Objective. To examine the feasibility of a home-based, video therapeutic exercise program on pain, fatigue, self-efficacy, and health status in fibromyalgia patients. Methods. Nine individuals who were previously diagnosed with fibromyalgia completed the study (out of an initial pool of 31). Subjects were randomly assigned to one of two groups: a group who received a home-based therapeutic exercise video and a control group who continued to undergo their current standard of care or "treatment-as-usual." The video group was instructed to conduct the exercises as prescribed in the 42-minute video at least 3 times per week for 4 weeks. The treatment-as-usual control group was instructed to continue to undergo their current standard-of-care and to not begin any new treatments during that time. Instruments measuring self-efficacy, pain, fatigue, self-rated health status and health distress were administered at baseline and 4 weeks. Results. None of the variables analyzed showed a significant change between the treatment and control groups over the course of the 4-week study. Conclusion. This study was not sufficiently powered to detect differences between the two groups. However, several of the treatment group participants subjectively indicated that they found the exercises to be helpful in the management of their fibromyalgia symptoms and the program did not exacerbate any of their symptoms. With this information, it appears that patients are able to tolerate the treatment and are able to complete the outcome measures. Between-group clinical outcomes will now need to be assessed in a larger clinical trial.

Therapeutic exercise has previously been shown to alter the static height of the medial longitudinal arch (MLA). It is still unknown, however, if these effects carry over into dynamic activities. PURPOSE: To determine if an 8-week foot strengthening exercise program increases static arch height and reduces vertical deformation of the MLA during mid-stance in running.METHODS: Thirty-four recreational runners (17 males, 17 females) have completed this ongoing study (age 24.06 ± 3.61 years, body mass 68.63 ± 12.95 kg, and height 173.34 ± 9.54 cm). To date, 22 subjects have been assigned to the control group (8 weeks of normal running) and 12 to the foot strengthening group (8 weeks of foot strengthening, along with normal running). Static arch height (SAH) and dynamic arch drop (DAD) were measured at baseline and following the 8-week intervention using Vicon motion analysis. Reflective markers were placed on the proximal and distal ends of the 1st and 5th metatarsals. These 4 markers were recorded in static double leg stance to estimate SAH, and in single leg mid-stance to give a measure of DAD during treadmill running at a self-selected pace. Ten-second trials were recorded at minutes 3 and 4 during running and DAD was evaluated for right and left feet by comparing arch height in mid-stance to the SAH. Following the intervention, data for SAH and DAD were compared across time points and statistical analysis performed to identify differences in the amount of change in SAH and DAD between groups. RESULTS: There was no difference noted in DAD between the groups as a whole, but the change in DAD from baseline to the end of week 8 was statistically significant for those in the foot strengthening group with an initial DAD of ≥ 3.80 mm (p < .028). There was also a statistically significant increase in SAH in the foot strengthening group compared to the control group (p = .013). CONCLUSIONS: These preliminary data suggest that the foot strengthening intervention was effective in increasing SAH compared to the control group. The intervention was most effective at decreasing DAD in those with the largest amount of DAD at baseline. At this time it is unknown whether this decrease in arch drop is associated with performance benefits or decreased injury risk in the recreational runner, and further research is needed to determine the clinical significance of these findings.

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INTRODUCTION: While strengthening and aerobic exercise have been shown to decrease chronic knee and hip pain, little is known about the effectiveness of Egoscue corrective exercises, which are intended to reduce musculoskeletal pain by bringing the body into postural alignment. PURPOSE: An experimental study to determine the acute effect following one treatment and the short-term effect after a 2 week program of Egoscue corrective exercises on knee pain, hip pain, and whole-body postural alignment. METHODS: Forty participants with chronic knee and/or hip pain (defined as pain on most days of the week for at least the previous 12 weeks) were randomly assigned and equally divided between an exercise group (n = 20) and a control group (n = 20). The exercise group completed a corrective exercise routine, as per the Egoscue Method, at least 5 d/wk for two weeks. The control group simply maintained their current lifestyle for the 2-week duration of the study. All participants kept a daily log of their average pain levels at rest and during movement using a Visual Analog Scale (VAS). Standing posture was assessed using PostureScreen Mobile® and pain and function were recorded using the Western Ontario and McMaster Universities Arthritis Index (WOMAC) at baseline and at the end of week 1 and 2. RESULTS: The exercise group experienced a significant decrease in pain during everyday movement as reported in daily VAS logs (p = 0.019). After controlling for age, BMI, past surgeries, arthritis status, and location of pain, there was a significant group x time interaction in WOMAC scores (p = 0.015). At week 2, WOMAC scores were significantly lower in the exercise group (p = 0.001) but not the control group (p > 0.05). Pain was not significantly different after one treatment. No significant changes in posture were observed in this study. CONCLUSION: Two weeks of corrective exercises significantly decreased knee and hip pain and improved function. Although an observable change in posture was not detected, further research is warranted to investigate the effects of Egoscue corrective exercises on posture over longer periods of time.

Musculoskeletal disorders are a considerable burden to the individual and the society at large. Therapeutic exercise and psychosocial interventions are longer-term therapies for relieving pain, improving function and outcomes after musculoskeletal disorders, and for enabling patients to manage their conditions. Healthcare professionals such as physiotherapists and occupational therapists widely use therapeutic exercise as part of a single or complex intervention. However, adherence to supervised or home exercise remains low among patients with musculoskeletal disorders. Understanding the barriers and facilitators of exercise adherence has the potential to improve the delivery of exercise programs and the design of interventions to improve adherence. Similarly, psychosocial interventions are recommended as a supplement to exercise therapy for the management of prolonged pain and disability after musculoskeletal disorders. Several psychosocial factors have been linked to prolonged pain and disability after hand injuries. However, while clinicians believe they have a role in managing psychosocial problems in hand therapy, barriers such as limited access and lack of knowledge pose a challenge to delivering psychosocial interventions. Current evidence shows that online-based coping skill programs provide cost-effective and accessible options for delivering psychosocial interventions in musculoskeletal care. However, there is a dearth of literature on the design, development, and implementation of online-based psychosocial interventions in hand therapy. This thesis includes four manuscripts with three overarching objectives. The first objective was to synthesize the qualitative evidence on barriers and facilitators of therapeutic exercise towards closing the gaps in adherence literature. The second objective was to understand the beliefs, attitude, knowledge and practice behavior of clinicians with regarding to managing psychosocial problems in hand therapy. The third objective was to provide a report on the design and development of a web-based coping skill training program for psychosocial problems specific to hand therapy. The fundamental aim is to provide toolkits that can be used to increase the knowledge and clinical practice behavior of physiotherapists and occupational therapists to optimize musculoskeletal health using therapeutic exercise and psychosocial interventions. The second and third manuscripts are a protocol and completed meta-synthesis of qualitative literature outlining the factors influencing adherence to therapeutic exercise in individuals with musculoskeletal disorders from the perspective of patients and healthcare professionals. We identified numerous factors influencing adherence to therapeutic exercise, which were organized according to the World Health Organization (WHO) multidimensional adherence framework. Based on the meta-ethnography line of argument, interpretation of identified themes: personal and lifestyle characteristics, health status and illness perception, nature of the program, health system, and social/environmental resources, showed that while some factors interact, others could be conceptualized as being on a continuum. These findings expanded the original model introduced by the WHO. The fourth manuscript presents a qualitative descriptive study designed to understand the knowledge, attitude, beliefs, and practice behavior of hand therapists practicing in Ontario with regards to psychosocial problems. The findings informed by the Theoretical Domains Framework provide insights into factors influencing the decision of clinicians to assess and manage psychosocial interventions in hand therapy. Addressing factors such as knowledge, attitudes, and beliefs about psychosocial factors at the individual and organizational level has the potential to increase the capacity of clinicians to adopt a clinical practice behavior that promotes the assessment and management of psychosocial problems in hand therapy. The fifth manuscript is a mixed-methods study describing the design, development, and usability testing of Hand Therapy Online COping Skills (HOCOS) training online program to support hand therapists in the management of psychosocial problems. Using a three-step process that involved needs assessment, heuristic testing, and user testing, we sought feedback from Information and Communication Technology experts and clinicians in hand therapy to develop the HOCOS prototype using iterative cycles. The results revealed heuristic violations and usability related to task performance, navigation, design aesthetics, content, functionality, and features and desire for future use. All violations were corrected in the final prototype, and participants expressed a high degree of satisfaction with using the final prototype in practice. The next phase of HOCOS design would require user testing by patients with hand injuries. / Thesis / Doctor of Philosophy (PhD) / Bone and joint injuries are very common in orthopedic practice and massive burden to individuals and society at large. Many patients are given exercises as part of their treatment to reduce pain and improve function. Unfortunately, many individuals continue to struggle with attending therapy sessions and doing exercises by themselves. Starting and continuing exercises are required to maximize the benefits from exercise recommendations. However, many barriers continue to make exercising a challenge. Research is needed to identify the challenges of starting and continuing exercises from the perspectives of both patients and healthcare professionals. In some situations, some patients with bone and joint injuries such as hand injuries continue to have pain and reduced function even after the original injury has healed. The weak relationship between the initial injury and present experience of pain and reduced function means other reasons like the mental, emotional, and social factors need to be considered in clinical practice. Healthcare professionals have reported several difficulties when dealing with psychosocial problems and want to learn strategies and skills for dealing with the mental, emotional, and social challenges affecting recovery after injuries to bones and joints. The use of the web-based coping skills training for managing psychosocial problems in individuals with bone and joint conditions has shown positive results. However, these strategies are yet to be explored in individuals with injuries to the hand and upper limb. This thesis includes four papers with the first two papers aimed at examining the literature on adherence to therapeutic exercise. Findings from these papers showed the interactions among the five factors influencing adherence to exercise according to the World Health Organization’s model: patient, health condition, treatment plan, health system, and socioeconomic factors. The third paper sought to understand the opinion of clinicians working in hand therapy about the mental, emotional, and social issues of patients. The result showed that participant’s beliefs, attitudes, knowledge and behavior concerning the assessment and management of psychosocial issues are shaped by several factors organized into six themes. The final paper reports on the steps involved in the making of a new internet coping skill program developed for use in individuals with hand and upper limb conditions. Review of the website by technology experts and clinicians showed areas for improvement which were subsequently amended until the participants reported satisfaction with the system. The clinicians expressed interest in using the online coping skill program in their hand therapy practice.

Alzheimers sjukdom är vanlig sjukdom i Sverige och övriga världen där symptombilden har en negativ inverkan på personens livssituation. Syftet med studien var att belysa vilka positiva effekter fysisk aktivitet har hos patienter med Alzheimers sjukdom. Studien genomfördes som en litteraturstudie och var grundad på 15 vetenskapliga artiklar. Resultatet indelades i tre huvudkategorier, påverkan på sinnesstämning, förbättrade kognitiva funktioner och förbättrad fysisk förmåga. Genom att utöva fysisk aktivitet förbättrades sinnesstämningen hos patienterna vilket visade sig genom att de blev mindre rastlösa, agiterade och oroliga. Psykofarmakaförbrukningen reducerades och patienterna kände sig mindre nedstämda efter att ha deltagit i fysiska övningar. Den kognitiva funktionen hos patienterna förbättrades, likaså förmågan att utföra den allmänna dagliga livsföringen. Genom fysisk träning blev patienterna rörligare, flexiblare, starkare, snabbare och de fick bättre balans. Resultatet visade att utövandet av fysisk aktivitet har olika positiva effekter hos patienter med Alzheimers sjukdom. Vidare forskning skulle kunna inrikta sig på vilken betydelse regelbunden träning har för att uppnå en positiv effekt av träningen. Patienter med Alzheimers sjukdom har lika stort behov av fysisk aktivitet som övriga befolkningen, det är därför betydelsefullt att patienternas behov av aktivitet uppmärksammas av sjuksköterskan. / Alzheimer´s disease is a common disease in Sweden and in rest of the world. The symptoms have a negative impact on the person's life situation. The purpose of this study was to investigate the positive impact of physical activity in patients with Alzheimer's disease. The study was conducted as a literature review and was based on 15 scientific articles. The results were divided into three main categories, the effect on mood, improved cognitive function and improved physical ability. The patients’ moods were improved by participation in physical activities and they became less restless, agitated and anxious. The consumption of psychotropic drugs was reduced and the patients felt less depressed after taking part in physical exercises. The cognitive function of patients improved, likewise the ability to perform the activities of daily living. The patients who participated in physical exercises became more mobilized, more flexible, stronger, faster, and they improved their balance. The results showed that physical activity has different positive impacts on patients with Alzheimer´s disease. Additional research could focus on what impact adherence has for achieving a positive effect of physical activity. Patients with Alzheimer’s disease have equal needs of physical activity as other people, therefore it´s important that nurses are aware of the patients’ needs for activity.

Ohälsa i form av stress har tilltagit under de senaste decennierna. Detta har lett till en ökning av antalet individer som årligen drabbas av sjukdomen utmattningssyndrom. Detta syndrom har nyligen accepterats som en egen diagnos men har ännu ingen konkret behandlingsmetod. En del av behandlingen kan utgöras av fysisk aktivitet. Trots detta ger inte alltid fysisk aktivitet önskvärd effekt. Detta kan till viss del bero på svårigheten att uppnå balans för individer med denna diagnos. Syftet med litteraturstudien är att beskriva individens upplevelse av fysisk aktivitet som behandling vid utmattningssyndrom. Författarna har valt att göra en litteraturstudie byggd på tolv artiklar av både kvalitativ och kvantitativ ansats. Detta för att utöka kunskapen inom området. Två kategorier identifierades utifrån artiklarna: “Att leva med utmattningssyndrom” och “Fysisk aktivitet som behandlingsmetod vid utmattningssyndrom”. Nämnda kategorier belyser bland annat svårigheter i nivåanpassning av fysisk aktivitet.  Resultatet visar att om aktiviteten inte individanpassas kan detta resultera i försämring av sjukdomen.

Background: The use of manual therapy for the management of lumbar spinal stenosis (LSS) has not been adequately systematically reviewed in an attempt to determine its effectiveness on patients with LSS. The lack of evidence in support ofcommonly used conservative interventions continues to result in a lack of clarity regarding what interventions should be used to manage patients with LSS. Objective: To use a randomized comparative trial to compare the functional clinical outcomes achieved by patients with LSS receiving two different physical therapy interventions. Methods: In this randomized controlled trial, a total of40 participants diagnosed with LSS were randomized into two groups. Both groups received 6 weeks of treatment. Participants assigned to group 1 (EX Group) received impairment-based exercises. Participants assigned to group 2 (EXMT Group) received impairment-based exercises as well as manual physical therapy techniques. The evaluation parameters included (1) McGill Pain Questionnaire, (2) the original version of the Oswestry Low Back Pain Disability Questionnaire (ODQ), (3) double inclinometer measurement for measuring thoracolumbar flexion and extension, (4) self-pace walking test, (5) hip abductor and extensor strength, and (6) hip external rotation and extension range of motion. All participants were evaluated before starting treatment, once at the end of 6 weeks of treatment, and again at 6 weeks following the completion of treatment. Results: In terms of overall treatmentefficacy, there were notable improvements observed over time regardless of treatment group. Results indicated significant improvement in perceived disability using ODQ in the EXMT treatment group in comparison to the EX group at follow-up. For the EXMT group, there were notable improvements in comparison to the EX group in multiple objective functional improvement measures. Conclusion: Results of this study suggest that a multimodal approach using manual therapy and therapeutic exercises is an effective treatment option for providing clinically significant short-term reduction in back pain and disability, as well as improvements in back mobility in patients with LSS. Physical therapists should strongly consider the impairment-based approachof manual therapy and specific exercises program for lumbar spine and hips as a treatment option for patients with lumbarspinal stenosis.

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