Bakgrund: Inom primärvården tillämpas vanligtvis hemträningsprogram som behandling. Flera studier har undersökt underlättande faktorer för följsamhet till hemträning. Sedan fysioterapeutprogrammet på Uppsala Universitet hösten 2014 utvecklade utbildningsplanen till ett mer biopsykosocialt inriktat lärande återfinns ingen forskning på hur fysioterapeuterna med den nya utbildningsplanen upplever att de kan underlätta patientens följsamhet. Syfte: Undersöka hur nyexaminerade fysioterapeuter, som påbörjat utbildningen på Uppsala Universitet höstterminen 2014 eller senare, upplever att de kan underlätta följsamheten till hemträningsprogram för patienter i primärvården. Metod: Kvalitativ deskriptiv design. Datan insamlades genom fem semistrukturerade intervjuer med nyexaminerade fysioterapeuter och bearbetades sedan med hjälp av en kvalitativ innehållsanalys. Resultat: Analysen resulterade i sju kategorier samt 19 underkategorier. De sju kategorierna bestod av “Individanpassa träningsupplägg och uppföljning”, “Öka patientens förståelse av hemövningar”, “Tillämpa socialt stöd vid hemträning”, “Kartlägga och framkalla motivation till hemträning”, “Utforska patientens beteende och mående”, “Etablera god patientkontakt” och “Tillgångar på arbetsplatsen”. Konklusion: Resultatet framställde många strategier som redan beforskats. Samtliga kategorier förutom ”Tillgångar på arbetsplatsen” speglar ett beteendemedicinskt perspektiv. Detta kan indikera på att framtidens fysioterapeuter är behjälpliga av denna typ av perspektiv vid bemötande av patienter för att underlätta följsamheten till hemträningsprogram inom primärvården. / Background: In primary care, it is common to apply home-based exercise programs as treatment. Several studies have investigated facilitating factors that affect adherence to home-based exercise. Since the physiotherapist program at Uppsala University in autumn 2014 developed the syllabus into a more biopsychosocial-oriented learning, no research can be found on how the physiotherapists with the new syllabus experience can facilitate the patient's adherence. Purpose: Examine how newly graduated physiotherapists, who began their education at Uppsala University in the autumn 2014 or later, experience that they can facilitate adherence with home-based exercise programs for patients in primary care. Method: Qualitative descriptive design. Data was collected through five semi-structured interviews with five newly graduated physiotherapists and was conducted with a qualitative content analysis. Results: The data resulted in seven categories and 19 subcategories. The seven categories consisted of "Personalizing training arrangements and follow-up", "Increasing the patient’s understanding of home-based exercise", "Applying social support in home-based exercise", "Chart and incite motivation for home-based exercise", "Explore patient behavior and well-being", "Establish good patient contact" and "Workplace assets". Conclusion: The result presented many strategies that already have been explored. All categories except "Workplace assets" reflected a behavioral medicine perspective. This perspective might be of value for future physiotherapists to facilitate adherence with home-based exercise programs in primary care.

Background: Physical training is recommended in various national and international guidelines for patients with cancer. Observational studies have shown that physical activity leads to reduced recurrence and mortality rates by 20–40% in colorectal, breast, and prostate cancer. Despite existing evidence, a systematic care structure is still lacking. The primary aim of this study is to implement and evaluate an online training platform to strengthen physical performance and patient empowerment after cancer surgery. Methods: The evaluation will be conducted as a prospective multicenter randomized controlled trial with three subgroups (colorectal-, breast-, and prostate cancer). Each group will include 100 patients (total 300 patients including dropouts; clinical stages T1–3 and/or N+; M0 after surgery intervention) and the primary endpoint (13% increase in the maximal oxygen consumption during exercise) will be examined. The intervention group will receive a 6-month home-based online training (2–3 times per week strength-endurance training using video presentations), bidirectional activity feedback information, online communication, and online counseling. The control group (usual care) will be advised lifestyle improvement. In-hospital testing will be performed before, during, and after the intervention. In addition to cardiopulmonary capacity, tumor specific diagnostics (liquid biopsy, depression and fatigue assessment, metabolic and endothelial screening) will be applied. Discussion: Due to the increasing incidence of cancer, associated with considerable mortality, morbidity and impaired quality of life, there is an imperative requirement for improved cancer care, of which structured physical training may become an integral component.

Background: People who have experienced a moderate or severe traumatic brain injury (TBI) will most likely live with motor and cognitive deficits including balance and poor mobility. These deficits may lead to limitations in activity participation, life satisfaction, and may increase the risk of falls. Improving access to rehabilitation care in the chronic phase of recovery is essential to prevent ongoing health issues. However, geographical restrictions, cost of transportation, or recently the COVID-19 pandemic restrictions may limit access to rehabilitation services. Telerehabilitation could serve as an alternative method to provide rehabilitation care while increasing access. Objectives: The overall objective of this dissertation was to understand the implementation of high-intensity telerehabilitation exercise programs for people living with a moderate or severe TBI and their family partners. This was accomplished by 1) determining the feasibility of using telerehabilitation, 2) investigating the effectiveness of high-intensity home-based telerehabilitation exercise programs on physical activity, functional mobility and dynamic balance, 3) understanding the perspectives and lived experiences of completing a telerehabilitation program, and 4) exploring how interpersonal behaviours can influence practice and be perceived in a telerehabilitation setting. Methodology: Influenced by a people-centered approach and explained by the Self-Determination Theory, this dissertation followed a mixed-method alternating single-subject design methodology. Five dyads composed of five persons living with a moderate or severe TBI and their family partners completed two high-intensity telerehabilitation programs remotely supervised, daily and weekly. The feasibility and effectiveness of the telerehabilitation programs were measured from a quantitative and qualitative perspective to replicate the clinical realities and understand all perspectives. Results: In this dissertation, the feasibility of using telerehabilitation with this population was highlighted by reporting high adherence, high usability, active engagement and safety. The effectiveness on physical activity levels, functional mobility, dynamic balance and concerns with falling was also demonstrated with no differences between the daily and weekly remote supervision schedule. The dyads described being highly satisfied, engaged, and enjoyed the remotely supervised exercise programs. The individuals with the TBI perceived more supportive behaviours than thwarting behaviours from the physiotherapist. Conclusion: This dissertation advances knowledge on telerehabilitation implementation for people living with cognitive and motor deficits following a TBI. High-intensity home-based telerehabilitation programs were shown to be feasible and effective. I introduced the importance of assessing needs-supportive and needs-thwarting interpersonal behaviours in the telerehabilitation context. Integrating these novel telerehabilitation concepts within emerging telerehabilitation models of care could significantly impact long-lasting positive health outcomes for individuals living with a moderate or severe TBI.

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