THE EPIDEMIOLOGY AND HEALTH ECONOMICS OF ANKLE INJURIES

The thesis focuses on a central theme of the epidemiology and health economics of ankle sprains to inform health policy and the provision of health services. It describes the burden, prognosis, resource utilization, and costs attributed to these injuries. The first manuscript systematically reviewed 34 studies on the direct and indirect costs of treating ankle and foot injuries. The overall costs per patient ranged from $2,075- $3,799 (2014 USD) for ankle sprains; $290-$20,132 for ankle fractures; and $6,345-$45,731 for foot fractures, reflecting differences in injury severity, treatment methods, and study characteristics. The second manuscript provided an epidemiological and economic profile of non-fracture ankle and foot injuries in Ontario using linked databases from the Institute for Clinical Evaluative Sciences. The incidence rate of ankle sprains was 16.9/1,000 person-years. Annually, ankle and foot injuries cost $21,685,876 (2015 CAD). The mean expenses per case were $99.98 (95% CI, $99.70-100.26) for any injury. Costs ranged from $133.78-$210.75 for ankle sprains and $1,497.12-$1,755.69 for dislocations. The third manuscript explored the impact of body mass index on recovery from medically attended grade 1 and 2 ankle sprains using the Foot and Ankle Outcome Score. Data came from a randomized controlled trial of a physiotherapy intervention in Kingston, Ontario. At six months, the odds ratio of recovery for participants with obesity was 0.60 (0.37-0.97) before adjustment and 0.74 (0.43-1.29) after adjustment compared to non-overweight participants. The fourth manuscript used trial data to examine the health-related quality of life among ankle sprain patients using the Health Utilities Index version 3 (HUI-3). The greatest improvements in scores were seen at one month post-injury (HUI-3: 0.88, 95% CI: 0.86-0.90). Individuals with grade 2 sprains had significantly lower ambulation scores than those with grade 1 sprains (0.70 vs. 0.84; p<0.05). The final manuscript used trial data to describe the financial burden (direct and indirect costs) of ankle sprains. The overall mean costs were $1,508 (SD: $1,452) at one month and increased to $2,206 (SD: $3,419) at six months. Individuals with more severe injuries at baseline had significantly higher (p<0.001) costs compared to individuals with less severe injuries, after controlling for confounders.

Stress Inversion Using LiDAR Tunnel Deformation Measurements

Far-field stresses are those present in a volume of rock prior to excavations being created. Estimates of the orientation and magnitude of far-field stresses, often used in mine design, are generally obtained by single-point measurements of stress, or large-scale, regional trends. Point measurements can be a poor representation of far-field stresses as a result of excavation-induced stresses and geological structures. For these reasons, far-field stress estimates can be associated with high levels of uncertainty. The purpose of this thesis is to investigate the practical feasibility, applications, and limitations of calibrating far-field stress estimates through tunnel deformation measurements captured using LiDAR imaging. A method that estimates the orientation and magnitude of excavation-induced principal stress changes through back-analysis of deformation measurements from LiDAR imaged tunnels was developed and tested using synthetic data. If excavation-induced stress change orientations and magnitudes can be accurately estimated, they can be used in the calibration of far-field stress input to numerical models. LiDAR point clouds have been proven to have a number of underground applications, thus it is desired to explore their use in numerical model calibration. The back-analysis method is founded on the superposition of stresses and requires a two-dimensional numerical model of the deforming tunnel. Principal stress changes of known orientation and magnitude are applied to the model to create calibration curves. Estimation can then be performed by minimizing squared differences between the measured tunnel and sets of calibration curve deformations. In addition to the back-analysis estimation method, a procedure consisting of previously existing techniques to measure tunnel deformation using LiDAR imaging was documented. Under ideal conditions, the back-analysis method estimated principal stress change orientations within ±5° and magnitudes within ±2 MPa. Results were comparable for four different tunnel profile shapes. Preliminary testing using plastic deformation, a rough tunnel profile, and profile occlusions suggests that the method can work under more realistic conditions. The results from this thesis set the groundwork for the continued development of a new, inexpensive, and efficient far-field stress estimate calibration method.