Physiotherapy

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Open Access
Fisioterapie rehabilitasiedienste en behoeftes in die Barkly-Oos Distrik
(University of the Free State, 1999-11) Kriel, Helena; Krause, M. W.
Afrikaans: Inleiding en doel van die studie 'n Gedetaileerde opname oor rehabilitasiedienste en -behoeftes van die Drakensberg Streeksdiensteraad in die Barkly-Oos distrik is in 1995 gemaak. Die distrik is 'n tipiese landelike gebied met 22 000 mense. Metodiek Die beskrywende studie het uit twee dele bestaan. Met die eerste deel is bepaal wat die rehabilitasiebehoeftes van persone wat in die studie ingesluit is, was. Eenhonderd-vyf-en-dertighuishoudings is d.m.v. eenvoudige ewekansige steekproeftrekking identifiseer wat deur die navorser en 'n navorsingshulp besoek is. 'n Totaal van 610 persone is in die studie ingesluit. Siftingstoetse is gebruik om enige persoon wat rehabilitasiedienste op die spesifieke tydstip sou benodig, te identifiseer. Die navorser het die persone evalueer om die aard van rehabilitasiedienste te bepaal wat benodig is (fisioterapie, arbeidsterapie, spraakterapie en "ander" wat maatskaplik en sielkundig ingesluit het). Aangesien die navorser 'n fisioterapeut is, kon slegs 'n beraming gemaak word van die ander rehabilitasiedienste as fisioterapie wat benodig is. Slegs die persone wat fisioterapie rehabilitasiedienste benodig het, is verder evalueer om die behoeftes en die spesifieke probleme aangaande rehabilitasie te bepaal, Met die tweede deel van die studie is die beskikbaarheid van rehabilitasiedienste in die area bepaal. Vraelyste oor die aard van rehabilitasie is aan persone gegee wat hulself as betrokke by rehabilitasie beskou het. Resultate Agt-komma-vyf persent van die persone wat nagevors is, is identifiseer wat rehabilitasiedienste sou kon benodig. Vier-komma-drie persent het fisioterapie rehabilitasiedienste benodig. Van dié persone het slegs 42% al vantevore kontak met rehabilitasiedienste gehad. Agt-en-tagtig-en-'n-half persent het die afgelope jaar geen rehabilitasiedienste ontvang nie. Die nie-beskikbaarheid van dienste was die belangrikste rede, asook 'n gebrek aan kennis dat rehabilitasiedienste beskikbaar was. Dertig-komma-agt persent het sentrale senuwee-probleme gehad, met 19.2% ortopediese probleme van die onderste ledemaat. Daar was baie min instellings en persone wat rehabilitasiedienste gelewer het. Dit was hoofsaaklik die verpleegpersoneel van die plaaslike hospitaal en die Streeksdiensteraad wat betrokke was met rehabilitasie. Daar is slegs een fisioterapeut in privaat praktyk en 14 verpleegkundiges, verpleegkunde assistente en lekewerkers identifiseer wat betrokke was met rehabilitasie. Met uitsondering van die fisioterapeut, was die selfaangeduide vlakke van kennis, selfvertroue en ervaring van die persone oor rehabilitasie onvoldoende. Gevolgtrekking Met baie min rehabilitasiedienste wat in die gebied aangebied word, en 4,3% van die persone wat fisioterapie rehabilitasiedienste benodig, kan die gevolgtrekking gemaak word dat daar 'n groot behoefte aan rehabilitasiedienste in die Barkly-Oos distrik is.
Open Access
Fisioterapeutiese behandeling van kroniese hoofpyne in depressiewe pasiënte; 'n vergelyking tussen individuele behandeling en 'n kombinasie van individuele behandeling en kollektiewe behandeling
(University of the Free State, 1999-11) Griessel, M. E.; Krause, M. W.
English: The incidence of depression today is so high, that it is described as "The common cold of mental illness". As Physiotherapist in a private practice, in Bloemfontein, a large part of the researchers daily work consisted of the treatment of chronic headaches in depression patients. The researcher discovered that the intensity of the patients headaches often varied occording to the frame of mind of the patient. The treatment of these headaches included individual physiotherapy that consisted of: spinal mobilization of the effected joints, pressure of the triggerpoints, massage and ultrasound. In this study the above mentioned treatments were compared to a combination of individual and collective treatments. It was determined which type of treatment was most effective in decreasing the total pain pattern (intensity, periodicity, reaction to analgesics) of the headache during treatment as well as one month after the treatment was ended. The study population consisted of patients which were diagnosed with major depression. All the depression patients that attended the two week depression programme in Hospital Park Clinic in Bloemfontein met the criteria to qualify and were referred for physiotherapy were therefore included in the study. So too were all the depression patients that attended the two week depression programme at Universitas Groupcentre in Bloemfontein that met with the necessary criteria and which were referred for physiotherapy included in the study programme. There was a total of fifteen test subjects in the control group and fifteen test subjects in the experimental group. The control group were treated individually and the experimental group received individual physiotherapy as well as collective treatment sessions. Results were obtained through evaluations, re-evaluations as well a re-evaluation that was conducted telephonically with the subjects one month after there discharge from the sentrum or clinic. Special attention was given during evaluations and re-evaluations to the total pain pattern of the test subjects headaches. From the results the observation was made that the control group and the experimental group were very comparitive groups as far as test subjects were concerned, subjective evaluations as well as objective evaluations. The two groups as median of the total pain pattern after the first evaluation were also exactly the same (II out of 15 for both groups). There was no statistical indicative difference with regard to the change of the total pain pattern from treatment to treatment between the two groups. There was a statistical indicative difference between the improvemnt of the total pain pattern from the first evaluation to the re-evaluation after one month. The control group's median of the total pain pattern one month after the treatment was 8 out of 15, while the experimentle group's median was 4 out of 15. The pain pattern of the experimental group was statistically indicative of more improvement than the control group. From this research the conclusion can therefore be made that the results from physiotherapy treatments of chronic headaches in depression patients differ during individual treatments and a combination of individual and collective treatments. A combination of individual and collective treatments deliver better long term results and therefore is the most recommended type of treatment for depression patients with chronic headaches.
Open Access
The development of a framework for the education and training of undergraduate physiotherapy students
(University of the Free State, 2002) Krause, Maria Wichura; Viljoen, M. J.; Nel, M. M.
English: Higher education and health care have undergone profound changes over the past decade, world-wide but particularly in South Africa. Physiotherapy as a profession cannot stand apart from this, and therefore the education and -training of professional physiotherapists need to be taken under scrutiny. The purpose of this research was to develop a framework with a view to making a contribution to physiotherapy education and training and health care. The research comprised a literature survey (examining educational and health requirements, needs and trends), interviews with physiotherapy educators in the United Kingdom, (to investigate aspects of their education and training), and departmental workshops in the Faculty of Health Sciences, University of the Free State (to reflect on and brainstorm the physiotherapy curriculum of the Department of Physiotherapy of this University). The physiotherapy curricula of a number of institutions offering physiotherapy education and training were studied as well. The literature survey paid attention to the transformation of the health care system in South Africa, the transformation of higher education and academic and educational requirements in South Africa, national and international trends in physiotherapy education, and the physiotherapy requirements of the population of South Africa. Based on the results of these exercises, a measuring instrument for the education and training of professional physiotherapists was compiled. The Delphi technique was employed as research method to test the measuring instrument. The Delphi technique is used to gain expert opinions on a matter or research problem. Delphi comprises submitting a questionnaire/research instrument to a panel of experts to elicit opinions and ideas. The instrument is implemented over a number of rounds until an acceptable degree of consensus is reached regarding the questions that were asked. In this study the instrument was converted into a checklist, comprising statements which were to be rated on a 5-point rating scale, and an opportunity for respondents comment on the statements. Seven domain experts were selected as respondents. Two rounds of the Delphi technique were required before acceptable consensus was reached and a final framework for the development of a physiotherapy education and training programme could be compiled. In short this framework comprises a vision and a mission for professional physical therapy, the objectives of physiotherapy education and training and definitions of physiotherapy as a profession and the physiotherapist as a qualified, registered professional health care worker. This is followed by the exit level outcomes of a physiotherapist education and training programme, as well as the specific and critical (non-context specific) outcomes that should be achieved to obtain a qualification. The themes that ought to be covered in order to be able to reach the outcomes are described, as well as requirements for the education and training progress and structure, in which aspects such as teaching and training approaches, student selection, recognition of prior learning, mobility and portability are attended to. This framework, which is the result of an in-depth and comprehensive study of higher education demands and requirements, the history of physiotherapy as health care profession and current needs of and trends in the profession, and the demands and requirements of health care in South Africa with special emphasis on physiotherapy, has the potential to be used over the wide front of physiotherapy education and training. The framework has been designed in a way which will enable institutions offering physiotherapy education and training to use it in developing innovative curricula. Through this a contribution can be made to physiotherapy education and training specifically, but also to health care.
Open Access
Prevelance of neurodevelopmental sequelae in infants who suffered moderate to severe neonatal asphyxia
(University of the Free State, 2005) Smith, Robyn; Kriel, Helena; Van der Vyver, A. E.
Globally four to nine million cases of newborn asphyxia occur each year. Despite major advances in monitoring technology, obstetric care and knowledge of fetal and neonatal pathologies, asphyxia remains a serious condition causing significant mortality and longterm morbidity. More than a million newborns that survive asphyxia at birth develop longlasting problems such as cerebral palsy, speaking, hearing and visual disabilities. The role of the physiotherapist in the follow up, assessment and early intervention of at risk infants is poorly researched and subject to much debate. The aims of the study were two-fold. The primary aim was to determine the proportion of neurodevelopmental sequelae in infants who suffered moderate to severe neonatal asphyxia. The secondary aim was to describe the population regarding maternal, neonatal and referral risk factors associated with asphyxia. This retrospective descriptive study included a study population of all infants diagnosed with grade II or III neonatal asphyxia admitted to the Pelonomi Hospital neonatal unit. All subjects had to have had a physiotherapy neurodevelopmental assessment between the ages of six weeks and twelve months of age. A total of 40 subjects were included in the study. Five subjects were lost to follow up and five did not meet the inclusion criteria. Information contained in the subjects’ medical record and physiotherapy file were used to complete a data form. The Data form contained the neurodevelopmental assessment score (NDS), which served as the objective measure for neurodevelopmental outcome. The NDS for the grade II and grade III subjects showed no statistical difference, whilst there was a tendency towards the grade III’s having a higher score indicating poorer developmental performance. The results indicated that 32% of the subjects presented with neurodevelopmental sequelae following moderate to severe birth asphyxia. In terms of risk factors this study found that hypertensive disease of pregnancy and intrauterine growth restriction were the most prevalent maternal risk factors. Neonatal risks indicated the majority of subjects had low (< 7) Apgar scores at both five and ten minutes of life. Five infants required mechanical ventilation following initial resuscitation. In 41% of the subjects, mothers resided outside of Bloemfontein at the time of the birth, and 37% of the deliveries occurred at a primary health care facility. Of the subjects 62% were delivered vaginally and 38% via caesarian section. In conclusion the study indicates that developmental sequelae are common in this study population. In some cases developmental delays were observed as early as six weeks of age. Neurological impairments however were only observed from nine months of age. It would therefore be suggested that all moderate to severely asphyxiated infants be followed up routinely and assessed by a physiotherapist for developmental problems from six weeks of age and on. A routine assessment by an occupational and speech therapist is also advised.
Open Access
Pelvic organ prolapse and pelvic floor muscle strength
(University of the Free State, 2006) Nieuwoudt, Elizabeth Maria; Cronje, H. S.; Prollius, A.; Krause, M. W.
English: The objective of the study was to research the relationship between pelvic floor muscle strength (PFMS) and pelvic organ prolapse (POP), and to find a threshold of PFMS where POP will manifest itself. A clinical cross-sectional analytic study was indicated. PFMS was tested with digital assessment using the modified Oxford scale and EMG testing with a vaginal electrode. Prolapse was assessed with the Pelvic Organ Prolapse Quantification (POP-Q) terminology. The analysis included 117 women. The correlation (-0.57) of the digital assessment of PFMS with POP is significant (p < 0.0001). 100% of women with grade 0 PFMS had a POP (POP-Q stage I-IV), while only 30% of women with a grade 5 PFMS had a POP of lesser severity (only stage I). Regarding EMG measurement of PFMS, there was a moderately significant correlation (r = -0.62; p < 0,001). However, one of the most interesting findings of the study was a significant correlation (-0.55) between the endurance of the PFM as was measured with EMG and POP (p < 0.0001). Women with either a stage 0 or I POP could hold a PFM contraction at a target set at 50% of the average of their three maximum contractions for a median of 12 seconds, while women with a more severe POP (stage II, III and IV) could hold the contraction for only 1 to 3 seconds. The results confirm clinical observations of the correlation between a weak PFM and a more severe POP. The study demonstrated that the threshold of PFMS where symptomatic POP manifests itself is grade 2 regarding digital testing using a modified Oxford scale (positive predictive value 60%; negative predictive value 85%; accuracy 73%) and 15μV when using EMG-testing (positive predictive value 60%; negative predictive value 68%; accuracy 74%). These results have clinical implications: women with a risk for developing symptomatic POP can be identified earlier and treated conservatively.
Open Access
Classification system for cerebral palsy wheelchair rugby players
(University of the Free State, 2006-05) Malan, Hetta; Grobler, L.; De Man, L.
English: Wheelchair rugby originated in 1977 in Canada, as a sport for athletes with tetraplegia (quadriplegia).The game has grown into an intense physical team sport for both female and male with a variety of disabilities involving all four limbs. Athletes are systematically grouped into sport classes according to their ability to move and perform basic functional skills in their specific sport. This allows for fairness. Cerebral palsy (CP) players joined the wheelchair rugby. Because the CP’s disability lies on a total different level, classifiers find it difficult to classify them correctly. The aim of the study as to explore whether the present classification system disadvantages the CP wheelchair rugby players. An explorative descriptive research design was used. Data was gathered by the use of the nominal group technique. The research took place at the 2005 International Wheelchair Amputee Sport championships in Brazil. Seven specialists in the field of wheelchair rugby participated in the study. The findings of the study and the conclusion reached indicated that there is a definite need for a different and more functional approach to bench testing cerebral palsy wheelchair rugby players. A new bench test format should be developed and could then be suggested to the International Wheelchair Rugby Federation for possible future inclusion in the classification manual.
Open Access
Oefen- en beseringsprofiel van Griffons en Puma rugbyspelers
(University of the Free State, 2011) Du Plessis, Sanell; Janse van Vuuren, Corlia
English: Rugby is a very popular, fast paced, high intensity team sport. The players are permanently in motion and contact with one another, and for this reason the risk of injury is very high. The number of injuries in professional, as well as amateur rugby has dramatically increased since rugby has become a professional sport. The fact that the style of play has also changed to a more running form of rugby also increases the potential of injuries for the players proportionally. Various research studies have been carried out on the epidemiology of rugby injuries at different levels of the game, but limited data exists on the exercise and injury profile of rugby players. This area is the aim of the study. A qualitative, descriptive, retrospective study is performed. The study population exists of the Griffons and Puma rugby players that competed in the 2010 Vodacom and Currie cup competitions in South Africa. Data of the incidence and treatment of injuries, pre-season fitness tests and exercise regimes for each union is included in this study, obtained through either a data vorm or questionnaire. A total of 89 injuries are recorded for 55 players over a period of nine months for February 2010 to October 2010. Physical contact between players caused more than half the injuries. There was a high incidence of lacerations to the head and face, while soft tissue injuries were also prominent. Forwards were injured more frequently than backline players, and the lower limb was the anatomical body part that was injured the most. The majority of injuries occurred during the second half of the match and was very mild to mild. The results of this study correspond greatly to previous literature and are of value in that it adds to the current existing databases of rugby injuries in South Africa. These databases can be well utilized in the structuring of injury prevention strategies by the rugby unions. The research also indicates that physiotherapy and rehabilitation plays aan important role in the treatment of sports injuries.
Open Access
The effect of physiotherapeutic Kinesio taping on selected physical symptoms associated with major depressive disorder
(University of the Free State, 2014-01-24) Erasmus, Karen; Bodenstein, K.; Du Toit, M.
English: Kinesio® taping is a relatively new form of therapeutic taping that has a variety of applications. Physiotherapists can use the tape to treat certain physical symptoms for example, pain, swelling and dysfunctional muscle activation. Major depressive disorder (MDD) is a mood disorder and physical symptoms most associated with MDD, and tested in this study were muscle tension, pain complaints, restricted breathing, less flexibility and centring of movement. The aim of this study was to investigate the effect of physiotherapeutic Kinesio® taping on selected physical symptoms associated with MDD. A double-blind, randomised controlled design was used, following a quantitative study approach. The study population consisted of 40 patients with MDD admitted to a private and public psychiatric institution in Bloemfontein. The majority (77.5%) of participants complained of pain during the study period (24 hours) and 58% complained of multiple areas of pain. The sensory and affective components associated with pain and tested by the Short Form McGill Pain Questionnaire (SF-MPQ) showed improvement in combined scores for both the experimental and placebo groups. The results of the Manual Assessment of Respiratory Motion (MARM) displayed improvement in both the placebo and experimental groups for balance of breathing and percentage ribcage motion. The Tinetti Mobility Test which assesses balance and gait showed no distinct results possibly due to the scale not being sensitive enough for the movement disorders tested Limitations of the study could have influenced the outcomes measured and it should be taken into account that of the 40 participants, 21 received physiotherapy. Other therapies received by participants during the study were not standardised and could not be controlled due to the multitude of stakeholders involved in the care of the patients. The treatment of physical symptoms associated with MDD with Kinesio® taping had mixed results, but Kinesio® taping could be a valuable adjuvant treatment modality. The importance of physiotherapy as part of the treatment regime for patients suffering from MDD was highlighted.
Open Access
The development of a physiotherapy intervention program for closed or open reduction and/or internal fixation of mandibular condyle fractures
(University of the Free State, 2014-09-16) Van der Merwe, Anke; Barnes, R.; Brandt, C.
English: Introduction: The need for physiotherapy intervention in the treatment of mandibular condyle fractures has been highlighted. No unifying criteria are currently available regarding a postsurgical functional exercise program for patients who sustained mandibular condyle fractures. Aim: The research study conducted aimed to perform a needs analysis amongst maxillo-facial surgeons and physiotherapists in South Africa, regarding the perceived need for a postoperative physiotherapy intervention program for patients who sustained mandibular condyle fractures. The study also aimed to develop a post-operative functional exercise program for patients who sustained mandibular condyle fractures. Methodology: The first part of the research comprised of a needs analysis questionnaire, sent out to qualified experts: one physiotherapist and one maxillo-facial surgeon from each of the training institutions in South Africa. The data obtained from the needs analysis questionnaire was used to compile an online questionnaire with statements regarding the type and dosage of a suitable physiotherapeutic treatment protocol. The Delphi method was used, and this questionnaire was sent out to a further 20 experts (national and international) in the fields of physiotherapy, maxillo-facial surgery and dental surgery. A convenience sampling method was used to select appropriately trained participants for the needs analysis and Delphi questionnaire. Results: A definite need for physiotherapy intervention for mandibular condyle fracture patients was proposed by the needs analysis participants (100%). A total of 85.7 % (needs analysis) and 100 % (Delphi questionnaire) of respondents indicated that all mandibular condyle fracture patients should receive in-hospital physiotherapy intervention. By utilising the Delphi method, a suitable physiotherapy intervention program for mandibular condyle fracture patients was developed. Inter-reviewer consensus was reached regarding what each exercise entails, as well as what in-hospital physiotherapy visits should be comprised of. Stability was reached regarding the commencement and dosage of the various jaw exercises. Conclusion: Experts in the field proposed that physiotherapists should provide post-operative rehabilitative therapy to patients who have sustained mandibular condyle fractures. The proposed post-surgical intervention program provided in this study can serve as a baseline for implementation in further research studies. The advantages of referring mandibular condyle fracture patients to physiotherapy were also presented.
Open Access
The effect of a core stability, m. gluteus medius and proprioceptive exercise program on dynamic postural control in netball players
(University of the Free State, 2014-11) Wilson, Marelise; Barnes, R. Y.
English: Dynamic postural control is the ability to perform a functional task with purposeful movements that translates the body’s centre of gravity without compromising a stable base of support. The functional task might involve jumping or hopping to a new location and immediately attempting to remain as still as possible or attempting to create movements such as reaching or throwing without compromising the base of support (Winter, Patla and Frank, 1990; Kahle and Gribble, 2009, Gribble, Hertel and Plisky, 2012). Maintaining dynamic postural control is essential for netball players as netball players frequently find themselves on one leg having to make an accurate pass. Research by Ferreira and Spamer (2010) evaluated the physical profile of elite university netball players and found poor balance in these netball players during pre-season. No literature could be found regarding studies investigating a programme that utilized the combination of core stability, m.gluteus medius (GMed) strengthening and proprioceptive balance exercises on dynamic postural control or studies investigating the effect of an exercise programme on dynamic postural control in netball players. The research study was undertaken to determine if an exercise programme that incorporates core stability, m.GMed strengthening and proprioceptive balance exercises would lead to a significant improvement (p˂0.05) in dynamic postural control in a group of netball players. A cross-over randomised clinical trial was performed. Sixteen female university netball players selected in the top junior group participated in this study. Participants were randomly divided in two groups. Group A participated three times a week for six weeks in the exercise programme while group B was considered as the control group after which the roles were reversed. The simple Star Excursion Balance Test (SEBT) with three trials and four directions were used to measure dynamic postural control of the participants. All participants were assessed at baseline, after six weeks and after 12 weeks. Participants from both groups were tested simultaneously, and the data collector and assistant were blinded to which group the participants belonged. Data were analyzed by a biostatistician using student’s and paired t-tests. Dynamic postural control as measured with the SEBT demonstrated a statistically significant improvement (p<0.05) across three reach directions (anterior, medial and posterior) in a group of netball players post participation in an exercise programme that incorporated core stability, m.GMed strengthening and proprioceptive balance exercises. The study proposes that an exercise programme that incorporates core stability, m.GMed and proprioceptive balance exercises could be beneficial for improving dynamic postural control in a group of netball players. The results of the study provided substantial evidence for the use of a combination of core stability, m.GMed strengthening and proprioceptive balance exercises in programmes rehabilitating netball players with poor dynamic postural control. The present study also provides a baseline for further research whether an exercise programme that incorporated core stability, m.GMed strengthening and proprioceptive balance exercises would contribute towards improved performance and injury prevention in netball players. The effectiveness of the exercise programme described in the present study could be implemented and investigated in other sporting codes requiring dynamic postural control. Netball players can also confidently use the developed exercise programme in the present study to eliminate shortcomings in their physical profile, with regards to dynamic postural control.
Open Access
Invloed van kinesiologie pleister op EMG-aktivering van skapulêre stabiliseerders en balspoed van `n tennisafslaan
(University of the Free State, 2015-02) Van der Lingen, Anna Sophia; Brandt, Corlia
English: Introduction: The effects of Kinesiology Tape on the neuromuscular system have been discussed in recent literature. The effects on power, range of motion, proprioception, and muscle strength can be vital to reach optimal functional performance. There is no research available that studies the effect of Kinesiology Tape on the scapular stabilisers in tennis players. Aim: The aim of the study was to determine if Kinesiology Tape can have i) an effect on the muscle activation of serratus anterior and lower trapezius muscles and ii) the ball speed of the tennis serve. Method: The study was a quantitive analitical case study on 19 male and 11 female (n = 30) tennis players (mean age = 19.83 years). The muscle activation of the serratus anterior and lower trapezius muscles were measured by means of EMG. Ball speed were measured with a Radar Speedgun. The intervention was the application of Kinesiology Tape on the scapular stabilisers. Results: The lower trapezius muscle`s mean highest measurement (p = 0.7143; t = 0.37; df = 29) and maximum measurements (p-value = 0.5376; t-value = -0.62; df = 29) improved, but were not statistical significant. The p-values for the serratus anterior muscles were 0.2181 (highest measurement) (t-values = 1.26; df = 29) and 0.0045 (mean measurement) (t-value = 3.08; df = 29) which are statistical significant. The mean minimum service speed improved after the application of Kinesiology Tape with 3.1 km/h, the mean maximum speed with 1.666 km/h and the mean mean speed with 1.9233 km/h. There was a statistical significant improvement of 1.9233 km/h in the mean serve speed (p = 0.218; t-value = 1.26; df = 29). Discussion and conclusion: It appears that there can be a statistical significant improvement in the mean EMG activity of the serratus anterior muscle after the application of Kinesiology Tape on the scapular stabilisers. No conclusion can be made on the effect the taping has neither on the ball speed of the serve nor on the activation of the lower trapezius muscle. The results are difficult to interpret because of the complex biomechanical interaction of the kinetic chain.
Open Access
Community health workers’ perception, attitudes and practices with regard to their role and interaction with physiotherapists regarding health promotion and prevention of illness
(University of the Free State, 2015-06) Lowe, Zanette; Janse van Vuuren, E. C.; Van Vuuren, S.
Introduction The Department of Health has proposed a new health plan to re-engineer primary health care within South Africa which will shift the focus from hospitalisation towards the treatment of conditions at primary care level in the community (RSA DoH 2011:1). Community health workers (CHWs) will be identified and trained to be involved in the promotion of health and the prevention of illness. In order to achieve these health goals it will be important that the contribution of each team member, including Physiotherapists and the CHWs, is clear and known to the rest of the health care team. Aim The main aim of this study was to determine the perceptions, attitudes and practices of CHWs in the Thabo Mofutsanyane District (Free State) with regard to health promotion and prevention of illness, as well as inter-professional referral or cooperation with physiotherapists related to this. Methodology In realising the main aim of this study, after ethical approval (ECUFS NR 174/20134) data were collected by means of a short demographic questionnaire, as well as focus group interviews. Findings The central perceptions, attitudes and practices of CHWs in this study focused on training, support and support systems as well as service delivery and patient care. CHWs expressed a need for improved and continuous structured training opportunities. These training opportunities could further be enhanced by the establishment of good support structures, and improved interdisciplinary teamwork, which would in return improve service delivery, patient care and ultimately health outcomes. Conclusion and Implementation of findings The findings of this study portrayed some limitations within the CHW-context of the piloted re-engineered primary health care system within South Africa. These findings could assist the DoH of the Free State to improve, amongst others the training and support systems for CHWs within the re-engineered primary health care system.
Open Access
Students’ experiences of interprofessional education in the Faculty of Health Sciences at the University of the Free State
(University of the Free State, 2016) Butler, Michelle; Janse van Vuuren, E. C.; Botma, Y.
English: Background and Aim Interprofessional education (IPE) is widely seen as an important part of any healthcare educational module in order to prepare students for collaborative practice after qualification. Collaborative practice is increasingly seen as important in fragmented healthcare systems typical of developing countries such as South Africa. In a population as diverse as that of South Africa, where 11 official languages exist, good communication and teamwork are paramount to the quality of patient care as well as to patient safety. In an educational setting where healthcare training is profession-specific with few opportunities for interaction between professions, an IPE module allows students to develop the skills necessary for collaborative practice. The aim of this study was to describe the students’ experience of the newly implemented IPE module at the University of the Free State, Bloemfontein, South Africa. Method This descriptive, qualitative inquiry made use of focus groups to gain insight into the students’ experiences of the newly implemented IPE module. Purposive sampling was used to recruit 22 students from various races, genders and language groups within the Faculty of Health Sciences and included medical, occupational therapy, nursing, physiotherapy, optometry and biokinetics students. Five focus groups were held. Focus groups were recorded, transcribed verbatim, checked and coded to identify emerging themes. Findings Four themes emerged from the data, namely learning about, educational aspects, organisation of the IPE module and other benefits. Conclusion The IPE module enhanced knowledge on the scope of profession and leadership. Student assessment, the use of a scenario-based simulation and logistical aspects still need attention, but even so the students experienced the IPE module very positively and found it valuable. Students reported some development of aspects related to collaborative practice, such as clinical communication skills, but identified that implementation of collaborative practice in clinical placements was limited.
Open Access
Carpal tunnel syndrome in physiotherapists in Bloemfontein
(University of the Free State, 2016-01-29) Human, Nadia; Barnes, R. Y.
English: Introduction: Carpal tunnel syndrome (CTS) is the most common compression neuropathy of the upper limb with a 3-5% prevalence among the worldwide general adult population. It is associated with specific personal factors, certain medical conditions, repetitive and forceful hand and wrist movements and occupation. This study aimed at investigating the prevalence of CTS among physiotherapists. Method: The cross-sectional study included 64 participants, chosen by means of convenience sampling from a population of 158 physiotherapists. Demographic data, details of occupational activities; possible personal, medical and occupational causative factors and arm and hand symptoms were gathered by a structured interview. A participant-completed Katz hand diagram was used to clarify information on upper limb symptoms. Typical CTS signs, height and weight were determined by a physical examination. Results: According to the case definition the prevalence of definitive CTS was 7.8% and of probable CTS was 7.8%. Age over 40 years and rheumatoid arthritis as personal or medical history causative factors was statistically significant among the definitive diagnosis group. Overweight showed a tendency towards a definitive CTS diagnosis. Years in practice, hours working overtime and working in the neurosurgery field was occupational causative factors in the definitive CTS diagnosed group. No occupational activities or treatment techniques could be found to be associated with the CTS diagnosis. Longer resting periods between patients was the only statistically significant management strategy among the definitive CTS diagnosed group. Conclusion: Physiotherapy is an at risk occupation for the development of CTS with a prevalence of 15.6% when combining the definitive and probable diagnosis groups, but with no clear occupational activities or treatment techniques as possible risk factors identified.
Open Access
Concussion knowledge among South African rugby players
(University of the Free State, 2016-07) Viljoen, Carel Thomas; Brandt, C.; Schoeman, M.
Background: Concussion is one the most frequently reported injuries among rugby players. Potential dangerous long term side-effects such as neurological deficits and chronic traumatic encephalopathy (CTE), explain why concussion is currently an extensively debated topic in the media. The largest part of South Africa’s rugby playing population consists of amateur players. Anecdotal evidence suggest that only a very limited proportion of amateur clubs and schools offer medical assistance at matches or practices, generally due to a lack of funding. BokSmart currently leans towards educating coaches and referees to recognize concussion signs and symptoms and to remove concussed players from the field. However, in a country where field side medical assistance is scarce, the players themselves can play a pivotal role to report possible concussions to their coach or the referee. Currently, no rugby safety management programme is focussing on concussion education among South African rugby players. Further research on concussion knowledge among rugby players are warranted to generate benchmark data needed to inform development and motivate implementation of educational programmes among rugby players, as an addition to the current BokSmart programme. Aims: To evaluate the knowledge on concussion and attitudes/behaviours regarding concussion and return to play (RTP) among South African amateur high school and club rugby players. Methods: A descriptive, cross-sectional study design was used to achieve the aims. The participants (n = 294) were divided into two groups namely; junior amateur high school (JAHS) (n = 216) and senior amateur club (SAC) (n = 78) rugby players. All participants completed the modified Rosenbaum Concussion Knowledge and Attitudes Survey – Student Version (RoCKAS-ST) in order to evaluate their concussion knowledge and attitudes/behaviours regarding concussion and RTP. Descriptive statistics were used to summarise continuous data with means and standard deviations or medians and percentiles as appropriate. Frequencies and percentages were calculated for categorical data while significance was set at p < 0.05 for comparative analyses. Results: The Concussion Knowledge Index (CKI) mean correct answered questions in the JAHS group was 10.46 ± 2.36 (range 3 – 15) of a maximum score of 17 points. Participants of the JAHS on average identified 62.4% of the CKI questions correctly. The CKI mean correct answered questions in the SAC group was 10.17 ± 2.35 (range 4 – 14) of a maximum score of 17 points. Participants of the SAC group on average identified 60.2% of the CKI questions correctly. On average the JAHS participants identified 66.3% of concussion symptoms correctly, while the SAC participants only identified 62.7% correctly. The Concussion Attitudes Index (CAI) mean correct answered questions in the JAHS group was 56.49 ± 8.81 (range 36 – 75) of a maximum score of 90 points. Participants of the JAHS group had a mean safe response of 65.6% when answering the attitude/behaviour regarding concussion and RTP questions. The CAI mean for correct answered questions in the SAC group was 55.88 ± 11.42 (range 20 – 75) of a maximum score of 90 points. Participants of the SAC group had a mean safe response of 67% when answering the attitude/behaviour regarding concussion questions. No statistical significance were found between the mean concussion knowledge scores (p > 0.37) of the JAHS and SAC participants. A p-value of p > 0.98 was noted, also showing no statistical significance between the JAHS and SAC participants’ mean concussion attitude scores. Conclusion: It was concluded that both junior and senior South African amateur rugby players had insufficient knowledge on concussion. The participants’ lack of concussion knowledge were further emphasised during the poor concussion symptom identification. Both groups showed unsafe attitudes/behaviours towards concussion and RTP.
Open Access
Parity and motor control in female recreational runners
(University of the Free State, 2016-07) Bouwer, Rochelle T.; Brandt, C.; Schoeman, M.
Female recreational runners are more prone to injuries than their male counterparts. Considering the associated risk for sustaining sport-related injuries with impaired core proprioception and the effect pregnancy has on females’ core structures, this study aimed to investigate the trunk motor control in parous and nulligravid female recreational runners. A descriptive cross sectional, case-control study was conducted and 29 female recreational runners were assessed. Eight parous participants were matched with eight participants from the nulligravid group. The matched nulligravid participants were significantly younger [95% CI: - 16 ; - 1] compared to the parous group and no significant difference [95% CI: - 45.9% ; 22.8%] was seen in comparison of sport-related injuries. When testing the muscle activation and endurance of the pelvic floor muscles, the nulligravid group performed better during the surface electromyography test, although no difference was found during the PERFECT test. No statistical significance was found between groups during the surface electromyography test for muscle activity of the Transverse Abdominis muscle [95% CI: - 201.3 ; 504.5], activation of local stabilisers using the pressure biofeedback unit test [95% CI: - 1 ; 1] as well as the Sahrmann test [95% CI: - 2.5 ; 2] to assess global mobility. The parous group tended to perform better during the sport specific plank test, to assess global core muscle function, but in contrast performed weaker in the active straight leg raise test used to assess global stability. During the single leg stand test as well as the unilateral squat (balance and control) no significant difference was found between groups. No significant difference was found between the parous and nulligravid group regarding injuries and only a few tests of trunk motor control showed statistical significant differences between the groups. Due to the small sample size of the matched groups and limited statistical differences that were found conclusive recommendations could not be made. Further research is warranted to investigate motor control in parous athletes.
Open Access
Lower limb muscle fatigue on grass and artificial turf playing surfaces among elite soccer players
(University of the Free State, 2016-07) Greyling, J. A. T.; Brandt, C.; Coetzee, D.
INTRODUCTION: Fatigue and hard playing surfaces have been indicated as risk factors for injury in soccer players. Recent literature, however, has found contradictory results on the prevalence of injuries on different playing surfaces, as well as regarding the interaction between fatigue and the type of playing surface. This raises the question as to the true mechanisms underlying the cause of injury on different playing surfaces. AIM: The aim was therefore to compare lower limb muscle fatigue on grass and artificial surfaces in elite soccer players. METHODS: Twenty two elite soccer players (mean age 24.8 years) were included in a cross-over study design. The players were randomly allocated to two conditions. It involved exposure to the same soccer-specific fatigue protocol on a grass and artificial surface respectively. A force plate was used for pre-test and post-fatigue measurements on force generation, force rates and jump height. The Pearson correlation coefficient was used to determine associations between baseline variables and interpreted by means of effect sizes and p-values. The Wilcoxon signed-ranks test was used to determine statistical significant changes from pre-test to post-test for each condition while the Chi-square test was used to compare the findings between the two conditions. RESULTS: Statistical significant correlations were found at baseline between propulsion and concentric forces (r=0.66, p<0.001); propulsion force and body mass (r=0.78, p<0.001); propulsion force and BMI (r=0.645, p<0.01); landing force and body mass (r=0.82, p<0.001); landing and eccentric forces (r=-0.75, p<0.001); jump height and concentric force (r=0.84, p<0.001); and body mass and concentric force (r=0.76, p<0.05). Propulsion and concentric forces increased statistical significance after fatigue on the grass surface (p=0.026 and 0.005 respectively). On the artificial surface there was a statistical significant increase in propulsion force and propulsion force rate post-fatigue (p=0.0001 and 0.0153 respectively). Comparison of the changes from baseline to fatigue between the two conditions yielded no significant differences (p>0.05). CONCLUSION: Limited significant differences were found comparing forces after fatigue on artificial and grass surfaces. The inconsistency in the behaviour of forces in response to fatigue indicate the possible variability in adaptation strategies to cope with a speculated fatigue state. Surface-specific training could therefore be recommended in order for muscle and sport/surface-specific adaptation to take place, thereby decreasing the risk for injury
Open Access
Lumbo-pelvic core stability: profiles of female long-distance runners
(University of the Free State, 2016-10) Pool, Lindie; Brandt, C.
Running is a sport characterised by a 90% prevalence of predominantly lower-limb overuse injuries. Stress urinary incontinence (SUI) is also prevalent and its hindrance in terms of participation falls within the definition of running injuries. Neuromuscular mechanisms within the proximal kinetic chain have been correlated to these injuries and conditions, however contrasting views exist. Adaptations within the tonic and phasic characteristics of core musculature have been shown to elicit a series of kinetic adaptations within the movement system predisposing injury/recurrence of injury. The aim of this research was to discuss the changes in core muscle characteristics in relation to risk of injury after exposure to a functional activity. Changes were presented by means of profiling. A secondary objective was to identify numerous internal and external risk factors of running-injury. A descriptive, cohort analytical study design was used with a convenience sample of fifteen (15) eligible experienced female long-distance runners registered in Bloemfontein-based accredited running-clubs. The baseline- and post-exercise profiling test battery included electromyography (EMG) of the pelvic floor muscles (PFM) and M. Transversus Abdominus (TrA)(ICC 0.98), pressure biofeedback testing (PBU) (ICC 0.90) and functional endurance testing (ICC 0.97). Any 24+ km functional longrun served as functional task. External, internal and demographic factors were identified using a self-compiled questionnaire. The majority of the TrA EMG, PBU and Dominant-Side lateral muscle group profiles displayed an increase in post-exercise value. The profiles illustrated both failure (decrease in value) and or possible neuromuscular mechanisms (increase in value) attempting to augment stability. These mechanisms are suggestive of a loss of stability on a more central level. The cohort also displayed remarkably low-level integrated stability activity (PBU) both at baseline and post-exercise. There were no statistical significant difference between the baseline and post-exercise profiles for any of the PFM (p=0.7957), TrA (p=0.2769), PBU (p=0.1875), Anterior Muscle Group (p=0.1688), Posterior Muscle Group (p=0.1909), Lateral Dominant Muscle Group (p=0.5897) or Non-Dominant Lateral Muscle Group measurements (p=0.1848). Knee injury was identified as the most prevalent previous running injury (47%). Only 20% of the 67% of participants that included muscle conditioning in training programs included the PFM. Running training errors were the most significant external causative factors present within the cohort together with insufficient periodisation and recovery from longruns. The results of this research support the inclusion of core-stability components in running injury risk management and rehabilitation. The major limitations of this research were the small sample size and absence of a control group. This may be addressed by future research on valid functional core testing. Future research should also establish scientific indicators of fatigue and correlation between corecharacteristics and risk of injury.
Open Access
Symptoms and quality of running experienced by road runners after a hip or knee replacement
(University of the Free State, 2016-12) Du Toit, Ninnette; Barnes, Roline
English: Discussion The literature on the subject shows that return to running after a hip or knee replacement varies from 3.8% to 100%. The research regarding the symptoms patients experience when returning to running after a hip or knee replacement is limited while there is even less research regarding the quality of running when returning after a hip or knee replacement. The purpose of this study is to describe the symptoms and quality of running experienced by road runners after a hip or knee replacement. Several studies have found that the intensity of running and mileage decreased while the frequency and duration of training increased after a hip or knee replacement. Data capturing and analysis Completed questionnaires were printed by the researcher and the data collected was captured on an Excel spread sheet. The Excel sheet was coded according to the responses to ensure that one language and format of capturing was utilised. The data received from the biostatistician were interpreted by the researcher. Results were divided into categories according to the type of surgery received (hip or knee replacement), the BMI and the rehabilitation participants received. Since the data is mostly descriptive, results were presented by means of frequencies and percentages for categorical data, and medians and means for continuous data. Results During this study ten patients were questioned regarding their demographics, symptoms and quality of running after a hip or knee replacement with the use of a questionnaire. The results of this study indicated that running with a replacement is possible, but symptoms such as pain and stiffness are present during and after running. Fifty percent of the participants gave negative feedback regarding running with a hip or knee replacement. Runners experienced a higher intensity of pain while running when compared to walking, though the intensity of pain experienced was less when compared to before the replacement. The level of stiffness experienced was lower after the replacement. Conclusion Running may not be safe in the long term when taking the results in account and is accompanied with discomfort and pain.
Open Access
Return to sport after injury: The relationship between an athlete’s type of motivation and a recurrence of injury
(University of the Free State, 2017-02) Human, Johan; Brandt, C.
Introduction and goal Development of the decision-based return to sport model attempts to address a lack of objective criteria in the literature to determine an athlete’s readiness to return to sport (Creighton, Shrier, Shultz, Meeuwisse and Matheson. 2010). The model reveals motivational factors that may modify complex return to sport decisions, often the responsibility of physiotherapists. An athlete with extrinsic motivation to return to sport may persuade the physiotherapist and/or coach to return to sport too soon which may lead to the athlete being re-injured. The aim of this study was to establish coaches’ expectations from physiotherapists regarding motivational factors for athletes to return to sport, athletes’ type of motivation to return to sport, and a relation to recurrence of injury. Methodology A descriptive and cohort-analytical design were used to collect quantitative data from two populations. Six track and field coaches of elite athletes older than 18 years, participated in structured interviews. The data collected with the structured interviews included the coaches’ expectations and views with regards to physiotherapists’ role in return to sport decisions. Fifteen injured elite athletes, older than 18 years, returning to sport after injury were tested with an adapted revised sport motivation scale to determine their type of motivation to return to sport and follow-up phone calls were used to determine if their return to sport was successful. Results Coaches were of the opinion that their elite athletes often return to sport too soon due to pressure from persons, sponsors or institutions and indicated that a recommendation regarding the type of motivation of an athlete to RTS will be of value. The Kruskal-Wallis test and Wilcoxon two sample test indicated that type of motivation was not found to statistically influence injury recurrence. Summary Although higher scores for extrinsic types of motivation was not found to statistically influence injury recurrence for elite track and field athletes in Bloemfontein, the noted trend of higher scores in these types of motivation needs further investigation on larger populations from different ages and types of sport. Track and field coaches of these athletes were of the opinion that their athletes often return to sport too soon due to motivational factors and did mention that they would value input from physiotherapists regarding motivational factors prevalent in their athletes that may cause further harm. Physiotherapists who cleared an elite athlete for return to sport based on the decision-based return to sport model, could modify their decisions and referral to an appropriate healthcare professional could benefit the athlete with a successful return to sport.