South African Journal of Physiotherapy最新文献

Background: Musculoskeletal pain (MSKP) is an extremely common pain disorder in almost all populations. Self-management (SM) support is a programme to prepare people to self-manage their health condition effectively, while maintaining quality of life. SM is a cost-effective and context-specific strategy to address the global public health burden.

Objectives: Self-management needs a change in behaviour from seeking unnecessary medical care to safely self-managing symptoms. As changing individuals' behaviour is challenging, the objective of my literature review was to identify the characteristics, in both therapist and patient, to successfully engage in SM.

Method: A narrative literature review, that could inform evidence-based support programmes for SM of MSKP.

Results: Studies on successful implementation of SM of MSKP do not report strong outcomes. However, in more recent years a few positive outcomes were reported, possibly as a result of research evidence for the application of psychosocial skills and contemporary pain neuroscience in the management of persistent MSKP.

Conclusion: Psychologically-informed physiotherapy, addressing psychosocial barriers to the maintenance of SM programmes, could facilitate more successful outcomes.

Clinical implications: Before engaging in a SM support programme, obstacles to behaviour change must be identified and addressed in a SM support programme, to facilitate individuals towards taking safe responsibility for their healthcare. Therapists working with patients with persistent MSKP, should upskill themselves to be in line with the latest pain and psychosocial research literature. Moreover, communication skills training seems to be a priority for effective SM support programmes.

Background: Knowledge of anatomy and pathology of the spine together with spinal deformities is integral to several healthcare disciplines. This knowledge is crucial for graduates for assessment and management of patients with spinal problems. Physiotherapy students generally find it difficult to conceptualise the integrity of the structure and function of the spine that affects their acquisition of related physiotherapy skills.

Objective: Our first objective was to introduce and evaluate the use of a Vision-Based Augmented Reality (VBAR) mobile application to teach students the anatomy and accessory movements of the spine. A further objective was to explore student experiences of and engagement with VBAR by conducting a post-lecture survey comparing VBAR to traditional teaching.

Methods: This post-intervention crossover design study included two groups: final year physiotherapy students (n = 74) and mean age of 23 (±1.8). The computing department at Teesside University developed the VBAR mobile application. Moreover, a survey adapted from a previously published article was disseminated to students to evaluate their level of understanding following the use of the VBAR application.

Results: The results demonstrated that the median questionnaire scores in students' perceived level of understanding for the VBAR group were significantly higher than for the traditional teaching group (p < 0.05).

Conclusion: The results of this post-intervention survey suggest that the integration of VBAR learning activities results in gains relating to students' understanding of spinal anatomy, function, pathology and deformities. These findings suggest that VBAR could be an additional teaching tool to support student learning.

Clinical implications: Greater understanding is expected to increase the quality of clinical practice.

Background: Physiotherapy, brace applications or surgery are the treatment options utilised to manage patients with scoliosis. Many different brace applications are used, and the success rates of orthoses vary.

Objectives: Brace applications can have detrimental impacts on the patient leading to physical discomfort, psychological discomfort, and in some instance the use of braces may even be painful. Therefore, future developments in this field should be aimed at improving the success rate and reducing physical distress experienced by the patient while using brace applications. The purpose of this article is to provide recommendations with respect to the most appropriate bracing approach in general.

Method: A narrative review of the scientific literature was carried out to substantiate the statements made in this article.

Results: The most important braces provided for the treatment of patients with scoliosis and the treatment results that can be achieved are presented and discussed, taking into account the most recent systematic reviews. A wide range of success rates have been found for the different brace applications.

Conclusion: Given that brace application may impact the patient leading to physical discomfort and psychological distress, good quality management in brace application for patients with scoliosis is needed to ensure the best possible outcome and the least stressful management.

Clinical implications: Safety in brace application for patients with scoliosis needs improvement. The use of standardised and reliable computer aided design (CAD) libraries and appropriate patient information based on published guidelines is suggested.

Background: High-quality evidence exists to support physiotherapy and brace treatment for scoliosis and other spinal deformities. However, according to previous systematic reviews, it seems that no evidence exists for surgery. Nevertheless, the number of research articles focussing on spinal surgery highly exceeds the number of articles focussing on conservative treatment.

Objective: The purpose of this study is to conduct an updated search for systematic reviews providing high-quality evidence for spinal surgery in patients with spinal deformities.

Method: A narrative review including PubMed and the Cochrane database was conducted on April 12, 2020, with the following search terms: (1) spinal deformities, surgery, systematic review and outcome; (2) kyphosis, surgery, systematic review and outcome; (3) Scheuermann's disease, surgery, systematic review and outcome, and (4) scoliosis, surgery, systematic review and outcome.

Results: No reviews containing prospective controlled or randomised controlled studies were found providing evidence for surgery.

Conclusions: A general indication for spine surgery just based on the Cobb angle is not given. In view of the long-term unknown variables and the possible long-term complications of such treatment, a surgical indication for patients with spinal deformities must be reviewed on an individual basis and considered carefully. A current systematic review appears necessary in order to be able to draw final conclusions on the indication for surgery in patients with spinal deformities.

Clinical implications: In view of the increasing number of surgeons with an affiliation to industry, the indication for surgery needs to be given by independent conservative specialists for spinal deformities in order to provide an objective recommendation.

Background: Field hockey, a team sport played by both men and women at both recreational and professional levels, requires maintaining a forward flexed posture putting stress on the lumbar spine. Hence, it is necessary to assess the muscles supporting the lumbar spine, especially those surrounding the hip, to inform strengthening exercises for this population.

Objectives: To establish the best body weight rehabilitation exercises shown to produce high muscle activation (≥ 61%MVIC - maximal voluntary isometric contraction) for both the gluteus maximus (Gmax) and medius (Gmed) muscles. Four exercises fell into this category.

Method: Surface electromyography (sEMG) was used to record the muscle activation of Gmax and Gmed of four body weight rehabilitation exercises in 26 high-performance female field hockey players. The %MVIC activation data of both Gmax and Gmed were analysed using a three-way ANOVA.

Results: The single-leg squat generated the highest %MVIC activation of both Gmax (125.65%MVIC) and Gmed (126.30%MVIC). The only statistically significant difference for Gmax was between the single-leg squat and plank with hip extension (p = 0.0487). No statistically significant difference was observed for Gmed between the four body weight rehabilitation exercises (p = 0.6285).

Conclusion: The four exercises generated similar %MVIC activation levels. The single-leg squat produced the highest observed %MVIC of Gmax and Gmed in high-performance female field hockey players and is, therefore, recommended.

Clinical implications: Implementation of the findings could result in benefits during prehabilitation, injury prevention programmes and the later stages of rehabilitation for high-performance female field hockey players.

Background: Musculoskeletal diseases (MSDs) are a major cause of disability worldwide. It is essential to address effective MSD management, including appropriate referrals to physiotherapists and other healthcare professionals. Limited information is available regarding the referral practices of medical practitioners for patients with MSD. The doctors' referral practices to physiotherapists can impact the patient population and the South African health system.

Objectives: To investigate or understand the referral practices of medical practitioners in Bloemfontein, South Africa, to physiotherapy services, for individuals living with MSD.

Method: A quantitative study approach, implementing a semi-structured questionnaire, was used. Forty-nine participants completed the questionnaire.

Results: The referral of patients with MSDs by medical practitioners to physiotherapy services varied and multidimensional factors influenced their referral practices. Medical practitioners were unsure of the specific role played by physiotherapists in the management of individuals living with MSD. A need for improved relationships and communication between medical practitioners and physiotherapists was identified.

Conclusions: Medical practitioners regularly referred individuals living with MSD to physiotherapists, but referral practices should be optimised in terms of evidence-based practice and the use of specialised physiotherapy services. In an attempt to decrease the burden of MSD, adequate awareness should be created for improved referral practices between medical practitioners and physiotherapists.

Clinical implications: Collaborative development of detailed guidelines for apt, evidence-based referrals should be developed, to ensure early detection and management of individuals living with MSD. Health care professionals should be educated and encouraged to refer individuals living with MSD to physiotherapists for appropriate management with clinical benefits including improvement of HRQOL and cost effectiveness of this management not only to the individual but also to the health system in South Africa. Physiotherapists should try to communicate their role in the treatment of individuals living with MSD to medical practitioners for the benefit of the patient.

Background: Studies have shown that perceptual and cognitive asymmetries are present in the auditory system in patients with adolescent idiopathic scoliosis (AIS). The Dichotic Listening (DL) paradigm was formerly performed in non-forced (NF) conditions only, and no study has examined the conditions of attention to one ear.

Objective: To investigate the perceptual and cognitive asymmetry in the auditory system in patients with AIS as well as the asymmetry changes according to the curvature characteristics of patients with AIS.

Method: The DL paradigm was performed on 38 patients with AIS and 10 healthy individuals in all conditions (NF, Forced Right [FR], Forced Left [FL]).

Results: In the NF and FL conditions, the mean number of correct responses for the left ear was significantly lower in patients with AIS than in healthy individuals (p < 0.05). The correct responses for the right ear in the NF condition, right and left ear in the FR condition, and right ear in the FL condition did not show a significant difference between the groups (p > 0.05). Also, there was no difference between patients with AIS with both functional 3-curve and 4-curve (p > 0.05).

Conclusion: Our study indicates perceptual and cognitive asymmetry or lateralisation in the auditory system in patients with AIS. The asymmetry might be caused by the inability to direct their attention to the left ear, which is not affected by their curvature type. Further studies are needed to investigate perceptual and cognitive asymmetry behaviour models in the auditory system in patients with AIS.

Clinical implications: Determination of perceptual and cognitive asymmetry in the auditory system may offer a new perspective on conservative treatment protocols for AIS patients. Besides, the DL paradigm can be easily used in patients with AIS as a non-invasive evaluation method in clinics.

Background: Accelerated rehabilitation pathway (ARP) decrease patients' hospital length of stay (LOS). A lack of evidence exists on physiotherapy management and outcome as part of ARP in South Africa (SA). Our study will aim to determine whether early mobilisation and increased frequency of physiotherapy treatments for participants after hip or knee arthroplasty surgery on post-operative day 0 (POD 0) affect outcome.

Methods/design: A quantitative prospective cohort study incorporating ARP on (n = 60) non-randomised elective hip and knee arthroplasty participants will be compared with a more conservatively managed historical control group (n = 60). The physiotherapy protocol includes early mobilisation and exercises 1-3 h post-operatively on POD 0 and a second mobilisation and exercise session, 1-2 h later. Outcomes measures are as follows: hours for LOS, the WOMAC measured pre-operatively, 6 weeks and 3 months post-operatively, 30-day readmission for safety and cost comparison between the prospective and historical cohorts. Descriptive statistics will be undertaken. A paired t-test will be used to analyse each of the outcome measures across the time periods if data are normally distributed. Length of stay, WOMAC score and cost data will be compared between the groups, using a Mann-Whitney U test. The occurrence of adverse events will be compared between the groups using Pearson's chi-square tests. The confidence interval will be set at 95% and p = 0.05 will be considered statistically significant.

Discussion: Globally, ARP's are successfully implemented to manage patients presenting with hip and knee osteoarthritis (OA). Research investigating physiotherapy protocols in an ARP is lacking in the literature.

Conclusion: Achieving the same-day discharge after hip and knee arthroplasty surgeries may help elective surgery backlogs and waiting lists in a more cost-effective manner.

Clinical implications: The same day discharge after arthroplasty may be a cost-effective management option in the future.

Protocol identification: Pan African Clinical Trial Registry, PACTR202103637993156.