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1
Brown, Annette I. "Functional adaptation to exercise in elderly subjects." Curtin University of Technology, School of Physiotherapy, 2002. http://espace.library.curtin.edu.au:80/R/?func=dbin-jump-full&object_id=12562.
Full textAbstract:
Maintenance of physical function with advancing age is vital to continued independent living, which is highly valued by older people. Although commonly associated with the ageing process, loss of functional ability may well be accelerated by inactivity and subsequent decreasing physical capacities, such as muscle performance or balance abilities. The impact of increased levels of activity on physical performance and functional ability was investigated by a single blind randomised controlled study.Two intervention programs, one based on increased levels of physical activity and the second on increased levels of social activity, were provided to a group of community-living participants aged 75 years and over. Another group, receiving no intervention was also included. The exercise intervention offered twice weekly sessions of exercise over a 16-week period. This was designed and supervised by physiotherapists. The social intervention offered a weekly, two-hour session over 13 weeks. Baseline, post-intervention and follow-up assessments measured aspects of physical performance (muscle, balance, gait and step height performance) and functional ability (tiredness of limbs, mobility tiredness and the need for assistance with mobility and activities of daily living). In addition, all participants completed a monthly health and falls report. One hundred and forty-nine subjects were admitted into the study with 108 completing the intervention phase and all four assessments.Analysis of data indicated that the exercise intervention was effective in improving muscle performance (shoulder abduction mean difference 13.00, 95%CI 11.63-14.37; hip abduction mean difference 5.97, 95%CI 4.73-7.20; knee flexion mean difference 4.10, 95%CI 3.32-4.88; dorsiflexion mean difference 4.72, 95%CI 3.74-5.71), dynamic balance ability (Functional Reach mean difference 11.45, 95%CI 9.41-13.48), ++maximal gait speed (mean difference 0.62, 95%CI 0.50-0.74) and step height performance (mean difference 0.19, 95%CI 0.01-0.29). Improvements in dynamic balance and maximal walk performance were maintained for a period of four months following cessation of the intervention. The social program did not affect aspects of physical performance.Functional improvements were evident for both exercise and social subjects. Immediate improvements in limb tiredness (upper mean difference 0.37, 95%CI -0.11-0.84; lower mean difference 0.63, 95%CI 0.37-0.89) and mobility tiredness (mean difference 1.43, 95%CI 1.16-1.70) and activities of daily living dependence (mean difference 0.25, 95%CI -0.23-0.75) were demonstrated. Four and eight months later, exercise subjects had maintained the improvement in mobility tiredness and activities of daily living dependence. Mobility dependence showed a delayed improvement in both the exercise and social intervention participants. This improvement was not evident immediately following intervention, but emerged at both the four and eight month follow-up assessments.An intention to treat analysis (involving both completing and non-completing subjects) confirmed the usefulness of the exercise intervention as a strategy to improve and maintain functional ability in older subjects, specifically with regard to tiredness of the lower limbs, tiredness during mobility tasks and activities of daily living dependence. In addition, following the cessation of the exercise intervention, participants reported less mobility tiredness and dependence in activities of daily living tasks over the following eight-month period.The relationship between physical performance and functional ability indicated that muscle performance and limb tiredness were significantly associated. Decreased muscle performance of the upper limb was associated with reports of increased ++
tiredness during functional activities involving the upper limb, such as combing hair and dressing the upper body. Similarly, decreased muscle performance of the lower limb, especially proximally, was associated with increasing tiredness of the lower limb during functional activities. Further, decreased proximal muscle performance of both the upper and lower limb was significantly associated with decreasing independence in the performance of physical activities of daily living. These results indicate the significant influence of muscle performance on functional ability, especially on tiredness of the limbs and activities of daily living dependence.The ability to predict future functional limitation, based on decreasing physical performance, was examined and shown to be of limited value. Hip muscle performance and changes in usual gait speed were poorly associated with increased lower limb tiredness and dependence in physical activities of daily living respectively. The lack of a robust relationship between variables of physical performance and functional ability measures indicates that loss of physical performance is not strongly associated with the development of functional limitations.Self-reported falls were monitored throughout the study. A significant increase in the number of participants reporting falls was evident in both the social intervention group and the control group throughout the study. In contrast, there was no change in the number of exercise participants reporting falls. These results suggest that the exercise intervention was effective at minimising the usual increase in the number of older people experiencing falls over time.The results of this study suggest that the exercise intervention program was effective in improving physical performance in elderly subjects. This also resulted in improved functional ability. Positive effects continued ++
following completion of the program as improvements in mobility and activities of daily living tasks were demonstrated for a further eight months. By contrast, the social intervention program appeared to influence only the need for help with mobility tasks in the longer term.Increased physical activity, in the form of an exercise intervention program, specifically designed for community-living elderly people, can improve and maintain functional ability, both immediately and for up to eight months following the completion of the program. As such, involvement in exercise, even in the short-term, should be encouraged as a means of maintaining physical independence in later life. Therapists devising exercise programs specifically for older people should ensure that the associated outcome measures incorporate assessments of functional ability and not simply measures of impairment. This study has demonstrated that a real benefit of increased physical activity in older people may well be the increased physical independence associated with participation.
2
Brown, Annette. "Functional adaptation to exercise in elderly subjects." Thesis, Curtin University, 2002. http://hdl.handle.net/20.500.11937/401.
Full textAbstract:
Maintenance of physical function with advancing age is vital to continued independent living, which is highly valued by older people. Although commonly associated with the ageing process, loss of functional ability may well be accelerated by inactivity and subsequent decreasing physical capacities, such as muscle performance or balance abilities. The impact of increased levels of activity on physical performance and functional ability was investigated by a single blind randomised controlled study.Two intervention programs, one based on increased levels of physical activity and the second on increased levels of social activity, were provided to a group of community-living participants aged 75 years and over. Another group, receiving no intervention was also included. The exercise intervention offered twice weekly sessions of exercise over a 16-week period. This was designed and supervised by physiotherapists. The social intervention offered a weekly, two-hour session over 13 weeks. Baseline, post-intervention and follow-up assessments measured aspects of physical performance (muscle, balance, gait and step height performance) and functional ability (tiredness of limbs, mobility tiredness and the need for assistance with mobility and activities of daily living). In addition, all participants completed a monthly health and falls report. One hundred and forty-nine subjects were admitted into the study with 108 completing the intervention phase and all four assessments.Analysis of data indicated that the exercise intervention was effective in improving muscle performance (shoulder abduction mean difference 13.00, 95%CI 11.63-14.37; hip abduction mean difference 5.97, 95%CI 4.73-7.20; knee flexion mean difference 4.10, 95%CI 3.32-4.88; dorsiflexion mean difference 4.72, 95%CI 3.74-5.71), dynamic balance ability (Functional Reach mean difference 11.45, 95%CI 9.41-13.48), maximal gait speed (mean difference 0.62, 95%CI 0.50-0.74) and step height performance (mean difference 0.19, 95%CI 0.01-0.29). Improvements in dynamic balance and maximal walk performance were maintained for a period of four months following cessation of the intervention. The social program did not affect aspects of physical performance.Functional improvements were evident for both exercise and social subjects. Immediate improvements in limb tiredness (upper mean difference 0.37, 95%CI -0.11-0.84; lower mean difference 0.63, 95%CI 0.37-0.89) and mobility tiredness (mean difference 1.43, 95%CI 1.16-1.70) and activities of daily living dependence (mean difference 0.25, 95%CI -0.23-0.75) were demonstrated. Four and eight months later, exercise subjects had maintained the improvement in mobility tiredness and activities of daily living dependence. Mobility dependence showed a delayed improvement in both the exercise and social intervention participants. This improvement was not evident immediately following intervention, but emerged at both the four and eight month follow-up assessments.An intention to treat analysis (involving both completing and non-completing subjects) confirmed the usefulness of the exercise intervention as a strategy to improve and maintain functional ability in older subjects, specifically with regard to tiredness of the lower limbs, tiredness during mobility tasks and activities of daily living dependence. In addition, following the cessation of the exercise intervention, participants reported less mobility tiredness and dependence in activities of daily living tasks over the following eight-month period.The relationship between physical performance and functional ability indicated that muscle performance and limb tiredness were significantly associated. Decreased muscle performance of the upper limb was associated with reports of increased tiredness during functional activities involving the upper limb, such as combing hair and dressing the upper body. Similarly, decreased muscle performance of the lower limb, especially proximally, was associated with increasing tiredness of the lower limb during functional activities. Further, decreased proximal muscle performance of both the upper and lower limb was significantly associated with decreasing independence in the performance of physical activities of daily living. These results indicate the significant influence of muscle performance on functional ability, especially on tiredness of the limbs and activities of daily living dependence.The ability to predict future functional limitation, based on decreasing physical performance, was examined and shown to be of limited value. Hip muscle performance and changes in usual gait speed were poorly associated with increased lower limb tiredness and dependence in physical activities of daily living respectively. The lack of a robust relationship between variables of physical performance and functional ability measures indicates that loss of physical performance is not strongly associated with the development of functional limitations.Self-reported falls were monitored throughout the study. A significant increase in the number of participants reporting falls was evident in both the social intervention group and the control group throughout the study. In contrast, there was no change in the number of exercise participants reporting falls. These results suggest that the exercise intervention was effective at minimising the usual increase in the number of older people experiencing falls over time.The results of this study suggest that the exercise intervention program was effective in improving physical performance in elderly subjects. This also resulted in improved functional ability. Positive effects continued following completion of the program as improvements in mobility and activities of daily living tasks were demonstrated for a further eight months. By contrast, the social intervention program appeared to influence only the need for help with mobility tasks in the longer term.Increased physical activity, in the form of an exercise intervention program, specifically designed for community-living elderly people, can improve and maintain functional ability, both immediately and for up to eight months following the completion of the program. As such, involvement in exercise, even in the short-term, should be encouraged as a means of maintaining physical independence in later life. Therapists devising exercise programs specifically for older people should ensure that the associated outcome measures incorporate assessments of functional ability and not simply measures of impairment. This study has demonstrated that a real benefit of increased physical activity in older people may well be the increased physical independence associated with participation.
3
Saxton, Judith. "Cognitive and functional decline in Alzheimer's disease." Thesis, University of Reading, 1990. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.254512.
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Skelton, Dawn Alexandra. "Strength, power and functional ability of healthy elderly people." Thesis, University College London (University of London), 1995. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.301793.
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Kvern, Margaret Anne Lysack. "Symptom distress, functional ability, family function and decision making preferences in cancer patients and their families." Thesis, National Library of Canada = Bibliothèque nationale du Canada, 2001. http://www.collectionscanada.ca/obj/s4/f2/dsk3/ftp04/MQ56133.pdf.
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Chilma, Dorothy Madalo. "Nutritional status and functional ability of older people in rural Malawi." Thesis, London School of Hygiene and Tropical Medicine (University of London), 1999. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.312510.
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7
Cunningham, Victoria Lynn. "Evaluation of a self-report measure of low-vision functional ability." Diss., The University of Arizona, 2003. http://hdl.handle.net/10150/280406.
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The majority of data used in outcome research has until recently been based primarily on treatment provider observations of the patient. Estimating the effect of rehabilitation treatment on functional ability is increasingly relying on patient self-report ratings. Controlling for measurement bias associated with the subjective nature of this type of data was handled by putting self-report and clinician responses to items on an 11-item functional ability instrument into the same metric using a Rasch model, allowing for an accurate picture of whether and how their perceptions differ. For this study, the traditionally clinician-rated instrument was modified to accommodate self-report ratings. The questionnaire was verbally administered during individualized discharge interviews to 112 visually-impaired geriatric veterans whose responses were then paired with clinician ratings. Clinician ratings replicate previous findings which provided a stable foundation against which the self-report ratings were compared. Fit statistics for self-report ratings demonstrate unidimensionality of the assumed functional ability construct. Construct validity, or to what extent clinicians and patients agree on what it is that is being measured (i.e., functional ability), was supported by a moderate correlation between person ability estimates. More informative, however, was the agreement on item difficulty estimates. While six of the 11 items had roughly the same difficulty estimates across the two rating samples, 5 others lacked agreement. Two possible reasons for this incongruity are (1) patient expectations about what they should be able to do by the end of rehabilitation are not realized and (2) exemplars used in eliciting self-report ratings are not as specific as those used by clinicians. The single-factor structure was also analyzed by a confirmatory factor analysis. Although the model did not meet conventional criteria of .95 for the CFI, it was the most parsimonious solution for both sets of ratings as demonstrated by a multisample analysis. These analyses indicated that self-perceived functional ability ratings may be used in place of clinician ratings on the majority of the FAST items. Until the remaining items are modified, at this point, self-report ratings may, at best, supplement, but not be used in place of, clinician ratings.
8
Dickerson, Anne E. "Age differences in functional performance : deficits or artifacts?" FIU Digital Commons, 1991. http://digitalcommons.fiu.edu/etd/2810.
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An experiment was conducted to compare the functional performance of 20 young adults and 20 older adults in two types of tasks. One type of task was normal activities of daily living which are meaningful, familiar, and well practiced while the other type was a contrived, relatively unfamiliar task of wrapping a package. While young and old adults did not differ in the ratings of the familiarity of the two tasks, results from an Age by Task Type mixed MANOVA demonstrated a significant age difference in both activities. This suggests that older adults show age-related decline with tasks even when those tasks are familiar, practiced, and ecologically valid.
9
Masood, Ansar. "Functional Metallic Glasses." Doctoral thesis, KTH, Teknisk materialfysik, 2012. http://urn.kb.se/resolve?urn=urn:nbn:se:kth:diva-101901.
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For decades, Metallic Glass, with its isotropic featureless structure while exhibiting outstanding mechanical properties was possible only at a high rate of quenching and with at least one dimension in the submicron regime. This limitation was overcome with the discovery of Bulk Metallic glasses, BMGs, containing three or more elements following the additional two empirical rules of optimum geometric size differences and negative energy of mixing among the constituent elements. Since then thousands of Fe-, Ni-, Al-, Mg-, Ti- based BMGs have been discovered and comprehensively investigated mainly by groups in Japan and USA. Yet the discovery of new combinations of elements for BMGs is alchemy. We do not know with certainty which element when added will make possible a transition from being a ribbon to a bulk rod. In this thesis we report a discovery of castable BMGs rods on substitution of Fe by nickel in an alloy of FeBNb which could otherwise have been only melt-spun into ribbons. For example, we find that substitution of just 6 at.% of Fe raises the glass forming range, GFA, to as much as ∆Tx =40K while the other parameters for GFA like Trg, γ, and δ reach enhanced values 0.57, 0.38, and 1.40 respectively. Furthermore, the electrical conductivity is found to increase by almost a factor of two. Magnetically it becomes softer with coercivity 260mOe which further reduces to much lower values on stress relaxation. Ni does not seem to carry a magnetic moment while it enhances the magnetic transition temperature linearly with Ni concentration. We have investigated the role of Ni in another more stable BMGs based FeBNbY system in which case ∆Tx becomes as large as 94K with comparable enhancement in the other GFA parameters. Due to the exceptional soft magnetic properties, Fe-based bulk metallic glasses are considered potential candidate for their use in energy transferring devices. Thus the effect of Ni substitution on bulk forming ability, magnetic and electrical transport properties have been studied for FeBNb and FeBNbY alloy systems. The role of Ni in these systems is densification of the atomic structure and its consequence. We have exploited the superior mechanical properties of BMGs by fabricating structures that are thin and sustainable. We have therefore investigated studies on the thin films of these materials retaining their excellent mechanical properties. Magnetic properties of FeBNb alloy were investigated in thin films form (~200-400nm) in the temperature range of 5-300K. These Pulsed Laser deposited amorphous films exhibit soft magnetism at room temperature, a characteristic of amorphous metals, while they reveal a shift in hysteresis loop (exchange anisotropy, HEB=18-25Oe), at liquid helium temperature. When thickness of films is reduced to few nanometers (~8-11nm), they exhibit high transparency (>60%) in optical spectrum and show appreciably high saturation Faraday rotation (12o/μm, λ= 611nm). Thin films (~200-400nm) of Ni substituted alloy (FeNiBNb) reveal spontaneous perpendicular magnetization at room temperature. Spin-reorientation transition was observed as a function of film thickness (25-400nm) and temperature (200-300K), and correlated to the order/disorder of ferromagnetic amorphous matrix as a function of temperature. These two phase films exhibits increased value of coercivity, magnetic hardening, below 25K and attributed to the spin glass state of the system. Using the bulk and thin films we have developed prototypes of sensors, current meters and such simple devices although not discussed in this Thesis. Ti-based bulk metallic glasses have been attracting significant attention due to their lower density and high specific strength from structural application point of view. High mechanical strength, lower values of young’s modulus, high yield strength along with excellent chemical behaviors of toxic free (Ni, Al, Be) Ti-based glassy metals make them attractive for biomedical applications. In the present work, toxic free Ti-Zr-Cu-Pd-Sn alloys were studied to optimize their bulk forming ability and we successfully developed glassy rods of at least 14mm diameter by Cu-mold casting. Along with high glass forming ability, as-casted BMGs exhibit excellent plasticity. One of the studied alloy (Ti41.5Zr10Cu35Pd11Sn2.5) exhibits distinct plasticity under uniaxial compression tests (12.63%) with strain hardening before failure which is not commonly seen in monolithic bulk metallic glasses.QC 20120906
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Sander, Sarah E. "The Effects of a core strengthening program on lower extremity functional ability /." Link to PDF version, 2005. http://libweb.cup.edu/thesis/umi-cup-1003.pdf.
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Manandhar, Mary Catherine. "Undernutrition and impaired functional ability amongst elderly slum dwellers in Mumbai, India." Thesis, London School of Hygiene and Tropical Medicine (University of London), 1999. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.367911.
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Habermann, Barbara L. "Speechreading ability in elementary school-age children with and without functional articulation disorders." PDXScholar, 1990. https://pdxscholar.library.pdx.edu/open_access_etds/4087.
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The purpose of this study was to compare the speechreading abilities of elementary school-age children with mild to severe articulation disorders with those of children with normal articulation. Speechreading ability, as determined by a speechreading test, indicates how well a person recognizes the visual cues of speech. Speech sounds that have similar visual characteristics have been defined as visemes by Jackson in 1988 and can be categorized into distinct groups based on their place of articulation. A relationship between recognition of these visemes and correct articulation was first proposed by Woodward and Barber in 1960. Dodd, in 1983, noted that speechread information shows a child how to produce a sound, while aural input simply offers a target at which to aim.
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Brown, Tyler Nolan. "The effects of acute muscular fatigue on the functional ability of the knee joint." Thesis, Montana State University, 2005. http://etd.lib.montana.edu/etd/2005/brown/BrownT1205.pdf.
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Freeman, Kaye Elizabeth. "Disease activity, functional ability and psychological status in individuals with newly diagnosed rheumatoid arthritis." Thesis, University of Derby, 1999. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.313220.
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Wallace, Linda S. "Self-efficacy expectations and functional ability in everyday activities in clients undergoing total knee arthroplasty." Virtual Press, 2000. http://liblink.bsu.edu/uhtbin/catkey/1180777.
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This longitudinal, descriptive study based on Bandura's self-efficacy theory (1977), examined the effects of educational activities on self-efficacy and of self-efficacy on functional ability in everyday activities in clients undergoing elective, primary, unilateral, total knee arthroplasty (TKA). Educational activities included: attending a joint replacement class and a physical therapy session, performing exercises, and reading educational materials. Other sources of client information were also discussed. Self efficacy was assessed regarding confidence in ability to perform activities required for discharge home. Cronbach's alpha for the self-efficacy scale was .94 (pre-education) and .81 (post-education). Functional ability in everyday activities was operationalized as length of hospital stay, discharge placement, and perceived health status. Perceived health status was assessed using the three-scale Western Ontario McMasters University Osteoarthritis Index (WOMAC). Cronbach's alpha was: pain .85, joint stiffness .76, and physical function .94 (preoperatively); and pain .86, joint stiffness .80, and physical function .94 (postoperatively).Evidence was collected from a convenience sample of 31 participants: (a) when the process of scheduling surgery began; (b) before surgery, after the client had opportunities to participate in educational activities, and (c) approximately six weeks after surgery. The orthopedic surgeon and professional staff reviewed instruments for validity. Five clients reviewed the questionnaires for understandability and readability. Data were analyzed using Pearson r correlation coefficients, independent samples t-tests, analyses of variance and chi-square tests. An alpha level of .05 was designated as significant.Higher self-efficacy scores were associated with more expected benefits, previous TKA, and greater pain relief. Lower self-efficacy scores correlated with greater improvement in self-efficacy. Shorter lengths of hospital stay were associated with greater joint stiffness reduction, younger age and previous TKA. Discharge home was associated with younger age and living with someone else. Participants that were "very sure" of the need for TKA exhibited higher self-efficacy scores than participants that were "unsure". Improved outcomes were not associated with any one type of educational activity.This study highlighted the need for further refinement of context sensitive self-efficacy instruments, more sophisticated means of assessing the impact of an increasing array of information sources and more longitudinal studies with larger sample sizes.Department of Educational Leadership
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Sellers, Diane. "Development of a functional eating and drinking ability classification system for individuals with cerebral palsy." Thesis, University of Brighton, 2014. https://research.brighton.ac.uk/en/studentTheses/104fbc32-1d32-4aec-8b28-b9bec6e19ef5.
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Background: Disorders of movement and posture associated with cerebral palsy (CP) often lead to childhood difficulties with feeding, eating, drinking and swallowing which extend into adulthood. The consequences of compromised eating and drinking skills include respiratory disease, due to food and fluid entering the lungs, and malnutrition, leading to poor growth and health. There is no agreement in clinical and research contexts about the classification of eating and drinking abilities of people with CP to reflect severity of limitations to function. The study aim was to develop a valid and reliable system to classify eating and drinking performance of people with CP, using a pragmatic Mixed Methods approach. Method: The first draft of the Eating and Drinking Ability Classification System (EDACS) was developed from my clinical experience, the research literature and clinical assessments. A series of groups were held, using a Nominal Group Process (NGP), inviting experts to closely examine the content and wording of EDACS. After each group, EDACS was modified and presented to the following group until no new ideas or comments were made. A Delphi Survey (DS) was conducted with a wider group of international experts to further examine and modify the content of EDACS; the DS was repeated until 80% of panellists agreed with the content. In the final stage, EDACS was used by speech and language therapists (SaLTs) and parents to classify the eating and drinking abilities of children with CP; the agreement and reliability between classifications was tested. Findings: Fifty six UK experts participated in 7 nominal groups. The revised EDACS draft was examined by 95 expert panellists in an international DS; more than 80% of panellists agreed with the content of EDACS, after two rounds of the DS. Experts included people with CP, parents, health professionals and researchers. When SaLTs used EDACS to classify 100 children, absolute agreement was 78%, kappa=0.72; ICC=0.93 (95% CI 0.90 to 0.95). Any disagreement was only by one level, with one exception. When SaLTs and parents classified 48 children, absolute agreement was 58%, kappa=0.45, ICC=0.86 (95% CI 0.76 to 0.92). Parents either agreed with SaLTs, or rated their children as more able by one level. The new Eating and Drinking Ability Classification System provides a valid and reliable system for classifying eating and drinking performance of people with CP. EDACS describes the whole range of ability from age 3 years, providing a context for parents to consider their own child’s eating and drinking.
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Kersaint, Gladis Swafford Jane. "Preservice elementary teachers' ability to generalize functional relationships the impact of two versions of a mathematics content course /." Normal, Ill. Illinois State University, 1998. http://wwwlib.umi.com/cr/ilstu/fullcit?p9835911.
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Thesis (Ph. D.)--Illinois State University, 1998.Title from title page screen, viewed July 5, 2006. Dissertation Committee: Jane O. Swafford (chair), John A. Dossey, Cheryl Hawker, Cynthia W. Langrall. Includes bibliographical references (leaves 142-158) and abstract. Also available in print.
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Jackson, Allison N. "Neurocognitive Ability in Individuals with Chronic Ankle Instability." Ohio University / OhioLINK, 2017. http://rave.ohiolink.edu/etdc/view?acc_num=ohiou1491917830289932.
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Drummond, Sean Patrick Andrews. "Cerebral activation as measured with functional magnetic resonance imaging during learning and working memory probes before and after total sleep deprivation /." Diss., Connect to a 24 p. preview or request complete full text in PDF format. Access restricted to UC campuses, 2000. http://wwwlib.umi.com/cr/ucsd/fullcit?p9970689.
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Brown, Matthew. "The Ability of the Functional Movement Screen in Predicting Injury Rates in Division I Female Athletes." University of Toledo / OhioLINK, 2011. http://rave.ohiolink.edu/etdc/view?acc_num=toledo1302275741.
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Snyder, Christine M. "A Comparison of Caregiver Report and Performance-Based Measures of Functional Ability in Dementia: An Examination of Moderating Variables." DigitalCommons@USU, 2011. https://digitalcommons.usu.edu/etd/1085.
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The functional abilities of 319 elderly individuals with dementia were assessed using an objective, performance-based measure (the Direct Assessment of Functional Abilities) and caregiver’s report (through the Assessment of Daily Activities and Dementia Severity Rating Scale). The association between the objective measure and caregiver report was examined. Logistic regression analyses demonstrated that caregivers’ reports of instrumental activities of daily living and basic activities of daily living were significantly associated with an objective measure of these functional abilities. Additionally, potential moderating variables were examined. None of the caregiver variables of gender, age, education level, caregiver-care recipient relation, prior and current relationship closeness, and frequency of contact were significant moderators of the association between caregiver report and the objective measure. Caregiver depression, anxiety, emotional status, and distress did not moderate this association. Additionally, none of the care recipient variables of cognitive status, depression, psychiatric symptoms, or dementia duration moderated the association between caregivers’ reports and the objective measure; however, the care recipients’ sensory motor impairments (hand, vision, or hearing impairments) significantly moderated the association between the objective measure and caregiver reports on one measure of functional ability. That is, when the caregiver report indicated mild/moderate functional impairment, the care recipient was 6.52 times as likely to be classified in the more severe group on the objective measure when sensory motor impairments were severe (p < 0.02), whereas the caregiver report and the objective measure were not associated for those care recipients whose caregiver report score indicated severe impairment when sensory motor impairments were mild/moderate (p = 0.24). These results provide some support for the use of proxy reports of functional abilities, with caution advised when the care recipient displays sensory motor impairments.
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Riekert, Marlene. "Effek van 'n kleinspier-ontwikkelingsprogram op die motoriese vermoë van ABET-leerders." Pretoria : [S.n.], 2005. http://upetd.up.ac.za/thesis/available/etd-07202005-160815.
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Brunton, Luke R. "Assessing functional ability in patients with severe hip and knee osteoarthritis : an assessment of measures of function in hip and knee joint replacement." Thesis, University of Bristol, 2015. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.686424.
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Introduction/Background: Outcomes assessment in orthopaedics has advanced over the last decade. There are various different methods that can be used in a clinical setting to assess function and pain. During a clinical consultation, a simple, quick and restricted history, examination and review of investigations can be undertaken. Aim: I wished to ascertain whether function improved as a result of knee or hip joint replacement, and which of the commonly used existing methods of assessing function are of most value in this context. Methods: To achieve this aim, I recruited a broad spectrum of patients about to undergo primary or revision surgery for hip (n=42) or knee (n=51) joint disease. The study design was an observational cohort study, with data collection points pre-operatively and at 3 months post-operatively. Results: Most participants had less pain and better function 3 months after surgery than pre-operatively. However, the mean scores obscured the fact that several participants showed no improvement or worsening on some of the scores. Participants with the worst functional scores at baseline were most likely to improve. Performance tests showed less overall improvement than self-assessment measures. Overall walking times correlate well with all the other scores, with the exception of the Short Form-12 mental component score and American Knee Society Knee Score. However, in hip participants those with the best Harris Hip Scores did not have the best walking times, or the best Western Ontario and McMaster Arthritis Index or best Short Form-12 scores. Flexion beyond 90 degrees did not correlate with functional scores at the hip. Both inter and intra-rater reliability findings were good for both the Harris Hip Score and American Knee society score. Conclusions: Differences are identified in the outcome between different health status instruments commonly used in assessing function by self report questionnaires, surgeon based and performance based assessments. More research is needed to identify either the best method or more likely different instruments to identify important specific domains after hip and knee joint surgery.
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Mac, Duff Lorraine. "The physical characteristics and functional manual handling ability of males and females ammunition handlers / Lorraine Mac Duff." Thesis, North-West University, 2005. http://hdl.handle.net/10394/815.
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Mismatch of human capabilities and the physical requirements of the job they are employed
to do, are often the focus of attention for ergonomists. Efforts to address these mismatches
require that the determination of both the characteristics of the job demands, as well as the
capabilities of the individual or population are objectively quantified.
A heavy manual handling task that was inherent in the performance of a specific job within a
military environment became the focus of this study. Concern was raised regarding the safety
and efficiency of the current employee population to carry out this task, with the equipment
and procedures that was originally designed for use by a younger and all male population.
Despite the change in user profile, there were no selection criteria in place for employee
selection that was based on objective quantified measurements of the physical demands of the
job.
Thus, the objectives of the study were as follows:
1. To determine if the lifting and carrying capabilities of the current population of
ammunition handlers can safely match the requirements of the manual
handling tasks inherent in their job.
2. To determine the correlation between aerobic, strength exertion or
anthropometric characteristics of the ammunition handler and their manual
handling capability.
3. To compare the functional strength capabilities between the female and male
ammunition handlers.
A one-time cross sectional study design was used. One hundred and eighty seven subjects
participated in the study, thirty eight of whom were women. The participants were drawn
from a sample of convenience from the worker population and who voluntarily agreed to
participate in the study.
A multi-faceted approach was taken to address the characteristics and capability of the
participants regarding manual material handling. The measured parameters included: basic
anthropometry, an aerobic capacity prediction test, isokinetic arm and leg strength tests and
an isometric back strength test. The participants also underwent a functional lift and carry test
that was designed specifically for this study and made use of the key ergonomics components
for the manual handling task being addressed. Dummy objects were constructed to replicate
the object that is handled, in three different mass configurations; 47 kg, 35 kg and 20 kg.
The results of the functional lift and carry test of the total population were compared to that of
the job requirements in terms of the mass of the object (47 kg), the time duration, the number
of repetitions and the levels to which the object had to be lifted (300 mm, 900 mm and
1500 mm) . The results indicated that only 43% of the total sample group could safely and
effectively match the manual handling requirements of the job. Of that group, 0% of the
women were able to fully meet the requirements.
Correlation tests were applied to the results of the anthropometric variables, the results of the
predicted aerobic capacity test, the arm, leg and back muscle strength tests, with that of the
functional lift and carry capability test results. There were no correlations found between the
functional test and that of the other variables. There was a moderate correlation found
between aerobic capacity and functional lift ability, as well as between right knee concentric
extensors endurance results and that of functional lift ability. Thus, there were no strong
predictive tests that could be used for employment screening purposes; the functional test
remains the closest representation to the job requirements.
The results of the functional test of the men and women subgroups were analysed for effect
size. There was a large effect size calculated (d>0.80) between the functional lift ability of
the men and the women of all levels for all masses. The implication is that a task must first
be designed to be non gender biased before a policy of open employment for heavy manual
handling tasks can be successfully implemented.
The findings of the study confirm that the entire current worker population would probably
not be able to safely and effectively perform the manual handling task they were required to
do within their post profile. The implications are that the risks for musculoskeletal injuries,
fatigue, uneven workload distribution and poor performance are high. The capabilities of the
workers do not match that of the job demands. However, should the mass of the object that is
handled be replaced with an object of similar capability and characteristics, but having a mass
of not more than 20 kg, more than 98% of the sample population would then be able to safely
and effectively perform the task.
The ergonomics interventions required to improve the mismatch of the job requirements to
capabilities would include 1) redesign of the manual handling task or 2) implementing a
functionally based selection criterion for employees to be posted in the specific job profile.Thesis (M.Sc. (Human Movement Science))--North-West University, Potchefstroom Campus, 2005.
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Welch, Emily C. "Functionally illiterate adults resolve reading difficulties presented by lexically ambiguous words : an investigation of the ability of the lexical quality hypothesis to describe differential reading skill /." Connect to online version, 2005. http://ada.mtholyoke.edu/setr/websrc/pdfs/www/2005/122.pdf.
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Westerbotn, Margareta. "Drug use among the very old living in ordinary households : aspects on well-being, cognitive and functional ability /." Stockholm, 2007. http://diss.kib.ki.se/2007/978-91-7140-979-9/.
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Fenwick, Debbie A. "Impairment, functional ability and quality of life in total hip replacement patients two to four years following surgery." Thesis, Queen Margaret University, 2006. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.435573.
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Eriksson, Jeanette Källstrand. "Being on the trail of ageing : functional visual ability and risk of falling in an increasingly ageing population." Doctoral thesis, Örebro universitet, Institutionen för hälsovetenskap och medicin, 2014. http://urn.kb.se/resolve?urn=urn:nbn:se:oru:diva-33837.
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The elderly population is estimated to increase worldwide. One of the major health determinants identified in this population are injuries where one of the most prevalent causes are falls. The overall aim of this thesis was to describe and explore visual impairment and falls of inpatients and independently living elderly in the community and how daily life activities were influenced by visual ability and risk of falling. Methods in the studies were a quantitative retrospective descriptive design for study I followed by two quantitative retrospective and explorative studies where in study II perceived vision related quality of life and in study III performance-based visual ability were investigated. Study IV was a qualitative explorative study using classic grounded theory. In study I all falls of inpatients at a medical clinic 65 years and older (n=68) were registered during one year. In study II and III a random sample (n=212) of independently living elderly between 70 and 85 years of age participated in both studies. In study IV seven women and six men between 73 and 85 years of age from the two previous studies and six visual instructors (n=19) participated. The data in study I was collected during 2004, study II and III between February 2009 to March 2010 and study IV December 2009 to January 2013. The results in study I showed that most falls in five hospital wards occurred at night and those most affected had an established visual impairment. Almost half the population in study II and III fell at least once. Perceived vision when performing daily life activities showed a positive association between visual impairment and falls in men but not in women (II). No associations were found between performance-based measured visual ability and falls (III). Visually impaired elderly did not consider risk of falling as a problem (). Their main concern is to remain themselves as who they used to be which is managed by self- preservation while maintaining their residual selves and resisting self decay. Maintaining residual self is done by living in the past mostly driven by inertia while resisting self decay is a proactive and purposeful driven strategy. It is a complex issue to do fall risk assessments and planning fall preventive action where the individual’s entire life situation has to be taken into consideration.
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Ryan, Cormac. "Free-living physical activity as an outcome measure of functional ability in individuals with chronic low back pain." Thesis, Glasgow Caledonian University, 2008. https://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.493920.
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Functional ability is an important outcome measure in people with chronic low back pain (CLBP). It is predominantly measured using self-report and physical performance testing. Both methods have limitations, and neither provides an objective insight into a person's functional ability in everyday life. The purpose of this thesis was to investigate if free-living physical activity (PA) monitoring could be used as an objective marker of functional ability during everyday life in people with chronic low back pain (CLBP).
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Moore, Margaret. "Examining the reading proficiency of office workers." Thesis, This resource online, 1994. http://scholar.lib.vt.edu/theses/available/etd-06232009-063359/.
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Doldo, Neil Anthony. "Racial and sex differences in strength, peak power, movement velocity, and functional ability in middle aged and older adults." College Park, Md. : University of Maryland, 2004. http://hdl.handle.net/1903/2331.
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Thesis (M.A.) -- University of Maryland, College Park, 2004.Thesis research directed by: Kinesiology. Title from t.p. of PDF. Includes bibliographical references. Published by UMI Dissertation Services, Ann Arbor, Mich. Also available in paper.
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Hamilton, Dawn M. "The influence of exercise self-efficacy on compliance, functional ability, and quality of life in a cardiac rehabilitation population." Thesis, National Library of Canada = Bibliothèque nationale du Canada, 2000. http://www.collectionscanada.ca/obj/s4/f2/dsk2/ftp03/MQ54712.pdf.
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Steffensen, Birgit F. "Functional ability in non-ambulatory people with Duchenne muscular dystrophy or spinal muscular atrophy assessed with the EK scale /." Stockholm, 2002. http://diss.kib.ki.se/2002/91-7349-252-3.
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Grindlay, Benjamin James William. "Comparison of psychological wellbeing and functional ability between elderly persons living independently and those residing in aged-care homes /." Title page, contents and abstract only, 1998. http://web4.library.adelaide.edu.au/theses/09SPS/09spsg866.pdf.
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Marti-Morales, Madeline. "Care coordination, family-centered care and functional ability in children with special health care needs in the United States." ScholarWorks, 2011. https://scholarworks.waldenu.edu/dissertations/870.
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Children with special health care needs (CSHCN) generally have physical, mental, or emotional conditions that require a broader range and greater quantity of health and related services compared to typical children. Care coordination (CC) and family-centered care (FCC) are necessary in the quality of health care for CSHCN. A gap exists in the literature regarding the impact of CC and FCC on children's functional ability (FA). Previous researchers have focused on met and unmet health care needs, but not on health outcomes or functionality. The purpose of this study was to determine if there was an association between CC, FCC, and FA in CSHCN. The design of this study was a secondary analysis of data from the 2005--2006 National Survey of CSHCN. The study was guided by an adapted socioecological multilevel conceptual framework. Statistical methods included univariate, bivariate, and multiple logistic regression analysis. Results indicated that CC was associated with FA in CSHCN. CSHCN that did not receive CC had a 53% increased risk (OR =1.53, 95%CI 1.21--1.94, p < 0.001) for a limitation in FA compared to CSHCN that received CC, controlling for age, gender, number of conditions, household poverty level, parental educational level, and health insurance. FCC was not associated with a limitation in FA in CSHCN ( p = 0.61). Findings from this study were consistent with the socioecological multilevel framework and the literature on care coordination. This study contributed to positive social change by providing information that can be used by public health officials, health care providers and policy makers in developing policies to assure that care coordination is provided to CSHCN and their families in order to improve their health outcomes and functionality.
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Dickerson, Anne E. "The effect of familiarity of task and choice on the functional performance of young and old adults." FIU Digital Commons, 1994. http://digitalcommons.fiu.edu/etd/2809.
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An experiment was conducted to compare the functional performance of young and old adults on familiar and unfamiliar tasks under two conditions of perceived control. Specifically, the relation between age and motor and process skills was examined. The familiar tasks were simple cooking tasks, whereas the unfamiliar tasks were contrived, meaningless tasks developed for this study. Young and old did not differ in the ratings of the familiarity of the tasks, but results from two Age by Task by Choice ANOVAs demonstrated a significant age difference for motor and process skills under all conditions. For the process skill scale, there was also a significant main effect for choice. This suggests that older adults demonstrate age-related decline even with activities that take motivational, experiential, and ecological validity components into account. Results also support the concept that perceived control can improve performance, but not differentially for older adults; that is, young and old adults both demonstrated improved performance when given their choice of tasks.
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Love, Sarah C. "The effect of botulinum toxin-A on the functional ability of young children with spastic hemiplegia due to cerebral palsy." Thesis, Curtin University, 2009. http://hdl.handle.net/20.500.11937/847.
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The purpose of this thesis is to determine the impact of very early-start injection of botulinum toxin-A (BoNT-A) on the quality of movement and the functional ability of children with hemiplegic cerebral palsy (CP). Traditionally, physiotherapy either with or without orthotic management has always been the mainstay of attempts to reduce muscle tone and improve function in children with CP. Several studies have demonstrated that injections of BoNT-A were effective in reducing spasticity in children with CP, and perhaps effective in preventing or reducing fixed muscle contracture, yet the tendency in published studies has been to concentrate on the outcomes of impairment (spasticity and range of movement measures) rather than on disability or functional ability.Over an extended period of time (1997–2008) two longitudinal, matched-pair, randomised, controlled trials (RCTs) were conducted to investigate the effect of BoNT-A on functional ability in children with spastic CP. The first matched-pair RCT in ambulant children with spastic hemiplegia due to CP was conducted between 1997 and 1999, and published in 2001. The aim was to determine the impact of BoNT-A on functional ability and gait. The length of time of the response to BoNTA was measured using the Modified Ashworth Scale (MAS), and the ratio of dynamic range of movement (R1) to static muscle length (R2). Functional ability was measured using the 88-item Gross Motor Function Measure (GMFM-88) and parental report. Although the subjects were matched on three separate and distinct criteria, there was significant variation in the degree and type of disability between the matched pairs. To enable the reporting of absolute measures of change to be clinically meaningful, an adjunct method of reporting outcomes (proportional change) was developed. This allowed change following intervention to be expressed in a manner that is both individualised and generalisable.This RCT demonstrated that the reduction in spasticity brought about by BoNT-A appeared to lead to a clinically significant acceleration of motor progress and improvement in walking patterns in children with spastic hemiplegia, aged between three and 13 years. Satisfaction was greater in the parents of recipients than in the parents of controls, but this may have been a placebo effect since their satisfaction did not correlate with the amount of improvement in spasticity or function in their child. The significant functional improvement documented after the injection of BoNT-A lasted longer than the pharmacological effect and there were no adverse events related to BoNT-A.These findings were included in pivotal submissions by Allergan Pty Ltd, the manufacturer of BOTOX® (the brand of BoNT-A used in the studies) as evidence, firstly to the Therapeutic Goods Administration, requesting approval for the use of BoNT-A in spastic equinus in children with CP aged two years and older, and secondly to the Australian Government, requesting Pharmaceutical Benefits Schemelisting for BoNT-A. Both submissions were successful. The submissions have resulted in BoNT-A being a recommended clinical intervention in Australia for the treatment of spastic equinus in children with CP over two years of age and the provision of government rebate or subsidy for BoNT-A when used for this indication.The finding of functional improvement in this first study also provided the justification for the second study presented in this dissertation: an investigation into the use of BoNT-A to facilitate functional gain in children with CP younger than two years of age.A second matched-pair, RCT of six monthly injections of BoNT-A in infants as they initiated early ambulation by pulling to stand commenced in 2002. The objectives were to determine the impact on the development of upright independent ambulation, to evaluate improvements in the quality of any motor gains achieved and identify any adverse issues that may be associated with administering BoNT-A to the very young infant. This was identified as the ‘early-start’ project.The outcome measures included measures of local technical response (MAS, R1 and R2) along with measures of functional ability and quality of movement (Gross Motor Function Measure, Gross Motor Performance Measure, Assisting Hand Assessment and the Physician Rating Scale).Increased functional gain and increased quality of movement of the children in the intervention (early-start) group compared with those in the control (standard practice) group was detected at follow-up at both two and three years of age.The findings also revealed that BoNT-A in doses of up to 12 Ukg-1 (BOTOX®, Allergan Pty Ltd, Irvine USA) proved to be safe and efficacious in the 20 children in this study, the youngest of whom was 11 months of age at admission. The possibility of dystonia being a contributor to contracture development also emerged as an interesting element of this second study.One issue that became obvious through the progress of the studies was the difficulty associated with the clinical identification and quantification of spasticity. In fact, it became clear that community paediatricians and general practitioners were reluctant to diagnose spastic hemiplegia until well after twelve months of age, in part due to a lack of confidence in clinical measurement tools. This fact led to the development of the Australian Spasticity Assessment Scale (ASAS) which, while not available for use in the two studies described here, was initiated following completion of Study 1 and is included as Chapters 17 and 18 for completeness.The findings of these two RCTs add to the limited body of knowledge about the effects of botulinum toxin type-A on the functional ability of the child with spasticity due to CP. In particular, serial BoNT-A as employed in Study 2 was shown to be safe and effective in improving the speed of acquisition and quality of independent ambulation when commenced at an earlier age (early-start) than current clinical practice advocates. The outcome of these interventions has been examined and shown to be safe and efficacious at an earlier age than that used in current clinical practice.
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Bezy, Judith M. "Driving behavior in a stratified sample of persons aged 65 years and older : associations with geographic location, gender, age, and functional status /." Thesis, Connect to this title online; UW restricted, 2003. http://hdl.handle.net/1773/5611.
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Brink, Marisa. "The effects of backward locomotion as part of a rehabilitation program on the functional ability of patients following knee injury." Thesis, Stellenbosch : University of Stellenbosch, 2010. http://hdl.handle.net/10019.1/5392.
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Thesis (M Sport Sc (Sport Science)--University of Stellenbosch, 2010.ENGLISH ABSTRACT: Knee injuries are common among the physically active population and are often severe enough that it requires surgery. Rehabilitation specialists are on the constant look-out for the most efficient and cost-effective treatment alternatives to provide athletes with an early return to sport. The inclusion of backward locomotion in knee rehabilitation programs has been proposed since it is considered a safe closed kinetic chain exercise which has been found to increase quadriceps strength and power as well as cardiorespiratory fitness. The primary aim of the study was to establish the efficacy of backward locomotion training during a knee rehabilitation program. Thirty nine men and women (aged 18 to 59 years) with knee pathologies volunteered for the study and were randomly assigned to the experimental group (EXP, n = 20) and control group (CON, n = 19). All participants underwent a 24 session knee rehabilitation program which included 20 – 30 minutes of cardiorespiratory training, either in backward mode (EXP), or forward mode (CON). Aerobic fitness, quadriceps and hamstrings strength and power, single leg balance, lower limb circumferences, and lower limb flexibility were measured before and after the rehabilitation program. Backward locomotion training resulted in a borderline statistical significant improvement in ventilatory threshold (VT) (p = 0.07) and a statistical significant improvement in peak power output (PPO) (p < 0.05). The VT and PPO of the backward locomotion group increased by 9 and 14%, respectively, compared to 0 and 4% in the forward locomotion group. Both groups showed statistically significant improvements in quadriceps and hamstrings strength, except the quadriceps of the uninvolved leg of the forward locomotion group. Similarly, both groups showed a statistically significant improvement in quadriceps and hamstrings average power, except the quadriceps of the uninvolved leg of the forward locomotion group. Single leg balance of the involved and uninvolved legs improved statistically significantly in both groups (p < 0.05). The differences in change between the two interventions were not statistically significantly different (p > 0.05) and the practical differences were small (ES ± 0.2). No statistically significant differences in the change in leg circumferences were observed between the two groups. Only the change in flexibility of the involved soleus was significantly different between the EXP and CON groups. The results show that backward locomotion training result in greater improvements in aerobic fitness and equal or greater improvements in quadriceps and hamstrings muscle strength and power, compared to forward locomotion training. Backward locomotion as well as forward locomotion contributes to the recovery of knee injuries, however, the practical significance of backward locomotion is greater than for forward locomotion. The conclusion of this is that backward locomotion is a better alternative rehabilitation program for athletes as this will affect a quicker return to their sport.
AFRIKAANSE OPSOMMING: Kniebeserings kom algemeen voor in die fisiek aktiewe bevolking en is dikwels so ernstig dat dit chirurgie vereis. Rehabilitasie-spesialiste is voortdurend op soek na die mees doeltreffende en koste-effektiewe alternatief vir behandeling om die atlete vinnig te laat terugkeer na hul sport. Die insluiting van agteruitbeweging in knie-rehabilitasieprogramme is al in die verlede voorgestel, aangesien dit beskou word as 'n veilige geslote-kinetieseketting oefening wat al geskik bevind is om quadriceps sterkte en krag, asook kardiorespiratoriese fiksheid te verbeter. Die hoofdoel van die studie was om die effektiwiteit van agteruitbewegingoefening in 'n knierehabilitasieprogram te bepaal. Nege-en-dertig mans en vroue (tussen die ouderdom van 18 en 59 jaar) met kniepatologieë het vrywillig ingestem om aan die studie deel te neem en is lukraak verdeel in die eksperimentele groep (EXP, n = 20) en kontrole groep (CON, n = 19). Alle deelnemers het 24 sessies voltooi waarvan 20 – 30 minute kardiorespiratoriese oefeninge was. Dit het óf in die agteruitrigting (EXP), óf vorentoe-rigting (CON) plaasgevind. Aërobiese fiksheid, quadriceps en hamstrings sterkte en krag, eenbeenbalans, omtrekke van die onderste ledemaat, en soepelheid van die onderste ledemaat is gemeet, voor en na die rehabilitasieprogram. Agteruitbeweging-oefening het 'n geringe verbetering in ventilatoriese draaipunt (VT) (p = 0.07) opgelewer wat grens aan 'n statisties betekenisvolle verbetering, asook 'n statisties betekenisvolle verbetering in piek kraguitset (PPO) (p <0.05). Die VT en PPO van die agteruitbeweging groep het onderskeidelik verbeter met 9 en 14%, in vergelyking met 0 en 4% in die vorentoe-beweging groep. Beide groepe het statisties betekenisvolle verbeteringe in quadriceps en hamstrings sterkte getoon, behalwe die quadriceps van die onbeseerde been van die vorentoe-beweging groep. Soortgelyk daaraan het beide groepe statisties betekenisvolle verbeteringe in quadriceps en hamstrings gemiddelde krag getoon, behalwe die quadriceps van die onbeseerde been van die vorentoe-beweging groep. Eenbeenbalans van die beseerde en onbeseerde bene het statisties betekenisvol verbeter in beide groepe (p < 0.05). Die verskil in verandering tussen die twee intervensies was nie statisties betekenisvol verskillend nie en die praktiese verskil was klein (ES ± 0.2). Geen statisties betekenisvolle verskille is waargeneem tussen die twee groepe in die verandering in beenomtrekke nie. Slegs die soepelheid van die beseerde soleus van die EXP groep het statisties betekenisvol verbeter tussen die twee groepe. Die resultate toon dat agteruitbeweging-oefening tot groter verbetering gelei het in aërobiese fiksheid en gelyke of groter verbetering in quadriceps en hamstrings sterkte en krag, in vergelyking met vorentoe-beweging oefening. Agteruitbeweging-oefening sowel as vorentoe-beweging oefening dra by tot die herstel van kniebeserings, maar die praktiese beduidendheid van agteruitbeweging-oefening is groter as vorentoe-beweging oefening. Die gevolgtrekking van die studie is dat agteruitbeweging 'n beter alternatiewe rehabilitasieprogram vir atlete is, met 'n gevolglike vinniger terugkeer na hul sport.
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Karlsson, Staffan. "Older people`s public health care and social services : Functional ability, health complaints, agreement in needs assessment and care satisfaction." Doctoral thesis, Lund University, Lund, Sweden, 2008. http://urn.kb.se/resolve?urn=urn:nbn:se:hh:diva-30857.
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The overall aim was to describe and compare functional ability and health complaints of older people receiving municipal care in relation to housing and informal care, and factors associated with medical health care, municipal care and informal care. Further, the aim was to investigate agreement in needs assessments between personnel and older people and to investigate care satisfaction and health-related quality of life among older people receiving municipal care and services. Study I and II included 1958 persons aged 65 years and above, who were assessed for functional ability, health complaints, and level of informal and municipal care and service. Study II in addition included data from a register including medical health care. In study III (n=152), standardised needs assessments were performed by the staff. Later, the older person’s view was collected in a personal interview concerning functional ability, health complaints, public and informal care. In addition (Study IV, n=166), SF-12 was used for measuring health-related quality of life and for measuring care satisfaction. Cohabitation was a predictor of a combination of municipal and informal care at home (OR: 5.935), while assistance with Instrumental Activities of Daily Living (IADL) provided by municipal home care and services predicted municipal care only (OR: 0.344). Care in special accommodation was predicted by advanced age (OR: 1.051), dependency in IADL (OR: 19.883), Personal Activities of Daily Living (PADL) (OR: 02.695), and impaired cognitive ability (OR: 3.849) with receiving municipal care only as a reference. Living alone (OR: 0.106), dependency in IADL (OR: 11.348) and PADL (OR: 2.506), impaired cognitive ability (OR: 3.448), impaired vision or blindness (OR: 1.812) and the absence of slowly healing wounds (OR: 0.407) were predictors of special accommodation with a combination of informal and municipal care at home as a reference. 35% of those with public care at home were admitted to hospital and 76% had contact with outpatient care by physician compared to 26% and 87% respectively of those in special accommodation. Living in special accommodation was associated with more contacts with primary health care (B=0.643) and fewer contacts with specialist care (B=-0.722). Informal care was associated with more contacts with primary health care (B=0.413), specialist care (B=0.787), admissions to (B=0.265) and days in hospital (B=1.573). Agreement for dependency in IADL and PADL varied between good (κ=0.78) and moderate (κ=0.43). Poor agreement was found for dizziness (κw=0.17) and fair agreement for impaired hearing, urinary incontinence, pain, anxiety and depressed mood (κw between 0.21 and 0.37). Older persons reported more health complaints than were found in the personnel’s assessments, although significantly lower estimation was found only for incontinence and vision. Agreement for provided public care at home was poor, while for informal care it varied between very good and moderate. Low care satisfaction was associated with dependency in IADL (B=-1.338 and B=-1.630), impaired mobility (B=-12.579), blindness (B=-26.143), faeces incontinence (B=-11.898 and B=-17.529) and anxiety (B=-6.105 and B=-27.197), while high care satisfaction was associated with dependency in PADL (B=2.109) and receiving informal care with IADL from spouse (B=8.738). In special accommodation, low care satisfaction had to do with continuity, timing, the staff’s personal characteristics and with their ability to give service. At home, the older people were the least satisfied with the staff’s ability to do housework and to give medical care, with the staff’s amount of time and with their own influence over their care.Härtill 1 appendix och 4 uppsatser
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Otsuka, Sadao. "Emotion perception mediates the predictive relationship between verbal ability and functional outcome in high-functioning adults with autism spectrum disorder." Kyoto University, 2017. http://hdl.handle.net/2433/225973.
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Gould, Anna. "The use of functional electrical stimulation as a treatment intervention to improve walking ability in a sub-acute stroke population." Thesis, University of Southampton, 2015. https://eprints.soton.ac.uk/393356/.
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To date, few authors have explored whether Functional Electrical Stimulation (FES) of the lower limb, can lead to improvements in gait parameters in a sub-acute stroke population using a randomised controlled study design. Addressing the limitations of previous studies and building on the current evidence to date, this study aims to explore the feasibility of conducting a two week gait training programme combined with FES (targeted to glutei and/or ankle dorsiflexor and evertor muscles) for people with sub-acute stroke, to inform the methodology of a larger randomised control trial. Fifteen medically stable sub-acute stroke survivors were randomised into one of two groups; in addition to routine therapy one group received one hour of gait training four times a week for two weeks (n=7), and the other group received gait training at an identical level of intensity but combined with FES targeted to glutei and/or ankle dorsiflexor and evertor muscles (n=8). Outcome measures, including gait speed and quality of walking pattern, were measured prior to and post gait training intervention, and at six week follow-up. All fifteen participants received the intended intensity of therapy and completed the trial. There were no drop outs during treatment or at follow-up. There was a significant improvement in gait speed and the quality of walking pattern between baseline assessment and immediately following both gait training programmes (week two). These improvements were maintained at six week follow-up. However, no trends were found in favour of either group. The current methodological process proved a feasible approach and sub-acute stroke patients were able to tolerate the gait training interventions however, modifications to the protocol to enhance the success of a follow-on randomised controlled trial are suggested.
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Cavalcante, Rossman Prudente. "AvaliaÃÃo da aptidÃo fÃsica de idosos atendidos em unidade de saÃde da cidade de Fortaleza, CearÃ." Universidade Federal do CearÃ, 2005. http://www.teses.ufc.br/tde_busca/arquivo.php?codArquivo=7587.
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INTRODUÃÃO: Um dos elementos principais da saÃde do idoso diz respeito à sua capacidade funcional e aptidÃo fÃsica. A escala de Katz à um dos diversos instrumentos utilizados para avaliar a capacidade funcional do idoso, mas seu desempenho para esta proposta nÃo tem sido avaliado no contexto dos serviÃos de saÃde do Brasil. Ademais, à importante para o planejamento de aÃÃes de saÃde se identificar o perfil no que se refere à aptidÃo fÃsica dos idosos brasileiros atendidos em unidades de saÃde. OBJETIVOS - O presente estudo teve como objetivos descrever o perfil funcional e a aptidÃo fÃsica de idosos atendidos em uma unidade secundÃria de saÃde na cidade de Fortaleza, CearÃ; e avaliar o desempenho da escala de Katz para rastreio da aptidÃo fÃsica quando comparada com um teste objetivo de avaliaÃÃo fÃsica desenvolvido especificamente para idosos (Senior Fitness Test). DELINEAMENTO/PARTICIPANTES: Estudo transversal com uma amostra de 133 indivÃduos (22 homens e 111 mulheres) com sessenta anos ou mais e que procuraram uma consulta com mÃdico generalista numa unidade secundÃria de saÃde, no caso especÃfico, o Centro de AtenÃÃo ao Idoso da Universidade Federal do CearÃ. RESULTADOS: A faixa etÃria dos participantes foi de 71 anos + 6,5. A maioria da amostra (86,4%) atingiu o escore da escala de Katz compatÃvel com independÃncia funcional. Por outro lado, quase a metade dos idosos (47,3%) apresentou escores crÃticos nas capacidades motoras avaliadas pelo Senior Fitness Test (forÃa, flexibilidade, potÃncia aerÃbia e mobilidade corporal). NÃo houve diferenÃa significativa quanto à aptidÃo fÃsica entre indivÃduos totalmente independentes e indivÃduos que relataram dificuldade em algum dos itens da escala de Katz. Os testes fÃsicos com Ãndices mais baixos foram os que avaliaram a potÃncia aerÃbia e flexibilidade dos mÃsculos que compÃem a cadeia posterior, enquanto que forÃa de membros inferiores e superiores foram os itens com resultados mais satisfatÃrios. Entre as variÃveis socioeconÃmicas analisadas, a idade, o sexo, a escolaridade e o arranjo familiar apresentaram associaÃÃo com alguns dos itens avaliados. CONCLUSÃO â Quase a metade de idosos atendidos em uma unidade secundÃria de saÃde apresentaram comprometimento importante da aptidÃo fÃsica, representando um segmento que necessita potencialmente de intervenÃÃo fÃsica. A escala de Katz nÃo se mostrou adequada para rastreio de comprometimento de aptidÃo fÃsica em idosos que acorrem à unidade de saÃde.RATIONAL â Functional status is one of the key elements for the health of elderly people. Although Katz index is widely used scale for measuring functional status, its validity has not been assessed in the Brazilian context.Furthermore, detailed data on the functional status of elderly people attending secundary care health units in Brazil are not available. OBJECTIVES â the aims of this study were to describe the profile of the functional status and physical fitness of elderly patients attending secondary care health units in a Brazilian city; to assess the performance of the Katz index to screen for physical function impairment against objective tests to assess physical function (gold-standard). DESIGN/PARTICIPANTS â cross-sectional study among elderly patients attending a secundary care health unit in Brazil. RESULTS - 133 patients were enrolled (111 female, 22 male), the mean age of the sample was 71+ 6.5 years. The great majority (86.4%) was classified by the Katz index as functionally independent, but 47.3% were found with functional impairment when assessed by physical tests. There was no association between the scores of physical performance assessed by Katz index and those by the physical tests. The most critically impaired physical domains were aerobic endurance and flexibility of back muscles. The impairment of certain physical domains was associated with age and literacy. CONCLUSIONS â A high proportion of elderly patients attending a secondary care health unit showed physical function impairment, representing those who need physical intervention. In such setting Katz index is not a valid instrument to screen for physical impairment.
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Silasi, Gergely, and University of Lethbridge Faculty of Arts and Science. "Novel treatments for inducing cortical plasticity and functional restitution following motor cortex stroke." Thesis, Lethbridge, Alta. : University of Lethbridge, Faculty of Arts and Science, 2005, 2005. http://hdl.handle.net/10133/278.
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Stroke remains a leading cause of disability in the western world, with symptoms ranging in severity from mild congnitive or motor impairments, to severe impairments in both cognitive and motor domains. Despite ongoing research aimed at helping stroke patients the disease cannot be prevented or cured, therefore a large body of research has been aimed at identifying effective rehabilitative strategies. Based on our understanding of normal brain function, and the meachanisms mediating the limited spontaneous recovery that is observed following injury, factors that promote brain plasticity are likely to be effective treatments for stroke symptoms. The current thesis investigated three novel treatments (COX-2 inhibitor drug, vitamin supplement diet, and social experience) in a rat model of focal ischemia in the motor cortex. All three treatments have been previously shown to alter plasticity in the normal brain, however the current experiments show that the treatments have differential effects following stroke. The COX-2 inhibitors provided limited improvement in functional performance, whereas the vitamin supplement treatment had no effect. Social experience on the other hand was found to block the usually observed spontaneous improvements following the stroke. These results suggest that factors that alter dendritic plasticity may in fact serve as effective stroke treatments depending on the site and the mechanisms whereby the plastic changes are induced.ix, 149 leaves : ill. ; 29 cm.
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Silal, Sandhya Prakash. "A randomised control trial for the restoration of functional ability in patients post total knee arthroplasty: Eccentric versus concentric cycling ergometry." Master's thesis, Faculty of Health Sciences, 2018. http://hdl.handle.net/11427/30804.
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Introduction: While the total knee arthroplasty procedure improves joint-specific outcomes, including pain and range of movement, functional deficits post-surgery has been noted. Movement abnormalities and quadriceps weakness of the operated limb, as well as a decrease in strength on the non-operated have been widely reported. Recovery of strength and function to normal levels is also rare, thereby predisposing patients to future disability with increasing age. The purpose of this study was to determine the effects of an eight-week eccentric cycling ergometry exercise intervention versus a concentric cycling ergometry exercise intervention in total knee arthroplasty recipients three to nine months post-surgery. This study aimed to a) investigate the change in joint kinetics, kinematics and muscle activity during the phases of gait, between the eccentric and concentric groups over time and b) To determine if an eccentric cycling exercise intervention produces greater improvements in knee function when compared to concentric cycling exercise. Methods: Eighteen participants, three to nine months post total knee arthroplasty were recruited and randomly assigned to either an eccentric or concentric cycling exercise intervention group. Participants performed three exercise sessions weekly over a progressive eight-week period on the Grucox Isokinetic Ergometer. Walking gait analyses and functional outcomes, as measured by the six-minute walk test and validated knee scores (Knee Injury and Osteoarthritis Outcome Score, SF-36 Health Survey and Tegner Activity Scale) were recorded pre- and post-intervention. Results: The concentric group knee flexion range of movement increased significantly during the swing phase of gait (p=0.021) post-intervention together with a significant increase in the peak knee flexion angle during swing (p=0.038). The concentric group showed significant differences between pre and post-rehabilitation in knee flexion range of movement during the swing phase of gait (p=0.030). Significant correlations between knee joint stiffness and the quadriceps:hamstring co-activation ratio were observed in the concentric intervention group pre-intervention: during the pre-activation phase of gait between knee joint stiffness and vastus medialis / biceps femoris (r=-0.68; p=0.042) and during load acceptance phase of gait between knee joint stiffness and vastus lateralis / biceps femoris (r=0.07; p=0.036). The eccentric group recorded neuromuscular changes post-intervention with a significant decrease in the muscle activity of the biceps femoris during load acceptance phase of gait (p=0.021). The eccentric group had significantly better functional outcomes in the overall score of Knee injury and Osteoarthritis Outcome post-intervention (p=0.008) with a significant increase in function seen in the Sports and Recreation subgroup (p=0.008) and a significant increase in the level of activity as measure by the Tegner Activity Scale post-intervention (p=0.028), despite not showing any significant changes in the knee joint kinetics and kinematics. The concentric group only reported a significant increase in the overall score of the of the SF-36 Health Survey (p=0.011) with significant increases in three of the subgroups post-intervention: Bodily pains had improved (p=0.042), the role limitations due to physical heath had improved (p=0.028) and the role limitations due to emotional health had also improved (p=0.009). The concentric group also showed significant improvement in the emotional health over the intervention in comparison to the eccentric intervention group (p=0.020). Both intervention groups reported a similar significant increase in the distance covered during the six-minute walk test post-intervention (p=0.038). Conclusion: The results of this exploratory study did not find the eccentric cycling rehabilitation intervention exclusively more effective than the concentric cycling intervention in the restoration of functional ability in patients post-TKA. The eccentric intervention did however result in neuromuscular adaptations consistent with a move towards a more typical asymptomatic gait pattern and participants reported greater functional improvements on validated knee functional assessments and levels of activity scores. The concentric intervention yielded kinematic changes and participants reported improvements in their emotional and physical health post-intervention. Eccentric training and its role in early stage post-operative rehabilitation is limited. Based on the findings from this exploratory study, the benefit of eccentric training as an adjunct to rehabilitation and its role in contributing to greater improvements in the restoration of functional ability post-TKA needs to be further explored.
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Sundling, Catherine. "Overall Accessibility of Public Transport for Older Adults." Doctoral thesis, Stockholms universitet, Perception och psykofysik, 2016. http://urn.kb.se/resolve?urn=urn:nbn:se:su:diva-126301.
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This thesis is based on four studies that explore accessibility for older adults during whole trips by public transport. The overall goal was to gain knowledge of the interrelationships among key variables and to develop a conceptual model of the overall accessibility of public transport. More specifically, the research goals were: (a) to explore links among the key variables postulated to be involved in overall accessibility and to explore the links between these variables and railway accessibility; (b) to gain a deeper understanding of links between critical incidents in traveling and travel behavior decisions; and (c) to develop a conceptual model of overall accessibility. The key variables contributing to overall accessibility are functional ability (depending partly on the person’s functional limitation or disease), travel behavior, and barriers encountered during whole-trip traveling involving train. Respondents with more than one functional limitation or disease reported lower functional ability than did those with only one such limitation and respondents with low functional ability were less frequent travelers than were those with high functional ability. Frequent travelers reported railway accessibility to be better than did those who traveled less frequently. The main barriers were ticket cost and poor punctuality, but respondents with the lowest functional ability attributed the barriers encountered to their own health. The critical incidents most frequently reported were found in the categories “physical environment onboard vehicles” and “physical environment at stations or stops”, as well as in the “pricing and planning during ticketing” phase of the trip. Five themes of reactions to critical incidents were identified that had resulted in behavior change: firm restrictions, unpredictability, unfair treatment, complicated trips, and earlier adverse experiences. A conceptual model of overall accessibility was developed, grounded in the empirical research results. This model is summarized in the following propositions: Overall accessibility is a reciprocal relationship among the barriers/facilitators encountered, functional ability, and travel behavior. Accessibility emerges in the person–environment interaction. To understand accessibility, past experiences and future expectations should both be considered, because both will guide travel decisions.Measurements enable future train travelling for everybody
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Rusonienė, Skirmantė. "Vaikų ūminių artritų diagnsotinių ir prognostinių biožymenų vertinimas." Doctoral thesis, Lithuanian Academic Libraries Network (LABT), 2015. http://vddb.library.lt/obj/LT-eLABa-0001:E.02~2014~D_20150109_111917-94937.
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Apie 70% vaikų, sergančių lėtiniais artritais, suaugusiųjų amžių pasiekia su tam tikru negalios lygiu ir kasdienės veiklos apribojimu. Todėl ypač aktualu nagrinėti vaikams lėtinių artritų priežastis bei prognostinius veiksnius ankstyvose sąnarių ligos stadijose.
Mūsų darbo tikslas buvo nustatyti ar ūminėje ligos fazėje nustatomų laboratorinių, imunologinių ir interleukinų (MRP8/14 (kalprotektinas), IL-6, IL-33) rodiklių pokyčiai, funkcinės būklės vertinimas bei ligos aktyvumas gali prognozuoti vaikams lėtinę sąnarių ligą. Atliktas tyrimas parodė, kad artritu susirgusiems vaikams MRP8/14 (kalprotektino) ir Il-6 koncentracijos buvo reikšmingai didesnės nei kontrolinės grupės vaikams tiek serume, tiek sinoviniame skystyje (p<0,01). Kalprotektinas ir IL-6 ūminėje ligos stadijoje stipriai koreliavo su ligos aktyvumo rodikliais (ENG, CRB, sąnarių pobūdžiu (poliartritu), rytiniu sąnarių sustingimu).
Taip pat nustatėme, kad didelės kalprotektino (> 5785 ng/ml) ir IL-6 (> 5,5 pg/ml) koncentracijos ūminėje artrito stadijoje buvo nustatytos tiems pacientams, kuriems sąnarių liga įgavo lėtinę eigą. Vertinome tai, kaip reikšmingus lėtinės sąnarių ligos kriterijus.
Šiame darbe sergančių artritų vaikų funkcinė būklė ir vaiko gyvenimo kokybė pirmą kartą Lietuvoje buvo įvertinta naujai įdiegiamu ne tik Lietuvoje, bet ir pasaulyje, įvairiapusiu jaunatvinių artritų vertinimo klausimynu JAMAR, bei duomenys palyginti su seniau Lietuvoje naudojamu vaiko sveikatos būklės vertinimo klausimynu... [toliau žr. visą tekstą]The earlier studies proved that nearly 70% of children with chronic arthritis reach the adulthood with a certain level of disability and restriction of daily activities. Therefore, it is very important to analyse the causes of arthritis and prognostic factors in the early stages of disease. The aim of our study was to determine whether the changes of laboratory, immunological and interleukins (MRP8/14 (calprotectin), IL-6, IL-33) indexes, assessment of functional condition, and disease activity may predict a chronic arthritis in children. The study showed that MRP8/14 (calprotectin) and Il-6 concentrations in the serum and synovial fluid of children with arthritis were significantly higher than in the control group of healthychildren (p<0.01). During the acute stage of disease, calprotectin and IL-6 concentrations strongly correlated with variables of disease activity (ESR, CRP, polyarthritis, morning stiffness of joints). Also, the analysis showed that high concentrations of calprotectin (> 5785ng/ml) and IL-6 (> 5.5 pg/ml) at the acute stage of arthritis were determined for those patients, whose were developed chronic arthritis. It was evaluated as significant criterion of the chronic joint disease. For the first time in Lithuania, the functional ability and the quality of life in children with arthritis were assessed using a newly introduced multidimensional assessment questionnaire for juvenile arthritis (JAMAR), and data was compared... [to full text]
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Paula, João Antonio Martini. "Avaliação do idoso : capacidade funcional, independencia e sua relação com outros indicadores de saude." [s.n.], 2007. http://repositorio.unicamp.br/jspui/handle/REPOSIP/253016.
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Orientador: Maria Jose D'Elboux DiogoTese (doutorado) - Universidade Estadual de Campinas, Faculdade de Educação
Made available in DSpace on 2018-08-08T05:57:22Z (GMT). No. of bitstreams: 1 Paula_JoaoAntonioMartini_D.pdf: 1106781 bytes, checksum: 8d6d7cf6d2c4798ef3aa30ddeba613d8 (MD5) Previous issue date: 2007
Resumo: O objetivo desta pesquisa foi identificar associações entre dados sóciodemográficos, de saúde física, antropométricos e de bem-estar subjetivo de 122 idosos atendidos em ambulatório de hospital universitário, e a sua capacidade funcional motora e cognitiva, que foi avaliada por meio da Short Physical Performance Battery (SPPB), do Mini-Exame do Estado Mental (MEEM) e da Medida de Independência Funcional (MIF), de acordo com gênero e faixa etária, verificando também associações entre estes. Foram observadas correlações significativas entre os escores dos três últimos e também entre estes e os outros indicadores. Os homens tiveram maiores rendimento mensal e escores antropométricos. As mulheres tiveram desempenho inferior nos testes SPPB, MEEM e MIF, e pior saúde percebida comparada. Entre grupos etários de 60 a 69, 70 a 79, e 80 anos ou mais, o último apresentou escores ou medidas menores em relação aos outros dois nas medidas antropométricas, na SPPB e no MEEM, mas teve maior bem-estar subjetivo. O número de doenças em prontuário associou-se positivamente ao índice de massa corpórea (IMC) e às circunferências de braço e quadril, e negativamente à pontuação de equilíbrio da SPPB. O número de medicamentos em uso associou-se positivamente ao de doenças, ao peso, ao IMC, e às circunferências de braço, cintura e quadril. Concluiu-se que os testes funcionais se associaram significativamente a outros indicadores de saúde, e que a SPPB e o MEEM, testes de observação direta do desempenho motor e cognitivo, respectivamente, complementaram os dados da MIF, um instrumento que avalia independência funcional em seus aspectos motores e cognitivo-sociais por meio do relato do próprio examinando ou de terceiro
Abstract: The purpose of this study was to identify associations among sociodemographic, physical health, anthropometric and subjective well-being data in 122 ambulatory elders of university hospital, and their motor and cognitive functional capacity, evaluated by means of the Short Physical Performance Battery (SPPB), the Functional Independence Measure (FIM) and the Mini-Mental State Examination (MMSE), in accordance with gender and age group, also verifying associations between these instruments. Significant correlations were found among the scores of the three functional tests, and also between their scores and those of other indicators. Men had greater monthly income and anthropometric scores. Women had lower performance in SPPB, MMSE and FIM tests, and worse compared perceived health. Among the age groups 60 to 69, 70 to 79 and 80 or more years old, the last one had lower scores than the others in anthropometric measures, SPPB and MMSE. On the other hand, this group had higher scores of subjective well-being. The number of registered diseases was positively associated with body mass index (BMI), upper arm, waist and hip circumference, and had negative correlation with the balance component of SPPB. The number of medicines in use was positively correlated with number of diseases, body weight, BMI, upper arm, waist and hip circumference. It was concluded that the functional tests were significantly associated with other health indicators, and also that SPPB and MMSE, motor and cognitive performance measures, respectively, complemented FIM, an instrument of reported functional independence in motor, cognitive and social activities
Doutorado
Educação, Sociedade, Politica e Cultura
Doutor em Educação
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Uutela, T. (Toini). "Health-related quality of life and functional ability as patient-reported outcomes in rheumatoid arthritis:a study from two Finnish hospital-based populations." Doctoral thesis, Oulun yliopisto, 2011. http://urn.fi/urn:isbn:9789514294051.
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Abstract Reduced physical function and persistent pain are serious consequences of rheumatoid arthritis (RA). Clinical trials have shown that patients with RA suffer from a poor health-related quality of life (HR-QoL). However, limited information is available on the HR-QoL of patients treated in normal clinical practice. The purpose of the present study was to obtain information of how RA can influence on the patients´ HR-QoL and functional ability in a clinical setting and to investigate the impact of disease-related and demographic factors on the HR-QoL. The theoretical framework of the study was the biopsychosocial concept of health, i.e. the ICF model (International Classification of Functioning, Disability and Health) endorsed by WHO. HR-QoL was measured by the Nottingham Health Profile (NHP) questionnaire and functional ability by the Health Assessment Questionnaire (HAQ). The contents of these instruments and the NHP results were evaluated also within the ICF categories. The study consisted of a cross-sectional series and a longitudinal cohort carried out in two central hospitals in Finland in the late 1990s. The cross-sectional group of 122 consecutive out-patients had a mean disease duration of 11 years. The HR-QoL values of the patients were compared with those of an age and gender matched ”healthy” control group living in the same area. The HR-QoL values of the patients were examined also at different functional ability levels. The longitudinal group of 62 consecutive patients had symptom duration ≤ 24 months and no prior use of antirheumatic drugs or glucocorticosteroids at inclusion. First, the impact of the treatment response assessed by the EULAR (DAS28) criteria on HR-QoL was examined at six months from disease onset. Secondly, the HR-QoL changes and their associations with age and gender and with the changes in disease activity, radiographic assessments of hands and feet and functional ability were examined for ten years after the onset of RA. RA patients had poorer scores than the controls in the NHP in the dimensions measuring mobility, pain and energy. These dimensions, along with sleep, displayed also a significant linear association with poorer HAQ levels (p < 0.001). A better treatment response during the first six months was linearly associated with better HR-QoL with respect to the pain, energy and mobility dimensions (p < 0.001). Those patients exhibiting no response to treatment had already at baseline the poorest HR-QoL in the dimension for pain and emotional reaction compared with those in the moderate and good responders. During the ten years´ follow-up, all NHP dimensions except social isolation displayed significant improvements, these being most marked during the first six months. Changes in disease activity correlated with changes in pain, energy and emotional reaction (p < 0.001). The mean level of the HAQ was well preserved over the ten years of this study and its changes were correlated with changes in pain, mobility and energy (p < 0.001). Women had somewhat poorer NHP improvements in the dimensions assessing energy, emotional reaction and social isolation than males. Disease duration associated strongly with poorer mobility and pain dimensions (p < 0.01). Within the ICF framework, pain, mobility, energy and sleep were identified as being the most important categories from the patient's perspective. The results of the present study demonstrate that RA has a major influence on the patients´ HR-QoL but early and active treatment can improve the situation. In the ICF framework, the NHP covers a broader spectrum of the ICF categories than can be assessed by the HAQTiivistelmä Alentunut fyysinen toimintakyky ja jatkuva kipu ovat nivelreumaan liittyviä vakavia seurannaisvaikutuksia. Kliiniset tutkimukset ovat osoittaneet, että nivelreumaa sairastavat potilaat kärsivät huonontuneesta terveyteen liittyvästä elämänlaadusta. Normaalista kliinisestä käytännöstä saatava tieto potilaiden terveyteen liittyvästä elämänlaadusta on kuitenkin niukkaa. Tämän tutkimuksen tarkoituksena oli saada tietoa nivelreuman vaikutuksista potilaiden terveyteen liittyvään elämänlaatuun ja toimintakykyyn kliinisessä asetelmassa ja tutkia sekä tautiin liittyvien että demografisten tekijöiden vaikutusta terveyteen liittyvään elämänlaatuun. Tutkimuksen teoreettisena viitekehyksenä käytettiin WHO:n hyväksymää toimintakyvyn, toimintarajoitteiden ja terveyden kansainvälistä luokitusta (ICF-malli). Terveyteen liittyvää elämänlaatua arvioitiin mittarilla Nottingham Health Profile (NHP) ja toimintakykyä mittarilla Health Assessment Questionnaire (HAQ). Kyseisten mittareiden sisältö samoin kuin NHP- tuloksia arvioitiin käyttämällä myös ICF- luokitusta. Tutkimus käsitti poikkileikkaus- ja pitkittäistutkimuksen, jotka toteutettiin 1990-luvun lopulla kahdessa suomalaisessa keskussairaalassa. Poikkileikkaustutkimukseen osallistui 122 perättäistä polikliinistä potilasta, joilla taudin kesto oli ollut keskimäärin 11 vuotta. Potilaiden terveyteen liittyvää elämänlaatua verrattiin samalla seudulla elävään iän ja sukupuolen suhteen kaltaistettuun verrokkiryhmään. Potilaiden terveyteen liittyvää elämänlaatua arvioitiin myös eri toimintakykytasoilla. Pitkittäistutkimus käsitti 62 perättäistä potilasta, joilla oireet olivat kestäneet ≤ 24 kuukautta ja jotka tutkimuksen alkaessa eivät olleet käyttäneet edeltävästi antireumaatteja tai kortikosteroideja. Näillä potilailla hoitovasteen vaikutusta terveyteen liittyvään elämänlaatuun arvioitiin EULAR DAS28- kriteerein kuuden kuukauden kohdalla taudin alusta. Lisäksi tutkittiin terveyteen liittyvän elämänlaadun muutoksia kymmenen vuoden ajalta nivelreuman alusta ja näiden muutosten yhteyttä ikään ja sukupuoleen, taudin aktiviteetissa ja käsissä ja jalkaterissä todettuihin röntgenmuutoksiin samoin kuin toimintakyvyn muutoksiin. Hoitovasteetta jääneillä potilailla oli jo lähtötilanteessa huonoin terveyteen liittyvä elämänlaatu kipu- ja tunnereaktiot- ulottuvuuksissa verrattuna kohtalaisen ja hyvän hoitovasteen saaneisiin. Kymmenen vuoden seurannassa kaikki NHP- ulottuvuudet sosiaalista eristyneisyyttä lukuun ottamatta osoittivat merkittävää paranemista. Selvintä se oli ensimmäisen kuuden kuukauden aikana. Taudin aktiviteetin muutokset korreloivat kipu-, tarmokkuus- ja tunnereaktiot- ulottuvuuksien muutoksiin (p < 0.001). Keskimääräinen HAQ- taso säilyi hyvänä kymmenen vuoden seurannassa ja HAQ- muutokset korreloivat kipu-, liikkuminen- ja tarmokkuus- ulottuvuuksien muutosten kanssa (p < 0.001). Naisilla oli miehiä jonkin verran huonompi NHP-paraneminen tarmokkuus-, tunnereaktiot- ja sosiaalinen eristyneisyys- ulottuvuuksissa. Taudin kesto oli selvästi yhteydessä huonompiin liikkuminen- ja kipu- ulottuvuuksiin (p < 0.01). ICF- luokitusta käytettäessä potilaiden näkökulmasta kipu, liikkuminen, tarmokkuus ja uni nousivat tärkeimmiksi kategorioiksi. Tämän tutkimuksen tulokset osoittavat, että nivelreumalla on huomattava vaikutus potilaiden terveyteen liittyvään elämänlaatuun, jota varhainen ja aktiivinen hoito voi kuitenkin parantaa. ICF- viitekehyksessä NHP kattaa laajemman spektrin ICF- luokista kuin HAQ
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Bin, Abdulwahab Sami S. A. "The use of Functional Electrical Stimulation (FES) in maintaining or improving the ability to stand and transfer in people with Multiple Sclerosis." Thesis, University of Southampton, 1992. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.316398.
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