published_or_final_version / Medical Sciences / Master / Master of Medical Sciences

published_or_final_version / Social Work and Social Administration / Master / Master of Philosophy

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Over the past decade results from a series of research studies have contributed to the development and evaluation of the Arthritis Self-Management Program (ASMP), a volunteer-led patient education program for persons with arthritis. To date, these studies have primarily focussed on program effectiveness, process, implementation, and dissemination. In these studies self-efficacy was identified as an important construct contributing to the program's effectiveness, however, the exact relationship between self-efficacy and health outcomes has not been determined. In this dissertation research I investigate the evidence of a causal relationship between self-efficacy and three program outcomes (a decrease in depression, less pain, and a higher self-rating of overall health status), and attempt to determine the nature of that relationship. The research methodology involved the use of structural equation modeling (SEM) with two longitudinal samples, one (n=122) of 1991 ASMP participants in British Columbia, the other (n=189) of 1992 ASMP participants in Ontario. In the analysis self-efficacy was paired separately with depression, pain and perceived health status. The results of the SEM failed to confirm a dominant causal relationship from self-efficacy to depression, or to pain. This may indicate that these variables have a reciprocal or "spiral" relationship or that both sets of variables may be caused by factors not considered in the analysis. The results of the SEM between self-efficacy and perceived health status did, however, show that higher self-rated health status leads to higher self-efficacy at a later time. The data did not show statistical significance for other causal patterns among these variables. The findings suggest that self-efficacy may play a moderator role in the complex relationship involving individuals with arthritis, their behaviors, and health outcomes. As well, the findings have implications for health promotion planning and research in that they reinforce the complex interplay of psychological and behavioral variables (probably influenced by social variables) in programs which attempt to give individuals greater control over their health. The efficacy and effectiveness of the ASMP has been established in previous studies. This study in no way calls these into question. It does, however, suggest that the mechanism by which these effective outcomes are achieved warrants further investigation.

There is an absence of nursing studies that explore interventions to enhance psychological well-being for advanced Alzheimer patients. While sensory stimulation has been identified as a nursing intervention for dementia patients. Few studies reporting the effects of such interventions for patients with late stage dementia are available. The purpose of this study was to examine the effects of sensory stimulation activities on the psychological wellbeing of advanced Alzheimer patients. The conceptual model of “the good life” developed by Lawton (1983) provided the framework for this study. A descriptive design with a single group and pre-test post-test repeated measures analysis of variance was used for this study.A convenience sample of 15 patients from three Midwest long-term care facilities was observed for the effects of music. Touch and smell on psychological well-being as measured by the Discomfort Scale for Dementias of the Alzheimer Type (DS-DAT) (Hurley, Volicer, Hanrahan, Houde & Volicer, 1992). The rights of patients were protected at all times, with legal guardians receiving a written explanation of the study. Actual stimulation activities were conducted by Activity Directors or assistants from each facility.Paired t-test analysis of data revealed that DS-DAT scores for all three stimulation activities were significantly lower at <.05 level of significance than baseline DS-DAT scores. Lower DS-DAT scores included more positive affect behaviors and fewer negative affect behavior. A conclusion was drawn that the three sensory stimulation activities increased psychological well-being in the advanced Alzheimer patient sample. This study was significant because findings will support rationale for education of nursing staff in sensory stimulation procedures and provide information on evaluation of intervention outcomes for advanced Alzheimer patients. / School of Nursing

Pulmonary patients attending outpatient rehabilitation experience an enhanced ability for physical activity. The current study assessed and characterized domestic physical activity levels of new and maintenance patients to 1) compare physical activity levels of pulmonary patients on rehabilitation and non-rehabilitation days, 2) to identify factors that may contribute to low physical activity levels and 3) to compare step count levels between 2 activity monitors.Eighteen patients (age, 66.2 ± 8.8 y; FEV1, 52.1 ± 11.8%) participating in pulmonary rehabilitation wore an accelerometer and pedometer for 7 consecutive days. Patients new to pulmonary rehabilitation and maintenance patients participated in the study. Upon returning the monitors, patients returned a log sheet with the times monitors were put on and taken off each morning and night.The participants who completed the one week assessment had an average step count of 3,800 ± 1,651 steps/day, with a significant difference (p < .05) between rehabilitation days (5,468 ± 2,810 steps/day) and non-rehabilitation days (2,874 ± 1,490 steps/day). The number of minutes/day spent in moderate walking activities was also significant (p < .05) between rehabilitation (10.9 ± 16.0 minutes/day) and non-rehabilitation days (3.1 ± 5.8 minutes/day). Male waist circumference and occupational status were significantly correlated with low physical activity levels. The pedometer and accelerometer step count values were not significantly different from each other.Patients participating in pulmonary rehabilitation have significantly different activity levels between rehabilitation and non-rehabilitation days. To increase activity benefits, patients with COPD should increase activity levels on rehabilitation and non-rehabilitation days. Special consideration should be taken to help patients increase physical activity levels on non-rehabilitation days.(key words: chronic obstructive pulmonary disease, pedometer, accelerometer, pulmonary rehabilitation. / School of Physical Education, Sport, and Exercise Science

Purpose: The primary purpose of the study was to assess if physical activity (PA) habits change between the first and final week in a phase II cardiac rehabilitation (CR) population and to determine if the PA habits differ on CR days versus non-CR days. The secondary purpose of the study was to determine if there were differences between the two PA assessment methods. Methods: There were 41 male subjects and 16 female subjects that volunteered for the study; however only 25 male subjects (age: 64.7 ± 11.4 years, BMI: 28.8 ± 4.5 kg/m2) and 11 female subjects (age: 65.2 ± 13.3 years, BMI: 31.6 ± 4.0 kg/m2) were included in the data analyses after accounting for dropouts and subject's whose data did not meet validation criteria. Subjects were required to wear both of the activity devices (pedometer and accelerometer) during both the first and final week assessments. Steps/day, activity counts/day, inactive minutes/day, light minutes/day and walking minutes/day were assessed by the Actigraph Accelerometer. Results: There was no significant difference in step counts from 5,290 ± 1,561 steps/day during the first week assessment to 5,730 ± 1,447 steps/day during the final week assessment. However, significant differences were seen between rehabilitation and nonrehabilitation days step counts/day (6,503 ± 1,663 steps/day vs. 4,517 ± 1517 steps/day, respectively). Furthermore, there was a significant increase between the first and final weeks activity counts/day (144,185 ± 56,399 counts/day vs. 165,220 ± 51,892 counts/day respectively) and a significant increase between rehabilitation and non-rehabilitation days activity counts/day (175,692 ± 58,239 counts/day vs. 133,712 ± 46,139 counts/day respectively). Conclusions: The results of the study suggest that patients are performing significantly more activity on days they attend rehabilitation versus days they do not attend rehabilitation. Furthermore, activity counts/day increased between the first and final weeks of rehabilitation and were higher on CR days vs. non-CR days, which may be due to the progressive exercise prescription associated with Phase II CR. Therefore, it was concluded that Phase II CR successfully increases the intensity of PA on CR days and between the first and final week of CR.Key Words: Cardiac Rehabilitation, Coronary Artery Disease, Pedometer, Accelerometer. / School of Physical Education, Sport, and Exercise Science