Community reintegration of people with traumatic brain injury in South Africa.

BACKGROUND: Traumatic brain injury (TBI) affects cognitive, behavioral and physical function, influencing community reintegration. OBJECTIVES: To describe the level of community reintegration and the associated influencing factors post-TBI in South Africa. METHODS: A cross-sectional analysis of patients living with TBI was done, using the Community Integration Questionnaire (CIQ), the World Health Organization Disability Assessment Schedule 2.0 (WHODAS 2.0), and the Quality of Life after Brain Injury Overall Score (QOLIBRI-OS). RESULTS: Of the 80 participants 54.0% presented with mild TBI. The median (IQR) score of the CIQ, WHODAS 2.0 and QOLIBRI-OS was 22 (7.5)/29, 31(18)/100 and 73 (45.5)/100. There was a moderate inverse relationship between the WHODAS 2.0 and CIQ scores (r = -0.68; p < 0.001) and a moderate positive correlation between the QOLIBRI-OS and CIQ scores (r = 0.54; p < 0.001). The WHODAS 2.0 scores also showed a strong inverse correlation with the QOLIBRI-OS scores (r = -0.76; p < 0.001). CONCLUSION: The participants had high levels of functioning and low levels of disability, both of which were found to be in tandem with high CIQ scores and generally good quality of life. Post-TBI patients are capable of achieving good community integration provided they attain high levels of functioning.

The effect of neural mobilisation on cervico-brachial pain: design of a randomised controlled trial.

BACKGROUND: Neck pain is a common musculoskeletal complaint and is often associated with shoulder or arm pain. There is a paucity of information on effective treatment for neck and arm pain, such as radiculopathy or cervico-brachial pain. Guidelines recommend neck mobilisation/ manipulation, exercises and advice as the treatment for neck pain, and neck and arm pain. There are a few studies that have used neural mobilisation as the treatment for cervico-brachial pain. Although results seem promising the studies have small sample sizes that make it difficult to draw definite conclusions. METHODS: A randomised controlled trial will be used to establish the effect of neural mobilisation on the pain, function and quality of life of patients with cervico-brachial pain. Patients will be recruited in four physiotherapy private practices and randomly assigned to usual care or usual care plus neural mobilisation. DISCUSSION: In clinical practice neural mobilisations is commonly used for cervico-brachial pain. Although study outcomes seem promising, most studies have small participant numbers. Targeting the neural structures as part of the management plan for a subgroup of patients with nerve mechano-sensitivity seems feasible. Patients with neuropathic pain and psychosocial risk factors such as catastrophising, respond poorly to treatment. Although a recent study found these patients less likely to respond to neural mobilisation, the current study will be able to assess whether neural mobilisation has any added benefit compared to usual care. The study will contribute to the knowledge base of treatment of patients with cervico-brachial pain. The findings of the study will be published in an appropriate journal. TRIAL REGISTRATION NUMBER: PACTR201303000500157.

Factors Informing the Development of a Clinical Pathway and Patients' Quality of Life after a Non-Union Fracture of the Lower Limb.

Patients with non-union fractures spend extended periods of time in the hospital following poor healing. Patients have to make several follow-up visits for medical and rehabilitation purposes. However, the clinical pathways and quality of life of these patients are unknown. This prospective study aimed to identify the clinical pathways (CPs) of 22 patients with lower-limb non-union fractures whilst determining their quality of life. Data were collected from hospital records from admission to discharge, utilizing a CP questionnaire. We used the same questionnaire to track patients' follow-up frequency, involvement in activities of daily living, and final outcomes at six months. We used the Short Form-36 questionnaire to assess patients' initial quality of life. The Kruskal-Wallis test compared the quality of life domains across different fracture sites. We examined CPs using medians and inter-quantile ranges. During the six-month follow-up period, 12 patients with lower-limb non-union fractures were readmitted. All of the patients had impairments, limited activity, and participation restrictions. Lower-limb fractures can have a substantial impact on emotional and physical health, and lower-limb non-union fractures may have an even greater effect on the emotional and physical health of patients, necessitating a more holistic approach to patient care.

Predictors of patient length of stay post stroke rehabilitation.

Background: There is little research on length of hospital stay (LOS) in patients post stroke in South African rehabilitation facilities. As LOS is an important indicator of cost-of-care, this information may be useful to all stakeholders. Objectives: To determine the predictors of hospital LOS in patients post stroke rehabilitation. Methods: A retrospective file review of 243 patients. Results: Patient functional ability was measured using the Functional Independence Measure (FIM). Predictors of LOS were determined with multiple regression analysis. The median admission and discharge FIM scores were 43 (range: 16-119) and 75 (range: 16-120) points respectively. The median LOS was 43 (range: 3-112) days. Predictors of LOS were premorbid psychiatric conditions, impaired speech, requiring oxygen support, the development of pneumonia and admission FIM motor score, with admission FIM motor score being the strongest individual predictor of LOS (41%). Conclusion: Admission FIM score had an influence on patient outcomes and LOS. Patients with higher admission FIM motor scores may be able to participate in rehabilitation better and thus have shorter LOS. Being able to predict LOS on admission allows facility administrators to manage bed occupancy, human and clinical resources in post stroke rehabilitation.

Navigating postgraduate research during the COVID-19 pandemic: A scoping review.

BACKGROUND:  The worldwide coronavirus disease 2019 (COVID-19) pandemic compelled higher education institutions and postgraduate students (master's and PhD) to rethink their research designs, as alert level restrictions affected data collection. OBJECTIVES:  To identify and map out the breadth of evidence available on the challenges and opportunities for conducting postgraduate research during the COVID-19 pandemic. METHOD:  A scoping review was conducted in CINAHL, MEDLINE (EBSCO), SCOPUS and PubMed databases. The authors independently began by screening the titles, the abstracts and full texts. Duplications were removed during the title and abstract screening by exporting them into EndNote. RESULTS:  The search identified 463 documents, and 12 were included in the final review. The documents were studies commentaries, letters (n = 1) from India and guidelines from countries across the globe. The common themes that were reported on the challenges of conducting postgraduate research were the inability to collect data, the digital divide and changes in study designs. CONCLUSION:  The review reports on the opportunities and challenges in conducting postgraduate research during the COVID-19 pandemic. Despite the limited evidence on the opportunities of conducting postgraduate research, most postgraduate research stalled because of COVID-19 restrictions. There is a need for more literature to explore further postgraduate research opportunities during COVID-19 and beyond.Contribution: The focus on the challenges and opportunities in conducting postgraduate research during the COVID-19 pandemic may assist in the development of strategies needed to mitigate the effects of this and future pandemics.

Scapular force: Couple ratios in healthy shoulders - An observational study reflecting typical values.

Background: Scapular stability is primarily maintained through the action of the scapular stabilisers and not through bony stability. The values of the force couple ratios of the scapular stabilisers remain largely unknown. Objectives: To determine typical scapular force couple strength ratios in the pain-free shoulders of healthy female and male participants. Methods: This was a quantitative cross-sectional study. The muscle strength of the serratus anterior upper and lower fibres, the upper, middle and lower trapezius and the rhomboids (in both shoulders) were determined in kilogram force (kgf) using a handheld dynamometer. The ratios of the force couples of the scapulae of both shoulders of the participants were calculated. Participants (both female and male) with healthy shoulders were recruited from the general public (a local university, schools, church groups and sport clubs). We mainly utilised descriptive analysis. Statistical significance was set at 5%. Results: Force couple ratios were as follows (means, with SD). Dominant arm in women: upper trapezius:lower trapezius 3.63 (0.97); serratus anterior lower fibres:lower trapezius = 1.97 (0.27); middle trapezius:serratus anterior upper fibres = 0.40 (0.10); serratus anterior lower fibres:rhomboids = 1.41 (0.21); lower trapezius:rhomboids = 0.74 (0.17). Dominant arm in men: upper trapezius:lower trapezius = 2.70 (0.72); serratus anterior lower fibres:lower trapezius = 2.15 (0.45); middle trapezius:serratus anterior upper fibres = 0.47 (0.12); serratus anterior lower fibres:rhomboids = 1.40 (0.31) and lower trapezius:rhomboids = 0.17 (0.6). Conclusion: Specific force couple strength ratios were determined, between and within the nondominant and the dominant arms of the shoulders of healthy women and men. Clinical implications: Scapular stability is mainly maintained through the optimal force couple balance of the scapular stabilisers.

Prevalence of concurrent headache and temporomandibular disorders: a systematic review protocol.

OBJECTIVE: The objective of this review is to determine the concurrent prevalence of temporomandibular disorders and headaches in patients. INTRODUCTION: Temporomandibular disorders affect the temporomandibular joint and associated orofacial structures. It is the second-most common musculoskeletal disorder experienced by adults. Headache is one of the most pervasive neurological disorders and can be an extremely disabling condition. Temporomandibular disorders and headache are known to often occur simultaneously and have a bi-directional relationship due to their close anatomical association. INCLUSION CRITERIA: The systematic review will include all studies with adult participants (>18 years) experiencing headaches (migraine, migraine with/without aura, tension-type, cervicogenic, and chronic headache) with symptoms of temporomandibular disorders occurring concurrently. METHODS: An initial search of PubMed will be followed by CINAHL, the Cochrane Central Register of Controlled Trials in the Cochrane Library, EBSCO MasterFILE Premier, PEDro, ProQuest Health and Medical Complete, Science Direct, and Scopus. Titles and abstracts of studies will be reviewed, and full text articles will be selected if the inclusion criteria are met. Studies that meet the eligibility criteria will then be assessed by two independent reviewers. Full-text articles will be selected if the inclusion criteria are met. A standardized critical appraisal checklist for studies reporting prevalence data will be used to assess methodological quality and a standardized data extraction tool will be used. The results from the included studies will be analyzed using JBI SUMARI software. SYSTEMATIC REVIEW REGISTRATION NUMBER: PROSPERO (CRD42019139689).

An electromyographic and kinematic study of the scapular stabilisers.

BACKGROUND: The scapular stabilisers, especially the actions of the force couples around the scapula, have an impact on the biomechanics of the scapula and the orientation of the glenoid. OBJECTIVES: The aim of our study was to determine both the muscle activity and the correlation between the muscle activity ratio of the lower force couple (the serratus anterior lower fibres and the lower trapezius). METHODS: This was a quantitative cross-sectional study. Muscle activity of the dominant serratus anterior lower fibres and the lower trapezius muscles was collected with surface electromyographic (EMG) sensors and an inertial motion capture system was used to measure the three-dimensional (3D) shoulder flexion in the sagittal plane and abduction in the frontal plane. Graph Pad 5 (Prism, San Diego, CA, USA) was used for the statistical analysis. The confidence level was set at 95% (p < 0.05). RESULTS: Sixteen men and women participated in our study, with a mean (standard deviation) age of 25.4 (± 4.6) years, weight of 80.2 (± 25.1) kg and height of 171.6 (± 10.3) cm. A strong negative correlation was found at the start of the abduction (r = -0.623; p = 0.01) between the muscle activity of the serratus anterior lower fibres and the lower trapezius. CONCLUSIONS: The only significant increase in the mean EMG ratio of serratus anterior lower fibres versus the lower trapezius was present at 60% (from baseline) of abduction (p = 0.03). CLINICAL IMPLICATIONS: The EMG activity ratio of serratus anterior lower fibres and lower trapezius remains variable in different movement planes.

Effect of Neural Mobilization on Nerve-Related Neck and Arm Pain: A Randomized Controlled Trial.

Purpose: Neural mobilization (NM) is often used to treat nerve-related conditions, and its use is reasonable with nerve-related neck and arm pain (NNAP). The aims of this study were to establish the effect of NM on the pain, function, and quality of life (QOL) of patients with NNAP and to establish whether high catastrophizing and neuropathic pain influence treatment outcomes. Method: A randomized controlled trial compared a usual-care (UC; n = 26) group, who received cervical and thoracic mobilization, exercises, and advice, with an intervention (UCNM; n = 60) group, who received the same treatment but with the addition of NM. Soft tissue mobilization along the tract of the nerve was used as the NM technique. The primary outcomes were pain intensity (rated on the Numerical Pain Rating Scale), function (Patient-Specific Functional Scale), and QOL (EuroQol-5D) at 3 weeks, 6 weeks, 6 months, and 12 months. The secondary outcomes were the presence of neuropathic pain (using the Neuropathic Diagnostic Questionnaire) and catastrophizing (Pain Catastrophising Scale). Results: Both groups improved in terms of pain, function, and QOL over the 12-month period (p < 0.05). No between-groups differences were found at 12 months, but the UCNM group had significantly less pain at 6 months (p = 0.03). Patients who still presented with neuropathic pain (p < 0.001) and high pain catastrophizing (p = 0.02) at 6- and 12-mo follow-ups had more pain. Conclusions: Both groups had similar improvements in function and QOL at 12-month follow-up. The UCNM group had significantly less pain at 6-month follow-up and a lower mean pain rating at 12-month follow-up, although the difference between groups was not significant. Neuropathic pain is common among this population and, where it persisted, patients had more pain and functional limitations at 12-mo follow-up.

Objectif : la mobilisation neurale (MN) est souvent utilisée pour traiter des douleurs d'origine nerveuse, et il est raisonnable d'y recourir pour le traitement des douleurs cervico-brachiales d'origine nerveuse (DCBN). La présente étude visait à établir l'effet de la MN sur la douleur, la fonction et la qualité de vie (QdV) des patients présentant des DCBN et à déterminer si la catastrophisation élevée et la douleur neuropathique influent sur les résultats des traitements. Méthodologie : un essai aléatoire et contrôlé comparant un groupe recevant des soins habituels (SH; n = 26; mobilisation cervicale et thoracique, exercices et conseils) à un groupe d'intervention (SHMN; n = 60; même traitement, mais avec l'ajout d'une MN). Les chercheurs ont utilisé la mobilisation des tissus mous le long de la voie nerveuse comme technique MN. Les résultats primaires étaient l'intensité de la douleur (classée d'après l'échelle d'évaluation numérique de la douleur), la fonction (échelle fonctionnelle propre au patient) et la QdV (EuroQol-5D) au bout de trois et de six semaines, de six et de 12 mois. Les résultats secondaires étaient la présence de douleur neuropathique (selon le questionnaire de diagnostic neuropathique) et la catastrophisation (échelle de catastrophisation de la douleur). Résultats : l'état des deux groupes s'est amélioré sur le plan de la douleur, de la fonction et de la QdV au cours de la période de 12 mois (p < 0,05). Les deux groupes ne présentaient aucune différence au bout de 12 mois, mais le groupe SHMN ressentait nettement moins de douleurs au bout de six mois (p = 0,03). Les patients qui présentaient encore des douleurs neuropathiques (p < 0,001) et une catastrophisation élevée de la douleur (p = 0,02) au moment du suivi (à six et 12 mois) ressentaient davantage de douleur. Conclusions : les deux groupes présentaient une amélioration semblable de la fonction et de la QdV au suivi de 12 mois. Le groupe SHMN présentait considérablement moins de douleur au suivi de six mois et une classification moyenne de la douleur plus basse au suivi de 12 mois, même si la différence entre les groupes n'était pas significative. La douleur neuropathique est courante au sein de cette population, et lorsqu'elle persistait, les patients présentaient plus de douleur et de limitations fonctionnelles au suivi de 12 mois.

Biodex© training post-stroke for postural stability in the upper trunk: A pilot study.

BACKGROUND: Stroke affects upper trunk postural stability and upper limb function in approximately 85% of stroke survivors. Upper trunk postural stability is essential for functioning of the upper limb and is a prerequisite for hand function. The rehabilitation of the upper limb and upper trunk post-stroke remains a challenge because of poor recovery of motor and sensory function. OBJECTIVES: To determine the effect of Biodex© upper limb weight-bearing training on upper trunk postural stability in patients post-stroke. METHOD: A longitudinal randomised control pilot trial with single blinding was undertaken to assess postural stability on the Biodex© at baseline and 1-month post-baseline. In addition to standard rehabilitative care, upper limb weight-bearing training on the Biodex© was added for participants in the experimental group. Descriptive data analysis and the Mann-Whitney test for group comparisons were done using STATA (p < 0.05). RESULTS: Fifteen participants took part, seven in the control and eight in the experimental group, with an overall median age of 55 years. At baseline there were statistically significant lower scores in the experimental group on overall (p = 0.02) and anterior/posterior (p = 0.009) stability level 6 (moderately unstable base of support) in the upper trunk postural stability scores. No statistically significant improvements were noted between groups on any of the Biodex© stability levels at 1-month post-baseline testing (p > 0.05). CONCLUSION: Upper limb weight-bearing training with the addition of Biodex© training did not result in improvements in upper trunk postural stability. CLINICAL IMPLICATIONS: The findings suggest that exercising on a moderately unstable base of support may improve upper trunk postural stability in patients post-stroke. The addition of Biodex© training to standard rehabilitative care for retraining and exercising upper trunk postural control in a weight-bearing position does not lead to better outcomes than standard care.

Barriers and facilitators in implementing an exercise-based injury prevention program for string players.

BACKGROUND: Musicians are at risk of developing playing-related injuries/musculoskeletal problems - to the extent that several injury-prevention strategies have been employed by them. In order to ensure compliance and improve implementation strategies, this study explores the opinions of musicians and music tutors on the barriers and facilitators in implementing an injury prevention program for string players, and the perceptions of the first mentioned as to the practicality of such an exercise-based injury prevention program. METHOD: This study employed a qualitative method (focus group discussion) to explore the opinions of musicians on exercise-based injury-prevention programs for string players and their implementation strategies. Content thematic analysis was used to analyze and interpret the data. RESULTS: Two music schools, with 11 musicians, participated in the study. The mean age and the mean years of experience of the participants were 28.2±6 years and 12.4±3.8 years respectively. The results of this study showed willingness in the musicians to adopt an exercise-based injury prevention program. However, the major challenge proved to be the time constraint of including an exercise program in the participants' normal practice and teaching routines. CONCLUSION: There is a willingness to explore possible exercise-based intervention programs to mitigate or prevent instrument-playing-related health problems. However, time constraints proved to be the major barrier to implementation. It was further concluded that consideration should be given to the duration of the intervention program and the mode to adopt in the implementation of the exercise program.

Effects of shoulder strapping in patients with stroke: A randomised control trial.

BACKGROUND: Disability post stroke remains a global problem, with upper limb involvement playing a key role. Shoulder strapping is one of the techniques used clinically to address this. OBJECTIVES: To compare the effect of two shoulder strapping techniques in patients with stroke. METHOD: A longitudinal randomised controlled trial included baseline, weeks one, two and six assessments of 56 participants with upper limb hemiplegia. The participants were assessed for shoulder subluxation, shoulder pain, upper limb motor function and muscle tone. They were randomised into control, longitudinal strapping or circumferential strapping groups. RESULTS: Longitudinal strapping had a non-significant decrease in shoulder subluxation and pain (p > 0.05). Circumferential strapping had no significant effect on any outcomes; however, it prevented the shoulder pain from worsening as much as in the control group (p > 0.05). General improvement in upper limb motor function was observed for all three groups. CONCLUSION: Trends in improvement showed that longitudinal strapping could be recommended because it positively influenced shoulder subluxation and pain. Even without significant changes, strapping creates awareness of the limb in patients and caregivers and could be of clinical benefit. CLINICAL IMPLICATION: Longitudinal strapping of the shoulder in patients with stroke seems to positively influence shoulder subluxation and pain.

The differences in functional recovery between HIV-positive and HIV-negative stroke survivors.

OBJECTIVES: This study aims to identify the differences in functional abilities between stroke survivors who are human immunodeficiency virus (HIV)-positive and HIV-negative. PATIENTS AND METHODS: This was a retrospective, longitudinal record review of stroke survivors' files between April 2005 and December 2010. Of a total of 173 stroke survivors who were admitted to the rehabilitation unit, 141 (75 males, 66 females; mean age 52.7±14.3 years; range, 19 to 86 years) met the inclusion criteria. The patients were divided into two groups as HIV-positive (n=21) and HIV-negative (n=120). Functional ability was recorded using the admission and discharge BETA® scores. RESULTS: Ischemic strokes were more prevalent than hemorrhagic strokes (74.5% vs. 25.5%, respectively) with hypertension as the most common (31.9%) stroke risk factor. The mean age of stroke onset for HIV-positive patients and HIV-negative patients was 39.6 years and 54.9 years, respectively. In HIV-positive patients, the mean duration of rehabilitation was 7.5-day shorter than HIV-negative patients. After receiving rehabilitation from a multidisciplinary team, the HIV-positive group improved with a mean of 40 points and the HIV-negative group improved with a mean of 38 points. The similarities in functional outcome between the HIV-positive and HIV-negative group were related to the fact that HIV-positive stroke survivors were relatively younger than the HIV-negative group. CONCLUSION: Our study results show that patients who sustain a stroke, are HIV-positive, are receiving antiretroviral therapy and rehabilita- tion may recover similar to those who are HIV-negative, spending a similar length of stay in a rehabilitation clinic. Therefore, stroke survivors who are HIV-positive should receive full rehabilitation similar to any other stroke survivors.

Ergonomic behaviour of learners in a digitally driven school environment: Modification using an ergonomic intervention programme.

BACKGROUND: Computer use is increasing amongst adolescents and so is the potential for related musculoskeletal pain and postural changes. The cumulative effect of this technology-induced, sedentary lifestyle leads to poor posture, pain, repetitive strain injury and dysfunctional movement patterns. OBJECTIVES: The purpose of this study was to establish the effect of a computer-related ergonomic intervention for adolescents in a school environment on posture and ergonomic behaviour. METHODS: All Grade 8 learners at two randomly selected private schools in Johannesburg were invited to participate in the study (n = 127). A controlled trial compared an intervention group with a control group. The computer usage questionnaire and rapid upper limb assessment (RULA) were assessed at baseline, 3 and 6 months post-intervention. The intervention consisted of a participatory educational programme. An intention-to-treat analysis was undertaken. Alpha level was set at p = 0.05. Descriptive statistics (frequencies and percentages) and between-group analysis of variance, determined differences in the number of participants in the RULA action levels between groups after the intervention and the comparison of positions and type of computer. RESULTS: At 6 months post-intervention, there were no participants in action level (AL) 4 and the number of participants in AL 3 had reduced from 26.2% at baseline to 14.8% in the intervention group (p < 0.001). The control group RULA scores worsened over the period of 6 months. Although the learners were still not in an 'acceptable' range of postural positions, there was a significant improvement between the pre-intervention and post-intervention stage (p < 0.001). CONCLUSION: These findings demonstrate the effect of an ergonomic intervention and its sustainability over 6 months. CLINICAL IMPLICATIONS: The clinical contribution of this study to our healthcare system is that through the early identification and intervention of the poor ergonomics in a school environment, a positive impact on reducing poor postural behaviour amongst learners can be achieved.

Functional status and physical impairments of adult patients infected with the human immunodeficiency virus admitted to hospital: a scoping review protocol.

RESEARCH QUESTION/OBJECTIVE: The objectives of this scoping review are to describe the physical impairments and subsequent level of function of adult individuals infected with the human immunodeficiency virus (HIV) admitted to an acute care hospital, determine the outcome measures used by rehabilitation professionals when evaluating said impairments and level of function in the population of interest, and identify the rehabilitation interventions offered to individuals while in hospital as a means of addressing these physical impairments and individuals' functional status.Specifically, the research questions are:The current scoping review will comprehensively identify the physical impairments of people living with HIV when admitted to an acute care hospital and highlight the subsequent influence on their level of function as a means of emphasizing the disability present. Findings regarding the rehabilitation interventions offered could inform clinical practice as a means of mapping which interventions are offered to address the related physical impairments and thus highlight areas for future research.

Musculoskeletal problems among string instrumentalists in South Africa.

BACKGROUND: Musicians who play string instruments are affected more by musculoskeletal injuries when compared to other instrument playing groups. Musculoskeletal problems are commonly found in the upper extremities and trunk. Several risk factors such as gender, practice hours and instrument played are associated with the prevalence and distribution of musculoskeletal problems among string instrumentalists. OBJECTIVES: The aim of this study was to determine the prevalence, distribution, severity and risk factors for musculoskeletal problems among string instrumentalists. METHOD: A cross-sectional study design using both online and paper-based questionnaires were used to collect data from string instrumentalists playing in both amateur and professional orchestras in South Africa. RESULTS: A total of 114 string instrumentalists participated in the study, of which 86 (77%) reported problems in one or more anatomic regions while 39 (35%) were currently experiencing musculoskeletal problems that affected their performance. The trunk and both shoulders were the most commonly affected body regions. The majority of the participants reported the severity of the complaints as mild to moderate with aching, soreness, tingling and fatigue being the most commonly used descriptors of the symptoms of playing-related musculoskeletal problems. CONCLUSION: The results of this study showed that the prevalence of musculoskeletal problems that affect performance is high among string instrumentalists in South Africa. An evaluation of associated risk factors with the aim of reducing injuries may be important in improving performance.

The Effectiveness of Neural Mobilization for Neuromusculoskeletal Conditions: A Systematic Review and Meta-analysis.

Study Design Systematic review with meta-analysis. Objectives To determine the efficacy of neural mobilization (NM) for musculoskeletal conditions with a neuropathic component. Background Neural mobilization, or neurodynamics, is a movement-based intervention aimed at restoring the homeostasis in and around the nervous system. The current level of evidence for NM is largely unknown. Methods A database search for randomized trials investigating the effect of NM on neuromusculoskeletal conditions was conducted, using standard methods for article identification, selection, and quality appraisal. Where possible, studies were pooled for meta-analysis, with pain, disability, and function as the primary outcomes. Results Forty studies were included in this review, of which 17 had a low risk of bias. Meta-analyses could only be performed on self-reported outcomes. For chronic low back pain, disability (Oswestry Disability Questionnaire [0-50]: mean difference, -9.26; 95% confidence interval [CI]: -14.50, -4.01; P<.001) and pain (intensity [0-10]: mean difference, -1.78; 95% CI: -2.55, -1.01; P<.001) improved following NM. For chronic neck-arm pain, pain improved (intensity: mean difference, -1.89; 95% CI: -3.14, -0.64; P<.001) following NM. For most of the clinical outcomes in individuals with carpal tunnel syndrome, NM was not effective (P>.11) but showed some positive neurophysiological effects (eg, reduced intraneural edema). Due to a scarcity of studies or conflicting results, the effect of NM remains uncertain for various conditions, such as postoperative low back pain, cubital tunnel syndrome, and lateral epicondylalgia. Conclusion This review reveals benefits of NM for back and neck pain, but the effect of NM on other conditions remains unclear. Due to the limited evidence and varying methodological quality, conclusions may change over time. Level of Evidence Therapy, level 1a. J Orthop Sports Phys Ther 2017;47(9):593-615. Epub 13 Jul 2017. doi:10.2519/jospt.2017.7117.

University of the Witwatersrand physiotherapy undergraduate curriculum alignment to medical conditions of patients within Gauteng state health facilities.

BACKGROUND: The healthcare sector requires graduates with the ability to confidently assess and manage the majority of the medical conditions seen in hospitals. OBJECTIVE: To establish whether the most prevalent medical conditions treated by physiotherapists in Gauteng (South Africa) state health facilities align with the University of the Witwatersrand (Wits) physiotherapy curriculum. METHODS: This was a retrospective review of condition-related statistics from physiotherapy departments within the Gauteng province state health facilities. Data from all Gauteng government hospitals that had submitted at least 75% of their physiotherapy condition-related statistics to the provincial statistics coordinator from January 2012 to December 2014 were considered and compared to medical conditions covered in the Wits 2015 physiotherapy curriculum to check if all conditions listed in the Gauteng statistics appeared within the Wits curriculum document. The number of teaching hours for the common conditions was noted to check the emphasis given to these conditions in the curriculum. RESULTS: Eighty-three per cent of the hospitals submitted 75% of their monthly statistics. Overall, the most common conditions treated were lower limb fractures (13%) followed by stroke (7.6%) (n = 705 597). Within the neuro-musculoskeletal category, the most common conditions after lower limb fractures were soft tissue injuries (15.1%) (n = 330 511). The most common cardiopulmonary conditions were tuberculosis (24.9%), followed by pneumonia (13.8%) (n = 94 895). The most common neurological conditions were stroke (30.9%) followed by cerebral palsy (17%) (n = 174 024). Within the non-specified categories, the number of intensive care unit (ICU) patients was the highest (23%), followed by sputum induction (21%) (n = 138 187). The most common conditions that were emphasised within the Wits curriculum as indicated by the teaching hours: fractures, 14.5 (66%) of 22 third-year orthopaedics hours; stroke, 30 (73%) of 41 third-year neurology hours; soft tissue injuries, 18 (38%) of 48 fourth-year neuro-musculoskeletal hours; back lesions, 24 (50%) of 48 fourth-year neuro-musculoskeletal hours; and ICU patients, 30 (79%) of 38 fourth-year cardiopulmonary hours. CONCLUSION: The Wits physiotherapy curriculum covers all medical conditions treated by physiotherapists within the Gauteng state health facilities, and overall, the curriculum prepares the students to practise in a variety of situations.

The effect of a computer-related ergonomic intervention program on learners in a school environment.

BACKGROUND: The interest in school ergonomic intervention programs and their effects on musculoskeletal pain is increasing around the world. OBJECTIVE: The objective of this longitudinal randomized control trial was to implement and measure the effects of a computer-related ergonomics intervention on grade eight learners in a school environment in Johannesburg South Africa (a developing country). METHODS: The sample comprised of a control group (n= 66) and an intervention group (n= 61). The outcome measures used were posture assessment using the Rapid Upper Limb Assessment tool (RULA) and the prevalence of musculoskeletal pain using a visual analogue scale (VAS). Measurements were done at baseline, three months and six months post intervention. RESULTS: The results showed that the posture of the intervention group changed significantly from an Action Level 4 to an Action level 2 and Action level 3, indicating a sustained improvement of learners' postural positions whilst using computers. The intervention group showed a significant reduction in the prevalence of musculoskeletal pain from 42.6% at baseline to 18% six months post intervention (p< 0.003). CONCLUSION: In conclusion, the results indicated that a computer-related intervention program for grade eight learners in a school environment is effective and that behavioural changes can be made that are sustainable over a period of six months.

The effectiveness of neural mobilizations in the treatment of musculoskeletal conditions: a systematic review protocol.

REVIEW QUESTION/OBJECTIVE: The objective of this review is to identify the effectiveness of neural mobilization techniques in various neuro-musculoskeletal conditions. Outcomes will be analyzed in terms of subgroups such as low back pain, cervico-brachial pain and carpal tunnel syndrome. BACKGROUND: Musculoskeletal disorders were ranked as the second largest contributor to disability worldwide in a study on the global burden of disease. Low back pain and neck pain contributed to 70% of disability in this comprehensive population-based study. Low back pain and neck pain are multifactorial, with heterogeneous populations. It has been proposed that targeting subgroups of patients may result in better treatment outcomes. Neck pain associated with upper limb pain is prevalent. These patients are more disabled than patients with neck pain alone. Similarly, low back pain with leg pain is a common phenomenon and is acknowledged as a predictor for chronicity.Neuropathic pain is often associated with musculoskeletal complaints including low back pain, whiplash associated disorders (WAD) and acute or chronic radiculopathy, and can be a feature of syndromes such as cervico-brachial pain syndrome. According to the International Association for the Study of Pain, neuropathic pain can be described as "pain caused by a lesion or disease of the somatosensory nervous system." Leg pain associated with back pain can be caused by central sensitization, denervation, nerve sensitization or somatically referred pain. In patients with WAD, neck pain is the most common symptom, but upper limb pain, weakness, paraesthesia and anesthesia are often present. Other conditions in which neural tissue is thought to contribute to the clinical picture are, for instance, lateral epicondalalgia and carpal tunnel syndrome.Management strategies for back pain and neck pain are often multimodal. However, the evidence for effective treatment of nerve related pain is lacking. Neural mobilizations are often used to affect the neural structures in conditions with signs of neural involvement or neural mechano-sensitivity. Neural mobilizations are defined as interventions aimed at affecting the neural structures or surrounding tissue (interface) directly or indirectly through manual techniques or exercise. Neural mobilizations have been studied in various populations such as low back pain, carpal tunnel syndrome, lateral epicondalalgia and cervico-brachial pain. Neural mobilization techniques studied include cervical lateral glides for cervico-brachial pain, nerve gliding exercises for the treatment of carpal tunnel syndrome, cervical lateral glides for lateral epicondalalgia and the slump as a neural mobilization technique in the treatment of low back pain. No specialized equipment is needed in the performance of neural mobilization techniques, which contributes to its popularity.Neural mobilization is said to affect the axoplasmic flow, movement of the nerve and its connective tissue and the circulation of the nerve by alteration of the pressure in the nervous system and dispersion of intraneural oedema. Neural mobilization decreases the excitability of dorsal horn cells. Neural mobilizations can be performed in various ways using passive movement, manual mobilization of the nerve or interface, and exercise. The aim of neural mobilization is to restore the mechanical and neurophysiological function of the nerve.Only one systematic review on the effectiveness of neural mobilizations could be identified in the literature. Since this review, several more studies have been published on this subject. The authors hypothesize that a review of the more recent literature (2008-2014) may confirm positive support for the use of neural mobilizations for neuro-musculoskeletal complaints as previously seen by Ellis and Hing. This review aims to include a meta-analysis and subgrouping of conditions which will be an extension of the previous review by Ellis and Hing. The outcomes of this systematic review may be used to inform clinical practice and the development of best practice guidelines.