Masters Degrees (Physiotherapy)

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  • ItemOpen Access
    Six week exercise and education programme for weight-bearing joint pain at primary health care facilities
    (University of the Free State, 2021-11) Malebo, Malebo Kopano; Barnes, Roline
    Background: Joint pain is a common cause of functional limitation and increased health expenditure among older people. The ageing population is increasing the prevalence of joint pain and the demand for care. Joint pain is prevalent globally, one in three individuals experience joint pain, and in South Africa, 24.48% of primary health care clinics patients experience joint pain. In adults over 65 years old in a rural context, 29.7% reported experiencing joint pain. Physiotherapists working in a primary health care context are required to treat many patients with joint pain in the absence of clear guidelines. In urban and peri-urban contexts, health education and exercise programmes have been shown to improve pain, quality of life and self-efficacy of individuals with joint pain. The study aimed to determine and compare the impact of six-week education and exercise intervention programme on female patients 50 - 70 years old living with weight-bearing joint pain for three months or longer in the Maluti-a-Phofung health sub-district receiving care at PHC Clinics. Method: A single-blind randomised controlled trial was conducted using convenience sampling. Following baseline measurement, participants were randomised into the intervention, workbook, and usual care groups. Data was collected using interviewer administered outcome measures and physical performance task battery. Demographic data was collected using a self-developed demographics questionnaire. Pain severity and pain interference data were collected using the brief pain Inventory short from. Self-efficacy data was collected using the chronic diseases self-efficacy scale. Quality of life data was collected using the EQ-5D-3L, and physical function data was collected using Physical Performance Task Battery. Data was collected at baseline and six weeks. A self-developed acceptability questionnaire to collect acceptability data for the intervention group was used at six weeks. Results: Forty-seven participants enrolled in the study with a median of three painful joints. The majority of the participants were obese and presented with hypertension. There was no statistically significant difference in the pain severity scores between the groups at baseline or six weeks. There was no statistically significant difference in the pain interference score at baseline, but there was a statistically significant change within the intervention group for pain severity (p=0.00) and workbook group for pain severity (p=0.02). There was a statistically significant change in the pain severity and pain inference score for the intervention and workbook group for change within groups. The was not statistically significant difference in self-efficacy at baseline but there was statistically significant improvement in self-efficacy for the intervention (p=0.02) group and workbook group (p=0.04) at six weeks. The was no statistically significant difference in quality of life at baseline but there was a statically significant change in the quality-of-life (p=0.00) VAS=90 IQR (85-9) perception in the intervention group. There was no statistically significant difference between groups in the physical performance task battery at baseline nor at six weeks but there was a statistically significant improvement in the physical performance task battery within the intervention and workbook groups. There was a statically significant change of the timed-six-minute walk test with an improvement of 66 meters in the intervention group. Conclusion: The impact of the intervention on the intervention group was to decrease pain severity and pain interference, improve quality of life, improve self-efficacy and to improve physical function. In the workbook group the programme improved pain severity and interference, improved self-efficacy, and improved physical function. The six-week intervention can be used to manage joint pain in primary health care clinics and the workbook group should be investigated further but provides a bases for the use of a short formats in remote primary health care clinics.
  • ItemOpen Access
    Knowledge, attitude, beliefs and practices of South African physiotherapists regarding the management of tension-type headaches
    (University of the Free State, 2021-11) Robertson, M. C.; Barnes, R.; Stander, C.
    Background: Tension-type headaches (TTH) are primary headaches that have been indicated by the Global Burden of Disease study as the third most common pain condition worldwide and are more prevalent than migraines. People living with TTH may experience significant decreases in their ability to participate in work, social or leisure activities and housework. Often persons living with TTH are managed by physiotherapists, and therefore physiotherapists should be knowledgeable regarding the therapeutic management of the condition. Currently, there is a paucity of literature in South Africa regarding the knowledge, attitude and beliefs, and practices of South African physiotherapists concerning the management of TTH. Aim of the study: The aim of the study was to explore the knowledge, attitude, beliefs and practices of South African physiotherapists regarding the management of persons living with tension-type headaches. Methodology: A cross-sectional research study was performed using a self-developed questionnaire sent via an electronic survey platform. All ethical considerations were taken into account during this process. Privacy and confidentiality were strictly maintained throughout the research process. Results: One hundred and thirty-four physiotherapists provided electronic consent and completed the questionnaire. The participants were mostly female (89.5%) with a mean age of 36.5 and the median number of years of practice was 13 years. The majority of the participants were working in the private sector and most participants had an interest in Musculoskeletal and Pain management conditions. For the knowledge section, 79 participants (58.96%) obtained a median score of 60%, which indicated that they had average knowledge regarding TTH. The majority of participants enjoyed providing treatment for TTH, favoured the multi-disciplinary team approach and agreed that evidence-based outcome measures should be utilized. In the belief section once again the majority favoured the multi-disciplinary team approach and believed that patients should be provided with alternative pain management strategies. The frequency of treatment varied from one to three times per week in the practice section and the participants preferred a combination of pharmacological and non-pharmacological interventions in the management approach. Discussion and conclusion: This KABP study regarding the management of persons living with TTH among South African physiotherapists demonstrated that the majority of the participants in this study had average knowledge regarding TTH. Many of the participants were not able to identify all of the muscles involved in the symptoms of TTH, which is a concern in the physiotherapy profession since the anatomy of the body is a fundamental part of the understanding of presenting conditions and the development of treatment strategies. Intervention programmes in the form of accredited professional development training to address this shortcoming through online discussions or webinars could be undertaken. This study found that the participants were in favour of a multi-disciplinary team and an evidence-based practice approach in the management of persons living with TTH. It is recommended that further research should be done around this topic within the South African context.
  • ItemOpen Access
    Physical activity, lifestyle habits and general health status of recreational sport participating and non-recreational sport participating males in Kimberley, Northern Cape
    (University of the Free State, 2020-01) Johnson, Shabnam; Janse Van Vuuren, Corlia; Bodenstein, Karen; Smith, Robyn; Nel, Heleen
    Introduction: An individual’s health is based on his or her mental and physical well-being (WHO, 2020a), while general health status may refer to the level of health of an individual as well as the level of health of the general population or an individual (Durstine & Moore, 2003). In line with this, the United Nations (UN) has set 17 sustainable developmental goals for the year 2030 (UN, 2015), which are aimed at encouraging and informing relevant health professionals on how to improve the general health status of the global community (UN, 2015). Goal 3 is specifically aimed at ensuring healthy lives and promoting well-being for all people of all ages, with the main objective being to reduce premature death resulting from non-communicable diseases (i.e. chronic lifestyle diseases (CLD)) (UN, 2015). Good lifestyle habits such as regular physical activity are associated with an improved life expectancy and an improved general health status (Kaptoge et al., 2018). The concept “lifestyle” refers to the way in which an individual lives and copes in his/her physical, psychological, social and economic environments on a day-to-day basis (Trovato, 2012). A healthy lifestyle improves the general health status of an individual by lowering the risk of developing CLD, being or becoming seriously ill or even early mortality (Takashi et al., 2013). Positive lifestyle habits such as regularly eating, and participating in physical activity can improve general health status whereas lifestyle habits such as excessive alcohol consumption, smoking and unhealthy eating are adverse lifestyle habits and can predispose the individual to CLD and poor general health (Borgan et al., 2015). Physical activity is one of the most important contributors to a good general health status. Physical activity is crucial in improving muscular strength and improving aerobic capacity (Garber et al., 2011). There is a decrease in sport participation after leaving school (Bloemhoff, 2010) which is where physical activity guidelines could become even more helpful. According to the American College of Sports Medicine’s (ACSM) recommendations for physical activity, a minimum of 150–300 minutes of moderate-intensity aerobic exercises or 75–150 minutes of vigorous aerobic exercises per week is advised in order to achieve health benefits (Riebe et al., 2018). The more time spent participating in physical activity, the better the health benefits which are achieved. However, Kyu et al. (2016) warn that exceeding the optimal physical activity levels and intensity may cause detrimental effects on the body. In particular, with regard to physical activity prescription, leisure-time physical activity is the most neglected area of physical activity. Recreational sport (as a form of leasuretime physical activity) can lead to increased opportunities to improve health by increasing aerobic capacity and strengthening muscles. It also provides social support and motivation while participating in physical activity which additionally allows for an improved mental state (Moore et al., 2012). Participation in recreational sports creates a sense of belonging, and provides positive and motivating social interaction (Eime et al., 2015). Chen et al. (2017) agreed that recreational sport has physiological and psychological benefits, but found the promotion of recreational sport by health professionals, such as physiotherapists, to be lacking. Recreational cricket is the most structured amateur sport in Kimberley making the inclusion of these players into a research study convenient. Cricket, as a professional or recreational sport, is a technical game and a test of endurance – mentally and physically (Webster, 2017). Physically, cricket improves stamina, endurance (aerobic fitness) and hand-eye coordination as well as perceptual skills. According to Ainsworth et al. (2011), the MET value of cricket was updated to 4.8 METS in 2011 after the previous two versions of the Compendium of Physical Activities listed the MET value as five. Mentally, cricket requires toughness and perseverance as individuals have to endure harsh conditions for long periods at a time, constantly and consistently thinking on their feet to plan and strategies (Filbay et al., 2017). Physiotherapists play an important role in the screening of patients and the prevention of complications from disease by means of health promotion. They also have the knowledge to prescribe exercises and incorporate everyday activities into a treatment programme considering current chronic diseases (O’Donoghue et al., 2012), such as type 2 diabetes, hypertension, increased cholesterol levels and obesity (UN, 2015). Physiotherapists are thus in an ideal position to promote healthy lifestyle habits such as physical activity and, in particular, promote recreational physical activity (Lowe et al., 2016) whilst improving the general health status of individuals and communities (Holm et al., 2015) and supporting the global drive towards better health for all. Aim The primary aim of this research study was to investigate the physical activity levels, lifestyle habits and general health status of recreational sport participating and nonrecreational sport participating adult males in Kimberley, Northern Cape Province, South Africa. Methods: A quantitative research design was used in this case-control study to compare the general health status, lifestyle habits and physical activity levels of recreational sport participating and non-recreational sport participating participants. Participants willing to partake in this study provided written consent before their participation. Data was collected using four self-administered questionnaires: a demographic questionnaire (compiled by the researcher), and three standardised questionnaires, the International Physical Activity Questionnaire (IPAQ), the Belloc and Breslow seven lifestyle habits questionnaire and the SF-36v2 health survey. Results and discussion: A total of 102 participants were included in this study with 51 participants in the recreational sport participating group and 51 in the non-recreational sport participating group. The recreational sport participating group had an overall higher level of physical activity per week compared with the non-recreational sport participating group. These results are in agreement with literature that found that recreational sport participation was a way of increasing physical activity levels and MET-minutes per week and limiting sedentary behaviour which is often associated with sedentary occupational duties (Owen et al., 2010). The majority of participants in both the recreational sport participating and nonrecreational sport participating group presented with moderately healthy lifestyle habits. Recreational sport participation is found to be associated with healthy lifestyle habits (Eime et al., 2015), however, in this research study the same level of lifestyle habits were found in the sport participating and non-recreational sport participating groups. Both groups had a similar number of participants who smoked, but more participants in the non-recreational sport participating group consumed alcohol. This could be as a result of the social or environmental influences as well as the socioeconomic environment (Keates et al., 2017), such as the occupational environment. The self-perceived general health status of both groups were comparable whereas the recreational sport participating group presented with slightly more participants with an improved mental health status. This could be attributed to the evidence that cricket, in particular, requires and improves mental concentration more than other sport types (Webster & Travill, 2018). However, participating in any recreational sport increases the overall level of physical activity of an individual which is associated with an improved mental and physical health status (Eime et al., 2015). Whilst this improved mental and physical functioning in return leads to an improved general health status of the individual (Eime et al., 2015). Conclusion: Participating in recreational sporting activities can increase the level of physical activity in an individual and promote the benefits associated with higher physical activity levels. It is, however, also important to include healthy lifestyle habits in general to optimise these health benefits and improve the general health status of an individual. Physiotherapists can play an important role in elevating physical activity levels and promote healthy lifestyle choices by education and referral to other members of the interprofessional team. Based on physiotherapists’ knowledge of exercise prescription and general health status, recreational sport should be promoted by physiotherapists to improve physical activity levels and general health status of individuals, and more importantly on community level to reach a larger portion of the population. Participation in recreational sport provides mental and physical health benefits, and could play an important role in health promotion and long term disease prevention, as expected through the UN’s sustainable development goals. This study provides important baseline information on physical activity levels, lifestyle habits and general health status of the 25-35-year-old male population in Kimberley, Northern Cape (by including both recreational sport participating and non-recreational sport participating individuals). This baseline information can now be utilised to inform, especially community interventions by physiotherapists, to support the UN’s drive towards ensuring “healthy lives and promote well-being for all at all ages”.
  • ItemOpen Access
    Association between deformity correction and clinical outcome post total knee arthroplasty
    (University of the Free State, 2020-06) Hartzenberg, F.; Van der Merwe, J. F.
    Background: The aim of this study was to establish if the degree of deformity correction during total knee arthroplasty (TKA) has an influence on post-operative patient satisfaction. Patient and methods: This was a retrospective, descriptive analytical study of 180 patients that underwent an elective TKA using computer assisted software. Patients were divided into two groups according to the degree of deformity correction required to obtain a neutral mechanical axis: 3-degrees-andmore or less-than-3-degrees. Knee injury and Osteoarthritis Outcome Scores (KOOS) were collected at the pre-operative, 6 week and 1 year post-operative intervals. The mean KOOS scores were compared at each interval and the difference between mean KOOS scores were compared for the following intervals: pre-operative to 6 weeks postoperative; pre-operative to 1 year postoperative; 6 weeks to 1 year postoperative. Results: The pre-operative mean KOOS scores for the group of patients that required a 3-degree-andmore deformity correction were statistically higher than the group requiring less-than-3-degreedeformity correction. At 6 week and 1 year follow ups there was no statistical difference between the two comparison groups. With respect to mean KOOS score improvement between intervals, the group that required less than 3 degrees of deformity correction showed statistically significant improvement in symptoms for the pre-operative to 1 year follow up period. Conclusion: Results of the study showed that patients requiring a lesser correction of their malalignment do better after TKA.
  • ItemOpen Access
    Risk factors and shoulder dysfunction in elite male fast bowlers in South Africa
    (University of the Free State, 2020-08) Rafferty, Keagan; Barnes, Roline
    Cricket is one of the world’s most popular sports. Cricketers are playing exponentially more matches due to the rise of wealth and opportunity, leaving modern-day fast bowlers at greater risk of injury. The aim of this study was to determine the intrinsic and extrinsic risk factors for shoulder dysfunction among elite male fast bowlers, 18 years and older, in South Africa. This descriptive observational cross-sectional study utilised a non-randomised, convenience sampling method, recruiting 33 elite male South African fast bowlers as study participants. Data collection entailed a modified Kerlan-Jobe Orthopaedic Clinic (KJOC) Shoulder and Elbow questionnaire, which was completed by each participant and an assessment procedure including the measurement of shoulder range of motion and stability, which was conducted by the researcher to determine the intrinsic and extrinsic risk factors for shoulder dysfunction in the participants. Data collection took place at the cricket stadiums which hosted the Knights team during the 2018/2019 domestic cricket season. Twenty-three participants (69.7%) were included in the shoulder dysfunction group and ten participants (30.3%) into the non-shoulder dysfunction group after classification by the researcher. Classification into the two groups were based on information obtained from the questionnaire and assessment procedure and participants meeting the conceptual definition of shoulder dysfunction as stated for this study. Results suggest that 23 (78.3%) participants in the shoulder dysfunction group were playing at franchise level, whereas 7 (70%) participants in the non-shoulder dysfunction group played at a provincial level. A higher chronic (1350) and acute (1175) bowling workload value was found within the non-shoulder dysfunction group, compared to the chronic (900) and acute (320) bowling workload values of 900 and 320 in the shoulder dysfunction group. Fast bowlers should be screened by the team physiotherapist regularly for early detection of risk factors, particularly those playing at a higher level and who have completed more seasons. A greater understanding and awareness of the identified risk factors will improve current fast bowler injury prevention strategies, ultimately improving the quality of cricket.
  • ItemOpen 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.
  • ItemOpen Access
    A study to identify the physiotherapy referral practices of South African medical practitioners in Bloemfontein for musculoskeletal patients
    (University of the Free State, 2017-07) Janse van Rensburg, Alida Maria; Barnes, Roline
    Background. The burden of Musculoskeletal disorders (MSD) are a great concern globally. To address this global problem effective MSD management including appropriate referrals to physiotherapist and other health professionals are essential. Limited knowledge regarding the practices of medical practitioners referrals for patients with MSD exist globally. An improved comprehension of medical practitioner referral practices to physiotherapy are essential because of the growing burden of MSD internationally and the impact on both the patient population and the South African health system. Aim. The aim of this study was to identify the physiotherapy referral practices that South African medical practitioners in Bloemfontein follow, for individuals living with MSD. Method. A mixed methods approach was utilised, implementing a semi structured questionnaire, designed with the assistance of an expert panel. The questionnaire was completed by 49 participants who were given a choice between completing the questions themselves, telephonically or in person. Interviews done telephonically and in person were recorded and open-ended questions were transcribed verbatim. The quantitative data was analysed with the assistance of the Department of Biostatistics at the University of the Free State. The qualitative data was analysed by the researcher. Results. Results showed that medical practitioner musculoskeletal referrals to physiotherapy vary and multifaceted factors have an influence on their referral practices. Medical practitioners tend to be unsure about the specific role physiotherapists play in the management of individuals living with MSD. Medical practitioners gained most of their knowledge regarding physiotherapy during their postgraduate experience. A need for improved relationships and communication between medical practitioners and physiotherapists were evident. Conclusions. All participating medical practitioners had an awareness regarding the physiotherapy profession and involvement in the management of individuals living with MSD. Medical practitioners regularly refer individuals suffering from MSD to physiotherapy, but their referral practices should be enhanced in terms of evidence based practice and the use of specialized physiotherapy services provided by physiotherapists. In order to decrease the burden of MSD awareness should be created and change should be advocated between all medical practitioners and physiotherapists and further research is necessary regarding referral practices of medical practitioners to all members of the inter professional medical team.
  • ItemOpen 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.
  • ItemOpen 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.
  • ItemOpen 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.
  • ItemOpen 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.
  • ItemOpen 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.
  • ItemOpen 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.
  • ItemOpen 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.
  • ItemOpen 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.
  • ItemOpen 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
  • ItemOpen 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.
  • ItemOpen 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.
  • ItemOpen 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.
  • ItemOpen 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.