Date Presented 04/05/19
Primary Author and Speaker: Laura Swink
Contributing Authors: Karen Atler, Tara Klinedinst, Christine Fruhauf, Brett Fling, Arlene Schmid
The purpose of this study was to manualize a fall-risk self-management (SM) program for people with Parkinson disease (PwP). Through 4 steps we adapted the Merging Yoga and Occupational Therapy (MY-OT) program with a fall-risk SM program for people with chronic stroke to meet the specific needs of PwP. Our purpose was to develop and adapt the Merging Yoga and Occupational Therapy for Parkinson Disease (MY-OT for PD) manuals prior to feasibility and pilot testing. We used a pragmatic qualitative design. Participants for the focus group (FG) were recruited from a convenience sample of a yoga for PD program. To be included in the FG participants had a self-reported diagnosis of PD, were at least 18, and understood English. Participants for the expert interviews were recruited as a purposive sample based on research or practice area expertise.
METHOD: In the process of creating manuals (facilitator and participant) we used 4 steps: a comprehensive literature review of theory/content, a 7-person FG of people with PD, 9 expert interviews of researchers or clinicians with expertise in the field of PD or fall-risk SM, and revisions based on deductive themes. First, we fulfilled a needs assessment through completion of a comprehensive literature review on OT interventions for PwP, falls and fall-risk SM programs for PwP, yoga for PwP, and general SM programming and theoretical underpinnings. We then adapted the MY-OT manuals and created MY-OT for PD preliminary manuals. Then, we conducted a 1-hour FG with 7 PwP. The group was led by an occupational therapist and followed a semi-structured guideline designed to assess needs and potential changes of the MY-OT for PD preliminary program. To obtain more varied feedback prior to finalizing the manuals, we interviewed 9 experts.
RESULTS: The FG and interviews were audio-recorded and transcribed verbatim. We used the following primary (and secondary) codes to guide qualitative data analysis: guiding model fall risk factors (biological, behavioral, environmental, socioeconomic), practicality (space, time, ability to combine with yoga), and program need (PD specific program, fall-risk specific program). Through an iterative consensus building process further secondary codes emerged from data that were not initially coded. We then categorized all of the coded data into the following deductive themes to guide revisions: revisions to the guiding model, revisions to content, and revisions to practicality of delivery. Examples of revisions to the guiding model included: addition of mental functions (including executive functions, anxiety, depression, and impulsivity) to biological fall risk, addition of fatigue related to managing daily activities, addition of weather and small animals to environmental fall risk, addition of access to PD specialists to socioeconomic fall risk. Examples of revisions to program content included: addition of freezing of gait tip sheet, addition of tips to reduce multi-tasking, addition of information related to medication scheduling and on/off times, addition of content about snow/ice adaptations. Examples of revisions to practicality of delivery included: separation of the participants into two groups to decrease group size, and the implementation of a scholarship program to pay for four people to attend yoga.
CONCLUSION: When adapting an intervention for a different population it is important to complete multi-step review to ensure appropriate content, delivery, and theoretical basis of the program.
IMPACT STATEMENT: This study is the first step in creating a manualized OT fall risk SM program for PwP. This qualitative study led to the creation of evidence-based manuals prior to the implementation of the community-based MY-OT for PD program.
References
Schmid, A. A., Van Puymbroeck, M., Portz, J. D., Atler, K. E., & Fruhauf, C. A. (2016). Merging Yoga and Occupational Therapy (MY-OT): A feasibility and pilot study. Complement Ther Med, 28, 44-49.
Pyatak, E. A., Carandang, K., & Davis, S. (2015). Developing a Manualized Occupational Therapy Diabetes Management Intervention Resilient, Empowered, Active Living With Diabetes. OTJR: occupation, participation and health, 35(3), 187-194.
Savin-Baden, M., & Major, C. H. (2013). Qualitative research: The essential guide to theory and practice.
