South African Journal of Physiotherapy最新文献

Background: Balance impairment is the predominant risk factor for falls in stroke survivors. A fear of falling after stroke can contribute to sedentary lifestyles, increased disability and risk of recurrence, leading to poor quality of life.

Objective: To determine the frequency and factors associated with balance impairments amongst stroke survivors at the University Hospital of Parakou.

Method: This cross-sectional study included adult stroke survivors. Stroke survivors after discharge were enrolled at the University Hospital of Parakou between 01 January 2020 and 30 September 2020. Balance impairments were measured by using the Berg Balance Scale (BBS), the Timed Up and Go (TUG) and the Get Up and Go (GUG) tests.

Results: A total of 54 stroke survivors were included, with a mean age of 58.37 ± 12.42 years and a male predominance of 68.52%. The mean BBS score was 36.87 ± 14.34 with a minimum and a maximum of 10 and 56, respectively. Thirteen (24.07%) had balance impairments (BBS score ≤ 20), 34 (62.96%) had a TUG score ≥ 14 s (abnormal), 9 (16.67%) presented a moderate risk of falling and 6 (11.11%) presented high risk of fall with the GUG test. Post-stroke duration (odds ratio [OR] = 0.04; 95% CI: 0.04-0.30; p < 0.01), severity of disability (OR = 8.33; 95% CI: 1.03-67.14; p = 0.03) and the number of physiotherapy sessions (OR = 0.18; 95% CI: 0.03-0.93; p = 0.02) were significantly associated with balance impairments.

Conclusion: Our results showed that almost one quarter of stroke survivors after discharge at the University Hospital of Parakou had balance impairments. Post-stroke duration, severity of disability and the number of physiotherapy sessions were significantly associated with balance impairments.

Clinical implications: [AQ1] Balance should be regularly assessed in people post-stroke. Further studies should document the content of rehabilitation and any rehabilitative efforts to improve balance in people post-stroke in Benin.

Background: Children with neuromuscular diseases (NMD) are at risk of morbidity and mortality because of progressive respiratory muscle weakness and ineffective cough. Inspiratory muscle training (IMT) aims to preserve or improve respiratory muscle strength, thereby reducing morbidity and improving health-related quality of life (HRQoL).

Objectives: To describe the safety and feasibility of a 6-week IMT programme using an electronic threshold device (Powerbreathe®). Any adverse events and changes in functional ability, spirometry, peak expiratory cough flow (PECF), inspiratory muscle strength and HRQoL (Pediatric Quality of Life [PedsQL]) were recorded.

Methods: A convenience sample of eight participants (n = 4 boys; median [interquartile range {IQR}] age: 12.21 [9.63-16.05] years) with various NMD were included in a pre-experimental, observational pre-test post-test feasibility study. Training consisted of 30 breaths, twice daily, 5 days a week, for 6 weeks.

Results: There were significant pre- to post-intervention improvements in upper limb function and coordination (p = 0.03) and inspiratory muscle strength: maximum inspiratory mouth pressure (Pimax) (p = 0.01); strength-index (p = 0.02); peak inspiratory flow (PIF) (p = 0.02), with no evidence of change in spirometry, PECF or HRQoL. No adverse events occurred and participant satisfaction and adherence levels were high.

Conclusion: Inspiratory muscle training (at an intensity of 30% Pimax) appears safe, feasible and acceptable, in a small sample of children and adolescents with NMD and was associated with improved inspiratory muscle strength, PIF and upper limb function and coordination.

Clinical implications: Larger, longer-term randomised controlled trials are warranted to confirm the safety and efficacy of IMT as an adjunct respiratory management strategy in children with NMD.

Background: Healthcare practitioners are required to integrate clinical experience with the best research evidence for the benefit of the patient.

Objective: Determine the attitudes, perceptions and barriers regarding evidence-based practice (EBP) in sports physiotherapy in Kenya.

Method: A quantitative crosssectional study was conducted among licensed physiotherapists in the Republic of Kenya through a self-administered questionnaire. Associations between selected sociodemographic characteristics (gender, age, training, experience, specialisation) and attitudes, perceptions and barriers were determined using a Chi-square test.

Results: A 55.9% (n = 391) response rate was recorded. A positive attitude towards EBP was reported by 94.6% (n = 370) of the respondents. The most obvious areas of agreement with attitude-and perception-related statements were that 'EBP is important in that patients can receive the best possible treatment' (95.9%; n = 375), and that it is important that 'evidence-based guidelines related to work exist' (84.6%; n = 331). There were no significant associations between the demographic characteristics (gender p = 0.104 [X ² = 2.638;1]; age p = 0.495 [X ² = 2.393;3]; training p = 0.590 [X ² = 4.644;6]; experience p = 0.980 [X ² = 0.426;4] and specialisation p = 0.649 [X ²= 0.207;1]); and attitudes and perceptions regarding EBP. Insufficient time was highlighted by 57.8% (n = 226) of the respondents as one of the 'most important barriers'.

Conclusion: Although physiotherapists presented with strong positive attitudes towards EBP in sports physiotherapy, barriers were identified which could hinder the implementation of EBP in sports physiotherapy.

Clinical implications: Barriers to applying EBP in sports physiotherapy may lead to inferior quality of care for athletes while addressing these barriers is crucial.

Background: For patients with colorectal cancer, surgical resection of the primary tumour remains the best treatment option. Surgery for colorectal cancer is being performed on patients who would previously not have been considered as suitable candidates. It remains to be seen which factors influence hospital length of stay (LOS) and the development of acute postoperative complications in South African patients.

Objectives: The objectives of our study were to determine the modifiable factors that influence patients' development of postoperative complications and hospital LOS and, to identify the types of postoperative complications that develop.

Method: A retrospective review and secondary analysis of information in an existing database of patients with colorectal cancer were conducted. Regression analysis statistics were used to determine the predictors of postoperative outcomes. The level of significance at which testing was performed was set at 5% (p ≤ 0.05).

Results: Data of 125 patients were included. Surgical site infections and postoperative paralytic ileus were the most frequently reported postoperative complications. Preoperative vigorous-intensity physical activity (p = 0.048, β = -0.000) and functional performance status (p = 0.05, β = 0.926) significantly predicted hospital LOS and the incidence of postoperative complications, respectively.

Conclusion: Preoperative physical activity and functional performance levels are predictors of acute postoperative outcomes in a private South African cohort of patients with colorectal cancer. Future research which includes other modifiable factors is required to make informed suggestions for changes in clinical practice.

Clinical implications: Patients requiring surgery for colorectal cancer should be screened for signs of physical deconditioning and referred for physiotherapy intervention before elective surgery to optimise their recovery.

Background: The announcement of a national lockdown in South Africa had country-wide impact on the delivery of health services. Strategies included prioritisation of patients and protecting patients who were considered at risk, resulting in the need for cancellation and temporary termination of many outpatient therapy services. This necessitated the urgent need to come up with a way of delivering physiotherapy rehabilitation services to patients in a more non-traditional format. Telerehabilitation allows for the provision of services by using electronic communication, thus ensuring that patients are still able to access necessary rehabilitation services.

Methods/design: This is a prospective, mixed method study with participants recruited from the outpatient physiotherapy department of Chris Hani Baragwanath Academic Hospital (CHBAH). Telerehabilitation services will be provided via the patients' preferred method of communication. On discharge, participants and therapists will be asked about their experiences of telerehabilitation.

Discussion: Because of the current coronavirus disease 2019 (COVID-19) pandemic, patients are unable to receive traditional face-to-face physiotherapy services. Telerehabilitation offers a suitable alternative to treatment, but the feasibility, outcome and experiences of offering these services in the public health system have not been studied.

Conclusion: This study will determine whether telerehabilitation is a feasible service that can be offered in the COVID-19 pandemic, as well as post-pandemic, to enable physiotherapists to access those patients who are often unable to attend physiotherapy because of transport costs and various other reasons for non-attendance.

Clinical implications: The results of this study may indicate a way of managing patients in situations where face to face therapy cannot be undertaken.

Protocol identification: Pan African Clinical Trial Registry, PACTR202103637993156.

Background: Exercise forms an important component in the management of ankylosing spondylitis (AS). The objective of our study was to determine the effects of a 6-month swimming, land-based stretching, strengthening and breathing exercise intervention in AS patients.

Methods/design: A total of 29 (14 females, 15 males) patients diagnosed with AS according to the Modified New York Criteria participated in our study. Participants were randomly assigned to an exercise group (ASE) (16 participants) and a control group (ASC) (13 participants). Erythrocyte sedimentation rate and C-reactive protein (CRP); anthropometric measurements; pulmonary function; aerobic capacity; balance; Bath AS Metrology Index; Bath AS Disease Activity Index and the Bath AS Functional Index were assessed.

Discussion: Erythrocyte sedimentation rate and CRP did not change notably within or between the groups from pre- to post-intervention. The between group analyses of the physical assessments favoured the ASE with observable improvements in chest expansion (p = 0.002), forced expiration volume (p = 0.012), absolute (p = 0.017) and relative (p = 0.003) maximal oxygen consumption, absolute (p = 0.028) and relative (p = 0.001) physical work capacity. Within the ASE, there is statistical evidence of improvements in 11 of the 19 physical variables. Within the ASC, five of the physical variables deteriorated substantially (p between 0.004 and 0.037) and only balance overall stability on the right improved (p = 0.016). The three functional assessments in the ASE improved (p < 0.007) compared with the ASC post-intervention. A 6-month combined exercise programme may improve physical and functional capacity of AS patients.

Conclusion: A multimodal exercise intervention may be useful in the management of ankylosing spondylitis.

Clinical implications: An unsupervised well -explained exercise programme combining swimming, land-based strengthening and stretching exercises and breathing exercises may be an option for patients with ankylosing spondylitis.

Trial registration: Registration not undertaken at the time of writing.

Background: The 6-min walk test (6MWT) is a validated tool, of submaximal intensity, used to objectively measure functional exercise capacity. In 2002, the American Thoracic Society (ATS) developed guidelines on standardising the implementation of the 6MWT. Despite the relative ease of conducting the 6MWT as per these guidelines, adaptations are implemented.

Objectives: Identify (1) what 6MWT adaptations to the ATS guidelines have been described in low-resource settings (LRS), (2) the purpose of the adapted 6MWT and (3) the reported argumentation for making these adaptations in relation to the specific context.

Methods: Five databases were searched from inception until February 2021. Studies that adapted and conducted the 6MWT in LRS were included. Data concerning the study source, participants, 6MWT: purpose, variations, outcome and rationale were extracted.

Results: A total of 24 studies were included. The majority of studies (n = 18; 75%) were conducted in lower-middle income countries. The most common adaptation implemented was variation to course length. Eight studies provided a rationale for adapting the 6MWT. Space constraint was the most common reason for adaptation.

Conclusion: The most common reason (space constraints) for adapting the 6MWT in LRS was addressed through adaptations in course length and/or configuration. The results of this review suggest that the value of the ATS-guided 6MWT in LRS may need to be re-evaluated.

Clinical implications: Using adapted forms of the 6MWT may lead to an underestimation of a patient's abilities, misinformed discharge and developing inappropriate exercise programmes. Additionally, diverting from ATS guidelines may affect the continuity of care.

Background: Runners in under-resourced communities in parts of South Africa present with a high prevalence of patellofemoral pain (PFP), which affects their level of participation in sporting activities. Therefore, a specific rehabilitation approach is necessary to manage the PFP-related needs of these runners within their means and reach.

Objective: To develop a community-based rehabilitation (CBR) implementation framework for PFP amongst runners in under-resourced communities.

Method: Our study used the Delphi technique to develop an appropriate rehabilitation implementation framework for PFP in community-based settings. Sport medicine experts, involved in the treatment and rehabilitation of PFP, were recruited to participate. The Delphi process consisted of three rounds to attain consensus amongst the experts on the components and elements that could be contained in a rehabilitation implementation framework for the management of PFP. Experts rated the framework items using a five-point Likert scale.

Results: A total of 19 experts participated in our study: 10 were females and 9 were males of whom 13 were aged between 36 and 55 years. Most were local experts (15) with 11-20 years of clinical experience. Four core rehabilitation implementation items were identified through the Delphi process. These were: (1) the establishment of transdisciplinary rehabilitation teams, (2) upskilling of available clinicians, their assistants and trainers, (3) implementation of a CBR programme at low-level or no-cost and (4) referral of cases to secondary or tertiary institutions for further management.

Conclusion: Consensus was reached for a comprehensive CBR implementation framework aimed at addressing the specific needs of runners with PFP in under-resourced communities.

Clinical implications: A further study to test the feasibility of the agreed-upon intervention is recommended.

Background: Metacarpal fractures, one of the most prevalent upper limb fractures, account for 10% of all bony injuries.

Objective: Our systematic review aimed to review, appraise and collate available evidence on hand rehabilitation programmes for the management of second to fifth metacarpal fractures in an adult human population after conservative and surgical management. Since 2008, no review on a similar topic has been performed, thus informing clinical practice for physiotherapists and occupational therapists.

Methods: Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) principles guided the reporting. Experimental, quasi-experimental, cohort and case-control studies between January 2008 and September 2018 were included. Searches were conducted on Medline, Academic Search Ultimate, CINAHL, CAB Abstracts, Health Source - Consumer Edition, Health Source: Nursing/Academic Edition, SPORTDiscus, Africa-Wide Information and MasterFILE Premier, Web-of-Science and Scopus. Screening, selection, appraisal and data extraction were independently performed by two reviewers. No meta-analysis was performed.

Results: A total of 1015 sources were identified, 525 duplicates removed and 514 excluded. Three articles were included in the final data extraction: one randomised controlled trial (RCT) and two observational studies.

Conclusion: Limited evidence is available that a well-designed, well-implemented home-based exercise programme results in statistically significant improved hand function (p ˂ 0.0001) and digital total active motion (TAM) (p = 0.013) compared with traditional physiotherapy (PT) post-surgically.

Clinical implications: Our study contributes to the knowledge base of hand rehabilitation after an individual sustained a second to fifth metacarpal fracture. The authors identified a gap where future studies should further investigate the effect of hand rehabilitation after conservative and surgical management.

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.