Background: Knee osteoarthritis (OA) is a prevalent disease that contributes to lower limb immobility and pain resulting in lost productivity in the work place. Repetitive loading of the knee joint, particularly in occupational settings, significantly increases OA risk. However, rest may promote tissue recovery and increase tissue tolerance to load. Therefore rest should be examined as a mechanism to prevent the development of knee OA. Purpose: The primary objective was to determine if rest can mitigate mechanical deformation of the stifle (knee) joint and articular cartilage damage during loading compared to an unloaded control in an intact porcine stifle model. Methods: A randomized controlled trial was conducted. Among 18 pairs of porcine hind limbs, one limb in each pair was randomly assigned to receive a loading intervention; while the matched pair served as control. Stifles in both groups were dissected, mounted into the loading apparatus, and pre-loaded. Intervention joints were then randomized into one of three loading protocols: no rest, 3:2 work:rest, and 1:1 work:rest; all of these protocols exposed joints to the same amount of cumulative load. Following loading, all joints were dissected to expose the cartilage. Cartilage damage was scored on a categorical scale. Deformation and energy dissipation were calculated for intervention limbs from data obtained from the loading apparatus. Results: Rest did not mitigate displacement or energy dissipation in the stifles exposed to loading. Rest was associated with reduced cartilage damage scores in the lateral femur in the 1:1 condition. Conclusion: Rest had little impact on joint mechanics and cartilage damage in this model. The small sample size may explain these results. Future investigations involving larger samples should assess if longer periods of rest are need to minimize joint damage as a result of loading. / Thesis / Master of Science (MSc) / Repetitive loading of the knee joint is linked to breakdown of knee cartilage leading to the development and progression of knee osteoarthritis (OA). For example, over-exposure to physically demanding tasks in the workplace (i.e. squatting, bending, lifting etc.) increases knee OA risk. However, it is possible that rest breaks can prevent cartilage damage by allowing the tissue to recover and maintain proper function. Therefore, the purpose of this work was to determine the influence of rest on knee joint mechanics and cartilage quality by repetitively loading pig knee joints and exposing them to varying periods of rest. Rest up to sixty seconds did not allow for tissue recovery, nor did it assist with joint function. This work suggests that longer periods of rest may be required to mitigate the damaging effects of loading, or that rest may not mitigate the effects of loading at all.

No description available.

Osteoarthritis is the 12th leading cause of years lived with disability globally and by 2040 more than 10 million Canadians will have knee osteoarthritis (KOA). Pain in persons with KOA is well-recognized, persistent and chronic with central sensitization (CS) being prevalent in ~30%. CS is measured by psychophysical testing and patient-reported methods such as the Central Sensitization Inventory (CSI). The CSI was developed using subgroups of people with chronic pain, but not those with KOA. Therefore, validity of the CSI in people with KOA is lacking. CS as indicated by psychophysical tests is associated with CSI scores lower than the recommended cut score. Therefore, we aimed to evaluate the validity of the CSI through Rasch analysis in persons with KOA. We then sought to determine the agreement of the Rasch calibrated (RC-CSI) version of the CSI with the original and to evaluate the validity of the RC-CSI with psychophysical tests in people with KOA. In the first study, the CSI was able to fit Rasch model. After iterative analysis, we found the CSI to be a singular construct with acceptable unidimensionality while retaining all 25 items. Only two items - frequent urination (item 21) and Skin problems (item 19) showed a pattern of uniform differential item functioning by age and sex respectively. Moreover, we generated a RC-CSI cut score of 31.37 that we used to compare with the original cut score of 40. In second study, the findings suggested a lack of agreement between the two versions of the CSI demonstrating small bias. When exploring sensitivity and specificity with psychophysical tests, the RC-CSI showed little clinical value over the original CSI. We therefore recommend that the original CSI should be used with individual clients as our preliminary findings suggest that there is no added benefit to using the RC- CSI. / Thesis / Master of Science Rehabilitation Science (MSc)

Thesis (DHSc) -- AUT University, 2008. / Includes bibliographical references. Also held in print (xvii, 177 leaves : ill. (some col.) ; 30 cm.) in the Archive at the City Campus (T 616.7223062 REI)

Thesis (Ph. D.)--University of Missouri--Columbia, 2004. / Typescript. Vita. Includes bibliographical references (leaves 104-115). Also issued on the Internet.

Thesis (doctoral)--Lund University, 1994. / Added t.p. with thesis statement inserted.

Thesis (Ph. D.)--University of Missouri--Columbia, 2004. / "July 2004." Typescript. Vita. Includes bibliographical references (leaves 104-115). Also issued on the Internet.

Thesis (doctoral)--Lund University, 1994. / Added t.p. with thesis statement inserted.

EFFECTS OF 24R,25(OH)2D3 IN THE TERATMENT OF KNEE OSTEOARTHRITIS Qingfen Pan 117 Pages Directed by Dr. Barbara Boyan Osteoarthritis (OA) is a degenerative disease characterized by joint inflammation and cartilage degeneration due to matrix degradation and chondrocyte apoptosis. Previously, drug therapies have been developed that aim to ease pain and reduce local inflammation. Currently, no effective drug exists that has no significant side effects. Therefore, an unmet medical demand exists for development of tissue-engineering strategies to promote articular cartilage repair and regeneration to treat OA. 24R,25-dihydroxyvitamin D3 [24R,25(OH)2D3] is an attractive option for articular cartilage repair because of its anti-inflammatory and anti-apoptotic properties. 24R,25(OH)2D3, which is a naturally occurring metabolite of vitamin D3, also has not been shown to cause toxic side effects. Results from the study demonstrate that 24R,25(OH)2D3 can inhibit chondrocyte apoptosis and suppress the production of catabolic factors that result in cartilage degeneration in the in vitro model. Furthermore, although 24R,25(OH)2D3 regulates components of TGF-β1 pathway, the effect of 24R,25(OH)2D3 is not mediated through TGF-β1 signaling. In vivo delivery of 24R,25(OH)2D3 prevented cartilage degeneration and disease progression. In addition, intraarticular injection of 24R,25(OH)2D3 had an effect on cytokines and growth factors production both locally and systemically. Human articular chondrocytes responded to 24R,25(OH)2D3 treatment in both sex and maturation dependent manner. Collectively, results from this study suggest that 24R,25(OH)2D3 ccould be used as a clinical therapy for knee OA.

Thesis (MScPhysio)--Stellenbosch University, 2012. / Background: Evidence for the effectiveness of physiotherapeutic interventions in the management of knee osteoarthritis (OA) is synthesised in the current clinical guidelines (CGs), providing clinicians with readily accessible and interpretable practice guidelines. However, CGs are often not specific to the local context of the target users, therefore hindering successful implementation of evidence into clinical practice. Formulating succinct and composite recommendations by synthesising the current CGs reporting on the evidence-based (EB) management of knee OA may assure contextual relevance and facilitate implementation of evidence into clinical practice. In addition, multifaceted interventions, such as evidence-based practice (EBP) workshops, are also postulated to promote the implementation of guideline recommendations, thereby enhancing clinical outcomes. Objectives: The primary objectives of this study were to: 1) describe the range of EB physiotherapeutic interventions in the management of knee OA as documented in the current CGs; and 2) develop composite clinical recommendations for a specific group of users working in Jerusalem. A secondary study objective was to ascertain the effect of translating the knowledge through a specifically-designed EBP workshop on the uptake of knowledge and implementation of EBP into clinical practice by physiotherapists working in Jerusalem. The EBP workshop was aimed at educating physiotherapists about the EB physiotherapeutic techniques for knee OA management. Study design: Two studies were conducted. A systematic review (SR) into EB clinical guidelines was conducted to describe and synthesise the available evidence and formulate composite recommendations for knee OA. The results of the SR were used to design an EBP workshop aimed at educating physiotherapists about EB physiotherapeutic techniques for treating knee OA patients. A pre-post quasi-experimental design was then conducted to assess the effect of this EBP workshop on the uptake and implementation of EBP into clinical practice amongst public sector physiotherapists working in Jerusalem. Methodology for quasi experimental study: Physiotherapists who regularly treat knee OA patients were recruited from a list of members registered with the Palestinian Physiotherapy Association Jerusalem. A three-month retrospective audit (initial audit) of knee OA patients’ physiotherapy records kept by the participating physiotherapists was conducted to establish current management patterns. EB strategies for knee OA was presented to the participating physiotherapists during a one-day workshop. A second audit of physiotherapy records was conducted three months after the EBP workshop to establish changes in the selection of physiotherapeutic management techniques for knee OA. Results: The initial audit revealed that the participating physiotherapists utilized one high EB modality namely, exercises, as a core management strategy in knee OA, but did not frequently implement other high EB modalities such as self-management and weight-loss programs. Following the EBP workshop, a statistically significant increase (p=0.008) in the implementation of weight-loss and self-management strategies in the management of knee OA was noted. Conversely, a statistically significant decrease was noticed in using patellar taping (low EB modality) in the management of knee OA (p=0.04). No significant changes were noticed in the utilization of other physiotherapy modalities supported by weak or modest EB recommendations. Conclusion: The study concluded that physiotherapists inherently prescribed exercise as a core management strategy for knee OA. Modalities supported by modest levels of evidence were used as adjunct treatments. The EBP workshop facilitated the increased application of high EB modalities such as weight-loss and self-management programs. The results of this study illustrate that an EBP workshop may be effective in promoting the implementation of EB physiotherapeutic modalities in the management of knee OA. However, larger studies with longer follow-up periods are required. / No Afrikaans abstract available