Masters Degrees (Physiotherapy)

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Browsing Masters Degrees (Physiotherapy) by Subject "Anterior knee pain"

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    The effect of a targeted functional movement retraining intervention on anterior knee pain and associated biomechanical mechanisms
    (Stellenbosch : Stellenbosch University, 2018-03) Leibbrandt, Dominique Claire; Louw, Quinette A.; Muller, Jacobus Hendrik; Stellenbosch University. Faculty of Medicine and Health Sciences. Dept. of Health & Rehabilitation Sciences. Physiotherapy.
    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.
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    Proprioceptive differences in individuals with Anterior knee pain
    (Stellenbosch : Stellenbosch University, 2018-03) Rhode, Carlyn; Louw, Quinette A.; Williams, Leonè G.; Stellenbosch University. Faculty of Medicine and Health Sciences. Dept. of Health & Rehabilitation Sciences. Physiotherapy.
    ENGLISH SUMMARY : Introduction: Anterior knee pain (AKP) affects physically active as well as sedentary individuals and commonly leads to chronic knee pain among young adults. Anterior knee pain has a huge socioeconomic impact on those affected as management remains challenging with symptoms persisting for years even after medical intervention. Proprioception plays an important role in sensory motor control of the knee and impacts motor action and knee joint stability. There are conflicting reports in the current literature on whether people with AKP have altered proprioception. Objectives: The purpose of this study was to investigate the proprioceptive abilities of individuals affected with anterior knee pain using a gold standard measurement tool. Proprioception was measured by compare active joint position sense during a weight bearing (single leg stance) and a none weight bearing task (active knee extension in sitting) between knees with AKP and knees without AKP. Methodology: A laboratory based descriptive cross-sectional study design was used to conduct this study. The Vicon 3D motion analysis system was used to test proprioception. Twenty-five participants who met the inclusion criteria and gave informed consent, were included in the study. Fifty knees were evaluated; 37 knees with AKP and 13 without AKP. Proprioception was measured by means of two active joint position sense testing in both a weight bearing (single leg squat) and a non-weight bearing (active knee extension) test position. Target angles were selfdetermined based on each participant’s capabilities and pain levels. The absolute error (AE) was used as the main outcome measure to assess proprioception. A normative criterion of an AE equal and greater than five degrees was classified as altered proprioception. The proprioception of the knees with AKP were compared to that of the knees without AKP. Results: The study participants were predominantly female (n=22) with a mean age of 27.8 years. Seventy-six percent (76%, n= 19) of the population were physically active and 44%, (n=11) reported being runners. The main finding of this study was that there was no significant difference in proprioception when comparing the knees with AKP to the knees without AKP (p <0.05). However, individuals with altered proprioception was identified in both the knees with AKP and the knees without AKP. The mean AE for the knees with AKP was 7.4o during SLS and 8.3o during active knee extension; whereas the mean AE for the knees without AKP were 8.3o during SLS and 5.9o during active knee extension. Insignificant differences were found via Chi-square calculations between the knees with AKP compared to the knees without AKP during single leg squat and during active knee extension. Conclusion: The current study findings showed that proprioception is not significantly more impaired in knees with AKP compared to knees without AKP during active reproduction proprioceptive testing. This study did however identify a group of individuals with altered proprioception, in both the knees with AKP and the knees without AKP. A likely reason could be due to compensation during gait in patients with AKP as well as the accuracy of the Vicon 3D motion analysis system. There was a tendency towards a larger mean AE during active knee extension in sitting in the knees with AKP. This finding could be reflective of the proprioceptive abilities of the knee joint specifically. The findings in this study support the assessment of proprioception in both knees in individuals with AKP and not only the knees with AKP.