Department of Physical Therapy Student Theses, Dissertations and Capstones

Document Type

Dissertation - NSU Access Only

Degree Name

Doctor of Philosophy (PhD) in Physical Therapy

Copyright Statement

All rights reserved. This publication is intended for use solely by faculty, students, and staff of Nova Southeastern University. No part of this publication may be reproduced, distributed, or transmitted in any form or by any means, now known or later developed, including but not limited to photocopying, recording, or other electronic or mechanical methods, without the prior written permission of the author or the publisher.

First Advisor

Alicia Fernandez-Fernandez

Date of original Performance / Presentation

January 2026

Publication Date / Copyright Date

1-1-2026

Abstract

Background Minorities with diabetes or cancer may experience heightened sympathetic–parasympathetic imbalance due to increased allostatic load (AL). Elevated AL reduces resilience and worsens health outcomes. Heart rate variability (HRV) is a key indicator of cardiovascular risk and overall autonomic balance. While internal biological stressors influencing AL are well documented, far less is known about how external stressors, like medical mistrust, shape baseline autonomic activity in minority populations. Objective This study explores whether external stressors, specifically medical mistrust, affect HRV in Black and Hispanic adults with neuropathic pain resulting from cancer induced peripheral neuropathy (CIPN) or diabetic neuropathy (DN). Methods A retrospective secondary analysis was conducted using data from 24 Black and/or Hispanic adults with peripheral neuropathy. Participants completed a modified Group Based Medical Mistrust Scale (mGBMMS) before their visit and reported pain severity via a numeric rating scale. Each participant then underwent a 15 minute resting 3-lead electrocardiogram (ECG) to assess autonomic function. Results Analyses evaluated relationships among race/ethnicity, neuropathy type, medical mistrust, pain intensity, and HRV (SDRR and RMSSD). Overall mistrust levels were low across groups. Both HRV indices were also low, with Black participants showing lower HRV and higher pain intensity than Hispanic participants. Race/ethnicity was significantly associated with RMSSD but not SDRR. Neuropathy type (CIPN vs. DN) showed no significant differences in either HRV measure. Pain intensity was significantly related to RMSSD, while medical mistrust showed no direct association with HRV. Discussion This study provides preliminary exploration into autonomic differences among minority groups with similar neuropathic pain drivers. Although limited by a small sample, findings suggest that Black participants displayed lower HRV and higher pain than Hispanic participants. Variation in medical management and treatment experiences across groups underscores the importance of examining how physical and emotional stressors jointly influence autonomic health. Incorporating HRV into person centered care models may enhance understanding of recovery barriers in minority populations. Conclusion Further research is needed to clarify how physiological and emotional stressors contribute to HRV patterns in minority groups, supporting more accurate health risk stratification and tailored clinical management. Keywords Heart rate variability, peripheral neuropathy, medical mistrust, autonomic dysfunction

Disciplines

Physical Therapy

Keywords

Autonomic dysfunction; Heart rate variability; Medical mistrust; Peripheral neuropathy

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