Submitted in partial compliance with the requirements for the Master's Degree in Technology: Chiropractic, Durban University of Technology, 2013. / Background: A triathlon comprises of a combination of swimming, cycling and running. Triathlons are usually classified as sprint distance, Olympic distance, and Ironman or ultra-distance. Triathlon was popularized in the 2000 Summer Olympic Games and, despite this, there is insufficient data relating to injuries in the South African context. This study aimed to determine the injury profile of amateur and semi-professional Kwa-Zulu Natal triathletes. Methods: This Institutional Research Board approved, cross sectional study, included 80 active members of the Kwa-Zulu Natal Triathlon Association. All triathletes completed a questionnaire on training and injury profiles; with only those having had a musculoskeletal complaint additionally completing a clinical consultation. In order to assess associations between presence of injury and explanatory variables, binary logistic regression using backward selection based on likelihood ratios was used. Data was described using frequency tables for categorical data and summary statistics for continuous data. Odds ratios was reported and a p value <0.05 was considered statistically significant. For triathletes reporting injuries, linear regression was used for factors associated with injury severity. Results: Fifty seven triathletes responded giving a response rate of 71% (68% male, 32% female). The point and period (year) prevalence of triathlon-related musculoskeletal pain was 17.5% and 68.4% respectively. The ranking of the most common site of injury in the last 12 months included the knee (64%), low back (21%) and thigh (18%); with females having had a significantly higher risk of injury than males (p=.019). Additionally, injury risk also increased with weight (p=.055), number of triathlons undertaken in the previous year (p=.031), number of triathlons in the last 4 months (p=.009) and running distance during competition times (p=.011). Injury risk decreased with increasing distance of cycling (p=.061) and swimming (p=.030) in a competition, and length of training in- and off-season (p=.105 and p=.043 respectively). Strong trends were demonstrated between injury severity and long-slow training distance (p=.006) and weight (p=.006). By contrast to risk of injury, injury severity was negatively associated with weight, while a long-slow distance was positively associated with the severity of the injury. Of all the health professions, chiropractic was the most utilized health profession. Conclusion and recommendations: The results concur with previous research, but add insights into factors predisposing triathletes to injury. The most common injuries require investigation to develop preventative interventions to reduce injuries in triathletes. Health professionals require education about triathlon-related injuries to improve preventative and curative interventions.

Magister Scientiae (Physiotherapy) - MSc(Physio) / Dance movements requires explosive power, sustained effort and both local and general endurance. Musculoskeletal injuries (MSI) are the most frequent medical problems among dancers in ballet, which is partly owing to inadequate training and dancers not being properly prepared for the demands of the dance performance. The purpose of the present study was to determine the cumulative incidence of musculoskeletal injuries amongst student dancers at TUT. The study used a prospective, cohort design. A total of 49 student dancers at Tshwane University of Technology (TUT) were followed up over 16 weeks in the 2007 academic year. The student dancers completed a questionnaire about previous injuries, and factors influencing injuries. Of the 49 student dancers, 41 (83%) consent to participate. There were 10 cumulative injuries incurred by 41 student dancers over 16 weeks period i.e. 7.1 %, 0.06 injuries incurred per student month at risk.The main limitations to this study were small sample size and possible reporting biases. Further research should aim to standardize injury definitions and classifications.

This descriptive retrospective cohort study utilized a large workers comp insurer database. All MRI's performed on peripheral joints during calendar year 2017 that were (a) 2 weeks after the initial clinic visit, or (b) greater than 6 weeks after injury, but (c) not more than 3 months after the date of injury were evaluated in this study. Individual diagnoses rendered on MRI reports for these cases were categorized as to whether ultrasound alone or ultrasound + xray could adequately provide the same diagnoses. Results showed that, ultrasound + xray would be able to provide all of the same diagnoses compared to MRI in 54% of cases vs 33% of cases using ultrasound alone, highlighting the utility of using ultrasound and xray together. The proportion of cases where ultrasound + xray could reasonably be substituted for MRI increases to 70% overall when less severe diagnoses, considered not likely to change management, were excluded from analysis. If point of care ultrasound was performed for all 1482 cases with subsequent MRIs pursued in only 30% of cases, a cost savings between $456,186 and $331,698 would be realized, translating to $308 to $224 per patient. Additionally, if ultrasound + xray was performed at the point of care during the first clinic visit for an injury, the definitive diagnoses could be reached on average 33.3 days earlier. In total, these results suggest a significant proportion of musculoskeletal workers comp injuries could be accurately and completely evaluated at the point of care using ultrasound and xray together. This could yield greater provider and patient confidence in the diagnosis and treatment plan as well as more expeditious accurate diagnoses leading to reductions in both direct and indirect costs.

Submitted in partial compliance with the requirements for the Master’s Degree in Technology: Chiropractic, Durban University of Technology, Durban, South Africa, 2015. / Background CrossFit is a workout program developed in 2000 which involves high intensity interval training coupled with resistance training elements of powerlifting and gymnastics. CrossFit has grown to include competitive events and there are an ever increasing number of affiliate gyms internationally. CrossFit’s greatest criticism is related to safety. There is limited published data on the exercise program. Aims The aims of this study were: to determine a retrospective cohort analysis of the demographic, injury and treatment profiles of participants at the 2013 United We Stand CrossFit Games who presented to the Durban University of Technology’s sports treatment facility; to determine the association, if any, between demographics and injury types; and, to provide any recommendations regarding the clinical record form used. Methods This study was a retrospective, quantitative, descriptive study on the chiropractic Student Sports Association’s report form in order to produce a retrospective cohort analysis of the injury and treatment profiles. Persons who made use of the chiropractic treatment facility at the 2013 United We Stand CrossFit Games were required to complete an informed consent form. A sixth year chiropractic student then filled in a Chiropractic Student Sports Association report form to record participant, complaint and treatment information. The study was not limited to competitors, but all persons who had access to the chiropractic treatment facility. These forms were then collated and data captured on the complaints which presented and were treated at the chiropractic treatment facility. Results The data collected revealed that 137 participants presented to the chiropractic treatment facility in 162 visits, with 263 complaints treated. The age range of the sample was between 18 and 43 years, with a mean age of 27.49 years. The majority of participants who presented to the CTF were competing athletes and just under half of the study sample reported to not having a history of previous injury. The study found that the lumbar region (20.9%), wrist/hand (14.4%), shin/calf (11.0%) and knee (10.2%) were the most commonly presented regions of complaint. The highest presenting mechanism of injury was that of overuse (22.4%) followed by running (19.0%). Acute injuries accounted for 72.20% of all injuries. With regards to diagnoses, myofascial trigger points made up 21.6% of all injuries, followed by muscle strains (19.7%). Facet syndromes of the spinal column accounted for 13% of diagnoses.It was shown that kinesiotape, manipulation, massage and ischemic compression were the top treatment interventions utilised. It was also shown that rest, ice and referrals were types of treatment that were not utilised. Due to statistical inconsistencies no significance tests were possible between demographic and injury characteristics. Recommendations were proposed in order to maximise the quality of data captured. Conclusion: The results add insight into the injuries presented and the treatment they acquired at the chiropractic treatment facility at a national CrossFit event. The most common injuries require investigation in both training and competitive environments. Various recommendations have been proposed for the record form used at sporting events in order to facilitate the collection of high quality data. / M

Bakgrund Personer med demenssjukdom har stor risk att utveckla beteendemässiga och psykiska symtom efter kirurgi vilket ställer höga krav på omvårdnadsarbetet i det postoperativa förloppet. Aktuell forskning som undersöker sjuksköterskor som har hand om denna patientgrupp i det postoperativa förloppet är begränsad och med anledning med detta ansågs det värdefullt att genomföra en studie som undersöker detta fenomen närmare. Syfte Studien syftade till att undersöka sjuksköterskors kunskaper om demenssjukdom samt beskriva sjuksköterskors arbetssätt i att lindra beteendemässiga och psykiska symtom hos personer med demenssjukdom som genomgått kirurgi. Metod Detta var en deskriptiv tvärsnittsstudie vilken använde sig av en onlinebaserad enkätundersökning som datainsamlingsmetod. Instrumentet Basic Knowledge of Alzheimer’s Disease (BKAD) användes för att testa kunskaper om den vanligaste typen av demenssjukdom. Kunskapen om beteendemässiga och psykiska symtom vid demens och metoder som sjuksköterskor använder sig av för att lindra dessa undersöktes genom utformade frågeställningar. Data inhämtades från januari till april månad år 2019 och totalt deltog 50 sjuksköterskor. Resultat Kunskapen om Alzheimers sjukdom var bristande och likaså även kunskapen om hur man behandlar beteendemässiga och psykiska symtom vid demens. Sjuksköterskors möten med denna patientgrupp rankades överlag som svåra och det visade sig att sjuksköterskor hade haft flertalet sådana möten i den postoperativa vårdverksamheten. Vidare rapporterades det att sjuksköterskors utbildning i demensvård från den grundläggande sjuksköterskeutbildningen var minimal och att utbildning i demensvård borde höjas i den grundläggande sjuksköterskeutbildningen. Slutsats och kliniska implikationer Demensvård som läroämne bör få större omfattning i den grundläggande sjuksköterskeutbildningen. Utbildningsinsatser bör prioriteras för att höja sjuksköterskors kunskaper om vård för personer med demenssjukdom genom organisatoriskt och pedagogiskt stöd. Om kunskapen i demensvård höjs torde även omvårdnaden för personer med demenssjukdom bli bättre. / Background People with dementia have a great risk of developing behavioral and psychological symptoms after surgery. This puts challenges on the nurses’ care for these patients. Current research that investigate nurses’ who care for these individuals in the postoperative phase is limited. Therefore, it was considered being important to investigate this phenomenon further.    Aim The study sought to investigate nurses’ knowledge of dementia, and their work methods in alleviating behavioral and psychological symptoms in dementia for people who had undergone surgery. Method The study was carried out as a descriptive, cross-sectional study using online surveys. The Basic Knowledge of Alzheimer’s Disease (BKAD) was used to test participants’ knowledge of Alzheimer’s disease. The knowledge of behavioral and psychological symptoms in dementia, and nurses’ working methods to alleviate these behaviors and symptoms was investigated by using developed questions. The study collected data from January to April, 2019 and a total of 50 nurses’ participated.  Result There was a deficit in the knowledge of Alzheimer’s disease, and also in the knowledge of how to treat behavioral and psychological symptoms in dementia. Nurses’ reported an overall difficulty in treating a person suffering from behavioral and psychological symptoms, and nurses’ also reported having several encounters with a person with dementia in the surgical ward. Nurses’ stated that training in dementia care in the baccalaureate program was low, and for this reason nurses’ stated that they wished that dementia care would get more attention. Conclusion and clinical implication Dementia care in the baccalaureate program would benefit from getting more attention. Different interventions in education of dementia care by using organizational support ought to be implemented in this process. If the knowledge of dementia care is increased there is a chance that the care for these individuals would become better.

Problem Statement: The burden of musculoskeletal injuries among workers is very high, particularly so in direct care workers involved in patient handling. Efforts to reduce injuries have shown mixed results. Strong evidence for intervention effectiveness is lacking.<p> Specific Aims: The goal of this study was to evaluate the effectiveness of a patient handling injury prevention program implemented in the Saskatoon Health Region (SHR) comparing it with a non-randomized control group, Regina QuAppelle Health Region (RQHR), in a pre-post design. Injury rates, lost-time days, and claim costs were the outcomes of interest.<p> Intervention: A Transfer, Lifting and Repositioning (TLR) program, consisting of engineering and administrative ergonomic controls, was implemented in SHR hospitals from 2002-2005.<p> Methods: Data on time loss and non-time loss injuries, lost time days, and claims costs were collected from the SHR and RQHR for corresponding time periods one year pre and one year post-intervention. Age, length of service, profession, and sex were selected as covariates. Full Time Equivalents (FTE) data were collected for each time period. Univariate and multivariate Poisson regression were performed.<p> Results: Rates for all injuries (number of injuries/100 FTE) dropped from 14.68 pre-intervention to 8.1 post-intervention. Control group all injury rates, while overall lower in absolute value, dropped to a lesser degree, from 9.29 to 8.4. Time loss injury rates decreased from 5.3 to 2.51 in the SHR, while they actually increased from 5.87 to 6.46 in the RQHR, for the same intervention periods. Poisson regression showed the greatest reduction in injury rate, both time loss (Rate ratio=0.48, 95% C.I: 0.34-0.68) and non-time loss (Rate Ratio=0.25, 95% C.I: 0.15-0.41) in the smaller long term care facility controlling for hospital size. Analysis of injury rates, incidence rate ratios, and incidence rate differences showed significant differences between the intervention and comparison group for all injuries and time loss injuries. Mean claim cost/injury decreased from $3906.20 to $2200.80 and mean time loss days/claim decreased from 35.87 days to 16.23 days for the SHR.<p> Conclusions: The study provides evidence for the effectiveness of a multi-factor TLR program for direct-care health workers, and emphasizes their implementation, especially in smaller hospitals.

Women in Benin commonly participate in physically demanding activities that involve the carriage of heavy loads on the head and back. These strenuous tasks combined with pregnancy can result in back pain that may persist after delivery in some cases. The objective of this study was to examine how the trunk postures of pregnant women in Benin were affected by their occupational activities. This study also examined trunk postures, as well as postures of the head relative to the trunk, in the specific task of carrying loads on the head. Finally, the instrument used in this study to measure trunk postures, the Virtual CorsetTM (VC) (Microstrain, Williston, VT, USA), was validated against a system of potentiometers. Questionnaires completed by 26 pregnant and 25 non-pregnant subjects revealed that 58% of pregnant women suffered from back pain since the start of pregnancy. An average of 328 instances of trunk flexion at angles larger than 60° were recorded during the workdays of 17 pregnant women, while 66 of those flexions events were held for more than four seconds. Furthermore, an average of 36% of the recorded workday was spent in trunk flexion at angles exceeding 20°. Trunk postural data, at C7 and S1, as well as sagittal positions of the head relative to the trunk were compared between pregnant and non-pregnant subjects and between unloaded and loaded walking conditions for the specific task of head load carriage. These comparisons showed that load on the head significantly increased upper trunk extension and lateral bending of the upper trunk towards the left during walking. Motion of the head relative to the trunk and motion of the upper trunk significantly decreased in the loaded condition and was compensated by increased motion at the sacrum level. In the validation study, the VC was moved at different speeds to observe the effects of accelerations on the angle measurements. Root mean square difference between the angles measured by the VC and the potentiometers were all below 5° and 6° for flexion-extension and lateral bending, respectively, with the exception of rapid movements where errors were slightly larger. / Thesis (Master, Mechanical and Materials Engineering) -- Queen's University, 2010-07-07 16:23:53.56

Magister Scientiae (Physiotherapy) - MSc(Physio) / Background: Musculoskeletal disorders (MSD’s) and sports injuries are commonly sustained throughout the world daily. They are dominant in many countries, with considerable cost involvement and impact on quality of life. For this reason they need to be recognised as a necessary part of general practice. MSD’s refer to a wide variety of diseases and disorders of the musculoskeletal system, such as degenerative and inflammatory conditions (arthritis), spinal and soft tissue disorders, osteoporosis and musculoskeletal injury. Managing these musculoskeletal conditions are a challenge and using the best available evidence should be the first the choice. All health professionals should have the ability to determine the best available evidence and thus strive to give their patients the best health care known to them. Evidence-based practice (EBP) is an important key in making this happen as it uses the best current evidence in the decision-making process regarding the care of patients. Literature highlights that health care professionals are expected to implement evidence-based practice (EBP); this means that newly graduated students and health care professionals alike are required to be confident in exercising this skill of EBP. When expecting EBP from students, educators need to realize that students have limited clinical experience. Therefore, they need the skills to acquire the best research evidence when applying the best treatment for patients. In introducing evidence-based practice, various research is aimed at evaluating the health professional’s attitude and behaviour towards evidence-based practice (EBP). There is limited research regarding the actual implementation of EBP in everyday practice. Aim: Therefore, the aim of the study was to determine if undergraduate physiotherapy students implement evidence-based practice in the management of musculoskeletal disorders and sports injuries. Objectives: The study had four objectives: i) To determine the most common treatment techniques used by students in the management of the conditions treated at the UWC clinic through data extraction of patient records in the clinic using a self-designed data extraction sheet, ii) To determine the knowledge and beliefs about EBP among undergraduate physiotherapy students through a survey, iii) To determine an evidence-based intervention strategy of one of the most common conditions seen through a systematic review and iv) To map the links between current practice, student beliefs and evidence-based information. vii Methodology: The study used a predominantly quantitative approach with a few open ended questions and took place at a student training Physiotherapy clinic. The first phase was a retrospective document analysis study which consisted of data extraction of patient records for the period January 2009 to December 2011. The second phase used a mixed methods approached and consisted of a questionnaire with both closed and open-ended questions. It was completed by the 2012 registered fourth year students regarding attitudes and knowledge of EBP. The third phase consisted of a systematic review to identify the evidence for interventions used to manage one of the most common conditions identified. In the final phase and discussion of this thesis triangulation of the data was used by the researcher in order to formulate a picture of whether students apply evidence-based practice by using the data extracted from the patient folders in combination with the questionnaire survey of the participants and the systematic review. Data analysis for phases one and two was done using SPSS Statistical package software to determine frequencies and descriptive statistics. Phase two also had two open ended questions and this was analysed thematically and data was coded, themes allocated and responses counted. The systematic review focused on systematic reviews of treatments for low back pain and this was narratively described. The research project received ethical clearance from the University of the Western Cape Research Grants and Study Leave Committee (project registration number: 12/3/12), and permission to conduct the survey was obtained from the Head of Department. Informed consent was obtained from all participants, they were informed of the research process at the outset of the project, and kept up-to-date at every major stage. Questionnaires for surveys were accompanied by an information sheet explaining the background and reason for conducting the survey, and students gave written, informed consent following an opportunity to clarify the study details. Results: The results showed that males were predominantly seen at the physiotherapy clinic, and that the most common complaint was pain in the neck, shoulder and lower back area. The students most common treatment choice was soft tissue mobilisation and the use of heat for all three these areas of pain. The questionnaire responses were also captured using SPSS and frequencies and descriptive statistics employed. These results showed that although students knew what EBP was it was not clear that they knew how to implement it. The systematic review assessed and established the most common treatments used in literature for the treatment of lower back pain; and pain, function and disability were viii the only outcomes considered. The only intervention that had a positive effect on the included outcomes was the use of manual therapy (spinal manipulation and mobilisation). In triangulating the data, it was shown that the students do not seem to use the same treatment choices as the literature indicates. Conclusion: The results show that there is very little link between the students choices of treatment for one of the common conditions highlighted and the current literature. It is therefore possible that although students understand the term EBP they do not show that they know how to use or implement the concept. Implications for practice: Institutions may need to be more vigilant about making provision for EBP in the curriculum as well as how it is implemented so that students can be comfortable with this practice. More randomised controlled trials and systematic reviews are necessary on physiotherapy interventions so that practice can be better informed. Finally, EBP is perhaps one way to promote a culture of life-long learning within the physiotherapy profession.

A retrospective investigation of Thoroughbred racehorses euthanazed as result of catastrophic musculoskeletal injury (CMI) at four racetracks in Gauteng, South Africa during the period of 1998-2004 was performed. Fifty-five cases of CMI from 103 603 starts were evaluated. The incidence of CMI per 1000 starts was 0.53, similar to the incidence reported worldwide. The affected limb of 32 of 55 horses with a CMI was evaluated radiographically, ultrasonographically and dissected. CMI occurred unilaterally and predominantly in the forelimbs, the left forelimb (LF) being most commonly affected. The suspensory apparatus, particularly the proximal sesamoid bones (PSB) was predominantly affected, mostly in the LF. Sixty-nine percent of the PSB fractures occurred biaxially, the medial PSB most commonly affected. PSB fractures were often associated with extensive damage to the flexor tendons and ligaments of the metacarpophalangeal joint. Lateral condylar fractures were more common than medial, and the right forelimb predominantly affected. Significant risk factors for CMI in this study were gender, racing interval, and weight carried. Gender relative to the number of starts had the highest statistical significance (intact males P<0.001 and geldings P=0.010). Intact males were 14.8 times more at risk than females and 5.3 times moreso than geldings. Horses carrying more than 59kg were 3.3 times more at risk of breakdown than horses carrying 54-59kg of weight (P=0.006). Horses with a racing interval of less than one week were approximately three times more at risk than those with longer intervals (P=0.025 and P=0.029 respectively). Statistically insignificant risk factors were racing year, going, distance, racetrack, age, size of field and draw. It is of paramount importance that CMI is strictly monitored and risk factors identified to implement preventative measures to circumvent occurrence of CMI, which may have a negative impact on this important spectator sport. This study provides benchmarks for the racing industry to monitor racetrack fatalities in Gauteng and to evaluate intervention strategies. Copyright / Dissertation (MMedVet)--University of Pretoria, 2009. / Companion Animal Clinical Studies / unrestricted

No description available.