Physiotherapy

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Browsing Physiotherapy by browse.metadata.advisor "Berner, Karina"

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    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.
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    Describing the rehabilitation workforce capacity data in the public sector of three rural provinces in South Africa
    (Stellenbosch : Stellenbosch University, 2022-04) Conradie, Thandi; Louw, Quinette; Berner, Karina; Stellenbosch University. Faculty of Medicine and Health Sciences. Dept. of Health and Rehabilitation Sciences. Physiotherapy.
    ENGLISH SUMMARY: Background: Rehabilitation capacity resources are limited or sometimes may be missing completely in low- and middle-income countries. Workforce is intricately linked with all the other health system components and is essential in leadership and governance, management of financial resources and technology, and rehabilitation service delivery. A workforce that is sufficient in number, skills and equitably distributed is vital. The classification of the rehabilitation workforce lacks a common, global definition. A standardised set of descriptors and indicators to describe rehabilitation workforce capacity allows comparison between countries or regions. This rehabilitation workforce data is important to provide a baseline for advocating to improve rehabilitation workforce capacity. Aim: The aim of the study is twofold. Firstly, the aim of the scoping review was to see how rehabilitation workforce capacity data is described and to synthesise the descriptors and indicators used to describe the workforce. Secondly, the aim of the primary study was to describe the rehabilitation workforce in the public sector of South Africa in three rural provinces with respect to number of therapists, distribution by population, type of therapists and qualifications, distribution between rural and urban, salary levels and level of care. Method: The research consisted of a scoping review and a primary study. The scoping review was conducted according to the five-step framework developed by Arksey and O’Malley. The scoping review included primary peer reviewed studies on rehabilitation workforce. Data on the rehabilitation workforce indicators and descriptors were extracted and synthesised. The results were used to describe the primary study workforce data. The primary study was a cross-sectional web-based survey using REDCap. The data was extracted and collated in MS Excel and analysed in SPSS and STATA. Results The findings from the scoping review showed that population adjusted ratios and absolute number of therapists are used to indicate the supply of the rehabilitation workforce. The distribution between urban versus rural and public versus private sectors are used to describe disparities between regions. Age and gender are used to describe the demographics of the rehabilitation workforce. The primary study results indicated that the population adjusted ratios for the rehabilitation workforce are alarmingly low. The number of therapists at primary level are minimal in comparison with secondary hospitals. There is a large disparity between the number of therapists working in rural areas versus the large number who work in urban areas. A third of the rehabilitation workforce rely on community service posts to staff their facilities. Conclusion: Collectively these findings imply that many people depending on the public sector arguably do not have access to rehabilitation services. South Africa will have to invest in strategies to monitor workforce capacity overtime to ensure further declines in the public health sector.
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    Physiotherapists awareness of bone demineralisation and falls risk in people living with HIV and their perceptions about fall risks management
    (Stellenbosch : Stellenbosch University, 2020-03) Charumbira, Maria Yvonne; Louw, Quinette A.; Berner, Karina; Stellenbosch University. Faculty of Medicine and Health Sciences. Dept. of Health & Rehabilitation Sciences. Physiotherapy.
    ENGLISH SUMMARY : Background: Sub-Saharan Africa has the greatest disease burden due to HIV globally. Improved access to better antiretroviral regimens has increased numbers and longevity of people living with HIV (PLWH). However, recent research has indicated a seemingly increased propensity for both falls and accelerated bone loss at younger-than-expected ages in PLWH. The benefits of anti-retroviral drugs may be overshadowed if PLWH suffer from excess morbidity such as falls, fractures and functional impairments. Physiotherapists play a crucial role in optimising function and quality of life of PLWH through prevention of falls and reducing the harm that results. Aim: This research aimed to describe the extent and nature of existing research relating to falls in PLWH and describe the relationship between bone demineralisation and falls in PLWH. It further aimed to explore physiotherapists’ awareness of falls risk and accelerated bone demineralisation in PLWH and their perceptions about current falls prevention in the care of PLWH in selected regions of sub-Saharan Africa. Method: The research consisted of a scoping review and a primary study. The scoping review included peer-reviewed studies (excluding narrative reviews) available in English with any information referring to falls in PLWH. Any data regarding bone demineralisation in these studies were also extracted. The results were used to explain concepts arising from the qualitative study. In the primary study, an interpretative exploratory qualitative research method with a phenomenological approach was employed to explore physiotherapists’ perceptions and experiences regarding bone health and falls in PLWH. In-depth semi-structured telephonic interviews were used to collect data from 21 physiotherapists working in primary HIV care. Transcribed interview data were coded in Atlas.ti.8® and analysed using inductive thematic analysis. Results: The scoping review identified 14 studies on falls in PLWH, with all but one study published in high income countries (HIC). Prevalence of falls in PLWH approximated that of seronegative counterparts, but the studies were mostly in middle-aged to older adults in whom geriatric syndromes may already be prevalent. Considerable agreement existed for risk factors regarding use of medications while evidence regarding functional and cognitive impairments were variable. Few studies compared risk factors for falls in PLWH with those in age and sex-matched seronegative population. There is currently no evidence for interventions to prevent or reduce falls risk in PLWH. The primary study revealed a lack of awareness by physiotherapists of falls risk and bone demineralisation in PLWH. As such, physiotherapists did not link falls or fractures to HIV or antiretroviral therapy (ART) when they did observe such events during their general patient assessments. However, in retrospect, some physiotherapists were able to recognise risk factors linked to falls in those with HIV. Current services for falls prevention as perceived by the physiotherapists were sub-optimal and lacked a patient-centred approach. Conclusion: Physiotherapists may need to be more aware of the potential risk of falls and bone demineralisation in PLWH and routinely assess for these phenomena in both older and younger PLWH. More awareness also needs to be created among other healthcare professionals and PLWH. Meanwhile, research on falls in younger PLWH and in sub-Saharan Africa, where HIV is most prevalent and where more robust clades exist, is needed. Relevant stakeholders including governments and PLWH themselves require concerted efforts in addressing health system challenges affecting the implementation of falls prevention services to PLWH at primary care level.
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    Self-reported function and hip extension gait biomechanics in adults with unilateral trans-femoral amputations using different socket designs in two South African metropoles : a cross-sectional study
    (Stellenbosch : Stellenbosch University, 2024-03) Smit, Elmari; Berner, Karina; Fisher, Dominic; Stellenbosch University. Faculty of Medicine and Health Sciences. Dept. of Health and Rehabilitation Sciences. Physiotherapy.
    ENGLISH SUMMARY: Background: Unilateral trans-femoral (TF) amputation significantly impacts mobility and biomechanics, often leading to secondary complications like lower back pain. In South Africa, Ischial Containment (IC) is the standard prosthetic socket design, but it may restrict hip mobility during gait. The Direct Socket (DS) design is proposed as an alternative, aiming to improve hip mobility and patient satisfaction. However, limited evidence exists on how DS design impacts subjective and objective mobility outcomes for TF amputees. Aim: This study aimed to describe self-reported mobility function and objectively-measured sagittal plane hip extension gait biomechanics based on different prosthetic socket designs (IC and DS) in adults with unilateral TF amputations in Cape Town and Tshwane. Additionally, it aimed to correlate objective and subjective results and compare the groups (intra- and intergroup). Methods: This cross-sectional study, with an analytical component, sampled participants with TF amputations through quota sampling. Participants underwent eligibility screening, including determining K-levels, measurements of hip range of motion (ROM) and dynamometry. Participants completed questionnaires (Walking (WQ35), Climbing Stairs (CSQ15), Rising and Sitting Down (R&SDQ39)) to assess perceived disability. All participants were fitted with a loaner Rheo knee and Vari-Flex foot before optoelectronic motion capture (OMC) gait analysis. OMC outcomes included temporospatial parameters (TSP) and stance phase hip extension kinematics and kinetics. Results from the screening and OMC were correlated with the subjective findings. Statistical significance was considered at 5% and effect sizes (ES) were calculated to evaluate clinical significance. Data were described using medians and interquartile ranges (IQR). Statistical analyses included Wilcoxon signed-rank tests, Mann-Whitney U-tests, Kruskal-Wallis H-tests, and Symmetry Index (SI) calculations. Results: Ten predominantly male adults (median age 54 (IQR 39-57)) participated, with three using IC and seven using DS sockets. Percentage of perceived disability showed a moderate ES (ES = -0.470, p = 0.183) favouring the IC socket design. Gait speed, cadence, stride length, step length and step time did not differ significantly between socket designs. Significant differences in ES were observed for step length and step time (ES = -0.748; p = 0.018) when comparing within the same group SI values showed the IC design to be more symmetrical for all TSP except step time, where DS was more symmetrical. Worse self-reported function was strongly correlated to longer step time (rS = 0.754, p = 0.012), lower cadence, shorter step length from amputated-to-sound limb, and slower average gait speed (range rS = -0.681 to -0.723, all p<0.02). Maximum hip extension for amputated and sound limbs showed moderate and small ES, favouring IC (ESs 0.324 to 0.252, p = 0.383 to 0.517), while hip flexion-to-extension ROM and kinetics showed small effect sizes without statistical significance. Conclusions: No definitive superior socket design emerged. This study highlights the complexity of selecting a prosthetic socket design (IC or DS) for TF amputees, emphasising the need to consider individual patient factors and functional status (K-level). However, due to the small sample size and restricted generalisability, further research with larger cohorts is necessary to validate these findings and provide more robust evidence for clinical decision-making.
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    Towards strengthening of rehabilitation at primary care : exploring the needs and perspectives regarding rehabilitation services in two South African and Zimbabwean settings
    (Stellenbosch : Stellenbosch University, 2024-03) Charumbira, Maria Yvonne; Louw, Quinette; Berner, Karina; Stellenbosch University. Faculty of Medicine and Health Sciences. Dept. of Health and Rehabilitation Sciences. Physiotherapy.
    ENGLISH SUMMARY: Introduction: There is an escalating demand for rehabilitation as a health strategy globally. The growing burden of health-related disability, particularly pronounced in low-and-middle-income countries (such as South Africa and Zimbabwe) will strain the already-compromised health systems. This juxtaposition of growing functioning problems and reportedly poor rehabilitation, notably at primary care, signifies an important gap towards strengthening of rehabilitation services. Detailed contextual information regarding the patients’ rehabilitation needs is required to inform the development of targeted strategies. Aim: The overall aim of the study was to explore the type and impact of functioning problems in adults, the associated rehabilitation service needs, and strategies to strengthen primary care rehabilitation in low-resource contexts. Research setting: The research was conducted across10 systematically selected primary health care facilities in two districts of the Eastern Cape, South Africa (Amathole and Buffalo City), and two districts in Manicaland, Zimbabwe (Mutare Urban and Makoni). Methodology: The research encompassed three interrelated studies: Study 1: A scoping review synthesized the status of peer-reviewed literature on functioning problems linked to health conditions contributing significantly to adult disability in South Africa and Zimbabwe. The problems were mapped to the International Classification of Functioning, Disability and Health framework. A web-based application, Rehab4all, was developed to facilitate this review. Study 2: A qualitative, descriptive study obtained diverse perspectives from 43 purposefully selected adult patients regarding the perceived impact of their functioning problems on their life roles and suggestions on how rehabilitation services can be improved. Study 3: A qualitative, descriptive study gained insights from 37 primary care providers on current rehabilitation service delivery and innovative ways of enhancing primary care rehabilitation. Results: A 130 distinct functioning problems were identified from 282 studies. There was a huge lack of evidence on health-related functioning problems among Zimbabwean adult populations. In South Africa, the top 20 functioning problems, with prevalence ranging from 15 – 70.6%, were predominantly related to mobility, pain, and mental health. The South African and Zimbabwean primary health care facilities were ill-equipped to address the wide array of prevalent functioning problems, as rehabilitation services are inadequate, inappropriate, or absent. A complex network of intertwined factors resulted in sub-optimal provision, access to, and utilization of rehabilitation. These factors included patients’ and providers’ lack of interest, awareness, knowledge, and skills regarding rehabilitation, compounded by lack of resources and high levels of undesirable social determinants of health. To improve the current situation, patients and providers recommended multifactorial strategies including education, skills training, community engagement and financial investment to ensure adequate supplies, infrastructure, and human resource capacity. Conclusion: Patients attending primary health care in South Africa and Zimbabwe have a high but under-recognised need for rehabilitation. The primary health care system falls short in its ability to identify, manage, and support the rehabilitation needs of people with functioning problems. Individuals’ participation in society is further hampered by the lack of development and integration of other government sectors. Achieving transformation in primary care rehabilitation within these countries will require an all- sector and society approach. This involves collaboration and coordination across various sectors and engaging the broader community in rehabilitation service development.