Browsing by Author "Bowerbank, Patricia"

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    A comparative study of the effects of meclofenamate, diclofenac and placebo, in combination with physiotherapy, on the healing of acute quadriceps and hamstring muscle tears
    (1991) Reynolds, Jonathan F; Bowerbank, Patricia; Noakes, Timothy D
    A double-blind, placebo controlled research technique was used to determine the effects of two non-steroidal anti-inflammatory drugs, meclofenamate and diclofenac, in combination with physiotherapy treatment, on the rate and extent of healing of acute hamstring muscle tears. Sixty patients were recruited and treated at No's 1 and 2 Military Hospitals in Voortrekkerhoogte and Wynberg, Cape Town, respectively. Patients were randomly allocated to one of three treatment groups: meclofenamate, diclofenac and placebo. Patient assessments were performed on days 1, 3 and 7 of the 7-day study period. These assessments included pain assessment (visual analogue scale), swelling measurement (thigh circumference measurement at the site of the muscle tear) and muscle performance test (Cybex isokinetic dynamometer and data reduction computer). All patients received physiotherapy treatment on all 7 days of the study. This comprised early rest, ice, compression and elevation (RICE), and later, ultrasound and deep transverse friction massage. An intensive regime of strengthening and stretching exercises was used throughout the study, beginning with stretching and isometric exercises gradually moving onto isotonic exercises and aerobic exercise including swimming, running and cycling. No competitive sport was allowed during the study period. Statistical significance was determined using the analysis-of-variance (ANOVA) test with an acceptance level of p<0.05. No differences in pain, swelling or muscle performance were demonstrated between the three treatment groups. In terms of the pain and swelling assessments, the injuries did not appear to be very severe. Accordingly, the groups were divided into severe and non-severe sub-groups and statistical significance was determined using the ANOVA test with an acceptance level of p<0.05. A significant difference was found in the severe hamstring injury sub-group. In this group, pain reduction was greater in the placebo group than in the meclofenamate group on day 7. There were no other significant differences found in this sub-group analysis. Relatively few side effects were encountered, and those encountered were mild. No patients were withdrawn from the study as a result of these adverse events. Drowsiness and gastro-intestinal disturbance were the most common side effects reported. In conclusion, the study found that no benefit was gained from the use of meclofenamate or diclofenac in combination with physiotherapeutic modalities as compared to the use of physiotherapeutic modalities on their own. Thus, the widespread use of NSAIDs in the treatment of acute muscle injuries may not be justified.
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    Stimulation of bone healing in new fractures of the tibial shaft using interferential currents
    (1994) Fourie, Jeanette Ann; Bowerbank, Patricia; Thompson, Mary Lou; Marks, Richard
    The aims . of this research were twofold, firstly to find out if interferential currents could reduce the healing time for fractures of the tibia and thereby prevent nonunion and secondly to develop a model which could predict nonunion, given the subject characteristics such as race, mechanism of injury, severity of fracture etc. Subjects, males only between the ages of 12 and 86, who had sustained fractures of the tibiae were entered into this double blind clinical trial on admission to the orthopaedic wards at Groote Schuur Hospital (between January 1989 and October 1991). According to strict inclusion and exclusion criteria, a final sample of 227 cases (208 subjects) were entered by block randomisation into three groups; an experimental group (n=41), placebo group (n=35) and control group (n= 151). lnterferential currents were applied to the experimental group via suction electrodes for, 30 minutes per day for 10 days, using a beat frequency of 10 - 25 Hz and a swing mode of 6 ϟ 6. The placebo group had the suction electrodes applied which produce a rhythmical massage effect. Subjects commented on pain relief which resulted in the addition of the control group as a check on the possible effect of suction, the control group received no intervention. The data were analysed firstly, by using the ANOV A with continuous covariates which resulted in a finding of no significant difference in the time taken to union for the three groups. The second statistical analysis using the same data set, were logistic regression models demonstrating risk factors for nonunion within 24, 32 and 40 weeks. These models were then validated, showing sensitivity and specificity for a variety of possible cutoffs. The conclusions reached about the validity of these models were that they could not be used to predict, accurately enough, those cases where surgical intervention would be necessary; however, for low cost non-invasive intervention they may have value.