PURPOSE:Despite increased recognition of the necessity of inclusive research and writing to encompass the diversity of human experience, discrepancies regarding how we conceptualize and describe disability persist. Differences in language signify differences in thinking, yet there also exist opportunities for reconciliation that center disability justice as a core tenet of rehabilitation research and practice. The purpose of this article is not merely to encourage academics to use the "right" language, but to question how we think about disability in our work and world. RESEARCH DESIGN:Bringing together literature from rehabilitation and critical and feminist disability studies, we propose a crip reimagining of rehabilitation research and practice. Rooted in feminist and queer theory, "to crip" means to apply a disability justice lens and unsettle ableist assumptions. RESULTS:Incorporating approaches from disabled scholars and activists encourages the adoption of a disability justice framework that centers the desires and needs of disabled people. In yet another political moment when disabled people face existential threats to their lives and well-being, it is essential that rehabilitation psychologists and other professionals follow the lead of disabled people to advance efforts for disability justice. IMPLICATIONS:Disability justice demands not the eradication of disability, but the creation of a world in which disability is recognized as part of human variation, an effort that starts without our own discipline. We must find ways to continue recognizing and promoting possibilities for treatment and support, while also understanding that many disabled people live meaningful, fulfilling lives with or without our assistance. (PsycInfo Database Record (c) 2026 APA, all rights reserved).

PURPOSE/OBJECTIVE:Long COVID is a complex chronic condition, affecting approximately 18% of adults in the United States and commonly involves fatigue, cognitive impairment, pain, and psychiatric conditions (e.g., depression, anxiety, posttraumatic stress disorder, and insomnia). Despite high psychiatric burden, many individuals do not receive mental health care, and little is known about their interest in psychological services. This study characterized symptom profiles of long COVID and examined correlates of patients' interest in rehabilitation psychology services. RESEARCH METHOD/DESIGN:Secondary data analysis of routinely collected clinical data. Descriptive statistics were calculated, and logistic regression analyses examined associations of interest. RESULTS:Participants in the full sample (N = 1,789) were predominantly White, non-Hispanic, and female, with high rates of fatigue (84.9%), cognitive difficulties (55.3%-74.3%), and psychiatric history (51.8%). Over half (56.8%) expressed interest in rehabilitation psychology services, including individual (50.2%) and group (32.1%) formats. Two participants were excluded from regression analyses due to sparse cell size, yielding a final analytic sample of n = 1,787. Interest in individual services was associated with not having a mental health provider, greater depression and anxiety, poor sleep, and lower cognitive functioning. Interest in group services was associated with psychiatric history, greater anxiety, lower cognitive and social functioning, and better physical functioning. CONCLUSION/IMPLICATIONS:Anxiety symptoms and cognitive difficulties are key correlates of interest in rehabilitation psychology services, underscoring the value of early screening and targeted intervention. Stigma and prioritization of medical concerns may limit engagement, highlighting the importance of psychoeducation and stigma-reduction efforts to support engagement in care. (PsycInfo Database Record (c) 2026 APA, all rights reserved).

The benefits of physical activity are well-established in people with multiple sclerosis (MS), yet most people with MS are insufficiently active. This article describes the study protocol for a randomized controlled trial designed to understand whether the ExerciseRx digital health platform improves physical activity, symptoms, and functioning in adults with MS. Participants are ambulatory adults with MS (N = 106) who engage in <150 minutes per week of moderate to vigorous intensity physical activity. Enrolled participants are assigned to 26 weeks of ExerciseRx app use versus a waitlist control. ExerciseRx is a cloud-based, HIPAA-compliant software platform that was created for healthcare providers to support patients in physical activity for wellness. ExerciseRx collects physical activity data from the patient’s personal smartphone and translates it into actionable metrics on a dashboard that can be used within the electronic health records. ExerciseRx personalizes a graded progression in step count goals, and healthcare providers can monitor progress towards these goals and support patients by providing semi-automated weekly feedback and encouragement in meeting physical activity goals. The primary outcome is the change in average daily step count throughout the 12-week intervention. Secondary outcomes include symptoms (fatigue intensity, pain intensity, sleep, and depressive symptoms), patient-reported functional outcomes (physical functioning, fatigue interference, pain interference, falls, and social participation), and qualitative analysis of participant and provider interviews on ExerciseRx usability and acceptability. Not applicable. Results of this trial will provide important new information on the efficacy of an innovative digital health intervention tool for physical activity promotion. This clinical trial is registered at ClinicalTrials.gov NCT06270641.

BackgroundThe benefits of physical activity are well established in people with multiple sclerosis (MS); yet, most people with MS are insufficiently active. Although many apps and devices are available to promote physical activity, these are not connected to electronic health records (EHRs), making it difficult for health care providers to prescribe and monitor their patients’ physical activity. The ExerciseRx platform is an innovative cloud-based, Health Insurance Portability and Accountability Act–compliant software platform (app+provider dashboard) that was developed to bridge the gap between consumer activity tracking devices, such as personal smartphones, and the EHR. The ExerciseRx app tracks a patient’s physical activity using their existing personal smartphone and provides a personalized graded progression in step count goals to increase step count gradually and safely over time. The ExerciseRx app also translates the activity data into actionable metrics on a provider dashboard within the EHR that the provider can use to make activity recommendations and monitor patients’ progress; they can also support patients by providing semiautomated weekly feedback and encouragement in meeting physical activity goals. ObjectiveThis paper describes the protocol for a randomized controlled trial designed to understand whether the ExerciseRx digital health platform improves physical activity, symptoms, and functioning in adults with MS relative to a waitlist, usual care control. MethodsParticipants are ambulatory adults with MS (n=106) who engage in <150 minutes per week of moderate to vigorous intense physical activity. Enrolled participants are assigned to use the ExerciseRx app for 12 weeks, versus a waitlist, usual care control. Participants allocated to the intervention condition have access to the ExerciseRx app, and their providers have access to the participants’ activity data via a provider dashboard, connected to the EHR. Participants allocated to usual care receive the care they would normally obtain at the MS Center, including encouragement to participate in and increase physical activity as tolerated from their clinical provider and a handout that describes the current physical activity recommendations for adults with MS and links to local and web-based resources suitable for MS. The primary outcome is the change in average daily step count throughout the 12-week intervention. Secondary outcomes include symptoms (fatigue intensity, pain intensity, sleep, and depressive symptoms), patient-reported functional outcomes (physical functioning, fatigue interference, pain interference, falls, and social participation), and qualitative analysis of participant and provider interviews on usability and acceptability of the ExerciseRx platform. ResultsThe study was funded in October 2023. Participant enrollment began in March 2024 and will continue through December 2025. As of July 25, 2025, a total of 85 participants have been enrolled in the trial. Data analysis and dissemination preparations will begin in January 2026. ConclusionsResults of this trial will provide important new information on the efficacy of an innovative digital health intervention tool for physical activity promotion. Trial RegistrationClinicalTrials.gov NCT06270641; https://clinicaltrials.gov/study/NCT06270641 International Registered Report Identifier (IRRID)DERR1-10.2196/72213

PurposeIndividuals with multiple sclerosis (MS) experience fear of falling (FOF), which is associated with negative health and quality-of-life consequences. Prior research has used FOF and concern about falling (CAF) interchangeably, but persons with MS report that CAF and FOF represent separate constructs that lie on a continuum. Unfortunately, no scale exists to understand the differences between CAF and FOF. Therefore, we developed a novel questionnaire, the Concern and Fear of Falling Evaluation (CAFFE), in which respondents rank their CAF and FOF on a continuum across various activities. This study aims to describe the scale development process and examine its psychometric properties.MethodsIn a single online survey, MS participants responded to demographic questionnaires, indicated whether they experience CAF and FOF, and completed the CAFFE. Psychometric evaluation of the CAFFE involved internal consistency, split-half cross validation, exploratory factor analysis (EFA), and confirmatory factor analysis (CFA).ResultsOut of 1,025 respondents, 64.6% reported CAF and 47.2% reported FOF. The EFA yielded a two-factor solution encompassing activities in open (factor 1) and closed environments (factor 2). The CFA replicated this two-factor solution and the CAFFE demonstrated excellent internal consistency (α = 0.98).ConclusionThe 27-item CAFFE is a highly reliable and valid measure capturing the tipping point at which point CAF moves to FOF. Future research should seek to define the tipping point from the MS community, as CAF may be an adaptive mechanism, whereas FOF may be a maladaptive behavior.

Background Long COVID is a serious public health concern due to its high prevalence and potentially debilitating symptoms. Symptoms may include fatigue, dyspnea, cognitive problems, insomnia, anxiety, and depression. There is currently no cure for long COVID, and the average length of recovery and proportion of patients who fully recover are still unknown. Subsequently, there is a critical need to improve function. Research in other chronic conditions suggests that psychosocial self-management interventions reduce symptom severity and interference with functioning. We describe the design of our study to examine the feasibility, acceptability, appropriateness, and preliminary efficacy of an intervention designed to improve symptom management and coping in adults with long COVID.Methods This pilot trial (N = 50) uses a pragmatic, randomized two-group parallel design set within the University of Washington Post-COVID Rehabilitation and Recovery Clinic. The self-management intervention is a 6-week, group-based telemedicine intervention that teaches evidence-based strategies to manage common symptoms and improve stress management as well as communication and self-advocacy. The comparator is a wait-list control. Participants complete self-report measures of the primary and secondary outcomes at baseline and post-treatment/wait-list. Primary outcomes include intervention feasibility, acceptability, and appropriateness. Secondary outcomes include Patient-Reported Outcomes Measurement Information System measures of fatigue, sleep disturbance, cognitive difficulties, self-efficacy, pain interference, depression and anxiety symptoms, and a measure of long COVID symptoms and impression of change. At post-intervention, intervention participants also complete a qualitative interview to inform intervention refinement. Quantitative data will be examined using descriptive and statistical analysis including t-tests and chi-square tests to compare the intervention and wait-list groups on secondary outcomes. Qualitative data will be analyzed using the rigorous and accelerated data reduction technique (RADaR).Discussion Results of this pilot randomized controlled trial will characterize the feasibility, acceptability, and appropriateness of the self-management intervention and inform intervention refinement necessary prior to further testing. Long COVID is a public health concern, and rehabilitation approaches that equip patients to manage symptoms may improve patient function and quality of life and reduce burden on the health care system.Trial registration NCT05658536. December 16, 2022.

Background and Purpose: Despite the frequency of concern about falling (CAF) and fear of falling (FOF) in multiple sclerosis (MS), there remains a lack of clarity between FOF and CAF, though persons with MS have indicated that CAF and FOF are distinct constructs. Our team previously developed and validated a new questionnaire, the Concern and Fear of Falling Evaluation (CAFFE), to assess these concepts. This study aimed to examine CAF and FOF prevalence, and determine relationships among CAF, FOF, and self-reported motor, cognitive, and psychological function in MS relapsing (RRMS) and progressive (PMS) subtypes. Methods: In a single online survey, participants with MS completed questions about CAF and FOF, demographic information, the CAFFE, and self-report measures of motor, cognitive, and psychological function. Results: A total of 912 individuals completed the survey. Persons with PMS reported greater CAF (80.1%) and FOF (59.1%) than those with RRMS (57.0% and 41.6%, respectively). Persons with PMS endorsing FOF (yes/no) reported greater FOF on the CAFFE, greater avoidance behavior, greater walking impairment, and poorer motor function than people with RRMS (P < 0.001). Self-reported motor function, walking impairment, and avoidance behavior were highly correlated to the CAFFE across the overall sample (P < 0.001). Discussions and Conclusions: These findings underscore the disparity between CAF and FOF, emphasize the importance of evaluating CAF and FOF in MS subtypes separately, and highlight both motor and non-motor factors contributing to CAF and FOF. Future work should focus on interventions that incorporate motor, cognitive, and psychological components to address CAF and FOF. Video Abstract: for more insights from the authors Supplemental Digital Content available at http://links.lww.com/JNPT/A481.

Post traumatic stress disorder (PTSD) and sleep disorders are prevalent among patients with long COVID. The intersection of PTSD and/or sleep disorders with long COVID is complex. Thus, use of a biopsychosocial lens for assessment and treatment along with a trauma-informed approach to clinical care is recommended. This review provides an overview of the literature on PTSD and sleep disorders among patients with long COVID, including prevalence rates, risk factors, and potential pathophysiology. Pharmacological and non-pharmacological treatment options are reviewed. Also, we provide actionable steps clinicians can integrate into their practice to help effectively assess and treat PTSD and sleep disorders, including validated symptom assessments, recommended referrals, and specific components of non-pharmacological interventions.

Background and Purpose Falls and fear of falling (FOF) in multiple sclerosis (MS) are highly prevalent issues. Previously, FOF and concern about falling (CAF) have been used interchangeably; however, persons with MS report that FOF is different than CAF. Therefore, our objective was to examine prevalence and relations of FOF and CAF to function in relapsing-remitting MS (RRMS) and progressive MS (PMS). Methods In an online survey, 1025 participants with MS indicated their FOF (yes/no) and CAF (yes/no), rated how they felt on a scale of no concern (0) to fearful (4) during 28 activities (the CF-Fall), and completed physical, cognitive, and psychological measures. Pearson's correlations were used to examine relations among the CF-Fall with other measures. In persons endorsing FOF and CAF, independent t-tests were used to compare functioning between subtypes. Results Overall, 60.2% of subjects reported that FOF and CAF are different constructs and 47.2% reported FOF (yes/no) and 64.6% reported CAF (yes/no). PMS reported greater FOF (59.1%) and CAF (80.1%) than RRMS (41.6% and 57.0%, respectively). Avoidance behavior (r = .82, p < .001), walking impairment (r = .83, p < .001), physical function (r = -.84, p < .001), and lower extremity function (r = -.85, p < .001) were most correlated to the CF-Fall. People with PMS endorsing FOF and CAF demonstrated greater FOF on the CF-Fall, greater avoidance behavior, poorer walking ability, physical function, life-space mobility, lower extremity function, but greater cognitive function than RRMS (all, p < .001). Discussion These findings underscore the disparity between FOF and CAF, emphasize the importance of evaluating FOF and CAF in MS subtypes separately, as rates for the whole sample may underestimate the prevalence in PMS, and highlight non-motor factors contributing to FOF and CAF. Future work should focus on interventions that incorporate motor, cognitive, and psychological components to address FOF and CAF. Falls and fear of falling (FOF) in multiple sclerosis (MS) are highly prevalent issues. Previously, FOF and concern about falling (CAF) have been used interchangeably; however, persons with MS report that FOF is different than CAF. Therefore, our objective was to examine prevalence and relations of FOF and CAF to function in relapsing-remitting MS (RRMS) and progressive MS (PMS). In an online survey, 1025 participants with MS indicated their FOF (yes/no) and CAF (yes/no), rated how they felt on a scale of no concern (0) to fearful (4) during 28 activities (the CF-Fall), and completed physical, cognitive, and psychological measures. Pearson's correlations were used to examine relations among the CF-Fall with other measures. In persons endorsing FOF and CAF, independent t-tests were used to compare functioning between subtypes. Overall, 60.2% of subjects reported that FOF and CAF are different constructs and 47.2% reported FOF (yes/no) and 64.6% reported CAF (yes/no). PMS reported greater FOF (59.1%) and CAF (80.1%) than RRMS (41.6% and 57.0%, respectively). Avoidance behavior (r = .82, p < .001), walking impairment (r = .83, p < .001), physical function (r = -.84, p < .001), and lower extremity function (r = -.85, p < .001) were most correlated to the CF-Fall. People with PMS endorsing FOF and CAF demonstrated greater FOF on the CF-Fall, greater avoidance behavior, poorer walking ability, physical function, life-space mobility, lower extremity function, but greater cognitive function than RRMS (all, p < .001). These findings underscore the disparity between FOF and CAF, emphasize the importance of evaluating FOF and CAF in MS subtypes separately, as rates for the whole sample may underestimate the prevalence in PMS, and highlight non-motor factors contributing to FOF and CAF. Future work should focus on interventions that incorporate motor, cognitive, and psychological components to address FOF and CAF.

BACKGROUND:As vaccines for the coronavirus become available, it will be important to know the rate of COVID-19 vaccine acceptability in adults with multiple sclerosis (MS), given that vaccination will be a key strategy for preventing SARS-CoV-2 infections. Using a national sample of adults with MS in the United States obtained early in the COVID-19 pandemic, the current study aimed to: (1) assess willingness to get a COVID-19 vaccine when available; (2) determine demographic, MS, and psychosocial correlates of vaccine willingness; and (3) measure where people with MS get their COVID-19 information and their perceived trustworthiness of such sources, which may influence COVID-19 vaccine willingness. METHODS:Adults with MS (N = 486) living in the United States completed a cross-sectional online survey (between 10 April 2020 and 06 May 2020) about their willingness to receive a COVID-19 vaccination once available. Participants also completed measures to describe the sample and to assess factors potentially related to vaccine willingness, including demographics, MS-specific variables, psychological measures, COVID-19 information sources, and perceived trustworthiness of their information sources. RESULTS:Approximately two-thirds of the participants (66.0%) reported a willingness to obtain a future COVID-19 vaccine, whereas 15.4%of the sample was unwilling. Greater willingness to receive the vaccine was associated with having a higher level of education and holding a higher perception of one's risk of catching COVID-19. Participants reported accessing COVID-19 information from many different sources. Approximately a third (31.6%) of the sample reported getting their information from healthcare providers. Healthcare providers and the National MS Society had the highest perceived trustworthiness for COVID-19 information. The perceived trustworthiness of information sources was highly associated with vaccine willingness. CONCLUSION:Early in the pandemic, willingness to get a COVID-19 vaccine was not universal in this large sample or people living with MS. Vaccine willingness was associated with a few variables including education level, perceived risk for COVID-19 infection, and trust in COVID-19 information sources. These results have important implications for guiding healthcare providers and the MS community as COVID-19 vaccines become widely available.

CME/CNE InformationActivity Available Online: To access the article, post-test, and evaluation online, go to https://www.highmarksce.com/mscare.Target Audience: The target audience for this activity is physicians, physician assistants, nursing professionals, rehabilitation professionals, mental health care clinicians, and other health care providers involved in the management of patients with multiple sclerosis (MS).Learning Objectives: 1) Describe the potential benefits of outdoor adventure programs as well as the similarities and differences between outdoor adventure programs and established nonpharmacologic treatments for mood, function, and quality of life in MS. 2) Describe future directions for research on outdoor adventure programs tailored to individuals with MS.Accreditation Statement:In support of improving patient care, this activity has been planned and implemented by the Consortium of Multiple Sclerosis Centers (CMSC) and Delaware Media Group. The CMSC is jointly accredited by the Accreditation Council for Continuing Medical Education (ACCME), the Accreditation Council for Pharmacy Education (ACPE), and the American Nurses Credentialing Center (ANCC), to provide continuing education for the healthcare team.Physician Credit: The CMSC designates this journal-based activity for a maximum of 0.75 AMA PRA Category 1 Credit(s)™. Physicians should claim only the credit commensurate with the extent of their participation in the activity.Nurse Credit: The CMSC designates this enduring material for 0.75 contact hour (none in the area of pharmacology).Disclosures: Francois Bethoux, MD, Editor in Chief of the International Journal of MS Care (IJMSC), has served as Physician Planner for this activity. He has disclosed relationships with Springer Publishing (royalty), Qr8 (receipt of intellectual property rights/patent holder), Biogen (receipt of intellectual property rights/patent holder, speakers’ bureau), GW Pharmaceuticals (consulting fee), MedRhythms (consulting fee, contracted research), Genentech (consulting fee), Helius Medical Technologies (consulting fee), Osmotica (consulting fee), Ipsen (consulting fee), and Adamas Pharmaceuticals (contracted research). Laurie Scudder, DNP, NP, has served as Reviewer for this activity. She has disclosed no relevant financial relationships. Tracy E. Herring, PhD, has disclosed no relevant financial relationships. Lindsey M. Knowles, PhD, has disclosed no relevant financial relationships. Kevin N. Alschuler, PhD, has disclosed no relevant financial relationships. The peer reviewers for IJMSC have disclosed no relevant financial relationships. The staff at IJMSC, CMSC, and Delaware Media Group who are in a position to influence content have disclosed no relevant financial relationships. Note: Financial relationships may have changed in the interval between listing these disclosures and publication of the article.Method of Participation:Release Date: August 1, 2021Valid for Credit Through: August 1, 2022In order to receive CME/CNE credit, participants must: 1) Review the continuing education information, including learning objectives and author disclosures.2) Study the educational content.3) Complete the post-test and evaluation, which are available at https://www.highmarksce.com/mscare.Statements of Credit are awarded upon successful completion of the evaluation and the post-test with a passing score of >70%. The post-test may be retaken if necessary. There is no fee to participate in this activity.Disclosure of Unlabeled Use: This educational activity may contain discussion of published and/or investigational uses of agents that are not approved by the FDA. The CMSC and Delaware Media Group do not recommend the use of any agent outside of the labeled indications. The opinions expressed in the educational activity are those of the faculty and do not necessarily represent the views of the CMSC or Delaware Media Group.Disclaimer: Participants have an implied responsibility to use the newly acquired information to enhance patient outcomes and their own professional development. The information presented in this activity is not meant to serve as a guideline for patient management. Any medications, diagnostic procedures, or treatments discussed in this publication should not be used by clinicians or other health care professionals without first evaluating their patients’ conditions, considering possible contraindications or risks, reviewing any applicable manufacturer’s product information, and comparing any therapeutic approach with the recommendations of other authorities.

Background: Multiple sclerosis (MS) organizations have recommended that adults with MS obtain the COVID-19 vaccination. Vaccine hesitancy is a barrier to full COVID-19 inoculation in the general population. Whether vaccine hesitancy is also a barrier towards optimizing vaccination rates in the MS community is unknown. To investigate vaccine hesitancy and inform efforts to increase vaccine uptake in the MS population, we conducted a follow up survey of a national sample of adults with MS living in the United States who completed an initial survey early in the COVID-19 pandemic. The current study aimed to answer questions vital to understanding vaccine hesitancy, specifically: (1) What is the prevalence of COVID-19 vaccine hesitancy in early 2021? (2) What are the reasons for and factors associated with current hesitancy? (3) How has vaccine willingness and hesitancy changed from April/May 2020 to January/February 2021? and (4) Who has changed in their vaccine willingness? Methods: Adults with MS living in the United States (N = 359) completed two online surveys (the first between 10 April 2020 and 06 May 2020; the second between 11 January 2021 and 08 February 2021) about their willingness and intent to obtain a COVID-19 vaccine. Participants also completed measures to assess factors potentially related to vaccine hesitancy, including demographics, MS variables, influenza vaccine history, vaccine concerns, and contextual factors, including perceived risk for SARS-CoV-2 infection, trust in COVID-19 information source, anxiety, and loneliness. Results: Of the participants who completed the second survey in early 2021, 20.3% were vaccine hesitant, that is, either reporting that they were undecided (13.9%) or not intending to get vaccinated (6.4%). Vaccine hesitancy decreased between the two surveys, with nearly three-fourths (73.8%) of the second sample reporting that they planned to obtain the COVID-19 vaccine. Vaccine hesitancy was associated with having a lower level of education, being non-White, not having a recent flu vaccination, holding a lower perception of one's risk of getting COVID-19, and having lower trust in the Centers for Disease Control and Prevention. Participants who were vaccine hesitant reported concerns about the long-term effects of the vaccine, the vaccine approval process, and the potential impact of the vaccine given their own health conditions/history. Notably, 90% of the undecided group wanted additional information about the vaccine before deciding. Vaccine willingness changed over time, with many of those who were somewhat willing more willing to get the COVID-19 vaccine at survey 2. Individuals who were unwilling at survey 1 were highly likely to remain unwilling at survey 2. Conclusion: Overall, COVID-19 vaccine hesitancy decreased during the pandemic, although one in five adults with MS were hesitant in early 2021. Of those who were undecided, most indicated that they wanted additional information about the vaccine before deciding whether to be vaccinated, suggesting additional educational efforts on the vaccine's safety, long-term effects, and potential health implications are still needed. Findings indicate that public health efforts may be best focused on those who are undecided, whose vaccine hesitancy may change over time and, possibly, with appropriate information or intervention.

Objective To describe pain intensity and interference in people with progressive multiple sclerosis (MS), compare these with people with relapsing-remitting multiple sclerosis (RRMS), and identify common and unique factors associated with pain intensity in people with progressive MS and RRMS. Design Observational, cross-sectional analysis using baseline data from a longitudinal survey on quality of life in participants with MS. Setting Community. Participants A total of 573 adults with MS (N=573; progressive MS, n=142; RRMS, n=431). Interventions Not applicable. Main Outcome Measures Average pain intensity was measured by an 11-point numeric rating scale, and pain interference was measured by the Patient-Reported Outcomes Measurement Information System Pain Interference Short Form. Results Participants with progressive MS reported moderate average pain intensity (3.22±2.50) and elevated pain interference (T score of 55.55±9.13). They did not differ significantly from those with RRMS in average pain intensity or pain interference. Common factors associated with higher average pain intensity were more severe disability, lower education level, unemployment, and current smoking. In those with progressive MS, older age was associated with lower average pain intensity. Conclusions Pain intensity and interference are similar across MS types. In addition to assessing and treating pain, it is important to screen for modifiable pain-related factors, such as smoking cessation, in this population.

Persons with multiple sclerosis (MS) often experience myriad symptoms that affect functioning and quality of life (QOL). Although there are a growing number of nonpharmacologic interventions designed to improve symptom severity and interference and maximize QOL, these particular treatments are limited by barriers to accessibility and, at times, a poor patient-intervention fit. Thus, it is important to consider alternative or supplemental nonpharmacologic treatments for people with MS. Outdoor adventure programs-group-based outdoor adventures aimed at enhancing QOL and fostering personal growth-could be one such alternative or supplemental approach. This topical review provides an overview of outdoor adventure programs; explores the current literature on these types of programs for the general population and medical populations; examines how outdoor adventure programs could enhance mood, functioning, and QOL for individuals with MS; and suggests future directions for research on outdoor adventure programs tailored to persons with MS.

People with chronic conditions, common among rehabilitation populations, may have risk factors that put them at higher risk for more severe illness due to coronavirus disease 2019 (COVID‐19).

Objectives: To (1) describe depressive symptom severity and suicidal ideation (SI) in persons with progressive multiple sclerosis (MS); (2) compare depressive symptom severity and SI in persons with progressive MS and persons with relapsing-remitting multiple sclerosis (RRMS); and (3) identify common and unique risk factors for greater depressive symptom severity and SI in persons with progressive MS compared with individuals with RRMS. Design: Observational, cross-sectional survey study. Setting: Community. Participants: Adults with MS (NZ573). Interventions: Not applicable. Main Outcome Measures: The dependent variables were depression symptoms and any SI measured by the Patient Health Questionnaire-9. Comparisons between groups used t tests and chi-square analyses, and risk factors were tested by examining the interaction of MS subtype (progressive MS and RRMS) and each risk factor in multiple regression models with bootstrapping. Results: Persons with progressive MS did not differ from persons with RRMS in levels of depressive symptoms or SI. Both groups reported mild depressive symptoms and approximately 10% endorsed SI. Common risk factors for greater depressive symptom severity were younger age, greater disability, greater speech and swallowing problems, and lower household income. Common risk factors for SI were shorter disease duration, greater disability, and greater speech and swallowing problems. Conclusions: In this sample, there were no group differences between persons with progressive MS and persons with RRMS in depressive symptom severity and SI. Although both groups reported mild depressive symptoms on average, nearly 1 in 4 persons met criteria for probable major depression, which underscores the importance of screening for and treating depressive disorders in all persons with MS. (C) 2020 by the American Congress of Rehabilitation Medicine

At-risk gambling is a public health problem that college students engage in at a disproportionate level compared to the general adult population. Brief interventions that incorporate personalized feedback have been efficacious at reducing gambling and related problems. The purpose of the present study was to examine the efficacy of personalized feedback-based interventions delivered via smartphone and text message. Participants were 255 students who met our screening criteria for “problem” or “pathological” gambling, and were randomized to one of three conditions: personalized feedback and follow-up targeted text messages (PFB-TXT); personalized feedback and follow-up educational information about gambling (PFB-EDU); and a control condition that received no personalized feedback or follow-up text messages. Dependent variables included percent days abstinent (PDA) from gambling, average amount wagered on a gambling day, and gambling-related problems. Results indicated that the PFB conditions did not have a direct effect relative to the control condition on the dependent variables at the six-month follow-up, but a statistically significant mediated effect on gambling-related problems via gambling norms did emerge at one-month. No differences between the two PFB conditions in terms of direct or indirect effects on the six-month outcome variables were determined. Findings from this study suggest that the personalized text condition did not provide greater efficacy in changing gambling-related outcomes over general educational messages with personalized feedback. To help explain the lack of direct intervention effects, we explored two hypotheses related to our study design and sample of gamblers.Résumé La pratique des jeux de hasard chez les étudiants universitaires constitue un problème de santé publique, car ils s’y adonnent en nombre disproportionné par rapport à la population adulte générale. Les interventions brèves qui incorporent une rétroaction personnalisée (RP) se sont avérées efficaces pour réduire la fréquence de jeu et les problèmes qui s’y rattachent. Ce projet visait à analyser l’efficacité des interventions axées sur la RP, relayées par téléphone intelligent et messagerie texte. 255 étudiants répondant à nos critères de sélection en matière de « problème de jeu » ou de jeu « pathologique » été répartis aléatoirement en trois groupes. Le premier groupe a reçu une RP et des messages textes de suivi; le deuxième groupe, une RP et du matériel d’information sur le jeu; et le troisième, soit le groupe contrôle, n’a reçu ni rétroaction ni message texte. Les variables dépendantes (VD) incluaient : le pourcentage de jours d’abstinence; la somme moyenne misée les jours de pari; ainsi que les problèmes de jeu. Selon nos résultats, la RP n’a aucun effet direct sur les VD au 6e mois de suivi par rapport au groupe contrôle; toutefois, on a constaté au 1er mois un effet de médiation statistiquement significatif d’une variable relative aux habitudes de jeu sur les problèmes de jeu. Par ailleurs, aucune différence n’a été observée entre les deux interventions quant à leur effet direct ou indirect sur les VD au 6e mois. Selon nos conclusions, la RP ne serait pas plus efficace que les messages d’information générale en ce qui touche l’incidence sur les problèmes de jeu. Pour tenter d’expliquer cette absence d’effet de l’intervention directe, nous proposons deux hypothèses, l’une relative à la méthodologie de notre étude et l’autre, à l’échantillon des joueurs.

Background: People living with MS during COVID-19 are experiencing the disruptions of the pandemic and concerns that their health status may place them at greater risk for worse COVID-19 outcomes. Objective: This study sought to understand how people living with MS in the United States experienced distress and perceived their COVID-19-related risk during the first surge of the pandemic. Methods: This was a web-based, self-report survey of people with MS who were living in the United States during the early stage of COVID-19. Primary outcomes were depression, anxiety, and positive-affect and well-being. Participants (N = 491) also provided data on demographics, MS-related factors, COVID-19 factors, and psychological coping. Results: Psychological distress was associated with age, psychological coping strategies, and having had symptoms consistent with COVID-19, but not with MS disease-related variables and COVID-19 risk factors. Perception of COVID-19-related risk was associated with age, MS disease severity, COVID-19-related factors, and anxiety. Conclusion: This study demonstrated that even during COVID-19, distress and risk perception are primarily driven by psychological factors, experiencing symptoms consistent with COVID-19 and age, with minimal contribution from individual differences in health status, providing an impetus for continued efforts to optimize psychological interventions for people living with MS.