Collaborative capacity development to complement stroke rehabilitation in Africa

This scholarly book focuses on stroke in Africa. Stroke is a leading cause of disability among adults of all ages, contributing significantly to health care costs related to long term implications, particularly if rehabilitation is sub-optimal. Given the burden of stroke in Africa, there is a need for a book that focuses on functioning African stroke survivors and the implications for rehabilitation within the African context. In addition, there is a need to progress with contextualised, person-centred, evidence-based guidance for the rehabilitation of people with stroke in Africa, thereby enabling them to lead socially and economically meaningful lives. The research incorporated in the book used a range of primary and secondary methodological approaches (scoping reviews, systematic reviews, meta-analyses, descriptive studies, surveys, health economics, and clinical practice guideline methodology) to shed new insights into African-centred issues and strategies to optimise function post-stroke

The effect of a targeted functional movement retraining intervention on anterior knee pain and associated biomechanical mechanisms

Thesis (PhD)--Stellenbosch University, 2018.ENGLISH SUMMARY : Background: Anterior knee pain (AKP) frequently affects the knee joint and may limit an individual’s ability to perform common activities of daily living (ADLs). It tends to become chronic, making it difficult to treat as the causes are not well understood. Individualised interventions are recommended due to the large variation of clinical presentations in subjects presenting with AKP. Aims: The main aim of this research is to assess the effect of an individualised functional retraining intervention on kinematic contributing factors, pain, function and self-reported recovery in subjects with AKP. The secondary aims are: • To create an evidence-based checklist to assist with the diagnosis of AKP • To create a decision-making algorithm for treating subjects with AKP based on their kinematic risk factors • To establish the test-retest reliability of lower limb kinematics during gait Summary of methods: Four study phases consisting of five studies with different methods were included in this dissertation. Each phase contributed towards a better understanding of the main theme, i.e. the treatment of biomechanical factors associated with AKP. Phases A and B are preliminary research necessary to aid the conceptualisation of phase D (the main study). Phase A consisted of three studies. Study 1 was a systematic review to create an evidence-based checklist for the clinical diagnosis of AKP. Study 2 was a systematic review on kinematic risk factors for AKP in order to establish which factors clinicians should address first in treatment. Study 3 was a repeatability study to establish the test-retest reliability of our measurement procedures. Phase B was the pilot phase and consisted of one study. Study 4 was a case series to establish the feasibility of our decision-making framework and intervention procedures. Phase C was a planning phase where the preliminary research from previous phases were analysed and necessary changes were made in order to improve the execution of the main intervention component of the thesis (phase D). Phase D was the main intervention study (Study 5). This was a series of n of 1 studies investigating the effect of an individualised functional retraining intervention on kinematic and clinical outcomes in 31 subjects with AKP. Setting: The research was conducted at the Tygerberg CAF Motion Analysis Laboratory and the treatments done at the Tygerberg Physiotherapy Clinic of the University of Stellenbosch in Cape Town, South Africa. Main results: Following a six-week individualised functional retraining intervention, 30 of the 31 subjects (96.8%) demonstrated improved pain levels (NPRS). All 31 participants (100%) demonstrated improved functional scores (AKPS) immediately post intervention. Nineteen of the 31 participants (61.3%) demonstrated a clinically significant improvement in their priority kinematic outcome post intervention. At six-month follow up, 15 participants (48.4%) rated themselves as fully recovered or pain-free on a 7-point Likert scale. Conclusion: An individualised approach to exercise is recommended to improve pain, function, kinematics and self-reported recovery in subjects with AKP as the effects are greater than a standard intervention approach. Clinicians need to be educated on common biomechanical contributing factors and how to tailor treatment accordingly.AFRIKAANSE OPSOMMING : Agtergrond: Anterior kniepyn (AKP) raak dikwels die kniegewrig en kan ’n individu se vermoë beperk om gewone daaglikse aktiwiteite uit te voer. Dit is geneig om tot ’n chroniese toestand te ontwikkel, wat dit moeilik maak om te behandel aangesien die oorsake nie goed verstaan word nie. Pasgemaakte intervensies vir AKP word aanbeveel weens die wye verskeidenheid kliniese vorme waarin dié toestand by subjekte voorkom. Doelwitte: Die hoofdoel van hierdie navorsing is om te bepaal watter uitwerking ’n pasgemaakte funksionele herskolingsintervensie het op bewegingsfaktore, pyn, funksie en selfaangemelde herstel by subjekte met AKP. Die sekondêre doelwitte is: • om ’n bewysgegronde kontrolelys op te stel om AKP te help diagnoseer; • om ’n besluitnemingsalgoritme vir die behandeling van subjekte met AKP te skep wat op hulle bewegingsrisikofaktore berus; en • om die toets-hertoets-betroubaarheid van beweging in die onderste ledemaat in loopgang te bepaal. Samevatting van metodes: Vir hierdie verhandeling is vier studiefases onderneem, wat uit vyf studies met verskillende metodes bestaan het. Elke fase het tot ’n beter begrip van die hooftema bygedra, naamlik die behandeling van die biomeganiese faktore wat met AKP verband hou. Fase A en B was voorlopige navorsing wat nodig was vir die konseptualisasie van fase D (die hoofstudie). Fase A het uit drie studies bestaan. Studie 1 was ’n stelselmatige oorsig om ’n bewysgegronde kontrolelys vir die kliniese diagnose van AKP op te stel. Studie 2 was ’n stelselmatige oorsig van die bewegingsrisikofaktore vir AKP om te bepaal op watter faktore klinici eerste in behandeling behoort te konsentreer. Studie 3 was ’n herhaalbaarheidstudie om die toets-hertoets-betroubaarheid van die meetprosedures vas te stel. Fase B was die proeffase en het uit een studie (Studie 4) bestaan. Studie 4 was ’n gevallereeks om die uitvoerbaarheid van die besluitnemingsraamwerk en intervensieprosedures te bepaal. Fase C was ’n beplanningsfase waarin die voorlopige navorsing van vorige fases ontleed en die nodige veranderinge aangebring is om die uitvoering van die hoofintervensiekomponent van die tesis (fase D) te verbeter. Fase D was die hoofintervensiestudie (Studie 5). Dit het ’n reeks enkelpasiëntproewe behels wat ondersoek ingestel het na die uitwerking van ’n pasgemaakte funksionele herskolingsintervensie op die bewegings- en kliniese uitkomste by 31 subjekte met AKP. Omgewing: Die navorsing is by die Bewegingsontledingslaboratorium van die Tygerbergse Sentrale Analitiese Fasiliteite onderneem, terwyl die behandeling by die Universiteit Stellenbosch se Tygerberg-fisioterapiekliniek in Kaapstad, Suid-Afrika, plaasgevind het. Hoofresultate: Ná ’n ses weke lange pasgemaakte funksionele herskolingsintervensie het 30 van die 31 subjekte (96.8%) ’n verbetering in pynvlakke (NPRS) getoon. Ál 31 deelnemers (100%) het onmiddellik ná die intervensie beter funksionele tellings (AKPS) behaal. Negentien van die 31 deelnemers (61.3%) het na afloop van die intervensie ’n klinies beduidende verbetering in hulle prioriteitsbewegingsuitkoms ervaar. Gedurende ’n nasorgbesoek ses maande later het 15 deelnemers (48.4%) hulleself as ten volle herstel of pynvry op ’n sewepunt-Likertskaal beskryf. Gevolgtrekking: In plaas van ’n standaardintervensiebenadering, word ’n pasgemaakte benadering tot oefening aanbeveel om ’n groter verbetering in pyn, funksie, beweging en selfaangemelde herstel by subjekte met AKP teweeg te bring. Klinici moet opleiding oor die algemene biomeganiese bydraende faktore ontvang, en oor hoe om behandeling dienooreenkomstig aan te pas

The effect of McConnell taping on knee biomechanics : what is the evidence?

Thesis (MScPhysio)--Stellenbosch University, 2015.ENGLISH ABSTRACT: This review aims to present the available evidence for the effect of McConnell taping on knee biomechanics in individuals with Anterior Knee Pain (AKP). Pubmed, Medline, Cinahl, Sportdiscus, Pedro and Science Direct electronic databases were searched from inception until September 2014. Experimental research into knee biomechanical or EMG outcomes of McConnell taping compared to no tape or placebo tape were included. Two reviewers completed the searches, selected the full text articles and assessed the risk of bias of eligible studies. Authors were contacted for missing data. Eight heterogeneous studies with a total sample of 220 were included in this review. All of the studies had a moderate to low risk of bias and compared taping to no tape and/ or placebo tape. Pooling of data was possible for three outcomes; average knee extensor moment, average VMO/VL ratio and average VMO-VL onset timing. None of these outcomes revealed significant differences. The evidence is currently insufficient to justify the routine use of the McConnell Taping technique in the treatment of Anterior Knee Pain. There is a need for more evidence on the aetiological pathways of Anterior knee Pain; level one evidence and studies investigating other potential mechanisms of McConnell taping.AFRIKAANSE OPSOMMING: Die objektief van hierdie resensie was om te bepaal wat die effekte van McConnell Patellar Vasbinding is op knie kinematika, kinetiek en spier aktivering in diegene met Voorafgaande Knie Pyn (VKP). Die navorsers het elektroniese databases soos Pubmed, Medline, Cinahl, Sportdiscus, Pedro en Science Direct, van aanvang tot September 2014, ondersoek. Eksperimenteel studie ontwerpe wat biomeganiese of EMG gevolge van McConnell Vasbinding vergelyk met geen vasbinding of placebo vasbinding, is ingesluit. Twee resente het die ondersoek voltooi, die volle tekse artikels gekies en die partydigheid risiko van die ingeslote studies, geskat. Skrywers is gekontak vir enige verlore data. Agt heterogeen studies uit ‘n totalle monster van 220 is in hierdie resensie ingesluit. Al die studies het ‘n gematigde tot laag risiko vir eensydigheid en vergelyk vasbinding met geen of placebo vasbinding. Data saamvoeging was moontlik vir drie uitslae, naamlik: gemiddelde knie ekstensor moment; gemiddelde VMO/VL ratio en gemiddelde aanval tydmeting. Geen gevolge het veelseggende verskille of afwykings vertoon. Tans is die bewys nie genoegsaam om die routiene gebruik van McConnell Vasbinding tegniek te regverdig nie in die behandeling van VKP. Meer bewyslewering op die etiologiese paaie van VKP; Graad een bewys en studies wat ander moontlike meganisme van Mc Connell Vasbinding ondersoek, is noodsaaklik

The development of an evidence-based clinical checklist for the diagnosis of anterior knee pain

CITATION: Leibbrandt, D. C. & Louw, Q. 2017. The development of an evidence-based clinical checklist for the diagnosis of anterior knee pain. South African Journal of Physiotherapy, 73(1):1-10, doi:10.4102/sajp.v73i1.353.The original publication is available at http://www.sajp.co.zaBackground: Anterior knee pain (AKP) or patellofemoral pain syndrome is common and may limit an individual’s ability to perform common activities of daily living such as stair climbing and prolonged sitting. The diagnosis is difficult as there are multiple definitions for this disorder and there are no accepted criteria for diagnosis. It is therefore most commonly a diagnosis that is made once other pathologies have been excluded. Objectives: The aim of this study was to create an evidence-based checklist for researchers and clinicians to use for the diagnosis of AKP. Methods: A systematic review was conducted in July 2016, and an evidence-based checklist was created based on the subjective and objective findings most commonly used to diagnose AKP. For the subjective factors, two or more of the systematic reviews needed to identify the factor as being important in the diagnosis of AKP. Results: Two systematic reviews, consisting of nine different diagnostic studies, were identified by our search methods. Diagnosis of AKP is based on the area of pain, age, duration of symptoms, common aggravating factors, manual palpation and exclusion of other pathologies. Of the functional tests, squatting demonstrated the highest sensitivity. Other useful tests include pain during stair climbing and prolonged sitting. The cluster of two out of three positive tests for squatting, isometric quadriceps contraction and palpation of the patella borders and the patella tilt test were also recommended as useful tests to include in the clinical assessment. Conclusion: A diagnostic checklist is useful as it provides a structured method for diagnosing AKP in a clinical setting. Research is needed to establish the causes of AKP as it is difficult to diagnose a condition with unknown aetiology.https://sajp.co.za/index.php/sajp/article/view/353Publisher's versio

Patients’ perceptions of recovery following a 6-week exercise intervention for the treatment of patellofemoral pain : a mixed methods study

CITATION: Leibbrandt, D. C. & Louw, Q. A. 2019. Patients’ perceptions of recovery following a 6-week exercise intervention for the treatment of patellofemoral pain : a mixed methods study. South African Journal of Physiotherapy, 75(1):a684, doi:10.4102/sajp.v75i1.684.The original publication is available at http://www.sajp.co.zaBackground: Patellofemoral pain (PFP) is a common and complex condition. The diagnosis and causal mechanisms are not well understood and therefore the long-term prognosis tends to be poor. Exercise is currently the only evidence-based treatment strategy suggested to improve pain and function in the long term. However, no qualitative studies have been conducted to establish patients’ perceptions of recovery in the long term following an exercise intervention. Objectives: To measure self-reported recovery on a 7-point Likert scale in 31 participants with PFP 6 months after a 6-week physiotherapy intervention. To explore the subjective accounts of patients who received a physiotherapy intervention for PFP, regarding their expectations and perceptions of recovery. Method: Semi-structured exit interviews were conducted electronically 6 months after intervention to ascertain the patients’ perspectives on whether expectations of treatment were met, and factors that influenced their recovery experience. Results: Quantitative analysis of self-reported recovery on a 7-point Likert scale showed that 48.4% of participants felt that they were ‘recovered’. Qualitative analysis showed three main categories: expectations of treatment, perceptions of recovery and changes in functional abilities. Conclusion: Clinicians should address patients’ expectations of treatment and include the patients in decision-making regarding their treatment. Long-term follow-up is essential to ensure that treatment effects have been maintained, and this should include information about patients’ self-reported recovery. Clinical implications: This study suggests that patients’ expectations of treatment and perceptions of recovery from PFP may influence prognosis. Clinicians need to collaborate with patients and involve them in decision-making to achieve their goals. An individualised treatment approach is essential to adequately address patients’ experiences, priorities and beliefs.https://sajp.co.za/index.php/sajp/article/view/684Publisher's versio

Differences in objective balance outcomes between elite female rugby players with and without a history of lateral ankle sprain

This study was conducted to examine differences in objective balance outcomes of female rugby players with (injury group; n = 12) and without (control group: n = 19) a history of lateral ankle sprains. The injured and the uninjured ankles in the previously injured players were also compared. An analytical cross-sectional design was used in this study, which was conducted at the Western Province Rugby Football Union’s (WPRFU) High Performance Centre in Cape Town, South Africa. The Noraxon myoPressureTM (Zebris) pressure plate was used to measure objective dynamic balance using COP (centre of pressure) parameters, namely sway area (SA), COP speed (COP sp), and time-to-boundary (TTB), during single-leg catch-and-throw, single-leg jump landing, and side stepping. The ankle sprain group had statistically significant differences in the SA outcome for the tasks catch-and-throw (p=0.04) and side step (p=0.01) compared with the control group. Regarding the TTB outcome in the treatment category, significant results for catch-and-throw (p=0.02) and side step (0=0.01) tasks were found in contrast to the controls. Further results yielded a substantial difference in COP speed outcome for the side step task (p=0.01) among players with a known history of ankle injury compared with the control category. Rugby players with a history of ankle sprain have altered dynamic balance and poor postural stability. Sway area and COP speed during side-step and catch-and-throw tasks can be used as practical measures of objective dynamic balance in rugby