Browsing by Author "Manie, Shamila"

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    Open Access
    Clinical education in physiotherapy: The experiences of final year students workplace-based learning at the University of Cape Town
    (2022) Timothy, Nastassia; Pienaar, Lunelle; Manie, Shamila
    Clinical education in the profession of Physiotherapy involves the teaching and training of students in real life clinical settings such as hospitals and clinics. The pedagogical support that Physiotherapy students receive in clinical settings is both formal and informal (Dornan, 2012). In the South African context and at the University of Cape Town (UCT), educational and professional support is provided to Physiotherapy students by both academic representatives from the university, clinical educators, and physiotherapy clinicians who are employed by the clinical site in which the clinical education occurs. The phenomenon of clinical education in Physiotherapy is well described in literature emanating from the global North, with fewer studies focused on the learning experiences of students in the South African context. Aligning with the need for curriculum transformation, specifically in this study landscape which is Physiotherapy at UCT, a better understanding of learning on the clinical platform is warranted. This study was conceptualised and conducted through an interpretivist lens and by drawing on the theoretical underpinnings of Lave and Wenger's (1991) Situated Learning Theory (SLT) and Communities of Practice (CoP). Encompassed within SLT is an understanding that learning is not isolated and internal but rather a social process which is dependent on interactions with others and the context in which the learning takes place (Jackson, 2007). Thus this study set out to determine how sociocultural and contextual elements influence learning experiences of final year Physiotherapy students during their clinical placements. This was done by the use of a qualitative, cross-sectional exploratory study design as this was determined to best capture the experiences of students (Austin & Sutton, 2014). Research data was collected by the use of both video diaries and follow-up semi-structured interviews with the six study participants. Discourse Analysis was used to analyse the data, using an analysis framework informed by concepts from both the theoretical framework and the literature review. The study results signify that for this cohort of participants, sociocultural influences, including influences of participation in the clinical site and the interactions and relationships with others, were more important than contextual influences such as the physical learning environment. Unanticipated findings included emotional and mental wellbeing and issues of power related to the physiotherapy clinician. Three main themes emerged from the evaluation of the study findings. Theme one: Student attributes and approach to learning; Theme two: Teacher attributes, skill and power and Theme three: Resources and support at clinical placement site. These themes were able to answer the research question for the study. What has been determined in this research study is that Physiotherapy students bring their own personal and learning attributes to the clinical placement which contribute to their development as a student physiotherapist and their ability to engage actively with learning opportunities. In addition the teacher, either a clinician or clinical educator, must have certain preferable qualities which allows for the development of good relationships between teacher and student, as well as fostering the student's ability to be agentic in maximising learning opportunities. Furthermore the study demonstrated that supported participation in physiotherapy practice allowed participants to learn, thus necessitating that the clinical site possess a culture which is accepting of students and their clinical learning. It is therefore of utmost importance that any limitation to student participation be addressed with urgency at the institution. Appropriate clinical sites must also be considered carefully in relation to the demands of the curriculum, the needs of Physiotherapy as a profession and the institutional culture of the placement.
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    The effect of a community based pulmonary rehabilitation programme on the quality of life of patients with pulmonary tuberculosis
    (2011) De Grass, Donna; Manie, Shamila
    The purpose of this study is to determine whether a community based rehabilitation exercise programme had an effect on pulmonary function, exercise tolerance and Health Related Quality of Life (HRQoL) in patients diagnosed with Pulmonary Tuberculosis (PTB). The prevalence of PTB in South Africa is one of the highest in the African continent. Assessing the effectiveness of the programme could provide further methods in improving compliance to pharmaceutical medication as well as an improvement in the morbidity experienced after diagnosis of PTB.
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    Evaluation of positive expiratory pressure (PEP) devices as an adjunct to cardio-respiratory physiotherapy in patients following open abdominal surgery
    (2015) Jacobs, Rene Catherine; Manie, Shamila; Pienaar, Lunelle
    Purpose: Cardio-respiratory physiotherapy for patients undergoing abdominal surgery has been found to be beneficial in improving lung function post-operatively and in the prevention and treatment of post-operative pulmonary complications (PPCs). The Blow Bottle, a Positive Expiratory Pressure (PEP) therapy device, is commonly used as an adjunct to physiotherapy. The Blow Bottle is low cost and can be easily made by the physiotherapist using readily available materials in the hospital setting. However, evidence to support the use of Blow Bottles in the post-operative management of abdominal surgery is minimal, with few studies reporting significant positive effects especially when compared to conventional cardio-respiratory physiotherapy techniques. Methodology: A randomized control was implemented in a public tertiary institution within the Western Cape. Patients admitted for open abdominal surgery via midline incision were eligible for the trial. Participants were randomly allocated to either the control group (CG) receiving conventional post-operative cardio-respiratory physiotherapy, or the intervention group (IG) who received the additional use of the Blow Bottle. Lung function and the development of post-operative pulmonary complications were the primary outcome s of this study. Lung Function was evaluated by means of spirometry testing and interpretation of Forced Expiratory Volume in 1 second (FEV 1) and Forced Vital Capacity (FVC). The development of post-operative pulmonary complications were diagnosed using the criteria by Mackay et al. (2005) where changes from pre-operative findings of auscultation; temperature, X-ray and sputum are evaluated post-operatively and recorded using the Adapted Abdominal Physiotherapy Outcomes Data Sheet (A-APODS). Results: A total of 19 participants were enrolled in the study, n=11 (CG) and n=8 (IG), predominantly female (n=14) and admitted for cancer related abdominal surgery (n=9). There was a statistically significant (p<0.05) marked reduction in post-operative lung function from baseline across groups, 62% in FEV 1 and 47% in FVC on the first post-operative day. The FEV 1 and FVC were similar across both the control and intervention groups for the first three post-operative days. On auscultation majority of participants had decreased breath sounds on the first post-operative day. However, no one participant developed a PPC across the duration of the study as diagnosed using the criteria by Mackay et al. (2005). Conclusion: Whether the additional use of the Blow Bottle is more beneficial than conventional post-operative cardio-physiotherapy alone is inconclusive due to the incremental drop out of participants from the study and small sample size. In this study there was however a significant reduction in lung function post-operatively. This mandates the need for further research investigating the abdominal surgical field and the use of devices to improve lung function, such as the Blow Bottle, as literature is scant and outdated, and sorely lacking in the resource constraint South African hospital settings.
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    Implementation of the physical function ICU test tool in a resource constrained intensive care unit to promote early mobilisation of critically ill patients- a feasibility study
    (BioMed Central, 2016-10-19) Tadyanemhandu, Cathrine; Manie, Shamila
    Background: The shift of focus in outcome measures from mortality to assessment of functional status in intensive care unit (ICU) patients has resulted in the emergence of mobilisation of critically ill patients as a standard physiotherapy practice in most medium and high income countries. The aim of this study was to determine the feasibility of an early mobilisation program and to report on the changes in patient clinical outcomes following the intervention in a low income country. Methods: A prospective cohort study was carried out at one public hospital. An adult cohort of 35 patients was recruited within 24 h of being admitted into the unit, irrespective of ventilation method over a period of three months. An early mobilisation programme was implemented and prescribed using the Physical Function ICU Test (PFIT-s) which commenced in either the ICU or high dependent unit. Results: The median age of the 35 patients was 29 years (IQR = 24–45 years). More than half of the patients had undergone surgery due to either gastrointestinal problems or obstetrical complications. A total of 94 out of a possible of 219 exercise sessions were delivered to the patients (43.0 %). The tool was implemented in 32 (91.4 %) patients on the initial PFIT-s measurement and 16 (45.7 %) of the patients required the assistance of two people to stand. The Initial PFIT-s mean score was 5.3 ± 1.8. On final PFIT-s measurement, out of the 30 (85.7 %) patients seen, 15 (42.9 %) of the patients did not require any assistance to stand and the final PFIT-s mean score was 7.0 ± 1.9. There was a significant difference in both the initial PFIT-s total score (t-value = 2.34, df = 30, p = .03) and the final PFIT-s score (t-value = 3.66, df = 28, p = .001) between males and females. During the treatment, no adverse event occurred in any of the patients. Conclusion: An early mobilisation program using PFIT-s was feasible and safe. There was a difference in functional capability based on gender, with males being more functionally active. Specific inclusion and exclusion criteria can lead to a delayed early mobilisation activities in ICU patients.
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    Reaching consensus on the physiotherapeutic management of patients following upper abdominal surgery: a pragmatic approach to interpret equivocal evidence
    (BioMed Central Ltd, 2012) Hanekom, Susan; Brooks, Dina; Denehy, Linda; Fagevik-Olsen, Monika; Hardcastle, Timothy; Manie, Shamila; Louw, Quinette
    BACKGROUND:Postoperative pulmonary complications remain the most significant cause of morbidity following open upper abdominal surgery despite advances in perioperative care. However, due to the poor quality primary research uncertainty surrounding the value of prophylactic physiotherapy intervention in the management of patients following abdominal surgery persists. The Delphi process has been proposed as a pragmatic methodology to guide clinical practice when evidence is equivocal. METHODS: The objective was to develop a clinical management algorithm for the post operative management of abdominal surgery patients. Eleven draft algorithm statements extracted from the extant literature by the primary research team were verified and rated by scientist clinicians (n = 5) in an electronic three round Delphi process. Algorithm statements which reached a priori defined consensus-semi-interquartile range (SIQR) < 0.5-were collated into the algorithm. RESULTS: The five panelists allocated to the abdominal surgery Delphi panel were from Australia, Canada, Sweden, and South Africa. The 11 draft algorithm statements were edited and 5 additional statements were formulated. The panel reached consensus on the rating of all statements. Four statements were rated essential. CONCLUSION: An expert Delphi panel interpreted the equivocal evidence for the physiotherapeutic management of patients following upper abdominal surgery. Through a process of consensus a clinical management algorithm was formulated. This algorithm can now be used by clinicians to guide clinical practice in this population.
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    The effectiveness of graded motor imagery for reducing phantom limb pain and disability in amputees
    (2018) Limakatso, Katleho Maxwell; Parker, Romy; Manie, Shamila; Madden, Tory
    Introduction Phantom limb pain (PLP) is described as painful sensations felt in the missing portion of an amputated limb. PLP occurs in up to 85% of amputees, making it the most common painful condition secondary to amputation. PLP interferes with sleep, mobility, and work, general activities of daily living and enjoyment of life. Current pharmacological and non-pharmacological interventions have shown limited efficacy for reducing PLP, perhaps because they do not effectively target the mechanisms that have been proposed to underlie PLP in people who have undergone amputations. Graded motor imagery (GMI) is a cortical mechanisms-based intervention which aims to reduce PLP using a graded sequence of strategies including left/right judgements, imagined movements and mirror therapy. The aim of this thesis was to investigate whether the GMI programme is effective for reducing PLP and disability in people who have undergone amputations. Methods A single blinded randomised controlled trial was conducted at Somerset, Khayelitsha and Victoria hospitals in Cape Town, South Africa. The experimental group underwent a 6-week GMI programme where each phase was carried out for two weeks, during which the patient received treatment for 30 minutes on two separate days of the first week (at least one day apart) and continued with a structured home-exercise programme during the first week until the end of the second week. The control group continued with routine care. Data on the outcomes- PLP severity, pain interference with function and health-related quality of life were collected at baseline, 6 weeks and 3 months by a blinded outcome assessor. Results The study recruited 21 participants from which 11 and 10 were randomly allocated to the experimental and control groups respectively. Within group analysis showed that participants in both the experimental and control groups had improved pain severity scores immediately after treatment and at 3-month follow-up. The between-group analysis showed that the experimental group had significantly greater improvements in pain immediately after treatment (p=0.02). However, there was no difference between groups at 3-months follow-up (p=0.14). To explore clinically meaningful improvements in pain, the Number Needed to Treat (NNT) were calculated using a cut-off of 3 points on a 0-10 scale. The NNT were 2 [95% CI: 1.1 – 6.5] and 3 [95% CI: 1.9 – 7.1] immediately after treatment and at 3-months follow-up respectively. For pain interference with function, within group analysis showed that participants in the experimental group had significant improvements immediately after treatment and at 3-month follow-up. The between-group analysis showed that the experimental group had significantly greater improvements in pain interference with function immediately after treatment (p=0.007) and at 3- month follow-up (p=0.02). The NNT were 1.4 [95% CI: 1 – 1.8] and 1.9 [95% CI: 1.1 – 6.5] immediately after treatment and at 3-months follow-up respectively. For disability, the experimental group had significantly fewer problems with mobility than the control group at 3 months (χ2 = 9.8; p= 0.04). Conclusion The results of the current study provide support for the use of GMI to treat PLP based on the proposition that PLP is driven by cortical mechanisms and that GMI effectively targets these mechanisms. On the basis of the significant pain reduction within the GMI group, the lack of serious adverse effects, and the ease of application, GMI may be a viable treatment for treating PLP in people who have undergone amputations. While more studies using rigorous methodology, including sham treatment, larger sample sizes and a more generalisable sample, are required, the efficacy of GMI coupled with its affordability and low risk, suggest that it is applicable in a resource-constrained primary health setting in South Africa.
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    The prevalence of pulmonary complications after thoracic and abdominal surgery and associated risk factors in patients admitted at a government hospital in Harare, Zimbabwe-a retrospective study
    (BioMed Central, 2017-08-22) Tadyanemhandu, Cathrine; Mukombachoto, Rufaro; Nhunzvi, Clement; Kaseke, Farayi; Chikwasha, Vasco; Chengetanai, Samson; Manie, Shamila
    Background: The burden of HIV/AIDS in Sub-Saharan Africa has presented unusual and challenging acute surgical problems across all specialties. Thoraco-abdominal surgery cuts through muscle and thereby disrupts the normal anatomy and activity of the respiratory muscles leading to reduced lung volumes and putting the patients at greater risk of developing post-operative pulmonary complications (PPCs). PPCs remain an important cause of post-operative morbidity, mortality, and impacts on the long-term outcomes of patients post hospital discharge. The objective of the study was to determine the pulmonary complications developing after abdominal and thoracic surgery and the associated risks factors. Methods: A retrospective records review of all abdominal and thoracic surgery patients admitted at a central hospital from January 2014 to October 2014 was done. Data collected included demographic data, surgical history, comorbidities and the PPCs present. Results: Out of the 92 patients whose records were reviewed, 55 (59.8%) were males and 84 (91.3%) had abdominal surgery. The mean age of the patients was 42.6 years (SD = 18.4). The common comorbidities were HIV infection noted in 14(15.2%) of the patients and hypertension in 10 (13.0%). Thirty nine (42.4%) developed PPCs and the most common complications were nosocomial pneumonia in 21 (22.8%) patients, ventilator associated pneumonia in 11 (12.0%), and atelectasis in 6 (6.5%) patients. Logistic regression showed that a history of alcohol consumption, prolonged surgery, prolonged stay in hospital or critical care unit, incision type, and comorbidities were significant risk factors for PPCs (p < 0.05). The mortality rate was 10.9%. Conclusion: PPCs like nosocomial and ventilator associated pneumonia were common and were associated with increased morbidity and adversely affected clinical outcomes of patients. HIV and hypertension presented significant comorbidities which the health team needed to recognize and address. Strategies to reduce the occurrence of PPCs have to be implemented through coordinated efforts by the health practitioners as a team during the entire perioperative period.