Browsing by Author "Hendricks, Candice"

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    Open Access
    An investigation into the risk factors of musculoskeletal diseases and the association between chronic diseases of lifestyle in an under-resourced area of the Cape Town Metropole
    (2019) Britz, Carmen; Hendricks, Candice; Jelsma, Jennifer
    Background: A recent shift in the global burden of disease from communicable to noncommunicable has shown that a third of the global burden of disease is attributable to noncommunicable disease, with the heaviest burden affecting poor communities in urban areas. Musculoskeletal disease (MSD) is the most common cause of severe chronic or persistent pain, functional limitations, and physical disability, affecting 20-50% of adults. Globally, disability due to musculoskeletal disease is estimated to have increased by 45% from 1990 to 2010 accounting for 6.8% of total years lived with disability. Research has highlighted a possible co-existence of musculoskeletal disease and chronic noncommunicable diseases of lifestyle, however, there is inadequate South African evidence regarding these inter-relationships and possible risk factors. This highlights a gap in research as management may not be appropriately targeted toward risk factors and thus may not reduce the high prevalence rates of musculoskeletal disease. Aim: The main aims of this study were firstly to determine the prevalence and patterns of acute and chronic musculoskeletal disease. The secondary aim was to explore the relationship between these factors by examining the patterns of onset of musculoskeletal disease, chronic diseases of lifestyle, and risk factors across gender and six age categories (from 18 years to 70 years and older) in patients seeking medical services at a community health centre in Cape Town, South Africa. It was hypothesised that if some conditions were found to have an earlier onset, these conditions might lay the foundation for the development of other chronic diseases of lifestyle and musculoskeletal disease. Methodology: A descriptive, cross-sectional, analytical study design was used at primary health care level at a community health centre in Cape Town, South Africa. All males and females aged 18 years and older, except those who were pregnant or unable to answer the English, Afrikaans, or isiXhosa versions of the selected questionnaires, were eligible to participate. The outcome measures were the Community Orientated Program for Control of Rheumatic Diseases (COPCORD) screening tool for musculoskeletal disease, the Brief Pain Inventory (BPI), the European Quality of Life-5 Dimensions (EQ-5D) health-related quality of life measure, the International Physical Activity Questionnaire (IPAQ), and anthropometric measures of weight, height, and waist and hip circumference. Data were collected via interview and anthropometric measurement. Responses were captured by online questionnaires on mobile devices using the mobile data collection application Magpi by DataDyne Group, LLC. Data were exported to Microsoft Office Excel spreadsheets for descriptive and inferential statistical analysis. Ethical permission was obtained from the University of Cape Town. Results: This study recruited 1115 participants, with a mean age of 48.7 ± 16.8 years. A prevalence rate of 33.6% (95% Confidence Intervals; CI: 30.1-36.5%) for acute MSD and 43.3% (CI: 40.4-46.3%) for chronic MSD was found. The number of participants reporting an overall prevalence of any MSD was 505 (45.7%; CI: 42.8-48.7%). The highest prevalence of MSD was found in females aged 40-59 years. The most common anatomical sites of chronic MSD were the knees (35.6%; CI: 31.5-39.9%), low back/pelvis (33.8%; CI: 29.8- 38.0%), shoulders (26.8%; CI: 23.1-30.9%), and hands/fingers (21.9%; CI: 18.5-25.7%). Of those with MSD, exercise was reported as the best management strategy for musculoskeletal pain (35.6% of 191 respondents; CI: 29.1-42.6%). Hypertension was found to be the most prevalent chronic disease of lifestyle (47.8%; CI: 44.8-50.7%), followed by type 2 diabetes mellitus (21.4%; CI: 19.1-23.9%), and hypercholesterolaemia (20.2%; CI: 17.9-22.6%). All chronic diseases, except chronic obstructive airway disease (COAD), increased with age, while COAD and both acute and chronic MSD peaked around the 50-59 age category and then decreased with age. Most females reported to be highly physically active (46.0%) while males reported mostly low physical activity levels (47.8%). Around the 50-59 year old age group the proportion of participants with a ‘high’ physical activity level decreased while that of participants with a ‘low’ physical activity level increased at the same age group. A higher proportion of those without MSD reported ‘high’ levels of physical activity (41% compared to 32%). In the 30-39 and 40-49 age groups, low levels of physical activity were associated with chronic MSD (70.6% compared to 37.5% of those. with high levels; Chi-Square=13.833; df=2; p=0.001). Body mass index (BMI) category was found to be associated with MSD (p< 0.001) with 73% of those with MSD being overweight or obese and 27% being extremely obese. There were significant differences in BMI between those with and without hypertension (p< 0.001), hypercholesterolaemia (p <0.001), and type 2 diabetes mellitus (p< 0.001). A trend of increasing obesity, high waisthip ratio and low levels of physical activity with age was observed. In smokers, being 30 years of age or older was associated with an increased risk of MSD (42% compared to 21.1%). Gender emerged as a risk factor in the 40-49 and 50-59 age categories with 76.2% of females in these categories reporting chronic MSD compared to 45.1% of the males. However, no risk factor seemed to track the plot of MSD. Age emerged as having the highest association with chronic MSD (Chi-Square=136.6; p< 0.001). Conclusions: Bivariate associations of musculoskeletal disease and chronic diseases of lifestyle were detected because they all become more prevalent with age. The comorbidity of musculoskeletal disease and chronic disease of lifestyle appeared to almost entirely be due to the aging process, rather than the mutual influence that musculoskeletal disease and chronic diseases of lifestyle may have. Low levels of physical activity were only associated with musculoskeletal disease among those in the 30-49 age categories. As previous evidence has shown that increased levels of physical activity can reduce pain in chronic or persistent musculoskeletal disease, a window of opportunity is suggested where increasing physical activity levels in the 30-49 age group may result in a decrease in the prevalence of musculoskeletal disease in the older age group. The only factor that emerged as being predictive in the group with the highest prevalence of musculoskeletal disease, the 40-59 age categories, was gender. Although gender is clearly not modifiable, this finding should inform the development of culturally appropriate intervention strategies. Implications: Although it was not possible to detect any evidence supporting causation, the co-existence of chronic musculoskeletal disease, chronic diseases of lifestyle, and risk factors highlights the need for holistic care to address the multiple problems experienced by adults, specifically as age progresses. The impact of chronic musculoskeletal disease is large, both in terms of prevalence and impact on health-related quality of life. The management of chronic musculoskeletal disease should thus focus on the most effective and affordable intervention strategies and healthcare systems and coherent policies for dealing with this condition should be developed. This management should not only be based on a pharmacological model but on biopsychosocial integration emphasising self management.
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    Open Access
    Minimalist versus conventional running shoes : effects on lower limb injury incidence, pain and muscle function experienced distance runners
    (2013) Marshall, Charlene; Burgess, Theresa; Hendricks, Candice; Schwellnus, Martin
    The aim of this randomised clinical trial over 12 weeks was to determine if the gradual transition (accompanied by calf muscle training), from conventional to minimalist running shoes 1) increased the risk of lower limb pain or injury and 2) improved lower limb muscle function (endurance, flexibility and power) in experienced distance runners. In addition, the effects of the transition on runner satisfaction were studied. To determine whether there were significant differences in lower limb injury incidence and pain, calf endurance, lower limb muscle flexibility, lower limb muscle power, footposture index, hallux ROM and participants’ satisfaction with the type of running shoes and performance between an experimental group, that ran in minimalist shoes, and a control group that ran in conventional shoes. (b) To determine whether there were significant differences in lower limb injury incidence and pain, calf endurance, lower limb muscle flexibility, lower limb muscle power, foot posture index, hallux ROM and participants’ satisfaction with the type of running shoes and performance between groups over time.
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    Osteoarthritis in women living in Cape Town: prevalence, characteristics, and the effects of a non-pharmacological intervention
    (2022) Hendricks, Candice; Parker, Romy
    Osteoarthritis contributes to the burden of physical disabilities globally, as it is the most common cause of severe chronic pain impacting the function of millions of people. Osteoarthritis is more commonly reported by women who are obese and are physically inactive. These modifiable risk factors of obesity and lack of physical activity are also associated with other chronic diseases of lifestyle (CDL). A paucity of epidemiological data exists on the relationship between OA and CDL in women attending primary health care centres in Cape Town in South Africa, therefore, there was a need to further explore these inter-relationships to be able to plan and implement effective nonpharmacological management strategies to address the multidimensional health problem. To inform the development and implementation of a contextually relevant non-pharmacological intervention for women with osteoarthritis at primary health care level, several studies were conducted. The primary aim of this research project was to develop, implement and evaluate an evidence-based non-pharmacological rehabilitation intervention, advocating a patient-centred selfmanagement approach, for women with OA and CDL at primary health care centres in Cape Town. The literature review highlighted that a non-pharmacological intervention, consisting of selfmanagement principles, health education and exercise would be an effective management strategy for women with both OA and CDL. However, there is a dearth of high-quality randomised controlled trials investigating the effects of such interventions on function and health outcomes in women with OA and comorbidities at primary health care level in a South African context. Standardised outcome measures were selected and used to gather data for the different studies. The WHODAS 2 12-item questionnaire measured functional ability, EQ-5D-3L questionnaire measured health-related quality of life, Brief pain inventory (BPI) measured pain severity and pain interference, and Self-efficacy for Managing Chronic Disease 6-item Scale (SE-6) measured the level of confidence in managing chronic diseases were used and were available in English, Afrikaans, and isiXhosa languages. However, the COPCORD (survey about general health and osteoarthritis) and IPAQ (survey about physical activity levels) were not available in these languages and therefore needed crosscultural adaptation and translation.
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    The incidence and associated risk factors of injury in professional golfers
    (2021) Visagie, Jacobus A; Hendricks, Candice; Naidoo, Niri
    Background Golf has become an immensely popular sport around the globe. The competitiveness of golf and the livelihood it provides to the professional players has led to copious amounts of training and individuals pushing the physiological limits of their bodies in order to play the perfect stroke. Therefore, this population is prone to injury, with prevalence of injury as high as 60%. Literature has shown the lower back to be the most frequently injured anatomical region. There is still a lack of evidence regarding the cause of these high injury rates amongst the professional golfers. Furthermore, investigation of the incidence or associated risk factors of injury has not been conducted amongst the professional players from South Africa. The importance of identifying associated risk factors of injury in this population is of vital importance as this could potentially influence their livelihood directly. Aim The aim of this study was to investigate the incidence of overall and region-specific injury in professional South African golfers. Furthermore, the potential risk factors leading to these injuries were investigated. Results 17 participants (60.7%) reported an injury and a total of 23 index injuries were documented. The incidence rate of injury was 3.27/1000hrs of playing golf. The most frequently injured anatomical regions were the lower back and shoulder (26.1%). There were statistically significant differences in the joint range of motion of horizontal adduction of the leading shoulder (p=0.04) between the group reporting an injury compared to the group with no injury. Furthermore, statistically significant differences were found in decreased range of motion of internal rotation of the trailing shoulder (p=0.04) in the group with a shoulder injury compared to the group without a shoulder injury, and as well as in the group with hip pain compared to the group without hip pain (p=0.048). The group with hip injuries also showed a decreased range of motion of external rotation of the leading hip (p=0.048). Furthermore, a decreased range of motion of external rotation of the leading shoulder had a statistically significant difference (p=0.026) between the group that reported a wrist injury and the group that did not. The group that reported lumbar spine injuries had significant decreased range of motion of external rotation in the trailing shoulder (p=0.031), horizontal adduction of the trailing shoulder (p=0.015), horizontal adduction of leading shoulder (p=0.029), and internal rotation of the leading hip (p=0.003). Furthermore, the uninjured group spent more hours on total training in the eleventh week, which also presented a statistically significant difference (p=0.03). Conclusion In conclusion, injuries amongst professional golfers are common and the anatomical regions most affected are the lower back and the shoulder. Improving the range of motion of the leading and trailing shoulder horizontal adduction, trailing shoulder internal and external rotation, and internal rotation of the leading hip range of motion by means of mobility exercises could potentially minimize the risk of sustaining injury amongst professional golfers. Training volume did not present a statistically significant difference between the injured and uninjured groups in overall or region-specific injuries.