The presence of pain in community-dwelling South African manual wheelchair users with spinal cord injury

BACKGROUND: Pain after spinal cord injury (SCI) is common and is likely to continue throughout life with varying levels of severity. OBJECTIVE: To determine the presence of pain, the sociodemographic and injury profile of community-dwelling manual wheelchair users. METHOD: This quantitative correlational study used a sociodemographic and injury profile sheet and the Douleur Neuropathique 4 Questions (DN4) questionnaire to document demographic, SCI profiles as well as pain characteristics. Pain severity was determined using the Numeric Rating Scale. Data were analysed using the Statistical Package for the Social Sciences (SPSS) v27 at 0.05 level of significance. RESULTS: The pain rate was 104; 85% of 122 participants and mainly in those with complete SCI (77.9%). Neuropathic pain was more common (76; 62.5%) and significantly associated (p < 0.05) with higher pain severity. Pain was mainly in one area of the body (59; 48.4%) but occurring in up to five areas. The most painful area had a mean severity of 6.7/10; was more common in the lower limbs below the injury level (48; 39.4%); and was burning in nature (40; 32.7%). CONCLUSIONS: Pain after SCI is as problematic in the South African context as it is globally. With the rising SCI prevalence in the country, understanding pain and its presentation is important for holistic management of a person with SCI. CLINICAL IMPLICATIONS: In-depth assessment of pain should be conducted and appropriate management interventions for specific pain types be prescribed to effectively reduce pain.The Southern African Spinal Cord Association (SASCA) and the National Research Fund (NRF) Thuthuka grant.http://www.sajp.co.za/index.php/sajpdm2022Physiotherap

Pain medication misuse in the South African spinal cord injury context

Background: Pain after spinal cord injury (SCI) is debilitating and has been reported to be difficult to treat, despite pharmacological interventions. Pain medication misuse (PMM) and associated individual factors among people with spinal cord injury (PWSCI) are scarce. Aim: To determine PMM and the associated factors in PWSCI. Setting: Homes of community-dwelling manual wheelchair users with SCI in South Africa. Methods: Community-dwelling PWSCI (n = 122) were consecutively sampled and the Pain Medication Questionnaire (PMQ) was used to determine PMM. Descriptive statistics, Fisher’s exact test, independent t-tests, and simple linear regression tests were performed using SPSS v27. Testing was conducted at the 0.05 level of significance. Results: Eighty-five per cent of the participants reported the presence of pain and 48.1% of them used pain medication. Forty-four percent of people who used pain medication scored ≥ 30, indicative of serious aberrant drug-taking behaviours. Opioids were mainly used for neuropathic pain and in combination with other types of medications such as anticonvulsants and non-steroidal anti-inflammatories (44.0%). Pain severity and the type of pain medication were found to be predictors of PMM (p  0.01 respectively). Conclusion: Pain relief after SCI remains difficult to achieve, with an evident high risk of PMM, which may lead to long-lasting side effects, dependency, or overdose. Contribution: This study has shown the need for the assessment of the potential risk of dependency before prescribing pain medication, particularly opioids to PWSCI

Development of a pain self-management intervention framework for people with spinal cord injury

DATA AVAILABILITY : The data that support the findings of this study are available from the corresponding author upon reasonable request.BACKGROUND : Pain is the most common reason for medical visits to primary health care practitioners. Pain self-management interventions are encouraged and there is no known self-management intervention framework available that clinicians and people with spinal cord injury (PWSCI) can use to guide treatment selection. AIM : This study aimed to develop a pain self-management intervention framework for PWSCI. SETTING : Online and facilitated in Gauteng, South Africa. METHODS : A three-round modified e-Delphi method was used to reach an 80% consensus among a 21-expert panel. Fifty-nine interventions were distributed via REDCap and a final online audio meeting was held to either include or exclude interventions in the final framework. SPSS v27 was used to analyse descriptive data and content analysis was used for qualitative responses. RESULTS : The final developed pain self-management framework consists of 56 interventions and includes interventions from multiple health professions to encompass medical, psychological, therapeutic and social interventions. Interventions are also specified for nociceptive and/or neuropathic pain and grouped according to the biopsychosocial model. CONCLUSION : The interprofessional framework may be used as a guideline for PWSCI to alleviate pain, as well as assist health professionals in clinical decision-making, by providing them with the freedom to choose acceptable and adequate interventions that may be appropriate to treat the affected individual’s pain. CONTRIBUTION : Pain management is a basic need at the primary healthcare level and PWSCI need access to the broad range of interventions available to manage their pain. The framework highlights the variety of appropriate interventions to guide both health professionals and PWSCI with pain relief options.http://www.phcfm.orgam2024PhysiotherapySDG-03:Good heatlh and well-bein

Management of spinal cord injury-related pain using complementary and alternative medicine : a scoping review protocol

OBJECTIVE : This scoping review will identify complementary and alternative medicine methods used to manage spinal cord injury–related pain. INTRODUCTION : Spinal cord injury–related pain is common, with a third of individuals experiencing severe pain. Conventional interventions are well documented, however, pain relief remains elusive for people with spinal cord injuries. Although complementary and alternative medicine is available to alleviate various health problems, little is known about the complementary and alternative medicine methods used to manage pain in people with spinal cord injuries. INCLUSION CRITERIA : This review will consider all studies on complementary and alternative medicine treatment methods used by adults with spinal cord injury to treat their associated pain. The concept of interest in this study is complementary and alternative medicine. Quantitative, qualitative, and mixed methods studies, text and opinion papers, as well as systematic reviews will be included in this review. METHODS : A three-step search strategy, consisting of an initial limited search, a full search, and a screening of the reference lists of all included articles will be undertaken. Key information sources to be searched include CINAHL, Cochrane Library, JBI Evidence Synthesis, MEDLINE, Scopus, Web of Science, DynaMed, Natural Medicines, HerbMed, Open Dissertations, and OpenGrey. All titles and abstracts of identified citations will be screened and then uploaded to a reference management program. The full text of studies potentially meeting the inclusion criteria will be assessed in detail, and relevant data will be extracted and reported in tabular format, in line with the objectives and scope of the review.The National Research Fund (NRF) Thuthuka grant and partial funding from the Southern African Spinal Cord Association.https://journals.lww.com/jbisrir/pages/default.aspxhj2023Physiotherap

Assessment of scapular position in patients suffering from shoulder dysfunction

Shoulder dysfunction inhibits 80% of competitive swimmers from performing optimally. The most common contributing factor to shoulder dysfunction is an altered scapula position. A standard for the distance between T4 and the medial border of the scapula is lacking. Measurements of the distance between T4 and the root of the scapula were made and the relationship of the distance and the function of trapezius middle fibres at resting length was tested. A Vernier caliper® (ICC 0.94) was used to measure the distance from T4 to the medial border of the scapula. Exercises and stretches to retrain and strengthen the middle fibres of the trapezius specifically were performed twice a week, scheduled around the swimmers’ regular training and strengthening sessions, for six weeks. The results showed that palpation of the scapula to measure the distance between T4 and the spinal root is reliable and valid. A normalisation index should be used to adjust for body build and posture. Furthermore, the distance between the thoracic spine and the scapula did not change, regardless of the statistical improvement in the function of trapezius middle fibres (p < 0.05). The research results are of importance for clinical practice, evaluation and treatment programmes for physiotherapists. The data obtained from this study can serve as a baseline for further studies.http://www.journals.co.za/content/journal/ajpherd1am2017Physiotherap

Epidemiology, clinical characteristics, and risk factors for running-related injuries among South African trail runners

Trail running involves running on varying natural terrains, often including large elevation gains/losses. Trail running has a high risk of injury, and runners often participate in remote regions where medical support is challenging. The aim of this study was to determine the epidemiology, clinical characteristic, and associated injury risk factors among trail runners. A modified Oslo Sports Trauma Research Center Questionnaire for Health Problems (OSTRC-H) was used biweekly to collect running-related injury (RRI) and training history data prospectively, among 152 participants (males n = 120, females n = 32) over 30 weeks. We report an overall injury rate of 19.6 RRIs per 1000 h and an RRI mean prevalence of 12.3%. The leading anatomical site of RRIs was the lower limb (82.9%), affecting the knee (29.8%), shin/lower leg (18.0%), and the foot/toes (13.7%). A history of previous RRI in the past 12 months (p = 0.0032) and having a chronic disease (p = 0.0188) are independent risk factors for RRIs among trail runners. Two in three trail runners sustain an RRI mainly affecting the knee, shin/lower leg, and foot/toes. A history of previous RRI in the past 12 months and a having chronic disease is independently associated with RRI among trail runners. These results could be used to develop future RRI prevention strategies, combined with clinical knowledge and experience.File S1: Online consent form and baseline questionnaire, File S2: Online follow-up questionnaire on the Qualtrics platform, File S3: The frequency of tissue and pathology types of RRIs among trail runners.https://www.mdpi.com/journal/ijerpham2022PhysiotherapySports MedicineStatistic

Epidemiology of injury and illness among trail runners : a systematic review

BACKGROUND : Trail running is characterised by large elevation gains/losses and uneven varying running surfaces. Limited information is available on injury and illness among trail runners to help guide injury and illness prevention strategies. OBJECTIVE : The primary aim of this review was to describe the epidemiology of injury and illness among trail runners. METHODS : Eight electronic databases were systematically searched (MEDLINE Ovid, PubMed, Scopus, SportsDiscus, CINAHL, Health Source: Nursing/Academic, Health Source: Consumer Ed., and Cochrane) from inception to November 2020. The search was conducted according to the PRISMA statement and the study was registered on PROSPERO international prospective register of systematic reviews (CRD42019135933). Full-text English and French studies that investigated injury and/or illness among trail runners participating in training/racing were included. The main outcome measurements included: trail running injury (incidence, prevalence, anatomical site, tissue type, pathology-type/specific diagnosis, severity), and illness (incidence, prevalence, symptoms, specific diagnosis, organ system, severity). The methodological quality of the included studies was assessed using an adapted Downs and Black assessment tool. RESULTS : Sixteen studies with 8644 participants were included. Thirteen studies investigated race-related injury and/or illness and three studies included training-related injuries. The overall incidence range was 1.6–4285.0 injuries per 1000 h of running and 65.0–6676.6 illnesses per 1000 h of running. The foot was the most common anatomical site of trail running injury followed by the knee, lower leg, thigh, and ankle. Skin lacerations/abrasions were the most common injury diagnoses followed by skin blisters, muscle strains, muscle cramping, and ligament sprains. The most common trail running illnesses reported related to the gastro-intestinal tract (GIT), followed by the metabolic, and cardiovascular systems. Symptoms of nausea and vomiting related to GIT distress and dehydration were commonly reported. CONCLUSION : Current trail running literature consists mainly of injury and illness outcomes specifically in relation to single-day race participation events. Limited evidence is available on training-related injury and illness in trail running. Our review showed that injury and illness are common among trail runners, but certain studies included in this review only focused on dermatological injuries (e.g. large number of feet blisters) and GIT symptoms. Specific areas for future research were identified that could improve the management of trail running injury and illness.https://www.springer.com/journal/402792022-02-04hj2021PhysiotherapySports MedicineDepartment of Library Service

Effect of lateral costal breathing dissociation exercises on the position of the scapula in level two up to senior national level swimmers

Swimmers depend on accessory breathing muscles for adequate ventilation. Pectoralis minor is an accessory breathing muscle. The daily repetition of gleno-humeral flexion and medial rotation results in adaptive shortening of Pectoralis, a common phenomenon in competitive swimmers. If Pectoralis minor is shortened the scapula is in an anteriorly tipped position. This anteriorly tipped position will affect scapula kinematics as well as the strength of Pectoralis minor to function as an accessory breathing muscle. One of the risk factors contributing to shoulder dysfunction in competitive swimmers is an altered scapular position. The study aimed to determine if lateral costal breathing dissociation exercises in conjunction with scapular retraining exercises had an effect on the position of the scapula in competitive swimmers. A comparative parallel group longitudinal design was used in this study. During a six week supervised intervention period the intervention group (n=28) and control group (n=30) did retraining of the scapula stabilisers and stretching of Pectoralis minor. The intervention group did breathing dissociation exercises to facilitate lateral costal breathing. No specific breathing exercises were facilitated within the control group. Pectoralis minor length and thoracic expansion had been measured. The function of the scapula stabilisers was evaluated. The resting as well as dynamic scapula positions were evaluated. Evaluations were done at baseline, six weeks and five months post intervention. Treatment groups were compared with respect to change from baseline to six weeks and baseline to five months in PMI, FVC and thoracic expansion utilizing analysis of covariance (ANCOVA) with covariates baseline reading. The intervention group showed an increase in the Pectoralis minor Index (PMI) of 0.5 (left & right) and the control group reflected an increase of 0.5 (left) and 0.7 (right). The intervention group reflected continuous improvement in PMI and the control group showed deterioration. In addition to the PMI upper thoracic, expansion decreased and lower thoracic expansion increased in the intervention group. The control group showed a decrease in upper and lower thoracic expansion. Groups were compared with respect to change from baseline to six weeks and five months respectively for categorical parameters, muscle function and scapula position (resting and dynamic) using Fisher’s exact test. After six weeks the intervention group showed significantly (p<0.04) less winging of the distal third of the scapula on the left side when compared to the control group. After five months the scapula showed significantly less tipping (p<0.02) during gleno-humeral flexion, on the left side. The McNemar test for symmetry had been applied to determine if any within group changes occurred. Within the intervention group ten of the thirteen markers used to determine the resting position of the scapula, reflected significant improvement compared to the six markers in the control group. Only the intervention group reflected remarkable improvement in function of the lower fibres of Trapezius muscle. Serratus anterior and middle fibres of Trapezius muscles showed significance within group improvement in function for both groups. The scapula showed significantly less dysrhythmia within the intervention group on the left and right sides (p< 0.0209) when compared to the control group. After five months the resting scapula position reflected deterioration for both groups. Dysrhythmia and winging of the scapula deteriorated from six weeks to five months for both groups. The muscle function of the lower fibres of Trapezius showed significance within group changes for both groups from six weeks to five months. The ability to contract Serratus anterior and the middle fibres of Trapezius agonistically was maintained from six weeks to five months. However the eccentric control and ability to contract the muscle without fatigue within the Serratus anterior and middle fibres of Trapezius showed deterioration from six weeks to five months for both groups. Conclusion: The increase in PMI and increase in lower thoracic expansion for the intervention group could favour swimmers to breathe more effectively. An increase in Pectoralis minor length resulted in a more posteriorly tipped scapula. This better positioned scapula promotes optimum function of the lower fibres of Trapezius. Contracting from a stable scapula, Pectoralis minor can fulfil its function as an accessory breathing muscle more effectively.Thesis (PhD)--University of Pretoria, 2015.tm2015PhysiotherapyPhDUnrestricte

Pain and its impact on functioning and disability in manual wheelchair users with spinal cord injury: a protocol for a mixed-methods study

INTRODUCTION: Approximately 80% of people with spinal cord injury experience clinically significant chronic pain. Pain (whether musculoskeletal or neuropathic) is consistently rated as one of the most difficult problems to manage and negatively affects the individual’s physical, psychological and social functioning and increases the risk of pain medication misuse and poor mental health. The aim of this study is to therefore determine the presence of pain and its impact on functioning and disability as well as to develop a framework for self-management of pain for South African manual wheelchair users with spinal cord injury. METHODS AND ANALYSIS: Community-dwelling participants with spinal cord injury will be invited to participate in this three-phase study. Phase 1 will use a quantitative, correlational design to determine factors related to pain such as pectoralis minor length, scapular dyskinesis, wheelchair functioning, physical quality of life, community reintegration and pain medication misuse. Demographic determinants of pain such as age, gender, type of occupation, completeness of injury and neurological level of injury will also be investigated. Participants with pain identified in phase 1 will be invited to partake in a qualitative descriptive and contextually designed phase 2 to explore their lived experience of pain through in-depth interviews. The results of phases 1 and 2 will then be used with the assistance from experts to develop a framework for self-management of pain using a modified Delphi study. Data analysis will include descriptive and inferential statistics (quantitative data) and thematic content analysis (qualitative data). ETHICS AND DISSEMINATION: Approval for this study is granted by the Faculty of Health Sciences Research Ethics Committee of the University of the Pretoria (approval number 125/2018). This study is registered with the South African National Health Research Database (reference GP201806005). This study’s findings will be shared in academic conferences and published in scientific peer reviewed journals.The National Research Fund (NRF) Thuthuka grant and partial funding from the Southern African Spinal Cord Association.http://bmjopen.bmj.compm2021Physiotherap

Inter- and intra-rater reliability of a technique assessing the length of the Latissimus Dorsi muscle

Background: Evidence-based practice requires the use of objective, valid and reliable tests for measuring the length of a muscle. Latissimus Dorsi is a muscle which undergoes length changes (loss of extensibility) and this muscle has a functional role in many aspects of sport and rehabilitation. The loss of extensibility may result in a decreased range of motion at the glenohumeral joint leading to dysfunction. Objectives: The aim of this study was to assess the inter-rater and intra-rater reliability of a technique adapted by Comerford and Mottram in 2012 for assessing the length of Latissimus Dorsi (LD) muscle. Method: Fifty-six students from a university’s physiotherapy department participated in this study. Four physiotherapists with clinical experience varying between 10 and 30 years independently performed the test for assessing the length of LD. The test was performed twice by each physiotherapist on every participant during two reading sessions. Results: The intra-class correlation coefficient (ICC) as determined in a mixed-effects, generalised least squares regression analysis was used to assess inter- and intra-rater reliability of the LD length test. A 0.05 level of significance was employed. A sample of 56 participants provided an ICC that varied between 0.76 and 0.55, which is regarded as moderate to poor reliability. The ICC between the experienced raters was found to be 0.48, with a novice rater having an ICC of 0.48 as well. The ICC between all the raters was 0.33, which constituted poor reliability. Conclusion: The poor to moderate reliability of the technique testing the length of LD test is not suitable for application in a research setting. Clinical implications: The small differences noted between Reading 1 and Reading 2 regarding the standard deviation of all the raters combined suggests that the LD length test may still prove to be useful in quantifying dysfunction in a clinical setting