Background: Reduced walking speed because of a stroke may limit activities of daily living (ADLs) and restrict social participation.
Objectives: To describe the level of balance impairment, activity limitations, and participation restrictions and to investigate their relationship with walking speed in Burundians with chronic stroke.
Methods: This cross-sectional study involved adult stroke survivors. Walking speed, balance, ADLs and social participation were assessed with the 10-meter walk test (10 mWT), the Berg balance scale (BBS), the activity limitation stroke scale and the participation measurement scale, respectively. In order to determine ambulatory independence status, participants were stratified into three walking speed groups (household ambulation, limited ambulation and full-community ambulation), based on the Perry classification.
Results: Fifty-eight adults (mean age 52.1 ± 11.4 years) with chronic stroke were included in our study. Most participants had severe balance impairments (median BBS score, 27). Their mean (± standard deviation [SD]) walking speeds, ADL levels and social participation levels were 0.68 ± 0.34 m/s, 50.8% ± 9.3% and 52.8% ± 8.6%, respectively. Walking speed correlated moderately with balance (rho = 0.5, p < 0.001) and strongly with ADL level (r = 0.7, p < 0.001) but not with participation level (r = 0.2, p = 0.25).
Conclusion: Using socio-culturally suitable tools, our study showed that walking speed correlates robustly with balance and ADL ability, but not with social participation, in Burundi, a low-income country.
Clinical implications: Exercises targeting walking speed would be very useful for people with chronic stroke living in low-resource countries, in order to promote their functional independence.
Background: Validation of an instrument consist of three main types: content, criterion and construct. Content validity needs to be determined in order for an instrument to be acceptable for use, validity establishes the fact that an instrument measures exactly what it proposes to measure. The Return-to-work assessment scale (RAS) was developed to measure three aspects of return to work: (Personal factors and/or issues, work issues and contextual factors) in 2021.
Objective: To report on the processes followed in establishing the face and content validity of the RAS.
Method: Twenty participants took part in our study, they were selected purposively and conveniently from a pool of professionals and post stroke survivors. The Delphi survey technique was used to arrive at consensus and professional opinion on the items included in the RAS. Consensus was sought on the items, domains and subdomains included in the RAS that was used to assess return-to-work after a stroke. Our study was concluded after the third round.
Result: One item was remove out of the original 86, three (3) domains made up of eleven (11) subdomains were retained. The RAS had consensus of 100% after three rounds of scrutiny for all items.
Conclusion: The RAS was found to be valid, thereby establishing its face and content validity.
Clinical implication: The RAS is valid and was recommended for psychometric testing which was the next stage after face and content validity.
Background: Back pain affects nurses' physical, social and emotional well-being, as they encounter difficulties in executing their social and occupational duties.
Objectives: Our study investigated the impact of a cross-cultural back pain campaign on nurses' beliefs about back pain; activating the participants to self-manage; coping strategies; sick leave claimed; and frequency of doctor visits.
Method: A single sample pre- and post-test design was used. The intervention was a 12-week educational campaign based on evidence-based back pain messages. Primary outcomes were measured by their beliefs about back pain and their activation to self-manage. Analyses were conducted using SPSS version 27.0 software, and significant differences from before and after the campaign were analysed using the Chi-square test at a 0.05 significance level.
Results: There were no significant differences in the age, gender and work hours of the nurses who participated before and after the campaign, except for their professional work settings (< 0.05). All secondary outcomes improved significantly after the campaign, and outcomes on beliefs about back pain showed significantly positive changes in six of the 14 items, while all questions pertaining to patient activation improved significantly.
Conclusion: The 12-week back pain campaign, based on contextualised, evidence-based back pain messages for Zambian nurses, motivated the participants to self-manage their back pain. However, not all beliefs about back pain changed positively after the campaign.
Clinical implications: The findings of this back pain education campaign show promise as a strategy to improve knowledge, behaviours and beliefs about back pain in African settings.
Background: The management of nonspecific chronic low back pain (NCLBP) is complex because of its multifactorial origin.
Objectives: To investigate NCLBP care by evaluating patients' condition and therapeutic management of health practitioners.
Method: A cross-sectional survey was carried out among 92 patients with NCLBP, 30 medical practitioners (MP) and 20 physiotherapists (PT) from four public health institutions in Burkina Faso. Patients completed the Visual Analogue Scale, Roland Morris Disability Questionnaire and Fear-Avoidance Beliefs Questionnaire. Practitioners were asked about therapy and continuing professional training.
Results: Pain was moderate to intense for 80% of participants with NCLBP. They were functionally affected and showed fear-avoidance beliefs related to physical and work activities. The majority (97%) of medical practitioners prescribed analgesics and 53% prescribed nonsteroidal anti-inflammatory drugs (NSAIDs). Physiotherapy was the most frequently recommended nonpharmacological treatment. Forty-three per cent of medical practitioners referred to physiotherapy; 20% never did. Physiotherapists practised both passive treatments, such as massage (50%), electrotherapy (55%) and thermotherapy (50%), as well as active treatments, such as general exercises (55%), specific exercises (70%), functional revalidation (50%) and back school (40%). Having had recent continuing professional training and assessing risk factors for chronicity were associated with MPs' and PTs' therapeutic choices.
Conclusion: Participants with NCLBP showed fear-avoidance beliefs, correlated with their algo-functional status. Prescribing habits of MPs were drug-based. Treatments by PTs were passive and active. Continuing professional training of healthcare practitioners and assessment of risk factors had a positive impact on therapeutic choices.
Clinical implications: Our study is an invitation to the health care system to improve the relationship between a patient's NCLBP and therapeutic choices.
Background: Grip strength has been identified as an important indicator of health status and predictor of clinical outcomes. The gold standard for measuring grip strength is the JAMAR® Hydraulic Hand Dynamometer. Less expensive dynamometers are available but have not been validated within a hospital setting.
Objectives: To validate the Camry Digital Handgrip Dynamometer (Model EH101) against the validated JAMAR® Dynamometer (Model J00105) in a hospital population.
Methods: A cross-sectional observational study with a randomised single-blind cross-over component was conducted on consenting adult patients admitted to general hospital wards. The best of three measurements taken using the dominant hand was used for analysis.
Results: Fifty-one participants (median [interquartile range] age 42 [30-58] years; n = 27 [52.9%] female) were included. The mean difference between the Jamar® and Camry measurements was 1.9 kg ± 3.6 kg (t-value 0.9; p = 0.4). There was a strong positive correlation between the Jamar® and the Camry devices (R = 0.94; r² = 0.88; p < 0.0001). Excellent agreement was found between Jamar® and Camry measurements (interclass correlational coefficient 0.97, 95% CI 0.94-0.99, p < 0.0001). Hand dominance significantly affected the agreement between devices (p = 0.002).
Conclusions: The Camry Digital Handgrip Dynamometer is a valid tool for assessing grip strength in hospitalised adult patients.
Clinical implications: The Camry Digital Handgrip Dynamometer could be used as an inexpensive tool to measure grip strength.
[This corrects the article DOI: 10.4102/sajp.v78i1.1756.].
Most physiotherapists today are familiar with the abbreviation ICF and know that it stands for the International Classification of Functioning, Disability and Health; the title of the World Health Organization's international standard for describing health and health related states. Most universities in South Africa and globally have adopted the framework of the ICF in their curricula especially in promoting clinical reasoning, however, translating that knowledge for recording and monitoring has been slow in coming. Less well known, is how the ICF is and can be used and how it can inform physiotherapy practice, research, education and administration. Our article outlines the importance of the ICF to physiotherapy and recommends resources to facilitate expanded ICF use by physiotherapists. Examples are given of how to use coding and the importance of aggregating data and concluding with resources that can assist with the expanded use. Sufficient evidence and resources are available to support the expanded use of the ICF for data collection and clinical coding.
Clinical implications: The aggregation of data can be used for the monitoring of universal health coverage especially in the context of National Health Insurance implementation.
Background: Pain after spinal cord injury (SCI) is common, and physiotherapy plays a pivotal role in alleviating pain for people with SCI.
Objective: To determine the modalities that physiotherapists in South Africa use to treat SCI-related pain and the factors that guide the selection of treatment modalities.
Method: A quantitative, cross-sectional design using a self-developed online survey was distributed to physiotherapists belonging to the South African Society of Physiotherapy and the Physiotherapy Association of South Africa. Data were analysed using SPSS v26, where descriptive data were analysed using frequency, percentages, means and standard deviations, and Fisher's exact tests for inferential analyses. Open-ended questions underwent thematic analysis.
Results: Forty-six responses were received. The most-used modalities were transcutaneous electrical nerve stimulation (29.8%), exercises (27.7%) and joint mobilisations (29.8%). Most physiotherapists used standardised measurements to objectively assess pain characteristics, with the visual analog scale being the most used (70.2%). Except for the cost of treatment, the factors that guided the selection of the modalities included the pain type, onset, duration, location and intensity, pain interference, duration of treatment, patient's preferences, other treatments that the patient was receiving for pain and psychosocial factors (87.2%).
Conclusions: Local physiotherapists use pain management modalities that are supported by the evidence to treat SCI-related pain.
Clinical implications: This study highlights the common modalities used by physiotherapists to treat SCI-related pain, as well as the selection criteria for the modalities. Owing to the low response rate, we caution against generalising these findings across the SCI pain management field.
Background: It remains unclear whether definite neural mechanosensitivity (NM) is required for neural mobilisations to be beneficial in people with spinally referred leg pain.
Objective: To determine whether the efficacy of neural mobilisations in patients with spinally referred leg pain depends on the presence and type of criteria used to define NM.
Method: PubMed, CINAHL, Cochrane Central Register of Controlled Trials, PEDro and Science Direct were searched from 1980 to March 2020. Randomised controlled trials evaluating the efficacy of neural mobilisations on pain and disability in spinally referred leg pain were included. Studies were grouped according to the certainty of NM into NMdefinite, NMunclear, NMuntested and NMabsent. Effects on pain and disability and subgroup differences were examined.
Results: We identified 21 studies in 914 patients (3 NMdefinite, 16 NMunclear, 2 NMuntested, 0 NMabsent). Meta-analysis revealed medium to large effect sizes on pain for neurodynamic compared to control interventions in NMdefinite and NMunclear groups. For disability, neurodynamic interventions had medium to large effects in NMunclear but not NMdefinite groups. NMuntested studies could not be pooled.
Conclusion: The nonexistence of studies in patients with negative neurodynamic tests prevents inferences whether neural mobilisations are effective in the absence of NM. The criteria used to define NM may not impact substantially on the efficacy of neural mobilisations. The mostly high risk of bias and heterogeneity prevents firm conclusions.
Clinical implications: Neural mobilisations seem beneficial to reduce pain and disability in spinally referred leg pain independent of the criteria used to interpret neurodynamic tests.
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