17 research outputs found
A study of the effects of exercise therapy on the comorbidity of attention deficit hyperactivity disorder (ADHD) and developmental co-ordination disorder (DCD).
No full textDoctoral degree. University of KwaZulu-Natal, Durban.Background: The literature suggests a high prevalence of comorbid ADHD and DCD in South Africa and worldwide. Specific figures of the suspected high prevalence are not available and the link between the two conditions are poorly understood. Medical treatment relies on neurostimulant drugs, which have little or no effect on the motor symptoms and have significant side effects. An intervention that addresses both motor co-ordination and attention/concentration impairments is essential in the overall management of children presenting with these comorbid conditions. This study aimed to document prevalence figures and demographic profile of children aged 8 to 9 years diagnosed with comorbid ADHD and DCD; and to design and develop and test efficacy of an exercise intervention that addresses symptoms of the comorbid conditions. Methodology: The study was located at remedial units within mainstream schools in KwaZulu-Natal, South Africa. Children aged 8 to 9 years diagnosed with ADHD were assessed using the modified Conners’ Teacher Rating Scale and the Copeland’s Symptom Checklist, the Development Co-ordination Disorder Questionnaire (DCDQ) and the Motor Assessment Battery for Children, edition 1 (MABC-1). A three round Delphi technique assisted in the development of an exercise intervention. The efficacy of the exercise intervention was tested via a quasi-experimental study. Children that were assessed were divided into four groups namely: Group (A) that were administered neuropharmacological medication prescribed by a medical practitioner; Group (B) were exposed to the exercise intervention only; Group (C) included children on neuropharmacological medication that were exposed to the exercise intervention and Group (D) served as the control, receiving routine care. All participants were grouped, according to parental preference. Effectiveness of each intervention was assessed using Wilcoxon Signed Ranked Test. Results: 151 children were tested. 74% were diagnosed with comorbid ADHD and DCD. The male to female ratio was 2:1. The combined subtype of ADHD was most commonly diagnosed with comorbidity. Consensus on structure and content in an exercise intervention was achieved in three rounds of the Delphi technique. The programme comprised 12 exercises. ADHD scores were as follows: Group A and B showed significant deterioration in these scores, Group C demonstrated a significant improvement and Group D showed no significant change. Results of motor scores: Group A and D showed a significant deterioration, while Group B and C demonstrated a significant improvement. Conclusions: The combination of medication plus exercises are effective in addressing and improving the symptoms of comorbid ADHD and DCD in children aged 8 to 9 in KZN, SA. Practitioners are cautioned to screen children with ADHD for DCD, following which treatment should be administered to address symptoms of both conditions, hence, providing a more effective and holistic form of management
Primary health care delivery : a case study of KwaZulu-Natal with special reference to physiotherapy.
No full textThesis (Ph.D.)-University of KwaZulu-Natal, Westville, 2009.The delivery of primary health care (PHC), as promulgated by the World Health Organization (WHO) and in South Africa, is of fundamental importance. Physiotherapy is an essential component of the health care delivery system and must promote PHC during clinical training and practice. In KwaZulu-Natal (KZN), PHC service delivery has been a problem for various reasons such as the history of the country (apartheid era pre- 1994), financial constraints, lack of human resources, physical infrastructure and time constraints. Service delivery within the health sector is reported frequently in the media as physiotherapists and radiographers embarked on a strike latter part of 2009 in KZN due to a discrepancy in the Occupation Specific Dispensation (OSD). Physiotherapists have highlighted that they were overworked, carrying the strain of vacancies, due to frequent resignations to migrate to the private sector. The aim of the research was to explore the promotion of PHC delivery in KZN. The objectives explored the empowerment of students and staff in the Health Science Disciplines to PHC service delivery. In addition, managers at provincial and local levels were included in the study. Barriers and factors that enhance the promotion of PHC were identified. The research design comprised of a survey, a quantitative and qualitative case study of KZN, using questionnaires or semi-structured interviews. The findings indicated that the physiotherapy staff lacked PHC training (p=0.000) and 48.7% of the Disciplines in Health Sciences indicated that the rural needs were not being addressed with regards to PHC service delivery (p=0.018). Each discipline operated within its own silo, without any consultation and inter-disciplinary collaboration, to the detriment of effective delivery of PHC services. Fragmentation and duplication of PHC services existed between Provincial and Local Governments as indicated by 46% of the managers, which is disconcerting post 15 years of democracy in South Africa. The main objective of the National Health Plan and Reconstruction and Development Programme (RDP) was to readdress the inequalities and fragmented health services. Numerous recommendations are made which will improve the journey towards transformation, comprehensive PHC service delivery, and the quality of life of all citizen
Rehabilitation service in the northern KwaZulu-Natal, uThungulu and service providers’ knowledge and attitudes towards public private partnerships.
No full textMaster’s degree. University of KwaZulu-Natal, Durban.Rehabilitation assists persons with disabilities attain physical independence and self-determination. In
South Africa, the distribution of rehabilitation services is largely poor. Rehabilitation services in
uThungulu District, KwaZulu-Natal are covered by the public sector. The uThungulu public health
sector provides limited rehabilitation services, with physiotherapists working in multidisciplinary
teams. Consequently, achieving rehabilitation goals of functional independence is affected. Public and
private rehabilitation service providers working together can help to combat this problem. Furthermore,
rehabilitation services are unevenly distributed in rural uThungulu.
This study explores current rehabilitation service provision practices in uThungulu and the possibility
of Public Private Partnerships (PPPs). A sample of 50(37 public and 13 private) rehabilitation service
providers were interviewed; using a mixed methods exploratory case study. Through the use of focus
groups, individual interviews and questionnaires, participants were requested information on their
perception of the availability, accessibility and equitability of rehabilitation services in uThungulu
district. The knowledge and attitude service providers had towards PPPs were also explored.
Rehabilitation practitioners reported poor rehabilitation service provision in uThungulu due to the poor
socio-economic circumstance of uThungulu, limited multidisciplinary rehabilitation service providers
and poor delivery of rehabilitation services. Sixty-four percent of the participants reported that their
rehabilitation was not sufficient. Ninety-two percent of the participants reported working in a
multidisciplinary team however human resource shortages were also reported resulting in institutions
being constantly short-staffed. Sixty-nine percent of the participants reported the non-availability of
designated rehabilitation units in their institutions. Professionals working at institutions with designated
rehabilitation units evaluated the effectiveness of the rehabilitation programme significantly more
positively than those working at institutions without such designated units (U= 98.5, p=0.01).
Participants stated that they receive an average of 5.37±4.79 rehabilitation referrals per day. Forty
percent of the participants stated that rehabilitation sessions occur daily, with 38% of respondents
reporting rehabilitation sessions lasting between 30 to 45 minutes. A moderate, positive correlation was
found between participants’ perceptions of managerial support and perceived rehabilitation programme
effectiveness (rs= 0.45, p=0.01). A weak, positive and statistically significant correlation between
perceived effectiveness of rehabilitation programme and ease of administrative process was found (rs=
0.29, p= 0.04). Two thirds (66%) of the participants did not know about PPP and only a third (34%)
knew about it.
Rehabilitation service in uThungulu is provided predominantly in hospital departments and less so at
community-based centres such as clinics. UThungulu’s rehabilitation services are multidisciplinary, but
often with an incomplete quota of rehabilitation practitioners. Rehabilitation services were perceivednegatively by providers in the uThungulu District. These negative perceptions were due to a lack of
equipment, the absence of designated rehabilitation units, human resource shortages, a lack of
managerial support and cumbersome administrative processes. Furthermore, rehabilitation service
providers perceived rehabilitation as insufficient and ineffective. Rehabilitation service providers in
uThungulu were not aware of PPPs. The possible utilisation of PPPs as tools for adequate rehabilitation
service provision thus could not be ascertained sufficiently. The few providers who were aware of PPPs
reported a positive potential for PPPs as vehicles of rehabilitation service provision
Mental health content in the physiotherapy undergraduate curriculum in South Africa
No full textBackground: Knowledge about mental health in physiotherapy practice is essential as mental health can impact physical health. Little is known about the mental health content in the South African physiotherapy undergraduate programme.
Objectives: Our study explored the mental health content in the undergraduate physiotherapy programme at eight universities and the perceptions of academic staff at an identified training institution in South Africa and stakeholders about the relevance of mental health in the undergraduate physiotherapy programme
Method: Our study employed a concurrent-mixed method design, which consisted of: (1) the administration of a survey to academic leaders or lecturers undertaking mental health teaching at universities and (2) an online interview that included stakeholders and a focus group to gauge perceptions of academic staff at an identified institution in South Africa.
Results: Seven of eight universities participated in our study. All the universities had a psychology module and agreed that it is crucial to have mental health content in the curriculum. There is diversity in the mental health content between the universities.
Conclusion: There is a need for consistency in the mental health content at all universities to ensure that all students receive the same skill set to have an impact on the quality of care.
Clinical implications: There is a need to include mental health content at universities offering theoretical and practical undergraduate programmes
Stakeholders’ views on public-private partnerships for rehabilitation services in South Africa ahead of National Health Insurance
No full textBackground: Quality rehabilitation services are limited in rural South African areas, such as KwaZulu-Natal (KZN). Public-private partnerships (PPPs) are increasingly valued as an effective model for public health delivery in developing countries; yet, their application in South Africa’s rehabilitation sector, especially with the upcoming National Health Insurance (NHI) for universal health coverage, remains unclear. This study examined perspectives on using PPPs for rehabilitation services within the District Health System in KZN in preparation for the NHI.Methods: A qualitative study in eThekwini, Amajuba and King Cetshwayo districts of KZN included 57 participants, selected through purposive sampling. Participants were rehabilitation practitioners, managers and social development representatives. Data were collected via focus groups and interviews and analysed using thematic analysis.Results: Participants noted that the NHI’s strategy of incorporating the private sector is designed to alleviate government pressure and provide financial incentives. Challenges mentioned include service availability, patient care and tariff disputes. Discrepancies between public and private sectors and the private sector’s financial sensitivities pose significant challenges to NHI implementation. A knowledge gap exists regarding the role of PPPs in the NHI context for rehabilitation services. Practitioners emphasised the necessity of adequate government funding for private sector partnerships to strengthen public health infrastructure.Conclusion: Stakeholders express varied views on PPPs for rehabilitation, highlighting the need for clear guidelines and funding support as South Africa nears NHI implementation.Contribution: This study provides insights into stakeholders’ views on PPPs for rehabilitation, identifying key benefits and challenges to inform effective NHI-aligned implementation strategies
Levels and Patterns of Physical Activity and Sedentary Behaviour of Primary School Learners in Lagos State, Nigeria
No full textBackground: Physical activity (PA) and sedentary behaviour (SB) assessment in children is critical for the prevention of noncommunicable diseases. African studies examining PA and SB of primary school-age children are few. This study investigated PA, SB levels and their correlates among primary school children in Lagos, Nigeria. Method: In a cross-sectional study of 733 learners, their self-reported PA and SB were assessed using the Children PA Questionnaire (CPAQ) (6–9 years age category) and Youth Activity Profile (YAP) (10–12 years age category) while pedometers were used for objective PA and SB assessment, and socioeconomic status (SES) index were measured using a structured questionnaire. Standardised procedures were used for anthropometric and cardiovascular measures. Results Based on CPAQ, 87.5% and 100% of the learners aged 6–9 years met the recommended PA and SB guidelines, respectively which were lower with pedometers (72.8% and 87.3%). The proportion of boys aged 6–9 years who met the guidelines for PA and SB (using pedometer) was significantly higher than that of the girls(PA: 80.7% vs. 64%, p = 0.018; SB: 94% vs. 80%, p = 0.008). Self-reported PA was positively associated with age (CPAQ: B = 455.39, p < 0.001; YAP: B = 1.638, p = 0.009) and negatively with SES (CPAQ: B = −201.39, p < 0.001; YAP: B = −1.000, p < 0.001). Objective PA was positively associated with waist to hip ratio(WHR) (6–9 years: B = 66090.24, p = 0.032) and negatively with sex (6–9 years: B = −5533.41, p = 0.027) and hip circumference (10–12 years: B = −1269.13, p = 0.017). SB was associated with SES in learners aged 10–12 years (B = −0.282, p = 0.003).Conclusion: High SES is a major predictor of reduced PA among these cohort of learners
Prevalence of Low Physical Fitness and Its Related Factors Among Primary School Learners in Lagos State, Nigeria
No full textBackground and Purpose: Current evidence shows that physical fitness (PF) is declining among children and adolescents in Africa and worldwide, and this trend is associated with increased cardiovascular morbidity and mortality. This study aimed to evaluate the baseline PF data of primary school children in Lagos State, Nigeria, and to determine the predictors of low PF within the cohort.
Materials and Methods: A total of 733 primary school children aged 6-12 years in Lagos, Nigeria, were included in this cross-sectional quantitative study. PF measures were assessed using the Eurofit battery test including sit and reach (S&R), standing long jump (SLJ), sit-ups (SU), 5 m shuttle run test (5 m-SRT), and cricket ball throw (CBT). A structured questionnaire was used to determine the socio-demographic factors. Anthropometric and cardiovascular measurements were performed using standardized protocols. Data were analyzed using descriptive statistics of frequencies, percentages, median, and quartiles, and inferential statistics of the Mann-Whitney U test, Quade analysis of covariance (ANCOVA) correlation matrix, and multiple linear regression model.
Results: Boys showed significantly higher SU counts (P<0.001), higher CBT (P<0.001), lower 5 m SRT (P=0.003), and the same SLJ (P=0.008) than girls, while S&R scores were statistically comparable (P=0.135). Also, the results showed that sex (B=-0.647, P=0.015), height (B=0.831, P=0.0001), weight (B=-0.641, P=0.007), and hip circumference (HC) (B=0.955, P=0.009) were significantly associated with total PF (measured using S&R, SLJ, SU,5 m SRT, and CBT).
Conclusion: Increased weight and gender were the main predictors of low PF among primary school children in Lagos, Nigeria
Effectiveness of telerehabilitation-based exercises plus transcranial direct current stimulation for stroke rehabilitation among older adults: A scoping review
No full textObjective: Physiotherapy rehabilitation of patients with stroke is challenging for the patient, their informal caregivers and the therapist involved. A telerehabilitation programme combined with transcranial direct current stimulation (tDCS) may be the more appealing approach that may save rehabilitation time and improve treatment outcomes. This study performs a scoping review on the effect of telerehabilitation-based exercises plus tDCS among older adults with stroke. Methods: This scoping adopts the Joana Briggs Institute guidelines for conducting a scoping review. Using Keywords and related MeSH terms to telerehabilitation-based exercises and tDCS among older adults with stroke, the following databases were searched: Cochrane, PubMed, Scopus, and Web of Science. Additional seven other databases (Academic Search Complete; PsycInfo; Health Source-Consumer Edition; Health Source: Nursing/Academic Edition; MEDLINE with Full Text; Academic Search Ultimate) were searched via EBSCOhost. The articles identified were imported to Mendeley for deduplication and then to Rayyan for further deduplication, title and abstract screening. Results: Out of 216 total articles retrieved, 6 met the study’s inclusion criteria and were extracted for this study. The evidence shows that the telerehabilitation-based exercise intervention with tDCS improves upper limb motor function among older adult patients with stroke. Discussion & conclusion: Most of the evidence found focused on a combination of virtual reality-based exercises plus tDCS, and none of the telerehabilitation exercise interventions follows the neurorehabilitation techniques such as the Brunnstrom approach and Bobath technique. While it can be concluded that the evidence points towards improving upper limb motor functions with virtual reality and tDCS for stroke rehabilitation among older adults, there is no evidence of its effect on non-motor symptoms such as pain and cognitive functions possibly due to unavailability of relevant studies. There is also a dearth of evidence for t he telerehabilitation programme that uses neurodevelopmental techniques such as Brunnstrom and Bobath approaches with tDCS. This is paramount in providing effective care to older adult patients with stroke
Patient characteristics, therapy service delivery and patient outcomes following pyrocarbon proximal interphalangeal joint arthroplasty
No full textTelerehabilitation-based exercises with or without transcranial direct current stimulation for pain, motor and cognitive function in older adults with mild cognitive impairments post-stroke: A multi-arm parallel-group randomized controlled trial study protocol
No full textBackground: Cognitive impairments, pain, and motor dysfunction are daunting challenges for stroke survivors, clinicians, and caregivers during rehabilitation programmes. There is a dearth of studies investigating the effectiveness of combining neurodevelopmental technique telerehabilitation-based exercises with transcranial direct current stimulation (tDCS) for stroke survivors with mild cognitive impairments post-stroke. Objectives: The primary aim of this study is to investigate and compare the effects of Telerehabilitation-Based Exercises with or without Transcranial Direct Current Stimulation (tDCS) on pain, motor and cognitive function in older adults with mild cognitive impairments post-stroke. Methods: A multi-arm parallel-group (three groups) randomized controlled trial study involving a minimum of 87 participants (29 per group) will be conducted. Participants will be randomized into either telerehabilitation programmes with tDCS, telerehabilitation programmes alone or conventional physiotherapy programmes. All participants will be treated 3 times weekly for 8 weeks (45 min of intervention per session). Discussion: The findings in this study are expected to guide the provision of effective and affordable rehabilitation for stroke survivors with mild cognitive impairment
