Physiotherapy

Permanent URI for this collectionhttps://eresearch.qmu.ac.uk/handle/20.500.12289/7190

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Accelerometry measurement of physical activity and sedentary behaviour in pre-school children
(Queen MArgaret Univrsity, 2013) Hislop, Jane
This thesis is based on six studies which address questions around the use of accelerometers to measure physical activity and sedentary behaviour of pre-school children: are shorter epochs more accurate? Which epochs are most accurate? Are there advantages to using triaxial accelerometers? Which cut-points are most accurate? Are different generations of Actigraph accelerometers comparable? What is the recommended wear time to provide a reliable estimate of habitual physical activity and sedentary behaviour? Analysis of 7-10 day accelerometry data, collected from 31 pre-school children (mean (SD) age 5.9 (0.7) y), suggests that shorter epochs (15 s) result in significantly greater estimates of time spent in moderate-to-vigorous physical activity (MVPA) in comparison to 60-s epochs (p <0.05). When compared against a direct observation method, Children's Activity Rating Scale (CARS), with 32 pre-school children (4.4 (0.8) y) during 1 hour of free-play, 15-s epochs were more accurate than 60-s epochs. Comparison of the triaxial RT3 against a uniaxial accelerometer, suggests no advantage of the RT3 accelerometer. The Puyau et al. (2002) cut-points had the 'best' agreement with estimates of sedentary behaviour, light intensity and MVPA against the CARS. Different generations of accelerometers were not comparable, however, application of a correction factor to the GT1M data (7164 = GT1M/0.91) may improve comparability of total physical activity. Finally, analysis of 7 day accelerometry data from 112 pre-school children (3.7 (0.7) y) suggests that 3 days of 7 hours provides a reliable estimate of habitual physical activity and that inclusion of weekend days is not necessary. This thesis highlights the implications that methodological decisions can have over apparent estimates of physical activity and sedentary behaviour and has made recommendations for accelerometry use. Ideally, there needs to be a move towards consensus, as, only by adopting standardised approaches to accelerometry use, will comparison between study outcomes become meaningful.
An assessment of neuromuscular performance, functional range of motion and quality of life characteristics in children diagnosed with hypermobility syndrome
(Queen Margaret University, 2008-06) Fatoye, Francis A.
Introduction: Hypermobility syndrome (HMS) is a common cause of morbidity in children, with the knee most frequently affected by its symptoms. Impaired joint proprioception has been reported in adults with HMS. Muscle weakness, problems with school activities and abnormal gait patterns have been observed in children with this condition. It has also been suggested that activities of daily living and physical and sporting activities may be limited in children with HMS due to pain. To date, the factors associated with HMS in children have not been well reported. The relationships between impairments, function and quality of life (QoL) have not been investigated in children with this condition. The purpose of this study was to identify the range of neuromuscular performance, functional range of motion (ROM) and QoL indices, and investigate the relationships between these features in children with HMS. A purpose-built motorised device was developed and validated for the assessment of knee joint proprioception as an integral part of the research programme. The test-retest repeatability of various outcome measures used for the present study was also investigated in healthy children and those with HMS. Methods: A cross-sectional study was conducted. Twenty nine children with HMS and 37 healthy children (aged 8 – 15 years) were investigated for neuromuscular indices, functional ROM and QoL. Knee joint kinaesthesia (JK) and position sense (JPS) were examined using a motorised device, muscle torque was tested with a digital myometer, passive ROM was measured with a universal goniometer and functional ROM was assessed using the VICON camera system. Pain intensity and QoL were measured using the Coloured Analogue Scale and the Paediatric Quality of life Inventory respectively. Mann-Whitney U tests and independent t-tests were performed to determine the differences between the two groups. The relationships between pain and each of the following: neuromuscular impairments, functional ROM and QoL were examined in children with HMS. The correlation between Beighton scores and each outcome was also evaluated in children with HMS. Results: Knee JK and JPS were significantly poorer (both p < 0.001) in children with HMS compared with the controls. Significantly reduced (p < 0.001) knee muscle torque was also observed in children with HMS. Pain intensity and passive knee ROM were significantly higher (both p < 0.001) in children with HMS. They also demonstrated significantly increased knee extension, reduced knee flexion in loading response and during maximal knee flexion of walking (all p <0.001). Moreover, the overall QoL perception and all the domains were significantly poorer (p range < 0.001 to 0.008) in children with HMS than the controls. No relationship (r range = -0.065 to 0.271; p range = 0.106 to 0.985) was found between pain, neuromuscular impairments and functional ROM in children with HMS. However, a significantly strong negative relationship (r = -0.65; p = <0.001) was established between pain and QoL in children with HMS. In addition, no relationship (r range = -0.014 to 0.315; p range = 0.112 to 0.895) was observed between Beighton scores and neuromuscular impairments, functional ROM and QoL in children with HMS. Conclusions: Children with HMS, compared with their healthy counterparts had knee joint proprioception and knee muscle torque deficits, increased passive knee ROM and pain intensity. Abnormal walking patterns (increased knee extension, reduced knee flexion in both mid stance and maximum knee flexion in swing phase during walking) were also found in children with HMS. They also presented with poorer QoL in comparison with the controls. Clinicians are to be aware of these identified features and should develop appropriate treatment intervention programmes for children with this condition.
An investigation of physical activity, influences on participation and psychological well-being in female undergraduates.
(Queen Margaret University, 2002) Bulley, C. J.
Recent health surveys have found that many young women do not participate in sufficient physical activity to produce health benefits. Consequently, they are at risk of developing cardiovascular disease, diabetes and osteoporosis in later life. The transition between secondary and higher education is associated with particular risks in relation to declining activity participation. There is clearly a need to explore the aetiology and impact of activity behaviour change in this context. A literature review identified several gaps relating to the validity of physical activity measurement, mental health benefits associated with participation and factors influencing changes in activity choices over time. Three studies were designed to address these issues in a female undergraduate population at Queen Margaret University College in Edinburgh. A theory is proposed to explain relationships between many of the variables explored. Study One aimed to validate the Scottish Physical Activity Questionnaire (SPAQ) against an estimate of time in moderate and vigorous activity derived from heart rate monitoring data. Women were monitored for three days of the seven-day recall period (N=23). Self-report and heart rate estimates of time in activity differed significantly (t test: p=0.008) and correlated poorly (r=0.03). The questionnaire was modified as a result of analysis and testing was repeated in a sample of 21 women. Modified SPAQ for students and heart rate estimates of time in activity did not differ significantly (p=0.119) and demonstrated improved correlations (r=0.59). Stage of Behaviour Change classifications also demonstrated hierarchical agreement with subjective and heart rate estimates of time in activity. Study Two aimed to establish baseline levels of exercise and moderate lifestyle physical activity in female undergraduates and to explore associations with psychological well-being over time. A large longitudinal survey was carried out using the modified SPAQ for students and psychometric measurement tools. The first survey time-point occurred at the start of the academic year and according to Stage of Behaviour Change classification 51% of participants were not active enough to achieve health benefits (n=425). The second survey was carried out two months later. Significant correlations were found between self-esteem scores and Stage of Behaviour Change classification in relation to moderate lifestyle PA (r=0.29), but not vigorous exercise. The low response to survey two (n=89) necessitated a change in methodology, implemented in the final study. Study Three aimed to explore changes in activity over the first academic year, influences on activity-related decisions and the effects of these choices on psychological well-being. Sixteen participants from the previous study sample were interviewed in a qualitative study design. Content analysis indicated that individuals frequently decreased their activity participation on entry to higher education, but some re-incorporated activity into their lifestyles over subsequent months. Many influences on activity patterns were discussed, including the negative impact of transition periods such as the summer vacation. Data analysis led to the development of the Narrative Integration Theory, which describes motivation to participate in physical activity as being influenced by the immediate affective reaction to the experience. This is reciprocally related to interacting personal, cultural, environmental and social influences and their integration into a sense of identity. Positive experiences are required to alter negative perceptions and to build feelings of competence in relation to activity participation. This thesis provides further understanding of the challenges to activity behaviour experienced by female students. Decisions relating to uptake of activity and continued participation are frequently made with conscious processing and reflect complex issues relating to personal identity and self-evaluations.
ASSESSING LOWER LIMB SOMATOSENSORY FUNCTION OF CHILDREN WITH UPPER MOTOR NEURON LESIONS
(2024-12-11) Marsico, Petra
Through the somatosensory system, we receive information about the external and internal state of our body as the foundation of our feedback-control system for all motor activities. Therefore, somatosensory function is essential for motor control, and motor learning. Lower limb somatosensory function is particularly important for balance, gait and mobility. Different modalities of the somatosensory system can be impaired in children with Upper Motor Neuron (UMN) lesions. Therefore, we require child-friendly outcome measures to assess somatosensory function of the lower limbs that can be included in a toolbox for clinicians and researchers. Methods: An overview of the current state of knowledge was compiled on the basis of a systematic review. The systematic review analysed the psychometric properties of the available measures for assessing lower limb somatosensory function. Subsequently, an expert panel participated in a Delphi study to identify the most important modalities of lower limb somatosensory function in relation to motor outcomes. We developed standardised protocols to assess various somatosensory modalities and investigated validity, reliability, and feasibility in children with UMN lesions. We investigated the relationships between tactile function, body awareness, and motor outcomes. Finally, we developed a sensor-based tool to assess lower limb proprioception and assessed its validity, reliability, and feasibility. Results and conclusions: The toolbox provides outcome measures to assess six modalities of lower limb exteroception, proprioception, and body awareness in children with UMN lesions. The feasibility and psychometric properties of the investigated outcome measures are confirmed as good. The correlations between the individual somatosensory and motor function assessments vary greatly. Structural body awareness and joint position sense showed the highest relationship to motor activity and are included into the core toolbox. Further studies should investigate the validity, reliability, and feasibility of a tactile localisation tasks of the whole lower limb to assess body awareness.
Chronic Patellofemoral Pain Syndrome: A randomised controlled trial based on the international classification of functioning, disability and health
(Queen Margaret University Colege, 2006-08) Syme, Grant
DETERMINING SELECTIVE VOLUNTARY MOTOR CONTROL OF THE LOWER EXTREMITY IN CHILDREN WITH CEREBRAL PALSY
(2018) Balzer, Julia
For physiotherapists working in neuro-paediatric gait-rehabilitation, improving motor control of the lower extremity is a major focus. Nevertheless, our understanding of selective voluntary motor control (SVMC) is in its infancy. This PhD project aimed to contribute to close this gap by investigating the nature of SVMC of the lower extremity in children with cerebral palsy (CP) and providing a psychometric robust yet sensitive measurement instrument for quantifying SVMC. The first study investigated the influence of SVMC and other lower extremity and trunk motor impairments on gait capacity using multiple regression-analyses. Although SVMC was not kept within the final model, these study results revealed the importance of SVMC in relation to muscle strength, trunk control and gait capacity. The aim of the second study was to establish validity and reliability of the German version of the ‘Selective Control Assessment of the Lower Extremity’ (SCALE). Although the psychometric properties of the German SCALE were good, information about its responsiveness is lacking. Accordingly, a systematic review was carried out to identify a SVMC measurement instrument with the highest level of evidence for its psychometric properties and best clinical utility. As the findings showed the absence of appropriate, responsive SVMC measures, the aim of the last study was to modify the existing SCALE to make it more sensitive. Due to the positive findings in relation to the psychometric properties of the SCALE, its procedure was combined with a surface electromyography Similarity Index (SI). The first validity and reliability results of the SCALE-SI are promising and serve as benchmarks when applying the SCALE-SI in future clinical and scientific practice. However, to use the SCALE-SI as an outcome measure for detecting therapy-induced changes of SVMC in children with CP, its responsiveness needs to be evaluated in future studies. Key Words: cerebral palsy, selective voluntary motor control, psychometric properties, lower extremity, gait rehabilitation
Development Of A Balance Recovery Confidence Scale For Community-Dwelling Older Adults
(2022) Soh, Shawn Leng-Hsien
Falls are concerning issues for older people. There is a lack of instruments that measure balance recovery confidence. Balance recovery confidence refers to the perceived ability to arrest falls. Patient-reported outcome measures (PROMs) are used to obtain information directly from the person being cared for. The overall aim of this thesis is to present the development of a PROM that measures balance recovery confidence in community-dwelling older adults. Methods: A sequential series of steps was taken to develop the PROM. First, a literature review was done to understand the self-efficacy theory, types of falls-related psychological concerns, PROMs used, the role of balance recovery control and the development of a PROM for the construct of interest. Four studies were then implemented. The first study systematically reviewed existing falls efficacy-related PROMs for their development, content validity and structural validity. The second study assessed the feasibility of studying near-falls and balance recovery among community-dwelling older adults. The third study constructed and validated the content of the balance recovery confidence scale with 22 community-dwelling older adults and 28 healthcare professionals. The final study assessed the psychometric properties of the newly developed PROM with 84 community-dwelling older adults in Singapore. Results and conclusions: Existing falls efficacy-related PROMs lack high-quality evidence in their development and content validity. The systematic review affirmed an absence of a suitable PROM of balance recovery confidence for community-dwelling older adults. The feasibility study demonstrated that balance recovery was a relatable concept for older adults. A 19-item balance recovery confidence scale was constructed and validated with experts’ consensus. Field testing showed that the scale has excellent psychometric properties, having moderate correlations with the Activities-specific Balance Confidence Scale, Falls Efficacy Scale-International, Late Life Function and Disability Instrument-Function and strong correlation with reactive postural control performance. Keywords: Patient-reported outcome measures, falls efficacy, balance recovery confidence, psychometric properties
THE EFFECTS OF ENHANCED SENSORI-MOTOR REHABILITATION ON INDICES OF FUNCTIONAL PERFORMANCE IN PATIENTS UNDERGOING TOTAL KNEE REPLACEMENT
(2019) Moutzouri, Maria
The primary aim of this thesis addressed a knowledge gap regarding whether sensori-motor training (SMT) stimuli implemented early post-surgery are capable of targeting persisting sensori-motor and neuromuscular deficits in TKR patients’ performance. Therefore, the effects of early enhanced sensori-motor training (ESMET) on self-reported and objective measures of physical function, sensori-motor, neuromuscular, and musculoskeletal performance capabilities of patients undergoing total knee replacement (TKR) were investigated. In order to assess the effects of SMT on patients’ functional mobility and sensori-motor function, as well as indirectly investigating the mechanism underpinning any observed effects, relevant outcome measures used in the literature were reviewed for their clinimetric properties. Indices of functional performance, as reflected by the Timed Up and Go Test (as primary outcome), balance-related performance, sensori-motor performance, neuromuscular performance, muscle size and knee ROM, as well as patient-reported measures (PROMs), were selected on the basis of their clinimetric utility to best reflect the outcome of the SMT intervention. A clinical survey of Greek physiotherapists’ perspectives revealed that contemporary usual care management of TKR-related rehabilitation incorporated in the majority of cases home-based exercises with emphasis on knee ROM and muscle strengthening (Moutzouri et al, 2016b). A first systematic review including studies with IIc-IV level of evidence (Moutzouri et al, 2016c), revealed that patients undergoing TKR surgery experience persisting deficits in static and dynamic balance and incidence of falls remain within the pre-surgery levels. In parallel, a second systematic review evaluating preliminary effects of contemporary functional physiotherapy programmes being augmented by SMT in TKR clinical population, revealed statistically significant greater effects for balance performance but not for functional capabilities. However, the number of studies that had met inclusion criteria was small (n = 5) and the nature of their designs, which had been as pilot studies in the majority of cases, precluded conclusive findings. Following preliminary investigations of reproducibility of measurement and related clinimetric characteristics of outcomes, the main aspect of the thesis reported on the findings of a novel randomised control trial (Moutzouri et al,2017), in which the effects of a newly formulated time-matched sensori-motor exercise training programme [ESMET] was compared with those from a functional exercise training programme [FET] (representing the control condition and usual care practice, and which have been characterised by the findings of the aforementioned clinical survey) during rehabilitation following TKR. Participants (n= 52) were allocated to 12-week programmes of rehabilitation, initiated in the second week post-surgery, and assessed at pre-surgery (0 weeks), 8 weeks post-surgery, and at 14 weeks post-surgery on outcomes which included indices of self-reported and objective measures of physical function, sensori-motor, neuromuscular, and musculoskeletal performance capabilities. The findings revealed significant advantages for the new sensori-motor focused rehabilitation on several outcomes (relative effect size range at 14 weeks post-surgery ~ 0.5 to 2.1), including a significant group by time interaction (F(1.7,82.5)GG = 11.0; p <0.005) for the study’s primary outcome (Timed Up and Go Test), favouring ESMET over FET by ~ 35 %. However, the study’ findings need to be interpreted with caution due to the single-blind nature of the study. Key words: total knee replacement; knee osteoarthritis, Rehabilitation; Balance; sensori-motor training
Effects of reconstruction surgery and individualised rehabilitation on neuromuscular, sensorimotor and musculoskeletal performance in patients with anterior cruciate ligament deficiency
(Queen Margaret University, Edinmburgh, 2016) Yates, Christopher
CONTEXT: Rehabilitation following Anterior Cruciate Ligament (ACL) Reconstruction (ACLR) benefits most patients electing ACLR surgery. Contemporary practice offers limited adaptation of the service to the needs of individual patients. This thesis focuses on a Randomised Control Trial (RCT) that evaluated the effects of a novel formulation of patient-centred musculoskeletal rehabilitation involving the Performance Profiling Technique (Butler and Hardy, 1992). Performance Profile Management (PPM), a programme of rehabilitation, was adapted to incorporate patient-physiotherapist negotiation and agreement on decisions for subsequent rehabilitation and treatment strategies. Therefore, the primary aim of the research was primarily to assess the efficacy of individually-tailored, self-managed rehabilitative care (PPM) in comparison to contemporary (CON) clinical practice. The latter would facilitate an understanding of patient needs and verify the circumstances in which rehabilitation might be enhanced by allowing individuals to play a key role in designing their treatment and recovery. A secondary clinical aim was to evaluate the strength of relationships amongst Patient-Based Outcome Measures (P-BOMs) and Clinician-Based Outcome Measures (C-BOMs). Currently, it is unknown which combination of outcome measures (P-BOMs or C-BOMs) delivers an optimum global assessment of functional and physical performance capabilities during patients' post-surgical rehabilitation. A clinically-relevant and significant association amongst P-BOMs and C-BOMs might indicate correct scaling of patients' own capability perceptions with those measured using objective assessment methods (C-BOMs) and endorse the utility for the clinical use of P-BOMs.
ENHANCING KINEMATIC SHOULDER FUNCTION EVALUATION THROUGH A VALID, SIMPLE AND CLINICALLY APPLICABLE SCORE
(Queen Margaret University, Edinburgh, 2019) Pichonnaz, Claude
Introduction Controversies surrounding Patient-Reported Outcome Measures (PROMs) and the cumbersome-nature of movement analysis-based (MAB) methods for shoulder function evaluation make the exploration of alternatives needed. Research aimed at the simplification of MAB outcome measures had demonstrated previously that the B-B Score, which relies on two movements only, was valid for out-of-laboratory evaluations of shoulder function. Nevertheless, further investigations were needed to optimise testing procedures, test the B-B Score’s capability of acquisition using a user-friendly device, and critically evaluate its measurement properties in comparison to current methods. Objective The aim of this thesis was to develop and assess the simplest possible MAB shoulder function scoring procedure for clinical measurement. Methods The research included four steps: 1) Optimisation of the B-B Score testing procedure (Phase 1 study [data-driven]), 2) Comparison of measurements using a smartphone or an inertial sensor system (Phase 2 study [data-driven]), 3) Validation in frequentlyoccurring pathologies (rotator cuff conditions, instability, fracture, capsulitis) (Phase 3 study [data-driven]), 4) Benchmarking of the new approach with concurrent MAB outcome measures and PROMs (literature review). Results Amongst the tested methods, the B-B score was optimised by using the mean of three replicates in the computation of the range of accelerations by angular velocities. The comparison of easily-used smartphone and reference device showed non-significant differences and excellent relationships between measurements (Intraclass Correlation Coefficient [ICC=0.97]). The smartphone’s B-B Score intra-rater and inter-rater reliability was excellent (ICC=0.92), but limits of agreement could reach up to ±19.4%. The score was responsive (area under the curve [AUC≥0.70]) and demonstrated excellent discriminative power between patients and controls (AUC≥0.90), except for shoulder instability (AUC=0.67). The correlations with PROMs were moderate to high. The benchmarking established that the measurement properties of the B-B Score compared equivalently with those of PROMs and MAB outcome measures, except for shoulder instability. Conclusion Shoulder function can be efficiently evaluated using a simple scoring procedure performed with a smartphone, which facilitates its objective assessment. Further research is needed to understand how best to reduce the effects of variability associated with single measurements in order to optimise clinical applicability and to explore the B-B Score’s properties in other situations requiring functional assessments of the shoulder. . Keywords: shoulder, shoulder function; outcome assessment; validation studies, reliability and validity; inertial sensors; smartphone sensors; body-worn sensors; kinematics; sensitivity and specificity.
FOOT DROP AND FATIGABILITY IN PEOPLE WITH MULTIPLE SCLEROSIS
(Queen Margaret University, Edinburgh, 2019) Andreopoulou, Georgia
People with Multiple Sclerosis (pwMS) often experience walking impairments such as foot drop which can lead to trip and falls. Foot drop can be either transient and is often induced by exercise (fatigability) in pwMS whose walking ability is not affected and can become more fixed with disease progression. The overall aim of this PhD was to explore foot drop, its presence in pwMS with different disability levels and the psychometric properties of outcomes used to evaluate walking impairments. The first study in this thesis was a systematic review into the level of evidence for the psychometric properties of walking measures that have been used to evaluate the effect of assistive technology such as FES for foot drop in MS. Moderate to strong psychometric evidence was found for the Multiple Sclerosis Walking Scale, Timed 25 Foot Walk, 6 minute and 10 meter walk tests. There were no psychometric studies for three-dimensional (3D) gait kinematics in pwMS even though it was one of the most frequently used outcome measures. The second study assessed the test-retest reliability of 3D ankle kinematics and spatiotemporal parameters in pwMS, with low Expanded Disability Status Scale (EDSS < 3.5) and in those with moderate to high EDSS (EDSS: 4-6). Reliability was excellent for ankle kinematics and spatiotemporal parameters in both groups, with lower minimal detectable change (MDC95%) values in the low EDSS group compared to the higher EDSS group. The third study investigated transient exercise induced foot drop in highly physically active pwMS (EDSS < 3.5) and health controls using 3D kinematics. It was found that 6 out of 15 pwMS and none of the healthy controls presented this phenomenon. The fourth study examined the direct orthotic effect of FES during dual-tasking (i.e. walking combined with a cognitive task) and after inducing fatigability. Low to moderate effect sizes indicated that the direct orthotic effect was higher under dual-task and fatiguing conditions but this needs to be confirmed in appropriately powered studies. In conclusion, the studies in this thesis have contributed to the psychometric evidence of gait kinematics in pwMS, have objectively documented the presence of transient foot drop in highly physically active pwMS and orthotic effect of FES under a variety of conditions simulating the perceived benefits in ‘real life’ reported by FES users. Key words: multiple sclerosis, foot drop, fatigability, FES, psychometric properties, 3D gait kinematics
FRAILTY, CARDIOVASCULAR FUNCTION AND RISK OF FALLING AMONGST PATIENTS WITH STAGE 5 CHRONIC KIDNEY DISEASE ON HAEMODIALYSIS
(Queen Margaret University, Edinburgh, 2019) Zanotto, Tobia
This PhD thesis explores the risk of falling of stage 5 chronic kidney disease (CKD-5) patients receiving haemodialysis (HD) therapy. Previous research has suggested that multiple risk factors such as older age, comorbidities, polypharmacy, and frailty contribute primarily to the increased risk of falling in this clinical population. However, HD patients are also characterised by severe cardiovascular disease burden that often manifests with symptoms of orthostatic intolerance, impaired blood pressure control and syncope, all of which may be implicated in the aetiology of falling. The aim of this thesis was to address important research questions, such as: Are frailty and its physical function/activity components associated with falling in CKD-5 patients on HD? Are baroreflex function and the cardiovascular responses to orthostasis also associated with falling? What is the relative importance of frailty and cardiovascular function as potential exercise-modifiable risk factors for falls in this patient group? A prospective observational study involving 76 prevalent HD patients (61.1±14 years) confirmed previous observations that CKD-5 patients on HD are at higher risk of falls compared to the non-uraemic population, as 37.7% of research participants experienced at least one fall during a 12-month follow-up, and the incidence of falls recorded was 1.16 falls/person-year. Although participants classified as fallers did not appear to differ from non-fallers in single physical function measures such as timed-up and go (TUG), 5 repetitions chair sit to stands (CSTS-5), or muscle strength, frailty and lower postural balance were associated with increased odds of falling. In addition, baroreflex function indices reflecting frequency of baroreflex activation, as well as the blood pressure response to a five-minute 60° head-up tilt test (HUT-60°) were associated with increased odds of falling and a greater number of falls. More importantly, we showed that modelling the risk of falling by adding a cardiovascular function variable to a frailty-only model improved significantly the prediction of number of falls experienced by CKD-5 patients on HD. Overall, this PhD thesis revealed that cardiovascular mechanisms implicated in the short-term regulation of blood pressure showed a greater relative importance than frailty in predicting falls in the study participants. These findings challenge the current assumption that frailty is the primary factor involved in the aetiology of falls in CKD-5 patients on HD. The clinical implications of this novel observation are also discussed from a preventive and rehabilitative perspective. Key words: Stage 5 chronic kidney disease, haemodialysis, falls, frailty, cardiovascular function.
Interrelationships and Effects of Accelerated Rehabilitation Conditioning and Gene Polymorphism on Functional and Physical Responsiveness of People Recovering from Anterior Cruciate Ligament Reconstruction Surgery
(Queen Margaret University, Edinburgh, 2014) Alkitani, Abdulhameed
Chapter one of this thesis offered a general insight on the anterior cruciate ligament (ACL) injury and the outcome measures of ACL rehabilitation while chapter two was a systematic review on the effects of “accelerated rehabilitation” after ACL reconstruction surgery. The review concluded that 5 out of 10 randomised control trial studies had demonstrated moderate relative effect sizes in terms of improved knee laxity, neuromuscular performance, range of motion and some patient-reported outcome measures following accelerated rehabilitation for patients with ACL reconstruction. Chapter three was a systematic review in which the genetic influence on responsiveness to strength conditioning and the outcomes of knee after ACL reconstruction were investigated. The findings revealed that intra-genotypic responses to strength conditioning were heterogeneous and that duration, intensity and frequency of strength conditioning were factors that contributed to the differential responses of genotypes in regulating gains in strength.
Investigating the experiences of people with 'RSI: an internet based qualitative study
(Queen Margaret University, 2009) Watson, Mohinder
This internet-based qualitative study aimed to explore the subjective experience of having Repetitive Strain Injury (RSI) using an 'insider's perspective' (Schneider and Conrad, 1983). A purposive sample of RSI sufferers was recruited from an online support group covering diverse experiences across different age groups, gender, occupations, health care use and both clinically recognised RSI conditions and diffuse nonspecific RSI. Data triangulation involving documentary analysis of 468 archived email postings and 5 asynchronous online focus groups (n=57) was used to illuminate different aspects of RSI sufferers' experiences. Data from each method was thematically analysed and the findings integrated. Firstly, methodologically the internet medium was found to be a valuable additional tool for accessing illness experiences. Further, the essence of the RSI experience was conceptualised as a major life change and uncertainty affecting people's employment, social participation and ability to perform routine daily activities such as caring for themselves, family members and the home. Also changed were their identities, financial circumstances and relationships both in and outside of work. RSI was found in the study to bear the hallmarks of a chronic pain condition with attendant implications for management and diagnosis. The significance and meaning of a medical diagnosis was found to extend far beyond establishing 'what was wrong'; it became a quest for evidence to support the reality of their suffering and a means of defending threats to their integrity and identity. The implications of these findings are discussed in the context of current chronic pain management which places less emphasis on finding a diagnosis on the premise that regardless of aetiology, the problems encountered are similar across different chronic pain conditions, and it is more useful to restore functioning and reduce disability. However, this study shows that the significance of a diagnosis should not be under- estimated since for the individual with RSI, it carries multiple meanings and profound consequences for their daily lives.
Laboratory and Clinical Investigation into Lower Limb Ischaemic Pain, and the Effect of Transcutaneous Electrical Nerve Stimulation (Tens) on Measures of Pain and Walking Performance
(Queen Margaret University, Edinburgh, 2013) Seenan, Christopher
Aims: The aims of this programme of research are to investigate the subjective description of ischaemic pain and to investigate the effects of TENS on lower limb ischaemic pain and walking performance in patients with Intermittent Claudication (IC). Methods: Four studies were conducted: two in the laboratory and two clinical trials. Laboratory- The first study investigated the reliability of a method of inducing lower limb ischaemic pain in healthy volunteers, the modified Submaximal Effort Tourniquet Test (mSETT). The second investigated the effects of High Frequency TENS (HF-TENS) and Placebo TENS (P-TENS) on lower limb ischaemic pain induced using the mSETT in healthy volunteers. Clinical- The first clinical study investigated the effects of HF-TENS and Low Frequency TENS (LF-TENS) on measures of pain and treadmill walking performance in patients with Peripheral Arterial Disease (PAD) and IC. The second examined patients' experiences of using TENS at home for PAD and IC. Results: The mSETT was found to have good test-retest reliability and induce pain similar in quality to that experienced by patients with IC. The pain experience induced with the mSETT was reduced by both HF- and P-TENS compared to baseline. HF-TENS however was more effective compared to P-TENS in this regard, prolonging time to pain threshold and tolerance whilst reducing the levels of pain reported throughout. In patients with PAD and IC, HF and LF-TENS interventions were found to increase maximum walking distance on a treadmill compared to P-TENS. HF-TENS was also found to increase pain-free walking distance. The experience of using TENS in daily life was characterised by feelings of both benefit and disappointment. This was interpreted through the following themes: (i) 'masking, but not taking the pain away' and (ii) 'walking further, but not far enough'. Conclusions: The mSETT is a reliable method of inducing lower limb, ischaemic pain in healthy volunteers and could be useful for the purposes of pre-clinical analgesic trials and investigation of the ischaemic pain experience. HF-TENS was found to reduce mSETT pain indicating hypoalgesic effects of TENS in experimentally induced, lower limb ischaemic pain. HF and LF-TENS have potential as interventions that increase walking performance for patients with IC. If using TENS at home for IC, expectations of treatment effect need to be managed to avoid disappointment and feelings of frustration.
Myofascial trigger points and innervation zone locations in upper trapezius muscles
(Queen Margaret University, Edinburgh, 2016) Barbero, Marco
Myofascial pain syndrome is characterized by sensory, motor and autonomic symptoms, and a myofascial trigger point (MTrP) is considered the principal clinical feature. Clinicians recognise myofascial pain syndrome as an important clinical entity but many basic and clinical issues need further research. Electrophysiological studies indicate that abnormal electrical activity is detectable near MTrPs. This phenomenon has been described as endplate noise and it has been purported to be associated MTrP pathophysiology. Authors also suggest that MTrPs are located in the innervation zone (IZ) of muscles. The aim of this thesis was to describe both the location of MTrP and the IZ’ locations in the upper trapezius muscle. The hypothesis was that distance between the IZ and the MTrP in upper trapezius muscle is equal to zero. This thesis includes two preliminary studies. The first one address the reliability of surface electromyography (EMG) in locating the IZ in upper trapezius muscle, and the second one address the reliability of a manual palpation protocol in locating the MTrP in upper trapezius muscle. The intrarater reliability of surface EMG in locating the IZ was almost perfect; with Kappa = 0.90 for operator A and Kappa = 0.92 for operator B. Also the interrater reliability showed an almost perfect agreement, with Kappa = 0.82. Both the operators conducted 900 estimations of IZ’ location through visual analysis of the EMG signals. The reliability of an experienced physiotherapist using a manual palpation protocol in locating the MTrP in the upper trapezius was established. An anatomical landmark system was defined and MTrP’ location established using X and Y values. The ICC values were 0.62 for X and 0.81 for Y. Twenty-four subjects with MTrP in upper trapezius were enrolled for this latter study. MTrP’ and IZ’ locations were described in 48 subjects. MTrPs were located in well-defined areas of the upper trapezius, showing a typical location with a mean distance from the IZ of 10.4 ± 5.8 mm. MTrPs in the upper trapezius are proximally located to the IZ but not overlapped by it (p = 0.6). These results extend the body of knowledge regarding the phenomenon of MTrP iperalgesia.
Outcome measures of physical function in adult unilateral lower limb amputees during prosthetic rehabilitation: use in clinical practice and psychometric properties
(Queen Margaret University, Edinburgh, 2016) Scopes, Judy
The aim of this thesis is to inform clinicians and researchers of the reliability and responsiveness of the most commonly used outcome measures in prosthetic rehabilitation in the UK. In addition, this thesis supports the call for more studies of high methodological quality to provide evidence of the psychometric properties of outcome measures of physical function in lower limb amputees. A survey (study I) of Allied Health Professionals established that the outcome measures used most often during prosthetic rehabilitation in the UK were: the Timed Up and Go (TUG), a timed walk test, the Locomotor Capability Index (LCI) and its modified version (LCI-5), the Socket Comfort Score (SCS) and the Special Interest Group in Amputee Medicine (SIGAM) Mobility Grades. A standardised quality checklist (COSMIN) was used in a systematic review (study II) to measure the methodological quality and strength of evidence of the published literature that reported on the psychometric properties of outcome measures used to measure physical function during prosthetic rehabilitation. The review found mixed methodological quality ratings and many studies with small sample sizes rendering the strength of the evidence indeterminate. A limited number of studies commented on limits of agreement and measurement error when reporting on reliability. Even fewer studies reported on responsiveness with only one reporting minimally clinically important difference (MCID) values. Values for consistency, agreement and measurement error, were calculated for the top five commonly used outcome measures as identified from the survey, using a test-retest study design with a period of 7 days between tests (study III). Minimum detectable change (MDC) values were calculated for the SIGAM, LCI-5, TUG and 2MWT. The EQ-5D-5LTM, a measure of the global health of the respondent, was also included as knowledge of its psychometric properties in a population of pwLLA is unknown. However, reliability could not be confirmed for the EQ-5D-5L or the SCS in this population. A longitudinal study (study IV), based during the early rehabilitation period (mean 84 days) following provision of a primary prosthesis, gathered data to calculate indices of responsiveness for the same six outcome measures. Effect sizes were presented for five measures: SIGAM, LCI-5, TUG, 2MWT, SCS and EQ-5D-5L. Minimal clinically important difference values were also presented for the first time for all the outcome measures in this population. A patient reported change questionnaire was used as the anchor in a Receiver Operator Characteristic (ROC) curve analysis to establish the MCID values.
Peri-surgical changes in functional capabilities associated with reconstructive knee surgery
(2017) Peer, Maria
This thesis, using a meta-analytical review of the literature and a controlled longitudinal cohort trial, addresses a knowledge gap regarding peri-surgical changes in self-reported and objective measures of physical function, neuromuscular and sensorimotor performance capabilities of patients undergoing total knee arthroplasty (TKA). Responsiveness and patterns of change in perceived exertion (Borg Category-Ratio Scale [CR-10]), perceived task duration (PTD) and neuromuscular performance during an intermittent isometric fatigue task (IIF) were also investigated. Twenty-six individuals (50 % female, 66.8 ± 1.4 years) underwent evaluation at 3 and ~12 weeks pre-surgery, and again at 6 and 12 weeks post-operatively. Patient-reported outcomes including the Knee injury and Osteoarthritis Outcome Score (KOOS), Oxford Knee Score (OKS), 36-Item Short Form Health Survey (SF-36), Performance Profile and International Physical Activity Questionnaire demonstrated significant changes in peri-surgical functional status. Significant time related interactions between operated and control legs were observed for range of movement, knee circumference and neuromuscular performance indices of volitional peak force (PFV), rate of force development, rate of force relaxation, electromechanical delay activation and relaxation (vastus medialis). Items of the KOOS (pain and activities of daily living), OKS and SF-36 (role emotional) and PFV demonstrated significant differences at three weeks pre-surgery compared to baseline. Differences in the rate of change of performance at week 6 and week 12 post-surgery contributed most to the overall interactive- and main effect-related changes in the selected outcome measures. In estimating patient perceptions of exercise stress in an environment mimicking aspects of self-managed rehabilitative conditioning, the Borg Category-Ratio Scale and PTD showed a differential pattern of change during a novel IIF, with the latter perceptual tool showing congruency with patterns of objective fatigue-related loss of performance. This thesis provides the most comprehensive evaluation of peri-surgical physical function using patient-reported and objective (physical and physiological performance) outcomes. Further, this study is the first to contribute insight into how people undergoing TKA perceive exercise exertion and task duration. The research presents possible directions of future research to optimise physical function of TKA recipients.
Physical activity, physical function and arterial stiffness of people undergoing maintenance haemodialysis for stage 5 chronic kidney disease
(Queen Margaret University, Edinburgh, 2015) Prescott, Sean
This thesis addresses current issues regarding assessment of physical activity (PA) and physical function (PF) status of haemodialysis (HD) patients, specifically: What is the recommended wear time to provide a reliable accelerometer estimate of habitual PA and sedentary behaviour? Can similar outcomes from different accelerometers be used interchangeably? Do subjectively and objectively estimated PA outcomes agree closely enough to be pooled? Which PF assessments are potentially most ‘useful’? This thesis also explores potential risk factors of arterial stiffness, a strong predictor of mortality in this population. A PA reliability study involving 70 maintenance HD patients (55.9 ± 15.7 years) over a seven-day monitoring period indicated one dialysis day and two non-diaysis days with a minimum of eight hours wear per day would provide reliable estimates of PA and sedentary behaviour regardless of accelerometer employed, and allowed 90% sample retention. Concordance studies indicated broad agreement for similar outcomes obtained via ActivPAL and Actigraph GT3X accelerometers but they were not interchangeable. ActivPAL is recommended for monitoring steps taken and time seated, Actigraph activity count output for total/overall PA. Questionnaire and accelerometer estimated PA outcomes may not be used interchangeably or pooled. More of the shared variance of physical performance was explained by clinical, demographic and habitual PA factors than for self-reported functional status thus recommending the former. Age, blood pressure and HD vintage were determinants of arterial stiffness, however PA and cardiorespiratory fitness did not appear to be risk factors in this sample. This thesis makes clear recommendations regarding implementation of PA and PF assessment methods, and illustrates their application on sample retention, as well as characterising and potentially identifying individuals at risk of poor outcomes. Emergence of HD vintage as a risk factor for arterial stiffness underscores the need for further research into adjunctive lifestyle interventions to manage health threats in this population.
PLAYING-RELATED MUSCULOSKELETAL DISORDERS AMONG MUSIC STUDENTS IN EUROPE
(2023) Cruder, Cinzia
Background and aims: The achievement and improvement of musical competences and technical abilities to reach the highest levels of performance may expose music students to a wide range of playing-related musculoskeletal disorders (PRMDs). The main aim of the present thesis was to longitudinally identify the factors associated with increased risk of PRMD onset among music students enrolled in different pan-European music institutions. Further goals were to determine the prevalence and incidence of PRMDs amongst music students during their training, as well as to describe and characterise the study population. Methods: 850 students from 56 European conservatories and music universities completed a web-based questionnaire on lifestyle and physical activity participation levels, musical practice habits, behaviours toward prevention, health history and PRMDs, as well as psychological distress, perfectionism and fatigue. The onset of PRMDs was assessed prospectively at 6 and 12 months. Results: At baseline, 560 participants (65.0%) self-reported a positive history of MSK complaints in the previous 12 months, 408 (48.0%) of whom self-reported PRMDs. Self-reported PRMDs were significantly associated with coming from West Europe (RRR=4.524; RRR>1), being a first- or a second-year Masters student (RRR=2.747; RRR>1), having more years of experience (RRR=1.040; RRR>1) and higher rates of perceived exertion after 45 minutes of practice without breaks (RRR=1.044; RRR>1). The incidences of PRMD onset at 6 and 12 months were 28.8% and 49.0%, respectively. Longitudinally, changes in physical activity level (both increase and decrease; 6-month AOR=2.343, 12-month-AOR=2.346; AOR>1), increased levels of fatigue (6-month AOR=1.084, 12-month-AOR=1.081; AOR>1) and increased level of socially-prescribed perfectionism (6-month AOR=1.102; AOR>1) were significantly associated with PRMD onset. The presence of MSK complaints at baseline (6-month AOR=0.145, 12-month-AOR=0.441; AOR<1), as well as changes to BMI and to levels of psychological distress (12-month AOR=0.663 and 0.914, respectively; AOR<1) retarded the onset of PRMDs. Conclusions: Cross-sectional and longitudinal findings showing high prevalence and incidence of PRMDs amongst music students, have been critically appraised as potential correlates, determinants and factors in the development of PRMDs. The findings offer contextualisation for revisiting contemporary evidence-based preventive strategies and optimisation of tailor-made interventions aimed at minimising the impact of PRMDs.