Ryan J. Walsh
Faculty Mentor: Shawn C. Roll PhD, OTR/L, RMSKS, FAOTA, FAIUM
Research Lab: Musculoskeletal Sonography and Occupational Performance (MSOP)
Workplace health promotion, participatory worker interventions, chronic disease prevention and management, implementation science, systems science.
Doctor of Philosophy (PhD)
in Rehabilitation and Participation Science
2023 | Washington University in St. Louis
Master of Science (MSc)
in Occupational Therapy
2018 | University of Illinois at Chicago
Master of Arts (MA)
in Curriculum and Instruction
2016 | University of Mississippi
Bachelor of Arts (BA)
2011 | University of South Florida
Walsh, R. J. (2023). Developing tools for the implementation and evaluation of participatory worker health promotion interventions [Doctoral dissertation, Washington University School of Medicine in St. Louis]. WUSM Theses and Dissertations, 39. https://doi.org/10.48765/13c8-t786 Show abstract
The chronic disease burden among American workers leads to substantial expenditures on healthcare, lost productivity at work, and reduced quality of life. Workers from communities of lower socioeconomic status (SES) shoulder a disproportionate burden of chronic diseases and costs. A promising strategy for addressing this population health burden is to develop and implement participatory worker health promotion interventions in workplaces. Part of this effort to develop and implement these programs entails improving the quality of evaluation tools and approaches. Thus, we completed a series of secondary analyses of a large participatory worker health promotion program trial called Working For You. Our first aim was to explore the structural and content validity of the Multifaceted Organizational Health Climate Assessment (MOHCA), a measure of organizational health climate not previously tested in low SES populations. We found that the MOCHA generates valid and reliable scores of participants’ perceived organizational health climate among a low SES population. Importantly, we found that in our lower SES worker population, model fit was better when the MOCHA organizational climate scale was divided into two subscales, including a novel organizational responsiveness subscale that may represent a unique facet of organizational health climate and inform other work. Our second aim was to develop a program logic model and demonstrate the utility of a new process measure of implementation quality called the Process Evaluation Rating Sheet (PERS) in our sample of workers of lower SES. Included in this aim was the demonstration that our Modified PERS demonstrated associations between implementation quality and program efficacy. Our third aim was to establish an association between upstream organizational health climate and perceived organizational support with downstream health behaviors, namely use of workplace health supports. We demonstrated an association between organizational health climate and use of workplace health supports, and found that use of instrumental and informational health supports differed by age and race. These aims together contributed evidence for the utility of current tools and approaches to evaluate and implement participatory worker health promotion programs among lower SES and minoritized workers.
Walsh, R. J., McKay, V. R., Hansen, P. E., Barco, P. P., Jones, K., Lee, Y., Patel, R. D., Chen, D., Heinemann, A. W., Lenze, E. J., & Wong, A. W. K. (2022). Using implementation science to guide the process of adapting a patient engagement intervention for inpatient spinal cord injury/disorder rehabilitation. Archives of Physical Medicine and Rehabilitation, 103(11), 2180-2188. https://doi.org/10.1016/j.apmr.2022.04.010 Show abstract
Objectives. This study aimed to describe the process of adapting an evidence-based patient engagement intervention, enhanced medical rehabilitation (E-MR), for inpatient spinal cord injury/disease (SCI/D) rehabilitation using an implementation science framework.
Design. We applied the collaborative intervention planning framework and included a community advisory board (CAB) in an intervention mapping process.
Setting. A rehabilitation hospital.
Participants. Stakeholders from inpatient SCI/D rehabilitation (N=7) serving as a CAB and working with the research team (N=7) to co-adapt E-MR.
Main Outcome Measures. Logic model and matrices of change used in CAB meetings to identify areas of intervention adaptation.
Results. The CAB and research team implemented adaptations to E-MR, including (1) identifying factors influencing patient engagement in SCI/D rehabilitation (e.g., therapist training); (2) revising intervention materials to meet SCI/D rehabilitation needs (e.g., modified personal goals interview and therapy trackers to match SCI needs); (3) incorporating E-MR into the rehabilitation hospital's operations (e.g., research team coordinated with CAB to store therapy trackers in the hospital system); and (4) retaining fidelity to the original intervention while best meeting the needs of SCI/D rehabilitation (e.g., maintained core E-MR principles while adapting).
Conclusions. This study demonstrated that structured processes guided by an implementation science framework can help researchers and clinicians identify adaptation targets and modify the E-MR program for inpatient SCI/D rehabilitation.
Lee, Y., Walsh, R. J., Fong, M. W. M., Sykora, M., Doering, M. M., & Wong, A. W. K. (2021). Heart rate variability as a biomarker of functional outcomes in persons with acquired brain injury: Systematic review and meta-analysis. Neuroscience & Biobehavioral Reviews, 131, 737-754. https://doi.org/10.1016/j.neubiorev.2021.10.004 Show abstract
This review aimed to quantify correlations between heart rate variability (HRV) and functional outcomes after acquired brain injury (ABI). We conducted a literature search from inception to January 2020 via electronic databases, using search terms with HRV, ABI, and functional outcomes. Meta-analyses included 16 studies with 906 persons with ABI. Results demonstrated significant associations: Low frequency (LF) (r = −0.28) and SDNN (r = −0.33) with neurological function; LF (r = −0.33), High frequency (HF) (r = −0.22), SDNN (r = −0.22), and RMSSD (r = −0.23) with emotional function; and LF (r = 0.34), HF (r = 0.41 to 0.43), SDNN (r = 0.43 to 0.51), and RMSSD (r = 0.46) with behavioral function. Results indicate that higher HRV is related to better neurological, emotional, and behavioral functions after ABI. In addition, persons with stroke showed lower HF (SMD = −0.50) and SDNN (SMD = −0.75) than healthy controls. The findings support the use of HRV as a biomarker to facilitate precise monitoring of post-ABI functions.
Walsh, R. J., Lee, J., Drasga, R. M., Leggett, C. S., Shapnick, H. M., & Kottorp, A. B. (2020). Everyday technology use and overall needed assistance to function in the home and community among urban older adults. Journal of Applied Gerontology, 39(10), 1115–1123. https://doi.org/10.1177/0733464819878620 Show abstract
Background. Older adults manage increasing numbers of everyday technologies to participate in home and community activities.
Purpose. We investigated how assessing use of everyday technologies enhanced predictions of overall needed assistance among urban older adults.
Method. We used a cross-sectional design to analyze responses from 114 participants completing the Everyday Technology Use Questionnaire, the Montreal Cognitive Assessment, and a sociodemographic questionnaire. We estimated overall needed assistance based on definitions in the Assessment of Motor and Process Skills. We created logistic regression models and receiver operator characteristic curves to analyze variables predicting overall needed assistance.
Findings. With high specificity and sensitivity, the Everyday Technology Use Questionnaire and the Montreal Cognitive Assessment were the strongest predictors of overall needed assistance.
Implications. Assessing everyday technology use enhanced predictions of overall needed assistance among urban older adults.
Wallcook, S., Malinowsky, C., Nygård, L., Charlesworth, G., Lee, J., Walsh, R., Gaber, S., & Kottorp, A. (2020). The perceived challenge of everyday technologies in Sweden, the United States and England: Exploring differential item functioning in the everyday technology use questionnaire. Scandinavian Journal of Occupational Therapy, 27(8), 554-566. https://doi.org/10.1080/11038128.2020.1723685 Show abstract
Background. The changing technological environment is reflected in regular updates made to the everyday technology (ET) use questionnaire (ETUQ). Newly added ETs may not present comparable challenges across countries and diagnoses.
Aims. To identify whether country context, or dementia diagnosis, impact ETs’ challenge level.
Material and methods. 315 older adults from three countries were included; Sweden (n = 73), United States (n = 114), England (n = 128), and had a confirmed diagnosis of mild dementia (n = 99) or no known cognitive impairment (n = 216). Differential Items Functioning (DIF) analysis was performed on 88 ETs included in the ETUQ by country and diagnosis. The impact of DIF was evaluated in a Differential Test Functioning (DTF) analysis.
Results. Nine items (10.2%) in the ETUQ showed statistically significant DIF between countries; five of which were public space ETs and none of which were information and communication technologies (ICTs). Three ICT items, and no others, showed significant DIF by diagnosis. The items’ DIF was shown to have no impact upon person measures of ability to use ET in the DTF.
Conclusions and significance. The utility of the ETUQ in occupational therapy practice and research internationally is highlighted through the stability of the challenge hierarchy and lack of impact on person measures.
Keywords. Age-friendly; daily life; dementia; dementia-friendly; information and communication technology; older adults; public space
Early, A., Walsh, R., & Douglas, B. (2019). The occupational therapy practitioner’s role in health promotion, injury prevention, and role participation for the older worker. WORK: A Journal of Prevention, Assessment & Rehabilitation, 63(2), 309-318. https://doi.org/10.3233/WOR-192924 Show abstract
As the population of individuals aged sixty-five and older continues to grow, the number of older individuals participating in the workforce rises alongside, with projections estimating as many as 72 million older workers by 2030. Due to this rapid increase in the number of older workers, new challenges to worker health and to health-related productivity will arise in the coming years. Occupational therapy practitioners are uniquely suited to address many of these challenges given their background in activity analysis, assessment and modification of job demands, health promotion and successful aging. However, there is need for continued research in this area to expand the role of the occupational therapy practitioner in prevention and return-to-work interventions focused on the older worker, and to advocate for the value occupational therapy practitioners can contribute to this field.
Keywords. work, gerontology, participation, prevention
Walsh, R., Drasga, R., Lee, J., Leggett, C., Shapnick, H., & Kottorp, A. (2018). Activity engagement and everyday technology use among older adults in an urban area. American Journal of Occupational Therapy, 72(4), 7204195040p1–7204195040p7. https://doi.org/10.5014/ajot.2018.031443 Show abstract
Objective. We investigated associations among activity engagement (AE), number of available and relevant everyday technologies, ability to use everyday technologies, and cognitive status among older adults in an urban area.
Method. This cross-sectional study included 110 participants and used three assessments: the Frenchay Activities Index to measure AE, the Everyday Technology Use Questionnaire to measure the number of and ability to use available and relevant everyday technologies, and the Montreal Cognitive Assessment to measure cognitive status. Data analyses used a one-way analysis of variance and a multiple linear regression model.
Results. The number of available and relevant everyday technologies was significantly different (p < .001) among groups that varied in level of AE. Ability to use everyday technologies did not significantly differ among groups. Cognitive status did not explain level of AE when the number of available and relevant everyday technologies was considered.
Conclusion. Increasing the accessibility of available and relevant everyday technologies among older adults in an urban area may increase AE.
Keywords. data analysis, montreal cognitive assessment, older adult, technology, linear regression