Veronica Ntsiea

Factors That Influence Functional Mobility Outcomes of Patients After Traumatic Brain Injury

Objective/Background The consequences of traumatic brain injury (TBI) include physical, cognitive, psychological, behavioural, and emotional deficits. Prognostic factors such as age, mechanism of injury, and severity of injury assist in determining the outcome of the patient. It is believed that predictors of recovery assist both the patient as well as family members in determining the potential outcomes for the patient. The objective of this study was to identify factors that influence functional mobility outcome of patients after TBI. Methods This was a cross-sectional study. Participants were assessed predischarge. The Glasgow Coma Scale on admission was noted to establish the severity of the TBI. The Rivermead Mobility Index was used to establish the functional mobility outcome. Results The sample consisted of 60 participants of which 56 (93%) were males. The average age of the participants in the study was 28 ± 8.5 years. More than 50% of the participants were unable to walk outside and 37% were able to climb a flight of stairs without help at the time of discharge from the hospital. Younger age (p < .001), male gender (p = .001), Grade 12 education (p = .001), being self employed (p < .001), having bowel and bladder continence (p < .001), not smoking and drinking (p < .001), and having occupational therapy sessions (p = .002) had a positive impact on function after TBI. Conclusion Previous studies have identified a multitude of factors and this study has served to confirm factors that have a positive impact on physical function after TBI within this study group.

Stroke survivors’ levels of community reintegration, quality of life, satisfaction with the physiotherapy services and the level of caregiver strain at community health centres within the Johannesburg area

Background Stroke survivors are discharged home before they are functionally independent and return home with activity limitations that would not be manageable without a caregiver. Aim To determine stroke survivors’ levels of community reintegration, quality of life (QOL), satisfaction with the physiotherapy services and the level of caregiver strain at community health centres within the Johannesburg area. Method This was a cross-sectional study using the following outcome measures: Maleka Stroke Community Reintegration Measure, Stroke-specific quality of life scale, Caregiver strain index and Physical therapy patient satisfaction questionnaire. Results A total of 108 stroke survivors and 45 caregivers participated in this study. The average age of the stroke survivors was 54 years (standard deviation = 12.73) and 58% (n = 62) had moderate to full community reintegration. They were happy with physiotherapy services but not with parking availability and cost of services. The QOL was poor with the lowest scores for energy and highest scores for vision and language domains. Twenty five (55%) caregivers were strained. A positive correlation was found between community reintegration and satisfaction with services (r = 0.27, p < 0.0001) and QOL (r = 0.51, p < 0.0001). A negative correlation was found between community reintegration and caregiver strain (r = -0.37, p < 0.0001). Conclusion Most stroke survivors are reintegrated into their communities except in the areas of work and education and have poor QOL and most of their caregivers are strained; however, they are satisfied with physiotherapy services.

The Impairments and Functional Outcomes of Patients Post Flexor Tendon Repair of the Hand

Backgrounds: Flexor tendon injuries are common hand injuries for which optimal surgical and postoperative treatment has not yet been established. The variability in results is great, with good outcomes being achieved in specialized hands units in developed countries. Minimal research has been undertaken in developing countries, in particular South Africa, regarding flexor tendon repair (FTR) and the outcomes thereof. Objectives: The purpose of this study was to establish the range of movement (ROM), grip strength, and hand function at 6 months post FTR as well as to determine the factors that affect the impairments and functional outcome at 6 months post FTR. Materials and Methods: The study was conducted at a tertiary hospital in South Africa. At 1, 3, and 6 months post FTR, the ROM of the injured and contralateral finger(s) were measured using a finger goniometer. The Total Active Motion (TAM) classification system was applied to each affected digit, and the average TAM was determined for the participants’ affected hand. At 3 and 6 months post FTR, the participants’ bilateral power and pinch grip strength were measured using a Jamar dynamometer and a pinch meter. The power and pinch grip strengths were calculated as a percentage of the unaffected hand. At 3 and 6 months post FTR, participants performed the Jebsen Hand Function Test (JHFT), and a Quick Disabilities of the Arm, Shoulder and Hand (QuickDASH) questionnaire was administered in an interview format. Results: A total of 126 participants enrolled in the study. There was a dropout rate of 48%, leaving 65 participants who completed 6 months follow-up, 41 males (63%) and 24 females (37%) aged 32 years (SD ± 12, n = 65). Out of 65 participants, 2% (n = 1) had an excellent outcome, 32% (n = 21) had a good outcome, 32% (n = 21) had a fair outcome, and 34% (n = 22) had a poor outcome with regard to TAM. At 6 months post FTR, the average power grip was 60% (SD ± 25, n = 65) of the unaffected hand while the average pinch grip was 52% (SD ± 42, n = 65) of the unaffected hand. The average score on the QuickDASH questionnaire was 19.34 (SD ± 16.89) at 6 months. Of the 41 participants who were employed prior to injury, 71% (n = 29) had returned to work by 6 months post surgery and scored an average of 15.89 (SD ± 23.74) on the QuickDASH work module. Sixty-eight percent (n = 44) of the patients had postoperative complications: the most common complication was tenodesis/adhesions (25%, n = 16), followed by contracture (22%, n = 14). There were only 4 ruptures (6%, n = 4) in this sample. Eleven participants (17%) underwent further surgery. The factors that affect the impairments and functional outcome at 6 months post FTR include age, zone of injury, number of digits injured, associated injury, delay between injury and surgery, and language barrier. Conclusion: Although there were some promising outcomes, during this period, participants did not consistently achieve the good or excellent functional outcomes achieved in developed countries. More research needs to be conducted regarding the outcome of FTR in South Africa, particularly in the public sector.

The implementation of the Objective Structured Practical Examination (OSPE) method: Students’ and examiners’ experiences

Background. Traditionally, physiotherapy practical skills have been assessed by a method that relies on the subjective interpretation of competency by the examiner and lacks the formative benefits of assessment. Objective. To describe and compare student performance and satisfaction and examiner satisfaction with regard to the Objective Structured Practical Examination (OSPE) and traditional mark sheets during the practical skills assessment. Method. Students and examiners taking part in the second-year physiotherapy practical skills test were invited to participate by completing a series of questionnaires. Performance of techniques was marked using both the OSPE and traditional mark sheets. Results. Sixty-seven students and nine examiners participated in the study. Students scored an average of 4.6% (SD ±16.4) better when using the traditional mark sheet. Nonetheless, students and examiners expressed a preference for the OSPE mark sheet. Conclusion. The OSPE mark sheet allows for increased objectivity, as the specific micro-skills are clearly listed and appropriately weighted. This resulted in increased satisfaction, but a decrease in marks obtained. By assessing the effect of implementation of the OSPE method on performance and satisfaction, change in the current situation can be monitored.