Research Articles (Physiotherapy)

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Stakeholder perspectives on promoting health enhancing sport through the Rwanda sports policy
(Routledge, 2023) Frantz, Jose M.; Mukaruzima, Lela; Duhamahoro, Jimmy
Sport is an adaptable channel for change. It has been widely used to enhance health and wellbeing, foster social cohesion, and engender peace and development in different societies. The government of Rwanda developed a Sports Development Policy (SDP) to advance sports within the spectrum of its development agendas. However, the extent to which health constructs are integrated and implemented within the tenets of this policy remain unexplored, despite their pivotal role in population wellbeing and in contributing to the country’s overarching development goals. This study sought to understand if and how the Rwanda SDP promotes sports for health from the stakeholders’ perspectives. In-depth semi structured interviews were used for thirteen purposively sampled stakeholders of the SDP. Thematic and narrative analysis were used to examine and report the findings. Themes highlighted a progressive awareness of the Sports Policy pertaining to health outcomes, less involvement of stakeholders in sport policy formulation which affected its implementation, disproportionate efforts between sports policies for health, competitive, and mass sports activities. Stakeholders further underscored cultural beliefs, attitudes, and contextual environmental factors as the key constraints to bridge the policy theory and practice of sports. Finally, findings emphasise the integral role stakeholders play in the life course of a policy. Further, the SDP does not primarily promote sports for health, but rather elite sports, on the premise that health benefits are automatically achieved through participation in sports activities. Thus, reinforcements are still needed to clearly define the national physical activity plan either through the SDP or other national physical activity guidelines.
Bayesian jackknife tests with a small number of subsets: application to HERA 21 cm power spectrum upper limits
(Monthly Notices of the Royal Astronomical Society, 2023) Wilensky, M.J; Kennedy, F; Bull, P
We present a Bayesian jackknife test for assessing the probability that a data set contains biased subsets, and, if so, which of the subsets are likely to be biased. The test can be used to assess the presence and likely source of statistical tension between different measurements of the same quantities in an automated manner. Under certain broadly applicable assumptions, the test is analytically tractable. We also provide an open-source code, CHIBORG, that performs both analytic and numerical computations of the test on general Gaussian-distributed data. After exploring the information theoretical aspects of the test and its performance with an array of simulations, we apply it to data from the Hydrogen Epoch of Reionization Array (HERA) to assess whether different sub-seasons of observing can justifiably be combined to produce a deeper 21 cm power spectrum upper limit. We find that, with a handful of exceptions, the HERA data in question are statistically consistent and this decision is justified. We conclude by pointing out the wide applicability of this test, including to CMB experiments and the H0 tension.
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.
Prevalence of secondary health conditions and mental status in persons with long-term spinal cord injury in South Africa: Comparison between public and private healthcare sectors
(South African Medical Journal, 2023) Rhoda, A; Joseph, C; Thurston, C; Nizeyimana, E
Background: Spinal cord injuries typically result in a range of negative health outcomes and health states, which impacts overall functioning, health and well-being. It remains important to establish the prevalence (burden) of health outcomes to help with the development of optimal treatment strategies. Objectives: To determine the prevalence and treatment rates of secondary health conditions (SHCs) and mental health states in persons with long-term spinal cord injury (SCI) receiving public compared with private healthcare services in South Africa. METHODS: A cross-sectional survey included 200 community-dwelling persons with long-term SCI, 60% with paraplegia, 53% with complete injuries and 156 from the public and 44 from private healthcare sectors. The following modules of the International Spinal Cord Injury (InSCI) community survey were used: (i) demographic and injury characteristics; (ii) SHCs and treatment rates; and (iii) vitality and emotional well-being. All statistical analyses were stratified according to healthcare sector
The role of environmental factors on health conditions, general health and quality of life in persons with spinal cord injuries in South Africa
(MDPI, 2023) Bezuidenhout, Lucian; Rhoda, Anthea; Conradsson, David Moulaee
The objective was to describe the individual items of the environmental factors and to investigate the relationship between the environmental factors to health conditions, general health and quality of life in people with SCI in South Africa. Methods: Two hundred persons with SCI participated in a cross-sectional survey design. This study formed part of the International Spinal Cord Injury (InSCI) Community Survey. Four major domains, environmental factors, health conditions, general health and quality of life of the survey questionnaire responses, were used for the analysis. Regression models were used to determine the association between the independent variable, which consisted of the specific environmental factors items, and the dependent variables comprising health conditions, general health and quality of life. Results: The commonly reported environmental barriers were public access, lack of short- and long-distance transport and finances. Environmental factors such as public access (p < 0.001), short- (p < 0.001) and long-distance transport (p = 0.001), and friends’ (p = 0.003) and colleagues’ (p < 0.001) attitudes and communication (p = 0.042) were significantly associated with the presence of secondary health conditions. Finances (p = 0.026), family attitudes (p = 0.037) and communication (p = 0.039) had a significant association with worsened mental health. Services (p = 0.022) and communication (p = 0.042) were also significantly associated with decreased general health.
Characteristics and outcomes of gunshot-acquired spinal cord injury in South Africa
(South African Medical Association, 2017) Joseph, C
Spinal cord injuries (SCIs) caused by assault present a unique challenge facing the healthcare system, in that very little is known about how these injuries manifest compared with other causes of injury. Understanding the nuances of gunshot SCIs could contribute towards better care provision. To determine the characteristics of gunshot SCI and compare both injury characteristics and outcomes between gunshot SCI and all other traumatic causes taken together. The gunshot SCI sub-cohort was derived from a 1-year prospective, population-based study, including both tertiary-level hospitals providing SCI care in the Cape Metropolitan area of South Africa (SA). All consenting 145 survivors, after a window period of 7 days, were included, and their demographic and injury characteristics were captured according to the International SCI Core Basic Data Set. Further, selected secondary medical complications (outcomes) were prospectively and routinely assessed throughout acute care. Both descriptive and inferential statistics were used to describe and compare characteristics and outcomes, respectively.
Towards an interprofessional competency-based model in South Africa: A Delphi study
(PubMed, 2022) Filies, Gérard Charl; Frantz, Jose M.
Background: The overall objective of any health professional curriculum is to ensure that the knowledge, skills and attitudes of the students are influenced by the curriculum and to instil these attributes into the students, to help them become capable, compassionate and inquisitive health professionals. Therefore, there is the need for medical educators to align their learning objectives with the core competencies needed to achieve this. Currently, in interprofessional education, it is not always clear which activities may be used to facilitate the development of interprofessional core competencies. However, if health professional students are exposed to the interprofessional core competencies effectively, it may result in health care professionals who have an improved understanding of interprofessional practices, thus improving these practices within their specific professions. The objective of this study was to identify teaching strategies and activities that aim to develop interprofessional competencies in undergraduate health care students at the University of the Western Cape, South Africa. Methods: In this study the Delphi method was used to reach a consensus on the most appropriate activities and assessment methods to use in an interprofessional curriculum that would assist in instilling interprofessional core competencies in undergraduate health care students. Results: 19 experts out of 69 invited participants took part in this Delphi study. The activities highlighted were case studies, joint clinical placements, simulations, role plays and workshops/discussions. The assessment forms highlighted by participants were portfolios, reflection and rubrics. Conclusion: It was evident from this study that such activities can be used to instil more than one core competency in undergraduate health care students.
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.
Exploration of the experiences of persons in the traumatic spinal cord injury population in relation to chronic pain management
(MDPI, 2023) Williams, Tammy-Lee; Joseph, Conran; Nilsson-Wikmar, Lena
Chronic pain amongst individuals with traumatic and nontraumatic spinal cord injury (SCI) has high prevalence rates, with severe impact on the activities of daily living, mood, sleep and quality of life. This study aimed to explore the experiences and challenges of chronic pain management amongst the traumatic spinal cord injury (TSCI) population in the Western Cape region of South Africa. A qualitative descriptive approach was chosen for the study, in which 13 individuals living with TSCI were purposively recruited and interviewed telephonically. An inductive thematic analytic approach was used. The results indicate ineffectiveness of standard pain management, with a lack of education regarding pain physiology and pain management strategies as well as unbalanced decision-making between clinician and patient. Thus, patients develop coping strategies to survive with pain. Current pain regimes are suboptimal at best, underpinned by the lack of clarity or a mutually agreed plan to mitigate and eradicate pain.
Institutional policies, practices and initiatives impacting research productivity: The strengthening of collaboration, leadership and professionalism in research management in the Southern African Development Community (SADC) and European Union (EU) higher education institutions (storm)
(Society of Research Administrators International, 2022) Frantz, Jose M.; George, Althea; Hunter-Hüsselmann, M.
Research productivity and research excellence are elements essential to the creation of a conducive research environment, in which research publications, research dissemination, and research utilization, are key in fostering the sustainability of higher education institutions. In this study, the current institutional policies, practices, and initiatives that encourage research productivity were explored. A mixed-method methodology, embodying a sequential exploratory approach, was adopted for the study. Non-probability, convenient sampling was used to select Higher Education Institutions (HEIs). A survey questionnaire comprising closed and open-ended questions was used for data collection. The data collection tool was piloted and refined. An integrative analysis consisting of descriptive statistical analysis and thematic analysis was used to analyze the collected data. The findings of this study highlight the instrumental role of university staff and students for research productivity. Building an institutional research culture was seen to boost research productivity. Increasing research capacity and visibility, the implementation of appropriate management infrastructure and the adoption of research policies were found to be effective strategies to support research productivity within Higher Education settings.
Factors influencing employment among people with spinal cord injury in South Africa
(Taylor and Francis Group, 2022) Bezuidenhou, Lucian; Rhoda, Anthea; Conradsson, David Moulaee
Theunemploymentratepostspinalcordinjury(SCI)in SouthAfricais highwithlimitedknow-ledgeof environmentalfactorsoutsidethehealthservices,especiallyin an unevenlydevelopedresourcesettinglikeSouthAfrica,affectingtheemploymentratein peoplewithSCI.Ourpurposewasto investi-gatefactorsassociatedwithemploymentin peoplewithSCIin SouthAfrica. TwohundredpersonswithSCIparticipatedin a cross-sectionalsurveydesign.Thisstudyformedpartof theInternationalSpinalCordInjuryCommunitySurvey.Subsectionsof thequestionnaireresponseswereusedas explanatoryvariablesto predictemploymentafterSCIusinglogisticregres-sionanalysis.
Using video to learn practical techniques in physiotherapy education
(South African Medical Association, 2020) Rowe, Michael; Sauls, Berenice
The traditional approach to developing practical skills in physiotherapy education presents several challenges. Because of larger class sizes, it is difficult for all students to see clearly what is being demonstrated, and because of limited staff numbers, lecturers cannot necessarily spend enough time with students to observe and correct their techniques.[1] This study aimed to explore an alternative means of instruction that is emerging as an area of interest in physiotherapy education. Video-based learning is increasingly being used in programmes with high levels of practical content to free up time in the classroom for lecturers to help students to problem solve instead. Video-based learning allows students to learn a practical technique using only online resources for instruction and demonstration components.
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.
Scoping review of acute stroke care management and rehabilitation in low and middle-income countries
(BMC, 2019) Chimatiro, George Lameck
Stroke is a major public health concern, affecting millions of people worldwide. Care of the condition however, remain inconsistent in developing countries. The purpose of this scoping review was to document evidence of stroke care and service delivery in low and middle-income countries to better inform development of a context-fit stroke model of care.
Knowledge about modifiable risk factors for non-communicable diseases adults living with HIV in Rwanda
(African health science, 2019) Biraguma, Juvenal
Non-communicable diseases (NCD) are of international public health concern. Of more concern are people living with HIV (PLHIV), who have the increased risk of developing NCDs, such as hypertension, stroke and diabetes. Research has revealed that there is a relationship between knowledge of NCD risk factors and risk perceptions in the general population.
Knowledge about modifiable risk factors for non-communicable diseases adults living with HIV in Rwanda
(African journals online (AJOL), 2019) Biraguma, Juvenal
Non-communicable diseases (NCD) are of international public health concern. Of more concern are people living with HIV (PLHIV), who have the increased risk of developing NCDs, such as hypertension, stroke and diabetes.
The structure, processes, and outcomes of stroke rehabilitation in Ghana: A study protocol
(Frontiers Media, 2022) Yarfi, Cosmos; Nyante, Gifty Gyamah; Rhoda, Anthea
Conventional and complementary treatments are often used in rehabilitation for persons with stroke. The conventional treatment makes use of medications, physiotherapy, occupational, speech, and diet therapies, while the complementary treatment makes use of homeopathy, naturopathy, massage, and acupuncture. The structure, process, and outcomes of stroke rehabilitation using conventional or complementary treatments have not been empirically investigated in Ghana. This study aims to investigate the structure, process, and outcomes of stroke rehabilitation at the Korle Bu Teaching Hospital (KBTH) in Accra and Kwayisi Christian Herbal Clinic (KCHC) in Nankese-Ayisaa, Ghana, and to explore the experiences of persons with stroke.
Establishing accelerometer cut-points to classify walking speed in people post stroke
(MDPI, 2022) Conradsson, David Moulaee; Bezuidenhout, Lucian John-Ross
While accelerometers could be used to monitor important domains of walking in daily living (e.g., walking speed), the interpretation of accelerometer data often relies on validation studies performed with healthy participants. The aim of this study was to develop cut-points for waistand ankle-worn accelerometers to differentiate non-ambulation from walking and different walking speeds in people post stroke. Forty-two post-stroke persons wore waist and ankle accelerometers (ActiGraph GT3x+, AG) while performing three non-ambulation activities (i.e., sitting, setting the table and washing dishes) and while walking in self-selected and brisk speeds. Receiver operating characteristic (ROC) curve analysis was used to define AG cut-points for non-ambulation and different walking speeds (0.41–0.8 m/s, 0.81–1.2 m/s and >1.2 m/s) by considering sensor placement, axis, filter setting and epoch length. Optimal data input and sensor placements for measuring walking were a vector magnitude at 15 s epochs for waist- and ankle-worn AG accelerometers, respectively.
Challenges experienced by community health workers and their motivation to attend a self-management programme
(AOSIS, 2022) Johnson, Levona J.; Schopp, Laura H.; Waggie, Firdouza
Community health workers (CHWs) are change agents expected to assist in decreasing the global burden of disease in the communities they serve. However, they themselves have health risk behaviours, which predispose them to non-communicable diseases and thus need to be empowered to make better health choices. There is a gap in literature detailing the challenges faced by CHWs in addressing their own health risk behaviours.: This study aimed to explore the challenges experienced by CHWs in carrying out their daily duties and the motivating factors to join a self-management programme.
Institutional culture and academic career progression: Perceptions and experiences of academic staf
(AOSIS (pty) Ltd, 2021-09-17) Barnes, Nina; Plessis, Marieta du; Frantz, Jose M.
Orientation: The South African higher education system is highly dependent on institutional cultures to enable the progression of academics with the aim to unlock the research potential of the country. Institutional cultures are directed by the values, practices and behaviours of its members. Research purpose: Establish and present, from the academics’ point of view, the values, practices and behaviours that facilitate an enabling institutional culture, which supports the career progression of academic staff. Motivation for the study: A comprehensive and deeper understanding of any higher education institutional culture requires analysis beyond the structural elements and established procedures of the institution. An understanding of how individuals interpret their environment, to support their career progression, is equally important. Research approach/design and method: A qualitative, phenomenological approach was followed, through individual, semi-structured interviews with 17 academics, across all career phases. Main findings: An institutional culture in support of academic career progression includes three major values of: equity and inclusion, an ethic of care and collaboration, that are interconnected to practices such as performance management, a career management system, a comprehensive induction and orientation, a collaborative structure, remuneration, as well as resources and support, together with behaviours, comprising the articulation of team values, alignment of individual and institutional values, as well as a systemic approach. Practical/managerial implications: Understanding the values, practices and behaviours within the context of higher education offers leaders and talent management practitioners the necessary factors to consider as they grapple to understand a culture that enables the career progression of academic staff. Contribution/value-add: Deeper understanding, from the academics’ point of view, the values, practices and behaviours that facilitate an enabling institutional culture, which supports the career progression of academic staff. © 2021, AOSIS (pty) Ltd. All rights reserved.

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