{"id":{"repo_id":"uwo","oai_identifier":"oai:uwo.scholaris.ca:20.500.14721/32608"},"canonical_url":"https://search.dev.ndltd.org/etd/uwo/oai:uwo.scholaris.ca:20.500.14721/32608","repository":{"repo_id":"uwo","name":"Western University","base_url":"https://uwo.scholaris.ca/server/oai/request"},"display":{"title":"Investigation of exercise, nutrition, and high tibial osteotomy interventions for patients with medial dominant knee osteoarthritis","abstract":"Purpose: To evaluate the effectiveness of two distinct interventions in improving outcomes for patients with knee osteoarthritis (OA) and varus alignment: 1) a 12-week minimally supervised therapeutic exercise program with nutrition recommendations, 2) and high tibial osteotomy (HTO). Methods: This dissertation involved four studies. Participants were recruited as part of two separate ongoing prospective cohort studies evaluating clinical, biomechanical, and physiological outcomes following a) a 12-week exercise and nutrition program (studies 1-2) or b) HTO (studies 3-4) for knee OA. For studies 1 & 2, we evaluated change in physiological measures (body composition, muscle strength, gait biomechanics), patient-reported measures (pain, function, quality of life, perceived exertion) and performance-based measures, and explored associations among variables. For studies 3 & 4, we evaluated responder criteria at 2 years after HTO, the rate of conversion from HTO to total knee replacement (TKR), and changes in patient-reported outcomes and gait biomechanics at 2, 5 and 10 years after HTO. We also evaluated associations between demographics and biomechanics with various clinical outcomes (i.e., responder criteria, TKR, clinically important improvements in patient-reported outcomes). Results: For the exercise and nutrition program, patients worked harder while experiencing decreases in exercise-induced pain. Patients also experienced substantial improvements in physiological measures (body composition, muscle strength, gait speed), and patient-reported and performance-based outcomes. While physiological measures were associated with patient-reported and performance-based outcomes, magnitudes of association were small. Following HTO, 78% of patients were responders to surgery at 2 years. There were also 5% of patients who went on to a TKR at 5 years, and 20% at 10 years after HTO. Substantial improvements in pain and function, and reductions in knee joint moments (i.e., >40%) were also maintained up to 10 years post-HTO. Changes in gait biomechanics were associated future TKR and meaningful improvements in pain and function. Conclusions: We showed a therapeutic exercise and nutrition program similar to everyday physical therapy practice can be effective in improving various patient outcomes. We also showed HTO leads to substantial long-term improvements and may delay the need for TKR, suggesting HTO may provide an opportunity for secondary prevention of OA.","abstract_html":"Purpose: To evaluate the effectiveness of two distinct interventions in improving outcomes for patients with knee osteoarthritis (OA) and varus alignment: 1) a 12-week minimally supervised therapeutic exercise program with nutrition recommendations, 2) and high tibial osteotomy (HTO). Methods: This dissertation involved four studies. Participants were recruited as part of two separate ongoing prospective cohort studies evaluating clinical, biomechanical, and physiological outcomes following a) a 12-week exercise and nutrition program (studies 1-2) or b) HTO (studies 3-4) for knee OA. For studies 1 & 2, we evaluated change in physiological measures (body composition, muscle strength, gait biomechanics), patient-reported measures (pain, function, quality of life, perceived exertion) and performance-based measures, and explored associations among variables. For studies 3 & 4, we evaluated responder criteria at 2 years after HTO, the rate of conversion from HTO to total knee replacement (TKR), and changes in patient-reported outcomes and gait biomechanics at 2, 5 and 10 years after HTO. We also evaluated associations between demographics and biomechanics with various clinical outcomes (i.e., responder criteria, TKR, clinically important improvements in patient-reported outcomes). Results: For the exercise and nutrition program, patients worked harder while experiencing decreases in exercise-induced pain. Patients also experienced substantial improvements in physiological measures (body composition, muscle strength, gait speed), and patient-reported and performance-based outcomes. While physiological measures were associated with patient-reported and performance-based outcomes, magnitudes of association were small. Following HTO, 78% of patients were responders to surgery at 2 years. There were also 5% of patients who went on to a TKR at 5 years, and 20% at 10 years after HTO. Substantial improvements in pain and function, and reductions in knee joint moments (i.e., >40%) were also maintained up to 10 years post-HTO. Changes in gait biomechanics were associated future TKR and meaningful improvements in pain and function. Conclusions: We showed a therapeutic exercise and nutrition program similar to everyday physical therapy practice can be effective in improving various patient outcomes. We also showed HTO leads to substantial long-term improvements and may delay the need for TKR, suggesting HTO may provide an opportunity for secondary prevention of OA.","abstract_has_math":false,"creators":["Primeau, Codie"],"institution":"The University of Western Ontario","degree_name":"Ph D","degree_level":null,"degree_discipline":"Health and Rehabilitation Sciences","degree_department":null,"school":null,"contributors":[],"advisors":["Marsh, Jacquelyn D.","Birmingham, Trevor B."],"committee_chairs":[],"committee_members":[],"year":2022,"date_issued":"2022-10-27","date_published":"2022-10-27","updated_at":"2026-07-27T21:56:07Z","subjects":["knee osteoarthritis","exercise","nutrition","high tibial osteotomy","varus alignment","knee joint moments"],"languages":["en_ca"],"rights":[],"rights_urls":[],"identifier_entries":[]},"links":{"outbound_url":"https://hdl.handle.net/20.500.14721/32608","outbound_label":"Handle","outbound_source":"dc:identifier.uri"},"metadata_groups":[{"id":"people","label":"People","entries":[{"key":"dc:contributor.advisor","label":"Advisor","values":["Marsh, Jacquelyn D.","Birmingham, Trevor B."]},{"key":"dc:creator","label":"Author","values":["Primeau, Codie"]}]},{"id":"academic_context","label":"Academic Context","entries":[{"key":"dc:date.accessioned","label":"Dc Date Accessioned","values":["2025-07-10T19:33:02Z"]},{"key":"dc:date.available","label":"Dc Date Available","values":["2025-07-10T19:33:02Z"]},{"key":"dc:date.issued","label":"Date","values":["2022-10-27"]},{"key":"dc:publisher","label":"Institution","values":["The University of Western Ontario"]},{"key":"dc:type","label":"Dc Type","values":["thesis"]},{"key":"thesis:degree_discipline","label":"Discipline","values":["Health and Rehabilitation Sciences"]},{"key":"thesis:degree_name","label":"Degree Name","values":["Ph D"]}]},{"id":"subjects_keywords","label":"Subjects and Keywords","entries":[{"key":"dc:subject","label":"Dc Subject","values":["knee osteoarthritis","exercise","nutrition","high tibial osteotomy","varus alignment","knee joint moments"]}]},{"id":"language_rights","label":"Language and Rights","entries":[{"key":"dc:language.iso","label":"Language (ISO)","values":["en_ca"]}]},{"id":"identifiers","label":"Identifiers","entries":[{"key":"dc:identifier.uri","label":"Identifier URI","values":["https://hdl.handle.net/20.500.14721/32608"]}]},{"id":"additional","label":"Additional Metadata","entries":[{"key":"dc:description","label":"Description","values":["Collaborative Specialization: Musculoskeletal Health Research","The thesis cover page in the PDF document includes references to Western University’s previous institutional repository platform, known as Scholarship@Western, and links to that platform (beginning with ir.lib.uwo.ca). In citing or referring to this thesis, use the DOI or handle from this page instead. Sample citation: Author name, \"Thesis title.\" (Year). Western University Open Repository. https://doi.org/10.71858/123456."]},{"key":"dc:description.abstract","label":"Abstract","values":["Purpose: To evaluate the effectiveness of two distinct interventions in improving outcomes for patients with knee osteoarthritis (OA) and varus alignment: 1) a 12-week minimally supervised therapeutic exercise program with nutrition recommendations, 2) and high tibial osteotomy (HTO). Methods: This dissertation involved four studies. Participants were recruited as part of two separate ongoing prospective cohort studies evaluating clinical, biomechanical, and physiological outcomes following a) a 12-week exercise and nutrition program (studies 1-2) or b) HTO (studies 3-4) for knee OA. For studies 1 & 2, we evaluated change in physiological measures (body composition, muscle strength, gait biomechanics), patient-reported measures (pain, function, quality of life, perceived exertion) and performance-based measures, and explored associations among variables. For studies 3 & 4, we evaluated responder criteria at 2 years after HTO, the rate of conversion from HTO to total knee replacement (TKR), and changes in patient-reported outcomes and gait biomechanics at 2, 5 and 10 years after HTO. We also evaluated associations between demographics and biomechanics with various clinical outcomes (i.e., responder criteria, TKR, clinically important improvements in patient-reported outcomes). Results: For the exercise and nutrition program, patients worked harder while experiencing decreases in exercise-induced pain. Patients also experienced substantial improvements in physiological measures (body composition, muscle strength, gait speed), and patient-reported and performance-based outcomes. While physiological measures were associated with patient-reported and performance-based outcomes, magnitudes of association were small. Following HTO, 78% of patients were responders to surgery at 2 years. There were also 5% of patients who went on to a TKR at 5 years, and 20% at 10 years after HTO. Substantial improvements in pain and function, and reductions in knee joint moments (i.e., >40%) were also maintained up to 10 years post-HTO. Changes in gait biomechanics were associated future TKR and meaningful improvements in pain and function. Conclusions: We showed a therapeutic exercise and nutrition program similar to everyday physical therapy practice can be effective in improving various patient outcomes. We also showed HTO leads to substantial long-term improvements and may delay the need for TKR, suggesting HTO may provide an opportunity for secondary prevention of OA."]},{"key":"dc:title","label":"Title","values":["Investigation of exercise, nutrition, and high tibial osteotomy interventions for patients with medial dominant knee osteoarthritis"]}]}],"canonical_facts":{"dc:contributor.advisor":["Marsh, Jacquelyn D.","Birmingham, Trevor B."],"dc:creator":["Primeau, Codie"],"dc:date.accessioned":["2025-07-10T19:33:02Z"],"dc:date.available":["2025-07-10T19:33:02Z"],"dc:date.issued":["2022-10-27"],"dc:description":["Collaborative Specialization: Musculoskeletal Health Research","The thesis cover page in the PDF document includes references to Western University’s previous institutional repository platform, known as Scholarship@Western, and links to that platform (beginning with ir.lib.uwo.ca). In citing or referring to this thesis, use the DOI or handle from this page instead. Sample citation: Author name, \"Thesis title.\" (Year). Western University Open Repository. https://doi.org/10.71858/123456."],"dc:description.abstract":["Purpose: To evaluate the effectiveness of two distinct interventions in improving outcomes for patients with knee osteoarthritis (OA) and varus alignment: 1) a 12-week minimally supervised therapeutic exercise program with nutrition recommendations, 2) and high tibial osteotomy (HTO). Methods: This dissertation involved four studies. Participants were recruited as part of two separate ongoing prospective cohort studies evaluating clinical, biomechanical, and physiological outcomes following a) a 12-week exercise and nutrition program (studies 1-2) or b) HTO (studies 3-4) for knee OA. For studies 1 & 2, we evaluated change in physiological measures (body composition, muscle strength, gait biomechanics), patient-reported measures (pain, function, quality of life, perceived exertion) and performance-based measures, and explored associations among variables. For studies 3 & 4, we evaluated responder criteria at 2 years after HTO, the rate of conversion from HTO to total knee replacement (TKR), and changes in patient-reported outcomes and gait biomechanics at 2, 5 and 10 years after HTO. We also evaluated associations between demographics and biomechanics with various clinical outcomes (i.e., responder criteria, TKR, clinically important improvements in patient-reported outcomes). Results: For the exercise and nutrition program, patients worked harder while experiencing decreases in exercise-induced pain. Patients also experienced substantial improvements in physiological measures (body composition, muscle strength, gait speed), and patient-reported and performance-based outcomes. While physiological measures were associated with patient-reported and performance-based outcomes, magnitudes of association were small. Following HTO, 78% of patients were responders to surgery at 2 years. There were also 5% of patients who went on to a TKR at 5 years, and 20% at 10 years after HTO. Substantial improvements in pain and function, and reductions in knee joint moments (i.e., >40%) were also maintained up to 10 years post-HTO. Changes in gait biomechanics were associated future TKR and meaningful improvements in pain and function. Conclusions: We showed a therapeutic exercise and nutrition program similar to everyday physical therapy practice can be effective in improving various patient outcomes. We also showed HTO leads to substantial long-term improvements and may delay the need for TKR, suggesting HTO may provide an opportunity for secondary prevention of OA."],"dc:identifier.uri":["https://hdl.handle.net/20.500.14721/32608"],"dc:language.iso":["en_ca"],"dc:publisher":["The University of Western Ontario"],"dc:subject":["knee osteoarthritis","exercise","nutrition","high tibial osteotomy","varus alignment","knee joint moments"],"dc:title":["Investigation of exercise, nutrition, and high tibial osteotomy interventions for patients with medial dominant knee osteoarthritis"],"dc:type":["thesis"],"thesis:degree_discipline":["Health and Rehabilitation Sciences"],"thesis:degree_name":["Ph D"]},"updated_at":"2026-07-27T21:56:07Z"}