Research Articles (Physiotherapy)

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Development and validation of a knowledge, attitudes and practices (KAP) questionnaire for healthcare professionals on environmental sustainability in healthcare in Southern Africa
(F1000 Research Ltd, 2024-10) Lister, Helga Elke; Mostert, Karien; Botha, Tanita; Field, Emma; Knock, Danté; Mubi, Natasha; Odendaal, Stefani; Rohde, Megan; Maric, Filip
BACKGROUND: The triple planetary crisis of climate change, environmental pollution, and biodiversity loss is increasingly driving poor health outcomes worldwide. Healthcare systems and services are often not environmentally sustainable and compound the problem, while healthcare professionals are also recognised as key leaders in advancing sustainable healthcare. To adopt this leadership position, healthcare professionals’ knowledge, attitudes, and practices regarding environmental sustainability in healthcare must be established. This article reports the development and validation of a new instrument for this purpose that corresponds to the specificities of the Southern African context. METHODS: Questionnaire development followed a seven-stage process. Information was obtained from a 2021 study titled ‘South African Healthcare Professionals’ Knowledge, Attitudes, and Practices Regarding Environmental Sustainability in Healthcare: A Mixed Methods Study’ to develop the instrument. Information was also sourced from the literature regarding environmental sustainability and healthcare to generate the first questionnaire with 29 items. The following stages included two rounds of expert input, separated by a pilot study with the target population to receive feedback regarding the instrument’s structure, relevance, and length. Content validity was determined through statistical analysis. RESULTS: Feedback was received from nine experts in stage two and 13 pilot study participants in stage four and incorporated to improve the questionnaire. In stage six, the questionnaire was rated by seven experts. The content validity index of the questionnaire was calculated at two different stages, after which the indices were compared. Following a final edit, the questionnaire has 24 questionnaire items. The closing analysis calculated the scale content validity index average (S-CVI/Ave) of 0,922; this indicates that the final questionnaire has excellent content validity. CONCLUSION: A questionnaire that assesses the knowledge, attitudes and practices of healthcare professionals regarding environmental sustainability in Southern Africa has been developed and validated. This questionnaire can now be used for further studies in Southern Africa.
Effectiveness of combined targeted and hormonal therapies for post-menopausal women with hormone receptor-positive and HER2-negative advanced breast cancer : a systematic review and meta-analysis of RCTs
(Sage, 2025) Okwor, Vitalis; Okwor, Chika Juliet; Ukwuoma, Maryjane; Nweke, Martins
OBJECTIVE : we aim to synthesize available evidence on the effectiveness of hormonal plus targeted therapies for post-menopausal women with hormone receptor-positive and HER2-negative advanced breast cancer. DATA SOURCES AND METHODS : We searched the following databases: Medline, PubMed, Cochrane Library, CINAHL, Web of Science, Scopus, and African Journal. Only studies that investigated the effectiveness of hormonal therapy combined with targeted therapy for HR+/HER2- advanced breast cancer treatment were included. The outcomes were progression-free survival (PFS), overall survival (OS) and objective response rate (ORR). A random-effect meta-analysis model was employed. Statistical analysis was performed using Comprehensive Meta-analysis version 3. RESULTS : 24 studies were included in the meta-analysis with an overall sample size of 7635. Median PFS, OS and ORR were found to be significantly increased in the combination group compared to hormonal monotherapy [SMD = 6.072 (95% CI = 3.785–8.360), p < 0.001], [SMD = 1.614 (95% CI = 0.139–3.089), p = 0.032] and [OR = 1.584 (CI 1.134–2.213), p = 0.007] respectively. Subgroup analysis showed a significant difference in PFS and ORR between patients who received “hormonal therapy + CDK4/6 inhibitors” vs hormonal therapy only [SMD = 6.015 (CI 3.069–8.960), p < 0.001], (OR = 1.828 (CI 1.030–3.243), p = 0.039] respectively. CONCUSION : Compared with hormonal monotherapy, targeted plus hormonal therapy significantly improves PFS, OS and ORR in postmenopausal women with HR+/HER2- advanced breast cancer.
Upper limb muscle strength and exercise endurance as predictors of successful extubation in mechanically ventilated patients
(SpringerOpen, 2024-05-22) De Beer‑Brandon, Caroline R.; Van Rooijen, Agatha Johanna; Becker, Piet J.; Paruk, Fathima; rubine.brandon@up.ac.za
BACKGROUND : Failed extubation increases the intensive care unit (ICU) length of stay, hospital length of stay, and financial costs and it reduces the patient’s functional ability. Avoiding failed extubation is of utmost importance, therefore predictors for successful extubation are paramount. OBJECTIVE : To determine if successful extubation in mechanically ventilated patients can be predicted by physiotherapists using upper limb muscle strength and exercise endurance. METHODS : Fifty-seven patients from the medical and trauma ICUs of a large academic hospital were eligible for testing. Muscle strength was evaluated using the Oxford grading scale, Medical Research Council score (MRC score), handgrip dynamometer, and maximum inspiratory pressure (MIP). Exercise endurance was tested while the patient was actively riding the MOTOmed ® letto2 cycle ergometer for six minutes with the upper limbs. RESULTS : Exercise endurance (time the patient rode actively) (P = 0.005), 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. Due to multicollinearity when developing the prediction equation, the final multivariable logistic regression prediction model included only exercise endurance and the number of days ventilated. The newly developed prediction equation conferred a sensitivity of 81.82% and a specificity of 77.14% to predict successful extubation. CONCLUSION : Successful extubation of mechanically ventilated patients can be predicted by physiotherapists using the newly developed prediction equation consisting of exercise endurance and number of days ventilated.
Level of disability in stroke survivors in the Greater Accra Region of Ghana
(Springer Open, 2024-10-08) Mohammed, Tawagidu; Nyante, Gifty Gyamah; Abdul‑Rahman, Mubarak; Mothabeng, Joyce Diphale
BACKGROUND : Many stroke survivors in low- and middle-income countries such as Ghana live with various degrees of disabilities. Insight into the level of disability and its determinants in stroke survivors has become very important. This study aimed to assess disability and determinants in stroke survivors in the Greater Accra Region of Ghana. METHODS : One hundred and eight community-dwelling stroke survivors undergoing outpatient physiotherapy rehabilitation were sampled for the study. The World Health Organization disability assessment schedule (WHODAS) questionnaire was used to assess the level of disability in the participants. Sociodemographic and clinical data were gathered to help assess the determinants of disability. Association between sociodemographics and disability, and clinical characteristics and disability were determined using chi-square/Fisher’s exact test. p values less than 0.005 were considered statistically significant. RESULTS : Most of the study participants were reported to have moderate to severe disabilities in their bodily function. Age, gender, marital status, and employment status were found to be associated with the level of disability in stroke survivors. CONCLUSION : Disability and its determinants in stroke need to be given much attention as disability affects the ability of stroke survivors to function independently.
Illness is more prevalent than injury in trail runners participating in a mountainous ultra trail race
(Taylor and Francis, 2025) Boshielo, Patience Matshepo; Jansen van Rensburg, Audrey; Viljoen, Carel Thomas; Botha, Tanita; De Villiers, Christina Elizabeth; Ramagole, Dimakatso Althea; Seyani, Limbikani; Janse van Rensburg, Dina Christina
OBJECTIVES : Trail running is a popular off-road sport involving running in natural environments over various terrains, often in remote locations. This study aims to investigate the epidemiology and risk factors of injuries and illnesses, i.e. medical encounters, on race day among trail runners in a high-altitude ultra trail race. METHODS : This descriptive cross-sectional study on an ultra trail race (38 km, 65 km and 100 km) in South Africa, included participants 18 years or older. Of the 331 race participants, 285(86.1%) consented to participate in the study. Data collection included demographic details, injuries (body region, specific body area, tissue type, pathology) and illnesses (organ system, symptom cluster, etiology). Risk factor analysis includes sex, age, weight, height, race distance, illness and injury history, training and running experience. Frequency (n, %), prevalence (%) and odds ratios (OR; 95%CI) are reported. RESULTS : Eighty-nine (31.2%) individuals reported 131 medical encounters [49 injuries (37.4%); 82 illnesses (62.6%)]. Injuries were sustained by 14.7% of athletes, and 22.5% reported illnesses. For injuries, the lower limb was mainly involved (n = 41; 83.7%). Most injuries affected the foot (n = 18; 36.7%), ankle (n = 10; 20.4%) and knee (n = 7; 14.3%). Tissue types mainly involved skin (n = 21; 42.8%), ligament (n = 7; 14.3%) and muscle (n = 7; 14.3%). Multiple (n = 45; 54.9%) and gastrointestinal (n = 17; 20.7%) organ systems were mainly involved in illnesses. Only 100 km runners reported dehydration (n = 28; 31.5%), and one in every six of these runners (n = 5; 17.9%) did not finish. Runners reporting fatigue (n = 21; 23.6%) had a high (n = 8; 38.1%) did not finish rate. Two in every five participants (n = 36; 40.4%) with a medical encounter, did not finish. No medical encounter-associated risk factors were identified. CONCLUSIONS : Illnesses were more common than injuries during the mountainous ultra trail race. Sustaining a medical encounter increased the chance of not completing the race. Further research on the epidemiology of race day medical encounters in trail running is required.
Performance of upper limb entry item to predict forced vital capacity in dysferlin-deficient limb girdle muscular dystrophy
(Elsevier, 2024-10) Borland, Holly; Moore, Ursula; Dressman, Heather Gordish; Human, Anri; Mayhew, Anna G.; Hilsden, Heather; Rufibach, Laura E.; Duong, Tina; Maron, Elke; DeWolf, Brittney; Rose, Kristy; Siener, Catherine; Thiele, Simone; Praxedes, Nieves Sanchez-Aguilera; Canal, Aurelie; Holsten, Scott; Sakamoto, Chikako; Pedrosa-Hernández, Irene; Bello, Luca; Alfano, Lindsay N.; Linda Pax Lowes The Jain COS Consortium; James, Meredith K.; Straub, Volker
Dysferlin-deficient limb girdle muscular dystrophy (LGMD R2), also referred to as dysferlinopathy, can be associated with respiratory muscle weakness as the disease progresses. Clinical practice guidelines recommend biennial lung function assessments in patients with dysferlinopathy to screen for respiratory impairment. However, lack of universal access to spirometry equipment and trained specialists makes regular monitoring challenging. This study investigated the use of the Performance of Upper Limb (PUL) clinical scale entry item as a low-cost screening tool to identify patients with dysferlinopathy at risk of respiratory impairment. Using data from 193 patients from the Jain Foundation’s International Clinical Outcomes Study, modelling identified a significant positive relationship between the PUL entry item and forced vital capacity (FVC). Eighty-eight percent of patients with the lowest PUL entry item score of 1 presented with FVC % predicted values of < 60 %, suggestive of respiratory impairment. By contrast, only 10 % of the remainder of the cohort (PUL entry item of 2 or more) had an FVC of < 60 %. This relationship also held true when accounting for ambulatory status, age, and sex as possible confounding factors. In summary, our results suggest that the PUL entry item could be implemented in clinical practice to screen for respiratory impairment where spirometry is not readily available.
Association between pre-operative total prostate-specific antigen and survivorship of prostate cancer following radical prostatectomy : a systematic review
(Karger Publishers, 2024-04) Okwor, Chika Juliet; Okwor, Vitalis Chukwuemeka; Meka, Ijeoma A.; Emedoh, Andrew Emeka; Nweke, Martins C.
OBJECTIVE : This review aimed to systematically quantify the association between pre-operative total prostate-specific antigen (tPSA) and survivorship of prostate cancer (PCa). METHODS : Data sources for the review included MEDLINE, PubMed, Cochrane Library, CINAHL, Academic Search Complete, PsycINFO, and relevant reference lists. Databases were searched from inception to June 2022. The study took place between May 2022 and March 2023. We included studies that applied a quantitative approach to examine the interaction between pre-operative PSA and survivorship of PCa. Pre-operative PSA constituted the independent variable, whereas survivorship of PCa as measured by biochemical recurrence and mortality constitute the outcome variable. A risk of bias assessment was conducted with the aid of a mixed-method appraisal tool. We employed metaanalysis to quantify the association of pre-operative PSA with biochemical recurrence and mortality and computed I2 to assess the degree of heterogeneity. RESULTS : We found a positive weak association between pre-operative PSA and biochemical recurrence (hazard ratio [HR] = 1.074; 95% CI = 1.042–1.106). With a median rise in PSA (≥2 ng/mL), the likelihood for biochemical recurrence increase by approximately 7.4%. There was statistically a significant association between PSA and mortality (HR = 1.222, CI = 0.917–1.630). CONCLUSIONS : Biochemical recurrence associates with preoperative PSA in an inconsistent manner. The sole use of preoperative PSA in estimating post-prostatectomy biochemical recurrence should be discouraged. There is need for a multifactorial model which employs a prudent combination of the most important and cost-effective biomarkers in predicting post-prostatectomy biochemical recurrence.
Psychometric properties and clinical utility of spinal health outcome measures in school-based interventions among children and adolescents : a systematic review protocol
(BMJ Publishing, 2024-11) Nkhata, Loveness A.; Human, Anri; Louw, Quinette A.; Brink, Yolandi
INTRODUCTION: Spinal health in children and adolescents has global implications, impacting school attendance, academic performance and physical activity. Effective school-based interventions are essential for promoting spinal health literacy, positive behaviours and academic success. OBJECTIVES: This review aims to collect data on school based interventions for spinal health in children and adolescents over the past two decades. It will examine interventions such as education, exercise and appropriate furniture, focusing on outcomes including musculoskeletal pain, posture, sedentary behaviour and academic performance. Additionally, the review will describe the psychometric properties and clinical utility of the outcome measures used in these studies. METHODS AND ANALYSIS: The systematic review will adhere to Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines, employing the PICO framework to define criteria for participants, interventions, comparisons, outcomes and study designs. Only English studies published between 2004 and 2024 will be included. Relevant databases will be searched using specific keywords derived from the PICO framework. The Critical Appraisal Tool and the COSMIN Risk of Bias tool will be used to evaluate the methodological quality and risk of bias in the selected studies. Review authors will independently assess articles, resolving discrepancies through consensus. Statistical analyses will be performed using CADIMA V.2.2.4.2 April 2023. RESULTS: Data will be collected based on various outcome measures, evaluated with an approved checklist and presented through descriptive narratives and tables. Findings will be disseminated via conference presentations, Faculty Research Day and publication in reputable journals. ETHICS AND DISSEMINATION: The study will adhere to the ethical principles outlined in the Declaration of Helsinki, ensuring a rigorous approach to minimise bias and guarantee valid results. Studies will be selected based on predetermined criteria following a consistent protocol. The findings will be disseminated through presentations and publication in peer-reviewed journals. PROSPERO REGISTRATION NUMBER: The systematic review protocol is registered on PROSPERO (registration number CRD42024543258), with a planned date of commencement from August 2024 to November 2024.
Developing an HIV-specific falls risk prediction model with a novel clinical index : a systematic review and meta-analysis method
(BioMed Central, 2024-12) Ibeneme, Sam C.; Odoh, Eunice; Martins, Nweke; Ibeneme, Georgian C.
BACKGROUND: Falls are a common problem experienced by people living with HIV yet predictive models specific to this population remain underdeveloped. We aimed to identify, assess and stratify the predictive strength of various physiological, behavioral, and HIV-specific factors associated with falls among people living with HIV and inform a predictive model for fall prevention. METHODS: Systematic review and meta-analysis were conducted to explore predictors of falls in people living with HIV. Data was sourced, screened, extracted, and analyzed by two independent reviewers from eight databases up to January 2nd, 2024, following the Preferred Reporting Items for Systematic Review and Meta-Analysis (PRISMA) protocol. Evidence quality and bias were assessed using the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) and the Mixed Method Appraisal Tool (MMAT), respectively. Pooled odds ratios (OR) with 95% confidence intervals (CI) were computed using random-effects models to establish associations between predictors and falls risk. We applied established criteria (Bradford Hill’s criteria, Rothman’s and Nweke’s viewpoints) to stratify risk factors and create a weighted predictive algorithm. RESULTS: This review included 12 studies on falls/balance dysfunction in 117,638 participants (54,513 people living with HIV), with varying ages (45–50 years), sample sizes (32−26,373), study durations (6 months to 15 years), disease stages (CD4+counts 347.2 cells/mm³ to ≥500 cells/µL) and fall definitions (self-reported histories to real-time reporting). Some predictors of falls in people living with HIV including depression, cannabis use, cognitive impairment/ neurocognitive adverse effects (NCAE), hypertension, and stavudine—showed perfect risk responsiveness (Ri=1), indicating their strong association with falls. Notably, cannabis use demonstrated the highest risk weight (Rw=3.0, p<0.05, 95%CI:1.51–5.82), followed by NCAE (Rw=2.3, p<0.05, 95%CI:1.66–3.21) and frailty with a broad confdence interval (Rw=2.2, p<0.05, 95%CI:0.73–14.40). Other significant predictors included hypertension (Rw=1.8, p<0.05, 95%CI:1.33–2.33), depression (Rw=1.6, p<0.05, 95%CI:1.22–2.18), stavudine use (Rw=1.5, p<0.05, 95%CI: 0.95–2.25), neuropathy (Rw=1.3, p<0.05, 95%CI:1.26–2.11), and polypharmacy (Rw=1.2, p<0.05, 95%CI:1.16–1.96). The fall risk threshold score was 12.8, representing the 76th percentile of the specific and sufficient risk weight. CONCLUSION: Our meta-analysis identifies predictors of falls in people living with HIV, emphasizing physiological, behavioral, and HIV-specific factors. Integrating these into clinical practice could mitigate falls-related sequelae. We propose a novel approach to falls risk prediction using a novel clinical index, resulting in a HIV-specific falls risk assessment tool.
Epidemiology and clinical characteristics of football injuries among academy players in Ghana
(BMJ Publishing Group, 2024-11) Kwakye, Samuel Koranteng; Mostert, Karien; Garnett, Daniel; Masenge, Andries
OBJECTIVE: To determine the epidemiology and clinical characteristics of match and training injuries among football players at an academy in Ghana. METHODS: In this prospective observational study, we followed 80 youth and adult football players at a Ghanaian academy over a season of 39 weeks. Medical attention and time-loss injuries, as well as exposure times of players, were recorded by resident physiotherapists using a standardised injury surveillance form. The average weekly injury prevalence was calculated. Injury incidence rates were calculated per 1000 exposure hours, with significance indicated as 95% CIs. RESULTS: 126 injuries were recorded during the season, with an average weekly injury prevalence of 4.1%. The overall injury incidence was 4.5 (95% CI 3.8 to 5.4) injuries per 1000 hours with under 14 (5.8 (3.3 to 10.2)/1000 hours) and under 18 players (5.7 (4.4 to 7.4)/1000 hours) recording a higher incidence than under 16 (5.1 (3.5 to 7.4)/1000 hours) and senior players (2.7 (1.9 to 3.9)/1000 hours). Match injury incidence was 13 times higher than training injury incidence (27.4 (21.5 to 34.9) vs 2.3 (1.8 to 3.0) injuries/1000 hours). Injuries to the lower extremities had the highest incidence (3.9 (2.1 to 7.2) injuries/1000 hours), with the knee being the most commonly injured site (n=30, 23.8%). The most common type of injury was a joint sprain (1.9 (1.5 to 2.5) injuries/1000 hours), and the most common injury mechanism was direct contact with another player (1.5 (1.1 to 2.0) injuries/1000 hours). Most injuries were moderately severe (2.0 (1.5 to 2.6) injuries/1000 hours). CONCLUSION: Ghanaian academy football players have a substantial risk of sustaining injuries, especially among younger players. Further studies should focus on developing specific injury prevention programmes in under-researched football-playing populations.
Association between life satisfaction and health behaviours among older adults : a systematic review and meta-analysis protocol
(BMJ Publishing Group, 2024-11) Alumona, Chiedozie J.; Scott, David R.; Odole, Adesola C.; Nweke, Martins C.; Kalu, Michael; Awosoga, Oluwaghohunmi A.
INTRODUCTION: Life satisfaction is a key indicator of successful ageing and reflects well-being. There is evidence of the association between life satisfaction and health behaviours among older adults. Therefore, this systematic review and meta-analysis protocol seeks to determine the strength and direction of the association between life satisfaction and health behaviours among older adults. METHODS AND ANALYSIS: This protocol followed the Preferred Reporting Items for Systematic Review and Meta-Analysis Protocols guidelines. We will search the electronic databases (MEDLINE, APA PsycINFO, Web of Science, CINAHL and Global Health) from inception to date. Only observational studies that described the association between life satisfaction and health behaviours—smoking, alcohol drinking, physical activity, diet/nutrition and sleep—will be included. Two independent reviewers will conduct screening, data extraction and risk of bias assessment of the articles. The risk of bias will be assessed using the Joanna Briggs Institute critical appraisal tools for cohort and analytical cross-sectional studies. Studies will be included in the meta-analysis if they report zero-order associations between life satisfaction and health behaviours; otherwise, a narrative synthesis will be presented. ETHICS AND DISSEMINATION: This study does not require ethics approval, as it involves analysing secondary data from published studies. The completed review will be published in a peer-reviewed journal and presented at conferences. TRIAL REGISTRATION NUMBER: PROSPERO (CRD42023441386).
Incidence, severity, and risk factors for injuries in female trail runners – a retrospective cross-sectional study
(Elsevier, 2025-01) Goodrum, Morven; Viljoen, Carel Thomas; Kaulback, Kelly
OBJECTIVES : To determine the incidence, severity, and nature of injuries sustained by female trail runners and investigate selected training variables as risk factors for injuries. DESIGN : Cross-sectional, retrospective cohort study. SETTING : Online questionnaire (Jisc Online Surveys). PARTICIPANTS : Female trail runners (n = 62) aged 39.1 ± 12.4 years. MAIN OUTCOME MEASURES : Training metrics (average weekly number of running sessions, mileage (km), session duration (mins), pace (min/km), ascent (m) and descent (m), number of running doubles per week, number of cross training doubles per week, type of cross training), incidence, severity and nature of trail running injuries sustained in the previous 12 months. RESULTS : The injury incidence was 14.3 injuries per 1000 h and mean severity score (OSTRC- H) was 80.95 ± 21.74. The main anatomical region affected was the lower limb (63.4%), primarily the ankle (13.9%), knee (13.0%) and lower leg (12.2%). The most common injury was tendinopathy (25.2%). A higher number of injuries sustained in the previous 12 months was weakly associated with a higher average duration of other (not trail) weekly running sessions (p = 0.017). CONCLUSIONS : Findings from this study could inform future injury prevention and treatment strategies. Prospective, longitudinal data on injuries in female trail runners is needed.
The influence of pain on community reintegration after spinal cord injury
(Wiley, 2025-01) Henderson, Valerie; Mashola, Mokgadi Kholofelo
BACKGROUND : Community reintegration is an important goal for people living with a spinal cord injury (SCI), and pain is suspected to limit reintegration due to its limitations in daily functioning, mood, and sleep. OBJECTIVES : To determine the influence of pain on community reintegration in manual wheelchair users with SCI. METHODS : The Reintegration to Normal Living Index was used to determine community reintegration, while the DN4 and the Wheelchair User's Shoulder Pain Index were used to determine the presence of neuropathic and shoulder pain respectively. Associations and differences between the pain variables and participants with and without pain were analyzed with Spearman correlations and Mann–Whitney U-tests using SPSS v27 at 0.05 significance level and 95% confidence interval. RESULTS : Of the 122 participants, 85.2% reported current pain, with a 77.7% median for community reintegration. Neuropathic pain (53.3%) was more common and severe than nociceptive shoulder pain (14.8%). There was no significant difference in community reintegration between participants with and without pain, nor any correlation between the overall presence of pain and community reintegration. The severity of pain, particularly shoulder pain, was negatively associated with taking trips out of town (p < 0.01), and overall community reintegration (p < 0.05). CONCLUSION : It is not the mere presence of pain that influences community reintegration, but rather the severity and the location of pain. Shoulder care and pain management need to be included in the rehabilitation program, as these are important considerations when rehabilitating people with SCI back into their communities.
Effectiveness of self-management programs among athletes with patellofemoral pain syndrome : protocol for a systematic review
(JMIR Publications, 2024-11) Masoudi, Ameen; Chemane, Nomzamo; Useh, Ushotanefe; Bello, Bashir; Magida, Nontembiso
BACKGROUND : Patellofemoral pain syndrome is a highly prevalent overuse knee injury in athletic populations associated with pain and functional limitations, exacerbated by activities such as running, pivoting, cycling, and jumping. Self-management programs empowering athletes to take an active role in controlling their symptoms for chronic musculoskeletal conditions such as patellofemoral pain syndrome have grown in popularity. However, the efficacy of self-management programs specifically for athletes with patellofemoral pain syndrome is unclear due to limited and heterogeneous evidence. OBJECTIVE : The systematic review study will evaluate the effectiveness of self-management programs on pain and function, in athletes with patellofemoral pain syndrome. METHODS : PubMed/MEDLINE, Cochrane Library, CINAHL (Cumulative Index to Nursing and Allied Health Literature), and PsycINFO databases will be systematically searched using terms related to “patellofemoral pain syndrome,” “self-management,” and “athletes.” Interventional studies that are randomized and nonrandomized controlled trials will be included, comparing self-management programs to other treatments or control conditions among athletes with patellofemoral pain syndrome. Four reviewers will independently screen studies, extract data using the COVIDENCE software, and assess the quality of the study and evidence using the Pedro scale of risk of bias tool and GRADE approach, respectively. If feasible, a meta-analysis will be performed using the RevMan (version 5.4; the Cochrane Collaboration). RESULTS : The systematic review is currently in the search phase, with the authors refining search strings for the selected databases. The final search strings are expected to be ready by March 2024, and the review is projected to be completed by July 2024. CONCLUSIONS : This systematic review protocol outlines a rigorous methodology for evaluating the effectiveness of self-management programs among athletes with patellofemoral pain syndrome. The findings will inform clinical practice and guide the development of tailored interventions to optimize outcomes for athletes with patellofemoral pain syndrome. TRIAL REGISTRATION : PROSPERO CRD42023492746; https://tinyurl.com/c5jze9ca INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID) : PRR1-10.2196/58340
Inspiratory muscle training in children with neuromuscular disorders
(AOSIS, 2024-08-08) Human, Anri; Corten, Lieselotte; Lozano-Ray, Eleonora; Morrow, Brenda M.; anri.human@up.ac.za
BACKGROUND : Progressive respiratory muscle weakness and ineffective cough contribute to morbidity and mortality in children with neuromuscular disorders (NMD). Inspiratory muscle training (IMT) aims to preserve or improve respiratory muscle strength and reduce respiratory morbidity. This study aimed to determine the safety and efficacy of IMT in children with NMD. METHODS/DESIGN : A randomised cross-over study compared a 3-month intervention (IMT) with control periods (no IMT). Children diagnosed with NMD (5 years – 18 years) performed 30 breaths (at 30% of maximum inspiratory mouth pressure [Pimax]) with an electronic threshold device, twice daily. During the control period, participants did not perform any IMT. DISCUSSION : Twenty three children (median [interquartile range {IQR}] age of 12.33 [10.03–14.17] years), mostly male (n = 20) and non-ambulant (n = 14) participated. No adverse events related to IMT were reported. No difference in median patient hospitalisation and respiratory tract infection (RTI) rates between non-training and intervention periods (p = 0.60; p = 0.21) was found. During IMT, Pimax and peak cough flow improved with a mean ± standard deviation (s.d.) of 14.57 ± 15.67 cmH2O and 32.27 ± 36.60 L/min, compared to 3.04 ± 11.93 cmH2O (p = 0.01) and −16.59 ± 48.29 L/min (p = 0.0005) during the non-training period. Similar to other studies, spirometry did not show a significant change. CONCLUSION : A 3-month IMT programme in children with NMD appears safe and welltolerated, with significant improvement in respiratory muscle strength and cough efficacy. CLINICAL IMPLICATIONS : Inspiratory muscle training could be considered a cost-effective adjunct to respiratory management in children with NMD. TRIAL REGISTRATION : Pan African Clinical Trial Registry, PACTR201506001171421, https://pactr.samrc.ac.za.
Frequency of red blood cell allo-immunization in transfused patients with sickle cell disease in Africa
(Makerere University Medical School, 2024-09) Nwagha, Theresa Ukamaka; Ugwu, Angela Ogechukwu; Nweke, Martins C.
BACKGROUND AND OBJECTIVES : Blood transfusion is an effective and proven treatment for some severe complications of sickle cell disease. Recurrent transfusions have put patients with sickle cell disease at risk of developing antibodies against the various antigens they were exposed to. This study aims to investigate the frequency of red blood cell alloimmunization in patients with sickle disease in Africa. MATERIALS AND METHODS : This is a systematic review of peer-reviewed and published literature. The review was conducted consistent with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses checklist. Data sources for the review include MEDLINE, PubMed, AJOL, CINAHL, Psych-Info and Academic Search Complete. Included in this review are articles that reported the frequency/prevalence of red blood cell alloimmunization in sickle cell disease patients in Africa. Eligible studies were subjected to independent full-text screening and data extraction. Risk of bias assessment was conducted with the aid of the mixed method appraisal tool. We employed a random-effects model of meta-analysis to estimate the pooled prevalence. We computed Cochrane’s Q statistics and I2 and prediction interval to quantify heterogeneity in effect size. RESULTS : The prevalence estimates range from 2.6% to 29%. Pooled prevalence was estimated to be 12.1% (95% CI 8.1 to 17.7), with significant heterogeneity (I2= 91.83; PI = 2 to 54%). CONCLUSION : The frequency of red cell alloantibody varies considerably in Africa.
The association between menstrual cycle phase, menstrual irregularities, contraceptive use and musculoskeletal injury among female athletes : a scoping review
(Springer, 2024-10) MacMillan, Candice; Olivier, Benita; Viljoen, Carel Thomas; Janse van Rensburg, Dina Christina; Sewry, Nicola Ann; candice.macmillan@up.ac.za
BACKGROUND : The influence of menstrual cycle phases (MCPs), menstrual irregularities (MI) and hormonal contraceptive (HC) use on injury among female athletes has been scrutinised. Existing systematic reviews investigating the effect of exposures affecting the endogenous reproductive hormone status on sporting injuries are limited in terms of the types of studies included and injuries investigated. OBJECTIVE : This scoping review aims to summarise the coverage of the literature related to the extent, nature and characteristics of the influence of MCP, MI and HC use on musculoskeletal injuries among athletes. It also aims to summarise key concepts and definitions in the relevant literature. Observational and experimental studies investigating the effect of MCP, MI, and HC on musculoskeletal injuries among female individuals of reproductive age were included. Studies specifically stating pregnant women, perimenopausal/postmenopausal athletes, or those using medication (other than HC) that affects reproductive hormone profiles or the musculoskeletal system were excluded. METHODS : This scoping review was conducted according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses Extension for Scoping reviews and JBI scoping review guidelines. Published and unpublished studies were sourced from several databases and resources. Initial keywords used included terms related to “menstrual cycle”, “hormonal contraception” and “injury.” Titles and abstracts of identified citations were screened independently and assessed for eligibility by two independent reviewers. Data from the included studies were extracted using a standard data extraction form. RESULTS : The search yielded 10,696 articles, of which 96 met the eligibility criteria. Most studies investigated MI (77%), and 49% included MCP as a contributing injury risk factor. Publications have increased over the last two decades. Collectively, only 16% of research has been conducted in Africa, Asia and Oceania. There were no studies from South America. Seventy-five percent of the studies investigated individual versus team (25%) sport athletes. Most studies only investigated elite or professional (n = 24; 25%) level athletes. The definitions of injury, eumenorrhea and MI differ vastly among studies. Regarding MI, most studies (69%) investigated secondary amenorrhea, followed by oligomenorrhea (51%) and primary amenorrhea (43%). Concerning HC, the influence of oral contraceptive pills was mainly investigated. CONCLUSIONS : Research related to MCP, MI and HC as contributing musculoskeletal injury risk factors is increasing; however, several gaps have been identified, including research from countries other than North America and Europe, the study population being non-professional/elite level athletes, athletes participating in team sports and specific injuries related to MCP, MI and HC, respectively. Differences in methodology and terminology of injury, MCP and MI hinder comparative summative research, and future research should consider current published guidelines during the study design. Identifying barriers to following standard guidelines or research investigating the most practical yet accurate methods to investigate the influence of MCP on musculoskeletal health might yield valuable insights for future research designs. CLINICAL TRIAL REGISTRATION : Scoping review registration number: Open Science Framework (https://doi.org/10.17605/OSF.IO/5GWBV).
High school rugby coaches’ knowledge and opinions of concussion in KwaZulu Natal province in South Africa : an ecological cross-sectional study
(BMC, 2024-06) Garnett, Daniel; Cobbing, Saul; Viljoen, Carel Thomas; Patricios, Jon
BACKGROUND: Concussions in Rugby Union are common with an increased risk to adolescent players. Coaches are key to injury prevention and a greater understanding of their knowledge and sentiments may guide future initiatives. There is a lack of data on rugby coaches, especially in South Africa. This study aimed to investigate the knowledge and opinions of high school rugby coaches regarding concussion management. METHODS: This cross-sectional study of 37 high school rugby coaches in South Africa, was conducted via a self-reported questionnaire. Concussion knowledge was scored for correct answers only with closed-question scaling methods to measure the importance of items of concussion management using a graphical rating scale. An attitude scale (Likert) was used to assess self-reported opinions and behaviours. Associations were calculated for participant characteristics and overall concussion injury knowledge. RESULTS: More participants showed good overall knowledge of ≥ 75% (n = 22, 59% vs. n = 15, 40%), especially those with greater coaching experience (p = 0.021). Player welfare was perceived more important than player performance (185 vs. 164), with concussion prevention most important (184 of 185). Appealing characteristics of an injury prevention programme were the improvement of player skill (173, SD ± 0.75, mean 4.68), being adaptable (171, ± 0.86, 4.62), and being completed in the warm-up (167, ± 0.93, 4.51). The biggest perceived barriers were duration (138, ± 1.59, mean 3.73), effort (130, ± 1.56, 3.51), compliance and lack of knowledge (both 127, ± 1.68, 3.43). CONCLUSION: These results support the implementation of ongoing concussion education for rugby coaches and identify areas for promoting awareness and knowledge of concussion injury prevention, identification, and specific management of younger athletes. Appealing characteristics and barriers are highlighted and may allow for improved implementation and adherence to concussion prevention programmes. KEY POINTS: • The risk of concussion to female athletes and younger athletes was under-reported and should be addressed in future coach-focused education initiatives. • Successive educational approaches may be effective in coaches’ knowledge retention, although the most appropriate delivery methods should be researched further. • The ideal injury prevention programme should improve player skill whilst reducing the risk of injury, be adaptable, completed during the warm-up and not take much time or effort to complete.
Effectiveness of a physiotherapy self-management programme for adult patients with chronic non-specific low back pain in low- and middle-income countries : protocol for a systematic review and meta-analysis
(BMJ Publishing Group, 2024-07) Motha, Sergant Given; Naidoo, Niri; Moyo-Chilufya, Maureen; Musekiwa, Alfred; Kgarosi, Kabelo; Mostert, Karien; u98201612@tuks.co.za
INTRODUCTION: Chronic non-specific low back pain (CNLBP) is among the most common musculoskeletal system conditions reported worldwide; however, few studies are available from low- and middle-income countries (LMICs). Self-management is a set of tasks performed by the patient aiming at managing their symptoms and interference in activities, mood and relationships due to pain. A physiotherapy-guided self-management programme (SMP) following a biopsychosocial approach has been reported as effective and affordable in the management of CNLBP in high-income countries. The objective of this systematic review is to determine the overall effectiveness of SMPs for adults with CNLBP in LMICs. METHODS AND ANALYSIS: In this systematic review, the Preferred Reporting Items for Systematic Reviews and Meta-Analyses-Protocol (PRISMA-P) guidelines will be followed. A three-step search strategy will be used to search the electronic databases (PubMed, MEDLINE, SPORTDiscus, Scopus and CINAHL, Academic Search Complete and PEDro) for randomised controlled trials assessing the effectiveness of physiotherapy-guided self-management for CNLBP among adult participants in LMICs. The processes of screening search results for eligible studies, extracting data from included studies and appraising will be done independently by at least two review authors. Random effects meta-analysis will be used to synthesise results and heterogeneity will be assessed using the I2 test statistic and χ2 test. ETHICS AND DISSEMINATION: Ethics clearance was obtained for the broader PhD study on the development of a physiotherapy-guided SMP for adult people with CNLBP in Limpopo Province, South Africa. The results of the manuscript for this protocol will be published in peer-reviewed journals and also presented at conferences, symposia, and congresses. PROSPERO REGISTRATION NUMBER: CRD42023399572.
Staff perspectives on transformational needs at a South African higher education institution
(Wiley, 2024-10) Magida, Nontembiso; Yazbek, Mariatha; Thambura, Julius Muchui; nontembiso.magida@up.ac.za
Transformation reflects the government's engagement and policies in restructuring higher education to cultivate the country's communal economy. Higher education is challenged in providing tertiary education to students from diverse environments, and staff transformation is needed. This cross-sectional study establishes the staff's perception of transformation in the School of Healthcare Sciences of a selected South African university. Staff were purposively sampled and were surveyed using an electronic questionnaire. The survey included aspects of equity, transformation, management, recognition, the social environment, the physical environment and general satisfaction. Demographic variables, including the perspective on transformation in the institution, the student body and transformation management, were descriptively analysed. Most staff members perceived the university as committed to transformation despite racial tensions and past injustices. Over two-thirds of the staff support the university's goal of increasing a diverse student body. Additionally, the management is comfortable with diversity and demonstrates equity for all. The implementation of transformation was actively considered and aligned with policies.

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