Lumbopelvic pain (LPP) is associated with altered abdominal muscle function yet few tools exist that enable physiotherapists to identify these changes in a clinical setting. Ultrasound imaging (USI) has potential however its ability to detect altered abdominal muscle function and associated changes in bladder base (BB) position during tests common to a physiotherapy assessment of LPP, has yet to be established. The aims of this research were to determine the validity and reliability of USI technique in a clinical setting, investigate the relationship between changes in abdominal muscle thickness and electrical activity, and compare sonographic characteristics of the abdominal wall, and BB position, between persons with and without LPP. Validity results indicate that 5o-10o of angular, and 8mm of inward/outward transducer motion don’t produce measurement error, and that transducer motion can be kept within these thresholds during two commonly used clinical tests; the Active Straight Leg Raise (ASLR) test and Abdominal Drawing in Manoeuvre (ADIM). Regarding reliability, measurements of abdominal muscle thickness, inter-recti distance (IRD) and BB position (healthy and LPP cohorts) during the ASLR and ADIM were good to excellent (within day ICC; 0.84-0.99, between day; 0.80-0.99). Crosscorrelation functions examining the relationship between changes in abdominal muscle thickness and activity during an ASLR and ADIM were low (r=0.22-0.40), and associated time lags large (-0.44-1.15s), suggesting that changes in muscle thickness represent more than changes in electrical activity. On comparing sonographic features between cohorts a series of features were identified that differed between the groups. Specifically, the LPP cohort had a thinner rectus abdominis (p<0.001), thicker perimuscular connective tissue (p=0.007), a wider IRD (p=0.005) and demonstrated smaller increases in TrA thickness (p≤0.00-0.05), and greater BB descent (p=0.02-0.03) during the ASLR. To determine if these sonographic features assist in discriminating LPP a statistical classification technique was piloted. Preliminary results identified a set of 14 sonographic features that classified LPP participants with 84% accuracy. These findings support an argument regarding the clinical value of USI and serve as the basis for future investigations aimed at determining if USI enhances the assessment, and ultimately treatment, of individuals with LPP.

A major challenge of the 21st century for the health-care professionals is to provide care for the ever-expanding population of people with renal-failure. Patient numbers are rising and specialist nurses, who are the pivotal factor in haemodialysis units, are becoming increasingly scarce. In this context it has become essential to understand the dynamics and functioning of haemodialysis units. The aim of this research project is to increase understanding of the lives of patients and carers by uncovering the culture of haemodialysis units. Ethnography, from the naturalistic paradigm, is a holistic study of culture, developed out of classical philosophy. This study examines the entire social world of the dialysis unit. It describes the ethnographic journey made over twenty-four months' research in two different dialysis units. The participants were amongst patients and carers from these two units. The fieldwork, which facilitated data collection, was based on a participatory process of observation, interviews and participant feedback. These data were analysed into domains and themes using Spradley's Research development sequence (1980) and the reflexive process. Through the theme-based analysis used during the research and writing of this ethnographic study an emergent theory of partnership in care became apparent. Such a theory contributes to our understanding of the culture of the dialysis unit. Uncovering the culture of dialysis units will not prevent the increase in numbers of people needing Renal Replacement Therapy. It does, however, shed light on the condition of living with renal failure and the nature of partnerships developed in the haemodialysis unit. It is these partnerships between people, machines and the environment that sets the dialysis unit apart in the hospital, giving it its own particular culture. Partnership means shared care where patients and carers work towards mutual goals. The realisation of these common goals leads towards the overall objective of better treatment outcomes.