QUESTION PAPER FROM MANCHESTER METROPOLITAN UNIVERSITY, UK

ADVANCED PHYSIOTHERAPY STUDIES

YOU ARE EXPECTED TO DEMONSTRATE CRITICAL APPRAISAL OF THE LITERATURE TO JUSTIFY YOUR ANSWERS

ANSWER 1 QUESTION:

SECTION A – MEASUREMENT OF PAIN

1.      Use the literature to critically discuss the most appropriate pain assessment tool for the following patient.

·      History of low back pain for 10 years

·      Not worked for 2 years

·      History of depression due to back pain

·      Husband assists her in getting dressed, does all shopping and housework.

·      Repeated episodes of failed treatment.

2.      You are planning a research study to investigate the effectiveness of ultrasound in the treatment of pain due to an acute supraspinatus tendonitis.

Using the literature critically evaluate and justify the choice of pain measurement tool for this study.

SECTION B – RESPIRATORY

3.      Clarke (1992) suggested that asthma and exercise have a difficult relationship.

Critically evaluate this statement with reference to current literature.

4.      Exercise is used in the management of patients with cystic fibrosis.

Critically evaluate how exercise may be used for a patient with moderate to severe disease.

SECTION C – NEUROLOGY

5.      The Barthel index was developed as a generic outcome measure and is often used with patients following stroke. Using the available literature, critically evaluate the strengths and weaknesses of this measure.

6.      Some outcome measures are said to measure disability, others impairment or handicap. Using examples of outcome measures and the available literature illustrate the differences between these terms and explain how an understanding of these concepts might influence the choice of outcome measure to be used with a patient who has experienced stroke.

STROKE

CARDIO REHABILITATION

Cardiac rehabilitation is a programme of exercise and information sessions that help you get back to everyday life as quickly as possible. It aims to help you:

• understand your condition
• recover from your surgery or heart attack
• make changes to your lifestyle that will help improve your heart health
• reduce the risk of a heart attack.

Who is it for?

Cardiac rehabilitation is available to anyone who has had:

• a heart attack
• a coronary angioplasty
• heart surgery

IMMUNE SYSTEM

The immune system is the body's defense against infectious organisms and other invaders. Through a series of steps called the immune response, the immune system attacks organisms and substances that invade body systems and cause disease.
The immune system is made up of a network of cells, tissues, and organs that work together to protect the body. The cells involved are white blood cells, or leukocytes, which come in two basic types that combine to seek out and destroy disease-causing organisms or substances.
Leukocytes are produced or stored in many locations in the body, including the thymus, spleen, and bone marrow. For this reason, they're called the lymphoid organs. There are also clumps of lymphoid tissue throughout the body, primarily as lymph nodes, that house the leukocytes.
The leukocytes circulate through the body between the organs and nodes via lymphatic vessels and blood vessels. In this way, the immune system works in a coordinated manner to monitor the body for germs or substances that might cause problems.
The two basic types of leukocytes are:

1. phagocytes, cells that chew up invading organisms
2. lymphocytes, cells that allow the body to remember and recognize previous invaders and help the body destroy them

A number of different cells are considered phagocytes. The most common type is the neutrophil, which primarily fights bacteria. If doctors are worried about a bacterial infection, they might order a blood test to see if a patient has an increased number of neutrophils triggered by the infection. Other types of phagocytes have their own jobs to make sure that the body responds appropriately to a specific type of invader.
The two kinds of lymphocytes are B lymphocytes and T lymphocytes. Lymphocytes start out in the bone marrow and either stay there and mature into B cells, or they leave for the thymus gland, where they mature into T cells. B lymphocytes and T lymphocytes have separate functions: B lymphocytes are like the body's military intelligence system, seeking out their targets and sending defenses to lock onto them. T cells are like the soldiers, destroying the invaders that the intelligence system has identified.
Here's how it works:
When antigens (foreign substances that invade the body) are detected, several types of cells work together to recognize them and respond. These cells trigger the B lymphocytes to produce antibodies, specialized proteins that lock onto specific antigens.
Once produced, these antibodies continue to exist in a person's body, so that if the same antigen is presented to the immune system again, the antibodies are already there to do their job. So if someone gets sick with a certain disease, like chickenpox, that person typically doesn't get sick from it again.
This is also how immunizations prevent certain diseases. An immunization introduces the body to an antigen in a way that doesn't make someone sick, but does allow the body to produce antibodies that will then protect the person from future attack by the germ or substance that produces that particular disease.
Although antibodies can recognize an antigen and lock onto it, they are not capable of destroying it without help. That's the job of the T cells, which are part of the system that destroys antigens that have been tagged by antibodies or cells that have been infected or somehow changed. (Some T cells are actually called "killer cells.") T cells also are involved in helping signal other cells (like phagocytes) to do their jobs.
Antibodies also can neutralize toxins (poisonous or damaging substances) produced by different organisms. Lastly, antibodies can activate a group of proteins called complement that are also part of the immune system. Complement assists in killing bacteria, viruses, or infected cells.
All of these specialized cells and parts of the immune system offer the body protection against disease. This protection is called immunity

Hypothesis Testing

Null hypothesis:

• Null hypothesis = H_o = the claim is a hypothesis that can be tested = a statement of "no effect" or "no difference".

Alternate hypothesis:

• Alternate hypothesis = H_A = the claim that is accepted if the null hypothesis is rejected.

Sample vs Population Mean:

• The greater the difference between sample mean and the population mean specified by the null hypothesis, the less probable it is that the sample really does come from the specified population.

• If a very large number of random samples are taken from any population, their means form a normal distribution - the random sampling distribution of means - which has a mean equal to the population mean.

• Critical values define the areas of acceptance and rejection.

Z-tests:

• Z-tests are different from t-tests in the sense that z-tests are used when the sample size>100. z-tests are less used than t-tests.

Type I and Type II Errors:

• Type I: Accepting Ha when Ho is true. Probability = alpha = level of significance. In essence, alpha is the amount of evidence the experimenter is demanding before abandoning the null hypothesis. The value of alpha is preset by the experimenter.

• Type II: Accepting Ho when Ha is true. Probability = beta. It should be noted that beta is not set initially by the experimenter. Each hypothesis test has an infinite number of Type II error probabilities.

• It is possible to guard against Type I error, preventing Type II error isn't easy.

Type I and Type II Errors in Tabulated Form:

	H1 (+Reality)	H0 (-Reality)
H1 (+Tests)	1-beta | Power | Some difference exists in reality and can be confirmed by statistical testing.	alpha | Type 1 error | No difference exists in reality but is falsely assumed by testing
H0 (-Tests)	Beta | Some difference exists in reality but cannot be confirmed by testing | Type II error	No difference exists in reality and cannot be confirmed by testing

Type 1 Error:

= b/(b+d)

Type 2 Error:

= c/(a+c)

Power of Statistical Tests:

• The ability to avoid type II error depends upon our ability to detect a null hypothesis that is false, and this is called the power of statistical tests.

• A tests power increases as: alpha increases, beta increases, size difference between sample and population mean increases, sampling error decreases, and sample size increases.

• Very power systems and statistical tests run the risk of making type I errors.

Directional Hypotheses:

• If Ha claims that mu lies either above or below the mu claimed by Ho, the hypothesis is bidirectional.

• If Ha claims mu lies above the mu claimed by Ho, the hypothesis is right tailed.

• If Ha claims mu lies below the mu claimed by Ho, the hypothesis is left tailed.

• One tailed tests are more powerful than two tailed tests.

Analysis of Variance (ANOVA):

• A t-test is used to test a hypothesis about a single mean.

• Some tests, however, require comparisons between two means.

• For example, Ho states that sample mean A = sample mean B = population mean.

• And Ha states that sample mean A and sample mean B are not equal to population mean.

• ANOVA involves a few groups written in columns, and their means written below them.

• One-Way ANOVA: When you are only testing the variability between and within groups with only one factor at a time. I.e. treatment only.

• Variance of A = Variance of B

• Two-Way ANOVA: When you are testing the variability between and within groups with more than one factor I.e. treatment and gender.

• The ANOVA only shows if there is variability in the results. If attributable to one factor or other factor and two factors in combination.

• If a single factor is significant than it is called the main effect.

• If a combination of factors is significant that it is an interaction effect. The two factors together differ from the sum of the individual effects alone.

Parametric Tests:

• Hypotheses refer to population parameters. The population mean (t and z tests) or population variance (F-tests).

• Hypotheses concern interval or ratio scale (continuous) data such as weight, blood pressure, IQ, per capita income, measures of clinical improvement, and so on.

• Population is normally distributed provided random sample of sufficient size.

Non-parametric Tests:

• Do not test hypothesis concerning parameters.

• Do not assume that the population is normally distributes, so they are distribution free tests.

• Used to test nominal and ordinal scale data.

• Generally less powerful than parametric tests.

Chi-Square Test:

• This test is used for testing hypotheses about nominal scale data.

• Tests proportions, telling us whether proportions of observations falling in different categories differ significantly from the proportions that would be expected by chance.

Chi-Square Test Example:

• Suppose you toss a coin 100 times and expect 50% of tosses to be heads and 50% to be tails. However, the actual result is 59 heads, 41 tails. Now, chi-square can show whether difference in proportion is too large to be expected by chance, i.e., "significant."

PATHOLOGY

PATHOLOGY

DEFINATION  : It is the scientific study of stucture and function of the body in disease; it deals with causes, effects, machanisms and nature of the disease. It is a discipline that bridges clinical practice and basic science, and involves the investigation of the underlying causes ( etiology ) of the disease as well as the mechanisms ( pathogenesis ) that results in the presenting sign and symptoms of the patient.

General pathology

General pathology, also called investigative pathology, experimental pathology, or theoretical pathology is a broad and complex scientific field which seeks to understand the mechanisms of injury to cells and tissues, as well as the body's means of responding to and repairing injury. Areas of study include cellular adaptation to injury, necrosis, inflammation, wound healing, and neoplasia. It forms the foundation of pathology, the application of this knowledge to diagnose diseases in humans and animals.
The term general pathology is also used to describe the practice of both anatomical and clinical pathology.

GAIT

Human locomotion or gait, may describe as a translatory progression of the body as a whole, produced by coordinated, rotatory movements of the body segments. The alternating movements of the lower extremities essentially support and carry along the head, arms and trunk. Walking is probably the most comprehensively studied of all human movements and the variety of technologies, coupled with the diversity of disciplinary persperctives has produced a complex and sometimes daunting literature.

PHASES OF THE GAIT CYCLE