Theses and Dissertations

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Open Access
A qualitative study: the influence of occupational therapy for pelvic floor dysfunction on functioning, disability, and health
(Colorado State University. Libraries, 2022) Pearce, Delaney M., author; Schmid, Arlene A., advisor; Atler, Karen E., committee member; Fruhauf, Christine A., committee member
Introduction: Approximately one quarter of all women in the United States experience symptoms of pelvic floor dysfunction (PFD). Occupational therapy (OT) for PFD is a relatively new area of expertise within the field, resulting in limited research on its efficacy. Objectives: Explore the ways in which OT for PFD influences health using the International Classification of Functioning, Disability, and Health (ICF) as a guide. Method: Four participants completed the study. Eligibility criteria included: >18 years old, biologically female, English speaking, self-reported pelvic floor issue, completed OT intervention for PFD within the last two years. Electronic medical records and Pelvic Floor Distress Inventory Questionnaire-10 (PFDI-20) scores prior to and after completing OT intervention for PFD were reviewed, and semi-structured interviews were conducted. Results: Four themes emerged: 1) improved mental health and physiological function, 2) promotion of the mind-body connection, 3) reintroduction of meaning, and 4) relationships with healthcare professionals and sociocultural influences. Each theme is tied to a component of the ICF. Conclusion: OT for PFD has a positive impact on health per the ICF. This may result in better function and participation in everyday life. More research is needed to investigate the generalizability of these findings.
Open Access
Do participants with chronic pain have improved self-efficacy after completing the MY-Skills intervention?
(Colorado State University. Libraries, 2020) Kinkel, Charla, author; Schmid, Arlene A., advisor; Atler, Karen E., committee member; Fruhauf, Christine A., committee member
Purpose: The aim of this study was to explore if participants with chronic pain have improved self-efficacy in performing daily activities and managing pain symptoms after completing the Merging Yoga and self-management Skills program (MY-Skills). Method: Care dyads, comprised of caregivers and care-recipients with chronic pain were recruited to complete the 8-week MY-Skills intervention. Twice each week, participants engaged in a one-hour group self-management course followed by a one-hour group yoga session developed for care dyads with chronic pain. Self-efficacy outcomes were collected using the Chronic Pain Self-Efficacy Scale (pain management, physical function, coping with symptoms); the PROMIS® Self-Efficacy for Managing Daily Activities Short Form 4a; and the PROMIS Self-Efficacy for Managing Symptoms Short Form 4a. Data for all participants were analyzed using a paired t-test. A post hoc exploratory analysis of separate caregiver and care-recipient outcomes was conducted using a Wilcoxon signed ranks test. Results: Eight participants completed the study (50.23±14.77 avg. age, 77% female, 69% with pain for > 10 years). The participants reported increased self-efficacy across all measures and domains, with significant improvement found for self-efficacy for physical function (38.97±19.45 vs. 59.10±18.60, p = .004). The post hoc exploratory analysis showed increased self-efficacy in all caregiver outcomes. Care-recipients reported increased self-efficacy in all areas except pain management, which significantly decreased. Conclusion: MY-Skills improved self-efficacy to varying degrees for participants in aggregate. Improvements in self-efficacy related to physical function demonstrated that MY-Skills increased participants' confidence in performing everyday occupations such as running errands, doing chores, working, and socializing. Interventions that improve self-efficacy, like MY-Skills, may help people with chronic pain gain function, problem-solving, and coping skills to reclaim a sense of control and enhance quality of life.
Open Access
Group occupational therapy and yoga: the caregiver experience
(Colorado State University. Libraries, 2016) Hinsey, Katie M., author; Schmid, Arlene A., advisor; Atler, Karen E., committee member; Fruhauf, Christine, committee member
The purpose of this qualitative study was to examine the experiences of caregivers of people with stroke after participating in a group occupational therapy and yoga intervention (MY-OT). Participants elected to either participate in the 8 week MY-OT intervention or to not attend. Participants completed the Zarit Burden Interview and Positive Aspects of Caring scale retrospectively after the MY-OT intervention. Caregivers also chose to participate in focus groups and individual interviews following the intervention. Qualitative data were analysed using an iterative, coding process to generate larger themes based on caregiver experience. Caregivers who attended the MY-OT intervention saw a 47% decrease in caregiver burden and a 26% increase in positive aspects of caring. Those who did not attend saw a 2% decrease in caregiver burden and a 4% decrease in positive aspects of caring. Five themes were elicited from focus groups and interviews: 1) Changes in daily life; 2) Coping Mechanisms; 3) Learning through observation; 4) Sense of community and 5) Learning new information. Group occupational therapy, focused on self-management, and yoga are effective and beneficial interventions for the caregiver and care recipient together.
Open Access
Merging yoga and occupational therapy for Parkinson's disease
(Colorado State University. Libraries, 2019) Swink, Laura A., author; Schmid, Arlene A., advisor; Atler, Karen E., committee member; Fruhauf, Christine A., committee member; Fling, Brett W., committee member
Purpose: The purpose of this dissertation was to develop a fall risk self-management program for people with Parkinson's disease (Merging Yoga and Occupational Therapy for Parkinson's Disease [MY-OT for PD]), conduct a feasibility and pilot study, and analyze outcomes following the MY-OT for PD program. Method: This dissertation includes three studies. Study One was a qualitative study which focused on the adaptation of a program originally designed for individuals with chronic stroke (i.e. Merging Yoga and Occupational Therapy) and development of a new program to specifically meet the needs of people with Parkinson's disease (PwP) (i.e. MY-OT for PD). To complete Study One, we conducted a focus group with PwP and nine expert interviews. Study One results led to the creation of Stage 1 manuals to guide the MY-OT for PD program. In Study Two, we completed the 8-week (14-session) MY-OT for PD program and focused on feasibility and pilot testing. Feasibility was assessed related to the process, resources, management, and scientific basis of the program. The following outcome measures were collected: five fall management scales, concern about falling, balance, balance confidence, and self-reported falls. Study Three was a mixed-methods analysis of health-related quality of life following the MY-OT for PD program. The quantitative outcome was a HRQoL standardized assessment specifically for PwP. The qualitative data were collected via two focus groups with participants after the program in which participants were asked about eight HRQoL domains from the quantitative assessment. Results: In the qualitative development study, three themes were identified related to revision of the MY-OT program (and development of Stage 1 manuals): revisions to the guiding model, revisions to content, revisions to delivery. We outlined changes to the manuals in relation to each theme and developed a new guiding model (the PD Fall Risk Model), altered manual content, and altered delivery aspects of the manual to create the PD-specific MY-OT for PD Stage 1 program manuals. We then implemented and tested the 8-week, 14-session MY-OT for PD program. Eighteen participants enrolled, one dropped out during the control period, and 17 participants completed an average of 12.82/14 sessions. Improvements were seen on all outcome measures, and significant differences were seen between the control and intervention periods on one of the fall management scales and balance, with significantly greater scores improvements during the intervention period as compared to the control period. HRQoL results were mixed because quantitative results showed no significant differences in HRQoL following the MY-OT for PD program, while qualitative results showed noted improvements in all HRQoL domains. Conclusion: MY-OT for PD is one promising program that decreased the number of self-reported falls during the intervention, improved balance, and participants reported improvements in HRQoL. In order to complete future trials, MY-OT for PD would need to be modified based on participant feedback and analysis of outcomes following the feasibility and pilot testing in Studies Two and Three.
Open Access
Merging yoga and occupational therapy for Parkinson's disease improves fatigue management and activity and participation measures
(Colorado State University. Libraries, 2019) Hill, Heather M., author; Schmid, Arlene A., advisor; Atler, Karen E., committee member; Fling, Brett W., committee member
Introduction: The purpose of this pilot study was to explore the influence of a fall-risk management intervention, Merging Yoga and Occupational Therapy for Parkinson's Disease (MY-OT-PD), on fatigue and activity and participation measures, as well as examine the relationship between fatigue and activity and participation measures in Parkinson's disease (PD). Methods: This mixed methods study included 17 participants with PD. Participants took the Modified Fatigue Impact Scale (MFIS) and the International Classification of Functioning, Disability, and Health Measure of Participation and Activities Screener (IMPACT-S) at three separate eight-week intervals: baseline (followed by an eight-week control period), pre-intervention, and post-intervention. Focus groups were completed at the conclusion of the study to qualitatively explore participants' perception of the intervention related to their fatigue and activity and participation levels. Results: Fatigue and activity and participation measures were significantly correlated (r = 0.76). Activity and participation measures (IMPACT-S) significantly improved after the intervention (p = 0.012). Four themes related to fatigue and/or activity and participation emerged following qualitative analysis including: 1) managing fatigue: paying attention and acting accordingly; 2) creating mindfulness in daily activities; 3) giving and receiving within a community; and 4) strengthening relationship to self and others. Conclusion: Participants experienced improvement in activity and participation measures as well as perceived fatigue management after engagement in a community-based, fall-risk management program, MY-OT-PD.
Open Access
Mind over matter: an exploratory case study of mind-body interventions in the burn unit
(Colorado State University. Libraries, 2019) Anderson, Abby, author; Schmid, Arlene A., advisor; Atler, Karen E., committee member; Yuma, Paula, committee member
Introduction: The aim of this case study was to explore the experience of five patients who participated in mind-body based occupational therapy (MB-OT) while in the burn unit. Individual responses to mind-body practices were assessed and patient perspectives were included to better understand what MB-OT brought to the recovery process.
Open Access
Perceived impact and experience of long-term yoga involvement for people with chronic pain
(Colorado State University. Libraries, 2018) Rose, Caroline M., author; Schmid, Arlene A., advisor; Atler, Karen E., committee member; Portz, Jennifer D., committee member
Introduction: The aim of this study was to investigate the perceived impact and experience of long-term involvement in a community-based group yoga class for people with chronic pain. Methods: Eleven participants, who previously completed an 8-week yoga intervention and continued attending yoga at a community pain clinic for 2 years, took part in the study. A mixed methods approach was employed. Two-year follow-ups of the Canadian Occupational Performance Measure (COPM) were collected and compared to baseline COPM scores to measure change in perceived occupational performance and satisfaction. Individual qualitative interviews were conducted to explore participants' perceived impact and experience of long-term yoga involvement. COPM data were analyzed using Wilcoxon sign ranked non-parametric tests and qualitative interviews were analyzed using an inductive approach. Findings: COPM performance and satisfaction scores significantly improved between baseline and follow up after 2 years of yoga. Three main themes emerged from the qualitative interviews: 1) Occupational shift from "living" to "existing," 2) The change process is "progressive," and 3) Yoga is "a positive thing I do in my life." Conclusion: Long-term involvement in community-based group yoga may improve and sustain occupational health and well-being. Therefore, occupational therapists may consider yoga as a tool to promote occupational health in people with chronic pain.
Open Access
Women's experience receiving occupational therapy for pelvic floor dysfunction: a case series
(Colorado State University. Libraries, 2021) Schmitz, Johanna R., author; Schmid, Arlene A., advisor; Atler, Karen E., committee member; Fruhauf, Christine A., committee member
Introduction: Pelvic floor dysfunction (PFD) is a condition that affects one third of women, greatly impacting their quality of life (QoL). There is limited research on occupational therapy (OT) and pelvic floor health as pelvic floor therapy is a relatively new topic in the field of OT. Objectives: Explore the experiences of women who have received OT for PFD. Method: Eligibility criteria included: ≥18 years old; biologically female participants; self-reported pelvic floor health issue; English speaking; completed OT intervention for PFD within the past two years. Four participants completed a semi-structured interview about their treatment and qualitative analyses were completed using inductive coding techniques. Participants' electronic medical records were reviewed. The Pelvic Floor Distress Inventory Questionnaire-20 (PFDI-20) was completed to assess changes in PFD symptoms and impact on QoL. Results: Qualitatively, three main themes emerged from the data across participants: 1) OT changed the course of women's ongoing journey with pelvic health, 2) women experienced relief through discovering OT, and 3) OT empowered women to be the experts of their own bodies. There were clinically significant changes in participants PFDI-20 scores indicating a decrease in PFD symptoms and impact of PFD symptoms on QOL following OT intervention. Conclusion: In conclusion, it appears that OT interventions may play an important role in positively impacting women's life with PFD. More research is needed to investigate the mechanisms of what makes OT interventions effective in treating PFD.
Open Access
Yoga improves balance, balance confidence, and occupational performance for adults with diabetic peripheral neuropathy: a pilot study
(Colorado State University. Libraries, 2015) Willis, Leslie Ann, author; Schmid, Arlene A., advisor; Atler, Karen E., committee member; Tracy, Brian L., committee member
The purpose of this study was to examine the preliminary efficacy of yoga on balance, balance confidence, occupational performance, and satisfaction with performance in adults with diabetic peripheral neuropathy (DPN). We used a non-controlled pretest-posttest design. Fifteen adults with DPN attended 8-weeks of yoga, including positive affirmations, breathing, postures, and relaxation. Balance was measured using the Berg Balance Scale (BBS); balance confidence, using the Activities-specific Balance Confidence Scale (ABC); and perceived occupational performance and satisfaction, using the Canadian Occupational Performance Measure (COPM). Significant improvements were found for balance (p=.009), balance confidence (p=.004), occupational performance (p=<.001), and satisfaction with performance (p=<.001). Improvements remained significant after the Bonferroni correction (α= .05/4- .0125). The effect sizes were medium for balance (dCohen = 0.65) and large for occupational performance and satisfaction (dCohen = 1.13, 1.07, respectively). Yoga appears to significantly improve balance, balance confidence, occupational performance, and satisfaction for adults with DPN. Further research utilizing a control group, a larger sample size, and randomization is required.

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