South African Journal of Physiotherapy最新文献

Background: High-impact chronic pain (HICP) presents significant challenges within primary healthcare (PHC) settings, particularly in resource-constrained environments such as South Africa. Limited evidence exists regarding physiotherapists' lived experiences managing this condition in local contexts.

Objectives: This study explored facilitators and barriers to providing adequate care for individuals with HICP, as experienced by physiotherapists working in Western Cape PHC facilities. It is envisaged that the findings may contribute to curriculum development, policy considerations, and clinical practice enhancement.

Method: A descriptive qualitative approach was employed, and semi-structured virtual interviews were conducted with eight purposively selected physiotherapists from Western Cape PHC facilities. Inductive thematic analysis guided data interpretation.

Results: Analysis revealed four interconnected themes: (1) High-impact chronic pain as a complex and disabling burden in PHC settings, (2) person-centred approaches as key facilitators, (3) systemic and personal barriers constraining effective management, and (4) specific needs for improved HICP care. While person-centred approaches were valued, participants struggled with implementation amid resource constraints.

Conclusion: High-impact chronic pain management in South African PHC settings requires attention to interrelated factors of time, support, and knowledge. While physiotherapists recognise effective approaches, implementation challenges necessitate systemic adjustments.

Clinical implications: These insights highlight the necessity for workforce planning reform, professional development in pain management, and enhanced interdisciplinary collaboration to better serve patients with HICP in resource-limited settings.

Background: Spinal cord injury (SCI) significantly impacts quality of life (QoL) through physical disabilities and reduced social participation.

Objectives: This study compared health system indicators, social factors and self-reported QoL between individuals with SCI accessing public versus private healthcare in South Africa.

Method: A cross-sectional survey using the International Spinal Cord Injury (InSCI) community survey questionnaire was conducted with 200 SCI individuals (156 public, 44 private sector) from Cape Town and Pretoria. Chi-square tests and correlation analyses were performed.

Results: Significant disparities were observed between cohorts. Public sector participants reported higher rates of disability pension receipt (82.1% vs 54.5%) and greater challenges accessing various services. Overall, self-reported QoL was 56%, with the private cohort reporting significantly higher satisfaction (64% vs 52%). Private sector participants also reported higher satisfaction with living conditions and personal relationships. Access to disability pension and healthcare negatively correlated with QoL, while access to public spaces, medication, transport and nursing care positively correlated with QoL.

Conclusion: This study reveals significant disparities in health system performance, social factors and QoL between SCI individuals accessing public versus private healthcare in South Africa.

Clinical implications: Findings highlight the need to address systemic inequities in healthcare access and social support for individuals with SCI to improve QoL across sectors.

Background: Early gross motor development is a crucial indicator of overall neurodevelopment. In low- and middle-income countries, lack of accessible assessment tools poses challenges for healthcare professionals evaluating infant neurodevelopment.

Objectives: To determine the agreement between the Alberta Infant Motor Scale (AIMS) and Bayley Scales of Infant Development-III (BSID-III) gross motor domain at 6 months and to evaluate the predictive validity of the AIMS at 6 months for identifying severe gross motor delays at 18 months.

Method: This nested subgroup study assessed 112 full-term infants using both AIMS and BSID-III at 6 months and BSID-III at 18 months. Agreement between measures was determined using Bland-Altman plots, while predictive validity was evaluated using receiver operating characteristic (ROC) curves with various cut-off scores.

Results: Bland-Altman analysis showed strong agreement between AIMS and BSID-III in the lower-performance range, with bias only in scores above 33. The traditional 10th percentile AIMS cut-off had low sensitivity (27.3%) but high specificity (98%) for predicting delays at 18 months. A modified 23rd percentile cut-off improved sensitivity to 63.6% while maintaining acceptable specificity (81.6%), with a 95.2% negative predictive value (NPV).

Conclusion: The AIMS demonstrates strong agreement with BSID-III when identifying potential developmental delays. The proposed 23rd percentile cut-off offers a more balanced screening threshold for this population.

Clinical implications: The AIMS presents a viable alternative to the BSID-III for initial screening in resource-limited settings. The high NPV at the 23rd percentile cut-off makes it useful for ruling out developmental delays.

Evidence-based practice (EBP) is a process that a clinician undertakes, implementing his or her clinical expertise while collaborating with the patient or client in the sociocultural context of care using the best available research evidence to inform practice. The approach has evolved over time in relation to its name, definition, scope and specific steps. In October 2001, member organisations of World Physiotherapy (then the World Confederation for Physical Therapy) gathered in London to discuss the status of EBP in the profession and to gain buy-in from regions to ensure that EBP would become a culture of practice in all regions. The purpose of this article is to describe the current state of EBP during physiotherapy as presented in the literature. Two decades have passed since this meeting, with noteworthy developments in clinical practice, education and research synthesis. Physiotherapists' opinions and attitudes towards EBP are favourable but do not always ensure good implementation and execution during clinical practice. Standardised outcome measures to evaluate the EBP of physiotherapists are available. Barriers remain, which are multifactorial, and facilitators such as time, support and education are integral to optimise implementation. The launch of the Physiotherapy Evidence Database is one strategy that facilitates EBP in physiotherapy.

Clinical implications: A culture of EBP exists upon reflection of published literature from different world regions. Consistent, quality implementation of EBP, including shared decision making with patients and evaluation of evidence implemented during clinical practice remain necessary.

Background: When students and educators understand a skill like clinical reasoning (CR) differently, attempting to develop it becomes challenging. Miscommunication in how different stakeholders understand this essential skill can potentially harm patients.

Objectives: Our study explores how physiotherapy students and educators (both lecturers and clinical educators [CEs]) in a physiotherapy department understand CR. The research aimed to identify any potential gaps in the stakeholders' understanding of CR and explore strategies for better alignment.

Method: A qualitative exploratory descriptive design was employed. In-depth interviews were conducted with 27 undergraduate physiotherapy students, 10 physiotherapy lecturers, and 8 CEs.

Results: Thematic analysis revealed three key themes: cognitive process, evidence-based practice, and clinical approach. Significant differences emerged between experts (lecturers and CEs) and novices (students) in conceptualising CR. The experts demonstrated a more holistic understanding, focusing on hypothesis generation and interconnected reasoning. In contrast, students focus on information collecting and justification of actions.

Conclusion: The findings highlight a gap in CR understanding that could potentially impede reaching expected learning outcomes.

Clinical implications: Our study recommends seeking alignment of students' and educators' perspectives through structured dialogue and intentionally designed educational strategies. This includes developing holistic assessment rubrics that acknowledge both foundational and advanced CR skills and implementing case-based learning approaches. And creating opportunities for educators to make their reasoning processes explicit and visible to students.

Background: Understanding the physical activity behaviours of adults at risk of poor health is important to inform targeted interventions. We profiled the frequency, intensity, duration and domain (work or non-work) of self-reported physical activities of rural South African adults living with hypertension.

Objectives: The aim of this study was to provide a profile of the frequency, intensity, duration and domain of self-reported physical activities over a 7-day period in adults with hypertension from a rural sub-district in South Africa.

Method: A total of 429 adults diagnosed with hypertension aged 40 years and above completed the International Physical Activity Questionnaire Long-Form via telephone interview. Data were summarised using means and standard deviations or medians and interquartile ranges. The Mann-Whitney U test and Krustal-Wallis rank test were used to assess physical activity differences by sex and work status. Statistical significance was set at p < 0.05.

Results: The mean age of the participants was 65.1 (standard deviation [s.d.] ± 10.9 years), 58% were women and 52% had paid or unpaid work. Men reported greater (duration and frequency) vigorous physical activity at work compared to women (p = 0.003 and p = 0.002). Walking frequency as a mode of transport was higher for working men and women (p < 0.001). Women reported higher frequency of moderate-intensity physical activity inside the house (p < 0.001) and outside the house (p < 0.001) compared to men. Non-working men and women spent more time sitting during the week compared to their working counterparts (p = 0.009).

Conclusion: The physical activity profile of hypertensive adults varied by sex and work status.

Clinical implications: Contextual factors such as gender roles are also related to the physical activity profile of hypertensive adults living in rural South Africa and should be considered when designing specific interventions targeted at improving hypertension control for this population.

Background: Worldwide, musculoskeletal disorders represent a global threat, and primary replacement arthroplasty is the preferred surgical treatment for late-stage arthritis. In South Africa, the waiting lists for arthroplasty are extensive and physiotherapists can have an impact on this situation by implementing prehabilitation; hence, the need to conduct research on the efficacy of such a programme.

Objectives: Develop a prehabilitation programme for a resource-scarce community in South Africa.

Method: Our study consisted of three phases wherein the first step entailed conducting a scoping review. The second phase was a consultation of stakeholders through semi-structured interviews and self-administered questionnaire, and the final stage was an evaluation of the effects of the prehabilitation programme by a pilot, single-blinded study on a convenient sample of patients.

Results: The scoping review identified several gaps in existing programmes such as duration, mode and content of the prehabilitation programmes. Stakeholder surveys revealed a lack of knowledge and understanding of physiotherapy and prehabilitation. This highlighted the need to investigate the efficacy of a hybrid model of prehabilitation.

Conclusion: Our study is novel within the South African public healthcare system, as it envisages a hybrid approach; and to construct a programme that is contextually relevant.

Clinical implications: Our study aims to deliver the services in a hybrid way using telerehabilitation and face-to-face therapy which will improve access and reduce waiting times.

Background: The pectoralis minor muscle (PMM) length is critical for shoulder movement and stability, often implicated in dysfunction and pain. The pectoralis minor index (PMI) quantifies this muscle's length relative to body dimensions. Typical PMI values range from 10.0 cm to 12.5 cm in healthy adults, with data for Kenyan populations.

Objectives: This study aimed to establish baseline PMI values among healthy 18-24-year-old university students in Kenya, examining variations by side dominance and sex to support clinical assessments.

Method: A cross-sectional descriptive study recruited 289 healthy young adults from Jomo Kenyatta University of Agriculture and Technology (JKUAT) using stratified and simple random sampling. Data were collected through a self-developed, interviewer-administered questionnaire, achieving a 93.4% response rate. PMI values were measured in three postures: supine, relaxed, and standing.

Results: In the standing relaxed position, the PMI mean was 10.6 cm on the dominant side and 11.2 cm on the non-dominant side, with significant variation indicated by a 95% confidence interval. A paired t-test revealed a significant difference between dominant and non-dominant sides (p < 0.0001).

Conclusion: Baseline PMI values for Kenyan young adults show significant differences by dominance and sex. These findings provide a foundational reference for assessing PMI in clinical settings, supporting physiotherapists and clinicians in evaluating and treating shoulder dysfunction using precise muscle length data.

Clinical implications: Establishing baseline PMI values assists physiotherapists in identifying deviations, enabling targeted interventions for shoulder dysfunction.

Introduction: Stroke is one of the global leading causes of disability, with a higher prevalence at a younger age in sub-Saharan Africa. Returning to functional status is a primary goal of rehabilitation for stroke survivors. However, the cost of intensive rehabilitation is often a barrier for the under-resourced in South Africa.

Patient presentation: This article describes the individualised 'return-to-function' approach to rehabilitation and its outcomes for five stroke survivors delivered through a non-profit public-private partnership in a low-income community in South Africa.

Management and outcome: A retrospective case series of stroke survivors who participated in the Bounce Back Journey (BBJ) programme between 2019 and 2021 was conducted. The beneficiaries' ages ranged from 21 to 55 years; two were females and three were males. The goals and outcomes of five stroke survivors with impairments, functional limitations and participation restrictions admitted into the BBJ programme were evaluated through standardised outcome measures. All the beneficiaries required financial support and extensive rehabilitation to return to a functional life. All showed improved outcomes in functional independence and health-related quality of life at discharge. Depressive symptoms clinically deteriorated in one patient. At discharge, all participants faced challenges finding opportunities to return to work.

Conclusion: The case series demonstrates how an alternative community-based rehabilitation programme has the potential to improve functionality, health-related quality of life and mental health.

Contribution: A low-cost, community-based, intensive rehabilitation programme can improve functionality, but return to work and community re-integration opportunities remain limited.

Background: The global rise in the older population, especially in sub-Saharan Africa, has heightened the impact of non-communicable diseases (NCDs), responsible for 74% of global deaths and the leading cause for years lived with disability. Physical activity (PA) has proven to manage NCDs; however, 80% of older adults in sub-Saharan Africa engage in low-to-moderate PA levels.

Objectives: This literature review explores current evidence on the effects of PA on ageing and NCDs in older people in sub-Saharan Africa. Insights gained will enable physiotherapists to refine their PA prescriptions, aligning short-term rehabilitative goals with the broader scope NCD management while fostering principles of healthy ageing.

Method: Electronic searches were conducted in: PubMed, EBSCOhost (Academic Search Premier - Africa-Wide Information, CINAHL, Health Sources Premier), Scopus and Google-Scholar to identify peer-reviewed studies published after 2010 related to PA, ageing, NCDs and older people (OP) in sub-Saharan Africa.

Results: A structured PA protocol, comprising aerobic activity at 60% - 79% of maximal heart rate and resistance training at 50% - 60% of one-repetition maximum (3 weekly sessions each), proved effective in reducing NCDs. Integrating lifestyle behaviour changes further enhanced outcomes, notably improving blood sugar management and cardiac health.

Conclusion: Structured aerobic and resistance PA, combined with lifestyle education, significantly reduces NCD risk factors in older adults, supporting healthy ageing.

Clinical implications: The current research base in the field of ageing in SSA is limited, indicating the need for non-pharmacological interventions to manage the prevalence of NCDs, including in mental/cognitive health, where PA has a direct influence.