Bakalauro darbe analizuojamas kineziterapijos vertikalioje vonioje ir salėje procedūrų derinimo poveikis, pacientų funkcinės būklės, skausmo, nugaros ir pilvo raumenų statinės ištvermės kaitai, esant juosmeninės stuburo dalies skausmams. / Physiotherapy bachelor thesis analyzes the vertical bath and hall harmonization of procedures and the patient's functional status change in lumbar spine pain.

This study examined the association between neuropathy limitations and depression in chemotherapy patients currently on treatment with a taxane-based, platinum-based or plant alkaloid chemotherapy drug. The Overall Neuropathy Limitations Scale (ONLS) and the Beck Depression Inventory-Short Form (BDI-SF) were used to assess neuropathy limitations and depression in 24 chemotherapy patients with reported symptoms of peripheral neuropathy. Average age of patients was 65 years, 66.6% were female, and average number of chemotherapy cycles completed was 5.6. Of the 24 patients, 37.5% of patients were on a single agent taxane-based drug, 37.5% of patients were on a taxane-based drug with a platinum based drug, 16.6% of patients were on a plant alkaloid, and 8.3% were on a combination of a taxane-based and another non-neurotoxic chemotherapy drug. The scores on both the BDI-SF and ONLS were very low. The mean score on the BDI-SF was 4.1 with a standard deviation of 2.7. The mean score on the ONLS was 2.2 with a standard deviation of 1.5. The study showed a non-significant relationship between neuropathy limitations and depression in chemotherapy patients. These findings show no association between neuropathy limitations and depression. Although all of these patients had symptoms of peripheral neuropathy, they were not severe enough to interfere with daily activities. The lack of relationship was not unexpected given the low scores on both the BDI-SF and ONLS. Future research should re-evaluate this relationship with a larger, more diverse sample.

Tradition measures of recovery, such as patient-reported symptoms, objective measures such as balance, specific dimensions such as depression, fatigue, cognitive status, and exercise tolerance do not fully capture the impact of the concussion on performing individual activities and participating in life situations as experienced by the patient. No concussion-specific measure of functional status currently exists. Objectives The overarching purpose of this dissertation was to develop a concussion-specific measure of functional status. There were two specific objectives: 1. To examine the concept of functioning post-concussion; 2. To generate questionnaire items based on a conceptual model of functioning. Methods This dissertation follows the recommendations of the Association for Medical Education in Europe as a framework with which to meet the objectives. The first objective was addressed by (1) generating a list of concussion-specific concepts through a systematic review (Chapter 3), and (2) qualitative interviews with individuals with persistent post-concussion symptoms and clinicians with concussion expertise (Chapter 4). The relationships between the concepts that emerged from those studies are presented graphically in a conceptual model to meet the second objective. The concepts were then transformed into questionnaire items and pretested through cognitive interviews with individuals with PPCS and clinicians with concussion expertise. Finally, the questionnaire items were critically evaluated for proportion of shared content against existing measures used in concussion clinical trials by coding all items to the International Classification of Functioning, Disability and Health. Results Objective 1 Three main themes emerged from the qualitative findings: (1) functioning at the level of the individual and society; (2) environmental barriers and facilitators; and (3) capacity, defined as the length of time one could perform a task before the onset of symptoms, and the length of time it took to recovery from those symptoms. Objective 2 The final questionnaire is presented as the CORE-Q, which is comprised of 53 items over three complimentary subscales, namely the Post-Concussion Functional Scale, the Concussion Modifiers Scale, and the Global Functional Recovery Scale. Each subscale corresponds to one of the three main themes. No existing outcome measure contained more than 40% of the content within the CORE-Q, or 55% of any subscale. Conclusions The CORE-Q is a unique measure of functional status post-concussion that considers functioning from a biopsychosocial perspective. Further studies are needed to assess the psychometric properties of the CORE-Q before it is adopted into clinical practice and intervention trials.

Purpose: Data from a National Institute on Aging funded grant, developed by the University of Miami (UM), Center for Family Studies, were analyzed to determine if baseline levels of cognitive function, physical performance, psychological well-being, physical health, and social support (SS) predict functional status [basic (BADL) and instrumental (IADL) activities of daily living] among Hispanic elders (30 months later). Participants: The parent grant randomly selected a population based sample of Hispanic seniors living in East Little Havana, Florida: n=216, `M' age = 80.0 yrs, `SD' = 6.0; female = 63%. Methods: Data from two time points of the parent grant separated by 30 months were used in this analysis. Self report and physical measures of: cognitive function (MMSE), physical performance (gait speed, grip strength, number of blocks walked in past 7 days), psychological well-being (CES-D), physical health (BMI & self-rated health), SS (Received SS scale), and functional status (BADL and IADL), measured by a derivative of the OARS Functional Assessment Questionnaire, were examined. Two stepwise regression equations (one for BADL and one for IADL as dependent variables respectively) were calculated using SPSS v17.0. The study was approved by UM and Temple University's IRB. Results: Gait speed and physical activity were positively associated with IADL while physical activity was positively associated with BADL. In contrast, received social support and age were negatively associated with each of these outcomes. Conclusion: `Young-old,' Hispanic adults with lower levels of received SS and higher gait speeds and levels of physical activity exhibit greater BADL and IADL capacity. Social Relevance: Results of this study have implications for the development of strategies that delay long-term placement of Hispanic elders with disability. / Physical Therapy

Cardiovascular disease (CVD) is a major public health problem and a primary cause of morbidity and mortality in the United States. Regular physical activity is recommended for prevention and management of CVD. Despite the cardiovascular health benefits of physical activity most adults are physically inactive. Therefore, the aim of this dissertation was to examine the factors associated with adherence to physical activity among individuals with or without CVD. The first paper is a report of a study conducted to examine which baseline demographic (age, gender, marital status, socioeconomic status, and place of residency), psychosocial (social support, depression, anxiety, and fatalism), and clinical (past history of exercising, comorbidity, and health literacy) variables predicted successful adoption of the active lifestyle recommendation of increasing moderate-to-vigorous physical activity by an accumulated 15 minutes or more each day following a CVD risk reduction intervention and 2) to identify which of those same factors predicted dropout from the CVD risk reduction intervention among at-risk individuals in rural America. The study sample consisted of 399 rural Americans. The results revealed that a higher anxiety level was a predictor of active lifestyle modification following a CVD risk reduction intervention. In contrast, younger age and low health literacy were predictors of dropout from a CVD risk reduction intervention. The second paper is a literature review of studies investigating the factors that affected enrollment in cardiac rehabilitation in patients with heart failure (HF). The aims of this review were to: (a) describe enrollment rates of patients with HF in cardiac rehabilitation programs, (b) review the literature on factors affecting enrollment of patients with HF, and (c) identify areas for future research. It is difficult to draw conclusion about enrollment rates because the period of time after hospital discharge that enrollment was measured varied across studies. A wide array of demographic, psychosocial, and clinical variables have been identified as potential barriers of enrollment in cardiac rehabilitation programs. Additional research including patients with HF is needed. The third paper is a report of a cross-sectional study of 279 patients with HF. The aims were to determine 1) the amount of variance in the functional status predicted by depressive symptoms, perceived control, self-rated health, HF self-care maintenance behaviors, and serum N-terminal pro-B-type natriuretic peptide ( NT-pro-BNP) biomarker of cardiac dysfunction in patients with HF and 2) whether NT-pro-BNP mediated the relationship between self-care maintenance behaviors and functional status. Depressive symptoms, poor self-rated health, non-adherence to physical activity, and greater serum NT-pro-BNP levels were independently associated with worse perceptions of functional status. Serum NT-pro-BNP levels partially mediated the association between adherence to physical activity and perception of functional status. The findings from this dissertation provided further evidence of the importance of adherence to physical activity and identify key variables that promote participation in interventions to promote heart healthy lifestyles and adherence to physical activity.

Objectives: The aim of this cross-sectional study was to assess the nutritional status and physical performance of the individuals over 65 years living in home for the elderly and as the main research question to assess whether there is a correlation between impaired nutritional status and worsened physical performance in older adults. Also tests whether the unwanted weight loss for the last 3 month affects impaired results in a standardized SPPB test and handgrip test. And finally, verify whether the optimal BMI valided for the elderly predispozes a good physical performance and considered as a protective factor in case of frailty - on functional status. Methods: The research was executed by a quantitative method with the investigation of respondents as a data collection technique. To elaborate the practical part and answer the research questions were used outputs from nutritional status testing (BMI, nutritional status according to MNA-FF, SMI) and functional evaluation (dynamometry, SPPB battery). The results of these variables diagnosed seniors in the norm, at risk and with pathology. Results: The resulting research sample consisted of 40 seniors, of whom 29 were women (72,5 %) and 11 were men (27,5 %). The normal nutritional status was found in the majority of participants - 67,5 %, the risk...

The aim of this thesis was to describe fatigue, functional limitations due to fatigue and health in patients with chronic obstructive pulmonary disease (COPD), as well as to compare patients with individuals from the general population and to test if pulmonary rehabilitation can reduce fatigue and functional limitations, and thus improve health. A further aim was to test the Fatigue Impact Scale (FIS) among patients with COPD. Two studies (I, II) had a descriptive comparative design with data from 36 and 151 patients with COPD respectively, and 37 and 95 individuals respectively, randomly selected from the general population. One study (III) was a randomised pre-test post-test study with 12 patients with COPD randomised to 12 weeks’ pulmonary rehabilitation and 14 patients in a control group. In a further study (IV), the FIS was tested for validity and reliability among 296 patients with COPD who reported fatigue. Assessments: Structured questions frequency, duration and severity of fatigue, functional limitations due to fatigue with FIS, six minutes’ walking distance, hand grip strength, functional performance and satisfaction with Canadian Occupational Performance Measure and health with St George’s Hospital Respiratory Questionnaire and Short Form-36. Almost half of the patients with COPD had a problem with fatigue every day and experienced fatigue as a severe symptom. More than 44% reported that fatigue was one of the worst symptoms. The experience of fatigue was related to the patients’ functional performance and health perceptions. Patients with COPD experienced a higher frequency, longer daily duration and greater severity of fatigue than individuals from the general population. After a 12 week pulmonary rehabilitation programme, there were no statistically significant differences between the patients randomised to the rehabilitation group and those in the control group. The patients in the rehabilitation group improved walking distances, performance and satisfaction with regard to their own selected activities compared with baseline. Confirmatory factor analysis on the three-factor model proposed for FIS showed that the fit of the model was not acceptable. Further validation of the FIS resulted in a removal of 15 items (FIS-25) and support for Pipers´ theoretical framework of subjective manifestations of fatigue including physical, emotional and cognitive dimensions and a general behavioural factor. The internal consistency, sensitivity and stability correlations of FIS-25 were satisfactory. In conclusion, fatigue is a major concern among patients with COPD, impacting on functioning and health. Interventions with 12 weeks’ pulmonary rehabilitation might not be effective enough to reduce fatigue and the functional limitations due to fatigue. More research is needed to solve the symptom burden of fatigue and its impact on functioning and health in patients with COPD.

Possibilities of prevention reflecting geriatric principles: Functional status and depressivity in old age Hana Vaňková, MD Abstract Background: Given the population ageing in Europe and in the Czech Republic, strategies aiming to prevent functional decline in older age are of great importance. Depression in old age increases functional decline and is also associated with increased morbidity, mortality and deterioration of quality of life (Anstey et al., 2007; Karakaya et al., 2009). Therefore, there is a need for a comprehensive intervention addressing both functional status and depressive symptoms. Methods: Using comprehensive geriatric assessment, the relationship between functional status and depressive symptoms was examined in 308 residents of long-term care facilities (RCFs) in the Czech Republic. Depressive symptoms were measured using the 15-item Geriatric Depression Scale. An additional randomized control trial (RCT) evaluated the effect of a dance-based therapy on depressive symptoms in 162 institutionalized older adults with average age over 80 years. Results: A multiple regression analyses adjusted for sociodemographic factors and for taking antidepressants found that cognitive function and functional limitation by pain were most strongly associated with depressive symptoms. The ability to...

Possibilities of prevention reflecting geriatric principles: Functional status and depressivity in old age Hana Vaňková, MD Abstract Background: Given the population ageing in Europe and in the Czech Republic, strategies aiming to prevent functional decline in older age are of great importance. Depression in old age increases functional decline and is also associated with increased morbidity, mortality and deterioration of quality of life (Anstey et al., 2007; Karakaya et al., 2009). Therefore, there is a need for a comprehensive intervention addressing both functional status and depressive symptoms. Methods: Using comprehensive geriatric assessment, the relationship between functional status and depressive symptoms was examined in 308 residents of long-term care facilities (RCFs) in the Czech Republic. Depressive symptoms were measured using the 15-item Geriatric Depression Scale. An additional randomized control trial (RCT) evaluated the effect of a dance-based therapy on depressive symptoms in 162 institutionalized older adults with average age over 80 years. Results: A multiple regression analyses adjusted for sociodemographic factors and for taking antidepressants found that cognitive function and functional limitation by pain were most strongly associated with depressive symptoms. The ability to...

Résumé : Dans la sclérodermie systémique (ScS), les contractures aux mains, pour lesquelles il n'existe aucun traitement prouvé, sont courantes et associées à de l'incapacité de la main, globale et au travail. Toutefois, quelques études sur les effets d'interventions comprenant des techniques manuelles ont montré des résultats prometteurs. Ainsi, le but de l'étude était d'explorer les effets d’un traitement ostéopathique sur la fonction de la main, des symptômes globaux de la maladie et le statut fonctionnel de personnes atteintes de ScS. Une série d'études à cas uniques (A[indice inférieur 1]-B-A[indice inférieur 2]) fut réalisée. Six participantes atteintes de ScS ont été recrutées parmi la cohorte du Groupe de recherche canadien sur la sclérodermie à deux sites (Hôpital général juif de Montréal et Centre hospitalier universitaire de Sherbrooke). Les participantes ont reçu neuf séances hebdomadaires d’ostéopathie semi-standardisées, ciblées sur les membres supérieurs, le thorax et la base du crâne. Des mesures répétées pendant les trois phases de l'étude ont été prises à une fréquence bihebdomadaire pour la raideur aux mains (RM) et les symptômes de douleur, dyspnée et fatigue; et hebdomadaire pour l'amplitude de mouvement des doigts (AMD), la fonction de la main (FM) et l'incapacité globale (IG). L'épaisseur/rigidité de la peau main/avant-bras (ÉPMA), l'incapacité au travail (IT) et la qualité de vie reliée à la santé (QVS) ont été mesurées à trois temps (avant et après l'intervention, ainsi qu'au suivi à un mois). Les variables à mesures répétées ont été représentées sur des graphiques linéaires soumis à des analyses visuelles, complétées du test Sheward's two Standard Deviation Band. Les différences ont été calculées pour les variables mesurées à trois temps. Toutes les participantes (n=6) ont montré une amélioration des variables reliées à la fonction manuelle (RM, AMD et FM), sauf pour l'ÉPMA (n=4). La majorité des participantes ont montré une amélioration des symptômes (douleur n=6, fatigue n=4 et dyspnée n=3/4) et des variables reliées au statut fonctionnel (IG n=5/5, IT n=4, score résumé physique n=6 et mental n=4 de la QVS). La plupart des effets se sont maintenus au suivi à un mois. Lorsque la comparaison était possible, presque toutes les améliorations observées ont été supérieures aux différences minimales cliniquement importantes suggérées pour cette population. Ces résultats suggèrent que l'ostéopathie pourrait être efficace pour réduire l'incapacité découlant des contractures aux mains de personnes souffrant de ScS, et devraient être vérifiés dans un essai clinique randomisé. // Abstract : In systemic sclerosis (SSc), hand contractures are common and associated with hand, global and work disability. There are no known effective treatments, although there have been a few promising studies with manual therapies. Our aim was to explore the effects of osteopathy on hand function, disease symptoms and functional status in SSc patients. A series of single case studies (A[subscript 1]-B-A[subscript 2] was undertaken. Six female SSc patients with hand contractures were recruited among subjects enrolled in the Canadian Scleroderma Research Group cohort at 2 sites (Jewish General Hospital, Montreal and Centre hospitalier universitaire de Sherbrooke, Sherbrooke). Participants received 9 weekly semi-standardized sessions of osteopathy targetted on upper limbs, thorax and cranial base. Repeated measures were taken during the three phases of the study, twice a week for hand stiffness and disease symptoms of pain, dyspnea and fatigue; and once a week for range of motion of fingers, hand disability and global disability. Upper limbs skin score, work disability and health-related quality of life were measured at baseline, after treatments and at 1-month follow-up. Data for each variable with repeated measures were represented on simple line graphs and visually interpreted, completed by the Sheward's two Standard Deviation Band test. Differences were calculated for variables measured at 3 time points. All participants (n=6) showed improvement in variables related to hand function (hand stiffness, range of motion of fingers and hand disability), except for upper limbs skin score (n=4). The majority of participants showed improvement in disease symptoms (pain n=6, fatigue n=4, et dyspnea n=3/4) as well as variables related to functional status (global disability n=5/5, work disability n=4, physical n=6 and mental n=4 component summary of health-related quality of life). Most improvements were maintained at 4 week follow up. When the comparison was possible, almost all observed improvements were higher than the minimal clinically important differences suggested for this population. These findings suggest that osteopathy may be effective in reducing disability from hand contractures in SSc. A randomized controlled trial is needed to confirm these results.