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Skelton, Deborah. "The effects of hyperbaric oxygen therapy on acute ankle sprains /." Thesis, McGill University, 2000. http://digitool.Library.McGill.CA:80/R/?func=dbin-jump-full&object_id=31140.
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This study investigated the effects of hyperbaric oxygen (HBO) therapy on acute ankle injuries and determined if HBO therapy shortened time to recovery, decreased edema and pain, and increased range of motion and strength of the ankle. Subjects were randomly assigned to either an experimental (HBO) group (n = 4) or a control group (n = 4). All subjects received the same standardized physical therapy for lateral ankle sprains at the McGill Sport Medicine Clinic. The HBO group received 5 consecutive HBO treatments at 2.5 ATA for 90 minutes starting within 24 hours post injury. The control group received no HBO treatments. All subjects were evaluated by a physician within 24 hours of injury. All subjects suffered a second-degree lateral ankle sprain. Pain, range of motion, strength, volume displacement, and function were evaluated on the day of injury (Day 1), on Day 6 post injury, and on the day of return to play (Day RTP). There was no significant difference in time to return to play. However, the HBO group (25.5 +/- 11.6 days) did return 31% faster than the control group (36.8 +/- 19.4 days). There were no differences found between groups on the variables. There was a decrease in pain found over time (Day 1 was 57 mm, Day 6 was 18.5 mm, and Day RTP was 7 mm). The results of this study suggest that with treatment of HBO there is no effect on ankle sprains for return to play or improved function.
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Cogger, Naomi. "Epidemiology of musculoskeletal injuries in two- and three-year-old Australian Thoroughbred racehorses." University of Sydney, 2006. http://hdl.handle.net/2123/1611.
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Doctor of PhilosophyThe aim of this research was to describe the epidemiology of musculoskeletal (MS) injuries in two- and three-year-old Thoroughbred racehorses. A 27 month longitudinal study commencing in May 2000 was conducted. The study convenience sampled 14 trainers with facilities at metropolitan and provincial racetracks in New South Wales, Australia. In the 2000/01 and 2001/02 racing season, 323 and 128 two-year-olds, respectively, were enrolled in the study. The 451 Thoroughbred horses contributed, 1, 272 preparations and 78, 154 training days to the study. Of the 323 horses enrolled in the 2000/01 racing season, 219 contributed three-year-old data to the study. During the study period 8%, of training days had missing training data and 3% of the 1, 986 starts in the races or barrier trials were incorrectly recorded. The rate of incorrect entries varied with both study month and trainer. Similarly, the rate of training days with missing data varied between trainers and with study month. Four hundred and twenty-eight MS injuries were recorded in association with 395 preparations in 248 two- and three-year-old Thoroughbred racehorses. The IR for all categories of MS injuries, except for tendon and ligament injuries, were higher in twoyear- olds than three-year-olds, although the differences were only significant for shin soreness. Seventy-eight percent of horses enrolled in the study started, in a barrier trial or race, within one year on entering the study. After accounting for other confounders, horses that had sustained a MS injury were 0.50 times less likely to start, in a race or trial, race than those that did not sustain an injury. Seventy percent of horses returned to training after their first MS injury, and the cumulative percentage of these horses that had recovered within six months of the initial MS injury was 55%. After adjusting for clustering at the level of the trainer, the analysis showed that horses that exercised at a gallop pace ≥ 890 m/minute (but had not started in a race) prior to the onset of MS injury, were 2.14 times more likely to recover than horses whose maximum speed, prior to the onset of the first MS injury, was less than 890 m/minute. Similarly, horses that had started in a race or barrier trial were 4.01 times more likely to recover than horses whose maximum speed was less than 890 m/minute. 8 Training days were grouped into units referred to as preparations. A preparation began on the day that the horse was enrolled in the study, or when a horse returned to training after an absence of more than seven days from the stable. The preparation continued until the horse was lost to follow-up or left the stable for a period of more than seven consecutive days. Univariable and multivariable analytical methods were used to examine the association between a range of independent variables and four preparationlevel measures of performance: (i) the duration of preparations, (ii) length of time from the beginning of the preparation until the first start in a race or barrier trial, (iii) length of time from the first start until the end of the preparation and (iv) rate of starts in races or barrier trials. After adjusting for confounders, younger horses tended to have shorter preparations, took longer to start in a race or barrier trial, had a shorter interval from the first start to the end of the preparation and fewer starts per 100 training days. MS injury was not conditionally associated with any of the outcomes considered in this chapter. Multivariate statistical models were used to explore risk factors for MS injuries. The results suggest that MS injuries involving structures in the lower forelimb (carpus to fetlock inclusive) could be reduced by limiting exposure to high-speed exercise. This supports the proposition that training injuries are caused by the accumulation of micro damage. The results suggest there are a number of other factors that vary at the trainer level that may be risk factors for injuries, in particular joint injuries. These include unmeasured variables such as the rate of increase in distance galloped at high-speed, conformation of the horse, skill of the riders and farrier and veterinary involvement.
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Ludcke, Justin A. "Modelling of inflatable rescue boats (IRBs) in surf conditions to reduce injuries." Thesis, Queensland University of Technology, 2001.
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The Inflatable Rescue Boat (IRB) is arguably the most effective rescue tool used by the Australian surf lifesavers. The exceptional features of high mobility and rapid response have enabled it to become an icon on Australia's popular beaches. However, the IRB's extensive use within an environment that is as rugged as it is spectacular, has led it to become a danger to those who risk their lives to save others.
Epidemiological research revealed lower limb injuries to be predominant, particularly the right leg. The common types of injuries were fractures and dislocations, as well as muscle or ligament strains and tears. The concern expressed by Surf Life Saving Queensland (SLSQ) and Surf Life Saving Australia (SLSA) led to a biomechanical investigation into this unique and relatively unresearched field. The aim of the research was to identify the causes of injury and propose processes that may reduce the instances and severity of injury to surf lifesavers during IRB operation.
Following a review of related research, a design analysis of the craft was undertaken as an introduction to the craft, its design and uses. The mechanical characteristics of the vessel were then evaluated and the accelerations applied to the crew in the IRB were established through field tests. The data were then combined and modelled in the 3-D mathematical modelling and simulation package, MADYMO. A tool was created to compare various scenarios of boat design and methods of operation to determine possible mechanisms to reduce injuries.
The results of this study showed that under simulated wave loading the boats flex around a pivot point determined by the position of the hinge in the floorboard. It was also found that the accelerations experienced by the crew exhibited similar characteristics to road vehicle accidents. Staged simulations indicated the attributes of an optimum foam in terms of thickness and density. Likewise, modelling of the boat and crew produced simulations that predicted realistic crew response to tested variables. Unfortunately, the observed lack of adherence to the SLSA footstrap Standard has impeded successful epidemiological and modelling outcomes. If uniformity of boat setup can be assured then epidemiological studies will be able to highlight the influence of implementing changes to the boat design.
In conclusion, the research provided a tool to successfully link the epidemiology and injury diagnosis to the mechanical engineering design through the use of biomechanics. This was a novel application of the mathematical modelling software MADYMO. Other craft can also be investigated in this manner to provide solutions to the problem identified and therefore reduce risk of injury for the operators.
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Comer, Shawn. "A comparison of the protective characteristics of selected ankle braces." Virtual Press, 1992. http://liblink.bsu.edu/uhtbin/catkey/845941.
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The purpose of this study was to compare the protective characteristics of four different ankle braces and one form of ankle taping. An inversion and plantar flexion platform was used to induce ankle movements. The subjects used in this study consisted of 10 volunteer male students. The subjects had no sprains five months prior to testing. All subjects were tested in the same size 10 shoes, high tops and low tops. A Certified Athletic Trainer applied all ankle braces and ankle tapings. A closed basketweave with heel locks, adherent spray, and pre-wrap was used for all taping conditions.After the application of the ankle braces or taping, each subject performed two tests on the inversion and plantar flexion platform. A random order was used among the subjects. An ankle inversion platform was modified to induce 30 degrees of inversion and 35 degrees of plantar flexion simultaneously. The subjects will be filmed using a Locam 16mm at 200 frame/second. All subjects were filmed from the posterior plane with markings on the posterior aspect of the lower leg to help analyze the movement at the subtalar joint. A Calcomp 9100 series digitizer that was interfaced with a VAX computer was used to analyze the data and calculate the amount of angular displacement at the subtalar joint. An ANOVA with repeated measures was used to determine significant differences between support techniques. University procedures for the protection of human subjects was followed. ANOVA procedures indicated no significant difference in angular displacement between braces. A statistical analysis indicated that low top shoes provided significantly more support than high top shoes in braced ankles.School of Physical Education
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郝東方. "踝關節扭傷的針灸治療文獻研究." HKBU Institutional Repository, 2010. http://repository.hkbu.edu.hk/etd_ra/1125.
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Simpson, Helene. "Physiotherapeutic management of acute ankle sprains : a survey of clinical practice in the Western Cape and comparison thereof to evidence based guidelines." Thesis, Stellenbosch : Stellenbosch University, 2013. http://hdl.handle.net/10019.1/85818.
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Thesis (MScPhysio)--Stellenbosch University, 2013.ENGLISH ABSTRACT: Ankle sprains are reportedly the most common lower limb injury amongst active individuals. Aim: The aim of this study was to investigate whether treatment interventions employed by physiotherapists during the first week of functional rehabilitation of an ankle sprain, at primary care level, were aligned with evidence-based guidelines for acute ankle sprains. Design: A descriptive cross-sectional study was conducted. Participants: A total of 91 physiotherapists from the Western Cape Metropole (WCM) completed questionnaires. Method: Physiotherapists' treatment interventions were recorded based on a case study of a typical moderately sprained ankle. According to classification of the West Point Ankle Grading System, a moderate sprain is a partial macroscopic tear of the ligaments with moderate pain, swelling and tenderness with some loss of motion and mild to moderate instability of the joint. Anticipated return to sport is two to six weeks. Relative occurrence of selected interventions during the first week of rehabilitation was calculated. Chi-square tests were used to compare differences between physiotherapists' responses and the recommendations of the practice guidelines. Results: Physiotherapists' overall selections of treatment interventions were in alignment with the "Koninklijk Nederlands Genootschap voor Fysiotherapie" (KNGF) guidelines and correlated positively to the recommendations stipulated by KNGF therein. Physiotherapists indicated many interventions for which good evidence exists: compression, cryotherapy, early mobilisation, and neuromuscular exercises. It is of concern that 49% – 91% (n = 91) physiotherapists indicated some form of manual mobilisations for which there is a lack of evidence, and more than two-thirds indicated the application of an electrotherapy intervention, which is not recommended in the guidelines. Conclusion: Physiotherapists should reconsider interventions for which there is no evidence as this may reduce cost of care, without compromising patient outcomes.
AFRIKAANSE OPSOMMING: Verslae dui daarop dat verstuite enkels die mees algemene besering van die onderste ledemaat van aktiewe persone is. Doelwit: Die doel van hierdie ondersoek was om vas te stel of fisioterapeute in primere gesondheidsorg se keuse van rehabilitasie tegnieke gedurende die eerste week van funksionele rehabilitasie na 'n enkel besering, op koers is met bewysgebaseerde kliniese riglyne in die hantering van akute enkel beserings. Ontwerp: 'n Beskrywende deursnit ondersoek is geloods. Deelnemers: 'n Vooraf opgestelde vraelys is deur 91 fisioterapeute in die Weskaapse metropool voltooi. Metodiek: 'n Gevalle studie is aangebied van 'n tipiese matige verstuite enkel. Die respondent moes hulle tegnieke in die hantering van die geval aandui. Volgens die klassifikasie van die “West Point Grading System” word so 'n verstuiting gekenmerk deur makroskopiese gedeeltelike skeur van die enkel ligamente, matige pyn, swelsel en tasteerheid van die area. Dit gaan gepaard met 'n effense verlies van beweging en stabiliteit van die gewrig. Die prognose vir so 'n besering om na sport terug te keer is om en by twee tot ses weke. Die insidensie van aanwending van geselekteerde metodes van behandeling gedurende die eerste week en die verhouding met die vooraf geselekteerde behandelings riglyne opgestel deur die “Koninklijk Nederlands Genootschap voor Fysiotherapie” (KNGF) is bereken en ontleed. Die “Chi-square” toets is gebruik om die verskil te bereken tussen die respons van die Fisioterapeute en die aanbevelings van die kliniese riglyne. Resultate: Oorkoepelend is die keuses van behandelings tegnieke deur die fisioterapeute in lyn met die riglyne van die 'Koninklijk Nederlands Genootschap voor Fysiotherapie' (KNGF). Verskeie sinvolle behandelings is gekies waarvoor daar positiewe aanduidings was, byvoorbeeld: lokale kompressie, ys terapie, en oefeninge. Dit is egter kommerwekkend dat 49 – 91% (n=91) van die deelnemers 'n manuele tegniek ingesluit het waar daar tans gebrekkige aanduidings voor bestaan. Verder, het meer as twee derdes van die fisioterapeute aangedui dat hulle elektroterapie sou gebruik wat nie in riglyne aanbeveel word nie. Gevolgtrekking: Fisioterapeute moet die gebruik van tegnieke waarvoor daar nie duidelike bewyse in die literatuur bestaan nie, heroorweeg, want dit mag die koste van behandeling verminder, sonder om die positiewe resultate van herstel, negatief te beinvloed.
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Harwin, Lauren Sandra. "Ankle kinematics and ground reaction force during single leg drop landing in sports participants with chronic groin pain." Thesis, Stellenbosch : Stellenbosch University, 2014. http://hdl.handle.net/10019.1/86520.
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Thesis (MScPhysio)--Stellenbosch University, 2014.ENGLISH ABSTRACT: Aims: This study aims to ascertain if there are differences in ankle kinematics and ground reaction force in sports participants with chronic groin pain compared to healthy controls. Methods: A cross sectional descriptive study design was used. Twenty participants - 10 cases with chronic groin pain and 10 healthy controls participated. The 10 cases included participants with unilateral pain (n=7) and bilateral pain (n=3). For analysis, the bilateral pain group was divided into the most and less painful side. The study was conducted at the FNB 3D Motion Analysis Laboratory, Stellenbosch University. Sagittal plane kinematics and VGRF was analysed during a single leg drop landing. Results: The group with unilateral groin pain had a higher peak force compared to the matched side of the controls. The bilateral pain groups had less plantarflexion at foot contact (most affected p=<0.001; least affected p=<0.001) and total range of motion (p=<0.05) compared to the control group. The bilaterally injured groin pain groups demonstrated less peak force when compared to controls. Conclusion: This is the first study to indicate alterations in ankle kinematics and VGRF and that these changes are more apparent in sports participants with bilateral pain. Less range of motion during the landing task illustrated by the bilateral pain group suggests less effective force absorption of the distal segments. In the bilateral groups it suggests that force attenuation may have occurred high up the kinetic chain which may place more strain on the groin. Clinically rehabilitation of the athlete with chronic groin pain should include the distal segments of the lower limb. Further research should be conducted in larger groups.
AFRIKAANSE OPSOMMING: Doelstellings: Hierdie studie poog om vas te stel of daar verskille in enkelbeweging en grondvloer-reaksiekrag is in deelnemers van sport met chroniese liespyn in vergelyking met gesonde kontrole deelnemers. Metode: ‘n Deursnee beskrywende studieontwerp is gebruik. Twintig deelnemers, 10 gevalle met chroniese liespyn en 10 gesonde kontrole het deelgeneem. Die 10 gevalle het ingesluit deelnemers met eensydige pyn (n=7) en bilaterale pyn (n=3). Vir die analise, is die bilaterale pyngroep verdeel in die mees en mins geaffekteerde kant. Die studie is gedoen by die FNB3D Beweginsanalise-laboratorium, Universiteit van Stellenbosch. Sagitaal-platvlak kinematiek en vertikale reaksiekrag is geanaliseer gedurende ‘n enkele beenlanding. Resultate: Die groep met eensydige liespyn het ‘n hoër piekkrag gehad in vergelyking met dieselfde kant van die kontrolegroep. Die bilaterale pyngroep het minder plantaarfleksie met voetkontak getoon (mees geaffekteer p=<0.001; minste geaffekteer p=<0.001) en totale beweginsomvang (p=<0.05) in vergelyking met die kontrolegroep. Die bilateraal-liesbeseringsgroep het minder piekkrag getoon in vergelyking met die kontrolegroep. Gevolgtrekking: Hierdie is die eerste studie om veranderings in enkelbeweging en grondreaksiekrag aan te toon, asook dat hierdie veranderinge meer opvallend is in persone wat aan sport deelneem wat bilaterale pyn ondervind. Verminderde beweginsomvang gedurende die landingstaak deur die bilaterale pyngroep suggereer minder effektiewe kragabsorpsie van die distale segmente. In die bilaterale groep suggereer dit dat kragvermindering waarskynlik hoog op die kinematiese ketting voorgekom het wat weer meer stremming op die lies plaas. Kliniese rehabilitasie van die atleet met chroniese pyn behoort die distale segmente van die onderste ledemaat in te sluit. Verdere navorsing behoort in groter groepe uitgevoer te word.
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Eades, Anne. "Factors that influence participation in self-management of wound care in three indigenous communities in Western Australia : clients' perspectives /." Murdoch University Digital Theses Program, 2008. http://wwwlib.murdoch.edu.au/adt/browse/view/adt-MU20090702.111437.
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Wells, Lauren Michelle. "A comparative study of positive versus negative polarity in the treatment of acute ankle sprains utilizing high voltage electrogalvanic stimulation." Scholarly Commons, 1986. https://scholarlycommons.pacific.edu/uop_etds/2122.
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Electrical stimulation has long been used in the treatment of a variety of ailments. Its current uses range from muscle re-education and orthotic substitute to scoliosis management and edema control. I chose to study the effect of electrode polarity in high voltage electrogalvanic stimulation in the treatment of edema for several reasons. I had access to subjects because I was the only physical therapist at the Stockton Orthopedic Medical Group. High voltage electrogalvanic stimulation is a commonly used modality in treating edema (Brown, 1981). High voltage generators have a polarity switch, and the direction manual which accompanies the Electro-Med generator used by the Stockton Orthopedic Medical Group states that the negative pole should be used for edema reduction. (Instruction manual for high voltage Electrogalvanic Stimulator, 1977). However, the effect of electrode polarity on edema reduction has not been demonstrated, nor documented in the literature.
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Atkinson, Judy. "Lifting the blankets: The transgenerational effects of trauma in Indigenous Australia." Thesis, Queensland University of Technology, 2001. https://eprints.qut.edu.au/35841/1/35841_Digitised%20Thesis.pdf.
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The two specific aims of the fieldwork were to understand: (a) the phenomena of violence in the lives of a group of Aboriginal and non-Aboriginal people (the later by invitation of the Aboriginal people), living within a central coastal region of Queensland; and (b) cultural and individual processes of recovery or healing from violence related trauma. More specifically the questions that guided the field studies were:
* What is the experience of violence?
* How do experiences of violence contribute to experiences/behaviours that influence situations of inter-and transgenerational trauma?
* What assists change or healing in such behaviours?
* What is healing and how do people heal?
* What cultural tools promote change or healing, and how can these be supported to promote individual, family and community well-being?
Through the literature review the thesis considers cultural processes Aboriginal peoples previously used to deal with the trauma of natural disaster or man induced conflict. The literature review is then used to consider the impacts of trauma on the lives of people general. Finally the literature make links to locate the violence of contemporary Aboriginal communal environment to levels of trauma transmitted across generations from colonising processes.
The thesis is based on evolving Indigenous research methodological approaches, as it uses an Aboriginal listening/learning process called *dadirri* which is described as a cyclic process of listening and observing, reflecting and learning, acting and evaluating, re-listening and re-learning, and acting with insight and responsibility both in the field and with integrity and fidelity within the dissertation.
The thesis demonstrates *dadirri* in Chapter Four as it allows the voices of six participants to tell their stories of trauma and of healing in meaningful painful conversation with each other. These six participants represent some of the six hundred people who participated in the fieldwork over the years of the study. It is from this conversation that the data for the explication of the trauma experience and the healing processes has been drawn.
Chapter Five of the thesis is the explication of the trauma experience. In this chapter links are made between the violence experience, thoughts and feelings and resulting behaviour; feelings of inadequacy as a result of childhood experiences; victim perpetrator survivor roles in family and community violence; the relationships between alcohol and drugs to trauma; suicidal behaviours as a result of trauma; the fractured self, and finally the trans generational effects of trauma.
Chapter Six is the explication of the healing processes as they were narrated by the participants. Healing was defined by participants as educating them selves about who they are. The themes on healing that emerged in chapter Four are: healing as an awakening to inner (unmet) needs; healing as an experience of safety; healing as community support; rebuilding a sense of family and community in healing; healing as an ever-deepening self-knowledge; the use of ceremony in healing; strengthening cultural and spiritual identity in healing; healing as transformation, and transcendence and integration in healing.
Chapter Seven presents a synthesis and integration of the material and a model proposed for understanding trauma and healing from an Aboriginal perspective.
The thesis is an exploratory study. The findings and conclusions will be of use in the development and delivery of programs for community action in primary prevention and critical intervention in family violence, alcohol and drug programs, social and emotional well-being programs and crime prevention strategies. The thesis could be used as a foundation for future studies into violence and into healing within Aboriginal situations within Australia.
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McGarry, Sarah. "Pediatric medical traumatic stress : the impact on children, parents and staff." Thesis, Edith Cowan University, Research Online, Perth, Western Australia, 2013. https://ro.ecu.edu.au/theses/605.
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Burns are one of the most painful and traumatising injuries an individual can sustain and constitute a serious global health threat to children. Despite the magnitude of this public health problem, little research has examined the psychological burden of these injuries. This study used a mixed-methods approach to investigate the effect of paediatric medical trauma on children who have sustained a burn, their parents and the healthcare professionals caring for these patients. The paediatric medical traumatic stress model provided a theoretical framework for this study.
Firstly, this study aimed to gain an understanding of the lived experience of children who sustain a burn. Using phenomenology as a methodology, the first paper in this thesis provided an in-depth understanding of children’s perceptions, thoughts and feelings about the lived experience of sustaining a burn. The findings identified two phases of trauma that are central to the burn experience. The paper found that children experience ongoing trauma in addition to the initial trauma of sustaining the burn, resulting in a cumulative trauma experience. Six themes were identified in the data describing the child’s experience: ongoing recurrent trauma; return to normal activities; behavioural changes; scarring-the permanent reminder; family functioning and adaptation. The methodology of this research provided a voice for the child’s perspective of the burn experience and the findings can be used to inform clinical care at all stages of the burn journey.
The second paper, a cross-sectional study, aimed to investigate the impact of exposure to paediatric trauma on parents of children with a burn and to identify risk factors and relationships between psychological distress and resilience. The results indicated that parents experienced significantly more symptoms of post-traumatic stress disorder than a comparative population. Factors including having a daughter, witnessing the event, feeling helpless or having past traumatic experiences significantly influenced symptoms of psychological distress and resilience. Findings from this study highlight that health professionals should screen parents to identify those at greatest risk and provide effective evidence-based interventions aimed at improving resilience and reducing stress, as part of standard, routine care.
The aim of the third paper was to gain an understanding of the lived experience of parents of a child with a burn injury. Using a phenomenological, qualitative methodology allowed aspects of the parents’ experience not collected in standardised outcome measures to be identified, enabling triangulation with the quantitative results found in the second study. The findings demonstrated that the experience of parents reflected a journey that was represented by three phases: the event, the inpatient phase and the return to the community. Within the three phases, themes of external stressors, emotional and behavioural responses and coping strategies were identified. These findings can be used for the development of protocols to underpin a comprehensive information and social support management plan for families. This would complement the surgical and medical treatment plan, providing direction for comprehensive service delivery.
Children, parents and health professionals are interconnected in a professional relationship. The aim of the fourth paper was to investigate the effect of exposure to paediatric medical trauma on multidisciplinary teams and the relationships between psychological distress, resilience and coping skills. Health professionals experienced significantly more symptoms of psychological distress and less resilience than comparative groups. Non-productive coping was associated with adverse psychological outcomes and younger health professionals were more vulnerable to psychological distress than those aged 25 years and above. Findings from this study may assist in developing organisational systems to facilitate optimal mental health and coping strategies in health professionals, with the aim of the maintenance of a healthy workforce.
Overall findings from this research provide evidence for health professionals to optimise a holistic clinical service at all stages of the burn journey. These findings provide previously unknown knowledge about the impact of paediatric medical trauma on children, parents and health professionals within a paediatric hospital.
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Kohne, Eckard Peter. "The short and intermediate effect of manipulation on chronic ankle instability syndrome." Thesis, 2005. http://hdl.handle.net/10321/188.
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Thesis (M.Tech.: Chiropractic)-Dept. of Chiropractic, Durban Institute of Technology, 2005
1 v. (various pagings) ; 30 cmFollowing an inversion ankle joint sprain, damage to the proprioceptive organs can occur, which is made worse by lack of proprioceptive retraining and will increase the chances of re-injury (Hoffman and Payne 1995:144 and Anderson, 2002). Pellow and Brantingham (2001) indicated that patients who received multiple manipulations improved more rapidly than patients in the placebo group. Therefore it is proposed that manipulation provokes changes in afferent input that may restore normal proprioceptive input (Slosberg, 1988). However, Pellow and Brantingham (2001) were not able to establish what effect multiple manipulations had, as opposed to a single manipulation, on the proprioception on the foot and ankle complex and how this may influence the clinical outcome of the patient’s treatment. Therefore, it was hypothesized that multiple manipulations of the foot and ankle complex would have a greater effect on chronic ankle instability syndrome than a single treatment in terms of overall improvement subjectively and objectively. In addition to this the following was also hypothesized: • That multiple manipulations of the foot and ankle complex would increase the ROM to a greater extent than single manipulations. • That multiple manipulations would decrease point tenderness more effectively than a single manipulation.
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Jorden, Ryan A. "Influence of ankle orthoses on ankle joint motion and postural stability before and after exercise." Thesis, 2000. http://hdl.handle.net/1957/33391.
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Ankle injuries comprise more than 15% of all sports injuries worldwide. The efficacy of the ankle taping for injury prevention has long been under scrutiny as numerous studies have shown that tape rapidly loses its ability to constrain ankle motion with exercise. Consequently, ankle braces (orthoses) are being used with increasing frequency for the prevention and functional management of ankle injuries. However, the motion restraining qualities of ankle orthoses have not been widely evaluated in closed kinetic chain environments under physiologic loads. The primary purpose of this study was to compare the abilities of four ankle orthoses (ankle taping, lace-up brace, semirigid orthosis and hybrid brace) against a control condition (no brace or tape) to control subtalar and talocrural motion during running on a laterally-tilted treadmill at 16.2 km/h before and after exercise. It has been hypothesized that ankle orthoses make a secondary contribution to injury prevention through enhanced proprioception. The secondary purpose of this study was to quantify the effects of the aforementioned ankle orthoses on
postural stability during single-limb stance following a bout of exercise. Fifteen healthy university students (8 men and 7 women) with no history of significant ankle injuries (age, mean �� SD: 22.9 �� 3.9 years) volunteered to participate in this study. Three-dimensional kinematic data were captured with an active infrared digital camera system sampling at 120 Hz. To address the first question, data analyses were performed using 2way univariate (Ankle Orthoses x Pre/Post-Exercise x Subjects) (5 x 2 x 15) repeated measures analysis of variance (ANOVA) to determine the existence of differences among three closed and four open kinematic chain dependent measures before and after exercise. Maximum inversion angles (MAXINV) were similar for all ankle orthoses, with no orthosis limiting inversion during tilted treadmill running significantly more than another, or compared to the control condition, either before or after exercise (p>.05). Pre-exercise MAXINV group means and standard deviations during treadmill running ranged from 6.8 �� 3.4 deg with the Royce Medical Speed Brace to 9.5 �� 4.1 deg in the tape condition; post-exercise MAXINV mean values ranged from 7.6 �� 3.2 deg for the Aircast Sport Stirrup to 9.1 �� 4.6 deg with closed basketweave tape. While not statistically significant (p=0.10), ankle taping provided the least amount of inversion restraint, both before and after the exercise bout. The MAXINV angles measured during treadmill running (8.2 �� 4.0 deg) and open chain inversion AROM measured with a goniometer
(34.5 �� 6.2 deg) were not related (r=-0.0003). The compressive forces present during closed kinetic chain activity are known to increase joint stability and thus may explain why MAXINV under dynamic varus loads was so much less in magnitude than inversion AROM measured under open kinetic chain conditions. The nonlinear relationship of these two variables supports our contention that reports of the motion controlling properties of ankle orthoses measured in open kinetic chain environments should not be used to infer the response characteristics of these same orthoses under dynamic, physiologic loads. To address the second question, data were analyzed using 3-way univariate (Ankle Orthoses x Pre/Post-Exercise x Eyes Open/Closed x Subjects) (5 x 2 x 2 x 15) repeated measures ANOVAs. Subjects' postural stability was assessed using a Biodex Balance System with eyes open and eyes closed conditions, before and after an exercise bout. The ankle orthoses evaluated did not influence postural stability as measured by mediolateral sway index, anteroposterior sway index, and overall sway index. Removal of visual perception via blindfolding resulted in significant decreases in all three measures of postural stability (p=.001). There was poor association among the closed chain postural stability parameters and the open chain AROM measures. These correlations ranged from r=.04 to .17, indicating minimal relationship between the amount of AROM permitted by the orthoses and postural stability as quantified by this method.Graduation date: 2000
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Lindsey-Renton, Catriona. "The immediate effect of manipulation in chronic ankle instability syndrome in terms of objective clinical findings." Thesis, 2005. http://hdl.handle.net/10321/190.
Full textAbstract:
Thesis (M.Tech.: Chiropractic)-Dept. of Chiropractic, Durban Institute of Technology, 2005
xiii, 81 leaves ; 30 cmDamage to the proprioceptive organs, as well as lack of proprioceptive retraining, after an inversion ankle sprain, has been shown to contribute to the problem of recurring ankle joint injuries, which has the highest incidence of sports related injuries. The proprioceptive organs are important as afferent pathways in reflexes and for the adjustment of posture and muscle tone (Miller and Narson, 1995 and Jerosch and Bischof, 1996). Manipulation is thought to cause a change in the afferent pathways of the manipulated joints and it is proposed that this change may restore normal proprioceptive input, in a previously injured joint (Wyke, 1981 and Slosberg 1988). This however is unproven as indicated in a study by Lephart and Fu, (1995), where techniques to improve proprioception remain untested and according to Brynin and Farrar (1995), screening for proprioceptive and neuromuscular co-ordination should be carried out as part of a chiropractor’s physical examination and injury evaluation. This was a qualitative pre-post clinical study. Forty (40) subjects between the ages of 25 and 45, who had been diagnosed with chronic ankle instability syndrome, were recruited.
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Pellow, Justin Edward. "The efficacy of adjusting the ankle in the treatment of subacute and chronic grade I and II ankle inversion sprains." Thesis, 1999. http://hdl.handle.net/10321/2882.
Full textAbstract:
Dissertation submitted in partial compliance with the requirements for the Master's Degree in Technology: Chiropractic, Technikon Natal, 1999.To investigate the efficacy of adjusting the ankle in the treatment of subacute and chronic grade I and II ankle inversion sprains. The researcher hypothesised that adjusting a symptomatic ankle, in terms of the above, would result in a more significant improvement than that of a placebo treatment
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Needham, Kim Jane. "The effectiveness of manipulation combined with static stretching of the gastrocnemius-soleus complex compared to manipulation alone in the treatment of subacute and chronic grades I and II ankle inversion sprains." Thesis, 2001. http://hdl.handle.net/10321/2861.
Full textAbstract:
A dissertation presented in partial compliance with the requirements for the Master's Degree in Technology: Chiropractic, Technikon Natal, 2001.The purpose of this study was to evaluate the relative effectiveness of chiropractic manipulation alone compared to chiropractic manipulation in conjunction with gastrocnemius and soleus stretching in the treatment of subacute and chronic grade I and II ankle inversion sprains
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Nakagawa, Lyn H. "Performance in static, dynamic, and clinical tests of postural control in individuals with functional ankle instability." Thesis, 2002. http://hdl.handle.net/1957/30248.
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Objectives: To evaluate postural control in individuals with functional ankle
instability using static, dynamic, and clinical balance tests. Also, to examine the
relationships between the performances in each of these tests. Design: Postural
control was evaluated with a single leg balance test, a balance test involving
movement, and the star excursion balance test. Participants: A volunteer sample
of 19 subjects with functional ankle instability and 19 uninjured control subjects.
Main Outcome Measures: Center of pressure sway path length was calculated for
the static and dynamic balance tests. Total reach distance was measured for the star
excursion balance test. Results: Subjects with functional ankle instability
demonstrated a significantly greater center of pressure sway path length in both the
static and dynamic balance tests. Conclusions: Functional ankle instability may
be associated with reduced postural control as demonstrated by decreased
performance in static and dynamic balance tests.Graduation date: 2003
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Nowak, Kasia Natalia. "The effectiveness of combining ankle and pelvic manipulation versus ankle manipulation alone in the management of chronic achilles tendinitis." Thesis, 2009. http://hdl.handle.net/10210/2681.
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McClure, Roderick. "The public health impact of minor injury." Phd thesis, 1994. http://hdl.handle.net/1885/144086.
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"Injury mechanism of supination ankle sprain incidents in sports: kinematics analysis with a model-based image-matching technique." 2010. http://library.cuhk.edu.hk/record=b5894310.
Full textAbstract:
Mok, Kam Ming.Thesis (M.Phil.)--Chinese University of Hong Kong, 2010.
Includes bibliographical references (leaves 36-44).
Abstracts in English and Chinese.
Abstract --- p.ii
Chinese abstract --- p.iii
Acknowledgement --- p.iv
Table of contents --- p.V
List of figures --- p.vii
List of tables --- p.viii
Chapter Chapter 1: --- Introduction --- p.1
Chapter Chapter 2: --- Review of literature --- p.3
Chapter 2.1 --- Why prevent ankle ligamentous sprain? --- p.3
Chapter 2.2 --- A sequence of injury prevention --- p.4
Chapter 2.3 --- Biomechanical approaches in defining injury mechanism --- p.5
Chapter 2.4 --- Injury mechanism of ankle ligamentous sprain in sports --- p.6
Chapter 2.5 --- Model-Based Image-Matching motion analysis --- p.7
Chapter Chapter 3: --- Development of an ankle joint Model-Based Image-Matching motion analysis technique --- p.9
Chapter 3.1 --- Introduction --- p.9
Chapter 3.2 --- Materials and method --- p.10
Chapter 3.2.1 --- Cadaver test --- p.10
Chapter 3.2.2 --- Model-Based Image-Matching motion analysis --- p.12
Chapter 3.2.3 --- Statistical analysis --- p.14
Chapter 3.3 --- Results --- p.15
Chapter 3.3.1 --- Validity --- p.15
Chapter 3.3.2 --- Intra-rater reliability --- p.16
Chapter 3.3.3 --- Inter-rater reliability --- p.17
Chapter 3.4 --- Discussion --- p.17
Chapter 3.5 --- Conclusion --- p.21
Chapter Chapter 4: --- Biomechanical motion analysis on ankle ligamentous sprain injury cases --- p.22
Chapter 4.1 --- Introduction --- p.22
Chapter 4.2 --- Materials and method --- p.24
Chapter 4.2.1 --- Case screening --- p.24
Chapter 4.2.2 --- Model-Based Image-Matching motion analysis --- p.24
Chapter 4.3 --- Results --- p.28
Chapter 4.3.1 --- High Jump Injury --- p.28
Chapter 4.3.2 --- Field hockey Injury --- p.28
Chapter 4.3.3 --- Tennis Injury --- p.29
Chapter 4.4 --- Discussion --- p.30
Chapter 4.5 --- Conclusion --- p.34
Chapter Chapter 5: --- Summary and future development --- p.35
References --- p.36
List of publications --- p.42
List of presentations at international and local conference --- p.43
List of Awards --- p.44
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Dicks, Jason. "The effect of ankle joint manipulation on peroneal and soleus muscle activity in chronic ankle instability syndrome." Thesis, 2016. http://hdl.handle.net/10321/1772.
Full textAbstract:
Submitted in partial compliance with the requirements for the Master’s Degree in Technology: Chiropractic, Durban University of Technology, Durban, South Africa, 2016.Purpose: Ankle sprains are amongst the most common injury sustained by athletes and the general public. When an ankle is repeatedly sprained it results in chronic ankle instability syndrome (CAIS). This repeated trauma results in disruption of the afferent nerve supply from the injured joint, which affects the motor neuron pool excitability of the peroneal and soleus muscles resulting in arthogenic muscle inhibition (AMI). Traditional treatment for CAIS focuses on rehabilitation of the affected muscles via strength and proprioceptive training. Recent literature has shown that the addition of ankle joint manipulation resulted in improved clinical outcomes in the treatment of CAIS. The mechanism on how joint manipulation affects AMI is under-investigated especially in extremity joints. Thus this study aimed to determine the immediate effect of ankle joint manipulation on peroneal and soleus muscle activity, by assessing surface electromyography (sEMG) H/M ratio to detect a change in the proportion of the total motor neuron pool being recruited, in participants with CAIS. Methods: The study utilised a quantitative, experimental, pre-test post-test study design. Forty two participants with grade I and II CAIS, aged 18-45 years, were randomly allocated into one of three groups. Group one received a single talocrural joint long axis distraction manipulation, group two received a sham manipulation and group three was the control receiving no intervention. sEMG H/M ratio measurements were taken before and immediately after the intervention using a Biopac wireless emg system. Results: The groups were comparable at baseline for age, gender, body mass index and H/M ratio measurements for the soleus and peroneal muscles (p < 0.050). Intra-group analysis of the soleus muscle H/M ratio showed no statistically significant change over time for the manipulation (p = 0.975) and sham (p = 0.056) groups, with the control group showing a statistically significant (p = 0.019) decrease in the H/M ratio. For the peroneal muscle no statistically significant (p > 0.050) differences were observed in any of the three groups. Inter-group analysis of the soleus muscle H/M ratio measurements showed no statistically significant differences between the three groups (p = 0.470; F = 1.010) over time, with Tukey’s HSD post-hoc test revealing a statistically significant (p = 0.028) difference being observed between the sham and control groups in terms of post soleus muscle H/M ratio measurements. Conclusion: This study failed to show that ankle joint manipulation affects the soleus and peroneal muscles in terms of H/M ratio measurements in participants with CAIS. There may have been a trend of an effect of the sham and manipulation interventions counteracting the muscle fatigue experienced in the control group, however further investigation is required.
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"Identification of ankle sprain motion from normal activities by dorsal foot kinematics data." 2008. http://library.cuhk.edu.hk/record=b5893566.
Full textAbstract:
Chan, Yue Yan.Thesis (M.Phil.)--Chinese University of Hong Kong, 2008.
Includes bibliographical references (leaves 36-40).
Abstracts in English and Chinese.
Abstract --- p.i
Chinese abstract --- p.ii
Acknowledgement --- p.iii
Table of Contents --- p.iv
List of figures --- p.vi
List of tables --- p.vii
Chapter Chapter 1: --- Introduction --- p.1
Chapter Chapter 2: --- Review of literature --- p.4
Chapter 2.1 --- Chapter introduction --- p.4
Chapter 2.2 --- Anatomy and kinematics of the ankle --- p.4
Chapter 2.3 --- Epidemiology of ankle sprain --- p.6
Chapter 2.4 --- Grading system for classification of ankle sprain --- p.7
Chapter 2.5 --- Previous measures of protecting ankle from sprain injury --- p.7
Chapter 2.6 --- Usage of motion sensors in human motion detection --- p.9
Chapter Chapter 3: --- A mechanical supination sprain simulator for studying ankle supination sprain kinematics --- p.11
Chapter 3.1 --- Chapter Introduction --- p.11
Chapter 3.2 --- Methods --- p.12
Chapter 3.3 --- Results --- p.17
Chapter 3.4 --- Discussion --- p.17
Chapter Chapter 4: --- Identification of simulated ankle supination sprain from other normal motions by gyrometers and accelerometers --- p.19
Chapter 4.1 --- Chapter introduction --- p.19
Chapter 4.2 --- Methods --- p.20
Chapter 4.2.1 --- Data collection --- p.20
Chapter 4.2.2 --- Support Vector Machine for classification of human motion --- p.22
Chapter 4.2.3 --- Training the Support Vector Machine --- p.23
Chapter 4.2.4 --- Support Vector Machine verification --- p.24
Chapter 4.2.5 --- Choose the optimal position of motion sensor --- p.25
Chapter 4.3 --- Results --- p.25
Chapter 4.4 --- Discussion --- p.29
Chapter Chapter 5: --- Summary and future development --- p.34
References --- p.36
List of publications --- p.41
List of presentations at international and local conferences --- p.41
Appendix I: --- p.42
Related publication:
"Chan, Y. Y., Fong, D. T. P., Yung, P. S. H., Fung, K. Y., & Chan, K. M (1998). A mechanical supination sprain simulator for studying ankle supination sprain kinematics. Journal of Biomechanics. 41(11), 2571-2574."
Appendix II: --- p.46
Ethical approval of the investigation of ankle torque and motion signal pattern in foot segment during simulate sprain and other motion
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Bellingham, Simon. "The relative effectiveness of Piroxicam versus Protease administration in the treatment of acute grade 1 and 2 ankle inversion sprains." Thesis, 2001. http://hdl.handle.net/10321/2158.
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A dissertation submitted to the Faculty of Health in partial compliance with the requirements for a Master's Degree in Technology: Chiropractic,Technikon Natal, 2001.The purpose of this study was to evaluate Piroxicam versus Protease administration, in terms of subjective and objective clinical findings, in order to determine the effectiveness of each approach in the treatment of grade 1 and 2 acute ankle inversion sprains. The study was a prospective, randomized, double blinded, controlled study. The study involved 30 subjects, 15 in each group which were selected from the general population. One group received Protease and strapping while the other group two received Piroxicam and strapping. Patients received 3 treatments over a period of one week. Patients in the Protease group received 1200mg (3 x 400mg) of Protease daily before meals for seven days. Patients in the Piroxicam group received 40mg (2 x 20mg) of Piroxicam for the first two days, and then 20mg (1 x 20mg) for the following five days, administered with meals. All patients were taught how to apply an elastic crepe bandage to the ankle, which was to be used at all times, except during bathing for the duration of the study
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Lubbe, Danella. "The effectiveness of combined manipulation and rehabilitation versus rehabilitation only, in the management of chronic ankle instability." Thesis, 2011. http://hdl.handle.net/10321/2102.
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Dissertation submitted in partial compliance with the requirements for the Masters Degree in Technology: Chiropractic, Durban University of Technology, 2011.Purpose: Chronic ankle instability (CAl) is characterised by ankle pain, weakness, edema, crepitus, adhesions, restrictions and ligamentous laxity. Various treatment options target a variety of aspects of this condition. However, there is a paucity of literature with regards to combined treatment choices. The purpose of this study was to investigate the relative effectiveness of combining manipulation with rehabilitation, compared to rehabilitation only, in participants with CAl. Methods: The study was a single blinded, randomised and comparative clinical trial at a chiropractic day clinic. Thirty participants with grade I and II CAl were recruited and randomly allocated into one of two treatment groups. Fifteen participants received a combination of manipulation and rehabilitation (coupled peroneal muscle strengthening and proprioception) and fifteen received the rehabilitation only programme. All six treatments in each group were conducted over five weeks. Results: A P value of <0.05 was considered statistically significant. The intra-group outcomes in the Manipulation and Rehabilitation Group indicate that statistically significant improvements were achieved for all six parameters in this study (VAS p<0.001; FAOI p<0.001; Algometer p<0.001; motion palpation p<0.001; WBO p=0.001 and BBS p<0.001). This is in comparison to the three outcomes where statistical significance was achieved (VAS p<0.001; FAOI p<0.001 and BBS p<0.001) in the Rehabilitation only Group. Inter-group analysis revealed statistically significant improvement in favour of the Manipulation and Rehabilitation Group for VAS (p<0.001); algometer readings (p=0.002) and Motion palpation findings (p<0.001). Conclusions: The findings of this study show that manipulation in combination with rehabilitation is relatively more effective than rehabilitation only for most outcome measures. III Key indexing terms: Ankle; Combination Therapy; Joint Instability; Manipulation; Rehabilitation
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Moti, Harsha. "The effect of three types of strapping on chronic ankle instability syndrome." Thesis, 2017. http://hdl.handle.net/10321/2534.
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Submitted in partial compliance with the requirements for the Master’s Degree in Technology: Chiropractic, Durban University of Technology, Durban, South Africa, 2017.Background: Acute ankle sprains and chronic ankle instability syndrome (CAIS) may be managed effectively through conservative management approaches such as strapping. There are two main types of strapping viz. rigid tape which is used to stabilise the joint and limit joint motion and elastic tape which permits joint motion but provides dynamic support. Kinesio™ tape is becoming increasingly popular in the management of various conditions. It is reportedly beneficial in reducing pain, improving circulation, increasing proprioception and correcting muscle function. Due to claimed benefits of Kinesio™ tape, it should, in theory, be beneficial in the management of individuals with CAIS particularly in terms of reducing pain and improving proprioception. AIM: To investigate the effect of three types of strapping applied in the method described for the application of Kinesio™ tape in the management of CAIS. METHODS This study consisted of three groups of 15 participants (recruited through convenience sampling) with each group receiving a different tape (i.e. rigid, elastic or Kinesio™ tape), all three groups, however, received the same taping method which was the Kinesio™ tape functional correction application. After obtaining informed consent each participant underwent a case history, physical examination and a foot an ankle orthopaedic examination. Thereafter, baseline measurements of subjective pain rating (NRS-101), pain threshold (analogue algometer), ankle dorsiflexion, plantarflexion and inversion (analogue goniometer) and proprioception (Biodex Biosway portable balance system) were documented. Depending on the group, the particular tape was then applied and a follow up consultation was made for two to three days later where the tape was removed, measurements were reassessed and the tape was reapplied. At the final consultation three to four days later, the tape was removed and final measurements were assessed and documented. Statistical intra- (using Wilcoxon Signed Ranks Test) and inter-group (using the Mann-Whitney U-test) analyses of the data were performed due to a skewed distribution of the variables. Data was analysed using SPSS version 21.0 with the level of significance set at 0.05. RESULTS The mean (± SD) age of the participants was 24.8 (4.7) and there were 23 male participants in total. Intra-group analyses of subjective outcome measurements showed significant increases (p < 0.05) in subjective pain rating in all three groups across all consultations. Similarly, intra-group analyses of objective outcome measurements found significant increases (p < 0.05) in pain threshold and dorsiflexion range of motion in all three groups across all consultations. Plantarflexion and inversion range of motion also showed significant increases (p < 0.05) but these were not consistent across all consultations. Intra-group analyses of the sway index showed no significant improvements (p > 0.05) in Groups Two and Three across the three consultations. Only Group One showed significant increases during the eyes open foam surface (EOFoS) (p = 0.013) and eyes closed foam surface (ECFoS) (p = 0.047) test conditions between Consultations One and Two. Inter-group analyses of subjective outcome measurements showed no significant increases (p > 0.05) in subjective pain rating across each of the three consults in all three groups. Inter-group analyses of objective outcome measurements revealed a significant increase in pain threshold (p = 0.040) between Groups Two and Three at Consultation One. There was a significant increase in plantarflexion between Groups One and Three at Consultation Two (p = 0.021) and Consultation Three (p = 0.030). There were no other significant results amongst the three groups. CONCLUSION The results suggest that pain rating, pain threshold and ankle dorsiflexion would improve if taping is applied in the manner described for Kinesio™ tape irrespective of the type of taping used in the management of CAIS. The taping method did not result in a significant difference in proprioception. Further studies, with larger sample sizes are required to confirm the findings of this study and to determine the role of taping in the management of CAIS.
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Van, der Toorn Ingrid. "The prevalence and clinical presentation of fibularis myofascial trigger points in the assessment and treatment of inversion ankle sprains." Thesis, 2007. http://hdl.handle.net/10321/175.
Full textAbstract:
Thesis (M.Tech.:Chiropractic)-Dept. of Chiropractic, Durban University of Technology, 2007
121 leavesAnkle sprains account for 85% of all injuries to the ankle (Garrick, 1997). Inversion sprains result from a twisting of a weight-bearing foot into a plantarflexed and inverted position leading to lateral ankle ligament injury. Louwerens and Snijders (1999) state that there are multiple factors involved in ankle sprains or lateral ankle instability. These include injury to the lateral ankle ligaments, proprioceptive dysfunction and decrease of central motor control. Other factors that still need further research include the role of the fibularis muscles, the influence of foot geometry and the role of subtalar instability in ankle sprains (Louwerens and Snijders, 1999). This study focused on the fibularis muscles. Fibularis longus and brevis muscles are found in the lateral compartment of the leg and function to evert/pronate the foot and plantarflex the ankle. Fibularis tertius is found in the anterior compartment and its function is to evert and dorsiflex the foot. Myofascial trigger points in these three muscles refer pain primarily over the lateral malleolus of the ankle, above, behind and below it (Travell and Simons, 1993 2: 371). This is the exact area where ankle sprain patients experience pain. Travel and Simons (1993 2:110) state that a once off traumatic occurrence can activate myofascial trigger points. When considering the mechanism of injury of a lateral ankle sprain, the importance of the fibularis muscles becomes obvious. When the ankle inverts during a lateral ankle sprain, these muscles are forcefully stretched whilst trying to contract to bring about their normal action. Therefore these muscles are often injured from traction when the foot inverts (Karageanes, 2004). It stands to reason that as a result of this mechanism of injury myofascial trigger points may develop in the fibularis muscles. It was hypothesised that fibularis muscle trigger points would prove to be more prevalent in the injured leg when compared to the uninjured leg. To further investigate this hypothesis, an analytical, cross sectional study (phase 1) was done on 44 participants between the ages of 15 and 50. Consecutive convenience sampling was used and participants were screened according to phase 1’s inclusion and exclusion criteria. According to Travel et al. (1999 1: 19) myofascial trigger points (whether active or latent) can cause significant motor dysfunction. Trevino, et al. (1994) stated that fibularis muscle weakness is thought to be a source of symptoms after an inversion sprain. Treatment for ankle sprains involves minimising swelling and bruising and encouraging adequate ankle protection in the acute phase. The patient is advised to rest for up to 72 hours to allow the ligaments to heal (Ivins, 2006). After the acute phase has passed, rehabilitation is focused on. This includes improving the ankle range of motion and proprioception. Attention is also given to strengthen the muscles, ligaments and tendons around the ankle joint. In the recommended treatment protocol however, no mention is made of evaluating the musculature around the ankle joint for myofascial trigger points and or treating these points. McGrew and Schenck (2003) noted that if the musculature and neural structures surrounding the ankle joint were affected during an ankle sprain injury, and were left unresolved, they would lead to chronic instability. It was hypothesised that lateral ankle pain due to inversion ankle sprain injuries may be due to referred pain from the fibularis muscle trigger points. Patients treated with dry needling of the fibularis muscle trigger points would therefore show a greater improvement in terms of subjective and objective clinical findings when compared to a placebo treatment (detuned ultrasound) applied to the fibularis muscle trigger points.
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Gaines, Dominique. "The relative effectiveness and correct sequencing of proprioceptive neuromuscular facilitation techniques (PNFT) and active rocker-board exercises in the rehabilitation of chronic ankle sprains." Thesis, 2005. http://hdl.handle.net/10321/203.
Full textAbstract:
Thesis (M.Tech.: Chiropractic) - Dept. of Chiropractic, Durban Institute of Technology, 2005
221 leaves ; 30 cmPreviously the focus has been on the improvement of strength prior to proprioception (Calliet, 1997; Flemister et al. 1998 and Buhler et al. 2002). However according to Oloff (1994); Vegso (1995); Calliet (1997); Kawaguchi (1999); Buhler et al. (2002) and McGrew et al. (2003), focus should lie in obtaining a functional range of motion (increased flexibility) and proprioceptive ability and strength will follow with normalization of the relationship of the anatomical structures. All research in this regard has never assessed the assumption that the strength of the relevant musculature would return (Blokker et al.1992 and Klaue et al.1998). The objectives of this study were: to determine the relative effectiveness of Proprioceptive Neuromuscular Facilitation as compared to the Active Rocker-Board Exercises in the rehabilitation of chronic ankle sprains; as well as to determine the best sequence of applying these techniques to chronic ankle sprains in terms of objective clinical findings.
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Botha, André. "The relative effectiveness of the Activator Adjustment Instrument versus diversified manipulation technique in Chronic Ankle Instability Syndrome (CAIS) in terms of objective and subjective findings." Thesis, 2015. http://hdl.handle.net/10321/1209.
Full textAbstract:
Submitted in partial compliance with the requirements for the Master’s Degree in Technology: Chiropractic, Durban University of Technology, South Africa, 2013.Background: Lateral ankle sprains and the sequelae of Chronic Ankle Instability Syndrome (CAIS) are common, reaching a peak prevalence of 85%. Manual joint manipulation is an intervention utilised for CAIS. Manipulations are applied either manually or via a mechanical device. The Activator Adjustment Instrument (AAI) is commonly applied to extremities; however, a paucity of research exists, in respect of extremity conditions. Thus this study compared an AAI manipulation with a manual long-axis distraction manipulation (diversified technique) in the treatment of CAIS. Method: This ethics approved, quantitative, randomised controlled clinical trial, of 40 participants allocated between two groups. After receipt of informed consent participants were evaluated against the inclusion criteria and baseline measures were taken. One treatment of either manual or activator manipulation was followed by a measurements-only consultation within 48 hours. A p-value <0.05 was considered statistically significant. Intra- and inter-group analyses were done utilising repeated measures ANOVA tests. Results: Both groups showed a statistically significant improvement on all outcome measures over time, but neither group showed a significant improvement over the other. A trend in the inter-group comparisons reflected parallel improvements in the Algometer, Berg Balance Scale and the dorsiflexion range of motion (objective measures) and non-parallel improvements in the Numerical Pain Rating Scale and Foot and Ankle Disability Index. Conclusion: The results suggested a trend towards subjective improvement in the AAI group, which may have been influenced by the novelty of the AAI. Further research with larger sample sizes and more homogenous participant groups are needed to verify this outcome.
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Noska, Katrin. "The immediate and short-term effect of spinal manipulative therapy on the lower leg musculature in lateral ankle sprain measured by surface electromyography during maximum voluntary contraction." Thesis, 2009. http://hdl.handle.net/10210/2838.
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Joseph, Lynette Colleen. "The relative effectiveness of muscle energy technique compared to manipulation in the treatment of chronic stable ankle inversion sprains." Thesis, 2005. http://hdl.handle.net/10321/197.
Full textAbstract:
Thesis (M.Tech.: Chiropractic)-Dept of Chiropractic, Durban Institute of Technology, 2005
x, 58, Annextures A-L, 20 leavesAn inversion ankle sprain can be defined as an injury caused by landing forcefully on an inverted, plantarflexed and internally rotated foot. This results in the fibres of the surrounding ligaments to become ruptured without disturbing the continuity of the ligament. Chronic stable ankle sprains was defined as the recurrent giving way of the ankle and there may be residual pain and swelling with no mechanical instability. According to literature, mechanisms involved in the development of chronic ankle sprains are: the lack of appropriate and early immobilization in severe cases, the development of scar tissue, lack of strengthening exercises or the development of hypermobility. Many treatments have been suggested to address these factors and would include: peripheral manipulation of the ankle joint, Muscle Energy Technique, muscle strengthening and stretching, proprioceptive training and deep transverse friction massage. Of the above mentioned treatments, Muscle Energy Technique has not been researched in a clinical setting for the treatment of chronic stable ankle inversion sprains. Therefore the purpose of this study was to investigate the relative effectiveness of Muscle Energy Technique compared to Manipulation in the treatment of chronic stable ankle inversion sprains.
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Belling, Kym Ashley. "The clinical responsiveness of motion palpation as a post-manipulation diagnostic tool in patients with chronic ankle instability syndrome." Thesis, 2011. http://hdl.handle.net/10321/672.
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Dissertation submitted in partial compliance with the requirements for the Masters
Degree in Technology: Chiropractic, Durban University of Technology, 2011.Introduction: Motion palpation is a commonly utilised clinical assessment tool of joint fixations. Most research surrounding motion palpation discusses inter and/or intra-examiner reliability as a pre-treatment tool. However, only two studies have assessed the reliability of motion palpation as a post-treatment diagnostic tool, and both these studies demonstrated that motion palpation has the ability to identify end-feel improvement in a restricted segment which had been manipulated. Therefore the use of motion palpation as a post-manipulation tool within the spine showed a relatively high level of responsiveness/efficacy of motion palpation. However little research has yet to be conducted on the use of motion palpation as a post-manipulation tool on the extremities and therefore this study aims to provide a clearer insight into the use of motion palpation as a post-treatment assessment tool in an extremity in terms of clinical responsiveness/validity of motion palpation. Furthermore the relationship between motion palpation and other clinical measures/short term outcomes, such as pain, functionality, range of motion and proprioception has yet to be seen i.e. when motion palpation indicates a reduction in a fixation due to manipulation does this correlate to a decrease in pain and increase in functionality, range of motion and proprioception. Therefore the primary aim of this study was to determine the clinical responsiveness of motion palpation as a post-manipulation diagnostic tool within the joints of the ankle in symptomatic participants with Chronic Ankle Instability (CAI). Method: Forty participants with CAI (Grade I and II) were recruited. One Group received manipulation (n=21), the other Group received no treatment (n=19). Motion palpation was performed, and subjective/objective measures were taken in both Groups pre- and posttreatment. Statistical analysis was performed using SPSS 15.0. Results: The findings of this study demonstrated that when using motion palpation as a posttreatment assessment tool a high level of responsiveness was observed (a highly significant association between being manipulated and End-Feel Improvement (EFI) occurred (p<0.001)); it was highly sensitive (0.90); and was highly specific (0.95). Overall no statistically significant association was observed in either group between, motion palpation results (with respect to EFI or no EFI noted) and any of the short term outcomes (the five subjective/objective clinical measures). Within the manipulation group; Visual Analogue Scale (VAS) (p=0.944), Functional Ankle Disability Index (FADI) (p=0.490), Pressure Algometer v (p=0.634), Berg Balance Scale (BBS) (p=0.512) and Weight Bearing Dorsiflexion (WBD) (p=0.966). In comparison, the control group; Visual Analogue Scale (VAS) (p=0.063), Functional Ankle Disability Index (FADI) (p=0.491), Pressure Algometer (p=0.828), Berg Balance Scale (BBS) (p=0.695) and Weight Bearing Dorsiflexion (WBD) (p=0.747). The most common fixations noted in this study, were mortise Long Axis Distraction (LAD), subtalar LAD and subtalar eversion. Conclusion: Therefore, motion palpation appears to be valid when used as a post-treatment tool in the foot and ankle; and overall, common fixations found in symptomatic participants with CAI in this study are similar to those found in previous studies.
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"Towards prevention of sport-related ankle sprain injury: from epidemiology study, aetiology and mechanism analysis, to the design of an intelligent sprain-free sports shoe." Thesis, 2008. http://library.cuhk.edu.hk/record=b6074602.
Full textAbstract:
After investigating the injury mechanism, this dissertation aims to design an intelligent sprain-free sports shoe for the prevention of sport-related ankle sprain injury. It consists of a three-step mechanism: (1) Sensing, (2) Identification, and (3) Correction. The progress of this dissertation covers two options of sensing and identification. The first option is to monitor the ankle spraining motion with the ankle inversion angle. A method to employ two tiny inertial and magnetic sensors at the shank and foot segment is adopted as the sensing system. A laboratory study is conducted to obtain ankle inversion magnitude and velocity during various sport motions. Together with the article kinematics reported in the accidental sprain case report, a standard for identifying ankle sprain is established. The second option is to monitor the ankle spraining motion with the ankle supination torque. A feasible method to estimate the complete ground reaction forces with the information from pressure insoles is presented. Then, a tiny in-shoe three-pressure-sensor system is devised to monitor the ankle supination torque during sport motions. With the information of failure torque at the ankle joint reported by previous cadaveric study, an identification system of the ankle supination torque is devised.Ankle sprain injury is the most common single type of sport-related musculoskeletal trauma which causes rupture and tear to the anterior talofibular ligament and ankle instability. In this dissertation, a new paradigm, "Orthopaedic Sport Biomechanics", is proposed to present the role of biomechanics in the practice of orthopaedics sports medicine, including the analysis of injury mechanism, and the design of prophylactic equipment for injury prevention. To directly investigate the injury, a case report of an accidental injury event in laboratory is presented. It was found that an internally rotated ankle orientation at foot strike may predispose the ankle joint to a supination sprain injury, by triggering lateral drift of the rearfoot and the subsequent vigorous inversion. At injury, the ankle joint reached an inversion of 48 degrees and an internal rotation of 10 degrees.
Future studies on the sensing and identification process, the correction, and the final evaluation are suggested. We hope that we could really invent the sprain-free shoe to help reducing the incidence of ankle sprain injury in sports in future.
Fong, Tik Pui Daniel.
Adviser: Kai-Ming Chan.
Source: Dissertation Abstracts International, Volume: 70-06, Section: B, page: 3635.
Thesis (Ph.D.)--Chinese University of Hong Kong, 2008.
Includes bibliographical references (leaves 102-127).
Electronic reproduction. Hong Kong : Chinese University of Hong Kong, [2012] System requirements: Adobe Acrobat Reader. Available via World Wide Web.
Electronic reproduction. [Ann Arbor, MI] : ProQuest Information and Learning, [200-] System requirements: Adobe Acrobat Reader. Available via World Wide Web.
Abstracts in English and Chinese.
School code: 1307.
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Harper, Shaun Michael. "The effectiveness of an ice pack, a menthol based cooling gel, a menthol based cooling gel with extracts and a placebo gel in the treatment of acute ankle sprain." Thesis, 2010. http://hdl.handle.net/10321/581.
Full textAbstract:
Dissertation submitted in partial compliance with the requirements for the Master's Degree in Technology: Chiropractic, Durban University of Technology, 2010.Cryotherapy is commonly used to decrease pain, swelling and disability in acute injury. The most common form traditionally used is ice packs, with menthol based cooling gels being increasingly used by physicians in place of ice. More recently companies are experimenting with adding herbs containing anti-inflammatory properties to these menthol based gels to enhance their effectiveness. There is a paucity of literature comparing different forms of cryotherapy to one another, and more experiments are necessary to determine if cooling gels containing menthol and cooling gels with menthol and anti-inflammatory herbs are comparable to that of conventional ice pack cryotherapy. Objectives To determine the relative effectiveness of an ice pack, a menthol based gel, a menthol based gel with herbal extracts (combination gel) and placebo gel in the treatment of an acute grade 1 or 2 inversion ankle sprains, in terms of subjective and objective measurements. Any adverse reactions were also noted. Method A placebo controlled randomised, single blinded clinical trial (n=48) was conducted. Participants were randomly allocated into one of the four groups. Each group consisted of 12 people between the ages of 18 and 45. Each participant had a case history, physical and ankle examination prior to being accepted to ensure that they met the inclusion and exclusion criteria. On the initial consultation the respective treatments were administered and participants were instructed on how to apply the gel or ice pack, which they were required to utilise at home three times per day for 3 days. Those receiving the gels were blinded as to which gel they were receiving, all gels looked and smelt the same. On the 4th day the participants returned for data collection and were instructed to stop using the treatment and return 7 days later for further data collection. Statistical analysis consisted of repeated measures of ANOVA and Bonferroni post hoc tests, with a p-value of <0.05 considered statistically significant. Results Intra-group and inter-group analysis showed that all four groups had statistically significant improvements in terms of subjective and objective measurements. The results of the study demonstrated that the effects produced by the two cooling gels containing menthol, are comparable with those of conventional/traditional ice pack cryotherapy in the treatment of acute grade 1 or 2 inversion ankle sprains. No adverse reactions were reported. Conclusion This study found that all four treatment interventions were effective and safe in treating acute grade 1 and 2 inversion ankle sprains, however the ice pack and both cooling gel groups appear to statistically significantly improve treatment outcomes at a similarly higher rate when compared to the placebo gel group.
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Parker, Alexandra. "The efficacy of the Graston technique instrument assisted soft tissue mobilization in the reduction of scar tissue in the management of chronic ankle instability syndrome following an ankle inversion sprain." Thesis, 2005. http://hdl.handle.net/10321/219.
Full textAbstract:
Thesis (M.Tech-:Chiropractic)-Dept. of Chiropractic, Durban Institute of Technology, 2005
xv, 121 leaves ; ill. ; 30 cmAccording to research, continuing symptoms of pain, instability, crepitus, weakness, stiffness (Pellow and Brantingham, 2001) and swelling (Patel and Warren, 1999:332) commonly follow an acute ankle sprain. The cause of these symptoms is often attributed to the development of a tight sensitive scar (Reid, 1992:251) within the injured ligament. The treatment options available include scar tissue debridement (Bassewitz and Shapiro, 1997), manipulation (Edmond, 1993:164), mobilization, (Hockenbury and Sammarco, 2001) and ultrasound (Thomson, Skinner & Piercy, 1991:43-44). Transverse friction massage could also be used to reduce adhesions (Kessler, 1990:85) and improve mobility of the tissues (Kessler, 1990:140). The Graston Technique Instrument Assisted Soft Tissue Mobilization (GTIASTM) comprises a set of stainless steel instruments (Carey 2003:2) designed to detect and reduce scar tissue and adhesions (Carey 2003:7) by bringing about an area of controlled microtrauma (Hammer, 2003(b):1) and inflammation (Carey 2003:32) through a mechanism similar to that of friction massage.
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Williams, Lisa Jane. "The inter-examiner reliability of motion palpation to detect joint dysfunction in hindfoot and midfoot joints." Thesis, 2010. http://hdl.handle.net/10321/519.
Full textAbstract:
Dissertation submitted in partial compliance with the requirements for the Masters Degree in Technology: Chiropractic, Durban University of Technology, 2010.The aim of this study was to determine the inter-examiner reliability of motion palpation to detect joint dysfunction in hindfoot and midfoot joints of asymptomatic feet and feet with chronic ankle instability syndrome. The rationale for this study was that motion palpation is a commonly used assessment tool that is used by the chiropractic profession to detect the need for manipulation of the spine and extremities. Also until the reliability of motion palpation is known, other studies using motion palpation as an assessment tool to detect the need for manipulation in the hindfoot and midfoot are questionable. The study was conducted at Durban University of Technology (DUT). Patients that responded to the adverts were then screened via telephonic interview. The researcher performed a case history, physical examination and a foot and ankle regional examination on each patient. Three masters chiropractic students then independently assessed both the symptomatic and asymptomatic feet of each patient and recorded their results. The data was then statistically analysed using SPSS version 15. It was found that the inter-examiner reliability of motion palpation for detecting restrictions in feet with chronic ankle instability syndrome was fair and for detecting instability, there was moderate reliability. In the asymptomatic group the examiners showed to have poor reliability in detecting restrictions and moderate reliability in detecting instability. Inter-examiner reliability was better in the symptomatic group and in this group examiners had more agreement on detecting instability as opposed to restrictions. This study has showed that inter-examiner reliability ranged from poor to moderate in the symptomatic and asymptomatic group with the reliability ranging from poor to moderate. Therefore, one can conclude that motion palpation can be used as an assessment tool to detect joint dysfunction in hindfoot and midfoot joints. However, further studies are warranted to address other subjective and objective measurements such as tenderness and range of motion together with motion palpation.
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Kahere, Morris. "The effectiveness of a myofascial treatment protocol combined with cryotherapy compared to cryotherapy alone in the treatment of acute and subacute ankle sprains." Thesis, 2017. http://hdl.handle.net/10321/2911.
Full textAbstract:
Submitted in partial fulfillment of the requirements for Master’s Degree in Technology: Chiropractic, Durban University of Technology, Durban, South Africa, 2017.Background: Ankle sprains are a frequently occurring injury sustained by sports individuals accounting for approximately 20% to 40% of all sports injuries (DiStefano et al. 2008; LeBrun and Krause, 2005). Ankle sprains are mainly caused by excessive inversion (Takao et al., 2005; Andersen et al., 2004), when the foot is twisted inwards and lands at a high velocity damaging the lateral capsule-ligamentous complex (Beynnon et al., 2005). According to Naqvi, Cunningham and Lynch (2012) untreated or inappropriately managed ankle sprains can lead to a cascade of negative alteration to both the joint structures and the individual’s lifestyle. According to Hale, Hertel and Olmsted-Kramer (2007) 30% of ankle sprains result in chronic ankle instability (CAI) and 78% of the CAI cases develop into post-traumatic ankle osteoarthritis. This poses a negative impact on an individual’s athletic performance. Ankle sprains can be managed conservatively with the utilization of the PRICE protocol during the acute stage, cross friction massage or instrument assisted soft tissue mobilization techniques (for example Graston®, FAKTR© Concept) for both acute and subacute ankle sprains (Bleakley, 2010). Aim: The purpose of this study was to determine the effectiveness of a myofascial treatment protocol (FAKTR© Concept) combined with cryotherapy compared to cryotherapy and sham laser in the treatment of sub-acute and acute ankle inversion sprains. Objectives: 1. To determine the effectiveness of a myofascial treatment protocol combined with cryotherapy in terms of subjective (numerical pain rating scale [NRS] and foot function index [FFI]) and objective (oedema measurements [EDM], digital inclinometer readings [DIR], algometer readings [AR] and stork balance stand test score [STR]) measurements in the treatment of acute and sub-acute ankle sprains. 2. To determine the effectiveness of sham laser combined with cryotherapy in terms of subjective (NRS and FFI) and objective (EDM, DIR, AR and STR) measurements in the treatment of acute and sub-acute ankle sprains. 3. To compare the relative improvement between the two groups in terms of subjective (NRS and FFI) and objective measurement (EDM, DIR, AR and STR). Study design: This was a quantitative randomised controlled clinical trial. Methods: Forty participants with sub-acute or acute ankle sprains of not more than three weeks were recruited into the study. All participants had a full case history, physical, and foot and ankle regional examination to assess for their eligibility for entry into the study in terms of inclusion and exclusion criteria. These participants were randomly allocated using the hat method into one of two study groups, Group A (treatment group) or Group B. Participants in Group A received a myofascial treatment protocol (FAKTR© Concept) combined with cryotherapy and Group B received cryotherapy and sham laser. These participants had four treatments in two weeks where the appropriate treatment was administered. Pre-treatment subjective (NRS and FFI) and objective (EDM, DIR, AR and STR) measurements were taken at each consultation. This data was analysed using SPSS software version 24.0. Results: The General Linear Model for repeated measures was used for the intra- group and inter-group analysis of the data. Intra-group analysis of the FAKTR© treatment group showed that the group had statistically significant improvements in terms of the subjective and objective measurements of the study with the p-value < 0.05 between all treatment periods. Intra-group analysis of the control group showed no statistically significant improvements in terms of subjective and objective measurements of the study. Inter-group analysis showed no statistically significant difference in terms of the DIR and EDM. The NRS, AR, STR and FFI readings showed statistically significant differences between the two groups with a p-value of < 0.05 mainly on the last two consultations. Conclusion: This study concluded that the myofascial treatment protocol (FAKTR© Concept) combined with cryotherapy was more effective than cryotherapy and sham laser in the treatment of sub-acute and acute inversion ankle sprains. The FAKTR© Concept treatment group appeared to show statistically significant improvements compared to the control group.
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Littleton, Susannah. "Outcomes in musculoskeletal injuries following road traffic crashes : an evaluation of an early intervention programme." Phd thesis, 2011. http://hdl.handle.net/1885/150200.
Full textAbstract:
Introduction
This thesis evaluates the effect of an early intervention programme on the physical and psychological health status of people with mild to moderate musculoskeletal injuries following road traffic crashes, and examines the influence of accident fault status and compensation claim status on recovery.
Methods
A sequential cohort of patients presenting to emergency departments in the Australian Capital Territory for treatment of mild to moderate musculoskeletal injuries sustained in road traffic crashes were recruited.
A control group of 95 patients received the usual care provided. An Intervention group of 98 patients were referred to a specialist clinic for assessment, during which an individualised, proactive rehabilitation plan was established.
Both physical and psychological health status were measured at baseline, six months and 12 months post-crash using the Short Form 36 (SF-36; Physical Component Score and Mental Component Score); the Hospital Anxiety and Depression Scale (HADS); and Functional Rating Index (FRI).
Three analyses were performed using the health outcome data obtained. Firstly, the influence of fault status on baseline physical and psychological health was evaluated by comparing the health outcomes scores of patients who caused the crash in which they were involved with scores from patients who were not at fault. Secondly, the effect of claiming compensation was evaluated for the control group by comparing SF-36, HADS and FRI scores between patients of the control group who had claimed compensation and those who did not claim compensation. Finally, the effect of the early intervention programme was evaluated by comparing health outcome scores of the control and intervention groups.
Results
Patients were enrolled a mean of 9.3 days following the crash. In the immediate post-crash period, the cohort was characterised by severe disability (FRI 55.5, SD 21.04), moderate levels of pain (pain intensity sub-scale of the FRI 2.0, SD 0.81) and high levels of anxiety (HADS-a9.1, SD 4.55).
Fault status had no effect on physical health; however, people that were not at fault had significantly worse psychological health at baseline as measured by SF-36 Mental Component Score.
Claiming compensation was associated with a worse SF-36 Physical Component Score, greater HADS-anxiety and worse FRI. Retention of a lawyer was significantly associated with a lower SF-36 Mental Component Score at 12 months.
The early intervention programme resulted in a statistically significant reduction in anxiety at 12 months. However, neither anxiety, nor any of the other measures of physical or psychological health were considered to be improved to a clinically significant level by the intervention.
Conclusion
Compensation status and psychological factors are independent determinants of longer term health following mild to moderate musculoskeletal injuries sustained in road traffic crashes. The early specialist assessment and proactive treatment planning implemented as part of this thesis, failed to improve health outcomes over usual care alone. Overall, recovery is influenced by both physical and psychological factors, and models of care need to address both of these components.
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Rudzki, Stephan J. "The cost of injury to the Australian army." Phd thesis, 2009. http://hdl.handle.net/1885/110379.
Full textAbstract:
This thesis is the first study to have determined a comprehensive estimate of the
cost of injury to the Australian Army. The approach used was that of a cost of illness
study, which summarised the economic burden of injury and provides information for
stakeholders, allowing them to make informed decisions on the allocation of scarce
healthcare resources. Cost of illness (COI) studies serve a different purpose to that of
health economic evaluations which are focused on evaluating the cost of an
intervention rather than estimating the cost of a particular disease. A "top down"
approach to analysis was adopted utilising high level organisational databases to obtain
cost data. This thesis adopted the primary perspective of government, but also
considered costs from a societal and individual perspective.
Estimating the economic burden of injury in a defined population is dependant
on the availability of data of sufficient quality and scope, which is often lacking. This
was the case in this thesis where available datasets contained data of poor quality or
insufficient detail to provide accurate injury cost data. A number of assumptions were
required in order to develop estimates of the contribution of injury to different sources
of cost. There is a clear requirement for Defence to improve it injury surveillance and
introduce an electronic health record to facilitate this. Efforts must also be made to link
clinical data with cost data to better inform decision makers about the relative benefits
achieved from the considerable cost resulting from injury.
The cost of injury has three components; direct costs; indirect costs; and
intangible costs. Direct costs considered in this analysis included external medical and
compensation costs, as well as compensation liabilities calculated by the Australian
Government Actuary. Indirect costs included productivity losses, with invalid pensions
also included because they constitute a significant cost to Government not usually
included in (COI) studies. An additional analysis of the net present value of lost wages
was conducted on those soldiers who were invalided from the Army. A novel approach,
termed the Capital Investment Model, was used to estimate the loss of training
investment as a result of premature separation from the Army due to injury. Intangible
costs were not included in this study because of the difficulty in placing a monetary
value on these aspects of injury.
Direct injury costs in 1996 were estimated to be between $40.75 and $42.36M
with outstanding compensation liabilities of $270M. Indirect costs were estimated to be
$10.74M with invalid pension liabilities of $63.82M. Capital losses due to premature
separation from the Army due to injury were estimated to be $10.1 OM. The total cost of
injury to the Australian Army (in 1996 dollars) was estimated to be between $61.59M
and $63.20M, with estimated pension and compensation liabilities of $333.82M. Injury
causes a significant financial impost.
This is also the first study to compare the cost and outcomes of a range of spinal
surgical procedures reflective of general orthopaedic community practice. It adopted a
"bottom up" approach to analysis, where detailed data was obtained from individual
records and a patient survey. This allowed for outcome and cost analysis by subgroup.
A number of findings were consistent with the literature, in particular the dissociation
between pain score and functional capacity. Increasing complexity of surgical
intervention increased costs with no improvement in clinical outcome and alarming levels of radiological exposure was found. Radiation exposure could not be compared
to other studies as they did not report the distribution of radiological investigations. The
decision to undergo surgery appears to be based on the baseline level of pain and the
fear of it worsening rather than specific clinical indications. The use of effective nonoperative
methods of reducing pain offers the prospect of significantly reducing the
patient demand for surgery and its attendant cost.
The greatest injury-related cost savings from a societal perspective are obtained
from interventions that promote early return to work and minimize lost productivity.
Preventing an injury prevents the associated cost, so efforts in the area of injury
prevention are critical in reducing the burden of injury. The significant reduction in
injury observed from the Defence Injury Prevention Program highlights the benefit of
effective primary prevention programs. Equally, once an injury occurs, secondary
prevention efforts seek to achieve maximum restoration of function with minimal
morbidity and cost. The results of the spinal surgery study have shown that
improvement in primary outcome measures are not effect by the cost of the chosen
intervention and efforts to achieve pain relief through non-operative means,in order to
prevent surgical intervention, should be a high priority for research, not just in Army
but in the broader community.
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Botes, Jacques Andre. "The effect of four different manipulative techniques on Iliotibial Band Friction Syndrome (ITBFS) in terms of primary and secondary outcome measures." Thesis, 2016. http://hdl.handle.net/10321/1626.
Full textAbstract:
Submitted in partial compliance with the requirements for the Master’s Degree in Technology: Chiropractic, Durban University of Technology, Durban, South Africa, 2016.Background: Iliotibial band friction syndrome is a common dysfunction seen in athletes. Athletes develop biomechanical changes yet still continue with their sport. However, this syndrome limits their ability to participate at peak performance. This study determined which participants benefitted in terms of biomechanical and clinical outcomes in one of four groups: ankle joint, superior tibio-fibular joint, sacroiliac joint or a combination manipulation group (which contained any two of the three joint restrictions). Methods: This Durban University of Technology Institutional Research and Ethics Committee approved prospective clinical trial, utilised stratified sampling, with 48 participants across four groups: ankle (14); superior tibio-fibular (11), sacroiliac (12) and combination (11). The participants underwent six treatments in three weeks. Data collection occurred before consultations one, three, five and seven. The data included primary measures of the knee score questionnaire (KSQ), the algometer, the visual analogue scale (VAS) and the secondary measures of the Feiss line, the heel leg alignment, bilateral leg length, Q angle and tibio-femoral angle. All data was computed utilising the ANOVA testing, with a p-value <0.05 being significant and a 95% confidence interval. Pearson’s correlations were completed for intragroup associations between primary and secondary outcome measures. Results: The intragroup analysis revealed that all groups had significant changes in the KSQ and VAS, with the exception of the sacroiliac joint manipulation group (KSQ outcome not significant). Intergroup analysis revealed no differences between the groups with the exception of the combination group, which showed a significant increase in the tibio-femoral angle. Most commonly, the Pearson’s correlation revealed that changes in leg length were related to differences in primary outcome measures, irrespective of the group being tested. Conclusion: The outcomes of this study indicated that manipulation of the distal kinematic chain improved alignment and clinical outcomes to a greater degree than manipulating proximal restrictions. It is suggested with caution (due to limited sample size) that patients should first have their distal kinematic chain manipulated before more proximal joints are manipulated to achieve better outcomes.
M
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Dollard, Joanne. "Comparative optimism about falling amongst community-dwelling older South Australians: a mixed methods approach." 2009. http://hdl.handle.net/2440/55404.
Full textAbstract:
People aged ≥65 years (older people) have a higher chance of falling than other age groups. However, based on qualitative research, older people do not believe that falls prevention information and strategies have personal relevance. This suggests that older people believe that falls are more likely to happen to other older people than themselves, that is, they might be comparatively optimistic about their chance of falling. It is important to understand comparative optimism about falling as it is a consistent reason given by older people for not participating in falls prevention activity. This thesis used a mixed methods design with a sequential strategy to investigate community-dwelling older people's comparative optimism about falling. Three studies were undertaken, using semi-structured interviews, cognitive interviews and telephone interviews to collect data. The semi-structured interview study, guided by the tenets of grounded theory, aimed to develop an explanation of why older people might be comparatively optimistic. A sampling frame (age, sex and direct and indirect history of falling) was used to guide recruiting respondents. Older people (N = 9) were interviewed about their chance and other older people's chance of falling. Interviews were analysed using the constant comparison method. The cognitive interview study investigated potential problems in survey items in order to refine them for the telephone interview study. Items were developed to measure older people's comparative optimism about falling. Older people (N = 13) were cognitively interviewed, and interviews were content analysed. The telephone interview study aimed to determine whether older people were comparatively optimistic about falling, and whether the direct and indirect experience of falling was associated with comparative optimism. A random sample of older people (N = 389) living in South Australia were telephone interviewed (response rate = 75%). The semi-structured interview study identified that it was a 'threat to identity' for respondents to say they had a chance of falling because of intrinsic risk factors. Respondents used strategies to maintain or protect their identity when discussing their chance of falling in the future or their reasons for falling in the past. In the cognitive interview study, respondents reported difficulty in rating their chance of falling, as they believed falls were unexpected and unpredictable. They reported difficulty in rating other people's chance of falling, as they believed they did not know other people their age, did not have enough information and/or did not know the answer. In the telephone interview study, most respondents believed they had the same chance (42%), or a lower chance (48%) of falling in the next 12 months, than other older people. Having fallen in the last 12 months was significantly associated with a lowered comparative optimism, but knowing other older people who had fallen was not associated with comparative optimism. This is the first quantitative study to report that the majority of a representative sample of community-dwelling older people were comparatively optimistic about their chance of falling. Self-presentation concerns about having a chance of falling support the core category to emerge from the semi-structured interview study. Messages such as 'you can reduce your risk of falls' may be ignored by older people. Alternative messages should promote identities that are relevant to older people, such as being independent, mobile and active, but these messages should be tested in further research.http://proxy.library.adelaide.edu.au/login?url= http://library.adelaide.edu.au/cgi-bin/Pwebrecon.cgi?BBID=1374964
Thesis (Ph.D.) - University of Adelaide, School of Psychology and School of Population Health and Clinical Practice, 2009