Pain medication misuse in the South African spinal cord injury context.

Background: Pain after spinal cord injury (SCI) is debilitating and has been reported to be difficult to treat, despite pharmacological interventions. Pain medication misuse (PMM) and associated individual factors among people with spinal cord injury (PWSCI) are scarce. Aim: To determine PMM and the associated factors in PWSCI. Setting: Homes of community-dwelling manual wheelchair users with SCI in South Africa. Methods: Community-dwelling PWSCI (n = 122) were consecutively sampled and the Pain Medication Questionnaire (PMQ) was used to determine PMM. Descriptive statistics, Fisher's exact test, independent t-tests, and simple linear regression tests were performed using SPSS v27. Testing was conducted at the 0.05 level of significance. Results: Eighty-five per cent of the participants reported the presence of pain and 48.1% of them used pain medication. Forty-four percent of people who used pain medication scored ≥ 30, indicative of serious aberrant drug-taking behaviours. Opioids were mainly used for neuropathic pain and in combination with other types of medications such as anticonvulsants and non-steroidal anti-inflammatories (44.0%). Pain severity and the type of pain medication were found to be predictors of PMM (p < 0.01 respectively). Conclusion: Pain relief after SCI remains difficult to achieve, with an evident high risk of PMM, which may lead to long-lasting side effects, dependency, or overdose. Contribution: This study has shown the need for the assessment of the potential risk of dependency before prescribing pain medication, particularly opioids to PWSCI.

Exploring the Experience of Living with Pain after Spinal Cord Injury: A Qualitative Study.

A spinal cord injury is a life-changing experience that results in functional limitations and an increased risk of secondary health conditions. People with spinal cord injury identify pain as the most devastating health problem following their injury that not only affects their social life but their mental well-being as well. This study is aimed at exploring the lived experience of living with pain by community-dwelling manual wheelchair users with spinal cord injuries. An explorative qualitative design was used to explore their experiences. In-depth interviews were recorded and transcribed, and the data were analysed using inductive thematic content analysis in the MAXQDA v2020. Fifteen manual wheelchair users with paraplegia participated in this study, and four themes were identified from their experience of living with pain: pain constantly lurks, pain is worse than the direct consequences of the SCI, pain is restrictive, and life continues despite the pain. Categories and subcategories included the participants being one with the pain; pain interfering with sleep; feelings of anger, isolation, and suicidal ideation; and uncertainties about what the future holds living with pain. Living with pain after SCI is a challenging feat, and effective management of pain is necessary to improve not only functioning and mobility but also mental health and life satisfaction.

Development of a pain self-management intervention framework for people with spinal cord injury.

BACKGROUND:  Pain is the most common reason for medical visits to primary health care practitioners. Pain self-management interventions are encouraged and there is no known self-management intervention framework available that clinicians and people with spinal cord injury (PWSCI) can use to guide treatment selection. AIM:  This study aimed to develop a pain self-management intervention framework for PWSCI. SETTING:  Online and facilitated in Gauteng, South Africa. METHODS:  A three-round modified e-Delphi method was used to reach an 80% consensus among a 21-expert panel. Fifty-nine interventions were distributed via REDCap and a final online audio meeting was held to either include or exclude interventions in the final framework. SPSS v27 was used to analyse descriptive data and content analysis was used for qualitative responses. RESULTS:  The final developed pain self-management framework consists of 56 interventions and includes interventions from multiple health professions to encompass medical, psychological, therapeutic and social interventions. Interventions are also specified for nociceptive and/or neuropathic pain and grouped according to the biopsychosocial model. CONCLUSION:  The interprofessional framework may be used as a guideline for PWSCI to alleviate pain, as well as assist health professionals in clinical decision-making, by providing them with the freedom to choose acceptable and adequate interventions that may be appropriate to treat the affected individual's pain.Contribution: Pain management is a basic need at the primary healthcare level and PWSCI need access to the broad range of interventions available to manage their pain. The framework highlights the variety of appropriate interventions to guide both health professionals and PWSCI with pain relief options.

Males, Older Age, Increased Training, Chronic Diseases, Allergies, and History of Injury Are Independent Risk Factors Associated With a History of Exercise-Associated Muscle Cramping in Distance Runners in 76 654 Race Entrants - SAFER XXIX.

OBJECTIVE: To determine independent risk factors associated with a history of exercise-associated muscle cramps (hEAMCs) in distance runner race entrants in a community-based mass participation event. DESIGN: Cross-sectional study. SETTING: 2012 to 2015, Two Oceans marathon races (21.1 and 56 km), South Africa. PARTICIPANTS: Seventy six thousand six hundred fifty-four consenting race entrants. ASSESSMENT OF RISK FACTORS: Entrants completed an online prerace medical screening questionnaire as part of the entry process. In a multiple model, sex, age, training variables, history of chronic disease, allergies, and running injuries were included as potential factors associated with hEAMC in 21.1 and 56 km entrants. MAIN OUTCOME MEASURES: Prevalence (%) and prevalence ratios (PRs, 95% confidence intervals) are reported. RESULTS: Men ( P < 0.0001) and older age (>40 years, P < 0.0001) were significantly associated with hEAMC. Therefore, the model was adjusted for sex and age group and run separately for 21.1- and 56-km entrants. Specific independent risk factors associated with hEAMC in 21.1- and 56-km entrants were: a history of chronic diseases (21.1 km: PR = 1.9; 56 km: PR = 1.6; P < 0.0001), running injury in the last 12 months (21.1 km: PR = 1.7; 56 km: PR = 1.4; P < 0.0001), history of allergies (21.1 km: PR = 1.4; 56 km: PR = 1.2; P < 0.0001), and various training variables (PR = 1.0-1.1). CONCLUSION: In 21.1- and 56-km race entrants, independent risk factors associated with hEAMC were men, older age, longer race distances, training variables, chronic diseases, history of allergies, and history of a running injury in the past 12 months.

Development of a trail running injury screening instrument: A multiple methods approach.

OBJECTIVE: To develop a trail running injury screening instrument (TRISI) for utilisation as clinical decision aid in determining if a trail runner is at an increased risk for injury. DESIGN: Multiple methods approach. METHODS: The study utilised five phases 1) identification of injury risk factors 2) determining the relevance of each identified risk factor in a trail running context, 3) creating the content of the Likert scale points from 0 to 4, 4) rescaling the Likert scale points to determine numerical values for the content of each Likert scale point, and 5) determining a weighted score for each injury risk factor that contributes to the overall combined composite score. RESULTS: Of the 77 identified injury risk factors, 26 were deemed relevant in trail running. The weighted score for each injury risk factor ranged from 2.21 to 5.53 with the highest calculated score being 5.53. The final TRISI includes risk categories of training, running equipment, demographics, previous injury, behavioural, psychological, nutrition, chronic disease, physiological, and biomechanical factors. CONCLUSION: The developed TRISI aims to assist the clinician during pre-race injury screening or during a training season to identify meaningful areas to target in designing injury risk management strategies and/or continuous health education.

The presence of pain in community-dwelling South African manual wheelchair users with spinal cord injury.

Background: Pain after spinal cord injury (SCI) is common and is likely to continue throughout life with varying levels of severity. Objective: To determine the presence of pain, the sociodemographic and injury profile of community-dwelling manual wheelchair users. Method: This quantitative correlational study used a sociodemographic and injury profile sheet and the Douleur Neuropathique 4 Questions (DN4) questionnaire to document demographic, SCI profiles as well as pain characteristics. Pain severity was determined using the Numeric Rating Scale. Data were analysed using the Statistical Package for the Social Sciences (SPSS) v27 at 0.05 level of significance. Results: The pain rate was 104; 85% of 122 participants and mainly in those with complete SCI (77.9%). Neuropathic pain was more common (76; 62.5%) and significantly associated (p < 0.05) with higher pain severity. Pain was mainly in one area of the body (59; 48.4%) but occurring in up to five areas. The most painful area had a mean severity of 6.7/10; was more common in the lower limbs below the injury level (48; 39.4%); and was burning in nature (40; 32.7%). Conclusions: Pain after SCI is as problematic in the South African context as it is globally. With the rising SCI prevalence in the country, understanding pain and its presentation is important for holistic management of a person with SCI. Clinical implications: In-depth assessment of pain should be conducted and appropriate management interventions for specific pain types be prescribed to effectively reduce pain.

Prevalence, Clinical Characteristics, and Self-Reported Treatment of Exercise-Associated Muscle Cramping Differ Between 21.1- and 56-Km Running Race Entrants-SAFER XXII.

OBJECTIVE: To determine whether the lifetime prevalence and clinical characteristics of exercise-associated muscle cramping (EAMC) differ between runners entering a 21.1- versus 56-km road race. DESIGN: Cross-sectional study. SETTING: The 2012 to 2015 Two Oceans Marathon races (21.1 and 56 km), South Africa. PARTICIPANTS: Participants were consenting race entrants (21.1 km = 44 458; 56 km = 26 962) who completed an online prerace medical screening questionnaire. INDEPENDENT VARIABLE: A history of EAMC. MAIN OUTCOME MEASURES: The main outcome variables were lifetime prevalence (%) and clinical characteristics (muscle groups affected, timing of occurrence, severity, frequency of serious EAMC, and self-reported treatment) of a history of EAMC. Differences between 56- and 21.1-km race entrants were explored (relative risk [RR]). RESULTS: The lifetime prevalence of EAMC was 12.8%, which was higher in 56- (20.0%; 95% CI 19.5-20.6) versus 21.1-km race entrants (8.5%; 8.2-8.8) ( P = 0.0001). In all entrants, the fourth quarter was the most common onset (46.4%), calf muscles were the most commonly affected (53.1%), and most EAMCs were of mild-to-moderate severity (95%). In 56- versus 21.1-km entrants, hamstring (RR = 1.7; 1.5-1.9) and quadriceps muscle groups (RR = 1.5; 1.3-1.7) were more frequently affected ( P = 0.0001), the onset of EAMC during racing was less common in the first quarter (RR = 0.3; 0.2-0.4) ( P = 0.0001), and serious EAMC was more frequent (RR = 1.6; 1.4-1.9) ( P = 0.0001). CONCLUSIONS: In 56- versus 21.1-km runners, a history of EAMC is 2 times more frequent and muscle groups affected, onset in a race, and severity of EAMC differed. The lifetime prevalence was lower than previously reported in other events. Risk factors associated with EAMC may differ between entrants for different race distances.

Management of spinal cord injury-related pain using complementary and alternative medicine: a scoping review protocol.

OBJECTIVE: This scoping review will identify complementary and alternative medicine methods used to manage spinal cord injury-related pain. INTRODUCTION: Spinal cord injury-related pain is common, with a third of individuals experiencing severe pain. Conventional interventions are well documented, however, pain relief remains elusive for people with spinal cord injuries. Although complementary and alternative medicine is available to alleviate various health problems, little is known about the complementary and alternative medicine methods used to manage pain in people with spinal cord injuries. INCLUSION CRITERIA: This review will consider all studies on complementary and alternative medicine treatment methods used by adults with spinal cord injury to treat their associated pain. The concept of interest in this study is complementary and alternative medicine. Quantitative, qualitative, and mixed methods studies, text and opinion papers, as well as systematic reviews will be included in this review. METHODS: A three-step search strategy, consisting of an initial limited search, a full search, and a screening of the reference lists of all included articles will be undertaken. Key information sources to be searched include CINAHL, Cochrane Library, JBI Evidence Synthesis, MEDLINE, Scopus, Web of Science, DynaMed, Natural Medicines, HerbMed, Open Dissertations, and OpenGrey. All titles and abstracts of identified citations will be screened and then uploaded to a reference management program. The full text of studies potentially meeting the inclusion criteria will be assessed in detail, and relevant data will be extracted and reported in tabular format, in line with the objectives and scope of the review.

Epidemiology, Clinical Characteristics, and Risk Factors for Running-Related Injuries among South African Trail Runners.

Trail running involves running on varying natural terrains, often including large elevation gains/losses. Trail running has a high risk of injury, and runners often participate in remote regions where medical support is challenging. The aim of this study was to determine the epidemiology, clinical characteristic, and associated injury risk factors among trail runners. A modified Oslo Sports Trauma Research Center Questionnaire for Health Problems (OSTRC-H) was used biweekly to collect running-related injury (RRI) and training history data prospectively, among 152 participants (males n = 120, females n = 32) over 30 weeks. We report an overall injury rate of 19.6 RRIs per 1000 h and an RRI mean prevalence of 12.3%. The leading anatomical site of RRIs was the lower limb (82.9%), affecting the knee (29.8%), shin/lower leg (18.0%), and the foot/toes (13.7%). A history of previous RRI in the past 12 months (p = 0.0032) and having a chronic disease (p = 0.0188) are independent risk factors for RRIs among trail runners. Two in three trail runners sustain an RRI mainly affecting the knee, shin/lower leg, and foot/toes. A history of previous RRI in the past 12 months and a having chronic disease is independently associated with RRI among trail runners. These results could be used to develop future RRI prevention strategies, combined with clinical knowledge and experience.

Epidemiology of Injury and Illness Among Trail Runners: A Systematic Review.

BACKGROUND: Trail running is characterised by large elevation gains/losses and uneven varying running surfaces. Limited information is available on injury and illness among trail runners to help guide injury and illness prevention strategies. OBJECTIVE: The primary aim of this review was to describe the epidemiology of injury and illness among trail runners. METHODS: Eight electronic databases were systematically searched (MEDLINE Ovid, PubMed, Scopus, SportsDiscus, CINAHL, Health Source: Nursing/Academic, Health Source: Consumer Ed., and Cochrane) from inception to November 2020. The search was conducted according to the PRISMA statement and the study was registered on PROSPERO international prospective register of systematic reviews (CRD42019135933). Full-text English and French studies that investigated injury and/or illness among trail runners participating in training/racing were included. The main outcome measurements included: trail running injury (incidence, prevalence, anatomical site, tissue type, pathology-type/specific diagnosis, severity), and illness (incidence, prevalence, symptoms, specific diagnosis, organ system, severity). The methodological quality of the included studies was assessed using an adapted Downs and Black assessment tool. RESULTS: Sixteen studies with 8644 participants were included. Thirteen studies investigated race-related injury and/or illness and three studies included training-related injuries. The overall incidence range was 1.6-4285.0 injuries per 1000 h of running and 65.0-6676.6 illnesses per 1000 h of running. The foot was the most common anatomical site of trail running injury followed by the knee, lower leg, thigh, and ankle. Skin lacerations/abrasions were the most common injury diagnoses followed by skin blisters, muscle strains, muscle cramping, and ligament sprains. The most common trail running illnesses reported related to the gastro-intestinal tract (GIT), followed by the metabolic, and cardiovascular systems. Symptoms of nausea and vomiting related to GIT distress and dehydration were commonly reported. CONCLUSION: Current trail running literature consists mainly of injury and illness outcomes specifically in relation to single-day race participation events. Limited evidence is available on training-related injury and illness in trail running. Our review showed that injury and illness are common among trail runners, but certain studies included in this review only focused on dermatological injuries (e.g. large number of feet blisters) and GIT symptoms. Specific areas for future research were identified that could improve the management of trail running injury and illness.

Pain and its impact on functioning and disability in manual wheelchair users with spinal cord injury: a protocol for a mixed-methods study.

INTRODUCTION: Approximately 80% of people with spinal cord injury experience clinically significant chronic pain. Pain (whether musculoskeletal or neuropathic) is consistently rated as one of the most difficult problems to manage and negatively affects the individual's physical, psychological and social functioning and increases the risk of pain medication misuse and poor mental health. The aim of this study is to therefore determine the presence of pain and its impact on functioning and disability as well as to develop a framework for self-management of pain for South African manual wheelchair users with spinal cord injury. METHODS AND ANALYSIS: Community-dwelling participants with spinal cord injury will be invited to participate in this three-phase study. Phase 1 will use a quantitative, correlational design to determine factors related to pain such as pectoralis minor length, scapular dyskinesis, wheelchair functioning, physical quality of life, community reintegration and pain medication misuse. Demographic determinants of pain such as age, gender, type of occupation, completeness of injury and neurological level of injury will also be investigated. Participants with pain identified in phase 1 will be invited to partake in a qualitative descriptive and contextually designed phase 2 to explore their lived experience of pain through in-depth interviews. The results of phases 1 and 2 will then be used with the assistance from experts to develop a framework for self-management of pain using a modified Delphi study. Data analysis will include descriptive and inferential statistics (quantitative data) and thematic content analysis (qualitative data). ETHICS AND DISSEMINATION: Approval for this study is granted by the Faculty of Health Sciences Research Ethics Committee of the University of the Pretoria (approval number 125/2018). This study is registered with the South African National Health Research Database (reference GP201806005). This study's findings will be shared in academic conferences and published in scientific peer-reviewed journals.

One in four trail running race entrants sustained an injury in the 12 months training preceding the 2019 SkyRun race.

OBJECTIVE: To determine the epidemiology and clinical characteristics of RRIs among trail runners who entered the 2019 SkyRun races. DESIGN: Descriptive cross-sectional study. SETTING: 2019 SkyRun races. PARTICIPANTS: Consent for data analysis was given by 305 of 412 (74%) race entrants. MAIN OUTCOME MEASURES: Retrospective annual incidence (RRIs/1000 h), point prevalence (%), frequency (%), characteristics (anatomical region, body area, tissue type, pathology type) and injury severity (mean severity score; 95% CI) of RRIs. RESULTS: 28.2% of participants reported at least one RRI. The retrospective annual incidence was 49.5 RRIs per 1000h and the point prevalence was 1.3%. Most injuries occurred in the lower limb (87.3%), with the knee (26.5%), ankle (21.6%), and foot (16.7%) reported as the most frequently injured body areas. Muscle/tendon accounted for 44.1% of tissue type injuries. Tendinopathy (27.5%), joint sprain (19.6%), and muscle injury (15.7%) were the most common pathology types reported. The mean injury severity score was 31.6. CONCLUSIONS: One in 4 trail runners reported at least one RRI in the 12 months leading up to a race. RRIs mostly affected the lower limb specifically the knee, ankle and foot. Future research should establish injury risk factors to ultimately develop specific injury prevention strategies.

Twelve tips for supervisors to move towards person-centered research supervision in health care sciences.

The research supervisory role is becoming increasingly complex due to issues such as diversity of students; mismatched expectations between the student, supervisor and higher education institution and shorter and specific time-bound research outcomes. The current postgraduate research supervision culture and supervision practices should change. Moving towards person-centered research supervision practices may enhance the research environment, as healthful relationships between supervisors and postgraduate students may lead to increased postgraduate research outcomes. Using a World Café, we critically reflected on our existing research supervision practices. All healthcare educators involved in postgraduate research supervision were purposively selected to participate. During the café, we explored and shared ideas in a safe space. Twelve tips emerged, which can be implemented to move existing supervision practices towards person-centered research supervision practices. We present these twelve tips from the perspective of the four constructs of person-centeredness as outlined by McCormack and McCance - pre-requisites, environment, process, and outcomes. The use of these tips may enable both supervisors and students to flourish. Avoiding routine, ritual supervision practices and embracing person-centredness, will enable supervisors to form healthful relationships and put the postgraduate student at the heart of our supervision practices.

Inter- and intra-rater reliability of a technique assessing the length of the Latissimus Dorsi muscle.

BACKGROUND: Evidence-based practice requires the use of objective, valid and reliable tests for measuring the length of a muscle. Latissimus Dorsi is a muscle which undergoes length changes (loss of extensibility) and this muscle has a functional role in many aspects of sport and rehabilitation. The loss of extensibility may result in a decreased range of motion at the glenohumeral joint leading to dysfunction. OBJECTIVES: The aim of this study was to assess the inter-rater and intra-rater reliability of a technique adapted by Comerford and Mottram in 2012 for assessing the length of Latissimus Dorsi (LD) muscle. METHOD: Fifty-six students from a university's physiotherapy department participated in this study. Four physiotherapists with clinical experience varying between 10 and 30 years independently performed the test for assessing the length of LD. The test was performed twice by each physiotherapist on every participant during two reading sessions. RESULTS: The intra-class correlation coefficient (ICC) as determined in a mixed-effects, generalised least squares regression analysis was used to assess inter- and intra-rater reliability of the LD length test. A 0.05 level of significance was employed. A sample of 56 participants provided an ICC that varied between 0.76 and 0.55, which is regarded as moderate to poor reliability. The ICC between the experienced raters was found to be 0.48, with a novice rater having an ICC of 0.48 as well. The ICC between all the raters was 0.33, which constituted poor reliability. CONCLUSION: The poor to moderate reliability of the technique testing the length of LD test is not suitable for application in a research setting. CLINICAL IMPLICATIONS: The small differences noted between Reading 1 and Reading 2 regarding the standard deviation of all the raters combined suggests that the LD length test may still prove to be useful in quantifying dysfunction in a clinical setting.