Thesis (MScPhysio (Physiotherapy))--University of Stellenbosch, 2007. / Objective The objective of this study was to establish the reliability and validity of a Portable Posture Analysis Method (PPAM). Design The design for the reliability section was a repeated measures observational study and the design for the validity section was a correlation study. Background The prevalence of spinal pain among high school learners is high (Murphy et al, 2002). It is also notable that the prevalence of back pain increases across the teenage years (Grimmer & Williams 2000, Burton et al 1996). In South Africa, the preliminary findings of a study conducted by a Physiotherapy masters candidate (Ms L Smith: ethics nr. N05/09/164) indicates that about 74% of high school learners in Cape Town complained of musculoskeletal pain. Posture has been identified by some researchers to be a primary predictor of the development of spinal, particularly upper quadrant pain among computer users (NIOSH 1997, Vieira et al 2004). Measurement of posture poses a real challenge to researchers wanting to accurately evaluate posture in research projects. Considering the practical implications in measuring posture, the validity and reliability of posture measurement are often reported to be poor. Many of these methods of indirect assessment of working posture have been reported on in the literature. These measures include; the goniometer, inclinometer, flexible electrogoniometer, flexicurve and photography (Harrison et al 2005, Christensen 1999, Nitschke et al 1999, Chen & Lee 1997). ...

Thesis (MScPhysio (Physiotherapy))--University of Stellenbosch, 2007. / AIM: The aim of this study was threefold. Firstly to determine the effect of passive thoracic flexion-rotation (PTFR) movement on the total static compliance of the respiratory system, tidal volume, respiratory rate and plateau pressure. Secondly, to identify the interventions used by physiotherapists to influence compliance and thirdly to compare the effects of these interventions. DESIGN: A one group, pre-test-post-test physiological study and a systematic review of the literature were performed. METHOD: A randomised sample consisting of 18 intubated and ventilated subjects of varying periods of ventilation and various conditions was obtained. The interventions used included tactile stimulation and PTFR movements. Subjects acted as their own controls. Objective variables namely tidal volume, respiratory rate and plateau pressure were recorded by a research assistant. These measurements were taken immediately following the intervention and repeated again three times in an interval of 20 minutes after the movement was discontinued. Total static compliance of the respiratory system was calculated as tidal volume divided by the difference between plateau pressure and positive end-expiratory pressure. The search strategy for the systematic review included the searching of five databases, a secondary search (pearling) and a hand search. Two independent reviewers agreed on the inclusion of articles and their methodological quality. A critical review form (Law et al 1998) was used for scoring methodological quality and a hierarchy of evidence for allocating the level of evidence of each study. Inclusion criteria were experimental studies, written in English and published after January 1995. Participants were intubated, ventilated humans, over the age of 18.

Thesis (MScPhysio (Physiotherapy))--Stellenbosch University, 2008. / The prevalence of low back pain (LBP) in United Arab Emirates (UAE) is estimated to be about 57% in males and 64% in females. Low back pain is commonly treated by primary care physicians and physiotherapists in the UAE. are increasingly used for clinical assessment, to demonstrate and reflect on the effectiveness of an intervention. Oswestry Disability Index (ODI) is Self-reported outcome measure that widely used and recommended for LBP. ODI Arabic version was developed and validated in women population. To date no UAE Arabic version of the ODI exists which has been cross-culturally adapted, validated and published in the peer-reviewed literature. . Objective The objectives are, to cross-culturally adapt the Arabic version of the ODI developed in Tunisia to devise a pre-final ODI-UAE Arabic version; to pre-test the pre-final ODI-UAE Arabic version in a target group of patients to devise the final ODI-UAE Arabic version; and to determine the reliability and construct validity of the final ODI-UAE Arabic version. Study design Culture adaptation, reliability and validity testing. Methodology The cross culture adaptation of the ODI Arabic version developed in Tunisia was performed in accordance with the published guidelines. For reliability 108 clients of UAE nationals with LBP were consecutively selected and completed the final ODI-UAE Arabic version, at baseline and 48 hours, and test–retest reliability and internal consistency were calculated. For validity 108 completed the final ODI-UAE Arabic version, VAS, and the Squat test at baseline and 4 weeks follow up; construct validity, items frequency response, response to change and floor and ceiling were evaluated. Results The ODI-UAE (9 questions) had high level of test–retest with ICC of 0.99; the mean at baseline and 48 hours was (0.68); Cronbach's alpha was 0.99. Strong positive correlation with VAS r =>0.70 (p = <0.01), and moderate inverse correlation between ODI and Squat r =>0.65 (p = <0.01).The results of the maximum frequency response were less than 80% for the entire 9 question. The effect size and the SRM of ODI-UAE, VAS and Squat test at baseline and 4 weeks were identical comparable the effect size, were 1.66, 1.85, and 1.59 respectively. ODI-UAE demonstrated absence of floor and ceiling effect; less than 15% of the respondents achieved the lowest or highest possible score respectively (0 -11.5) or (87-100%). Conclusion The ODI-UAE Arabic version is an easy to understand, reliable and valid condition-specific outcome measure for the measurement of the limitation of functional ability cause by LBP in the United Arab Emirates national population.

Thesis (MScPhysio (Interdisciplinary Health Sciences. Physiotherapy))--University of Stellenbosch, 2009. / ENGLISH ABSTRACT: Background: Children who lack the motor coordination to perform the tasks that have usually been acquired at their age, given normal intellectual ability and the absence of other neurological disorders, are classified as having Developmental Coordination Disorder (DCD) according to DSMIV. Limited professional resources prohibit individual therapy and these children are being treated in “gross motor groups” regardless of the fact that this has limited proven efficacy. This study aims to investigate whether group exercise physiotherapy does improve the gross motor function of children with DCD aged six to ten years old. Methods: Thirty-nine children were assessed at pre and post intervention on the Movement Assessment Battery for Children (M-ABC) as well as the Perceived Efficacy and Goal Setting (PEGS) questionnaire by a blinded research assistant. They were randomly allocated to either a control (N=19) or an intervention group (N=20). The intervention group was then further subdivided into groups of four to six per group to attend group exercise sessions of 30 – 45 minutes three times per week. Group exercises were aimed at improving manual dexterity, ball skills and balance by incorporating aerobic exercises, strengthening exercises, coordination as well as task specific activities. Results: There was a significant increase (p=.028) in the total scores tested by the experimental group on the M-ABC after the eight week intervention. Manual dexterity skills had improved significantly (p=.035). There was a trend for ball skills to improve (p=.088) but no improvement was recorded for static or dynamic balance post intervention. PEGS results indicated that subjects considered themselves as very competent regardless of their abilities. Conclusions: The results of this study support the hypothesis that an eight week group exercise program can improve the gross motor skills of children with DCD. It would seem that implementing such an intervention is a viable option, especially where resources limit the availability of one to one therapy. / AFRIKAANSE OPSOMMING: Agtergrond: Kinders wat „n gebrek aan motoriese koördinasie het om ouderdoms verwante take te verrig, gegewe dat hulle normale intellektuele vermoëns het en die afwesigheid van ander neorologiese abnormaliteite, word geklassifiseer as “Developmental Coordination Disorder” (DCD) volgens die DSM IV. Beperkte professionele menslike hulpbronne voorkom individele terapie en hierdie kinders word gewoonlik behandel in grofmotoriese groepe, ongeag dat daar min bewyse is dat dit „n effektiewe behandelings metode is. Die doel van hierdie studie is om vas te stel of „n fisioterapie groepsoefenprogram „n effektiewe behandelingsvorm is om die grofmotoriese vaardighede in ses tot tienjarige primêre skool kinders, met „n diagnose van DCD, verbeter. Metodes: Nege-en-dertig kinders was geassesseer met die “Movement Assessment Battery for Children” (M-ABC) en die “Perceived Efficacy and Goal Setting” (PEGS) vraelys deur „n geblinde navorsingsassistent. Hulle is in twee groepe nl kontrole groep wat nie intervensie gekry het nie (N=19) en „n eksperimentele groep (N=20)verdeel deur eenvoudige ewekansige toewysing. Die eksperimentele groep was verder onderverdeel in groepe van vier tot ses om groepsoefeningsessies by te woon drie keer „n week vir 30 tot 45 minute. Die doel van die groepsoefeninge was om die volgende areas te verbeter: handvaardigheid, balvaardigheid en balans deur die inkorporasie van balansaktiwiteite, spierversterkingsoefeninge, koördinasie sowel as taak spesifieke aktiwiteite. Die deelnemers was weer geassesseer met die Movement-ABC en die PEGS na die agt weke lange intervensie program. Resultate: Daar was 'n beduidende toename (p=.028) in die algehele telling deur die eksperimentele groep op die M-ABC na die agt weke deelname. Handvaardigheid het beduidend verbeter (p=.035). Daar was „n tendens vir balvaardighede om te verbeter (p=0.88), maar geen verbetering was aangedui vir balans na die ingryping nie. Die PEGS resultate was moeilik om te interpreteer aangesien die deelnemers hulself as baie vaardig gesien het ten spyte van hulle vermoëns. Gevolgtrekking: Die resultate van hierdie studie ondersteun die hipotese dat 'n doelgerigte groepsoefeningsprogram wel die grofmotoriese vaardighede van kinders met „n diagnose van DCD verbeter. Fisioterapeute kan 'n groepsofeningsprogram met vertroue implementeer waar 'n tekort aan menslike hulpbronne een tot een terapie beperk.

Thesis (MScPhysio (Physiotherapy))--University of Stellenbosch, 2007. / Study Aim: To describe the profile and selected outcomes of CABG patients admitted in the Cape metropolitan area. Design: A prospective descriptive study design with a multicentre observational approach was followed. Method: All patients undergoing isolated CABG surgery, whether elective or emergency, during a three-month period (15 August–15 November 2005) were included in the study. Demographic data, pre-operative medical status, intra-operative, as well as post-operative information were collected using a self-designed structured initial assessment form (SIA). Means and standard deviations were calculated where applicable. Relationships between different variables were analyzed by means of: ANOVA, correlations, linear and logistic regressions. Where it appeared that the ANOVA assumptions were violated, non-parametric bootstrap techniques were employed. Results: Two hundred and forty five patients were admitted to the seven hospitals which provide CABG surgery in the Cape metropolitan area in the allotted period. The profile of patients admitted to private and state institutions were similar. The mean age of the sample was 60 (±10). The mean LOS of the total cohort was 12 (±5.5) days, with patients in the state hospitals staying longer 13.4 days (± 7.1). Patients who were older than 60 were twice as likely to have a LOS >12days (odds ratio = 2.49; 95% confidence interval = 1.33 to 4.65). The development of a pleural effusion or pneumothorax was associated with an increased LOS (p<0.01). At least one PPC was reported in 65% of the population. A mortality rate of only 3% was reported. Conclusion: Patients in this cohort were younger than in developed countries. An age greater than 60 years was a predictor of an LOS >12days in the current cohort. Patients were most likely to develop a PPC on day three after CABG surgery. Physiotherapeutic intervention, if any, would be well aimed at those patients older than 60 years of age. Screening of patients in the first three post-operative days for the development of PPCs is also advised.

Thesis (MScPhysio)--Stellenbosch University, 2004 / ENGLISH ABSTRACT: Background: Children with Attention Deficit Hyperactivity Disorder (ADHD) have been reported to have motor proficiency problems. Few studies have established the extent of these motor problems and few studies investigate both gross and fine motor proficiency. The studies which do investigate motor proficiency, often also include other aspects, for example physical fitness, grip strength or kinaesthesia. It is important to be able to identify motor proficiency deficit in this population group early for appropriate intervention to be as effective as possible. The first step in this process is to identify the areas of motor proficiency deficits experienced by these children. Study Design: A cross-sectional descriptive study was done. Objective: The main aim of this study was to establish if children with ADHD demonstrate motor proficiency problems. A second aim was to identify in which areas of motor proficiency they have the most problems. Method: A sample of 28 boys and 9 girls (n = 37) children with ADHD, between the ages of six and ten, were identified by the medical practitioners at four school clinics in the Cape Metropole. The Bruininks-Oseretsky Test of Motor Proficiency was used to test the children. The demographic and other factors that could have affected the motor proficiency in these children were recorded. Results: The range, mean and standard deviation were calculated for all the subtests and the three composite scores. Eighty-one percent of children scored below the expected norm on the Battery Composite Score (20th percentile) with the difference in age equivalent scores being significantly different (p < 0.01), the Gross Motor Composite Score (20th percentile and p < 0.01) and on the Running Speed and Agility Subtest (p < 0.01), the Balance Subtest (p < 0.01), Strength Subtest (p < 0.01) and the Upper Limb Coordination Subtest (p < 0.01). No significant motor proficiency problems were identified in the Fine Motor Composite Score (35th percentile), the Bilateral Coordination Subtest, the Response Speed Subtest, the Visual motor Subtest or the Visual Motor Control Subtest. Conclusions: These results support the literature in so far as motor proficiency deficits are present in children with ADHD, which in turn supports the need for early identification of these problems. / AFRIKAANSE OPSOMMING: Agergrond: Kinders met Aandag Afleibaarheid Hiperaktiwiteit Sindroom (ADHD) demonstreer probleme met motoriese vaardighede. 'n Paar studies is gedoen om dié bepaalde motoriese vaardighede te bepaal en sommige studies kombineer die ondersoek met ander aspekte van motoriese vaardigheid soos, fiksheid, greep sterkte of kinestesie. Dit is belangrik om die tekortkominge vroeg te identifiseer om effektiewe intervensie so vroeg moontlik te inisieer. Die eerste stap is om die spesifieke vaardighede waarmee hierdie groep kinders probleme ondervind, te identifiseer. Studie: 'n Dwarssnit beskrywende studie is uitgevoer. Doel: Die doel van die studie was om te bepaal of kinders met ADHD motoriese probleme het en of daar spesifieke aspekte van motoriese vaardigheid is waar hulle tekortkominge toon. Metodiek: 'n Steekproef van 28 seuns en 9 dogters (n = 37) tussen die ouderdomme van ses tot tien jaar, met ADHD is deur die mediese praktisyns geïdentifiseer, en getoets. Die Bruininks- Oseretsky Toets vir Motoriese Vaardigheid is gebruik. Enige faktore wat motoriese vaardigheid kon beïnvloed is gedokumenteer. Resultate: Die reikwydte, gemiddelde en standaard afwyking is bereken vir al die sub-toetse en die drie saamgestelde tellings. Een en tagtig persent van die kinders het tellings onder die verwagte norm behaal vir die Saamgestelde Telling van die Battery van toetse (20ste persentiel) met die verskil in ouderdomtelling beduidend verskillend (p<O.01).Die Growwe Motoriese Saamgesteldetelling was (20ste persentiel en p<O.01), die Hardloopspoed- en Ratsheidsubtoets (p<O.01), die Balanssubtoets (p<O.01), Kragsubtoets (p<O.01) en die Boonste Ledemaat Koordinasie-subtoets (p<O.01). Geen beduidende tekorte is deur middel van die Saamgestelde Fyn Motoriese Vaardigheidstoetse (3Sste persentiel), die Bilaterale Koordinasiesubtoets, die Reaksiespoed-subtoets, die Visuele Motoriese subtoets of die Visuele Motoriese Beheer-subtoets gevind nie. Gevolgtrekkings: Die resultate ondersteun die bevindinge uit die literatuur rakende die probleme wat kinders met ADHD met motoriese vaadigheid ervaar en ondersteun die behoefte vir vroeë identifisering om effektiewe intervensie so vroeg moontlik te begin.

Thesis (MSc) -- University of Stellenbosch, 2002. / ENGLISH ABSTRACT: South Africa is a multicultural, multiracial and multilingual nation ("the rainbow nation") with different traditions, values and cultural practices. Due to this diversity there are different belief systems, which give rise to different attitudes and practices towards various health issues such as disability, which in turn, have an impact on the rehabilitation of people with disability. The purpose of this study is to investigate the knowledge, attitudes and cultural beliefs towards disability and to identify the commonalities and differences of three broad cultural groups of South Africa (Blacks, Coloureds and Whites), and to determine their influence on the rehabilitation of disabled people in the Cape Town area. Sixty respondents (20 Blacks, 20 Coloureds and 20 Whites) were interviewed utilizing the knowledge, attitude and belief (KAB) survey in the form of a structured interview. Both probability and non-probability (systematic and purposive) sampling were used. The study was carried out using both quantitative and qualitative methods. The results showed that Whites and Colored generally had a fairly good knowledge of disability and its causes, acquired while they were young, whereas Blacks had a more superficial knowledge of disability, which was only acquired after the birth of a disabled child. The results also revealed that quantitatively all the cultural groups held positive attitudes towards the rehabilitation, education, marriage, childbearing and employment of people with disability. Attitudes towards the stigma attached to being disabled were also encouraging. In contrast, the qualitative data showed disparities between the three cultural groups in attitudes towards rehabilitation, education and marriage. Although rehabilitation is considered an important aspect to disabled people and their families, some Blacks experience problems in transporting their children to centres where rehabilitation services are offered. Socio-economic factors also have a bearing on this. The results revealed a general lack of awareness of disability among school children and teachers in Black and the Coloured schools, which may make it difficult for disabled children to be integrated into mainstream schooling. Marriage and childbearing was regarded as a way of increasing the support base of individuals with disability in the Black group, while the Coloured and White groups viewed marriage as a way of enjoying life and having children a matter of individual choice. Concerning employment and the promotion of people with disability, all three groups believed that disabled people have a right to be employed and earn a salary. In the area of beliefs, the results showed that the Black group blamed disability on witchcraft and that they consult health professionals, folk healers and look to God for healing. Most of the Whites and Coloureds believed that disability is a result of natural causes, human error or the will of God. There is an uneven geographic distribution of information about disability. Cultural beliefs towards disability may delay or hinder early identification of children and intervention. Two main recommendations are made arising from these results. Firstly, health professionals should know and understand the culture, values, beliefs and expectations of their clients and, more importantly, bring services to the recipients in their own familiar environment, culture and community, via the CBR model. Secondly, I recommend that an evaluation of knowledge and attitudes towards disability should be done in schools, where the disability awareness has been raised by some NGOs as compared with those where no intervention has taken place. A survey of this kind should be done in all the provinces of South Africa. The findings from this research thus have very serious implications for the provision of inclusive education and quality rehabilitation services for all the disabled children of South Africa. / AFRIKAANSE OPSOMMING: Suid-Afrika het 'n multi-kulturele, veelrassige en veeltalige bevolking ("die reënboog nasie") met uiteenlopende tradisies, waardes en kulturele praktyke. Hierdie diversiteit gee aanleiding tot verskillende sienswyses en praktyke met betrekking tot gesondheidskwessies soos gestremdheid, wat op gestremde persone 'n impak het. Die doel van hierdie studie was om die kennis, sienswyses en kulturele opvattings rakende gestremdheid by die drie breë kulturele groepe van Suid-Afrika (Swartes, Kleurlinge en Blankes) te ondersoek en te bepaal wat die verskille en ooreenkomste is en hoe dit die uitkoms van rehabilitasie van gestremde persone in die Wes-Kaap raak. Sestig respondente (20 Swartes, 20 Kleurlinge en 20 Blankes )is tydens gestruktureerde onderhoude ondervra. Die "Knowledge, attitude and belief' (KAB) onderhoud is gebruik: Beide 'n waarskynlikheids en nie-waarskynlikheids steekproef en 'n kwantitatiewe en kwalitatiewe ondersoekmetode is vir die studie gebruik Die resultate het getoon dat Blankes sowel as Kleurlinge 'n redelike goeie kennis het van gestremdheid en die oorsake daarvan, wat reeds op 'n jong ouderdom opgedoen word. Daarteenoor het Swartes gewoonlik 'n meer oppervlakkige kennis van gestremdheid, wat eers na die geboorte van 'n gestremde kind verwerf word. Kwantitatief is getoon dat al die kultuurgroepe 'n positiewe houding het teenoor rehabilitasie en onderrig van, huwelik met, hê van kinders en indiensneming van gestremdes. Houding teenoor die stigma gekoppel aan gestremdheid was ook bevredigend. In teenstelling hiermee het die kwalitatiewe data ongelykheid tussen die drie kultuurgroepe getoon in houding teenoor rehabilitasie en onderrig van en huwelik met gestremdes. Swartes beskou rehabilitasie as belangrik vir die gestremde sowel as die familie, maar ervaar probleme met toeganklikheid tot rehabilitasie. Sosio-ekonomiese faktore impakteer hierop. Skoolkinders en onderwysers in Swart en Kleurlingskole toon 'n algemene gebrek aan bewustheid van gestremdheid, wat integrasie in die hoofstroom-onderwys kan bemoeilik. Die Swart groep het huwelik met en hê van kinders beskou as 'n manier om die ondersteuningsnetwerk van die gestremde uit te brei, waarteenoor die Blanke en Kleurling groepe die huwelik beskou as 'n manier vir die gestremde om die lewe te geniet en dat die hê van kinders 'n individu se keuse is. AI drie die groepe glo dat die gestremde die reg het op indiensneming en om 'n salaris te verdien. Sover dit die sienswyses oor gestremdheid betref, blameer die Swart groep die toorkuns daarvoor en besoek hulle die tradisionele geneser sowel as professionele gesondheidswerkers. Hulle verwag genesing van God .. Blankes en Kleurlinge glo dat gestremdheid die gevolg is van natuurlike oorsake, menslike foute of die wil van God. Daar was ongelyke geografiese verspreiding van inligting oor gestremdheid. Kulturele sienswyses oor gestremdeheid mag 'n remmende invloed hê op op vroeë identifikasie en intervensie by kinders. Twee hoof aanbevelings kan op grond van die resultate gemaak word. Eerstens behoort professionele gesondheidswerkers ingelig te wees oor die kultuur, waardes, sienswyses en verwagtinge van hul kliënte, en dit te verstaan. Dienslewering behoort na die ontvangers se eie omgewing, kultuur en gemeenskap via die GBR-model gebring te word. Tweedens beveel ek aan dat 'n evaluering van kennis en sienswyses, rakende gestremdheid, in skole gedoen word. 'n Vergelyking kan getref word tussen die skole waar bewusmaking van gestremdheid reeds deur NRO's gedoen is, teenoor die waar geen intervensie was nie. So 'n ondersoek behoort in al die provinsies van Suid-Afrika uitgevoer te word. Die uitkoms van hierdie studie het dus implikasies vir beide die voorsiening van inklusiewe onderrig en kwaliteit rehabilitasie-dienste vir al die gestremde kinders in Suid-Afrika.

Thesis (MScPhysio (Interdisciplinary Health Sciences. Physiotherapy))--University of Stellenobosch, 2010. / Background: Low back pain (LBP) has a high prevalence worldwide. LBP is significantly associated with a range of poor socio-demographic circumstances which should be addressed in preventive programs. Despite this there is a dearth of information about the prevalence and associated factors among low-income communities in South Africa. It is speculated that the burden of LBP may be most significant in these underprivileged communities. Objective: The objective of this study was to assess the prevalence of LBP among the lowincome communities in the Cape Town Metropole and to establish associated factors in order to make recommendations for management. Study design: A cross-sectional study was conducted among the visitors of eight community health centres (CHCs) in the Cape Town Metropole. Methodology: A new measurement tool was developed based on existing validated outcome measures and initial testing of the psychometric properties of the questionnaire was conducted. The questionnaire was administered to 489 eligible subjects. Descriptive analysis was used to describe the sample and logistic regression analytical techniques were applied to determine associated factors. Main findings: Lifetime prevalence for LBP was 76.49% (n=358). About 37% (n=133) suffered from chronic LBP. LBP was significantly associated with belonging to the black ethnic group, any co-morbidity, poor perceived general health, and any type of pain medication. Lifting weights > 20 kg and kneeling and squatting were physical factors significantly associated with LBP. Severe psychological distress was significantly associated with acute and chronic LBP. Having a better or same perceived general health compared to a year ago, was protective for LBP. Conclusion: LBP has a high prevalence among the low income communities, visiting the CHCs, in the Cape Town Metropole. Multiple factors were associated with LBP, which imply that a tailormade multidisciplinary program addressing lifestyle issues, self management strategies, medication use, chronic diseases and psychosocial factors may be required for this population to combat LBP.

Thesis (MScPhysio)--Stellenbosch University, 2013. / ENGLISH ABSTRACT: Aim: The aim of this study is to determine if the addition of a pre-extubation recruitment manoeuvre to standard care is safe and will improve lung compliance and subsequent PaO2/FiO2 (PF ratio) after extubation in postoperative coronary artery bypass graft surgery patients. Design: Prospective, triple blind, randomised, controlled trial. Method: This study was conducted in a private hospital in the Northern suburbs of Cape Town, South Africa. All patients admitted between 03/10/2010 and 22/11/2011, for uncomplicated elective coronary artery bypass graft (CABG) surgery were eligible for inclusion into the study. Patients were randomly allocated into either the intervention group or the control group. The intervention group received a gradual build-up lung recruitment manoeuvre (RM). The primary outcome was PaO2/FiO2 (PF ratio). The secondary outcomes were safety and static lung compliance. ICU length of stay (LOS) and hospital LOS were also recorded. The pre-RM hemodynamic stability of the patient was checked before the intervention and repeated at 5 minutes after the intervention by the nursing sister. Data to calculate static lung compliance was captured at the same time. Criteria for safety and discontinuation of the RM were monitored during the intervention by the principle investigator only. Results: Of the 69 patients eligible for the study 47 were randomly allocated into the intervention group (n=22) and control group (n=25) respectively. Groups were the same at baseline with regards to sex, pulmonary risk, sedation and surgical procedures. The RM could be completed in all patients. The prior defined criteria for discontinuation of the RM were not reached in any of the patients. No adverse effects were noted. The PaO2/FiO2 (PF ratio) decreased significantly in both groups from pre-surgery measurements compared to when measured before the RM (p<0.001). There was a tendency noted for the intervention group to return to pre-surgery measurements of PF ratio within 12 hours after extubation when compared to the control group. There was no significant difference between the groups from extubation to 24 hours (p = 0.6). The static compliance improved at 5 minutes following the RM (p<0.001) and remained improved until extubation (p<0.001) for the intervention group. No difference was noted in the static compliance of the control group over the same time period. The mean hospital length of stay for the intervention group was 8.61 (95% confidence interval 7.26 to 9.96 days) and 10.08 (95% confidence interval 8.52 – 11.63 days) for the control group. Conclusion: A gradual recruitment manoeuvre at 30cmH2O 30minutes before extubation significantly improved static lung compliance within 5 minutes with no adverse hemodynamic side effects. There was noted maintained improved PF ratio at extubation or immediately afterwards for the intervention group and no difference in the PF ratio between the intervention group and control group. / AFRIKAANSE OPSOMMING: Doel: Die doel van hierdie studie is om te bepaal of die toevoeging van ’n pre-ekstubasie herwinningstegniek tot standaard sorg veilig is, en of dit longvervormbaarheid en gevolglike PaO2/FiO2 (PF-verhouding) na ekstubasie in post-operatiewe kroonaaromleidingchirurgiepasiënte sal verbeter. Ontwerp: Prospektiewe, trippel-blinde, ewekansige, gekontroleerde proefneming. Metode: Hierdie studie is uitgevoer in ’n privaat hospitaal in die noordelike voorstede van Kaapstad, Suid-Afrika. Alle pasiënte wat tussen 03/10/2010 en 22/11/2011 gehospitaliseer is vir ongekompliseerde elektiewe kroonaaromleidingchirurgie, kon in aanmerking kom vir die studie. Pasiënte is op ewekansige wyse ingedeel in die intervensie- en kontrolegroepe. ’n Geleidelike-opbou-van-druk-longherwinningstegniek (HT) is op die intervensiegroep toegepas. Die primêre uitkoms was die PaO2 /FiO2 (PF-verhouding). Die sekondêre uitkoms was veiligheid en statiese longvervormbaarheid. ISE-verblyf en hospitaalverblyf is ook genoteer. Die navorsingsassistent het data van bestaande eenheiddokumentasie geneem. Die pre-HT-hemodinamiese stabiliteit van die pasiënte is gemonitor voor en weer 5 minute na die intervensie. Inligting om die statiese longvervormbaarheid te bereken is terselfdertyd genoteer. Kriteria vir veiligheid en vir die staking van die HT is gemonitor tydens uitvoering deur die primêre ondersoeker en die verpleegkundige. Resultate: Van die 69 pasiënte wat in aanmerking kon kom vir die studie is 47 op ewekansige wyse ingedeel in die intervensiegroep (n=22) en die kontrolegroep (n=25). Die groepe was dieselfde by die basislyn. Die herwinningstegniek kon volledig op alle pasiënte uitgevoer word. Die vooraf gedefinieerde kriteria vir staking van die HT is met geen pasiënte bereik nie. Geen nadelige uitwerking is genoteer nie. Die PaO2 /FiO2 (PF-verhouding) het beduidend verminder in beide groepe van pre-operatiewe metings in vergelyking met meting voor die HT (p<0.001). ‘n Neiging is genoteer dat die intervensiegroep binne 12 uur na ekstubasie tot pre-chirurgie PF-metings teruggekeer het. Daar was geen merkbare verskil tussen die groepe vanaf ekstubasie tot 24 uur (p=0.6) nie. Die statiese vervormbaarheid het verbeter teen 5 minute na HT (p<0.001) en het verbeter gebly tot ekstubasie (p<0.001) vir die intervensiegroep. Daar was geen verskil in die statiese vervormbaarheid van die kontrolegroep nie. Die gemiddelde hospitaalverblyf vir die intervensiegroep was 8.61 (95% betroubaarheidsinterval 7.26 tot 9.96 dae) en 10.08 (95% betroubaarheidsinterval 8.52 – 11.63 dae) vir die kontrolegroep. Gevolgtrekking: ’n Geleidelike herwinningstegniek teen 30cmH2O 30 minute voor ekstubasie het statiese longvervormbaarheid beduidend verbeter binne 5 minute, met geen nadelige hemodinamiese newe-effekte nie. Daar was geen verskil in die oksigenasie-indeks tussen die intervensie- en kontrolegroep na ekstubasie nie.

Thesis (MScPhysio)--Stellenbosch University, 2014. / ENGLISH ABSTRACT: Chronic groin pain is widespread across many sporting disciplines. The aim of our research was to determine if there are kinematic differences of the thoracic spine in active sports people with chronic groin pain, compared with healthy controls. A cross-sectional descriptive design was followed. Participants were required to complete six single leg drop landings with each leg from a 20cm height. The study was done in the 3D Movement Analysis Laboratory at the University of Stellenbosch. Ten male participants with unilateral or bilateral chronic groin pain of more than 3 months duration and 10 asymptomatic males, matched for age and sports participation, were recruited. The main outcome measures were: thoracic spine angle at initial foot contact, maximum thoracic spine angle, range of movement (ROM) (difference between the minimum and maximum values) and thoracic spine angle at lowest vertical point of the pelvis. This was assessed in all 3 movement planes: the sagittal plane (X plane), the coronal plane (Y plane) and the transverse plane (Z plane). The results of our study showed that for the unilaterally affected groin pain group, the cases landed in significantly more thoracic flexion (P<0.001 with large effect size) and were in significantly more thoracic flexion still at the lowest point. Peak thoracic flexion was significantly more in the cases than the controls. (P<0.001 with medium effect size) The same was true for the bilaterally affected group when landing on the most painful side, although this was not statistically significant. There were no significant differences in the frontal or transverse planes. In the bilaterally painful group, axial rotation ROM was significantly reduced when landing on either leg (worst affected side: P=0.040 with medium effect size and least affected side: p=0.006 with large effect size). The same occurred in the unilaterally affected group, although this was not statistically significant. Our study suggests that, in participants with chronic groin pain, there is greater thoracic forward flexion away from neutral during landing and that total axial rotation ROM during landing is diminished. / AFRIKAANSE OPSOMMING: Kroniese liespyn kom dikwels en in verskeie sportsoorte voor. Die doel van ons studie was om te bepaal of daar kinematiese verskille van die torakale werwelkolom is in aktiewe sportmense met chroniese liespyn, in vergelyking met gesonde kontroles. ‘n Dwars-deursnit beskrywende studiemetode is gevolg, en uitgevoer in die 3D Beweging Analise Laboratorium, Universiteit van Stellenbosch. Deelnemers moes ses landings op een been doen, met elke been, vanaf 'n 20cm hoogte. Tien mans met eensydige of bilaterale chroniese liespyn vir langer as 3 maande, en 10 asimptomatiese mans (ooreenstemmende ouderdom en sport deelname) het deelgeneem. Die hoof uitkomste wat gemeet is, was torakale werwelkolom krommingshoek by aanvanklike voet-kontak, maksimum torakale werwelkolom krommingshoek, omvang van beweging (OVB) (verskil tussen die minimum en maksimum waardes) en torakale werwelkolom krommingshoek by die laagste punt van die bekken. Dit is beoordeel in al 3 beweging vlakke: die sagittale (X) vlak, die koronale/frontale (Y) vlak en die transversale (Z) vlak. Die resultate van die studie het getoon dat, in die eensydig-geaffekteerde liespyn groep, die deelnemers in beduidend meer torakale fleksie geland het(P < 0.001, met 'n groot effekgrootte), asook met aansienlik meer torakale fleksie by die laagste punt na landing. Piek torakale fleksie was aansienlik meer in die liespyn-gevalle as in die kontroles. (P < 0.001, met middelmatige effekgrootte ) Dieselfde het vir die bilateraalgeaffekteerde groep gegeld wanneer hulle op hul mees pynlike kant geland het, hoewel dit nie statisties beduidend was nie. Daar was geen betekenisvolle verskille in die frontale of transversale vlakke van beweging nie. In die bilateraal pynlike groep, was aksiale rotasie OVB aansienlik verminder wanneer die gevalle op hul pynlikste been óf op hul minder pynlike been geland het ( mees pynlike been : P = 0,040, met 'n middelmatige effekgrootte en minder pynlike been : p = 0,006, met 'n groot effekgrootte ). Dieselfde het in die eensydig-geaffekteerde groep gebeur, hoewel dit nie statisties beduidend was nie. Ons studie dui daarop dat, in deelnemers met chroniese liespyn, daar meer torokale fleksie weg van neutraal tydens landing is en dat die totale aksiale rotasie OVB tydens die landing verminder is, in vergelyking met die kontrolegroep.