Дисертації з теми "Leg Wounds and injuries Australia"

The purpose of this study was to determine the vastus medialis oblique muscular electromyographical (EMG) activity during two therapeutic exercises: the modified straight leg raise and the traditional straight leg raise. Two subject groups of 10 subjects each, one with anterior knee pain (PHY) and the other group with no history of patellofemoral pathology (NORM), performed the traditional straight leg raise (SLR) and a modified straight leg raise with external hip rotation (MOD). Each subject performed an isometric maximum voluntary contraction and three trials of each of the two therapeutic exercises. The EMG variables analyzed were the percent of the maximum voluntary contraction for each muscle, vastus medialis oblique, vastus lateralis, and rectus femoris: the percent of the maximum voluntary contraction of the ratio between the vastus medialis oblique and the vastus lateralis; the percent of the maximum voluntary contraction for the integrated EMG for each muscle; and the percent of the maximum voluntary contraction for the root mean square for each muscle. The statistical analysis was conducted with two-way analysis of variance procedures. The statistical analysis revealed no significant differences; however, the data appeared to illustrate a trend toward more electromyographical activity in the vastus medialis oblique in the PHY subject group during the MOD therapeutic exercise. This suggests that the MOD therapeutic exercise may be able to isolate the vastus medialis oblique muscle in persons with anterior knee pain and allow them to regain strength and normal function earlier than with the use of the SLR therapeutic exercise.
School of Physical Education

The sample included 29 healthy competitive male distance runners. Bilateral measurements were taken for selected variables of the talocalcaneal flexibility by means of a mechanical goniometer, and of the peak isokinetic knee strength on a Cybex II device. The frontal and horizontal plane motions of the lower limbs of the subjects were recorded by high speed filming and videotaping while they were running on a motor driven treadmill at their training pace under two conditions: with running shoes and barefoot. A detailed description of each runner's history was obtained and bilateral dominance characteristics were determined. Significant functional asymmetries were found for subtalar joint flexibility (eversion, inversion, and eversion/inversion ratio) and peak isokinetic knee strength (flexion, extension, total, and flexion/extension ratio). Significant kinematic asymmetries were revealed during the foot support phase in lower leg angle, rearfoot angle, mediolateral velocity of the foot, and in some temporal parameters. The two running conditions differed significantly only for the pretouchdown phase of support. Significant trends of association were identified between selected components of the lower limb functional and kinematical asymmetries which were characterized by consistent laterality patterns. Multivariate asymmetry components and running injury patterns were independent. Only asymmetries in foot pronation during barefoot running tended to significantly differentiate between runners grouped by injury incidence. The phenomenon of functional and kinematic asymmetries in runners is warranted.

Running injuries were compared between twenty four middle distance (800 metress) and forty four marathon runners of elite status in Queensland, Australia. All runners were interviewed individually on their injury history and possible associations. The runners were biomechanically examined to assess their foot type which were categorised as either pes planus, pes cavus or normal. Anthropometric and body mass index measurements indicated that the middle distance athletes were lighter in weight and taller than the marathon runners (p < 0.01). Cavoid foot type occurred in 50% of runners, with significantly more occurring in marathon runners ( 61. 4%) than middle distance runners (18.2%). The runners linked injuries mainly to hard or uneven terrains, overtraining, and insufficient rest after an injury. Common injuries suffered by marathon runners were mainly back problems, hip ailments and sciatica. Common injuries to middle distance runners were mainly knee problems, stress farctures and sciatica. Marathon runners incurred more injuries than the middle distance runners (97% compared to 81.8%) which was statistically significant and the injuries suffered were different.

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.

Thesis (MScPhysio)--Stellenbosch University, 2014.
ENGLISH ABSTRACT: Introduction: Groin injuries are among the top six injuries in contact sports and may lead to career ending chronic pain. Research on the role of knee kinematics in developing chronic groin pain in sport is scarce. Objective: The purpose of this study was to determine if there are differences in knee kinematics during a single-leg drop-landing in sports participants with chronic groin pain compared to asymptomatic controls. Methodology: A descriptive study was conducted. Twenty active sports’ participants were recruited from soccer and rugby clubs situated around the Cape Peninsula area, Western Cape, South Africa. The three-dimensional (3D) knee kinematics of ten cases with chronic groin pain and ten asymptomatic controls was analysed. Knee kinematics was analysed in the FNB-3D Vicon Laboratory at Stellenbosch University, using an eight camera Vicon system. A positive adductor squeeze test was used as a diagnostic test to include cases with chronic groin pain. Each participant performed six single-leg drop landings. The main outcome measure was 3D knee kinematics at initial foot contact and at the lowest vertical position of the drop landing. The following sub-groups were analysed: seven unilateral groin pain cases compared to their seven matched controls; three bilateral groin pain cases where their most painful leg and least painful leg were compared to their matched controls, respectively. Descriptive statistical techniques were used for all outcome measures; means and standard deviations (SD) were calculated, followed by a Student’s t-test to determine significant differences between the cases and controls. For all outcomes with p-values equal to or below 0.05, the effect size was calculated using the Cohen’s D. Results: The findings of this study indicated a significant difference (p=0.0001) between cases with unilateral groin pain having less knee internal rotation compared to the controls at the lowest vertical position of the drop landing in the transverse plane. Significantly less internal rotation (p<0.0001), was also noted in the cases with bilateral groin pain (in the most painful leg and the less painful leg), although this was noted at foot contact. Cases with bilateral groin pain also had significantly (p<0.001) more knee varus (adduction) during the landing phase. Conclusion: Differences in knee kinematics between sports participants with chronic groin pain and asymptomatic controls were found. These findings imply that the knee joint should be included during assessment and rehabilitation of individuals suffering with chronic groin pain. Due to the cross-sectional study design of the current study, it cannot be stated for certain whether the knee kinematics noted in the groin pain group are causative or as a result of groin pain. Future prospective studies are thus recommended; these studies should focus on the effect of contralateral knee kinematics on the hip adductors and may include exploration of the muscular components during a single-leg drop landing.
AFRIKAANSE OPSOMMING: Inleiding: Lies beserings is een van die top ses beserings in kontak sport en kan lei tot chroniese lies pyn en selfs die be-eindigging van ‘n sportloopbaan. Navorsing oor die rol van knie kinematika in die ontwikkeling van chroniese liesbeserings in sport is skaars. Doelwit: Die doel van hierdie studie was om te bepaal of daar verskille in die knie kinematika is tydens 'n enkel been val landing in sport deelnemers met chroniese lies pyn in vergelyking met gesonde kontroles. Metode: 'n Beskrywende studie was uitgevoer. Twintig aktiewe sport deelnemers is gewerf van rugby en sokker sportklubs geleë rondom die Kaapse Skiereiland, Wes-Kaap, Suid-Afrika. Die 3D knie kinematika van tien gevalle met chroniese lies pyn en tien asimptomatiese bypassende kontroles is ontleed. Knie kinematika was ontleed in die FNB-3D Vicon Laboratorium by die Universiteit van Stellenbosch, met behulp van 'n agt-kamera Vicon stelsel. 'n Positiewe Adduktor druk toets was gebruik as 'n diagnostiese toets om gevalle met chroniese lies pyn in te sluit. Om die knie kinematika te analiseer, het elke deelnemer ses enkel been val landings uitgevoer . Die belangrikste uitkomsmeting was 3D knie kinematika by die aanvanklike voet kontak en by die laagste vertikale posisie van die enkel-been val landing. Die volgende sub-groepe was ontleed: sewe unilaterale lies pyn gevalle in vergelyking met hul sewe bypassende kontroles; drie bilaterale lies pyn gevalle waar hul mees pynlike been, sowel as minder pynlike been onderskeidelik vergelyk was met hul bypassende kontroles. Beskrywende statistiese tegnieke was gebruik vir alle uitkoms maatreëls; gemiddeldes en standaardafwykings (SA) was bereken, gevolg deur 'n Studente’s t-toets om beduidende verskille tussen die gevalle en kontroles te bepaal. Vir al die uitkomste met p-waardes gelyk of onder 0.05, is die effekgrootte bereken deur die Cohen’s D. Resultate: Die bevindings van hierdie studie dui op 'n beduidende verskil (p=0,0001) tussen gevalle met unilaterale lies pyn met minder interne knie rotasie in vergelyking met die kontroles by die laagste vertikale posisie van die val landing in die dwars vlak. Aansienlik minder interne rotasie (p<0,0001), is ook opgemerk in gevalle met bilaterale lies pyn (in die mees pynlike been en die minder pynlik been), alhoewel tydens voet kontak. Gevalle met bilaterale lies pyn het ook betekenisvol (p <0.001) meer knie varus (adduksie) tydens die landingsfase gehad. Gevolgtrekking: Verskille bestaan in die knie kinematika tussen sport deelnemers met chroniese liesbesering pyn en gesonde kontroles. Hierdie bevindinge impliseer dat die knie behoort ingesluit te word tydens die assessering en rehabilitasie van individue met chroniese lies pyn. As gevolg van die deursnee-studie ontwerp van hierdie studie, kan dit nie bevestig word of die knie kinematika die oorsaak van die chroniese pyn is nie. Toekomstige voornemende studies word dus aanbeveel, hierdie studies moet fokus op die effek van die kinematika van die kontralaterale knie op die heup adduktore en kan moontlik die ondersoek van die spier kinetika tydens hierdie aktiwiteit insluit.

Thesis (MScPhysio)--Stellenbosch University, 2014.
ENGLISH ABSTRACT: Introduction: Chronic groin injuries are common among athletes and have the potential to lead to chronic and career-ending pain. There is no evidence available whether pelvic kinematics can be perceived as a risk factor in developing chronic groin pain in sport or be the cause of further injuries of the lower quadrant or lumbar spine. Objective: The purpose of this study was to determine if there are any differences in pelvic kinematics of active sports participants with chronic groin pain compared to healthy controls during a single-leg drop-landing. Methodology: A descriptive study was conducted. The three-dimensional (3D) pelvic kinematics of ten cases with chronic groin pain and ten asymptomatic controls was analyzed. Pelvic kinematics was analyzed at the FNB 3D Vicon Laboratory at Stellenbosch University using an eight camera Vicon system. A physical examination, including functional movements, posture analysis, hip, knee and ankle passive range of motion measurements, sacro-iliac tests and anthropometric measurements was done by two physiotherapists prior to the 3D analysis. To analyze the pelvic kinematics, each participant performed six single-leg drop-landings. The main outcome measure was 3D pelvic kinematics at initial foot contact (IFC) and foot contact at lowest vertical position (LVP). The following sub-groups were analyzed: seven with unilateral groin pain and three with bilateral groin pain; the latter was further divided into those with the most painful leg and the least painful leg. Mean and standard deviations (SD) for pelvic kinematics were calculated and significant differences between sub-groups were determined using two-tailed Student’s t-tests. The Cohen’s D effect size calculator was used to calculate the effect size of significant differences in pelvic kinematics between case and control groups. Results: The findings indicated a significant difference (p=0.03) in frontal plane pelvic kinematics at IFC for the unilateral group. The most painful groin group showed significant differences at IFC (p=0.004) and at LVP (p=0.04) in the frontal plane pelvic kinematics. The least painful groin group showed a significant difference at LVP (p=0.01). All cases landed with pelvic downward lateral tilt during the landing phase compared to matched controls. The groin pain group with bilateral pain showed significant differences at IFC (p < 0.001) and LVP (p=0.005) for the most painful groin; and the least painful groin at IFC (p=0.01) and LVP (p=0.01) in the sagittal plane pelvic kinematics. The bilateral groin pain group showed an increase of anterior pelvic tilt in the sagittal plane during the landing phase when compared to matched controls. Increased internal pelvic rotation in the transverse plane was significant for the unilateral group at IFC (p=0.04) and for the most painful groin group at IFC (p < 0.001) and LVP (p < 0.001) compared to matched controls. Conclusion: Results from this study shows that pelvic kinematic changes in the frontal, sagittal and transverse planes do occur in patients with chronic groin pain when compared to controls. This may imply that muscle weakness around the hip and pelvis may contribute to the development of chronic groin pain in active sports participants. Rehabilitation of these muscles should be taken into consideration when treating patients with chronic groin injuries. Further research should be focused on muscular recruitment patterns in sports participants with groin pain to critically define the muscular causal factors in more depth.
AFRIKAANSE OPSOMMING: Inleiding: Kroniese lies beserings is ‘n algemene verskynsel onder die aktiewe sport populasie. Dit mag tot kroniese pyn lei en het die potensiaal om ‘n sport loopbaan te be-eindig. Tans, is daar geen verdere navorsing beskikbaar oor die invloed van bekken kinematika op onderste ledemaat beserings asook die moontlike oorsaak tot kroniese lies pyn in atlete nie. Oogmerk: Die doel van hierdie studie was om vas te stel watter verskille in die bekken kinematika ontstaan tussen aktiewe sport deelnemers met kroniese lies pyn teenoor aktiewe sport deelnemers sonder enige pyn of beserings tydens ‘n enkel been aftrap beweging. Metodologie: Tien deelnemers met kroniese lies pyn en tien asimptomatiese deelnemers is gebruik om die verskille tussen die 3D bekken kinematika te bepaal. Die FNB 3D Vicon Lab by die Stellenbosch Universiteit is gebruik vir die data analise en insameling. Deelnemers het ‘n fisiese ondersoek ondergaan wat die voglende ingesluit het: funksionele bewegings, postuur analise, omvang van beweging van die heup, knie en enkel, toetse ter uitsluiting van die ilio-sakrale gewrig asook antropometriese aftmetings. Elke deelnemer is versoek om ses enkel-been aftrap sessies te doen. Die hoof uitkomsmeting was die bekken hoeke in the frontale vlak by inisiële voet kontak (IVK) asook die voet kontak teen die laagste vertikale posisie (LVP). Resultate: Die resultate wys ’n beduidende verskil (p=0.03) in die frontale vlak vir bekken kinematika by IVK vir die unilaterale groep. Die mees geaffekteerde been wys ’n beduidende verskil by IVK (p=0.004) en by LVK (p=0.04) in die frontale vlak vir bekken kinematika. Die groep met die minste geaffekteerde been toon ’n beduidende verskil by LVP (p=0.01). Alle simptomatiese deelnemers het met die bekken in afwaartse bekken kanteling geland tydens die landings fase. Die groep met bilaterale pyn toon ’n beduidende verskil by IVK (p < 0.001) en by LVP (p=0.005) vir die mees geaffekteerde been en vir die minste geaffekteerde been by IVK (p=0.01) en LVP (0.01) in die sagittale vlak vir bekken kinematika. Die bilaterale groep met kroniese lies pyn land met meer anterior bekken kanteling in die sagittale vlak gedurende die landings fase teenoor die asimptomatiese groep. Interne bekken rotasie was beduidend meer vir die unilaterale groep by IVK (p=0.04) en vir die mees geaffekteerde been by IVK (p < 0.001) en LVP (p < 0.001) teenoor asimptomatiese deelnemers. Gevolgtrekking: Die resultate van hierdie studie bewys dat daar wel ‘n verskil is in die bekken kinematika van deelnemers met kroniese lies pyn teenoor asimptomatiese deelnemers. Hierdie verskille is waarneembaar in die frontale, sagittale en transverse vlakke. Dit impliseer dat spier swakheid van die bekken en heup spiere ‘n bydrae mag he tot die ontwikkeling van kroniese lies beserings in atlete. Rehabilitasie van bogenoemde spiere is belangrik in die behandeling van kroniese lies beserings. Verdere navorsing oor spier aktiverings patrone in aktiewe, sports deelnemers met kroniese lies pyn word benodig, om die oorsprongs faktore te ondersoek.

Thesis (MScPhysio)--Stellenbosch University, 2014.
ENGLISH ABSTRACT: Aims: This study aims to ascertain if there are differences in ankle kinematics and ground reaction force in sports participants with chronic groin pain compared to healthy controls. Methods: A cross sectional descriptive study design was used. Twenty participants - 10 cases with chronic groin pain and 10 healthy controls participated. The 10 cases included participants with unilateral pain (n=7) and bilateral pain (n=3). For analysis, the bilateral pain group was divided into the most and less painful side. The study was conducted at the FNB 3D Motion Analysis Laboratory, Stellenbosch University. Sagittal plane kinematics and VGRF was analysed during a single leg drop landing. Results: The group with unilateral groin pain had a higher peak force compared to the matched side of the controls. The bilateral pain groups had less plantarflexion at foot contact (most affected p=<0.001; least affected p=<0.001) and total range of motion (p=<0.05) compared to the control group. The bilaterally injured groin pain groups demonstrated less peak force when compared to controls. Conclusion: This is the first study to indicate alterations in ankle kinematics and VGRF and that these changes are more apparent in sports participants with bilateral pain. Less range of motion during the landing task illustrated by the bilateral pain group suggests less effective force absorption of the distal segments. In the bilateral groups it suggests that force attenuation may have occurred high up the kinetic chain which may place more strain on the groin. Clinically rehabilitation of the athlete with chronic groin pain should include the distal segments of the lower limb. Further research should be conducted in larger groups.
AFRIKAANSE OPSOMMING: Doelstellings: Hierdie studie poog om vas te stel of daar verskille in enkelbeweging en grondvloer-reaksiekrag is in deelnemers van sport met chroniese liespyn in vergelyking met gesonde kontrole deelnemers. Metode: ‘n Deursnee beskrywende studieontwerp is gebruik. Twintig deelnemers, 10 gevalle met chroniese liespyn en 10 gesonde kontrole het deelgeneem. Die 10 gevalle het ingesluit deelnemers met eensydige pyn (n=7) en bilaterale pyn (n=3). Vir die analise, is die bilaterale pyngroep verdeel in die mees en mins geaffekteerde kant. Die studie is gedoen by die FNB3D Beweginsanalise-laboratorium, Universiteit van Stellenbosch. Sagitaal-platvlak kinematiek en vertikale reaksiekrag is geanaliseer gedurende ‘n enkele beenlanding. Resultate: Die groep met eensydige liespyn het ‘n hoër piekkrag gehad in vergelyking met dieselfde kant van die kontrolegroep. Die bilaterale pyngroep het minder plantaarfleksie met voetkontak getoon (mees geaffekteer p=<0.001; minste geaffekteer p=<0.001) en totale beweginsomvang (p=<0.05) in vergelyking met die kontrolegroep. Die bilateraal-liesbeseringsgroep het minder piekkrag getoon in vergelyking met die kontrolegroep. Gevolgtrekking: Hierdie is die eerste studie om veranderings in enkelbeweging en grondreaksiekrag aan te toon, asook dat hierdie veranderinge meer opvallend is in persone wat aan sport deelneem wat bilaterale pyn ondervind. Verminderde beweginsomvang gedurende die landingstaak deur die bilaterale pyngroep suggereer minder effektiewe kragabsorpsie van die distale segmente. In die bilaterale groep suggereer dit dat kragvermindering waarskynlik hoog op die kinematiese ketting voorgekom het wat weer meer stremming op die lies plaas. Kliniese rehabilitasie van die atleet met chroniese pyn behoort die distale segmente van die onderste ledemaat in te sluit. Verdere navorsing behoort in groter groepe uitgevoer te word.

The purpose of this study was to determine the effectiveness of a modified sitting position straight leg raise on vastus medialis oblique (VMO) strength and EMG activity as compared to a traditional straight leg raise. A total of twenty-three subjects were recruited for this study. The subjects were randomly assigned to one of the following groups: (group I) modified straight leg raise (MSLR), and (group II) straight leg raise (SLR). The exercise program was three weeks long. University procedures for the protection of human subjects were followed. The subjects began with a 5 minute warm-up on a Cybex stationary bike set at 90 revolutions / minute. The subject then had electrodes placed on the Vastus Lateralis (VL) and Vastus Medialis Oblique (VMO). A Macintosh computer was used to record the EMG data. The subject then performed a standard Cybex test for knee flexion and extension. The Cybex dynamometer was placed at the knee joint line, the chair back tilt was at 85 degrees, the hip, chest, and thigh restraints were all fastened. The subjects in group I (Modified sitting SLR) and II (SLR) then returned the next day for their first rehabilitation lesson. Each subject group then participated in their respected exercise program for a total of three weeks. After three weeks of rehabilitation, the subjects retested using the same procedures followed in the pretest. A two tailed t-test was used to determine significance of the difference between means of the two groups. No significant differences were found between the two groups.
School of Physical Education

Thesis (MScPhysio)--Stellenbosch University, 2014.
ENGLISH ABSTRACT: Introduction-Groin injuries are among the top six most cited injuries in soccer and account for 10-18 per cent of all injuries reported in contact sport. Groin pain can result from a variety of pathologies, but according to literature, 63 per cent of groin pain is due to adductor pathology. Objective-The objective of this study was to explore if there are kinematic differences in the hip joint in sports participants with groin pain compared to matched healthy controls. Study design A cross sectional, descriptive study was conducted. Study setting-The study was conducted at the FNB -3D motion analysis laboratory at the University of Stellenbosch, South Africa. Outcome variables-The dependent variables included hip kinematics in the sagittal, frontal and transverse planes at foot strike, lowest vertical point of the pelvis and total range of hip motion during a single leg drop landing. Methodology-The study sample comprised 20 male club level soccer-and, rugby players, running and cycling participants between the ages of 18-55 years of age. Ten of the subjects had chronic groin pain and the other ten were healthy matched controls. An eight-camera Vicon system was used to analyse the kinematics of the hip joint during single leg drop landing. For the purpose of comparison, the data was analysed for participants with unilateral groin pain and matched controls (n=14) and participants with bilateral groin pain and controls (n=6). The full set of data was subdivided for analysis into three distinct sub-groups. Unilaterally injured groin cases (n=7) were matched with seven healthy controls for analysis. Bilaterally injured groin cases (n=3) were matched with three healthy controls. Results-Cases with unilateral groin pain at initial contact had significantly more abduction of the hip joint when compared to controls (p<0.05). The effect size of this difference was large (0.94). Cases with unilateral groin pain also demonstrated greater hip internal rotation while the controls had external rotation (p<0.05) during a drop landing activity. Bilaterally injured groin cases landed with significantly (p=?) greater ranges of hip flexion as well as in significantly (p=?) more hip abduction during a drop landing activity. They also demonstrated greater total range of motion in the frontal plan when compared to controls. Groin pain cases overall demonstrated greater ranges of motion and tended to land in more abduction compared to controls. Conclusion-This study found that during a single leg drop landing, sports participants with unilateral chronic groin pain landed with significantly greater hip abduction and exhibited larger total range of motion in the transverse plane, which may indicate impaired stability of the hip complex when compared to controls.
AFRIKAANSE OPSOMMING: Inleiding-Liesbeserings is een van die top ses mees prominente sokker beserings. Dit beloop 10-18 persent van alle beserings wat in kontaksport aangemeld word. Liespyn kan die gevolg wees van ‘n verskeidenheid patologië, maar volgens die literatuur is 63 persent van liespyn as gevolg adduktor patologie. Doelwitte-Die doelwit van hierdie studie was om ondersoek in te stel of daar enige kinematiese veranderinge in die heupgewrig is in spelers met liespyn in vergelyking met dieselfde vergelykbare spelers sonder liespyn. Studie Ontwerp-‘n Deursnit, beskrywende studie was onderneem. Studie Omgewing-Die studie was uitgevoer by die FNB-3D bewegingsanalise laboratorium van die Stellenbosch Universiteit, Suid-Afrika. Uitkomsveranderlikes-Die afhanklike veranderlikes het in gesluit die heup kinematika in die sagitale, frontale en transvers vlakke met voet kontak endie laagste vertikale punt van die pelvis sowel as die totale heup omvang van beweging gedurende een been landing. Metodologie-Die studie populasie het bestaan uit 20 manlike sokker- en, rugbyspelers, hardlopers en fietsryers tussen die ouderdomme van 18 en 55 jaar. Tien van die deelnemers het kroniese liespyn gehad en die ander tien in die gelyke gesonde groep was sonder liespyn. Die agt kamera Vicon sisteem was gebruik om die kinematika van die heupgewrig te analseer tydens een been landing. Vir die doel om ‘n vergelyking te kan maak, was die data geanaliseer van deelnemers met unilaterale liespyn en die vergelykende groep sonder liespyn (n=14) en deelnemers met bilaterale liespyn en hulle vergelykende groep sonder liespyn (n=6).. Die volledige stel data was onderverdeel in drie afsonderlike sub groepe. Vir die analiese was unilaterale liesbeserings (n=7) vergelyk met sewe deelnemers sonder liespyn in die kontrolegroep. Deelnemers met bilaterale liesbeserings (n=3) was vergelyk met drie in die kontrolegroep. Resultate-Die deelnemers met unilaterale liespyn het met eerste kontak beduidend meer abduksie van die heupgewrig gehad in vergelyking met die kontrolegroep (p<0.05). Die effek van hierdie verskil was groot (0.94). Die deelnemers met unilaterale liespyn het ook ‘n grooter interne rotasie getoon, terwyl die kontrole groep meer eksterne rotasie gedemonstreer het (p<0.05) met landing. Deelnemers met bilaterale liespyn het beduidend (p=?) meer heup fleksie en abduksie omvang van beweging tydens landing. Hulle het ook ‘n groter totale heup omvang van beweging in die frontale vlak gehad in vergelyking met die kontrolegroep. Deelnemers met liespyn het oor die algemeen ‘n grooter omvang van beweging getoon, en was geneig om met meer abduksie van die heup te land as die kontrolegroep. Gevolgtrekking-Die studie toon dat deelnemers met kroniese unilaterale liespyn, tydens een been landing, beduidende meerheup abduksie toon en dat die heup in die transverse vlak meer totale omvang van beweging gebruik wat kan dui op onstabiliteit in die heupkompleks in vergelyking met die kontrolegroep.

Thesis (MScPhysio)--Stellenbosch University, 2014.
ENGLISH ABSTRACT: Chronic groin pain is widespread across many sporting disciplines. The aim of our research was to determine if there are kinematic differences of the thoracic spine in active sports people with chronic groin pain, compared with healthy controls. A cross-sectional descriptive design was followed. Participants were required to complete six single leg drop landings with each leg from a 20cm height. The study was done in the 3D Movement Analysis Laboratory at the University of Stellenbosch. Ten male participants with unilateral or bilateral chronic groin pain of more than 3 months duration and 10 asymptomatic males, matched for age and sports participation, were recruited. The main outcome measures were: thoracic spine angle at initial foot contact, maximum thoracic spine angle, range of movement (ROM) (difference between the minimum and maximum values) and thoracic spine angle at lowest vertical point of the pelvis. This was assessed in all 3 movement planes: the sagittal plane (X plane), the coronal plane (Y plane) and the transverse plane (Z plane). The results of our study showed that for the unilaterally affected groin pain group, the cases landed in significantly more thoracic flexion (P<0.001 with large effect size) and were in significantly more thoracic flexion still at the lowest point. Peak thoracic flexion was significantly more in the cases than the controls. (P<0.001 with medium effect size) The same was true for the bilaterally affected group when landing on the most painful side, although this was not statistically significant. There were no significant differences in the frontal or transverse planes. In the bilaterally painful group, axial rotation ROM was significantly reduced when landing on either leg (worst affected side: P=0.040 with medium effect size and least affected side: p=0.006 with large effect size). The same occurred in the unilaterally affected group, although this was not statistically significant. Our study suggests that, in participants with chronic groin pain, there is greater thoracic forward flexion away from neutral during landing and that total axial rotation ROM during landing is diminished.
AFRIKAANSE OPSOMMING: Kroniese liespyn kom dikwels en in verskeie sportsoorte voor. Die doel van ons studie was om te bepaal of daar kinematiese verskille van die torakale werwelkolom is in aktiewe sportmense met chroniese liespyn, in vergelyking met gesonde kontroles. ‘n Dwars-deursnit beskrywende studiemetode is gevolg, en uitgevoer in die 3D Beweging Analise Laboratorium, Universiteit van Stellenbosch. Deelnemers moes ses landings op een been doen, met elke been, vanaf 'n 20cm hoogte. Tien mans met eensydige of bilaterale chroniese liespyn vir langer as 3 maande, en 10 asimptomatiese mans (ooreenstemmende ouderdom en sport deelname) het deelgeneem. Die hoof uitkomste wat gemeet is, was torakale werwelkolom krommingshoek by aanvanklike voet-kontak, maksimum torakale werwelkolom krommingshoek, omvang van beweging (OVB) (verskil tussen die minimum en maksimum waardes) en torakale werwelkolom krommingshoek by die laagste punt van die bekken. Dit is beoordeel in al 3 beweging vlakke: die sagittale (X) vlak, die koronale/frontale (Y) vlak en die transversale (Z) vlak. Die resultate van die studie het getoon dat, in die eensydig-geaffekteerde liespyn groep, die deelnemers in beduidend meer torakale fleksie geland het(P < 0.001, met 'n groot effekgrootte), asook met aansienlik meer torakale fleksie by die laagste punt na landing. Piek torakale fleksie was aansienlik meer in die liespyn-gevalle as in die kontroles. (P < 0.001, met middelmatige effekgrootte ) Dieselfde het vir die bilateraalgeaffekteerde groep gegeld wanneer hulle op hul mees pynlike kant geland het, hoewel dit nie statisties beduidend was nie. Daar was geen betekenisvolle verskille in die frontale of transversale vlakke van beweging nie. In die bilateraal pynlike groep, was aksiale rotasie OVB aansienlik verminder wanneer die gevalle op hul pynlikste been óf op hul minder pynlike been geland het ( mees pynlike been : P = 0,040, met 'n middelmatige effekgrootte en minder pynlike been : p = 0,006, met 'n groot effekgrootte ). Dieselfde het in die eensydig-geaffekteerde groep gebeur, hoewel dit nie statisties beduidend was nie. Ons studie dui daarop dat, in deelnemers met chroniese liespyn, daar meer torokale fleksie weg van neutraal tydens landing is en dat die totale aksiale rotasie OVB tydens die landing verminder is, in vergelyking met die kontrolegroep.

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.

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.

Tibial stress fractures are common in runners. However, it is unclear what factors are associated with tibial stress fractures. This study aimed to investigate 1) magnitudes of bone contact forces occurring while running 2) whether or not repeated application of running loads is sufficient to explain tibial stress fractures and 3) whether or not muscle fatigue alters the potential of tibial stress fractures. Tibial stress fractures were predicted through an estimation of the minimum number of cycles to failure (Nfail) using an integrated experimental and mathematical modeling approach. Short running trials within a speed range of 3.5-4 m/s of ten male runners were evaluated with a coupled force plate and 3 dimensional motion analysis system. The collected data were used to estimate joint reaction forces (JRF) and joint moments. Using these JRF and muscle forces predicted from optimization, 2-D bone contact forces at the distal end of the tibia were determined. Next, tibial stresses were estimated by applying these bone contact forces to a tibial model, which were then used to predict the Nfail. All procedures were repeated after plantarflexors fatigued from prolonged running. This study found that peaks of compressive and posterior shear forces occurred during mid stance, and these peaks equaled 8.91 ± 1.14 BW and -0.53 ± 0.16 BW, respectively. These bone contact forces led to a backward bending of the tibia during most of the stance phase and resulted in the maximum stresses of - 43.4 ± 10.3 MPa on the posterior face of the tibia. These maximum stresses predicted the group mean of Nfail as being 5.28*10⁶ cycles. However, 2.5% to 56% of population of runners have a chance of getting tibial stress fractures within 1 million cycles of a repeated foot impact. Within the context of muscle force and stress estimation procedures used in this study, Nfail appeared to increase after fatigue, not decrease as we hypothesized.
Graduation date: 2005

The purpose of this study was to examine the relationship between leg dominance and knee mechanics to provide further information about the etiology of ACL injury. Sixteen healthy females between the ages of 18 and 22 who were NCAA Division I varsity soccer players participated in this study. Subjects were instructed to perform a cutting maneuver; where they sprinted full speed and then performed an evasive maneuver (planting on one leg and pushing off to the other leg in a new direction) at a 45° angle with their dominate leg (DL) and non-dominate leg (NDL). Subjects were required to perform five successful cuts on each side given in a random order. Bilateral kinematic and kinetic data were collected during the cutting trials. After the cutting trials, subjects performed bilateral isometric and isokinetic testing using a Cybex Norm dynamometer at a speed of 60°/sec to evaluate knee muscle strength. During the braking phase the NDL showed greater (P=0.003) power absorption, greater (P=0.01) peak internal rotation angle and greater (P=0.005) peak flexion velocity. During the propulsive phase the DL showed greater (P=0.01) power production, greater (P=0.038) peak internal adductor moment and greater (P=0.02) peak extension velocity. In addition, no differences (P>0.05) in knee extensor and flexor isometric and isokinetic torques between the two limbs were shown. The results of this study show that a difference in knee mechanics during cutting does exist between the DL and NDL. The findings of this study will increase the knowledge base of ACL injury in females and aid in the design of more appropriate neuromuscular, plyometric and strength training protocols for injury prevention.
School of Physical Education, Sport, and Exercise Science

Thesis (M.Tech.: Chiropractic)-Dept. of Chiropractic, Durban University of Technology, 2007 144 leaves
Objective: The aim of this study was to investigate the relative effectiveness of TENS, versus, needling, versus Electro-needling in the treatment of MTSS. First objective The first objective was to evaluate the effectiveness of TENS therapy on MTSS with respect to the patients subjective and objective responses to the treatment. Second Objective The second objective was to evaluate the effectiveness of needling therapy on MTSS, with respect to the patient’s subjective and objective responses to the treatment. Third Objective The third objective was to evaluate the effects of electro-needling on MTSS, with respect to the patients’ subjective and objective responses to the treatment. Fourth Objective The fourth objective was to integrate the subjective and objective data collected in order to determine the viability of each of the therapies in comparison to one another as treatment options of MTSS.

Submitted in partial compliance with the requirements for the Master’s Degree in Technology: Chiropractic, Durban University of Technology, 2014.
Background: Classical ballet is an art form that seems graceful on the surface. However, beneath the disguise of beauty and ease lies an extremely physically demanding activity that calls for dedication, strength and perseverance. Ballet requires a specific body type and precise techniques, which predispose the dancer to musculoskeletal injury. Although a few studies have been conducted to investigate biomechanical factors as risk factors for injury in ballet dancers, few have included amateur ballet dancers and a range of biomechanical factors. Objectives: This study aimed to determine characteristics of ballet-related injury in amateur ballet dancers in the greater Durban area; to measure and record lower limb biomechanical measurements of these dancers; and to identify associations between the biomechanical measurements and characteristics of injury in the population. Method: A quantitative, questionnaire-based survey with biomechanical measurements was conducted on 21 amateur ballet dancers in the greater Durban area. Statistical analysis included the description of categorical variables using frequency and percentages in tables and bar charts. Continuous variables were summarised using mean, standard deviation and range, or median and range as appropriate. Independent Sample T-tests were used to compare biomechanical measurements between two independent groups. A p value <0.05 was considered as statistically significant. Pearson’s correlations and ANOVA testing were also used. Results: The period prevalence of ballet-related injury over the last 2 years was found to be 62% and the point prevalence 38%. There were 37 total previous injuries, most of which occurred in the hamstring (24%). Most of the worst previous injuries were reported to have occurred in the low back (31%). Most of the worst previous (70%) and current (93%) injuries occurred over time. The worst previous injuries reported ranged from mild to severe in severity, while the worst current injuries reported ranged from mild to moderate. Significant associations were found between right weight-bearing ankle dorsiflexion and previous injury; right weight-bearing ankle dorsiflexion and current injury; ‘functional turnout’ and onset of injury; right non weight-bearing ankle dorsiflexion and onset of injury; and ‘compensated turnout’ and onset of injury. Conclusion: The results suggest a significant association between musculoskeletal ballet-related injury and reduced weight-bearing ankle dorsiflexion; between injuries that occur over time (overuse injuries) and decreased ‘functional turnout’; and between overuse injuries and decreased non weight-bearing ankle dorsiflexion. These findings may help identify risk factors for injury in ballet dancers and contribute towards preventing ballet-related injury.
M

In gymnastics, females are often afflicted with lower extremity injuries during the landing phase of a backward rotating skill. The purpose of this study was to assess the efficacy of using a drop landing and backward somersault landing to compare and contrast the kinetic and kinematic differences between the two tasks in order to determine if a drop landing is a suitable representative task to analyze when examining landing injury mechanisms. Eleven female NCAA Division I gymnasts (age 19.3 ± 0.9 yrs; body height 1.66 ± 0.05 m; body mass 61.36 ± 6.02 kg) were recruited to perform drop landings and backward somersaults. Two force plates along with a 3D movement analysis system were used to collect kinetic and kinematic data. A repeated measures ANOVA was used to examine the differences in the variables with the significance level set at 0.05. There were mechanical differences and significance found between the peak vertical ground reaction forces, loading rate, kinetic and kinematic variables in the sagittal and frontal planes during the two tasks. It is evident that results may underestimate the effect of gymnastics landing impacts on risk of lower extremity injury because of the mechanical differences and significance found between the two tasks.
Access to thesis permanently restricted to Ball State community only.

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