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    A model for training radiographers in image interpretation in Kenya
    (2021-09-19) Rugut, Daniel Kipkemoi; Sibiya, Maureen Nokuthula; Nkosi, Pauline Busisiwe
    Background In Kenya, there is an acute shortage of radiologists, particularly in the County and Sub-county hospitals in the rural and remote areas. Radiographs are sent to national and referral hospitals for radiological reports. This often results in a delay in the treatment of patients. According to the Kenya government’s strategic Plan of Vision 2030, it is set to provide equitable and affordable healthcare to all her citizens. This vision may not be realized in the radiology sector due to the shortage of radiologists. Aim This study aimed to explore the perceptions of Kenyan radiographers about training in image interpretation of the chest and musculoskeletal systems, to supplement the shortage of radiologists. Methodology An exploratory sequential mixed methods design was used to conduct this study in two phases. Phase 1 was conducted through focus group discussions interviews with thirty radiographers employed in five public hospitals in Uasin-Ngishu County. The findings of Phase 1 were used to develop the questionnaire for Phase 2 of the study. A self-administered questionnaire was used to collect data from participants in thirty-five purposively selected public hospitals. A total of 336 questionnaires were distributed. Three hundred and eleven questionnaires were completed and returned. The questionnaires were analyzed resulting in a response rate of 93%. The results of the two phases were integrated. Thematic analysis of the qualitative data was used to identify themes. SPSS Statistics Version 26 was used to analyze quantitative data. Findings The results from the two phases of data collection indicated that there was an acute shortage of radiologists in Kenya, resulting in a huge gap in the provision of radiological reports. It was the perception of the participants that if radiographers were trained in image interpretation of the chest and musculoskeletal systems, patients would receive prompt image interpretation reports. Hence, a model for training radiographers in image interpretation to supplement the shortage of radiologists was developed. Conclusion This study has revealed that there is a gap in the provision of radiological reports due to the shortage of radiologists. There is a need to train radiographers in image interpretation to supplement the shortage of radiologists. Therefore, the radiography education curriculum needs to be reviewed to incorporate image interpretation.
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    The epidemiology of musculoskeletal injuries in competitive lifesavers in KwaZulu-Natal
    (2020-11-30) Billson, Carmel Beth; O'Connor, Laura; Clifton, Stuart Ronald
    Lifesaving is a multidimensional sport which can lead to injury and a high likelihood of overuse-related injuries. The environment within which lifesaving occurs is unique, with the soft beach sand and unpredictable nature of the ocean. It is difficult to assess the effects that injuries may have on the training and competitive performance of lifesavers as the incidence and severity of these injuries have not previously been studied in South Africa. Thus, this study investigated the epidemiology of lifesaving induced musculoskeletal (MSK) injuries in competitive lifesavers in KwaZulu-Natal. Lifesavers are under-investigated, yet the growth and development of the sport requires that athletes are assessed for injury. This study could aid in educating federations, coaches and athletes regarding MSK injuries sustained by lifesavers, thereby assisting athletes to be more competitive at national and international competition levels. Method: A quantitative, descriptive, cross-sectional epidemiological survey was used to collect data from 100 competitive lifesavers in KwaZulu-Natal. The questionnaire was pre-validated and hand delivered to the lifesaving clubs that agreed to participate, where the lifesavers selfselected to participate. Informed consent was obtained. The survey contained questions related to demographics, activity participation, psychosocial factors and the occurrence of lifesaving related musculoskeletal pain. Results: The respondents were male (65%, n=65) and had a mean age of 28.6 years (±SD 14, range 16-73). The lifetime prevalence of MSK injury from lifesaving was 72% (n=72), with a total of 177 injuries being reported with shoulder pain being the most prevalent (38%). The 12- month prevalence showed 133 injuries were sustained whereas for current prevalence there were 86 injuries. Lower back pain was most frequently reported over these periods (26% and 22% respectively). The board race was the most popular event participated in at 76% (n=76), followed by surf ski 69% (n=69) and thirdly surf swim 67% (n=67). Seventy-four percent (74%) of board paddlers, 68% of surf ski paddlers and 67% of beach sprint and flags participants had experienced MSK pain related to lifesaving. Of the 72 competitors that experienced lifesaving MSK injuries more than half reported that it negatively affected them psychologically either in training, competition or overall. Injuries cause athletes to miss training sessions, which result in loss of fitness and falling behind the other athletes, this could cause a lack of confidence, lack of self-belief and lack of motivation to continue training and competing. The worst injury that the respondents had sustained occur mostly due to running (44%), was overuse related (43%), occurring in season (70%) and was described as a sharp, shooting severe pain with a constant and recurrent nature. It affected the athlete’s participation in the sport (75%) and required them to seek medical attention (89%). The only factor found to be related to MSK injuries was the number of rest days, which was significantly lower in those who suffered injuries (p=0.04). All other demographic, health, lifestyle and lifesaving activity participation factors were not associated with MSK lifesaving injuries (p < 0.05). Conclusion: This is the first study to document MSK injuries in lifesaving athletes in South Africa. The high prevalence of injuries necessitates that mechanisms are put in place to prevent injury. In addition, the mechanics of running on sand requires further investigation to understand its impact on injury
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    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.
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    An injury profile and management analysis of marathon runners at selected marathons in the great eThekwini and uMgungundlovu Municipalities during 2014
    (2016) Van Niekerk, Giselle; Korporaal, Charmaine Maria; Gomes, Adrian Neil
    Background: Running injuries are increasingly common as participation in this sport increases. Health care providers need to be better able to treat and manage these injuries and prevent their recurrence. Thus, there is a need for profiles of different population groups to enable the development of health promotion and injury prevention strategies. This research study profiled and tracked runners over seven marathons held in the eThekwini and uMgungundlovu Municipalities during the first quarter of 2014. Methods: This Durban University of Technology, Institutional Research and Ethics Committee approved retrospective Chiropractic Treatment Facility record analysis, analysed 741 recorded marathon visits. The records were based on a previously validated data collection tool (CSSA questionnaire) that allowed clinical data to be captured relating to patient demographics, anatomical site of the complaint, clinical impression, diagnosis and treatment. These fields were analysed for each visit, and then captured in SPSS version 22 with records only being excluded because they were unsigned. Descriptive and inferential statistics (McNemar’s tests) were compiled and a p-value of 0.05 was used. Results: The majority of the runners were Black males of approximately 40 years of age. A total of 95.6% of runners presented with overuse injuries, of which 73.6% and 89.3% had no history of previous injury or trauma respectively, and with 94.7% being able to continue participation. The shin and calf (21.7%), thigh (21.6%) and lumbar regions (16.1%) were most commonly affected by injuries which were predominantly muscle strains (23.2%) and SI syndrome (21.4%). These injuries were treated by manipulation (82.8%), massage (57.2%) and PNF stretching (33.6%). With runners that presented at subsequent marathons, a significant difference (McNemar’s p=0.013) in history of previous injury between the first and second marathon was found, with the runner being more likely to report a history of previous injury at their second marathon visit. Specific trends, although not significant, were found for specific subgroups (defined by age, gender, ethnicity, history of previous injury / trauma and chronicity of the diagnoses). Conclusion: The data is not dissimilar to the literature on running injuries, although specific trends in terms of sub categories were noted. These trends require further investigation through prospective, longitudinal studies.
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    A musculoskeletal injury profile of league tennis players in the northern eThekwini region
    (2016) Benporath, Michael Craig; Haswell, Garrick
    Background: Tennis is one of the most popular sports globally with over 75 million players around the world. Most studies have focused on junior or elite level players although the majority of players around the world are presumed to be recreational/non-professional players. To date, limited research is available pertaining to the epidemiology of tennis related musculoskeletal in non-professional league tennis players in South Africa. This study aimed to determine the profile of musculoskeletal injuries amongst league tennis players in the northern eThekwini region. Methods: This was a quantitative, cross-sectional, descriptive study utilizing a self-administered questionnaire, developed specifically for this research utilizing an expert group and pilot study. The questionnaire contained sections on demographics, tennis history, training and nutrition, court surface and equipment as well as a section on tennis related musculoskeletal injuries. Risk factors for injury were first tested using chi square tests in the case of categorical variables, and t-tests in the case of continuous variables. In order to assess the relationship between injury and potential risk factors for injury, a binary logistic regression using backward selection based on likelihood ratios was used. Odds ratios and 95% confidence intervals of the variables remaining in the model at the end were reported. A p value <0.05 was used to indicate statistical significance. Results: Eighty league tennis players responded giving a response rate of 70.16%. The period prevalence, and the point prevalence of tennis related musculoskeletal injury was 68.75% and 36.25% respectively. A predominance of injuries to the upper extremity were recorded (49%) compared to the lower extremity (27.5%) and the back and trunk (23.5%). The elbow was the most common anatomical site of injury (21.4%) followed by the shoulder (19.4%), the lumbar spine (17.3%) and the knee (8.2%). Age was considered to be a risk factor for injury (p=0.049) as older players in the study (49.32 (17.547) years of age) were less likely to contract an injury than younger players (48.38 (13.210) years of age). The likelihood of injury decreased with a higher Body Mass Index (p=0.042). The relationship between consumption of spirit alcohol and injury was significant (p=0.043). Ex-smokers had a higher chance of contracting an injury (p=0.013). It was also found that those who cycled weekly were less likely to contract an injury (p=0.040). Conclusion: The results concur with other studies on recreational/non-professional tennis players and add insight into risk factors predisposing this population to injury. Health care practitioners need to understand the risk factors for injury in this population so that players can be better managed. Using the results of the study, an injury prevention strategy such as a strength and conditioning program, needs to be implemented with the goal to reduce or prevent common injuries in this population of players.