Please use this identifier to cite or link to this item:
|Title:||Optimising Musculoskeletal Health: Focus on Exercise Therapy and Psychosocial Interventions|
|Keywords:||Therapeutic Exercise;Psychosocial Intervention;Adherence;Musculoskeletal;Behavior;Web-based Interventions|
|Abstract:||Musculoskeletal disorders are a considerable burden to the individual and the society at large. Therapeutic exercise and psychosocial interventions are longer-term therapies for relieving pain, improving function and outcomes after musculoskeletal disorders, and for enabling patients to manage their conditions. Healthcare professionals such as physiotherapists and occupational therapists widely use therapeutic exercise as part of a single or complex intervention. However, adherence to supervised or home exercise remains low among patients with musculoskeletal disorders. Understanding the barriers and facilitators of exercise adherence has the potential to improve the delivery of exercise programs and the design of interventions to improve adherence. Similarly, psychosocial interventions are recommended as a supplement to exercise therapy for the management of prolonged pain and disability after musculoskeletal disorders. Several psychosocial factors have been linked to prolonged pain and disability after hand injuries. However, while clinicians believe they have a role in managing psychosocial problems in hand therapy, barriers such as limited access and lack of knowledge pose a challenge to delivering psychosocial interventions. Current evidence shows that online-based coping skill programs provide cost-effective and accessible options for delivering psychosocial interventions in musculoskeletal care. However, there is a dearth of literature on the design, development, and implementation of online-based psychosocial interventions in hand therapy. This thesis includes four manuscripts with three overarching objectives. The first objective was to synthesize the qualitative evidence on barriers and facilitators of therapeutic exercise towards closing the gaps in adherence literature. The second objective was to understand the beliefs, attitude, knowledge and practice behavior of clinicians with regarding to managing psychosocial problems in hand therapy. The third objective was to provide a report on the design and development of a web-based coping skill training program for psychosocial problems specific to hand therapy. The fundamental aim is to provide toolkits that can be used to increase the knowledge and clinical practice behavior of physiotherapists and occupational therapists to optimize musculoskeletal health using therapeutic exercise and psychosocial interventions. The second and third manuscripts are a protocol and completed meta-synthesis of qualitative literature outlining the factors influencing adherence to therapeutic exercise in individuals with musculoskeletal disorders from the perspective of patients and healthcare professionals. We identified numerous factors influencing adherence to therapeutic exercise, which were organized according to the World Health Organization (WHO) multidimensional adherence framework. Based on the meta-ethnography line of argument, interpretation of identified themes: personal and lifestyle characteristics, health status and illness perception, nature of the program, health system, and social/environmental resources, showed that while some factors interact, others could be conceptualized as being on a continuum. These findings expanded the original model introduced by the WHO. The fourth manuscript presents a qualitative descriptive study designed to understand the knowledge, attitude, beliefs, and practice behavior of hand therapists practicing in Ontario with regards to psychosocial problems. The findings informed by the Theoretical Domains Framework provide insights into factors influencing the decision of clinicians to assess and manage psychosocial interventions in hand therapy. Addressing factors such as knowledge, attitudes, and beliefs about psychosocial factors at the individual and organizational level has the potential to increase the capacity of clinicians to adopt a clinical practice behavior that promotes the assessment and management of psychosocial problems in hand therapy. The fifth manuscript is a mixed-methods study describing the design, development, and usability testing of Hand Therapy Online COping Skills (HOCOS) training online program to support hand therapists in the management of psychosocial problems. Using a three-step process that involved needs assessment, heuristic testing, and user testing, we sought feedback from Information and Communication Technology experts and clinicians in hand therapy to develop the HOCOS prototype using iterative cycles. The results revealed heuristic violations and usability related to task performance, navigation, design aesthetics, content, functionality, and features and desire for future use. All violations were corrected in the final prototype, and participants expressed a high degree of satisfaction with using the final prototype in practice. The next phase of HOCOS design would require user testing by patients with hand injuries.|
|Appears in Collections:||Open Access Dissertations and Theses|
Files in This Item:
|Babatunde_Folarin_O_2020_March_PhD_Rehebilitation_Science.pdf||2.86 MB||Adobe PDF||View/Open|
Items in MacSphere are protected by copyright, with all rights reserved, unless otherwise indicated.