Search

To explore the perspectives of ten clinicians from different medical disciplines with experience in managing PFP on how to conduct biomechanical assessments in individuals with PFP in a clinical setting.An explorative qualitative design was used to explore the perspectives of ten clinicians with at least five years of experience managing patients with patellofemoral pain. A series of semi-structured interviews were done over Zoom video chat. The participants were from six different medical disciplines (physiotherapy, biokinetics, podiatry, sport science, sports medicine, orthopaedic surgery). Data was analysed thematically.Four main themes emerged from the data. These were: 1) biomechanical contributing factors that clinicians routinely screen for in patients with PFP; 2) relevant functional activities for biomechanical screening in patients with PFP; 3) conducting gait analysis assessments in a clinical setting; and 4) challenges of biomechanical assessment in patients with PFP. The clinicians expressed conflicting opinions on the usefulness of clinical gait analysis. The clinicians questioned the clinical applicability of some of the biomechanical factors identified as important in the evidence.It is important for clinicians to include the biomechanical assessment of functional activities linked to pain when managing patients with PFP. However, some of the biomechanical factors identified in the evidence are too difficult to observe without 3D movement analysis equipment and should not be considered clinically relevant. Expert clinical opinion is important to provide contextual information when addressing biomechanics in individuals with PFP.

Rugby union has been a professional sport for many years. Along with the growing professionalism of the sport, there has been increasing scientific interest in the physical profiles of rugby players as such profiling may inform player selection, conditioning, monitoring, and injury prevention strategies. This descriptive cross-sectional study compared elite junior rugby union players' anthropometric and physical performance profiles according to specific playing positions. One hundred and eighty-four under-21 rugby players (age 19.58 ± 0.88 years) participated during their pre-season (forwards, n = 91; backs, n = 93). Anthropometry and physical performance assessments included body mass, height, speed (10 and 30 metres [m]), reactive agility time (RAT), and single-leg hop for distance (SHD). Data analyses included descriptive statistics, t-tests, and one-way analysis of variance (ANOVA), with the level of statistical significance set at p

Force-time curves produced during a countermovement jump (CMJ) have traditionally been classified by visual observation as either unimodal (one concentric phase peak) or bimodal (two peaks). The association between CMJ modality and jump performance remains unclear and future studies may benefit from standardising and expanding modality classification. This study described a numerical method based on the timing and relative magnitude of concentric force-time curve prominences. Adult male elite rugby union players (n = 214) performed six CMJs on a force-instrumented treadmill and an algorithm using turning-point logic was applied to categorise jumps and define modality sub-groups. A sensitivity analysis demonstrated that the minimum prominence threshold (MPT) affected categorisation, as the proportion of bimodal jumps decreased with each 1% increase in MPT. Within-athlete consistency was also affected; between 43% and 63% of participants were consistently categorised as bimodal or unimodal depending on the selected MPT. Modified reactive strength index (RSImod), but not jump height or take-off momentum, was greater in unimodal jumps. Take-off momentum and RSImod were greater in subcategories where maximum force occurred early in the concentric phase. Future research should implement objective classification methods to enhance transparency and comparability and consider subcategories to investigate CMJ force production strategies.

Purpose: Anterior cruciate ligament (ACL) injuries are among the most severe injuries in the Gaelic Athletic Association. Hop tests measure functional performance after ACL reconstruction as they replicate the key requirements for a match situation. However, research examining functional recovery of ACL-reconstructed Gaelic athletes is lacking. The objective of this study is to determine if athletes restore normal hop symmetry after ACL reconstruction and to examine if bilateral deficiencies persist in hop performance following return to sport. Methods: A cross-sectional design was used to evaluate hop performance of 30 ACL-reconstructed Gaelic athletes who had returned to competition and 30 uninjured controls in a battery of hop tests including a single, 6-m, triple, and triple-crossover hop test. Results: In each test, the mean symmetry score of the ACL reconstruction group was above the cutoff for normal performance of 90% adopted by this study (98%, 99%, 97%, and 99% for the single, 6-m, triple, and triple-crossover hop, respectively). No significant differences in absolute hop scores emerged between involved and control limbs, with the exception of the single-hop test where healthy dominant limbs hopped significantly further than ACL-reconstructed dominant limbs (P = .02). No significant deficits were identified on the noninvolved side. Conclusions: The majority of ACL-reconstructed Gaelic athletes demonstrate normal levels of hop symmetry after returning to competition. Suboptimal hop performance can persist on the involved side compared with control limbs. Targeted rehabilitation may be warranted after returning to competition to restore performance to levels of healthy uninjured athletes.

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.

Background Recent research has indicated a seemingly increased propensity for both falls and accelerated bone loss in people living with HIV (PLWH). Physiotherapists play a crucial role in optimising function and quality of life of PLWH through prevention of falls and reducing the harm that results. Aim This study aimed to explore physiotherapists’ awareness of falls risk and accelerated bone demineralisation in PLWH and their perceptions of current falls prevention strategies in the care of PLWH in selected regions of sub-Saharan Africa. Method An exploratory descriptive qualitative research method was employed to explore physiotherapists’ perceptions and experiences regarding bone health and falls in PLWH. In-depth semi-structured telephonic interviews were used to collect data from 21 physiotherapists working in primary HIV care. Transcribed interview data were coded in Atlas.ti.8® and analysed using inductive thematic analysis. Results The primary study revealed a lack of awareness by physiotherapists of falls risk and bone demineralisation in PLWH. As such, physiotherapists did not link falls or fractures to HIV or antiretroviral therapy (ART) when they did observe such events during their general patient assessments. However, in retrospect, some physiotherapists were able to recognise risk factors linked to falls in those with HIV. Current services for falls prevention, as perceived by the physiotherapists, were sub-optimal. Conclusion Physiotherapists may need to be more aware of the potential risk of falls and bone demineralisation in PLWH and routinely assess for these phenomena in both older and younger PLWH.

Dancing is an attractive form of exercise among older adults and may positively influence physical and psychosocial health. The aim of this systematic review was to synthesize the evidence examining the dance prescription and effectiveness of dance in community dwelling older adults.Eight databases were searched to identify randomized controlled trials that evaluated the effectiveness of dance programs on community-dwelling older adults from 2007 to December 2020. Data regarding participants, dance programs and outcomes of interest were extracted and narratively synthesized. A meta-analysis was performed on the outcome data where possible.Twenty-two studies met the inclusion criteria, of those 15 were deemed to be fair quality and 7 high quality using the PEDro scale. Nineteen studies included in the meta-analysis found that dancing can improve mobility and endurance compared to no intervention and afforded equivalent outcomes compared to other exercise programs.The findings suggest that dance is an effective, safe and viable activity for community-dwelling older adults..

The World Health Organisation emphasises the importance of addressing gaps in health systems where rehabilitation services are poorly integrated. In South Africa, regions with the largest disability rates are usually the areas where rehabilitation is least accessible, due to inadequate workforce capacity. The first step towards addressing workforce capacity is to determine current capacity. This paper presents a cross-sectional study to describe rehabilitation workforce data in the public sector of three rural South African provinces. A web-based therapist survey and a telephonic facility survey was conducted. Data were collected regarding total number of therapists per province, age, years employed, qualifications, salary level, profession type, level of care, and rural/urban distribution. Descriptive statistics were conducted, while Chi-squared tests compared professions regarding highest qualification and salary level. Population-adjusted ratios were calculated using national uninsured population statistics. The web-based survey had 639 responses while the telephonic survey reported on 1166 therapists. Results indicated that the mean age of therapists across the respective provinces was 28, 35 and 31 years of age, and the mean employment years in the respective provinces were three, eight and five years. Most of the workforce (n = 574) had a bachelor’s degree as their highest qualification. A total of 27% of the workforce were community service therapists and 61% of therapists earned a production-level salary. Occupational therapy was best (40%) and speech and audiology therapy least (7%) represented. Three percent of therapists worked at primary level, versus eighty percent at secondary level. Forty percent of therapists worked in rural areas. Workforce density per province ranged from 0.71–0.98 per 10,000 population. Overall, results show that the rehabilitation workforce density is low, and that the distribution of therapists between rural and urban settings, and levels of care, is inequitable. Considering the rise in rehabilitation need, prioritisation and strengthening of the rehabilitation workforce capacity is vital to ensure integration across all levels of care and service.

Mobile Electroencephalography (EEG) provides insights into cortical contributions to postural control. Although changes in theta (4–8 Hz) and alpha frequency power (8–12 Hz) were shown to reflect attentional and sensorimotor processing during balance tasks, information about the effect of stance leg on cortical processing related to postural control is lacking. Therefore, the aim was to examine patterns of cortical activity during single-leg stance with varying surface stability. EEG and force plate data from 21 healthy males (22.43 ± 2.23 years) was recorded during unipedal stance (left/right) on a stable and unstable surface. Using source-space analysis, power spectral density was analyzed in the theta, alpha-1 (8–10 Hz) and alpha-2 (10–12 Hz) frequency bands. Repeated measures ANOVA with the factors leg and surface stability revealed significant interaction effects in the left (p = 0.045, ηp2 = 0.13) and right motor clusters (F = 16.156; p = 0.001, ηp2 = 0.41). Furthermore, significant main effects for surface stability were observed for the fronto-central cluster (theta), left and right motor (alpha-1), as well as for the right parieto-occipital cluster (alpha-1/alpha-2). Leg dependent changes in alpha-2 power may indicate lateralized patterns of cortical processing in motor areas during single-leg stance. Future studies may therefore consider lateralized patterns of cortical activity for the interpretation of postural deficiencies in unilateral lower limb injuries.

RATIONALE, AIM AND OBJECTIVE The physiotherapy profession did not escape the effects of racially based segregatory practises. While numerous strategies and initiatives have been employed to redress the inequities of the past, the extent of demographic transformation within the physiotherapy profession in South Africa remains uncertain. Transformation is defined in this article as an intentional change aimed at addressing inequalities and the ultimate goal is for population group and gender profiles of higher education graduates to be representative of the national epidemiological profile. This paper describes the demographic patterns of Health Professions Council of South Africa (HPCSA) registered physiotherapists from 1938 to 2018. METHOD A retrospective record review of the HPCSA database from 1938 until 2018 was performed. De-identified data were extracted, coded and analyzed for descriptive purposes. Z-tests were used for analysis of proportion differences, along with P-values and 95% confidence intervals for interpretation. RESULTS In 2018, 7663 physiotherapists (6350 women and 1313 men) were registered with the HPCSA. Most registered physiotherapists (55.6%) were classified as white, followed by black (17.3%), coloured (10.3%) and Indian (9.8%). A progressive increase was found in the number of new registrations over time (1949-2018) by black (0.00%-24.38% of total new registrations), coloured (0.00%-15.47%) and Indian individuals (0.00%-10.03%), with a statistically significant increase in newly registered black therapists in the decade prior to 2018 (P = .005). Gender transformation appears to be occurring at a slower pace as the profession remains female-dominated (82.9% of registered physiotherapists in 2018). CONCLUSION There has been a steady transformation of the South African physiotherapy graduates composition regarding population categories and gender. However, it is clear that much more than selection criteria is needed to transform the profession in a way that is nationally representative, remain actively accountable for transformation and apt for local context.

IntroductionWearable inertial measurement units (IMUs) enable gait analysis in the clinic, but require calibrations that may affect subsequent gait measurements. This study assessed concurrent validity and within-session reliability of gait kinematics measured by a frequently calibrated IMU-based system. Calibration pose accuracy and intra-rater repeatability, and IMU orientation tracking accuracy, were additionally quantified. MethodsCalibration poses and gait were recorded in 15 women using IMUs and optical motion capture (OMC) (reference standard) simultaneously. Participants performed six consecutive trials: each comprising a calibration pose and a walk. IMU tracking was assessed separately (once-off) using technical static and dynamic tests. Differences of > 5° constituted clinical significance. ResultsConcurrent validity for gait revealed clinically significant between-system differences for sagittal angles (root-mean-square error [RMSE] 6.7°–15.0°; bias −9.3°–3.0°) and hip rotation (RMSE 7.9°; bias −4.2°). After removing modelling offsets, differences for all angles (except hip rotation) were < 5°. Gait curves correlated highly between systems (r > 0.8), except hip rotation, pelvic tilt and -obliquity. Within-session reliability of IMU-measured gait angles was clinically acceptable (standard error of measurement [SEM] < 5°). Calibration poses were repeatable (SEM 0.3°–2.2°). Pose accuracy revealed mean absolute differences (MAD)

BACKGROUND School-based interventions to prevent the metabolic and musculoskeletal health risks associated with accumulation of sedentary behaviour have shown relative success. In resource limited environments, interventions that rely on teachers to delivery additional curricula or on parents’ engagement in learning materials may not be feasible. Interventions that alter the physical classroom environment and do not rely on additional capacity or are likely to succeed in reducing classroom sedentary behaviour. OBJECTIVE To systematically search, identify and summarize the effectiveness of classroom-based interventions aimed at reducing classroom sedentary behavior and improving spinal health. METHODS The review included experimental studies conducted exclusively in school classrooms that objectively measured classroom sedentary behaviour and spinal health measures. Four databases were searched in April 2021. Search terms related to sedentary behaviour, classroom sitting, classroom neck and back pain. Study findings were summarized in tables and a meat-analysis of homogenous review outcomes data was conducted. RESULTS Twelves experimental studies from high-income countries were included. Nine studies focused on SB and three on spinal health. All but one SB study reported decreases in classroom sitting time. The pooled medium-term effects of a subset of SB interventions showed a statistically significant decreases in sitting (p=0.03), while short and long-term effects were not significantly reduced (p=0.13 and p=0.23, respectively). A meta-analysis of spinal health studies reported statistically significant improvements in spinal behaviour during functional tasks (p=0.005). CONCLUSIONS Classroom-based interventions aimed at reducing SB and improving spinal health may be effective without placing additional burden on teachers and parents. Standardized outcomes for school-based SB are encouraged so findings from various settings may be pooled to determine overall effect across studies.

The World Health Organization recognizes rehabilitation as an essential component of universal health coverage (UHC). In many countries, UHC builds on a standard benefits package of services that is informed by the country's essential medicines list, standard treatment guidelines and primary health care essential laboratory list. In South Africa, primary health care is largely provided and managed by primary health-care nurses and medical officers in accordance with primary health care standard treatment guidelines. However, rehabilitation is mostly excluded from these guidelines. This paper describes the 10-year process that led to rehabilitation referral recommendations being considered for inclusion in South Africa's primary health care standard treatment guidelines. There were five key events: (i) a breakthrough moment; (ii) producing a scientific evidence synthesis and formulating recommendations; (iii) presenting recommendations to the national essential medicines list committee; (iv) mapping rehabilitation recommendations onto relevant treatment guideline sections; and (v) submitting revised recommendations to the committee for final consideration. The main lesson learnt is that, by working together, rehabilitation professionals can be of sufficient number to make a difference, improve service delivery and increase referrals to rehabilitation from primary health care. A remaining challenge is the lack of a rehabilitation representative on the national essential medicines list committee, which could hamper understanding of rehabilitation and of the complexities of the supporting evidence.L'Organisation mondiale de la Santé considère la réadaptation comme un élément indispensable de la couverture sanitaire universelle (CSU). Dans de nombreux pays, la CSU repose sur un modèle de prestations de services qui tient compte de la liste nationale de médicaments essentiels, des directives thérapeutiques normalisées et d'une liste des analyses en laboratoire essentielles dans le cadre des soins primaires. En Afrique du Sud, les soins primaires sont majoritairement assurés et gérés par du personnel infirmier et médical, conformément aux directives thérapeutiques normalisées en la matière. En revanche, la réadaptation n'y figure généralement pas. Le présent document décrit les dix années de processus qui ont permis d'émettre des recommandations de référence relatives à la réadaptation, que l'Afrique du Sud envisage d'inscrire dans ses directives thérapeutiques normalisées de soins primaires. Cinq événements clés ont été retenus: (i) un moment charnière; (ii) la réalisation d'une synthèse des preuves scientifiques et la formulation de recommandations; (iii) la présentation de ces recommandations au comité responsable de la liste nationale de médicaments essentiels; (iv) l'intégration des recommandations en matière de réadaptation dans les rubriques correspondantes des directives thérapeutiques; et enfin, (v) la soumission des recommandations révisées au comité pour examen final. Le principal enseignement tiré est qu'en collaborant, les professionnels de la réadaptation peuvent être suffisamment nombreux pour faire la différence, améliorer la qualité des services et augmenter les transferts depuis les soins primaires vers les structures de réadaptation. Un défi subsiste: l'absence de représentants du secteur au sein du comité responsable de la liste nationale de médicaments essentiels, ce qui pourrait nuire à la compréhension de la réadaptation et du degré de complexité des faits qui l’étayent.La Organización Mundial de la Salud reconoce que la rehabilitación es un componente esencial de la cobertura sanitaria universal (CSU). En muchos países, la cobertura sanitaria universal depende de un paquete estándar de servicios que se basa en la lista de medicamentos esenciales del país, las directrices de tratamiento estándar y la lista de laboratorios esenciales de atención primaria. En Sudáfrica, la atención primaria la prestan y gestionan en gran medida el personal de enfermería y los médicos de atención primaria, de conformidad con las directrices de tratamiento estándar de la atención primaria. Sin embargo, la rehabilitación queda excluida en su mayor parte de estas directrices. Este artículo describe el proceso de 10 años que llevó a que se contemplara la posibilidad de incluir las recomendaciones de derivación a rehabilitación en las directrices de tratamiento estándar de la atención primaria en Sudáfrica. Hubo cinco acontecimientos clave: (i) un momento decisivo; (ii) la elaboración de una síntesis de datos científicos y la formulación de recomendaciones; (iii) la presentación de las recomendaciones al comité de la lista nacional de medicamentos esenciales; (iv) la adaptación de las recomendaciones de rehabilitación a las secciones pertinentes de las directrices de tratamiento; y (v) la presentación de las recomendaciones revisadas al comité para su estudio final. La principal lección aprendida es que, trabajando juntos, los profesionales de la rehabilitación pueden ser lo bastante numerosos como para marcar la diferencia, mejorar la prestación de servicios y aumentar las derivaciones a la rehabilitación desde la atención primaria. Un desafío que aún persiste es que no hay un representante de la rehabilitación en el comité de la lista nacional de medicamentos esenciales, lo que podría dificultar la comprensión de la rehabilitación y de las complejidades de las pruebas que la sustentan.تدرك منظمة الصحة العالمية أن إعادة التأهيل تعد مكونًا أساسيًا للتغطية الصحية الشاملة (UHC). ترتكز التغطية الصحية الشاملة في العديد من الدول على حزمة ذات مزايا قياسية من الخدمات، والتي تكون على دراية بقائمة الأدوية الأساسية للدولة، وإرشادات العلاج القياسية، وقائمة المختبرات الأساسية للرعاية الصحية الأولية. يتم في جنوب إفريقيا تقديم الرعاية الصحية الأولية وإدارتها إلى حد كبير بواسطة ممرضات الرعاية الصحية الأولية، والموظفين الطبيين، وفقًا لإرشادات العلاج القياسية للرعاية الصحية الأولية. ومع ذلك، فإن إعادة التأهيل يتم في الغالب استبعادها من هذه المبادئ الإرشادات. تصف هذه الورقة العملية التي استمرت لمدة 10 سنوات، والتي أدت إلى النظر في توصيات الإحالة لإعادة التأهيل بهدف تضمينها في إرشادات العلاج القياسي للرعاية الصحية الأولية في جنوب إفريقيا. كانت هناك خمسة أحداث رئيسية: (1) لحظة انفراج؛ و(2) إنتاج تجميع للأدلة العلمية وصياغة التوصيات؛ و(3) تقديم التوصيات إلى لجنة قائمة الأدوية الأساسية الوطنية؛ و(4) تطبيق توصيات إعادة التأهيل على أقسام إرشادات العلاج ذات الصلة؛ و(5) تقديم توصيات منقحة إلى اللجنة للنظر فيها بشكل نهائي. الدرس الرئيسي المستفاد هو أنه من خلال العمل معًا، يمكن أن يكون هناك عدد كافٍ من إخصائيي إعادة التأهيل لإحداث الفرق، وتحسين تقديم الخدمة، وزيادة الإحالات إلى إعادة التأهيل من الرعاية الصحية الأولية. التحدي الباقي هو الافتقار إلى وجود ممثل لإعادة التأهيل في لجنة قائمة الأدوية الأساسية الوطنية، مما قد يعيق فهم إعادة التأهيل وتعقيدات الأدلة الداعمة.世卫组织认为康复治疗是全民健康覆盖 (UHC) 的重要组成部分。在许多国家，UHC 通过提供一揽子标准福利服务实现，这些服务项目根据国家基本药物清单、标准治疗指南和初级医疗保健服务基本实验室清单制定。在南非，初级卫生保健服务主要由初级卫生保健护士和医务人员根据初级卫生保健标准治疗指南提供和管理。然而，这些指南中大多不包含康复治疗。本文描述了历经 10 年将康复转诊建议纳入南非初级卫生保健标准治疗指南的过程。包含五个主要事件：(i) 突破性时刻；(ii) 提供综合科学证据并提出建议；(iii) 向国家基本药物目录工作委员会提出建议；(iv) 将康复治疗建议纳入相关治疗指南部分；以及 (v) 向委员会提交修改后的建议以供最终审议。可借鉴的主要经验是，康复治疗师可以通过合作弥补康复人才不足的问题、提高服务水平以及增加初级卫生保健的康复治疗转诊率。但问题是，国家基本药物目录工作委员会中缺少康复治疗师代表，这可能会妨碍理解康复治疗以及复杂的支持证据。.Всемирная организация здравоохранения признает реабилитацию важнейшим компонентом всеобщего охвата услугами здравоохранения (ВОУЗ). Во многих странах ВОУЗ основывается на стандартном пакете услуг, который основан на перечне основных лекарственных средств страны, стандартных руководящих принципах по лечению и перечне основных лабораторий первичной медико-санитарной помощи. В Южной Африке первичная медико-санитарная помощь в основном предоставляется и управляется медсестрами и медицинскими работниками служб первичной медико-санитарной помощи в соответствии со стандартными руководящими принципами лечения в рамках первичной медико-санитарной помощи. Однако реабилитация в основном исключена из этих руководящих принципов. В этом документе описывается 10-летний процесс, результатом которого стало рассмотрение рекомендаций по направлениям на реабилитацию для их включения в стандартные руководящие принципы лечения в рамках первичной медико-санитарной помощи в Южной Африке. Основных событий было пять: (i) момент прорыва; (ii) подготовка синтеза научных данных и формулирование рекомендаций; (iii) представление рекомендаций комитету по национальному перечню основных лекарственных средств; (iv) сопоставление рекомендаций по реабилитации с соответствующими разделами руководящих принципов по лечению; (v) передача пересмотренных рекомендаций комитету для окончательного рассмотрения. Главный вывод заключается в том, что специалистов по реабилитации нужно подготовить в достаточном количестве, чтобы совместными усилиями изменить ситуацию, улучшить предоставление услуг и увеличить количество направлений на реабилитацию из учреждений первичной медико-санитарной помощи. Нерешенной задачей является отсутствие представителя по реабилитации в комитете по национальному перечню основных лекарственных средств, что может затруднить понимание реабилитации и сложностей подтверждающих доказательств.

Refereed/Peer-reviewed Rationale and Aims: The prevalence of chronic musculoskeletal pain (CMSP) is high and rising. The multidimensional impact of CMSP on individuals necessitates multidisciplinary evidence-based strategies to prevent and manage chronic pain. Primary health care (PHC) is the first point of care in many healthcare systems and evidence implementation at this point is important. We aim to describe the process of development of a comprehensive list of evidence-based recommendations derived from different high-quality clinical practice guidelines (CPGs) to inform the PHC healthcare of adults with CMSP. Method: A systematic review was conducted of CPGs that focussed on PHC management of CMSP in adults. CPGs were identified by searching 13 guideline clearinghouses and five online databases. Eligible CPGs were critically appraised using Appraisal of Guidelines Research and Evaluation, Version II (AGREE II). A stepwise systematic process was followed to identify a core set of recommendations. This process comprised the following: extract recommendations; analyze recommendations; synthesize recommendations by assimilating similar recommendations; determine the strength of the body of evidence underpinning the recommendations and produce a list of synthesized recommendations. Results: Six high-quality CPGs were identified, providing 156 recommendations. These were condensed to 42 statements covering topics about the approach to care, assessment, advice and education, referral, pharmacological management, physical therapy, electrotherapy, psychological therapy, complementary therapy and self-management. The set of recommendations encompasses a person-centered approach, collaborative decision making, a biopsychosocial approach, patient education and empowerment towards self-management. Conclusion: The process of developing composite recommendations from multiple CPGs enables end-users to access comprehensive information on managing CMSP in PHC settings that is not available from one singular CPG. The content and evidence base for recommendations varied between CPGs. A similar stepwise process may be used to develop a core set of recommendations for other health conditions, where multiple, diverse CPGs exist.

ObjectivesTo explore the opportunities and challenges within the health system to facilitate the achievement of universal health coverage (UHC) for people with stroke (PWS) in South Africa (SA).SettingSA.DesignScoping review.Search methodsWe conducted a scoping review of opportunities and challenges to achieve UHC for PWS in SA. Global and Africa-specific databases and grey literature were searched in July 2020. We included studies of all designs that described the healthcare system for PWS. Two frameworks, the Health Systems Dynamics Framework and WHO Framework, were used to map data on governance and regulation, resources, service delivery, context, reorientation of care and community engagement. A narrative approach was used to synthesise results.ResultsFifty-nine articles were included in the review. Over half (n=31, 52.5%) were conducted in Western Cape province and most (n=41, 69.4%) were conducted in urban areas. Studies evaluated a diverse range of health system categories and various outcomes. The most common reported component was service delivery (n=46, 77.9%), and only four studies (6.7%) evaluated governance and regulation. Service delivery factors for stroke care were frequently reported as poor and compounded by context-related limiting factors. Governance and regulations for stroke care in terms of government support, investment in policy, treatment guidelines, resource distribution and commitment to evidence-based solutions were limited. Promising supporting factors included adequately equipped and staffed urban tertiary facilities, the emergence of Stroke units, prompt assessment by health professionals, positive staff attitudes and care, two clinical care guidelines and educational and information resources being available.ConclusionThis review fills a gap in the literature by providing the range of opportunities and challenges to achieve health for all PWS in SA. It highlights some health system areas that show encouraging trends to improve service delivery including comprehensiveness, quality and perceptions of care.

Background: Medical professionals working in an elite sport environment have the challenging task to balance the athlete’s readiness to return to the playing field after severe injury with other stakeholders’ (coaches, sponsors, teammates) opinions and objectives.Objectives: Our study aimed to evaluate differences in the physical profiles of elite rugby players at return to play (RTP) after a severe knee injury, compared with their pre-injury profiles and matched controls.Method: Before the injury, participants performed four performance tests during their preseason screening. These tests were repeated and compared to baseline once a player was declared fit to play.Results: Significant differences (p ≤ 0.05) were found in the injured players’ group who were slower over 10 m speed, in their decision-making time and the total time of the reactive agility tests at RTP, whilst controls were significantly faster over 10 m and 30 m speed tests. The countermovement jump outcomes showed significant improvement in the uninjured participants (p ≤ 0.05).Conclusion: Our study highlights that injured players’ running speeds and decision-making times are slower after injury. The uninjured players have a positive outcome to training and match stimulus by improving their running speed and lower body explosive power during the season.Clinical implications: Our study provides insight into the RTP profile of elite rugby players, and a novel finding was the decision-making time deficit. This highlights the importance of cognitive training during injury rehabilitation as athletes make numerous decisions in a pressured and uncontrolled environment during a match. Speed training development is recommended as the athletes were slower after severe knee injury.

Aim: The aim of this study was to explore the perspectives of physiotherapists in four selected regions of sub-Saharan Africa regarding health system challenges impacting the integration of physiotherapy-led falls prevention services in the primary care of persons living with HIV (PLWH). Background: Falls may pose a significant problem among younger PLWH in low- and middle-income countries. Physiotherapists’ role in optimising function and quality of life can do much in the prevention of falls in PLWH and reducing the harm that results. However, falls prevention strategies have not been implemented effectively especially in primary health care settings in sub-Saharan Africa. Physiotherapists’ account of the health system challenges they encounter may provide insights into potential strategies that may be considered in optimising fall prevention for PLWH in poorly resourced settings. Methods: A descriptive qualitative study was conducted in selected urban districts in the capital cities of four sub-Saharan African countries. In-depth interviews were conducted with 21 purposively selected physiotherapists involved in the primary care of PLWH. Audio recordings of interviews were transcribed verbatim and analysed using deductive thematic content analysis. Findings: The main results are presented in the theme ‘Health care system challenges’ and in nine categories informed by the WHO health system framework: lack of policies and clinical practice guidelines, shortage/Inaccessible falls prevention services, inadequate human resource, physiotherapists not adequately equipped in falls prevention, inaccessible/No facilities for BMD measurement, inefficient data capturing systems, lack of evidence regarding falls among PLWH, unclear physiotherapy role descriptions, inefficient referral system. Physiotherapists highlighted the need for more information and research regarding fall prevention for PLWH, promote their role in the primary care of PLWH and adopt a patient-centred approach to fall prevention.

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.

The World Health Organization (WHO) recommends that access to rehabilitation is a human right. To date, however, rehabilitation in South Africa has not been a health priority. The focus has rather been on saving lives from communicable diseases such as HIV/AIDs and TB, which has been increasingly successful. Whilst more South Africans are now living with pharmacologically managed chronic, communicable diseases, they often suffer significant challenges to their physical and mental health. Moreover, there are many health conditions in South Africa that have not attracted as much attention, and which also compromise individuals' capacity to contribute effectively to their own wellbeing, that of their families and communities, and to the general economy. These include birth trauma, degenerative neurological conditions, acquired injuries such as spinal cord damage, limb amputation or head trauma, and chronic noncommunicable diseases (heart or kidney disease, stroke). In the absence of robust prevalence studies, it is estimated that one-in-three adults suffer from at least one chronic health challenge. For South Africa not to invest in rehabilitation is counter-productive, as it means that a significant percentage of its population cannot contribute to its economy. In the face of scant health resources to underpin equitable rehabilitation services, evidence needs to be provided to demonstrate that for increased expenditure on rehabilitation, there will be increased return at individual, family, society, and country levels.This article presents challenges and solutions to ensure that South Africa can meet WHO 2030 Rehabilitation Goals for equitable provision of effective public rehabilitation services using the WHO's health system building block framework.IMPLICATIONS FOR REHABILITATIONTo meet the challenge of providing rehabilitation for those in need requires country-specific, strategic, evidence-informed, and planned decisions in terms of best investment for highest return.Whilst there is sound international evidence for best-practice rehabilitation care, country-specific strategies are required to identify and address local barriers to evidence implementation.In South Africa, where rehabilitation has not been a priority to date, it is important that a planned and well-costed approach is taken to ensure provision of equitable, accessible, affordable, and evidence-based rehabilitation.Measuring social, economic, and educational return on investment from rehabilitation should be part of the South African service-delivery planning process.National data could be obtained through adding additional questions on disability to the national census and through local surveys and reports at various public health care facilities.

Background Little is known about how human immunodeficiency virus (HIV) affects walking biomechanics, or about associations between HIV-related gait deviations, functional performance, and self-reported outcomes. This paper reports on (1) gait biomechanics and variability in people with HIV (PWH) and (2) associations with clinical tests, self-reported function, and falls. Methods A cross-sectional study tested consecutively sampled PWH (n = 50) and HIV-seronegative participants ([SNP] n = 50). Participants underwent 3-dimensional gait analysis, performed clinical tests (short walk and single leg stance tests with and without dual tasking, chair-rise tests, and a physical performance battery), and completed questionnaires about function and falls. Between-group comparisons were done using analysis of covariance. Linear correlations between gait variability, clinical tests, and patient-reported outcomes were established. Results People with HIV and SNP had comparable median ages (PWH = 36.6, interquartile range [IQR] = 32.0–45.6]; SNP = 31.1, IQR = 23.2–45.1). Compared with SNP, PWH walked slower (adjusted mean difference [MD] = −0.2 meters per second [m/s], 95% confidence interval [CI] = −0.3 to −0.1) with greater variability (adjusted MD = 14.7 variability score points, 95% CI = 9.9–19.5). Moreover, PWH were slower in five-times sit-to-stand (5STS) performance (adjusted MD = 1.9 seconds, 95% CI = 1.00–2.9). Significant deviations in hip kinematics (increased flexion; adjusted MDs = 2.4°–2.8°, P = .012–.016) and knee kinematics (reduced flexion; adjusted MDs = 2.3°–3.7°, P = .007–.027) were found in PWH during dual-task (DT) walking. The PWH’s 5STS moderately correlated with larger gait variability (usual pace r = −0.5; dual task r = −0.6), poorer self-reported mobility (r = 0.4) and self-care function (r = 0.5), and fear of falling (P = .003). Conclusions People with HIV presented with biomechanical deviations suggestive of a slowed and variable gait, especially under cognitive challenges. Five-times STS may be useful to screen for gait deviations in PWH., In a South African sample, relatively young adults with HIV demonstrated biomechanical walking deviations suggesting a slowed, unstable gait pattern, especially under cognitive challenges. Five-times sit-to-stand may provide a screening test for early detection of mobility deviations in clinical settings.

Background People with stroke and their caregivers experience numerous information needs; internet-based resources may offer cost-effective ways to improve access to information about this condition and its management, including the availability of resources and support. The quality of online health information is, therefore, an important consideration for both developers and consumers of these online resources. Objective This study aims to map and evaluate the content, readability, understandability, design, and quality characteristics of freely available online information resources (ie, websites) that empower people with stroke and their caregivers with information and self-help strategies poststroke. Methods This descriptive review will follow the five systematic and rigorous methodological steps that are recommended for scoping reviews, which include the following: (1) identifying the research question, (2) identifying relevant studies, (3) selecting the studies, (4) charting the data, and (5) collating, summarizing, and reporting the results. Data will then be synthesized and analyzed thematically. Results As of February 2021, the scoping review is in the data extraction stage. Data will be synthesized, and the first results are expected to be submitted for publication in an open-access peer-reviewed journal in August 2021. In addition, we will develop an accessible summary of the results for stakeholder meetings. Ethical approval is not required for this review, as it will only include publicly available information. Conclusions This study is novel and will evaluate the typology, content, and design-related criteria, including accessibility, aesthetics, navigability, interactivity, privacy, and data protection, of online information resources for stroke. The review will be limited to online resources published in English. International Registered Report Identifier (IRRID) DERR1-10.2196/23174

The prevalence of spinal pain is high in children and adolescents attending school. There are no evidence-based guidelines to promote spinal health (spinal pain and spinal well-being) in schools.This study aimed to 1) determine the usefulness of school-based interventions in promoting spinal health in children and adolescents and 2) synthesize the evidence in a user-friendly infographic.A search was performed across eight databases from the inception of the databases to August 2019 for full-text English-language articles which assessed the effect of school-based interventions on spinal health. Spinal health outcomes included pain limited to the spinal area including lower back, upper back, neck, and neck-shoulder pain, and impacts of spinal pain (e.g., absenteeism from school). Studies were appraised for methodological quality (PEDro scale and Johanna Briggs Institute checklist). The usefulness of interventions was based on meta-analyses; calculated effect size; the number of spinal health outcomes; and the direction of the (summary) effect of the intervention.Twenty-two studies were included. Four interventions were identified: 1) exercise; 2) education; 3) the combination of exercise and education; and 4) furniture.School-based exercise is most useful to promote spinal health in the short term, followed by a combination of exercise and education, and education-only interventions.

Background Rehabilitation can improve function in many people with chronic health conditions. It is important to consider priority conditions requiring rehabilitation, so it can be realistically positioned and costed in national health financing systems like South Africa (SA)‘s proposed National Health Insurance (NHI). This paper describes temporal trends of top-ranked conditions on years lived with disability (YLDs) rates in SA, for which physical rehabilitation can ameliorate associated disability. Methods This study is a systematic synthesis of publicly available Global Burden of Disease (GBD) 2017 estimates. The top 11 conditions contributing most to YLDs and for which evidence-based rehabilitation interventions exist were identified. Age-standardized rates per 100,000 and YLDs counts were extracted from 1990 to 2017. Significance of changes in temporal trends was determined using Mann-Kendall trend tests. Best-fit rates of yearly changes were calculated per condition, using GBD estimates (2012–2017), and extrapolated (by imposing the best-fit regression line onto results for each subsequent predicted year) as forecasts (2018–2022). Results Trends for YLDs counts per condition year (1990–2017) and forecasted values (2018–2022) showed an overall steady increase for all conditions, except HIV and respiratory conditions. YLDs counts almost doubled from 1990 to 2017, with a 17% predicted increase from 2017 to 2022. The proportionate contribution to YLDs counts reduced over time for all conditions, except HIV. Although age-standardized YLDs rates appear relatively stable over the analyzed periods for all conditions (except HIV, respiratory conditions and type 2 diabetes), trend changes in YLDs rates over 28 years were significant for all conditions, except neonatal (p = 0.855), hearing loss (p = 0.100) and musculoskeletal conditions (p = 0.300). Significant trend decreases were apparent for 4/9 conditions, implying that another 5/9 conditions showed trend increases over 28 years. Predicted all-age prevalence in 2022 suggests relatively large increases for cardiovascular disease and heart failure, and burns, while relative decreases are predicted for fractures and dislocations, stroke, and musculoskeletal conditions. Conclusion Rehabilitation needs in SA are potentially massive and unmet, highlighting the need for innovative and context-specific rehabilitation that considers current local needs and projected changes. These findings should be considered when designing the NHI and other schemes in SA to ensure human and financial resources are deployed efficiently.

Exercise as a treatment option for people with mental disorders is a field of growing interest. The increased number of published randomized controlled trials (RCTs) evaluating the effects of exercise in the treatment of anxiety and related disorders in recent years calls for an update of the available meta-analytic evidence. Electronic databases (PubMed, CINAHL, PSYCArticles, and Embase) were searched up to 17.2.2021, for RCTs evaluating the effects of exercise on anxiety and stress symptoms in adults with anxiety and related disorders. A random effects meta-analysis was conducted. A total of 13 RCTs comprising 731 adult participants (exercise n=376; control n=355) were included. Exercise had a small, bordering medium, but statistically significant effect on decreasing anxiety symptoms compared to control condition (standardized mean difference=-0.425, 95%CI -0.67 to -0.17; I2 = 47.9%) in people with anxiety and related disorders. Our meta-analysis updates the existing evidence supporting exercise as an efficacious intervention for anxiety and related disorders. Although the updated meta-analytic evidence is less heterogenous than previously reported, future research is still needed to explore the factors moderating the effects of exercise on outcome such as frequency, intensity, duration of the sessions, and type of exercise and qualification of the provider in more detail. ispartof: PSYCHIATRY RESEARCH vol:302 ispartof: location:Ireland status: published