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Bakgrund: Patienter med postcovid är en ny population som fysioterapeuter behandlar. Symtomen postcovid medför påverkar utförandet av ADL. Förmågan att utföra ADL är väsentligt för välmåendet och bidrar till ökad livskvalitet. Arbeta ur ett biopsykosocialt perspektiv som fysioterapeut är viktigt vid bemötande av patienter med postcovid på grund av varierade symtom och vad det medför för svårigheter med att utföra ADL. Att ha en fungerande vardag och god hälsa är av betydelse. Att stötta detta ligger till grund för fysioterapi. Syfte: Undersöka upplevelser av att klara aktiviteter i det dagliga livet och fysioterapins betydelse hos patienter med postcovid symtom. Metod: Kvalitativ metod med induktiv ansats och semistrukturerade intervjuer medpatienter som har postcovid symtom. Kvalitativ manifest innehållsanalys användes för att genomföra dataanalysen. Resultat: Fyra kategorier identifierades: Ej arbetsför på grund av postcovid, Rädsla för ansträning utgör hinder för daglig aktivitet, Svårigheter att utföra ADL på grund av trötthetoch orkeslöshet av postcovid symtom och I behov av stöd för att orka med ADL, till följd av postcovid. Slutsats: Deltagarna upplever psykiska och fysiska svårigheter som påverkar utförandet av ADL. Fysioterapin har spelat stor roll i rehabiliteringen för återgång till att klara ADL efterbesvär med postcovid symtom. Nyckelord: ADL, fysioterapi, postcovid, respondent inlärningsteori, socialkognitiv teori,undvikandebeteende

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Patient participation is a concept used to describe the patients’ involvement in their healthcare. The aim of this licentiate thesis was to explore primary healthcare patients’ experiences of patient participation prior to and within multimodal pain rehabilitation. Qualitative interviews were conducted with seventeen patients, 14 women and 3 men, who had completed multimodal pain rehabilitation for persistent pain. Data was analyzed using qualitative content analysis.The findings show that patient participation can be understood as a complex and individualized interaction between the patient and the healthcare professionals. There were both positive and negative experiences of patient participation prior to, as well as within the multimodal rehabilitation. Experiences prior to the multimodal pain rehabilitation indicated a lack of patient participation including a search of recognition and an alienation from the healthcare system. Patients experienced satisfying patient participation within the multimodal rehabilitation, which was described as a continuous exchange of emotions and cognitions between the patients and the healthcare professionals. Patients’ emotions and cognitions were important in the patient – healthcare interaction and for patient participation. A confidence-inspiring alliance with the healthcare professionals, built on mutual trust and respect, was experienced as a basis for patient participation. The patients experienced unfulfilled medical needs, being unconfirmed, and having their point of view disregarded by healthcare professionals, to limit patient participation. Insufficient communication with the healthcare professionals was also perceived restricting patient participation. The patients emphasized that healthcare professionals needed to play an active role to include the patients in dialogue and to build common ground in the interaction. The healthcare professionals’ expertise, empathy and personal qualities were important for patient participation.In conclusion, patients with persistent pain had experiences of poor patient participation from encounters with healthcare professionals prior to multimodal pain rehabilitation. In contrast, these patients then experienced satisfying patient participation within the multimodal pain rehabilitation. Healthcare professionals need to play an active role in developing a relationship and finding common ground, through confirmation and dialogue, to increase patient participation in rehabilitation planning and decision-making.

Physiotherapy is essential to optimize the results of shoulder joint replacement, but requires a close monitoring and co-operation between patient and physiotherapist. The development of telerehabilitation brings opportunities for distance-spanning and home-based physiotherapy interventions. The aim of this thesis is to explore effects and to describe experiences among patients participating in interactive video-based physiotherapy at home after shoulder joint replacement. A series of 22 patients underwent shoulder joint replacement and initial physiotherapy at the hospital. After discharge, 12 patients were referred to conventional out-patient physiotherapy (control), while 10 patients participated in a telerehabilitation intervention in the form of interactive video-based physiotherapy at home. Shoulder function, activity limitations and health-related quality of life were assessed before surgery and two months after surgery. The experiences of participating in the telerehabilitation were described using open interviews and qualitative content analysis. Two months post surgery, members of the telerehabilitation group had participated in more physiotherapy sessions (p<.001) and showed significantly better recovery regarding shoulder pain (p<.001), shoulder joint external rotation (p=.002), shoulder function and activity limitations (p<.001) and in two dimensions of health-related quality of life (p=.004 and p=.001) compared to the control group. All telerehabilitation group participants expressed that they were satisfied with the rehabilitation and that they had experienced technique and exercise as safe. In the interviews seven categories of the participants' experiences were revealed: An odd reinforced communication; Pain-free exercising as an effective routine; The home as an exercising arena; Closeness at a distance; From a dependent patient to a strengthened person; Facilitated daily living; Continuous rehabilitation process. The identified theme was: Achieving prerequisites for recovery competence. In conclusion, interactive video-based physiotherapy at home after shoulder joint replacement was experienced positively by the participating patients and seemed more effective than conventional post-discharge rehabilitation procedures concerning short-time recovery. This could be explained by the fact that the telerehabilitation group participated in more patient-physiotherapy sessions compared to the control group, but the interviews also indicate that the modality might have promoted continuity and patient participation and competence.

Bakgrund: Många svenska patienter genomgår årligen thoraxkirurgi. Initial postoperativ rehabilitering riktas främst till att förbättra patienternas grad av dyspné samt rörlighet i thorax, och patienterna rekommenderas att vidmakthålla rehabiliteringsprogrammen även efter hospitaliseringstillfället. I hälsopsykologiska teorier beskrivs att biopsykosociala faktorer simultant inverkar på vidmakthållande av rehabilitering, något som inte tidigare har studerats på patienter som genomgått thoraxkirurgi. Syfte: Denna deskriptiva tvärsnittsstudie undersökte samband mellan vidmakthållande av rörlighets- samt andningsträning och psykologiskt stöd samt emotionellt tillstånd hos patienter 3 månader efter thoraxkirurgi. Metod: Kvantitativa data insamlades av en forskargrupp genom ett frågeformulär som undersökte vidmakthållande av rehabiliterande insatser samt mätinstrumenten Modified Medical Research Council dyspnea scale (mMRC) och Quality of Recovery -15 Sweden (QoR-15swe). Insamlade data analyserades av författaren med Spearman’s korrelationskoefficient i SPSS. Resultat: Resultaten visade inga signifikanta samband mellan vidmakthållande av rehabiliteringsprogrammen och grad av dyspné, psykologiskt stöd eller emotionellt tillstånd. Resultaten hade genomgående liten spridning kring medianen. Slutsatser: Studien påvisade inte att centrala biopsykosociala faktorer korrelerade med vidmakthållande av rehabilitering efter thoraxkirurgi. Majoriteten av patienterna uppgav ett gott postoperativt mående. Dock kunde förväxlingsfaktorer ha påverkat resultaten vilket tyder på att det krävs fler studier med större kontroll över förväxlingsfaktorer för att säkerställa att det inte finns någon korrelation. / Background: Many Swedes go through thoracic surgery every year. Initial postoperative rehabilitation is primarily focused on improving the patient’s dyspnea and thoracic range of motion, and the patients are recommended to maintain the rehabilitation programs after hospital discharge. Health psychology theories describe that biopsychosocial factors simultaneously influence the maintenance of rehabilitation, something that has not previously been studied in patients who have undergone thoracic surgery. Aim: This descriptive cross-sectional study investigated the relationship between maintenance of movement and breathing rehabilitation with psychological support and emotional state in patients 3 months after thoracic surgery. Methods: Quantitative data were collected by a research group through a questionnaire that explored the maintenance of rehabilitation as well as with the Modified Medical Research Council dyspnea scale (mMRC) and the Quality of Recovery -15 Sweden (QoR-15swe) and were analyzed by the author with Spearman's correlation coefficient in SPSS. Result: The results showed no significant relationships between maintenance of rehabilitation programs and extent of dyspnea, psychological support, or emotional state. The results had a consistently small spread around the median. Conclusions: The study did not show that relevant biopsychosocial factors correlated with maintenance of rehabilitation after thoracic surgery. Most of the patients reported a good postoperative well-being. However, confounding factors could have affected the results, which suggests that more studies with greater control over confounding factors are required to ensure that there is no correlation.