Linda Li

Professor

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Graduate Student Supervision

Doctoral Student Supervision

Dissertations completed in 2010 or later are listed below. Please note that there is a 6-12 month delay to add the latest dissertations.

Self-managing with physical activity wearables: emerging ethical issues from the perspectives of persons living with arthritis (2021)

Background: Using wearables to self-monitor physical activity is a promising approach to support self-management among persons with arthritis. Little is known, however, about ethical issues (benefits and downsides) that may be experienced by persons with arthritis when using a wearable. Better understanding of these experiences is needed if wearable technology is to be incorporated in arthritis self-management in ways that are ethically aware.Objective: To develop understanding of the perspectives of persons with arthritis on their use of a physical activity wearable in their everyday self-management. Methods: The thesis consists of 3 projects, involving: 1) a meta-synthesis of qualitative evidence that included an exhaustive search of 5 electronic databases and a thematic synthesis of eligible articles; 2) a secondary analysis of qualitative interviews with 21 participants with knee osteoarthritis, following their use of a wearable as part of a physical activity counselling intervention study involving a physiotherapist (PT); 3) a social constructivist application of grounded theory to conduct and analyze qualitative interviews with 14 participants with rheumatoid arthritis, following their use of a wearable as part of a physical activity counselling intervention study involving a PT. Each project draws on a relational ethics lens to explore benefits and downsides identified in participants’ perspectives. Findings: Across projects, participants conveyed 1) how using a wearable expanded and/or challenged their capability of making autonomous choices to be more physically active or not; 2) how using a wearable enhanced and/or threatened to undermine mutual trustworthiness in their relationship with the PT; 3) how using a wearable helped or challenged them in preserving a valued sense of self, in which independence and productivity play a role. Using a relational ethics lens drew attention to how participants’ experiences intertwined with desires to maintain a positive moral identity shaped by the context in which they live. Conclusions: The thesis contributes empirical evidence of relational ethics issues to sparse literature on how persons with arthritis experience using a physical activity wearable positively and/or negatively. It brings to light salient ethical issues pertaining to relational autonomy experienced in participants’ relationships with themselves and health professionals when using a wearable.

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Master's Student Supervision

Theses completed in 2010 or later are listed below. Please note that there is a 6-12 month delay to add the latest theses.

Feasibility of the KneeOA mobile application for managing knee osteoarthritis (2023)

Osteoarthritis (OA) is a leading contributor to pain, disability, and lower quality of life. Though guidelines recommend physical activity as first-line treatment for people with OA, few engage in adequate levels of physical activity. Conducting a literature review on the use of self-directed digital tools to support physical activity in people with OA revealed only a small subset of tools have improved physical activity participation. Given the need for a self-directed digital tool designed to improve physical activity in people with knee OA symptoms, the KneeOA app was developed alongside arthritis experts and patient partners. The KneeOA app has features supported by behavioral change techniques such as goal setting, action planning, self-monitoring, and being compatible with a Fitbit® activity tracker to promote physical activity participation. This feasibility study evaluated the practicality and implementation of the KneeOA app and Fitbit® based intervention using a single-group pre-post design. Participants used KneeOA with a Fitbit Inspire 2™ for 12 weeks, being encouraged to use the app at least once a week. Questionnaires about pain, OA disease status, as well as physical activity habits and behaviour were completed at 2 time points and a subset of participants completed end of study interviews. This thesis presents the preliminary analysis of the 16 participants who consented between March and September 2022. Though preliminary results suggest 5 out of 6 feasibility benchmarks were not met, practicality could be improved by increasing the frequency of self-monitoring prompts. Though there were no statistical changes, there were trends towards improvements in physical activity habits and behaviour, pain, knee-related symptoms, and activities of daily living, but deterioration in knee-related sports and quality of life measures. Usage data suggested that participants used the app on average for 3 minutes and 11 seconds during each session. Preliminary findings from the interviews suggest that the intervention has been generally acceptable with room for improvements. The feasibility study must be completed to make conclusions on feasibility benchmarks and other trends of findings. Participants will be continued to be purposively sampled and interviewed using a modified guide for the remainder of the study.

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The association between the number of behavior change techniques used in physical therapist counselling and self-management outcomes in people with rheumatoid arthritis (2023)

Background: Self-management is crucial to disease management of rheumatoid arthritis (RA) to reduce symptom burden, improve quality of life, and enhance physical function. To facilitate behavior change, physiotherapists can apply behavior change techniques (BCTs) to promote self-management and physical activity. A 40-item taxonomy can be used to identify BCTs in interventions targeting physical activity participation. The number of BCTs used can vary and no optimal number has been found when designing interventions. Objective: To explore the association between the number of BCTs in the initial physical therapy counselling session and participant’s change in self-management ability and physical activity participation.Methods: This study was an exploratory, secondary analysis nested within a randomised controlled trial investigating the effectiveness of a multifaceted counselling program on improving self-management ability of people with RA. Participants completed a 26-week intervention, in which they had seven physical activity counselling sessions with a Brief Action Planning-trained physiotherapist. During counselling, the physiotherapists helped participants set activity goals. Self-management ability and physical activity participation were assessed before and after the intervention using the Patient Activation Measure and a multisensory device, respectively. Participants were eligible for the secondary analysis if: 1) they consented to having their first counselling session recorded, 2) they completed both pre- and post- intervention assessments measuring at least one of the outcome variables. The first counselling session was coded for BCTs using the 40-item taxonomy. A heat map was developed to visualise the BCTs used in counselling. Correlation and univariate regression were conducted to explore the association between the number of BCTs in the initial session and change in self-management outcomes.Results: Of the 40 BCTs, 18 were identified in the sample of counselling sessions. There was no significant relationship between the number of BCTs and the self-management outcomes. A potential threshold of 8 or more BCTs was explored, and no relationship was found with the outcome variables.Conclusion: The number of BCTs used does not seem to influence the effectiveness of an intervention on self-management outcomes of people with RA.

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A pilot randomized trial of a novel intervention to promote physical activity in people with knee osteoarthritis: protocol and baseline analysis from the TRACK-OA study (2016)

Objectives: (1) Develop a protocol for a pilot randomized controlled trial (RCT) of a novel physical activity (PA) counseling intervention to increase bouted moderate-to-vigorous physical activity (MVPA) time (bout ≥ 10 minutes at ≥ 3 Metabolic Equivalents [METs]) and decrease bouted sedentary time (bout > 20 minutes at ≤ 1.5 METs) for people with knee osteoarthritis (OA), and (2) conduct a secondary baseline analysis to assess the relationships between a measure of patient engagement and bouted MVPA time, as well as bouted sedentary time. Methods: A protocol for a pilot RCT was developed and published. Feasibility objectives related to study processes, resources, management, and effectiveness were set. Inclusion criteria were a diagnosis of knee OA or having experienced four weeks of knee symptoms during the last year, no inflammatory arthritis, and no contra-indications to being active. Patient engagement was measured with the Partners in Health Scale (PIH). MVPA and sedentary time were measured with the BodyMedia SenseWear Mini (SW). Knee OA status was assessed with the Knee injury and OA Outcome Score. Bivariate and stepwise regression analyses were performed to estimate the relationship between PIH and bouted MVPA/sedentary time. Results: Participants (female = 28, male = 6), were aged [mean (standard deviation [SD])] 55.5 (8.6) years, with a BMI of 27.2 (4.7) kg/m². The sample indicated a PIH of 24.4 (16.4), 53.9 (62.4) minutes of daily bouted MVPA, and 508.9 (178.9) minutes of bouted sedentary time. Regression analysis [b (standard error [SE]) where b indicates estimated regression coefficient] found log-transformed bouted MVPA was not associated with PIH, but was negatively associated with age, b = -0.042 (0.018; p
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Understanding the Experiences of Rural Community-Dwelling Older Adults in Using a New DVD-Delivered Otago Exercise Program on British Columbia (2014)

INTRODUCTION: The home-based Otago Exercise Program (OEP) has been shown to reduce the occurrence of falls in community-dwelling seniors. A new OEP DVD was recently developed to be delivered to people living in rural communities with minimal coaching by a physical therapist (PT). This thesis aimed to: 1) understand older adults’ experiences in using the DVD-delivered OEP, and 2) explore barriers and facilitators to implementing the DVD-delivered OEP from the participants’ perspectives. METHODS: Thirty-two rural community-dwelling older adults (≥75 years old) who participated in a six-month DVD-delivered OEP study were invited to participate in this qualitative study. Two small group interviews were initially conducted to explore the breadth of participants’ experiences with the program. These were followed by semi-structured individual interviews to gain an in-depth understanding of these experiences. An inductive constant comparison analysis involving coding of transcripts was performed. To ensure methodological rigour, field notes, journaling and an audit trail were maintained and peer-review took place.RESULTS: Five participants partook in group interviews and 16 in individual interviews. Three themes emerged. Theme 1, ‘The OEP DVD: Useful training tool but in need of more pep’, reflected participants’ experiences that the DVD provided important guidance at program onset, but was too slow and low-energy for longer-term use. Theme 2, ‘Providing greater control over one’s exercise regimen, but sometimes life gets in the way of staying active’, described participants’ appreciation of the program’s flexibility, but personal health concerns and everyday lives imposed challenges for adhering to the program. Theme 3, ‘Social creatures: Wanting greater human connection during exercise’, described how some participants desired further social interactions for enhancing motivation and sense of guidance. CONCLUSION: PTs prescribing the OEP should inform participants of the option to use the manual whenever they feel they have taken full advantage of the DVD and to perform the program with friends and family. The importance of exercise even when living with health problems should be raised at program onset, and methods of integrating the program with everyday activities should be promoted.

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Cumulative Occupational Physical Load as a Risk Factor for Knee Osteoarthritis in Mena and Women (2012)

Objective: To determine the association between cumulative occupational physical load (COPL) to the knee and the presence of symptomatic osteoarthritis (SOA) and magnetic resonance imaging–defined osteoarthritis (MRI-OA).Methods: Cross-sectional analyses of symptomatic and asymptomatic (n=327) individuals were performed. Inclusion criteria for the symptomatic participants were: 1) having pain, aching, or discomfort in or around the knee on most days of the month at any time in the past; 2) having any pain, aching, or discomfort in or around the knee in the past 12 months. Asymptomatic participants responded “no” to both knee pain questions. COPL was calculated using a self-reported level of activity (five levels) and participation in knee bending/kneeling tasks (three levels) for each occupation held. SOA was defined by the Kellgren Lawrence x-ray grade ≥2, plus the presence of knee pain, as defined by the study inclusion pain criteria. MRI-OA was defined using the criteria specified by Hunter and associates. Logistic regression analyses, adjusted with population weights, were used to examine the associations between COPL (reference group=the lowest COPL quarter) and the presence of SOA and MRI-OA, respectively, after controlling for age, female sex, body mass index, and two-way interactions.Results: Participants (women=167, men=160) were on average 58.5 (SD=11.0) years old with a BMI of 26.3 (SD=4.7). Of those, 102 (31.2%) participants had SOA. For SOA, a monotonic statistically significant relationship was found between COPL 4 (highest quarter; odds ratio (OR)=8.16; 95% CI=1.89, 35.27) and COPL 3 (OR=5.73; 95% CI=1.36, 24.12) versus COPL 1. For MRI-OA, monotonic and statistically significant associations were found in COPL 4 versus 1 (OR=9.54; 95% CI=2.65, 34.27); COPL 3 versus 1 (OR=9.04; 95% CI=2.65, 30.88); COPL 2 versus 1 (OR=7.18; 95% CI=2.17, 23.70). Conclusion: COPL is a significant risk factor for knee OA. Dose response relationships between COPL and both SOA and MRI-OA were found. This study provides new insight into the role of occupation in knee OA, although the results should be interpreted cautiously due to limitations associated with the cross-sectional study design.

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Understanding Rural Rehabilitation Practice: Perspectives of Occupational Therapists and Physical Therapists in British Columbia (2011)

Background:Providing rehabilitation services to meet the needs of rural residents and address poor health outcomes requires overcoming the challenges of geography, limited referral options and a shortage of occupational therapists (OTs) and physical therapists (PTs). However, little is known about how rehabilitation professionals in rural areas enact their practice to meet and overcome these challenges. To address this gap and contribute to enhancing health for rural residents, this research constructed an understanding of rural rehabilitation practice from the perspectives of OTs and PTs in rural British Columbia (BC). Methods: This qualitative study employed a purposive sample of OTs and PTs in rural communities (population
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