South African Journal of Physiotherapy最新文献

Background: Global changes in physiotherapy entry-level educational programmes to exit with a Doctorate or Master's degree have consequences if physiotherapy education, worldwide, is to remain professionally competitive. However, within the South African context, such global competitiveness should be carefully considered against the national healthcare needs and implementation of the National Health Insurance (NHI) programme, with a bigger emphasis on a skilled mid-level workforce, including physiotherapy technicians or community rehabilitation workers.

Objectives: These competing interests are carefully considered, against the theoretical background of international DPT training; human resource and financial constraints in the South African healthcare sector; reforms of the South African health and educational sectors intended to address the inequalities of the past; the need for quality healthcare delivery and the professional reputation of physiotherapy in South Africa.

Methods: A framework for physiotherapy education in South Africa, to move on from the current educational crossroads, is proposed through an integration of multiple theoretical perspectives.

Results: The framework is based on the current challenges being experienced in physiotherapy education and healthcare service delivery, which could be addressed by changes in the education sphere.

Conclusion: The baseline suggestions for (re)considering the current education environment for physiotherapy, as proposed in my article, are to ensure that the profession remains relevant and able to confront the current changes presented by the South African healthcare system, including the implementation of the NHI plan, whilst remaining globally aligned and competitive.

Clinical implications: The suggested, reconsidered, educational framework for physiotherapy in South Africa could become pivotal in advancing the profession on both a national and international level, through further critical conversations.

Background: Carpal tunnel syndrome (CTS) is the most prevalent upper limb compression neuropathy. Surgical or nonsurgical treatment is recommended. Both mild and moderate CTS can be managed conservatively. Neurodynamic mobilisation techniques (NMTs) of the median nerve have not been widely studied, and conflicting findings exist.

Methods/design: Sixty-two female patients with mild or moderate bilateral CTS were assigned one wrist to the treatment group (TG) and the other to the control group (CG). Both groups underwent carpal bone mobilisation. The TG underwent NMTs while the CG received a placebo elbow mobilisation not targeting the median nerve. The Numerical Rating Pain Scale, JAMAR Plus Digital Hand dynamometer and Functional Status Scale (FSS) were used to assess pain, grip strength and functional status.

Discussion: Comparison of groups showed that NMTs at 5 weeks decreased pain intensity by 1.15 (p = 0.001) and by 2 (p ˂ 0.001) at 10 weeks. Difference in functional status was 0.45 at 5 weeks (p = 0.003) and 0.84 at 10 weeks (p = 0.003). The CG's grip strength improved by 0.59 (p = 0.05) after 5 weeks and 0.61 (p = 0.028) at 10 weeks. Both groups improved in all parameters over time.

Conclusion: When combined with carpal bone mobilisation, both NMTs and placebo elbow mobilisation seem to reduce pain intensity and improve grip strength and functional status. However, NMTs had better results in pain intensity and FSS.

Clinical implications: Women with mild or moderate bilateral CTS may benefit from NMTs as a conservative treatment option.

Trial registration: Pan African Clinical Trials Registry, PACTR202201807752672, https://pactr.samrc.ac.za/TrialDisplay.aspx?TrialID=19340.

Background: Elderly patients report a decrease in function and activities of daily living following abdominal surgery. The objectives of our pilot study were to determine the effects of a single pre-operative physiotherapy session consisting of education and exercise on clinical and physical function outcomes in elderly patients.

Methods/design: A single-blind pilot randomised controlled trial evaluated clinical and functional outcomes of elderly patients following surgery in a private hospital in Pretoria, South Africa. The outcomes included length of hospital stay (LOS), postoperative pulmonary complications (PPC), first mobilisation uptime, DeMorton Mobility Index (DEMMI), 6-minute walk test (6MWT), Lawton-Brody's instrumental activities of daily living (IADL) and the Functional Comorbidity Index (FCI). Descriptive and inferential statistics were undertaken, and statistical significance was set at p ≤ 0.05.

Discussion: Twelve participants (n = 11 female [91.67%] and n = 1 [8.33%] male) with a mean age of 65.75 (±4.47) years were included. Most participants (n = 10, 83.33%) underwent lower abdominal laparotomy (n = 10, 83.33%). The median hospital LOS was n = 4 (IQR 3.25-4) days; walking distance at first mobilisation was 130 m (IQR (85-225), with intervention participants walking further (intervention: 177 m, IQR 100-242.50; control: 90, IQR 60 m - 245 m; p = 0.59). Recruitment was low, with only 10.95% referrals and 47.82% nonconsents.

Conclusion: A single physiotherapy session prior to surgery demonstrated a potential favourable change in elderly patients' mobility postoperatively; however, further research is necessary.

Clinical implication: A once-off pre-operative physiotherapy session could enhance recovery in elderly patients.

Trial registration: Pan African Clinical Trial Registry, PACTR201809874713904, https://pactr.samrc.ac.za/TrialDisplay.aspx?TrialID=3593.

Background: Diastasis recti is diagnosed when the interrecti distance (IRD) is larger than a threshold value. Published thresholds were measured at rest with ultrasound while in Benin physiotherapists use calipers during abdominal contraction.

Objectives: The aim was to define IRD threshold values measured with calipers in Beninese participants in order to diagnose diastasis recti in a clinical environment and identify women needing abdominal rehabilitation.

Method: Interrecti distance was measured using ultrasound and calipers. Linea alba stiffness was assessed by palpation, abdominal strength and endurance by manual testing. In men and nulliparous women, IRD threshold values were defined as IRD P90. In postpartum women, IRD P80 and a threshold defined with a receiver operating characteristics (ROC) curve based on linea alba stiffness were used. In these women, abdominal strength and endurance were compared depending on IRD threshold and linea alba stiffness with a Mann Whitney test.

Results: In 391 Beninese participants, the IRD threshold measured with calipers was 17 mm in men, 15 mm in nulliparous and 18 mm (15 mm with ROC curve) in postpartum women. Postpartum women with an IRD above 18 mm had significantly lower abdominal strength. Those with a slack linea alba had significantly lower abdominal strength and endurance.

Conclusion: The defined IRD threshold values can be used in a Beninese clinical environment. Future studies should confirm whether they can be applied to other African populations.

Clinical implications: Abdominal rehabilitation should be recommended to postpartum women whose IRD is above the threshold values but also in cases of slack linea alba and poor abdominal function.

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.