This research explores the meaning of learning as a process of social participation in clinical practice. The study focused on six first‐year student physiotherapists during a period of early clinical experience on a work integrated learning programme. The programme was unique at the time of the study in that it placed students in clinical settings from the first week of their undergraduate experience. The research applied a case study design and qualitative data were gathered from each student via on‐line learning journals, reflection lines and pre/post experience interviews. Data were analysed, between and within cases, to develop a sense of progressive narrative through the experiences made significant by each participant over the course of the clinical experience. An abductive logic was applied to develop a more theoretical explanation of learning as participation in clinical practice for each participant. The study concludes that these individuals adopted an agentic approach and recognised the benefit to their learning of proactively seeking opportunities to get involved in practice. Interaction with a range of co‐participants was valued, for a variety of reasons. Students were more willing to discuss their own deficits and ask questions of junior clinicians. Interactions with senior clinicians were more likely to challenge and extend the students' practice. Interactions with non‐physiotherapy colleagues in the multidisciplinary team were valued for the different perspectives they offered. Students valued participation in situations where they could assume greater responsibility, as long as their efforts were recognised by the clinical educator. Participants did not always see value in “routine” practice where there was little opportunity to be involved in decision making or discussion, describing their involvement as being “an extra pair of hands”. Participants described their performance of secondary Discourses of practice in the construction of their respective identities, which I describe as productive worker, trustworthy student, engaged student and junior professional. These Discourses supported participants' bids for recognition and progressive involvement in communities of clinical practice. However, where the participant identity was associated too strongly with a particular Discourse the educator could restrict access to learning opportunities. Participants dis‐identified themselves from Discourses that conflicted with individual habitus and conveyed lack of care or unethical behaviour. Where power relations challenged the possibility of overt rejection, participants were strategic and excluded these Discourses from their future, rather than current repertoires. At the start of their early clinical experience, participants expressed a desire to “learn by doing” and “learn on the job”. These cases demonstrate that even at an early stage of experience, participants were contributing to the productivity of the workplace and they felt valued when their contributions were recognised. These cases demonstrate that mutual relations support participation but require ongoing negotiation. Considering mutuality as a mechanism for participation in early clinical experience can support analysis of the ways in which social relations support both learning and work objectives. Mutuality as a mechanism for participation requires the learner and educator to recognise these dual objectives. Changing conditions of practice can threaten mutuality. Where a threat occurs, it is countered by adaptive practices that continue to support mutuality in terms of engagement, repertoire and enterprise with the community of clinical practice.

Partagé entre d'anciennes traditions et une pratique médicale moderne, le thermalisme contemporain s'est construit comme une culture particulière de la santé qui confronte, sans pour autant les opposer, ces deux champs de savoir. Un regard ethnographique, fondé sur plusieurs terrains effectués en France (Aix-les-Bains) et en Italie (Salsomaggiore), permet de préciser plusieurs particularités de la pratique thermale européenne. En premier, l'expérience du corps et de la maladie relève autant de l'expérience individuelle que de l'expérience sociale. Dans la pluralité et la diversité des recours médicaux disponibles, le thermalisme a aussi cette particularité de mettre en avant la volonté du curiste qui est devenu un acteur de la « mécanique » physique et psychique du traitement. Non seulement il interagit activement avec ses thérapeutes mais il contribue à la construction et à la diffusion de la mythologie et de l'imaginaire thermal. Un imaginaire qui est d'ailleurs véhiculé par la ville thermale. Cette-dernière n'est pas qu'un lieu de cure mais plutôt un théâtre ou se met en scène et se légitime une certaine vision de la santé. Enfin, un dernier élément participe à l'épanouissement de la pratique thermale, le soin lui-même qui se compose de l'efficacité de l'eau et de la qualité des prestations des soignants. Ces derniers ont développé, au fil de leurs pratiques un rapport particulier au corps fait de proximité et de distance. Ils jouent ainsi le rôle du « passeur » et mettent en contact le curiste et la source. / Shared between ancient traditions and modern health practice, contemporary hydrotherapy has become a peculiar health culture encompassing, without mutually excluding, both of these knowledges. This ethnographic work based on field studies in France (Aix-les-Bains) and in Italy (Salsomaggiore) shed light on several aspects of the use of hydrotherapy in Europe. First, the perception of one's own body and of the disease rises from both personal and social experiences. Among all available health practices, hydrotherapy is peculiar in giving a central role to its user, at the same time subject and object of both the physical and psychological aspects of the treatment. Not only he actively interacts with his therapists, but he plays a pivotal role in building and spreading the mythology and the imagination of thermal baths, which are in turn conveyed by the spa town. This becomes not just the geographical place where the therapy is held, but also and most importantly a stage to represent and legitimate a certain view of health. A final important aspect contributing to the flourishing of hydrotherapy is the treatment itself, the effectiveness of the therapeutic water, the quality of the services provided by the therapists who developed a particular relationship with illness. At the crossroads of different types of medicines, ‘ medecines savantes', popular and alternative medicine, modern hydrotherapy revealed itself as a dynamic reality whose plurality allows the use of syncretism to explain the combining of different (often contradictory) beliefs and practices.

Resumo: Avaliou-se a resposta de diferentes protocolos fisioterapêuticos em cães após a indução de atrofia muscular por meio da imobilização do joelho por 30 dias. Os grupos foram denominados grupo C ou controle, grupo M (massagem e movimentação passiva), grupo E (massagem, movimentação passiva e eletroterapia), grupo H (massagem, movimentação passiva e hidroterapia em esteira aquática) e grupo EH (massagem, movimentação passiva, eletroterapia e hidroterapia em esteira aquática). Foram mensurados, os graus de claudicação, amplitude articular, circunferência da coxa, variação sérica das enzimas creatina-quinase e lactato-desidrogenase, bem como a morfometria muscular das fibras de contração rápida e contração lenta do músculo vasto lateral marcadas pela técnica de imunoistoquímica. Os cães do grupo H apresentaram retorno mais precoce à função do membro pélvico direito, mostrando que a hidroterapia pode ser beneficamente empregada para a recuperação em cães claudicantes. A fisioterapia reduziu a contratura articular. Verificou-se maior recuperação da área transversal das fibras musculares de contração lenta e rápida nos cães submetidos à eletroterapia aos 60 dias de pós-operatório. De acordo com os resultados encontrados, foi possível concluir que as modalidades terapêuticas de massagem, movimentação passiva da articulação, estimulação elétrica neuromuscular e hidroterapia por caminhada em esteira aquática aceleram a recuperação clínica em cães com atrofia muscular induzida / Abstract: The response to different physiotherapeutic protocols was evaluated in dogs with muscle atrophy induced by a 30-day-long immobilization of the stifle joint. The animals were divided in groups namely: C (control), M (massage and passive range of motion), E (massage, passive range of motion and neuromuscular electrical stimulation), H (massage, passive range of motion and hydrotherapy in underwater treadmill), and EH group (massage, passive range of motion, neuromuscular electrical stimulation and hydrotherapy in underwater treadmill). The degree of lameness, range motion, thigh circumference, range of serum creatine kinase (CK) and lactate dehydrogenase (LDH) were then evaluated, as well as the morphometry of fast- and slow-twitch muscle fibers of the vastus lateralis by immunohistochemistry. Group H dogs regained function of the right hind limb faster than the other groups. This result shows that hydrotherapy helped in the recovery process of lame dogs. Physiotherapy reduced the joint contracture. There was a higher recovery rate of cross-sectional area of slow-twitch and fast-twitch muscle fibers and thigh circumference in dogs submitted to neuromuscular electrical stimulation at 60 days post-surgery. According to these results, it was possible to conclude that therapeutics modalities such as massage, passive range of motion of the joint, neuromuscular electrical stimulation and hydrotherapy by walking on underwater treadmill accelerate clinical recovery in dogs with induced muscle atrophy / Orientador: João Guilherme Padilha Filho / Coorientador: Vera Maria Villamil Martins / Banca: André Luís Selmi / Banca: Marcelo Meller Alievi / Banca: Paola Castro Moraes / Banca: Renée Laufer Amorim / Doutor

Submitted by Izabel Franco (izabel-franco@ufscar.br) on 2016-09-27T20:19:19Z No. of bitstreams: 1 DissMF.pdf: 1690143 bytes, checksum: 926071d3df13b9586913717047c129c9 (MD5) / Approved for entry into archive by Marina Freitas (marinapf@ufscar.br) on 2016-10-10T19:00:59Z (GMT) No. of bitstreams: 1 DissMF.pdf: 1690143 bytes, checksum: 926071d3df13b9586913717047c129c9 (MD5) / Approved for entry into archive by Marina Freitas (marinapf@ufscar.br) on 2016-10-10T19:01:11Z (GMT) No. of bitstreams: 1 DissMF.pdf: 1690143 bytes, checksum: 926071d3df13b9586913717047c129c9 (MD5) / Made available in DSpace on 2016-10-10T19:01:21Z (GMT). No. of bitstreams: 1 DissMF.pdf: 1690143 bytes, checksum: 926071d3df13b9586913717047c129c9 (MD5) Previous issue date: 2015-05-29 / Fundação de Amparo à Pesquisa do Estado de São Paulo (FAPESP) / The fibromyalgia syndrome (FMS) is a rheumatologic condition characterized by non-inflammatory widespread chronic pain and tender points in specific anatomic locations. In addition to the pain symptoms, FMS is also associated with the presence of a variety of symptoms such as fatigue and dyspnea, which has called attention to the review of the respiratory system in women with FMS. Thus, this work consisted of two studies aiming to elucidate the unknown aspects related to the respiratory system of women with FMS. The Study I, entitled "Pulmonary function, respiratory muscle strength and thoracoabdominal mobility in women with fibromyalgia syndrome: association with clinical manifestations", aimed to evaluate lung function, respiratory muscle strength and thoracoabdominal mobility as well as to assess possible associations of respiratory variables with clinical manifestations in women with FMS. The results show that the FMS group in this study has lower respiratory muscle endurance, inspiratory muscle strength and thoracic mobility compared to healthy participants. In addition, the study demonstrated that the lower inspiratory muscle strength, the greater the number of tender points and fatigue and lower axillary mobility. The Study II, entitled "Influence aerobic hydrotherapy program on lung function, respiratory muscle strength and thoracoabdominal mobility in women with fibromyalgia syndrome: a randomized controlled trial", aimed to evaluate the influence of an aerobic hydrotherapy program on respiratory variables and clinical manifestations in women with FMS and assess the association between respiratory variables and clinical manifestations. The results show that a 16-week aerobic hydrotherapy program increased the slow vital capacity, the forced vital capacity, the inspiratory muscle strength, the thoracic mobility, the pressure pain threshold, well-being, and decreased pain, and limitations caused by physical aspects. Clinical improvement was not associated with the respiratory variables. Conclusion: The subjects with FMS had lower respiratory muscle endurance, inspiratory muscle strength and thoracic mobility compared to healthy subjects. In addition, a 16-week aerobic hydrotherapy program showed to be effective in ameliorating lung function, inspiratory muscle strength, thoracic mobility, pressure pain threshold, well-being, pain and limitations caused by physical aspects. However, clinical improvement of FMS symptoms was not associated with the improvement of respiratory variables. / A síndrome fibromiálgica (SFM) é uma condição reumatológica, caracterizada por dor crônica difusa não inflamatória e tender points em locais anatômicos específicos. Além do quadro doloroso, a SFM também está associada à presença de uma variedade de sintomas como a fadiga e a dispneia, os quais têm chamado a atenção para a avaliação do sistema respiratório em mulheres com SFM. Assim, essa dissertação foi composta por dois estudos com o intuito de elucidar os aspectos desconhecidos relacionados ao sistema respiratório de mulheres com SFM. O Estudo I, intitulado “Função pulmonar, força muscular respiratória e mobilidade tóracoabdominal em mulheres com síndrome fibromiálgica: associação com as manifestações clínicas”, teve como objetivo avaliar a função pulmonar, a força muscular respiratória e a mobilidade tóracoabdominal, bem como avaliar as possíveis associações das variáveis respiratórias com as manifestações clinicas em mulheres com SFM. Os resultados mostram que as voluntárias do grupo SFM estudadas apresentam menor endurance muscular respiratória, força muscular inspiratória e mobilidade torácica em relação às voluntárias saudáveis. Além disso, o estudo revelou que quanto menor a força muscular inspiratória, maior o número de tender points ativos e fadiga e menor a mobilidade axilar. O Estudo II, intitulado “Influência de um programa de hidroterapia aeróbio sobre a função pulmonar, força muscular respiratória e mobilidade tóracoabdominal em mulheres com síndrome fibromiálgica: ensaio clínico randomizado controlado”, teve como objetivo avaliar a influência de um programa de hidroterapia aeróbio sobre variáveis respiratórias e manifestações clínicas em mulheres com SFM, bem como avaliar a associação entre as variáveis respiratórias com as manifestações clínicas. Os resultados mostram que o programa de hidroterapia aeróbio de 16 semanas aumentou a capacidade vital lenta, a capacidade vital forçada, a força muscular inspiratória, a mobilidade torácica, o limiar de dor à pressão e o bem-estar, e reduziu a dor e a limitação por aspectos físicos. A melhora clínica não apresentou associação com as variáveis respiratórias. Conclusão: As voluntárias com SFM apresentam menor endurance muscular respiratória, força muscular inspiratória e mobilidade torácica em relação às voluntárias saudáveis. Além disso, um programa de hidroterapia aeróbio de 16 semanas promoveu melhora da função pulmonar, da força muscular inspiratória, da mobilidade torácica, do limiar de dor à pressão, do bem-estar, da dor e da limitação por aspectos físicos. No entanto, a melhora clínica da SFM não apresentou associação com a melhora das variáveis respiratórias.

Made available in DSpace on 2014-12-17T14:13:28Z (GMT). No. of bitstreams: 1 SandraCA.pdf: 1939260 bytes, checksum: d309536e1e95c99f48eadd4712c26a0f (MD5) Previous issue date: 2008-09-26 / Fibromyalgia (FM) is a chronic rheumatic syndrome characterized by diffuse muscle-skeletal pain, and aerobic exercises represent a fundamental portion in therapeutic approach. Objective of this study was to evaluate the effectiveness of aerobic exercises accomplished in the water of the sea (thalassotherapy) for women with FM and to compare with exercises accomplished in the swimming pool, involving a multidisciplinary team, composed by rheumatologists, physical therapists, students of physical therapy and students of physical education. Forty six (46) women with age between 18 and 60 years with FM were randomized in 2 groups: a swimming pool group (23 patients) and a sea group (23 patients). 80th groups trained a week with the same program of aerobic conditioning 3 times (60 minutes each) for 12 weeks. Ali the patients were evaluated, before and immediately after treatment, with Visual Analogical Scale (VAS) for pain and fatigue, number of tending points, Fibromyalgia Impact Ouestionnaire (FIO), Short Form 36 Health Survey (SF-36), Pittsburgh Sleep Ouality Index (PSOI) and Beck Oepression Inventory (BOI). For statistical analysis, it was used paired-t test for analysis intra-group and non-paired test for inter-groups analysis, significance levei of p <0,05. Four patients, of each group, didn't complete the training programo Groups were homogeneous and they were compared in initial evaluation, except for BOI (p <0,05). Both groups presented statistically significant improvement for ali appraised parameters in the post-treatment compared with initial evaluation, there were reduction of intensity of pain and fatigue, number of tending points, better functional capacity (FIO), life quality (SF-36), quality of sleep (PSQI) and depression indexes (BOI). However, in comparison among the groups, group of sea (thalassotherapy) presented better results for ali parameters, however with statistically significant difference just only for depression indexes (BOI). At the end, it was observed that accomplishment of aerobic exercises in sea water or swimming pool was effective as part of treatment for patients with FM. However, exercise programs with thalassotherapy seems to bring more benefits, mainly related to emotional aspects, could be a therapeutic option of low cost for patients with FM in our area / A Fibromialgia (FM) ? uma s?ndrome reum?tica cr?nica, caracterizada por dor m?sculo esquel?tica difusa, onde os exerc?cios aer?bicos representam uma parcela fundamental na sua abordagem terap?utica. O objetivo deste estudo foi avaliar a efic?cia de exerc?cios aer?bicos realizados na ?gua do mar (talassoterapia) para mulheres com FM e comparar com exerc?cios realizados na piscina, envolvendo uma equipe multidisciplinar, composta por reumatologistas, fisioterapeutas e estudantes de fisioterapia e educa??o f?sica. Quarenta e seis (46) mulheres com idade entre 18 e 60 anos com FM foram randomizadas em 2 grupos: grupo da piscina (23 pacientes) e grupo do mar (23 pacientes). Ambos os grupos foram treinados com o mesmo programa de condicionamento aer?bico: tr?s vezes por semana, durante 60 minutos, por 12 semanas. Todas as pacientes foram avaliadas, antes e imediatamente ap?s o tratamento, pela Escala Visual Anal?gica (EV A) para dor e fadiga, contagem do n?mero de tender points, Fibromyalgia Impact Questionnaire (FIQ), Short Form 36 Health Survey (SF-36), Pittsburgh Sleep Quality Index (PSQI) e Beck Oepression Inventory (BDI). Na an?lise estat?stica, foram utilizados o teste t pareado para an?lise intragrupo e o teste t n?o-pareado para an?lise intrergrupos, sendo considerado um n?vel de signific?ncia p < 0,05. Quatro pacientes de cada grupo n?o completaram o programa de treinamento. Os grupos foram homog?neos e compar?veis na avalia??o inicial, com exce??o do BOI (p <0,05). Ambos os grupos apresentaram melhora estatisticamente significante em todos os par?metros avaliados no p?s-tratamento, comparado com a avalia??o inicial, com redu??o da intensidade da dor e fadiga, do n?mero de tend,er points, melhora da capacidade funcional (FIQ), qualidade de vida (SF-36), qualidade do sono (PSQI) e dos ?ndices e depress?o (BOI). Entretanto, na compara??o entre os grupos, o grupo do mar (talassoterapia) apresentou melhores resultados em todos os par?metros, por?m com diferen?a estatisticamente significante apenas nos ?ndices de depress?o (BOI). Ao final, observamos que a realiza??o de exerc?cios aer?bicos na ?gua do mar ou da piscina se mostrou efetiva como parte do tratamento de pacientes com FM. Entretanto, o programa de exerc?cios associado ? talassoterapia parece trazer mais benef?cios, principalmente relacionados a aspectos emocionais, podendo ser uma op??o terap?utica de baixo custo para pacientes com FM em nossa regi?o

Este trabalho discorre sobre como o município de Águas de São Pedro, situado no centro do Estado de São Paulo, constituído na década de 1930 como um espaço voltado à atividade turística, destaca-se pelo potencial termal. Até hoje a estância hidromineral tem no turismo a principal atividade econômica; entretanto, nossa pesquisa busca compreender se o atrativo primordial do Município está atrelado às águas medicinais, ou se outras características singulares da pequena cidade, como tranquilidade, beleza paisagística e segurança, o tornam um lugar propício ao passeio. Buscamos entender por que, dentre tantas opções de cidades interioranas disponíveis em São Paulo, Águas de São Pedro é escolhida como local de residência fixa, lugar de estabelecimento de casas de veraneio, sendo palco de um grande crescimento imobiliário; assim, desvendamos quais fatores da estância são responsáveis por atrair os turistas e veranistas/turistas de segunda residência. Os dados da pesquisa foram obtidos por meio de pesquisa bibliográfica, observação direta, conversas informais, aplicação de questionários e entrevistas com vários atores socioeconômicos, tais como moradores, turistas, veranistas, rede hoteleira, comércios, imobiliárias e gestores municipais. Os resultados apontam que o município já passou por vários ciclos turísticos e, apesar de a estância hidromineral de Águas de São Pedro ser uma referência regional e até nacional de águas termais, e do poder público estar investindo para apresentar à sociedade um lugar cheio de qualidade de vida, símbolo de bem-estar, grande parcela dos turistas procura a cidade pelo passeio, gastronomia e compras, caracterizando um turismo excursionista, sem pernoite. Este é o motivo pelo qual a cidade vem passando por grande reestruturação paisagística, orquestrada pelo poder público e porque recebe incrementos do poder privado no que se refere à variedade de produtos e serviços ofertados. Percebemos que a maior parcela de moradores e turistas não têm o hábito de utilizar as águas medicinais, mesmo sabendo que a água sulfurosa, também chamada de \"Fonte da Juventude\", utilizada para ingestão e banhos terapêuticos, é a segunda melhor do mundo, superada apenas pela fonte de Pergoli, em Tabiano, na Itália (CAMARGO, 1990), porém o reconhecimento da Cidade como cidade das águas, cidade termal, cidade saúde, é resiliente. / This paper discusses how the waters of São Pedro, located in the center of São Paulo, formed in the 1930s as a space oriented to tourism, the thermal potential. To date the health resort has in the main tourism economic activity, however our research seeks to understand the primary attraction of the city is related to medicinal waters, or other unique characteristics of small town like tranquility, natural beauty and safety, make it a place conducive to walking. We try to understand why among so many choices of inner cities available in Sao Paulo Aguas de Sao Pedro is chosen as a fixed place of residence, place of establishment of second homes, the scene of a major real estate growth, thus unveil which resort factors are responsible to attract tourists and vacationers/second residence tourists. The survey data were obtained by means of literature, direct observation, informal conversations, questionnaires, and interviews with various socio-economic actors, such as residents, tourists, vacationers, hotel chain, trade, real estate and municipal managers. The results show that the city has had several tour cycles and that despite the health resort of Aguas de Sao Pedro is a regional and even national reference thermal waters, and the government is investing to present to society a place full of quality life, health symbol, a large proportion of tourists looking for the city by walking, dining and shopping, featuring a hiker tourism without overnight. Why the city has been undergoing major restructuring landscape orchestrated by the government, and receiving increments of private power as regards the variety of products and services offered. We realize that the largest share of locals and tourists do not have the habit of using medicinal waters, even though the source of sulphurous water, also called the \"Fountain of Youth\", used for intake and therapeutic baths, it is the second best in the world, surpassed only by the source of Pergoli in Tabiano, Italy (CAMARGO, 1990), but the recognition of the city as a city of water, spa town, city health, is resilient.

Introdução: Tem se afirmado que não há a possibilidade de haver melhora da estabilidade dinâmica postural utilizando exercícios na água, isto é, onde a gravidade apresenta-se diminuída. Neste estudo randomizado e controlado avaliamos e comparamos a estabilidade dinâmica postural em indivíduos saudáveis que realizaram exercícios sensório-motor no solo ou na água. Métodos: Através do Biodex Balance System®, foram avaliados os limites de estabilidade postural, antes e após um programa de exercícios, de 60 indivíduos saudáveis do sexo masculino divididos em 3 grupos (solo, piscina e controle). Os indivíduos dos grupos solo e piscina realizaram um treinamento sensório-motor por 2 meses no solo e na água respectivamente; o grupo controle não realizou nenhum tipo de exercício. Resultados: 1) Foram encontradas diferenças significativas na estabilidade dinâmica entre o grupo solo e controle; 2) Foram encontradas diferenças significativas na estabilidade dinâmica entreo grupo piscina e controle; 3) Não foram encontradas diferenças significativas entre o grupo solo e piscina. Conclusões: realizar exercícios sensório-motor melhora a estabilidade postural em indivíduos saudáveis do sexo masculino, sem diferenças significativas entre os ambientes de treino (solo e água) comparados / Introduction: It has been stated that there is no way to improve dynamic postural stability using exercises in water, i.e. where there is reduced gravity. In this controlled, randomized study, we evaluate and compare postural dynamic stability in healthy individuals who performed sensory-motor exercises on the ground or in water. Methods: Through the Biodex Balance System®, the limits of postural stability were evaluated before and after a program of exercises, in 60 healthy males, divided into three groups (ground, swimming pool and control). The individuals in the ground and swimming pool groups carried out sensorial-motor training for two months, on the ground and in the water, respectively; the control group did not perform any kind of exercises. Results: 1) Significant differences were found in dynamic stability between the ground and control groups; 2) Significant differences were found in dynamic stability between the swimming pool and control groups; 3) No significant differences were found between the ground and swimming pool groups. Conclusions: performing sensory-motor exercises improves postural stability in healthy males, without significant differences between the training environments (ground and water) compared in this study

M.A. (Psychology) / Numerous amounts ofliterature has confirmed the positive correlation that exists between exercise and psychological well-being. With the increased interest in the associated psychological factors ofpain, the present study was undertaken to investigate the effects of chronic pain on rheumatoid arthritic and osteoarthritic patients, with the overall aim of reducing, and alleviating these factors. The psychological factors studied were depression, effects ofthe impact ofarthritis, for example, on the independent, physical and psychosocial aspects oftheir lives, as well as coping. It was hypothesized that by engaging in an aquatic exercise program there would be a reduction/alleviation ofpain, which in tum would demonstrate a reduction in the psychological components ofpain. Evidence was found to support the hypothesis, due to the fact that, after exposure to the aquatic therapy program, subjects demonstrated a reduction in pain followed by a reduction in depression, slight improvement in coping with their arthritis, and the impact of arthritis was partially alleviated. The need for a larger sample group, as well a longer period of investigation will be needed for future research.

Magister Scientiae (Physiotherapy) - MSc(Physio) / Rheumatic disease is estimated to be one of the most disabling diseases in South Africa and the world. The most common rheumatic diseases are osteoarthritis, fibromyalgia, rheumatoid arthritis, gout and systemic lupus erythematosus. The symptoms of the disease include pain, stiffness, swelling, decreased function. The patient’s functional abilities are severely affected by the pain which in turn, leads to poor quality of life and adverse stress. As a result patients who suffer with one or with a combination of rheumatic disease will experience pain, stress, decreased functional abilities and poor quality of life. The physical properties of water and the therapeutic effects of hydrotherapy, make hydrotherapy an effective form of exercise available to physiotherapists in the treatment of rheumatic disease. The aim of the current study was to determine the effects of a hydrotherapy intervention on the pain, stress, quality of life and functional abilities in patients with rheumatic disease. A quantitative and qualitative research design was employed to meet the objectives. The quantitative aspect involved an A-B-A design and the qualitative part of the study compromised indepth interviews which took place after the intervention. The instruments used were the WHOQOL-BREF instrument, the Visual Analogue Scale (VAS), the Weekly Stress Inventory-Short Form (WSI-SF) and the Health Assessment Questionnaire. (HAQ). The sample consisted of 19 patients who were diagnosed with one or a combination of rheumatic disease. The study was conducted at the hydrotherapy pool at Groote Schuur Hospital in Cape Town. Within the study sample, the majority of the participants were female (84%) with osteoarthritis being common among the participants (53%). The mean age was 60 years. The intervention had a significant impact on pain reduction (p = 0.0001), quality of life (p<0.05). However, the impact of hydrotherapy on stress and the social relationship domain in quality of life was inconclusive. It is thus evident from this study that hydrotherapy as a treatment modality for physiotherapists can be used to impact on the pain, quality of life and functional abilities in patients with rheumatic disease. iv Keywords

The topic of this thesis is design of hydrotherapy bathtub for upper limbs that reacts mainly to ergonomic weaknesses of current solutions. Created design concept is mainly focused on users comfort. Its appearance reflects the environment of medical and rehabilitation facilities.