Exploring prevention and management of secondary health conditions in people with spinal cord injury in South Africa

Background/Aims Preventative care for people with spinal cord injury is neglected, even though secondary health conditions are prevalent among this group. There is limited information on preventative care for secondary health conditions among people with spinal cord injury. This study aimed to explore how people with spinal cord injury prevent and manage secondary health conditions. Methods A total of 17 individuals with spinal cord injury attending an outpatients clinic at a public rehabilitation hospital were interviewed face to face. All the interviews were transcribed verbatim and analysed using thematic content analysis. Results The participants used different strategies to prevent and manage secondary health conditions, such as medication, assistive devices, self-management, resilience coping strategies and therapeutic approaches. The participants found prevention of secondary health conditions ‘challenging’ and some of the strategies were ineffective. Conclusions Although many strategies are used by people with spinal cord injury to prevent and manage secondary health conditions, the experience is difficult. To minimise the occurrence and the consequence of secondary health conditions among people with spinal cord injury, health professionals must promote and support preventative care for secondary health conditions.

International Journal of Therapy and Rehabilitation article reviewers for 2020 and 2021

The International Journal of Therapy and Rehabilitation would like to thank our reviewers for all their hard work reviewing articles in 2020 and 2021 (as well as for previous years). We appreciate the valuable time and effort you spend to help us maintain standards, improve accessibility and provide reliability for our articles. We are continuing to partner with Publons ( https://publons.com/home/ ) to enable our reviewers to keep track of this work for appraisals, job applications and continuing professional development. We would like to thank you for all your outstanding support and look forward to working together again in future.

The effects of breathing exercises on respiratory functions, functional capacity and quality of life in vehicle spray painters

Background/aims Workers engaged in vehicle spray painting are at a risk of developing respiratory problems because of the solvents in the spray paints. Changes in respiratory functions and functional capacities caused by spray painting can be improved with respiratory exercises. The aim of this study was to examine the effects of respiratory exercises on the respiratory functions, functional capacity and quality of life in vehicle spray painters. Methods A total of 70 volunteers with similar characteristics participated in the study. The groups were divided into two groups randomly (35 study group, 35 control group). Respiratory functions (value of forced expiratory volume percentage in 1 second [FEV1]), forced vital capacity percentage [FVC], FEV1/FVC percentage, peak expiratory flow percentage [PEF (%)] and maximum voluntary ventilation percentage [MVV (%)]), functional capacity (6-Minute Walk Test) and quality of life (Short Form Health Survey [SF-36]) were evaluated. The study group undertook supervised breathing exercises 3 days a week for 6 weeks. The same exercises were given to the control group as a home programme. Home programmes were followed up by telephone calls. Evaluations were performed again after 6 weeks. Results In the study group, FEV1 (%) increased more than in the control group (P<0.05). The increase in PEF (%) was similar in both groups (P>0.05). In the study group, FEV1/FVC (%) and MVV (%) were significantly different before and after the intervention (P<0.05), but there was no difference in the control group (P>0.05). There was a greater increase in the study group than in the control group (P<0.05). 6-Minute Walk Test distance (m) before and after the intervention in both groups were similar (P>0.05). Before and after the intervention, a significant difference was found in the vitality and the social function domains of the SF-36 in the study group. In the comparisons of groups, a significant difference was found in the study group in the role-emotional, social function and bodily pain domains of the SF-36 after the intervention (P<0.05). Conclusions Breathing exercises can be recommended for vehicle spray painters to avoid an increase in respiratory resistance and to improve their quality of life.

Examining the effects of upper extremity function and arm sling type on balance, gait and fall risk in patients with hemiparesis

Background/aims Previous studies have reported conflicting results on the effects of arm slings on the balance and gait of patients with hemiparesis. These previous studies did not consider the ability to control the upper extremity on the affected side as a factor that could affect the patient's balance or gait when an arm sling was applied. Hence, the aim of this study was to investigate the effect of upper extremity function in the affected side and arm position according to the sling type on balance, gait and fall. Methods A total of 31 stroke patients participated in the study and were assigned to two groups according to upper extremity function (low-score group and high-score group). Under three conditions (no sling, forearm sling and shoulder sling), a fall risk test, postural stability test and limits of stability test were performed and speed, stride duration, step length and total time were measured. Results When the high-score group wore forearm slings, the static and dynamic balance ability decreased and the fall risk increased. When the low-score group wore forearm slings and shoulder slings, the static and dynamic balance ability increased and the fall risk decreased. The high-score group had a shorter gait time when wearing shoulder slings. When the low-score group wore forearm slings, the speed and step length increased and the total time decreased, enhancing the overall gait ability. Conclusions For stroke patients with better upper extremity control ability, shoulder slings are more appropriate. For patients with poor upper extremity control ability, forearm slings are more appropriate. Using the appropriate sling according to the upper extremity function can improve balance and gait ability and fall risk can be reduced.

Improving access to cardiac rehabilitation in rural and remote areas: a protocol for a community-based qualitative case study

Background/Aims Heart disease is the largest single cause of death and contributes to poor quality of life and high healthcare costs in Australia. There are higher rates of heart disease in rural and remote areas, with the highest rates in Aboriginal and Torres Strait Islander people. Cardiac rehabilitation is known to improve health outcomes for people with heart disease but referral rates remain low (30.2% overall and 46% following acute coronary syndrome) in Australia. Further, access to cardiac rehabilitation in rural and remote areas is affected by there being few centre-based services, and poor use of home-based services. The aim of this protocol is to investigate: (i) understanding of cardiac rehabilitation by health staff, community leaders and community participants discharged from hospital following treatment for heart disease; (ii) access and support for cardiac rehabilitation in rural and remote areas via health service availability in each community. Methods A qualitative case study methodology, using an interpretive descriptive framework, will be used together with content analysis that will encompass identification of themes through a deductive/inductive process. Conclusions To improve access to services and health outcomes in rural and remote areas, a strong evidence base is essential. To achieve this, as well as having appropriate methodology, it is necessary to build relationships and trust with local communities and healthcare providers. This research protocol describes a qualitative community-based case study, together with processes to build sound relationships required for effective data collection through semi-structured interviews or focus groups. Each step of the pre-research planning data collection and analysis is described in detail for the guidance of future researchers.

Feasibility of the basic movements of Azeri dance in the balance and posture of a person with Parkinson's disease: ABA single-subject design

Background/aims Basic movements of Azeri dance as an intervention may have an impact on the physical and mental status of people with Parkinson's disease. The aim of this study was to assess the feasibility and efficacy of basic movements of Azeri dance on the balance and static posture of a person with Parkinson's disease. The effects of basic movements of Azeri dance on quality of life, quality of sleep and the performance in activities of daily living were reported before and after the intervention. Methods In this single-subject experimental ABA design, a 64-year-old man with a 4-year history of Parkinson's disease was selected. The outcome measures consisted of the Functional Reach Test, Timed Up and Go Test, qualitative static posture analysis, Short Form Health Survey, Modified Barthel Index and Pittsburgh Sleep Quality Index. Results An increasing trend in balance from the initial baseline stage through to the end of the intervention stage was found. Static posture analysis showed that the patient's posture improved qualitatively. His quality of life score changed after the intervention; however, his sleep quality and activites of daily living scores did not change. Conclusions Basic movements of Azeri dance are useful in the rehabilitation of patients with Parkinson's disease who have balance issues and postural instability, but further research is warranted.

The impact of walker height positions and their influence on triceps activity and energy conservation: a pilot study

Background/Aims Millions of adults use walkers for functional mobility. Inappropriate walker use is associated with incorrect height, forward-leaning posture, and increased energy expenditure. Few studies have investigated the impact of walker positions and their influence on triceps activity. The present study assessed walker height and baseline positioning for individuals with a 50% weight bearing restriction of the lower extremity, and implications for energy conservation. Methods A total of 38 young adults (mean age = 24.95 years; 84.2% female; 15.8% male) participated in this study with a two-wheeled walker. Participants executed five walker positions while maintaining 50% weight bearing of the lower extremity to determine the effect on triceps electromyography activity. Results Triceps electromyography activity did significantly change across the five walker positions assessed (X2 [df=37, P<0.001]). This study showed that the median electromyography activity for positions B (median=0.268) and A (median=0.280) was significantly less than the median electromyography activity for position E (median=0.452; P<0.001). The effect sizes for comparisons of positions B and E (r=0.49) as well as A and E were the largest (r=0.53). Conclusions These findings suggest an elbow angle of 26–35° (position B), followed by an elbow angle of 15–25° (position A), with the walker in line with the heels of the participant, to be superior in minimising exertion of the triceps.

Characterisation of hospital-produced guidelines regarding management of temporary tube feeding care in general paediatric patients

Background/Aims There is significant variation in the implementation of temporary tube feeding management in children and a paucity of associated clinical practice guidelines covering all phases of care, from decision making regarding tube insertion through to tube weaning. Development of clinical practice guidelines should consider levels of evidence other than randomised control trials. Examining hospital-produced guidelines used by frontline health staff, for example, could distinguish areas of application of evidence-based recommendations, as well as domains of care in need of increased implementation. This article describes the content of existing hospital-produced guidelines relating to tube feeding care in a general paediatric population. Methods Hospital-produced guidelines were sought by mailing 200 health services worldwide and searching Queensland Health's Electronic Publishing Service in Australia and Google. A content analysis was then performed. Results The 13 collected hospital-produced guidelines from Australia, the UK and Canada generally comprehensively reported on processes related to the decision-making, tube placement and tube maintenance phases. However, reporting on oral feeding while tube feeding, tube feeding dependency, tube feeding exit planning, and the social and emotional aspects of tube feeding were areas within these phases that had limited coverage. Recommendations for the phase of tube weaning were also infrequently included. Conclusions Development of formal clinical practice guidelines covering all tube feeding phases should assist in optimising patient and health service outcomes.

Effect of acute static stretching on the passive mechanical properties of the Achilles tendon: a systematic review and meta-analysis

Background/Aims Little is known about the effectiveness of static stretching on the tendinous structures. The aim of this study was to verify the effect of acute static stretching on the passive mechanical properties of the Achilles tendon. Methods Databases were searched with the descriptors ‘muscle stretching exercises,’ ‘adult’ and ‘Achilles tendon’ with a sample consisting of physically active young adults. Two blind reviewers performed the review. Results A total of four studies were selected. After the meta-analysis, no significant difference was observed for range of motion (−0.73; 95% confidence interval −2.18–0.71; I2=0%), muscle-tendon unit (−0.02; 95% confidence interval −0.23–0.19; I2= 83%), muscle (−0.43; 95% confidence interval −0.92–0.06; I2= 0%) and tendon stiffness (3.70; 95% confidence interval 1.57–5,83; I2=0%; P=0.0007) and passive torque (−1.35; 95% confidence interval −4.75–2.05; I2= 0%). Maximum voluntary isometric contraction showed an alteration with a longer stretching time (1215 seconds). Conclusions Passive static stretching (60–1215 seconds) does not significantly alter the analysed variables.