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Thesis (D.P.T.Sc.)--University of California, San Francisco, 2009. / Source: Dissertation Abstracts International, Volume: 70-06, Section: B, page: 3470. Adviser: Sandra Radtka.

Thesis (Ph.D.)--New York University, 1998. / Source: Dissertation Abstracts International, Volume: 00-00, Section: B, page: 0000. Chairperson: Jim Hinojosa.

The purpose of this study was to examine whether or not there was a relationship between the worldviews of people with chronic pain and the health care choices that they make. The background of the study included evidence of a cultural shift toward integration of complementary and alternative medicine (CAM) with conventional health care practices. The justification for the study was established with regard to previous research indicating that people with chronic health conditions, demographic predictors, and philosophical differences might contribute to characteristics associated with CAM use. In the literature review, two premises were established: (1) that healing is the psychophysiological response to underlying beliefs, and (2) that Pepper's worldviews (Pepper, 1942) characterize beliefs and expectancies underlying cognitive processes. The study involved a survey packet mailed to prospective subjects who were clients at a traditional teaching hospital clinic specializing in pain management. The survey packet included a list of demographic characteristics, the Health Care Choice List, and the World Hypotheses Scale as measurement of Pepperian worldviews. The data were analyzed by using multiple linear regression, correlation coefficients, and Chi-square Crosstabs procedure. Overall, results of the present study indicated that the combination of age and formistic (categorical) worldview were statistically significant predictors of conventional health care choices by participants in this study. Subjects who were older were less likely to use CAM; and subjects who identified with formism as a dominant worldview were less likely to use CAM. Although formistic worldview was the only statistically significant predictor of health care choices among the worldview categories, there were directional trends of health care choices in relation to worldviews. Subjects endorsing formistic (categorical) and mechanistic (cause and effect) worldviews were more likely to use conventional methods, and subjects with contextualistic (cause and effect relative to context), organismic (interactive whole) worldviews, and equal scores in two worldview categories, were more likely to use CAM methods.

This multi-centered study examined the prevalence of outcome measure use in physiotherapy practice for low back pain, the frequency and timing of use and the factors associated with their use. A review of 265 charts of clients who had received treatment for low back pain from 53 physiotherapists was completed to identify outcome measure use. / Review of the charts identified seven standardized and thirteen non-standardized outcome measures that were used in clinical practice. Of these, all were measures of impairment except for two that measured disability. Standardized and non-standardized measures were mainly used at the initial evaluation. 27% and 66%. Thirty-four percent (95% CI, 14--50) of the physiotherapists were identified as users of standardized measures. The users of standardized measures provided more treatments (p = 0.0018), and the treatments were over a longer period of time (p = 0.0029) than non-users and the source of payment for the physiotherapy service was from Worker's Compensation, motor vehicle and hospitals rather than from private insurance (p = 0.0000035).

The purpose of this study was to determine whether there were differences in mortality, dialysis method survival, hospital admissions and days of hospitalization, between diabetic patients with end-stage renal disease (ESRD) treated by continuous ambulatory dialysis (CAPD) and those treated by haemodialysis (HD). / All diabetic patients (n = 241) treated for newly diagnosed ESRD in four university teaching hospitals, in Montreal, between 1980 and 1993, were studied (n = 112 began with CAPD, n = 129 with HD). / The data regarding these patients were analyzed using actuarial methods and Cox's proportional hazards model, controlling for severity of pre-treatment co-morbid conditions. Intent-to-treat (ITT) and treatment history (TxHx) censoring criteria of analysis were also used. / At baseline, the CAPD patients were younger and had more co-morbid conditions, particularly cardiovascular diseases, than the HD patients did. / The findings regarding mortality and first dialysis method change were similar in both the ITT and TxHx analyses. The mortality rate ratios varied with time since beginning of treatment. The adjusted mortality rate ratios (ARR) for CAPD patients relative to HD patients during year 1, 2, 3, and thereafter were 1.1, 1.6, 2.9, and 4.5 respectively. The rate of dialysis method change was also greater in the CAPD patients compared with HD patients (ARR = 4.4, P $<$ 0.001). / Both the rate of hospital admissions and average days of hospitalization for the CAPD patients were about twice those for the HD patients (0.21 vs 0.11 admissions, and 4.6 days vs 2.4 days, per month of first dialysis therapy). / The findings regarding mortality suggest that in the short term, the initial choice of dialysis method and any subsequent switch between CAPD and HD for a patient can be made without serious concern about the influence of the dialysis modality on patient survival. However, in the longer term, the influence of the choice of the initial dialysis on patient survival is substantial.

Physical therapists recommend neurodevelopmental therapy (NDT) for cerebral palsy, but its effectiveness is unknown. A randomized controlled trial was undertaken to compare the effects, over six months, of intensive (weekly) NDT therapy and basic (monthly) NDT, on the motor development of young children with suspected cerebral palsy. / The trial soon strayed from its plans, but it was continued in order to identify all problem areas, to allow refinement of the measurement system and to plan a "trial proper" with good internal validity. In this, statistical power had to be sacrificed; nevertheless, the average outcome for the 17 infants on the intensive regimen was substantially better than that for the 12 on the basic regimen, after adjusting for the child's age, term birth or not, and mother's education (the equivalent of a t-statistic with 24 df was 3.49; p =.0019). / Inter-rater agreement, one aspect of external validity, was also tested and proved excellent.

Background. Pain after knee surgery has been reported as a common problem. It is highly ranked in terms of intensity and has important consequences on both quality of life and psychological well-being. However, assessment and management of postoperative pain remain a key clinical problem. / Objectives. To describe the occurrence of pain after total knee arthroplasty (TKA) and knee arthroscopy; identify the predictors of postoperative pain and evaluate the consequences of pain on quality of life and on depression status. / Methods. Patients were recruited from nine university and regional hospitals in the province of Quebec and were followed for three months after knee surgery. Time points of postoperative day 7 and month 3 were our prime interest. We used a prospective cohort design to investigate characteristics of postoperative pain and a case-control design to identify the impact of postoperative pain on quality of life and on depression. Both logistic regression and multiple linear regression models were used to analyze postoperative pain intensity and the impact of postoperative pain respectively. (Abstract shortened by UMI.)

This study investigated the effects of providing body weight support (BWS) on the gait pattern of 15 incomplete spinal cord lesioned subjects. Electromyographic (EMG), joint angular displacement and temporal distance parameters were simultaneously recorded as subjects walked on a treadmill while 0% and 40% of their body weight was mechanically supported by an overhead harness. The effects of 0% and 40% BWS while walking with and without parallel bars and at different treadmill speeds was further investigated in a subgroup of 8 subjects. / In general, 40% BWS led to a decrease in prolonged EMG activity of proximal muscles, a decrease in premature activation of distal muscles as well as a decrease in clonus. Such changes in EMG activity were evident especially during more demanding external conditions such as walking without parallel bars or at faster treadmill speeds. A general decrease in EMG mean burst amplitude for lower limb muscles was also noted. Sagittal angular displacement profiles revealed a straighter trunk and knee alignment during initial and midstance. Forty percent BWS appeared to facilitate gait by allowing subjects to walk for longer periods and to walk at faster treadmill speeds. Increases in stride length, single limb support time and decreases in total double support time were also noted with 40% BWS at comparable treadmill speeds. The results this study suggest that BWS facilitates the expression of a more normal gait pattern.