Faculty of 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 Systematic review of the sensitivity, specificity and validity of the active straight leg raise test in low back pain(2024) Lee, Andrew Christopher; Korporaal, Charmaine Maria; Jack, D. A.Background The active straight leg raise test (ASLR) is a commonly used clinical diagnostic test in a heterogenous group of conditions classified as low back pain. It may be used in a battery of tests to obtain a clinical diagnosis or to aid in the assessment of motor control in the lumbopelvic hip complex in the sagittal plane. A few variations of the ASLR exist in the literature. There is therefore a need to analyse the literature to determine to the most appropriate clinical application and interpretation of the test as the incorrect and/or ineffective application of the ASLR may influence patient outcomes. Data sources A systematic review of PubMed, Google Scholar, Cochrane Reviews, Cumulative Index to Nursing and Allied Health Literature (CINAHL) and Scopus. Study selection All electronic or paper, English articles, which possessed the required key indexing terms and represented randomised and non-randomised controlled study designs were included. Data extraction and synthesis The blind review of the 25 articles was conducted by three independent reviewers (nine reviewers in total) using the non-randomised controlled trials (NOS) and Liddle scales. This allowed the methodological rigour of the article to be ranked. This ranking was compared to a critical appraisal of the article in order to achieve an overall decision with regards to the contribution of the article to the level of evidence for ASLR test. Results The evaluations and combined evidence were then determined for the ASLR under the heading non-pregnancy related PGP, LBP, and LPP, and various lift heights <10cm, 10-30cm, 30-60cm, full available range of motion, and unspecified range of motion. Due to study design (observational), no study exceeded level 3 evidence. Conclusion The ASLR was found to have a valid face construct, but assertions made in relation to its constructed validity in non-pregnancy related LBP is limited and conflicting. It is unclear if a positive ASLR result is from failure form closure of the public symphysis or the SIJ and if motor control is a contributing factor or product of pain.Item A model to develop and promote knowledge and practice of breast self-examination among African women in rural KwaZulu-Natal province of South Africa(2024) Sarmah, Nelisha; Sibiya, Maureen Nokuthula; Khoza, Thandokuhle EmmanuelBackground Breast self-examination (BSE) is considered one of the screening methods used for the early detection of breast cancer in addition to mammography. BSE is a safe, easy, free, and painless method used to identify any abnormalities of the breast and it is highly recommended for breast cancer screening among women in low resourced areas. Despite these recommendations, a low uptake of BSE in low middle-income countries (LMIC) is of concern. To date, a lack of knowledge, awareness, cultural influences, and socio-demographic factors have been highlighted as an influence on the uptake of BSE globally. However, much uncertainty still exists from a South African viewpoint, considering the different sociocultural backgrounds. Aim This study aims to explore and describe knowledge, perceptions, and factors that influence BSE uptake among rural African women in the KZN province of South Africa, and ultimately develop a model to develop and promote the knowledge and practice of BSE. Methodology The research was guided by the Care-Seeking Behaviour (CSB) theoretical framework. The research objectives were achieved by employing a qualitative case study design and an interpretivist paradigm. The data collection process consisted of an in-depth semi-structured one-on-one interview. The sample was selected based on a purposive sampling approach. This study was conducted in the iLembe District of KZN province of South Africa, a predominantly rural district. Study participants were African women aged 20 or older who resided in the rural iLembe District of the province of KZN. Data saturation was achieved with 22 participants. After the data were collected, they were transcribed verbatim and analysed using deductive thematic analysis. Findings In this study, several factors were found to influence the practice of BSE among rural South African women. This included, knowledge and awareness, clinical and socio-demographic influences, preventative healthcare habits, sociocultural factors, breast cancer beliefs, healthcare perception, and delayed healthcare services. In this study, the researcher noted that participants with higher levels of education were more likely to practice BSE. In addition, several participants had various traditional interpretations of breast cancer. Furthermore, there were participants who reported using complementary and self-treatment practices as a habit for health-related concerns. The findings of this study also indicate that participants perception of breast cancer and breast cancer screening may influence their willingness to participate in BSE programmes. Moreover, it was found that social support from family, friends, and community members encourage women to discuss their breast health. A lack of confidence in conventional medical methods of preventative health practices (BSE) was also attributed to clinical and socio-demographic factors and delayed access to healthcare services. Based on the findings of this study, a model was developed to promote BSE knowledge and practice among rural African women in KZN.Item An investigation of rejection rates, sources thereof and methods to reduce specimen rejection(2024) Ballim, Afsana; Mbatha, Joyce NonhlanhlaBackground Specimen rejection occurs when specimens are sent to a medical diagnostic laboratory and are deemed unsuitable for analysis based on specimen acceptability criteria. Patient care may be hindered due to rejections. Specimen rejections impact negatively on patients, healthcare workers and the diagnostic laboratory. The aim of this study was to investigate specimen rejection rates, the contributing factors, and methods to reduce the number of rejected specimens, thereby improving healthcare for the patient as well as improving the financial and quality standing of the laboratory. Materials and methods Rejection statistics were obtained for King Dinuzulu Hospital Complex (KDL) and RK Khan Hospital (RKK) for a period of six months. An investigation of the rejection rates and common causes for rejection was conducted. The information gathered from the rejection statistics was used to create training material for training workshops. Pre training and post-training questionnaires were completed to determine the effectiveness of the training. Rejection statistics were re-collected for two months post the training workshop sessions to evaluate the rejection rates for improvement. Results The initial rejection rates indicated that KDL and RKK exceeded the allowable limit of rejections (National Health Laboratory Service allowable limit < 3%). The primary reason for specimen rejections was identified as errors that occur in the pre-analytical phase, with haemolysis emerging as the predominant contributing factor. Training workshops were conducted, although the improvement in assessment score for the workshop was 49.6% (p < 0.001), the rejection statistics collected post-training workshop showed an insignificant change in overall rejection rates at KDL and RKK (p-value = 0.139 and 0.242 respectively). Conclusion Specimen rejection is a growing problem that requires mitigation. Structured training has shown to improve pre-analytical knowledge, however, it was noted that the interventions taken by offering training workshops did not reduce the rate of specimen rejections.Item Assessing the burden of hepatitis B in South Africa, predicting disease prevalence and modelling the impact of hepatitis B birth dose vaccination(2024) Moonsay, Shelina; Prabdial-Sing, Nishi; Pillay, PavitraIn 2016, WHO adopted a resolution to eliminate hepatitis B by 2030, targeted at reducing disease burden. In South Africa, HBV disease burden has largely been estimated from community-based or sentinel studies, thereby limiting its accuracy. Since 2009, the WHO recommended the addition of a birth dose of the HBV vaccine to current vaccine schedules to mitigate the risks of vertical transmission. This intervention is crucial to reduce disease burden, given the increased risks of developing chronic disease if contracted at birth or infancy. Despite the introduction of the HBV vaccine into their EPI schedule in 1995, South Africa is yet to fulfil this recommendation. In this study, our objective was to assess HBV disease burden in the public health sector of South Africa through meticulous analyses of an extensive national dataset spanning 2015 to 2019. Additionally, we aimed to model the potential impact of a birth dose of the HBV vaccine using country-specific HBV prevalence data obtained from our own testing conducted on women attending antenatal care in 2017. Over the five years, the national HBV prevalence was 9.02%, declining gradually each year. Overall, males had consistently higher prevalence rates than females. The observed lower infection and higher immunity rates among vaccine-eligible individuals clearly demonstrated the positive impact of the HBV vaccine. Nevertheless, HBV infection among these individuals was quite concerning, highlighting the roll-over effects of suboptimal vaccine coverage rates. The prevalence of HBsAg among pregnant women was alarmingly high at 11.24%, further compounded by the high HBeAg prevalence among these women. These findings alerted us to the increased probability of vertical transmission, representing a concerning source of disease burden in the country. Among vaccine-eligible women under 19 years old, HBsAg prevalence was surprisingly high at 8.08%, noting that these women still had approximately 30 more years of potential child-bearing. These findings pose a serious threat to achieving, or even nearing, WHO elimination goals. Using a deterministic HBV transmission model to simulate the impact of a birth dose of the HBV vaccine, we estimated more than a three-fold reduction in chronic HBV infections and HBV-related deaths, specifically when considering new cases from initiation of our model. In essence, this represents a greater than three-fold reduction in HBV disease burden. Our findings are unique for South Africa given their national representation and country-specific model inputs. Despite the introduction of the HBV vaccine in 1995, hepatitis B remained highly endemic in South Africa. Adding a birth dose to the current HBV vaccination schedule and achieving optimal vaccine coverage rates will markedly reduce country HBV burden. We therefore recommend prompt implementation of a birth dose of the HBV vaccine, together with increased efforts aimed at improving HBV vaccine coverage rates to optimal levels.Item Homoeopathic perceptions of gut dysbiosis as a clinically significant obstacle to cure(2024) Hendriks, Marizel; Ghuman, ShanazEchoing Hippocrates' notion that “All diseaes begin in the gut”, recent scientific research strengthens the connection between gut microbial health with overall well-being. This study delves into how South African homoeopathic practitioners address gut dysbiosis, a microbial imbalance within the gut linked to various chronic conditions. Homoeopaths interviewed for this study observed a rise in gut dysbiosis, attributing it to factors like lifestyle choices and medication use. Their treatment approach emphasizes individualized remedies and therapies tailored to each patient's unique physical, mental, and emotional symptoms. Treatment plans often incorporate dietary modifications, alongside the use of probiotics and prebiotics to support gut health. The study reveals gut dysbiosis as a significant obstacle to cure in homoeopathic treatment. The high cost of stool analysis tests restricts their use in assessing gut health, making it challenging for the interviewed homoeopaths to arrive at a diagnosis. Participants expressed a strong need for more comprehensive education on gut dysbiosis and bowel nosodes within the South African homoeopathic training curriculum. In conclusion, this study suggests that gut dysbiosis presents a clinically significant obstacle to cure in homoeopathic treatment for chronic conditions. A holistic approach combining homoeopathic remedies with dietary and lifestyle changes appears to be effective. Further research is warranted to enhance homoeopathic education on gut health and its impact on chronic diseases.Item Practice-related hygiene behaviours utilized by Chiropractors pre, during and post the COVID-19 pandemic in South Africa.(2024) Enslin, Jan-Frederik; Krishna, Suresh Babu Naidu; O’Connor, LauraBackground: The COVID-19 pandemic had an impact on the delivery of healthcare services worldwide. The Allied Health Professions Council of South Africa implemented regulations to control the spread of the virus, including social distancing, face masks/shields, hand sanitisation, surface disinfection, and protective shields. Chiropractors had to incorporate new hygiene measures to ensure the safety of their patients and themselves. Without adherence to proper hygiene protocols, manual therapy poses a substantial risk of transmission for both the practitioner and the patient. There is limited information available regarding the changes made by chiropractors to their practices in response to the pandemic and if these changed behaviours are still being implemented. Exploring and understanding changes in behaviour can help identify areas where chiropractors may need additional support or resources to adapt to new circumstances and can provide valuable information on how the pandemic has impacted the field of chiropractic care. Additionally, by studying how chiropractors adapted during the pandemic can help gain insight into best practices for future challenges or crises that may arise, as well as can help improve patient care and outcomes in the future. Aim: To determine the practice-related hygiene behaviours of chiropractors before, during and post the COVID-19 pandemic in South Africa. Methodology: An anonymous online survey was completed by registered Chiropractors in South Africa (n=119) registered with the Allied Health Professions Council of South Africa, having provided informed consent. The survey consisted of questions related to practice hygiene behaviours pre, during and post the COVID-19 pandemic and distributed via a link on QuestionPro®. The survey closed on 02/02/2024. Results: The study examined the distribution of hand and equipment disinfection in a healthcare setting, before and after the COVID-19 pandemic. The response rate for the survey was 22.45%. A total of 36% of chiropractors had been practicing for seven years and 60% lived in urban or major cities. Most practitioners returned to their work in level 4 of lockdown and practiced as a sole practitioner. The study found a significant statistical difference that sanitiser availability and the use of personal protective equipment were less prevalent before and after the pandemic than during the pandemic. Most chiropractors (78%) felt that the COVID-19 hygiene protocols made them more aware about practice hygiene behaviours. However, 30% of chiropractors believed they were likely to contract COVID-19 if they did not adhere to proper hygiene practices. Barriers to implementing hygiene practices during COVID-19 included patient reluctance, lack of time, resources and difficulty in adhering to hygiene practices. Half of the chiropractors agreed to continue with good hygiene practices post COVID-19. Conclusion: The COVID-19 pandemic resulted in increased adherence to practice related hygiene behaviours with the implementation of safety precautions such as protective screens and face masks. Many of the chiropractors continued to utilise these behaviours after the pandemic.Item An exploration of the adoption of personal nonpharmaceutical intervention measures by students at a university of technology in response to the COVID-19 pandemic(2024) Kell, Colette Melissa; Haffejee, Firoza; Jinabhai, Champaklal C.Background In March 2020 the World Health Organisation (WHO) declared coronavirus disease (COVID-19) to be a global pandemic. Due to the novel nature of the virus, there was no effective vaccine or established treatment methods, and public health officials turned to the personal non-pharmaceutical protective intervention (NPI) measures of physical distancing, hand sanitisation and the wearing of masks to interrupt disease transmission and ‘flatten’ the pandemic curve. Despite the WHO recommendation that NPIs should be included as part of any pandemic response, prior to the COVID-19 pandemic, little behavioural science research had been conducted on how to improve NPI adoption. During the COVID-19 pandemic, many Knowledge, Attitude and Practice (KAP) surveys investigated NPI compliance, but there is a dearth of qualitative literature to provide insight into the barriers and facilitators to adoption in specific populations. Over the past two decades, the South African Higher education sector has largely been transformed to accommodate students from poor and rural backgrounds. As a result, students requiring accommodation in the urban centres where universities are often based, has dramatically increased. During the COVID-19 pandemic these students effectively became mobile members of their households, returning home at various times and lockdown levels, potentially spreading the disease to relatively isolated areas. In addition, studies have consistently found that young people were more likely to be considered non adopters of the COVID-19 NPIs, partly due to the increase in risk taking behaviour associated with adolescence. In South Africa, the risk behaviour of young people is also of significant public health concern in the context of HIV/AIDS, teenage pregnancy, substance abuse and violence, this is compounded by the limited success of large research interventions. Yet, despite the acknowledgement of the need for specificity in designing youth targeted interventions, there has been little exploration of how and why South African adolescents adopt positive behaviours. Knowledge of which would be useful to better understand behaviour motivation and inform strategies for positive behaviour change. Aim This study aimed to gain an understanding of the factors influencing the adoption of the personal NPIs in response to the COVID-19 pandemic, among students at a University of Technology (UOT). Insight into these factors was used to develop guidelines to inform the design of targeted interventions to promote positive behaviour change by South African adolescents. Methodology This exploratory, qualitative study sought to understand behaviour change using the Capability, Opportunity, Motivation, Behaviour (COM-B) model. Eighteen student participants at a UOT were selected using purposive, maximum variability sampling. Each participant was interviewed individually via Microsoft Teams. Data was transcribed verbatim and analysed both deductively and inductively. Deductive analysis was guided by Theoretical Domains Framework which was developed to integrate with the COM-B model. Where possible, participant statements were coded to the appropriate domain, statements relevant to the aim of the study but did not align with the TDF domains which were inductively analysed using the Tesch approach to qualitative analysis and Braun and Clarke (2006) thematic approach. Findings This study found that NPI adoption among students evolved over time, closely aligned to the available published literature regarding NPI efficacy and WHO recommendations, but not necessarily aligned to or in compliance with government regulations. A notable exception was the reduced compliance when interacting with loved ones. In these circumstances, despite high levels of both the psychological and physical capability to perform the protective behaviours, the participants lacked the social opportunity and emotional motivation to do so. Notable factors that facilitated NPI adoption included trust in international health organisations, personal experience of COVID-19 and an altruistic desire to protect others. Factors that acted as barriers to NPI adoption included in-group trust, government distrust and social disapproval for adoption. The major themes that emerged included the need for autonomy in adolescent health decision making, the importance of social connection, the influence of social media, and the need to include young people in the development of targeted behaviour change interventions (BCIs). Conclusion This study contributes to the limited body of knowledge regarding the factors that served as barriers and facilitators to the adoption of positive health behaviours by South African adolescents in the context of the COVID-19 pandemic. These factors contributed to the development of guidelines which can be utilised by the relevant stakeholders when designing BCIs targeting this group.Item Primary caregiver experiences and perspectives on caring for a child with chronic kidney disease within a South African context(2024) Govender, Shamanie; Adam, Jamila KathoonBackground: Informal and unpaid caregivers play an important role in the management of paediatric patients who have chronic kidney disease (CKD). The burdens that the caregivers experience during their caregiving roles and responsibilities have not been extensively researched, particularly within this patient population. The high physical, psychosocial and economic burdens experienced by the caregiver can in turn lead to negative impact on the child’s health outcomes and medical treatment. This study ascertained the burdens that caregivers experienced, in their care of paediatric CKD patients, who were receiving haemodialysis, in the renal unit of a large public hospital in KwaZulu Natal, South Africa. Methods of communication and types of information provided by the renal healthcare team and the support needs of caregivers to reduce burden, anxiety and social dysfunction was elicited. Methods: Two standardized instruments, namely, the General Health Questionnaire - 12 and the Paediatric Renal-Care Burden Scale were used to ascertain burden, anxiety, and social dysfunction experienced among caregivers of CKD paediatric patients on haemodialysis. Two semi-structured questionnaires were administered. In the first instance, caregivers were asked to provide information on areas that could assist them to alleviate the burden of caregiving and the second questionnaire was used to ascertain from renal staff, the methods they used to communicate with, and the information they provided to caregivers. Results: Twenty-one caregivers participated in the study, with females providing most of the caregiving duties (76.2%). Using the PR-CBS, financial burden emerged as the highest burden experienced (mean = 4,86 and SD = 0,77). The use of the GHQ – 12, revealed that anxiety and distress were significantly high in caregivers (mean = 0.95 and 0.85) respectively. Overall, 18 caregivers had moderate to high burden. The total mean burden score for the PR-CBS for females was significantly higher than that for males (11.30; SD = 6.11 vs 7.83; SD = 4.70). This is confirmed by the total mean burden score declared by females for GHQ – 12, which was also significantly higher than that declared by males (6.58; SD = 2.83 vs 3.75; SD = 1.80). There was significant positive correlation between GHQ-12 anxiety score (p= 0.003) and PR-CBS burden score (p = 0.005). Conclusion: The prevalence of burdens, anxiety and social dysfunction was significantly high among caregivers of CKD paediatric patients and is often overlooked by the renal Background: Informal and unpaid caregivers play an important role in the management of paediatric patients who have chronic kidney disease (CKD). The burdens that the caregivers experience during their caregiving roles and responsibilities have not been extensively researched, particularly within this patient population. The high physical, psychosocial and economic burdens experienced by the caregiver can in turn lead to negative impact on the child’s health outcomes and medical treatment. This study ascertained the burdens that caregivers experienced, in their care of paediatric CKD patients, who were receiving haemodialysis, in the renal unit of a large public hospital in KwaZulu Natal, South Africa. Methods of communication and types of information provided by the renal healthcare team and the support needs of caregivers to reduce burden, anxiety and social dysfunction was elicited. Methods: Two standardized instruments, namely, the General Health Questionnaire - 12 and the Paediatric Renal-Care Burden Scale were used to ascertain burden, anxiety, and social dysfunction experienced among caregivers of CKD paediatric patients on haemodialysis. Two semi-structured questionnaires were administered. In the first instance, caregivers were asked to provide information on areas that could assist them to alleviate the burden of caregiving and the second questionnaire was used to ascertain from renal staff, the methods they used to communicate with, and the information they provided to caregivers. Results: Twenty-one caregivers participated in the study, with females providing most of the caregiving duties (76.2%). Using the PR-CBS, financial burden emerged as the highest burden experienced (mean = 4,86 and SD = 0,77). The use of the GHQ – 12, revealed that anxiety and distress were significantly high in caregivers (mean = 0.95 and 0.85) respectively. Overall, 18 caregivers had moderate to high burden. The total mean burden score for the PR-CBS for females was significantly higher than that for males (11.30; SD = 6.11 vs 7.83; SD = 4.70). This is confirmed by the total mean burden score declared by females for GHQ – 12, which was also significantly higher than that declared by males (6.58; SD = 2.83 vs 3.75; SD = 1.80). There was significant positive correlation between GHQ-12 anxiety score (p= 0.003) and PR-CBS burden score (p = 0.005). Conclusion: The prevalence of burdens, anxiety and social dysfunction was significantly high among caregivers of CKD paediatric patients and is often overlooked by the renal healthcare team. The experiences of this unique population of caregivers are complex and multifaceted, but despite the various challenges they encounter, they continue to provide care and support for their young patients. Renal healthcare practitioners may use the findings to develop and provide suitable supportive interventions and resources for these caregivers. It is essential that these be included in treatment guidelines for the ill child, not only to reduce caregiver burdens but also to improve the overall CKD paediatric patient outcomes.Item The assessment of intensive care unit-acquired weakness in adult patients at risk of post intensive care syndrome(2024) Van Vuuren, Noline; Prakaschandra, Dorcas Rosaley; Memela, Mduduzi E.; Van der Merwe, E.Intensive care unit-acquired weakness (ICUAW) is a syndrome of generalised neuromuscular weakness that develops in critically ill patients for which there is no alternative explanation other than the critical illness itself, and which has a prevalence of 25% to 80% in ICU survivors. The diagnosis and grading of ICUAW is made by excluding other causes of neuromuscular weakness and by repetitive clinical examination of muscle strength using the Medical Research Council Sum-Score (MRC-SS). The aim of the study was to evaluate ICUAW, and diagnostic methods available for this condition, in ICU survivors at risk of post intensive care syndrome (PICS) in a South African tertiary public sector hospital. METHODOLOGY: A prospective, single-centre observational study was conducted in a multi-disciplinary tertiary ICU in Eastern Cape. Patients at risk for post intensive care syndrome were included in the study. Patients were evaluated for ICUAW at six weeks and six months post-hospitalisation with the MRC-SS and handheld dynamometry (HDD). Full criteria ICUAW is defined as an MRC-SS of less than 48 out of 60. RESULTS: We enrolled 150 patients in the study, of which 103 patients completed the six month follow-up. At six weeks and six months, respectively, 3 and 2 patients’ MRC SS were less than 48/60. The median MRC-SS was 58/60 (IQR: 52-60) at six weeks and 60/60 (IQR: 58-60) at six months. There was an average change of 32,75% in the mean force from six weeks to six months for all muscle actions on both sides, with p < 0.001 indicating a significant difference. Fair correlations (r = 03-0.5) were observed between the MRC scale and HHD measurements for each muscle action from six weeks to six months. The correlation between the MRC scale and HHD proved to be significant (p < 0.001). CONCLUSION: There is a low incidence of the full criteria of ICUAW in relatively young and previously healthy ICU survivors at risk for PICS. Both the MRC-sum scores and HHD measurements showed a significant improvement over six months and there was an acceptable correlation between them. The findings of this study indicate that the strength assessed by both methods is related and tends to change in a similar direction over time.