suggest the potential utility of combined MCC and TC interventions for managing CNNP. Along with qualitative feedback regarding facilitators and barriers to participation, the findings support and inform a future randomized trial evaluating the combined benefits of MCC and TC for CNNP in nurses.Clinical Trial Registration #NCT06523036.

Background Participating in physical activity (PA) can be challenging for persons with chronic and significant lung disease due to the multifaceted disruptive effects of their symptoms and variable disease course. Objectives Our study investigates a novel approach to increasing PA by collaboratively and adaptively developing a Tai Chi (TC) class for and by persons with lung diseases and explores participants’ perceptions of their experiences in the co-developed TC class. Methods We initiated a collaboration between the Interstitial Lung Disease (ILD) Collaborative and the Tai Chi Foundation to develop a TC class appropriate for persons with ILD and other lung diseases. The TC class was offered online, during the early phases of the COVID-19 pandemic, when pulmonary patients were isolated socially. TC class sessions were held twice weekly for 12 weeks with 12 participants. Ethnographic field methods were used to collect observations and conduct interviews with teachers and students. The Social Ecological Model (SEM) for understanding factors in intrapersonal, interpersonal, social, and organizational contexts was used to explore ways in which wellness practices, particularly those involving changes in health behaviors, can be collaboratively conceived, and developed by persons with the lived experience of illness and community organizations that are sensitive to their personal and social contexts. The constant comparative method was used for data analysis. Results Our findings include the importance of (1) creating a supportive class environment, characterized by interactive and reciprocal relationships among students and teachers; (2) alternating segments of movement and meditation to avoid fatigue and breathlessness; (3) cultivating sensory awareness and body trust, resting when needed and rejoining the movements when ready; (4) increasing the capacity to meditate through deepening presence and renewing the vital connection with inner and outer sources of energy; (5) reducing, through meditative movement, the persistent anxiety, isolation, and sense of loss that accompany chronic disease diagnosis and progression. Conclusion We documented a collaboration between the TC and pulmonary communities to design a TC class for persons with chronic and significant lung disease. We employed the SEM to provide insights into how teachers, informed by their students, can use effective pedagogical skills to create core curricula with modifications appropriate for a specific population.

Background Given the deleterious effects of physical inactivity in persons with chronic obstructive pulmonary disease (COPD) and/or heart failure (HF), interventions that promote long-term daily physical activity are needed. Mindful Steps, designed to promote walking behaviors in COPD and HF, is a multicomponent intervention that integrates mind-body content with other self-regulatory components. The aim of the current qualitative study was to characterize participants’ experiences with Mindful Steps and understand the perceived influence of the intervention on walking and health. Method In the context of a pilot randomized controlled feasibility trial comparing the year-long Mindful Steps program to usual care among individuals with COPD and HF, semi-structured qualitative interviews were administered at 6- and 12-months. Interviews were audio recorded and transcribed. The constant comparative method was used to code transcripts, identify categories, and develop interrelated themes. Results Nineteen participants (63% female; M age = 70.2 years, SD = 6.95) who were randomized to the intervention group completed the 6-month interview and 17 completed the 12-month interview. The pedometer with feedback, live group classes, and mind-body videos were described as the most helpful intervention components. Participants learned several strategies that helped their walking (e.g., breathing regulation and awareness, body awareness, mind-body techniques, pacing), described walking as enjoyable, and identified internal reasons for walking (e.g., to feel good). They also reported several physical and mental health benefits of the intervention. Some participants reported limited influence of the intervention on walking or health. Many participants continued to use the strategies they learned in the first half of the intervention at 12-months. Conclusions The mind-body content of Mindful Steps appeared to positively influence walking behaviors. Participants’ experiences with the intervention helped to identify areas for future intervention refinement. Future quantitative work is needed to corroborate these qualitative findings and assess the efficacy of the intervention on long-term physical activity engagement. Trial Registration This trial is registered in Clinical Trials.gov, ID number NCT01551953.

Purpose: Chronic obstructive pulmonary disease (COPD) is associated with dyspnea, decreased physical activity, and reduced quality-of-life. While pulmonary rehabilitation is helpful, maintenance of physical activity afterwards is problematic. We sought to explore qualitatively the multi-dimensional, biopsychosocial experience of patients with COPD who participated in Tai Chi (TC) vs. group walking to facilitate physical activity after pulmonary rehabilitation). Methods: We analyzed semi-structured qualitative exit interviews (N = 81) from a randomized controlled trial comparing 6-months TC with a time-matched group walking intervention and usual care control (UC). Transcripts were reviewed by at least 2 independent reviewers utilizing a social constructivist framework and theoretical sampling approach. An in-depth analysis of an exemplar subset was performed to thematic saturation and captured emergent themes within and between groups. Results: Focused analysis was conducted on 54 transcripts (N = 21 TC, N = 16 Walking, N = 17 UC). Participants were characterized by mean age 68.5 (+/- 8.3) years, GOLD Stage = 3.0 (IQR 2.0-3.0), baseline FEV1 percent predicted 48.8% (+/- 16.4), and 48.2% female. We identified predominant themes of breathlessness, and associated fear and embarrassment that limited physical activity across all groups. In both TC and walking, participants reported improvements in energy and endurance. Those in TC additionally shared improvements in breathing, mobility, and capacity for daily activities facilitated by body and breath awareness, emotional control and regulation of breathing, and an adaptive reframing of breathlessness. Conclusion: TC promoted physical and mental wellbeing by diminishing fear and embarrassment associated with breathlessness. Results highlight the multimodal characteristics of TC that may facilitate continued physical activity and improvement in quality of life.

One of the most pervasive ways the inquiry movement has needed to be reshaped since its inception is as a mechanism to respond to a global pandemic. As COVID-19 necessitated an abrupt transition to remote delivery of instruction, teachers needed a powerful form of professional learning to understand and respond with changes to serve their students during this challenging time. At P. K. Yonge Developmental Research School, a K-12 school, the leadership team designed a Canvas website devoted to teacher inquiry, enabling teachers to share experiences, collaborate, and address issues regarding the abrupt transition to emergency remote instruction. In this issue, five pandemic inquiry teams present their reflective essays, to describe their collaborations to re-imagine classroom communities; empower students to express their views of the pandemic; re-construct curricula to capture essential learnings; modify for struggling students, and bridge the opportunity gap for students of color.

Objective: The purpose of this study was to characterize expectations, attitudes, and experiences of individuals with migraine who were randomly assigned to receive chiropractic care delivered within a randomized controlled trial in a hospital-based integrative care center. Methods: This qualitative substudy was conducted as a part of a 2-arm pilot pragmatic randomized controlled trial investigating a multimodal model of chiropractic care for women with episodic migraine (4-13 migraines per month). Women were randomly assigned to chiropractic care (10 sessions over 14 weeks) plus enhanced usual care vs enhanced usual care alone. Semistructured interviews were conducted at baseline and 14-week follow-up with 15 randomly selected participants from the 29 participants randomized to the chiropractic group. Qualitative analysis was performed by 2 independent reviewers using a constant comparative method of analysis for generating grounded theory. Results: Integrating baseline and follow-up interviews, 3 themes emerged: over the course of treatment with chiropractic care, participants became more aware of the role of musculoskeletal tension, pain, and posture in triggering migraine; participants revised their prior conceptions of chiropractic care beyond spinal manipulation; and participants viewed the chiropractor-patient relationship as an essential and valuable component to effectively managing their migraines. Conclusion: In this qualitative study, women with episodic migraine after receiving comprehensive chiropractic care described chiropractic as a multimodal intervention where they learned about musculoskeletal contributions to migraine, discovered new ways to affect their symptoms, and developed a collaborative patient-practitioner relationship. The results of this study provide insights into perceptions of chiropractic care among women with migraine and suggestions for future trials.

This qualitative study was conducted to more fully understand health care providers and community leaders’ perceptions of the opioid crisis in rural Maine. In 2017, Maine continued to have one of the highest opioid overdose death rates in the country, more than double the national average. I (first author) visited eight treatment centers in Maine providing support and treatment to people recovering form Opioid Use Disorder (OUD), shadowing health care providers. I also attended OUD-related meetings held with community leaders. I conducted a total of 33 semi-structured interviews with health care providers, community leaders, and NGOs in the state of Maine. Three themes emerged integrating observations with semi-structured interviews: i) Impact of emergence of new extended release opioids, their prescription patterns, and culture around them; ii) Subjectivity of pain and importance of understanding psychic injury in OUD treatment; iii) Socio-political context and perception of OUD in Maine. Our society’s perception of pain has deep historical and cultural sources that influence the way that pain has been perceived and treated in the medical setting. Resources beyond the medical environment are needed to address pain adequately.

In teacher inquiry, the metaphor of stance is used to describe a positionality towards teaching that includes questioning classroom practices, engaging in cycles of continuous improvement, and generating knowledge. We expand the metaphor of stance to include a metaphor for complicated movements while maintaining balance - dynamic structural integration (DSI) - an analogy to teachers functioning in schools, as they perform complex actions and conduct teacher inquiry. Their stance informs their movement within DSI. Current research neglects the dynamic, interactive context of teachers, students, and school leaders, and the necessity of structural supports within schools while enacting change. We present a case study of a teacher inquiry, illustrating DSI in a school context, through observations and interviews of teachers and school leaders. Teacher inquiry was informed by colleagues and leaders through strategically designed structural supports within the school; the inquiry, reciprocally informed the school leadership by elevating the voices of teachers and students actively engaged in reform within the classroom, through specifically designed structures. We propose leadership for learning through DSI and describe teachers and school leaders as learners in and with the learning organisation, both supporting, and being informed by, teacher inquiry.

Objectives: Breast cancer treatment leaves breast cancer survivors (BCS) with an array of lasting side effects, including persistent postsurgical pain (PPSP). In this study, we explored the perceptions of BCS with PPSP as they learned Qigong mind-body exercise (QMBE), a multimodal practice rooted in Traditional Chinese Medicine. Methods: Participants included 18 female BCS treated for stage 0-III breast cancer and experiencing PPSP. Participants were taught QMBE over 12 weeks. Semi-structured interviews were conducted before and after the intervention. Results: BCS disclosed a disconnect between mind and body that emerged during treatment. They perceived QMBE as moving meditation, which enabled them to reconnect mind and body, lessen their pain, and make peace with their bodies. Conclusion: These women's experiences both inform the promise of integrating QMBE and related mind-body exercise into PPSP clinical practice guidelines and suggest new areas of research regarding the role of multimodal interventions for holistic healing in BCS.

Background: Hundreds of randomized controlled studies have documented the effectiveness of Tai Chi (TC) to alleviate symptoms from varied medical conditions. Researchers, however, have called for alternate methods to discern participants’ perspectives and to provide additional information regarding the TC protocols, TC teachers’ qualifications, and the social contexts for learning and practicing TC. Purpose: This naturalistic study was designed to explore the perspectives of an experienced TC practitioner and those of her TC teachers as they reflected upon her 9-year journey with TC as she faced varied medical crises. Methods: Using an ethnographic approach, participant observation, the researcher observed participant’s TC classes, conducted in-depth, semi-structured interviews with the participant and her teachers and informal interviews in the field. Context: Participant was a 72-year-old female, who had suffered from spinal stenosis, hip arthritis, and bladder cancer. The participant attended two types of TC classes: a therapeutic Tai Chi (TTC) including a modified short form (10 forms) taught by a physical therapist and a traditional TC class including the Yang style short form taught by a Tai Chi practitioner with 50 years of experience. Findings: 1) TCC provided explicit cues and links between TC and functional fitness, improving the participant’s balance, daily life activities, and increased exercise efficacy and resilience; 2) TC provided a novel challenge motivating the participant’s continued practice while learning complex TC movements. 3) Traditional TC classes provided a supportive community, facilitating a meditative stance, and enabled the participant to subdue the “monkey mind” of a terminal cancer diagnosis.

Despite a history of research in general education on novice teachers, researchers have only recently begun to investigate the experiences of beginning special educators. Many of these studies describe problems encountered, noting the high attrition rate among beginning special education teachers and emphasizing the importance of keeping qualified special educators in the field. The findings of this survey of first-year special education teachers ( N = 596) extend the literature by revealing the influence of classroom and school context factors on new teachers' accomplishments and problems.

Teacher researchers have documented the experiences of beginning teachers, describing novices who have been challenged by the responsibilities of managing and organizing classrooms and meeting the diverse needs of students (Blase, 1985; Burden, 1990; Feiman-Nemser, 1983; Huberman, 1993; Kagan, 1992; Lortie, 1975; Ryan, 1986; Sprinthall, Reiman, & Thies-Sprinthall, 1996; Veenman, 1984). These beginning years have been described as the and survival phase of teaching (Huberman, 1993), characterized as either (marked by a sense of discovery) or painful (a focus on survival). According to Huberman (1993), easy beginnings are consonant with a sense of discovery and enthusiasm (openness, inventiveness, creativity) and good rapport with pupils. Painful beginnings have to do with exhaustion ... and coping (p. 244). These two distinct types of beginnings eventually stabilize, moving either into a phase of increasing commitment to teaching or increasing disillusionment with the profession. During the past decade, researchers in special education have begun to investigate the unique and complex challenges encountered by novice special educators (e.g., Billingsley & Tomchin, 1992; Billingsley, Carlson, & Klein, 2004; Boyer & Lee, 2001; Busch, Pederson, Espin, & Weissenburger, 2001; Griffin, Kilgore, Winn, Otis-Wilborn, Hou, & Garvan, 2006; Kilgore, Griffin, Winn, & Otis-Wilborn, 2003; Otis-Wilborn, Winn, Griffin, & Kilgore, 2005; Whitaker, 2000; 2003). These investigations have documented numerous factors in special education settings that contribute to the stresses of the first year of teaching for them, including: role ambiguity, students posing complex behavioral and academic challenges, large caseloads, insufficient curricular and technical resources, inadequate administrative support, inadequate time for planning, few opportunities for collaboration and professional development, and excessive procedural demands. In the following section, we review pertinent literature regarding novice teachers, with a focus on the changing roles of special educators, relationships between novice teachers and their colleagues, and accessibility of the general education curriculum to students with disabilities. Changing Roles of Special Educators As novice special educators assume positions in schools, they frequently face ambiguous, conflicting, and fragmented expectations from their colleagues, supervisors, and the families of children they serve. Many educators, as well as some novice teachers, hold traditional views of special education, believing that the role of the special educator is to teach small groups of children using specialized instructional strategies (CEC, 2000). The field of special education, however, is changing. The 1997 and 2004 amendments to the IDEA (Individuals with Disabilities Education Improvement Act) mandate placement opportunities for students with disabilities within general education classrooms and emphasize participation and progress in the general education curriculum. The No Child Left Behind Act of 2001 provides further support for the participation of students with disabilities in the general education curriculum by requiring their involvement in accountability systems (NCLB, 2002). Confusion, however, and sometimes, resistance to the aims of more inclusive educational opportunities for students with disabilities have created challenges for novice teachers (e.g., Conderman & Stephens, 2000). Inclusion requires novice special educators to collaborate and co-teach with their general education colleagues; yet they are also expected to provide intensive, individualized instruction. Juggling these varied, and often, competing responsibilities is a particularly difficult task for a beginning teacher. Relationships between Novice Teachers and Their Colleagues According to Darling-Hammond and Sclan (1996), at all levels and sectors . …

Collaborative problem solving is an activity in which special education teachers and other school professionals work together to solve the academic or behavioral problems of their students. The purpose of this study was to understand preservice teachers' perceptions of a collaborative problem solving activity they implemented with other professionals (e.g., general education teachers, school counselors, and speech and language pathologists) during their student teaching semester. These students formed a collaborative relationship with a school professional in an effort to assist the pair in supporting children with learning and/or behavior problems in general education settings. Findings from this study suggest that the problem-solving project expanded student teachers' definitions of collaboration by increasing their awareness of facilitators and obstacles to it. However, collaboration in practice was not an easy task for student teachers, with school context variables playing a role in facilitating successful or less than successful collaboration.

The perspectives of general and special education teacher educators, who are nationally recognized for their work in the areas of learning disabilities, inclusive education, and teacher education, were explored. Study participants were asked to reveal how the inclusion of students with learning disabilities has impacted their professional lives in ways they did not expect. In addition, they responded to questions about the unexpected outcomes of inclusion on students with learning disabilities and their typical peers. Results suggest that (a) preparing teachers, not only for inclusion, but also for the diverse classrooms of today, is challenging; (b) the real world of schools is where teacher educators believe they need, and want, to be because important questions can be posed and solutions found within schools; (c) colleges of education, like schools, need to be reformed to encourage and support intensive, prolonged site-based work; and (d) outcomes for students with learning disabilities included in general education classrooms cannot be de-contextualized.

The purpose of the current study was to examine beginning special educators' experiences in their attempts to implement two key requirements associated with reauthorization of the Individuals with Disabilities Act of 1997: access to the general education curriculum and participation in general education programs. We conducted in-depth interviews with 36 beginning special educators. Eighty-one percent of the teachers reported facing significant barriers in implementing the two IDEA 1997 requirements. Specific barriers are reported with implications for changes in teacher preparation and organizational structures in schools to support teachers in meeting the requirements of federal legislation supporting individual with disabilities.

The purpose of this paper is to present the preliminary results of a three-year investigation of the problems of practice of beginning special education teachers and the contexts in which they work. Our research study was designed to answer the following research questions: (a) What are beginning special educators' problems of practice? and; (b) What contextual factors facilitate or impede beginning special education Teachers' efforts to solve their problems of practice? The most frequently cited problems were related to insufficient curricular materials, dealing with behavior management/discipline, and obstacles to collaboration with general educators. The most significant sources of support were from other special education teachers; in general, novice special education teachers perceived themselves as segregated from the general education community, isolated from their general education peers and administrative staff. Discussion and implications regarding novice teacher induction programs and teacher education curriculum are presented.

Coral Springs Middle School teachers took Coalition of Essential Schools' (CES) principles seriously. They were the topic of workshops, facul ty meetings, retreats, and summer training at Brown University. Over time they became especial ly interested in the view that children are natural learners and that it was the teacher's responsibility to find strategies that work for individual children. Placing at-risk students in every class forced every teacher to abandon old methods that worked well