OpenUCT :: Browsing by Subject "Physiotherapy"

Browsing by Subject "Physiotherapy"

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Open Access
A systematic review protocol on the effectiveness of therapeutic exercises utilised by physiotherapists to improve function in patients with burns
(BioMed Central, 2017-10-23) Mudawarima, Tapfuma; Chiwaridzo, Matthew; Jelsma, Jennifer; Grimmer, Karen; Muchemwa, Faith C
Background: Therapeutic exercises play a crucial role in the management of burn injuries. The broad objective of this review is to systematically evaluate the effectiveness, safety and applicability to low-income countries of therapeutic exercises utilised by physiotherapists to improve function in patients with burns. Population = adults and children/adolescents with burns of any aspect of their bodies. Interventions = any aerobic and/or strength exercises delivered as part of a rehabilitation programme by anyone (e.g. physiotherapists, occupational therapists, nurses, doctors, community workers and patients themselves). Comparators = any comparator. Outcomes = any measure of outcome (e.g. quality of life, pain, muscle strength, range of movement, fear or quality of movement). Settings = any setting in any country. Methods/design: A systematic review will be conducted by two blinded independent reviewers who will search articles on PubMed, CiNAHL, Cochrane library, Medline, Pedro, OTseeker, EMBASE, PsychINFO and EBSCOhost using predefined criteria. Studies of human participants of any age suffering from burns will be eligible, and there will be no restrictions on total body surface area. Only randomised controlled trials will be considered for this review, and the methodological quality of studies meeting the selection criteria will be evaluated using the Cochrane Collaboration tool for assessing risk of bias. The PRISMA reporting standards will be used to write the review. A narrative analysis of the findings will be done, but if pooling is possible, meta-analysis will be considered. Discussion: Burns may have a long-lasting impact on both psychological and physical functioning and thus it is important to identify and evaluate the effects of current and past aerobic and strength exercises on patients with burns. By identifying the characteristics of effective exercise programmes, guidelines can be suggested for developing intervention programmes aimed at improving the function of patients with burns. The safety and precautions of exercise regimes and the optimal frequency, duration, time and intensity will also be examined to inform further intervention. Systematic review registration. PROSPERO CDR42016048370.
Open Access
An exploration of services and member profiles at Senior Service Centres in the Western Cape, South Africa
(2018) Harris, Fahmida; Amosun, Seyi Ladele; Kalula, Sebastiana
Introduction The number of South Africans aged 60 years and older is increasing. The National Development Plan (NDP) aims to raise average life expectancy to 70 years by 2030. In response to similar global trends, the World Health Organization (WHO) developed the global Active Ageing Policy Framework (AAPF) to inform the actions taken by countries to address the needs of older persons, acknowledging the different contexts and cultures. The WHO recommended that the framework should have been evaluated to test its applicability and use in member countries by the first half of the twenty-first century. In South Africa, Senior Service Centres for Older persons were set up in communities to provide services to enhance the achievement of the goals of the AAPF. Unfortunately, little information is available on how the framework has been applied to inform services offered in African countries, including South Africa. This study explored services provided by Service Centres for Older Persons in the Western Cape using the WHO framework on Active Ageing as a guide to the services. The study was conducted in two phases. Aims In the first phase, the study explored the characteristics of Service Centres – the organisational structures, the types of services offered, the profile of the managers, and their perception of the needs of the members of the centres. In the second phase, the study explored the profile of the members of these centres by determining their socio-demographic profile, health and psychosocial characteristics. Methodology In phase 1, forty-one service centres were selected by stratified random sampling to proportionally represent the five districts and the Cape Metropole in the province. Only 35 service centres consented to take part in the study. In phase 2, a sample of convenience was recruited from 3 051 registered members at the 35 service centres. Only 625 members consented to participate. A cross sectional, descriptive research design was utilised to collect data on the characteristics of the service centres from the managers, using a modified self-developed questionnaire. To explore the profile of members of the service centres, a self-developed questionnaire and two standardised questionnaires namely, World Health Organization Quality of Life-BREF (WHOQOL-BREF) and World Health Organization Disability Assessment Schedule II (WHODAS II), were administered. Data analysis Descriptive statistics were used to analyse the responses to the closed-ended questions in phases 1 and 2 of the study, and data presented as frequencies. Similarly, responses to the open-ended questions were summarised and themes were identified. In phase 1, quantitative and qualitative responses were analysed according to the WHO Active Ageing Framework. In phase 2, the data generated were analysed according to the WHO International Classification of Functioning, Disability and Health Framework (ICF) model. Results Services offered to members at the centres in the six categories of determinants of the AAPF included the following: • Health and social care systems – Limited screening programs were provided as part of health promotion and disease prevention services. • Behavioural – Physical activity/exercise programmes were most common, but no programs addressed healthy eating habits, tobacco and alcohol abuse, or adherence to medication use. • Personal factors – Services were provided to enhance members’ cognitive skills. • Physical environment – No services were offered on falls prevention. • Social environment – Different types of social support programmes were offered, including meeting education and literacy needs of members through the provision of Adult Basic Education Training (ABET). • Economic – Some centres offered members opportunities for formal work and volunteering, while some provided income generation activities. Most of the managers had high school education but expressed the need for training to manage these centres. The managers perceived the needs of the members would relate to health care, social support, inactivity, isolation and safety among others. The summary of the profile of the 625 members of the centres are presented in the domains of the ICF model: • Personal factors – The members were predominantly widowed women with a mean age of 74.1 ±7.51 years (range 60–100 years). Most members displayed good lifestyle habits and engaged in various leisure and physical activities. Members were also satisfied with themselves, their health, bodily appearance and quality of life and reported a variety of aspirations for their future with and without possible future-orientated behaviours. • Health conditions – Hypertension, arthritis and diabetes were the most common health problems reported by members for which they took medication. Falls were not common among members although the majority feared falling. • Body structure and function – Most members expressed good cognitive function, could concentrate and follow conversations, and reported no hearing, visual or bladder problems. Members also reported good postural balance. • Activities and participation – Members were satisfied with their abilities to do daily activities, participate in the community, and learn new tasks. • Environmental factors – Most members resided with their children or family for various reasons, including needing care for themselves or to provide care to their children and/or extended families. Discussion and conclusion Using the WHO AAPF as a guide, it was found that services provided by Service Centres for Older Persons in the Western Cape, although varied, were deficient at most service centres. The managers responsible for providing these programmes were women with limited skills who needed more education and training to be able to manage the centres appropriately. The members of service centres, despite presenting with health challenges and multi-morbidities, indicated aspirations for the future. In view of the goals of the National Development Plan (NDP) to increase life expectancy of older persons to 70 years by 2030, a more comprehensive exploration of the profile of older persons will assist the managers of the Service Centres to respond more appropriately to the diversity of needs and interests of members.
Open Access
The association between prematurity, motor fuction and health related quality of life among learners in the foundation primary phase
(2017) Oosthuizen, Henriëtte; Ferguson, Gillian D; Jelsma, Jennifer
Introduction and Aims: Children born prematurely (≤ 36 weeks gestation) are at risk of poor developmental outcomes and are more likely than their full-term (FT) peers to have behavioural, physical and/or cognitive limitations. In order to deliver effective interventions, therapists need to have a sound understanding of the problems experienced by children who were born prematurely. Presently, very little is known about the functional problems of young school aged children, living in the Free State province of South Africa, who were born prematurely. Methodology: This study was conducted in 15 randomly selected schools located within in a 100 km radius of Bloemfontein. Two groups of children in grades R, 1 and 2 (age range: 5-8 years) were recruited, the first group (PREM group) consisted of children having a history of premature birth (≤ 36 weeks). The second group consisted of full term children (FT group) who were matched for age and gender to the first group. The PREM group was categorised into three subgroups according to prematurity status: late premature (34-36 weeks, LP), moderate (MP) to very premature (29-33 weeks, VP) and extremely premature (≤ 28 weeks, EP). A self-designed questionnaire was used to record demographic and medical information obtained from parents. The questions were related to antenatal factors, birth and medical history of the child. The Movement Assessment Battery for Children second edition (MABC-2) and MABC-2 Checklist were used to evaluate functional motor problems in children. The European Quality of Life Dimension Scale- Youth version (EQ-5D-Y) was used to determine the Health Related Quality of Life of the children and the Strengths and Difficulties Questionnaire (SDQ) was used to describe the behavioural and emotional status of each child according to their parents and teachers. Ethical approval was obtained from the University of Cape Town Research Ethics Committee (HREC REF: 694/2014) and permission to conduct the study within schools was granted by the Free State Education Department. Informed consent and assent was obtained. Parents were interviewed by a research assistant using the self-designed questionnaire. A different researcher then tested all children using the MABC-2 and assisted each child to complete the EQ-5D-Y. The parents and teachers each completed the SDQ and teachers completed the MABC-2 checklist. Statistical analysis was conducted using SAS® Version 9.4 and STATISTICA 10. The data were summarized using descriptive statistics (i.e. number of available data (n), mean, and standard deviation, minimum, median and maximum). The Mann Whitney U test was used to compare groups (PREM vs FT groups) and the Chi-square test was used to determine any association between groups and 5 descriptive variables. Comparisons between prematurity subgroups were conducted using the Kruskal- Wallis ANOVA. Results: 122 children participated in this study: 61 FT children and 61 PREM children. The PREM group consisted of 23 children who were classified as late premature, 27 who were moderate to very premature and 11 children who were extremely premature There were no differences between groups in terms of age (U = 1760, z = -0.51, p = 0.610), gender (Chi = 0.03, df = 2, p = 0.86), grade level (Chi = 0.386, df = 3, p = 0.98) and socioeconomic status [as defined by mothers level of education (Chi = 3.79, df = 2, p = 0.15) and school quintile (Chi = 5.22, df =2, p = 0.07)]. Differences were found in terms of maternal age at delivery (PREM = 31.9 years [SD=5.2] vs. FT = 29.02 years [SD = 3.5] df = 120, t = -3.61, p < 0.001). As expected, the PREM group had a significantly lower birthweight compared to the FT group (PREM = 2201g [SD = 748] vs. FT = 3132g [SD = 406], df = 120, t = 8.54, p < 0.001). 96.7% of those in the PREM group were born via C/section (p < 0.0001). Apart from one case of respiratory distress, the FT group reported no neonatal complications. As expected, more candidates in the PREM group were more frequently hospitalised (Chi = 34.605, df = 2), and cases of CP were reported. The APGAR scores were significantly different between FT and PREM groups at 1min (p<0.0001) and 5min (p<0.0001) Regarding motor performance, there was a significant difference in MABC-2 Total Standard Scores (MABC TSS) (U = 1425.0, z = 2.23, p = 0.026) and the MABC-Checklist Total Motor Scores (U = 1016.5, z = -4.32, p < 0.0001) with FT group performing better and reporting less functional motor problems than the PREM group. Regarding HRQoL, we found that groups were also significantly different in terms of the Mobility domain of the EQ-5D-Y with the Prem group reporting more problems than the FT group (Chi = 6.31, df =1, p = 0.012). No differences were found between groups with regard to the Looking After Myself (Chi = 2.03, df =1, p = 0.153), Usual Activities (Chi = 0.00, df = 1, p = 1.0), Worried/Sad/Unhappy (Chi = 1.22, df =1, p = 0.541), and Pain/Discomfort (Chi = 3.59, df = 1, p = 0.165) domains. In terms of emotional-behavioural status, we found no differences between the two groups in terms of Parent Total Difficulties scores (U = 1791.50, z = -0.351, p = 0.725) as well as Teachers Total Difficulties Scores (U = 1518.0, z = -1.751, p = 0.08). However, the FT group scored lower than the PREM group on the emotional domain (U = 1404.0, z = -2.33, p = 0.02) indicating less problems and higher on the prosocial domain (U = 1335.0, z = 2.68, p = 0.007) indicating more positive factors in this group. On examination of the PREM sub groups, we found no differences in Parent Total Difficulties Score between groups (p = 0.377). When we compared parent versus teacher SDQ scores, 45 (73.8 %) cases where the parent and teacher were in agreement with the "normal" assigned score. In addition, there were 2 (3.3 %) cases were the parent and teacher respectively assigned a score of "abnormal" and "borderline". Regarding the Impact scores, parents/caregivers reported that the difficulties (emotional, conduct, hyperactivity, peer and prosocial problems) did not have an impact on a child's friendship (p = 0.2889), classroom learning (p = 0.2325), leisure activities (p = 0.3585) or their home life (p = 0.1248). In contrast, teachers' responses indicated that the difficulties had an influence on classroom learning (p = 0.0030) but not friendships (p = 0.2374). Discussion: The late premature group made up a bigger proportion of the premature group. This correlates with the PPIP report, where the same trend was noted for the South African premature population (Pattinson, Saving Babies [PPIP], 2012-2013; Kalimba & Ballot, 2013). Findings from this study correlated with literature on PREM children being more at risk of decreased motor function when compared to FT peers (Hack et al., 2002; Chyi et al., 2008; Stephans & Vohr, 2009; Van Baar et al., 2009; Hornby & Woodward, 2009; Van Baar et al, 2013). Fine motor skills is essential in a child's daily activities and very important to function at school. This study indicated a deficiency within fine motor and balance domains within the PREM group. Maternal age surfaced as predictor of motor performance as younger mothers (< 19 years) have an increased risk of low birth weight and premature infants (very and extremely premature) (Schempf, Branum, Lukacs & Schoendorf, 2007; Gibbs, Wendt, Peters & Hogue, 2012; Kalimba & Ballot, 2013; Fall, Sachdev, Osmond, Restrepo-Mendez, Victora, Martorell, Stein, Sinha, et al., 2015; Benli, Benli, Usta, Atakul, Koroglu, 2015). Literature on older mothers (≥ age 35) also showed an increased risk towards premature birth (moderate and very premature) with more medical conditions (such as hypertension and diabetes)-this was not the case in this research (Schempf et al., 2007; Gibbs et al., 2012; Kalimba & Ballot, 2013; Fall et al., 2015; Benli et al., 2015), however it is reported that PREM infants from older mothers show somewhat better outcomes of infants later in life (Schempf et al., 2007; Gibbs et al., 2012; Kalimba & Ballot, 2013; Fall et al., 2015; Benli et al., 2015). Other findings from this research indicated that, from the teachers' perspectives, PREM children showed a greater tendency towards emotional and prosocial behaviour impairments, than the FT population. This align with literature where premature infants are mentioned to be more susceptible to behaviour performance problems at school-age (Kerstjens et al., 2012; Bos et al., 2013; Moreira et al., 7 2014). In this research, the extremely premature group had more behavioural problems which had an impact on theses children's leisure activities, peer, and classroom learning. Conclusion: Our findings suggest that PREM children have more motor problems than FT children and that the very preterm group showed the highest risk for motor problems. Maternal age also indicated to be an influencing factor where mothers younger than 19, as well as mother over 35, both indicated a risk for premature birth, resulting in low birth weight. Other risk factors influencing function in the PREM, apart from low birth weight, indicated by the results were factors like respiratory distress, apnoea, haemorrhaging and the exposure to post-natal steroids. According to teacher's perceptions, the children in the PREM group, tended to show more behavioural and emotional problems that those of the FT sample.
Open Access
Burn injuries in Zimbabwe: development of guidelines for physiotherapy rehabilitation of musculoskeletal impairments and functional limitations
(2022) Mudawarima, Tapfuma; Jelsma, Jennifer
Background and need: Burn injuries are a major cause of hospital admission in low-income countries such as Zimbabwe and often lead to secondary complications such as disfigurements, contractures, and scar formations. The study aimed to establish “Guidelines for Rehabilitation of Musculoskeletal Impairments and Functional Limitations for Zimbabwe for Patients with Burns” based on the best evidence available. There were three good candidates for use as the source guideline, but ultimately, the Agency for Clinical Innovation (ACI) of New South Wales in Australia guidelines1 was chosen. The contextualisation of these guidelines for the Zimbabwean situation was informed by the outcomes of five sub-studies. A summary of the methodologies applied and the key results follow. Methods and Results: The Epidemiology of Burns in Zimbabwe: The characteristics of patients with burns in Zimbabwe was established through a retrospective record review (descriptive review) to characterise patients admitted with burns to the two central hospitals in Harare over fifteen months. The sample consisted of 926 admission records and 435 full patient folders were retrieved and analysed. Unfortunately, 425 full folders of children were missing and 85 folders of adults. There was a clear difference in presentation between children and adults, with children constituting over threequarters of all admissions, but with less severe injuries. Post-discharge follow-up: Access to rehabilitation and impact on Health-Related Quality of Life (HRQoL): The second study investigated the utilisation of post-discharge care, regarding referral after discharge and home programme. This was a study with a small sample, 14 adult and 23 child respondents. Despite referrals having been made to local rehabilitation departments, there was practically no further post-discharge contact with rehabilitation and only a single person received post-discharge rehabilitation. Both Health-Related Quality of Life (HRQoL) instruments used by the adult respondents indicated less impact on physical domains of functioning with the greatest impact in pain and emotional well-being. In the absence of trained counsellors, rehabilitation therapists might need to step into this role. Systematic review: The broad objective of this review was to systematically evaluate the effectiveness, safety and applicability to low-income countries of therapeutic exercises utilised by physiotherapists to improve function in patients with burns. The review, which included 19 papers, established that exercises (either resistance or aerobic), are effective and generally have a positive effect on muscle strength and aerobic capacity. However, there was a risk of bias in many of the papers and the evidence is not of high quality. As most of the research enrolled paediatric patients older than seven years and no adverse effects were reported, it can be concluded that resistance exercise is safe for this group of patients. However, as most children admitted with burns are younger than seven years, exercise needs to be carefully monitored in this group as safety and efficacy have not been proven for younger children. The results from this support the use of aerobic and resistance as an important component of a burn rehabilitation program as they have shown to improve muscle strength aerobic capacity and functional status even after hospital discharge, especially in patients with severe burns. Documentation of the current rehabilitation practice: This phase documented clinical interventions used to treat musculoskeletal problems by observation of seven rehabilitation workers (not only physiotherapists), based in the five central hospitals, one provincial and one district hospital. The treatments of five adults and five paediatric patients were observed at each hospital, a total of 70 treatments in all. The most significant finding was that the management of patients with burns was offered by a single rehabilitation worker a Physiotherapists (PT), Occupational Therapists (OT) or Rehabilitation Technician (RT), working in Burns' Units without any specialised training or additional courses. The management of burns across all hospitals was similar, and information saturation was reached with the planned number of observations. Passive and active movements were used almost universally, and the patients received a ward programme, which included positioning. Sitting and standing were included in some patients and patients were monitored for any adverse effects. A major weakness observed was the lack of baseline assessment or treatment progress during treatment. No compression bandages were applied and no scar tissue massage was done. Identification and adaptation of the suitable guidelines: Following a literature search and examination of different guidelines by two independent reviewers, the Agency for Clinical Innovation of New South Wales, Australia1 was chosen as a candidate for amendment. The guidelines were amended based on the results of the previous studies and subjected to a Delphi process with four to six Zimbabwean rehabilitation therapists who were experienced in the field of burn management. A credible set of guidelines for Zimbabwe for the rehabilitation of musculoskeletal impairments and functional limitations was thus produced. Conclusion: The current study adds to the body of knowledge through the development of guidelines for the physiotherapy rehabilitation of musculoskeletal impairments and functional limitations for patients with burns in low- and middle-income countries. The thesis has provided an evidence-based framework for patients, rehabilitation workers and policymakers to inform the provision of effective management of patients with burns. The Zimbabwe Guidelines should be regarded as a first attempt rather than the final version and hopefully will be subjected to further review as they are tried out in practice.
Open Access
Burn injuries in Zimbabwe: development of guidelines for physiotherapy rehabilitation of musculoskeletal impairments and functional limitations
(2021) Mudawarima, Tapfuma; Jelsma, Jennifer; Grimmer Karen
Background and need: Burn injuries are a major cause of hospital admission in low-income countries such as Zimbabwe and often lead to secondary complications such as disfigurements, contractures, and scar formations. The study aimed to establish “Guidelines for Rehabilitation of Musculoskeletal Impairments and Functional Limitations for Zimbabwe for Patients with Burns” based on the best evidence available. There were three good candidates for use as the source guideline, but ultimately, the Agency for Clinical Innovation (ACI) of New South Wales in Australia guidelines1 was chosen. The contextualisation of these guidelines for the Zimbabwean situation was informed by the outcomes of five sub-studies. A summary of the methodologies applied and the key results follow. Methods and Results: The Epidemiology of Burns in Zimbabwe: The characteristics of patients with burns in Zimbabwe was established through a retrospective record review (descriptive review) to characterise patients admitted with burns to the two central hospitals in Harare over fifteen months. The sample consisted of 926 admission records and 435 full patient folders were retrieved and analysed. Unfortunately, 425 full folders of children were missing and 85 folders of adults. There was a clear difference in presentation between children and adults, with children constituting over threequarters of all admissions, but with less severe injuries. Post-discharge follow-up: Access to rehabilitation and impact on Health-Related Quality of Life (HRQoL): The second study investigated the utilisation of post-discharge care, regarding referral after discharge and home programme. This was a study with a small sample, 14 adult and 23 child respondents. Despite referrals having been made to local rehabilitation departments, there was practically no further post-discharge contact with rehabilitation and only a single person received post-discharge rehabilitation. Both Health-Related Quality of Life (HRQoL) instruments used by the adult respondents indicated less impact on physical domains of functioning with the greatest impact in pain and emotional well-being. In the absence of trained counsellors, rehabilitation therapists might need to step into this role. Systematic review: The broad objective of this review was to systematically evaluate the effectiveness, safety and applicability to low-income countries of therapeutic exercises utilised by physiotherapists to improve function in patients with burns. The review, which included 19 papers, established that exercises (either resistance or aerobic), are effective and generally have a positive effect on muscle strength and aerobic capacity. However, there was a risk of bias in many of the papers and the evidence is not of high quality. As most of the research enrolled paediatric patients older than seven years and no adverse effects were reported, it can be concluded that resistance exercise is safe for this group of patients. However, as most children admitted with burns are younger than seven years, exercise needs to be carefully monitored in this group as safety and efficacy have not been proven for younger children. iii The results from this support the use of aerobic and resistance as an important component of a burn rehabilitation program as they have shown to improve muscle strength aerobic capacity and functional status even after hospital discharge, especially in patients with severe burns. Documentation of the current rehabilitation practice: This phase documented clinical interventions used to treat musculoskeletal problems by observation of seven rehabilitation workers (not only physiotherapists), based in the five central hospitals, one provincial and one district hospital. The treatments of five adults and five paediatric patients were observed at each hospital, a total of 70 treatments in all. The most significant finding was that the management of patients with burns was offered by a single rehabilitation worker a Physiotherapists (PT), Occupational Therapists (OT) or Rehabilitation Technician (RT), working in Burns' Units without any specialised training or additional courses. The management of burns across all hospitals was similar, and information saturation was reached with the planned number of observations. Passive and active movements were used almost universally, and the patients received a ward programme, which included positioning. Sitting and standing were included in some patients and patients were monitored for any adverse effects. A major weakness observed was the lack of baseline assessment or treatment progress during treatment. No compression bandages were applied and no scar tissue massage was done. Identification and adaptation of the suitable guidelines: Following a literature search and examination of different guidelines by two independent reviewers, the Agency for Clinical Innovation of New South Wales, Australia1 was chosen as a candidate for amendment. The guidelines were amended based on the results of the previous studies and subjected to a Delphi process with four to six Zimbabwean rehabilitation therapists who were experienced in the field of burn management. A credible set of guidelines for Zimbabwe for the rehabilitation of musculoskeletal impairments and functional limitations was thus produced. Conclusion: The current study adds to the body of knowledge through the development of guidelines for the physiotherapy rehabilitation of musculoskeletal impairments and functional limitations for patients with burns in low- and middle-income countries. The thesis has provided an evidence-based framework for patients, rehabilitation workers and policymakers to inform the provision of effective management of patients with burns. The Zimbabwe Guidelines should be regarded as a first attempt rather than the final version and hopefully will be subjected to further review as they are tried out in practice.
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 comparative study of the effects of meclofenamate, diclofenac and placebo, in combination with physiotherapy, on the healing of acute quadriceps and hamstring muscle tears
(1991) Reynolds, Jonathan F; Bowerbank, Patricia; Noakes, Timothy D
A double-blind, placebo controlled research technique was used to determine the effects of two non-steroidal anti-inflammatory drugs, meclofenamate and diclofenac, in combination with physiotherapy treatment, on the rate and extent of healing of acute hamstring muscle tears. Sixty patients were recruited and treated at No's 1 and 2 Military Hospitals in Voortrekkerhoogte and Wynberg, Cape Town, respectively. Patients were randomly allocated to one of three treatment groups: meclofenamate, diclofenac and placebo. Patient assessments were performed on days 1, 3 and 7 of the 7-day study period. These assessments included pain assessment (visual analogue scale), swelling measurement (thigh circumference measurement at the site of the muscle tear) and muscle performance test (Cybex isokinetic dynamometer and data reduction computer). All patients received physiotherapy treatment on all 7 days of the study. This comprised early rest, ice, compression and elevation (RICE), and later, ultrasound and deep transverse friction massage. An intensive regime of strengthening and stretching exercises was used throughout the study, beginning with stretching and isometric exercises gradually moving onto isotonic exercises and aerobic exercise including swimming, running and cycling. No competitive sport was allowed during the study period. Statistical significance was determined using the analysis-of-variance (ANOVA) test with an acceptance level of p<0.05. No differences in pain, swelling or muscle performance were demonstrated between the three treatment groups. In terms of the pain and swelling assessments, the injuries did not appear to be very severe. Accordingly, the groups were divided into severe and non-severe sub-groups and statistical significance was determined using the ANOVA test with an acceptance level of p<0.05. A significant difference was found in the severe hamstring injury sub-group. In this group, pain reduction was greater in the placebo group than in the meclofenamate group on day 7. There were no other significant differences found in this sub-group analysis. Relatively few side effects were encountered, and those encountered were mild. No patients were withdrawn from the study as a result of these adverse events. Drowsiness and gastro-intestinal disturbance were the most common side effects reported. In conclusion, the study found that no benefit was gained from the use of meclofenamate or diclofenac in combination with physiotherapeutic modalities as compared to the use of physiotherapeutic modalities on their own. Thus, the widespread use of NSAIDs in the treatment of acute muscle injuries may not be justified.
Open Access
A comparison of hospital-based and community-based models of cerebral palsy rehabilitation
(2013) Dambi, Jermaine Matewu; Jelsma, Jennifer
Cerebral palsy is a disabling and permanent condition which requires sustained rehabilitation over a long period of time. There is much debate as to which model of service delivery is most appropriate for children with cerebral palsy and their mothers. The aim of this study was to compare the efficacy and effectiveness of two models of service delivery currently offered in Harare, Zimbabwe. One of these is a hospital-based and the other a community-based service. A quasi-experimental study was done to determine the efficacy of two service delivery models from the perspective of caregivers and functional gains in children. Questionnaires were distributed to caregivers of children with CP at baseline and after three months. The caregivers were 46 in total, with twenty caregivers having children receiving rehabilitation services under an outreach program and 26 receiving services as outpatients at a central hospital. The caregivers’ health- related quality of life was assessed using the EQ-5D, the burden of care was measured using the Caregiver Strain Index, satisfaction with physiotherapy was assessed using the modified Medrisk satisfaction with physiotherapy services questionnaire and compliance was measured as an index of the met appointments from the scheduled appointments. Additionally, motor functional changes in children with CP were assessed at baseline and after three months using the Gross Motor Function Measurement (GMFM-88). Children receiving community based treatment children were significantly older than children in the hospital based group. However, the two groups were comparable in terms of sociodemographics of both children and caregivers at baseline. The correlation between age and change in score was tested and found to be non-significant (r=-.103, p=.497). Spearman’s rho indicated that as the level of severity increased in terms of GMFCS level, so the amount of improvement decreased (rho=-568, p<;.000). However, as age was significantly different between the two groups and there were more severely affected children in the community based treatment group, regression analysis was done to establish which factors predicted the amount of change in the GMFM Score. Dummy variables were created for the categorical variable of the group and the ordinal variable of GMFCS was dichotomised into level 3 and above and level 4 and below. The resulting model accounted for25% of the variance (adjusted R²= .25) after the score of one child was removed after residual analysis indicated that he/she had improved more than two standard deviations from the mean residual. The results indicate that, once age and category were controlled for, children in the community based treatment group improved 3.5 points more than children receiving hospital based services. Children who were more severely disabled showed 4.7 points less improvement, and for each month of age, children showed .04 less improvement, although this was not significant.
Open Access
A comparison of treatment protocols for infants with motor delay
(2012) Olivier, Odette; Ferguson, Gillian; Jelsma, Jennifer
Purpose: Early intervention (EI) strategies are reported to have positive results on decreasing the extent of motor delay in children. However, most studies regarding treatment of infants with motor delay as a result of psychosocial/environmental factors have taken place in developed countries where resource constraints are not as severe as in the South African context. The aim was thus to determine which intervention protocol (standard vs. intense group orientated therapy) was the most feasible and efficacious for infants with motor delay, primarily due to psychosocial/environmental factors. Methodology: A cross sectional, descriptive, correlational research approach was used to identify infants with motor delay using the Bayley Infant Neurodevelopmental Screener III (BINS) at three Well Baby clinics. After a baseline assessment, infants who met the criteria to participate entered an experimental study consisting of a single blinded randomized control trial. The final sample included 24 infants aged 3 to 12 months. Participants were randomly divided into two groups and a repeated measures design was followed to conduct this study. The Bayley Scales of Infant Development II (BSID II) was used to evaluate motor progress over a three month intervention period. The standard group received treatment once a month for three months compared to a weekly treatment session attended by dyads in the intense group. Care-giver compliance along with their level of satisfaction was investigated using self-structured questionnaires. Results: Twenty four participants were recruited with a mean age of 5.69 months (SD= 2.36; range 3-10.4). Both monthly and weekly treatment groups showed significant motor developmental progress over the intervention period. The overall difference between the groups was not significant (p=.78) and by the final assessment, during the intervention period, both groups displayed similar psychomotor developmental indices (monthly: mean= 87.92, SD= 10.87, range 73-109; weekly: mean= 94.18, SD= 7.63, range 85-109). However there was a medium to large effect size ( d = 0.65) in favour of the weekly treatment group and they also showed better initial developmental progress after 1 month compared to the gradual trend of progress illustrated by the monthly group. After treatment sessions were withheld for six weeks, an assessment of motor performance showed the monthly group retained their skills better than the weekly group. This difference had a medium effect size of d = 0.58 in favour of the monthly group. Care-givers generally showed a high level of satisfaction with no significant differences between groups (p= .64). Similarly, no statistically significant difference was found between the groups in terms of compliance to the home programme. Conclusion: Both the intense and standard group orientated treatment protocols had significantly positive results after treatment. The intense group showed rapid initial progress compared to the monthly group. However, the monthly group better retained their skills after treatment was discontinued. Therefore, in a South African, low socio-economic context, the monthly protocol might be more practical and cost effective.
Open Access
A cross cultural study of motor development in the Western Cape
(1986) Irwin-Carruthers, Sheena Margaret Hamilton; Molteno, Christopher D
Despite conflicting evidence regarding advanced motor behaviour in black African infants, very few comparative studies have been published. Reliable developmental norms for local populations are essential for the early identification of developmental disabilities. In this study the sample consisted of 681 black and 741 white infants drawn proportionally from the Child Health Care Clinics in the northern areas of greater Cape Town. Babies were sampled in specified age-intervals between the ages of 16 and 1170 days. Variables studied were sex, birth-ranking, weight-percentile at the time of testing, marital status of the mother, parents' education and occupation, family size and family income. The demographic characteristics of the sample were compared with those of the population as a whole, based upon the 1980 census. The testing instruments were the gross and fine motor-adaptive sections of the Denver Developmental Screening Test, supplemented by another 21 items representing reflex reactions or specific components of movement. These supplementary items were pre-tested for inter- and intra-observer reliability. The percentage of children responding to the different tests at different ages was determined by probit analysis or, where more appropriate, by non-parametric logistic regression. Differences between the black and white South African infants were subjected to further statistical analysis, as was the contribution of the different variables to the attainment age. Comparison of the performance of the South African infants with the Denver norms showed that both black and white babies were in advance of the Denver children on the majority of fine motor items. The black infants were also considerably advanced in gross motor behaviour; the white infants less markedly so. In the very few (3) items in which the Denver children excelled, doubts exist regarding either scoring criteria or cultural suitability. Comparative analysis of the two South African samples identified certain consistent developmental trends. The black infants performed better on basic grasping patterns whereas the white infants were advanced in manipulative skills. The black infants were advanced on gross motor behaviour in the first year but were overtaken by the white group on learned gross motor skills in the second and third year, with the exception of items requiring physical strength. Very little correlation could be shown between motor achievement and socio- economic factors. Differences appear to be largely due to child-handling practices and experiential learning, but ethnic characteristics may well play a role in the advanced early gross motor development of the black infant. Heavier infants also performed better in both groups, indicating nutritional influences. The clinical implications of the findings are discussed and recommendations made for implementation and for further research.
Open Access
Cross-sectional analysis of car restraint system use during transportation of children with special health care needs in the Western Cape
(2020) Phillips, Kerry-Ann; Corten, Lieselotte; Scott, Desiree
Background: Road traffic injuries are the leading cause of death in children and young adults. Children are at increased risk of fatalities and serious injury due to the differences in their body segment proportions affecting their body kinetics in a vehicle accident. Serious injury and death can be reduced by the appropriate use of car restraint systems (CRS). Children with special health care needs (CSHCN), particularly children with poor postural control, may need adaptive seating to improve postural support and sitting ability within the vehicle due to their additional physical needs. Standard CRS might be unsafe or inappropriate for children with physical disabilities. Research Aims: The thesis aimed to understand the current CRS usage as well as the parents' experiences and perspectives of transportation of CSHCN in the Western Cape, and to determine the postural support needs of CSHCN and the suitability of different CRS designs to meet these needs during transportation. This was achieved through a survey study, followed by a cross-sectional study. Assessing the use of car restraint systems in children with special health care needs; a Western Cape based survey study Objectives: To determine the modes of transport and the prevalence of the use of postural support systems by CSHCN. Along with describing the current use of seatbelts, standard or specialised CRS and exploring the challenges faced by parents of CSHCN during transportation. Methods: A descriptive quantitative survey was performed amongst a convenience sample of all parents of CSHCN between the age of 4 – 18 years enrolled at three special needs schools in the Western Cape, South Africa. Parents had to be able to read and understand English or Afrikaans to be eligible for enrolment in the study. Focus group discussions were conducted to validate the self-designed questionnaire. Results: Parents of 268 children were enrolled in the study (median (IQR) age 11.52 (14.63- 8.86) years; 58.96% male). The most common diagnosis was cerebral palsy (CP) (29.10%), and most children were transported to school with public transport, including school bus (73.13%). The mode of transport was linked to the distance travelled and affordability, and each had its own challenges. The main challenges of parents using private transport were transporting the wheelchair (10.82%) and the unavailability of demarcated disability parking bays (7.46%). When using public transport parents identified their child's poor sitting balance (6.34%) and lack of space within the vehicle (5.60%) as the greatest challenges. The majority of children (58.96%) came from low-to-middle income households (< R6500 per month), significantly impacting the use of a CRS, with more children from higher income families being transported in a CRS (X²= 48.14, p< 0.001). Difficulties with sitting balance was reported in 25.75% of the children and was significantly association to the parents understanding of their child's sitting balance (X²= 17.72, p< 0.001). Parents who felt that their child had difficulty with their sitting balance were more likely to use a CRS. Furthermore, a significant association between currently using a CRS and child's weight was observed (X²= 11.54, p=0.021), as children who weighed more were less likely to still be using a CRS. Most parents (54.48%, n=146) did not know South Africa's current legislation on CRS, which was significantly associated with a lower CRS usage (X²= 19.84, p< 0.001). Half of the parents (n= 139, 51.87%) were not willing to spend money on a CRS as they felt that a car seat was not necessary for their child. The amount parents were willing to spend on a CRS was significantly associated with having ever made use of a CRS (X2=43.38, p< 0.001). Conclusions: Parents of CSHCN reported many challenges in transporting their child depending on the mode of transportation. CRS usage was associated with parent perception on the child's sitting abilities, lower weight, knowledge of legislation and a higher household income. Despite these, CRS usage amongst CSHCN is lower than expected as (48.88% – 55.22%) children that are still within the age and weight range to use a CRS as required by law did not report CRS usage. This could link in with the affordability of the CRS and failure to know the legislation on CRS by parents. This study highlights the need for national campaigns to promote and educate citizens on road safety and CRS legislation. Due to the lack of financial resources in low to middle income countries, it is vital that an affordable CRS is made available or is subsidized by the government where families are unable to afford the cost themselves, particularly for use in public transport. Effectiveness of currently available car restraint systems to maintain correct seating position during transportation for children with special health care needs Objectives: To determine the characteristics of CSHCN who require specialised CRS for their postural support needs, through assessment of their sitting ability and whether these needs are met by different CRS. Methods: Participants in the earlier survey study were invited to take part in a crosssectional and pre-post design study. A screening tool for identifying sitting balance problems was developed and found to be reliable for inter- and intra-rater reliability (k>0.700, p0.879). This tool was used to identify CSHCN who had difficulty sitting independently on different types of seats. These participants underwent a standardised sitting balance assessment, using the Level of Sitting Scale (LSS), to identify eligible participants with postural support needs. Participants were excluded if they recently had surgery or had an unstable health condition which could alter their sitting balance. The ability of two standard CRS (Car Seat and Booster seat), two Specialised CRS (one locally and one internationally produced), and Seatbelt only to provide adequate postural support was investigated. Head and trunk postures were analysed and categorised, by deviation from the midline, by photographs taken from different viewpoints. Results: There were 78 CSHCN enrolled in the study (mean (SD) age 11.50 (3.70) years; 65.75% male), the most common diagnosis was CP (63.48%), the majority of participants did not require any support to maintain sitting balance and were categorised as levels 5-8 of the LSS (78.08%). According to the World Health Organisation anthropometric guidelines 54.79% (n=40) of the participants should still use a CRS, either a Booster Seat (42.47%, n=31) or a Car Seat (12.33%, n=9). The head or torso fully supported and between the side supports of the CRS was the most common posture in all the viewpoints of the different CRS except for the lateral head viewpoint of the CRS Car Seat (50.00%; n=4), the Booster Seat (60.00%; n=18), and the International Specialised CRS (60.61%; n=20), as well as the anterior torso viewpoint of the Seatbelt only (50.75%; n=34). The CRS that resulted in the largest proportion of unacceptable posture deviations from the standard position were the Seatbelt only (20.90%, n=56) and the Booster Seat (18.33%, n=22). Out of position (OOP) postures were observed in all the devices for the anterior and lateral head positions (3.03% - 20.00%). The Booster Seat, the Local Specialised CRS and the Seatbelt only devices had participants with OOP postures in all four viewpoints. A key observation in the current study is the lack of torso support for the majority of CSHCN in the anterior torso viewpoint of the Seatbelt Only CRS (55.22%, n=37), indicating that the use of a Seatbelt only does not provide adequate postural support for all CSHCN despite them meeting WHO anthropometric requirements. No significant association was found between the pre- and post-test postural analysis scores of the Seatbelt only (X2=2.14, p=0.144) which could be as a result of the large postural deviations pre-testing (41.79%, n=28) remained post-testing. However, there was a significant association between the preand post-test scores of the anterior head viewpoint of the Booster seat (X2= 7.94, p=0.005), indicating lateral head deviation. The post-test postural analysis score of the Booster Seat anterior head viewpoint was significantly associated with a deviated posture (X2= 7.94, p=0.005). Other OOP observations included postures that could not be categorised by head and trunk deviation from the midline including head or torso rotation, abnormal limb placement, body extension and slouching. Overall performance scores are a sum of the number of viewpoints where the CSHCN posture worsens post-test. an indication of the number of CSHCN whose posture worsened post-test in each of the viewpoints of the CRS. Although there was no correlation between the LSS score and the overall performance score of any CRS device which would indicate if the CSHCN balance influences CRS performance, the Booster Seat (80.00%, n=24) and the Seatbelt only (55.23%, n=37) devices had the greatest number of participants with a poor overall performance. The viewpoints which had the worst performance scores were the anterior and lateral head of the Booster Seat (46.67%, n=14 and 43.33%, n=13 respectively) and both viewpoints had majority of participants worsen their scores. All CRS performed adequately in the lateral torso viewpoint, indicating sufficient support of the torso in the sagittal plane. Conclusions: The postural support needs of CHSCN are unique and depend on the child's anthropometry and the severity of their disability. The currently available CRS designs may not provide the postural support needed for many CSHCN. Postural deviations of the head, torso and limbs were observed which could be dangerous in the event of an accident. This study was not able to determine specific characteristics of CSHCN that require specialised CRS, as there was no association between the LSS and the overall performance score for any of the CRS devices. However, devices that offer less head and torso lateral support, or do not offer additional harness support such as the Seatbelt Only and the Booster Seat showed the largest proportion of OOP postures in CSHCN. Thesis Conclusion: This thesis highlights the complex transportation needs of CSHCN in South Africa and how the different CRS can influence posture. Additional observational research is required to determine the CRS usage in the CSHCN population to compare to the prevalence of CRS usage found in this survey study. Future research could incorporate other specialised CRS designs, particularly ones that are suitable for CSHCN beyond standard CRS weight and height limits or those with severe physical limitations that could not be tested during this study's simulated course. Practitioners prescribing and advising parents on CRS devices for the safe transportation of CSHCN should integrate thorough patient assessment and knowledge of manufacturer CRS design specifications to promote CRS usage. Policies should consider and accommodate for the challenges faced by CSHCN and their families in accessing, affording and utilising transport services. Advocacy and education programs should be combined with legislation enforcement to support improved implementation of CRS usage amongst all children, regardless of their disability status. For effective implementation for CSHCN, CRS should be affordable, accessible, functional and accommodate growth and postural support needs.
Open Access
The development of posture in very low birthweight infants (<1500 grams)
(1993) Magasiner, Vivien Adele; Molteno, Christopher D; Malan, A
The aims of the study were to examine postural development in very low birthweight and normal birthweight infants and to determine whether deviant postures were predictive of adverse neurodevelopmental outcome. In the first part of the study the 7 postural responses selected by Vojta to evaluate neuromotor development were applied to 69 very low birthweight (VLBW < 1 500 grams) infants and to 28 healthy full-term infants of normal birthweight (> 2500 grams). Of the 69 VLBW infants, 43 were small for gestational age and 26 appropriate for gestational age. All infants were examined at term and 4 months corrected age. They were all later assessed on the Griffiths Mental Development Scale at 12 and 18 months corrected age. There were significant differences in postural reactions between the 2 groups which confirmed the lower tone and greater extension previously described in VLBW infants. An important finding in the study was that poor head and trunk righting noted at 4 months corrected age in VLBW infants, was associated with less developed locomotion at 12 and 18 months as assessed by the Griffiths Mental Development Scale. Thus, a delay in maturation in VLBW infants which was apparent from the assessment of postural responses was still identifiable on the locomotor sub-scales at 12 and 18 months. Five of Vojta's responses were shown to be useful as part of the neurological assessment of high risk infants. In the second part of the study, the 5 useful Vojta responses were incorporated into the Infant Neurodevelopmental Assessment (INA) which was used to assess 76 high risk VLBW infants. The 76 infants consisted of 34 infants with intracranial lesions on ultrasound and 42 without intracranial lesions. All infants were assessed at term and 4 % months corrected age using the INA. At 12 months corrected age they were all assessed on the Griffiths Mental Development Scale. Six infants were diagnosed as having cerebral palsy, all of whom had intracranial lesions. Several clinical signs indicative of cerebral palsy were significant at 4 % months corrected age and will be useful in future studies to diagnose cerebral palsy early. The association between lack of head and trunk control at 4 % months corrected age and a lower locomotor score at 12 months corrected age proved to be significant again and reinforces the finding that early delay in maturation is identifiable on the locomotor scale at 12 months corrected age.
Open Access
Disability in under-resourced areas in the Western Cape, South Africa : a descriptive analytical study
(2015) Maart, Soraya; Amosun, Seyi L; Jelsma, Jennifer
Disability is a complex construct, and our understanding of it has evolved over the years from a purely medical description to encapsulating the experience of those with disability in the context in which they live. The International Classification of Functioning, Disability and Health (ICF) provides a framework to explore the concept in a biopsychosocial framework taking into account the interaction of a person with a health condition with their environment. The central purpose of this thesis was to explore disability within an under resourced context in order to provide data to service planners to improve the health and well-being of those affected. The exploration of disability involved a cross-sectional survey using instruments based on the ICF framework including the Washington Group Short Set of Questions on Disability, the WHODAS-2, the WHOQOL-BREF and the EQ-5D. The objectives were to establish the prevalence of disability and the description of the impairments, functional limitations and participation restrictions of those identified with disabilities. A total of 950 households were visited in Oudtshoorn (a semi-rural town) and Nyanga (a peri-urban area) and information was gathered on 7336 individuals with a mean age of 30.5 years. The majority of the participants were women. Both areas presented with estimates higher than those from the national census (5.0-6,7%). The urban area of Nyanga presented with a disability prevalence of 13.1% and the semi-rural area of Oudtshoorn with a prevalence of 6.8%. Overall the disability rate was 9.7%. The types of impairment and functional limitations were similar in the two areas, but more severe disability was reported in the semi-rural area, that also had significantly more elderly people. Non-communicable diseases were identified as the major cause of disability in both areas, followed by communicable diseases in Oudtshoorn and unintentional trauma in Nyanga. However, a person was twice as likely to be disabled due to non-communicable disease (Odds Ratio 2.2) when living in Oudtshoorn, and three times more likely to be disabled due to intentional trauma when living in Nyanga (Odds Ratio 0.3). Non-communicable diseases were responsible for the largest number of healthy life years lost. Those living in Nyanga had a higher burden of disability due to their lower quality of life scores as measured by the EQ-5D. Respondents in Nyanga consistently scored higher (worse) on all domains of the WHODAS-2 compared to respondents in Oudtshoorn. Living in Nyanga was associated with a 10% increase in domain scores. However, the pattern of scoring was similar and both areas reported worst functioning for the domains of Getting Around and Life Activities, which are associated with physical mobility. Respondents in Oudtshoorn reported better QoL and HRQoL than those in Nyanga. Functional level predicted the QoL scores, with Nyanga reporting worse functioning. Being employed and married was associated with a higher (better) EQ-5D VAS score, while mobility problems, pain or discomfort and anxiety or depression decreased the score. Transport was the most commonly identified barrier in both areas. Major barriers for those living in Oudtshoorn were Surroundings and Help in the home, whereas Help in the home and Prejudice and discrimination were viewed as the major barriers for respondents in Nyanga. The elderly were the ones most likely to not receive the rehabilitation services that they needed. The conclusions that can be drawn from this research are that context influences the experience of disability, and that disability prevalence alone is an insufficient basis for service planning. Those who experience greater deprivation also have a worse experience of disability. It is therefore essential for South Africa policy makers to view disability through a socio-political lens to ensure the equalisation of opportunities for people with disabilities. Improved quality of life for those living in under-resourced communities should be a priority. Service providers should have a broad range of skills to enable them to address not only the rehabilitation needs of people with disabilities, but also their social needs.
Open Access
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.
Open Access
The effect of a teacher-based intervention programme for primary schools on learner's health-related quality of life, body mass index and physical fitness: a randomised control trial
(2017) Bowers, Jodie; Naidoo, Nirmala
Background: Childhood obesity, a rising problem world-wide and within South Africa, has been negatively linked with both physical fitness (PF) and health-related quality of life (HRQoL). The school environment is the ideal setting for children to obtain the skills and knowledge to increase physical activity (PA) levels and healthy diets. PA and school-based nutrition intervention programmes have been shown to have positive effects on diet and PA behaviours in children. However, there is minimal literature reporting on the effectiveness of school-based interventions in a South African setting. Aim: The primary aim of the first phase of the study was to provide a contextual background regarding the provision of PA in school-based PE programmes within a small sample of schools from which the learners in the intervention study were drawn. The primary aim of the second phase of the study was to determine the effect of a teacher-based intervention programme after six weeks for primary schools with less than the mandated amount or no specific amount of PE on learner's HRQoL, Body Mass Index (BMI) and PF. Methodology: Ten schools were randomly selected from the circuit lists within the Port Elizabeth Education District. Ten staff members from the selected schools completed the School Environment Questionnaire in order to provide a situational analysis regarding the provision of PA in school-based PE programmes. A sample of 300 learners (aged nine to eleven) from four randomly selected schools participated in the pre-testing measures in order to establish the weight status (using BMI and waist circumference (WC)), HRQoL (using the EQ-5D-Y), and PF (using the Eurofit test battery). Class teachers, from schools with less than the mandated amount of PE or no specific amount of PE, who were part of the experimental group, implemented the intervention. In order to implement the intervention, they received training and were given a PE programme booklet. The PE intervention programme was in line with the Curriculum and Assessment Policy Statement teaching plan for life skills, and was based on targeting the deficiencies found in the pre-testing fitness measurements. Post-testing measures, using the same learners, were conducted six weeks later. The obtained results were analysed using STATISTICA version 12. Results: Phase one of the study revealed that PE was provided at all schools. The curriculum was followed by 90% of schools, but only 30% had teachers with PE qualifications. PE policies and practices were being developed and/or implemented in 70% of schools, and 50% had no specific amount of time mandated to PE, or less than the mandated amount. Soccer was offered at all schools, and 80% of schools had access to an outdoor sports field and an outdoor paved area. Phase two of the study found that the control and experimental groups were not equivalent at baseline with regard to gender distribution, BMI Z-scores and interpretations, the EQ-5D-Y "looking after myself" variable, and the sit-up test. No positive significant differences were noted in BMI Z-scores, WC, HRQoL, or PF components in the experimental group after the six-week intervention. Discussion: The average duration of PE at 70% of the participating schools was longer than the national average, despite half of the schools not implementing the mandated amount of PE. Gaps in the curriculum content and unqualified PE teachers may have prevented learners from developing the necessary skills associated with PE, including the various components of PF. The six-week teacher-based intervention was found to be ineffective. Similar results were seen in other South African studies. Insignificant intervention findings may be the result of poor intervention implementation or compliance, time constraints experienced by participating teachers, and the short six-week duration of the intervention. Teachers mainly commented on the enjoyment of the intervention programme by the learners. Conclusion: This study concludes that the effects of the six week teacher-based intervention, on primary school learners' HRQoL, BMI, and PF, was insignificant. Nevertheless, all schools provided PE, despite half of the schools not implementing the amount mandated. This study provides a platform for future studies in the attempt to reduce the occurrence of obesity in school children; thereby reducing its increasing national burden on health and the economy.
Open Access
The effect of the functional stimulation of the abdominal muscles on functional activity in patients with stroke: a feasiblity [sic] study
(2012) Moosajie, Crystal; Jelsma, Jennifer
Background: Stroke is a leading cause of death and disability in both developed and developing countries. Stroke results in a loss of movement on one side of the body and patients have trouble moving the trunk in relation to the pull of gravity, regardless of which muscle action is required. Re-educating the function of the trunk muscles is essential in successful rehabilitation of patients with stroke. Functional Electrical Stimulation (FES) of the abdominal muscles is an intervention which may result in increasing the activation of these muscles and improving proximal stability and function. However the effects of FES, although proved useful in other muscles groups, have not been tested when applied to the abdominal muscle in patients who have had a stroke. Aims: The aim of this study was to evaluate the effect of FES of the abdominals on th e functional recovery in patients with stroke, when used as part of physiotherapy treatment. Secondary aims are to document the content of physiotherapy received during rehabilitation and compare it to that of published literature.
Open Access
The effect of the Nintendo Wii Fit on the balance control and gross motor function of children with spastic hemiplegic cerebral palsy
(2010) Pronk, Marieke Daniela; Jelsma, Jennifer; Jelsma, Dorothee; Ferguson, Gillian
Background: Balance and postural control are an integral part of gross motor function in activities of daily living. Studies have shown that children with hemiplegic cerebral palsy have poor directional specificity as well as problems with the temporal and spatial modulation of appropriate muscle action in response to balance perturbations. Children with hemiplegia have also been shown to develop direction-specific postural control at a slower pace than typically developing children. Apart from their postural muscle coordination problems, these children have difficulties with sensory integration which contributes to increased reaction time. Research on balance training in children with cerebral palsy has demonstrated that improved balance translates into more effective gross motor function. It appears that postural control mechanisms are still modifiable for children with cerebral palsy even in elementary to middle school ages. Physiotherapy treatment for children with cerebral palsy should therefore involve balance training as a focus of intervention. Literature on balance control and virtual reality rehabilitation justifies investigating the use of a commercially ~vailable gaming system, such as the Nintendo Wii Fit, as a rehabilitation tool to improve balance control and therefore gross motor function in children with cerebral palsy. Objective: To determine the effect of an intervention with the Nintendo Wii Fit on the balance control and gross motor function of children with spastic hemiplegic cerebral palsy.
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
The effects of supervised versus non-supervised Pilates mat exercises on non-specific chronic low back pain
(2014) Chemaly, Catherine; Jelsma, Jennifer
Chronic non-specific low back pain (NSCLBP) is a common low back condition affecting a large proportion of the population suffering from low back pain (LBP). Exercise therapy is recommended as the first line treatment for NSCLBP but no type of exercise has been found to be more effective than another in improving pain and function outcomes. Low back pain trials have compared heterogeneous exercise types to date. Pilates mat classes are a popular form of exercise taught by therapists. The aim of this study was to compare outcomes of an eight-week supervised Pilates mat programme with those of a similar non-supervised home exercise programme with regard to pain intensity, function, medication use, health related quality of life, adherence, and participant satisfaction with such exercise programmes in treating NSCLBP. A randomised control trial was done to compare the effect of a supervised Pilates at programme with a non-supervised home programme of similar exercises. The programmes were comparable for both the type of exercise and the participation duration of programmes (per week) and included the same fourteen exercises with gradual progressions. The Pilates classes were held twice a week for a 45 minute class and the home programme required doing the exercises for 30 minutes, three times a week, for an eight-week period. All participants were women who had been suffering from NSCLBP for longer than six weeks and who had volunteered to participate, or were referred by a therapist. The participants were screened and randomly allocated to the respective groups: a supervised exercise group (SEG) and a home exercise group (HEG). All the individual sessions and the supervised classes were held at a multi-disciplinary centre, which housed both a private physiotherapy practice and a Pilates studio. Outcome measures were measured at baseline, four weeks, eight weeks and 12 weeks by an assessor who was blinded to group allocation. The primary outcomes of pain and function were measured using the Pain Intensity Numeric Rating Scale (PINRS) and the Roland Morris Disability Questionnaire (RMDQ) respectively. Change in medication was measured as a percentage change in medication; mobility of the pelvis and lumbar spine was measured using the fingertip-to-floor (FTF) test; health-related quality of life was assessed using the EQ-5D questionnaire, and the confidence to perform certain tasks was measured using the pain self-efficacy questionnaire (PSEQ). Additionally, patient satisfaction was measured at eight weeks using the Better Backs Patient Satisfaction Questionnaire, and adherence was measured by calculating a percentage of the maximum adherence.