Case fatality of patients with stroke over a 12-month period post stroke

Introduction. Stroke is among the top 4 causes of death in SouthAfrica and the top 10 leading causes of disability worldwide. There is a dearth of literature on stroke incidence, prevalence and outcome in sub-Saharan Africa. We aimed to establish the case fatality of stroke patients over a 12-month period post discharge from hospital.Methods. A total of 200 patients with first-time ischaemic stroke were recruited from Chris Hani Baragwanath Academic Hospital and followed up for 12 months. The Barthel Index (BI) and Rivermead Mobility Index (RMI) were used to establish patient functional ability and, by inference, stroke severity. Follow-up assessments were performed at 3, 6 and 12 months post discharge. Data analysis was largely descriptive in nature.Results. Thirty-eight per cent of patients died within the 12 month follow-up period; 25.5% within 3 months of discharge. The average length of hospital stay was 6 days. Low BI scores at discharge were observed in the majority of patients who died.Conclusion. The 12-month cumulative mortality was high (highest at the 3-month follow-up). The short hospital stay and poor functional ability of the patients post stroke possibly left them vulnerable to bed-rest complications, such as chest infections and pressure sores

Factors influencing Zimbabwean physiotherapy students in choosing physiotherapy as a career

People join professions for different reasons and the same applies to physiotherapists. The aim of the study was to identify the reasons for choosing physiotherapy as a career by Zimbabwean physiotherapy students. The study used a descriptive cross-sectional design where a questionnaire was administered to 60 students. Data were collected on the demographics of the students and also on their rating on the importance of 12 factors for their influence in them choosing physiotherapy as a career.Three factors, which were, “the results I obtained at ‘A’Level” (68%), “job availability”(67%) and “desire to help others”(60%), were rated by more than 60% of the students as factors that had been “very important” in their decision to pursue physiotherapy as a career. Two factors, “I always wanted to be a physiotherapist” and “I worked with or received treatment from a physiotherapist”, were the only factors, which were rated by more than 70% of the students as no important in the students’ decision. Using the paired t-test, no significant statistical differences were found between male and female students, in their rating of importance of all twelve factors, (p-value=0.01)

An audit of the physiotherapy management of paraplegic patients with sacral pressure sores

Introduction: Pressure sores are the most common complication post spinal cord injury that requires patients to be on bed rest. Patient bed rest delay rehabilitation and may lead to other complications associated with immobility. This study sought to establish the treatment interventions physiotherapists provide to patients with sacral pressure sores and the factors that they consider when deciding whether the patient should receive physiotherapy in the ward or gym. Methods: This was a questionnaire based survey of physiotherapists working in spinal cord injury rehabilitation units in South Africa. The self-designed questionnaire was sent to all the main spinal rehabilitation units in the country (14) located in Gauteng, Kwa-Zulu Natal, Western Cape, Eastern Cape and Free State provinces. Results: Thirty-nine physiotherapists from a total of 51 completed the questionnaires (76% response rate). The most common treatment practice for patients with sacral pressure sores was bed rest (98%). The most common physio-therapy practices (70%) included were upper limb muscle strengthening, upper and lower limb passive movements, positioning into prone and side lying and passive stretching. The choice of treatment environment was influenced by doctors’ orders and the size, grade and duration of the pressure sores. Conclusion: Direct involvement in pressure sore management in South Africa seem to be less than in other parts of the world. If we are to minimise the pressure sore impact, it appears like we need more focus on gait re-education and standardised ADL programmes and patient treatment in the gym to possibly maximise healing and rehabilitation

The association between psychological stress and low back pain among district hospital employees in Gauteng, South Africa

The presence of low back pain (LBP) can be influenced by psychosocial  stress experienced  at  work.  The  aim  of  this  study  was  to  determine the point prevalence for LBP and the psychological stress expe-rienced at work as a factor associated with the presence of LBP amongst staff  employed  at  district  hospital  in  Pretoria,  Gauteng,  South  Africa.  A  self-administered questionnaire was  completed  by  all  participants. Results indicated that the point prevalence for LBP was 47.46%. Sixty five point five seven percent of employees who experienced stress at work all the time, suffered from LBP (p=0.001). Stress experienced at work all the time increased the risk of LBP (OR 3.47 CI 1.46 ; 8.23).  A clinical recommendation resulting from this study is that healthcare providers need to include the provision of education, support and appropriate  referral for patients who perceive themselves to have high levels of stress

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

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