South African Journal of Physiotherapy最新文献

Self-management is an important strategy to improve quality of life, appropriately manage long-term health conditions, and reduce the economic burden of long-term health conditions. However, equitable healthcare access remains an issue, and the focus on 'self' in self-management is problematic. Our review aims to explore the conceptualisation and evolution of supported self-management in an African context and its relevance to physiotherapy. A state-of-the-art review of the literature was undertaken by the authors. The authors knowledge of the subject area and a database search retrieved recent articles exploring patients' and healthcare providers' understanding of supported self-management in Africa. Relevant articles were read, and data summaries of included studies were extracted and tabulated. Findings were organised deductively. Sixteen studies, 11 primary research, and 5 reviews (2016-2023) undertaken in a variety of sub-Saharan countries with healthcare workers (~n = 177) and people (~n = 16 115) living with a mix of non-communicable and communicable conditions were considered in this state-of-the-art review. Self-management perceptions were drawn from Western authors spanning development research and understanding of the concepts in Western thinking. We conclude that imported concepts, such as supported self-management for long-term conditions, should be considered within local health delivery solutions. These should be embedded in an understanding of traditional African health systems.

Clinical implications: There is a need to develop locally derived African solutions. Self-management strategies for long-term health conditions should be developed, considering traditional holistic African health systems.

In the last decade, concussion research has exploded in multiple fields of scientific research. This has helped to clarify what causes, influences, and perpetuates human concussion, and displays the integral role physiotherapists play in concussion management. In this article we discuss the latest research relevant to the key role of physiotherapy in concussion management. A narrative review of the literature on concussion was conducted. The current review analyses how concussion has influenced physiotherapy in several categories: assessment, treatment, management, research rigour and building the profile of the profession. Scientific concussion research has largely converged in support of the role of physiotherapists utilising specific components including: (1) autonomic, (2) cervicogenic, (3) vestibulo-ocular and (4) psychological approaches to management. Latest research supports the critical role of physiotherapy in concussion care in the assessment, management, and prevention of concussion with scope for further interdisciplinary collaborations.

Clinical implications: Concussion is complex. A basic mental health, Vestibular Ocular Motor Screening (VOMS) and four key components relating to concussion management (autonomic, cervicogenic, vestibular oculomotor, and psychological approaches to management) should be included in the undergraduate and postgraduate curriculum. This will aid clinical physiotherapists to support their patients. A call to advance more intradisciplinary physiotherapy teamwork should be encouraged as valuable knowledge sharing is potentially lost within the framework of 'specialisation'. If needed, the skills of a greater interdisciplinary team are imperative to facilitate patient management and recovery from this multi-faceted injury.

Background: The Internship and Community Service Programme (ICSP) places newly graduated health professionals for a compulsory training period. Universities adopt multiple strategies to encourage students to select rural placements for ICSP.

Objectives: This study describes ICSP choices among final-year MBChB and Health and Rehabilitation Science students at a South African university and the factors influencing their decisions.

Method: A cross-sectional qualitative descriptive study was conducted using a self-developed online questionnaire. Eighty-five final-year students were recruited.

Results: Most respondents (n = 38, 45.8%) chose the Western Cape (WC) as their first choice placement. There was a significant difference between MBChB and other health science students' choice of level of healthcare (χ = 10.39, p = 0.006), with MBChB less likely to choose primary healthcare (PHC) level placements. District and tertiary care options were perceived as better sites for learning and practice, while PHC and rural sites, considered underresourced and understaffed, were avoided. Although MBChB students indicated a lower preference for rural placements, this was not significant.Factors influencing ICSP application decisions included professional support, work environment, and social and personal considerations.

Conclusion: Students' placement choices were based on their perceptions of clinical exposure, learning opportunities, mentorship and supervision. Placements closer to home were preferred. UG clinical exposure and rural background seem to have some impact on choice but need further investigation.

Clinical implications: Universities should continue to explore ways to improve students' readiness for practice in underresourced settings. Improved exposure to rural and PHC sites during training could encourage better uptake during ICSP placement.

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.