Saudi Cultural Missions Theses & Dissertations
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Item Restricted Understanding work participation in workers with lower limb osteoarthritis(The University of Queensland, 2024) Alyousef, Yousef Saleh; Smith, Michelle; Johnston, VenerinaAbstract Osteoarthritis (OA), particularly of the lower limb, is a prevalent health condition affecting people who are still participating in the workforce. People with lower limb OA typically experience joint pain, reduced mobility, muscle weakness and difficulties with ambulatory activities. These impairments can impact an individual’s life in several domains, including work participation. Research is scarce on the impact and management of lower limb OA in relation to work. This thesis aims to understand work participation in workers with lower limb OA using a range of indicators such as work status, work ability, productivity, absenteeism and presenteeism. This is accomplished through five studies presented across five chapters. Study 1 systematically reviewed the literature to explore work-related outcomes in individuals with lower limb OA compared to healthy controls. This review confirmed that the literature in this area is limited – seven studies were identified, two of which were included in a meta-analysis. No studies investigated work-related outcomes in individuals with foot or ankle OA. A meta-analysis revealed that individuals with lower limb OA were less frequently in paid employment than healthy controls (odds ratio: 0.25; 95% confidence intervals: 0.12, 0.53). Evidence from single studies suggests that individuals with hip and knee OA have greater absenteeism and presenteeism and poorer functional capacity than healthy controls. To address gaps in the literature identified in the previous systematic review, Study 2 was a cross-sectional online survey that compared work-related outcomes and difficulty performing work in workers with (n=124) and without (n=106) lower limb OA. The survey included three validated scales of work-specific outcomes: the Work Ability Index (WAI), the World Health Organization’s Health and Work Performance Questionnaire (WHO-HPQ), and the Work Role Functioning Questionnaire. We found that workers with lower limb OA have poorer work ability and productivity (p<0.001), and more difficulty with work scheduling demands and physical demands (p≤0.05) than healthy workers. There was no statistical difference in absenteeism or overall ability to meet work demands between workers with and without lower limb OA. Study 3 complemented the findings of Studies 1 and 2 by using semi-structured interviews to explore the perspectives of 22 workers with lower limb OA on difficulties they experienced at work, concerns they have about work, and strategies they use to manage at work. A thematic analysis identified six major themes related to participants’ experiences of working with lower limb OA: weight-bearing physical demands are challenging; lower limb OA can affect work performance; emotional consequences of pain; concerns about work in the future; positive experiences of supportive colleagues and managers; and minimal effects on sedentary work. Three main themes were identified relating to strategies to remain at work: adjustments at work to help manage pain; regular strategies (e.g., changing positions and postures) to manage pain; and consulting healthcare professionals, but usually not specifically for work. This study identified challenges experienced by workers with lower limb OA that need to be addressed to help workers with OA to remain in the workforce. Based on the findings of Study 3, a cross-sectional online survey was conducted with Australian physiotherapists to explore their current management strategies when treating patients with lower limb OA, with the aim of determining how work concerns were addressed in their practice (Study 4). A total of 132 physiotherapists with at least two years of experience treating patients with lower limb OA completed the survey. The findings suggest that while the key interventions used by most Australian physiotherapists to manage people with lower limb OA are consistent with current clinical guidelines, most physiotherapists do not include activities to help people remain productive in the workforce. There is a need to better understand and address the lack of work support included in physiotherapy consultations with patients with lower limb OA. Study 5 conducted a systematic review and meta-analysis to determine the impact of interventions on work-related outcomes in workers with lower limb OA. Fourteen studies met the inclusion criteria, with seven studies included in the meta-analysis. The meta-analysis revealed no significant difference in employment status two or more years after surgical treatment (odds ratio: 3.47; 95% CI: 0.92, 13.14) or in work ability three months after non-surgical treatment (mean difference: 0.45; 95% CI: -1.11, 2.00) compared to pre-treatment among individuals with knee and/or hip OA. However, single studies reported positive changes post-treatment in absenteeism, work functioning and impact on work. This highlights the need for further research into work-specific interventions that address the unique challenges experienced by individuals with lower limb OA in the workplace. Overall, the findings from this thesis contribute to our understanding of work participation in workers with lower limb OA. The data provides healthcare professionals and employers with a deeper understanding of the difficulties people with lower limb OA experience at work and highlight the lack of evidence for interventions to maximise work participation in this population.29 0Item Restricted Identification of changes in circadian clock genes in osteoarthritis following heat shock(The university of Manchester, 2024) Alhamdan, Ziyad; Biant, LeelaIntroduction. Osteoarthritis (OA) is a prevalent condition that causes pain, stiffness, and decreased joint function due to the gradual degradation of articular cartilage. With an ageing global population, there is an urgent need for effective prevention and treatment methods. Recent studies suggest that circadian rhythms, which regulate various physiological processes, may also play a role in cartilage health. This study investigates the influence of heat sleeve therapy on the circadian clock-controlled regulation of cartilage homeostasis in human cartilage affected by OA. The aim of this study is to extend the current understanding of how heat induction influences the circadian regulation of cartilage homeostasis in OA-affected knee samples. Methods. This quantitative study compares the effects of heat sleeve therapy on articular cartilage between two groups: a control group kept at 18°C and an experimental group subjected to higher temperatures. Histological examinations were performed using Safranin O/Fast Green, Haematoxylin and Eosin (H&E), and RGB Trichrome staining to assess structural changes in the cartilage. Additionally, immunofluorescence labelling using Invitrogen's EVOS M7000 was employed to analyze the expression of clock genes Bmal1 and Clock. Result. The study found that heat sleeve therapy affected the expression of clock genes Bmal1 and Clock, as well as cartilage structure and composition. Histological staining revealed significant differences in proteoglycan concentration, tissue architecture, and collagen distribution between the control and heat-treated groups. These changes suggest that heat treatment may influence cartilage degradation and repair processes in OA. Conclusion. The results indicate that circadian rhythms and environmental stresses such as heat can impact cartilage health in OA. Understanding the role of clock genes in cartilage metabolism and stress responses could lead to new treatment targets for OA. Further research is needed to explore the potential therapeutic benefits of modulating circadian rhythms and heat stress responses in cartilage tissue.9 0Item Restricted Anatomic, Histologic and Histomorphometric Analysis of the Acetabular Labrum and its Enthesis(The University of Edinburgh, 2024-04-19) Alomiery, Abdulaziz; Alashkham, Abduelmenem; Hall, Andrew; Gillingwater, TomThe acetabular labrum is a fibrocartilaginous tissue attached to the acetabular rim of the hip joint. It plays a vital role in maintaining both static and dynamic hip joint stability, with multiple associations to pain sensation, proprioception, and various hip joint disorders. Various traumatic and pathological conditions can compromise the structural integrity of the labral body and its attachment, leading to disruptions in hip joint stability. The localisation of the labrum within a large load-bearing joint has led to disparities in its structural and functional characteristics at the cross-sectional level. These disparities are localised within distinct labral zones (i.e., inner and outer zones), which are commonly attributed to the functional adaptation of each zone to mechanical loads. Despite the labrum's critical role in hip joint function, its intricate micro-anatomical differences, both within its main body and at its attachment to bone, have remained largely unexplored in the current research. The primary objective of this project was to provide a detailed investigation of several micro-anatomical aspects of the labrum, encompassing labral innervation, vascularity, attachment features, degrees of degenerative changes, and levels of tears. The aim was placed on understanding the effects of labral morpho-functional zones on the distribution dynamics of these micro-anatomical characteristics. Secondly, this project also assesses the relationship between labral vascularity and innervation and their potential implications on labral healing and degeneration. Human tissue was obtained from 9 embalmed cadavers, comprising a total of 16 hemipelves (10 males and 6 females) with an average age of 80 years. Each hip was divided into 8 distinct regions, resulting in a total of 128 regional segments. The histological investigations produced a total of 742 tissue sections, which were utilised in a variety of histological and immunohistochemical staining techniques. Initially, a systematic zone-specific approach for labral assessment was developed to achieve a thorough understanding of the distribution dynamics of labral histologic and histopathologic characteristics across different zonal territories. The histopathologic evaluation of the labrum revealed a significant increase in the severity of multiple degenerative features, which were predominantly concentrated in the inner labral zone near the articular surface. These degenerative changes encompassed alterations in matrix proteoglycan content, cellularity, collagen organisation, and surface, including the lamellar layer. Immunohistochemical analysis and quantification of labral neuro-vascularity revealed a significantly higher concentration in the outer labral zone, near the joint capsule, with notably reduced neuro-vascularity in the inner zone. The analysis of sensory nerve endings revealed distinct distribution patterns for proprioceptive and nociceptive innervations within the labrum. Various types of sensory corpuscles (including Pacini, Ruffini, Golgi, and unclassified corpuscles), along with free nerve endings (both perivascular and non-perivascular), were significantly more concentrated within the outer labral zone. The histological examination of the labral enthesis structure and morphology unveiled a fibrocartilaginous type of attachment. Notably, the attachment of the labrum to the bone exhibited marked differences in structural morphology between the inner and outer zones. The histopathologic and histomorphometric analysis of the enthesis’s layers, including calcified fibrocartilage region (CFC), tidemark (TM) and cement line (CL), revealed a significantly more developed and compact attachment in the inner zone. In contrast, the outer enthesis displayed a notably weaker anchorage, characterised by less defined entheseal features, a higher frequency of entheseal and cortical bone micro-damage, and a greater incidence of inflammatory and degenerative changes. The labral morpho-functional zones play a significant role in shaping multiple micro-anatomic features of the labrum, affecting the distribution of degeneration processes and labral healing capability. The delineation of these distinct zonal frameworks offers insights into the labrum's functional adaptation to its mechanical environment and a zone-specific vulnerability to injury and degeneration.25 0Item Restricted In Vitro Assessment of Adipose-Derived Mesenchymal Stem Cell attachment to Injured Cartilage in Agarose Hydrogel Biomaterial(Saudi Digital Library, 2023-08-18) Sabah, Reem; Hall, AndrewArticular cartilage (AC) injuries are a prevalent problem leading to osteoarthritis (OA), which significantly impacts the quality of life of millions worldwide. Tissue engineering using mesenchymal stem cells (MSCs) holds potential as a promising therapeutic approach. This study aimed to investigate the attachment of adipose-derived MSCs (A-MSCs) to cartilage with four types of injuries: scraping, load, 3 mm biopsy punch, and scalpel cut. Injured explants and A-MSCs were placed inside 12 culture wells embedded in 2% agarose, one explant per well, hydrogel biomaterial to mimic native cartilage in vitro. The hypothesis was that A-MSCs would attach to the injured sites. Bovine cartilage explants (N=3) were subjected to the four injury types, totalling 56 explants, and the study was conducted over seven days, with attachment assessment on days 5 and 7 using confocal laser scanning microscopy (CLSM). The results revealed a decreased cartilage viability in both load and scraping injuries, with higher Propidium Iodide (PI)-labelled levels observed on CLSM. Additionally, the number of A-MSCs attachment was higher on these injuries compared to the 3mm biopsy punch and scalpel cut. Additionally, day 7 viability percentage was lower compared to day 5 across all injury samples. These findings suggest that injured areas show increased A-MSC attachment, indicating the potential of A-MSCs for promoting tissue repair. This study has implications for tissue engineering in developing a model to study A-MSCs behaviour to injured cartilage explants. Future recommendations include increasing the culture time to promote chondrogenesis and utilising a human model for a more clinically relevant approach. Understanding the attachment behaviour of A-MSCs to injured cartilage enhances the knowledge base in cartilage tissue engineering and contributes to future therapeutic advancements.4 0Item Restricted Population Variations in Ankle Complex Structure Using MachineLearning 3D-MRI Statistical Shape Modelling and Implications for Osteoarthritis: The Newcastle Thousand Families Study Cohort(newcastle universaty, 2023-06-09) Mohammed, Esa; Birrell, FraserBackground: Osteoarthritis (OA) is the most common joint condition. Although risk factors are well-recognised, the underlying pathogenesis is not fully understood. OA may be linked to biomechanics and force distribution during activities, with the ankle playing a crucial role in absorbing and transferring lower-limb forces. The ankle is structurally complex and understudied. Further understanding of ankle morphology could lead to better prevention of, and treatments for OA. This study aims to reconstruct Three-dimensional Statistical Shape Models (3D-SSM) from ankle MRIs, identify key ankle morphological features and explore their inter-relation to OA in the Newcastle Thousand Families birth cohort. Methods: Prospectively collected data from 206 cohort participants aged 62 was used: 3D-SSM were built using ankle MRI images to quantify morphological features (bone shape/area, and joint space widths (JSW)) of ankle bones and joints. Sex differences, presence/absence of knee/hip OA, and associations between quantified morphological features and other clinical variables (body anthropometry, bone mineral density (BMD), and self-reported questionnaire data) were analysed. Results: This study found significant sex differences in ankle morphology, with females having smaller JSW, bone area, and thinner bone shapes. Knee OA showed a pes-plan foot bone shape while the hip OA had pes-cavus. Positive associations were found between ankle JSW and BMD. Subtalar posterior JSW showed a positive association with knee JSW. Several ankle JSWs showed a positive association with hip JSW in males only. Participants with hip/knee OA have smaller ankle JSWs compared to others. Conclusions: This is the first study using novel machine-learning techniques simplifying morphological complexity to examine ankle structure and its association with OA, using a population birth cohort. Results showed significant associations between ankle morphology and OA. This indicates ankle morphology may have direct effects on knee and hip OA through gait and mechanical force distribution. However, further studies are needed to confirm this hypothesis, which could be tested in subsequent reviews of this cohort14 0