Witness Mudzi

Case fatality of patients with stroke over a 12-month period post stroke

INTRODUCTION Stroke is among the top 4 causes of death in South Africa and the top 10 leading causes of disability worldwide. There is a dearth of literature on stroke incidence, prevalence and outcome in sub-Saharan Africa. We aimed to establish the case fatality of stroke patients over a 12-month period post discharge from hospital. METHODS A total of 200 patients with first-time ischaemic stroke were recruited from Chris Hani Baragwanath Academic Hospital and followed up for 12 months. The Barthel Index (BI) and Rivermead Mobility Index (RMI) were used to establish patient functional ability and, by inference, stroke severity. Follow-up assessments were performed at 3, 6 and 12 months post discharge. Data analysis was largely descriptive in nature. RESULTS Thirty-eight per cent of patients died within the 12 month follow-up period; 25.5% within 3 months of discharge. The average length of hospital stay was 6 days. Low BI scores at discharge were observed in the majority of patients who died. CONCLUSION The 12-month cumulative mortality was high (highest at the 3-month follow-up). The short hospital stay and poor functional ability of the patients post stroke possibly left them vulnerable to bed-rest complications, such as chest infections and pressure sores.

Community participation of patients 12 months post-stroke in Johannesburg, South Africa

Abstract Background Improvement in health-related quality of life (HRQL) is the main goal of rehabilitation. The ability of the stroke-patient to participate in various situations signifies successful rehabilitation. The aim of the study was to establish the extent of community participation and the barriers and facilitators to the participation for stroke patients after their discharge. Method This study formed part of a larger study focusing on the impact of caregiver education on stroke survivors and their careers. This was a longitudinal study comprising 200 patients with first-time ischaemic stroke. Although the patients were followed up at home at 3 months, 6 months and 12 months post-stroke, this paper focuses on the 12-months follow-up participation results. Patient functional ability was measured by using the Barthel Index (BI) and the Rivermead Mobility Index (RMI), whereas participation was measured by using the International Classification of Functioning, Disability and Health (ICF) checklist. Descriptive statistics were used to analyse the data. Results Patients experienced severe to complete difficulty when undertaking single and multiple tasks without help 12-months post-discharge. They struggled with the preparation of meals, household work and interpersonal interactions, and they had difficulties with community life and partaking in recreation and leisure activities. Immediate family and societal attitudes were viewed as facilitators to community participation whereas friends, transportation services and social security services were viewed as barriers to community participation. Conclusion The patient-ability to socialise and participate in community issues is currently poor. The identified barriers to community participation need to be addressed in order to improve patient-participation in the community post-stroke.

The Effectiveness of Neural Mobilization for Neuromusculoskeletal Conditions: A Systematic Review and Meta-analysis

&NA; • STUDY DESIGN: Systematic review with meta‐analysis. • OBJECTIVES: To determine the efficacy of neural mobilization (NM) for musculoskeletal conditions with a neuropathic component. • BACKGROUND: Neural mobilization, or neurodynamics, is a movement‐based intervention aimed at restoring the homeostasis in and around the nervous system. The current level of evidence for NM is largely unknown. • METHODS: A database search for randomized trials investigating the effect of NM on neuromusculoskeletal conditions was conducted, using standard methods for article identification, selection, and quality appraisal. Where possible, studies were pooled for meta‐analysis, with pain, disability, and function as the primary outcomes. • RESULTS: Forty studies were included in this review, of which 17 had a low risk of bias. Meta‐analyses could only be performed on self‐reported outcomes. For chronic low back pain, disability (Oswestry Disability Questionnaire [0‐50]: mean difference, ‐9.26; 95% confidence interval [CI]: ‐14.50, ‐4.01; P<.001) and pain (intensity [0‐10]: mean difference, ‐1.78; 95% CI: ‐2.55, ‐1.01; P<.001) improved following NM. For chronic neck‐arm pain, pain improved (intensity: mean difference, ‐1.89; 95% CI: ‐3.14, ‐0.64; P<.001) following NM. For most of the clinical outcomes in individuals with carpal tunnel syndrome, NM was not effective (P>.11) but showed some positive neurophysiological effects (eg, reduced intraneural edema). Due to a scarcity of studies or conflicting results, the effect of NM remains uncertain for various conditions, such as postoperative low back pain, cubital tunnel syndrome, and lateral epicondylalgia. • CONCLUSION: This review reveals benefits of NM for back and neck pain, but the effect of NM on other conditions remains unclear. Due to the limited evidence and varying methodological quality, conclusions may change over time. • LEVEL OF EVIDENCE: Therapy, level 1a. • KEY WORDS: back pain, exercise, manual therapy, musculoskeletal conditions, neck pain, nerve mobilization, neurodynamics, physical therapy

Effect of penetrating trunk trauma on the recovery of adult survivors: a pilot study.

Gunshot and/or stab wounds to the trunk are injuries seen in South African hospitals. Patients are managed in the intensive care unit. Prolonged mechanical ventilation with immobilization results in some degree of muscle dysfunction. Our goal was to determine if patients recover adequately spontaneously following critical illness. No formal rehabilitation programmes exist in South Africa for these patients following discharge. A prospective, observational study was conducted. Patients were recruited from three ICUs in Johannesburg. Lung function tests, dynamometry, quality of life, 6-minute-walk, and oxygen uptake tests were performed over 6 months following discharge from the hospital. The control group consisted of existing data for healthy volunteers. Distance walked during 6-minute-wallk test was significantly reduced for the study group compared to the control group (1 month [p=0.00251]; 6 months [p=0.0355]). At 1 month there was a significant reduction in quadriceps and triceps strength for the study group compared to the control group (p=0.0089; p=0.0246, respectively). Quadriceps strength remained significantly reduced for the study group (3 months [p=0.0489]). No difference in muscle strength was detected between the groups at 6 months. Actual and predicted residual volumes differed significantly for the study group (1 month [p=0.0034]; 6 months [p=0.0157]). A trend of muscle weakness (to 3 months), poor exercise capacity, and abnormal lung volumes was identified. A formal rehabilitation programme may be needed to address these disabilities.

The effect of neural mobilisation on cervico-brachial pain: design of a randomised controlled trial.

BackgroundNeck pain is a common musculoskeletal complaint and is often associated with shoulder or arm pain. There is a paucity of information on effective treatment for neck and arm pain, such as radiculopathy or cervico-brachial pain. Guidelines recommend neck mobilisation/ manipulation, exercises and advice as the treatment for neck pain, and neck and arm pain. There are a few studies that have used neural mobilisation as the treatment for cervico-brachial pain. Although results seem promising the studies have small sample sizes that make it difficult to draw definite conclusions.MethodsA randomised controlled trial will be used to establish the effect of neural mobilisation on the pain, function and quality of life of patients with cervico-brachial pain. Patients will be recruited in four physiotherapy private practices and randomly assigned to usual care or usual care plus neural mobilisation.DiscussionIn clinical practice neural mobilisations is commonly used for cervico-brachial pain. Although study outcomes seem promising, most studies have small participant numbers. Targeting the neural structures as part of the management plan for a subgroup of patients with nerve mechano-sensitivity seems feasible. Patients with neuropathic pain and psychosocial risk factors such as catastrophising, respond poorly to treatment. Although a recent study found these patients less likely to respond to neural mobilisation, the current study will be able to assess whether neural mobilisation has any added benefit compared to usual care. The study will contribute to the knowledge base of treatment of patients with cervico-brachial pain. The findings of the study will be published in an appropriate journal.Trial registrationTrial registration Number: PACTR201303000500157.

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.

Effects of shoulder strapping in patients with stroke: A randomised control trial

Background Disability post stroke remains a global problem, with upper limb involvement playing a key role. Shoulder strapping is one of the techniques used clinically to address this. Objectives To compare the effect of two shoulder strapping techniques in patients with stroke. Method A longitudinal randomised controlled trial included baseline, weeks one, two and six assessments of 56 participants with upper limb hemiplegia. The participants were assessed for shoulder subluxation, shoulder pain, upper limb motor function and muscle tone. They were randomised into control, longitudinal strapping or circumferential strapping groups. Results Longitudinal strapping had a non-significant decrease in shoulder subluxation and pain (p > 0.05). Circumferential strapping had no significant effect on any outcomes; however, it prevented the shoulder pain from worsening as much as in the control group (p > 0.05). General improvement in upper limb motor function was observed for all three groups. Conclusion Trends in improvement showed that longitudinal strapping could be recommended because it positively influenced shoulder subluxation and pain. Even without significant changes, strapping creates awareness of the limb in patients and caregivers and could be of clinical benefit. Clinical implication Longitudinal strapping of the shoulder in patients with stroke seems to positively influence shoulder subluxation and pain.

Ergonomic behaviour of learners in a digitally driven school environment: Modification using an ergonomic intervention programme

Background Computer use is increasing amongst adolescents and so is the potential for related musculoskeletal pain and postural changes. The cumulative effect of this technology-induced, sedentary lifestyle leads to poor posture, pain, repetitive strain injury and dysfunctional movement patterns. Objectives The purpose of this study was to establish the effect of a computer-related ergonomic intervention for adolescents in a school environment on posture and ergonomic behaviour. Methods All Grade 8 learners at two randomly selected private schools in Johannesburg were invited to participate in the study (n = 127). A controlled trial compared an intervention group with a control group. The computer usage questionnaire and rapid upper limb assessment (RULA) were assessed at baseline, 3 and 6 months post-intervention. The intervention consisted of a participatory educational programme. An intention-to-treat analysis was undertaken. Alpha level was set at p = 0.05. Descriptive statistics (frequencies and percentages) and between-group analysis of variance, determined differences in the number of participants in the RULA action levels between groups after the intervention and the comparison of positions and type of computer. Results At 6 months post-intervention, there were no participants in action level (AL) 4 and the number of participants in AL 3 had reduced from 26.2% at baseline to 14.8% in the intervention group (p < 0.001). The control group RULA scores worsened over the period of 6 months. Although the learners were still not in an ’acceptable’ range of postural positions, there was a significant improvement between the pre-intervention and post-intervention stage (p < 0.001). Conclusion These findings demonstrate the effect of an ergonomic intervention and its sustainability over 6 months. Clinical implications The clinical contribution of this study to our healthcare system is that through the early identification and intervention of the poor ergonomics in a school environment, a positive impact on reducing poor postural behaviour amongst learners can be achieved.

University of the Witwatersrand physiotherapy undergraduate curriculum alignment to medical conditions of patients within Gauteng state health facilities

Background The healthcare sector requires graduates with the ability to confidently assess and manage the majority of the medical conditions seen in hospitals. Objective To establish whether the most prevalent medical conditions treated by physiotherapists in Gauteng (South Africa) state health facilities align with the University of the Witwatersrand (Wits) physiotherapy curriculum. Methods This was a retrospective review of condition-related statistics from physiotherapy departments within the Gauteng province state health facilities. Data from all Gauteng government hospitals that had submitted at least 75% of their physiotherapy condition–related statistics to the provincial statistics coordinator from January 2012 to December 2014 were considered and compared to medical conditions covered in the Wits 2015 physiotherapy curriculum to check if all conditions listed in the Gauteng statistics appeared within the Wits curriculum document. The number of teaching hours for the common conditions was noted to check the emphasis given to these conditions in the curriculum. Results Eighty-three per cent of the hospitals submitted 75% of their monthly statistics. Overall, the most common conditions treated were lower limb fractures (13%) followed by stroke (7.6%) (n = 705 597). Within the neuro-musculoskeletal category, the most common conditions after lower limb fractures were soft tissue injuries (15.1%) (n = 330 511). The most common cardiopulmonary conditions were tuberculosis (24.9%), followed by pneumonia (13.8%) (n = 94 895). The most common neurological conditions were stroke (30.9%) followed by cerebral palsy (17%) (n = 174 024). Within the non-specified categories, the number of intensive care unit (ICU) patients was the highest (23%), followed by sputum induction (21%) (n = 138 187). The most common conditions that were emphasised within the Wits curriculum as indicated by the teaching hours: fractures, 14.5 (66%) of 22 third-year orthopaedics hours; stroke, 30 (73%) of 41 third-year neurology hours; soft tissue injuries, 18 (38%) of 48 fourth-year neuro-musculoskeletal hours; back lesions, 24 (50%) of 48 fourth-year neuro-musculoskeletal hours; and ICU patients, 30 (79%) of 38 fourth-year cardiopulmonary hours. Conclusion The Wits physiotherapy curriculum covers all medical conditions treated by physiotherapists within the Gauteng state health facilities, and overall, the curriculum prepares the students to practise in a variety of situations.

Musculoskeletal problems among string instrumentalists in South Africa

Background Musicians who play string instruments are affected more by musculoskeletal injuries when compared to other instrument playing groups. Musculoskeletal problems are commonly found in the upper extremities and trunk. Several risk factors such as gender, practice hours and instrument played are associated with the prevalence and distribution of musculoskeletal problems among string instrumentalists. Objectives The aim of this study was to determine the prevalence, distribution, severity and risk factors for musculoskeletal problems among string instrumentalists. Method A cross-sectional study design using both online and paper-based questionnaires were used to collect data from string instrumentalists playing in both amateur and professional orchestras in South Africa. Results A total of 114 string instrumentalists participated in the study, of which 86 (77%) reported problems in one or more anatomic regions while 39 (35%) were currently experiencing musculoskeletal problems that affected their performance. The trunk and both shoulders were the most commonly affected body regions. The majority of the participants reported the severity of the complaints as mild to moderate with aching, soreness, tingling and fatigue being the most commonly used descriptors of the symptoms of playing-related musculoskeletal problems. Conclusion The results of this study showed that the prevalence of musculoskeletal problems that affect performance is high among string instrumentalists in South Africa. An evaluation of associated risk factors with the aim of reducing injuries may be important in improving performance.