COVID-19: Contrasting experiences of South African physiotherapists based on patient exposure

Background: The coronavirus disease 2019 (COVID-19) pandemic has exposed physiotherapists to unique work-related challenges. However, there is a lack of research regarding the mental health and lived experiences of South African physiotherapists during the COVID-19 pandemic.Objectives: To determine levels of mental and physical health, burnout, depression, anxiety and resilience and coping strategies used by a sample of South African physiotherapists with and without exposure to patients with COVID-19. Lived work experience, perceived health and sources of support were also explored.Method: A non-experimental, cross-sectional, mixed-method design was used. Physiotherapists completed an online survey comprising: a demographic questionnaire; scales assessing mental and physical health, burnout, depression, anxiety and coping strategies and six open-ended questions. A total of 171 physiotherapists participated in our study, 43.3% of whom were exposed to patients with COVID-19.Results: The exposure group scored significantly higher on self-reported mental health, anxiety, depression and burnout than the non-exposure group. No significant differences were reported for physical health and resilience. Significantly more maladaptive coping strategies were employed by the exposure group. Participants’ lived experiences highlighted similar experiences, as well as work-related challenges. Both groups reported that primary sources of support were significant others, but highlighted the lack of organisational support.Conclusion: Irrespective of the degree of exposure to COVID-19, the mental health and lived experiences of physiotherapists working in South Africa has been negatively impacted by COVID-19.Clinical implications: Understanding physiotherapists’ well-being and lived experiences during the pandemic may guide workplace interventions. Our findings suggest the need for psycho-educational intervention programmes to be implemented at an organisational level.

A profile of adult patients with major burns admitted to a Level 1 Trauma Centre and their functional outcomes at discharge: A retrospective review

Background: Patients with major burns suffer with pain, which impacts their physical function during hospitalisation.Objectives: To describe the demographics, burn characteristics, clinical course, physical function, complications developed after major burns and to establish predictors of non-independent physical function at hospital discharge.Method: Records of all consecutive adult burn admissions to a Level 1 Trauma Centre between 2015 and 2017 were screened retrospectively against our study criteria, using the Trauma Bank Data Registry. Anonymised data from included records were captured on specifically designed data extraction forms. Descriptive statistics were used to summarise findings. A regression analysis was undertaken to establish predictors of non-independent function at discharge.Results: Males represented 87.7% (n = 64) of included records (n = 73). Median age was 38 (interquartile range [IQR]: 22). Thermal burns were most reported (n = 47, 64.4%), followed by median total body surface area (TBSA) 31% and head and arms were most affected (60.3% and 71.2%). Injury severity was high with median intensive care unit (ICU) length of stay (LOS) of 17 (IQR: 34) and hospital LOS 44 (IQR: 31) days. Wound debridement was mostly performed (n = 27, 36.9%) with limb oedema as a common complication (n = 15, 21.7%). Muscle strength and functional performance improved throughout LOS. None of the variables identified were predictors of non-independent function at hospital discharge.Conclusion: Adults with major burns were predominantly male, in mid-life and sustained thermal injury with a high injury severity. Decreased range of motion (ROM) of affected areas, ‘fair’ muscle strength and independent function were recorded for most patients at hospital discharge.Clinical implications: These findings contribute to the limited body of evidence on the profile, clinical course and outcomes of South African adult burn patients.

Acknowledgement to reviewers

No abstract availalble.

Spinal deformities: Evidence and patient safety in management

No abstract available.

Effect of Chêneau style braces on vertebral wedging amongst individuals with adolescent idiopathic scoliosis

Background: It is generally accepted that braces can stop curve progression but little evidence exists regarding structural improvement in the spine using spinal bracing. Our study aimed to investigate the possible structural improvements of vertebral wedging with high correction bracing.Objectives: The aim of our study was to assess whether spinal brace treatment may influence vertebral wedging in adolescent idiopathic scoliosis (AIS).Method: We reviewed our database according to the following inclusion criteria: girls with a diagnosis of AIS, Risser 0–2, age 10–14 years with Cobb angles greater than 35°. Our study cohort consisted of 27 patients fulfilling the inclusion criteria with an average brace wearing time of 16.6 h per day and Cobb angles between 36° and 79°. The target value for our study was the apical vertebra wedging, measured twice before brace treatment commenced and twice after the average follow-up period of 20.5 months of treatment.Results: The average apex wedging noted before brace wearing started was 9.8° (median: 9) and after a period of 20.5 months of brace wearing, it had reduced to an average of 5.8° (median: 4.9), (p 0.001). This would indicate a structural correction of 44%.Conclusions: Our study supports the hypothesis that spinal high correction braces improve the degree of vertebral wedging in skeletally immature girls with AIS.Clinical implications: Structural corrections of the apical vertebra seem possible when high correction asymmetric braces are used in the treatment of patients with AIS.

Guidelines for the conservative treatment of spinal deformities – Questionnaire for a Delphi consensus

Background: Spinal deformity is the oldest disease known to humankind. Many types of treatment methods, including both conservative and surgical, are in use.Objective: We aimed to validate a published guideline protocol based on the conservative treatment of spinal deformities.Method: A modified Delphi technique was used with a questionnaire sent out to professionals worldwide regarding the conservative treatment of spinal deformities.Results: Our study was completed after two rounds. A strong level of agreement of 80% and more (consensus cut-off point) was achieved in most questions in the first round. Some statements were below this margin, and they were sent to the participants via email in the second round for re-evaluation. Consensus was achieved in almost all of the statements in the second round. Only two items did not reach the cut-off point but were close to this value.Conclusion: This proposed Guideline Protocol was approved by the participants using the Delphi method and can be used as a valid tool for the conservative treatment of spinal deformities.Clinical implications: A conservative treatment guideline in spinal deformity management, will provide consistency in treatment and will facilitate comparability with surgery. It will be useful in determining the cost-effectiveness of treatment and in choosing the right patient for the right method of treatment. This guideline might help in this context, and may also create a systematic method for clinicians to use as a reference in both research and clinical practice.

Editorial 2021

No abstract available.

Conservative treatment of a scoliosis patient after two heart surgeries in early childhood – A case report

Introduction: This is a case report of a juvenile female patient with scoliosis following two heart surgeries for congenital heart disease (CHD).Patient presentation, management and outcome: Initially, the premenarchial female was 9 years old and had a Tanner stage 2–3 with a single thoracic curve of 65° Cobb. Because of the high risk for progression, immediate brace treatment was proposed as the father declined surgery. The patient received intensive treatment according to the Schroth Best Practice® programme and a Gensingen Brace® designed for large thoracic curves. Over the 18 months following the initial visit, she received two additional braces. As a result, the progression of the main curve was prevented. The patient continues to maintain an improved cosmetic result and is currently at a Risser 2.Conclusion: Surgery performed for CHD in rare cases may lead to stiff spinal deformity as a consequence of that surgery. Progression of a severe and stiff curve was prevented during the most vulnerable phase of the pubertal growth spurt with an improved clinical result. Therefore, we assume that the patient may have a normal life in adulthood with minor restrictions only. Supported by pattern-specific high correction exercises and braces, these typical single thoracic curves can be re-compensated to a more balanced appearance, less prone to progression in adulthood.Clinical implications: Because of the relative high risks of spinal fusion and the long-term unknowns of such an intervention, high-impact conservative treatment should be implemented first before surgical correction is considered.

Corrigendum: Prevalence and clinical characteristics associated with peripheral neuropathy amongst persons on HAART in Busia County, Kenya

No abstract available.

South African physiotherapists’ perspectives on the competencies needed to work in special schools for learners with special needs

Background: Investigation into, and description of competencies in the various sectors in which the physiotherapy profession is practised, contribute to the standardisation of practice, professional education, and guides research and administration, and is necessary in South Africa.Objective: To identify the competencies implemented by physiotherapists working in an educational setting for learners with special needs and to determine physiotherapists’ opinions on the identified competencies.Methods: A sequential mixed method research design was implemented to explore the competencies that physiotherapists implement during their intervention for children with special needs through focus group discussions (FGDs). A questionnaire based on the statements that emerged from the thematic analysis of the transcribed FGDs, and validated, was implemented in a cross-sectional survey amongst all physiotherapists employed in special schools. SPSS version 24 was used for the analysis of closed responses and thematic analysis was done on open-ended responses (n = 22).Results: The respondents’ knowledge and skills regarding physiotherapy theories and implementation ranged from ‘good’ to ‘very good’. However, integration of the therapeutic knowledge and skills in different aspects of the special educational environment, and community integration, were rated ‘poor’ to ‘fair’. Support of physiotherapists to implement policies and procedures, and to attend continuing professional development, ranged from ‘fair’ to ‘poor’.Conclusion: Lack of knowledge in educational policies and procedures in classroom strategies negatively influence the integration of therapeutic strategies in the special educational environment.Clinical implications: The contribution of our study to learners with special needs in schools was outlined.