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An Investigation Into the Risk Factors of Musculoskeletal Diseases and The An investigation into the risk factors of musculoskeletal diseases and the association between chronic diseases of lifestyle in an under-resourced area of the Cape Town Metropole Town A dissertation prepared and submitted to the University of Cape Town by: CarmenCape Britz ofBRTCAR008 In fulfilment of the requirements for the degree Master of Science in Physiotherapy (MSc Physiotherapy) by dissertation February 2019 Supervisor: Mrs Candice Hendricks Co-SupervisorUniversity: Prof Jennifer Jelsma Division of Physiotherapy Department of Health & Rehabilitation Sciences Faculty of Health Sciences UNIVERSITY OF CAPE TOWN The copyright of this thesis vests inTown the author. No quotation from it or information derived from it is to be published without full acknowledgement of the source. The thesis is to be used for private study or non- commercial research purposes Capeonly. of Published by the University of Cape Town (UCT) in terms of the non-exclusive license granted to UCT by the author. University Declaration I, Carmen Britz, hereby declare that the work on which this dissertation/thesis is based is my original work (except where acknowledgements indicate otherwise) and that neither the whole work nor any part of it has been, is being, or is to be submitted for another degree in this or any other university. I empower the university to reproduce for the purpose of research either the whole or any portion of the contents in any manner whatsoever. Signature: Date: 09 February 2019 ii Acknowledgements I would like to acknowledge and extend my sincere thanks to the people without whom this study would not have been possible: The Lord God, my heavenly Father, for allowing me the opportunity to undertake and complete this challenging task. Mrs. Candice Hendricks and Professor Jennifer Jelsma, my supervisors, for their words of wisdom and expert guidance in research methodology and statistical analysis, financial assistance, continuous enthusiasm, encouragement and support, and time and work invested into this project. Thank you for both being so patient and for believing in my potential. The Western Cape Department of Health for granting permission for this study to be carried out within one of their institutions. The management and staff of Mitchells Plain Community Health Centre for the use of their facility, as well as their patience, understanding and generous assistance. All volunteers who offered their time to participate in this study. All research assistants who assisted in interviews and anthropometric measurements during the data collection period. The National Research Foundation (NRF) Thuthuka student support grant, the University of Cape Town Masters Research Scholarship, and the Yeoman bequest bursary for financial assistance. Your assistance with this study is greatly appreciated. Thank you. iii Table of Contents Declaration .................................................................................................................... ii Acknowledgements ....................................................................................................... iii Abstract ........................................................................................................................ ix List of Tables ............................................................................................................... xiii List of Figures ............................................................................................................... xv List of Abbreviations ...................................................................................................xvii 1 INTRODUCTION .................................................................................................... 1 1.1 Background .................................................................................................................... 1 1.2 Problem Statement and Research Questions ................................................................ 3 1.2.1 Null Hypothesis ....................................................................................................... 4 1.3 Aims & Objectives .......................................................................................................... 5 1.3.1 Aims......................................................................................................................... 5 1.3.2 Objectives ................................................................................................................ 5 1.4 Significance of this study ................................................................................................ 6 1.5 Research Setting ............................................................................................................ 6 1.6 Dissertation Outline ....................................................................................................... 8 2 LITERATURE REVIEW .................................................................................................... 9 2.1 Introduction to the Literature Review ........................................................................... 9 2.2 Burden of Disease .......................................................................................................... 9 2.3 Musculoskeletal Disease and Its Prevalence ............................................................... 10 2.3.1 Global Prevalence of Musculoskeletal Disease ..................................................... 11 2.3.2 South African Prevalence of Musculoskeletal Disease ......................................... 11 2.3.3 Age and Gender .................................................................................................... 12 2.4 Pathophysiology and Development of Musculoskeletal Pain ...................................... 13 2.4.1 Classification of Pain ............................................................................................. 13 2.4.2 Acute Musculoskeletal Pain .................................................................................. 16 iv 2.4.3 Chronic or Persistent Musculoskeletal Pain .......................................................... 17 2.5 Measurement of Musculoskeletal Pain ....................................................................... 20 2.5.1 Visual Analogue Scale and Numeric Rating Scale ................................................. 20 2.5.2 McGill Pain Questionnaire .................................................................................... 21 2.5.3 Brief Pain Inventory .............................................................................................. 21 2.5.4 Community Orientated Programme for Control of Rheumatic Diseases ............. 22 2.6 Risk Factors for Musculoskeletal Disease .................................................................... 22 2.6.1 Gender .................................................................................................................. 26 2.6.2 Obesity .................................................................................................................. 26 2.6.3 Low Levels of Physical Activity .............................................................................. 29 2.6.4 Other Risk Factors ................................................................................................. 31 2.7 Chronic Diseases of Lifestyle ........................................................................................ 32 2.7.1 Prevalence of Chronic Diseases of Lifestyle .......................................................... 32 2.7.2 Pathophysiology of Chronic Diseases of Lifestyle ................................................. 33 2.7.3 Risk Factors for Chronic Diseases of Lifestyle ....................................................... 37 2.7.4 Intervention Strategies for Chronic Diseases of Lifestyle ..................................... 40 2.8 Associations between Musculoskeletal Disease, Chronic Diseases of Lifestyle, and Risk Factors .................................................................................................................. 43 2.9 Health-Related Quality of Life and Musculoskeletal Disease and Chronic Diseases of Lifestyle ........................................................................................................................ 50 2.10 Intervention Strategies for Musculoskeletal Disease ................................................ 50 2.10.1 Pharmacological Intervention for Musculoskeletal Disease ............................... 51 2.10.2 Non-Pharmacological Intervention for Musculoskeletal Disease ....................... 55 2.11 Summary of the Literature Review ............................................................................ 57 3 METHODOLOGY ........................................................................................................ 59 3.1 Introduction ................................................................................................................. 59 3.2 Research Design ........................................................................................................... 59 3.3 Participants .................................................................................................................. 59 v 3.3.1 Sample Size Determination ................................................................................... 60 3.4 Instrumentation and Outcome Measures ................................................................... 61 3.4.1 Community Orientated
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