Thesis (MScPhysio (Physiotherapy))--University of Stellenbosch, 2006. / Postoperative rehabilitation programs have shown little efficacy in decreasing pain and disability in short and long term outcomes for lumbar discectomy. Preoperative education in other disciplines of medicine and physiotherapy has shown to decrease pain and disability postoperatively. No studies to date have been published on preoperative education for spinal lumbar surgery patients with radiculopathy. Objective: The objective of this study was to contribute towards further understanding of the preoperative educational requirements of patients undergoing lumbar surgery for lumbar radiculopthy. Method Two surveys were conducted. A new questionnaire was developed for patients to determine their preoperative educational needs regarding spinal surgery due to radiculopathy. These questionnaires were administered at 4-weeks postoperatively to patients from four spinal surgeons in the Greater Kansas City metropolitan area of the US. A second physiotherapist survey was developed and distributed to physiotherapists registered with the Kansas and Missouri State Boards who were actively involved in treating spinal surgery patients in Kansas and Missouri. The data collected from completed questionnaires were analyzed using descriptive and inferential statistical tests....

published_or_final_version / Medical Sciences / Master / Master of Medical Sciences

Background: Coronary heart disease (CHD) remains a major cause of death and ill- health in Scotland. Coronary artery bypass grafting (CABG) aims to relieve CHD symptoms, improve quality of life and increase life expectancy in high-risk groups. Partners may positively or negatively influence patient outcome, and they too may be adversely affected by the experience of CABG. Health care is currently organised around the patient. The partner's is seen as merely assisting patient recovery. Their health and well-being is neglected despite them being at an increased risk of CHD. Research has been limited in the partner variables that have been examined. Their health needs and concerns and the influence of the patient on partner outcome have seldom been examined and the effects of CABG on the dyad. The dyad has not previously been examined as an outcome variable of interest.

[Truncated abstract] Autologous Chondrocyte Implantation (ACI) has shown early clinical success as a repair procedure to address focal articular cartilage defects in the knee, and involves isolating and culturing a patient's own chondrocytes in vitro and re-implantation of those cells into the cartilage defect. Over time, repair tissue can develop and remodel into hyaline-like cartilage. A progressive partial weight bearing (PWB) program becomes the critical factor in applying protection and progressive stimulation of the implanted cells, to promote best chondrocyte differentiation and development, without overloading the graft. The aim of this thesis was to investigate whether patients could replicate this theoretical load bearing model to possibly render the best quality tissue development. In addition, this proposed external load progression is only a means to loading the articular surface. Several factors, including those that may result from pathology, have the potential to influence gait patterns, and therefore, articular loading. The association between increasing external loads (ground reaction forces - GRF) and knee joint kinetics during partial and full weight bearing gait was, therefore, investigated in the ACI patient group, as was the contribution of other gait variables to these knee joint kinetics which may be modified by the clinician. Finally, current weight bearing (WB) protocols have been based on early ACI surgical techniques. With advancement in the surgical procedure and ongoing clinical experience, we employed a randomised controlled clinical trial to assess the effectiveness of an 'accelerated' load bearing program, compared with the traditionally 'conservative' post-operative protocol. ... Although similar spatio-temporal, knee kinematic and external loading parameters were observed between the traditional and accelerated rehabilitation groups, the accelerated group was 'more comparable' to the controls in their external knee adduction and flexion moments, where the traditional group had lower knee moments. Knee moments greatly affect knee articular loading, and large adduction moments have been related to poor clinical outcomes after surgery. Therefore, the return of normal levels may be ideal for graft stimulation, however, may overload the immature chondrocytes. Acceleration of the intensive rehabilitation program will enable the patient to return to normal activities earlier, whilst reducing time and expenses associated with the rehabilitative process, and may enhance long-term tissue development. However, continued follow-up is required to determine if there are any detrimental effects that may emerge as a result of the accelerated load bearing program, and assess the recovery of normal gait patterns and whether longer term graft outcomes are affected by the recovery time course of normal gait function, and/or abnormal loading mechanics in gait. Furthermore, analysis at all levels of PWB is needed to identify a more complete set of variables attributing to the magnitude of external knee joint kinetics and, therefore, knee articular loading, while the influence muscle activation patterns may have on articular loading needs to be investigated. This becomes critical when you consider loads experienced by the articular surface throughout the early post-operative period following ACI may be important to short- and long-term graft development.

The purpose of this study was to determine the effectiveness of the Augmented Soft Tissue Mobilization (A.S.T.M.) Rehabilitation Technique on total knee replacement patients. The specific measurements assessed were stride length (SL), stride frequency (SF), walking velocity, support time (ST), total time (TT), static and walking range of motion (ROM) of the hip, knee, and ankle, ground reaction forces (GRF), and torques. Fourteen subjects (Female = 7, Male = 7) completed the study. Subjects were randomly assigned to two experimental groups, the Traditional Therapy treatment or the A.S.T.M. treatment. There were five testing sessions: pre operation, 8 weeks, 12 weeks, 16 weeks, and 24 weeks post operation. On the 12 week test, the subject had completed their assigned of treatment protocol. Static ROM was derived from gonimetric measurements before each testing session. Stride length, stride frequency, velocity, time, and walking ROM were derived from accelerometer data. Statistical analysis using ANOVA revealed a significant change in all static ROM, SL, and ST. The data indicated that both groups of the Total Knee Replacement patients did improve their functional status from their status prior to surgery. In addition, the data indicated that the Augmented Soft Tissue Mobilization program and the Traditional Therapy program are equally acceptable rehabilitation techniques. / School of Physical Education

Coronary bypass surgery is an increasingly common occurrence. Current literature does not validate the coping mechanisms involved for patients facing this life-threatening event. Lazarus’ theory of stress and coping was utilized as the framework for the study. The purpose of the study was to identify the degree of threat coronary bypass surgery presents and coping mechanisms utilized with this specific insult. The significance of the study was to assist nurses in identification of perceived risks/benefits of having open heart surgery from the patient’s perspective. The population included patients from a private cardiovascular practice in Indianapolis, Indiana. The convenience sample included 38 subjects recovering from coronary bypass graft surgery. Subjects were identified as uncomplicated post-operative surgical patients and were mailed questionnaires one month after discharge from the hospital. The Jalowiec Coping Scale and a questionnaire for demographic data were utilized to collect data. Procedures for protection of human subjects were followed. The research design was non-experimental and descriptive, correlational procedures were utilized to analyze data.The data supported the notions that clients utilized both problem-focused coping and emotion-focused coping, and emotion-focused coping strategies were more effective in reducing the threat. Education was significantly related to emotive coping styles and clients that perceived a higher threat intensity utilized more emotion-focused coping strategies. Recognition of the need to minimize stressors can be an important role the nurse facilitates. Through participatory care, the nurse may assist in finding the meaning for the stressor and encourage open communication patterns and emotional responses. Allowing for reduction of threat perception and intensity may enhance the outcome of the experience. / School of Nursing

The experience of living through an unexpected, life-threatening cardiovascular surgery can be a profound. This study examined the experience of 4 men who had survived ruptured aortic aneurysm using a phenomenological research design.Audio-taped interviews were analyzed for common themes and patterns. Two strong, opposing constitutive patterns were found. The patterns the data conveyed were: 1) fear as a response to overwhelming pain and clouded perceptions, and 2) gratitude for recovery in an atmosphere of caring support.This study was significant in beginning to bring to understanding the phenomenon of surviving major, unexpected cardiovascular surgical trauma. It is recommended that health care providers be more attentive to similar patients' experiences and listen to how their lives have changed as a result of their experiences. / School of Nursing

[Truncated abstract] Unicondylar knee arthroplasty (UKA) has re-emerged as a successful treatment option for isolated single compartment tibio-femoral joint osteoarthritis. However despite its increasing use, controversy still remains over fixed or mobile bearing tibial components, as there is a lack to prospective randomised studies reported in the literature. In addition, the theoretical advantages of the mobile bearing for knee kinematics, kinetics and clinical outcome have not been evaluated in vivo. The aim of this research study was to explore the clinical and biomechanical outcomes of the fixed and mobile bearing UKA. . . . When the results for the both studies were combined, utilising the Preservation and MG fixed bearing prostheses, there was a significant relationship between knee adduction moment, and a poor prognosis predicted from RSA. Those patients with translation or rotation of the tibial component in any direction above 1mm and 1.5 degrees respectively were considered to have a poor prognosis for long term fixation. Of the 28 patients, the 8 patients considered to have a poor prognosis, had increased knee adduction moments post-surgery (mean difference = 1.66Nm.kg-1, p = 0.007). There was no difference between the groups for knee flexion moment (mean difference 0.16Nm.kg-1, p = 0.844). Pre-surgery gait was unable to predict the post-surgery outcome, due to the significant changes in gait from pre- to post-surgery. Care must taken when implanting the Preservation mobile bearing prosthesis, as long term outcome is questionable. The mobile bearing prosthesis also produced the worst clinical outcome, however the theoretical advantages of the mobile bearing does not affect gait. Gait analysis is a useful tool to identify patient who are overloading their prosthesis, leading to potential early failure. Identification of these gait patterns can allow for early intervention to reduce joint load, and possible extend the longevity of the prosthesis.

There is a growing recognition that removal of an eye may cause a significant impact on a person's body image and her or his role in society; and may evoke a variety of emotional responses. The loss of an eye does not only signal disfigurement, it also means a loss of a body part and a vital sense; that of sight. Without vision, individuals have difficulty communicating. The emotional responses to this loss many a times, go unrecognized as the doctors and nurses who are in close contact with the patient at this time are not necessarily prepared to provide emotional care. This study seeks to address this gap by identifying the emotional impact of loss of an eye and sight on people's lives and the implication it has for health care workers, especially nurses. The eliciting of the different feelings and experiences of these patients can provide information for the formulation and design of protocols for holistic health care management. A non-experimental exploratory and descriptive design was used to conduct In-depth conversational interviews with seven purposively selected participants who had enucleation or evisceration between 2000 and 2005. Information-rich data yielded findings that clearly stressed the need for greater sensitization to the problem. All the participants expressed shock at the final diagnosis of enucleation or evisceration even if this was on their request. Patients wanted to know about the operation and its outcome, the prosthesis, how will it look like and its fit. Findings indicate that answers to these questions were not provided. Patients were not adequately emotionally prepared pre-operatively and were therefore not appropriately cared for post-operatively. Families were not satisfactorily involved and as such were not in a position to provide emotional support that the patients needed The recommendation was that a study to explore the health care team's knowledge in the psychological and emotional management of patients in crisis should be conducted as a benchmark for further training. / Health Studies / M.A. (Health Studies)

The purpose of this study was to identify the strengths and weaknesses of a pre-operative health education programme provided to cardiac surgery patients at a private hospital in Gauteng. A questionnaire was used to collect data and indicated that most patients were satisfied with the pre-operative education that they received before their cardiac surgery procedure, and therefore felt well prepared for the operation. It is, however, evident that family involvement with pre-operative education was not satisfactory. This lack of family involvement is a limitation in the present programme. The study also noted that patients must be informed about visiting hours, and the intense feeling of the endotracheal tube post-operatively should be emphasised. / Health Studies / M.A. (Health Studies)