South African Journal of Physiotherapy
The South African Journal of Physiotherapy is the official scholarly refereed journal of the South African Society of Physiotherapy. It aims to publish original research and facilitate continuing professional development for physiotherapists and other health professions both nationally and internationally. The South African Journal of Physiotherapy is dedicated to the advancement of physiotherapy through publication of research and scholarly work concerned with, but not limited to, its scientific basis and clinical application, education of practitioners, management of services and policy. We welcome original research and reviews covering diverse topics in the field of physiotherapy.
|Publisher||SA Society of Physiotherapy|
|Coverage||Vol 72 Issue 1 2016 - current|
Rural South Africans' rehabilitation experiences : case studies from the Northern Cape Province : original research
Background : Rehabilitation is often challenging in South Africa, but South Africans living in remote rural settings might experience unique challenges.
Objective : This article interrogates issues of access to rehabilitation in a selected sample from rural South Africa through case studies.
Method : This qualitative study utilised a case study design. Eight case studies were done in a purposively sampled rural town in the Northern Cape Province. Data were collected through in-depth interviews. Data were analysed according to the principles of interpretative phenomenological analysis.
Results : The case study participants were not integrated into the community. They experienced higher levels of disability than one would expect from their impairments. Their impairments were not modified. No retraining of function was implemented. Early intervention and childhood development activities were not provided. Participants were not linked with self-help or peer support groups. Provision of assistive devices was challenged. Environmental barriers aggravated the situation.
Conclusion : We theorise that one-on-one therapy is not the solution to the rehabilitation needs of persons with disabilities in remote, rural settings. We recommend a move to community-based rehabilitation and transdisciplinary teamwork supported by family members, community health workers and peer mentors. Therapists are ideally situated to explore the feasibility of such programmes and to pilot them in various communities.
Aims : To examine how the choice of words explaining ultrasound (US) may influence the outcome of physiotherapy treatment for low back pain (LBP).
Methods : Sixty-seven patients with LBP < 3 months were randomly allocated to one of three groups - traditional education about US (control group [CG]), inflated education about US (experimental group [EG]) or extra-inflated education about US (extra-experimental group [EEG]). Each patient received the exact same application of US that has shown clinical efficacy for LBP (1.5 Watts/cm2 for 10 minutes at 1 Megahertz, pulsed 20% over a 20 cm2 area), but received different explanations (CG, EG or EEG). Before and immediately after US, measurements of LBP and leg pain (numeric rating scale), lumbar flexion (distance to floor) and straight leg raise (SLR) (inclinometer) were taken. Statistical analysis consisted of mixed-factorial analyses of variance and chi-square analyses to measure differences between the three groups, as well as meeting or exceeding minimal detectable changes (MDCs) for pain, lumbar flexion and SLR.
Results : Both EG and EEG groups showed a statistically significant improvement for SLR (p < 0.0001), while the CG did not. The EEG group participants were 4.4 times (95% confidence interval: 1.1 to 17.5) more likely to improve beyond the MDC than the CG. No significant differences were found between the groups for LBP, leg pain or lumbar flexion.
Conclusion : The choice of words when applying a treatment in physiotherapy can alter the efficacy of the treatment.
Background : In South Africa, pulmonary tuberculosis (PTB) remains a problem of epidemic proportions. Despite evidence demonstrating persistent lung impairment after PTB cure, few population-based South African studies have investigated this finding. Pulmonary rehabilitation post-cure is not routinely received.
Objectives : To determine the effects of PTB on lung function in adults with current or past PTB. To determine any association between PTB and chronic obstructive pulmonary disease (COPD).
Methods : This study was observational and cross-sectional in design. Participants (n = 55) were included if they were HIV positive on treatment, had current PTB and were on treatment, and/or had previous PTB and completed treatment or if they were healthy adult subjects with no history of PTB. A sample of convenience was used with participants coming from a similar socio-economic background and undergoing spirometry testing. Multiple regression analyses were conducted on each lung function variable.
Results : Compared to normal percentage-predicted values, forced expiratory volume in 1 second (FEV1), forced vital capacity (FVC) and FEV1:FVC were significantly reduced in those with current PTB by 23.39%, 15.99% and 6.4%, respectively. Both FEV1 and FVC were significantly reduced in those with past PTB by 11.76% and 10.79%, respectively. There was no association between PTB and COPD - those with previous PTB having a reduced FEV1:FVC (4.88% less than the norm), which was just short of significance (p = 0.059).
Conclusions : Lung function is reduced both during and after treatment for PTB and these deficits may persist. This has implications regarding the need for pulmonary rehabilitation even after medical cure.
Does a physiotherapy programme of gross motor training influence motor function and activities of daily living in children presenting with developmental coordination disorder? : original research
Background : Children with developmental coordination disorder (DCD) lack motor coordination and have difficulty performing motor skills and activities of daily living. Research shows these children do not outgrow their motor difficulties and without intervention do not improve. Physiotherapy is relevant for these children, but due to limited clinical protocols for DCD the aim of this study was to determine the effect of a gross motor training programme for 6â??12-year-old children with DCD.
Methods : This randomised pre-test, post-test study recruited 64 children with scores of 15th percentile or below using the Movement Assessment Battery for Children (M-ABC). The children were divided equally into an intervention group receiving 8 weeks of gross motor training for core stability, strengthening exercises, balance and coordination with task-specific activities for 30 min per week, while the control group continued with general therapy and activities of daily living. The M-ABC and Developmental Coordination Disorder Questionnaire (DCDQ) were used to assess each child before and after 8 weeks.
Results : Sixty children completed the study, with 43 males and 17 females (mean age 10.02 years, SD = 2.10). There were no adverse reactions to the programme and M-ABC scores for the intervention programme improved by 6.46%, ball skills (3.54%) and balance (4.80%) compared with the control (0.17%) and (0.15%), respectively. There were significant (p < 0.05) improvements in DCDQ scores, but teachers allocated lower scores than parents.
Conclusion : This study supports 8 weeks of gross motor training which can be a beneficial intervention for physiotherapists to improve gross motor function for DCD.
The effect of positioning and diaphragmatic breathing exercises on respiratory muscle activity in people with chronic obstructive pulmonary disease : original research
Background : Body positioning and diaphragmatic breathing may alter respiratory pattern and reduce dyspnoea in people with chronic obstructive pulmonary disease (COPD).
Objectives : To determine the effect of positioning and diaphragmatic breathing on respiratory muscle activity in a convenience sample of people with COPD, using surface electromyography (sEMG).
Methods : This prospective descriptive study recorded sEMG measurements at baseline, after upright positioning, during diaphragmatic breathing and 5 minutes thereafter. Vital signs and levels of perceived dyspnoea were recorded at baseline and at the end of the study. Data were analysed using repeated measures ANOVAs with post hoc t-tests for dependent and independent variables.
Results : Eighteen participants (13 male; mean ± standard deviation age 59.0 ± 7.9 years) were enrolled. Total diaphragmatic activity did not change with repositioning (p = 0.2), but activity increased from 7.3 ± 4.2 µV at baseline to 10.0 ± 3.3 µV during diaphragmatic breathing (p = 0.006) with a subsequent reduction from baseline to 6.1 ± 3.5 µV (p = 0.007) at the final measurement. There was no change in intercostal muscle activity at different time points (p = 0.8). No adverse events occurred. Nutritional status significantly affected diaphragmatic activity (p = 0.004), with participants with normal body mass index (BMI) showing the greatest response to both positioning and diaphragmatic breathing. There were no significant changes in vital signs, except for a reduction in systolic/diastolic blood pressure from 139.6 ± 18.7/80.4 ± 13.0 to 126.0 ± 15.1/75.2 ± 14.7 (p < 0.05).
Conclusion : A single session of diaphragmatic breathing transiently improved diaphragmatic muscle activity, with no associated reduction in dyspnoea.
The development of an intervention to manage pain in people with late-stage osteoarthritis : original research
Background : Osteoarthritis (OA) is one of the most common musculoskeletal conditions worldwide, affecting the functional abilities of millions of people. Arthroplasty is recommended as a successful treatment option for late-stage OA. However, in South Africa there are extensive waiting lists for OA-related arthroplasty in government hospitals. This has negative consequences for patients having to cope for long periods of time with chronic pain and its impact. Alternative treatment methods in the form of physiotherapy-led exercise and education programmes focusing on pain, disability, self-efficacy, physical function and health-related quality of life have had good impact in populations elsewhere.
Objectives : To develop an exercise and education intervention based on the current literature and by doing a field survey in a South African population.
Results : A combined educational approach, with a strong focus on the physical aspects of exercise in particular, was adopted for the intervention in order to improve function and manage the disability associated with OA.
Conclusion : This paper reports on the process and development of an intervention for use in South Africans with late-stage OA awaiting arthroplasty.