Research Articles (Physiotherapy)

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Learning with technology in physiotherapy education: Design, implementation and evaluation of a flipped classroom teaching approach
(BMC, 219) Røe, Yngve; Rowe, Michael; Ødegaard, Nina B.
The purpose of the study was to describe the design, implementation and evaluation of a flipped classroom teaching approach in physiotherapy education. The flipped classroom is a blended learning approach in which students receive digital lectures as homework, while active learning activities are used in the classroom. Flipped classroom teaching enables a learning environment that aims to develop higher-order cognitive skills. The study design was a historically controlled, prospective, cohort study. An eight week theoretical course on musculoskeletal disorders was redesigned, moving from a conventional approach to a flipped classroom model. Pre-class learning material consisted of about 12 h of video lectures and other digital learning resources that were split up over the duration of the course. In-class activities consisted of seven full-day seminars where students worked in groups in order to solve problem-based assignments. The assignments were designed to reflect authentic clinical problems and required critical thinking and reasoning. Outcomes were measured with coursegrades and compared with historical controls of conventional teaching, using descriptive statistics. Self-perceived learning outcomes and students’ experiences were also collected in a survey.
What clinical competencies do we expect from physiotherapy students at the University of the Western Cape?
(Aosis, 1998) Simuzingili, Tyson; Amosun, Seyi Ladele
The purpose o f this study is to identify the clinical competencies that are expected o f physiotherapy students at the University o f the Western Cape. A list o fte n categories o f clinical competencies was first compiled from the literature and administered to 2 lecturers, 5 clinical supervisors and 10 fin a l year students, to elicit their perspectives o f expected clinical competencies. Based on the outcome o f this, a list o f eight categories o f competencies was administered to 7 lecturers, 50 clinical supervisors and 31 fin a l year students. Participants were requested to rank the competencies in order o f what was considered to be essential. The analysis o f 79 responses revealed similarities among lecturers, clinical supervisors and students in the ranking o f three competencies, but disparities in the ranking o f fiv e competencies. Reasons fo r the disparities, and the impact o f the disparities on students are discussed. Further research is recommended to identify the reasons fo r the disparities.
Injury surveillance in Taekwondo and Judo during physiotherapy coverage of the seventh All Africa Games
(AOSIS, 2001) Phillips, Julie; Frantz, Jose M.; Amosun, Seyi Ladele; Weitz, W.
OBJECTIVE: To obtain data relating to the incidence of injuries s stained during taekwondo and judo competitions at the 7th All Africa Games. Methods: Prospective recording of injuries sustained by athletes who sought physiotherapy services at the games. Details of type of injury, injury sites and injury severity were obtained. RESULTS: Seventy athletes out of 390 participants reported injuries. The overall injury risk ratio was 0.18. Injuries reported were strains/sprains (65,6%), bruises/contusions (16.1%) and dislocations or fractures (12,9%). The upper limbs were more commonly injured. Of the injuries sustained, approximately 18%, 69% and 13% were respectively classified as mild, moderate and severe injuries. CONCLUSION: The high incidence of moderate to severe injuries highlights the need for injury prevention programs and the presence of medical staff at major tournaments in order to make early diagnosis and appropriate intervention.
Health promotion needs of physically disabled individuals with lower limb amputation in Rwanda
(Taylor and Francis, 2005) Amosun, Seyi Ladele; Mutimura, Eugene; Frantz, Jose M.
PURPOSE. The objectives of the study were to identify the health-related behaviors among physically disabled individuals with lower limb amputation resident in Rwanda, the factors that influenced these behaviors, and the major issues that should be targeted in health promotion programs for physically disabled individuals with lower limb amputation. METHOD. A cross-sectional survey, utilizing a self-administered questionnaire, was carried out among 334 lower limb amputees who volunteered to take part in the study. In addition, a sub-sample of 15 participants was purposively selected for in-depth face-to-face interviews. RESULTS. Many participants did not engage in physical exercises (64.7%). Others abused alcohol on daily basis (14.4%), smoked 11 – 20 cigarettes daily (13.2%), and used recreational drugs such as marijuana, opium and cocaine (9.6%). There were significant associations between the age group of the participants and participation in exercises (P=0.001), and consuming alcohol, tobacco and recreational drugs (P = 0.001). In-depth interviews revealed factors influencing the behavior of participants. CONCLUSIONS. Participants were found to be at risk of secondary complications because of poor lifestyle choices. There is a need to develop and promote wellness-enhancing behaviors in order to enhance the health status of physically disabled individuals in Rwanda who have lower limb amputations.
Influence of previous participation in physical activity on its perceptions among tertiary institution students
(Africa Association for Health, Physical Education, Recreation,Sport and Dance/LAM Publications Limited, 2006) Tumusiime, David; Frantz, Jose M.
Physical inactivity is one of the leading causes of the major non-communicable diseases, which contribute substantially to the global burden of diseases, death and disability. The burden of mortality, morbidity and disability attributable to non-communicable diseases is currently greatest and is continually growing in the developing countries. Most declines in physical activity (PA) occur during the transition period when a person goes from high school to College or University. The objectives of this study were to identify perceived benefits of and barriers to PA and determine whether previous participation in PA does have an influence on these perceptions. A cross- sectional and descriptive study with quantitative design was conducted. Five hundred (500) tertiary institution students were randomly sampled from purposively selected departments and classes at each of the five government educational tertiary institutions in Rwanda. A pre-coded self-administered questionnaire with a small number of open-ended questions was administered to the students. A response rate of 425 (85%) was obtained. Descriptive and inferential statistics were used to analyse the data, by means of SAS version 8 software. Frequencies and percentages for mean score values with standard deviations for each perception variable were descriptively obtained. False Discovery Rate (FDR) at 5% for multiple test adjustment and Spearman’s correlation (r) tests were used to identify the significant influence of previous participation on perceptions. More than 70% students were not participating in PA at tertiary level. Psychological benefits of PA were some of the most important perceived benefits cited by the students. Most of the important barriers cited concerned equipment and time constraints to exercising. Associations were found between previous participation and the current perceptions of PA. The findings of this study demonstrate that previous participation can influence perceptions of PA among the students. Physical activity promotion programmes should consider the role of these factors which should be emphasised from childhood.
Barriers to utilisation of physiotherapy services among the elderly in the Livingstone district, Zambia
(University of the Western Cape, 2006) Malambo, Pasmore; Marais, Margaret R.
AIM: The purpose of this study was to identify the barriers to utilisation of physiotherapy services among elderly people in Zambia. METHODS: By means of a convenience sampling technique, 200 elderly people, both males and females aged 60 years and above, were recruited from the Livingstone District in Zambia. A structured questionnaire, developed from literature, was used for collecting data. The Excel software programme and Statistical Package for Social Science (SPSS) were used for the capturing and analyses of the data, using descriptive and inferential statistical analyses. RESULTS: The factors that influenced the utilization of physiotherapy services by the participants were: non-referral to the service, long distances, transport, unavailability of the service in the communities and lack of awareness of physiotherapy. Income was significantly associated (p<0.05) with their inability to go for physiotherapy services. DISCUSSION: The results of this study show that physiotherapy services are not meeting the needs of the elderly in the Livingstone District in Zambia there is a need for the physiotherapy profession to raise awareness of their role in the elderly and become promoters of healthy and active aging by providing services at primary health care level through outreach programmes. CONCLUSION: Well-coordinated health services that integrate social, economical and physical services for the elderly in the district are recommended in order to achieve active and healthy ageing.
Sexual risk behaviour among female school adolescents in a local community in the Western Cape, South Africa
(LAM Publications Limited, 2006) Phillips, Julie; Malcolm, C.
Youth in Sub-Saharan Africa are faced with a changeover from adolescence to adulthood shadowed by the growing HIV/AIDS epidemic sweeping through the African continent. With this growing HIV/AIDS epidemic in South Africa it is important to understand the behaviours that place youth at risk of HIV/AIDS, other STDs and unwanted pregnancies in order to develop and to implement appropriate health-promoting interventions. The prevalence of self-reported sexual risk behaviours of high school girls was investigated at three high schools in the Strand, Western Cape. Data was collected using a self-administered questionnaire adapted from the Youth Risk Behavior Surveillance System. Statistical methods of data analysis included cross-tabulations using the Chi-square test for association between sexual risk behaviours and socio-demographic variables. The study sample consisted of 801 female high school learners aged 13-19 years (X=15.75 years, SD = 1.57). Twenty-seven percent of the learners reported being sexually active with 3.6% reporting sexual intercourse onset before 14 years of age. Forty-five percent reported having had more than one sexual partner and 50% of the sample reported no condom use. More than 5% of the learners had already been pregnant. Most learners (78.9%) indicated that they had been informed about HIV/AIDS at school, and 82.5% indicated that they are aware of the consequences of unprotected sex. Results of the study confirm that many female high school learners are engaging in sexual risk behaviours despite risk knowledge. The results emphasise the need to provide learners with targeted information and skills at an early age.
Perceived constraints to physical activity among students at paramedical institutions in Uganda
(LAM Publications Limited, 2006) Nizeamana, E.; Phillips, Julie
In the developing world, particularly Sub-Saharan Africa, physical inactivity along with tobacco use, poor diet and nutrition are increasingly parts of today’s lifestyle. The aim of this study was to assess the levels of physical activity, and to investigate perceived constraints to physical activity among students in paramedical institutions in Uganda. A self-administered questionnaire adapted from the literature was administered to 400 students. The results indicated that 59% of participants were classified as physically active and 41% as sedentary. Males were significantly more active than females. For male participants, “lack of the right equipment to exercise” and “wanting to do other things in their free time” were perceived as the major constraints to physical activity. For female participants, “lack of motivation” and “tiredness after exercise” were perceived as the major constraints to physical activity. Thus, recommendations to eliminate these specific constraints and increase physical activity of paramedical institution students are offered. The findings of this study demonstrate that there is an influence of socio-demographic characteristics on participation in physical activity and perceived constraints to physical activity. The findings further indicate the need of health promotion intervention aiming at promoting physical activity among paramedical institution students in Uganda.
Experiences of caregivers of stroke patients in Lusaka, Zambia
(University of the Western Cape, 2006) Khondowe, Oswell; Mpofu, Ratie; Rhoda, Anthea
INTRODUCTION: Stroke is a major cause of death and most survivors are left with residual disability and are dependent on others for essential care. OBJECTIVES: The objective of the present study was to determine the experiences of informal caregivers of stroke patients receiving out-patient physiotherapy treatment at the University Teaching hospital in Lusaka, Zambia. METHODS: Both quantitative and qualitative approaches were used to collect data in the present study. PARTICIPANTS: A convenient sample of 70 caregivers was selected for the quantitative part of the study while 10 caregivers were purposively selected for the in-depth qualitative interviews. Setting: Out-patients at the University Teaching Hospital (UTH) in Lusaka, Zambia INTERVENTION: The Caregiver Strain Index was used to collect quantitative data and in-depth interviews provided the qualitative data. RESULTS: The mean age of the participants was 37.6 years. The study sample consisted of more females (70%) than males (30%). Financial constraints, family adjustments and being overwhelmed by their care-giving role were the experiences mostly highlighted by the caregivers in this study CONCLUSION: Caregivers are important role players in the rehabilitation of stroke patients. It is therefore important that rehabilitation professionals are aware of the experiences of these caregivers so that their needs could also be addressed when managing the stroke patient
Rehabilitation of stroke patients treated at a community based rehabilitation centre
(University of the Western Cape, 2006) Rhoda, Anthea; Hendry, Jenny
AIM: The overall aim of the study was to compile a profile of stroke patients receiving out-patient rehabilitation in the community. Included in the profile was the referral and rehabilitation process. METHOD: The study design was descriptive, utilizing a retrospective survey of patient documentation. Patient records were used to collate the data. RESULTS: Records of 168 patients were included in the study. A large percentage (55.9%) of the patients were referred by primary level sources. Thirty three percent of the patients were assessed within their first two weeks post-stroke. Sixty nine percent of the patients received rehabilitation for less than 3 months with an average of one treatment session per week. Results indicate an improvement in functional status of the patients when comparing admission and discharge scores (p=< 0.0005). CONCLUSION: Out-patient community based rehabilitation could have a positive effect on the functional status of stroke patients.
Stress and smoking among university students at the University of the Western Cape
(University of the Western Cape, 2006) Frantz, Jose M.
INTRODUCTION: Stress is one of the most commonly reported reasons for smoking and generally smokers are perceived to experience more stress than non-smokers. Reducing stress may thus be an important part of smoking cessation. OBJECTIVES: The aim of the current study was to determine the prevalence of smoking and stress among university students attending the University of the Western Cape. METHODS: A cross-sectional descriptive survey study design was used to describe and identify smoking habits of university students as well as their stress levels. The data was captured on Excel and SPSS was used to analyse the data. PARTICIPANTS: Nine hundred and twelve university students. Setting: Students enrolled at six faculties at the University of the Western Cape. Intervention: Self-answered questionnaire RESULTS: Slightly more than half (53%) of the students had smoked previously but only, 61% of these reported having smoked in the last month (current smokers). Females reported to experience more stress than males (stress score 21.6 vs 16.6). The main reasons for smoking included helping to relax, just enjoying smoking , coping with stress and smoking because friends smoke. CONCLUSION: Students need to know that increased stress levels are associated with smoking. Groups at higher risk are: those being older than 30 years; female; of the coloured ethnic group; in the fourth year of study and studying in the law faculty .
Concerns about physical inactivity among adolescents in the Strand, South Africa
(University of the Western Cape, 2006) Phillips, Julie
INTRODUCTION: Strong evidence exist to support the assumption that regular physical activity is one of the most cost effective interventions for the prevention and management of chronic diseases of lifestyle, and should therefore be widely promoted. However, concerns about physical inactivity among adolescents have been raised in various countries. The levels of habitual physical activity among urbanized South Africans seems no better than what obtains in similarly urbanized populations in other countries. Objective: The aim of the study was to highlight the type of recreational physical activities, as well as the frequency and duration in which learners from the four high schools (n=1042) in the Strand, Western Cape participated in. Objective: The aim of the study was to highlight the type of recreational physical activities, as well as the frequency and duration in which learners from the four high schools (n=1042) in the Strand, Western Cape participated in. METHODOLOGY: The instrument utilized was a self-administered questionnaire adapted from the one developed by the South Australian Branch of Sports Medicine to determine recreational activities in school children. RESULTS: A high proportion of learners were found to be involved in different recreational physical activities, which included rugby, soccer, netball and walking. However, learners were not participating at a level at which the health benefits of participation could be maximized. DISCUSSION: The outcome of the current study suggests that it is unlikely that the learners maximized the health benefits of participation in physical activities. They may thus be prone to the possibilities of developing chronic diseases of lifestyle. CONCLUSION: High school learners should routinely be informed about the importance of incorporating physical activity into their lives.
Physical inactivity as one of the chronic disease risk factors among high school learners in public schools in a local community in South Africa
(Stellenbosch University, 2006) Frantz, Jose M.
This study aimed to determine the physical activity levels and existence of risk factors associated with chronic diseases of lifestyle among high school learners. A crosssectional research design was used to obtain information about physical activity levels from 951 learners from two high schools in a local community in the Western Province of South Africa. Physical activity levels were obtained using the KUOPIO Ischaemic Heart Disease 24-hour physical activity record over a seven-day period. Anthropometrical and blood pressure measurements as well as behaviours including cigarette smoking and alcohol use were recorded as risk factors for chronic diseases of lifestyle. Statistical analyses were performed using the Statistical Package for Social Science (2000). Risk factors were identified as obesity, physical inactivity, smoking and hypertension. Variance of analysis (ANOVA) was used to statistically determine differences in groups. The results indicated that 32% of the learners were classified as being physically inactive and that 21% engaged in health risk behaviours. In addition, 35% of the learners had more than one risk factor for chronic diseases of lifestyle present. Since cardiovascular risk factors have been shown to persist into adulthood, health professionals should assume some responsibility for the prevention, detection, and intervention relevant to cardiovascular risk factors in adolescents.
Medical coverage at soccer sessions
(University of the Western Cape, 2007) Twizere, J.; Frantz, Jose M.
INTRODUCTION: Soccer in Rwanda exposes soccer players to the risk of injury warranting a need for medical coverage at both training and competitive sessions. This study aims to identify the prevalence, period of injury occurrence, and severity of common soccer injuries among the 1st and 2nd division soccer teams in Rwanda. METHODS: A cross-sectional retrospective quantitative study design was used. Simple random sampling, clustered within teams, was used to get a sample of this study. During sample selection, the random order was determined using the random number generator in Microsoft Excel. Data for soccer players was gathered, using a close-ended questionnaire. The data from soccer players were captured and analyzed with the Microsoft Excel package. RESULTS: The study revealed 68.1 % injury prevalence with a significantly high rate of injuries occurring during training (p< 0.005). Most of the training injuries were moderate followed by major, minor and severe injuries while most injuries during competition were major-moderate, followed by severe-minor. CONCLUSION: The prevalence, period of injury occurrence and severity of injuries in Rwanda indeed warrants medical coverage as a first preventive strategy.
Effects of strength-training trials for children and adolescents with spastic cerebral palsy: a systematic review
(University of the Western Cape, 2007) Matheri, Joseph Mwangi; Frantz, Jose M.
OBJECTIVE: To evaluate the effects of strength-training on lower limb muscles and motor activity among children and adolescents with spastic Cerebral Palsy. METHODS: A comprehensive search of full text published studies in English was performed. Electronic databases were searched with no limit for year of publication. Terms used included: exercise, children, youth, disability, treatment, strength training, spastic cerebral palsy, muscle strength, training program, therapeutic exercise, gait training, and physical function. Reference lists of retrieved articles were also examined to identify additional studies. To be included, studies had to be: randomised controlled trials evaluating strength training outcomes on children and adolescents with spastic CP. Those with intellectual disability were excluded. Evaluation for quality: Trials were rated for methodological quality using the PEDro scale independently by the 2 researchers. RESULTS: Of 4 selected trials, 1 an abstract was excluded, 3 full articles were included. Trials methodological quality ranged from 6 to 8 on PEDro scale. Two studies reported significant muscle strength changes following strength training, with effect sizes ranging from d equal to 1.17 to 1.78 and another reported improved gait and perceived body image. CONCLUSION: Trials demonstrate that strength-training improves strength of targeted muscle and motor functioning. More rigorous trials on larger samples should evaluate the impact of specificity in strength-training and cost-effectiveness of programs.
HIV/AIDS education in South Africa: knowledge, attitudes and beliefs of high school learners in Paarl and Wellington
(University of the Western Cape, 2007) Pharaoh, Hamilton; Frantz, Jose M.; Rhoda, Anthea
INTRODUCTION: In South Africa about 1500 people become HIV infected every day. More than half of these new infections occur in young people. HIV/AIDS programmes have been implemented to combat the disease, but yet the incidences are still on the increase. AIM: The aim of this study was to determine the knowledge, attitudes and beliefs of high school learners about HIV/AIDS in the Paarl and Wellington area. Methodology: This study made use of a quantitative study design, by means of a self-administered questionnaire in order to reflect the knowledge, attitudes and beliefs of high school learners in the Paarl and Wellington areas regarding HIV/AIDS. Convenient sampling was used to obtain a large enough sample size to represent the learner population represented by the high schools in Paarl and Wellington. Data analysis was done using the SPSS version 10.0 to obtain frequencies, means and percentages. Cross-tabulations were done to determine relationships between variables. RESULTS: This study confirms that the learners have basic knowledge regarding HIV/AIDS. The learners make use of this knowledge during some stages of their decision-making but a lack of more in-depth knowledge in certain areas may put them at risk of becoming HIV infected. They might not perceive themselves to be at risk. Their beliefs and attitudes in some instances did afford them the opportunity to make certain safer choices regarding their sexual health. CONCLUSION: It is evident that the HIV/AIDS education programmes is making an impact to improve the knowledge of the learners. Further research is however needed to find even more effectives means to provide learners and the rest of the population with more in-depth knowledge regarding HIV/AIDS
Challenges facing physiotherapy education in Africa
(Nova Southeastern University, 2007) Frantz, Jose M.
Health care is changing and the demands put on health professionals are increasing. Physiotherapy education should reflect the health and social priorities of the nation. The World Confederation of Physical Therapy (WCPT) is committed to assisting physiotherapy associations in developing educational standards. Physiotherapy education in Africa however, seems to have a real need for assistance from the WCPT. The aim of this paper is to highlight the challenges facing physiotherapy education in Africa. The Delphi methodology was used to obtain information from key informants involved in the area of physiotherapy education from a variety of African countries. The majority of the participants were people who have experienced physiotherapy education in Africa either as graduates or current teachers. Data were analyzed into themes and sent back to respondents for confirmation. The most important challenges highlighted were: lack of undergraduate training opportunities, limited number of therapists, upgrading of physiotherapy educators, research as a major component of physiotherapy education, and recognition of physiotherapy as an essential service. It is concluded that assistance is needed for physiotherapists from Africa to take their rightful place in the health team and higher education institutions should look at improving diploma qualifications of physiotherapists in African countries.
Health-promotion needs of youth with a spinal cord injury in South Africa
(Informa Healthcare, 2007) Njoki, Emma; Frantz, Jose M.; Mpofu, Ratie
Purpose. To determine the health promotion needs through an exploration of health-related behaviours and the factors that influence the behaviour of physically disabled youth with spinal cord injury. Methods. A descriptive and exploratory study that utilized a qualitative approach was carried out among ten participants aged between 15 and 29 years who were purposely selected. Information was obtained from individual face-to-face interviews and a focus-group discussion. Results. The participants were involved in risky health behaviours including sedentary lifestyles, use of alcohol, tobacco, and drugs. Various factors that influenced their participation in these behaviours were identified including personal struggles with identity and adjustment issues. Conclusions. The results emphasize that participants were involved in health-risk behaviours, which are associated with development of secondary conditions such as respiratory problems, heart diseases, and stroke. Health-promotion strategies employed for these individuals should address the psychological impact of spinal cord injury (SCI) on the individual as an influence to participation in health risk behaviours.
A systematic review on effects of physical activity Interventions on early motor development in children with Down syndrome
(University of the Western Cape, 2007) Khondowe, Oswell; Simons, Johan; Nikodem, Cheryl
PURPOSE: The main aim of this review was to evaluate the effect of physical activity on motor development in children with Down Syndrome by means of a systematic review. METHODS: An extensive literature search of published studies in English from 1980 to May 2006 was performed. Of the fifty-eight studies identified only four met the inclusion criteria. This review included studies that investigated the effects of physical activity on motor development in children with Down Syndrome and evaluated the outcomes in terms of the level of activity. RESULTS: One study showed a significant decrease in length of time to independent walking in the intervention group (C l -101(-180.48 - -21.52]. Two studies (N=84) reported a significant improvement in the total developmental quotient following intensive physical activity (wmd and Cl 95% -13.07 [-17. 66, -8.48]. Three studies showed an increased in locomotor developmental skills following physical activity intervention. CONCLUSION: The results of this review support the use of programmes that are designed to improve motor development in children with Down Syndrome. We recommend that physical activity programmes need to be intensive and parents should be incorporated to strengthen the outcomes.
Towards interdisciplinary practice: A shared community-based practice experience
(University of the Western Cape, 2007) Filies, Gerard C.; Mlenzana, Nondwe; Khondowe, Oswell
INTRODUCTION: Service-learning is an educational approach that allows for a structured learning experience for students, combining community service with preparation and reflection. Through service learning, students not only provide community service but also learn about the context in which the service is provided. METHODS: Shared Community-Based Practice (SCBP) is a pioneering service-learning initiative of the University of the Western Cape (UWC) for all health and welfare disciplines located within a community setting. It is unique in the sense that it affords students from discipline-specific domains, an opportunity to practice interdisciplinary in a structured and coordinated manner. SCBP was designed to meet discipline-specific, multidisciplinary and personal goals through the development and implementation of an intervention care plan. Four centres in Nyanga and Mitchelll's Plain were targeted for placement of students in the Community and Health Sciences Faculty at UWC. Focus group discussions were held with the centres personnel and the needs of the centres were identified. Interventions were designed based on these needs. RESULTS: The main themes identified included the need for training, awareness and lack of resources. Implementation of the projects had its challenges but students were able to overcome them. CONCLUSION: Shared community based practice is an initiative that can be used effectively in communities in an interdisciplinary manner.

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