Darbo aktualumas: Osteoartritas (OA) senstančioje visuomenėje darosi vis svarbesnė problema. Daugumai žmonių OA – tai sindromas, kurį sudaro sąnarių skausmo, sustingimo ir dėl to prastėjančių funkcijų simptomai ir kuris daro didelę įtaką gyvenimo kokybei (Conaghan & Sharma, 2009). Sergantiems osteoartritu ligoniams pažeidžiamos daugelis gyvenimo sričių: apsitarnavimas, namų ruoša, darbas, laisvalaikis, judėjimas, miegas (Thorstenson, 2007; Sunden et al. ,2007). Siekiant sumažinti skausmą bei pagerinti funkciją pacientams, sergantiems kelių sąnarių osteoartritu, analizavome, kaip skirtingos kineziterapijos programos veikia pacientų skausmą, pusiausvyrą ir šlaunies raumenų jėgą. Tyrimo objektas: skausmo, pusiausvyros ir raumenų jėgos pokyčiai, taikant skirtingas kineziterapijos programas – kineziterapiją vandenyje bei kelių sąnarių mobilizaciją ir kineziterapiją salėje bei TENS. Tyrimo tikslas: Nustatyti skirtingų kineziterapijos programų efektyvumą ligoniams, sergantiems kelio sąnario osteoartritu. Tyrimo uždaviniai: 1. Nustatyti klinikinio rodiklio – kelių sąnarių skausmo stiprumo – kaitą, taikant skirtingas kineziterapijos programas; 2. Nustatyti funkcinių rodiklių: statinės ir dinaminės pusiausvyros bei blauzdą tiesiančių raumenų jėgos kaitą, taikant skirtingas kineziterapijos programas; 3. Nustatyti, kuri kineziterapijos programa veiksmingesnė, mažinant skausmą ir didinant funkciją – pusiausvyrą bei blauzdą tiesiančių raumenų jėgą. Tyrimo hipotezė: Manome, kad taikydami... [toliau žr. visą tekstą] / Problem of study: Osteoarthritis (OA), in an aging society is becoming increasingly important problem. OA, for the majority of people - is a syndrome consisting of joint pain, stiffness and function because of deteriorating symptoms and who have a significant impact on the quality of life (Conaghan & Sharma, 2009). Patients ill with osteoarthritis are vulnerable to many disabilities in different areas of life: self-service, household chores, work, leisure, movement, sleep (Thorstenson, 2007; Sunden e al. 2007). In order to reduce pain and improve function in patients with knee osteoarthritis, we examined how different physical therapy programes are affecting the pain, balance and strength of the thigh muscles of the patients.. Object of study: changes in pain, balance and muscle strength while applying different physical therapy programs - physical therapy in water, knee joint mobilization, physical therapy room and TENS. Aim of study: to determine the effectiveness of various physical therapy programs for patients with knee osteoarthritis. Goals of study: 1. Establish a clinical indicator – change in the intensity of knee pain with different physical therapy programs; 2. Identify the functional characteristics: static and dynamic balance and change in force of the extensor muscles of the thigh, with different physical therapy programs; 3. To establish which physical therapy program is more effective in reducing pain and improving function - balance and power of the extensor... [to full text]

Tez (Tıpta Uzmanlık) - Süleyman Demirel Üniversitesi, Tıp Fakültesi, Ortopedi ve Travmatoloji Anabilim Dalı, 2005. / Bibliyografya var.

Tez (Tıpta Uzmanlık) - Süleyman Demirel Üniversitesi, Tıp Fakültesi, Ortopedi ve Travmatoloji Anabilim Dalı, 2005. / Bibliyografya var.

Thesis (DHSc) -- AUT University, 2008. / Includes bibliographical references. Also held in print (xvii, 177 leaves : ill. (some col.) ; 30 cm.) in the Archive at the City Campus (T 616.7223062 REI)

Thesis (doctoral)--Lund University, 1994. / Added t.p. with thesis statement inserted.

Thesis (doctoral)--Lund University, 1994. / Added t.p. with thesis statement inserted.

Thesis title: Health Professional-patient communication in relation to weight managementBackground: Global obesity levels have doubled since 1980 and are expected to rise. It is associated with key health risks such as heart disease, some cancers and osteoarthritis and hence has considerable economic consequences for health care resources. Key policy guidelines recommend that all health professionals (HPs) should discuss weight management with their patients making every contact count. However, we know HPs find discussions about weight challenging due to lack of time, training and skills. Knee Osteoarthritis (KO) and obesity are inextricably linked and together with a rise in obesity levels and growing numbers of older citizens rates of KO are set to escalate. As obesity is the key modifiable risk factor for KO, discussions about weight are paramount. This thesis explored this relationship further from the perspectives of patient and HPs, focusing on KO as an exemplar condition where there is scope for improved weight management. Methods: Utilising qualitative methods, three studies were undertaken. Firstly, a systematic review and thematic synthesis was conducted of published literature of physicians' views and experiences of discussing weight management within routine clinical consultations, not specific to KO. Secondly, HPs' experiences of discussing weight in consultations with KO patients through semi-structured interviews were conducted with 26 HPs. Interviews were audio recorded and analysed using TA. A final study recruited 25 overweight/obese patients with KO and investigated their experiences of talking about weight with HPs. Results: Overarching themes were identified across the studies. Firstly, HPs are pessimistic about patients' desire to lose weight and their capacity to help them. Several factors lead physicians and HPs to be reticent to accept responsibility for discussions about weight. Within routine consultations and between HPs and KO patients, weight was viewed as a sensitive topic. Both HPs and patients recognized the difficult cycle of pain, reduced mobility and weight gain. Patients with KO desire patient-centred (PC) care but, despite HPs recognizing its value, they do not receive it. Both physicians and HPs lack communication skills in weight management. Conclusions: The work undertaken in this thesis demonstrates that barriers preventing effective clinical interactions about weight identified in routine consultations still exist, even when two conditions such as KO and obesity are inextricably linked. Although HPs and patients hold similar understanding of these interrelationships and recognise the value of PC discussions, HPs struggle in effective behavior change talk. HPs expressed impatience with the efforts of their patients. To readdress this imbalance all consultations about weight should be PC. Both physicians and HPs were inadequately trained to discuss weight and patients' views supported this. HPs working with overweight patients should be trained in evidence-based behaviour change techniques and PC communication techniques to increase their confidence to support patients in weight management. Finally, health psychologists have the skills to both deliver and guide discussions about weight.

Background: Knee pain is a common musculoskeletal complaint with an estimated annual population prevalence of 25% in people aged over 55 years. There are many causes of knee pain though osteoarthritis (OA) is one of the most frequent. Not all people with OA, however, have knee pain. There is discordance between pain intensity and disease severity, the reason for which is unknown. Variation in pain sensitivity may be one possible explanation. Quantitative sensory testing (QST) is a non-invasive technique using non-painful and painful stimuli to assess altered sensitivities in the skin and muscle. Little is known, however, about pain sensitivity in people with knee pain and the role of psychosocial factors in relation to pain sensitivity and pain intensity. Intra-articular steroids are a widely used and effective therapy for knee OA though response to treatment varies in both magnitude and duration of response. Pain sensitivity and/or psychosocial factors may explain some of the variation observed in response to treatment. Aims: To determine whether (i) greater sensitivity to stimuli is associated with higher levels of pain intensity in a population-based sample with knee pain, and whether those associations are mediated by psychosocial factors, (ii) there are changes in QST following intra-articular steroid injections in patients with symptomatic knee OA, and (iii) whether psychosocial factors and sensitivity to stimuli at baseline predict change in pain following intervention. Methods: 72 men and women with knee pain were recruited from a population-based cohort. All had QST assessments and completed a range of questionnaire instruments addressing pain intensity and psychosocial factors. QST assessments (including thermal, mechanical, vibration and pressure) were made at the most affected knee and contralateral forearm. Assessments of tender point count, wind-up ratio and diffuse noxious inhibitory control were also performed. Structural equation modelling was used to determine whether associations between QST measures and pain intensity were mediated by a latent psychosocial factor. In a separate open label trial of intra-articular steroid injections, 32 men and women with symptomatic knee OA underwent QST assessments and also completed questionnaires. The assessments were performed at both knees at the baseline visit (prior to injection) and at a post-injection visit 5-15 days later. Changes in QST were assessed using Wilcoxon matched pairs signed-rank with linear regression used to determine baseline QST predictors of change in pain. Results: In the observational study, mechanical hyperalgesia (tender point count, mechanical pain sensitivity, and allodynia), illness perceptions, catastrophizing and disability scores were positively associated with higher levels of pain intensity. Mediation analyses revealed stronger associations for the indirect effect including a latent psychosocial mediator between measures of mechanical hyperalgesia and global pain, and stronger associations for the direct effect between measures of mechanical hyperalgesia and knee pain. In the intervention study no changes in QST were observed between visits. However, lower baseline mechanical pain thresholds at the injected knee and illness perceptions predicted response to treatment. Conclusion: Illness perceptions and mechanical hyperalgesia can be used to identify subjects experiencing higher levels of global and knee pain intensity, and those who were more likely to respond to intra-articular steroid therapy. Changes in knee pain following intervention with steroid injection are not explained by changes in pain sensitivity.

京都大学 / 0048 / 新制・課程博士 / 博士(人間健康科学) / 甲第21705号 / 人健博第71号 / 新制||人健||5(附属図書館) / 京都大学大学院医学研究科人間健康科学系専攻 / (主査)教授 市橋 則明, 教授 黒木 裕士, 教授 妻木 範行 / 学位規則第4条第1項該当 / Doctor of Human Health Sciences / Kyoto University / DFAM

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