https://www.um.edu.mt/library/oar/handle/123456789/2279 2026-04-09T14:50:00Z https://www.um.edu.mt/library/oar/handle/123456789/144586 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/123456789/144561 Title: Associations between anthropometric characteristics, self-reported musculoskeletal and visceral symptoms, and squat movement quality : a cross-section study Authors: Xerri de Caro, John; Pirotta, Andrew; Schembri, Emanuel; Borg, Malcolm Abstract: Background: This study investigated associations between anthropometric characteristics, postural deviations, musculoskeletal and visceral symptoms, and squat movement quality to clarify how individual physical attributes and symptom profiles influence fundamental movement performance. Method(s): A cross-sectional observational study recruited adults aged 18–65 who could ambulate without pain. Anthropometric and body composition measures were collected. Standardized posture images and multi-angle squat videos were obtained, and visual classifications of posture and squat technique were conducted using predefined criteria. Descriptive statistics characterized the sample, and multivariable logistic regression with LASSO regularization examined associations between demographic, postural, and symptom variables and binary squat outcomes. Results: Two hundred participants (57.5% female; median age 26 years) were included. Males showed higher stature, lean mass, and waist circumference, whereas females exhibited higher body fat and reported more neck pain and headaches. Forward head posture was common (62%), while women demonstrated more favorable upper-body alignment. Most participants maintained neutral lumbar posture and grounded heels during squats, with sex differences in foot rotation and knee path. Higher fat mass predicted reduced squat depth (OR = 1.06, 95% CI: 1.00 to 1.11, p = 0.033); heel lift and absent forward knee movement were associated with better spinal neutrality (OR = 0.07 and 0.18, both p ≤ 0.002); and low skeletal muscle mass (OR = 0.87, 95% CI: 0.79 to 0.95, p = 0.004) and heel lift (OR = 7.09, 95% CI: 1.86 to 26.2, p = 0.003) predicted suboptimal knee tracking. Only 8% achieved a fully “perfect” squat. Conclusion(s): Suboptimal squat mechanics were linked to higher fat mass, lower skeletal muscle mass, and compensatory lower-limb strategies, suggesting that squat quality reflects an interaction among body composition, posture, and motor control rather than any single demographic or anthropometric factor. 2026-01-01T00:00:00Z https://www.um.edu.mt/library/oar/handle/123456789/143229 Title: Effect of neuromuscular electrical nerve stimulation on quadriceps muscle strength and endurance in COPD patients. A randomised controlled trial Authors: Debattista, Randall; Agius, Tonio P.; Sciriha, Anabel Abstract: Introduction: Neuromuscular Electric Nerve Stimulation (NMES) is a modality that is gaining interest as part of the management of participants with Chronic Obstructive Pulmonary Disease (COPD). Given the increased knowledge of how the muscle changes structurally as the respiratory condition deteriorates, treatment options are being investigated to help maintain and improve strength and endurance in patients who are limited due to poor exercise tolerance and increased dyspnoea and cannot part-take in rehabilitation.; Method: Using a randomised control trial design, 33 participants who required admission to hospital due to an acute exacerbation of COPD, with a moderate to severe classification based on the MRC score, were recruited and randomly allocated to an experimental (males: 83.33%, females: 16.67%) or control group (males: 60%, females: 40%). Isometric quadriceps strength was assessed using the hand-held dynamometer, and quadriceps endurance was evaluated with the quadriceps endurance test. Additionally, the rectus femoris cross-sectional area, width, and thickness were measured using an ultrasound. All outcome measures were measured at baseline and upon discharge from the hospital, following the intervention, in all participants. The experimental group received 30 minutes of NMES stimulation on the quadriceps muscles daily throughout their hospitalisation stay (mean days: Experimental – 7.78 days, Control–9.45 days), over and above the usual physiotherapy treatment provided to all participants by physiotherapists in the ward. The control group received only Physiotherapy treatment provided in the ward. All outcome measures were repeated before discharge.; Results: Statistically significant improvements in rectus femoris thickness (left and right: P<0.001) and rectus femoris width on the right side (P=0.017) were reported in the experimental group. In contrast, statistically significant declines in mean values for the left and right Rectus Femoris width were registered for the control group (left: P=0.006, right: P< 0.001). 2025-01-01T00:00:00Z https://www.um.edu.mt/library/oar/handle/123456789/134397 Title: Utilizing muscle energy techniques for biomechanical changes in chronic obstructive pulmonary disease : variations in outcomes based on Global Initiative for Chronic Obstructive Lung Disease Classification Authors: Agius, Tonio P.; Sevasta, Kimberley; Sciriha, Anabel Abstract: Background: Muscle energy techniques (METs) are manipulative interventions under current investigation for their impact not only within the musculoskeletal domain, but also in chronic obstructive pulmonary disease (COPD) patients. Previous research reported beneficial effects from a 4-week MET program on pulmonary function, functional capacity, and daily activities. Patients diagnosed with COPD are categorized using the Global Initiative for Chronic Obstructive Lung Disease (GOLD) strategy, to guide tailored treatment regimens for different COPD phenotypes. Given positive outcomes from the MET program across all COPD classifications, investigating outcomes with the different traditional GOLD stages seemed warranted.; Materials and methods: A parallel-group, randomized controlled trial was adopted. A total of 108 participants with COPD were recruited and randomly assigned to the intervention or control group. All patients were classified by the GOLD classification. The intervention group received MET interventions, three-times weekly for 4 consecutive weeks, while the control group continued with their standard medical treatment. The study is clinically registered (clinicaltrials.gov identifier: NCT04773860).; Results: All 108 patients completed the program, showing significant improvements across all three GOLD classifications. A significant difference in forced expiratory volume in 1 second (FEV1 ) was reported across the three GOLD classifications at both time points (p < 0.001). The changes observed in forced vital capacity (FVC) measures displayed significant differences at week 0 when comparing all three groups (p = 0.039). No statistically significant differences were observed in the other outcome measures.; Conclusion: A 4-week MET program resulted in more significant improvements in lung function measures among more severe COPD patients, whereas no substantial improvements were observed in chest measurements, activities of daily living (ADLs), or exercise tolerance tests when examining the different GOLD stage groups.; Clinical significance: This study shows benefits of a 4-week MET intervention period on patients suffering from COPD, which led to statistically significant improvements resulted within the pulmonary function measures, chest expansion and ADL performance, and improvement in walking distance. All these outcome measurements provide evidence that this technique can be an effective treatment which can be used as an adjunct with other nonpharmacological physiotherapeutic treatments offered to these patients. Analysis per GOLD classification did not result in any differences between the groups based on COPD severity. 2024-01-01T00:00:00Z