Ronel Roos

The South African Journal of Physiotherapy is the official scholarly refereed journal of the South African Society of Physiotherapy. It aims to publish original research and facilitate continuing professional development for physiotherapists and other health professions both nationally and internationally.

Background and Aims: Patients following cardiac surgery experience alterations in pulmonary function and respiratory muscle strength during hospital stay. Inefficient breathing affects functional movement and influences health and wellness. The purpose was to determine the physical activity and breathing pattern dysfunction in patients following a median sternotomy after the hospital and identify the factors contributing to the dysfunction.Methods: A cross‐sectional study, using telehealth video consultations, took place from December 2022 to November 2023, 3 months to 1 year after hospital discharge. The presence of breathing pattern dysfunction was determined using the Nijmegen Questionnaire, the Self‐Evaluation of Breathing Questionnaire, the Breath Hold Time test, and chest expansion evaluation. The Physical Activity Vital Sign provides information on physical activity. Descriptive and inferential statistical analysis was done with statistical significance set at p ≤ 0.05.Results: The population consisted of 52 adults (median age, 57 (14 IQR) years; n = 31 (59. 6%) males). Most underwent surgery for coronary artery bypass grafting (n = 27 [51.9%]) and spent 7 (IQR 8) days in hospital. In total, 46 (88.5%) participated in weekly aerobic exercise of a median duration of 140 (IQR 228) minutes. Only 11 (21.15%) reported strength training. Rating of breathing pattern dysfunction was Nijmegen Questionnaire 16.98 (±9.76) versus Self‐Evaluation of Breathing Questionnaire 10.00 (IQR 12), and n = 20 (38.5%) and n = 8 (15.4%) scored positive for breathing pattern dysfunction, respectively. The mean Breath Hold Time test was 21.60 (±5.94) seconds. Increasing weekly aerobic exercise was associated with the Self‐Evaluation of Breathing Questionnaire (r = −0.30, p = 0.03), Breath Hold Time test (r = 0.29, p = 0.04), lower chest expansion (r = 0.39, p = 0.003), and upper chest expansion (r = 0.33, p = 0.02).Conclusion: Breathing pattern dysfunction is present long‐term and weekly participation in aerobic exercise lessens this dysfunction. Health education and advocacy for participation in cardiac rehabilitation are required to enhance physical activity levels and reduce inefficient breathing.

Evidence-based practice (EBP) is a process that a clinician undertakes, implementing his or her clinical expertise while collaborating with the patient or client in the sociocultural context of care using the best available research evidence to inform practice. The approach has evolved over time in relation to its name, definition, scope and specific steps. In October 2001, member organisations of World Physiotherapy (then the World Confederation for Physical Therapy) gathered in London to discuss the status of EBP in the profession and to gain buy-in from regions to ensure that EBP would become a culture of practice in all regions. The purpose of this article is to describe the current state of EBP during physiotherapy as presented in the literature. Two decades have passed since this meeting, with noteworthy developments in clinical practice, education and research synthesis. Physiotherapists’ opinions and attitudes towards EBP are favourable but do not always ensure good implementation and execution during clinical practice. Standardised outcome measures to evaluate the EBP of physiotherapists are available. Barriers remain, which are multifactorial, and facilitators such as time, support and education are integral to optimise implementation. The launch of the Physiotherapy Evidence Database is one strategy that facilitates EBP in physiotherapy. Clinical implications: A culture of EBP exists upon reflection of published literature from different world regions. Consistent, quality implementation of EBP, including shared decision making with patients and evaluation of evidence implemented during clinical practice remain necessary.

Background: Core outcome sets for people with multiple long-term conditions (multimorbidity) intervention studies offer an opportunity to compare data across studies and countries. However, a key research gap remains: the development of the World Health Organization (WHO) International Classification of Functioning, Disability and Health (ICF) Core Set for multimorbidity rehabilitation. ICF Core Sets are a selection of essential categories from the full ICF classification that are considered most relevant for describing the functioning of a person with a specific health condition or in a specific healthcare context. This study aims to develop and validate an ICF Core Set for exercise-based multimorbidity rehabilitation. Unlike system- or disease-specific rehabilitation, multimorbidity rehabilitation entails using a modified structure that accommodates all conditions that an individual with multimorbidity has. Methods: The three-phase, multi-method process created by the WHO and ICF Research Branch will be followed. The process will involve conducting four preparatory studies (phase 1), including (i) a systematic literature review (to examine researcher perspectives), (ii) a qualitative study (to examine patient perspectives), (iii) an expert survey (to examine health professional perspectives), and (iv) an empirical study (to examine clinical perspectives). This will be followed by an international consensus conference (phase 2) where lists of ICF categories resulting from phase 1 studies will be consolidated into a first version of an ICF Core Set for multimorbidity rehabilitation, which will be validated using an international comparative data analysis (phase 3). Conclusion: An ICF Core Set created for multimorbidity rehabilitation will (1) benefit patients with multimorbidity who are often excluded from clinical trials of single-disease rehabilitation programs, (2) ensure precise and comprehensive assessment and documentation of functioning and disability relevant to this patient population, (3) help rehabilitation providers and their patients and/or caregivers when setting rehabilitation goals and planning rehabilitative interventions to achieve those goals, (4) help researchers in the synthesis of evidence for multimorbidity rehabilitation and facilitate the comparability of data across studies and countries, and (5) provide the scientific basis from which assessment tools can be derived for use in clinical and research settings and health care administration. Trial Registration: COMET database ( https://www.comet-initiative.org/Studies/Details/3266 ).

Purpose: Thoracic trauma causes pain and hospitalisation. Middle- and high-income countries have different trauma contexts and populations. To report patients’ clinical presentation (pain and shortness of breath) and its influence on hospital length of stay (LOS), acute care management, and discharge destinations in South Africa (SA) and Sweden. Methods: Prospective observational multicenter study by means of clinical record review. Two centers in SA and four centers in Sweden participated. One thousand nine hundred and eighteen adults with thoracic trauma were screened over the 20 months period. Study objectives guided information retrieved from clinical records. Statistical analysis was done with significance at p-value < 0.05. Results: Three-hundred-sixty-four participants were recruited with most being male (n = 170/179 (95%) SA; n = 125/185 (68%) Sweden). Type and mechanism of injury differed (SA penetrating (82%) versus Sweden blunt (95%); SA assaults (90%) versus Sweden falls (44%)). Unilateral haemopneumothorax was common (SA 68%, Sweden 35%) and managed with intercostal drainage. Rib cage injuries were common in the Swedish cohort with rib fixation surgery for 17%. Physiotherapy treatment frequency was mostly daily. Blunt injury resulted in higher pain levels during deep breathing (day 1: p = 0.014; day 2: p < 0.001; day 3: p < 0.001) and shortness of breath during activity (day 1: p = 0.036; day 2: p = 0.003; day 3: p < 0.001). LOS was shorter for SA cohort (5 (± 4) versus 7 (± 5) days; p = 0.024). Age influenced LOS in the blunt injury group. Discharge destination was mostly home (99% SA, 56% Sweden). Conclusion: Priority care is indicated for those who are older and have blunt thoracic injury to prevent pulmonary complications and prolonged hospitalisation.

Background: Pain and shortness of breath (SOB) after thoracic trauma predispose patients to complications and prolonged hospital length of stay (LOS). Patient management after thoracic trauma is seldom reported. Objectives: To describe patient profiles, symptoms, management, adverse events, complications, discharge destinations and follow-up referral services. Method: Prospective observational design using clinical record review at two university-affiliated hospitals over 18 months. Adults with thoracic trauma diagnosis were consecutively screened for inclusion. Study objectives guided information retrieved from records. Statistical analyses were done with significance at p< 0.05. Results: Most were male (n = 170/179; 95%). Penetrating trauma following assault was common (n = 146/179; 82%). Conservative management included analgesia (n = 176/178; 98%) and intercostal drain insertion (n = 165/179; 92%). Physiotherapists treated patients daily. Management involved functional activities (cycling [n = 71/149; 48%], early mobilisation [n = 120/174; 69%]), lung volume enhancement (deep breathing exercises [n = 97/174; 56%], positive expiratory pressure [n = 98/174; 56%]), secretion removal (active coughing [n = 60/174; 34%]). Shoulder (n = 43/174; 25%) and trunk (n = 6/153; 4%) ROM were seldom done. Blunt trauma caused higher pain during deep breathing (median 7/10; IQR: 3.5–8.0) versus penetrating trauma (median 4/10; IQR: 2.0–7.5; p= 0.04). Most reported ‘slight’ to ‘very slight’ SOB. Time out-of-bed and distance walked increased daily with smokers mobilising away from bed frequently (n = 73/95; 77%). Few adverse events and complications occurred. Mean LOS was 5.5 ± 4.3 days. Most were discharged home (n = 177/179; 99%); two were referred for follow-up physiotherapy. Conclusion: Management is guided by individual patient needs. Treatment comprises early mobilisation, lung volume enhancement, and secretion removal with less attention on ROM exercises and post-discharge services. Clinical implications: Shoulder and trunk ROM should be prioritised. Service delivery approaches need review considering the evidence.

Background: Pulmonary complications influence morbidity, mortality and hospital stay in patients following cardiac surgery. Acute post-operative pain and less than optimal respiratory muscle strength may affect a patient’s ability to take deep breaths, cough and clear secretions, thereby influencing recovery after surgery. To date, few studies described patients’ pain levels, respiratory muscle strength and the presence of pulmonary dysfunction preoperatively and evaluated the effect of a median sternotomy on parameters at hospital discharge. This study investigates this in patients at a private urban hospital in South Africa. Methods: Participants were consecutively sampled for this longitudinal observational study and assessed at hospital admission and discharge. The visual analogue scale provides information on participants’ pain levels. Respiratory muscle strength (maximal inspiratory pressure and peak inspiratory flow) was assessed with a POWERbreathe KHI device. The presence of pulmonary complications was determined with a chest X-ray radiographic scoring tool. Descriptive and inferential analyses with significance set at p ≤ 0.05 were performed. Results: The population consisted of 61 participants [males: n = 47 (77%)], and the majority underwent coronary artery bypass graft surgery (n = 35, 57%) and had a theatre time of 5.84 (± 1.30) h and time on cardiopulmonary bypass 2.01 (IQR1.14) h. Intensive care stay was 5 (IQR 2.75) days with mechanical ventilation time 17.33 (IQR 11.21) h and hospital stay 9 (IQR 7) days. Forty-one (67.2%) participants had weak respiratory muscles at hospital admission. Respiratory muscle strength reduced significantly between hospital admission and discharge: maximal inspiratory pressure: 55 cmH₂0 vs 30.66 cmH₂0, p < 0.001, and peak inspiratory flow: 2.70 l/s vs. 1.66 l/s, p < 0.001. Atelectasis (n = 28, 46, 6%) and pleural fluid (n = 26, 43, 3%) were chest X-ray abnormalities at hospital discharge. Chest X-ray scores (Z = − 5.825, p < 0.001) and pain levels (Z = − 5.867, p < 0.001) increased significantly over time. There was a fair, negative correlation between admission maximal inspiratory pressure and chest X-ray scores, which was statistically significant (r = − 0.356, p = 0.004). Conclusions: Respiratory muscle weakness, abnormal chest X-ray findings and persistent pain were noted in study participants. This study highlights the need for continued rehabilitation services to optimise patient outcomes as it relates to ventilation and pain management.

The South African Journal of Physiotherapy is the official scholarly refereed journal of the South African Society of Physiotherapy. It aims to publish original research and facilitate continuing professional development for physiotherapists and other health professions both nationally and internationally.

The South African Journal of Physiotherapy is the official scholarly refereed journal of the South African Society of Physiotherapy. It aims to publish original research and facilitate continuing professional development for physiotherapists and other health professions both nationally and internationally.