It is a common practice for physiotherapists working in Intensive Care Unit (ICU) to treat patients who are intubated and mechanically ventilated and assist with extubation. The role of chest physiotherapy treatment (CPT) with extubation hasn’t been scientifically proven to be effective. Purpose of the Study The purpose of this pilot study was to determine whether the omission of one CPT prior to extubation influences the outcome of patients four-hours after extubation. Methods A randomized-controlled trial (RCT) was conducted in an academic hospital with 20- cardiothoracic and general ICU beds. Patients consented to participate in the study after ethical clearance was obtained from University of Witwatersrand Committee for Research on Human Subjects. Twenty-two patients were randomly assigned to a control group to receive CPT and suctioning prior to extubation (n=12) or to an experimental group to receive suctioning only prior to extubation (n=10). All patients were then re-assessed four-hours after extubation to assess the difference in outcome measures in arterial blood gases (ABG), breathing pattern, peak expiratory flow rate (PEFR), respiratory rate (RR), cough effectiveness and re-intubation rate. Groups were compared with respect to the categorical parameters using the Fischer’s exact test. A two-sample t-test with unequal variances and a non-parametric Mann-Whitney test were used to compare the ABG and RR results between the groups. Results and Discussion The ABG, breathing pattern, RR, and cough effectiveness were not statistically significant between the groups. PEFR could not be measured due to the inability to follow instruction by the majority of patients. None of the patients required re-intubation within 24-hours. Eight patients in each group received CPT after four-hours due to clinical findings of an ineffective cough, added sounds and abnormal breathing patterns. Conclusion: Patients in the control group had a significant shorter period of mechanical ventilation (MV) than those allocated in the experimental group. However eight patients in both groups required CPT treatment when assessed four hours after extubation.

MSc, Physiotherapy, Faculty of Health Sciences, University of the Witwatersrand / Introduction Rotator cuff tears can cause great impairment of the shoulder joint with debilitating pain and dysfunction. The surgical repair of rotator cuff tears result in an extensive rehabilitation being required. This process can be affected by various demographic, surgical and rehabilitative factors. There appear to be no studies relating these factors to the rehabilitation process. The aim of this study was to determine the prevalence of partial and full thickness tears seen in one physiotherapy practice over the period of four and a half years. It also was to identify and analyse the factors affecting the amount of physiotherapy following a rotator cuff repair. Methods This was a retrospective record review. It was also a cross sectional correlational study. Results The prevalence of partial and full thickness rotator cuff tears seen over a period of four and a half years in one physiotherapy practice is very similar. Partial thickness tears constituted 46% of the entire sample and full thickness made up 54% of the sample. Four out of eleven factors were found to be associated with the amount of physiotherapy received after a rotator cuff repair. These factors included the age of the patient, whether the patient was injured on duty, iv preoperative physiotherapy and additional procedures after surgery such as a revision of the repair or a manipulation of the shoulder. Conclusion There are only a few factors shown to be associated with the rehabilitation process after a rotator cuff repair. These factors would need to be correlated against outcome in future studies.

ABSTRACT The purpose of this study was to determine if there is a relationship between knee integrity and function in patients who have had a total knee replacement. Twenty-two patients were selected at the arthroplasty clinics at the Johannesburg Hospital and Chris Hani Baragwaneth Hospital. This occurred at six weeks following a primary total knee replacement. Twenty-two subjects who participated in the study underwent two tests. The first test measured the patients’ functional ability using the Iowa Level of Assistance (ILOA) Scale. Knee integrity was measured using the Knee Society Knee Score. The two examiners were blinded to each other’s results. The results indicate that there is no relationship between knee integrity measured using the Knee Society Knee Score and function measured using the ILOA Scale (p= 0.19).

PhD thesis, Faculty of Health Sciences, University of the Witwatersrand, 2008 / This thesis centres around the issues concerning HIV/AIDS and physiotherapy education, curriculum and practice. In particular, this thesis examines which HIV specific content should be included in a physiotherapy curriculum and ultimately presents a conceptual framework for HIV input into the curriculum. There is a vast body of literature available on HIV. For physiotherapists, however, apart from a brief review given by Nixon and Cott (2000) using the ICIDH, no comprehensive literature is available that places information on HIV into a framework that speaks to physiotherapists as part of the rehabilitation fraternity. The literature on impairments is descriptive and buried in the medical model as symptoms. Section one of the literature review placed the literature in such a framework and provided a comprehensive description using the ICF and related aspects that concern physiotherapists. The ICF captures all the elements of current rehabilitation theory and practice and the literature is presented in an ICF framework. In addition, important background information on prevalence, its determinants, treatment approaches and subsequent impacts were reviewed. As most of the literature available still remains in the medical model, the conditions that manifest and from which patients develop impairments, were reviewed. The effects of HIV on body systems are extensive and pervasive. In each body system HIV has direct effects on mature and maturing cells e.g. progenitor cells and mature muscle cells. In the musculoskeletal system HIV impacts on functional systems and organs resulting in pathophysiological changes that manifest as impairments such as muscle wasting. Conditions manifesting in all body systems were reviewed and outlined. Impairments such as pain, breathlessness and proximal muscle weakness were reported in the literature. In addition to impairments, analysis of the literature revealed studies that had found high levels of functional and activity limitations as well as impacts on Health-related Quality of Life in HIV. The literature also presents the current status of physiotherapy interventions. Many studies have reported that exercises are a safe and effective mode of intervention not-withstanding the limitations encountered. The second part of the literature review focussed on aspects concerned with curriculum. Previous studies have focused on establishing baseline knowledge, attitudes and practices (KAP) to HIV and the impact of training programmes on KAP. What the actual content was for health workers, in particular physiotherapists and the approach to incorporating HIV into curricula is a gap in the literature. To inform the overall aim, with context-appropriate HIV content, this study undertook a number of studies in order to obtain the necessary information on HIV, specific to physiotherapy. Therefore the overall approach was a mixed methods one employing both a quantitative and qualitative study mix. The first and second studies informed the clinical picture and were both cross-sectional and descriptive. In both studies descriptive statistics were used to analyse data, especially in determining the absence or presence of conditions. Study 1 sought to establish the level of referral to physiotherapy by retrospectively examining the patient records of patients admitted with HIVrelated conditions over a period of one year. Of the 732 patient records reviewed, 139 (19%) had diagnoses considered suitable for physiotherapy and 3% were referred to physiotherapy. Study 2 aimed to establish a relevant overview of the functional and participation limitations of people living with HIV. Two groups of patients were studied i.e. an in-patient group and an outpatient group. The out-patient group was from a well resourced mining out-patient setting. The ICF checklist was utilised to collect the data and statistical analysis was performed to indicate the presence or absence of impairments, activity limitations and participation restrictions. A logistic regression was done to determine the odds of activity, limitation or participation restriction given certain levels of domains. Both groups showed high levels of impairment. For the in-patient group loss of muscle power 75%(n=60) energy and drive 75%(n=60), disturbed sleep 71%(n=56), emotional problems 62%(49), mild-severe pain 80%(66), weight maintenance difficulties and diarrhoea were apparent. In the out-patient mining group memory problems, energy and drive functions 36%(n=18), sleep 24% (n=12) and emotional functions 28% (n=14), seeing 32% (n=17), hearing, vestibularproblems 28%(n=14) and pain 55%(n=28), blood pressure and respiratory problems 24%(n=12), weight maintenance 63%(n=32), sexual functions 22%(n=11) and reduced proximal muscular power 24%(n=12) were encountered. The in-patient group had high levels of activity limitations and participation restrictions, while the out-patient mining group did not. There was association between the different domains and in the in-patient group gender (p=0.02) and marital status (p=0.01) were likely to influence the activity and participation levels and the experience of the environment. The remaining three studies involved aspects related to informing the curriculum component of this thesis. Study 3 audited the universities’ curricular documents to establish what the current curriculum included. Seven of the eight universities that offer physiotherapy training were reviewed and their curricula were generally scanty on information regarding HIV/AIDS. When compared to the areas outlined as a result of the literature review, the study of the patients and focus groups with clinicians and academic staff, revealed some gaps, in particular; the types of conditionsand the influence of HIV on other body systems which are pertinent to the clinical reasoning process for the physiotherapist: The philosophy of care and approach to management and the physiotherapists’ role in HIV prevention, treatment and care were evident gaps. Study 4 sought to develop a framework of HIV content for a physiotherapy curriculum. This was done by integrating the results found so far and verifying and enriching this data by gaining clinicians’ and academics’ insights and perceptions around HIV, based on their clinical and educational experience. Focus group discussions were conducted and a qualitative approach was undertaken for data analysis. A framework for curricula content emerged from this exercise. In study 5 the framework of HIV content was used to develop a questionnaire that was sent out in the Delphi survey to academic staff with the aim to test the level of consensus. Eighty three components of the curriculum under four outcome areas (Appendix 7.2) were sent to 68 academic staff who were identified. Of the 68 academic staff, 58 were available and 47 responded and consented to participate. All but two topics obtained consensus set at 80% and the remaining two obtained consensus in the second round. The final chapter discusses the results of these studies and illustrates how these results on HIV affect and can be applied to the physiotherapy curriculum, when applied to the UNAIDS mainstreaming criteria. Applying the mainstreaming principles to the process of including HIV content into the curriculum, ensures that the process is not done in a piece meal fashion but encompasses all important facets which were identified. The programme, if systematically implemented, could result in a coordinated outcome accounting for all the important facets. A conceptual framework is drawn from the results of this thesis illustrating the three levels of curriculum taxonomy: At the micro level, through the body systems, the meso level through the role of physiotherapy, dealing with internal and external domains and teaching approaches. The macro level is accounted for by the facilitatory activities such as advocacy among clinicians and academics and forming strategic partnerships at all levels.

Thesis (MPH)--University of Limpopo,2010. / Background: Tuberculosis is one of the major public health problems in Lesotho. With the occurrence of multi-drug resistant tuberculosis, little is known about the views of health care workers on this disease. The aim of this study was to investigate the knowledge, attitudes, and practices of healthcare professionals about prevention and control of MDR-TB at Botsabelo hospital, situated in Maseru, Lesotho. Methods: This study was conducted by means of a semi-structured, anonymous, and self-administered questionnaire that was sent to health care workers. Returned questionnaires were collected through designated boxes stationed at selected places at the study site from 23rd September to 13th October 2010. The investigator and his assistants collected the returned questionnaires on the 15th October 2010. Results: The results of this study indicate that, overall, less than half (47.3%) of respondents had good level of knowledge about MDR-TB; but the overwhelming majority of them held negative attitude towards patients with MDR-TB. Further analysis showed that the level of knowledge did not affect the attitude towards patients suffering from MDR-TB but it influenced their practices. Having good level of knowledge about MDR-TB was associated with good practices such as the use of protective masks and MDR-TB guidelines and involvement in educating patients about MDR-TB. Moreover, the findings of this study showed also that the attitude of respondents towards patients suffering from MDR-TB did not influence their practices. Conclusion: In conclusion, less than half of respondents had good level of knowledge about MDR-TB, but over 85.5% of them held negative attitude towards patients suffering from MDR-TB. Although the level of knowledge about MDR-TB was found not to have influenced the attitude of respondents towards patients suffering from MDR-TB; and that xi their attitude did not influence practices, good level of knowledge was positively associated with safer practices such as using protective masks, educating patients on MDR-TB, and referring to the MDR-TB guidelines manual. An educational remedial intervention is recommended.

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The majority of people affected by stroke are older however one fifth of all persons with stroke are younger than 65 years. In Sweden the mean age at the time of a stroke is 75 years and about 5 % of those who suffer a stroke are 55 years or younger. The aim of this thesis was to describe and analyse the consequences of stroke in the younger population in terms of experiences of the rehabilitation process, return to work, self-reported physical and cognitive function and life satisfaction. Sex differences, as well as gender specific associations regarding factors of importance for return to work, deteriorated physical ability and satisfaction with life as a whole, were also studied. This thesis was based on an in-depth interview study and self reported data collected from a questionnaire answered by 1068 individuals, 18-55 years old with a first ever stroke registered in Riks-Stroke, the Swedish national quality register for stroke care. The questionnaire concerned aspects of current health condition, living and social arrangements, physical and cognitive functions, activities in daily life, relationships, social life, leisure pursuits, self-perception, participation, work and life satisfaction. Most of the questions aimed to investigate differences between the present time and before stroke onset. In-depth interviews with two men and three women aged 37-54, living at home after their stroke generated the hypotheses that younger persons with stroke are frustrated and feel invisible and outside. Rehabilitation for the young was perceived as in adequate due to the fact that the rehabilitation setting does not acknowledge the specific needs that younger persons with stroke have. Prior to the stroke 855 of 1068 (80%) of the participants, had been in paid employment. After the stroke, 65% of the men and 66 % of the women returned to work. Factors of importance for return to work were associated with the self-reported data: the feeling that it was important to work (OR 5.1), not perceiving oneself as a burden to others (OR 3.3), not having a deteriorated ability to run a shorter distance (OR 2.8) and having support for return to work (OR 3.7). Changes in self-reported physical and cognitive functions as compared with pre-stroke condition was explored in 867 (513 men and 354 women) P-ADL independent persons with stroke. Deteriorated physical abilities were reported in 56-79% and deteriorated cognitive abilities in 48- 68% of the participants. Women were significantly more affected in terms of both physical and cognitive deterioration than the men. Seventy-two percent of the participants did not know how much they could physically exert themselves after their stroke, women significantly more than men. In addition, significant associations were found between deteriorated physical function and deteriorated cognitive function as well as fear of physical exertion. The strongest association for deteriorated ability to move in crowded environments was the risk factors deteriorated cognitive ability (OR of 5.4) and being afraid of physical exertion (OR of 3.1). Life Satisfaction and factors associated with not being satisfied with life as a whole in 1068 (631 men and 437 women) persons with stroke was assessed with the LiSat 9, baseline data from Riks- Stroke and self-reported answers from the questionnaire. Fifty-three percent of the participants were not satisfied with life as a whole. Men and women were analyzed separately in terms of associations with not being satisfied with life as a whole. Women who had a haemorrhage (OR 3.9) and a deteriorated ability to concentrate (OR 2.1) had a higher risk of not being satisfied. For men the risk was associated with living without a significant other (OR 3.2), not working (OR 2.3) and deteriorated ability to concentrate (OR 2.0). In conclusion, younger individuals who have experienced a stroke feel frustrated and invisible due to the fact that their needs are not acknowledged. Age and gender have an impact on outcome of present rehabilitation programs and the problems of younger persons with stroke can be detected at an earlier stage by developing appropriate instrument and delivering information directly aimed at physical functioning. Further studies on gender specific differences in stroke outcome concerning physical and cognitive functions as well as life situation after stroke are needed. In order to optimize rehabilitation in terms of return to work, external support and motivation seem to be important factors to consider. Key words: Adult, cognition disorders, gender differences, middle aged, motor activity, quality of life,questionnaires, stroke, work

This study explores the immanent paradigm in clinical physiotherapy, a professional field where knowledge to a large extent is demonstrated in skilled action whose embodied character prevents this kind of knowledge from being completely articulated. The following is a hermeneutic study in which a first person perspective, based on years of professional experience, is employed as the basis for interpretation and analysis. The knowledge and insights derived from this approach are often framed through the deliberate methodological use of analogy and metaphor. The practice of clinical physiotherapy is often modelled on the mechanic's workshop inasmuch as bodily problems and diseases are putatively repaired through a technically skilled approach. This study explores the problematic nature of this dualist paradigm in relation to the professional challenge of encountering bodily experiences such as absence and alienation.This instrumental model of knowledge and practice leaves little room for the physiotherapist's own professional experience to be a source of knowledge through reflection. The study points at phenomenological perspectives on the living body as an alternative epistemological framework of the practice of physiotherapy. / QC 20100910

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