<p>Neurodynamics refers to the mechanical and physiological components of</p> <p>the nervous system and the interconnections between them (Shacklock, 1995).</p> <p>This is a phase 1 pilot trial investigating the immediate effect of a neurodynamic</p> <p>treatment as compared to a sham treatment in eight participants with low back</p> <p>pain. Primary outcome measures included: H-reflex latency and nerve</p> <p>conduction velocity. Secondary outcome measures included: the sitting slump</p> <p>test and visual analog scale for pain following a neurodynamic treatment</p> <p>compared to a sham treatment on eight participants with low back pain. T-tests</p> <p>were used to analyze any differences between the groups at baseline and post-</p> <p>intervention. No statistically significant differences were observed between the</p> <p>groups at baseline. Statistically significant differences were noted post-</p> <p>intervention between the treatment groups for H-reflex latency (t(5)=4.323,</p> <p>p=0.008) and the unaffected leg sitting slump test (t(5)=3.402, p=0.019). The H-</p> <p>reflex latency increased for the group following the neurodynamic treatment and</p> <p>decreased following the sham treatment. This was not expected and is of</p> <p>interest due to the possible mechanisms that may be underlying these</p> <p>phenomena. Despite the small sample size used in this study, differences were</p> <p>observed and displayed trends that were unanticipated. These between-group</p> <p>differences are of interest but require further investigation using a larger sample</p> <p>population. Sample size calculations for future studies based on the primary</p> <p>outcome measures yielded a sample of 2008 participants. This accounted for</p> <p>both a 20% difference between the two groups and a 20% dropout rate. Future</p> <p>studies need to investigate the most beneficial length of time, type and dosage of</p> <p>neurodynamic treatments, as well as, the most appropriate times to assess the</p> <p>outcome measures. Comparison to controls would be beneficial in subsequent</p> <p>studies.</p> / Master of Science Rehabilitation Science (MSc)

<p><strong>Background and objectives</strong>: Physiotherapists provide conservative treatment for neck pain utilizing manual therapies (MT), including spinal manipulation. Adverse events (AE) have been associated with manipulation provided mainly by other professions. Physiotherapy specific data are lacking. Definitions of AEs following MT require clear standardized criteria informed by both practitioners and patients. The objectives of this thesis were to: a) establish practice patterns of spinal manipulation in Canadian manipulative physiotherapists (CMPTs), b) establish patients’ perceptions of an AE related to MT and c) pilot the collection of AE data reported by practitioners and patients. <strong>Methods</strong>: For the first objective, multiple linear regression of survey data determined the association between experience and frequency of use of manipulation amongst CMPTs. For the second objective, Poisson regression identified predictors of patients more likely to report the occurrence of an AE. The final objective utilized descriptive statistics of patient and practitioner reported AE to assess feasibility for a future large-scale study. <strong>Results</strong>: For the first, increased experience was associated with increased use of upper cervical manipulation in males (14% more often for every 10 years after certification; beta 1.37, (95% confidence interval) (0.89,1.85) pConclusion: Manipulation by CMPTs remains a valued option as experience increases. Adverse events reported by patients are influenced by expectations. A large cohort study attempting to accurately define and measure AE rates following manipulation will be challenging to perform in private practice settings.</p> / Doctor of Philosophy (PhD)

<p>Details on the CanWell program can be found at www.canwellprogram.ca</p> / <p>People with cancer face many challenges related to their disease and its associated treatments. This dissertation consists of two studies directly evaluating the effects of exercise on cancer survivors who participated in a community-based exercise program (CanWell program) and a measurement paper that evaluated a measure of symptom burden. The first study outlines the development and effectiveness of the CanWell program as measured by the 6-minute walk test, STEEP treadmill test, Functional Cancer Therapy Assessment – General, and the Edmonton Symptom Assessment System (ESAS). This study found that participants in the CanWell program have significantly improved physical abilities, improved quality-of-life, and lower levels of cancer disease burden. The second study was conducted to evaluate the long-term exercise compliance, facilitators and barriers to continuation of exercise. Outcome measures used were similar to those in the first study with a survey explored facilitators and barriers to exercise. The results of this study found that while CanWell graduates were able to maintain the functional levels (no change in 6-minute walk test), there were significant reductions in exercise aerobic abilities (time on treadmill). The main exercise barriers included fatigue, cost, and return to work. In the last study, the measurement properties of the ESAS were investigated using Rasch analysis leading to a revised scoring algorithm to meet unidimensionality and interval scaling. The ESAS scores from study #1 were re-analyzed using the new interval-level scoring scheme. This Rasch-based scoring resulted in different conclusions than the traditional ordinal scaling.</p> / Doctor of Philosophy (PhD)

<p><strong>Objective</strong>: To perform an environmental survey of clinical practice amongst surgeons and physiotherapists in making return to sport (RTS) decisions following ACL reconstruction (ACLR); to gain a better understanding of how clinicians and patients define successful return to sport; and to compare patients’ level of satisfaction with their current level of activity following ACLR.</p> <p><strong>Design: </strong>Multidisciplinary cross sectional study.</p> <p><strong>Setting</strong>: Online</p> <p><strong>Participants:</strong> Orthopaedic surgeons and registered physiotherapists; and patients who had undergone ACLR within the previous 6-18 months.</p> <p><strong>Interventions: </strong>Surgeons and physiotherapists completed separate web surveys, each consisting of 10 closed format questions that included sections on demographics, outcome measures, treatment procedures, and RTS decisions. Patients completed a web survey consisting of 19 questions about their activity level, their experience surrounding the process of rehabilitation after ACLR, and their decisions surrounding RTS.</p> <p><strong>Main Outcome Measures</strong><strong>: </strong>Descriptive and subjective data were collected for all groups. Clinician responses were compared for differences in frequencies of clinical outcome measures used to decide RTS readiness. Frequency data were collected for all groups for the definition of successful RTS following ACLR using a self-report form. The relationship between patient satisfaction and current level of activity following ACLR was compared using the Tegner Activity Scale and Single Assessment Numeric Evaluation (SANE).</p> <p><strong>Results:</strong> All patients were unanimous in their definition of successful RTS post ACLR as the ability to fully participate in pre-injury level of sport with no limitations or deficits (100%), and restoring functional stability (100%). Mean Tegner activity level scores of respondents decreased a mean of 3.4 (SD ± 2.5) from pre-injury to current level of activity (p < 0.011). However, no significant decrease from pre-injury level of activity to expected level of activity post surgery was seen. A statistically significant correlation was demonstrated between patients’ level of satisfaction and current level of activity (r = 0.84, p = 0.02), with higher levels of activity associated with increased levels of satisfaction. Overall, the majority of clinician respondents reported that jump tests, range of motion (ROM), Lachman clinical test of stability, pain, swelling, functional movement and giving way contributed to their RTS decisions. Unanimous consensus existed between clinicians for the ability to participate in any level of sport, with or without limitations, as the definition of successful RTS following ACLR.</p> <p><strong>Conclusions:</strong> Following ACLR, medically cleared patients had not met their high expectations of functional stability and ability to return to their pre-injury level of sport. The discordance between unmet expectations and current level of sporting activity was reflected in lower rates of patient satisfaction. Most clinicians reported using primarily impairment based not self-report measures to contribute to their RTS decisions. Clinicians and patients expressed subtle differences in their definition of successful RTS.</p> <p><strong>Clinical Relevance: </strong>Establishing an operational definition of success, and professional consensus on measures which include patient reported outcomes is an important next step in the development of goal oriented RTS guidelines.</p> / Master of Science Rehabilitation Science (MSc)

Background: The digitalization is increasing in healthcare and also in physiotherapy, making it possible to meet patients through digital healthcare visits in an accessible and efficient way. More research is needed about physiotherapeutic digital care visits and  physiotherapists’ thoughts about conducting the first visit over a digital platform as their insights can contribute to future development. Aim: The aim of the study was to explore physiotherapists’ thoughts about conducting the first visit over a digital platform within the primary health care. Method: A qualitative descriptive study was conducted with semi-structured interviews. Six physiotherapistst working in primary care participated in individual interviews and were recruited through purposive and snowball sampling. The interview material was analyzed using qualitative content analysis with an inductive approach. Result: The data analysis resulted in ten subcategories sorted into four categories: The digital format, The influence of factors related to the patient, Areas of use and development and The physiotherapeutic work.  Conclusion: The physiotherapists had a positive attitude towards digital first visits, however they felt that it was not suitable for all patients and therefore a combination of digital and physical visits were preferred. They also believed that more education and guidelines are required to implement digital new visits to a greater extent. / Bakgrund: Digitaliseringen inom vården ökar och även så inom fysioterapin, där man genom digitala vårdbesök kan träffa patienter på ett lättillgängligt och effektivt sätt. Det behövs dock mer forskning kring digitala vårdbesök inom fysioterapi och fysioterapeuters tankar kring ämnet då deras insikter kan bidra till framtida utveckling.  Syfte: Syftet med studien var att undersöka fysioterapeuters tankar om digitala nybesök inom primärvården. Metod: En kvalitativ beskrivande studie genomfördes med semistrukturerade intervjuer. Sex fysioterapeuter som arbetar inom primärvården deltog i enskilda intervjuer och rekryterades genom ändamålsenligt-och snöbollsurval. Intervjumaterialet analyserades med kvalitativ innehållsanalys med en induktiv ansats. Resultat: Dataanalysen resulterade i tio underkategorier sorterade i fyra kategorier: Det digitala formatet, Patientrelaterade faktorer påverkar, Användnings-och utvecklingsområden och Det fysioterapeutiska arbetet. Slutsats: Fysioterapeuterna hade en positiv inställning till att använda sig av digitala nybesök, men ansåg att det inte lämpade sig för alla patienter och att möjligheten till både digitala och fysiska besök var att föredra. De menade även att det krävs mer utbildning och tydligare riktlinjer för att implementera digitala nybesök i större utsträckning.

Bakgrund: Förlossningsskador och andra besvär postpartum är vanligt förekommande. Fysioterapi har visat sig ha stark evidens för att hjälpa med smärta och funktion för dessa besvär. Trots detta används fysioterapeuter i mycket liten utsträckning inom förlossningsvården. Syfte: Syftet var att kartlägga prevalensen och omfattningen av förlossningsskador och andra besvär samt att ta reda på hur rehabiliteringsprocessen såg ut. Metod: En kvantitativ ansats med empiristisk-atomistisk design användes. Kartläggningen gjordes med hjälp av en digital enkät som delades i allmänna facebookgrupper riktade till mammor och kvinnor. Den insamlade datan analyserades med hjälp av frekvenstabeller, Pearsons korrelationskoefficient samt Chi2-test. Resultat: Över 80% av deltagarna hade fått en bristningsskada vid förlossning, där majoriteten fått grad 2. Av deltagarna uppgav 63% att de haft besvär efter förlossningen och 50% uppgav att de hade kvarstående besvär idag. Majoriteten uppgav att de haft multipla besvär, där inkontinens var vanligast förekommande. Efter återbesök hos barnmorska uppgav 54% att de inte fått någon information om sina besvär och 72% fick ingen information om rehabilitering för dem. Hälften av alla deltagare hade utfört någon form av rehabilitering efter sin förlossning, där bäckenbottenträning var det absolut vanligaste. 62% visste inte om att man kan söka hjälp hos en fysioterapeut för förlossningsrelaterade besvär.  Konklusion: Utbredningen av förlossningsrelaterade besvär är stor och många lever med kvarstående besvär långt efter sin förlossning. Fysioterapi är en outnyttjad resurs och fysioterapeuter bör med fördel kunna användas som en del av den standardiserade förlossningsvården i Sverige idag. Fler högkvalitativa studier behövs för att öka kunskapen inom ämnet. / Background: Childbirth injuries and other postpartum complications are common. Physiotherapy has shown strong evidence for helping with pain and function related to these complications. Despite this, physiotherapists are rarely used in standard maternity care.  Objective: The objective was to map the prevalence and extent of childbirth injuries and other complications, as well as to understand the rehabilitation process.  Method: A quantitative approach with an empiricist-atomistic design was used. The mapping was conducted using a digital survey shared in general Facebook groups targeted at mothers and women. The collected data were analyzed using frequency tables, Pearson’s correlation coefficient, and Chi-square tests.  Results: Over 80% of participants had suffered a perineal tear during childbirth, with the majority experiencing a second-degree tear. Of the participants, 63% reported complications after childbirth, and 50% reported having ongoing issues today. The majority reported multiple complications, with incontinence being the most common. After follow-up visits with a midwife, 54% stated they received no information about their complications, and 72% received no information about rehabilitation for them. Half of all participants had undergone some form of rehabilitation after childbirth, with pelvic floor exercises being the most common. Additionally, 62% did not know that they could seek help from a physiotherapist for childbirth-related complications.  Conclusion: The prevalence of childbirth-related complications is high, and many live with persistent issues long after childbirth. Physiotherapy is an underutilized resource, and physiotherapists should be integrated into the standardized maternity care in Sweden today. More high-quality studies are needed to increase knowledge in this field.

Bakgrund: Komplext regionalt smärtsyndrom (CRPS) kännetecknas av en långvarig neuropatisk smärta i en kroppsdel där smärtan ej står i proportion till den utlösande händelsen. Syndromet kan inkludera sensibilitetsförändringar, ödem, hudfärgsförändringar samt rörlighets- och funktionsnedsättningar. Konsekvenserna kan bli stora i form av extrem smärta och försämrad livskvalitet. Syfte: Syftet med denna litteraturstudie var att hitta fysioterapeutiska behandlingsmetoder vid CRPS samt att undersöka deras effekter. Metod: Sökningar genomfördes i databaserna PubMed, Cinahl och Web of Science mellan januari och maj 2024. Sökningen resulterade i 88 artiklar varav 14 inkluderades. Resultat: 31 fysioterapeutiska behandlingsmetoder hittades. De vanligaste var Graded Motor Imagery (GMI), Mirror Therapy (MT), exponeringsbaserade interventioner och multimodala rehabiliteringsinsatser tillsammans med aerob träning. Exempel på andra metoder som användes var avslappningsmetoder, transkutan elektrisk nervstimulering (TENS), akupunktur, desensibilisering, tactile discrimination training och flertalet passiva behandlingsmetoder. Utfallsmåtten var olika mellan vuxna och yngre. Det som utvärderades var smärta, funktion, svullnad, livskvalitet, rädsla för smärta eller skada och smärtkatastrofiering. Konklusion: GMI kan förbättra smärta och funktion på medellång och lång sikt. MT kan förbättra smärta och funktion på kort och möjligen lång sikt. Graderad exponering eller exponering in vivo kan ge signifikanta förbättringar av funktion, smärta, katastroftankar kring smärta samt upplevd skadlighet av rörelser. Aerob träning kan minska smärta och/eller nedsatt funktion vid CRPS. Multimodala och tvärvetenskapliga insatser är viktiga för att uppnå ett bra resultat. Fler randomiserade kontrollerade studier behövs för att kunna avgöra långtidseffekterna av interventionerna. / Background: Complex regional pain syndrome (CRPS) is characterized by a long-term neuropathic pain in a body part where the pain is disproportionate to the triggering event. The syndrome may include changes in sensitivity, changes of skin color, oedema, reduced mobility and disability. The consequences can become severe such as extreme pain and reduced quality of life. Purpose: To find physiotherapeutic treatment methods for CRPS and to investigate their effects. Method: Searches were conducted in the databases PubMed, Cinahl and Web of Science between January-May 2024. The search resulted in 88 articles of which 14 were included. Results: 31 physiotherapeutic treatment methods were found. The most common ones were Graded Motor Imagery (GMI), Mirror Therapy (MT), exposure-based interventions and multimodal rehabilitation interventions along with aerobic exercise. Examples of other methods used were relaxation methods, transcutaneous electrical nerve stimulation (TENS), acupuncture, desensitization, tactile discrimination training and several passive methods of treatment. The outcome measures varied between adults and younger people. Pain, function, swelling, quality of life, fear of pain or injury and pain catastrophizing were evaluated. Conclusion: GMI may provide clinically meaningful medium- and long-term improvements in both pain and function. MT can improve pain and function in short and possibly long term. Graded exposure or exposure in vivo can significantly improve motor function, pain, pain-catastrophizing as well as perceived harmfulness of activities. Aerobic exercise may reduce pain and/or impaired motor function related to CRPS. Multimodal and interdisciplinary efforts are important to achieve good results. More randomized controlled trials are needed to determine the long-term effects of the interventions.

No / In October 2015 I started an optional Student Supervised Physiotherapy clinic for neurologically impaired patients. The primary aim of the clinic is to provide an experiential learning environment for Levels 5 and 6 students. The secondary aim of the clinic is to provide an assessment, review and treatment to local service users experiencing neurological problems and who are seeking further/alternate physiotherapy within a learning environment. The clinic is the first dedicated student supervised neurological physiotherapy clinic in the UK that we are aware of.

Thesis (MScPhysio)--University of Stellenbosch, 2011. / ENGLISH ABSTRACT: Aim: The aim of the study was to improve understanding of the hip joint kinematics in cricket fast bowlers and to ascertain whether a relationship exists between hip joint biomechanical parameters, including kinematics, ROM characteristics and lumbar symptoms. Study design: A descriptive cross-sectional study was conducted. Participants: Sixteen adult male fast bowlers between the ages of 18 and 40 years old, playing first-club league, were featured in the study. Main outcome measures: To obtain data with regards to the training history, as well as the nature of lumbar-spine symptoms experienced by the cricket fast bowlers, a newly designed questionnaire was compiled. For analysis of the front foot hip joint ROM and kinematics, the biomechanical equipment used included: a two-dimensional Canon MV950 Digital Video Camcorder, a Kodak EasyShare C310 camera and XSENS Motion Tracking equipment (Xsens Technologies B. V., Enschede, Netherlands). Results: Eight of the sixteen bowlers in our study experienced LBP in the season with seven of these bowlers presenting with recent symptoms most of which are experienced after bowling a spell and described as “tightness” or a “stabbing pain” in the lower back. Intensity of LBP ranged between 1/10 to 8/10. Front foot hip joint kinematics of fast bowlers showed highly individualised patterns of movement between different subjects. Medium amplitude movements in the flexion/extension as well as the rotation plane of movement showed a significant difference in bowlers with- and without LBP. No significant differences between groups with LBP and without LBP were found in the three passive hip ROM measurements. Conclusions: It has proved to be very difficult to improve the understanding of the front foot hip biomechanics in cricket fast bowlers due to the high inter-subject variability. Variability in movement patterns remains under-researched by sports biomechanics. Although decreased hip mobility could alter mechanical forces transmitted to the lumbar spine and therefore predispose or be a causative factor in LBP development, this study found no significant relation between these parameters. The sample size was very small in this study which will influence the validity of results. Our study confirmed the high incidence of LBP and preventative efforts for bowlers should therefore be strongly supported. / AFRIKAANSE OPSOMMING: Doelwit: Die doelwit van die studie was om die heupgewrig kinematika van krieket snelboulers beter te verstaan en om vas te stel of daar ‘n verwantskap bestaan tussen heupgewrig biomeganiese parameters, insluitende kinematika, omvang van beweging karakter en lumbale simptome. Studie ontwerp: ‘n Deursneë beskrywende studie is onderneem. Deelnemers: Sestien volwasse manlike snelboulers tussen die ouderdomme van 18 en 40 jaar oud wat eerste liga speel maak deel uit van die studie. Hoof uitkoms maatreëls: ‘n Nuut ontwerpte vraelys is opgestel om data aangaande oefen geskiedenis sowel as aard van lumbale simptome wat deur krieket snelboulers ervaar word in te samel. Die biomeganiese apparaat wat gebruik is vir die analiese van die voorvoet heup omvang van beweging, sowel as die kinematika, sluit in: ‘n twee dimensionele Canon MV950 Digitale Video Camcorder, ‘n Kodak EasyShare C310 kamera en XSENS beweging volgende apparaat (Xsens Technologies B. V., Enschede, Netherlands). Resultate: Agt van die sestien boulers in ons studie het lae rug pyn in die seisoen ervaar. Sewe van die boulers het gepresenteer met onlangse simptome waarvan die meeste na ‘n bouler se boulbeurt ervaar is en beskryf was as ‘n “styfheid” of “steekpyn” in die lae rug. Die intensiteit van die lae rug pyn het gewissel tussen 1/10 en 8/10. Voorvoet heup kinematika van snelboulers het hoogs individualistiese patrone van beweging getoon tussen verskillende deelnemers. Medium amplitude bewegings in die fleksie/ekstensie sowel as die rotasie plein van beweging het ‘n beduidende verskil tussen boulers met- en sonder lae rug pyn getoon. Geen beduidende verskille tussen die groep met- en sonder rugpyn is gevind met die drie passiewe heup omvang van beweging meetings nie. Gevolgtrekkings: Dit blyk baie moelik te wees om die voorvoet heup biomeganika in krieket snelboulers beter te verstaan a.g.v. die hoë inter-deelnemer veranderlikheid. Veranderlikheid in bewegings patrone is nog nie genoeg nagevors deur sport biomeganici nie. Alhoewel ingekorte heup mobiliteit meganiese kragte wat deur die lumbale werwelkolom gaan kan wysig, en sodoende die ontwikkeling van lae rug pyn kan predisponeer of ‘n oorsakende faktor kan wees, het hierdie studie nie ‘n beduidende verwantskap tussen die parameters gevind nie. Die steekproef groote was baie klein en dit sal die geldigheid van die resultate beïnvloed. Ons studie het die hoë insidensie van lae rug pyn bevestig en pogings tot voorkomende maatreëls moet daarom ten sterkste ondersteun word.

Title: Rehabilitation of Child with Cerebral Palsy in the Preoperative and Postoperative Period Author: Renata Šmídová Objective: During my practice I have met with a number of pediatric patients affected by cerebral palsy who underwent corrective orthopedic surgery, which in some cases were unfortunately unsuccessful. Based on the initial acquisition of information on this issue, I found a number of studies and articles on the success of orthopedic surgery in cerebral palsy. In many studies point out that the proper choice of physiotherapy has great benefit for orthopedic intervention, so I decide to map a connections orthopedic and physiotherapy approaches on the case and describe the elements of rehabilitation used in the treatment of selected patient. In the first part of the thesis I process in detail neurological disorder cerebral palsy (CP) and surgical treatment of deformities resulting from the operation of this disease. The second part includes a case study that describes the rehabilitation work of the physiotherapist with a child patient who undergoes corrective surgery on the lower limb. The third section contains qualitative research, conducted on the parents. Using the survey was to determine the effect of parents' opinion and the whole course of therapy. The aim: Demonstrate the...