Feasibility of the First Known Adaptive Intervention for People With SCI
Condition: Spinal Cord Injuries
MeSH terms: Spinal Cord Injuries
Study type: Interventional

Summary: 
      The overall goal of the proposed research is to conduct a pilot study to test the feasibility
      and acceptability of a home-based exercise intervention (SMART-HEALTH). The primary purpose
      of the pilot study is to assess the feasibility of intervention delivery (Aim 1), the
      acceptability of the intervention by participants (Aim 2) and estimate effect sizes for a
      future trial (Aim 3).
    

Detailed description: 
      The proposed project aims to address low adherence to exercise interventions among people
      with SCI. Specifically, we will conduct a 12-week pilot study of a SMART design using a
      telehealth-delivered intervention previously developed for people with mobility disability as
      the primary intervention strategy. This intervention, Movement-to-Music (M2M), has been
      previously packaged as a collection of videos disseminated through an app on a weekly
      schedule. M2M has been shown to effectively improve physiological outcomes among people with
      a neurological disability, including SCI. Data collection will include accelerometer-based
      measurement of physical activity and sleep during the intervention, a 3-day physical activity
      recall, and assessment of physiological (e.g., grip strength) and psychosocial factors (i.e.,
      depression, anxiety) collected before and after intervention. Social Cognitive Theory has
      been used successfully in past studies to improve many health behaviors. Thus, it will be
      utilized into SMART-HEALTH as the following constructs: self-efficacy, self-regulation,
      social support, and outcome expectations.

      A sample of individuals with SCI will be randomized to 3 weeks or 6 weeks of M2M with social
      networking support for the first treatment stage. Depending on adherence, they will either
      continue with the intervention received in the first treatment stage or be randomized a
      second time. Specifically, participants with high adherence (40 or more minutes) will
      continue M2M with social networking support, while those with low adherence (less than 40
      minutes) will be randomized to an augmented arm that includes individualized behavioral
      coaching or to an arm that switches to M2M Live. The second treatment stage will last until
      the participant has completed a total of 12 weeks on the program. The social networking
      support, individualized behavioral coaching, and M2M Live sessions will be completed through
      secure videoconferencing on the mobile health platform, which will allow a singular location
      for tracking intervention activity. All security features of the integrated videoconferencing
      software will be used, including passwords and waiting rooms.

      M2M. In the first treatment stage, all participants will receive M2M as the evidence-based
      home exercise intervention. M2M is provided in the form of an exercise routine that includes
      aerobic and strength training set to music. Each week the participants will receive a set of
      exercise videos, which they will be asked to complete 3 times during the week. Exercise
      videos begin with a low dose of minutes, approximately 10 to 15 minutes for a total of 40
      minutes for the week, and increase by 3-5 minutes each week.

      Social Networking Support. In the first treatment stage, all participants will also receive
      social networking support. The group will also be able to communicate through the mobile
      health platform via features such as messaging, posting, commenting, and liking. Each week a
      discussion board will provide an opportunity for participants to post comments concerning the
      week's exercise content, weekly article, and/or their experience with the program that week.

      Individual Behavioral Coaching. Some participants with sub-optimal adherence in the first
      treatment stage will be randomized to one of two treatment groups in the second treatment
      stage. Half of these participants will receive M2M plus social networking support augmented
      with individualized behavioral coaching.

      M2M Live. The remaining half of participants with sub-optimal adherence in the first
      treatment stage will switch to another M2M-based home exercise intervention, M2M Live. This
      involves one-on-one tele-exercise training with an M2M instructor. During the first week of
      M2M Live, the participant will set a schedule to meet with the M2M instructor one time per
      week for an exercise session. The exercise session will be recorded and posted for the
      participant to complete 2 additional times.
    

Intervention name(s): Movement-2-Music + Social Networking Support
Intervention type(s): Behavioral
Intervention description(s): The primary goal of the proposed research is to conduct a 12-week pilot study of the SMART-HEALTH intervention in 30 individuals with SCI. There are several unique features of this study design, including a novel adapted exercise program (M2M), instructor-led, individualized training (M2M Live; described in D.2.1), individualized behavioral coaching, and social networking support.
Other intervention name(s): Individual Behavioral Coaching; Movement-2-Music Live
Allocation: Randomized
Intervention model: Factorial Assignment
Intervention model description: sequential multiple assignment randomized trial
Masking: Triple (Participant, Investigator, Outcomes Assessor)
Primary purpose: Prevention
Keywords: exercise; behavioral coaching