Theses and dissertations (Health Sciences)

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Identification and management of yellow flags in chronic low back pain by Chiropractic Master's students at a University of Technology teaching clinic
(2023-05-31) Egumbo, Shameez; Ghuman, Shanaz
Chronic low back pain (CLBP) is one of the leading causes of disability worldwide, preventing many people from performing day to day tasks. Low back pain is the third most common reason for visits to the doctors, right after skin disorders and osteoarthritis. Even though doctors of chiropractic treat more than just back pain, many patients initially visit a chiropractor looking for relief from this persuasive condition. Yellow flags are psychosocial issues that can be indicative of long-term chronicity in low back pain. It is therefore appropriate for chiropractors to know how to manage yellow flags in patients with low back pain, since the two are related. The aim of this study, therefore, is to investigate the identification, knowledge, and the management of yellow flags at teaching clinic by chiropractic master’s students. AIM AND OBJECTIVES OF THE STUDY The aim of the study was to explore and describe the identification and management of yellow flags in chronic low back pain by chiropractic master’s students at a university of technology teaching clinic. METHODOLOGY A qualitative, exploratory, descriptive study was conducted. Master’s degree chiropractic students, who had been clinically active for five months and treated a minimum of five low back pain patients were interviewed to establish their identification and management of yellow flags in CLBP. Semi-structured interviews were conducted in English, which were then transcribed to a Microsoft Word document. The transcripts were analysed using Tsech’s eight steps of thematic analysis to establish the themes, categories and codes. RESULTS AND DISCUSSION This qualitative, descriptive study explored 10 chiropractic master’s students’ identification and management of yellow flags in their chronic low back pain patients. It was found that the chiropractic master’s students had limited understanding of psychosocial factors. Their lack of information and clinical expertise lead to uncertainty pertaining to the identification, assessment and management of yellow flags. The participants acknowledged their shortcomings and suggested numerous limitations to the integration of psychosocial assessments as part of routine practice. The lack of formal education in the theory, assessment and management was the most frequently cited barrier among those raised by the participants. The review of the chiropractic curricula was outside the purview of this study. Nevertheless, considering the comparable findings reported in the literature further supported this, it may suggest a need for chiropractic education of yellow flag assessment and management to be reviewed and strengthened. CONCLUSIONS This is the first South African study that had been conducted on registered master’s degree chiropractic students’ identification and management of yellow flags in chronic low back pain. This study will add to the existing literature and enable other registered master’s degree students and new graduate chiropractors to have a better understanding of the of the management of yellow flag patients.
The prevalance of and associated risk factors for low back pain in medical outpatients of a selected Umdoni Municipality health care clinic
(2018) Khumalo, Khanyisile P.; Haffejee, Firoza
Background: Low back pain (LBP) can affect any population and is experienced by any race, gender or age group. The lifetime prevalence of LBP is reported to vary from 44.4% to 90% in different populations in Western countries and 36% to 70.9% in African countries. Studies have been conducted in developed countries, or urban areas of developing countries regarding LBP and they report the LBP prevalence to vary from 48% to 90%. However, very limited literature about LBP and its risk factors in rural areas exist. There are few studies that have been conducted in rural areas; however, none of these investigated a South African rural area and since the demographics and type of work of this population differs, it may affect the prevalence of LBP. Aim of study: The aim of this study was to determine the prevalence of and associated risk factors for low back pain in medical out patients of a selected Umdoni Municipality Primary Health Care Clinic. Methodology: This study design was a cross-sectional survey, set in a quantitative paradigm, in which data was collected by means of a questionnaire. This study was conducted in a primary health care clinic of the Umdoni Municipality. The convenience sequential sampling method was used to select the qualifying participants (as per inclusion/ exclusion criteria) from the patients in the waiting room of the clinic. Participants (n=400) were recruited by the researcher in the clinic waiting room / reception. All collected data was captured on an Excel spreadsheet and subsequently transferred to the statistical program for the Social Sciences (SPSS) version 23. A p value less than 0.05 was considered statistically significant. Pearson’s chi square tests and Fisher’s exact test were utilized in order to determine the association between low back pain and various factors. Odds ratios were calculated to determine risk factors for LBP. LBP was correlated with demographics as well as daily activities or chores. Results: A total of 400 questionnaires were completed by the participants in the form of an interview with the researcher. The lifetime and point prevalence of LBP was 79.3% (n = 317) and 32.5% (n = 130) respectively. LBP increased with an increasing age (p = 0.028). Similarly, LBP increased in people with higher BMI (p < 0.001). More females (83.4%, n = 231) suffered from LBP than did males (69.9%, n = 86, p = 0.002). The prevalence of LBP was not correlated with other demographic factors. More females (98%, n = 272) performed household chores than did males (78.8%, n = 97, p < 0.001). These chores included fetching firewood (p < 0.001), washing clothes (p < 0.001) and cooking (p < 0.001). Although there was no relationship between performing household chores and the lifetime prevalence LBP (p = 0.842), there was a relationship between performing these chores and the point prevalence of LBP (p = 0.004). More females (96%, n = 266) than males (65.9%, n = 81) fetched water (p = 0.001). Bivariate analysis indicated that LBP was increased with an increasing number of pregnancies (p < 0.001). The risk of LBP was increased in those who underwent a C-section (OR = 2,748, 95% CI: 1,108-6,819, p = 0.024). Similarly the risk of LBP was increased in those women who had an epidural (OR = 3.115, 95% CI: 1,355 -7,157, p = 0.005). Almost a fifth of the participants lifted heavy objects for a prolonged period of time (19.5%, n = 78, p < 0.001). Lifting heavy objects was strongly associated with an increased lifetime prevalence of LBP (OR = 6.014, 95% CI: 2.131 - 16.976, P < 0.001). There was no correlation between physical activity and the prevalence of LBP (p = 0.084). However Pearson’s chi square test showed that those that walked experienced more LBP compared to those involved in other physical activities (p = 0.024). In addition, those who walked, were often walking to fetch water and this may have caused the LBP. Low back pain affected daily activities such as bending (30.5%, n = 122, p < 0.001) and lifting of objects (18%, n = 72, p < 0.001). It also resulted in absenteeism from work and loss of jobs. Knowledge of chiropractic was poor (1%, n = 4, p < 0.001) and 99% (n = 396, p < 0.001) of the participants had never been treated by a chiropractor. Conclusion: Low back pain prevalence was high in the Umdoni Municipality population. Activities related to life in poor socio-economic backgrounds, such as fetching water from the river, were highly associated with LBP. Participants were unaware of the field of chiropractic treatment and since chiropractors are involved in manually treating low back, it is recommended that chiropractic treatment be incorporated into the services provided at primary health care clinics in the area.
The role of selected factors in the short-term prognosis of acute and chronic low back pain in patients attending Durban University of Technology Chiropractic Day Clinic
(2017) Allenbrook, Keric P.; O'Connor, Laura; Young, Karin
Background: The increasing cost and prevalence of chronic low back pain (LBP), has resulted in more resources being devoted to its treatment and management than ever before, despite only approximately 10% of acute cases progressing to chronicity. Determining prognostic factors for the short-term improvement of acute and chronic patients with LBP has become a research focus area to try and identify baseline factors that may affect a patients’ improvement with conservative treatment. Internationally studies have been conducted in developed countries however similar studies are lacking in developing settings like South Africa. It is unclear if the prognostic factors identified would be similar across populations. Thus, this study aimed to determine if pain, disability (social and physical), anxiety, depression, work fear-avoidance and locus of control, were associated with short-term prognosis, as determined by self-reported improvement using a Patients Global Impression of Change (PGIC) scale, in acute and chronic LBP patients attending the Durban University of Technology Chiropractic Day Clinic (DUT CDC). Method: Consecutive patients seeking treatment at the DUT CDC with a new episode of non-specific LBP, who met the study criteria, were approached for participation in the study. On agreeing to participate they were given the Bournemouth Questionnaire (BQ), a demographic questionnaire and a letter of information and consent (LOIC) at the initial consultation by student chiropractors. Those participants that were still attending treatment at the 4th/5th and tenth visit were required to complete the BQ and the PGIC. Results: A hundred participants were enrolled in the study, 65% had acute LBP and 52% were male. Only 20% of the initial group were still attending treatment at the 4th/5th follow-up. Baseline comparisons of those with acute and chronic pain revealed no significant difference in gender or age. Acute patients at the initial visit had higher levels of disability (social and physical), anxiety, depression and fear-avoidance beliefs than the chronic pain participants. At the 4th/5th treatment, the acute pain patients showed a significant decrease in pain (p=0.002) and disability (p=0.032), with all other measures decreasing from baseline measures. Similarly, chronic pain participants had a significant decrease in pain (p=0.038) but a significant increase in depression (p=0.015) scores, with all other prognostic factors being rated higher than at the initial consultation. The majority of participants (85%) in this study reported a clinical improvement in their LBP. In the acute pain sufferers, all but one participant reported improvement, thus identification of prognostic factors or this group was not possible. In the chronic pain participants, no factors were identified as prognostic for improvement, regardless of the low numbers still attending at the 4th/5th visit. Conclusions: Trends suggested that chronic pain sufferers were less likely to report decreases in the prognostic factors (except for pain), when compared to the acute pain participants. In the chronic LBP participants, no factors were associated with improved prognosis. The predictive value in determining which patients were less likely to improve was limited in the current study due to a small sample size.
An investigation into the prevalence and risk factors of occupational low back pain amongst commercial pilots registered with the South African Civil Aviation Authority
(2015-03-06) Stander, Barend Jacobus; Matkovich, Grant
Background Occupational low back pain (LBP) has been described as a significant burden to society. Although there is uncertainty and conflicting studies on the exact causes and combination of causes of LBP, it has been found that occupations which require prolonged sitting periods and have exposure to physical factors such as whole body vibration (WBV) and / or awkward posture, results in increased likelihood for LBP. Pilots are not sheltered from the development of LBP, with the lifetime prevalence of LBP varying from 31.5% to a significant 82%. Additionally, point prevalence varies significantly between 5.1% and 68%, which illustrates that individual pilot and / or occupational factors may contribute to specific pilot subgroups. This could apply to commercial pilots, who use seats that were found to be ineffective in terms of their depth and inclination, therefore limiting the height and impact of the lumbar support. There is a paucity of studies performed on LBP relating to commercial pilots, specifically, on their unique occupational setting. Research is therefore warranted to illustrate the possible risk factors to which they are exposed to, as impeded performance may lead to catastrophic consequences if a pilot’s ability to complete actions critical to flight becomes hindered. Aim To determine the prevalence of low back pain (LBP) in commercial pilots and identify possible risk factors that pilots are exposed to. Study designs The study transpired as a cross sectional questionnaire survey. Participants Study comprised of 100 commercial pilots registered with the South African Civil Aviation Authority (SACAA) and affiliated with the various participating companies utilizing O.R. Tambo International Airport. Methodology All commercial pilots registered with the SACAA and who make use of the O.R.Tambo International Airport (operate through or from) and affiliated with the participating companies during the research study, was approached for participation. Pilots were required to sign and agree to the letter of information and informed consent, as well as the confidentiality agreement. Questionnaires were distributed and all documents were collected, following completion thereof. Pilots were not allocated to more than one group during the data collection (recording) phase of the study. Subgroup analysis was however not excluded in the analysis. IBM SPSS version 21 was used for analysis. A p value <0.05 was considered as statistically significant. Demographics of the pilots were described in the same manner as in the case of categorical variables, and using summary statistics such as mean, standard deviation and range for quantitative variables. Prevalence and characteristics of the low back pain is described using relative frequency and percentages, with 95% confidence intervals. Associations between risk factors and low back pain was identified with log linear regression analysis and tested using Pearson’s chi square test in the case of categorical variables and t-tests in the case of continuous variables. Results The lifetime prevalence of LBP amongst commercial pilots was 80.8%, with the annual prevalence reaching 68.7%. Majority of commercial pilots were white, married males, with nearly the entire population having reached similar educational levels. Considering the male predominance of this population, gender was significantly associated with LBP. Although the female population was much smaller than the male population, it was also found that females were six times more at risk of developing LBP; however the risk was not statistically significant. Awkward posture such as twisting and being stressed at work were found to be significantly related to LBP. Having a history as an ex-smoker or non-smoker was found to be a risk for LBP development. BMI was also significantly related to LBP; however, an inverse relationship is indicated. Having a subjective rating of good health versus excellent health was also an indicator of risk for LBP. Conclusion: Commercial pilots have a significant risk for LBP development. It was found that subjective ratings of own health was a good indicator of LBP whereby good health versus excellent health, was a significant risk factor. Although greater portions of the populace are white males, normally less at risk, a significant lifetime and annual prevalence of LBP was found. Furthermore, the small female population had potentially considerable contribution to the prevalence of LBP through their significant odds ratio. Being a current smoker carried less risk in comparison to a history of an ex-smoker or non-smoker, which further complicates the so often debated contribution of this proposed risk factor. Interesting results were found through the inverse proportional relationship that exists between BMI and LBP, whereby every unit increase in BMI results in a relative decreased risk for LBP development. Majority of the proposed risk factors of LBP was not found to be significant, except stress and twisting, which were found to be common risk factors amongst commercial pilots.
The prevalence and associated risk factors of low back pain in an automotive production company
(2012-08-17) Raad, Tarnia; Korporaal, Charmaine Maria
Objectives: To determine the prevalence and associated risk factors of low back pain (LBP) in an automotive production company, evaluating the relationship between selected risk factors, type of occupational activity and the prevalence of LBP. Methods : This was a descriptive study at a large automotive production company entailing 200 physical production employees and 200 sedentary employees. Using a cross sectional study design, a retrospective analysis investigated the LBP prevalence, by means of a questionnaire. Individuals reported on demographics, injury location, injury aetiology, injury nature, extent of treatment rendered and time lost from work. Additionally, data was obtained regarding smoking, occupational stress and fitness.Results: A significant difference was found between sedentary and manual employees with regards to age, gender, ethnicity, marital status, education and medical aid. Similarly a significant difference between the groups was found for the point prevalence of LBP, current LBP description (sharp, shooting, dull aching, stabbing and catching pain descriptions), past LBP description (catching pain description), sidedness/ location of pain as well as associated features of the current LBP (viz. pins and needles, pain to the knees, numbness, bed rest, absence from work, pain at work and pain on weekends) and associated features of past LBP (viz. pins and needles, pain to the knees, numbness, bed rest, absence from work, pain at work and pain on weekends). There were no noted psychosocial factor that impacted on a difference between the groups, but there was a significant difference between the manual and sedentary employees with regards to absenteeism. Conclusion: A significant rate of LBP was reported amongst both the sedentary (59.6%) and the manual (89%) employees, implying that the costs to the company are relatively high. It is, therefore, suggested that the company looks at a variety of strategies to reduce the burden of LBP in their employees.
The role of psychosocial risk factors on the prevalence of low back pain amongst Grade 12 learners in public schools in the greater Durban area
(2010) Seethal, Verusha J.; Van Niekerk, L.; Wilson, Laura Maie
Background: Low back pain (LBP) is the most prevalent musculoskeletal condition experienced by human beings and the most common cause of disability in developed nations. Psychosocial factors, involving aspects of social and psychological behaviour, have previously been documented as potential risk factors in the development of adult LBP. However, more research is required to fully understand the role of psychosocial risk factors on the prevalence of LBP amongst adolescents. Objective: To determine the prevalence of LBP and to identify selected psychosocial risk factors associated with LBP amongst Grade 12 learners in the Greater Durban area. Methods: A population-based study was conducted amongst a stratified random sample of 20 public secondary schools in all three educational districts in the Greater Durban area. Data was collected by means of a structured questionnaire administered to the sample population consisting of Grade 12 learners. Using an exploratory research design, the individuals reported on demographics as well as prevalence, severity, frequency and chronicity of LBP. In addition, data was obtained regarding various psychosocial risk factors including depression, exam stress and anxiety, socio-economic status, family history of LBP, smoking, alcohol and drug abuse amongst the respondents. Results: The prevalence of LBP was 57.42% with a median frequency of 8 times a month. About a third (33.9%) of the respondents experienced difficulty bending whilst 35% reported that their LBP spread down to the legs below their knees. The daily activity most affected by LBP was having a good night‟s sleep (50.6%), followed closely by playing sports (47.4%) and concentrating in class (46.6%). The majority of the respondents that suffered from LBP had taken pain relief medication (47.1%) whilst only 21% of the respondents had missed school because of LBP. With regards to the psychosocial risk factors under investigation, three of the risk factors did not show any association to LBP. They included socio-economic status, smoking and recreational drug use. In contrast, five psychosocial risk factors showed an 6 association to LBP. They included alcohol abuse, family history, exam stress, anxiety and depression. Finally, after adjusting for all other risk factors for adolescent LBP, depression and high exam stress showed the strongest correlation with the occurrence of LBP amongst Grade 12 learners in the Greater Durban area. Conclusion: LBP amongst adolescents is a common problem that increases with age, representing a risk for LBP in adulthood. The researcher is of the opinion, that this illustrates the need for further investigations with more profound studies on the risk factors so that more light can be shed on how to manage this ever-growing problem.
The prevalence and risk factors for occupational low back pain in manual therapists
(2009) Pereira, Nicole; Korporaal, Charmaine Maria
Manual therapists are susceptible to occupational low back pain. The aim of this study was to determine the prevalence and risk factors for occupational low back pain in manual therapists and to determine and compare the prevalence and risk factors for occupational low back pain among various types of manual therapists in South Africa. This study was conducted as a cross-sectional survey and a self-administered questionnaire, developed from the literature and validated prior to the study, was mailed to 1500 randomly selected manual therapists, including: physiotherapists, occupational therapists, biokineticists, chiropractors, reflexologists, aromatherapists and massage therapists. A total of 233 completed questionnaires were returned, giving a response rate of 15.53%. Results revealed that the point prevalence of low back pain in manual therapists was very high at 41%, the one-year prevalence was 59% and the career prevalence was 74%. The point prevalence of low back pain was highest in aromatherapists and biokineticists, while both the one-year and career prevalence of low back pain was highest in occupational therapists and massage therapists. The risk factors for low back pain in manual therapists were: BMI; previous abdominal surgery; previous trauma to the low back, hips, knees or ankles; a physically stressful job; not having an assistant and work in a hospital or other setting. In keeping with the literature, various workrelated factors were implicated in the development and / or exacerbation of low back pain in certain manual therapists more than others and low back pain history in the different manual therapists was also in accordance with the literature. To conclude, low back pain is prevalent among South African manual therapists and the development and implementation of preventative programs to reduce rates of occupational low back pain in manual therapists is mandatory.

Theses and dissertations (Health Sciences)

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