Fatigue is a distressing, complex, and multidimensional sensation, that is common in individuals with chronic obstructive pulmonary disease (COPD), and impacts negatively on their functioning and quality of life. Limited research has been conducted to examine how various factors may influence the different dimensions of subjective fatigue experienced in these individuals. Four dimensions of subjective fatigue including: emotional, behavioural, cognitive, and physical, were examined in a convenience sample of 42 participants with COPD who attended an outpatient pulmonary rehabilitation program. The primary purpose of this feasibility study was to determine the proportion of individuals experiencing the four dimensions of fatigue, and to examine the relationships between these dimensions of fatigue and various influencing factors (dyspnea, depression, anxiety, sleep quality, activity limitation, heart rate, and oxygen saturation). The secondary purpose was to compare the four dimensions of fatigue by sex, supplemental oxygen use, smoking status, and severity of dyspnea, and to examine the relationships between the four dimensions of fatigue and age, the number of co-morbidities, and the amount of pulmonary rehabilitation received. Self-report questionnaires were used to measure fatigue (Multidimensional Fatigue Inventory MFI), anxiety and depression (Hospital Anxiety and Depression Scale HADS), and sleep quality (Pittsburgh Sleep Quality Index PSQI). Pulmonary rehabilitation health records were accessed to collect data on the remaining variables. The majority of the participants (61.9% - 81.0%) experienced moderate levels of subjective fatigue in all four dimensions. Moderate to severe levels of physical fatigue were experienced in 95.3% of the participants. The only significant relationship was between anxiety and emotional fatigue; all other relationships were statistically insignificant. There were no significant differences between sex, supplemental oxygen use, smoking status, and severity of dyspnea on the four dimensions of subjective fatigue. Many of the participants had probable presence of clinical anxiety (42.9%), where the prevalence of anxiety was nearly twice as high as depression (21.4%). Findings from this study can be used by healthcare professionals to gain a better understanding of fatigue in individuals with COPD who attend pulmonary rehabilitation, and help in developing effective interventions for reducing the distressing effects of fatigue.

Utmanande beteende kan ofta innebära aktivitetsinskränkningar för individer som lider av beteendet men även för omgivningen. Detta innebär färre möjligheter till aktivitet och delaktighet och riskerar att gå ut över livskvalitén. Idag saknas ett fokus för att utveckla arbetsterapeutiska metoder inom området och forskningen som finns är begränsad. Syftet med examensarbetet var att visa vilka arbetsterapeutiska metoder som beskrivs i litteraturen för att minska utmanande beteende. Studiedesignen som användes var scoping review. Databaserna som användes var AMED, CINAHL, MEDLINE och PsycINFO. Inklusionskriterier för artiklarna var att de var tillgängliga i fulltext, skrivna på engelska och publicerade mellan 2003 och 2018. Sökning resulterade i 124 träffar varav 13 var dubbletter. Resultatet inkluderade 20 artiklar som motsvarade syftet varav 13 var publicerade i USA. Resultatet visade en stor bredd av metoder som delades in i fyra nyckelområden: aktivitetsbaserade metoder, miljöbaserade metoder, sensoriska metoder samt stöd och strategier. Detta är ett relativt outforskat område där det finns stora möjligheter för arbetsterapeuter att bidra med sin kompetens. / Challenging behaviour often results in occupational limitations for the individual that suffer from the behaviour, but also for their surroundings. This entails reduced possibilities to activity and participation which will affect their quality of life. There is a lack of focus on developing occupational therapeutic methods within this area today, also the current research within the field is limited. The aim of this bachelor thesis was to explore occupational therapeutic methods described in the literature to reduce challenging behaviour. Scoping review was used as study design. In AMED, CINAHL, MEDLINE and Psycinfo were 124 articles found, 13 of these were doublets. The result included 20 articles corresponding to the aim, 13 of these were published in USA. and 20 articles which corresponded to the aim was included in the results. All included articles were available in full text, written in english and published between 2003- 2018. A wide range of methods were shown in the results. These were categorized into four key issues: activity based methods, environmental methods, sensory methods and support and strategies. This field is relatively unexplored and there are large possibilities for occupational therapists to contribute with competence.

FundaÃÃo Cearense de Apoio ao Desenvolvimento Cientifico e TecnolÃgico / Caracterizar as incapacidades fÃsicas, a limitaÃÃo de atividade e restriÃÃo da participaÃÃo social de pessoas no momento pÃs-alta de hansenÃase diagnosticadas no perÃodo de 2004-2006 no MunicÃpio de Fortaleza/CE. METODOLOGIA. Estudo transversal realizado em unidades bÃsicas de saÃde da Secretaria Executiva Regional III, no perÃodo de agosto de 2008 a maio de 2009. Foram avaliados 45 pacientes em pÃs-alta de hansenÃase. Realizou-se avaliaÃÃo simplificada das funÃÃes neurais. AlÃm disso, foram aplicados a escala Triagem para LimitaÃÃo de Atividade e ConsciÃncia de Risco (âSALSAâ) e a escala de ParticipaÃÃo Social. RESULTADOS. A populaÃÃo do estudo foi composta em sua maioria por mulheres (60%), com idade mÃdia de 53,5 anos. Os participantes, em sua maioria, eram multibacilares (55,6%). Constatou-se um aumento de pacientes com graus 1 e 2 na atualidade, comparado com o momento da alta da poliquimioterapia. 60% dos pacientes apresentaram escore EHF (eye, hand, foot) 0. A maioria (84,4%) dos pacientes nÃo apresentou restriÃÃo à participaÃÃo social, 66,6% nÃo apresentaram limitaÃÃo funcional, mas 75,5% exibiram consciÃncia de risco 0. Houve correlaÃÃes significativamente positivas entre os escores SALSA e EHF (p=0,0254; rho=0,3330), SALSA e ParticipaÃÃo Social (p=0,0004; rho=0,5056) e ParticipaÃÃo Social e EHF (p=0,0100; 0,3800). CONCLUSÃES. Existe necessidade da continuidade da assistÃncia visando à integralidade da atenÃÃo, de forma a assegurar aÃÃes preventivas, curativas e de reabilitaÃÃo. O perÃodo pÃs-alta da doenÃa necessita de cuidados e acompanhamento dos pacientes, em razÃo do risco do desenvolvimento de reaÃÃes, incapacidades fÃsicas e restriÃÃo à participaÃÃo social dos indivÃduos. / To describe clinical and psychosocial aspects of leprosy patients after release from treatment, who were diagnosed from 2004-2006 in the city of Fortaleza (Cearà State, Brazil); to describe in these patients activity limitation, safety awareness and social participation. METHODS. A cross-sectional study was carried out in primary health care centers of Fortaleza, from August 2008 to May 2009. Forty-five patients after release from treatment were included. A structured questionnaire was applied, and neural functions of peripheral nerves were assessed. In addition, the Screening of Activity Limitation and Safety Awareness (SALSA) and the Social Participation scale were applied. RESULTS. The majority of the study population consisted of females (60%), with a mean age of 53,5 years, mainly of underprivileged socio-cultural status. 55,6% were classified as multibacillary. We observed an increase of disability grading 1 and 2, as compared to the date of release from treatment with multidrug therapy. Sixty % of the patients presented with an EHF score of 0. The majority (84,4%) did not show any restriction of social participation, 66,6% did not have any functional limitation, and 75,5% did not present any safety awareness. There was a positive correlation between SALSA and EHF scores (p=0,0254; rho=0,3330), SALSA and Social Participation (p=0,0004; rho=0,5056), and Social Participation and EHF score (p=0,0100; rho=0,3800). CONCLUSIONS. Considering the fact that a considerable part of patients presented with sequels and light functional limitations, and that few had low safety awareness, we conclude that patients need special attention after release from multidrug therapy. Health education activities should be intensified, as the majority of patients, even after treatment, had limited knowledge about the disease and as a considerable part suffered from discrimination.

Regional Differences in Healthy Life Expectancy in Czechia Abstract Over the past decade, the health status of the population has also been measured by Healthy Life Expectancy indicator. This indicator covers not only the quantitative aspect, but it takes into the account also the qualitative aspect of prolonging human life. The main objective of this thesis is to evaluate the differences in healthy life expectancy among the regions of Czechia, both in terms of space and time (2009-2014). The introductory part of the thesis outlines the connections of the origin of the healthy life expectancy indicator and analyses the methods of its construction. The theoretical part of the thesis also includes description of sample surveys. To calculate healthy life years, the Sullivan method is used. Data on health status were obtained from the SILC survey. According to the results of the analysis, there is considerable variability between regions in terms of healthy life expectancy. The difference is significantly higher in terms of healthy life expectancy than in the case of life expectancy. A more detailed analysis of the distribution of the healthy life expectancy values has revealed that there is a certain "paradox" of healthy life expectancy in relation to life expectancy, since there are regions where the high...

<p>The World Health Organisation estimates that the majority of the disabled population resides in the developing world, but most of the research on outcomes of patients originates from the developed world. In the light of the differences in healthcare structures and function, especially rehabilitation between settings and countries, it is imperative to have an understanding of the&nbsp / functioning of patients at discharge with the objective of measuring the level at which outcomes are met. The aim of this study was therefore to determine the process of rehabilitation and the&nbsp / outcome of patients following in-patient rehabilitation at a facility in the Western Cape. A quantitative research design was employed to address the objectives. Self-administered&nbsp / questionnaires were developed to collate information pertaining to the demographic-, socioeconomic- and medical profile of patients and data extraction sheets collected information relating&nbsp / to the process of rehabilitation and the impairment status of patients on admission. With regards to activity and participation, a longitudinal study design was used, which utilised standardised&nbsp / outcomes measures. The sample consisted of all patients with stroke and spinal cord injury admitted within a three-month period, and all ethical principles relating to research on human&nbsp / subjects, as stipulated in the Helsinki Declaration were adhered to during data collection, with ethical clearance obtained from relevant authorities. The SAS and the Microsoft Excel Package&nbsp / 2007 were used to analyse the quantitative data elements. Descriptive statistics using frequencies, percentages, ranges, means, and standard deviations and inferential statistics using&nbsp / chi-square, student T-tests and correlation tests, for determining the predictors of functional outcome, were calculated. There were 175 patients, whereof 82 were patients with stroke and 93&nbsp / with spinal cord injury, with 143 (76 presenting with spinal cord injury and 67 with stroke) meeting the inclusion criteria on admission. The mean age of those with spinal cord injury and stroke&nbsp / was 34.14 and 52.95 years. Most of the patients with spinal cord injuries were single (73.68%), whereas the majority (53.73%) of patients with strokes were married at the time of injury. All&nbsp / patients were managed by the doctor and the nurse, with most of the patients receiving physiotherapy, occupational therapy and social assistance from the social worker. With regards to recreational activities, 46.87% of patients with spinal cord injury and 39.39% of those with stroke attended the learn to swim programme, and 29.68% of patients with spinal cord injury attended the wheelchair basketball sessions. The mean length of hospital stay for patients with spinal cord injury and stroke was 73.11 and 51. 62 days, with most of the spinal cord injured patients&nbsp / (80.26%) and stroke patients (82.08%) discharged home without follow-up rehabilitation. The most prevalent impairments on admission of the spinal cord injury cohort were muscle&nbsp / weakness (75.0%), bladder incontinence (71.1%) and reduced sensation (69.7%), whereas patients with stroke presented mostly with muscle paralysis (80.6%), abnormal tone (76.1%) and aphasia (50.8%). Functional limitations experienced by the participants included, mobility, stair climbing and transfers. The participants experienced participation restrictions in the following&nbsp / domains, leisure activities and employment. A clinical significant improvement was noted in execution of functional task of patients with spinal cord injury (p&lt / 0.0001) and stroke (p&lt / 0.0001)&nbsp / between admission and discharge. A significant statistical change was also detected for the participation elements of both stroke and spinal cord injury cohorts. Functional ability on&nbsp / admission was found to be a predictor of functional outcome of the stroke diagnostic group at discharge, whereas the multiple&nbsp / redictor model of functional outcome of the spinal cord injured cohort at discharge was significant with remaining variables of functional outcome score on admission (p&lt / 0.0001) and bladder -and bowel impairment(s) (p=0.0247). The study findings suggest that despite the significant change in activity and participation, most of the patients were discharged home without further follow-up for rehabilitation, irrespective of the activity&nbsp / limitations and participation restrictions still experienced at the time of discharge. The latter finding&nbsp / questions the duration of the length of hospital stay, which does not allow patients to be independent in all meaningful activities and participatory actions and roles by the end of inpatient rehabilitation. The study findings could assist authorities to adapt the existing rehabilitation&nbsp / programme and referral process . </p>

Obesity and physical inactivity are major risk factors for numerous chronic diseases, conditions, and early mortality. Healthy body weight and physical activity (PA) are also positively associated with health-related quality of life (HRQL). However, obesity and physical inactivity levels in Canadian youth and adults are high. This thesis comprises five studies exploring the burden of obesity and physical inactivity, focusing on HRQL. The first study assessed PA research productivity in Canada from 1990-2005. Canada produced approximately 5% of global PA research, 50% originating from Ontario, the biomedical and clinical areas accounting for 40% each; however, research in population health and health services was lacking. The second study used data from the Physical Activity Longitudinal Study (PALS), the 22-year follow-up of the 1981 Canada Fitness Survey, to assess PA and obesity tracking from youth to adulthood. Over 80% of overweight/obese youth became overweight/obese adults, while the majority of overweight/obese adults had not been overweight/obese youth; almost all healthy weight adults had been healthy weight youth. PA did not track over 22 years. The third study used the PALS data to examine the long-term effect of youth BMI and PA on adult HRQL (SF-36), using dichotomized outcomes based on Canadian norms. Contrary to expectations, overweight youth were more likely than healthy weight youth to score at/above the norm in adult HRQL, especially in the mental health domains. Youth PA was not associated with adult HRQL. The fourth study used the same data to explore the youth BMI-adult HRQL relationship using continuous outcomes, by sex. Youth BMI was positively associated with mental HRQL in adult females only; no negative impacts emerged. The fifth study used the Canadian Community Health Survey (CCHS) Cycle 3.1 data to investigate the combined association of PA and BMI to HRQL among Canadian adults, including self-rated health, participation/activity limitation, and total disability days, by age and sex. Inactive individuals had increased odds of adverse HRQL, regardless of weight status; underweight, overweight, and obesity were of little consequence for active individuals. Collectively, these results help to better understand the health burdens created by the current epidemics of obesity and physical inactivity in Canadians throughout their lifespans. / Thesis (Ph.D, Kinesiology & Health Studies) -- Queen's University, 2010-12-08 18:00:44.214

<p>The World Health Organisation estimates that the majority of the disabled population resides in the developing world, but most of the research on outcomes of patients originates from the developed world. In the light of the differences in healthcare structures and function, especially rehabilitation between settings and countries, it is imperative to have an understanding of the&nbsp / functioning of patients at discharge with the objective of measuring the level at which outcomes are met. The aim of this study was therefore to determine the process of rehabilitation and the&nbsp / outcome of patients following in-patient rehabilitation at a facility in the Western Cape. A quantitative research design was employed to address the objectives. Self-administered&nbsp / questionnaires were developed to collate information pertaining to the demographic-, socioeconomic- and medical profile of patients and data extraction sheets collected information relating&nbsp / to the process of rehabilitation and the impairment status of patients on admission. With regards to activity and participation, a longitudinal study design was used, which utilised standardised&nbsp / outcomes measures. The sample consisted of all patients with stroke and spinal cord injury admitted within a three-month period, and all ethical principles relating to research on human&nbsp / subjects, as stipulated in the Helsinki Declaration were adhered to during data collection, with ethical clearance obtained from relevant authorities. The SAS and the Microsoft Excel Package&nbsp / 2007 were used to analyse the quantitative data elements. Descriptive statistics using frequencies, percentages, ranges, means, and standard deviations and inferential statistics using&nbsp / chi-square, student T-tests and correlation tests, for determining the predictors of functional outcome, were calculated. There were 175 patients, whereof 82 were patients with stroke and 93&nbsp / with spinal cord injury, with 143 (76 presenting with spinal cord injury and 67 with stroke) meeting the inclusion criteria on admission. The mean age of those with spinal cord injury and stroke&nbsp / was 34.14 and 52.95 years. Most of the patients with spinal cord injuries were single (73.68%), whereas the majority (53.73%) of patients with strokes were married at the time of injury. All&nbsp / patients were managed by the doctor and the nurse, with most of the patients receiving physiotherapy, occupational therapy and social assistance from the social worker. With regards to recreational activities, 46.87% of patients with spinal cord injury and 39.39% of those with stroke attended the learn to swim programme, and 29.68% of patients with spinal cord injury attended the wheelchair basketball sessions. The mean length of hospital stay for patients with spinal cord injury and stroke was 73.11 and 51. 62 days, with most of the spinal cord injured patients&nbsp / (80.26%) and stroke patients (82.08%) discharged home without follow-up rehabilitation. The most prevalent impairments on admission of the spinal cord injury cohort were muscle&nbsp / weakness (75.0%), bladder incontinence (71.1%) and reduced sensation (69.7%), whereas patients with stroke presented mostly with muscle paralysis (80.6%), abnormal tone (76.1%) and aphasia (50.8%). Functional limitations experienced by the participants included, mobility, stair climbing and transfers. The participants experienced participation restrictions in the following&nbsp / domains, leisure activities and employment. A clinical significant improvement was noted in execution of functional task of patients with spinal cord injury (p&lt / 0.0001) and stroke (p&lt / 0.0001)&nbsp / between admission and discharge. A significant statistical change was also detected for the participation elements of both stroke and spinal cord injury cohorts. Functional ability on&nbsp / admission was found to be a predictor of functional outcome of the stroke diagnostic group at discharge, whereas the multiple&nbsp / redictor model of functional outcome of the spinal cord injured cohort at discharge was significant with remaining variables of functional outcome score on admission (p&lt / 0.0001) and bladder -and bowel impairment(s) (p=0.0247). The study findings suggest that despite the significant change in activity and participation, most of the patients were discharged home without further follow-up for rehabilitation, irrespective of the activity&nbsp / limitations and participation restrictions still experienced at the time of discharge. The latter finding&nbsp / questions the duration of the length of hospital stay, which does not allow patients to be independent in all meaningful activities and participatory actions and roles by the end of inpatient rehabilitation. The study findings could assist authorities to adapt the existing rehabilitation&nbsp / programme and referral process . </p>

Magister Scientiae (Physiotherapy) - MSc(Physio) / The World Health Organisation estimates that the majority of the disabled population resides in the developing world, but most of the research on outcomes of patients originates from the developed world. In the light of the differences in healthcare structures and function, especially rehabilitation between settings and countries, it is imperative to have an understanding of the functioning of patients at discharge with the objective of measuring the level at which outcomes are met. The aim of this study was therefore to determine the process of rehabilitation and the outcome of patients following in-patient rehabilitation at a facility in the Western Cape. A quantitative research design was employed to address the objectives. Self-administered questionnaires were developed to collate information pertaining to the demographic-, socioeconomic- and medical profile of patients and data extraction sheets collected information relating to the process of rehabilitation and the impairment status of patients on admission. With regards to activity and participation, a longitudinal study design was used, which utilised standardised outcomes measures. The sample consisted of all patients with stroke and spinal cord injury admitted within a three-month period, and all ethical principles relating to research on human subjects, as stipulated in the Helsinki Declaration were adhered to during data collection, with ethical clearance obtained from relevant authorities. The SAS and the Microsoft Excel Package 2007 were used to analyse the quantitative data elements. Descriptive statistics using frequencies, percentages, ranges, means, and standard deviations and inferential statistics using chi-square, student T-tests and correlation tests, for determining the predictors of functional outcome, were calculated. There were 175 patients, whereof 82 were patients with stroke and 93 with spinal cord injury, with 143 (76 presenting with spinal cord injury and 67 with stroke) meeting the inclusion criteria on admission. The mean age of those with spinal cord injury and stroke was 34.14 and 52.95 years. Most of the patients with spinal cord injuries were single (73.68%), whereas the majority (53.73%) of patients with strokes were married at the time of injury. All patients were managed by the doctor and the nurse, with most of the patients receiving physiotherapy, occupational therapy and social assistance from the social worker. With regards to recreational activities, 46.87% of patients with spinal cord injury and 39.39% of those with stroke attended the learn to swim programme, and 29.68% of patients with spinal cord injury attended the wheelchair basketball sessions. The mean length of hospital stay for patients with spinal cord injury and stroke was 73.11 and 51. 62 days, with most of the spinal cord injured patients (80.26%) and stroke patients (82.08%) discharged home without follow-up rehabilitation. The most prevalent impairments on admission of the spinal cord injury cohort were muscle weakness (75.0%), bladder incontinence (71.1%) and reduced sensation (69.7%), whereas patients with stroke presented mostly with muscle paralysis (80.6%), abnormal tone (76.1%) and aphasia (50.8%). Functional limitations experienced by the participants included, mobility, stair climbing and transfers. The participants experienced participation restrictions in the following domains, leisure activities and employment. A clinical significant improvement was noted in execution of functional task of patients with spinal cord injury (p< 0.0001) and stroke (p< 0.0001) between admission and discharge. A significant statistical change was also detected for the participation elements of both stroke and spinal cord injury cohorts. Functional ability on admission was found to be a predictor of functional outcome of the stroke diagnostic group at discharge, whereas the multiple redictor model of functional outcome of the spinal cord injured cohort at discharge was significant with remaining variables of functional outcome score on admission (p<0.0001) and bladder -and bowel impairment(s) (p=0.0247). The study findings suggest that despite the significant change in activity and participation, most of the patients were discharged home without further follow-up for rehabilitation, irrespective of the activity limitations and participation restrictions still experienced at the time of discharge. The latter finding questions the duration of the length of hospital stay, which does not allow patients to be independent in all meaningful activities and participatory actions and roles by the end of inpatient rehabilitation. The study findings could assist authorities to adapt the existing rehabilitation programme and referral process . / South Africa

Malgré l’amélioration du taux de survie, les survivants de la leucémie aiguë lymphoblastique (LAL) pédiatrique souffrent toujours de séquelles de la maladie et des traitements, dont au niveau neuromusculosquelettique (NMSQ). L’objectif de ce mémoire était de décrire les déficiences, limitations d’activité et restrictions de participation que présentent les survivants de LAL pédiatrique à long terme ainsi que d’explorer la prise en charge usuelle en physiothérapie de ces séquelles NMSQ. Le premier article est un d’étude descriptive rétrospective. Les résultats de cette étude supportent les séquelles NMSQ documentées dans la littérature en plus d’apporter des précisions sur les différences entre les survivants présentant ou non une ostéonécrose de la hanche. Le niveau d’association a également été évalué entre certaines variables de déficiences et limitations d’activité. Le second article est une étude de cas unique. Cette étude a permis de constater que, bien que les physiothérapeutes d’un des centres spécialisés en hémato-oncologie pédiatrique du Québec soient expertes dans le domaine, il n’existe actuellement aucune prise en charge standardisée des séquelles NMSQ des survivants de la LAL à long terme. L’identification des barrières et facilitateurs à l’implantation d’une prise en charge perçue comme optimale par les physiothérapeutes apporte des pistes de solution pertinentes à l’amélioration des pratiques. Les projets de recherche présentés dans ce mémoire permettent de constater que les déficiences et les limitations d’activité des survivants de la LAL pédiatrique sont importantes. Les physiothérapeutes sont parmi les détenteurs d’enjeux clés dans l’optimisation de la prise en charge de cette population grandissante. / Although survival rate has improved, survivors of childhood acute lymphoblastic leukemia (cALL) still suffer from late adverse effects related to the disease and its treatment including neuromusculoskeletal (NMSK) morbidities. The aims of this research were to describe the impairments, activity limitations, and participation restrictions of long-term survivors of cALL and explore current physiotherapy clinical practice regarding these NMSK late adverse effects. The first manuscript is a retrospective descriptive study. Results of this study confirm the long-term NMSK late adverse effects documented in the literature and provide additional information about differences between survivors with and without hip osteonecrosis. Furthermore, relationships between some variables of impairments and activity limitations were identified. The second manuscript is a case study. A focus group with expert physiotherapists in pediatric hemato-oncology from a specialized centre revealed that standardized clinical practice guidelines for the management of long term NMSK late adverse effects of survivors of cALL are lacking. Identification of barriers and facilitators to the implementation of clinical practice perceived as optimal by physiotherapists provides relevant solutions to improve long-term care of this population. Findings from these studies highlight that impairments and activity limitations of survivors of cALL are important. Physiotherapists are key stakeholders in optimizing long-term care of this growing population.