Introduktion: Smärta är den vanligaste orsaken till att människor i Sverige söker vård inom primärvården idag. Smärta kan delas in i smärtklassifikationer där den vanligast förekommande är nociceptiv smärta. Två behandlingsmetoder svenska fysioterapeuter använder kliniskt vid behandling av smärta är akupunktur och dry needling. Vid akupunktur används nålar i specifika akupunkturpunkter och vid dry needling används nålar direkt i aktiva triggerpunkter eller smärtsam- och stel muskulatur. Det är inte bevisat hur akupunktur och dry needling fungerar men samma verkningsmekanismer tros förklara båda behandlingsmetoderna. Åsikterna är delade inom forskningsvärlden och bland svenska fysioterapeuter huruvida behandlingsmetoderna överhuvudtaget ska användas kliniskt till följd av bristande evidens. Syfte: Syftet var att undersöka svenska fysioterapeuters användning samt uppfattning om behandlingsresultat av dry needling och akupunktur. Metod: För att besvara syftet genomfördes en enkätundersökning med två urvalsmetoder. En egenkonstruerad e-enkät användes som utformades efter källor, inkluderingskriterier och andra enkäter. Resultat: 60 svar analyserades. 51 fysioterapeuter hade utbildning i akupunktur, av dessa använde 22% aldrig behandlingsmetoden. 19 fysioterapeuter hade utbildning i dry needling, av dessa använde 11% aldrig behandlingsmetoden. Bäst behandlingsresultat upplevdes vid behandling av nociceptiv smärta. Det fanns inget statistiskt samband mellan ålder och användning av behandlingsmetoderna eller användning och tid med utbildning i metoderna. Konklusion: Ett större antal fysioterapeuter använde akupunktur jämfört med dry needling. Främsta anledningen till att de med utbildning inte använde behandlingsmetoderna var bristen på evidens. Gemensamt för behandlingsmetoderna var att bäst behandlingsresultat upplevdes vid behandling av nociceptiv smärta. Baserat på denna studie finns behov av fler studier som undersöker dry needling och akupunktur i syfte att påverka evidensgraden.

Stroke is the first cause of disability and second most frequent cause of mortality after ischemic heart disease in adults worldwide. The influence of visual system impairment on the patient’s functional ability and quality of life are still largely neglected in neurological rehabilitation. Therapists are seldom concerned with the visual status and ability of their patients. Members of the rehabilitation team rarely assess, monitor or treat impairment of visual efficiency processes and visual information processing dysfunction that may be observed in patients after a stroke. In the absence of specific intervention visual deficits stabilise and become permanent due to poor or almost absent spontaneous recovery of the visual system in stroke patients. A matched-pair randomised controlled trial was conducted. Twenty-four (24) participants were screened based on their functional activity level as measured on the Stroke Activity Scale (SAS). When a participant’s SAS score matched a previously allocated participant’s score, that particular participant was placed in the opposite group from the existing matched participant. If the newly assessed participant’s SAS did not match another participant’s SAS, the participant was randomly allocated to either the experimental or the control group. The process was repeated until (24) patients had been allocated into two groups consisting of twelve (12) participants per group as they were admitted to Tshwane Rehabilitation Centre (TRC). Group 1 (Experimental Group) received saccadic eye movement training with visual scanning exercises integrated with task-specific activities and Group 2 (Control Group) received task-specific activities for four (4) consecutive weeks. Participants functional progress on body impairment and functional activity level were assessed and documented on a weekly basis during the intervention period of four (4) weeks. In order to determine whether the integration of visual scanning through saccadic eye movement training had a permanent or long-term effect on the participants’ functional ability and quality of life after rehabilitation had been terminated, functional progress on body impairment-, functional activity and participation levels as well as their perceived quality of life were assessed and documented eight (8), twelve (12), sixteen (16) and twenty (20) weeks after admission to the rehabilitation facility. A large number of participants were lost to follow-up following discharge from the TRC after the intervention period of four (4) weeks. As result of the small sample group at week eight (8), week twelve (12), week sixteen (16) and week twenty (20), these results were not discussed. Results of the matched-pair randomised controlled trial indicated that the effect of saccadic eye movement training with visual scanning exercises integrated with task specific activities as an intervention for participants that presented with unilateral spatial inattention, visual-spatial disorders and visual-constructive disorders poststroke resulted in significant improvement in impairment level. This improvement related to oculomotor visual performance, visual attention, depression as well as results on functional activity level with regard to the ability to independently complete ADL after four (4) weeks of rehabilitation. It may therefore be concluded that saccadic eye movement training with visual scanning exercises integrated with task-specific activities as an intervention tend to improve functional ability in participants that presented with unilateral spatial inattention, visual-spatial disorders and visual-constructive disorders post-stroke. / Dissertation (MPhysT)--University of Pretoria, 2013. / Physiotherapy / unrestricted

Sjukskrivningstiden har ökat dramatiskt sedan 1990 talet, utmattningssyndrom kan vara en orsak till detta. Den behandling som oftast rekommenderas är multimodal rehabilitering för utmattningssyndrom. Studier visar dock att rehabiliteringen inte verkar minska sjukskrivningstiden. Syftet med studien är att beskriva upplevelsen och erfarenheten av Multimodal rehabilitering vid utmattningssyndrom. Metoden som användes var en kvalitativ ansats med individuella semistrukturerade intervjuer. Det gjordes ett ändamålsenligt urval föratt syftet skulle kunna besvaras. Det blev totalt sex deltagare, där en användes som en pilotintervju och exkluderades från analysen. Resultatet bestod av fyra kategorier; känsla av gemenskap, bibehållen effekt, teamarbete och medvetenhet. Slutsatsen är att MMR är en komplexbehandling på en komplex problematik. Där flera av komponenterna upplevdes värdefulla av deltagarna. Det kan därmed finnas ett värde i att studera sjukskrivningstid i korrelation med andra utfallsmått.

Bakgrund: Inom svensk sjukvård används medicinsk yoga som behandling. Tidigare forskning har visat på positiva effekter hos patienter med olika symtom och sjukdomstillstånd men den tillgängliga evidensen är låg till måttlig. Fysioterapeuters erfarenhet av behandlingen har tidigare inte studerats.  Syfte: Att beskriva fysioterapeuters erfarenheter och tankar om yoga som behandling inom primärvården. Metod: En kvalitativ intervjustudie med semistrukturerade intervjuer genomfördes under 2023 med fem kvinnliga fysioterapeuter med 7-10 års erfarenhet av yoga som behandling inom primärvården i Östergötland. Studiens intervjumaterial analyserades enligt en kvalitativ innehållsanalys med induktiv ansats.  Resultat: Analysen resulterade i huvudkategorierna; “Fysioterapeutens roll vid yoga”, “Genomförande av yoga som behandling”, “Patienten beskriven utifrån fysioterapeutens perspektiv” och “Yoga som behandling”, med tillhörande underkategorier. Yoga beskrevs som en tillåtande behandling som passar flera patientgrupper då den går att individanpassa. Kunskapen om yoga behöver stärkas för att öka förståelsen av behandlingsformen. Konklusion: Fysioterapeuterna uppfattar yoga som en tillåtande behandlingsform med ett biopsykosocialt perspektiv som är användbar vid behandling av flertalet patientgrupper. Fysioterapeuterna ser att de har en viktig roll i att individanpassa behandling och att personliga egenskaper och pedagogisk förmåga är betydande för upplevelsen av behandlingen. Det finns ett värde i att öka kunskapen om yogans effekter.

Bakgrund: Att vara ny på arbetsmarknaden kan för många vara både krävande och påfrestande, dels med nya kollegor och miljöer, dels att man direkt får ett stort ansvar. Kännedomen om övergången från fysioterapeutstudent till fysioterapeut är svag, men i de få studier som gjorts är ett återkommande tema som ses hos både fysioterapeuter och sjuksköterskor att man som nyexaminerad känner att den egna kunskapsnivån ska vara densamma som erfarna yrkesutövare. Syftet: Syftet med studien var att beskriva nyexaminerade fysioterapeuters upplevelse av utbildningen som förberedelse inför arbetslivet. Metod: Sex semistrukturerade intervjuer genomfördes med nyexaminerade fysioterapeuter. Materialet av de inspelade intervjuerna analyserades sedan genom kvalitativ innehållsanalys. Resultatet: Den kvalitativa analysen resulterade i fyra kategorier samt underkategorier. Kategorierna blev kurser som varit till fördel för yrket, kursmoment som saknas med behövs i utbildningen, de största utmaningarna som nyexaminerad och strategier för att klara yrket. Konklusion: Praktiken och de praktiska kurserna upplevdes viktigast för att lägga grunden till fysioterapiyrket men det finns förbättringspotential. Nyexaminerade fysioterapeuter upplevde att det var ett stort steg från student till fysioterapeut men att ta hjälp av sina mer erfarna kollegor och även lära sig att identifiera, prioritera och begränsa sig var av stor vikt för att motverka stress.

Bakgrund: Cirka 80 procent av befolkningen drabbas av ländryggssmärta, och därmed är den vanligaste orsaken till funktionshinder globalt. Orsaken till ländryggssmärta är omtvistat och tidigare studier visar att det inte är möjligt att hitta en specifik orsak till detta. Det finns olika teorier kring vad ländryggssmärta beror på, en vanlig uppfattning är hur du lyfter har betydelse för att utveckla ländryggssmärta. En diskussion förs inom forskning om lyft med böjd rygg är en bidragande orsak till ryggbesvär. Syfte: Syftet var att kartlägga om ryggflexion under belastning kan orsaka ländryggsbesvär. Metod: Litteratursökningen gjordes i databaserna PubMed och CINAHL. Totalt inkluderades elva studier varav tio var kvantitativa och en var kvalitativ design. Resultat: Övervägande studier beskrev lyft som en riskfaktor för ländryggssmärta. Det framkom inte om ryggflexion under belastning orsakar ländryggssmärta eller om lyft med neutral rygg är ett säkrare lyft. Personer med ländryggssmärta lyfter med mindre ryggflexion än personer utan ländryggssmärta. Av två studier som fokuserade på den totala belastningen i ryggen gällande stoop lift och squat lift, visade en studie att stoop lift producerade mer total belastning än squat lift. Den andra studien visar på att stoop lift producerade totalt mindre belastning i ryggen jämfört med squat lift. Konklusion: Resultat visar att ryggflexion under belastning varken ökar risken för ländryggssmärta eller är en orsak till detta. Den biomekaniska litteraturen stödjer inte att squat lift är bättre än stoop lift för att minska risken för ländryggssmärta. / Background: Approximately 80 percent of the population experiences lower back pain, making it the most common cause of disability globally. The cause of lower back pain is debated, and previous studies indicate that it is not possible to identify a specific cause. Various theories exist regarding the origins of lower back pain, with a common belief being that lifting technique plays a role in its development. Research has discussed whether lifting with a rounded back contributes to back problems. Objective: The aim was to investigate whether lumbar flexion during loading can cause lower back discomfort. Method: A literature search was conducted in the PubMed and CINAHL databases. Eleven studies were included, of which ten were quantitative and one had a qualitative design. Results: Most studies described lifting as a risk factor for lower back pain. However, it remains unclear whether lumbar flexion during loading directly causes lower back pain or if lifting with a neutral spine is a safer approach. Individuals with lower back pain tend to lift with less lumbar flexion than those without pain. Two studies focused on total back load during stoop lift and squat lift. One study found that stoop lift resulted in greater total load than squat lift, while the other study showed that stoop lift produced less total load in the back compared to squat lift. Conclusion: The results suggest that lumbar flexion during loading does not increase the risk of lower back pain or serve as a direct cause. Biomechanical literature does not support the notion that squat lift is superior to stoop lift in reducing the risk of lower back pain.

Made available in DSpace on 2015-12-06T23:07:27Z (GMT). No. of bitstreams: 0 Previous issue date: 2006 / Fundação de Amparo à Pesquisa do Estado do Amazonas (FAPEAM) / O objetivo deste estudo é investigar o Ensino da Fisioterapia Preventiva na Graduação das Escolas da Região Norte do Brasil a partir de docentes e discentes. Procurou-se, assim, delinear objetivos, conteúdos, estratégias de ensino e de avaliação das propostas curriculares bem como conhecer os docentes responsáveis por este ensino. As expectativas dos docentes e discentes e a contribuição deste ensino para a atuação na Atenção Básica à Saúde foram investigados, correlacionando os dados com a literatura pertinente. Optamos por desenvolver uma pesquisa de caráter exploratório, descritiva, realizada a partir de uma abordagem quantitativa e qualitativa em duas das quatro escolas que atualmente formam fisioterapeutas na Região: uma privada em Manaus (Amazonas) e outra pública em Belém (Pará). Entrevistamos quatro professores e vinte discentes e analisamos os planos de ensino das disciplinas e módulos correspondentes. Os dados foram analisados pela técnica de Análise de Conteúdo. Observou-se que a inserção da fisioterapia preventiva e os cenários de aprendizagem para as práticas bem como os objetivos e critérios para seleção de conteúdos divergem pouco entre si. As dificuldades mais referidas tanto pelos professores como pelos estudantes são a reduzida carga horária e a necessidade de maior abrangência de cenários para as práticas. Discutiu-se também alguns traços do perfil dos docentes, investigando os atributos considerados mais relevantes para o exercício da docência na área. Uma perspectiva humanística a boa interação professor-aluno, à vivência e experiência, a transmissão de segurança aos discentes, a arte de saber associar teoria com a prática, a criatividade e incentivo a iniciação científica foram as características apontadas para um “bom professor” nesta área. Acreditamos, com este estudo, estar contribuindo para a melhor compreensão do ensino da Fisioterapia Preventiva como parte fundamental para a formação do fisioterapeuta no tocante a Atenção Primária, além de incentivar a busca de novos caminhos que apontem para a melhor qualidade e aperfeiçoamento deste ensino, contribuindo sobremaneira, para o enriquecimento do atendimento no SUS. / The purpose of this study is to investigate the Preventive Physiotherapy Teaching in the Graduation schools, in the north part of Brazil, from the professors and student’s point of view. We aimed to delineate objectives, contents and teaching strategies and to analyze curricular proposals as well as to know those in charge for this teaching program. The professors and students’ expectations and the contribution of this teaching program to act in the Basic Attention to Health were analyzed, and the obtained data were correlated with the proper literature. Our option was to develop an exploratory, descriptive research based on a quantitative and qualitative approach and carried out in two out of the four schools that, at present, are responsible for physiotherapist formation in this area: one was a private school in Manaus (Amazon State) and the other was a public school located in Belém (Pará State). Four professors and 20 students were interviewed and the teaching discipline plans and corresponding modules were analyzed. Data were evaluated according to the Content Analysis technique. It was observed that the preventive physiotherapy program insertion and the teaching settings for the practice, as well as objectives and criteria for the content selection did not differ among themselves. The most mentioned difficulties referred either by professors and students are reduced workload and the need of more wide-ranging settings for the practice. Some professors’ traits were analyzed investigating the more relevant features for the exercise of teaching in this area. A humanistic perspective, a fine professor-student interaction, experience and practice, bring confidence for the professors, the art of knowing how to associate theory with practice, creativeness and incentive to the initial scientific start-up were considered the major characteristics to be “ a good professor” in this area. We hope that this study could bring some contribution to have a better comprehension of the Preventive Physiotherapy Teaching as essential in the physiotherapist formation regarding Primary Attention. Also, to encourage the search for new paths to bring quality and development to this teaching and thus, significantly contributing to the SUS (National Health System) assistance. / BV UNIFESP: Teses e dissertações

Magister Scientiae (Physiotherapy) - MSc(Physio) / Background: Musculoskeletal disorders (MSD’s) and sports injuries are commonly sustained throughout the world daily. They are dominant in many countries, with considerable cost involvement and impact on quality of life. For this reason they need to be recognised as a necessary part of general practice. MSD’s refer to a wide variety of diseases and disorders of the musculoskeletal system, such as degenerative and inflammatory conditions (arthritis), spinal and soft tissue disorders, osteoporosis and musculoskeletal injury. Managing these musculoskeletal conditions are a challenge and using the best available evidence should be the first the choice. All health professionals should have the ability to determine the best available evidence and thus strive to give their patients the best health care known to them. Evidence-based practice (EBP) is an important key in making this happen as it uses the best current evidence in the decision-making process regarding the care of patients. Literature highlights that health care professionals are expected to implement evidence-based practice (EBP); this means that newly graduated students and health care professionals alike are required to be confident in exercising this skill of EBP. When expecting EBP from students, educators need to realize that students have limited clinical experience. Therefore, they need the skills to acquire the best research evidence when applying the best treatment for patients. In introducing evidence-based practice, various research is aimed at evaluating the health professional’s attitude and behaviour towards evidence-based practice (EBP). There is limited research regarding the actual implementation of EBP in everyday practice. Aim: Therefore, the aim of the study was to determine if undergraduate physiotherapy students implement evidence-based practice in the management of musculoskeletal disorders and sports injuries. Objectives: The study had four objectives: i) To determine the most common treatment techniques used by students in the management of the conditions treated at the UWC clinic through data extraction of patient records in the clinic using a self-designed data extraction sheet, ii) To determine the knowledge and beliefs about EBP among undergraduate physiotherapy students through a survey, iii) To determine an evidence-based intervention strategy of one of the most common conditions seen through a systematic review and iv) To map the links between current practice, student beliefs and evidence-based information. vii Methodology: The study used a predominantly quantitative approach with a few open ended questions and took place at a student training Physiotherapy clinic. The first phase was a retrospective document analysis study which consisted of data extraction of patient records for the period January 2009 to December 2011. The second phase used a mixed methods approached and consisted of a questionnaire with both closed and open-ended questions. It was completed by the 2012 registered fourth year students regarding attitudes and knowledge of EBP. The third phase consisted of a systematic review to identify the evidence for interventions used to manage one of the most common conditions identified. In the final phase and discussion of this thesis triangulation of the data was used by the researcher in order to formulate a picture of whether students apply evidence-based practice by using the data extracted from the patient folders in combination with the questionnaire survey of the participants and the systematic review. Data analysis for phases one and two was done using SPSS Statistical package software to determine frequencies and descriptive statistics. Phase two also had two open ended questions and this was analysed thematically and data was coded, themes allocated and responses counted. The systematic review focused on systematic reviews of treatments for low back pain and this was narratively described. The research project received ethical clearance from the University of the Western Cape Research Grants and Study Leave Committee (project registration number: 12/3/12), and permission to conduct the survey was obtained from the Head of Department. Informed consent was obtained from all participants, they were informed of the research process at the outset of the project, and kept up-to-date at every major stage. Questionnaires for surveys were accompanied by an information sheet explaining the background and reason for conducting the survey, and students gave written, informed consent following an opportunity to clarify the study details. Results: The results showed that males were predominantly seen at the physiotherapy clinic, and that the most common complaint was pain in the neck, shoulder and lower back area. The students most common treatment choice was soft tissue mobilisation and the use of heat for all three these areas of pain. The questionnaire responses were also captured using SPSS and frequencies and descriptive statistics employed. These results showed that although students knew what EBP was it was not clear that they knew how to implement it. The systematic review assessed and established the most common treatments used in literature for the treatment of lower back pain; and pain, function and disability were viii the only outcomes considered. The only intervention that had a positive effect on the included outcomes was the use of manual therapy (spinal manipulation and mobilisation). In triangulating the data, it was shown that the students do not seem to use the same treatment choices as the literature indicates. Conclusion: The results show that there is very little link between the students choices of treatment for one of the common conditions highlighted and the current literature. It is therefore possible that although students understand the term EBP they do not show that they know how to use or implement the concept. Implications for practice: Institutions may need to be more vigilant about making provision for EBP in the curriculum as well as how it is implemented so that students can be comfortable with this practice. More randomised controlled trials and systematic reviews are necessary on physiotherapy interventions so that practice can be better informed. Finally, EBP is perhaps one way to promote a culture of life-long learning within the physiotherapy profession.

<p><strong>Introduction:</strong> Children with acquired brain injury (ABI) receive physiotherapy interventions to promote motor skill relearning. Theoretically-driven motor learning strategies (MLS) may support therapists in this goal, but their use with this complex population is unexplored. Virtual reality (VR) games are popular interventions that may influence therapist use of MLS. A valid, reliable method to examine MLS during usual and VR-based interventions is required.</p> <p><strong>Purpose: </strong>To: 1) identify the active ingredients of VR interventions; 2) develop and examine the psychometric properties of an instrument to measure MLS use; and 3) explore physiotherapists’ perspectives on promoting motor learning within usual and VR-based interventions for children with ABI.</p> <p><strong>Methods:</strong> A scoping review methodology was used to identify the active ingredients of VR interventions. Nineteen experts and clinicians participated in a content validation process to develop an instrument to measure MLS. Inter-rater reliability of the instrument was evaluated within 22 videotaped usual and VR-based physiotherapy sessions with children with ABI. Six therapists participated in qualitative interviews about these interventions.</p> <p><strong>Results:</strong> The scoping review identified<em> </em>11 active ingredients of VR; 6 related to motor learning theory. The Motor Learning Strategy Rating Instrument (MLSRI) was developed. Inter-rater reliability was high (0.81) for usual interventions but low (0.28) for VR-based interventions. Therapists described the importance of considering intervention goals and child characteristics when promoting motor learning; VR was viewed as a complex, motivating intervention that influenced their use of verbal strategies.</p> <p><strong>Conclusions:</strong> A motor learning theoretical framework may be relevant to clinicians and researchers using VR in pediatric rehabilitation. Qualitative findings enhance understanding of how therapists promote motor learning in usual and VR-based physiotherapy interventions for children withABI. The use of MLS can be measured reliably within usual interventions, but further instrument refinements are required to rate MLS use within VR-based physiotherapy for children with ABI.</p> / Doctor of Philosophy (PhD)

<p><strong>Background: </strong>Walking dysfunction is one of the most disabling and persistent of stroke-related sequela. Theory- and research-derived motor learning principles (MLPs) offer an ideal theoretical framework for the development and evaluation of walking-skill focused interventions.</p> <p><strong>Purpose: </strong>To: 1) appraise the degree of adherence to motor learning principles (MLPs) in current post-stroke walking-skill training research; 2) describe the Motor Learning Walking Program (MLWP), a novel, MLPs-framed walking training program; and 3) compare the MLWP to an alternate theory-framed walking-focused intervention in community-dwelling individuals within one year of stroke.</p> <p><strong>Methods: </strong>A scoping review methodology was used to identify the prevalent theoretical frameworks in current post-stroke walking training literature, and to appraise the adherence to selected MLPs in walking-focused interventions. A randomized controlled trial (n=71) was conducted to compare the MLWP to a body-weight-supported treadmill training (BWSTT) intervention.</p> <p><strong>Results: </strong>In the scoping review of 27 walking-focused studies, a minority of investigators explicitly stated a theoretical-framework. Application of MLPs was inconsistent across interventions. In the randomized controlled trial, both intervention groups improved walking function after 5 weeks of training however, there were no significant between-group differences in the primary and secondary outcomes.</p> <p><strong>Conclusions:</strong> To date, there has been limited integration of MLPs into post-stroke walking-skill training literature. This randomized controlled trial is unique in its comparison of two theoretically divergent, yet equally intense, walking-training interventions. While the results were equivocal, future research should continue to explore the impact of application of MLPs on walking-skill recovery after stroke.</p> / Doctor of Philosophy (PhD)