Faculty of Health Sciences
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Item Perceptions and experiences of elderly patients receiving chiropractic care in the Durban Metropolitan area(2024) Claire de Lange, Holly; Varatharajullu, DesireeBackground: The elderly population experience a significant musculoskeletal burden. Both the population and their healthcare burdens are expected to increase due to the elderly’s extended life expectancies. This escalating healthcare burden falls to the public healthcare sector, on which the majority of the population relies in the South African context. The current experiences of elderly individuals in this public system are poor due to the disease centred approach implemented in care. Chiropractic care implements a patient-centred approach to healthcare which is more suitable to meet the needs of this vulnerable population. Chiropractic care effectively manages musculoskeletal conditions; however, it remains largely underutilised by the public. In South Africa, Chiropractic Care’s public presence is limited to two university clinics due to the outdated legislature restricting the profession in the public healthcare sector. This limits the public exposure to Chiropractic Care’s non-invasive and non-pharmacological approach for managing musculoskeletal pain. There is limited research in both the local and international contexts into the perceptions and experiences towards Chiropractic Care from the elderly’s perspective, therefore demonstrating the value of additional research into this topic. Aim: This study aimed to explore the perceptions and experiences of elderly individuals receiving Chiropractic Care in the Durban Metropolitan area. Method: This qualitative study was conducted utilising an exploratory, descriptive approach. A random-purposive sampling of 11 elderly individuals with at least one previous Chiropractic Care experience was implemented. Semi-structured interviews were performed to provide insights into the perceptions and experiences of this population. Thematic analysis was performed using the Tesch method. Results: Thematic analysis extracted six themes, including understanding of Chiropractic Care; factors influencing the pursuit of Chiropractic Care; the impact of care on the elderly experience; insights provided through lifetime experiences; the impacts of age on the elderly experience; and the attraction of an alternative healthcare approach. Conclusion: This analysis indicated that although understanding of Chiropractic Care was limited by this population, all elderly participants shared positive perceptions of Chiropractic Care. A lack of language eloquence was observed when participants discussed Chiropractic terminology. New Chiropractic Care experiences have the potential to change the previous negative perceptions, while misinformation can be combated through patient education. Recommendation-based pursuit of Chiropractic Care is insufficient, and a focus on exposing new individuals to Chiropractic Care through alternative methods, such as community outreach, should be prioritised. The patient-centred approach in Chiropractic Care created a positive healthcare experience for the elderly individuals in this study. The elderly felt age had minimal impact on the Chiropractic Care they were provided, compared to the age based discrimination they experienced in the mainstream public sector. When the clinical care provided to the elderly is substandard, the negative perceptions of ageing and the ability to successfully access care are reinforced. Chiropractic care was viewed by the elderly as a superior healthcare alternative to the pharmacological and surgical options they were traditionally offered.Item The immediate effect of chiropractic cervical spinal manipulative therapy on joint position sense and balance in elderly participants in the eThekwini Municipality(2023-05-31) Bonsma, Robyn Debra; Varatharajullu, Desiree; Prince, Cleo KirstyBackground The elderly population is growing due to medical advancements. Falls risk is one of the leading causes of death and injury in individuals over the age of 60 years, given that aging causes a degeneration of vestibular, visual and proprioceptive systems, aiding in balance. Chiropractic management has been identified as a strategy which may aid in the improvement of balance. There is a paucity in the literature when it comes to chiropractic treatment and its effect on joint position sense and balance, as well as paucity regarding the elderly population. Aim The aim of this study was to determine the immediate effect of cervical spine chiropractic manipulative therapy on joint position sense and sway index, as a part of balance in elderly participants in the eThekwini Municipality, in South Africa. Method This was a pre-post study in which 30 healthy participants with a mean age of 71 years of age participated. The elbow joint position sense was measured using a goniometer, and static balance was tested using the Biodex Biosway® portable balance system. The participants reproduced a predetermined angle of flexion of the elbow (blindfolded) pre- and post- intervention. The participants were tested for sway index on the Biodex Biosway® portable balance system with eyes open, pre- and post-intervention. The intervention of this study was a single cervical spine manipulation of the most restricted facet using the diversified technique. The location of the manipulation was not specific to a particular area of the cervical spine but the most restricted segment was adjustment. The joint position sense and balance of the pre- and post-intervention data were compared using statistical software IBM SPSS version 27. Results There was a significant improvement of joint position sense (p=0.032) after chiropractic spinal manipulation of the cervical spine; this was shown by the increase in accuracy of joint position sense. There was no significant improvement in static balance (p=0.683) after chiropractic spinal manipulation of the cervical spine. In this study, 76.7% of the participants were female and 23.3% were male and the ethnic distribution was as follows 90% white, 6.7% black and 3.3% Indian. Conclusion This study suggests that cervical spinal manipulation may alter sensorimotor functions associated with aspects of balance, such as joint position sense in the elderly, and thus decrease falls. This is due to the improvement in joint position sense post-chiropractic spinal manipulation however, it is unknown if this effect translates to the lower limb. Further studies need to be done to determine the effect of chiropractic manipulation on balance in the elderly as chiropractic spinal manipulation influences aspects of balance in the elderly but it is unclear as to the lasting length of its effects. It is also unclear as to the effect of longterm chiropractic treatment in both balance and falls prevention.