Search

Summary Background The purpose of this study was to investigate how people with acute low back pain respond to this common symptom and whether they perceive themselves able to influence their back pain episode. Method A total of 272 home visits were undertaken with 64 participants. The primary outcome measures for this study were the Multi-dimensional Health Locus of Control forms A (general) and C (condition-specific). Results Participants' perceptions of control over their back pain changed over time and were not synonymous with their perceptions about general health. Sex differences were evident, with men perceiving a greater influence of powerful others and chance factors in their acute back pain than women participants. Conclusions When people develop back pain, their psychological make-up influences how they respond. Locus of control may be a factor affecting this response and is likely to form part of a broader issue of ‘perceived control over health'. The clinical implications for physiotherapists are discussed.

Background: Self-help and physical leisure activities are important to maintain safe functional mobility among older people. Purpose: The purpose of this study was to determine the feasibility of conducting a phase III randomised controlled trial (RCT) to evaluate the benefits of dance among people with Parkinsons’ (PwP). We built on previous proof-of-principle trials, focusing on areas of greatest methodological uncertainty. Methods: Ethical approval was granted by the National Research Ethics Service (NRES) Committee South Central Southampton A, reference: 12/SC/0355. We screened 103 PwP and fifty-one were recruited and randomised to the control (n = 15) or experimental group (n = 36). Three ballroom (Social Foxtrot, Waltz, Tango) and 3 Latin American (Rumba, Cha Cha, Rock ‘n’ Roll) dances were taught by professional teachers in a dance centre. The classes lasted one hour, twice a week, for 10 weeks and PwP danced with their spouse, a friend or a volunteer. A battery of assessments (balance, confidence, spinal posture, mobility and health outcome) was completed at home by an assessor (unaware of participant group allocation) at baseline, 3 and 6 months post-randomisation. Results: The average age of participants was 71 years (49-85); 25 were male. Partners and volunteers were of similar age. The feasibility findings focused on recruitment, retention, outcome measures and dance selection. Target recruitment was achieved, with most PwP coming from Parkinsons’ UK Groups. Of the 35 people who took part in the dance classes, 19 nominated a dance partner and 16 danced with healthy volunteer dance partners (recruited by the study team). Five people did not complete the dance classes for health and personal reasons, with one disliking dancing. The remaining participants completed on average 18 of the 20 classes. Travel assistance was costly and time-consuming but important to participants. One data set was unavailable at 3 months and 4 data points were missing from the assessment data. Outcome variables were compared between dance and control groups at 3 and 6 months separately, in analyses of covariance. Estimated mean differences between dance and control (controlled for baseline differences) were explored with model based 95% confidence intervals. As expected, no overall significant differences were found in this feasibility study. Subgroup analysis identified that (a) previous fallers, (b) PwP who have had the condition for longer (diagnosed = 2011) and (c) male participants appeared to benefit most from the dance intervention. Findings suggested trends and significant improvements (p Conclusion(s): We have demonstrated the feasibility of conducting a RCT to evaluate the benefits of ballroom and Latin American dancing for PwP, with procedural recommendations for the main trial. Implications: More research is needed.

Background: There is growing evidence of the benefits of balance training exercise for people with Parkinson's [PwP] but outcomes of long-term exercise through self-help and leisure activities such as dance are less well-researched. Purpose: This qualitative exploration is one component of a study to determine the feasibility of conducting a phase III trial to evaluate the benefits of dance among PwP. Its inclusion has permitted novel examination of participants’ views about the appropriateness of dance as an intervention for PwP. Methods: The two-arm feasibility randomised controlled trial comprised 35 PwP who participated in one-hour dance classes, twice a week for 10 weeks, and 15 PwP who did not undertake the classes. Fourteen of the 35 participants in the dance group were interviewed within a month of completing the dance programme, in which 3 ballroom and 3 Latin American dances were taught by professional teachers in a dance centre. Their dance partners: spouse, friend or a volunteer, were also interviewed. PwP were selected purposively to attain maximum variation in relation to factors that might impact on their experience: age, gender and relationship with dance partner. The sample thus selected comprised 7 men [age range 65–79] and 7 women [age range 49–81]. Six danced with their spouse; 2 with a friend or relative and 6 with one or more volunteer partners not previously known to them. In-depth, semi-structured interviews explored participants’ experiences and views about the venue and access issues; instructors’ teaching styles; challenges encountered; perceived impact on mobility and other outcomes; interest in continuing with dance; and acceptability of trial procedures. Interviews were recorded with consent and fully transcribed. Data were managed and analysed thematically. Results: Participants liked the dance studio and appreciated support with travel arrangements through reserved parking or pre-arranged taxis. The instructors’ technical and interpersonal skills were widely regarded as enabling motivation, encouragement and learning. Challenges encountered whilst dancing related to turning, coordination and keeping up with the music. Learning and remembering the steps was difficult for some PwP and their partners. Participants reported experiencing a multi- faceted feeling of enjoyment incorporating a sense of achievement, pleasure in dancing and a rewarding social interaction. PwP who identified a clear outcome in terms of balance or mobility were a minority; their partners sometimes seemed more confident that they saw positive change. The experience of taking part in the dance programme was heavily influenced by their partner; participant? perceived advantages and the potential for tension arising from dancing with both close relatives and volunteers. All expressed an interest in continuing to dance; potential obstacles identified were lack of knowledge about local options, lack of a partner, cost and indecision about preference for a Parkinson's only or a general class. Trial procedures and assessments were typically perceived as acceptable and not onerous. Conclusion(s): The broad-ranging insights of participants suggest that dance is appropriate and acceptable to PwP and inform plans for running the dance programme on a larger scale and for evaluating the outcomes in a Phase III trial. Implications: Findings will inform clinical trial design.

Background: Turning is considered the single most injurious fall-related activity in people with Parkinson's disease, with difficulty in turning being a sensitive predictor of freezing, falling and quality of life, highlighting the physical and psychosocial importance of improving turning performance for people with Parkinson's. A growing body of literature, including the 2014 European Guidelines for physiotherapy in Parkinson's, recommends the use of dance (which includes turning) as a form of treatment and management however, its effect on turning ability in people with Parkinson's has not been investigated. Purpose: The purpose of this research study was to investigate the effects of a ballroom and Latin American dancing on turning in people with Parkinson's. Methods: Twenty-four people with Parkinson's were randomly allocated to receive either twenty, one-hour dancing classes over 10 weeks (n = 12), or usual care (n = 12). Using 3-D movement analysis, data were collected before and after the intervention period on twelve, 180° on-the-spot turns in either a preferred/unpreferred and predicted/unpredicted direction. Measures of (1) latency and (2) horizontal movement of the eyes, head, thorax, shoulders, pelvis and feet were taken from a light cue to the point of first foot movement, alongside (3) the centre of mass displacement, and (4) the total time. The standing start 180 degrees turn test (SS180) was also completed. Statistical analysis (4-way ANOVA) investigated pre-assessment versus post-assessment, and the influence of dancing or usual care, as well as the interaction of the preferred and predicted turn direction. Results: Groups were comparable for all baseline demographics. A significant 4-way interaction (preference*prediction*time*group*) was found for head latency (p = 0.008), with mean values showing a longer latency in the usual care group during predicted/preferred turn directions. Similar trends were also shown in pelvis latency (p = 0.077), first (p = 0.063) and second (p = 0.081) foot movement, with mean values suggesting longer pelvis latency in predicted/un-preferred turning and slower foot movement in un-predicted/un-preferred turning in the usual care group. Significant between-group differences were also found for pelvis rotation (p = 0.036), with the usual care group showing greater rotation, with similar results in other body segments. No differences were found in the centre of mass displacement, turn time, or the SS180. Conclusion(s): Movement of the head, pelvis, and feet during turning in people with Parkinson's are affected by dancing, with body segments appearing more co-ordinated in time and sequence, however the nature and extent of the effect depends on the type of turn completed, showing an influence of preference and prediction. Implications: Results suggest ballroom and Latin American dancing may influence turning ability for people with Parkinson's, which surprisingly indicates a more ‘en bloc’ turning pattern. In rehabilitation, physiotherapists should consider the implications of encouraging the ‘en bloc’ turning pattern in people with Parkinson's, to improve turning performance, although further research is warranted.

Acute low back pain (LBP) is a commonly occurring symptom that can impact considerably upon a person’s life. This thesis is concerned with perceptions of control in people with acute LBP, how they respond to this symptom and the way it impacts upon their lives.