https://www.um.edu.mt/library/oar/handle/123456789/2293 2026-05-31T17:23:10Z 2026-05-31T17:23:10Z https://www.um.edu.mt/library/oar/handle/123456789/145483 2026-04-13T10:06:04Z 2025-01-01T00:00:00Z

Title: Prehabilitation for video assisted thoracic surgery : effects on aerobic capacity, lung function and quality of life Abstract: Background: Video-Assisted Thoracic Surgery is a minimally invasive surgical technique that has become increasingly common for thoracic procedures such as lung resections (Shigemura et al. 2006). It aims at improving the physiologic reserves of the patients before an operation to withstand the stress of the surgery (Liu ZJ et al. 2020). The study aims to investigate whether a prehabilitation programme improves the aerobic capacity, lung function and Quality of Life of patients diagnosed with lung cancer prior to Video-Assisted Thoracic Surgery. Methodology: 22 participants who met the inclusion criteria were invited to attend for the prehabilitation programme at Sir Anthony Mamo Oncology Centre. The duration of the programme was that of 7 weeks, with sessions held twice weekly. All participants in the experimental group were asked to follow a regime of exercises consisted of aerobic, resistance and breathing exercises. The control group did not carry out the exercise regime. The cohort chosen for the study underwent an assessment at week 0 in the initial assessment for the 6-minute walk test, spirometry, and the St. George’s Respiratory Questionnaire. All tests were repeated at week 4, week 7 prior to Video Assisted Thoracic Surgery and repeated at 1-month and 2-months post-VATS. Results: A 7-week prehabilitation programme demonstrated minimal improvements in the 6-minute walk test distance, symptom relief of the St. George’s Respiratory Questionnaire, and post-operative lung function of the Forced Expiratory Volume in one second, in the experimental group. Discussion and Conclusion: The intervention suggested slight benefits with minimal clinical impact, mainly due to the small sample size and the inconsistent attendance during the data collection process since 3 participants did not attend for 75% of the sessions. Repeating the study using a larger sample size is recommended to evaluate further the significance and representation of the results obtained. Description: M.Sc.(Melit.)

2025-01-01T00:00:00Z https://www.um.edu.mt/library/oar/handle/123456789/145482 2026-04-13T10:02:15Z 2025-01-01T00:00:00Z

Title: The effects of pulmonary rehabilitation on bone mineral density in patients diagnosed with chronic obstructive pulmonary disease Abstract: Pulmonary Rehabilitation (PR) is a fundamental intervention for managing Chronic Obstructive Pulmonary Disease (COPD) with exercise training as its key component. COPD patients have a high prevalence of osteopenia and osteoporosis, primarily due to glucocorticosteroid use, which significantly increases their risks of falls and fractures and associated adverse consequences. Evidence regarding the effects of PR on Bone Mineral Density (BMD) in COPD patients is notably limited. Therefore, the aim of this study was to investigate the effects of PR on BMD, fall and fracture risks, and functional exercise capacity in patients with COPD. A quasi-experimental randomised controlled trial was adopted. 31 participants diagnosed with COPD were recruited and allocated to either the active group (n=17) which received a 16-week PR programme followed by a 36-week home exercise programme (HEP) or the control group (n=14) which did not receive the PR programme and the following HEP. All participants underwent the following assessments at baseline: BMD measurements using a DEXA scan, functional mobility level and fall risk assessed using the Timed “Up and Go” test, functional exercise capacity using the 6-minute walk test and 10-year probability of hip and major osteoporotic fractures predicted using the FRAX tool. These assessments were repeated at weeks 16 and 52, except for BMD measurements, which were reassessed only at week 52. Clinically and statistically significant improvements in the 6-minute walk distance (p = .007) and non-statistically significant improvements in functional mobility and reduction of fall risk were observed in the active group after the PR programme. Preservation of femoral neck BMD and improved lumbar spine BMD were shown in the active group from baseline to week 52, alongside reduced fracture and fall risk and significant functional mobility gains (p = .006). Such outcomes were observed to be worse in the control group. As a conclusion, a 16-week PR programme resulted in significant gains in patients diagnosed with COPD, with potential long-term benefits for bone health, making this intervention a potential non-pharmacological strategy for managing BMD loss and preventing fragility fractures in these patients, particularly those on chronic glucocorticosteroids, to help preserve their lung function and functional mobility, lower their healthcare utilisation, and ameliorate their quality of life and long term prognosis. Description: M.Sc.(Melit.)

2025-01-01T00:00:00Z https://www.um.edu.mt/library/oar/handle/123456789/144586 2026-03-04T13:17:17Z 2025-01-01T00:00:00Z

Title: Contextual experiences of Maltese stroke survivors during their rehabilitation journey : an interpretative phenomenological study using status passage theory Abstract: Introduction: The adjustment period of stroke survivors can be very individualised, as they experience the changes in their lives during rehabilitation, and also when discharged into the community. Understanding the meaning behind stroke survivors’ lived experience of rehabilitation during this process is crucial. On discharge back home, reintegration into the relationships and roles within their familial and societal networks is important to explore, as it is the expression of the status of the ‘stroke patient’ as a person, within their individual cultural context. Exploring contextual lived experience of persons following stroke is therefore essential in the implementation of person-centred care. Methodology: This study aimed to explore Maltese stroke survivors’ lived experience following rehabilitation, on discharge to the community. Participants were interviewed 3 months, 6 months, and 9 months following discharge into the community. Interviews were audiotaped and transcribed verbatim. Interpretative Phenomenological Analysis (IPA) was used to analyse the findings. A specific theory, Status Passage Theory (SPT), was also used in a second analysis of these transcribed interviews to deepen the exploration of the lived experience of stroke survivors during the rehabilitation process. This analysis was done using the five properties of SPT: Reversibility, Desirability, Temporality, Shaping of Status Passage and Multiplicity. Findings: Group Experiential Themes (GETs) constructed from the IPA included the engagement and understanding of rehabilitation during their in-patient stay, limited active participation in the discharge process from the rehabilitation hospital into the community, the meaning of home and family for the Maltese stroke survivor, the diversity of levels of health literacy within participants, and the influence of Maltese familial networks on stroke survivors’ experiences. A matrix constructed from the codes generated from the analysis using SPT indicated that they were aligned with the GETs. The GETs were also displayed in a matrix using a ‘best-fit’ framework approach method, and this matrix showed that they did fit in the five properties of Status Passage, in more than one property of this theory. In this way, this alignment of the properties of the SPT brought out different aspects of the GETs constructed within the IPA, not only at a static point in time, but related to periods of transition across time. It also indicated how some aspects of the GETs constructed from the IPA were influential in the shaping of the status passage of the participants, as stroke survivors during the rehabilitation process. Conclusion: The findings in this study highlighted specific aspects related to active participation, knowledge and understanding required for the contextual management of Maltese stroke survivors within Maltese healthcare systems and within the Maltese sociocultural context. Stroke survivors within this context may benefit from an increase in shared clinical decision-making in the management of their healthcare, including the discharge process, with assistance where necessary. The support of familial networks appears to be a crucial component of their process of recovery whilst back in the community. This vital component may need to be supplemented by the involvement of health care professionals in stroke survivors where this social capital and cohesion are not present, to enable discharge into the community. This individualised approach is an important component of person-centred care. Description: Ph.D.(Melit.)

2025-01-01T00:00:00Z https://www.um.edu.mt/library/oar/handle/123456789/129875 2024-12-17T09:14:06Z 2024-01-01T00:00:00Z

Title: Barriers and motivators to gym attendance by older persons Abstract: Introduction: The importance of, and awareness towards healthy ageing and active ageing are major points of discussion in view of the increase in average longevity across the globe, and Malta is no exception. Improving physical fitness dimensions may play a role in active ageing. The barriers and motivators to physical activity within the older population have been largely studied, much more than to the specific context of gym attendance. Therefore, the aim of this study was to explore the attitudes of community-dwelling older persons (≥ 65 years) towards gym attendance with the purpose of providing the evidence to support policy makers and entrepreneurs to promote workout spaces that are specifically designed for and intended to the needs of older persons. Method: A multi-method case study approach was adopted, consisting of data collected via an online survey in a first phase, followed by data collected from interviews in a second phase. Both the survey questionnaire and the interview guide were developed by the research team. Data in Phase 1 was collected through the social media platform Facebook. Participants for Phase 2 – the interview phase, were approached following their self declared interest to participate in this phase. Analysis was carried out using descriptive and inferential methods for the findings from Phase 1; framework analysis was used to interpret the findings from Phase 2 using the socio-ecological framework and social determinants of health as a basis for discussion and interpretation. Findings/ results: 177 community-dwelling older persons participated in Phase 1. 12 participants participated in Phase 2. The key findings from the first phase are that the likelihood of attending a gym is greater amongst the young old (65-69 years), those living with a spouse/partner, those living in the Northern Harbour District, as well as those with higher education levels. Conversely, the likelihood of not attending a gym is greater for the older old (≥80 years), those living with children, those living in the Southern Harbour district or Gozo and Comino District, and those with lower educational levels. Barriers and motivators were also analysed through a 1-5 Likert scale, with 1 representing the least and 5 representing the greatest. In the order of greatest to lowest barriers to attending a gym, the top five barriers were cost (3.12), lack of age-appropriate programs (3.07), lack of willpower (3.01), poor health (2.98), and lack of positive attitude (2.80). The greatest five motivators were good health (4.18), physical functioning benefits (3.95), physical benefits (3.92), improved well-being (3.89), and health benefits (3.87). A trend was also observed between genders, where females experienced greater barriers when compared to males. Individual factors such as perceived health limitations and perceived negative mental health were found to be more likely to act as a barrier to gym attendance than social factors, whilst social factors such as economic support and good neighbourhood and built environment were more likely to motivate older persons to attending a gym. Conclusion: Whilst most older persons understand the benefits of gym attendance, this attendance is dependent on a number of factors that may impact a decision to pursue such goals. For policy makers and entrepreneurs knowing what hinders and/ or motivates older persons to attending a gym may serve to focus on reducing the barriers and promoting motivators amongst older persons in pursuit of national and global goals linked to active and healthy ageing. Description: M.Sc.(Melit.)

2024-01-01T00:00:00Z