No description available.

No description available.

No description available.

No description available.

No description available.

No description available.

<p>Osteoarthritis (OA) is a progressive degenerative joint disease affecting over 4 million Canadians. The knee is most commonly affected joint, making knee OA a leading cause of chronic disability. Leg power is more closely related to physical performance than leg strength in healthy older adults, but power has yet to be studied in people with knee OA. Self-efficacy beliefs, or the confidence one has in their own abilities, is a variable closely related to physical performance in people with knee OA.</p> <p>The objective of this study was to identify the extent to which knee extensor strength, knee extensor power and self-efficacy explained variance in physical performance measures in adults with knee OA.</p> <p>Thirty-three participants diagnosed with clinical knee OA were included (5 men; mean age 61.1 ± 6.2 y). Dependent variables included a timed stair ascent, a timed stair descent, and the six minute walk test (SMWT). Independent variables included self-efficacy beliefs for pain, mean peak knee extensor power and mean knee extensor strength.</p> <p>Pearson correlations and linear regression models were completed using SPSS 15.</p> <p>Average values on the numeric pain rating scale (NPRS), self-efficacy beliefs for pain and mean peak knee extensor power explained 34.7 % and 42.7% of the variance observed on the timed stair ascent and the timed stair descent, respectively. The determinants of the SMWT were different, with 29.4 % of the variance being explained by average NPRS and body mass index.</p> <p>Similar to previous work conducted on healthy older adults, it appears that in adults with knee OA, knee extensor power is a closer determinant of physical performance when compared to knee extensor strength, on challenging everyday tasks, like ascending or descending a flight of stairs. For longer endurance type activities like the SMWT, the physical requirements may be different. Clinicians should consider these results when advising patients on the exercise interventions needed to maintain or improve physical performance.</p> / Master of Science (MSc)

<p><strong>Purpose: </strong>This study describes gait characteristics and evaluates whether step length, step time and stance time symmetry index (SI) ratio (differences between limbs divided by the bilateral average) and variables of each limb (limb-specific) can be reliably measured in a sample of unilateral knee osteoarthritis (KOA) and healthy participants. A secondary objective estimates between- and within-group differences and correlations between SIs and limb-specific variables with measures of pain, perceived exertion and physical function over an experimental walking intervention.</p> <p><strong>Design: </strong>Observational cohort. SI and limb-specific variables test-retest reliability and differences in KOA and healthy individuals before and after the walk intervention were estimated.<strong> </strong></p> <p><strong>Methods: </strong>Eight subjects were in each of the KOA and healthy groups. The GAITRite® captured step length, step time and stance time on three test occasions. Test-retest reliability was measured over two administrations. Pain (Numeric Pain Rating Scale) and perceived exertion (Borg Rating of Perceived Exertion) were collected before and after each test. The six-minute and treadmill walk tests comprised the experimental walking intervention. Point and interval estimates of SIs and limb-specific variables before and after the walk intervention for test-retest reliability, between- and within-group differences as well as Pearson correlations were obtained.</p> <p><strong>Results: </strong>Limb-specific variables showed better test-retest reliability (ICC 0.94 to 0.97) than SIs (ICC 0.77 to 0.87). Differences were observed in both groups’ perceived exertion rating (KOA -7.4 (-8.5 to -6.4); Healthy -6.7 (-8.0 to -5.5)) over the experimental walking intervention. In the KOA group, high correlations (r = 0.75 to 0.93) were observed between pain and both step and stance times as well as physical function and step length, varying in magnitude and direction depending on which limb was supporting.</p> <p><strong>Conclusion: </strong>The findings suggest that limb-specific measures are reliable and useful as biomechanical indices of compensatory KOA gait, correlating with pain and physical function.</p> / Master of Science (MSc)

<p>The purpose of this thesis was to improve the understanding of pain measurement and management in people with knee OA through: 1) Developing a theoretical model that may help in pain management and measurement; 2) Exploring the knee OA individuals’ views about three pain measures and 3) To determine if low frequency (≤100 Hz) pulsed subsensory threshold electrical stimulation produced either through pulsed electromagnetic field (PEMF) or pulsed electrical stimulation (PES) versus sham PEMF/PES intervention is effective in improving pain and physical function in the knee OA population.</p> <p>After pain theories literature review, a theoretical model was developed to address the gap between pain theories and clinical pain measurement and management. The patient’s views about three pain measures were not explored before 96 participants were recruited and completed the Verbal Numerical Rating Scale (VNRS), Intermittent and Constant Osteoarthritis pain Questionnaire (ICOAP) and the Short Form-McGill Pain Quetionnaire-2 (SF-MPQ-2). Participants were asked how well each pain measure describes their pain on a 10 cm Visual Analogue Scale (0 = does not describe your pain at all, and 10 = describes your pain completely. The time taken to complete and score the pain measure as well as the number of errors and questions while filling the pain measures were recorded. Systematic electronic searches were performed. Duplicate title, abstract and full text screening, risk of bias assessment, data extraction and grading the quality of evidence were performed. Data analysis was performed using Revman 5 software.</p> <p>Our sample of individuals with knee OA showed that VNRS, SF-MPQ-2 and ICOAP describe knee OA pain experience with no preference of one over the others. The systematic review conclusion was that PEMF/PES may be beneficial to improve physical function but not pain in people with knee OA with low and very low quality of evidence respectively</p> / Master of Health Sciences (MSc)

<p><strong>Objective</strong>: To perform an environmental survey of clinical practice amongst surgeons and physiotherapists in making return to sport (RTS) decisions following ACL reconstruction (ACLR); to gain a better understanding of how clinicians and patients define successful return to sport; and to compare patients’ level of satisfaction with their current level of activity following ACLR.</p> <p><strong>Design: </strong>Multidisciplinary cross sectional study.</p> <p><strong>Setting</strong>: Online</p> <p><strong>Participants:</strong> Orthopaedic surgeons and registered physiotherapists; and patients who had undergone ACLR within the previous 6-18 months.</p> <p><strong>Interventions: </strong>Surgeons and physiotherapists completed separate web surveys, each consisting of 10 closed format questions that included sections on demographics, outcome measures, treatment procedures, and RTS decisions. Patients completed a web survey consisting of 19 questions about their activity level, their experience surrounding the process of rehabilitation after ACLR, and their decisions surrounding RTS.</p> <p><strong>Main Outcome Measures</strong><strong>: </strong>Descriptive and subjective data were collected for all groups. Clinician responses were compared for differences in frequencies of clinical outcome measures used to decide RTS readiness. Frequency data were collected for all groups for the definition of successful RTS following ACLR using a self-report form. The relationship between patient satisfaction and current level of activity following ACLR was compared using the Tegner Activity Scale and Single Assessment Numeric Evaluation (SANE).</p> <p><strong>Results:</strong> All patients were unanimous in their definition of successful RTS post ACLR as the ability to fully participate in pre-injury level of sport with no limitations or deficits (100%), and restoring functional stability (100%). Mean Tegner activity level scores of respondents decreased a mean of 3.4 (SD ± 2.5) from pre-injury to current level of activity (p < 0.011). However, no significant decrease from pre-injury level of activity to expected level of activity post surgery was seen. A statistically significant correlation was demonstrated between patients’ level of satisfaction and current level of activity (r = 0.84, p = 0.02), with higher levels of activity associated with increased levels of satisfaction. Overall, the majority of clinician respondents reported that jump tests, range of motion (ROM), Lachman clinical test of stability, pain, swelling, functional movement and giving way contributed to their RTS decisions. Unanimous consensus existed between clinicians for the ability to participate in any level of sport, with or without limitations, as the definition of successful RTS following ACLR.</p> <p><strong>Conclusions:</strong> Following ACLR, medically cleared patients had not met their high expectations of functional stability and ability to return to their pre-injury level of sport. The discordance between unmet expectations and current level of sporting activity was reflected in lower rates of patient satisfaction. Most clinicians reported using primarily impairment based not self-report measures to contribute to their RTS decisions. Clinicians and patients expressed subtle differences in their definition of successful RTS.</p> <p><strong>Clinical Relevance: </strong>Establishing an operational definition of success, and professional consensus on measures which include patient reported outcomes is an important next step in the development of goal oriented RTS guidelines.</p> / Master of Science Rehabilitation Science (MSc)