Magister Scientiae (Physiotherapy) - MSc(Physio) / Chronic diseases of lifestyle (CDL) are on a raising trend in the world regardless of age, economic class or geographical location of a population. The mortality rate associated with CDL is alarmingly among the highest globally. Tanzania is not exempted from this development. Literature indicates that physical activity is a health practice that can prevent CDL. It is recommended that medical practitioners should hold the responsibility of counselling patients on physical activity. Some studies outside Africa found an association between doctors’ physical activity patterns and their counselling practices on the same. This study therefore sought to establish whether physical inactivity among medical doctors in Tanzania significantly influenced their counselling practices on physical activity. A cross sectional quantitative survey at the Muhimbili National Hospital and Muhimbili Orthopedic Institute was conducted to derive the required information. A self administered structured questionnaire was voluntarily answered by 144 medical doctors. The Statistical Package for Social Sciences (SPSS) version 17 was used for data capturing and analysis. Descriptive statistics were employed to summarize data and was expressed as means, standard deviation, frequencies and percentages. The students’t-test was used to compare mean physical activity between different groups. Furthermore students’t-test and analysis of variance tests were used to examine association between different variables. Chisquare tests were used to test for associations between categorical variables. Alpha level was set at p< 0.05. Most of the participants in this study were sedentary in their leisure time and only active at work. When their quality of physical activity counselling was assessed, the majority of them were found to be poor physical activity counsellors. A significant association was found between physical activity and age, as well as physical activity and counselling practice (p<0.05). Participants mostly informed their patients about the intensity and duration of exercising more than any other idea of physical activity such as types of exercises, issuing of a written prescription and planning for a follow up. Lack of knowledge and experience about details of physical activity were reasons offered for failure to counsel. Participants also reported the inconvenience of physical activity facility’s schedules, fatigue and tiredness to be their barriers to physical activity participation. Doctors in Tanzania lacked personal initiative to participate in physical activity and consequently lacked the motivation to counsel. Measures around enhancing this health practice should be enhanced by all stakeholders including medical doctors, physiotherapists and patients. The need for short term and long term training in matters related to physical activity are therefore necessary among the practicing doctors and those undergoing training in medical schools. Physiotherapists who are trained in movement science can offer valuable advice/information to medical doctors to ensure that medical doctors acquire physical activity prescription and counselling knowledge. Collaboration between stakeholders in campaigning against sedentary lifestyles should be enhanced. Further reasons for failure to counsel, hindrances to physical activity participation and modern approaches to counselling should be explored. / South Africa

Magister Scientiae (Physiotherapy) - MSc(Physio) / According to the United Nations, more than half a billion people (about 650 million) worldwide are disabled. Disability can have a vast impact on both the individual and the family. Rehabilitation is therefore a fundamental need for the persons with disability to achieve functional independence and have an improved quality of life. To enhance the effectiveness of rehabilitation, it is important to seek clients perspectives of the rehabilitation services and to incorporate these perspectives into the planning and delivery of rehabilitation services. In areas where rehabilitation services are available in South Africa, minimal research has been done to explore the clients experiences regarding provision of these services. The aim of this study therefore was to explore the persons with physical disabilities experiences of the rehabilitation services they received at community health centres (CHCs) in the Cape Town Metro Health District. Data was collected using a mixed methods design in the form of a sequential exploratory strategy. Qualitative data collection was done using in-depth interviews and this was followed by administration of an interview questionnaire. The questionnaire was developed using results from the in-depth interviews together with information from literature. Ten persons with physical isabilities, who had received rehabilitation services at participated in the in-depth interviews and 95 responded to the interview questionnaire. The interviews were tape-recorded and transcribed verbatim and they were analysed using predetermined themes. The SPSS version 16.0 was used to analyse the quantitative data which was presented in frequencies, medians, quartiles and percentages. The results of the study revealed that the participants experienced problems with getting transport to travel to the community health centres and getting adequate information from the service providers particularly information regarding disability and support services available for them. Experiences regarding participants involvement in their rehabilitation were generally positive. Generally, the participants reported positive experiences regarding their interaction with service providers and family support and involvement and this study recommends the staff to maintain their standards regarding these two dimensions of rehabilitation. However most of the participants were not concerned about whether the service providers gave them an opportunity to express their preferences or not. The results indicate the need to improve transport services for persons with physical disabilities and to give them more information regarding support services. The service providers should also give the clients more opportunities to get involved in their rehabilitation and educate them about the benefits of them getting involved. / South Africa

Magister Scientiae (Physiotherapy) - MSc(Physio) / The World Health Organisation estimates that the majority of the disabled population resides in the developing world, but most of the research on outcomes of patients originates from the developed world. In the light of the differences in healthcare structures and function, especially rehabilitation between settings and countries, it is imperative to have an understanding of the functioning of patients at discharge with the objective of measuring the level at which outcomes are met. The aim of this study was therefore to determine the process of rehabilitation and the outcome of patients following in-patient rehabilitation at a facility in the Western Cape. A quantitative research design was employed to address the objectives. Self-administered questionnaires were developed to collate information pertaining to the demographic-, socioeconomic- and medical profile of patients and data extraction sheets collected information relating to the process of rehabilitation and the impairment status of patients on admission. With regards to activity and participation, a longitudinal study design was used, which utilised standardised outcomes measures. The sample consisted of all patients with stroke and spinal cord injury admitted within a three-month period, and all ethical principles relating to research on human subjects, as stipulated in the Helsinki Declaration were adhered to during data collection, with ethical clearance obtained from relevant authorities. The SAS and the Microsoft Excel Package 2007 were used to analyse the quantitative data elements. Descriptive statistics using frequencies, percentages, ranges, means, and standard deviations and inferential statistics using chi-square, student T-tests and correlation tests, for determining the predictors of functional outcome, were calculated. There were 175 patients, whereof 82 were patients with stroke and 93 with spinal cord injury, with 143 (76 presenting with spinal cord injury and 67 with stroke) meeting the inclusion criteria on admission. The mean age of those with spinal cord injury and stroke was 34.14 and 52.95 years. Most of the patients with spinal cord injuries were single (73.68%), whereas the majority (53.73%) of patients with strokes were married at the time of injury. All patients were managed by the doctor and the nurse, with most of the patients receiving physiotherapy, occupational therapy and social assistance from the social worker. With regards to recreational activities, 46.87% of patients with spinal cord injury and 39.39% of those with stroke attended the learn to swim programme, and 29.68% of patients with spinal cord injury attended the wheelchair basketball sessions. The mean length of hospital stay for patients with spinal cord injury and stroke was 73.11 and 51. 62 days, with most of the spinal cord injured patients (80.26%) and stroke patients (82.08%) discharged home without follow-up rehabilitation. The most prevalent impairments on admission of the spinal cord injury cohort were muscle weakness (75.0%), bladder incontinence (71.1%) and reduced sensation (69.7%), whereas patients with stroke presented mostly with muscle paralysis (80.6%), abnormal tone (76.1%) and aphasia (50.8%). Functional limitations experienced by the participants included, mobility, stair climbing and transfers. The participants experienced participation restrictions in the following domains, leisure activities and employment. A clinical significant improvement was noted in execution of functional task of patients with spinal cord injury (p< 0.0001) and stroke (p< 0.0001) between admission and discharge. A significant statistical change was also detected for the participation elements of both stroke and spinal cord injury cohorts. Functional ability on admission was found to be a predictor of functional outcome of the stroke diagnostic group at discharge, whereas the multiple redictor model of functional outcome of the spinal cord injured cohort at discharge was significant with remaining variables of functional outcome score on admission (p<0.0001) and bladder -and bowel impairment(s) (p=0.0247). The study findings suggest that despite the significant change in activity and participation, most of the patients were discharged home without further follow-up for rehabilitation, irrespective of the activity limitations and participation restrictions still experienced at the time of discharge. The latter finding questions the duration of the length of hospital stay, which does not allow patients to be independent in all meaningful activities and participatory actions and roles by the end of inpatient rehabilitation. The study findings could assist authorities to adapt the existing rehabilitation programme and referral process . / South Africa

Magister Scientiae (Physiotherapy) - MSc(Physio) / Physical inactivity has become a global health concern and is among the 10 leading causes of death and disability. This has led to increased concern for chronic diseases of lifestyle (CDL). Studies have revealed that regular physical activity is effective in combating several CDL such as cardiovascular disease, diabetes, cancer, hypertension and obesity. Physiotherapists are in a position to combat inactivity and effectively promote physical activity to their clients. Studies however have shown that participation in physical activity among physiotherapists could have an impact on the promotion of physical activity and their health practices. This study therefore sought to establish the relationship between physical activity levels of physiotherapists and their physical activity promotion strategies and barriers to promoting physical activity. Sequential Mixed Method Design was used in this study. Data was collected by means of a self administered questionnaire and a total of 92 physiotherapists voluntarily answered the questionnaire. A focus group discussion comprising of 10 purposively selected physiotherapists was conducted. The questionnaire assessed physical activity levels and physical activity promoting strategies of the participants while the focus groupdiscussion looked at the barriers to promoting physical activity. The Statistical Packages for Social Sciences (SPSS) version 18 was used for data capturing and analysis. Descriptive statistics were employed to summarize demographic information as means, standard deviation, frequencies and percentages. Inferential statistics (chi-square) was used to test the associations between different categorical variables (p<0.05). For the qualitative data, focus group discussions were used to collect data. Tape recorded interviews were transcribed verbatim, field notes typed, sorting and arranging data was done and themes were generated. Thematic analysis was then done under the generated themes. Ethical issues pertaining to informed consent, anonymity, confidentiality and the right to withdraw from the study were respected in this current study. The findings in the current study revealed that a big number of the participants were physical active both at work and recreation domains. However, there was no statistically significant association between physical activity and the demographicvariables. The results in this study revealed that the majority of participants were good physical activity promoting practices, although there was no significant association between physical activity levels and the physical activity promoting practices. The finding in this study revealed that discussing physical activity and giving out information regarding physical activity to their clients were the most common methods used in promoting physical activity. However, participants also highlighted barriers they ace in promotion of physical activity such as policies on physical activity, cultural influence, nature of work, time management as well as environmental barriers. The study demonstrates the need for all stakeholders to come up with solutions to break the barriers to promotion of physical activity. In return it will bring about enormous health&nbsp; benefits to the general population. / South Africa

Magister Scientiae (Physiotherapy) - MSc(Physio) / Playing related musculoskeletal disorder (PRMD) is common among instrumentalists, professionals, amateurs and music students with a prevalence ranging from 39-47% with an impact on playing and performance. This is synonymous to the prevalence of musculoskeletal disorders among other work population. Risk factors such as lack of warm ups, awkward posture, long playing hours and bad techniques has been consistently indicated as risk factors influencing the incidence of PRMDs among instrumentalists. The aim of this study is to design a warm up programme for instrumentalists. The study population and sample are instrumentalists at the Centre for Performing Arts, University of the Western Cape. A cross sectional study design with a quantitative approach was utilized in this study to determine the prevalence, severity, distribution of PRMDs and its association with quality of life. All the instrumentalists learning or playing a musical instrument of the Centre for Performing Arts was approached to participate in this study. In the first phase of the study, a self administered questionnaire was used to collect data regarding prevalence, distribution and the severity of PRMDs and health related quality of life. The instruments for this study are the standard NORDIC questionnaire for musculoskeletal disorders to determine pain distribution and prevalence, the visual analogue scale to determine the pain severity and the WHOQOL –BREF, a quality of life questionnaire and an adapted questionnaire to determine the knowledge of instrumentalists about injury prevention strategies. The second phase of the study, a systematic review of evidence was done on the pattern of warm up and practice habits of instrumentalists. The third phase of the study to design the content of the study was done using a Delphi study. The Statistical Package for Social Sciences (SPSS) was used for descriptive and inferential statistics. Chi square was used to determine the association of prevalence, distribution and severity on quality of life. Alpha level was set at 0.05. Ethical clearance and permission to conduct study was sought, written informed consents from participants was sought clearly stating the right to participate and withdraw from study was respected and anonymity and confidentiality was be ensured. The results of the study show that 82.4 % lifetime prevalence and current prevalence of 23.5 % among instrumental musicians in a Centre for Performing Arts. The shoulder (41.2 %), neck (29.4 %) and the wrists and hands (29.4%) are the mostly affected region on the body. The most common symptoms are tightness and soreness. However, the results of the systematic review shows that there is a lack of operational term for warm up in the performing arts and this therefore could be responsible for the variations in the influence of warm up on the prevention of PRMDs. The content of the warm up programme was designed using a Delphi study and stretching and postural awareness were included with musical warm up as part of a regular warm up exercise, although, consensus was not reached on the duration of the warm up programme. Strengthening and conditioning were included to in a different exercise program done three times per week. Education on injury prevention strategies were also included in the programme and the mode of instruction agreed on was active learning and group instruction in classroom. The role of warm up exercise in the prevention of PRMDs using this model could reduce the incidence of PRMDs. However, it is important to note that the programme should be tested in order to determine the overall effect it has on PRMDs. / South Africa

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Government demands to increase the number of physiotherapy students have led to problems in acquiring extra placements in which these students can experience their clinical education. This problem has been accentuated by difficulties with recruitment and retention of physiotherapy staff that might take on the role of clinical educator. This study uses empirical data to explore how further placements could be found without compromising the quality of the learning experiences. Action research is used to identify current practice and areas where change may be advantageous. Perceptions are drawn from professionals and students - physiotherapy managers, clinical educators and physiotherapy students. Data collecting techniques include interviews (13 physiotherapy managers) and five questionnaires – with clinical educators (n=67 and 42) and students (n= 73, 76 and 62) as samples. All data are triangulated to justify the study findings. The findings are framed around concepts of management and learning within clinical education. Evidence that emerged during the action research process led to two main changes. Firstly more junior grades of physiotherapy staff were included within the pool of clinical educators. Secondly a new ‘model’ of facilitating learning was established through the creation of ‘learning teams’ where both students and clinical educators worked together to share and develop knowledge. Changes meant that increased student numbers were accommodated without compromising quality. This was demonstrated through positive student evaluation of clinical placements at the end of their degree course. The impact of accommodating students within physiotherapy settings is discussed in relation to departmental, personal and professional management. Priority could be given to improving how student learning might influence not only personal but also professional development.

Background: Physical inactivity affects every system in the body and is associated with many chronic diseases. This impacts on the lives of individuals and has substantial social and economic implications. A large proportion of the UK population is insufficiently active and system-wide approaches to promoting physical activity are required. There are over 55,000 physiotherapists in the United Kingdom, yet little is known about physical activity promotion in this domain of healthcare. The overarching research aim is to explore physical activity promotion in physiotherapy practice and to understand the factors that influence current practice. Method: This programme of research is underpinned by a philosophical position of pragmatism. Within this methodological framework, a systematic scoping review was first undertaken to assess the state of the existing global evidence. Following this, a mixed methods study, was completed using a sequential explanatory design. Phase 1 involved a national, cross-sectional survey of UK physiotherapists. Phase 2 involved a qualitative, explanatory follow-up which aimed to further explain the quantitative findings. Findings: Thirty-one studies were included in the systematic scoping review. Findings from Phase 1 of the mixed methods study indicated that respondents (n=514) initiate conversations with patients about physical activity but lack a systematic approach. Physical activity status was not routinely assessed, signposting to other services was inconsistent, and knowledge of the physical activity guidelines was poor. These findings were further explained in Phase 2; participants (n=12) highlighted a lack of understanding of key concepts which underpinned the inconsistent approach to physical activity promotion. Phase 2 also identified that physiotherapists focus on short-term restoration of function over longer-term promotion of health. Conclusion: Physical inactivity is a major public health issue, and physiotherapists have the potential to contribute to tackling inactivity. However, the current approaches identified within this programme of research were inconsistent and unsystematic. Changes in demography necessitate holistic physiotherapy approaches that promote long-term health and wellbeing. Recommendations are made to improve physiotherapy practice in line with the aspiration of orientating healthcare toward prevention.