Evaluation of functional activity compensation strategies, level of physical activity, quality of life and management of physiotherapy for non-operative children with Legg-Calve-Perthes Disease

Mashabi, Abdulrhman 2021. Evaluation of functional activity compensation strategies, level of physical activity, quality of life and management of physiotherapy for non-operative children with Legg-Calve-Perthes Disease. PhD Thesis, Cardiff University. Item availability restricted.

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Abstract

Abstract Background Legg-Calve-Perthes (Perthes) disease is defined as poor blood circulation in the hip joint and is associated with pain, limited range of motion, muscle weakness and joint instability. Physiotherapy is a key management approach to improve hip mobility and muscle strength to enhance daily functional activities. Walking was the only task that has been considered in the Perthes literature, while limited information is available regarding how children with Perthes could perform daily functional activities such as balance and squat activities. These activities have been recommended in the physiotherapy programme for non-operative children with Perthes to enhance their independence. Therefore, there is a need to investigate how non-operative children with Perthes perform during these activities to identify the abnormal movement pattern to help in setting an optimal rehabilitation goal. In addition, there is a need to understand the difficulties that may face patients with Perthes in the course of their lives. It is recommended that investigating physical activity level, quality of life, and how they manage the physiotherapy treatment is essential to understand Perthes disease's effect on children with Perthes and their families. Therefore, this thesis aims to provide essential knowledge to understand the effects of the disease better through: - evaluating how non-operative children with Perthes compensate in their movement during three functional activities (walking, single leg balance and squat), - evaluating physical activity levels and quality of life, and evaluating how they manage physiotherapy treatment. Methods This thesis was divided into two studies: study one aims to systematically review Perthes gait literature's quality and identify movement-compensation strategies during walking in non-operative children with Perthes. The quality of Perthes gait literature has been investigated by two independent reviewers using the adapted Downs and Black checklist. Study two aims to evaluate how non-operative children with Perthes perform during three functional activities (walking, single-leg balance and squat) by using the movement analysis toolkit, to evaluate the physical activity level and quality of life, and to evaluate how non-operative children with Perthes and their families manage the physiotherapy treatment by completing the questionnaires. Before investigating the abnormal movement pattern during three functional activities for children with Perthes, it is important to establish the reliability of the researcher on placing markers and the reliability of children walking to identify the source of error associated with biomechanical data. This reliability study has been investigated as part of the methods for study 2. Results The systematic review study identified eight articles that met all the inclusion criteria. The analysis of the overall agreement between two independent raters performing the adapted Downs and Black checklist on literature revealed an ‘almost perfect’ agreement as presented a Kappa value of 0.906 (95% CI: 0.84–1). The quality of Perthes gait literature displayed variations in data quality, with scores ranging from 12 to 17 out of 20 due to limitations on reporting, internal validity, external validity, and power information. The second study showed a statistically significant difference in the Perthes group compared to control in three functional activities (P<0.05). The hip joint was the most affected joint during functional activities as it showed lower minimum hip flexion and decreased hip rotation by approximately 7° on the affected Perthes leg compared to the control group. The kinetic data demonstrated that the peak of hip abductor moment was significantly higher in the Perthes group than the control group in three functional activities. In addition, children with Perthes iii demonstrated no statically significant difference in the level of physical activity compared to the control group (p>0.05), while they showed a statically significant difference (p<0.05) in quality of life as presented four scores lower than the control group. A questionnaire on managing physiotherapy treatment revealed that both non-operative children with Perthes and their parents reported greatly concerning pain. Conclusion The finding of movement-compensation strategy during functional activities and poor quality of life among non-operative children with Perthes may be due to pain, hip abductor muscle weakness, abnormal femoral head shape and lack of participation in the activities. Therefore, more research is needed to investigate the role of physiotherapy, pain management, and finding safe and enjoyable activities such as swimming and cycling to reduce the consequences of Perthes disease and help clinical providers set an optimal rehabilitation goal.

Item Type:	Thesis (PhD)
Date Type:	Completion
Status:	Unpublished
Schools:	Healthcare Sciences
Date of First Compliant Deposit:	13 June 2022
Last Modified:	06 Jul 2023 01:59
URI:	https://orca.cardiff.ac.uk/id/eprint/150438

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