A research report submitted to the Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, in partial fulfillment of the requirements for the degree of Masters of Science in Physiotherapy. Johannesburg 2017 / Background: There is limited research available on the use of outcome measures in intensive care units (ICU) in a South African setting.The Chelsea Critical Care Physical Assessment tool (CPAx) is a measure of morbidity related to physical function and assesses respiratory function and functional abilities of critically ill patients. Objectives: The objectives of this study were to establish the effect of the use of the CPAx tool on ICU and hospital length of stay (LOS) in the care of critically ill patients; to establish the usefulness of the CPAx tool according to patient admission diagnosis; to determine if a relationship exists between CPAx scores and severity of illness or general morbidity during ICU admission; and to establish physiotherapists’ perceptions and views towards the use of the CPAx tool in their daily clinical practice in ICU. Design: The study consisted of two parts. Part one was a quasi-experimental design with a historical matched control group. Part two was a survey-based design. Methods: The study took place in a South African public sector hospital. Twenty six participants each were recruited into the experimental and control groups. Participants from the control group were matched with participants in the experimental group according to age, gender, diagnosis and acute physiology and chronic health evaluation (APACHE) II scores. CPAx scores and sequential organ failure assessment (SOFA) scores were calculated for participants in the experimental group on alternate weekdays during their ICU stay. Comparisons of ICU and hospital LOS between the study participants and historical control group were done using an independent t-test. Pearson’s correlation coefficient was used to determine if a relationship existed between CPAx scores, APACHE II scores or SOFA scores. A p-value ≤ 0.05 was deemed statistically significant. A questionnaire was developed and was completed by the research assistants who administered the CPAx tool to participants in the experimental group in order to determine their perceptions of the tool. Results: The mean age for the CPAx group was 37.88 (±13.37) years and for the control group was 37.81 (±12.21) years. The CPAx group consisted of 14 (53.8%) participants who underwent surgical procedures and 12 (46.2%) participants with traumatic orthopaedic injuries. The control group consisted of 14 (53.8%) participants who underwent surgical procedures and 12 (46.2%) participants with traumatic orthopaedic injuries. The mean initial SOFA score for the CPAx group was 2.42 (±1.79) and for the control group was 4.15 (±2.6). A p=0.03 indicates that there was a statistically significant difference between the two groups with regards to initial SOFA scores. The mean SOFA score at ICU discharge for the CPAx group was 1.80 (±0.42) and for the control group was 2.87 (±1.81). A p=0.05 indicates that there was a statistically significant difference between the two groups with regards to SOFA scores at ICU discharge. The mean initial CPAx score for the experimental group was 29.73 points (±14.81) and the mean CPAx score at ICU discharge was 36.15 (±8.33). The mean CPAx scores changed by 9.45 points between admission and discharge from ICU for participants who underwent surgical procedures and the mean CPAx scores changed by 3.9 points between admission and discharge from ICU for participants who sustained traumatic orthopaedic injuries. The mean ICU LOS for the CPAx group was 5.84 days (±7.43) and for the control group was 4.56 days (±5.25). The mean hospital LOS for the CPAx group was 17.43 (±16.68) days and for the control group was 19.31 days (±15.79); however, in both cases differences were not statistically significant. APACHE II scores had a very weak negative correlation with initial CPAx scores. APACHE II scores had a very weak positive correlation with CPAx scores at ICU discharge. There was a statistically significant difference between the two groups with regards to initial SOFA scores (p=0.05). Initial SOFA scores had a statistically significant moderate negative correlation with initial CPAx scores (r=-0.45, p=0.02). Initial SOFA scores had a weak negative correlation with CPAx scores at ICU discharge. Initial CPAx scores had a moderate positive correlation with SOFA scores at ICU discharge. CPAx scores at ICU discharge had a very strong statistically significant positive correlation with SOFA scores at ICU discharge (r=0.80, p=0.05).The CPAx tool proved to be more responsive in a surgical population than in a trauma population. Clinicians had positive perceptions of the CPAx tool in the management of critically ill patients. Discussion: Participants in the CPAx group were well matched with those in the historical control group with regards to age, gender, diagnoses and severity of illness. Those in the CPAx group had lower extent of organ dysfunction than those in the control group which might account for their shorter period of hospitalisation. Patients with a higher risk for mortality on admission into the ICU displayed lower functional abilities and, in turn, lower CPAx scores were measured. A greater change in CPAx scores was observed for participants recovering from surgical interventions compared to those recovering from traumatic orthopaedic injuries. Participants with low morbidity at the time of ICU admission seemed to have a greater ability to perform functional activities during their ICU stay. Limitations of the study included a small patient sample, a limited number of research assistants as well as lack of content validation of the questionnaire used. A multi-centre trial on the use of CPAx in ICU patient management could yield a wider perception of physiotherapists regarding the usefulness of the tool in daily clinical practice. Measuring the effect of the CPAx tool on participants’ length of mechanical ventilation could also be an interesting clinical outcome to consider. Conclusion: The data presented in this study show that the use of the CPAx tool does not have an influence on ICU and hospital LOS in a small sample of surgical and trauma participants. The tool appears to be more useful when used in the care of patients who are recovering from surgical procedures rather than those who sustained complex traumatic injuries. Physiotherapy clinicians that participated in the study supported the use of the CPAx tool in this single-centre trial and generally had positive perceptions towards the use of the tool. / MT2017

Magister Scientiae (Physiotherapy) - MSc(Physio) / The education system in South Africa has been on a path of change since 1994, in an effort to correct the injustices and inequalities of our apartheid past. In 2001 Education White Paper Six and the inclusive education policy was introduced. This policy is based on creating an environment where special needs education is seen as a non-racial and integrated part of the education system and envisages the role of special schools changing in order to facilitate this process. Special schools will continue to provide services to the severely disabled and high needs learner. However staff at special schools will be encouraged to make their expertise and resources available to the ordinary schools in the community. This study is focused on the role of the physiotherapist in special schools. The introduction of the new policy required physiotherapists to serve the needs of learners at special schools as well as provide indirect support to ordinary schools in the community. However physiotherapists have not been trained to provide indirect support and feel that they have not had adequate assistance to improve their skills and knowledge in this area. This study therefore looked at how the knowledge, skills and attitudes of physiotherapists can be enhanced and developed in order to meet the need of successfully implementing inclusive education. The aim of the study was to design, implement and evaluate an intervention aimed at improving the knowledge, skills and attitudes of physiotherapists in providing indirect support in the education system. In order to do so, it was necessary to meet the following objectives. Firstly to determine how physiotherapists perceive indirect support and their role in the district based support team; and secondly to determine the barriers experienced by physiotherapists in providing indirect support as well as their needs to provide appropriate support within the inclusive education framework. A qualitative study was conducted using the action research method. This study involved five special schools in the Western Cape and a total of nine participating physiotherapists. Focus group discussions were used to collect data. The first focus group discussion involved participants identifying their perceptions of indirect support, their role in the district based support team, barriers to indirect support and their needs in order to provide appropriate support in the inclusive education framework. The data collected were analyzed using content analysis. The findings revealed that many of the physiotherapists are experiencing difficulties in making the shift from direct to indirect support, due to not having been provided with the necessary support, resources and training to facilitate the transition to inclusive education practices. A second round of focus group discussions were held for the physiotherapists to prioritise a need that the intervention would be based on. Thereafter a training workshop was held, based on the prioritised need, to improve the provision of indirect support by physiotherapists. This research has shown that physiotherapists have begun to engage with the change process by questioning the implications of the inclusive education policy and looking at how their role in special schools needs to change. The physiotherapists require assistance in the facilitation of a transition from providing mainly direct support in special schools, to also providing indirect support in an inclusive education setting. They require the assistance of the school management and the Department of Education to provide the necessary support, resources and training to facilitate the transition to inclusive education practices.

Title: Patients' Knowledge about Physiotherapy. Objectives: To contact representatives of foreign professional organizations to determine whether they were surveyed public knowledge about the physiotherapy, and let them answer some solved questions. Secondly, to investigate patients' knowledge about physiotherapy, if they see the difference between a physiotherapist and a masseur and if they properly title or address the physiotherapists. In case of desinformation of the patients to think what would be the best way to improve that. Methods: An english written questionnaire containing 6 questions was sent to the representatives of professional organizations by e-mail. The survey among Czech patients was conducted using a structured questionnaire consisting of 10 questions. Distribution took place in Prague and Pardubice. Results: Only 31% of the representatives of the professional organizations reported that the survey about the public knowledge about the physiotherapy was conducted but the document could not be obtained. 77% of the representatives also stated that patients with no previous experience with the physiotherapy rather know what is the content of this field and 69% also believed that the patients used name / surname most commonly in addressing the physiotherapists. 38% said that the...

Title: Stereognosis assessment in the hands area of physiotherapy students. Objectives of work: The main objective of this dissertation is an evaluation of stereognosis functions of hands and also the influence from the practise of palpation skills on the stereognosis at a group of thirty physiotherapy students from the first-year bachelor's degree during two measurements at an interval of six months. Next aim is to compare results of these measurements and to evaluate potential changes. Methods: This dissertation work was made by form of clinical study. The evaluation criterion was time and perfection in performed tests. For the assessment of hand stereognosis at the research group were used 4 simple tests without using sight: test by Petrie - sort the balls by size, to recognise a foam made letters and to determine the roughness of sandpaper. Results: The results show that during the study of physiotherapy at students there has been a slight development in the stereognosis functions. The influence of somatosensory learning during the six months period helped to reduce the number of errors which have been made by probands while taking the assigned tests. Results indicate that regular and careful practise of palpation ability has a particular influence for development and improvement of...

Bakgrund: Fotboll är en av världens största idrotter och står för en stor del av alla sportrelaterade skador. Skadorna kan leda till nedsatt hälsa, kostnader för samhället samt slutet av en spelarkarriär. Hittills har forskningen främst fokuserats på träning när det gäller skadeförebyggande åtgärder. Det finns även andra faktorer som kan minska skaderisken men som i dagsläget inte utforskats i samma utsträckning. Syfte: Syftet var att undersöka uppfattningar och erfarenheter, hos fysioterapeuter till elitfotbollslag, rörande orsaker till skador samt viktiga komponenter för skadeförebyggande arbete inom elitfotboll. Metod: Studien har en kvalitativ ansats med deskriptiv design. Fem semistrukturerade intervjuer genomfördes och bearbetades genom en kvalitativ innehållsanalys. Resultat: Inom ”Orsaker till skador” identifierades fem kategorier; ”Fysisk belastning”, ”Psykisk- och social press”, ”Tränartyp”, ”Spelsituation” och ”Social situation”. ”Komponenter för skadeförebyggande arbete” genererade sex kategorier; ”Lagets resurser”, ”Planera belastning”, ”Kommunikation mellan medicinska teamet, tränarna och spelarna”, ”Utbildning av medicinska teamet, tränarna och spelarna”, ”Hitta balans i spelarnas vardag” och ”Hur spelarna mår fysiskt och psykiskt”. Konklusion: Flera aspekter påverkar uppkomsten av skador och därav behöver flera komponenter tas i beaktning vid förebyggandet av dessa. Vidare studier behövs för att täcka in ytterligare områden och för att kunna dra slutsatser om vilka av de möjliga komponenterna som bör prioriteras. / Background: Soccer is the world´s biggest sport and is responsible for a lot of all the sports related injuries. These injuries can result in impaired health, expenses for the society and the end of a career. The main focus of today´s research regarding injury preventions are different types of training. There may also be other components that might reduce the risk of getting injured that hasn´t been explored as much.  Purpose: The aim was to investigate the perceptions and experiences of physiotherapists working for elite soccer clubs, regarding causes of injuries and important injury preventive methods. Method: A qualitative descriptive design was used in this study. Five semi structured interviews were performed and a qualitative content analysis was used. Result: Based on ”Causes of injuries”, five categories were identified; "Physical load", "Psychological and social pressure", "Type of trainer", "Game situation" and "Social situation". ”Injury prevention methods” generated six categories; "The team´s resources", "Planning Load", "Communication between the medical team, coaches and players", "Education of the medical team, coaches and players", "Finding balance in players' everyday life," and "How the players feel physically and psyochologically." Conclusion: Several aspects affect the occurrence of injuries, and therefore several components need to be taken into account in the prevention of these. Further studies are needed to cover additional areas and to draw conclusions about which of the possible components that should be prioritized.

Bakgrund: Interaktion och bemötande är viktiga i vården. Hur en person uppfattar ett bemötande är individuellt och beror på tidigare erfarenheter och social status. Bio-psyko-sociala faktorer kan ha inverkan på interaktionen då patienters beteende kan påverkas av sjukdomstillstånd och tidigare erfarenheter. Syfte: Att undersöka hur fysioterapeuter som arbetar inom Akademiska sjukhuset och Uppsala kommun upplevde att de blivit kränkande bemötta av patienter utifrån sitt kön och om patientens sjukdomstillstånd och ålder har betydelse i bemötandet.  Design och metod: En kvantitativ tvärsnittsstudie med en komparativ och deskriptiv design. Sammanlagt 84 fysioterapeuter från Akademiska sjukhuset och Uppsala kommun besvarade en egenkonstruerad webbenkät. Resultatet analyserades med beskrivande statistik, Chi-2 test och kvalitativ innehållsanalys.  Resultat: En hög andel av fysioterapeuterna (83%) hade erfarenheter av kränkande bemötande och ingen signifikant skillnad sågs mellan könen eller arbetsplats gällande dessa erfarenheter. Störst andel av de manliga fysioterapeuterna rapporterade att de upplevt hot och våld från patienter medan kvinnliga fysioterapeuter uppgav att de fick utstå mer sexuella trakasserier. Patienter med smärta eller demens var de patientgrupper som flest fysioterapeuter upplevde sig blivit kränkande bemötta av.  Konklusion: Kränkningar mot fysioterapeuter är vanligt förekommande oavsett kön. Patientens sjukdomstillstånd har stor betydelse vid kränkande beteende mot fysioterapeuten. Det är viktigt att uppmärksamma ämnet både i utbildning och inom yrkeslivet. Fler studier krävs för att styrka resultatet. / Background: Interaction and communication are important in health care. How a person perceives a response is individual and depends on past experiences and social status. Bio-psycho-social factors can affect the interaction as patients' behavior is affected by disease states and previous experiences.  Purpose: To investigate how physiotherapists working at Akademiska Sjukhuset and Uppsala municipality experienced how they were treated by patients based on their gender and if the patient's disease states and age can affect the interaction.  Design and method: A quantitative cross-sectional study with a comparative and descriptive design. A total of 84 physiotherapists from Akademiska Sjukhuset and Uppsala municipality answered a self-designed web questionnaire survey. The result was analyzed with descriptive statistics, Chi-2 test and qualitative content analysis.  Result: A high proportion of physiotherapists (83%) had experience of abusive treatment and no significant difference was seen between the sexes or the workplace regarding these experiences. Largest share of male physiotherapists reported that they experienced threats and violence from patients while female physiotherapists stated that they suffered more sexual harassment. Physiotherapists experienced the most abusive treatment of patients with pain or dementia. Conclusion: Violations against physiotherapists are commonplace regardless of gender. The patient's disease condition is of great importance in the case of offensive behavior against the physiotherapist. It´s important to pay attention to the subject both in education and in professional life. More studies are required to strengthen the results.

Magister Scientiae (Physiotherapy) - MSc(Physio) / The use of information and communication technology to support physiotherapy students in South Africa Over the past few decades, there has been a global shift toward the use of information and communication technology (ICT) in healthcare, which has been shown to enhance the support provided to healthcare professionals, as well as to improve service delivery, patient care and student education. This study aims to investigate the use of ICT at South African universities to provide support to physiotherapy students and what the experiences and perceptions of those students are on the use of ICT as a means of receiving support. The study design was a cross-sectional, descriptive survey using a self-administered questionnaire. The survey population included all of the undergraduate physiotherapy students (n=1105) from six of the eight universities offering the physiotherapy degree in South Africa. The sample size consisted of the 529 students from the survey population who had completed and returned questionnaires, indicating a response rate of 47.8%. The results of the study showed that the use of ICT varied according to racial demographics, as well as the university attended and that there was a preference among students (94.7%) for face-to-face contact as the method by which support was accessed. Furthermore, confidence in the use of ICT for research and in promoting academic development was low (42.9% and 39.1% respectively), which raises concerns with the shift in healthcare toward evidence-based practices. In conclusion, there is a concern that with the move toward community based service delivery in South Africa, certain groups of physiotherapy students may not be well placed to make use of ICT services as a means of accessing support.

Bakgrund Världshälsoorganisationen (WHO) klassar våld i nära relationer som ett folkhälsoproblem. Även om både män och kvinnor är utsatta så är det främst kvinnor som utsätts för den här typen av våld och enligt Nationellt centrum för kvinnofrid (NCK) är kvinnor nästan tre gånger mer utsatta än män. Hälso- och sjukvården behöver utveckla sitt arbete för att upptäcka våldsutsatta patienter men det finns begränsad forskning om hur fysioterapeuter arbetar med detta ämne. Syfte Att utforska fysioterapeuters upplevelser och erfarenheter av att möta kvinnor som blivit utsatta för våld i nära relation. Metod I studien användes en kvalitativ design med en semistrukturerad intervjuguide. Sex fysioterapeuter, som samtliga arbetade på antingen privat eller offentlig vårdcentral inom primärvården i Region Uppsala, intervjuades. Resultat Deltagarnas erfarenheter varierade i stor grad. Ingen av deltagarna ställde frågan om våldsutsatthet som en standardiserad fråga vid nybesök. Tvärtom uttryckte flera att de upplevde sig behöva skapa en relation med patienten innan de kunde ställa frågan. Deltagarna tog till olika åtgärder vid våldsutsatthet, framförallt hänvisade de vidare till kurator och/eller gav vidare information om kvinnofridslinjen. Samtliga upplevde ett behov av djupare kunskap och förståelse om ämnet. Konklusion Mer praktisk och teoretisk kunskap samt medvetenhet hos fysioterapeuter behövs för att de ska kunna arbeta mer effektivt med kvinnor som utsätts för våld i nära relation. / Background The World Health Organization (WHO) classifies intimate partner violence as a global health problem. Even if both men and women are affected, data from National Centre for Knowledge on Men’s Violence against Women (NCK) shows that almost three times more women than men have been affected. The Swedish health care needs to improve on how they work on finding these patients but there is little research of how physiotherapists work regarding this matter. Objective To explore how physiotherapists investigate and examine female patients who are or have been a victim of intimate partner violence. Methods This survey used a qualitative method with a semi structured interview guide. Six interviews were carried through with physiotherapists who worked in Uppsala’s primary care, either in public or private health centers. Results The survey showed various experiences within the partakers. None of the physiotherapists asked about intimate partner violence as a standardized question at all new visits. On the contrary, several informants expressed that they felt a need to create a relationship with the patients before asking such questions. The physiotherapist took different actions when detecting intimate partner violence; mainly referring the patients to a curator and/or giving information of the women’s peace line. All partakers felt the need of a deeper knowledge and understanding of this issue. Conclusion Physiotherapists need more awareness as well as practical and theoretical knowledge to be able to work more efficiently with women that are affected by intimate partner violence.

Abstract Background: Soccer includes quick turns, jumps and decelerations, which entails an increased risk of injury. Women are exposed to more long-term injuries than men. Physiotherapists who work with injury management and return to play need to take account factors from a biopsychosocial perspective. Purpose: The aim of this study is to explore physiotherapist's experiences of working with injury management and returning to play in Damallsvenskan, after common injuries in soccer. Method: A descriptive qualitative study based on five semi-structured interviews was applied. The content of the interviews was analyzed with qualitative content analysis. Results: The results show that physiotherapist´s in Damallsvenskan experience that good communication between affected parties facilitates the work with injury management. The work includes considering risks, working with mental barriers and helping the player to be physically ready for recovery by treating the damaged tissue. Physiotherapists experience that different resources affect injury management. Conclusion: The physiotherapists describe how an important part of the work is to help the player to become physically ready for recovery by treating the tissue and working with mental barriers. Good communication facilitates cooperation within the team. The pressure to get players ready for a match in a short time includes considerations of risks, which is affected by work experience. Physiotherapists in Damallsvenskan experience that resources affect injury management. Furthermore, quantitative research should focus on whether an increased presence of physiotherapists in Damallsvenskan can reduce the risk of players injuring themselves again. / Sammanfattning Bakgrund: Fotboll inkluderar snabba vändningar, hopp och inbromsningar, vilket medför en ökad risk för skador. Kvinnor utsätts för mer långvariga skador än män. Fysioterapeuter som arbetar med skadehantering och återgång till spel behöver ta hänsyn till faktorer ur ett biopsykosocialt perspektiv.  Syfte: Syftet med studien är att belysa fysioterapeuters upplevelser och erfarenheter av att arbeta med skadehantering och återgång till spel i Damallsvenskan, efter vanligt förekommande skador i fotboll. Metod: Studien är en deskriptiv kvalitativ studie baserad på fem semistrukturerade intervjuer. Innehållet i intervjuerna analyserades med kvalitativ innehållsanalys. Resultat: Resultatet visar att fysioterapeuter i Damallsvenskan upplever att en god kommunikation mellan berörda parter underlättar arbetet med skadehantering. Arbetet inkluderar övervägande av risker, arbete med mentala hinder och hjälpa spelaren att bli kroppsligt redo för återgång, genom att behandla den skadade vävnaden. Fysioterapeuterna upplever att olika resurser påverkar skadehanteringen.  Konklusion: Fysioterapeuterna beskriver hur en viktig del av arbetet är hjälpa spelaren att bli kroppsligt redo för återgång genom att behandla vävnaden och arbeta med mentala hinder. En god kommunikation underlättar samarbetet inom teamet. Pressen att få spelare matchklara på kort tid inkluderar överväganden av risker, vilket påverkas av arbetslivserfarenhet. Fysioterapeuter i Damallsvenskan upplever att resurser påverkar skadehanteringen. Vidare bör kvantitativ forskning fokusera på om en ökad närvaro av fysioterapeuter i Damallsvenskan kan minska risken för spelare att åter skada sig.

Bakgrund: Långvarig smärta är ett vanligt symtom bland befolkningen och ett folkhälsoproblem. Kvinnor drabbas i större utsträckning än män av diagnoser kopplade till långvarig smärta. Rapporter visar att vården inte är jämställd på flera sätt, exempelvis föreligger könsskillnader i vårdtillgång gällande väntetider samt åtgärder och vårdkvalitet mellan kvinnor och män. Fysioterapeuter inom primärvård och slutenvård möter ofta patienter med långvariga smärttillstånd. Att behandla patienten utifrån vad som är bäst för patienten och inte diskriminera utifrån till exempel kön är en del av de etiska regler som fysioterapeuter ska förhålla sig till. Syfte: Syftet med denna studie var att undersöka fem fysioterapeuters erfarenheter och upplevelser av jämställdhet i vården av patienter med långvariga smärttillstånd.  Metod: En kvalitativ design med semistrukturerade intervjuer tillämpades. Fem fysioterapeuter verksamma inom slutenvård och primärvård rekryterades till studien genom ett strategiskt urval. Data från intervjuerna bearbetades med kvalitativ innehållsanalys. Resultat: Analysen genererade sex kategorier och fjorton underkategorier. De sex kategorierna bestod av Fysioterapeuters syn på jämställdhet varierar, Fysioterapeuter strävar efter jämställd vård, Jämställdhet – Två sidor av ett mynt, Strukturella orättvisor i sjukvård och hos myndigheter, Förändring krävs inom sjukvården för jämställd vård och Vården ojämlik idag även på grund av andra faktorer än kön.  Slutsats: Fysioterapeuterna ansåg att smärtvården idag är inte jämställd och kvinnor missgynnas. Sjukvården bör fortsätta arbeta med strukturella problem och vårdgivarens eget ansvar bör understrykas. / Background: Long-term pain is a common symptom among the population. Women are affected to a greater extent than men by diagnoses linked to long-term pain. Reports show that healthcare is not equal in several ways, such as the gender difference in the availability of care and the quality of care between women and men. Physiotherapists in primary care and inpatient care often meet patients with long-term pain conditions. Treating the patient based on what is best for the patient and not discriminate based on gender are parts of the ethical rules that physiotherapists must relate to.  Aim: The aim of this study was to examine five physiotherapists' experiences of gender equality in the care of patients with long-term pain conditions. Method: A qualitative design with semi-structured interviews was applied. Five physiotherapists active in inpatient and primary care were recruited to the study through a strategic selection. A qualitative content analysis was used to process the data. Results: The analysis generated six categories and fourteen subcategories. The six categories consisted of Physiotherapists' views on gender equality vary, Physiotherapists strive for gender equal healthcare, Gender equality - Two sides of a coin, Structural injustices in healthcare and with authorities, Change is required in healthcare for gender equality and Healthcare is unequal today due to other factors than gender. Conclusion: The physiotherapists considered that healthcare today is not equal, and women are in a disadvantaged. Healthcare should continue to work with structural problems and the caregiver's own responsibility should be emphasized.