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Complex orthopaedic surgery is often indicated in the management of deformity in children with spastic diplegic cerebral palsy (CP) and a long rehabilitation programme is important for a successful outcome. However, the frequency and content of physiotherapy treatment following surgery varies between centres. This thesis aimed at providing a scientific basis for post-operative rehabilitation following multi-level surgery in children with CP. The effect of muscle weakness on function in patients with CP is recognised. However, the short and long-term impact of multi-level orthopaedic surgery on muscle strength is unclear. Strength changes would have implications for both surgical and conservative treatment planning. The objectives of this study were to establish a better understanding of the impact of surgery on muscle strength, gait and function, as well as the natural history of weakness in CP. Furthermore, the study aimed to clarify whether physiotherapy, focused on resistance strengthening techniques, was more effective than routine physiotherapy. The reliability of a protocol for measuring muscle strength in lower limb muscle groups in this population was firstly established. A pilot study of 10 children with a diagnosis of spastic diplegic CP and healthy counterparts demonstrated a reliable strength testing protocol. The main study of 20 diplegic children who underwent multi-level surgery showed that despite improvements in gait parameters, significant loss of strength in lower limb muscle groups and gross motor function persisted at six months. The value of intensive physiotherapy was assessed in a randomised controlled trial six months after surgery. Advantages of resistance training over active exercise were demonstrated. Assessment at one year showed that surgical patients preserved the post-physiotherapy strength and function gains but these did not reach the pre-operative values. Another group of 10 diplegic children who received routine physiotherapy but no surgical treatment for 12 months showed significant deterioration of their gait. The rate of deterioration demonstrated in conservatively treated diplegic patients and the degree of weakness caused by surgery, should inform parents and clinicians during decisions regarding surgery. Future research in multi-level surgery should include specific strength assessment protocols. The results from the randomised clinical trial showed that overall intensive strengthening regimes after multi-level surgery are beneficial. This finding would have significant implications on managing resources and designing appropriate rehabilitation programmes after multi-level orthopaedic surgery.

There has recently been an increased pressure in all-healthcare disciplines to provide interventions that are scientific, safe, efficient and cost-effective. Evidence-based practice is said to be the current best approach to address these attributes. All healthcare professionals including physiotherapists need to adopt it. Numerous physiotherapy studies have been carried out to ascertain the attitudes towards, knowledge of, engagement in as well as the barriers of evidence-based practice. These studies were mostly carried out in the developed countries and almost none in the devloping African countries. By means of an exploratory cross-sectional study, deploying both quantitative and qualitative methods, this study investigated the Tanzanian physiotherapists attitudes towards the concept of evidence-absed practice. The study also examined the knowledge that they possess, that could enable them engage in evidence-based related activities. In addition, this study explored the barriers they experience while practicing evidence-based practice.

There is increasing evidence that stroke survivors benefit from the provision of intensive, task-specific therapy in the rehabilitation of motor function. Providing such therapy to a number of stroke survivors in a group setting (know as circuit class therapy) has been proposed as an alternative model of physiotherapy service delivery within the inpatient rehabilitation setting. This study investigated the effectiveness and feasibility of circuit class therapy, as compared to the standard practice of one-to-one therapy sessions, within a representative sample of stroke survivors receiving inpatient rehabilitation. / Thesis (PhD)--University of South Australia, 2006.

The decreasing Australian health dollar requires closer scrutiny on what outcome is purchased for it. Quality outcomes are produced by quality services, it is important to identify the constructs of quality care from individual stakeholders' perspectives. Empirical research on quality constructs is limited to medical and nursing literature. Within Physiotherapy and Chiropractics, little research has been undertaken to examine the constructs of quality care from individual stakeholder perspectives, or to develop monitoring systems that reflect the nature and philosophy of Physiotherapy and Chiropractic care / This research explored and expanded upon current knowledge on the constructs of quality and current quality monitoring standards within Physiotherapy and Chiropractic private sector services in Australia. This research explored individual primary stakeholder perspectives of quality (patients, providers and funders). The study identified factors that acted as barriers and incentives in the provision of quality care. This research generated a model of innovative quality monitoring strategies, which reflected stakeholders' perspectives, and could be utilised across private and public funding sectors / This research utilised a mixed method approach of qualitative and quantitative research paradigms. The main methods comprised of interviews with key stakeholders, surveys of patient's perspectives of quality care and an educational outreach program for providers / The findings highlight the multi-dimensional and multifactorial nature of health care quality and its constructs from the perspectives of different stakeholders. Patients and providers' expectations of quality were congruent and contained quality constructs ranging across structure, process and outcome dimensions. This research identified that patient expectations of quality are underpinned by patient-centred care and effective communication between patient and provider. In contrast, funders' perspectives of quality were unidimensional with predominant emphasis on cost of services. This study found funders' monitoring standards were inadequate in identifying poor practices or providing incentives to improve practice. This research provided ways in which funding agencies could continue to use traditional methods of monitoring (such as costs) as well as employing innovative strategies such as patient perspectives on the quality of care they would receive / This research provides the first known evaluation approach for patients to provide feedback on their expectations of quality of Physiotherapy and Chiropractic services. The unique evaluation instrument is profession-specific and it considers patients' expectations using an episode-of-care model rather than the traditional occasion-of-service model. The findings from the survey of Physiotherapy and Chiropractic patients identified the importance of meeting patient expectations prior to, during, and after, the first occasion-of-service with the provider in the episode, and then at three subsequent service points in the episode / This research identified providers' perspectives of an educational outreach program, which aimed to inform and educate them regarding the quality of care they provided. The findings indicated that providers were genuinely interested in uptake of patient feedback into clinical practice. Numerous dissemination strategies were possible within their practices and within their profession / This explanatory research is the first of its kind in providing foundational research evidence on the constructs of quality within private practice Physiotherapy and Chiropractics from different stakeholders' perspectives. It has also established that patients can be effectively engaged in monitoring quality of care. The findings highlight that patient expectations of quality vary throughout an episode-of-care and this needs to be recognised by other stakeholders in quality monitoring and quality improvement initiatives. The findings from this research can form the basis for future research in examining relationships of constructs of quality across other patient populations with other Allied Health disciplines, and in testing innovative quality improvement initiatives / Thesis (PhD)--University of South Australia, 2005

The decreasing Australian health dollar requires closer scrutiny on what outcome is purchased for it. Quality outcomes are produced by quality services, it is important to identify the constructs of quality care from individual stakeholders' perspectives. Empirical research on quality constructs is limited to medical and nursing literature. Within Physiotherapy and Chiropractics, little research has been undertaken to examine the constructs of quality care from individual stakeholder perspectives, or to develop monitoring systems that reflect the nature and philosophy of Physiotherapy and Chiropractic care / This research explored and expanded upon current knowledge on the constructs of quality and current quality monitoring standards within Physiotherapy and Chiropractic private sector services in Australia. This research explored individual primary stakeholder perspectives of quality (patients, providers and funders). The study identified factors that acted as barriers and incentives in the provision of quality care. This research generated a model of innovative quality monitoring strategies, which reflected stakeholders' perspectives, and could be utilised across private and public funding sectors / This research utilised a mixed method approach of qualitative and quantitative research paradigms. The main methods comprised of interviews with key stakeholders, surveys of patient's perspectives of quality care and an educational outreach program for providers / The findings highlight the multi-dimensional and multifactorial nature of health care quality and its constructs from the perspectives of different stakeholders. Patients and providers' expectations of quality were congruent and contained quality constructs ranging across structure, process and outcome dimensions. This research identified that patient expectations of quality are underpinned by patient-centred care and effective communication between patient and provider. In contrast, funders' perspectives of quality were unidimensional with predominant emphasis on cost of services. This study found funders' monitoring standards were inadequate in identifying poor practices or providing incentives to improve practice. This research provided ways in which funding agencies could continue to use traditional methods of monitoring (such as costs) as well as employing innovative strategies such as patient perspectives on the quality of care they would receive / This research provides the first known evaluation approach for patients to provide feedback on their expectations of quality of Physiotherapy and Chiropractic services. The unique evaluation instrument is profession-specific and it considers patients' expectations using an episode-of-care model rather than the traditional occasion-of-service model. The findings from the survey of Physiotherapy and Chiropractic patients identified the importance of meeting patient expectations prior to, during, and after, the first occasion-of-service with the provider in the episode, and then at three subsequent service points in the episode / This research identified providers' perspectives of an educational outreach program, which aimed to inform and educate them regarding the quality of care they provided. The findings indicated that providers were genuinely interested in uptake of patient feedback into clinical practice. Numerous dissemination strategies were possible within their practices and within their profession / This explanatory research is the first of its kind in providing foundational research evidence on the constructs of quality within private practice Physiotherapy and Chiropractics from different stakeholders' perspectives. It has also established that patients can be effectively engaged in monitoring quality of care. The findings highlight that patient expectations of quality vary throughout an episode-of-care and this needs to be recognised by other stakeholders in quality monitoring and quality improvement initiatives. The findings from this research can form the basis for future research in examining relationships of constructs of quality across other patient populations with other Allied Health disciplines, and in testing innovative quality improvement initiatives / Thesis (PhD)--University of South Australia, 2005

The decreasing Australian health dollar requires closer scrutiny on what outcome is purchased for it. Quality outcomes are produced by quality services, it is important to identify the constructs of quality care from individual stakeholders' perspectives. Empirical research on quality constructs is limited to medical and nursing literature. Within Physiotherapy and Chiropractics, little research has been undertaken to examine the constructs of quality care from individual stakeholder perspectives, or to develop monitoring systems that reflect the nature and philosophy of Physiotherapy and Chiropractic care / This research explored and expanded upon current knowledge on the constructs of quality and current quality monitoring standards within Physiotherapy and Chiropractic private sector services in Australia. This research explored individual primary stakeholder perspectives of quality (patients, providers and funders). The study identified factors that acted as barriers and incentives in the provision of quality care. This research generated a model of innovative quality monitoring strategies, which reflected stakeholders' perspectives, and could be utilised across private and public funding sectors / This research utilised a mixed method approach of qualitative and quantitative research paradigms. The main methods comprised of interviews with key stakeholders, surveys of patient's perspectives of quality care and an educational outreach program for providers / The findings highlight the multi-dimensional and multifactorial nature of health care quality and its constructs from the perspectives of different stakeholders. Patients and providers' expectations of quality were congruent and contained quality constructs ranging across structure, process and outcome dimensions. This research identified that patient expectations of quality are underpinned by patient-centred care and effective communication between patient and provider. In contrast, funders' perspectives of quality were unidimensional with predominant emphasis on cost of services. This study found funders' monitoring standards were inadequate in identifying poor practices or providing incentives to improve practice. This research provided ways in which funding agencies could continue to use traditional methods of monitoring (such as costs) as well as employing innovative strategies such as patient perspectives on the quality of care they would receive / This research provides the first known evaluation approach for patients to provide feedback on their expectations of quality of Physiotherapy and Chiropractic services. The unique evaluation instrument is profession-specific and it considers patients' expectations using an episode-of-care model rather than the traditional occasion-of-service model. The findings from the survey of Physiotherapy and Chiropractic patients identified the importance of meeting patient expectations prior to, during, and after, the first occasion-of-service with the provider in the episode, and then at three subsequent service points in the episode / This research identified providers' perspectives of an educational outreach program, which aimed to inform and educate them regarding the quality of care they provided. The findings indicated that providers were genuinely interested in uptake of patient feedback into clinical practice. Numerous dissemination strategies were possible within their practices and within their profession / This explanatory research is the first of its kind in providing foundational research evidence on the constructs of quality within private practice Physiotherapy and Chiropractics from different stakeholders' perspectives. It has also established that patients can be effectively engaged in monitoring quality of care. The findings highlight that patient expectations of quality vary throughout an episode-of-care and this needs to be recognised by other stakeholders in quality monitoring and quality improvement initiatives. The findings from this research can form the basis for future research in examining relationships of constructs of quality across other patient populations with other Allied Health disciplines, and in testing innovative quality improvement initiatives / Thesis (PhD)--University of South Australia, 2005

The decreasing Australian health dollar requires closer scrutiny on what outcome is purchased for it. Quality outcomes are produced by quality services, it is important to identify the constructs of quality care from individual stakeholders' perspectives. Empirical research on quality constructs is limited to medical and nursing literature. Within Physiotherapy and Chiropractics, little research has been undertaken to examine the constructs of quality care from individual stakeholder perspectives, or to develop monitoring systems that reflect the nature and philosophy of Physiotherapy and Chiropractic care / This research explored and expanded upon current knowledge on the constructs of quality and current quality monitoring standards within Physiotherapy and Chiropractic private sector services in Australia. This research explored individual primary stakeholder perspectives of quality (patients, providers and funders). The study identified factors that acted as barriers and incentives in the provision of quality care. This research generated a model of innovative quality monitoring strategies, which reflected stakeholders' perspectives, and could be utilised across private and public funding sectors / This research utilised a mixed method approach of qualitative and quantitative research paradigms. The main methods comprised of interviews with key stakeholders, surveys of patient's perspectives of quality care and an educational outreach program for providers / The findings highlight the multi-dimensional and multifactorial nature of health care quality and its constructs from the perspectives of different stakeholders. Patients and providers' expectations of quality were congruent and contained quality constructs ranging across structure, process and outcome dimensions. This research identified that patient expectations of quality are underpinned by patient-centred care and effective communication between patient and provider. In contrast, funders' perspectives of quality were unidimensional with predominant emphasis on cost of services. This study found funders' monitoring standards were inadequate in identifying poor practices or providing incentives to improve practice. This research provided ways in which funding agencies could continue to use traditional methods of monitoring (such as costs) as well as employing innovative strategies such as patient perspectives on the quality of care they would receive / This research provides the first known evaluation approach for patients to provide feedback on their expectations of quality of Physiotherapy and Chiropractic services. The unique evaluation instrument is profession-specific and it considers patients' expectations using an episode-of-care model rather than the traditional occasion-of-service model. The findings from the survey of Physiotherapy and Chiropractic patients identified the importance of meeting patient expectations prior to, during, and after, the first occasion-of-service with the provider in the episode, and then at three subsequent service points in the episode / This research identified providers' perspectives of an educational outreach program, which aimed to inform and educate them regarding the quality of care they provided. The findings indicated that providers were genuinely interested in uptake of patient feedback into clinical practice. Numerous dissemination strategies were possible within their practices and within their profession / This explanatory research is the first of its kind in providing foundational research evidence on the constructs of quality within private practice Physiotherapy and Chiropractics from different stakeholders' perspectives. It has also established that patients can be effectively engaged in monitoring quality of care. The findings highlight that patient expectations of quality vary throughout an episode-of-care and this needs to be recognised by other stakeholders in quality monitoring and quality improvement initiatives. The findings from this research can form the basis for future research in examining relationships of constructs of quality across other patient populations with other Allied Health disciplines, and in testing innovative quality improvement initiatives / Thesis (PhD)--University of South Australia, 2005

Thesis (PhD)--University of Stellenbosch, 2005. / Bibliography. Also available via the Internet.

Diss. (sammanfattning) Linköping : Univ., 2001. / Härtill 4 uppsatser.