Little or no research has been conducted to explore patients' expectations of physiotherapy, or the effect that pre-conceived expectations might have on the outcome of treatment. This thesis aimed to fill that void. Stage one involved a review of the literature to develop a conceptual framework and understanding of expectations and how they may affect outcome. Stage two explored the evidence regarding the role of patients' expectations of physiotherapy and the impact that such expectations may have on the outcome of treatment. Three studies were carried out (1) a Delphi study with physiotherapists; (2) exploratory interviews with patients; and (3) the development and testing of a questionnaire. Stage three examined the relationship between patients' expectations of benefit and the outcome of physiotherapy using a postal survey of patients, with upper or lower limb musculoskeletal problems. Stage four consisted of a randomised-controlled trial aimed at determining whether manipulation of patients' expectations of benefit could influence treatment outcome in patients with non-traumatic knee problems. The results from stage one suggested that patient expectations were likely to be associated with patients' previous experiences of physiotherapy, anecdotal knowledge, preferences, expectation of benefit, time related issues, such as duration of condition (chronicity), educational level and work status. In stage two, the Delphi study with thirteen physiotherapists, resulted in a list of factors, ranked in order of importance, that they believed may influence the outcome of physiotherapy. The list concurred with the literature. Twelve patients were then interviewed. They generally had a positive view of physiotherapy, understood why they needed to have physiotherapy, but had limited knowledge of what physiotherapy is, what physiotherapists do or what level of involvement that they would have in their treatment. Their knowledge came mainly from first-hand or anecdotal experience of physiotherapy. Finally, a questionnaire was developed to gather information on patients' expectations and tested on 18 patients. The survey in stage three (n=289) found statistically significant positive relationships (p<0.002) between expectations of benefit before treatment and trauma, upper limb problems, locus of control and satisfaction with the health care received so far. Furthermore, negative relationships were found between the expectations variable and duration of condition and previous experience of physiotherapy. A statistically significant positive relationship (p<0.004) was also found between expectations of benefit and treatment outcome in terms of change in functional disability, perceived improvement, change in health status and satisfaction. Finally, 95 patients with nontraumatic knee problems participated in the randomised controlled trial in stage four. However, the results found no evidence that the intervention, through changes In expectations or locus of control, improved the outcome of physiotherapy. The research carried out in this thesis appears to support the notion that the characteristics that patients demonstrate in terms of their beliefs, perceptions and cognitions appear to have some influence on the course of their physiotherapy. The findings suggest that physiotherapists need to be more aware of the psychological attributes of their patients as well as the effect that their intervention (communication, handling and therapeutic) has on their patients' beliefs, perceptions and cognitions. However, further research is needed to determine whether, and by what means, patients' expectations can be influenced to improve the outcome of physiotherapy.

The physiotherapist-patient interaction is the medium through which physiotherapy is practiced. However, to date little physiotherapy research literature reports on physiotherapists' interactive behaviours in clinical practice. The objectives of this study were to explore, interpret and describe experienced cardiorespiratory physiotherapists' understandings of their interactive behaviours when treating chronically breathless patients and to make recommendations for practice. The study is located in the interpretive research paradigm. It has adopted a hermeneutic phenomenological approach underpinned by a relativist ontological stance and Gadamerian philosophy (1975/2004). Five experienced cardiorespiratory physiotherapists' were video recorded in a natural treatment setting with a chronically breathless patient. Data were generated through a video-cued recall and reflection, and a follow-up interview with each physiotherapist. Three themes were derived from the physiotherapists' accounts: 'Creating a facilitative space', 'Accessing and attending to your world' and 'Sharing my world'. These were considered to be key dimensions of physiotherapists' understandings of their interactive behaviours. The concept of 'Merging Worlds - facilitating the journey to a shared understanding and purpose, and safe achievement of purpose' draws together these key dimensions and represents the nature of the interactional behaviours of experienced physiotherapists when managing chronically breathless patients. The challenge of explicating tacit practice knowledge was observed during the process of data generation. This issue was considered alongside the thematic interpretation and the concept of 'Merging Worlds' to inform the development of a new model of physiotherapy practice: Mindful, Reciprocal Interaction. A series of questions to facilitate explication of, and critical reflection on interactive behaviours were developed for use by physiotherapists to enhance their interactive behaviours during encounters with patients. The findings of this study provide new knowledge for physiotherapy practice.

Rationale: The prevalence of low back pain and associated costs to society are high. Despite this, the number of studies investigating observational data on the quality and costs of care in routine health care services, such as chiropractic, is relatively small in comparison to the clinical trial evidence available on the effectiveness and cost-effectiveness of manual therapies for low back pain. Objective: To document the quality and cost of care in low back pain patients undergoing routine chiropractic care in the United Kingdom. Design: Prospective single cohort multi-centre study. Participants: A sample of 120 chiropractors and 421 patients. Methods: Following the development of a data collection instrument and a pilot study, patients suffering from low back pain were recruited by chiropractic clinics in the United Kingdom. Information was recorded using a patient self-report questionnaire at baseline prior to the initial consultation, and participants were mailed a follow-up questionnaire at three months. Health outcomes, patient experiences of the process and safety of care, and related costs in the intervening three month period were documented. Results: Four hundred and twenty-one patients formed the baseline sample, and 238 (57%) of these returned the follow-up questionnaire at three months. Statistically significant change scores (p = 0.0001) were seen for the health status measures including the Roland-Morris Disability Questionnaire, Bournemouth Questionnaire, EuroQol-5D and bothersomeness scale. One hundred and sixty-eight of 238 (70%) patients reported a clinically significant improvement on the Perceived Global Effect scale, and 73 (31%) of these were considered recovered anytime during the study period using definitions of recovery (i.e. acceptable quality of life, no disability and no pain for a whole month). One hundred and twenty-nine (54%) of patients at follow-up rated chiropractic care for their low back condition as ‘very helpful’. The number of patients rating the process of care (i.e. time and explanations given by chiropractor as well involvement in decisions about care) as ‘very good’ ranged from 157 to 168 (66% to 71% respectively of the patients at follow-up). One hundred and twenty-five (52%) of patients at follow-up reported adverse events of care (i.e. worsening of their back pain, stiffness, soreness and/or general discomfort immediately or shortly after the chiropractic treatment visits); however, only 13 (5%) of these reported that they were unable to carry on with their usual activities and/or work as a result of these events. On average, the total cost of care was £481.83 (95% CI = 333.17 to 639.42) per patient. Lost productivity resulting from time away from work was the most important contributor to these costs (59.6%). The cost of chiropractic visits was the second most important contributor, which accounted for nearly one-third of total costs (32.8%). Other health care usage including general practitioner visits, medical procedures and diagnostic imaging were responsible for a small proportion of total costs ranging from 0.4% to 1.6%. Conclusions: This programme of research is the first prospective study conducted in routine chiropractic practice simultaneously documenting information about health outcomes and patient experiences and costs of care. Patients improved markedly within the first three months of care and expressed high satisfaction with the chiropractic treatment and consultation they received. Chiropractic care was relatively safe, with common yet benign adverse events that had little influence on activities of daily living. Taken overall, patients receiving chiropractic care reported improvement at arguably reasonable cost, suggesting this approach to the health care of patients with low back pain be considered in the wider context of health care delivery in the United Kingdom.

No description available.

Orientadora : Profª. Drª. Vera Lúcia Israel / Dissertação (mestrado) - Universidade Federal do Paraná, Setor de Ciências Biológicas, Programa de Pós-Graduação em Educação Física. Defesa: Curitiba, 11/03/2013 / Bibliografia : fls. 78-91 / Área de concentração: Exercício e esporte / Resumo: O presente estudo teve como objetivo analisar o desenvolvimento neuropsicomotor de crianças de zero a três anos de idade frequentadoras de Centros de Educação Infantil (CEI's) do Ensino Público e verificar os fatores de risco associados ao desenvolvimento das mesmas. A pesquisa é caracterizada como estudo observacional, analítico, transversal. Participaram do estudo 77 crianças de zero a três anos de idade, matriculadas nos CEI's públicos do Município de Matinhos/PR. A abordagem do desenvolvimento infantil foi contextual, por meio de avaliação fisioterapêutica lúdica com Teste de Triagem de Denver II, também foram realizadas avaliações complementares do estado nutricional, por meio das medidas antropométricas. Para análise foi realizada uma regressão logística utilizando como seleção de modelo Logit com resposta binária e método Stepwise (Backward). O desenvolvimento neuropsicomotor encontrou-se dentro dos parâmetros de normalidade em 68,8% (n=53) e com riscos de atrasos em 31,2% (n=24). Na escala utilizada a área de melhor desempenho foi a motora fina - adaptativa (3,75%) e a mais questionável foi da linguagem (57,5%). Quanto à avaliação nutricional foi acurado que 48% (n=37) das crianças estavam eutróficas e 52% (n=40) apresentaram algum risco nutricional, sendo que 1 criança (1,3%) apresentou desnutrição pregressa, 25 crianças (32,5%) tiveram risco de sobrepeso e 14 crianças (18,2%) apresentaram obesidade. Na análise, pela regressão logística, verificou-se que o baixo peso ao nascer (OR= 181), a renda familiar mensal (OR=9) e a ausência do pai (OR=34) são fatores estatisticamente significantes sobre o risco de atrasos em seu desenvolvimento. Este estudo reforça a natureza sistêmica e multifatorial do desenvolvimento e comprova a necessidade de acompanhamento e monitoramento, especialmente em crianças com condições desfavoráveis, uma vez que a intensa neuroplasticidade nos primeiros anos de vida, a interação entre indivíduo, ambiente e tarefa, bem como a suscetibilidade à estimulação, repercutirão em mudanças no comportamento motor. Nota-se que é preciso um aprofundamento na investigação nos resultados para minimizar o risco de atraso no desenvolvimento neuropsicomotor das crianças participantes, afim de que se tenha uma estimulação adequada no desenvolvimento infantil, tanto na família quanto nas instituições de educação infantil. / Abstract: The present study aimed to analyse the neuropsychomotor development of children aged zero to three years attending the Early Childhood Education Centers (ERC's) of the public education and to check the risk factors associated with the development of the child. The research is characterized as observational, analytical, cross. The study included 77 children aged zero to three years, enrolled in public ERC's of Matinhos/PR. The approach of development was contextual, through playful physical therapy evaluation with Denver Screening Test II, it was also carried out further assessments of nutritional status (anthropometric measures). For analysis it was performed logistic regression using as model selection Logit with binary response and stepwise method (backward). Neuropsychomotor development was found within normal limits in 68.8% (n = 53) and with risks of delays in 31.2% (n = 24). In the used scale, the area with the best performance was the fine motor - Adaptive (3.75%) and the more questionable was language (57.5%). As for nutritional assessment it was ascertained that 48% (n = 37) of the children were normal weight and 52% (n = 40) showed some nutritional risk, and 1 child (1.3%) showed stunted, 25 children (32, 5%) were at risk for overweight and 14 children (18.2%) were obese. In logistic regression analysis it was found that low birth weight (OR = 181), the monthly household income (OR = 9) and the absence of the father (OR = 34) are statistically significant factors on the risk of delays in its development. This study reinforces the systemic and multifactorial nature of development and demonstrates the need for tracking and monitoring, especially in children with unfavorable conditions, since the intense neuroplasticity in early life, the interaction between individual, task and environment, as well as susceptibility to stimulation, reflects on changes in motor behavior. It was noticed that it's necessary a deeper investigation in the results to minimize the risk of neuropsychomotor developmental delay in children, so that an adequate stimulation on children's development may be reached, both in the family and in the educational institutions.

Introduction The centrality of the patient to health care has been increasingly recognised both politically and professionally. Patient-centred care has become synonymous with high-quality care and a number of studies have reinforced patient's desire for, and the positive impact of the approach. Although the concept emerged over 30 years ago, it is still not clear what it is, upon what theories it is based, or how to measure it. Whilst the concept has been explored within medicine, nursing and other allied health professions, within physiotherapy there has only been minimal discussion. The aim of this research was to explore the meaning of patient-centred care in relation to low back pain, from the perspective of musculoskeletal physiotherapists. Methods Purposive sampling was initially used to select participants. Subsequently theoretical sampling was adopted whereby analysis of the data informed the sample selection. Nine musculoskeletal physiotherapists agreed to participate in the study. They ranged in experience from five to 25 years. Individual semi- structured interviews were adopted as the method of data collection. The interviews were audio taped and then transcribed verbatim. Analysis broadly followed the Grounded Theory approach outlined by Strauss and Corbin (1990). It consisted of a process of open, axial and selective coding. Constant comparative analysis resulted in the identification with a core category and three inter-related sub-categories and the development of a substantive theory of patient-centred care.

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.

No description available.

La lombalgie est un problème de santé public induisant de nombreuses répercussions sur le plan économique et social. Le passage à la chronicité concerne moins de 10% des lombalgies, mais représente 85% des coûts liés à la prise en charge de cette pathologie. Dans ce contexte, il parait indispensable de pouvoir optimiser les programmes de réentrainement à l’effort du lombalgique chronique afin de les rendre le plus efficace et le plus pertinent possible. Ce travail de thèse a pour objectif d’évaluer les facteurs mécaniques des membres inférieurs au moyen des relations moment-vitesse dans des conditions isocinétiques. Dans une première étude, nous avons évalué les muscles extenseurs du genou et les muscles fléchisseurs et extenseurs du tronc chez des sujets lombalgiques et des sujets sains. Nous avons, ainsi mis en évidence une faiblesse significative au niveau de la force et de la puissance des muscles extenseurs du genou chez les sujets lombalgiques associée à la faiblesse musculaire du tronc classiquement évoquée pour cette population. Après avoir mis en place, dans une seconde étude, un protocole d’évaluation permettant d’établir des relations moment- et puissance-vitesse pour les muscles extenseurs et fléchisseurs de la hanche, nous avons évalué la force et la puissance de ces groupes musculaires chez des sujets lombalgiques. Les résultats ont, comme pour la première étude, mis en avant une faiblesse significative au niveau de la force et de la puissance de ces groupes musculaires, par rapport à des sujets sains, avec un déficit plus marqué au niveau des extenseurs, comme pour le tronc. L’ensemble des résultats obtenus dans le cadre de ce travail de thèse démontre qu’il est important de proposer un travail de force et de puissance au niveau des membres inférieurs pour les patients lombalgiques chroniques afin de mieux lutter contre le syndrome de déconditionnement qui touche l’ensemble des chaines musculaires des patients. / Low back pain is a public health problem inducing economical and social consequences. Chronicity involves less than 10% of low back pain, but represents 85% of the total costs related to this pathology. In this context, it seems essential to optimize chronic low back pain rehabilitation programs to make them more effective and relevant. The purpose of this phD was then to evaluate lower limbs mechanical factors using torque- and power-velocity relationships. In a first study, knee extensors muscles and trunk flexor and extensor muscles were evaluated in chronic low back pain and healthy subjects. A significant knee extensor strength and power weakness weas observed for chronic low back pain subjects, associated with the typical trunk weakness referred to this population. The second study focused on establishing a protocol allowing assessing hip flexor and extensor torque- and power-velocity relationships. This protocol was then applied to evaluate flexor and extensor hip muscles in chronic low back pain subjects. Results, in accordance with the first study, highlighted a significant strength and power weakness for hip muscle groups in chronic low back pain relative to healthy subjects, with a greater hip extensor deficit, as it is generally observed for the trunk.In conclusion, these different studies showed the importance of proposing torque and power lower limbs rehabilitation for chronic low back pain patients to better fight against the deconditioning syndrome that affects all muscular chains in this population.

Après avoir été contre-indiquée, l’activité physique prend une place de plus en plus importante dans la prise en charge de la sclérose en plaques (SEP). L’entraînement à intensité faible ou modérée est largement documenté, contrairement à la haute intensité. Ce travail s’est intéressé aux effets de l’entraînement en intervalle à haute intensité combiné au renforcement musculaire durant 12 semaines chez 26 patients atteints de SEP. Nos résultats indiquent que la consommation pic d’oxygène, la puissance maximale tolérée, la force isocinétique des quadriceps et ischio-jambiers, ainsi que la qualité de vie sont améliorées. Les femmes présentent des améliorations plus importantes et plus nombreuses que les hommes, cependant le niveau de handicap ne semble pas limiter les améliorations. Notre travail a permis de démontrer que l’entraînement en intervalle à haute intensité combiné au renforcement musculaire est bien toléré et permet des améliorations des capacités physiques et de la qualité de vie. / After being contraindicated, physical activity take an increasingly important place in the management of multiple sclerosis (MS). The training at mild to moderate intensity is widely documented, contrary to the high intensity training. This work has focused on the effects of high intensity interval training combined with resistance training during 12 weeks in 26 MS patients. Our results show that peak oxygen consumption, maximum tolerated power, isokinetic muscle strength in both quadriceps and hamstrings and quality of life are improved. Women show more important and more numerous improvements than men, however, the disability level does not seem to limit improvements. Our work has demonstrated that high intensity interval training combined with resistance training is well tolerated and allows physical capacities and quality of life improvements.