Browsing by Author "Naidoo, Niri"

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    Open Access
    Factors contributing to falls in a tertiary acute care setting in Cape Town, South Africa: a descriptive study
    (2020) Irving, Athene; Rogers, Christine; Naidoo, Niri
    Introduction. Patient falls occur frequently in the acute hospital setting and are one of the most common adverse events experienced by hospitalised patients. In-hospital falls have negative outcomes for patients, causing injuries in up to half of those who fall. Falls in hospital create additional costs for health services due to increased length of stay (LOS), and greater health resource use. In contrast to much research focused on in-hospital falls worldwide, little is known about the rate, contributing factors and outcomes of inpatient falls in the state sector in South African hospitals. At the research hospital, a Falls Policy has been in place since 2013. The chosen falls risk screening tool, the Morse Falls Scale (MFS), had not been locally validated, and therefore its ability to accurately discriminate between patients who fall and patients who do not fall was unknown. A focused analysis of local falls incident reporting, and a description of contributory factors and consequences of falls, could better inform and target falls and fall injury prevention. Furthermore, this research may assist in service development and refining the Falls Policy. Methodology. The aim of this study was to obtain broad-based data on the magnitude of patient falls, and to identify factors contributing to falls. The aim was achieved in two parts, the first was a retrospective record review design. Predictive risk factors for falls were explored by comparing two patient groups, a Fall-Group and a Non-fall Group. In the FallGroup, further objectives related to describing circumstances surrounding fall events, including activities patients were performing at the time of the fall, the time of day and day of week the fall occurred, locations of fall events, and the clinical consequences sustained as a result of the fall. The use of the existing falls risk screening tool, the MFS, as well as its predictive accuracy to correctly identify patients at increased risk of falling was investigated. Second, a survey of nurses at the research hospital was undertaken to examine nurses' knowledge, attitudes and beliefs around the Falls Policy and current falls prevention practices. Results. There were 171 reported fall events during the ten-month period, representing 11.77% of adverse events and a falls rate of 0.73 per 1000 patient occupied bed days (POBD) during this time. Significant predictive risk factors for falling were a longer LOS and having a greater number of comorbid conditions. While the mean age of the sample was 50.0 years (SD=17.3 years), the Fall Group was significantly older than the Non-fall Group (p = .004). There were significantly more deaths in the Fall Group (p = .001), and this group had a longer average LOS (p < .001) compared to the Non-fall Group. The only sub-scale from the MFS that was significantly associated with falls was walking status. Minor-moderate clinical consequences were experienced as a result of the fall in 97% of cases (n=124). This study demonstrated that the MFS in use in the hospital has a low predictive accuracy of 55% at the current cut-off score of 50. At this score, the MFS has a sensitivity of 35.9% and a specificity of 75.4%. While an initial MFS was found in each of the cases, there was only evidence of a repeat MFS in 13 participants (9.7%) in the Fall Group. The nursing survey showed 70% of respondents had not had training on the Falls Policy (n=93) and only 37% (n=49) reported receiving regular feedback on fall rates. Receptiveness of most (66%, n=91) nurses to more training in falls prevention is encouraging. Discussion. The fall rate of 0.73 falls per POBD was lower than expected when compared to international studies. At the research hospital, when the Falls Policy was introduced in 2013, a fall was not defined in the policy and as highlighted in the nursing survey, there still appears to be lack of clarity on the fall definition. The MFS had a low predictive accuracy at the current cut-off score. The low sensitivity and specificity of the MFS in this setting may be due to the MFS not being updated regularly as per the Falls Policy. A further reason for the MFS poor predictive value may be the younger age group found in this sample when compared to international studies where the scale has performed better. Recommendations. The poor predictive value of the current risk screening tool found in this study is concerning. Therefore, further investigation into whether the MFS performs better if it is updated more frequently, and if completed in full, as per the Falls Policy, is recommended. Alternatively, the hospital should consider all patients with multiple comorbidities and those with longer length of stays at high risk, and provide interventions to minimise risk as per the Falls Policy. Future research into factors contributing to fall events and falls prevention should follow a prospective design and be supported at management as well as ward level. Further investigation into the most appropriate way to reduce harm from falls is recommended at the research site. Conclusion. This descriptive study provides a starting point for the hospital to examine the Falls Policy and falls prevention strategies currently in use. It is hoped that the study will contribute to local awareness-raising and capacity-building and help the hospital evaluate current practice and set a baseline for improvement.
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    Open Access
    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.
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    The relationship between kinaesthesia, motor performance, physical fitness and joint mobility in children with and without joint hypermobility in Nigeria
    (2022) Anieto, Ebuka Miracle; Naidoo, Niri; Smits-Engelsman, B C M
    Background: Some children with generalized joint hypermobility (GJH) develop symptoms at some point, which could negatively affect their overall health status. When GJH presents with symptoms, it is described as benign joint hypermobility syndrome (BJHS). Some of the symptoms may include pain, soft tissue injuries, and early onset osteoarthritis. The factors that may predict the development of symptoms in people with GJH have not been established. It is important to explore and identify the factors that modulate the clinical outcomes of children with joint hypermobility, and the factors that predispose some children to developing BJHS). Exploring these factors will help in establishing indicators to observe in longitudinal studies to identify causality, and in developing interventions that will be specifically targeted at influencing those modulators. Aims: to determine the relationship between kinaesthesia, motor performance, fitness and joint mobility in children, and to also determine if kinaesthesia, motor performance, fitness are different in children diagnosed with GJH compared to those who have normal mobility. Methods: a cross-sectional, analytical study was conducted involving children from two primary schools in South-Eastern part of Nigeria. The Beighton criteria were used for the classification of GJH, while using a cut-off of ≥ 6 out of the 9-maximum score. The children were allocated into two groups: children with GJH, and children with normal mobility (NM). Motor performance, fitness and kinaesthesia were measured in all the children. Motor performance and fitness were measured using the performance and fitness battery (PERF-FIT), while kinaesthesia was measured using wedges. Partial correlation was used to evaluate the relationship between the outcomes, while controlling for age and BMI. The non-parametric ANCOVA test (Quade's test) was used to evaluate the differences in the outcomes (motor performance, fitness, and kinaesthesia) between children with GJH and children with NM, while also controlling for age and BMI. Results: A total of 91 children (51.6% girls, and 48.4% boys) participated in the study. The mean age of the children was 8.20 ± 1.98. GJH was identified in a total of 35 (38.46%) children, while 56 (61.54%) children had normal mobility. GJH was more frequent in females (60.0%) than in males (40.0%). There was no statistically significant correlation between joint mobility and kinaesthesia. There was also no statistically significant correlation between joint mobility and motor performance items, as well as the fitness items. There was a statistically significant positive correlation between kinaesthesia and some motor performance items including ball bounce, ball throw and dynamic balance, as well as a significant negative correlation between kinaesthesia and one fitness item- ladder run. Furthermore, there was a statistically significant positive correlation between age and kinaesthesia (correct wedges discrimination). The study also showed that motor performance items, kinaesthesia, and most fitness items, did not differ significantly between children with GJH and children with NM. Conclusion: Joint mobility may not have a significant influence on motor performance and fitness in children that are still at their early stage of growth. Kinaesthesia may be an important factor to consider in children, as it had significant correlations with some motor performance and a fitness item. Furthermore, kinaesthesia is better when the children are older.