South African Journal of Physiotherapy最新文献

Background: The global estimate of shoulder pain is 67% and is often associated with subacromial impingement syndrome. Interventions include corticosteroid injection (CSI) therapy and physiotherapy. Further information is needed to compare the effect of these interventions on pain, joint range of motion (ROM) and shoulder function.

Objectives: To summarise the best evidence comparing the effect of CSI versus physiotherapy on pain, shoulder ROM and shoulder function in patients with subacromial impingement syndrome.

Method: This evidence statement is based on a systematic review and meta-analysis of three randomised controlled trials (RCTs), namely, Rhon et al. (2014) (n = 136), Hay et al. (2003) (n = 207) and Van der Windt et al. (1998) (n = 109), with a total of 452 participants. A total of 14 studies were reviewed and only 3 studies met the inclusion criteria.

Results: An improvement in shoulder function was found in favour of CSI at 6- to 7-week follow-up (p < 0.0001), but no evidence was found for the superiority of CSI compared to physiotherapy for pain and ROM over 4-12 weeks. In 24 and 48 weeks, no evidence was found for the superiority of CSI compared to physiotherapy for shoulder function, pain or ROM.

Conclusion: No evidence was found for the superiority of CSI compared to physiotherapy for pain and ROM in the short term besides an improvement in shoulder function in favour of CSI at 6-7 weeks. There was a weak recommendation with moderate quality of evidence based on three RCTs (2B).

Clinical implications: This evidence statement may inform clinical practice when determining which intervention is best suited to manage patients with shoulder pain.

Background: Medical professionals working in an elite sport environment have the challenging task to balance the athlete's readiness to return to the playing field after severe injury with other stakeholders' (coaches, sponsors, teammates) opinions and objectives.

Objectives: Our study aimed to evaluate differences in the physical profiles of elite rugby players at return to play (RTP) after a severe knee injury, compared with their pre-injury profiles and matched controls.

Method: Before the injury, participants performed four performance tests during their preseason screening. These tests were repeated and compared to baseline once a player was declared fit to play.

Results: Significant differences (p ≤ 0.05) were found in the injured players' group who were slower over 10 m speed, in their decision-making time and the total time of the reactive agility tests at RTP, whilst controls were significantly faster over 10 m and 30 m speed tests. The countermovement jump outcomes showed significant improvement in the uninjured participants (p ≤ 0.05).

Conclusion: Our study highlights that injured players' running speeds and decision-making times are slower after injury. The uninjured players have a positive outcome to training and match stimulus by improving their running speed and lower body explosive power during the season.

Clinical implications: Our study provides insight into the RTP profile of elite rugby players, and a novel finding was the decision-making time deficit. This highlights the importance of cognitive training during injury rehabilitation as athletes make numerous decisions in a pressured and uncontrolled environment during a match. Speed training development is recommended as the athletes were slower after severe knee injury.

Background: Gross motor delays are common in infants and preschool children infected with human immunodeficiency virus (HIV). These delays persist in children of school-going age and may affect participation in classroom and playground activities; however, the extent of the problem is poorly understood in this age group.

Objectives: Our study aimed to determine the motor function, muscle strength and health-related quality of life (HRQoL) in children aged 5-10 years who were perinatally infected with HIV.

Methods: In our cross-sectional study, participants were recruited using convenience sampling from a Gauteng HIV clinic. Participants were assessed using the Movement Assessment Battery for Children, Second Edition (MABC-2), standing broad jump test (SBJT), Paediatric Quality of Life Inventory^TM (PedsQL) and a sociodemographic questionnaire.

Results: Thirty children participated in our study. The MABC-2 showed 60% of the children assessed were either at risk of developmental delay or were already delayed, with the domain of manual dexterity being most affected. The SBJT showed female participants had weaker muscle strength than males. The mean total score on the PedsQL was 81%, with the subscales ranging from very high quality of life scores to moderately high quality of life scores, with emotional functioning having one of the lower overall scores.

Conclusion: Children who have been perinatally infected with HIV are at significant risk of delayed motor function. Muscle strength is also an area of concern, as is emotional HRQoL. Further research and implementation of holistic rehabilitation programmes are needed.

Clinical implications: Children with HIV need to be prioritised for developmental screening throughout childhood. Health promotion and early intervention need to be at the forefront of our fight against this pandemic.

Background: Physiotherapy skills such as suction and manual hyperinflation (MHI) are used to manage patients in intensive care. Performing these skills effectively and safely requires a level of expertise. It is unknown whether a once-off preclinical high-fidelity simulation activity incorporating these skills would translate to clinical practice inclusion.

Objectives: To determine students' perceptions of a simulation-based education (SBE) activity and clinical educators' opinions of students' implementation of skills into practice.

Method: Our study consisted of two parts: a retrospective record review of students' feedback with the Simulation Effectiveness Tool - Modified (SET-M) and the Simulation Laboratory Questionnaire. A nominal group technique (NGT) with clinical educators provided information on students' skills implementation. Descriptive data analysis was undertaken.

Results: Six SBE sessions, lasting 3 hours each, with 49 students (n = 8-9 students per session) were undertaken. Students perceived the teaching activity positively. Five (33.33%) of 15 clinical educators participated in the NGT. Participants had a mean age of 35.8 (± 8.9) years, were qualified for 13.9 (± 8.9) years and had been supervising students for 7.8 (± 6.7) years. The clinical educators' top five opinions regarding students' implementation of the intensive care unit (ICU) skills were: handling skills improved, students had greater confidence performing these skills, students were more observant of a patient's response to the skill being performed, students had better theoretical knowledge and students had more accurate recall for precautions.

Conclusion: Clinical educators reported a change in students' clinical practice with regard to skills implementation.

Clinical implications: A once-off preclinical SBE activity influences students' ICU practice.

Background: It is generally accepted that braces can stop curve progression but little evidence exists regarding structural improvement in the spine using spinal bracing. Our study aimed to investigate the possible structural improvements of vertebral wedging with high correction bracing.

Objectives: The aim of our study was to assess whether spinal brace treatment may influence vertebral wedging in adolescent idiopathic scoliosis (AIS).

Method: We reviewed our database according to the following inclusion criteria: girls with a diagnosis of AIS, Risser 0-2, age 10-14 years with Cobb angles greater than 35°. Our study cohort consisted of 27 patients fulfilling the inclusion criteria with an average brace wearing time of 16.6 h per day and Cobb angles between 36° and 79°. The target value for our study was the apical vertebra wedging, measured twice before brace treatment commenced and twice after the average follow-up period of 20.5 months of treatment.

Results: The average apex wedging noted before brace wearing started was 9.8° (median: 9) and after a period of 20.5 months of brace wearing, it had reduced to an average of 5.8° (median: 4.9), (p < 0.001). This would indicate a structural correction of 44%.

Conclusions: Our study supports the hypothesis that spinal high correction braces improve the degree of vertebral wedging in skeletally immature girls with AIS.

Clinical implications: Structural corrections of the apical vertebra seem possible when high correction asymmetric braces are used in the treatment of patients with AIS.

Background: Spinal deformity is the oldest disease known to humankind. Many types of treatment methods, including both conservative and surgical, are in use.

Objective: We aimed to validate a published guideline protocol based on the conservative treatment of spinal deformities.

Method: A modified Delphi technique was used with a questionnaire sent out to professionals worldwide regarding the conservative treatment of spinal deformities.

Results: Our study was completed after two rounds. A strong level of agreement of 80% and more (consensus cut-off point) was achieved in most questions in the first round. Some statements were below this margin, and they were sent to the participants via email in the second round for re-evaluation. Consensus was achieved in almost all of the statements in the second round. Only two items did not reach the cut-off point but were close to this value.

Conclusion: This proposed Guideline Protocol was approved by the participants using the Delphi method and can be used as a valid tool for the conservative treatment of spinal deformities.

Clinical implications: A conservative treatment guideline in spinal deformity management, will provide consistency in treatment and will facilitate comparability with surgery. It will be useful in determining the cost-effectiveness of treatment and in choosing the right patient for the right method of treatment. This guideline might help in this context, and may also create a systematic method for clinicians to use as a reference in both research and clinical practice.

Introduction: This is a case report of a juvenile female patient with scoliosis following two heart surgeries for congenital heart disease (CHD).

Patient presentation management and outcome: Initially, the premenarchial female was 9 years old and had a Tanner stage 2-3 with a single thoracic curve of 65° Cobb. Because of the high risk for progression, immediate brace treatment was proposed as the father declined surgery. The patient received intensive treatment according to the Schroth Best Practice® programme and a Gensingen Brace® designed for large thoracic curves. Over the 18 months following the initial visit, she received two additional braces. As a result, the progression of the main curve was prevented. The patient continues to maintain an improved cosmetic result and is currently at a Risser 2.

Conclusion: Surgery performed for CHD in rare cases may lead to stiff spinal deformity as a consequence of that surgery. Progression of a severe and stiff curve was prevented during the most vulnerable phase of the pubertal growth spurt with an improved clinical result. Therefore, we assume that the patient may have a normal life in adulthood with minor restrictions only. Supported by pattern-specific high correction exercises and braces, these typical single thoracic curves can be re-compensated to a more balanced appearance, less prone to progression in adulthood.

Clinical implications: Because of the relative high risks of spinal fusion and the long-term unknowns of such an intervention, high-impact conservative treatment should be implemented first before surgical correction is considered.

[This corrects the article DOI: 10.4102/sajp.v76i1.1430.].