Outcome predictors for patellar tendinopathy in jumping athletes
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- Tez No: 760974
- Danışmanlar: PROF. DYLAN MORRİSSEY
- Tez Türü: Doktora
- Konular: Spor, Sports
- Anahtar Kelimeler: Belirtilmemiş.
- Yıl: 2021
- Dil: İngilizce
- Üniversite: Queen Mary University of London
- Enstitü: Yurtdışı Enstitü
- Ana Bilim Dalı: Belirtilmemiş.
- Bilim Dalı: Belirtilmemiş.
- Sayfa Sayısı: 223
Özet
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Özet (Çeviri)
Introduction Patellar Tendinopathy (PT) is poorly understood with the absence of statistical models considering combinations of various associated factors potentially obscuring understanding of how jumping athletes with PT present and progress. I developed and conducted an international prospective cohort of jumping athletes with a one year follow-up to determine the outcome predictors for PT recovery in order to understand who gets better, why and when. Aims The overarching aim of this thesis was to build statistical models that explain how PT presents in jumping athletes, predict PT outcome and are clinically useful. Methods This PhD consisted of four studies: Systematic review, feasibility study, case-control study and cohort study. I assessed quality, risk of bias and evidence levels of the current literature with the systematic review and provided an evidence gap map for the associations between landing biomechanics and PT. In preparation for the cohort study, I tested feasibility, validity and reliability of measurements. Online questionnaire battery yielded data from an international cohort of jumping athletes with a one year follow-up. I conducted multivariable regression analysis with selfreported variables to explain how jumping athletes with PT present in the case-control study and to predict recovery of PT in the cohort study. Results The systematic review with evidence gap map and meta-analysis identified that landing biomechanics might be associated with PT, but the level of evidence was typically limited or very limited with a high risk of bias. I have therefore focused on non-biomechanical factors in the prospective cohort study. The tested questionnaires were valid and reliable for online use, and the cohort study plan was feasible. The case-control study showed that self-reported sports specific and bio-psycho-social factors partially distinguish PT from other knee problems (n=221) with acceptable accuracy (AUC=0.76), specificity (70.8%) and sensitivity (70.5%), and partially explain both the variance of PT severity (n=132, R 2=0.44) and compromised participation with acceptable accuracy (AUC=0.72). 128 jumping athletes with PT provided 25,284 days total analysis time at risk (198±141 days) in the cohort study survival analysis. Recovery rate was 45%, mainly occurring around 6 months. The final multivariable cox proportional-hazards model partially predicted PT recovery with acceptable model performance and internal validation (optimism-corrected Harrell's C 7 discrimination=0.77 and Calibration Slope=0.86). The model showed PT recovery was associated with a higher KOOS-PF score (lower severity), a shorter time-off from sport, feeling more rested after sleep, not having concurrent tendon problems, higher training duration and symptoms which are modified by movement. Conclusion This is the first research project investigating outcome prediction for PT in a large international cohort of elite and non-elite jumping athletes. The developmental statistical causal model showed that the combination of sports specific and biomedical variables were potentially predictive of PT recovery. Demographic or psychosocial variables did not contribute to the model. These findings could support clinical decision making by helping to clarify who gets better, why they get better and when they get better. Our exploratory recovery model is readily applicable in clinical practice and could help researchers and clinicians to better understand the prognosis of PT.
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