The effect of a targeted functional movement retraining intervention on anterior knee pain and associated biomechanical mechanisms

Leibbrandt, Dominique Claire (2018-03)

Thesis (PhD)--Stellenbosch University, 2018.

Thesis

ENGLISH SUMMARY : Background: Anterior knee pain (AKP) frequently affects the knee joint and may limit an individual’s ability to perform common activities of daily living (ADLs). It tends to become chronic, making it difficult to treat as the causes are not well understood. Individualised interventions are recommended due to the large variation of clinical presentations in subjects presenting with AKP. Aims: The main aim of this research is to assess the effect of an individualised functional retraining intervention on kinematic contributing factors, pain, function and self-reported recovery in subjects with AKP. The secondary aims are: • To create an evidence-based checklist to assist with the diagnosis of AKP • To create a decision-making algorithm for treating subjects with AKP based on their kinematic risk factors • To establish the test-retest reliability of lower limb kinematics during gait Summary of methods: Four study phases consisting of five studies with different methods were included in this dissertation. Each phase contributed towards a better understanding of the main theme, i.e. the treatment of biomechanical factors associated with AKP. Phases A and B are preliminary research necessary to aid the conceptualisation of phase D (the main study). Phase A consisted of three studies. Study 1 was a systematic review to create an evidence-based checklist for the clinical diagnosis of AKP. Study 2 was a systematic review on kinematic risk factors for AKP in order to establish which factors clinicians should address first in treatment. Study 3 was a repeatability study to establish the test-retest reliability of our measurement procedures. Phase B was the pilot phase and consisted of one study. Study 4 was a case series to establish the feasibility of our decision-making framework and intervention procedures. Phase C was a planning phase where the preliminary research from previous phases were analysed and necessary changes were made in order to improve the execution of the main intervention component of the thesis (phase D). Phase D was the main intervention study (Study 5). This was a series of n of 1 studies investigating the effect of an individualised functional retraining intervention on kinematic and clinical outcomes in 31 subjects with AKP. Setting: The research was conducted at the Tygerberg CAF Motion Analysis Laboratory and the treatments done at the Tygerberg Physiotherapy Clinic of the University of Stellenbosch in Cape Town, South Africa. Main results: Following a six-week individualised functional retraining intervention, 30 of the 31 subjects (96.8%) demonstrated improved pain levels (NPRS). All 31 participants (100%) demonstrated improved functional scores (AKPS) immediately post intervention. Nineteen of the 31 participants (61.3%) demonstrated a clinically significant improvement in their priority kinematic outcome post intervention. At six-month follow up, 15 participants (48.4%) rated themselves as fully recovered or pain-free on a 7-point Likert scale. Conclusion: An individualised approach to exercise is recommended to improve pain, function, kinematics and self-reported recovery in subjects with AKP as the effects are greater than a standard intervention approach. Clinicians need to be educated on common biomechanical contributing factors and how to tailor treatment accordingly.

AFRIKAANSE OPSOMMING : Agtergrond: Anterior kniepyn (AKP) raak dikwels die kniegewrig en kan ’n individu se vermoë beperk om gewone daaglikse aktiwiteite uit te voer. Dit is geneig om tot ’n chroniese toestand te ontwikkel, wat dit moeilik maak om te behandel aangesien die oorsake nie goed verstaan word nie. Pasgemaakte intervensies vir AKP word aanbeveel weens die wye verskeidenheid kliniese vorme waarin dié toestand by subjekte voorkom. Doelwitte: Die hoofdoel van hierdie navorsing is om te bepaal watter uitwerking ’n pasgemaakte funksionele herskolingsintervensie het op bewegingsfaktore, pyn, funksie en selfaangemelde herstel by subjekte met AKP. Die sekondêre doelwitte is: • om ’n bewysgegronde kontrolelys op te stel om AKP te help diagnoseer; • om ’n besluitnemingsalgoritme vir die behandeling van subjekte met AKP te skep wat op hulle bewegingsrisikofaktore berus; en • om die toets-hertoets-betroubaarheid van beweging in die onderste ledemaat in loopgang te bepaal. Samevatting van metodes: Vir hierdie verhandeling is vier studiefases onderneem, wat uit vyf studies met verskillende metodes bestaan het. Elke fase het tot ’n beter begrip van die hooftema bygedra, naamlik die behandeling van die biomeganiese faktore wat met AKP verband hou. Fase A en B was voorlopige navorsing wat nodig was vir die konseptualisasie van fase D (die hoofstudie). Fase A het uit drie studies bestaan. Studie 1 was ’n stelselmatige oorsig om ’n bewysgegronde kontrolelys vir die kliniese diagnose van AKP op te stel. Studie 2 was ’n stelselmatige oorsig van die bewegingsrisikofaktore vir AKP om te bepaal op watter faktore klinici eerste in behandeling behoort te konsentreer. Studie 3 was ’n herhaalbaarheidstudie om die toets-hertoets-betroubaarheid van die meetprosedures vas te stel. Fase B was die proeffase en het uit een studie (Studie 4) bestaan. Studie 4 was ’n gevallereeks om die uitvoerbaarheid van die besluitnemingsraamwerk en intervensieprosedures te bepaal. Fase C was ’n beplanningsfase waarin die voorlopige navorsing van vorige fases ontleed en die nodige veranderinge aangebring is om die uitvoering van die hoofintervensiekomponent van die tesis (fase D) te verbeter. Fase D was die hoofintervensiestudie (Studie 5). Dit het ’n reeks enkelpasiëntproewe behels wat ondersoek ingestel het na die uitwerking van ’n pasgemaakte funksionele herskolingsintervensie op die bewegings- en kliniese uitkomste by 31 subjekte met AKP. Omgewing: Die navorsing is by die Bewegingsontledingslaboratorium van die Tygerbergse Sentrale Analitiese Fasiliteite onderneem, terwyl die behandeling by die Universiteit Stellenbosch se Tygerberg-fisioterapiekliniek in Kaapstad, Suid-Afrika, plaasgevind het. Hoofresultate: Ná ’n ses weke lange pasgemaakte funksionele herskolingsintervensie het 30 van die 31 subjekte (96.8%) ’n verbetering in pynvlakke (NPRS) getoon. Ál 31 deelnemers (100%) het onmiddellik ná die intervensie beter funksionele tellings (AKPS) behaal. Negentien van die 31 deelnemers (61.3%) het na afloop van die intervensie ’n klinies beduidende verbetering in hulle prioriteitsbewegingsuitkoms ervaar. Gedurende ’n nasorgbesoek ses maande later het 15 deelnemers (48.4%) hulleself as ten volle herstel of pynvry op ’n sewepunt-Likertskaal beskryf. Gevolgtrekking: In plaas van ’n standaardintervensiebenadering, word ’n pasgemaakte benadering tot oefening aanbeveel om ’n groter verbetering in pyn, funksie, beweging en selfaangemelde herstel by subjekte met AKP teweeg te bring. Klinici moet opleiding oor die algemene biomeganiese bydraende faktore ontvang, en oor hoe om behandeling dienooreenkomstig aan te pas.

Please refer to this item in SUNScholar by using the following persistent URL: http://hdl.handle.net/10019.1/103299
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