Thesis (M.Ost.)--Unitec New Zealand, 2008. / Coda (electronic version) title page has 2009 as date of publication. Includes bibliographical references (leaves 43-50).

Thesis (M.S.)--University of Tennessee Health Science Center, 2009. / Title from title page screen (viewed on October 8, 2009). Research advisor: Denis DiAngelo, Ph.D. Document formatted into pages (viii, 75 p. : ill.). Vita. Abstract. Includes bibliographical references (p. 34-38).

Thesis (M. Med. Sc.)--University of Hong Kong, 2003. / Includes bibliographical references (leaves 81-94). Also available in print.

Thesis (Ph. D.)--University of Missouri-Columbia, 2007. / The entire dissertation/thesis text is included in the research.pdf file; the official abstract appears in the short.pdf file (which also appears in the research.pdf); a non-technical general description, or public abstract, appears in the public.pdf file. Title from title screen of research.pdf file (viewed on October 16, 2007) Vita. Includes bibliographical references.

Low back pain is the most common cause of disability in the United Kingdom with health care costs of more than 1 billion pounds per year. One reason associated with low back pain is the degeneration of intervertebral discs due to loads on the spine. Daily postures such as standing and sitting produce different loads on the discs. Previously, many studies investigated the stress and pressure within the disc in these postures. The results do not agree with each other and the experiments have many limitations. The aim of this project was to assess the feasibility of incorporating magnetic resonance (MR) imaging and finite element (FE) analysis to predict the pressure and stresses developed by different daily postures in an individual. Transient and non-transient subject specific 2D models of nine individuals in standing and sitting were created based on previously acquired MR images. The geometry of these FE models was based on supine MR images. The sitting and standing boundary conditions were calculated by comparing their MR images with the supine posture. The results showed that for six subjects sitting created more intradiscal pressure compared to standing and in one subject standing more than sitting. For two of the subjects the pressure was nearly the same in sitting and standing. Because of the 2D model’s limitations, 3D models of an individual were developed. Both transient and non-transient models of the individual were created. The intradiscal pressure results were three times lower compared to the 2D models. This was due to consideration of out of plane deformation in the 3D models. These results were in the range of in-vivo and in-vitro measurements available in the literature. In conclusion, it was possible to create kinematic transient subject specific FE models based on the MR images in different postures. 2D models provide a method for comparing the postures but 3D models may be more realistic.

No description available.

Objetivos: Evaluar la prevalencia de dolor lumbar, la discapacidad provocada por este y sus factores asociados en trabajadores de vigilancia en un distrito de Lima, Perú. Métodos: Se realizó un estudio transversal en vigilantes de Miraflores, Lima. El muestreo se realizó por conglomerados. El dolor lumbar se midió con el cuestionario Nórdico para dolor lumbar y la discapacidad lumbar se midió con el cuestionario de Oswestry. Adicionalmente se midió actividad física mediante la versión corta del Cuestionario Internacional de la Actividad Física (IPAQ-SF) y datos sociodemográficos. Se calculó la prevalencia de lumbalgia y además se calculó razones de prevalencia crudas y ajustadas con sus intervalos de confianza al 95% utilizando regresión de Poisson con varianza robusta. Resultados: Se incluyeron 335 personas en el estudio. El 98% fueron hombres y la mediana de la edad en la población fue de 42 años (IQR: 21). El 55,8% presentó un nivel mínimo de actividad física, mientras que el 27,8 % realiza actividad física intensa. La prevalencia de dolor lumbar fue de 65,3% y la discapacidad fue 26,6%. Se encontró el tiempo sentado [ RPa: 2,21; IC95%=1,45-3,38] y la edad [RPa: 1,58; IC95%= 1,01-2,47] como factores asociados a la discapacidad. Conclusión: Dos de cada tres vigilantes presentaron dolor lumbar y aproximadamente unos de cada cuatro presentaron discapacidad por dolor lumbar. / Objective: Evaluate the prevalence of low back pain, the disability caused by this and the associated factor in watchmen in a district of Lima. Methods: It has been made a cross-sectional study of watchmen in Miraflores, Lima. The sampling was performed by clusters. The low back pain was measured by the Nordic questionnaire for low back pain and lumbar disability was measured with the Oswestry questionnaire. Additionally, the physical activity was measured by the short version of the International Questionnaire of Physical Activity (IPAQ-SF) and sociodemographic data. The prevalence of low back pain was calculated and the crude and adjusted prevalence ratios were calculated with their 95% confidence intervals using Poisson regression with robust variance. Results. The study includes 335 people. 98% were men, the median age was 42 (IQR:21). The 55.8% had a minimum level of physical activity. The prevalence of low back pain was 65.3% and the disability was 26.6%. the seated time was found [RPa: 2,21; IC95%=1,45-3,38] and age [RPa: 1,58; IC95%= 1,01-2,47] as factors associated with disability. Conclusion: Two out of three watchmen had low back pain and one in four had disability for low back pain.

Lumbar intervertebral disc disorder is a spinal condition that affects the normal function of the intervertebral discs mainly due to the natural aging process. This condition can manifest itself in pain and limited motion in the legs, amongst others. Posterolateral Fusion (PLF) and Posterior Lumbar Interbody Fusion (PLIF) are two of the most used surgical procedures for treating lumbar intervertebral disc disease. Although these procedures are commonly used and performed successfully the impact in terms of the stresses developed in the posterior implants employed and in the spinal components adjacent to the surgical site has not been exhaustively investigated. In addition, the consequences of the procedure on the reduction of the Range of Motion of the lumbar spine is not clearly understood. The objective of this research is to investigate the effect of one-level spinal fusion of lumbar segment L4-L5 on the stresses and the range of motion at the remaining, adjacent lumbar levels. Four 3 dimensional finite element models of a lumbosacral spine were created from Computer Tomography data (CT scan). The models were used to investigate four surgical scenarios, including the use of 0o and 4o interbody cages, in addition to the un-instrumented spine for flexion, extension, torsion and lateral bending motions. The predictions obtained from the models enabled the mechanical behaviour of the lumbar spine following fusion surgery using 0 o and 4o cages to be investigated and compared. In addition, a clinical study was performed to quantify the reduction in the range of motion for subjects who had undergone L4/5 posterior lumbar interbody fusion surgery. The clinical results were compared to those of subjects who had not undergone surgery and to the range of motion predictions from the computational model. The results from this research demonstrate that the insertion of posterior instrumentation does not have an impact on the spinal structures above the L3/4 intervertebral disc. However, the pedicle screws and the insertion of the interbody cages causes stress levels in the area adjacent to the surgical site to rise which could promote accelerated degeneration of the discs. Additionally, this study demonstrates how the pedicle screws are affected by the surgical spinal fusion techniques. Furthermore, the investigation demonstrates how posterior lumbar interbody fusion causes the range of motion of patients that had undergone this surgery to decrease. The results from the comparison of the behaviour of the use of 0º and 4º interbody cages in L4-5 posterolateral fusion demonstrates that the stress levels in the adjacent vertebrae, intervertebral discs and pedicle screw fixation system increase when 4º are used cages than when 0º cages were employed. The results from the in-vitro study show a decrease in the range of motion of the subjects who had undergone L4/5 posterior lumbar interbody fusion surgery when compared with the subjects with no low back pain history. This indicates that the PLIF surgery combined with the normal disc degeneration is subjected to higher stresses than the healthy spine.

M.Tech. (Chiropractic) / The purpose of this study is to evaluate whether action potential simulation (APS) therapy is more effective than placebo therapy in terms of pain relief and improvement in lumbar spine range of motion when treating chronic lumbar spine pain. The comparison of the two therapies was accomplished by objective and subjective assessments. The study was conducted by means of a double blind clinical trial with two experimental groups. Thirty subjects eighteen years of age and older who suffered from chronic lumbar spine pain were chosen from the general population who responded to the advertisements and from Tarentaal Home for the Aged. The researcher examined each of these subjects in order to be accepted into the study. Each subject was treated ten times over a two-week period and underwent a one-month follow-up consultation to be re-examined. Subjects in both groups received therapy for eight minutes at an amplitude of 1-2mA. Only the APS group received the electric current and the placebo group did not receive the electric current. The objective assessment was by means of measurement of the lumbar spine ranges of motion using an inclinometer. The subjective assessment was measured by means of two questionnaires, which are widely accepted in the research community namely: a) Oswestry Low Back Pain and Disability Questionnaire b) McGill Pain Questionnaire. The results, which were obtained, were statistically analyzed using the Mann-Whitney Rank Sum test (inter-group comparison) and the Wilcoxon Signed Rank test (intra-group comparison). Graphs were created using the actual values of each patient in each group and using the medians obtained. The study concluded that both the APS and the placebo group improved in terms of lumbar spine range of motion and pain relief even though not all the results were statistically significant. The graphs representing the mean values at the first, final and one-month follow-up consultations of each group showed the apparent improvement in terms of range of motion in the lumbar spine and pain relief. The APS group's mean values, at the above mentioned consultations, showed a greater improvement in range of motion and pain relief when being compared to the placebo group's mean values that are represented on the respective graphs.

Philosophiae Doctor - PhD / Lumbo-sacral radiculopathy (LSR) is clinically defined as low back and referred leg symptoms accompanied by an objective sensory and/or motor deficit due to nerve root compromise. LSR is a common condition encountered by physiotherapists in clinical practice and the assessment and diagnosis remains a challenge owing to the complex anatomy of the lumbo-sacral spine segment and the various differentials. Moreover, LSR imposes a significant impact on patients’ health, functional ability, socio-economic status and quality of life. There are several diagnostic tools and procedures which are commonly utilised in practice, including diagnostic neuropathic pain screening questionnaires, clinical neurological tests, electro-diagnostics and imaging. However, the diagnostic utility and correlation of these tests have not been fully explored and remains debatable among clinicians and researchers in the fields of musculo-skeletal health and neurology. The aim of this study was to determine a correlation of the S-LANSS score, clinical neurological examination (CNE) findings and magnetic resonance imaging (MRI) reports in the diagnosis of LSR among patients who presented with low back and referred leg symptoms. The study was conducted in three phases. In phase one, two systematic literature reviews were conducted; firstly, to establish the evidence-based accuracy of CNE in diagnosing LSR, and secondly, to establish the evidence-based accuracy of MRI in diagnosing LSR. In both systematic literature reviews, the diagnostic tests accuracy (DTA) protocol was used in planning, design and execution of literature search, selection of relevant studies, quality assessment, data analysis and presentation of the results. In phase two, clinical validation of an adopted S-LANSS scale and lumbar MRI reporting protocol were established, and a standardised evidence based lumbar CNE protocol developed.The face and content validity of the original S-LANSS score was established among a sample of Kenyan physiotherapists and patients who presented with low back and referred leg symptoms, using both quantitative and qualitative research designs. This was followed by a test-re-test reliability study on the adapted version of the S- LNASS score. The face and content validity of the adopted lumbar MRI reporting protocol was established among a sample of Kenyan radiologists followed by an inter-rater reliability. An evidence-based lumbar CNE protocol was developed; standardised and inter-examiner reliability was also examined among a sample of Kenyan physiotherapists. Finally, in phase three, a cross-sectional blinded validity study was conducted in six different physiotherapy departments. Participants (patients, physiotherapists and radiologists) were recruited using strict in- and exclusion criteria and data was collected using a pain and demographic questionnaire, the S-LANSS scale, the CNE protocol, the Oswestry Disability Index (ODI) and the MRI lumbar spine reporting protocol. Data was captured, cleaned and analysed using SPSS version 21. Descriptive analysis was done using frequencies, means and percentages, while inferential analysis was conducted using Spearman’s rank correlation coefficient test r to establish the correlation between the diagnostic tests. Cross tabulations, receiver operating curves (ROC) and scatter plots were used to establish the sensitivity and/or specificity of S-LANSS scale and individual CNE tests as defined by MRI. In phase three, which formed the main study of the research project, a total of 102 participants were recruited in this study with a gender distribution of 57% females and 43% males. The majority (67%) had neuropathic pain according to the S-LANSS scale and their pain intensity ranged from moderate (4-6) to severe (7-9) as recorded on a Numeric Pain rating Scale (NPRS), and was more common among manual workers. Similarly, patients whose pain had a neuropathic component had moderate to severe disability. The S-LANSS scale and lower limb neuro-dynamic tests were the most sensitive tests 0.79 and 0.75 respectively, while deep tendon reflexes were the most specific tests (0.87). The S-LANSS and CNE correlated fairly but significantly with MRI (r=0.36, P=0.01).LSR is a common condition and its assessment and diagnosis remains a clinical challenge among physiotherapists. MRI is a high-cost diagnostic tool but is being used by many clinicians in making decisions regarding the management of patients. Rapid and low-cost neuropathic pain screening by the use of the S-LANSS scale, together with use of evidence-based CNE of neuro-conduction and neuro-dynamic tests may be used in confirming nerve-root related MRI findings. These may be used in making a decision on whether to manage a patient conservatively using pharmacological agents and manual physiotherapy and therapeutic exercise, or consider surgery in the initial management of patients with clinical suspicion of LSR. This is especially valuable in the resource-poor settings like Kenya and other sub-Saharan African countries where MRI is costly or unavailable.