Recommendations of behavioural facilitators for success in a physiotherapy clinical practice module: Successful students’ perspectives

Students struggle to bridge the gap between theory and application thereof in clinical settings. Exploring the behaviours of students who have been shown to be successful in the clinical practice module of physiotherapy could provide an insight into what facilitated their success. Sharing this information with other students could assist with decreasing anxiety and improving student success

Prevalence of concussion and adherence to return-to-play guidelines amongst male secondary school rugby and hockey players

Concussion injuries are common in contact sports. Young players can suffer lifethreatening complications if concussion is not recognised and managed.To determine the prevalence of concussion amongst secondary school rugby and hockey players and describe players’ knowledge and adherence to return-to-play guidelines.A mixed-method approach included Phase A, which utilised a questionnaire completed by 221 players (n = 139 rugby; n = 82 hockey) between 13 and 18 years of age, and Phase B, which utilised three focus group discussions of 15 participants who had suffered a concussion

The Modular Socket System as Rural Solution in Indonesia

INTRODUCTION: The majority of the people in low-income countries, who need assistive technology do not have access to prosthetic devices [1]. Instead of these people having to make a long journey to one of the few prosthetic workshops, solutions like the Modular Socket System (MSS, Össur®) may be useful, because potentially they could be delivered and manufactured on site, at the location of the person [2]. This could make it suitable for application in a Community Based Rehabilitation (CBR) setting.The aim of this study was to evaluate the technical feasibility of the MSS for implementation in a CBR setting in terms of required tools, skills and required production time. METHODS: The study was performed at the Department of Prosthetics & Orthotics of the Jakarta I Polytechnic School of Health Science (JSPO). Four JSPO students received a three days training in manufacturing of the MSS. Lower limb amputees were recruited to participate in this study from the region of Jakarta (n = 5) and Bali (n = 10). A set of standardized instruments including the two minutes’ walking test (2MWT) and Prosthesis Evaluation Questionnaire (PEQ) were used to measure performance and satisfaction with the prosthesis. Production and maintenance logbooks were filled out by the involved prosthetists to evaluate the technical feasibility of the MSS. RESULTS AND DISCUSSION: Performance (2MWT) and satisfaction (PEQ) scores were comparable to that of similar studies with other lower leg prostheses [3,4]. Both measures did not decrease significantly over time (Figure 1). This suggest that the JSPO students were able to reach sufficient quality.It took the prosthetists 3.5 to 10.5 hours to fit an amputee with a MSS prosthesis. Mean socket production time was 2.0±0.6 hours and mean prosthesis assembly and fitting time was 4.1±2.6 hours. The only non-portable machine needed for the production of the prosthesis was a grinding machine (router). Smaller portable machines used were a cast cutter/jigsaw, Icecast® Compact and resin injection tool. If in the future the grinding machine will be replaced by a handheld tool, production of the MSS could be performed on site, making it suitable for use in a rural setting. Figure 1: The results of the 2MWT at the moment of fitting (t0), at 1-3 months post fitting (t1), and at the end evaluation at 4-6 months post fitting (t2). CONCLUSIONS: Patients who normally have to travel long distances to access prosthetic services were only required to make one visit to the health facility in order to receive a prosthesis. From a technical and quality perspective the method seems feasible, although, high costs remain an issue.ACKNOWLEDGEMENTSMaterials and training for the production of all prostheses were sponsored by Össur®. REFERENCES: 1.Borg J, et al. Assistive Technology for Children with Disabilities: Creating Opportunities for Education, Inclusion and Participation - a discussion paper. 20152.Normann E, et al., Prosthetics and orthotics international. 35(1):76-80, 20113.Boonstra AM, et al. Prosthetics and orthotics international. 17(2):78-82, 19934.Zidarov D, et al. Archives of Physical Medicine and Rehabilitation. 90(4):634-645, 200

Experiences of lower limb prosthetic users in a rural setting in the Mpumalanga Province, South Africa

BACKGROUND: Ambulation with a prosthesis is the ultimate goal of rehabilitation for a person with a major lower limb amputation. Due to challenges with prosthetic service delivery in rural settings, many patients with amputations are not benefitting from prosthetic interventions. Inaccessibility to prosthetic services results in worse functional outcomes and quality of life. Learning from the experiences of current prosthetic users in this setting can assist to improve prosthetic service delivery. OBJECTIVES: To explore the experiences of lower limb prosthetic users and to understand the importance of a lower limb prosthesis to a prosthetic user in a rural area of South Africa. STUDY DESIGN: A generic qualitative approach and an explorative design were utilised in this study. METHODS: A semi-structured interview guide was used to collect data from nine prosthetic users in a rural area in the Mpumalanga province of South Africa. Interviews were audio-recorded, transcribed verbatim and analysed thematically. Demographic details and information related to acute in-patient rehabilitation were analysed descriptively. RESULTS: All participants were independent in activities of daily living with their prosthesis and participated actively in their community. Participants reported that their prosthesis was essential to their functioning. High travel cost was highlighted as a barrier to the maintenance of their prosthesis. Patients were dissatisfied with being unemployed. CONCLUSION: Prosthetic intervention positively influences function, independence and community participation. Challenges relating to the accessibility, cost and maintenance of prosthetics should be a priority to ensure continued functional independence for prosthetic users

A qualitative study of the challenges of providing pre-prosthetic rehabilitation in rural South Africa

BACKGROUND: There is a known shortage of rehabilitation staff in rural settings and a sharp increase in the number of lower limb amputations being performed. A lack of adequate pre-prosthetic rehabilitation will result in worse physical and psychological outcomes for a person with a lower limb amputation, and they will not be eligible to be fitted with a prosthesis. OBJECTIVE: To explore therapists’ experiences with providing pre-prosthetic rehabilitation in a rural setting. Study design: A qualitative descriptive approach was used to collect and analyse data. METHODS: Data were collected from 17 purposively sampled therapists in five district hospitals in a rural community in South Africa. Data were collected in two rounds of focus groups to explore the challenges of providing pre-prosthetic rehabilitation in rural South Africa. Results: The main themes identified in the study were (1) a lack of government health system support, (2) poor socioeconomic circumstances of patients and (3) cultural factors that influence rehabilitation. These themes all negatively influence the therapists’ ability to follow up patients for pre-prosthetic rehabilitation after discharge from hospital. A lack of adequate pre-prosthetic rehabilitation is a substantial barrier to prosthetic fitting in rural South Africa. Patients who do not receive pre-prosthetic rehabilitation have a poorly shaped residuum or other complications such as knee or hip joint contractures which disqualifies them from being referred to prosthetic services. CONCLUSION: Therapists involved in this study identified the most important barriers to patients having access to prosthetic services.IS

The use of a direct manufacturing prosthetic socket system in a rural community in South Africa: a pilot study and lessons for future research

BACKGROUND: Challenges exist with the provision of appropriate mobility assistive devices in rural areas. The use of the direct manufacturing prosthetic socket system is a possible solution to these challenges. OBJECTIVES: The objective of this study was to test and explore the clients’ perspectives with the application of this device. Study design: Within a mixed-methods approach, a longitudinal sequential explanatory design was applied. METHODS: The Orthotic and Prosthetic User’s Survey was administered to explore the use of the direct manufacturing prosthetic socket system in terms of function, health-related quality of life and client satisfaction. A conveniently selected sample of 21 individuals who suffered a unilateral trans-tibial amputation was included. Data were collected at 1, 3 and 6 months post fitting, and two focus group discussions were also administered. RESULTS: Of the 21 participants recruited, 11 returned for follow up. Although participants reported favourably about the prosthesis, their scores were generally worse than the norms with regard to function and quality of life. Participants highlighted the need for improvement in the cosmetic appearance of the prosthesis. CONCLUSION: The direct manufacturing prosthetic socket system could be considered as an alternative technique of socket manufacturing for individuals living in rural areas due to the shorter manufacture time and promising initial results, but further research on this topic with a bigger sample is recommended.ISI & Scopu

Retention of Improved Plantar Sensation in Patients with Type II Diabetes Mellitus and Sensory Peripheral Neuropathy after One Month of Vibrating Insole Therapy:A Pilot Study

Sensory peripheral neuropathy is a common complication of diabetes mellitus and the biggest risk factor for diabetic foot ulcers. There is currently no available treatment that can reverse sensory loss in the diabetic population. The application of mechanical noise has been shown to improve vibration perception threshold or plantar sensation (through stochastic resonance) in the short term, but the therapeutic use, and longer-term effects have not been explored. In this study, vibrating insoles were therapeutically used by 22 participants, for 30 min per day, on a daily basis, for a month by persons with diabetic sensory peripheral neuropathy. The therapeutic application of vibrating insoles in this cohort significantly improved VPT by an average of 8.5 V ( p = 0.001) post-intervention and 8.2 V ( p &lt; 0.001) post-washout. This statistically and clinically relevant improvement can play a role in protection against diabetic foot ulcers and the delay of subsequent lower-extremity amputation. </p

Retention of Improved Plantar Sensation in Patients with Type II Diabetes Mellitus and Sensory Peripheral Neuropathy after One Month of Vibrating Insole Therapy:A Pilot Study

Sensory peripheral neuropathy is a common complication of diabetes mellitus and the biggest risk factor for diabetic foot ulcers. There is currently no available treatment that can reverse sensory loss in the diabetic population. The application of mechanical noise has been shown to improve vibration perception threshold or plantar sensation (through stochastic resonance) in the short term, but the therapeutic use, and longer-term effects have not been explored. In this study, vibrating insoles were therapeutically used by 22 participants, for 30 min per day, on a daily basis, for a month by persons with diabetic sensory peripheral neuropathy. The therapeutic application of vibrating insoles in this cohort significantly improved VPT by an average of 8.5 V ( p = 0.001) post-intervention and 8.2 V ( p &lt; 0.001) post-washout. This statistically and clinically relevant improvement can play a role in protection against diabetic foot ulcers and the delay of subsequent lower-extremity amputation. </p

Barriers and facilitators to utilisation of rehabilitation services amongst persons with lower-limb amputations in a rural community in South Africa

Persons with disabilities who reside in rural areas experience challenges accessing and utilising health services and rehabilitation. Due to the high prevalence of diabetes mellitus in rural regions, the risk of having a lower-limb amputation is increasing. Comprehensive rehabilitation is vital to mitigate the negative impact that a lower-limb amputation has on a person. To explore the barriers and facilitators to accessing rehabilitation experienced by persons with lower-limb amputations in a rural setting

Improving vibration perception in a patient with type 2 diabetes and sensory peripheral neuropathy

Introduction: Diabetes mellitus (DM) and its related sensory peripheral neuropathy (SPN) are the biggest risk factors for foot ulcer formation and lower limb amputation. Reduced vibration perception results in less sensitivity to pressure and is a known risk factor for diabetic foot ulcers. Improving vibration perception in the feet of people with SPN could be protective against foot ulcers. The aim of this study was to determine if a therapeutic vibrating insole, used for 35 consecutive days, could improve vibration perception in a patient with type 2 DM. Patient presentation: The patient was a 63 year-old male with a medical history of peripheral vascular disease, controlled hypertension, hyperlipidaemia, artherosclerosis and SPN secondary to controlled type 2 diabetes. Management and outcome: The patient used the insoles for 20 min a day for 35 consecutive days. Vibration perception thresholds were measured four times in total: once at baseline, immediately post intervention, 1 month and 10 months later. Vibration perception threshold decreased with an average of 22 V (range 6 V-34 V) dependant on the tested location and time after intervention. The improvement remained after 1 and 10 months. Conclusion: The use of a vibrating insole as a therapeutic device improved this patient's perception of vibration in his feet. Clinically, vibrating insoles potentially might reduce the risk for ulcer formation and subsequent lower limb amputation in patients with DM and SPN. Clinical implications: Using a vibrating insole therapeutically, can potentially improve the perception of vibration and pressure in patients with sensory peripheral neuropathy secondary to type 2 diabetes mellitus. Improved vibration perception might reduce the risk for diabetic ulcer formation and subsequent lower limb amputation