Prevalence of concussion and adherence to return-to-play guidelines amongst male secondary school rugby and hockey players.

BACKGROUND: Concussion injuries are common in contact sports. Young players can suffer life-threatening complications if concussion is not recognised and managed. OBJECTIVES: To determine the prevalence of concussion amongst secondary school rugby and hockey players and describe players' knowledge and adherence to return-to-play guidelines. METHOD: A mixed-method approach included Phase A, which utilised a questionnaire completed by 221 players (n = 139 rugby; n = 82 hockey) between 13 and 18 years of age, and Phase B, which utilised three focus group discussions of 15 participants who had suffered a concussion. RESULTS: The prevalence of concussion (n = 221) was 31.2% (n = 69). Of those, 71% (n = 49) were rugby players. Those who had suffered a concussion were more confident in identifying symptoms of concussion in themselves and others compared with those who did not suffer a concussion (p = 0.001), were more aware of return-to-play guidelines and more confident in their knowledge of concussion (p = 0.001). There were no differences between groups when identifying concussion symptoms. Of those who had a concussion, 30.4% (n = 21) adhered to return-to-play guidelines and followed graded return-to-play after their concussion. Explanations for non-adherence to return-to-play protocols included peer pressure, intrinsic motivation and ignorance. CONCLUSION: Nearly a third had suffered a concussion injury; having suffered a concussion, and awareness of return-to-play guidelines, did not guarantee adherence to return-to-play protocols. Peer pressure and intrinsic factors explained this lack of adherence. CLINICAL IMPLICATIONS: Physiotherapists are often involved with the diagnosis and management of concussion injuries among rugby and hockey players. Understanding the prevalence and the reasons why young players do not adhere to the 'return to play' guidelines may inform preventative strategies.

Recommendations of behavioural facilitators for success in a physiotherapy clinical practice module: Successful students' perspectives.

BACKGROUND: Students struggle to bridge the gap between theory and application thereof in clinical settings. Exploring the behaviours of students who have been shown to be successful in the clinical practice module of physiotherapy could provide an insight into what facilitated their success. Sharing this information with other students could assist with decreasing anxiety and improving student success. OBJECTIVES: The objective of this study was to explore behaviours that facilitate student success in a physiotherapy clinical practice module from the perspective of high-achieving students. METHOD: Data were collected at the University of the Western Cape's physiotherapy department in South Africa. Ten students with the highest marks in clinical practice from the 2016 and 2017 final-year cohorts were purposively selected and invited to participate in two different Nominal Group Technique (NGT) discussions. In total, 14 students consented to participate in the study. A demographic and socio-economic status questionnaire and an NGT discussion were used to collect data. Participants analysed the NGT discussion data themselves by ranking facilitators in order of priority. RESULTS: Doing pre-block preparation, self-reflection and having a good rapport with patients as well as personal motivation and coping strategies were identified as the most important behavioural facilitators for physiotherapy students' success in a clinical practice module. CONCLUSION: Clinical practice is considered to be the most stressful module for undergraduate physiotherapy students. Considering this, recommendations from previously successful students could contribute towards the success of present and future students and in decreasing the stress associated with clinical practice. CLINICAL IMPLICATIONS: Recommendations from students on behavioural facilitators that enabled them to be successful in a physiotherapy clinical practice module can assist future students entering clinical practice to be successful in this stressful module. This information is also useful for clinical educators to assist students who struggle, and to recommend potential changes or improvements to the current physiotherapy clinical practice module.

Improving vibration perception in a patient with type 2 diabetes and sensory peripheral neuropathy.

INTRODUCTION: Diabetes mellitus (DM) and its related sensory peripheral neuropathy (SPN) are the biggest risk factors for foot ulcer formation and lower limb amputation. Reduced vibration perception results in less sensitivity to pressure and is a known risk factor for diabetic foot ulcers. Improving vibration perception in the feet of people with SPN could be protective against foot ulcers. The aim of this study was to determine if a therapeutic vibrating insole, used for 35 consecutive days, could improve vibration perception in a patient with type 2 DM. PATIENT PRESENTATION: The patient was a 63 year-old male with a medical history of peripheral vascular disease, controlled hypertension, hyperlipidaemia, artherosclerosis and SPN secondary to controlled type 2 diabetes. MANAGEMENT AND OUTCOME: The patient used the insoles for 20 min a day for 35 consecutive days. Vibration perception thresholds were measured four times in total: once at baseline, immediately post intervention, 1 month and 10 months later. Vibration perception threshold decreased with an average of 22 V (range 6 V-34 V) dependant on the tested location and time after intervention. The improvement remained after 1 and 10 months. CONCLUSION: The use of a vibrating insole as a therapeutic device improved this patient's perception of vibration in his feet. Clinically, vibrating insoles potentially might reduce the risk for ulcer formation and subsequent lower limb amputation in patients with DM and SPN. CLINICAL IMPLICATIONS: Using a vibrating insole therapeutically, can potentially improve the perception of vibration and pressure in patients with sensory peripheral neuropathy secondary to type 2 diabetes mellitus. Improved vibration perception might reduce the risk for diabetic ulcer formation and subsequent lower limb amputation.

Participation restrictions and vocational rehabilitation needs experienced by persons with a unilateral lower limb amputation in the Western Cape, South Africa.

BACKGROUND: Vocational rehabilitation (VR) aims to rehabilitate a person with an amputation back into actively participating in society. Even though lower limb amputation (LLA) surgery is commonly performed in South Africa (SA), little research has been published on the participation restrictions experienced by and vocational needs of persons with LLA in the Western Cape (WC). OBJECTIVES: The aim of this study was to determine and explore the participation restrictions and VR needs of persons with a unilateral LLA in the WC. METHOD: A mixed-methods approach and a sequential exploratory design were utilised to collect data from 50 persons with an LLA. Participants were conveniently sampled within the Cape Metropole region of the WC, SA. The World Health Organization Disability Assessment Schedule 2.0 (WHODAS 2.0) tool was used to collect the quantitative data, and telephonic interviews were conducted for qualitative data collection. RESULTS: A third (28%) of participants in this study were unemployed, and only 14% (n = 7) of the participants owned or used a prosthesis. In addition, 50% of the participants either had a disability grant or were on pension. The participation restrictions identified were mainly related to mobility where 74% (n = 37) of participants had extreme difficulty with mobility in general, 92% (n = 46) struggled with walking distances longer than 1 km and 80% (n = 40) had extreme difficulty in completing household tasks quickly. The main VR needs identified in this study were the inadequate rehabilitation services that target ambulation (standing and walking) to facilitate employment. CONCLUSION: Persons with a unilateral LLA still experience significant difficulties in mobility 3 months post-amputation, which negatively affects their participation in society and vocational activities.

Barriers and facilitators to utilisation of rehabilitation services amongst persons with lower-limb amputations in a rural community in South Africa.

BACKGROUND:: Persons with disabilities who reside in rural areas experience challenges accessing and utilising health services and rehabilitation. Due to the high prevalence of diabetes mellitus in rural regions, the risk of having a lower-limb amputation is increasing. Comprehensive rehabilitation is vital to mitigate the negative impact that a lower-limb amputation has on a person. OBJECTIVE:: To explore the barriers and facilitators to accessing rehabilitation experienced by persons with lower-limb amputations in a rural setting. STUDY DESIGN:: A qualitative descriptive approach was used to collect and analyse data. METHODS:: Data were collected from 11 conveniently sampled participants from three sub-district hospitals in the rural iLembe district, Kwa-Zulu Natal, South Africa. Data were collected using semi-structured interviews to explore the barriers and facilitators perceived by persons with lower-limb amputations in a rural region. RESULTS:: The three main barriers identified in this study were environmental factors, financial constraints and impairments. These barriers negatively impacted the participant's utilisation of rehabilitation. The two main facilitators identified were environmental facilitators and personal factors which aided participant's utilisation of rehabilitation. CONCLUSION:: Access to rehabilitation was mainly hindered by the challenges utilising transport to the hospital, while self-motivation to improve was the strongest facilitator to utilising rehabilitation. CLINICAL RELEVANCE: Rehabilitation is essential in preparation for prosthetic fitting. If a person cannot access rehabilitation services, they will remain dependent on caregivers. Highlighting the challenges to utilisation of rehabilitation in rural areas can assist to reduce these barriers and improve the functional status of persons with lower-limb amputations.

Experiences of lower limb prosthetic users in a rural setting in the Mpumalanga Province, South Africa.

BACKGROUND:: Ambulation with a prosthesis is the ultimate goal of rehabilitation for a person with a major lower limb amputation. Due to challenges with prosthetic service delivery in rural settings, many patients with amputations are not benefitting from prosthetic interventions. Inaccessibility to prosthetic services results in worse functional outcomes and quality of life. Learning from the experiences of current prosthetic users in this setting can assist to improve prosthetic service delivery. OBJECTIVES:: To explore the experiences of lower limb prosthetic users and to understand the importance of a lower limb prosthesis to a prosthetic user in a rural area of South Africa. STUDY DESIGN:: A generic qualitative approach and an explorative design were utilised in this study. METHODS:: A semi-structured interview guide was used to collect data from nine prosthetic users in a rural area in the Mpumalanga province of South Africa. Interviews were audio-recorded, transcribed verbatim and analysed thematically. Demographic details and information related to acute in-patient rehabilitation were analysed descriptively. RESULTS:: All participants were independent in activities of daily living with their prosthesis and participated actively in their community. Participants reported that their prosthesis was essential to their functioning. High travel cost was highlighted as a barrier to the maintenance of their prosthesis. Patients were dissatisfied with being unemployed. CONCLUSION:: Prosthetic intervention positively influences function, independence and community participation. Challenges relating to the accessibility, cost and maintenance of prosthetics should be a priority to ensure continued functional independence for prosthetic users. CLINICAL RELEVANCE: Understanding the importance of a prosthesis to a prosthetic user validates prosthetic intervention for persons living with an amputation in a rural setting and is vital in establishing and remodelling effective systems for prosthetic service delivery.

A qualitative study of the challenges of providing pre-prosthetic rehabilitation in rural South Africa.

BACKGROUND: There is a known shortage of rehabilitation staff in rural settings and a sharp increase in the number of lower limb amputations being performed. A lack of adequate pre-prosthetic rehabilitation will result in worse physical and psychological outcomes for a person with a lower limb amputation, and they will not be eligible to be fitted with a prosthesis. OBJECTIVE: To explore therapists' experiences with providing pre-prosthetic rehabilitation in a rural setting. STUDY DESIGN: A qualitative descriptive approach was used to collect and analyse data. METHODS: Data were collected from 17 purposively sampled therapists in five district hospitals in a rural community in South Africa. Data were collected in two rounds of focus groups to explore the challenges of providing pre-prosthetic rehabilitation in rural South Africa. RESULTS: The main themes identified in the study were (1) a lack of government health system support, (2) poor socioeconomic circumstances of patients and (3) cultural factors that influence rehabilitation. These themes all negatively influence the therapists' ability to follow up patients for pre-prosthetic rehabilitation after discharge from hospital. A lack of adequate pre-prosthetic rehabilitation is a substantial barrier to prosthetic fitting in rural South Africa. Patients who do not receive pre-prosthetic rehabilitation have a poorly shaped residuum or other complications such as knee or hip joint contractures which disqualifies them from being referred to prosthetic services. CONCLUSION: Therapists involved in this study identified the most important barriers to patients having access to prosthetic services. Clinical relevance Pre-prosthetic rehabilitation provides care of the residuum; maintenance or improvement of physical strength, joint range of motion and referral to a prosthetist. By exploring the challenges known to exist in this service, we can identify potential ways to reduce these barriers and improve the lives of those who use it.

The modular socket system in a rural setting in Indonesia.

BACKGROUND: Prosthetic services are inaccessible to people living in rural areas. Systems like the modular socket system have the potential to be fabricated outside of the prosthetic workshop. OBJECTIVES: This study aimed to evaluate the patient's performance and satisfaction with the use of the modular socket system, and the technical feasibility of its implementation in a rural setting. STUDY DESIGN: A quantitative longitudinal descriptive study design was followed. METHODS: A total of 15 persons with a lower limb amputation were fitted with the modular socket system and followed over 4-6 months. Performance was measured using a 2-min walk test, 10-m walk test and mobility and function questionnaire. Satisfaction was measured by the Socket Fit Comfort Score, Prosthesis Evaluation Questionnaire and EuroQoL 5 Dimensions 5 Levels. Notes on technical feasibility were taken at the moment of fitting ( t0), at 1-3 months post fitting ( t1) and at the end evaluation at 4-6 months post fitting ( t2). RESULTS: Performance did not change between t0 and t2. The comfort of the socket fit reduced between t0 and t2. Satisfaction with prosthesis and general health status stayed constant over time. The average fitting-time for the modular socket system was 6.4 h. CONCLUSION: The modular socket system can be considered a useful alternative for use in rural settings. Clinical relevance The use of the modular socket system is feasible and can improve accessibility to prosthetic technology in rural areas. Experienced prosthetic users were satisfied with the performance and the device. The shorter manufacturing time and use of only hand-held tools makes it an ideal alternative for use in remote and rural settings.

The use of a direct manufacturing prosthetic socket system in a rural community in South Africa: A pilot study and lessons for future research.

BACKGROUND: Challenges exist with the provision of appropriate mobility assistive devices in rural areas. The use of the direct manufacturing prosthetic socket system is a possible solution to these challenges. OBJECTIVES: The objective of this study was to test and explore the clients' perspectives with the application of this device. STUDY DESIGN: Within a mixed-methods approach, a longitudinal sequential explanatory design was applied. METHODS: The Orthotic and Prosthetic User's Survey was administered to explore the use of the direct manufacturing prosthetic socket system in terms of function, health-related quality of life and client satisfaction. A conveniently selected sample of 21 individuals who suffered a unilateral trans-tibial amputation was included. Data were collected at 1, 3 and 6 months post fitting, and two focus group discussions were also administered. RESULTS: Of the 21 participants recruited, 11 returned for follow up. Although participants reported favourably about the prosthesis, their scores were generally worse than the norms with regard to function and quality of life. Participants highlighted the need for improvement in the cosmetic appearance of the prosthesis. CONCLUSION: The direct manufacturing prosthetic socket system could be considered as an alternative technique of socket manufacturing for individuals living in rural areas due to the shorter manufacture time and promising initial results, but further research on this topic with a bigger sample is recommended. Clinical relevance The direct manufacturing prosthetic socket system may be considered as an alternative to the traditional prosthetic socket manufacturing technique used in South Africa. As this device requires only one visit and therefore decreased travel by the patients to the hospitals, it could be applicable to more amputees who cannot return to hospital post discharge.

Roles and challenges of the multidisciplinary team involved in prosthetic rehabilitation, in a rural district in South Africa.

BACKGROUND: Major lower limb amputations result in a significant sense of loss, psychological stress, and decrease in function and overall quality of life for the amputee. The holistic, patient-centered prosthetic rehabilitation of an amputee requires input from a team of dedicated health professionals from different disciplines commonly referred to as a multidisciplinary team (MDT). MDT rehabilitation is considered crucial in the reintegration of the amputee into the community, as well as for providing psychological support after limb loss. Multidisciplinary and interdisciplinary rehabilitation has been proven to be more successful than therapy provided by individual therapists in a number of different populations, regardless of the population studied. However, in most developing countries, there is a significant lack of multidisciplinary rehabilitation. AIM: To explore the roles and challenges of the members of the MDT involved in trans-tibial amputation rehabilitation in a rural community in South Africa (SA). DESIGN: An explorative sequential qualitative descriptive study. SETTING: A rural district in the KwaZulu Natal province in SA. PARTICIPANTS: Nine prosthetic users, three surgeons, three traditional healers, 17 therapists, four prosthetists, and four community health workers. INSTRUMENTS FOR DATA COLLECTION: Semistructured interviews and focus group discussions. RESULTS: The roles of the members of the MDT were clarified, and various members of the MDT highlighted specific challenges relating to their experiences and roles in the rehabilitation team. Lack of interdisciplinary rehabilitation and communication among team members, as well as lack of resources, and patient education negatively impact the rehabilitation of trans-tibial amputees. CONCLUSION: Aiming to address the limited resources available to health care professionals, as well as improved communication and interdisciplinary rehabilitation, could potentially improve the overall rehabilitation of persons with a lower limb amputation in the rural setting.