Validation of an evidence-based biomechanical risk factor screening tool for patellofemoral pain
| dc.contributor.advisor | Louw, Quinette A. | en_ZA |
| dc.contributor.author | Green, Tanya | en_ZA |
| dc.contributor.other | Stellenbosch University. Faculty of Medicine and Health Sciences. Dept. of Health & Rehabilitation Sciences. Physiotherapy. | en_ZA |
| dc.date.accessioned | 2021-11-23T13:51:50Z | |
| dc.date.accessioned | 2021-12-22T14:23:49Z | |
| dc.date.available | 2021-11-23T13:51:50Z | |
| dc.date.available | 2021-12-22T14:23:49Z | |
| dc.date.issued | 2021-12 | |
| dc.description | Thesis (MScPhysio)--Stellenbosch University, 2021. | en_ZA |
| dc.description.abstract | ENGLISH SUMMARY : Background: Patellofemoral pain (PFP) is a musculoskeletal disorder of the knee commonly known to affect active adolescent and young adult populations. Altered lower-extremity biomechanics is recognised as a contributing factor resulting in increased stress of the patellofemoral joint (PFJ), which may ultimately cause PFP. Two-dimensional (2D) video gait analysis is a practical way to assess gait kinematics in a clinical setting. However, comparisons between 2D clinical observational gait analysis and the ‘gold standard’ three-dimensional (3D) motion analysis using an evidence-based biomechanical risk factor screening tool to identify biomechanical risk factors have not been established yet. Aim and objectives: This study aimed to ascertain agreement between the identification of biomechanical risk factors in individuals with PFP using 2D observational gait analysis (clinical standard) by clinicians and 3D motion analysis (gold standard) by an experienced analyst. The interrater reliability and concurrent validity of 2D clinical observational gait analysis by employing an evidence-based biomechanical risk factor screening tool were investigated. Methods The data were collected using a cross-sectional, descriptive study design. Interrater reliability and concurrent validity of 2D clinical observational gait analysis were investigated by observing walking and running videos of 18 recreational runners. Two physiotherapists (raters) independently reviewed the recordings to identify kinematic risk factors constructed from the evidence-based biomechanical risk factor screening tool. Sixteen frontal, sagittal and transverse hip, knee and ankle kinematic variables were investigated and rated dichotomously (yes/no) at specific phases in the gait cycle. The percentage agreement and Cohen’s kappa statistic were used to calculate agreement within raters and between 2D and 3D kinematic variables. Results: Overall, 2D clinical observational gait analysis demonstrated moderate interrater reliability and concurrent validity based on the percentage agreement. The agreement for interrater reliability ranged widely for walking (percentage agreement = 50%–77.78%; kappa = -0.09–0.27) and running (percentage agreement = 44.44%–77.78%; kappa = -0.15–0.35). Only two of the eight kinematic variables for walking demonstrated a high percentage agreement, namely increased peak knee extension and increased overall ankle dorsiflexion (77.78%). Running showed a high percentage agreement in three of the eight kinematic variables, namely increased peak knee flexion (77.78%), increased ankle dorsiflexion and increased ankle eversion (72.22%). Observed agreement for 2D kinematics versus 3D kinematics observed differed significantly between raters. Rater 1’s mean findings demonstrated a percentage agreement of 60.41% (with kappa = 0.05) in walking and 64.58% (with kappa = 0.09) in running. Rater 2’s mean findings demonstrated a percentage agreement of 76.38% (with kappa = 0.15) in walking and 81.25% (with kappa = 0.20) in running. Conclusion: The study findings invalidated the use of 2D clinical observational gait analysis employed for the identification of lower-extremity biomechanics and constructed from the evidence-based biomechanical risk factor screening tool in recreational runners with PFP. However, there was overall moderate to fair interrater reliability. The results show that 2D clinical observational gait analysis of certain kinematics included in the evidence-based biomechanical risk factor screening tool should be used cautiously, as the reliability and validity are not adequate for all the kinematic factors included. Clinicians should consider both the best available evidence and the reliability of clinical measurements when screening individuals with PFP in clinical practice to ensure that biomechanical analysis is accurate and relevant. | en_ZA |
| dc.description.abstract | AFRIKAANSE OPSOMMING : Agtergrond: Patellofemorale pyn (PFP) is ʼn muskuloskeletale knieversteuring wat algemeen onder aktiewe adolessente en jong volwassenes voorkom. Veranderde laerekstremiteit-biomeganika word erken as ʼn bydraende faktor tot verhoogde spanning van die patellofemorale gewrig (PFG), wat uiteindelik PFP kan veroorsaak. Gangontleding deur tweedimensionele (2D) video is ʼn praktiese manier om gangkinematika in ʼn kliniese omgewing te assesseer. Vergelykings tussen 2D gangontleding deur kliniese waarneming en die ‘goue standaard’, driedimensionele (3D) bewegingsontleding, met behulp van ʼn bewysgebaseerde biomeganiese risikofaktor-siftingsinstrument vir die identifikasie van biomeganiese risikofaktore is egter nog nie voldoende bewerkstellig nie. Doel en doelstellings: Die doel van hierdie studie was om ooreenstemming tussen die identifikasie van biomeganies geassosieerde risikofaktore by individue met PFP met behulp van 2D gangontleding deur kliniese waarneming (kliniese standaard) deur klinici en die gebruik van 3D bewegingsontleding (goue standaard) deur ʼn ervare ontleder met behulp van die bewysgebaseerde biomeganiese risikofaktor-siftingsinstrument te bepaal. Die tussenbeoordelaar-betroubaarheid en gepaardgaande geldigheid van 2D gangontleding deur kliniese waarneming met behulp van ʼn bewysgebaseerde biomeganiese risikofaktor-siftingsinstrument is ondersoek. Metodes: Die data is ingesamel deur ʼn deursnee-, beskrywende studie-ontwerp. Interbeoordelaar-betroubaarheid en gepaardgaande geldigheid van die 2D gangontleding deur kliniese waarneming is ondersoek deur waarneming van stap- en drafvideo’s van 18 ontspanningsdrawwers. Twee fisioterapeute (beoordelaars) het die opnames onafhanklik beoordeel ten einde kinematiese risikofaktore te identifiseer wat uit die bewysgebaseerde biomeganiese risikofaktor-siftingsinstrument saamgestel is. Sestien frontale, sagittale en transverse heup-, knie en enkel- kinematiese veranderlikes is ondersoek en tweedelig (ja/nee) by spesifieke fases in die gangsiklus beoordeel. Die persentasie-ooreenstemming en Cohen se kappa-statistiek is gebruik om ooreenstemming tussen beoordelaars en tussen 2D en 3D kinematiese veranderlikes te bereken. Resultate: In die algemeen het die 2D gangontleding deur kliniese waarneming matige interbeoordelaar-betroubaarheid en gepaardgaande geldigheid op grond van die persentasie-ooreenkoms getoon. Die ooreenstemming vir interbeoordelaar-betroubaarheid het aanmerklik gewissel vir stap (persentasie-ooreenstemming = 50%–77.78%; kappa = -0.09–0.27) en draf (persentasie-ooreenstemming = 44.44%–77.78%; kappa = -0.15–0.35). Slegs twee van die agt kinematiese veranderlikes vir stap het ʼn hoë persentasie-ooreenstemming getoon, naamlik verhoogde piekknie-ekstensie en verhoogde algehele enkeldorsifleksie (77.78%). Draf het ʼn hoë persentasie-ooreenstemming in drie van die agt kinematiese veranderlikes getoon, naamlik verhoogde piekkniefleksie (77.78%), verhoogde enkeldorsifleksie en verhoogde enkeleversie (72.22%). Waargenome ooreenstemming tussen 2D kinematika en 3D kinematika het aanmerklik tussen die beoordelaars verskil. Beoordelaar 1 se gemiddelde bevindinge het ʼn persentasie-ooreenkoms van 60.41% (met kappa = 0.05) vir stap en 64.58% (met kappa = 0.09) vir draf getoon. Beoordelaar 2 se gemiddelde bevindinge het ʼn persentasie-ooreenkoms van 76.38% (met kappa = 0.15) vir stap en 81.25% (met kappa = 0.20) vir draf getoon. Gevolgtrekking: Die studiebevindinge het die gebruik van 2D gangontleding deur kliniese waarneming vir die identifikasie van laerekstremiteit-biomeganika by ontspanningsdrawwers met PFP saamgestel uit ʼn bewysgebaseerde biomeganiese risikofaktor-siftingsinstrument ongeldig verklaar. Daar was egter algehele matige tot redelike interbeoordelaar-betroubaarheid. Die resultate toon dat 2D gangontleding deur kliniese waarneming vir sekere kinematika ingesluit by die bewysgebaseerde biomeganiese risikofaktor-siftingsinstrument omsigtig gebruik moet word, aangesien die betroubaarheid en geldigheid daarvan nie voldoende is vir al die kinematiese faktore wat daarby ingesluit is nie. Klinici moet sowel die beste beskikbare bewyse as die betroubaarheid van kliniese metings in ag neem wanneer individue met PFP in die kliniese praktyk gesif word ten einde akkurate en toepaslike biomeganiese ontleding te verseker. | af_ZA |
| dc.description.version | Masters | |
| dc.format.extent | xv, 101 pages ; illustrations, includes annexures | |
| dc.identifier.uri | http://hdl.handle.net/10019.1/123829 | |
| dc.language.iso | en_ZA | en_ZA |
| dc.publisher | Stellenbosch : Stellenbosch University | |
| dc.rights.holder | Stellenbosch University | |
| dc.subject | Patellofemoral joint -- Movements | en_ZA |
| dc.subject | Knee -- Movements | en_ZA |
| dc.subject | Biomechanics | en_ZA |
| dc.subject | Gait in humans -- Research | en_ZA |
| dc.subject | Medical screening -- Methodology | en_ZA |
| dc.subject | UCTD | |
| dc.title | Validation of an evidence-based biomechanical risk factor screening tool for patellofemoral pain | en_ZA |
| dc.type | Thesis | en_ZA |