Physiotherapy

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Role of massage and stretching in recovery from exercise and in delayed onset muscle soreness.
(1997) Viranna, N. V.; Mars, Maurice.
Adequate recovery from intense exercise is essential to optimise performance and reduce the associated symptoms of tiredness, fatigue and lethargy. The purpose of the study was to :- i. investigate the effects of massage and stretching in delaying the development of fatigue during repeated bouts of dynamic activity and, ii. to investigate the relative effects of massage and stretching on delayed onset muscle soreness (DOMS). Eighteen volunteer males participated in this study. They were randomly allocated into one of six groups of an Orthogonal Latin square design. Subjects performed five repetitions of as many heel raises as possible in 45 seconds. Each repetition was followed by a recovery technique of three minutes duration. This was repeated weekly until each group has had all three recovery techniques. A fatigue index % was calculated from the decline in the number of repetitions from stage 1 to stage 5. Muscle soreness ratings were retrospectively assessed at 12-36 hour after each session. An analysis of variance showed a significant difference in the fatigue indices. Post hoc intergroup comparison using paired T-tests with the Bonferroni adjustment showed a significant difference between rest and massage (p=0.0001) and rest and stretching (p=0.0006). The differences between massage and stretching were not significant. Fourteen (77.8%) and Fifteen (83.3%) subjects showed an improvement in performance following massage and stretching respectively. Massage is associated with significantly less muscle soreness than stretching (p<0,001). DOMS was most frequently found in the stretching group while the lowest incidence and lowest mean ratings of muscle soreness associated with DOMS was found in the massage group. The difference between massage and stretching was marginal (p=046I) and showed a trend that massage is associated with less DOMS than stretching. This suggests that rest is the least beneficial recovery technique, and that massage may be superior to stretching as there is less muscle soreness.
A study to investigate the relationship between obstetric brachial plexus palsies and cephalopelvic disproporation (including fetal macrosomia)
(2002) Pillay, Kalaimani.; Naidoo, Krishnasmay Soobiah.
In view of the lifelong impact of Obstetrical Brachial Plexus Palsies (OBPP), prevention of OBPP would be of great significance. Despite contemporary advances in antenatal planning and assessment, OBPP remains an unfortunate consequence after difficult childbirth. Permanent brachial plexus palsy is a leading cause of litigation related to birth trauma. Objectives: To determine the incidence of Obstetrical Brachial Plexus Palsy (OBPP), Cephalopelvic Disproportion (CPD) and macrosomia in KwaZulu-Natal. As well as to investigate the relationship between OBPP and CPD, and the relationship between OBPP and macrosomia. The study also aimed to determine whether antenatal risk factors could identify those prone to OBPP. Study design: This was a case control study that included all deliveries from 1997 to 2000 from four provincial hospitals (Addington, King Edward VIII, Prince Mshiyeni Memorial and RK Khan hospital). The outcome variable was OBPP. Results were analyzed using Statistical Program for Social Sciences (SPSS). Results: A total of 60 infants of 76 352 deliveries sustained OBPP. The incidence of OBPP was found to be 0.72 per 1000 deliveries. The incidence of CPD was found to be 33.5 per 1000 deliveries and the incidence of macrosomia was found to be 16.7 per 1000 deliveries. Race, Maternal height> 150 cm, gravida >3, parity >4, history of a previous big baby, normal vaginal delivery, delivery by a midwife, difficult labour, inadequate or doubtful pelvic capacity, birth weight of >3700 g and gestation period> 34 weeks were significant risk factors. Logistic regression analysis showed that race, parity> 4, normal vaginal delivery and gestation period> 35 weeks were the variables most associated with OBPP. Using linear regression model was obtained for the calculation of predictive risk scores. Conclusion: Using standard statistical formulae the probability of OBPP can be calculated in women with significant risk factors from the logistic regression formula. This would need to be validated and could provide a useful tool for screening for OBPP thus contributing to preventing this devastating complication of birth trauma. The risk assessment profile would contribute greatly to the prediction of OBPP and the subsequent prevention of this debilitating birth injury.
Underweight and overweight in primary school children in eThekwini district in KwaZulu-Natal, South Africa.
(AOSIS, 2010) Puckree, Threethambal.; Naidoo, Pooveshni.; Pillay, Prabashni.; Naidoo, Therona.
Background: The prevalence of overweight and obesity in children has been increasing worldwide. South Africa has minimal data on childhood body weight. Objectives: This study determined whether school children in the eThekwini district in KwaZulu-Natal, South Africa, were underweight or overweight. Method: A survey with quantitative and qualitative components was conducted amongst 120 participants between 10 years and 12 years of age. The participants were randomly selected from six public schools in an urban district of the province. A calibrated Goldline bathroom scale was used to measure body weight and a KDS Freo non-elastic measuring tape was used to measure height. A questionnaire consisting of open and close-ended questions collected demographic and lifestyle information. Body mass index (BMI) was calculated from height and weight data. Proportions of obese, overweight and underweight children were calculated and subjected to chi-square tests at the p ≤ 0.05 significance level. All qualitative information was summarised. Results: According to World Health Organization criteria, 66% of the children were underweight, 28% were of normal weight and 5% were overweight. The proportion of underweight children increased with age (64% of children aged between 10 years and 11 years vs 70% for 12-year-olds). Of the underweight children, 41% were female and 51% were Indian.Only one child was obese. BMI was related to dietary patterns and activity levels during and outside school hours. Conclusion: A significant number of primary school children from the six selected public schools in the eThekwini district were underweight. More effort is required to improve the nutritional status of school children in the eThekwini district.
A correlation between injury incidence, injury prevalence and balance in rugby players.
(2012) Ras, Jaco.; Puckree, Threethambal.
No abstract available.
A randomised controlled trial to assess the effect of a balance and stability training intervention on balance and functional independence in stroke patients.
(2012) Naidoo, Pooveshni.; Puckree, Threethambal.
Introduction: Balance dysfunction, particularly in standing, is a devastating sequel to stroke since the ability to balance is one of the most critical motor control factors in daily life. Physiotherapists use a variety of balance and stability techniques as a part of treatment programmes to improve functional independence in patients following a stroke. However more scientific evidence for the effectiveness of these techniques or programs is required. Purpose: The purpose of this study was to quantify the effect of a balance and stability training program on stability, balance and functional independence in stroke patients. Method: The aims of this study were achieved using a randomised controlled trial. A questionnaire allowed the collection of demographic data from fifty participants who had suffered the first stroke, regardless of gender or race. The Postural Assessment Scale for Stroke patients (PASS), Berg Balance Scale (BBS), Barthel Index (BI) and questionnaire were administered to all fifty participants on the first and last weeks of a twelve week physiotherapy program. For ten weeks twenty five randomly assigned participants in each of the control and experimental groups underwent either normal physiotherapy or stability and balance intervention exercise program respectively. Data Analysis: The raw data was normalized by calculating percent changes for each item for each participant and the pooled data subjected to Wilcoxon signed ranks testing, paired samples signed tests and Pearson’s correlations. Results: PASS, BBS and BI scores increased significantly from pre-test to post-tests in both groups, with greater changes noted in the experimental group, showing improvements in stability, balance and function. In addition a strong and significant correlation between stability scores and balance scores suggested that stability is important to improve balance. Similarly a strong and significant correlation between stability and balance scores with function scores confirms the value of stability and balance in improving function. It was further noted that in addition to a certain degree of spontaneous recovery, traditional physiotherapy programs also result in improvement in stability, balance and function but not to the same extent as with the program of treatment which emphasizes stability and balance exercises. Conclusion: A significant improvement in the stability, balance and function in stroke patients was achieved with the balance and stability intervention program. Conventional physiotherapy methods also improved stability, balance and function, but to a lesser extent than the balance and stability training.
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.
Physiotherapy rehabilitation in the context of HIV and disability in KwaZulu-Natal.
(2012) Cobbing, Saul.; Rhode, Margaret.; Hanass-Hancock, Jill.
Aim: The purpose of this study was to describe the experiences of people living with the human immunodeficiency virus who underwent a physiotherapy rehabilitation programme, with the aim of informing and improving future physiotherapy rehabilitation interventions. Methodology: Design: A qualitative research design was adopted, using the International Classification of Function, Disability and Health as a guiding framework. Population: All adult HIV positive patients who were referred for physiotherapy rehabilitation at a public-funded South African hospital during the course of a five week clinical block. Sample: Fourteen participants were eligible for the study. Eight of these participants, who were able to attend the post-rehabilitation interview, were considered for final analysis in the study. Study setting: A public-funded hospital within the eThekwini district of KwaZulu-Natal, South Africa. Research procedure: All eligible participants were requested to complete a questionnaire, the World Health Organisation Disability Assessment Schedule, prior to commencing a physiotherapy rehabilitation programme. After the period of rehabilitation, participants were interviewed using 14 open-ended questions designed to explore their experiences of this programme. Results: The questionnaire data described the participants’ demographics and illustrated the varying cognitive and physical challenges faced by these eight individuals. Content analysis of the eight interviews revealed the following themes: the participants’ knowledge of their health conditions and their prescribed medication, the impact of their illness on their impairments, activities and participation in their daily lives, the context in which these factors exist, the participants’ experience of physiotherapy rehabilitation and the barriers they faced in accessing continued rehabilitation. Conclusion: While participants reported mostly positive experiences related to physiotherapy rehabilitation, they face a number of barriers that limit their access to continued rehabilitation. It is hoped that the results of this study will assist in informing the development of future physiotherapy interventions, which are better designed to suit the needs of PLHIV in a South African public health context.
A study to determine the practices, attitudes and experiences of public sector physiotherapists and occupational therapists in the post operative rehabilitation of flexor tendons of the hand.
(2013) Mncube, Nomzamo.; Puckree, Threethambal.
The management of flexor tendon injuries in the hand is complex and requires skill not only on the part of the surgeon but also the rehabilitation therapists and compliance on the part of the patient. Anecdotally it is clear that therapists (occupational therapists and physiotherapists) gain their skills and knowledge as practitioners through hands-on experience, since very little specialized training is available in the field of hand therapy. Therapists should equip themselves with the knowledge of the surgical management of the patient, since post-operative rehabilitation depends on it. Ideally the hand surgeons should advise the therapists or dictate the post-operative management based on the surgical technique performed. The actual practices, attitudes and experiences of South African therapists in the management of flexor tendons are not known. The purpose of this study was to determine the practices, attitudes and experiences of the public sector physiotherapists and occupational therapists in the postoperative rehabilitation of patients post repair of flexor tendons surgery in the hand. The first part of the study consisted of a cross sectional survey which explored the postoperative rehabilitation practices, attitudes, and experiences regarding flexor tendon rehabilitation. The second part which was a focus group discussion sought in depth information on the attitudes and experiences of the therapists. Sixty three therapists from different public hospital settings in two districts of KwaZulu-Natal completed a validated questionnaire. The therapists were accessed from randomly selected hospitals located in two conveniently selected health districts in KwaZulu- Natal. The findings suggest that the use of the Kleinert-type and immobilisation protocols is widely used. Overall there was no significant differences in the choice of rehabilitation protocol, but this differed by hospital setting. Therapists in the tertiary hospital preferred the Duran protocol (53.6%, p = 0.003). Regional hospitals utilized the immobilization protocol (74.1%, p=0.045) and district hospitals treated presenting postoperative symptoms mostly (20% p=0.75).There was no statistical (p=0.196) difference on the decision to initiate therapy amongst different hospital settings. Frequency of therapy visits varied, but was not statistically different (p=0.16) amongst different hospital settings. More respondents (29.2%) reported typically initiating active ROM exercises on the fourth post-operative week. There was a significant difference (p=0.002) in the initiation of active range of movement amongst different hospital settings. Approximately 37% of the respondents discontinue protective splinting at five weeks. There was a significant difference (p=0.004) by hospital setting regarding when the protective splinting should be discontinued. Initiation of resistance exercises varied between four and six weeks. Nearly half (49%) of the therapists reported that they are sometimes apprehensive about how to progress patients through rehabilitation. The focus group revealed that there is poor communication between therapists and surgeons, lack of protocol guidance, lack of knowledge of the flexor tendon protocols of the newly qualified therapists and doctors. During the focus group discussion therapist’s attitudes and experiences were revealed through the eight themes that emerged namely challenges experienced during flexor tendon (FT) rehabilitation, the patient's socio-economic background, patient’s home environment, compliance with flexor tendon rehabilitation protocol, multidisciplinary team approach, clinical experience, university undergraduate curriculum on flexor tendon rehabilitation, outcomes of flexor tendon postoperative rehabilitation. Conclusion. The rehabilitation protocols that are commonly used include the Kleinert -type and the immobilisation protocols. Duran type protocol was used less frequently, only when it was the best option for that particular patient according to the surgeon or the surgical management of that patient. The focus group discussion revealed that rural hospital therapists modify the protocols, due to lack of resources and the poor compliance of the patients. rehabilitation practices, flexor tendon experiences, hospital settings
A comparative study to determine the immediate effects of paraffin wax and moist heat therapies on pain, joint range of movement and grip ability in adults with rheumatoid arthritis afffecting the hands.
(2013) Ramsudh, Thirusha.; Ramklass, Serela Samita.; Joubert, Robin Wendy Elizabeth.
Physiotherapists use many treatment modalities in the management of rheumatoid arthritis of the hand. Two commonly used heating modalities are moist heat and paraffin wax therapy. The aim of this study was thus to compare the immediate effectiveness of moist heat therapy and paraffin wax therapy in the management of the rheumatoid hand. A quantitative, pretest – posttest design was used to compare the effects of paraffin wax and moist heat therapy on pain, joint range of movement and grip ability in adults with stage II rheumatoid arthritis, affecting the hands. One hundred and fifteen subjects at a district/regional provincial health care institution in the Ethekwini metro district were randomly allocated to two groups. Fifty six subjects in Group 1 were treated with paraffin wax therapy, using the drip-wrap method and active hand exercises and in Group 2, fifty nine subjects were treated with moist heat therapy and active hand exercises. Pre- and posttest measurements were taken in all subjects. Pain was measured using the numerical pain rating scale and intrinsic hand joint range of movement was measured using a metal short arm goniometer and the dorsal approach. Hand span and grip ability were also measured. Results revealed that both treatment modalities were effective in helping moderate pain, increase joint range of movement and improve grip ability in the adult rheumatoid hand. Paraffin wax improved joint range of movement significantly more than moist heat therapy in 25% of joints (p≤0.05). Right hand span was also significantly improved (p=0.013) by the application of wax. No statistically significant differences were found between the effects of paraffin wax and moist heat therapy on pain and grip ability however the findings of this study suggest clinical significance as both modalities improved pain perception and grip ability in the rheumatoid hand.
Racial integration and dynamics amongst occupational therapy students at the University of KwaZulu-Natal.
(2014) Christopher, Chantal Juanita.; Van der Reyden, Dain.
Post democracy lecture venues within the Discipline of Occupational Therapy and campus at the University of KwaZulu-Natal display racial clustering where homogenous racial groups self-segregate and sit amongst those that look similar to themselves. This feature which, according to an extensive literature search occurs across the world appears resistant to change even within small occupational therapy classes which create extensive contact between students, with formal and informal opportunities to integrate. This descriptive qualitative study aimed to explore the occupational therapy student participants’ lived reality of racial integration and classroom dynamics from years 2, 3 and 4 in the context of studying at the University of KwaZulu-Natal. The data collection tool was racially homogenous focus groups that yielded deep and rich discourse around an opening vignette and subsequent probes. Thematic analysis with a Critical Race Theory lens informed the data display and reduction process. Data yielded important findings that allude to contemporary racialisation amongst “born-free” occupational therapy students with strong convergence with international research and literature. Themes displayed students’ rationale behind ‘Othering’— the behaviour of creating Us/Them divisions along various factors; the racialising of space as a legacy of apartheid as well as in new ways and forms; varying promoters of social cohesion that they believe enhance integration as well as particular barriers within the academy and particularly the Discipline of Occupational Therapy. Recommendations allude to the need for pedagogical review, staff conscientisation around student lived reality, as well as the creation of a milieu of social cohesion.
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.
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.
Home-based rehabilitation for people living with HIV in a resource-poor setting in KwaZulu-Natal, South Africa.
(2016) Cobbing, Saul.; Hanass-Hancock, Jill.; Myezwa, Hellen.; Maharaj, Sonill.
This PhD thesis centres on a home-based rehabilitation intervention (HBR) for people living with HIV (PLHIV) in a resource-poor setting in KwaZulu-Natal, South Africa. South Africa has the highest number of people infected with HIV worldwide, with 6.4 million PLHIV out of an estimated global total of 36.7 million. Antiretroviral therapy (ART) has ensured that PLHIV are living longer lives. However, there is a wide range of evidence that shows that PLHIV are prone to a broad range of physical and cognitive disabilities. It is crucial that PLHIV are able to attain a good health-related quality of life and optimal functioning, to support the success of the wide roll out of ART in countries like South Africa. Rehabilitation and exercise have been shown to improve the quality of life and function of PLHIV but there are numerous barriers facing patients who need to access rehabilitation. This PhD study aimed to determine the effect of an alternative approach of service delivery, namely a disability-inclusive HBR intervention, on PLHIVs’ perceived disability, quality of life, functional mobility and functional capacity. The study was situated in a resource-poor, semi-rural community in KwaZulu-Natal, the province with the highest HIV prevalence in South Africa. The design of the study intervention was informed by the synthesis of the evidence from a scoping review on HBR interventions for PLHIV, which revealed a paucity of evidence, and the practical experience of the lead author as a rehabilitation practitioner working with PLHIV. Embedded in a wider investigation related to an alternative model of care, this novel intervention, undertaken through a randomised control trial methodology, found that HBR is a safe strategy for treating the functional limitations experienced by PLHIV and may further improve their quality of life. While participants in the intervention group showed greater improvements across all outcome measures, between-group differences were nonsignificant. The community healthcare workers, who were trained via a task shifting approach to implement this HBR programme, reported feeling empowered by the knowledge and skills they attained through this study and gave valuable advice for improving future interventions. A synthesis of the overall PhD study results demonstrated that this intervention satisfied a number of the fundamental principles of a model of care for the rehabilitation of PLHIV, developed in the same study location. By building on the successes of this PhD study and addressing the limitations of its design and process, researchers can design and implement new rehabilitation interventions that involve multidisciplinary collaboration and the screening and treatment of people with a wide range of chronic conditions. This research should be combined with advocacy efforts to ensure that theoretical findings are translated into policies and practices that benefit all PLHIV, particularly those in resource-poor communities.
Perceptions of physiotherapists on disability: awareness and health promotion.
(2017) Pather, Joan.; Chetty, Verusia.; Chemane, Nomzamo Charity Thobekile.
Background: The lack of effective accommodation and integration of people living with disabilities in the community raises the need for rehabilitation professionals such as physiotherapists to deliver disability awareness programmes. These programmes aim to reduce environmental and attitudinal barriers that exist in their communities. Limited information about the perceptions of physiotherapists in South Africa on disability awareness programmes is available. Objectives: To explore perceptions of physiotherapists on disability awareness programmes as a health promotion strategy in public healthcare. Method: Two focus group discussions were conducted with public healthcare physiotherapists employed at urban and rural facilities. Transcribed data were analysed using conventional content thematic analysis and described perceptions of participating physiotherapists on disability and disability awareness programmes targeting community awareness. Results: The discussions revealed five major themes, namely, knowledge dearth consequence, personal factors, facilitators to disability awareness programmes, barriers to disability awareness programmes, and recommendations. Conclusion: The need to address the barriers to disability awareness programmes is essential to advocate for disability issues that pose environmental and attitudinal barriers to access in all areas of society. Access to healthcare is hindered by lack of understanding and subsequent behaviour including stigmatisation of people with disabilities. Therefore, it is essential for rehabilitation professionals to offer comprehensive disability culturally sensitive awareness programmes to communities in order to influence attitudes and behaviour toward people with disabilities.
Effect of electrotherapy on pain, functional activity, and health-related quality of life of Nigerian individuals with knee osteoarthritis.
(2018) Usman, Zubair.; Maharaj, Sonill Sooknunan.
Abstract Osteoarthritis (OA) of the knee is a chronic degenerative articular disease that causes pain, limits joint mobility and physical function and reduces quality of life. Electrotherapeutic modalities such as interferential current (IFC) and therapeutic ultrasound (US) are used in the management of chronic pain and reduced physical activity in individuals with knee OA. It is not clear whether simultaneous application of these physical agents as a combination therapy (CT) would improve pain, physical activity and health-related quality of life (HRQoL) of individuals with knee OA. Objective: This study aimed to determine the effects of CT, IFC, and US on pain, functional activity and HRQoL of individuals with knee osteoarthritis in Nigeria. Participants: Participants diagnosed with knee osteoarthritis according to the American College of Rheumatology, attending the Physiotherapy Outpatient Units of Rasheed Shekoni Specialist Hospital (RSSH), the Federal Medical Centre (FMC), and Dutse General Hospital were recruited for the study. A total of 133 participants, with ages ranging between 58 and 82 years (mean = 66.19 ± 8.50 years) and out of which 53 (40%) were male and 80 (60%) were female (median = 56 years), participated in the study. Methods: This is a multi-center randomized controlled study. The participants were randomly assigned to 4 groups: US (n = 34), IFC (n=34), CT (n=33), and control (n=32). Each group had 3 treatment sessions per week for 12 weeks. Participants in the control group received heat therapy using infrared radiation (IRR). The visual analogue scale (VAS), Western Ontario and McMaster Universities Osteoarthritis (WOMAC) Index, Short Form-36 Health Survey (SF-36) questionnaire, and goniometer were used to assess pain severity, functional activity, HRQoL and knee range of motion (ROM) respectively. All measurements were taken and recorded at baseline and post-treatment. Main outcome measures: The primary outcome measures were pain, functional activity, and health-related quality of life, with active and passive knee range of motion being secondary outcomes. The variables were analyzed using one-way ANOVA, and independent and dependent sample t-test using the Statistical Package for the Social Sciences. Results: At baseline, there were no significant differences (p<0.05) between all the groups on the primary (pain, physical function and HRQoL), and secondary (ROM) outcomes. One-way between-subjects ANOVA was conducted to compare the post-intervention effects of the electrotherapy combination (US & IFC) therapy with the control group on pain, functional ii activity, and HRQoL. There were significant differences in the pain severity, physical function, and HRQoL scores (p<0.05) of participant in the electrotherapy (US, IFC & CT) groups compared to the control group. Post-hoc comparisons using the Tukey HSD test indicated that the mean scores of the electrotherapy groups differed significantly from the control group. However, comparisons were made between the intervention (US, IFC & CT) groups post-treatment. There was no significant difference (p>0.05) between each of the intervention groups (US, IFC &CT) on pain, functional activity and HRQoL post-treatment. In terms of effects, no interventional group was superior to another among the experimental groups. Between-group comparison at follow-up (each group compared with the control group) showed significant improvement in measures of pain severity, improved physical activity and quality of life in each group. Changes in secondary outcomes, over time, were statistically significant (p<0.05) in the experimental groups (US, IFC, & CT). There were increases in knee range of motion, both active and passive. No differences were observed in knee range of motion, both active and passive, in the control group (P >0.05). Conclusion: The use of electrotherapy modalities ‒ CT (US & IFC), US and IFC ‒ was beneficial as they elicited improvement in pain severity, functional activity and HRQoL in individuals with knee osteoarthritis, but none of the modalities proved to be more effective than the others.
Investigating occupational risk factors of low back pain and related disability among patients attending a private physiotherapy practice in Gaborone, Botswana.
(2018) Chihumbiri, Noreen Vimbiso.; Nadasan, Thayananthee.
Globally, low back pain (LBP) is regarded as the most common cause of occupational illness, job- related disability and absenteeism from work. The presence of LBP in the working age is a great cause for concern, as it is this population that contributes greatly to the productivity and economic viability of a country. However, in order to effect meaningful changes, such as formulating primary prevention and subsequent management strategies aimed at curbing the rising burden of occupational LBP, it is necessary to understand the physical activities that workers are frequently exposed to in the work place that put them at risk of developing LBP. Botswana is largely dependent on the working age population to drive its economy therefore necessitating introductory research, as reported in various industries on occupational risk factors that may hamper optimal worker participation. This research therefore aimed to determine the occupational risk factors and the resulting back-related disability in patients presenting with LBP to a private physiotherapy practice in Gaborone, Botswana. The objectives were fulfilled by using a structured, self–administered questionnaire to describe the demographics of the individuals, determine the extent of sickness absenteeism from work owing to LBP and to establish the resulting back-related disability through the Roland-Morris Disability Questionnaire (RDQ). Furthermore, the relationship between occupational risk factors and the level of back-related disability as well as the demographic profile of the study participants and the level of back-related disability were determined based on statistical analysis. The study was successful in establishing that the slight majority were females (52%) and the mean age of participants was 41 years. 35.3 percent of the study participants had between 10 to 19 years of work experience while 43.7 percent were classified as overweight. The results also reflect that minor LBP disability level was reported by 79.8% while 57.2 percent had missed between three to seven days of work in the previous year because of LBP. The occupational risk factors dynamic loads, static loads, repetitive loads, ergonomic environmental conditions, vibrations, prolonged standing, prolonged sitting, prolonged walking were significantly associated with LBP. The odds of having severe back-related disability are increased approximately 163 % for females (p-value= .043613). The presence of LBP and its associated disability in the working age, a population that drives the commercial hub of a nation, calls for recognition of this growing burden as a liability to the economic growth of Botswana. Investigating occupational factors of LBP would assist in making policies that address the different risk factors of LBP particularly in females and the 30 to 39 years age group as these are the commonly affected. In addition, emerging industries with increased risk of back-related disability can be prioritised in terms of ergonomic interventions as well as implementing health policies to help curb the escalating burden of LBP and facilitate optimal worker participation whose indefinite benefits would go a long way in enhancing the economy. Keywords: Low back pain, Risk factors, Disability, Occupational Health, Health Promotion
Rehabilitation service in the northern KwaZulu-Natal, uThungulu and service providers’ knowledge and attitudes towards public private partnerships.
(2018) Mazibuko, Senzelwe Mfihlakalo.; Nadasan, Thayananthee.; Olagbegi, Oladapo Michael.
Rehabilitation assists persons with disabilities attain physical independence and self-determination. In South Africa, the distribution of rehabilitation services is largely poor. Rehabilitation services in uThungulu District, KwaZulu-Natal are covered by the public sector. The uThungulu public health sector provides limited rehabilitation services, with physiotherapists working in multidisciplinary teams. Consequently, achieving rehabilitation goals of functional independence is affected. Public and private rehabilitation service providers working together can help to combat this problem. Furthermore, rehabilitation services are unevenly distributed in rural uThungulu. This study explores current rehabilitation service provision practices in uThungulu and the possibility of Public Private Partnerships (PPPs). A sample of 50(37 public and 13 private) rehabilitation service providers were interviewed; using a mixed methods exploratory case study. Through the use of focus groups, individual interviews and questionnaires, participants were requested information on their perception of the availability, accessibility and equitability of rehabilitation services in uThungulu district. The knowledge and attitude service providers had towards PPPs were also explored. Rehabilitation practitioners reported poor rehabilitation service provision in uThungulu due to the poor socio-economic circumstance of uThungulu, limited multidisciplinary rehabilitation service providers and poor delivery of rehabilitation services. Sixty-four percent of the participants reported that their rehabilitation was not sufficient. Ninety-two percent of the participants reported working in a multidisciplinary team however human resource shortages were also reported resulting in institutions being constantly short-staffed. Sixty-nine percent of the participants reported the non-availability of designated rehabilitation units in their institutions. Professionals working at institutions with designated rehabilitation units evaluated the effectiveness of the rehabilitation programme significantly more positively than those working at institutions without such designated units (U= 98.5, p=0.01). Participants stated that they receive an average of 5.37±4.79 rehabilitation referrals per day. Forty percent of the participants stated that rehabilitation sessions occur daily, with 38% of respondents reporting rehabilitation sessions lasting between 30 to 45 minutes. A moderate, positive correlation was found between participants’ perceptions of managerial support and perceived rehabilitation programme effectiveness (rs= 0.45, p=0.01). A weak, positive and statistically significant correlation between perceived effectiveness of rehabilitation programme and ease of administrative process was found (rs= 0.29, p= 0.04). Two thirds (66%) of the participants did not know about PPP and only a third (34%) knew about it. Rehabilitation service in uThungulu is provided predominantly in hospital departments and less so at community-based centres such as clinics. UThungulu’s rehabilitation services are multidisciplinary, but often with an incomplete quota of rehabilitation practitioners. Rehabilitation services were perceivednegatively by providers in the uThungulu District. These negative perceptions were due to a lack of equipment, the absence of designated rehabilitation units, human resource shortages, a lack of managerial support and cumbersome administrative processes. Furthermore, rehabilitation service providers perceived rehabilitation as insufficient and ineffective. Rehabilitation service providers in uThungulu were not aware of PPPs. The possible utilisation of PPPs as tools for adequate rehabilitation service provision thus could not be ascertained sufficiently. The few providers who were aware of PPPs reported a positive potential for PPPs as vehicles of rehabilitation service provision.
Community-based primary healthcare training for physiotherapy in KwaZulu- Natal: perceptions of physiotherapy academics.
(2018) Govender, Geneshree.; Chetty, Verusia.
ABSTRACT Background: The healthcare system in South Africa is faced with many challenges. There is an unequal distribution of health services between urban and rural communities, with rural communities having restricted access to healthcare services. Rural areas struggle to sometimes recruit and retain health professionals as a result of poor infrastructure and logistical obstacles. Clinical education is a rudimentary component of the undergraduate physiotherapy curriculum and is the means by which undergraduate students are exposed to a wide range of patients and conditions. It allows for relevant integration between theory and clinical practice. Clinical education has evolved into an educational model, with the aim of generating empirical learning strategies for undergraduate students. Clinical education generally commences in the second year of the degree, with hours of clinical practice escalating until the final, fourth, year of training; allowing undergraduate students to become independent, skilled therapists post- graduation. Community-based education is an efficient way of providing health services to under-resourced communities. The University of KwaZulu-Natal has initiated the community- based primary healthcare training (CBPHCT) platform, also referred to as decentralised clinical training (DCT), in an attempt to provide equal and fair access to health services to under- resourced communities, as well as to provide a holistic learning environment for undergraduate physiotherapy students. Exposure to the challenges experienced within the primary healthcare system allows for students to develop competent skills and core competencies to provide optimal healthcare services. In addition, community-based training in the primary healthcare (CBPHCT) setting reduces the load experienced by on-site clinicians. It is therefore highly beneficial in an overburdened healthcare system. In order to provide optimal service to under- resourced communities, the CBPHCT framework needs to be regularly reviewed to include current evidence-based health trends and new teaching and learning methods. Objective: The study aimed to explore the perceptions of physiotherapy academics about a novel clinical education platform in the primary healthcare setting in the province of KwaZulu- Natal. Methods: A qualitative research method was adopted. All academics at the UKZN physiotherapy department were interviewed, when their perceptions of CBPHCT were explored via open-ended interviews. The data was then transcribed and analysed using thematic analysis. v Results: Four overarching themes were identified, namely curriculum review, constraints to decentralised learning, benefits of community-based clinical education and recommendations for the learning platform. Conclusion: Participants reported both positive and negative experiences of the novel CBPHCT platform. It facilitated personal growth for both the students and academics. However, the framework was challenged by resource limitations, clinical educator challenges and lack of supervision. The academics felt that effective communication between the Department of Health (DoH) and the university needs to be well established in order to improve the partnership. The academics also recommended improving simple logistics and infrastructure on site in order to make the placements more attractive to students and to retain healthcare professionals. They also suggested the recruitment of local supervisors, even on a part-time basis. Engaging the community as part of the framework was recommended in order to enhance social accountability in the students. The academics concluded that the current curriculum needs to be regularly reviewed to address various challenges, whilst encouraging a cohesive relationship between all stakeholders in order to provide a well-integrated teaching and learning environment. Keywords: physiotherapy, clinical education, community-based primary healthcare, decentralised training.
A study of the effects of exercise therapy on the comorbidity of attention deficit hyperactivity disorder (ADHD) and developmental co-ordination disorder (DCD).
(2019) Dawson, Pamela Marie Therese.; Nadasan, Thayananthee.; Govender, Preesha.
Background: The literature suggests a high prevalence of comorbid ADHD and DCD in South Africa and worldwide. Specific figures of the suspected high prevalence are not available and the link between the two conditions are poorly understood. Medical treatment relies on neurostimulant drugs, which have little or no effect on the motor symptoms and have significant side effects. An intervention that addresses both motor co-ordination and attention/concentration impairments is essential in the overall management of children presenting with these comorbid conditions. This study aimed to document prevalence figures and demographic profile of children aged 8 to 9 years diagnosed with comorbid ADHD and DCD; and to design and develop and test efficacy of an exercise intervention that addresses symptoms of the comorbid conditions. Methodology: The study was located at remedial units within mainstream schools in KwaZulu-Natal, South Africa. Children aged 8 to 9 years diagnosed with ADHD were assessed using the modified Conners’ Teacher Rating Scale and the Copeland’s Symptom Checklist, the Development Co-ordination Disorder Questionnaire (DCDQ) and the Motor Assessment Battery for Children, edition 1 (MABC-1). A three round Delphi technique assisted in the development of an exercise intervention. The efficacy of the exercise intervention was tested via a quasi-experimental study. Children that were assessed were divided into four groups namely: Group (A) that were administered neuropharmacological medication prescribed by a medical practitioner; Group (B) were exposed to the exercise intervention only; Group (C) included children on neuropharmacological medication that were exposed to the exercise intervention and Group (D) served as the control, receiving routine care. All participants were grouped, according to parental preference. Effectiveness of each intervention was assessed using Wilcoxon Signed Ranked Test. Results: 151 children were tested. 74% were diagnosed with comorbid ADHD and DCD. The male to female ratio was 2:1. The combined subtype of ADHD was most commonly diagnosed with comorbidity. Consensus on structure and content in an exercise intervention was achieved in three rounds of the Delphi technique. The programme comprised 12 exercises. ADHD scores were as follows: Group A and B showed significant deterioration in these scores, Group C demonstrated a significant improvement and Group D showed no significant change. Results of motor scores: Group A and D showed a significant deterioration, while Group B and C demonstrated a significant improvement. Conclusions: The combination of medication plus exercises are effective in addressing and improving the symptoms of comorbid ADHD and DCD in children aged 8 to 9 in KZN, SA. Practitioners are cautioned to screen children with ADHD for DCD, following which treatment should be administered to address symptoms of both conditions, hence, providing a more effective and holistic form of management.

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