South African Journal of Physiotherapy最新文献

Background: Managing children with cerebral palsy (CP) in poorly-resourced contexts, especially those with greater functional limitations, is challenging. Unmitigated orthopaedic complications can further restrict already compromised functional capacity. Where rehabilitation skills and knowledge are scarce, primary healthcare worker- and caregiver-implemented routines are warranted. The essential elements of a home-based routine to mitigate musculoskeletal (MSK) complications in children with severe CP in resource-limited settings (RLSs) have not been determined.

Objectives: To summarise the evidence for programmes and interventions that mitigate MSK complications in children with severe CP and make recommendations for a programme suited to RLSs.

Method: Scientific databases and professional websites were searched for studies and reports describing guidelines, interventions or programmes for children aged 0-18 years with severe, partially- or non-ambulant CP, that included aims for the prevention of MSK complications. Articles reporting on surgical, pharmacological and advanced or expensive technological interventions were excluded.

Results: A total of 57 studies or reports were included in the review. Low-grade evidence exists for 24-hour postural management (24-h PM), supported standing, sustained stretching and splinting to mitigate MSK complications in children with CP. Caregiver training and support, and integration of the programme into daily routines were identified as important components for successful implementation.

Conclusion: Clinical guidelines and evidence that support caregiver-delivered interventions to reduce MSK complications in children with severe CP are limited, and only weak recommendations can be made.

Clinical implications: There is a need for context-specific, home-based intervention programmes to prevent MSK complications in children with CP in RLSs.

Background: Caring for children with special needs places a burden on caregivers. The challenges experienced can be conceptualised as personal and environmental, as per the International Classification of Functioning, Disability and Health Framework (ICF).

Objectives: Supported the caregiver experiences when caring for children with special needs and to conceptualise these needs in relation to the personal and environmental factors set out in the ICF.

Method: A qualitative exploratory study was conducted, using purposive and snowball sampling. Semi-structured interviews were used to collect the data, which were then analysed thematically.

Results: A total of six themes arose from the data. Two of these were related to personal factors: unemployment and caregiving, and marital uncertainty. The other four themes were related to environmental factors: family and caregiving factors, educational factors, health-systems challenges and perceptions of children with special needs.

Conclusion: Caregivers of children with special needs experienced personal challenges, which resulted in feelings of isolation from family and society. They also faced environmental challenges in sectors such as education and health.

Clinical implications: The management of children with special needs should include interventions within their environments to assist caregivers with their tasks. This could contribute to improved quality of life for both the caregivers and their children.

Background: Globally, there is a significant gap in detailed neurodevelopmental data for infants under 3 months, despite 6 weeks being identified a critical milestone for neuro-behavioural development. Normative values and optimal scores for healthy infants at 6 and 10 weeks postnatally are lacking in many settings. In South Africa, the statutory neurodevelopmental assessments at these ages exclude notable characteristics of central nervous system maturation and limit opportunities to collect data of early developmental progress.

Objectives: Our study aimed to assess developmental characteristics of healthy term infants aged 6 and 10 weeks using the Hammersmith Neonatal Neurological Examination (HNNE).

Method: A prospective longitudinal study was performed on 35 healthy term-born infants from low-risk pregnancies at 6 and 10 weeks' postnatal age in the Tshwane district. The statuses of infants' neurodevelopment in six domains were recorded using the HNNE. Optimality scores were derived from the raw scores of 34 items, using the 10th and 5th percentiles as cut-off points.

Results: Evidences of neurodevelopmental advancements, particularly in posture, muscle tone and visual behaviour between 6 and 10 weeks were illustrated, and total examination optimality scores of 29.5 in 91% and 31.5 in 94% of infants were recorded at 6 and 10 weeks, respectively.

Conclusion: This article provides data on the neurodevelopment characteristics of infants at and between 6- and 10-weeks post term ages.

Clinical implications: The findings support the viewpoint to identify important milestone characteristics during early screening.

Background: The global coronavirus disease 2019 (COVID-19) pandemic irrevocably influenced our lives, yet research in a diversity of countries is lacking. Cardiorespiratory fitness may be impaired for up to a year post-COVID-19 infection.

Objectives: Our study aimed to compare acute and exertional symptoms, fatigue, and exercise performance in masters-age endurance athletes according to their return-to-sport status.

Method: A cross-sectional survey-based observational study of long-distance runners and cyclists was conducted. Data were stratified into two groups: those who returned to their pre-illness level of sport and those who did not and were compared statistically.

Results: A total of 308 survey responses were included in the analysis. The mean age of the athletes was 44.9 + 10.2 years, with 55.2% being male. The group that did not return to their pre-illness level of sport (31.5%) had more post-COVID sequelae, worse illness severity, with a higher frequency of resting and exertional symptoms, notably fatigue and dyspnoea. Decreased exercise capacity was correlated with increased physical fatigue scores.

Conclusion: Almost one-third of endurance athletes suffered protracted exercise tolerance post-COVID-19. Long-term symptoms may be more consequential in this athlete population.

Clinical implications: Symptoms that may indicate cardiopulmonary consequences in recreational athletes should be investigated in order to facilitate return to sport and the important mental and physical benefits thereof. This will augment outcomes after respiratory tract infections and management of return to sport and expectations of endurance athletes.

Background: Knowledge about mental health in physiotherapy practice is essential as mental health can impact physical health. Little is known about the mental health content in the South African physiotherapy undergraduate programme.

Objectives: Our study explored the mental health content in the undergraduate physiotherapy programme at eight universities and the perceptions of academic staff at an identified training institution in South Africa and stakeholders about the relevance of mental health in the undergraduate physiotherapy programme.

Method: Our study employed a concurrent-mixed method design, which consisted of: (1) the administration of a survey to academic leaders or lecturers undertaking mental health teaching at universities and (2) an online interview that included stakeholders and a focus group to gauge perceptions of academic staff at an identified institution in South Africa.

Results: Seven of eight universities participated in our study. All the universities had a psychology module and agreed that it is crucial to have mental health content in the curriculum. There is diversity in the mental health content between the universities.

Conclusion: There is a need for consistency in the mental health content at all universities to ensure that all students receive the same skill set to have an impact on the quality of care.

Clinical implications: There is a need to include mental health content at universities offering theoretical and practical undergraduate programmes.

Background: People living with human immunodeficiency virus (PLWH) live longer, but experience human immunodeficiency virus (HIV)-related comorbidities and disabilities that lower their quality of life. Understanding the prevalence, risk factors, and disability patterns is crucial for tailored interventions.

Objectives: To explore the prevalence and predictors of HIV-related disability among PLWH in Nigeria.

Method: This cross-sectional survey involved 385 PLWH, exploring demographic data, HIV history, recent symptoms, disability (measured by the WHO Disability Assessment Schedule-WHODAS 2.0). Descriptive statistics summarised the data, all variables were entered into univariate and multivariate regression models. IBM SPSS 25^® was used for all analyses at a 95% confidence level.

Results: The prevalence of disability among PLWH was 39.5%, the mean age was 42.2 ± 10.43 years, and 73% of the participants were females. Factors significantly associated with disability were marital status (p = 0.009) and level of education (p = 0.001).

Conclusion: The study reveals a prevalence of disability (39.5%) among PLWH on antiretroviral therapy (ART), emphasising the need for tailored interventions considering socio-demographic factors. Continuous screening, risk identification, and effective management strategies are imperative, recognising disability as an indicator of health and quality of life.

Clinical implications: With PLWH experiencing increased life expectancy, the study underscores the need for an informed patient-centred approach to care, recognising the specific challenges faced by PLWH in Nigeria and guiding the development of targeted interventions to enhance both functional outcomes and overall well-being.

Background: Adults with spinal cord injuries perceived peer support as beneficial in preventing secondary health conditions, but the role of peer support among adolescent learners with paraplegia in special schools is still unknown.

Objectives: To explore the perspectives of current and previous learners with paraplegia on peer support to prevent pressure ulcers in a special school.

Method: A qualitative, exploratory, descriptive study design was used. The authors conducted 12 semi-structured telephonic, audio-recorded interviews and a focus group discussion with current and previous learners with paraplegia attending a special school. The interviews were transcribed verbatim and translated, and data were organised using the Nvivo-12 Pro program. Through conducting an inductive thematic analysis categories, sub-themes and themes were identified from the participants' narratives.

Results: The participants' perspectives included positive and challenging aspects of peer support reflected in four sub-themes: group-based support, individual peer mentoring, challenges with peer support and the roles of the school physiotherapist regarding peer support.

Conclusion: Learners saw peer support as a crucial strategy in preventing and reducing pressure ulcers. Establishing a peer support system with group and individual components in special schools could be a game-changer to end pressure ulcers among learners with paraplegia and ensure better health and educational outcomes.

Clinical implications: Physiotherapists in special schools should support peer support initiatives among learners with paraplegia to ensure successful pressure ulcer prevention.

Self-management is an important strategy to improve quality of life, appropriately manage long-term health conditions, and reduce the economic burden of long-term health conditions. However, equitable healthcare access remains an issue, and the focus on 'self' in self-management is problematic. Our review aims to explore the conceptualisation and evolution of supported self-management in an African context and its relevance to physiotherapy. A state-of-the-art review of the literature was undertaken by the authors. The authors knowledge of the subject area and a database search retrieved recent articles exploring patients' and healthcare providers' understanding of supported self-management in Africa. Relevant articles were read, and data summaries of included studies were extracted and tabulated. Findings were organised deductively. Sixteen studies, 11 primary research, and 5 reviews (2016-2023) undertaken in a variety of sub-Saharan countries with healthcare workers (~n = 177) and people (~n = 16 115) living with a mix of non-communicable and communicable conditions were considered in this state-of-the-art review. Self-management perceptions were drawn from Western authors spanning development research and understanding of the concepts in Western thinking. We conclude that imported concepts, such as supported self-management for long-term conditions, should be considered within local health delivery solutions. These should be embedded in an understanding of traditional African health systems.

Clinical implications: There is a need to develop locally derived African solutions. Self-management strategies for long-term health conditions should be developed, considering traditional holistic African health systems.

In the last decade, concussion research has exploded in multiple fields of scientific research. This has helped to clarify what causes, influences, and perpetuates human concussion, and displays the integral role physiotherapists play in concussion management. In this article we discuss the latest research relevant to the key role of physiotherapy in concussion management. A narrative review of the literature on concussion was conducted. The current review analyses how concussion has influenced physiotherapy in several categories: assessment, treatment, management, research rigour and building the profile of the profession. Scientific concussion research has largely converged in support of the role of physiotherapists utilising specific components including: (1) autonomic, (2) cervicogenic, (3) vestibulo-ocular and (4) psychological approaches to management. Latest research supports the critical role of physiotherapy in concussion care in the assessment, management, and prevention of concussion with scope for further interdisciplinary collaborations.

Clinical implications: Concussion is complex. A basic mental health, Vestibular Ocular Motor Screening (VOMS) and four key components relating to concussion management (autonomic, cervicogenic, vestibular oculomotor, and psychological approaches to management) should be included in the undergraduate and postgraduate curriculum. This will aid clinical physiotherapists to support their patients. A call to advance more intradisciplinary physiotherapy teamwork should be encouraged as valuable knowledge sharing is potentially lost within the framework of 'specialisation'. If needed, the skills of a greater interdisciplinary team are imperative to facilitate patient management and recovery from this multi-faceted injury.

Background: The Internship and Community Service Programme (ICSP) places newly graduated health professionals for a compulsory training period. Universities adopt multiple strategies to encourage students to select rural placements for ICSP.

Objectives: This study describes ICSP choices among final-year MBChB and Health and Rehabilitation Science students at a South African university and the factors influencing their decisions.

Method: A cross-sectional qualitative descriptive study was conducted using a self-developed online questionnaire. Eighty-five final-year students were recruited.

Results: Most respondents (n = 38, 45.8%) chose the Western Cape (WC) as their first choice placement. There was a significant difference between MBChB and other health science students' choice of level of healthcare (χ = 10.39, p = 0.006), with MBChB less likely to choose primary healthcare (PHC) level placements. District and tertiary care options were perceived as better sites for learning and practice, while PHC and rural sites, considered underresourced and understaffed, were avoided. Although MBChB students indicated a lower preference for rural placements, this was not significant.Factors influencing ICSP application decisions included professional support, work environment, and social and personal considerations.

Conclusion: Students' placement choices were based on their perceptions of clinical exposure, learning opportunities, mentorship and supervision. Placements closer to home were preferred. UG clinical exposure and rural background seem to have some impact on choice but need further investigation.

Clinical implications: Universities should continue to explore ways to improve students' readiness for practice in underresourced settings. Improved exposure to rural and PHC sites during training could encourage better uptake during ICSP placement.