<?xml version="1.0" encoding="UTF-8"?><xml><records><record><source-app name="Biblio" version="7.x">Drupal-Biblio</source-app><ref-type>17</ref-type><contributors><authors><author><style face="normal" font="default" size="100%">Silverman, Arielle M</style></author><author><style face="normal" font="default" size="100%">Verrall, Aimee M</style></author><author><style face="normal" font="default" size="100%">Alschuler, Kevin N</style></author><author><style face="normal" font="default" size="100%">Smith, Amanda E</style></author><author><style face="normal" font="default" size="100%">Ehde, Dawn M</style></author></authors></contributors><titles><title><style face="normal" font="default" size="100%">Bouncing back again, and again: a qualitative study of resilience in people with multiple sclerosis.</style></title><secondary-title><style face="normal" font="default" size="100%">Disabil Rehabil</style></secondary-title></titles><dates><year><style  face="normal" font="default" size="100%">2016</style></year><pub-dates><date><style  face="normal" font="default" size="100%">2016 Feb 15</style></date></pub-dates></dates><pages><style face="normal" font="default" size="100%">1-9</style></pages><language><style face="normal" font="default" size="100%">eng</style></language><abstract><style face="normal" font="default" size="100%">&lt;p&gt;Purpose The purpose of this study was to describe the meaning of resilience, factors facilitating resilience and barriers to resilience, from the perspective of persons with multiple sclerosis (MS), their care partners and community stakeholders. Method We conducted four focus groups: two with middle-aged (36-62 years) individuals with MS [one with men (n&amp;thinsp;=&amp;thinsp;6) and one with women (n&amp;thinsp;=&amp;thinsp;6)], one for partners of individuals with MS (n&amp;thinsp;=&amp;thinsp;11) and one with community stakeholders serving people with MS (n&amp;thinsp;=&amp;thinsp;9). We asked participants to describe what resilience means to them, what factors facilitate resilience and what barriers to resilience they perceive. We analyzed the focus group transcripts for emerging themes and sub-themes. Results Participants found it difficult to generate a concise definition of resilience, but they generated evocative descriptions of the concept. Psychological adaptation, social connection, life meaning, planning and physical wellness emerged as facilitators of resilience. Resilience depletion, negative thoughts and feelings, social limitations, social stigma and physical fatigue emerged as barriers to resilience. Conclusion The unpredictable nature of MS can present unique challenges to resilient adjustment, especially during middle age. However, several factors can contribute to resilience and quality of life, and these factors are amenable to intervention. Implications for Rehabilitation Resilience is the capacity to bounce back and thrive when faced with challenges. People with MS develop resilience through psychological adaptation, social connection, life meaning, planning ahead and physical wellness. Barriers to resilience with MS include burnout, negative thoughts and feelings, social difficulties, stigma and fatigue. Interventions should address both individual and social factors that support resilience, such as promoting positive thinking, planning and engagement in meaningful activities.&lt;/p&gt;
</style></abstract></record><record><source-app name="Biblio" version="7.x">Drupal-Biblio</source-app><ref-type>17</ref-type><contributors><authors><author><style face="normal" font="default" size="100%">Ehde, Dawn M</style></author><author><style face="normal" font="default" size="100%">Elzea, Jamie L</style></author><author><style face="normal" font="default" size="100%">Verrall, Aimee M</style></author><author><style face="normal" font="default" size="100%">Gibbons, Laura E</style></author><author><style face="normal" font="default" size="100%">Smith, Amanda</style></author><author><style face="normal" font="default" size="100%">Amtmann, Dagmar</style></author></authors></contributors><titles><title><style face="normal" font="default" size="100%">Efficacy of A Telephone-Delivered Self-Management Intervention For Persons With Multiple Sclerosis: a Randomized Controlled Trial With a One-Year Follow-Up.</style></title><secondary-title><style face="normal" font="default" size="100%">Arch Phys Med Rehabil</style></secondary-title></titles><dates><year><style  face="normal" font="default" size="100%">2015</style></year><pub-dates><date><style  face="normal" font="default" size="100%">2015 Nov</style></date></pub-dates></dates><volume><style face="normal" font="default" size="100%">96</style></volume><pages><style face="normal" font="default" size="100%">1945-1958</style></pages><language><style face="normal" font="default" size="100%">eng</style></language><abstract><style face="normal" font="default" size="100%">&lt;p&gt;OBJECTIVE: To evaluate the efficacy of a telephone-delivered self-management intervention for fatigue, pain, and depression in adults with multiple sclerosis (MS). DESIGN: Single-center, randomized (1:1), single blind (outcome assessors) parallel-group trial with a primary end-point of post-treatment (9-11 weeks post-randomization) and long-term follow-ups at 6- and 12-months. SETTING: Telephone-delivered across the United States. PARTICIPANTS: Adults with MS (N=163) with fatigue, chronic pain, and/or moderate depressive symptoms (age range 25-76 years). INTERVENTIONS: Eight-week individual telephone-delivered self-management intervention (T-SM: n=75) versus an eight-week individual telephone-delivered MS education intervention (T-ED: n=88). MAIN OUTCOME MEASURES: The primary outcome was the proportion who achieved a &amp;gt; 50% decrease in one or more symptom - fatigue impact, pain interference, and/or depression severity. Secondary outcomes included continuous measures of pain, fatigue impact, depression, self-efficacy, activation, health-related quality of life, resilience, and affect. RESULTS: For our primary outcome, 58% of those in the T-SM and 46% of those in the T-Ed had a &amp;gt; 50% reduction in one or more symptom; this difference was not statistically significant (OR: 1.50, 95% CI: 0.77 to 2.93, p = 0.238). Participants in both groups significantly improved from baseline to post-treatment in primary and secondary outcome measures (p &amp;lt; 0.05). T-SM participants reported significantly higher treatment satisfaction and therapeutic alliance and greater improvements in activation, positive affect, and social roles. Improvements were generally maintained at 6- and 12-months. CONCLUSIONS: Both interventions resulted in short- and long-term, clinically meaningful benefits. The study demonstrated that the telephone is an effective method for engaging participants in and extending the reach of care for individuals with MS.&lt;/p&gt;
</style></abstract><issue><style face="normal" font="default" size="100%">11</style></issue><section><style face="normal" font="default" size="100%">1945</style></section></record><record><source-app name="Biblio" version="7.x">Drupal-Biblio</source-app><ref-type>17</ref-type><contributors><authors><author><style face="normal" font="default" size="100%">Matsuda, Patricia Noritake</style></author><author><style face="normal" font="default" size="100%">Verrall, Aimee M</style></author><author><style face="normal" font="default" size="100%">Finlayson, Marcia L</style></author><author><style face="normal" font="default" size="100%">Molton, Ivan R</style></author><author><style face="normal" font="default" size="100%">Jensen, Mark P</style></author></authors></contributors><titles><title><style face="normal" font="default" size="100%">Falls Among Adults Aging With Disability.</style></title><secondary-title><style face="normal" font="default" size="100%">Arch Phys Med Rehabil</style></secondary-title></titles><dates><year><style  face="normal" font="default" size="100%">2015</style></year><pub-dates><date><style  face="normal" font="default" size="100%">2014 Oct 19</style></date></pub-dates></dates><language><style face="normal" font="default" size="100%">eng</style></language><abstract><style face="normal" font="default" size="100%">&lt;p&gt;OBJECTIVE: To investigate the prevalence of and risk factors for falling among individuals aging with multiple sclerosis (MS), muscular dystrophy (MD), postpolio syndrome (PPS), and spinal cord injury (SCI). DESIGN: Cross-sectional survey data from 2009 to 2010 were analyzed. We used forward logistic regression models to examine whether risk factors such as age, sex, mobility level, years since diagnosis, vision, balance, weakness, number of comorbid conditions, and physical activity could distinguish participants who reported falling from those who did not. SETTING: Surveys were mailed to community-dwelling individuals who had 1 of 4 diagnoses (MS, MD, PPS, or SCI). The survey response rate was 91%. PARTICIPANTS: A convenience sample of community-dwelling individuals (N=1862; age, 18-94y) with MS, MD, PPS, or SCI in the United States. INTERVENTIONS: Not applicable. MAIN OUTCOME MEASURE: Self-reported fall within the last 6 months. RESULTS: Fall prevalence for people with MS (54%), MD (70%), PPS (55%), and SCI (40%). Across all 4 groups, fall rates peaked in middle age (45-64y) and among people with moderate mobility limitations. Seven risk factors differentiated participants who fell from those who did not: mobility level, imbalance, age, curvilinear age (age(2)), number of comorbid conditions, duration of diagnosis, and sex. The models differed across diagnostic groups. CONCLUSIONS: People aging with long-term physical disabilities experience unique challenges that affect their risk of falls. A better understanding of the frequency, severity, and risk factors of falls across diagnostic groups is needed to design and implement customized, effective fall prevention and management programs for these individuals.&lt;/p&gt;
</style></abstract></record><record><source-app name="Biblio" version="7.x">Drupal-Biblio</source-app><ref-type>47</ref-type><contributors><authors><author><style face="normal" font="default" size="100%">Verall, AM</style></author><author><style face="normal" font="default" size="100%">Johnson, KL</style></author><author><style face="normal" font="default" size="100%">Yorkston, K M</style></author><author><style face="normal" font="default" size="100%">Matter, B</style></author><author><style face="normal" font="default" size="100%">Smith, A</style></author><author><style face="normal" font="default" size="100%">Nelson, I</style></author></authors></contributors><titles><title><style face="normal" font="default" size="100%">Translating Research Findings into Useful Tools for Patients and Providers</style></title></titles><dates><year><style  face="normal" font="default" size="100%">2015</style></year></dates><pub-location><style face="normal" font="default" size="100%">Poster presented at Lehmann's Day, Seattle, Washington</style></pub-location><language><style face="normal" font="default" size="100%">eng</style></language></record><record><source-app name="Biblio" version="7.x">Drupal-Biblio</source-app><ref-type>47</ref-type><contributors><authors><author><style face="normal" font="default" size="100%">Verrall, Aimee M</style></author><author><style face="normal" font="default" size="100%">Alschuler, Kevin A</style></author><author><style face="normal" font="default" size="100%">Johnson, KL</style></author><author><style face="normal" font="default" size="100%">Molton, I R</style></author></authors></contributors><titles><title><style face="normal" font="default" size="100%">Aging with a Long-Term Physical Disability: Primary and Rehabilitation Care Use.</style></title></titles><dates><year><style  face="normal" font="default" size="100%">2014</style></year></dates><pub-location><style face="normal" font="default" size="100%">Poster presented at the American Public Health Association’s Annual Conference, New Orleans, Louisiana</style></pub-location><language><style face="normal" font="default" size="100%">eng</style></language><abstract><style face="normal" font="default" size="100%">&lt;p&gt;&lt;u&gt;Introduction.&lt;/u&gt;&amp;nbsp; People with disabilities and chronic conditions indicate high utilization of many types of health care in numerous settings. &amp;nbsp;People with long-term physical disabilities (LTPD), such as multiple sclerosis, muscular dystrophy, post-polio syndrome, and spinal cord injury, are living longer than ever.&amp;nbsp; Now, people with LTPDs&amp;rsquo; health may not only experience secondary conditions (pain, fatigue, depression) from their original disability, but aging as well.&amp;nbsp; In this study we examined the use of primary and rehabilitation care by people aging with LTPD.&amp;nbsp;&lt;/p&gt;
&lt;p&gt;&lt;u&gt;Methods.&lt;/u&gt; We identified needs, barriers / facilitators, and predisposing characteristics of primary and rehabilitation care use from a self-reported survey collected in 2012&amp;ndash;2013 of community dwelling people aging with LTPD. &amp;nbsp;We used Anderson&amp;rsquo;s model of health services utilization as a conceptual model.&lt;/p&gt;
&lt;p&gt;&lt;u&gt;Results&lt;/u&gt;.&amp;nbsp; The survey was completed by 1,369 people with LTPD with a mean age of 63 years.&amp;nbsp; In the last 12 months, 70% reported seeing a primary care provider (PCP) and 65% a rehabilitation provider.&amp;nbsp; The most common need predicting PCP use was severe mobility limitation and pain interference.&amp;nbsp; For seeing rehabilitation providers the main predictor, also a need, was all ranges of mobility issues (mild to severe).&amp;nbsp; Relative to men, women with LTPD were less likely to see a PCP.&amp;nbsp; Surprisingly, socioeconomic status and health insurance coverage were not predictors of health care usage.&lt;/p&gt;
&lt;p&gt;&lt;u&gt;Conclusion&lt;/u&gt;.&amp;nbsp; Needs, overwhelmingly mobility driven, affect use of health services among people with LTPD.&amp;nbsp; More research is needed to further describe the complex health care usage of people aging with LTPD.&amp;nbsp;&lt;/p&gt;
</style></abstract></record><record><source-app name="Biblio" version="7.x">Drupal-Biblio</source-app><ref-type>17</ref-type><contributors><authors><author><style face="normal" font="default" size="100%">Fogelberg, Donald J</style></author><author><style face="normal" font="default" size="100%">Vitiello, Michael V</style></author><author><style face="normal" font="default" size="100%">Hoffman, Jeanne M</style></author><author><style face="normal" font="default" size="100%">Bamer, Alyssa M</style></author><author><style face="normal" font="default" size="100%">Amtmann, Dagmar</style></author></authors></contributors><titles><title><style face="normal" font="default" size="100%">Comparison of Self-Report Sleep Measures for Individuals With Multiple Sclerosis and Spinal Cord Injury.</style></title><secondary-title><style face="normal" font="default" size="100%">Arch Phys Med Rehabil</style></secondary-title></titles><dates><year><style  face="normal" font="default" size="100%">2014</style></year><pub-dates><date><style  face="normal" font="default" size="100%">2014 Oct 23</style></date></pub-dates></dates><language><style face="normal" font="default" size="100%">eng</style></language><abstract><style face="normal" font="default" size="100%">&lt;p&gt;OBJECTIVE: To investigate self-report measures of sleep disturbances and sleep-related impairments in samples of individuals with multiple sclerosis (MS) or spinal cord injury (SCI). DESIGN: Cross-sectional survey. SETTING: Community based. PARTICIPANTS: Adults (age &amp;ge;18y) (N=700) with either MS (n=461) or SCI (n=239) who were enrolled in a longitudinal survey of self-reported health outcomes and who completed self-report sleep measures at 1 time point. INTERVENTIONS: None. MAIN OUTCOME MEASURES: Medical Outcomes Study Sleep Scale (MOS-S), Patient Reported Outcomes Measurement Information System (PROMIS) sleep disturbance short form, and PROMIS sleep-related impairments short form. RESULTS: Mean scores on the MOS-S sleep index II were significantly worse for both the MS and SCI samples than those of previously reported samples representative of the U.S. general population (P&amp;lt;.0001 for each group). The PROMIS sleep disturbance short form and PROMIS sleep-related impairments short form scores of the MS sample were also significantly different from those reported for the calibration cohort (P&amp;lt;.0001 on each scale). However, although the scores of the SCI sample were significantly different from those of the comparison cohort for the PROMIS sleep-related impairments short form (P=.045), the differences on the PROMIS sleep disturbance short form were not significant (P=.069). CONCLUSIONS: Although the MOS-S scores for the MS and SCI cohorts clearly indicated significantly high levels of sleep-related problems and were consistent with existing literature, the more ambiguous findings from the PROMIS sleep disturbance short form and PROMIS sleep-related impairments short form suggest that not enough is currently known about how these instruments function when applied to those with chronic neurologic dysfunction.&lt;/p&gt;
</style></abstract></record><record><source-app name="Biblio" version="7.x">Drupal-Biblio</source-app><ref-type>47</ref-type><contributors><authors><author><style face="normal" font="default" size="100%">Yorkston, Kathryn</style></author><author><style face="normal" font="default" size="100%">Baylor, Carolyn</style></author><author><style face="normal" font="default" size="100%">Amtmann, Dagmar</style></author><author><style face="normal" font="default" size="100%">Verrall, Aimee M</style></author></authors></contributors><titles><title><style face="normal" font="default" size="100%">Integrating Development of Self-Efficacy into Treatment Decisions</style></title></titles><dates><year><style  face="normal" font="default" size="100%">2014</style></year></dates><pub-location><style face="normal" font="default" size="100%">Oral presentation at the American Speech-Language-Hearing Association’s Convention, Orlando, Florida</style></pub-location><language><style face="normal" font="default" size="100%">eng</style></language><abstract><style face="normal" font="default" size="100%">&lt;p&gt;Summary&lt;/p&gt;
&lt;p&gt;&lt;u&gt;Definitions:&amp;nbsp; &lt;/u&gt;&lt;/p&gt;
&lt;p&gt;People living with chronic communication problems such as aphasia learn to manage their own conditions.&amp;nbsp; They decide whether or not to adhere to exercise programs, to participate in social activities and roles, and to use the health-care resources available to them. Self-management is based on the idea that those with a chronic condition should take an active, central role in managing their disease, secondary conditions, and health care (Rae-Grant et al, 2011). Development of self-efficacy is an important component of self-management. &lt;u&gt;Self-efficacy&lt;/u&gt; is the belief in one&amp;rsquo;s ability to produce the effects or outcomes one wants (Bandura, 1977).&amp;nbsp; Because self-efficacy can be taught, speech-language pathologists should incorporate principles of self-efficacy into treatment plans.&amp;nbsp; Bandura suggests self-efficacy can be improved by focusing on four factors that are potentially amendable to intervention: performance accomplishment, vicarious experience, verbal persuasion and maintenance of an optimal physiological state.&amp;nbsp;&lt;/p&gt;
&lt;p&gt;&lt;u&gt;Background&lt;/u&gt; &lt;u&gt;of Qualitative &amp;amp; Quantitative Research&lt;/u&gt;&lt;/p&gt;
&lt;p&gt;Self-efficacy has been studied in people with various communication disorders including, voice disorders, stuttering, and hearing loss.&amp;nbsp; Recently, Runne (2012) conducted a series of semi-structured interviews with people in the chronic phase of stroke.&amp;nbsp; The five participants experienced either aphasia, dysarthria or both.&amp;nbsp; Questions related to their level of confidence regarding communication and the development of confidence over time.&amp;nbsp; Thematic analysis suggests that progress requires hard work, develops over a long period of time, and involves &amp;ldquo;working with what you have.&amp;rdquo;&amp;nbsp; Participants indicated that their family member&amp;rsquo;s role should be one of encouragement and praise.&amp;nbsp; For healthcare providers, the suggestions included &amp;ldquo;treat me like an individual and take time to get to know me.&amp;rdquo;&amp;nbsp;&lt;/p&gt;
&lt;p&gt;In a series of focus groups, we asked people aging with chronic physical disability to help us define the meaning of &amp;ldquo;aging well with disability.&amp;rdquo;&amp;nbsp; Many participants alluded to issues related to self-efficacy.&amp;nbsp; One participant told us, &amp;ldquo;successful aging with disability is recreating yourself.&amp;rdquo; Another indicated that successful aging was &amp;ldquo;to pull yourself up by your own bootstraps and do the things you need to do . . and want to do.&amp;rdquo;&lt;/p&gt;
&lt;p&gt;&lt;u&gt;Treatment Decisions:&lt;/u&gt;&amp;nbsp; In planning and implementing treatment, clinicians and clients should share in the decisions.&lt;/p&gt;
&lt;p&gt;&lt;u&gt;Participation Focused Intervention&lt;/u&gt;:&amp;nbsp; Because it is important that intervention be individualized, targeted to real-world communication situations and focused on development of self-efficacy, we use the acronym PACE to describe a four step procedure for developing communication strategies (Yorkston et al, 2006):&lt;/p&gt;
&lt;ul&gt;
	&lt;li&gt;
		Priorities: Given limited energy and resources, it is important for those with communication problems to set priorities, to define what is important.&lt;/li&gt;
	&lt;li&gt;
		Awareness: After setting priorities, people with communication problems need to become aware of potential barriers to participation and the resources available to get around those barriers.&lt;/li&gt;
	&lt;li&gt;
		Constructing the Strategies: &amp;nbsp;Many of the people describe a process where they begin to do things in a different way.&amp;nbsp; Changing how things get done involves constructing and employing a personal set of strategies.&amp;nbsp; At first this is done with the clinician and later, people with communication disorders can set priorities and construct potential strategies independently.&lt;/li&gt;
	&lt;li&gt;
		Evaluation: An important last step in the development of strategies is to evaluate them by asking the question - does the strategy work for me? Evaluation involves weighing cost and benefits of the strategies and modifying them as needed.&lt;/li&gt;
&lt;/ul&gt;
&lt;p&gt;&lt;u&gt;Outcome Measures&lt;/u&gt;:&amp;nbsp; Because current healthcare trends demand documentation that healthcare services are regarded as valuable and bring about meaningful change from client perspectives, self-reported outcome measures are becoming increasingly important.&amp;nbsp; Self-reported measures of communicative participation are available (Baylor et al, 2013).&amp;nbsp; This item bank was developed using modern psychometric methods and validated with community-dwelling adults with various communication conditions.&amp;nbsp; A ten item short form is available.&amp;nbsp; A measure of self-efficacy for disease management has also recently been developed using rigorous psychometric methods.&amp;nbsp; Called the University of Washington Self-Efficacy Scale, the full item bank contains 17 items with five response options ranging from &amp;lsquo;not at all (confident)&amp;rsquo; to &amp;lsquo;completely (confident)&amp;rsquo;. Examples of items include: Can you keep your [condition] from being the center of your life? and Can you figure out effective solutions to [condition] related issues that come up? A 6-item short form is also available.&amp;nbsp; Taken together these scales allow clinicians to document treatment outcome both in terms of enhanced participation and self-efficacy.&lt;/p&gt;
&lt;p&gt;&lt;u&gt;Conclusions:&lt;/u&gt;&lt;/p&gt;
&lt;p&gt;Understanding the nature of self-efficacy is important for a number of reasons.&amp;nbsp; First, self-efficacy has been shown to be a predictor of physical, cognitive and social functioning.&amp;nbsp; It is also associated with improved health status, health behaviors and reduced medical services usage. It may also be a valuable predictor of healthy aging in individuals with degenerative conditions such as multiple sclerosis. In addition to its value as a predictor, self-efficacy is important because it is increasingly seen as a fruitful target for intervention.&lt;/p&gt;
&lt;p&gt;&lt;u&gt;References&lt;/u&gt;&lt;/p&gt;
&lt;p&gt;Amtmann, D., Bamer, A. M., Cook, K. F., Askew, R. L., Noonan, V. K., &amp;amp; Brockway, J. A. (2012). University of Washington self-efficacy scale: a new self-efficacy scale for people with disabilities. &lt;em&gt;Arch Phys Med Rehabil, 93&lt;/em&gt;(10), 1757-1765.&lt;/p&gt;
&lt;p&gt;Bandura, A. (1977). Self-efficacy: Toward a unifying theory of behavioral change. &lt;em&gt;Psychological Review, 84&lt;/em&gt;, 191-215.&lt;/p&gt;
&lt;p&gt;Baylor, C., Yorkston, K., Eadie, T., Kim, J., Chung, H., &amp;amp; Amtmann, D. (2013). The Communicative Participation Item Bank (CPIB):&amp;nbsp; Item bank calibration and development of a disorder-generic short form. &lt;em&gt;Journal of Speech Language and Hearing Research, 56&lt;/em&gt;, 1190-1208.&lt;/p&gt;
&lt;p&gt;Rae-Grant, A. D., Turner, A., Sloan, A., Miller, D., Hunziker, J., &amp;amp; Haselkorn, J. (2011). Self-management in neurological disorders: Systematic review of the the literature and potential&amp;nbsp;&lt;/p&gt;
</style></abstract></record><record><source-app name="Biblio" version="7.x">Drupal-Biblio</source-app><ref-type>10</ref-type><contributors><authors><author><style face="normal" font="default" size="100%">Verrall, Aimee M</style></author><author><style face="normal" font="default" size="100%">Anjali R. Truitt</style></author><author><style face="normal" font="default" size="100%">Katherine G. Schomer</style></author><author><style face="normal" font="default" size="100%">Artherholt, Samantha</style></author><author><style face="normal" font="default" size="100%">Dawn Ehde</style></author><author><style face="normal" font="default" size="100%">Jensen, Mark P</style></author></authors></contributors><titles><title><style face="normal" font="default" size="100%">Scoping Review of Health and Wellness Interventions for People Aging with and into Physical Disability</style></title><secondary-title><style face="normal" font="default" size="100%">American Public Health Association's (APHA) Annual Meeting</style></secondary-title></titles><dates><year><style  face="normal" font="default" size="100%">2013</style></year></dates><publisher><style face="normal" font="default" size="100%">American Public Health Association's (APHA) Annual Meeting</style></publisher><pub-location><style face="normal" font="default" size="100%">Boston, MA</style></pub-location><language><style face="normal" font="default" size="100%">eng</style></language><abstract><style face="normal" font="default" size="100%">&lt;p&gt;&lt;u&gt;Introduction.&lt;/u&gt;&amp;nbsp; There is an urgent need to increase knowledge, services, and evidence-based health and wellness (HW) interventions for people aging with and into disability as traditional aging services are expanding to serve this subpopulation. People who are aging with or into physical disabilities have high prevalence of comorbid conditions and health risk factors and this subpopulation is projected to increase dramatically in the next 20 years.&amp;nbsp; A scoping review of the HW intervention literature was conducted in order to: (1) assess the adaptability of the interventions for people aging with a physical disability and (2) contrast the interventions with evidenced-based HW interventions in aging populations that are being implemented across the U.S. on a larger scale.&lt;/p&gt;
&lt;p&gt;&lt;u&gt;Methods.&lt;/u&gt; PubMed, CINAHL, and PsycINFO were searched for peer-reviewed articles about adults with spinal cord injury, multiple sclerosis, stroke, osteoarthritis, post-polio syndrome, and muscular dystrophy. The inclusion criteria for articles included:&amp;nbsp; (1) addressed promotion of HW in adults with physical disabilities; (2) focused on community-based behavioral or educational intervention that targeted HW.&lt;/p&gt;
&lt;p&gt;&lt;u&gt;Results&lt;/u&gt;.&amp;nbsp; Data were extracted from 82 articles meeting inclusion criteria. The most common HW interventions included exercise, self-management, counseling, and health education, which often paralleled interventions being deployed by aging agencies.&lt;/p&gt;
&lt;p&gt;&lt;u&gt;Conclusion&lt;/u&gt;.&amp;nbsp; There is support for adapting concepts and strategies from HW interventions from the fields of both aging and disability by applying standard adaptation models to create evidence-based HW interventions for the subpopulation of people aging with and into disability.&amp;nbsp;&lt;/p&gt;
</style></abstract></record><record><source-app name="Biblio" version="7.x">Drupal-Biblio</source-app><ref-type>10</ref-type><contributors><authors><author><style face="normal" font="default" size="100%">Thomas E. McNalley</style></author><author><style face="normal" font="default" size="100%">Yorkston, Kathryn M</style></author><author><style face="normal" font="default" size="100%">Jensen, Mark P</style></author><author><style face="normal" font="default" size="100%">Anjali R. Truitt</style></author><author><style face="normal" font="default" size="100%">Baylor, Carolyn</style></author><author><style face="normal" font="default" size="100%">Katherine G. Schomer</style></author><author><style face="normal" font="default" size="100%">Molton, Ivan R</style></author><author><style face="normal" font="default" size="100%">Verrall, Aimee M</style></author></authors></contributors><titles><title><style face="normal" font="default" size="100%">Scoping Review of Secondary Health Conditions fo People Aging with Post-Polio Syndrome</style></title><secondary-title><style face="normal" font="default" size="100%">American Public Health Association's (APHA) Annual Meeting</style></secondary-title></titles><dates><year><style  face="normal" font="default" size="100%">2013</style></year></dates><publisher><style face="normal" font="default" size="100%">American Public Health Association's (APHA) Annual Meeting</style></publisher><pub-location><style face="normal" font="default" size="100%">Boston, MA</style></pub-location><language><style face="normal" font="default" size="100%">eng</style></language><abstract><style face="normal" font="default" size="100%">&lt;p&gt;&lt;u&gt;Introduction.&lt;/u&gt;&amp;nbsp; Post-polio syndrome (PPS), occurring in approximately half of people who previous contracted polio, is characterized by increased weakness, pain and fatigue. Although this orphaned condition was nearly eradicated world-wide in the 20&lt;sup&gt;th&lt;/sup&gt; century, almost nothing is known about the trajectory of associated health conditions as people age or how these conditions can be distinguished from typical aging. &amp;nbsp;An environmental scan of the literature was conducted to establish a platform of shared knowledge to better understand the needs of this population. Specifically, this review examined the types, frequency, timing of onset, and severity of associated health conditions in persons aging with or into PPS.&lt;/p&gt;
&lt;p&gt;&lt;u&gt;Methods.&lt;/u&gt; PubMed, CINAHL, and PsycINFO were searched for data-based articles about adults with PPS using a list of 76 chronic conditions. Articles were included that explored prevalence / incidence, severity, frequency, duration, or life course of associated conditions.&lt;/p&gt;
&lt;p&gt;&lt;u&gt;Results&lt;/u&gt;.&amp;nbsp; Data were extracted from 57 articles. As expected, fatigue, pain, and muscle weakness were the most prevalent conditions.&amp;nbsp; In addition, a number of other conditions were reported: respiration problems, depression, sleep disturbance, injurious falls, bone or joint problems, cardiovascular health, diabetes, bladder function, and skin problems.&lt;/p&gt;
&lt;p&gt;&lt;u&gt;Conclusion&lt;/u&gt;.&amp;nbsp; A number of potentially treatable health conditions are common in people aging with PPS.&amp;nbsp; The lack of longitudinal studies limits our ability to draw conclusions about age and duration effects. Such information is needed to guide home and community based services or care coordination delivered through the network of programs sponsored by the aging agencies.&lt;/p&gt;
</style></abstract></record><record><source-app name="Biblio" version="7.x">Drupal-Biblio</source-app><ref-type>17</ref-type><contributors><authors><author><style face="normal" font="default" size="100%">Amtmann, Dagmar</style></author><author><style face="normal" font="default" size="100%">Bamer, Alyssa M</style></author><author><style face="normal" font="default" size="100%">Verrall, Aimee</style></author><author><style face="normal" font="default" size="100%">Salem, Rana</style></author><author><style face="normal" font="default" size="100%">Borson, Soo</style></author></authors></contributors><titles><title><style face="normal" font="default" size="100%">Symptom Profiles in Individuals Aging with Post-Polio Syndrome.</style></title><secondary-title><style face="normal" font="default" size="100%">J Am Geriatr Soc</style></secondary-title></titles><dates><year><style  face="normal" font="default" size="100%">2013</style></year><pub-dates><date><style  face="normal" font="default" size="100%">2013 Oct</style></date></pub-dates></dates><volume><style face="normal" font="default" size="100%">61</style></volume><pages><style face="normal" font="default" size="100%">1813-1815</style></pages><language><style face="normal" font="default" size="100%">eng</style></language><issue><style face="normal" font="default" size="100%">10</style></issue></record><record><source-app name="Biblio" version="7.x">Drupal-Biblio</source-app><ref-type>17</ref-type><contributors><authors><author><style face="normal" font="default" size="100%">Victorson, David</style></author><author><style face="normal" font="default" size="100%">Manly, Jennifer</style></author><author><style face="normal" font="default" size="100%">Wallner-Allen, Kathleen</style></author><author><style face="normal" font="default" size="100%">Fox, Nathan</style></author><author><style face="normal" font="default" size="100%">Purnell, Christy</style></author><author><style face="normal" font="default" size="100%">Hendrie, Hugh</style></author><author><style face="normal" font="default" size="100%">Havlik, Richard</style></author><author><style face="normal" font="default" size="100%">Harniss, Mark</style></author><author><style face="normal" font="default" size="100%">Magasi, Susan</style></author><author><style face="normal" font="default" size="100%">Correia, Helena</style></author><author><style face="normal" font="default" size="100%">Gershon, Richard</style></author></authors></contributors><titles><title><style face="normal" font="default" size="100%">Using the NIH Toolbox in special populations: considerations for assessment of pediatric, geriatric, culturally diverse, non-English-speaking, and disabled individuals.</style></title><secondary-title><style face="normal" font="default" size="100%">Neurology</style></secondary-title></titles><keywords><keyword><style  face="normal" font="default" size="100%">Cultural Diversity</style></keyword><keyword><style  face="normal" font="default" size="100%">Culture</style></keyword><keyword><style  face="normal" font="default" size="100%">Disabled Persons</style></keyword><keyword><style  face="normal" font="default" size="100%">Geriatrics</style></keyword><keyword><style  face="normal" font="default" size="100%">Humans</style></keyword><keyword><style  face="normal" font="default" size="100%">Language</style></keyword><keyword><style  face="normal" font="default" size="100%">National Institutes of Health (U.S.)</style></keyword><keyword><style  face="normal" font="default" size="100%">Pediatrics</style></keyword><keyword><style  face="normal" font="default" size="100%">United States</style></keyword></keywords><dates><year><style  face="normal" font="default" size="100%">2013</style></year><pub-dates><date><style  face="normal" font="default" size="100%">2013 Mar 12</style></date></pub-dates></dates><volume><style face="normal" font="default" size="100%">80</style></volume><pages><style face="normal" font="default" size="100%">S13-9</style></pages><language><style face="normal" font="default" size="100%">eng</style></language><abstract><style face="normal" font="default" size="100%">&lt;p&gt;BACKGROUND: In order to develop health outcomes measures that are relevant and applicable to the general population, it is essential to consider the needs and requirements of special subgroups, such as the young, elderly, disabled, and people of different ethnic and cultural backgrounds, within that population. METHODS: The NIH Toolbox project convened several working groups to address assessment issues for the following subgroups: pediatric, geriatric, cultural, non-English-speaking, and disabled. Each group reviewed all NIH Toolbox instruments in their entirety. RESULTS: Each working group provided recommendations to the scientific study teams regarding instrument content, presentation, and administration. When feasible and appropriate, instruments and administration procedures have been modified in accordance with these recommendations. CONCLUSION: Health outcome measurement can benefit from expert input regarding assessment considerations for special subgroups.&lt;/p&gt;
</style></abstract><issue><style face="normal" font="default" size="100%">11 Suppl 3</style></issue></record><record><source-app name="Biblio" version="7.x">Drupal-Biblio</source-app><ref-type>17</ref-type><contributors><authors><author><style face="normal" font="default" size="100%">Amtmann, Dagmar</style></author><author><style face="normal" font="default" size="100%">Borson, Soo</style></author><author><style face="normal" font="default" size="100%">Salem, Rana</style></author><author><style face="normal" font="default" size="100%">Johnson, Kurt L</style></author><author><style face="normal" font="default" size="100%">Verrall, Aimee</style></author></authors></contributors><titles><title><style face="normal" font="default" size="100%">Aging with disabilities: Comparing symptoms and quality of life indicators of individuals aging with disabilities to U.S. general population norms.</style></title><secondary-title><style face="normal" font="default" size="100%">Journal of the American Geriatrics Society</style></secondary-title></titles><keywords><keyword><style  face="normal" font="default" size="100%">Special Issue: 2012 Annual Scientific Meeting Abstract Book</style></keyword></keywords><dates><year><style  face="normal" font="default" size="100%">2012</style></year></dates><pub-location><style face="normal" font="default" size="100%">Seattle, WA</style></pub-location><volume><style face="normal" font="default" size="100%">60</style></volume><pages><style face="normal" font="default" size="100%">S185</style></pages><language><style face="normal" font="default" size="100%">eng</style></language><abstract><style face="normal" font="default" size="100%">&lt;p&gt;Background: Advances in medical care and rehabilitation have extended the lifespan of people with long-term physical disabilities. However, quantifying the excess burden of symptoms in persons aging with disabilities has been hindered by lack of common metrics across measures and clinical populations. The NIH-funded PROMIS initiative used modern psychometric methods to develop instruments that do use a common metric and provide US population norms for many important domains. The objective of the current study was to construct profiles of symptoms and QoL indicators in persons aging with a long-term disability and to compare them to US population norms. Methods: PROMIS short forms measuring 7 symptoms or QoL indicators (fatigue, pain interference with activities, physical and social function, depression, and sleep and wake disturbance) were completed by individuals with muscular dystrophy (264), multiple sclerosis (481), post-polio syndrome (445), and spinal cord injury (323) (total N=1513) participating in an ongoing longitudinal survey. Individuals aged 45-94 were included in this analysis. Scores for the overall sample, by diagnostic group and by age categories, were compared to the PROMIS US population norms. Results: Compared to the US general population, individuals aging with disabilities reported a higher symptom burden and poorer QoL on 6 of 7 measures (all p&amp;lt;0.0001). Only wake disturbance did not differ from the general population. Statistically significant differences ranged from a low of 2.4 points (sleep disturbance) to a high of 14.4 points (physical function) (T-score metric with a mean of 50 and sd of 10). Comparison to age group norms suggested that older (65+) individuals with disabilities experienced worse fatigue, more pain interference, higher depressive symptoms and lower social function than younger disabled groups.Differences between the disabled and general population groups in symptom burden and QoL widened with age; the oldest group, aged 75+, fared worst. Conclusions: Results clearly document that discrepancies in symptoms and QoL between the general population and people with disabilities increase with aging. Individuals with long-term disabilities constitute a subgroup of the aging population that may require specialized specialized models of health care to manage symptoms adequately, and optimize function and QoL.&lt;/p&gt;
</style></abstract><issue><style face="normal" font="default" size="100%">S4</style></issue></record><record><source-app name="Biblio" version="7.x">Drupal-Biblio</source-app><ref-type>17</ref-type><contributors><authors><author><style face="normal" font="default" size="100%">Yorkston, Kathryn M</style></author><author><style face="normal" font="default" size="100%">Verrall, Aimee</style></author><author><style face="normal" font="default" size="100%">Johnson, Kurt L</style></author></authors></contributors><titles><title><style face="normal" font="default" size="100%">Aging with longstanding physical disability: A focus group study</style></title><secondary-title><style face="normal" font="default" size="100%">Journal of the American Geriatrics Society</style></secondary-title></titles><dates><year><style  face="normal" font="default" size="100%">2012</style></year></dates><urls><web-urls><url><style face="normal" font="default" size="100%">http://onlinelibrary.wiley.com/doi/10.1111/j.1532-5415.2012.04000.x/pdf</style></url></web-urls></urls><volume><style face="normal" font="default" size="100%">60</style></volume><pages><style face="normal" font="default" size="100%">s240</style></pages><language><style face="normal" font="default" size="100%">eng</style></language><abstract><style face="normal" font="default" size="100%">&lt;p&gt;Background: People aging with longstanding physical disability must deal with competing trajectories. Physical function is declining while confidence in the ability to cope is improving. Social support is likely to decline with retirement &amp;amp; aging significant others while medical management is improving thus increasing life expectancy. Methods: Four focus groups were conducted soliciting advice for health care teams seeing patients aging with a longstanding disability. Participants included people with spinal cord injury (N = 7), postpolio syndrome (N = 7), multiple sclerosis (N = 5), and muscular dystrophy (N = 4). All were at least 45 years of age and living with their disability for at least 8 years. Focus groups transcripts were reviewed and coded using Atlas.ti and a framework of themes was developed. Results: Four major themes emerged which are described in Table 1. Conclusions: Health care providers should acknowledge the skills that people with longstanding disability bring to the task of prioritizing their goals and managing their condition. Healthcare providers can assist them in developing individualized self-management interventions that help to maintain function and independence as they age.&lt;/p&gt;
</style></abstract><issue><style face="normal" font="default" size="100%">S4</style></issue></record><record><source-app name="Biblio" version="7.x">Drupal-Biblio</source-app><ref-type>17</ref-type><contributors><authors><author><style face="normal" font="default" size="100%">Alschuler, Kevin N</style></author><author><style face="normal" font="default" size="100%">Gibbons, Laura E</style></author><author><style face="normal" font="default" size="100%">Rosenberg, Dori E</style></author><author><style face="normal" font="default" size="100%">Ehde, Dawn M</style></author><author><style face="normal" font="default" size="100%">Verrall, Aimee</style></author><author><style face="normal" font="default" size="100%">Bamer, Alyssa M</style></author><author><style face="normal" font="default" size="100%">Jensen, Mark P</style></author></authors></contributors><titles><title><style face="normal" font="default" size="100%">Body mass index and waist circumference in persons aging with muscular dystrophy, multiple sclerosis, post-polio syndrome, and spinal cord injury.</style></title><secondary-title><style face="normal" font="default" size="100%">Disability and Health Journal</style></secondary-title><alt-title><style face="normal" font="default" size="100%">Disabil Health J</style></alt-title></titles><dates><year><style  face="normal" font="default" size="100%">2012</style></year><pub-dates><date><style  face="normal" font="default" size="100%">2012 Jul</style></date></pub-dates></dates><volume><style face="normal" font="default" size="100%">5</style></volume><pages><style face="normal" font="default" size="100%">177-84</style></pages><language><style face="normal" font="default" size="100%">eng</style></language><abstract><style face="normal" font="default" size="100%">&lt;p&gt;BACKGROUND: Body mass index (BMI) and waist circumference (WC) are well-understood in the general population, but are not adequately understood among persons with disabilities. OBJECTIVE: To describe and compare BMI and WC among individuals with muscular dystrophy (MD), multiple sclerosis (MS), post-polio syndrome (PPS), and spinal cord injury (SCI). BMI scores were also compared to normative data of the U.S. population, with consideration for age, sex, and mobility limitations. METHODS: Persons with MD (n = 339), MS (n = 597), PPS (n = 443), and SCI (n = 488) completed postal surveys that included self-reported BMI and WC data. NHANES data were used to compare the current sample with a representative US sample. RESULTS: Participants with PPS had higher BMI than participants with MD, MS, and SCI. In addition, participants with MS had significantly higher BMI relative to participants with SCI. BMI was significantly positively associated with age, years since diagnosis, mobility, and interactions of some of these factors. Relative to the general population, BMI was lower in MD, MS, and SCI across age groups, as well as in men with PPS and women ages 60-74 years with PPS. No significant differences were identified between MD, MS, PPS, and SCI in WC. CONCLUSIONS: The presence of group differences in BMI and absence of group differences in WC suggests that BMI may not accurately represent health risk in SCI, MD, and possibly MS, because of biasing elements of the conditions, such as changes in body composition and mobility limitations.&lt;/p&gt;
</style></abstract><issue><style face="normal" font="default" size="100%">3</style></issue><custom1><style face="normal" font="default" size="100%">http://www.ncbi.nlm.nih.gov/pubmed/22726858?dopt=Abstract</style></custom1></record><record><source-app name="Biblio" version="7.x">Drupal-Biblio</source-app><ref-type>10</ref-type><contributors><authors><author><style face="normal" font="default" size="100%">Bombardier, Charles H</style></author><author><style face="normal" font="default" size="100%">Rosenberg, Dori E</style></author><author><style face="normal" font="default" size="100%">Motl, Robert W</style></author><author><style face="normal" font="default" size="100%">Artherholt, Samantha</style></author><author><style face="normal" font="default" size="100%">Verrall, Aimee</style></author><author><style face="normal" font="default" size="100%">Jensen, Mark P</style></author></authors></contributors><titles><title><style face="normal" font="default" size="100%">Depression and physical activity among adults with multiple sclerosis, muscular dystrophy, spinal cord injury, and post-polio syndrome</style></title></titles><dates><year><style  face="normal" font="default" size="100%">2012</style></year></dates><urls><web-urls><url><style face="normal" font="default" size="100%">http://www.posters2view.com/ectrims2012/view.php?nu=969</style></url></web-urls></urls><publisher><style face="normal" font="default" size="100%">European Committee for Treatment and Research in Multiple Sclerosis (ECTRIMS)</style></publisher><pub-location><style face="normal" font="default" size="100%">Lyon, France</style></pub-location><language><style face="normal" font="default" size="100%">eng</style></language></record><record><source-app name="Biblio" version="7.x">Drupal-Biblio</source-app><ref-type>17</ref-type><contributors><authors><author><style face="normal" font="default" size="100%">Alschuler, Kevin N</style></author><author><style face="normal" font="default" size="100%">Jensen, Mark P</style></author><author><style face="normal" font="default" size="100%">Goetz, Mark C</style></author><author><style face="normal" font="default" size="100%">Smith, Amanda E</style></author><author><style face="normal" font="default" size="100%">Verrall, Aimee</style></author><author><style face="normal" font="default" size="100%">Molton, Ivan R</style></author></authors></contributors><titles><title><style face="normal" font="default" size="100%">Effects of pain and fatigue on physical functioning and depression in persons with muscular dystrophy.</style></title><secondary-title><style face="normal" font="default" size="100%">Disability and Health Journal</style></secondary-title><alt-title><style face="normal" font="default" size="100%">Disabil Health J</style></alt-title></titles><dates><year><style  face="normal" font="default" size="100%">2012</style></year><pub-dates><date><style  face="normal" font="default" size="100%">2012 Oct</style></date></pub-dates></dates><volume><style face="normal" font="default" size="100%">5</style></volume><pages><style face="normal" font="default" size="100%">277-83</style></pages><language><style face="normal" font="default" size="100%">eng</style></language><abstract><style face="normal" font="default" size="100%">&lt;p&gt;BACKGROUND: Pain and fatigue are common symptoms experienced by persons with muscular dystrophy (MD). However, it is unclear from previous studies whether pain and fatigue have independent effects on physical functioning and depression, and whether age moderates the relationship of pain and fatigue with physical functioning and depression. OBJECTIVE: This cross-sectional study aimed to describe the relationship of pain and fatigue to physical functioning and depression in persons 20-89 years old with MD. METHOD: A convenience sample of 332 individuals with MD completed a questionnaire that included measures of physical functioning (PROMIS item bank items), depression (PHQ-9), pain intensity (0-10 NRS), and fatigue (0-10 NRS). RESULTS: Pain and fatigue were each independently associated with physical functioning and depression. Depressive symptoms were most severe among middle-aged participants (45-64 years old) relative to older and younger participants. Physical functioning had a negative relationship with chronological age. CONCLUSIONS: Symptoms of pain and fatigue are significantly and independently related to physical functioning and depression in persons with MD. Research is needed to determine if treatments that target both pain and fatigue in patients with MD have more beneficial effects than treatments that target only one of these symptoms.&lt;/p&gt;
</style></abstract><issue><style face="normal" font="default" size="100%">4</style></issue><custom1><style face="normal" font="default" size="100%">http://www.ncbi.nlm.nih.gov/pubmed/23021739?dopt=Abstract</style></custom1></record><record><source-app name="Biblio" version="7.x">Drupal-Biblio</source-app><ref-type>10</ref-type><contributors><authors><author><style face="normal" font="default" size="100%">Bombardier, Charles H</style></author><author><style face="normal" font="default" size="100%">Ehde, Dawn M</style></author><author><style face="normal" font="default" size="100%">Gibbons, Laura E</style></author><author><style face="normal" font="default" size="100%">Kraft, George H</style></author><author><style face="normal" font="default" size="100%">Verrall, Aimee</style></author></authors></contributors><titles><title><style face="normal" font="default" size="100%">The effects of telephone-based physical activity counselling on fatigue, pain, symptoms and quality of life in people with multiple sclerosis and major depression</style></title></titles><dates><year><style  face="normal" font="default" size="100%">2012</style></year></dates><urls><web-urls><url><style face="normal" font="default" size="100%">http://www.posters2view.com/ectrims2012/view.php?nu=486</style></url></web-urls></urls><publisher><style face="normal" font="default" size="100%">European Committee for Treatment and Research in Multiple Sclerosis (ECTRIMS)</style></publisher><pub-location><style face="normal" font="default" size="100%">Lyon, France</style></pub-location><language><style face="normal" font="default" size="100%">eng</style></language></record><record><source-app name="Biblio" version="7.x">Drupal-Biblio</source-app><ref-type>17</ref-type><contributors><authors><author><style face="normal" font="default" size="100%">Molton, Ivan R</style></author><author><style face="normal" font="default" size="100%">Goetz, Mark C</style></author><author><style face="normal" font="default" size="100%">Jensen, Mark P</style></author><author><style face="normal" font="default" size="100%">Verrall, Aimee</style></author></authors></contributors><titles><title><style face="normal" font="default" size="100%">Evidence for “accelerated aging” in older adults with disability?</style></title><secondary-title><style face="normal" font="default" size="100%">Journal of the American Geriatrics Society</style></secondary-title></titles><dates><year><style  face="normal" font="default" size="100%">2012</style></year></dates><urls><web-urls><url><style face="normal" font="default" size="100%">http://onlinelibrary.wiley.com/doi/10.1111/j.1532-5415.2012.04000.x/pdf</style></url></web-urls></urls><volume><style face="normal" font="default" size="100%">60</style></volume><pages><style face="normal" font="default" size="100%">s239</style></pages><language><style face="normal" font="default" size="100%">eng</style></language><abstract><style face="normal" font="default" size="100%">&lt;p&gt;BACKGROUND: Improvements in medical care have led to longer life-spans for people with disabilities acquired early in life. However, there is some evidence that these improvements in longevity are offset by increased rates of medical conditions, due to a more rapid decline of organ system functioning in persons with disability. This phenomenon has been called &amp;ldquo;accelerated aging.&amp;rdquo; However, the existence of this phenomenon has not been adequately established in large samples with adequate age-matched controls. METHODS: The present study assessed self-reported rates of certain medical conditions in a large national sample of people with either spinal cord injury (n=540), post-polio syndrome (446), muscular dystrophy (382) or multiple sclerosis (640), and compared them to normative data taken from the National Health Interview Survey (NHIS) of more than 21,000 adults. Health conditions assessed included hypertension, coronary artery disease, cancer, diabetes, pain conditions, and vision trouble. Comparisons were conducted in four age bands: 18-44, 45-65, 65-75, 75+. Chi-square and independent samples t-tests were used for all analyses. RESULTS:Participants in the experimental sample were primarily Caucasian (92%) and female (63.3%), with an average age of 54.5 years. Results suggested that, across age bands, individuals with disabilities reported greater rates of hypertension, arthritis, joint pain and difficulties with vision (all p values &amp;lt; 0.05). However, in more advanced age bands (65-75 and 75+), adults with disabilities also reported greater frequency of organ system diseases (diabetes, coronary artery disease, and cancer) than were present in age matched national norms (all p values &amp;lt; 0.01). CONCLUSIONS: These results lend support to the idea of &amp;ldquo;accelerated aging&amp;rdquo; of organ systems in persons growing older with longstanding physical disabilities. Health care providers should be aware of the special medical needs associated with organ system decline in these individuals.&lt;/p&gt;
</style></abstract><issue><style face="normal" font="default" size="100%">S4</style></issue></record><record><source-app name="Biblio" version="7.x">Drupal-Biblio</source-app><ref-type>10</ref-type><contributors><authors><author><style face="normal" font="default" size="100%">Kraft, George H</style></author><author><style face="normal" font="default" size="100%">Amtmann, Dagmar</style></author><author><style face="normal" font="default" size="100%">Johnson, Kurt L</style></author><author><style face="normal" font="default" size="100%">Weir, Virginia G</style></author><author><style face="normal" font="default" size="100%">Verrall, Aimee</style></author><author><style face="normal" font="default" size="100%">Bamer, Alyssa M</style></author></authors></contributors><titles><title><style face="normal" font="default" size="100%">Hidden symptoms of multiple sclerosis increase with patient age</style></title></titles><dates><year><style  face="normal" font="default" size="100%">2012</style></year></dates><urls><web-urls><url><style face="normal" font="default" size="100%">http://www.posters2view.com/ectrims2012/view.php?nu=187</style></url></web-urls></urls><publisher><style face="normal" font="default" size="100%">European Committee for Treatment and Research in Multiple Sclerosis (ECTRIMS)</style></publisher><pub-location><style face="normal" font="default" size="100%">Lyon, France</style></pub-location><language><style face="normal" font="default" size="100%">eng</style></language><abstract><style face="normal" font="default" size="100%">&lt;p&gt;Background: Although many of the more obvious symptoms of multiple sclerosis (MS), such as weakness, ataxia, and bladder problems, are incorporated into the Kurtzke Expanded Disability Status Scale (EDSS), less information is available on the prevalence of &amp;quot;hidden&amp;quot; manifestations of this disease, such as fatigue, depression, pain, and anxiety. The recent completion of the NIH-funded PROMIS and Neuro-QoL initiatives allow comparison of less apparent symptoms with age-matched norms from a large, industrialized population.&amp;nbsp; The aim of the current study was to compare less apparent symptoms of MS as well as quality of life (QoL) indicators with population norms and to stratify changes in symptom burden with increasing age.&lt;/p&gt;
&lt;p&gt;Methods: PROMIS short forms, based on US population norms, on 11 hidden symptoms (fatigue, depression, pain interference, anxiety, sleep disturbance, and wake disturbance) and quality of life indicators (cognitive concerns, executive functioning, physical function, global mental function, and social role) were completed by 1,543 individuals with MS in three cross-sectional surveys.&amp;nbsp; Scores for the overall sample were compared on Neuro-QoL cognitive function.&amp;nbsp; Results in 9 domains from age groups 18-34 (n=104), 35-44 (n=195), 45-54 (n=440), 55-64 (n=544), 65-74 (n=223) and older than 75 (n=37) were compared with PROMIS population norms.&lt;/p&gt;
&lt;p&gt;Results: When comparing the whole sample to the US population, adults with MS reported significantly higher symptom burden on all 11 domains, (p&amp;lt;0.0001).&amp;nbsp; Depression showed the least difference and physical function the greatest difference. Comparisons to age group norms showed increasing symptom burden in older cohorts.&amp;nbsp; The 18-34 group reported significantly higher levels of fatigue, pain interference, sleep disturbance, and physical function than the corresponding age norm, (p&amp;lt;0.005).&amp;nbsp; Age groups 35-44 and 45-54 reported significantly higher burden on all domains except global mental function while age groups 55-64 and 65-74 reported higher burden on all 9 domains compared with PROMIS population norms (except age group 65-74 reported significantly less sleep disturbance), (p&amp;lt;0.005).&lt;/p&gt;
&lt;p&gt;Conclusion:&amp;nbsp; Our findings indicate that most of these less-apparent symptoms increase with age. In particular, physical and mental function and satisfaction with social role decrease while fatigue increases most with age.&amp;nbsp; Older adults living with MS may require targeted health care strategies to optimize quality of life.&lt;/p&gt;
</style></abstract></record><record><source-app name="Biblio" version="7.x">Drupal-Biblio</source-app><ref-type>10</ref-type><contributors><authors><author><style face="normal" font="default" size="100%">Finlayson, Marcia</style></author><author><style face="normal" font="default" size="100%">Verrall, Aimee</style></author><author><style face="normal" font="default" size="100%">Matsuda, Patricia Noritake</style></author><author><style face="normal" font="default" size="100%">Molton, Ivan R</style></author><author><style face="normal" font="default" size="100%">Jensen, Mark P</style></author></authors></contributors><titles><title><style face="normal" font="default" size="100%">Prevalence of Falling and Injuries in Older Adults with a Physical Disability</style></title></titles><dates><year><style  face="normal" font="default" size="100%">2012</style></year></dates><publisher><style face="normal" font="default" size="100%">American Public Health Association (APHA) Annual Meeting</style></publisher><pub-location><style face="normal" font="default" size="100%">San Francisco, CA</style></pub-location><language><style face="normal" font="default" size="100%">eng</style></language><abstract><style face="normal" font="default" size="100%">&lt;p&gt;Introduction. Falling among older adults is a wide-spread problem that often has devastating consequences for the individual and family. However, knowledge about the scope and correlates of falls among people aging with multiple sclerosis (MS), muscular dystrophy (MD), post-polio (PPS) and spinal cord injury (SCI) is very limited. Research in this area is particularly important because these individuals often experience problems with mobility, balance, sensation, and muscle power that place them at significant risk for both falls and injurious falls. Methods. Cross-sectional data were used from a survey of individuals aging (45 yrs +) with MS, MD, PPS, and SCI (n = 1,862). The survey contained 6 questions about falling. Logistical regression models were built to examine whether factors such as age, sex, and mobility were associated with falling. Results. The prevalence of falls reported in the last 6 months was 73% MD, 56% MS, 55%, PPS, 42% SCI. The rate of injurious falls was 23% MD, 19% MD, 22% PPS, 20% SCI. The major factor associated with falling in older adults across all 4 disabilities was limitations in mobility . Sex was only significant in people with MS, with women being less likely to fall than men. Younger and middle age categories tended to have an increased odds of falling. Conclusion. Preventing falls in persons with disabilities is of paramount importance. A better understanding of the frequency, severity, and correlates of falls is an important first step towards designing effective fall prevention and management programs for these individuals.&lt;/p&gt;
</style></abstract></record><record><source-app name="Biblio" version="7.x">Drupal-Biblio</source-app><ref-type>10</ref-type><contributors><authors><author><style face="normal" font="default" size="100%">Matsuda, Patricia Noritake</style></author><author><style face="normal" font="default" size="100%">Verrall, Aimee</style></author><author><style face="normal" font="default" size="100%">Finlayson, Marcia</style></author><author><style face="normal" font="default" size="100%">Molton, Ivan R</style></author><author><style face="normal" font="default" size="100%">Jensen, Mark P</style></author></authors></contributors><titles><title><style face="normal" font="default" size="100%">Prevalence of Falling and Injuries in People Aging with Multiple Sclerosis, Muscular Dystrophy, Post-Polio Syndrome, and Spinal Cord Injury</style></title></titles><dates><year><style  face="normal" font="default" size="100%">2012</style></year></dates><publisher><style face="normal" font="default" size="100%">International Symposium on Gait and Balance in Multiple Sclerosis</style></publisher><pub-location><style face="normal" font="default" size="100%">Portland, OR</style></pub-location><language><style face="normal" font="default" size="100%">eng</style></language><abstract><style face="normal" font="default" size="100%">&lt;p&gt;&lt;strong&gt;&lt;u&gt;Background.&lt;/u&gt;&lt;/strong&gt;&amp;nbsp; Falls among older adults often have devastating consequences.&amp;nbsp; However, knowledge about the scope and correlates of falls among people aging with multiple sclerosis (MS), muscular dystrophy (MD), post-polio (PPS), and spinal cord injury (SCI) is limited.&amp;nbsp; Research in this area is particularly important because these individuals often experience problems with mobility, balance, sensation, and strength that place them at significant risk for both falls and injurious falls.&lt;/p&gt;
&lt;p&gt;&lt;strong&gt;&lt;u&gt;Methods&lt;/u&gt;&lt;/strong&gt;&lt;u&gt;.&lt;/u&gt; Cross-sectional data were used from a survey of individuals aging (45 yrs +) with MS, MD, PPS, and SCI (n = 1,862). The survey contained 6 questions about falling. Logistic regression models were built to examine whether age, sex, and mobility were associated with falling.&lt;/p&gt;
&lt;p&gt;&lt;strong&gt;&lt;u&gt;Results&lt;/u&gt;&lt;/strong&gt;&lt;strong&gt;.&lt;/strong&gt;&amp;nbsp; The prevalence of falls reported in the last 6 months was 73% for people with MD, 56% for MS, 55% PPS, and 42% for SCI. The rates of injurious falls were:&amp;nbsp; 23% in MD, 22% in PPS, 20% in SCI, and 19% in MS. The major factor associated with falling in all group was limitations in mobility (e.g., reporting use of an assistive device for mobility or limited self-mobility with use of physical assistance or device). Sex was only significant in people with MS, with women being less likely to fall than men.&amp;nbsp; Across all 4 groups the prevalence of falls was highest among the middle age groups (e.g.44-64).relative to the older groups (65+).&lt;/p&gt;
&lt;p&gt;&lt;strong&gt;&lt;u&gt;Conclusion/Clinical Relevance&lt;/u&gt;&lt;/strong&gt;&lt;strong&gt;:&lt;/strong&gt;&amp;nbsp; Falls are a common experience among people aging with MS, MD, PPS, or SCI.&amp;nbsp; Falls were experienced by all age groups studied, but greatest in those who are middle-aged (45-64).&amp;nbsp; This suggests that fall prevention strategies should not be limited to older individuals. &amp;nbsp;&amp;nbsp;Preventing falls is of paramount importance.&amp;nbsp; A better understanding of the frequency, severity, and correlates of falls will assist health care providers to develop effective fall prevention and management programs for these individuals.&amp;nbsp;&lt;/p&gt;
</style></abstract></record><record><source-app name="Biblio" version="7.x">Drupal-Biblio</source-app><ref-type>10</ref-type><contributors><authors><author><style face="normal" font="default" size="100%">Smith, Amanda E</style></author><author><style face="normal" font="default" size="100%">McMullen, Kara A</style></author><author><style face="normal" font="default" size="100%">Molton, Ivan R</style></author><author><style face="normal" font="default" size="100%">Verrall, Aimee</style></author></authors></contributors><titles><title><style face="normal" font="default" size="100%">Symptom Burden in Persons with Muscular Dystrophy (MD)</style></title></titles><dates><year><style  face="normal" font="default" size="100%">2012</style></year></dates><publisher><style face="normal" font="default" size="100%">American Public Health Association (APHA) Annual Meeting</style></publisher><pub-location><style face="normal" font="default" size="100%">San Francisco, CA</style></pub-location><language><style face="normal" font="default" size="100%">eng</style></language><abstract><style face="normal" font="default" size="100%">&lt;p&gt;Introduction: Research suggests that pain, fatigue, imbalance, memory loss and vision loss may be a significant problem in persons with muscular dystrophy. The current study examines these symptoms, and their impact on patient functioning.&lt;/p&gt;
&lt;p&gt;Methods: 170 people with Myotonic Dystrophy Type 1 or Facioscapulohumeral Dystrophy participated in a study examining MD. Measures assessed incidence,, severity and course of five symptoms using a 0 to 10 Numerical Rating Scale. Social integration and psychological functioning were assessed using the Community Integration Questionnaire (CIQ) and the SF-36 mental component score. Descriptive and regression analyses examined the association between symptoms and functioning.&lt;/p&gt;
&lt;p&gt;Results: The most common symptoms reported were fatigue (90.6%), imbalance (82.4%) and pain (76.5%). The most severe symptom was imbalance (50.0% reported levels &amp;gt;6 on the NRS), followed by fatigue (46.5% &amp;gt;6). All symptoms were more likely to stay the same or get worse than improve since onset.When controlling for potential confounds, these symptoms explained 17% of the variance of the mental component score, 10% of home competency, 10% of social integration, and 9% of productive activity.&lt;/p&gt;
&lt;p&gt;Discussion: Pain, fatigue and imbalance are commonly reported symptoms in persons with MD. The severity and trajectory of these symptoms highlight a need for interventions to mitigate their impact on people with MD, and to improve productive activity and social integration. Further research is needed to examine the relationships among these symptoms and functioning and to guide clinical practices.&lt;/p&gt;
</style></abstract></record><record><source-app name="Biblio" version="7.x">Drupal-Biblio</source-app><ref-type>17</ref-type><contributors><authors><author><style face="normal" font="default" size="100%">Goetz, Mark C</style></author><author><style face="normal" font="default" size="100%">Jensen, Mark P</style></author><author><style face="normal" font="default" size="100%">Verrall, Aimee</style></author><author><style face="normal" font="default" size="100%">Ehde, Dawn M</style></author><author><style face="normal" font="default" size="100%">Bamer, Alyssa M</style></author><author><style face="normal" font="default" size="100%">Molton, Ivan R</style></author><author><style face="normal" font="default" size="100%">Kraft, George H</style></author></authors></contributors><titles><title><style face="normal" font="default" size="100%">Age effects of sleep problems in individuals with multiple sclerosis.</style></title><secondary-title><style face="normal" font="default" size="100%">International Journal of MS Care</style></secondary-title></titles><keywords><keyword><style  face="normal" font="default" size="100%">Sleep and MS</style></keyword></keywords><dates><year><style  face="normal" font="default" size="100%">2011</style></year></dates><urls><web-urls><url><style face="normal" font="default" size="100%">http://www.ijmsc.org/doi/pdf/10.7224/1537-2073-13.S3.1</style></url></web-urls></urls><volume><style face="normal" font="default" size="100%">13</style></volume><pages><style face="normal" font="default" size="100%">17-18</style></pages><language><style face="normal" font="default" size="100%">eng</style></language><abstract><style face="normal" font="default" size="100%">&lt;p&gt;Background: Sleep disturbances in individuals with multiple sclerosis (MS) are relatively common (ie, with many studies showing prevalence of approximately 50%), and evidence indicates that sleep problems are more common in MS samples than in samples of individuals who do not have MS. There is also evidence among the general population suggesting that sleep problems increase with age. However, previous research suggests that among some disability groups (eg, spinal cord injury) there may be a decline in sleep problems with age. Objectives: Based on previous research, we hypothesized that 1) sleep dysfunction in an MS sample would be greater when compared with a normative sample and 2) an examination of aging variables (chronological age, disability duration, and age at disability onset) would show a negative relationship between chronological age and the severity of sleep disturbance. Methods: A survey was administered to 584 individuals with MS that included measures of demographic characteristics and the PROMIS Sleep Disturbance Item Bank. The analytic strategy was based on a Jensen et al. (2009) paper in which a series of multiple regression analyses examined the independent contribution of three age-related variables to sleep problems: chronological age, disability duration, and age at disability onset. Results: Hypothesis 1 was not supported in that comparisons of the MS and normative data on the PROMIS revealed no differences in sleep disruption. Hypothesis 2 was supported in that the findings suggested that younger and middle-aged participants reported more sleep disturbance than did older participants. When controlling for chronological age, disability duration and age at disability onset were not significantly associated with sleep difficulties. Conclusion: One possible explanation for the age effect found is a cohort effect where the older adult groups could potentially include participants who are healthier than the younger participants (ie, health factors associated with sleep disturbance might be related to mortality). It is also possible that age influences or is associated with some third variable that influences sleep quality (eg, employed vs. retired). Longitudinal research following the same group of patients over time is needed to help test these possible explanations.&lt;/p&gt;
</style></abstract><issue><style face="normal" font="default" size="100%">S3</style></issue></record><record><source-app name="Biblio" version="7.x">Drupal-Biblio</source-app><ref-type>17</ref-type><contributors><authors><author><style face="normal" font="default" size="100%">Jensen, Mark P</style></author><author><style face="normal" font="default" size="100%">Alschuler, Kevin N</style></author><author><style face="normal" font="default" size="100%">Smith, Amanda E</style></author><author><style face="normal" font="default" size="100%">Verrall, Aimee</style></author><author><style face="normal" font="default" size="100%">Goetz, Mark C</style></author><author><style face="normal" font="default" size="100%">Molton, Ivan R</style></author></authors></contributors><titles><title><style face="normal" font="default" size="100%">Pain and fatigue in persons with postpolio syndrome: independent effects on functioning.</style></title><secondary-title><style face="normal" font="default" size="100%">Archives of Physical Medicine and Rehabilitation</style></secondary-title><alt-title><style face="normal" font="default" size="100%">Arch Phys Med Rehabil</style></alt-title></titles><keywords><keyword><style  face="normal" font="default" size="100%">Activities of Daily Living</style></keyword><keyword><style  face="normal" font="default" size="100%">Adult</style></keyword><keyword><style  face="normal" font="default" size="100%">Age Factors</style></keyword><keyword><style  face="normal" font="default" size="100%">Aged</style></keyword><keyword><style  face="normal" font="default" size="100%">Aged, 80 and over</style></keyword><keyword><style  face="normal" font="default" size="100%">Cross-Sectional Studies</style></keyword><keyword><style  face="normal" font="default" size="100%">Fatigue</style></keyword><keyword><style  face="normal" font="default" size="100%">Female</style></keyword><keyword><style  face="normal" font="default" size="100%">Humans</style></keyword><keyword><style  face="normal" font="default" size="100%">Male</style></keyword><keyword><style  face="normal" font="default" size="100%">Middle Aged</style></keyword><keyword><style  face="normal" font="default" size="100%">Pain</style></keyword><keyword><style  face="normal" font="default" size="100%">Postpoliomyelitis Syndrome</style></keyword></keywords><dates><year><style  face="normal" font="default" size="100%">2011</style></year><pub-dates><date><style  face="normal" font="default" size="100%">2011 Nov</style></date></pub-dates></dates><volume><style face="normal" font="default" size="100%">92</style></volume><pages><style face="normal" font="default" size="100%">1796-801</style></pages><language><style face="normal" font="default" size="100%">eng</style></language><abstract><style face="normal" font="default" size="100%">&lt;p&gt;OBJECTIVES: To better understand the importance of pain and fatigue in relation to functioning, and to investigate the role that age plays in these relationships in individuals with postpolio syndrome (PPS). DESIGN: Cross-sectional survey. SETTING: Community-based survey. PARTICIPANTS: Convenience sample of 446 individuals with PPS. INTERVENTIONS: Not applicable. MAIN OUTCOME MEASURES: Physical functioning (Patient Reported Outcomes Measurement Information System Physical Functioning item bank items), psychological functioning (Patient Health Questionnaire-9), pain intensity (0-10 numerical rating scale [NRS]), and fatigue (0-10 NRS). RESULTS: Pain and fatigue make independent contributions to the prediction of physical and psychological functioning. Depression was more severe in the middle-aged (&amp;le;64y) group than in the young-old (65-74y) or middle-old to oldest (&amp;ge;75y) groups, although the associations between pain and fatigue and both physical and psychological functioning are similar across all age cohorts. CONCLUSIONS: Complaints of pain or fatigue in patients with PPS who are older or elderly should not be attributed &amp;quot;merely&amp;quot; to the process of aging. The findings also support the need for clinical trials to develop and evaluate interventions that may help patients with PPS function better by treating pain and fatigue, as well as the negative effects that these symptoms can have on functioning.&lt;/p&gt;
</style></abstract><issue><style face="normal" font="default" size="100%">11</style></issue><custom1><style face="normal" font="default" size="100%">http://www.ncbi.nlm.nih.gov/pubmed/22032213?dopt=Abstract</style></custom1></record><record><source-app name="Biblio" version="7.x">Drupal-Biblio</source-app><ref-type>17</ref-type><contributors><authors><author><style face="normal" font="default" size="100%">Johnson, Kurt L</style></author><author><style face="normal" font="default" size="100%">Bamer, Alyssa M</style></author><author><style face="normal" font="default" size="100%">Verrall, Aimee</style></author><author><style face="normal" font="default" size="100%">McMullen, Kara A</style></author></authors></contributors><titles><title><style face="normal" font="default" size="100%">Predicting unemployment in people ageing with multiple sclerosis.</style></title><secondary-title><style face="normal" font="default" size="100%">Multiple Sclerosis</style></secondary-title></titles><dates><year><style  face="normal" font="default" size="100%">2011</style></year></dates><urls><web-urls><url><style face="normal" font="default" size="100%">http://msj.sagepub.com/content/17/10_suppl/S277.full.pdf+html</style></url></web-urls></urls><volume><style face="normal" font="default" size="100%">17</style></volume><pages><style face="normal" font="default" size="100%">S486</style></pages><language><style face="normal" font="default" size="100%">eng</style></language><abstract><style face="normal" font="default" size="100%">&lt;p&gt;Background: Older adults who have a disability report higher rates of unemployment than older adults without a disability and one of the significant risks associated with disability is poverty. Approximately 90% of individuals diagnosed with MS are employed before their diagnosis, but as few as 30% remain working in as little as 5 years after diagnosis. About 40% of unemployed people with MS want to return to work. Little is known about changes in employment status for people with MS as they age. Objectives: Examine the predictors of unemployment stratified by age groups in people with MS. Methods: Data were analyzed from a cross-sectional survey of community-dwelling people with MS (n = 1,271) collected in 2006. Participants were recruited from the Greater Washington Chapter of the USA National MS Society (NMSS) and were eligible if they self-reported a diagnosis of MS and were at least 18 years of age. Measures of secondary conditions, employment status, history of MS, and demographic characteristics were included in the survey.A stratified, prediction logistical regression was run across 4 age groups (18 &amp;ndash; 34 yrs, 35 &amp;ndash; 44yrs, 45 &amp;ndash; 54 yrs, 55-64 yrs) and gender, duration of MS, EDSS Mobility, MS subtype, education level, problems thinking, cognitive fatigue, physical fatigue, pain, depression, and sleep problems were included as predictors. Results: The percentage of unemployed among people with MS climbed from 39% of 18-34 yr olds to 47% of 35-44 yr olds, to 58% of 45-54 yr olds to 75% of 55-64 yr olds. Predictors of unemployment were similar throughout the 3 middle age groups (35 &amp;ndash; 64 yrs) and included duration of disease, EDSS mobility level, problems thinking.Predictors differed in the youngest age group (18-34 yrs) where only education level was a statistically significant. Also, the contribution of pain as a significant predictor only occurred in the 35-44 age group. Conclusions: People with MS are more likely to be unemployed when their MS progresses including mobility limitations as well as cognitive impairments. Surprisingly, secondary conditions of fatigue, depression, and sleep problems were not associated unemployment. Programs and services to support employment should target people with MS who are experiencing mobility and cognitive changes as they age.&lt;/p&gt;
</style></abstract><issue><style face="normal" font="default" size="100%">10 Suppl</style></issue></record><record><source-app name="Biblio" version="7.x">Drupal-Biblio</source-app><ref-type>10</ref-type><contributors><authors><author><style face="normal" font="default" size="100%">Johnson, K.</style></author></authors><secondary-authors><author><style face="normal" font="default" size="100%">Hertz, D.</style></author></secondary-authors><tertiary-authors><author><style face="normal" font="default" size="100%">Alschuler, K.</style></author><author><style face="normal" font="default" size="100%">Stobbe, G.</style></author><author><style face="normal" font="default" size="100%">Von Geldern, G.</style></author><author><style face="normal" font="default" size="100%">Kraft, G.</style></author><author><style face="normal" font="default" size="100%">Reynolds, P.</style></author><author><style face="normal" font="default" size="100%">Wundes, A.</style></author><author><style face="normal" font="default" size="100%">Alexander, K.</style></author><author><style face="normal" font="default" size="100%">Kalb, R.</style></author><author><style face="normal" font="default" size="100%">Unruh, K.</style></author><author><style face="normal" font="default" size="100%">Scott, J.</style></author></tertiary-authors></contributors><titles><title><style face="normal" font="default" size="100%">Multiple Sclerosis Project ECHO:  Outreach to rural providers to provide innovative collaborative training using video conferencing</style></title><secondary-title><style face="normal" font="default" size="100%">Annual Meeting  of the National Association of Rehabilitation Research and Training Centers</style></secondary-title></titles><language><style face="normal" font="default" size="100%">eng</style></language></record><record><source-app name="Biblio" version="7.x">Drupal-Biblio</source-app><ref-type>10</ref-type><contributors><authors><author><style face="normal" font="default" size="100%">Johnson, K.</style></author></authors><secondary-authors><author><style face="normal" font="default" size="100%">Stobbe, G.</style></author></secondary-authors><tertiary-authors><author><style face="normal" font="default" size="100%">Hertz, D.</style></author><author><style face="normal" font="default" size="100%">Alschuler, K.</style></author><author><style face="normal" font="default" size="100%">Alexander, K.</style></author><author><style face="normal" font="default" size="100%">Wundes, A.</style></author><author><style face="normal" font="default" size="100%">Kraft, G.</style></author><author><style face="normal" font="default" size="100%">Unruh, K.</style></author><author><style face="normal" font="default" size="100%">Kalb, R.</style></author><author><style face="normal" font="default" size="100%">Von Geldern, G.</style></author><author><style face="normal" font="default" size="100%">Reynolds, P.</style></author><author><style face="normal" font="default" size="100%">Scott, J.</style></author></tertiary-authors></contributors><titles><title><style face="normal" font="default" size="100%">Multiple Sclerosis Project Echo:  Outreach to Rural Providers to provide Innovative Collaborative Training Using Video Conferencing</style></title><secondary-title><style face="normal" font="default" size="100%">Northwest Regional Telehealth Resource Center</style></secondary-title></titles><language><style face="normal" font="default" size="100%">eng</style></language></record></records></xml>