Repository logo
 

Theses and dissertations (Health Sciences)

Permanent URI for this collectionhttp://ir-dev.dut.ac.za/handle/10321/12

Browse

Has files: YesSubject: search.filters.subject.Musculoskeletal system

Search Results

Now showing 1 - 5 of 5
  • Thumbnail Image
    Item
    Chiropractic students’ perception and practice of patient education on management of musculoskeletal conditions at a tertiary education teaching clinic
    (2023-05-31) Nieuwenhuis, Hardus; Maharaj, Praveena; Korporaal, Charmaine Maria
    Background Modern healthcare is characterised by patient-centred care, which requires that healthcare professionals have equal proficiency in communication and practical skills. As part of their duty as healthcare professionals, chiropractors must show patients how to help themselves through patient education, which requires communication skills. Patient education no longer solely involves or refers to knowledge transfer alone, but rather working with patients in their specific context to build knowledge together from a partnership perspective and to share power in this dynamic. From this perspective, patient education becomes a tool to empower patients and improve their self-efficacy and coping habits, without constantly relying on passive care. This study presents a detailed evaluation of patient education within a South African chiropractic student context at the Durban University of Technology. Aims and Objectives This study aimed to describe chiropractic students’ perceptions and practice of patient education of musculoskeletal conditions at a teaching clinic. The objectives were to evaluate the students’ perception of patient education and the strategies they use; their self-reported practice of patient education; barriers that students face when educating patients; factors that contribute to their patient education skills development, and to determine whether there is an association between demographics, their perception and practice. Methods The study was an anonymous web-based questionnaire with a cross-sectional design within a quantitative paradigm. The survey used in this study stems from a physiotherapist study. Permission was obtained from the author to replicate the study in a South African context at the Durban University of Technology Chiropractic Day Clinic (DUT CDC). The original survey was then put through a focus group and pilot study and subsequently adapted to include questions related explicitly to chiropractic and the student population at the Durban University of Technology. Weekly reminders were sent via email to class representatives to distribute among their respective classes. A total of 42 completed questionnaires were used for analysis in this study. Cronbach’s alpha was used to assess internal consistency of scales. The scale scores were computed by averaging the 18 items for Question 6 and Question 5 respectively where Ttests were used to compare these scores between the demographic variables for binary data, ANOVA for ordinal data and Pearson’s correlation analysis, where the demographic variable was quantitative and normally distributed. A Wilcoxon signed ranks test was used for the comparison of time spent on patient education at initial consults and time spent on patient education at follow-up consults Results Overall, the students viewed most of the patient education items to be important and should be discussed with patients. In practice, however, the frequency of their practice did not correspond to the perceived importance. Only a few items were practised to the same extent as the perceived importance thereof. The chiropractic students’ discussions with their patients tend to focus on the main complaint of patients. In most cases, students educate their patients through one-on-one discussions, physical demonstration and anatomy models. During initial visits, students usually spend between 6–15 minutes educating their patients; in follow-up visits, the time is reduced to 6–10 minutes. In most cases, students cited patient characteristics as a barrier to effective patient education. For the chiropractic students, developing their patient education skills was largely dependent on their interactions with supervising clinicians. There was no association between demographics, perceived importance, and practice behaviour in this study. Conclusion Although the patient education topics were generally deemed important by chiropractic students, the topics considered most important are directly related to the main complaints of their patients, with more complex topics not being perceived as necessary as those directly related to the complaint, such as diagnosis. Like their perceptions, the students most frequently addressed the topics they deemed important; thus, their perceptions and practice were congruent (for issues related to the main complaint of the patients). An important finding of this study was that, although DUT follows an evidence-based paradigm, many students perceived pathoanatomical explanations to be important and, thus, provided their patients with such explanations, even though the literature does not support it. In addition, the students reported several methods through which they educate their patients. However, the assessment of whether it was successful was mainly centred around physical activity rather than the patients’ understanding of the information discussed. The results indicate an opportunity to improve the patient education skills of students, as they appear to have difficulty adjusting to difficult situations, and thereby perceive factors to be barriers that are not actual barriers but rather challenges.
  • Thumbnail Image
    Item
    Exploring communication as a means to deliver patient education for musculoskeletal care by chiropractors in the eThekwini Municipality
    (2023-05-31) Chapman, Frances Cowley; Orton, Penelope; Prince, Cleo Kirsty
    Background: Communication is a fundamental tool used by all healthcare practitioners, as well as chiropractors, in delivering care. Practitioners use communication to connect with their patients to form trusting relationships and obtain clinically relevant information to reach a diagnosis. It is also used to deliver important healthcare information to the patient regarding their condition, relevant lifestyle changes, interventions and outcomes. The way a practitioner has utilized communication, their ability to deliver succinct patient education that is empathetic and relevant to the patients’ life, and preferences are important factors in the success of the treatment and management delivered. Despite this, communication is still considered a complex phenomenon with little concordance on its success experienced by both the patient and the practitioner. Patient education has been identified as a key factor in delivering optimal management and care of musculoskeletal disease, which is a central component of chiropractic scope of practice. It has also been identified as an important component of chronic care management and encouraging self-management, which is a fundamental part of managing risk factors for both musculoskeletal disease and chronic disease. The eThekwini Municipality, the study location, is a socioeconomically diverse region, which historically suffers from language and social disparities, which affect the delivery and success of healthcare. This research adds a unique insight into how chiropractors in eThekwini utilize communication to deliver patient education to their patients. Methodology: A qualitative research methodology was utilized to collect data through semi-structured interviews. The data were analyzed using thematic analysis to extract the meaning and understanding of the interviews. Eight interviews were conducted before data saturation was reached. Results: Three main themes, namely communication skills, communication barriers and communication techniques, emerged from the data with a number of sub-themes. Conclusion: The results revealed that all the participants thought communication skills and patient education were fundamental to how they delivered care. Their perception on the acquisition of these skills were varied and ranged from passive time in practice, foundational at a university level, and necessitating further studies. When exploring the barriers, it was thought that although patient perception was an important factor, this could be as a result of a consumeristic medical system, poor communication on the practitioners part and a lack of a unified profession identity of chiropractic. Socioeconomic, language and cultural issues still affect the delivery of care and adequate patient education, even though South Africa has been a democracy for 29 years. Communication techniques have evolved, including the utilization of communication technologies, which can contribute to patient-centeredness. Paternalistic and diseasecentered communication techniques still underpin manual therapy but patient-centered techniques are emerging.
  • Thumbnail Image
    Item
    An exploration into the utilisation of the biopsychosocial model by chiropractors in the eThekwini Municipality
    (2022-09-29) Williamson, Rosanne Louise; O’Connor, Laura
    Background: The biopsychosocial (BPS) model is one of the many models of healthcare and its utilisation has been encouraged when treating and managing musculoskeletal conditions, especially neck and low back pain. Chiropractors are viewed as primary care providers, focused on the treatment and management of musculoskeletal conditions, most of which are spine related. This study aims to explore the utilisation of the biopsychosocial model by chiropractors in the eThekwini Municipality. Method: A qualitative, exploratory, descriptive study was conducted, in which twelve chiropractors within the eThekwini Municipality were interviewed to explore their understanding, attitudes, utilisation and challenges when utilising the BPS model. Semi-structured interviews were conducted in English, and later transcribed verbatim. Transcripts were analysed using Tesch’s method to form codes, themes and subthemes. Results: Female and male chiropractors were interviewed. They displayed knowledge of and a positive attitude towards the BPS model and its constituents. The chiropractors’ felt that chiropractic institutions should implement further practical training in the model to adequately prepare students for practice as many of the interviewees felt that addressing psychosocial factors was beyond their scope of practice and that they did not have the required skills. The most mentioned challenge was time, and how it resulted in constraints when utilising the model. This impacted them being able to implement the model effectively. Few used screening tools citing a lack of training or that they added to the time constraints. Conclusion: Chiropractors had positive attitudes towards and knew about the BPS model. They used the model in their practices to varying degrees with time and skills being the biggest challenges to effective implementation. It is recommended that chiropractic associations and training institutions provide additional practical training to teach students and practitioners how to implement the model in a clinical setting.
  • Thumbnail Image
    Item
    Upper body musculoskeletal pain associated with remote working of academics at the Durban University of Technology during the COVID-19 pandemic
    (2022-09-29) Narainsamy, Nevinia
    BACKGROUND The world-wide pandemic COVID-19, which initiated international lockdowns and varied degrees of work considerations, enforced remote working to reduce the spread of infection. Ergonomic support for effective remote working during this rapid transition received little consideration. Musculoskeletal disorders (MSDs) associated with musculoskeletal pain (MSP) are frequently linked to poor ergonomic support at the workplace and compromises the quality of life of those affected. MSP may be aggravated by prolonged, repetitive, and awkward movements, poor posture and ergonomics, or a fast-paced workload. Additionally, the onset of upper body MSP contributes to workrelated MSDs, resulting in decreased work productivity. It is believed that the current shift to remote working may result in an increase in MSP. This study, therefore, aims to determine the prevalence and effects of upper body musculoskeletal pain (head, neck, shoulder and back) associated with the ergonomic changes of remote working during the current COVID-19 pandemic. OBJECTIVES 1. To determine the prevalence of musculoskeletal pain among those working remotely during the COVID-19 pandemic. 2. To determine the selected risk factors predisposing to upper body musculoskeletal pain as an ergonomic effect of remote working. 3. To identify the extent to which remote working has impacted the occurrence of musculoskeletal pain with particular reference to ergonomic aspects. 4. To determine the effects of musculoskeletal pain and its impact on work performance/productivity. 5. To provide guidelines/recommendations and future considerations to support the prevention of MSP during remote working. METHOD A quantitative, descriptive cross-sectional study was conducted on all Durban University of Technology (DUT) academic staff members, to obtain relevant data regarding the onset of musculoskeletal pain and ergonomical factors, whilst working remotely during the COVID19 pandemic. Data were collected through the use of an online questionnaire, administered through DUT’s electronic platform. The Dutch Musculoskeletal Questionnaire was adapted to focus more on ergonomics and working remotely. Descriptive statistics were used to provide summarised questionnaire data. All data were analyzed using the IBM SPSS version 25 software package. Bivariate analyses, such as the Pearson’s chisquared test, ANOVA, and T-tests, where appropriate, were done. A p<0.05 was considered statistically significant. Findings of similar studies, both locally and internationally, provided generalised and more contextualised recommendations related to the ergonomic effects of working remotely. RESULTS In summary, 87.2% of participants reported to having musculoskeletal pain (MSP) prior to COVID-19. However, there was a massive increase in MSP while remote working, with 81.8% of participants reporting MSP during COVID-19. A great number of academic staff members (52.7%) reported to have worked remotely and having suitable equipment (59.1%) to facilitate remote work. With a reported increase in workload (89.1%), there was also an increase in productivity (53.6%). The most severe location of pain while remote working was the back (25.5%). Ergonomic factors that were noteworthy were that 64.5% participants sat without their back supported; shoulders were not relaxed in neutral (68.2%); wrists were not in a neutral position (51.8%) and the neck was not in a neutral position while remote working (63.6%). These factors remained consistent before and during COVID-19, indicating a minute change in the statistical significance of ergonomic factors. The p-value was less than 0.001. Regarding the emotional states of the respondents, it has been revealed that there was an association between the emotional status before and during COVID-19. All corresponding p-values were less than 0.001, indicating a statistically significant relationship. CONCLUSION The COVID-19 pandemic has placed unprecedented pressures on governments, economies, and families, posing what many observers consider the largest global peacetime challenge since the Great Depression a century ago. In South Africa, the government moved swiftly after the first confirmed case of COVID-19 on 5 March 2020, which subsequently led to a national lockdown by 27 March 2020. This placed huge challenges on the population, especially for the poor and those working from home. The exponential rise in COVID-19 infections rapidly transformed how and if people would return to the traditional way of working. Working from home during the nationwide lockdown led to poor quality of work and a lack of efficiency, which ultimately led to poor work productivity. Many employers worldwide chose to protect both the health and job security of their employees by implementing remote working. The average household lack the components of a functional office setup such as a simple desk and good quality chair. This consequently predisposed many to work hunched over coffee tables or on kitchen stools without proper neck and back support. It is possible that many working individuals will emerge with increased incidence of MSP after the coronavirus crisis. Ergonomic support for effective remote working may have been ignored amidst the more disastrous effects of the pandemic, but the crisis becoming a major contributor to an increased onset of MSP. This is likely to remain as the norm, even after the shifting of lockdowns, for millions of workers. The adverse effects of the pandemic thus appear to extend beyond its direct consequences into an increased onset of ergonomical concerns that warrants some investigation. This study therefore aimed to determine the prevalence and effects of upper body (head, neck, shoulder and back) musculoskeletal pain associated with ergonomic changes experienced with remote working during the COVID-19 pandemic. It is hoped that the results of this study will inform interventions to redress such effects in remote working climates.
  • Thumbnail Image
    Item
    The effect of long axis manipulation of the third metacarpophalangeal joint on articular surface separation, peri-articular soft tissue movement and joint cavitation
    (2015-03-06) Fogwell, William Peter; Shaik, Junaid
    Aim: To determine the effect of long axis manipulation of the third metacarpophalangeal joint (MCP) on articular surface separation, peri-articular soft tissue movement and joint cavitation. Participants: Forty two right-handed healthy individuals between 18 and 28 years of age from the Durban University of Technology campuses, KwaZulu Natal. Methodology: Written informed consent was obtained from each participant. A case history, physical examination and a hand and wrist orthopaedic assessment was conducted for each participant. Study specific data, such as sex, age, height and weight were recorded. A diagnostic ultrasound (US) scan was done to the left third MCP joint for each participant while distractive manipulation was applied to the joint. The presence or absence of audible release was noted and the tension levels applied to the joint was measured with a digital tension meter. Joint surface separation (JSS), synovial membrane position (SMP), gas bubble presence and location were assessed on the US recordings at baseline, just prior to cavitation, at maximum traction and in the post-traction resting joint. IBM SPSS version 20 was used to analyse the data. Independent sample t-tests were used to compare the means between the two groups and the associations were compared using Pearson’s chi square tests. A p value <0.05 was considered as statistically significant. Results: Long axis manipulation resulted in audible release in 22 of the participants (Group and no audible release in 20 of the participants (Group 2). No significant difference in joint surface separation or the synovial membrane position could be established between MCP joints that cavitated and MCP joints that did not cavitate at the baseline, as well as in maximum traction and in the post-procedure resting joint (p > 0.05; t-test). Hyperechoic gas bubbles were present in 21 of the 22 participants of Group 1 and no gas bubbles could be visualised in the participants in Group 2. The presence of intra-articular hyperechoic gas bubbles was highly associated with audible release (p < 0.001; Pearson’s chi square test). Due to the predefined features of cavitation, gas bubble inception was could not be detected in the Group 1 participants prior to cavitation. In Group 1, 95.5% of the gas bubbles were present in the middle third of the joint at maximum traction. At the post traction resting joint evaluation, no gas bubble was evident in 42.9% (n = 9) of the joints; 42.9% (n = 9) indicated bubbles were present only in the dorsal third, whilst 9.5% (n = 2) presented bubbles in the middle and dorsal third; and in one case gas bubbles were seen in the dorsal, middle and ventral thirds of the joint space. The mean manipulative force recorded in participants in which gas bubble inception took place during manipulation was 5.7 kg, and in those with no gas bubble inception was 12 kg. There was a significant difference between the mean traction force applied to those with and to those without a gas bubble appearance (p < 0.001; t-test). Conclusion: No significant differences were observed between the cavitation and non-cavitation groups for the joint surface separation and synovial membrane movement at various stages of manipulation. A significant association was established between the audible release of a joint that was manipulated and the appearance of intra-articular gas bubbles or micro-bubbles. The mean traction force that was required to cause cavitation was significantly lower than the force to which joints with no cavitation were tensioned. The findings concur with those of previous studies that cavitation is a necessary component of joint manipulation.