A thesis submitted to the Faculty of Health Sciences, University of the
Witwatersrand, Johannesburg, in fulfillment of the requirements for the
degree of Doctor of Philosophy
Johannesburg, 2019 / Background Evidence shows that the global prevalence of knee osteoarthritis (KOA)
is high, with limited data on the management of the disease. The use of novel
modalities to treat the condition is low due to poor understanding of their clinical
effects. Therefore there are gaps in the knowledge on the prevalence and treatment
modalities for patients diagnosed with KOA.
Aim: The aim was threefold; (i) to determine the prevalence of KOA in South Africa
aged 45yrs-75yrs; (ii) to determine the current management of KOA; and (iii) to
determine the effect of Low Level Laser therapy (LLLT) on the structural and functional
components related to KOA in a South African cohort, aged 45-75yrs.
Methods: The methodology will be discussed in terms of the three specified
objectives; (i) prevalence study data - a self-reported data collection sheet listing 19
relevant ICD 10 codes; completed by South African medical aid providers. (ii) The
treatment paradigm study, which encompassed a deemed KOA management
paradigm validated questionnaire sent electronically to 742 general, specialist and
allied practitioners, identifying the incidence of KOA and deemed efficacy and
compliance of various management tool. These practitioners were identified from a
database of medical and allied practitioners in both the private and public sector of
South Africa. The questionnaire consisted of two close ended questions indicating the
incidence of KOA and bilateral KOA patients consulted at the practice; one choice
question indicating the most suggested mode of therapy from a choice of
pharmaceutical, surgical, homeopathic, physical exercise therapy and LLLT and
finally, 3 Likert type scale questions on the deemed efficacy and compliance of the
modes of therapy as stated above. (iii) The intervention study which was a randomized
controlled trial (RCT) utilizing pre marked questionnaire sheets on 111 participants.
Participants were randomized into one of three intervention groups; (1) exercise group
(n=39), (2) LLLT group (n=40), and (3) combined exercise-LLLT group (n=32). Data
on knee circumference, the Western Ontario and McMaster Universities Osteoarthritis
Index (WOMAC), knee range of motion (ROM) and the one minute timed sit–to-stand
test was used. These tests were done at four time points: (T1) baseline, (T2) post-12
session intervention, (T3) one month post intervention and (T4) three months post
intervention.
Results: The results will be discussed in terms of the three specified objectives; (i)
The prevalence of KOA was reported as 17.5%, 28.0% and 38.5% in a South African
population over 45yrs. (ii) Four hundred and thirteen clinicians completed the
questionnaire, reporting a KOA patient intake of 53%. Pharmacology (36.3%) and
physical exercise (35.3%) was the most common management protocols compared to
surgical intervention, homeopathy and LLLT. Pharmacotherapy (73%) and physical
exercise (92%) were observed as effective treatments. Seventy five percent of all
practitioners responded with an answer of “no comment” when asked the deemed
efficacy of LLLT. Practitioners viewed patients with KOA to have low compliance with
physical exercise and pharmacotherapy (iii) the participant demographic included 86
females and 25 males, the average age reported was 61.8 ± 5.6yrs. At 12-week
follow-up, knee circumference decreased significantly in all groups (p<0.05), the effect
was highest in the LLLT group. All groups experienced improvements in the WOMAC
pain scale, but the LLLT group showed the greatest improvement (p<0.05). Knee
ROM values improved significantly across all three groups; however, the effect of the
intervention was most significant (p<0.005) in the combined LLLT-exercise group.
Physical functionality scores showed a greater improvement in the combined LLLTexercise
group at all three data collection points.
Conclusions: The estimated prevalence of KOA is 17-35% based on data collected
from a specified South African cohort. Pharmacotherapy is a commonly suggested
KOA management mode, whilst clinicians view physical exercise as effective. LLLT
was not a known tool for the treatment of KOA. In addition to the improved functionality
observed, pain was lowered significantly, particularly in the combined exercise-LLLT
group. Study results have shown that LLLT used in isolation or in combination with
physical exercise is an effective management tool. / MT 2020
| Identifer | oai:union.ndltd.org:netd.ac.za/oai:union.ndltd.org:wits/oai:wiredspace.wits.ac.za:10539/29133 |
| Date | January 2019 |
| Creators | Kholvadia, Aayesha |
| Source Sets | South African National ETD Portal |
| Language | English |
| Detected Language | English |
| Type | Thesis |
| Format | Online resource (165 leaves), application/pdf |
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