Theses and Dissertations (Physiotherapy)

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Physiotherapy for central vestibular dysfunction in poststroke patients in the sub-acute phase
(University of Pretoria, 2019) Eksteen, Carina A.; Heinze, Barbara M.; andoret@mweb.co.za; Van Wyk, Andoret
Background Vestibular dysfunction arising from the central components of the vestibular system are associated with impaired balance. Due to decreased spontaneous recovery of the central vestibular system post-stroke, patients may develop maladaptive sensory strategies in the early months post-stroke in response to the absence of specific management to address vestibular dysfunction following a stroke. Methods A phase 1 cross-sectional survey was conducted to determine the prevalence of clinical features and activity limitations associated with central vestibular dysfunction in patients who are in the sub-acute phase post-stroke (N=102). A phase 2 singleblind cluster randomised controlled trial (RCT) was conducted to determine the effect of vestibular rehabilitation therapy (VRT) integrated with task-specific activities received by patients in the experimental group, compared to patients who received task-specific activities alone in the control group. After central vestibular dysfunction was diagnosed based on the outcome of the assessment of smooth pursuit or saccadic eye movement using videonystagmography (VNG) or the assessment of vestibulo-ocular reflex (VOR)-gain using video head impulse test (vHIT) during the cross-sectional survey, 60 patients were randomly allocated to either an experimental group (N=30) or control group (N=30). Patients in the experimental group received a combination of VRT integrated with task-specific activities as part of the treatment as an “add-on” intervention compared to patients in the control group who received taskspecific activities alone during the two-week intervention period. Results A high prevalence of clinical features associated with central vestibular dysfunction, including impairment of smooth pursuit eye movement (97.1%-99.0%), utricle and superior vestibular nerve function (97.1%) and higher vestibular function (97.1%), were observed. A high prevalence of activity limitations associated with central vestibular dysfunction, including impaired functional ability (98.0%), ability to modify gait in response to changing task demands (97.1%) and functional balance (87.3%), were also observed in the current study. Findings of the single-blind cluster RCT demonstrated that between-group comparison based on logistic regression adjusted for age, gender and race, patients in the experimental group that received VRT integrated with task-specific activities improved significantly more in oculomotor function, specifically saccadic movement (velocity and accuracy), level of depression and functional ability, compared to patients in the control group who received task-specific activities alone. Conclusion The high prevalence of clinical features and activity limitations associated with central vestibular dysfunction on body structure and function, as well as activity level in patients post-stroke, may suggest that the measurement of these clinical features and activity limitations associated with central vestibular dysfunction might be a robust biomarker that may be applied in the guidance and interpretation of treatment outcomes post-stroke. Findings of the study adds to an increasing body of evidence that the CNS has the capability to compensate for central vestibular dysfunction and re-weight sensory inputs post-stroke. Input from the visual system may compensate for the loss of vestibular information and is thus a substitute as a reference for earth vertical in controlling posture and trunk stability. Implication Vestibular rehabilitation therapy integrated with task-specific activities are a low cost, safe and effective complement to standard treatment of stroke patients.
Epidemiology, clinical characteristics and associated injury risk factors among South African amateur field hockey players
(University of Pretoria, 2024-07-22) Viljoen, Carel; Janse van Rensburg, Christa; Rees, Huw; u16033168@tuks.co.za; Lennon, Peter
Background: Field hockey is a popular sport played internationally. Field hockey is physically taxing as it requires lots of low-level intensity running with bouts of sprinting. Although field hockey participation is associated with injury, there has yet to be a prospective epidemiological study performed on South African field hockey players. Objective: To determine the epidemiology, clinical characteristics and associated risk factors for injuries in adult amateur field hockey players at a field hockey club in Johannesburg, South Africa. Methods: A prospective cohort study in which 36 participants (males n=21, females n=15) were followed up fortnightly over 10 weeks. Participants used a modified version of the Olso Sports Trauma Research Centre Questionnaire for Health Problems (OSTRC-H2) to self-register data related to field hockey injuries and risk factors associated with injury. Results: The mean injury period prevalence was 40.9%. We reported a high injury incidence of 75.0/1 000 h of field hockey exposure. The lower limb (56.9%) was the most injured anatomical region with the knee (21.6%), ankle (13.7%) and hip/groin (13.7%) being the most frequently injured body areas. Not participating in cross-training protected players against injury (OR 0.1; p=0.0088), whereas participating in three training sessions a week increased the likelihood of injury (OR 12.1; p=0.0247). Conclusion: Amateur South African field hockey players had a high injury incidence, with most injuries affecting the lower limb. Higher training volume placed players at risk of injury. The results of this study may aid the development of injury prevention programmes, but studies with a larger sample including more than one club are required.
Physiotherapists’ experiences of forensic audits by South African Medical Funding Schemes
(University of Pretoria, 2024) Mostert, Karien; Van Staden, C.W.; cope.saphysio@gmail.com; Meyer, Lesley
Background Forensic audits for billing irregularities have been conducted and researched in other countries, such as Australia, Canada, and the United States of America but not South Africa. Forensic auditors were reported to have been uncompromising in their belief that healthcare professionals were guilty of billing irregularities and had to be harshly penalised. The forensic investigators disregarded any valid reasons for irregular billing patterns, with resultant unfair audit outcomes. Small practices were forced to close their doors, leaving patients without medical support in small towns. Medical practitioners who presented their cases to a court of law were vindicated. No other studies were found regarding billing irregularity audits conducted on medical professionals or physiotherapists in South Africa. The Health Professions Council of South Africa conducted fraud, waste, and abuse audits on reported physiotherapists which was documented, and a survey was conducted on medical schemes regarding their opinion of fraud, waste, and abuse amongst medical practitioners. Aim This study aimed to explore and describe physiotherapists’ experiences of forensic audits conducted by medical funding scheme in South Africa, in the private sector. Methods An explorative, descriptive qualitative study was conducted with audited private-practice physiotherapists. Ethical clearance and informed consent was obtained. Participants were sampled through purposive and snowball methods. A total of 14 participants were interviewed, reaching saturation. Participants were interviewed using 11 individual interviews and three group discussions. Thirteen participants attended the group discussion in groups of five, six, and two participants, respectively. Four interviewers were used as a form of bracketing, and a semi-structured interview guide was provided to maintain rigor. Data were analysed using open coding and axial coding to describe the themes and subthemes. Findings were verified through member checking. Findings Six themes emerged from the rich data collected. The first five themes describe the experiences physiotherapists had, namely: 1) “unfairly persecuted, judged, and penalised”; 2) “overpowered and oppressed”, 3) “naively entrapped between a rock and a hard place”, 4) “distressed with a knife over your head”, and 5) “detrimental and hurtful”. These five themes emphasised that participants experienced the audits as unfair. Participants further described the experience as being worse than a stressful impact event, which led to detrimental outcomes, such as attrition of physiotherapists through, amongst others, closure of practices, and emigration. The last theme, 6) “seeking remedies pre-emptively and preparedly”, was about how physiotherapists wanted to improve audit processes to reduce its negative impact on physiotherapists. Conclusion Physiotherapists experienced the forensic audits adversely and made recommendations on how these may be averted. Further studies may investigate how these audits may be tailored more constructively in curtailing adverse experiences of physiotherapists. If this study’s findings are corroborated, then solutions need to be implemented by stakeholders who have been tasked with protecting the profession.
Functional outcomes of medical and trauma patients in a critical care unit using the Chelsea Critical Care Physical Assessment tool
(University of Pretoria, 2024) Mshunqane, Nombeko; Hanekom, Silmara; chresia22@gmail.com; Tjale, Lebogang
Introduction: The use of outcome measures by healthcare providers in daily clinical practise assists to better follow a patient’s condition progress in order to provide effective quality of care. The role of physiotherapists in the intensive care unit promotes lung function and facilitates early patient mobilization to prevent complications. The implementation of the Chelsea Critical Care Physical Assessment (CPAx) tool in daily use will benefit both patients and clinicians as patient specific rehabilitation will be encouraged. Aim: The purpose of this study was to determine the functional outcomes using the Chelsea Critical Care Physical Assessment tool in critically ill patients admitted in the trauma and medical critical care units. Research design: This was a quantitative prospective observational cohort study. Methodology: The first part of this study was an Integrative literature review which followed a framework for evidence synthesis as outlined by Arksey and O’Malley. The main study was a prospective quantitative observational study which followed the STROBE guidelines for observational studies. The study population included adult patients admitted in the trauma and medical Intensive Care Units (ICU), as well as patients admitted in High Care (HC) units who were diagnosed with trauma or a medical condition. Participants were patients in the critical care units who were recruited from three teaching hospitals in the Tshwane district. Physiotherapists working in the ICU and HC units were trained on how to use the CPAx tool, before they assessed patients. Ethical clearance was granted by the university of Pretoria Research Ethics committee. Written consent was obtained from the recruited patients and physiotherapists. A retrospective consent was obtained from patients who were unable to give consent at the initial assessment or from their families. Data was collected every second day in ICU and HC until each patient was discharged out of HC. Data Analysis: Data from the integrative review was analysed thematically. Data analysis was executed by a statistician using the program IBM SPSS Statistics version 28. Results were compared between the patients diagnosed with a medical and trauma conditions. Results: The results of the integrative review showed that the CPAx tool is comprehensive, it enhances the accuracy of patient assessment and assists physiotherapists to draw up patient specific treatment plans to address the identified impairments. The main study highlighted that the respiratory function, the cough reflex, rolling in the bed and grip strength improved quicker. An increase in CPAx scores correlated with improvement in the GCS in both groups. The trauma patients spent less days in the ICU and HC with slightly lower scores when compared to medical patients. Conclusion: Holistic intensive care specific outcomes are rare in the physiotherapy profession. The CPAx tool includes both the respiratory and musculoskeletal assessment in critically ill patients. Patients can be assessed from when they are sedated or unresponsive. Evaluating the functional outcomes using the tool encouraged patient specific rehabilitation programmes and frequent use of the tool by physiotherapists Clinical implications: the CPAx tool is an innovative tool to measure physical function in the critical care population. The tool is efficient in assisting to develop fir critically ill patients.
Injury-related medical encounters during the 2019 SkyRun races and the associated risk factors for injury
(University of Pretoria, 2024) Viljoen, Carel; Viljoen, Carel; Garnett, Daniel; Janse van Rensburg, Christa; tylarosegrobler@gmail.com; Grobler, Tyla Rose
Background: Trail running races are often hosted in remote environments, challenging medical support. The sport is associated with a high incidence of injury and requires more work towards improved injury prevention in this field. Aim: To determine the epidemiology and associated risk factors for injury-related medical encounters among trail runners participating in a high-altitude trail running event in 2019. Hypothesis: Demographic variables (sex and age) are associated with a higher risk for injury-related medical encounters. Study design: A descriptive cross-sectional study design. Level of evidence: Level II Methods: Medical staff documented all injury-related medical encounters among 412 trail runners during a high-altitude trail running event (100km, 65km, 38km). The study outcomes include injury prevalence (% of runners with medical encounters), clinical characteristics (anatomical region, body area, tissue type and pathology type) and risk factors associated with injury-related medical encounters (p<0.05). Results: The overall injury-related medical encounter prevalence was 15.3%. The 100 km race accounted for most medical encounters (92.1%). Injuries mostly involved the lower limb (88.9%), specifically the foot (38.4%) and the knee (23.3%). The tissue type most affected was ligament/joint capsule (13.7%), followed by muscle/tendon (11%). Joint sprains (13.7%) and muscle strains (8.2%) were the pathology types most affected by injury. Sex and age categories did not show an associated risk of injury-related medical encounters during the races. Conclusion: Approximately one in every six trail runners participating in a high-altitude trail event reported an injury-related medical encounter mostly affecting the lower limb. Sex and age showed no association with a higher risk of reporting an injury-related medical encounter. Clinical relevance: Knowledge of the most common injury-related medical encounters could assist in the development of injury prevention strategies that can be incorporated into race preparation
The epidemiology, clinical characteristics and associated risk factors of injuries in crossfit athletes : a prospective cohort study
(University of Pretoria, 2023) Viljoen, Carel; Garnett, Daniel; Janse van Rensburg, Christa; caitycrow@gmail.com; Crow, Caitlin Ashley
Background: CrossFit is a type of high-intensity training that includes aerobic exercises, gymnastics, powerlifting and Olympic-style weightlifting. CrossFit is a rapidly growing exercise regime associated with high injury rates. There is insufficient literature regarding risk factors for injury amongst CrossFit athletes, with few prospective cohort studies reported globally. Objective: To determine the epidemiology, clinical characteristics and associated risk factors for injuries in adult CrossFit athletes training at a box in Pretoria, South Africa. Methods: Prospective cohort study among 48 participants (males n = 20 (41.7%), females n = 28 (58.3%)), followed over 12 weeks. A modified Olso Sports Trauma Research Centre Questionnaire for Health Problems (OSTRC-H2) was used biweekly to capture self-reported CrossFit-related injury (CRI) and training data. Results: Overall, 24 injuries were sustained by 18 participants. We reported an overall mean injury prevalence of 37.5%, a mean injury prevalence per two-week period of 19.4%, and a mean injury rate of 0.26 injuries per 1000 hours of CrossFit exposure. Females sustained a higher injury rate than males (0.29 vs 0.22 injuries per 1000 hours). The leading anatomical sites of CRIs involved the shoulder (41.7%), lumbosacral spine (20.8%) and knee (8.3%). The most commonly injured tissues included muscle (41.79%), followed by synovium/capsulitis (16.7%) and tendinopathies (12.5%). Half the reported injuries did not result in days lost from CrossFit participation (50.0%), and a history of a previous CRI in the past six months was an independent risk factor for obtaining a current CRI. Conclusion: Approximately one in three CrossFit athletes sustained a CRI affecting mainly the shoulder, lumbar spine and knee. A previous injury in the past six months is a significant risk factor for sustaining a new CrossFit injury. A combination of clinical knowledge, experience, and the results of this study could assist in developing future injury prevention strategies among CrossFit athletes.
Epidemiology and associated injury risk factors in figure skating : a systematic review
(University of Pretoria, 2023) Viljoen, Carel; Janse van Rensburg, Christa; natasha.schmidt@semli.co.za; Schmidt, Natasha Therese
Title: Epidemiology and associated injury risk factors in figure skating: a systematic review Candidate: Natasha Therese Schmidt Supervisor: Carel Thomas Viljoen Co-supervisor: Dina Christa Janse van Rensburg Co-authors on mansucript: Dina Christa Janse van Rensburg, Marlene Schoeman, Manuela Besomi, Audrey Jansen van Rensburg, Susan Scheepers, Dan Garnett, Carel Thomas Viljoen. Degree: M. PhysT Background: Figure skating is a mode of physical activity that is technically and aesthetically demanding, requiring athletes to perform jumps, spins, throws and lifts. The technical demand of figure skating has increased in recent years. The escalated technical demand is predicted to increase the number of figure skaters presenting with injuries. Objective: To identify and critically appraise the available evidence on the epidemiology of injury and injury risk factors in figure skating. Design: Systematic review. Data Source and search strategy: Eight databases were searched for relevant studies from inception 02 June 2022 to 28 April 2023 together with manual reference searching. The search strategy was developed by the lead author under the supervision of a Medical Librarian and the main supervisor. Two sets of keywords were developed to address our research aims. The results of the first set of keywords were combined with an OR operator followed by the second set. Thereafter, an AND operator combined the two sets of keywords. Study Selection Criteria and study selection: Studies reporting on the epidemiology of injury and/or investigating injury risk factors in figure skating were included. The identified studies were imported to EndNote 20 to identify and remove duplicates. Two researchers independently screened the titles and abstracts for potentially eligible studies. The two reviewers then independently screened the full texts of the studies identified as eligible based on title and abstract screening. Any discrepancies in selection between the two reviewers was resolved via consensus. To ensure all potentially relevant studies were included, one reviewer screened the reference lists of all included studies. Data Extraction: The included studies were distributed to four of the six authors for data extraction on a standardized data extraction sheet. One researcher extracted data from all included studies for quality control. Data Analysis: Meta-analysis could not be completed due to the heterogenous nature of the studies. Risk of Bias: Risk of bias (RoB) was assessed using the quality in prognostic factor studies tool. A meeting was held between two authors where each domain and signalling item of the tool was discussed to ensure inter-rater reliability and they optimised the tool for use. The RoB was assessed independently per domain and ranked as either high or a low RoB. Two authors independently assessed the RoB of each included study. Discrepancies were resolved through consensus meeting between the two authors. For the RoB assessment, an observed agreement of 73% for interrater reliability was recorded before the consensus meetings. There was a significant similarity in the ratings of RoB (p<0.001) between the two reviewers, with Cohen’s kappa=0.612 indicating a moderate level of agreement. Results: Twenty-nine studies were included. The prevalence range was 2.1%-34%, and the incidence, of injury was 1.72 per 1000 hours of ice training. The most frequently injured anatomical region was the lower limb, particularly the knee, foot and ankle with the most reported pathology types were fractures and sprains. Significant intrinsic injury risk factors included an older age, previous history of stress fracture and a higher body mass. Significant extrinsic injury risk factors included training more than 12 sessions per week, skipping meals, relative energy deficiency in sports indicators, hamstring and quadriceps immobility, training rather than competing, increased time on-ice time and boot-foot length difference. The quality of evidence on figure skating injuries and injury risk factors is poor. More than half of the studies did not use a validated outcome measure and many of the studies did not consider important confounders. None of the included studies defined injury according to the 2020 IOC consensus statement of recording and reporting injuries and many studies did not follow a recognized conceptual framework or model. Conclusion The incidence of figure skating injuries per 1000 hours was higher than in other artistic sports such as ballet. The most frequently injured anatomical region was the lower limb and the most common pathology types were fractures and sprains. Overall, our review identified three significant intrinsic and eight significant extrinsic risk factors. More consistent data reporting and injury definitions is needed. PROSPERO registration number: CRD42021293641
Development of a school-based framework to support SIAS toolkit for learners with physical disabilities in Limpopo Province
(University of Pretoria, 2023) Mathye, Desmond; Mshunqane, Nombeko; Tshabalala, Muziwakhe; makwenasibuyi@gmail.com; Sibuyi, Makwena M.
Background and aims: The Department of Basic Education (DBE) launched a policy to provide standardised procedures for Screening, Identifying, Assessing and Supporting (SIAS) learners experiencing barriers to learning. This policy is another strategy to give access to quality education that accommodates the needs of learners, including those living with various disabilities, in schools. Furthermore, it advocates for adopting the social model of disability and promotes interprofessional collaboration. Providing adequate and relevant support can retain learners with learning barriers and reduce dropout. Its implementation is met with significant barriers at the level of the child’s environment at school (microsystem) and the relationship between educators and caregivers (mesosystems). The shortage of physiotherapists is a challenge both nationally and internationally. The composition of support structures at school level lacks physiotherapists, and more so in Limpopo Province. The aim of the study was to develop a school-based framework for the three special schools to support a toolkit for learners with physical disabilities in Limpopo Province. To achieve this aim, the researcher explored the implementation, challenges and solutions related to the SIAS toolkit and evaluated support programmes developed for learners with physical disabilities. Methodology: A parallel convergent mixed-method research design, underpinned by a dialectical pluralism approach, was employed in conducting this study. Both the qualitative and quantitative studies carried equal weight. Thus, data collection and analysis occurred concurrently. There were three main studies. Study 1 was qualitative in nature and comprised semi-structured interviews with caregivers of Grade 7 learners, focus group discussions with physiotherapists, Grade R educators and School-Based Support Teams, and a document analysis of the SIAS toolkits for the Grade R learners. Study 2 was quantitative and carried out through an online and paper survey with educators. Study 3 was the point of convergence to produce one data set through a joint display analysis. Study 3 led to the development of the school-based framework. Research outputs: There was triangulation of data. Nine themes emerged pertaining to the challenges with implementation namely; human resource management, training, implementation of SIAS and other policies, support structures, support to learners, caregiver participation, knowledge of roles of therapists, collaboration and assistive devices whereas five themes emerged with regards to the solutions namely; human resource management, training, special school curriculum, functionality of School-Based Support Team and collaboration. The survey showed that not all SIAS toolkits were being used. The findings from the meta synthesis pointed out that educators were limited in the ability to identify and support learners with barriers due to lack of knowledge with the SIAS policy toolkits. Thus, these findings led to the development of the school-based framework which adopted the knowledge process management model. The model illustrated identifying, creating, gaining, sharing, applying, evaluating and preserving knowledge pertaining to the SIAS policy and toolkits. Contributions to the body of knowledge were disseminated at the 23rd AMCOA annual congress on the 4th of October 2022, titled: Self-study: a strategy applied by physiotherapists to gain knowledge on the SIAS policy in LIMPOPO province. Impact of the research: This study was envisaged to, firstly, promote the practice of screening learners, identifying learners with barriers to learning, using relevant stakeholders to assess the nature of barriers and providing individualised support to learners at school; and secondly, to point out the need for interprofessional collaboration for effective implementation of the SIAS policy through its toolkits. Thus, the school-based framework is developed to assist special schools with the use of SIAS toolkits and foster interprofessional collaboration through knowledge sharing. This developed framework should be evaluated for its impact and outcome in Limpopo Province. The effect of dialectical pluralism in this study will undoubtedly provide SIAS policy reviewers with a valuable point of reference. Keywords: SIAS policy, implementation, inclusive education, therapists, identification of barriers, educators, SBST, training, physical disabilities, caregivers.
The epidemiology, clinical characteristics and associated risk factors for injury among football players at an academy in Ghana
(University of Pretoria, 2023-05-18) Mostert, Karien; Garnett, Daniel; kwamed88@gmail.com; Kwakye, Samuel Koranteng
Background: Football is arguably the most common team sport in the world, with a resultant and rapid increase in the formation of young football academies, including Ghana. However, football is significantly associated with a risk of injury. Efforts are being focused on younger populations to reduce injuries through improving understanding of epidemiology and injury prevention strategies. Sparse knowledge on injuries and their risk factors specific to academy football players in Ghana is available. Aim of the study: To determine the epidemiology, clinical characteristics and risk factors of football injuries, among players at a football academy in Ghana. Design: Observational prospective cohort study. Setting: A football academy in the Volta Region of Ghana. Participants: Fifty-three young (under 18 years) and 27 adult (18 years and above) football players. Methods: Eighty male, young and adult academy football players were recruited at a football academy in Ghana using total population sampling. Baseline measurements taken before the start of the football season included height using a stadiometer (Seca 213), weight using a digital scale (Omron HN-289), and ankle dorsiflexion (DF) range of motion (ROM) were measured with a tape measure. Functional ankle instability was measured with the Star Excursion Balance Test (SEBT) and the Cumberland Ankle Instability Tool (CAIT). A standardised injury surveillance form (SIS) developed by the International Olympic Committee (IOC), was used by two qualified senior physiotherapists to prospectively document players’ injuries and injury characteristics during one season. The first author visited the study site once a month to ensure` validity of data captured to extract data from physiotherapists’ files. All data collected were entered into a Microsoft Excel spreadsheet for analysis according to the International Olympic Committee (IOC) reporting guidelines. In addition to descriptive statistics, selected variables associated with football injuries were statistically investigated using Spearman’s rank correlation with interpretation at a significance level of 5%. Results: A total of 126 injuries were reported during the assessed football season, with 66% and 60% occurring during matches and training, respectively. The average weekly injury prevalence was 4.1%, and overall injury incidence was 4.5 injuries per 1 000 hours. Match incidence (27.4 per 1 000 hours) was higher than training incidence (2.3 per 1 000 hours). The U14, U16 and U18 players suffered higher injury incidence (5.8, 5.1, 5.7 injuries per 1 000 hours respectively) compared to senior players (2.7 per 1 000 hours). A total of 109 injuries (86.5%) affected the lower limb, with the knee (n=30, 23.8%) being the most affected, followed by the ankle and the hip/groin (both n=17, 13.5%), and 57 (45.2%) injuries were due to acute trauma, occurring with direct contact with another player (n=42, 33.3%). The most common injury areas were joint sprains (n=54, 43.9%), followed by muscle strains (n=33, 26.2%), and bone contusions (n=11, 8.7%). The severity of injuries was mostly moderate (n=56, 44.4%). New injuries (n=112, 88.9%) occurred more commonly during matches than during training (n=59. 46.8% vs n=53, 42.1%). Of the total recorded number of recurrent injuries (n=14, 11.1%), most occurred among the U18 players (n=10, 17.2%). The following risk factors were associated with overall-, match- or training injury incidence during the season: Age was negatively associated with overall injury incidence (r=-0.589, p=0.000), and training injury incidence (r=-0.314, p=0.005). A record of previous injury among U18 players was associated with training injury incidence (r= 0.436, p=0.023). The Body Mass Index (BMI) was negatively associated with overall injury incidence (r=-0.513, p=0.000) and training injury incidence (r=- 0.395, p=0.000). However, only for U18 players the BMI was negatively associated with overall injury incidence (r=- 0.428, p=0.021), based on age category. CAIT scores (for ankle instability) were positively associated with overall (n=0.263, p=0.019) and match injury incidence (r=0.263, p=0.029) whilst only senior players’ range of motion (ROM) of the left ankle (dorsiflexion) was positively associated with training injury incidence (r=0.436, p=0.023). Player position was associated with match injury incidence (r=0.241, p=0.031) while the attacker position among U16 was associated with training injury incidence (r=0.669, p=0.003). Conclusion: Injury incidence over a competitive season was higher among younger players, compared to senior players. The majority of training injuries occurred in non-contact scenarios, whereas contact injuries were more common during matches. Most reported injuries were joint sprains and muscle strains, which mostly affected the lower limb. A younger age, lower BMI and higher self-reported functional ankle instability were risk factors associated with overall injury incidence of the whole population. In U18 players, a lower BMI and a previous injury were risk factors associated with increased injury incidence. Adult players’ ankle dorsiflexion ROM was associated with injury incidence. The ‘Attacker’ playing position was associated with an increased injury incidence among U16 players. This study's findings contribute to the collective understanding of injuries and risk injury factors among academy football players. These results can guide the development of future injury prevention strategies, specifically in Ghana. Further studies should focus on examining risk factors for specific anatomical locations, especially the ankle and the knee as well as specific injury types.
Caregivers' burden of caring for children with cerebral palsy in Lagos, Nigeria
(University of Pretoria, 2021) Mshunqane, Nombeko; Eksteen, Carina A.; lilychinweakuma@gmail.com; Akuma, Lilian C.
Introduction Cerebral Palsy is a disorder that affects the development of movement and posture causing limitation of activity and participation restriction. Due to the physical challenges faced by children with cerebral palsy, they depend on their caregivers (which include parents, grandparents) and other relatives of the family for their activities of daily living and care. Caring for a child with activity limitation increases the burden of care on the caregivers. Investigations on caregivers’ quality of life (QoL), socio-economic and psychosocial factors of caring for CP children had been done; however, there is a dearth of literature on the burden of care on caregivers of children with CP. Aim: This research sought to establish caregivers’ burden of caring for children with cerebral palsy in Lagos, Nigeria. Methods: A sequential mixed method design was used. This involved collecting quantitative data first, followed by qualitative data from the same population sample. A purposive sampling method was used to select the participants. The Zarit Burden Interview questionnaire was used to collect the quantitative data and focus group discussions were used to collect the qualitative data. The Zarit Burden Interview questionnaire was handed to 120 participants who are caregivers of children with cerebral palsy on the day of their appointment to the clinic. All participants were required to complete the questionnaire; thereafter the same participant joined the focus group discussion (FGD), for qualitative data collection. There were six (6) FGDs comprising often (10) participants in each group, adding to a total of sixty (60) participants. Data from the Zarit Burden Interview questionnaire were analysed using descriptive statistics and chi-square tests, whilst data from FGD were transcribed verbatim and analysed using open coding. Conclusion: The findings of the study show that caregivers of children with CP face challenges that make caring for their children burdensome. The study showed that the caregivers faced challenges in the following areas; accessibility to healthcare and education, mode of transporting their children, financial, and social support. It was recommended that policymakers and the government intervene by making policies and setting up structures that will help alleviate the burden of the caregivers. The introduction of community awareness programs and support groups was recommended. Key terms: Burden of caring, Caregivers, Care giving, Cerebral Palsy, Children, Physiotherapy
Development of a model for the rehabilitation of children with disabilities in the greater Giyani Municipality in Limpopo Province, South Africa
(University of Pretoria, 2015-04) Eksteen, Carina A.; desphysio@hotmail.com; Mathye, Desmond
The rehabilitation of children with disability (CWDs) in a rural area is difficult because of the multiple challenges associated with rural and under-resourced areas. These challenges include accessibility of health-care facilities, shortage of experienced rehabilitation professionals and limited rehabilitation models to direct how the rehabilitation of CWDs should be conducted within a rural South African context. The primary research question for this study was: how should a model for the rehabilitation of CWDs look like in Giyani? The aim of the study was to develop a descriptive model for the rehabilitation of CWDs by health-care workers. The objectives of the study were to: (1) synthesise concepts, (2) synthesise non-relational statements, (3) organise relational statements, and (4) present the theory as a model with an ultimate goal of improving the health, function, and participation of CWDs. A qualitative, theory-generating, exploratory, descriptive and contextual approach was used. Data collection was divided into two phases. The primary objective of Phase 1 was to generate data through face-to-face interviews with caregivers of CWDs, rehabilitation professionals and community rehabilitation workers (CRWs) in order to develop concepts. The objective of Phase 2 was to expand data gathering from caregivers and rehabilitation professionals through focus group discussions (FGDs). Data from the interviews and FGDs was transcribed verbatim, translated into English, and analysed using an inductive approach. Ten caregivers participated in the interviews. Participants were predominantly mothers and unemployed. The CWDs whose caregivers participated in the interviews were under the age of six and had mostly a cerebral palsy diagnosis (80%). Eight rehabilitation professionals and two CRWs participated in the interviews. A total of ten caregivers participated in three FGDs. Participants were predominantly mothers. The CWDs whose caregivers participated in FGDs were less than or equal to two years of age and were diagnosed with cerebral palsy (80%). Six rehabilitation professionals participated in one FGD. Sixteen concepts and non-relational statements were developed: 1) cause of childhood disability 2) available services 3) role of caregivers 4) caregivers‘ source of support 5) caregivers‘ coping strategy 6) caregivers‘ level of satisfaction 7) caregivers‘ expectations 8) role of rehabilitation professionals 9) rehabilitation professionals‘ competency 10) factors that affect the rehabilitation professionals‘ work ethic 11) rehabilitation professionals‘ plan of action 12) role of CRWs 13) role of the municipality towards people with disabilities 14) role of Pfunanani Special School 15) challenges experienced 16) societal perception of CWDs Seven relational statements were developed to show the relationship between the sixteen concepts. Lastly, a model for the rehabilitation of CWDs was presented. The implication of the model is that the rehabilitation professionals and CRWs have a responsibility to reduce child-related, family-caregiver related, and health-care related challenges. In addition, the local government and the education sector have a responsibility to reduce community related challenges. The assumption of the model is that a reduction in child-related, family-caregiver related, health-care related, and community related challenges is likely to improve the caregivers‘ ability to support the CWD and ensure that there is continuity of care or treatment.
Inter- and intra-rater reliability of a technique for assessing the length of the Latissimus Dorsi muscle
(University of Pretoria, 2014-10-29) Van Rooijen, Agatha Johanna; Marais, A.M. (Annemarie); tania.vanrooijen@up.ac.za; Dawood, Muhammad
Introduction The length of a muscle has been described as one of the factors contributing to the ideal movement at a joint. A decrease in the length of a muscle results in a decrease in the range of motion at the joint in direct relation to the function of that specific muscle. M Latissimus Dorsi is a muscle which undergoes length changes (loss of extensibility) and this muscle has a functional role in many aspects of sport and rehabilitation. The loss of extensibility may result in a decreased range of motion at the glenohumeral joint leading to dysfunction. Evidence-based practise requires the use of objective, valid and reliable tests for measuring the length of a muscle. No scientific evidence of reliability for any documented technique testing the length of m Latissimus Dorsi (LD) was found. Aim The aim of this study was to assess the inter-rater and intra-rater reliability of a technique adapted by Commerford and Mottram (2012) for assessing the length of LD. Study design The design of the study is a within-participant test-retest non-experimental quantitative study for reliability purposes Method Fifty-six volunteering students recruited from the Physiotherapy Department of the University of Pretoria were the participants in this study. Four qualified physiotherapists with varying numbers of years of clinical experience independently performed the test for assessing the length of LD. The test was performed twice by each physiotherapist on every participant and two measurement sessions were done. A pilot study was also done. Data Analysis and conclusion A sample of 56 participants provided an intraclass correlation coefficient (ICC) of less than 0.9 and this is regarded as poor reliability. The agreement between each rater and the differences in the two levels of experience of raters were also assessed. The ICC was used to determine the inter-rater and intra-rater reliability of the LD length test. A 0.05 level of significance was employed. The ICC between the experienced raters was found to be 0.48 with a novice rater ICC of 0.48 as well. The ICC between all the raters was 0.33. This constitutes poor reliability. The poor reliability of the technique testing the length of LD was identified and addressed in order for adequate usage thereof, in research and in practice. Recommendations of a new technique to test the length of LD was provided by the researcher. A suggestion was made regarding a manner of testing its reliability.
Mechanical traction versus joint mobilisation in the treatment of acute non-specific neck pain in adult patients
(University of Pretoria, 2013) Marais, Andre; Korkie, Elzette; nicolene@atphysio.co.za; Breed, Nicolene
Background Non-specific neck pain (NS-NP) is a common phenomenon resulting in physical and social dysfunction, high utilisation of healthcare and economic burden. In South Africa the incidence of one or more episodes of neck pain in working people between the ages of 25 and 29 years of age is reported to range between 25% and 30% while approximations of the incidence of neck pain for people aged 45 years and above rise to 50%. The hypothesised point prevalence of acute NS-NP in the adult population is 10%. Mechanical traction and joint mobilisation are treatment modalities used for acute NS-NP. The value of mechanical traction for neck pain has been questioned because studies pertaining to the effectiveness thereof are limited, with small sample sizes and are of poor quality. Aim: To assess whether mechanical traction or joint mobilisation of the cervical spine was more effective in the treatment of acute NS-NP in adult patients, when combined with secondary treatment categories [electrotherapy (E.T.), exercise and soft tissue joint mobilisation (STM)]. Methodology: A descriptive retrospective analysis was conducted on the clinical records of patients suffering from acute non-specific neck pain who were treated at the Physiotherapy Outpatient Department of the Steve Biko Hospital from 2000-2011 . Non-probability purposive sampling was done. The inclusion criteria were as follows: age 18-50 years, acute NS-NP with or without referred pain, pain rated on the Visual Analogue Scale at first treatment and discharge, treated with joint mobilisation or mechanical traction and more than one treatment in a two week period. The exclusion criteria were as follows: cervical pathology, fractures, malignancy, surgery, whiplash-associated disorders and involvement in litigation or compensation claims. A total of 109 records were included. The outcomes of this study was calculated by the change in reported pain intensity as measured with a Visual Analogue Scale (VAS) Nicolene Breed 23032473 Page 5 in the patient records and by assessing clinical improvement. Regression analysis was employed for data analysis. Results: The treatment groups differed marginally (p=0.08) with respect to a positive change in VAS with joint mobilisation indicating a greater change in VAS scores with a mean change in VAS of 3.94mm, while the secondary treatment categories differed significantly (p=0.03) with respect to a positive change in VAS with exercise and STM with a mean change in VAS of 4.20mm seeming more effective in reducing acute NS-NP. Traction had an increased risk of poor clinical outcome in terms of pain reduction (OR:-3.26; 95% CI; 1.16-9.15). Compared to the joint mobilisation group, the traction group’s risk for poor clinical outcome was increased by 3.26. Relative to E.T., exercise and STM prevented a poor clinical outcome (OR=0.39; 95% CI; p=0.04). Conclusion: Joint mobilisation combined with exercise and STM had a clinically significant, positive outcome in the treatment of acute non-specific neck pain, as opposed to mechanical traction combined with exercise and STM.
Exercise Associated Muscle Cramps in Cyclists : Epidemiology, clinical characteristics and risk factors
(University of Pretoria, 2020) Viljoen, Carel; Schwellnus, Martin; pohlcarey@gmail.com; Pohl, Carey
Background: Exercise associated muscle cramping (EAMC) is a common medical condition encountered by endurance athletes, yet information regarding EAMC in cyclists in lacking. Aim of the study: To determine the epidemiology, clinical characteristics, and independent risk factors associated with EAMC in cyclists participating in a mass participation cycling event. Design: Cross-sectional study Setting: 2016 Cape Town Cycle Tour (CTCT), South Africa Participants: 22560 consenting cycle race entrants Methods: Epidemiological data (lifetime prevalence and annual incidence) and clinical characteristics (main muscle groups affected, timing of onset, severity [mild - severe] and frequency of serious forms of EAMC [sEAMC]) in cyclists with a history of EAMC (hEAMC) are reported on. A multiple regression analysis was applied in order to determine if the following factors were associated risk factors for EAMC in cyclists with a hEAMC: chronic disease composite score, cycling training / racing history (years of recreational cycling, years of participation in distance cycling events > 2 hours, average number of training sessions per week, average weekly cycling distance in the last 12 months, and average training speed), history of chronic disease (history of cardiovascular disease [CVD], risk factors for CVD, symptoms of CVD, metabolic/hormonal disease, respiratory disease, gastrointestinal disease, nervous system/psychiatric disease, kidney/bladder disease, haematological/immune system disease, and cancer) and allergies, and history of cycling injuries. Results: A total of 35914 cyclists entered the race, 27349 completed the online pre-race medical screening questionnaire, and 22560 gave informed consent for the use of their data in this study (62.82% of all race entrants). The lifetime prevalence of EAMC was 30.6%, with an annual incidence of 18.7%. The quadriceps muscle group was the most commonly affected muscle group (47.7%), the most common time period for the onset of EAMC was during the fourth quarter of the race (63.0%), and mild (less than 5 minutes) EAMC occurred more frequently (67.0%) than other forms of EAMC. Serious EAMC was reported by 5.6% of the study population, and included whole body EAMC (3.2%) and EAMC associated with dark urine (2.2%). Novel independent risk factors associated with an increased risk of hEAMC in cyclists were: a higher chronic disease composite score (PR=1.34 per 2 unit increase; p<0.0001), a history of any allergies (PR=1.17; p<0.0001), a history of an acute onset injury (PR=1.31; p<0.0001), a history of a gradual onset injury (PR=1.29; p<0.0001), and increased number of years participating in cycling events of > 2 hours (PR=1.34 per 2 unit increase, p<0.0001). Increased number of years as a recreational cyclist (PR=0.96 per 5 unit increase, p=0.0012) and increased average weekly training/racing frequency in the last 12 months (PR=0.95 per 2 unit increase, p=0.0015) were associated with a decreased risk of EAMC. From the univariate analysis, we identified a significantly higher prevalence of lifetime hEAMC in male cyclists (PR=2.16; p<0.0001), and a higher prevalence of hEAMC in the ≥51-year age category (37.6%). Conclusion: One in three cyclists report a lifetime hEAMC. In cyclists with a hEAMC, the quadriceps muscle group is the most commonly affected muscle group, EAMC commonly occurs in the last quarter of the race, most EAMC cases are reported as mild, and sEAMC is not common. The results from this study could influence the future prevention and management programmes of EAMC in recreational cyclists, and assist medical personnel in the planning and implementation of medical care at mass participation cycling events. A higher chronic disease composite score, a history of allergies, a history of injury (acute onset or gradual onset) and training / racing variables are novel independent risk factors associated with a hEAMC in cyclists taking part in a mass participation cycling event. Risk factors for EAMC need to be taken into consideration when implementing prevention and management programmes of EAMC in cyclists. Clinicians should also consider that in some cases, EAMC may be associated with underlying chronic diseases or allergies, and/or the medications used to treat such conditions. In addition, injury history and training variables need to be considered in the prevention and management of EAMC in cyclists. Keywords: muscle cramping, exercise associated muscle cramping, EAMC, cyclists, clinical characteristics, epidemiology, risk factors, chronic disease
Epidemiology, clinical characteristics, and associated risk factors for injury among university student rugby players
(University of Pretoria, 2020) Viljoen, Carel; Bayne, Helen; Schwellnus, Martin; sanetphysio@gmail.com; Van Zyl, Sanet
Background: Specific features of university student rugby players and the tournaments they compete in may involve epidemiology, clinical characteristics, and associated risk factors that differ from other populations. To date, this has not been studied. Aim of the study: To determine the epidemiology, clinical characteristics of and the associated risk factors for rugby-related injuries in university student rugby players. Design: Prospective cohort study Setting: Rugby teams (Young Guns [YG] and Varsity Cup [VC] representing the University of Pretoria (UP) in the Varsity Rugby tournament. Participants: 171 male university student rugby players. Methods: A prospective cohort study was conducted over two consecutive rugby seasons (2018/19 and 2019/20). Male student rugby players at UP that were included in the YG and VC squads, were followed over a total period of 35 weeks (2018/19: 18 weeks, 2019/20: 17 weeks). The two squads were comprised of a total of 179 players over the two-year period, where 171 players gave consent for study participation. Baseline data were collected at the beginning of pre-season preparations. These included player’s age, playing position and highest level of representation, and completion of injury history and medical history questionnaires. Medical staff affiliated with the teams recorded all training and match time-loss injuries during preseason and in-competition period. Data are reported as the incidence (injuries per 1 000 player-hours: 95% CI) of time-loss rugby-related injuries, injured player proportion (%), frequency (% of injuries) of injury characteristics and injury severity grade (time loss) for training and match injuries. These outcome measures are reported for anatomical region, body area, tissue type, pathology type, and mechanism of injury. The relative risk (RR) of injury was calculated for potential risk factors (participant demographics [age groups], rugby specific information [level of competition, playing position, highest level of play], medical history of disease [medical risk category], and injury history [acute or chronic injury 12 months prior, severe injury in entire sporting career]) by means of univariate analysis. Results: The primary findings with regards to epidemiology and clinical characteristics are as follows: 1) 60% of players sustained an injury during each season, 2) 64% of all injuries occurred during matches and the overall injury incidence (per 1 000 player hours) was significantly higher in matches (131.1) compared with training (2.4), 3) 84% of injuries were new injuries, 4) during training, most injuries (65%) affected the lower limb, while in matches upper limb (37%) and lower limb injuries (36%) were equally common, 5) training injuries mostly affected the ankle (16%) body area, whereas match injuries more frequently affected the shoulder (20%), 6) the majority of injuries involved muscle/tendon (57%) as the tissue type, of which approximately half were muscle injuries and a third were muscle contusions, 7) the injury severity profile was similar between match and training injuries and more than a quarter of all injuries resulted in time-loss of more than 28 days, 8) contact mechanisms of injury lead to most injuries in matches, whereas non-contact mechanisms accounted for a larger proportion of training injuries, 9) almost half of match injuries occur during the tackle phase (49%), and 10) a high percentage of players could not recall the match period where the injury occurred (24%). The following risk factors associated with incurring an injury during a season were identified: 1) the older age group within the student cohort, 2) higher level of tournament, and 3) any recent injury (past 12 months), 4) a recent injury (past 12 months) to the lower limb. Conclusion: The injured player proportion and match injury incidence were higher in university student rugby players participating in the VC and YG tournaments than has been previously reported in elite professional rugby. The number and severity profiles of training and match injuries were similar. Training injuries mostly occurred in non-contact situations and affected the lower limb, whereas contact injuries were more common in matches and the upper and lower limb were affected at equal frequencies. We show an association between injury risk and age, level of competition, previous acute and/or chronic injury during the past 12 months and specifically a lower limb injury in the past 12 months. The study findings can add to the collective knowledge of injuries and associated risk for injury among student rugby players which in turn may assist medical team members to plan and implement effective injury prevention strategies for this specific population in future.
Upper limb muscle strength and endurance as predictors of successful extubation in mechanically ventilated patients : a predictive correlational study
(University of Pretoria, 2020) Van Rooijen, Agatha Johanna; Paruk, Fathima; rubine.debeer@up.ac.za; De Beer, Caroline Rubine
Mechanical ventilation temporarily replaces or supports breathing in the critically ill patient. Prolonged mechanical ventilation is associated with an increase in nosocomial infections, respiratory muscle weakness and intensive care unit acquired weakness (ICU-AW). Since the inception of mechanical ventilators, successful weaning and extubation failure has always been a challenge that physiotherapists, nurses and physicians grapple with. Due to the complexity of determining extubation readiness 10% to 20% of patients still fail extubation and therefore predictors for successful extubation are paramount. Different parameters including, rapid shallow breathing index (RSBI), partial pressure of arterial oxygen to fraction of inspired oxygen ratio (PaO2/FiO2 ratio) and maximum inspiratory pressure (MIP) were used to predict extubation readiness, but none could be used in isolation. Failed extubation increases the intensive care unit (ICU) length of stay, the hospital length of stay, the financial costs and it decreases the patient’s functional ability, muscle strength and health-related quality of life (HRQOL). Early mobilisation and rehabilitation according to a patient centred program are essential to decrease the development of peripheral muscle weakness and respiratory muscle weakness. Previous research studies demonstrated associations between respiratory muscle weakness and peripheral muscle weakness as well as possible associations between successful extubation, exercise endurance and upper limb muscle strength respectively. The aim of this study was to determine if upper limb muscle strength and exercise endurance can be used by physiotherapists as predictors of successful extubation in mechanically ventilated patients. The statistical objective of this study was to develop a prediction equation based on upper limb muscle strength and exercise endurance for outcome of extubation. A total of 463 patients were recruited from the medical and trauma ICU’s of a large Academic hospital. Fifty seven of these patients were eligible for testing. Peripheral and respiratory muscle strength was evaluated using the Oxford grading scale, Medical Research Council score (MRC-score), handgrip dynamometer and MIP. Exercise endurance was tested while patients were riding the MOTOmed® letto2 cycle ergometer for six minutes with the upper limbs. In an attempt to determine whether upper limb muscle strength and exercise endurance can predict successful extubation, a prediction equation was developed. Univariable logistic analysis was performed to identify the marginal significant and significant factors to be included in the multivariable logistic regression analysis to develop the final prediction equation. The predictive ability of the prediction equation was assessed using cross validation. Testing was based on a 0.05 level of significance. Data analysis employed STATA version 15.1 software. The results demonstrated that the exercise endurance (time the patient rode actively) (P = 0.005), general body muscle strength (MRC-score: P = 0.007) and number of days ventilated (P = 0.005) were associated with successful extubation. The handgrip strength (P = 0.061), MIP (P = 0.095) and muscle strength of the sternocleidomastoid (P = 0.053) and trapezius muscles (P = 0.075) were marginally associated with successful extubation. The muscle strength of the deltoid (P = 0.273) and pectoralis major muscles (P = 0.327) were not significantly associated with successful extubation. Due to multicollinearity between muscle strength and exercise endurance, elimination of factors were done. The newly developed prediction equation only included the exercise endurance and the number of days ventilated as the other factors did not contribute to the predictive value of the equation. This newly developed prediction equation had a sensitivity of 81.82% and a specificity of 77.14% to predict successful extubation. Conclusion: Exercise endurance can be used as predictor of successful extubation in mechanically ventilated patients when physiotherapists apply the newly developed prediction equation ŷ = -1.0064 – (0.17 x active time) + (0.230 x ventilator days) and the value for ŷ is less than or equal to -0.282. Theoretically the equation indicated that if the number of days the patient is ventilated decrease and the exercise endurance increase the risk to fail extubation will decrease. Clinically, successful extubation reduce the ICU length of stay, hospital length of stay and the development of ICU-AW. It increases the patients’ functional level and HRQOL, therefore the findings of this study have the potential to impact positively on patient outcomes.
Contextualisation of physiotherapy clinical practice guidelines for hospitalised prematurely born infants in South Africa
(University of Pretoria, 2019) Eksteen, Carina A.; Maree, C.M. (Carin); janeske@live.com; Van der Walt, Petronella J.
Background: The incidence of premature infant births in South Africa (SA) is estimated at 168 000 per year. Current concern is that premature birth may be associated with lower educational achievement, greater need for social grants in adulthood and lower rates of employment due to the increased risk of disability caused by post-birth complications. Physiotherapists working in neonatal intensive care units (NICUs), high care units (HCUs) or kangaroo mother care (KMC) wards have a unique window of opportunity to influence the infants’ neuromusculoskeletal systems and motor organisation and monitor respiratory function to decrease the risk of impairment. Physiotherapists working in NICUs, HCUs or KMC wards in high-income countries have well-defined clinical practice guidelines (CPGs) to guide the standard of practice, such guidelines are not available in SA. Ethical approval to conduct this study was obtained from the Research Ethics Committee of the Faculty of Health Sciences, University of Pretoria (99/2014). Purpose: The primary aim of the study was to contextualise a CPG for physiotherapists treating prematurely born infants in NICUs, HCUs or KMC wards. Methods: An exploratory sequential mixed methods research approach was followed. Phase 1 was qualitative in nature and consisted of focus group discussions / interviews / online survey with consenting multidisciplinary team (MDT) members and parents or caregivers to gain information on the current patient journeys of prematurely born infants in SA. An integrative literature search was undertaken to identify current CPGs for physiotherapists on the management of prematurely born infants in NICUs, HCUs or KMC wards. Phase 2 entailed the compilation of a questionnaire consisting of the statements identified during the focus group discussions / interviews and recommendations from the identified literature. The statements and recommendations were validated in Phase 3 by using a Delphi method (quantitative research approach) Results: In Phase 1, four possible patient journeys for prematurely born infants in SA were identified. Seven CPGs or position statements were identified and critically appraised by three appraisers using the AGREE II instrument. Three CPGs / position statements were found to be valid for inclusion in this study and permission for inclusion was obtained from the authors of the selected CPGs / position statements. A list of evidence-based recommendations (from the literature) and statements derived from the patient journey that were appropriate for the SA health care context were validated by expert physiotherapists working in clinical and/or academic settings in NICUs, HCUs or KMC wards in SA. The statements were included in the contextualised CPG if they were graded 60% (and above) by participants. Conclusion: A clinical practice guideline was contextualised for use by physiotherapists working in NICUs, HCUs or KMC wards in SA. It is recommended that future research be undertaken to determine the application of the CPG in physiotherapy practice in SA. Implication: The implication is that physiotherapy management of prematurely born infants in NICUs, HCUs and KMC wards in SA could potentially be standardised, and may result in the standardisation of infant care while reducing unwarranted health care cost and outcomes. Key words: Prematurely born infants, physiotherapy, clinical practice guidelines, contextualisation
Pectoralis minor index (PMI) range and scapular dyskinesis in university students presenting with a kyphotic posture and an ideal posture
(University of Pretoria, 2019) Korkie, Elzette; mamsemola@gmail.com; Komati, Muhle Annah
Conclusion The study has shown that it is not only the PM muscle length that plays a role in altered scapular alignment and kinematics, but also the stability that the scapular stabilising muscle function contributes. There were two gaps identified in the current literature, as previously mentioned. These gaps have been addressed, in the current study.
Cervical pain and the association with scapula and cervical dyskinesis in grade 7 learners in private schools in Tshwane
(University of Pretoria, 2019) Korkie, Elzette; anneliephysio@gmail.com; Van Heerden, Annelie
Cervical pain is a common musculoskeletal condition that starts as early as adolescence and continues on into adulthood. Cervical pain in the adolescents is present worldwide and affects between 18-40% of all adolescents. Contributing factors to cervical pain vary from sex, an increase in age, emotional and psychological problems to sustained seated positions and sitting posture as well as the use of information technology. An association between cervical pain and scapula- and cervical dyskinesis has been seen in the adult population. The treatment of the dyskinesis in adults led to a significant decrease in cervical pain. Clinically, if scapula- and cervical dyskinesis is present potential strain on the cervical spine could lead to cervical pain and dysfunction. A possible association between scapula- and cervical dyskinesis and cervical pain in adolescents has not been explored. Furthermore, limited literature is available about the presence of cervical pain in South African adolescents. The purpose of this study was twofold; firstly, it was to determine the presence of cervical pain in Grade 7 learners in private schools in Tshwane, Gauteng, South Africa. Secondly, it was to determine the association of cervical pain with scapula- and cervical dyskinesis in the Grade 7 participants. Four private schools in the greater Tshwane took part in the study with a total of 123 Grade 7 learners participating. The learners had a mean age of 12.97 years. The data collection took place at the various schools in October and November 2016. The participants completed a questionnaire on cervical pain and questions on certain previously determined factors related to cervical pain. The Scapula Dyskinesis Test (SDT) and Overhead Arm Lift Test (OALT) were used to determine scapula and cervical dyskinesis.
Factors influencing the use of outcome measures by community-based physiotherapists in Gauteng Province, South Africa
(University of Pretoria, 2017) Mostert-Wentzel, Karien; kwena.mabasa@gmail.com; Mabasa, Kwena Joyce
The use of outcome measures by rehabilitation professionals has been advocated for many years; however, routine use is still lacking. Literature on the factors influencing the use of outcome measures locally is limited; therefore, the purpose of this study was to determine the factors that influence the use of outcome measures by community-based physiotherapists in Gauteng Province. While 75 community-based physiotherapists from Gauteng Province invited to participate in the study, 48 community-based physiotherapists responded. A descriptive cross-sectional approach was used in this study. A validated questionnaire was piloted to test its applicability to the South African setting. Thirty-seven per cent of the participants used at least one outcome measure in practice. Support from colleagues and positive attitudes were identified as factors that facilitated the use while lack of knowledge, lack of skills and lack of time were identified as barriers towards the use of outcome measures. The only statistically significant relationship found was between the lack of knowledge and the lower level of use of outcome measures. In conclusion, it was evident that there was poor usage of outcome measures by community-based physiotherapists in Gauteng Province and the barriers identified ranged from individual level to organisational level. Recommendations are made regarding policy for the implementation of policies and guidelines on outcome measures and monitoring thereof in form of audits. Special interest groups could offer courses on outcome measures and physiotherapists be encouraged to undergo postgraduate education. Therefore, the researcher suggests that continuous training be provided within the workplace and outcome measures be adopted.

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