Développement et exploration des effets d’une intervention en activité physique offerte en télésanté pour les adultes ayant des symptômes persistants d’un traumatisme craniocérébral léger

L’activité physique est de plus en plus utilisée comme moyen d’intervention en réadaptation pour aider à gérer les symptômes persistants des adultes de 18 à 65 ans à la suite d’un traumatisme craniocérébral léger (TCCL). Toutefois, il n’existe pas d’intervention en activité physique destinée à être offerte en modalité de télésanté auprès des adultes qui ont des symptômes persistants de ce traumatisme depuis plus de trois mois et qui reçoivent des services de réadaptation. Cette thèse vise à répondre à ce besoin clinique. Ainsi, elle est structurée autour de deux objectifs distincts. Le premier objectif est de documenter les composantes essentielles des interventions existantes qui utilisent l’activité physique auprès des personnes ayant des symptômes persistants d’un TCCL. Le second objectif est de développer et d’évaluer la faisabilité, la sécurité, l’acceptabilité ainsi que d’explorer les effets sur la santé d’une intervention progressive de marche offerte en télésanté à des adultes ayant des symptômes persistants d’un TCCL. Quatre projets ont été réalisés pour atteindre ces objectifs. Le premier est une revue de la portée des écrits scientifiques et de la littérature grise au sujet des interventions en activité physique pour la réadaptation des personnes ayant subi un TCCL. Le deuxième est une étude transversale utilisant un sondage électronique auprès de professionnels travaillant dans 16 points de service offrant de la réadaptation spécialisée à ses usagers au Québec. Le troisième est une étude qualitative portant sur les perspectives d’experts cliniques et d’usagers d’une intervention en activité physique fournis par un de ces programmes. Les résultats de ces trois premiers projets ont généré les connaissances nécessaires pour informer la conception d’une intervention progressive de marche de huit semaines en télésanté pour cette clientèle. L’évaluation de la faisabilité, de la sécurité, de l’acceptabilité et l’exploration des effets sur la santé de cette nouvelle intervention font l’objet du quatrième projet. Vingt adultes ayant des symptômes persistants d’un TCCL ont participé à ce dernier projet qui utilise un devis mixte parallèle convergent. Puisque les résultats de l’évaluation de la nouvelle intervention en activité physique démontrent qu’elle est faisable, sécuritaire, acceptable et potentiellement bénéfique pour la santé des adultes ayant un TCCL, cette nouvelle intervention prometteuse devrait faire l’objet d’autres études pour déterminer son efficacité. Si elle s’avère efficace, elle pourrait ultimement être implantée en milieux cliniques. Les résultats des projets de cette thèse représentent un pas important vers une plus grande accessibilité aux services en activité physique pour les adultes avec des symptômes persistants d’un TCCL.Physical activity is increasingly being used as a rehabilitation intervention to help manage persistent symptoms of adults following a mild traumatic brain injury (mTBI). However, there is no physical activity intervention designed to be delivered via telehealth to adults receiving rehabilitation services who have persisting symptoms for more than three months following a mTBI. This thesis aims to address this clinical need. As such, it is structured around two distinct objectives. The first objective is to identify the essential components of existing physical activity interventions for people with persistent symptoms of mTBI. The second objective is to develop and evaluate the feasibility, safety, acceptability and explore the health effects of a progressive walking intervention offered via telehealth to adults with persistent symptoms of mTBI. Four projects were conducted to meet these objectives. The first is a scoping review of the scientific and grey literature on physical activity interventions for the rehabilitation of individuals with mTBI. The second is a cross-sectional study using an electronic survey of professionals working in 16 sites across Quebec offering specialized rehabilitation for people who have suffered an mTBI. The third is a qualitative study of the perspectives of clinical experts and users of a physical activity intervention provided by one of these programs. The results of these first three projects generated the knowledge necessary to inform the development of an eight-week progressive telehealth walking intervention for adults with mTBI symptoms. Evaluating the feasibility, safety, acceptability, and exploring the health effects of this new intervention is the focus of the fourth project. Twenty adults with persistent symptoms of mTBI participated in this latter project, which uses a parallel convergent mixed-method design. Since the results of the evaluation of the new physical activity intervention demonstrate that it is feasible, safe, acceptable, and potentially beneficial to the health of adults with mTBI, this promising new intervention should be further studied to determine its effectiveness. If proven effective, it could ultimately be implemented in clinical settings. The results of the projects within this thesis contribute significantly to increasing accessibility to physical activity services for adults with persistent symptoms of mTBI

Use of Drawing as a Communication Tool for alleviating digital anxiety: Exploring digital anxiety in smart mobile users

The ever-present smart mobile device has changed the everyday life of users in both positive and negative ways, and connects users’ lives online and offline. The existence of fewer gaps between online and offline worlds has shaped a new form of social relationship, new ways of thinking, and had sparked changes in smart mobile users’ behaviour. This thesis investigates the problem of digital anxiety among smart mobile users. The aim of this research project is to investigate how digital drawing affects digital anxiety in the smart mobile user. The research is based on the premise that drawing is a communication tool, and it investigates what types of digital drawing content help the smart mobile user relieve their digital anxiety. This research proposes guidelines for the use of drawing to help the smart mobile user who is experiencing digital anxiety. First, I established digital anxiety as a theoretical construct, and then conducted exploratory studies to investigate the practical problems faced by the smart mobile user. I determined the meaning of digital anxiety, and the precise symptoms experienced by the user suffering from digital anxiety, through a theoretical framework and an exploratory study. Lastly, I conducted empirical studies aimed at designing a method of measuring the level of digital anxiety. This method was tested with hundreds of participants, and was used for conducting the digital drawing experiment at the end of my research project. Overall, this thesis establishes the scope for determining digital anxiety, provides a method of quantifying digital anxiety, and demonstrates the use of digital drawing to relieve digital anxiety in the smart mobile user. I conclude that my research investigates the use of drawing as a communication tool for smart mobile users as a way of improving their memory, emotional wellbeing, and social relationships. I hope my research can serve as a guideline or a methodology in the design of an educational programme or high-tech industries on the basis of a cognition-mediated model

Exploring how women use the Alexander Technique: psycho-physical re-education in the postpartum

Background The postpartum phase is a transitional period of heightened vulnerability for women with potentially compromised self-care. Fatigue and musculo-skeletal tension can impact well-being. While postnatal depression (PND) has received much research attention, a systematic literature review on lumbo-pelvic pain (LPP) in the postpartum for the years 2008-2018 revealed only ten randomised controlled treatment trials. This suggests that some aspects of the postpartum are under-researched. The Alexander Technique (AT) is a long- established holistic self-management approach shown to be effective in managing psycho- physical tension issues and heightening self-efficacy and self-care.Research studies An interpretative phenomenological analysis explored how eight women with different amounts of AT-experience with babies under a year used the method in the postpartum. Findings suggest that participants used a variety of self-care strategies and skills to consciously modify their self-management via awareness. Using the AT led to a range of well-being benefits through a sense of agency regarding their self-care. Applying the AT while lying in semi-supine was important to their lives. In a second study, a small-scale mixed- methods feasibility study, 15 women without prior experience and with babies under a year were given access to an online self-care package based on AT principles. Eleven women completed the study. Participants were able to draw on aspects of the AT which positively impacted their self-care. This benefitted their well-being and changed their postpartum experience. Prioritising time for themselves to practice the AT while lying down in semi- supine was challenging. Implications/conclusions These studies are the first (known) studies exploring how women use the AT in the postpartum. The AT has significance for self- management, self-care and prioritising maternal needs for rest and addressing tension issues. Further research into the AT as an approach to supporting perinatal well-being is warranted

Qigong at Work: Where East Meets West

State of the Art Qigong is part of Traditional Chinese Medicine (TMC) and aims to balance body and mind. The roots of Qigong lie in China, where Confucian and Daoist scholars (500-400 B.C.) noted that one must learn to balance and relax one’s thoughts and emotions to avoid illness (Yang, 1997). In the Western world, Qigong is best known for its slow and coordinated movements. According to TCM, these movements will help regulate one’s ‘qi’, or life energy, through the body to improve the health and harmony of mind and body. During the practice of Qigong, one’s breathing, attention and movement are aligned. As such, Qigong is sometimes considered Mindfulness in movement (although there are many important differences). New perspectives / contributionsQigong has many positive outcomes on health and wellness. In both patient groups and healthy individuals, Qigong has been shown to improve psychological well-being, quality of life, immune function, balance and related risk-factors, and bone density (Jahnke et al., 2010). As such, Qigong offers a validated way to reduce the physical and mental activation that results from a person's work. While recent research has demonstrated how important it is to take short breaks at work, there is still little attention for Qigong exercises as a means to recover at work.Practical Implications In this presentation, we will explain and practice several Qigong exercises. These movements can be used at work (and at home) to recover from (hormonal) activation, ‘empty’ one’s head, and restore the body-mind balance. <br/

Physical well-being for women living with metastatic breast cancer

Despite established benefits of exercise for early breast cancer, its role for women with metastatic disease is unknown. The broad aims of this thesis were to determine the capacity and interest for physical activity in women with metastatic breast cancer, and to use this information to develop and pilot a physical activity intervention. An additional aim was to assess the accuracy of physical activity monitors. Physical function of the metastatic population was firstly compared to a healthy cohort. Although on average women with metastasis had lower levels of fitness than healthy women, some outperformed healthy counterparts. An interview with women with metastatic breast cancer revealed the majority were interested in physical activity, with strong preference for home-based activity. Based on programming preferences, the safety and feasibility of a partially-supervised home-based program of resistance training and walking was evaluated. Women were randomised to control or physical activity. Retention rates were excellent with no adverse events. Trends favouring the exercise group were observed for physical function and symptom burden. Within the program of research, it was identified there is limited data to support the use of physical activity monitors in women of similar age to those with metastatic disease. The accuracy of the Actigraph™, SenseWear® and ActiHeart® monitors in older women was therefore evaluated. At the group level, all three monitors had acceptable agreement for total energy expenditure. Based on accuracy and cost, the Actigraph™ was recommended as the preferred device. In conclusion, despite heterogeneity, most women with metastatic breast cancer are interested and capable of being physically active and a partially-supervised physical activity program is safe and may improve well-being for these women

IFPOC Symposium:Discovering antecedents and consequences of complex change recipients' reactions to organizational change.

IFPOC symposium: Discovering antecedents and consequences of complex change recipients' reactions to organizational change Chairs: Maria Vakola (Athens University of Economics and Business) &amp; Karen Van Dam (Open University) Discussant: Mel Fugate (American University, Washington, D.C) State of the art Organisations are required to continuously change and develop but there is a high failure rate associated with change implementation success. In the past two decades, change researchers have started to investigate change recipients' reactions to change recognizing the crucial role of these reactions for successful change. This symposium aims at identifying and discussing the complex processes that underlie the relationships among antecedents, reactions and outcomes associated with organizational change. New perspective / contributions This symposium consists of five studies that extend our knowledge in the field by (i) providing an analysis of change recipients' reactions going beyond the dichotomous approaches (acceptance or resistance) (ii) revealing understudied antecedents-reactions and reactions-consequences patterns and relationships (iii) shedding light on the role of contextual factors i.e team climate and individual factors i.e emotion regulation on the adaptation to change. This symposium is based on a combination of both quantitative (i.e diary, survey) and qualitative (i.e interviews) research methodology. Research / practical implications This symposium aims to increase our understanding of the complex processes associated with change recipients' reactions to change. Discovering how these reactions are created and what are their results may reveal important contingencies that can explain how positive organizational outcomes during times of change can be stimulated which is beneficial for both researchers and practitioners

An Online Mindfulness Intervention for Pain and Wellbeing

Chronic pain is a prevalent health care issue that needs to be better addressed. Mindfulness techniques are a promising method to help individuals reduce the negative impact of chronic pain. Research has also indicated the effectiveness of delivering psychological interventions online for a variety of health problems including chronic pain. This thesis aimed to investigate presenting a mindfulness intervention for chronic pain via the internet. An online mindfulness intervention was developed and initially trialed in post joint arthroplasty patients. The failure to recruit adequate numbers and high dropout rates led to a qualitative study, which aimed to explore the lived experiences of individuals who had undergone a joint arthroplasty including: their thoughts and attitudes surrounding their pain, online treatments, and mindfulness. A third study trialed the intervention on a different population who potentially experience chronic pain, limb amputees, to investigate the user experience of the intervention structure and online resources. Taken together these studies demonstrated that this online intervention could be used to successfully deliver mindfulness techniques for chronic pain conditions. Qualitative results demonstrated that psychological treatments are currently underutilized in individuals experiencing chronic pain prior to joint arthroplasty. Online interventions could be feasibly delivered to these individuals to help with their pain management

A mixed method investigation to develop a specialised occupational therapy theory based intervention manual for use with young people with emerging mental health issues

Background: Mental ill-health is a significant problem among young people, negatively affecting their quality of life with long-term consequences. A need exists for a broader range of interventions to address the determinants that affect mental health, early, when problems are emerging. Research suggests that the balance and nature of daily occupational choices can influence mental health in adults, but its influence on adolescent mental health has yet to be fully explored. Adolescence is a key period in developing occupational choice and learning how to balance daily occupations. To date there is a limited understanding of how adolescents choose and balance occupations, the relationship of occupational choices to mental health, and whether an intervention developed with young people can support individuals in their occupational choices to affect their mental health. Aim: This study aims to understand how young people use their time, their perception of this process in relation to their situational context and mental health, and to inform the co-development of an occupational therapy theory-based intervention for young people aged 16 to 17 years experiencing emerging mental health difficulties. Methodology: Informed by the Intervention Mapping framework, a pragmatic five-study, sequential, mixed method project was completed. Study one used a systematic scoping review method, to describe the academic literature reporting occupation-based interventions designed to improve the mental health of adolescents. Study two surveyed a cohort sample of typical 16- to 17-year-olds from two mainstream UK co-educational secondary schools, using time-use diaries and the SDQ questionnaires. Providing a sampling frame for a third study using a constructivist grounded theory method. The findings from the first three studies informed a structured consultation with occupational therapists and researchers using a consensus Delphi study, designed to prioritise emerging occupational determinants. Study five used the prioritised determinants to inform the content development of a manualised intervention, which underwent initial acceptability testing with young people. Results: The scoping review found three occupational therapy-based interventions targeting adolescent mental health, and a diverse range of thirty-six other occupation-based studies, using a wide breadth of approaches and outcome measures across a variety of settings. A school cohort sample of 134 students completed two surveys, providing an insight into the feasibility issues, recruitment rate, measure completion and potential for patterns and relationships. Drawing on the sample, six focus groups were conducted with twenty-seven young people, informing a theoretical model of occupational choice. The Delphi identified and prioritised eighty-nine determinants leading to the prioritisation of eighteen, informing the aims, objectives, and content of the intervention. The studies informed the construction of the eight-week ‘Activity-Time Use’ intervention manual including exploration and development of the occupational repertoire, balancing occupation, volitional aspects, the situational context, occupational choice, and the occupational self. The intervention review against six acceptability criteria suggested that the intervention required minor amendments but appeared acceptable to the target population. Conclusion: New knowledge of occupational determinants and their influence on occupational choices, in conjunction with occupational therapy and behaviour change theories, informed a manualised intervention, co-developed with young people and experts, which, following initial acceptability testing with young people, shows potential for further development and feasibility testing