3. Electronic Theses and Dissertations (ETDs) - All submissions
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Item Pain management at the orthopaedoc spine clinic located at the Chris Hani Baragwanath Academic Hospital(2018) Maina, Anne WanjiruThis study examined outpatient disability in chronic low back pain (cLBP), assessed whether patients received treatment, and clinicians’ prescribing habits. Methods and materials: This prospective, single-centre cross-sectional study was conducted from the 1st of July to the 31st of October 2016. An Oswestry Disability questionnaire (ODI) and medical records were surveyed in 279 participants. Results: The median ODI was 48.9%. More than 50% of patients reported ‘fairly severe’ to ‘very severe’ pain that significantly limited walking distance and ability to lift objects. In contrast, standing, sitting, travel and social life were relatively unaffected. Paracetamol was readily available 23% of the time, non-steroidal antiinflammatories 46%, and opioid-like drugs 7%. Discussion: The above average ODI and its discrepant impact on Activities of Daily Living may be due to drug shortages with patients judiciously self-dosing for selected activities. Conclusion: Pain significantly disabled participants. Essentially all drugs underwent shortages despite clinician compliance with evidence-based protocols.Item Knowledge, attitudes and beliefs towards patients with chronic low back pain among final year School of Therapeutic Sciences students at the University of the Witwatersrand: a cross-sectional study(2018) Mukoka, GraceKnowledge of pain influences health care providers’ attitudes and beliefs about patients with chronic low back pain. In turn, affects the choice of management approach. However, little is known about this topic among students pursuing various undergraduate health science programmes. The purpose of this study was to determine the level of knowledge of pain, attitudes and beliefs about patients with chronic low back pain, and establish their association with demographic characteristics among final year undergraduate students of the School of Therapeutic Sciences at the University of the Witwatersrand in South Africa. This is a cross-sectional study where two self-administered questionnaires (NPQ for knowledge of physiology of pain and HC-PAIRS for attitudes and beliefs) were distributed to the study population of 224 students, and the demographic details of participants were collected. Out of 224 eligible students, 145(65%) participated in this study which represents the analytical population with female respondence (n = 115, 79%). The overall NPQ-mean score is 6.01(SD 1.98), and the mean scores were significant by gender (0.05) and across the programmes of study (0.005). Physiotherapy had the highest NPQ-mean scores 6.97(1.77) while occupational therapy had the lowest NPQ-mean scores 5.21(2.09). An overall HC-PAIRS-mean score is 63.1(8.9). Females had significantly more negative attitudes and beliefs about patients with chronic low back pain (p-value = 0.04). There is no significance difference HC-PAIRS-mean scores by age, history of low back pain and programme of study. NPQ-mean scores has an inverse relationship with HC-PAIRS-mean scores (p-value = 0.0002). There is a deficit in the level of knowledge of neurophysiology of pain among the final year, School of Therapeutic Science students. Their attitudes and beliefs regarding patients with chronic low back pain are negative. Knowledge of pain influences the attitudes and beliefs about patients with chronic low back pain. Therefore, changing the attitudes of students would require improving their knowledge of pain by updating their curriculi for chronic pain content with the current management recommendations. Keywords: Knowledge of pain, attitude, beliefs, patients with chronic low back pain, undergraduate studentsItem A disability profile of Impala Platinum Mine workers presenting with nonspecific lower back pain(2017) Tsheole, Rorisang PrimroseBACKGROUND: Lower back pain (LBP) due to ergonomic exposure in a work environment is wide spread in most countries and is the leading cause of disability affecting quality of life and work performance of an individual suffering from it. LBP is the most common reason for repeated medical consultation and subsequent absenteeism. It is reported that LBP is responsible for a third of work related disability disorders and it is estimated to cause 21.7 million disability adjusted life years (DALY‘s). In addition to the physical impact, lower back pain can influence psychological issues such as anxiety, depression and fear of job loss. Mining is an ancient occupation characterised by intense physical labour such as lifting, carrying, pulling and pushing heavy materials, operating heavy machinery and working in constricted environment. Despite the fact that ergonomics plays a major role in mining, the element of proper ergonomics is currently ignored or applied in a minimal scale in South African mining.LBP continues to have a high prevalence in mining industries. AIM: To profile the disability level of Impala Mine workers presenting with nonspecific lower back pain. METHODS: A cross-sectional quantitative study using a consecutive sampling method was conducted on mine workers employed at Impala platinum mine as rock drill operators (RDOs) and scraper winch operators (SWOs) aged between 20 and 60 years who had been employed in the current occupation for at least a period of one year. Interviews were conducted using the questionnaires based on Oswestry Disability Index (ODI) assessing disability levels, Who Disability Assessment Schedule II (WHODAS II) for activity limitation and participation restriction and Who Quality of life-Bref (WHOQOL-BREF) to measure quality of life. The study received ethical approval from the University of the Witwatersrand Human Research Ethics Committee: (Medical) (Ethical clearance no.M140813). Consent was sort from participants and Impala hospitals granted permission for the study. Data was analysed using Statistica version12.5. Descriptive data was presented as frequencies expressed in percentages. The Spearman correlation test was applied to establish the association among variables. Further analysis was done by fitting bivariate and multivariate linear regression models to quantify the magnitude of relationship between age, job category, disability, activity limitation, participation restriction and quality of life. Finally data was illustrated by means of tables and a scatter graph.RESULTS: From the study sample, 44% (n=151) of the SWOs reported moderate disability while 36% (n=132) of the RDOs reported moderate disability. Results revealed that disability level was significantly associated with job category (p-value 0.04). Activity limitation level was adversely affected and showed a positive correlation with disability(r=0.831). Only a small proportion of participants reported severe participation restrictions RDOs (0. 76%) and SWOs (1. 99%). Majority of participants reported moderate to good Quality of life (QoL) with only a small proportion reporting poor QoL RDOs (4.55%) and SWOs(3.31%).The findings of the study showed no statistical difference between the two job categories in terms of activity limitation (p=0.20), participation restriction (p=0.31) and QoL (p=0.56). There was a negative correlation between QoL and disability (r=-0.536).The result of the bi-variate linear regression showed a statistical significance between age and years of service with disability (P=0.001). DISCUSSIONS: Disability due to nonspecific lower back pain (NSLBP) was significantly associated with job category, suggesting that SWOs were the category mostly affected than the RDOs. The results revealed no statistical difference between two job categories in relation to activity limitation, participation restrictions and QoL. Furthermore, the results showed a strong positive correlation between disability and activity limitation and a moderate positive correlation between disability and participation restriction while a moderate negative correlation between disability and QoL was noted. The results of the linear regression highlighted that increased age and long years of service predisposes the miners to higher levels of disability and activity limitation, resulting in difficulties with participation in work related or societal activities which subsequently leads to poor QoL. CONCLUSION: Results of the current study revealed that the majority of RDOs and SWOs presented with moderate disability due to NSLBP. This study identified that age, job category and length of service were significantly associated with the severity and functional disability of LBP among RDO‘s and SWO‘s.Activity limitation level was adversely affected among RDO‘s and SWO‘s whereas participation restriction levels and QoL levels were less affected.Item The prevalence and factors associated with low back pain in Physiotherapy students at the University of the Witwatersrand(2013-05-30) Burger, Salmina MagdalenaThe research reported in this dissertation centered around the prevalence and factors associated with low back pain (LBP) among the undergraduate physiotherapy students at the University of the Witwatersrand. Physiotherapy students are prone to LBP due to a flexion posture while studying, lifting patients and working. After pathology, muscle activity is influenced, affecting optimal function of the spine. Preventative strategies can minimise recurrences of LBP. Physiotherapy students enrolled for 2010 at the University of the Witwatersrand participated in a cross-sectional prevalence study. A questionnaire, multi-stage fitness test and physical assessment were completed. Statistical analysis was done with univariate analysis for associations with LBP. The study revealed that the lifetime LBP prevalence was 35.6% among all four physiotherapy year groups. The prevalence increased from first year to third year but unexpectedly decreased in the fourth year group. Significant associations with LBP were posterior-anterior mobilisations on L4 (p=0.003) and L5 (p≤0.001) centrally, left lumbar multifidus (LM) cross-sectional area (p=0.02), right obliquus internus abdominis (p=0.02) and transversus abdominis (TrA) thickness at rest (p=0.03), both TrA during contraction, left (p=0.02) and right (p=0.01), as well as the pull of the TrA during contraction on the left (p=0.03). The present work is the first study to show measurements with ultrasound imaging of LM and TrA on physiotherapy students. The prevalence of LBP might be reduced if students are more aware of LBP and consequential muscle imbalances that might perpetuate the problem. The dissertation concludes with a discussion of future research avenues. It is suggested that an intervention to make students aware of LBP and risk assessments in South Africa will help to identify and address hazards in the workplace.Item Occupational related low-back pain (LBP) in truck drivers(2013-01-25) Ramroop, ShaunMotivation Occupational driving has often been associated with a high prevalence of low-back pain (LBP). Truck drivers in the petrochemical industry in South Africa are vulnerable to occupational related LBP because of the very nature of their job, and this vulnerability has to date not been quantified. The individual and job factors that contribute to cause this pain are diverse and might include prolonged sitting, exposure to whole-body vibration, heavy physical work, smoking and other psychosocial factors. Studies on the prevalence and knowledge of the risk factors associated with occupational related LBP are important since they allow not only for the determination of the impact of the condition on society or on a given social stratum, but can also help to organize health services and channel investments necessary for the prevention and control of occupational related LBP. Aim The aim of this study was to determine the prevalence of occupational related LBP in a defined cohort of truck drivers and to ascertain if certain risk factors i.e. demographic factors of the truck drivers, manual material handling (heavy physical work), static work posture and perceived levels of whole-body vibration are associated with truck driving and LBP. Methods The study design chosen was descriptive, cross-sectional and quantitative in nature. For the study, the widely established “Standardized Nordic Questionnaire” (SNQ) was used to collect data. The questionnaire was divided into three sections, viz. biographical, low-back pain, and risk factors for ease of completion by the participants of this study. A total of 450 drivers participated in the study by completing the questionnaire. SPSS version 15.0 (SPSS Inc., Chicago, Illinois, USA) was used to analyze the data. Descriptive and inferential statistics was used in the analysis of the data. Results Of the 450 drivers, 385 (86%) experience LBP and 65 (14%) reported to have not experienced any form of LBP. On the scale of 0 to 10, 68 drivers (15%) indicated that they had pain as bad as it could be, whereas 32 drivers (7%) indicated that they suffered no back pain at all. When the severity of the pain was categorised, as low, medium and high, 40.5 % of the LBP respondents indicated that they had a high severity of LBP. Smoking, static work posture and total years of driving were all found to be significantly associated with LBP. Whole-body vibration, body mass index (BMI) and heavy physical work were found to have no association with LBP which was not expected. Conclusion The prevalence of occupational related low-back pain in petrochemical truck drivers was 89%. Smoking, static work posture and total years of driving were the risk factors associated with LBP amongst the truck drivers.Item The association between hip rotation range of motion and non-specific low back pain in distance runners from a running club in Central Gauteng(2011-11-03) Taljaard, Tracy LeighIntroduction Various authors have proposed that there may be altered hip rotation range of motion (ROM) in patients with low back pain (LBP). However, limited studies have been conducted to investigate the association between hip rotation ROM and LBP specifically in distance runners. The aim of this study was to determine whether there is an association between hip rotation ROM and non-specific LBP in distance runners. Methods A cross-sectional design was used to look at the relationship between hip rotation ROM and LBP. Thirty five runners with LBP (24 males, 11 females) and 51 runners without LBP (29 males, 22 females) participated in the study. A questionnaire was used to divide participants into LBP and no LBP groups and to evaluate certain factors specific to LBP. Passive rotation ROM was measured in prone position using a hand-held inclinometer. Results Results showed no statistically significant difference (p>0.05) in hip rotation ROM between the two groups. Furthermore, no statistically significant difference (p>0.05) was found for factors specific to running, between the two groups. Conclusion Although no association was found between hip rotation ROM and LBP in distance runners, further research is needed into other possible causative factors of LBP in distance runners. Keywords Low back pain, hip biomechanics, hip mobility, hip rotation, sports and running Operational definitions Low back pain (LBP): pain and discomfort located below the costal margins and above the gluteal folds, with or without associated leg pain (Van Tulder et al 2006). Non-specific LBP: pain not attributable to a clearly recognisable pathology (Koes et al 2006). Healthy distance runner: a runner who has had no LBP symptoms within the last 6 months. Time trial: an unofficial road running race in which participants are timed individually over a set distance, in this case, 4km.