Effect of cardiac surgery in young children with congenital heart disease on parenting stress in central South Africa: Initial outcomes

Introduction and aim: Parents of children with congenital heart disease (CHD) are at increased risk of ongoing stress and psychological morbidity. The aim of this study was to determine stress in parents of children with CHD who underwent cardiac surgery. The levels of stress experienced by parents of children with CHD in South Africa are unknown. Reported parenting stress outcomes in children with CHD in developed countries are conflicting.Materials and methods: Forty-eight consecutive children, 30 months and younger, and their parents were recruited into this observational descriptive study. Parenting stress was assessed using the Parenting Stress Index Short Form. Parenting stress outcomes were compared over time, and variables associated with parenting stress determined at baseline, three-month and six-month post-cardiac surgery.Sociodemographic information including maternal age, parental educational attainment and occupational status were collected using a self-developed questionnaire. Medical severity of the cardiac disease was rated according to the Cardiologists Perception of Medical Severity Scale. Socio-economic status was determined using Hollingshead’s Index of Social Position and developmental status was assessed using the Bayley Scales of Infant and Toddler Development, Third Edition.Results: Baseline data was collected for 40 parents. Sixty percent of parents (n=24) experienced clinically significant stress prior to cardiac surgery. Levels of parenting stress were significantly decreased at both three-month (p<0.001) and six-month post-cardiac surgery (p<0.001). However, just more than a third of parents experienced ongoing stress. There was a significant association between neurodevelopmental outcome (p=0.03), perceived health-related quality of life (p=0.02), age at first cardiac surgery (p=0.03) and maternal age (p=0.04) and levels of parenting stress.Conclusion: The findings of this study showed that most parents experienced clinically significant levels of stress prior to cardiac surgery in their children. Parenting stress declined significantly post-cardiac surgery, but a considerable number of parents experienced ongoing stress. In conclusion, parents of children with CHD should be screened regularly for risk of psychosocial problems requiring referral for treatment

Promotion, prevention and protection: interventions at the population- and community-levels for mental, neurological and substance use disorders in low- and middle-income countries

Background In addition to services within the health system, interventions at the population and community levels are also important for the promotion of mental health, primary prevention of mental, neurological and substance use (MNS) disorders, identification and case detection of MNS disorders; and to a lesser degree treatment, care and rehabilitation. This study aims to identify “best practice” and “good practice” interventions that can feasibly be delivered at these population- and community-levels in low- and middle-income countries (LMICs), to aid the identification of resource efficiencies and allocation in LMICs. Methods A narrative review was conducted given the wide range of relevant interventions. Expert consensus was used to identify “best practice” at the population-level on the basis of existing quasi-experimental natural experiments and cost effectiveness, with small scale emerging and promising evidence comprising “good practice”. At the community-level, using expert consensus, the ACE (Assessing Cost-Effectiveness in Prevention Project) grading system was used to differentiate “best practice” interventions with sufficient evidence from “good practice” interventions with limited but promising evidence. ResultsAt the population-level, laws and regulations to control alcohol demand and restrict access to lethal means of suicide were considered “best practice”. Child protection laws, improved control of neurocysticercosis and mass awareness campaigns were identified as “good practice”. At the community level, socio-emotional learning programmes in schools and parenting programmes during infancy were identified as “best practice”. The following were all identified as “good practice”: Integrating mental health promotion strategies into workplace occupational health and safety policies; mental health information and awareness programmes as well as detection of MNS disorders in schools; early child enrichment/preschool educational programs and parenting programs for children aged 2–14 years; gender equity and/or economic empowerment programs for vulnerable groups; training of gatekeepers to identify people with MNS disorders in the community; and training non-specialist community members at a neighbourhood level to assist with community-based support and rehabilitation of people with mental disorders. Conclusion Interventions provided at the population- and community-levels have an important role to play in promoting mental health, preventing the onset, and protecting those with MNS disorders. The importance of inter-sectoral enga

Physiotherapy Modalities used in the Management of Chronic Low Back Pain

Chronic low back pain (CLBP) is a costly andcommon medical problem accounting for 75-90% of compensationcosts as a result of repeated treatments, long term work absenteeismand social support-unemployment compensation. Physiotherapytreatment modalities are commonly used in the management ofCLBP. Data on the management of CLBP by physiotherapists inlow income countries are scarce.A cross-sectional survey was used to investigate the managementof CLBP by physiotherapists in Kwazulu-Natal (KZN). Theobjectives of the study were to establish: the commonly used physiotherapymodalities; reasons; and the evidence base used for their choice. Six hundred and eighty-five self-administeredquestionnaires were posted to all registered physiotherapists in KZN.Of 213 returned questionnaires, 141 (20.6%) met the inclusion criteria as they managed patients with CLBP.General exercises (30%); spinal mobilisation (28%); myofascial release (18%), education (12%) and training oflocal stabilisers(12%) were the commonly used treatment modalities. Key reasons for the selection of the treatmentmodalities were undergraduate education received; own clinical experience and the attendance of postgraduate courses/physiotherapy conferences.From the reasons specified for the selection of treatment modalities, the use of written current available literaturethrough reading of journal articles was sparsely utilized

Caregiver strain and quality of life 6 - 36 Months post stroke

Background: Caregivers of patients with stroke are central in providing for the patient’s needs post stroke. The well-being and quality of life of the caregiver is important in the rehabilitation of the patient with stroke. This study sought to establish the: functional level of patients, level of strain and quality of life of the caregiver, and the factors that influence caregivers’ quality of life six to 36 months post stroke. Methods: This was a cross-sectional study which included 35 patients six to 36 months post stroke and their primary caregiver utilising a sample of convenience from local clinics/hospitals in Johannesburg. Demographic information was obtained from the patient and the caregiver using a questionnaire. The Barthel Index (BI), Caregiver Strain Index (CSI) and the EQ-5D were also administered. Results: On the BI, 60% of the patients were moderately dependent to independent while 77% of the caregivers were strained. Older caregivers were 81% more likely to experience a decrease in quality of life than younger caregivers. Conclusion: A large proportion of patients are discharged from hospital without receving rehabilitation and are still dependent on caregivers six to 36 months post stroke. Caregivers of patients with stroke need more support from health professionals to mitigate against the high strain and low quality of life that they experience when caring for patients six to 36 months post stroke

Caregiver strain and quality of life 6 - 36 Months post stroke

Background: Caregivers of patients with stroke are central in providing for the patient’s needs post stroke. The well-being and quality of life of the caregiver is important in the rehabilitation of the patient with stroke. This study sought to establish the: functional level of patients, level of strain and quality of life of the caregiver, and the factors that influence caregivers’ quality of life six to 36 months post stroke. Methods: This was a cross-sectional study which included 35 patients six to 36 months post stroke and their primary caregiver utilising a sample of convenience from local clinics/hospitals in Johannesburg. Demographic information was obtained from the patient and the caregiver using a questionnaire. The Barthel Index (BI), Caregiver Strain Index (CSI) and the EQ-5D were also administered. Results: On the BI, 60% of the patients were moderately dependent to independent while 77% of the caregivers were strained. Older caregivers were 81% more likely to experience a decrease in quality of life than younger caregivers. Conclusion: A large proportion of patients are discharged from hospital without receving rehabilitation and are still dependent on caregivers six to 36 months post stroke. Caregivers of patients with stroke need more support from health professionals to mitigate against the high strain and low quality of life that they experience when caring for patients six to 36 months post stroke

Factors which are predictive of return work after stroke

Stroke impacts on a survivor’s ability to participate in community activities such as return to work (RTW) and affects people who are within the working age. There is a dearth of literature on RTW after stroke in developing countries. This study aimed to bridge this gap in South Africa, and was conducted within the Gauteng province as it comprises the largest share of the South African population. Seventy-two stroke survivors participated in this cross-sectional study. A demographic questionnaire; Barthel index; Modified Rivermead mobility index and Montreal cognitive assessment were used to determine the characteristics of study participants. The mean (standard deviation) scores for the Barthel Index (BI), Modified Rivermead mobility index (MRMI) and Montreal cognitive assessment (MoCA) were 19.6 (±0.2), 39.5 (±0.9) and 25.1 (±4.8) respectively. Thirty-one (43%) of the stroke survivors returned to work at six months after stroke. Stroke survivors with left hemiplegia had a greater chance of RTW than those with right hemiplegia (odds ratio 7.7). For every unit increase in the BI and MoCA score, the likelihood of RTW increased by 1.6 and 1.3 respectively. Conclusion: Side of hemiplegia, independence in activities of daily living and cognitive ability were found to be predictors of RTW at six months after stroke. It is important to identify people with cognitive impairments after stroke so that efforts can be made to increase awareness of the potential role that cognitive impairments may play in RTW

University of the Witwatersrand physiotherapy undergraduate curriculum alignment to medical conditions of patients within Gauteng state health facilities

Background: The healthcare sector requires graduates with the ability to confidently assess and manage the majority of the medical conditions seen in hospitals. Objective: To establish whether the most prevalent medical conditions treated by physiotherapists in Gauteng (South Africa) state health facilities align with the University of the Witwatersrand (Wits) physiotherapy curriculum. Methods: This was a retrospective review of condition-related statistics from physiotherapy departments within the Gauteng province state health facilities. Data from all Gauteng government hospitals that had submitted at least 75% of their physiotherapy condition–related statistics to the provincial statistics coordinator from January 2012 to December 2014 were considered and compared to medical conditions covered in the Wits 2015 physiotherapy curriculum to check if all conditions listed in the Gauteng statistics appeared within the Wits curriculum document. The number of teaching hours for the common conditions was noted to check the emphasis given to these conditions in the curriculum. Results: Eighty-three per cent of the hospitals submitted 75% of their monthly statistics. Overall, the most common conditions treated were lower limb fractures (13%) followed by stroke (7.6%) (n = 705 597). Within the neuro-musculoskeletal category, the most common conditions after lower limb fractures were soft tissue injuries (15.1%) (n = 330 511). The most common cardiopulmonary conditions were tuberculosis (24.9%), followed by pneumonia (13.8%) (n = 94 895). The most common neurological conditions were stroke (30.9%) followed by cerebral palsy (17%) (n = 174 024). Within the non-specified categories, the number of intensive care unit (ICU) patients was the highest (23%), followed by sputum induction (21%) (n = 138 187). The most common conditions that were emphasised within the Wits curriculum as indicated by the teaching hours: fractures, 14.5 (66%) of 22 third-year orthopaedics hours; stroke, 30 (73%) of 41 third-year neurology hours; soft tissue injuries, 18 (38%) of 48 fourth-year neuro-musculoskeletal hours; back lesions, 24 (50%) of 48 fourth-year neuro-musculoskeletal hours; and ICU patients, 30 (79%) of 38 fourth-year cardiopulmonary hours. Conclusion: The Wits physiotherapy curriculum covers all medical conditions treated by physiotherapists within the Gauteng state health facilities, and overall, the curriculum prepares the students to practise in a variety of situations

The implementation of the Objective Structured Practical Examination (OSPE) method: Students’ and examiners’ experiences

Background. Traditionally, physiotherapy practical skills have been assessed by a method that relies on the subjective interpretation of competency by the examiner and lacks the formative benefits of  assessment.Objective. To describe and compare student performance and satisfaction and examiner satisfaction  with regard to the Objective Structured Practical Examination (OSPE) and traditional mark sheets during the practical skills assessment.Method. Students and examiners taking part in the second-year physiotherapy practical skills test were invited to participate by completing a series of questionnaires. Performance of techniques was marked using both the OSPE and traditional mark sheets.Results. Sixty-seven students and nine examiners participated in the study. Students scored an average of 4.6% (SD ±16.4) better when using the traditional mark sheet. Nonetheless, students and examiners expressed a preference for the OSPE mark sheet.Conclusion. The OSPE mark sheet allows for increased objectivity, as the specific micro-skills are clearly  listed and appropriately weighted. This resulted in increased satisfaction, but a decrease in marks obtained. By assessing the effect of implementation of the OSPE method on performance and satisfaction, change in the current situation can be monitored

Inter-examiner reliability when using the Objective Structured Practical Examination (OSPE) mark sheet for physiotherapy practical

The Objective Structured Practical Examination (OSPE) format is used during practical examinations as part of the physiotherapy undergraduate curriculum at the University of the Witwatersrand. Various factors influence inter-examiner reliability and investigating the inter-examiner reliability when using the OSPE can lead to improvement of the examination process. The aim of this study was to establish inter-examiner reliability when using the OSPE mark sheet. Methods: Twelve examiners participated in this study. Thirty-three second year PT students were examined at six stations and by two examiners at each station. The Spearman’s correlation test was used to establish inter-examiner reliability. Results: The general inter-examiner reliability of the OSPE mark sheet was high. There was a high correlation between examiners who had the same level of experience (r=0.79 to r=0.93; p<0.001). The background knowledge section of the OSPE mark sheet showed the greatest inter-examiner reliability (r=0.75 to r=0.91; p<0.001). Discussion: In general, a high inter-examiner reliability was found. Examiners with the same level of experience seemed to generally have better inter-examiner reliability when using the OSPE mark sheet. Furthermore, a well-described, operationalised list of micro-skills also improved inter-examiner reliability. Conclusion: The OSPE mark sheet aids inter-examiner reliability. The use of this method of examination should be encouraged