Stacey Schepens Niemiec PhD, OTR/L
Research Assistant Professor
Room: CHP 133
Phone: (323) 442-2069
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Research Assistant Professor Stacey Schepens Niemiec is an expert on the interrelationships between activity, mobility, chronic conditions and falls in older adults. She holds a K12 research award from the Rehabilitation Research Career Development program funded by the National Center for Medical Rehabilitation Research and the National Institute of Neurological Disorders. Dr. Schepens Niemiec completed postdoctoral fellowships at USC and the University of Michigan.
Postdoctoral Fellowship in Occupational Science and Occupational Therapy
University of Southern California
Postdoctoral Fellowship in Physical Medicine & Rehabilitation
University of Michigan
Doctor of Philosophy (PhD) in Instructional Technology
Wayne State University
Master of Science (MS) in Occupational Therapy
Wayne State University
Bachelor of Science (BS) in Occupational Therapy
Wayne State University
Clark, F. A., Blanchard, J., Sleight, A., Cogan, A., Eallonardo, L., Florindez, L., Gleason, S., Heymann, R., Hill, V., Holden, A., Jackson, J. M., Mandel, D. R., Murphy, M., Proffitt, R., Niemiec, S. S., Vigen, C., & Zemke, R. (2015). Lifestyle redesign: The intervention tested in the USC Well Elderly Studies (2nd ed.). Bethesda, MD: The American Occupational Therapy Association, Inc. Link to full text Abstract →
Reorganized, expanded, and updated, this new edition of the award-winning Lifestyle Redesign gives practical guidance in this preventative occupational therapy program for independent-living older adults. The work integrates the concept of the USC's landmark Well Elderly Studies, which determined that preventive occupational therapy greatly enhances the health and quality of life of independent-living older adults.
Twelve modules, including those on longevity, stress, home safety and navigating health care, illustrate how to incorporate the program into practice. Includes a flash drive with program handouts.
Juang, C., Knight, B. G., Carlson, M., Schepens Niemiec, S. L., Vigen, C., & Clark, F. (2017). Understanding the mechanisms of change in a lifestyle intervention for older adults. The Gerontologist, Advance online publication. https://dx.doi.org/10.1093/geront/gnw152. Link to full text Abstract →
PURPOSE OF THE STUDY: This study investigated the mechanisms of change underlying an activity-based lifestyle intervention, an occupational therapy program aimed at promoting healthy habits, and routines in older adults. We examined two activity-relevant factors as potential mediators linking the intervention to reduced symptoms of depression: activity frequency and global perceptions of activity significance. Social connections and perceived control were assessed to understand how activity-related factors relate to reduced symptoms of depression.
DESIGN AND METHODS: The sample consisted of 460 multiethnic community-dwelling older adults aged 60-95 years. Participants were randomly assigned to a 6-month lifestyle redesign intervention (n = 232) or a no-treatment control (n = 228) condition. After the 6-month period, 360 individuals completed post-testing. Latent change score models were used to represent changes from baseline over the experimental interval. Structural equation models were applied to examine the indirect effects of the intervention on reduced depressive symptoms.
RESULTS: The results demonstrated significant indirect effects from intervention receipt to decreased depressive symptoms via increased activity frequency and activity significance. Higher activity frequency was linked to fewer depressive symptoms via heightened social connections, whereas increased activity significance was associated with fewer depressive symptoms via enhanced perceived control.
IMPLICATIONS: The results support basic principles of occupational therapy by highlighting important mediating roles of activity frequency and activity significance in reducing depressive symptoms. Understanding of these change mechanisms can help optimize activity-centered interventions to reduce depressive symptoms.
Murphy, S. L., Kratz, A. L., & Schepens Niemiec, S. L. (2017). Assessing fatigability in the lab and in daily life in older adults with osteoarthritis using perceived, performance, and ecological measures. The Journals of Gerontology Series A: Biological Science and Medical Sciences, 72, 115-120. http://dx.doi.org/10.1093/gerona/glw173. Link to full text Abstract →
BACKGROUND: Fatigue in older adults is associated with functional decline and reduced participation in daily life; however, it is not well characterized. Examining fatigue within activity performance, or "fatigability," is a recommended approach to begin to understand fatigue and its underlying mechanisms. This study examined the construct validity of lab-based measures of fatigability and compared these measures with fatigability in daily life (termed ecological fatigability).
METHODS: Participants with osteoarthritis and fatigue (n = 163) underwent laboratory assessments, completed questionnaires, and wore accelerometers for 7 days while tracking symptoms and behaviors. Lab-based fatigability measures were quantified using the 6-minute walk test. Perceived fatigability was assessed by asking participants before and after the test to report: (i) fatigue severity and (ii) perceived exertion. Performance fatigability was calculated using change in walking speed divided by total distance walked. Ecological fatigability was calculated from the 7-day assessment in which fatigue severity was reported five times a day and physical activity was continuously measured. Additional ecological measures (eg, self-pacing) were examined.
RESULTS: Lab-based perceived and performance fatigability measures were highly inter-correlated, moderately correlated with gait speed and metabolic measures, and weakly correlated with physical activity. Although ecological fatigability was weakly correlated with lab-based measures, participants with high fatigability on lab-based measures demonstrated more self-pacing behaviors than participants with low fatigability.
CONCLUSION: Lab-based fatigability measures are related to physical capacity measured both in the lab and daily life. Lab-based fatigability measures provide important information regarding daily life fatigability useful for future intervention development.
Schepens Niemiec, S. L., Carlson, M., Martinez, J., Guzman, L., Mahajan, A., & Clark, F. (2015). Developing occupation-based preventive programs for late-middle-aged Latino patients in safety-net health systems. American Journal of Occupational Therapy, 69, 6906240010p1-6906240010p11. http://dx.doi.org/10.5014/ajot.2015.015958. Link to full text Abstract →
Latino adults between ages 50 and 60 yr are at high risk for developing chronic conditions that can lead to early disability. We conducted a qualitative pilot study with 11 Latinos in this demographic group to develop a foundational schema for the design of health promotion programs that could be implemented by occupational therapy practitioners in primary care settings for this population. One-on-one interviews addressing routines and activities, health management, and health care utilization were conducted, audiotaped, and transcribed. Results of a content analysis of the qualitative data revealed the following six domains of most concern: Weight Management; Disease Management; Mental Health and Well-Being; Personal Finances; Family, Friends, and Community; and Stress Management. A typology of perceived health-actualizing strategies was derived for each domain. This schema can be used by occupational therapy practitioners to inform the development of health-promotion lifestyle interventions designed specifically for late-middle-aged Latinos.
Mallinson, T., Schepens Niemiec, S. L., Carlson, M., Leland, N., Vigen, C., Blanchard, J., & Clark, F. (2014). Development and validation of the activity significance personal evaluation (ASPEn) scale. Australian Occupational Therapy Journal, 61, 384-393. http://dx.doi.org/10.1111/1440-1630.12155. Link to full text Abstract →
BACKGROUND/AIM: Engagement in desired occupations can promote health and wellbeing in older adults. Assessments of engagement often measure frequency, amount or importance of specific activities. This study aimed to develop a scale to measure older adults' evaluation of the extent to which their everyday activities are contributing to their health and wellness.
METHODS: Eighteen items, each scored with a seven-point rating scale, were initially developed by content experts, covering perceptions of how daily activities contribute to physical and mental health, as well as satisfaction and activity participation in the last six months. Rasch analysis methods were used to refine the scale using the pencil and paper responses of 460 community-living older adults.
RESULTS: Initial Rasch analysis indicated three unlabelled rating scale categories were seldom used, reducing measurement precision. Five items were conceptually different by misfit statistics and principal component analysis. Subsequently, those items were removed and the number of rating scale steps reduced to 4. The remaining 13-item, 4-step scale, termed the Activity Significance Personal Evaluation (ASPEn), formed a unidimensional hierarchy with good fit statistics and targeting. Person separation reliability (2.7) and internal consistency (.91) indicated the tool is appropriate for individual person measurement. Relative validity indicated equivalence between Rasch measures and total raw scores.
CONCLUSIONS: ASPEn is a brief, easily administered assessment of older adults' perception of the contribution of everyday activities to personal health and wellness. ASPEn may facilitate occupational therapy practice by enabling clinicians to assess change in meaning of an older adult's activity over time.
Leland, N. E., Marcione, N., Schepens Niemiec, S. L., Kelkar, K., & Fogelberg, D. (2014). What is occupational therapy’s role in addressing sleep problems among older adults?. OTJR: Occupation, Participation and Health, 34, 141-149. http://dx.doi.org/10.3928/15394492-20140513-01. Link to full text Abstract →
Sleep problems, prevalent among older adults, are associated with poor outcomes and high health care costs. In 2008, rest and sleep became its own area of occupation in the American Occupational Therapy Association’s Occupational Therapy Practice Framework. The current scoping review examined a broad context of sleep research to highlight efficacious interventions for older adults that fall within the occupational therapy scope of practice and present an agenda for research and practice. Four sleep intervention areas clearly aligned with the practice framework, including cognitive behavioral therapy for insomnia, physical activity, and multicomponent interventions. Occupational therapy is primed to address sleep problems by targeting the context and environment, performance patterns, and limited engagement in evening activities that may contribute to poor sleep. Occupational therapy researchers and clinicians need to work collaboratively to establish the evidence base for occupation-centered sleep interventions to improve the health and quality of life of older adults.
Murphy, S., & Schepens Niemiec, S. (2014). Aging, fatigue, and fatigability: Implications for occupational and physical therapists. Current Geriatrics Reports, 3(3), 135-141. http://dx.doi.org/10.1007/s13670-014-0093-6. Link to full text Abstract →
Fatigue is a common yet complex symptom among older adults that is linked to interference with daily activity performance and reduced quality of life. Although fatigue is not routinely evaluated or treated by health care providers, rehabilitation can play a key role in addressing fatigue in older adults. This paper provides a review about fatigue in older adults and discusses current assessment and treatment options for occupational and physical therapists.
Kratz, A. L., Schepens, S. L., & Murphy, S. L. (2013). Effects of cognitive task demands on subsequent symptoms and activity in adults with symptomatic osteoarthritis. American Journal of Occupational Therapy, 67, 683-691. http://dx.doi.org/10.5014/ajot.2013.008540. Link to full text Abstract →
OBJECTIVE: Adults with osteoarthritis (OA) experience fatigue in daily life that is negatively related to physical activity; however, it is unclear how task demands affect fatigue and occupational performance. We examined effects of a cognitive task on subsequent symptoms and activity.
METHOD: Adults with knee or hip OA completed a standardized cognitive task during a lab visit. Objective physical activity and symptoms were tracked during two home-monitoring periods (i.e., 4-day period before and 5-day period after the lab visit). Multilevel modeling was used to compare pretask with posttask fatigue, pain, and activity levels.
RESULTS: Fatigue increased and pain decreased for 2 days after performing the lab task. The authors found no pretask to posttask changes in activity levels. At posttask, daily fatigue and activity patterns changed relative to baseline.
CONCLUSION: For adults with symptomatic OA, cognitive task demands may be an important contributor to fatigue and pain.
Schepens, S. L., Sen, A., Painter, J. A., & Murphy, S. L. (2012). Relationship between fall-related efficacy and activity engagement in community-dwelling older adults: A meta-analytic review. American Journal of Occupational Therapy, 66, 137-148. http://dx.doi.org/10.5014/ajot.2012.001156. Link to full text Abstract →
OBJECTIVE: Fear of falling can lead to restricted activity, but little is known about how this fear affects different aspects of people's lives. This study examined the relationship between fall-related efficacy (i.e., confidence or belief in one's ability to perform activities without losing balance or falling) and activity and participation.
METHOD: We conducted a meta-analysis of studies comparing community-dwelling older adults' fall-related efficacy to measures of activity or participation.
RESULTS: An examination of 20 cross-sectional and prospective studies found a strong positive relationship between fall-related efficacy and activity (r = .53; 95% CI [.47, .58]). An insufficient number of studies examining fall-related efficacy and participation were available for analysis.
CONCLUSION: Low fall-related efficacy may be an important barrier to occupational engagement for many older adults and warrants careful consideration by occupational therapists. Future research should explore interventions that target fall-related efficacy and examine their effects on activity performance and engagement.
Schepens, S. L., Braun, M. E., & Murphy, S. L. (2012). Effect of tailored activity pacing on self-perceived joint stiffness in adults with knee or hip osteoarthritis [Brief report]. American Journal of Occupational Therapy, 66, 363-367. http://dx.doi.org/10.5014/ajot.2010.004036. Link to full text Abstract →
OBJECTIVE: We examined the effects of a tailored activity-pacing intervention on self-perceived joint stiffness in adults with osteoarthritis (OA).
METHOD: Thirty-two adults with hip or knee OA were randomized to a tailored or general activity-pacing intervention. Participants' symptoms and physical activity over 5 days were used to tailor activity pacing. The outcome was self-perceived joint stiffness measured at baseline, 4 wk, and 10 wk. A linear mixed regression model was used.
RESULTS: The tailored group significantly improved in stiffness compared with the general group over time. We found a significantly different linear trend between groups (Time × Group, p = .046) in which the tailored group had decreasing stiffness over the three time points, denoting continued improvement. The general group's stiffness improved from baseline to 4 wk but returned to baseline levels at 10 wk.
CONCLUSION: Tailoring activity pacing may be effective in sustaining improvements in self-perceived joint stiffness in adults with OA.
Schepens, S. L., Kratz, A. L., & Murphy, S. L. (2012). Fatigability in osteoarthritis: Effects of an activity bout on subsequent symptoms and activity. The Journals of Gerontology Series A: Biological Science and Medical Sciences, 67, 1114-1120. http://dx.doi.org/10.1093/gerona/gls076. Link to full text Abstract →
BACKGROUND: Older adults with osteoarthritis (OA) are more likely to experience increased fatigue following bouts of physical activity than those without OA. The highly "fatigable" nature of this population is problematic as it has been linked to OA severity and decreased function. This study examined the effects of engaging in standardized lab-based physical tasks on subsequent fatigue, pain, and activity in older adults with OA.
METHODS: Thirty-five older adults with OA performed lab-based tasks (sweeping, grocery shopping, and walking) in 15-minute circuits until they felt too fatigued to continue. Fatigue and pain were self-reported (0-10 scale) following each circuit and at set intervals during a 4-day baseline (pretask) and a 5-day posttask home period. Activity was tracked via wrist-worn accelerometer. Multilevel modeling was used to examine levels and patterns of fatigue, pain, and activity across the study period.
RESULTS: The lab-based tasks altered subsequent levels and patterns of fatigue and activity but had no effects on pain. Compared with baseline, on the day of the lab-based tasks, fatigue was higher and more stable, and activity was significantly lower and dropped steadily toward evening. Activity returned to baseline levels and patterns by the day following the lab-based tasks while fatigue was lower for 3 days following task performance.
CONCLUSIONS: Among older adults with OA, a bout of standardized physical activity resulted in increased fatigue and reduced activity, but effects were short-lived. Future studies will need to identify factors that differentiate people who are particularly fatigable in order to target interventions.
Goldberg, A., & Schepens, S. L. (2011). Measurement error and minimum detectable change in 4-meter gait speed in older adults. Aging Clinical and Experimental Research, 23, 406-412. Link to full text Abstract →
BACKGROUND AND AIMS: Gait speed is a commonly-used assessment and outcomes measure in geriatric clinical and research settings. Although relative reliability of usual gait speed has been well studied in community- dwelling older adults, less emphasis has been placed on a measure of absolute reliability (the standard error of measurement [SEM]), and on an associated clinically relevant index of real change in gait speed, minimum detectable change (MDC). The purpose of this study was to quantify measurement error and MDC for usual gait speed over 4 meters in community-dwelling older adults ambulating at intermediate and fast speeds.
METHODS: Community-dwelling older adults ambulating at intermediate gait speed (IGS), (n=15, mean age 74.2 yrs) and fast gait speed (FGS), (n=15, mean age 72.1) were included in this study. Participants performed two trials of gait speed over a distance of 4 meters. SEM and MDC at the 95% confidence level (MDC95) were computed for the IGS and FGS groups.
RESULTS: Mean gait speed was 85.4 cm/s (IGS) and 129.9 cm/s (FGS). Measurement error (<5% of mean gait speed) and minimum detectable change (<13% of mean gait speed) were low in both groups. MDC95 was computed as 10.8 cm/s and 14.4 cm/s for the IGS and FGS groups, respectively.
CONCLUSIONS: To be considered real change beyond the bounds of measurement error, change in 4-meter gait speed should exceed 10.8 cm/s (for intermediate speed ambulators) or 14.4 cm/s (for fast speed ambulators). Low measurement error in assessing 4-meter gait speed in community-dwelling older adults suggests that gait speed assessed over short distances has excellent reproducibility across trials. Low minimum change values suggest that 4-meter gait speed may be responsive and sensitive to change.
Schepens, S. L., Goldberg, A., & Wallace, M. (2010). The short version of the Activities-Specific Balance Confidence (ABC) Scale: Its validity, reliability, and relationship to balance impairment and falls in older adults. Archives of Gerontology and Geriatrics, 51, 9-12. http://dx.doi.org/10.1016/j.archger.2009.06.003. Link to full text Abstract →
A shortened version of the ABC 16-item scale (ABC-16), the ABC-6, has been proposed as an alternative balance confidence measure. We investigated whether the ABC-6 is a valid and reliable measure of balance confidence and examined its relationship to balance impairment and falls in older adults. Thirty-five community-dwelling older adults completed the ABC-16, including the 6 questions of the ABC-6. They also completed the following clinical balance tests: unipedal stance time (UST), functional reach (FR), Timed Up and Go (TUG), and maximum step length (MSL). Participants reported 12-month falls history. Balance confidence on the ABC-6 was significantly lower than on the ABC-16, however scores were highly correlated. Fallers reported lower balance confidence than non-fallers as measured by the ABC-6 scale, but confidence did not differ between the groups with the ABC-16. The ABC-6 significantly correlated with all balance tests assessed and number of falls. The ABC-16 significantly correlated with all balance tests assessed, but not with number of falls. Test-retest reliability for the ABC-16 and ABC-6 was good to excellent. The ABC-6 is a valid and reliable measure of balance confidence in community-dwelling older adults, and shows stronger relationships to falls than does the ABC-16. The ABC-6 may be a more useful balance confidence assessment tool than the ABC-16.
Goldberg, A., Schepens, S. L., Feely, S. M., Garbern, J. Y., Miller, L. J., Siskind, C. E., & Conti, G. E. (2010). Deficits in stepping response time are associated with impairments in balance and mobility in people with Huntington disease. Journal of the Neurological Sciences, 298, 91-95. http://dx.doi.org/10.1016/j.jns.2010.08.002. Link to full text Abstract →
Huntington disease (HD) is a disorder characterized by chorea, dystonia, bradykinesia, cognitive decline and psychiatric comorbidities. Balance and gait impairments, as well as falls, are common manifestations of the disease. The importance of compensatory rapid stepping to maintain equilibrium in older adults is established, yet little is known of the role of stepping response times (SRTs) in balance control in people with HD. SRTs and commonly-used clinical measures of balance and mobility were evaluated in fourteen symptomatic participants with HD, and nine controls at a university mobility research laboratory. Relative and absolute reliability, as well as minimal detectable change in SRT were quantified in the HD participants. HD participants exhibited slower SRTs and poorer dynamic balance, mobility and motor performance than controls. HD participants also reported lower balance confidence than controls. Deficits in SRT were associated with low balance confidence and impairments on clinical measures of balance, mobility, and motor performance in HD participants. Measures of relative and absolute reliability indicate that SRT is reliable and reproducible across trials in people with HD. A moderately low percent minimal detectable change suggests that SRT appears sensitive to detecting real change in people with HD. SRT is impaired in people with HD and may be a valid and objective marker of disease progression.
Goldberg, A., Schepens, S. L., & Wallace, M. (2010). Concurrent validity and reliability of the Maximum Step Length test in older adults. Journal of Geriatric Physical Therapy, 33(3), 122-127. http://dx.doi.org/10.1097/JPT.0b013e3181eda302. Link to full text Abstract →
PURPOSE: This study assessed concurrent validity of the Maximum Step Length (MSL) test as a measure of falls risk and balance-impairment for community-dwelling older adults. A secondary purpose was to determine intra- and interrater reliability and standard error of measurement of the MSL test.
METHODS: Thirty-five community-dwelling adults aged 60 or older provided a 12-month falls history. Functional measures included the MSL test, Single Limb Stance Time, Functional Reach test, Timed Up and Go test, and a test of trunk position sense. Pearson correlation coefficient, intraclass correlation coefficient (a coefficient of relative reliability), and standard error of measurement (a measure of absolute reliability) were calculated as indices of concurrent validity and reliability of the MSL test. Minimal detectable change was also calculated; this represents actual change beyond that of measurement error or random variation in stepping performance.
RESULTS: Correlations between MSL score and clinical balance measures and self-reported number of falls in the past 12 months ranged from fair to good. Same-day and 1-month intrarater test-retest reliability of the MSL test was excellent. Same-day interrater reliability between 2 raters was also excellent. Measurement error of the MSL test was low. Minimal detectable change for the MSL test at the 95% confidence level was 7.32 inches.
CONCLUSION: The MSL test appears to be a valid and reliable measure of balance-impairment and falls risk in older adults. Clinicians should consider incorporating the MSL test into their battery of falls risk assessment tools. Use of this test as a screening measure may reduce the incidence of falls in community-dwelling older adults. Real change in performance requires a difference of more than 7.32 inches between trials; differences less than this should be interpreted as being due to measurement error or random variation in stepping performance.
Conti, G. E., & Schepens, S. L. (2009). Changes in hemiplegic grasp following distributed repetitive intervention: A case series. Occupational Therapy International, 16, 204-217. http://dx.doi.org/10.1002/oti.276. Link to full text Abstract →
The purpose of this pilot study was to investigate the efficacy of a distributed model of repetitive and focused intervention on grasp force, and clinical and functional hand measures in persons with chronic hemiplegia and limited hand recovery from self-reported stroke. A case series design was used. Focused repetitive unilateral and bilateral interventions were provided in a distributed manner (three times a week for 6 weeks) to three persons with upper limb hemiplegia of more than 1 year. Data from instrumented grasp force, and clinical and functional measures were obtained at weeks 0, 3, 6 and 9. Each participant improved in at least one measure of grasp force, as well as in clinical skill and function. All participants improved in the quality of handwriting. Improved outcomes remained above baseline levels following 3 weeks of non-intervention. The findings are compatible with current evidence of adaptive cortical plasticity following increased repetition. The findings show that, for these three persons, distributed repetitive practice was sufficient to effect change. Localization by cerebral area affected is not possible, nor is it possible to parse the effectiveness of any component of the intervention. A larger group study is warranted to determine whether similar results may be found for other persons with chronic hemiplegia. Future studies should incorporate kinematic handwriting analysis and a greater range of functional tasks.