Masters Degrees (Physiotherapy)

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The effects of a three visit supervised physiotherapy exercise programme versus a six visit supervised physiotherapy exercise programme in children with supracondylar fractures without neurovascular injuries.
(2014) Ramnarain, Reshma.; Maharaj, Sonill Sooknunan.
Background From the literature that has been reviewed for this study it is evident that there is a lack of research conducted investigating the value of early mobilization and exercise treatment of supracondylar fractures (SCF) in children. There has been no documented research conducted in South Africa on the frequency of physiotherapy treatment in children with SCF of the elbow joint or compliance of the child and parent/caregiver/guardian to a physiotherapy upper limb home exercise programme. Currently there is no set physiotherapy treatment protocol for SCF. Therefore this study attempts to investigate the effects of a supervised physiotherapy exercise programme in children with SCF and the compliance of the child to the home exercise programme monitored and conducted by the parent/caregiver/guardian. Aims and Objectives The primary aim of this study was to compare the effects of an exercise programme supervised by the researcher fortnightly (three visits) over a six week period to those who attended physiotherapy once per week (six visits) over a six week period. The secondary aim was to determine the compliance of the child supervised by the parent/caregiver/guardian at home with a physiotherapy home exercise programme over the 6 week period when not attending formal physiotherapy sessions at the hospital. The objectives used in the study was to determine pain, range of motion, activities of daily living and compliance of the physiotherapy exercise programme of flexion, extension supination and pronation movements at the elbow joint and soft tissue mobilization over three formal physiotherapy treatment sessions (3 visits) compared to six formal physiotherapy treatment sessions (6 visits) over the six week period. Study Design A randomised experimental design with a sample size of 50 children with SCF from three provincial hospitals in the eThekwini district was followed. The study population comprised of children between the ages of four to thirteen years presenting with SCF of the elbow joint in the participating hospitals. The children were randomly and equally assigned into two groups using a computer programme either into group A (intervention group) or group B (control group). The researcher was blinded to the groupings. The researcher performed the physiotherapy treatment programme consisting of six basic elbow exercises namely: flexion, extension, pronation and supination movements of the elbow joint (Appendix VI). Each of the exercises was conducted 20 times. Soft tissue mobilization was the other technique conducted where the researcher performed a passive stretch at the biceps muscle of the affected arm on the children during the formal physiotherapy sessions (Appendix VII). The stretch was repeated five times. Functional activities such as washing your face, eating and combing the hair (extension and flexion) as well as keying and un-keying a door (supination and pronation) are some of the basic activities one requires in life. These activities are only possible if there is 90%-100% full range of motion at the elbow joint. Group A received the physiotherapy regimen three times over a period of six weeks (first, third and sixth week) whereas group B received the same physiotherapy regimen of basic elbow exercises six times (once per week) over a six week period. Group A and group B were taught and requested to continue with the same basic elbow exercises performed in the hospital as a home programme where each exercise was performed 20 times three times a day. The parent/caregiver/guardian was taught how to record the relevant information on the record sheet (Appendix VI). This information was used to assess the compliance of the child with the home exercise programme supervised by the parent/caregiver/guardian. Data analysis The completed questionnaires consisting of the demographic data that was coded and was entered into an excel spreadsheet and descriptive statistics were performed using the Statistical Package for Social Sciences IBM SPSS version 20. The significance was set at p < 0.05. Baseline characteristics were compared between the two randomised groups using Pearson’s Chi Square Tests and the Fisher Exact Test. Data were described at each time point by group using non parametric descriptive statistics including median and interquartile range. Comparisons between groups were done at each time point using non parametric Mann- Whitney tests. Results The p value was identified to assess whether the effects of a) pain, b) range of motion, c) functional activities and d) compliance between the intervention group (three visit supervised physiotherapy exercise programme) and the control group (six visit supervised physiotherapy exercise programme) differed over time. A p value <0.05 was considered statistically significant. There was no evidence for a beneficial effect of the intervention group over the control group in terms of the differences in pain, range of motion and activities of daily living using the relevant assessment tools. In the intervention group there was a slight increase in flexion values at a non - significantly faster rate than those of the control group. There was however, significantly less compliance to the home exercise programme in the intervention group (three visits) compared to the control group (six visits). Conclusion The results of this study show that the condition of the children in the intervention group (three visit supervised physiotherapy exercise programme) improved with regards to pain, range of motion and function at the affected elbow at approximately the same rate as the children in the control group (six visit supervised physiotherapy exercise programme). Perhaps a more thorough illustration, demonstration and explanation of the purpose of the home exercises need to be communicated to the children and the caregivers in order to obtain a more positive response of the children to their compliance to the home exercise programme. Children presenting with supracondylar fractures without neurovascular injuries could possibly attend fewer formal physiotherapy sessions but comply with a home exercise programme which proved beneficial. Therefore children especially those from rural areas may spend less time attending formal physiotherapy sessions at public hospitals. The overall results will also be beneficial to the parent/caregiver/guardian as they will possibly spend less time away from work and will probably cut travel time and costs to bring the child to hospital.
A study to determine the physiotherapy management of children with cerebral palsy in public hospitals of KwaZulu-Natal.
(2015) White, Tracey-Lee.; Maharaj, Sonill Sooknunan.
Background: Medical advances have resulted in the survival of infants born prematurely, placing them at risk and escalating the number of children diagnosed with Cerebral Palsy (CP). CP is a permanent yet changing condition and is one of the leading childhood disabilities with many physiological, mental and secondary complications requiring therapy. Physiotherapy forms an important role in the management of children with CP. However, in KwaZulu-Natal (KZN), limited rehabilitation equipment, poor provision of assistive devices and restrictions on the employment of health care professionals places major strain on the overall management of children with CP. Aim and Objective: To determine the physiotherapy management of children with CP in KZN public hospitals, with the objective of identifying current management practices of children with CP in urban and rural public hospitals, in order to improve the management of these children with CP. Study Design: The study was a cross sectional survey study using a self-designed open and closed-ended questionnaire based on the aim and objectives of this study. Physiotherapists (PTs) employed at various levels of public hospitals in KZN were selected to make up the study population. A quantitative approach was utilised and the sample size of the study was 152. The data collected was systematically and thematically analysed. Results: The response rate of the study was 72 (52.6%) of which 63 (87.5%) were female and 9 (12.5%) were male. The mean age of the participants was 32 years old. Forty one (56.9%) of the PTs worked in a rural hospital while 31 (43.1%) of the participants were employed in an urban hospital. The majority 35 (48.6%) of the respondents treated one to 10 children with CP a month. A limited number of participants 25 (34.7%) used outcome measures to evaluate their children with CP. A Likert scale was used to rate the importance of the common treatment techniques and the most important treatment techniques used by the PTs in this study were postural stabilising activities 68 (94.4%), respiratory care 67 (92.9%) and positioning 67 (92.9%). Most of the participants 32 (45.0%) reported that managing children with CP in a multidisciplinary team (MDT) resulted in a significant difference (p=0.002) between rural and urban based PTs. The Majority of the rural based PTs 39 (95.1%) predominantly managed children with CP in a MDT, while most urban based PTs 24 (77.4%) preferred an individual approach. Twenty one (51.2%) of the rural based PTs predominantly managed children with CP on a monthly basis significantly different (p=0.001) from those 19 (61.3%) of the urban based PTs in this study who managed children with CP on a bi-monthly basis. Seventy one (98.6%) of the respondents in this study included the caregiver (CG) in their management approach. Handover management 69 (97.2%) and back care techniques 64 (90.2%) were the most important CG management approaches as rated on a Likert scale. Thirty two (44.4%) of the participants reported having insufficient skills to manage children with CP, while only 12 (16.7%) participated in CP postgraduate training. Sixty three (87.5%) of the participants reported experiencing one or more challenges whilst managing children with CP; CG complications 21 (34.1%) and a lack of resources 19 (29.7%) were the most common. Fifty eight (80.6%) of the participants provided recommendations for improving the management of children with CP in KZN. The recommended suggestions provided by 19 (33.5%) of the participants were to refine the undergraduate training curriculum and to improve the accessibility of post graduate CP training. Conclusion: The results of this study revealed that the management of children with CP in KZN encourages a MDT approach. This study found that the majority of the rural based PTs managed children with CP in a MDT on a monthly basis reflecting differently from those urban based PTs who managed children with CP individually and on a bi-monthly basis. In this study there were many challenges expressed by the PTs regarding the management of children with CP. It would therefore seem that implementing clinical protocols, procuring assistive devices and employing additional PTs and other health care professionals is a viable option in assisting those PTs already employed in the KZN public health sector. Despite these challenges the overall management of children with CP in KZN is viewed as holistic and favourable.
A study to determine the type, prevalence, risk factors and coping strategies of physiotherapists experiencing work related neuro-musculoskeletal disorders in KwaZulu-Natal.
(2014) Pillay, Hayley Candice.; Maharaj, Sonill Sooknunan.
Work related neuro-musculoskeletal disorders (WRNMD) account for the greatest burden of all types of injuries, and is a key area of concern in the health care sector. Physiotherapy often requires various labour intensive tasks and techniques, which may be done repetitively for prolonged periods. There is little data available on occupational injuries of Physiotherapists in KwaZulu-Natal Province, South Africa. The impact, effect and consequences of the dynamics and nature of physiotherapy needs to be assessed with particular focus on the neuro-musculoskeletal system of the physiotherapist, when executing the various techniques of physiotherapy practice. The aim of the study was to determine the prevalence of work related neuro-musculoskeletal disorders experience by physiotherapists, to identify the anatomical sites most affected, and to describe risk factors that contribute to injury and the coping strategies they use to overcome them. Study design: This study was a cross sectional point prevalence descriptive study using self administered questionnaires, with open- and closed-ended questions. A convenience sample was used of all physiotherapists practicing in the public and private sectors in KwaZulu-Natal were included, this constituting a sample of 681 professionals. Results: Of the 205 physiotherapist who participated, 86% reported having had incurred work related WRNMD. They reported that 38.5% of injury occurred in the first five years following graduation. The neck (33.2%) and the lower back (31.2%) were the anatomical areas most affected. The techniques associated with massage, mobilisation, manipulation, chest physiotherapy and general rehabilitation were found to have a significant relationship with prevalence of WRNMD (p value < .05). Physiotherapists practicing in the public sector hospitals showed a greater prevalence to injury compared to those in the private sector. Transferring dependent patients was described as a major risk by 62.5% of physiotherapist. Modifying the physiotherapist’s posture or patient’s treatment position was seen as the common effective strategy. Conclusion: The prevalence of WRNMD amongst physiotherapists is relatively high, with the neck and lower back being predominant sites of injury, the main risk factors being lifting or transferring of dependent patients, with the number of years of experience being a contributing factor. Those practicing in the clinical fields of chest, neurology and orthopaedics are more likely to incur WRNMD. The results of this study indicate that particular attention should be given to techniques of manual handling and to hand- intensive manual therapy techniques. Current coping strategies most used were modifying the patient’s position or the physiotherapist’s posture during treatment. Specific strategies should be developed by physiotherapists, with regards to how many hours it is safe to perform certain physiotherapy techniques e.g. percussion, or the number of patients that require labour intensive treatment such, as massage or manipulation, could be treated in a time period. This study highlights the fact that physiotherapists are presenting with work related neuro-musculoskeletal disorders which may pose a significant threat to the length of the physiotherapist’s career, their general well being, and the maintenance of a viable work force for healthcare organisations.
A survey to determine the need and scope for a cardiac rehabilitation programme at Grey's Hospital in KwaZulu-Natal : a multi disciplinary perspective.
(2012) Rabilal, Melisha.; Maharaj, Sonill Sooknunan.
Aim : The study was explored within the context of a survey to determine the need and scope for a cardiac rehabilitation programme at Grey’s Hospital in Kwa Zulu-Natal. A multi-disciplinary perspective was sought as a cardiac rehabilitation programme with a multi-disciplinary approach is holistic. Also it is an effective intervention as secondary prevention in the care of the cardiac patient. Design : Exploratory survey in a “case-study”. Setting : a provincial, tertiary hospital in Kwa-Zulu Natal Participants : Permanent healthcare workers employed by the Department of health and working in the various units at Grey’s Hospital with more than 3 years experience. Staff included nurses and doctors in the coronary care unit, medical ward D1, catheterization unit and the cardiac clinic. Allied staff such as occupational therapists, dieticians, psychologists and physiotherapists also participated in this study. Staff not satisfying the above criteria and those not consenting to be part of the study were excluded. 58 questionnaires were distributed and 35 were returned completed. Intervention : A self developed questionnaire was used and information was obtained about the demographics of the healthcare workers, relevant interaction with cardiac patients and aspects of training related to cardiac conditions. Questions were directed to professionals as pertained to their respective scope of practice. Some questions were “open” ended and required responses with descriptions and/ or explanations. Admission records were perused in various cardiac units to determine the number of cardiac patients accessing services at Grey’s Hospital. Results : The total number of cardiac patients that attended Grey’s Hospital from January 2007 to December 2011 was 19983. The cardiac clinic showed an increase annually in the number of patients each year from 2495 in 2007 to 3569 in 2011 with a total number of 15928 over 5 years. All professionals assisted patients with achieving cardiac rehabilitation goals. There was a need demonstrated for the implementation of written resources for patient education; and training of staff in cardiac rehabilitation according to international guidelines. Basic life support (CPR) training is present among some professionals. A structured referral of patients for cardiac rehabilitation is not present and a phase I-IV cardiac rehabilitation programme with updated protocols is not present at Grey’s Hospital. Health professionals listed the scope of practice for current and potential interventions with cardiac patients. Healthcare workers also expressed their views on the value of a multi-disciplinary cardiac rehabilitation programme at Grey’s Hospital. Benefits for a multi-disciplinary cardiac rehabilitation programme at referral hospitals were listed by the multi-disciplinary healthcare workers. It was found there is a strong agreement to have a cardiac rehabilitation programme at Grey’s Hospital across all disciplines. An overall agreement of 32/35 for rehabilitation programme is statistically significant with p < 0.001. Conclusion : There is a need for a multi-disciplinary cardiac rehabilitation programme at Grey’s Hospital.

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