Erin A. Goodwin
Department of Occupational Therapy, University of St. Augustine for Health Sciences
APPROVED, ACCEPTED, AND SIGNED: (Cassandra Nelson)
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Cassandra Nelson, OTD, MOT, MBA, CNS, CEAS I, Doctoral Coordinator
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PD, Program Director
A Capstone Presented in Partial Fulfillment of the Requirement for the Degree of
DOCTOR OF OCCUPATIONAL THERAPY
University of St. Augustine for Health Sciences
April, 202
| Introduction | 3 |
| --- | --- |
| Background Theory/Model Problem | 3 4 5 |
| Purpose | 5 |
| Significance | 6 |
| Literature Review | 7 |
| Methodology | 12 |
| Project Description | 13 |
| Methods | 16 |
| Capstone Project/Experience Objectives | 21 |
| Timeline | 22 |
| Results | 23 |
| Project Summary | 24 |
| Project Outcome and Analysis | 25 |
| Discussion | 29 |
| Interpretation of Results | 30 |
| Dissemination | 31 |
| Limitations | 31 |
| Implications for Profession | 32 |
| Future Directions | 33 |
| Conclusion | 34 |
| References | 35 |
| Appendices | 36 |
Mothering is a collection of occupations shaped by lifestyle, experience, and culture. Studies show that there are ergonomic risks involved in caretaking tasks and an increase in musculoskeletal injuries amongst mothers of children under 4 years old (Sanders MJ & Morse T., 2005). However, there is little preventive education emphasizing maternal body mechanics post-discharge. The purpose of this capstone project is to increase awareness of postpartum musculoskeletal injuries in mothers and their link to poor body mechanics during child care tasks and the benefit of an accessible online education resource, guided by the Person Environment Occupation Performance (PEOP) Model, that teaches proper ergonomics during common caretaking activities mothers perform to prevent strain and injury that can limit occupational engagement.
The primary population of interest includes postpartum mothers aged 20-45 who are at increased risk for musculoskeletal injury related to the physical demands of child-rearing activities. Across the literature, demographic factors such as delivery type and maternal age are consistently associated with a higher prevalence of neck, shoulder, arm, and hand pain, particularly among women recovering from a cesarean delivery, and this is associated with advanced maternal age. (Algabbani et al., 2025; Lucas, Connor, & Bose, 2021). These injury risks are also influenced by social determinants of health, particularly income and economic stability, which affect access to healthcare services, including preventive and rehabilitative care (Office of Disease Prevention and Health Promotion ODPHP, n.d.). Common injuries, including muscle strains and sprains associated with lifting, carrying, and managing infant equipment, can impair engagement in essential daily occupations and caregiving tasks, limiting occupational participation and overall well-being (Koyasu, 2015; Lucas Connor, & Bose, 2021; Maha, 2025).
Postpartum mothers may prioritize the needs of their children over their own health, even when experiencing pain or injury related to caregiving activities. This pattern is not always a conscious decision but is influenced by multiple factors, including sociocultural expectations surrounding maternal roles and caregiving responsibilities (Adams et al., 2023; Madden et al., 2022). As a result, mothers may delay or avoid seeking healthcare services, allowing musculoskeletal strain to accumulate during routine childcare tasks such as feeding, lifting, transferring infants, and managing child-related equipment (Adams et al., 2023; Office of Disease Prevention and Health Promotion ODPHP, n.d.). These behaviors can increase the likelihood that acute musculoskeletal issues progress to more chronic pain or injury, limiting engagement in daily occupations. Although ergonomic baby equipment is widely available, household economic constraints may restrict access to rehabilitative and preventive services, such as occupational or physical therapy, further contributing to unmet maternal health needs (Adams et al., 2023; Office of Disease Prevention and Health Promotion ODPHP, n.d.).
The person-environment-occupation-performance (PEOP) model, developed by Christiansen and Baum in 1991, emphasizes the dynamic interaction among individual characteristics, environmental contexts, occupational demands, and performance outcomes (Christiansen & Baum, 1991). The PEOP model examines how personal factors, environmental supports or barriers, and the demands of everyday occupations collectively influence meaningful participation and engagement (Christiansen & Baum, 1991). In this capstone project, the PEOP models serve as the guiding framework for musculoskeletal injury prevention by informing the design of an occupational therapy-led educational intervention centered on real-world caregiving activities. The “person” (postpartum mothers) is addressed through education on postpartum physical recovery, ergonomic awareness, and fatigue management. The “environment” component is targeted through home adaptation and equipment recommendations. The “occupation” component is reflected in the focus on routine childcare tasks such as lifting, feeding, transferring, and carrying. By improving these components, this intervention strives to support safer movement patterns and enhance performance during caregiving occupations. Aligning with PEOP’s principles, the online education videos address both intrinsic and extrinsic factors that influence occupational performance, reinforcing how supportive environments and task modifications can reduce strain and improve sustained engagement in daily occupations (Bass et al., 2015; Bass et al., 2024).
New mothers face many physical/musculoskeletal demands as they transition into the role of caregiver. The daily activities of feeding, changing, lifting, and carrying their infants and equipment, all tasks that fall within the Occupational Therapy Practice Framework (OTPF-4) domains as caregiving, ADLs, and IADLs, often involve repeated physical strain that puts parents in awkward positions and postures that can cause pain, limiting occupational participation in caregiving tasks (Havens et al., 2020; Brown et al., 2004). Many of the tasks that make up these activities require prolonged bending and twisting, increasing the risk of injury and strain (Sanders & Morse, 2005; Vincent & Hocking, 2013). Although evidence indicates that parents (particularly mothers) are at risk of injury during routine childcare activities (Li et al., 2023; Lucas et al., 2021), mothers report a lack of structured ergonomic education post-discharge (Vincent & Hocking, 2013). Dismissal of symptoms, cultural stigma, and limited access to resources prevent mothers from discussing their own health and wellness, especially those who face socioeconomic disadvantages (Carlson et al., 2025). Despite this evidence, structured, preventative, occupational therapy-led ergonomic education addressing body mechanics during everyday childcare tasks is still limited during the postpartum period and the years beyond (Vincent & Hocking, 2013; Adams et al., 2023)
The purpose of this capstone project is to develop short, accessible educational videos that provide new and expectant mothers with instruction in proper body mechanics during common childcare tasks. The videos will include ergonomic strategies, recommendations for accessible adaptive equipment, and recovery techniques such as stretching to address overuse and musculoskeletal strain. This project aims to support injury prevention, reduce pain, and improve occupational performance by promoting safer movement patterns during routine caregiving activities.
Occupational therapists have historically worked with postpartum women in hospital settings, occupational rehabilitation, and home health services, where their role often includes education on ergonomics, safe lifting techniques, and adaptive strategies for daily tasks such as infant care (Sanders & Morse, 2005; Vincent & Hocking, 2013). However, occupational therapy involvement in preventive care for musculoskeletal injuries in new mothers is limited, despite evidence of high injury prevalence and unmet educational needs during the postpartum period (Adams et al., 2023; Algabbani et al., 2025). As a result, many mothers do not receive timely, occupation-based guidance to support safe engagement in caregiving tasks (Adams et al, 2023; Vincent & Hocking, 2013). There is a growing need for occupational therapy services delivered through community-based, accessible platforms to expand access to preventive education, especially for mothers who face barriers to traditional in-person care (Office of Disease Prevention and Health Promotion ODPHP, n.d.).
Reducing musculoskeletal strain and other injuries will support proper nutrition, promote better sleep, and satisfy psychological needs, thereby enabling higher-level functioning amongst mothers (Koyasu et al., 2015; Sanders & Morse, 2005). By reducing pain and improving function, mothers can experience greater self-efficacy and esteem, which can enhance role identity, improve emotional well-being, and resilience against things like postpartum depression. By informing on common barriers (e.g., crib and car height) and offering real-world alternatives, such as equipment and modifications, an occupational therapist can lead an online educational program in a video-style format to support occupational mastery and sustainability.
The population focus of this capstone is postpartum mothers ages 20 to 45 with children under four who engage in repetitive childcare tasks such as nursing, lifting and carrying, supporting their child, and using baby equipment. Mothers of children under four years old experience high rates of musculoskeletal strain, commonly affecting the low back, neck, shoulders, and upper extremities, related to their caregiving activities (Sanders & Morse, 2005; Algabbani et al., 2025; Weis et al., 2021). A postpartum care needs assessment reflected that 97.3% of postpartum women experience musculoskeletal pain, yet only 24% reported ever receiving ergonomic or injury-prevention education (Adams et al., 2023). These high rates of pain are further influenced by physiological changes associated with pregnancy and postpartum recovery, including increased joint laxity related to hormonal changes, making women more susceptible to musculoskeletal injury during childcare activities (Weis et al., 2021). When combined with gender-occupational demands related to pregnancy, childbirth, recovery and breastfeeding, these physiological vulnerabilities increase injury risk during routine caregiving tasks (Weis et al., 2021; Sanders & Morse, 2005). Additionally, mothers experiencing socioeconomic disadvantage or living in underserved communities face barriers such as reduced follow-up care, limited access to education and fewer physical resources to support musculoskeletal injury prevention and care (Adams et al., 2023; Carlson et al., 2025; Office of Disease Prevention and Health Promotion ODPHP, n.d.; Healthy People; Weis et al., 2021).
The literature suggests a strong correlation between musculoskeletal pain/injury and engaging in childcare occupations. There is a high prevalence of low back, neck, shoulder, and upper extremity pain reported amongst postpartum women that interferes with their performance as a caregiver, daily activities, and sleep. Across multiple studies, mothers of young children report high rates of low back, neck, shoulder, and upper extremity pain associated with the physical demands of caregiving activities (Sanders & Morse, 2005; Algabbani et al., 2025; Adams et al., 2023; Vincent & Hocking, 2013; Weis et al., 2021; Brown et al., 2004; Havens et al., 2025; Lucas, Connor, & Bose, 2021; Hamilton et al., 2024). Not only is this musculoskeletal pain common, but it also limits function, hindering mothers' ability to perform caregiving tasks, manage daily activities, and obtain enough rest or sleep (Adams et al., 2023; Vincent & Hocking, 2013). Research indicates that common caregiving occupations, such as lifting and carrying infants, handling car seats and baby equipment, and maintaining awkward postures, place increased physical demands on postpartum mothers and can contribute to musculoskeletal strain (Brown et al., 2004; Sanders & Morse, 2005; Havens et al., 2025). The literature emphasizes that musculoskeletal pain among mothers of young children is closely linked to the repetitive and physically demanding childcare occupations, showing that there is a potential for impaired or reduced occupational participation.
Tasks associated with caregiving activities increase the risk of injury
Both biomechanical and observational studies demonstrate that the physical demands in routine caregiving occupations put postpartum mothers at increased risk for musculoskeletal injury. Across the literature, repetitive caregiving tasks involving bending, twisting, reaching, and prolonged or asymmetrical carrying impose significant mechanical stress on the spine and upper extremities, particularly when performed in home environments that do not support optimal ergonomics (Sanders & Morse, 2005; Vincent & Hocking, 2013). Biomechanics research indicates that asymmetrical infant carrying and common lifting strategies alter gait patterns, postural stability, and load distribution, thereby increasing the risk of musculoskeletal strain (Brown et al., 2004; Havens et al., 2020; Pehlivan et al., 2025; Li et al., 2023). Observational studies show that movement patterns frequently occur during everyday childcare activities, increasing injury risk over time (Havens et al., 2025; Weis et al., 2021). From an occupational therapy perspective, these findings show how the interaction among task demands, environmental context, and individual movement strategies aligns with the PEOP model and occupational therapy practice framework and can negatively influence occupational performance.
There is a lack of ergonomic and preventative education in postpartum care
Despite the high prevalence of musculoskeletal pain and biomechanical risk associated with routine childcare tasks, the literature indicates a lack of accessible, preventive ergonomic education for mothers following hospital discharge. Across multiple studies, postpartum education prioritizes infant care practices while overlooking maternal physical health, body mechanics, and injury prevention strategies (Adams et al., 2023; Vincent & Hocking, 2013; Koyasu et al., 2015; Madden et al., 2022; Ezeukwu et al., 2020). As a result, mothers report normalization of pain and receiving little to no guidance on safe movement patterns or ergonomic strategies for performing everyday childcare occupations (Sanders & Morse, 2005; Brown et al., 2004; Havens et al., 2020; Weis et al., 2021). The gap in maternal-focused post-discharge education is exacerbated for mothers experiencing systemic barriers, such as limited access to follow-up care and preventive services, and those facing socioeconomic disadvantage (Carlson et al., 2025; Office of Disease Prevention and Health Promotion ODPHP, n.d.). There is a need for structured, occupational therapy-led preventative education that addresses maternal body mechanics within the context of real-world caregiving tasks.
Occupational therapists have historically worked with postpartum women in hospital settings, outpatient rehabilitation, and home health services. Their role often includes education on ergonomics, safe lifting techniques, and adaptive strategies for daily tasks such as infant care. Occupational therapy addresses musculoskeletal injury risk in postpartum populations through its focus on task analysis, body mechanics, and the interaction among the individual, environment, and the occupations performed. Research evaluating caregiving tasks demonstrates that everyday activities such as lifting infants, managing car seats, and performing childcare routines frequently involve biomechanical risks that can be addressed through task modification, environmental adaptation, and education, which are all core components of occupational therapy practice (Sanders & Morse, 2005; Vincent & Hocking, 2013).
This role aligns with the Occupational Therapy Practice Framework (OTPF-4), which identifies caregiving, activities of daily living, instrumental activities of daily living, and health management as core areas of occupational therapy practice and supports education and environmental modification to promote enhanced occupational performance (American Occupational Therapy Association AOTA, 2020).
The physical demands of caregiving occupations, combined with limited preventive education and access to ergonomic education, place postpartum mothers at increased risk for musculoskeletal injury that can reduce occupational participation (Sanders & Morse, 2005; Adams et al., 2023). Despite evidence in the literature reflecting a strong association between high rates of pain and routine childcare tasks, structured, accessible education addressing maternal body mechanics post-hospital discharge remains limited (Adams et al., 2023; Vincent & Hocking, 2013). Guided by the OTPF-4 and PEOP model, this capstone project aims to address this gap by focusing on injury prevention, improved task performance, and sustained engagement in caregiving occupations through an accessible, occupation-based educational approach.
Plan for Sustainability.
Evaluation Plan.
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