Eric Evans

Vertebral artery dissection (VAD) is an uncommon but critical cause of ischemic stroke in young adults. While some cases of VAD are associated with trauma, many occur spontaneously or without clearly identifiable precipitating events. This case report describes a 33-year-old male with a history of migraines and attention deficit hyperactivity disorder (ADHD) who presented with worsening left-side headache, neck pain, nausea, and left arm paresthesia. His initial presentation to urgent care resulted in conservative treatment without improvement. The patient later presented to the emergency department following persistent symptoms and a recent history of chiropractic visits, based solely on patient self-report. Computed tomography angiography (CTA) revealed vertebral artery aneurysm and pseudoaneurysm, magnetic resonance imaging (MRI) demonstrated an acute lacunar infarct in the left cerebellar hemisphere, and magnetic resonance angiography (MRA) confirmed bilateral VAD. Transesophageal echocardiography (TEE) later revealed a patent foramen ovale (PFO), though no immediate intervention was required. The patient was managed with dual antiplatelet therapy and supportive medications for migraine and vertigo. This case warrants reporting due to the patient’s atypical age, absence of clear trauma, and the diagnostic delay caused by overlapping migraine symptoms. While a temporal association with recent neck manipulation was noted, causation cannot be established. Early recognition and appropriate imaging are essential to prevent disabling outcomes and guide proper management in at-risk populations.

Immune thrombocytopenic purpura (ITP) is a rare autoimmune condition characterized by isolated thrombocytopenia in the absence of an identifiable secondary cause. While most cases respond to first-line therapy, relapsed or refractory forms, particularly in patients with coexisting autoimmune disorders, pose significant diagnostic and treatment challenges. Recent reports have identified rare instances of autoimmune cytopenias following severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) mRNA vaccination, raising concern for potential immune reactivation in predisposed individuals with prior immune dysregulation. We present the case of a 68-year-old male with a history of ITP and autoimmune hemolytic anemia who developed a severe relapse of thrombocytopenia, epistaxis, and suspected gastrointestinal hemorrhage shortly after coronavirus disease 2019 (COVID-19) vaccination. Despite initial treatment with corticosteroids, intravenous immunoglobulin, and platelet transfusions, the patient experienced a second relapse requiring escalation of care with additional immunosuppressive therapy and close hematologic follow-up. Ultimately, his condition improved with a multimodal approach and coordinated outpatient management. This case is clinically significant due to its temporal association with COVID-19 vaccination and the relapsing nature of ITP in the setting of systemic autoimmunity. It underscores the importance of early recognition, timely intervention, and vigilant monitoring in preventing life-threatening complications. The report adds to a growing body of literature highlighting the need for individualized care strategies and post-vaccine surveillance in patients at heightened risk of autoimmune reactivation.

Background: Individuals with physical disabilities experience higher rates of chronic health conditions than individuals without physical disabilities. Self-management programs that use health coaching are effective at eliciting health behavior change in health outcomes such as goal setting, adherence, and health care use. Additionally, web-based resources such as telehealth-based technologies, including SMSS text messaging, web-based applications, and educational multimedia content, can complement health coaching to improve health-related behaviors and the use of health services. The complexity of studies using these resources requires a fidelity protocol to ensure that health behavior studies are administered properly. Objective: The My Health, My Life, My Way fidelity protocol provides methods, strategies, and procedures of a multifaceted telehealth program for individuals with permanent physical disabilities and chronic health conditions. This health behavior study is a randomized controlled trial with four study arms: (1) scheduled coaching calls with gamified rewards, (2) no scheduled coaching calls with gamified rewards, (3) scheduled coaching calls with fixed rewards, and (4) no scheduled coaching calls with fixed rewards. To guide the fidelity protocol developed, we used the National Institutes of Health Behavior Change Consortium framework (NIH BCC). Methods: The fidelity intervention protocol was developed by using the 5 primary domains provided by the NIH BCC: study design, provider training, treatment delivery, treatment receipt, and enactment of treatment skills. Following the NIH BCC guidelines and implementing social cognitive theory, this study is designed to ensure that all study arms receive equal treatment across conditions and groups. Health coaches and providers will be trained to deliver consistent health coaching, and thus participants will receive appropriate attention. Educational content will be developed to account for health literacy and comprehension of the material. Multiple fidelity intervention steps such as coaching call logs, regular content review, and participant progress monitoring will translate to participants using the skills learned in their daily lives. Different monitoring steps will be implemented to minimize differences among the 4 treatment groups. Results: My Health, My Life, My Way has been approved by the institutional review board and will begin enrollment in January 2024 and end in December 2024, with results reported in early 2025. Conclusions: Intervention fidelity protocols are necessary to ensure that health behavior change studies can be implemented in larger real-world settings. The My Health, My Life, My Way fidelity protocol has used the guidelines by the NIH BCC to administer a telehealth intervention combined with health coaching for individuals with physical disabilities and chronic health conditions. This fidelity protocol can be used as a complementary resource for other researchers who conduct similar research using telehealth technologies and health coaching in real-world settings. Trial Registration: ClinicalTrials NCT05481593; https://clinicaltrials.gov/study/NCT05481593 International Registered Report Identifier (IRRID): PRR1-10.2196/53410

Background: While self-management programs have had significant improvements for individuals with chronic conditions, less is known about the impact of self-management programs for individuals with physical disabilities who experience chronic conditions, as no holistic self-management programs exist for this population. Similarly, there is limited knowledge of how other stakeholders, such as caregivers, health experts, and researchers, view self-management programs in the context of disability, chronic health conditions, and assistive technologies. Objective: This study aimed to obtain insight into how stakeholders perceive self-management relating to physical disability, chronic conditions, and assistive technologies. Methods: Nine focus groups were conducted by 2 trained facilitators using semistructured interview guides. Each guide contained questions relating to stakeholders’ experiences, challenges with self-management programs, and perceptions of assistive technologies. Focus groups were audio recorded and transcribed. Thematic analysis was conducted on the focus group data. Results: A total of 47 individuals participated in the focus groups. By using a constructivist grounded approach and inductive data collection, three main themes emerged from the focus groups: (1) perspectives, (2) needs, and (3) barriers of stakeholders. Stakeholders emphasized the importance of physical activity, mental health, symptom management, medication management, participant centeredness, and chronic disease and disability education. Participants viewed technology as a beneficial aide to their daily self-management and expressed their desire to have peer-to-peer support in web-based self-management programs. Additional views of technology included the ability to access individualized, educational content and connect with other individuals who experience similar health conditions or struggle with caregiving duties. Conclusions: The findings suggest that the development of any web-based self-management program should include mental health education and resources in addition to physical activity content and symptom management and be cost-effective. Beyond the inclusion of educational resources, stakeholders desired customization or patient centeredness in the program to meet the overall needs of individuals with physical disabilities and caregivers. The development of web-based self-management programs should be holistic in meeting the needs of all stakeholders. Trial Registration: ClinicalTrials.gov NCT05481593; https://clinicaltrials.gov/study/NCT05481593

BACKGROUND Diabetes mellitus (DM) is a complex and multifaceted condition that requires adopting a healthy lifestyle. Health coaching (HC) is an effective approach used in diabetes management to empower people towards behavioral change and help manage their blood sugar levels. There is a need to investigate how technology is being used in HC interventions for diabetes management. OBJECTIVE Therefore, this study aims to review the literature on technology use in HC interventions for type-2 diabetes management. METHODS A scoping review of the literature was conducted through a search of PubMed, Embase, and Scopus Databases. We included peer-reviewed articles that focused on HC for people with type-2 diabetes and included the HbA1c drop as one of the main outcomes of the intervention. RESULTS Twenty-eight records were extracted from 4315 individual articles retrieved from the search strategy. The analysis encompassed various intervention designs, HC dynamics, and theoretical grounds. Notably, the focus was directed toward technology adoption and glycemic control outcomes. Twenty interventions reported a significant drop in HbA1C. Twenty-four studies integrated technological elements to deliver the interventions where the predominant reliance was on conventional phone usage. Only seven of the included studies incorporated mobile phones as part of their interventions, and within this subset, merely four studies employed mobile apps. CONCLUSIONS The findings illuminate the dynamic interplay between technology, HC strategies, and health outcomes. Although HC is an effective approach for glycemic control in people with diabetes mellitus, the scarcity of utilizing prevalent digital technologies suggests potential opportunities for enhancing diabetes management interventions.

BACKGROUND Individuals with physical disabilities experience higher rates of chronic health conditions than individuals without physical disabilities. Self-management programs that use health coaching are effective at eliciting health behavior change in health outcomes such as goal setting, adherence, and health care use. Additionally, web-based resources such as telehealth-based technologies, including SMSS text messaging, web-based applications, and educational multimedia content, can complement health coaching to improve health-related behaviors and the use of health services. The complexity of studies using these resources requires a fidelity protocol to ensure that health behavior studies are administered properly. OBJECTIVE The My Health, My Life, My Way fidelity protocol provides methods, strategies, and procedures of a multifaceted telehealth program for individuals with permanent physical disabilities and chronic health conditions. This health behavior study is a randomized controlled trial with four study arms: (1) scheduled coaching calls with gamified rewards, (2) no scheduled coaching calls with gamified rewards, (3) scheduled coaching calls with fixed rewards, and (4) no scheduled coaching calls with fixed rewards. To guide the fidelity protocol developed, we used the National Institutes of Health Behavior Change Consortium framework (NIH BCC). METHODS The fidelity intervention protocol was developed by using the 5 primary domains provided by the NIH BCC: study design, provider training, treatment delivery, treatment receipt, and enactment of treatment skills. Following the NIH BCC guidelines and implementing social cognitive theory, this study is designed to ensure that all study arms receive equal treatment across conditions and groups. Health coaches and providers will be trained to deliver consistent health coaching, and thus participants will receive appropriate attention. Educational content will be developed to account for health literacy and comprehension of the material. Multiple fidelity intervention steps such as coaching call logs, regular content review, and participant progress monitoring will translate to participants using the skills learned in their daily lives. Different monitoring steps will be implemented to minimize differences among the 4 treatment groups. RESULTS My Health, My Life, My Way has been approved by the institutional review board and will begin enrollment in January 2024 and end in December 2024, with results reported in early 2025. CONCLUSIONS Intervention fidelity protocols are necessary to ensure that health behavior change studies can be implemented in larger real-world settings. The My Health, My Life, My Way fidelity protocol has used the guidelines by the NIH BCC to administer a telehealth intervention combined with health coaching for individuals with physical disabilities and chronic health conditions. This fidelity protocol can be used as a complementary resource for other researchers who conduct similar research using telehealth technologies and health coaching in real-world settings. CLINICALTRIAL ClinicalTrials NCT05481593; https://clinicaltrials.gov/study/NCT05481593 INTERNATIONAL REGISTERED REPORT PRR1-10.2196/53410

Background: Individuals with disabilities living with chronic health conditions require self-management programs that are accessible, sustainable, inclusive, and adaptable. Health coaching is an effective approach to promoting behavior change in self-management. Health coaching combined with telehealth technology has the potential to improve the overall quality of, and access to, health services. Objective: This protocol outlines the study design for implementing the My Health, My Life, My Way intervention. The study will assess the feasibility, acceptability, and preliminary efficacy of the intervention for people with disabilities and optimize it. Methods: The My Health, My Life, My Way study is a 4-arm randomized controlled trial evaluating the delivery of a 6-month intervention involving telecoaching, inclusive educational content, and technology access for 200 individuals with chronic conditions and physical disabilities. This study uses the engineering-inspired multiphase optimization strategy (MOST) framework to evaluate intervention components and assess whether a combination or lack of individual elements influences behavior. Participants will be randomized to 1 of 4 study arms: scheduled coaching calls and gamified rewards, no scheduled coaching calls and gamified rewards, scheduled coaching calls and flat rewards, and no scheduled coaching calls and flat rewards. Results: The My Health, My Life, My Way study was approved by the institutional review board of the University of Alabama at Birmingham, and recruitment and enrollment will begin in May 2023. Data analysis is expected to be completed within 6 months of ending data collection. This clinical trial protocol was developed based on the SPIRIT (Standard Protocol Items: Recommendations for Interventional Trials) 2013 statement. Conclusions: The My Health, My Life, My Way study will help to optimize and improve our understanding of the feasibility and efficacy of a web-based self-management program for people with physical disabilities and chronic conditions. More specifically, My Health, My Life, My Way will determine which combination of interventions (coaching calls and gamification) will result in increased participation in self-management programming. The My Health, My Life, My Way intervention has the potential to become a scalable and novel method to successfully manage chronic conditions in people with disabilities. Trial Registration: ClinicalTrials.gov NCT05481593; https://clinicaltrials.gov/ct2/show/NCT05481593 International Registered Report Identifier (IRRID): PRR1-10.2196/31694

BACKGROUND Individuals with disabilities living with chronic health conditions require self-management programs that are accessible, sustainable, inclusive, and adaptable. Health coaching is an effective approach to promoting behavior change in self-management. Health coaching combined with telehealth technology has the potential to improve the overall quality of, and access to, health services. OBJECTIVE This protocol outlines the study design for implementing the My Health, My Life, My Way intervention. The study will assess the feasibility, acceptability, and preliminary efficacy of the intervention for people with disabilities and optimize it. METHODS The My Health, My Life, My Way study is a 4-arm randomized controlled trial evaluating the delivery of a 6-month intervention involving telecoaching, inclusive educational content, and technology access for 200 individuals with chronic conditions and physical disabilities. This study uses the engineering-inspired multiphase optimization strategy (MOST) framework to evaluate intervention components and assess whether a combination or lack of individual elements influences behavior. Participants will be randomized to 1 of 4 study arms: scheduled coaching calls and gamified rewards, no scheduled coaching calls and gamified rewards, scheduled coaching calls and flat rewards, and no scheduled coaching calls and flat rewards. RESULTS The My Health, My Life, My Way study was approved by the institutional review board of the University of Alabama at Birmingham, and recruitment and enrollment will begin in May 2023. Data analysis is expected to be completed within 6 months of ending data collection. This clinical trial protocol was developed based on the SPIRIT (Standard Protocol Items: Recommendations for Interventional Trials) 2013 statement. CONCLUSIONS The My Health, My Life, My Way study will help to optimize and improve our understanding of the feasibility and efficacy of a web-based self-management program for people with physical disabilities and chronic conditions. More specifically, My Health, My Life, My Way will determine which combination of interventions (coaching calls and gamification) will result in increased participation in self-management programming. The My Health, My Life, My Way intervention has the potential to become a scalable and novel method to successfully manage chronic conditions in people with disabilities. CLINICALTRIAL ClinicalTrials.gov NCT05481593; https://clinicaltrials.gov/ct2/show/NCT05481593 INTERNATIONAL REGISTERED REPORT PRR1-10.2196/31694

BACKGROUND While self-management programs have had significant improvements for individuals with chronic conditions, less is known about the impact of self-management programs for individuals with physical disabilities who experience chronic conditions, as no holistic self-management programs exist for this population. Similarly, there is limited knowledge of how other stakeholders, such as caregivers, health experts, and researchers, view self-management programs in the context of disability, chronic health conditions, and assistive technologies. OBJECTIVE This study aimed to obtain insight into how stakeholders perceive self-management relating to physical disability, chronic conditions, and assistive technologies. METHODS Nine focus groups were conducted by 2 trained facilitators using semistructured interview guides. Each guide contained questions relating to stakeholders’ experiences, challenges with self-management programs, and perceptions of assistive technologies. Focus groups were audio recorded and transcribed. Thematic analysis was conducted on the focus group data. RESULTS A total of 47 individuals participated in the focus groups. By using a constructivist grounded approach and inductive data collection, three main themes emerged from the focus groups: (1) perspectives, (2) needs, and (3) barriers of stakeholders. Stakeholders emphasized the importance of physical activity, mental health, symptom management, medication management, participant centeredness, and chronic disease and disability education. Participants viewed technology as a beneficial aide to their daily self-management and expressed their desire to have peer-to-peer support in web-based self-management programs. Additional views of technology included the ability to access individualized, educational content and connect with other individuals who experience similar health conditions or struggle with caregiving duties. CONCLUSIONS The findings suggest that the development of any web-based self-management program should include mental health education and resources in addition to physical activity content and symptom management and be cost-effective. Beyond the inclusion of educational resources, stakeholders desired customization or patient centeredness in the program to meet the overall needs of individuals with physical disabilities and caregivers. The development of web-based self-management programs should be holistic in meeting the needs of all stakeholders. CLINICALTRIAL ClinicalTrials.gov NCT05481593; https://clinicaltrials.gov/study/NCT05481593

Separately, both physical activity and virtual reality can attenuate pain sensitivity in healthy adults. What is unknown is whether virtual reality combined with physical activity (active virtual reality) could have a greater hypoalgesic effect compared to non-active virtual reality distraction (passive virtual reality engagement).Objective: The purpose of this study was to determine whether playing physically active virtual reality games exert a greater hypoalgesic effect than a non-active virtual reality game.Methods: Participants (n = 36) played three different active virtual reality games (Beat Saber, Holopoint, and Hot Squat) and one non-active virtual reality game (Relax Walk) for 15 min on four different visits. During gameplay, participants wore accelerometers on the thigh, wrist, and waist to measure movement intensity and quantity. Pressure pain thresholds were measured on the forearm and thigh immediately prior to gameplay (pretest) and immediately following each gaming bout (posttest).Results: Analysis of the accelerometer data indicated that Hot Squat elicited greater whole-body and lower body moderate to vigorous physical activity compared to the other games. The ANOVA revealed an overall hypoalgesic effect of the virtual reality games on the forearm, regardless of game type. Results also showed a significant hypoalgesic effect on the thigh following gameplay for Hot Squat, Holopoint, and Relax Walk VR. The magnitude of pain reduction was significantly greater during Hot Squat compared to the other games.Conclusion: Virtual reality gameplay exerted a hypoalgesic effect on experimental pressure pain. Additionally, the data provided evidence of a potential enhanced hypoalgesic effect of physically active virtual reality compared to non-active VR on pressure pain sensitivity.