Introduction
Stress and emotional exhaustion have been shown to negatively impact academic performance, engagement, and satisfaction. (Kindel & Raforth, 2019; Williams et al., 2018). Students in doctoral physical therapy (DPT) programs experience immense stress due to intense expectations and course loads throughout the curriculum. As a result, this has taken a heavy and longstanding toll on the psychosocial and emotional well-being of DPT students. This added burden may reduce students’ engagement, satisfaction, and compromise learning proficiency, intellectual health, and academic performance (Bergmann et al., 2019). The negative effects may extend to diminish students’ capacities to provide compassionate care to patients and families (Veigh et al., 2021).
This stress and emotional exhaustion were further intensified during the COVID-19 pandemic and persisted during the post-pandemic. Balakrishnan et al. explored the mental health impact of the pandemic on physical and occupational therapy students. Using the Depression Anxiety Stress Scales (DASS), the data collected from 90 students showed a significant increase in stress, anxiety, and depression during the pandemic (Balakrishnan et al., 2022).
Meditation and DPT Student Learning
The rigor, stress, and isolation of a Doctor of Physical Therapy (DPT) program that DPT students experienced during the pandemic may have negatively impacted their learning. Meditation may be an effective way to address this stress. Studies on the effectiveness of meditation for physical therapy students have shown significant results (Chambers et al., 2016; Kindel & Raforth, 2019). Many studies have shown the mental, spiritual, and psychological benefits of meditation, including stress reduction (Chambers et al., 2016; Hwang et al., 2018; Kindel & Raforth, 2019). Among these studies, Chambers et al. showed that meditation significantly reduced blood pressure and perceived stress based on subjective questionnaires among DPT students. (Chambers et al., 2016). In a study conducted on physical therapy students, blood pressure (BP) and salvatory cortisol levels along with three questionnaires were used to demonstrate the changes based on meditation practice (Chambers et al., 2016). The result of the study demonstrated a significant improvement in well-being in BP and perceived stress reduction. Furthermore, Kindel and Rafoth included mindfulness meditation into the DPT curriculum induced significant improvements in students’ perceived stress and mindfulness measured by the Perceived Stress Scale (PSS) and Five Factor Mindfulness Questionnaire (FFMQ), respectively (Kindel & Raforth, 2019).
In-Person versus Online Interventions
Students of the post-pandemic era have evolved to exploit virtual learning. Most meditation interventions and research on DPT students have required in-person measurements (Chambers et al., 2016; Kindel & Raforth, 2019). While students’ ability to manage stress and maintain wellness was of utmost importance during the pandemic, the in-person meditation programs became unsustainable when classes pivoted online. Before the pandemic, studies examining online mindfulness meditation in college programs found positive impacts (Beauchemin et al., 2018; Zollars et al., 2019). Therefore, there is a significant relevance and surging need to develop and deliver a sustainable online meditation program. Such a program may continue to provide the known benefits of online mindfulness meditation to DPT students’ well-being when needed most.
Purpose
The purpose of this study was to provide a six-week sustainable online meditation program for DPT students to investigate the possible impact on their well-being measured by the Perceived Wellness Survey PWS. We hypothesized that the intervention group will show improvement in their perceived wellness measured by the PWS questionnaire results.
Methods
Setting and Sampling
The inclusion criteria for this study were the eighty-eight first or second-year DPT students enrolled in the West Coast University (WCU) DPT Program at the time of the study. There were no exclusion criteria. Upon receiving the study information via email from the principal investigator (PI) to all first and second-year students, thirty-two students volunteered for the study. To randomly assign students to intervention and control groups, the study PI gave each volunteer student a number. The numbers were then assigned to either the intervention or control group by another investigator. A convenience sample size of thirty-two students was registered for this clinical trial study; sixteen students were randomly assigned to the study group and sixteen to the control group.
Procedure
This study was approved by the West Coast University IRB committee (IRB #:12022021). A week prior to the start, the participants met with the PI for an online introduction to the study. In this meeting, the PI explained the required days, times, and the PWS questionnaire. Consent forms were provided to students after signing up for the study by email. Subsequently, participants completed the PWS and submitted to the study investigators by email.
The study group met with the PI over Zoom for 25 minutes three times a week. The PI started each session by practicing 10 diaphragmatic breathing and then asked the participants to close their eyes and listen to the guided meditation for 20 minutes. The guided meditation was focused on relaxation and body awareness. At the end of each session, the PI asked students to write three things they are grateful for. The sessions were conducted for 6 consecutive weeks, three times a week, a total of 18 sessions (Table 1). The PI monitored the participants to ensure participation during the sessions. The control group did not receive any intervention.
Upon completion of six weeks, the participants in the intervention and control groups completed the PWS again and emailed the completed forms to the investigators. Upon the study’s completion, the same program was offered to the control group.
Measures
The Perceived Wellness Survey (PWS) is an evidence-based questionnaire measuring the well-being of a person in six components (Adams et al., 1997; Bart et al., 2018; Bhattacharya et al., 2023; Kaveh et al., 2016). The six categories of the survey include psychological (psy), emotional (emot), social (soc), physical (phyt), spiritual (spirit), and intellectual (intel) health. Each category includes six questions with answers ranked from 1 to 6. There are thirty-six total questions in PWS and a maximum score of 36 for each category and 216 for combined categories (Adams et al., 1997; Bart et al., 2018). The reliability and validity of the PWS were studied and found to be an effective tool for evaluating the different dimensions of perceived wellness (Bhattacharya et al., 2023; Kaveh et al., 2016).
Data Analysis
The raw PWS data collected from the subjects were recoded and organized (Adams et al., 1997). The recoding process is required due to the different meanings of scores in PWS responses. For some questions with a negative connotation, a high score (i.e., 5 or 6) means lower perceived wellness (i.e., “I rarely count on good things happening to me”). For such questions, the answers were reverse-coded. For example, rank 1 was recoded to 6, rank 4 was recoded to 3, etc.
The data were then examined to ensure they met the assumptions of normalcy (e.g., non-significant Shapiro-Wilk test; non-significant skewness). using JASP statistical software (JASP v. 0.18, Netherlands). Descriptive statistics were then generated to produce mean and standard deviations for each dependent variable (i.e., psychological, emotional, physical, spiritual, intellectual, and social) and for each group (e.g., study and control). An initial 2-way (factorial)
Analysis of Variance with repeated measures (RMANOVA) was created for each of the six dependent variables (DVs) using the two groups as the second factor. Then, independent and dependent t-tests were run to establish differences from pre-testing to post-testing on each group (paired t-tests) and differences between the study group and control group at each time point (independent t-tests).
Results
Thirty-two DPT students at WCU (21 first-year and 11 second-year students) participated in this study. All participants completed the pre and post-PWS questionnaire and all participants in the intervention group completed the intervention sessions.
All data tested negative for any issues with normalcy or skewness. Based on the results of RMANOVA for each DV, there was a tendency for the study group to change differently than the control group, however, only the PHYT (F = 5.81, p = 0.022) and INTEL (F = 6.89, p = 0.01) were significant for this interaction. Specifically, the study group experienced an increase in physical and intellectual health relative to the control group. Furthermore, paired t-tests were needed to determine the simple main effects. Paired t-tests comparing pre to post test data on each DV for the study group and the control group revealed significant changes in the study group from pre to post testing on the Psy, Intel, and Emot variables (p < 0.05); the control group changed on the Emot variable (p < 0.05), as seen in Table 2. Specifically, the study group only experienced an increase in psychological, intellectual, and both the study and control groups experienced an increase in emotional health.
Independent t-tests were not significant between the two groups at pre-testing but the independent t-tests at post testing between the two groups revealed significant differences for the psychological, emotional, and intellectual measures (t = 2.24, p = 0.032; t = 2.57, p = 0.015; and t = 2.22, p = 0.03 respectively) as seen in Table 3.
Discussion
The purpose of this study was to investigate the impacts on the well-being of DPT students by providing a six-week sustainable online meditation program and measuring their well-being using the PWS questionnaire. Our results confirmed our hypothesis that a six-week online meditation program improves perceived wellness in three out of the six categories assessed (emotional, psychological, and intellectual). These findings were consistent with previous studies (Chambers et al., 2016; Kindel & Rafoth, 2019; Sleimen-Malkoun et al., 2023).
Emotional and Psychological Health
This study showed that the intervention group improved in the emotional and psychological categories. The results are consistent with previous studies (Kindel & Raforth, 2019; Ma et al., 2017). The diaphragmatic breathing was consistently emphasized from the beginning and throughout the sessions. Previous studies found diaphragmatic breathing to cause a significant improvement in sustained attention and anxiety reduction, measured by blood cortisol levels (Ma et al., 2017). Also, Kindel and Rafoth concluded that mindfulness intervention can decrease stress in DPT students (Kindel & Raforth, 2019).
Intellectual Health
Our study demonstrated a significant treatment effect in the intellectual category of the PWS. It is important to mention that mindfulness meditation has been shown to improve short-term cognitive performance (Sleimen-Malkoun et al., 2023) which might explain the improvement in the intellectual component of PWS. A vital component of meditation is to pay attention to the present moment which is crucial to optimize the cognitive benefits.
Stress and Academic Performance
The combined effect of emotional, psychological, intellectual, and physical improvement found in this study is likely related to lowered stress levels and increased academic success. A negative correlation between perceived stress and academics was shown in a study in 2012 (Talib & Zia-ur-Rehman, 2012). Furthermore, when studying stress in DPT students, it was found that stress management can prevent burnout and therefore improve academic success (Williams et al., 2018).
Feasibility of Online DPT Student Meditation Programs
The results of this study provide evidence for the benefits of a sustainable online meditation program utilized for DPT students. In the current study, there was a 100% adherence over 6-week of meditation which is a testimony to the sustainability of the program. In this study, we used a method that is minimal impact and easy for the participants. This provides an easy tool for the participants to practice meditation independently. Even after the completion of the study. Conducting the sessions remotely through Zoom and the data collection through an easy survey, PWS, created a sustainable and time-efficient program for busy graduate students.
Future Research
There is a potential correlation between student well-being, mental health, perceived stress levels, and academic performance (Beauchemin et al., 2018). Improvement in wellness may improve students’ academic performance and, therefore, their academic success (Kindel & Raforth, 2019). In addition to preparing students academically, we sense the pressing obligation for DPT programs to equip students with awareness and evidence-based modalities to effectively regulate stress, promote mental well-being, and learning proficiency. Future studies are required to study the possible effect of an independent program for graduate students’ stress levels and academic performance throughout a semester.
Conclusion
Our results indicate that online meditation for six weeks, three days a week for 20 minutes, significantly improved DPT students’ psychological, emotional, and intellectual health according to the PWS. The result of this study suggests that DPT students may more effectively manage their stress and enhance their well-being by integrating meditation into their weekly routines.