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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ItemHistology of the fascial-periosteal interface in lower limb chronic deep posterior compartment syndrome(University of Melbourne, 2007)
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ItemThe functional mobility scale for children with cerebral palsy: reliability and validity( 2008-02)The purpose of this thesis was to investigate the psychometric properties and clinical utility of the Functional Mobility Scale (FMS) for children with cerebral palsy (CP). The FMS quantifies mobility according to the need for assistive devices in different environmental settings. Initially a systematic review was conducted on the psychometric properties and clinical utility of existing evaluative outcome measures that assessed activity limitation in children with CP. Good to excellent reliability was found for all tools. In contrast, the validity and responsiveness of many tools required further investigation. The FMS was the only tool to quantify activity with different assistive devices for a range of environmental settings. A key objective of this thesis was to investigate the reliability, construct, concurrent and discriminative validity, as well as the responsiveness to change of the FMS. (For complete abstract open document)
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ItemSevere crouch gait in the sagittal gait patterns of spastic diplegic cerebral palsy: the impact of single event multilevel surgery( 2005)The purpose of this thesis was to study the outcome of Single Event Multilevel Surgery (SEMLS) on the gait pattern known as crouch gait in children with spastic diplegic cerebral palsy. The term “crouch gait” in the literature has been defined by many authors to mean a flexed knee coupled with many different combinations of posture at the ankle. Consequently it was necessary to provide a robust definition of crouch gait before the outcome study could proceed. Crouch gait was defined in the context of a classification of sagittal gait patterns in spastic diplegia. In the cross-sectional study on the classification of sagittal gait patterns, 187 children with spastic diplegia were categorised according to visual recognition of their gait pattern and sagittal plane kinematic data. Six gait patterns in spastic diplegia were identified, one of which was crouch gait. A pattern of increasing age, severity and biomechanical incompetency in maintaining an extended posture was seen across the gait patterns and crouch gait appeared to be the “end” gait pattern. A longitudinal study documented how the identified gait patterns evolved over time. Thirty-four children were followed for more than one year and the results indicated that the stability of the gait pattern was variable. The reliability of the classification was found to be acceptable. (For complete abstract open document)
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ItemPrevention of falls in the subacute hospital setting( 2004)Falls are a relatively frequent occurrence amongst older people. Rates of falls amongst patients in subacute care are substantially higher than amongst people living in the community. Falls have been reported to cause physical and psychological injury, increase the likelihood of being discharged to nursing home, and are associated with longer lengths of stay in hospital. Thus, minimisation of falls in the subacute hospital setting is of high public health importance. (For complete abstract open document)
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ItemAn investigation of the clinical assessment of joint position sense( 2000-11)The assessment of proprioception in contemporary clinical practice usually involves having the patients with eyes closed attempt to identify passively held test positions using verbal descriptions or limb matching responses. It is equally common for the examiner to estimate the accuracy of these responses without the aid of a measuring instrument. Since these uninstrumented assessments are unlikely to allow adequate identification or quantification of a patient’s proprioceptive deficits, the aim of this study was to develop and validate an improved method for the clinical assessment of joint position sense. The two main types of assessment investigated were: (1) replication of joint positions using limb matching responses, during which the test and response positions were measured using computer-aided or manual digitisation of videotape images, and (2) joint position sense assessments where rating scales were used to define either the test or response positions. (For complete abstract open document)
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ItemThe Melbourne pusher scale: a reliability and validity study( 2003)The pushing phenomenon in stroke patients has been more extensively researched in recent years. Previous studies have concentrated on examining the incidence, causes and functional outcome for these patients, however, the validity for this research has been questioned due to the lack of use of a psychometrically sound assessment scale for pushing. The first aim of the current study was to develop a clear, concise, ordinal pushing scale, the Melbourne Pusher Scale, that would measure the severity of pushing in acute stroke patients. The second aim was to determine the reliability and validity of the Melbourne Pusher Scale in measuring the pushing phenomenon. The study involved 30 acute stroke patients for the inter-rater reliability and validity studies, 20 acute stroke patients for the intra-rater reliability, and 15 control subjects for the validity study. The Melbourne Pusher Scale was found to have strong inter-rater reliability (Kappa statistic= 0.91) as well as strong intra-rater reliability (Kappa statistic= 0.92). The investigation of concurrent validity of the scale found the Melbourne Pusher Scale to have some validity. Further research using video analysis in a larger sample may aid in the validation of this scale. Not only is the Melbourne Pusher Scale the first such scale to have psychometric analysis documented, it is the first reliable scale that measures the severity of pushing. The Melbourne Pusher Scale may aid in future research into the cause and management of the pushing phenomenon, more accurate clinical decision-making and the effective use of relevant health care resources for these acute stroke patients.
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ItemThe three dimensional angular kinematics of the lumbo-pelvic-hip complex during running( 2002)From an anatomical and biomechanical perspective, the lumbar spine, pelvis and hip may be considered as an integrated complex that is highly likely to operate in a coordinate manner during a functional task such as running. Furthermore, given that runners are at risk of numerous overuse injuries and that dynamic biomechanical parameters may be capable of explaining a proportion of this risk, certain angular rotations of the lumbo-pelvic-hip complex during running may potentially relate to injury. The overall research objectives of this thesis were twofold. First, to develop and evaluate a method with which to measure the three dimensional angular kinematics of the lumbo-pelvic-hip complex during running. Second, to implement the developed method to assess the independent effects of gender, speed and injury. Whilst the overall level of repeatability associated with the measurement of the three dimensional angular kinematics of the lumbo-pelvic-hip complex during was found to be satisfactory, several angular rotations were susceptible to errors that needed to be considered when interpreting the results of subsequent investigations. Use of a high powered treadmill with a small intra-stride belt speed fluctuation allowed a suitable representation of the typical three dimensional angular kinematics of the lumbo-pelvic-hip complex during running to be obtained. Significant differences between males and females existed for certain anthropometric and spatio-temporal parameters. Whilst the basic patterns of the angular rotations of the lumbo-pelvic-hip complex during running were found to be similar for males and females, differences occurred for the amplitudes of some of the angular rotations. Females displayed greater amplitudes of lumbar spine lateral bend and axial rotation, pelvis anterior-posterior title, obliquity and axial rotation, and, hip adduction- abduction compared to males. An offset was also apparent between the male and female group mean waveform for pelvis anterior-posterior tilt. Typical patterns were evident in the waveforms of the angular rotations of the lumbo-pelvic-hip complex during running. With increasing running speed from 2 m/s to 5 m/s, the amplitudes of most of the angular rotations increased with no appreciable change to the patterns of the waveforms. When comparing a group of runners who had sustained an injury in the previous twelve months attributable to running to an injury-free (control) group, none of the measured anthropometric or spatio-temporal parameters were significantly different between groups. In addition, no significant differences were found for any of the lumbar spine or pelvis angular parameters. Injured females displayed an increased amplitude of hip adduction-abduction whilst injured males displayed increased peak hip flexion. The findings of this thesis suggest that the three dimensional angular rotations of the lumbo-pelvic-hip complex display intricate but characteristic patterns during running. The angular rotations are influenced by factors such as gender and speed. However, the current findings did not demonstrate a clear association between anthropometric and dynamic biomechanical parameters of the lumbo-pelvic-hip complex and running injuries. This may be because no association truly exists. It may also be due to methodical issues such as reduced statistical power and the heterogeneity of the injured group. Further research is therefore required exploring the integrated biomechanical function of the lumbo-pelvic-hip complex during running with a particular focus on potential relationships with specific injury categories.
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ItemThe effect of the 'Mother and baby' exercise program on new mothers psychological well-being and depressive symptoms( 2007)The benefits of physiotherapy exercise and allied health education programs on new mothers psychological well-being have never been studied, despite extensive awareness worldwide on cost-effective and non-medicated strategies to prevent women from developing Post-natal Depression (PND). The findings of previous studies investigating general physical activity and depression have often been limited by general populations, not including women in the post-natal period, small sample sizes and/or the lack of an adequate control group. In order to determine whether an allied health intervention including specialised women's health physiotherapy exercise combined with mother crafting education, the first randomised controlled trial was completed. The aim of this study was to determine the effect of an eight week physiotherapy based exercise program with allied health education named the “Mother & Baby" program on the psychological well-being of new mothers. The experimental group (n=62) attended the "'Mother & Baby" program once a week for eight weeks and the control group (n=73) received the same educational material as the experimental group via mail. The primary outcome measures of psychological well-being, depressive symptoms and measure of physical activity levels were collected at baseline, eight weeks later (post program) and then twelve weeks later. Results indicated a significant effect on well-being scores and depressive symptoms of the exercise group when compared with the control group over the three time periods (p< 0.001). Women who had been identified as "'at risk" of post-natal depression had reduced their depressive symptoms by 50% by the end of the intervention. More specifically, there was a significant effect on well-being scores and depressive symptoms at eight weeks (p < 0.001) and this effect on both well-being scores and depressive symptoms were maintained four weeks later after completion of the program. A correlation analysis revealed The Affect Balance Scale of well-being and the Edinburgh Post-natal Depression Scale were well-correlated (p<0.01) indicating a high well-being score reflected low symptoms of post-natal depression. Analyses also revealed that the intervention did not significantly increase participants’ physical activity levels. However, membership of the “Mother & Baby” program was a strong predictor of well-being scores and depression symptoms. The significant results of this trial demonstrate the effectiveness of the "Mother & Baby" Program which involves specialised women's health physiotherapy exercise and allied health education, on new mothers' psychological well-being and risk of depression. The results of this study reinforce that a multi-factorial intervention, involving both physiotherapy exercise and allied health education are required to influence well-being and post-natal depression symptoms.
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ItemClassification of low back pain( 2002)Low back pain is a common and costly problem in the community. A variety of treatment approaches have failed to make an impact on the size of this problem. A false assumption of low back pain sufferers as a homogeneous population is proposed as contributing to the failure of treatment. The research in this thesis intended to investigate the proposition that homogeneous categories of low back pain can he developed to enable improved effectiveness of specific treatment. Part 1 of the thesis developed a methodological model for the development and validation of a LBP classification system. Part 2 applied this model to the development and validation of a classification system based on internal disc disruption and selected psychosocial factors. The application of the model was via four research studies. In the first sections of Part 1, the low back pain literature pertaining to classification was reviewed. No classification system for low back pain was found to be accepted or validated, and a variety of methodological approaches to development and validation were observed. However, strong evidence exists for the unsuitability of uni-dimensional classification systems for low back pain. In addition, because of the complexity of low back pain, and a lack of information regarding causal relationships, the development of a natural classification may be an unrealistic goal. In order to clarify appropriate methodology for the development and validation of low back pain classification systems, a review of the biological, non-Hodgkin's lymphoma and headache classification literature was performed. A consistent use of methodological approaches was described, and through comparison with the low back pain literature, a new methodological model for the classification of low back pain presented. Additional methodological issues regarding determination of causation were discussed and applied, in combination with the methodological model, in reviewing the literature on internal disc disruption and psychosocial factors. This final review provided a background for the research studies in Part 2. The first study in Part 2 developed and evaluated the reliability and validity of a questionnaire for the measurement of subjective complaints. 'The questionnaire was shown to have acceptable reliability and validity in a self administered format and was therefore used in the subsequent studies. The second study investigated the role of inflammation in internal disc disruption by measuring the presence of inflammatory markers in surgically excised discs assessed as being disrupted. These discs were then compared to age matched discs from fresh cadavers with no history of significant low back pain. The demonstration of inflammatory markers in the discs assessed as having internal disc disruption provided support for the inclusion of inflammatory related criteria in the proposed classification system. The development of the classification system based on internal disc disruption and psychosocial factors was described in the chapter of the third research study. The classification system was then tested for discriminant validity, and cross-validated using cluster analysis, with both analyses providing support for preliminary validity. The final study in Part 2 evaluated the predictive validity of the classification system in a sample of participants undergoing a functional restoration program. The classification categories predicted outcome of the program, with the presence of internal disc disruption being shown to be the strongest predictor of poor outcome. This thesis provides a broad review of the research literature relevant to the classification of low back pain. The methodological model arising from that review was applied in an example of the development and validation of a classification system. Further research is required on validation of the classification system proposed in this thesis. However, to impact upon the extent of the low back pain problem, extensive further research on additional classification categories and specific treatment is required.