Department of Physiotherapy

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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.
Activity limitations and factors influencing functional outcome of patients with stroke following rehabilitation at a specialised facility in the Western Cape
(African Health Sciences, 2013) Joseph, Conran; Rhoda, Anthea
BACKGROUND: Determining the functional abilities and factors influencing outcome of patients with stroke following rehabilitation are essential for the planning of future interventions and services in order to optimise recovery. OBJECTIVES: To determine the activity limitations and factors influencing functional outcome of patients with stroke managed at a specialised rehabilitation centre. METHODOLOGY: A longitudinal study design was used to determine the functional outcomes of patients admitted to the centre on admission and discharge. A data gathering sheet was developed to collect information pertaining to the demographicand medical profile and process of rehabilitation, whereas the Barthel Index was used to collect data relating to functional abilities. For analysis, descriptive statistics as well as inferential statistics (Student t test) were utilised to determine the paired differences. Six prognostic factors influencing functional outcome were selected and tested using linear (bivariate) regression. RESULTS: The mean Barthel Index scores on admission and at discharge were 58.85 and 81.59 respectively. A significant improvement was noted in the execution of functional task of patients with stroke (p< 0.01) between the data collection points. Despite the significant overall improvement, results show a high prevalence of dependence with walking and stair climbing at discharge. Only functional ability on admission (r=0.49) predicted a favourable functional outcome at discharge. CONCLUSION: This study highlights the limitations of younger stroke survivors and the need for continued rehabilitation following in-patient care. It further underscores the administration of a functional rating scale on admission in order to aggressively manage activity limitations.
Activity limitations and participation restrictions four years after traumatic spinal cord injury in Cape Town, South Africa
(University of the Western Cape, 2018) van Wyk, Vania; Joseph, Conran; Mlenzana, Nondwe
The distressing event of Spinal Cord Injury (SCI) leads to complete or incomplete injury, and results in many complications such as such as neurogenic shock, cardiovascular disease, temperature regulatory problems, respiratory complications, dysphagia, thromboembolism, and pressure ulcers amongst others. These complications limit the individual’s functioning and participation. Participation is fruitful and meaningful when you are actively involved in a specific activity. To understand the lack of participation within a specific setting, it is important to know what the limitations in activities are, and what causes these limitations. The goal of rehabilitation should be to reintegrate patients back into the community so that they can fulfil their roles. Aim: The aim of the study was (1) To determine included participants’ socio-demographic and injury characteristics; (2) To describe healthcare services received by people living with long-term Traumatic Spinal Cord Injury (TCSI) over the past 12 months; (3) To determine the point prevalence of common activity limitations of survivors of TSCI four years after injury; (4) To determine the point prevalence of participation restrictions of survivors of TSCI four years after injury; and (5) To determine factors associated with activity limitations and selected participation restrictions four years after injury.
Actual and perceived substance use of health science students at a university in the Western Cape, South Africa
(Makerere Medical School, Uganda, 2011) Steyl, Tania; Phillips, Julie
Background: Substance use among youth is a worldwide epidemic that impacts negatively on the health sector as well as the family and society. Early student life is a time of tremendously high motivation to conform to the behaviours, values, and attitudes that are valued by the youth culture. They observe their peers’ behavior and alter their own behaviour with their peers’ norms and expectations. This compliance with perceived peer norms can however lead to increased smoking, alcohol and drug use. Objectives: To determine and analyze risky and health promoting behaviour of health science students at a university in the Western Cape, South Africa. In this paper the association between actual risk and perceived risk for substance is discussed. Methods: A self-administered questionnaire containing items from both the NCHRBS and the ACHA-NCHA were administered to 201 health science students at a South African university. Results: When perceptions of typical student behaviour were compared to actual reported behaviour, overestimated consumption patterns for the typical student was found for smoking, alcohol and drug use. Conclusion: The misperceptions of peer norms have important educational or prevention program implications. These findings clearly indicate that educational and awareness programs regarding alcohol and drug use should take perceptions of peer alcohol and drug use into consideration.
The adaptation and contextualization of the bridges stroke self-management intervention for patients living with stroke in the Western Cape, South Africa
(University of the Western Cape, 2018) Groenewald, Ryan Clive; Rhoda, Anthea
Background: Many patients with stroke feel ill-prepared for discharge from stroke rehabilitation, despite having undergone extensive periods of therapy. From the available research, there is clear evidence that disease specific self-management interventions (SMI) are effective at changing targeted behavioural outcomes, and ultimately improve patient participation restrictions, using self-efficacy principles. A stroke SMI, originally developed by the Bridges Organization to address participation restriction in patients living with stroke in the United Kingdom (UK); was successfully adapted and contextualized for the New Zealand stroke population. A similar stroke SMI could have equal positive benefits for the South African stroke population but would need to be contextually relevant. Aim: This study aims to adapt and contextualize the original UK Bridges stroke SMI workbook for implementation with the South African stroke population. Method: The qualitative, exploratory study is conducted in five phases. Thirteen healthcare professionals (Phase 1) and 12 patients with stroke (Phase 2) are engaged with by the researcher using focus group discussions to understand their views on the implementation of self-management intervention in the local context; and one-on-one interviews with local South African patients living with stroke are conducted to explore their experiences (Phase 3) and build contextually relevant local vignettes. The adaptation and contextualization process of the Bridges stroke SMI workbook to the South African context occurs using the participant feedback and built vignettes from Phases 1 to 3. Consensus on the adaptation of the workbook is then reached through the use of an expert panel for peer-review (Phase 4), and a final focus group discussion with local healthcare professionals in the field of stroke rehabilitation (Phase 5) to produce the final South African Bridges stroke SMI workbook. Phase 1 and 5 participants were conveniently selected; while purposive sampling was applied for Phases 2 and 3. Throughout the various study phases, a thematic analysis procedure is employed by the researcher to analyse and interpret the themes identified through the qualitative data collected. A deductive approach was employed by the researcher for the focus group discussion data of Phase 1, 2, and 5; and an inductive approach to the data from the interviews in Phase 3. The trustworthiness criteria of credibility, transferability, dependability, and confirmability were applied.
Adapting the learning environment of a first year interprofessional module towards collaborative-ready graduates
(Nurse Education Today, 2022) Filies, G.C.; Kock-Africa, L.
Background: There has been a global call for a more collaborative workforce to combat the complex healthcare challenges experienced in societies. As a result, health professions education has amended their curricula to include interprofessional education as a strategy to allow students to learn from, with and about each other across disciplines during their training. It is imperative to review the learning environment of these interprofessional modules. To determine the learning environment for the acquisition of the interprofessional core competencies, there needs to be an understanding of the changes to the module, and the impact it has on student performance over a selected period. Objective: This study aimed to determine how have the changes to the material dimension of the learning environment for first-year students in an IPE curriculum promoted student learning. Methods: A document analysis research design was used to extract data over a two-year period. An adaptation of the Context, Input, Process, Product and Outcomes evaluation model was to determine how changes to the learning environment of students registered for a first year interprofessional module, promoted learning. Results: The findings reveal that curriculum changes made to the location and setting can yield improvements in the development and enhancement of the selected interprofessional education core competencies. Conclusion: This study concludes that in alignment with the learning styles of the 21st century student, curriculum development should include an enhanced form of deeper learning in the light of the fourth industrial revolution.
Alcohol use among black female adolescents in a South African community: A mixed methods investigation
(Faculty of Community and Health Sciences, University of the Western Cape, 2008) Phillips, Julie
Background: According to the World Health Organization global alcohol consumption has increased in recent decades, with most of this increase occurring in developing countries. Added to this is the concern of the increased social acceptability of alcohol use and the widespread experimentation with alcohol during adolescence. Objectives: The purpose of this study was to better understand health risk behaviours, specifically alcohol use, among black female high school learners in a designated research locale of a local community in the Western Cape, South Africa. Study design: The method of inquiry in this study was a mixed methods sequential explanatory strategy. Results: A lifetime prevalence of alcohol use was reported by 57.8% of the study sample. All the participants agreed that drinking has a negative influence on adolescent health. Conclusion: Alcohol use in South Africa is an ever-increasing health problem and the current study provides evidence that the prevalence of this behaviour remains a public health concern.
An analysis of health promoting and risky behaviours of health science students of the University of the Western Cape
(University of the Western Cape, 2007) Steyl, Tania; Phillips, J.S.; Dept. of Physiotherapy; Faculty of Community and Health Sciences
Assessing and understanding the health needs and abilities of university and college students is vital in creating healthy campus communities. Student learning is a central part of the higher education academic mission, and health promotion serves this mission by supporting students and creating healthy learning environments. Findings from various studies suggest that students entering the university setting put themselves at risk through unhealthy behaviours. Health science students are the future health professionals who will teach health promotion and disease prevention. The aim of this study was to determine and analyse health risk behaviours and health promoting behaviours among health science students at the University of the Western Cape. The study further aimed to identify the factors influencing these students' engagement in these risk behaviours.
Another piece to the epidemiological puzzle of traumatic spinal cord injury in Cape Town, South Africa: A population-based study2018
(Health and Medical Publishing Group, 2018) Phillips, J; Braaf, J; Joseph, C
The epidemiology of traumatic spinal cord injury (TSCI) is poorly understood in developing countries. In South Africa (SA) specifically, two healthcare systems (private v. government funded) exist, and it is therefore important to assess patient characteristics in order to plan appropriately.To determine epidemiological characteristics of TSCI in the private healthcare system in Cape Town, SA, and compare findings with previously published data from the government sector.
Assessment and treatment choices of physiotherapists treating non-specific low back pain in Rwanda
(University of the Western Cape, 2005) Twagirayezu, Jacques; Gurie, P Mrs; Dept. of Physiotherapy; Faculty of Community and Health Sciences
The aim of this study was to determine assessment and treatment choices of physiotherapists treating non-specific low back pain in Rwanda. The main objectives were to identify the common types of low back pain treated by physiotherapists, to determine the
Assessment of risk factors for Non-Communicable diseases among a cohort of community health workers in Western Cape, South Africa
(The College of Medicine and the Medical Association of Malawi, 2021-09) Johnson, Levona; Schopp, Laura; Waggie, Firdouza; Frantz, J.M
Community Health Workers (CHWs) have been identified as the key health professionals to drive the agenda of the prevention of health risk behaviours, linked to noncommunicable diseases (NCDs) in South Africa. They are regarded as the agents of change, who will provide impetus to the achievement of the health behaviour goals, set out by the South African National Department of Health1 . However, this cohort, may suffer from an array of NCDs. There are various risk factors that influence the health of individuals and contribute to NCDs, including modifiable and non-modifiable risk factors, which cannot be changed, or altered by an intervention, such as age, family history, gender and ethnicity2,3. Modifiable risk factors have been classified as behavioural, physical, and biological4 . Globally, NCDs are responsible for 80% of premature deaths in LMICs5,6. In response to the NCD pandemic, the World Health Organisation (WHO) set a global target in 2012, which was aimed at reducing premature deaths, caused by NCDs, by 25%, by the year 20257 . However, this goal will require drastic, immediate, and targeted approaches that address the root causes of NCDs. South Africa has followed the global trend, and evidence depicts an increase in NCDs8 , with a 27% probability of dying between the ages of 30 and 70 years, as a result of cardiovascular diseases (CVDs), diabetes, cancers, or chronic respiratory conditions7,9. This is similar to other countries such as India (26%), Philippines (28%), Democratic People’s Republic of Korea (27%), Mali (26%), Russian Federation (30%), Ukraine (28%) , Tajikistan (29%), Fiji (31%), Afghanistan (31%) and Armenia (31%)9 In the Western Cape, the prevalence of chronic diseases of lifestyle raises major concerns about the communities’ health risk behaviour. The Burden of Disease Survey for the Western Cape, which was released on 24 April 2017, reported that NCDs contributed to 61% of deaths in the Western Province10
Attitudes of health science students towards people with disabilities at Kilimanjaro Christian Medical Centre (KCMC) in Tanzania
(2010) Sheriff, Insiyya Djamil; Rhoda, Anthea
The effects of disability on the individual not only include physical, psychological and emotional adjustments but also negative attitudes of able bodied people towards persons with disabilities. The attitudes of healthcare professionals towards persons with disabilities could affect rehabilitation outcomes as well as the reintegration of these people into society. The aim of the study was to investigate the attitudes of health science students towards persons with disabilities at Kilimanjaro Christian Medical Centre (KCMC), in Tanzania. An explorative quantitative research design using a cross-sectional survey was used. The study sample (182) included all Physiotherapy, Occupational Therapy, Nursing, Medical and Optometry students. Data was collected using the Attitudes Towards Disabled Persons Scale,consisting of 20 items rated on a six-point Likert Type Scale. A demographic questionnaire which included questions relating to the contact of the students with persons with disabilities was also administered. Descriptive and Inferential statistical analysis was conducted using the Statistical Package for the Social Sciences version 15.0. Permission to conduct the study was obtained from the Higher Degrees Committee and the Senate Research Grant and Study Leave Committee of the University of the Western Cape. Further permission was requested from Ministry of Education, Research and Ethics Department in Tanzania and the authorities of the respective Health Sciences programmes to include students in the study. Information obtained was handled with confidentiality and anonymity, and the students had the right to withdraw from the study at anytime.The results revealed that the sample consisted of more females (58%) than males (41.2%).The majority of the participants were between the ages of 20-29 years. The highest response rate was from the medical students (29.1%) followed by the physiotherapy students (27.5%).The Optometry and physiotherapy students had more positive attitudes than the rest of the health science students who participated. The mean score on the ATDP scale was 59.01 (12.3) with scores ranging from 18 to 90. The results therefore revealed that overall the students had a neutral to negative attitude towards persons with disabilities. With regards to the contact of the students with persons with disabilities 26.9% of the participants responded that they had had a long talk with a person with a disability while only 17.6% of the students responded that persons with disabilities visited their homes. The mean contact score was 22.72 indicating that the students had a slightly above average contact with persons with disabilities. No association was found between the attitude and contact mean scores.Information obtained in this study could be used to influence the curriculum of Health Science Students at Kilimanjaro Christian Medical Centre.
The attitudes of physiotherapists in Gaborone and Ramotswa, Botswana, towards treating people living with HIV/AIDS
(University of the Western Cape, 2007) Kambole, Mercy Mulenga; Struthers, Patricia; Dept. of Physiotherapy; Faculty of Community and Health Sciences
Physiotherapists are increasingly treating peole living with HIV/AIDS. However, there is little information which has been reported on their attitudes in providing treatment to people with HIV/AIDS or what facilitates positive attitudes. The aim of this study was to determine attitudes of physiotherapists towards treating people living with HIV/AIDS in Botswana.
Awareness of physiotherapy interventions among pregnant females in antenatal clinics, Buffalo city municipality, Eastern Cape, South Africa
(2013) Sajan, Merly; Phillips, Julie
Aim: The aim of the study was to to explore women’s awareness and use of antenatal services at Cecilia Makiwane Hospital. Objectives: The specific objectives were to determine the awareness of physiotherapy interventions among pregnant women attending antenatal clinic as well as the health professional’s knowledge about physiotherapy in the antenatal clinic.
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.
Barriers and facilitators regarding patient adherence towards physiotherapy rehabilitation programs in the management of osteoarthritis in Nairobi, Kenya.
(University of Western Cape, 2020) Wanunda, Wendy Ashley; Mlenzana, Nondwe; Tawa, Nassib
Reduced adherence levels have been demonstrated by some patients affected with Osteoarthritis. Therefore, this study aimed at exploring the barriers and facilitators regarding patient adherence towards physiotherapy rehabilitation programs in the management of osteoarthritis in Nairobi, Kenya. The objectives of the study were to determine the clinical profile of patients with osteoarthritis on physiotherapy rehabilitation programs, to explore the patient-reported barriers and facilitators towards physiotherapy rehabilitation programs and exploring physiotherapists’ perceptions of patient adherence towards physiotherapy rehabilitation programs. The study setting was at the Kenyatta National Hospital physiotherapy clinic in Nairobi, Kenya.
Barriers and facilitators therapists experience regarding their support provision in an inclusive education system
(2009) Kotze, Josephine Dianne; Struthers, P.
In South Africa, the Education White Paper 6 on Special Needs Education (2001) Building an inclusive education and training system stated that the special schools would be resource centres for ordinary schools that admit learners with disabilities. Occupational therapists,physiotherapists, speech and language therapists (collectively called therapists) had previously been employed in special schools, but under the new structure, would form part of the district-based support teams to provide their support to ordinary and full service schools.Therapists working in an inclusive education system would need to change the focus of their model of support from a medical model of direct support to a health-promoting model of indirect support. The aim of the current study was to determine whether therapists are changing their model of support in building inclusive and health-promoting schools and also to determine the barriers and facilitators they experience in providing their support in an inclusive education system. This study used both qualitative and quantitative methodology.The quantitative component was a non-experimental, descriptive, cross-sectional design,using one questionnaire in a survey. The questionnaire was used to determine the type of support provided to schools. In total, 97 therapists, who worked at special schools in the Western Cape, participated in the study by completing the questionnaire. The test-retest results of the questionnaire indicated that most of questions (63%) showed perfect agreement (Kappa 0.81-1.0). Quantitative data analysis was done by descriptive statistics, using SPSS.The results indicated that therapists were using the medical model of support combined with a more holistic approach using the principles of the health-promoting framework. The qualitative component involved three group interviews, which were held at three different special schools, in three different education districts, with a total of 12 therapists. The group interviews were used to determine the barriers and facilitators that either prevent or promote provision of support. Qualitative data analysis was done by using content analysis with codes and themes to determine barriers and facilitators. The barriers included the following: therapists’ uncertainty about roles; lack of networking, lack of certain competencies and training; delayed response from district; lack of policy;autocratic leadership styles; exclusion from the district-based support team; concern to support learners at special school; therapists being based at the special school; lack of human resources; insufficient time; cost of therapists’ training; education department circuit boundaries affecting communication;negative attitudes of principals and educators; and parents’ non-involvement. The facilitators included therapists’ competencies to fulfil roles; educators’ positive attitude; meetings; training to improve therapists’ skills; the co-ordinating role of the district-based support team;and the supportive role of learner support educator and the principal. This study provides evidence concerning therapists’ roles and the barriers and facilitators which therapists experience regarding their support provision in an inclusive education system.
Barriers and facilitators to utilisation of rehabilitation services amongst persons with lower-limb amputations in a rural community in Kwa-Zulu Natal
(University of the Western Cape, 2017) Naidoo, Ugendrie; Ennion, L.; Rhoda, Anthea
An estimated 387 million people worldwide already have diabetes mellitus (DM), with those numbers rising to an estimated 592 million people by the year 2035. The prevalence of diabetes mellitus continues to increase with the largest increase seen in low- and middleincome countries, such as South Africa (Shaw, Sicree,& Zimmet, 2010; Peer et al., 2012; International Diabetes Federation, 2014; Bertram et al., 2013; Mayosi et al., 2009). Lowerlimb amputation is a common complication of uncontrolled diabetes mellitus (Moxey et al., 2011) and there is a marked increase in the incidence of diabetes mellitus in rural areas in South Africa. The impact that the amputation has on the individual's life can be devastating since the amputation of the limb is likely to be accompanied by a profound sense of loss. Rehabilitation can assist to retrain physical and functional abilities, psychological and emotional adjustment issues, as well as social and community reintegration (Manderson & Warren, 2010). Therefore, comprehensive rehabilitation is vital to mitigate the negative impact that a lower-limb amputation has on a person. Persons with disabilities who live in rural areas experience challenges accessing health services and rehabilitation (Harris et al., 2011). Even though challenges with accessing healthcare in rural settings are well documented, there is no literature specifically pertaining to persons with lower-limb amputations in a rural South African context.
Barriers and facilitators to utilisation of rehabilitation services amongst persons with lower-limb amputations in a rural community in South Africa
(SAGE Publications, 2018) Naidoo, Ugendrie; Ennion, Liezel
BACKGROUND: Persons with disabilities who reside in rural areas experience challenges accessing and utilising health services and rehabilitation. Due to the high prevalence of diabetes mellitus in rural regions, the risk of having a lower-limb amputation is increasing. Comprehensive rehabilitation is vital to mitigate the negative impact that a lower-limb amputation has on a person. OBJECTIVE: To explore the barriers and facilitators to accessing rehabilitation experienced by persons with lower-limb amputations in a rural setting. STUDY DESIGN: A qualitative descriptive approach was used to collect and analyse data. Methods: Data were collected from 11 conveniently sampled participants from three sub-district hospitals in the rural iLembe district, Kwa-Zulu Natal, South Africa. Data were collected using semi-structured interviews to explore the barriers and facilitators perceived by persons with lower-limb amputations in a rural region. RESULTS: The three main barriers identified in this study were environmental factors, financial constraints and impairments. These barriers negatively impacted the participant’s utilisation of rehabilitation. The two main facilitators identified were environmental facilitators and personal factors which aided participant’s utilisation of rehabilitation. CONCLUSION: Access to rehabilitation was mainly hindered by the challenges utilising transport to the hospital, while self-motivation to improve was the strongest facilitator to utilising rehabilitation.
Barriers experienced by parents/caregivers of children with clubfoot deformity attending specific clinics in Uganda
(University of the Western Cape, 2006) Herman, Kazibwe; Struthers, Patricia; Dept. of Physiotherapy; Faculty of Science
Clubfoot is the most common congenital structural deformity that leads to physical impairments in children in many poor developing countries. Inadequately treated or neglected clubfoot has been found to be a common cause of ohysical disability globally among children and young growing adults. Many children are referred to the clinics for treatment but some parents do not comply with the treatment regimen whcih requires attending for consecutive treatment sessions. The purpose of this study was to investigate barriers to treatment attendance parents/caregivers of children with clubfoot encounter in complying with clubfoot treatment during the plaster csting phase in Uganda.

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