OpenUCT :: Browsing by Author "Parker, Romy"

Browsing by Author "Parker, Romy"

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Open Access
A retrospective audit of pain assessment and management post caesarean section at New Somerset Hospital in Cape Town, South Africa
(2022) Munsaka, Effraim Frackson; van Dyk, Dominique; Parker, Romy
Background: The most common major surgical procedure performed worldwide is the caesarean section (CS). Effective pain management is a priority for women undergoing this procedure, to reduce the incidence of persistent pain, (a risk factor for postpartum depression), as well as optimize maternal-neonatal bonding and the successful establishment of breastfeeding. Multimodal analgesia is the gold standard for post-caesarean section analgesia. At present, no perioperative pain management protocols could be identified for the management of patients presenting for CS at regional hospitals in South Africa. This audit aimed to review the folders of patients who underwent CS, with reference to perioperative pain management guidelines for CS. Methods: A descriptive, retrospective, cross-sectional audit was conducted. Three hundred folders (10% of the annual number of caesarean procedures performed) from New Somerset Hospital, a regional hospital in Cape Town, South Africa were reviewed. Results: The women were a mean age of 30 years (SD 6.2). Median gravidity was 3 (IQR 2-3) and parity was 1 (IQR 1-2); 52% had previously undergone a CS. In 93.3%, spinal anaesthesia was employed for CS. Pain assessment was poor, with only 55 (18%) patients having their pain assessed on the day of the operation. Analgesia was prescribed in over 98% of the patients, however, medication was only administered as prescribed in 32.6%. Non-steroidal anti inflammatory drugs (NSAIDs) were prescribed in < 1.67% of cases. None of the patients received a patient-controlled analgesia (PCA), transversus abdominis plane (TAP) block, or wound infusion catheter as supplementary strategies. Conclusions: Pain management for post-CS patient at this hospital is lacking. There is the need for the implementation of a structured assessment tool to improve administration of analgesics in these patients. In addition, the reasons for the omission of NSAIDs from the analgesia regimen requires investigation. Hospitals require post-CS pain protocols to guide management especially in resource-limited settings.
Open Access
Acute pain assessment and management in the prehospital setting, in the Western Cape, South Africa: a knowledge, attitudes and practices survey
(2020-04-28) Lourens, Andrit; Hodkinson, Peter; Parker, Romy
Background Acute pain is frequently encountered in the prehospital setting, and therefore, a fundamental aspect of quality emergency care. Research has shown a positive association between healthcare providers’ knowledge of, and attitudes towards pain and pain management practices. This study aimed to describe the knowledge, attitudes, and practices of emergency care providers regarding acute pain assessment and management in the prehospital setting, in the Western Cape, South Africa. The specific objectives were to, identify gaps in pain knowledge; assess attitudes regarding pain assessment and management; describe pain assessment and management behaviours and practices; and identify barriers to and enablers of pain care. Methods A web-based descriptive cross-sectional survey was conducted among emergency care providers of all qualifications, using a face-validated Knowledge, Attitudes and Practices of Pain survey. Results Responses of 100 participants were included in the analysis. The survey response rate could not be calculated. The mean age of respondents was 34.74 (SD 8.13) years and the mean years’ experience 10.02 (SD 6.47). Most respondents were male (69%), employed in the public/government sector (93%) as operational practitioners (85%) with 54% of respondents having attended medical education on pain care in the last 2 years. The mean percentage for knowledge and attitudes regarding pain among emergency care providers was 58.01% (SD 15.66) with gaps identified in various aspects of pain and pain care. Practitioners with higher qualifications, more years’ experience and those who did not attend medical education on pain, achieved higher scores. Alcohol and drug use by patients were the most selected barrier to pain care while the availability of higher qualified practitioners was the most selected enabler. When asked to record pain scores, practitioners were less inclined to assign scores which were self-reported by the patients in the case scenarios. The participant dropout rate was 35%. Conclusion Our results suggest that there is suboptimal knowledge and attitudes regarding pain among emergency care providers in the Western Cape, South Africa. Gaps in pain knowledge, attitudes and practices were identified. Some barriers and enablers of pain care in the South African prehospital setting were identified but further research is indicated.
Open Access
Cervico-mandibular muscle activity in females with chronic cervical pain a descriptive, cross-sectional, correctional study
(2012) Lang, Patricia; Parker, Romy; Burgess, Theresa
Chronic musculoskeletal conditions of the spine and periphery are a burden both internationally and in South Africa. There is a socio-economic burden as a consequence of the severity, duration and recurrence of chronic cervical musculoskeletal conditions among information technology and sedentary office workers. However, the precise mechanisms behind chronic cervical disorders remain unclear. It is theorised that the pathophysiological mechanisms in chronic cervical musculoskeletal conditions share a similar theoretical framework to chronic pain itself. The biopsychosocial model of chronic pain accepts the dynamic nature of pain. This model accepts the dual biological and psychosocial components that enhance the experience and maintenance of chronic pain, through central sensitisation. There appears to be a neurophysiological, biomechanical and psychological link between the cervical area and the temporomandibular area. Although numerous studies have implied that individuals with temporomandibular disorders have concurrent cervical dysfunction, there is currently no evidence that individuals with cervical dysfunction exhibit altered muscle activity in the masseter and cervical erector spinae muscles or report teeth clenching habits. Consequently, identification of factors that may contribute to chronic cervical musculoskeletal conditions, stemming from the temporomandibular area, may potentially be lost. The aim of the present study was to explore the activity levels of the cervicomandibular muscles in females with chronic cervical musculoskeletal conditions, who showed no symptoms of temporomandibular disorders. This study had a descriptive cross-sectional correlational design with single-blinding. The telephonic screening process was followed by the signing of informed consent forms. Validated questionnaires were used for categorisation and comparison of the socio-demographic and biopsychosocial profiles of the pain group (n = 20) and the no pain group (n = 22). The screening, informed consent and questionnaires were completed by an assistant. The first of five questionnaires, the adapted Research Diagnostic Criteria History questionnaire, was used as an instrument for exclusion of temporomandibular disorders and the recording of a daytime parafunctional teeth clenching habit. The remaining four questionnaires, listed as the Neck Disability Index, the Computer Usage Questionnaire, the Brief Pain Inventory, and the EuroQol-5D were used for determining levels of cervical disability for categorisation and comparison between groups, as well as for determining levels of pain-related disability, occupational and sporting activity, and health related quality of life.
Open Access
A cross sectional study to determine whether there are central nervous system changes in football players who have sustained recurrent lateral ankle injuries using the laterality judgement task, two point discrimination test and limb perception testing
(2016) Jakoet, Rashaad; Parker, Romy; Burgess, Theresa
Background: A chronic ankle sprain injury is a condition that affects professional, amateur and social football players globally. Despite a large amount of research into the medical management of this condition, it remains one of the most frequently experienced injuries in professional football. A previous ankle sprain is a recognised risk factor for future lateral ankle sprain injury. No previous study has investigated the effects of chronic lateral ankle sprains on the cortical representation of the ankle in the brain. Aim: To determine if there are any changes in the primary and secondary somatosensory cortices of football players who have a history of recurrent ankle sprain injuries Methods: 25 professional male football players (13 previously injured, 12 noninjured) with an average age of 24.9y (+/- 4.49y) from a national first division club were recruited for the study. . All players included in the study completed an informed consent form before participation in the study and were declared fit to play by the clubs medical staff. Player demographics and training history were collected by means of a questionnaire followed by anthropometric measurements being taken. Tests used in the assessment of complex regional pain syndrome (Laterality Judgement Task recognition, two point discrimination and limb perception drawing) were used to assess for cortical representation changes in both limbs of injured players and uninjured players.
Open Access
Cross sectional study to determine whether there are central nervous system changes in rugby players who have sustained recurrent ankle injuries
(2017) Rawlinson, Alice Jane; Parker, Romy; Burgess, Theresa
Background: Rugby is a popular game played around the world and has one of the highest recorded injury rates in sport. The literature exposes ankle injuries as one of the most common areas injured in sport and this trend carries through in rugby too, with lateral ankle sprains predominating. Recurrent ankle injuries are commonly reported in the literature and account for high economic and social burden. There are many intrinsic and extrinsic risk factors credited with causing lateral ankle injuries but to date the literature does not show conclusive evidence for management and prevention of recurrent injuries. A new area of research that has not previously been explored is the neurological influence on recurrent injury. Central processing is a recognised form of learning seen in adults and children during normal development and training and more recently acknowledged in injury settings. This phenomenon has also been seen in abnormal states of development such as neglect and chronic pain. Central Nervous System Changes In Recurrent Ankle Injuries In Rugby Player 2 Aim: The purpose of this study was to investigate whether there are changes in the central nervous system of rugby players with recurrent ankle injuries. Methods: An experimental and control group was used for this cross sectional study. Participants were recruited from the Golden Lions Rugby Union. Forty-six players in total were recruited. The control group consisted of 22 players, and the recurrent injury group consisted of 24 players. Medical and Sports History Questionnaire was administered as well as a battery of four physical test procedures. The questionnaire asked participants to provide information regarding demographics, playing position, training and playing history, current general health, current and previous injury history, and specifically ankle injury history. The four testing procedures were: body image testing, laterality testing, two point discrimination testing and pressure-pain threshold testing. Results: The results were collected and recorded. Between group and within group comparisons were made for the control and recurrent injury groups. From the Medical and Sports History Questionnaire the results indicated that the recurrent injury group participated in a significantly shorter preseason training period compared to the control group. The laterality testing within group analysis had a significant difference, the injured side had a slower recognition time [1.4(1.3-1.6)] compared to the uninjured side [1.3(1.15-1.5) Central Nervous System Changes In Recurrent Ankle Injuries In Rugby Player 3 p<0.01]. Pressure pain threshold testing produced a significant difference for the control group on the ATFL test site and the PTFL site. The PTFL site also demonstrated significant difference in the between group comparison analysis. The results from the two point discrimination testing and the body image testing produced interesting results. The two point discrimination tests performed on the both the recurrent injury group and the control group using within group comparison showed significant differences on the anterior talofibular ligament between the affected and nonaffected limbs. The between group test result were also significant for the injured vs control side at the ATFL site. The affected side showed a poorer ability to differentiate between one and two points, needing a bigger area before two points were distinguished from one. Similarly, body image testing showed significant differences in the within group comparison of total area drawn for the recurrent injury group only. In the recurrent injury group, the drawing of the affected foot was significantly larger than the drawing of the unaffected side. The control group showed no differences between sides. Conclusion: The study recommends that there is a relationship between central nervous system changes in recurrent ankle injuries in the sample group of professional rugby players. The data indicates that preseason length is a factor to be considered in recurrent ankle injuries. The clinical tests focussed specifically on central nervous system changes also produced some illuminating results. The recurrent injury group demonstrated significant difference between injured and uninjured sides in both two point discrimination testing of the ATFL ligaments and in the body image drawing of the foot and ankle. The control group in contrast didn't yield any differences between sides for these same tests. The pressure pain testing and laterality testing producing significant results also indicate the central nervous system involvement in recurrent injury.
Open Access
Developing an in-depth understanding of acute pain assessment and management in the prehospital setting in the Western Cape, South Africa, the factors influencing practice and what improvement measures could advance prehospital acute pain management
(2020) Lourens, Andrit; Hodkinson, Peter; Parker, Romy
Introduction: Acute pain is a common reason for seeking emergency care in the prehospital and emergency centre settings where pain prevalence ranges widely. Pain is a significant global health problem which often goes unnoticed and is undermanaged. To this end, a project consisting of a series of research studies aimed to develop an understanding of acute prehospital pain assessment and management in South Africa was conducted to identify how best to improve this field. Methods: The project consisted of four distinct objectives to be investigated as separate but interconnected studies. The first objective was answered through a secondary research methodology (scoping review) to identify and map the body of evidence on acute prehospital pain assessment and management in Africa. The remaining three objectives were answered using primary research methods in studies conducted in the Western Cape, South Africa. Two observational studies, (i) a cross-sectional online survey and (ii) a retrospective review, respectively, aimed to describe (i) the knowledge, attitudes and practices regarding prehospital acute pain assessment and management among emergency care providers and (ii) current prehospital acute pain assessment and management practices in high acuity trauma patients. The final study employed qualitative research methods using focus groups and content analysis to explore and describe emergency care providers' perspectives of acute pain assessment and management as well as perceived barriers and facilitators to pain management. Main results: In the scoping review, six publications on acute pain research in the African prehospital setting were identified, indicative of the paucity and immaturity of this research area. In the cross-sectional online survey, suboptimal levels of knowledge and attitudes regarding pain (58.01%) were found among emergency care providers, with gaps in all aspects of pain knowledge and attitudes of distrust in self-reported pain identified. The retrospective review recorded pain scores were documented in only 18.1% of the high acuity trauma patients reviewed, while moderate-to-severe pain (78.6%) was prevalent among those who had a pain score documented. Less than 3% of all trauma patients, and less than 8% of those with moderate-to-severe pain received analgesic medication, thus, suggesting less than ideal prehospital pain assessment and management practices. In the final qualitative study, six focus groups and one interview were conducted among 25 emergency care providers. Through content analysis five themes, namely: assessing pain is difficult in this setting; many factors affect clinical reasoning some unique to this (hostile) setting; basic and intermediate life support practitioners' reality of prehospital pain care; the emergency centre does not understand what we do, how we work, what it is like; and how can we do better; emerged from the data. Conclusion: Africa has a scarcity of prehospital pain research with current evidence mainly from South Africa while knowledge of prehospital pain assessment and management in the Western Cape, South Africa proved to be a significant gap. This gap appears to be underpinned by limited educational focus, lack of pain prioritisation in emergency medical services (EMS) organisations, lack of clear evidence-based prehospital pain clinical practice guidelines, and emergency care providers' indifference towards prehospital pain care. A joint approach from EMS organisations and educational institutions, coupled with clinical practice guideline development, as well as interdisciplinary collaboration between prehospital emergency care and emergency medicine, are required. Further research must focus on developing the body of African prehospital pain knowledge to inform clinical practice and advance quality prehospital pain care.
Open Access
Developing an in-depth understanding of the prevalence, risk factors and treatment recommendations for phantom limb pain, and patient-generated care priorities for people who have undergone lower limb amputations
(2022) Limakatso, Maxwell Katleho; Parker, Romy
Introduction: Phantom limb pain is a common complication in people who have undergone limb amputation, with prevalence estimates ranging between 29% and 85.6%. Current systematic-review evidence suggests that recommended treatments are no more effective than placebo for reducing Phantom Limb Pain (PLP). Moreover, there is evidence suggesting that people with amputations may not be getting the treatment they want at different time-points after amputation. In consideration of these points, a research project comprised of a series of interconnected studies aimed to develop an in-depth understanding of the global burden of PLP and patient care priorities after limb amputations, and generate expert recommendations on the best management of PLP in people with amputations. Methods: The research project is comprised of a series of four interconnected studies addressing the four primary aims of the project. A systematic review and meta-analysis were conducted to determine the pooled prevalence estimate and risk factors for PLP in people with amputations. A cross sectional study was conducted to determine the prevalence and risk factors for PLP in people who had undergone lower limb amputations at Groote Schuur Hospital. An expert Delphi study was conducted to reach expert consensus and make recommendations on the effective treatments for PLP in people with limb amputations. Lastly, a patient Delphi study was conducted to generate patient consensus on care priorities for people who have had lower limb amputation for a year or less and for those who have had lower limb amputations for more than a year. Results: The systematic review and meta-analysis of 39 studies revealed a pooled PLP prevalence estimate of 64% [95%CI: 60.01 – 68.05], with a significantly higher prevalence estimate in studies conducted in developed countries 66.55% [95% CI: 62.02 –71.64] than those conducted in developing countries 53.98% [95% CI: 44.79–63.05] (U = 57, p = 0.03). Risk factors that were consistently positively associated with PLP included having an amputation of a lower limb, stump pain, non-painful phantom sensations, persistent pre-amputation pain, proximal site of amputation, and diabetic cause of amputation. The cross-sectional study using a sample of African people with amputations showed a PLP prevalence of 50.78% [95% CI: 41.80 – 59.72] during the week preceding data collection. In this group of patients, persistent pre-operative pain was the only risk factor associated with PLP in the multivariate logistic regression analysis [OR 2.25 (1.03 – 5.05); P=0.04]. In the expert Delphi study, consensus was reached on one pharmacological (amitriptyline) and six nonpharmacological (Graded Motor Imagery, mirror therapy, Cognitive Behavioural Therapy, virtual reality training, sensory discrimination training, use of a functional prosthesis) treatments that were considered effective for managing PLP, and on two treatments [citalopram (60%) and Pulsed Radiofrequency Stimulation of the dorsal root ganglion (70%)] that were considered ineffective. In the patient Delphi study, consensus was reached on 24 short-term care priorities and 12 long-term care priorities. The general consensus among the participants was that pre-amputation, they wanted education support to help them manage their expectations and prepare for life after amputation. In the early stage after amputation, they wanted help with dealing with the psychological trauma of having lost a limb. In the long-term, however, the participants prioritised the need for living a functional and normal life, with respect and dignity like everyone else. Conclusion: The prevalence of PLP in people with limb amputations is high, and awareness of this condition needs to be raised among healthcare professionals to implement evidence-based strategies for alleviating PLP by targeting the relevant underlying mechanisms and modifiable risk factors. Evidence-based medicine indicates that PLP is best managed using non-pharmacological and noninterventional treatments addressing biopsychosocial contributors for PLP. Finally, preparing people for life after amputation and helping them deal with the psychological trauma of having lost a limb may contribute to improved clinical outcomes that may enable them to live a functional and normal life, with respect and dignity.
Open Access
Do psychosocial factors predict pain after participation in an ultramarathon race?
(2019) Rabbitte, Jessica; Parker, Romy; Burgess, Theresa
BACKGROUND Participation in ultramarathon races is increasing globally. Although endurance running has numerous physical and psychological benefits, due to the excessive volume of training and the physical and emotional demands of completing an ultramarathon event, exercise-induced muscle damage and delayed-onset muscle soreness are common. Recovery is central to improving performance and is also a determining factor in return to training. Recovery requires both physical and psychological adaptation. However, there is limited research exploring the effect psychosocial factors play on pain recovery following competition, particularly in endurance runners. More specifically, the role fear avoidance beliefs, pain catastrophizing and self-efficacy play in pain recovery following an ultramarathon race. This information is important to contribute to the limited research on the association between psychosocial factors and recovery from pain in endurance runners. Additionally, this information may provide insight into pain recovery following the Comrades Marathon and reduce time away from running. AIMS AND OBJECTIVES The aim of this study was to investigate the relationship between psychosocial factors (fear avoidance beliefs, pain catastrophizing and self-efficacy beliefs) and pain recovery in runners following the 2017 Comrades Marathon. The specific objectives of the study were to explore whether the psychosocial factors of pain catastrophizing, fear avoidance beliefs and self-efficacy beliefs: a) predict pain in ultramarathon runners after competing in the Comrades Marathon; and b) affect recovery in runners competing in the Comrades Marathon. METHODS This study had a descriptive, longitudinal cohort design. Healthy ultramarathon runners between the ages of 20 and 60 who had qualified for and were intending to compete in the 2017 Comrades Marathon were included in this study. Participants who failed to provide informed consent, reported any signs of illness two weeks prior to the race or any relevant medical or surgical procedure that would prevent participation in the race, were diagnosed with a history of chronic pain or who did not complete the race were excluded. All participants were required to complete a medical and sports history questionnaire and baseline psychosocial questionnaires (Athlete Fear Avoidance Questionnaire, Pain Catastrophizing Questionnaire, Self-Efficacy Questionnaire) two weeks prior to the race at a presentation evening held at participating running clubs. Recovery from pain was recorded by completing a pain logbook (Pain Severity Score of the Brief Pain Inventory) starting the evening of the day on which the Comrades Marathon was run and on each night for nine days following the race, with a total of 10 entries. The questionnaires were validated in previous studies by a panel of experts and were available in both hard copy and electronic format. RESULTS The study sample consisted of 77 participants with a mean age of 41 years, 45 (58%) of whom were male and predominantly English speaking (74%). The majority of participants (78%) had completed the Comrades Marathon previously with 13% being novices to the ultramarathon distance. The average finishing time for the study participants in the 2017 Comrades Marathon was 10 hours and 16 minutes. Seventy percent reported that they had previously used pain-relieving medication after a race. The majority of participants(86%) documented a history of injury, with 55% reporting a current injury. Only 6% reported currently using chronic pain-relieving medication. The baseline psychosocial questionnaires revealed that the majority of the participants demonstrated low fear avoidance beliefs (79%), low pain catastrophizing beliefs (88%) and high self-efficacy beliefs (97%). It took five days from the day of the Comrades Marathon for 75% of the runners to score a pain rating of one or lower in the pain logbook and seven days for 75% of the runners to report no pain. There were no correlations between psychosocial factors and pain recovery in this sample of Comrades runners. There was no correlation between finishing times and pain during recovery. CONCLUSION In conclusion, this study showed that in this sample of ultramarathon runners pre-race psychosocial factors had no effect on recovery following the 2017 Comrades Marathon. High self-efficacy scores, previous experience, higher pain tolerance and better coping strategies in ultramarathon runners may be contributing factors to these results. Future research needs to explore endurance runners who do not complete the race, assess the profile of the ultramarathon race and assess different recovery markers
Open Access
Does Foam Rolling have a Positive Effect on Performance and Recovery from Post Exercise Induced Muscle Damage: A Systematic Review of the Literature to Guide Practitioners on the use of Foam Rolling
(2018) Hill, Hayd'n; Hendricks, Sharief; Parker, Romy; Lombard, Wayne
Foam rolling is a form of myofascial release performed by the individual using their body weight, as opposed to the pressure being applied by the clinician. Foam rolling is currently used by athletes at all levels, from recreational to elite athletes. Foam rolling is used as a warm up to aid performance and/or recovery. This study aims to review the literature to determine if foam rolling enhances performance, positively affects recovery from exercise induced muscle damage, and whether there is a consensus on the protocol to achieve performance and recovery enhancement. Seven electronic databases, Google Scholar, Science Direct, Pubmed Central, Pubmed, ISI Web of Science, Medline and Scopus, were searched using terms related to foam rolling between January 2006 and April 2017. Published articles that included foam rolling as a recovery intervention and/or a performance enhancing tool were included in the study and assessed using the PEDro scale for methodological quality ratings. This dissertation will consolidate and add to the knowledge on the use of foam rolling. It will highlight when foam rolling should be used and recommend a specific protocol that should be used for performance and/or recovery purposes. This may address the confusion around when foam rolling should be used and show foam rolling to be effective as a recovery tool or for enhancing performance. This may help with better management of athletes by sports personnel, and in turn improve their performance and enhance their recovery. A total of 33 articles met the inclusion criterion and were systematically reviewed. There is evidence supporting the use of foam rolling in a warm-up consisting of dynamic stretching and an active warm-up to enhance performance; mainly through its effects on flexibility while maintaining muscle contractility. There is also evidence supporting the use of foam rolling to enhance recovery from exercise induced muscle damage and delayed onset of muscle soreness, with its main effects being the shortening of time to return to baseline performance, flexibility and pressure pain threshold. The mechanism by which foam rolling acts seems to be a neural response to pressure exerted. Sixty to ninety seconds of foam rolling may suffice to achieve the above desired effects. Further research is needed to determine the exact mechanisms of action of foam rolling, as well as the risks that may be associated with foam rolling.
Open Access
The effects of a six-week physiotherapist-led exercise and education intervention in patients with osteoarthritis, awaiting an arthroplasty in the South Africa
(2015) Saw, Melissa Michelle; Parker, Romy; Edries, Naila
Background: Osteoarthritis (OA) is one of the leading causes of disability worldwide. A major challenge facing those with severe OA is long waiting lists delaying access to joint replacements. Patients are known to wait more than five years for a joint replacement in the Western Cape of South Africa (SA). The main complaint in this population is pain and its consequences including activity limitations, participation restrictions and reduced quality of life. Hip or knee OA is not merely joint degeneration but a condition requiring holistic management, even while waiting for surgery. Most of the literature in this field is available from high income countries exploring the effects of interventions during short waiting periods. Thus research is warranted in a low income country such as SA, in those waiting for long periods to explore the effects of a six-week physiotherapist-led exercise and education intervention. Methods: A single blinded randomised controlled trial, aligned with CONSORT guidelines, was performed at Tygerberg Hospital in the Western Cape, SA. The experimental group attended a six-week group-based physiotherapist-led intervention including education, exercise and relaxation. The control group continued to receive usual care. The primary outcome measure was pain with secondary measures of disability, function, quality of life and self-efficacy. Measures were obtained at six weeks, 12 weeks and six months by a blinded physiotherapist. An open ended questionnaire was completed by the participants in the experimental group at month six. Analysis was by intention to treat. Two-way analysis of variance and post-hoc Tukey comparisons were used for parametric data, Pearson Chi squared calculations for categorical data. Effect sizes were established for significant differences between groups. Results: The study recruited 42 participants from the waiting list for a hip or knee arthroplasty. Mean waiting time was 3.6 ± 2.5 years. Compared to the control group, the experimental group had significant improvements with large effect sizes at month six for pain interference (3.49 ± 2.63 vs. 6.09 ± 2.43; p=0.02, ES=1.15) and function (15m fastest speed walk) (15.09 ± 6.04s vs 20.10 ± 8.79s; p=0.03, ES=0.88). Furthermore, the experimental group displayed significant (p < 0.01) and sustained improvements at month six in pain severity, disability and function (15m normal speed walk, sit-stand, 6-minute walk). Subgroup analysis showed participants with knee OA responded better to the intervention than those with OA of the hip or combined hip and knee OA. Participants enjoyed the intervention reporting improved knowledge, function and activity, pain relief and improvement in psychosocial aspects. Conclusions: A six-week physiotherapist-led exercise and education intervention brought about significant long term improvements in pain interference and functional walking ability in patients with osteoarthritis, awaiting a joint replacement compared with a control group. Such a programme also appears to have significant and sustained improvements in pain severity and disability. Further research with longer follow up is recommended to determine if results are sustained.
Open Access
The effects of scapulothoracic rehabilitation on shoulder pain in competitive swimmers Megan Dutton.
(2012) Dutton, Megan; Burgess, Theresa; Parker, Romy
Competitive swimmers have a high incidence of shoulder pain. Secondary shoulder impingement is thought to be primarily responsible for shoulder pain in competitive swimmers. The effective management of shoulder impingement has been widely investigated; however there is minimal consensus on the optimal method of treatment and rehabilitation of shoulder impingement. In addition, current research does not adequately consider the role of scapulothoracic rehabilitation in the management of shoulder impingement. Aim: To determine the effects of a scapulothoracic rehabilitation programme on shoulder pain in competitive swimmers.
Open Access
Efficacy of a peer-led exercise and education programme combined with a therapeutic relationship to manage pain in rural amaXhosa women living with HIV/AIDS compared to a therapeutic relationship alone
(2017) Jackson, Kirsty Nontsikelelo; Parker, Romy; Wadley, Antonia
Background: Pain is the one of the most prevalent symptoms in people living with Human Immunodeficiency Virus/Acquired Immune Disease Syndrome (HIV/AIDS) and is largely undermanaged. In urban amaXhosa women living with HIV/AIDS (LWHA), the 'Positive Living' (PL) programme has been identified as an effective non-pharmacological intervention for managing pain and may be affected by an empathetic therapeutic relationship. As a high prevalence of pain is likely to exist in rural amaXhosa women LWHA in South Africa, research is warranted on these two interventions amongst this population. Aim: To determine the effect of the combined PL programme and therapeutic relationship intervention (PL intervention), in comparison to a therapeutic relationship intervention (TR intervention) alone on pain severity, pain interference, symptoms of depression, health-related quality of life (HRQoL), self-efficacy and physical function in rural amaXhosa women LWHA. Method: A single-blind randomised trial was conducted using a sample of convenience. Interviewer administered questionnaires and functional tests at Baseline and at Weeks 4, 8, 12 and 24 were collected for the PL and TR intervention groups. Regression analysis determined the change of the primary outcomes, pain severity and interference, and secondary outcomes over the 24 weeks of the study. Results: Forty-nine amaXhosa women LWHA participated in the study. The PL programme and the data collection points were poorly attended by both groups. The pain severity and pain interference scores improved significantly in the PL (n = 26) and TR (n = 23) intervention groups over the 24 weeks of the study, with no significant differences between intervention groups. Symptoms of depression, HRQoL, self-efficacy and six of eight physical function tests were also significantly improved in the PL and TR intervention groups and, with the exception of self-efficacy, no significant differences existed between intervention groups. Conclusion: The therapeutic relationship appears to be sufficient to manage pain in rural amaXhosa women LWHA and should therefore be recognised as a necessary intervention to provide effective and adequate pain management.
Open Access
The epidemiology of injuries in competitive adolescent swimmers attending a Johannesburg swim squad
(2016) Scorgie, Inneke; Burgess, Theresa; Parker, Romy
Background: Swimming is a popular competitive and recreational sport performed worldwide by all generations. Although swimming is associated with many positive health benefits, swimmers are at risk of developing musculoskeletal injuries. In particular, competitive swimmers may be at increased risk of injury, due to regular participation in demanding training regimes. Adolescent swimmers may be at increased risk of injury due to physiological and biological vulnerability associated with growth and development. However, there is a lack of evidence regarding the epidemiology of injuries in competitive adolescent swimmers. Aim: The aim of this study was to determine the relationship between injury incidence and potential risk factors in adolescent swimmers over a 24 - week period. Specific Objectives: (a) To describe the demographic and training characteristics of competitive adolescent swimmers; (b) to establish the incidence and nature of self - reported swimming - related injuries in competitive adolescent swimmers; (c) to determine if any specific intrinsic factors and extrinsic factors were associated with increased risk of injury in competitive adolescent swimmers. Methods: Twenty three competitive adolescent swimmers aged 12 to 18 years were recruited for the study. Swimmers attended a study information session and parents/legal guardians were emailed information sheets and informed consent forms. All participants brought signed informed consent forms from parents/legal guardians to the baseline data collection session. At baseline testing participants signed their own informed assent forms and completed the baseline questionnaire, anthropometry measurements, glenohumeral range of movement measurements, the Beighton score and glenohumeral and knee muscle strength measurements. Participants were advised on how to complete the electronic injury report and training questionnaire. A familiarisation trial - run of the survey was completed in the week following baseline testing. Formal data collection commenced two weeks after baseline testing. Participants were required to submit the injury report and training questionnaire on a weekly basis for the 24 - week study period. Results: The mean age for commencement of swimming training in both the injured and uninjured groups was approximately 7.5 years. The injured group had significantly decreased subscapularis muscle strength (p = 0.02) and significantly higher average training session distances (p = 0.04), compared to the uninjured group. Fourteen participants (60%) sustained injuries during the 24 - week study period. The injury rate was 22.4 per 1 000 athletic exposures (AE's). Sixty injuries were sustained in total; 16 were index, and 44 were recurrent injuries. The most common injury location was the knee joint (n = 20). The only factors associated with increased injury risk in this study were previous injury history (OR: 7.50; 95% CIs 1.02 - 55.00) and reduced percentage of time in breaststroke training (OR: 12.83; 95% C I s: 1.69 - 97.19). Few swimming training sessions were modified or changed due to injury, and the majority of injurie s did not receive any treatment. Conclusion The injury incidence of adolescent competitive swimmers attending a Johannesburg - based swim squad is high. In addition, the high number of recurrent injuries, the minimal adaptation of training loads in response to injury, and the low access to appropriate treatment suggest a lack of knowledge or poor practices regarding swimming - related injuries. Pre - season screening, specific to swimming, could assist in identifying weakness and potential risk factors for injury in this vulnerable age - group. Improving health literacy with education in swimmers, coaches and parents could reduce future injury incidence rates. Therefore, further research is needed regarding injury incidence, risk factors and training profiles of this population. Moreover, consensus regarding injury definitions and training loads in adolescent swimmers is needed to standardise reporting and to facilitate further research in this field.
Open Access
The epidemiology of injuries sustained by canoeists during the 2006 Isuzu Berg River canoe marathon
(2009) Feher, Richard; Burgess, Theresa; Parker, Romy
Includes abstract. Includes bibliographical references (leaves 53-59).
Open Access
An explorative study of factors influencing health-related quality of life in patients with femoral fractures
(2013) Siebritz, Ruth; Parker, Romy; Burgess, Theresa
Includes abstract. Includes bibliographical references.
Open Access
Gabapentinoids for treatment of neuropathic pain: a medicines usage evaluation at the Groote Schuur hospital chronic pain management clinic
(2020) Moabelo, Machuene; Parker, Romy
Background Neuropathic pain (NP), defined as pain caused by a lesion or disease of the somatosensory system, affects 6.9 – 10 % of people worldwide. Pregabalin is currently recommended as a first line drug for NP in South Africa. Methods A cross-sectional retrospective descriptive medicines usage evaluation (MUE) of Pregabalin at Groote Schuur Chronic Pain clinic for the year 2017 was conducted. A MUE using a standardized data collection form was performed on 100 randomly selected folders. Data are summarized using descriptive statistics. Results The majority of cases were women (76) with a mean age of 55.9y (SD12.49). A diagnosis of NP was recorded in 58 folders and a “possible” diagnosis recorded in 7 folders. In 79 cases there was no mention of a tool/method used to diagnose NP. The most common condition diagnosed was chronic post-surgical pain with a neuropathic component (n=16), followed by NP (n=15). The most common initiating and current dose of Pregabalin was 75mg twice daily. In 56 patients, Pregabalin was prescribed in conjunction with a tricyclic antidepressant (TCA) or selective noradrenaline reuptake inhibitor (SNRI). Patient education was documented as having taken place in 76 of cases. Conclusions Based on this MUE we recommend the use of screening tools for the diagnosis of neuropathic pain, and a focus on the initiating dose of Pregabalin. The use of a standardized assessment document and the interdisciplinary team input at this clinic appears to optimize prescribing of Pregabalin in line with practice guidelines.
Open Access
How WEIRD are the South African acute pain guidelines? An analysis of the 2015 South African acute pain guidelines
(2022) Deedat, Raees; Parker, Romy
Background: There is increasing recognition that health care research is biased owing to skewed reliance on data from WEIRD (Western, Educated, Industrialized, Rich, Democracies) populations. This research explores health care discrepancy, primarily experienced by non-westernised, non-industrialised, non-rich and non-white people in the context of formulating the South African Acute Pain Guidelines, 2015 as published by the South African Society of Anaesthesiologists (the extant protocol at the time of writing). Methods: An established, peer-reviewed and published WEIRD (Western, Educated, Industrialized, Rich, Democracies) / non-WEIRD protocol for categorizing clinical population datasets was applied to the published datasets used in formulating the 2015 South African Acute Pain Guidelines. Results: A total of 5,246,847 patient data points were included in the numerous studies that formed part of the final analysis. Only 1% (n=73,539) of the patient data points originated from countries classified as nonWEIRD. Conclusions: The results confirmed the hypothesis that the 2015 South African Acute Pain Guidelines are based primarily on data from WEIRD population datasets. This study reveals an important type of bias in the scientific pain literature and also demonstrates a form of analysis that will encourage future published guidelines and research to be more inclusive of the depth and diversity of South African clinical practice.
Open Access
An investigation into the impact on low back pain of an educational leaflet designed according to lifestyle and need
(2008) Yates, Deborah; Jelsma, Jennifer; Parker, Romy
Low Back Pain (LBP) is a major health problem in many countries at considerable cost to the economy but there is little information available regarding LBP in South Africa. The prevalence and impact is likely to be similar to elsewhere. As South Africa has a small health budget and many health problems to attend to, a cost effective approach to the management of LBP would seem essential. Education, information and advice have been shown to be effective in treating some aspects of LBP and a leaflet is a low-cost method of providing these. Apparently if a leaflet is designed according to the needs of a specific population. it has the potential to be more effective within that group. It has been suggested that the use of such leaflets should be investigated before more expensive treatment. This study therefore aimed to develop an information leaflet about LBP that was appropriate for a resource poor community in Cape Town. The impact of this leaflet was then examined in a second stage of the project. Stage One: Pamphlet development. Stage One: To compile a lifestyle profile of people seeking help for LBP in a resource poor community and to use this profile. together with information about perceived needs of these people regarding LBP. to develop an information leaflet. Method Stage One: Sample: Adults (over the age of 18 years) of a resource poor community who attended the community health centre to consult the doctor for an episode of ALBP, and who agreed to participate in the study, were interviewed about their lifestyle and their perceived needs regarding information to help them manage their LBP. Instrumentation: The Lifestyle Questionnaire consisted of 116 questions, which were based on information obtained from the literature review and the 20-year experience of physiotherapy of the researcher.
Open Access
An investigation into the nature and prevalence of musculoskeletal conditions among women attending a community clinic, and the effectiveness of an intervention programme for these patients
(2016) Barnes, Roline Yvette; Jelsma, Jennifer; Parker, Romy
The thesis set out to document the process of developing and testing a non-pharmacological biopsychosocial intervention programme which included exercise and health education for women with musculoskeletal conditions attending a clinic in a poorly resourced area of the Free State Province in South Africa. To inform the development of an appropriate intervention, several sub-studies were undertaken. Systematic reviews on the use of exercise and health education in adults were undertaken, one on the impact of these interventions on adults with chronic diseases of lifestyle (diabetes mellitus type II, hypertension) and the risk factor obesity, and the other on the impact on adults with musculoskeletal conditions. The selected research tools, which were chosen based on the framework of the International Classification of Functioning, Disability and Health (ICF) were subjected to a rigorous translation process. A facility-based descriptive observational cross-sectional study was undertaken to determine the prevalence and nature of musculoskeletal conditions amongst women between the ages of 40 and 64 years attending a community clinic. The gathered information was then used to modify and adapt existing non-pharmacological programmes and develop an intervention programme tailor made for these patients. Finally, an experimental randomised controlled trial was undertaken to determine the effectiveness of usual care against a non-pharmacological intervention utilising a workbook for the women identified in the survey.
Open Access
Levels of physical activity in people living with chronic pain: Do they change after participating in a Chronic Pain Management Program?
(2019) Swartz, Damian; Parker, Romy
Purpose: The purpose of this study was to determine whether levels of physical activity in people with chronic pain change after participating in a Chronic Pain Management Program (CPMP) at Groote Schuur Hospital (GSH). Methods: A pre-experimental pre-test, post-test study was conducted, consisting of 14 men and women suffering from chronic pain who were referred to a Chronic Pain Management Program (CPMP) from the Chronic Pain Management Clinic at GSH in Cape Town, South Africa. Subjective and objective measuring tools, including pedometry, were used to collect data and non-parametric analysis was conducted to analyse data. Results: 14 participants met the Inclusion criteria. Levels of physical activity changed markedly, but not significantly. Objectively-tested and self-reported physical activity levels changed significantly among participants who took part in a CPMP. Significant improvements in Pain Severity Scores and Pain Interference Scores occurred after the CPMP and there was convergent validity between self-reported and objectively-tested levels of physical activity in those suffering from chronic pain after the CPMP. Conclusion: The Chronic Pain Management Program at Groote Schuur Hospital in Cape Town has shown to improve function and physical activity of those patients living with chronic pain who take part in the CPMP, with function improving significantly, and physical activity nearly doubling in the group being tested who took part in the 5-week long program. The CPMP at GSH should be seen as the beginning of a greater movement towards increasing physical activity in the chronic pain sphere. Research in more public healthcare facilities is needed to increase knowledge around education, pacing and implementation strategies across South Africa.