Gymnaeta of the genus Tachycines are described from Guizhou Province, southern China; i.e., Tachycines (Gymnaeta) zhongisp. nov., Tachycines (Gymnaeta) jinniuisp. nov., Tachycines (Gymnaeta) shibenzhangisp. nov., Tachycines (Gymnaeta) lahaidensissp. nov., Tachycines (Gymnaeta) pinglangussp. nov., Tachycines (Gymnaeta) shanduensissp. nov., Tachycines (Gymnaeta) buyiisp. nov., Tachycines (Gymnaeta) portaesp. nov., Tachycines (Gymnaeta) ziyunensissp.nov., and Tachycines (Gymnaeta) jialiangensissp. nov. All specimens were collected from Guizhou Plateau.Ten new karst cave-dwelling rhaphidophorids species of the subgenus  Gymnaeta Adelung, 1902 belongs to the tribe Aemodogryllini that is comprised of 67 species predominantly distributed in China, with eight species extending southwards to Southeast Asia: six in Vietnam, one in Myanmar, and one in the Philippines (Tachycines (Gymnaeta) inhabit cave habitats  aspes  is a valid species and not a synonym of Tachycines (Gymnaeta) proximus  according to the varying degrees of reduction of the fastigium vertices and eyes, the higher number of spines on the hind tibia, and the shape of male genitalia. Moreover, we consider that Eutachycinescrenatus  should be transferred to the subgenus Gymnaeta, due to the following genitalic characteristics: median lobe that is shorter than lateral lobe and four lateral lobes that are not sclerotized.In recent years, the interest in cave organisms research has increased, and many cave beetles, spiders, cave crickets, ant-loving beetles, cave millipedes, and cave ted Figs , but theted Figs . In thisInstitute of Karst Caves, Guizhou Normal University, Guizhou Province, China (IKCGZNU).All specimens in this article were collected in karst caves by hand, sometimes assisted with a swipe net, and preserved in 75% ethanol. Morphological characteristics were examined using an Olympus SZ61 stereomicroscope. The male genitalia was preserved in a solution of ethanol and glycerin. Photographs were taken by an Olympus DP22 digital camera and processed with Adobe Photoshop CS6. All specimens are deposited in the The morphological terms and classification follow Taxon classificationAnimaliaOrthopteraRhaphidophoridaeSubgenus Adelung, 190234BD426E-8E78-574C-88DB-7ACD60789CACGymnaetaAnnuaire du Musée Zoologique de l’Académie Impériale des Sciences de St. Petersburg 7: 62; Kirby 1906. A Synonymic Catalogue of Orthoptera 2: 125. Adelung, 1902. Diestrammena (Gymnaeta)Orthopteroid and Pseudoneuropteroid Insects of Russian Empire and adjacent countries, 329, 352, 434; Proceedings of the Zoological Institute of the Russian Academy of Sciences, 257: 49; Otte 2000. Orthoptera Species File 8: 55; Zootaxa 1917: 55; Zootaxa 2272: 21. : Jacobson, 1905[1902–1905]. In: Jacobson and Bianchi, Tachycines (Gymnaeta)Konowia 13 (1–3): 218; Karny 1937. Genera Insectorum 206: 248; Storozhenko 1990. Entomologicheskoe Obozrenie 69(4): 845, 847; Qin et al. 2018. Zootaxa 4374(4): 452; Zootaxa 4560(2): 274; Zootaxa 4674(4): 492; ZooKeys 937: 21–29; Zootaxa 4809(1): 72. : Karny, 1934. Gymnaetaberezovskii Adelung, by subsequent designation; authority: Kirby, W.F. 1906. A Synonymic Catalogue of Orthoptera  2: i–viii, 1–562.Taxon classificationAnimaliaOrthopteraRhaphidophoridae60754258-796F-5BB1-8733-3B64FFFA0213http://zoobank.org/705C74CA-5D8A-46E1-8223-FDA318E27D72Holotype, 1♂, Daxiao Dong, Xinchang township, Liuzhi Special District, 900 m, 2019-VII-28, collected by Jinhua Zhong, Xulin Zhou, Lingzhi Ou, Guang Wang, Benzhang Shi, Juan Liao and Liangfeng An; paratypes, 5♂, 2♀, same collection data as for holotype.T. (G.) caudatus (T. (G.) chenhui  regarding the shape of the male epiphallus, but the new species is smaller, with its body length not exceeding 13 mm, vertex conical tubercles extremely reduced, scarce  chenhui has a larger body exceeding 13 mm, vertex conical tubercles of intermediate development, ventral conical projections of 3rd–8th abdominal sternites developed, forming larger and longer projections, hind tarsus with bristles ventrally.This new species is similar to caudatus  regardinrce Fig. , ventralMale. Body medium and small-sized . Body ♂11.2–11.6, ♀10.8–12.1; pronotum ♂3.5, ♀3.8; fore femur ♂11.1–11.5, ♀10.8–12.3; hind femur ♂18.5–19.3, ♀18.4–20.0, ovipositor 10.0–11.2.Weak light and dark light zones.Troglobite.The specific epithet refers to the person’s last name who led us to collect the specimens.Taxon classificationAnimaliaOrthopteraRhaphidophoridaeB188F142-7154-59F1-B65D-89387466F2E2http://zoobank.org/144C1AF3-1041-4D1C-A340-C9C6832F74CCHolotype, 1♀, Jinniu Cave  trapezialis Zhou & Yang, 2020 but differs from the latter by having slightly reduced eyes and the conical tubercles of the vertex intermediately reduce, the hind tibia dorsally on each side has 78–85 spines instead of 54–60 spines.The new species is very similar to Female. Body medium sized. Vertex conical tubercles slightly reduced, apex obtuse, ommateum black and well developed. Legs elongate and slender; fore femur approx. 2.5–2.7 times longer than the pronotum, ventrally unarmed, the internal genicular lobe with a small spine, external genicular lobe with one elongate movable spur; ventral side of fore tibiae with one internal spur and two external spurs. Mid femur with an elongate movable spur on internal and external genicular lobes, ventrally unarmed; mid tibiae beneath with two internal spurs and two external spurs. Hind femur without ventral spine, internal genicular lobe without spine; hind tibiae dorsally on both sides with 79–86 spines, arranged in groups. Supra-internal spur of hind tibiae not exceeding ventral apex of hind tarsus. Hind tarsus keeled ventrally, with one dorsal apical spine. Cerci long and slender. Ovipositor shorter than half length of hind femur.Male. Unknown.Body color uniform, yellowish brown, eyes black.(mm). Body ♀ 13.7–16.7; pronotum ♀ 5.1–5.3; fore femur ♀ 13.6–14.1; hind femur ♀ 25.2–26.0; ovipositor 8.4–8.5.Dark light zone.Troglophile.The new species is named after the collection locality of the specimens (Jinniu cave).Taxon classificationAnimaliaOrthopteraRhaphidophoridae3BB7D26E-9E70-59A3-BCA4-AA8803A11B57http://zoobank.org/84644FCC-1440-4FF1-B00E-3D1A70F9450AHolotype, 1♂, Xuehua Cave, Zhonghe Town, Sandu County, 2019-VII-28, collected by Xulin Zhou, Benchang Shi, Changzhen Zheng, Haixia Luo, Gui Liang, Hailian Lan, Panpan Ren and Juan Liao; paratypes, 16♂, 15♀, same data as the holotype.rd–8th abdominal sternites developed, and the distal ones are obtuse and densely ciliated.The characteristic of the male genitalia of the new species is distinct from that of other groups: the epiphallus of the male genitalia is semi-circular, and the lateral sclerites sub-elliptical. In addition, the conical tubercles of the vertex are absent, the ommateum are extremely degenerated, the mid tibiae ventrally without spur or spine, the ventral conical projections of 3Male. Body smaller than the average for the subgenus. Vertex conical tubercles absent, ommateum extremely degenerated, present by narrow stripes with several black facets . Legs elongate and slender, fore femur approx. 2.6–3.0 times longer than the pronotum, ventrally unarmed, external genicular lobe with one elongate movable spur, internal knee lobe without spine; fore tibiae beneath with one external spur , but without internal spur. Mid femur with an elongate movable spur on both internal and external genicular lobes, ventrally unarmed; mid tibiae ventrally without internal or external spur. Hind femur without spines ventrally; hind tibiae dorsally with 11–18 inner spines and 13–18 outer spines, sparsely arranged. Supra-internal spur of hind tibiae not exceeding ventral apex of hind tarsus. Hind tarsus ventrally with bristles. Ventral conical projections of 3rd–8th abdominal sternites developed, but distal ones obtuse and densely ciliated. Epiphallus of male genitalia nearly semi-circular, lateral sclerites sub-elliptical . Body ♂9.4–12.1, ♀11.2–12.5; pronotum ♂2.9–3.3, ♀ 3.0–3.2; fore femur ♂ 8.1–8.8, ♀ 8.2–9.6; hind femur ♂ 13.6–14.6, ♀ 13.6–14.8; ovipositor 9.1–10.0.Dark light zone.Troglobite.The specific epithet refers to the name of the person who provided crucial help in collecting the specimens.Taxon classificationAnimaliaOrthopteraRhaphidophoridaeA65AAC53-5476-5943-8742-B3D28404E9B5http://zoobank.org/365EE275-1199-4EC4-A0BA-0CD676277EEEHolotype, 1♂, Lahaide Dong, Pinglang Town, Duyun City, 2015-VII-24, collected by Qing Wen, Dongshan Xu, Yuanchan Yu, Yi Luo, Guang Zhang; paratypes, 6♂, 8♀, same data as the holotype.Tachycines (Gymnaeta) shibenzhangi sp. nov., as both species have an arc-shaped epiphallus. The difference is that the ventral surface of the hind tarsus keeled in the new species, but differs from the latter in that: lower notch of the epiphallus is rather small, hind tarsus keeled beneath, epiphallus of male nearly n-shaped; ventral conical projections of 3rd–8th abdominal sternites developed, apex mucronate without dense cilia.The new species is very similar to Male. Body medium sized. Vertex conical tubercles inconspicuous, eyes moderately reduced, approx. 1/2 the size of the normal eye. Legs elongate, slender; fore femur approx. 2.1–2.5 times longer than the pronotum, ventrally unarmed, external genicular lobe with one elongated movable spur, internal knee lobe without spine; fore tibiae ventrally with two external spurs and one internal spur. Mid femur with an elongate movable spur on the internal and external genicular lobes, ventrally unarmed; mid tibiae beneath with one external spur and one internal spur. Hind femur without spine ventrally; hind tibiae dorsally with 27–30 internal spines and 22–26 external spines, sparsely arranged. Supra-internal spur of hind tibiae not exceeding the ventral apex of hind tarsus. Hind tarsus keeled ventrally. Ventral conical projections of 3rd–8th abdominal sternites developed, distally mucronate without cilia. Epiphallus of male genitalia nearly n-shaped, lateral sclerites distinctly long and narrow.Female. Appearance is similar to the male. The subgenital plate is nearly triangular, its apical area slight obtuse . Body ♂ 10.5–12.3, ♀ 11.2–12.6; pronotum ♂ 4.0–4.8, ♀ 3.8–3.9; fore femur ♂ 10.2–10.30, ♀ 10.1–10.3; hind femur ♂ 18.9–19.0, ♀ 18.0–18.1; ovipositor 10.0–11.0.Dark light zone.Troglobite.The specific epithet refers to the Lahaide cave.Taxon classificationAnimaliaOrthopteraRhaphidophoridaeC7DDA052-CD52-5193-B7EA-FD3DC8AB7658http://zoobank.org/C2D9C063-9A83-464F-8EE2-EDDD561C4745Holotype 1♂, Lagaobieran Dong, Pinglang Town, Duyun City, 2015-VII-25, collected by Qing Wen; paratypes, 11♂, 16♀, 2015-VII-25, collected by Qing Wen, Dongshan Xu, Yi Luo, Yuanchan Yu, Guang Zhang.Tachycines (Gymnaeta) ferecaecus : both species have a nearly quadrate-shaped epiphallus, but the new species can be distinguished from the latter by the absence of an ommateum (without any black facets), only the base of the ommateum was faintly visible.The new species is very similar to Male. Body medium sized in the subgenus . Body ♂ 9.5–13.0, ♀ 8.2–12.0; pronotum ♂ 3.2–3.8,♀ 3.2–3.4; fore femur ♂ 10.2–10.50, ♀ 10.2–10.4; hind femur ♂ 13.2–14.7, ♀ 13.2–14.6; ovipositor 8.0–10.4.Dark light zone.Troglobite.The specific epithet refers to the locality where the type specimens were collected.Taxon classificationAnimaliaOrthopteraRhaphidophoridae9440300A-AA5B-5DFC-A7A4-AC9E901732D2http://zoobank.org/ED670C87-E4D5-48C1-A93C-83949F4F8FC3Holotype 1♂, Shuilong Cave, Sandu County, 2019-VII-22, collected by Xulin Zhou, Benchang Shi, Changzhen Zheng, Gui Liang, Haixia Luo, Hailian Lan, Juan Liao; paratypes, 6♂, 8♀, same data as holotype.Tachycines (Gymnaeta) solida  and Tachycines (Gymnaeta) tongrenus Feng, Huang & Luo, 2020, but the male epiphallus of the new species has a distal shallow notch clearly wider than the upper notch, the median process of the male genitalia is significantly longer than the lateral sclerites, hind tibiae dorsally on both sides with 34–46 spines, hind tarsus keeled beneath; however, in Tachycines (Gymnaeta) solida, the male epiphallus has the upper and lower notches almost the same size, hind tibiae dorsally on both sides with 62–69 spines; in Tachycines (Gymnaeta) tongrenus, the hind tibia dorsally with 48–49 inner spines and 54–56 outer spines, hind tarsus with bristles ventrally.This species is rather similar to Male. Body rather large for this subgenus. Vertex conical tubercles are well developed, bisected from the base; ommateum is black and well developed . Body ♂ 17.3–19.5, ♀17.3.0–19.6; pronotum ♂ 6.8–7.6, ♀ 66–7.3; fore femur ♂ 13.3–15.1, ♀ 13.8–14.6; hind femur ♂ 28.5–31.9, ♀ 28.4–30.7; ovipositor 12.8–13.5.Light zone, weak light zone, and dark light zone.Troglophile.The name of the new species refers to the type locality.Taxon classificationAnimaliaOrthopteraRhaphidophoridaeBDAF810C-D431-5DBC-A705-A47FDC7F974Dhttp://zoobank.org/935DF22A-FD7C-4C2C-80FF-04743039FDE2Holotype 1♂, Sanjiaoshan Cave, Ziyun County, 2019-X-2, collected by Xulin Zhou, Haixia Luo, Panpan Ren, Meizhen Deng and Suqin Zhao; paratypes, ♂15, ♀18, same data as holotype.Tachycines (Gymnaeta) solida , but differs as follows: the new species epiphallus of male genitalia with upper notch smaller and shallower than lower notch, hind tarsus ventrally with bristles; in T. (G.) solida the epiphallus of the male genitalia with upper notch and lower notch almost the same size, hind tarsus keeled ventrally.This new species is rather similar to Description. Male. Body rather small for this subgenus. Vertex conical tubercles well-developed, bisected from the base; ommateum black and well developed. Legs elongate and slender; fore femur 2.0–2.1 times longer than the pronotum, ventrally unarmed, external genicular lobe with one elongate movable spur, internal knee lobe without spine; fore tibiae beneath with two external spurs and one internal spur. Mid femur with an elongate movable spur on both internal and external genicular lobes, ventrally unarmed; mid tibiae beneath with one external spur and one internal spur. Hind femur without spines ventrally; hind tibiae dorsally with 35–44 internal spines and 36–46 external spines, arranged in groups. Supra-internal spur of hind tibiae not exceeding the ventral apex of hind tarsus. Hind tarsus ventrally with bristles. Epiphallus of male genitalia nearly H-shaped, lower notch rather deeper than upper notch . Body ♂10.5–11.3, ♀10.8–11.5; pronotum ♂3.9–4.5, ♀4.1–4.6; fore femur ♂ 8.3–8.9, ♀ 8.4–9.3; hind femur ♂ 14.7–16.5, ♀ 15.3–17.8; ovipositor 7.2–8.6.Light zone, weak light zone, and dark light zone.Troglophiles.The specific epithet refers to the native BuYi people who have lived in southern Guizhou for generations.Taxon classificationAnimaliaOrthopteraRhaphidophoridae650CBEF2-1CDE-5D7C-87FA-819DA248AB34http://zoobank.org/6A1D6FF0-A4CC-4921-9E0B-0E6EDFC09E7EHolotype 1♂, Niujingchongzi Dong Weining County, 2019-VII-17, collected by Xulin Zhou, Lingzhi Ou, Guang Wang, Rongxiang Su Benzhang Shi, Juan Liao and Liangfeng An. paratypes, 4♂, 2♀, same data as holotype.Tachycines (Gymnaeta) buyii sp. nov., but it can be distinguished from the latter by the structure of epiphallus, and hind tarsus keeled ventrally.The new species is most closely related to Male. Body rather small for this subgenus. Vertex conical tubercles well developed, bisected from the base; ommateum black and well developed. Legs elongate and slender; fore femur 1.8–1.9 times longer than the pronotum, ventrally unarmed, external genicular lobe with one elongate movable spur, internal knee lobe with a small spine; fore tibiae beneath with two external spurs and one internal spur. Mid femur with an elongate movable spur on both internal and external genicular lobes, ventrally unarmed; mid tibiae beneath with one external spur and one internal spur. Hind femur without spines ventrally; hind tibiae dorsally with 65–81 internal spines and 63–81 external spines, arranged in groups. Supra-internal spur of hind tibiae not exceeding the ventral apex of hind tarsus. Hind tarsus keeled ventrally. Epiphallus of male genitalia nearly door-shaped, lower notch rather deeper than upper notch . Body ♂6.0–7.0, ♀6.3–7.0; pronotum ♂4.0–4.5, ♀3.8–4.5; fore femur ♂6.8–8.0, ♀6.5–7.5; hind femur ♂10.0–11.5, ♀10.5–11.5; ovipositor 5.5–6.0.Light and weak light zone.Troglophile.porta meaning door.The specific epithet refers to the shape of epiphallus, the Latin word Taxon classificationAnimaliaOrthopteraRhaphidophoridae7243602A-9FA7-5E5E-AB7A-0259E41F1E5Dhttp://zoobank.org/53F85BED-D0B8-46F5-AC23-0DE66CF2C3F1Holotype 1♂, Sanjiaoshan cave, Ziyun County, 2019-X-2, collected by Xulin Zhou, Haixia Luo, Panpan Ren, Meizhen Deng and Suqin Zhao, paratypes 15♂, 38♀, same data as holotype.Tachycines (Gymnaeta) shibenzhangi sp. nov., it can easily be distinguished by the eyes moderately reduced, ventral conical projections of 3rd–8th abdominal sternites developed, distal mucronate without ciliated; but the latter of eyes extremely reduce, ventral conical projections of 3rd–8th abdominal sternites developed, distal obtuse and densely ciliated.The new species is rather similar to Male. Body medium size . Body ♂11.4–12.8, ♀12.2–13.2, pronotum ♂ 3.5–4.3, ♀ 3.9–4.3, fore femur ♂ 11.0–12.1, ♀ 10.2–10.8, hind femur ♂ 17.9–19.2, ♀ 16.9–17.9; ovipositor 8.9–10.3.Dark light zone.Troglobite.The name of the new species refers to the type locality.Taxon classificationAnimaliaOrthopteraRhaphidophoridaeBCC3032F-587C-5ACF-AC68-103EB72D4DFEhttp://zoobank.org/68C1DDDD-C8AD-432B-9BBD-85D4610A79A5Holotype 1♂, Lajilou Cave, Jialiang Town, Libo County, 2017-X-23, collected by Xulin Zhou, Dongshan Xu, Weicheng Yang; paratypes, 4♂, 2♀, same data as holotype.T. (G.) ziyunensis sp. nov. but differs in that the hind tarsus ventrally bears bristles in T. (G.) ziyunensis sp. nov., and by the hind tibiae armed with 9–15 spines on both sides; however, the hind tarsus is keeled ventrally in T. (G.) jialiangensis sp. nov., and the hind tibiae are provided with 17–25 spines on both sides.This species is similar to Male. Body medium in size. Vertex conical tubercles almost absent, ommateum moderately reduced. Legs elongate and slender; fore femur 2.9–3.0 times longer than the pronotum, ventrally unarmed, external genicular lobe with single elongate movable spur, internal knee lobe without spine; fore tibiae beneath with two external spurs and one internal spur. Mid femur with an elongate movable spur on both internal and external genicular lobes, ventrally unarmed; mid tibiae beneath with an external spur and without internal spur. Hind femur without spines ventrally; hind tibiae dorsally with 18–25 internal spines and 17 or 18 external spines, sparsely arranged. Supra-internal spur of hind tibiae not exceeding ventral apex of hind tarsus. Hind tarsus keeled ventrally . Body ♂ 11.8–12.0, ♀ 11.2–13.0; pronotum ♂ 3.5–3.6, ♀ 3.4–4.2; fore femur ♂ 10.3–10.6, ♀10.4–13.2; hind femur ♂17.5–18.4, ♀17.1–21.66, ovipositor 8.3–9.9.Dark light zone.Troglobite.The name of the new species refers to the type locality.Environmental conditions typical of the habitat deep within caves include the complete absence of light, a stable and usually very high humidity (> 95%), relatively low levels of available nutrients, and a nearly constant temperature . Cave orRhaphidophoridae, Aemodogryllinae and Rhaphidophorinae, occurring in East Asia. Among them, species of the subgenus Gymnaeta are widely adapted to cave ecosystems, and belong to the Aemodogryllinae. The distribution of cave species of Gymnaeta is consistent with that of karst landforms, while the surface species are widely distributed in East Asia, ranging from forests to swamps, deserts, and the Tibet Plateau. According to our observation of many years, the surface-dwelling species of Gymnaeta usually demonstrate the following characteristics: a larger body size, darker body coloration, the ommateum and conical tubercles on the vertex well-developed, abdominal sternites without ventral projections, ventral spurs of the fore tibiae and mid tibiae well developed, the dorsal spines of hind tibiae dark and arranged in dense clusters, and the hind femur muscles well-developed, and hence these species are physically agile and good jumpers. Surface-dwelling species of Gymnaeta are widely distributed throughout China.There are two subfamilies of Gymnaeta are not good at jumping, as they have less developed legs muscles, leading them to almost walking on the ground like cave beetles when in danger. They are mainly distributed in karst areas of south China. We think that these morphological changes have occurred through adaptive evolution to cave environments. In addition, we consider the presence or absence of cilia on the distal of abdominal sternites projections in cave-adapted species of the subgenus Gymnaeta an important taxonomic characteristic. While these species in Chinese karst caves may be morphologically similar to surface-dwelling species, we suggest they may be genetically distinct, potentially representing different subspecies or lineages and we expect our future work to expand on these theories.In contrast, the cave-adapted species of the subgenus have the ommateum and conical tubercles of the vertex reduced, the body appears thinner and smaller, the legs appear more slender, the ventral spurs of fore tibiae and mid tibiae are reduced and sometimes absent, the dorsal spines of hind tibiae are not pigmented and are sparse, the hind femur muscles are not obvious, and the ventral projections of abdominal sternites are developed. The cave-dwelling Caves and their associated ecosystems (mostly karst) represent resources of great value. These values can be grouped into three general clusters: ecological-scientific, economic, and cultural. Cave habitats and species are attracting increasing interest and concern among conservationists, cavers, and speleobiologists, and for good reason. Most troglobionts are highly restricted geographically and often are numerically rare, making them vulnerable to even relatively minor disturbances. As cave organisms are an essential part of biodiversity, it is hoped that we can raise public awareness and take adequate measures to protect karst cave ecosystems.In China, we have a rich diversity of troglobionts, but the biodiversity of Karst caves in China is under serious threat. We should choose high value and high priority caves, which need emergency attention in relation to protection, management, and conservation actions in the karst region of China. Such a fact does not exclude the need for the conservation of the other caves that should require attention, management, and/or conservation plans coordinated by the environmental supervisory agencies.


Falls are common in people with multiple sclerosis. There is rising interest in how the multifactorial and chronic nature of fall risk among people with multiple sclerosis can be addressed through self-management. Thus, the aims were to investigate the extent and the scope of publications on self-management of falls in people with multiple sclerosis, and to identify how the concept of self-management was defined and used.A systematic literature search in Medline, Cochrane, Web of Science and PsycInfo was conducted to identify publications until July 2022.Published methodological guidance was followed. Articles targeting: (1) people with multiple sclerosis, (2) falls, and (3) self-management were selected. Of 1656 records, 203 publications were assessed for eligibility, of which 173 did not meet the inclusion criteria, and 16 publications did not contain empirical data. The type of publication, study focus, and study design was extracted. If applicable, key findings, self-management tasks and skills, and the definition of self-management were extracted.Fourteen original articles met all inclusion criteria. Ten articles represented six different fall prevention interventions. Three publications were randomized controlled trials. Self-management content was variable and not comprehensive in nature. None of the 14 publications included a self-management definition.The limited number of original articles and the even fewer intervention studies show that the research on self-management of falls in people with multiple sclerosis is in its infancy. To progress in the research area of self-management of falls, a more robust, consensus-based description of self-management frameworks and activities is needed. Evidence to date indicates that efficacious self-management requires careful self-monitoring of one's condition and cognitive, behavioral, and emotional responses to coping with the medical condition.14 Lorig and Holman14 were among the first to operationalize the concept of self-management into three self-management tasks: medical management, role management, and emotional management; and six self-management skills: problem solving, decision making, resource utilization, the formation of patient–provider partnership, action planning, and self-tailoring. This conceptualization has been recognized in the multiple sclerosis self-management literature.22 To address self-management tasks and build self-management skills, self-management interventions focusing on fall risk reduction among people with multiple sclerosis often include educational components as well as opportunities to build skills .20For people living with long-term conditions like multiple sclerosis, self-management of disease effects is essential to prevent falls during day-to-day activities.23 However, scoping reviews on self-management in people with multiple sclerosis are few2426 and none focus specifically on self-management approaches to reduce fall risks. The present scoping review was undertaken to investigate the extent and the scope of publications on self-management of falls in people with multiple sclerosis, and to identify how the concept of self-management was defined and used.To inform self-management approaches for fall prevention among people with multiple sclerosis, a comprehensive understanding of the depth and breadth of the published literature pertaining to this area of inquiry is needed. Scoping reviews are uniquely effective in identifying gaps in the literature, especially when evidence on a given area of inquiry is just emerging.28: (1) identifying the research question; (2) identifying relevant studies; (3) selecting studies; (4) charting the data; and (5) collating, summarizing, and reporting the results. We adhered to the methodological guidelines of the Preferred Reporting Items for Systematic Reviews and Meta-Analysis extension for Scoping Reviews.29A scoping review design was used, and the study was conducted in five stages according to published methodological guidanceIdentified research questions were: (1) What is the extent and nature of publications related to self-management of falls in people with multiple sclerosis? and (2) How is the concept of self-management defined and operationalized in those publications?The research team and a research librarian developed a systematic search strategy. The search was conducted in September 2020, April 2021, and August 2022, and included publications published until July 2022. The search was limited to publications written in the English language that were published in the databases Ovid Medline, Cochrane, Web of Science, and PsycInfo. The search terms were Multiple Sclerosis, Multiple Sclerosis or Disseminated Sclerosis, Accidental falls, and Fall. Self-management was not included as a search term to allow us to include publications that did not specifically mention “self-management,” “self-care,” or other specific terms. The search strategies for each database are presented in the appendix.14 orthe publication included descriptions related to at least one self-management task or at least one self-management skill described by Lorig and Holman,the authors described their work as self-management, orthe publication included at least one outcome pertaining to improving self-management skills, ability to engage in self-management tasks, or other behavioral changes in relation to falls.The process of identifying relevant literature is described in The inclusion criteria were developed with the goal of targeting publications addressing (1) people with multiple sclerosis, (2) falls, and (3) self-management. Three specific inclusion criteria were applied as follows:14 were addressed, using a manifest-directed content analysis approach.30 Examples of the quotations from the included publications, and coded tasks or skills are presented in A data charting form was created via discussions in the research group. Year of publication, author, country of origin, type of publication, study focus, and study design were extracted from the publications. If applicable, study acronym, key findings, self-management tasks and skills, and definition of self-management were extracted. In the first step, three authors  extracted data. In the next step, the same three authors identified and coded which self-management tasks and/or skills according to Lorig and Holmann = 83137; the United Kingdom, n = 33840; Italy n = 141; Brazil, n = 142; and Germany, n = 1.43 Original articles included randomized controlled trials, n = 342; pilot/feasibility studies, n = 540; observational cohort studies, n = 235; qualitative studies, n = 343; and mixed methods study, n = 1.39 An overview of the extent and nature of all publications including key findings, and self-management tasks and skills are presented in 39 one out of 15 participants, and Cattaneo, 201941 16 out of 90 participants.In total 14 articles were included . The art31 an exercise/education program,32 Free From Falls and Free From Falls Online,37 Balance Right in Multiple Sclerosis,3840 NEUROFALL,41 and Online Spaced Education.42Of the 14 included publications, 10 original articles represented six different fall prevention interventions: Safe at Home Behavioral Attitude Activity Symptoms,Safe at Home Behavioral Attitude Activity Symptoms is a fall risk management program. The group-based intervention drew upon participants’ existing experiences, promoted group problem-solving, and fostered a climate of mutual support for behavioral change. It is described as a self-management program by the authors. The pre-post design used to evaluate the intervention as part of a pilot study31 showed a significant increase in knowledge of fall risk factors (P < 0.0001); significant self-efficacy improvements (P = 0.0016); increased knowledge and skills to manage falls and fall risk; and promoted changes in behavior to reduce personal fall risk.The exercise/education program was described by the authors as being based on self-management practices. The pilot feasibility randomized controlled trial32 included a comparison of three different fall prevention interventions: (A) a home-based exercise program that targeted physiological risk factors; (B) an educational program that targeted behavioral risk factors and included problem-solving, action planning, peer-modeling, vicarious learning, social persuasion, and guided mastery; and (C) a combined exercise and educational program that targeted both physiological and behavioral risk factors for falls. The fall prevention interventions were compared to (D) a wait-list control group. Findings from the pilot feasibility randomized controlled trial revealed lower fall risk scores in exercise groups (A and C) compared to the non-exercise groups (C and D) (P < 0.01), but no group difference in fall prevention behavior.32Free From Falls and Free From Falls Online are balancing exercise and education fall prevention programs delivered either face-to-face  or online via webinars, and home exercises . The three publications associated with Free From Falls and Free From Falls Online were: a retrospective observational study,33 a randomized controlled trial,37 and a pilot randomized controlled trial.34 Both programs aim to increase knowledge of fall risk factors, and knowledge and skills about fall prevention strategies, and are described as self-management programs. The programs feature action planning of fall prevention strategies, activities to increase fall prevention and fall management confidence, and to identify fall prevention resources in the community. Findings from a retrospective observational study showed that the Free From Falls program improved balance confidence, balance performance and functional mobility, and reduced falls; all measures improved significantly (P < 0.05).33 The Free From Falls program has been evaluated in a randomized controlled trial which did not indicate that in-person group exercise and education were superior to written education and neurologist-initiated interventions.37 Findings from the pilot randomized controlled trial did not indicate that the Free From Falls Online program was associated with a lower probability of falling.34Both Balance Right in Multiple Sclerosis is a home balance exercise and fall prevention education program. The three publications associated with the program included: a mixed method description of the development of the intervention,39 a Health Technology Assessment feasibility randomized controlled trial,40 and a feasibility randomized controlled trial.38 The Balance Right in Multiple Sclerosis is described as a self-management program aiming to improve exercise self-efficacy and to enhance participants’ knowledge and skills about fall prevention and management. It comprises educational components to increase knowledge about fall risk factors, and activities to support the development of coping strategies such as problem-solving, decision-making, action planning, and the setting and imagery of short-term goals. A collaborative, partnership approach between participants and the program leader is emphasized. The Balance Right in Multiple Sclerosis has been evaluated in a feasibility randomized controlled trial,38 which showed that the procedures were acceptable. Refinement of the used methods of reporting falls, i.e. prospectively reported falls diaries returned every two weeks, were required.The NEUROFALL program is an educational, and mobility and balance exercise fall prevention program designed to reduce falls and increase social participation. The participants are educated about fall risk factors and strategies to both prevent falls and increase social participation. The program is not explicitly described as a self-management program by the authors but comprises problem-solving, decision-making, and action-planning activities. The program has been evaluated in a randomized controlled trial.41 No statistically significant between-group differences were found for the percentage number of fallers, but the program improved participants’ ability to carry out activities of daily living and decreased participation restrictions.The Online Spaced Education is an online education program. The primary outcomes sought through the program include knowledge retention and behavioral change to reduce falls. It is not explicitly described as a self-management program by the authors, but they state that patient education is a strategy to enhance self-management and the long-term goal of Online Spaced Education is to enhance protective behaviors related to fall risk in daily life situations. The Online Spaced Education program has been evaluated in a randomized controlled trial.42 Although participants in both the intervention group and the control group  experienced reduced fall rates no significant differences between the intervention and control groups were found.35 which showed that people with multiple sclerosis who fall use more fall prevention strategies than those who do not fall; one phenomenological study13 which explored and described the lived experience of perceived self-efficacy in avoiding a fall during basic activities of daily living; and two qualitative studies which investigated: the views of people with multiple sclerosis on fall prevention programs43; and a person-centered definition of falls, circumstances surrounding falls, and attributes facilitating program participation.36The remaining four publications included in this scoping review were: one observational cohort study41 referred to the Lorig and Holman framework in their intervention description or in the discussion of their findings.None of the 14 publications included in the scoping review presented a definition of self-management. However, four publicationsn = 10 publications.314143 Emotional management was identified in six publications43 and medical management in four publications.42 One publication included content on all three tasks.31 At least two, but most often all three of the skills problem solving, decision-making, and action planning were mentioned jointly and they were the most frequently identified skills, n = 13.313543 Resource utilization was the least identified skill, n = 6.3142 All six self-management skills were identified in four publications.42Of the three self-management tasks, role management was highlighted most frequently, This scoping review aimed to investigate the extent and scope of publications related to self-management of falls in people with multiple sclerosis, and to identify how the concept of self-management was defined and used in the identified publications. The nature of the identified publications is consistent with an emerging field of research: 10 publications were related to six intervention programs, and only three of these publications were full-scale randomized controlled trials. Further, only two observational cohort studies and three qualitative studies were identified.15 and Lorig and Holman,14 and more recent such as Audulv’s conceptualization of self-management for people living with neurological conditions.12 These frameworks are important resources that appear to be underutilized.None of the publications included a definition of self-management, although several authors described their intervention as a self-management program and/or reported that their intervention included activities related to self-management. Even though there is no commonly accepted definition of self-management, there are several well-used frameworks, such as Barlow41 However, the program components were not consistently connected to any self-management definition or operationalization of the concept. This lack of clarity of what “self-management” entails complicates efforts to map how the intervention activities relate to established frameworks of self-management and mechanisms of impact. Evidence to date suggests that fall prevention interventions for people with multiple sclerosis that utilize self-management strategies are promising. Although the three randomized controlled trials did not show any difference between control and intervention groups regarding falls,42 the NEUROFALL program improved participants’ ability to carry out activities of daily living and decreased participation restrictions,41 and in the Online Spaced Education program both groups reduced their fall rates.42 The five pilot and feasibility studies40 also point to the potential value of self-management approaches to fall prevention for people with multiple sclerosis. In the light of this encouraging evidence, identifying the intervention content and processes that support or hinder the attainment of outcomes sought  will be instrumental to inform future intervention development efforts.Four of the intervention programs referred to the Lorig and Holman framework of self-management.44 including environmental, behavioral, and physical and psychological factors, the neglect of these skills is a shortcoming. Our findings could be related to our use of a manifest-directed content analysis, which requires that only “visible, obvious components”45 of the text are coded. This highlights the value of both developing a consensus-based description of self-management skills for use in fall prevention programs for people with multiple sclerosis and explicitly naming those skills in intervention descriptions.The most frequently identified self-management skills were decision-making, problem-solving, and action planning. It could be suggested that these skills are easier to embed in intervention programs as they are interrelated. The skills of resource utilization, forming of patient–provider relationship, and self-tailoring were infrequently mentioned in the publications. As people with multiple sclerosis experience diverse and interacting fall risk factors47 While ambulatory and non-ambulatory people with multiple sclerosis share some influences on fall risk, new evidence suggests some fall risk factors for non-ambulatory people with multiple sclerosis are unique, such as performing a transfer.48 Therefore, it is of uttermost importance to also provide fall prevention programs for non-ambulatory people with multiple sclerosis.All the six intervention programs targeted primarily ambulatory people with multiple sclerosis. Multiple sclerosis is a progressive disease and approximately 25% of people with multiple sclerosis are non-ambulatory and use wheelchairs or scooters.28 and constantly discussed the progress. Another strength is the broad inclusion criteria, which increased the likelihood to cover the research area of self-management of falls for people with multiple sclerosis. In the identification of tasks and skills, we used a deductive analysis30 based on an established framework14 which allowed us to operationalize self-management despite the lack of definitions and conceptualizations in the publications.A strength of the present study is that three researchers collaborated in all methodological steps49 Further, as “a text always involves multiple meanings and there is always some degree of interpretation when approaching a text,”45 we may in our manifest-directed content analysis have misinterpreted the authors’ descriptions and either coded too few or too many as tasks or skills.Our review had several limitations. Our first round of review only examined the title and abstract, so relevant studies may have been missed due to, for instance, potential selection bias, which is a known limitation of the scoping review methodology.The limited number of original articles and the even fewer intervention studies show that the research on self-management of falls in people with multiple sclerosis is in its infancy. None of the publications provided a definition of self-management and rarely explicitly described self-management tasks or skills. To progress in the research area of self-management of falls for ambulatory and non-ambulatory people with multiple sclerosis, more robust, consensus-based descriptions of self-management frameworks that clearly delineate key self-management activities are needed. Naming and utilizing a shared self-management construct combined with process evaluations conducted in tandem with randomized controlled trials will inform the development of effective fall prevention interventions for people with multiple sclerosis.Self-management as an approach in clinical practice to prevent falls in people with multiple sclerosis seems promising and might be a crucial factor in future multiple sclerosis health care.It is probably too early to implement the self-management approach in clinical guidelines due to the weak state of the evidence.


The Arthritis Foundation’s Walk With Ease (WWE) program has been shown toreduce arthritis symptoms and increase physical performance for up to 1year. However, research on community-based WWE implementation is limited.The purpose of this study was to examine early implementation at communityorganizations that received 1-year WWE implementation grants from theOsteoarthritis Action Alliance.n = 3, >30% of goal enrollment) and no enrollmentat 6 months (n = 2). The Planning for Sustainabilityframework guided qualitative analysis of factors affecting earlyimplementation.Program managers at five Osteoarthritis Action Alliance grantee organizationsparticipated in 45-minute telephone interviews. Interviewees representedorganizations with the highest WWE enrollment at 6 months recent major structural changes within theirorganization, (2) difficulties in communicating logistics internally, and(3) difficulties in balancing WWE with other responsibilities. Allorganizations experienced barriers that required altering their originalimplementation plans; however, practical solutions like adapting the programto improve flexibility, training organizational staff as leaders, andutilizing community partnerships served to address multiple barrierssimultaneously.Building organizational capacity by overcoming early barriers is a keyelement of early implementation. Our findings offer concrete solutions toearly WWE implementation barriers and suggest the need for further researchon adaptations to improve WWE’s flexibility in community organizations. Doctor-diagnosed arthritis affects 54.4 million (22.7%) adults and is the number onecause of disability in the United States . RegularThe Arthritis Foundation’s Walk With Ease (WWE) program, an evidence-based physicalactivity intervention, can reduce arthritis symptoms and increase physical performancefor up to 1 year . It has Proceeding through the early stages of program implementation requires significantresource investment, as organizations build capacity and develop routinizedprocedures to sustain a program over time . In 2016https://oaaction.unc.edu/resource-library/for-community-partners/,offered one-on-one support to grantees, and organized monthly group calls wheregrantees could discuss experiences, successful strategies, lessons learned, andplans for sustainability.The small grants program aimed to help organizations implement WWE successfully,document challenges and lessons learned during the 1-year installation period, and,ultimately, embed WWE in their organizations long term. The OAAA provided marketingand implementation resources at Our qualitative evaluation involved semistructured interviews with WWE programmanagers at grantee organizations to examine characteristics of the earlyimplementation period. These CBOs represented diverse sectors ranging from healthcare to recreation and aging services. Interviews were conducted during the springof 2018, approximately 8 months into the organizations’ grants.Early implementation activities, like building organizational capacity andintegrating a program with other activities, are vital steps toward programsustainability . Since tWe selected for the interview three grantees that exceeded 30% of their goal WWEenrollment at their 6-month progress report (henceforth “high-enrollmentorganizations” or “HEOs”) and two that had not enrolled any WWE participants atthe same time point . Questions assessed grantees’ experiences within the 11 constructsof the Planning for Sustainability framework, including organizational readinessto implement, perceptions about WWE’s effectiveness and compatibility with otherorganizational programming, and use of internal or external program champions orcommunity partners during the early implementation process .Telephone interviews were conducted by one trained interviewer, who was familiarwith qualitative research procedures and with the OAAA small grants program butwho had not been the grantees’ previous OAAA contact. Prior to the interview,program managers received an agenda of interview topics by email, though not thespecific interview questions themselves. Interviews lasted for approximately 45minutes, were recorded with permission, and transcribed.We coded interview transcripts using NVivo 11 Data analysis software . Coding Only one of the three HEOs reached half its enrollment goal 6 months into its grant;the other two reached slightly over 30% . The twoThe organizations we interviewed shared many characteristics and WWEimplementation strategies . Every oAdditionally, every organization engaged community partners, though for differentpurposes. At all organizations, community partners offered locations for WWEgroups to meet and provided marketing assistance. Two organizations also engagedcommunity partners to independently offer the program. No organization relied oncommunity partners for financial support or planned to do so after grant fundingended.We wish it was an 18-month grant. . . . We needed about four or fivemonths to get everything up and going and to be able get everybody onboard. Because you know as well as I do when you’re dealing with thepowers that be, it’s a long process, but then once you get to the top,it was smooth sailing after that.All but one organization reported unexpected delays during early implementation,due to difficulties in engaging senior leadership, recruiting WWE leaders, orrecruiting partner organizations. One organization expressed a desire tolengthen the grant to allow time to manage unexpected difficulties:We had already had . . . about three years prior experience of workingwith the program, embedding it into our system. . . . I think it workedto our advantage that we already had Walk with Ease presence within theregion.The organization that did not report delays was the same one that exceeded 50% ofits goal participant reach. Program managers spoke of their existing experiencewith WWE as the means for success under this time line:While common themes regarding early implementation emerged from allorganizations, the two LEOs shared three organizational characteristics notreported by any HEOs:Substantial changes in organizational structure orleadership: Both LEOs began their WWE grants in the midstof major organizational changes. One LEO experienced an organizationalmerger at the same time as the WWE grant, while the other reportedsignificant senior leadership turnover at the beginning of the grantperiod.Difficulties in communicating logistics within theirorganization: Technological and communication difficultiesbetween different organizational departments delayed programimplementation at both LEOs.Difficulties in balancing WWE and other programresponsibilities: At one LEO, a program manager admitted,“I do multiple programs, so I have to juggle, you know . . . so, yeah,I’ve had to put some things on the back burner.” At the otherorganization, a program manager reported, “I have been, you know, alittle bit more lax than I have with other programs . . . not due to thecurriculum it’s just due to my time constraint and . . . mypriorities.”All organizations reported experiencing implementation barriers in the earlymonths of their WWE grants, and none adhered exactly to their originalimplementation plans. Barriers reflected various factors, including geography,climate, organizational structure and staffing, and potential participants’needs. However, organizations experienced many common barriers and oftenemployed similar solutions to address them . Three rAdapt the instructor-led program to be offered 2, instead of 3,times per week: Program managers from four organizations,unprompted by the interviewer, recommended that the instructor-led WWEprogram be offered twice instead of 3 times per week. Organizationsrecommended this adaptation in response to difficulties in engagingolder adults and recruiting program leaders, as it would reduce strainon their time. One organization actually implemented the adaptationdespite the reduction in program fidelity it caused:With some sites . . . sometimes they can’t commit to three days aweek and that’s what the evidence shows is best, so we haveencouraged them to start with two and then move up to three andthat really has been helpful, and we can start recording thedata when it gets to the three days a week.Utilize community partnerships: Partnership with otherCBOs was the most common way in which each organization addressedimplementation barriers. Every grantee had initially planned to partnerwith organizations like senior centers, aging services, hospitals,clinics, and worksite wellness programs; however, the exact role ofcommunity partners changed as the specific needs became clearer.Community partners were particularly useful in solving resourcebarriers: They provided indoor walking space for winter classes, offeredaudiences for marketing WWE, and helped reach participants over largegeographic areas.Train organizational staff as WWE leaders, instead ofvolunteers: All grantees were required to train WWEinstructors as part of their grant. Three organizations trained onlytheir or partners’ staff, while two also relied on volunteers. Bothorganizations that trained volunteers experienced barriers, includingdifficulties in recruiting volunteers, lack of long-term commitment,and/or inability to provide incentives:They couldn’t offer up that voluntary work and we didn’t have theopportunity to reimburse them for things like travel or providesome incentive for that leader.Maybe I wasn’t expecting it to be as hard . . . I had a fewpeople say that they were really interested in volunteering tobe trained to teach the class, and then one person dropped out .. . two people were trained and one person halfway throughdropped out. . . . I didn’t realize it would be that timeconsuming.[Program manager] trained three people and in the end only oneperson ended up teaching it, and then after the six-week sessionthey were like I don’t want to teach it again.During the first 6 months of their WWE grants, every organization experiencedunexpected barriers, and only one reached more than 50% of its recruitment goal.Many early implementation barriers mirrored those experienced by Oregon StateUniversity extension offices in 2012–2013 when they implemented WWE at countyoffices across Oregon . In thatBeyond the Oregon State University study, our findings mirror implementationexperiences for other evidence-based programs for older adults, including Fit &Strong!, EnhanceFitness, and the Chronic Disease Self-Management Program . As in oOrganizations implementing other programs also used implementation strategies similarto those of the grantees in our study, including evaluating available resources,like physical space and staff time , traininMost organizations in our study experienced implementation barriers that slowed WWEenrollment; however, these delays should not necessarily be considered wasted time.Rather, actions taken to surmount barriers may be useful as capacity-buildingactivities. Implementation literature in health promotion variously define capacitybuilding as (1) rendering an organization more able to address current and futurehealth issues, (2) creating increased problem-solving capabilities , or(3) improving organizational skills, motivations, knowledge, or attitudes towardimplementing innovations . From thOur research also confirms the vital role of community partners in reachingparticipants and providing resources that organizations lack. Community partnershipssometimes took longer than expected to establish; however, their critical role ingrantees’ implementation experiences suggests that partners offer benefits wellworth the effort to bring them on board. It follows that organizations fundingimplementation efforts should emphasize partnerships and provide grantees sufficienttime to establish them.In this study, one especially relevant aspect of organizational capacity was existingexperience with WWE. It is notable that one LEO with prior experience still failedto recruit any participants by the 6-month point in the grant. However, this granteecoordinated with a partner that lacked prior WWE experience and that suffered delaysin gaining senior leadership support and surmounting administrative andcommunication hurdles.Just as all HEOs had prior experience with WWE that facilitated implementation, theLEOs shared several barriers not reported by any HEOs. They each experienced recent,major structural changes and reported difficulties with internal communication,suggesting that implementing a new program may be complicated when existingprocesses are in flux or not functioning well. They also reported challenges injuggling WWE with other responsibilities. Just as prior experience with WWE enhancedcapacity to implement WWE for the HEOs, these characteristics in the LEOs likelyreduced organizational capacity to implement.Our findings build on existing literature by offering concrete solutions to commonearly implementation barriers. Difficulties recruiting and retaining volunteer WWEleaders suggest that, where possible, organizations should use staff instead.Additionally, organizations’ frequent suggestion to adapt the instructor-led programto twice a week indicates the need for additional research to validate thisadaptation or to explore other adaptations to improve program-organizational fit.The OAAA began this effort to improve program flexibility by working with theArthritis Foundation and the CDC to determine acceptable program adaptations duringthis grant period. It was determined that an “enhanced self-directed” format couldbe offered whereby participants would read the guidebook on their own but congregatewith other participants 1 to 3 times per week for group walks. In some cases,organizations provided a trained WWE leader to lead the walking activity andinformally review guidebook content.A few study limitations should be considered:Use of enrollment numbers as the sole measure of earlyimplementation success: We interviewed organizations withthe highest and lowest WWE enrollment halfway into their grants, aimingto hear varying early implementation experiences. However, as this studyand others indicate, enrollment is only one part of the earlyimplementation experience and does not adequately measurecapacity-building activities that are vital for program sustainability(nability. High anEvaluating only OAAA grantees limits generalizability:Grantees were selected from a pool of applicants and were more likelythan the general population of CBOs serving older adults to haveexperience with WWE or other evidence-based programs. Additionally,grantees received external support from the OAAA through monthly callsand participated in a learning collaborative with other grantees.Therefore, implementation actions, plans for sustainability, andsolutions to barriers may over-reflect strategies endorsed by theOAAA.Small sample size may allow for random bias: This studyrelied on interviews with only five OAAA grantees. However, we maximizedthe variety of our sample by selecting grantees with the highest andlowest enrollment by the date of their 6-month progress report (s report .Understanding how to successfully implement arthritis-appropriate, evidence-basedprograms in CBOs, and to sustain them after initial funding ends, is importantfor grant funders, organizational leaders investing time and effort in programs,and community members with arthritis who can benefit from them. Thisinvestigation examined early implementation experiences for CBOs thatexperienced the highest and lowest enrollment among OAAA small grant recipients.The results of this study could inform organizations in developing plans toimplement WWE, anticipating barriers, and strategizing solutions to overcomethem. Given similarities between implementation experiences in this study andstudies of other evidence-based programs, our study could also informimplementation research for other programs—particularly regarding addressingimplementation barriers. Our results also suggest avenues for future research inWWE—particularly the need to test adaptations that could improve the program’sflexibility and enhance the likelihood of WWE’s long-term uptake withinorganizations.


The COVID-19 pandemic created unprecedented shifts in the way health programs and services are delivered. A national lockdown to prevent the spread of COVID-19 in Australia was introduced in March 2020. This lockdown included the closure of exercise clinics, fitness centers, and other community spaces, which, before the pandemic, were used to deliver Beat It. Beat It is an 8-week in-person, community-based, and clinician-led group exercise and education program for adults self-managing diabetes. To continue offering Beat It, it was adapted from an in-person program to a fully web-based supervised group exercise program for adults with type 2 diabetes (T2DM).Beat It Online program produced comparable health outcomes to the Beat It in-person program in terms of improving physical fitness  and waist circumference in older adults with T2DM.This study aims to assess whether the Beat It Online, a twice-weekly supervised group exercise and education program conducted via videoconference over 8 weeks. Anthropometric measurements and physical fitness parameters were assessed at baseline and completion. The adaptations to Beat It are reported using the Model for Adaptation, Design, and Impact, including the type of changes , the criteria for making those changes (why and how), and the intended and unintended outcomes. The intended outcomes were comparable functional fitness as well as physical and mental health improvements across demographics and socioeconomic status.Australians with T2DM who were aged ≥60 years were included. They were enrolled in P<.001). The Model for Adaptation, Design, and Impact reports on 9 clinical, practical, and technical aspects of Beat It that were adapted for web-based delivery.A total of 171 adults  with T2DM were included in the study, with 40.4% (n=69) residing in lower socioeconomic areas. On the completion of the 8-week program, significant improvements in waist circumference, aerobic capacity, muscular strength, flexibility, and balance were observed in both male and female participants  adapted for culturally and linguistically diverse communities will provide greater insights into the efficacy of this promising program.This study found that  According to the International Diabetes Federation, more than half a billion people worldwide have diabetes , with tyPhysical activity is a cornerstone of T2DM management, along with dietary and pharmacological interventions . CurrentPhysical activity has a substantial role in maintaining functional fitness . ExercisBeat It, an 8-week in-person, community-based, and clinician-led group exercise and education program for adults self-managing diabetes. To continue offering this translational program, Beat It was adapted from an in-person program to a fully web-based supervised group exercise program for adults with T2DM.Small and large-scale community-based supervised group exercise programs for older adults with T2DM have demonstrated effectiveness in improving physical fitness in the short term (immediately after intervention) -19, withBeat It program have been published elsewhere [Beat It program significantly improved physical fitness  and reduced waist circumference for older adults (age ≥60 years), and these benefits were maintained for up to 12 months postprogram [Beat ItOnline program provides comparable benefits to participants. Thus, the aim of this study was to assess whether the Beat It Online program was effective in improving physical fitness  and waist circumference during the height of the COVID-19 pandemic.The short- and long-term health and physical fitness outcomes from the traditionally delivered in-person lsewhere ,22. ThisBeat It Online is an 8-week program that involves twice-weekly synchronous group exercise and education sessions, delivered via videoconferencing, by accredited exercise physiologists (AEPs).Programs were delivered by AEPs to participants who resided in New South Wales (NSW) and the Australian Capital Territory (ACT). Exercise sessions include moderate-intensity aerobic, resistance, flexibility, and balance-based exercises, and the education sessions focus on different areas of diabetes self-management. Participants completed a pre-exercise screening, baseline measures, and fitness testing during a web-based 1-on-1 initial consultation with the AEP. This consultation also included motivational interviewing to ascertain participants’ goals and their facilitators and barriers to change .The information gathered during the consultation was used to create a customized exercise program with the participant, considering their physical ability, existing fitness levels, and any comorbidities or injuries that could be exacerbated by exercise. Each exercise program comprised home exercise options that participants could replicate with minimal equipment or using items available around the home, including dynamic warm-up and cooldown, and aerobic , resistance , balance , and flexibility exercises . During the web-based group exercise sessions, participants completed their exercise program under the supervision of an AEP, who was able to modify exercises in accordance with the participant’s progress.Zoom bombing and other security concerns were prevented.Zoom videoconferencing software  was the preferred platform for delivering the group exercise and education sessions. All AEPs purchased a subscription to Zoom as a security precaution to ensure that 2-factor authentication, passcodes, and waiting rooms were available; thus, incidents such as Beat It Trainer to ensure the consistent and effective delivery of the program. This accredited continuing professional development training course, certified by Diabetes Qualified, a subsidiary of Diabetes NSW & ACT, consisted of 12 hours of asynchronous web-based modules and assessments, followed by a 1-day synchronous session focused on the clinical, practical, and technical requirements of delivering the Beat It program. Additionally, AEPs also completed a supplemental 2-hour synchronous training session focused on considerations for web-based delivery. To maintain this certification, all AEPs are required to complete a refresher course within 2 years of completing the initial training.All AEPs completed a specialized facilitator training program called Beat It Program (in-person and Online) are outlined in From May 2020 to October 2021, participants were recruited through email using the National Diabetes Services Scheme database or advertisements on the Diabetes NSW & ACT website. Prior to commencing, participants were required to provide evidence of medical clearance to exercise from their general practitioner and were then eligible to attend their web-based initial health and fitness assessment with their AEP. Standard exclusion criteria for the This study was approved by the Macquarie University Human Ethics Committee (5201950887424).Beat It Online, as well as an evaluation questionnaire prior to and at the completion of the program. Sociodemographic information, including gender, date of birth, and residential postcode, was collected. Postcodes were used as a measure of socioeconomic status as previously described [This study used a pre-post evaluation design where participants completed web-based physical assessment sessions at baseline and at 8 weeks of escribed . Height escribed . An asseescribed . The aveThe Diabetes Empowerment Scale (DES) is a measure of psychosocial self-efficacy that was developed specifically for a diabetes population. The DES short form contains 8 items that can be used to provide a brief general assessment of diabetes psychosocial self-efficacy . ParticiThe Patient Activation Measure (PAM) assesses a person’s self-reported knowledge, skill, and confidence for the self-management of their health or chronic condition . Each itt tests were performed to identify differences in fitness measures at baseline and program completion.Data analysis was performed using SPSS statistical software . Mean and SD were calculated for continuous variables. Frequencies and percentages were calculated for categorical variables, excluding participants with missing data for that variable. Paired 2-tailed Beat It has been represented using the Model for Adaptation, Design, and Impact (MADI) [The adaptation of t (MADI) . This moBeat It Online adaptations using the MADI model are shown in Beat It that were adapted for web-based delivery. Each of these aspects had moderating and mediating factors to support program fidelity while operationalizing Beat It in a web-based context. The intended outcomes were comparable functional fitness and physical and mental health improvements across demographics and socioeconomic status. These outcomes are reported in Beat It Online was as effective as the in-person program.The Beat It Online. Of the 171 individuals, 54 (32%) were male, age ranged from 60 to 89 years with a mean age of 71 (SD 5.6) years, and 69 (40%) resided in lower socioeconomic areas. Participants attended between 5 and 16 exercise sessions, with 70% (n=119) of the cohort attending at least 14 out of the 16 sessions. For the education sessions, participants attended between 0 and 6 sessions, with 80% (n=137) of the cohort attending at least 5 out of the 6 education sessions.A total of 171 individuals were included in the study. These individuals were aged ≥60 years, had reported a diagnosis of T2DM, and had participated in Improvements in waist circumference, aerobic capacity, muscular strength, flexibility, and balance were observed postprogram in both male and female participants .Survey evaluation data was received from 49 (29%) of the 171 participants. Most participants rated their health as being good to excellent both at baseline and postprogram , whereas improvements in their general quality of life rated as being good to excellent were reported postprogram .P<.001), whereas nonsignificant improvements in PAM scores were observed .Significant improvements in DES scores were reported postprogram , reduced waist circumference, and improved self-efficacy and quality of life in older adults with T2DM. This finding is important because globally, it has been reported that during the home confinement of lockdowns and necessary isolation, most individuals decreased their physical activity levels and increased sedentary behavior [This study found that  program ,22. Thisbehavior , and thobehavior .Beat It program [Beat It were similar to that outlined by Schwartz and colleagues [In this study, we used MADI, an implementation science framework, to transparently evaluate and report on the adaptations to the  program . We idenlleagues  in theirlleagues . A comprlleagues , provideBeat It Online program produced significant improvements in all physical fitness measures, as well as self-efficacy and self-reported quality of life, in a cohort that was aged 71  years. At a time when older adults across the world were told to isolate at home, Beat It Online provided a socially supportive setting for vulnerable individuals with a chronic condition and comorbidities to exercise safely, boost their mood, and connect with their peers while following health directives related to COVID-19. This program is particularly important given that research has shown that stay-at-home orders have resulted in the loss of formal and incidental social connections, putting older adults at acute risk for loneliness [The focus in diabetes care has traditionally been around the optimization of glycemic control and deterrence of complications . Howeverneliness . Furtherneliness .Beat It Online program has debunked the pervasive stereotype that older adults are resistant and incapable of engaging with new technologies [The nologies . The parnologies  and alignologies . This fiBeat It Online program. A longer follow-up is needed to ascertain if participants maintained the benefits gained from this program, any unintended outcomes, and whether Beat It Online is pragmatic outside of a global pandemic. We conducted a 1-year follow-up of the in-person Beat It program and concluded that participants maintained improvements in their health 12 months after completing the 8-week program [A limitation of this study is that it used a pre-post evaluation with no comparison group, which is a common design for translational community-based programs . Another program .Beat It Online offers a flexible and inclusive solution with significant physical and mental health benefits to individuals. Further evaluation of Beat It (both in-person and Online) adapted for culturally and linguistically diverse communities will provide greater insights into the efficacy of this promising program.This study revealed that a fully web-delivered, clinician-led, and supervised group exercise program provided important health benefits to older adults with T2DM. This study offers important findings for practitioners and policy makers seeking to maintain independence of older persons with T2DM, reversing frailty and maximizing functional and physical fitness while improving overall quality of life. The COVID-19 pandemic has created unprecedented shifts in the way key health programs and services are delivered.


Is a group-coaching program designed to reduce stress and teach resilience skills feasible, acceptable, and preliminarily useful for health care workers during the COVID-19 pandemic?In this pilot cohort study of 153 health care workers and hospital employees from a single health system, the group-coaching program was feasible and acceptable, as demonstrated by high demand, retention, and satisfaction. Measured according to validated scales, self-reported resilience, stress, anxiety, and burnout improved among participants.Results of this study suggest that resilience-building programs may support improved mental health outcomes. Health care workers face serious mental health challenges as a result of ongoing work stress. The COVID-19 pandemic exacerbated that stress, resulting in high rates of anxiety, depression, and burnout. To date, few evidence-based programs targeting mental health outcomes in health care workers have been described.To assess the feasibility, acceptability, and preliminary outcomes of a skills-based coaching program designed to reduce stress and build resilience.A pilot cohort study was conducted between September 2020 and April 2021 using preprogram and postprogram assessments and a mixed-methods analysis. Duration of follow-up was 7 weeks. The coaching program was delivered via video conferencing. Participants were health care workers and staff from a large urban health system.The Promoting Resilience in Stress Management (PRISM) program, a manualized, skills-based coaching program originally developed for adolescents and young adults with serious/chronic illness, was adapted to support health care workers and staff (“PRISM at Work”). It included 6 weekly 1-hour group sessions.Feasibility was defined a priori as 70% completion rates. Acceptability was defined quantitatively (satisfaction scores) and qualitatively (open-ended questions regarding experience with program). Preliminary outcomes were assessed with preprogram and post program assessments of self-reported resilience, stress, anxiety, and burnout using validated instruments. Descriptive statistics summarized demographic variables and feasibility and acceptability. Linear mixed effects regression models examined preliminary outcomes, controlling for relevant covariates.A total of 153 participants  enrolled. Of the 132 health care workers who provided follow-up surveys, 120 (91%) had completed the program, and 116 (88%) reported being satisfied. Answers to open-ended questions suggested that participants wanted more PRISM either with longer or additional sessions. Participant-reported resilience , stress , anxiety , and burnout-exhaustion  improved after the program.Results of this study suggest that PRISM at Work may have utility for health care workers and staff in that the program was found to be feasible, acceptable, and associated with improved outcomes. This cohort study assesses the feasibility and acceptability of a skills-based training program for health care workers and hospital employees during the COVID-19 pandemic as well as preliminary outcomes as indicated by participant-reported resilience, anxiety, stress, and burnout. The Promoting Resilience in Stress Management (PRISM) program is an empirically designed skills-based training program positioned to mitigate stress and build resilience in groups facing elevated levels of stress.18 Previous work translated this patient-centered program to one that supported HCWs (“PRISM at Work”).19To date, few evidenced-based methods have addressed burnout and poor mental health among HCWs. We postulated that a specific focus on bolstering resilience, defined as the process of harnessing resources to maintain well-being in the face of substantial stress,This study was designed to determine the feasibility and acceptability of PRISM at Work for HCWs and hospital employees during the COVID-19 pandemic. We also examined preliminary outcomes by assessing changes in participant-reported resilience, anxiety, stress, and burnout. We hypothesized that HCWs would find PRISM to be feasible, acceptable, and helpful for navigating the stress and burdens of their daily work and lives.18 The program was rigorously tested and refined with stakeholder feedback from patients and families, and feasibility, acceptability, and efficacy have been demonstrated in groups of patients with varying diseases.21 In response to COVID-19, we translated and piloted PRISM to a program that could also support health care staff.19PRISM is a manualized  skills-based training program originally developed for adolescents and young adults with serious or chronic illness. With a theoretical basis in stress and coping theory, PRISM intentionally diverged from traditional cognitive behavioral therapy by focusing instead on brief skills-based training for practicality and feasibility.22 which facilitated participants’ practice and tracking of skills, and handouts describing each skill and how to practice the techniques. Details of the program have been reported in previous publications.20PRISM at Work is composed of a 6-session group-based curriculum administered by 2 trained PRISM coaches on a video conferencing platform. The program included 6 weekly 1-hour sessions, covering (1) science of resilience, (2) stress management, (3) goal setting, (4) cognitive reframing, (5) meaning-making, and (6) coming together and moving forward with resilience. Sessions include didactic teaching of the skill, group reflection, and discussion of next steps in smaller breakout rooms. Participants in this study also received access to an award-winning smartphone app,20 Each coach completed 6 to 8 hours of training, which included supervised leading of pilot groups, practice scenarios, and review of the script. Audio for each class was recorded to assess fidelity to the script.Four nonmedical research staff were trained to facilitate group sessions. These coaches included individuals with master’s and doctorate level psychology or social work degrees, consistent with the training of coaches from other PRISM trials.STROBE) reporting guideline for cohort studies.Eligible participants (HCWs and staff) were initially recruited from a children’s hospital, and the program was extended to nursing staff at the affiliated University Medical Center. Courses were advertised via institutional announcements and through division and hospital leadership. Attempts to minimize bias related to availability were addressed by offering courses on various times and days. All interested participants provided signed informed consent. Enrollment occurred from September 2020 to April 2021. We delivered 2 to 3 PRISM courses in 5 waves, every 6 to 8 weeks. At study start, 12 participants at maximum were enrolled for each course; based on participant feedback, we reduced class sizes to 10 midway through the study. This study was approved by the Seattle Children’s Hospital Institutional Review Board. Data reporting followed the Strengthening the Reporting of Observational Studies in Epidemiology ; higher scores reflect higher resilience. Adult population norms are: 25th percentile: 29 points, 50th percentile: 32 points, 75th percentile: 36 points.24Analysis of preliminary outcome data was determined by preprogram and postprogram assessments with validated instruments. Self-perceived resilience was assessed with the 10-item Connor-Davidson Resilience scale.25 Items are scored on a 5-point Likert scale; higher scores indicate higher stress. Internal consistency, reliability, and validity are established.27 Scores ranging from 0 to 13 indicate low stress, from 14 to 26, moderate stress, and from 27 to 40, high stress.26Stress was assessed with the 10-item Perceived Stress Scale, a widely used global stress measure assessing the degree to which life situations are stressful.28; items are scored on a 4-point Likert scale with higher scores indicating higher anxiety. The GAD-7 has good reliability, and validity, with cut points of 5 interpreted as mild anxiety, 10 as moderate anxiety, and 15 as severe anxiety.28Anxiety was assessed with the Generalized Anxiety Disorder 7-item scale (GAD-7)30 Total scores and cut points are not recommended30; instead the scale includes 3 subscales: exhaustion (feelings of being overextended and exhausted by one's work), cynicism (an indifference or a distant attitude toward one’s work), and professional efficacy (satisfaction with past and present accomplishments). Published mean (SD) norms for raw scores in health care were for exhaustion, 2.2 (1.5), for cynicism, 1.4 (1.2), and for professional efficacy, 4.2 (1.0).30 The MBI-General Survey has been used with diverse populations of health care workers, including nurses, laboratory technicians, and hospital managers.32Burnout was assessed with the 16-item Maslach Burnout Inventory (MBI)–General Survey.33 The Hope Scale includes a total score and 2 subscales: pathway, indicating one’s perceived ability to generate a route to their goals, and agency, indicating one’s perceived ability to initiate and maintain the actions necessary to reach a goal. Strong internal reliability and validity have been established.33 Items are scored on an 8-item Likert scale with higher scores indicating higher hope.Hope was assessed with a 12-item Hope Scale, measuring overall perception that one’s goals can be met.35 Items are scored on a 5-point Likert scale; higher scores indicate more benefit-finding. This scale has demonstrated internal consistency, reliability, and validity in multiple cancer studies.36 For use in the current study, items remained the same; the question stem was changed from “having had breast cancer” to “the COVID-19 pandemic.”Benefit-finding was assessed with an adapted 17-item Benefit-Finding Scale with each item expressing potential benefit from the COVID-19 experience.37 Items are scored on a 5-point Likert scale. This scale is reliable, valid, and highly related to work-related and general well-being variables.37 Higher scores indicate higher meaning.Meaning in work was assessed with the 10-item Work and Meaning Inventory, assessing different dimensions of experiencing work as meaningful. Items map onto 3 factors: positive meaning from work, meaning-making through work, and greater good motivations.Demographic and work-related variables were collected at baseline including self-reported gender, age, language, education, marital status, and race and ethnicity. Job category was determined by binary categorization of their job title: patient-facing (interacted regularly with patients/families) and nonpatient facing (did not interact regularly with patients/families). Two additional variables were coded for each participant as covariates: cohort indicating the individual class they participated in and wave indicating the specific week in which their class began.SRQR) were followed to code responses.38 Four coders  conducted directed content analysis with Dedoose qualitative analysis software, version 7.0.23  using an a priori codebook based on questions from the interview guide and informed by previous PRISM trials.39 Once the codebook was finalized, the same coders sequentially coded each transcript into code categories. Consensus meetings refined codes and resolved discrepancies. Numbers of similar responses within a code category were tabulated and divided by the number of total responses, yielding a percentage of endorsement for that item.Participant-reported demographic and work-related variables, feasibility data , and acceptability data  were summarized descriptively using numbers and percentages. For qualitative analysis of acceptability data, the Standards for Reporting Qualitative Research . These variables were chosen for the possibility that certain age groups, patient-facing jobs, family composition/support, and different phases of the pandemic might be associated with higher stress levels and increased response to the training. A nested random effects structure was included in all models to account for clustering due to repeated assessments within participants and participants receiving training in group setting. All analyses were performed using the R statistical software, version 4.1.0 . Statistical significance was set at 2-sided A total of 153 participants provided informed consent with a mean (SD) age of 40.6 (10.1) years; 140 (92%) were female; 12 (7%) were male; 1 (1%) was nonbinary; 8 (5%) were Asian or Asian American; 4 (8%) were multiracial or biracial; 2 (1%) were Hispanic; and 128 (87%) were White . A totalBaseline instrument scores suggested low levels of self-perceived resilience , moderate level of stress , moderate level of anxiety , and high levels of burnout-exhaustion  .We created 15 cohorts  consisting of 8 to 12 participants comprising 5 waves (periods of time in which they started the course). Of the 153 who completed baseline surveys, 145 (95%) attended the first session. Of those who attended the first session, 113 (78%) attended 5 or 6 of the 6 total sessions. One-hundred percent of offered courses filled to capacity, with an average of 5 people on the waitlist per class. A total of 132 participants (91%) completed follow-up surveys, and 93 participants (64%) completed open-ended questions. The 21 participants (14%) who missed the follow-up assessment were not substantially different from the participants who completed the follow-up assessment in any of the demographic variables and baseline outcome values.All 4 PRISM coaches successfully delivered the program at least once. Content fidelity was 100%.We observed no psychosocial or emotional concerns associated with the PRISM at Work program. Specifically, no participant verbalized psychosocial or emotional concerns to a degree that prompted external support outside that of the program coaches.Of 132 HCWs who provided follow-up surveys, 116 participants (88%) reported being satisfied with PRISM overall, 120 participants (91%) were satisfied or very satisfied with the frequency of sessions, and 110 participants (83%) were satisfied or very satisfied with the length of sessions .Of the 92 participants who responded to the open-ended questions , 91 partRegression analyses controlled for age, wave of program, marital status, and job category. Given that participants were predominantly White and female, those variables were not used as covariates, and educational level was not used because of its potential association with job category. Regression results suggested that employee-reported outcomes were associated with PRISM at Work . SpecifiThe PRISM at Work program was designed to help HCWs and hospital staff manage stress and improve resilience through a manualized, skills-based coaching curriculum. In this pilot cohort study conducted during the COVID-19 pandemic, we found PRISM at Work to be feasible and acceptable among those who agreed to participate. Our data also suggest that receipt of PRISM was associated with increased perceptions of resilience and reduced feelings of anxiety, stress and burnout from preprogram to postprogram assessments.40 Resilience-building programs have been consistently recommended for the workplace, both prepandemic and postpandemic, particularly for high-stress occupations such as health care.42 Existing guidelines for mental health programs for HCWs recommend easily accessible programs that are brief, simple, and incorporate digital components to augment convenience and accessibility.43 Facilitators to successful implementation of these programs include a positive, safe learning environment that includes formal and informal discussions and that provides opportunities for reflection and shared learning.44 PRISM at Work meets all of these recommendations.Given the nature of the COVID-19 pandemic, resilience resources for HCW and medical staff are needed. Although programs such as PRISM may not address systemic factors associated with burnout for health care workers and staff including long work hours, staffing shortages, and ongoing personal risk, and mandated programs may be less-likely to be well received, HCW well-being certainly can and should be addressed.45 In the era of COVID-19, resilience is a vital component in coping with ongoing stress, finding meaning in one’s work, and the future of the US health care system’s ability to weather burnout and adequately staff personnel.46 We found that mean resilience scores in this population (both preprogram and postprogram) were low in comparison with adult norms. It is unclear whether this finding is a manifestation of the COVID-19 pandemic or whether this low perception of one’s own resilience was common before the pandemic. Regardless, opportunities to learn, reflect on, and develop one’s resilience resources are necessary. These tools are not always intuitive or innate. We and others have shown that via deliberate action, individual resilience resources can be bolstered.21 In health care, it is important to note that such deliberate actions must come from both individual HCWs and the health care organizations who support them.47For HCWs with high levels of job strain, attention to well-being and resilience is critical.This study has limitations. First, this was a pilot study which limited our ability to offer the course on a larger scale. Successful enrollment was based on motivation, self-selection, and the ability to attend the class. As a result, participants may have been more receptive to the content of this program. Further, staff had to take their own time to participate in this program, and thus we may have inadvertently created barriers to attendance. The number of physician attendees, for example, was limited. Similarly, those who responded to the open-ended questions may have been more favorable about the program than those who did not reply. Next, the demographic characteristics of participants indicated a lack of diversity. Although efforts were made to improve diversity by reaching out to the division heads and representatives for underrepresented groups, it remains unclear whether PRISM at Work would be feasible, acceptable, or preliminarily efficacious for staff who identify as men, nonbinary, or who have been historically marginalized. Future work must not only improve on the diversity of participants but also ensure that all eligible HCWs and staff have the opportunity to participate. Similarly, our experience at a single health-system may not be generalizable to other institutions.With only 2 data points from each participant, we were limited in our ability to infer differences within participants. Change scores, although substantial, did not often cross cut-off thresholds. The design of this study as a cohort study limits our ability to infer efficacy. Larger trials may aid in confirmation of our preliminary findings.In this pilot cohort study, we found that the PRISM at Work program may be a promising resource with utility for teaching resilience skills to HCWs and hospital staff, a group facing elevated stress and poor outcomes. With growing attention and interest in improving these outcomes, results of our study suggest that integrating a resilience-promoting curriculum is feasible and acceptable. Further, use of the program was associated with improved self-reported resilience, stress, and burnout. PRISM at Work appears to be one approach toward offering deliberate action in response to prevalence of poor mental health outcomes in this community.