South African Journal of Physiotherapy最新文献

Background: Effective healthcare delivery occurs when health professionals collaborate and provide holistic, patient-centred care. Physiotherapists and chiropractors treat a common range of patients with an overlap in their scope of practice and modalities because of typical healthcare roles that could lead to 'perceived' animosity.

Objectives: To assess the knowledge, attitudes, and perceptions of qualified chiropractors and physiotherapists regarding each other's practice.

Method: A cross-sectional survey using an online questionnaire and analysed descriptively.

Results: Participants were chiropractors (n = 116) and physiotherapists (n = 190). Chiropractors achieved a mean knowledge score of 75.7%, with physiotherapists at 59.7% on the assessments of each other's patients; an average score of 85.3% and 72.0% respectively, on knowledge of treatment modalities; knowledge score of 82.4% and 77.3% respectively, on the conditions treated by the other professional. A total of 82.8% (n = 96) of chiropractors and 70.0% (n = 133) of physiotherapists indicated the other professionals' competence in treating neuromusculoskeletal conditions. Inter-professional referrals occurred between 81.9% of chiropractors (n = 95) and 55.3% of physiotherapists (n = 105). Chiropractors (69.0%, n = 80) and physiotherapists (55.3%, n = 105) wanted to collaborate to manage patients.

Conclusion: In the surveyed population in South Africa, chiropractors and physiotherapists had good knowledge, positive attitudes and perceptions of each other's practices, especially in the private sector.

Clinical implications: Inter-professional collaboration between chiropractors and physiotherapists should be encouraged so that healthcare delivery can be holistic and patient-centred for better clinical outcomes.

Background: Traumatic spinal cord injury (TSCI) survivors are confronted by both physical and psychosocial barriers when returning to their communities. Therefore, reintegration is an important aspect of their journey back into social life.

Objectives: To assess psychosocial reintegration after TSCI in Rwanda.

Method: All community-dwelling adults who were registered in the previous epidemiological study were recruited and injury characteristics questionnaire and the Sydney Psychosocial Reintegration Scale version 2 (SPRS-2) were used to collect data through a telephone interview.

Results: The study traced 58 participants, 77.6% (n = 45) were male and 56.9% (n = 33) were categorised with paraplegia. Overall, the results show poor community reintegration. The SPRS-2 and domain mean (SD) scores were: overall SPRS-2 of 20.95 (11.56), occupational activity (OA) of 3.68 (4.31), interpersonal relationship (IR) of 7.11(4.31) and living skills (LS) of 7.43 (5.32). Gender significantly influenced overall SPRS-2 (p = 0.011) and two domains: OA (p = 0.005) and LS (p = 0.012). Level of injury was significantly associated with an OA domain score of SPRS-2 (p = 0.002). Gender explained 29% of the variance in the LS domain of SPRS-2, with males reporting better psychosocial reintegration.

Conclusion: Gender strongly predicted psychosocial reintegration following a TSCI, which is an indication of the role of social support.

Clinical implications: Traumatic SCI rehabilitation should be holistic to help prepare the person to return to the community. There should be an assessment of an individual's readiness to return to the community before discharge from the hospital.

Background: Partial vascular occlusion (PVO) can increase muscle strength and hypertrophy without joint overload. However, PVO could increase the possibility of imbalances and injuries during physical activity.

Objectives: To identify changes in strength, muscle activation, and postural control during the use of PVO in young women.

Method: A total of 14 healthy women aged between 18 and 30 years were evaluated. Dynamometry was used to analyse the strength of the quadriceps muscle, and surface electromyography to evaluate quadriceps muscle activity. A force platform was utilised to assess postural control, static single-legged support, single-legged squat, and climbing and descending stairs. Participants were randomly assigned to the evaluations either with or without PVO. The results were compared and correlated.

Results: The performance of static, dynamic, or stair exercises, with or without PVO, did not indicate differences in muscle strength and recruitment (p > 0.05). The use of PVO improved the velocity of anteroposterior (AP) oscillation of static postural control (p = 0.001). We found a moderate negative correlation between muscle strength and postural control during the ascending stairs task with the use of PVO (r = -0.54; r = -0.59), while in the group without PVO, the correlation was moderate to high (r = -0.55; r = -0.76).

Conclusion: The use of PVO did not impair muscle strength and recruitment of the quadriceps or postural control in healthy women.

Clinical implications: Partial vascular occlusion can be used during dynamic exercises without impairing the balance and muscle strength of the quadriceps during its execution.

Background: Understanding health-related quality of life (HRQOL) among people with HIV (PWH) can inform strategies to maintain or improve health and functioning. Most HRQOL research has focused on resource-rich settings, underrepresenting younger cohorts in low-resource settings.

Objectives: To assess HRQOL and associated factors in PWH visiting two primary healthcare clinics in the Western Cape, South Africa.

Method: A cross-sectional study included 48 PWH (58.3% women; mean age: 39.2 [10.3]). Health-related QOL was assessed using EQ-5D-5L descriptive domains, visual analogue scale (EQ-VAS), and index score (EQ-index). Mobility was assessed using clinical tests. Tobit regression determined associations.

Results: Mean and median EQ-VAS scores were 88.14 (16.35) and 95.00. Mean and median EQ-index scores were 0.84 (0.10) and 0.90. PWH reported problems as pain/discomfort (35.4%), depression/anxiety (25.0%), mobility (22.9%), usual activities (18.7%) and self-care (12.5%) domains. Slow chair rise (p = 0.012), low income (p = 0.030), longer HIV duration (p = 0.009) and polypharmacy (p = 0.034) were associated with lower HRQOL. Antiretroviral therapy (ART) adherence was associated with higher HRQOL (p = 0.020).

Conclusion: Despite high overall HRQOL, specific domains presented challenges to PWH. Health-related QOL was associated with chair rise repetitions, income, HIV duration, polypharmacy, and treatment adherence. Comprehensive care and contextualised interventions to address these through rehabilitation, including health promotion, are proposed strategies for future investigation.

Clinical implications: Clinicians should be cognisant of potential physical and mental functioning problems, and factors related to drug therapy, socio-economic status and disease duration that may affect HRQOL even in seemingly unimpaired PWH.

Hand therapy for individuals who sustained hand injuries is included in the Health Professions Council of South Africa (HPCSA) physiotherapy scope of practice. The training that physiotherapists receive at the undergraduate level lays the foundation for them to deliver hand therapy or hand rehabilitation according to the International Classification of Functioning, Disability and Health domains in a uniquely South African health service context. Further structured formal and informal postgraduate continued education opportunities may put physiotherapists in the ideal position in a multidisciplinary team to deliver optimal hand therapy. The problem is that the physiotherapist's role in the multidisciplinary team delivering hand therapy in the past two decades has decreased, leaving room for a lack of health professional services in South Africa's private sector where physiotherapists are often the first consultation in, for example, sports teams, but more pertinently, in the public and rural areas. The International Federation of Societies for Hand Therapy (IFSHT) practice profile and physiotherapy scope of practice, curriculum and education information assist in achieving the aim of this commentary to position physiotherapists in South Africa as primary health practitioners in delivering hand therapy.

Clinical implication: The effective management of individuals with hand-related conditions and injuries is pertinent to ensure optimal hand function and quality of life. Equal continued formal education opportunities should thus be created for all multidisciplinary team professions at a postgraduate level.

Background: Knee hyperextension is common following stroke because of changes in joint range of motion (ROM), muscle tone and strength on the hemiparetic side. There is no clear consensus in the literature as to the cause of knee hyperextension during the stance phase of gait.

Objectives: Our study aimed to determine the feasibility of methods to investigate the association between ankle joint function and knee hyperextension in patients with hemiparetic stroke during the stance phase of gait.

Methods: We used a cross-sectional observational study to assess bilateral ankle muscle strength using a handheld dynamometer, ROM using a digital inclinometer and muscle tone using the Modified Tardieu Scale. The knee angles of the hemiparetic leg during the stance phase of gait were assessed using the Kinovea movement analysis software. Data were analysed using the Statistical Package for the Social Sciences with significance level set at 0.05 and 95% confidence intervals.

Results: Twelve participants were included, and no alterations were necessary to the planned methodology. We found positive associations in six participants between the tibialis anterior muscle tone and the hemiparetic knee angles during heel strike, terminal stance and pre-swing phases (p < 0.05, p < 0.01 and p < 0.01, respectively).

Conclusion: The results of the data analysis suggests that there may be a correlation between tibialis anterior muscle tone and knee hyperextension, a larger study will be imperative to confirm this association.

Clinical implications: The methods described in our pilot study are feasible for a larger study to be conducted with the recommendations considered.

Background: Outcome measures can assess the change in the health status of a patient in an intensive care unit (ICU). The Chelsea Critical Care Physical Assessment (CPAx) tool is used to assess the functional outcomes to monitor patient progression or regression in an ICU.

Objectives: Our study aimed to identify studies that assess the functional outcomes of patients nursed in ICUs that use the CPAx tool.

Method: An integrative review framework was used. Data were analysed in five steps to formulate a conclusion that aligned with the objective of our study. Data were extracted from peer-reviewed articles published online between 2013 and 2022. Databases that were used include Google Scholar, Directory of Open Access Journals (DOAJ) and PubMed for reviewed articles. Keywords were used in the search strategy, and screening of abstracts was done to extract studies that met the inclusion criteria.

Results: We retrieved 41 studies, of which 11 matched the inclusion criteria. Data were thematically arranged into studies measuring the validity and reliability of the CPAx tool, using the CPAx tool to measure outcomes in the ICU, the tool used at ICU and hospital discharge.

Conclusion: The use of the CPAx tool has no impact on measuring the hospital length of stay or quality of life.

Clinical implications: The tool is comprehensive and enhances the accuracy of patient assessment.

Background: Hand grip strength (HGS) measurements serve as an objective measure of upper extremity function. Reliable hand strength evaluation is vital for assessing treatment effectiveness.

Objectives: To determine the influence of hand dominance, gender, and body mass index (BMI) on HGS among university students in Ghana.

Method: In our cross-sectional study of 304 participants, height, weight, and BMI were measured using a stadiometer and weighing scale. Hand grip strength was assessed with a dynamometer. We compared HGS in dominant and non-dominant hands for males and females using a paired t-test and analysed the correlation between grip strength and weight, height, and BMI using Pearson's correlation coefficient.

Results: The mean HGS for right-hand dominant (RHD) male participants was 35.62 kg (± 7.36) for the right hand compared with 32.84 kg (± 7.36) for the left hand. For females RHD the mean HGS in the right hand was 24.60 kg (± 6.42) compared to 22.12 kg (± 5.37) in the left hand. The mean weight, height and BMI of participants were 62.86 kg (± 10.30), 1.67 m (± 0.09) and 22.9 kg/m² (± 4.9), respectively. A significant relationship existed between HGS and height (r = 0.492; p < 0.01) as well as HGS and BMI (r = 0.290; p < 0.01). However, no notable connection was found between HGS and weight (r = 0.001; p = 0.982).

Conclusion: Hand grip strength was significantly stronger in the dominant hand of both males and females.

Clinical implications: Physiotherapists should test HGS objectively and quantitatively for use in disease evaluation, diagnosis, and therapy.