Tesis sobre el tema "Physiotherapy Care"
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1
Belchamber, Caroline Anne. "Physiotherapy palliative cancer care : a case study approach". Thesis, Bournemouth University, 2016. http://eprints.bournemouth.ac.uk/24774/.
Resumen
There is evidence to suggest that the role of the allied health professional continues to evolve in the delivery of palliative cancer care services. Whilst it appears that there is an increasing need for physiotherapists, there is a lack of understanding about the nature of their role, their educational needs and their place within the rehabilitation team. The aim of my work was to explore a local palliative cancer care physiotherapy service provision in the light of best practice recommendations, using both my own practice development and a research study. For my research a qualitative approach using a single case study design was chosen as it provided a framework to facilitate the inclusion of multiple perspectives in a complex context within an area of healthcare where little research has been undertaken. Multiple methods of data collection were used from numerous perspectives, which included four data sets: interviews (healthcare professionals [10]); interviews (service users [10]); observations (physiotherapists [2] treating service users [5]); and policy document collection (NICE guidelines; white papers [12]). Detailed data analysis was then carried out using a thematic approach within a framework, comparing and contrasting patterns within and across the four data sets. Emergent themes highlighted a number of important aspects relating to physiotherapists including: new ways of working, shift in mindset and treatment planning, emotional adjustment and integration of professional boundaries. My primary research and practice development project combined to evidence the metamorphosis of both the physiotherapist profession and service provision where competencies around mentorship, entrepreneurship, leadership, policy championship, integrated teamwork, humanisation and self-reflection embodied within the psycho-social-cultural-spiritual model of healthcare enabled them to meet key policy recommendations of service quality and innovation. A debate is necessary around the need for profession specific or service specific outcomes in this area, and how physiotherapists ‘prove their worth’ now that they are an integral part of palliative cancer care provision.
2
Kuisma, Raija. "Domiciliary physiotherapy in Hong Kong: studyof the outcomes of domiciliary physiotherapy for patients withfractured proximal femur". Thesis, The University of Hong Kong (Pokfulam, Hong Kong), 2000. http://hub.hku.hk/bib/B31240409.
3
Phillips, Kerry-Ann. "Cross-sectional analysis of car restraint system use during transportation of children with special health care needs in the Western Cape". Master's thesis, Faculty of Health Sciences, 2021. http://hdl.handle.net/11427/33926.
Resumen
Background: Road traffic injuries are the leading cause of death in children and young adults. Children are at increased risk of fatalities and serious injury due to the differences in their body segment proportions affecting their body kinetics in a vehicle accident. Serious injury and death can be reduced by the appropriate use of car restraint systems (CRS). Children with special health care needs (CSHCN), particularly children with poor postural control, may need adaptive seating to improve postural support and sitting ability within the vehicle due to their additional physical needs. Standard CRS might be unsafe or inappropriate for children with physical disabilities. Research Aims: The thesis aimed to understand the current CRS usage as well as the parents' experiences and perspectives of transportation of CSHCN in the Western Cape, and to determine the postural support needs of CSHCN and the suitability of different CRS designs to meet these needs during transportation. This was achieved through a survey study, followed by a cross-sectional study. Assessing the use of car restraint systems in children with special health care needs; a Western Cape based survey study Objectives: To determine the modes of transport and the prevalence of the use of postural support systems by CSHCN. Along with describing the current use of seatbelts, standard or specialised CRS and exploring the challenges faced by parents of CSHCN during transportation. Methods: A descriptive quantitative survey was performed amongst a convenience sample of all parents of CSHCN between the age of 4 – 18 years enrolled at three special needs schools in the Western Cape, South Africa. Parents had to be able to read and understand English or Afrikaans to be eligible for enrolment in the study. Focus group discussions were conducted to validate the self-designed questionnaire. Results: Parents of 268 children were enrolled in the study (median (IQR) age 11.52 (14.63- 8.86) years; 58.96% male). The most common diagnosis was cerebral palsy (CP) (29.10%), and most children were transported to school with public transport, including school bus (73.13%). The mode of transport was linked to the distance travelled and affordability, and each had its own challenges. The main challenges of parents using private transport were transporting the wheelchair (10.82%) and the unavailability of demarcated disability parking bays (7.46%). When using public transport parents identified their child's poor sitting balance (6.34%) and lack of space within the vehicle (5.60%) as the greatest challenges. The majority of children (58.96%) came from low-to-middle income households (< R6500 per month), significantly impacting the use of a CRS, with more children from higher income families being transported in a CRS (X²= 48.14, p< 0.001). Difficulties with sitting balance was reported in 25.75% of the children and was significantly association to the parents understanding of their child's sitting balance (X²= 17.72, p< 0.001). Parents who felt that their child had difficulty with their sitting balance were more likely to use a CRS. Furthermore, a significant association between currently using a CRS and child's weight was observed (X²= 11.54, p=0.021), as children who weighed more were less likely to still be using a CRS. Most parents (54.48%, n=146) did not know South Africa's current legislation on CRS, which was significantly associated with a lower CRS usage (X²= 19.84, p< 0.001). Half of the parents (n= 139, 51.87%) were not willing to spend money on a CRS as they felt that a car seat was not necessary for their child. The amount parents were willing to spend on a CRS was significantly associated with having ever made use of a CRS (X2=43.38, p< 0.001). Conclusions: Parents of CSHCN reported many challenges in transporting their child depending on the mode of transportation. CRS usage was associated with parent perception on the child's sitting abilities, lower weight, knowledge of legislation and a higher household income. Despite these, CRS usage amongst CSHCN is lower than expected as (48.88% – 55.22%) children that are still within the age and weight range to use a CRS as required by law did not report CRS usage. This could link in with the affordability of the CRS and failure to know the legislation on CRS by parents. This study highlights the need for national campaigns to promote and educate citizens on road safety and CRS legislation. Due to the lack of financial resources in low to middle income countries, it is vital that an affordable CRS is made available or is subsidized by the government where families are unable to afford the cost themselves, particularly for use in public transport. Effectiveness of currently available car restraint systems to maintain correct seating position during transportation for children with special health care needs Objectives: To determine the characteristics of CSHCN who require specialised CRS for their postural support needs, through assessment of their sitting ability and whether these needs are met by different CRS. Methods: Participants in the earlier survey study were invited to take part in a crosssectional and pre-post design study. A screening tool for identifying sitting balance problems was developed and found to be reliable for inter- and intra-rater reliability (k>0.700, p0.879). This tool was used to identify CSHCN who had difficulty sitting independently on different types of seats. These participants underwent a standardised sitting balance assessment, using the Level of Sitting Scale (LSS), to identify eligible participants with postural support needs. Participants were excluded if they recently had surgery or had an unstable health condition which could alter their sitting balance. The ability of two standard CRS (Car Seat and Booster seat), two Specialised CRS (one locally and one internationally produced), and Seatbelt only to provide adequate postural support was investigated. Head and trunk postures were analysed and categorised, by deviation from the midline, by photographs taken from different viewpoints. Results: There were 78 CSHCN enrolled in the study (mean (SD) age 11.50 (3.70) years; 65.75% male), the most common diagnosis was CP (63.48%), the majority of participants did not require any support to maintain sitting balance and were categorised as levels 5-8 of the LSS (78.08%). According to the World Health Organisation anthropometric guidelines 54.79% (n=40) of the participants should still use a CRS, either a Booster Seat (42.47%, n=31) or a Car Seat (12.33%, n=9). The head or torso fully supported and between the side supports of the CRS was the most common posture in all the viewpoints of the different CRS except for the lateral head viewpoint of the CRS Car Seat (50.00%; n=4), the Booster Seat (60.00%; n=18), and the International Specialised CRS (60.61%; n=20), as well as the anterior torso viewpoint of the Seatbelt only (50.75%; n=34). The CRS that resulted in the largest proportion of unacceptable posture deviations from the standard position were the Seatbelt only (20.90%, n=56) and the Booster Seat (18.33%, n=22). Out of position (OOP) postures were observed in all the devices for the anterior and lateral head positions (3.03% - 20.00%). The Booster Seat, the Local Specialised CRS and the Seatbelt only devices had participants with OOP postures in all four viewpoints. A key observation in the current study is the lack of torso support for the majority of CSHCN in the anterior torso viewpoint of the Seatbelt Only CRS (55.22%, n=37), indicating that the use of a Seatbelt only does not provide adequate postural support for all CSHCN despite them meeting WHO anthropometric requirements. No significant association was found between the pre- and post-test postural analysis scores of the Seatbelt only (X2=2.14, p=0.144) which could be as a result of the large postural deviations pre-testing (41.79%, n=28) remained post-testing. However, there was a significant association between the preand post-test scores of the anterior head viewpoint of the Booster seat (X2= 7.94, p=0.005), indicating lateral head deviation. The post-test postural analysis score of the Booster Seat anterior head viewpoint was significantly associated with a deviated posture (X2= 7.94, p=0.005). Other OOP observations included postures that could not be categorised by head and trunk deviation from the midline including head or torso rotation, abnormal limb placement, body extension and slouching. Overall performance scores are a sum of the number of viewpoints where the CSHCN posture worsens post-test. an indication of the number of CSHCN whose posture worsened post-test in each of the viewpoints of the CRS. Although there was no correlation between the LSS score and the overall performance score of any CRS device which would indicate if the CSHCN balance influences CRS performance, the Booster Seat (80.00%, n=24) and the Seatbelt only (55.23%, n=37) devices had the greatest number of participants with a poor overall performance. The viewpoints which had the worst performance scores were the anterior and lateral head of the Booster Seat (46.67%, n=14 and 43.33%, n=13 respectively) and both viewpoints had majority of participants worsen their scores. All CRS performed adequately in the lateral torso viewpoint, indicating sufficient support of the torso in the sagittal plane. Conclusions: The postural support needs of CHSCN are unique and depend on the child's anthropometry and the severity of their disability. The currently available CRS designs may not provide the postural support needed for many CSHCN. Postural deviations of the head, torso and limbs were observed which could be dangerous in the event of an accident. This study was not able to determine specific characteristics of CSHCN that require specialised CRS, as there was no association between the LSS and the overall performance score for any of the CRS devices. However, devices that offer less head and torso lateral support, or do not offer additional harness support such as the Seatbelt Only and the Booster Seat showed the largest proportion of OOP postures in CSHCN. Thesis Conclusion: This thesis highlights the complex transportation needs of CSHCN in South Africa and how the different CRS can influence posture. Additional observational research is required to determine the CRS usage in the CSHCN population to compare to the prevalence of CRS usage found in this survey study. Future research could incorporate other specialised CRS designs, particularly ones that are suitable for CSHCN beyond standard CRS weight and height limits or those with severe physical limitations that could not be tested during this study's simulated course. Practitioners prescribing and advising parents on CRS devices for the safe transportation of CSHCN should integrate thorough patient assessment and knowledge of manufacturer CRS design specifications to promote CRS usage. Policies should consider and accommodate for the challenges faced by CSHCN and their families in accessing, affording and utilising transport services. Advocacy and education programs should be combined with legislation enforcement to support improved implementation of CRS usage amongst all children, regardless of their disability status. For effective implementation for CSHCN, CRS should be affordable, accessible, functional and accommodate growth and postural support needs.
4
Kuisma, Raija. "Domiciliary physiotherapy in Hong Kong : study of the outcomes of domiciliary physiotherapy for patients with fractured proximal femur /". Hong Kong : University of Hong Kong, 2000. http://sunzi.lib.hku.hk/hkuto/record.jsp?B21734628.
5
Parker, Ian Gerard. "Investigations into a physiotherapy-led vestibular rehabilitation model of care". Phd thesis, Australian Catholic University, 2022. https://acuresearchbank.acu.edu.au/download/b62ec624c7a9fd577877a1507ea3af22c625ca49706b689d3e617591d3f47001/6194475/Parker_2022_Investigations_into_a_physiotherapy-led_vestibular.pdf.
Resumen
People with dizziness commonly seek medical solutions through primary contact medical practitioners and Ear Nose and Throat (ENT) outpatient services. Physiotherapists trained in vestibular rehabilitation may independently and safely assess and manage these people. This thesis presents a programme of research undertaken to investigate a standalone physiotherapy-led vestibular rehabilitation service and its management of people with dizziness screened from the wait lists of ENT outpatient services. A systematic review and two clinical studies support the main service investigation.
The published systematic review, Study 1, synthesised vestibular diagnostic proportions reported by the specialties of ENT/Otology, Neurology, Emergency, General Practice and Physiotherapy, enabling comparison with the findings of the clinical studies in this programme of research. A 2020 update found increased awareness for setting-specific differences in diagnostic proportions and for benign paroxysmal positional vertigo (BPPV) diagnostic procedures; however, awareness of correct BPPV management was still deficient.
The Study 2 pilot demonstrated the feasibility of the model of care and informed the extension of the trial into a major study. Sixty-seven participants from an ENT wait list included a 44:23 female to male ratio, a mean age of 55.2 years (SD 17.57) and a diagnostic profile of common diagnoses including BPPV (22%), unilateral vestibular hypofunction (40%), vestibular migraine (10%) and cervicogenic dizziness (6%). Service outcomes included a mean wait of 382.6 days (SD 246.3) with 31(46%) participants receiving one occasion of service. Nine percent of people assessed were returned to ENT for consultant review and no adverse events were recorded. Patient management led to the resolution of BPPV and unilateral vestibular hypofunction clinical signs and significant improvements in the Dizziness Handicap Inventory (34.9/100 to 11.1/100, p< 0.001) and the Activities-specific Balance Confidence scale (78.3/100 to 87.9/100, p= 0.009).
Study 3, an interrater reliability trial between a vestibular audiologist and physiotherapist for diagnostic accuracy and referrals for vestibular rehabilitation included 22 people (82% female) with dizziness from ENT wait lists with a mean age of 54.9 years (SD 19.44). Clinician diagnoses compared closely for the common forms of vestibular dysfunction: BPPV 100% agreement (Kappa 1.0), unilateral vestibular hypofunction 77.3% (Kappa 0.54), vestibular migraine 95.5% (Kappa 0.78), and cervicogenic dizziness 86.4% (Kappa 0.65). Percentage agreement for referral to vestibular rehabilitation was 95.5% (Kappa 0.89).
Study 4 investigated a cohort of 301 people with dizziness (191 (63%) females) from ENT wait lists averaging 55.5 years (SD 17.23) in age and with a diagnostic profile of BPPV (20%), unilateral vestibular hypofunction (36%), vestibular migraine (15%) and cervicogenic dizziness (8%). Wait times reduced significantly from 390.2 days (SD 243.5) in 2013 to 93.0 days (SD 219.4) (p= 0.004) in 2017, and occasions of service and duration of treatment were skewed positively towards medians of one. Consumer engagement using visual analogue scales showed consistently high median levels of satisfaction for wait time (9.3/10 cm) and service quality (10/10 cm). Clinical effectiveness of the model of care was demonstrated through its treatment of BPPV leading to resolution in 48 out of 50 people (p< 0.001) and its treatment of unilateral vestibular hypofunction leading to compensation in 47 out of 54 people presenting with uncompensated DVA (p< 0.001). Whole cohort Dizziness Handicap Inventory scores improved from 38.1/100 (SD 22.1) to 24.6/100 (SD 21.6) (p< 0.001) and Activities-specific Balance Confidence scale scores from 73.2/100 (SD 21.89) to 81.0/100 (SD 18.94) (p< 0.001).
Investigating the burden of dizziness, initial assessment utility scores calculated from the Assessment of Quality-of-Life 8 Dimensions questionnaire averaged 0.58 (SE 0.01), representing a 30% reduction in quality of life compared with published normal population scores. Treatment saw a significant improvement in the utility by 0.08 (95% CI 0.06, 0.10) (p< 0.001). Using the Work Productivity and Activity Impairment (Dizziness) questionnaire, absenteeism in 2013 participants amounted to potential annualised lost wages of AUD $16380 per person: reducing to AUD $4185 by 2017. Presenteeism by people with dizziness at a mean of 30%, represented a considerable potential cost in lost productivity to employers in 2013 at AUD $20998, reducing with wait reduction by 2017 to AUD $5308. Cost consequences analysis using decision tree modelling of two models of care, physiotherapy-led and ENT-led, showed dominance in cost by the physiotherapy-led model.
In conclusion, the physiotherapy-led vestibular rehabilitation model of care was shown to be one of high value care; being clinically, service, and cost effective, and safe and satisfactory for people with dizziness referred to an ENT waitlist. Research into the burden of dizziness considering quality of life, absenteeism and presenteeism indicated considerable consequences for people with dizziness and found the physiotherapy-led model improved this burden significantly. In the Australian public hospital setting, independent, primary contact, physiotherapy-led vestibular rehabilitation services provide a safe, effective, efficient and cost-effective pathway for people with dizziness referred to ENT.
6
Pensri, Praneet. "Current physiotherapy management of low back pain in Thailand". Thesis, University of Ulster, 2002. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.249457.
7
Conroy, Sherrill. "Moral inclinations of medical, nursing and physiotherapy students". Thesis, University of Oxford, 2001. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.367447.
8
Naidoo, Melissa. "Family and patient perception of physiotherapy care rendered to patients in the cardiothoracic intensive care unit". University of the Western Cape, 2018. http://hdl.handle.net/11394/6978.
Resumen
Magister Artium - MABackground: Physiotherapists are involved in the management of patients in the cardiothoracic Intensive Care Unit (ICU). Patient and family perception of care has become an important measure in evaluating the quality of care, including care in the intensive care setting. Overall Aim: To explore and describe the family and patient perception of physiotherapy care rendered in a public sector cardiothoracic ICU in the Western Cape, South Africa. Method: This study was conducted in two phases. Phase 1 (scoping review) identified and described available outcomes for measuring family perception of ICU care by searching six databases from inception to the 20th June 2018. Results from the scoping review informed the discussion schedule for the first primary study of Phase 2. Phase 2 (two exploratory descriptive qualitative primary studies) explored and described i) family perception and ii) patient perception of physiotherapy care in a cardiothoracic ICU. Audio-taped, individual face to face semi-structured interviews were conducted with family and patient participants that met the inclusion and exclusion sampling criteria (purposive sampling). Data was transcribed verbatim and analysed using deductive-inductive thematic content analysis. The data was coded, categorised and themes were generated. Trustworthiness of the data was ensured through methods addressing credibility, dependability, confirmability and transferability. Results: A total of ten full text studies were included in the scoping review. Included studies were published between 2006 and 2017, were conducted in both developed and developing countries, in different ICUs (except cardiothoracic ICU)and all used different quantitative outcome measures to measure family perception of ICU care. Thirteen cardiothoracic ICU patients and their respective family members partook in the studies describing patient and family perception of cardiothoracic ICU physiotherapy care. The median patient age was 62 years; the mean ICU length of stay 6 days and the median family age was 55. Themes arising from the family perception of care data analysed included: i) understanding of physiotherapy care (the role of the physiotherapist, perceived benefit of physiotherapy and communication), family involvement in physiotherapy care (physical presence during physiotherapy sessions and decision-making), and satisfaction of physiotherapy ICU care. Themes arising from patient perception of care data analysed included: i) Physiotherapy management of patients, ii) The Physiotherapists – skill, iii) knowledge and professionalism, iv) Continuity of Care, v) Tangibility, vi) Physiotherapy benefits, vii) Decision-Making, viii) Communication, ix) Satisfaction of Physiotherapy ICU care. Overall, family and patients were satisfied with the physiotherapy care in the cardiothoracic ICU. However, there were areas of improvement such as the understanding of physiotherapy care, communication, family involvement in the physiotherapy care and decision-making. Conclusion: While there are multiple quantitative measures for measuring family perception of ICU care there is no “gold” standard measure that has been identified. A qualitative measure and research design would allow richer in-depth information on family perception of ICU care. The findings from the family and patient perception of cardiothoracic ICU physiotherapy care are influenced by many factors. While family and patients perceive cardiothoracic ICU physiotherapy care both positively and negatively, the majority of patient and family were satisfied overall with the care the patient received. Family perception of ICU physiotherapy care should be evaluated in order to identify areas for improvement in quality of care and could add to the body of evidence in ICU physiotherapy practice.
9
Holdsworth, Lesley K. "A study of direct access to physiotherapy in a primary care setting". Thesis, Glasgow Caledonian University, 2002. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.251175.
Resumen
The ability of a patient to access physiotherapy directly (patient self-referral), although used widely in the private sector, is not the mechanism in use within the NHS where there exists a system of open access controlled by doctors. This study aimed to develop, implement and investigate a direct access physiotherapy service within a primary care setting in a health district of Scotland. The service was introduced and compared to the existing system of open access over a twelve-month period (1997-1998). Demographic and clinical data was collected relating to two samples: Control Year Group: All GP referrals for a year prior to the study year collected retrospectively. Study Year Group: General practitioner (GP) and direct access (DA) referrals. All patients were followed up one-month after discharge, and the number of associated GP consultations collated together with patient, physiotherapist, general practitioner and service non-user views of physiotherapy generally and direct access specifically. There were similar numbers of referrals (339 vs. 340) with no significant differences with regard to patient age or gender between the Control and Study Year Groups. The Study Year Group however revealed significant differences between DA and GP referrals. DA referrals, all of which were appropriate, accounted for 22.4% of total referrals in comparison to 77.6% GP referrals. DA patients were more likely to have been: male, younger, suffering from conditions of a shorter duration, in paid employment with less work absence, who were more compliant with attendance, had fewer physiotherapy contacts, lower reporting of symptom severity at discharge and were more highly satisfied with their physiotherapy care. This group also demonstrated a greater confidence in knowing when to access physiotherapy and were highly supportive of the effectiveness of physiotherapy. DA patients also consulted their general practitioner significantly less often than GP referrals (p = 0.001). Support for direct access was strongly expressed by service users and nonusers, physiotherapists and general practitioners. Direct access to physiotherapy is an example of an innovative, flexible approach to primary care service provision encouraged by current health policy.
10
Achmat, Faiza. "Factors associated with improvement in the gross motor function outcomes of children with acquired brain injury in a paediatric intermediate care facility in the Western Cape, South Africa: A descriptive study". Master's thesis, University of Cape Town, 2018. http://hdl.handle.net/11427/29575.
Resumen
Aim: The study aimed to record the recovery patterns of gross motor function following acquired brain injury (ABI) in 17 participants, aged two to 14 years, receiving physiotherapy intervention at a paediatric intermediate care facility in the Western Cape, South Africa. Objectives of the study were to explore if factors such as age at injury, time since injury, intervention type, injury severity, gender, and the health- related quality of life of the child and caregiver were predictive of improvement of motor function and participation. Methods: A quantitative, longitudinal, prospective cohort design with repeated measures was employed. The children received physiotherapy either intensively or intermittently within eight months post brain insult. The Gross Motor Function Classification System (GMFCS) was used to classify the children according to their functional abilities. The Gross Motor Function Measure 88 (GMFM88) was used to assess changes in the child’s gross motor function. The Paediatric Evaluation of Disability Inventory (PEDI) evaluated functional performance in daily life activities (participation). The EQ-5D-Y proxy version and the Caregiver Strain Index (CSI) evaluated the health-related quality of life of the children and caregivers respectively. Assessments were performed at Baseline, Week 3, 7, 9 and 13 after admission to the study. Analysis: Descriptive statistics were used to describe the demographic data of the participants. Non-parametric analysis was performed to determine the time points at which the greatest improvement occurred because the sample was relatively small to support an adequately powered randomized intermittent trial. The GMFM88 was the primary outcome measure and the changes in score over the 13-week study period were plotted graphically in an attempt to identify patterns of improvement. The change in score from Baseline to Week 3 was also used as the dependent variable in investigating the determinants of short term improvement between the five measurement time points. Scatterplots and Spearman’s rho were used to investigate the relationship between changes in GMFM88 score from Baseline to Week 3 and the age of the child at injury, time from injury and Baseline GMFM88 score. The Kruskal Wallis ANOVA for ordinal data was used to establish whether there were differences in all the outcome measures at the different time points: between Baseline and Week 3, between Week 3 and Week 7 and between Week 7 and Week 9 and, if significant, a post-hoc Sign test was done to see where the differences lay. The effect size was calculated by dividing the z value by the square root of the total number of observations at both time points. Simple regression analysis was used to determine the variance in Week 9 GMFM88% score accounted for by the Baseline score. Results: Seventeen participants met the inclusion criteria and were recruited. There were more boys (n=14) than girls (n=3) admitted with brain injury and the majority of the total sample (n=14) were drawn from families with minimal financial resources. Although no differences were found between the two intervention groups, the greatest improvement in GMFM88 scores was observed within the first three weeks of intervention, regardless of the time since injury. Three patterns of recovery were identified through plotting the GMFM88 scores: Group A, included participants with a high baseline score who showed sustained but small improvement until reaching the ceiling score; Group B, participants who started with lower scores and then improved considerably; and Group C, participants who started with low scores and showed slower and smaller improvement. Most participants (n=13) returned to near normal motor function after Week 9 (over 90% on the GMFM). Four participants did not show the same improvement: The Week 9 GMFM88 score was less than 60% in one participant and less than 30% for the other three. In this study, participants who showed the greatest improvement were those children on GMFCS levels three and four. The Baseline GMFM88 scores were significantly correlated with other time points (rho=0.886 at Week 9 and 0.748 at Week 13), but not with the change in scores. The effect size of the change in GMFM88 scores from one time point to the other were all measured as medium (effect size of 0.5 but less than 1.3) and the largest effect size was seen between Baseline and Week 7 (effect size=.660). Change in score from Baseline to Week 3 was not predicted by gender, cause of injury or method of intervention delivered (intensive or intermittent). The Baseline motor score accounted for 86% of the variance of the Week 9 GMFM88% score and each point in the baseline score increased the Week 9 score by .94. The PEDI Mobility Score demonstrated a similar pattern of improvement to the GMFM88, but the pattern in progression of the PEDI Self-care domain was less clear. The EQ-5D-Y Proxies indicated that at Week 13, at least five children still had problems in one or more of the dimensions, with the greatest number (n=-8) having problems with the Usual Activities and Worried, Sad, or Unhappy domains. The older (above age nine years), higher functioning children made less gains in their functional abilities. The greatest cumulative cause of strain reported by the thirteen respondents, was a change in the former self of the child, followed closely by financial strain and work adjustments. The caregivers of the children in Group C, the most disabled group, experienced double the strain at Week 13 than caregivers of children with mild and moderate brain injury. Although not correlated at Baseline, the CSI was negatively correlated with the proxy EQ-5D-Y reported visual analogue general health scale at Week 13 (n=10, rho=-724, p=.018) .655, p=.021). Conclusions: Although, most participants in the study regained physical functioning, approximately 25% admitted for rehabilitation with ABI might have significant residual motor damage and require on-going rehabilitative support. Although there were no other factors identified which predicted the outcome, these children could be identified based on poor GMFM88 scores on admission to rehabilitation. The EQ-5D-Y indicated that at Week 13, eight of the 12 proxies reported that participants had problems with anxiety and depression. Rehabilitation might therefore need to include a greater emphasis on self-care and mental health of the child, even when motor control has been established. Planning of long-term support should start early to maximise recovery and reduce the stress on caregivers. The study findings cannot be generalised due to the small sample size, but the results should alert therapists at the Facility to the possible long-term outcomes of children admitted with ABI. The study findings can assist with the formulation of patient specific and family centred rehabilitation care plans for children admitted with ABI at the Facility.
11
Richardson, Barbara. "Paradigms of practice in physiotherapy and the implications for professional development". Thesis, University of East Anglia, 1996. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.309097.
12
Davids, Nailah. "The motor development of HIV positive and HIV negative children aged three to six years, residing in institutions and in foster care". Master's thesis, University of Cape Town, 2008. http://hdl.handle.net/11427/3010.
Resumen
Includes abstract.Includes bibliographical references (leaves 129-135).
To compare the motor development of children aged 3-6 years with HIV/AIDS in institutions and in foster care using the Peabody Motor Developmental Scale (PDMS II). A description of socio-economic conditions to the children, to compare the health status of HIV positive children, to establish and compare developmental quotients of children across two care-giving environments and compare performance of children with and without HIV, to determine to what extent developmental quotient changes over a six-month period and establish which factors predict performance. A descriptive, analytical, prospective, longtudinal study design was used. 44 children participated in the study at baseline. The children were recruited from four institutions in Cape Town and from community outreach programmes supporting foster parents. Six months later 37 children were tested.
13
Forskvist, Lina-Maria y Andrea Harrtoft. "Stress och alkoholkonsumtion bland fysioterapeutstudenter vid Uppsala Universitet: Hur korrelerar stress med alkoholkonsumtion?" Thesis, Uppsala universitet, Fysioterapi, 2019. http://urn.kb.se/resolve?urn=urn:nbn:se:uu:diva-384169.
Resumen
Background University can be stressful, and some students use alcohol to handle their stress. The alcohol consumption in our youth affects future alcohol habits. Caregivers experience and attitude towards alcohol affects patients care and treatment. Purpose To investigate the stress level and number of hazardous drinkers among physiotherapy students at Uppsala Universitet. It was also to investigate the difference between the genders regarding stress and alcohol consumption, also the correlation between stress and alcohol consumption. Design and method This was a cross-sectional study with a correlating and comparative design where physiotherapy students answered a survey regarding stress and alcohol consumption. Results In this survey, 176 students participated of which 169 were analyzed. Twenty-one percent had a high stress level and 30% had a hazardous drinking. The women were more stressed (p=0,02), but no difference was seen between the genders regarding alcohol consumption (p=0,06). There was no correlation between stress and alcohol consumption for the whole group (r= 0,22, p=0,78), for women (r=0,12, p=0,21) or for men (r=-0,12, p=0,34). Conclusion A moderate to high stress level was common and 35% had a hazardous drinking or an abuse/dependence. The women had a higher stress level, but the alcohol consumption was similar between the sexes. There was no correlation between stress and alcohol consumption. However, interventions against stress and alcohol could be necessary since these students will have an important role in the future.
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Wand, Benedict Martin. "Developing, testing and refining a physiotherapy model of care for acute low back pain". Thesis, Brunel University, 2002. http://bura.brunel.ac.uk/handle/2438/7124.
Resumen
This thesis is concerned with the physiotherapy management of acute low back pain. Various national guidelines contain conflicting views regarding the role of physiotherapy in the management of acute low back pain. The discrepancies involve primarily the content and timing of physiotherapy intervention. There is a need to place the physiotherapy management of acute low back pain on a more firm research base. A comprehensive literature review was undertaken to develop a best practice model of care for acute low back pain. This model was tested in a randomised controlled trial. Subjects involved in the treatment model demonstrated significantly better short-term outcomes than subjects given advice only. Furthermore, subjects treated early demonstrated significantly better long-term outcome than subjects who waited six weeks for their treatment. Changes in pain and physical function were found to be the factors most closely associated with good outcome in the short-term. Good outcome in the long term was associated with improvement in a number of physical and psychological variables. It is recommended that changes be made to the treatment model to facilitate improvement in pain relief and maintenance of physical and social function to further enhance treatment effectiveness.
15
Tall, Märta y Matilda Sellergren. "Fysioterapeuters upplevelser och erfarenheter av fysioterapi postpartum". Thesis, Uppsala universitet, Fysioterapi, 2018. http://urn.kb.se/resolve?urn=urn:nbn:se:uu:diva-351920.
Resumen
Bakgrund Kvinnosjukvården i Sverige idag har stor förbättringspotential då det bland annat saknas riktlinjer kring behandling och uppföljning av bristningar i bäckenbottenmuskulaturen. Förlossningsskador kan påverka livskvaliteten hos den drabbade. Fysioterapeuter kan vara behjälpliga med rehabiliteringen av dessa. Syfte och frågeställning Syftet var att ta reda på fysioterapeuters upplevelser och erfarenheter av att arbeta med fysioterapi postpartum. Design och metod En kvalitativ explorativ och deskriptiv design användes och studien baserades på semistrukturerade intervjuer av fem fysioterapeuter. Intervjumaterialet bearbetades med kvalitativ innehållsanalys enligt Graneheim et al. Resultat Under databearbetningen framkom fem kategorier med totalt 14 subkategorier. Kategorierna var kultur och synsätt, vårdmötet, patienten, positiva aspekter av yrket samt utveckling. Det som beskrevs var bland annat en önskan om att fysioterapeuter ska bli en större del av mödravården, bortprioritering av kvinnosjukvård, bristen på riktlinjer, att patienterna ofta har stora besvär trots tidigare uppföljning i mödravården samt glädjen i yrket. Konklusion Fysioterapeuter upplever sig ha en viktig roll i rehabiliteringen efter förlossningsskador, och önskar att få en större roll i mödravården. Kvinnosjukvård upplevs inte ha hög prioritet inom fysioterapeutisk grundutbildning, och informanterna efterfrågar svenska riktlinjer kring rehabilitering efter gynekologisk kirurgi och kejsarsnitt. Fysioterapeuter upplever dock att arbetet är roligt och att de har tacksamma patienter de kan göra stor skillnad för. Vidare forskning kring fysioterapi efter förlossning anses vara nödvändigt. Nyckelord Physiotherapy, experiences, women’s health, post partum care.Background Women's healthcare in Sweden today has great potential of improvement, as there is, among other things, no guidelines for treatment and follow-up of injuries to the pelvic floor muscles. These injuries can affect the quality of life. Physiotherapists can assist with the rehabilitation of these conditions. Purpose The purpose was to investigate physiotherapists experiences of physiotherapy after childbirth. Design and method A qualitative, explorative and descriptive design was used and was based on semi structured interviews. Five physiotherapists were interviewed and the material was processed using qualitative content analysis according to Graneheim et al. Results Five categories emerged during the data analysis, with a total of 14 subcategories. The categories were culture and approach, the patient meeting, the patient, positive aspects of the profession and progress. What was described was, among other things, the desire for physiotherapists to become a bigger part of maternity care, the prioritization of women’s health care, the lack of guidelines, the patient often having problems despite previous follow- up in the maternity care and the joy of the profession. Conclusion Physiotherapists experience that they have an important role in rehabilitation after maternal injuries and wish to have a greater role in rehabilitation in maternity care. Women’s health care is not percieved as a high priority in physioterapeutic primary education. The informants perceive a need for Swedish guidelines for rehabilitation after gynecological surgery and cesarean sections. Physiotherapists, however, find that the work is fun and that they have grateful patients they can make a big difference to. Further research on physical therapy after child birth is considered necessary. Key words Physiotherapy, experiences, women’s health, post partum care.
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Mwanza, Christo. "Physiotherapists’ perceptions on stroke rehabilitation with focus on palliative care in Lusaka, Zambia". University of the Western Cape, 2015. http://hdl.handle.net/11394/4734.
Resumen
Magister Scientiae (Physiotherapy) - MSc(Physio)Palliative care is a vague and often confusing term used to describe a type of treatment model for chronic and life-threatening illnesses. WHO describes palliative care as an approach that improves the quality of life of patients and their families facing the problem associated with life-threatening illness by: early identification, impeccable assessment, and treatment of pain, physical, psychosocial and spiritual. The aim of this study is to explore the perceptions of physiotherapists on palliative care in order to contribute to the understanding of the role of physiotherapists to the care of stroke patient in Zambia. The objectives of this study are to explore physiotherapists’ knowledge on palliative care, their perceptions on management of palliative care as well as explore its application in the rehabilitation of stroke patients; and lastly to make recommendations on guidelines based on the outcomes of this study. Method: an exploratory study, using qualitative design was used. Data collection techniques were in-depth individual interviews and FGDs that consisted of purposively sampling of physiotherapists working; at four selected hospitals and a rehabilitation centre in Lusaka. Audio recording from the interviews was transcribed verbatim for each session by an independent person. The study employed thematic content analysis for data analysis. The data was classified systematically by means of coding to identify key factors or issues such as concepts, categories, themes and the relationship between them. Results indicated that all participants in the current study perceived palliative care as a medical care for the chronic and terminal ill patient in whom stroke patient and family will benefit if it is applied in the early stages of the disease trajectory; as well as it does improve the patient and family quality of life. Furthermore they emphasized on multidisciplinary team and holistic approaches in order to achieve all its tenets. Conclusion: the study had succeeded in exploring the physiotherapists’ perceptions on palliative care and contributed to the understanding of the role of physiotherapy to the care of stroke patients in general.
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Hanekom, Susan. "The implementation and evaluation of a best practice physiotherapy protocol in a surgical ICU". Thesis, Stellenbosch : University of Stellenbosch, 2010. http://hdl.handle.net/10019.1/5328.
Resumen
BibliographyThesis (PhD ( Interdisciplinary Health))--University of Stellenbosch, 2010.
Bibliography
ENGLISH ABSTRACT: Introduction: It is increasingly being recognized that how intensive care services are delivered may have a greater impact on patient outcome than the individual therapies. Uncertainty regarding the optimal physiotherapy service provision model in a surgical intensive care unit (ICU) exists. Methodology: The aims of this study were to 1) develop an evidence-based physiotherapy protocol; 2) validate the content of the protocol; and 3) conduct an explorative intervention trial to compare usual care to the estimated effects of providing a physiotherapy service guided by an evidence-based physiotherapy protocol by a dedicated physiotherapist. A systematic review process was used to synthesize the evidence in eight subject areas. The GRADE system was used to formulate best practice recommendations and algorithm statements. Forty-two experts from a variety of disciplines were invited to participate in a Delphi process. Finally, the evidence-based physiotherapy protocol was implemented in a surgical ICU over four three-week intervention periods by a group of research therapists. The outcomes measured included ventilator time, ventilation proportions, failed extubation proportions, length of ICU and hospital stay, mortality, functional capacity, functional ability and cost (using nursing workload as proxy). Results: Fifty-three research reports in eight subject areas were identified, 23 draft best-practice recommendations and 198 algorithm statements were formulated. The draft protocol consisted of five clinical management algorithms. Fifteen international research experts and twelve national academics in the field of critical care agreed to participate in the Delphi process. Consensus was reached on the formulation of 87% (20/23) recommendations and the rating of 66% (130/198) statements. The risk of an adverse event during the protocol care intervention period was 6:1000 treatment sessions (p=0.34). Patients admitted to the unit during the protocol care intervention period were less likely to be intubated (RR 0.16 95%CI 0.07 – 0.71; RRR 0.84 NNT 5.02; p=0.005) or fail extubation (RR 0.23 95%CI 0.05 – 0.98; RRR =0.77 NNT 6.95; p=0.04). The mean difference in the daily unit TISS-28 score between the two condition periods was 1.99 95%CI 0.65 – 3.35 (p=0.04). Patients managed by the protocol tended to remain in the hospital for a shorter time after unit discharge (p=0.05). There was no difference in the time spent on the ventilator (p=0.50), mortality (p=0.52) or in the six minute walk distance (p=0.65). In addition there was no difference in the proportion of patients who reached independence in any of the Barthel Index activities measured within 48 hours of discharge from the unit. Conclusions: The use of an evidence-based physiotherapy protocol for the comprehensive physiotherapeutic management of patients in a surgical ICU was feasible and safe. The preliminary results of this study suggest that a physiotherapy service, which is guided by an evidence-based protocol and offered by a dedicated unit therapist, has the potential to lower the cost of ICU care and facilitate the functional recovery of patients after unit discharge. This information can now be considered by administrators to optimize the physiotherapy service provided in ICU.
AFRIKAANSE OPSOMMING: Inleiding: Daar word toenemend erken dat die wyse waarop dienste gelewer word, ‘n groter impak mag hê op die uitkoms van pasiënte as die spesifieke modaliteite in gebruik. Onsekerheid heers tans oor die optimale fisioterapie diens model om te volg in ‘n chirurgiese intensiewe sorg eenheid (ISE). Metodologie: The doel van hierdie projek was om 1) ‘n bewysgesteunde protokol te ontwikkel; 2) die geldigheid van die protokol te bevestig; en 3) om deur middel van ‘n eksploratiewe studie die uitkoms van pasiënte te vergelyk wanneer die fisioterapie diens gelewer word aan die hand van die bewysgesteunde protokol deur ‘n toegewyde fisioterapeut, teenoor wanneer die gewone fisioterapie diens gelewer word. Die empiriese bewyse in agt onderwerp areas is gesintetiseer na afloop van ‘n sistematiese literatuur oorsig proses. Die GRADE sisteem is gebruik om beste praktyk aanbevelings en algoritme stellings te formuleer. Twee en veertig kundige persone van verskeie disiplines is genooi om deel te neem aan die Delphi proses om die geldigheid van die protokol te bevestig. Uiteindelik is die geldige bewysgesteunde protokol oor ‘n tydperk van vier drie weke intervensie periodes deur ‘n groep navorsings terapeute in ‘n chirurgiese ISE geïmplementeer. Die tyd wat pasiënte geventileer is, die proporsie pasiënte wat geïntubeer en geherintubeer is in die tydperk, die lengte van ISE en hospitaal verblyf, mortaliteit, funksionele kapasiteit asook funksionele vaardigheid en koste (deur die verpleeg werkslading te gebruik as ‘n indikasie van koste) is gemeet. Resultate: Drie en vyftig navorsings verslae in agt onderwerp areas is geïdentifiseer, 23 konsep aanbevelings en 198 algoritme stellings is geformuleer. Die konsep protokol het uit vyf algoritmes bestaan. Vyftien internasionale en twaalf nasionale kundiges het die uitnodiging aanvaar om aan die delphi proses deel te neem. Konsensus is bereik vir die formulering van 87% (20/23) van die aanbevelings en die gradering van 66% (130/198) van die algoritme stellings. Die risiko vir ‘n ongunstige episode tydens die protokol intervensie periode was 6:1000 sessies (p=0.34). Pasiënte wat tydens die protokol intervensie periode tot die eenheid toegelaat is was minder geneig om geïntubeer te word (RR 0.16 95%CI 0.07 – 0.71; RRR 0.84 NNT 5.02; p=0.005) of om ‘n ekstubasie te faal (RR 0.23 95%CI 0.05 – 0.98; RRR =0.77 NNT 6.95; p=0.04). Die gemiddelde verskil in die daaglikse eenheid TISS-28 telling tussen die twee intervensie periodes was 1.99 95%CI 0.65 – 3.35 (p=0.04). Patiente wat tydens die protokol intervensie periode behandel is was geneig om vinniger uit die hospitaal ontslaan te word nadat hul uit die eenheid ontslaan is (p=0.05). Daar was geen verskil in die ventilasie tyd, (p=0.50) die mortaliteit (p=0.52) of die afstand wat pasiente in ses minute kon aflê binne 48 uur na ontslag uit die eenheid (p=0.65) nie. Daar was ook geen verskil in die proporsie pasiente wat onafhanklikheid bereik het in enige van die kategorieë van die Barthell Index instrument nie. Gevolgtrekking: Die gebruik van die protokol vir die omvattende hantering van pasiënte in ‘n chirurgiese eenheid is haalbaar en veilig. Die voorlopige resultate van hierdie studie dui daarop dat wanneer ‘n fisioterapie diens in ‘n chirurgiese ISE gelewer word aan die hand van ‘n bewysgesteunde protokol deur ‘n toegewyde fisioterapeut dit die potensiaal het om ISE koste te verminder en die funksionele herstel van pasiente na ontslag uit die eenheid te fasiliteer. Hierdie inligting kan nou deur administrateurs oorweeg word om ‘n optimale fisioterapie diens in ‘n chirurgiese ISE te verseker.
18
Kingau, Naomi Wanjiru. "Contextualization of a physiotherapy clinical practice guideline for stroke rehabilitation in Kenya". University of the Western Cape, 2018. http://hdl.handle.net/11394/6272.
Resumen
Philosophiae Doctor - PhD (Physiotherapy)Stroke is the third leading cause of death and disability worldwide. Eighty five per cent of strokes occur in developing countries, and it is estimated that the prevalence will increase in future. Evidence based rehabilitation programs inherent in clinical practice guidelines has the potential to improves functional activities, and participation. However Kenya does not have this guideline. Most clinical guidelines are developed in the western world, and reflect developed world healthcare systems and resources that are not always appropriate to developing nations. Likewise, guidelines are costly to produce. Kenya lacks the resources and the expertise for de novo guideline development. It is therefore appropriate and cost effective to contextualise the available high quality recommendations.
19
Bernhardsson, Susanne. "Advancing evidence-based practice in primary care physiotherapy : Guideline implementation, clinical practice, and patient preferences". Doctoral thesis, Linköpings universitet, Avdelningen för fysioterapi, 2015. http://urn.kb.se/resolve?urn=urn:nbn:se:liu:diva-122558.
Resumen
Research on physiotherapy treatment interventions has increased dramatically in the past 25 years and it is a challenge to transfer research findings into clinical practice, so that patients benefit from effective treatment. Development of clinical practice guidelines is a potentially useful strategy to implement research evidence into practice. However, the impact of guideline implementation in Swedish primary care physiotherapy is unknown. To achieve evidence-based practice (EBP), research evidence should be integrated with clinical expertise and patient preferences, but knowledge is limited about these factors in Swedish primary care physiotherapy. The overall aim of this thesis was to increase understanding of factors of importance for the implementation of EBP in Swedish primary care physiotherapy. Specific aims were: to translate and adapt a questionnaire for the measurement of EBP and guidelines; to investigate physiotherapists’ attitudes, knowledge and behaviour related to EBP and guidelines; to examine clinical practice patterns; to evaluate the effects of a tailored guideline implementation strategy; and to explore patients’ preferences for physiotherapy. The thesis comprises four studies (A-D), reported in five papers. In Study A, a questionnaire for the measurement of EBP and guidelines was translated, cross-culturally adapted, and tested for validity (n=10) and reliability (n=42). Study B was a cross-sectional study in which this questionnaire was used to survey primary care physiotherapists in the county council Region Västra Götaland (n=271). In Study C, a strategy for the implementation of guidelines was developed and evaluated, using the same questionnaire (n=271 at baseline, n=256 at follow-up), in a prospective controlled trial. The strategy was based on an implementation model, was tailored to address the determinants of guideline use identified in Study B, and comprised several components including an educational seminar. Study D was an exploratory qualitative study of patients with musculoskeletal disorders (n=20), using qualitative content analysis. The validity and reliability of the questionnaire was found to be satisfactory. Most physiotherapists have a positive regard for EBP and guidelines, although these attitudes are not fully reflected in the reported use of guidelines. The most important determinants of guideline use were considering guidelines important to facilitate practice and knowing how to integrate patient preferences with guidelines. The tailored, multi-component guideline implementation significantly affected awareness of, knowledge of, and access to guidelines. Use of guidelines was significantly affected among those who attended an implementation seminar. Clinical practice for common musculoskeletal conditions included interventions supported by evidence of various strengths as well as interventions with insufficient research evidence. The most frequently reported interventions were advice and exercise therapy. The interviewed patients expressed trust and confidence in the professionalism of physiotherapists and in the therapists’ ability to choose appropriate treatment, rendering treatment preferences subordinate. This trust seemed to foster active engagement in their physiotherapy. In conclusion: The adapted questionnaire can be used to reliably measure EBP in physiotherapy. The positive attitudes found do not necessarily translate to guideline use, due to several perceived barriers. The tailored guideline implementation strategy used can be effective to reduce barriers and contribute to increased use of guidelines. The clinical practice patterns identified suggest that physiotherapists rely both on research evidence and their clinical expertise when choosing treatment methods. Patients’ trust in their physiotherapist’s competence and preference for active engagement in their therapy need to be embraced by the clinician and, together with the therapist’s clinical expertise, integrated with guideline use in the clinical decision making. Further research is needed on how the EBP components and different knowledge sources can be integrated in physiotherapy practice, as well as on implementation effects on patient outcomes.
20
Alfadil, Tsabeeh Abdalrahman. "Knowledge attitudes and practices regarding physiotherapy management of patients admitted to Intensive Care Units in Khartoum State". University of the Western Cape, 2017. http://hdl.handle.net/11394/6284.
Resumen
Masters of Science - Msc (Physiotherapy)The Physiotherapist is an important member of the multidisciplinary team managing critically ill patients in the ICU. Physiotherapy practice in the ICU has shown itself to be effective, whereas the lack of physiotherapy management in the care of critically ill patients may prolong recovery. Therefore, the knowledge and attitudes about physiotherapy management by the other Health Care Professionals of the team is essential in order to facilitate efficient and effective medical services. This study aimed to determine other Health Care Professional' knowledge, attitudes regarding physiotherapy management in the ICU. As well as, it determined the current physiotherapy practices applied by physiotherapists in ICUs in Khartoum State - Republic of Sudan. The study was conducted due to limited studies in this field.
21
Makalla, Abdallah R. "The role of physiotherapy in the management of patients following cardiac surgery in Tanzania". University of the Western Cape, 2014. http://hdl.handle.net/11394/4186.
Resumen
Magister Scientiae (Physiotherapy) - MSc(Physio)An increase of cardiac surgeries globally has been associated with an increasing number of people with cardiovascular disease in both developed and developing countries. Following cardiac surgery, pulmonary complications are an important cause of morbidity leading to significant prolonged hospitalisation, mortality and overall hospital costs. Physiotherapists have been part of cardiac multidisciplinary team playing a role in prevention and managing respiratory complications post-operatively. Numbers of studies have investigated on the efficacy of physiotherapy interventions in managing patients following cardiac surgery. However, there is no consensus in the literature with regards to intensity, duration of the session and content of therapy in this specialised area of cardio-pulmonary. These variations of physiotherapy intervention have made difficult to find agreement on the necessity of physiotherapy care in the post-operative management of patients following cardiac surgery. To date, however, there have been limited or no studies done on the role of physiotherapy in the Cardiac Unit setting. Thus, the aim of the study was to investigate the role of physiotherapy in the post-operative management of patients following cardiac surgery at Muhimbili National Hospital (MNH), Tanzania. An explanatory sequential mixed method study design was used. A descriptive retrospective study design was chosen for the quantitative phase using a convenient sample of all 105 patients’ records operated from January 2010 to 31st December 2013. With regards to the qualitative phase, 2 Cardiac Surgeons and 10 Physiotherapists working at MNH were conveniently sampled to explore their perceptions on the post-operative role of physiotherapy in the management of patients following cardiac surgery at MNH. Ethical clearance was obtained from the University of the Western Cape and Muhimbili National Hospital to conduct the study. Anonymity and confidentiality was ensured for all participants and their participation was voluntary. They were allowed to withdraw from the study anytime without any negative consequences. Following ethical issues; quantitative data (i.e. profile and process of care of patients) was collected by means of a data extraction sheet while the two separate semi-structured interview guides were used for qualitative data. A total of 105 patients’ records were obtained. Quantitative data was analysed using SPSS 22.0 version. A descriptive statistics was used. The mean age of the study sample was 30.6 (SD=10.5). More than half (54.3%) were females and males 45.7% of the sample. The results show that Rheumatic Heart Disease (RHD) accounted for the majority (74.3%) of cardiac diseases. Double valve repair accounted for 71.4%. A decline in the number of surgeries performed were noted from 2010 (48.6%) to 2013 (10.5%). The mean number of days spent in Intensive Care Unit (ICU) were 6.4 (SD=5.3) and in the ward 12.2 (SD=7.8). A total of 21.4% of the sample developed post-operative complications and 10.5% of the total sample died. A substantial number of patients (77.7%) were referred for physiotherapy treatment post-operatively, with most of these referrals (70.0%) on the first day post-operatively. The majority (37.8%) of the patients received 3 physiotherapy sessions in the ICU with most of these patients (79.3%) being seen once a day in the ICU and (65.8%) in the ward. Physiotherapists prescribed (53.7%) a combination of breathing exercises, active limb mobilisation, incentive spirometry and progressive ambulation in the ICU. A combination of breathing exercises, active limb mobilisations, endurance training and posture correction was frequently (89.5%) prescribed in the ward. Content analysis was used to analyse qualitative data. Cardiac Surgeons were aware of the role of Physiotherapists on the post-operative management of patients following cardiac surgery. They also identified shortcomings on the side of Physiotherapists’ in terms of poor co-operation, inadequate skills and a lack of motivation to work in the Cardiac Unit. On the other hand, Physiotherapists revealed that there was communication breakdown between them and Cardiac Surgeons. They added that they were not motivated to work in the Cardiac Unit due to their inadequate skills in the area of investigation, training and lack of working facilities. Although they had consensus on different techniques, they had variations on the application procedure, intensity and frequency. Cardiac Surgeons and Physiotherapists agreed that hospital management should motivate Physiotherapists by opening a Physiotherapy Unit within the Cardiac Complex and train Physiotherapists in the area of cardio-pulmonary. From these findings it can be concluded that, poor communication and lack of trained Physiotherapists in the field of cardio-pulmonary is a setback which need to be addressed. Also, lack of standard treatment procedure among Physiotherapists brings variations in this world of evidence based practice.
22
Akeneh, Ukari Josiah Smith. "Roles of physiotherapy in primary health care: Awareness and perceptions of other health care professionals in Rivers East Senatorial District, Rivers State, Nigeria". University of the Western Cape, 2019. http://hdl.handle.net/11394/7005.
Resumen
Magister Scientiae (Physiotherapy) - MSc(Physio)BACKGROUND: Access to basic health care services through the primary health care (PHC) settings, was affirmed as a fundamental human right by the World health organisation (WHO) in 1978 in Alma Ata (Kazakhstan). Internationally, interdisciplinary collaboration among health care professionals (HCPs) have been the preferred approach to addressing the health and psychosocial needs of the populace. The PHC being the first point of contact for most Nigerians and the cornerstone of health care policies in Nigeria, covers promotive, preventative, curative and rehabilitative services. Although, Physiotherapy has ideally qualified personnel to contribute to the attainment of the goals and objectives of the PHC policies, these services are mostly carried out by other HCP’s subdivided as clinicians (medical doctors, dentists, nurses/midwives, optometrists, pharmacists, radiographers, laboratory scientists) and clinical assistants (pharmacy technicians, radiography technicians, laboratory technicians and community health extension workers). Physiotherapy services are mostly concentrated at tertiary and secondary health care settings. AIM: To determine the awareness and explore the perceptions of clinicians and clinical assistants employed in the type 3 primary health care (PHC) settings of Rivers East Senatorial district of Rivers State, Nigeria, regarding the roles of Physiotherapy in a PHC setting.
23
Daulat, John Alexander. "An alternative group physiotherapy programme for the management of chronic low back pain in Primary Care". Thesis, Middlesex University, 2016. http://eprints.mdx.ac.uk/21275/.
Resumen
Objectives: To design, implement and evaluate an alternative physiotherapy group exercise programme used for managing chronic low back pain (CLBP) in Primary Care. Introduction: CLBP is a disabling condition with no established standard management. Conservative treatments such as supervised exercise and manual therapy have demonstrated some benefit. Group exercise programmes used in physiotherapy practice are a cost effective treatment for managing CLBP but currently lack a combination of individualized specific exercises, one to one education and manual therapy (‘hands on’ techniques). An alternative group programme was designed to address these limitations. Methods: This thesis consisted of two stages; a survey and a mixed methods design study. The physiotherapy survey was used in stage 1 to investigate what type of exercises are prescribed by physiotherapists and which group programmes are used in clinical practice for managing CLBP. One hundred and fifty-four questionnaires were distributed with a response rate of 63%. Ninety-seven percent of physiotherapists surveyed refer their CLBP patients to group programmes but only 47% of all respondents were able to refer non-English speaking patients. None of the group programmes offered manual therapy. The alternative group physiotherapy programme was developed using this research, review of the literature and consultation with service providers. In stage 2, the alternative group exercise programme was evaluated using a mixed methods preliminary study consisting of a core quantitative and supplementary qualitative phases. The alternative group programme (Group A) was compared to a standard group exercise programme used in clinical practice (Group B) in a single blinded randomised controlled trial. Participants with CLBP were allocated to the two programme groups by block randomisation. Participants in both groups attended six one-hour programme sessions over a 3-month period. Outcomes measuring function, pain, quality of life (EQ-5D) and satisfaction with treatment were used to evaluate the effectiveness of the programmes pre and post programme attendance and at 6 months. Focus groups in the qualitative phase were used to explore patients’ experiences regarding their treatment in the two group programmes. Results Stage 2: Eight-one participants were randomised to the two groups (41 in Group A; 40 in Group B). There was a drop-rate of 33% and only 41% were followed up at 6-months (n=10, Group A; n=12, Group B). There were no statistically significant differences between groups in outcome scores and apart from the EQ-5D at six months, the associated effect sizes were small. The within group analysis revealed significantly lower disability and pain scores post-programme compared to pre-programme in both groups. There were significantly higher EQ-5D scores post-programme compared to pre-programme in Group A but not in Group B. Quality of life deteriorated in Group B at 6-months. The focus group interviews showed that patients prefer individualised exercises and one-to-one education which are components of the alternative programme. Conclusion: This alternative programme may provide a suitable addition to existing programmes available for managing CLBP. This research may change the way physiotherapists deliver exercise for CLBP patients in a group setting.
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Sagbrant, Emelie y Johanna Trolin. "Fysioterapeuters upplevelser och erfarenheter av digitala vårdmöten : En intervjustudie". Thesis, Uppsala universitet, Åsenlöf: Fysioterapi, 2021. http://urn.kb.se/resolve?urn=urn:nbn:se:uu:diva-444431.
Resumen
Bakgrund: Digitala vårdmöten är något som används mer och mer, särskilt i samband med COVID-19 men även i enlighet med olika mål för digitalisering. Videomöten har visat sig fungera ganska bra som alternativ till vanliga besök och telefon, men det saknas en bild av hur just fysioterapeuter upplever digitala möten. Syfte: Att undersöka fysioterapeuters upplevelser och erfarenheter av digitala vårdmöten jämfört med traditionella fysioterapeutbesök inom primärvården. Metod: Studien har en kvalitativ design. Data samlades in genom 5 semistrukturerade intervjuer med fysioterapeuter och analyserades med hjälp av kvalitativ innehållsanalys. Resultat: Analysen av intervjuerna resulterade i 6 kategorier och 15 underkategorier. Kategorierna var; Digitala möten kan underlätta för patienten och fysioterapeuten, Fysioterapeutens arbete utvecklas och anpassas under pandemin, Utmanande att få till bra digitala möten, Möjligheter med digitala möten, Begränsningar med digitala möten och Förbättringspotential. Konklusion: Digitala vårdmöten inom fysioterapi skulle kunna vara ett alternativ för patienter som är intresserade och för besök som innefattar samtal, observation, rådgivning, träning och uppföljning, och där det inte krävs en mer ingående manuell undersökning. Digitala möten kan underlätta för både patienten och fysioterapeuten, men fortsatt utveckling av teknik och tillgänglighet behövs för att ytterligare förbättra patientarbetet.Background: Digital healthcare consultations is something used more and more, especially during COVID-19 but also in accordance with various goals for digitization. Video consultations has proven to work well as an alternative to regular visits and telephone calls, but there is no clear view on how physiotherapists experience digital meetings. Objective: To investigate physiotherapists' experiences of digital care meetings compared to traditional physiotherapist visits in primary care. Method: The study has a qualitative design. Data was collected through 5 semi-structured interviews with physiotherapists and analyzed using qualitative content analysis. Result: The analysis of the interviews resulted in 6 categories and 15 subcategories. The categories were; Digital meetings can make it easier for the patient and the physiotherapist, The physiotherapists' work is developed and adapted during the pandemic, Challenging to get good digital meetings, Opportunities with digital meetings, Limitations with digital meetings and Potential for improvement. Conclusion: Digital care meetings in physiotherapy could be an alternative when patients want it and for visits including conversation, observation, advice, training and follow-up, and where there is no need for a more thorough manual examination. Digital meetings can make it easier for both the patient and the physiotherapist, but further development of technology and accessibility is needed to improve the work with the patient.
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Öhman, Ann. "Profession on the move : Changing conditions and gendered development in physiotherapy". Doctoral thesis, Umeå universitet, Epidemiologi och folkhälsovetenskap, 2001. http://urn.kb.se/resolve?urn=urn:nbn:se:umu:diva-7519.
Resumen
Physiotherapy in Sweden has developed from a practical, hands-on, assistant job predominantly taught at college level to a university-based academic discipline emphasising evidence-based practice and research. Women are in majority although an increasing number of men have entered the profession. Women and men physiotherapists tend to undertake different career paths. The overall aim of the present thesis was to use a gender perspective to describe and analyse attitudes to the professional role, health care work and the development of the profession among actors engaged in physiotherapy education. A questionnaire was distributed in 1997 to all Swedish physiotherapy students in the second semester of the education (n=273). The same cohort was investigated in 1999 at the completion of the education. The response rate was 93 percent at both occasions. For an international comparison, the same questionnaire was distributed in 1997 and in 1999 to a group of Canadian physiotherapy students in their first and last semesters (n=60). Qualitative research interviews were conducted with 8 novices in physiotherapy and with 14 women educators in academia. Five focus group discussions with clinical supervisors were conducted (10 women and 5 men). Methods used were Grounded theory, factor analysis, logistic regression and path analysis. Feminist theories and Bourdieu's theory of culture constituted a theoretical framework Four ideal types were identified among the novices representing attitudes to the professional role. The Treater and The Supervisor were attitudes found among the women, whereas The Coach and The Entrepreneur were attitudes among the men. Type of health care facility was important for their positioning in the organisational hierarchy. Swedish students favour future employment in private practice. Sports medicine clinics and fitness centres are health care facilities highly endorsed, as is health promotion. Neither care of elderly nor hospital work are preferable fields of practice. Research is not favoured. Men students are more likely to have chosen the profession because of their interest in physical activity and sports. They are also more likely to prefer owning a private clinic and working with alternative approaches such as fitness training in sports medicine clinics. Women students are more likely to prefer an employment in private practice. The Canadian men students favour private practice whereas the women prefer the public sector of health care. The academic educators experience a gap between theory and practice which causes conflicting messages to students. Competing professions, emergent societal change and a conservative clinical practice constitute threats to the profession. The uniqueness of professional competency, theoretical development and new arenas such as home rehabilitation, consulting and research constitute a vision for future development of the profession. Masculinity is highly valued for status and power whereas femininity symbolises empathy and caring. The clinical supervisors update their theoretical knowledge base through supervision of students, but claim that students lack hands-on skills. Stress at work, unequal power relations in the hierarchy and restructuring of health care are factors that influence work satisfaction negatively. To conclude, gendered habitus, different symbolic capital and different attitudes towards health care work and development of the profession were found in the sub-fields of physiotherapy.digitalisering@umu
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Ntamo, Precious Nomatende. "Poor attendance for outpatient physiotherapy by patients discharged from Mthatha General Hospital with a stroke in 2007". Thesis, Walter Sisulu University, 2011. http://hdl.handle.net/11260/d1006933.
Resumen
Background: Stroke is a major cause of disability in the world and its long term effects require good adherence to treatment protocols of physiotherapy. This will ensure optimal rehabilitation and reduce the burden of care in the society and the health service. Superficial analysis of existing data from the Physiotherapy Department of Mthatha General Hospital (MGH) revealed that there was poor attendance of outpatient physiotherapy by patients discharged from MGH with stroke and this had negative effects on outcomes and health care costs. Aim: To identify factors that influence poor attendance for outpatient physiotherapy by patients discharged from MGH with a stroke. Methods: Following approval from the Research Ethics Committee to conduct the study, an observational descriptive study design was used. The study population was 139 patients with stroke who attended for physiotherapy in MGH from January 2007 to December 2007. From a sample size of 103 randomly selected patients, 85 patients participated in the study with a response rate of 82%. Data collection was done using structured interviews and SPSS was used for data analysis. Results: The majority (86%) of patients did not attend physiotherapy until discharge from physiotherapy department. The major factors that influenced poor attendance were movement of patients to other areas (36%) and long distance from MGH (29%). Conclusion: The majority of stroke patients who attended for rehabilitation in MGH Physiotherapy Department lived in rural areas which were distant from Mthatha and could not attend physiotherapy at MGH as required by the physiotherapists. Recommendation: Development of a Provincial Rehabilitation Policy to address the unavailability of physiotherapy services at clinics and health care centers and ensure creation and filling of vacant physiotherapy positions at these levels of care.
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Jenkins, Virginia Sue. "An exploration of physiotherapy students attitudes to attachment and their interactions with patients in a clinical setting". Thesis, University College London (University of London), 2002. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.252186.
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Gustavsson, Catharina. "Self-management of Persistent Neck Pain : A Multi-component Group Intervention in Primary Health Care". Doctoral thesis, Uppsala universitet, Institutionen för folkhälso- och vårdvetenskap, 2011. http://urn.kb.se/resolve?urn=urn:nbn:se:uu:diva-134522.
Resumen
The overall aim of this thesis was to evaluate effects of a multi-component pain and stress self-management group intervention (PASS) and to explore plausible predictors associated with short-term and long-term treatment effects among patients with persistent tension-type neck pain in primary health care (PHC). Study I was a pilot study in order to explore feasibility of the study design and methods. It included 37 participants randomly assigned to the intervention (n=18) or treatment-as-usual (n=19). Study II-III was a pragmatic randomized controlled trial that compared effects of the PASS and individually administered physiotherapy (IAPT) on patients with persistent tension-type neck pain in PHC. Study II evaluated short-term effects over a 20-week follow-up. Study III evaluated long-term effects on maintenance over a follow-up period of 2 years. Studies included 156 participants randomly assigned to PASS (n=77) or IAPT (n=79). Study IV explored predictive factors for favorable outcome in disability regarding participants assigned to PASS. The results showed that PASS had better effects than IAPT regarding coping with pain, in terms of patients’ ability to control pain, self-efficacy regarding activities interfered with by pain, disability and catastrophizing, over the 20-week follow-up, and treatment effects were largely maintained over a 2-year follow-up. Post-treatment scores in disability, self-efficacy and pain intensity were associated with long-term outcome in pain-related disability 2 years post-treatment following PASS. Pre-treatment characteristics explained only a minor proportion of variance in disability, and were assumed weakly associated with treatment success and long-term outcome. Key components for enhancement of long-term efficacy in pain self-management coping efforts were adequately targeted by PASS. It is suggested important to strengthen self-efficacy beliefs in regard to pain coping, to reduce disability and enhance pain self-management in the treatment of persistent neck pain, and to induce long-term maintenance of treatment gains on disability following a pain self-management intervention.
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Karachi, Farhana. "Survival and health related quality of life of patients 12 months following discharge from an adult surgical intensive care unit". Thesis, Stellenbosch : University of Stellenbosch, 2005. http://hdl.handle.net/10019.1/1868.
Resumen
Thesis (MScPhysio(Interdisciplinary Health Sciences. Physiotherapy))--University of Stellenbosch, 2005.Objectives: This study forms part of a baseline study conducted on patients admitted to an adult surgical ICU between June and October 2003. The survival rate and health related quality of life (HRQoL) of patients 12months following ICU discharge was determined. The correlation of selected demographic and ICU variables to survival and HRQoL was determined. Design: Prospective observational cohort study. Setting: Tenbed closed public tertiary adult surgical ICU. Patients: 180 subjects obtained from a previous baseline study. Measurements: The baseline study provided the demographic data and ICU variables. Survival rate was determined from a Kaplan Meier survival curve. A self-developed questionnaire was used to obtain other selected variables for comparison. A modified Short-Form 36 version 2 (SF-36v2) was use to measure HRQoL perceptions of patients. Results: The survival rate was 62% at 12 months following ICU admission. None of the selected variables were significantly correlated to the long-term survival outcome except for APACHE II which was negatively correlated to this outcome (p<0.01). Forty-six subjects took part in the HRQoL study. The mean HRQoL scores ranged between 43% and 53% for each of the SF-36 HRQoL domains. The physical functioning (43.5%), role play (44.5%) and role emotion (43.1%) domains had the lowest scores. APACHE II had a significantly negative correlation to the physical functioning domain of HRQoL (p=0.02). Age was positively correlated to social functioning (p<0.01) and role emotion (p=0.03). Patients employed after ICU had significantly higher scores for general health (p<0.01) than those who were not. Patients unsure of their TB status and HIV status had significantly lower scores in general health (p=0.02) and role emotion (p=0.05) respectively. ICU length of stay was negatively correlated to role play (p=0.05) and role emotion (p<0.01). Intubation period was negatively correlated to general health (p=0.04). Conclusion: APACHE II was the only variable significantly correlated to both long-term survival and the physical functioning domain of HRQoL. Although the long-term survival was comparable to that of international ICU populations the HRQoL outcomes were slightly lower. Similar to international studies and a South African study evaluating the HRQoL of aids sufferers and police, the current ICU population presented more limitation in the physical functioning, role play and role emotion domains of HRQoL.
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Andersson, Helena y Nathalie Stenquist. "Det dom inte nämner : Enkätstudie om informationen Sveriges hälso- och sjukvård erbjuder kvinnor gällande postpartumträning". Thesis, Luleå tekniska universitet, Hälsa och rehabilitering, 2018. http://urn.kb.se/resolve?urn=urn:nbn:se:ltu:diva-67226.
Resumen
Background: After pregnancy and childbirth the female body goes through changes in both body and mind. Inadequate research has been done in the field of physical activity and exercise in postpartum women. Swedish counties has not formed a cohesive plan of antenatal care which creates variations throughout the country. Purpose: The aim for this study was to investigate how women are being informed about physical activity and exercise postpartum by Swedish healthcare. Method: To complete this study a survey was made and via a snowball sampling distributed throughout social media. Participants; 1023 women whom represented each county of Sweden. Inclusion criteria; to have given birth in Sweden the last 5 years and understand the Swedish language. Results: Women get limited oral and written information about physical activity and exercise. The information is mainly distributed by a midwife and women rarely get to meet a physiotherapist postpartum. Half of the women that did meet with a physiotherapist used the information but was in general not satisfied with its content. Conclusion: Postpartum activity and exercise is an individual process that should be exerted in consultation with a physiotherapist and the field of physiotherapy should be utilized to a greater extent in Swedish antenatal care.
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Nel, Stephanus Gerhardus. "The effects of a lung recruitment manoeuvre before extubation on pulmonary function after coronary artery bypass surgery". Thesis, Stellenbosch : Stellenbosch University, 2013. http://hdl.handle.net/10019.1/85871.
Resumen
Thesis (MScPhysio)--Stellenbosch University, 2013.ENGLISH ABSTRACT: Aim: The aim of this study is to determine if the addition of a pre-extubation recruitment manoeuvre to standard care is safe and will improve lung compliance and subsequent PaO2/FiO2 (PF ratio) after extubation in postoperative coronary artery bypass graft surgery patients. Design: Prospective, triple blind, randomised, controlled trial. Method: This study was conducted in a private hospital in the Northern suburbs of Cape Town, South Africa. All patients admitted between 03/10/2010 and 22/11/2011, for uncomplicated elective coronary artery bypass graft (CABG) surgery were eligible for inclusion into the study. Patients were randomly allocated into either the intervention group or the control group. The intervention group received a gradual build-up lung recruitment manoeuvre (RM). The primary outcome was PaO2/FiO2 (PF ratio). The secondary outcomes were safety and static lung compliance. ICU length of stay (LOS) and hospital LOS were also recorded. The pre-RM hemodynamic stability of the patient was checked before the intervention and repeated at 5 minutes after the intervention by the nursing sister. Data to calculate static lung compliance was captured at the same time. Criteria for safety and discontinuation of the RM were monitored during the intervention by the principle investigator only. Results: Of the 69 patients eligible for the study 47 were randomly allocated into the intervention group (n=22) and control group (n=25) respectively. Groups were the same at baseline with regards to sex, pulmonary risk, sedation and surgical procedures. The RM could be completed in all patients. The prior defined criteria for discontinuation of the RM were not reached in any of the patients. No adverse effects were noted. The PaO2/FiO2 (PF ratio) decreased significantly in both groups from pre-surgery measurements compared to when measured before the RM (p<0.001). There was a tendency noted for the intervention group to return to pre-surgery measurements of PF ratio within 12 hours after extubation when compared to the control group. There was no significant difference between the groups from extubation to 24 hours (p = 0.6). The static compliance improved at 5 minutes following the RM (p<0.001) and remained improved until extubation (p<0.001) for the intervention group. No difference was noted in the static compliance of the control group over the same time period. The mean hospital length of stay for the intervention group was 8.61 (95% confidence interval 7.26 to 9.96 days) and 10.08 (95% confidence interval 8.52 – 11.63 days) for the control group. Conclusion: A gradual recruitment manoeuvre at 30cmH2O 30minutes before extubation significantly improved static lung compliance within 5 minutes with no adverse hemodynamic side effects. There was noted maintained improved PF ratio at extubation or immediately afterwards for the intervention group and no difference in the PF ratio between the intervention group and control group.
AFRIKAANSE OPSOMMING: Doel: Die doel van hierdie studie is om te bepaal of die toevoeging van ’n pre-ekstubasie herwinningstegniek tot standaard sorg veilig is, en of dit longvervormbaarheid en gevolglike PaO2/FiO2 (PF-verhouding) na ekstubasie in post-operatiewe kroonaaromleidingchirurgiepasiënte sal verbeter. Ontwerp: Prospektiewe, trippel-blinde, ewekansige, gekontroleerde proefneming. Metode: Hierdie studie is uitgevoer in ’n privaat hospitaal in die noordelike voorstede van Kaapstad, Suid-Afrika. Alle pasiënte wat tussen 03/10/2010 en 22/11/2011 gehospitaliseer is vir ongekompliseerde elektiewe kroonaaromleidingchirurgie, kon in aanmerking kom vir die studie. Pasiënte is op ewekansige wyse ingedeel in die intervensie- en kontrolegroepe. ’n Geleidelike-opbou-van-druk-longherwinningstegniek (HT) is op die intervensiegroep toegepas. Die primêre uitkoms was die PaO2 /FiO2 (PF-verhouding). Die sekondêre uitkoms was veiligheid en statiese longvervormbaarheid. ISE-verblyf en hospitaalverblyf is ook genoteer. Die navorsingsassistent het data van bestaande eenheiddokumentasie geneem. Die pre-HT-hemodinamiese stabiliteit van die pasiënte is gemonitor voor en weer 5 minute na die intervensie. Inligting om die statiese longvervormbaarheid te bereken is terselfdertyd genoteer. Kriteria vir veiligheid en vir die staking van die HT is gemonitor tydens uitvoering deur die primêre ondersoeker en die verpleegkundige. Resultate: Van die 69 pasiënte wat in aanmerking kon kom vir die studie is 47 op ewekansige wyse ingedeel in die intervensiegroep (n=22) en die kontrolegroep (n=25). Die groepe was dieselfde by die basislyn. Die herwinningstegniek kon volledig op alle pasiënte uitgevoer word. Die vooraf gedefinieerde kriteria vir staking van die HT is met geen pasiënte bereik nie. Geen nadelige uitwerking is genoteer nie. Die PaO2 /FiO2 (PF-verhouding) het beduidend verminder in beide groepe van pre-operatiewe metings in vergelyking met meting voor die HT (p<0.001). ‘n Neiging is genoteer dat die intervensiegroep binne 12 uur na ekstubasie tot pre-chirurgie PF-metings teruggekeer het. Daar was geen merkbare verskil tussen die groepe vanaf ekstubasie tot 24 uur (p=0.6) nie. Die statiese vervormbaarheid het verbeter teen 5 minute na HT (p<0.001) en het verbeter gebly tot ekstubasie (p<0.001) vir die intervensiegroep. Daar was geen verskil in die statiese vervormbaarheid van die kontrolegroep nie. Die gemiddelde hospitaalverblyf vir die intervensiegroep was 8.61 (95% betroubaarheidsinterval 7.26 tot 9.96 dae) en 10.08 (95% betroubaarheidsinterval 8.52 – 11.63 dae) vir die kontrolegroep. Gevolgtrekking: ’n Geleidelike herwinningstegniek teen 30cmH2O 30 minute voor ekstubasie het statiese longvervormbaarheid beduidend verbeter binne 5 minute, met geen nadelige hemodinamiese newe-effekte nie. Daar was geen verskil in die oksigenasie-indeks tussen die intervensie- en kontrolegroep na ekstubasie nie.
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Clark, Nicholas y Jesper Bengs. "Fysioterapeuters upplevelser och erfarenheter av att använda sig av the High Intensity Functional Exercise Program (the HIFE Program) på äldreboende". Thesis, Uppsala universitet, Åsenlöf: Fysioterapi, 2021. http://urn.kb.se/resolve?urn=urn:nbn:se:uu:diva-443668.
Resumen
Bakgrund: The High Intensity Functional Exercise (HIFE) program har visats ha goda effekter på fysisk funktionsförmåga och ADL-förmåga för äldre personer boende på äldreboende och hjälpberoende i ADL. Det finns dock begränsat med kunskap om fysioterapeuters upplevelser och erfarenheter av att använda sig av HIFE på äldreboende. Denna studie kan bidra till förståelse för hur fysioterapeuter kan utföra högkvalitativ träning för denna population. Syfte: Att undersöka fysioterapeuters upplevelser och erfarenheter av att använda sig av HIFE för äldre personer boende på äldreboende. Metod: För att besvara syftet valdes en kvalitativ design och fem fysioterapeuter som har arbetat enligt HIFE på äldreboende i Sverige intervjuades genom enskilda semistrukturerade intervjuer. Intervjuerna analyserades med kvalitativ innehållsanalys. Resultat: Utifrån insamlade data identifierades fyra kategorier med sammanlagt 17 underkategorier. Kategorierna var: Framgångsrik implementering kräver mångas engagemang, Viktigt att göra ett aktivt val av deltagare, Utmana deltagarna nära sina gränser och Effekter av träningen på många plan. Konklusion: Samtliga fysioterapeuter gav uttryck för att det finns ett stort behov av HIFE på äldreboenden. HIFE ansågs lämpligt för många boende och möjliggör att utmana deltagarna till en hög intensitet så att de kan få en god effekt av träningen. För att lyckas krävs mångas engagemang innan, under och efter träningsperioden.Background: The High Intensity Functional Exercise (HIFE) program has been shown to have good effect on physical function and ADL in elderly people living in nursing homes and dependent on assistance with activities in daily living (ADL). However, there is limited knowledge regarding physiotherapists' experiences of using HIFE in nursing homes. This study can help to understand how physiotherapists can perform high-quality training with this population. Aim: To investigate physiotherapists' experiences of HIFE with elderly people living in nursing homes. Methods: To achieve the objective of this study a qualitative design was chosen and five physiotherapists that have worked according to HIFE in nursing homes in Sweden were interviewed using a semi-structured approach. The interviews were analyzed using qualitative content analysis. Results: Based on the collated data, four categories were identified with a total of 17 subcategories: Successful implementation requires the commitment of many, Important to actively choose participants, Push the participants close to their limits and Effects of the training seen on many levels. Conclusion: All physiotherapists expressed a great need for HIFE in nursing homes. HIFE was considered suitable for many of the residents and made it possible to challenge the participants to a high intensity and thus saw a greater effect. In order to succeed, commitment is required from a number of people before, during and after the training period.
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Rossouw, Tania. "Strategic options for the physiotherapy industry in the current context of private healthcare in South Africa". Thesis, Stellenbosch : Stellenbosch University, 2006. http://hdl.handle.net/10019.1/50644.
Resumen
Thesis (MBA)--Stellenbosch University, 2006.ENGLISH ABSTRACT: South Africa's healthcare industry is at a crossroad as pressure in both the public and private sectors is increasing. The extent of change in the industry is overwhelming and it is seen as a very turbulent and unstable environment. Healthcare professionals must reconsider their position in the industry and adapt in this ever-changing environment. The physiotherapy profession forms a small part of the healthcare value chain, but it fulfils an important role in the healthcare system. Unfortunately the profession shows no clear direction and purpose. There also exists a mismatch between the current healthcare environment demands and the physiotherapy service delivery. If they do not adapt in this environment which is in turmoil and have a clear strategy for the way forward, they will be pushed out of the healthcare value chain and become obsolete. The aim of this research report was then to do an in depth analysis of the private healthcare industry in which physiotherapy is operating, to analyse the external physiotherapy industry and an internal analysis of the profession so as to construct a generic strategy for the physiotherapy profession in the private healthcare sector in South Africa. To achieve this aim, it was determined that qualitative, investigative research would be conducted. The research methodology used in this research report was a combination of primary and secondary research. Firstly, secondary research in the form of a literature review was conducted to provide a comprehensive insight into the provision of health care in South Africa. Thereafter, primary research was conducted through semi-structured, in-depth interviews with a purposive sample of physiotherapy industry experts to analyse the external physiotherapy Industry as well as the internal profession environment. Main findings include that the physiotherapy industry is becoming less attractive as competitive forces in the physiotherapy and private healthcare industry are moderate to strong. Deconstruction of the healthcare value chain in the private sector is increasing intra- and inter-professional competition. Government plays a major role in the attractiveness of the industry as they are restricting competitive and market forces and minimising profits through legislation. Medical schemes are trying to contain costs and managed healthcare is coming to the forefront. The physiotherapy market is stagnating and the clients' needs and requirements are changing. Opportunities that were identified we~e the expansion into new markets, involvement in other industries and broadening the scope of practice. Threats are mainly from governmental legislation and policies, vertical integration from the hospital and medical scheme industries and the threat of substitutes, especially alternative health. From the internal profession analysis a current strategy was identified and a strategic intent was formulated as the physiotherapy profession wants to be the preferred and relevant health care service provider in prevention, management and rehabilitation of potential and actual movement impairments of individuals. Strengths to help build this vision included their high regard and profile, quality training, increase in research and evidence and their whole service package. Weaknesses that must be overcome include poor business, managerial and marketing skills, limited role models and leaders and the high levels of intra-professional competition leading to the demise of the profession. Having completed the analysis, major strategic thrusts with a focussed differentiated approach for the profession could then be formulated: • Define physiotherapy and the scope of practice. • Reinstate physiotherapy in the healthcare system. • Develop leadership. • Cooperate within the profession. • Maintain professional autonomy. • Develop business skills.
AFRIKAANSE OPSOMMING: Gesondheidsprofessies moet hul posisie in die industrie herevalueer en aanpas in hierdie steeds wisselende omgewing. Die fisioterapie professie beslaan 'n klein deeltjie van die gesondheidsorg waardeketting, maar dit vervul 'n baie belangrike rol in die gesondheidsorg stelsel. Ongelukkig blyk dit asof die professie geen rigting en doeleindes het waarna dit beweeg en streef nie. Verder bestaan daar ook 'n wanbelyning tussen die huidige gesondheidsorg omgewingvereistes en die dienste wat fisioterapie verrig. Indien die fisioterapie professie nie aanpas in hierdie onstuimige omgewing nie en 'n duidelike strategie ontwikkel vir die toekoms nie, staan dit in gevaar om te verval uit die gesondheidsorg-waardeketting en te vergaan. Die doel van hierdie navorsingswerkstuk is dan om 'n in diepte analise te doen van die privaat gesondheidsorgindustrie waarin fisiolerapeute funksioneer, om die eksterne fisioterapie-industrie sowel as die interne professie te analiseer; ten einde 'n generiese strategie vir die fisiolerapie-professie in privaat gesondheid in Suid Afrika te ontwikkel. Om hierdie doelwitte te bereik is daar besluit om kwalitatiewe navorsing te doen. Die navorsingsmetodologie wat gebruik is bestaan uit 'n kombinasie van primere en sekondere navorsing. Sekondere navorsing is gedoen in die vorm van 'n literatuuroorsig om 'n omvattende oorsig te gee van die gesondheidsorg dienslewering in Suid Afrika. Daarna is primere navorsing gedoen in die vorm van gedeeltelike gestruktureerde, in diepte onderhoude met 'n doelbewuste steekproef van fisioterapie-kundiges om die eksterne omgewing en interne professie te evalueer. Hoof bevindings uit die analise is dat die fisioterapie-industrie se aantreklikheid besig is om te verminder as gevolg van gemiddelde tot sterk kompeterende kragte. Dekonstruksie van die gesondheidsorg-waardeketting in die privaatsektor lei tot verhoogde intra- en inter-professionele kompetisie. Die regering speel ook 'n groot rol in die aantreklikheid van die industrie en hulle beperk natuurlike kompetisie en markkragte en minimaliseer winste deur middel van wetgewing. Mediese fondse probeer kostes beperk en besturende gesondheidsorg begin ontluik. Die huidige fisioterapiemark is besig om te stagneer en kliente se behoeftes en vereistes is besig om te verander. Geleenthede wat geidentifiseer is sluit in die uitbreiding na nuwe markte, betrokkenheid by ander industrie; en die verbreding van fisioterapie se bestek van praktyk. Bedreigings bestaan hoofsaaklik vanaf regeringswetgewing en regulasies, vertikale integrasie van die hospitaal en mediese fonds industriee en die bedreiging van plaasvervangers, veral alternatiewe gesondheid. Vanaf die interne professie-analise is daar 'n huidige strategie geidentifiseer en 'n strategiese intensie kon geformuleer word. Hierdie intensie is dat die fisioterapieprofessie die gewenste en relevante gesondheidsorg diensverskaffer sal wees in die voorkoming, bestuur en rehabilitasie van potensiele en werklike bewegingsaantastings van individue. Sterkpunte in die professie wat hierdie intensie kan ondersteun, sluit in hul goeie profiel en agting, kwaliteit opleiding, toename in navorsing en hul volledige dienspakket. Swakpunte wat oorkom moet word is swak besigheids-, bestuur - en bemarkingsvaardighede, beperkte rolmodelle en leiers en die intra-professionele kompetisie wat die professie as 'n geheel ondermyn. Nadat die analise gedoen is kon daar hoof strategiese rigtings geformuleer word met 'n gefokusde differensiasie benadering: • Definieer fisioterapie en bestek van praktyk. • Hervestig fisioterapie in die gesondheidsorgstelsel. • Ontwikkel leierskap. • Samewerking in die professie. • Behou professionele outonomiteit. • Ontwikkel besigheidsvaardighede.
34
Peerbhay, Sarfaraz. "Private sector intensive care physiotherapists profile and current practices in South Africa". University of Western Cape, 2020. http://hdl.handle.net/11394/7689.
Resumen
Magister Scientiae (Physiotherapy) - MSc(Physio)Variability of profile and practices (roles) of the ICU physiotherapists exists globally. The profile and current practices (roles) of the private practice physiotherapist in the private ICU has been minimally explored especially in South Africa (SA). A dearth of survey data and in-depth exploration of the latter exists in the current literature. The aim of this study was to determine and explore the profile and current practices (roles) of the ICU physiotherapists in private ICUs in SA.
2022
35
Murphy, Michelle Leonie. "Total Joint Replacements: Analysis of the Impact of Physiotherapy on Hospital Length of Stay and Models of Care". Thesis, Curtin University, 2016. http://hdl.handle.net/20.500.11937/55081.
Resumen
Hospital length of stay (LOS) following total joint replacement surgery has reduced significantly with advancements in models of care. This natural cohort study examined why individual deviated from the clinical pathway and the risk of increased LOS using chronic conditions and the Risk Assessment and Prediction Tool (RAPT). Physiotherapy milestones, morbid obesity, wound issues and age were identified with increased LOS. The RAPT was found to be valid. Critical review of hospital processes is recommended.
36
Marice, Prior. "Professional Development of Physiotherapists Working in Long-term Care". Thèse, Université d'Ottawa / University of Ottawa, 2012. http://hdl.handle.net/10393/23414.
Resumen
The purpose of this study is to learn about the professional development practices of physiotherapists working in long-term care homes in Ontario. A survey was created based on relevant literature and piloted for this study. The survey included both quantitative and open-ended questions. 44 Physiotherapist responded, which represents approximately 10% of physiotherapists working in long-term care in Ontario. The results indicate that physiotherapists are isolated from their physiotherapist peers and lack access to communities of practice, professional socialisation, professional culture and social regulation. Although physiotherapists’ interactions with interprofessional teams added breadth to their knowledge, these interactions did not enhance their profession-specific skills. Many physiotherapists are seeking professional community and social supports in healthcare settings outside of the long-term care context. The implications of this study are that physiotherapists, their professional associations, and their college must understand the importance of professional socialization in learning, and ensure that physiotherapists working in long-term care have access to and seek such social support. Physiotherapy service providers in long-term care should provide mentoring, support and opportunities for social learning for their clinicians. Finally, long-term care homes and the Ministry of Health and Long-term care need to ensure that policies provide a better definition of the role of physiotherapists in long-term care.
37
Jones, Robert J. "An investigation into the development of a computerized information system for NHS physiotherapy services in England : an action research study". Thesis, University of Kent, 2000. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.324658.
38
Chang, Angela T. "Physiotherapy intervention in the long-term intensive care stay patient : use of head-up tilt and inspiratory muscle training /". [St. Lucia, Qld.], 2004. http://www.library.uq.edu.au/pdfserve.php?image=thesisabs/absthe18873.pdf.
39
Miller, Julia Susan. "Videotaped exercises and instruction for primary care physiotherapy patients : exploring the role they play in shoulder and back pain". Thesis, University of Liverpool, 2006. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.428997.
40
Thunborg, Charlotta. "Exploring dementia care dyads' person transfer situations from a behavioral medicine perspective in physiotherapy : development of an assessment scale". Doctoral thesis, Örebro universitet, Institutionen för hälsovetenskap och medicin, 2015. http://urn.kb.se/resolve?urn=urn:nbn:se:oru:diva-45277.
Resumen
Individuals who suffer from severe dementia require assistance when performing activities of daily living. The highly important person transfer situation is influenced by complex, intertwined biopsychosocial factors that are related to the expression of personal, environmental and behavioral variables, which can interfere with the performance of dementia-care dyads' transfer situations. The overall aim of this study was to leverage a behavioral medicine perspective in physiotherapy to explore, intervene in, and develop an assessment scale for problematic person transfer situations including persons with dementia and the interaction with the caregiver in these transfer situations. Interviews were performed with ten caregivers who were recruited to two focus groups and worked in a special care unit for persons with dementia; interviewees described their experiences pursuant to assisting persons with dementia in transfer situations (I). Literature review and video recordings elicited 93 possible items for the new scale. Expert opinions and item-content validity index reduced the number of items to 17 that spanned two areas. Eight items related to the actions of persons with dementias, whereas nine related to caregiver actions. The feasibility testing of the scale in eight person transfer situations showed that the scale was ready for inter- and intra-rated reliability testing (II). Inter- and intra- rater reliability was good (III). In two single-case experimental design studies, the new scale was shown to contribute to a substantial gathering of data on behaviors in care dyads' person transfer situations (IV). In summary, the results of the thesis show that person transfer situations in dementia special care units are influenced by different biopsychosocial factors and that the new assessment scale can support decision-making about treatment strategies. These findings are important in promoting evidence-based behavior change strategies that can facilitate both sets of individuals—i.e., both persons with dementia and caregivers—in transfer situations. The results highlight important research issues that merit attention in future studies.
41
Andersson, Nicklas y Peter Thörnell. "Plantar fasciit : Sjukgymnastiska behandlingsmetoder inom primärvården i Dalarnas-, Gävleborgs- och Västmanlands län". Thesis, Uppsala universitet, Sjukgymnastik, 2010. http://urn.kb.se/resolve?urn=urn:nbn:se:uu:diva-140224.
Resumen
Abstract Background: Plantar fasciitis is the most common heel injury and is a long-term pain syndrom in the attachment of the plantar fascia to the calcaneus bone. The condition is treated mainly in primary care, but there is currently no treatment guideline for the treatment of plantar fasciitis in Sweden. The purpose of this study was to investigate which treatment that occurred in primary care in Dalarna, Gävleborg and Västmanland counties, which treatments that were most common alone and in combination with each other. The aim was also to investigate if the four most commonly used treatment methods as physical therapists said they had used were supported in the literature, and if there was any difference between county employees and private physical therapists in the choice of treatment method. Method: 100 physiotherapists in primary care in Dalarna, Gävleborg and Västmanland counties, received a questionnaire by mail. 80 of the 100 physiotherapists were county employees and 20 were private employees. They were asked about what treatment methods they used for plantar fasciitis, both individual treatments and combination treatments. A comparison was made between county employees and private employees' choice of treatments and the four individual most frequently used treatments were examined on the basis of recent research. Results: 65 physiotherapists answered the survey, of which 61 of them treated patients with plantar fasciitis. The four most frequently used treatments were taping, stretch of the plantar fascia, advice about start using insoles and advice about changing of shoes. The first three treatments named above were also those most commonly used in combination with each other. This was true for physiotherapists in county as well as in private employment. There is some evidence that these three treatments relieve pain particularly in short term. Conclusion: The four most frequently used treatments were taping, stretch of the plantar fascia, advice about start using insoles and advice about changing of shoes. The conclusion drawn from the evidence currently available to taping, stretch of the plantar fascia and insoles is that it should be a part of the treatment plan for patients with plantar fasciitis. Further research is needed where larger studies and follow-up studies over a longer time is made. Studies of the most common combination treatments should be made, to mimic how they are used in everyday clinical practice.Sammanfattning Bakgrund: Plantar fasciit är den vanligaste hälskadan och är ett långvarigt smärttillstånd i plantaraponeurosens infästning i calcaneus. Tillståndet behandlas framförallt inom primärvården där det idag saknas en behandlingsriktlinje för behandling av plantar fasciit. Syftet med studien var att undersöka vilka behandlingsmetoder som förekom inom primärvården i Dalarnas-, Gävleborgs- och Västmanlands län, vilka behandlingar som var vanligast och vilka som förekom i kombination med varandra. Syftet var även att undersöka om de fyra vanligast använda behandlingsmetoderna som sjukgymnasterna uppgav sig använda hade stöd i litteraturen samt om det var någon skillnad mellan landstingsanställda och privata sjukgymnasters val av behandlingsmetod. Metod: 100 sjukgymnaster inom primärvåden i Dalarnas-, Gävleborgs- och Västmanlands län, 80 landstingsanställda och 20 privatanställda, fick en enkät per e-post. Där frågades de om vilka behandlingsmetoder som användes vid plantar fasciit, både enskilda behandlingar och kombinationsbehandlingar. En jämförelse gjordes mellan landstingsanställdas och privatanställdas val av behandlingsmetoder och de fyra enskilt mest frekvent använda behandlingarna granskades utifrån senaste forskningen. Resultat: 65 sjukgymnaster svarade på enkäten varav 61 av dem behandlade patienter med plantar fasciit. De fyra mest frekvent använda behandlingarna var tejpning, stretch av plantarfascian, råd om inlägg samt råd om byte av skor. De tre förstnämnda behandlingsmetoderna var även de som var vanligast i kombination med varandra och vanligast för både landstingsanställda och privatanställda sjukgymnaster. Det finns visst stöd i litteraturen för dessa tre behandlingsmetoder som smärtlindrande, framförallt på kort sikt. Konklusion: De fyra mest frekvent använda behandlingarna var tejpning, stretch av plantarfascian, råd om inlägg samt råd om byte av skor. Slutsatsen dras utifrån den evidens som för närvarande finns att tejpning, stretch av plantarfascian samt råd om inlägg i dagsläget rekommenderas ingå i behandlingen av plantar fasciit. Ytterligare forskning behövs dock där större studier samt uppföljningsstudier under längre tid görs. Även studier av de vanliga kombinationsbehandlingarna bör göras, för att efterlikna hur de används i den kliniska vardagen.
42
Patman, Shane Michael. "The effect of physiotherapy on the prevention and treatment of ventilator-associated pneumonia for intensive care patients with acquired brain injury". Thesis, Curtin University, 2005. http://hdl.handle.net/20.500.11937/230.
Resumen
Background: Ventilator-associated pneumonia is a major cause of morbidity and mortality for patients in an intensive care unit. Once present, ventilator-associated pneumonia is known to increase the duration of mechanical ventilation, time in the intensive care unit, and length of hospital stay. Patients with acquired brain injury are commonly admitted to the intensive care unit and considered to be at a high risk for the development of respiratory complications such as ventilator-associated pneumonia, which could potentially impact on the intensive care unit costs and outcomes. Respiratory physiotherapy is often provided to prevent and/or treat ventilator-associated pneumonia in patients with acquired brain injury. The theoretical rationale of the respiratory physiotherapy is to improve airway clearance and enhance ventilation which may reduce the incidence of pulmonary infections and thus ventilator-associated pneumonia, and may in turn decrease the duration of mechanical ventilation, prevent the need for tracheostomy and hence result in reduced costs and shorter hospital stay. Although respiratory physiotherapy may be beneficial in reversing or preventing ventilator-associated pneumonia, to date there are no data concerning the effectiveness of respiratory physiotherapy in patients with acquired brain injury. Hence from an evidence-based perspective, at present there is no justification for the role of respiratory physiotherapy in the management of patients with acquired brain injury in the intensive care unit. Aim: This two-part, prospective randomised controlled trial aimed to investigate the effect of regular prophylactic respiratory physiotherapy on the incidence of ventilator-associated pneumonia, duration of mechanical ventilation, and length of intensive care unit stay in adults with acquired brain injury, as compared to a control group (Part A).The second part of the study (Part B) randomised those subjects from Part A who developed a ventilatorassociated pneumonia into a treatment or control group to establish if the provision of a regimen of regular respiratory physiotherapy influenced the outcome of ventilator-associated pneumonia. Additionally, this study also aimed to provide the first description of the financial costs of respiratory physiotherapy time in providing interventions to patients with acquired brain injury in the intensive care unit and investigated the cost effectiveness of respiratory physiotherapy interventions in decreasing the incidence of ventilator-associated pneumonia, duration of mechanical ventilation and length of intensive care unit stay. Subjects: 144 adult patients with acquired brain injury admitted with a Glasgow Coma Scale of nine or less, requiring intracranial pressure monitoring, and invasive ventilatory support for greater than 24 hours, were randomised to a treatment group or a control group. Methods: For subjects randomised to the treatment groups, the regimen of respiratory physiotherapy treatment was repeated six times per 24-hour period and continued until the subject was weaned from mechanical ventilatory support. Each respiratory physiotherapy intervention of 30 minute duration comprised a regimen of positioning, manual hyperinflation and suctioning. In both Parts A and B, the control group received standard nursing and medical care but no respiratory physiotherapy interventions. Results: Consent was obtained for 144 subjects, with 72 randomised for treatment in Part A. Part A groups were comparable with respect to demographic variables, with the exception of body mass index and gender distribution.Using intention to treat philosophy, there were no significant differences for incidence of ventilator-associated pneumonia [Treatment Group 14/72 (19.4%) vs. Control 19/72 (26.4%); p = 0.32], duration of mechanical ventilation (hr) [172.8 vs. 206.3); p = 0.18], or length of intensive care unit stay (hr) [224.2 vs. 256.4; p = 0.22]. For subjects with acquired brain injury receiving this prophylactic regimen of respiratory physiotherapy in the intensive care unit, in an attempt to prevent ventilator-associated pneumonia, the cost of physiotherapy was $487 per subject. Comparatively the intensive care unit mechanical ventilation bed day cost was $33,380 per subject. The cost of Part A respiratory physiotherapy time for Treatment Group 1 was 1.7 per cent of the cost of subject's intensive care unit mechanical ventilation bed days. Thirty-three subjects (22.9%) from Part A developed ventilator-associated pneumonia, and were transferred to Part B and re-randomised, 17 to the Treatment Group 3. Part B groups were comparable with respect to demographic variables. No significant differences were detected in the dependent variables for Part B of the study, with similar duration of mechanical ventilation (hr) [342.0 vs. 351.0); p = 0. 89], and length of ICU stay (hr) [384.7 vs. 397.9; p = 0.84] noted. In those subjects with acquired brain injury in whom ventilator-associated pneumonia developed, the regimen of respiratory physiotherapy for the remaining duration of mechanical ventilation following diagnosis of ventilator-associated pneumonia costed an average of $788. Comparatively the intensive care unit bed day cost for the period of mechanical ventilation was $43,865. The cost of Part B respiratory physiotherapy time for Treatment Group 3 was 1.8 per cent of the cost of their intensive care unit mechanical ventilation bed days.Subjects with a ventilator-associated pneumonia were significantly younger, were admitted with a lower Glasgow coma scale, and more likely to have been admitted with a chest injury than subjects without a ventilator-associated pneumonia. Duration of mechanical ventilation and length of intensive care unit stay were significantly increased in subjects with ventilatorassociated pneumonia, but length of hospital stay was not significantly different. Significant differences in the costs of respiratory physiotherapy and intensive care unit mechanical ventilation bed day costs were evident between those subjects with ventilator-associated pneumonia as compared to those without ventilator-associated pneumonia. For subjects with ventilator-associated pneumonia, the respiratory physiotherapy time cost was $1,029 per subject, compared to $510 for subjects without ventilator-associated pneumonia. The intensive care unit mechanical ventilation bed day cost for subjects with ventilator-associated pneumonia was $61,092 per subject, and $25,142 for those without a ventilator-associated pneumonia, giving an incremental health cost of $35,950 per episode of ventilatorassociated pneumonia. No significant differences were evident in the cost of respiratory physiotherapy as a per cent of the cost of their intensive care unit mechanical ventilation bed days, with findings of 1.4 per cent in those with ventilator-associated pneumonia and 1.1 per cent in those without ventilator-associated pneumonia.Conclusion: Use of a regular prophylactic respiratory physiotherapy regimen comprising of positioning, manual hyperinflation and suctioning, in addition to routine medical and nursing care, did not appear to prevent ventilator-associated pneumonia, reduce length of ventilation or intensive care unit stay in adults with acquired brain injury. Furthermore, in those acquired brain injury subjects with ventilator-associated pneumonia, regular respiratory physiotherapy did not appear to expedite recovery in terms of reducing length of ventilation or intensive care unit stay. It can be concluded from the findings of this study that the presence of ventilator-associated pneumonia has a significant influence on morbidity and costs in subjects with acquired brain injury. Whilst statistically significant results were not found with clinical variables, it is suggested that the provision of a prophylactic respiratory physiotherapy regimen costing $487 per subject is a worthwhile investment in attempts to avoid the incremental health cost of $35,950 per episode of ventilator-associated pneumonia. In subjects with ventilator-associated pneumonia it is concluded that the cost of respiratory physiotherapy would not appear to be justified in attempts to reduce the duration of mechanical ventilation.
43
Ponto, Jamie. "The role of the physiotherapist in the neonatal intensive care unit: perceptions from neonatal healthcare professionals". University of the Western Cape, 2020. http://hdl.handle.net/11394/7570.
Resumen
Magister Scientiae (Physiotherapy) - MSc(Physio)Background: The role of the physiotherapist in the neonatal intensive care unit is unclear. How other neonatal healthcare professionals and physiotherapists themselves perceive their role in the management of neonates, their practice patterns and services, their role in the neonatal intensive care multidisciplinary team, their use of evidence-based practice and awareness of the profession in this setting has not been well explored. This information is lacking in the South African healthcare context as well. Therefore, the aim of the study was to explore and describe the perception of doctors, nurses and physiotherapists of the role of the physiotherapist in public and private sector neonatal intensive care units in South Africa. Methods: A qualitative exploratory research design was used. All medical practitioners (paediatricians and neonatologists), nurses and physiotherapists working in the neonatal intensive care units in two private sector and two public sector hospitals in the Cape Metropole region in the Western Cape South Africa who provided consent to participate were included. An inclusive (total population) sampling method was used where all healthcare professionals working in these units were invited to an individual face-to-face audiotaped interview using a semi-structured interview guide and conducted by the researcher at a time and place convenient to the participants following informed consent. Data was transcribed verbatim and analysed using both deductive and inductive thematic content analysis to develop codes, categories and themes. Trustworthiness was ensured by ensuring credibility, conformability, dependability and transferability of data. Ethics was obtained from the relevant Institutional Review Board. Results: Twenty-one healthcare professionals participated, including doctors (n=5), nurses (n=6) and physiotherapists (n=10). The mean age in years of the participants was 41+/–11 years with the physiotherapists having the lowest mean age. The participants had various years of general and neonatal intensive care experience and physiotherapists in specific only had basic undergraduate qualifications with minimal specialised training in neonatal intensive care. Five major themes emerged namely: i) the role of the physiotherapists in the management of the neonatal ICU patient, ii) practice patterns and services iii) teamwork iv) training and qualifications including evidence-based practice, v) awareness of and exposure to neonatal intensive care physiotherapy. Conclusion: Physiotherapists working in this neonatal intensive care setting need to promote their profession through education of other neonatal healthcare professionals in order to improve awareness, referral patterns and integration into the multidisciplinary team. Evidence-based practices and improving training and skills development in the area of neonatal physiotherapy can be further explored in this setting.
44
Bowerbank, Pat. "The strategic development of a health care organisation : a longitudinal study of the South African physiotherapy profession, 1971 to 2000". Doctoral thesis, University of Cape Town, 2003. http://hdl.handle.net/11427/22077.
Resumen
Bibliography: pages 147-155.This research focuses specifically on the South African physiotherapy profession, that societal institution which is primarily concerned with health, illness and the physical elements of movement In the human body. Together with South African society as a whole this Institution has experienced monumental changes over the last 30 years. The objective of this research is to describe and critically evaluate the nature, direction and depth of those changes for the South African physiotherapy profession. To this end the research attempts to Identify some of the broad political and societal trends in the macroenvironment, and to contextualise these within the healthcare environment and the physiotherapy profession. The main argument is that social circumstances determine not only the health of the population, but also the health care services and how health care professionals function In society (Benatar, 1997). Health care services and how health care professional's function in society are socially constructed phenomena and therefore there are marked differences in the way health care is delivered from country to country and one political system to another. Over the past decade, management research has increasingly paid attention to the manner in which organisations work to Influence and shape their environments (Lawrence, 1999). A central Issue has become the manner in which organisational environments are constituted, reproduced and transformed through organisational action and relationships.
45
Patman, Shane Michael. "The effect of physiotherapy on the prevention and treatment of ventilator-associated pneumonia for intensive care patients with acquired brain injury". Curtin University of Technology, School of Physiotherapy, 2005. http://espace.library.curtin.edu.au:80/R/?func=dbin-jump-full&object_id=16406.
Resumen
Background: Ventilator-associated pneumonia is a major cause of morbidity and mortality for patients in an intensive care unit. Once present, ventilator-associated pneumonia is known to increase the duration of mechanical ventilation, time in the intensive care unit, and length of hospital stay. Patients with acquired brain injury are commonly admitted to the intensive care unit and considered to be at a high risk for the development of respiratory complications such as ventilator-associated pneumonia, which could potentially impact on the intensive care unit costs and outcomes. Respiratory physiotherapy is often provided to prevent and/or treat ventilator-associated pneumonia in patients with acquired brain injury. The theoretical rationale of the respiratory physiotherapy is to improve airway clearance and enhance ventilation which may reduce the incidence of pulmonary infections and thus ventilator-associated pneumonia, and may in turn decrease the duration of mechanical ventilation, prevent the need for tracheostomy and hence result in reduced costs and shorter hospital stay. Although respiratory physiotherapy may be beneficial in reversing or preventing ventilator-associated pneumonia, to date there are no data concerning the effectiveness of respiratory physiotherapy in patients with acquired brain injury. Hence from an evidence-based perspective, at present there is no justification for the role of respiratory physiotherapy in the management of patients with acquired brain injury in the intensive care unit. Aim: This two-part, prospective randomised controlled trial aimed to investigate the effect of regular prophylactic respiratory physiotherapy on the incidence of ventilator-associated pneumonia, duration of mechanical ventilation, and length of intensive care unit stay in adults with acquired brain injury, as compared to a control group (Part A).The second part of the study (Part B) randomised those subjects from Part A who developed a ventilatorassociated pneumonia into a treatment or control group to establish if the provision of a regimen of regular respiratory physiotherapy influenced the outcome of ventilator-associated pneumonia. Additionally, this study also aimed to provide the first description of the financial costs of respiratory physiotherapy time in providing interventions to patients with acquired brain injury in the intensive care unit and investigated the cost effectiveness of respiratory physiotherapy interventions in decreasing the incidence of ventilator-associated pneumonia, duration of mechanical ventilation and length of intensive care unit stay. Subjects: 144 adult patients with acquired brain injury admitted with a Glasgow Coma Scale of nine or less, requiring intracranial pressure monitoring, and invasive ventilatory support for greater than 24 hours, were randomised to a treatment group or a control group. Methods: For subjects randomised to the treatment groups, the regimen of respiratory physiotherapy treatment was repeated six times per 24-hour period and continued until the subject was weaned from mechanical ventilatory support. Each respiratory physiotherapy intervention of 30 minute duration comprised a regimen of positioning, manual hyperinflation and suctioning. In both Parts A and B, the control group received standard nursing and medical care but no respiratory physiotherapy interventions. Results: Consent was obtained for 144 subjects, with 72 randomised for treatment in Part A. Part A groups were comparable with respect to demographic variables, with the exception of body mass index and gender distribution.
Using intention to treat philosophy, there were no significant differences for incidence of ventilator-associated pneumonia [Treatment Group 14/72 (19.4%) vs. Control 19/72 (26.4%); p = 0.32], duration of mechanical ventilation (hr) [172.8 vs. 206.3); p = 0.18], or length of intensive care unit stay (hr) [224.2 vs. 256.4; p = 0.22]. For subjects with acquired brain injury receiving this prophylactic regimen of respiratory physiotherapy in the intensive care unit, in an attempt to prevent ventilator-associated pneumonia, the cost of physiotherapy was $487 per subject. Comparatively the intensive care unit mechanical ventilation bed day cost was $33,380 per subject. The cost of Part A respiratory physiotherapy time for Treatment Group 1 was 1.7 per cent of the cost of subject's intensive care unit mechanical ventilation bed days. Thirty-three subjects (22.9%) from Part A developed ventilator-associated pneumonia, and were transferred to Part B and re-randomised, 17 to the Treatment Group 3. Part B groups were comparable with respect to demographic variables. No significant differences were detected in the dependent variables for Part B of the study, with similar duration of mechanical ventilation (hr) [342.0 vs. 351.0); p = 0. 89], and length of ICU stay (hr) [384.7 vs. 397.9; p = 0.84] noted. In those subjects with acquired brain injury in whom ventilator-associated pneumonia developed, the regimen of respiratory physiotherapy for the remaining duration of mechanical ventilation following diagnosis of ventilator-associated pneumonia costed an average of $788. Comparatively the intensive care unit bed day cost for the period of mechanical ventilation was $43,865. The cost of Part B respiratory physiotherapy time for Treatment Group 3 was 1.8 per cent of the cost of their intensive care unit mechanical ventilation bed days.
Subjects with a ventilator-associated pneumonia were significantly younger, were admitted with a lower Glasgow coma scale, and more likely to have been admitted with a chest injury than subjects without a ventilator-associated pneumonia. Duration of mechanical ventilation and length of intensive care unit stay were significantly increased in subjects with ventilatorassociated pneumonia, but length of hospital stay was not significantly different. Significant differences in the costs of respiratory physiotherapy and intensive care unit mechanical ventilation bed day costs were evident between those subjects with ventilator-associated pneumonia as compared to those without ventilator-associated pneumonia. For subjects with ventilator-associated pneumonia, the respiratory physiotherapy time cost was $1,029 per subject, compared to $510 for subjects without ventilator-associated pneumonia. The intensive care unit mechanical ventilation bed day cost for subjects with ventilator-associated pneumonia was $61,092 per subject, and $25,142 for those without a ventilator-associated pneumonia, giving an incremental health cost of $35,950 per episode of ventilatorassociated pneumonia. No significant differences were evident in the cost of respiratory physiotherapy as a per cent of the cost of their intensive care unit mechanical ventilation bed days, with findings of 1.4 per cent in those with ventilator-associated pneumonia and 1.1 per cent in those without ventilator-associated pneumonia.
Conclusion: Use of a regular prophylactic respiratory physiotherapy regimen comprising of positioning, manual hyperinflation and suctioning, in addition to routine medical and nursing care, did not appear to prevent ventilator-associated pneumonia, reduce length of ventilation or intensive care unit stay in adults with acquired brain injury. Furthermore, in those acquired brain injury subjects with ventilator-associated pneumonia, regular respiratory physiotherapy did not appear to expedite recovery in terms of reducing length of ventilation or intensive care unit stay. It can be concluded from the findings of this study that the presence of ventilator-associated pneumonia has a significant influence on morbidity and costs in subjects with acquired brain injury. Whilst statistically significant results were not found with clinical variables, it is suggested that the provision of a prophylactic respiratory physiotherapy regimen costing $487 per subject is a worthwhile investment in attempts to avoid the incremental health cost of $35,950 per episode of ventilator-associated pneumonia. In subjects with ventilator-associated pneumonia it is concluded that the cost of respiratory physiotherapy would not appear to be justified in attempts to reduce the duration of mechanical ventilation.
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Hanekom, Susan. "The profile of a surgical ICU in a public sector tertiary hospital in South Africa". Thesis, Stellenbosch : University of Stellenbosch, 2004. http://hdl.handle.net/10019.1/16335.
Resumen
Thesis (MScFisio)--University of Stellenbosch, 2004.ENGLISH ABSTRACT: Objective: To describe the baseline data of a surgical ICU in South Africa before the implementation of an evidence-based physiotherapy practice protocol. Design: Prospective cohort observational study Setting: Ten-bed closed surgical unit in a university affiliated tertiary hospital. Patients: All adult ICU admissions from 16 June - 30 September 2003. Measurements: The patient’s clinical data including demographic information, admission diagnosis, surgery classification and co-morbidities were recorded on admission to the unit. APACHE II score was calculated. The physiotherapy techniques, positions and functional activities used, the frequency and duration of physiotherapy treatment sessions, the provision of after-hours service and the diagnosis of pulmonary complications were also recorded daily. The time of mechanical ventilation was calculated and the number of re-intubations documented. The ICU length of stay or mortality was recorded. Results: 160 patients were admitted. Patients were 49 +/- 19.95 years of age. The mean APACHE II score was 12.3 +/ 7.19 and a 12.3% mortality was observed. Thirty seven percent of patients were admitted to the unit following elective surgery. Patients stayed in the unit for 5.94 +/- 6.55 days. Hypertension was the most frequent co-morbidity found in this cohort (42%), and 21% of patients tested, tested positive for HIV. Co-morbidities had no significant association with ICU LOS or mortality. Nine hundred and twenty seven physiotherapy records were obtained. Students were responsible for 39% (n=366) of treatment sessions, the unit therapist for 34% (n=311) and the on-call therapists for 27% (n=250). Despite routine daily physiotherapy for all patients in the unit, 39% (n=62) developed excessive secretions, 30% (n=48) of patients developed pneumonia and 27% (n=43) of patients were diagnosed with basal atelectasis. Nineteen patients (12%) died in the ICU. Patients spent a mean of 5.94 (SD 6.55) days in the unit. One hundred patients (63%) were ventilated. Almost a third of ventilated patients (31%) were intubated more than once. The patients spent a mean time of 3.8 days (SD 6.30) on the ventilator every time they were re-intubated. The development of pulmonary complications significantly increased the time on the ventilator and the LOS. Conclusions: This baseline study of a surgical ICU presents a picture of a unit providing care comparable to first world environments. The picture of the physiotherapy service provided in this unit is of a “traditional” service based neither on the available evidence regarding the prevention or management of pulmonary complications, nor on the incorporation of early rehabilitation into the management of mechanically ventilated adult patients in ICU.
AFRIKAANSE OPSOMMING: Doel: Om die basis lyn van ‘n chirurgiese intensiewe sorg eenheid in Suid Afrika te beskryf voor die implementering van ‘n bewysgesteunde fisioterapie protokol in die eenheid. Studie struktuur: Prospektiewe kohort observerende studie. Eenheid: Tien bed geslote eenheid in ‘n tertiêre opleidingshospitaal. Pasiënte: Alle volwasse pasiënte opgeneem in die eenheid tussen 16 Junie en 30 September 2003. Meetings: Demografiese data, diagnose met opname, chirurgie klassifikasie en ko-morbiditeite is aangeteken by opname. APACHE II is bereken. Die fisioterapie tegnieke, pasiënt posisies en funksionele aktiwiteite gebruik in behandelingssessies, die frekwensie en duur van behandelingssessies, die verskaffing van na-ure diens aan die eenheid asook die komplikasies gediagnoseer is daagliks aangeteken. Die tyd wat pasiënte geventileer is asook die aantal kere geher-intubeer is bereken. Die tydsduur van eenheid verblyf asook mortaliteit is aangeteken. Results: 160 pasiënte is opgeneem, met ‘n gemiddelde ouderdom van 49 +/- 19.95. Die gemiddelde APACHE II telling was 12.3 +/ 7.19 en die mortaliteit was 12.3%. Sewe en dertig persent van pasiënte is opgeneem na elektiewe chirurgie. Pasiënte bly in die eenheid gemiddeld vir 5.94 +/- 6.55 dae. Hipertensie was die mees algemene ko-morbiditeit (42%), en 21% van die pasiënte wat getoets is, het positief getoets vir HIV. Ko-morbiditeite het geen beduidende verband getoon met die tyd in die eenheid of mortaliteit nie. 927 Fisioterapie rekords is aangeteken. Studente was verantwoordelik vir 39% (n=366) van die behandelingssessies, die eenheid terapeut vir 34% (n=311) en die op-roep fisioterapeute vir 27% (n=250). Ten spyte van daaglikse roetine fisioterapie behandeling van alle pasiënte in die eenheid het 39% (n=62) oormatige sekresies ontwikkel, 30% (n=48) is met pneumonie gediagnoseer en 27% (n=43) met basale atelektase. Negentien pasiënte (12%) is dood in die eenheid. Die tydsduur van eenheid verblyf was 5.94 (SD 6.55) dae. Een honderd pasiënte (63%) is geventileer. Byna een derde (31%) van pasiënte is geher-intubeer. Met elke her-intubasie het die pasiënte gemiddeld 3.8 (SD 6.30) dae langer op die ventilator gebly. Pulmonale komplikasies het beide die tydsduur in die eenheid as op die ventilator betekenisvol verleng. Gevolgtrekkings: Hierdie basislyn studie beskryf ‘n eenheid waar pasiënte mediese sorg ontvang soortgelyk aan eerste wêreld lande. Die fisioterapeutiese diens wat gelewer word is egter nie gebasseer op die nuutste bewyse in die literatuur nie. Nog, in die voorkoming of in die behandeling van pulmonale komplikasies, nog in die vroëere inkorporasie van rehabilitasie in die hantering van volwasse pasiënte in ‘n intensiewe sorg eenheid.
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Hall, Kathleen. "Evaluation of the inclusion of an allied health assistant within an adult cystic fibrosis centre : Their role, scope of practice, and impact on physiotherapy services". Phd thesis, Australian Catholic University, 2022. https://acuresearchbank.acu.edu.au/download/a9aabf04e7990c21a11434836755d94710b1c5027b3d4c3231cedb891efdb6ae/43714907/Hall_2022_Evaluation_of_the_inclusion_of_an.pdf.
Resumen
Cystic Fibrosis (CF) is a chronic, progressive disorder and the predominant genetic condition in Australia. The last few decades have seen a rise in the survival age and numbers of adults with Cystic Fibrosis attributable primarily to improved access to multidisciplinary care delivery via dedicated CF services and the impact of new medications, including, most recently, modulator therapies. These increased numbers and complexity of care delivery requirements have presented challenges for developing sustainable models of care delivery. Physiotherapy is a key component of the multidisciplinary care delivered to adults with CF. Several countries have developed clinical practice and standards of care guidelines, including physiotherapy clinical guidelines, that recommend requirements for care delivery, structure, staffing, and roles of the multidisciplinary team for adults with CF. However, it is not known if current physiotherapy services meet the recommended guidelines in terms of care delivery. Meeting service demands with growing numbers of patients will require innovative service redesigns to deliver efficiencies and services amenable to both staff and patients.
Implementing an allied health assistant (AHA) role into CF physiotherapy services may be feasible and sustainable for remodelling care delivery. Delegating clinical and non-clinical tasks to a specially trained AHA could improve physiotherapy care delivery and may change the scope of practice for CF physiotherapists. Currently, there is no published evidence on how a service redesign involving an AHA role may affect patient safety or the scope of practice of physiotherapists and AHAs in acute respiratory clinical settings, specifically in adult CF care. The overarching aim of this thesis was to establish current physiotherapy care delivery for adults with CF and then implement and evaluate a service redesign using an AHA role. Four studies were completed. The first study aimed to establish current CF physiotherapy care delivery and benchmark against current clinical guideline evidence. The second study examined the redesign of the CF physiotherapy service using a systematic workforce redesign system, the Calderdale Framework. Study three examined the changes to the remodelled CF physiotherapy care delivery for both physiotherapists and AHAs associated with implementing the AHA role. Finally, the fourth study examined changes in staff and patients' perceptions of the care delivery pre-and post-implementation of the AHA role.
Study 1 examined physiotherapy service provision, scope of practice, and skill mix in a large tertiary adult CF service using a cross-sectional observational study. Results showed that care was provided by 22 physiotherapists. Respiratory (n = 1058, 38%), and exercise treatments (n = 338, 12%) were provided frequently. However, other recommended activities, such as exercise testing (n = 20, 1%) and detailed treatment reviews (n = 79, 3%) occurred infrequently. Time for research was limited. Junior physiotherapists undertook more exercise treatments per day (p < 0.001), with senior physiotherapists attending outpatient clinics (p < 0.001). Findings from this study suggest that adherence to clinical practice recommendations could be improved. A redesign of services that would support and improve the existing staffing and skill mix within adult CF services to meet recommended standards of care was undertaken. Development and implementation of an AHA role were proposed as part of service redesign.
Study 2 examined the real-world application of the Calderdale Framework as a workforce redesign to implement an AHA role within an acute respiratory physiotherapy service. Staff perceptions were collected at four time points during the implementation to assess the Framework’s serviceability. Clinical and non-clinical delegation tasks were developed for acute respiratory physiotherapy care. In addition to AHA competency training, all staff received training in delegation procedures, emphasising risk mitigation. Six new comprehensive clinical task instructions, guidelines and other resources were created. Using the Calderdale Framework to support implementation was perceived by staff to be a positive experience. A positive change in the perceptions of the value and role of an AHA and increased confidence in the understanding of delegation procedures was perceived by staff.
Study 3 explored the changes to physiotherapy care delivery following the addition of an AHA into CF physiotherapy service in a pragmatic pre-post design study. This study describes care delivery in terms of the service provision, scope of practice, skill mix and any safety implications for patients with CF and staff associated with the new model of care. Overall, physiotherapy care delivery Increased. Physiotherapists conducted fewer respiratory (p<0.001) and exercise treatments (p < 0.001) but increased complex review of care for inpatients (p<0.001). Physiotherapists’ activity in multidisciplinary outpatient clinics increased (56% vs 76%, p<0.01). The AHA provided 20% of all service provision. The AHA delivered clinical care as delegated established respiratory (5%) and exercise treatments (10%) and completed the majority of all exercise tests (n = 25). Most AHA activity involved non-direct clinical care, such as managing equipment and patient-related administrative tasks. No adverse events were reported.
Study 4 examined patient and staff perceptions of, and satisfaction with, the physiotherapy care delivery pre-implementation of the AHA role and assessed any perceived change to care delivery post-implementation of a new AHA role in a pragmatic pre-post-study design. Pre/post response rates were similar: patients 35% (n = 63) vs 36% (n = 62), multidisciplinary team 51% (n = 18) vs 49% (n = 17). According to patients, physiotherapists provided good to excellent care (P1-87%, P2-88%, p=0.097) pre- and post-AHA implementation. Two-thirds of patients reported involvement with the AHA. Physiotherapy care delivery was perceived as effective by 72% of participants pre-implementation and increased to 87% post-implementation (p = 0.024). The multidisciplinary team acknowledged physiotherapy staff as valuable, despite 22% reporting that access to physiotherapy did not happen pre-implementation. As a result of the addition of the AHA, senior physiotherapists were more accessible for clinical discussion and clinical research, improving physiotherapy care delivery according to multidisciplinary team staff. Overall findings suggested that an AHA role did not change the perceived high quality of physiotherapy care but improved the care's perceived effectiveness.
Implementing an AHA role within an acute respiratory physiotherapy service has contributed new evidence regarding scope of practice and its impact on physiotherapy care delivery. It should be considered by physiotherapists and other allied health professionals to support remodelling care delivery. The development of AHA roles in other allied health professional services and other hospital and community settings should be supported by evidence demonstrating the scope of practice and acceptability of such roles. Other healthcare service delivery models can benefit from moving towards evidence-based care delivery recommendations, improving effectiveness and maintaining high quality. An evidence-based redesign system is recommended when redesigning a health service, particularly skill mix. An effective system must be comprehensive, systematic and engage all stakeholders, including comprehensive training for new and appropriate AHA activity, training for all staff in delegation procedures and ongoing mentoring and supervision for the role. Research is needed to provide robust data to support the effectiveness of these new models of care delivery, which extend the scope of practice for AHAs while enhancing the contributions of both junior and senior physiotherapists, demonstrating a better overall workforce delivery, as well as cost-effectiveness.
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Karlsson, Frida y Viktor Wiklundh. "Kränkande bemötande från patienter : Har fysioterapeutens kön inverkan på bemötandet från patienten? - en enkätstudie". Thesis, Uppsala universitet, Fysioterapi, 2017. http://urn.kb.se/resolve?urn=urn:nbn:se:uu:diva-337302.
Resumen
Bakgrund: Interaktion och bemötande är viktiga i vården. Hur en person uppfattar ett bemötande är individuellt och beror på tidigare erfarenheter och social status. Bio-psyko-sociala faktorer kan ha inverkan på interaktionen då patienters beteende kan påverkas av sjukdomstillstånd och tidigare erfarenheter. Syfte: Att undersöka hur fysioterapeuter som arbetar inom Akademiska sjukhuset och Uppsala kommun upplevde att de blivit kränkande bemötta av patienter utifrån sitt kön och om patientens sjukdomstillstånd och ålder har betydelse i bemötandet. Design och metod: En kvantitativ tvärsnittsstudie med en komparativ och deskriptiv design. Sammanlagt 84 fysioterapeuter från Akademiska sjukhuset och Uppsala kommun besvarade en egenkonstruerad webbenkät. Resultatet analyserades med beskrivande statistik, Chi-2 test och kvalitativ innehållsanalys. Resultat: En hög andel av fysioterapeuterna (83%) hade erfarenheter av kränkande bemötande och ingen signifikant skillnad sågs mellan könen eller arbetsplats gällande dessa erfarenheter. Störst andel av de manliga fysioterapeuterna rapporterade att de upplevt hot och våld från patienter medan kvinnliga fysioterapeuter uppgav att de fick utstå mer sexuella trakasserier. Patienter med smärta eller demens var de patientgrupper som flest fysioterapeuter upplevde sig blivit kränkande bemötta av. Konklusion: Kränkningar mot fysioterapeuter är vanligt förekommande oavsett kön. Patientens sjukdomstillstånd har stor betydelse vid kränkande beteende mot fysioterapeuten. Det är viktigt att uppmärksamma ämnet både i utbildning och inom yrkeslivet. Fler studier krävs för att styrka resultatet.Background: Interaction and communication are important in health care. How a person perceives a response is individual and depends on past experiences and social status. Bio-psycho-social factors can affect the interaction as patients' behavior is affected by disease states and previous experiences. Purpose: To investigate how physiotherapists working at Akademiska Sjukhuset and Uppsala municipality experienced how they were treated by patients based on their gender and if the patient's disease states and age can affect the interaction. Design and method: A quantitative cross-sectional study with a comparative and descriptive design. A total of 84 physiotherapists from Akademiska Sjukhuset and Uppsala municipality answered a self-designed web questionnaire survey. The result was analyzed with descriptive statistics, Chi-2 test and qualitative content analysis. Result: A high proportion of physiotherapists (83%) had experience of abusive treatment and no significant difference was seen between the sexes or the workplace regarding these experiences. Largest share of male physiotherapists reported that they experienced threats and violence from patients while female physiotherapists stated that they suffered more sexual harassment. Physiotherapists experienced the most abusive treatment of patients with pain or dementia. Conclusion: Violations against physiotherapists are commonplace regardless of gender. The patient's disease condition is of great importance in the case of offensive behavior against the physiotherapist. It´s important to pay attention to the subject both in education and in professional life. More studies are required to strengthen the results.
49
Demmelmaier, Ingrid. "Behaviours, Beliefs and Back Pain : Prognostic Factors for Disability in the General Population and Implementation of Screening in Primary Care Physiotherapy". Doctoral thesis, Uppsala universitet, Institutionen för folkhälso- och vårdvetenskap, 2010. http://urn.kb.se/resolve?urn=urn:nbn:se:uu:diva-121424.
Resumen
Aim: The overall aim of this thesis was to study prognostic factors for prolonged disability in back pain in the general population and physiotherapists’ screening for prolonged disability, applying a social cognitive learning perspective. Methods and results: Studies I and II were based on a survey in the general population in Sweden. Study I included 1024 individuals aged 20-50 years, reporting non-specific back pain. Four groups (n = 100, 215, 172 and 537) based on duration and recurrence of back pain were formed and compared. After controlling for pain intensity, catastrophising and expectations of future pain were positively correlated to pain duration. Perceived social support was negatively correlated to pain duration. Study II was longitudinal over 12 months and analysed one group reporting first-episode back pain (n = 77), and one group reporting long-term back pain (n = 302). Future pain intensity and disability were predicted by initial levels of pain and disability and pain-related cognitions in both groups. Study III examined the inter-rater reliability of a research protocol for assessment of physiotherapists’ telephone screening for prolonged disability. The results demonstrated sufficient inter-rater reliability. Study IV evaluated the effect of a tailored skills training intervention on physiotherapists’ screening for prolonged disability in back pain. Four physiotherapists in primary care participated in four quasi-experimental single-subject studies. Effects were seen in all participants, with increased screening of prognostic factors and less time spent on detailed discussions about back pain. Conclusions: The identification of mainly cognitive explanatory variables indicates the relevance of a social cognitive perspective of back pain-related disability (studies I and II). Physiotherapists’ telephone screening for prolonged disability in back can be reliably assessed (study III). It is suggested that interventions based on social cognitive theory are effective in producing change in specified clinical behaviours in physiotherapists (study IV).
50
Ryall, Alison Claire. "The natural history of and risk factors for musculoskeletal disorders of the upper limb presenting to primary care and physiotherapy services". Thesis, University of Southampton, 2005. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.436927.