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.

Made available in DSpace on 2014-12-17T15:39:01Z (GMT). No. of bitstreams: 1 MariannaCMDL_DISSERT.pdf: 1367439 bytes, checksum: d091551e753c01139c7e5672341527aa (MD5) Previous issue date: 2013-05-10 / the Millon Behavioral Medicine Diagnostic is an instrument, developed from a consensus among health professionals, to identify psychological factors that may compromise the conducting of medical treatment in order to allow a better adhesion. As it has been one of the most used tools to assess bariatric surgery, the objective of this research is to verify the evidence validity of Millon Behavioral Medicine Diagnostic (MBMD) for psychological assessment of candidates for bariatric surgery. Method: males and females volunteers, aged 18 to 70, grouped in 150 patients admitted for surgical procedures or suffering from chronic diseases (control group) and 426 patients candidates for bariatric surgery, contacted in person or by the internet. For the study in the face group were also administered Millon Index of Personality Styles (MIPS), the Millon Clinical Multiaxial Inventory-III (MCMI-III) and the General Health Questionnaire of Goldberg, just in bariatric surgery patients. Results: there are indicators of semantic adaptation of the instrument, with 27 factors in five areas of the instrument, all with satisfactory levels of validity. The reliabitity indicators were satisfactory in 18 of the 32 scales that comprise the MBMD, while relations with the other three instruments showed significant variations compared to the original indicators. The MBMD was sensitive to differences between groups about gender, age, education, marital status, body mass index, comorbidities and chronic disease patients and with or without obesity. The use of this instrument in the assessment of candidates for bariatric surgery presents indicators of validity in view the limitations as to the realiability of certain scales / o Millon Behavioral Medicine Diagnostic ? um instrumento elaborado a partir do consenso entre profissionais de sa?de, visando identificar fatores psicol?gicos que venham a comprometer tratamentos m?dicos para que sejam conduzidos de modo a viabilizar uma melhor ades?o. Como tem sido um dos instrumentos mais utilizados para avalia??o em cirurgia bari?trica em outros pa?ses, o objetivo desta pesquisa ? verificar evid?ncias de validade do Millon Behavioral Medicine Diagnostic (MBMD) para avalia??o psicol?gica de candidatos a cirurgia bari?trica. M?todo: volunt?rios dos sexos masculino e feminino, com idades entre 18 a 70, agrupados em 150 pacientes internados para procedimentos cir?rgicos ou portadores de doen?as cr?nicas (grupo controle) e 426 pacientes candidato ? cirurgia bari?trica, contatados presencialmente ou por interm?dio de uma p?gina na internet. Para os estudos tamb?m foram administrados no grupo presencial de bari?trica o Millon Index of Personality Styles (MIPS), o Millon Clinical Multiaxial Inventory-III (MCMI-III) e o Question?rio de Sa?de Geral de Goldberg, apenas nos pacientes de cirurgia bari?trica. Resultados: h? indicadores de adapta??o sem?ntica do instrumento, com 27 fatores em seus cinco dom?nios, todos com ?ndices satisfat?rios de validade. Os indicadores de precis?o se mostraram satisfat?rios em 18 das 32 escalas que comp?em o MBMD, ao passo que as rela??es com os outros tr?s instrumentos apresentaram varia??es importantes se comparados aos indicadores originais. O MBMD se mostrou sens?vel ?s diferen?as entre grupos quanto ao sexo, faixa et?ria, escolaridade, estado civil, ?ndice de Massa Corporal (IMC), presen?a de comorbidades e em portadores de doen?as cr?nicas com e sem obesidade. O uso deste instrumento nas avalia??es de candidatos ? cirurgia bari?trica apresenta indicadores de validade tendo em vista as limita??es quanto ? precis?o de determinadas escalas

The Behavioral Medicine Questionnare (BMQ) is a 44- item instrument administered via a computer CRT display or pencil and paper. The BMQ was designed to help primary care physicians treating spinal disorders to screen for emotional factors which warrant further psychological evaluation. The test is composed of three scales: Anxiety, Depression, and Somatization. Concurrent validity for each scale was determined through comparisons with subject (n = 133) scores on clinician judgement ratings, pain drawings, and the MMPI. The psychometric properties of the test were supported through statistical analysis. Significant correlations were found between the BMQ, MMPI, and clinician ratings, with the latter showing relationships of lesser strength. The only significant correlation to subject generated pain drawings was to the BMQ depression scale. Analysis indicated the need for seperate norms for males and females. Further research is needed to facilitate measurement and interpretation of the BMQ.

No description available.

Långvarig ländryggssmärta är ett vanligt hälsoproblem som innebär omfattande negativa konsekvenser för den som drabbas. Faktorer som tilltro till den egna förmågan (self-efficacy) och copingstrategier anses ha en väsentlig betydelse vid hantering av långvarig smärta. Syfte: Att undersöka sambandet mellan skattad smärta, self-efficacy och copingstrategier hos en grupp patienter med långvarig ländryggssmärta. Metod : 53 patienter i åldern 18-65 år med ländryggssmärta mer än 3 månader besvarade frågeformulär gällande bakgrundsdata, self-efficacy (Self-Efficacy Scale), copingstrategier (Coping Strategies Questionnaire) och smärtintensitet (VAS-skalan). Samband beräknades med Pearsons produktmoment korrelationsmetod. Envägs variansanalys Anova användes för beräkning av skillnader mellan åldersgrupperna. Resultat: Ett negativt samband visades mellan self-efficacy och copingstrategierna avleda  r = -0.36 (p = 0.025), öka beteendeaktiviteter  r = -0.43 (p = 0.006) och smärtbeteende  r = -0.47 (p = 0.003) och ett positivt samband mellan katastroftankar och skattad smärta r = 0.37 (p = 0.022). Hos män sågs ett negativt samband  mellan self-efficacy och  copingstrategierna katastroftankar  r = -0.63 ( p = 0.003), avleda uppmärksamhet  r = -0.55 (p = 0.001), ökande aktivitet  r = -0.58 ( p = 0.007) och smärtbeteende  r = -0.50 ( p = 0.025) samt ett positivt samband mellan self-efficacy och copingstrategin ignorera smärtupplevelser  r = 0.51 (p =0.021). Ålderskillnader framkom där åldersgruppen 18-30 år i högre grad använde copingstrategin be och hoppas (p = 0.049). Konklusion: Det förelåg samband mellan skattad smärta, self-efficacy och copingstrategier hos denna grupp av patienter med långvarig ländryggssmärta . Även könsskillnader samt skillnader mellan åldersgrupperna visades. Resultatet stöder vikten av kunskap om hur smärta, self-efficacy och copingstrategier samvarierar, och vikten av att tidigt identifiera låg grad av self-efficacy och katastroftankar hos patienter med ländryggssmärta.

Bakgrund: Kvinnor har högre sjukfrånvaro än män och inom undersköterskeyrket, som är kvinnodominerat, märks detta tydligare. Det finns därmed anledning att uppmärksamma och kartlägga vad som upplevs främja kvinnors arbetsnärvaro och arbetsförmåga i detta yrke. Syfte: Syftet med studien var att utforska äldre kvinnliga undersköterskors upplevelser av betydelse för bibehållen arbetsförmåga inom kommunal äldreomsorg. Metod: Studien genomfördes som en beskrivande kvalitativ intervjustudie med kvalitativ manifest innehålls-analys. Sex friska undersköterskor mellan 55-58 år i kommunal äldreomsorg valdes genom ändamålsenligt urval till semistrukturerade individuella djupintervjuer. Fynd: Under-sköterskorna har förmåga att identifiera och verkställa egna behov. De gör anpassningar, framför allt i privatlivet, och når välbefinnande genom meningsfull tillvaro. Deras beteende kan kopplas till känsla av sammanhang, empowerment och intern känsla av kontroll. Nio kategorier identifierades: Hälsa och fysisk aktivitet, Fysisk arbetsmiljö, Organisation, Samverkan och kommunikation, Medveten anpassning, Arbetstillfredsställelse, Meningsfull tillvaro, Inställning och attityd samt Samhällsnivå. Konklusion: Det är huvudsakligen aspekter av psykosocial karaktär, med inslag av fysisk aktivitet, som upplevs främja arbets-förmåga hos de kvinnliga undersköterskorna. Fynden kan skapa underlag för hälsostödjande arbete där ett beteendemedicinskt synsätt kan vara av värde för förståelsen av hur biopsyko-sociala faktorer samverkar för bibehållen arbetsförmåga. / Background: Women have higher sickness absence rates than men especially within the female dominated profession of assistant nurses. Hence, there is reason to draw attention to and identify what is perceived to promote women’s work attendance and work ability within this profession. Aim: The aim of the study was to explore older female assistant nurses’ experiences of importance for the maintenance of work ability in municipal elderly care. Methods: A descriptive qualitative interview study was conducted and analysed with qualitative manifest content analysis. Six healthy assistant nurses between 55-58 years in municipal elderly care were selected through purposive sampling for semi-structured in-depth interviews. Findings: The assistant nurses are able to identify and implement needs of their own. They adapt, mainly in the private life, and achieve well-being through a meaningful existence. Their behavior can be linked to sence of coherence, empowerment and internal locus of control. Nine categories were identified: Health and physical activity, Physical work environment, Organisation, Collaboration and communication, Intentional adaptions, Work satisfaction, Meaningful existence, Preference and attitude and Societal level. Conclusion: Mainly aspects of psychosocial nature, with elements of physical activity, are perceived to promote work ability by the female assistant nurses. The findings can contribute to form a basis for promotional work where a behavioral medicine approach can be of value in the understanding of how biopsychosocial factors interact for the maintenance of work ability.

Submitted by Automa??o e Estat?stica (sst@bczm.ufrn.br) on 2015-12-01T20:35:38Z No. of bitstreams: 1 BrendaLuannaFernandesCortesDantas_DISSERT.pdf: 1225033 bytes, checksum: d7b5c4e41959453abcf8e2f488a3fd60 (MD5) / Approved for entry into archive by Arlan Eloi Leite Silva (eloihistoriador@yahoo.com.br) on 2015-12-08T22:51:33Z (GMT) No. of bitstreams: 1 BrendaLuannaFernandesCortesDantas_DISSERT.pdf: 1225033 bytes, checksum: d7b5c4e41959453abcf8e2f488a3fd60 (MD5) / Made available in DSpace on 2015-12-08T22:51:33Z (GMT). No. of bitstreams: 1 BrendaLuannaFernandesCortesDantas_DISSERT.pdf: 1225033 bytes, checksum: d7b5c4e41959453abcf8e2f488a3fd60 (MD5) Previous issue date: 2014-08-13 / A Hipertens?o Arterial Sist?mica - HAS- ? definida como s?ndrome cuja caracter?stica principal ? a presen?a de n?veis tensionais elevados, associada a altera??es de n?veis funcionais ou estruturais nos ?rg?os aos quais atinge. Suas causas espec?ficas n?o s?o bem delimitadas e possui car?ter assintom?tico. Devido ? sua cronicidade exige ader?ncia ao plano de tratamento de forma permanente e sistem?tica, implicando em mudan?as no estilo de vida, combinadas ou n?o com uso de medicamentos. Os invent?rios de personalidade t?m sido largamente utilizados no delineamento de tra?os indicativos de dificuldades com ades?o ao tratamento. Nesse sentido, desenvolvido por Theodore Millon, o Millon Behavioral Medicine Diagnostic - MBMD ? um instrumento elaborado a partir do consenso entre profissionais de sa?de, visando identificar fatores psicol?gicos que venham a comprometer tratamentos m?dicos para que sejam conduzidos de modo a viabilizar uma melhor ades?o. Objetivos: avalia??o de evidencias de validade do Millon Behavioral Medicine Diagnostic - MBMD para p?blico de pacientes com hipertens?o, com vistas ? investiga??o de indicadores implicados na ades?o ou n?o ao tratamento anti-hipertensivo. M?todo: contou-se com amostra de 200 participantes, dos sexos masculino e feminino, com faixa et?ria entre 20 e 70 anos, recrutados presencialmente em um Hospital Universit?rio da cidade de Natal/RN. Foi administrado um protocolo de entrevista para obter informa??es sobre dados s?cio demogr?ficos, hist?ria cl?nica, h?bitos de cuidado e forma de conduzir o tratamento, e posteriormente segui-se a administra??o do pr?prio MBMD. Resultados: Por meio de An?lise Fatorial Confirmat?ria verificou-se que a organiza??o proposta pelos fatores ? favor?vel e se ajusta ? teoria, permitindo a visualiza??o de outros constructos subjecentes ?s escalas, com ?ndices de ajustes adequados e indicadores satisfat?rios de Alpha de Cronbach. Al?m disso, o MBMD revelou-se sens?vel ?s diferen?as intragrupais quanto as vari?veis sexo, idade, escolaridade, estado civil, profiss?o, renda, hist?rico de HAS, tempo de diagn?stico, uso de medica??o, presen?a de comorbidades, acompanhamento m?dico, uso de ?lcool e tabaco, dieta hiposs?dica, suporte social e crit?rios de ades?o. A utiliza??o de tal instrumento na avalia??o de ades?o ao tratamento anti-hipertensivo apresenta, portanto, indicadores de validade. / Systemic Arterial Hypertension ? SAH ? is defined as the syndrome which its main feature is the presence of high tensional levels, associated with alterations of functional or structural levels in the organs that it strikes. Its specific causes are not very well bounded and have an asymptomatic character. Due to its chronicity it requires adherence to the treatment plan in a systematic and permanent manner, implicating in lifestyle changes, combined or not with the use of medication. The personality inventories have been largely used in the lineation of indicative traits of difficulties with the adherence to the treatment. In this sense, developed by Theodore Millon, the Millon Behavioural Medicine Diagnostic ? MBMD is an instrument made from the consensus among healthcare professionals, aiming at identifying psychological factors that may compromise medical treatment so that they can be conducted in a way to enable a better adherence. Objective: evaluation of the evidence of validity of the Millon Behavioural Medicine Diagnostic ? MBMD for a public of patients with hypertension, aiming at investigating the indicators implicated in the adherence or not to the anti-hypertensive treatment. Method: there was a group of 200 participants in a university hospital in the city of Natal/RN, males and females, ranging from 20 to 70 years old. An interview protocol was administered in order to obtain information about socio-demographic data, clinical history, healthcare habits and way of conducting treatment, and after, the administration of the MBMD followed. Results: by means of Factor Analysis it was verified that the organization proposed by the factors is favorable and it adjusts to the theory, allowing the visualization of other underlying constructs to the scales, with adequate adjustment indexes and satisfactory Cronbach?s alpha indicators. Besides, the MBMD revealed itself sensitive to the intragroup differences relative to the sex, age, schooling, marital status, profession, income, SAH history, diagnostic time, medication use, comorbidity presence, hyposodic diet, social support and adherence criteria variables. The utilization of such instrument in the evaluation of the adherence to the anti-hypertensive treatment show, therefore, indicators of validity.

There are currently no effective methods for treating and preventing chronic pain. The aim of this thesis was to study prognostic factors for health care utilization, and the long-term outcomes of tailored behavioral medicine treatment for patients with musculoskeletal pain. Another aim was to increase knowledge about physical therapists’ assessment and analysis of patients’ pain conditions and to investigate the potential of subgrouping patients based on prognostic factors. Methods: In Study I, a prospective population-based cohort was followed over 21 years. Data from three measure points were analyzed: 1995 (n=2425), 2007 (n=1582) and 2016 (n=1184). Study II was a 10-year follow-up of randomized controlled trial (n=97), comparing tailored behavioral medicine treatment and exercise-based physical therapy. In Study III, a descriptive and explorative design was applied, using data from video-recordings of 12 physical therapists. In study IV, assignment to three subgroups based on the Örebro Musculoskeletal Pain Screening Questionnaire was validated against reference instruments, and the stability between two points of measurement was investigated in patients (n=40) who were seeking primary health care due to musculoskeletal pain. Results: Chronic pain, female gender and high age predict high health care utilization over 21 years, and a trajectory of stable high health care utilization over the entire period. The differences between groups in favor for tailored behavioral medicine treatment reported at post-treatment and after two years, were not maintained at the 10-year follow-up. A majority of the physical therapists assessed factors for poor prognosis. The analyses were mainly based on biomedical assessments and none of the physical therapists included behavioral factors. Subgroup assignment according to the Örebro Musculoskeletal Pain Screening Questionnaire appears to be valid and stable over time. Conclusion: Prognostic factors such as chronic pain and female gender need to be considered when allocating health care resources and planning treatment to improve long-term outcomes. The treatment should also be tailored based on individual functional behavioral analyses of key behaviors and on patient´s biomedical and psychosocial condition, including strategies for maintenance of behavioral changes. Evidence-based methods for integrating behavioral medicine treatment into physical therapy need to be further evaluated and improved.

Bakgrund: Basal Kroppskännedom (BK) är en rörelsebaserad behandlingsmetod som praktiseras av specialiserade sjukgymnaster/fysioterapeuter. Metoden har visat sig vara verksam på ett flertal patientgrupper, men metoden har till största delen använts och forskats på inom psykiatrin. Det har däremot inte studerats hur erfarenheten ser ut för fysioterapeuter i olika verksamheter och som arbetar med olika patientgrupper gällande hur BK kan påverka patienterna i deras vardagliga liv. Syfte: Att undersöka fysioterapeuters erfarenheter av hur behandling med Basal Kroppskännedom kan påverka patienterna i deras vardagliga liv. Metod: Studien är en kvalitativ explorativstudie. Sex informanter intervjuades utifrån en semistrukturerad intervjuguide. Dataanalysen gjordes med induktiv ansats och manifest fokus. Resultat: Dataanalysen resulterade i 7 kategorier och 22 underkategorier. De 7 kategorierna benämndes: ökad självkännedom, självkänsla, kommunikation, makt över sitt liv, hälsorelaterade beteendeförändringar, kroppsligt och bättre förutsättningar i livet. Slutsats: Studien visar att de intervjuade fysioterapeuternas erfarenhet är att behandling med Basal Kroppskännedom, oavsett patientgrupp eller verksamhet, på många sätt har en positiv inverkan på patienterna i deras vardagliga liv. Informanternas erfarenhet var att patienterna ändrade såväl inre som yttre beteenden. Till dessa räknas tankar, känslor och fysiologiska reaktioner respektive aktivitet, levnadsvanor, rörelsemönster och social interaktion. Sju kategorier och tjugotvå underkategorier identifierades vilka täcker in ovan nämnda beteenden. Författarnas uppfattning är att det verkar finnas en bred tillämpbarhet av BK inom fysioterapin. / Background: Basic Body Awareness Therapy (BBAT) is a movement-based treatment method practised by specialized physiotherapists. The method has proven to be efficient on multiple patient groups, but the method has mostly been used and researched on within the psychiatric area. However, the experiences of physiotherapists in different areas and who work with different patient groups regarding how BBAT may affect patients in their everyday life, have not been studied. Aim: To examine physiotherapists’ experiences of how treatment with basic body awareness therapy can impact patients in their everyday life. Method: The study is a qualitative explorative study. Six informants were interviewed based on a semistructured interview guide. Analysis of data was made with inductive approach and manifest focus. Result: The analysis of data resulted in 7 categories and 22 subcategories. The 7 categories were named: increased self-awareness, self-esteem, communication, power over one’s life, health related behavioral changes, bodily and better conditions in life. Conclusion: This study shows that the experiences of the physiotherapists who were interviewed are that treatment with Basic Body Awareness Therapy, regardless of patient group or area of treatment, in many ways has a positive impact on the patients in their everyday life. The experiences of the informants were that the patients changed covert as well as overt behaviors. These include thoughts, emotions, and physiological reactions respectively activities, living habits, patterns of movement and social interaction. Seven categories and twenty-two subcategories were identified which covers the mentioned behaviors. The authors view is that BBAT within physiotherapy seems to be broadly applicable.

Bakgrund: KOL är en progressiv inflammatorisk sjukdom som påverkar lungvävnaden och luftvägarna. Ett karakteristiskt symtom är dyspné som kan leda till rädsla för ansträngning. De flesta uppnår inte rekommendationerna för fysisk aktivitet. Under 2020 ökade trycket på hälso-och sjukvården, insatser minskade och hos riskgrupper har fysisk och psykisk ohälsa ökat. Fysioterapeuter har en viktig roll att hitta strategier för att vidmakthålla fysisk aktivitet, vilket kan försvåras under en pandemi.  Syfte: Att undersöka hur personer med kronisk obstruktiv lungsjukdom upplever sina möjligheter till fysisk aktivitet under covid-19 pandemin och hur de upplever att detta påverkar deras livskvalité. Metod: Sex semistrukturerade intervjuer hos deltagare med KOL genomfördes som analyserades genom en kvalitativ innehållsanalys.  Resultat: Dataanalysen gav tre kategorier. Resultatet visade upplevelser av minskad fysisk aktivitet, försämrat psykiskt välmående och minskat socialt stöd. Slutsats: Studien gav en möjlig förklaring till vad som påverkar möjligheterna till fysisk aktivitet under covid-19. Minskat socialt stöd och ökad oro/rädsla i relation till fysisk aktivitet påverkade vidmakthållandet av fysisk aktivitet och deltagarnas upplevda livskvalité. / Background: COPD is a progressive inflammatory disease that affects lung tissue and airways. A characteristic symptom is dyspnea that can lead to fear of effort. Most people do not meet the recommendations of physical activity. During 2020 the pressure on health careincreased, interventions reduced and amongst groups at most risk physical and mental illness has increased. Physiotherapist has an important part in finding strategies in maintaining physical activity, which can obstruct during a pandemic.  Aim: To examine how people with chronic obstructive pulmonary disease experience their opportunities to physical activity during the covid-19 pandemic and how they experience that affects their quality of life. Methods: Six semi-structured interviews with participants with COPD implemented which has been analyzed through a qualitative content analysis. Results: The analysis gave three categories. The results showed decreased levels of physical activity, deteriorating well-being and reduced social support. Conclusion: This study gave a possible explanation to what affects the opportunities to physical activity during covid-19. Reduced social support and increased anxiety/fear inrelation to physical activity was affected at the participants to maintain physical activity and experience of quality of life.