Dans les pathologies ostéo-articulaires, les critères d’évaluation rapportés par les patients (Patient-Reported Outcomes ou PROs) sont désormais les critères de jugement incontournables, réclamés par les autorités sanitaires et les organismes de régulation. La validation de leurs propriétés psychométriques et leur adaptation transculturelle sont donc indispensables pour pouvoir les utiliser dans les essais thérapeutiques internationaux. Ce processus complexe de validation transculturelle permet d’élaborer une version du PRO dans le langage cible qui prenne en considération tous les spécificités socioculturelles et les équivalences linguistiques.Ce travail de thèse a comme problématique la validation transculturelle des PROs spécifiquement développés pour les pathologies du genou et de la hanche. Après avoir explicité les recommandations publiées dans ce domaine puis avoir réalisé une revue de la littérature de la qualité méthodologique des auto-questionnaires disponibles pour ces pathologies articulaires, nous avons entrepris les validations transculturelles du questionnaire KOOS (ou Knee injury and Osteoarthritis Outcome Score), du questionnaire HOOS (ou Hip disability and Osteoarthritis Outcome Score) et de leurs formes réduites (KOOS-PS et HOOS-PS pour Physical function Short form). Ces auto-questionnaires, développés en langue anglaise au cours de la dernière décennie, permettent d’évaluer de manière globale (symptômes, retentissement fonctionnel dans les activités quotidiennes et sportives, qualité de vie) des pathologies du genou ou de la hanche, aussi bien traumatiques que dégénératives. Après traduction et adaptation française selon les recommandations internationales, les versions françaises du KOOS, du HOOS, du KOOS-PS et du HOOS-PS ont ensuite été validées de manière prospective dans des cohortes françaises bi-centriques de patients arthrosiques suivis en milieu rhumatologique et orthopédique. Les résultats de ces travaux, publiés sous la forme de trois articles originaux, démontrent que les propriétés psychométriques des versions françaises de ces questionnaires sont satisfaisantes quelle que soit la sévérité de l’arthrose, en terme de faisabilité, de cohérence interne, de reproductibilité, de validité et de sensibilité au changement (après mise en place de prothèse totale ou viscosupplémentation par acide hyaluronique). Ces PROs capturent des concepts supplémentaires pertinents, comme le retentissement sur les activités sportives ou la qualité de vie, et permettent avec le même outil de mesure le suivi longitudinal de patients, depuis l’atteinte traumatique jusqu’à l’arthrose. Ils améliorent ainsi l’évaluation globale des pathologies du genou et de la hanche. La validation exhaustive, y compris transculturelle, permet à ce jour de considérer les questionnaires KOOS et le HOOS comme des PROS de référence. A ce titre, leur utilisation dans les essais thérapeutiques internationaux doit être encouragée. / In joint diseases, Patient-Reported Outcomes (PROs) are now critical outcome measures, required by health authorities and regulatory agencies. Cross-cultural adaptation and validation of the psychometric properties of such PROs are needed in order to use them in international therapeutic trials. Thanks to this complex process of cross-cultural validation, the PRO in the target language can take into account the specific socio-cultural features and the linguistic equivalences. The aim of this thesis was to undertake the cross-cultural validation of PROs specifically developed for knee and hip disorders. After explaining the published recommendations for cross-cultural adaptation and then conducting a thorough review of reports dealing with the methodological evaluation of self-administered questionnaires in these joint diseases, we carried out the cross-cultural validation of the KOOS questionnaire (Knee injury and Osteoarthritis Outcome Score), the HOOS questionnaire (Hip disability and Osteoarthritis Outcome Score) and their shortened versions (KOOS-PS and HOOS-PS for Physical function Short form). In the last ten years, these self-administered questionnaires were developed in English to assess the patients’ opinion (symptoms, functional disability in activities of daily life or sports activities, quality of life) about their knee and hip problems, both for traumatic and degenerative joint diseases. Following a translation and cross-cultural adaptation in French in accordance with international recommendations, the French versions of the KOOS, HOOS, KOOS-PS and HOO-PS were validated in a bi-centric prospective study of osteoarthritis patients treated in two rheumatology and orthopedics departments. The results of this work, published as three original articles, demonstrate that the psychometric properties of the French versions of these questionnaires are satisfactory in terms of feasibility, internal consistency, reliability, validity and responsiveness (following total hip or knee replacement or intra-articular injection of hyaluronic acid), whatever the degree of severity of osteoarthritis. By capturing additional relevant concepts such as functional disability in sports activities or quality of life and allowing the longitudinal follow-up of patients (from traumatic lesions to osteoarthritis), with the same measurement tool, theses PROs improve the overall assessment of hip and knee disorders. In the light of the exhaustive validation, including cross-cultural adaptation, the KOOS and HOOS questionnaires can now be considered as references PROs in hip and knee disorders and their use in international therapeutic trials should be encouraged.

Dans les pathologies ostéo-articulaires, les critères d'évaluation rapportés par les patients (Patient-Reported Outcomes ou PROs) sont désormais les critères de jugement incontournables, réclamés par les autorités sanitaires et les organismes de régulation. La validation de leurs propriétés psychométriques et leur adaptation transculturelle sont donc indispensables pour pouvoir les utiliser dans les essais thérapeutiques internationaux. Ce processus complexe de validation transculturelle permet d'élaborer une version du PRO dans le langage cible qui prenne en considération tous les spécificités socioculturelles et les équivalences linguistiques.Ce travail de thèse a comme problématique la validation transculturelle des PROs spécifiquement développés pour les pathologies du genou et de la hanche. Après avoir explicité les recommandations publiées dans ce domaine puis avoir réalisé une revue de la littérature de la qualité méthodologique des auto-questionnaires disponibles pour ces pathologies articulaires, nous avons entrepris les validations transculturelles du questionnaire KOOS (ou Knee injury and Osteoarthritis Outcome Score), du questionnaire HOOS (ou Hip disability and Osteoarthritis Outcome Score) et de leurs formes réduites (KOOS-PS et HOOS-PS pour Physical function Short form). Ces auto-questionnaires, développés en langue anglaise au cours de la dernière décennie, permettent d'évaluer de manière globale (symptômes, retentissement fonctionnel dans les activités quotidiennes et sportives, qualité de vie) des pathologies du genou ou de la hanche, aussi bien traumatiques que dégénératives. Après traduction et adaptation française selon les recommandations internationales, les versions françaises du KOOS, du HOOS, du KOOS-PS et du HOOS-PS ont ensuite été validées de manière prospective dans des cohortes françaises bi-centriques de patients arthrosiques suivis en milieu rhumatologique et orthopédique. Les résultats de ces travaux, publiés sous la forme de trois articles originaux, démontrent que les propriétés psychométriques des versions françaises de ces questionnaires sont satisfaisantes quelle que soit la sévérité de l'arthrose, en terme de faisabilité, de cohérence interne, de reproductibilité, de validité et de sensibilité au changement (après mise en place de prothèse totale ou viscosupplémentation par acide hyaluronique). Ces PROs capturent des concepts supplémentaires pertinents, comme le retentissement sur les activités sportives ou la qualité de vie, et permettent avec le même outil de mesure le suivi longitudinal de patients, depuis l'atteinte traumatique jusqu'à l'arthrose. Ils améliorent ainsi l'évaluation globale des pathologies du genou et de la hanche. La validation exhaustive, y compris transculturelle, permet à ce jour de considérer les questionnaires KOOS et le HOOS comme des PROS de référence. A ce titre, leur utilisation dans les essais thérapeutiques internationaux doit être encouragée.

Syfte Syftet med föreliggande studie var att undersöka genomförbarheten av en hög-intensiv träningsintervention efter knäplastikoperation samt hur knäplastikopererade personers självvalda gånghastighet, maximal vadmuskelstyrka, vadmuskeluthållighet och självupplevda symptom, smärta, ADL funktion och hälsorelaterad livskvalité påverkas av tidigt insatt hög-intensiv styrketräning av vadmuskulaturen. Metod Femton forskningspersoner randomiserades till en träningsgrupp (n=7), som utförde hemträningsprogram i form av hög-intensiv vadmuskelträning samt till en kontrollgrupp (n=8) som utförde samma rehabiliteringsprogram som träningsgruppen utan hög-intensiv vadmuskelträning. En testprocedur genomfördes 3 respektive 12 veckor efter knäplastikoperationen. Självvald gånghastighet mättes genom ett 30 meters gångtest, vadmuskeluthållighet mättes med ett standardiserat tåhävningstest på ett ben, maximal isometrisk vadmuskelstyrka mättes med hjälp av en isometrisk dynamometer och självskattad symptom, smärta, ADL funktion och livskvalité utvärderades genom Knee injury Osteoarthritis Outcome Score (KOOS). Resultat Denna studie påvisar viss problematik med följsamheten i träningsregim för båda grupperna. Båda gruppernas sammanslagna resultat uppvisade signikant förbättrad självvald gånghastighet, maximal vadmuskelstyrka och uthållighet över tid. Trots detta ökade träningsgruppen den självvalda gånghastigheten signifikant mer än kontrollgruppen över tid. Träningsgruppen hade även mindre besvär på grund av smärta 12 veckor efter operationen. Båda gruppernas sammanslagna resultat förbättrades över tid gällande deras egen skattning av symptom, smärta, ADL funktion och livskvalité. Däremot förbättrade träningsgruppen alla variabler signifikant medan det för kontrollgruppen endast var livskvalitén som förbättrades signifikant över tid. Konklusion Tidigt insatt hög-intensiv vadmuskelträning efter knäplastikoperation är genomförbart och kan ha en viss positiv effekt på personens egen upplevelse av symtom, smärta, funktion och hälsorelaterad livskvalité. Självvald gånghastighet förefaller öka mer vid tidigt insatt hög-intensiv vadmuskelträning efter nio veckors träning jämfört med samma rehabiliteringsprogram utan hög-intensiv vadmuskelträning. / Aim The aim of this study was to determine the feasibility of a high-intensive exercise intervention following a knee arthroplasty, and also to evaluate possible effects on self-selected walking speed, calf muscle strength and self-rated symptoms, pain, ADL function and quality of life after high-intensive calf muscle training in an early post-operative phase. Method Fifteen participants were randomized into an exercise group (n=7), who performed a home-exercise program, consisting of high-intensive calf muscle exercise, and into a control group (n=8) who performed the same rehabilitation program but without the high-intensive calf muscle training. A test procedure was conducted after 3 and 12 weeks following the knee arthroplasty. Self-selected walking speed was measured by a 30 meter walking test, calf muscle endurance training was measured with a standardized one-leg heel-rise test, maximal isometric calf muscle strength was measured with an isometric dynamometer, and self-rated symptom, pain, ADL function and quality of life were evaluated with Knee injury Osteoarthritis Outcome Score (KOOS). Results There were problems with adherence to exercise regimes in both groups. The results of both groups demonstrated improved self-selected walking speed, calf muscle endurance and maximal isometric calf muscle strength over time. However, the exercise group increased self-selected walking speed more than the control group. The exercise group reported fewer disorders due to pain 12 weeks after surgery. The results of both groups showed improved self-rated symptoms, pain, ADL function and quality of life over time, however, the exercise group improved all these variables significantly, while the control group significantly improved the quality of life aspect. Conclusions Early initiated high-intensive calf-muscle training following a knee artroplasthy is feasible and may have positive effects on self-rated symptoms, pain, ADL function and quality of life. Also, self-selected walking speed increased more with early initiated high-intensive calf muscle training after nine weeks when compared to the same rehabilitation program without high-intensive calf muscle training.

Introduction: Arthroscopic partial resection of degenerative meniscal injuries has previously been frequently performed but has been questioned in recent years. However, contradictory data exist. Aim: We aimed to asses patient- reported outcome in patients over 40 years of age after arthroscopic surgery due to degenerative meniscal injury. We further aimed to compare women and men due to diagnosis and to examine the number of patients that have needed knee arthroplasty during the follow-up period. Methods: Patients > 40 years of age who underwent arthroscopic surgery of the knee in the years of 2011-2013 were studied using validated questionnaire KOOS (Knee Injury and Osteoarthritis Outcome Score) along with a self-constructed questionnaire. Results: In all subjects, the highest median score was seen in all daily living (Women:93, Men: 96) and knee pain (Women: 86, Men: 92). The lowest score was seen in sports and recreation (Women: 55, Men: 65). Men had an overall higher KOOS-score in every subscale compared to women (p>0.05). No significant difference was seen between women and men divided by diagnosis (p>0.05). 72% women and 80% men experienced improved knee function today compared to before surgery. 22% women and 14% men experienced deterioration in knee function. 6% women and men experienced unaltered knee function. 24 patients (9.5%) had got a knee arthroplasty. Conclusions: This study showed that most middle-age patients experienced increased knee function and high satisfaction rate after partial meniscectomy when suffering from degenerative meniscal injury.

Thesis (MA)--Stellenbosch University, 2013. / ENGLISH ABSTRACT: Traditionally the body has been neglected within Western philosophical thought. In this tradition man is seen as a dualist organism whose mind is more highly valued than his or her body. Since the start of the twentieth century, especially, there has also been Western thinkers who deconstruct the traditional, opposisional view of the mind and body. Most of these thinkers are men, and they argue from a male perspective. The deconstruction of the opposition between mind and body is, however, also useful for feminism, as the woman was traditionally seen as more bodily, and less rational, than the man. This view of woman can be used to support arguments that her place is within the home, where she should look after the bodily and emotional needs of her husband and children. First and second wave feminists criticised above-mentioned traditional view of women by arguing that the woman is just as rational as the man. Other feminists make use of the 'male' criticism of the body-mind opposition by arguing that traditionally female attributes and activities are not less valuable than male ones. In this thesis it is argued that the novellas Klaaglied vir Koos, Erf and Louoond should be read against this background as feminist texts in which the traditionally female space of the kitchen is celebrated as a space in which the female subject can create art and develop a perspective on the outside world. Focusing on the body and on traditionally female values (such as the domestic space) have implications for, amongst others, epistemology, ethical thought and literary theory. The way these implications are developed in the three novellas are explored in this thesis. Domestic spaces are not only celebrated in these texts, they are also represented as problematical, limited spaces which isolate the protagonists of the novellas and withhold them from the potential of political solidarity. The novellas are therefore treated in this thesis as complex texts in which the literary focus on domestic space, female embodiment and man‘s relationship with food is both celebrated and problematised. / AFRIKAANSE OPSOMMING: Tradisioneel is die liggaam afgeskeep in die Westerse filosofie. Binne hierdie tradisie is die mens beskou as ‘n dualistiese organisme wie se verstand meer waardevol is as sy of haar liggaam. Veral sedert die begin van die twintigste eeu is daar ook Westerse denkers wat die tradisionele, opposisionele siening van die liggaam en die verstand dekonstrueer. Die meeste van hierdie denkers is mans en neem slegs die manlike perspektief in ag. Die dekonstruksie van die opposisie tussen liggaam en verstand is egter ook nuttig vir die feminisme, omdat die vrou tradisioneel gesien is as meer liggaamlik en minder rasioneel as die man. Hierdie tradisionele siening van die vrou kan gebruik word om te argumenteer dat haar plek in die huishoudelike ruimte is, waar sy kan omsien na die liggaamlike en emosionele behoeftes van haar man en kinders. Eerste- en tweedegolf-feministe het bogenoemde tradisionele opvattings veral gekritiseer deur te argumenteer dat die vrou net so rasioneel soos die man is. Latere feministe bou egter voort op 'manlike‘ kritiek teen die opposisie tussen liggaam en verstand deur te argumenteer dat tradisioneel vroulike eienskappe en aktiwiteite nie minder waardevol is as sogenaamde manlike eienskappe nie. In hierdie tesis word geargumenteer dat die novelles Klaaglied vir Koos en Erf deur Lettie Viljoen en Louoond deur Jeanne Goosen teen hierdie agtergrond gelees kan word as feministiese tekste waarin die tradisioneel vroulike ruimte van die kombuis gevier word as ‘n ruimte waarin die vroulike subjek ‘n perspektief op die buitewêreld kan ontwikkel en kuns kan skep. ʼn Fokus op die liggaam en op tradisioneel vroulike elemente (soos die huishoudelike ruimte) behels implikasies vir onder andere die epistemologie, etiese denke en literêre teorie. Hierdie implikasies word verken soos wat hulle na vore kom in die drie novelles. In die novelles word die huishoudelike ruimte egter ook uitgebeeld as ʼn problematiese, beperkende ruimte wat die hoofkarakters van die novelles afsny van die buitewêreld en van die moontlikheid van politieke solidariteit. Daar word geargumenteer dat die novelles dus komplekse tekste is waarin literatuur wat fokus op die huishoudelike ruimte, vroulike liggaamlikheid en die mens se verhouding met kos sowel gevier en geproblematiseer kan word.

In her lifetime Jacoba Elizabeth (Nonnie) de la Rey, née Greeff (1856-1923) was widely known not only for being the wife of the eminent General Koos de la Rey, but also for her exceptional tenacity during the Second Anglo-Boer War (1899-1902). From December 1900 to the conclusion of the war in May 1902 she and her children lived a nomadic life. Nonnie's experiences were recorded in her memoirs, Mijne omzwervingen en beproevingen gedurende den oorlog, which were published in Amsterdam in 1903. Shortly thereafter – also in 1903 – the English edition, A Woman's Wanderings and Trials During the Anglo-Boer War, as translated by Lucy Hotz, was published in Londen. The 18 months that Nonnie spent wandering through the country probably constitute the most important phase of her life, but she experienced a great deal more, which she recorded in another memoir. Her childhood and pioneer's life are well documented. At the age of eighteen Nonnie met Jacobus Herculaas de la Rey; they were married on 24 October 1876 and settled in the vicinity of Lichtenburg. The period from 1880 to 1899 constitute a kaleidoscope of events in Nonnie's life, for example the First Anglo-Boer War (1880-1881), the loss of Nonnie's father and mother, and a move to the farm Elandsfontein. The South African War broke out in 1899. Nonnie's life during the war years can be divided into two phases, namely the period when she lived in Lichtenburg (October 1899 to November 1900), and the period characterised as her wandering years (December 1900 to May 1902). Events in Nonnie de la Rey's life from 1902 to 1923 include their official visit to Europe, the restoration of Elandsfontein, Union (1910) and Koos de la Rey's political involvement, the Rebellion of 1914 and the death of Koos de la Rey. In her final years Nonnie was involved with various organisations. She was an eminent presence in her community, being revered as a “volksmoeder” by her compatriots. She died in 1923. / Dissertation (MHCS)--University of Pretoria, 2005. / Historical and Heritage Studies / unrestricted

Text in Afrikaans / ’n Merkbare opbloei in die publikasie van literêre niefiksietekste wêreldwyd het gelei tot die klassifikasie van sodanige tekste as ’n vierde genre. Die politieke oorgang in Suid-Afrika in 1994 het gelei tot ’n soortgelyke toename in outobiografiese tekste waarin kommentaar gelewer word op die Suid-Afrikaanse politieke werklikheid deur die vertel van sowel persoonlike as kollektiewe geskiedenisse. Daymond en Visagie (2012) identifiseer outo-etnografie, apologie en belydenis as kenmerke van die Suid-Afrikaanse outobiografie ná 1994. In hierdie navorsingsverslag word enkele resente skrywersoutobiografieë van onderskeidelik Elsa Joubert (’n Wonderlike geweld: jeugherinneringe (2005); Reisiger (2009)), André P. Brink (’n Vurk in die pad (2009)) en Koos Kombuis (Seks & drugs & boeremusiek: die memoirs van ‘n volksverraaier (2000); Die tyd van die Kombi’s: ‘n persoonlike blik op die Afrikaanse rock-rebellie (2009)) gemeet aan die kriteria wat deur Daymond en Visagie voorgestel word. Die beskrywing en interpretasie van verskeie outo-etnografiese merkers lei daartoe dat hierdie outobiografieë as ’n vorm van kulturele introspeksie beskou kan word. / A marked proliferation in the publication of literary nonfiction globally led to the classification of such texts as a fourth genre. The political transition in South Africa in 1994 caused a similar increase in autobiographical texts in which commentary is offered on the South African political reality through the telling of both personal and collective histories. Daymond and Visagie (2012) identify autoethnography, apologia and confession as characteristics of post-1994 South African autobiographies. In this research report some contemporary writers’ autobiographies, respectively those of Elsa Joubert (’n Wonderlike geweld: jeugherinneringe (2005); Reisiger (2009)), André P. Brink (’n Vurkin die pad (2009)) and Koos Kombuis (Seks & drugs & boeremusiek: die memoirs van ‘n volksverraaier (2000); Die tyd van die Kombi’s: ‘n persoonlike blik op die Afrikaanse rock-rebellie (2009)) are evaluated using the criteria proposed by Daymond and Visagie. The description and interpretation of various autoethnographical markers confirm that these autobiographies can be considered a form of cultural introspection. / Afrikaans and Theory of Literature / M.A. (Afrikaans)