Thesis (M.Tech.: Chiropractic)-Dept. of Chiropractic, Durban Institute of Technology, 2006 xiv, 61 leaves, Annexures 1-12, 20 leaves / It is well known that the lifetime incidence of lower back pain (LBP) is particularly high (Richardson et al., 1999). Most cases of LBP are self-limiting, however certain regional biomechanical deficits may be overlooked, such as core stability. As a result of this, LBP may become a chronic condition in the athletic and general population. This principle can be applied to road running, as the forces that pass through the muscles of the lower limbs and trunk cannot be properly absorbed if the trunk musculature is not properly trained. This may lead to lower back pain as a result of inadequate functioning and strength of stabilizing structures (Hedrick, 2000). The purpose of this exploratory cross-sectional study was to determine the relationship between core muscle strength and chronic lower back pain in amateur female road runners and non-runners. The focus was to determine the core stability values in mmHg between amateur female runners with and without chronic LBP, and female non-runners with and without chronic LBP; as well as to compare female runners and non-runners with regard to core muscle strength.

Pain is a personal subjective experience with physiological and psychological components and involves many complex processes. In 1965 Melzack and Wall proposed the influential gate control theory (GCT) of pain and, in general, this has been supported by subsequent research. This theory postulates that cells in the substantia gelatinosa, located within the spinal cord, act like a gate mechanism that modulates the flow of information through the spinal cord to the brain and thus impacts on the pain experience. The abundance of literature and experimental data that is available from pain research supports the development and testing of computational models for the simulation and exploration of the pain process. Despite the fact that pain is an ideal candidate for modeling, it is an area that has received little attention. One of the few published models (Britton and Skevington, 1989; Britton et al., 1996) translated the explicitness of the GCT and its well-defined architecture into a basic mathematical model. The aim of this research is to develop a biologically appropriate computational model of pain, capable of modelling both acute and chronic pain states, and describe applications and simulations appropriate to such a model. Therefore this research firstly replicates a mathematical model of pain (Britton and Skevington, 1989; Britton et al., 1996) to explore its adequacy and to assess its potential for further development. The original model is then developed and extended to produce a more biologically plausible representation of the pain processes involved in the Gate Control mechanism. The improvements in the computational model have enabled a clinically plausible simulation of a pain modulatory technique, transcutaneous electrical nerve stimulation (TENS), which validates the model’s representation of the GCT and provides insight into how pain modulation can occur. Other developments to this model show its unique ability to represent symptoms of chronic pain, such as allodynia and hyperalgesia, which are associated with pathological pain states developed through the loss of inhibition and glial cell activation

Många personer över 65 år lever med smärta. Det ingår i sjuksköterskans arbetsuppgifter att bedöma och utvärdera smärta. Syfte: Syftet med denna litteraturstudie var att genom existerande forskning beskriva vårdpersonals kunskap och attityder till smärtbedömning och smärtskattning i sitt dagliga arbete vid vård av äldre. Metod: I denna litteraturstudie användes sökbaserna Cinahl och Pubmed. Resultat: Resultatet baseras på 10 artiklar, 7 kvantitativa , 2 kvalitativa och en artikel där båda metoderna användes. De faktorer som påverkar smärtskattningen sågs vara erfarenhet och utbildning, utbildning i smärtskattning visade sig öka självförtroendet hos personalen. Även olika hinder, så som kognitiv nedsättning hos patienten och tidsbrist för vårdpersonalen, ligger i vägen för en adekvat smärtskattning. Generellt hade vårdpersonalen en positiv inställning till utbildning inom området smärtbedömning och även en stor intention att smärtskatta och göra detta korrekt. Det kunde ses att vårdpersonalens fördomar och attityder till äldres smärta påverkade smärtbedömningen. Slutsats: Smärtskattning av den äldre patienten är av största vikt för att minska smärta, lidande och andra följdtillstånd som obehandlad smärta orsakar. Med stöd från den samlade litteraturen, anses även att utbildning av personalen är ett mycket viktigt sätt att utveckla och förbättra smärtbedömningen inom vården. / Many people over the age of 65 are living with pain. It’s a part of the nurse profession to assess and evaluate pain. Purpose: The purpose of this literature review was by existing research explore nurses knowledge and attitudes towards pain assessment and pain measurement in the care of elderly patients. Methods: In this literature review the databases Cinahl and Pubmed were used. Results: The results in this study are based on 10 articles. 7 quantitative, 2 qualitative and 1 were both methods was used. Factors that influenced how the patients’ pain was assessed by the health care givers was experience and education, attitudes and different obstacles that made adequate assessments difficult, such as patients having cognitive impairment and lack of time to perform assessment. In general, the caregivers had a positive attitude towards education about pain assessment and a great intention to assess pain correctly. However, it could be shown that negative attitudes and prejudices against pain in the older patient and how it should manifest affected how the pain assessment was performed. Conclusions: Negative attitudes regarding aging that is still exists in our society is affecting the health care of the individual. The authors believe, in support of the reviewed literature, that education is an important way to improve and develop the pain assessment performance.

Bakgrund: Smärta är ett komplext och omfattande problem inom sjukvården. Utan adekvat behandling kan smärta leda till sämre livskvalitet för patienten. Sjuksköterskan har en viktig och betydelsefull roll i att identifiera och bedöma patientens smärta då en optimalt utförd smärtbedömning är en förutsättning för adekvat smärtlindring. Att se människan bakom patienten är en viktig aspekt för att identifiera smärta ur ett helhetsperspektiv. Syfte: Syftet var att undersöka sjuksköterskors bedömning av patienters smärta. Metod: En litteraturöversikt baserad på elva vetenskapliga artiklar, med både kvantitativ och kvalitativ design. Resultat: Resultatet presenteras i fyra olika huvudteman. Verbal kommunikation, Observation av patienters smärta med subteman: smärtbeteenden och fysiologiska tecken, Hjälpmedel för smärtbedömning och Sjuksköterskans förförståelse och tidigare erfarenheter av smärta. Inga evidensbaserade rutiner eller riktlinjer följdes. Diskussion: Resultatet diskuterades med anknytning till personcentrerad vård och konsensus begreppet människa. Smärtbedömningen utfördes oftast utifrån sjuksköterskans egen tolkning och var inte alltid anpassad efter den enskilda individen. Patienter som har smärta är i behov av att bli sedda och smärtbedömda utifrån deras individuella behov. Sjuksköterskor har därför en central roll i att individanpassa bedömningen av smärta. / Background: Pain is a complex and major problem in health care. Without adequate treatment, pain can lead to decreased quality of life for the patient. The nurse has an important and significant role in identifying and assessing the patient's pain when an optimally performed pain assessment is a prerequisite for adequate pain relief. To see the person behind the patient is a key aspect of identifying pain from a holistic perspective. Aim: The aim was to explore the nurses' assessment of pain in patients. Method: A literature review based on eleven scientific articles, with both quantitative and qualitative design. Results: The results are presented in four main themes. Verbal communication, Observation of patients' pain subthemes: behaviors related to pain and physiological signs, Pain assessment tools and Nurse's preunderstanding and past experiences of pain. No evidence-based rutines or guidelines were followed. Discussion: The results were discussed related to person-centered care and the concept of human. Pain assessment was usually carried out on the basis of the nurse's own interpretation and were not always tailored to the individual. Patients who have pain need to be seen and pain assessed on their individual needs. Nurses have therefore a major role to individualize the assessment of pain.

Pain experienced as a result of a disabling medical condition is a frequent problem in the clinical community and can often be present in any individual with this kind of health concern. Such pain is typically characterized by severe implications reflected on both a person‘s personal life, as well as on a country‘s health and economic systems. Research on pain has revealed that patients not only experience several types of pain that could prove to be challenging to address, but also that each individual can interpret the same type, location and severity of this pain in different subjective ways, making the need for more effective pain measurement methods an imperative and troublesome effort. In retrospect, the healthcare field is currently trying to enhance the available medical methods with alternatives that would be more efficient in providing accurate pain assessment. Most efforts revolve around traditional methods of measuring pain characteristics, which typically involve the 2-Dimensional (2-D) representation of the human body, often used to collect information regarding the type and location of pain. However, these 2-D pain drawings can be limited in their ability to efficiently visualize pain characteristics for diagnosis purposes. Nonetheless, patients have been shown to prefer such drawings. This research develops an alternative interactive software solution to help in addressing the aforementioned situation, by employing the capabilities that advancements in 3-Dimension (3-D) technology offer. Subsequently, in the anticipation that limitations of current 2-D pain visualization will be solved, the developed approach facilitates the measurement of pain experiences via a 3-D visualization model of the patient. To ensure that it can effectively perform in real-world medical practice, the 3-D pain drawing is evaluated in this research through real-life case studies that are carried out in designated settings. The research findings have shown that the developed approach can potentially make significant contributions to society, science/technology and healthcare provision, with patients and clinicians suggesting that 3-D technology can be a promising means in the pursuit for more effective pain measurement solutions.

Submitted in partial compliance with the requirements for the Master’s Degree in Technology: Chiropractic, Durban University of Technology, Durban, South Africa, 2016. / Background: Neck pain is a condition that is becoming more common throughout the world and most people can expect to experience some degree of neck pain sometime during their life. There is a need for early diagnosis and follow-up of neck pain to assess a patient’s level of self-rated disability due to the escalating disability burden and compensation costs associated with neck pain. For this reason, disability questionnaires are increasingly used for clinical assessment and as an outcome measurement for the treatment of neck pain. Translation and cross-cultural adaptation of disability questionnaires have thus become increasingly necessary when dealing with different cultural groups. Methods: This is a quantitative validity and reliability assessment study comparing the English versions of the Neck Disability Index (NDI) and the Quadruple Visual Analogue Scale (QVAS) to their translated Afrikaans counterparts. The first step was to translate the questionnaires into Afrikaans. The translated questionnaires were then scrutinised and critiqued by an Expert group, who are fluent in both the Afrikaans and English languages, and back translated to English in order or establish their face validity. A small pilot study was conducted with the original and translated versions of the questionnaires to establish their content validity. The translated and original versions of the NDI and QVAS were given to a study group to complete with a suitable time delay between the completions of the questionnaires. The results from the study group were statistically analysed to establish concurrent validity and reliability. Results: There were 50 participants each completing one English NDI and QVAS and one Afrikaans NDI and QVAS. The results indicate high reliability for both the Afrikaans NDI (α = 0.900) and QVAS (α = 0.883). The Afrikaans NDI and QVAS are deemed reliable compared to their English counterparts. The results indicated a significant level of concurrent validity for both the NDI and the QVAS. Both the Afrikaans versions of the NDI and QVAS were deemed reliable and concurrent validity was established. The NDI and QVAS were successfully translated and the Afrikaans versions can now be used in the Afrikaans population as viable alternatives to the English NDI and QVAS. / M

Bakgrund: Studier visar att sjuksköterskor ofta underskattar barns smärta. Vid omvårdnad av barn med smärta bör självskattning vara förstahandsvalet vid smärtskattning. Smärtskattning och dokumentation är sjuksköterskans ansvar, därför behöver sjuksköterskor utbildning och riktlinjer för att förbättra smärtbehandlingen för barn och ungdomar.  Syfte: Syftet var att kartlägga sjuksköterskors attityder och kunskaper gällande smärta hos barn och ungdomar på en pediatrisk akutvårdsavdelning. Ytterligare ett syfte var att se om en intervention kan påverka sjuksköterskornas attityder och kunskaper samt smärtskattningsfrekvens. Metod/design: En kvantitativ kvasiexperimentell studie utfördes. En enkät besvarades av 30 sjuksköterskor före och efter en intervention, vilken innebar ett deltagande i en utbildning om barns smärta och användning av smärtskattningsinstrument. Vid utbildningen utformades även riktlinjer gällande smärtskattning på avdelningen. Resultat: När användandet av smärtskattning värderades i en femgradig betygsskala fick sjuksköterskorna högre medelbetyg efter interventionen jämfört med innan (1,69 vs 2,5; p=0,049). Ingen signifikant förändring kunde påvisas gällande sjuksköterskornas attityder och kunskaper. Slutsats: Smärtskattningsfrekvensen blev signifikant högre efter en intervention med evidensbaserat utbildningsmaterial och utformning av riktlinjer för smärtskattning. Ingen skillnad hittades mellan bakgrundsfaktorer och attityd- och kunskapsformuläret. Sjuksköterskorna på avdelningen behöver fortsätta arbeta för att riktlinjerna kring smärtskattning följs och uppdateras utifrån forskning och kliniska erfarenheter. / Background: Studies show that nurses often underestimate children´s pain. Self-report should be the standard when caring for a child with pain. Pain measurement and documentation is the nurse´s responsibility, therefore pediatric nurses need education and established guidelines to improve pediatric pain management. Aim: The aim was to survey nurse`s knowledge and attitudes regarding pain in children and adolescents in an pediatric ward. Another aim was to investigate if an intervention could affect nurse’s knowledge and attitudes towards children`s pain, as well as the frequency of pain measurement. Method: A quantitative and quasi-experimental study was conducted. A questionnaire was handed out to 30 nurses before and after an intervention regarding pain in children. During the intervention the nurses learned how to use validated pain measurement-tools and guidelines regarding pain measurement was formed. Results: The use of pain measurement-tools were evaluated in a five-point rating scale, the nurses got higher average points after the intervention than before (1.69 vs 2.5; p=0,049). No significant change was found regarding nurses' attitudes and knowledge. Conclusion: The frequency of pain measurement was significantly higher after an intervention with evidence based training and development of guidelines for pain measurement. No difference was found between background information and the answers to the questionnaire. Nurses on the ward have to continue the evaluation of pain measurement and the guidelines based on research and experiences.

A dissertation completed in partial compliance with the requirements for a Master's Degree in Technology Chiropractic, Durban Institute of Technology, 2006. / Neck pain is a common problem, globally, as well as in South Africa. Zulu is the first language of a very large proportion of the South African population, and as such, addressing the needs of this population group with respect to neck pain is a priority. Many reliable pain indexes exist in English to record the degree of disability with regards to neck pain. These are invaluable tools in aiding the health practitioner to assess the progress of treatment and the severity of the patient's disability. Two of the most credible and frequently used indexes are the Canadian Memorial Chiropractic College Neck Disability Index (CMCC NDl) and the Short Form McGill Pain Questionnaire (SFMPQ). However, no such scale exists in Zulu. The purpose of this pilot investigation was, firstly, to analyze and critique the Zulu translations of the CMCC NDl and the SFMPQ in order to establish their face validity. Secondly, to establish their concurrent validity ensuring that the translated questionnaires are specific and sensitive enough to use as tools in data collection when compared to their English counterparts. Thirdly, to make recommendations for further improvement in terms of the Zulu questionnaires and lastly, to make recommendations for further studies for improvement in terms of the use of these questionnaires as research tools amongst the Zulu speaking population of South Africa. Firstly, the CMCC NDl and the SFMP questionnaires were translated into Zulu by means of a focus group. These versions were then assessed by means of a focus (or discussion) group, to assess their face validity. Changes were made to the original translations according to the recommendations of this group. These versions were then assessed with regards to their concurrent validity with the original English versions. Fifty volunteers, who were literate in both English and Zulu and who have suffered with neck pain, filled in both the Zulu and English versions of both questionnaires. / M

Submitted in partial compliance with the requirements for the Master’s Degree in Technology: Chiropractic, Durban University of Technology, Durban, South Africa, 2016. / Background: Neck pain is a condition that is becoming more common throughout the world and most people can expect to experience some degree of neck pain sometime during their life. There is a need for early diagnosis and follow-up of neck pain to assess a patient’s level of self-rated disability due to the escalating disability burden and compensation costs associated with neck pain. For this reason, disability questionnaires are increasingly used for clinical assessment and as an outcome measurement for the treatment of neck pain. Translation and cross-cultural adaptation of disability questionnaires have thus become increasingly necessary when dealing with different cultural groups. Methods: This is a quantitative validity and reliability assessment study comparing the English versions of the Neck Disability Index (NDI) and the Quadruple Visual Analogue Scale (QVAS) to their translated Afrikaans counterparts. The first step was to translate the questionnaires into Afrikaans. The translated questionnaires were then scrutinised and critiqued by an Expert group, who are fluent in both the Afrikaans and English languages, and back translated to English in order or establish their face validity. A small pilot study was conducted with the original and translated versions of the questionnaires to establish their content validity. The translated and original versions of the NDI and QVAS were given to a study group to complete with a suitable time delay between the completions of the questionnaires. The results from the study group were statistically analysed to establish concurrent validity and reliability. Results: There were 50 participants each completing one English NDI and QVAS and one Afrikaans NDI and QVAS. The results indicate high reliability for both the Afrikaans NDI (α = 0.900) and QVAS (α = 0.883). The Afrikaans NDI and QVAS are deemed reliable compared to their English counterparts. The results indicated a significant level of concurrent validity for both the NDI and the QVAS. Both the Afrikaans versions of the NDI and QVAS were deemed reliable and concurrent validity was established. The NDI and QVAS were successfully translated and the Afrikaans versions can now be used in the Afrikaans population as viable alternatives to the English NDI and QVAS. / M

Pain can be a warning sign, but in surgery it is associated mainly with medical procedures. The aim of the research survey was to map out the pain rating scales that are used in practice in surgical patients, to determine the opinion of surgical nurses on these scales and patient experience. Furthermore, the paperwas aimed at the creation of a recommended procedure for evaluation of pain in surgical patients. In the empirical part of the thesis, quantitative and qualitative research was used. In the quantitative research, two questionnaires were created - for nurses (a non-standardized questionnaire) and for surgical patients (a combination of a non-standardized and standardized questionnaire). The focus group method with surgical patients and nurses was used as a qualitative method. The research survey shows that the most commonly used scale in practice is the visual analogue scale and verbal evaluation. Although these methods are widely used, our results suggest that they are not entirely sufficient. Respondents from the groups of nurses and patients wanted to add more accurate verbal description to the evaluation and increase the frequency of pain evaluation by a doctor and nurse. The most frequent symptoms of pain from the perspective of patients included: limited mobility and self-sufficiency, emotional lability, and verbal manifestations. And from the perspective of nurses: limited mobility, non-cooperation, limited self-sufficiency and verbal manifestations. Among the methods that are used most often by patientsto relieve painare medicinesprescribed by the doctor, relief positions, sleep and rest. More than 90% of patients are satisfied with the cooperation with the nurse and the doctor in the evaluation and treatment of pain. Based on the data analysis, a procedure for assessing pain in surgical patients has been proposed. Its clarity and usability were verified using the focus group method with surgical nurses and patients. Both the nurses and the patients assessed the recommended procedure quite positively. Possible pitfalls were perceived in the necessity of sufficient nurse-patient cooperation and enough time to implement the proposed assessment. The research survey was carried out in the territory of the South Bohemian region and is processed as part of thesolution of the GAJU team grant project - Use of Measuring Instruments in Nursing Practice (059/2018/S).