Faculty of Health Sciences

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Motion palpation used as a postmanipulation assessment tool for monitoring end-feel improvement : a randomized controlled trial of test responsiveness
(Elsevier BV, 2009-09) Lakhani, Ekta; Nook, Brian; Haas, Mitchell; Docrat, Aadil
A tenet of motion palpation theory is the ability to confirm postadjustive segmental end-feel improvement (EFI). Only one previous trial has evaluated the responsiveness of EFI; this was a study of the thoracic spine. The purpose of this study was to evaluate the responsiveness of postadjustive end-feel for evaluating improvement in putative segmental spinal motion restriction after spinal manipulative therapy (SMT) of the cervical spine.
Methods
A prospective, blinded, randomized placebo-controlled pilot trial was conducted with 20 symptomatic and 10 asymptomatic participants recruited from a chiropractic teaching clinic. The treatment group received SMT, and the control group received placebo detuned ultrasound. Responsiveness was evaluated as the etiologic fraction (% of cases with EFI attributable to SMT) and as the sensitivity and specificity of change.
Results
For the entire sample, the etiologic fraction was 63% (P = .002), sensitivity was 93%, and specificity was 67%. For symptomatic participants, a strong relationship appeared to exist between receiving SMT and EFI (etiologic fraction = 78%, P = .006; sensitivity = 90%; specificity = 80%). A strong relationship was not found for asymptomatic participants (etiologic fraction = 40%, P = .444; sensitivity = 100%; specificity = 40%), where EFI was recorded frequently, whether participants received SMT or detuned ultrasound.
Conclusion
The findings of this study showed that motion palpation of end-feel assessment appears to be a responsive postmanipulation assessment tool in the cervical spine for determining whether perceived motion restriction found before treatment improves after SMT. This observation may be limited to symptomatic participants.
The effect of dry needling on trapezius muscle activity and post needling soreness in participants with latent trapezius myofascial trigger points
(2019-09-05) Peter, Steven J.; Kretzmann, Heidi
Background: Dry needling (DN) is an established and effective modality which is used globally for the treatment of myofascial trigger points (MFTPs). Post-needling soreness (PNS) is a common side effect which is felt shortly after DN at the site of needle insertion and peaks at 24 hours post-treatment. Research of its effects on muscle activity, range of motion, numerical pain rating scale and pain pressure threshold exist but focuses on pre- and post-needling measurements and a follow up measurement at 24 hours. This study objectively tried to investigate the effects of DN in the first few hours after treatment, in terms of pain pressure threshold (PPT), range of motion (ROM), surface electromyography (sEMG), and post needling soreness. Objectives To determine the effect of dry needling latent myofascial trigger points (LMFTPs) in the upper trapezius muscle with respect to: numerical pain rating scale (NRS), PPT, ROM and sEMG in the first four hours after treatment. Methodology This was a quantitative pre-test post-test design study with repeated follow up measurements. Through a purposive convenient sampling strategy, 15 asymptomatic volunteers were recruited into the study. Baseline readings were taken for the NRS, sEMG, PPT and ROM readings were then taken. After baseline readings were taken, the LMFTP was dry needled, and the measurements were taken again in the same order. The measurements were taken every hour for four hours post needling. IBM SPSS version 25 was used to analyse the data. A p value <0.05 was considered as statistically significant. Comparison of measurements over time were achieved using non-parametric Friedman tests for paired data. Post hoc tests were done in the case of a significant Friedman’s test in order to determine which pairs of measurements differed. Correlations between the changes over time of each measurement were done using non-parametric Spearman’s correlation. Results For the NRS there was a statistically significant increase in perceived pain at the first measurement post treatment (p < 0.001). While there was no significant difference in algometer measurements over time (p = 0.321). CROM showed an improvement in all tested movements: ipsilateral PA rotation (p < 0.001), contralateral PA rotation (p < 0.001), ipsilateral lateral flexion (p = 0.001) and contralateral lateral flexion (p < 0.001). With regards to sEMG root mean square (RMS) There was no difference between the time points (p = 0. 534). The following correlations were noted: Changes in contralateral and ipsilateral PA rotation were strongly positively correlated together (rho = 0.711). Changes in ipsilateral PA rotation was negatively correlated with change in 1- minute rest (rho = -0.569). Changes in contralateral PA rotation was positively correlated with change in mean contraction (rho = 0.527). Conclusions In conclusion, the results of this study show that DN of LMFTPs in the upper trapezius muscle may be effective at improving CROM without eliciting a strong PNS effect or a significant drop in PPT. As this is one of the few studies that exist to test objective and subjective results in the first four hours after needling, it is difficult to draw strong conclusions.
The effect of talocrural joint manipulation on muscle activity of the lower limb, balance, pain and disability in participants with chronic ankle instability syndrome
(2019-09-05) McLaren, Murray James; O’Connor, Laura; Puckree, Threethambal
Background and Purpose: Ankle sprain injuries are prevalent in both the sporting and general population and can develop into chronic ankle instability syndrome (CAIS). When this occurs, there is a tendency for the ankle to re-sprain following an acute ankle sprain. Deficits in proprioception and neuromuscular control, specifically of the peroneal muscles, may lead to altered balance and postural stability in patients with CAIS. Recent research suggests that the ankle invertors and plantarflexors are also affected. Joint manipulation has been shown to result in reduced pain and improved foot and ankle functioning in individuals with CAIS, however, the exact mechanism(s) through which joint manipulation brings about these effects is not clear and the field of extremity joint manipulation on arthrogenic muscle inhibition (AMI) is under-investigated. This study aimed to determine the immediate effect of talocrural joint manipulation on postural stability and the muscle activity of the ankle invertors, evertors and plantarflexors by assessing surface electromyography (sEMG) of these muscles during static single-limb postural stability testing. Subjective outcomes of pain and disability were also measured through the use of the foot and ankle disability index (FADI). Methods: This study used a randomized, single blinded placebo controlled pre-test, and a repeated post-test measures experimental design. A sample of 42 participants, with grade I or II CAIS, aged 18-45 years, were randomly allocated into two groups. One group received a long axis distraction talocrural joint manipulation and the other group, a sham manipulation. General pain and disability (FADI), postural stability (Biosway Portable Balance System) and muscle activity (Biopac wireless EMG system) measurements were taken before the intervention. Muscle activity and postural stability were assessed again immediately after the intervention and then again 20 minutes later. Postural stability and muscle activity were measured both with participants’ eyes opened and eyes closed. FADI measurements were taken 24 hours after the intervention. Results: The two groups were comparable at baseline for age, gender, body mass index, pain and disability, postural stability and muscle activity (p > 0.050). An inter-group analysis showed a significant improvement in FADI (p= 0.005) and general pain scores (p= 0.039) when compared to the placebo group post-manipulation. There were no significant changes in the manipulation group for muscle activity and postural stability when compared to the placebo group (p > 0.050). Intra-group analysis showed an overall improvement over time for eyes opened postural stability in the manipulation group (p= 0.040) and decreased fibularis longus muscle activity in the placebo group with eyes open balance testing (p= 0.047) and eyes closed balance testing (p= 0.023). Conclusion: The results of this study showed that talocrural joint manipulation had a positive effect on pain and disability in individuals with CAIS. No significant differences were found between the intervention and placebo groups for limb muscle activity and postural stability. Intra-group analysis showed that the manipulation had a positive effect on eyes-open postural stability performance and that there may have been a trend of an effect of manipulation counteracting muscle fatigue experienced in the fibularis longus of the placebo group. Further investigation to further elucidate the effect of manipulation in CAIS is recommended.
An exploration into factors resulting in career change by qualified chiropractors within the eThekwini Municipality
(2019-09-05) Perumall, Joanna; Sibiya, Nokuthula M.; Abdul-Rasheed, Ashura
Chiropractic in South Africa faces different and greater challenges when compared to chiropractic in other parts of the world because chiropractic is a form of complementary and alternative medicine which is isolated within the healthcare system of South Africa. Chiropractors are burdened by the lack of acceptance and recognition both publicly and professionally. This results in financial challenges thereby impacting negatively on income and the ability to maintain a practice. Furthermore, the perceptions of chiropractors’ are altered after failing to find success in active practice. These factors result in career dissatisfaction. Consequently, they pursue alternate careers to satisfy their personal and professional needs. While many studies have explored career satisfaction among practicing chiropractors, the factors influencing career change by qualified chiropractors have been minimally explored. Aim of the study The aim of the research study was to explore and discuss the factors resulting in career change by qualified chiropractors within the eThekwini municipality. Methodology A qualitative, explorative, descriptive and contextual design was employed to guide the study. A structured interview guide was used to conduct in-depth interviews with 10 non-practicing chiropractors within the eThekwini municipality. The main research questions for this study were “Why are you not a practicing chiropractor?”, “Do you have other professional qualifications?”, “What do you think are the benefits of being in this career as opposed to practicing as a chiropractor?” and “Do you wish to practice as a chiropractor in the future?” Thematic analysis was used to analyse the data of this study The main themes that emerged from the study were the challenges of private practice, perceptions of the chiropractic programme and choosing alternate careers over chiropractic. The participants of this study expressed financial challenges in private practice, a lack of recognition of the profession and the time invested into private practice left no time for family responsibilities. The participants explained that the chiropractic programme and research component is a tedious process with minimal rewards post-qualification. Furthermore, the participants experienced greater benefits and rewards in alternate careers. Conclusion The findings that emerged from this study indicate that chiropractors are faced with numerous challenges post-qualification. Therefore, it is necessary for the DUT chiropractic faculty and staff to actively engage with chiropractic candidates and chiropractic students and vice versa (Leach 2004). Such engagement will adequately equip the students with a better understanding and knowledge of the programme to assist in their success post-qualification.
An exploration into the diagnosis and management of neck pain by Ayurvedic practitioners in South Africa
(2019-09-05) Manda, Karmen; Maharaj, Madhu; Ashura, Abdul-Rasheed
Background The health care system of South Africa is growing exponentially and providing patients with various treatment options. Recently, Ayurveda has become popular because of its nature-based and spiritual approach to ailments. Neck pain has been researched to a great extent in allopathic medicine, but not in the context of Ayurvedic medicine. Although there is a wealth of information regarding Ayurveda and its basic principles, there are limited publications on the Ayurvedic approach to common musculoskeletal conditions such as neck pain. Therefore, the aim of this study was to determine the Ayurvedic approach to the diagnosis and management of neck pain by Ayurvedic practitioners in South Africa. Method A qualitative exploratory descriptive study was conducted using standardized open-ended questions. Eight Ayurvedic practitioners, from South Africa, from the provinces of KwaZulu-Natal and Gauteng, were interviewed to establish their methods of diagnosis and management of neck pain. The interviews were semi– structured and conducted in English and later transcribed verbatim. The transcripts were then analysed using thematic analysis to establish codes, categories and themes. Results Eight out of thirteen registered Ayurvedic practitioners in South Africa participated in the study. Five main themes emerged from the data: the Ayurvedic approach to management of neck pain, the Ayurvedic diagnosis of neck pain, the Ayurvedic treatment of neck pain, the use of modalities in the Ayurvedic profession for the management of neck pain and the basis of referral in the Ayurvedic profession to manage a patient with neck pain. Participants discussed the importance of the three dosha principle and the importance of knowing the “root cause” of an ailment as an integral part of the management of a patient with neck pain. The three dosha principle focuses on vata, pitta and kapha, which are the constituents of the human body. It is essential that there is homeostasis of the three doshas to maintain good health and a disease-free state. The participants, in this study, discussed the root cause of an ailment as being the underlying factors that bring about pain in the body. Participants stressed the importance of the “pulse diagnosis,” the integration of modern technology and the threefold principle of darshana, sparshna and prashana in order to properly diagnose a patient. These diagnostic tools emphasize the holistic approach of the Ayurvedic system of medicine. The treatment method varied amongst participants. Although each practitioner practices differently, the basic principles of the profession are still applied when administrating treatment to a patient. Treatment focused on panchakarma therapy, greeva basti, shirodhara, massage and potli therapy, herbal oils and medication. The goal of Ayurvedic treatment is to pacify the aggravated doshas, utilizing these various treatment options. Participants in this study focused on yoga, marma therapy and patient education as modalities that are utilized by the profession to assist in the management of neck pain. They discussed the importance of referral to the appropriate health care professional, so that the patient receives the best possible care. The results of this study revealed that the Ayurvedic system of medicine is a holistic system of medicine that addresses all aspects of the mind, body and spirit. In Ayurveda, the management of a patient relies on the patient, practitioner and the “three dosha principle”. The foundation of the “three dosha principle” focuses on vata, pitta and kapha. Essentially, various ratios of vata, pitta and kapha exist in every individual, however, when there is lack of homeostasis between these three elements, disease occurs in the body. The therapeutic goal in Ayurveda is to restore doshic balance in the body. Conclusion This is the first South African study to be conducted on the Ayurvedic management and diagnosis of the musculoskeletal condition, neck pain. This study will add to the body of literature and enable other practitioners to have a better understanding of Ayurveda, thus giving the patient the best, appropriate care available. The foundation of Ayurveda is the “three dosha principle” which the profession applies to holistic patient management, focuses on the mind, body and spirit of the patient, rather than the disease per se.
The epidemiology of low back pain in male adolescent field hockey players in the eThekwini municipality
(2019-09-05) De Wit, Dale Cameron; Pillay, Julian David; Ducray, Jennifer Frances
Background: Field hockey is a popular international sport which is played in 132 countries across the world. Due to the nature of hockey, players repeatedly perform a combination of forward flexion and rotational movements of the spine in order to strike the ball. These movements have been shown to increase the risk for pain and injury to the lumbar spine. Due to the popularity of the sport of field hockey more empirical randomised controlled studies and/or observational studies need to be conducted to determine the pathomechanics of the nature of lower back pain and injury among players. Objectives: The objectives of this study were to determine the prevalence and incidence of low back pain in male adolescent field hockey players; to determine the characteristics of the low back pain in terms of location, chronicity, disability and treatment sought; and to determine the selected risk factors (demographics, equipment, health and lifestyle) of low back pain in male adolescent field hockey players. Method: A descriptive study of cross-sectional design, using a survey data collection tool was used on 112 male adolescent field hockey players in the eThekwini Municipality. The questionnaire data were then statistically analysed using IBM SPSS version 25 with statistical significance set at p value <0.05. Descriptive statistics such as mean and standard deviation, or median and inter-quartile range were used to summarise responses to continuous variables as appropriate. Categorical variables were described using frequency tables. Associations between risk factors and low back pain were tested using Pearson’s chi square test and t-tests as appropriate. Results: A total of 68 participants completed and returned their questionnaires yielding a participation rate of 60.7%. The period prevalence of low back pain was 63.2% and the incidence was 38.2%. Point prevalence at the beginning of the season, mid-season, and end of season was 25%, 32.4% and 22.1% respectively. The most common location for low back pain was the middle low back region (39.5%), and the most common duration of pain was a few hours (32.6%). Most participants (79.1%) did not classify their pain as a disability, and only 44.2% of participants received medical treatment for their low back pain. The results were found to be statistically significant between hydration and low back pain (p = 0.050) i.e. those individuals who did not hydrate frequently during matches and training were significantly more likely to experience low back pain. Conclusion: Low back pain in male adolescent field hockey players is a common phenomenon. The results of this study, although limited to a select group of adolescents, showed a slightly higher prevalence of LBP to that of previous studies. More importantly, even though most participants did not experience low back pain classified as a disability, low back pain still had a large impact on participants, as nearly half of participants consulted with a medical professional for treatment. The study further indicates the need for frequent hydration during matches and training as inadequate hydration was found to be significantly related to low back pain. We highlight this as a novel finding and recommend special consideration to this by athletes and coaches. Moreover, the need for the development of strategies in the prevention and management of low back pain in field hockey is further recommended.
Perceptions of new graduate chiropractors in their management of paediatric patients in the eThekwini municipality
(2019-09-05) Frederick, Tarryn Miranda; Varatharajullu, Desiree; Sibiya, Nokuthula
Chiropractic is the most frequently utilised complementary and alternative medicine therapy by children and adolescents worldwide. Evidence suggests that childhood health and lifestyle can impact on the health and quality of life in adulthood. The chiropractic care of paediatric patients should therefore be considered as a viable, conservative approach to the holistic management of children. The chiropractic management of paediatric patients is still however surrounded by controversy, from the public and other healthcare professions, largely due to the lack of scientific research in this field. With the adoption of evidence-based practice, it is imperative that the chiropractic profession remain dynamic, continually exploring, questioning and researching the elements that contribute towards effective chiropractic paediatric treatment and management. This study endeavours to provide a new viewpoint from the perspective of new graduate chiropractors on their confidence and competence with regards to paediatric patient management, which are aspects, regarded by multiple studies, as vital elements of successful patient management in the healthcare sector. The findings of this research can provide a greater understanding of the methods which can be implemented in order to foster knowledge, skill and overall confidence during tertiary education, with respect to the field of chiropractic paediatric training. Aim of the study The aim of the study was to assess the perceptions of new graduate chiropractors in their management of paediatric patients in the eThekwini Municipality. Methodology A qualitative, explorative, descriptive research design was utilised for this study. A purposive sample of 10 new graduate chiropractors in the eThekwini Municipality were interviewed. Their perceptions with regards to their paediatric patient management were obtained through semi-structured interviews. Eight key questions, relating to chiropractic paediatric patient management and paediatric educational training, were used to encourage the discussion. The data collected were stored electronically and then transcribed. The transcripts were then coded and analysed by the researcher to identify categories and subcategories. Interpretation of the coded data thereafter occurred, utilising the themes and sub-themes previously identified by the researcher. Results Four main themes were identified in the study, namely self-perception of confidence, knowledge and skill in paediatric patient management; exposure and training received in the chiropractic course; challenges encountered in paediatric patient management; and further enhancement of paediatric patient management. Participants expressed a lack of confidence and competence with regards to their management of the paediatric population. A strong correlation was exhibited between their perceived lack of skill in paediatric treatment and management and increased referral rates for this patient category. Participants stated that their lack of exposure to paediatric patients during the chiropractic paediatric curriculum in the course, negatively impacted on their diagnostic and orthopaedic assessment skills, as well as their ability to facilitate treatment to this age group. Participants identified areas of enhancement in the chiropractic paediatric component of the chiropractic programme. A variety of obstacles encountered by new graduate chiropractors were discussed, including parental satisfaction and influence on paediatric treatment; communication and time management skills; uncooperative patients and lack of competence and confidence with regards to paediatric patient management. Methods to improve paediatric assessment and treatment were then highlighted and discussed further. Conclusion This study is the first in South Africa to assess the perceptions of new graduate chiropractors in their management of paediatric patients. These perceptions were based on a variety of factors such as self-perceived competence, self- confidence, professional education and continued professional development, as well as practitioner experience. While new graduate chiropractors acknowledged the beneficial aspects of the chiropractic paediatric component of the chiropractic programme, they provided constructive feedback and recommendations for further enhancement of the chiropractic paediatric curriculum in the chiropractic course. The lack of exposure to paediatric patients prior to private practice was highlighted as a key factor that negatively impacted on new graduate chiropractors’ confidence to assess, treat and manage this patient population. Therefore, it is recommended that the findings of this research be utilised by the Durban University of Technology’s Chiropractic Department in order to enhance the quality of their chiropractic paediatric curriculum.
The prevalence of and risk factors for cardiovascular disease in patients seeking treatment at the Durban University of Technology Chiropractic Day Clinic
(2018) Fillis, Lynn; Harpham, Graeme John; Korporaal, Charmaine Maria
Introduction: Cardiovascular disease (CVD) is a major contributor to death in South Africa. Literature suggests that patients with musculoskeletal complaints frequently present with co- morbid pathologies such as hypertension and angina. However, ambiguity exists in the literature as to whether a relationship between the presence of CVD and the presence of musculoskeletal complaints exists. Methodology: This quantitative cross-sectional retrospective cohort analysis utilised a validated data sheet to collect demographic characteristics; morbidity and prevalence of cardiovascular disease and musculoskeletal complaints; and their associated risk factors from 1066 clinic files of new patients who presented to the Durban University of Technology Chiropractic Day Clinic in one year. The data were manually extracted, coded and were captured on an Excel spreadsheet and imported into IBM Statistical Package for the Social Sciences (SPSS) version 24 for analysis. A two-tailed 0.05 level of significance was used. Where associations were found, Pearson chi-square tests or Fisher exact test was used for categorical variables, and independent t-tests for quantitative variables was utilised to determine the significance of the association, indicating whether the association was greater than chance alone (i.e. a p value <0.05 being considered statistically significant) (Singh, 2014). If the data were not normally distributed a Mann-Whitney U test was utilised. Odds ratios were calculated to determine the risk of the exposure where possible (Singh 2017). Results: The patients presenting between 9 June 2015 and 9 June 2016 were predominantly Indian males; mean age of 37.87 years (SD 16.53 years); range five weeks to 86 years of age; majority within the 20-29 year age group. Most patients sought treatment for a primary musculoskeletal complaint (25% reported a secondary musculoskeletal complaint), characterised by chronic, moderate lumbar spine/abdomen pain of sharp character, with no associated pain radiation. The prevalence of cardiovascular disease was 25.2%, with hypertension and peripheral vascular disease as the most frequent. Risk factors in both the cardiovascular and non-cardiovascular disease groups included non-modifiable risk factors (viz. advancing age; gender; race/ethnicity and family history of CVD); and modifiable risk factors (viz. overweight/obesity; physical inactivity; blood pressure abnormalities; tobacco use; alcohol use; high fat and carbohydrate diet; diabetes mellitus; connective tissue disease; hypercholesterolaemia; use of non-cardiac medication and mental wellness). About 25% of patients reported the use of medication (the majority having been prescribed multiple medications (including anti-diabetics, anti-hypertensives, cholesterol-lowering drugs and anti-coagulants). Nearly 100% of CVD patients reported chronic medication use. Univariate logistic regression analysis revealed a number medications and common risk factors influenced the presentation of musculoskeletal complaints between CVD and non-CVD patients. With multivariable analysis, it was found that many of the medications lost significance after adjustment for confounders/influencing factors, although antihypertensive (OR 36.6; p=<0.001) and thyroid agents (OR 5.1; p=0.078) remained associated with CVD. Common/mutual risk factors for CVD and MSD including: increasing age (OR 1.1 p=<0.001), family history of CVD (OR 2.1; p=0.006), smoking (OR 1.9; p=0.054) and grade 1 HTN (OR 2.5; p=0.043) were significantly associated with having CVD. Furthermore, MSCs located in the SI joint/pelvis (OR 7.1; p=0.005) and head (OR 7.3; p=0.019), as well as the thoracic spine/chest/ribs (OR 4.9; p=0.015) and shoulder/brachium (OR 3.1; p=0.090) were shown to be significantly associated with CVD. Conclusion: The results of this study suggest that patients who seek treatment at the DUT CDC may present with both MSDs and CVD. Moreover, this study suggests that there may be an association between CVD and the presenting MSC. It is evident that the presentation of MSDs in CVD patients is multifactorial involving the use of cardiac and non-cardiac medication, and the presence of common CVD and MSD risk factors. However this study cannot conclusively comment on these pathophysiological changes. The current study can only speculate on causality based on known mechanisms as described in literature, however reverse causality may exist (viz. a lack of exercise, presence of MSCs may actually predispose to the CVDs). It is possible that CVD patients, who frequently sought treatment at chiropractic teaching clinics, may present with musculoskeletal side-effects associated with the use of cardiac and non-cardiac medications. This may result in the development of chronicity of musculoskeletal complaints, unresponsiveness to treatment and/or delayed recovery. It is important for chiropractic interns to be aware of this association as it affects how these patients are currently treated and managed thus affecting their prognosis. Caution needs to be applied as the outcomes of this study need to be investigated prospectively in larger sample sizes, different contexts and with some refinement of the data collection tool to confirm the outcomes of this study.
The effect of cervical spine manipulation on grip strength and muscle activity in asymptomatic participants with cervical spine dysfunction
(2018) Fenton, Daniel James; O'Connor, Laura
Objective: The effects of spinal manipulation are well documented, however there is a gap in the current literature regarding the neurophysiological mechanisms responsible for these effects. Further evidence is required to reveal the specific neurophysiological mechanisms of spinal manipulative therapy and its effect on muscle activity. The objectives of this study were to investigate the short-term effects of a single cervical spine manipulation on grip strength and muscle activity of the forearm flexors and extensors in an asymptomatic sample when compared to a control. Methods: A randomised, controlled, pre-test, post-test, repeated measures design allowed for 46 participants, aged 18-35 years old, with joint dysfunction at C7 to be allocated to either a cervical spine manipulation or a control group. Force output and muscle activity of the forearm flexors and extensors were measured before and immediately after the intervention and again at 5, 10 and 15-minutes. IBM SPSS was used to analyse the data with significance set at (p=0.05). Repeated measures ANOVA testing and Post hoc contrast studies were used to determine significance within, and between, groups. Results: In the treatment group there was a statistically significant change in muscle activity over time in the Extensor carpi radialis (p=0,013) and Extensor digitorum (p=0,021). Similarly, force output increased within the treatment group over time (p=0,012). A statistically significant beneficial treatment effect was identified between the groups in the Extensor carpi radialis (p=0,001) and Flexor digitorum superficialis (p=0,019) muscles only. Conclusion: Though statistical significance was not detected in all muscle groups, this study showed a trend of a treatment effect following cervical spine manipulation (C7) with most values lying just outside the parameters set for significance. Specific muscles of the forearm were affected more than others. Future studies are required with a larger sample to validate the trends observed in this study.
Development and validation of a patient satisfaction monitoring tool for the Durban University of Technology Chiropractic Clinic
(2018) Singh, Ashmindher; Varatharajullu, Desiree; Cruickshank, Gillian
Background Patient perceptions of the value of services and care they obtain at healthcare practices offer healthcare providers and staff important information to effect improvements. Studies have shown a high rate of patient satisfaction of patients receiving chiropractic care. South Africa is distinguished as the only country in Africa to offer training in chiropractic. Currently, only two tertiary establishments in South Africa, the Durban University of Technology and the University of Johannesburg offer a master’s in Chiropractic degree. There is, however, no feedback system currently implemented at the Durban University of Technology Chiropractic day clinic for patients to indicate levels of satisfaction. Patient satisfaction surveys are considered as a means of gathering patients valued opinions on primary health care services that they have received. This study evaluated the patients’ feedback in creating a patient satisfaction survey for use at the DUT CDC on a continual basis. Aim The aim of this study was to develop a valid and reliable patient satisfaction questionnaire, which could easily be used on a routine basis in order to monitor patient satisfaction levels at the DUT CDC in terms of quality of care, accessibility and interpersonal factors. Method This study consisted of three phases. Phase one was a preliminary review of the literature on questionnaire design and conceptual frameworks. Phase two consisted of instrument development, expert group and pilot testing. The development of the instrument and its contents was informed by the review of the literature and questionnaire exemplars from phase one. In this phase, a second questionnaire was developed and trialled with the expert group, as it was used to rate the significance of the questions on the patient satisfaction questionnaire (PSQ); subsequently the PSQ was piloted. Phase three was the handing out of the PSQ and the rating patient satisfaction questionnaire (RPSQ) to patients attending at the DUT CDC. Results The PSQ and RPSQ questionnaires were completed by 400 patients. The patients gave their suggestions as to which statements should be included in the final PSQ. The statements with a majority agreement were included in the final PSQ. The final PSQ was shown to be reliable with Cronbach's Alpha score of 0.93. Conclusion The final PSQ could help to continually monitor patient satisfaction at the DUT CDC. The clinic committee could utilise the feedback to implement or build on quality improvement initiatives, which would assist in demonstrating a commitment to patient-centred care and improve the overall healthcare experience at the DUT CDC.

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