Physiotherapy

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3D measurement of cervical and thoracic postural dynamism in sitting : a pilot study
(Stellenbosch : Stellenbosch University, 2013-12) Fourie, Sarie Marissa; Louw, Quinette; Van Niekerk, Sjan-Mari; Van der Westhuizen, Gareth; Stellenbosch University. Faculty of Medicine and Health Sciences. Dept. of Interdisciplinary Health Sciences. Physiotherapy.
ENGLISH ABSTRACT: The aim of this study was to improve the measurement of postural dynamism in the sitting position using a three-dimensional (3D) motion analysis system. The primary objective was to describe pilot data for postural dynamism of the cervical and thoracic spines while working at a desktop computer. The secondary objective was to refine the process of posture measurement and analysis by decreasing data processing time. Certain factors in 3D motion analysis can lead to an increase in gaps in data collected during trial capture, which in turn will lead to a longer time of data processing. In the first phase of this study, a number of such factors were identified and altered. A series of pilot studies was performed to test the improvement of data processing time when altering these factors. In the first two pilot studies, camera and tripod positionings were explored and refined, workstation layout and anatomical landmark marker placement were investigated, and optimal capture frequency was established. In both these pilot studies, outcomes were established by means of trial and error by experimenting with a variety of different options for the different outcomes. In the third pilot study, computer software which provides computer tasks for the participant during primary trial capture was tested. Two independent computer users performed all the activities as per software, after which they were required to give oral feedback and suggestions on improvement in terms of user friendliness. The objective of the fourth and final pilot study was to include all of the outcomes from the preceeding pilot studies and attempt a trial run of the actual data collection process. A study participant with no affiliation to the research project was used and a complete trial run was performed after which the measurement process was deemed feasible. In the primary study, 18 student volunteers completed a sequence of computer tasks, including keyboard, mouse and reading activities. Prior to data capture, full range of motion of the thoracic and cervical spines were measured in three dimensions for every participant. Data capture took place for the full duration of performance of all computer activities. Outcome parameters for postural dynamism included true range of motion (degrees), proportional range of motion (percentage) and motion frequency (movement per minute) in all three planes of motion of the cervical and thoracic spines. Typing tasks were associated with biggest movement ranges and motion frequencies. Mouse activity was associated with the most stationary posture, exhibiting the least frequent movement as well as the smallest ranges of motion. The results from this study allow us to better understand the dynamic nature of posture, as well as postural dynamism associated with different computer tasks. This study provides a baseline for future research of 3D motion analysis of the sitting posture. It also marks the need for further research regarding ergonomics, use and potential alternatives in the computer workstation and input devices.
Accuracy of clinical neurological examination in diagnosing lumbo-sacral radiculopathy : a systematic literature review
(BioMed Central, 2017-02-23) Tawa, Nassib; Rhoda, Anthea; Diener, Ina
ENGLISH SUMMARY : Background: Lumbar radiculopathy remains a clinical challenge among primary care clinicians in both assessment and diagnosis. This often leads to misdiagnosis and inappropriate treatment of patients resulting in poor health outcomes, exacerbating this already debilitating condition. This review evaluated 12 primary diagnostic accuracy studies that specifically assessed the performance of various individual and grouped clinical neurological tests in detecting nerve root impingement, as established in the current literature. Methods: Eight electronic data bases were searched for relevant articles from inception until July 2016. All primary diagnostic studies which investigated the accuracy of clinical neurological test (s) in diagnosing lumbar radiculopathy among patients with low back and referred leg symptoms were screened for inclusion. Qualifying studies were retrieved and independently assessed for methodological quality using the ‘Quality Assessment of Diagnostic tests Accuracy Studies’ criteria. Results: A total of 12 studies which investigated standard components of clinical neurological examination of (sensory, motor, tendon reflex and neuro-dynamics) of the lumbo-sacral spine were included. The mean inter-observer agreement on quality assessment by two independent reviewers was fair (k = 0.3 – 0.7). The diagnostic performance of sensory testing using MR imaging as a reference standard demonstrated a sensitivity (confidence interval 95%) 0.61 (0.47-0.73) and a specificity of 0.63 (0.38-0.84). Motor tests sensitivity was poor to moderate, ranging from 0.13 (0.04-0.31) to 0.61 (0.36-0.83). Generally, the diagnostic performance of reflex testing was notably good with specificity ranging from (confidence interval 95%) 0.60 (0.51-0.69) to 0.93 (0.87-0.97) and sensitivity ranging from 0.14 (0.09-0.21) to 0.67 (0.21-0.94). Femoral nerve stretch test had a high sensitivity of (confidence interval 95%) 1.00 (0.40-1.00) and specificity of 0.83 (0.52-0.98) while SLR test recorded a mean sensitivity of 0.84 (0.72-0.92) and specificity of 0.78 (0.67-0.87). Conclusions: There is a scarcity of studies on the diagnostic accuracy of clinical neurological examination testing. Furthermore there seem to be a disconnect among researchers regarding the diagnostic utility of lower limb neurodynamic tests which include the Straight Leg Raise and Femoral Nerve tests for sciatic and femoral nerve respectively. Whether these tests are able to detect the presence of disc herniation and subsequent nerve root compression or hyper-sensitivity of the sacral and femoral plexus due to mechanical irritation still remains debatable.
Achieving universal health coverage for people with stroke in South Africa : protocol for a scoping review
(BMJ Publishing, 2020-10) Van Niekerk, Sjan-Mari; Inglis-Jassiem, Gakeemah; Kamalakannan, Sureshkumar; Fernandes, Silke; Webster, Jayne; English, Rene; Smythe, Tracey; Louw, Q. A.
Introduction Stroke is the second most common cause of death after HIV/AIDS and a significant health burden in South Africa. The extent to which universal health coverage (UHC) is achieved for people with stroke in South Africa is unknown. Therefore, a scoping review to explore the opportunities and challenges within the South African health system to facilitate the achievement of UHC for people with stroke is warranted. Methods and analysis The scoping review will follow the approach recommended by Levac, Colquhoun and O’Brien, which includes five steps: (1) identifying the research question, (2) identifying relevant studies, (3) selecting the studies, (4) charting the data, and (5) collating, summarising and reporting the results. Health Systems Dynamics Framework and WHO Framework on integrated people-centred health services will be used to map, synthesise and analyse data thematically.
The activity and participation profile of persons with traumatic spinal cord injury in the Cape Metropole, Western Cape, South Africa : a prospective, descriptive study
(Stellenbosch : Stellenbosch University, 2012-03) Maclachlan, Mirda; Inglis-Jassiem, Gakeemah; Hillier, Susan; Stellenbosch University. Faculty of Health Sciences. Dept. of Interdisciplinary Health Sciences. Physiotherapy.
ENGLISH ABSTRACT: Background Traumatic spinal cord injury (SCI) remains one of the most serious and devastating injuries often resulting in permanent disability and with life changing implications for the individual and his/her family. Successful reintegration into community life and employment after SCI is considered important goals of rehabilitation as this has been positively associated with quality of life, self esteem and life satisfaction. The International Classification of Functioning, Disability and Health (ICF) allows researchers to identify the impact of environmental factors on functioning and disability. Minimal research, particularly in South Africa, has been done on the impact of the environment on persons living with various health conditions and specifically spinal cord injury. Objectives The main purpose of this study was to describe and compare the level of participation of persons with traumatic SCI at two time points (discharge and six months after discharge) from the inpatient rehabilitation setting and to identify the environmental barriers experienced. Methods A prospective, descriptive study was conducted using consecutive sampling. All patients with traumatic SCI that were discharged from September 1, 2008 from the Western Cape Rehabilitation Centre (WCRC) who were eligible for this study were included. Two questionnaires (one based on the ICF and one purposely-developed) and the International Standards for the Classification of SCI (ISCSCI) were used. Data were analyzed with the statistical software package STATISTICA. Results A person sustaining a traumatic SCI in the Cape Metropolitan area of the Western Cape Province is most likely to be a male, young (20 to 29 years), of the Black or Coloured race and living in the Cape Flats suburbs. More than half of the subjects had a grade eight to ten level of education which together with the lack of employers’ responsibilities towards part-time workers might explain the low percentage (11%) of employment at six months after discharge from the WCRC. Complete paraplegia, occurring mainly in the thoracic cord, was the most common neurological disability found in this study. The most common secondary condition was pain followed by spasticity limiting function. The low incidence of pressure sores and urinary tract infections found in this study contradicts findings of previous studies.The majority of the subjects were discharged to the same house they were living in at the time of their injury. However, due to various architectural barriers, some of them were not able to function independently in their homes. Inaccessibility of public transport, the lack of recreational and sport facilities, lack of social support structures in the community and inadequate financial resources were the main environmental barriers experienced by these individuals. Conclusion The main finding of this study was the low employment rate and the difficulty experienced with reintegration at community level after SCI. The results of this study confirm the significant contribution of environmental factors in participation, especially those of transport and education in return to work. Fourteen years after the publication of the Integrated National Disability Strategy (INDS) White Paper (1997), legislative strategies to ensure that people with disabilities have equal access to social and economic opportunities remain lacking.
The aetiology of upper quadrant musculoskeletal pain in high school learners using desktop computers : a prospective study
(Stellenbosch : Stellenbosch University, 2008-03) Prins, Yolandi; Crous, Lynette; Louw, Quinette; Stellenbosch University. Faculty of Health Sciences. Dept. of Interdisciplinary Health Sciences. Physiotherapy.
The Western Cape Education Department initiated a project that aims to provide all the learners from the province with computer access and to promote computer use in schools. Prolonged sitting in front of computers and psychosocial factors have been associated with musculoskeletal symptoms internationally. However, the impact of computer use on musculoskeletal pain among South African high school learners is yet to be determined. Objective The objective of the study was to determine whether sitting postural alignment and psychosocial factors contribute to the development of upper quadrant musculoskeletal pain in grade ten high school learners working on desktop computers. Study design An observational analytical study was performed on a sample of 104 asymptomatic high school learners. Methodology Six high schools in the Western Cape metropole were randomly selected 322 grade ten learners who are using desktop computers, were screened for upper quadrant musculoskeletal pain. Measurements at baseline were taken of the 104 asymptomatic learners, 49 girls and 55 boys. The sitting postural alignment was measured by using the Portable Posture Analysis Method (PPAM), which measured head tilt; cervical angle; shoulder pro- and retraction angle and thoracic angle in the sagittal plane. Depression and anxiety were described by using the Beck Depression Inventory (BDI) and the Multidimensional Anxiety Scale for Children (MASC) respectively. The exposure to computer use was described in terms of duration and frequency of daily and weekly computer use. At three and six months post baseline, the onset and area of upper quadrant musculoskeletal pain was determined by using the Computer Usage Questionnaire. Results After six months, 27 of the 104 learners developed upper quadrant musculoskeletal pain due to seated or computer-related activities. There was no difference in computer exposure between the learners who developed upper quadrant musculoskeletal pain symptoms and the learners who remained asymptomatic. An extreme cervical angle (<34.75° or >43.95°; OR 2.6; 95% CI: 1.0-6.7) and a combination of extreme cervical and thoracic angle (<63.1° or >71.1°; OR 2.19; 95% CI: 1.0-5.6) were significant postural risk factors for the development of upper quadrant musculoskeletal pain. There was a tendency for boys to be at a greater risk for upper quadrant musculoskeletal pain than the girls (OR 1.94; 95% CI: 0.9-4.9). Weight greater than 54.15kg and a depression score greater than 11 was found to be significantly associated with a poor posture (OR 3.1; 95% CI: 1.0-9.7; OR 1.02; 95% CI: 1.0-1.1). Discussion and conclusion The study concluded that poor posture, relating to extreme cervical and thoracic angles, is a risk factor for the development of upper quadrant musculoskeletal pain in high school learners working on desktop computers. South African boys were at a greater risk of developing upper quadrant musculoskeletal pain than the girls. However the study found no causal relationship between depression, anxiety and upper quadrant musculoskeletal pain among South African high school learners and computer usage.
Analysis of the vertical ground reaction forces in sports participants with adductor-related groin pain : a comparison study
(Stellenbosch : Stellenbosch University, 2016-03) Coetsee, Anica; Brink, Yolandi; Morris, Linzette; Stellenbosch University. Faculty of Medicine and Health Sciences. Dept. of Interdisciplinary Health Sciences. Physiotherapy.
ENGLISH ABSTRACT: Objectives: The objective of this study was to describe the differences in vertical ground reaction forces (VGRF) in male sports participants with adductor-related groin pain, compared to matched asymptomatic controls. Design: A descriptive observational study with cross-sectional time frame was conducted. Setting: Laboratory based setting at the 3D Human Biomechanics Central Analytical Facility were implemented. Participants: A consecutive sample of twenty-six active male sports participants, thirteen subjects with adductor-related groin pain (unilateral and bilateral) and thirteen matched asymptomatic controls were included. Main Outcome Measures: Three outcome measures were used: time to peak landing force, peak landing force and time to lowest vertical position of the pelvis. Results: Greater differences were seen in time to peak landing force and peak landing force in the unilateral pain group versus the matched controls. No statistical or clinical differences were found in either of the three outcome measures (p>0.05) between the subjects and their matched controls. Conclusions: This study demonstrates similar VGRFs between subjects with and without chronic adductor-related groin pain and that changes in VGRF might not result from adductor-related groin pain. Clinically, teaching appropriate landing strategies to decrease VGRF may not be useful in male sports participants with chronic adductor-related groin pain.
Ankle kinematics and ground reaction force during single leg drop landing in sports participants with chronic groin pain
(Stellenbosch : Stellenbosch University, 2014-04) Harwin, Lauren Sandra; Fisher, Dominic; Louw, Quinette; Stellenbosch University. Faculty of Medicine and Health Sciences. Dept. of Interdisciplinary Health Sciences. Physiotherapy.
ENGLISH ABSTRACT: Aims: This study aims to ascertain if there are differences in ankle kinematics and ground reaction force in sports participants with chronic groin pain compared to healthy controls. Methods: A cross sectional descriptive study design was used. Twenty participants - 10 cases with chronic groin pain and 10 healthy controls participated. The 10 cases included participants with unilateral pain (n=7) and bilateral pain (n=3). For analysis, the bilateral pain group was divided into the most and less painful side. The study was conducted at the FNB 3D Motion Analysis Laboratory, Stellenbosch University. Sagittal plane kinematics and VGRF was analysed during a single leg drop landing. Results: The group with unilateral groin pain had a higher peak force compared to the matched side of the controls. The bilateral pain groups had less plantarflexion at foot contact (most affected p=<0.001; least affected p=<0.001) and total range of motion (p=<0.05) compared to the control group. The bilaterally injured groin pain groups demonstrated less peak force when compared to controls. Conclusion: This is the first study to indicate alterations in ankle kinematics and VGRF and that these changes are more apparent in sports participants with bilateral pain. Less range of motion during the landing task illustrated by the bilateral pain group suggests less effective force absorption of the distal segments. In the bilateral groups it suggests that force attenuation may have occurred high up the kinetic chain which may place more strain on the groin. Clinically rehabilitation of the athlete with chronic groin pain should include the distal segments of the lower limb. Further research should be conducted in larger groups.
Approaches toward learning in physiotherapy
(AOSIS Publishing, 2013-11-11) Keiller, L.; Louw, A.
The aim of this study was to investigate the approaches toward learning of undergraduate Physiotherapy students in a PBl module to enhance facilitation of learning at the Stellenbosch University, Division of Physiotherapy in South Africa. This quantitative, descriptive study utilized the revised Two-factor Study Process Questionnaire (r-SPQ-2f) to evaluate the study cohorts’ approaches toward learning in the module. results of the data instruments were analysed statistically and discussed in a descriptive manner. There were a statistically significant greater number of students who adopted a deep approach toward learning at the commencement of the academic year. Students showed a trend toward an increase in their intrinsic interest in the learning material as the module progressed. Students in the Applied Physiotherapy module (ATP) started to shift their focus from a surface learning approach to a deep learning approach. further research is needed to determine the long-term changes in approach toward learning and the possible determinants of these changes. This can be done in conjunction with the implementation of quality assurance mechanisms for learning material and earlier preparation of students for the change in the learning environment.
Are lifestyle cardiovascular disease risk factors associated with pre-hypertension in 15–18 years rural Nigerian youth? : a cross sectional study
(BioMed Central, 2015-11) Odunaiya, N. A.; Louw, Q. A.; Grimmer, K. A.
Background: Cardiovascular disease (CVD) is a public health concern worldwide. Hypertensive heart disease is predominant in Nigeria. To effectively reduce CVD in Nigeria, the prevalence of, and factors associated with, pre-hypertension in Nigerian youth first need to be established. Methods: A locally-validated CVD risk factor survey was completed by 15–18 year olds in a rural setting in south- west Nigeria. Body Mass Index (BMI), waist-hip ratio and systolic and diastolic blood pressure was measured. Putative risk factors were tested in gender-specific hypothesized causal pathways for overweight/obesity, and for pre-hypertension. Results: Of 1079 participants, prevalence of systolic pre-hypertension was 33.2 %, diastolic pre-hypertension prevalence approximated 5 %, and hypertension occurred in less than 10 % sample. There were no gender differences in prevalence of pre- hypertension, and significant predictors of systolic pre-hypertension (high BMI and older age) were identified. Considering high BMI, older age was a risk for both genders, whilst fried food preference was female-only risk, and low breakfast cereal intake was a male-only risk. Conclusion: Rural Nigerian adolescents are at-risk of future CVD because of lifestyle factors, and high prevalence of systolic pre-hypertension. Relevant interventions can now be proposed to reduce BMI and thus ameliorate future rural adult Nigerian CVD.
Assessment for incipient hospital-acquired deconditioning in acute hospital settings : a systematic literature review
(Medical Journals Sweden AB, 2019) Gordon, Susan; Grimmer-Somers, Karen; Barras, Sarah
Objectives: To systematically identify literature reporting on assessment instruments relevant for incipient hospital-acquired deconditioning during acute hospital admissions; evaluate their psychometric properties; and identify individual assessment items to form the basis of a comprehensive acute hospital test battery for hospital-acquired deconditioning. Design and data sources: Systematic evidence scan of MEDLINE, CINAHL, PubMed and Google Scholar from database inception to January 2018. Study selection: Papers reporting psychometric properties of assessment instruments to detect change in body function and structure, relevant to hospital-acquired deconditioning were selected. Included instruments should assess one or more elements of hospital-acquired deconditioning, reflect the short time-frame constraints of acute hospital admissions, and be able to be applied by any healthcare provider. Quality evaluation: Evidence of psychometric properties and utility were assessed using a validated instrument. Data extraction: Hospital-acquired deconditioning assessment items. Results: Eight potentially-relevant instruments were identified, with moderate-to-good validity and utility, but limited evidence of reliability. These instruments reported a total of 53 hospital-acquired deconditioning assessment items. Seventeen items with measurement periods greater than 3 days were excluded. The remaining items measured anthropometrics, gait, balance, mobility, activities of daily living, and skin integrity. Conclusion: These assessment items provide the basis of a multifaceted evidence-based test battery to comprehensively and repeatedly assess acute hospital inpatient function for incipient hospital-acquired deconditioning.
Assessment of functional capacity in low-resource settings – adapted six-minute walk tests
(Stellenbosch : Stellenbosch University, 2021-03) Fell, Brittany L.; Heine, Martin, 1957-; Hanekom, Susan D.; Stellenbosch University. Faculty of Medicine and Health Sciences. Dept. of Health & Rehabilitation Sciences. Physiotherapy.
ENGLISH SUMMARY : Background: Measuring functional capacity is an important assessment tool that aids researchers and clinicians in determining the diagnosis, prognosis, and management of patients in various populations. The gold standard for functional capacity testing is cardiopulmonary exercise testing. However, this test requires specialised equipment and trained staff, and is therefore not readily available in many clinical settings. The 6-minute walk test (6MWT) is used as a validated alternative, requiring minimal resources or training. In 2002 the American Thoracic Society (ATS) published guidelines to standardise the implementation of the test. However, considering several constraints, especially within the context of ow-resource settings (LRS) researchers and clinicians alike have had to adapt the methods used when implementing the test. Using different methods for the same test may limit the interpretation and clinical applications of the test. The aim of this theses is to evaluate the application and protocols used for the 6-minute walk test within LRS. Methods: A scoping review was undertaken to identify published studies that implement adapted protocols when conducting the 6MWT. Additionally, the rationale for these adaptations were investigated. Five electronic databases were accessed and searched from inception to October 2019. Data concerning the study source, participants, reported 6MWT purpose, variations (e.g. course length), 6MWT outcome, and rationale for making protocol adaptations were extracted. The findings in this study were used to inform the development of a cross-sectional study with the aim to determine the agreement between the ATS standard 30m 6MWT pathway, a 10m straight and a 10m figure-ofeight pathway, in patients with non-communicable disease. Results: The search returned 564 records of which 22 studies were included. Studies were predominantly conducted in lower-middle income countries. The most common adaptation made to ATS guidelines was course length, being either shorter or longer than the standard 30 meters. Few studies (n = 8, 36%) provided a rationale for adapting the 6MWT. However, based on these eight studies, space limitations was the most common argument for making adaptations. Subsequently, we recruited 27 patients with one or more non-communicable disease to perform two 6MWTs. Fifteen participants performed both a 30 meter straight and a 10m straight 6MWT and twelve participants performed a 30m straight and a 10mfigure-of-eight 6MWT. Regardless of chosen configuration (10m figure-of-eight versus 10m straight), a shortened 6MWT pathway resulted in a significantly smaller 6-minute walk distance. Moreover, the difference was larger than the reported minimal clinically important difference thereby highlighting the clinical implications of adapting the 6MWT. Conclusion: Strict adherence to the ATS guidelines for conducting the 6MWT is challenging. Common adaptations included a change in course length and/or course configuration (chapter 2), with such adaptations having clinically relevant implications to the outcome of the 6WMT (chapter 3). This provides limitations to the application and interpretation of the test. Researchers and clinicians need to take this into consideration when adapting the protocol used for the 6MWT. Reference equations that take into account the adaptations should be considered. However, accounting for every variation of the test may not be feasible. Alternative tests for functional capacity testing within the context of LRS may be a more practical solution.
Asymmetry in hip, knee and ankle kinematics in cyclists with chronic unilateral patellofemoral pain
(Stellenbosch : Stellenbosch University, 2016-03) Brand, Erika Gertruida; Louw, Q.; Crous, L.; Stellenbosch University. Faculty of Medicine and Health Sciences. Dept. of Interdisciplinary Health Sciences. Physiotherapy.
ENGLISH ABSTRACT: Background: Cycling has grown in popularity over the last number of years and the nature of the sport has led to a high incidence of overuse injuries such as patellofemoral pain (PFP). With patellofemoral pain being multifactorial numerous aspects have been investigated. In an attempt to further investigate contributing factors, asymmetry of joint kinematics in the lower limb has been investigated. Kinematics of the hip, knee and ankle joints in the sagittal, coronal and transverse plane were evaluated. Aim: The aim of this study was to investigate whether asymmetry of hip, knee and ankle kinematics in cyclists could contribute to patellofemoral pain when compared with cyclist without knee pain. Study Design: Descriptive study design was incorporated. Study Setting: This study was conducted at the FNB -3D motion analysis laboratory at the University of Stellenbosch, South Africa. Method: Road cyclists were recruited in South Africa and Namibia. The study sample comprised of seven road cyclists (4 with PFP and 3 without pain) who were evaluated at the FNB Motion Analysis Laboratory at Stellenbosch University. The Vicon Motion Systems (Ltd) (Oxford, UK) was used to capture three-dimensional joint kinematics. Collected data was utilised to draw graphs for visual comparison. Results: In the sagittal plane no asymmetry was noted in the hip and knee movement, but asymmetry was present in the ankle joint. However the asymmetry was present for both asymptomatic and symptomatic groups. In the coronal and transverse plane asymmetry was present in all joints; both the asymptomatic and symptomatic group presented some level of asymmetry. Conclusion: Asymmetry was apparent in the hip, knee and ankle joints in the coronal and the transverse plane, however it is present in the symptomatic as well as in the asymptomatic group and could therefore not be identified as a contributing factor for the development of patellofemoral pain. These findings highlight the fact that PFP is multifactorial and that all possible contributing factors should be kept in mind when evaluating and treating cyclists with PFP.
Balance in recreational/non-professional dancers with snapping hip : a cross-sectional study
(Stellenbosch : Stellenbosch University, 2022-04) Lategan, Roxanne; Brink, Yolandi; Berner, Karina; Stellenbosch University. Faculty of Medicine and Health Sciences. Dept. of Health and Rehabilitation Sciences. Physiotherapy.
ENGLISH SUMMARY: Snapping hip (SH) or coxa sultans is a common condition amongst the dance population. The symptoms are insidious and often ignored until it becomes painful or problematic. Hip muscle weakness is a common characteristic of SH, particularly affecting the gluteus medius muscle. A weak gluteus medius muscle has been linked to poor balance in the healthy population, and balance is a skill dancers need to be proficient in. Furthermore, gluteus medius weakness may relate to the three main predictors of dance-related lower limb injuries (Functional Turnout [FTO], compensated turnout [CTO], and hip external rotation [HER]). To date no studies have been conducted on dynamic balance and associated factors in a group of dancers with SH. A better understanding of factors associated with SH in dancers could suggest potential strategies for screening and rehabilitation to improve performance, quality of life, and mitigate future recurrence of the condition. Aim: This study aimed to describe FTO, CTO, HER range of motion (ROM), hip muscle strength (HER and hip abduction), and dynamic balance in a group of recreational dancers with SH, to describe any differences between the affected and unaffected sides, and to determine whether there were any relationships between the variables. Methodology: A descriptive cross-sectional study was conducted. A questionnaire was filled in by potentially eligible volunteers, to screen for SH and to gather demographic information. Eligible participants were measured for FTO and HER ROM, hip muscle strength tests were conducted with a hand-held dynamometer, and the Y-test for dynamic balance was performed. Descriptive results were presented using means, percentages, standard deviations and 95% confidence intervals. Differences between groups were based on the paired t-test and relationships were calculated using Pearson’s correlation coefficients. A one-way ANOVA test was used to compare four pain categories according to age. The level of significance was set at p<0.05. Results: Twenty-three female participants aged 15-40 years were clinically diagnosed with internal SH. The relationship between HER muscle strength on the affected side and CTO was significant (p=0.013), and moderately positively correlated (r=0.51). Other noteworthy albeit non-significant relationships were hip abduction muscle strength and balance on the unaffected side (r=0.40; p=0.06), hip abduction strength on the unaffected side and CTO (r=0.37; p=0.08), and HER strength and balance on the unaffected side (r=0.37; p=0.08). There were no significant differences between sides (all p>0.05) and pain was not related to age (p= 0.416). Conclusion: Findings did not demonstrate poorer dynamic balance on the affected leg in dancers with SH than in the unaffected leg and were inconclusive in terms of other relationships and comparisons, including a relationship between gluteus medius and dynamic balance. HER muscle strength on the affected side and CTO may however need to be considered as related factors when screening for impairments in dancers with SH. Little knowledge remains regarding SH and dynamic balance in dancers. More studies with larger samples are needed to make more conclusive inferences about these outcomes.
Benefits of curriculum renewal : the Stellenbosch University physiotherapy experience
(Health & Medical Publishing Group, 2014-10) Unger, Marianne; Hanekom, Susan D.
Background. Driven by a changing healthcare environment, the Division of Physiotherapy (Stellenbosch University) reduced core content and adopted a multimodal approach to teaching and learning. The benefits of curriculum renewal, however, are seldom investigated despite ongoing internal appraisal. Evaluation of the BSc Physiotherapy programme was considered incomplete without determining the worth of the programme. Objectives. To determine whether there was a change in students’ perception of the impact of the programme on personal development; and whether the programme prepared them for community service. Methods. A descriptive comparative desktop analysis was conducted in which the data from the Faculty’s Programme Evaluation process were compared between students enrolled in the old curriculum (2006) and students enrolled in the new curriculum (2011) using pooled data and t-tests to compare responses between the two groups. A level of significance was set at p<0.05. Results. A significant increase in scores was noted for various graduate attributes developed as a result of the programme, such as critical thinking, clinical reasoning, communication and sourcing information (p<0.01). Similarly, students scored their perceptions related to programme structure significantly higher (p<0.01). No change was reported regarding students’ ability to maintain a balance between studies and other activities. Scores pertaining to their perception of readiness for community service or professional practice remained the same with both cohorts believing they were well prepared. Conclusion. The renewed format seemed to benefit students greatly in assisting the development of graduate attributes. Students were significantly more satisfied with the structure of the renewed curriculum and – despite extensive changes – the principles-based multimodal approach to teaching and learning was perceived as effective for preparing students for community service. Programmes undertaking curriculum renewal should not only focus on the curriculum content but also develop a variety of learning opportunities to facilitate the development of graduate attributes. The next cycle of evaluation should however reflect on clinical practice.
Biomechanical analysis of specific motor impairments contributing to early functional decline in adults living with HIV-1 infection : a sub-study to the Cape Winelands HAART to HEART (Prevalence)/EndoAfrica study
(Stellenbosch : Stellenbosch University, 2019-04) Berner, Karina; Louw, Q. A.; Morris, L. D.; Baumeister, J.; Stellenbosch University. Faculty of Medicine and Health Sciences. Dept. of Health & Rehabilitation Sciences. Physiotherapy.
ENGLISH SUMMARY : Background: HIV-1 infection has become a chronic condition. Although people living with HIV-1 infection (PLHIV) now have near-normal life expectancies, walking-related impairments remain concerning as they occur early and may lead to falls. A poor understanding remains of how movement patterns are affected due to a lack of biomechanical studies. Three-dimensional (3D) motion analysis can provide insight into movement patterns and assist in identifying a valid performance-based screening test for detecting early motor impairments in PLHIV. Aim: The aim of this research was to investigate gait and balance impairments existing in PLHIV using 3D motion analysis. It further aimed to correlate 3D analysis findings (via a gait summary score), as well as self-reported function and history and fear of falling, to physical performance tests which may be considered in clinical practice to screen for early functional decline in PLHIV. Methods: The research was divided into three parts: Part I presented a systematic review describing objective gait and balance impairments in PLHIV. Results contributed to the theoretical groundwork for study conceptualisation and aided in selecting clinically relevant biomechanical outcomes and performance-based tests. Part II comprised validity and reliability testing of a portable 3D gait analysis (3DGA) system, newly obtained by the motion laboratory, in 16 healthy student volunteers, as well as in eight consecutively recruited PLHIV and eight community-matched seronegative participants (SNP). The studies determined the psychometric properties of specific 3DGA outcomes to aid appropriate data interpretation in the next phase. Part III comprised the main observational study to cross-sectionally describe key biomechanical characteristics in 50 PLHIV relative to 50 community-matched SNP (consecutively sampled). The study was conducted in a clinical setting, and performancebased tests were assessed in addition to the 3D motion analysis. Gait analysis results, fallrelated outcomes and self-reported function were correlated to clinical test performance to identify the most valid performance-based screening test. Main results: The systematic review (Part I) revealed some agreement that PLHIV walk slower and have increased centre of pressure (COP) excursions and postural reflex latencies, particularly under challenging conditions. No included studies used 3DGA. The validity and reliability studies (Part II) demonstrated that, with regular recalibration, the 3DGA system reliably measures gait biomechanics in SNP and PLHIV, except for four discrete angles. The system/model highly compares to the reference model after accounting for modelling differences. The field study (Part III) revealed that the gait of PLHIV (median age: 36.61 years) was significantly slowed and rigid relative to SNP (median age: 31.10 years). This pattern manifested when walking at a usual pace or when performing a dual task. Dual task walking further revealed joint range of motion (ROM) changes at the hip and knee in a distal-to-proximal pattern-shift. PLHIV also demonstrated increased COP excursion in dual task single-leg stance. PLHIV were significantly slower in completing the Five-Times Sit-To-Stand (5STS) Test. Slowed sit-tostand was significantly related to gait rigidity, worse self-reported function, and fear of falling. Conclusion: Relatively young PLHIV present with biomechanical gait and balance impairments that resemble patterns noted in elders, especially under dual task conditions. The 5STS test is recommended as a valid clinical screening test. These findings improve understanding of movement impairments in PLHIV and highlight the need for early screening. Further research is needed to determine whether the 5STS test predicts falls, and whether the impairments noted in PLHIV are reversible. Early identification and rehabilitation can reduce healthcare utilisation needs in PLHIV.
Biomechanical risk factors associated with iliotibial band syndrome in runners : a systematic review
(BioMed Central, 2015-11) Aderem, Jodi; Louw, Quinette A.
Background Iliotibial band syndrome is the second most common running injury. A gradual increase in its occurrence has been noted over the past decade. This may be related to the increasing number of runners worldwide. Since the last systematic review, six additional papers have been published, providing an opportunity for this review to explore the previously identified proximal risk factors in more detail. The aim of this systematic review is thus to provide an up to date quantitative synthesis of the trunk, pelvis and lower limb biomechanical risk factors associated with Iliotibial band syndrome in runners and to provide an algorithm for future research and clinical guidance. Methods An electronic search was conducted of literature published up until April 2015. The critical appraisal tool for quantitative studies was used to evaluate methodological quality of eligible studies. Forest plots displayed biomechanical findings, mean differences and confidence intervals. Level of evidence and clinical impact were evaluated for each risk factor. A meta-analysis was conducted where possible. Result Thirteen studies were included (prospective (n = 1), cross-sectional (n = 12)). Overall the methodological score of the studies was moderate. Female shod runners who went onto developing Iliotibial band syndrome presented with increased peak hip adduction and increased peak knee internal rotation during stance. Female shod runners with Iliotibial band syndrome presented with increased: peak knee internal rotation and peak trunk ipsilateral during stance. Conclusion Findings indicate new quantitative evidence about the biomechanical risk factors associated with Iliotibial band syndrome in runners. Despite these findings, there are a number of limitations to this review including: the limited number of studies, small effect sizes and methodological shortcomings. This review has considered these shortcomings and has summarised the best available evidence to guide clinical decisions and plan future research on Iliotibial band syndrome aetiology and risk.
The biomechanical risk factors associated with preventing and managing iliotibial band syndrome in runners : a systematic review
(Stellenbosch : Stellenbosch University, 2015-04) Aderem, Jodi; Louw, Quinette; Stellenbosch University. Faculty of Health Sciences. Interdisciplinary Health Sciences. Physiotherapy.
ENGLISH ABSTRACT: Introduction: Iliotibial band syndrome (ITBS), an overuse injury, is the second most common running injury and the main cause of lateral knee pain in runners. Due to the increasing number of runners worldwide there has been an increase in its occurrence. Runners with ITBS typically experience symptoms just after heel strike at approximately 20°-30° of knee flexion (impingement zone) during the stance phase of running. A variety of intrinsic and extrinsic risk factors may be responsible for why some runners are more prone to developing symptoms during the impingement zone as opposed to others. Abnormalities in running biomechanics is an intrinsic risk factor which has been most extensively described in literature but little is known about its exact relationship to ITBS. Objectives: The purpose of this systematic review was to provide an up to date evidence synthesis of the biomechanical risk factors associated with ITBS. These risk factors may need to be considered in the prevention or management of ITBS in runners. A clinical algorithm is also presented. Methods: A systematic review with meta-analysis was conducted. An electronic search was performed in PubMed, PEDro, SPORTSDisc and Scopus of literature published up-until May 2014. Cross-sectional and cohort studies were eligible for inclusion if they evaluated the lower limb biomechanics of runners with ITBS or those who went onto developing it. All studies included in the review were methodologically appraised. Evidence was graded according to the level of evidence, consistency of evidence and the clinical impact. Data was described narratively using tables or narrative summaries where appropriate. A meta-analysis was conducted for biomechanical risk factors which were reported in at least two studies, provided that homogeneity in the outcomes and samples were present. Results: A total of 11 studies were included (1 prospective and 10 cross-sectional). Overall the methodological score of the studies was moderate. Increased peak hip adduction and knee internal rotation during the stance phase may predict the development of ITBS in female runners. These biomechanical risk factors may need to be screened for ITBS prevention, despite the evidence base being limited to a single study. Currently there is no conclusive evidence that any of the biomechanical parameters need to be considered when managing runners with ITBS. Stellenbosch University https://scholar.sun.ac.za iii Conclusion: Biomechanical differences may exist between runners with ITBS and those who may develop ITBS compared to healthy runners. Although a large variety of biomechanical risk factors were evaluated, the evidence base for screening or managing these risk factors for runners with ITBS is limited. This is due to a small evidence base, small clinical effect and heterogeneity between study outcomes and findings. Further prospective and cross-sectional research is required to ascertain if abnormalities in running biomechanics may be related to why runners develop ITBS or to ascertain which risk factors may be involved when managing these runners.
Building capacity for development and implementation of clinical practice guidelines
(Health and Medical Publishing Group, 2017) Louw, Q.; Dizon, J. M.; Grimmer, K.; McCaul, M.; Kredo, T.; Young, T.
Robust, reliable and transparent methodologies are necessary to ensure that clinical practice guidelines (CPGs) meet international criteria. In South Africa (SA) and other low- and middle-income countries, upskilling and training of individuals in the processes of CPG development is needed. Since de novo CPG development is time-consuming and expensive, new emerging CPG-development approaches (adopting, contextualising, adapting and updating existing good-quality CPGs) are potentially more appropriate for our context. These emerging CPG-development methods are either not included or sparsely covered in existing training opportunities. The SA Guidelines Excellence (SAGE) team has responded innovatively to the need for CPG training in SA. We have revised an existing SA course and developed an online, open-access CPG-development toolkit. This Guideline Toolkit is a comprehensive guideline resource designed to assist individuals who are interested in knowing how to develop CPGs. Findings from the SAGE project can now be implemented with this innovative CPG training programme. This level of CPG capacity development has the potential to influence CPG knowledge, development, practices and uptake by clinicians, managers, academics and policy-makers around the country.
Building capacity in primary care rehabilitation clinical practice guidelines : a South African initiative
(BioMed Central, 2018-09-29) Louw, Q.; Grimmer, K.; Dizon, J. M; Machingaidze, S.; Parker, H.; Ernstzen, D.
Background: The large number of South Africans with disability who cannot access good quality rehabilitation presents a public health and human rights challenge. A cost-effective, efficient approach is required to address this. Implementation of high-quality, contextually relevant clinical practice guidelines (CPGs) could be a solution; however, this requires significant investment in innovative capacity-building. Methods: A qualitative descriptive national study was conducted to explore the perspectives of South African stakeholders in rehabilitation, regarding CPG capacity-building. Twenty rehabilitation professionals (physiotherapists, occupational therapists, speech language therapists, podiatrists, rehabilitation managers or directors) were interviewed. Transcribed interview data were analysed using a deductive content analysis approach, mapping findings to an international capacity-building framework to produce new knowledge. Results: Capacity-building is required in content, purpose and construction of locally relevant CPGs, as well as personal, workforce and systems capacity. Principles and strategies were derived to underpin implementation of CPGs that are user friendly, context specific, relevant to the needs of end-users, and achievable within available resources. Collaboration, networks and communication are required at national, provincial and regional level, within and between sectors. A central agency for CPG methods, writing, implementation and evaluation is indicated. Conclusion: South African rehabilitation can benefit from a multi-level CPG capacity-building focusing on performance, personal, workforce and systems issues.
Cardiovascular disease risk factors among school attending adolescents in rural Nigeria
(Stellenbosch : Stellenbosch University, 2016-03) Oduniaya, Nse Ayooluwa; Louw, Quinette; Grimmer, Karen; Stellenbosch University. Faculty of Medicine and Health Sciences. Dept. of Interdisciplinary Health Sciences. Physiotherapy.
ENGLISH ABSTRACT: Background: The prevalence of Cardiovascular Disease (CVD) is increasing in Nigeria, particularly hypertensive heart disease among the working class population. Unfortunately, resources for effective management of CVD at acute stage are sparse and expensive for the average Nigerian making preventive measure the best option for Nigeria. CVD risk factors have been identified in adolescents in many countries but information on CVD risk factors among Nigerian adolescents, especially rural adolescents, are sparse. This study aimed to develop culturally appropriate lifestyle CVD risk factors questionnaire for adolescents in Nigeria and to investigate CVD risk factors and its associates among 15-18 years school attending adolescents in rural Nigeria. Methods: The study was conducted in rural south west Nigeria, one of the six geopolitical zones of Nigeria. The people living in this area are Yoruba speaking population of Nigeria. The study was conducted in four phases. Phase 1: development of a composite lifestyle CVD risk factors questionnaire through systematic review, expert panel and target population. Phase 2: Cross cultural validation of composite measure developed to facilitate its use among rural adolescents. Phase 3: Pilot study to assess the logistics of the study and to test the reliability of the newly developed questionnaire. Phase 4: investigation into CVD risk factors among adolescents. CVD risk factors such as smoking, alcohol, Physical inactivity, and poor diet using the newly developed questionnaire were assessed. Blood pressure, BMI and waist hip ratio were also assessed using standardized protocol. Data was analyzed qualitatively and quantitatively. Content validation of the questionnaire was done qualitatively using expert consensus and adolescents’ feedback. Reliability was tested using ICC (Intraclass Correlation), Kappa and paired t test. CVD risk factors data was analyzed descriptively first, then with Pearson correlation and multiple regressions to determine associations among risk factors at 95% confidence interval (0.05 level of significance). Result: European countries showed high prevalence of smoking among adolescents in the systematic review. The prevalence of dyslipidemia ranged from 2.5% of total cholesterol (TC) in rural Iran adolescents to 48.9% high Triglyceride (TG) in rural Mexican adolescents. Overweight and obesity prevalence ranged from 0.6% prevalence in an age (10 y) of a study to 48.7%. Studies from the United States showed a decreasing trend in pre hypertension and hypertension, overweight and obesity. The newly developed composite lifestyle CVD risk factors questionnaire for adolescents had moderate to good reliability. Intraclass correlation (ICC) ranged from 0.3 - 0.7 and 0.3-0.8 in English and Yoruba versions’ subscales respectively. Kappa statistics showed moderate to strong agreement in priority questions in English and Yoruba versions. Investigation into the CVD risk factors showed high prevalence and clustering of CVD risk factors; 7.1% adolescents were smokers, 10.2% drank excessive alcohol, 27.9% had low physical activity level, 59.8% consumed high cholesterol diet, 6.1%, consumed low vegetable 8.1% consume low fruit 65.5% had high salt intake, 33.1% had pre hypertension ( systolic), 5.5% had pre hypertension (diastolic) 3.2% had hypertension (systolic) 0.8% had hypertension (diastolic). Smoking and drinking were significantly higher in males and physical activity was significantly higher in females. Smoking and drinking were significantly associated in both males and females and the odd of drinking and smoking was more elevated in girls. Systolic pre- hypertension was associated with age and high BMI in boys and was associated with only high BMI in girls. Conclusion: Nigerian rural adolescents are at risk of future adult CVD. There is an urgent need to put measures in place to prevent future epidemic of CVD in adulthood. CVD prevention program for boys and girls should be tailored to address gender specific CVD risk factors.

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