Bakgrund: Fibromyalgi är ett långvarigt smärtsyndrom med en prevalens kring 4 % för kvinnor och 1% för män. Träning rekommenderas till patienter som del i behandling. Tidigare sammanställningar av forskning visar på brister i kvalitet och variation i utformning av interventioner. Osäkerhet råder kring vilken typ av aerob träning som har störst effekt på smärta. Syfte: Denna litteraturstudie syftade till att sammanställa det vetenskapliga evidensläget gällande effekten av aerob träning på upplevd smärta hos fibromyalgipatienter. Metod: En litteraturstudie med systematisk litteratursökning i databaserna PEDro och PubMed. Studiernas kvalitet granskades med PEDros granskningsmall och en evidensgradering genomfördes med hjälp av GRADEstud. Resultat: Nio studier, med 529 deltagare totalt, av lägst medelhög kvalitet inkluderades i studien. Studierna visar på en positiv, kliniskt relevant effekt på smärtintensitet, av aerob träning vid jämförelse med kontrollgrupper och liknande effekt jämfört med annan aerob träningsmodalitet, lågintensiv träning eller styrketräning. Evidensstyrkan var måttligt hög för att likvärdig smärtminskning erhålls oberoende av modalitet av aerob träning. Evidensstyrkan var låg för att konkludera att aerob träning är bättre än en kontrollgruppsintervention, lika bra som styrketräning eller lågintensiv träning. Orsakerna till resultatet av evidensgraderingen beror främst på heterogenitet i studiernas interventioner. Konklusion: Det går utifrån granskningen inte att se någon skillnad avseende smärtintensitet mellan aerob träning och en annan aktiv intervention. Studierna är små, har skillnader i interventioner och resultat. Mot bakgrund av detta kan inga säkra slutsatser dras gällande vilken form av träning som är bäst vid fibromyalgi. / Background: Fibromyalgia is a chronic pain syndrome with a prevalence of around 4% for women and 1% for men. Physical exercise is recommended for patients as part of treatment. Earlier reviews indicate a lack of quality and heterogenity in intervention designs. There are uncertainties of which type of aerobic exercise has the biggest effect on pain. Objective: This review aimed to summarize the scientific level of evidence concerning aerobic exercise on pain level for the fibromyalgia population. Method: For this systematic review a structured litterature search was carried out in the databases PubMed and PEDro. Quality was assessed with the PEDro-scale and reliability was evaluated with GRADEstud. Results: Nine RCT's including 529 subjects, with at least 5 points on the PEDro scale were included. The studies show a positive, clinically relevant effect on pain level, of aerobic training when compared to control groups (evidence: low) and similar effects on pain (evidence: moderately high) when compared to other training modality, low intensity aerobic exercise (evidence: low) or strength training (evidence: low). Heterogeneity in the studies reduces the level of evidence in all categories.  Conclusion: The populations are generally small and generally there is a large heterogenity in the interventions. No difference between aerobic training and other active interventions was observed in terms of pain reduction. It is not possible to conclude which modality of training is best for patients with fibromyalgia. To clarify evidence, there is a need for more studies with similar interventions.

Bakgrund: Obesitas förekommer i stort sett över hela världen. Orsakerna till en oönskad ökning av kroppsvikten är komplexa där både biologiska, miljömässiga och beteendemässiga faktorer kan ligga bakom. Tidigare studier har visat att det finns en utbredd stigmatisering i samhället av personer med obesitas, även inom sjukvården. Befintlig forskning har inte undersökt personer med obesitas upplevelser av fysioterapeutisk vård i Sverige, den kunskapsluckan ämnar denna uppsats att uppfylla.  Syfte: Syftet med denna studie är att undersöka huruvida personer med obesitas inom svensk fysioterapeutisk vård påverkas av eventuell stigmatisering eller diskriminering. Metod: En kvalitativ metod baserad på semistrukturerade intervjuer användes. Totalt deltog fem informanter, där intervjuerna skedde separat via zoom. Materialet analyserades sedan genom en kvalitativ innehållsanalys. Resultat: I resultatet framkom tre kategorier med tillhörande subkategorier. En informant beskrev upplevelser av diskriminering vid kontakt med fysioterapeuter, övriga hade haft en positiv upplevelse. Den tydligaste gemensamma faktorn var önskan om att bli bemött som en hel person, där samtliga beskrev att de ville bli sedda som en individ samt att fysioterapeuten skulle vara rak och ärlig i diskussioner  om vikt, förutsatt att det var nödvändigt att ta upp i förhållande till kontaktorsaken.   Slutsats: Resultatet är inte generaliserbart på den svenska fysioterapeutiska vården i stort. Det öppnar dock upp för en möjlighet att hitta relevanta mönster både internt inom studien samt i förhållande till andra liknande studier. / Background: Obesity is a global occurrence, the reasons behind an unwanted weight gain are complex where biological, environmental and behavioral factors all play a role. Prior research has shown that stigmatization of people with obesity is common in society and in healthcare. No prior research could be found regarding the experiences of obese people in encounters with physiotherapists in Sweden, this gap in knowledge is the focus of this paper. Objective: To investigate if people with obesity within Swedish physiotherapy care are affected by any stigmatization or discrimination. Method: This study utilized a qualitative method based on semi-structured interviews. Five participants were included in the study and were interviewed through the web based video software Zoom. The data was analyzed by way of qualitative content analysis Results: Three categories were identified with subsequent subcategories. One out of five participants described discrimination by their physiotherapist, the remaining participants described positive experiences. A common theme among the participants was the desire to be seen as an individual and that their physiotherapist should be honest and direct regarding the subject of weight as long as it is relevant to the context of their visit.  Conclusion: The results of this study cannot be generalized on Swedish physiotherapy care as a whole, however it does offer an opportunity to investigate relevant patterns internally in this study and compare them in relation to similar studies performed on the subject.

Thesis (MScPhysio (Physiotherapy))--University of Stellenbosch, 2007. / Study Aim: To describe the profile and selected outcomes of CABG patients admitted in the Cape metropolitan area. Design: A prospective descriptive study design with a multicentre observational approach was followed. Method: All patients undergoing isolated CABG surgery, whether elective or emergency, during a three-month period (15 August–15 November 2005) were included in the study. Demographic data, pre-operative medical status, intra-operative, as well as post-operative information were collected using a self-designed structured initial assessment form (SIA). Means and standard deviations were calculated where applicable. Relationships between different variables were analyzed by means of: ANOVA, correlations, linear and logistic regressions. Where it appeared that the ANOVA assumptions were violated, non-parametric bootstrap techniques were employed. Results: Two hundred and forty five patients were admitted to the seven hospitals which provide CABG surgery in the Cape metropolitan area in the allotted period. The profile of patients admitted to private and state institutions were similar. The mean age of the sample was 60 (±10). The mean LOS of the total cohort was 12 (±5.5) days, with patients in the state hospitals staying longer 13.4 days (± 7.1). Patients who were older than 60 were twice as likely to have a LOS >12days (odds ratio = 2.49; 95% confidence interval = 1.33 to 4.65). The development of a pleural effusion or pneumothorax was associated with an increased LOS (p<0.01). At least one PPC was reported in 65% of the population. A mortality rate of only 3% was reported. Conclusion: Patients in this cohort were younger than in developed countries. An age greater than 60 years was a predictor of an LOS >12days in the current cohort. Patients were most likely to develop a PPC on day three after CABG surgery. Physiotherapeutic intervention, if any, would be well aimed at those patients older than 60 years of age. Screening of patients in the first three post-operative days for the development of PPCs is also advised.

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M.Sc. (Physiotherapy), Faculty of Health Sciences, University of the Witwatersrand, 2009 / Low back pain (LBP) is one of the commonest and most costly medical problems in both the low and high income countries accounting for 75-90% of compensation costs. Compensation costs for LBP in South Africa in the year 2000 were approximately two hundred million rand and about 30 000 people suffer from neck and back problems on a daily basis. Physiotherapy treatment modalities are commonly used in the management of LBP but there is no consensus on the choice of treatment modalities. A cross-sectional survey was used to investigate the treatment modalities used by physiotherapists in Kwazulu-Natal (KZN) for the management of chronic low back pain (CLBP). The objectives of the study were to establish the commonly used physiotherapy modalities in the management of CLBP, the reasons behind the selection of those modalities and the extent to which the physiotherapists in KZN used evidence based modalities when managing CLBP. Self-Administered questionnaires were posted to all registered physiotherapists in KZN, that is, six hundred and eighty-five (685) physiotherapists. A 31% (213) response rate was achieved, of which 20.6% (141) met the inclusion criteria and 10.5% (72) were excluded. The results established that general exercises (30%); spinal mobilisation (28%); myofascial release (18%), education (12%) and training of local stabilisers (12%) were the commonly used treatment modalities in the management of CLBP. The key reasons for the selection of the treatment modalities were the undergraduate education received; own clinical experience and the attendance of postgraduate courses/physiotherapy conferences. Treatment modalities were not selected on the basis of the current available evidence hence evidence-based practice is not employed by physiotherapists in KZN in the management of patients with CLBP.

A Research Report submitted to the Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, in partial fulfilment of the requirement for the degree of Master of Science in Physiotherapy Johannesburg, 2017 / Background: The cognitive elements of fear avoidance and pain catastrophising in individuals suffering from chronic pain, including chronic low back pain and chronic musculoskeletal conditions, have been found to be significant impediments to recovery. However, little is known about the influence of fear avoidance and pain catastrophising on chronic non-specific neck pain, especially in the context of a South African population. The purpose of this study was to determine the prevalence of fear avoidance and pain catastrophising in patients suffering from chronic neck pain of three or more months’ duration who were attending physiotherapy in private clinics in Johannesburg, South Africa. The objectives of this study were to establish the prevalence of fear avoidance, the prevalence of pain catastrophising, and to establish the association between demographic variables and fear avoidance and pain catastrophising respectively. Methods: In order to fulfil the objectives, a cross-sectional design was used on the basis of the validated Tampa Scale for Kinesiophobia-11 (TSK-11) and the Pain Catastrophising Scale (PCS) questionnaires to determine the prevalence of fear avoidance and pain catastrophising respectively in patients suffering with chronic neck pain. The patients were sampled sequentially from randomly selected private practices in Johannesburg, South Africa, with the particular focus being on musculoskeletal conditions. The demographic data included gender, age, pain intensity, marital status, highest level of education attained, employment status, duration of neck pain, and whether or not the participant had had to reduce his/her work load as a result of the pain experienced. These factors were tested in terms of their association between fear avoidance and pain catastrophising respectively, and of the association between fear avoidance and pain catastrophising itself. A total of 106 participants were interviewed. The data from the questionnaires and the demographic questionnaires were analysed using Statistica, version 12. The results were considered significant when p-values of 0.05 were attained. Results: A total of 106 participants with a mean age of 48.7 years (SD=14.8; range 20-80 years) were drawn sequentially from a randomly selected total of 25 private practices. Female participants constituted 81.1% (n=86) of the total participants and 76.4% had some form of tertiary education. The majority (76.4%) were working and most (79.2%) had not reduced their work load as a result of their pain. Many participants were in a relationship (67.9%) and the pain intensity showed a mean of 4.4 on the VAS (SD=2.2; range 0.3-8.7), with the median pain duration being 96 months (8 years) (IQR=30-180 months) (2.5-15 years); range 3-756 months (0.25-63 years)). The TSK-11–Total showed a mean score of 22.9 and 25.5% of the participants (n=106) presented with significant fear avoidance measured on theTSK-11-Total scale. The prevalence was based on a cut-off equivalent to the midpoint scale. The median score for the PCS-Total was 12. The prevalence of clinically relevant scores for the PCS-Total was 15.1% (n=106) of the population studied, based on a cut-off score of =30. There was a significant, positive correlation between the TSK-Total and the PCS-Total and its subscales; and between the TSK-SF and the PCS-Total and its subscales. Significant association was found between the highest level of education and the TSK-11-Total score. The mean TSK-11 score for those with secondary education (26.0 ± 3.4) was higher than that for patients with a tertiary education (21.9 ± 1.5), indicating that those with a secondary education were more likely to be fear avoidant than those with a tertiary education. There was a significant, positive correlation between pain intensity and the TSK-Total score, and a significant positive correlation between pain intensity and the PCS-Total score. No significant association was found for fear avoidance and pain catastrophising in respect of any of the other demographic variables. Conclusion: This prevalence study established that of the sample of adults attending physiotherapy for chronic non-specific neck pain, 25.5% suffer from fear avoidance and 15.1% suffer from pain catastrophising. An association was found between the total scores for fear avoidance and pain catastrophising. Furthermore, an association was also found between fear avoidance and its subscale, somatic focus, and between pain catastrophising and all its subscales, namely rumination, magnification and helplessness. Yet another positive association was found between secondary education and fear avoidance, and a positive correlation between pain intensity and both fear avoidance and pain catastrophising respectively. / MT2018