Catherine Backman

Introduction: Inflammatory arthritis (IA) can limit everyday occupations, yet engaging in valued occupations is believed to promote health. This dissertation explores the relationship between occupation and health in adults with IA and a healthy comparison (HC) group, and the impact of public health restrictions on occupation and health during the first wave of the COVID-19 pandemic. Methods: A cross-sectional design was employed with participants recruited through community advertising. Occupations were elicited and occupational characteristics measured using Personal Projects Analysis; and aspects of health assessed using the SF-36 Health Survey (Physical and Mental Component Scores), Occupational Balance Questionnaire, Satisfaction with Life Scale, and telomere length (from dried blood spots). During the first “stay home” phase of the pandemic, all self-report measures were repeated online to compare with pre-pandemic ratings. Data were analyzed with content analyses, Chi-square tests, t-tests, linear regressions, and ANCOVAs. Results: 143 adults (76 HC, 67 IA) participated in the cross-sectional study; a subset of 71 (37 HC, 34 IA) participated in the pandemic before-and-after study. Participants engaged in six major categories of occupations related to health, leisure, home, community, relationships, and life planning. These categories did not differ between IA and HC groups. The IA group rated occupational characteristics higher than the HC group, with between-group differences in three of the 19 characteristics after controlling for demographic covariates. Different occupational characteristics were associated with physical health for the two groups; among the more salient characteristics were the perceived Difficulty, Importance, Stress, Progress, Others’ view, and Control attributed to one’s occupations. Occupational balance was higher in the HC group than the IA group, but not statistically significant when adjusted for physical health. There was no between-group difference in telomere length, or associations between occupational characteristics and telomere length. Mental health scores decreased compared to pre-pandemic ratings in the HC group only, and the IA group engaged in fewer social occupations than the HC group. Conclusion: These findings help fill a gap in the literature with a nuanced understanding of the association between occupation and health, which may inform recommendations on the kinds of occupations likely to promote health.

View record

Low back injury (LBI) is associated with altered core muscle function and studies have validated the role of these deep stabilizing muscles in prevention and treatment of back pain and injury. No previous studies have evaluated the impact of surgery such as abdominal hysterectomy (AH) on these deep stabilizers and the potential for increased risk of LBI following surgery. The aims of this research were to investigate a link between AH and LBI first with administrative health data analysis and then clinically by measuring muscle thickness with rehabilitation ultrasound imaging (RUSI) before and after surgery.A retrospective cohort of 37,057 female frontline healthcare workers, a population at high risk of occupational LBI due to the heavy nature of their work, was extracted. Exclusion of 27,987 due to a history of back pain or injury, prior hysterectomy or failure to meet the provincial residency requirement of five years left a sample size of 9,070. Within this research sample, 634 (7%) had undergone hysterectomy, a prevalence much lower than the published value of 30%. Statistical analysis revealed no increased risk of LBI in this cohort of healthcare workers without prior history of LBI. Clinical RUSI assessment of the core muscles would investigate if this was because there was no change in the muscle function post-surgically. Validity and reliability of RUSI to evaluate core muscle function have been established for intersessions up to two weeks. A group of women not undergoing AH was used to establish reliability over intervals of four, eight and twelve weeks. Intraclass correlations (ICC₃,₁) ranging from 0.75 to 0.90 for measured muscle thickness in the deep abdominal and lumbar muscles exceeded the minimum standard of 0.70 for research purposes. Percent change measures did not meet this standard. A prospective descriptive case series involving nine individuals undergoing AH found post-surgical decreases in measurements of the deep abdominal stabilizers most notably in the participants with a history of previous low back pain/injury or who were obese. These findings support continued investigation of the relationship between AH and LBI including individuals with risk factors such as prior low back pain/injury and/or obesity.

View record

BACKGROUND: As the social justice movement has lessened the gender gap in occupational participation, the subject of balance in life is receiving enormous attention. A growing body of literature suggests that imbalance can increase individual’s health risks. Although various theories about balance have been developed, it remains elusive as a concept. Understanding how people experience and perceive balance is essential to conceptualizing balance and promoting individual and societal health. OBJECTIVE: To better understand the ways in which men and women in dual-income couples with at least one preschool-aged child perceive and experience balance in everyday life. METHODS: The study was primarily informed by a phenomenographic approach. Fifteen heterosexual, dual-income couples living with at least one child under six years old were recruited from a metropolitan area. Each partner in each couple individually participated in two semi-structured interviews. The first interview was designed to explore participants’ overall experiences of daily life, while the second interview aimed to elicit their experiences and perceptions of balance. Phenomenographic and critical discourse analyses were applied to the interview data. The quality of the findings was assured by peer-debriefing, reflexivity, and the verification of transferability. RESULTS: Two key conceptions of balance were identified: managing life and participating in a mix of occupations. In elucidating these conceptions, parents associated the former with meeting collective needs and the latter with meeting individual needs. Trying to simultaneously satisfy these two conceptions/constructions of balance created tension. Managing life reinforced parents’ intensive commitment to parenting and led to balance, but it limited their engagement in personal occupations, which led to imbalance. Conversely, participating in a mix of occupations allowed parents to meet their own needs and was associated with balance, but as it reduced the time they spent with their families, it led to imbalance. CONCLUSION: Employed parents with young children live with two competing conceptions/constructions of balance, which can create tension and affect health. Developing health care and employment policies that help parents to attain a greater sense of balance by harmonizing collective needs of the family and their personal needs may mediate this tension.

View record

Background: Research from numerous fields of science is providing strong evidence demonstrating that the conditions young children live within mould their health and developmental trajectories. While science and policy call for nurturing environments to preserve developmental potential, the current global reality is that war and civil unrest displace millions of children from their homes, desecrating their social supports and environments. Furthermore, little research has drawn attention to the experience of the youngest children during and after war. Objective: To holistically document the environments of young children (0 to 3 years) before, during and after a 20-year war and mass internal displacement in northern Uganda in order to deepen current understandings, address research gaps and inform interventions. Methods: This applied ethnography used purposive sampling in three sites of the Amuru District over a one-year period. Interviews, focus groups, longitudinal case studies, participant observation, document review, and photo documentation with young children, caregivers (siblings, parents, and others) and community leaders explored multiple views on early childhood health and development. Results: War and displacement seriously thwarted caregivers from employing their extensive knowledge and traditional care practices that protected and nurtured their young children in rural agrarian communities. Young children were exposed to numerous, cumulative factors that previous research has documented as risks to well-being and long-term developmental potential. This risk persisted well into post-conflict resettlement. However, despite dire conditions, there were also factors that acted to protect children and examples of children’s healthy functioning. Conclusions: Disrupted social structures and environments appear to influence young children's health and developmental futures in all phases of war, displacement and resettlement. Results suggest that the efforts by state and the international community to mitigate risk and promote positive development for vulnerable young children were insufficient and incommensurate with the degree of evidence supporting the critical importance of the early years. Future efforts must build on local culture and address the most relevant and pressing needs of children in close collaboration with families and communities. The rebuilding of healthy, peaceful societies depends upon the preservation of the immense human capital and boundless potential within children.

View record

Total hip (THA) and total knee arthroplasty (TKA) are cost-effective interventions for advanced osteoarthritis (OA) of the knee and hip. With the rapidly growing number of these procedures performed annually in Canada and the United States, greater attention needs to be directed to identify rehabilitation practices that optimize outcomes and minimize cost. Currently, there is no consensus on rehabilitation best practice and no evidence-based clinical practice guidelines to inform clinical decision-making on post-acute rehabilitation following THA and TKA. A multi-phase, mixed-method project integrated stakeholder perspectives, research evidence and expert opinion to develop best practice recommendations for THA and TKA rehabilitation. Chapter 2 involved 11 focus groups and eight interviews to identify key themes related from North American patients and health care professionals on rehabilitation practices and outcomes. Chapters 3-4 are Cochrane systematic reviews examining the strength of the evidence for post-acute physiotherapy after THA and TKA. Chapter 5-6 involved two parallel Delphi surveys with consumers, clinicians and researchers to develop consensus on a range of rehabilitation topics to inform best practice for THA and TKA rehabilitation. Chapter 2: Six key themes emerged relating to communication, patient expectations, patient attitude, forms of support, barriers to recovery, and diversity of outcomes. Chapters 3-4: Systematic reviews of THA (n=8) and TKA (n=7) trials revealed limited, low to high quality evidence with mixed findings for various forms of post-acute physiotherapy on pain, function and health-related quality of life. Trial heterogeneity prevented meta-analysis. Chapters 5-6: Consensus (80% agreement) was reached on the need for post-acute rehabilitation, types of interventions, rehabilitation providers, treatment settings, outcomes and outcome measurement. Consensus was not reached regarding timing and dosage of rehabilitation. Sub-group analysis revealed few differences comparing responses by profession, primary role and country. This thesis has taken important first steps in identifying appropriate rehabilitation interventions and health care resources to optimize individuals’ activity, participation and health-related quality of life after THA and TKA. Further, it highlights the need for more high quality research to address the knowledge gaps and inform policy on this important and understudied aspect of arthroplasty surgery.

View record