Thesis (MScPhysio)--Stellenbosch University, 2012 / ENGLISH ABSTRACT: SYSTEMATIC REVIEW ABSTRACT - BACKGROUND: Ankle Foot Orthoses (AFOs) are considered as the most suitable lower limb orthosis to correct gait deficits related to ankle instability. AFOs are recommended to minimize gait deviations and to correct drop foot or equinus foot in hemiplegic patients. OBJECTIVES - To identify the effectiveness of different ankle orthoses and/or supports on the temporal, spatial, kinetic and kinematic gait parameters. To critically appraise the methodological quality of the included studies and to provide a description of the studies with a view to identify opportunities to improve future research quality. METHODS - Search strategy A comprehensive search was conducted between March and October 2010, and updated in August 2011. Thirteen computerized bibliographic databases were individually searched, namely PubMed Central, Cohrane Library, CINAHL, OT Seeker, SPORTDiscus, PsyARTICLE, PEDro, Proquest, Biomed Central, Science Direct, Clinicaltrials.gov, Web of Science, and Ingenta Connect. All databases were searched since their inception. The following key terms were used: stroke, hemipleg*, assistive device*, ankle foot orthos*, AFO, (splint*), taping, and strapping. A secondary search (pearling) was conducted by screening the reference lists of all eligible full text studies. The authors of the unpublished studies were conducted to minimize publication bias. Selection criteria The following selection criteria applied: all relevant randomized and non-randomized controlled trails published in English; participants were post-stroke patients older than eighteen years; interventions included any type of ankle foot orthosis (AFO), ankle taping or strapping and ankle foot splint without any additional intervention and the comparison/control groups were limited to walking without support, either barefoot or walking with shoes only. Studies were excluded when the outcome measures did not focus on at least one of the following: temporal spatial gait parameters, kinetic gait parameters or kinematic gait parameters. Data collection and analysis Two reviewers independently selected trials for inclusion and assessed methodological quality. The data was extracted by the primary reviewer and validated by a second reviewer. In event of disagreement, a third reviewer was asked to re-evaluate until consensus could be reached. Homogenous data were statistically summarized in sub-group meta-analysis using Revman© Review Manager Software. The results of heterogeneous data were summarized in a narrative form. MAIN RESULTS - The search yielded 11134 initial hits. Sixteen studies met the inclusion/exclusion criteria. The studies investigated the immediate effect of various types of AFOs on a broad range of temporal spatial gait parameters mainly gait speed, cadence, stride and step length. Only two studies reported on the kinetic and six on various kinematic gait parameters. The meta-analysis yielded significant improvement in gait speed (0.06 m/s; 95% CI 0.04, 0.08. p < 00001), walking cadence (5.41; 95% CI 3.79, 7.03. p < 00001), stride length (6.67; 95% CI 3.29, 10.06. p < 00001) and step length (2.66; 95% CI 1.59, 3.72. p < 0.00001). CONCLUSION - AFOs are effective to improve mobility, gait speed, cadence, stride and step length for post-stroke patients and may have a positive impact on the daily function of post-stroke patients. . The long term benefit or adverse effects of AFOs are still inconclusive. The effectiveness of AFOs on the kinetic and the frontal- or transverse- plane joint kinematics is largely unresolved. There is insufficient evidence to either support or refute the effectiveness of taping/strapping and splinting of the ankle on hemiplegic gait. EXPERIMENTAL STUDY ABSTRACT - BACKGROUND: Temporal, spatial and affected ankle kinematic gait parameters of adults with hemiplegia are significantly different from the normal able-bodied population. Enabling hemiplegic patients to walk is a major goal of rehabilitation programs. Taping of the plegic ankle could be utilized by therapists as external support of the ankle to improve foot position and placement during gait rehabilitation. OBJECTIVE - The purpose of the study was to describe the immediate effect of neutral ankle taping on temporal spatial gait parameters and ankle joint kinematics of the affected ankle in ambulant adult hemiplegic patients. METHODS - A clinical trial using a crossover randomized testing order was conducted on a convenient sample of ten ambulant hemiplegic patients at the Physiotherapy and Motion Analysis Clinic, Faculty of Health Sciences, Stellenbosch University, Tygerberg, Cape Town, South Africa. The affected ankle joint was taped in a neutral talocrural dorsiflexion/ plantarflexion and neutral hindfoot inversion/ eversion position using rigid adhesive tape (5 cm). The gait parameters were analysed according to the Plug-In Gait Model using a motion analysis system (Vicon Nexus 1.1.7; Vicon Motion System Limited, Oxford, UK). The analyses were repeated six times for each testing condition and the average values were used for further analysis. The data were analyzed using Least Square Means tests and post hoc Fisher (Least Significant Difference) LSD multiple comparison tests to determine the significant differences at 95% confidence level. RESULTS - The main results of the study indicate that taping of the affected ankle joint in a neutral position does not significantly improve (p>0.5) temporal spatial gait parameters and ankle joint kinematics in ambulant adult hemiplegic patients. The following positive trends were however found and need to be further explored in larger homogeneous study samples: ankle taping of ambulant adult hemiplegic patients has limited benefits on selected temporal parameters as ankle taping could potentially improve cadence. Ankle taping could decrease plantarflexion of the plegic leg at initial contact. CONCLUSIONS - A systematic review revealed no conclusive evidence either to support or refute the beneficial effects of ankle taping on gait parameters of ambulant adult hemiplegic patients. Ankle taping of ambulant adult hemiplegic patients has potential clinical benefits on temporal, spatial and affected ankle kinematics, gait cadence and affected leg swing and stance duration.

Thesis (MScPhysio (Physiotherapy))--University of Stellenbosch, 2007. / Stroke is a difficult condition to manage because of the complex nature of its effects. Caregivers are therefore, crucial in providing ongoing care for the stroke patient at home. Caregivers experience considerable strain during caregiving, as their needs are often overlooked because therapeutic management tends to focus mainly on the stroke patient. In third world countries like South Africa, there are currently no research studies found describing an optimum support intervention which addresses the caregivers' needs and reduces their strain levels. Objective To determine the effectiveness of a caregiver support intervention programme (CSIP) that was developed to address the expressed needs identified by the primary caregiver of the stroke patient in the Bishop Lavis community. Method A prospective and descriptive qualitative study design was used to evaluate the effectiveness of the CSIP. A total of 29 caregivers participated in three CSIPs, which were implemented over five sessions each. The Barthel Index was used to measure the functional level of each stroke patient. The needs of stroke caregivers were determined by 15 semi-structured interviews, until data saturation was reached. The Caregiver Strain Index was completed before and after implementation of the CSIP, in order to measure whether the intervention programme had been effective in reducing the caregivers' level of strain. Written or verbal feedback forms was also completed by the caregivers after each of the five intervention sessions. Results were analysed using repeated measures ANOVA and descriptive qualitative analysis. Results The qualitative results of this study suggest that the CSIP was effective in addressing mainly the physical needs, as well as the emotional, educational and socio-economic needs of the primary caregivers. The CSIP was also effective in reducing caregiver strain in 61.5% of the sample (N=13). However, an additional finding of this study was the personal and logistical barriers identified which limited the caregivers' attendance of the sessions. Conclusion The CSIP was effective in addressing the physical, emotional, socio-economic and educational needs of the primary caregiver. In addition, the results also verified that the CSIP was effective in reducing caregiver strain in the majority of the caregivers, despite a small sample size. The barriers identified which affected the caregivers' attendance, need to be taken into consideration when planning future intervention programmes for caregivers in poor socioeconomic communities. Due to the low attendance rate by the caregivers, a larger sample size is recommended to accommodate for the high drop-out rates in such a population.

Thesis (MScPhysio)--Stellenbosch University, 2012. / Background: Evidence for the effectiveness of physiotherapeutic interventions in the management of knee osteoarthritis (OA) is synthesised in the current clinical guidelines (CGs), providing clinicians with readily accessible and interpretable practice guidelines. However, CGs are often not specific to the local context of the target users, therefore hindering successful implementation of evidence into clinical practice. Formulating succinct and composite recommendations by synthesising the current CGs reporting on the evidence-based (EB) management of knee OA may assure contextual relevance and facilitate implementation of evidence into clinical practice. In addition, multifaceted interventions, such as evidence-based practice (EBP) workshops, are also postulated to promote the implementation of guideline recommendations, thereby enhancing clinical outcomes. Objectives: The primary objectives of this study were to: 1) describe the range of EB physiotherapeutic interventions in the management of knee OA as documented in the current CGs; and 2) develop composite clinical recommendations for a specific group of users working in Jerusalem. A secondary study objective was to ascertain the effect of translating the knowledge through a specifically-designed EBP workshop on the uptake of knowledge and implementation of EBP into clinical practice by physiotherapists working in Jerusalem. The EBP workshop was aimed at educating physiotherapists about the EB physiotherapeutic techniques for knee OA management. Study design: Two studies were conducted. A systematic review (SR) into EB clinical guidelines was conducted to describe and synthesise the available evidence and formulate composite recommendations for knee OA. The results of the SR were used to design an EBP workshop aimed at educating physiotherapists about EB physiotherapeutic techniques for treating knee OA patients. A pre-post quasi-experimental design was then conducted to assess the effect of this EBP workshop on the uptake and implementation of EBP into clinical practice amongst public sector physiotherapists working in Jerusalem. Methodology for quasi experimental study: Physiotherapists who regularly treat knee OA patients were recruited from a list of members registered with the Palestinian Physiotherapy Association Jerusalem. A three-month retrospective audit (initial audit) of knee OA patients’ physiotherapy records kept by the participating physiotherapists was conducted to establish current management patterns. EB strategies for knee OA was presented to the participating physiotherapists during a one-day workshop. A second audit of physiotherapy records was conducted three months after the EBP workshop to establish changes in the selection of physiotherapeutic management techniques for knee OA. Results: The initial audit revealed that the participating physiotherapists utilized one high EB modality namely, exercises, as a core management strategy in knee OA, but did not frequently implement other high EB modalities such as self-management and weight-loss programs. Following the EBP workshop, a statistically significant increase (p=0.008) in the implementation of weight-loss and self-management strategies in the management of knee OA was noted. Conversely, a statistically significant decrease was noticed in using patellar taping (low EB modality) in the management of knee OA (p=0.04). No significant changes were noticed in the utilization of other physiotherapy modalities supported by weak or modest EB recommendations. Conclusion: The study concluded that physiotherapists inherently prescribed exercise as a core management strategy for knee OA. Modalities supported by modest levels of evidence were used as adjunct treatments. The EBP workshop facilitated the increased application of high EB modalities such as weight-loss and self-management programs. The results of this study illustrate that an EBP workshop may be effective in promoting the implementation of EB physiotherapeutic modalities in the management of knee OA. However, larger studies with longer follow-up periods are required. / No Afrikaans abstract available

Thesis (MScPhysio)--Stellenbosch University, 2012. / ENGLISH ABSTRACT: Background Traumatic spinal cord injury (SCI) remains one of the most serious and devastating injuries often resulting in permanent disability and with life changing implications for the individual and his/her family. Successful reintegration into community life and employment after SCI is considered important goals of rehabilitation as this has been positively associated with quality of life, self esteem and life satisfaction. The International Classification of Functioning, Disability and Health (ICF) allows researchers to identify the impact of environmental factors on functioning and disability. Minimal research, particularly in South Africa, has been done on the impact of the environment on persons living with various health conditions and specifically spinal cord injury. Objectives The main purpose of this study was to describe and compare the level of participation of persons with traumatic SCI at two time points (discharge and six months after discharge) from the inpatient rehabilitation setting and to identify the environmental barriers experienced. Methods A prospective, descriptive study was conducted using consecutive sampling. All patients with traumatic SCI that were discharged from September 1, 2008 from the Western Cape Rehabilitation Centre (WCRC) who were eligible for this study were included. Two questionnaires (one based on the ICF and one purposely-developed) and the International Standards for the Classification of SCI (ISCSCI) were used. Data were analyzed with the statistical software package STATISTICA. Results A person sustaining a traumatic SCI in the Cape Metropolitan area of the Western Cape Province is most likely to be a male, young (20 to 29 years), of the Black or Coloured race and living in the Cape Flats suburbs. More than half of the subjects had a grade eight to ten level of education which together with the lack of employers’ responsibilities towards part-time workers might explain the low percentage (11%) of employment at six months after discharge from the WCRC. Complete paraplegia, occurring mainly in the thoracic cord, was the most common neurological disability found in this study. The most common secondary condition was pain followed by spasticity limiting function. The low incidence of pressure sores and urinary tract infections found in this study contradicts findings of previous studies.The majority of the subjects were discharged to the same house they were living in at the time of their injury. However, due to various architectural barriers, some of them were not able to function independently in their homes. Inaccessibility of public transport, the lack of recreational and sport facilities, lack of social support structures in the community and inadequate financial resources were the main environmental barriers experienced by these individuals. Conclusion The main finding of this study was the low employment rate and the difficulty experienced with reintegration at community level after SCI. The results of this study confirm the significant contribution of environmental factors in participation, especially those of transport and education in return to work. Fourteen years after the publication of the Integrated National Disability Strategy (INDS) White Paper (1997), legislative strategies to ensure that people with disabilities have equal access to social and economic opportunities remain lacking. / AFRIKAANSE OPSOMMING: Agtergrond Traumatiese spinaalkoordbesering (SKB) lei dikwels tot permanente verlamming en dit het lewensveranderende implikasies vir die individu en sy/haar familie. Suksesvolle herintegrasie in die gemeenskap en werkverrigting na SKB is belangrike doelstellings vir rehabilitasie omdat dit positief met lewenskwaliteit, selfrespek en lewens-bevrediging geassosieer word. Die Internasionale Klassifisering van Funksionering, Gestremdheid en Gesondheid (IKF) bied aan navorsers die geleentheid om die impak van omgewingsfaktore op funksionering en gestremdheid te identifiseer. Daar is veral in Suid-Afrika beperkte navorsing oor die impak van die omgewing op mense met verskillende gesondheidstoestande, spesifiek SKB. Doel Die hoofdoel van hierdie studie was om die vlak van deelname van mense met traumatiese SKB op twee verskillende tye te beskryf en te vergelyk, onmiddellik na hulle uit die rehabilitasiesentrum ontslaan is, en ses maande later. Die studie het ook ten doel gehad om die omgewingsfaktore te identifiseer wat deelname negatief beïnvloed. Metode Daar is van ’n beskrywende studie gebruik gemaak. Alle pasiënte met traumatiese SKB wat vanaf 1 September 2008 vanaf die Wes-Kaapse Rehabilitasiesentrum (WKRS) ontslaan is en wat voldoen het aan die insluitingskriteria is ingesluit. Twee vraelyste is gebruik om data in te samel – een is op die IKF gebaseer en een is spesifiek vir die studie ontwikkel. Daar is ook van die Internasionale Standaarde vir die Klassifisering van SKB (ISKSKB) gebruik gemaak om data in te samel. Data is met behulp van STATISTICA, ’n statistiese sagteware pakket, geanaliseer. Resultate Iemand wat ’n traumatiese SKB in die Kaapse metropolitaanse gebied van die Wes-Kaap provinsie opdoen, is mees waarskynlik ’n jong man (20 tot 29 jaar) van die Swart of Kleurling ras wat woonagtig in die voorstede op die Kaapse Vlakte is. Meer as die helfte van die deelnemers in die studie het slegs ’n opvoedingsvlak van graad agt tot tien. Hierdie aspek, tesame met die gebrek aan werkgewers se verantwoordelikheid teenoor deeltydse werknemers is dalk die rede waarom slegs 11% van die deelnemers ses maande na hulle uit die WKRS ontslaan is, werksaam was. Volledige paraplegie, hoofsaaklik as gevolg van ’n besering van die torakale spinaalkoord, was die algemeenste neurologiese besering wat in hierdie studie gevind is. Die algemeenste sekondêre komplikasie wat voorgekom het, was pyn gevolg deur spastisiteit. Die lae voorkoms van druksere en urienweginfeksies in dié studie is in teenstelling met bevindings van vorige studies. Die meeste deelnemers is ontslaan na dieselfde huis waar hulle voor die besering gewoon het, maar as gevolg van verskeie argitektoniese hindernisse, kon sommige van hulle nie onafhanklik binne hulle wonings funksioneer nie. Die ontoeganklikheid van openbare vervoer, die gebrek aan ontspannings- en sportfasiliteite, die gebrek aan sosiale ondersteuningsnetwerke in die gemeenskap en onvoldoende finansiële hulpbronne was die algemeenste omgewingshindernisse wat deur die deelnemers ondervind is. Samevatting Die belangrikste bevinding van dié studie was dat slegs ’n klein persentasie van die deelnemers ses maande na hul ontslaan is, werksaam was en dat herintegrasie in die gemeenskap na ’n SKB baie moeilik is. Die resultate van die studie bevestig die belangrike rol wat omgewingsfaktore by deelname speel, veral die faktore wat te make het met vervoer en die opvoedingsvlak wanneer daar na ’n werk teruggekeer word. Veertien jaar na die publikasie van die Geïntegreerde Nasionale Gestremdheidstrategie in 1997, is wetgewende strategieë om gelyke toegang tot sosiale en ekonomiese geleenthede vir persone met gestremdhede te verseker, steeds gebrekkig.

Thesis (MScPhysio)--Stellenbosch University, 2008. / ENGLISH ABSTRACT: Acute exacerbation is an important event of COPD as it causes significant disability and mortality. Especially repeated hospitalisation of patients with acute exacerbation has been associated with reduce quality of life and excessive hospitalisation cost. Chronic Obstructive Pulmonary Disease causes significant functional limitations that translate into enormous economic and societal burden. Study Aim: To describe the profile and selected outcomes of Chronic Obstructive Pulmonary Disease (COPD) patients admitted with acute exacerbation to hospitals in the northern suburbs of the Western Cape. Study design: A multicenter retrospective descriptive single subject design was used. Method: Patients admitted with the diagnosis of COPD with acute exacerbation in the time period 01June 2004-01June 2005 were followed up retrospectively for a period of 12 months. The demographics, medical condition on admission and past presentation of acute exacerbation, length of stay in hospital and the number of readmissions for acute exacerbation in the 12 month period were collected and recorded on a self designed data capture sheet. Results: One hundred and seventy eight patients were admitted with acute exacerbation at the three hospitals. The mean age of the patients were 63 (±11.73), more males than females (103: 75) were admitted. Subjects spent a mean of 5.67 (±6.55), days in hospital with every admission and admission frequency of up to eight periods were recorded. Of the n=178 admitted, 56% had one admission and 44% had 2 or more admissions in the study year. This resulted in a total of 338 hospital admissions with the 78 subjects responsible for the majority of admissions (238) Subjects presenting with two or more co-morbidities had a significantly greater risk of multiple re admissions. Subjects with three or more admissions had two or more co morbidities (p=0.001), comparatively those with one admission had only one co morbidity. Congestive cardiac failure (p=0.01) as well as the lack of Long Term Oxygen Therapy p=0.017) were associated with increase risk of three or more admissions. Conclusion: Patients admitted with acute exacerbation to the hospitals where the study was conducted presented with an age ranging from 30-95 years. Patients with 2 or more admissions experience up to eight readmissions episodes in the study year. This is a cause of concern in respect of the burden of disease on especially the younger economically viable South African population. In the current study factors that influenced readmission were the presence of two or more co morbid diseases, specifically the presence of congestive cardiac failure as well as the lack of LTOT. Interventions including a pulmonary rehabilitation programme post discharge should be aimed at decreasing frequency of hospitalisation especially in those patients who are a risk of readmission. / AFRIKAANSE OPSOMMING: Verergering van simptome in Kroniese Obstruktiewe Lugweg Siekte (KOLS) is baie belangrik as gevolg van die ongeskiktheid en mortalitieit wat dit veroorsaak. Dit veroorsaak vermindering in die kwaliteit van lewe en verhoog hospitaal koste verbind met die siekte. Die beperkings toe te skrywe aan die Kroniese Obstruktiewe Lugweg Siekte veroorsaak ontsettende ekonomiese en sosiale druk. Doelstelling: Om die profiel en geselekteerde uitkomste van pasiente met Kroniese Obstruktiewe Lugweg Siekte toegelaat met verergering in die hospitale van die noordelike voorstede van die Wes Kaap te beskryf. Studie ontwerp: ʼn Multisentrum retrospektiewe beskrywende enkel persoon studie. Studie metode: Pasiente toegelaat met verergering van Kroniese Obstruktiewe Lugweg Siekte in die periode 01Junie 2004-01Junie 2005 was retrospektief opgevolg vir ‘n periode van 12-maande. Demografiese data, mediese toestand op toelating en ontslag, lengte van hospitaal verblyf en getal toelatings in die 12- maande was gekollekteer en gedokumenteer op self ontwerpde vorms. Resultate: Een-honderd agt en seventig pasiente was toegelaat met verergering by die drie hospitale. Die gemiddelde ouderdom van die studie populasie was 63 (±11.73) met meer mans as vrouens (103: 75) toegelaat. Die studie populasie het gemiddelde dae van 5.67 (±6.55), in die hospitaal deurgebring en toelating frekwensie van agt episodes was gedokumenteer. Van die n=178 toegelaat was 56% eenkeer toegelaat en 44% het 2 of meer toelatings in die studie jaar gehad. Dit het in 338 hospital toelaatings veroorsaak en 78 van die studie populasie verantwoordelik vir die meeste van die toelatings (238). Die groep met drie of meer toelatings in die studie jaar het twee of meer siektetoestande (p=0.001) gehad, teenorgesteld met die wat net een toelaat was met een siektetoestand. Hart versaaking (p=0.01) en die gebrek aan suurstof by die huis (p=0.017) was verbind met meer risiko van drie of meer toelating. Samevatting: Die ouderdoms verskil was wydbeskrywend van 30-95 jaar van die pasiente wat in die studie jaar toegelaat is by die drie hospitale. Pasiente wat 2 of meer keer toegelaat is het tot agt hertoelatings in die studie jaar gehad. Kommerwekkend is die uitwerking van die siekte op die jonger werkend populasie in Suid Afrika. In die studie was hertoelating beinvloed deur die teenwoordigheid van twee of meer siektetoestande, spesifiek hart versaaking sowel as die gebrek aan suurstof by die huis. Intervensies insluitende pulmonale rehabilitasie na ontslag se doel moet wees om vermindering van heraaldelike hospitalisasie in hoë risiko pasiente vir hospitalisasie.

Thesis (MScPhysio (Physiotherapy))--University of Stellenbosch, 2009. / Introduction Decreased hip extension in the paretic leg is a common impairment after stroke. Gluteal taping was introduced as a technique that helped in increasing hip extension of the paretic leg, and step length in the unaffected leg. The aim of this study was to further investigate the effect of gluteal taping on other temporal spatial and kinematic parameters using a 3D motion analysis system (Moven System). Methods The study was conducted in two phases. Phase 1 entailed examining the intra trial reliability of the Moven System, where eight subjects were recruited and tested twice at their normal pace of walking, and twice again at their maximum speed. Phase 2 involved studying the effect of gluteal taping on temporal spatial and kinematic parameters. Thirty subjects participated and were tested under three taping conditions (no tape, therapeutic tape, and placebo tape), while walking at their self selected walking speed. Intra-class correlation coefficient ICC determined around 95% confidence intervals was used to examine the intra trial reliability of the Moven System. Repeated measures-ANOVA was used to study the temporal spatial, and kinematic variables during the three taping conditions. Results The Moven showed moderate to excellent reliability in measuring the gait variables including temporal spatial parameters and sagittal kinematic parameters in addition to the lateral pelvic tilt. Taping caused significant increase in hip extension and reduction in knee flexion at terminal stance for the paretic leg. There was a trend toward better hip flexion at terminal stance, and a mild trend toward more planter flexion at terminal stance. Both treatment and placebo tapes caused an increase in the step lengths of either leg, and a significant increase in gait velocity and cadence. Conclusion Gluteal taping may be beneficial in producing important clinical effects post stroke, and can be used as an adjunct strategy during gait rehabilitation. Further research is needed to understand the mechanism of how taping produces effects, and to further explore its effect on kinetic and muscle activation variables.

Thesis (MScPhysio)--Stellenbosch University, 2014. / ENGLISH ABSTRACT: Introduction: Groin injuries are among the top six injuries in contact sports and may lead to career ending chronic pain. Research on the role of knee kinematics in developing chronic groin pain in sport is scarce. Objective: The purpose of this study was to determine if there are differences in knee kinematics during a single-leg drop-landing in sports participants with chronic groin pain compared to asymptomatic controls. Methodology: A descriptive study was conducted. Twenty active sports’ participants were recruited from soccer and rugby clubs situated around the Cape Peninsula area, Western Cape, South Africa. The three-dimensional (3D) knee kinematics of ten cases with chronic groin pain and ten asymptomatic controls was analysed. Knee kinematics was analysed in the FNB-3D Vicon Laboratory at Stellenbosch University, using an eight camera Vicon system. A positive adductor squeeze test was used as a diagnostic test to include cases with chronic groin pain. Each participant performed six single-leg drop landings. The main outcome measure was 3D knee kinematics at initial foot contact and at the lowest vertical position of the drop landing. The following sub-groups were analysed: seven unilateral groin pain cases compared to their seven matched controls; three bilateral groin pain cases where their most painful leg and least painful leg were compared to their matched controls, respectively. Descriptive statistical techniques were used for all outcome measures; means and standard deviations (SD) were calculated, followed by a Student’s t-test to determine significant differences between the cases and controls. For all outcomes with p-values equal to or below 0.05, the effect size was calculated using the Cohen’s D. Results: The findings of this study indicated a significant difference (p=0.0001) between cases with unilateral groin pain having less knee internal rotation compared to the controls at the lowest vertical position of the drop landing in the transverse plane. Significantly less internal rotation (p<0.0001), was also noted in the cases with bilateral groin pain (in the most painful leg and the less painful leg), although this was noted at foot contact. Cases with bilateral groin pain also had significantly (p<0.001) more knee varus (adduction) during the landing phase. Conclusion: Differences in knee kinematics between sports participants with chronic groin pain and asymptomatic controls were found. These findings imply that the knee joint should be included during assessment and rehabilitation of individuals suffering with chronic groin pain. Due to the cross-sectional study design of the current study, it cannot be stated for certain whether the knee kinematics noted in the groin pain group are causative or as a result of groin pain. Future prospective studies are thus recommended; these studies should focus on the effect of contralateral knee kinematics on the hip adductors and may include exploration of the muscular components during a single-leg drop landing. / AFRIKAANSE OPSOMMING: Inleiding: Lies beserings is een van die top ses beserings in kontak sport en kan lei tot chroniese lies pyn en selfs die be-eindigging van ‘n sportloopbaan. Navorsing oor die rol van knie kinematika in die ontwikkeling van chroniese liesbeserings in sport is skaars. Doelwit: Die doel van hierdie studie was om te bepaal of daar verskille in die knie kinematika is tydens 'n enkel been val landing in sport deelnemers met chroniese lies pyn in vergelyking met gesonde kontroles. Metode: 'n Beskrywende studie was uitgevoer. Twintig aktiewe sport deelnemers is gewerf van rugby en sokker sportklubs geleë rondom die Kaapse Skiereiland, Wes-Kaap, Suid-Afrika. Die 3D knie kinematika van tien gevalle met chroniese lies pyn en tien asimptomatiese bypassende kontroles is ontleed. Knie kinematika was ontleed in die FNB-3D Vicon Laboratorium by die Universiteit van Stellenbosch, met behulp van 'n agt-kamera Vicon stelsel. 'n Positiewe Adduktor druk toets was gebruik as 'n diagnostiese toets om gevalle met chroniese lies pyn in te sluit. Om die knie kinematika te analiseer, het elke deelnemer ses enkel been val landings uitgevoer . Die belangrikste uitkomsmeting was 3D knie kinematika by die aanvanklike voet kontak en by die laagste vertikale posisie van die enkel-been val landing. Die volgende sub-groepe was ontleed: sewe unilaterale lies pyn gevalle in vergelyking met hul sewe bypassende kontroles; drie bilaterale lies pyn gevalle waar hul mees pynlike been, sowel as minder pynlike been onderskeidelik vergelyk was met hul bypassende kontroles. Beskrywende statistiese tegnieke was gebruik vir alle uitkoms maatreëls; gemiddeldes en standaardafwykings (SA) was bereken, gevolg deur 'n Studente’s t-toets om beduidende verskille tussen die gevalle en kontroles te bepaal. Vir al die uitkomste met p-waardes gelyk of onder 0.05, is die effekgrootte bereken deur die Cohen’s D. Resultate: Die bevindings van hierdie studie dui op 'n beduidende verskil (p=0,0001) tussen gevalle met unilaterale lies pyn met minder interne knie rotasie in vergelyking met die kontroles by die laagste vertikale posisie van die val landing in die dwars vlak. Aansienlik minder interne rotasie (p<0,0001), is ook opgemerk in gevalle met bilaterale lies pyn (in die mees pynlike been en die minder pynlik been), alhoewel tydens voet kontak. Gevalle met bilaterale lies pyn het ook betekenisvol (p <0.001) meer knie varus (adduksie) tydens die landingsfase gehad. Gevolgtrekking: Verskille bestaan in die knie kinematika tussen sport deelnemers met chroniese liesbesering pyn en gesonde kontroles. Hierdie bevindinge impliseer dat die knie behoort ingesluit te word tydens die assessering en rehabilitasie van individue met chroniese lies pyn. As gevolg van die deursnee-studie ontwerp van hierdie studie, kan dit nie bevestig word of die knie kinematika die oorsaak van die chroniese pyn is nie. Toekomstige voornemende studies word dus aanbeveel, hierdie studies moet fokus op die effek van die kinematika van die kontralaterale knie op die heup adduktore en kan moontlik die ondersoek van die spier kinetika tydens hierdie aktiwiteit insluit.

Thesis (PhD)--Stellenbosch University, 2013. / ENGLISH ABSTRACT: Research objective To test a novel concept that exposing patients with fibromyalgia syndrome (FMS) to visuals of exercise activities elicits neurophysiological changes in functional brain areas associated with pain catastrophization; thereby providing preliminary support for the further development/testing of a virtual reality exposure therapy (VRET) exercise program aimed at reducing pain catastrophization toward exercise therapy in patients with FMS. Methods The main study of this research consisted of a three-phase exploratory fMRI study. Phase 1 involved the development/validation of the fMRI visual task. Phase 2 involved the exploration of the differences in neural correlates associated with pain catastrophizing between participants with FMS and healthy controls when exposed to various visuals of exercise and passive/relaxing activities. Phase 3 involved the testing of the preliminary efficacy of a novel VRET exercise program on pain catastrophization in participants with FMS. The fMRI task consisted of two stimuli: active (exercise activity visuals)/passive (relaxing activity visuals). Structural images as well as blood-oxygenation-level-dependent (BOLD) contrasts were acquired for the conditions and compared within-subjects/groups and between-groups. The condition of interest was the active>passive condition (where brain activations for the passive condition were subtracted from the active condition). The brain volumes collected during ‗on‘ conditions were compared with the brain volumes collected during ‗off‘ conditions using Students‘ t test. Statistic images were thresholded using clusters determined by Z>2.3 and a (corrected) cluster significance threshold of p=0.05. Results The right (R) middle and inferior frontal gyrus and R posterior cerebellum were significantly activated for the participants with FMS, and not the healthy control group, during the active>passive condition (phase 2). At baseline, during the active>passive condition (phase 3), the intervention/VRET group showed significant activation (p<0.05) in the R insular cortex, R anterior and posterior cerebellum, R parahippocampal gyrus, R middle frontal gyrus, R corpus callosum, R thalamus, R supramarginal gyrus and R middle and superior temporal gyrus; the control group showed significant activation in the R anterior and posterior cerebellum, R middle and superior temporal gyrus, R middle frontal gyrus, R insular cortex, R supramarginal gyrus and R precentral gyrus. Post-intervention, during the active>passive condition, R posterior cerebellum activation was still significant (p<0.05) for the intervention group; R anterior cerebellum, left (L) middle and inferior frontal gyrus, and R superior parietal lobe activation was found to be significant (p<0.000) for the control group, although these areas were not found to be significantly activated at baseline for the control group. Conclusion We could not provide confirmatory evidence for the efficacy of a novel VRET program for pain catastrophization in patients with FMS. However, the findings of this study does suggest that pain catastrophization in patients with FMS could be confirmed with fMRI. Research is therefore warranted to further develop a proper VRET exercise program and to test the effect of this program on pain catastrophization in patients with FMS. / AFRIKAANSE OPSOMMING: Navorsing doelstelling Om 'n nuwe konsep dat die blootstelling van pasiënte met fibromialgie sindroom (FMS) aan beeldmateriaal van oefening, ontlok neurofisiologiese veranderinge in funksionele brein-areas wat verband hou met pyn katastrofering te toets; sodoende voorlopige steun vir die verdere ontwikkeling/toetsing van 'n virtuele realiteit blootstelling terapie (VRET) oefenprogram wat gemik is op die vermindering van pyn katastrofering na oefenterapie in pasiënte met die FMS te bied. Metodes Die hoofstudie van hierdie navorsing bestaan uit 'n drie-fase verkennende fMRI studie. Fase 1 het die ontwikkeling/validering van die fMRI visuele taak behels. Fase 2 het die ondersoek van die verskille in die neurale korrelate geassosieer met pyn katastrofering tussen deelnemers met FMS en gesonde kontroles wanneer hulle blootgestel word aan verskeie beeldmateriaal van oefening en passiewe/ontspannende aktiwiteite behels. Fase 3 het die toets van die voorlopige effektiwiteit van 'n nuwe VRET oefenprogram op pyn katastrofering in deelnemers met FMS behels. Die fMRI taak het bestaan uit twee stimuli: aktiewe (oefening aktiwiteit beeldmateriaal)/passiewe (ontspannende aktiwiteit beeldmateriaal). Strukturele beelde sowel as bloed-suurstof-vlak-afhanklike (BSVA) kontraste is vir die toestande verkry en vergelyk binne-deelnemers/groepe en tussen-groepe. Die toestand van belang was die aktiewe>passiewe toestand (waar brein aktivering vir die passiewe toestand afgetrek is van die aktiewe toestand). Die brein volumes wat ingesamel tydens die 'aan' toestande is vergelyk met die brein volumes wat ingesamel is gedurende die 'af' toestande met die gebruik van Studente se t-toets. Drempel statistiek beelde is gegroepeer deur Z> 2,3 en 'n (gekorrigeerde) groepeerde betekenisvolle drempel van p = 0.05. Resultate Die regter (R) middel- en inferior-frontale gyrus en R posterior serebellum is betekenisvol geaktiveer vir die deelnemers met FMS, maar nie vir die gesonde kontrole groep nie, gedurende die aktiewe>passiewe toestand (fase 2). By basislyn, tydens die aktiewe>passiewe toestand (fase 3), die intervensie / VRET groep het betekenisvolle aktivering (p <0.05) in die R insulaire korteks, R anterior en posterior serebellum, R para- hippokampus gyrus, R middel-frontale gyrus, R korpus kallosum, R talamus, R supramarginale gyrus en R middel- en superior-temporale gyrus; die kontrole groep het betekenisvolle aktivering in die R anterior en posterior serebellum, R middel- en superior-temporale gyrus, R middel-frontale gyrus, R insulaire korteks, R supramarginale gyrus en R presentrale gyrus. Post-intervensie, tydens die aktiewe>passiewe toestand, was R posterior serebellum aktivering betekenisvol (p <0.05) vir die intervensie groep; R anterior serebellum, links (L) middel- en inferior-frontale gyrus en R superior pariëtale lob aktivering was betekenisvol (p <0.000) vir die kontrole groep, alhoewel geen betekenisvolle basislyn aktivering in hierdie areas by die kontrole groep plaasgevind het nie. Gevolgtrekking Ons kan nie bewyse vir die effektiwiteit van 'n nuwe VRET program vir pyn katastrofering in pasiënte met FMS bevestig nie. Nietemin, dui die bevindinge van hierdie studie wel daarop dat pyn katastrofering in pasiënte met FMS bevestig kon word met fMRI. Verdere navorsing is dus geregverdig om 'n behoorlike VRET oefenprogram te ontwikkel en die uitwerking van hierdie program op pyn katastrofering in pasiënte met FMS te toets.

Thesis (MScPhysio (Physiotherapy))--University of Stellenbosch, 2007. / INTRODUCTION Computer use has been identified as a risk factor for the development of musculoskeletal dysfunction among children and adolescents internationally. Computer exposure has increased in the Western Cape since 2002, with the inception of a project to install computer laboratories in all schools in the province. As musculoskeletal dysfunction experienced during adolescence is predictive of musculoskeletal disorders in adulthood, it is essential to identify all risk and/or associative factors. METHODOLOGY A descriptive study was conducted with the aim to investigate whether the musculoskeletal dysfunction of high school learners in the Cape Metropolitan region was related to their computer use. This study was conducted in two phases. Phase 1 of the study entailed the completion of a new questionnaire, the Computer Usage Questionnaire, by grade 10-12 learners. The learner sample was divided in a computer and a non-computer group depending on their exposure to the school computer. Phase 2 of the study involved the assessment of the ergonomic design of the computer laboratories at randomly selected high schools within the Cape Metropolitan region. RESULTS A total of 1073 learners (65% girls & 35% boys), aged 14-18 years, completed the CUQ in phase 1 of the study. The results indicated that learners in the computer group had greater weekly exposure to computers than the non-computer group. The prevalence of musculoskeletal dysfunction among this learner sample was 74%. The most common body areas of dysfunction were the head, low back and neck. The female gender, playing sport and using the school computer for more than three years were associated with musculoskeletal dysfunction. Weekly computer use of more than seven hours was predictive of general musculoskeletal dysfunction, low back pain and neck pain. Twenty nine computer laboratories within 16 selected high schools were assessed by means of the Computer Workstation Design Assessment (CWDA). Out of a total score of 40, the computer laboratories obtained average scores of less than 45%, indicating compliance with less than half of the standard ergonomic requirements. The average scores for the workspace environment was less than 40%. The design of the desk, chair and computer screen had the poorest compliance to ergonomic guidelines. DISCUSSION AND CONCLUSION The prevalence of musculoskeletal dysfunction among this sample was higher than among other similar samples on the same study topic. The higher prevalence may be attributed to the poor ergonomic design of the computer laboratories in the Cape Metropolitan region. Learners’ reduced participation in activities such as sport and working on a computer due to their musculoskeletal dysfunction, may impact on their choice of a future career. The tendency of learners not to seek medical advice for their musculoskeletal dysfunction may predispose the development of chronic musculoskeletal disorders. Education of related parties on safe computing habits as well as advice on the ergonomic design of computer laboratories is recommended to prevent the progression of adolescent musculoskeletal dysfunction into chronic disorders in adulthood.

Thesis (MScFisio)--University of Stellenbosch, 2004. / ENGLISH ABSTRACT: Objective: To describe the baseline data of a surgical ICU in South Africa before the implementation of an evidence-based physiotherapy practice protocol. Design: Prospective cohort observational study Setting: Ten-bed closed surgical unit in a university affiliated tertiary hospital. Patients: All adult ICU admissions from 16 June - 30 September 2003. Measurements: The patient’s clinical data including demographic information, admission diagnosis, surgery classification and co-morbidities were recorded on admission to the unit. APACHE II score was calculated. The physiotherapy techniques, positions and functional activities used, the frequency and duration of physiotherapy treatment sessions, the provision of after-hours service and the diagnosis of pulmonary complications were also recorded daily. The time of mechanical ventilation was calculated and the number of re-intubations documented. The ICU length of stay or mortality was recorded. Results: 160 patients were admitted. Patients were 49 +/- 19.95 years of age. The mean APACHE II score was 12.3 +/ 7.19 and a 12.3% mortality was observed. Thirty seven percent of patients were admitted to the unit following elective surgery. Patients stayed in the unit for 5.94 +/- 6.55 days. Hypertension was the most frequent co-morbidity found in this cohort (42%), and 21% of patients tested, tested positive for HIV. Co-morbidities had no significant association with ICU LOS or mortality. Nine hundred and twenty seven physiotherapy records were obtained. Students were responsible for 39% (n=366) of treatment sessions, the unit therapist for 34% (n=311) and the on-call therapists for 27% (n=250). Despite routine daily physiotherapy for all patients in the unit, 39% (n=62) developed excessive secretions, 30% (n=48) of patients developed pneumonia and 27% (n=43) of patients were diagnosed with basal atelectasis. Nineteen patients (12%) died in the ICU. Patients spent a mean of 5.94 (SD 6.55) days in the unit. One hundred patients (63%) were ventilated. Almost a third of ventilated patients (31%) were intubated more than once. The patients spent a mean time of 3.8 days (SD 6.30) on the ventilator every time they were re-intubated. The development of pulmonary complications significantly increased the time on the ventilator and the LOS. Conclusions: This baseline study of a surgical ICU presents a picture of a unit providing care comparable to first world environments. The picture of the physiotherapy service provided in this unit is of a “traditional” service based neither on the available evidence regarding the prevention or management of pulmonary complications, nor on the incorporation of early rehabilitation into the management of mechanically ventilated adult patients in ICU. / AFRIKAANSE OPSOMMING: Doel: Om die basis lyn van ‘n chirurgiese intensiewe sorg eenheid in Suid Afrika te beskryf voor die implementering van ‘n bewysgesteunde fisioterapie protokol in die eenheid. Studie struktuur: Prospektiewe kohort observerende studie. Eenheid: Tien bed geslote eenheid in ‘n tertiêre opleidingshospitaal. Pasiënte: Alle volwasse pasiënte opgeneem in die eenheid tussen 16 Junie en 30 September 2003. Meetings: Demografiese data, diagnose met opname, chirurgie klassifikasie en ko-morbiditeite is aangeteken by opname. APACHE II is bereken. Die fisioterapie tegnieke, pasiënt posisies en funksionele aktiwiteite gebruik in behandelingssessies, die frekwensie en duur van behandelingssessies, die verskaffing van na-ure diens aan die eenheid asook die komplikasies gediagnoseer is daagliks aangeteken. Die tyd wat pasiënte geventileer is asook die aantal kere geher-intubeer is bereken. Die tydsduur van eenheid verblyf asook mortaliteit is aangeteken. Results: 160 pasiënte is opgeneem, met ‘n gemiddelde ouderdom van 49 +/- 19.95. Die gemiddelde APACHE II telling was 12.3 +/ 7.19 en die mortaliteit was 12.3%. Sewe en dertig persent van pasiënte is opgeneem na elektiewe chirurgie. Pasiënte bly in die eenheid gemiddeld vir 5.94 +/- 6.55 dae. Hipertensie was die mees algemene ko-morbiditeit (42%), en 21% van die pasiënte wat getoets is, het positief getoets vir HIV. Ko-morbiditeite het geen beduidende verband getoon met die tyd in die eenheid of mortaliteit nie. 927 Fisioterapie rekords is aangeteken. Studente was verantwoordelik vir 39% (n=366) van die behandelingssessies, die eenheid terapeut vir 34% (n=311) en die op-roep fisioterapeute vir 27% (n=250). Ten spyte van daaglikse roetine fisioterapie behandeling van alle pasiënte in die eenheid het 39% (n=62) oormatige sekresies ontwikkel, 30% (n=48) is met pneumonie gediagnoseer en 27% (n=43) met basale atelektase. Negentien pasiënte (12%) is dood in die eenheid. Die tydsduur van eenheid verblyf was 5.94 (SD 6.55) dae. Een honderd pasiënte (63%) is geventileer. Byna een derde (31%) van pasiënte is geher-intubeer. Met elke her-intubasie het die pasiënte gemiddeld 3.8 (SD 6.30) dae langer op die ventilator gebly. Pulmonale komplikasies het beide die tydsduur in die eenheid as op die ventilator betekenisvol verleng. Gevolgtrekkings: Hierdie basislyn studie beskryf ‘n eenheid waar pasiënte mediese sorg ontvang soortgelyk aan eerste wêreld lande. Die fisioterapeutiese diens wat gelewer word is egter nie gebasseer op die nuutste bewyse in die literatuur nie. Nog, in die voorkoming of in die behandeling van pulmonale komplikasies, nog in die vroëere inkorporasie van rehabilitasie in die hantering van volwasse pasiënte in ‘n intensiewe sorg eenheid.