All ETDs from UAB

Advisory Committee Chair

David Morris

Advisory Committee Members

Cecilia Graham

Sharon Shaw

Richard Shewchuk

Laura Vogtle

Document Type


Date of Award


Degree Name by School

Doctor of Science in Physical Therapy (DScPT) School of Health Professions


Background: Despite the strong evidence indicating the benefits of regular physical activity (PA) for health and functioning, individuals with a traumatic brain injury (TBI) do not engage in PA at levels consistent with public health recommendations. To eliminate the health disparities and promote PA in this population, the barriers unique to individuals with TBI should be identified by different stakeholders to establish effective health promotion programs that have sustainable outcomes. There is limited evidence to guide the development and delivery of effective PA interventions in the TBI field. Objectives: The specific aims of this study are: 1) to identify the most important barriers to PA as perceived by individuals with TBI; 2) to organize and prioritize the specific barriers to PA identified by individuals with TBI; 3) to develop a cognitive map to define dimensions and domains related to PA barriers following TBI and 4) to investigate the utility of the Nominal Group Technique (NGT), card sorting, Multidimensional Scaling (MDS) and Hierarchical Cluster Analysis (HCA) in physical therapy (PT) and TBI research. Design: Cross sectional study design Methods: Two separate NGT sessions were conducted with individuals with TBI to generate and prioritize a list of barriers to PA following TBI. Physical therapists (PTs) who treat patients with TBI organized and prioritized specific barriers to PA as perceived by individuals with TBI by a card sorting exercise and then rated the extent of their agreement of the barriers to PA on a 4-point Likert rating scale. MDS and HCA were used to generate the cognitive map. The main outcome measures were the number of PA barrier domains, their relative ranks, and the cognitive map. Results: Individuals with TBI (n=13) generated a total of 101 items; 33 items were selected for further prioritization. After combining similar results, 27 final items were used for the card sorting activity. The cognitive map organized concepts into five clusters, interpreted as (1) cognitive dysfunction, (2) sensori-motor dysfunction, (3) physio-medical limitations, (4) socio-physical limitations and (5) psychological limitations. The MDS two-dimensional solution demonstrated a good fit (RSQ =0.982; stress=0.018). Conclusions: A novel, combined approach allowed stakeholders' inputs to identify and organize domains related to PA barriers following TBI to guide development and delivery of PA models specific for individuals with TBI.