The importance of quality in the practice of physiotherapy. The case of the Regional Specialised Paediatric Hospital in Kielce

Wojciech Kiebzak, Małgorzata Starczyńska, Zbigniew Śliwiński, Ireneusz M. Kowalski, Lucyna Robak, Marek Kiljański, Marek Woszczak, Magdalena Jaskólska-Pisiewicz

Wojciech Kiebzak, Małgorzata Starczyńska, Zbigniew Śliwiński, Ireneusz M. Kowalski, Lucyna Robak, Marek Kiljański, Marek Woszczak, Magdalena Jaskólska-Pisiewicz – The importance of quality in the practice of physiotherapy. The case of the Regional Specialised Paediatric Hospital in Kielce. Fizjoterapia Polska 2007; 7(2), 133-144

Abstract

Background. The aim of this paper was to show that procedures used within the framework of therapeutic management at the Regional Specialised Paediatric Hospital in Kielce improve the quality of service, which is the main condition for the hospital to remain on the market of health service providers. The high quality of services has been confirmed by the recent conferring of an accreditation certificate which requires that the hospital operate on the basis of a number of documented procedures, instructions and standards. The therapeutic activities of the hospital are based on a set of instructions providing detailed guidelines concerning the management of particular medical conditions. Material and methods. The study included children who were hospitalized or treated on an outpatient basis. Patient management was based on a set of instructions. An anonymous questionnaire concerning the quality of treatment and the level of satisfaction with the service was distributed among the children’s guardians and parents. Results. In the first and the second half of the year 2005, 95% and 86% of parents respectively assessed service quality as very good. 92% of parents gave the rating of very good in the first half of the year 2006 and 79% did so in the second half of the year. These results confirmed the high quality and efficacy of as well as satisfaction with the treatment received by the children. Conclusions. The observance of specified instructions during the therapeutic process improves the quality of service and minimizes the possibility of medical malpractice.

Key words:

quality, standard, instructions, rehabilitation treatment

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Body equilibrium assessment in patients with degenerative changes after whole-body cryostimulation connected with physiotherapy

Marek Kiljański, Zbigniew Śliwiński, Wojciech Kufel, Wojciech Kiebzak, Marek Woszczak

Marek Kiljański, Zbigniew Śliwiński, Wojciech Kufel, Wojciech Kiebzak, Marek Woszczak – Body equilibrium assessment in patients with degenerative changes after whole-body cryostimulation connected with physiotherapy. Fizjoterapia Polska 2007; 7(3); 286-298

Abstract
Background. The authors present the results obtained in a group of 126 participants. The aim of the study was to determine whether a four-week program of physiotherapy including whole-body cryostimulation, applied in patients with degenerative changes in the spine, influences their body equilibrium and pain sensation. Material and methods. The examined group comprised 66 patients with degenerative changes in the lumbar spine, while the control group consisted of 60 participants. Apart from an individually designed rehabilitation program, each patient participated in 20 sessions of whole-body cryostimulation. The measurement of lumbosacral spine mobility and the assessment of pain sensation using the Visual Analogue Scale (VAS) were performed before the first and after the last session. Moreover, after the first, tenth and twentieth session of general cryostimulation, measurements on a stabilometric platform were conducted. The healthy participants, who were qualified as the control group, underwent tests on the stabilometric platform after one session in the cryogenic chamber. The aim of these tests was to compare the differences in the stabilogram curve in healthy individuals and patients with degenerative changes in the lumbar spine. The effect of cryostimulation procedures on pain sensation and mobility of the lumbosacral spine was assessed. Additionally, the effect of cryogenic temperatures on body equilibrium was studied. Results. The comparison of the results, obtained before the procedure and after completing the therapy indicates that general cryostimulation in a physiotherapeutic program for patients with degenerative changes in the lumbar spine contributes to relaxation of excessively tense muscles. Conclusions. The use of whole body cryostimulation in patients with degenerative changes in the lumbosacral spine, combined with a properly designed and managed physiotherapeutic program, decreases pain sensation in a statistically significant way. The application of cryogenic temperatures, combined with physiotherapeutic program, favourably affect patient body equilibrium.
Słowa kluczowe
physiotherapy, spine, cryostimulation, coordination, stabilometric platform
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Assessment of the efficacy of local cryotherapy in children with cerebral palsy

Marek Woszczak, Zbigniew Śliwiński, Marek Kiljański, Wojciech Kiebzak, Marcin Szczepanik, Wiesław Tomaszewski

Marek Woszczak, Zbigniew Śliwiński, Marek Kiljański, Wojciech Kiebzak, Marcin Szczepanik, Wiesław Tomaszewski – Assessment of the efficacy of local cryotherapy in children with cerebral palsy. Fizjoterapia Polska 2007; 7(3); 275-285

Abstract
Background. The author presents the results of a study of 60 children with infantile cerebral palsy carried out at a rehabilitation centre in the town of Zgorzelec. The study aimed to demonstrate that a 4-week programme of customised kinesiotherapy with cryostimulation of the lower limbs with liquid nitrogen vapour could have a beneficial effect on motor status as well as muscle tone and skin surface temperature in children with infantile cerebral palsy. Material and methods. A group of children of both sexes aged 3-14 with infantile cerebral palsy underwent 4 weeks of customised kinesiotherapy combined with cryostimulation of both lower limbs. Muscle tone was determined with a Szirmai myotonometer using special methodology. The level of spasticity was estimated with the Ashworth test, and motor activity assessment was made before and after the treatment according to a score table designed by the authors. Thermovisual recordings of skin surface temperature in the lower limbs were made immediately before and 5 and 15 minutes after cryostimulation procedures at the beginning and end of the 4-week programme. Results and Conclusions. A comparison of the results of the motor activity assessment, Ashworth test and myotonometry before and after the rehabilitation programme shows that the use of cryostimulation in the rehabilitation of children with infantile cerebral palsy results in a reduction of spasticity in the lower limbs and improvement in motor activity. Thermovisual analysis of skin surface temperature demonstrates full adaptation of the children’s vascular system, i.e. excellent safety of topical cryostimulation.
Key words:
infantile cerebral palsy, spastic muscle tone, local cryostimulation, Ashworth test, motor activity assessment, Szirmai myotonometer, thermovision
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Thermovision recordings of skin surface temperatures following selected physical therapy procedures and comparison of procedure efficacy

Zbigniew Śliwiński, Wojciech Kufel, Marek Woszczak, Grzegorz Śliwiński, Anna Lipińska

Zbigniew Śliwiński, Wojciech Kufel, Marek Woszczak, Grzegorz Śliwiński, Anna Lipińska – Thermovision recordings of skin surface temperatures following selected physical therapy procedures and comparison of procedure efficacy. Fizjoterapia Polska 2009; 9(4); 321-331

Abstract
Background. The results of a thermovision study of the body surface of patients subjected to various physical therapy procedures are presented. Pain intensity is also assessed using a Yisual Analogue Scale (VAS). The aim ofthe paperis to compare the efficacy of these procedures. Material and methods. The study involved 38 patients (15 males and 23 females) aged 19-78 years (mean age 58.1 years) with diagnosed degenerative changes and pain syndromes ofjoints of the lower extremities (13 patients), upper extremities (7 patients) and the vertebral column (18 patients). Ali patients were divided into 4 groups and subjected to NSAID iontophoresis (Group 1), anodę galvanisation (Group 2), galvanisa-tion followed immediately by an NSAID rub-in (Group 3), and NSAID rub-in alone (Group 4). Pain intensity was assessed using a subjective scalę (VAS) on the first, fifth and tenth procedurę day The distribution of temperature in the treated area was also recorded with an Agema 570 thermo-vision camera on the day of the first and last procedure. Results. A subjective reduction in pain intensity was recorded in all groups. Patients from the first group reported 50.2% improvement, patients from Group 2 reported 44.9% improvement, Group 3 reported 62.2% improvement, and Group 4 reported 38.9% improvement over baseline (first day of treatment). Changes in skin surface temperature were also observed but were not significant for Group 4. Conclusions. In the subjective opinion of the patients, the most efficacious procedure was anode galvanization immediately followed by an NSAID rub-in. The superior efficacy of this procedure appears to be related to the higher dose of medication being introduced into the treated area and greater skin hyperaemia compared to iontophoresis alone. Medication rub-in following galvanisation is effective and more cost-effective as the-re are no drug losses due to the drug remaining in the vehicle, as is observed during an iontophoresis procedure.
Key words:
iontophoresis, galvanic current, rub-in, thermovision, linear VAS scale
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Functional symptoms of core stability improvement in rehabilitation of patients with low back pain syndrom

Tomasz Łosień, Krzysztof Banasiak, Katarzyna Kniaziew-Gomoluch, Marek Woszczak, Beata Kita

T. Łosień, K. Banasiak, K. Kniaziew-Gomoluch, M. Woszczak, B. Kita – Functional symptoms of core stability improvement in rehabilitation of patients with low back pain syndrome. Fizjoterapia Polska 2019; 19(4); 142-148

Abstract
Aim. The goal of the below work was to estimate the effectiveness of deep torso muscles exercises and its influence on the low back pain syndrome.
Material and methods: Research group consisted of 46 individuals, including 30 women and 16 men, who suffered from the low back pain syndrome. Age range of patients was between 32 and 62 years old, with the average age of 47 years old. Two research tools were used in the above work, the international questionnaire Revised Oswestry Low Back Pain Disability which contains 10 questions about the pain sensations during performing daily activities, and self-created questionnaire containing 6 questions including one about the level of pain felt by the patient. After filling both questionnaires patients took part in the 30 day long rehabilitation program where exercises strengthening the deep torso muscles were performed. After they finished the program, the individuals were asked to fill questionnaires again.
Results. Total level of health complaints after training cycle was 7.91 and decreased in a statistically significant way in relation to the value before the training cycle when it was 23.59, the difference being 15.67. The results arousing from the study clearly indicate a decrease in pain sensations among patients submitted to this analysis. After a full monthly therapy, average perceptible pain measured by the VAS scale decreased by 2.2 points and amounted to 3.67 points.
Conclusions. Performed tests clearly indicate that deep muscle exercise therapy repeated in cycles significantly reduced the subjective pain sensations among examined patients. General physical fitness improvement was also observed. Final results of research prove that strengthening of the torso muscles is an effective way of low back pain treatment.

Key words:
low back pain syndrome, functional training, deep torso muscles, VAS, Revised Oswestry Low Back Pain Disability Questionary

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Comprehensive draining therapy in the treatment of lymphoedema in women after mastectomy

Marek Woszczak, Katarzyna Syrewicz, Iga Woźniak, Łukasz Goździewicz, Katarzyna Bogacz, Karolina Kossakowska

M. Woszczak, K. Syrewicz, I. Woźniak, Ł. Goździewicz, K. Bogacz, K. Kossakowska – Comprehensive draining therapy in the treatment of lymphoedema in women after mastectomy. Fizjoterapia Polska 2019; 19(4); 28-40

Abstract
Introduction. Breast cancer is one of the most dangerous malignancies tumor, and the incidence of this disease is still growing. As a result of treatment and related removal or impairment of lymph node structure, a frequent complication is lymphoedema. There are many methods of treatment, however, the most recommended and currently the most effective is a complex decongestive therapy.
Purpose of this study. The aim of the study was to evaluate the effectiveness of complex decongestive therapy, its influence on the reduction of lymphoedema and the improvement of mobility and strength of the upper limb.
Materials and methods. The study was conducted on a group of 60 women after unilateral mastectomy at the Świętokrzyski Oncology Center in Kielce. The examined patients were divided into two groups: research and control. In the study group consisting of 30 women, KFTU treatments were performed, while other rehabilitation procedures were performed. The therapeutic cycle lasted 10 days. At the beginning and at the end of the treatment, the change in pain severity was assessed on the VAS scale and the range of motion was measured using the goniometric method, the limb circumferences were measured with a centimeter tape and SUR was measured using a dynamometer.
Results. In both groups, after the end of the therapy, all parameters were improved, but in the research group where a complex decongestive therapy was used, the effect was more noticeable. In the study group there was a significant decrease in pain sensation, decreased limb circumference and visible improvement in strength and range of motion.
Conclusions.The use of both methods of treatment brings effects in the form of reduction of lymphatic edema, however, a complex decongestive therapy is a more effective method of improvement.

Key words:
mastectomy, comprehensive draining therapy, lymphoderma

 

 

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Evaluation of combination therapy with the use of low-frequency magnetic field and ultraphonophoresis for patients with chronic osteoarthrits of the knee

Marek Woszczak, Kacper Kucz, Marek Kiljański, Marta Woszczak

M. Woszczak, K. Kucz, M. Kiljański, M. Woszczak – Ocena terapii skojarzonej polem magnetycznym niskiej częstotliwości i ultrafonoforezy u pacjentów z przewlekłą chorobą zwyrodnieniową stawów kolanowych. FP 2013; 13(3); 48-54

Summary
The aim of the study was to evaluate the combination therapy involving low-frequency magnetic field and phonophoresis applied lo patients suffering from osteoarthritis (ICD – M 77).
The assessment of physical condition was made through 6 climbs of a patient onto a 17 centimeire step within 30 seconds, the first step was made with less aching leg.
Thanks to this test the group of patients qualified to the study was homogeneous. The study involved 62 people (47 women, 75 men) aged 41-86, randomly assigned to two comparative groups. The patients’ health was assessed by means of WOMAC scale, Pain Assessment Scale VAS and functional kneeling test. The examination was conducted twice: before the beginning of the treatment and after a series of physiotherapeutic sessions. Group A was treated with the combination therapy including magnetic field and ultraphonophoresis
Group B was treated with low frequency magnetic field in addition, both groups were abo subjected To kinesiotherapy strengthening the four-headed muscle of the femur. For the statistical analysis of the research the Statistical Package for Social Sciences was employed (PASW 78). To check the effectiveness of the therapy in group A the Test of Relevant Statistical Differences t-siudent for paired data was applied.

Key words
osteoarthritis of the knee, low-frequency magnetic field, phonophoresis

 

 

Assessment of physical endurance in students of the 1st and 2nd grade of secondary school

Marek Woszczak, Katarzyna Bogacz, Marcin Szczepanik, Sławomir Jandziś,Karolina Kossakowska, Magdalena Józefowicz-Korczyńska

M. Woszczak, K. Bogacz, M. Szczepanik, S. Jandziś,K. Kossakowska, M. Józefowicz-Korczyńska – Assessment of physical endurance in students of the 1st and 2nd grade of secondary school. Fizjoterapia Polska 2018; 18(2); 70-82

Abstract

Introduction. Physical endurance is a very important element of everyone’s health. It is a health aspect comprising the factors which may affect the level of physical endurance. That is why it is important to know what allows to keep it as high as possible.
Objective. The purpose of this study was to demonstrate the differences in the levels of physical endurance of students of 1st and 2nd grade of secondary school.
Materials and methods. The studies were conducted on secondary school students. It covered 70 students, including 37 women and 33 men. The physical endurance level was examined using the Harvard Step-Up Test. The study included analysis of the effects of sex, age, place of residence and BMI on the level of physical endurance.
Results and conclusions. The research results allowed to draw the conclusions that sex, place of residence or BMI are not statistically significant for the level of physical endurance of the persons studied. As for age, the research results may indicate that at 5% significance level, age is statistically relevant for the level of physical endurance – older students demonstrate more good and very good fitness results, while the number of average and poor physical endurance results decreases.

Key words:
physical endurance, Harvard Step-up Test, physical endurance index

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Professor Andrzej Zembaty

Sławomir Jandziś, Marek Woszczak, Marek Kiljański, Renata Szczepaniak

S. Jandziś, M. Woszczak, M. Kiljański, R. Szczepaniak – Profesor Andrzej Zembaty. FP 2013; 13(4); 57-59

Abstract

The 50th anniversary of the organized activity of physiotherapists in Poland is an opportunity to present the figure of one of the eminent representatives of our profession, prof. Andrzej Zembaty, PhD. He was born on April 21, 1935 in Jasło to an intelligentsia family. The mother was a teacher, my father graduated from the Jagiellonian University law department and worked as a judge in Jasło and then Sanok. Andrzej Zembaty, after passing the final exams at the high school in Sanok, he began studies at the University of Physical Education in Warsaw, which he graduated in 1958. In 1960, he started working as a physiotherapist at the Metropolitan Rehabilitation Center for Motion Disorders in Konstancin and in 1964 as a teacher of the profession at the Medical Vocational College in Konstancin. In 1972, at the request of prof. Marian Weiss, director of STOCER and curator of the Rehabilitation Department at the University of Physical Education in Warsaw, was employed as a senior assistant at the same facility. He returned to the university, with whom he associated most of his professional life. He held the following function: 1979 – head of the Department of Movement Rehabilitation, 1982 – Rector’s representative for the appointment of the Rehabilitation Department, 1983 – deputy director. Institute of Biological Sciences, 1984 – 1987 – vice-dean for student and organizational affairs at the newly appointed Faculty, 1987 – 1990 – vice-dean for didactics. The last place of professional and didactic activity before retiring in 1999 was the University of Physical Education in Katowice, where the Professor headed the Kinesitherapy Unit.

Key words:
Therapeutic rehabilitation, physiotherapists, rehabilitation history

Eligibility of COPD patients for physiotherapy based on a six minute walk test and treadmill test

Katarzyna Bogacz, Marek Woszczak, Jacek Łuniewski, Marcin Krajczy, Bartosz Pańczyszak, Jan Szczegielniak, Marek Kiljański

K. Bogacz, M. Woszczak, J. Łuniewski, M. Krajczy, B. Pańczyszak, J. Szczegielniak, M. Kiljański – Eligibility of COPD patients for physiotherapy based on a six minute walk test and treadmill test; Fizjoterapia Polska 2018; 18(1); 96-106

Abstract

Objective. The aim of the paper was to assess the results of physiotherapy of COPD patients whose elgibility for the relevant rehabilitation model was assessed with the help of the 6-MWT test and the treadmill test according to the modified Bruce protocol.
Materials and methods. 80 individuals suffering from COPD treated as in-patients at the MSWiA Specialist Hospital in Głuchołazy between May 2017 and September 2017 were examined. After a 3-week comprehensive physiotherapy, the exercise stress test, spirometry test and dyspnoea assessment on the modified 10-point Borg scale were repeated in both groups of COPD patients.
Results. Calculations were performed using the IBM SPSS software. In order to assess consistency between the distribution of the results with the normal distribution, the Kolmogorov-Smirnov test was used. As the distribution differed from the normal distribution, nonparametric methods were used for further analysis. In order to assess the significance of differences between the two groups in terms of quantitative variables, Mann-Whitney tests were used, while Wilcoxon tests were used for dependent samples to assess the significance of changes over time in the same patients (bound pairs). The statistical significance threshold was set at p < 0.001.
Conclusions
1. A significant improvement was noticed in the level of exercise stress tolerance after physiotherapy both among patients assessed according to the modified Bruce test and patients assessed with the 6-minute walk test.
2. A significant improvement was shown in the values of spirometric indicators after physiotherapy both among patients assessed according to the modified Bruce test and patients assessed with the 6-minute walk test.
3. A significant decrease was shown in the level of dyspnoea after physiotherapy both among patients assessed according to the modified Bruce test and patients assessed with the 6-minute walk test.

Key words:

COPD, modified Bruce protocol, 6-MWT test, physiotherapy

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