Physiotherapists In South Africa Research Articles

Osteoarthritis rehabilitative practices among biokineticists and physiotherapists in South Africa

Osteoarthritis rehabilitative practices among biokineticists and physiotherapists in South Africa

Physiotherapy practice in lymphoedema in South Africa: A survey

Background: Lymphoedema is a chronic condition that is increasing in prevalence and requires specialised management to avoid possible life-threatening complications.Objectives: To describe the perceived knowledge of physiotherapists about lymphoedema and its management, the lymphoedema patient load seen by physiotherapists, and the current treatment approaches of physiotherapists in South Africa when managing lymphoedema.Method: A quantitative study using self-administered, online questionnaires were distributed among physiotherapists.Results: Knowledge of lymphoedema management is perceived to be lacking among physiotherapists. Physiotherapists are getting limited referrals and spending little time managing patients with lymphoedema. Only a few physiotherapists have post-graduate education in lymphoedema management, thus international treatment standards still need to be met.Conclusion: In order to meet international standards and patient needs, future research investigating the physiotherapy perspective is needed in lymphoedema management.Clinical implications: Educational bodies and policymakers may use this data to facilitate improvement in physiotherapy management of the condition and provision of care.

Team approach to osteoarthritis management: Viewpoints of biokineticists and physiotherapists in South Africa.

The rehabilitative nature of biokinetics and physiotherapy in osteoarthritis management highlights a complex interaction between different professions to achieve effective outcomes for the patient. The success of a team approach is dependent on key competencies for optimal patient-focused care and appropriate cross-referral systems. To explore and describe the viewpoints of biokineticists and physiotherapists regarding a team approach to osteoarthritis management in the South African public and private healthcare setting. A descriptive methodology with a convenience sampling technique was used. The target population consisted of biokineticists (n=47) and physiotherapists (n=165) located within the South African healthcare sectors. A self-administered, online questionnaire surveyed rehabilitative professionals' views of a team approach to osteoarthritis management. There is no evidence that the biokineticists and physiotherapists differ with respect to how they rate the communication between team members in osteoarthritis management (p=0.68). Communication was viewed as neither of a high nor low quality by biokineticists (43%) and physiotherapists (36%). Biokineticists (54%) and physiotherapists (69%) felt adequately equipped on their understanding of the role of various healthcare professions involved in osteoarthritis management (p=0.22). However, 43% of rehabilitative professionals indicated that they had not been exposed to interprofessional education initiatives (p=0.61). Both professions were well-versed on the roles of various professions involved in osteoarthritis management, however, communication was not optimal. While this study creates an awareness of the benefits of team-based management for osteoarthritis, the findings could stimulate debate on the optimal implementation of key competencies required for effective teamwork, thereby facilitating patient-focused care and referral systems.

Mental health patterns of physiotherapists in South Africa during COVID-19.

While attention has been drawn to the impact of the coronavirus disease 2019 (COVID-19) pandemic on the mental health of healthcare workers generally, little is known regarding mental health changes over time in frontline and non-frontline physiotherapists during this period. Our study aimed to investigate differences in mental health trends among frontline and non-frontline physiotherapists across three time periods during the pandemic. Survey-based data were collected from 366 practising physiotherapists across three time periods during the pandemic (Time 1: n = 171; Time 2: n = 101; Time 3: n = 94). Variations in reported mental health of frontline and non-frontline respondents generally and over time were analysed using comparative statistical techniques and trend analysis. Frontline physiotherapists reported significantly lower levels of general mental well-being and resilience, and significantly higher levels of burnout and maladaptive strategy use. Only frontline physiotherapists' general mental well-being and resilience decreased over time, whereas depression decreased over time for both groups. Anxiety decreased over time for non-frontline physiotherapists but initially decreased and then increased for frontline physiotherapists. Burnout increased initially and then decreased for non-frontline physiotherapists. Varying mental health trends were found between frontline and non-frontline physiotherapists over time. Nuanced mental health interventions that consider the period of the pandemic and degree of exposure are needed. Understandings of the mental health trajectories experienced by physiotherapists across the pandemic can inform long-term, targeted interventions that effectively enhance well-being, retention, and sustainability of practitioners, and thus the care delivered, in the healthcare system.

Determining the management of pain in people with spinal cord injury by physiotherapists in South Africa

BackgroundPain after spinal cord injury (SCI) is common, and physiotherapy plays a pivotal role in alleviating pain for people with SCI.ObjectiveTo determine the modalities that physiotherapists in South Africa use to treat SCI-related pain and the factors that guide the selection of treatment modalities.MethodA quantitative, cross-sectional design using a self-developed online survey was distributed to physiotherapists belonging to the South African Society of Physiotherapy and the Physiotherapy Association of South Africa. Data were analysed using SPSS v26, where descriptive data were analysed using frequency, percentages, means and standard deviations, and Fisher’s exact tests for inferential analyses. Open-ended questions underwent thematic analysis.ResultsForty-six responses were received. The most-used modalities were transcutaneous electrical nerve stimulation (29.8%), exercises (27.7%) and joint mobilisations (29.8%). Most physiotherapists used standardised measurements to objectively assess pain characteristics, with the visual analog scale being the most used (70.2%). Except for the cost of treatment, the factors that guided the selection of the modalities included the pain type, onset, duration, location and intensity, pain interference, duration of treatment, patient’s preferences, other treatments that the patient was receiving for pain and psychosocial factors (87.2%).ConclusionsLocal physiotherapists use pain management modalities that are supported by the evidence to treat SCI-related pain.Clinical implicationsThis study highlights the common modalities used by physiotherapists to treat SCI-related pain, as well as the selection criteria for the modalities. Owing to the low response rate, we caution against generalising these findings across the SCI pain management field.

Current knowledge and practice of post-stroke unilateral spatial neglect rehabilitation: A cross-sectional survey of South African neurorehabilitation physiotherapists.

BackgroundUnilateral spatial neglect (USN) affects the rehabilitation process leading to poor functional outcomes after stroke. South African physiotherapists’ level of uptake of available evidence in USN rehabilitation and the barriers they encounter are not known.ObjectivesTo evaluate knowledge, current practice enablers and barriers to USN management in stroke survivors amongst physiotherapists in South Africa.MethodsOur cross-sectional survey used a total sampling technique. Questionnaires were sent to neurorehabilitation physiotherapists in South Africa. Descriptive and inferential statistics analysed the data.ResultsThe overall knowledge score of USN was 14.11 ± 5.23 of a total of 25. The knowledge was good for definitions of USN; moderate for incidences, causes, screening, diagnosis and prognosis of USN and poor for pharmacological approaches to the management of USN. A significant low positive correlation between respondents’ age (r = 0.46; p = 0.016) and years of practice as a physiotherapist (r = 0.43; p = 0.026) and knowledge of USN was found. The most frequently utilised intervention was constraint-induced movement therapy; the commonly utilised assessment tool was the comb and razor test. ‘Inadequate therapy time’ (55.56%) and ‘lack of relevant equipment for rehabilitation of USN’ (38.89%) were identified as major barriers to USN rehabilitation. Major enablers to USN rehabilitation were the ‘presence of multidisciplinary stroke team in clinical practice’ (83.35%) and ‘availability of adequate staff’ (76.47%).ConclusionPhysiotherapists demonstrated a fair knowledge of USN although knowledge about pharmacological management of USN was modest. Current practice in post-stroke USN by South African neuro-physiotherapists follows current evidence and practice guidelines.Clinical implicationOur study shows the level of knowledge and current practice of post-stroke USN rehabilitation. The demonstrated fair knowledge of USN may be improved through training, curriculum modifications or continuing professional development. Identified barriers to the rehabilitation of post-stroke USN can assist health policy, managers and clinicians to improve stroke-specific care.

Current knowledge of idiopathic scoliosis among practising physiotherapists in South Africa.

BackgroundIdiopathic scoliosis (IS) is a common musculoskeletal condition with a multi-factorial aetiology characterised by a three-dimensional torsional deformity of the spine.ObjectivesTo 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).MethodAn 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.ResultsTwo 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.ConclusionThe 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 implicationsPhysiotherapists 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.

Happiness among South African private sector physiotherapists.

BackgroundHappiness of people can affect their daily functioning and work performance. There is limited research assessing the happiness levels of various disciplines within the health care industry. This article is the first attempt to evaluate the happiness levels of private sector physiotherapists in South Africa.ObjectivesResearch in happiness and physiotherapy studies are two research areas that are not associated with one another in a global perspective. The objective of this study was to assess the happiness levels of private sector physiotherapists in South Africa.MethodsA hypothesised model was statistically tested using a quantitative questionnaire, which was completed online. The target population of this study were all private sector physiotherapists who are members of the South African Society of Physiotherapy. A total of 395 respondents participated in the study.ResultsThis study confirmed that factors such as influence, social relations, life balance, optimism, work and leisure are all positively associated with the happiness levels of private sector physiotherapists in South Africa. These variables are recommended as key focus areas for physiotherapy practice owners to address, in order to positively affect the happiness levels of all people in their workplace.ConclusionThe study concludes the following: if happiness becomes a priority, then owners of physiotherapy practices need to generate a workforce who are more productive, demonstrate greater collaboration with colleagues and patients, are more positively energised, are less absent and are more loyal to the practice.Clinical ImplicationsThe contribution of this study is that it highlights the importance of managing staff in private physiotherapy practices in a holistic manner.

Knowledge, attitude and practice about health promotion amongst physiotherapists in South Africa

Knowledge, attitude and practice about health promotion amongst physiotherapists in South Africa

Ethical misconduct by registered physiotherapists in South Africa (2007-2013): A mixed methods approach.

BackgroundThe role of ethics in a medical context is to protect the interests of patients. Thus, it is critically important to understand the guilty verdicts related to professional standard breaches and ethics misconduct of physiotherapists.AimTo analyse the case content and penalties of all guilty verdicts related to ethics misconduct against registered physiotherapists in South Africa.MethodsA mixed methods approach was followed consisting of epidemiological data analysis and qualitative content analysis. The data documents were formal annual lists (2007–2013) of guilty verdicts related to ethical misconduct. Quantitative data analysis focused on annual frequencies of guilty verdicts, transgression categories and the imposed penalties. Qualitative data analysis focused on content analysis of the case content for each guilty verdict.ResultsRelatively few physiotherapists (0.05%) are annually found guilty of ethical misconduct. The two most frequent penalties were fines of R5000.00 and fines of R8000.00 – R10 000.00. The majority of transgressions involved fraudulent conduct (70.3%), followed by performance of procedures without patient consent (10.8%). Fraudulent conduct involved issuing misleading, inaccurate or false medical statements, and false or inaccurate medical aid scheme claims.ConclusionUnethical conduct by physiotherapists in South Africa occurs rarely. The majority of penalties imposed on sanctioned physiotherapists were monetary penalties.

Physiotherapists’ knowledge of pain: A cross-sectional correlational study of members of the South African Sports and Orthopaedic Manipulative Special Interest Groups

Background. Pain is the most common complaint for which patients seek the help of a physiotherapist. Furthermore, pain has been identified as the fifth vital sign, indicating the attention with which physiotherapists should be assessing pain. Previous studies have found deficits in pain knowledge among healthcare providers. Poor knowledge about pain is recognised to lead to poor assessment ability, and subsequently, to poor pain management.Objective. To investigate the pain knowledge of sports and orthopaedic manipulative physiotherapists in South Africa (SA).Methods. Data were collected online by means of a demographic questionnaire and Unruh’s Revised Pain Knowledge and Attitudes Questionnaire (RPKAQ). Participants were members of the Sports Physiotherapy Group and Orthopaedic Manipulative Physiotherapy Group of the South African Society of Physiotherapy.Results. The mean score for the RPKAQ was 65.5% (standard deviation (SD) ±8.6). Only 14.45% of the physiotherapists scored ≥75%. Lowest scores were obtained for the ‘assessment and measurement of pain’ (47.6%; SD ±15.6) and ‘developmental changes in pain perception’ (58.7%; SD ±20.8) sections of the RPKAQ, while the highest mean score was obtained for the ‘physiological basis of pain’ section (76.8%; SD±14.6). Gender, ethnicity (defined by home language), academic training and clinical experience did not contribute significantly to overall pain knowledge.Conclusion. There is an inadequate level of pain knowledge among members of the sports and orthopaedic manipulative physiotherapy groups in SA, particularly in the areas of the assessment and measurement of pain, and developmental changes in pain perception.

Physiotherapists’ knowledge of pain: A cross-sectional correlational study of members of the South African Sports and Orthopaedic Manipulative Special Interest Groups

Background. Pain is the most common complaint for which patients seek the help of a physiotherapist. Furthermore, pain has been identified as the fifth vital sign, indicating the attention with which physiotherapists should be assessing pain. Previous studies have found deficits in pain knowledge among healthcare providers. Poor knowledge about pain is recognised to lead to poor assessment ability, and subsequently, to poor pain management.Objective. To investigate the pain knowledge of sports and orthopaedic manipulative physiotherapists in South Africa (SA).Methods. Data were collected online by means of a demographic questionnaire and Unruh’s Revised Pain Knowledge and Attitudes Questionnaire (RPKAQ). Participants were members of the Sports Physiotherapy Group and Orthopaedic Manipulative Physiotherapy Group of the South African Society of Physiotherapy.Results. The mean score for the RPKAQ was 65.5% (standard deviation (SD) ±8.6). Only 14.45% of the physiotherapists scored ≥75%. Lowest scores were obtained for the ‘assessment and measurement of pain’ (47.6%; SD ±15.6) and ‘developmental changes in pain perception’ (58.7%; SD ±20.8) sections of the RPKAQ, while the highest mean score was obtained for the ‘physiological basis of pain’ section (76.8%; SD±14.6). Gender, ethnicity (defined by home language), academic training and clinical experience did not contribute significantly to overall pain knowledge.Conclusion. There is an inadequate level of pain knowledge among members of the sports and orthopaedic manipulative physiotherapy groups in SA, particularly in the areas of the assessment and measurement of pain, and developmental changes in pain perception.

Physiotherapists’ knowledge of pain: A cross-sectional correlational study of members of the South African Sports and Orthopaedic Manipulative Special Interest Groups

Background. Pain is the most common complaint for which patients seek the help of a physiotherapist. Furthermore, pain has been identified as the fifth vital sign, indicating the attention with which physiotherapists should be assessing pain. Previous studies have found deficits in pain knowledge among healthcare providers. Poor knowledge about pain is recognised to lead to poor assessment ability, and subsequently, to poor pain management.Objective. To investigate the pain knowledge of sports and orthopaedic manipulative physiotherapists in South Africa (SA).Methods. Data were collected online by means of a demographic questionnaire and Unruh’s Revised Pain Knowledge and Attitudes Questionnaire (RPKAQ). Participants were members of the Sports Physiotherapy Group and Orthopaedic Manipulative Physiotherapy Group of the South African Society of Physiotherapy.Results. The mean score for the RPKAQ was 65.5% (standard deviation (SD) ±8.6). Only 14.45% of the physiotherapists scored ≥75%. Lowest scores were obtained for the ‘assessment and measurement of pain’ (47.6%; SD ±15.6) and ‘developmental changes in pain perception’ (58.7%; SD ±20.8) sections of the RPKAQ, while the highest mean score was obtained for the ‘physiological basis of pain’ section (76.8%; SD±14.6). Gender, ethnicity (defined by home language), academic training and clinical experience did not contribute significantly to overall pain knowledge.Conclusion. There is an inadequate level of pain knowledge among members of the sports and orthopaedic manipulative physiotherapy groups in SA, particularly in the areas of the assessment and measurement of pain, and developmental changes in pain perception.

Effects of electrical stimulation in early Bells palsy on facial disability index scores

Recovery following facial nerve palsy is variable. Physiotherapists try to restore function in patients with Bell’s palsy. The choice of treatment modality depends on the stage of the condition. Although limited evidence exists for the use of electrical stimulation in the acute stage of Bell’s palsy, some physiotherapists in South Africa have been applying this modality. This study examined the effects of electrical stimulation on functional recovery from Bell’s palsy using the Facial Disability Index, a tool that documents recovery from the patients’ perspective. A two group pre-test post-test experimental design comprising of 16 patients with Bell’s Palsy of less than 30 days duration was utilized. Patients with a clinical diagnosis of Bell’s Palsy were systematically allocated to the control and experimental groups. Patients (n=16) were pre-tested and post-tested using the Facial Disability Index. Both groups were treated with heat, massage, exercises and given a home program. The experimental group also received electrical stimulation. The FDI of the control group improved between 17, 8% and 95, 4% with a mean of 52, 8%. The improvement in the experimental group ranged between 14, 8% and 126% with a mean of 49, 8%. Certain clinical residuals persisted in a mild form in both groups on discharge from the study. The effects of electrical stimulation as used in this study during the acute phase of Bell’s palsy, quantified as the FDI was clinically but not statistically significant. A larger sample size, longer stimulation time or both should be investigated.

Effects of electrical stimulation on house-brackmann scores in early bells palsy

ABSTRACTLimited evidence may support the application of electrical stimulation in the subacute and chronic stages of facial palsy, yet some physiotherapists in South Africa have been applying this modality in the acute stage in the absence of published evidence of clinical efficacy. This preliminary study's aim was to determine the safety and potential efficacy of applying electrical stimulation to the facial muscles during the early phase of Bells palsy. A pretest posttest control vs. experimental groups design composed of 16 patients with Bell's palsy of less than 30 days' duration. Adult patients with clinical diagnosis of Bell's palsy were systematically (every second patient) allocated to the control and experimental groups. Each group (n = 8) was pretested and posttested using the House-Brackmann index. Both groups were treated with heat, massage, exercises, and a home program. The experimental group also received electrical stimulation. The House-Brackmann Scale of the control group improved between 17% and 50% with a mean of 30%. The scores of the experimental group ranged between 17% and 75% with a mean of 37%. The difference between the groups was not statistically significant (two-tailed p = 0.36). Electrical stimulation as used in this study during the acute phase of Bell's palsy is safe but may not have added value over spontaneous recovery and multimodal physiotherapy. A larger sample size or longer stimulation time or both should be investigated.

The awareness and use of outcome measures by South African physiotherapists

Physiotherapists as well as otherhealth care providers a reunder pressure to provide evidence for the effectiveness of their interventions. Therefore it has become necessary to employ standardized androbust outcome measures in clinical practice. The objective of this study was to determine the awareness of and use of outcome measures (OM’s)amongst physiotherapists in South Africa. A survey was conducted in2004 using a self-developed electronic questionnaire consisting of 18questions, both open- and closed-ended. A population-based sample consisting of 1102 members on the email address list of the South Africa Society of Physiotherapy (SASP) was used. Data analysis consisted ofboth descriptive statistics and qualitative analysis for the open-endedquestions. The response rate was 15.2% (n=168). Ninety one percent of respondents reported to have heard of OM’s while 84% reported using OM’s regularly. Impairment related measures were predominantly in use. The two main themes that emerged from therespondents’comments related to reasons forusing OM’s were “effective clinical practice”(82%) and “evidence-basedpractice” (15%). Time constraints and lack of sufficient knowledge in the use of OM’s, were cited as obstacles tousing OM’s. These findings have implications forthe South African physiotherapy community in terms of education,continuous professional development (CPD) and future research in the usage frequency of OM’s.

Sexual harassment of the physiotherapist in South Africa

No study has been conducted on sexual harassment of physiotherapists in South Africa and it is therefore not known whether harassment occurs and if it does, to what extent. To this purpose, a questionnaire on sexual harassment and other sexual-related issues in the physiotherapy work environment in South Africa, was sent to a random selection of 982 physiotherapists registered with the Health Professions Council of South Africa. The response rate was 32%. This paper presents the results of the first half of the questionnaire, which was devoted to sexual harassment of the physiotherapist. Approximately 60% had experienced sexual harassment, of which 83.98% had been perpetrated by patients. Only 5.82% of the respondents had received some form of information in this regard. The most common form of harassment was requests for a hug or kiss.

Development of a framework with specific reference to exit-level outcomes for the education and training of South African undergraduate physiotherapy students

The aim of the study was to develop a framework for undergraduate programmes for the education and training of physiotherapists in South Africa. The research comprised a literature survey, interviews with United Kingdom physiotherapy educators and departmental workshops in South Africa. The Delphi technique was employed as research method to evaluate the proposed framework. The measuring instrument was a questionnaire comprising of amongst others, statements related to exit-level outcomes, which were rated on a five-point rating scale. Two rounds of the Delphi technique were required before acceptable consensus was reached and a framework for the development of a physiotherapy education and training programme was compiled. The framework has been designed as a benchmark for the development of innovative physiotherapy curricula in South Africa. This paper provides information of the exit-level outcomes specified in the framework.

Private practitioners`use of exercise therapy in lower back pain

Introduction: Lower back pain (LBP) is a common problem treated by physiotherapists. Recent research confirms the need for a more dynamic approach, to the management of this condition and includes progressive activity and exercise. The current use of exercise therapy for people with LBP and the implementation of evidence based practice in this field in South Africa, is unknown. As 80% of physiotherapists in South Africa offer services in private sector, the purpose of the study was to determine the use of this modality by physiotherapists. The specific aims were to determine how many physiotherapists utilise exercise therapy, how much therapy time is spent on it and how the modality is applied. This information can determine whether there is a need for continuing professional development in this area.Method: A stratified random sample of 489 South African physiotherapists was selected to take part in a survey by means of a questionnaire. Data was analysed descriptively and relationships between categories were analysed using Chi-square tests (p<5).Results: A response rate of 85% was reached. All but one physiotherapist used exercise therapy however, only 16% of the physiotherapists spent more than half of the course of treatment on exercise therapy. Most respondents (96%) specified dosages, 95% progressed exercises, but only 46% alwaysre-assess exercises at follow-up visits. Homeexercises are often prescribed, but group exercises are seldom used.Conclusion: South African physiotherapists in private practice use exercise therapy as a treatment modality for people with LBP. Inconsistencies concerning the implementation and time spent on exercises, suggests the need for continual professional development in this area

Some thoughts on practising physiotherapy in a multi-cultural country

Physiotherapists in South Africa are often confronted with ethicalissues, which arise from the multi-cultural nature of the society. This paper discusses the ethical theory of cultural relativism in an attempt to highlight the complexities of making moral judgements across cultural, ethnic and religious boundaries.