South African Journal of Physiotherapy最新文献

Background: Hearing impairment, including deafness, affects approximately 5% of the global population, with the majority residing in low- and middle-income countries (LMICs) such as South Africa. Despite the constitutional right to healthcare for all, patients with deafness face persistent health inequalities because of communication barriers with healthcare professionals. Physiotherapists are often unprepared to provide care for patients with deafness, leading to a breakdown in communication and poor healthcare outcomes.

Objectives: This study explored physiotherapists' perceptions regarding the challenges faced by patients with deafness in accessing rehabilitative care in South Africa.

Method: A qualitative research approach was used, with social constructivism as the guiding paradigm. In-depth individual interviews were conducted with 18 purposively selected physiotherapists across three public hospitals in KwaZulu-Natal, South Africa. Data were analysed using Elo and Kyngäs content analysis framework, which involves a systematic three-phase approach.

Results: The study identified five main categories: (1) access to rehabilitative care, (2) communication barriers, (3) disability stigma and cultural barriers, (4) healthcare system challenges and (5) future aspirations.

Conclusion: The findings highlight the need for improved communication strategies, sign language training and a more inclusive approach within the healthcare system to enhance access to rehabilitative care for patients with deafness. The study underscores the importance of addressing systemic and individual factors to provide equitable healthcare to all patients, including those with hearing impairments.

Clinical implications: The study underscores the urgent need for physiotherapists to receive sign language and cultural competency training to improve communication and healthcare delivery for patients with deafness, ensuring equitable access to rehabilitative care.

Background: Neuromuscular electrical stimulation (NMES) has demonstrated its efficacy in improving strength, muscle development, optimising microcirculation, reducing frailty and mortality risk. A better understanding of its prescription and effects in patients with coronavirus syndrome post (COVID-19) could favour its use.

Objectives: To find evidence that compares the effectiveness of NMES in the increasing muscle mass, muscle strength and functional independence of patients in post-intensive care unit (ICU) with COVID-19 syndrome.

Method: A systematic search was carried out in electronic databases: PubMed, Science Direct, Scopus, Ovid and Cochrane from 22 May 2022 to 30 April 2023, without language restriction, including clinical controlled trials (CCTs) and prospective longitudinal studies (PLS). Prospero registration (CRD42022332036).

Results: A total of 1718 scientific articles were found; four articles met the inclusion criteria. For NMES dosing, intervention time ranged from 9 days to 30 days, the stimulus frequency was between 20 Hz and 121 Hz and the pulse width was between 350 µs and 1400 µs. The application time ranged from 30 min to 60 min, the intensity was between 20 mA and 250 mA and the stimulated muscle groups were quadriceps, tibialis anterior, hamstrings and gluteus.

Conclusion: The use of NMES after COVID-19 such as integral complementary strategy improves muscle mass, strength and functionality of the patients optimising recovery results.

Clinical implications: The addition of NMES to standard physical therapy might have a positive impact on the recovery of individuals who have survived COVID-19.

Background: Post-operative rehabilitation is key to successful outcomes in anterior cruciate ligament (ACL) surgery. This study aimed to determine the management strategies (accelerated vs. non-accelerated protocols) and treatment modalities used by physiotherapists for post-operative ACL rehabilitation in Gauteng, South Africa.

Objectives: This study determined the frequency of accelerated and non-accelerated protocols, identified rehabilitation objectives, commonly used physiotherapy modalities and exercise recommendations within the first 6 weeks of post-operative ACL rehabilitation.

Method: A cross-sectional study was carried out between 15 December 2021 and 27 May 2022, using a custom-designed questionnaire. The survey was initially distributed to members of the South African Society of Physiotherapy (SASP) and Physiotherapy Association of South Africa (PASA), as well as shared on social media platforms. Data collection was completed in 6 months. Descriptive statistics (frequencies means and percentages) were analysed.

Results: Out of 120 responses received, 47% (56) were analysed. Management strategies included the accelerated and non-accelerated programmes: 70% (39) of the participants used the accelerated protocol and 23% (13) used the non-accelerated protocol. Furthermore, 59% used protective bracing as part of their management and 66% (37) started rehabilitation post-operatively. Treatment modalities used included myofascial release (75%, 41), peripheral joint mobilisation (63%, 35), massage (57%, 32) and cryotherapy (34%, 19).

Conclusion: Remarkable variation was found in treatment protocols, modalities and exercise prescription.

Clinical implications: Using clinical evaluation, objective outcome measures and functional tests as an objective criterion is crucial in decision-making regarding return to function and sport.

Background: Idiopathic scoliosis is a three-dimensional spinal curvature treated during adolescence with physiotherapy, braces or surgery. This can be stressful for patients. Few studies compare the quality of life of adolescents with and without scoliosis. Our study aims to investigate the quality of life of adolescents with and without scoliosis using the KIDSCREEN-27 questionnaire.

Objectives: The aim of this study was to investigate the quality of life of adolescents with scoliosis in comparison to adolescents without scoliosis.

Method: This comparative cross-sectional study included 60 participants who answered KIDSCREEN-27 accompanied by questions about age, sport intensity and their school category. Girls between the ages of 12 and 17 were included in the study. For each category of KIDSCREEN-27, the values were compared between participants with and without scoliosis.

Results: Statistical analysis was done using R Version 4.3.3. In none of the categories were the mean T-scores of adolescents with scoliosis significantly lower than those of the comparison group. In the scoliosis group, 33% (n = 10) showed values rated as 'low' quality of life in the category 'physical well-being'. In the category 'psychological well-being', 36% (n = 11) showed 'low' values.

Conclusion: A general statement about the quality of life in adolescents with scoliosis cannot be made, but monitoring during treatment appears to be important. It is a complex construct that varies for each patient. KIDSCREEN-27 can quickly and easily identify low quality of life in patients with scoliosis.

Clinical implications: Physiotherapists play an important role in the scoliosis treatment team as they usually see the patients most often. Thus, early recognition of impaired quality of life is crucial to offer a targeted therapy plan.

Background: Physical impairment affects up to 60% of intensive care unit (ICU) survivors due to factors such as ICU-acquired neuromuscular weakness (ICU-AW), chronic pain, deconditioning and reduced organ and metabolic function. This impairment is linked to lower health-related quality of life (HRQOL).

Objectives: Our study aimed to assess physical impairment and HRQOL among critically ill patients post hospital discharge.

Method: Intensive care unit survivors were assessed six weeks and six months post hospital discharge. Physical performance was evaluated using the six-minute walk test (6MWT) and muscle strength with the Medical Research Council (MRC) score. Patients' HRQOL was determined using the Rand Short Form-36 questionnaire.

Results: A total of 107 patients (median age 42 years), including 50% with COVID-19, completed the 6-month follow-up. Although significant improvements were observed, 53.5% walked less than 80% of the predicted 6MWT distance at six months, with females disproportionately affected. Poor physical performance was associated with lower physical and mental HRQOL. Pain interfering with activities was reported by 26.2% at six months. Only 2% met full criteria for ICU-AW at six months. By six weeks, only 15% had attended physiotherapy.

Conclusion: Intensive care unit survivors exhibited a high incidence of physical impairment and pain at six months, impacting HRQOL. Very few patients met full ICU-AW criteria.

Clinical implications: Physical impairment after critical illness is multifactorial and is not only attributable to muscle weakness. The recovery process of young, previously non-frail ICU survivors in the public healthcare setting may be improved by introducing rehabilitation pathways.

Background: Mining industry workers face substantial challenges returning to work after occupational injuries. Despite the critical importance of successful return to work (RTW) outcomes, there is limited understanding of specific predictors within the mining sector that influence these outcomes.

Objectives: To systematically identify and analyse factors influencing RTW among mine workers following on-duty injuries and synthesise evidence to inform rehabilitation strategies.

Method: We searched PubMed, CINAHL, Google Scholar and PsycINFO databases for literature published between 1996 and December 2024. Studies were screened using predetermined inclusion and exclusion criteria. Data from eligible studies were extracted and analysed thematically to identify key predictors of RTW outcomes.

Results: Three studies met the inclusion criteria. Negative RTW predictors (barriers) included physical complications (muscular atrophy, chronic pain), psychological factors (work avoidance, secondary gains) and workplace challenges (harsh conditions, job stress). Positive predictors (facilitators) encompassed supportive work environments, shorter rehabilitation periods, and financial stability. Demographic characteristics, particularly younger age and higher education levels, were associated with improved RTW outcomes.

Conclusion: Return to work success among mine workers is influenced by multiple interconnected factors spanning physical, psychological, workplace and demographic domains.

Clinical implications: These findings emphasise the need for comprehensive rehabilitation programmes integrating medical care, psychological support and workplace modifications. Future research should focus on developing targeted interventions that address these multiple dimensions of RTW in the mining sector.

Background: Pain and shortness of breath (SOB) after thoracic trauma predispose patients to complications and prolonged hospital length of stay (LOS). Patient management after thoracic trauma is seldom reported.

Objectives: To describe patient profiles, symptoms, management, adverse events, complications, discharge destinations and follow-up referral services.

Method: Prospective observational design using clinical record review at two university-affiliated hospitals over 18 months. Adults with thoracic trauma diagnosis were consecutively screened for inclusion. Study objectives guided information retrieved from records. Statistical analyses were done with significance at p< 0.05.

Results: Most were male (n = 170/179; 95%). Penetrating trauma following assault was common (n = 146/179; 82%). Conservative management included analgesia (n = 176/178; 98%) and intercostal drain insertion (n = 165/179; 92%). Physiotherapists treated patients daily. Management involved functional activities (cycling [n = 71/149; 48%], early mobilisation [n = 120/174; 69%]), lung volume enhancement (deep breathing exercises [n = 97/174; 56%], positive expiratory pressure [n = 98/174; 56%]), secretion removal (active coughing [n = 60/174; 34%]). Shoulder (n = 43/174; 25%) and trunk (n = 6/153; 4%) ROM were seldom done. Blunt trauma caused higher pain during deep breathing (median 7/10; IQR: 3.5-8.0) versus penetrating trauma (median 4/10; IQR: 2.0-7.5; p= 0.04). Most reported 'slight' to 'very slight' SOB. Time out-of-bed and distance walked increased daily with smokers mobilising away from bed frequently (n = 73/95; 77%). Few adverse events and complications occurred. Mean LOS was 5.5 ± 4.3 days. Most were discharged home (n = 177/179; 99%); two were referred for follow-up physiotherapy.

Conclusion: Management is guided by individual patient needs. Treatment comprises early mobilisation, lung volume enhancement, and secretion removal with less attention on ROM exercises and post-discharge services.

Clinical implications: Shoulder and trunk ROM should be prioritised. Service delivery approaches need review considering the evidence.

Background: Physical activity (PA) is an important indicator for disease prevention in adults with spinal cord injuries (SCIs). Regular PA can improve functioning, community reintegration, economic participation and overall well-being.

Objectives: Determine PA levels of community-dwelling adults with traumatic spinal cord injury (TSCI) in the Cape Metropolitan, South Africa.

Method: A quantitative, cross-sectional design was used in the Cape Metropole. The population included all community-dwelling adults with TSCIs, regardless of mobility status. Physical activity levels were measured using an ActiGraph wGT3X-BT accelerometer, classified by intensities: sedentary behaviour (SED), light intensity PA (LIPA) and moderate-to-vigorous PA (MVPA). Descriptive and analytical statistical tests described PA intensities and investigated group differences.

Results: A total of 76 participants (mean age 36 years, standard deviation [s.d.] 10.93), mainly males (88.2%), were recruited. Time spent in SED, LIPA and MVPA among wheelchair users was 761.12 min/day (77.6%), 203.11 min/day (20.7%) and 16.96 min/day (1.7%), respectively. Ambulatory individuals spent 972.47 min/day (98.1%) in SED/LIPA and 18.80 min/day in MVPA (1.9%). Time since injury (p = 0.005) and age (p < 0.001) resulted in more MVPA for older wheelchair users and ambulatory individuals with recent injuries.

Conclusion: Participants spend most time sedentary, followed by LIPA. Adults with SCI are not meeting recommended PA levels for health benefits. Understanding barriers to PA is essential for developing targeted interventions to optimise PA levels.

Clinical implications: Cape Metropole's unique SCI profile with mostly young males, results in long-term injury impacts. Sedentary behaviour increases risks for morbidity and early mortality. Thus, exploring PA's role in SCI rehabilitation is important for healthy ageing.

Background: Polytrauma can be life altering, requiring a holistic approach to reach the highest functional level. Physiotherapists prescribe home exercise programmes (HEPs) to prevent complications associated with immobility. Adherence to HEPs is crucial, yet factors influencing non-adherence remain underexplored.

Objectives: Our study explored patients with polytrauma perspectives on adherence to prescribed HEPs.

Method: A qualitative exploratory, descriptive design was used to recruit participants purposively from a rehabilitation unit in Tshwane district, South Africa. Participants diagnosed with polytrauma, aged 18 years or older, and prescribed a HEP were included, while those with cognitive impairments or language barriers were excluded. Consent was obtained while hospitalised, and participants were contacted 3 months post-discharge for telephonic semistructured interviews lasting 30-45 min. Ethical clearance (reference number: 595/2022) and institutional permission were granted. Interviews were audio-recorded and conducted until data were saturated. Data were verbatim transcribed and analysed thematically to identify key themes and sub-themes.

Results: Thirteen participants (8 male and 5 female participants) with a mean age of 43.77 (standard deviation = 10.45) were interviewed. The four major themes were physical, psycho-cognitive, social and environmental factors. Adherence barriers were more significant than facilitators. The most frequently reported facilitator was family support, whereas the most commonly reported barrier was pain.

Conclusion: Polytrauma patients identified more barriers than facilitators affecting HEP adherence. Pain significantly hindered adherence, while family support was a key enabler.

Clinical implication: Physiotherapists should work collaboratively with patients to develop inclusive HEPs that consider their demographic, social, psychological, physical and environmental context.