Browsing by Author "Corten, Lieselotte"

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    Open Access
    A critical evaluation of the effectiveness of interventions for improving the well-being of caregivers of children with cerebral palsy: a systematic review protocol
    (BioMed Central, 2016-07-13) Dambi, Jermaine M; Jelsma, Jennifer; Mlambo, Tecla; Chiwaridzo, Matthew; Tadyanemhandu, Cathrine; Chikwanha, Mildred T; Corten, Lieselotte
    Background: Over the years, family-centered care has evolved as the “gold standard” model for the provision of healthcare services. With the advent of family-centered approach to care comes the inherent need to provide support services to caregivers in addition to meeting the functional needs of children with physical disabilities such as cerebral palsy (CP). Provision of care for a child with CP is invariably associated with poor health outcomes in caregivers. As such, there has been a surge in the development and implementation of interventions for improving the health and well-being of these caregivers. However, there is a paucity of the collective, empirical evidence of the efficacy of these interventions. Therefore, the broad objective of this review is to systematically review the literature on the effectiveness of interventions designed to improve caregivers’ well-being. Methods/design: This is a systematic review for the evaluation of the effectiveness of interventions designed to improve caregivers’ well-being. Two independent, blinded, reviewers will search articles on PubMed, Scopus, Web of Science, CINAHL, Psych Info, and Africa-Wide Information using a predefined criterion. Thereafter, three independent reviewers will screen the retrieved articles. The methodological quality of studies meeting the selection criterion will be evaluated using the Briggs Institute checklists. Afterwards, two independent researchers will then apply a preset data-extraction form to collect data. We will perform a narrative data analysis of the final sample of studies included for the review. Discussion: The proposed systematic review will provide the empirical evidence of the efficacy of interventions for improving the well-being of caregivers of children with physical disabilities. This is important given the great need for evidenced-based care and the greater need to improve the health and well-being of caregivers. Systematic review registration: PROSPERO CRD42016033975.
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    Open Access
    A systematic review of the psychometric properties of the cross-cultural translations and adaptations of the Multidimensional Perceived Social Support Scale (MSPSS)
    (BioMed Central, 2018-05-02) Dambi, Jermaine M; Corten, Lieselotte; Chiwaridzo, Matthew; Jack, Helen; Mlambo, Tecla; Jelsma, Jennifer
    Background Social support (SS) has been identified as an essential buffer to stressful life events. Consequently, there has been a surge in the evaluation of SS as a wellbeing indicator. The Multidimensional Perceived Social Support Scale (MSPSS) has evolved as one of the most extensively translated and validated social support outcome measures. Due to linguistic and cultural differences, there is need to test the psychometrics of the adapted versions. However, there is a paucity of systematic evidence of the psychometrics of adapted and translated versions of the MSPSS across settings. Objectives To understand the psychometric properties of the MSPSS for non-English speaking populations by conducting a systematic review of studies that examine the psychometric properties of non-English versions of the MSPSS. Methods We searched Africa-Wide Information, CINAHL, Medline and PsycINFO, for articles published in English on the translation and or validation of the MSPSS. Methodological quality and quality of psychometric properties of the retrieved translations were assessed using the COSMIN checklist and a validated quality assessment criterion, respectively. The two assessments were combined to produce the best level of evidence per language/translation. Results Seventy articles evaluating the MSPSS in 22 languages were retrieved. Most translations [16/22] were not rigorously translated (only solitary backward-forward translations were performed, reconciliation was poorly described, or were not pretested). There was poor evidence for structural validity, as confirmatory factor analysis was performed in only nine studies. Internal consistency was reported in all studies. Most attained a Cronbach’s alpha of at least 0.70 against a backdrop of fair methodological quality. There was poor evidence for construct validity. Conclusion There is limited evidence supporting the psychometric robustness of the translated versions of the MSPSS, and given the variability, the individual psychometrics of a translation must be considered prior to use. Responsiveness, measurement error and cut-off values should also be assessed to increase the clinical utility and psychometric robustness of the translated versions of the MSPSS. Trial registration PROSPERO-CRD42016052394.
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    Open Access
    Coaches' knowledge of injury and associated risk factors among young track and field athletes: A case study on the Western Cape Talent Development Programme (TDP) branch of the Mass participation, Opportunity and accessibility, Development and growth (MOD) programme for U12-U14 track and field athletes
    (2021) Isaacs, Neda; Corten, Lieselotte; Ferguson, Gillian
    Background: The management, prevention, and recognition of injuries forms an integral part of coaches training. It is imperative that coaches are equipped with a sound understanding of specialised coaching to teach developing athletes correct performance techniques, promote strategies to reduce the risk of injury, and be able to determine the need for medical attention in the event of an injury (9). The South African Department of Cultural Affairs and Sport (DCAS) has created opportunities for young people living in low socio-economic settings to participate in various sports within the Mass participation, Opportunity and Development and growth (MOD) programme (10). Athletes showing potential for competing at a provincial or national level are selected into the specialised Talent Development Programmes (TDP). The MOD and TDP also provides an employment opportunity for coaches. At present, very little is known about the knowledge and practices of coaches working with young athletes in low socio-economic settings within South Africa. Aim and Objectives: The aim of the present study was to investigate the knowledge and practices of youth athletics coaches employed by the Western Cape (WC) TDP branch of the MOD within the under 12–14 year age group. The specific objectives were to: 1) describe the coaches qualifications and experience, using an online Demographic and Coaching Practices (D&CP) questionnaire; 2) assess coaches' knowledge regarding athlete development, injuries, and the management of injuries using an online Multiple Choice Quiz (MCQ); 3) describe coaches practices regarding injury prevention techniques using the D&CP questionnaire and 4) assess the relationship between the coaches a) experience and their MCQ scores, b) qualification and MCQ score, and c) qualification in first aid and the MCQ subsection score relating to injury and injury management. Method: A descriptive cross-sectional design was used. Inclusion criteria were: 1) coaches associated with the TDP for Athletics in the WC, 2) coaches with > one year's experience coaching U12-14 athletics, and 3) access to internet. Exclusion criteria were: 1) coaches < one season coaching experience. Ethics approval was granted by the University of Cape Town Human Research Ethics Committee (HREC REF 554/2019). The online MCQ consisted of 40 questions covering topics relating to coaches' knowledge and understanding of methods used to reduce the risk of injury and management of acute injuries. The D&CP questionnaire included questions related to the practices used by coaches to reduce injury risk and management protocols used during pre-season, training, or in competition. Results: Twenty-six coaches consented to participate; five coaches exercised their right to withdraw after having only completed the online MCQ component. Profile of coaches: 16 of the 21 coaches (76.19%) reported having a coaching qualification. Most coaches were certified by Athletics South Africa (n = 12; 57.14%). Most coaches (n = 17; 81%) held a first aid qualifications ranging from level one to three. Participants' experience ranged from less than five years to 15 years (median = 7 years; IQR = 10.5 years). Performance on the MCQ: The median score achieved by the coaches (n = 26) for the MCQ was 14 out of 40 points (35%; IQR = 4) and only two coaches achieved a score greater than 50%. Coaching Practices: Most coaches (71%) used 30-minute warm-up sessions which included various exercise techniques. During warm-ups, a few of the coaches (n = 11) included static stretching, while the majority (n = 19) included dynamic stretching techniques. During competition season, most coaches encouraged athletes to complete a cool-down following each event (n = 17; 80.95%). Most coaches (90%) incorporated a pre-season conditioning programme, lasting an average of 7.5 weeks (range = 2-16 weeks). Injury Management: 19% of coaches relied on the first aider present at each training session. Sixteen of the 21 coaches depended on medical professionals to make the final decision regarding to returning the athlete to training and competing, and 38.5% (n = 26) of coaches believed it was the coach or parents' decision. Relationship between MCQ Performance and Coaching profile: A moderate correlation between coaches' years of experience and MCQ score was found, however this was not significant (r = 0.43; p = 0.054), and weak non-significant correlations were found between MCQ scores were not significantly for groups of coaches who held or did not possesses a coaching qualification (u = 37; z = 0.21; p = 0.84). There was no difference between coaches who had a first aid qualification and those who did not on the MCQ test scores (u = 22; z = 1.03; p = 0.32). Discussion and Conclusion: Coaches' knowledge regarding injuries, practices used to reduce the risk of injuries, and the acute medical management of injuries is less than optimal. Several coaches performed poorly on the MCQ, and some practices used by the coaches in our sample were questionable. Despite the majority having qualifications in both coaching and first aid, their understanding relating to injuries and the practices used did not always reflect the latest guidelines for coaching youth athletes. The findings of the present study are similar to the findings of others studies (11). This may be as a result of insufficient coaching development throughout their careers. The present findings indicated that 42.3% of TDP coaches still use outdated warm-up techniques (i.e., static stretches). Coaches are generally aware of the importance of strength and conditioning programmes. The moderate correlation between years of experience and MCQ score suggests that coaches do gain implicit knowledge through their experience. As health professionals working in the field of sport, physiotherapists are key allies for sharing knowledge with coaches. Empowering coaches with the knowledge and skills required to reduce the risk of injury development and manage injuries appropriately may, in turn, provide developing athletes with the support they require.
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    Open Access
    Cross-sectional analysis of car restraint system use during transportation of children with special health care needs in the Western Cape
    (2020) Phillips, Kerry-Ann; Corten, Lieselotte; Scott, Desiree
    Background: Road traffic injuries are the leading cause of death in children and young adults. Children are at increased risk of fatalities and serious injury due to the differences in their body segment proportions affecting their body kinetics in a vehicle accident. Serious injury and death can be reduced by the appropriate use of car restraint systems (CRS). Children with special health care needs (CSHCN), particularly children with poor postural control, may need adaptive seating to improve postural support and sitting ability within the vehicle due to their additional physical needs. Standard CRS might be unsafe or inappropriate for children with physical disabilities. Research Aims: The thesis aimed to understand the current CRS usage as well as the parents' experiences and perspectives of transportation of CSHCN in the Western Cape, and to determine the postural support needs of CSHCN and the suitability of different CRS designs to meet these needs during transportation. This was achieved through a survey study, followed by a cross-sectional study. Assessing the use of car restraint systems in children with special health care needs; a Western Cape based survey study Objectives: To determine the modes of transport and the prevalence of the use of postural support systems by CSHCN. Along with describing the current use of seatbelts, standard or specialised CRS and exploring the challenges faced by parents of CSHCN during transportation. Methods: A descriptive quantitative survey was performed amongst a convenience sample of all parents of CSHCN between the age of 4 – 18 years enrolled at three special needs schools in the Western Cape, South Africa. Parents had to be able to read and understand English or Afrikaans to be eligible for enrolment in the study. Focus group discussions were conducted to validate the self-designed questionnaire. Results: Parents of 268 children were enrolled in the study (median (IQR) age 11.52 (14.63- 8.86) years; 58.96% male). The most common diagnosis was cerebral palsy (CP) (29.10%), and most children were transported to school with public transport, including school bus (73.13%). The mode of transport was linked to the distance travelled and affordability, and each had its own challenges. The main challenges of parents using private transport were transporting the wheelchair (10.82%) and the unavailability of demarcated disability parking bays (7.46%). When using public transport parents identified their child's poor sitting balance (6.34%) and lack of space within the vehicle (5.60%) as the greatest challenges. The majority of children (58.96%) came from low-to-middle income households (< R6500 per month), significantly impacting the use of a CRS, with more children from higher income families being transported in a CRS (X²= 48.14, p< 0.001). Difficulties with sitting balance was reported in 25.75% of the children and was significantly association to the parents understanding of their child's sitting balance (X²= 17.72, p< 0.001). Parents who felt that their child had difficulty with their sitting balance were more likely to use a CRS. Furthermore, a significant association between currently using a CRS and child's weight was observed (X²= 11.54, p=0.021), as children who weighed more were less likely to still be using a CRS. Most parents (54.48%, n=146) did not know South Africa's current legislation on CRS, which was significantly associated with a lower CRS usage (X²= 19.84, p< 0.001). Half of the parents (n= 139, 51.87%) were not willing to spend money on a CRS as they felt that a car seat was not necessary for their child. The amount parents were willing to spend on a CRS was significantly associated with having ever made use of a CRS (X2=43.38, p< 0.001). Conclusions: Parents of CSHCN reported many challenges in transporting their child depending on the mode of transportation. CRS usage was associated with parent perception on the child's sitting abilities, lower weight, knowledge of legislation and a higher household income. Despite these, CRS usage amongst CSHCN is lower than expected as (48.88% – 55.22%) children that are still within the age and weight range to use a CRS as required by law did not report CRS usage. This could link in with the affordability of the CRS and failure to know the legislation on CRS by parents. This study highlights the need for national campaigns to promote and educate citizens on road safety and CRS legislation. Due to the lack of financial resources in low to middle income countries, it is vital that an affordable CRS is made available or is subsidized by the government where families are unable to afford the cost themselves, particularly for use in public transport. Effectiveness of currently available car restraint systems to maintain correct seating position during transportation for children with special health care needs Objectives: To determine the characteristics of CSHCN who require specialised CRS for their postural support needs, through assessment of their sitting ability and whether these needs are met by different CRS. Methods: Participants in the earlier survey study were invited to take part in a crosssectional and pre-post design study. A screening tool for identifying sitting balance problems was developed and found to be reliable for inter- and intra-rater reliability (k>0.700, p0.879). This tool was used to identify CSHCN who had difficulty sitting independently on different types of seats. These participants underwent a standardised sitting balance assessment, using the Level of Sitting Scale (LSS), to identify eligible participants with postural support needs. Participants were excluded if they recently had surgery or had an unstable health condition which could alter their sitting balance. The ability of two standard CRS (Car Seat and Booster seat), two Specialised CRS (one locally and one internationally produced), and Seatbelt only to provide adequate postural support was investigated. Head and trunk postures were analysed and categorised, by deviation from the midline, by photographs taken from different viewpoints. Results: There were 78 CSHCN enrolled in the study (mean (SD) age 11.50 (3.70) years; 65.75% male), the most common diagnosis was CP (63.48%), the majority of participants did not require any support to maintain sitting balance and were categorised as levels 5-8 of the LSS (78.08%). According to the World Health Organisation anthropometric guidelines 54.79% (n=40) of the participants should still use a CRS, either a Booster Seat (42.47%, n=31) or a Car Seat (12.33%, n=9). The head or torso fully supported and between the side supports of the CRS was the most common posture in all the viewpoints of the different CRS except for the lateral head viewpoint of the CRS Car Seat (50.00%; n=4), the Booster Seat (60.00%; n=18), and the International Specialised CRS (60.61%; n=20), as well as the anterior torso viewpoint of the Seatbelt only (50.75%; n=34). The CRS that resulted in the largest proportion of unacceptable posture deviations from the standard position were the Seatbelt only (20.90%, n=56) and the Booster Seat (18.33%, n=22). Out of position (OOP) postures were observed in all the devices for the anterior and lateral head positions (3.03% - 20.00%). The Booster Seat, the Local Specialised CRS and the Seatbelt only devices had participants with OOP postures in all four viewpoints. A key observation in the current study is the lack of torso support for the majority of CSHCN in the anterior torso viewpoint of the Seatbelt Only CRS (55.22%, n=37), indicating that the use of a Seatbelt only does not provide adequate postural support for all CSHCN despite them meeting WHO anthropometric requirements. No significant association was found between the pre- and post-test postural analysis scores of the Seatbelt only (X2=2.14, p=0.144) which could be as a result of the large postural deviations pre-testing (41.79%, n=28) remained post-testing. However, there was a significant association between the preand post-test scores of the anterior head viewpoint of the Booster seat (X2= 7.94, p=0.005), indicating lateral head deviation. The post-test postural analysis score of the Booster Seat anterior head viewpoint was significantly associated with a deviated posture (X2= 7.94, p=0.005). Other OOP observations included postures that could not be categorised by head and trunk deviation from the midline including head or torso rotation, abnormal limb placement, body extension and slouching. Overall performance scores are a sum of the number of viewpoints where the CSHCN posture worsens post-test. an indication of the number of CSHCN whose posture worsened post-test in each of the viewpoints of the CRS. Although there was no correlation between the LSS score and the overall performance score of any CRS device which would indicate if the CSHCN balance influences CRS performance, the Booster Seat (80.00%, n=24) and the Seatbelt only (55.23%, n=37) devices had the greatest number of participants with a poor overall performance. The viewpoints which had the worst performance scores were the anterior and lateral head of the Booster Seat (46.67%, n=14 and 43.33%, n=13 respectively) and both viewpoints had majority of participants worsen their scores. All CRS performed adequately in the lateral torso viewpoint, indicating sufficient support of the torso in the sagittal plane. Conclusions: The postural support needs of CHSCN are unique and depend on the child's anthropometry and the severity of their disability. The currently available CRS designs may not provide the postural support needed for many CSHCN. Postural deviations of the head, torso and limbs were observed which could be dangerous in the event of an accident. This study was not able to determine specific characteristics of CSHCN that require specialised CRS, as there was no association between the LSS and the overall performance score for any of the CRS devices. However, devices that offer less head and torso lateral support, or do not offer additional harness support such as the Seatbelt Only and the Booster Seat showed the largest proportion of OOP postures in CSHCN. Thesis Conclusion: This thesis highlights the complex transportation needs of CSHCN in South Africa and how the different CRS can influence posture. Additional observational research is required to determine the CRS usage in the CSHCN population to compare to the prevalence of CRS usage found in this survey study. Future research could incorporate other specialised CRS designs, particularly ones that are suitable for CSHCN beyond standard CRS weight and height limits or those with severe physical limitations that could not be tested during this study's simulated course. Practitioners prescribing and advising parents on CRS devices for the safe transportation of CSHCN should integrate thorough patient assessment and knowledge of manufacturer CRS design specifications to promote CRS usage. Policies should consider and accommodate for the challenges faced by CSHCN and their families in accessing, affording and utilising transport services. Advocacy and education programs should be combined with legislation enforcement to support improved implementation of CRS usage amongst all children, regardless of their disability status. For effective implementation for CSHCN, CRS should be affordable, accessible, functional and accommodate growth and postural support needs.
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    An evaluation of psychometric properties of caregiver burden outcome measures used in caregivers of children with cerebral palsy: a systematic review protocol
    (BioMed Central, 2016-03-09) Dambi, Jermaine M; Jelsma, Jennifer; Mlambo, Tecla; Chiwaridzo, Matthew; Dangarembizi-Munambah, Nyaradzai; Corten, Lieselotte
    Background: Cerebral palsy (CP) is the most common, life-long paediatric disability. Taking care of a child with CP often results in caregiver burden/strain in the long run. As caregivers play an essential role in the rehabilitation of these children, it is therefore important to routinely screen for health outcomes in informal caregivers. Consequently, a plethora of caregiver burden outcome measures have been developed; however, there is a dearth of evidence of the most psychometrically sound tools. Therefore, the broad objective of this systematic review is to evaluate the psychometrical properties and clinical utility of tools used to measure caregiver burden in caregivers of children with CP. Methods/design: This is a systematic review for the evaluation of the psychometric properties of caregiver burden outcome tools. Two independent and blinded reviewers will search articles on PubMed, Scopus, Web of Science, CINAHL, PsychINFO and Africa-Wide Google Scholar. Information will be analysed using predefined criteria. Thereafter, three independent reviewers will then screen the retrieved articles. The methodological quality of studies on the development and validation of the identified tools will be evaluated using the four point COnsensus-based Standards for the selection of health Measurement INstruments (COSMIN) checklist. Finally, the psychometric properties of the tools which were developed and validated from methodological sound studies will then be analysed using predefined criteria. Discussion: The proposed systematic review will give an extensive review of the psychometrical properties of tools used to measure caregiver burden in caregivers of children with CP. We hope to identify tools that can be used to accurately screen for caregiver burden both in clinical setting and for research purposes.
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    Exploring pedagogical dissonance in including a traditional acupuncture treatment approach into a western biomedical evidence-based Physiotherapy curriculum
    (2022) Anjos, Ana Alexandra; Maart, Soraya; Corten, Lieselotte
    Background: We cannot speak about complementary and alternative medicine without speaking about the most popular form of it, acupuncture, and its connection with health maintenance or forms of intervention to recover it. Over the last few years, acupuncture has been increasingly used for the treatment of pain either as a combined or complementing therapy, and evidence also suggests an increased in physiotherapists interested in acupuncture. The study aimed to 1) explore the scientific support for the combined use of acupuncture and physiotherapy in MSK conditions through a systematic review and 2) to explore the inclusion of acupuncture in undergraduate curricula as an elective course by doing a quantitative descriptive survey. Methods: Three major databases were used for the conduction of the systematic review of literature, taking place from March 2019 to May 2019, i.e., Cochrane Library, PubMed, and PEDro (Physiotherapy Evidence Database). For inclusion criteria were accepted only randomized controlled trials (RCT) published in English, released within the past decade, and using subject's adult population with MSK conditions. A quantitative descriptive survey was conducted among physiotherapists registered with professional societies in the United Arab Emirates and South Africa. A questionnaire was distributed to registered members using an online format to explore demographic information, usage of acupuncture as a treatment modality, and level of agreement for including acupuncture in undergraduate curricula. Results: Systematic Review (CHAPTER 3) The results from the electronic search yielded a total of 227 abstracts and study titles. Eight studies were considered after a detailed screening, in the included studies six of them were considered for a quantitative meta-analysis and all eight were used to perform a qualitative analysis. In total 960 patients were included, with 349 and 611 patients respectively divided into intervention and control groups. No statistically significant results were found in studies assessing pain to back up the combination of physiotherapy and acupuncture, as well in studies assessing range of motion in knee osteoarthritis. When comparing the baseline of physiotherapy combined with acupuncture or physiotherapy alone statistically significant improvements were found within-group. The studies that examined Isometric Neck-Muscle Strength (INMS) expressed noteworthy bettering within groups with physiotherapy combined with acupuncture being more viable than acupuncture or physiotherapy alone. The Constant Shoulder Assessment (CSA) for shoulder function was altogether superior within the exercise plus acupuncture group compared with the exercise group. Survey (CHAPTER 4) One hundred eighty-one physiotherapists completed the survey, with 35.4% (n=64) from the UAE, while 64.5% (n=117) were from South Africa. Additionally, 78.5% (n=142) of the participants were female, while 21.5% (n=39) were males. The mean (SD) age of the participants was 41.2 (11.9) years, and there was no statistical difference between the two countries (t=0.04, p=0.97). Thirty-five percent had a postgraduate qualification. Sixty-two (34.2%) physiotherapists reported a specialization in acupuncture, with the majority at certificate level. More physiotherapists in the UAE (57%) agreed that acupuncture ought to be included within the undergrad educational curriculum compared to South Africa (44%). Conclusion: There was no noteworthy prove found to back that the addition of acupuncture to physiotherapy treatments includes advantages to pain decrease. This review did, however, observe benefits of including acupuncture together with physiotherapy treatment in the diminishing of neck incapacity, muscle strength and shoulder function. Although physiotherapists are gaining qualification in acupuncture and using in practice, there is not sufficient traction on the inclusion of acupuncture in undergraduate curriculum.
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    Incidence of injuries and associated factors at the senior inter provincial field hockey tournament
    (2020) Pereira, Nicholas Samora; Corten, Lieselotte; Burgess, Theresa
    Background Field Hockey is an Olympic sport that is played widely across the world at various levels. In South Africa, it is a growing sport with increasing participation for both males and females. It is a high-speed team sport, consisting of short bursts of sprinting with technical coordination of a stick and ball, as well as the tactical execution of a coach's game plan. Participation in sports, including field hockey, comes with an accepted risk of injury; however, within the team setting it can have several implications for the individual: their health, physical performance, and psychological state, both immediately and in the long term. Despite injury incidence in other team sports being well-documented, there is limited research in field hockey generally, and injury incidence and associated risk factors in South African field hockey specifically. Aim The aim of the present study was to determine the incidence of injury and associated factors amongst players participating in the 2018 South African men's and women's inter provincial field hockey tournament. Objectives The specific objectives of the study were to determine (at the 2018 men's and women's senior field hockey seven-day inter provincial tournament in South Africa): • the incidence of injury amongst players; • the burden of acquired sport injuries defined by time loss and medical attention; • the associative factors related to injury (i.e. coaching qualifications, presence of medical staff, and other non-modifiable risk factors); and • the injury incidence, injury burden and distribution of anatomical injuries between males and females. Methods The study had a descriptive, longitudinal design. All players and coaches attending the 2018 South African Hockey Association men's and women's IPT were invited to enrol in the study and were recruited prior to the start of the respective tournament periods. All the attending players participate in senior field hockey, either for club or university teams in their province. Each provincial hockey union selects their best available team of players to represent them at the inter provincial tournament which comprises of three sections. Only the teams participating in the “A” sections were eligible for recruitment into the study. The female tournament was hosted in Durban during May of 2018 and the male tournament was hosted in Pietermaritzburg in August of 2018. Participants were excluded if they were under 18 years of age or did not provide informed consent. Enrolled coaches and players were asked to complete a self-reported questionnaire. Players information was used to gather the provincial team, playing position and previous injury history. Coaching information was used to gather the educational level, years of experience and the resources available to coaches. Players were additionally asked to independently complete daily injury report forms on all seven tournament match days. This was used to collect information on injury incidence and nature, medical attention required, and time loss during the tournament week. Results Two hundred and seventy-two players (133 females; 139 males) and 22 coaches took part in this study. All injury incidence was found to be 99.5 (95% CI: 71.9 – 127.1) injuries per 1000 player match hours for males and 77.9 (95% CI: 47.1 - 108.1) injuries per 1000 player match hours for females. The incidence of medical attention injuries was 70.3 (95% CI: 46.1 – 94.4) injuries per 1000 player match hours for males, and 51.9 (95% CI: 32.3 – 71.5) injuries per 1000 player match hours for females. The incidence of time loss was 7.5 (95% CI: -0.7 – 15.75) injuries per 1000 player match hours for males, and 4.3 (95% CI: 1.04 – 9.7) injuries per 1000 player match hours for females. A large portion of injuries affected the lower extremity, accounting for 69% of injuries in male players and 70% of injuries in female players. There were no significant relationships between injury incidence and the availability of team medical support staff, coaches' education level, coaches South African Hockey Association (SAHA) level, or coaches' first aid qualifications respectively. However, players with coaches who had a Federation of International Hockey (FIH) qualification had lower injury incidence rates compared to players with coaches who did not hold this qualification (p = 0.015; Fisher exact), with a lower incidence of injury in players coached by a FIH qualified coach (logistic regression analysis p = 0.054). Players who reported previous injuries within the last 12 months were 3.5 times more likely to sustain an injury during the tournament, compared to players with no previous injury history (p < 0.0001). Female players were 2.4 times more likely to seek medical attention compared to male players (p = 0.046). There was a statistically significant association between players reporting previous injury (within the past two years) and injury during the tournament (p < 0.0001), with players who had a previous injury being 5 times more likely of sustaining an injury during the tournament. Conclusion To our knowledge, this was the largest observational study conducted in South African field hockey that included both male and female players. High incidence rates of all injuries and medical attention injuries were identified, however, the incidence of time loss injuries was much lower in comparison to existing literature. It is possible that players continue to participate in matches despite injuries requiring medical attention, that medical support staff may not limit match participation for injured players adequately, or that players seek reassurance from medical support staff for minor injuries. The findings support the existing literature reporting that the lower extremity experiences the largest amount of injuries reported by field hockey players. In the present study, the lower extremity was affected in 69% of all injuries reported in the male tournament, and in 70% of all injuries in the female tournament. In addition, previous injury history was identified as a significant risk factor for injury, which is aligned with findings from injury monitoring studies of different team sports. The findings of this study highlight the need for consensus on injury definitions in field hockey. Further research is critical to determine injury prevention strategies for male and female field hockey players.
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    The effects of graded motor imagery and its components on phantom limb pain and disability in upper and lower limb amputees: a systematic review protocol
    (BioMed Central, 2016-09-01) Limakatso, Katleho; Corten, Lieselotte; Parker, Romy
    Background: Phantom limb pain (PLP) is characterized by the anatomical shifting of neighbouring somatosensory and motor areas into a deafferented cortical area of the brain contralateral to the amputated limb. It has been shown that maladaptive neuroplasticity is positively correlated to the perception of PLP in amputees. Recent studies support the use of graded motor imagery (GMI) and its component to alleviate the severity of PLP and disability. However, there is insufficient collective empirical evidence exploring the effectiveness of these treatment modalities in amputees with PLP. This systematic review will therefore explore the effects of GMI and its individual components on PLP and disability in upper and lower limb amputees. Methods: We will utilize a customized search strategy to search PubMed, Cochrane Central register of Controlled Trials, MEDLINE, Embase, PsycINFO, PEDro, Scopus, CINAHL, LILACS, DARE, Africa-Wide Information and Web of Science. We will also look at clinicaltrials.gov (http://www.clinicaltrials.gov/), Pactr.gov (http://www.pactr.org/) and EU Clinical trials register (https://www.clinicaltrialsregister.eu/) for ongoing research. Two independent reviewers will screen articles for methodological validity. Thereafter, data from included studies will be extracted by two independent reviewers through a customized pre-set data extraction sheet. Studies with a comparable intervention and outcome measure will be pooled for meta-analysis. Studies with high heterogeneity will be analysed through random effects model. A narrative data analysis will be considered where there is insufficient data to perform a meta-analysis. Discussion: Several studies investigating the effectiveness of GMI and its different components on PLP have drawn contrasting conclusions regarding the efficacy and applicability of GMI in clinical practice. This systematic review will therefore gather and critically appraise all relevant data, to generate a substantial conclusion and recommendations for clinical practice and research on this subject.
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    The use of assisted autogenic drainage in children with acute and chronic respiratory disease
    (2017) Corten, Lieselotte; Morrow, Brenda M; Jelsma, Jennifer
    Background: Respiratory problems, both acute and chronic, remain an important cause of disease burden for children worldwide. Airway clearance techniques, as part of the management of these conditions, might influence the course of the disease thereby reducing this burden. Objective: This PhD thesis aimed to explore the epidemiology and management of children with acute respiratory diseases admitted to a paediatric hospital in Cape Town, South Africa; and to determine the usefulness and safety of assisted autogenic drainage in children with an acute (pneumonia) or chronic (cystic fibrosis) respiratory disease. In order to do this, several linked studies were undertaken including a retrospective folder review, two systematic reviews and two pragmatic randomised controlled trials.