Theses and dissertations (Health Sciences)
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Item Chiropractic manipulation and mobilization for postpartum low back pain : a systematic review(2024) Phakathi, Londeka Nokulunga; Thandar, Yasmeen; Venketsamy, YomikaBackground: Prior research has documented empirical support for the effectiveness of chiropractic treatment for postpartum low back pain (PLBP), mostly in pregnancy but very few in postpartum. Nevertheless, the trustworthiness and calibre of the evidence from these studies has not been adequately scrutinised to authenticate their conclusions and determine whether clinical efficacy or effectiveness is present. Therefore, the objective of this study was to assess the current evidence in the literature about the therapeutic effectiveness of chiropractic manipulation and mobilisation for chronic lower back pain/pelvic girdle pain in postpartum women. Method: This study employed a qualitative evidence synthesis methodology, specifically utilising the Cochrane systematic review strategy. The literature was sourced via an electronic literature search (e.g. Google Scholar, PubMed, Medline, ProQuest Health, etc). The key search terms used were ‘low back pain’, ‘pelvic girdle pain’ together with ‘postpartum’, ‘chiropractic’, ‘manipulation’, and ‘mobilisation’. In addition to the key terms listed above, the search strategy for postpartum low back pain encompassed the following terms: ‘post-natal mechanical low back-ache’ or ‘sacroiliac syndrome/dysfunction’ or ‘sacral subluxation’ or ‘sacral pain’ or ‘lumbopelvic’ or ‘lumbar facet syndrome’. For manipulation and mobilisation, the search encompassed ‘sacral adjustment’ or ‘spinal manipulative therapy’ or ‘manual therapy’. A total of 2127 articles were identified, however 8 were suitable for inclusion. Data was extracted from each included study onto a prepared data extraction sheet. There were 4 reviewers that reviewed the 8 (4 RCTs and 4 CRs) articles included. The independent reviewers only reviewed the 4 RCTs. For Critical Appraisal and Quality of Evidence, Rev Man “Risk of Bias” was used tool for randomised controlled trials (RCTs) and for case reports (CRs), the Joanna Briggs Institute Critical Appraisal Tool (JBICAT) was selected was used. The GRADE (Grading of Recommendations, Assessment, Development and Evaluation) system was used to rank the evidence on various levels of clinical strength in relation to treatment outcomes. Results: While 3 of the 4 RCTs demonstrated no significant evidence to support a superior effectiveness of chiropractic manipulation and mobilisation in postpartum low back pain, Pritchard (2001) showed statistically significant evidence in supporting the improvement chiropractic manipulation and mobilisation provided in this demographic. The outcomes in all 4 CRs showed large degrees of favourability to the effectiveness of chiropractic manipulation and mobilisation. However, the quality of the evidence was low to moderate at most, thus affecting the extent to which generalizability can be made, in to relation to postpartum low back pain. Conclusion: This study highlighted a dearth in literature and the need for conducting research of higher quality within this demographic. There were also discrepancies in the utilisation of the LBP term and its clinical scope. It is highly important that these discrepancies are resolved by establishing a more concrete and deliberate guideline or definition of this phrase. The production of more RCTs with larger sample sizes that include a variety of demographic characteristics (race, socioeconomic status, age, etc.), was recommended.Item An epidemiological investigation into low back pain in schoolteachers within the Greater Tzaneen Municipality in Limpopo, South Africa(2022-09-29) Prinsloo, Imé Mari; Docrat, Aadil; Prince, Cleo KirstyBackground: Low back pain (LBP) is a common and significant disease found in the entire population but increased among the working population. Studies have shown that prevalence among LBP in schoolteachers are increased, yet there has been limited studies looking at urban and rural schoolteachers simultaneously. Objectives: To determine the incidence and lifetime prevalence of low back pain among schoolteachers within the Greater Tzaneen Municipality, South Africa; to determine the risk factors (in terms of demographics, lifestyle, and occupational factors) of developing LBP; and to determine the management strategies sufferers of LBP use to get relief. Methods: This was a quantitative, descriptive, cross-sectional study conducted within schools of the Greater Tzaneen Municipality. Teachers working in both the urban and rural school setting were approached to partake in the study. Those who met the criteria were invited to complete the selfadministered questionnaires, online or hard copies. In total 345 questionnaires were completed. Results: Of the 345 completed questionnaires 67% reported having LBP. Significant associations were made between the prevalence of LBP and increased mental stress (51.5%). Similarly, LBP sufferers had a higher BMI (p=.010); have been teaching for longer, (p=.049); and spend more time working at a computer, p<.001. Aggravating factors of LBP included bending/twisting the body, lack of sleep, reaching overhead, sitting, standing, and stress/tension. The strongest corresponding factor being stress and tension (p<.001). Conclusion: In this specific community there was no significant difference in prevalence of LBP between urban and rural schoolteacher. Notwithstanding previous research, this study highlights that global statistics is not always appropriate in South African context. This draws attention to the need for research specifically based on our diverse country.