Feasibility Meets Implementation Science: Narrowing the Research-To-Practice Gap for Exercise Activity in Multiple Sclerosis

Background: There is a need to identify why multiple sclerosis exercise research is not translating into real-world participation. To lay the foundations of strong clinical research, considering the translational element of implementation science at the feasibility phase of a trial is vital. Methods: Document analysis was used to examine document sources on exercise activity interventions designed for people living with multiple sclerosis. Document sources focused on multiple sclerosis research that incorporated exercise pre scription elements and behaviour change and were feasibility studies incorporating aspects of implementation science. Results: Implementation science should come much earlier than the efficacy or effectiveness research pipeline. An alternate view is outlined where feasibility and implementation science should meet based on case examples that have not yet shown strong efficacy or effectiveness. Findings from our key themes indicate a need for a cyclical iterative approach to the translational process. Multiple aspects of feasibility and how it can be assessed using an implementation science lens to support more successful interventions are provided. The determination of feasibility in behaviour change should involve implementation science as feasibility is drawn on for theory development, optimising the intervention design and quality of implementation strategies, and identifying those delivering the intervention before conducting efficacy and effectiveness research. Conclusions: Document analysis methodology is underused in qualitative research and was appropriate to use as it was a very resource, time-efficient and an unobtrusive process that could track change and development to explore the integration of implementation science at the feasibility phase, with the findings indicating the earlier implementation science is introduced into multiple sclerosis exercise interventions the better

Feasibility meets implementation science: Narrowing the research-to-practice gap for exercise activity in multiple sclerosis

Background: There is a need to identify why multiple sclerosis exercise research is not translating into real-world participation. To lay the foundations of strong clinical research, considering the translational element of implementation science at the feasibility phase of a trial is vital. Methods: Document analysis was used to examine document sources on exercise activity interventions designed for people living with multiple sclerosis. Document sources focused on multiple sclerosis research that incorporated exercise prescription elements and behaviour change and were feasibility studies incorporating aspects of implementation science. Results: Implementation science should come much earlier than the efficacy or effectiveness research pipeline. An alternate view is outlined where feasibility and implementation science should meet based on case examples that have not yet shown strong efficacy or effectiveness. Findings from our key themes indicate a need for a cyclical iterative approach to the translational process. Multiple aspects of feasibility and how it can be assessed using an implementation science lens to support more successful interventions are provided. The determination of feasibility in behaviour change should involve implementation science as feasibility is drawn on for theory development, optimising the intervention design and quality of implementation strategies, and identifying those delivering the intervention before conducting efficacy and effectiveness research. Conclusions: Document analysis methodology is underused in qualitative research and was appropriate to use as it was a very resource, time-efficient and an unobtrusive process that could track change and development to explore the integration of implementation science at the feasibility phase, with the findings indicating the earlier implementation science is introduced into multiple sclerosis exercise interventions the better

Unknown, Unloved? Teachers’ Reported Use and Effectiveness of Classroom Management Strategies for Students with Symptoms of ADHD

Background Effectiveness studies indicate various classroom management strategies (CMSs) that are helpful for students with attention-deficit/hyperactivity disorder (ADHD), but little is known about teachers’ experiences with these CMSs in school practice. Objective This study examined primary and secondary school teachers’ reported frequency of use and the perceived effectiveness of evidence-based CMSs for students with symptoms of ADHD. Method Dutch primary (n = 89) and secondary (n = 51) school teachers completed a survey in which they reported how often they use and how effective they experience several CMSs for students with ADHD symptoms. The frequency of use of CMSs was also rated for typically developing (TD) students. Results Teachers reported applying antecedent-based CMSs most often and self-regulation CMSs least often, which was in accordance with the perceived effectiveness of these types of CMSs. Primary school teachers applied antecedent-based CMSs more often for students with ADHD symptoms than for TD students, whereas secondary school teachers did not adapt their use of CMSs especially for such students. Secondary school teachers with a more positive attitude towards ADHD reported that they use CMSs more frequently for students with ADHD symptoms. Other teacher characteristics did not play a significant role. Conclusion Teachers’ reported frequency of use and the perceived effectiveness of CMSs for students with ADHD symptoms do not conform to evidence-based effectiveness. Regarding the use of CMSs, secondary school teachers generally do not provide additional support for students with ADHD symptoms. These findings have important implications for the provision of adequate teacher training

The Effects of Classroom Interventions on Off-Task and Disruptive Classroom Behavior in Children with Symptoms of Attention-Deficit/Hyperactivity Disorder:A Meta-Analytic Review

Children with attention-deficit/hyperactivity disorder (ADHD) often exhibit problem behavior in class, which teachers often struggle to manage due to a lack of knowledge and skills to use classroom management strategies. The aim of this meta-analytic review was to determine the effectiveness of several types of classroom interventions (antecedent-based, consequence-based, self-regulation, combined) that can be applied by teachers in order to decrease off-task and disruptive classroom behavior in children with symptoms of ADHD. A second aim was to identify potential moderators (classroom setting, type of measure, students' age, gender, intelligence, and medication use). Finally, it was qualitatively explored whether the identified classroom interventions also directly or indirectly affected behavioral and academic outcomes of classmates. Separate meta-analyses were performed on standardized mean differences (SMDs) for 24 within-subjects design (WSD) and 76 single-subject design (SSD) studies. Results showed that classroom interventions reduce off-task and disruptive classroom behavior in children with symptoms of ADHD (WSDs: MSMD = 0.92; SSDs: MSMD = 3.08), with largest effects for consequence-based (WSDs: MSMD = 1.82) and self-regulation interventions (SSDs: MSMD = 3.61). Larger effects were obtained in general education classrooms than in other classroom settings. No reliable conclusions could be formulated about moderating effects of type of measure and students' age, gender, intelligence, and medication use, mainly because of power problems. Finally, classroom interventions appeared to also benefit classmates' behavioral and academic outcomes

Exploring neuropsychological effects of a self-monitoring intervention for ADHD-symptoms in school

Children who have symptoms of Attention Deficit/Hyperactivity Disorder (ADHD) often experience disruptive and off-task behavior and lower school performance than would be expected based on their cognitive abilities. These behavior and achievement difficulties are a challenge to teachers, who often provide inclusive education for children with ADHD. This study explored whether a self-monitoring intervention can help children with ADHD-symptoms to reduce off-task behavior as well as improve their cognition. The participating children were seven boys in special needs education with an age between nine and twelve. The students used an interval timer to remind themselves to monitor whether they were still on task. During math classes, observations, teacher ratings and neuropsychological tests were assessed. The results showed that off-task behavior was significantly reduced during the period the interval timer was used compared to baseline (reduction from 46.8 to 27.3%), as measured by observations (effect size: η2p = .83) and this was confirmed by teacher ratings (effect size: η2p = .69). With respect to cognition, children only showed significant improvements in inhibition (effect sizes: Cohen's d = 2.62 and 1.24). The teachers as well as students evaluated the intervention mainly as positive. In line with previous studies, we found that that a self-monitoring intervention can be beneficial for children with ADHD-symptoms. Larger studies including a control group and blind observers are necessary to establish these results and to investigate the underlying mechanisms