Saudi Cultural Missions Theses & Dissertations
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Item Restricted Understanding work participation in workers with lower limb osteoarthritis(The University of Queensland, 2024) Alyousef, Yousef Saleh; Smith, Michelle; Johnston, VenerinaAbstract Osteoarthritis (OA), particularly of the lower limb, is a prevalent health condition affecting people who are still participating in the workforce. People with lower limb OA typically experience joint pain, reduced mobility, muscle weakness and difficulties with ambulatory activities. These impairments can impact an individual’s life in several domains, including work participation. Research is scarce on the impact and management of lower limb OA in relation to work. This thesis aims to understand work participation in workers with lower limb OA using a range of indicators such as work status, work ability, productivity, absenteeism and presenteeism. This is accomplished through five studies presented across five chapters. Study 1 systematically reviewed the literature to explore work-related outcomes in individuals with lower limb OA compared to healthy controls. This review confirmed that the literature in this area is limited – seven studies were identified, two of which were included in a meta-analysis. No studies investigated work-related outcomes in individuals with foot or ankle OA. A meta-analysis revealed that individuals with lower limb OA were less frequently in paid employment than healthy controls (odds ratio: 0.25; 95% confidence intervals: 0.12, 0.53). Evidence from single studies suggests that individuals with hip and knee OA have greater absenteeism and presenteeism and poorer functional capacity than healthy controls. To address gaps in the literature identified in the previous systematic review, Study 2 was a cross-sectional online survey that compared work-related outcomes and difficulty performing work in workers with (n=124) and without (n=106) lower limb OA. The survey included three validated scales of work-specific outcomes: the Work Ability Index (WAI), the World Health Organization’s Health and Work Performance Questionnaire (WHO-HPQ), and the Work Role Functioning Questionnaire. We found that workers with lower limb OA have poorer work ability and productivity (p<0.001), and more difficulty with work scheduling demands and physical demands (p≤0.05) than healthy workers. There was no statistical difference in absenteeism or overall ability to meet work demands between workers with and without lower limb OA. Study 3 complemented the findings of Studies 1 and 2 by using semi-structured interviews to explore the perspectives of 22 workers with lower limb OA on difficulties they experienced at work, concerns they have about work, and strategies they use to manage at work. A thematic analysis identified six major themes related to participants’ experiences of working with lower limb OA: weight-bearing physical demands are challenging; lower limb OA can affect work performance; emotional consequences of pain; concerns about work in the future; positive experiences of supportive colleagues and managers; and minimal effects on sedentary work. Three main themes were identified relating to strategies to remain at work: adjustments at work to help manage pain; regular strategies (e.g., changing positions and postures) to manage pain; and consulting healthcare professionals, but usually not specifically for work. This study identified challenges experienced by workers with lower limb OA that need to be addressed to help workers with OA to remain in the workforce. Based on the findings of Study 3, a cross-sectional online survey was conducted with Australian physiotherapists to explore their current management strategies when treating patients with lower limb OA, with the aim of determining how work concerns were addressed in their practice (Study 4). A total of 132 physiotherapists with at least two years of experience treating patients with lower limb OA completed the survey. The findings suggest that while the key interventions used by most Australian physiotherapists to manage people with lower limb OA are consistent with current clinical guidelines, most physiotherapists do not include activities to help people remain productive in the workforce. There is a need to better understand and address the lack of work support included in physiotherapy consultations with patients with lower limb OA. Study 5 conducted a systematic review and meta-analysis to determine the impact of interventions on work-related outcomes in workers with lower limb OA. Fourteen studies met the inclusion criteria, with seven studies included in the meta-analysis. The meta-analysis revealed no significant difference in employment status two or more years after surgical treatment (odds ratio: 3.47; 95% CI: 0.92, 13.14) or in work ability three months after non-surgical treatment (mean difference: 0.45; 95% CI: -1.11, 2.00) compared to pre-treatment among individuals with knee and/or hip OA. However, single studies reported positive changes post-treatment in absenteeism, work functioning and impact on work. This highlights the need for further research into work-specific interventions that address the unique challenges experienced by individuals with lower limb OA in the workplace. Overall, the findings from this thesis contribute to our understanding of work participation in workers with lower limb OA. The data provides healthcare professionals and employers with a deeper understanding of the difficulties people with lower limb OA experience at work and highlight the lack of evidence for interventions to maximise work participation in this population.27 0Item Restricted Advances in the assessment and rehabilitation of ambulatory chronic stroke survivors.(King's College London, 2024-11-13) Ajaj, Kawthar; Pavlou, Marousa; Harridge, Stephen; Sorinola, IsaacWalking at a functional level is a requirement for walking safely in the community. Walking at a functional level requires good balance control and the ability to perform functional tasks while walking in challenging situations such as walking across a busy road. This thesis attempts to answer a number of questions regarding assessment of walking at a functional level in older people at risk of falls and in stroke survivors. The first part of the work involves a systematic review. The aim of the systematic review is to identify the available clinical OM used in clinical physiotherapy to assess walking at a functional level for stroke rehabilitation and to evaluate their psychometric properties. The review was conducted in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) guidelines. The Consensus-based Standards for the selection of health status Measurement Instruments (COSMIN) tool was used to assess the risk of bias in the quality of the methodological design and statistical methods in reliability, validity, and responsiveness in the included studies. Fifty-four studies were included in the review, six OM were identified for dynamic balance, twenty-one OM for functional gait, and three studies including five tests each for motor and cognitive tests to assess dual task while walking. The most tested psychometric properties were reliability and construct validity. Studies on responsiveness were limited. The aim of the first experimental study (Chapter 5) is to identify the associations between walking at a functional level and subjective visual verticality (SVV), cognitive function, psychosocial aspects, and physical activity (PA) levels. Twenty chronic stroke survivors capable of independently walking at least 6 metres and twenty healthy controls were recruited in this study. Assessment of functional-level walking included the Mini-Balance Evaluation Test (Mini-BESTest), and the Functional Gait Assessment (FGA). The Rod and Disc test was used to assess the SVV, the Cambridge Neuropsychological Test Automated Battery (CANTAB) tests for the cognitive functions, a set of questionnaires were used to assess psychosocial aspects and the AX3 monitor to determine the PA levels. The difference was significant between the groups in the Mini-BESTest and the FGA (p<0.001), lower (i.e., worse) Mini-BESTest and FGA scores were observed for ambulatory chronic stroke survivors. Balance confidence emerged as a key factor associated with both the Mini-BESTest and the FGA in ambulatory chronic stroke survivors. The Spearman’s rank-order correlations between the balance confidence scale and the Mini-Best, and the FGA were (rs = 0.72 and 0.75) respectively in ambulatory chronic stroke survivors. The results suggest that there is a need for rehabilitation for walking at a functional level for ambulatory stroke survivors and balance confidence should be considered in their assessment and treatment. Difficulties in balance control and limited walking functions are also common in older adults and increase their risk of falls. Both populations (older adults at risk of falls and stroke survivors) need balance training rehabilitation based on a multifactorial approach, which current rehabilitation programmes do not incorporate. Current rehabilitation programmes are limited to simple physical exercises. In addition, previous studies have shown that adherence rates to exercise rehabilitation programmes are low. Using telerehabilitation can enhance adherence rates and adds enjoyment to the exercise rehabilitation programmes. The aim of the next experimental work presented in this thesis was to assess the feasibility and acceptability of a novel telerehabilitation system in older adults at risk of falls and ambulatory chronic stroke survivors: the HOLOBalance system. This is a platform that uses a hologram to deliver the exercise instructions for balance training and uses wearable sensors to detect simultaneous body movements. The training addresses all components relevant to balance using multisensory rehabilitation exercises, exergames, and cognitive training. In addition to assessment of feasibility and acceptability, trends of improvement in balance and functional gait were also investigated. This was undertaken in both older adults at risk of falls and stroke survivors. For older adults at risk of falls (n=54) the participants were randomised to HOLOBalance intervention home-based (HOLOBalance), clinic based (HOLOBox) or control groups. In a second study, the HOLOBalance system (clinic based HOLOBox) was assessed for feasibility and acceptability in stroke survivors (n=8). The main finding from both feasibility studies was that the HOLOBalance system was feasible and acceptable for older adults at risk of falls and ambulatory stroke survivors, as assessed by drop-out, adherence rates, exit interviews, and usability scales. The preliminary data showed that there were trends of improvement in balance and functional gait measures in the intervention groups (HOLOBalance and HOLOBox) in the older adults, and in the stroke survivors who had received the clinic based HOLOBox intervention.48 0Item Restricted Developing an intervention to enhance the engagement and motivation of stroke patients with cognitive impairment in physiotherapy rehabilitation programmes in Saudi Arabia(Universit of Nottingham, 2023) Alshaibani, Fahad; Yates, Katie Robinson; Pip Logan, JenIntroduction Globally, a stroke occurs every two seconds, making it the second leading cause of death after ischemic heart disease. Strokes reduce quality of life and increase disabilities and are often associated with cognitive impairment (CI) with an increased dependency, risk of mortality, development of depression and poor quality of life. Indeed, the incidence of CI after stroke is relatively high, reported to affect 40-70% of stroke survivors, therefore CI after stroke is an important research priority as agreed by stroke patients, caregivers, as well as health professionals. Post-stroke rehabilitation promotes functional recovery and independence of stroke survivors but CI after stroke is negatively associated with poorer functional outcomes. The presence of CI after a stroke can also affect the rehabilitation process as such stroke survivors may be less motivated and interested in rehabilitation programmes and engage in fewer therapy sessions. The concept of engagement and motivation is identified as a cognitive state, therefore, motivation and engagement in the physiotherapy treatment programme tend to be insufficient in stroke survivors with CI. This thesis aimed to develop an intervention to improve engagement and motivation in physiotherapy treatment for stroke survivors with CI in the Kingdom of Saudi Arabia. Methods A mixture of methods approach with three interlinked studies was conducted within the development stage of the Medical Research Council (MRC) framework for the development of complex interventions. A scoping review (study one) was conducted to explore the engagement and motivation strategies used in physical therapy practice for stroke patients with cognitive impairment. Qualitative interviews (study two) with physiotherapists were conducted to identify the individuals and environmental facilitators and barriers to applying engagement and motivation strategies in the Saudi physiotherapy rehabilitation context. These findings were combined with the use of a theoretical domain framework to develop a behaviour change intervention. The intervention was presented in programme theory using a logic model to demonstrate the visual pipeline consequence, highlighting the evidence-based findings, facilitators and barriers, selected behaviour change techniques, mechanism of action and intervention outcomes. After designing the logic model and explaining the intervention components, stakeholders were engaged using the nominal group technique (study three) to discuss the applicability of the behaviour change intervention in the local rehabilitation context and refine the logic model. Results The scoping review included 17 studies and indicated a lack of robust evidence on strategies used in physical therapy practice and how these strategies were applied and improved the level of engagement and motivation of stroke patients with CI during treatment. The engagement and motivation strategies identified were therapeutic interactions and communication, an enriched environment, the use of technology, and applying strategy training. The qualitative interviews conducted with twelve physiotherapists identified five facilitators, “Promising impacts”, “Professional responsibilities and treatment priority”, “Positive connections with patients and their families”, “Training and educational support”, and “Physiotherapists self-attitude” and four barriers, “Information and case identification”, “Organisational culture”, “Patient belief and circumstances”, and “Physiotherapists` awareness and self-confidence”. The stakeholder engagement activity was conducted with fifteen stakeholders including physiotherapists, heads of departments, quality managers and clinical researchers. The participants agreed that educational workshops and restructuring the physiotherapy department environment were extremely important (67%) or important (33%) behaviour change techniques to enhance professionals' skills and improve stroke rehabilitation services. Regarding changing protocols, more than a quarter of the participants (27%) were not sure that changing protocols would be an effective strategy to enhance physiotherapists' skills and stroke patient outcomes. They attributed this to physiotherapists' negative attitude regards using the rehabilitation protocols, the long process to change protocols, frequent changes in the rehabilitation protocols and organisational pressure to develop protocols for accreditation purposes. These responses were used to amend the logic model and intervention. Conclusion This thesis highlighted the complexity of patient engagement and motivation, as well as the role of individual and environmental factors in supporting stroke patients with CI engagement and motivation in rehabilitation programmes. The study explored the facilitators and barriers to applying engagement and motivation strategies in the Saudi rehabilitation context and acknowledged the individual and organisational barriers. Consequently, a theoretically driven behaviour change intervention was developed to improve the engagement and motivation of stroke patients with CI in physiotherapy rehabilitation programmes. The thesis concluded with recommendations and suggestions regarding improving the rehabilitation services for stroke patients with CI, considering engagement and motivation and further researching different strategies to support them. It also provided recommendations for policymakers in the Saudi rehabilitation context to improve the services provided for stroke patients with CI and the importance of multidisciplinary collaboration to support patients' outcomes and treatment services. Following the intervention development, research is needed to deliver and evaluate the behaviour change intervention for improving the engagement and motivation of stroke patients with CI.8 0Item Restricted Physiotherapy in the prevention and management of radiotherapy-induced trismus: a critical review(2015) Ghannam, Abdulaziz Mohammed; Fedele, StefanoAims: The aim of this study is to review current evidence on the use of physiotherapy in the prevention and treatment of Radiotherapy-induced trismus in Head and Neck cancer patients (HNC) and report on its efficacy in such condition. Methods: We searched the digital databases of Medline, Embase, Cochrane Library and PubMed for articles published in the period from January 1980 to July 2015 that were related to the topic. The key word used were trismus, radiotherapy induced trismus, radiotherapy induced trismus, head and neck cancer and physiotherapy in titles, abstract and Mesh terms. Additional articles identified by tracing any literature containing preventive methods or managements for trismus in patients of head and neck cancer. Results: 11 articles related to the use of physiotherapy as a management and/or preventive tool for RT-induced trismus were identified of which 3 were randomized controlled trials, 2 were controlled trails, 5 were cohort studies and 1 were prospective case series. Modalities of physiotherapy used in these studies included unassisted exercises, tongue blade assisted exercises, Therabite® Jaw Motion Rehabilitation System, Dynasplint Trismus System, Engström jaw mobilizing device. Current evidence suggests that passive jaw mobilization devices can be beneficial in individuals with RT-induced trismus, whereas unassisted exercises and active range motion techniques seems to provide less clear benefits. Conclusion: This review demonstrate the various techniques of physiotherapy in prevention and management of radiotherapy induced trismus and its efficacy. Physiotherapy is a valid noninvasive method to manage radiotherapy induced trismus that need more investigation to maximise its benefits. Passive jaw mobilization devices and structured physiotherapy protocols coupled with positive motivation are effective in increasing mouth opening in HNC treated or planned to be treated with radiotherapy.20 0