Health Professions theses and dissertations
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Item Assistive technology evaluation in spinal cord diseases : facilitators and barriers(University of Missouri--Columbia, 2024) Rasmussen, Kial-Ann; Janes, William E.Spinal cord diseases (SCDs) are a set of conditions affecting the spinal cord that can cause functional deficits, disrupting people's identities, purpose, and dignity. Assistive technology (AT) is a vital intervention that enables many people with SCDs to participate in daily activities. Evaluation is the most critical phase in AT provision because all other phases are based on it. A three-round Delphi technique surveyed 18 expert AT providers to identify facilitators for and barriers to AT evaluation. In round one, participants generated ideas about relevant barriers and facilitators. These data were analyzed using conceptual content analysis to identify barriers and facilitators that became the content of the subsequent surveys. In rounds two and three, the participants ranked agreement with each item on a 7- point Likert scale and provided rank orders for the top five barriers and the top five facilitators. Participants also had the opportunity to provide qualitative feedback on each item. Stability was measured using Wilcoxon matched-pairs signed-ranks tests, and consensus was measured using the interquartile range. The final analysis identified 14 facilitators and 10 barriers that achieved both stability and consensus. The top barriers to AT evaluation are largely related to system problems related to the US healthcare landscape. The top facilitators for AT evaluation are largely related to centering the user in the evaluation process.Item A low-cost and movement-based tool for concussion diagnosis(University of Missouri--Columbia, 2024) Thomas, Jacob Matthew; Guess, TrentThe most used assessment for identifying sport related concussion (SRC), the Sport Concussion Assessment Tool (SCAT), is subjective and relies heavily on selfreported symptomology and visual assessment of neuromotor control. Concussion-related neuromotor control deficits can be quantified using instrumented assessment systems. This is useful, as measures of neuromotor control provide more objective diagnostic criteria and can be reassessed throughout recovery to guide the rehabilitation process. However, many currently available tools for instrumented assessment of neuromotor control are too large or expensive to be clinically feasible. This dissertation proposes a novel and clinically feasible tool, the Mizzou Pointof- Care Assessment System (MPASS), which is comprised of multiple low-cost devices to measure kinematics, kinetics, and reaction time during functional movement tasks. In this work, MPASS is used to assess differences between 20 collegiate athletes with acute concussion diagnosis (less than 2 weeks post-concussion) and 20 sport, position, and sexmatched healthy collegiate athletes. Differences in neuromotor control are assessed during static balance, walking, reaction time, and countermovement jump tasks. Results indicate MPASS can detect neuromotor control differences between these two groups. Further, a machine learning model using MPASS outcome measures discriminated between the two groups with an accuracy of 82.5 percent. These results demonstrate promise for MPASS as a clinically feasible tool and a diagnostic asset for providing objective assessment of neuromotor control following SRC.Item Occupational needs of chronic orthopedic trauma patients(University of Missouri--Columbia, 2024) Shea Lemoins, Samantha Nicole; Wolf, Timothy J.Millions of orthopedic trauma injuries occur yearly in the U.S., requiring surgical intervention and hospital admission. These orthopedic injuries are a leading cause of death and disability in the United States, with lower-extremity injuries being the leading cause of trauma hospitalizations among people under 65 (Archer et al., 2009; Jarman et al., 2021). Healthcare providers address the patient's immediate needs in the acute orthopedic setting, stabilizing the patient's medical status and addressing life-threatening issues in the event of trauma. Additionally, early ambulation and activity are prescribed in the orthopedic setting to combat common symptomology of orthopedic injury, including pain and infection. Emphasis on early activity and ambulation is rooted in evidence of decreased infection rates and length of stay (Castella et al., 2020; de Vries et al., 2012; Fukumoto et al., 2013; Kamel et al., 2003; Lei, 2021; Shakil-ur-Rehman, 2012). However, this emphasis on mobility is often done in a way that deemphasizes functional outcomes of other meaningful activities, e.g., participation in physical exercise, education, sexual activity, home management, social roles, and participation. While mobility is important for overall health, engagement in other meaningful activities, e.g., childcare and employment, is also central to health, well-being, and quality of life for adults with orthopedic injuries. Over 50 percent of adults with musculoskeletal conditions, which include orthopedic injuries, report decreased participation in activities of daily living (ADL; selfcare activities such as dressing, bathing, grooming, etc.), even with an emphasis on mobility and activity within the acute setting (Haider et al., 2020; Herrera-Escobar et al., 2018). These self-reported limitations in ADL are common and negatively impact one's quality of life. Basic activities of daily living are addressed in the acute care setting; however, not extensively and are not carried out post-acute due to the interruption of one's continuum of care, i.e., meeting basic OT goals in the acute setting with no referral to post-acute OT services. The impact of orthopedic injuries on mobility and ADL is well-documented in peer-reviewed literature. However, engagement in other meaningful tasks outside of ADL has yet to be explored and measured to investigate the potential benefits of prolonging the individual's care post-orthopedic event to address ongoing needs in the post-acute setting outside of mobility alone (Falvey, 2021; Gabbe et al., 2012). Given the known impact of orthopedic injuries on ADL participation, it is plausible that limitations also extend to other meaningful activities, e.g., instrumental activities of daily living (IADL) and social participation, which may impact community reintegration, health, and overall quality of life. Therefore, increased focus on exploring the prevalence of these other potential deficits, the need for continued care post-acute, and their impact on quality of life is warranted. Additionally, there is a need to explore the impact of the patient's biopsychosocial contexts and how one's mental health contributes to or is influenced by decreased occupational participation. Objective: (1) Explore chronic (>3 months) activity participation and mental health changes and quality of life in persons who experience a traumatic orthopedic injury; (2) Determine the feasibility and acceptability of the Cognitive Orientation to Daily Occupational Performance to enhance performance and participation in meaningful occupations through a feasibility study. Methodology: Aim 1 of this study was an exploratory cross-sectional study to evaluate the adult orthopedic lower-extremity patient's ongoing needs, including instrumental activities of daily living, social roles and participation, and perceived quality of life. The initial cross-sectional study was followed by a pilot study (Aim 2) to assess the feasibility and acceptability of the planned intervention.Item Self-management for chronic spinal cord injury : developing and implementing the spinal cord injury self-management program(University of Missouri--Columbia, 2024) Kraus, Bridget Greer; Wolf, Timothy J.Individuals with spinal cord injury (SCI) experience a higher rate of secondary health conditions (SHCs) compared to the general population. These SHCs lead to costly healthcare treatment, hospitalizations, poorer quality of life, decreased wellbeing, and even death. Self-management (SM) is a proven approach to help reduce the negative impacts of various chronic diseases, but formal SM programs have not been successful when trialed with the SCI population. This dissertation aimed to explore facilitators and barriers to SM behaviors and SM program involvement, understand the needs of persons with chronic SCI to successfully engage in SM, develop a SM program, and implement that program to assess feasibility, acceptability, estimate effect, and understand participants' experiences of engagement. This dissertation includes a three-study series. The first is a cross-sectional quantitative survey exploring chronic needs, facilitators, and barriers for people with SCI related to SM. The results of this survey informed the development of the Spinal Cord Injury Self-Management (SCISM) Program. In the second study, we piloted the SCISM Program and qualitatively evaluated the experiences of participants. And in the final study, we quantitively assessed the feasibility, acceptability, and the estimated effects of the SCISM Program. Overall, people with SCI want to be better at SM and prefer virtual programs that involve peers and address mental health. Participants felt that the SCISM Program fostered community, accountability, and spurred learning and habit changes. Lastly, participants agreed that the SCISM Program was feasible, acceptable, and produced moderate and large positive effects on the reduction of SHCs and goal attainment. The SCISM Program should be further evaluated through efficacy trials to understand its potential as a tailored SCI SM Program to reduce SHCs and improve quality of life for those with SCI.Item COVID-19 perspectives, prevention behavior, and vaccine intention among health workers in Sierra Leone : a low-resource context(University of Missouri--Columbia, 2023) David, Ifeolu John; Schatz, EnidThe COVID-19 pandemic profoundly impacted health workers, who were already affected by the 2014 Ebola outbreak in Sierra Leone. However, there is limited research on health workers' COVID-19 experiences in low- and middle-income countries (LMIC). In this study, 24 in-depth interviews were conducted with health workers from three regions in Sierra Leone. The study analysis focused on examining COVID-19 experiences, prevention behavior, and vaccine uptake among healthcare workers in Sierra Leone while exploring the applicability of the 5-C model in understanding their vaccine attitudes, intentions, and uptake. The study found that the COVID-19 pandemic had a significant negative impact on the emotional and mental well-being of health workers. Their experiences during the 2014 Ebola outbreak shaped their perceptions of COVID-19. Health workers' COVID-19 prevention practices were influenced by their perception of the severity of the virus and their familiarity with preventive measures. Vaccine uptake decisions were influenced by their perceptions of other vaccines and the desire to protect themselves and set examples. To improve COVID-19 prevention behavior among health workers, interventions should focus on overcoming barriers such as limited access to protective equipment and addressing disapproval and conspiracy theories through community engagement.