Physiotherapy - Theses
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ItemThe reliability and validity of the squeeze test for athletic groin pain in Australian Rules Football players(University of Melbourne, 2009)
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ItemDevelopmental outcomes and rates of early intervention at two years in infants born extremely preterm or extremely low birth weight( 2013)This thesis investigated the rates of developmental delay, neurosensory disability and early intervention at two years in a cohort of extremely preterm and/or extremely low birthweight (EP/ELBW) infants. These infants are at higher risk of impairments such as cerebral palsy (CP) or delayed development than term born infants, thus rates of impairment are a key outcome indicator. Timely access to early intervention (EI) services for EP/ELBW children with delays is recognised as important yet little is known about appropriate access to EI in Victoria, Australia. Follow-up of EP/ELBW children at two years provides a snapshot of early development and access to EI services. A systematic review and critical evaluation of the literature reporting two-year neurodevelopmental outcomes for EP/ELBW infants was performed. Rates of developmental delay and neurosensory impairments were identified in infant cohorts from the post surfactant era. Rates of CP ranged from 5% to 76% with most studies reporting rates between 10% and 20%. Most studies used the Bayley assessment to report neurodevelopmental outcome. The most prevalent developmental impairment was cognitive delay or motor delay without CP with the majority of studies reporting rates in the 15% to 40% range. Rates of delay were highest in studies from the USA compared to Australia, Europe and Asia. Methodological variability limited direct comparisons between studies and meta-analysis was not considered appropriate. A retrospective cohort study of EP/ELBW infants from the Royal Women’s Hospital (RWH) at two years corrected age was performed. Developmental outcomes of 109 children were assessed using the Bayley-III assessment tool with children classified as no delay (≥ -1 SD) mildly (<-1 to -2 SD), moderately (<-2 to -3SD) or severely delayed (<-3SD). The follow-up rate was 50% (n=109) of survivors to discharge. With reference to Bayley-III test norms, cognitive delay occurred in 18% (n=19), language delay in 29% (n=29) and motor delay in 19% (n=19) of children. A control group assessed with the Bayley-III by the Victorian Infant Collaborative Study group (VICS) provided an additional representative group against which to reference the outcomes. The VICS control group mean values were 108.9 (14.4) for cognitive, 108.3 (14.8) for language and 118.4 (16.7) for motor development. The rates of delay increased significantly for most categories when referenced to the VICS norms with the concurrent comparator group identified as important in accurately determining rates of delay. Neurosensory assessment identified a 7% rate of CP and there were no children with blindness or deafness. A retrospective audit was performed from a subcohort of this RWH EP/ELBW cohort, comprising 80 children with data reporting receipt of EI in the first two years. The rate of receipt of EI during the first two years was 68% (n=54). Birthweight significantly predicted the receipt of EI (OR 0.79; 95%CI 0.63-1.00, p=0.045). Children with moderate to severe delay were more likely to be receiving EI than those with no delay (OR 4.20; 95%CI 1.41-12.52; p=0.01) and all children with CP were receiving EI at two years. There was an unmet need for EI with at least 20% of children with moderate to severe delay and 35% with mild delay not receiving EI. There were also a large proportion (60.5%) of children with no delay at two years who received EI. A questionnaire used to capture EI services information identified that over 75% of families utilised two or more therapy disciplines in the first two years. Waiting times were reported as an area of concern despite overall satisfaction with EI services. This thesis identified rates of neurodevelopmental impairment and receipt of EI for a cohort of EP/ELBW children from the RWH. Whilst follow-up rates were low, this study identified rates of delay and disability comparable to cohorts from Australia, Europe and Asia. The rates of EI utilisation were high, however the targeting of EI to children with delays was variable. The goal for EP/ELBW children is to provide timely and targeted intervention and early developmental surveillance is needed to achieve this. Areas for future research have been identified for children born EP/ELBW to inform clinical decision-making and assist in the strategic planning for regional services.
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ItemThe influence of trunk-thigh angle on the feasibility of maintaining a neutral lumbar spine in prolonged sitting( 2011)The aim of this study was to explore the feasibility of sitting with a neutral lumbar curve over a prolonged period as a prophylactic measure for low back pain. Low back pain is a major complaint in Western Society, and the shift towards a predominantly sitting posture for work and leisure has not helped to diminish the frequency of this ailment. Adopting a neutral sagittal lumbar spine posture during prolonged sitting, defined as a midrange lumbar curve, has been recommended. The neutral lumbar spine posture is favoured for minimising the deleterious effects that are proposed to accumulate with sitting in extremes of lumbar flexion or extension. The position of the thighs relative to the trunk i.e. the hip flexion angle is considered a major influence on the curvature of the lumbar spine during sitting. The mechanism referred to as ‘lumbofemoral’ rhythm indicates that in the sagittal plane, the thighs and lumbar spine move concurrently, with flexion of the hips being accompanied by flexion of the lumbar spine. Thus, the posture of the lumbar spine in sitting is dependent on the angle of the thighs with respect to the trunk. In conventional sitting with the thighs horizontal (trunk-thigh angle 90°), it was proposed that significantly more activity in the back extensor muscles would be required to hold a neutral lumbar curve against the influence of the lumbofemoral biomechanics than with the thighs lowered 30° from the horizontal (trunk-thigh angle 120°). As a result, subjects sitting in the 90° posture would experience more muscle fatigue, evidenced by a slump into lumbar flexion over time. Thus, whilst previous research has shown that a neutral lumbar curve can be adopted in sitting, it is as yet unknown whether this posture can be maintained for prolonged periods of time particularly when the thighs are horizontal. In this research it was hypothesized that participants sitting with a trunk-thigh angle of 90° would demonstrate a greater deviation in lumbar angle over time that when sitting with a trunk-thigh angle of 120°. An exploratory study with a two-way time series design was used to address this gap in the literature. A sample of convenience of 15 participants, aged 18-35 years was recruited, each fulfilling the eligibility criteria. Each participant was tested in the two sitting positions described; Test Position 1 was defined by a trunk-thigh angle of 90°, and Test Position 2 by a trunk-thigh angle 120°. Tests were held in alternate sequence, with each test lasting 15 minutes, interspersed with a short 5-minute rest. The use of two tri-axial accelerometers, attached to the skin over the midline spine (T12 and S2) of participants, provided continuous measurement of lumbar angle. Participants were instructed on how to adopt the neutral lumbar curve, and were asked to maintain this posture for the duration of the test, whilst watching a series of movie clips on a screen ahead. At the end of each trial participants recorded the level of effort required to maintain the starting neutral lumbar spine position. Statistical analysis showed that participants were able to adopt the neutral lumbar curve in both sitting positions. With a midpoint sagittal lumbar angle of 12.33 (±7.93°) in Test Position 1, and 15.57 (±8.04°) in Test Position 2, participants adopted a mean start lumbar angle of 10.30 (±7.84°) and 10.09 (9.58°) respectively. However, in both sitting positions, participants were unable to maintain the start position over the 15-minute period. Absolute values showed a mean maximal deviation in lumbar angle of 7.52 (±4.76°) in Test Position 1 and 5.87 (±6.31°) in Test Position 2. The difference in trunk-thigh angle did not lead to a significant difference in the postural behaviour, with a similar onset and magnitude of increased lumbar flexion (5°) occurring in both test positions. In addition, the difference in trunk-thigh angle was not reflected in the level of effort reported with participants scoring relatively low values for holding the posture in the two positions. Thus the hypothesis for this study was rejected. There were a number of limitations to this study, in particular the variations in lumbar angle that occurred within the small sample size. Apart from increasing the number of participants, future research should include subjects from populations defined by age, gender, and task/ workplace, and the time frame should be increased to allow any subtle, yet cumulative effects from sitting with a different trunk-thigh angle to emerge. The investigation would benefit from measurement of adjacent spinal regions to determine their effect on the sitting lumbar posture, and from the use of electromyography to monitor back muscle activity.