No description available.

Background: Standardized outcome measures used in assessment of chronic disease need to be relevant to the client if interventions based on the results are to be meaningful. The Modified Health Assessment Questionnaire (MHAQ) (Pincus et al., 1983) is an eight-item questionnaire used commonly with individuals with Rheumatoid Arthritis (RA) to assess self-reported function. This scale has been translated and validated in multiple languages and cultures but has never been evaluated for its relevance with a Canadian Indigenous population despite its frequent application in clinical and health research settings. Purpose: The primary objective of the following study was to determine whether or not the MHAQ is an appropriate measurement tool to adequately document the lived experiences of activity and participation in First Nations individuals diagnosed with RA. Methodology: A mixed methods sequential explanatory approach was utilized. The quantitative component consisted of secondary analysis of an existing clinical database developed at the University of Manitoba Health Sciences Arthritis Centre (UMHSAC). MHAQ scores and other indicators of disease activity of First Nations (n=252) and Caucasian (n=633) individuals with RA were examined for significant differences. The results informed a qualitative phase using interpretive description methodology whereby semi-structured interviews were held with 25 First Nations individuals with RA. Results: A significant relationship was observed between ethnicity and MHAQ score (p<0.001) where the First Nations cohort demonstrated significantly higher scores in pain and MHAQ scores (p<0.001), as well as physician global assessment and morning stiffness (p<0.05). Pain was the single greatest predictor of MHAQ score (p<0.001). In contrast, a convergence coding matrix comparing MHAQ scores to first-hand narratives found only 65% agreement in responses. The thematic analysis of the qualitative component resulted in three key themes: Ka-wachi-wa-pinaywin (“Coldness in the bones”), Adaptive Resilience, and Family Relations. Conclusion: Concurrent validity of the MHAQ in a First Nations population was supported through statistical analyses but convergent validity was not supported by subsequent qualitative and mixed methods approaches. The assessment of disability requires an integrated approach that takes into consideration an individual’s personal context. Both barriers and facilitators in the environment, as well as personal factors, must be addressed. / February 2016

Arthritis deformans in its atrophic form (rheumatoid arthritis) is, perhaps, best defined as a chronic disease affecting many joints, principally the smaller ones. It occurs chiefly in the female sex, is due probably to the action of a toxin, and is characterised by changes in the cartilages and the soft structures surrounding the joints, thus causing great immobility and deformity. That arthritis is a disease of great antiquity is borne out by the fact that recently-unearthed bones from tombs of about 3700-1300 B.C. showed unmistakable evidence of the affection. In exarnination of remains in Egypt, remains representative of all periods from early predynastic times dovm to the Fifth Dynasty after Christ, "the disease which showed itself with by far the greatest frequency in the bodies of all periods is rheumatoid arthritis". Virchow has left records describing the affection in bones unearthed from Pompeii. From these remote times onwards through the Middle Ages to the present day, an almost continuous series of historical records testifies that the disease has always been with us, and also that its clinical characters have remained unaltered through all the ages. The aetiology and pathology of the disease have, however, been so shrouded in darkness that we find the various writers, in their information on the subject, making indiscriminate use of the terms rheumatism, gout and arthritis to designate this affection.

No description available.

Thesis (M.P.H.)--University of Hong Kong, 2006.

No description available.

No description available.

No description available.

A consecutive series of 280 Charnley low-friction arthroplasties, performed between 1966 and 1978, on 192 patients, who were less than 40 years of age at the time of operation, were followed up for an average duration of 20.1 years. Patients were divided into four groups based on underlying disease process, and only three patients (5 hips) could not be traced. Patients with rheumatoid arthritis had significantly lower rates of acetabular component loosening, migration and revision (all p< 0.05), and patients with developmental dysplasia of the hip had the highest rates as well as a significantly higher rate of combined clinical and radiological component failure (p < 0.05). Patients with degenerative arthrosis had the highest rates of femoral implant loosening, revision and failure (all p < 0.05), and patients with ankylosing spondylitis and rheumatoid arthritis had the lowest. Age (< 30 years or 30 to 40 years at operation), gender, heterotopic ossification, hypertrophy of the femoral cortex at the tip of the prosthesis or development of changes in the medial femoral calcar were not associated with an increased risk of component failure or revision (all p > 0.05). The average annual rate of wear of revised components, in each of the four groups and the series as a whole, was significantly higher than the rate in surviving original components (p < 0.04), and the development of osteolysis, and increasing wear of the acetabular component were associated with failure and revision of both the acetabular and femoral components (both p < 0.01). Cox regression analysis confirmed that increasing average annual acetabular wear was the most significant factor determining the outcome of the arthroplasty (p < 0.001). For each additional millimetre of wear observed, the risk of component failure or revision in any one year increased significantly (p < 0.02). The 25-year survivorship of implants with an average acetabular wear rate of less than 0.1 mm/yr (117 arthroplasties) was greater than 90% but no arthroplasties with a rate in excess of 0.2 mm/yr survived 25 years, and only 40% survived 20 years.

The problem considered in this thesis is developing a set of digital features relevant in describing finger-hand function of early-onset rheumatoid arthritis (RA) patients. The premise is based on a novel telerehabilitation gaming system that operates on a store-and-forward design. The solution to this problem was to develop a full-scale gaming platform to examine client movement performance for precision aiming tasks based on a set of digital features. To complement the movement performance, still imagery in three unique poses are captured during a session to detect visual symptoms during disease activity and early warning signs of deformities that can arise from joint damage. Resulting data is gathered in a clinic or housed in a content management system where features are extracted and analyzed, providing reports/queries for care providers and allowing remote monitoring. The goal is to help automate monitoring patient finger-hand function between office visits from a remote location, on a smaller scale and with minimal supervision. The contributions presented in this work include development of a detailed set of digital features derived from a custom built gaming platform to highlight client movement performance and algorithms to extract hand structure to approximate goniometry measurements of joint angles monitoring for potential changes during progression of the disease. The significance of this contribution is that it provides a readily accessible, experimental platform for the provision of physical therapy tailored to the individual RA patient through the use of a telerehabilitation gaming platform.