[Truncated abstract] There have been few studies into the effects of rehabilitation following lumbar microdiscectomy and consequently little evidence of its effect, if any, on outcome. Most studies cited fall into one of two categories: research involving a spinal surgery procedure without rehabilitation, or research involving spinal surgery with a nonspecific generic 'rehabilitation' or 'physical therapy'. In an era of evidence based medicine the efficacy of specific rehabilitation protocols following defined lumbar spine surgical procedures needs to be established for surgeons, therapists and patients to have confidence that the rehabilitation is appropriate and effective. The study was proposed to investigate the outcome of a specific and novel rehabilitation protocol commenced immediately after lumbar microdiscectomy. Data collected from the research cohort were compared to data collected from a contrast group who underwent standard rehabilitation at a distant site. A retrospective study (Phase One) was carried out with a cohort of post-operative microdiscectomy patients between February 2000 and December 2002. The outcome of surgery followed by the rehabilitation protocol was assessed using validated outcome instruments. A contrast or control group was not included. After reviewing the data limitations with the design and implementation of the study were identified. A prospective study (Phase Two) was proposed and changes made in the principal outcome measure used, in the demographic data to be retrieved, the addition of pain scales, and in the exclusion of compensable patients. A contrast group was included for the prospective study. ... The study group commenced exercise and posture correction the day following surgery. There were restrictions placed on activity involving bending. The contrast group followed the advice of the surgeon in Queensland and attended rehabilitation at local physiotherapy facilities. Both groups were followed for 12 months using outcome instruments. Strict comparison between WA and QLD cohorts were limited due to sample size, however trends were observed. Data of the prospective study showed that there was greater reduction in back pain with the early rehabilitation protocol (P<.0001) compared to standard rehabilitation (P=.09), while there was no difference between groups in leg pain. There was a significant improvement in the level of functional disability between time-points for the WA cohort, and overall change from pre-operative RMQ measures to 12 months in both groups were statistically significant. The WA group was less reliant on pain medication and was more satisfied with the results of their surgery. The primary hypothesis of this study that there would be a difference in outcome following lumbar microdiscectomy in patients who receive early specific rehabilitation compared to those who receive standard rehabilitation at another centre, was supported in both primary and secondary outcome data. The key finding of this study was that commencing the early exercise protocol resulted in significantly less back pain over the 12 month time period of the study. Other major findings were that the WA cohort demonstrated significant improvement in function at all time-points and between all time-points except six to 12 months, took less pain medication and were more satisfied with the outcome of their surgery than the QLD cohort.

D.Litt. et Phil. (Psychology) / Over the past four decades we have witnessed the emergence of amazingly sophisticated means of cardiovascular diagnosis and therapy. For the first time in many years, some Western countries could report a decline in cardiovascular deaths. During this same span of years we have witnessed the remarkable development of an array of technological achievements that include the means for invasive diagnostic procedure such as cardiac catherization, and non-invasive methods of echocardiography, magnetic, radio-isotopic and positron imagery which provide detailed diagnostic and prognostic information. This innovations along with synthetic grafts have permitted surgical interventions that would not have been conceivable at the outset of this cardiovascular odyssey. Another major advance has been the appearance of new pharmacological modalities; the diuretics, the beta-adrenergic receptors and angiotension converting enzyme inhibitors, the calcium antagonists and other anti-hypersensitive agents, a spectrum of antiarrhythmic compounds, anticoagulants and fibrinolytic therapy, and the promise of still more innovative and novel modes of therapy which will appear via genetic engineering. Over the past years there has been equally significant development in the area of cardiovascular epidemiology. These advances include the demonstration of validity and the efficacy of various therapeutic programmes by the unique development of complex multi-center trials, as well as long-term population-based studies. Through this endeavours specific risk factors that impart independent risk ofpremature cardiovascular morbidity and mortality has been identified. Some of these risk factors are clearly not modifiable such as advancing years, male gender and race. Others are at least partly modifiable: predisposition to diabetes myelitis and increased body mass. By virtue of multi-center trials we have clear evidence that cigarette smoking, rising systolic and diastolic arterial pressures, serum cholesterol levels, and diabetes are modifiable. It is a known fact that not all individuals with coronary artery disease are cured by medication or by means of a surgical intervention. In addition to this, the reduction of traditional biomedical risk factors have been shown to be insufficient in averting the reocclusion and the further occlusion of coronary arteries in patient populations.

D.Litt. et. Phil. / Head injury is the major cause of death for individuals under 35 years old in the United States of America, and a similar picture exists in South Africa. A major cause of traumatic brain injury is motor vehicle accidents. In addition, the advances in modem medical technology increase the chances for survival, for example, sophisticated medical diagnostic techniques such as computerised tomography (CT), and magnetic resonance imaging (MRI). Advances in emergency trauma and neurosurgical procedures have also increased the number of survivors following a head injury. The symptoms resulting from head injury include disturbed physical, cognitive, psychological and behavioural functioning. Long-term management of these symptoms is usually required. A body of evidence exists that demonstrates the value of rehabilitation during the first year of recovery from traumatic brain injury. Head injury cases often result in litigation in that the injured person may be entitled to compensation for the injuries sustained. Considerable forensic debate exists around the issue of whether the victim's symptoms are attributable to organic brain damage, or whether they reflect a pre-existing functional psychological state of psychiatric illness, or personality disorder. Further still, the individual may be 'malingering' or faking postconcussion symptoms of headache, dizziness, fatigue, memory deficit, impaired concentration, irritability, anxiety, insomnia, concern about bodily functions, and hypersensitivity to light and noise. Alternatively, a common diagnosis is traumatic neurosis with a psychogenic basis, and in the context of litigation is referred to as "compensation neurosis". Specifically, the issue of contention revolves around concussion, and mild or minor head injuries. This study proposed that both neuropathophysiological and psychosocial symptoms occur in the event of a traumatic brain injury. This view supports the traditional model that pain or the sequelae of head injury are not affected by compensation. Therefore, the objective of the study was that follow-up assessment after compensation pay-outs should produce similar results to the assessment results obtained during the litigation process. The hypotheses of the study were essentially confirmed. The neuropsychological error scores produced in the assessments during litigation, and two-to-four years after the completion of litigation were similar. However, similar to other studies, variations were evident. Four exceptions were demonstrated in that significant improvement was evident with regard to shotterm verbal memory delayed recall for paragraphs, and for immediate recall (without and after interference) in verbal memory for a word list. These improvements therefore pertain to verbal memory. The fourth improvement occurred with respect to manual dexterity and visual-motor work speed, although the improvement may be peripheral or primary (neurological). Further findings included that no gender differences were evident in the neuropsychological posttest scores. It was confirmed that individuals with a good Glasgow Outcome Scale rating showed less posttraumatic amnesia, a shorter time since injury, less additional injuries, and a lower compensation sum. It was also supported that individuals with a good Glasgow Outcome Scale rating showed less impairment on neuropsychological indices. However, an exception was that individuals with a moderate Glasgow Outcome Scale rating showed improvement on the neuropsychological index measuring immediate concentration, visual scanning, and visual-motor work speed. The qualitative data or psychosocial measures of severity and outcome produced a similar picture that the majority of subjects maintained their pretest status although some exceptions were evident. Within the medico-legal domain it was shown that, in general, concordance of severity was high amongst the medical experts for the plaintiffs and the defendents. However, their prognoses were indicated to be less accurate, and whilst their consistency in documenting diagnoses in the reports of the subjects was adequate, they were found to be inconsistent in documenting severity ratings and prognoses. It was suggested that improvements may be attributed to neurophysiological differences, non-participation in a rehabilitation programme, the interference and delay of rehabilitation, increased psychological reactions associated with litigation, and mechanisms of secondary gain which may by attributed to the other players, such as the family, the attorneys, the medical experts, among others, and not only to the individual or victim.

M.A. / The line between the postmodernism and modernism is largely unbridgeable. The line between left and right sides is also division. Sometimes there is a narrow and rapid point of crossing, and then it is gone. Modernism and post modernism are only alike in their sharing of a common semantic. The line is a division in thinking. Both sides are isolated by the lack of a significant bridge. The line also signifies that there can either be one or the other way of thinking, the two cannot exist on the same page - but they do. And they do it in life, too. Psychology has, by it's very attempts to prove itself a science, isolated the individuals uniqueness and connection with other humanity, by inadvertently developing a therapeutic stance of separateness and isolation. What makes this doubly sad is that psychology has rationalised that this is not the case. The right side of the text speaks clearly of human input, and pro-active contact on a physical and caring level, and the residents grow. The left hints at what might be the case, because it is, after all, only a theory. The research conducted looks good, but may not be correct... No theory will put itself on the line. The right side is on the line every second of every day. Lives are being built here. By sitting and reflecting at a person, in a 'therapeutic environment', the person is immediately isolated from any human social interaction or input. By studying the individual and his behaviour with a view to dissect cause, effect and totality have become victims. The person of needs be must become 'abnormal'. He becomes different, an anomaly. Then both himself and the community scream for an end to stigmatization. This text is a metaphor for the conflict experienced between being humans and psychology. There are many other ways to view this text.

As a result of medical advancement and cultural patterns of Western society, traumatic head injury is increasingly a problem for the injured, their families, medical and social services professionals, and the community at large. Head trauma is remarkable because of the complex nature of the residual disabilities which include long lasting cognitive and emotional problems, social isolation, and family disruption. The purpose of this study was to re-examine the phenomenon of recovery after mild to moderate head injury using an ethnographic research approach. The data were based on the experiences of 21 disabled and their families in the community setting. The disabled represented a range of stages of recovery and severity of disability. The data was collected using three field work strategies: extensive semi-structured interviews, participant observation, and non-academic document review. After collection the data was subjected to thematic and content analysis, that resulted in the selection of themes that characterized the experiences for the head injured and their families. The themes for the head injured informants were: dead days, loneliness, and forgetting. The family members' experiences were represented in the themes: responsibility, vulnerability, tough love, gender differences, and reactions to the experience. Next the data were interpreted using five theoretical concepts from cultural anthropology: liminality, personhood, social labelling, sick role and double bind. In addition, the reflexive influence of the investigator on the research process was addressed. The trustworthiness of the ethnography was assessed in terms of credibility, transferability, dependability and confirmability. Several variables were found to be important to the long term outcome of head injury. These variables were: family directed therapy, double bind communication patterns, and lifelong recovery. Two other factors were found to be critical for the recovery of the head injured. These were economic disincentives to the return to employment and the importance of the social and family environment. In the final section the research and policy implications of the study were discussed in relation to management and service provisions.

The purpose of this study was to describe the relationship between health expectations and compliance in persons who were attending a cardiac rehabilitation program. Three subscales of the Olivas Health Motivation Scale were administered to a convenience sample of 23 subjects at two points in time: at the beginning and at the completion of the prescribed sessions. A significant relationship was found between Stimulus Outcome Expectations and the duration of exercise at the beginning of the cardiac rehabilitation sessions (r = -.51, p =.02). The relationship between Regimen Efficacy Expectations and the duration of exercise was also found to be significant at the beginning of the sessions (r = -.40, p =.05). There was no significant relationship between health expectations and compliance at the completion of the sessions. One measure of health expectations, Stimulus Outcome Expectations (F = 10.11, p =.01), and two measures of compliance, duration of exercise (F = 406.45, p =.00) and metabolic equivalents (F = 74.14, p =.00), were significantly different between the beginning and the completion of cardiac rehabilitation.

The purpose of the study was to determine the effects of either a programmed instruction booklet or group lecture on knowledge of post myocardial infarction patients. A convenience sample of 30 post myocardial infarction patients enrolled in Cardiac Rehabilitation at a midwestern hospital were asked to participate.Subjects were assigned either to the experimental group or the lecture group. The pretest was administered to both groups. The experimental group received the self instruction booklet and the lecture group received a posttest was immediately completed by the participants. A nonequivalent pretest-posttest repeated measure design was utilized in the study.The results of the study showed a mean improvement in knowledge scores for both the booklet group and lecture group, with the booklet group having the larger gain in knowledge scores. The knowledge gain however, was not significant at the 0.05 level. / School of Nursing

While many short-term physical activity (PA) interventions in cardiac rehabilitation (CR) patients have proven to be successful at increasing PA levels, little is known about the long-term impact these interventions have. The purpose of the current study was to determine if the Increased Physical Activity in Cardiac Patients (IPAC) study utilizing pedometer feedback, motivational messages, and a combination of both were successful at increasing PA levels and improving cardiovascular disease (CVD) risk factors after 12 months. The results of the study indicated that none of the IPAC interventions were successful at increasing PA levels after 12 months compared to the usual care group and all groups reverted back to baseline levels. Additionally, no significant differences were seen across time or between groups in most CVD risk factors. Further research is needed to develop PA interventions in CR patients that foster long-term PA maintenance. / School of Physical Education, Sport, and Exercise Science

Stroke is one of the leading causes of mortality and disability worldwide. The majority of stroke patients are elderly. Advanced age, hypertension, diabetes mellitus, atrial fibrillation, smoking and heavy alcohol drinking are the major risk factors. Treatment of modifiable risk factors is an important strategy for primary and secondary stroke prevention. The primary aim of this thesis was to examine stroke risk factor profile, risk factor management and clinical outcomes, as well as their association with ethnicity (defined as English-speaking background ? ESB, and non-English-speaking background - NESB) in a group of elderly patients from a multiethnic background. Stroke risk factor profile and outcomes of stroke were similar between English and non-English-speaking background patients. However, a higher prevalence of diabetes mellitus in the NESB patient group was observed in the study (41% vs. 10% in the ESB patient group) (Chapter 2). In addition, predictive factors and predictive models for stroke outcomes were developed. Advanced age, visual field loss and stroke type were the main predictors for mortality and functional dependency at 12 months post-stroke (Chapter 3). Delirium occurred in one quarter of the elderly patient post-stroke and was also associated with a worse clinical outcome (Chapter 4). Risk factor management may be suboptimal in elderly patients. For example, anticoagulant therapy for stroke prevention in patients with atrial fibrillation was underused, particularly in NESB patients (Chapter 2). The reasons for under-usage of anticoagulant therapy were investigated in a general practitioner survey (Chapter 6). Results showed that NESB, older age, cognitive impairment (especially living alone) were significant potential barriers for anticoagulant prescription by general practitioners. Stroke units have been proven to be a better care model for stroke patients, with shortened hospital length of stay and improved clinical outcomes. Clinical audits from Bankstown Combined (Co-located) Acute and Rehabilitation Stroke Unit and later the newly established Blacktown Combined Co-located Stroke Unit have demonstrated these benefits (Chapter 5). However, further studies need to be performed in order to determine whether a combined co-located stroke unit care model is superior to other stroke unit care models, and if so, the reasons behind this.

Abdominal obesity is a part of insulin resistance syndrome that is closely linked to increased risk of coronary artery disease (CAD). Because fat tissue acts as an endocrine target and source of hormone production, increased metabolism or production of chemical messengers in fat tissue may result in metabolic perturbations that contribute to occurrence and recurrence of coronary events. This dissertation research entails two separate approaches. The first study, a cross-sectional analysis, sought to determine whether serum cortisol responses to oral glucose loading are associated with abdominal obesity, non-esterified fatty acid (NEFA) suppression, and self-reported symptoms of depression in 26 non-diabetic coronary patients. We conclude that lower cortisol responses to oral glucose loading are associated with abdominal obesity, reduced NEFA suppression, and fewer symptoms of depression (P���0.028). Future prospective studies should determine whether psychosocial risk factors, such as depression and anxiety, increase cortisol production, whether increases in cortisol production act synergistically with a positive energy balance in the development of abdominal obesity, and whether increases in abdominal obesity lead to increases in cortisol metabolism and insulin resistance. C-reactive protein (CRP) is a marker of low-grade inflammation that is associated with increased risk for recurrent events in coronary patients. Fat tissue also secretes proinflammatory cytokines that stimulate hepatic production of CRP. Thus, the second study, an intervention study, sought to determine whether the first three months of cardiac rehabilitation could reduce serum concentrations of CRP and the proinflammatory cytokine, tumor necrosis factor-�� (TNF-��), in our non-diabetic coronary patients (N=26). Results from the intervention study showed significant reductions in serum CRP levels (P=0.012) that were associated with reductions in waist circumferences after cardiac rehabilitation (r=0.39, P=0.049). However, changes in serum TNF-�� levels after cardiac rehabilitation were nonsignificant (P=0.869). Thus, we conclude that cardiac rehabilitation may reduce the severity of low-grade inflammatory conditions, in part, through reductions in waist circumference in non-diabetic coronary patients. / Graduation date: 2001