Background: Osteoarthritis (OA) is one of the leading causes of disability worldwide. A major challenge facing those with severe OA is long waiting lists delaying access to joint replacements. Patients are known to wait more than five years for a joint replacement in the Western Cape of South Africa (SA). The main complaint in this population is pain and its consequences including activity limitations, participation restrictions and reduced quality of life. Hip or knee OA is not merely joint degeneration but a condition requiring holistic management, even while waiting for surgery. Most of the literature in this field is available from high income countries exploring the effects of interventions during short waiting periods. Thus research is warranted in a low income country such as SA, in those waiting for long periods to explore the effects of a six-week physiotherapist-led exercise and education intervention. Methods: A single blinded randomised controlled trial, aligned with CONSORT guidelines, was performed at Tygerberg Hospital in the Western Cape, SA. The experimental group attended a six-week group-based physiotherapist-led intervention including education, exercise and relaxation. The control group continued to receive usual care. The primary outcome measure was pain with secondary measures of disability, function, quality of life and self-efficacy. Measures were obtained at six weeks, 12 weeks and six months by a blinded physiotherapist. An open ended questionnaire was completed by the participants in the experimental group at month six. Analysis was by intention to treat. Two-way analysis of variance and post-hoc Tukey comparisons were used for parametric data, Pearson Chi squared calculations for categorical data. Effect sizes were established for significant differences between groups. Results: The study recruited 42 participants from the waiting list for a hip or knee arthroplasty. Mean waiting time was 3.6 ± 2.5 years. Compared to the control group, the experimental group had significant improvements with large effect sizes at month six for pain interference (3.49 ± 2.63 vs. 6.09 ± 2.43; p=0.02, ES=1.15) and function (15m fastest speed walk) (15.09 ± 6.04s vs 20.10 ± 8.79s; p=0.03, ES=0.88). Furthermore, the experimental group displayed significant (p < 0.01) and sustained improvements at month six in pain severity, disability and function (15m normal speed walk, sit-stand, 6-minute walk). Subgroup analysis showed participants with knee OA responded better to the intervention than those with OA of the hip or combined hip and knee OA. Participants enjoyed the intervention reporting improved knowledge, function and activity, pain relief and improvement in psychosocial aspects. Conclusions: A six-week physiotherapist-led exercise and education intervention brought about significant long term improvements in pain interference and functional walking ability in patients with osteoarthritis, awaiting a joint replacement compared with a control group. Such a programme also appears to have significant and sustained improvements in pain severity and disability. Further research with longer follow up is recommended to determine if results are sustained.

Background: Childhood obesity, a rising problem world-wide and within South Africa, has been negatively linked with both physical fitness (PF) and health-related quality of life (HRQoL). The school environment is the ideal setting for children to obtain the skills and knowledge to increase physical activity (PA) levels and healthy diets. PA and school-based nutrition intervention programmes have been shown to have positive effects on diet and PA behaviours in children. However, there is minimal literature reporting on the effectiveness of school-based interventions in a South African setting. Aim: The primary aim of the first phase of the study was to provide a contextual background regarding the provision of PA in school-based PE programmes within a small sample of schools from which the learners in the intervention study were drawn. The primary aim of the second phase of the study was to determine the effect of a teacher-based intervention programme after six weeks for primary schools with less than the mandated amount or no specific amount of PE on learner's HRQoL, Body Mass Index (BMI) and PF. Methodology: Ten schools were randomly selected from the circuit lists within the Port Elizabeth Education District. Ten staff members from the selected schools completed the School Environment Questionnaire in order to provide a situational analysis regarding the provision of PA in school-based PE programmes. A sample of 300 learners (aged nine to eleven) from four randomly selected schools participated in the pre-testing measures in order to establish the weight status (using BMI and waist circumference (WC)), HRQoL (using the EQ-5D-Y), and PF (using the Eurofit test battery). Class teachers, from schools with less than the mandated amount of PE or no specific amount of PE, who were part of the experimental group, implemented the intervention. In order to implement the intervention, they received training and were given a PE programme booklet. The PE intervention programme was in line with the Curriculum and Assessment Policy Statement teaching plan for life skills, and was based on targeting the deficiencies found in the pre-testing fitness measurements. Post-testing measures, using the same learners, were conducted six weeks later. The obtained results were analysed using STATISTICA version 12. Results: Phase one of the study revealed that PE was provided at all schools. The curriculum was followed by 90% of schools, but only 30% had teachers with PE qualifications. PE policies and practices were being developed and/or implemented in 70% of schools, and 50% had no specific amount of time mandated to PE, or less than the mandated amount. Soccer was offered at all schools, and 80% of schools had access to an outdoor sports field and an outdoor paved area. Phase two of the study found that the control and experimental groups were not equivalent at baseline with regard to gender distribution, BMI Z-scores and interpretations, the EQ-5D-Y "looking after myself" variable, and the sit-up test. No positive significant differences were noted in BMI Z-scores, WC, HRQoL, or PF components in the experimental group after the six-week intervention. Discussion: The average duration of PE at 70% of the participating schools was longer than the national average, despite half of the schools not implementing the mandated amount of PE. Gaps in the curriculum content and unqualified PE teachers may have prevented learners from developing the necessary skills associated with PE, including the various components of PF. The six-week teacher-based intervention was found to be ineffective. Similar results were seen in other South African studies. Insignificant intervention findings may be the result of poor intervention implementation or compliance, time constraints experienced by participating teachers, and the short six-week duration of the intervention. Teachers mainly commented on the enjoyment of the intervention programme by the learners. Conclusion: This study concludes that the effects of the six week teacher-based intervention, on primary school learners' HRQoL, BMI, and PF, was insignificant. Nevertheless, all schools provided PE, despite half of the schools not implementing the amount mandated. This study provides a platform for future studies in the attempt to reduce the occurrence of obesity in school children; thereby reducing its increasing national burden on health and the economy.

Includes abstract. / Includes bibliographical references (leaves 139-151). / Low Back Pain (LBP) is a major health problem in many countries at considerable cost to the economy but there is little information available regarding LBP in South Africa. The prevalence and impact is likely to be similar to elsewhere. As South Africa has a small health budget and many health problems to attend to, a cost effective approach to the management of LBP would seem essential. Education, information and advice have been shown to be effective in treating some aspects of LBP and a leaflet is a low-cost method of providing these. Apparently if a leaflet is designed according to the needs of a specific population. it has the potential to be more effective within that group. It has been suggested that the use of such leaflets should be investigated before more expensive treatment. This study therefore aimed to develop an information leaflet about LBP that was appropriate for a resource poor community in Cape Town. The impact of this leaflet was then examined in a second stage of the project. Stage One: Pamphlet development. Stage One: To compile a lifestyle profile of people seeking help for LBP in a resource poor community and to use this profile. together with information about perceived needs of these people regarding LBP. to develop an information leaflet. Method Stage One: Sample: Adults (over the age of 18 years) of a resource poor community who attended the community health centre to consult the doctor for an episode of ALBP, and who agreed to participate in the study, were interviewed about their lifestyle and their perceived needs regarding information to help them manage their LBP. Instrumentation: The Lifestyle Questionnaire consisted of 116 questions, which were based on information obtained from the literature review and the 20-year experience of physiotherapy of the researcher.

Background: The main focus of care in intensive care units (ICU) has historically been on preventing mortality. With advancing knowledge and technology, more patients now survive their ICU stay. Therefore, critical care priorities have recently shifted to preventing critical illness related morbidities, including ICU-acquired weakness (ICUAW) and delirium, in order to optimise functional, psychosocial, cognitive, and quality of life outcomes for survivors of critical illness and their families. Early mobilisation and ICU-based rehabilitation are recommended interventions to achieve these clinical objectives. There are no published studies describing early mobilisation practice in Namibia. Aims: This study aimed to describe the profile of patients admitted to two private intensive care units in Windhoek, Namibia, and to describe practices, attitudes and perceptions of nurses, doctors, and physiotherapists regarding early mobilisation of critically ill patients in those ICUs. Methodology: A retrospective, descriptive record review was conducted to describe the ICU patient profile and documented mobility practice. Charts of 870 patients admitted between 01 January 2016 and 31 December 2016 to two private Windhoek ICUs were included in the record review. A descriptive, cross-sectional, self-administered survey was used to assess knowledge of ICUAW and early mobilisation, reported mobility practice, personal views on early mobilisation, perceived contraindications/precautions to early mobility, the perceived barriers to the provision of early mobility, perceived permissible activity levels based on patient physiological status, and sedation practices. A total 39 nurses, doctors, and physiotherapists were included in the survey. Results: Record Review: 538 (61.8%) patients were male. Mean age was 56 (SD 14.9, range 18-90) years. Most admissions were elective (n=577; 66.3%). Coronary angiogram (n=179; 20.6%), cardiac conditions (n=113; 13%) and cardiac surgery (n=90; 10.3%) were the main admission diagnoses. Most patients (n=697; 80.1%) did not receive mechanical ventilation; average length of stay in ICU was 3.41 (1-37) days, and duration of mechanical ventilation was 0.7 (0-20) days. The mortality rate was 5.2%. Three hundred and fifty-two (40.5%) patients received physiotherapy treatment, with the majority (n=271; 78.6%) being mobilised once daily. Most patients (n=253; 73.3%) who were mobilised were done so within 48 hours of ICU admission. Physiotherapy techniques used were manual chest physiotherapy, mobilisation to a chair, and active range of motion exercises. Five (1.4%) patients experienced adverse events during physiotherapy treatment (change in systolic blood pressure to 200mmHg during treatment). Delirium was not assessed or monitored in any included patient. Survey: The overall response rate was 24.1% (n=42). Clinician group response rates were physiotherapists 10.2% (n=13); nurses 65.6% (n=21); and doctors 55.6% (n=5). Most participants underestimated the incidence of ICUAW (n=17; 44.7%) and reported unfamiliarity with the literature on early mobilisation (n=19; 51.4%). Twenty-five (38.5%) of sixty-five total physiotherapist responses reported they would mobilise patients once daily, while thirty-one (47.7%) responses reported they would mobilise patients twice daily. Twenty-seven (41.5%) physiotherapist responses reported they spend 16-30 minutes mobilising a patient. The mobilisation team described consisted mainly of physiotherapists, nurses, and porters. Routinely used physiotherapy techniques included manual chest physiotherapy, bed mobility, pre-gait activities and strengthening exercises. Providers reported conservativism in permissible patient activity levels, especially in ventilated patients. The most commonly reported barriers to early mobilisation were requiring a doctor's referral for mobilisation, medical instability, excessive sedation, safety concerns, inadequate training, and lack of communication. Conclusion: Patients were admitted electively, mainly post-cardiac surgery or for cardiac-related diagnoses. Delirium is not being standardly monitored in ICU. This could contribute significantly to poor patient outcomes. Quality improvement programmes to implement and optimise delirium monitoring and prevention in Namibian ICUs are recommended. Physiotherapists routinely use manual chest techniques, bed mobility, pre-gait activity, and strengthening exercises in ICU. Survey participants underestimated the likely incidence of ICUAW and lacked sufficient knowledge and training on early mobilisation. Many barriers to early mobilisation were identified in this study, which should be addressed through implementing quality improvement programmes to direct and improve ICU mobility practice. Future point-prevalence studies are recommended with larger sample sizes from both the private and public sectors to increase the generalisability of results.

Made available in DSpace on 2016-04-27T18:47:06Z (GMT). No. of bitstreams: 1 Cristina Cristovao Ribeiro da Silva.pdf: 674034 bytes, checksum: 116308f3cf039218a353ec8a232b8f63 (MD5) Previous issue date: 2011-05-06 / Coordenação de Aperfeiçoamento de Pessoal de Nível Superior / Both aging and longevity are decisive phenomena on various fields of personal and social life. Those phenomena, in turn, require the formation of qualified professionals to assist elderly people, like the physiotherapist. There are two ways of dealing with the elderly population: The first is the geriatric physiotherapy , focused on treatment and prevention of aging/old-age diseases; the second one is gerontologic physiotherapy , whose approach, being based on gerontology, involves, besides aging diseases treatment and prevention mode, the utilization of a perspective where the elderly is seen in a integral manner, considering her or his biological, psychological and social aspects. The differentiation is necessary and complex; it has contributed to the delimitation of the central objectives of this dissertation, that is to say, to situate Gerontologic Physiotherapy inside Physiotherapy, as well as to identify the characteristics of assistance in Gerontologic Physiotherapy. The method chosen was qualitative assessment, with exploratory-descriptive profile; for data collection, have been selected case study and participative observation , both longitudinally conducted under the perspective of gerontologic physiotherapy, involving 22 assistances on a female patient, 94 years old, widow, 4 children, housewife, congestive cardiac insufficiency (CCI), pain in the knee. Although specific, the outcomes were significant, involving, among other aspects, what could be called rebirth . Thus, the patient became lady of her desires , re-appropriating herself of the wishing condition, often denied to the elderly, despite the fact that such condition is age-independent. The investigation has demonstrated that whenever the physiotherapist orients her or himself after gerontologic physiotherapy s principles, the outcomes are quite satisfactory for physical, as well as for social, psychological, and existential aspects / O envelhecimento e a longevidade são fenômenos com importantes repercussões nos vários âmbitos da vida pessoal e social. Implicam, por sua vez, na formação de profissionais qualificados para atender o idoso, a exemplo do fisioterapeuta. Na fisioterapia encontramos duas linhas de atuação junto á população idosa: a primeira é a fisioterapia geriátrica , que tem como foco o tratamento e a prevenção das doenças próprias do envelhecimento e da velhice; a segunda é a fisioterapia gerontológica cuja abordagem, por estar pautada na gerontologia envolve, além do tratamento das doenças do envelhecimento e do modo de prevenilas, a utilização de uma abordagem em que o idoso é visto de forma integral, considerando seus aspectos biológicos, psicológicos e sociais. Trata-se de uma diferenciação necessária e complexa; diferenciação que contribuiu para a delimitação dos objetivos centrais desta dissertação, ou seja, identificar o lugar da Fisioterapia Gerontológica na Fisioterapia e identificar as características dos atendimentos da Fisioterapia Gerontológica. A opção metodológica adotada foi à abordagem qualitativa de perfil exploratório-descritivo; no que tange ao procedimento de coleta de dados, a opção recaiu sobre o estudo de caso e a observação participante , ambos de corte longitudinal e na perspectiva da fisioterapia gerontológica, envolveu 22 atendimentos em uma paciente do sexo feminino, de 94 anos, viúva, mãe de 4 filhos, dona de casa, com diagnóstico de insuficiência cardíaca congestiva (ICC) e dor em joelhos (artrose). Apesar de pontuais, os resultados obtidos foram significativos envolvendo, entre outros aspectos, o que poderíamos batizar de renascimento do sujeito . Assim, a paciente tornou-se senhora dos seus desejos , se re-apropriando da condição de ser desejante ; condição tantas vezes negada aos idosos, mas que independe da idade cronológica. A investigação demonstrou que quando o fisioterapeuta se pauta pelos princípios da fisioterapia gerontológica, os resultados são muito satisfatórios, tanto nos aspectos físicos, como nos âmbitos social, psicológico e existencial

Subsequent to a High Court ruling, educational support was made available to children with severe to profound intellectual disability in the Western Cape in the form of multi-professional outreach teams. Neither the attainment of learning outcomes nor indicators of educational performance have been reported for those receiving these services. The use of the P scales, which were developed in the United Kingdom to specify educational attainment targets, have been piloted by the outreach teams. However, the reliability and responsiveness to change of these scales needed to be established within the Western Cape context. This research aimed, firstly, to develop a profile of the children in receipt of support from the rural outreach team through the use of a record review, which could inform future service delivery. The second aim was to validate the P scales in the context of rural districts in the Western Cape. The third was to document the nature, content and frequency of intervention by the team. The fourth aim was to identify variables that might be associated with the attainment of learning outcomes. The study population of 498 children had a mean age of 9.9 years and 60% were male. Afrikaans was the home language for most (68%), followed by IsiXhosa (28%). Only 29% lived with both parents, 33% with a single parent, and a high number were in foster care (13%). The most prevalent associated health condition was found to be cerebral palsy (27.9%). Many presented with more than one condition, frequently involving epilepsy. Prominent aetiological factors were classified as maternal and child (25%) or congenital and hereditary (23%) conditions. Chronic medication was used by 37%, but information on other medical procedures was largely unavailable. Children (62%) received additional therapeutic services from the Western Cape Department of Health (62%) and other therapists, including students. The need in terms of wheelchairs and buggies was met, but access to standing frames was limited. Transport was largely available through the special care centres. Where the classification systems were applied, most children were found to be mobile, with good hand function. However, most children were “seldom effective” in communicating their needs. For all subject areas measured by the P scales, peaks were observed at P1(ii) and between P4, P5. Reliability, internal consistency and responsiveness of the P scales were established through a longitudinal study design, using two routinely assessed scores of 83 participants - done at least one year apart. The internal consistency (reliability) (Cronbach’s alpha) was very high in the whole sample (.99) but somewhat lower in the children with a higher performance level (.71). The scale was responsive and the Sign test indicated improvement in every item across time, with at least 39 of the 83 children improving from the first to the second assessment. Known group validity was determined by comparing P scale scores to scores across the different levels of the three routinely applied classification scales [gross motor (n=181), manual ability (n=181) and communication (n=177)]. In every case, the scale item score was significantly associated with the level of the corresponding classification system. Concurrent validity, using the Vineland Adaptive Behaviour Scales II as the gold standard with 41 participants, was demonstrated. Each item was significantly correlated with the relevant specifying performance attainment targets of the Vineland Adaptive Behaviour Scale item (range rho=.61-.84). Feasibility and acceptability of the P scales were determined by twelve professionals in the field. Eight reported them to be useful. It was concluded that selective, routine use can be valuable in tracking learners’ performance. A descriptive analytical longitudinal record review of 83 participants was used to establish which factors were related to educational performance over a period of at least one year. Age, language concordance, medical conditions, independent mobility, effective communication, comprehensive support and individual intervention from Western Cape Education Department team members did not emerge as significant indicators of change in participation ability of this study population. Recommendations include the following. The high number of children in need of medical support implies that there should be good working relationships between teams, centres and communitybased services from Department of Health. It is imperative that rehabilitation services remain in place, with optimal use of additional services and interdepartmental communication on the operational level to ensure that every child receives the necessary therapeutic support. The P scale scores indicated that there were two groups of children, those with very limited performance (P1) and those with improved ability to participate (P4, P5). As their support needs are likely to be different, this should be factored into the programmes and training of support staff. It is strongly recommended that all children receiving support from WCED should have their information entered using the same data base and this information should be amalgamated centrally to inform future planning of services and training within the region. The P scales indicated that, when used within the context of the rural team, these scales were both valid and reliable. It is therefore recommended that a similar approach to administration, namely collaborative scoring after training on assessment procedure, be adopted throughout the province. It was also encouraging that the P scales were responsive to change and approximately half of the children showed improvement over a period of six months or more. The high correlation between the scales in children with the most profound impairments implies that it might be sufficient to administer only one or two of the four scales in this group. The P scales have the potential to be rolled out alongside the newly developed Learning Programme for Learners with Severe to Profound Intellectual Disability. With the emphasis on educational performance, it could become the standard assessment tool. The instrument would then need to be validated within a larger context, with training of administrators and standardisation of the assessment process a prerequisite.

Bibliography / Thesis (PhD ( Interdisciplinary Health))--University of Stellenbosch, 2010. / Bibliography / ENGLISH ABSTRACT: Introduction: It is increasingly being recognized that how intensive care services are delivered may have a greater impact on patient outcome than the individual therapies. Uncertainty regarding the optimal physiotherapy service provision model in a surgical intensive care unit (ICU) exists. Methodology: The aims of this study were to 1) develop an evidence-based physiotherapy protocol; 2) validate the content of the protocol; and 3) conduct an explorative intervention trial to compare usual care to the estimated effects of providing a physiotherapy service guided by an evidence-based physiotherapy protocol by a dedicated physiotherapist. A systematic review process was used to synthesize the evidence in eight subject areas. The GRADE system was used to formulate best practice recommendations and algorithm statements. Forty-two experts from a variety of disciplines were invited to participate in a Delphi process. Finally, the evidence-based physiotherapy protocol was implemented in a surgical ICU over four three-week intervention periods by a group of research therapists. The outcomes measured included ventilator time, ventilation proportions, failed extubation proportions, length of ICU and hospital stay, mortality, functional capacity, functional ability and cost (using nursing workload as proxy). Results: Fifty-three research reports in eight subject areas were identified, 23 draft best-practice recommendations and 198 algorithm statements were formulated. The draft protocol consisted of five clinical management algorithms. Fifteen international research experts and twelve national academics in the field of critical care agreed to participate in the Delphi process. Consensus was reached on the formulation of 87% (20/23) recommendations and the rating of 66% (130/198) statements. The risk of an adverse event during the protocol care intervention period was 6:1000 treatment sessions (p=0.34). Patients admitted to the unit during the protocol care intervention period were less likely to be intubated (RR 0.16 95%CI 0.07 – 0.71; RRR 0.84 NNT 5.02; p=0.005) or fail extubation (RR 0.23 95%CI 0.05 – 0.98; RRR =0.77 NNT 6.95; p=0.04). The mean difference in the daily unit TISS-28 score between the two condition periods was 1.99 95%CI 0.65 – 3.35 (p=0.04). Patients managed by the protocol tended to remain in the hospital for a shorter time after unit discharge (p=0.05). There was no difference in the time spent on the ventilator (p=0.50), mortality (p=0.52) or in the six minute walk distance (p=0.65). In addition there was no difference in the proportion of patients who reached independence in any of the Barthel Index activities measured within 48 hours of discharge from the unit. Conclusions: The use of an evidence-based physiotherapy protocol for the comprehensive physiotherapeutic management of patients in a surgical ICU was feasible and safe. The preliminary results of this study suggest that a physiotherapy service, which is guided by an evidence-based protocol and offered by a dedicated unit therapist, has the potential to lower the cost of ICU care and facilitate the functional recovery of patients after unit discharge. This information can now be considered by administrators to optimize the physiotherapy service provided in ICU. / AFRIKAANSE OPSOMMING: Inleiding: Daar word toenemend erken dat die wyse waarop dienste gelewer word, ‘n groter impak mag hê op die uitkoms van pasiënte as die spesifieke modaliteite in gebruik. Onsekerheid heers tans oor die optimale fisioterapie diens model om te volg in ‘n chirurgiese intensiewe sorg eenheid (ISE). Metodologie: The doel van hierdie projek was om 1) ‘n bewysgesteunde protokol te ontwikkel; 2) die geldigheid van die protokol te bevestig; en 3) om deur middel van ‘n eksploratiewe studie die uitkoms van pasiënte te vergelyk wanneer die fisioterapie diens gelewer word aan die hand van die bewysgesteunde protokol deur ‘n toegewyde fisioterapeut, teenoor wanneer die gewone fisioterapie diens gelewer word. Die empiriese bewyse in agt onderwerp areas is gesintetiseer na afloop van ‘n sistematiese literatuur oorsig proses. Die GRADE sisteem is gebruik om beste praktyk aanbevelings en algoritme stellings te formuleer. Twee en veertig kundige persone van verskeie disiplines is genooi om deel te neem aan die Delphi proses om die geldigheid van die protokol te bevestig. Uiteindelik is die geldige bewysgesteunde protokol oor ‘n tydperk van vier drie weke intervensie periodes deur ‘n groep navorsings terapeute in ‘n chirurgiese ISE geïmplementeer. Die tyd wat pasiënte geventileer is, die proporsie pasiënte wat geïntubeer en geherintubeer is in die tydperk, die lengte van ISE en hospitaal verblyf, mortaliteit, funksionele kapasiteit asook funksionele vaardigheid en koste (deur die verpleeg werkslading te gebruik as ‘n indikasie van koste) is gemeet. Resultate: Drie en vyftig navorsings verslae in agt onderwerp areas is geïdentifiseer, 23 konsep aanbevelings en 198 algoritme stellings is geformuleer. Die konsep protokol het uit vyf algoritmes bestaan. Vyftien internasionale en twaalf nasionale kundiges het die uitnodiging aanvaar om aan die delphi proses deel te neem. Konsensus is bereik vir die formulering van 87% (20/23) van die aanbevelings en die gradering van 66% (130/198) van die algoritme stellings. Die risiko vir ‘n ongunstige episode tydens die protokol intervensie periode was 6:1000 sessies (p=0.34). Pasiënte wat tydens die protokol intervensie periode tot die eenheid toegelaat is was minder geneig om geïntubeer te word (RR 0.16 95%CI 0.07 – 0.71; RRR 0.84 NNT 5.02; p=0.005) of om ‘n ekstubasie te faal (RR 0.23 95%CI 0.05 – 0.98; RRR =0.77 NNT 6.95; p=0.04). Die gemiddelde verskil in die daaglikse eenheid TISS-28 telling tussen die twee intervensie periodes was 1.99 95%CI 0.65 – 3.35 (p=0.04). Patiente wat tydens die protokol intervensie periode behandel is was geneig om vinniger uit die hospitaal ontslaan te word nadat hul uit die eenheid ontslaan is (p=0.05). Daar was geen verskil in die ventilasie tyd, (p=0.50) die mortaliteit (p=0.52) of die afstand wat pasiente in ses minute kon aflê binne 48 uur na ontslag uit die eenheid (p=0.65) nie. Daar was ook geen verskil in die proporsie pasiente wat onafhanklikheid bereik het in enige van die kategorieë van die Barthell Index instrument nie. Gevolgtrekking: Die gebruik van die protokol vir die omvattende hantering van pasiënte in ‘n chirurgiese eenheid is haalbaar en veilig. Die voorlopige resultate van hierdie studie dui daarop dat wanneer ‘n fisioterapie diens in ‘n chirurgiese ISE gelewer word aan die hand van ‘n bewysgesteunde protokol deur ‘n toegewyde fisioterapeut dit die potensiaal het om ISE koste te verminder en die funksionele herstel van pasiente na ontslag uit die eenheid te fasiliteer. Hierdie inligting kan nou deur administrateurs oorweeg word om ‘n optimale fisioterapie diens in ‘n chirurgiese ISE te verseker.

1. SOUHRN Název práce: Možnosti využití ájurvédy ve fyzioterapii Cíle práce: Na základě dvou kazuistik zhodnotit možnost využití jógové a marmové terapie ve fyzioterapii. Metody řešení: Případová studie dvou probandů s chronickými "bolestmi v kříži"; dvě ženy ve věku 22 let. Každodenní provádění jógové a marmové autoterapie po dobu jednoho měsíce. Zhodnocení účinnosti zvolené autoterapie na základě porovnání vstupního a výstupního kineziologického rozboru, testu s využitím manžety tonometru a dotazníků subjektivního hodnocení bolesti VAS a SF MPQ. Výsledky: U obou probandů došlo po aplikaci autoterapie k pozitivním změnám v kineziologickém rozboru, k pozitivním změnám při vyhodnocení testu s použitím manžety tonometru i k pozitivní změnám při hodnocení subjektivních bolestí v kříži pomocí dotazníku VAS i SF MPQ. Klíčová slova: ájurvéda, autoterapie, jóga, marmy, chronické bolesti v kříži

Název práce: Viscerovertebrální vztahy v praxi fyzioterapeuta Název v anglickém jazyce: Viscerovertebral relations in a physiotherapy practice Cíl práce: Cílem této diplomové práce je zpracovat dostupné informace a poznatky o viscerovertebrálních vztazích. Všechny viscerovertebrální vztahy vycházejí z velmi úzké propojenosti s autonomním nervovým systémem. Bylo snahou poukázat na problematiku vnímání hranic mezi zdravím a nemocí. Metoda: Diplomová práce je zpracována ve formě utříděné a komentované literární rešerše. Bylo použito několik dostupných zdrojů, z kterých byly čerpány informace a poznatky pro získání přehledu o dané problematice. Výsledky: Výsledky poukazují na rozdíly ve vnímání počátku nemoci a onemocnění vnitřního orgánu. Nelze stanovit přesné hranice mezi počátkem "vzniku onemocnění" a již nemocným vnitřním orgánem. Ale ještě dříve než je možné pozorovat onemocnění vnitřního orgánu pomocí interních vyšetření, lze pozorovat reflexní změny a funkční poruchy pohybového aparátu související a poukazující na onemocnění vnitřního orgánu. Díky pozornému přístupu fyzioterapeuta během odebírání anamnézy a následné vyšetření a vyhledávání souvislostí (např. opakující se funkční poruchy, reflexní změny - Headovy zóny, atd.), lze často předejít dalším komplikacím souvisejícím s nerozpoznaným...

La présente étude a pour objet de questionner le concept de pédagogie somatopsychique en formation initiale de masso-kinésithérapie, d'en explorer les fondements théoriques, de réfléchir à une démarche pédagogique pour la mettre en œuvre et d'interroger les conditions de cette mise en œuvre. Une méthodologie basée sur des enquêtes menées auprès d’étudiants et d’instituts de formation en masso-kinésithérapie sur le territoire français a permis de recueillir des informations sur les conditions optimales de mise en place d’un tel enseignement. Les résultats montrent l’intérêt d’un enseignement structuré qui peut contribuer à développer, dés le début du cursus de formation en masso-kinésithérapie, une posture d’éducateur en santé facilitant in fine l’autonomisation du patient quant à la gestion de sa problématique de santé. / This study is designed to question the concept of somatopsychic pedagogy in initial training of physiotherapy, to explore the theoretical foundations, to reflect on a pedagogical approach to implement the strategy and to examine the conditions of this implementation. A methodology based on surveys conducted among students and training institutes in physiotherapy on the French territory allowed to gather information on the optimum conditions for establishment such a teaching. The results show the interest of a structured teaching which can help to develop, in the beginning of the curriculum for training in physiotherapy, a health educator posture facilitating ultimately empowering the patient with respect to the management of his health problem.