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- Oldfors Engström, Lena, 1948-
(author)
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Att förstå patienters bristande deltagande i individualiserat rehabiliteringsprogram
- 2002
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Licentiate thesis (other academic/artistic)abstract
- The aim of this investigation was to elucidate and describe those patients who had discontinued their participation and/or paticipated infrequently in physiotherapy treatment based on their own activity and responsibility. The ambition was to understand the phenomenon of compliance/adherence from various perspectives in behavioural as well as social science.In study I the phenomenon compliance/adherence was studied in relation to Health Locus of Control and Health Belief variables. This study was based on a questionnaire that was answered by all patients before beginning of treatment. Questions concerning the patients´conceptions about both health locus of control and health beliefs were the focus.The definitions of compliance/adherence were completed treatment period and exercise frequency, respectively. Those patients who completed the treatment were also studied regarded exercise frequency.The results of study I showed that those who discontinued their treatment reported a higher perceived threat from their health condition (higher level of dysfunction (higher pain intensity) and a higher perceived severity of their health condition (higher level of dysfunction, worse general health) than those who completed treatment. The results also showed that those who exercised once a week or less often valued the significance of the caring situation as lower (HLC), perceived a higher threat from their health condition (higher pain intensity), a higher severity of their health condition (higher level of dysfunction, worse general health, greater distrution of impairment), more barriers to treatment (lower expectations), and had certain differences in demographic variables (younger individuals, more women) than those who exercised more often (HB).Study II investigated patients´descriptions of their reasons for discontinuing the treatment, whether those reasons varied, and if so how they varied. Sixteen patients who had discontinued their treatment were interviewed with open-ended questions. The inteviews began with a question about the background to the physiotherapy treatment. There were questions concerning carrying out the treatment as well as concerning what they thought about their impairment. The patients were also asked about their priotities in daily life, as these wre presumed to be anobstacle to the treatment over a shorter or longer period of time. The third domain concerned how they experiebced the patient/physiotherapist relationship. The interviews were anlysed qualitatively.Analysis of study II resulted in four different descriptions of reasons for treatment discontinuation. A) It was about time to end treatment and continue on alone. B) The treatment was not the most important activity to spend time on. C) An agreement with the physiothreapist to discontinue treatment due to lack of effect. D) No viewpoint as to why they discontinued the treatment. In further analysis of category D, this group appeared to experience varoius forms of powerlessness. They felt their trustworthiness was often questioned. They experienced frustration in their life situation as others made the important descisions and they themselves had little to say.They defended themselves by talking about their own conceptions of the reasons for their impairment and what should be done about them. In comparing category D with categories A, B, C it was found that those in the latter three categories experienced varying degrees of control in different situations, whereas those in category D did not experience a feeling of control.Conclusion: The concept of compliance in physiotherapy is ambiguous. The concept involves one part defining what will concern the other part. It is clear that the physiotherapist and the patient do not always agree about the aim of the treatment. Instead, we should develop the concept of concordance in encounters with the patients and abandon the reasoning of compliance.
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| 4. |
- Eriksson, Lisbeth
(author)
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Effects and patients' experiences of interactive video-based physiotherapy at home after shoulder joint replacement
- 2009
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Licentiate thesis (other academic/artistic)abstract
- Physiotherapy is essential to optimize the results of shoulder joint replacement, but requires a close monitoring and co-operation between patient and physiotherapist. The development of telerehabilitation brings opportunities for distance-spanning and home-based physiotherapy interventions. The aim of this thesis is to explore effects and to describe experiences among patients participating in interactive video-based physiotherapy at home after shoulder joint replacement. A series of 22 patients underwent shoulder joint replacement and initial physiotherapy at the hospital. After discharge, 12 patients were referred to conventional out-patient physiotherapy (control), while 10 patients participated in a telerehabilitation intervention in the form of interactive video-based physiotherapy at home. Shoulder function, activity limitations and health-related quality of life were assessed before surgery and two months after surgery. The experiences of participating in the telerehabilitation were described using open interviews and qualitative content analysis. Two months post surgery, members of the telerehabilitation group had participated in more physiotherapy sessions (p<.001) and showed significantly better recovery regarding shoulder pain (p<.001), shoulder joint external rotation (p=.002), shoulder function and activity limitations (p<.001) and in two dimensions of health-related quality of life (p=.004 and p=.001) compared to the control group. All telerehabilitation group participants expressed that they were satisfied with the rehabilitation and that they had experienced technique and exercise as safe. In the interviews seven categories of the participants' experiences were revealed: An odd reinforced communication; Pain-free exercising as an effective routine; The home as an exercising arena; Closeness at a distance; From a dependent patient to a strengthened person; Facilitated daily living; Continuous rehabilitation process. The identified theme was: Achieving prerequisites for recovery competence. In conclusion, interactive video-based physiotherapy at home after shoulder joint replacement was experienced positively by the participating patients and seemed more effective than conventional post-discharge rehabilitation procedures concerning short-time recovery. This could be explained by the fact that the telerehabilitation group participated in more patient-physiotherapy sessions compared to the control group, but the interviews also indicate that the modality might have promoted continuity and patient participation and competence.
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- Melander-Wikman, Anita
(author)
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Empowerment in living practice : mobile ICT as a tool for empowerment of elderly people in home health care
- 2007
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Licentiate thesis (other academic/artistic)abstract
- The aging of Europe's population is a crucial challenge for the 21st century. Today, the mean life expectancy in Sweden is 83 years for women and 78 for men. Providing health care of high quality on equal terms for all citizens is an important political goal in Sweden. It is a great challenge for providers to achieve elderly care of high quality and to develop products, services and technologies that meet the needs of elderly people. Increased use of various forms of Information and Communication Technology (ICT) can enable the citizens to take more active part in their own health care. Dimensions of empowerment such as participation and ability to influence/control one's life situation imply an approach to health care with the patient/client in focus. The aim of this thesis was to explore different dimensions of empowerment and empowerment methodology for elderly persons in home health care, and if ICT is a useful tool in this process. Methods used included interviews with patients with experience of rehabilitation, reflective learning workshops with first line staff in home care and an intervention where a mobile safety alarm was tested by elderly individuals. Different analysis methods were used, including Grounded Theory, Latent content analysis and constructivist Grounded Theory together with reflections. My findings were that the process of rehabilitation was experienced as a parallel process based on traditional and individual models, implying that a patient copes with a situation by shifting between being compliant and adopting more self-regulatory behaviour. The results indicated low patient participation in and influence on the rehabilitation process in the hospital. When ICT as an empowering tool was implemented, findings showed that elderly people experienced the use of a mobile safety alarm as an empowering tool. The mobile safety alarm gave the freedom of movement needed to be physical active and still feel safe. The positioning device was not experienced as a threat to their integrity. Mobility and safety were experienced as more important than privacy. Freedom of movement and mobility were described as matters of freedom and empowerment. My research findings indicate that in order to improve home health care services from the patient's/client's perspective, we need to work with the triads of participation, empowerment and mobile Information and Communication Technology. We need to critically and creatively reflect on what clients say and then try to respond positively to what we learn. Real improvement might only occur when accountability changes.
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- Öhman, Anna, 1957
(author)
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Congenital muscular torticollis
- 2007
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Licentiate thesis (other academic/artistic)abstract
- Congenital Muscular torticollis Anna Öhman. Institute of Neuroscience and Physiology, Division of Physical Therapy, Sahlgrenska Academy at Göteborg University, Göteborg, Sweden. Abstract Aim: The aim of study I was to describe the functional and cosmetic status in children earlier treated for congenital muscular torticollis (CMT) with regard to asymmetry of head position, range of motion (ROM), muscle function i.e. strength/endurance and craniofacial asymmetry. The aim of study II was to find reference values for ROM in rotation and lateral flexion in the paediatric cervical spine and also to find reference values muscle function in the lateral neck flexorers of infants. Methods: Fifty-four children treated for CMT between the years 1999 and 2001 at the Department of Physiotherapy at Queen Silvia Children’s Hospital, Göteborg, Sweden participated in study I. In study II 38 healthy infants participated, they were recruited between October 2004 and October 2005 from the Child Health Centre in Göteborg, Sweden. In both studies ROM in rotation and lateral flexion of the neck were measured and muscle function i.e. strength/endurance of the lateral flexor muscles of the neck were estimated. Neck rotation was measured with an arthrodial protractor. Lateral flexion was measured with the infant/child lying in supine on a big protractor. Muscle function i.e. strength/endurance of the lateral flexor muscles of the neck was measured in study I with the child lying on the side lifting their head up. In study II muscle function of the neck lateral flexor muscles was estimated with a five-degree scale. Also the presence of asymmetry of the face, posture and lateral band were observed and estimated according to a scoring sheet in study I. The parents answered a questionnaire about birth history and completed a subjective assessment. Results: In study I the majority of the children attained an overall excellent/good status and the most notable findings were craniofacial asymmetry and asymmetry in muscle function i.e. strength/endurance. There were moderate correlations between craniofacial asymmetry and rotation (p=0.00, r=0,39), between rotation and side flexion (p=0,00 r=0.47) and a strong correlation between head tilt and subjective assessment (p=0.00 r=0,62). The overall score had a moderate correlation with both craniofacial asymmetry and rotation and a strong correlation with head tilt. In study II reference values for the mean ROM in neck rotation in healthy infants were in mean 110° with SD 6,2° and a range between 100°-120°. The measurements in rotation at two months of age were about 5° less than at the other ages. In lateral flexion the mean ROM was 70° with SD 2,2° and a range between 65°-75°. Infants of two months of age had the median muscle function score of 1 interquartile range 1 to 2. Infants of four months of age had the median score 3 interquartile range 2 to 3. Infants of six months of age had the median score of 3 and interquartile range 3. Infants of ten months of age had the median score 3 interquartile range 3 to 4. There was no significant difference between genders. Conclusion: In study I most children had an overall excellent/good status and the most notable findings were craniofacial asymmetry and asymmetry in muscle endurance. Functional problems were rare. More studies are needed to find out the importance of muscular balance between the affected and non- affected side and also suitable treatment and duration of treatment. In study II reference values for ROM in infants in rotation of the neck were 110° with a range 100°-120° and in lateral flexion 70° with a range 65°-75°. In muscle function most two months old infants scored 1 and the scores increased with age. Reference values for muscle function in the neck can be used in clinic to grade muscle function in infants with CMT. Keywords: Craniofacial asymmetry, rotation, lateral flexion, muscle function, infants, reference values, torticollis, physiotherapy.
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