Chronic nonadherence is the complete lack of adherence on the part of a patient to at least one aspect of their therapeutic regime for extended periods of time. Chronic nonadherence is similar to other forms of nonadherence in that it is a phenomena which is dangerous for patients, frustrating for practitioners, and costly to the health care system. However, unlike other forms of nonadherence, very little is known about this subject. In order to determine factors related to chronic nonadherence to a home exercise program, 15 male arthritis patients of varying ages underwent an in-depth structured interview. Eight of these patients were identified by the Arthritis Society as being chronic, treatment nonadherents. The other seven patients were randomly chosen from among the population of male arthritis patients in order to provide a comparison to the chronic nonadherent population. Ten variables were examined in this study in the hopes of determining factors related to chronic nonadherence. These variables were as follows: demographics, The Health Beliefs Model, patient's explanatory model, nature of the illness, satisfaction with practitioner attributes, shared responsibility, overall satisfaction, attitudes of significant others, use of unorthodox treatments, and problems with the home exercise program. Data analysis failed to produce any statistically significant findings, however the study did point to some interesting associations. One finding from this study is that nonadherence seems to be related to patient's Health Beliefs Models. Based on this finding the study then goes on to recommend an appropriate intervention which can be used by practitioners to enhance patient adherence. A second finding from this study is that a small number of the chronic nonadherent group were actually adherent to their home exercise programs. Several explanations have been provided as to how these patients might have been falsely labelled as chronic nonadherents. / Arts, Faculty of / Social Work, School of / Graduate

Rheumatoid Arthritis (RA) is the most common type of chronic inflammatory arthritis (Thompson, 1998). When appropriately prescribed, therapeutic exercise is useful in the care of patients with RA (Semble et aI., 1990). A pre-test - post-test randomized groups design was adopted for the study to compare the effects of a land- and water-based exercise programme in RA patients. A total of ten subjects, diagnosed with RA functional class I or II according to Steinbrocker, were assigned to either a group performing water-based exercises (W, n=4), a group performing land-based exercises (L, n=4), or a control group, who were requested to continue with their present sedentary lifestyle (C, n=2). For inclusion in the study, subjects were required to be on stable medication. Categories of dependent variables measured, were disease activity, haematology, functional and psychological status as well as physical status. There was a reduction in total swollen and tender joint counts in both experimental groups, but not the control group. The reduction was greater in group W than group L. Total tender joint count (DC) decreased by 53% (p<0.1O) and the total swollen joint count (SJC) decreased by 31% (p>0.05) in group W. In group L, the total TIC decreased by 4,7% (p>0.05) and the total SIC decreased by 8,5% (p>0.05). The haematological values remained globally unchanged in all three groups concerning the hemolglobin (Hb) values. There were changes in the erythrocyte sedimentation rate (ESR) in the groups, however changes were not significant (p>0.05). The ESR decreased by 29% in group Wand by 33% in group C. There was a slight increase in group L's ESR (11,9%) but values remained within the normal range. There was an improvement in the patients self-assessed disability and psychological status in the experimental groups while there was a deterioration in the control group's. Health Assessment Questionnaire (HAQ) scores improved by 15% in group W (p>0.05), 18% in group L (p>0.05) and deteriorated by 13% in group C (p>0.05). There was no change in the total Profile of Mood States (POMS) score of the control group, however, significant (p<0.05) improvements were observed in the experimental groups. There was a 163% improvement in group L's and a 990/0 improvement in group W's affective states. As far as physical condition is concerned, in genera~ there was an improvement in group Wand group L's physical condition, while there was no improvements noted in group C. Group W showed the following changes in physical condition: Body mass decreased by 9,2% (p>0.05). Mean blood pressure values remained unchanged. 50-ft walk time improved by 18% (p<0.05). Right and left grip strength increased by 18% and 35% respectively, (p<0.05). Absolute VO2max increased by 28% and relative VO2max increased by 30% (p<0.05). Right knee flexor strength increased by 43% (p<0.05) and left knee flexor strength by 24% (p>0.05). Increases in right and left knee extensor strength were 32% (p>0.05) and 34% (p>0.05) respectively. Improvement in joint mobility was also noted. There was a significant (p<0.05) improvement in both right and left wrist extension range of motion(ROM). Right wrist extension ROM improved by 49% and left wrist extension ROM improved by 31%. Improvements were also noted in wrist flexion ROM however changes were not significant (p>0.05). There was an 12% and 19% increase in right and left wrist flexion ROM respectively. In addition, there was a 12% (p<0.05) increase in right knee flexion ROM and a 14% increase in left knee flexion ROM (p<0.05). Mean body mass and blood pressure remained unchanged. 50-ft walk test time improved by 15% (p<0.05). Right and left grip strength increased by 4,8% and 16.1% respectively (p>0.05). Relative VO2max increased by 16.6% and absolute VO2max by 31% (p<0.05). Right knee flexor strength increased by 22.1% and left knee flexor strength by 23.8% (p>O.05). Increase in right and left knee extensor strength was 9% and 2,4% respectively (p>O.05). Right wrist extension ROM increased by 20.7% and left wrist extension ROM increased by 15,7% (p>0.05). There was a significant (p<0.05) increase in left wrist flexion (7,6%), but right wrist flexion ROM decreased by 2.6% (p>0.05). Improvements in right and left knee flexion ROM were also significant (p<0.05), 9,2% and 7,4%, respectively. Group C showed the following changes in physical condition: Mean body mass increased by 2% (p>O.05), while blood pressure and 50-ft walk time remained globally unchanged. Left grip strength decreased by 16% (p>O.05) and right grip strength remained the same. Although not significant (p>O.05), there was a 11% decrease in relative VO2max and a 6,7% decrease in absolute VO2max. Muscle strength also showed deterioration in group C. Right and left knee flexor strength decreased by 1,8% and 12%, respectively (p>0.05). Left knee extensor strength remained unchanged while right knee extensor strength decreased by 9,7% (p>0.05). Right wrist extension ROM decreased by 4.7% and left wrist extension ROM increased by 6.7%, although the increase was not significant (p>O.05). While right wrist flexion ROM decreased by 1,3% and left wrist flexion ROM decreased by 21% (p>0.05). There were no significant (p>O.05) changes in group C's right and left knee flexion ROM. Right knee flexion ROM decreased by 1,2% and left knee flexion ROM increased by 1,2%. Based on the above results of the study, both exercise interventions are beneficial in the treatment of RA. Appropriate land-based exercises do not appear to enhance disease activity, however, the water-based exercise programme was superior in controlling the disease activity. Further research is required, using larger samples and evaluating the long-term effects of various exercise interventions. / Dissertation (MA (Human Movement Sciences))--University of Pretoria, 2006. / Biokinetics, Sport and Leisure Sciences / unrestricted

M.A. / As compared with psychoanalytic and other psychotherapies, behaviour therapy appears to have three distinct advantages. First of all, the treatment approach is precise. The target behaviours to be modified are specified, the methods to be used are clearly delineated, and the results can be readily evaluated (Marks, 1982). Second, the use of explicit learning principles is a sound basis for effective interventions as a result of their demonstrated scientific validity (Kazdin & Wilson, 1978). Third, the economy of time and costs is quite good. Not surprisingly, then, the overall outcomes achieved with behaviour therapy compare favourably with those of other approaches (Smith, Glass & Miller, 1980). Behaviour therapy usually achieves results in a short period of time because it is generally directed to specific symptoms, leading to faster relief of an individual's distress and to lower financial costs. In addition, more people can be treated by a given therapist.