Dissertations / Theses on the topic 'Foot 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.

Research shows that up to 80% of recreational skiers have lower limb alignments which can impede their ability to turn their skis properly (Subotnick,1982). The most difficult of these alignment problems to control within a ski-boot is the varus alignment of the subtalar joint (Macintyre and Matheson, 1988). The use of custom molded footbeds made specifically for use inside of ski boots has been suggested as one method of compensating for a varus aligned foot. This study compared the effectiveness of one brand of custom molded ski boot footbed with that of a noncustom insole in controlling the motions of the lower limb associated with subtalar varus. Specifically these motions were those of the rearfoot and the navicular tubercle, along with the alignment of the tibial tuberosity with respect to the mid-line of the ski boot. In addition, subjects were given the opportunity to assess their subjective feelings of edge control, pain, and fatigue while skiing with both the custom molded footbeds and non-custom insoles. The subject group for this study consisted of 13 advanced level adult skiers who demonstrated more than three degrees of subtalar varus when non-weight bearing. Each subject received a pair of custom molded ski boot footbeds at the beginning of the study. Ski boots that had been cut away at the rear and the medial side were used in the laboratory in order to observe the motions of the navicular tubercle and the rearfoot as the subject transferred their weight in a simulated skiing motion. The right and left navicular tubercle, tibial tubercle, and the insertion of the Achilles at the calcaneus of each subject were located by palpation and marked. After sufficient practice of the weight transfer motion, two trials of each landmark were photographed using 35mm slide film. The subjects were first photographed while using the non-custom insoles and again using the custom molded footbeds. The slides were digitized and comparisons were made between the two types of insoles for both the start and end locations of the landmarks as well as for the ranges of motion through which the landmarks traveled. Statistical analyses of the group results indicated that there was significantly less (p=0.000) navicular motion during the shift from the start to the end positions with the use of the custom molded footbeds as compared to the non-custom insoles. The rearfoot angle was significantly less at both the start (p=0.000) and end (p=0.000) positions with the use of the custom footbeds as compared to the noncustom insoles. There was no statistical difference between the amount of rearfoot motion allowed by either type of insole. The tibial tubercle was positioned significantly (p=0.000) closer to the mid-line of the ski boot when using the custom footbeds than with the use of the non-custom insoles. These results indicate that the custom footbeds domaintain the subtalar joint in a more neutral position than do non-custom insoles. During the skiing section of the study the subjects rated the custom footbeds as providing better edge control (p=0.000) and resulting in less fatigue (p=0.000) than noncustom insoles. There was no statistical significance when comparing the ratings given by the group for the level of pain experienced with the use of either type of insole. There was a statistically significant improvement (p=0.000) in race times for the group when using the custom footbeds as compared to the non-custom insoles. The results of this study indicate that custom molded ski boot footbeds are able to control subtalar motion more effectively than a non-custom insole. It appears that this control of subtalar motion enhances the skiing experience by increasing edge control and reducing the amount of fatigue experienced.
Education, Faculty of
Curriculum and Pedagogy (EDCP), Department of
Graduate

This was a holistic study. Four themes were investigated to demonstrate the effectiveness of orthotic intervention for plantar ulceration affecting leprosy impaired subjects in India. 1. Efficacy Efficacy was demonstrated, primarily, through analysis of data pertaining to a controlled trial. Thirty-seven subjects, presenting with leprosy impairments including anaesthesia and plantar ulceration, were fitted with orthoses and allocated to an experimental group. Thirty-four similar subjects, were not offered orthoses and were allocated to a control group. After 8 months 52% of the ulcers presented by Experimental group and 12% of the ulcers presented by the Control group had healed. The rationale supporting the prescription of orthoses was investigated using the EMED system. It was demonstrated that intervention with orthoses resulted in significantly lower sub pedal peak pressures than intervention with leprosy sandals. 2. Implementation and Sustain ability Ulcer assessment data from March 1994 to January 1995 were used to compare the effects of orthoses supplied by the investigator with orthoses supplied by an Indian technician. The service, evaluated on the strength of these findings, was considered to have been successfully implemented. The analysis of data, collected from January 1995 to December 1995, was used to explain why the service was not sustained at an acceptable level. 3. Acceptability Interview data were analysed to describe the attitudes of the subjects to the intervention (n = 46). Indications from the analysis were that neither ulcer status (healed or unresolved) nor group allocation (Experimental or Control) affected attitudes towards the intervention. A general indication was that the intervention was favourably endorsed. 4. Appropriateness Using the Delphi technique (n = 10), a consensus on indicators of "appropriate" impairment control measures was sought. Differences of opinion were not resolved, but group priorities were ranked and a polled response was recorded. The results of the study were similar to the criteria suggested by the Delphi contributors.

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.

Dissertação de Mestrado em Ciência do Desporto, área de especialização em Treino de Alto Rendimento Desportivo, apresentada à Faculdade de Ciências do Desporto e de Educação Física da Universidade do Porto

Dissertação de Mestrado em Ciência do Desporto, área de especialização em Treino de Alto Rendimento Desportivo, apresentada à Faculdade de Ciências do Desporto e de Educação Física da Universidade do Porto

CNPq
O tratamento e cuidados com úlceras de pé diabético é uma questão de saúde pública. As técnicas atuais utilizadas para o acompanhamento do processo de cicatrização de úlceras abertas são baseadas principalmente em medidas aproximadas da área da ferida e envolvem contato direto, o que representa riscos de contaminação para o paciente. Neste trabalho é proposto o uso de técnicas de visão computacional para medir não apenas a área, mas o volume de úlceras abertas, fornecendo informação objetiva sobre o processo de cicatrização para os médicos, evitando contato direto com a ferida durante o procedimento de medição. A técnica proposta envolve a aquisição de uma sequência de imagens da ferida com iluminação estruturada usando um laser de baixa potência em linha, seguida de reconstrução da profundidade a partir da geometria do dispositivo de aquisição. É identificada a região da ferida de forma semiautomática e construída uma superfície fictícia do que seria a pele natural para servir de base para o cálculo do volume, que corresponde à quantidade de tecido faltante. Experimentos controlados ex-vivo utilizando um modelo de borracha de um Pé Diabético e um joelho de porco com uma ferida artificial representando a pele humana demonstram a viabilidade da técnica proposta.
Treatment and follow-up of Diabetic Foot ulcers is a major public health issue. Current techniques used for following up the healing process of open ulcers are mostly based on approximate area measurements of the wound and involve direct contact, which poses risks of contamination for the patient. This work proposes the use of computer vision techniques to measure not just the area, but the volume of open ulcers, providing additional objective information about the healing process to physicians while avoiding direct contact with the wound during the measurement procedure. The proposed technique involves acquiring a sequence of images of the wound with structured illumination using a low-power laser beam line, followed by depth reconstruction from the geometry of the acquisition device. The wound region is identified in a semi-automatic way and a fictitious surface of what would be the normal skin surface is then used to compute the volume, which corresponds to the missing amount of tissue. Controlled ex-vivo experiments using a rubber model of a Diabetic Foot and a knuckle of pork with an artificial wound representing the human skin demonstrate the viability of the proposed technique.
5000

Plantar fasciitis is the most common disorder of the foot and is characterised by pain involving the inferomedial aspect of the heel that is exacerbated by activity after periods of non-weightbearing. Despite an abundance of anecdotal evidence indicating that aberrant function of the foot is an aetiological factor in the development of plantar heel pain, there is little scientific evidence linking abnormal arch mechanics with plantar fasciitis. The primary purpose of this thesis was to investigate the biomechanics of plantar fasciitis by evaluating the sagittal plane kinematics and kinetics of the medial longitudinal arch during gait. Specifically, a low-dose motion X-ray technique, known as digital fluoroscopy, was used to evaluate the sagittal plane kinematics of the arch and a capacitance-based pressure plate was used to determine regional vertical ground reaction forces acting on the sole of the foot during gait. Since digital fluoroscopy has not been widely used in gait analysis, the methodological phase of this study concentrated on identifying and quantifying the inherent limitations and potential errors in employing fluoroscopy as a gait analysis technique. In particular, the methodological phase evaluated the potential impact of the physical restrictions of the equipment on gait and the acquisition of gait data, as well as the magnitude of the distortion errors inherent in fluoroscopic images of the medial longitudinal arch. The findings indicate that digital fluoroscopy may be effectively used as a two-dimensional motion analysis technique for the evaluation of movement of the medial longitudinal arch during walking. The methodological studies demonstrate that the structural limitations of modem fluoroscopic systems are unlikely to substantially influence the acquisition of gait data. However, out-ofplane motion of osseous segments of the foot and the temporal response of the imaging system represent the major shortcomings of employing fluoroscopy as a gait analysis tool. Tests conducted on foot models and in vivo indicated that the application of published dist01iion correction procedures provided a method that is highly repeatable, with fluoroscopic image enors constituting less than 5 percent of the movement range. In the experimental phase of this thesis, a digital fluoroscope and a pressure platform were used to evaluate the kinematics and kinetics of the medial longitudinal arch in people with and without plantar fasciitis. While pressure analysis demonstrated that patients with plantar fasciitis make gait adjustments that reduce the level of force beneath the rearfoot and forefoot of the symptomatic foot, fluoroscopy indicated that neither the dynamic shape nor the motion of the medial longitudinal arch differed between subjects with and without heel pain. Consequently, abnonnal arch shape and motion are not associated with the progression of plantar fasciitis. The peak arch angle was, however, positively correlated to the increased fascial thickness that was prototypic of plantar fasciitis. Thus, arch mechanics may play an important secondary role in plantar fasciitis by modifying the severity of heel pain, once present. In addition, increased loading and flexion of the digits was observed in patients with heel pain, suggesting that digital function plays an important, and previously unidentified, protective role in plantar fasciitis by bracing the medial longitudinal arch and thereby reducing the loading in the plantar fascia. The findings also suggest that plantar fasciitis may represent a bilateral process and raise questions regarding the rationale behind current treatments aimed at modifying the mechanics of the medial longitudinal arch in heel pain.

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.

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

Thesis (M.Tech.: Chiropractic)-Dept. of Chiropractic, Durban Institute of Technology, 2005 xiv, 99 leaves
Plantar Fasciitis (PF), also called ‘the painful heel syndrome’, is a common cause of heel pain (Barrett and O’Malley, 1999:2200), accounting for between 7% and 10% of all running injuries (Batt and Tanji, 1995:77; Chandler and Kibler, 1993:345). Primarily an overuse injury, resulting from tensile overload, it involves inflammation and micro-tears of the plantar fascia at its insertion on the calcaneus (Lillegard and Rucker, 1993:168; Barrett and O’Malley, 1999:2200). The body’s attempt to heal these micro-tears leads to chronic inflammation and the formation of adhesions (Ambrosius and Kondracki, 1992:30). Transverse friction massage has been found to be beneficial in the treatment of PF (Hyde and Gengenbach, 1997:478,481; Hertling and Kessler, 1996:137). Cyriax (1984) and Prentice (1994) state the effect of frictions to include the breakdown of adhesions (scar tissue), as well as preventing the formation of further adhesions. Graston Technique Instrument-assisted Soft Tissue Mobilisation (GISTM), based on the principles of frictions, aims to break down adhesions, realign collagen fibres and aid in the completion of the inflammatory process (Carey-Loghmani, 2003:31, 51-62; Hammer, 2001). Enabling us to see changes on ultrasonography, which has been found to be an objective, non-invasive way of evaluating PF (Wall and Harkness, 1993:468; Tsai et al, 2000:259; Cardinal et al, 1996:258). These changes include decreased thickness of the fascia. The aim of the study was to see the effect of GISTM on PF in runners, in terms of ultrasonography, and identify any correlation between these findings and other objective and subjective findings.

Submitted in partial compliance with the requirements for the Master’s Degree in Technology: Chiropractic, Department of Chiropractic, Faculty of Health Sciences, Durban University of Technology, Durban, South Africa. 2015.
Background: Plantar fasciitis (PF) is inflammation of the plantar surface of the foot, usually at the calcaneal attachment and is most commonly due to overuse. It is the most common foot condition treated by healthcare providers. Conservative treatment using taping is one of the first lines of treatment for PF. Low-Dye taping and Kinesio taping are two types of taping techniques commonly used to treat PF. Low-Dye taping and Kinesio taping have different intrinsic tape properties as well as different mechanisms of action in the treatment of PF. Low-Dye taping involves the use of a non-stretch, rigid tape. Rigid tape is commonly used by therapists primarily for the mechanical properties the tape provides to support the injured structure as well as to protect against re-injury. Low-Dye taping shortens the distance between origin and insertion of the plantar musculature and fascia, decreasing stress and tensile forces along the plantar plate to protect the plantar fascia and allow healing to occur. Kinesio tape is an elastic tape that allows a one-way longitudinal stretch; it is applied in a specific manner to achieve its therapeutic effects and forms convolutions on the skin. The proposed mechanism of action of Kinesio tape involves improving circulation of blood and lymphatics to resolve oedema caused by the inflammatory component of PF; suppressing pain, and; relieving muscle tension to return fascia and muscle functioning to normal. Both forms of tape have shown effectiveness in the treatment of PF; however the effectiveness of one taping technique versus the other has not yet been explored. Objectives: The purpose of this study was to determine the effectiveness of Kinesio tape alone versus Low-Dye tape alone in the treatment of PF in terms of both objective and subjective measures. Methods: Thirty participants with a diagnosis of PF, between the ages of 20 and 45, were randomly allocated into two treatment groups. Both groups received treatment in the form of a taping technique, either Kinesio tape or Low-Dye tape. Assessments were made pre-treatment at each visit and at a follow up visit, with seven visits in total. Assessments included objective data measures (ultrasonography, algometer readings, weight-bearing ankle dorsiflexion measurements) and subjective measures (the visual analogue scale and the foot function index questionnaire). Data was recorded in a data collection sheet and Statistical Package for the Social Sciences version 21 was used to analyze the data with a p value of < 0.05 considered as being statistically significant. Results: Most outcomes showed a significant improvement over time regardless of which form of treatment they received. For the VAS and pain walking outside, in the disability section of the FFI, there was statistical evidence of the Kinesio tape group improving more than the Low-Dye tape group. For morning pain, in the pain section of the FFI, and pain climbing curbs, in the disability section of the FFI, there was statistical evidence of the Low-Dye tape group improving more than the Kinesio tape group. For all the other outcomes there was a non-significant trend towards the Low-Dye tape group showing a greater improvement than the Kinesio tape group. Conclusion: Kinesio taping and Low-Dye taping were both found to be effective in the treatment of PF with neither form of tape showing superiority to the other in the treatment of PF.

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.

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

Lower extremity injuries in running based team sports are extensive and debilitating. No studies to date have examined the contribution of lower limb comfort in preventing and or managing injuries. Objectives: Address one of the most common issues in professional football; the high incidence of lower extremity injury by examining the relation between lower limb comfort, injury and performance.