Research Articles (Physiotherapy)

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Association between socio-demographic and injury factors, and physical activity behaviour in people with spinal cord injury : a theory-informed systematic review and meta-analysis
(BioMed Central, 2025-07) Nweke, Martins C.; Van Vuuren, Megan; Bester, Kobus; Maritz, Andrea; Van Vuuren, Lane; Vilakazi, Yolanda; Dlamini, Ayanda; Ncedani, Andiswa; Mostert, Karien
BACKGROUND : Identifying the determinants of physical (in)activity behaviour among people with spinal cord injury (PWSCI) will aid the prediction of speed and extent of recovery and inform strategies to optimise physical activity participation during physical rehabilitation. This review examined the association between socio-demographics, injury factors, and physical activity in PWSCI. METHODS : The Preferred Items for Reporting Systematic Reviews and Meta-analysis Protocols (PRISMA-P) provided the structure for this review. The epidemiological triangle and Bradford criteria further informed the review, as well as Rothman's causality model and Nweke's viewpoints. The review outcomes included injury factors and socio-demographic (intrinsic and extrinsic) factors associated with physical (in)activity in PWSCI. We searched four databases: PubMed, Medline, the Cumulative Index for Nursing and Allied Health Literature (CINHAL) and Academic Search Complete. The review used predefined eligibility criteria and a data screening and extraction template. The first author verified the extracted data. We employed narrative and quantitative syntheses and used a comprehensive Meta-analysis 4 to answer the review question. RESULTS : We retrieved 4,129 articles, of which 16 (nine cross-sectional studies, six cohorts and one non-randomised clinical trial) with 2,716 participants were eligible. The mean age of participants in the included studies was 45 years, and about 14% were female. Physical (in) activity was statistically significantly associated with income (OR = 1.58, CI 1.23–2.04), completeness of lesion (OR = 0.86 CI 0.82–0.90), and mobility aid (3.12, CI 1.57–6.19). No statistically significant association existed between physical (in) activity and age (OR = 1.09, CI 0.46–2.58), sex (OR = 0.66, CI 0.43–1.03), education (OR = 0.66, CI 0.42–1.06), time since injury (OR = 0,971, CI 0,749–1,26), vertebral level of the lesion (OR = 0.92, CI 0.71–1.11), or mechanism of injury (OR = 1.48, CI 0.74–2.97) among PWSCI. CONCLUSIONS : Efforts to optimise physical activity participation among PWSCI should consider the completeness of injury, income and type of mobility aid during rehabilitation programs. Factors such as employment status, residence, and type of house were less underscoring, and most studies needed more robust conceptual and theoretical underpinnings. TRIAL REGISTRATION : The review was registered with PROSPERO (ID: CRD42024544295).
Development of a high-performing, cost-effective and inclusive Afrocentric predictive model for stroke : a meta-analysis approach
(BioMed Central, 2025-07) Nweke, Martins C.; Oyirinnaya, P.; Nwoha, P.; Mitha, S.B.; Mshunqane, Nombeko; Govender, N.; Ukwuoma, M.; Ibeneme, S.C.
BACKGROUND : Predicting stroke risk is critical for preventive interventions. Most validated prediction models do not include data from African populations and may not be appropriate for the region. Relying solely on statistical significance to identify predictors may compromise algorithm performance. Also, some of the existing models include expensive biomarkers that are unsuitable for resource-limited settings. This study aims to develop a cost-effective and inclusive Afrocentric predictive model for stroke (CAPMS). METHODS : We conducted a meta-analysis following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses protocol and searched the PubMed, Scopus, African Journal, Medline, Cochrane Library, Web of Science, and Cumulative Index for Nursing and Allied Health Literature databases. We included case‒control and cohort studies reporting stroke risk factors and their estimates among African populations. Titles and abstracts were independently screened. Meta-analyses were performed using Comprehensive Meta-analysis version 3. RESULTS : More than 50% of the eligible studies examined both ischemic and hemorrhagic stroke. More than 20 stroke risk factors were identified in Africa, with 18 eligible for meta-analysis. Homocysteine (risk weight [Rw] = 13.9, risk stability index [Ri] = 0.67), hypertension (Rw = 5.6, Ri = 0.94), and cardiac events (Rw = 3.1, Ri = 0.8) were the strongest independent predictors. Low green vegetable consumption (Rw = 2.4, Ri = 1.0), stress (Rw = 1.76, Ri = 1.0), and hypertension were the most clinically responsive risk factors. All risk factors/biomarkers except homocysteine cost between $2.8 and 12.2, indicating cost-effectiveness. A critical risk point of 12.7 was set at the 90th percentile. The cumulative Rw and costs for CAPMS 1 (20 and $1.2–4.6) and CAPMS 2 (22.4 and $6.5–17.3) indicate high performance and cost-effectiveness. CONCLUSIONS : Targeted screening via the CAPMS 1 and CAPMS 2 models offers a cost-effective solution for stroke screening in African clinics and communities. Immediate validation of the CAPMS is needed to evaluate its performance, feasibility, and acceptability in the region. REGISTRATION : The study protocol is registered with PROSPERO (ID: CRD42023430437).
Trail running safety : a review of serious adverse events reported in online news articles
(Sage, 2025-09) Viljoen, Carel Thomas; Da Cruz, Monique; Matlala, Kgame; Groves, Megan; Du Toit, Kaylin; Fourie, Loria; Silva, Bruno; Scheer, Volker; Macmillan, Candice; Janse van Rensburg, Dina Christina; carel.viljoen@up.ac.za
Trail running is an endurance sport that entails running outdoors on natural terrain. Scientific literature provides minimal information on serious adverse events that occur during trail running. The objectives of this review were to identify and summarize the available information published in online worldwide news articles and to categorize the results in fatal, missing, and catastrophic events in trail running. Over a 14-wk period, online news articles were searched using Google Advanced Search and DuckDuckGo for reports on serious adverse events during trail running. Data were extracted and summarized from online news articles that met the inclusion criteria. Ninety-four online news articles reported on 127 runners involved in serious adverse events during trail running. Among the serious adverse events reported in this review, 82% (n = 104) were fatal trail running events; 29% (n = 37) were related to missing events, of which 54% (n = 20) of the missing events resulted in death; and 6% (n = 6) were catastrophic injuries. Most runners were males (73%) aged 16 to 75 y (41.5 ± 12.6 y). The most common intrinsic causes of death were cardiac arrest (58%) and collapse (38%), whereas the most common extrinsic causes of death were cold weather resulting in potential hypothermia (40%) and blunt trauma following falling/slipping (25%). Almost half the runners who went missing (41%) were found. The 6 runners involved in catastrophic events (6%) suffered severe burn wounds, brain damage, and frostbite. Serious adverse events in trail running seem to be rare. This review reports multiple serious adverse events during trail running. Although these events are rare, they highlight the need for further research and improved reporting. These findings can assist in developing future prevention strategies for trail running events and guide medical staff during race-day medical planning.
Screening for suicidal thoughts, attempts, and associated factors in endurance and ultra-endurance runners
(Edizioni Minerva Medica, 2025-07) Scheer, Volker; Valero, David; Knechtle, Beat; Valero, Encarna; Viljoen, Carel Thomas; Thuany, Mabliny
BACKGROUND : Suicide is one of the leading causes of premature death. Prevalence of suicidal thoughts in the general adult population is approximately 4%, with lifetime prevalence of 5.6%, and suicidal attempts of 2.7%. No data are available on endurance runners (ER) and ultra-endurance runners (UER). METHODS : Prospective cohort study of ER (distance of ≥21.1 km-42.2 km) and UER (≥42.2 km), collecting self-reported data on biometrics, social, psychological, medical, and training history. Suicidal risk was assessed via the Patient Health Questionnaire (PHQ-9) and open questions. Statistical analysis included descriptive, predictive techniques, and regression analysis. RESULTS : A total of N.=601 runners participated in the study (female N.=222; male N.=379; mean age [standard deviation (SD)] 42.8 (10.1) years). Suicidal thoughts were present in 8.0%, with a lifetime prevalence of 14.1% (P<0.001). Previous suicidal attempts occurred in 2%. Associated factors for suicidal thoughts included previous diagnosis of depression (P<0.001), anxiety (P=0.015), age (P=0.013), and participating in fewer (<9) competitions per year (P=0.026). Associated factors of lifetime risk of suicidal thoughts included previous diagnoses of depression (P<0.001) and age (P=0.015). Runners aged less <30 years of age presented with a higher risk of suicide (P<0.001) than older runners. Associated factors for previous suicidal attempts included previous diagnosis of depression (P=0.01) and stress (P=0.028). CONCLUSIONS : We present novel data on prevalence of suicidal thoughts in ER/UER, which were 2-2.5-fold higher than in the general population. Creating awareness among athletes, families, coaches, medical teams, and race organizers and providing education, screening and access to appropriate support are important to reduce the burden of suicide in this sport.
Efficacy of aerobic exercise for HIV-associated neurocognitive disorders receiving ART : an RCT
(AOSIS, 2024-12-11) Nweke, Martins C.; Mshunqane, Nombeko; u19394595@tuks.co.za
BACKGROUND : HIV-associated neurocognitive disorder (HAND) affects an individual’s capacity for independence and engagement in everyday activities, posing challenges in environments with limited resources and low social support. OBJECTIVES : To ascertain the efficacy of exercise (AE) for activity and participation (AP) level in people with HAND. METHOD : This is a randomised controlled trial that is parallel-group in nature, with intention-to-treat analysis and disguised allocation. Seventy-three people with HAND in total were randomised at random to the AE and control groups. Three 20 -60-min sessions of moderate-intensity AE training on a cycle ergometer were included of the 12-week intervention. Individual tolerability served as the basis for progression. Three months after the intervention, at the conclusion of the intervention, and at the baseline, outcomes were measured. The AP constitutes the main outcome variable. To investigate the impact of AE on AP level, rank analysis of covariance was performed after log-transformation. RESULTS : When comparing the AE to the control group, there were significant increases in social wellbeing AP (Cohen d = 0.550; p = 0.021), emotion AP (Cohen d = 0.641; p = 0.007) and overall AP level (Cohen d = 0.896; p < 0.001). There was no discernible variation in AP across the groups three months following AE (Cohen d = 0.437; p = 0.067). CONCLUSION : AE induces a small increase in AP among individuals with HAND. CLINICAL IMPLICATIONS : For people with HAND, regular AE is a good way to manage AP restriction. Increasing AE participation may improve AP restriction.
Physiotherapists transgressions lodged at the Health Professions Council of South Africa between 2010 and 2020
(AOSIS, 2024-11-29) Dantile, Nokuzola Doris; Mshunqane, Nombeko; Van Staden, Cornelius W.
BACKGROUND : Complaints of ethical and professional misconduct are lodged and processed by the Health Professions Council of South Africa (HPCSA) in accordance with their legal mandate. OBJECTIVES : This study describes the nature and frequency of transgressions by physiotherapists as concluded by the HPCSA for the period from 2010 to 2020. METHOD : A total sampling method was used to extract all records of transgressions lodged against physiotherapists between 2010 and 2020. In a quantitative retrospective records review design, data were captured with the objective to report these descriptively. Ethics approval was granted by the Faculty of Health Sciences Research Ethics Committee of the University of Pretoria and permission to use the records was granted by HPCSA. RESULTS : Twenty-one transgressions by physiotherapists during the study period were recorded at the HPCSA. Most transgressions were charging for services not rendered (n = 20 times), invoices drafted inaccurately (n = 17) and false claims submitted to the medical aid schemes (n = 15). Other transgressions included failure to obtain informed consent and patient identity prior to treatment, charging for an unkept appointment, overservicing, misleading advertisements, love relationship with a patient and treating an animal in the same practice as humans. CONCLUSION : The transgressions were unprofessional in nature with the most frequently reported being false claims and accounts submitted to the medical aid by physiotherapists for services not rendered. CLINICAL IMPLICATIONS : The knowledge of transgressions will influence decision making and restrain infringement to enhance sound ethical practice.
Namibian healthcare professionals’ knowledge, attitudes and practices regarding environmental sustainability in healthcare
(MDPI, 2025-05) Lister, Helga Elke; Mostert, Karien; Ramkilawon, Gopika Devi; Oelschig, Cathrine; Ntiyane, Olwethu; Richardt, Erika; Da Silva Rocha, Deonelia Paulo; Sheerin, Savannah; Phaahla, Tshepang; Ashipala, Daniel; Pretorius, Louise; Munangatire, Takaedza; Maric, Filip
Among the many actions required to avert further intensification of today’s social, ecological and health crises is also the improvement of healthcare’s environmental sustainability, including in countries particularly vulnerable to such crises. The present study aimed to identify Namibian healthcare professionals’ knowledge, attitudes and practices, along with barriers and educational needs, as a foundation for context-relevant interventions. The study used a non-experimental, descriptive quantitative research design with an existing validated cross-sectional questionnaire as its data collection tool. Both purposive and snowball sampling were used to select healthcare professionals (n = 71) to participate in the quantitative online questionnaire. R (version 4.2.1) software was used to analyse the data from the completed questionnaires. The results showed that the Namibian healthcare professionals participating in this study have basic knowledge of and positive attitudes toward environmental sustainability in healthcare. However, various barriers to implementing strategies towards environmental sustainability exist that currently prevent the implementation of relevant practices. These should be overcome by the Namibian health system by providing the necessary frameworks, policies, measures and resources to drive improvements in environmental sustainability. Additionally, future and current healthcare professionals must receive training across all professional education levels to enable implementation in practice and effective advocacy and planetary health promotion.
Perspectives on adherence to prescribed home exercises after polytrauma : a qualitative study
(AOSIS, 2025-06) Monaiwa, Keamogetswe; Yazbek, Mariatha; Magida, Nontembiso
BACKGROUND : Polytrauma can be life altering, requiring a holistic approach to reach the highest functional level. Physiotherapists prescribe home exercise programmes (HEPs) to prevent complications associated with immobility. Adherence to HEPs is crucial, yet factors influencing non-adherence remain underexplored. OBJECTIVES : Our study explored patients with polytrauma perspectives on adherence to prescribed HEPs. METHOD : A qualitative exploratory, descriptive design was used to recruit participants purposively from a rehabilitation unit in Tshwane district, South Africa. Participants diagnosed with polytrauma, aged 18 years or older, and prescribed a HEP were included, while those with cognitive impairments or language barriers were excluded. Consent was obtained while hospitalised, and participants were contacted 3 months post-discharge for telephonic semistructured interviews lasting 30–45 min. Ethical clearance (reference number: 595/2022) and institutional permission were granted. Interviews were audio-recorded and conducted until data were saturated. Data were verbatim transcribed and analysed thematically to identify key themes and sub-themes. RESULTS : Thirteen participants (8 male and 5 female participants) with a mean age of 43.77 (standard deviation = 10.45) were interviewed. The four major themes were physical, psycho-cognitive, social and environmental factors. Adherence barriers were more significant than facilitators. The most frequently reported facilitator was family support, whereas the most commonly reported barrier was pain. CONCLUSION : Polytrauma patients identified more barriers than facilitators affecting HEP adherence. Pain significantly hindered adherence, while family support was a key enabler. CLINICAL IMPLICATION : Physiotherapists should work collaboratively with patients to develop inclusive HEPs that consider their demographic, social, psychological, physical and environmental context.
Pectoralis minor index range of healthy 18–24-year-old students from a Kenyan public university
(AOSIS, 2025-02) Agweyu, Eugene C.; Matheri, Joseph M.; Olivier, Benita; Korkie, Elzette
BACKGROUND : The pectoralis minor muscle (PMM) length is critical for shoulder movement and stability, often implicated in dysfunction and pain. The pectoralis minor index (PMI) quantifies this muscle’s length relative to body dimensions. Typical PMI values range from 10.0 cm to 12.5 cm in healthy adults, with data for Kenyan populations. OBJECTIVES : This study aimed to establish baseline PMI values among healthy 18–24-year-old university students in Kenya, examining variations by side dominance and sex to support clinical assessments. METHOD : A cross-sectional descriptive study recruited 289 healthy young adults from Jomo Kenyatta University of Agriculture and Technology (JKUAT) using stratified and simple random sampling. Data were collected through a self-developed, interviewer-administered questionnaire, achieving a 93.4% response rate. PMI values were measured in three postures: supine, relaxed, and standing. RESULTS : In the standing relaxed position, the PMI mean was 10.6 cm on the dominant side and 11.2 cm on the non-dominant side, with significant variation indicated by a 95% confidence interval. A paired t-test revealed a significant difference between dominant and non-dominant sides (p < 0.0001). CONCLUSION : Baseline PMI values for Kenyan young adults show significant differences by dominance and sex. These findings provide a foundational reference for assessing PMI in clinical settings, supporting physiotherapists and clinicians in evaluating and treating shoulder dysfunction using precise muscle length data. CLINICAL IMPLICATIONS : Establishing baseline PMI values assists physiotherapists in identifying deviations, enabling targeted interventions for shoulder dysfunction.
Using complex systems to understand running-related injuries
(Taylor and Francis, 2025) Thuany, Mabliny; Vieira, Douglas; Viljoen, Carel Thomas; Weiss, Katja; Knechtle, Beat; Gomes, Thayse Natacha
This study aims to investigate anthropometric and training characteristics associated with injuries in runners using a complex approach. We conducted a cross-sectional study with 97 Brazilian runners of both sexes (age: 39.1 ± 11.5 years; body mass index: 24.2 ± 4.2 kg/m2). A web survey was used for data collection, including age, sex, body weight, body height, training volume/frequency, session duration, running pace and injury information (yes or no; the number of injuries). The partial correlation parameter was used for network estimation, considering both sexes. For women, injury occurrence was positively and strongly associated with training frequency (r = 0.57) and the number of competitions (r = 0.64), while for men, a negative and strong association was found with age (r=-0.69), and positive associations were observed with BMI (r = 0.89) and training volume (r = 0.82). Network centrality showed that training session duration and the number of competitions/year presented a higher expected influence value for women (−1.47) and men (−1.31). Using a non-linear approach with Brazilian non-professional runners, training characteristics had a stronger influence on running-related injuries.
The SCIEPR checklist : a tool for standardizing chest X-ray interpretation in resource-constrained settings – a pilot study
(Elsevier, 2025-05) Sethole, Khethiwe Margaret; Mshunqane, Nombeko; margaret.sethole@up.ac.za
INTRODUCTION : Checklists improve performance in specialized fields such as radiology. The SCIEPR (Standardization, Communication, Image Evaluation, and Pattern Recognition) checklist was developed to aid nonradiologists in interpreting chest radiographs in district hospitals with no radiologists onsite. This study aims to investigate the clinical utility of the SCIEPR checklist. METHODS : A descriptive cross-sectional pilot study included 103 participants, including 40 radiographers and 63 doctors from four district hospitals. Radiographers completed sections A and B regarding imaging protocols for chest radiographs, while doctors filled out section C for systematically searching for abnormalities. After four weeks of using the checklist, the participants completed a survey comprising 23 closed-ended and seven open-ended questions. Key measures included compliance in completing the checklist and evaluating the end-user's perceptions of the checklist. RESULTS : Seventy-four SCIEPR checklists were adequately completed. Sections A and B had 100 % compliance. Two items were omitted from Section C. Forty-one participants completed the survey tool (22 doctors and 19 radiographers). Participants had mixed opinions on the checklist's impact on time and workload. No item changes were suggested. Participants reported that the checklist enhanced patient care, improved service quality, reduced interpretation time, and reduced patient waiting time. CONCLUSION : Following the pilot study, we refined section C of the SCIEPR checklist, improving content and face validity. The SCIEPR checklist promotes interprofessional collaboration and may reduce omission errors by standardizing imaging protocols. IMPLICATIONS FOR PRACTICE : The SCIEPR checklist is designed to enhance collaboration between radiographers and medical doctors in chest imaging and interpretation. Its main goal is to improve the consistency and accuracy of chest X-ray interpretations, particularly in resource-limited settings with no radiologist onsite.
Characterization and stratification of risk factors of stroke in people living with HIV : a theory-informed systematic review
(BioMed Central, 2025-05) Nweke, Martins C.; Mshunqane, Nombeko
BACKGROUND : Identification and stratification of risk factors for stroke among individuals living with HIV (PLWH) will facilitate primary prevention and prognostication, as well as strategies aimed at optimizing neurorehabilitation. This review sought to characterize and stratify the risk factors associated with stroke in PLWH. METHODS : The review was structured in accordance with the preferred items for reporting systematic reviews and meta-analysis (PRISMA) checklist. The epidemiological triangle, Bradford criteria, and Rothman causality model further informed the review. The review outcomes encompassed cardiovascular factors, HIV-related factors, and personal and extrinsic factors associated with stroke in PLWH. We conducted searches in PubMed, Scopus, Medline, Web of Science, Cumulative Index for Nursing and Allied Health Literature, and African Journal (SABINET). Data screening and extraction were independently performed utilizing predefined eligibility criteria and a data-extraction template. Narrative synthesis and risk stratification were employed to analyze the results. RESULTS : Thirty studies (22 cohorts and eight case–control) with a sample size of 353,995 participants were included in this review. The mean age of the participants was 45.1 ± 10.7 years. The majority of the participants (72.4%) were male. Risk factors for stroke in PLWH include cardiovascular factors (advanced age, tobacco use, hypertension, diabetes, atrial fibrillation, etc.), HIV-related factors (high viral load and low nadir CD4 count), personal factors (advanced age and female sex), and comorbidities (hepatitis C virus infection, chronic kidney disease, coronary artery disease, and liver fibrosis or cirrhosis). Diabetes, atrial fibrillation, smoking habits, hypertension, age, and viral load demonstrated a high likelihood of association with stroke in PLWH and should be prioritized when constructing clinical prediction algorithms for HIV-related stroke. CONCLUSIONS : The most important factors were hypertension and chronic kidney disease, followed by smoking, dyslipidemia, diabetes, HCV, HBV, CD4 count, use of ART, TB, and substance use (cocaine). The least important factors were age, sex, ethnicity, obesity, alcohol use, ART duration, and viral load. The predictive significance of these factors is still evolving, given the average moderate certainty of evidence. Predictive and preventative models should target factors with a high causality index and low investigative costs. TRIAL REGISTRATION : The review is part of a larger review registered with the PROSPERO (ID: CRD42024524494).
Burden and distribution of chronic kidney disease in sub-Saharan Africa : a systematic review with meta-analysis
(Faculty of Medicine, Makerere University, 2025) Nweke, Martins C.; Ado-Aghughu, Theresa; Daniels, Tobi; Imo, Uzunma
BACKGROUND : Chronic kidney disease (CKD) is fast becoming a leading non-communicable disease in sub-Saharan Africa. Efforts directed at mitigating CKD will thrive on precise and accurate estimation of CKD burden, which often varies widely owing to study characteristics like methods of estimating Glomerular Filtration Rate (GFR) and study population. OBJECTIVE : To determine the burden of CKD and distribution of this burden in sub-Saharan Africa based on study characteristics. METHODS : Involved systematic review of articles peer-reviewed literature published in English. Review was conducted consistent with Preferred Reporting Items for Systematic Reviews and Meta-Analyses checklist. Data sources for review include MEDLINE, PubMed, CINAHL, Academic Search Complete, African wide information and articles that reported prevalence of chronic kidney disease in sub-Saharan Africa. Bias risk assessment was conducted using mixed-method appraisal tool. Random-effect model of meta-analysis was employed to quantify effects of variation study characteristics on burden of chronic kidney disease in sub-Saharan Africa. RESULTS : Showed statistically significant difference in CKD prevalence by study population (F=2.547, p=.019) and epidemiological significance difference in GFR estimate method with Schwartz approach (35%). Conclusion: CKD remains a public health issue in sub-Saharan Africa and the distribution varies widely according to region, study population and method of estimating GFR.
Exploring the experience of living with pain after spinal cord Injury : a qualitative study
(Hindawi Limited, 2024-02-02) Mashola, Mokgadi Kholofelo; Korkie, Elzette; Mothabeng, Diphale Joyce; joyce.mothabeng@up.ac.za
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.
Establishing a digital health care ecosystem in a health sciences university in South Africa : protocol for a mixed methods study
(JMIR Publications, 2025-03) Govender, Samantha; Cochrane, Maria Elizabeth; Mogale, Mabina; Gordon, Reno; Tshephe, Tjodwapi
BACKGROUND : Comprehensive and formalized digital health care ecosystems in health sciences tertiary education in South Africa do not currently exist, but they have the potential to influence teaching and learning, research, and community engagement. OBJECTIVE : A total of 3 key objectives underpin the study, that is, determining the health care curriculum needs and required content for the development of a formalized digital health ecosystem, determining the level of readiness of staff and students to participate in a digital health care ecosystem, and determining whether community engagement and strategic partnerships can contribute to the sustainability of a digital health care ecosystem. METHODS : A multipronged approach will be used to address the objectives, with a mixed methods design being undertaken. The qualitative phases will be phenomenological in nature, and triangulation of information along with thematic analysis will be conducted on the collected data. Quantitative data will be collected prospectively and cross-sectionally and analyzed using descriptive analysis. Sampling will include subject experts for the Delphi technique, staff and students at the University, clinical training and education partners, and community leaders. This study has received ethical approval from the Sefako Makgatho Health Sciences University Research and Ethics Committee (SMUREC/H/260/2023:PG). RESULTS : Data collection for the first phase will begin in January 2024 and conclude in December 2024. Phase 2 and 3 of the study will be conducted concurrently, with data collection starting in January 2025 and concluding in December 2026. CONCLUSIONS : The establishment of a digital health care ecosystem has the potential to benefit staff, students, and communities through stakeholder collaboration, educational opportunities, research projects, and improved service delivery.
Development and validation of a knowledge, attitudes and practices (KAP) questionnaire for healthcare professionals on environmental sustainability in healthcare in Southern Africa
(F1000 Research Ltd, 2024-10) Lister, Helga Elke; Mostert, Karien; Botha, Tanita; Field, Emma; Knock, Danté; Mubi, Natasha; Odendaal, Stefani; Rohde, Megan; Maric, Filip
BACKGROUND: The triple planetary crisis of climate change, environmental pollution, and biodiversity loss is increasingly driving poor health outcomes worldwide. Healthcare systems and services are often not environmentally sustainable and compound the problem, while healthcare professionals are also recognised as key leaders in advancing sustainable healthcare. To adopt this leadership position, healthcare professionals’ knowledge, attitudes, and practices regarding environmental sustainability in healthcare must be established. This article reports the development and validation of a new instrument for this purpose that corresponds to the specificities of the Southern African context. METHODS: Questionnaire development followed a seven-stage process. Information was obtained from a 2021 study titled ‘South African Healthcare Professionals’ Knowledge, Attitudes, and Practices Regarding Environmental Sustainability in Healthcare: A Mixed Methods Study’ to develop the instrument. Information was also sourced from the literature regarding environmental sustainability and healthcare to generate the first questionnaire with 29 items. The following stages included two rounds of expert input, separated by a pilot study with the target population to receive feedback regarding the instrument’s structure, relevance, and length. Content validity was determined through statistical analysis. RESULTS: Feedback was received from nine experts in stage two and 13 pilot study participants in stage four and incorporated to improve the questionnaire. In stage six, the questionnaire was rated by seven experts. The content validity index of the questionnaire was calculated at two different stages, after which the indices were compared. Following a final edit, the questionnaire has 24 questionnaire items. The closing analysis calculated the scale content validity index average (S-CVI/Ave) of 0,922; this indicates that the final questionnaire has excellent content validity. CONCLUSION: A questionnaire that assesses the knowledge, attitudes and practices of healthcare professionals regarding environmental sustainability in Southern Africa has been developed and validated. This questionnaire can now be used for further studies in Southern Africa.
Effectiveness of combined targeted and hormonal therapies for post-menopausal women with hormone receptor-positive and HER2-negative advanced breast cancer : a systematic review and meta-analysis of RCTs
(Sage, 2025) Okwor, Vitalis; Okwor, Chika Juliet; Ukwuoma, Maryjane; Nweke, Martins C.
OBJECTIVE : we aim to synthesize available evidence on the effectiveness of hormonal plus targeted therapies for post-menopausal women with hormone receptor-positive and HER2-negative advanced breast cancer. DATA SOURCES AND METHODS : We searched the following databases: Medline, PubMed, Cochrane Library, CINAHL, Web of Science, Scopus, and African Journal. Only studies that investigated the effectiveness of hormonal therapy combined with targeted therapy for HR+/HER2- advanced breast cancer treatment were included. The outcomes were progression-free survival (PFS), overall survival (OS) and objective response rate (ORR). A random-effect meta-analysis model was employed. Statistical analysis was performed using Comprehensive Meta-analysis version 3. RESULTS : 24 studies were included in the meta-analysis with an overall sample size of 7635. Median PFS, OS and ORR were found to be significantly increased in the combination group compared to hormonal monotherapy [SMD = 6.072 (95% CI = 3.785–8.360), p < 0.001], [SMD = 1.614 (95% CI = 0.139–3.089), p = 0.032] and [OR = 1.584 (CI 1.134–2.213), p = 0.007] respectively. Subgroup analysis showed a significant difference in PFS and ORR between patients who received “hormonal therapy + CDK4/6 inhibitors” vs hormonal therapy only [SMD = 6.015 (CI 3.069–8.960), p < 0.001], (OR = 1.828 (CI 1.030–3.243), p = 0.039] respectively. CONCUSION : Compared with hormonal monotherapy, targeted plus hormonal therapy significantly improves PFS, OS and ORR in postmenopausal women with HR+/HER2- advanced breast cancer.
Upper limb muscle strength and exercise endurance as predictors of successful extubation in mechanically ventilated patients
(SpringerOpen, 2024-05-22) De Beer‑Brandon, Caroline R.; Van Rooijen, Agatha Johanna; Becker, Piet J.; Paruk, Fathima; rubine.brandon@up.ac.za
BACKGROUND : Failed extubation increases the intensive care unit (ICU) length of stay, hospital length of stay, and financial costs and it reduces the patient’s functional ability. Avoiding failed extubation is of utmost importance, therefore predictors for successful extubation are paramount. OBJECTIVE : To determine if successful extubation in mechanically ventilated patients can be predicted by physiotherapists using upper limb muscle strength and exercise endurance. METHODS : Fifty-seven patients from the medical and trauma ICUs of a large academic hospital were eligible for testing. Muscle strength was evaluated using the Oxford grading scale, Medical Research Council score (MRC score), handgrip dynamometer, and maximum inspiratory pressure (MIP). Exercise endurance was tested while the patient was actively riding the MOTOmed ® letto2 cycle ergometer for six minutes with the upper limbs. RESULTS : Exercise endurance (time the patient rode actively) (P = 0.005), MRC-score (P = 0.007), and number of days ventilated (P = 0.005) were associated with successful extubation. The handgrip strength (P = 0.061), MIP (P = 0.095), and muscle strength of the sternocleidomastoid (P = 0.053) and trapezius muscles (P = 0.075) were marginally associated with successful extubation. Due to multicollinearity when developing the prediction equation, the final multivariable logistic regression prediction model included only exercise endurance and the number of days ventilated. The newly developed prediction equation conferred a sensitivity of 81.82% and a specificity of 77.14% to predict successful extubation. CONCLUSION : Successful extubation of mechanically ventilated patients can be predicted by physiotherapists using the newly developed prediction equation consisting of exercise endurance and number of days ventilated.
Level of disability in stroke survivors in the Greater Accra Region of Ghana
(Springer Open, 2024-10-08) Mohammed, Tawagidu; Nyante, Gifty Gyamah; Abdul‑Rahman, Mubarak; Mothabeng, Joyce Diphale
BACKGROUND : Many stroke survivors in low- and middle-income countries such as Ghana live with various degrees of disabilities. Insight into the level of disability and its determinants in stroke survivors has become very important. This study aimed to assess disability and determinants in stroke survivors in the Greater Accra Region of Ghana. METHODS : One hundred and eight community-dwelling stroke survivors undergoing outpatient physiotherapy rehabilitation were sampled for the study. The World Health Organization disability assessment schedule (WHODAS) questionnaire was used to assess the level of disability in the participants. Sociodemographic and clinical data were gathered to help assess the determinants of disability. Association between sociodemographics and disability, and clinical characteristics and disability were determined using chi-square/Fisher’s exact test. p values less than 0.005 were considered statistically significant. RESULTS : Most of the study participants were reported to have moderate to severe disabilities in their bodily function. Age, gender, marital status, and employment status were found to be associated with the level of disability in stroke survivors. CONCLUSION : Disability and its determinants in stroke need to be given much attention as disability affects the ability of stroke survivors to function independently.
Illness is more prevalent than injury in trail runners participating in a mountainous ultra trail race
(Taylor and Francis, 2025) Boshielo, Patience Matshepo; Jansen van Rensburg, Audrey; Viljoen, Carel Thomas; Botha, Tanita; De Villiers, Christina Elizabeth; Ramagole, Dimakatso Althea; Seyani, Limbikani; Janse van Rensburg, Dina Christina
OBJECTIVES : Trail running is a popular off-road sport involving running in natural environments over various terrains, often in remote locations. This study aims to investigate the epidemiology and risk factors of injuries and illnesses, i.e. medical encounters, on race day among trail runners in a high-altitude ultra trail race. METHODS : This descriptive cross-sectional study on an ultra trail race (38 km, 65 km and 100 km) in South Africa, included participants 18 years or older. Of the 331 race participants, 285(86.1%) consented to participate in the study. Data collection included demographic details, injuries (body region, specific body area, tissue type, pathology) and illnesses (organ system, symptom cluster, etiology). Risk factor analysis includes sex, age, weight, height, race distance, illness and injury history, training and running experience. Frequency (n, %), prevalence (%) and odds ratios (OR; 95%CI) are reported. RESULTS : Eighty-nine (31.2%) individuals reported 131 medical encounters [49 injuries (37.4%); 82 illnesses (62.6%)]. Injuries were sustained by 14.7% of athletes, and 22.5% reported illnesses. For injuries, the lower limb was mainly involved (n = 41; 83.7%). Most injuries affected the foot (n = 18; 36.7%), ankle (n = 10; 20.4%) and knee (n = 7; 14.3%). Tissue types mainly involved skin (n = 21; 42.8%), ligament (n = 7; 14.3%) and muscle (n = 7; 14.3%). Multiple (n = 45; 54.9%) and gastrointestinal (n = 17; 20.7%) organ systems were mainly involved in illnesses. Only 100 km runners reported dehydration (n = 28; 31.5%), and one in every six of these runners (n = 5; 17.9%) did not finish. Runners reporting fatigue (n = 21; 23.6%) had a high (n = 8; 38.1%) did not finish rate. Two in every five participants (n = 36; 40.4%) with a medical encounter, did not finish. No medical encounter-associated risk factors were identified. CONCLUSIONS : Illnesses were more common than injuries during the mountainous ultra trail race. Sustaining a medical encounter increased the chance of not completing the race. Further research on the epidemiology of race day medical encounters in trail running is required.

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