UWCScholar :: Browsing by Author "Diener, Ina"

Browsing by Author "Diener, Ina"

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Accuracy of clinical neurological examination in diagnosing lumbo-sacral radiculopathy: a systematic literature review
(BMC, 2017) Tawa, Nassib; Rhoda, Anthea; Diener, Ina
BACKGROUND: Lumbar radiculopathy remains a clinical challenge among primary care clinicians in both assessment and diagnosis. This often leads to misdiagnosis and inappropriate treatment of patients resulting in poor health outcomes, exacerbating this already debilitating condition. This review evaluated 12 primary diagnostic accuracy studies that specifically assessed the performance of various individual and grouped clinical neurological tests in detecting nerve root impingement, as established in the current literature. METHODS: Eight electronic data bases were searched for relevant articles from inception until July 2016. All primary diagnostic studies which investigated the accuracy of clinical neurological test (s) in diagnosing lumbar radiculopathy among patients with low back and referred leg symptoms were screened for inclusion. Qualifying studies were retrieved and independently assessed for methodological quality using the ‘Quality Assessment of Diagnostic tests Accuracy Studies’ criteria. RESULTS: A total of 12 studies which investigated standard components of clinical neurological examination of (sensory, motor, tendon reflex and neuro-dynamics) of the lumbo-sacral spine were included. The mean inter-observer agreement on quality assessment by two independent reviewers was fair (k = 0.3 – 0.7). The diagnostic performance of sensory testing using MR imaging as a reference standard demonstrated a sensitivity (confidence interval 95%) 0.61 (0.47-0.73) and a specificity of 0.63 (0.38-0.84). Motor tests sensitivity was poor to moderate, ranging from 0.13 (0.04-0.31) to 0.61 (0.36-0.83). Generally, the diagnostic performance of reflex testing was notably good with specificity ranging from (confidence interval 95%) 0.60 (0.51-0.69) to 0.93 (0.87-0.97) and sensitivity ranging from 0.14 (0.09-0.21) to 0.67 (0.21-0.94). Femoral nerve stretch test had a high sensitivity of (confidence interval 95%) 1.00 (0.40-1.00) and specificity of 0.83 (0.52-0.98) while SLR test recorded a mean sensitivity of 0.84 (0.72-0.92) and specificity of 0.78 (0.67-0.87). CONCLUSION: There is a scarcity of studies on the diagnostic accuracy of clinical neurological examination testing. Furthermore there seem to be a disconnect among researchers regarding the diagnostic utility of lower limb neurodynamic tests which include the Straight Leg Raise and Femoral Nerve tests for sciatic and femoral nerve respectively. Whether these tests are able to detect the presence of disc herniation and subsequent nerve root compression or hyper-sensitivity of the sacral and femoral plexus due to mechanical irritation still remains debatable.
Accuracy of magnetic resonance imaging in detecting lumbo-sacral nerve root compromise: A systematic literature review
(BioMed Central, 2016) Tawa, Nassib; Rhoda, Anthea; Diener, Ina
Background: MRI is considered to be the diagnostic tool of choice in diagnosing nerve root compromise among patients presenting with clinical suspicion of lumbo-sacral radiculopathy. There exists controversy among researchers and clinicians regarding the diagnostic utility and accuracy of MRI in detecting nerve root compromise and radiculopathy. This review evaluated 4 primary diagnostic accuracy studies that specifically assessed the accuracy of MRI in detecting nerve root compromise, as established in the current literature. Methods: Eight electronic data bases were searched for relevant articles from inception until January 2014. All primary diagnostic studies which investigated the accuracy of MRI in diagnosing nerve root compromise among patients with low back and referred leg symptoms were screened for inclusion. Qualifying studies were retrieved and independently assessed for methodological quality using the 'Quality Assessment of Diagnostic tests Accuracy Studies' criteria. Results: Four studies qualified for inclusion in this review. The sensitivity of MRI in detecting lumbar nerve root compromise was very low at 0.25 (95 % CI) while the specificity was relatively high at 0.92 (95 % CI). Conclusions: There is lack of sufficient high quality scientific evidence in support or against the use of MRI in diagnosing nerve root compression and radiculopathy. Therefore, clinicians should always correlate the findings of MRI with the patients' medical history and clinical presentation in clinical decision making.
Back pain amongst dentistry students at the University of Western Cape
(University of the Western Cape, 2008) Pradeep, Joseph Reejen; Frantz, José; Diener, Ina; Faculty of Science
Back pain has been reported to be the most common type of discomfort in all occupational groups. Studies have shown that dentists experience more neck, shoulder and back pain than practitioners in other occupational groups. This has caused an increase of social and economic costs of healthcare and increased frequency of sickness absenteeism in Western countries. About 72% of dentists experience back pain according to studies done in Western countries thus showing a very high prevalence among dentist. This study aimed to investigate the prevalence of back pain among dentistry undergraduate students. As there have been reports of high prevalence of back pain among dentistry students in Western countries.
The correlation of the self-reported Leeds assessment of neuropathic symptoms and signs score, clinical neurological examination findings and magnetic resonance imaging findings in patients with Lumbo-sacral radiculopathy
(University of the Western Cape, 2014) Tawa, Nassib; Rhoda, Anthea; Diener, Ina
Lumbo-sacral radiculopathy (LSR) is clinically defined as low back and referred leg symptoms accompanied by an objective sensory and/or motor deficit due to nerve root compromise. LSR is a common condition encountered by physiotherapists in clinical practice and the assessment and diagnosis remains a challenge owing to the complex anatomy of the lumbo-sacral spine segment and the various differentials. Moreover, LSR imposes a significant impact on patients’ health, functional ability, socio-economic status and quality of life. There are several diagnostic tools and procedures which are commonly utilised in practice, including diagnostic neuropathic pain screening questionnaires, clinical neurological tests, electro-diagnostics and imaging. However, the diagnostic utility and correlation of these tests have not been fully explored and remains debatable among clinicians and researchers in the fields of musculo-skeletal health and neurology. The aim of this study was to determine a correlation of the S-LANSS score, clinical neurological examination (CNE) findings and magnetic resonance imaging (MRI) reports in the diagnosis of LSR among patients who presented with low back and referred leg symptoms. The study was conducted in three phases. In phase one, two systematic literature reviews were conducted; firstly, to establish the evidence-based accuracy of CNE in diagnosing LSR, and secondly, to establish the evidence-based accuracy of MRI in diagnosing LSR. In both systematic literature reviews, the diagnostic tests accuracy (DTA) protocol was used in planning, design and execution of literature search, selection of relevant studies, quality assessment, data analysis and presentation of the results. In phase two, clinical validation of an adopted S-LANSS scale and lumbar MRI reporting protocol were established, and a standardised evidence based lumbar CNE protocol developed.The face and content validity of the original S-LANSS score was established among a sample of Kenyan physiotherapists and patients who presented with low back and referred leg symptoms, using both quantitative and qualitative research designs. This was followed by a test-re-test reliability study on the adapted version of the S- LNASS score. The face and content validity of the adopted lumbar MRI reporting protocol was established among a sample of Kenyan radiologists followed by an inter-rater reliability. An evidence-based lumbar CNE protocol was developed; standardised and inter-examiner reliability was also examined among a sample of Kenyan physiotherapists. Finally, in phase three, a cross-sectional blinded validity study was conducted in six different physiotherapy departments. Participants (patients, physiotherapists and radiologists) were recruited using strict in- and exclusion criteria and data was collected using a pain and demographic questionnaire, the S-LANSS scale, the CNE protocol, the Oswestry Disability Index (ODI) and the MRI lumbar spine reporting protocol. Data was captured, cleaned and analysed using SPSS version 21. Descriptive analysis was done using frequencies, means and percentages, while inferential analysis was conducted using Spearman’s rank correlation coefficient test r to establish the correlation between the diagnostic tests. Cross tabulations, receiver operating curves (ROC) and scatter plots were used to establish the sensitivity and/or specificity of S-LANSS scale and individual CNE tests as defined by MRI. In phase three, which formed the main study of the research project, a total of 102 participants were recruited in this study with a gender distribution of 57% females and 43% males. The majority (67%) had neuropathic pain according to the S-LANSS scale and their pain intensity ranged from moderate (4-6) to severe (7-9) as recorded on a Numeric Pain rating Scale (NPRS), and was more common among manual workers. Similarly, patients whose pain had a neuropathic component had moderate to severe disability. The S-LANSS scale and lower limb neuro-dynamic tests were the most sensitive tests 0.79 and 0.75 respectively, while deep tendon reflexes were the most specific tests (0.87). The S-LANSS and CNE correlated fairly but significantly with MRI (r=0.36, P=0.01).LSR is a common condition and its assessment and diagnosis remains a clinical challenge among physiotherapists. MRI is a high-cost diagnostic tool but is being used by many clinicians in making decisions regarding the management of patients. Rapid and low-cost neuropathic pain screening by the use of the S-LANSS scale, together with use of evidence-based CNE of neuro-conduction and neuro-dynamic tests may be used in confirming nerve-root related MRI findings. These may be used in making a decision on whether to manage a patient conservatively using pharmacological agents and manual physiotherapy and therapeutic exercise, or consider surgery in the initial management of patients with clinical suspicion of LSR. This is especially valuable in the resource-poor settings like Kenya and other sub-Saharan African countries where MRI is costly or unavailable.
Does the South African physiotherapy journal fulfill the needs of its constituency? a retrospective article review
(AOSIS OpenJournals, 2011) Frantz, Jose M.; Diener, Ina; Jelsma, Jennifer
Professional journals are used to disseminate the knowledge of scholars in the profession and to provide clinicians with guidance for best practice. This article aimed to retrospectively review the role of the South African Journal of Physiotherapy and its contribution to the profession. An archival research design was used to collect information from the archives of the South African Society of Physiotherapy website. The information was retrieved using a data capture sheet and descriptive statistics were used throughout to establish frequencies for the relevant information. During the identified period, 170 articles were published. The greatest number of papers originated in South Africa (81%), 8% from the rest of Africa and 11% written by international authors. Authors with a Masters degree contributed almost 50% of the papers and those with doctorates were responsible for at least 25% of the papers. Most of the papers presented original research (81%) with secondary research such as reviews and scholarly papers accounting for 19% of the total. The most common speciality area addressed through research was linked to musculoskeletal conditions. The journal appears to have provided an important platform for South African academics and emerging researchers to publish their findings. It is suggested that the journal should give preference to papers that deal with issues that are unique to South Africa and sub-Saharan Africa, as these are the least likely to be published elsewhere. In addition, the journal should emphasise papers that will advance the profession.
The effect of ballet exercise classes on BMI, perceived pain, physical function and quality of life in patients with osteoarthritis (OA) of the hip and knee
(University of the Western Cape, 2012) Van der Linde, Lavinia; Diener, Ina
Introduction: Osteoarthritis (OA) is one of the prevalent debilitating diseases in South Africa, often leading to activity limitations, participation restrictions and a poor quality of life. Older people often lead more sedentary lifestyles, which may further aggravate their symptoms. Exercise therapy has demonstrated good outcomes in the OA population. Many dance interventions have become popular in OA treatment and results suggest their effects to be more successful than traditional physiotherapy exercises regimes. Ballet dance exercises have not yet been explored in the treatment of OA, even though it has been proposed to have positive effects on the body. Purpose: to determine the effect of a program of ballet dance exercise classes on BMI, perceived pain, physical function and quality of life in patients with osteoarthritis (OA) of the hip and knee, compared to the existing Midros Clinic program of exercise classes. Methods: The study used a randomized, cross-sectional, quantitative, experimental study using pre- and post-intervention as well as multiple time-point testing. A sample of 52 males and females were recruited in Midros, Middelburg Cape. The inclusion criteria of the study were persons aged 65 years and older, with OA of the hip and/or knee, clinically diagnosed according to the criteria of the American College of Rheumatology. The VAS, Timed Up and Go Test (TUGT), WOMAC and the SF-8 Index, respectively measured reported perceived pain, physical function, quality of life and health status in the study groups. BMI, pulse and blood pressure were also recorded to further monitor the effects of the interventions. A comparable number of scores were obtained over six weeks of bi-weekly ballet exercise classes (intervention group = IG), and nine weeks of two-weekly exercise classes at the Midros Clinic (comparison group = CG). Descriptive statistics were used to analyse the demographic information and inferential statistics were used to determine the associations for parametric data; a two tailed p-value was calculated; the 95% CI was calculated using the approximation of Katz. The p-value was classified as significant if p<0.05. Results: The demographics and baseline measurements of the IG and CG were comparable. A series of five exercise classes (over nine weeks) had a significantly beneficial effect on BMI and systolic BP, perceived and actual physical function, and QOL, whereas a series of 12 ballet exercise classes ( over six weeks) had a significant positive effect on BMI and diastolic BP, perceived pain, perceived physical function, and QOL. The comparison of responses to the outcome measures by male and female participants demonstrated that, contrary to findings in the reviewed literature, females held more positive perceptions than males on their perceived severity of joint pain and function, physical and mental health, and well being. A series of the existing exercise classes of Midros Clinic brought about more significant changes than a program of ballet exercise classes in the research parameters measured, despite exercise classes taking place much less frequently than the ballet classes. Conclusion: Although both interventions were found to both bring about positive changes in older persons with OA, a series of ballet exercises classes did not result in better outcomes than the currently existing Midros Clinic group exercise classes. The results of the current study demonstrate that exercise interventions are found to be the most beneficial in improving the quality of life of OA sufferers.
Knowledge, attitudes and beliefs on contributing factors among low back pain patients attending outpatient physiotherapy treatment in Malawi
(2017) Tarimo, Nesto; Diener, Ina
BACKGROUND: Low back pain (LBP) affects many people globally. Its aetiology is not clear. Patients lack knowledge of its contributing factors and have negative perception about their LBP. This study aimed to identify knowledge, attitudes and beliefs regarding the perceived contributing factors to LBP among patients attending physiotherapy outpatient departments in Malawi. This information can possibly facilitate planning of a LBP education programme in Malawi. METHODS: A quantitative cross-sectional survey was conducted, using a six-part selfadministered questionnaire with questions on demographic information, participants’ attitudes and beliefs regarding their LBP, knowledge about the course and causes of LBP, beliefs regarding nine contributing factors to LBP (identified in a Delphi study) and the sources of the participants’ knowledge. Data were analysed descriptively using the Statistical Package for Social Sciences (version 19.0). A Chi-square test was used to determine any association between variables (alpha 0.05). All ethical procedures were strictly followed. RESULTS: Most participants (186, 91.2 %) did not manage to answer all six questions regarding knowledge correctly and were regarded as ‘partially knowledgeable’ about the course and causes of LBP. More than half (67%) portrayed negative attitudes and beliefs about LBP in general. The findings also showed a statistically significant relationship between knowledge, attitudes and beliefs (p = 0.04). CONCLUSION: This study highlighted that many patients with LBP in Malawi are not adequately knowledgeable about LBP and hold negative attitudes and beliefs regarding their LBP. Therefore, LBP management programmes in Malawi should include education programmes aimed at empowering patients with knowledge regarding LBP, as well as changing their negative attitudes and beliefs about their pain. Patients’ understanding of the cause and nature of their pain may enhance the achievement of treatment goals.
Knowledge, attitudes and beliefs on contributing factors among low back pain patients attending outpatients physiotherapy treatment in Malawi
(University of the Western Cape, 2011) Tarimo, Nesto Salia; Diener, Ina; Dept. of Physiotherapy; Faculty of Community and Health Sciences
Low back pain (LBP) is a growing health and socio-economic problem worldwide, affecting humans from adolescent to adult age. In developed countries, more than 80% of adults are at risk of suffering a disabling episode of LBP at one point during their life time. In developing countries, particularly in Africa, the life time prevalence of LBP varies in population groups, but the disability due to LBP is increasing. The aetiology of LBP is multifactorial, and there is still no consensus on the exact cause and contributing factors to LBP. In addition, little is known about patients' knowledge and beliefs on the contributing factors to their LBP. The current study therefore, aimed to identify patients' knowledge, attitudes and beliefs on the contributing factors to LBP, among patients attending physiotherapy outpatient departments in Malawi.
A Survey of perceived disability and contributing risk factors to work-related low back pain amongst nurses in Rwanda
(University of the Western Cape, 2011) Ndagijimana, Pierre Claver; Diener, Ina; Dept. of Physiotherapy; Faculty of Community and Health Sciences
Nursing is worldwide regarded as a high risk occupation for the development of work-related low back pain (WRLBP). LBP is one of the most common causes of disability, creating an important socio-economic problem in modern society. Studies report that more than 80% of workers suffer from WRLBP once in their occupational lives. Among nurses, the lifetime prevalence has been found to be higher, varying up to 90% of a nursing population. The current study aimed at determining the prevalence, perceived disability and contributing/risk factors to WRLBP among nurses in Rwanda, identifying the perceived contributing risk factors of WRLBP and intervention strategies received by those nurses. A descriptive quantitative cross-sectional survey using convenience sampling was used to gather data with a self-administered questionnaire on a sample of 226 nurses. The study population included all registered nurses of Kabgayi District Hospital and Nyanza District Hospitals and their respective health centers. To be included, the nurses had to have suffered from WRLBP during the previous 6 months before data collection. The Nordic Back Pain Questionnaire, the Oswestry Disability Index and an open-ended questionnaire regarding perceived risk factors have been used. Descriptive statistics to summarize data and inferential statistics such as chisquare test to test the relationship between different variables of the study have been studied at 5% levels. Correlation coefficients in terms of cross-tabulation were also studied at 1% level of significance. The current study highlights one-month prevalent rates of 70.4%, and one-week prevalent rates of 54.4%. WRLBP among nurses has been found to be significantly associated with gender according to the p-value of 0.007 among the studied variables, and good correlation coefficients between disability scores, together with the length of WRLBP and BMI with 0.0001, 0.0030 respectively. Nurses in the current study reported WRLBP as a result of a wide range of factors related to their work, manual handling being the major physical work activity exposing them to WRLBP. The perceived risk factors for WRLBP reported in this study were classified into 4 categories. The first category included work positional factors such as standing, sitting, bending, and awkward work postures. The second group included work-related nursing tasks such as lifting patients and items at work, repositioning and transferring patients, bed making, washing patients, and many others. In the third group, psychosocial factors like poor relationship with colleagues, work pressure and reduced job satisfaction have been listed. Finally, some non-occupational factors such as aging, pregnancy, menstruation, history of back pain, being female and body built have also been perceived as contributing factors to WRLBP. The Oswestry Disability Index demonstrated a mild to moderate disability due to WRLBP in this group of nurses. WRLBP has a negative impact in health services due to activity limitation, lost time and lowered productivity. The study concludes that nurses must be protected from ergonomic work stressors, and improvement of awareness of urses with regards to ergonomic stressors seems to be crucial. However, an effort by different parties concerned with the problem at all levels in Rwanda is needed. The government of Rwanda, through the Ministry of Health in particular, will be recommended to put strategies in place for the management, reduction and prevention of WRLBP amongst health workers, especially in the nursing population.

Browsing by Author "Diener, Ina"

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