Current knowledge of idiopathic scoliosis among practicing physiotherapists in South Africa

Du Toit, Abraham Coetzee (2020-03)

Thesis (MScPhysio)--Stellenbosch University, 2020.


ENGLISH ABSTRACT : Background: The knowledge of Idiopathic Scoliosis has been assessed in Poland, the United States of America (USA), and the United Kingdom (UK) and all the studies concluded that the knowledge of idiopathic scoliosis (IS) among physiotherapy students is limited with respect to the International Society on Scoliosis Orthopaedic and Rehabilitation Treatment (SOSORT) guidelines. Early recognition and the correct initial management is essential in this progressive disorder, and thus physiotherapists should be aware of the basic criteria involved in the screening, diagnosis, and treatment of IS patients. Aim and Objective: The aim of this project was to ascertain the current level of basic knowledge on Idiopathic Scoliosis (IS) among registered practicing physiotherapists that express an interest in the orthopaedic, muscular, manual and manipulative therapy in South Africa. Furthermore, an objective was to compare the knowledge between the physiotherapists that are registered with the Orthopaedic Manipulative Physiotherapy Group (OMPG) and the physiotherapists that are not registered with this group but who are also interested in orthopaedic, muscular, manual or manipulative therapy. The last objective was to identify any knowledge gaps that exist and the potential for future research studies on IS. Methodology: This was a descriptive study and an online survey was used to collect the data. A previously designed and tested 10-question survey consisted of the majority of the questionnaire. The questions were based on the 2011 SOSORT Guidelines and assessed the following aspects of IS: definition, cause, development, prevalence, diagnosis, treatment, and bracing. The questionnaire also included opinionated questions on the types of physical activity that would be beneficial/harmful to patient’s scoliosis and familiarity with conservative treatment methods for IS. An additional five questions consisted of evidenced based conservative treatment and to ascertain confidence with the assessment, management and education of IS patients. The study was advertised in South African OMPG physiotherapy newsletters with the aim to attract physiotherapists that manage and are interested in the orthopaedic care of patients. The newsletters contained an online link to the information leaflet, consent form, and questionnaire (Appendices A, B, and C). These methods of advertising attracted a diverse group of actively practicing physiotherapy populations of different ages, backgrounds, experiences, with the aim to reduce selection bias and sampling error. Results: Two hundred and twenty-three (223) Physiotherapists spread across the 9 different provinces/regions of South Africa met the inclusion criteria and formed part of the study. One hundred and sixteen (116) of these physiotherapists were members of the OMPG, and the other 107 physiotherapists were not members of the OMPG but expressed an interest in the orthopaedic, muscular, manual or manipulative fields. The analysis showed that 73.5% was able to correctly identify the aetiology of IS and 86% was able to identify when IS is likely to develop. Forty-eight percent (48%) of the physiotherapists correctly identified IS as a three-dimensional deformity, and 41% of the participants incorrectly thought that IS is a lateral curvature of the spine. The participants had a poor understanding of the prevalence, diagnosis, and treatment involved in IS affected clients with only 16%, 17%, and 26% respectively providing the correct responses. Forty-two-point six percent (42.6%) of the physiotherapy group correctly identified when bracing should be recommended for patients with IS. The study further indicated a lack of knowledge regarding the methods of conservative treatment and scoliosis schools available worldwide, with more than 76% of the group not being aware of any of the schools or recognised any treatment methods used for scoliosis rehabilitation. In 85% of the questions, the OMPG group performed better than the non-OMPG group. In 42% of the questions in the survey, the OMPG group achieved a higher than 50% ‘correct’ response rate compared to the non-OMPG group who only managed to achieve a higher than 50% in 28% of the questions. Conclusion: Our findings showed that about one third (33.6%) of the physiotherapists participating in the study could answer more than 50% of these questions correctly and 16.5% could answer 70% of the questions correctly in relation to the widely accepted guidelines on IS management. The findings indicate a lack of knowledge regarding IS patient prevalence, screening, recognition, diagnosis and treatment. The responses and results in the OMPG group were better than the non-OMPG group but still very low especially due to the fact that only 28% of the OMPG group correctly identified the conservative treatment involved with IS. Future research studies should be aimed at identifying the prevalence of IS at a national level in SA. Investigating the content curriculum at under-graduate level in SA, referral strategies for IS patients in SA, and comparing the management of IS in the private and public sectors of SA.

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