[Truncated abstract] There have been few studies into the effects of rehabilitation following lumbar microdiscectomy and consequently little evidence of its effect, if any, on outcome. Most studies cited fall into one of two categories: research involving a spinal surgery procedure without rehabilitation, or research involving spinal surgery with a nonspecific generic 'rehabilitation' or 'physical therapy'. In an era of evidence based medicine the efficacy of specific rehabilitation protocols following defined lumbar spine surgical procedures needs to be established for surgeons, therapists and patients to have confidence that the rehabilitation is appropriate and effective. The study was proposed to investigate the outcome of a specific and novel rehabilitation protocol commenced immediately after lumbar microdiscectomy. Data collected from the research cohort were compared to data collected from a contrast group who underwent standard rehabilitation at a distant site. A retrospective study (Phase One) was carried out with a cohort of post-operative microdiscectomy patients between February 2000 and December 2002. The outcome of surgery followed by the rehabilitation protocol was assessed using validated outcome instruments. A contrast or control group was not included. After reviewing the data limitations with the design and implementation of the study were identified. A prospective study (Phase Two) was proposed and changes made in the principal outcome measure used, in the demographic data to be retrieved, the addition of pain scales, and in the exclusion of compensable patients. A contrast group was included for the prospective study. ... The study group commenced exercise and posture correction the day following surgery. There were restrictions placed on activity involving bending. The contrast group followed the advice of the surgeon in Queensland and attended rehabilitation at local physiotherapy facilities. Both groups were followed for 12 months using outcome instruments. Strict comparison between WA and QLD cohorts were limited due to sample size, however trends were observed. Data of the prospective study showed that there was greater reduction in back pain with the early rehabilitation protocol (P<.0001) compared to standard rehabilitation (P=.09), while there was no difference between groups in leg pain. There was a significant improvement in the level of functional disability between time-points for the WA cohort, and overall change from pre-operative RMQ measures to 12 months in both groups were statistically significant. The WA group was less reliant on pain medication and was more satisfied with the results of their surgery. The primary hypothesis of this study that there would be a difference in outcome following lumbar microdiscectomy in patients who receive early specific rehabilitation compared to those who receive standard rehabilitation at another centre, was supported in both primary and secondary outcome data. The key finding of this study was that commencing the early exercise protocol resulted in significantly less back pain over the 12 month time period of the study. Other major findings were that the WA cohort demonstrated significant improvement in function at all time-points and between all time-points except six to 12 months, took less pain medication and were more satisfied with the outcome of their surgery than the QLD cohort.

Thesis (M.CM)--Hong Kong Baptist University, 2006. / Dissertation submitted to the School of Chinese Medicine. Includes bibliographical references (leaves 31-38).

Thesis (M.CM)--Hong Kong Baptist University, 2006. / Dissertation submitted to the School of Chinese Medicine. Includes bibliographical references (leaf 53).

Thesis (M.CM)--Hong Kong Baptist University, 2006. / Dissertation submitted to the School of Chinese Medicine. Includes bibliographical references (leaves 29-31).

Diss. (sammanfattning) Stockholm : Karol. inst., 2002. / Härtill 5 uppsatser.

Thesis (M.Sc.). / Written for the Dept. of Pharmacology and Therapeutics. Title from title page of PDF (viewed 2009/06/29). Includes bibliographical references.

Thesis (M.Ost.)--Unitec New Zealand, 2008. / Coda (electronic version) title-page has 2009 date. Includes bibliographical references (leaves 38-47).

Thesis (MSc.(Anatomy)--Faculty of Health Sciences)-University of Pretoria, 2007. / Includes bibliographical references.

A avaliação da curvatura da coluna cervical realizada por quiropraxistas, fisioterapeutas e ortopedistas é importante para a obtenção de um resultado clínico desejável, sendo o exame de Raios-X considerado o padrão ouro e o mais utilizado na prática clínica. Entretanto, devido à sua natureza invasiva é considerado inadequado para uso repetido ao acompanhar tratamentos posturais, além das dificuldades encontradas na portabilidade do equipamento, o tempo necessário para obter e ler a imagem radiográfica e os custos relacionados ao exame. Neste sentido, pesquisadores têm buscado métodos menos invasivos, práticos e de baixo custo para diagnosticar alterações das curvaturas da coluna vertebral. Não obstante, a escolha de um instrumento deve ser baseada em parâmetros científicos como validade, repetibilidade e reprodutibilidade. O flexicurva já apresenta essas propriedades psicométricas em relação a coluna torácica e lombar, mas carece de informações sobre seu uso na coluna cervical. Essa dissertação foi dividida em dois estudos: Estudo 1 - Realizou-se uma revisão sistemática com objetivo de investigar os métodos não invasivos disponíveis para avaliar a curvatura cervical no plano sagital. A metodologia utilizada neste estudo seguiu as recomendações propostas pela Colaboração Cochrane. Dezesseis artigos foram incluídos para revisão a partir dos critérios de seleção. Na avaliação da qualidade metodológica treze dos dezesseis estudos foram considerados de alta qualidade. Um total de 5 métodos para avaliar a lordose da coluna cervical foram encontrados nos artigos revisados: (1) Fotogrametria; (2) Avaliação visual; (3) Flexicurva; (4) Sistema de digitalização 3D; (5) Sistema por ultrassom de postura 3D. Os resultados dessa revisão sistemática permitem concluir que a fotogrametria apresentou os melhores resultados de reprodutibilidade, contudo, carece de validação concorrente. A avaliação visual se mostrou não reprodutível e também carece de validação concorrente. O flexicurva demostrou resultados controversos para reprodutibilidade e a necessidade de mais estudos com diferentes pontos anatômicos para avaliação da validade concorrente. E, ambos os sistemas que avaliam a coluna cervical em 3D requerem mais estudos, além do fato de serem mais caros e complexos para aplicabilidade. Estudo 2 - No estudo de validação, os objetivos foram: (1) identificar a validade concorrente do instrumento flexicurva a partir da verificação de concordância entre os resultados do exame de Raios-X e do flexicurva; (2) verificar a reprodutibilidade intra e inter avaliador do instrumento flexicurva; e (3) identificar a capacidade diagnóstica da medida fornecida pelo instrumento flexicurva. A amostra foi composta por 118 indivíduos adultos voluntários, de ambos os sexos divididos em dois grupos: (1) grupo VAL (n= 55) participou da fase de validação concorrente; (2) grupo REP (n=58) participou da fase de avaliação da reprodutibilidade do flexicurva. Para fins de análise, os grupos VAL e REP foram divididos em sub-grupos pelo Índice de Massa Corpórea (IMC). Na análise estatística, para a validade concorrente foram utilizados: Teste de Correlação Produto-Momento de Pearson, Teste t pareado, cálculo do erro RMS e análise gráfica de Bland e Altman. Para a reprodutibilidade: Coeficiente de Correlação Intraclasse (ICC), erro padrão da medida (SEM) e o mínimo erro detectável (MDC). (<0,05). O grupo REP apresentou resultados de excelente reprodutibilidade intra avaliador (ICC= 0,771; p<0,001; SEM=4,40; MDC=8,60) e inter avaliador (ICC=0,775; p<0,001; SEM=4,30; MDC=8,50), sendo esse resultado mantido para os sub-grupos ‘baixo peso’ e ‘sobrepeso’, enquanto que no sub-grupo ‘saudável’ o resultado de reprodutibilidade foi considerado moderado. No que diz respeito à validação concorrente, o grupo VAL apresentou correlação alta entre os ângulos flexicurva e ângulos Cobb (r=0,570; p<0,001; Erro RMS=9,83º). Ainda, o sub-grupo ‘baixo peso’ apresentou correlação praticamente perfeita (r=0,926; p<0,001; Erro RMS=5,66º), o sub-grupo ‘saudável’ correlação alta (r=0,575; p<0,001; Erro RMS=9,01º), e o sub-grupo ‘sobrepeso’ não apresentou correlação (r=0,069; p=0,832). Quanto à capacidade diagnóstica, o flexicurva apresentou sensibilidade de 59% e especificidade de 44%. Conclui-se que o flexicurva mostrou-se um instrumento reprodutível para ser usado pelo mesmo avaliador assim como por diferentes avaliadores, e também se mostrou um instrumento válido para avaliar a curvatura da coluna cervical no plano sagital em indivíduos adultos classificados pelo IMC com baixo peso e saudáveis. / The evaluation of the curvature of the cervical spine carried out by chiropractors, physical therapists and orthopedists is important for obtaining a desired clinical result, being the X-ray examination the gold standard and the most widely used in clinical practice. However, because of its invasive nature is considered unsuitable for repeated use to monitor postural treatments, in addition difficulties in portability of the equipment, the time required to obtain and read the radiographic image and costs related to the examination. In this sense, researchers have investigated less invasive, practical and low cost methods to diagnose changes in curvature of the spine. However, the choice of a tool should be based on scientific parameters such as validity, reproducibility and repeatability. The flexicurve already has these psychometric properties with respect to the thoracic and lumbar spine, but lacks information on its use in the cervical spine. This dissertation was divided into two studies: Study 1 - We performed a systematic review in order to investigate the non-invasive methods available to evaluate the cervical curvature in the sagittal plane. The methodology used in this study followed the recommendations proposed by the Cochrane Collaboration. Sixteen articles were included for review from the selection criteria. In assessing the methodological quality thirteen of the sixteen studies were considered high quality. A total of five methods to assess the lordosis of the cervical spine were found in review articles: (1) Photogrammetry; (2) Visual assessment; (3) Flexicurve; (4) 3D scanning system; (5) 3D ultrasound posture system. The results of this systematic review showed that the photogrammetry showed the best results of reproducibility, however, lack concurrent validation. Visual assessment showed not be reproducible and also lacks concurrent validation. The flexicurve demonstrated controversial results for reproducibility and the need for more studies with different anatomical sites for evaluation of the concurrent validity. And both systems that evaluate the cervical spine in 3D require further study, and the fact they are more expensive and complex for applicability. Study 2 - In the validation study, the objectives were: (1) identify the concurrent validity of the flexicurve instrument from the concordance between the results of the examination of X-rays and flexicurve; (2) to verify the reproducibility intra and inter evaluator of flexicurve instrument; and (3) identify the diagnostic capacity of the measure provided by flexicurve instrument. The sample consisted of 118 adult volunteers individuals of both sexes divided into two groups : (1) VAL group (n=55) participated in the concurrent validation phase; (2) REP group (n=58) participated in the evaluation phase of the reproducibility of flexicurve. For analysis purposes, the VAL and REP groups were divided into sub-groups by body mass index (BMI). In statistical analysis, for concurrent validity were used: Correlation Test Product-Moment Pearson, paired t test, RMS error and graphical analysis of Bland and Altman. For reproducibility: intraclass correlation coefficient (ICC), standard error of measurement (SEM) and the minimum detectable change (MDC). (<0,05). The REP group presented results of excellent reproducibility intra evaluator (ICC= 0,771; p<0,001; SEM=4,40; MDC=8,60) and inter evaluator (ICC=0,775; p<0,001; SEM=4,30; MDC=8,50), this result being maintained for sub-groups "low weight" and "overweight", while in "healthy" subgroup reproducibility of the result was considered moderate. Regarding the concurrent validation, the VAL group showed high correlation between the angles of flexicurve and Cobb angles (r=0,570; p<0,001; RMS Error=9,83º). Still, the sub-group “underweight” showed practically perfect correlation (r=0,926; p<0,001; RMS error=5,66º), the “healthy” sub-group high correlation (r=0,575; p<0,001; RMS error<9,01º), and the sub- group “overweight” showed no correlation (r=0,069; p=0,832). As for the diagnostic capacity, flexicurve had a sensitivity of 59% and specificity of 44% .In conclusion the flexicurve showed a reproducible tool to be used by the same evaluator as well as by different evaluators, and also proved a valid tool to assess curvature of the cervical spine in the sagittal plane in adults classified by BMI underweight and healthy.

Made available in DSpace on 2016-08-03T16:31:14Z (GMT). No. of bitstreams: 1 CAPA.pdf: 39961 bytes, checksum: cf4605c3ea187328b828df9a9ace748e (MD5) Previous issue date: 2010-04-20 / This study aimed to evaluate the growth phase in a sample of 49 patients, with ages ranging from 9 to 15 years old, observing the cervical vertebrae on lateral radiographs taken in natural head position (NHP) and positioning errors, with head inclination up to 15° (NHP-High) and 15° down (NHP-Low), to define how important this is in the accuracy assessment phase of growth. The weighted kappa test showed a substantial degree of agreement between NHP and NHP High and between NHP and NHP-Low. Since the nonparametric test of wilcoxon (p <0.05) showed statistically significant difference between these comparisons. Thus, the NHP showed to be more reliable in assessing the cervical vertebrae maturation (CVM), furthermore the radiographs with positioning accuracy evaluated did not show statistically significant with the PNC.(AU) / Este trabalho teve como finalidade avaliar a fase de crescimento em uma amostra de 49 pacientes, com idades variando de 9 a 15 anos, observando as vértebras cervicais em radiografias laterais, tomadas na posição natural de cabeça (PNC) e com erros de posicionamento, com inclinações de cabeça de 15o para cima (PNC-Alta) e de 15 o para baixo (PNC-Baixa), visando definir o quão importante isto é na precisão da avaliação da fase de crescimento. O teste kappa ponderado mostrou um grau de concordância substancial entre PNC e PNC-Alta e entre PNC e PNC-Baixa. Já o teste não paramétrico de wilcoxon (p<0,05) mostrou diferença estatisticamente significante entre essas comparações. Desta forma, a PNC demonstrou ser mais confiável na avaliação do Índice de Maturação das Vértebras Cervicais (IMVC), porém as telerradiografias com erro de posicionamento avaliadas não tiveram um grau de discordância que indicasse sua não utilização na clínica para predição de crescimento.(AU)