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The majority of people affected by stroke are older however one fifth of all persons with stroke are younger than 65 years. In Sweden the mean age at the time of a stroke is 75 years and about 5 % of those who suffer a stroke are 55 years or younger. The aim of this thesis was to describe and analyse the consequences of stroke in the younger population in terms of experiences of the rehabilitation process, return to work, self-reported physical and cognitive function and life satisfaction. Sex differences, as well as gender specific associations regarding factors of importance for return to work, deteriorated physical ability and satisfaction with life as a whole, were also studied. This thesis was based on an in-depth interview study and self reported data collected from a questionnaire answered by 1068 individuals, 18-55 years old with a first ever stroke registered in Riks-Stroke, the Swedish national quality register for stroke care. The questionnaire concerned aspects of current health condition, living and social arrangements, physical and cognitive functions, activities in daily life, relationships, social life, leisure pursuits, self-perception, participation, work and life satisfaction. Most of the questions aimed to investigate differences between the present time and before stroke onset. In-depth interviews with two men and three women aged 37-54, living at home after their stroke generated the hypotheses that younger persons with stroke are frustrated and feel invisible and outside. Rehabilitation for the young was perceived as in adequate due to the fact that the rehabilitation setting does not acknowledge the specific needs that younger persons with stroke have. Prior to the stroke 855 of 1068 (80%) of the participants, had been in paid employment. After the stroke, 65% of the men and 66 % of the women returned to work. Factors of importance for return to work were associated with the self-reported data: the feeling that it was important to work (OR 5.1), not perceiving oneself as a burden to others (OR 3.3), not having a deteriorated ability to run a shorter distance (OR 2.8) and having support for return to work (OR 3.7). Changes in self-reported physical and cognitive functions as compared with pre-stroke condition was explored in 867 (513 men and 354 women) P-ADL independent persons with stroke. Deteriorated physical abilities were reported in 56-79% and deteriorated cognitive abilities in 48- 68% of the participants. Women were significantly more affected in terms of both physical and cognitive deterioration than the men. Seventy-two percent of the participants did not know how much they could physically exert themselves after their stroke, women significantly more than men. In addition, significant associations were found between deteriorated physical function and deteriorated cognitive function as well as fear of physical exertion. The strongest association for deteriorated ability to move in crowded environments was the risk factors deteriorated cognitive ability (OR of 5.4) and being afraid of physical exertion (OR of 3.1). Life Satisfaction and factors associated with not being satisfied with life as a whole in 1068 (631 men and 437 women) persons with stroke was assessed with the LiSat 9, baseline data from Riks- Stroke and self-reported answers from the questionnaire. Fifty-three percent of the participants were not satisfied with life as a whole. Men and women were analyzed separately in terms of associations with not being satisfied with life as a whole. Women who had a haemorrhage (OR 3.9) and a deteriorated ability to concentrate (OR 2.1) had a higher risk of not being satisfied. For men the risk was associated with living without a significant other (OR 3.2), not working (OR 2.3) and deteriorated ability to concentrate (OR 2.0). In conclusion, younger individuals who have experienced a stroke feel frustrated and invisible due to the fact that their needs are not acknowledged. Age and gender have an impact on outcome of present rehabilitation programs and the problems of younger persons with stroke can be detected at an earlier stage by developing appropriate instrument and delivering information directly aimed at physical functioning. Further studies on gender specific differences in stroke outcome concerning physical and cognitive functions as well as life situation after stroke are needed. In order to optimize rehabilitation in terms of return to work, external support and motivation seem to be important factors to consider. Key words: Adult, cognition disorders, gender differences, middle aged, motor activity, quality of life,questionnaires, stroke, work

This study explores the immanent paradigm in clinical physiotherapy, a professional field where knowledge to a large extent is demonstrated in skilled action whose embodied character prevents this kind of knowledge from being completely articulated. The following is a hermeneutic study in which a first person perspective, based on years of professional experience, is employed as the basis for interpretation and analysis. The knowledge and insights derived from this approach are often framed through the deliberate methodological use of analogy and metaphor. The practice of clinical physiotherapy is often modelled on the mechanic's workshop inasmuch as bodily problems and diseases are putatively repaired through a technically skilled approach. This study explores the problematic nature of this dualist paradigm in relation to the professional challenge of encountering bodily experiences such as absence and alienation.This instrumental model of knowledge and practice leaves little room for the physiotherapist's own professional experience to be a source of knowledge through reflection. The study points at phenomenological perspectives on the living body as an alternative epistemological framework of the practice of physiotherapy. / QC 20100910

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Syfte Syftet med denna uppsats var att ta reda på vilka effekter, såväl positiva som negativa, fysisk aktivitet kan ha hos människor i rehabilitering. Följande frågeställningar användes: Vilken bakgrund har de olika smärttillstånden? Vilken form av fysisk aktivitet och vilken duration, frekvens och intensitet används? Hur påverkas personerna i fråga av den fysiska aktiviteten på smärttillståndet - positiva/negativa effekter? Metod Studien baseras på fem intervjuer med kvinnor i rehabilitering, i form av sjukgymnastik. Detta för att på bästa sätt kunna studera och belysa hur människor kan påverkas positivt eller negativt av fysisk aktivitet vid olika fysiska smärttillstånd. Svaren från intervjuerna har sedan sammanställts och jämförts med tidigare forskning och annan litteratur inom området. Litteraturstudier har även bedrivits både för bakgrundsinformation samt för ökad kunskap inom ämnet. Resultat Resultatet visade att de intervjuade kvinnorna som går på rehabilitering, upplever förbättrad fysisk kapacitet och minskad smärta vid träning, oavsett de olika smärttillstånden och smärtorsakerna för respektive intervjuperson. De aktuella smärttillstånden var arbetsskada, olycksfallsskada, idrottsskada, utbrändhet samt medfödd funktionsnedsättning. Alla intervjupersoner har tränat under olika långa perioder och de går alla på rehabilitering under obestämd tid - det beror på hur kroppen fortsätter att svara på träningen och hur man själv upplever träningens effekter. Alla upplever, hittills, att träningen givit positiva effekter förutsatt att man endast tränar efter egen förmåga samt att man inte tränar för hårt, vilket resulterar i bakslag med negativa effekter. Gemensamt för de intervjuade är att de upplever positiva effekter vid underhållen träning, det vill säga att man regelbundet tränar på en lagom nivå och inte gör långa uppehåll i sin träning. Träningsuppehåll, har enligt de intervjuade, påvisat en upplevd ökad smärta och mindre rörlighet än vid uppehållen träning. Slutsats Fysisk aktivitet som rehabilitering ger positiva effekter så länge träningen individanpassas och ser till aktuellt smärttillstånd. Regelbundenhet samt en lagom nivå på frekvens, duration och intensitet är ledorden för optimala effekter. / Aims The aim of this study was to conclude what effects, both positive and negative, physical activity can have for people in rehabilitation. The following questions were used: What background have the different pain states? What form of physical activity and the duration, frequency and intensity of use? How are the people in question affected by the physical activity on the pain state - positive / negative effects? Methods The study is based on five interviews with women in rehabilitation, in the form of physiotherapy. I thought, this way could help me to find out however people can be affected, positively or negatively, by physical activity at various physical pain. The answers from the interviews was then compiled and compared with previous researched and other material. Literature studies have also derived background information and for increased knowledge in the subject. Results The results showed that the interviewed women who go to rehabilitation, feel improved physical capacity and decreased pain during exercise, irrespective of the different painstates and painfactors for each interviewee. The current pain permits are one workrelated injury, accident injury, sports injury, overworked and congenital disabilities. All interviewees are in rehabilitation for an indefinite period of time - it depends on how their body continues to respond to exercise and how you feel effects of endurance training. Everyone feel, so far, that the exercise has positive effects, provided that you only train your own potential and that you are not training too hard, resulting in a backlash of negative effects. Interviewees also shared that they experience positive effects in maintenance training – if they train regularly on a comfortable level and not take long breaks in their training. Training paus demonstrated a perceived increased pain and less mobility, than in training periods. Conclusion Physical activity in rehabilitation showed positive effects as long workout was individualized and look at the prevailing pain. Regularity train in combination with a moderate level of frequency, duration and intensity revealed optimal positive effects.

SAMMANFATTNING Bakgrund: I det sjukgymnastiska yrket ingår det viktiga arbetet med att formulera relevanta mål för rehabilitering. Målsättningen ger en riktning för sjukgymnast och patient att sträva efter och kan enligt forskning leda till bättre rehabiliteringsresultat. Tillvägagångssättet för att ta fram mål och målsättningar varierar och det finns flera faktorer att ta hänsyn till i målsättningsprocessen. Sjukgymnastprogrammet på Mälardalens högskola (MDH) utformar mål utifrån ett beteendemedicinskt perspektiv där målen operationaliseras. Syfte: Studiens syfte var att beskriva hur sjukgymnaster på en universitetsansluten klinik i Bangkok tillämpar och resonerar kring mål och målsättning i patientarbetet. Metod: Studien var en kvalitativ tvärsnittsstudie med deskriptiv design som utfördes genom semistrukturerade intervjuer med åtta informanter. Meningskoncentrering och meningstolkning användes för att analysera intervjuerna. Resultat och slutsats: Sjukgymnasterna arbetar med mål och målsättningar på den universitetsanslutna kliniken i Bangkok. Olika arbetsätt tillämpades och flera faktorer påverkade målsättningen. Målsättningsarbetet tog hänsyn till patienten delaktighet och ansågs betydelsefullt. Vanligtvis sattes kortsiktiga mål för att minska smärta eller förbättra funktion. Utvärderingen utfördes med valida och reliabla instrument eller genom observation. Målen operationaliserades inte och dokumenterades sällan vilket försvårade dess utvärdering. Flera aspekter kunde tolkas och analyseras till beteendemedicinska teorier, tolkningar gjordes framför allt till den social kognitiva teorin (SCT). Nyckelord: Beteendemedicin, Målsättning, Sjukgymnastik, Utvärdering / ABSTRACT Background: In the physiotherapy profession includes the important work of formulating appropriate goals for rehabilitation. The goal provides a direction for the physical therapist and patient and lead according to research to better rehabilitation outcomes. The approach to develop goals and goal-settings vary and there are several factors to take into account during the process. The physical therapy program at Mälardalen University (MDH) formulating goals based on a behavioral medicine perspective where goals are operationalized. Objective: The purpose of this study was to describe how physical therapists at a university-affiliated clinic in Bangkok, implement and reasoning about goals and goal-setting in rehabilitation. Method: The study was a qualitative cross-sectional study with descriptive design, which was conducted through semi-structured interviews. Sentence shortening and sentence interpretation was used to analyze the interviews. Results and Conclusion: Physical therapists work with goals and goal-settings at the university affiliated clinic in Bangkok. Different working methods were applied and several factors affected the goal. The goal-setting took account of patient participation and was considered important. Usually short-term goals for reducing pain or improving body functions were used. The evaluation was carried out with valid and reliable instrument or by observation. The goals were not operationalized and rarely documented which obstruct the evaluation of goals. Several aspects could be interpreted and analyzed to behavior medicine theories, interpretations were made primarily to the Social Cognitive Theory (SCT). Keywords: Behavioral medicine, Evaluation, Goal setting, Physical therapy

Swedish healthcare organizations have undergone substantial organizational and economic restructuring during the 1990s due to financial cutbacks. Little is known about recently graduated healthcare professionals´ work experience in healthcare and their future career preferences. The overall aims of this thesis was, to increase knowledge about how recently graduated healthcare professionals in Sweden perceive their work in healthcare organizations. A gender perspective is adopted. In this national cross-sectional study, four stratified random samples were separately drawn from the 1999 Swedish university graduates who were nurses (NS), occupational therapists (OT), physical therapists (PT) and (registered) physicians (PN) and who at the time of the sampling procedure were living in Sweden. Stratification was performed by sex. A total of 3989 were eligible and of those, 1434 were selected: 535 NS, 250 OT, 250 PT and 399 PN. A questionnaire was constructed containing questions about socio-demographic factors, working conditions, career preferences,  work satisfaction and questions about the responsibility for and actual work with home and family, the so called unpaid household work. The questionnaires also contained questions measuring psychosocial working conditions: the effort-reward imbalance questionnaire (ERI-Q) and the demand-control questionnaire (DCQ). Collection of the data for NS, OT and PT was completed in March 2002 and for PN in May 2003. The response rate was 81% and 76% respectively. The total sample thus consists of 1145 participants; 423 nurses, 212 occupational therapists, 205 physiotherapists and 305 physicians.  Most of the respondents were employed in the public sector, but many desired privately employment within the coming five year period, men more often than women. Career preferences for future work differed between women and men. A majority indicated that they did not have the opportunity to pursue knowledge development in the professional field during working hours and nearly one half could not work as independently as they wished. Satisfaction with work in general was high, but many were dissatisfied with management at work and a majority was dissatisfied with the work organization. This dissatisfaction was associated with the opportunity to work as independently as they wished and the opportunity to pursue knowledge development in the professional field. Significantly more women than men had the main responsibility for home and family and did most of the unpaid household work. Among the OT and PT working for county councils and municipalities, the results revealed that those working for municipalities, experienced low control at work compared with those working for county councils. No differences were found between OT and PT or between men and women in the two professions regarding the DCQ and the ERI-Q except for the WOC scale. Women had significantly higher scores on the WOC scale compared with men. Logistic regression analyses revealed a significant association between WOC and ERI, effort, reward and sex. One fourth of the OT and PT working for county councils and municipalities was dissatisfied with their job and this dissatisfaction was significantly associated with type of employer, reward and effort-reward imbalance (in the ERI-Q) and control (in the DCQ). Differences regarding scoring on the ERI-Q were found between nurses and physicians working in county councils but not between women and men in the same group, with the exception of the scores on overcommitment. Significantly more nurses were defined as having high effort, low reward and effort-reward imbalance compared with the physicians. More women in the NS and PN group were defined as experiencing WOC compared to men.  Logistic regression analyses revealed significant associations between experiences of WOC and ERI, effort and reward. Nearly one fifth in the NS and PN group were dissatisfied with work and this dissatisfaction was particularly high among those with high effort, low reward, those with the greatest imbalance between effort and reward and those who experienced high overcommitment. In conclusion, in order to limit future work related problems and to be able to retain well educated professionals in healthcare work, dissatisfaction among the recently graduated must be taken seriously. Healthcare employers should better utilize the knowledge that recently graduated possess, regarding for example how to be a part of the development of the profession and the job. It is also important that healthcare employers address gender (in) equality at work and that work environments allow both women and men to combine careers with family duties. / healthcare, work satisfaction, career, gender equality, health science education, recently graduated, novices, nurses, occupational therapists, physiotherapists, physicians, ERI-Q, effort, reward, effort-reward imbalance, overcommitment, DCQ, demand, control, job strain

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Sammanfattning Syfte och frågeställningar Syftet med studien var att kartlägga sjukgymnasters användning av specifik träning av djupa nackmuskler vid behandling av nacksmärta. Frågeställningarna var: ”I hur stor utsträckning använder sig sjukgymnaster av träningsmoment som syftar till specifik träning av djupa nackmuskler i behandlingen av nacksmärta?”, ”Förekommer det något samband mellan hur stor utsträckning sjukgymnaster använder denna specifika träning, och deras specialistkompetens inom idrottsmedicin respektive ortopedisk manuell terapi?”, ”Vilken övning används mest?” och ”I vilken utsträckning anser sjukgymnaster att specifik träning av djupa nackmuskler är relevant vid behandling av nacksmärta?”   Metod Metoden var en enkätstudie. Utifrån studiens syfte och frågeställningar utformades en webbenkät. Enkäten testades på fyra sjukgymnastkollegor och reviderades därefter flera gånger. Enkäten skickades ut till 161 sjukgymnaster. Enkätundersökningen genomfördes under tidsperioden februari-mars 2014.   Resultat Av 161 utskick registrerades 53 svar (33%). Specifik träning av djupa nackmuskler ansågs vara relevant i större utsträckning jämfört med specifik träning av ytlig nackmuskulatur vid behandling av nacksmärta. Hållningskorrigering var den övning som förekom i störst utsträckning. Träning av ledpositionsminne och  uthållighetsträning med hjälp av trycksensor, förekom minst. Signifikanta skillnader observerades mellan sjukgymnaster med och utan specialistkompetens när det gällde deras användning av uthållighetsträning av djupa nackflexorer med hjälp av en trycksensor, samt träning av nackens ledpositionsminne. Specialistsjukgymnaster inriktade mot ortopedisk manuell terapi använde ögonmotorisk träning i signifikant större utsträckning än specialistsjukgymnasterna inriktade mot idrottsmedicin.   Slutsats Bland de 53 sjukgymnaster som besvarade enkäten, användes hållningsträning i störst utsträckning. De övningar som förekom i minst utsträckning var träning av nackens ledpositionsminne samt  uthållighetsträning med hjälp av trycksensor. Skillnad förekom mellan specialister och ickespecialister i användningen av övningar. Sjukgymnasterna ansåg inte att grundutbilningen gav dem tillräckliga kunskaper om träning vid nacksmärta. / Abstract Aim The aim of this study was to survey the use of deep neck muscle training, used by physiotherapists in their treatment of neck pain. The research questions were: “ To what extent are exercises of deep neck muscle training used by physiotherapists in their treatment of neck pain?”, “ Is there a relationship between the use of deep neck muscle training by physiotherapists and their specialist training, targeting sports medicine respectively orthopedic manual therapy?” , “Which is the most frequently used exercise?” and “ To what extent is the use of deep neck muscle training argued  by physiotherapists as being relevant in the treatment of neck pain?”. Method A questionnaire was used for this study.  Based on the aim and research questions, a web questionnaire was designed. The questionnaire was tested on four physiotherapists associates and subsequently revised during an iterative process. The questionnaire was sent to 161 physiotherapists and carried out during February to Mars 2014. Results There were in total 53 replies (33%). In the treatment of neck pain, the use of specific deep neck muscle training was viewed as relevant to a greater extent,  in comparison to the use of superficial neck muscle training. The type of exercise most frequently used was postural training. Exercises aiming to train the joint position sense as well as endurance training using a pressure sensor, were least employed. Considering the use of exercise to train the joint position sense and endurance training using a pressure sensor, significant differences were observed between physiotherapists with or without specialist training. Physiotherapists with specialist training targeting orthopedic manual therapy, were using eye motion coordination training to a significant greater extent in comparison to the ones targeting sports medicine. Conclusions Among the 53 responding physiotherapists postural training was used to the greatest extent. Exercises to train the joint position sense of the neck as well as endurance training using a pressure sensor, were used to the least extent. Differences were observed between physiotherapists with and without specialist training in their use of exercises. According to the physiotherapists, the basic education did not provide sufficient training concerning physical exercise as treatment of neck pain