Thesis (doctoral)--Göteborg University, 1994. / Added t.p. with thesis statement inserted.

In this workshop, the STFM Group on Musculoskeletal Education will facilitate participants incorporating the ACGME milestones into a musculoskeletal curriculum. Participants will submit prior to the workshop perceived barriers in implementing the milestones. During the workshop, participants will engage in a hands-on curriculum that promotes milestone progression in residents, including concepts such as self-learning and leadership while learning core musculoskeletal medicine concepts, such as shoulder/knee exams and concussion management. Participants will apply these skills while training to administer a SMART (Sideline Management Assessment Response Techniques) course and thus learn how to assess resident competence in providing medical coverage at sporting events where these key concepts and skills such as spinal immobilization are necessary. The workshop will conclude with a discussion on collaboration and methods that promote interdisciplinary education in musculoskeletal medicine. Objectives: After attending this workshop, participants will be able to: 1. Apply the ACGME milestones to key portions of a musculoskeletal curriculum, including joint exams, joint injections, casting/splinting, and sideline management 2. Reproduce hands-on skill stations in a residency setting, form the foundation for residency competence, and promote muscle memory in key musculoskeletal procedures. 3. Lead a SMART (Sideline Management Assessment Response Techniques) course in their residency setting.

This descriptive retrospective cohort study utilized a large workers comp insurer database. All MRI's performed on peripheral joints during calendar year 2017 that were (a) 2 weeks after the initial clinic visit, or (b) greater than 6 weeks after injury, but (c) not more than 3 months after the date of injury were evaluated in this study. Individual diagnoses rendered on MRI reports for these cases were categorized as to whether ultrasound alone or ultrasound + xray could adequately provide the same diagnoses. Results showed that, ultrasound + xray would be able to provide all of the same diagnoses compared to MRI in 54% of cases vs 33% of cases using ultrasound alone, highlighting the utility of using ultrasound and xray together. The proportion of cases where ultrasound + xray could reasonably be substituted for MRI increases to 70% overall when less severe diagnoses, considered not likely to change management, were excluded from analysis. If point of care ultrasound was performed for all 1482 cases with subsequent MRIs pursued in only 30% of cases, a cost savings between $456,186 and $331,698 would be realized, translating to $308 to $224 per patient. Additionally, if ultrasound + xray was performed at the point of care during the first clinic visit for an injury, the definitive diagnoses could be reached on average 33.3 days earlier. In total, these results suggest a significant proportion of musculoskeletal workers comp injuries could be accurately and completely evaluated at the point of care using ultrasound and xray together. This could yield greater provider and patient confidence in the diagnosis and treatment plan as well as more expeditious accurate diagnoses leading to reductions in both direct and indirect costs.

The purpose of this study was to investigate problem areas of organists' performance as indicated by common experiences of pain. The research problems were to determine the specific areas of the body that were affected by pain, to determine the perceived level of that pain on a scale indicative of its severity, and to explore the relationship between demographic and performance-related factors within the population and specific area of reported pain. An examination of the demographic, performance-related, and pain data, as well as subject comments, indicated possible relationships of the pain experience to other factors. Organists attributed their pain to instrument characteristics, such as keyboard action, music rack height, bench design, and pedalboard shape. Pain was also associated with the time spent playing the organ, playing literature which required large reaches and rapid passage work, such as french toccatas, or playing with incorrect posture. To explore these relationships to spinal and upper extremity pain, further research is indicated.

Developmental dysplasia of the hip (DDH) is a condition that involves the dislocation of the head of the femur in the acetabulum of the pelvic bone. Although it may not interfere with a child's range of motion during infancy, DDH can cause various effects over time such as joint pain, abnormal gait, and even paralysis. It is crucial to catch this phenomenon early on so that permanent disability is not introduced to the patient. In this study, an excitation device was used to send a broadband frequency signal through a hip joint simulated by a 3D printed bone apparatus consisting of a left femur and left pelvic bone. Accelerometers were used to sense the transmission of this signal through the bones tested. Variability was induced through different experiments in order to determine where the optimal frequency for detection of DDH would be. After variability was quantified for all of the nonconsecutive and consecutive trials, the excitation device was tested on a raw chicken quarter through the knee joint since this was very similar to the hip joint. Coherence, phase, and transfer function graphs were used to demonstrate the degree of variability, optimal frequencies for detection, and degree of signal transmission through the joints tested. The results from the 3D printed bone model showed that the height of accelerometer suspension, loosened coupling of sensors, and vertical alignment of the bone model apparatus affected the transfer function and phase graphs of the experiments while coherence stayed relatively the same. On the other hand, the results from the raw chicken model displayed similarities between graphs for little to no joint dislocation but the complete dislocation of the bone yielded significantly different graphs.

Background: Firefighters (FFs) are exposed to life-threatening conditions while carrying out their tasks. These strenuous conditions predispose them to a high rate of disability, morbidity and mortality. These hazardous conditions put them at risk for work limitations, but the literature is scarce in this matter. Objective: The overarching objective of this thesis is to determine the role of FFs health as predictors of work limitations in fire service. Specifically, the first objective is to determine whether work limitations differ among FFs based on the location or number of painful sites. The secondary objective is to determine whether non-musculoskeletal comorbid health condition predict work limitations among FFs. Participants: A convenience sample of FFs between the age of 18-60 years working in the province of Ontario, Canada. Methods: Participants completed either an online or paper-based survey including a work limitation questionnaire(WLQ-26) and a self-reported comorbidity questionnaire. For the first objective, a one-way ANOVA and post hoc test was used to determine the differences in work limitations among FFs based on the number or location of painful sites. For the secondary objective, a univariate linear regression was used to evaluate whether non-MSK comorbid health condition predict work limitations among FFs. Results: FFs with three or more painful sites had more physical limitations than FFs without pain, (Mean difference=1.03/10; 95% CI: 0.16-1.62; p=0.02). FFs with pain at the region of the spine experienced more physical limitations compared to FFs with no pain (Mean difference=0.89/10; 95% CI: 0.17-1.62; p=0.007). For the secondary objective, univariate analysis showed that having at least one comorbidity(p=0.04) had a small, but significant association with greater mental work limitations (F2,316=2.94; p=0.05; R2=0.02). Separate univariate analysis showed that women FFs having one comorbidity had a small but significant association with physical (R2=0.07; F2,97=3.92, p=0.02) and mental work limitations (R2=0.04; F2,101=1.89, p=0.15) than women without non-MSK comorbidity. Conclusion: Having multiple painful sites or pain at the spinal region influenced work limitations among FFs. Also, non-MSK comorbidity impacted mental limitations among FFs; especially among women FFs. Therefore, managing MSK and on-MSK comorbidities is a necessary health care goal to prevent work limitations. / Thesis / Master of Science (MSc)

by Agnes Kam-Kwan Chow Gardner. / Thesis (M.Phil.)--Chinese University of Hong Kong, 1989. / Bibliography: leaves 136-144.

Thesis (M. Sc.)--York University, 2000. Graduate Programme in Kinesiology and Health Science. / Typescript. Includes bibliographical references (leaves 16-23). Also available on the Internet. MODE OF ACCESS via web browser by entering the following URL: http://wwwlib.umi.com/cr/yorku/fullcit?pMQ59170.

Cerebral palsy (CP) is a heterogeneous disorder in which movement and posture are affected. Increased excitation of the central nervous system leads to neural symptoms, which can cause spasticity and muscle weakness. These neural abnormalities result in secondary CP-related mechanical adaptations of muscles and tendons, which can lead to muscle contracture, joint deformities and pain. Therapeutic interventions are therefore essential to treat CP-induced abnormalities. Passive stretching in particular is a popular treatment method in clinical practice. However, due to a lack of scientific evidence, clinicians often have to make assumptions about the mechanical adaptability of muscles and tendons. Currently, the mechanical properties of muscles and tendons in children with CP and their adaptability are not well understood, which makes it difficult to implement evidence-based practice in clinical settings. Therefore, the overall purpose of this research was to examine the mechanical properties of the medial gastrocnemius muscle and Achilles tendon in children with spastic CP, and the adaptations of the muscle and tendon to acute and long-term passive stretching. The first experimental Chapter (3) was carried out in healthy adults, to assess the agreement between two methods of deriving Achilles tendon stiffness (i) active contraction of the triceps surae muscles to elongate the Achilles tendon, or (ii) passive rotation of the ankle joint. Taking into consideration the tendon’s viscoelastic response, the effects of strain-rate on Achilles tendon stiffness were also described. Results revealed that tendon stiffness measured using the “active method” was 6% greater than the “passive method”. There was also a significant increase in Achilles tendon stiffness in response to increased strain-rate. As the more commonly used active method is problematic to be used in children with CP, due to muscle weakness and excessive co-contraction, the passive method of deriving tendon stiffness was used in subsequent experimental studies. In experimental Chapter 4, differences in the mechanical properties of the Achilles tendon and triceps surae muscles between children with CP and their typically developing (TD) peers, were investigated. The results revealed that estimates of triceps surae muscle stiffness were significantly greater in children with CP compared to TD children. The results also showed that despite a smaller tendon cross-sectional area in children with CP, Achilles tendon stiffness was not different between groups. In addition, children with CP had a steeper tendon stiffness-strain-rate relationship compared to TD children. These results have significant clinical implications regarding the diagnosis of spasticity using the current clinical methods. Experimental Chapters 5 and 6 examined the muscle’s and tendon’s response to stretch. Passive stretching, implemented by a clinician or by the children themselves, is a commonly used intervention for children with CP with the aim of inducing structural alterations in muscles and tendons to improve function. In order for these alterations to take place, elongation of the muscle and fascicles would presumably need to occur with acute stretching. To date, this assumption has not been tested. Thus, the purpose of Chapter 5 was to investigate the medial gastrocnemius and muscle fascicle response to acute stretching, using two commonly used stretch techniques. Results of this study revealed that 100 s of stretching caused a transient increase in tendon (1.0 cm), muscle (0.8 cm) and fascicle lengths (0.6 cm). This effect was independent of stretch technique. These results provide evidence that the muscle and fascicles are capable of elongating in response to stretch in children with spastic CP. They provide a basis for the hypothesis that the spastic muscle may be able to adapt in response to long-term stretching. Thus, the purpose of the final experimental Chapter (6) was to assess the effects of a six week passive stretching intervention (four days per week, 15 minutes per day) on muscle and tendon properties, and gait parameters in children with CP. Results revealed there was a significant reduction in joint stiffness in the experimental group following six weeks of stretching. This was accompanied by a reduction in muscle stiffness, but with no alterations in Achilles tendon stiffness. Additionally, there were no positive effects of passive stretching on gait parameters. Together, the results of the present series of investigations demonstrates how fundamental knowledge of muscle and tendon mechanics in children with spastic CP, can be implemented to support evidence-based clinical practice.

Musculoskeletal pain is one of the most common illnesses among the people in NE Thailand which is commonly treated by self-medication. Ya-chud (several medicines together in a small plastic bag) for the treatment of musculoskeletal pain is an illegal treatment but has been used by lay people for more than 20 years. A better understanding of the people's perception of and behaviour in taking Ya-chud for treatment of musculoskeletal pain should help in designing an effective implementation programme to reduce the taking ofYa-chud. The study group was 15 years old and over and lived in 2 rural (N = 619) and 2 urban (N = 494) areas of NE Thailand. The study method used individual interviewing. The study aimed to investigate self-treatment of musculoskeletal pain with and without Ya-chud in the urban and rural areas. The attitudes of Ya-chud users in the urban (N = 136) and the rural (N = 128) were measured using a 6 point Likert Scale with a Conbach's alpha coefficient of 0.7509. Comparative analyses of variables between these two areas and between the users and non-users were conducted. Indepth interviews and laboratory analysis of Ya-chud samples were carried out to obtain more detailed information. The study found that Ya-chud for musculoskeletal pain was often used as the alternative treatment to treat pain which occurred at many locations of the body at the same time when the previous outcome had been unsatisfactory. The discriminant stepwise analysis showed that 85.9 percent of Ya-chud users in both rural and urban areas were 25 years old and over and had an education level of primary/secondary school. The overall prevalence of Ya-chud users in the rural areas was higher than in the urban areas but the prevalence of those who had taken Ya-chud within one year was greater in the urban areas. Ya-chud use varied with the season. It peaked during periods of heavy work such as harvesting. The main source of Ya-chud was groceries (82.3 percent in the urban and 79.6 percent in the rural). People had the perception that Ya-chud was a potent drug, cheap and had beneficial effects. They also perceived that the specific name of Ya-chud was easy to remember and described their symptoms. Attitudes towards Ya-chud were positive in the rural areas but negative in the urban areas (p < 0.01). Most of the respondents did not know the harmful effects of Ya-chud. The study showed that the locations of pain for nonusers were not different from the users and also that the treatment outcome after taking Ya-chud was predominantly 'no change' (46.2 percent in the rural and 44.6 . percent in the urban) (p < 0.01). The results from the Ya-chud users in-depth interviews indicated that in the urban areas there was more use of massage, rest and health services for the treatment of musculoskeletal pain but in the rural areas medicines from the drug stores were more often used (p < 0.01). Only 10.9 percent of the respondents could be cured by the above treatments in the urban areas and 4.4 percent in the rural areas (p > 0.05). After taking Ya-chud the result of treatment was a 'cure' for 45.5 percent of users in the urban and for 35.3 percent of users in the rural areas (p > 0.05). Identification of the medicines contained in a packet showed that steroids, NSAIDs and tranquillisers were most often combined in a package. It can be concluded that Ya-chud for musculoskeletal pain is not only unnecessary but also a dangerous use of these hazardous medicines which mask the symptoms rather than cure the illness. Intensive and continuous education campaigns together with legal enforcement should be beneficial for a short term programme to reduce Ya-chud use. Long term programmes should focus on providing licensed dispensers in every drug store so that the lay people can gain more helpful knowledge about medicines and so that legal enforcement can be better implemented since pressure could then be brought to ensure such licensed dispensers complied with legislation.