Low back pain (LBP) remains a common health problem and one of the most prevalent musculoskeletal conditions found among developed and developing nations. The following paper reports on an updated ...search of the current literature into the prevalence of LBP among African nations and highlights the specific challenges faced in retrieving epidemiological information in Africa.
A comprehensive search of all accessible bibliographic databases was conducted. Population-based studies into the prevalence of LBP among children/adolescents and adults living in Africa were included. Methodological quality of included studies was appraised using an adapted tool. Meta-analyses, subgroup analyses, sensitivity analyses and publication bias were also conducted.
Sixty-five studies were included in this review. The majority of the studies were conducted in Nigeria (n = 31;47%) and South Africa (n = 16;25%). Forty-three included studies (66.2%) were found to be of higher methodological quality. The pooled lifetime, annual and point prevalence of LBP in Africa was 47% (95% CI 37;58); 57% (95% CI 51;63) and 39% (95% CI 30;47), respectively.
This review found that the lifetime, annual and point prevalence of LBP among African nations was considerably higher than or comparable to global LBP prevalence estimates reported. Due to the poor methodological quality found among many of the included studies, the over-representation of affluent countries and the difficulty in sourcing and retrieving potential African studies, it is recommended that future African LBP researchers conduct methodologically robust studies and report their findings in accessible resources.
The original protocol of this systematic review was initially registered on PROSPERO with registration number CRD42014010417 on 09 July 2014.
Low back pain (LBP) is the most prevalent musculoskeletal condition and one the most common causes of disability in the developed nations. Anecdotally, there is a general assumption that LBP ...prevalence in Africa is comparatively lower than in developed countries. The aim of this review was to systematically appraise the published prevalence studies conducted on the African continent to establish the prevalence of LBP in Africa.
A comprehensive search was conducted in April 2006. The following databases PEDro, Psychinfo, Science Direct, SportsDiscus, PubMed, CINAHL, Biblioline Pro-African Wide NiPAD and SA ePublications were individually searched using specifically developed search strategies for epidemiological research conducted on LBP amongst the African population. Two reviewers independently evaluated the methodological quality of the studies reviewed.
A total of 27 eligible epidemiological studies were included in this review. The majority of the studies (63%) were conducted in South Africa (37%) and Nigeria (26%). The most common population group involved workers (48%), while scholars comprised 15% of the population. 67% of the studies were found to be methodologically sound, and the LBP prevalence of these were analyzed. The mean LBP point prevalence among the adolescents was 12% and among adults was 32%. The average one year prevalence of LBP among adolescents was 33% and among adults was 50%. The average lifetime prevalence of LBP among the adolescents was 36% and among adults was 62%.
The findings support the global burden of disease of LBP, in addition to suggesting that LBP prevalence among Africans is rising and is of concern. Further research into the most effective strategies to prevent and manage LBP in Africa is warranted.
The World Health Organization (WHO) recommends that access to rehabilitation is a human right. To date, however, rehabilitation in South Africa has not been a health priority. The focus has rather ...been on saving lives from communicable diseases such as HIV/AIDs and TB, which has been increasingly successful. Whilst more South Africans are now living with pharmacologically managed chronic, communicable diseases, they often suffer significant challenges to their physical and mental health. Moreover, there are many health conditions in South Africa that have not attracted as much attention, and which also compromise individuals' capacity to contribute effectively to their own wellbeing, that of their families and communities, and to the general economy. These include birth trauma, degenerative neurological conditions, acquired injuries such as spinal cord damage, limb amputation or head trauma, and chronic noncommunicable diseases (heart or kidney disease, stroke). In the absence of robust prevalence studies, it is estimated that one-in-three adults suffer from at least one chronic health challenge. For South Africa not to invest in rehabilitation is counter-productive, as it means that a significant percentage of its population cannot contribute to its economy. In the face of scant health resources to underpin equitable rehabilitation services, evidence needs to be provided to demonstrate that for increased expenditure on rehabilitation, there will be increased return at individual, family, society, and country levels.
This article presents challenges and solutions to ensure that South Africa can meet WHO 2030 Rehabilitation Goals for equitable provision of effective public rehabilitation services using the WHO's health system building block framework.
IMPLICATIONS FOR REHABILITATION
To meet the challenge of providing rehabilitation for those in need requires country-specific, strategic, evidence-informed, and planned decisions in terms of best investment for highest return.
Whilst there is sound international evidence for best-practice rehabilitation care, country-specific strategies are required to identify and address local barriers to evidence implementation.
In South Africa, where rehabilitation has not been a priority to date, it is important that a planned and well-costed approach is taken to ensure provision of equitable, accessible, affordable, and evidence-based rehabilitation.
Measuring social, economic, and educational return on investment from rehabilitation should be part of the South African service-delivery planning process.
National data could be obtained through adding additional questions on disability to the national census and through local surveys and reports at various public health care facilities.
Wearable inertial measurement units (IMUs) enable gait analysis in the clinic, but require calibrations that may affect subsequent gait measurements. This study assessed concurrent validity and ...within-session reliability of gait kinematics measured by a frequently calibrated IMU-based system. Calibration pose accuracy and intra-rater repeatability, and IMU orientation tracking accuracy, were additionally quantified.
Calibration poses and gait were recorded in 15 women using IMUs and optical motion capture (OMC) (reference standard) simultaneously. Participants performed six consecutive trials: each comprising a calibration pose and a walk. IMU tracking was assessed separately (once-off) using technical static and dynamic tests. Differences of > 5° constituted clinical significance.
Concurrent validity for gait revealed clinically significant between-system differences for sagittal angles (root-mean-square error RMSE 6.7°–15.0°; bias −9.3°–3.0°) and hip rotation (RMSE 7.9°; bias −4.2°). After removing modelling offsets, differences for all angles (except hip rotation) were < 5°. Gait curves correlated highly between systems (r > 0.8), except hip rotation, pelvic tilt and -obliquity. Within-session reliability of IMU-measured gait angles was clinically acceptable (standard error of measurement SEM < 5°). Calibration poses were repeatable (SEM 0.3°–2.2°). Pose accuracy revealed mean absolute differences (MAD) < 5° for all angles except sagittal ankle, hip and pelvis. IMU tracking accuracy demonstrated RMSE ≤ 2.0°.
A frequently calibrated IMU system provides reliable gait measurements; comparing highly to OMC after removing modelling differences. Calibration poses can be implemented accurately for most angles and consistently. IMU-measured gait data are clinically useful and comparable within participants, but should not be compared to OMC-measured data.
Gait and balance deficits are reported in adults with HIV infection and are associated with reduced quality of life. Current research suggests an increased fall-incidence in this population, with ...fall rates among middle-aged adults with HIV approximating that in seronegative elderly populations. Gait and postural balance rely on a complex interaction of the motor system, sensory control, and cognitive function. However, due to disease progression and complications related to ongoing inflammation, these systems may be compromised in people with HIV. Consequently, locomotor impairments may result that can contribute to higher-than-expected fall rates. The aim of this review was to synthesize the evidence regarding objective gait and balance impairments in adults with HIV, and to emphasize those which could contribute to increased fall risk.
This review followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. An electronic search of published observational studies was conducted in March 2016. Methodological quality was assessed using the NIH Quality Assessment Tool for Observational Cohort and Cross-Sectional Studies. Narrative synthesis of gait and balance outcomes was performed, and meta-analyses where possible.
Seventeen studies were included, with fair to low methodological quality. All studies used clinical tests for gait-assessment. Gait outcomes assessed were speed, initiation-time and cadence. No studies assessed kinetics or kinematics. Balance was assessed using both instrumented and clinical tests. Outcomes were mainly related to center of pressure, postural reflex latencies, and timed clinical tests. There is some agreement that adults with HIV walk slower and have increased center of pressure excursions and -long loop postural reflex latencies, particularly under challenging conditions.
Gait and balance impairments exist in people with HIV, resembling fall-associated parameters in the elderly. Impairments are more pronounced during challenging conditions, might be associated with disease severity, are not influenced by antiretroviral therapy, and might not be associated with peripheral neuropathy. Results should be interpreted cautiously due to overall poor methodological quality and heterogeneity. Locomotor impairments in adults with HIV are currently insufficiently quantified. Future research involving more methodological uniformity is warranted to better understand such impairments and to inform clinical decision-making, including fall-prevention strategies, in this population.
To systematically review the current evidence for the effectiveness of Virtual Reality (VR), in conjunction with pharmacologic analgesia on reducing pain and anxiety in burn injury patients ...undergoing wound dressing changes and physiotherapy management compared with pharmacologic analgesia alone or other forms of distraction.
A comprehensive search was conducted between December 2007 and January 2008, and updated in January 2009, before publication. Computerized bibliographic databases were individually searched using specifically developed search strategies to identify eligible studies.
Nine studies were deemed eligible for inclusion in this review. Wound dressing changes was the most common procedure during which VR was trialed. Pain was the primary outcome measure in all of the studies included. Anxiety was a secondary outcome measure in 3 of the 9 included studies. VR, in conjunction with pharmacologic analgesics, significantly reduced pain experienced by burn injury patients during wound dressing changes and physiotherapy. There is equivocal evidence for the effect of VR in conjunction with pharmacologic analgesics on reducing anxiety in burn injury patients during wound dressing changes and physiotherapy.
This is the first known systematic review to report on the effectiveness of VR, in conjunction with pharmacologic analgesia on reducing pain and anxiety in burn injury patients undergoing wound dressing changes and physiotherapy management compared with pharmacologic analgesia alone or other forms of distraction. Used as an adjunct to the current burn pain management regimens, VR could possibly assist health professionals in making the rehabilitation process for burn patients less excruciating, thereby improving functional outcomes. Further research investigating the effect of VR on anxiety in burn injury patients is warranted.
Pain catastrophization has recently been recognized as a barrier to the healthy development of physical functioning among chronic pain patients. Levels of pain catastrophization in chronic pain ...patients are commonly measured using the Pain Catastrophizing Scale (PCS).
To cross-culturally adapt and validate the South African PCS (SA-PCS) among English-, Afrikaans- and Xhosa-speaking patients with fibromyalgia living in the Cape Metropole area, Western Cape, South Africa.
The original PCS was cross-culturally adapted in accordance with international standards to develop an English, Afrikaans and Xhosa version of the SA-PCS using a repeated measures study design. Psychometric testing included face/content validity, internal consistency (Cronbach's alpha-α), test-retest reliability (intraclass coefficient correlations-ICC), sensitivity-to-change and cross-sectional convergent validity (by comparing the adapted SA-PCS to related constructs).
The cross-culturally adapted English, Afrikaans and Xhosa SA-PCS showed good face and content validity, excellent internal consistency (with Chronbach's α = 0.98, 0.98 and 0.97 for the English, Afrikaans and Xhosa SA-PCS, as a whole, respectively), excellent test-retest reliability (with ICC's of 0.90, 0.91 and 0.89 for the English, Afrikaans and Xhosa SA-PCS, respectively); as well as satisfactory sensitivity-to-change (with a minimum detectable change of 8.8, 9.0 and 9.3 for the English, Afrikaans and Xhosa SA-PCS, respectively) and cross-sectional convergent validity (when compared to pain severity as well as South African versions of the Tampa scale for Kinesiophobia and the revised Fibromyalgia Impact Questionnaire).
The SA-PCS can therefore be recommended as simple, efficient, valid and reliable tool which shows satisfactory sensitivity-to-change and cross-sectional convergent validity, for use among English, Afrikaans and Xhosa-speaking patients with fibromyalgia attending the public health sector in the Western Cape area of South Africa.
Background and Aims
Accurate assessment of any patient relies on the use of appropriate measurements which are culturally‐ and linguistically‐applicable and valid. The following study aimed to ...translate, cross‐culturally adapt and test the nomological validity, structural validity, internal consistency, test‐retest reliability, sensitivity‐to‐change and feasibility of the Swahili version of the Pain Catastrophizing Scale (Swa‐PCS) among refugees who survived torture/war trauma living with chronic pain in Kenya.
Methods
An observational study was conducted. Translation and cultural adaptation of the original PCS for the Swahili‐speaking refugee population in Kenya, who survived torture or war trauma was undertaken. Following this process, a validation study was conducted on the newly‐adapted instrument, to ascertain the psychometric properties (nomological validity, structural validity, internal consistency, test‐retest reliability, sensitivity‐to change, and ceiling and floor effects).
Results
Fifty participants were included in this study. Correlations between pain catastrophization and fear‐avoidance behavior measures were significant (r = 0.538, p < 0.01). Ceiling effects were 42−48% with no floor effects. Standard errors of measurement values were between 0.938 and 3.38. Minimal‐detectable‐change values were between 2.17 and 7.82. Internal consistency was satisfactory to good, for the whole and subsections respectively (range α = 0.693−0.845). Magnification had the lowest α. Test−retest reliability was also satisfactory to good (range ICC = 0.672−0.878). Confirmatory factor analysis confirmed that the Swa‐PCS had three factors which explained the majority of the variance. Root mean square error of approximation and comparative fit index were calculated for goodness‐of‐fit assessment, and were 0.18 and 0.83, respectively.
Conclusion
This study showed that the adapted Swa‐PCS displayed overall satisfactory to good internal consistency, test‐retest reliability and sensitivity‐to‐change. Furthermore, the Swa‐PCS scores were related to fear‐avoidance behavior scores as expected (nomological validity). Structural validation of the Swa‐PCS requires further investigation. Further testing of the psychometric properties of the Swa‐PCS is however warranted.
Background: The need for rehabilitation in South Africa has doubled between 1990 and 2017 and is expected to increase in the coming years. However, the rehabilitation needs of South Africans (and ...globally) remain largely unmet. Establishing a common understanding of the value of rehabilitation can inform clinical practice and policymaking to achieve Universal Health Coverage (UHC).Objectives: This study aims to explore the value of rehabilitation services in South Africa’s public healthcare sector by gathering perspectives from stakeholders. The goal is to inform policy decisions related to the implementation of National Health Insurance (NHI) in South Africa.Method: The study used a phenomenological approach and interpretivist paradigm. Semi-structured interviews were conducted face-to-face, online, or telephonically with 12 stakeholders from various rehabilitation sectors. The value of rehabilitation was analysed and categorised into five main categories: context, service delivery, patient outcomes, economic and financial components, and collaboration within and between sectors.Results: The value of rehabilitation was found to be multifaceted, because of the varying health, economic, and social challenges faced by many South Africans.Conclusion: The study identified components of value-based rehabilitation that should be prioritised in the proposed NHI of South Africa. Future research should explore all stakeholder perspectives, including patients, and provide empirical evidence of rehabilitation’s economic and societal value.Contribution: We highlight priority areas that are central to the value of rehabilitation in South Africa and other low- and middle-income countries (LMICs). Tailoring rehabilitation services to patient and community needs is crucial for achieving value-based care. Given South Africa’s commitment to the United Nations Convention on the Rights of Persons with Disabilities, prioritising rehabilitation remains essential.
Abstract Objective The purpose of this study was to ascertain the feasibility and potential effect of a low-cost VR system (eMagin Z800 3DVisor), used in conjunction with pharmacological analgesia, ...on reducing pain and anxiety in adult burn patients undergoing physiotherapy treatment, compared to pharmacologic analgesia alone at a South African hospital. Study design Single-blind, within-subject study design. Methods Pain and anxiety outcome measures were measured by a blinded assessor using the Numeric Pain Rating Scale and Burn Specific Pain and Anxiety Scale. Box-and-whisker plot method, Chi-square tests as well as the Student's paired t -test were used to analyze data. Main findings Eleven eligible adult burn patients consented to participate in this study (3 female, 8 male; median age 33 years: range 23–54 years). A marginal ( p = 0.06) to insignificant ( p = 0.13) difference between the two sessions (analgesia with VR and analgesia without VR) in reducing pain was found. No significant difference ( p = 0.58) was found between the two sessions (analgesia with VR and analgesia without VR) for anxiety. Conclusion There seems to be a trend that the low-cost VR system, when added to routine pharmacological analgesics, is a safe technique and could be of considerable benefit if implemented into the pain management regime of burn units at a South African hospital.
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