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Background: Injuries related to endurance running have attracted attention as the sport has become more competitive, and as athletes seek to improve their performance. Consequently, endurance runners are increasingly becoming more susceptible to lower extremity running injuries.Objectives: The aim of this study was to establish the prevalence of running-related injuries among professional endurance runners in the Rift Valley, Kenya.Methods: We used a cross-sectional survey design targeting professional endurance runners who had participated in both local and international running competitions. The sample size consisted of 209 respondents selected through stratified and simple random sampling techniques, of which 167 participated in the study. A self-administered questionnaire was used to collect data on the prevalence of injuries among the endurance runners. The data were analysed using descriptive statistics.Results: The prevalence of running injuries was 63% (n=106). The prevalence among males (n=64; 69%) was higher in comparison with that of females (n=42; 57%). The posterior thigh was the most common site for injuries among the athletes (n=87; 52%), followed by the lower back (n=78; 47%) and ankle (n=63; 38%).Conclusion: The prevalence of running-related injuries was high among professional Kenyan endurance runners compared to other populations. These findings therefore form the basis of future research to explore the mechanisms behind the injuries and the feasibility of targeted injury prevention programmes.

BACKGROUND: Spinal pain is one of the leading causes of morbidity globally. There is an increase in the number of children and adolescents who experience spinal pain and the lifetime prevalence of adolescent spinal pain varies between countries. In Africa, one in two adolescents experiences spinal pain and the prevalence is increasing. OBJECTIVE: This study reports on the knowledge and perspectives of school-attending children, adolescents, teachers, and parents/guardians regarding spinal health. METHODS: We conducted a descriptive qualitative case study with an interpretative and phenomenological approach. Data coding, management and analysis was done using ATLAS.ti computer software. RESULTS: Ninety-three participants (66 women and 27 men) were enrolled in the study. The barriers associated with students’ spinal health were multifactorial, including low levels of physical activity, dangerous gameplay, sports risks, poor ergonomics, school bags, insufficient knowledge, and pregnancy risks. Participants proposed strategies to improve spinal health including the provision of students’ lockers, advice on appropriate school bag types, embedding spinal education in the curriculum, general advocacy for spinal health, and integration of technology in teaching and learning. CONCLUSION: There is a need for further engagement on school-based spinal health promotion programs that consider local socio-economic, educational, and cultural factors.

The study aimed at determining the prevalence of lower limb fractures among adult patients at Mama Lucy Kibaki Hospital. The study adopted a cohort analysis and matched casecontrol study. It was conducted at Mama Lucy Kibaki Hospital, Nairobi. The study population was drawn from 80 respondents who presented with lower limb fractures. Categorical data was presented in the form of frequency tables, graphs and charts. In view of the study findings, it was concluded that: there is a high prevalence of lower limb fractures among adults compared to upper limb fractures; the fracture pattern had the most common occurrence; high energy trauma was the major cause of lower limb fractures and tibia/fibula shaft was the commonly involved fractured bone. The study recommends that the hospital administration should adequately prepare for fractures that involve the lower limb given that the mostly occur in the study area; hospitals should ensure that their facilities are well equipped with surgical equipment and instruments. Further, the clinicians should be well trained and to handle the oblique fracture and tibia/fibula shaft fractures of the lower limb since it accounted for the majority of cases observed.

Rationale, aims, and objectives Despite research being done on spinal tuberculosis, diagnosing this condition at an early stage remains problematic due to its insidious onset and the varying symptoms being associated. Most individuals present to the health care facility with either simple back pain at an early stage or neurological complications at a later stage, when spinal compression and vertebral collapse have occurred as a result of delayed diagnosis. The prevention of secondary complications is therefore dependent on early recognition and diagnosis. The objective of this review was to identify common clinical patterns in case presentations and develop an evidence-based clinical guidance tool to assist clinicians in the early identification of spinal tuberculosis. Method A comprehensive literature search was conducted for published spinal tuberculosis case studies, which yielded 28 cases after critical appraisal. Data from the studies were categorized in order to assist with a factor analysis and the development of an evidence framework for screening and diagnosing spinal tuberculosis. An evidence-based clinical guidance tool was then designed from the data obtained. Results Factors associated with spinal tuberculosis and frequently reported symptoms and physical signs with which the patient could present upon assessment were identified. Options for investigations at primary, secondary, and tertiary levels were also identified. Conclusion Through the use of an evidence-based clinical guidance tool, the clinician could be guided in the early suspicion and management of individuals with spinal tuberculosis and prevention of secondary complications.

Background: Chronic pain is a common clinical symptom and has a high socio-economic and health burden on patients, clinicians and the healthcare sector. Globally, clinicians continue to exhibit limited knowledge, negative attitudes and misconceptions about chronic pain, raising public health concerns. Objective: Our study aimed to determine the level of knowledge, attitudes and practices of clinicians towards assessment and management of patients with chronic pain in a tertiary hospital. Methods: This cross-sectional study at a tertiary care hospital in Kenya adopted a census method to recruit participants (n = 240). A questionnaire containing 77 items derived from the Revised Pain Knowledge and Attitudes Questionnaire (RPKAQ) and the Knowledge and Attitudes Survey regarding Pain (KASRP) was used to collect data. The questionnaire had three parts. Part A had six items to determine information on demographic characteristics. Part B and C had 54 and 23 items, respectively, that determined information on knowledge, attitudes and practice of clinicians managing chronic pain. Data were analysed using SPSS Version 24. Results: Response rate was 83.3% (n = 153). Only 9% (n = 14) of the respondents were believed to have adequate knowledge and positive attitudes; 62% (n = 95) used best practice for cognitive/behavioural management of chronic pain. Few (9% n = 14) used best practice in the assessment and measurement of chronic pain. Conclusion: There is inadequate knowledge, attitudes and practices amongst clinicians regarding assessment and management of chronic pain. Future research is needed in a wider population to compare these results. Clinical implication: It may motivate clinicians to improve their level of knowledge, attitudes and practices for pain management, hence improving poor chronic pain outcome.

Background A fifth of adults in low- and middle-income countries (LMICs) have multimorbid conditions, which are linked to socio-economic deprivation and aging. Multimorbidity is associated with high rates of functional problems and disability, increased healthcare utilization, and lower quality of life. Literature on multimorbidity and associations with function is mostly from high-income countries (HICs) and focused among older adults. Moreover, data regarding disease patterns and their impact on person-centered outcomes are limited. There is a need for research into understanding common patterns of multimorbidity, and their association with functional impairments, particularly in LMICs. Such information may contribute towards evidence-based and context-relevant strategic policy, planning, and delivery models for health and rehabilitation services, which is imperative in attaining Universal Health Coverage (UHC). The planned scoping review aims to provide an overview of the scope and nature of existing literature on multimorbidity patterns and function among adults in LMICs. Methods A scoping review will be conducted using a five-step framework and reported according to the PRISMA-ScR guidelines. A comprehensive electronic search of PubMed/MEDLINE, Scopus, EBSCOhost, Scielo, Cochrane and Google Scholar will be conducted and updated from the last pilot search ran in September 2020. Studies of any design will be included if they are reported in English, published (between January 1976 and the last search date) in a peer-reviewed journal, and describe multimorbidity patterns and associations with physical functional impairments, activity limitations or participation restrictions among adults in LMICs. Search results will be independently screened by two reviewers and data extraction will cover study characteristics, participants’ characteristics, multimorbidity measures, patterns analysis, and functional measures. Descriptive statistics and narrative synthesis will be used to synthesize and summarize findings. Discussion Patients with multimorbidity have unique and cross-cutting needs, hence the need for integrated and person-centered approaches to policy, planning, and delivery of medical and rehabilitation services. Considering the shift towards UHC and primary healthcare-led management of chronic diseases, the proposed scoping review is timely. Findings will provide insights into the current extent and scope of multimorbidity research, and guide future inquiry in the field. Trial registration Open Science Framework (OSF), https://osf.io/gcy7z/

Background: Idiopathic scoliosis (IS) is a common musculoskeletal condition with a multi-factorial aetiology characterised by a three-dimensional torsional deformity of the spine. Objectives: To ascertain the current level of knowledge on IS among registered practising physiotherapists who expressed an interest in orthopaedic, muscular, manual and manipulative therapy in South Africa (SA). Method: An online survey was used to collect the data. The questions were based on an existing questionnaire, validated by a South African panel of experts in the field of musculoskeletal physiotherapy and updated based on the 2016 Society of Scoliosis Orthopaedic Rehabilitation Treatment (SOSORT) guidelines for the assessment and management of IS. Results: Two hundred and twenty-three physiotherapists spread across the nine provinces of SA met the inclusion criteria and were included in our study. Our findings showed that about one-third (33.6%) of the physiotherapists could answer more than 50% of these questions correctly, and 16.5% could answer 70% of the questions correctly in relation to the widely accepted guidelines on IS management. Conclusion: The participants had a poor understanding of the diagnosis and treatment involved in managing patients with IS and a lack of knowledge regarding the methods of conservative treatment for scoliosis. Future studies should be aimed at assessing intervention strategies to improve the knowledge of IS in physiotherapists in SA, especially regarding diagnosis and identifying appropriate management strategies. Clinical implications: Physiotherapists are often the first contact practitioners for patients presenting with scoliosis and therefore need to have the necessary clinical knowledge on the assessment and management of IS. Our study can improve the awareness among the South African physiotherapists regarding IS and its complex presentation and management.

Background Given the size and mass of the thoracic segment, understanding its neuromotor control demand during over ground running at different speeds is important in the rehabilitation and research setting. This study describes key kinematics characteristics as proxy measures for thoracic neuromotor control. We hypothesized that thoracic kinematics would differ significantly when running at different running speeds and that speed related thoracic kinematic changes would not differ between gender. Methods Three-dimensional thoracic kinematics of 19 healthy runners were recorded using an optical 3D motion capture system. We compared peak kinematic angles and range of motion of the thorax in each anatomical plane, in three running speeds during the stance phase. The Wilcoxon Signed Rank Test was used to analyse thoracic kinematics differences across different speeds. Results There was increased group peak kinematic angles and total range of motion during slower and faster than self-selected pace compared to self-selected pace in all three planes. There were gender differences in the changes in kinematic measures at different running speeds. Conclusion Our findings suggest that the differences in thoracic kinematics as a result of non-self-selected running speed may be due either to the increased neuromotor demands inherent to that running speed or due to the individual's adjustment to running at an unfamiliar speed. Further investigation is required to determine whether protocols that require participants to run at speeds other than self-selected pace confound the results. We therefore recommend normative data set protocols that avoid potential confounding by employing only self-selected pace. Our findings further suggest kinematic changes due to speed differed across gender, most notably in the transverse plane. Thus, we propose that gender specific normative data sets may be required.

Background Running economy (RE) is a determinant of performance in endurance sports and is a complex multi-factorial measure which reflects the combined functioning of bio-mechanical, neuro-muscular, metabolic and cardio-respiratory factors some of which are hereditary or adapt to coaching. Kenyan distance runners have dominated major global events with their unmatched performance for decades and this phenomenon has prompted several investigations aimed at establishing possible factors associated with their performance. This systematic review was aimed at establishing up-to date quantitative synthesis of evidence on biomechanical factors associated with running economy and performance of elite Kenyan distance runners and to provide an algorithm for future research and coaching strategies. Methods A comprehensive electronic search was conducted through June 2017. Quality appraisal was independently done by both reviewers using the STROBE checklist. Descriptive summaries and tables were used to illustrate biomechanical outcomes, mean differences and confidence intervals. Evidence from reviewed studies was graded according to the Australian National Health and Medical Research Council (NHMRC) hierarchy for aetiological factors and meta-analysis was performed where applicable. Results Eight cross-sectional studies were included. The overall methodological score was moderate (58%). Elite Kenyan distance runners have significant longer gastroc-Achilles tendons compared to their counterparts while their shank length is not significantly longer. There is no certainty of evidence regarding the association between their characteristic unique profile of tall and slender bodies, low BMI and low body mass, short ground contact and flight times, greater forward lean torso and faster and greater forward leg swing with RE and performance. Conclusion Our findings presents evidence on biomechanical factors associated with RE and performance of elite Kenyan distance runners. Despite these findings, there are a number of limitations inherent to this review including; low level of evidence, minimal number of included studies, small sample size and lack of appropriate control subjects. However, we considered these shortcomings and summarised the best available evidence in attempt to give direction to future research and coaching strategies.

Standards for Reporting Diagnostic Test Accuracy Studies (STARD) framework. The additional file one describes the application of the STARD framework guidelines in the study. (DOCX 14 kb)

Background Lumbar radiculopathy remains a clinical challenge among primary care clinicians in both assessment and diagnosis. This often leads to misdiagnosis and inappropriate treatment of patients resulting in poor health outcomes, exacerbating this already debilitating condition. This review evaluated 12 primary diagnostic accuracy studies that specifically assessed the performance of various individual and grouped clinical neurological tests in detecting nerve root impingement, as established in the current literature. Methods Eight electronic data bases were searched for relevant articles from inception until July 2016. All primary diagnostic studies which investigated the accuracy of clinical neurological test (s) in diagnosing lumbar radiculopathy among patients with low back and referred leg symptoms were screened for inclusion. Qualifying studies were retrieved and independently assessed for methodological quality using the ‘Quality Assessment of Diagnostic tests Accuracy Studies’ criteria. Results A total of 12 studies which investigated standard components of clinical neurological examination of (sensory, motor, tendon reflex and neuro-dynamics) of the lumbo-sacral spine were included. The mean inter-observer agreement on quality assessment by two independent reviewers was fair (k = 0.3 – 0.7). The diagnostic performance of sensory testing using MR imaging as a reference standard demonstrated a sensitivity (confidence interval 95%) 0.61 (0.47-0.73) and a specificity of 0.63 (0.38-0.84). Motor tests sensitivity was poor to moderate, ranging from 0.13 (0.04-0.31) to 0.61 (0.36-0.83). Generally, the diagnostic performance of reflex testing was notably good with specificity ranging from (confidence interval 95%) 0.60 (0.51-0.69) to 0.93 (0.87-0.97) and sensitivity ranging from 0.14 (0.09-0.21) to 0.67 (0.21-0.94). Femoral nerve stretch test had a high sensitivity of (confidence interval 95%) 1.00 (0.40-1.00) and specificity of 0.83 (0.52-0.98) while SLR test recorded a mean sensitivity of 0.84 (0.72-0.92) and specificity of 0.78 (0.67-0.87). Conclusions There is a scarcity of studies on the diagnostic accuracy of clinical neurological examination testing. Furthermore there seem to be a disconnect among researchers regarding the diagnostic utility of lower limb neuro-dynamic tests which include the Straight Leg Raise and Femoral Nerve tests for sciatic and femoral nerve respectively. Whether these tests are able to detect the presence of disc herniation and subsequent nerve root compression or hyper-sensitivity of the sacral and femoral plexus due to mechanical irritation still remains debatable.

Background MRI is considered to be the diagnostic tool of choice in diagnosing nerve root compromise among patients presenting with clinical suspicion of lumbo-sacral radiculopathy. There exists controversy among researchers and clinicians regarding the diagnostic utility and accuracy of MRI in detecting nerve root compromise and radiculopathy. This review evaluated 4 primary diagnostic accuracy studies that specifically assessed the accuracy of MRI in detecting nerve root compromise, as established in the current literature. Methods Eight electronic data bases were searched for relevant articles from inception until January 2014. All primary diagnostic studies which investigated the accuracy of MRI in diagnosing nerve root compromise among patients with low back and referred leg symptoms were screened for inclusion. Qualifying studies were retrieved and independently assessed for methodological quality using the ‘Quality Assessment of Diagnostic tests Accuracy Studies’ criteria. Results Four studies qualified for inclusion in this review. The sensitivity of MRI in detecting lumbar nerve root compromise was very low at 0.25 (95 % CI) while the specificity was relatively high at 0.92 (95 % CI). Conclusions There is lack of sufficient high quality scientific evidence in support or against the use of MRI in diagnosing nerve root compression and radiculopathy. Therefore, clinicians should always correlate the findings of MRI with the patients’ medical history and clinical presentation in clinical decision making.