Thesis (M.Tech.: Chiropractic)-Dept. of Chiropractic, Durban University of Technology, 2007 xi, 61 leaves, Annexures A-E, 1-5 / Research is more than merely an academic exercise. It is a key ingredient in establishing chiropractic’s role in an evolving health care system (Dallas, 1997). Very little is known about the changes in the chiropractic patient population over time (Hartvigsen et al. 2003). Despite the widespread use of chiropractic, good descriptive data on chiropractors and their patients are limited (Coulter and Shekelle, 2005). Few studies have been reported which deal specifically with patients attending chiropractic teaching clinics (Nyiendo and Olsen, 1988). A teaching clinic is an outpatient clinic that provides health care for patients, as opposed to inpatients treated in a hospital. Teaching clinics are traditionally operated by educational institutes and provide free or low-cost services to patients (http://en.wikipedia.org/wiki/Teaching_clinic). In April 1994 the chiropractic day clinic was officially opened at the former Technikon Natal (now the Durban University of Technology). Thousands of patients have been treated at this clinic over this twelve year period. In 1994, Elga Renate Drews, conducted research aimed at identifying characteristics of chiropractic patients and their complaints at the chiropractic teaching clinic at Technikon Natal and private practices in South Africa. This survey was conducted from February 1994 to the end of April 1994. 162 Patients were involved in this study. A survey was completed which included the patient’s age, gender, occupation, presenting condition, duration of complaint, previous treatment, referral, severity, quality of pain and their disability. A comparison was made between patients seen in private practice and at the teaching clinic. It was found that generally both populations were very similar, with the exception of the patients’ age and occupation. No other research investigating patient characteristics has been undertaken at Durban University of Technology chiropractic day clinic after 1994. Furthermore, in the study conducted by Drews no mention was made of the type of treatment that was given to patients either in private practice or at the teaching clinic. Although the first successful chiropractic adjustment recorded was in the thoracic spine by Dr. D.D. Palmer, research since then has focused on the lumbar spine (Di Fabio, 1992). In reviewing literature relating to the thoracic spine, it is apparent that in comparison to the cervical and lumbar regions, the thoracic spine has been neglected (Edmonston and Singer, 1997). In South Africa there remains a paucity of information on the types of thoracic conditions chiropractors treat and the management protocols. The present research aimed to shed light on this aspect by collecting data from one of only two chiropractic teaching clinics in South Africa, namely the Durban University of Technology chiropractic day clinic. The purpose of this research was to investigate the age, gender, occupation (whether of a sedentary or non-sedentary nature), prevalence of pain, presenting complaints, common conditions treated and common management protocols of patients who presented with thoracic pain to the Durban University of Technology Chiropractic Day Clinic.

Thesis (M.Tech.: Chiropractic)-Dept. of Chiropractic, Durban University of Technology, 2007 xiii, 77, Annexures 1-19, 19 leaves / The increasing contribution of chiropractors in health care has generated greater interest in understanding the characteristics of chiropractic practice patterns and treatments (Mootz et al., 2005). However, despite the rapid growth and extensive use of chiropractic, good descriptive data on chiropractors and their patients remains limited (Coulter and Shekelle, 2005). Even fewer studies have been reported which deal specifically with patients attending chiropractic-teaching clinics (Nyiendo and Olsen, 1988). According to Nyiendo and Haldeman (1986), there remains a paucity of empirical data regarding the type of patients seeking care at a chiropractic-teaching clinic and the types of treatments provided at these clinics. According to Till and Till (2000), South Africa is largely a developing country with scattered developed communities. Its requirements and opportunities as they relate to chiropractic may differ significantly from those in other developed countries. It was also estimated that in South Africa only a fraction of the country’s population have any notion of what chiropractic is, thus the largest challenge lies with educating the public about chiropractic (http://www.chiroweb.com, 2005). The lack of attention given to the chiropractic management of extremity conditions has contributed to a perception that chiropractic is unable to manage extremity conditions proficiently (Hoskins et al., 2006). There is a noted lack of research on the management of extremity conditions within chiropractic (Hoskins et al., 2006); therefore the current study focused on all components of the extremity system. Objectives: The purpose of this research is to conduct a descriptive study of extremity cases on record at the Durban University of Technology Chiropractic Day Clinic from 1995 to 2005 and the objectives are as follows: •To determine the prevalence of extremity complaints over the past decade at the Durban University of Technology Chiropractic Day Clinic. •To identify the demographics of patients that visited the Durban University of Technology Chiropractic Day Clinic. •To identify the most common presenting region and complaints of the extremity system as well as the aetiology and associated signs and symptoms of these complaints at the Durban University of Technology Chiropractic Day Clinic. •To identify the nature of the interventions and methods most commonly used in the management of patients at the initial consult and where possible contra-indications to any treatment modality

Objective : Low back pain (LBP), and in particular sacroiliac joint syndrome, is a significant health concern for both patient and their chiropractor with regards to quality of life and work related musculoskeletal disorders. Therefore, chiropractors often utilise mechanical aids to reduce the impact on the chiropractor’s health. It is, however, important to establish whether these mechanical aids are indeed clinically effective, therefore, this study evaluated the Activator Adjusting Instrument (AAI) against an AAI placebo to determine whether this adjusting instrument is an effective aid for both the chiropractor and the patient. Method : This randomised, placebo controlled clinical trial consisted of 40 patients (20 per group), screened by stringent inclusion criteria assessed through a telephonic and clinical assessment screen. Post receipt of informed consent from the patients, measurements (NRS, Revised Oswestry Disability Questionnaire, algometer) were taken at baseline, prior to consultation three and at the follow consultation. This procedure occurred with four interventions over a two week period. Results: The AAI group showed clinical significance for all clinical measures as compared to the AAI placebo group which attained clinical significance only for the Revised Oswestry Disability Questionnaire. By comparison there was only a statistically significant difference between the groups in terms of the algometer readings (p= 0.037). Conclusion : Therefore, it is evident that the AAI seems to have clinical benefit beyond a placebo. However this is not reflected in the statistical analysis. It is, therefore, suggested that this study be repeated with a larger sample size in order to verify the effect on the statistical analysis outcomes.

Dissertation submitted in partial compliance with the requirements for the Master’s Degree in Technology: Chiropractic Durban University of Technology, 2013. / Objectives: Myofascial pain dysfunction is a common musculoskeletal disorder, known to affect athletes. This research aimed to create a map of myofascial trigger points (MFTPs), to ascertain sport specific combinations. Design and Setting: This IRB approved study was a cross-sectional, observational study. Participants: Forty swimmers and forty non-swimmers (soccer players). Measurements : All participants underwent one assessment, non-intervention session where primary measures included: shoulder disability index (SDI), myofascial diagnostic scale (MDS), algometer and numerical pain rating scale (NRS). Manual palpation, the MDS and an algometer assessed MFTPs and the SDI overall function. SPSS version 20 (IBM) using Pearson’s chi square tests / Fisher’s exact tests compared MFTP locations between the groups, and non-parametric Mann-Whitney tests compared continuous measures (due to significant non-normal distribution), with a p-value <0.05 level of significance. Results: MFTP presence is very uncommon in swimmers, with associated pain and loss of function being very low on average. No evidence was found that swimmers were affected more than non swimmers by MFTPs related pain or loss of function, but has indicated that algometer measurements for infraspinatus MFTP 1, were significantly higher (p<0.027) (showing decreased tenderness) than the values in non swimmers. Conclusions: These results contradict the literature which suggests that unique activity specific patterns of MFTPs exist. This may be as a result of underlying systemic causes of MFTPs that obscured the pattern in this study. It is therefore suggested that larger trials with more participants per group be done in order to verify the results of this study.

Thesis (M.Tech.: Chiropractic)-Dept. of Chiropractic, Durban University of Technology, 2006 116 leaves / The aim was to evaluate the prevalence of hand and wrist pain, as well as the relationships between occupational overuse syndromes in the hands and wrists of chiropractors in South Africa as a result of their daily use of manual therapy techniques while at work. There are very few statistics available that disclose the nature and incidence of work related injuries. However those statistics that do exist suggest that hands on patient activities place physical therapists at greater risk of injury in comparison to other health care workers (Lunne et al., 2000). A study conducted by Bork et al.(1996) determined the prevalence of work-related musculoskeletal injuries sustained by physical therapists. Hand pain (29.6%) and back pain (45%) where the leading cause of pain in physical therapists (Bork et al., 1996.) Chiropractic and physiotherapy are both health care professions that specialize in the treatment of disorders pertaining to the neuro-musculo-skeletal system (Hunter, 2004). Physical therapists use manual therapy techniques as part of their daily working activities, so it can be assumed that chiropractors too will have a high prevalence of hand and wrist pain as they utilize similar therapeutic techniques to physical therapists. Cromie et al.(2000) evaluated the prevalence, severity, risks, and responses of disorders in physical therapists. He identified 4 categories of major risk factors commonly associated with workers musculo-skeletal disorders in physical therapists 1. Risk factors related to specific activities. 2. Postural risk factors. 3. Risk factors with regard to work load issues 4. Risk factors in regard of work capacity and health of the participant (Cromie et al., 2000). Physical risk factors found to be associated with neck, shoulder, or hand and wrist disorders in cross sectional studies are heavy lifting, monotonous work, static work postures, vibrations and repetitive jobs, and a high work pace (Alfredsson et al., 1999). Other factors that have been associated with musculoskeletal pain are higher age and female gender (de Zwart et al., 2001; Wahlstedt et al., 2001; Feveile et al., 2002).

Submitted in partial compliance with the requirements for the Master’s Degree in Technology: Chiropractic, Durban University of Technology, Durban, South Africa, 2018. / Background ABSTRACT In the chiropractic profession, it has been an established goal to utilise evidence-based practice (EBP) in clinical practice in order to empower chiropractors to develop effective treatment protocols. However, the extent to which chiropractors are utilising EBP, and the factors associated with its implementation in practice is unknown. The lack of research in this regard suggests that further studies need to be undertaken within the chiropractic profession in South Africa in order to fully understand the relationship of factors which contribute to the adoption and application of EBP by chiropractors in clinical practice. Therefore, the aim of this study was to investigate the knowledge of, attitudes towards, perceptions of and perceived barriers towards EBP by chiropractors within the eThekwini municipality. Method A pre-validated cross sectional descriptive survey was administered to chiropractors practicing within the eThekwini municipality (n = 101) by hand delivery. The questionnaire was validated by means of a focus group and pilot testing. Participants gave informed consent prior to participation. Data were analysed using using SPSS Statistics 24.0 and Statgraphics Centurion 15.1 (2006) to determine the descriptive and inferential statistics while the open- ended questions were analysed qualitatively using manifest coding. Results A response rate of 51% (n=51) was obtained. The majority of respondents were male (51%), mean age of 37.8 years, practicing for less than 19 years, working in full time practice (76.5%) between 40 and 49 hours per week (45.1%). The majority of the respondents had a positive attitude and perception towards EBP with respondents showing a willingness to improve skills (72.6%) and utilisation (52.9%) of EBP. Respondent 15 explained that “it is very important to have the skills in order to utilise EBP. Once you have the skills, utilising EBP becomes easy”. Responses highlighted that respondents are engaging with scientific literature when necessary and possess the skills necessary to utilise EBP. The majority of respondents believe that they had a strong academic foundation in their knowledge and skills related to accessing and interpreting information, yet 47.1% reported not having received formal training in search strategies to access literature. However, most felt confident about their knowledge and skills to utilise EBP. Insufficient time (66.7%), lack of generalisability of the literature findings to their patient population (49.0%) and the inability to apply research findings to individual patients with unique characteristics (45.1%) were the three top barriers identified. Respondent 12 described: “most articles are vague or time consuming and searching for relevant, up to date and reliable articles is a difficult process that can take a lot of time” as a possible barrier to utilising EBP. Conclusion The respondents in this study had a favourable attitude towards, and perception of, EBP and its usefulness to chiropractic practice. However, like other healthcare professionals they felt that they had insufficient time to utilise EBP. This study also highlighted the importance of academic institutions providing the necessary skills required to utilise EBP. It is recommended that workshops focusing on EBP principles and training are arranged to assist practitioners in integrating EBP into practice / M

Dissertation submitted in partial compliance with the requirements for the Master's Degree in Technology: Chiropractic, Durban University of Technology, 2017. / Title: A profile of patients presenting with spinal pain at Mahalapye and Shoshong World Spine Care clinics in Botswana Background: Spinal pain such as low back and neck pain, are common and can cause severe long term pain which results in a major burden on individuals and health care systems (Woolf and Pfledger, 2003; Hondras et al., 2015a). Low-income countries often have few resources for adequately addressing musculoskeletal (MSK) pain (Louw et al., 2007). Thus, World Spine Care (WSC), a non-governmental organization, opened two clinics in Botswana to help improve spinal health care by providing access to MSK specialists (Haldeman et al., 2015). These clinics have been functional since 2012, and to date the profile of patients attending these clinics has not been investigated. Studies on patients attending chiropractic clinics have been carried out internationally (Hartvigsen et al., 2002; Giles et al., 2002; Coulter and Shekelle, 2005; Holt and Beck, 2005; Mootz et al., 2005; Sorensen et al., 2006; Garner et al., 2007; Stevens, 2007; Rubinstein et al., 2008; Martinez et al., 2009; Ailliet et al., 2010; Lischyna and Mior, 2012) and locally (Benjamin, 2007; Jaman, 2007; Mohamed, 2007; Venketsamy, 2007; Higgs, 2009; McDonald, 2012; Hitge, 2014), and yet very little information exists on the patients presenting to clinics in the public sector of Botswana. Demographic and disease profiles of patients vary by clinical setting, from country to country, and within regions of the same country (Hoy et al., 2010a). Thus, this study aimed to determine the demographic and disease profile of spinal pain patients attending the WSC clinics in Mahalapye and Shoshong in Botswana. Method: A retrospective, descriptive study design was used to extract data from the WSC patient files at the Mahalapye and Shoshong WSC clinics from 1 November 2012 to 31 March 2016. The research proposal was approved by the Institutional Research Ethics Committee (IREC); REC 53/16 (Appendix A), WSC (Appendix B) and Botswana MoH (Appendix C). Patient files included had provided consent for their files to be used for research purposes (Appendix F). Data recorded included demographic characteristics, factors related to spinal pain, the presenting complaint and the presence of co-morbid conditions. The data was analysed using Statistical Package for the Social Science (SPSS) version 24.0. Descriptive statistics in the form of graphs and cross tabulations were used to describe the demographic and disease profile of the spinal pain patients. Inferential statistics like chi-square, Fischer’s exact test for categorical variables and Independent student’s t tests for numerical variables were used to determine differences between the two clinics. A p-value of less than 0.05 was used to indicate statistical significance (Singh, 2016). Results: The sample size was 65% (n=714). There was a female preponderance (75.2%, n=537), a mean age of 50.6 years (±SD 16.13). Most patients were married (38%) and the most common occupations were either farmers (18.2%, n=129) or unemployed (16.3%, n=115). The majority of patients suffered from chronic (88%), idiopathic (59.5%), low back pain (69.9%), followed by upper/mid back (19.1%), with the least visits occurring for neck pain (8%). The most frequent diagnosis was joint dysfunction with associated soft tissue disorders. The patients reported mild disability with moderate pain intensity and most patients had not experienced previous spinal pain (60%). The patients did not report a secondary area of MSK pain (28.6%) and 73.9% of patients presented with at least one comorbid condition. Patients attending the rural clinic were older on average (52.7 years, ±SD 16.92) than those at the urban clinic (48.9 years, ±15.29) (p = 0.002). There were more women attending the urban clinic when compared to the rural clinic (p = 0.009), with those attending the rural clinic most often reporting a primary school level of education in contrast to those in the urban clinic having most likely obtained a more than secondary school education (p < 0.001). More patients in the urban clinic had “other mechanical” e.g. joint dysfunction as an aetiology for their spinal pain when compared to the rural clinic (p = 0.039). In terms of pain duration, the rural clinic patients were more likely to present with acute and subacute pain than at the urban clinic (p = 0.001). The rural clinic patients also reported more previous episodes of spinal pain in contrast to those from the urban clinic (p <0.001). Conclusion: The spinal pain patients attending the WSC clinics had many similarities to spinal pain patients internationally and in SA, however unique differences were found specifically when the urban and rural clinic patients were compared. The findings of this study can assist WSC to provide more targeted healthcare at each clinic and within this region. / National Research Fund / M

Thesis (M.Tech.: Chiropractic) -Dept. of Chiropractic, Durban Institute of Technology, 2002 xiii, 93 leaves / The purpose of this study was to determine the short to medium term effectiveness of Proprioceptive Neuromuscular Facilitaion (P.N.F.) stretching [using the Contract- Relax-Antagonist-Contract (C.R.A.C.) technique] as an adjunct treatment to cervical manipulation in the treatment of Mechanical Neck Pain.

Thesis (M.Tech.: Chiropractic)- Dept. of Chiropractic, Durban Institute of Technology, 2002 xii, 90 leaves / The purpose of this study was to determine the relative efficacy of topical flurbiprofen in the form of a local action transcutaneous patch (LAT), in the treatment of lateral epicondylitis.

Thesis (M.Tech.: Chiropractic) -Dept. of Chiropractic, Technikon Natal, 2002 1 v. (various pagings) / The purpose of this clinical trial was to evaluate the efficacy of Magnesium phosphate, as an adjunct to dry needling, in the treatment of Myofascial Pain Syndrome (MPS), in terms of objective and subjective clinical findings. MPS is a frequently encountered condition. If not treated adequately, this condition can lead to long term, recurrent pain, as well as patient and physician frustration. Many treatment protocols have been examined with contradictory results and research into epidemiological studies and combinations of various treatment protocols are lacking.