South African Journal of Physiotherapy

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ISSN / EISSN : 0379-6175 / 2410-8219
Published by: AOSIS Open Journals (10.4102)
Total articles ≅ 1,474
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Pegdwendé A. Kaboré, Orokiatou B. Zanga, Bénédicte Schepens
Published: 28 September 2022
South African Journal of Physiotherapy, Volume 78; https://doi.org/10.4102/sajp.v78i1.1787

Abstract:
Background: The management of nonspecific chronic low back pain (NCLBP) is complex because of its multifactorial origin. Objectives: To investigate NCLBP care by evaluating patients’ condition and therapeutic management of health practitioners. Method: A cross-sectional survey was carried out among 92 patients with NCLBP, 30 medical practitioners (MP) and 20 physiotherapists (PT) from four public health institutions in Burkina Faso. Patients completed the Visual Analogue Scale, Roland Morris Disability Questionnaire and Fear-Avoidance Beliefs Questionnaire. Practitioners were asked about therapy and continuing professional training. Results: Pain was moderate to intense for 80% of participants with NCLBP. They were functionally affected and showed fear-avoidance beliefs related to physical and work activities. The majority (97%) of medical practitioners prescribed analgesics and 53% prescribed nonsteroidal anti-inflammatory drugs (NSAIDs). Physiotherapy was the most frequently recommended nonpharmacological treatment. Forty-three per cent of medical practitioners referred to physiotherapy; 20% never did. Physiotherapists practised both passive treatments, such as massage (50%), electrotherapy (55%) and thermotherapy (50%), as well as active treatments, such as general exercises (55%), specific exercises (70%), functional revalidation (50%) and back school (40%). Having had recent continuing professional training and assessing risk factors for chronicity were associated with MPs’ and PTs’ therapeutic choices. Conclusion: Participants with NCLBP showed fear-avoidance beliefs, correlated with their algo-functional status. Prescribing habits of MPs were drug-based. Treatments by PTs were passive and active. Continuing professional training of healthcare practitioners and assessment of risk factors had a positive impact on therapeutic choices. Clinical implications: Our study is an invitation to the health care system to improve the relationship between a patient’s NCLBP and therapeutic choices.
Rozelle Labuschagne, Ronel Roos
Published: 27 September 2022
South African Journal of Physiotherapy, Volume 78; https://doi.org/10.4102/sajp.v78i1.1782

Abstract:
Background: Elderly patients report a decrease in function and activities of daily living following abdominal surgery. The objectives of our pilot study were to determine the effects of a single pre-operative physiotherapy session consisting of education and exercise on clinical and physical function outcomes in elderly patients. Methods/design: A single-blind pilot randomised controlled trial evaluated clinical and functional outcomes of elderly patients following surgery in a private hospital in Pretoria, South Africa. The outcomes included length of hospital stay (LOS), postoperative pulmonary complications (PPC), first mobilisation uptime, DeMorton Mobility Index (DEMMI), 6-minute walk test (6MWT), Lawton–Brody’s instrumental activities of daily living (IADL) and the Functional Comorbidity Index (FCI). Descriptive and inferential statistics were undertaken, and statistical significance was set at p ≤ 0.05. Discussion: Twelve participants (n = 11 female [91.67%] and n = 1 [8.33%] male) with a mean age of 65.75 (±4.47) years were included. Most participants (n = 10, 83.33%) underwent lower abdominal laparotomy (n = 10, 83.33%). The median hospital LOS was n = 4 (IQR 3.25–4) days; walking distance at first mobilisation was 130 m (IQR (85–225), with intervention participants walking further (intervention: 177 m, IQR 100–242.50; control: 90, IQR 60 m – 245 m; p = 0.59). Recruitment was low, with only 10.95% referrals and 47.82% nonconsents. Conclusion: A single physiotherapy session prior to surgery demonstrated a potential favourable change in elderly patients’ mobility postoperatively; however, further research is necessary. Clinical implication: A once-off pre-operative physiotherapy session could enhance recovery in elderly patients. Trial registration: Pan African Clinical Trial Registry, PACTR201809874713904, https://pactr.samrc.ac.za/TrialDisplay.aspx?TrialID=3593
Alison Lupton-Smith, Kyla Fourie, Anele Mazinyo, Molebogeng Mokone, Siwelile Nxaba, Brenda Morrow
Published: 26 September 2022
South African Journal of Physiotherapy, Volume 78; https://doi.org/10.4102/sajp.v78i1.1768

Abstract:
Background: Grip strength has been identified as an important indicator of health status and predictor of clinical outcomes. The gold standard for measuring grip strength is the JAMAR® Hydraulic Hand Dynamometer. Less expensive dynamometers are available but have not been validated within a hospital setting. Objectives: To validate the Camry Digital Handgrip Dynamometer (Model EH101) against the validated JAMAR® Dynamometer (Model J00105) in a hospital population. Methods: A cross-sectional observational study with a randomised single-blind cross-over component was conducted on consenting adult patients admitted to general hospital wards. The best of three measurements taken using the dominant hand was used for analysis. Results: Fifty-one participants (median [interquartile range] age 42 [30–58] years; n = 27 [52.9%] female) were included. The mean difference between the Jamar® and Camry measurements was 1.9 kg ± 3.6 kg (t-value 0.9; p = 0.4). There was a strong positive correlation between the Jamar® and the Camry devices (R = 0.94; r² = 0.88; p < 0.0001). Excellent agreement was found between Jamar® and Camry measurements (interclass correlational coefficient 0.97, 95% CI 0.94–0.99, p < 0.0001). Hand dominance significantly affected the agreement between devices (p = 0.002). Conclusions: The Camry Digital Handgrip Dynamometer is a valid tool for assessing grip strength in hospitalised adult patients. Clinical implications: The Camry Digital Handgrip Dynamometer could be used as an inexpensive tool to measure grip strength.
Abdulsalam M. Yakasai, Musa S. Danazumi, Umar M. Gidado, Jibril M. Nuhu, Sani A. Haruna
Published: 19 September 2022
South African Journal of Physiotherapy, Volume 78; https://doi.org/10.4102/sajp.v78i1.1786

Vaneshveri Naidoo, Aimée V. Stewart, Morake E.D. Maleka
Published: 31 August 2022
South African Journal of Physiotherapy, Volume 78; https://doi.org/10.4102/sajp.v78i1.1759

Abstract:
Background: Physiotherapy clinical education is complex. The dynamic learning milieu is fluid and multidimensional, which contributes to the complexity of the clinical learning experience. Consequently, there are numerous factors which impact the clinical learning experience which cannot be measured objectively – a gap which led to the development of our study. Objectives: To develop, validate, and test the reliability of an assessment tool that evaluates the effectiveness and quality of physiotherapy clinical education programmes. Method: A mixed methods approach in three phases included physiotherapy academics, clinical educators, and clinicians throughout South Africa. Phase One was a qualitative study: focus group discussions determined items and domains of the tool. Phase Two established the content and construct validity of the tool, a scoring system and a name for the tool, using the Delphi method. In Phase Three, factor analysis reduced the number of items, and the feasibility and utility of the tool was determined cross-sectionally. Results: The Vaneshveri Naidoo Clinical Programme Evaluation Tool (VN-CPET) of 58 items and six domains was developed and found to be valid, reliable (α = 0.75) and useful. The six domains of VN-CPET include governance; academic processes; learning exposure; clinical orientation; clinical supervision and quality assurance and monitoring and evaluation. Conclusion: The Vaneshveri Naidoo Clinical Programme Evaluation Tool is a valid, reliable and standardised tool, that evaluates the quality and effectiveness of physiotherapy clinical education programmes. Clinical implications: This tool can objectively evaluate the quality and effectiveness of physiotherapy clinical education programmes in South Africa, and other health science education programmes, both locally and globally, with minor modification.
Correction
Benita Olivier, Oluchukwu L. Obiora, Candice MacMillan, Caroline Finch
Published: 31 August 2022
South African Journal of Physiotherapy, Volume 78; https://doi.org/10.4102/sajp.v78i1.1815

Beverley J. Weinberg, Ronel Roos, Heleen van Aswegen
Published: 27 June 2022
South African Journal of Physiotherapy, Volume 78; https://doi.org/10.4102/sajp.v78i1.1764

Abstract:
Background: Rib fractures are a common thoracic injury and notable source of chest pain. Chest pain may lead to compromised respiratory and physical function. Objectives: Our study aimed to synthesise the evidence on the effectiveness of nonpharmacological therapeutic interventions on pain and physical function in adults admitted with rib fractures to acute care settings. Secondary outcomes included length of stay (LOS), respiratory complications, respiratory function and mortality rate. Method: A systematic literature search of English articles in nine databases was conducted. The Joanna Briggs Institute’s System for the Unified Management, Assessment and Review of Information (SUMARI) was used to conduct our study. Articles written from January 2000 to December 2017 were considered and a search update was completed in 2021. Meta-analysis was conducted for pre- versus post-bundle of care implementation for LOS, pneumonia incidence and mortality rate. Certainty of evidence was appraised using the grading of recommendations, assessment, development and evaluation (GRADE) approach. Results: Sixteen studies were included (n = 2034). Certain interventions were shown to improve respiratory function and reduce pain, pulmonary complications, LOS and mortality rate. No interventions were identified which objectively improved physical function. Meta-analysis showed a statistically significant reduction in relative risk of developing pneumonia (p = 0.00) by 63% following bundled care implementation. Certainty of evidence for this outcome was rated as very low following GRADE appraisal. Conclusion: Nonpharmacological therapeutic interventions used in combination with pharmacological management are viable treatment options to reduce pain, improve respiratory function and reduce the incidence of respiratory complications following acute rib fractures. Clinical implications: Acupuncture, transcutaneous electrical nerve stimulation (TENS), noninvasive ventilation (NIV) modalities, physiotherapy techniques and multidisciplinary pathways used alongside pharmacological interventions are effective modalities for use in the treatment of acute rib fractures. Multidisciplinary care pathways are important management strategies and reduce the risk of developing pneumonia.
Retha-Mari Prinsloo, Monique M. Keller
South African Journal of Physiotherapy, Volume 78; https://doi.org/10.4102/sajp.v78i1.1755

Abstract:
Background: Advanced rehabilitation pathway (ARP) after hip and knee arthroplasties is popular globally and is gaining ground in South Africa (SA). A multidisciplinary team in Rustenburg, SA, has implemented an ARP with the first same-day discharge (SDD) from hospital. The lack of evidence of physiotherapy protocols within an ARP determined our study. Objectives: Determine and compare hospital length of stay (LOS) (hours), patient satisfaction (Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC)), patient safety (30-day re-admission) and cost between the two cohorts. Method: A quantitative prospective patient (treatment) group receiving early mobilisation with increased frequency of physiotherapy on post-operative day zero (POD0) was compared to a conservatively managed retrospective historical (control) group following post-operative elective hip and knee arthroplasties. Results: Results for the prospective group which were significantly improved relative to the retrospective group included decreased LOS (median 7.650, p < 0.001), less pain at 6 weeks (mean 16.20, standard deviation [SD] = 2.673, p < 0.001), less stiffness (mean 5.82, SD = 1.214, p = 0.007), higher function (mean 54.87, SD = 8.544, p < 0.001), lower hospital cost (mean R43 340, p < 0.001) and physiotherapy cost (mean R1069, p < 0.001), and total costs compared to the retrospective group (mean R117 062, p < 0.001). Conclusion: Safe and cost-effective SDD is possible in an ARP with earlier mobilisation and increased frequency of physiotherapy on POD0. Clinical implications: Achieving safe SDD after hip and knee arthroplasty surgeries saved costs and improved patient satisfaction, with a decrease in LOS being beneficial for medical funders and stakeholders including government aiming to implement National Health Insurance (NHI) in the future.
Estelle Buys, Thayananthee Nadasan, Ntsikelelo Pefile, Michael O. Ogunlana, Deshini Naidoo
South African Journal of Physiotherapy, Volume 78; https://doi.org/10.4102/sajp.v78i1.1631

Abstract:
Background: Community reintegration is a major outcome of rehabilitation after the acute phase in people with spinal cord injury (PWSCI). Objective: To investigated clinical and socio-demographic factors determining community participation in PWSCI, living in the greater eThekwini Municipality, KwaZulu-Natal province. Method: Our quantitative, cross-sectional study had a convenient sample of 41 PWSCI. A trained interviewer obtained socio-demographic information using a structured questionnaire. Participants completed the Reintegration to Normal Living Index (RNLI). Descriptive statistics were used in summarising the data; inferential statistics, -a t-test and analysis of variance (ANOVA) assessed the association of clinical and socio-demographic factors with the extent of community reintegration. A multiple linear regression investigated the determinants of community reintegration with the alpha level set at p = 0.05. Results: Mean age of the participants was 41 years (s.d.: 10, range 25–66), with the majority (n = 32, 78%) being male. The mean RNLI score was 68% (s.d.: 22, range 24–100). Participants scored higher on the RNLI if they were male (mean difference [MD] 18%, 95% confidence interval [CI]: 2–34), were employed (MD 16%, 95% CI: 0–32), had a salary (MD 19%, 95% CI: 5–32) and had no muscle spasms (MD 14%, 95% CI: 1–27. Muscle spasms (p = 0.012, 95% CI: 3.85–29.05) and being female PWSCI (p = 0.010, 95% CI: −35.75 to −5.18) were significant negative predictors of community reintegration. Conclusion: Community reintegration may be influenced by socio-economic factors. Special interventions for muscle spasms and support for women living with spinal cord injuries may enhance community reintegration. Clinical implication: Therapists need to focus on community reintegration with female PWSCI and on returning to PWSCI to work as this was improved community reintegration.
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