Mixed Methodology of Scientific Research in Healthcare.

Background: Scientific research is usually classified as quantitative or qualitative. However, methodologists are increasingly emphasizing the integration of qualitative and quantitative data as the center of mixed methods (mix methodologies). Mixed research method implies the use of different research methods, ie. quantitative and qualitative methods in one study. Objective: The aim of this review paper is to present the purpose of using a mixed methodology in health research. Methods: The relevant articles were searched from online data sources including PubMed and Google Scholar. Results: This approach to the use of mixed methods creates opportunities for a deeper study of various problems. The purpose of using mixed research methods is to obtain valid answers to research questions, however the researcher may still have different reasons or purposes for which he wants to strengthen the research study and its conclusions by applying mixed methods. The use of mixed scientific methodology is widely used in the field of health outcomes and should not be limited to a closed list of possible methodological options. Conclusion: Recently, there has been an increase in the number of scientific studies in healthcare that use mixed research methods. The advantage of applying this scientific method is that through the triangulation of data obtained by different (quantitative / qualitative) approaches, we get a deeper and more complete picture of the phenomenon in health care that we observe.

Influence of Motion Therapy in the Prevention of Lumbar Pain Syndrome Relapse.

INTRODUCTION: Lumbar pain syndrome is one of the most common conditions in clinical practice, more common than 290 other pathological conditions, which affect up to 84% of adults in a certain period of their life. The origin of the lower back pain can be classified as mechanical, neuropathic and secondary due to another illness. Patient education and information, muscle strengthening exercises, maintenance of routine daily physical activity and pain therapy are the basis of acute non-specific pain syndrome therapy. AIM: To determine the success of the motion therapy procedure in the prevention of lumbar pain syndrome relapse. MATERIAL AND METHODS: The research is prospective, longitudinal, manipulative and controllable. It was conducted in the private practice "Praxis - dr. Pecar" in the period from June 20, 2014 to June 1, 2016, and included 200 respondents with symptoms of lumbar pain syndromes divided into the experimental (n=100) and control (n=100) groups. The presence of lumbar pain syndrome relapse in respondents experimental and control group was recorded in the second and third clinical examination. RESULTS: In the second examination, 4 (4%) of the respondents from experimental group and 37 (37%) of the control group responded had LBS relapse. In the third examination, the number of respondents with recurrent LBS in the experimental group was 4 (4%), while in the control group was 17 (17%). After the study, no statistically significant difference was observed in the mean age of respondents who had LBS relapse compared to respondents without LBS relapse, as well as significant influence of sex structure on relapse in the experimental and control group during the second and third examination. CONCLUSION: After the second examination, the relapse rate in the experimental group was statistically significantly higher in the respondents withstanding jobs, while there was no statistically significant difference in the control group and both groups after the third examination.

Efficacy of tennis elbow (epicondylitis humeri radialis) treatment in CBR "Praxis".

Tennis elbow (Epicondylitis humeri radialis) is the most frequent reason that patients with elbow pain report to a physician. The exact cause of elbow pain is still unclear. However, it is certainly causally connected with connective intersection between forearm muscle and bone in the elbow region. In this paper, we analyzed patients that, over the period of 15 years, reported to "Praxis" clinic for elbow pain treatment (Epicondylitis humeri radialis). Of the total number of 228 patients, 126 were male, 101 female while one patient was younger than 14. Initial analysis established that average overall health condition grade was 2,87 at the onset of treatment. Following the treatment completion that grade was 4,48. Of the total number of 223 patients who were treated by combined method of manipulation and local corticosteroid instillation, eight patients received physical therapy as well. Thus, surgical treatment was not necessary in any patient. The patients' treatment included: 1. Application of manipulative methods in order to reestablish mobility in the "blocked" radio-humeral and the upper radio-ulnar joints. 2. Local instillation of corticosteroid depot in order to control inflammation (enthesitis) and thus, eliminate pain and establish physiological conditions for functioning of joint and local structures. Unlike conservative method which includes initial immobilization due to irritation and inflammation development prevention with concomitant analgesic and antirheumatic therapy, initial application of manipulation with reinstatement of joint mobility instead of immobilization with subsequent instillation of steroid preparations achieves functional restitution and fast reinstatement of full working ability, as a rule.

Measuring outcomes in acute neurorehabilitation in General Hospital setting - our experience.

In General Hospital setting, where varieties of patients are included in neurorehabilitation process, set of multidisciplinary functional tests were established, as a routine in daily work. Tests were done by physiotherapists and occupational therapists who were members of rehabilitation team. Our aim was to select the tests which can be used as a routine and are applicable for different neurological impairments in daily work. Tests were applied to inpatients admitted to the Medical, Trauma, Neurology and Neurosurgery wards in the Rashid Hospital, DOHMS, Dubai. Fifty inpatients with different neurological impairments admitted to totally 8 wards, were tested in the beginning of rehabilitation process and on discharge from the hospital. Nine tests were used as standardized tests for measuring motor, cognitive, focal impairment, ADL activities and disability: Motricity Index, Trunk Control Test, Standing Balance score, Functional Ambulation Categories test, Mini Mental State Examination, Canadian Neurological Scale, Action Research Arm test, Bartel Index and Functional Independent Measurements. FIM, Motricity Index and Trunk Control Test were applicable for all tested patients, with required adaptation for different neurological conditions within the same score. Other tests were not applicable for all patients as routine, but there were very useful for certain number of patients as a measurement of functional improvement. It is very important to have proper setup of tests, which are simple, reliable and valid for measuring impairment, disability and handicap and which can be used as standardized part of assessment protocol. Also, they must be applicable for different neurological impairments to monitor treatment progress. Combination of tests performed by different professionals and comprehensive approach of all team members is very important for measuring outcomes in rehabilitation and evaluating patient's impairment and disability. Proper hospital setup, optimal number of staff, good communication and team work are leading to better outcome in neurorehabilitation process.

Osteoarthritis, application of physical therapy proceduers.

Osteoarthritis (OA) is a group of overlapping disorders, which may have different aetiology but similar biological, morphologic and clinical outcome. In osteoarthritis, process will not encompass the joint cartilage only, but the entire joint, including sub-hondral bone, ligaments, capsule, and sinovial membrane and surrounding muscles. Osteoarthritis is a multi-factor disorder of sinovial joints, which occurs as result of mechanical and biological factors, which destabilise normal hondrocyte function, partitioning of cartilage, extra-cellular matrix and sub-hondral bone. The earliest changes, which are restricted to the joint cartilage surface only, do not cause any subjective feeling. The pain in arthrosis occurs (or re-occurs) a bit later, Diagnosis will be determined based on clinical exam as well as signs and symptoms present. Symptomatic and functional treatment of osteoarthritis as one of rheumatic disorders must be taken throughout years, sometimes throughout a lifetime. It encompasses application of many medications and physical therapy procedures.

Significance of specificity of Tinetti B-POMA test and fall risk factor in third age of life.

As for the third age, psychophysical abilities of humans gradually decrease, while the ability of adaptation to endogenous and exogenous burdens is going down. In 1987, "Harada" et al. (1) have found out that 9.5 million persons in USA have difficulties running daily activities, while 59% of them (which is 5.6 million) are older than 65 years in age. The study has encompassed 77 questioned persons of both sexes with their average age 71.73 +/- 5.63 (scope of 65-90 years in age), chosen by random sampling. Each patient has been questioned in his/her own home and familiar to great extent with the methodology and aims of the questionnaire. Percentage of questioned women was 64.94% (50 patients) while the percentage for men was 35.06% (27 patients). As for the value of risk factor score achieved conducting the questionnaire and B-POMA test, there are statistically significant differences between men and women, as well as between patients who fell and those who never did. As for the way of life (alone or in the community), there are no significant statistical differences. Average results gained through B-POMA test in this study are statistically significantly higher in men and patients who did not provide data about falling, while there was no statistically significant difference in the way of life. In relation to the percentage of maximum number of positive answers to particular questions, regarding gender, way of life and the data about falling, there were no statistically significant differences between the value of B-POMA test and the risk factor score (the questionnaire).

[Deep Relief sonophoresis in degenerative changes of the knee joint]. / Sonoforeza Deep Relief gelom kod degenerativnih promjena koljenog zgloba.

We analysed 130 persons with osteoarthritis of knee and compared efficiency Deep Relief gel with sonophoresis and ultrasound with standard gel. Deep Relief has significant better effect for less pain and better improvement of functional capacity in comparison with ultrasound. Results of examination are statistic significant.

The effects of McKenzie and Brunkow exercise program on spinal mobility comparative study.

This study encompassed 64 participants with symptoms of low back pain, 33 in McKenzie group and 31 in Brunkow group. Patients attended exercise program daily and they were asked to do the same exercise at home--five times a day in series of 5 to 10 repetition each time, depending of stage of disease and pain intensity. All patients were assessed for the spinal motion, before and after the treatment. All parameters for spinal movements showed improvement after exercising McKenzie program for lower back pain with a significant difference of p<0.01 for all motions. Also, in Brunkow group, all of the parameters showed statistically significant improvement at the end of treatment in relation to pre-treatment values, with significant difference of p<0.01 for all motions. Statistically comparison between McKenzie and Brunkow difference in score at the end of the treatment showed statistically significant improvement in McKenzie group, for extension, right and left side flexion, while flexion score didn't show statistically significant difference. McKenzie exercises seemed to be more effective than Brunkow exercises for improvement in spinal motion. Both, McKenzie and Brunkow exercises can be used for spinal mobility improvement in patients with lower back pain, but is preferable to use McKenzie exercises first, to decrease the pain and increase spinal mobility, and then Brunkow exercises to strengthen the paravertebral muscles.

Brunkow exercises and low back pain.

Brunkow exercises starting with dynamic contraction of hands and feet with fixed point on the wrist or/and heal. Dynamic contraction from the beginning, transferring through kinetic chain, leads to isometric contraction of the group of muscles, which has to be included in the exercise. Starting positions determine the group of muscles to be trained. The purpose of this study is to investigate influence of Brunkow exercises on spinal motion improvement and pain relief and to evaluate use of Brunkow exercises, as a routine method for lower back pain in Physical Medicine and Rehabilitation Centres. Thirty-four patients with symptoms of low back pain were included in study. Patients received a mean of 14.9 treatments with standard deviation of 8.96. All patients were assessed before and after the treatment for spinal mobility and flexibility as well as pain intensity. All parameters for spinal movements showed statistically significant improvement in patients with low back pain who practiced Brunkow exercise program at the end of treatment in relations to pre-treatment values, with significant difference of p<0.01 for all motions. Pain was reduced on VAS for X=1.,7 with S.D. 1.97. Difference Test was t=6.020 with significant difference p<0.01. Flexibility of spine increased, so average difference in values before and after treatment for Shober test was 0.5 cm with SD 0.65. Difference test was t=3.794 with significant difference p<0.01. Brunkow exercises for low back pain are beneficial treatment for increasing flexibility and mobility of spine and improving the pain.

Risk factors of fall in elderly people.

Falls are the leading accidental cause of death among elderly people in their homes. Falls and their consequences are the primary reason in 40% of admissions to hospitals for people older than 65 years. The study population consisted of 77 randomly selected patients of both genders older then 65 years. Each patient was tested in his/her home and was completely informed about the methodology and the goals of investigation. Based on the exclusion criteria, three patients were excluded from the study, which means the investigation was conducted on 27 males (35.06%) and 50 females (64.94%) with the average age being 71.23 +/- 5.63 years. For each patient, a specially prepared questionnaire about risk factors was filled in. The sum of affirmative answers represented a relative index of fall risk. All patients were evaluated through Folstein's Mini-Mental State Examination Test that is suitable for on-sight use in patient's home. The score value over 20 excludes dementias, delirium, schizophrenia and affective disorders. Considering the values of the risk factor, scores obtained by the questionnaire and MMSE test scores, statistically significant differences were found between males and females (p < 0.005, respectively p < 0.01), "fallers" and "non-fallers" (p < 0.001, respectively p < 0.01), while considering the relation to the way of living (alone or with family), there were no statistically significant differences (p > 0.05).

[Lesions of the peripheral nerves after surgical treatment of fractures of the distal humerus]. / Lezije perifernih nerava nakon operativno saniranih prijeloma distalnog humerusa.

In the work we have examined 44 patients (16 women and 28 men), which the break of distal humerus is saned with operation, using adequate OSM. The average years of women patients was 29 (from 3 to 79), and of male patients 24 (from 1 to 75). After thr operative sanitary breaks distal part of humerus, using adequate OSM (fillo Kurschneri, platho metalico, clavo spiralis), it can come on lesion of perifer nerves of the arm, and mostly of n. radialis. Lesions of n. radialis we have notice on 5 patients. The rehabilitation our patients was made with prevention contraction of shoulder, elbow, hand and fingers using kinesitherapy, hydrotherapy and electrotherapy paralysis musculature with intentional exercises to the reinervation of perifer motor neuron and raising the force of musculus.

[Kinesitherapy in the treatment of muscle spasm]. / Kineziterapija u tretmanu misicnog spazma.

Muscular spasm is type of the increased muscle tone which is common in the upper motor neuron lesion and it can be developed due to disease (stroke, MS, tumors, infection, intoxication) and trauma. This research included 30 patients with muscular spasm after upper motor neuron lesion. All of the patients were treated by passive exercises and stretching of agonists and antagonists. All patients were males, with age between 25 and 45 years (average 26.9 years). Applying t-test, in testing significant differences in changing muscular spasm, in relationship to the length of the kinesitherapy treatment, there were no significant differences between 1st and 15th day of treatment. Significant difference in spasm grades was after 30th day of treatment compare to 1st and 15th day. This research showed that decreasing muscle spasm we could be expected by applying the kinesitherapy procedures for a longer time.

Co-relation between risk factors of falls down and the Berg balance scale in elderly people (third age).

This study encompassed 77 randomly assigned participants of both sexes and older than 65 of age. Every participant was questioned in his/her own house and completely familiarized with the methodology and the aims of the questionnaire. Out of 27 men, data on falls down were provided by 4 participants (14.81%): one of them lived alone while three of them lived in their families. Out of 50 women, data on falls down were provided by 17 (34%) participants: 9 of them lived in their families and 8 lived alone. Out of all living alone women 44% fell down twice or more during this study in comparison to 20% of living alone men. Regarding the values of the score of risk factors obtained throughout the questionnaire and the Berg balance scale, there are statistically significant differences between men and women (p < 0.005, i.e. p < 0.01), as well as participants that have never fallen down (p < 0.001, i.e. p < 0.01), while regarding the life style (living alone or in the family) there are no statistically significant differences (P > 0.05). Nowadays, the Berg balance scale is the most frequently used questionnaire that is, in total, significantly superior to other ever utilized tests. Average values of results obtained throughout the Berg balance scale in this study are statistically significantly higher in men and those participants who did not provide data on falls down, while regarding the life style there are no statistically significant differences.