Objective: To examine the workplace challenges of lupus patients. Methods: A cross sectional study surveyed lupus patients seen at the Toronto Lupus Clinic in the last 2 years. We included questions on health, work context and psychosocial perceptions. Descriptive statistics described the sociodemographic and clinical characteristics of the sample; multivariable analysis examined factors associated with workplace activity limitations, job strain, and job accommodations. Results: 362 respondents completed the questionnaire (60% response). 49.7% were currently employed. Participants who recently left work had higher disease activity and workplace activity limitations. Employed participants had low to moderate job strain. Seventy percent of employed participants used job accommodations. Health, work context, and psychological factors were significantly associated with workplace activity limitations, job strain and job accommodations. Conclusion: Persons living with lupus are faced by different challenges at the workplace. Workplace difficulties and needs of individuals with lupus should be assessed by health professionals.

Objective: To examine the workplace challenges of lupus patients. Methods: A cross sectional study surveyed lupus patients seen at the Toronto Lupus Clinic in the last 2 years. We included questions on health, work context and psychosocial perceptions. Descriptive statistics described the sociodemographic and clinical characteristics of the sample; multivariable analysis examined factors associated with workplace activity limitations, job strain, and job accommodations. Results: 362 respondents completed the questionnaire (60% response). 49.7% were currently employed. Participants who recently left work had higher disease activity and workplace activity limitations. Employed participants had low to moderate job strain. Seventy percent of employed participants used job accommodations. Health, work context, and psychological factors were significantly associated with workplace activity limitations, job strain and job accommodations. Conclusion: Persons living with lupus are faced by different challenges at the workplace. Workplace difficulties and needs of individuals with lupus should be assessed by health professionals.

Objective: The increased survival rate amongst female breast cancer survivors creates a need for an understanding of chronic disability after surgery. The objective of this study is to explore the association between impairments (e.g., pain, mobility, strength) and the personality trait, fear of physical activity, and chronic daily activity limitations for women who had their surgery at least six months prior to the study. Hypothesis: The study hypothesis is that women with high levels of physical impairments and the personality trait of fear of physical activity will also have higher levels of daily activity limitations six months or more after their breast cancer surgery. Design: A cross-sectional design. Outcome Measures: Disabilities of Shoulder, Arm, and Hand (DASH), Visual Analog Scale for Pain (VAS-Pain), Fear Avoidance Belief Questionnaire – Physical Activity (FABQ-PA), and objective measures of shoulder mobility and strength. Participants: Women who had been diagnosed and undergone surgery for breast cancer, stage 1-3. They must have had their surgery at least six months previously and have completed chemotherapy or radiation therapy. Both English- and French-speaking women from the Ottawa-Gatineau region were eligible. Results: Data from twelve women were analysed with a mean age of 58.0±8.9 years and post-operative time of 4.0± 2.8 years. DASH scores mean was 12.2 ± 11.38. VAS-Pain (rs=0.819; p<.001), FABQ-Physical Activity (rs=0.746; p<.005) were significantly associated with DASH score, whereas non-significant associations were found with supraspinatus strength (rs = 0.182; p < .572) or infraspinatus strength (rs=0.553; p<.062) using the Spearman Rho test. Also, no significant relationships were observed between range of motion (hand-behind-back; p =.366; hand-behind-head; p=.390) and DASH scores using a Kruskal-Wallis test. Conclusion: The results of this exploratory study suggest that the reported daily activity limitations of women who have had breast cancer surgery may be related to the participant pain perception and/or fear of physical activity.

Objective: The increased survival rate amongst female breast cancer survivors creates a need for an understanding of chronic disability after surgery. The objective of this study is to explore the association between impairments (e.g., pain, mobility, strength) and the personality trait, fear of physical activity, and chronic daily activity limitations for women who had their surgery at least six months prior to the study. Hypothesis: The study hypothesis is that women with high levels of physical impairments and the personality trait of fear of physical activity will also have higher levels of daily activity limitations six months or more after their breast cancer surgery. Design: A cross-sectional design. Outcome Measures: Disabilities of Shoulder, Arm, and Hand (DASH), Visual Analog Scale for Pain (VAS-Pain), Fear Avoidance Belief Questionnaire – Physical Activity (FABQ-PA), and objective measures of shoulder mobility and strength. Participants: Women who had been diagnosed and undergone surgery for breast cancer, stage 1-3. They must have had their surgery at least six months previously and have completed chemotherapy or radiation therapy. Both English- and French-speaking women from the Ottawa-Gatineau region were eligible. Results: Data from twelve women were analysed with a mean age of 58.0±8.9 years and post-operative time of 4.0± 2.8 years. DASH scores mean was 12.2 ± 11.38. VAS-Pain (rs=0.819; p<.001), FABQ-Physical Activity (rs=0.746; p<.005) were significantly associated with DASH score, whereas non-significant associations were found with supraspinatus strength (rs = 0.182; p < .572) or infraspinatus strength (rs=0.553; p<.062) using the Spearman Rho test. Also, no significant relationships were observed between range of motion (hand-behind-back; p =.366; hand-behind-head; p=.390) and DASH scores using a Kruskal-Wallis test. Conclusion: The results of this exploratory study suggest that the reported daily activity limitations of women who have had breast cancer surgery may be related to the participant pain perception and/or fear of physical activity.

No description available.

Background: Dysfunctional breathing (DB) is a respiratory disorder involving an upper chest breathing pattern and respiratory symptoms that cannot be attributed to a medical diagnosis. Aim: The overall aim of this thesis was to describe patients with DB and investigate clinical outcomes after physiotherapy treatment. Methods: Study I was descriptive and comparative, that included 25 patients with DB and 25 age- and sex-matched patients with asthma. Health-related quality of life (HRQoL), anxiety, depression, sense of coherence, influence on daily life due to breathing problems, respiratory symptoms, emergency room visits and asthma medication were investigated. Study II, a 5-year follow-up study based on the same sample as study I (22 patients with DB, 23 patients with asthma), studied treatment outcomes after information and breathing retraining. Study III was descriptive and correlational (20 healthy subjects), investigating whether the Respiratory Movement Measuring Instrument (RMMI) can discriminate between different breathing patterns in varying body positions. Study III also studied correlations between respiratory movements and breathing volumes (12 healthy subjects). Study IV was a single-subject AB design with follow-ups. Self-registered patient-specific respiratory symptoms and respiratory-related activity limitations and breathing pattern (measured with the RMMI) were evaluated after an intervention consisting of information and breathing retraining in five patients with DB. Results: Patients with DB had lower HRQoL (SF-36): vitality (mean 47 vs. 62), social functioning (70 vs. 94) and role emotional (64 vs. 94) (p&lt;0.05) than patients with asthma. The DB group had a higher prevalence of anxiety (56% vs. 24%) and experienced more breathing problems than the asthma group. Patients with DB had made several emergency room visits and had been treated with asthma medication. At the 5-year follow-up, patients with DB showed improved HRQoL (SF-36): physical function 77 to 87 (p=0.04), decreased breathing problems and emergency room visits, and they were not treated with asthma medication. The RMMI can differentiate between different breathing patterns in different body positions. Strong correlations between respiratory movements and breathing volumes were observed (rs 0.86-1.00). The results in study IV indicate that patients with DB benefit from information and breathing retraining regarding decreased respiratory symptoms and activity limitations and improved breathing pattern.

Syftet med examensarbetet var att beskriva hur personer med fibromyalgi upplevde att fritidsaktiviteter påverkades av smärta. Som datainsamlingsmetod valdes en intervju. Semistrukturerade intervjuer genomfördes med tio kvinnor. Frågorna utformades från centrala begrepp i The Model of Human Occupation. Inklusionskriterierna var att deltagarna skulle ha diagnosen fibromyalgi och vara i arbetsför ålder. De hade även ett lönearbete, ideellt arbete eller deltog i eftergymnasiala studier på minst deltid. Intervjuerna analyserades utifrån en kvalitativ innehållsanalys och resultatet presenterades i form av fem huvudkategorier med tillhörande underkategorier. De fem huvudkategorierna som beskrev smärtans påverkan på fritidsaktiviteter var; Miljöns betydelse, Aktivitetsbe-gränsningar, Anpassningsstrategier, Aktiviteter för smärtlindring och Balans i vardagen. Smärtan hade gjort att informanterna tvingats välja bort några av de fritidsaktiviteter de utförde tidigare. De fortsatte att engagera sig i fritidsaktiviteter som hade ett stort värde för dem om smärtan inte upplevdes för begränsande under eller efter utförandet. Miljön och aktivitetens krav påverkade tillsammans med smärtan aktivitetsutförandet.

Magister Scientiae (Physiotherapy) - MSc(Physio) / Stroke is the third leading cause of death and disability worldwide. The Uitenhage Provincial Hospital admits many stroke patients. To date, no in-depth study has been conducted on stroke patients admitted to the Hospital. This study identified the profile of stroke patients admitted to the Uitenhage Provincial Hospital and explored the challenges that these patients experienced post stroke. A concurrent mixed model design was used to collect the data. Firstly retrospective data was obtained by means of a quantitative data gathering instrument designed by the researcher. The information obtained, included data relating to demographic characteristics, reported risk factors relating to stroke, stroke onset-admission interval and length of hospital stay, as well as information relating to the process of physiotherapy. Secondly quantitative prospective information was collected by means of the Barthel Index, the Modified Rankin Scale and the Facilitators And Barriers Survey. The sample for the quantitative phase was drawn from medical records of 168 stroke patients admitted to the Uitenhage Provincial Hospital from the 1 of January 2008 up to and including the 31 of December 2009. For the second prospective quantitative part of the study, participants were selected conveniently from the admitted patients. In the qualitative phase, nine participants taken of the sampled participants were selected. The Microsoft Excel 2007 Package and the SPSS 18 for social sciences were used to analyse the quantitative data. Means, standard deviations, frequencies and percentages were calculated for descriptive purposes and the Chi-square test was used to test for associations between variables. Qualitative analysis began with the transcription of voice recordings and the translation of relevant Afrikaans transcription into English. Emerging categories were identified within the pre-determined themes. Permission and ethical clearance was obtained from the Higher Degrees Committee and the Senate Research and Grants and Study Leave Committee of the University of the Western Cape and permission to conduct this study was also obtained from the Medical Superintendent of the Uitenhage Provincial Hospital. Altogether 461 patients had been admitted with stroke during the relevant period, but only 168 could be included in the retrospective quantitative study. The mean age of the participants was 61,54 years; 59% were females and 41% males. The majority of the participants (86,9%) were admitted on the same day of stroke onset, and the mean length of hospital stay was 7,38 days. Hypertension was the most common reported risk factor, at 79%. Only 165 of the participants received physiotherapy while hospitalised, with the mean total physiotherapy sessions being 2,56 sessions. In 90% of the cases, physiotherapy sessions were discontinued due to the patient being discharged from the Hospital. The mean Barthel Index score was 81,46 and the family care domain of the Modified Rankin Scale was the most affected. Participants experienced participation restrictions and activity limitations due to stairs, gravel surfaces and kerb cuts. During the qualitative interviews participants reported activity limitations related to walking and activities of daily living. The participants also experienced participation restrictions, which included dependency on others, decreased social support and an array of emotions experienced post stroke. The current study’s findings suggest that the discharge of patients from the hospital post stroke should follow a mulitidisciplinary approach. Rehabilitation professionals should play an active role in the discharge process in providing patient and caregiver education.

Assessment in patients with NMD consists principally of measures of motor impairment since they are well known by clinicians and their measures do not require much equipment. The conventional treatments in patients with NMD are above-all focused on the diminution of motor impairments by maintaining or improving joint mobility, muscle strength and endurance. Nevertheless, a reduction of motor impairments does not directly lead to a higher ability in performing daily activities. Therefore, activity limitations should be measured specifically. A new scale of activity limitations was first developed in children and adults with NMD. The use of the Rasch model provided a scale to assess the fundamental psychometric qualities. Secondly, relationships between motor impairments and activity limitations were investigated to verify the assumption that reduced motor impairments do not necessarily lead to higher activity levels. Finally, to complete the investigation of psychometric qualities, a longitudinal study of the developed questionnaire was carried out to evaluate its sensitivity to change. Chapter 1 presents the development of ACTIVLIM, a Rasch-built measure of activity limitations and its validation in children and adults with NMD. ACTIVLIM is a self-reported questionnaire that assesses the difficulties adult patients and parents of affected children perceive when they or their children perform daily activities. This questionnaire originally included 126 daily activities and was submitted to 369 patients. The Rasch model selected 22 daily activities to define a linear and unidimensional measure of activity limitations in patients with NMD. The validity and the reproducibility of the results were also studied. A second section of Chapter 1 demonstrates why the measure of activity limitations in children with NMD as assessed using the ACTIVLIM questionnaire is based upon the perception of their parents. A third section of Chapter 1 compares the difficulties self-perceived by the patients with the difficulties observed by external examiners. The agreement between both measures is very good, indicating that the use of ACTIVLIM as a self-reporting questionnaire is a valid method to assess activity limitations in patients with NMD. Chapter 2 investigates the relationships between motor impairments and activity limitations as measured with the ACTIVLIM questionnaire. As the anatomical basis and pathophysiology are different from one NMD to another, the relationships between impairments and activity limitations were investigated in six main diagnostic groups and in the whole sample without diagnostic distinction. Gait speed and muscle weakness in proximal and flexor muscle groups were significantly but moderately correlated to the activity limitations, indicating that the latter cannot simply be inferred from motor impairments but should be independently measured and treated. Chapter 3 investigates the sensitivity to change of the ACTIVLIM questionnaire. As NMD are progressive disorders, it is important that the ACTIVLIM questionnaire be able to assess the change over time in the activity level of patients with NMD in order to characterize the disease course and to quantify the effects of new treatments on activity limitations in these patients. Finally, the last section discusses the results of the different chapters and presents perspectives for future research.

<p>The overall aim of this thesis was to describe (1) needs for occupational therapy among persons with self-perceived activity limitations and/or participation restrictions due to long-term/recurrent pain, and (2) treatment interventions in occupational therapy to meet demonstrated needs. The Liss’ model for assessing health care needs was used as a structural scheme. A randomly selected sample (n=10,000) from the Swedish general population aged 18-58 years was the foundation for the study population with and without pain. In addition, occupational therapists were included (n=109). Data collection was made by postal questionnaires. The results showed a prevalence of 26 % and an incidence rate of 0.07. Demographic characteristics of the sample were female gender, ages 40-58 years and fewer years of education than those without pain. Pain in shoulders/lower back of searing/aching/gnawing character was the most frequently reported. A majority of the respondents reported affective/emo-tional effects of pain mainly of depressive character and they had previously been on sick leave due to pain. Women reported higher frequencies of self-perceived activity limitations/ participation restrictions due to pain, more difficulties with intermediate ADL, perceived higher job demands and had longer sick leave than men. Men perceived poorer social support than did women. Needs for occupational therapy were reported mainly as a consequence of activity and temporal imbalance. High health care consumers reported higher frequencies of needs/problems than did low health care consumers. The main goals and interventions suggested by occupational therapists to meet the needs in pain management focused on increased knowledge of handling daily occupations with the purpose to reduce pain, maintain competence/improve performance of home maintenance, reduce consequences of pain and increase knowledge how to handle effects of pain.</p>