South African Journal of Physiotherapy最新文献

Background: Early mobilisation (EM) of critically ill patients in intensive care units (ICUs) has gained significant attention because of its potential to improve patient outcomes. Despite the recognised benefits of EM, implementation remains inconsistent.

Objectives: To describe the knowledge, attitudes and practices of healthcare professionals regarding EM of critically ill patients in Windhoek.

Method: A descriptive, cross-sectional design using a self-administered survey was conducted in Windhoek, Namibia, targeting nurses, doctors and physiotherapists working in private ICUs.

Results: A total of 174 surveys were distributed, with a response rate of 24.1% (n = 42). Respondents included 21 nurses, 5 doctors and 13 physiotherapists. Most participants underestimated the incidence of ICU-acquired weakness and reported unfamiliarity with EM literature (n = 19, 51.4%). Furthermore, 25 respondents (67.6%) reported that patients were not automatically assessed for mobilisation, the majority reported requiring a doctor's referral (n = 31, 83.8%). Mobility practices were conservative, especially when patients were intubated or in the presence of radial and femoral catheters. Major patient-level barriers included medical instability (n = 24, 72.7%) and excessive sedation (n = 18, 54.5%); whereas institutional barriers were the requirement for a doctor's referral (n = 22, 64.7%) and no written guidelines or protocols for mobilisation (n = 16, 47.1%). Provider level barriers were that mobility is not perceived as important by some individuals (n = 18, 78.3%).

Conclusion: Our study revealed knowledge gaps, conservative mobility practices and numerous barriers to EM implementation at the patient, provider and institutional levels.

Clinical implications: The findings highlight the need for targeted education, training programmes, standardised mobility protocols and the establishment of a dedicated mobility champion to promote EM in Windhoek ICUs.

Background: Spinal cord injury (SCI) presents a significant health challenge, characterised by damage to the spinal cord resulting from trauma, inflammation, tumours or other aetiologies. This injury often leads to a range of debilitating consequences, including loss of motor function, sensation, sphincter control and autonomic nerve function below the site of injury, as well as challenges with self-care and performance of instrumental activities of daily living (ADLs).

Objectives: This study aimed to determine the prevalence, risk factors and characteristics of SCI among adult patients in three selected counties in Kenya.

Method: A population of 213 patients from three counties in Kenya was used for this study. Then, a retrospective descriptive cross-sectional study design was utilised to evaluate the prevalence of SCI.

Results: The findings reveal a predominant prevalence in male patients, accounting for 84.04% of occurrences, with the highest incidence observed among individuals aged 26-35 years (36.15%). Motor vehicle accidents are the leading cause, accounting for 45.07% of cases, followed by falls from height accounting for 42.25% of cases and violence, specifically gunshot injuries, which account for 7.04% of incidents.

Conclusion: The findings of this study provide a comprehensive epidemiology of SCI in three counties in Kenya with male patients recording high prevalence in motor vehicle accidents and falls from height as well as in severity and associated SCI complications.

Clinical implications: This finding provides significant information on safety awareness and a platform to develop rehabilitation programmes for patients with SCI in Kenya.

Background: The Participation Measurement Scale (PM-Scale) is an International Classification of Functioning, Disability and Health-based and Rasch-built scale developed specifically to assess participation in people with stroke.

Objectives: Our study aimed to estimate the minimal clinically important difference (MCID) for the PM-Scale.

Method: We performed a secondary analysis of data from the 'Circuit walking, balance, cycling and strength training' trial. Participants underwent mixed and collective physical activities or sociocultural activities for 12 weeks, and participation data were collected before and after the interventions. The activity limitations (ACTIVLIM)-Stroke scale was used as the anchor of importance. The MCID for the PM-Scale was estimated using receiver operating characteristic (ROC) curves and the Youden index.

Results: Data were collected from 46 people with chronic stroke, of which 22% were female, with median (Percentile 25, Percentile 75) age of 54 (44; 60) years, and time since stroke is 24 (11; 37) months. For all participants, the PM-Scale measures range from -2.98 logits to 5.02 logits. The area under the curve (AUC) for the receiver operating characteristic (ROC)-analysis was 0.74 yielding an estimated MCID of 1.98 logit for the PM-Scale.

Conclusion: Our study estimated the MCID of the PM-Scale at 1.98 logit, enabling a more precise interpretation of the outcome in the clinical and research settings.

Clinical implications: An improvement of at least 1.98 logit on the PM-Scale is required to induce a clinical change in the independence in activities of daily living in people with chronic stroke.

Background: Cancer is the main cause of morbidity and mortality worldwide, and its symptoms can affect an individual's life holistically.

Objectives: Our study aimed to determine the health-related quality of life (HRQoL) of individuals dealing with cancer in the Free State, South Africa.

Method: A descriptive, cross-sectional study design utilising the standardised Functional Assessment of Cancer Therapy - General (FACT-G) questionnaire as well as a self-developed sociodemographic and general health information questionnaire was used in this study. The study was conducted at the Universitas Annex Oncology Clinic.

Results: A total of 507 participants were conveniently sampled. The median age was 53 years with 73.8% being female. The FACT-G's overall score ranged from 11.7 to 108, with a median of 76.7 (interquartile range [IQR] 63-89.5). The Social or Family Well-Being subscale indicated the highest median of 22.2 and the Emotional Well-Being subscale the lowest of 18. The Physical Well-Being subscale found that 61.8% of individuals felt forced to spend time in bed and 53.4% experienced nausea. The Functional Well-Being subscale showed that 70.3% of individuals accepted their illness and 51.6% enjoyed their life.

Conclusion: Our study highlights the importance of using a clinical assessment tool to determine the influence of cancer on the individual's HRQoL. Involvement of the individual's family and friends during management, as well as identifying the need for psychosocial support, is crucial for positively influencing HRQoL.

Clinical implications: The FACT-G is a valuable tool in guiding physiotherapists and other healthcare professionals with patients' cancer-related treatment experiences.

Background: Acute exacerbation of chronic obstructive pulmonary disease (AECOPD) is a leading cause of morbidity and mortality in South Africa. Physiotherapy practice and factors that influence management of patients with AECOPD are unknown.

Objectives: To explore physiotherapy practice in the management of patients with AECOPD in South African private healthcare settings and to identify and describe factors that influence physiotherapy patient management.

Method: The study adopted a qualitative descriptive design using semi-structured interviews. Purposive and snowball sampling was used to identify physiotherapists working in private healthcare in three South African provinces. Individual interviews were conducted face-to-face or via telephone and transcribed verbatim. Content analysis was done using an inductive approach.

Results: Participants (n = 9) working in private hospitals reported that their management is based on patient-specific needs assessment. Treatment interventions included various respiratory physiotherapy techniques and exercise rehabilitation strategies. Patient education on self-management of disease symptoms featured prominently. Enablers of physiotherapy management included supportive workplace relations, conducive work environment, physiotherapists' competence, familial support and patient cooperation. Barriers identified included limited communication, nurses' attitudes, work environment, disease burden, mental health challenges and limited professional development opportunities.

Conclusion: Physiotherapists provide individual needs-based care to patients with AECOPD. Various enablers and barriers to physiotherapy patient management have been identified.

Clinical implications: Advocacy for physiotherapy, better communication between multidisciplinary team members and recognition of the need for psychological support are important factors to address to enhance the care provided to patients with AECOPD.

Background: Adherence to management regimes is pivotal to successfully managing patients with low back pain (LBP). Barriers decrease adherence, resulting in disability.

Objectives: Our pilot study aimed to determine barriers associated with physiotherapy treatment attendance and home exercise programme adherence among patients with LBP and treating physiotherapists in Eswatini.

Method: A cross-sectional descriptive pilot study using a self-developed Research Electronic Data Capture (REDCap) survey was conducted with 62 LBP patients. Descriptive, regression and bivariate statistical analyses with odds ratios (OR) were used to identify adherence barriers.

Results: Twenty-two (35.5%) participants missed appointments because of feeling better. Twenty-one participants (33.9%) missed scheduled appointments due to painful sessions, cost and the burden of changing their routines. Home exercise adherence was positively associated with understanding the condition (p = 0.001) and negatively with too many exercises (p = 0.005).

Conclusion: Our study identified patient barriers to physiotherapy adherence, particularly females aged 40-69 years. Although doctor referrals improved adherence, time constraints and pain remained significant barriers. Barriers to prescribed home exercise programme adherence included pain during exercises, fear, no time, forgetting/no reference and too many exercises. While most participants understood their condition, some lacked understanding, underscoring the need for better education. Addressing these barriers could enhance adherence and reduce the impact of LBP.

Clinical implications: To overcome the barrier of adherence to keeping appointments, prioritising health education and providing reasons for exercises should be empathised. Exercise programme adherence could be improved by providing reference material, less and more meaningful and/or functional exercises.

Background: HIV-associated neurocognitive disorder (HAND) affects an individual's capacity for independence and engagement in everyday activities, posing challenges in environments with limited resources and low social support.

Objectives: To ascertain the efficacy of exercise (AE) for activity and participation (AP) level in people with HAND.

Method: This is a randomised controlled trial that is parallel-group in nature, with intention-to-treat analysis and disguised allocation. Seventy-three people with HAND in total were randomised at random to the AE and control groups. Three 20-60-min sessions of moderate-intensity AE training on a cycle ergometer were included of the 12-week intervention. Individual tolerability served as the basis for progression. Three months after the intervention, at the conclusion of the intervention, and at the baseline, outcomes were measured. The AP constitutes the main outcome variable. To investigate the impact of AE on AP level, rank analysis of covariance was performed after log-transformation.

Results: When comparing the AE to the control group, there were significant increases in social wellbeing AP (Cohen d = 0.550; p = 0.021), emotion AP (Cohen d = 0.641; p = 0.007) and overall AP level (Cohen d = 0.896; p < 0.001). There was no discernible variation in AP across the groups three months following AE (Cohen d = 0.437; p = 0.067).

Conclusion: AE induces a small increase in AP among individuals with HAND.

Clinical implications: For people with HAND, regular AE is a good way to manage AP restriction. Increasing AE participation may improve AP restriction.

Background: Rugby-related injuries are a leading cause of dropout from competitive sports, high insurance compensation, disability and socioeconomic marginalisation. The debilitating effect of these injuries on players may deny them the benefits associated with rugby and can lead to premature termination of a rugby career.

Objectives: To determine the prevalence, incidence and risk factors for rugby-related injuries among male Safari Sevens rugby tournament players in Kenya.

Method: Following ethical approval and clearance, this cross-sectional study was carried out among October 2021 teams of male players in the Safari Sevens rugby tournament. Players (n = 113) voluntarily completed Rugby International Consensus Group 'injury report form'. Descriptive statistics and odds ratios were calculated.

Results: A point prevalence of 47 (41.6%) respondents at pre-tournament was found. The tournament recorded 117.6 player-match hours with an incidence of 33 (29.2%) injuries occurring during competition. In contact phase of rugby match, 'being tackled' was associated with a higher number of injuries mostly in the lower limbs. Surface of the playing field was likely to expose a player to injury in pre-competition and during the tournament. Additionally, players who had recurrent previous injuries and oversize gear were more likely to be injured during the tournament.

Conclusion: The study showed competition injury incidence similar to that reported in previous studies. Lower limb injuries were most prevalent, especially the ankle while 'getting tackled' during matches.

Clinical implications: There is a need for an algorithm for injury risk assessment, knee and ankle control training protocol, and use of dynamic knee and ankle supports.

Background: Complaints of ethical and professional misconduct are lodged and processed by the Health Professions Council of South Africa (HPCSA) in accordance with their legal mandate.

Objectives: This study describes the nature and frequency of transgressions by physiotherapists as concluded by the HPCSA for the period from 2010 to 2020.

Method: A total sampling method was used to extract all records of transgressions lodged against physiotherapists between 2010 and 2020. In a quantitative retrospective records review design, data were captured with the objective to report these descriptively. Ethics approval was granted by the Faculty of Health Sciences Research Ethics Committee of the University of Pretoria and permission to use the records was granted by HPCSA.

Results: Twenty-one transgressions by physiotherapists during the study period were recorded at the HPCSA. Most transgressions were charging for services not rendered (n = 20 times), invoices drafted inaccurately (n = 17) and false claims submitted to the medical aid schemes (n = 15). Other transgressions included failure to obtain informed consent and patient identity prior to treatment, charging for an unkept appointment, overservicing, misleading advertisements, love relationship with a patient and treating an animal in the same practice as humans.

Conclusion: The transgressions were unprofessional in nature with the most frequently reported being false claims and accounts submitted to the medical aid by physiotherapists for services not rendered.

Clinical implications: The knowledge of transgressions will influence decision making and restrain infringement to enhance sound ethical practice.

This conference report includes abstracts from the centenary congress held in Cape Town in September 2024, marking a significant milestone in the celebration of 100 years of the South African Society of Physiotherapy™ (SASP^®). As part of the celebration, the SASP^® hosted the World Physiotherapy - Africa Region Congress, which brought together diverse international and African perspectives. The scientific programme had exciting sessions, focussing on physiotherapy and multidisciplinary aspects. Engaging Indaba and Debate sessions covered topics such as Strengthening Rehabilitation in Africa, Innovation in Rehabilitation, Reframing Care for People with Musculoskeletal Pain, Research in Children with Disabilities and Translating Research into Practice in Africa. These abstracts reflect the broad range of research and ideas presented, contributing to the future of physiotherapy and rehabilitation on the continent.