Doctoral Degrees (Physiotherapy)

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Browsing Doctoral Degrees (Physiotherapy) by Author "Fisher, Dominic"

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    Sedentariness and back health in Western Cape school learners : a feasibility study
    (Stellenbosch : Stellenbosch University, 2023-03) Fisher, Dominic; Louw, Quinette A.; Cockcroft, John; Stellenbosch University. Faculty of Medicine and Health Sciences. Dept. of Health and Rehabilitation Sciences. Physiotherapy.
    ENGLISH SUMMARY: Introduction: Spinal musculoskeletal conditions and non-communicable cardiometabolic diseases are increasing global health concerns adding to the growing need for rehabilitation services. Sedentary behaviour has been associated with deleterious spinal and cardiometabolic health. School-based interventions aimed at stunting the progression of these conditions from childhood to adulthood by reducing sedentary behaviour have shown promise. Interventions that have shown efficacy in improving spinal health and cardiometabolic outcomes in developed, well-resourced settings cannot be effectively adopted in contexts challenged by socio-cultural, economic, and political factors. Preventative health strategies are favoured in contexts where health burdens are strained by prevalent infectious diseases. Aim: The aim of this project was to develop a contextualised, evidence-based intervention aimed at reducing sedentary behaviour and improve spinal health outcomes in South African school children and assess the feasibility of the intervention. Methodology: A systematic review of classroom-based interventions aimed at reducing sedentary behaviour and improving spinal health was conducted. The efficacy of interventions using objectively measured sedentary behaviour and spinal health outcomes included in the review were tabulated and a meta-analysis of homogenous review outcomes was conducted. Effective intervention strategies were extracted to inform the development of a proposed intervention. A qualitative study of educator’s perspectives of the factors that influence learners’ movement during class time was then conducted. Individual depth interviews with primary school principals and focus group discussions with primary school teachers in the Western Cape were recorded and transcribed. An inductive analysis was used to provide contextual insight of the environment into which the interventions would be implemented. A pragmatic stepped wedge cluster randomized controlled feasibility trial of an intervention aimed at reducing classroom sedentary behaviour and improving spinal health was conducted. The 13-week long intervention comprised a novel, multifunctional sit-stand desk and a playlist of health education and movement videos. Participants’ classroom furniture was replaced with the intervention furniture and teachers were provided with a playlist of health education and movement videos to be played routinely during school hours. Primary, feasibility outcomes were assessed through individual interviews with teachers and focus group discussions with a subsample of learners and researcher monitoring. Secondary, objective study outcomes related to sedentary behaviour and postural dynamism were measured using activPAL sensors and inertial measurement units respectively. Results: Nine sedentary behaviour and three spinal health intervention studies from high income countries were included in the review. A subset of the eight sedentary behaviour intervention studies that reported reduced classroom sitting time reported a significant pooled medium-term effect (P=.03). All the studies that reported a reduction in sitting time incorporated alternative classroom furniture that allowed learners to alternate between sitting and standing. A meta-analysis of the spinal health studies demonstrated significant improvements in spinal behaviour during a functional task. All the spinal health studies incorporated a health education component. Thirteen principal individual depth interviews and 6 teacher focus group discussions were conducted. Educators perceived that learner spent most of their class time sitting. We found that teacher-related factors pertaining to their ability to control the classroom and whether they had attended in-service learning on learners’ movement during class influenced learners’ movement. In addition, structural factors related to classroom size, the number of learners in the class and classroom furniture design also played a role. Educators’ attitude to learners’ movement in class was driven by school culture. Two classrooms were recruited into the feasibility study. Three of the five success indicators of the feasibility set a priori were met by both clusters. These included the delivery of the health education and movement videos, compliance with wearing activPAL sensors and IMUs and the integrity of the sedentary behaviour and postural dynamism data. The withdrawal of one cluster (classroom) from the study after completing the intervention period, but before follow-up measurements were taken meant that the feasibility criterion related to cluster (classroom) retention was not met. A positive trend of reduced sedentary behaviour was found after in the retained cluster. A one-year follow up measurement of sedentary behaviour showed a statistically significant reduction in sitting time (P=.001), increase in standing time (P=.002) compared to baseline measurements. There was also a statistically significant increase in postural dynamism at 13-week follow up as measured by total pause time. Conclusion: The study succeeded in developing a contextualised, evidence-based intervention that showed preliminary effectiveness in reducing classroom sedentary behaviour and improving spinal health. Based on the findings of this study, a pilot trial, incorporating recommendations strategies to improve cluster retention should be conducted in future.