Dissertations / Theses on the topic 'Back Wounds and injuries Australia'

Doctor of Philosophy
The 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.

The purpose of this study was to use EMG data of the erector spinae muscles synchronized with three-dimensional video techniques to determine the body's responses to asymmetric lifting under weight belt conditions. The subjects performed static maximum voluntary exertions and dynamic lifts from 0° and 45° from the midline of the body. Three weight belt conditions were used. EMG data revealed significant differences in EMG variables with belt conditions. Weight belt use decreased burst area, peak voltage, and maximum frequency. Kinematic data indicated a significant difference in the left knee and left and right elbow range of motion when the type of lift, symmetric or asymmetric, was considered. Lifting technique also produced a significant effect on the maximum and minimum velocity of the center of mass. The results of the study indicate that weight belt use is an effective means of reducing spinal compression and thus may be helpful in preventing low back injury.
School of Physical Education

Back injury has predominantly been a problem which has affected a large cross-section of nursing staff involved with direct patient care. While back injury prevention has been instituted in hospitals for sometime, the percentage of nurses with back injury remains high. Within a major teaching hospital, a ward in which nurses suffered a high rate of back injuries was identified. Through an action research approach the researcher (who worked in the same area as the participants) developed and implemented an individualized back injury prevention programme. The 4 criteria by which the study was measured included, a reduction of back injuries, worth of the programme, behavioural change and cognitive knowledge acquisition. The participants who were involved in the study demonstrated that individual back education has a positive effect upon reducing the injury rate of nurses' back injuries. The study also describes the importance of maintaining good communication skills and co-operation with the people involved or whose behaviour is being changed. Social Learning Theory was the framework from which the design and implementation of teaching was derived.

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.

Lower Back Disorders account for 16-19% of work related claims and 33-41% of dollars paid in workers? compensation (as cited in Marras, 1999), with impacts to society approaching $100 billion dollars annually (as cited in Marras et al., 1999). Dr. William Marras engineered a device to track trunk kinematics in order to develop a Job Risk Classification Model for predicting high-risk group probability of lower back injury. The device has been validated, but other technologies such as 3-D motion capture can potentially gather the same data. This study examined the use of motion capture to apply two- and three-plane lifting tasks to the Marras model and compare results with commonly used assessment techniques. Regardless of the fact that the Marras model results were drastically different from NIOSH and RULA, motion capture was able to gather all necessary data for running the models and has a promising future in ergonomic assessments.

Thesis (MScPhysio)--Stellenbosch University, 2015.
ENGLISH ABSTRACT: Aims: To assess the effect of a chair and computer screen height adjustment on the neck and upper back musculoskeletal symptoms in an office worker. Methods: An N=1 study was conducted using the ABC design. Ethics approval was obtained for the study and the participant provided informed written consent. The participant was assessed over three four week phases as she performed her habitual computer work. The outcome measures assessed during the three phases were the pain intensity and perceived sitting comfort. The three phases were named the baseline, intervention and wash-out phases. During the baseline phase, the outcome measures were obtained at the participant‟s habitual work station. The intervention phase involved a vertical adjustment of the chair and computer screen height. The wash-out phase allowed the participant to adjust the chair and computer screen height to their choice. A follow-up interview was conducted with the participant three months after completion of the study. The mean values and the ranges of the pain intensity and perceived comfort were obtained and compared. The data collected was captured on a Microsoft Excel 2010 spread sheet, where after the data was tabulated and presented graphically. Results: The mean pain intensity of the participant increased slightly during the intervention phase in comparison to the baseline phase, but remained stable during the wash-out phase. The mean perceived sitting comfort deteriorated initially during the intervention phase, but improved later during the intervention phase and showed greater improvement during the wash out phase. The perceived sitting comfort showed more improvement than the pain intensity during the washout phase. Both the pain intensity and perceived sitting comfort showed improvement at the three months follow up assessment, post completion of the study. Conclusion: The vertical height adjustment of the chair and the VDT did not improve the participant‟s pain intensity and perceived sitting comfort when compared to the participant‟s habitual workstation parameters. The findings do not favour the horizontal viewing angle. The findings of this study however support the use of „slightly below horizontal‟ viewing angle as being conducive to reduce the pain intensity and improve the sitting comfort of an office worker.
AFRIKAANSE OPSOMMING: Doelstelling: Om die effek te bepaal van die hoogte aanpassing van die stoel en rekenaarskerm op die nek en bo-rug muskuloskeletale simptome van 'n kantoorwerker. Metodes: „n N=1 studie was uitgevoer deur gebruik te maak van die ABC ontwerp. Etiese goedkeuring was verkry vir die studie en die deelnemer het ingeligte skriftelike toestemming verleen. Die deelnemer was ge-evalueer oor drie vier week-lange fases terwyl sy haar gewone rekenaarwerk verrig het. Die uitkomsmetings ge-evalueer tydens die drie fases was pyn intensiteit en waargenome sitgemak. Die drie fases was genoem die basislyn, intervensie en uitwas fases. Gedurende die basislyn fase was die uitkomsmetings by die deelnemer se gewone werkstasie ingevorder. Die intervensie fase het 'n vertikale aanpassing van die stoel en rekenaarskerm behels. Die uitwas fase het die deelnemer toegelaat om haar stoel en rekenaarskerm se hoogte aan te pas volgens haar keuse. 'n Opvolg onderhoud was gevoer met die deelnemer drie maande na die voltooiing van die studie. Die resultate was vasgelê op 'n Microsoft Excel 2010 data bladsy, waarna die data getabuleer en grafies uitgebeeld is. Resultate: Die gemiddelde pyn intensiteit van die deelnermer het effens toegeneem tydens die intervensie fase in vergelyking met die basislyn fase, maar het stabiel gebly tydens die uitwas fase. Die gemiddelde waargenome sitgemak het aanvanklik verswak tydens die intervensie fase, maar het later verbeter tydens die intervensie fase en het aangehou verbeter tydens die uitwas fase. Die waargenome sitgemak het groter verbetering getoon as die pyn intensiteit tydens die uitwas fase. Beide pyn intensiteit en waargenome sitgemak het verbetering getoon by die drie maande opvolg evaluasie, na voltooiing van die studie. Gevolgtrekking. Die vertikale hoogte aanpassing van die stoel en rekenaarskerm het nie die deelnemer se pyn intensiteit en waargenome sitgemak in vergelyking met die deelnemer se gewone werkstasie parameters verbeter nie. Hierdie bevindinge is nie ten voordeel van die horisontale kykhoek nie. Nietemin, ondersteun die bevindinge van hierdie studie die gebruik van die "effens onder die horisontale" kykhoek as bevorderend om die pyn intensiteit te verminder en die sitgemak van 'n kantoorwerker te verbeter.

Thesis (MScPhysio)--Stellenbosch University, 2015.
ENGLISH ABSTRACT: Aims: To assess the effect of a vertical height adjustment of the chair and visual display unit (VDU) on work related upper quadrant musculoskeletal pain (WRUQMP) and sitting comfort in computer users. The upper quadrant refers to the occiput, cervical and upper thoracic spine including the clavicles and scapulae. Methods: An N=1 study was conducted using the ABC design whereby an ergonomic workstation adjustment, of VDU and chair height, was compared to the subject’s usual workstation settings. Pain and sitting comfort were measured using visual analogue scales (VAS). The subject was assessed over the four week phases as she performed her typical VDU work. The results were compiled and tabulated. Results: Both the mean and variance in pain intensity decreased after the workstation intervention. A deterioration was noted in sitting comfort. Conclusion: The vertical height adjustment of the chair and VDU may have contributed to a decrease in WRUQMP in this subject. This safe, economical workstation intervention may be a practical management option for the computer user suffering from WRUQMP. Further research into the measurement of comfort whilst sitting at a computer workstation, is recommended.
AFRIKAANSE OPSOMMING: Doelwitte: Om die effek te bepaal van n vertikale aanpassing van die stoel en beeldskerm van rekenaargebruikers op werksverwandte boonste kwadrant muskuloskeletale pyn en sitgemak. Die boonste kwadrant verwys na die oksiput, servikale en boonste torakale werwelkolom en sluit ook die klavikel en skapula in. Methode: Die N=1 studie is onderneem met gebruik van die ABC ontwerp in terme waarvan n ergonomiese aanpassing van stoel en beeldskerm vergelyk is met die normale gebruik van die deelnemer. Pyn en sitgemak is gemeet deur die gebruik van die Visueel analoogskaal. Die interwensies is ge-evalueer oor vierweekfases tydens normale rekenaar gebruik van die deelnemer. Die resultate is saamgestel en getabuleer. Uitkoms: Beide die gemiddelde en veranderlike pynintensiteit het verminder nadat die werkstasie aangepas is. Geen verbetering in sitgemak is opgemerk nie. Gevolgtrekking: Die vertikale hoogte-aanpassing van die stoel en beeldskerm het moontlik bygedra tot die verminderde pynvlakke in hierdie deelnemer. Hierdie veilige, ekonomiese verstelling is moontlik n praktiese beheeropsie vir rekenaargebruikers wat werksverwandte boonste kwadrant muskuloskeletale pyn verduur. Verder studie in die meet en waarneming van sitgemak tydens rekenaarwerk is nodig.

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.

Submitted in partial compliance with the requirements for the Master’s Degree in Technology: Chiropractic, Durban University of Technology, Durban, South Africa, 2018.
Background: Chronic non-specific low back pain (CNSLBP) is a common ailment treated by chiropractors. Most chiropractors focus on the localised lumbar area of pain. Other chiropractors focus on restoring function to compensating articulations in the ‗full kinematic chain‘ by assessing and treating the lower extremity in conjunction to the low back. Patients with LBP often exhibit decreased hip-related ranges of motion that may result in future LBP, relapse and a prolonged recovery time. Studies investigating the effect of treating the kinematic chain in relation to LBP are limited and the literature, although widely taught and practiced, is largely anecdotal. Chiropractic manipulation has shown to be effective in the treatment of LBP and many lower extremity conditions. Objectives: This study set out to determine if a combination of low back and hip manipulation would result in a more beneficial outcome for the participant, suffering with CNSLBP, than low back manipulation alone in terms of objective and subjective outcomes. Method: The study was a randomised controlled clinical trial which, through purposive sampling, consisted of 50 participants with CNSLBP and hip joint dysfunction. The participants were randomly divided into two groups of 25 each [A and B]. Group A received low back manipulation alone and Group B received combined low back and hip manipulation. Subjective data was obtained through the Oswestry Low Back Pain Disability Index (ODI) and the Numerical Pain Rating Scale (NPRS). Objective data was obtained through the use of a Force Dial Algometer and an Inclinometer. Data collection occurred at the first, third and fifth consultations and was coded and analysed using IBM SPSS version 24.0. A p-value value of less than 0.05 was considered to be statistically relevant. Results: Intra-group testing showed that there was a significant difference over time, within both groups, with regards to internal rotation and external rotation of the hip, flexion of the lumbar spine, increased pain tolerance in Algometer tests, decreased NPRS values and decreased ODI scores. Within Group A, the mean scores for hip flexion reflected a more significant increase over time than those of Group B. Within Group B, the mean scores for left and right rotation of the lumbar spine reflected a more significant change over time than those of Group A. Inter-group testing showed no significantly differential treatment effect for any of the subjective and objective outcomes. This means that both treatments were equally effective and the hypothesis, that suggested that Group B would improve more than Group A, was incorrect. Conclusion: Both treatment groups improved subjectively and objectively with regards to CNSLBP. Inter-group testing showed that statistically, and for all outcome measurements, there were no significant differences between the two treatment group‘s results. This suggested that there was no additional benefit in combining hip joint manipulation with low back manipulation in the treatment of CNSLBP.
M

Dissertation submitted in partial compliance with the requirements for the Master’s Degree in Technology: Chiropractic, Durban University of Technology, 2009.
Manual therapists are susceptible to occupational low back pain. The aim of this study was to determine the prevalence and risk factors for occupational low back pain in manual therapists and to determine and compare the prevalence and risk factors for occupational low back pain among various types of manual therapists in South Africa. This study was conducted as a cross-sectional survey and a self-administered questionnaire, developed from the literature and validated prior to the study, was mailed to 1500 randomly selected manual therapists, including: physiotherapists, occupational therapists, biokineticists, chiropractors, reflexologists, aromatherapists and massage therapists. A total of 233 completed questionnaires were returned, giving a response rate of 15.53%. Results revealed that the point prevalence of low back pain in manual therapists was very high at 41%, the one-year prevalence was 59% and the career prevalence was 74%. The point prevalence of low back pain was highest in aromatherapists and biokineticists, while both the one-year and career prevalence of low back pain was highest in occupational therapists and massage therapists. The risk factors for low back pain in manual therapists were: BMI; previous abdominal surgery; previous trauma to the low back, hips, knees or ankles; a physically stressful job; not having an assistant and work in a hospital or other setting. In keeping with the literature, various workrelated factors were implicated in the development and / or exacerbation of low back pain in certain manual therapists more than others and low back pain history in the different manual therapists was also in accordance with the literature. To conclude, low back pain is prevalent among South African manual therapists and the development and implementation of preventative programs to reduce rates of occupational low back pain in manual therapists is mandatory.

Firefighting is a very hazardous profession. Firefighters experience an injury rate that is three times higher than other physically demanding professions and the death rate in the fire service is also much higher compared to typical. Throughout the literature, data suggest the physical nature of firefighting contributes to the high incidence of injury and death among firefighters. As such, special interest groups and firefighting organizations advocate for firefighters to exercise and stay fit in order to safeguard their physical health. Yet, despite these efforts, firefighters still experience a very high incidence of back injuries and heart attacks which can lead to early retirement from disability or death. In the first aim of this dissertation, we examined the relationships between specific back fitness tests and history of back injuries in 113 firefighters in an effort to understand which fitness tests may aid in screening firefighters for risk of back injury. We found that a test of lumbar extension flexibility was associated with a higher incidence of back injuries among our sample (p<0.01). In the second aim of the study, we investigated whether perceived fitness was related to history of back injuries since firefighters’ perceptions of their fitness level may direct how they choose to perform job tasks that pose high risk for injury. Within the same sample of firefighters, we found that perceived fitness was not related to history of back injuries nor was the relationship between actual fitness and history of back injuries mediated by perceived fitness. However, perceived fitness correlated with scores on our back strength (r=0.28; p=0.003) and hamstring strength (r=0.21; p=0.03) tests. In the third aim of the dissertation, we sought to develop a treadmill walking protocol to screen firefighters for low aerobic capacity which is a major risk factor for heart attack. Thirty-eight male firefighters wore a vest weighing 20% of their body weight and performed a walking VO2max test in which the treadmill grade increased by 1% each minute. The predicted VO2max from this walking test was very accurate; within a standard error of the estimate of 3.2 ml/kg/min. This new (Moore) protocol requires only a standard treadmill and is more job specific than a running test. In conclusion, more research needs to be conducted to understand how firefighters’ perceived fitness directs their behaviors when performing job tasks and how high levels of fitness can protect against back injuries and heart attacks in firefighters. This dissertation has contributed to the development of screening protocols to aid in preventing these adverse events.
Graduation date: 2013

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.

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.

Submitted in fulfillment of the requirements for the Master’s Degree in Technology: Chiropractic, Durban University of Technology, Durban, South Africa, 2017.
Mid-back pain (mbp) is defined as pain occurring within the limits of the third thoracic (T3) and ninth thoracic (T9) vertebrae, caused by the dysfunction of the musculoskeletal structures in the thoracic spine. It can present as pain and/ burning between the shoulder blades with reduced thoracic spine mobility and increased muscle tension. Congenital disorders such as scoliosis and Scheuermann’s disease, or acquired disorders such as thoracic facet and costovertebral joint dysfunction may cause mbp. The thoracic facet and costovertebral joints are similar in anatomy and share a mutually dependent biomechanical relationship. There were a handful of controlled studies that highlighted the effectiveness of thoracic facet manipulation on mbp, but there were none on the effects of costovertebral manipulation on mbp. Objectives The aim of this study was to investigate the immediate effects of the combination of thoracic facet and costovertebral joint manipulation on mbp in terms of pain perception, pressure pain thresholds (PPT) and thoracic spine range of motion (ROM). Design A prospective single-blind randomised comparative clinical trial. Setting This study was conducted in a university setting at the Durban University of Technology Chiropractic Day Clinic Participants Fifty participants were recruited via responses to advertisements placed around the Durban University of Technology (DUT) campuses and individuals presenting at the Chiropractic Day Clinic (CDC). Intervention The participants were divided into two groups of twenty-five. Group A received the thoracic facet joint manipulations and Group B received a combination of the thoracic facet and costovertebral joint manipulations. Outcome measures All subjective and objective measurements were taken before and after the application of the manipulations. Pain perception i.e. subjective measurement) was measured by the Numerical Pain Rating Scale (NPRS), pressure pain thresholds (PPT) (i.e. objective measurement) were measured by the Wagner’s FDK Force Gage Algometer and thoracic spine range of motion (ROM) i.e. objective measurement was measured by the Saunders Digital Inclinometer. Results The data was analyzed using the latest version of SPSS and a p-value = 0.05 was used to determine statistical significance. Descriptive statistics in the form of univariate analysis described the data in terms of measures of central tendency and measures of dispersion. Data that was distributed normally was analyzed using the t-test and ANOVA. Data that was distributed abnormally was analyzed using the non-parametric Wilcoxon ranked and Mann Whitney tests. Nominal and ordinal data was analyzed using the Chi squared test. The results of the intra-group analysis indicated a statistically significant decrease in pain perception (p ≤ 0.000), increase in PPT (p ≤ 0.05) and decrease in thoracic spine ROM (p ≤ 0.000). However, the results for the inter-group analysis indicate there was no statistically significant difference in pain perception (p = 0.386), PPT (p > 0.05) and thoracic spine ROM (p >0.05) between Group A and Group B. Conclusions These results showed that the combination of thoracic facet and costovertebral joint manipulation was as effective as thoracic facet joint manipulation alone, in the treatment of mbp. These findings suggested that manipulation of the costovertebral joints may not be necessary for the effective treatment of mbp.
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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, 2016.
Background: Musculoskeletal disorders (MSDs) are a significant and common occupational health concern, consequently impacting work attendance and performance. High prevalence rates of MSDs have been reported amongst school teachers. Studies have linked these higher prevalence rates to typical daily teaching activities including prolonged standing, awkward postures, heavy lifting, bending and repetitive movements. Objectives: To determine the prevalence of neck, shoulder and low back pain among primary school teachers in the Central Durban area; to identify any risk factors associated with neck, shoulder and low back pain; and to establish the relationship, if any, between the prevalence and risk factors of neck, shoulder and low back pain among primary school teachers. Methods: This was a quantitative, descriptive and cross-sectional study, conducted in 12 selected public primary schools within the Central Durban area. Volunteers who met the inclusion criteria (n = 97) were invited to complete self-administered questionnaires. Results: Of the 97 completed questionnaires 83.1 percent (%) reported neck and shoulder pain and 71.0% low back pain. Neck and shoulder pain were significantly associated with a forward-bent head posture (p = 0.001), ethnicity (p = 0.001), and history of a severe trauma/injury (p = 0.006). Similarly, significant associations were noted with regards to medical conditions (p = 0.006), a backward-bent head posture (p = 0.016), lifting of heavy loads (p = 0.045) and treatment for severe injury (p = 0.047). Associations were also noted between low back pain and prolonged standing (p = 0.000), ethnicity (p = 0.008), transportation methods (p = 0.023), medical conditions (p = 0.031) and a history of a severe trauma/injury (p = 0.049). Conclusion: This is a first South African study, to our knowledge that highlights increased prevalence rates for both neck and shoulder pain and low back pain amongst teachers, with a variety of associated risk factors. This draws attention to the urgent need for intervention programs to be implemented to prevent/reduce the development of musculoskeletal pain amongst teachers.
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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.
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Thesis (Ph.D.) - University of Adelaide, School of Psychology and School of Population Health and Clinical Practice, 2009

Dissertation submitted in partial compliance with the requirements for the Masters Degree in Technology: Chiropractic, Durban University of Technology, 2010.
Background: Low back pain (LBP) is the most prevalent musculoskeletal condition experienced by human beings and the most common cause of disability in developed nations. Psychosocial factors, involving aspects of social and psychological behaviour, have previously been documented as potential risk factors in the development of adult LBP. However, more research is required to fully understand the role of psychosocial risk factors on the prevalence of LBP amongst adolescents. Objective: To determine the prevalence of LBP and to identify selected psychosocial risk factors associated with LBP amongst Grade 12 learners in the Greater Durban area. Methods: A population-based study was conducted amongst a stratified random sample of 20 public secondary schools in all three educational districts in the Greater Durban area. Data was collected by means of a structured questionnaire administered to the sample population consisting of Grade 12 learners. Using an exploratory research design, the individuals reported on demographics as well as prevalence, severity, frequency and chronicity of LBP. In addition, data was obtained regarding various psychosocial risk factors including depression, exam stress and anxiety, socio-economic status, family history of LBP, smoking, alcohol and drug abuse amongst the respondents. Results: The prevalence of LBP was 57.42% with a median frequency of 8 times a month. About a third (33.9%) of the respondents experienced difficulty bending whilst 35% reported that their LBP spread down to the legs below their knees. The daily activity most affected by LBP was having a good night‟s sleep (50.6%), followed closely by playing sports (47.4%) and concentrating in class (46.6%). The majority of the respondents that suffered from LBP had taken pain relief medication (47.1%) whilst only 21% of the respondents had missed school because of LBP. With regards to the psychosocial risk factors under investigation, three of the risk factors did not show any association to LBP. They included socio-economic status, smoking and recreational drug use. In contrast, five psychosocial risk factors showed an 6 association to LBP. They included alcohol abuse, family history, exam stress, anxiety and depression. Finally, after adjusting for all other risk factors for adolescent LBP, depression and high exam stress showed the strongest correlation with the occurrence of LBP amongst Grade 12 learners in the Greater Durban area. Conclusion: LBP amongst adolescents is a common problem that increases with age, representing a risk for LBP in adulthood. The researcher is of the opinion, that this illustrates the need for further investigations with more profound studies on the risk factors so that more light can be shed on how to manage this ever-growing problem.