Knee osteoarthritis (OA) is a debilitating and costly chronic health condition affecting approximately 10% of Canadians. Total Knee Arthroplasty (TKA) is an effective procedure restoring quality of life and providing pain relief for patients with knee OA. The benefits of TKA are well established for patients with knee OA, but determining those who would most benefit is a challenging task. Physical functioning in patients with knee OA has been shown to be a key factor for appropriateness for TKA. The Lower Extremity Functional Scale (LEFS) and the Oxford Knee Score (OKS) are two patient-reported outcome measures (PROMs) measuring physical function that can be utilized to assist health care professionals in determining the need for TKA among this population. The LEFS is a regional PROM consisting of 20 questions asking about activities relating to lower extremity functioning. Questions are scored on a 5-point descriptive scale from 0 (extreme difficulty or unable to perform the activity) to 4 (no difficulty) with a total score of 80. Higher scores represent higher functioning. The OKS is a site-specific PROM that asks questions about pain and function and consists of 12 items ranked on a 5-point descriptive scale. Scores range from 1 to 5 (total score of 60) for each item with lower scores representing higher function. The purpose of this thesis was to determine the diagnostic accuracy for the LEFS and the OKS for determining appropriateness for TKA in people with primary knee OA. The hypothesis for the current study was that the LEFS would have higher diagnostic accuracy for appropriateness for TKA compared to the OKS. A cross-sectional retrospective study of patients with knee OA attending a Regional Joint Assessment Program (RJAP) from January to September 2013 was conducted. Classification of appropriateness for TKA was determined by the attending orthopedic surgeon’s decision at the end of the assessment. Diagnostic accuracy for the OKS and the LEFS were determined using the area under the curve (AUC) of the receiver operator characteristic (ROC) curve. Cut-off scores were calculated for both outcome measures. Four hundred and twenty one patients eligible for the study (41.8% males; 66.9 years old) completed the OKS and the LEFS. The diagnostic accuracy for the OKS and the LEFS was determined using the AUC of the ROC curve for each patient-reported measure using Stata ® version 12.1. The cut-off scores were determined as the point on the ROC curve yielding the best sensitivity and specificity for the two outcome measures. The results showed the LEFS did not have higher diagnostic accuracy (LEFS AUC = 0.686 (95% CI = 0.636 – 0.736); OKS AUC = 0.674 (95% CI = 0.623- 0.724)) for determining appropriateness for TKA in patients with primary knee OA in isolation. The best cut-off score for those deemed appropriate for TKA among patients with knee OA was 26 out of 80 LEFS points and 42 points out of 60 OKS points. The results of this thesis agree with previous research reporting that decision-making regarding the need for TKA in patients with knee OA is multi-factorial. Our data confirm that this decision cannot be based on patient-reported physical function alone. Factors other than or in addition to patient-reported lower limb physical functioning should be considered when determining which patients with knee OA would most benefit from TKA. Further research evaluating these factors is warranted to improve triage services for patients with knee OA most likely to benefit from TKA. / Thesis / Master of Science Rehabilitation Science (MSc)

Maintenance of physical function with advancing age is vital to continued independent living, which is highly valued by older people. Although commonly associated with the ageing process, loss of functional ability may well be accelerated by inactivity and subsequent decreasing physical capacities, such as muscle performance or balance abilities. The impact of increased levels of activity on physical performance and functional ability was investigated by a single blind randomised controlled study.Two intervention programs, one based on increased levels of physical activity and the second on increased levels of social activity, were provided to a group of community-living participants aged 75 years and over. Another group, receiving no intervention was also included. The exercise intervention offered twice weekly sessions of exercise over a 16-week period. This was designed and supervised by physiotherapists. The social intervention offered a weekly, two-hour session over 13 weeks. Baseline, post-intervention and follow-up assessments measured aspects of physical performance (muscle, balance, gait and step height performance) and functional ability (tiredness of limbs, mobility tiredness and the need for assistance with mobility and activities of daily living). In addition, all participants completed a monthly health and falls report. One hundred and forty-nine subjects were admitted into the study with 108 completing the intervention phase and all four assessments.Analysis of data indicated that the exercise intervention was effective in improving muscle performance (shoulder abduction mean difference 13.00, 95%CI 11.63-14.37; hip abduction mean difference 5.97, 95%CI 4.73-7.20; knee flexion mean difference 4.10, 95%CI 3.32-4.88; dorsiflexion mean difference 4.72, 95%CI 3.74-5.71), dynamic balance ability (Functional Reach mean difference 11.45, 95%CI 9.41-13.48), ++ / maximal gait speed (mean difference 0.62, 95%CI 0.50-0.74) and step height performance (mean difference 0.19, 95%CI 0.01-0.29). Improvements in dynamic balance and maximal walk performance were maintained for a period of four months following cessation of the intervention. The social program did not affect aspects of physical performance.Functional improvements were evident for both exercise and social subjects. Immediate improvements in limb tiredness (upper mean difference 0.37, 95%CI -0.11-0.84; lower mean difference 0.63, 95%CI 0.37-0.89) and mobility tiredness (mean difference 1.43, 95%CI 1.16-1.70) and activities of daily living dependence (mean difference 0.25, 95%CI -0.23-0.75) were demonstrated. Four and eight months later, exercise subjects had maintained the improvement in mobility tiredness and activities of daily living dependence. Mobility dependence showed a delayed improvement in both the exercise and social intervention participants. This improvement was not evident immediately following intervention, but emerged at both the four and eight month follow-up assessments.An intention to treat analysis (involving both completing and non-completing subjects) confirmed the usefulness of the exercise intervention as a strategy to improve and maintain functional ability in older subjects, specifically with regard to tiredness of the lower limbs, tiredness during mobility tasks and activities of daily living dependence. In addition, following the cessation of the exercise intervention, participants reported less mobility tiredness and dependence in activities of daily living tasks over the following eight-month period.The relationship between physical performance and functional ability indicated that muscle performance and limb tiredness were significantly associated. Decreased muscle performance of the upper limb was associated with reports of increased ++ / tiredness during functional activities involving the upper limb, such as combing hair and dressing the upper body. Similarly, decreased muscle performance of the lower limb, especially proximally, was associated with increasing tiredness of the lower limb during functional activities. Further, decreased proximal muscle performance of both the upper and lower limb was significantly associated with decreasing independence in the performance of physical activities of daily living. These results indicate the significant influence of muscle performance on functional ability, especially on tiredness of the limbs and activities of daily living dependence.The ability to predict future functional limitation, based on decreasing physical performance, was examined and shown to be of limited value. Hip muscle performance and changes in usual gait speed were poorly associated with increased lower limb tiredness and dependence in physical activities of daily living respectively. The lack of a robust relationship between variables of physical performance and functional ability measures indicates that loss of physical performance is not strongly associated with the development of functional limitations.Self-reported falls were monitored throughout the study. A significant increase in the number of participants reporting falls was evident in both the social intervention group and the control group throughout the study. In contrast, there was no change in the number of exercise participants reporting falls. These results suggest that the exercise intervention was effective at minimising the usual increase in the number of older people experiencing falls over time.The results of this study suggest that the exercise intervention program was effective in improving physical performance in elderly subjects. This also resulted in improved functional ability. Positive effects continued ++ / following completion of the program as improvements in mobility and activities of daily living tasks were demonstrated for a further eight months. By contrast, the social intervention program appeared to influence only the need for help with mobility tasks in the longer term.Increased physical activity, in the form of an exercise intervention program, specifically designed for community-living elderly people, can improve and maintain functional ability, both immediately and for up to eight months following the completion of the program. As such, involvement in exercise, even in the short-term, should be encouraged as a means of maintaining physical independence in later life. Therapists devising exercise programs specifically for older people should ensure that the associated outcome measures incorporate assessments of functional ability and not simply measures of impairment. This study has demonstrated that a real benefit of increased physical activity in older people may well be the increased physical independence associated with participation.

Background and Purpose: Self-efficacy plays a major role in determining physical function during the earlier stages of the knee osteoarthritis (OA) and it may be a significant factor in the maintenance of physical function across the span of OA severity. This study examined the contribution of self-efficacy to objective and subjective measures of physical function at both maximal and sub-maximal levels. The relationship between self-efficacy and quality of life was also examined. Participants: Twenty community-dwelling adults with knee OA (age 69±14 years) were recruited for this study. Methods: Subjective maximal and sub-maximal performance were determined using the Maximal Activity Score (MAS) and Adjusted Activity Score (AAS) respectively of the Human Activity Profile. The objective measure of sub-maximal physical function was the 6-minute walk test (6MWT) while the Incremental Shuttle Walk Test (ISWT) was the maximal measure. Quality of life was determined using the Short Form Health Survey 36 (SF-36) and self-efficacy was measured using the Arthritis Self-Efficacy (ASE) scale. Disease severity was determined using the Western Ontario and McMaster University Osteoarthritis Index (WOMAC). A stepwise multiple linear regression analysis was performed using each of 6MWT, ISWT, AAS and MAS as the dependent variable, and the WOMAC and ASE as independent variables. Results: Self-efficacy explained 44% of the variance in the 6MWT but only 16% in the ISWT. Self-efficacy explained approximately 30% of the variance in both the MAS and AAS. A moderate relationship was observed between self-efficacy and the Physical Component Score (PCS) (r=0.51) of health-related quality of life, but no relationship was observed with the Mental Component Score (MCS). Discussion and Conclusion: In mild to moderate knee OA, sub-maximal physical function was substantively influenced by an individual’s belief in his/her ability to perform a given task, but not so when the intensity of the activity approached maximal levels. This differential relationship between sub-maximal and maximal performance was not present using subjective reports of performance. These findings indicate that therapy utilizing training at sub-maximal levels in mild to moderate knee OA should focus on strategies for enhancing self-efficacy; whereas with training at relatively high intensities, less focus should be given to enhancing self-efficacy. / Thesis (Master, Rehabilitation Science) -- Queen's University, 2008-04-25 15:28:10.666

The purpose of this study was to examine whether perceived neighbourhood characteristics and personal characteristics in 2007/2008 predicted health-related outcomes: steps taken per day, life-space mobility, physical function, body mass index (BMI), and body composition-related health benefits in 2010/2011 among community-dwelling older adults. The total sample consisted of 341 men and women above the age of 62 years. Steps per day were measured using pedometers for a 3-day period and the change score was reported as a binary outcome: increased steps and decreased steps. Life-space mobility was assessed using the Life-Space Assessment and the outcome was the life-space score as a continuous variable. Physical function was assessed using the Late Life Function and Disability Instrument. The outcome was the total score as a continuous variable. BMI was assessed using the index of the participants’ self-reported weight divided by the height squared. Body composition-related health benefits were assessed using the participants’ BMI refined by the participants’ self-assessed waist circumference. The independent variable was the perception of the neighbourhood environment assessed using select items of the Neighbourhood Environment Walkability Scale in four categories: presence and maintenance of sidewalks; aesthetics; walkability safety; and traffic safety. Demographic and health information (sex, age, self-rated health, physical function limitations, number of chronic conditions and body mass index) were also collected. Regression analysis showed that although more positive perceptions of neighbourhood characteristics such as walkability safety, traffic safety and sidewalks were associated with health-related outcomes, overall, the perceived neighbourhood environment was not a strong predictor of health-related outcomes among community-dwelling older adults. These outcomes were mostly predicted by demographic and health status variables (i.e. chronic conditions, self-rated health, body mass index, physical function limitations). Initiatives targeted at the neighbourhood environment should consider the health-related outcome of interest (i.e. walking, mobility, physical function or obesity), the specific age group (i.e. old age or very old age and oldest old age), and the importance of demographic and health variables in shaping the relationship between the neighbourhood environment and these outcomes.

A randomized, controlled, clinical trial of a yoga-based exercise intervention for knee osteoarthritis / Background: Knee osteoarthritis is a chronic disease involving the breakdown of joint tissues resulting in pain and disability. Exercise provides equivalent pain relief to medication, improves physical functioning, and ameliorates co-morbidities. However, certain forms of exercise can potentially overload the joint and exacerbate symptoms; the optimal type is unknown. We developed a yoga-based exercise intervention designed for knee osteoarthritis by incorporating postures that minimize a mechanical loading variable implicated in disease progression. Purpose: The objective was to compare the efficacy of this biomechanically-tailored yoga program as treatment for knee osteoarthritis with the current “gold standard” of physical therapy, and a no-exercise attention control group. Methods: A single-blinded, 12-week, 3-arm, parallel randomized control trial was conducted. Participants (women 50 years or over, with clinical knee osteoarthritis; n=31) were stratified by disease severity and randomized to receive biomechanical yoga exercise (YE; n=10), traditional exercise (TE; n=11), or no-exercise (NE; n=10). The primary outcome measure was pain; secondary outcomes included patient-reported physical function and mobility performance; and tertiary outcomes included muscular strength, quality-of-life, and symptoms of depression. Results: The YE and TE groups demonstrated statistically and clinically significant within-group improvements in pain, physical function, and mobility performance (p<0.017), while the NE group did not. The YE group reported greater improvements in pain compared to the NE group (p=0.003). The YE group also demonstrated greater improvements in physical function compared to NE (p=0.010). There were no significant between-group differences in mobility performance, strength, quality-of-life, or depression (p>0.05). Conclusion: Yoga appears as an efficacious and well-tolerated conservative treatment option for women with knee osteoarthritis. The yoga intervention yielded comparable, and in some cases possibly greater improvements in the major burdening symptoms of the disease compared to traditional physical therapy. Future investigations with larger samples are warranted to establish effectiveness and possibly superiority to traditional exercise. / Thesis / Master of Science (MSc) / Osteoarthritis of the knee is a debilitating joint disease and a leading cause of disability. Treatment often involves medication to control pain and surgery when drugs fail. Exercise is a conservative approach to improve symptoms and quality of life. Some forms of exercise however can overload the knee and possibly worsen the disease. We have developed a yoga-inspired exercise regimen specifically for knee osteoarthritis that minimizes damaging mechanical loads. To test this program, women with knee osteoarthritis were randomly assigned to receive either 12 weeks of yoga, traditional physical therapy, or no-exercise. Before and after the intervention, pain, physical function, and mobility were measured. The yoga and traditional exercise groups demonstrated improvements in pain, physical function, and mobility; while the no-exercise group did not. In some aspects, yoga even outperformed traditional exercise. These findings suggest yoga is as effective as traditional exercise, and potentially more so, in treating knee osteoarthritis.

No description available.

N/A / Thesis / Master of Science (MS)

No description available.

Falls among Canadian older adults is a growing problem, not only in terms of incident rates and its impacts, but most importantly, the vast scope of preventable morbidity and mortality. A decline in age-related physical function is acknowledged as a risk factor of falls. Community-based group exercise programs such as Yang style tai chi may help to reduce fall risk by improving components of physical function. To investigate, a pretest-posttest experimental design was conducted. Post-intervention assessments revealed Yang style tai chi practiced three times a week over eight weeks improved balance, muscle strength and muscle endurance. These findings suggest Yang style tai chi is moderately effective in reducing fall risk but further research is needed to determine the true effectiveness of tai chi as a fall prevention strategy. This study provides directions for future research guided by a proposed conceptual framework and offers some tentative recommendations for community health practice. / UOIT

Most pediatric orthopaedic interventions are intended to improve or preserve physical function, yet their outcomes have been assessed using primarily surrogate measures (e.g., radiographic indices) that may not accurately represent patients'function. Physical function may be more appropriately measured with activity-based scales, but these have been infrequently applied in surgical studies. The purpose of this study was to identify existing activity-based physical-function scales appropriate for pediatric orthopaedics, to present criteria useful for scale selection, and to discuss the special problems of measuring physical function in children. Twenty-one scales relevant to pediatric orthopaedics are described according to their target population, purpose, method of administration, content, and quality of standardization. These scales have been further classified according to a new taxonomy. The unique aspects of measuring physical function in children are discussed and include the effect of age and development, method of reporting, and question formats. Standardized measures of physical function based on physical-activity ability exist and should be used more frequently to assess pediatric orthopaedic interventions