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Physical activity profile of hypertensive adults living in rural South Africa

Background: Understanding the physical activity behaviours of adults at risk of poor health is important to inform targeted interventions. We profiled the frequency, intensity, duration and domain (work or non-work) of self-reported physical activities of rural South African adults living with hypertension.Objectives: The aim of this study was to provide a profile of the frequency, intensity, duration and domain of self-reported physical activities over a 7-day period in adults with hypertension from a rural sub-district in South Africa.Method: A total of 429 adults diagnosed with hypertension aged 40 years and above completed the International Physical Activity Questionnaire Long-Form via telephone interview. Data were summarised using means and standard deviations or medians and interquartile ranges. The Mann–Whitney U test and Krustal–Wallis rank test were used to assess physical activity differences by sex and work status. Statistical significance was set at p 0.05.Results: The mean age of the participants was 65.1 (standard deviation [s.d.] ± 10.9 years), 58% were women and 52% had paid or unpaid work. Men reported greater (duration and frequency) vigorous physical activity at work compared to women (p = 0.003 and p = 0.002). Walking frequency as a mode of transport was higher for working men and women (p 0.001). Women reported higher frequency of moderate-intensity physical activity inside the house (p 0.001) and outside the house (p 0.001) compared to men. Non-working men and women spent more time sitting during the week compared to their working counterparts (p = 0.009).Conclusion: The physical activity profile of hypertensive adults varied by sex and work status.Clinical implications: Contextual factors such as gender roles are also related to the physical activity profile of hypertensive adults living in rural South Africa and should be considered when designing specific interventions targeted at improving hypertension control for this population.

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A protocol for delivery of prehabilitation in lower limb arthroplasty in South Africa

Background: Worldwide, musculoskeletal disorders represent a global threat, and primary replacement arthroplasty is the preferred surgical treatment for late-stage arthritis. In South Africa, the waiting lists for arthroplasty are extensive and physiotherapists can have an impact on this situation by implementing prehabilitation; hence, the need to conduct research on the efficacy of such a programme.Objectives: Develop a prehabilitation programme for a resource-scarce community in South Africa.Method: Our study consisted of three phases wherein the first step entailed conducting a scoping review. The second phase was a consultation of stakeholders through semi-structured interviews and self-administered questionnaire, and the final stage was an evaluation of the effects of the prehabilitation programme by a pilot, single-blinded study on a convenient sample of patients.Results: The scoping review identified several gaps in existing programmes such as duration, mode and content of the prehabilitation programmes. Stakeholder surveys revealed a lack of knowledge and understanding of physiotherapy and prehabilitation. This highlighted the need to investigate the efficacy of a hybrid model of prehabilitation.Conclusion: Our study is novel within the South African public healthcare system, as it envisages a hybrid approach; and to construct a programme that is contextually relevant.Clinical implications: Our study aims to deliver the services in a hybrid way using telerehabilitation and face-to-face therapy which will improve access and reduce waiting times.

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Undergraduate students' choices around community service and internship: A single faculty study.

The Internship and Community Service Programme (ICSP) places newly graduated health professionals for a compulsory training period. Universities adopt multiple strategies to encourage students to select rural placements for ICSP. This study describes ICSP choices among final-year MBChB and Health and Rehabilitation Science students at a South African university and the factors influencing their decisions. A cross-sectional qualitative descriptive study was conducted using a self-developed online questionnaire. Eighty-five final-year students were recruited. Most respondents (n = 38, 45.8%) chose the Western Cape (WC) as their first choice placement. There was a significant difference between MBChB and other health science students' choice of level of healthcare (χ = 10.39, p = 0.006), with MBChB less likely to choose primary healthcare (PHC) level placements. District and tertiary care options were perceived as better sites for learning and practice, while PHC and rural sites, considered underresourced and understaffed, were avoided. Although MBChB students indicated a lower preference for rural placements, this was not significant.Factors influencing ICSP application decisions included professional support, work environment, and social and personal considerations. Students' placement choices were based on their perceptions of clinical exposure, learning opportunities, mentorship and supervision. Placements closer to home were preferred. UG clinical exposure and rural background seem to have some impact on choice but need further investigation. Universities should continue to explore ways to improve students' readiness for practice in underresourced settings. Improved exposure to rural and PHC sites during training could encourage better uptake during ICSP placement.

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Psychosocial reintegration post-traumatic spinal cord injury in Rwanda: An exploratory study.

Traumatic spinal cord injury (TSCI) survivors are confronted by both physical and psychosocial barriers when returning to their communities. Therefore, reintegration is an important aspect of their journey back into social life. To assess psychosocial reintegration after TSCI in Rwanda. All community-dwelling adults who were registered in the previous epidemiological study were recruited and injury characteristics questionnaire and the Sydney Psychosocial Reintegration Scale version 2 (SPRS-2) were used to collect data through a telephone interview. The study traced 58 participants, 77.6% (n = 45) were male and 56.9% (n = 33) were categorised with paraplegia. Overall, the results show poor community reintegration. The SPRS-2 and domain mean (SD) scores were: overall SPRS-2 of 20.95 (11.56), occupational activity (OA) of 3.68 (4.31), interpersonal relationship (IR) of 7.11(4.31) and living skills (LS) of 7.43 (5.32). Gender significantly influenced overall SPRS-2 (p = 0.011) and two domains: OA (p = 0.005) and LS (p = 0.012). Level of injury was significantly associated with an OA domain score of SPRS-2 (p = 0.002). Gender explained 29% of the variance in the LS domain of SPRS-2, with males reporting better psychosocial reintegration. Gender strongly predicted psychosocial reintegration following a TSCI, which is an indication of the role of social support. Traumatic SCI rehabilitation should be holistic to help prepare the person to return to the community. There should be an assessment of an individual's readiness to return to the community before discharge from the hospital.

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Bilateral versus unilateral upper limb training in (sub)acute stroke: A systematic and meta-analysis.

Integrating high dosage bilateral movements to improve upper limb (UL) recovery after stroke is a rehabilitation strategy that could potentially improve bimanual activities. This study aims to compare the effects of bilateral with unilateral UL training on upper limb impairments and functional independence in (sub)acute stroke. Five electronic databases (PubMed, Scopus, PEDro, ScienceDirect, Web of Science) were systematically searched from inception to June 2023. Randomised controlled trials comparing the effect of bilateral training to unilateral training in stroke survivors (< 6 months poststroke) were included. The treatment effect was computed by the standard mean differences (SMDs). The review included 14 studies involving 706 participants. Bilateral training yielded a significant improvement on UL impairments measured by FMA-UE compared to unilateral training (SMD = 0.48; 95% CI: 0.08 to 0.88; P = 0.02). In addition, subgroup analysis based on the severity of UL impairments reported significant results in favour of bilateral UL training in improving UL impairments compared to unilateral training in "no motor capacity" patients (SMD = 0.66; 95% CI: 0.16 to 1.15; P = 0.009). Furthermore, a significant difference was observed in favour of bilateral UL training compared to unilateral UL training on daily activities measured by Functional Independence Measure (SMD = 0.45; 0.13 to 0.78; P = 0.006). Bilateral UL training was superior to unilateral training in improving impairments measured by FMA-UE and functional independence in daily activities measured by Functional Independence Measure in (sub)acute stroke. Bilateral upper limb training promotes recovery of impairments and daily activities in (sub)acute phase of stroke.

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