South African Journal of Physiotherapy最新文献

Background: Acute exacerbation of chronic obstructive pulmonary disease (AECOPD) is a leading cause of morbidity and mortality in South Africa. Physiotherapy practice and factors that influence management of patients with AECOPD are unknown.

Objectives: To explore physiotherapy practice in the management of patients with AECOPD in South African private healthcare settings and to identify and describe factors that influence physiotherapy patient management.

Method: The study adopted a qualitative descriptive design using semi-structured interviews. Purposive and snowball sampling was used to identify physiotherapists working in private healthcare in three South African provinces. Individual interviews were conducted face-to-face or via telephone and transcribed verbatim. Content analysis was done using an inductive approach.

Results: Participants (n = 9) working in private hospitals reported that their management is based on patient-specific needs assessment. Treatment interventions included various respiratory physiotherapy techniques and exercise rehabilitation strategies. Patient education on self-management of disease symptoms featured prominently. Enablers of physiotherapy management included supportive workplace relations, conducive work environment, physiotherapists' competence, familial support and patient cooperation. Barriers identified included limited communication, nurses' attitudes, work environment, disease burden, mental health challenges and limited professional development opportunities.

Conclusion: Physiotherapists provide individual needs-based care to patients with AECOPD. Various enablers and barriers to physiotherapy patient management have been identified.

Clinical implications: Advocacy for physiotherapy, better communication between multidisciplinary team members and recognition of the need for psychological support are important factors to address to enhance the care provided to patients with AECOPD.

Background: Adherence to management regimes is pivotal to successfully managing patients with low back pain (LBP). Barriers decrease adherence, resulting in disability.

Objectives: Our pilot study aimed to determine barriers associated with physiotherapy treatment attendance and home exercise programme adherence among patients with LBP and treating physiotherapists in Eswatini.

Method: A cross-sectional descriptive pilot study using a self-developed Research Electronic Data Capture (REDCap) survey was conducted with 62 LBP patients. Descriptive, regression and bivariate statistical analyses with odds ratios (OR) were used to identify adherence barriers.

Results: Twenty-two (35.5%) participants missed appointments because of feeling better. Twenty-one participants (33.9%) missed scheduled appointments due to painful sessions, cost and the burden of changing their routines. Home exercise adherence was positively associated with understanding the condition (p = 0.001) and negatively with too many exercises (p = 0.005).

Conclusion: Our study identified patient barriers to physiotherapy adherence, particularly females aged 40-69 years. Although doctor referrals improved adherence, time constraints and pain remained significant barriers. Barriers to prescribed home exercise programme adherence included pain during exercises, fear, no time, forgetting/no reference and too many exercises. While most participants understood their condition, some lacked understanding, underscoring the need for better education. Addressing these barriers could enhance adherence and reduce the impact of LBP.

Clinical implications: To overcome the barrier of adherence to keeping appointments, prioritising health education and providing reasons for exercises should be empathised. Exercise programme adherence could be improved by providing reference material, less and more meaningful and/or functional exercises.

Background: HIV-associated neurocognitive disorder (HAND) affects an individual's capacity for independence and engagement in everyday activities, posing challenges in environments with limited resources and low social support.

Objectives: To ascertain the efficacy of exercise (AE) for activity and participation (AP) level in people with HAND.

Method: This is a randomised controlled trial that is parallel-group in nature, with intention-to-treat analysis and disguised allocation. Seventy-three people with HAND in total were randomised at random to the AE and control groups. Three 20-60-min sessions of moderate-intensity AE training on a cycle ergometer were included of the 12-week intervention. Individual tolerability served as the basis for progression. Three months after the intervention, at the conclusion of the intervention, and at the baseline, outcomes were measured. The AP constitutes the main outcome variable. To investigate the impact of AE on AP level, rank analysis of covariance was performed after log-transformation.

Results: When comparing the AE to the control group, there were significant increases in social wellbeing AP (Cohen d = 0.550; p = 0.021), emotion AP (Cohen d = 0.641; p = 0.007) and overall AP level (Cohen d = 0.896; p < 0.001). There was no discernible variation in AP across the groups three months following AE (Cohen d = 0.437; p = 0.067).

Conclusion: AE induces a small increase in AP among individuals with HAND.

Clinical implications: For people with HAND, regular AE is a good way to manage AP restriction. Increasing AE participation may improve AP restriction.

Background: Rugby-related injuries are a leading cause of dropout from competitive sports, high insurance compensation, disability and socioeconomic marginalisation. The debilitating effect of these injuries on players may deny them the benefits associated with rugby and can lead to premature termination of a rugby career.

Objectives: To determine the prevalence, incidence and risk factors for rugby-related injuries among male Safari Sevens rugby tournament players in Kenya.

Method: Following ethical approval and clearance, this cross-sectional study was carried out among October 2021 teams of male players in the Safari Sevens rugby tournament. Players (n = 113) voluntarily completed Rugby International Consensus Group 'injury report form'. Descriptive statistics and odds ratios were calculated.

Results: A point prevalence of 47 (41.6%) respondents at pre-tournament was found. The tournament recorded 117.6 player-match hours with an incidence of 33 (29.2%) injuries occurring during competition. In contact phase of rugby match, 'being tackled' was associated with a higher number of injuries mostly in the lower limbs. Surface of the playing field was likely to expose a player to injury in pre-competition and during the tournament. Additionally, players who had recurrent previous injuries and oversize gear were more likely to be injured during the tournament.

Conclusion: The study showed competition injury incidence similar to that reported in previous studies. Lower limb injuries were most prevalent, especially the ankle while 'getting tackled' during matches.

Clinical implications: There is a need for an algorithm for injury risk assessment, knee and ankle control training protocol, and use of dynamic knee and ankle supports.

Background: Complaints of ethical and professional misconduct are lodged and processed by the Health Professions Council of South Africa (HPCSA) in accordance with their legal mandate.

Objectives: This study describes the nature and frequency of transgressions by physiotherapists as concluded by the HPCSA for the period from 2010 to 2020.

Method: A total sampling method was used to extract all records of transgressions lodged against physiotherapists between 2010 and 2020. In a quantitative retrospective records review design, data were captured with the objective to report these descriptively. Ethics approval was granted by the Faculty of Health Sciences Research Ethics Committee of the University of Pretoria and permission to use the records was granted by HPCSA.

Results: Twenty-one transgressions by physiotherapists during the study period were recorded at the HPCSA. Most transgressions were charging for services not rendered (n = 20 times), invoices drafted inaccurately (n = 17) and false claims submitted to the medical aid schemes (n = 15). Other transgressions included failure to obtain informed consent and patient identity prior to treatment, charging for an unkept appointment, overservicing, misleading advertisements, love relationship with a patient and treating an animal in the same practice as humans.

Conclusion: The transgressions were unprofessional in nature with the most frequently reported being false claims and accounts submitted to the medical aid by physiotherapists for services not rendered.

Clinical implications: The knowledge of transgressions will influence decision making and restrain infringement to enhance sound ethical practice.

This conference report includes abstracts from the centenary congress held in Cape Town in September 2024, marking a significant milestone in the celebration of 100 years of the South African Society of Physiotherapy™ (SASP^®). As part of the celebration, the SASP^® hosted the World Physiotherapy - Africa Region Congress, which brought together diverse international and African perspectives. The scientific programme had exciting sessions, focussing on physiotherapy and multidisciplinary aspects. Engaging Indaba and Debate sessions covered topics such as Strengthening Rehabilitation in Africa, Innovation in Rehabilitation, Reframing Care for People with Musculoskeletal Pain, Research in Children with Disabilities and Translating Research into Practice in Africa. These abstracts reflect the broad range of research and ideas presented, contributing to the future of physiotherapy and rehabilitation on the continent.

Background: Stroke presents significant challenges for both survivors and caregivers, particularly in resource-limited settings like Zimbabwe. Identifying factors contributing to caregiver burden strain (CBS) is crucial to enhance support strategies.

Objectives: This longitudinal study identified caregiver and stroke survivor characteristics associated with CBS among caregivers in Harare, Zimbabwe.

Method: Altogether 188 stroke survivors and their caregivers participated with CBS assessed at 3 months and 12 months using the Caregivers Strain Index. Multiple linear regression was used to evaluate the association of explanatory variables with CBS. Model fit was evaluated using the Akaike's Information Criterion and R ².

Results: Caregivers experiencing anxiety or depression showed increased CBS at 3 months (β = 2.46, p < 0.001) and 12 months (β = 2.73, p = 0.016). Work adjustments were associated with higher CBS at 3 months (β = 3.84, p < 0.001). Caregivers feeling overwhelmed had significantly higher CBS at 3 months (β = 3.36, p < 0.001). Stroke survivors' poor physical outcomes and reliance on health insurance were associated with CBS at 12 months (β = 4.34, p = 0.006). Caring for married stroke survivors was associated with reduced CBS (β = -2.83, p < 0.001).

Conclusion: Caregiver anxiety, depression, work adjustments and poor physical and social outcomes in stroke survivors contributed to increased CBS. Targeted interventions addressing mental health and social support are essential to reduce CBS.

Clinical implications: Multifaceted interventions that address caregiver mental health and social support are vital to reduce CBS and improve outcomes in resource-constrained settings like Zimbabwe.

Background: Critical care units require an interprofessional management approach to optimise patients' health. Clinical education and training delivered in remote healthcare settings are vital for fostering interprofessional collaboration (IPC) among health science students for future team functioning.

Objectives: Our study explored the IPC among clinicians in the intensive care unit (ICU) setting at two South African decentralised clinical training facilities to understand the existing collaborative practices that students are exposed to during their clinical training.

Method: A qualitative study design, utilising semi-structured interviews, was used to gather information on the experiences of 40 purposively selected participants working in the ICU settings at the two clinical sites. Data collected from the interviews were transcribed verbatim and thematically analysed.

Results: Four major themes were identified from the data, namely, scope-of-practice dispute, teamwork disruption, organisational obstacles and future aspirations.

Conclusion: Participants believed that a lack of professional regard by medical doctors and an inadequate understanding of the role of other professionals impeded appropriate referral practice and collaborative team functioning. Under-exposure to interprofessional education (IPE) at an undergraduate level and the pervasive medical hierarchy were perceived as a primary attributable cause of this phenomenon. Moreover, the coronavirus disease 2019 (COVID-19) pandemic and persistent staff shortages purportedly obstructed potential opportunities to collaborate in multidisciplinary meetings. Participants believed that improving undergraduate IPE and compulsory multidisciplinary meetings to promote communication would improve team functioning in these clinical settings.

Clinical implications: Undergraduate IPE is a feasible approach to improve collaborative care in ICUs to achieve better patient outcomes.

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.