Introdução O câncer é uma doença crônica que ocupa posição de destaque. A adesão, as atitudes e o comportamento dos pacientes têm sido freqüentemente relatadas como um fator determinante para o sucesso da terapia com antineoplásicos orais. Objetivos Caracterizar o perfil de pacientes com terapia antineoplásica via oral, aspectos da doença, atitudes, crenças e percepções frente à doença e tratamento. População e Método Foram estudados 61 pacientes com diagnóstico de câncer sob terapia antineoplásica via oral em um ambulatório de hospital particular da cidade de São Paulo. Os instrumentos de avaliação usados foram Teste Morisky e Green, Escala de Lócus de Controle da Saúde e um questionário sobre fatores que podem interferir no tratamento medicamentoso. Valores de p<0,05 foram considerados estatisticamente significantes. Resultados Os pacientes estudados eram 64% mulheres, 54,8±15,6 anos, 95% brancos, 74% casados; 80% com ensino superior; 37% com renda entre 5 a 10 salários mínimos; 29% ocupavam atividades administrativas e comerciais; 34% tinham câncer gastrintestinal; 34% dos pacientes faziam uso do medicamento Capecitabina; tempo de doença de 37,1 ± 62,2 meses; tempo de tratamento 14,4 ± 25,1 meses; e tempo de tratamento com antineoplásico oral 8,6 ± 14,8 meses. O Teste Morisky e Green foi positivo em 28% dos pacientes e 25% afirmaram interrupção do tratamento. Na Escala de Lócus de Controle da Saúde os valores do lócus de controle interno (21,7±4,3) e externo-outros poderosos (22,5± 4,1) foram semelhantes e o menor valor foi no domínio externalidade-acaso (16,5±6,0), além de que os pacientes informaram poucas dificuldades que podem influenciar a adesão ao tratamento com antineoplásico oral. Houve as seguintes associações estatisticamente significantes (p<0,05): 1-Pacientes com teste de Morisky e Green positivo tinham maior tempo de tratamento e em relação ao medicamento oral, a positividade ocorreu com dois pacientes em uso de Mercaptopurina e cerca de um quarto em uso de Dexametasona, Talidomida e Hormonioterápicos. 2-Na Escala de Lócus de Controle de Saúde os pacientes que apresentaram maiores índices de internalidade eram do sexo masculino, que não realizaram cirurgia, não faziam massagem, com menor tempo de doença e de tratamento. Os pacientes com maiores índices no domínio de externalidade-outros poderosos interromperam o tratamento. Os pacientes que apresentaram maiores índices de externalidade-acaso faziam uso de antineoplásico oral continuamente e não praticavam rituais religiosos como outras formas de tratamento. 3-O questionário que avaliou aspectos frente ao tratamento mostrou que os pacientes que apresentaram mais dificuldade, tinham mais tempo de tratamento com antineoplásico via oral. Conclusões Os pacientes apresentaram atitudes positivas frente ao tratamento com medicamentos antineoplásicos orais e relataram poucas dificuldades no manejo da terapia / Introduction Cancer is a chronic disease ranked in an outstanding position. Patients’ compliance, attitudes and behavior have been frequently reported as a determining factor for the success of the therapy with oral antineoplastic drugs. Objectives Characterize oral antineoplastic therapy patients’ profiles; disease aspects and behavior, beliefs and perceptions with regard to the disease and the treatment. Population and Method Sixty-one patients diagnosed with cancer undergoing oral antineoplastic therapy in the out-patient unit of a private hospital in the city of São Paulo were studied. Assessment instruments applied were Morisky and Green Test, Health Locus of Control Scale and a questionnaire on factors that can interfere in drug treatment. P<0.05 values were considered statistically significant. Results Patients studied were 64% women, 54.8±15.6 years, 95% white, 74% married; 80% university graduated; 37% with monthly income between US$ 817.75 to US$ 1635.50; 29% worked on business and administrative activities, 34% had gastrointestinal cancer; 34% took Capecitabine; length of time of the disease was 37.1 ± 62.2 months; length of time of the treatment 14.4 ± 25.1 months; and length of time of oral antineoplastic therapy 8.6 ± 14.8 months. Morisky and Green Test was found to be positive in 28% of the patients and 25% stated having interrupted the treatment. In the Health Locus of Control (HLC) Scale, the scores of internal HLC (21.7±4.3) and powerful others externally HLC (22.5± 4.1) were similar. The lowest score was observed in the dimension of chance external HLC (16.5±6.0). Besides, patients reported few difficulties that can influence on their compliance with oral antineoplastic treatment. The following statistically significant (p<0.05) associations were observed: 1-Patients showing positive Morisky and Green test were longer under treatment in relation to the oral drug. Positive tests were observed in two patients using Mercaptopurine and in roughly one fourth, using Dexamethasona, Thalidomide and Hormonietherapics. 2-In Health Locus of Control Scale, men who did not undergo surgery, did not use to have a massage and with shorter time of disease and treatment were those who showed higher scores in Internal HLC. Patients with higher scores in the dimension of powerful others external HLC interrupted the treatment. Patients who showed higher scores in the dimension of Chance External HLC used oral antineoplastic drugs continuously and did not took part in religious rituals as other forms of treatment 3-The questionnaire that assessed aspects related to the treatment revealed that patients who showed more difficulties, were being treated with oral antineoplastic drugs for a longer time. Conclusions Patients showed positive attitudes regarding the treatment with oral antineoplastic drugs and reported few difficulties to lead with the therapy

<p>The aim of this investigation was to elucidate and describe those patients who had discontinued their participation and/or paticipated infrequently in physiotherapy treatment based on their own activity and responsibility. The ambition was to understand the phenomenon of compliance/adherence from various perspectives in behavioural as well as social science.</p><p>In study I the phenomenon compliance/adherence was studied in relation to Health Locus of Control and Health Belief variables. This study was based on a questionnaire that was answered by all patients before beginning of treatment. Questions concerning the patients´conceptions about both health locus of control and health beliefs were the focus.The definitions of compliance/adherence were completed treatment period and exercise frequency, respectively. Those patients who completed the treatment were also studied regarded exercise frequency.</p><p>The results of study I showed that those who discontinued their treatment reported a higher perceived threat from their health condition (higher level of dysfunction (higher pain intensity) and a higher perceived severity of their health condition (higher level of dysfunction, worse general health) than those who completed treatment. The results also showed that those who exercised once a week or less often valued the significance of the caring situation as lower (HLC), perceived a higher threat from their health condition (higher pain intensity), a higher severity of their health condition (higher level of dysfunction, worse general health, greater distrution of impairment), more barriers to treatment (lower expectations), and had certain differences in demographic variables (younger individuals, more women) than those who exercised more often (HB).</p><p>Study II investigated patients´descriptions of their reasons for discontinuing the treatment, whether those reasons varied, and if so how they varied. Sixteen patients who had discontinued their treatment were interviewed with open-ended questions. The inteviews began with a question about the background to the physiotherapy treatment. There were questions concerning carrying out the treatment as well as concerning what they thought about their impairment. The patients were also asked about their priotities in daily life, as these wre presumed to be anobstacle to the treatment over a shorter or longer period of time. The third domain concerned how they experiebced the patient/physiotherapist relationship. The interviews were anlysed qualitatively.</p><p>Analysis of study II resulted in four different descriptions of reasons for treatment discontinuation. A) It was about time to end treatment and continue on alone. B) The treatment was not the most important activity to spend time on. C) An agreement with the physiothreapist to discontinue treatment due to lack of effect. D) No viewpoint as to why they discontinued the treatment. In further analysis of category D, this group appeared to experience varoius forms of powerlessness. They felt their trustworthiness was often questioned. They experienced frustration in their life situation as others made the important descisions and they themselves had little to say.They defended themselves by talking about their own conceptions of the reasons for their impairment and what should be done about them. In comparing category D with categories A, B, C it was found that those in the latter three categories experienced varying degrees of control in different situations, whereas those in category D did not experience a feeling of control.</p><p>Conclusion: The concept of compliance in physiotherapy is ambiguous. The concept involves one part defining what will concern the other part. It is clear that the physiotherapist and the patient do not always agree about the aim of the treatment. Instead, we should develop the concept of concordance in encounters with the patients and abandon the reasoning of compliance.</p>

Introdução O câncer é uma doença crônica que ocupa posição de destaque. A adesão, as atitudes e o comportamento dos pacientes têm sido freqüentemente relatadas como um fator determinante para o sucesso da terapia com antineoplásicos orais. Objetivos Caracterizar o perfil de pacientes com terapia antineoplásica via oral, aspectos da doença, atitudes, crenças e percepções frente à doença e tratamento. População e Método Foram estudados 61 pacientes com diagnóstico de câncer sob terapia antineoplásica via oral em um ambulatório de hospital particular da cidade de São Paulo. Os instrumentos de avaliação usados foram Teste Morisky e Green, Escala de Lócus de Controle da Saúde e um questionário sobre fatores que podem interferir no tratamento medicamentoso. Valores de p<0,05 foram considerados estatisticamente significantes. Resultados Os pacientes estudados eram 64% mulheres, 54,8±15,6 anos, 95% brancos, 74% casados; 80% com ensino superior; 37% com renda entre 5 a 10 salários mínimos; 29% ocupavam atividades administrativas e comerciais; 34% tinham câncer gastrintestinal; 34% dos pacientes faziam uso do medicamento Capecitabina; tempo de doença de 37,1 ± 62,2 meses; tempo de tratamento 14,4 ± 25,1 meses; e tempo de tratamento com antineoplásico oral 8,6 ± 14,8 meses. O Teste Morisky e Green foi positivo em 28% dos pacientes e 25% afirmaram interrupção do tratamento. Na Escala de Lócus de Controle da Saúde os valores do lócus de controle interno (21,7±4,3) e externo-outros poderosos (22,5± 4,1) foram semelhantes e o menor valor foi no domínio externalidade-acaso (16,5±6,0), além de que os pacientes informaram poucas dificuldades que podem influenciar a adesão ao tratamento com antineoplásico oral. Houve as seguintes associações estatisticamente significantes (p<0,05): 1-Pacientes com teste de Morisky e Green positivo tinham maior tempo de tratamento e em relação ao medicamento oral, a positividade ocorreu com dois pacientes em uso de Mercaptopurina e cerca de um quarto em uso de Dexametasona, Talidomida e Hormonioterápicos. 2-Na Escala de Lócus de Controle de Saúde os pacientes que apresentaram maiores índices de internalidade eram do sexo masculino, que não realizaram cirurgia, não faziam massagem, com menor tempo de doença e de tratamento. Os pacientes com maiores índices no domínio de externalidade-outros poderosos interromperam o tratamento. Os pacientes que apresentaram maiores índices de externalidade-acaso faziam uso de antineoplásico oral continuamente e não praticavam rituais religiosos como outras formas de tratamento. 3-O questionário que avaliou aspectos frente ao tratamento mostrou que os pacientes que apresentaram mais dificuldade, tinham mais tempo de tratamento com antineoplásico via oral. Conclusões Os pacientes apresentaram atitudes positivas frente ao tratamento com medicamentos antineoplásicos orais e relataram poucas dificuldades no manejo da terapia / Introduction Cancer is a chronic disease ranked in an outstanding position. Patients’ compliance, attitudes and behavior have been frequently reported as a determining factor for the success of the therapy with oral antineoplastic drugs. Objectives Characterize oral antineoplastic therapy patients’ profiles; disease aspects and behavior, beliefs and perceptions with regard to the disease and the treatment. Population and Method Sixty-one patients diagnosed with cancer undergoing oral antineoplastic therapy in the out-patient unit of a private hospital in the city of São Paulo were studied. Assessment instruments applied were Morisky and Green Test, Health Locus of Control Scale and a questionnaire on factors that can interfere in drug treatment. P<0.05 values were considered statistically significant. Results Patients studied were 64% women, 54.8±15.6 years, 95% white, 74% married; 80% university graduated; 37% with monthly income between US$ 817.75 to US$ 1635.50; 29% worked on business and administrative activities, 34% had gastrointestinal cancer; 34% took Capecitabine; length of time of the disease was 37.1 ± 62.2 months; length of time of the treatment 14.4 ± 25.1 months; and length of time of oral antineoplastic therapy 8.6 ± 14.8 months. Morisky and Green Test was found to be positive in 28% of the patients and 25% stated having interrupted the treatment. In the Health Locus of Control (HLC) Scale, the scores of internal HLC (21.7±4.3) and powerful others externally HLC (22.5± 4.1) were similar. The lowest score was observed in the dimension of chance external HLC (16.5±6.0). Besides, patients reported few difficulties that can influence on their compliance with oral antineoplastic treatment. The following statistically significant (p<0.05) associations were observed: 1-Patients showing positive Morisky and Green test were longer under treatment in relation to the oral drug. Positive tests were observed in two patients using Mercaptopurine and in roughly one fourth, using Dexamethasona, Thalidomide and Hormonietherapics. 2-In Health Locus of Control Scale, men who did not undergo surgery, did not use to have a massage and with shorter time of disease and treatment were those who showed higher scores in Internal HLC. Patients with higher scores in the dimension of powerful others external HLC interrupted the treatment. Patients who showed higher scores in the dimension of Chance External HLC used oral antineoplastic drugs continuously and did not took part in religious rituals as other forms of treatment 3-The questionnaire that assessed aspects related to the treatment revealed that patients who showed more difficulties, were being treated with oral antineoplastic drugs for a longer time. Conclusions Patients showed positive attitudes regarding the treatment with oral antineoplastic drugs and reported few difficulties to lead with the therapy

La maladie pulmonaire obstructive chronique (MPOC) est une maladie respiratoire irréversible, évolutive et très fréquente qui fait peser un lourd fardeau sur le système de santé, les patients et leurs proches. La réadaptation pulmonaire (RP) est efficace pour réduire la dyspnée et l’utilisation des ressources en soins de santé et pour améliorer la capacité physique et la qualité de vie des patients. L’entraînement physique est la pierre angulaire de la RP, mais elle n’est bénéfique que si les patients 1) assistent aux séances d’exercice, 2) se conforment à l'intensité des exercices prescrits et 3) maintiennent l'exercice physique régulier après la RP. La dépression comorbide est disproportionnée dans la MPOC et s’est révélée être un facteur prédictif de « mauvaise » fréquentation de la RP, et d'abandon de la pratique physique régulière après le programme. À notre connaissance, aucune étude ne s'est intéressée aux prédicteurs de conformité à l'intensité d'exercice prescrit pendant la RP et seules quelques études ont explorées les facteurs associés au maintien de l'exercice après la RP. L’objectif principal de cette étude consistait à examiner dans quelle mesure les symptômes dépressifs à l'entrée de la RP permettent de prédire 1) la présence aux séances de RP, 2) le respect de l'intensité (conformité) des exercices d’endurance prescrits pendant la RP, et 3) le niveau d’exercice physique maintenu 9 mois après la RP. Un deuxième objectif consistait à explorer d'autres variables susceptibles d'être associées à ces paramètres. Trente-six patients (64 % de femmes) atteints de la MPOC stable, modérée à sévère, ont été inscrits à un programme de RP de 12 semaines comportant 36 séances d’exercice physique supervisé. À l’entrée du RP les patients ont rempli l’Inventaire de Dépression de Beck (BDI-II, le prédicteur principal) et le formulaire C de l’Échelle du locus de contrôle sur la santé (LCS), et ont subi des tests de fonction pulmonaire et une épreuve d’effort progressif à vélo (pour déterminer l'intensité de l'exercice pour la RP). Ensuite, ils ont été répartis de façon aléatoire dans trois groupes à intensité d’exercice différente. La fréquentation de la RP était définie comme le pourcentage de séances suivies; la conformité, comme la durée d’entraînement pratiquée à la fréquence cardiaque cible; et le maintien de l'exercice physique régulier comme le niveau d’exercice fait au cours d’une semaine 9 mois après la RP (enregistré dans un journal d’activité physique et calculé en équivalents métaboliques de l’effort [MET] minutes ). La médiane (écart interquartile ou IQR) du score au BDI-II était de 8,5 points (6-13), la médiane (IQR) du taux de la fréquentation aux séances était de 83% (67-94), la médiane du taux de compliance à l’intensité d'exercice était de 94% (71-99), et la médiane du nombre de minutes MET après la RP était de 706 (445-1146). Les analyses de régression linéaire ne montrent pas de relation entre les symptômes dépressifs pré-RP et la fréquentation des séances de la RP (ß = 0,12; p = 0,478). Par-contre, ils étaient associés à la conformité à l'intensité de l’exercice physique pendant la RP (ß = -0,40; p = 0,047), et à la poursuite de la pratique d’un exercice physique régulier après la RP (ß = -0,50; p = 0,004). Les analyses étaient ajustées pour des covariables prédéfinies. Les analyses exploratoires ont révélé que certaines variables supplémentaires (y compris LCS) étaient associées aux issues mesurées. Les résultats de cette étude montrent que même les niveaux de dépression sous-cliniques pourraient jouer un rôle important dans la compliance aux programme de réentraînement, et au maintien d’un style de vie actif après la période de réadaptation. Cela a des implications pour améliorer le dépistage des « mauvais » résultats dans la RP et pour l'élaboration d'interventions ciblées pour améliorer les bénéfices pour la santé découlant de la réadaptation pour la MPOC. / Abstract : Chronic obstructive pulmonary disease (COPD) is an irreversible, progressive, and highly prevalent respiratory illness that poses a great burden on the healthcare system, patients, and their families. Pulmonary rehabilitation (PR) is effective in reducing dyspnea and health care resource utilization, and increasing exercise capacity and quality of life. Exercise training is the cornerstone of PR but is only beneficial if patients 1) attend sessions, 2) comply with the prescribed exercise regimen, and 3) maintain regular exercise after supervised PR ends. Comorbid depression is disproportionately high in COPD and has been found to predict poor attendance at PR and low levels of exercise maintained afterwards. To our knowledge, no study has investigated predictors of exercise compliance during PR, and only a few studies have examined predictors of exercise maintenance post PR. The primary objective of this study was to examine how much baseline depressive symptomatology can predict 1) PR attendance, 2) PR exercise compliance, and 3) levels of exercise maintained at 9-months post PR. A secondary, exploratory objective was to identify additional variables that might also have significant associations with these outcomes. Thirty-six patients (64% female) with stable COPD were enrolled in a 12-week 36-session supervised exercise intervention in the context of a PR program. Patients underwent evaluations at entry to PR which included the Beck Depression Inventory (BDI-II, the main predictor), the Multidimensional Health Locus of Control (HLC) Scale Form-C, pulmonary function tests, and an incremental cycling test (to determine the exercise intensity prescription). Patients were randomized to one of three groups of varying exercise intensity. Attendance was defined as the percent of total sessions attended, compliance as the percent of endurance training time exercising at a prescribed target heart rate, and post-PR exercise as the total exercise performed over a 7-day period recorded in a physical activity diary and calculated as metabolic equivalent of task (MET) minutes. Median (IQR) baseline BDI-II was 8.5 (6-13), median (IQR) percent attendance was 83 (67-94), median (IQR) percent exercise compliance was 94 (71-99), and median (IQR) exercise MET-minutes post PR was 706 (445-1146). In multiple regression analyses, baseline depressive symptomatology did not emerge as a significant independent predictor of PR attendance (ß = .12, p = .478), but was a significant predictor of PR exercise compliance (ß = -.40, p = .047), and of exercise maintained post PR (ß = -.50, p = .004), with adjustment for a-priori defined covariates. Secondary exploratory analyses revealed that certain additional variables (including HLC) had associations with particular outcomes. The findings suggest that even subclinical levels of depression can predict PR exercise compliance and post-PR exercise levels. This has implications for improving screening for, and understanding of, poor outcomes in PR and for developing targeted interventions to optimize the health benefits that can be derived during and after PR for COPD.

The aim of this investigation was to elucidate and describe those patients who had discontinued their participation and/or paticipated infrequently in physiotherapy treatment based on their own activity and responsibility. The ambition was to understand the phenomenon of compliance/adherence from various perspectives in behavioural as well as social science. In study I the phenomenon compliance/adherence was studied in relation to Health Locus of Control and Health Belief variables. This study was based on a questionnaire that was answered by all patients before beginning of treatment. Questions concerning the patients´conceptions about both health locus of control and health beliefs were the focus.The definitions of compliance/adherence were completed treatment period and exercise frequency, respectively. Those patients who completed the treatment were also studied regarded exercise frequency. The results of study I showed that those who discontinued their treatment reported a higher perceived threat from their health condition (higher level of dysfunction (higher pain intensity) and a higher perceived severity of their health condition (higher level of dysfunction, worse general health) than those who completed treatment. The results also showed that those who exercised once a week or less often valued the significance of the caring situation as lower (HLC), perceived a higher threat from their health condition (higher pain intensity), a higher severity of their health condition (higher level of dysfunction, worse general health, greater distrution of impairment), more barriers to treatment (lower expectations), and had certain differences in demographic variables (younger individuals, more women) than those who exercised more often (HB). Study II investigated patients´descriptions of their reasons for discontinuing the treatment, whether those reasons varied, and if so how they varied. Sixteen patients who had discontinued their treatment were interviewed with open-ended questions. The inteviews began with a question about the background to the physiotherapy treatment. There were questions concerning carrying out the treatment as well as concerning what they thought about their impairment. The patients were also asked about their priotities in daily life, as these wre presumed to be anobstacle to the treatment over a shorter or longer period of time. The third domain concerned how they experiebced the patient/physiotherapist relationship. The interviews were anlysed qualitatively. Analysis of study II resulted in four different descriptions of reasons for treatment discontinuation. A) It was about time to end treatment and continue on alone. B) The treatment was not the most important activity to spend time on. C) An agreement with the physiothreapist to discontinue treatment due to lack of effect. D) No viewpoint as to why they discontinued the treatment. In further analysis of category D, this group appeared to experience varoius forms of powerlessness. They felt their trustworthiness was often questioned. They experienced frustration in their life situation as others made the important descisions and they themselves had little to say.They defended themselves by talking about their own conceptions of the reasons for their impairment and what should be done about them. In comparing category D with categories A, B, C it was found that those in the latter three categories experienced varying degrees of control in different situations, whereas those in category D did not experience a feeling of control. Conclusion: The concept of compliance in physiotherapy is ambiguous. The concept involves one part defining what will concern the other part. It is clear that the physiotherapist and the patient do not always agree about the aim of the treatment. Instead, we should develop the concept of concordance in encounters with the patients and abandon the reasoning of compliance. / Syftet med denna undersökning var att tydliggöra och beskriva de patienter som avbrutit sitt deltagande och/eller deltagit sällan i en behandling med sjukgymnastik baserad på egen aktivitet och eget ansvar. En ambition var att förstå fenomenet följsamhet utifrån några olika teoretiska perspektiv inom såväl beteende- som samhällsvetenskap. I Delstudie I studerades fenomenet följsamhet i relation till beteendeaspekter avseende patientuppfattningar om styrmekanismer som påverkar den egna hälsan (HLC) och patientupplevda hälsohot och hälsohotens konsekvenser (HB). Denna delstudie bygger på frågeformulär, som besvarades av samtliga patienter innan behandlingsstart. De frågor som mäter patientens uppfattningar om vad som styr den egna hälsan och frågor som mäter patientupplevda hälsohot och hälsoerfarenheter har bearbetats. Definitionerna på följsamhet var dels fullföljd träningsperiod, dels träningsfrekvens. De patienter som genomförde träningen jämfördes med de som avbröt den. De som genomförde träningen studerades dessutom avseende träningsfrekvens. Resultatet i Delstudie I visade att de som avbröt sin behandling, rapporterade större hot av sitt hälsotillstånd (högre smärtintensitet) och större konsekvenser av hälsotillståndet (sämre funktionsförmåga, sämre allmänt hälsotillstånd) än de som genomförde den. Resultatet visade dessutom att de som tränade en gång i veckan eller mer sällan hade värderat vårdsituationens betydelse lägre (HLC), upplevde större hot av sitt hälsotillstånd (högre smärtintensitet), större konsekvenser av hälsotillståndet (större funktionsnedsättning, sämre allmänt hälsotillstånd, större besvärsutbredning), fler hinder för behandlingen (lägre förväntningar) och uppvisade andra demografiska faktorer (yngre individer, fler kvinnor) än de som tränade oftare (HB). I Delstudie II studerades hur patienter själva beskriver anledningen till avbrott i behandlingen, om dessa anledningar kan variera och hur de varierar. Sexton patienter som avbrutit sin behandling intervjuades med öppna frågor. Intervjun inleddes med en fråga om bakgrunden till den sjukgymnastiska behandlingen. De ställdes inför frågor som hade anknytning till genom!örandet av behandlingen och vad de trodde själva om sina besvär. Frågor om patienternas prioriteringar i vardagen ingick, vilka antogs kunna utgöra hinder för behandling under en kortare eller längre tid. Ett tredje område som ingick, rörde deras erfarenheter av patient/sjukgymnast relationen. Intervjuerna analyserades kvalitativt. Analysen i Delstudie II resulterade i att fyra olika beskrivningar av orsaker till avbrott i behandlingen genererades. A) Det var dags att avsluta och gå vidare på egen hand. B) Behandlingen var inte det viktigaste att lägga sin tid på. C) Överenskommelse med sjukgymnasten att avbryta behandlingen på grund av uteblivna resultat. D) Avsaknad av ställningstagande till avbrott i behandlingen. Vid en fårdjupadanalys av kategori D framstod att denna grupp erfar olika former av maktlöshet. Det yttrade sig i beskrivningar av att deras trovärdighet ofta är ifrågasatt, att deras livssituation är en ständig frustration där andra tar de viktiga besluten och där de själva inte har mycket att säga till om, samt att de värjer sig mot att berätta om sina fåreställningar om vad de själva tror besvären beror på och vad man gör åt dem. Vid en jämförelse mellan kategori D och A, B, C har kategorierna A, B och C varierande grad av kontroll i olika situationer medan kategori D saknar kontroll.