School of Anatomical Sciences (ETDs)

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Browsing School of Anatomical Sciences (ETDs) by Keyword "Activities of Daily Living (ADLs)"

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    Assessment of disability resulting from degenerative joint disease in a southern African skeletal population
    (University of the Witwatersrand, Johannesburg, 2023) Gavin, Jessica Robyn Brinkworth; Carrasco, Lorena Nunez; Meyer, Anja; Keyes, Craig
    Age-related skeletal changes, like degenerative joint disease (DJD), are often used to estimate age in forensic settings, yet these changes also reflect the living experience of individuals as they progress through life. This study set out to assess the impact of DJD in a sample of southern African deceased individuals and the subsequent effects on these individuals’ Activities of Daily Living (ADLs). A novel scoring system was created, translating DJD frequency and severity into how the individual was potentially physically disabled. A sample of 150 southern African individuals between the ages of 35 and 90 years were assessed for signs of DJD in each of the major joints, both for the peripheral (TMJ, shoulder, elbow, wrist, finger, hip, knee, ankle and toe joints) and axial (cervical, thoracic and lumbar vertebral joints) regions. The severity of DJD was then translated into various ADLs (transferring, eating, talking, object manipulation, walking and posture changes: head rotation; twisting and bending) that may have been affected. Socio-economic Status (SES) was included as this would have a significant impact on the types of DJD and subsequent ADL impairment seen, as well as how these individuals may have been impacted within their respective contexts. Results for DJD severity and frequencies indicated that the shoulder most often presented with the most severe DJD score with 42.67% of the pooled sample presenting with a score of 3. It was also interesting to note that most of the upper peripheral joints were affected, with the entire sample presenting with some form of DJD in the elbow, specifically. For the axial skeleton, severity scores were much more variable across different vertebral regions, with the highest severity percentage per region was seen in the thoracic vertebra (5%). In general, females presented with higher severity scores for DJD across all joints, with the TMJ (47%) and toe (22%) joints being statistically higher in females. When controlling for population affinity and sex the same trend was observed in the white sample, specifically the white females (TMJ = 22%). Black males; however, presented with higher severity frequency of DJD in the axial skeleton, specifically the lumbar vertebrae (32%). The white cohort showed very little correlation with age in relation to the TMJ, whereas this was true for the elbow and ankle in the southern African black individuals. This study indicated moderate impacts in transferring (53%), walking (51%), and eating (41%) activities for all individuals. Females presented with significantly higher ADLs for all activities except posture changes whereas problems with eating and talking were more often seen in southern African white individuals. Differences between different socio-economic status groups were also noticed with the lower SES group showing increased levels of impairment across most of the ADLs which may relate to activity differences when age is controlled for. The focus of this research was to provide deeper information into impairment and disability caused by DJD. To conduct research on individuals were their lives and stories were limited and underexplored. This research highlights the need to continue studies on skeletal remains of individuals impaired by DJD, with focus on trends on joint and activity limitations within past and present contexts