Bakalauro darbe analizuojamas dirbančių kineziterapeutų empatiškumas, nustatomas lygis. Tyrime dalyvavo 101 respondentas: 8 Tauragės reabilitacijos centro, 13 Šiaulių reabilitacijos centro, 14 Šiaulių respublikinės ligoninės, 17 Lietuvos sveikatos mokslų universiteto ligoninės Kauno klinikos, 8 Kelmės ligoninės, 8 Mažeikių ligoninės, 10 Palangos reabilitacijos ligoninės, 4 KMU Psichofiziologijos ir reabilitacijos instituto, 10 UAB Sveikatos centro „Energetikas“, 9 VšĮ Klaipėdos ligoninės (buvusi VšĮ Klaipėdos jūrininkų ligoninė) kineziterapeutai. Empatiškumas buvo tirtas pagal A. Mechrabyen, N. Epštein metodiką. Tyrimu buvo siekiama išsiaiškinti dirbančių kineziterapeutų empatiškumo lygmenį. Buvo tiriama empatijos lygmens priklausomybe nuo lyties, amžiaus, darbo stažo ir šeimyninės padėties. Empatiškumo tyrimo rezultatai buvo lyginami su būsimųjų kineziterapeutų empatijos lygmenimis studijų metu, amžiaus ir lyties atžvilgiu. Analizuojant tyrimo duomenis buvo siekiama nustatyti, ar kinta dirbančių kineziterapeutų empatiškumo lygmuo nuo darbo stažo. Tyrimo rezultatai parodė, jog didėjant amžiui bei darbo stažui empatiškumo lygis dirbančių kineziterapeutų mažėja. Darbuotojai įpranta saugoti save, tampa mažiau įsiklausantys į paciento problemas, stengiasi išvengti galimų konfliktinių bei dviprasmiškų situacijų. Dirbančių kineziterapeutų empatiškumo lygmuo turi tendenciją mažėti didėjant darbo stažui. Daugėja žemo empatijos lygmens specialistų, o aukštas empatiškumo lygmuo turi... [toliau žr. visą tekstą] / The final thesis analyses the empathy in working physical therapists and the level of empathy is measured. The research involved 101 respondents : 8 in Tauragės rehabilitation center, 13 in rehabilitation center of Šiauliai, 14 in Republican Hospital of Šiauliai, 17 in Lithuanian University of Health Sciences Kaunas Clinics Hospital, 8 in Kelmė hospital, 8 in Mazeikiai hospital, 10 in Rehabilitation Hospital of Palanga, 4 in Department of Psychophysiology and Rehabilitation, 10 UAB Health center " Energy", 9 in Klaipeda hospital former seamen's Hospital physical therapists. The empathy has been studied according to the methodology of A. Mechrabian and N. Epstein. The research aimed to find out the level of empathy in employed physical therapists. It was investigated empathy level dependence on sex, age, working experience and family status. The empathy test results were compared with future physical therapists empathy levels during the studies with regard to age and sex. The aim of the analysis of the data was used to determine, if empathy level changes in physical therapists working experience. The results showed that with increasing age and years of working experience empathy level of physical therapists rapidly decline. Compassion, emotional understanding and empathy skills declining because of life experience working with complicated patients. Therefore, more and more people get used to protect themeselves, they become less and less listening to others more trying to work... [to full text]

The purpose of this study was to assess the reliability and validity of a new computerized method of assessing balance and gaze control under a broad range of physical and visual conditions in people with vestibular hypofunction. Test retest reliability for balance performance as measured by COP excursion was good in all conditions with ICCs ranging from .64 to .90 in the AP and ML directions. Closed loop visual tracking as measured by COD had high reliability on the sponge and treadmill (ICC=.71-.75) as compared to open loop tracking (ICC=.325-.463) which was poor. Convergent validity showed poor correlation between clinical tests and the electronic balance and gaze assessments. Construct validity demonstrated that as physical and visual loads increased, balance performance decreased significantly on the sponge as measured by an increase in COP excursion and visual tracking performance decreased significantly on the treadmill as measured by a decrease in COD.

The purpose of this study was to determine if a ten week, twice weekly group exercise program using large amplitude movement and functional mobility training was effective at improving mobility and quality of life in old, older adults (i.e. average age 80 years) with Parkinson’s disease (PD). This exercise program builds on existing large amplitude movement training programs, but differs in that it is delivered in a group format, in an older cohort and incorporates functional training related to the tasks of daily living. To determine the long term training effects of the program, a follow up assessment was conducted at four months post intervention. Sixteen participants with PD with an average age of 80 years (range 69-91years) were recruited through a hospital-based Seniors Outpatient Clinic. Participants were assessed before starting (PRE) and upon completion (POST) of the intervention. To decrease the likelihood that the results would be affected by day-to-day fluctuations in mobility that are often seen with PD, 3 measures were gathered at both PRE and POST and then averaged to provide a single PRE and POST score. A single follow-up assessment was conducted four months after completion. Outcome measures included: Movement Disorder Society-Unified Parkinson’s Disease Rating Scale-Part III, Timed Up and Go, Berg Balance Scale, Sit-to-stand Test, gait characteristics (GaitRite system), Parkinson’s Disease Questionnaire – 39 and Goal Attainment Scale. Results indicate significant improvements from PRE to POST (p≤0.05) in all measures of physical function (effect sizes (ES) ranging from 0.35-0.87), Quality of Life (QOL) (mobility dimension, ES=0.34) and personal goal achievement (ES=2.12). Therefore this group exercise program was effective in improving mobility and QOL for an older adult population with PD. The program frequency and duration was adequate to achieve the desired training effects while being manageable for an old, older population to attend. Further, in those participants who continued to engage in ongoing physical activity, improvements were maintained at 4 months after completion of the program for MDS-UPDRS, TUG, gait velocity, QOL (bodily discomfort dimension) and GAS. / Graduate / 0382 / gallagher_karla@yahoo.ca

Physiotherapy for people with stroke has been found to be beneficial but details of the most effective interventions are unclear. Further development of the evidence base for stroke physiotherapy is limited by a lack of clinical practice models, sensitive clinically based outcome measures and effective stratification techniques to characterise homogenous groups of subjects. These issues are addressed here with regard to balance and posture. These aspects were chosen because they form a cornerstone of stroke physiotherapy as they are thought essential for the rehabilitation of functional activities. A systematic review of assessment methods in the literature revealed a lack of measurement tools which met the utility criteria: reliability, validity, sensitivity to short-term change, suitability for a wide range of abilities, ease of use and suitability for different settings. This prompted the development of a new measurement tool. Firstly, a model of the clinical assessment process was developed using an adapted focus group method with neurological physiotherapists. This informed the content of a new measurement tool which combined an ordinal scale with functional performance tests- the Brunel Balance Assessment. The tool was evaluated in a series of studies involving 92 stroke patients. It was hierarchical (coefficient of reproducibility= 0.99, coefficient of scalability = 0.69), reliable (100% agreement) and valid as a measure of balance disability (r=0.58-0.97). The psychometric properties of the individual functional performance tests were also tested and found to be reliable (ICCs =0.88-1) and valid (r=0.32-0.63). Measurement error ranged 0-40% and the minimum change needed to detect true clinical change was calculated for each test. Balance disability, measured with the Brunel Balance Assessment, is heterogeneous with sitting, standing and stepping balance forming distinct levels of ability (p<0.027). Consequently, the BBA could be used to stratify people with stroke according to balance ability. Weakness, sensation and age were significant independent contributors to balance disability (r2=82.7%). Balance ability was a strong contributor to independence in ADL (p<0.0001). The findings of this thesis address the issues that have limited research into stroke physiotherapy with regard to balance disability. In relation to clinical practice, a robust measurement and stratification tool has been developed.

No description available.

Obtaining a patient’s informed consent to treatment is an expected component of clinical interactions. The notion that a person as an autonomous being has a right to decide whether or not to consent to medical treatment from an informed basis has its origins in both law and ethical theory. In this research I investigate the issue of informed consent from two overall perspectives. The first concerns its basis in ethical theories of autonomy and its interpretation by the law and by health professional guidelines. The second involves an empirical examination of its occurrence within the communicative interaction between a physiotherapist and their patient, and its interpretation by the physiotherapist. I use qualitative research methods involving analysis of individual audio-taped treatment encounters in private physiotherapy practice and interviews with the treating physiotherapist. A central tenet of this study is that the translation of both legal and ethical criteria into the context of the clinical encounter requires a process of negotiation and communicative interaction between the patient and health professional. This research seeks to understand this process, and the factors that influence it in the specific context of physiotherapists and the private practice clinical encounter. (For complete abstract open document)

Falls are a relatively frequent occurrence amongst older people. Rates of falls amongst patients in subacute care are substantially higher than amongst people living in the community. Falls have been reported to cause physical and psychological injury, increase the likelihood of being discharged to nursing home, and are associated with longer lengths of stay in hospital. Thus, minimisation of falls in the subacute hospital setting is of high public health importance. (For complete abstract open document)

Diagnosing shoulder pain conditions is a challenging area of musculoskeletal practice. Subacromial impingement syndrome (SIS) is a clinical syndrome that indicates pain and pathology involving the subacromial bursa and rotator cuff tendons within the subacromial space. The three stages of SIS are subacromial bursitis, partial thickness and full thickness rotator cuff tears. The cause of SIS is believed to be multi-factorial with both extrinsic and intrinsic factors involved in its pathogenesis. Clinicians have traditionally diagnosed SIS using a clinical examination including a subjective history followed by confirmatory clinical tests. A review of the evidence for diagnostic accuracy of clinical tests highlights that individual tests have poor diagnostic accuracy. A combination of clinical tests or a clinical examination per se may be useful at ruling out rotator cuff tears, but is less accurate at detecting rotator cuff tears when it is present. There is consensus in the literature that particular combinations of signs and clinical features may be useful in diagnosing rotator cuff tears but not for diagnosing SIS. The vast majority of research to date examining the clinical diagnosis of SIS has been focused on individual clinical tests carried out by medical practitioners in specialist and tertiary care settings. This review has established that the majority of diagnostic accuracy studies for SIS and rotator cuff tears have had poor methodological design. This exploratory study was conducted with subjects undergoing a standardized clinical examination (index test) by a physiotherapist. The decision as to which specific tests were chosen for this research was based on supporting research within the literature and the test’s actual use within the New Zealand clinical setting. This included subjective history questions, active and passive shoulder movement tests and eleven SIS tests. Subjects were referred for a diagnostic ultrasound scan immediately following the clinical examination and results from the scan stood as the criterion reference standard. Thirty eight individuals (males n=23, females n=15) with new onset shoulder pain, who met the inclusion criteria, were assessed by a participating physiotherapist. Sensitivity, specificity, positive likelihood ratios, negative likelihood ratios and respective 95% confidence intervals were calculated for all variables of the examination. Individual variables from the clinical examination were tested for their association with the diagnostic ultrasound scan reference criterion using Pearson Chi-Squared Exact test. Potential predictor variables were retained as potential predictors for use in the logistic regression analysis to determine the most accurate set of clinical examination variables for diagnosing SIS and the individual pathological stages of SIS. The results indicate that no historical, subjective or objective features from the clinical examination are accurate in diagnosing SIS or rotator cuff tears. The presence of night pain demonstrated a significant correlation (P<0.02) with the criterion reference standard for the presence of subacromial bursa fluid/bunching. Night pain and pain with overhead activity has a high sensitivity for subacromial bursa fluid/bunching being present. The absence of night pain and the absence of pain with overhead activity are two subjective phenomena from a clinical examination that are useful in ruling out subacromial bursa fluid/bunching being present. Night pain was also found to be the best predictor of subacromial bursa fluid/bunching being present (P<0.012). Male gender (P<0.034) was the best predictor of partial thickness rotator cuff tears while being 60 years of age or older (P<0.01) significantly correlated with full thickness rotator cuff tears. The Drop Arm Sign (P<0.01) and External Rotation Lag Sign (P<0.01) were significantly correlated with SIS and full thickness rotator cuff tears. Clinical tests for all three pathological stages of SIS and subacromial bursa fluid/bunching being present, had equivalent or if not greater diagnostic accuracy than previous report studies in the literature. The Hawkins-Kennedy Test and Neer Sign can be used in the primary care setting to rule out the presence of subacromial bursa fluid/bunching or SIS if the tests are negative. For mid to end stage SIS (rotator cuff tears) the Empty Can Test and Drop Arm Sign with their high sensitivity can be used to rule out rotator cuff tears especially to the supraspinatus tendon when the tests are negative. Despite the small sample size and other limitations of this study, the findings are an important addition to the current literature surrounding the diagnostic accuracy of clinical tests for SIS and rotator cuff tears. This is the first study to use physiotherapists as examiners and to be set in a primary care setting. The study is also the first to examine the diagnostic accuracy of a range of historical and subjective features from the clinical examination. The results found in the current study could be used by future studies as a starting point in the development of a clinical decision or prediction rule to assist clinicians in the diagnosis of SIS and rotator cuff tears.

Introduktion: Kvinnans kropp genomgår stora förändringar under en graviditet som till viss del kvarstår postpartum. Under denna period sker en fysiologisk återuppbyggnad av muskulatur och stödjevävnad och träning bör påbörjas så snart som möjligt efter förlossning. Fysioterapeutiskt handledd träning har positiv effekt på nyblivna mammors fysiska och psykiska välmående med en ökad fysisk aktivitetsnivå som följd. Dock upplever många kvinnor att de inte har tillräckligt hög motivation för att prioritera sin egen hälsa efter graviditet. Syfte: Syftet med studien var att undersöka om ett individuellt anpassat träningsprogram kunde öka bålstyrkan hos postpartum-kvinnor samt ta reda på deltagarnas upplevelser av träningsperioden. Metod: Ett informationsbrev förmedlades via sociala medier. Totalt 46 kvinnor anmälde intresse varav 14 kvinnor stämde överens med studiens inklusions- och exklusionskriterier. Ett randomiserat urval ägde rum för att begränsa antalet deltagare. Totalt åtta kvinnor deltog i studien. Individuella möten skedde före och efter träningsperioden, där deltagarna fick svara på ett frågeformulär, utföra ett styrketest samt fick en genomgång av träningsprogrammet. Träningsperioden varade i fyra veckor med fokus på styrka, kontroll och stabilitet i bålen. Resultat: Samtliga kvinnor fick en mätbar styrkeökning. Genom frågeformuläret framkom att de upplevde ökad energi, förbättrad motivation till träning samt en styrkeökning som var applicerbar i vardagen. Konklusion: Individualiserad styrketräning postpartum är effektivt och kan ge en mätbar styrkeökning på kort tid. Träningsperioden resulterade förutom styrkeökning till en upplevelse av ökad energi samt ökad motivation till träning. Deltagarna upplevde ett behov av vägledning som ej finns tillgängligt inom mödravården idag. Fler och mer omfattande studier krävs.

Introduktion: Handboll är en fysisk kontaktsport där det förekommer många armrörelser över huvudhöjd, detta kan i sin tur göra att skulderleden utsätts för stor påfrestning med smärta som följd. Syfte: Syftet med studien var att undersöka ledrörlighet, muskelstyrka och smärta i skulderleden under säsong hos kvinnliga elithandbollsspelare. Metod: I denna prospektiva studie har 14 kvinnliga elithandbollsspelare studerats under en säsong. Mätningarna utfördes vid tre tillfällen under en sex månaders period. Deltagarnasaktivarörlighet (goniometer) och isometrisk muskelstyrka (handhållen dynamometer) i inåt-och utåtrotation i GH-ledenmättes. I samband med dessa tillfällen fick deltagarna även svara på enenkät gällande upplevd axelsmärta.Resultat: Från den första till den sista mätningen ökade inåtrotation i kastarm och icke kastarm signifikant (p=0,014 &amp; p=0,007). tROM ökade inte signifikant i varken kastarm eller icke kastarm (p=0,188 &amp; p=0,069). Utåtrotation, GIRD, ERG höll sig relativt konstant under studien. Muskelstyrkan i kastarm ökade signifikant i både inåtrotation (p=0,048) och utåtrotation (p=0,000) medan det endast skedde en signifikant ökning i utåtrotation (p=0,000) för icke kastarm. Samtidigt minskade den upplevda smärtan hos deltagarna från 211poängtill 143poäng(OSTRC) under studien. Konklusion: Deltagarnas muskelstyrka i utåtrotation och rörlighet i inåtrotation ökade i GH-leden under säsong samtidigt som deltagarnas självskattade skuldersmärta minskade under säsong. Att smärtan minskade kan bero på att muskelstyrkan och rörligheten hos deltagarna förbättrades. Dock efterfrågarförfattarnaytterligare forskning inom området där spelarna följs över säsong.