ObjectivesInvestigate the types of health professionals delivering physical activity (PA) interventions to persons with physical disabilities (PwPD), the settings, and the characteristics of these interventions.Data SourceFive major databases were used to extract peer-reviewed articles published from 2002-2025.Inclusion and Exclusion CriteriaStudies with a PA-based intervention for PwPD at least 18 years of age were included. Studies were excluded if published in non-English, if fewer than 51% of the study included PwPD, or if disability was only age-related.Data ExtractionArticles were reviewed and coded by two independent reviewers using a standard form. Extracted data included study design, sample size, population diagnosis, profession conducting the intervention, intervention setting and country, and characteristics of the PA intervention.Data SynthesisData were synthesized using descriptive and qualitative methods.ResultsNinety-eight articles were included. Various professionals provided PA interventions; physical therapy and research staff were the most common. PA interventions were delivered in a variety of settings with community-based centers being most prevalent. PA interventions varied in frequency, intensity, duration, and type.ConclusionPA interventions are conducted by a variety of health professions and settings. Less-involved professions could play a larger role in the provision of these interventions to promote health management for PwPD. PA intervention characteristics vary widely which may impact efficient development of evidence-based exercise programming for PwPD.

Participating in physical activity and meeting physical activity guidelines are far more challenging for persons with disabilities than for the general population. This American College of Sports Medicine expert consensus statement provides an evidence-based summary of (i) the impact of physiological factors, physical activity guidelines, and barriers on physical activity participation and prescription for individuals with disabilities; (ii) three consensus statements derived from research evidence; and (iii) five practical recommendations for prescribing and designing physical activity programs tailored to adults with disabilities, based on an integration of research evidence with expert consensus.

Purpose This study investigated the relationships among exercise engagement, psychosocial factors, and social participation for adults aging with physical disabilities (AAwPD). Design A cross-sectional study within a community-based cohort study of participation among AAwPD was conducted. Setting A comprehensive survey was administered online or via telephone. Participants Participants were 474 individuals between the ages of 45-65, primarily living in the Midwestern United States, who reported living with a physical disability for at least 5 years. Method Survey questions created based on prior consolidation of activity domains assessed exercise engagement. Psychosocial health and social participation were measured using the Patient Reported Outcomes Measurement Information System. Chi-square tests, t-tests, and a general linear model were used to examine differences between exercisers and non-exercisers. Results Participants who exercised reported less pain (P < .001), fatigue (P < .001), and depression (P < .001) and greater self-efficacy for management of chronic conditions (P = .002), satisfaction with participation in social roles and activities (P < .001), and ability to participate in social roles and activities (P < .001) compared with non-exercising participants. Conclusions AAwPD who exercised reported fewer secondary conditions and greater social participation. Although causal relationships cannot be drawn, and the frequency, duration, and intensity of exercise were not examined, this study lays important groundwork for future research to determine the health and participation benefits of exercise for AAwPD. Future studies should also focus on the development of exercise interventions to support successful aging with disability.

Social participation is associated with better health, quality of life, physical activity, and engagement in community living and is thus an emerging health priority. Transportation plays an important role in facilitating social participation. Our team recently reported in the Journal of Disability and Health that Missouri-dwelling adults aging with long-term physical disabilities who use paratransit services as their primary transportation mode are more likely to participate in social roles and activities outside the home compared to those who do not use paratransit. In March of 2023, the paratransit company Metro Call-A-Ride that serves St. Louis announced major scale backs to their coverage zones due in part to staffing shortages. This decision has been met with a formal complaint filed to the U.S. Department of Justice as well as protest from the St. Louis disability community and advocates. Thousands of individuals who relied on Call-A-Ride for their routine community outings—to work, grocery stores, or medical appointments, for example—have been affected by the cuts. In this commentary, we will summarize the media coverage this decision has received, including the perspectives of disability rights advocates and individuals who have been directly affected. We will then present an overview of our original research findings in the context of these recent events and a brief synthesis of existing literature on paratransit services in the U.S. The commentary will end with proposed policy, research, and programming solutions for St. Louis's Metro Call-A-Ride and public transportation at large.

The purpose of this scoping review was to characterize the nature and scope of existing literature on the role of built environments in the community participation of adults aging with physical disabilities (AAwPD). A scoping review was selected to identify the volume and types of evidence available, pinpoint knowledge gaps, and clarify key concepts. Twenty-one articles were included for review, all of which were published within the last 20 years and identified components of the built environment for intervention. Results demonstrated the need for investigators to identify common indicators, use a shared lexicon, and improve dissemination of results across disciplines.

Research ObjectivesTo evaluate a set of 9 activity domain measures to broadly assess community participation and change in participation over time for persons aging with disability.DesignA cohort study with repeated measures three times annually (T1, T2, T3) between 2019-2022.SettingThe general community.ParticipantsA community-based sample (N=323) of persons ages 45-65 responded to a survey. The cohort is majority female (68.7%) and single (61.9%), and over one-third (34.3%) is non-White.InterventionsNot applicable.Main Outcome MeasuresNine activity domain measures were developed based on extant research and evaluated with assistance from community-based support service providers. For each activity domain, 5 questions were asked regarding participation in the domains of activities and the quality of participation (satisfaction with time spent, changes in participation, and barriers and facilitators of participation). Participants were asked if they thought changes were attributable to aging, the COVID pandemic, or other factors.ResultsFindings showed varying levels of participation across the 9 activity domains, with the lowest participation rate for employment and the highest participation rates for personal leisure and managing medications across T1, T2, and T3. Participants wished they spent more time engaging in exercise, employment, exterior and interior chores, community leisure, social activities, and civic and religious activities and less time managing medical conditions, doing interior chores, and engaging in leisure at home. Change in participation over the 3-year period was limited; most change was reported as activity reduction. In general, respondents indicated that reduction was due to their aging or the COVID-19 pandemic. Personal assistance, transportation, environmental modifications, and improved health were identified as factors needed to help increase participation levels.ConclusionsCharacterizing participation is an important element of delivering effective community-based care. We concluded that the activity domain measures demonstrated efficiency in identifying participation rates and change. Community-based organizations may deem them useful for assessing support and service needs to facilitate participation.Author(s) DisclosuresNo conflicts to disclose.

Date Presented 03/23/24 This poster highlights the results of a randomized controlled trial of a community-based exercise program that improved health outcomes for persons with spinal cord injury (PwSCI) and proposes ideas to address physical activity for PwSCI. Primary Author and Speaker: Kelly L Taylor Additional Authors and Speakers: Kerri Morgan Contributing Authors: Rachel Heeb, Kimberly Walker, Susan Tucker, Carla Walker, Holly Hollingsworth, W. Todd Cade

OBJECTIVE:To identify goals for exercising among community-dwelling persons with spinal cord injury (PwSCI). DESIGN:Qualitative descriptive study. SETTING:Community-based exercise facility for persons with a disability. PARTICIPANTS:Fifty-five PwSCI identified their exercise goals prior to participation in a community-based exercise intervention. INTERVENTIONS:None. OUTCOME MEASURES:A modified version of the Canadian Occupational Performance Measure was used to ask about exercise goals. The International Classification of Functioning, Disability, and Health (ICF) was used to code the goals for themes. RESULTS:The participants were predominantly male (76%) and Black (56%) with thoracic-level injury (51%) and a mean age of 39.44 (standard deviation [SD] 13.62). A total of 231 goals (mean 4.2 goals per participant; SD 1.25) were identified. Participants rated their performance and satisfaction with their goals as 4.256 (SD 1.55) and 3.57 (SD 1.67), respectively. Participants most frequently reported goals related to endurance, muscle strengthening, weight loss, activities of daily living, transferring, and home and community mobility. The most commonly reported goals fell into five ICF domains: Functions of Cardiovascular, Hematological, Immunological, and Respiratory Systems; Neuromusculoskeletal and Movement-Related Functions; Structures Related to Movement; Mobility; and Self-Care. CONCLUSION:PwSCI have goals they would like to achieve through participation in exercise. The goals are multifaceted and encompass improving health and fitness as well as improving performance in everyday activities such as transferring and mobility. Identifying themes of goals for PwSCI to achieve through exercise is an important step in developing programs and interventions needed to support PwSCI living in the community.

Abstract Change in social participation over time among mid-life adults with disabilities as they grow older is under-studied. Existing research indicates that social participation among persons with disabilities, younger and older, is positively associated with health and well-being outcomes including mental health and life satisfaction. Despite this knowledge, few studies have explored if and how social participation changes year to year, and how symptoms of aging with disability including pain, fatigue, and depression may influence those changes. We undertook a cohort survey (2019-2021) with a sample of adults aged 45-64 (N=323) with self-reported mobility disability, collecting data over three annual time points, in order to better understand if we could see annual change in social participation that could help inform early interventions to support and sustain social participation. Our results found that T-scores from PROMIS measures of physical function, depression, and pain changed little over time, but level of fatigue did significantly change. PROMIS T-scores of satisfaction with social roles and activities and did not change over time, but T-scores for ability to participate in social roles and activities increased over time. T-Scores for physical function, depression, fatigue, and pain were significantly associated with both participation outcomes. In qualitative data, most participants (63%) said their participation declined over the 3 years, attributing change to health, aging with disability symptoms, and the COVID-19 pandemic. Study limitations include potential effects of the COVID-19 pandemic on participation and disability/health. Findings suggest the need to consider aging with disability symptoms when evaluating participation interventions.

Background Adults aging with long-term physical disabilities (AAwPD) face personal and environmental barriers to living independently, but little is known about their perspectives on and experiences with physical activity (PA). Purpose The purpose of this study was to explore the perspectives of AAwPD on PA. Research Design Qualitative semi-structured interviews with AAwPD were conducted virtually via phone or videoconference. Study Sample A convenience sample of AAwPD aged 45-65 and living with a physical disability for at least 5 years was recruited through aging organizations, disability organizations, and social media in St. Louis, Missouri until thematic saturation was reached (n = 20). Data Collection and Analysis Participants were asked semi-structured interview questions about their perspectives and experiences with PA following an interview guide developed by disability, aging, and qualitative research experts. Data were analyzed using text analysis in NVivo 12. Codes were developed into themes by the research team and validated using member checking methods. Results Four themes emerged from the data: barriers and facilitators to engaging in PA, motivations and beliefs regarding PA, benefits of PA, and PA routines and habits. Participants reported a desire to engage in more PA but described barriers such as pain and fatigue symptoms, secondary health conditions, lack of social support, and fear of falling. Accessibility of facilities and equipment (eg, lack of ramps or equipment not at wheelchair height) and transportation barriers (eg, inconvenient schedules or excessive wait times) were specifically described as major environmental barriers. Conclusion Most participants' reported PA routines did not meet the quantity or intensity levels recommended by current guidelines. These results may help inform healthcare providers, community programs, and future interventions to improve PA levels for AAwPD, an underserved but growing demographic.

Purpose The purpose of this study was to identify clinician knowledge regarding manual wheelchair (MWC) training in an inpatient rehabilitation (IPR) setting, identify current MWC education provided to new manual wheelchair users (MWUs), and determine how MWC training resources can be developed or modified to promote use among IPR clinicians.Methods Semi-structured interviews were conducted with 20 licenced IPR clinicians who work with MWUs. Using a traditional qualitative research design, researchers completed open, data-driven coding of interview transcripts. Overarching themes were determined through content analysis.Results Participants included 12 physical therapists, six occupational therapists, one physical therapy assistant, and one occupational therapy assistant. Five themes emerged from the interviews: (1) clinician knowledge, education, and experience (2) current training content (3) training environment, (4) desired programme components (5) barriers to implementation. Participants reported receiving minimal education in school and from their employers on training MWUs. While clinicians expressed the importance of MWU education, they used varying training approaches with little standardization. Participants identified that training protocols for IPR are beneficial if they are quick, straightforward, and flexible.Conclusions While MWC training occurs during IPR stays, it appears to be inconsistent across facilities, clinicians, and patients, with varying degrees of adherence to evidence-based practices. This is likely due to limited feasibility and awareness of existing MWC training resources. Clinician input gathered from these interviews provides information for how to best integrate MWC training programmes into the rehabilitative process. Findings may inform the development and assessment of more clinically feasible MWC training protocols.Implications for RehabilitationNew manual wheelchair users must learn numerous wheelchair-related skills in order to participate in everyday life activities.Manual wheelchair education for new users during inpatient rehabilitation is often inconsistent across facilities, clinicians, and patients, with varying degrees of adherence to existing evidence-based practices.Systematic challenges often act as a barrier to the implementation of more comprehensive, structured manual wheelchair training protocols.Manual wheelchair training resources must be concise, flexible, customisable, and easy to follow in order to promote increased implementation among inpatient rehabilitation clinicians.

Wheelchair propulsion interventions typically teach manual wheelchair users to perform wheelchair propulsion biomechanics as recommended by the Clinical Practice Guidelines (CPG). Outcome measures for these interventions are primarily laboratory based. Discrepancies remain between manual wheelchair propulsion (MWP) in laboratory-based examinations and propulsion in the real-world. Current developments in machine learning (ML) allow for monitoring of MWP in the real world. In this study, we collected data from participants enrolled in two wheelchair propulsion interventions, then built an ML algorithm to distinguish CPG recommended MWP patterns from non-CPG-recommended patterns. Eight primary manual wheelchair users did not initially follow CPG recommendations but learned and performed CPG propulsion after the interventions. Participants each wore two inertial measurement units as they propelled their wheelchairs on a roller system, indoors overground, and outdoors. ML models were trained to classify propulsion patterns as following the CPG or not following the CPG. Video recordings were used for reference. For indoor detection, we found that a subject-independent model was able to achieve 85% accuracy. For outdoor detection, we found that the subject-independent model achieved 75.4% accuracy. These results provide further evidence that CPG and non-CPG-recommended MWP patterns can be predicted with wearable sensors using an ML algorithm.

BACKGROUND:Fatigue negatively impacts the function and quality of life of people with disabilities (PwD). Mobile health (mHealth) platforms are recognized as effective and accessible approaches to delivering health interventions and may show higher satisfaction by tailoring the information toward personalized needs for PwD. OBJECTIVE:To evaluate the acceptability, feasibility, and participant engagement with a Short Message Service (SMS) text messaging intervention for fatigue self-management and to explore the pre- and post-score health changes in PwD. METHODS:A total of 27 PwD (multiple sclerosis = 9, spinal cord injury = 9, or stroke = 9) experiencing fatigue in their daily lives participated in a 12-week self-management text messaging intervention. Participants completed a demographic survey and health outcome measures, including patient activation, self-efficacy for managing symptoms, fatigue, sleep, and satisfaction with participation in social roles before and after the intervention. Participants also completed a client satisfaction questionnaire after the intervention. We also tracked the program retention and SMS response rates over the 12-week intervention period. RESULTS:Twenty-five participants completed the entire intervention (93% retention rate), and the overall SMS response rate was 84.67%, indicating high acceptability and adherence to the intervention. The mean satisfaction score was 3.18, indicating high satisfaction with the intervention. Despite finding a negligible effect on patient activation, we found a small intervention effect on self-efficacy for managing symptoms (η2 = 0.04) and moderate effects on fatigue (η2 = 0.06-0.12), sleep (η2 = 0.11), and satisfaction with participation in social roles (η2 = 0.08). CONCLUSIONS:This study provides initial feasibility and health outcome change evidence to support an SMS text messaging intervention to manage fatigue in PwD.

Abstract Community participation measures for persons aging with disability were developed and evaluated to support community-based organizations (CBOs) with efficient assessment of change in participation and need for supports/services to facilitate participation. This study aimed to evaluate a set of 9 activity domain measures to broadly assess community participation and change in participation over time. A community-based sample (N=323) of persons ages 45-65 responded to a survey with repeated measures three times annually (T1, T2, T3) between 2019-2022. Nine activity domain measures were developed based on extant research and evaluated with assistance from community-based support service providers. Statistical analyses employed T-tests and Chi-square tests to assess change in participation over time, perceptions of participation satisfaction, and assistance needed to facilitate participation. Participants were asked if they thought changes were attributable to aging, the COVID pandemic, or other factors. Findings showed varying levels of participation across the 9 activity domains, with the lowest participation rate for employment and the highest participation rates for personal leisure and managing medications across T1, T2, and T3. Change in participation over the 3-year period was limited; most change was reported as activity reduction. In general, respondents indicated that reduction was due to their aging or the COVID-19 pandemic. Personal assistance, transportation, environmental modifications, and improved health were identified as factors needed to help increase participation levels. Conclusions were that activity domain measures demonstrated efficiency in identifying participation rates and change. CBOs may deem them useful for assessing support and service needs to facilitate participation.

Points of InterestAdults aging with long-term physical disabilities value participating in their communities but often face barriers in the built environmentCommon built environment factors that influence community participation for this population include the perceived safety of one's neighborhood, the accessibility of community buildings, access to transportation, and environments that facilitate a sense of community and belongingThe COVID-19 pandemic negatively affected access to various supports and spaces for adults aging with long-term physical disabilities, which in turn restricted their community participationPoorly resourced neighborhoods may increase community participation restrictions for adults aging with long-term physical disabilities This study qualitatively explored how adults aging with long-term physical disabilities perceive the built environment to influence their community participation. A convenience sample of community-dwelling adults with long-term physical disabilities ages 45-65 participated in virtual semi-structured interviews until thematic saturation was reached (n = 20). Data were analyzed using interpretive phenomenological analysis. Five themes were identified: vigilance and sense of safety, accessibility of and access to transportation, community environment accessibility, sense of community, and access to support, spaces, and resources during the COVID-19 pandemic. Multiple participants described their neighborhoods as unsafe and reported not leaving their homes in months due to inaccessible home entrances or pandemic-related concerns. These results enhance our understanding of how this population perceives environmental barriers to community participation, particularly in low-resourced neighborhoods during the COVID-19 pandemic. These results may inform researchers, community organizations, and funding agencies in intervention development and implementation to address built environment barriers.

BACKGROUND:Adults aging with long-term physical disabilities (AAwPDs) experience barriers in the built environment that can hinder their participation in meaningful social roles and activities. However, interventions addressing built environment barriers to participation for AAwPD are limited. OBJECTIVE:The purpose of this study was to examine how the built environment and other socioenvironmental factors influence the social participation of AAwPD to inform future interventions and service provision. We hypothesized that social participation would be significantly different between AAwPD using private versus public transportation and living in urban versus rural areas. METHODS:This cross-sectional study of 331 Missouri-dwelling AAwPD reports findings on relationships among transportation mode, urban versus rural residence, and ability to participate in social roles and activities using PROMIS measures. A multivariate analysis of covariance (MANCOVA) explored differences in social participation across transportation mode and residential location. Linear regression examined associations among socioenvironmental factors, individual factors, and social participation. RESULTS:The MANCOVA demonstrated significant differences in social participation across transportation mode and urban versus rural residential location. Specifically, AAwPD using paratransit and living in urban areas reported significantly higher social participation than rural-dwelling individuals and private transportation users (p < .001). The linear regression revealed that individual factors served a larger role in predicting social participation than built or social environmental factors. CONCLUSIONS:Our findings suggest that transportation mode plays a significant role in shaping social participation outcomes for AAwPD. However, compared to built and social environmental factors, individual factors (i.e., physical function, 'aging-with-disability' symptoms) may restrict social participation more.

PURPOSE:This study examined prevalence and relationships among falls, injuries, fear of falling, and social participation in people aging with long-term physical disability (PAwLTPD). MATERIALS AND METHODS:A convenience sample of 474 PAwLTPD recruited from community agencies and social media as baseline of a longitudinal cohort study. Inclusion criteria: 45-65 years, self-reported physical disability for ≥5 years, and English-speaking. Self-report surveys of physical/mental health, falls in the past year, fear of falling, and Patient-Reported Outcomes Measurement Information System (PROMIS) ability and satisfaction with participation in social roles and activities measures were collected. RESULTS:Mean age 56.8 years; participants were mostly female (66.7%) and White (61.4%). Nearly 65% reported a fall; 56.6% of falls resulted in injury. Falls and fall-related injuries were associated with worse physical/mental health and presence of >5 health conditions. Seventy-five percent of participants reported fear of falling. Lower ability and satisfaction with participation were found in participants who fell and worried about falls. CONCLUSIONS:PAwLTPD are at increased risk of falls, fall-related injuries, and fear of falling, which affects their ability to engage in social activities. Future research is needed to understand circumstances associated with falls and to develop effective interventions to address falls in PAwLTPD.

Background Chronic health conditions, secondary conditions, and decreasing functional ability related to aging and/or changes in underlying impairment may influence participation for persons aging with long-term physical disability (AwD). Objective To examine sample integrity and baseline findings through exploration of associations of sociodemographic, health, and disability factors with social participation for persons AwD. Methods This is a longitudinal cohort study following persons AwD over three years, reporting baseline cohort study data. A convenience sample of 474 persons AwD aged 45–65 reporting physical disability of ≥5 years’ duration was recruited through community organizations and social media. The cohort was majority female (66.7%) and single (62.0%), and over one-third (38.6%) was non-White. Pain, fatigue, depression, ability to participate in, and satisfaction with, social roles and activities were measured with the Patient Reported Outcomes Measurement Information System. Results were manually compared against AwD study samples identified through a focused literature review and national census data. Results Participants aged 55–60 and 61–65 had significantly lower rates of employment and marriage and higher rates of living alone than participants aged 45–54. Participants reported higher rates of fatigue, pain, and depression and lower ability to participate in, and satisfaction with, participation in, social roles and activities than the general population. Ability to participate and satisfaction with participation were highest among Black/African American participants. Conclusions Participants reported higher rates of common AwD symptoms and lower ability to participate and satisfaction with participation than the general population, consistent with prior studies of AwD samples. This cohort reflects the AwD population and can be considered an AwD sample, comparable to those found in existing literature. The focus of future analyses will be to gain a greater understanding of chronic health conditions, incidence of falls, engagement in everyday life activities, and the impact of the environment.