Physiotherapy - Theses

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    Addressing physical and psychological factors in knee osteoarthritis
    Ahamed, Yasmin ( 2014)
    Knee osteoarthritis (OA) is a prevalent, chronic musculoskeletal condition. Pain is the most common symptom and is associated with poorer physical function, lower limb muscle weakness, psychological impairments, and reduced quality-of-life. Strong evidence supports the use of strengthening exercises to improve pain and physical function in this patient population. There is also a growing body of research examining the effects of psychologist-delivered pain coping skills training (PCST) on pain and physical and psychological impairments, particularly in conditions such as chronic low back pain and cancer-related pain. Though typically provided separately, there are clinical-, resource- and personnel-advantages of exercise and PCST being delivered together by physiotherapists as they already have expertise in administering exercise for knee OA. Apart from a small pilot study conducted by our research group, no other studies to date have examined the effects of an integrated PCST and strengthening exercise program delivered solely by physiotherapists in those with knee OA. Therefore, this thesis investigated whether an integrated 12-week strengthening exercise and PCST program delivered by physiotherapists is more efficacious than either program alone in treating pain and self-reported physical function in individuals with knee OA. Additionally, the thesis examined the efficacy of these interventions on improving muscle strength, objective measures of physical functioning, psychological functioning, health-related quality-of-life, and physical activity levels. This was a multi-site, assessor-blinded, three-arm randomised controlled trial involving 10 individual physiotherapy visits together with home PCST and/or exercise practice in 222 individuals with symptomatic knee OA. The results demonstrated that a physiotherapist-delivered Integrated PCST and strengthening exercise intervention for knee OA is more effective than either PCST or strengthening exercise alone for improving physical function and for several secondary outcomes including pain on walking, arthritis self-efficacy and pain coping attempts. In addition, all treatment arms were well received by participants as there was good adherence to treatments and all groups reported minimal adverse events. However, it is important to determine whether the Integrated intervention is efficacious in maintaining improvements in symptoms found over the longer-term given the chronic nature of knee OA. The longer-term effects of strengthening exercise interventions and PCST are not well known. Therefore, this thesis also examined whether any of the benefits of the 12-week intervention on the outcomes mentioned above were maintained over a 32 and 52-week longer-term follow-up period. These results showed that the integrated intervention was more efficacious over the individual treatment groups alone for maintaining improvements in physical function, self-efficacy, coping attempts, and global improvements in pain, physical function and overall. This long-term study also highlighted effective strategies for maintaining good adherence to treatment. The studies in this thesis provide scientific evidence for an integrated pain coping skills training and strengthening exercise for the management of knee OA pain, physical dysfunction, psychological impairments, muscle strength, functional performance, and quality of life over both the short and longer-term.