South African Journal of Physiotherapy最新文献

Background: Historically, the profession of physiotherapy in South Africa has closely aligned itself with our former colonial master, the United Kingdom. Whilst efforts have been made in recent years to transform our profession, numerous challenges remain. An improved understanding of the topic of decoloniality is a useful and necessary way of beginning to address these challenges.

Objectives: The aim of this opinion piece is to encourage further dialogue amongst South African physiotherapists working in all sectors - a dialogue that must focus on genuinely transforming our profession to be better suited to serving the majority of South Africans.

Method: Global and local literature related to decoloniality is summarised for readers, followed by a closer scrutiny of how this topic relates to some of the challenges faced by the profession of physiotherapy in South Africa.

Results: The evidence presented demonstrates that whilst some efforts have been made to transform South African physiotherapy, significant work and dialogue is required to bring about a true transformation of the profession.

Conclusion: An honest and transparent conversation about decoloniality and transformation can assist in realising the potential of our profession, thereby improving the health and well-being of all South Africans.

Clinical implications: Real engagement with this topic can assist in transforming who enters our profession, what we teach, where and why we conduct research and how we can ensure that physiotherapy practice contributes to real social justice by benefitting the majority of our population.

Background: Individuals with Down syndrome may struggle with anticipatory postural adjustments, and adapt slower to motor tasks and environmental changes, due to decreased motor proficiency.

Objectives: To determine the effectiveness of virtual reality therapy (VRT), specifically Nintendo Wii, combined with physiotherapy or occupational therapy (OT) for improving motor proficiency in individuals with Down syndrome, compared to standard physiotherapy, OT or no intervention.

Method: Nine computerised databases were searched from inception to July 2020. Methodological quality of randomised controlled trials and quasi-experimental studies was appraised using the physiotherapy evidence database (PEDro) scale and the Joanna Briggs Institute Critical Appraisal Checklist for Case Reports.

Results: Two randomised controlled trials and four quasi-experimental studies were included, with an average PEDro score of 7.3. One included case study scored 5. This review included 345 participants. Motor proficiency includes balance, coordination, strength and agility. Agility showed a significant improvement after 5 (p = 0.01) or 24 (p < 0.01) weeks. Strength showed a significant improvement after a 6- (p = 0.000) or 24-week intervention (p < 0.05). Balance showed inconclusive results for adults, and significant improvement in children after 6 (p = 0.000), 8 (p < 0.05) or 24 (p < 0.003) weeks. One study (n = 155) showed that upper limb and bilateral coordination improved significantly after 24 weeks (p < 0.003).

Conclusion: Level II, III-1 and IV evidence suggested that VRT may be valuable to improve agility and strength in individuals with Down syndrome, and balance and coordination in children with Down syndrome.

Clinical implications: It may be beneficial to use VRT in addition to standard physiotherapy or OT interventions for improving motor proficiency in individuals with Down syndrome.

Background: Pelvic floor dysfunction (PFD) is a common problem in both men and women. Despite the high prevalence and negative effects on quality of life, there is still a lack of research in this area which translates into clinical practice and education.

Objectives: My study discusses how gaps and controversies in current research and evidence on PFD might be addressed by positioning PFD within a contemporary biopsychosocial model of care (BPSM).

Method: Various databases were searched for relevant studies published between 2010 and 2020 to support hypotheses and statements.

Results: My study focuses on the available evidence of PFD in both men and women as related to the themes and sub-themes of the BPSM, and how this available evidence might translate into education and clinical practice. It highlights areas of research, education and clinical practice that need to be explored and how the different components of healthcare may influence one another.

Conclusion: Biomedical aspects regarding pelvic health are mostly investigated and taught, whilst psychological, cognitive, behavioural, social and occupational factors, individualised care, communication and therapeutic alliances are still under-investigated and not integrated or translated at a sufficient level into research, education and clinical practice.

Clinical implications: Incorporating the integration of all factors of the BPSM into research is important for effective knowledge translation and enhancement of a de-compartmentalised approach to management. The interaction between the different components of the BPSM should be investigated especially in a South African population.

Background: A limited number of studies on the epidemiology of injuries and fitness profiles of netball players in South Africa have been conducted, but no research on the potential morphological and skill-related fitness predictors of injuries could be located.

Objectives: We investigated whether morphological or skill-related factors measured in the pre-season could predict injuries sustained in-season.

Method: In our cohort study, 77 under-18 (U18), U19, U21 and senior elite netball players underwent pre-season testing including anthropometry, balance, flexibility, explosive power, upper and lower body strength, core strength, speed and agility testing. A questionnaire was used to collect demographic data, elite-level experience and injury history. Injuries in pre-season, training and matches were recorded during the subsequent 2017-2018 season using an injury profile sheet.

Results: Amongst the 77 players who underwent pre-season fitness tests, 33 players (42.9%) had at least one injury. Regarding player morphology, a significant association of body mass and body fat percentage with injury risk was found in a simple logistic regression. In a multiple logistic regression analysis, only fat percentage (p = 0.0508) remained a significant predictor of injury at the 10% significance level, with higher fat percentage being associated with lower injury risk.

Conclusion: Heavier players and players with a higher fat percentage had a decreased injury risk.

Clinical implications: As a result of the apparent protective effect of heavier weight of players, referees should more strictly enforce the no-contact rule in netball. Further research on functional movement screening as a tool for potential prediction of injury in netball is recommended.

Background: Shifting from face-to-face teaching to incorporating technology may prepare students better for future work as health professionals. Evidence of blended teaching's effect on the academic performance of undergraduate physiotherapy students' performance is scarce.

Objective: The purpose of our study was to determine students' theoretical and clinical performance in a blended teaching module compared to their own performance in two knowledge areas taught face to face, and student perceptions of blended teaching in the third-year physiotherapy curriculum.

Methods: The cross-sectional study design included 47 third-year physiotherapy students. The orthopaedic module was delivered using a blended teaching approach in two consecutive semesters, whilst two other physiotherapy knowledge areas, neuromusculoskeletal and cardiopulmonary, in the same semesters were delivered face to face. Theoretical and clinical performances of students were compared for significance and effect. Students were assessed on their theoretical and clinical knowledge in all areas using the same assessment methods. The students (n = 43) also completed a survey on their blended teaching experience.

Results: Significantly higher theoretical marks for orthopaedics were calculated compared to neuromusculoskeletal and cardiopulmonary for both semesters with a large positive effect (average Cohen d = 4.44) for blended teaching on theoretical examination performance; no statistically significant difference for clinical performances. Students felt engaged in the blended teaching process, and 72% preferred blended teaching over face-to-face teaching or online delivery.

Conclusion: Blended teaching improved the theoretical marks, demonstrating that knowledge acquisition was improved, but not clinical performance.

Clinical implications: The study contributes to the knowledge base of blended learning in Health Science Education in South Africa. The authors identified a gap where future studies should investigate the effect of blended learning on clinical performance outcomes as a continuation from this one.

Background: Respiratory morbidity is common in children with neuromuscular diseases (NMD) owing to chronic hypoventilation and impaired cough. Optimal, cost-effective respiratory management requires implementation of clinical practice guidelines and a coordinated multidisciplinary team approach.

Objectives: To explore South African physiotherapists' knowledge, perception and implementation of respiratory clinical practice guidelines for non-ventilated children with NMD.

Methods: An online survey was conducted amongst members of the South African Society of Physiotherapy's Cardiopulmonary Rehabilitation (CPRG) and Paediatric special interest groups and purposive sampling of non-member South African physiotherapists with respiratory paediatrics expertise (N= 481).

Results: Most respondents worked in private healthcare, with 1-10 years' experience treating patients with NMD. For acute and chronic management, most participants recommended nebulisation and 24-h postural management for general respiratory care. Percussions, vibrations, positioning, adapted postural drainage, breathing exercises and manually assisted cough were favoured as airway clearance techniques. In addition, participants supported non-invasive ventilation, oscillatory devices and respiratory muscle training for chronic management.

Conclusion: Respondents seemed aware of internationally-endorsed NMD clinical practice guidelines and recommendations, but traditional manual airway clearance techniques were favoured. This survey provided novel insight into the knowledge, perspectives and implementation of NMD clinical practice guidelines amongst South African physiotherapists.

Clinical implications: There is an urgent need to increase the abilities of South African physiotherapists who manage children with NMD, as well as the establishment of specialised centres with the relevant equipment, ventilatory support and expertise in order to provide safe, cost-effective and individualised patient care.

Background: Considering the injury incidence rate (IR) associated with elite-level rugby, measures to reduce players' injury risk are important. Establishing scientifically sound, pre-season musculoskeletal screening protocols forms part of injury prevention strategies.

Objective: To determine the interrater and intrarater reliability of the flexibility and strength tests included in the Sport Science Lab^® (SSL) screening protocol.

Methods: We determine the interrater and intrarater reliability of 11 flexibility and nine strength tests. Twenty-four injury-free, elite, adult (> 18 years), male rugby players were screened by two raters on two occasions. To establish intrarater and interrater reliability, Gwet's AC₁, AC₂ and intraclass correlation coefficients (ICC) were used for the analysis of binary, ordinal and continuous variables, respectively. Statistical significance was set at 95%.

Results: Flexibility tests which require lineal measurement had at least substantial interrater (ICC = 0.70-0.96) and intrarater reliability (ICC = 0.89-0.97). Most of the flexibility tests with binary outcomes attained almost perfect interrater and intrarater reliability (Gwet's AC₁ = 0.8-0.97). All strength tests attained at least substantial interrater (Gwet's AC₂ = 0.73-0.96) and intrarater (Gwet's AC₂ = 0.67-0.97) reliability.

Conclusion: The level of interrater and intrarater reliability of most of the flexibility and strength tests investigated supports their use to quantify various aspects of neuromusculoskeletal qualities and possible intrinsic risk factors amongst elite rugby players.

Clinical implications: Establishing the reliability of tests, is one step to support the inclusion thereof in official screening protocols. Results of our study, verify the reliability of the simple, clinically friendly strength and flexibility tests included and therefore support their use as preparticipation screening tools for rugby players. Further investigation as to the association thereof to athletes' injury risk and performance is warranted.

Background: Secondary health conditions (SHCs) such as pain, pressure sores, sexual problems, bowel and bladder problems are prevalent throughout the lifespan of people with spinal cord injury (SCI). Studies have reported that SHCs decrease life expectancy and increase health care costs. Studies on the lived experience of SHCs are, however, limited.

Objectives: To explore the experiences of SHCs amongst people with SCI in a public rehabilitation hospital in South Africa.

Method: Face-to-face semi-structured interviews were conducted with people with SCI from August 2018 to July 2019. All interviews were transcribed verbatim and analysed using a content analysis approach.

Results: Seventeen people with SCI were interviewed. Participants experienced a range of SHCs. The most common experienced SHC was pain (94%). The main theme that emerged from the analysis was 'the impact of secondary health conditions on health and well-being'. The categories linked to the impact were SHCs co-occurrence and how SHCs limit function, restrict participation, affect mental health and disrupt lives.

Conclusion: We found that SHCs were enormously impactful on our participants' lives and health, as illustrated by their stories of fear, embarrassment and shame. Understanding people with SCI experiences of SHCs can enhance communication between people with SCI and health professionals and may help develop prevention strategies.

Clinical implications: To enhance patient-centred care, health professionals are encouraged to actively listen to patients' experiences of illness and the impact on health and wellbeing.

Background: Across the lifespan, people with spinal cord injury (SCI) may experience preventable secondary health conditions (SHCs) such as pressures sores, muscle spasms and urinary tract infections (UTIs). Some factors influencing prevention of SHCs include social support, poor access to care and the prevention style of individuals. There is limited research on these factors.

Objective: To explore personal factors influencing the prevention of SHCs in people with SCI.

Method: An explorative qualitative study included participants recruited in an outpatient department at a rehabilitation hospital. Semi-structured interviews were conducted with patients with SCI. Interviews were transcribed verbatim. Data analysis was conducted using content analysis.

Results: Seventeen individuals with SCI were interviewed. From the interview analysis, six personal factors were identified, namely, socio-economic status; mental well-being (forgetfulness, beliefs, attitude); lack of knowledge of SHCs and prevention; lifestyle choices and practising prevention care; patient activation (self-management, problem-solving, resilience, self-awareness, help-seeking behaviour) and owning an appropriate assistive device.

Conclusion: Socio-economic status, mental well-being, knowledge of SHCs and prevention care, behaviour patterns, patient activation and owning an appropriate assistive device can influence prevention of SHCs. To enhance patient-oriented care, a model of care for people with SCI should consider these factors when developing prevention strategies. Future research could look into identifying environmental factors that influence the prevention of SHCs in people with SCI.

Clinical implications: Tailored prevention strategies need to be developed, health professionals must ask patients about individual factors that may be barriers or facilitators to preventing secondary health conditions.