Submitted in fulfilment of the requirements for the Degree of Master of Technology: Chiropractic, Technikon Natal, 2002. / The purpose of this study was to determine the efficacy of Myofascial Adhesion Manipulation (grip and rip) in the treatment of Myofascial Pain Syndrome. The study was a prospective, unblinded, randomized, placebo-controlled, clinical trial. The sample size used was 60 patients selected from the Durban Metropolitan Area. Only patients diagnosed with active trigger points in either the Trapezius and/or the Levator Scapulae muscles were accepted into the study. The sample was divided into two groups of 30 patients each. One group received Myofascial Adhesion Manipulation, whilst the other group received placebo ultrasound. Each patient received four treatments over a maximum period of 3 weeks. Data was obtained from the patients at the first and second consultations, prior to treatments, and at the fourth consultation, immediately following the treatment. Subjective data was obtained with the Numerical Pain Rating Scale (NRS 101) and the Short-Form McGill Pain Questionnaire (S-FMPQ). Objective data was obtained from pressure threshold algometry and the Myofascial Diagnostic Scale (MDS) / M

A dissertation submitted in partial compliance with the requirements for a Master's Degree in Technology: Chiropractic, Durban Institute of Technology, 2003. / The purpose of this study was to investigate the efficacy of dry needling latent myofascial trigger points, in the treatment of Myofascial Pain Syndrome. The study was a prospective, randomized placebo controlled study. Sixty patients, between the ages of 18-60, from the greater Durban area participated in the study. They underwent a case history, relevant physical examination and a cervical spine examination. The sixty subjects were randomly allocated into two groups of thirty. Group one received sham/ placebo needling while group two received dry needling, after being diagnosed systematically as suffering from latent myofascial trigger points of the trapezius and/or the levator scapulae muscle/muscles. Each patient received two treatments within a week with a one-week follow-up. Subjective and objective measures were taken at all three visits. Subjective data was obtained from the Numerical Pain Rating Scale 101 and objective data was obtained from the use of the algometer. This data was used to perform statistical analysis using parametric unpaired and paired t-tests to compare inter- and intra-group data respectively, at a 95% level of confidence. / M

A dissertation submitted in partial compliance with the requirements for a Masters Degree in Technology: Chiropractic, Durban Institute of Technology, 2005. xii, 62, [18] leaves / The purpose of this study was to determine the comparative effectiveness of cryo-ischaemic compression, using the Cold Tennis-ball Technique, and ischaemic compression, using normal tennis balls, in the treatment of Myofascial Pain Syndrome The study was a randomised, controlled, comparative clinical trial. The samlpe population comprised of sixty patients between the ages of 18-35 years. Patients were screened according to the inclusion and exclusion criteria, were selected and randomly divided into two groups. One group, of thirty patients, received ischaemic compression using normal tennis balls, whilst the second group, of thirty patients, received ischaemic compression using the Cold Tennis-ball Technique. Patients received four treatments over a period of two weeks. Data was obtained from each patient prior to and immediately after each treatment. Objective data was obtained from pressure threshold algometry and the Myofascial Diagnostic Scale. Subjective data was obtained from the Numerical Pain Rating Scale (NRS) and patients were required to give a sensory description of their pain at two-minute intervals during the course of the treatment. Statistical analysis of the data was performed using the SPSS version 11.5 and Stata version 9.0 software. Treatment effects for quantitative outcomes were analysed using repeated measures ANOVA. Profile plots were examined in order to assess in which direction the significance lay. Ordinal outcomes were examined for a treatment effect using ordinal logistic regression modelling. These models also examined a time by group interaction. Nonparametric Spearman’s correlation coefficients were used to examine intra-group relationships. / M

A dissertation submitted in partial compliance with the requirements for a Master's Degree in Technology: Chiropractic, Durban Institute of Technology, 2003. / The purpose of this study was to investigate the immediate and short term effectiveness of dry needling the primary, active Biceps TrP on the pain experienced during shoulder flexion and abduction range of motion, as well as on an associated bicipital tendonitis and satellite TrP's. The study was a prospective, controlled, pilot study that included 30 patients from the greater Durban area. All patients were between the ages of 20 and 45 years and all were diagnosed with an active trigger point (TrP) in the Biceps muscle. Each patient was required to attend three visits on three consecutive days. The treatment intervention was dry needling of the active Biceps TrP. Subjective and objective data was obtained from the patients before and after the first consultation. At the second consultation, if the Biceps TrP was still present andactive, the subjective and objective data was obtained before and after the treatment again (Group lA). If, however, at this consultation, the TrP had resolved,no treatment intervention wasgivenand both types of data were obtained only once (Group lB). The third consultation was reserved for data collection only, no treatment intervention wasgiven to the patients. / M

A dissertation submitted in partial compliance with the requirements for the Masters Degree in Technology: Chiropractic, Durban Institute Of Technology, 2006. xviii, 134, 7 leaves. / Shoulder injuries, which account for 8% to 20% of volleyball injuries, are usually rotator cuff and / or biceps tendinosis caused by overuse (Briner et al.1999); in addition 38-75% of competitive swimmers have had a history of shoulder pain, while 9 - 35% of these swimmers were currently experiencing pain (McMaster and Troup, 1993). Rotator cuff tendinosis is also found in laborers involved in repeated overhead activities (i.e. among shipyard welders and steel plate workers), with a prevalence of 18, 3% and 16, 2% respectively (Herberts et al. 1984). Fricker and Hoy (1995), suggest that the principal cause of tendinosis of the rotator cuff muscles is repetitive microtrauma, due to overfatigued muscles and / or weakening of the rotator cuff and scapulothoracic muscles. The etiology of impingement syndrome is therefore multifactorial and is commonly associated with other clinical entities such as weak or dysfunctional scapular musculature, posterior glenohumeral capsule tightness, inflammation of tendons (viz. supraspinatus and long head of biceps), bursal inflammation and glenohumeral instability (Michener et al., 2003). Shoulder syndromes are often related to the development and perpetuation of myofascial trigger points (TrPs) as found by Hains (2002), who suggested that these TrPs become activated during mechanical stress and overload of the involved shoulder musculature. Hammer (1991), suggests that the most valuable modality to treat chronic overuse soft tissue syndromes (irrespective of muscular or tendinous in origin) is friction massage to both regions. Cyriax (1984) and Prentice (1994) state the effect of frictions to include the breakdown of adhesions (scar tissue), as well as preventing the formation of further adhesions. / M

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Mémoire du D.E.S. : Biologie médicale : Université de Nantes : 2005. Thèse d'exercice : Pharmacie : Université de Nantes : 2005. / Bibliogr. f. 124-127 [75 réf.].

published_or_final_version / Surgery / Master / Master of Medical Sciences

　　　Obstructive sleep apnoea (OSA) is the most common sleep-related breathing disorder and is associated with a range of adverse physical, social and psychological outcomes that affect quality of life (QoL). Two systematic reviews of the literature (part of this thesis work) found there is conflicting evidence of how different mandibular advancement device (MAD) designs features may affect clinical and subjective OSA outcomes in certain patients. Therefore, a randomized cross-over trial was conducted. Firstly, the correlation between clinical OSA indicators and QOL was explored among patients referred for OSA treatment using MADs. In addition, associations of OSA risk factors, dental status and demographic variables with clinical OSA indicators and QoL indices were determined. Secondly, the efficacy of two different MADs in the treatment of adult OSA patients was assessed and compared. Thirdly, the efficacy of the two MADs in the treatment of adult OSA patients from the subjective perspective of their bed partners was determined. 　　　A consecutive sample of 45 adult OSA patients referred from Queen Mary Hospital Sleep Centre to the Prince Philip Dental Hospital for oral appliance therapy was recruited and treated with a monobloc MAD and a twinblock MADs for a period of 3 months per MAD (cross-over randomised trial). Changes in clinical OSA outcomes were assessed by polysomnography (PSG) and changes in subjective outcomes by the disease-specific Sleep Apnoea Quality of Life Index (SAQLI) questionnaire, the Functional Outcome of Sleep Questionnaire (FOSQ) and Epworth Sleepiness Scale (ESS). Patient compliance, side-effects and MAD preference, as well as MAD treatment impact on the patients’ bed partner was also assessed. At baseline, some clinical OSA indicators, subjective QoL and certain OSA risk factors were significantly correlated (p<0.05). There were significant variations in clinical OSA indicators and subjective QoL indices with respect to certain risk factors (p<0.05), demographic variables (p<0.05) and dental status (p<0.01). 　　　There was a significant difference in favour of the monobloc MAD in terms of improving the apnoea-hypopnoea index (AHI) (p<0.05) and oxygen desaturation index (ODI) (p<0.01). Significantly more patients achieved clinical treatment success with the monobloc compared to the twinblock (p<0.05). Both MADs were efficacious in improving patients’ SAQLI score (p<0.01), FOSQ score (p<0.01) and ESS score (p<0.01). Significantly more patients achieved QoL treatment success with the monobloc (p<0.05) compared to the twinblock. More patients were ‘very satisfied’ with the monobloc treatment (p<0.05) and 63% preferred it to the twinblock. 　　　 No significant difference was found between patients’ and bed partners perceptions of symptom improvement post treatment, however, the monobloc resulted in a significant reduction in bed partners’ daytime sleepiness (p<0.01) and allowed significantly more co-sleeping at night (p<0.05). 　　　 　　　This study concluded that the monobloc is superior in improving subjective QoL and clinical OSA indicators. The monobloc was the preferred MAD and patients were more satisfied with it; bed partners rated this MAD as superior in improving their own daytime sleepiness and co-sleeping. / published_or_final_version / Dentistry / Doctoral / Doctor of Philosophy

Poor adherence to continuous positive airway pressure (CPAP) treatment in patients with obstructive sleep apnoea (OSA) limits its therapeutic effectiveness and has a major impact on clinical outcomes. Effective education programme is important to enhance CPAP use. However, existing education programmes are either manpower or resource demanding and may not be feasible in clinical practice. Moreover, the Self-Efficacy Measure for Sleep Apnoea (SEMSA) has been widely adopted for assessing adherence-related cognitions on CPAP therapy in OSA patients, but it was not available for Chinese. The aims of this thesis are: (i) to perform linguistic and psychometric evaluation of a Chinese version of SEMSA (SEMSA-C); (ii) to examine the efficacy of brief motivational enhancement education programme in addition to standard care versus standard care only on improving adherence to CPAP treatment in patients with OSA. The SEMSA-C was obtained after the standard forward-backward translation process. A randomised controlled trial was then conducted on newly diagnosed OSA patients. Patients in the control group received standard care (SC) comprising advice on the importance of CPAP therapy and its care while those in the intervention group received SC plus motivational enhancement education programme (ME). ME focused to enhance subjects’ knowledge, motivation and self-efficacy to use CPAP, comprising one 45-minute session on the day after CPAP titration and one 10-minute telephone follow-up shortly after commencing CPAP treatment. Epworth Sleepiness Scale (ESS), SEMSA-C, and quality of life were assessed. CPAP usage data were downloaded at the completion of this 3-month study. The primary outcome was the CPAP adherence. Furthermore, 21 patients were randomly sampled at baseline and completed the SEMSA-C at one week. 100 patients (Men : Women, 84 : 16) with OSA indicated for CPAP treatment were recruited, with an average age of 52±10 years, and apnoea hypopnoea index (AHI) of 36.2±22 events/hour. Factor analysis of SEMSA-C identified three factors: risk perception, outcome expectancies and treatment self-efficacy. Their corresponding internal consistency was high with Cronbach’s alpha >0.88, which were larger than all correlations between subscales (Range: 0.14 to 0.58). The correlations between items and their hypothesized subscale (Range: 0.58 to 0.85) were generally higher than the correlations between items and their competing subscales (Range: -0.10 to 0.58). One-week test-retest intra-class correlation ranged from 0.70 to 0.82. CPAP adherence was associated with outcome expectancies and treatment self-efficacy at 3-month assessment. Furthermore, SEMSA-C demonstrated an improvement in self-efficacy (standardised response mean = 0.33, p = .044) but no significant changes were observed in the other two factors, after CPAP use. The 100 patients were followed for 3 months. The interventional effects maintained during the 3-month study period. There were a better CPAP use [higher daily CPAP usage of 2 hours/day (Cohen d = 1.33, p < .001), four-fold the number of subjects using CPAP for ≥ 70% of days with ≥ 4 hours per day (p < 0.001)], and greater improvements in ESS by 2.2 (p = 0.001) and treatment self-efficacy by 0.2 (p = 0.012) in the intervention group, relative to the control group. The traditional Chinese SEMSA-C possesses satisfactory psychometric properties. It is a reliable and responsive instrument to measure perceived risks, outcome expectancies and treatment self-efficacy in Chinese patients with OSA. Moreover, the newly developed brief motivational enhancement education programme in addition to standard care is effective in improving adherence to CPAP treatment, treatment self-efficacy and daytime sleepiness. / published_or_final_version / Nursing Studies / Doctoral / Doctor of Nursing