South African Journal of Physiotherapy - latest Issue
Volumes & issues
Volume 72, Issue 1, 2016
Rural South Africans' rehabilitation experiences : case studies from the Northern Cape Province : original researchSource: South African Journal of Physiotherapy 72, pp 1 –8 (2016) http://dx.doi.org/10.4102/sajp.v72i1.298More Less
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.
Source: South African Journal of Physiotherapy 72, pp 1 –7 (2016) http://dx.doi.org/10.4102/sajp.v72i1.306More Less
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.
Source: South African Journal of Physiotherapy 72, pp 1 –6 (2016) http://dx.doi.org/10.4102/sajp.v72i1.307More Less
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 researchAuthor Sonill S. MaharajSource: South African Journal of Physiotherapy 72, pp 1 –9 (2016) http://dx.doi.org/10.4102/sajp.v72i1.304More Less
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 researchSource: South African Journal of Physiotherapy 72, pp 1 –6 (2016) http://dx.doi.org/10.4102/sajp.v72i1.315More Less
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 researchSource: South African Journal of Physiotherapy 72, pp 1 –7 (2016) http://dx.doi.org/10.4102/sajp.v72i1.311More Less
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.
Effectiveness of resistance strength training in children and adolescents with ≥30% total body surface area : a systematic review : original researchSource: South African Journal of Physiotherapy 72, pp 1 –8 (2016) http://dx.doi.org/10.4102/sajp.v72i1.303More Less
Purpose : Children and adolescents with burn injuries are at risk of living with social, educational, physical and psychological impairments. The systematic review aimed to ascertain the effectiveness of resistance strength training on muscle strength and lean body mass (LBM) in children and adolescents with burn injuries.
Method : Five databases were searched. Randomised controlled trials with an intervention defined as a supervised, individualised resistance exercise programme were sought. The outcomes included muscle strength and/or LBM. The PEDro scale was used to describe the methodological quality. Comparable data were combined using RevMan©.
Results : Seven papers were included in the review with an average methodological appraisal score of 5.7/11. Comparable data were combined for muscle strength and LBM. The meta-analysis revealed no significant clinical difference between the exercise and standard care groups after 3 months of strength training for both muscle strength (p = 0.43) and LBM (p = 0.60).
Conclusions : There is no conclusive evidence to support the benefit of strength training for children and adolescents with burns injuries in terms of muscle strength and LBM. However, it appears that isokinetic training might benefit children and adolescents with burns, but more studies investigating the effect of isokinetic training are required.
The energy expenditure of people with spinal cord injury whilst walking compared to an able-bodied population : original researchSource: South African Journal of Physiotherapy 72, pp 1 –7 (2016) http://dx.doi.org/10.4102/sajp.v72i1.255More Less
Background : In the field of spinal cord injury (SCI) research there is an emphasis on the ability to ambulate.
Purpose : To determine the ambulation energy expenditure (EE) and factors that affect ambulation EE in SCI participants compared to able-bodied participants.
Methods : This was a cross-sectional study. Participants were recruited from seven SCI rehabilitation units within the Johannesburg area. The following were used: demographic questionnaire to capture participants' characteristics, modified Ashworth scale for spasticity; goniometer for range of movement (ROM); American Spinal Injury Association (ASIA) scale for patient classification; accelerometer for EE and the six-minute walk test (6MWT) for endurance. Characteristics of the study participants were summarised using descriptive statistics. Data were analysed as follows: two-sample t-test for comparison between the able-bodied and SCI sample and Pearson product moment correlations for relationship between identified factors and EE.
Results : Participants comprised 45 in the SCI group and 21 in the able-bodied group. The mean energy expenditure per metre (EE/m) for the SCI participants was 0.33 (± 0.29) calories compared to 0.08 (± 0.02) calories for the able-bodied participants. A decrease in walking velocity resulted in an increase in EE. For SCI participants, every decrease in degree of hip flexion ROM resulted in a 0.003 increase in EE/m walked. A unit decrease in velocity resulted in an increase of 0.41 in EE/m walked. Energy expenditure per metre decreased from ASIA A to ASIA D. Crutch walking utilised 0.34 calories per metre less energy than walking frames (p = 0.03).
Conclusion : Based on this study's findings, factors to consider in order to maximise energy efficiency whilst walking are maintaining hip flexion ROM and optimising velocity of walking.
A qualitative investigation of the role of paediatric rehabilitation professionals in rural South Africa : rehabilitation professionals' perspectives : original researchSource: South African Journal of Physiotherapy 72, pp 1 –7 (2016) http://dx.doi.org/10.4102/sajp.v72i1.290More Less
Purpose : To investigate the role that rehabilitation professionals play in the rehabilitation of children with disabilities in the rural and under-resourced community of Giyani in South Africa.
Method : A qualitative, exploratory and descriptive approach was used. Semi-structured face-to-face interviews were used to collect data from a convenient sample of eight rehabilitation professionals. Data were transcribed verbatim by two trained students and verified by the main researcher. An inductive approach to qualitative data analysis was used. In vivo and open coding were used to generate codes.
Results : Analysis of data resulted in 21 codes, 9 subcategories, 5 categories and 1 theme. The role of rehabilitation professionals was described in terms of the five categories which are to examine newborn babies and children at risk, support caregivers of children with disabilities, impart skills training for caregivers of children with disabilities, rehabilitate children with disabilities and conduct follow-ups in communities where the children with disabilities reside.
Conclusion : The role that rehabilitation professionals play in the rural and under-resourced community of Giyani in South Africa is similar to the role played in high-income countries. The role that rehabilitation professionals play is not only focused on the child but also on the family.
Effect of corticosteroid injections versus physiotherapy on pain, shoulder range of motion and shoulder function in patients with subacromial impingement syndrome : a systematic review and meta-analysis : original researchSource: South African Journal of Physiotherapy 72, pp 1 –9 (2016) http://dx.doi.org/10.4102/sajp.v72i1.318More Less
Background: Subacromial impingement syndrome (SIS) is one of the most common causes of shoulder pain. Limited research has been conducted into the efficacy of corticosteroid injections (CSIs) compared to physiotherapy in the management of SIS.
Objective: To critically appraise and establish the best available evidence for the effectiveness of CSI in comparison with physiotherapy for the management of pain, shoulder range of motion (ROM) and shoulder function in patients with SIS.
Methodology: Seven databases were searched from inception to February 2016, namely PubMed, Science Direct, EBSCO Host: SPORTDiscus, EBSCO Host: CINAHL, Cochrane, Scopus and PEDro. The main search terms were shoulder impingement syndrome and/or subacromial impingement syndrome, corticosteroid injections and/or steroid injections, physical therapy and/or physiotherapy. Only randomised controlled trials (RCTs) were considered for inclusion. The articles were appraised according to the PEDro scale. The Revman© Review Manager Software was used to combine the results of shoulder function and the data were illustrated in forest plots.
Results: The PEDro scores of the three RCTs that qualified for this review ranged from 7 to 8/10. There is Level II evidence suggesting that besides a significant improvement in shoulder function in favour of CSI at 6-7 weeks follow-up (p < 0.0001), no evidence was found for the superiority of CSIs compared with physiotherapy for pain, ROM and shoulder function in the short- (1-3 months), mid- (6 months) and long term (12 months).
Conclusion: In patients with SIS only a short term significant improvement in shoulder function was found in favour of CSIs.
Conceptualisation of community-based rehabilitation in Southern Africa : a systematic review : original researchSource: South African Journal of Physiotherapy 72, pp 1 –8 (2016) http://dx.doi.org/10.4102/sajp.v72i1.301More Less
Background: Community-Based Rehabilitation (CBR) has evolved over the last 30 years and now focuses on empowering persons with disabilities to access and benefit from a wide range of services. The evidence for CBR is frequently cited in the literature as being scanty and of poor quality.
Purpose: We sought to determine how CBR is conceptualised and understood in the literature from Southern Africa. Our interest centred on to what extent the literature could inform policy makers and practitioners in the region.
Methods: A systematic review of the literature from countries in Southern Africa guided by Population, Intervention/Phenomenon of Interest, Context and Outcome of Interest to the reviewer (PICO) was employed. This involved an extensive, internally valid and systematic search of electronic databases using specific keywords/subject heading combinations. Journal articles reporting on a description or objectives of CBR, published after 2006, and journal articles written in English of all types of studies were included. Data were charted according to the emergent themes. Two independent raters coded the emergent themes.
Results: Nine from a possible 257 published articles were reviewed; four of these were programme evaluations. Themes describing CBR converged on community development and poverty reduction. Only one article referred to human rights. Training and supervision of CBR workers and education of the community about disability were frequently reported activities.
Conclusion: In isolated cases, the literature is aligned to components of the CBR matrix. However, consistent with previous criticism of CBR, the literature is meagre, as is the evidence to inform policy makers and practitioners in southern Africa.