Background: Respiratory problems, both acute and chronic, remain an important cause of disease burden for children worldwide. Airway clearance techniques, as part of the management of these conditions, might influence the course of the disease thereby reducing this burden. Objective: This PhD thesis aimed to explore the epidemiology and management of children with acute respiratory diseases admitted to a paediatric hospital in Cape Town, South Africa; and to determine the usefulness and safety of assisted autogenic drainage in children with an acute (pneumonia) or chronic (cystic fibrosis) respiratory disease. In order to do this, several linked studies were undertaken including a retrospective folder review, two systematic reviews and two pragmatic randomised controlled trials.

Includes bibliographical references (leaves 129-164). / The aim of this study was to determine the occupational health and safety knowledge, practices and injury pattern of workers at a specific beverage manufacturing company.

Includes abstract. / Includes bibliographical references (leaves 129-135). / To compare the motor development of children aged 3-6 years with HIV/AIDS in institutions and in foster care using the Peabody Motor Developmental Scale (PDMS II). A description of socio-economic conditions to the children, to compare the health status of HIV positive children, to establish and compare developmental quotients of children across two care-giving environments and compare performance of children with and without HIV, to determine to what extent developmental quotient changes over a six-month period and establish which factors predict performance. A descriptive, analytical, prospective, longtudinal study design was used. 44 children participated in the study at baseline. The children were recruited from four institutions in Cape Town and from community outreach programmes supporting foster parents. Six months later 37 children were tested.

Includes bibliographical references (leaves 138-150). / The main aim of this study was to document the prevalence and severity of motor and mental delay in a sample of HIV infected children. A secondary aim was to document their motor and mental performance at three monthly intervals for a period of six months.

Introduction: The national health system is experiencing major challenges due to a shortage of key human resources and a quadruple burden of disease. A cadre of trained community health workers, namely home-based carers (HBCs), have been trained in response to an increased need for health services. It is unclear to what extent the HBCs are able to provide rehabilitation support to their clients. Methodology: A quasi-experimental design was used to identify the impact of the collaboration between HBCs and physiotherapy students. Fifty HBCs from four organisations working within the Cape Town Metropolitan area were randomly selected and assigned to a control (n=25) and experimental (n=25) group. A validated checklist, based on the National Guidelines on Home Based Care and Community Based Care (Department of Health. 2001), and a self-developed questionnaire was used to determine the demographics and training of the HBCs; and the conditions of their clients. Results: The results indicated that the HBCs were predominantly middle-aged females with a highest qualification of Grade 12. No differences in gender or age were seen when we compared the control and experimental groups. The mean age of our sample size was 40.9 years (SD 11.13 and range 20-67 years), with a mean age of 43.6 year (SD 10.7) in the control group; and 38.1 years (SD 11.1) in the experimental group. There was a significant difference in the mean career length (with a mean of 778 months in the control group, and 497 months in the experimental group (p=0.006)) and length of training (mean control group = 773 months and experimental group = 502 months (p=0.007)) between the control and experimental groups. Although the control group spent more time on wound care and mathematics, the content of training was similar across the four organisations with HIV/AIDS topics reported by all respondents. There were no differences between the groups with regards to client profile, which included age, diagnosis and main problems. Despite the similar training opportunities, the HBCs who hosted physiotherapy students demonstrated significantly more interventions in every domain (activities of daily living (p=0.025), personal needs (p=0.006), environment needs (p=0.002) and lifestyle needs (p<.001)) than those who had not been exposed to students, except for the Core Home/Community Based Care (CHBC) (p=0.743). From the 25 HBC's in the experimental group, only twenty completed the questionnaire with regards to attitude towards collaboration with students. Of these twenty, 16 indicated that they strongly agreed that working with physiotherapy students was a good experience and that the students contributed to their understanding of the clients and their conditions. Eighteen of them also indicated that they learned from the students. The students were also supportive towards this program as they responded positively on each question, except for learning from the HBCs, which had a high neutral response rate. Conclusion: The training of the HBCs seems to prepare them insufficiently towards the management of their clients, who present more often with chronic diseases of lifestyle than with communicable diseases, as seen in the past. Exposure to a different discipline within the home context does result in an improvement of skills, especially in areas not covered by basic training. HBCs' skills with regards to rehabilitation can be improved by collaboration with physiotherapy students at community placements. This collaboration is shown to be mutually beneficial. Therefore, we recommend the implementation of this collaboration model in future, as all health professionals need continuous support to maintain a high standard of care and upgrade their skills.

Background Frequently, soccer players are in search of methods to speed-up recovery post-exercise due to fixture congestion. Players and staff have limited reliable evidence regarding the most effective recovery methods post-exercise. Vast differences in infrastructure, staff and finances exist between teams in South African soccer leagues. Monitoring the implementation of recovery methods by each team presents a significant challenge. The purpose of the present study is to describe the recovery methods, frequency of use, barriers to implementation and factors influencing potential decision makers. The findings could assist medical staff and players to select evidence-based methods. Methods A descriptive observational cross-sectional study was employed. Staff responsible for recovery methods throughout three professional soccer leagues in South Africa were purposively recruited. A customised questionnaire was designed to obtain data on the recovery methods implemented by South African soccer teams, as well as to investigate barriers to implementation of these methods. A panel of experts reviewed and validated the questionnaire. The majority of the questionnaires were completed online, and several face-to-face interviews were conducted. Confidentiality of the data was ensured, and informed consent was obtained from each participant. Results A total of 48 questionnaires were completed, 16 from each of the three leagues. Two questionnaires were excluded as participants indicated that they did not use recovery methods and one questionnaire was incomplete. The majority of respondents were fitness trainers or physiotherapists with an average of 8 ± 4 years’ working experience in soccer. Five different recovery methods were used most frequently. Rehydration (n= 45, 94%), nutrition (n= 41, 85%), and stretching (n= 41, 85%) post-exercise, were reportedly used most frequently. The majority of participants (n= 38, 79%) considered the recovery methods to improve performance. There was no statistical difference in the average number of recovery methods utilised by teams in the Premier Soccer League (PSL) and National First Division (NFD; PSL 7 ± 2 vs. NFD 6 ± 1, p = 0.24). However, National Second Division (NSD) teams used significantly fewer recovery methods than PSL teams (PSL 7 ± 2 vs. NSD 5 ± 1, p < 0.003). The greatest barriers staff reported were a lack of player interest and insufficient funds. Conclusion The findings of this study suggest that the use of recovery methods occurs at all professional levels of South African soccer. Teams are implementing recovery methods without sufficient evidence to justify its use (i.e. stretching, massage, active recovery or cold water immersion). While nutrition and hydration are very well utilised across South African soccer, sleep interventions remain under utilised. Most teams sourced protocols based on anecdotal evidence, therefore recovery method implementation should be re-examined. Teams in the top tiered league used more recovery methods compared to lower tiered teams, most likely due to the greater resources available. However, a lack of player interest was one of the biggest barriers to implementation. It is recommended that staff and players receive improved and focused educational interventions regarding the efficacy of various recovery methods, which may also assist in altering behaviour towards more evidence-based recovery methods.

This research project aimed to determine whether a two-week period of intensive physiotherapy in groups, using the Neurodevelopmental Approach or Constraint Induced Movement Therapy (CIMT), would result in a functional improvement in the hand function of children with hemiplegia. It also aimed to determine if group CIMT was more effective than group physiotherapy based on the Neurodevelopmental (NDT) approach. The feasibility of CIMT in the South African context was also investigated Sixty-five children with hemiplegia were requested to participate in the research study at the Red Cross Children's Hospital in Cape Town, South Africa. Twelve of these patients eventually participated in the study. They were divided into CIMT and NDT based physiotherapy groups. Both groups received intensive physiotherapy for a period of two weeks (every day for two hours). The non-affected upper limb of the CIMT group was restrained with a glove, whilst the NOT based physiotherapy group was unrestrained. The children were assessed before therapy, directly after therapy at two weeks, using the Peabody Developmental Fine Motor Scale and kinematic analysis (Vicon Clinical Manager), and again one month later using the Peabody Developmental Fine Motor Scale. The results showed that the children (in both the CIMT and NDT-based physiotherapy groups) demonstrated a significant improvement in grasp function (with a change in median grasp score from 28.5 to 33.0, p&lt;0.02) and visual motor integration (with a change in median VMI score from 71.0 to 78.0, p&lt;0.02) following two weeks of intensive physiotherapy and that this improvement in function was maintained for a month following therapy. There did not appear to be any benefit of group CIMT over that of NDT based physiotherapy - however this is said with caution due to the small sample size. Through the questionnaire and informal interviews, it was felt that CIMT in its' current form was not feasible for use in the South African context, mainly due to lack of financial and human resources. Further research is recommended to determine whether a different mode of CIMT therapy would be more feasible in the South African context. However, it was felt that due to the improvement seen after two weeks of group intensive physiotherapy, an attempt should be made to integrate periodic sessions of intensive group therapy into local community settings, particularly in the South African context of inadequate resources, to provide regular therapy to children living in rural areas.

Includes bibliographical references. / Background: Stroke is a leading cause of death and disability in both developed and developing countries. Stroke results in a loss of movement on one side of the body and patients have trouble moving the trunk in relation to the pull of gravity, regardless of which muscle action is required. Re-educating the function of the trunk muscles is essential in successful rehabilitation of patients with stroke. Functional Electrical Stimulation (FES) of the abdominal muscles is an intervention which may result in increasing the activation of these muscles and improving proximal stability and function. However the effects of FES, although proved useful in other muscles groups, have not been tested when applied to the abdominal muscle in patients who have had a stroke. Aims: The aim of this study was to evaluate the effect of FES of the abdominals on th e functional recovery in patients with stroke, when used as part of physiotherapy treatment. Secondary aims are to document the content of physiotherapy received during rehabilitation and compare it to that of published literature.

Introduction: The prevalence of health risk behaviours is growing amongst South African employees. Health risk behaviours have been identified as a major contributor to reduced health related quality of life (HRQoL) and the increase prevalence of non-communicable diseases. Worksite wellness programmes promise to promote behaviour changes amongst employees and to improve their HRQoL. Aims: The aim of this study was to evaluate the short-term efficacy of an employee wellness programme on HRQoL, health behaviour change, levels of self efficacy, pain intensity, body mass index (BMI) and absenteeism amongst clothing and textile manufacturing employees. Methods: The study was a randomised control trial consisting of 80 participants from three clothing manufacturing companies in South Africa. The experimental group was subjected to a wellness programme based on the principles of cognitive behaviour therapy (CBT) as well as weekly supervised exercise classes over six weeks. The control group received a once-off health promotion talk and various educational pamphlets, with no further intervention. Measurements were recorded at baseline and at six weeks post-intervention. Outcome measures used included the EQ-5D, Brief Pain Inventory-SF, Stanford Exercise Behaviours Scale, Stanford Self-Efficacy Scale, Stanford Self-Rated Health Scale, BMI and absenteeism. Data Analysis: All the data were analysed with the Statistica-8 software program. Although t-tests are the most commonly used statistical method for evaluating the differences in the means between two groups (e.g. control and experimental), it assumes that the variable is normally distributed. Thus, because the ordinal data were not normally distributed, non-parametric tests were used to evaluate the differences in the medians between the two groups and to determine the level of significance. The Sign test was used in place of the paired t-test to determine the within group changes. The Mann- Whitney U test was used in place of the independent t-test to determine the difference between the two groups. Results: The experimental group consisted of 39 subjects. At six weeks post intervention the experimental group demonstrated improvement in almost every parameter. In contrast, apart from an overall decrease in time off work, there was no change noted in the behaviour of the control group. Seventy percent of the experimental group had improved HRQoL VAS scores post intervention, indicating improved perceived HRQoL. In comparison, only 58% of the control group had improved HRQoL VAS scores post intervention. v Conclusion: An employee wellness programme based on the principles of CBT combined with weekly aerobic exercise class was beneficial in improving the HRQoL and changing health-related behaviours of clothing/textile manufacturing employees.

Gait difficulties experienced by individuals following a stroke may be related to the commonly observed reduced hip extension in the stance phase of gait. The aim of this initial exploratory study was to evaluate the effects of a home-based strengthening programme on hip muscle strength and gait performance in individuals following stroke. Six chronic stroke patients (> 9 months duration) participated in this pretest-posttest group design which was composed of two six week phases, A and B, where B immediately followed A. No training or advice was given to the six subjects during phase A. During Phase B, the same six subjects participated in a "hip extension focused" home exercise programme aimed at improving hip extensor muscle strength and the range of anterior hip structures. The exercise programme consisted of functional strengthening, task related activities and stretching. At the end of this sixweek period, the subjects were re-tested in order to evaluate the effects of the exercise programme. The outcome measures included isometric muscle strength, walking speed and range of the anterior structures of the hip. The walking section of the Motor Assessment Scale for Stroke and the Nottingham Extended Activities of Daily Living were also employed. In addition, clinical gait analysis was used to gather measures of gait velocity, step length and hip joint excursion. Statistically significant increases were found in the study group (n = 6) for the identified parameter of hip extensor strength after the intervention (p = 0.05), although this change could not necessarily be attributed to intervention effects alone. Hip extension strength was significantly correlated with (1) step length (r = 0.82; p = 0.04) and (2) joint excursion (r = 0.8; p = 0.05) after the intervention. These correlations, although tentative and not conclusive, suggest that hip extensor strength may influence gait performance and therefore warrants further investigation. While the results obtained from this exploratory study appear to suggest that the hip extensors play an important role in providing stability for the lower limb during gait, a randomised controlled study with a larger cohort of patients would be necessary to make any definitive conclusions.