Doctoral Degrees (Physiotherapy)

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    Effect of electrotherapy on pain, functional activity, and health-related quality of life of Nigerian individuals with knee osteoarthritis.
    (2018) Usman, Zubair.; Maharaj, Sonill Sooknunan.
    Abstract Osteoarthritis (OA) of the knee is a chronic degenerative articular disease that causes pain, limits joint mobility and physical function and reduces quality of life. Electrotherapeutic modalities such as interferential current (IFC) and therapeutic ultrasound (US) are used in the management of chronic pain and reduced physical activity in individuals with knee OA. It is not clear whether simultaneous application of these physical agents as a combination therapy (CT) would improve pain, physical activity and health-related quality of life (HRQoL) of individuals with knee OA. Objective: This study aimed to determine the effects of CT, IFC, and US on pain, functional activity and HRQoL of individuals with knee osteoarthritis in Nigeria. Participants: Participants diagnosed with knee osteoarthritis according to the American College of Rheumatology, attending the Physiotherapy Outpatient Units of Rasheed Shekoni Specialist Hospital (RSSH), the Federal Medical Centre (FMC), and Dutse General Hospital were recruited for the study. A total of 133 participants, with ages ranging between 58 and 82 years (mean = 66.19 ± 8.50 years) and out of which 53 (40%) were male and 80 (60%) were female (median = 56 years), participated in the study. Methods: This is a multi-center randomized controlled study. The participants were randomly assigned to 4 groups: US (n = 34), IFC (n=34), CT (n=33), and control (n=32). Each group had 3 treatment sessions per week for 12 weeks. Participants in the control group received heat therapy using infrared radiation (IRR). The visual analogue scale (VAS), Western Ontario and McMaster Universities Osteoarthritis (WOMAC) Index, Short Form-36 Health Survey (SF-36) questionnaire, and goniometer were used to assess pain severity, functional activity, HRQoL and knee range of motion (ROM) respectively. All measurements were taken and recorded at baseline and post-treatment. Main outcome measures: The primary outcome measures were pain, functional activity, and health-related quality of life, with active and passive knee range of motion being secondary outcomes. The variables were analyzed using one-way ANOVA, and independent and dependent sample t-test using the Statistical Package for the Social Sciences. Results: At baseline, there were no significant differences (p<0.05) between all the groups on the primary (pain, physical function and HRQoL), and secondary (ROM) outcomes. One-way between-subjects ANOVA was conducted to compare the post-intervention effects of the electrotherapy combination (US & IFC) therapy with the control group on pain, functional ii activity, and HRQoL. There were significant differences in the pain severity, physical function, and HRQoL scores (p<0.05) of participant in the electrotherapy (US, IFC & CT) groups compared to the control group. Post-hoc comparisons using the Tukey HSD test indicated that the mean scores of the electrotherapy groups differed significantly from the control group. However, comparisons were made between the intervention (US, IFC & CT) groups post-treatment. There was no significant difference (p>0.05) between each of the intervention groups (US, IFC &CT) on pain, functional activity and HRQoL post-treatment. In terms of effects, no interventional group was superior to another among the experimental groups. Between-group comparison at follow-up (each group compared with the control group) showed significant improvement in measures of pain severity, improved physical activity and quality of life in each group. Changes in secondary outcomes, over time, were statistically significant (p<0.05) in the experimental groups (US, IFC, & CT). There were increases in knee range of motion, both active and passive. No differences were observed in knee range of motion, both active and passive, in the control group (P >0.05). Conclusion: The use of electrotherapy modalities ‒ CT (US & IFC), US and IFC ‒ was beneficial as they elicited improvement in pain severity, functional activity and HRQoL in individuals with knee osteoarthritis, but none of the modalities proved to be more effective than the others.
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    A study of the effects of exercise therapy on the comorbidity of attention deficit hyperactivity disorder (ADHD) and developmental co-ordination disorder (DCD).
    (2019) Dawson, Pamela Marie Therese.; Nadasan, Thayananthee.; Govender, Preesha.
    Background: The literature suggests a high prevalence of comorbid ADHD and DCD in South Africa and worldwide. Specific figures of the suspected high prevalence are not available and the link between the two conditions are poorly understood. Medical treatment relies on neurostimulant drugs, which have little or no effect on the motor symptoms and have significant side effects. An intervention that addresses both motor co-ordination and attention/concentration impairments is essential in the overall management of children presenting with these comorbid conditions. This study aimed to document prevalence figures and demographic profile of children aged 8 to 9 years diagnosed with comorbid ADHD and DCD; and to design and develop and test efficacy of an exercise intervention that addresses symptoms of the comorbid conditions. Methodology: The study was located at remedial units within mainstream schools in KwaZulu-Natal, South Africa. Children aged 8 to 9 years diagnosed with ADHD were assessed using the modified Conners’ Teacher Rating Scale and the Copeland’s Symptom Checklist, the Development Co-ordination Disorder Questionnaire (DCDQ) and the Motor Assessment Battery for Children, edition 1 (MABC-1). A three round Delphi technique assisted in the development of an exercise intervention. The efficacy of the exercise intervention was tested via a quasi-experimental study. Children that were assessed were divided into four groups namely: Group (A) that were administered neuropharmacological medication prescribed by a medical practitioner; Group (B) were exposed to the exercise intervention only; Group (C) included children on neuropharmacological medication that were exposed to the exercise intervention and Group (D) served as the control, receiving routine care. All participants were grouped, according to parental preference. Effectiveness of each intervention was assessed using Wilcoxon Signed Ranked Test. Results: 151 children were tested. 74% were diagnosed with comorbid ADHD and DCD. The male to female ratio was 2:1. The combined subtype of ADHD was most commonly diagnosed with comorbidity. Consensus on structure and content in an exercise intervention was achieved in three rounds of the Delphi technique. The programme comprised 12 exercises. ADHD scores were as follows: Group A and B showed significant deterioration in these scores, Group C demonstrated a significant improvement and Group D showed no significant change. Results of motor scores: Group A and D showed a significant deterioration, while Group B and C demonstrated a significant improvement. Conclusions: The combination of medication plus exercises are effective in addressing and improving the symptoms of comorbid ADHD and DCD in children aged 8 to 9 in KZN, SA. Practitioners are cautioned to screen children with ADHD for DCD, following which treatment should be administered to address symptoms of both conditions, hence, providing a more effective and holistic form of management.
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    Home-based rehabilitation for people living with HIV in a resource-poor setting in KwaZulu-Natal, South Africa.
    (2016) Cobbing, Saul.; Hanass-Hancock, Jill.; Myezwa, Hellen.; Maharaj, Sonill.
    This PhD thesis centres on a home-based rehabilitation intervention (HBR) for people living with HIV (PLHIV) in a resource-poor setting in KwaZulu-Natal, South Africa. South Africa has the highest number of people infected with HIV worldwide, with 6.4 million PLHIV out of an estimated global total of 36.7 million. Antiretroviral therapy (ART) has ensured that PLHIV are living longer lives. However, there is a wide range of evidence that shows that PLHIV are prone to a broad range of physical and cognitive disabilities. It is crucial that PLHIV are able to attain a good health-related quality of life and optimal functioning, to support the success of the wide roll out of ART in countries like South Africa. Rehabilitation and exercise have been shown to improve the quality of life and function of PLHIV but there are numerous barriers facing patients who need to access rehabilitation. This PhD study aimed to determine the effect of an alternative approach of service delivery, namely a disability-inclusive HBR intervention, on PLHIVs’ perceived disability, quality of life, functional mobility and functional capacity. The study was situated in a resource-poor, semi-rural community in KwaZulu-Natal, the province with the highest HIV prevalence in South Africa. The design of the study intervention was informed by the synthesis of the evidence from a scoping review on HBR interventions for PLHIV, which revealed a paucity of evidence, and the practical experience of the lead author as a rehabilitation practitioner working with PLHIV. Embedded in a wider investigation related to an alternative model of care, this novel intervention, undertaken through a randomised control trial methodology, found that HBR is a safe strategy for treating the functional limitations experienced by PLHIV and may further improve their quality of life. While participants in the intervention group showed greater improvements across all outcome measures, between-group differences were nonsignificant. The community healthcare workers, who were trained via a task shifting approach to implement this HBR programme, reported feeling empowered by the knowledge and skills they attained through this study and gave valuable advice for improving future interventions. A synthesis of the overall PhD study results demonstrated that this intervention satisfied a number of the fundamental principles of a model of care for the rehabilitation of PLHIV, developed in the same study location. By building on the successes of this PhD study and addressing the limitations of its design and process, researchers can design and implement new rehabilitation interventions that involve multidisciplinary collaboration and the screening and treatment of people with a wide range of chronic conditions. This research should be combined with advocacy efforts to ensure that theoretical findings are translated into policies and practices that benefit all PLHIV, particularly those in resource-poor communities.