Browsing by Author "Schmid, Arlene A., committee member"
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Item Open Access A theory-driven logic model of equine-assisted psychotherapy for at-risk youth(Colorado State University. Libraries, 2021) Kelly, Erin, author; Wood, Wendy, advisor; Schmid, Arlene A., committee member; Stallones, Lorann, committee memberMental health issues among adolescent and young adult populations are highly prevalent. Mental illness can impact long term success and puts individuals at risk of negative quality of life outcomes. Equine-assisted psychotherapy interventions for at-risk youth are intended to support the development of important life skills and mitigate the risk factors one may be facing. The purpose of this study was to assess an equine-assisted psychotherapy program for at risk youth, the Equine Assisted Life Skills Training (EALST) program, using the structure of a theory-driven logic model. Using a qualitative description approach, I developed a theory-driven logic model to understand the underlying aspects of the EALST program. The aspects included the theoretical assumptions, resources, activities, outputs, outcomes, and impact of the program. I conducted semi-structured interviews with eight program stakeholders, with the questions aimed at explicating stakeholder's conceptualizations of each of these logic model categories. The results of the analysis of these interviews were mapped into a logic model format. This particular type of logic model focused on elucidating the theoretical assumptions of the program stakeholders in order to develop existing program theory. These theoretical assumptions, along with the other aspects of the logic model, will support the program providers in further developing their working theories and more effectively implementing the program. Next steps include identifying measures of hypothesized outcomes in order to test and further refine the identified program theory.Item Open Access Determinants of driving performance following stroke(Colorado State University. Libraries, 2022) Pollet, Aviva Katherine, author; Lodha, Neha, advisor; Li, Kaigang, committee member; Schmid, Arlene A., committee memberOverall introduction: Individuals with stroke experience motor and cognitive deficits both of which can impact driving performance. Using two separate studies, we evaluated the influence of motor and cognitive factors on driving performance in stroke survivors. In the first study, we evaluated how driving impairments in stroke survivors is influenced by the use of either the paretic or non-paretic leg for pedal control. Methods 1: Twenty-two individuals with chronic stroke were recruited in two groups depending on their lower-limb choice for pedal control 1) paretic leg drivers, individuals using their paretic leg to control the car pedals (N = 11, 68.4 ± 7.8 years) and 2) non-paretic leg drivers, individuals using their non-paretic leg to control the car pedals (N = 11, 61.1 ± 13.7 years). Both groups performed a car following task in a driving simulator. The task required participants to follow a lead car by controlling the gas pedal accurately and respond to brake lights by pressing the brake pedal as fast as possible. We quantified gas pedal error using root mean square error (RMSE). We measured brake response time as the time from the onset of the brake lights of the lead car to the application of the brake pedal. We also dissociated the brake response time into pre-motor and motor response times. We used the Driving Habits Questionnaire (DHQ) to measure self-reported on-road driving behavior. Additionally, using surface electromyography (EMG), we analyzed neuromuscular activation using burst duration and amplitude, and coordination using overlap and coactivation of the tibialis anterior (TA) and medial gastrocnemius (MG) during the braking portion of the car following task. Results 1: The paretic leg drivers showed greater gas pedal RMSE than the non-paretic leg drivers (p ≤ 0.01). The paretic leg drivers had a slower brake response time than the non-paretic leg drivers (p < 0.05). Premotor response time was not different between the two groups (p = 0.71), however, the paretic leg drivers had a significantly slower motor response time relative to the non-paretic leg drivers (p < 0.05). The paretic leg drivers had lower DHQ scores than the non-paretic leg drivers (p ≤ 0.01). DHQ and brake response time were negatively correlated (r = - 0.42, p ≤ 0.05). Additionally, paretic leg drivers showed longer TA EMG burst duration (p <0.05) and more TA-MG overlap (p <0.05). TA EMG burst duration was positively correlated to brake response time (r = 0.51, p < 0.05) and motor response time (r = 0.61, p < 0.05). TA-MG overlap was positively correlated to brake response time (r = 0.76, p = 0.001). In the second study, we evaluated how cognitive load influenced driving impairments in stroke survivors. Methods 2: Ten individuals with chronic stroke participated in the current study (N = 10, 65.6 ± 14.9 years). The participants performed simulated driving without (single-task) and with (dual-task) a cognitive load. The single-task driving required participants to drive along a rural road and brake as quickly as possible when an unexpected hazard, such as wildlife crossing into the driving lane, was encountered. The dual-task driving required participants to drive in the same driving scenario while performing a secondary cognitive task. The cognitive task involved mental arithmetic to induce higher cognitive load while driving. Specifically, participants were asked to subtract 4 and add 3 to a random number and do so repeatedly until the end of the driving task. We measured lane departures as the number of times the edge of the participant's vehicle left the designated driving lane. We measured speed compliance as the percent of total time the individual was within +/- 5 MPH of the speed limit between events. Additionally, we measured brake response time as the time from the appearance of the hazard stimulus to the application of the brake pedal. Results 2: Individuals with stroke show more lane departures throughout the entire drive during dual-task driving than single-task driving (p < 0.05). Additionally, individuals with stroke show worse speed compliance during dual-task driving than single-task driving (p < 0.05). There was no difference in brake response time between the single-task and dual-task driving (p = 0.18). Overall conclusion: Driving performance in stroke survivors is influenced by limb selection for pedal control and cognitive load. The current studies demonstrate the need to assess and train motor and cognitive deficits that contribute to driving performance in individuals with stroke. Motor deficits in pedal control and brake response time contribute to unsafe driving in individuals with stroke. Cognitive deficits in lane departures and speed compliance in driving with cognitive load also contribute to unsafe driving in individuals with stroke. To address these deficits, stroke driving rehabilitation programs should focus on driving leg and cognitive environment of driving.Item Embargo Effect of a videoconference-delivered physical activity intervention on quality of life in colorectal cancer survivors(Colorado State University. Libraries, 2023) Prien, Lydia, author; Leach, Heather, advisor; Schmid, Arlene A., committee member; Zimmaro, Lauren A., committee memberINTRODUCTION: Colorectal cancer is the fourth most common cancer diagnosed in both men and women in the United States. For every 100 people diagnosed with colon cancer, 64 are expected to live five or more years after diagnosis. With this growing number of colorectal cancer survivors, quality of life (QOL) becomes an important patient reported outcome within this population. QOL is multidimensional and includes various dimensions of wellbeing (e.g., physical, emotional, social) that can be improved with physical activity. Previous research has established that face-to-face supervised physical activity (PA) interventions can improve QOL among colorectal cancer survivors (CRC) (Mishra et al., 2012). However, these interventions require a lot of resources, and may be difficult to access. Thus, researchers have turned to distance-based physical activity (PA) interventions (digital health tools, text messaging, prerecorded home-based workouts etc.) to increase access and scalability of PA interventions for CRC survivors. Previous studies that have examined the effect of distance-based PA interventions for improving QOL in CRC survivors did not find improvements in QOL. For example, Kim et al. (2019) found no significant improvements in QOL following an unsupervised, homebased, DVD exercise program, and Chan et al. (2022) found no significant changes in QOL, following a text messaging intervention. These finding suggest that distance-based PA interventions may not be as effective as face-to-face for improving QOL in CRC survivors and may be due to a lack of contact with other survivors and/or diminished PA adherence/compliance due to lack of supervision and instruction from an exercise professional. Since the COVID-19 pandemic, videoconference PA interventions have grown in popularity, and may be able to overcome some of the limitations of both face-to-face and distance-based PA interventions for improving QOL in CRC survivors. However, to date there are no previous studies that have examined the effect of a videoconference intervention on QOL in CRC survivors. This study will examine changes in QOL in colorectal cancer survivors following a 12-week, videoconference, PA intervention. This study will be a secondary data analysis of participants enrolled in Testing Group Activity CorrelaTes In Colorectal Cancer Survivors (TACTICS), a pilot randomized controlled trial with the primary aims of determining feasibility, and preliminary effects on physical activity. METHODS: TACTICS is a 12-week pilot randomized controlled trial where the intervention group received group-based exercise sessions 2x/week, and five behavior change discussion sessions delivered via Zoom. The control group received standard physical activity recommendations. QOL was measured at baseline and 12-weeks using the Functional Assessment of Cancer Therapy–Colorectal (FACT-C). Mean change, standard deviation, and effect size were reported to measure improvements in QOL. Established minimal clinically important differences (MCID) are a Δ5 points for total and a Δ2 points for QOL subscales. The proportion achieving MCID's in intervention vs. control were compared using Fisher's Exact tests, and independent t-tests or chi square tests explored differences in participant characteristics between those did vs. did not achieve MCID. RESULTS: Participants (n= 13 intervention, n=12 control) were mostly 56% female and M=61.2±11.7 years old. Among intervention participants, proportion who achieved MCID was 23.1% total, 15.4% physical, 38.5% functional, 23.1% social, and 15.4 % emotional, compared to 41.7% total, 33.3% physical, 25.0% functional, 41.7% social wellbeing, and 16.7% emotional among control. None of these proportions differed between groups (p>.05). For the physical QOL subscale, BMI was higher [t(11)=2.92, p=.014] and baseline scores were lower [t(7)=-2.34, p=.052] among those who achieved MCID. CONCLUSION: We observed small improvements in QOL within CRC survivors. There were no statistically significant differences in achieving clinically relevant improvements in QOL between intervention and control group participants. Larger randomized studies are needed to definitively determine if a videoconference exercise intervention can elicit clinically relevant improvements in QOL compared to a control group.  Item Open Access Exploring the relationship among occupational functioning factors in adults with type two diabetes mellitus(Colorado State University. Libraries, 2017) Langton, Stacy, author; Malcolm, Matthew, advisor; Nelson, Tracy, committee member; Schmid, Arlene A., committee memberType two diabetes mellitus (T2DM) is a common diagnosis among the U.S. population, however many individuals struggle to effectively control their glycemic levels. T2DM can have an impact on individuals physically and psychosocially with worse outcomes in low social economic status (SES) populations. Several physical and psychosocial factors have been found to influence self-management behaviors in individuals with T2DM. Researchers have not examined self-efficacy, locus of control (LoC), quality of life (QoL), activity (a set of tasks consisting of goal directed actions), and mood simultaneously to better understand the multitude of factors that can influence diabetes control (HbA1c). Additionally, self-efficacy has not been evaluated as composed of various constructs related to diabetes self-management. The Occupational Functioning Model facilitates conceptualization of: self-efficacy, LoC, QoL, activity, mood, and HbA1c; and their possible relationships. The primary purpose of this study was to determine the predictor effect of the occupational functioning factors of self-efficacy, LoC, QoL, activity, and mood on HbA1c. The secondary purpose is to determine the predictor effect of the occupational functioning factors of self-efficacy, LoC, QoL, mood, and HbA1c on activity. Occupational functioning factors were assessed using validated questionnaires. Seventy-six individuals with T2DM who are patients at a safety-net primary care facility participated in the study. Correlational analyses, factor analysis, and hierarchical regression were conducted. Factor analyses determined that the self-efficacy measure was composed of two constructs related to diet and T2DM management. Several occupational functioning factors were found to have significant and moderate to strong relationships. Self-efficacy for diet (-0.50, p < 0.001) and T2DM management (0.24, p < 0.05) explained 17.80% variance of HbA1c. Self-efficacy for T2DM management (0.31, p < 0.01) and LoC attributed to chance (-0.26, p < 0.05) explained 29.4% of the variance in activity. According to the study results, having a strong sense of self-efficacy for diet predicts better diabetes control in adults with T2DM and low SES. However, participants who perceived a greater ability to recognize when and how to care for T2DM-related problems (self-efficacy for T2DM management) experienced higher HbA1c levels. Adults with strong self-efficacy for T2DM management and low attribution of diabetes outcomes to chance engaged more frequently in activities (including domestic, work/leisure, and outdoor activities). Considering specific aspects of self-efficacy (i.e. diet and T2DM management) seems to be an important area of assessment in determining individuals at risk for poor diabetes control and reduced activity. Future research may explore how T2DM self-management behaviors relate to occupational functioning, and whether they predict HbA1c and activity. Future studies should also determine how circumstances associated with low SES, such as food insecurity and limited healthcare resources, impact the relationship among self-efficacy, LoC, activity, and diabetes control. The results from the present study may be used to inform assessment and intervention in experimental research with the goal to improve self-management behaviors and diabetes control in individuals with T2DM.