Doctoral Degrees (Physiotherapy)
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Browsing Doctoral Degrees (Physiotherapy) by browse.metadata.advisor "Louw, Quinette"
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- ItemCardiovascular disease risk factors among school attending adolescents in rural Nigeria(Stellenbosch : Stellenbosch University, 2016-03) Oduniaya, Nse Ayooluwa; Louw, Quinette; Grimmer, Karen; Stellenbosch University. Faculty of Medicine and Health Sciences. Dept. of Interdisciplinary Health Sciences. Physiotherapy.ENGLISH ABSTRACT: Background: The prevalence of Cardiovascular Disease (CVD) is increasing in Nigeria, particularly hypertensive heart disease among the working class population. Unfortunately, resources for effective management of CVD at acute stage are sparse and expensive for the average Nigerian making preventive measure the best option for Nigeria. CVD risk factors have been identified in adolescents in many countries but information on CVD risk factors among Nigerian adolescents, especially rural adolescents, are sparse. This study aimed to develop culturally appropriate lifestyle CVD risk factors questionnaire for adolescents in Nigeria and to investigate CVD risk factors and its associates among 15-18 years school attending adolescents in rural Nigeria. Methods: The study was conducted in rural south west Nigeria, one of the six geopolitical zones of Nigeria. The people living in this area are Yoruba speaking population of Nigeria. The study was conducted in four phases. Phase 1: development of a composite lifestyle CVD risk factors questionnaire through systematic review, expert panel and target population. Phase 2: Cross cultural validation of composite measure developed to facilitate its use among rural adolescents. Phase 3: Pilot study to assess the logistics of the study and to test the reliability of the newly developed questionnaire. Phase 4: investigation into CVD risk factors among adolescents. CVD risk factors such as smoking, alcohol, Physical inactivity, and poor diet using the newly developed questionnaire were assessed. Blood pressure, BMI and waist hip ratio were also assessed using standardized protocol. Data was analyzed qualitatively and quantitatively. Content validation of the questionnaire was done qualitatively using expert consensus and adolescents’ feedback. Reliability was tested using ICC (Intraclass Correlation), Kappa and paired t test. CVD risk factors data was analyzed descriptively first, then with Pearson correlation and multiple regressions to determine associations among risk factors at 95% confidence interval (0.05 level of significance). Result: European countries showed high prevalence of smoking among adolescents in the systematic review. The prevalence of dyslipidemia ranged from 2.5% of total cholesterol (TC) in rural Iran adolescents to 48.9% high Triglyceride (TG) in rural Mexican adolescents. Overweight and obesity prevalence ranged from 0.6% prevalence in an age (10 y) of a study to 48.7%. Studies from the United States showed a decreasing trend in pre hypertension and hypertension, overweight and obesity. The newly developed composite lifestyle CVD risk factors questionnaire for adolescents had moderate to good reliability. Intraclass correlation (ICC) ranged from 0.3 - 0.7 and 0.3-0.8 in English and Yoruba versions’ subscales respectively. Kappa statistics showed moderate to strong agreement in priority questions in English and Yoruba versions. Investigation into the CVD risk factors showed high prevalence and clustering of CVD risk factors; 7.1% adolescents were smokers, 10.2% drank excessive alcohol, 27.9% had low physical activity level, 59.8% consumed high cholesterol diet, 6.1%, consumed low vegetable 8.1% consume low fruit 65.5% had high salt intake, 33.1% had pre hypertension ( systolic), 5.5% had pre hypertension (diastolic) 3.2% had hypertension (systolic) 0.8% had hypertension (diastolic). Smoking and drinking were significantly higher in males and physical activity was significantly higher in females. Smoking and drinking were significantly associated in both males and females and the odd of drinking and smoking was more elevated in girls. Systolic pre- hypertension was associated with age and high BMI in boys and was associated with only high BMI in girls. Conclusion: Nigerian rural adolescents are at risk of future adult CVD. There is an urgent need to put measures in place to prevent future epidemic of CVD in adulthood. CVD prevention program for boys and girls should be tailored to address gender specific CVD risk factors.
- ItemReturn to play in elite rugby players after severe knee injuries : addressing the knowledge gaps(Stellenbosch : Stellenbosch University, 2022-04) Robyn, Aneurin Dean; Louw, Quinette; Baumeister, Jochen; Stellenbosch University. Faculty of Medicine and Health Sciences. Dept. of Health and Rehabilitation Sciences. Physiotherapy.ENGLISH SUMMARY: Introduction: Rugby union has been a professional sport for many years. Along with the growing professionalism of the sport, there has been increasing scientific interest in the physical profiles of rugby players as such profiling may inform player selection, conditioning, monitoring, and injury prevention strategies. Medical professionals working in an elite sports environment have the challenging task of determining if an athlete is ready to return to the playing field after severe injury. Merely passing a battery of physical tests is arguably insufficient for an injured athlete to successfully recover to preinjury status. Aim: This dissertation aims to describe elite rugby union players' physical and psychological profiles at the return to play after sustaining severe knee injuries compared to their preinjury level. This dissertation contributes new knowledge and adds practical pieces to the growing return to play puzzle. Research setting: This study was performed in Cape Town, South Africa, with the identified participants of five elite rugby teams based in the Cape Winelands and Metropole areas. Testing was conducted in an indoor biomechanical laboratory and an indoor sports facility with an artificial grass surface. This kept the testing environment consistent by eliminating any weather condition interference. Methodology: Study 1: This descriptive cross-sectional study aimed to compare the anthropometry and physical profiles of elite junior rugby union players according to specific playing positions. Study 2: A prospective cohort study was performed to compare the injured participants' physical testing at return to play with baseline after sustaining a severe knee injury. Study 3: A prospective cohort study was done with injured participants completing two psychological questionnaires to assess their psychological readiness at return to play and evaluate if there was any improvement between return to training and return to play. Study 4: A prospective cohort study with a new analytical method of statistical parametric mapping analysis to assess the countermovement jump curve. Results: Study 1: This study provides up-to-date confirmation of the variation in specific playing position profiles and skills according to specific game demands at the junior elite level. Players’ profiles are matched to the specific demands of the game. Study 2: This study highlights that injured players’ running speed and decision-making time are slower after injury. The uninjured players' exposure to training and match stimulus improved their running speed and lower body explosive power during the season. Study 3: This study reported good psychological readiness and successful recovery to the preinjury status of elite rugby players after a severe knee injury. The improved scores from return to training to return to play give insight to treating professionals that athletes need longer recovery time as training exposure will decrease fear of reinjury and increase confidence in their knee function before returning to the competitive playing field. Study 4: This study's two key findings are that there was (i) no asymmetry detected and (ii) the improved peak force of affected limb at return to play after a severe knee injury which is contrary to current evidence. Conclusion: An athlete who returns to play is a complex problem and needs a complex solution. My dissertation has contributed to the elite sports population by providing return to play details on elite rugby union players’ physical and psychological profiles after a severe knee injury. This new information will give treating professionals the necessary insight and additional pieces to this complex return to play puzzle. Recommendation: An interdisciplinary approach with specific needs by developing a more holistic return to play recipe for better return to play decisions and lower reinjury rates. We monitor elite athletes for a more extended period (at least six months) after a successful return to the playing field; provide the sports medicine community information on any reinjuries, other musculoskeletal injuries, and return to (match) performance parameters. Artificial intelligence is one promising approach to inform decision-making processes by adding various player data in an algorithm to provide a return to play recommendation.
- ItemVirtual reality exposure therapy as treatment for pain catastrophizing in Fibromyalgia patients : proof-of-concept(Stellenbosch : Stellenbosch University, 2013-03) Morris, Linzette Deidre; Louw, Quinette; Grimmer, Karen; Stellenbosch University. Faculty of Medicine and Health Sciences. Dept. of Interdisciplinary Health Sciences. Physiotherapy.ENGLISH ABSTRACT: Research objective To test a novel concept that exposing patients with fibromyalgia syndrome (FMS) to visuals of exercise activities elicits neurophysiological changes in functional brain areas associated with pain catastrophization; thereby providing preliminary support for the further development/testing of a virtual reality exposure therapy (VRET) exercise program aimed at reducing pain catastrophization toward exercise therapy in patients with FMS. Methods The main study of this research consisted of a three-phase exploratory fMRI study. Phase 1 involved the development/validation of the fMRI visual task. Phase 2 involved the exploration of the differences in neural correlates associated with pain catastrophizing between participants with FMS and healthy controls when exposed to various visuals of exercise and passive/relaxing activities. Phase 3 involved the testing of the preliminary efficacy of a novel VRET exercise program on pain catastrophization in participants with FMS. The fMRI task consisted of two stimuli: active (exercise activity visuals)/passive (relaxing activity visuals). Structural images as well as blood-oxygenation-level-dependent (BOLD) contrasts were acquired for the conditions and compared within-subjects/groups and between-groups. The condition of interest was the active>passive condition (where brain activations for the passive condition were subtracted from the active condition). The brain volumes collected during ‗on‘ conditions were compared with the brain volumes collected during ‗off‘ conditions using Students‘ t test. Statistic images were thresholded using clusters determined by Z>2.3 and a (corrected) cluster significance threshold of p=0.05. Results The right (R) middle and inferior frontal gyrus and R posterior cerebellum were significantly activated for the participants with FMS, and not the healthy control group, during the active>passive condition (phase 2). At baseline, during the active>passive condition (phase 3), the intervention/VRET group showed significant activation (p<0.05) in the R insular cortex, R anterior and posterior cerebellum, R parahippocampal gyrus, R middle frontal gyrus, R corpus callosum, R thalamus, R supramarginal gyrus and R middle and superior temporal gyrus; the control group showed significant activation in the R anterior and posterior cerebellum, R middle and superior temporal gyrus, R middle frontal gyrus, R insular cortex, R supramarginal gyrus and R precentral gyrus. Post-intervention, during the active>passive condition, R posterior cerebellum activation was still significant (p<0.05) for the intervention group; R anterior cerebellum, left (L) middle and inferior frontal gyrus, and R superior parietal lobe activation was found to be significant (p<0.000) for the control group, although these areas were not found to be significantly activated at baseline for the control group. Conclusion We could not provide confirmatory evidence for the efficacy of a novel VRET program for pain catastrophization in patients with FMS. However, the findings of this study does suggest that pain catastrophization in patients with FMS could be confirmed with fMRI. Research is therefore warranted to further develop a proper VRET exercise program and to test the effect of this program on pain catastrophization in patients with FMS.