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Objective: Chronic back pain (CBP) is responsible for considerable suffering across the world and is frequently associated with decreased functional capacity, quality of life, and substantial health care costs. Fear avoidance beliefs (FAB) comprise cognitions and fears about the potential for physical activities to produce pain and harm and are common among people with CBP. Collectively, research shows that FAB are frequently associated with low levels of physical activity, poorer work outcomes, and disability. Therefore, the purpose of this systematic review is to systematically locate and synthesize the current evidence regarding the effectiveness of psychological interventions on fear avoidance beliefs and fear avoidance behavior in patients with CBP. Design: A systematic literature search was conducted based on Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines and included the databases Web of Science, PubMed, Cochrane, CINAHL, Medline, and PsycINFO. Results: A total of 5,052 records were identified resulting in 2,448 documents after duplicates were removed. We screened 147 studies full text. Twenty-two studies were included in the qualitative synthesis. FAB were assessed by the Fear Avoidance Beliefs Questionnaire, the Tampa Scale of Kinesiophobia and the Avoidance Exercise Questionnaire. Interventions included cognitive behavior therapy (CBT), psychoeducation (PE), and other psychological approaches like motivational interviewing. Twelve of 22 studies demonstrated significant improvements in FAB for people with CBP who underwent a PE or CBT intervention or a different psychological approach. Conclusion: CBT and PE interventions are mainly used to address FAB among people with CBP. However, there is still inconsistent evidence as to which psychological interventions are most effective to treat FAB among people with CBP. [ABSTRACT FROM AUTHOR]

Objective: This article is the first in a three-part series focused on designing theory-based interventions to increase leisure time physical activity (LTPA) in persons with spinal cord injury (SCI). The purpose of this first study was to compare social cognitions for LTPA between people classified as LTPA actors, intenders, and nonintenders, as per Schwarzer's Health Action Process Approach (HAPA) model. Method: Participants were 238 men and women living with a SCI (M age = 44.14, SD = 12.74; 44.5% paraplegic) who were subsequently classified as LTPA actors (n = 105), intenders (n = 73), or nonintenders (n = 60). Participants completed a questionnaire that assessed the following HAPA constructs: LTPA outcome expectancies, self-efficacy, intentions, planning, and action control. Results: A MANCOVA revealed significant between-groups differences for all variables (ps < .001). For all of the measures, actors scored significantly higher than intenders who, in turn, scored significantly higher than nonintenders. Conclusion/Implications: It is both theoretically and practically important to distinguish between LTPA nonintenders, intenders, and actors when developing LTPA-enhancing interventions for people with SCI. These distinctions inform the design and testing of the interventions reported in the two accompanying articles. [ABSTRACT FROM AUTHOR]

To explore the perceptions of people with spinal cord injury (SCI) regarding preferred messengers and methods for obtaining physical activity (PA) information. Design: Using a phenomenological approach and interviewing techniques, five focus groups discussed PA information delivery methods and messengers. Participant: Sixteen community-dwelling adults with SCI (30.5% tetraplegia, 37.5% paraplegia; at least one-year post injury) whose PA levels ranged from sedentary to regularly active. Results: Content analyses revealed that the preferred media of r obtaining PA information were passive sources (e.g., Internet, DVDs, newsletters). The preferred messengers were peers and health service providers. There were diverse perspectives about the value and types of PA messages to share with people in the acute, rehabilitation, and postdischarge stages. Conclusions: The methods and messengers identified in this study illustrate the need for interdisciplinary engagement among various program and health care providers to work together to effectively deliver PA information to all individuals with SCI. People will be receptive to different messages, from different channels, at different times. [ABSTRACT FROM AUTHOR]

Objective: To evaluate the efficacy of an 8-week implementation intention intervention for promoting physical activity among individuals with spinal cord injury. Study Design: Randomized clinical trial. Method: Participants were randomly assigned to an implementation intention intervention (n = 26) or control (n = 28) condition and were asked to engage in 30 min of moderate to heavy intensity physical activity 3 times per week. Results: Participants who formed implementation intentions followed through with their physical activity intentions, engaging in more physical activity than participants in the control condition. Participants in the intervention condition also experienced sustained motivation and greater confidence to schedule physical activity compared with participants in the control condition. Implications: These findings suggest a role for implementation intentions in health promotion programs for people with spinal cord injury. [ABSTRACT FROM AUTHOR]

Objective: To examine the utility of the theory of planned behavior (TPB) for predicting leisure time physical activity (LTPA) among individuals with spinal cord injury (SCI). Study Design: Prospective correlational design. Participants: 104 men (n = 75) and women (n = 29) with SCI. Method: Baseline telephone interview assessing attitudes, subjective norms, perceived behavioral control (PBC), and intentions for engaging in LTPA. One-week follow-up telephone interview assessing frequency of LTPA. Results: Attitudes (β = .29), subjective norms (β = .29), and PBC (β = .47) each predicted LTPA intentions. LTPA intentions (β = .45) but not PBC (β = -.05) predicted LTPA. Furthermore, intentions mediated the attitudes-LTPA, subjective norms-LTPA, and PBC-LTPA relationships. Conclusions: These findings support the tenets of the TPB and provide a foundation for developing interventions promoting LTPA in the SCI population. [ABSTRACT FROM AUTHOR]

Purpose: To assess exercise as a strategy for reducing pain and improving subjective well-being (SWB) among people with spinal cord injury (SCI). Design: Randomized controlled trial. Method and Participants: Thirty-four individuals with SCI. Exercisers performed aerobic and resistance training twice weekly, whereas wait-list controls maintained their usual level of activity. Results: Analyses of covariance indicated that after 3 months, exercisers reported less pain, depression, and stress, as well as greater perceived quality of life and better physical self-concept than controls (ps < .05). Regression analyses revealed that changes in pain and stress mediated exercise-induced changes in perceived quality of life and depression. Conclusion: Changes in pain and stress may be mechanisms by which exercise improves SWB among people with SCI. [ABSTRACT FROM AUTHOR]

Purpose/Objective: Research on physical activity behavioral support has mainly focused on measuring the absence or presence of behavior change techniques (BCTs) delivered by a counselor. We present a method to measure BCT delivery and receipt in physical activity behavioral support interventions. Research Method/Design: The method was developed and tested using transcripts from behavior change counseling sessions delivered as part of a theory- and evidence-based physical activity intervention for adults with disabilities. Using existing methods, a new method was developed to code counselor and clients' verbal statements (BCTs and other statements). Two coders independently coded 30 transcripts of audio-recorded counseling sessions. Interrater reliability was assessed using percentage agreement and Prevalence Adjusted Bias Adjusted Kappa (PABAK). Results: Forty-eight codes were developed for counselor statements (35 BCT delivery and 13 other statements) and 46 codes for client statements (34 BCT receipt and 12 other statements). The average interrater reliability was considered nearly perfect for the counselor statements (84% agreement; PABAK = .98) and client statements (86% agreement; PABAK = .98). The BCT delivered and received were most frequently related to Goals and Planning (counselor:36%, client:35%), Support Strategies (counselor:21%, client:17%) and Self Belief (counselor:13%, client:24%). Conclusions/Implications: This study presents a reliable coding method to measure BCT delivery and receipt in physical activity behavioral support interventions. The method can be used to enhance intervention fidelity assessment and study interactions between counselors and clients with and without disabilities. Measuring and evaluating BCT delivery and receipt can provide new insights into what types of behavioral support work best under which circumstances. [ABSTRACT FROM AUTHOR]

Objective: The purpose of this pilot study was to test the efficacy and feasibility of a group-mediated cognitive-behavioral training (GMCB) intervention for increasing self-managed leisure-time physical activity (LTPA) among people with spinal cord injury (SCI) who are already somewhat active. Methods: Participants were 13 members of a supervised exercise program for adults with SCI. They took part in a 9-week, evidence-based, theoretically framed, GMCB intervention designed to promote self-regulatory skills and to increase the amount of time spent in self-managed LTPA, outside of the supervised program. Minutes/week of self-managed and supervised LTPA were measured pre- and postintervention, along with measures of social-cognitive variables. Participants' and the interventionist's perceptions of the intervention were also assessed. Results: Participants nearly doubled their total min/week of LTPA, as the result of a significant increase in self-managed LTPA from baseline (M = 42.00 ± 69.57 min/week) to postintervention (M = 197.50 ± 270.86 min/week; p < .05), at no cost to supervised LTPA. Consistent with the GMCB and counseling of self-regulatory skills, self-regulatory efficacy was sustained and action planning increased from pre- (M = 4.63 ± 3.25) to postintervention (Ai = 6.83 ± 2.40; p - .06). The intervention materials and protocol were perceived as usable by the interventionist and participants and had good intervention fidelity. Conclusions: Persons with SCI can voluntarily increase their self-managed LTPA after learning and practicing self-regulatory skills. GMCB training interventions are a feasible approach for teaching these skills. [ABSTRACT FROM AUTHOR]

Objective: The purpose of this study was to investigate the leadership behaviors of spinal cord injury (SCI) peer mentors and examine whether behaviors of peer mentors align with the tenets of transformational leadership theory. Method: A total of 12 SCI peer mentors aged 28-75 (M = 49.4) who had between 3 and 56 years (M = 13.9) of mentoring experience were recruited for the study. Utilizing a qualitative methodology (informed by a social constructionist approach), each mentor engaged in a semistructured interview about their experiences as a peer mentor. Interviews were transcribed verbatim and subjected to a directed content analysis. Results: SCI peer mentors reported using mentorship behaviors and engaging with mentees in a manner that closely aligns with the core components of transformational leadership theory: idealized influence, inspirational motivation, individualized consideration, and intellectual stimulation. A new subcomponent of inspirational motivation described as 'active promotion of achievement' was also identified and may be unique to the context of peer mentorship. Conclusions: SCI peer mentors inherently use behaviors associated with transformational leadership theory when interacting with mentees. The results from this study have the potential to inform SCI peer mentor training programs about specific leadership behaviors that mentors could be taught to use and could lead to more effective mentoring practices for people with SCI. [ABSTRACT FROM AUTHOR]

Objective: The majority of people with spinal cord injury (SCI) do not engage in sufficient leisure-time physical activity (LTPA) to attain fitness benefits; however, many have good intentions to be active. This paper describes two pilot interventions targeting people with SCI who are insufficiently active but intend to be active (i.e., "intenders"). Method: Study 1 examined the effects of a single, telephone-based counseling session on self-regulatory efficacy, intentions, and action plans for LTPA among seven men and women with paraplegia or tetraplegia. Study 2 examined the effects of a home-based strength- training session, delivered by a peer and a fitness trainer, on strength-training task self-efficacy, intentions, action plans, and behavior. Participants were 11 men and women with paraplegia. Results: The counseling session (Study 1) yielded medium- to large-sized increases in participants' confidence to set LTPA goals and intentions to be active. The home visit (Study 2) produced medium- to large-sized increases in task self-efficacy, barrier self-efficacy, intentions, action planning, and strength-training behavior from baseline to 4 weeks after the visit. Conclusions/Implications: Study 1 findings provide preliminary evidence that a single counseling session can impact key determinants of LTPA among intenders with SCI. Study 2 findings demonstrate the potential utility of a peer-mediated, home-based strength training session for positively influencing social cognitions and strength-training behavior. Together, these studies provide evidence and resources for intervention strategies to promote LTPA among intenders with SCI, a population for whom LTPA interventions and resources are scarcely available. [ABSTRACT FROM AUTHOR]