Sammanfattning: Introduktion: Hos äldre leder fall ofta till nedsatt funktion och ökad rädsla för att falla igen. Träning av balans och muskelstyrka har visat sig vara den åtgärd som bäst förebygger fall i åldersgruppen. Appen MinBalans är ett självtest under utveckling för att äldre ska kunna mäta sin balans och benstyrka med en mobiltelefon. Användbarhetstester är viktiga under utvecklandet av appar, särskilt gällande självtester då appen används på egen hand.   Syfte: Syftet med studien var att utvärdera användbarheten av en prototyp av appen MinBalans med avseende på testinstruktioner och genomförande.   Metod: Kvalitativ och kvantitativ metod tillämpades. Användartester av appen, innehållande balanstest och benstyrketest, gjordes på sju deltagare över 70 år. Observationer med Think aloud-metoden, semi-strukturerade intervjuer och System Usability Scale (SUS) användes. Resultaten analyserades genom en deskriptiv sammanställning av observationsprotokoll och SUS-mätning. En tematisk analys gjordes utifrån intervjuerna samt film- och ljudinspelningar av observationerna.   Resultat: Den tematiska analysen resulterade i två teman; Kognitiv utmaning och Otydligheter i appen. Vanligt förekommande problem var att minnas allt från instruktionsfilmerna och att navigera i appen. Observationsprotokollet påvisar en inlärningsfaktor och att alla deltagare klarade 45% av uppgifterna utan problem. SUS-mätningen tyder på en bra användbarhet av appen.   Slutsats: Äldre upplever användandet av MinBalans som positivt och med viss hjälp klarar de av att utföra självtest av balans och styrka. MinBalans kan vara möjlig att använda på egen hand då användaren möjligges en inlärningsperiod. Efter ändringar av främst navigering i appen och information i filmerna är det möjligt att appen kan vara användarvänlig från start.

Introduktion: Fysioterapeutiska interventioner har effekt för att minska smärtintensitet och bidra till förbättrad kroppsmedvetenhet hos patienter med långvarig smärta. Ingen fysioterapeutisk intervention har visat sig vara mer effektiv än någon annan för att minska smärtintensitet. Inkludering av behandlingsmål och fokus på livskvalitet kan bidra till förbättrade behandlingsresultat. Syfte: Syftet med studien var att utvärdera om det finns skillnader i hur patienter med långvarig smärta självskattar måluppfyllelse, upplevd smärta och livskvalitet efter olika fysioterapeutiska interventioner. Metod: En tvärsnittsstudie med enkät som datainsamlingsmetod. Primärt utfallsmått var måluppfyllelse (GAS), sekundära utfallsmått var smärta (NRS) och livskvalitet (SF-36). Interventionsgrupperna delades in i; Basal kroppskännedom (BK), Joanne Elphinstone Movement Systems (JEMS), gymträning, stabilitetsträning och annat. Resultat: Fyrtiosex deltagare (78% kvinnor) rekryterades konsekutivt via distriktsrehabiliteringsenheterna alternativt via brev. Medelålder 53 år (SD ±16). En smärtduration på 1-5 år var vanligast förekommande i hela studiepopulationen. Ingen statistiskt signifikant skillnad mellan interventionsgrupperna påvisades vid analys med Kruskal-Wallis H-test. Skattningarna visade på högst skattad måluppfyllelse hos interventionsgruppen BK. Högst skattat medianvärde av allmänna hälsouppfattningar hos interventionsgruppen gymträning. Högst skattat medianvärde av genomsnittlig smärta hos interventionsgruppen JEMS. Slutsats: Studien påvisade inga statistiska skillnader mellan interventionsgrupperna men en viss variation i utfallen. Framtida större studier vore önskvärt för att verifiera resultaten i denna studie.

Magister Scientiae (Physiotherapy) - MSc(Physio) / BACKGROUND: Access to basic health care services through the primary health care (PHC) settings, was affirmed as a fundamental human right by the World health organisation (WHO) in 1978 in Alma Ata (Kazakhstan). Internationally, interdisciplinary collaboration among health care professionals (HCPs) have been the preferred approach to addressing the health and psychosocial needs of the populace. The PHC being the first point of contact for most Nigerians and the cornerstone of health care policies in Nigeria, covers promotive, preventative, curative and rehabilitative services. Although, Physiotherapy has ideally qualified personnel to contribute to the attainment of the goals and objectives of the PHC policies, these services are mostly carried out by other HCP’s subdivided as clinicians (medical doctors, dentists, nurses/midwives, optometrists, pharmacists, radiographers, laboratory scientists) and clinical assistants (pharmacy technicians, radiography technicians, laboratory technicians and community health extension workers). Physiotherapy services are mostly concentrated at tertiary and secondary health care settings. AIM: To determine the awareness and explore the perceptions of clinicians and clinical assistants employed in the type 3 primary health care (PHC) settings of Rivers East Senatorial district of Rivers State, Nigeria, regarding the roles of Physiotherapy in a PHC setting.

Orientador: Ismael Forte Freitas Júnior / Banca: Henrique Luiz Monteiro / Banca: Yeda Aparecida de Oliveira Duarte / Resumo: verificar a relação entre hipertensão arterial e fatores de riscos cardiovascular isolados e aglomerados em idosos com 80 anos ou mais de Presidente Prudente - SP. Metodologia: Foram investigados 113 indivíduos com idade entre 80 e 95 anos, com média de 83,4+2,9 anos, de ambos os sexos. Para os fatores de risco cardiovascular foram utilizados a Circunferência de Cintura (CC), o Índice de Massa Corporal (IMC), a porcentagem de gordura total, mensurada por meio do DEXA, a HA foi aferida por meio do aparelho automático(Omron Healthcare) e perfil lipídico por meio da análise bioquímica do plasma. Foi aplicado um questionário de morbidade referida para verificar presença/ausência de HA. Foi empregado a análise de Regressão Logística por meio do Odds ratio para verificar a força de associação. As análises estatísticas foram realizadas por meio do software estatístico SPSS versão 13.0 ... (Resumo completo, clicar acesso eletrônico abaixo) / Abstract: The objective of this study was to identify which cardiovascular risk factors are the most frequent in a Brazilian sample of subjects aged 80 years or older.Methods:The sample was composed of 113 individuals aged 80 to 95 years(83.4+2.9 years) of both sexes. Waist circumference(WC), body mass index(BMI), percentage of total body fat(%BF), hypertension(AH) and lipid profile were used for characterization of cardiovascular risk factors(CRF). The chi-square test was used to assess proportions of CRF observed in the sample and Student's t test was applied to compare the results between sexes. Statistical analysis was performed using SPSS, version 17.0. The significance level was set at 5%.Results:We observed high prevalence of CRF, mainly AH(67.3%) and %BF(79.6%). Male subjects presented higher statistical values for weight, height and WC(p<0.001), and female higher TC and %BF(p<0.001). It is found that 7.1% of male and 4.2% of female showed no CRF, and 71.3% of male and 85.9% of female had three or more CRF ... (Complete abstract click electronic access below) / Mestre

<p>Validerat; 20101217 (root)</p>

Bakgrund: Elever som studerar vid alpina skidgymnasium i Sverige löper en ökad skaderisk under sin studietid och då framförallt i de nedre extremiteterna. Det visar sig även att de elever som skadar sig får mentala konsekvenser till följd av skadan till exempel i form av identitetsförlust eller utanförskap. Syfte: Syftet med studien var att utforska och beskriva hur ungdomar, som studerar på svenska alpina skidgymnasium upplever utbildningens preventiva åtgärder för att undvika, samt minska antalet skador vid träning och tävling för eleverna. Metod: Studien är en kvalitativ intervjustudie. De intervjuer som gjordes utfördes var semistrukturerade. För att rekrytera informanter togs kontakt med ett alpint skidgymnasium som författarna tilläts besöka och genomföra studien på. Efter genomförda intervjuer analyserades materialet med en kvalitativ innehållsanalys. Resultat: Analys av datamaterialet resulterade i två huvudkategorier: Skadeprevention från utbildningen, Upplevelser ur elevens perspektiv. Samtliga huvudkategorier har egna underkategorier. Konklusion: Analysen av materialet visade att informanterna upplevde att det fanns ett behov av att öka det skadepreventiva arbetet från utbildningens sida för att kunna minska riskerna för skador.

Background: Non-specific low back pain is a growing problem in society. No treatment have shown satisfying results to reduce pain or disability for patients with non-specific low back pain, and 1-18% of these patients develop chronic low back pain. STarT Back Screening Tool (SBST) is an instrument for sub grouping patients with non-specific low back pain into low, medium or high risk of developing chronic low back pain and then modifying the treatment after the different needs of every patient. The purpose of this study was to do a systematic review, investigating validation of the SBST to evaluate the justification of its use by clinicians. Method: Pubmed, Cinahl and Medline was searched in February 2017 for studies investigating criterion validity, construct validity and content validity of the SBST. The author (JG) assessed risk of bias and extracted relevant data following the procedures of PRISMA-statement. Result: 15 articles were identified for inclusion in the review. 8 articles investigated criterion validity, 11 articles investigated construct validity and 1 article investigated content validity. Predictive validity showed heterogeneous statistical analysis and varying results, a narrative result was presented that showed marginal benefits for the use of SBST for prediction of future outcome. Concurrent validity was measured with Spearman’s rank correlation coefficient in all investigated articles, showing results between 0.34-0.802. Discriminant validity was measured with Area under the curve analysis in all articles, scoring between 0.69-0.92. Convergent validity showed a Pearson’s correlation between 0.708-0.811 and a Spearman’s rank correlation between 0.35-0.74. Conclusion: Because of heterogeneity of the results it is not possible to draw conclusive conclusions. However, results tend to show limited evidence for the use of SBST as a predictive instrument for patients with non-specific low back pain.

Background: Ventilator-associated pneumonia is a major cause of morbidity and mortality for patients in an intensive care unit. Once present, ventilator-associated pneumonia is known to increase the duration of mechanical ventilation, time in the intensive care unit, and length of hospital stay. Patients with acquired brain injury are commonly admitted to the intensive care unit and considered to be at a high risk for the development of respiratory complications such as ventilator-associated pneumonia, which could potentially impact on the intensive care unit costs and outcomes. Respiratory physiotherapy is often provided to prevent and/or treat ventilator-associated pneumonia in patients with acquired brain injury. The theoretical rationale of the respiratory physiotherapy is to improve airway clearance and enhance ventilation which may reduce the incidence of pulmonary infections and thus ventilator-associated pneumonia, and may in turn decrease the duration of mechanical ventilation, prevent the need for tracheostomy and hence result in reduced costs and shorter hospital stay. Although respiratory physiotherapy may be beneficial in reversing or preventing ventilator-associated pneumonia, to date there are no data concerning the effectiveness of respiratory physiotherapy in patients with acquired brain injury. Hence from an evidence-based perspective, at present there is no justification for the role of respiratory physiotherapy in the management of patients with acquired brain injury in the intensive care unit. Aim: This two-part, prospective randomised controlled trial aimed to investigate the effect of regular prophylactic respiratory physiotherapy on the incidence of ventilator-associated pneumonia, duration of mechanical ventilation, and length of intensive care unit stay in adults with acquired brain injury, as compared to a control group (Part A). / The second part of the study (Part B) randomised those subjects from Part A who developed a ventilatorassociated pneumonia into a treatment or control group to establish if the provision of a regimen of regular respiratory physiotherapy influenced the outcome of ventilator-associated pneumonia. Additionally, this study also aimed to provide the first description of the financial costs of respiratory physiotherapy time in providing interventions to patients with acquired brain injury in the intensive care unit and investigated the cost effectiveness of respiratory physiotherapy interventions in decreasing the incidence of ventilator-associated pneumonia, duration of mechanical ventilation and length of intensive care unit stay. Subjects: 144 adult patients with acquired brain injury admitted with a Glasgow Coma Scale of nine or less, requiring intracranial pressure monitoring, and invasive ventilatory support for greater than 24 hours, were randomised to a treatment group or a control group. Methods: For subjects randomised to the treatment groups, the regimen of respiratory physiotherapy treatment was repeated six times per 24-hour period and continued until the subject was weaned from mechanical ventilatory support. Each respiratory physiotherapy intervention of 30 minute duration comprised a regimen of positioning, manual hyperinflation and suctioning. In both Parts A and B, the control group received standard nursing and medical care but no respiratory physiotherapy interventions. Results: Consent was obtained for 144 subjects, with 72 randomised for treatment in Part A. Part A groups were comparable with respect to demographic variables, with the exception of body mass index and gender distribution. / Using intention to treat philosophy, there were no significant differences for incidence of ventilator-associated pneumonia [Treatment Group 14/72 (19.4%) vs. Control 19/72 (26.4%); p = 0.32], duration of mechanical ventilation (hr) [172.8 vs. 206.3); p = 0.18], or length of intensive care unit stay (hr) [224.2 vs. 256.4; p = 0.22]. For subjects with acquired brain injury receiving this prophylactic regimen of respiratory physiotherapy in the intensive care unit, in an attempt to prevent ventilator-associated pneumonia, the cost of physiotherapy was $487 per subject. Comparatively the intensive care unit mechanical ventilation bed day cost was $33,380 per subject. The cost of Part A respiratory physiotherapy time for Treatment Group 1 was 1.7 per cent of the cost of subject's intensive care unit mechanical ventilation bed days. Thirty-three subjects (22.9%) from Part A developed ventilator-associated pneumonia, and were transferred to Part B and re-randomised, 17 to the Treatment Group 3. Part B groups were comparable with respect to demographic variables. No significant differences were detected in the dependent variables for Part B of the study, with similar duration of mechanical ventilation (hr) [342.0 vs. 351.0); p = 0. 89], and length of ICU stay (hr) [384.7 vs. 397.9; p = 0.84] noted. In those subjects with acquired brain injury in whom ventilator-associated pneumonia developed, the regimen of respiratory physiotherapy for the remaining duration of mechanical ventilation following diagnosis of ventilator-associated pneumonia costed an average of $788. Comparatively the intensive care unit bed day cost for the period of mechanical ventilation was $43,865. The cost of Part B respiratory physiotherapy time for Treatment Group 3 was 1.8 per cent of the cost of their intensive care unit mechanical ventilation bed days. / Subjects with a ventilator-associated pneumonia were significantly younger, were admitted with a lower Glasgow coma scale, and more likely to have been admitted with a chest injury than subjects without a ventilator-associated pneumonia. Duration of mechanical ventilation and length of intensive care unit stay were significantly increased in subjects with ventilatorassociated pneumonia, but length of hospital stay was not significantly different. Significant differences in the costs of respiratory physiotherapy and intensive care unit mechanical ventilation bed day costs were evident between those subjects with ventilator-associated pneumonia as compared to those without ventilator-associated pneumonia. For subjects with ventilator-associated pneumonia, the respiratory physiotherapy time cost was $1,029 per subject, compared to $510 for subjects without ventilator-associated pneumonia. The intensive care unit mechanical ventilation bed day cost for subjects with ventilator-associated pneumonia was $61,092 per subject, and $25,142 for those without a ventilator-associated pneumonia, giving an incremental health cost of $35,950 per episode of ventilatorassociated pneumonia. No significant differences were evident in the cost of respiratory physiotherapy as a per cent of the cost of their intensive care unit mechanical ventilation bed days, with findings of 1.4 per cent in those with ventilator-associated pneumonia and 1.1 per cent in those without ventilator-associated pneumonia. / Conclusion: Use of a regular prophylactic respiratory physiotherapy regimen comprising of positioning, manual hyperinflation and suctioning, in addition to routine medical and nursing care, did not appear to prevent ventilator-associated pneumonia, reduce length of ventilation or intensive care unit stay in adults with acquired brain injury. Furthermore, in those acquired brain injury subjects with ventilator-associated pneumonia, regular respiratory physiotherapy did not appear to expedite recovery in terms of reducing length of ventilation or intensive care unit stay. It can be concluded from the findings of this study that the presence of ventilator-associated pneumonia has a significant influence on morbidity and costs in subjects with acquired brain injury. Whilst statistically significant results were not found with clinical variables, it is suggested that the provision of a prophylactic respiratory physiotherapy regimen costing $487 per subject is a worthwhile investment in attempts to avoid the incremental health cost of $35,950 per episode of ventilator-associated pneumonia. In subjects with ventilator-associated pneumonia it is concluded that the cost of respiratory physiotherapy would not appear to be justified in attempts to reduce the duration of mechanical ventilation.

The aim of this study was to evaluate the effect of participation in the Otago Exercise Programme (OEP) on strength and balance. The change in a number of balance and strength measures were compared between a group of community dwelling women over the age of 80 years participating in the OEP and a control group matched by gender and age.Study design: A cohort study of two independent groups.Participants: Nineteen women over the age of 80 years who were community dwelling and participating in the OEP and 18 age matched community dwelling women who continued with their normal activities of daily living.Main outcome measures: Participants' strength and balance was measured using the timed up and go test, the step test, the 30 second chair stand test and gait velocity. Participants' fear of falling was measured with the Modified Falls Efficacy Scale and falls were monitored using a falls diary.Results: There were no statistically significant improvements in strength and balance in the OEP group and no statistically significant differences between the OEP and control group, after participating in the OEP for 6 months. The only statistically significant change in the OEP group was a slowing of gait velocity, all other outcome measures remained unchanged for both the OEP group and the control group.Conclusions: There were no statistically significant improvements in strength and balance after participating in the OEP. These results are consistent with those of the original Otago trial and the subsequent meta-analysis of all the Otago trials. The results from this study need to be interpreted with caution, as due to the small sample size the study was underpowered. The critical components of the OEP remain unknown.

Emergency on-call duties have been highlighted as a key stress factor in newly qualified physiotherapists whose job performance may be affected. The concept of stress relating to on-call work, the general lack of interest or confidence in the respiratory on-call field, and subsequent difficulties with recruitment and retention, pose a difficult problem for managers of services responsible for the maintenance of a competent workforce and a high standard of service provision. Differences in novice and expert physiotherapists’ patient management and clinical reasoning strategies have been previously examined in orthopaedic, neurology, domiciliary and cardiorespiratory fields. However, no such investigations have been undertaken in the field of emergency on-call. The purpose of this study was to determine if differences existed between novice and expert physiotherapists who had by definition differing levels of context-related experience within the emergency on-call environment. This study also aimed to consider what factors may influence their physiotherapy intervention for an acute cardiorespiratory patient. A purpose-designed vignette-based postal questionnaire was administered to 26 emergency on-call providers in New Zealand. The questionnaire sought demographic data, investigated participants’ attitudes towards emergency on-call service provision and presented a vignette-based clinical scenario which asked questions throughout an evolving clinical case scenario. Analysis was performed using the computer software package for social sciences, SPSS for Windows (version 14), results were analysed using descriptive statistics, and significance testing was performed using non-parametric methods. A good response rate was achieved (78.8%; n = 56). Statistically significant differences between novices and experts were determined in scores for confidence, stress, and support required, also in the factors affecting stress levels. Novices are less confident (p = < .0001), more stressed (p = < .001) and require more support than experts (p = < .001). Factors which influenced both novice, and to a lesser extent, expert stress levels when working as emergency on-call physiotherapists, were established. A relationship was determined between confidence and level of support required (r = -.65; p = < .001); confidence and amount of stress felt (r = -.58; p = < .001); and support required and stress felt (r = .47; p = < .001). Some differences were demonstrated between novice and expert physiotherapists in their answers to a clinical case scenario. Although these were not statistically significant, a trend was noted which may reflect the different clinical reasoning strategies of these physiotherapists. There is a need for novices to gain the type of experience which includes independent problem solving and guided reflection; the use of vignette-based case studies may be one method which could be further exploited. The profession is responsible for the provision of better ways to meet the needs of our future emergency on-call workforce. If this is not achieved, other professional groups will be required to fill the gaps and physiotherapy; particularly cardiorespiratory physiotherapy will lose out.