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Reference intervals (RIs) are sets of percentiles that outline the range of laboratory test results belonging to healthy individuals. They are essential for the interpretation of laboratory test results. A wide variety of factors affect the validity of RIs. Among them are the statistical methods used to estimate RIs. However, little investigation has gone into the effect that different statistical methods have on the resulting RIs. This is particularly needed as the complexity of paediatric data makes it difficult to estimate RIs. These difficulties, however, can be addressed using appropriate statistical techniques, provided that there is an outline of scenarios under which these techniques are truly “appropriate”. The objective of this thesis is to provide a thorough investigation into the effect of different statistical methods on RIs. A systematic review was first conducted with a focus on paediatric RIs. The results of this review revealed that critical analysis steps are often overlooked due to complicated paediatric data. Even though a guideline addressing the establishment of RIs is available, there is great heterogeneity in the statistical methods chosen to estimate paediatric RIs. An extensive simulation involving the three most commonly used approaches to estimate RIs (the parametric, non-parametric, and robust methods) was also conducted to investigate and compare the performance of the different methods. The simulation results show that, when data follows a Gaussian distribution, or close to it, the parametric method provides the best estimates. The non-parametric method did not provide the best estimates of RIs (compared to the parametric method) unless data was highly skewed and/or large sample sizes were used. In addition, the bias and MSE associated with the parametric method when data follows a Gaussian distribution was mathematically derived, which may lead to the development of a bias corrected and more precise approach in the future. / Thesis / Master of Science (MSc)

The purpose of this thesis was to determine the effectiveness of strategies to reduce sedentary behaviour (SB) and to communicate these strategies to healthy adults working in academic occupations using an educational video. Study One was a systematic review and meta-analysis of published literature on strategies to reduce SB in the home and workplace environments for healthy adults. Study Two was a single group pre-post study design to determine the effect of an educational video on viewers’ health beliefs related to reducing SB and daily sitting time. The information gained from these studies could be used to inform future interventions to reduce SB in the adult population. / Thesis / Master of Science Rehabilitation Science (MSc)

Young adulthood is an important period in the development of obesity. Undergraduate students are particularly at-risk since they gain more weight than those not attending university. As students transition from high school to university, they often adopt unhealthy lifestyle behaviours which are thought to lead to weight gain. On average, students gain three to five pounds (1.4-2.3 kg) during their first year of undergraduate education. However, less is known about how body composition changes throughout the four-year course of undergraduate education and what causes these changes. We thus conducted a systematic review to synthesize a comprehensive list of factors associated with obesity traits (e.g. body mass index, body fat percentage, muscle mass) in undergraduate students. Two hundred thirty-eight studies were included (175 cross-sectional, 49 cohort, 11 interventional, 3 qualitative). We identified age, sex, ethnicity, socioeconomic status, religion, diet, eating habits, physical activity, sedentary activity, sleep, stress, university campus life, alcohol use, smoking, psychiatric disorders, body image, eating attitude, eating regulation, personality, and social/cultural influences as factors which are associated with obesity traits. These factors guided the design of the Genetic and EnviroNmental Effects on weight in University Students (GENEiUS) study, a prospective observational study which investigates the genetic and environmental determinants of body composition in undergraduate students over four years. The GENEiUS study will recruit 2500 multiethnic first- year undergraduates aged 17–25 years and will follow them every six months for four years. Primary outcomes are body mass index, waist circumference, waist-to-hip ratio, body fat mass and body fat percentage. This study will help design obesity prevention programs in universities. / Thesis / Master of Science (MSc)

Rationale: The use of ultrasound as an adjuvant to conservative treatment for neck pain is common, but the evidence of its benefit remains unclear. Objective: To determine the effectiveness of ultrasound as an adjuvant to exercise or/and manual therapy for the improvement of patient-centered outcomes in adults with non-specific neck pain. Methods: Electronic databases including MEDLINE, EMBASE, AMED, CINAHL, CENTRAL, PEDro and PubMed were searched from date of inception to March 2019 for controlled trials involving ultrasound or phonophoresis as an adjuvant to exercise or/and manual therapy in adults with non-specific neck pain. Review Manager 5.3 was used to calculate mean group differences. Main results: Six studies (361 participants) examining ultrasound or phonophoresis as an adjuvant to exercise or/and manual therapy for sub-acute and chronic non-specific neck pain were included. The quality of evidence was of very low GRADE. Phonophoresis with capsaicin plus exercise improved pain immediately post-treatment (MD -3.30, 95% CI: -4.05 to -2.55) but not with diclofenac sodium plus exercise as compared to exercise alone. Continuous ultrasound plus exercise improved pain and Pressure Pain Threshold (PPT) at immediate post-treatment (pain: MD -3.42, 95% CI: -4.08 to -2.7; PPT: MD 0.91, 95% CI: 0.68 to 1.14 ) and at intermediate - term (pain: MD -2.70 95% CI: -3.62 to -1.78; PPT: MD 0.27 95% CI: 0.03 to 0.51) as compared to exercise alone. Continuous ultrasound or High Power Pain Threshold (HPPT) ultrasound plus manual therapy and exercise showed no benefit for pain reduction (MD -0.75, 95% CI: -2.08 to 0.58), increase in PPT (MD -1.15, 95% CI: -2.55 to 0.25) or improved function/disability (MD -1.05, 95% CI: -4.27 to 2.17) at immediate or short-term as compared to manual therapy and exercise. Conclusion: Based on very low quality evidence, there is insufficient data to support ultrasound or phonophoresis as an adjuvant treatment for non-specific neck pain. / Thesis / Master of Science Rehabilitation Science (MSc) / Ultrasound therapy is widely used with exercise or manual therapy for the treatment of neck pain. Yet, its benefits are not clear. This review looked at the benefits of ultrasound added to exercise, manual therapy or both for the treatment of neck pain. The review contains six studies with 361 participants who suffered from neck pain. The results showed very low quality evidence. Applying capsaicin cream with ultrasound or continuous ultrasound in conjunction with exercise had some benefit for improving pain. The same treatment did not improve function as compared to exercise alone. There was no benefit in improving pain or function by adding continuous or high power ultrasound to manual therapy and exercise compared to manual therapy and exercise alone. Due to very low quality evidence, we are uncertain of whether there is a benefit to adding ultrasound to exercise or/and manual therapy for treatment of neck pain.

No / Fatigue is common in people with multiple sclerosis (MS) and symptoms of fatigue are often reported as the most debilitating symptoms of the disease. However, there are few reports of interventions for fatigue in MS. A systematic review of published literature examining pharmacological and psychosocial/psychological interventions for fatigue in MS was conducted. The search and review strategy undertaken used the Centre for Reviews and Dissemination guidelines. Papers were reviewed by two independent reviewers. Of 81 studies short-listed for inclusion, 15 studies were included, of which 10 were studies of pharmacological therapy and five were studies of psychosocial/psychological interventions. Of the pharmacological studies, two were rated as of moderate-to-high quality, three of moderate quality, two of moderate-to-low quality and three of low quality. Of the psychosocial/psychological studies, three were rated as of moderate quality and two of moderate-to-low quality. None of the studies reviewed reached the highest level of quality according to pre-agreed criteria. Regardless of level of quality, effectiveness of both pharmacological and psychosocial/psychological interventions was modest at best and often absent. Accordingly, there is little evidence-based advice that can be offered to people with MS to help manage their fatigue.

Yes / Purpose: The aim of this study was to systematically review the literature to investigate the link (if any) between vision and dizziness. Methods: Medline, CINAHL, AMED, Web of Science and The Cochrane Library were searched with keywords chosen to find articles which investigated the causes of dizziness and considered vision as a possible trigger. Citation chaining of all included papers was performed in addition to the hand searching of all reference lists. Unpublished literature was identified using www.opengrey.eu. The review considered studies involving adults which link, measure or attempt to improve any aspect of vision in relation to dizziness. Results: Nine thousand six hundred and eighty one possible references were found, and the abstracts were screened independently by two reviewers to determine if they should be included in the study. Thirteen papers were found which investigated whether dizziness was linked to an assessment of vision. Visual impairment measures were crude and typically self-report, or Snellen visual acuity with little or no measurement details. Five studies found an independent link between dizziness and vision, five found a weak association (typically finding a link when univariate analyses were used, but not when multivariate analyses were used), and three found no association. Studies finding a strong link were usually cross-sectional with a large study population whereas those finding a weak association had relatively small numbers of participants. Studies which did not find an association used a broad definition of dizziness that included the term light-headedness, an unreliable Rosenbaum near visual acuity chart or an unusual categorisation of visual acuity. Conclusions: This review suggests that dizziness (although likely not ‘light-headedness’) is linked with poor vision although further studies using more appropriate measures of vision are recommended. / Deborah Armstrong was funded by a College of Optometrists Research Scholarship and Emily Charlesworth by a College of Optometrists summer studentship.

No description available.

Chronic non-specific low back pain (CNSLBP) is a widespread but poorly understood condition that places a substantial burden on the sufferer, health services and the wider economy. Existing approaches to management do not demonstrate impressive levels of effectiveness. There is growing evidence that CNSLBP is associated with significant alterations in central nervous system (CNS) structure and function, suggesting a possible role for the brain in the aetiology of the condition, and presenting a case for novel therapies which aim to treat CNSLBP by affecting brain function. One such potential therapeutic approach is non-invasive brain stimulation (NIBS). Following a literature review discussing the epidemiology and management of low back pain, the evidence for altered CNS function and the potential role of brain stimulation in CNSLBP and chronic pain generally this thesis includes 3 original scientific studies: (i) A Cochrane systematic review of the effectiveness of NIBS techniques for the treatment of chronic pain; (ii) A randomised double-blind exploratory study of transcranial direct current stimulation of the motor cortex in the treatment of CNSLBP; (iii) Is blinding to the stimulation condition maintained in trials comparing 2mA tDCS with sham stimulation? A randomised cross-over study. Results: There is limited existing evidence that some forms of NIBS may have a beneficial effect on chronic pain, though caution is warranted. Exploratory data from study 2 is not suggestive that tDCS to the motor cortex is effective for treating CNSLBP. Commonly used sham controls in trials of tDCS do not ensure adequate blinding, and so introduce a potential source of bias to the existing evidence base. Conclusion: Further research is required to establish the value of NIBS as a treatment for chronic pain and CNSLBP. Future research in tDCS will need to develop and employ fully validated sham controls to ensure adequate blinding. NIBS cannot currently be recommended for the treatment of CNSLBP.

Ankylosing spondylitis (AS) is a chronic, inflammatory rheumatic disease that has a highly variable disease course. Three biologic agents, adalimumab, etanercept, and infliximab, have been developed for the treatment of AS. We conducted three studies: 1) an exploratory analysis of a year-long longitudinal dataset to gain insight into the variability of disease activity, physical function, and well-being and to explore the relationship between these outcome measures; 2) a systematic review of the available evidence for the efficacy of biologic treatment; 3) a systematic review of potential adverse effects of this treatment. We found that repeated measures of disease activity, function and well-being fluctuate considerably between patients, with complex patterns occurring over time within patients. There was mostly high quality evidence that these biologics are efficacious against placebo. We did not find evidence of an increase in serious adverse events or serious infections from short-term randomized controlled trials.