Elzette Korkie

Background: In a traditional South African undergraduate physiotherapy curriculum, students can be expected to evaluate and treat a non-complicated patient at a 3rd-year level. While students are expected to apply classroom knowledge in clinical settings, some struggle to transfer theoretical knowledge and skills into clinical practice. This may be because patient-specific management requires applied knowledge and skills, which are more challenging than skills in a simulated classroom environment. Objectives: To explore the expected levels of clinical readiness by academic lecturers and clinicians exposed to 3rd-year clinical training among incoming 3rd-year physiotherapy students before their clinical work. Method: A qualitative, exploratory descriptive design was employed, using online focus group discussions as the primary data collection method. Three focus group discussions were conducted on the Blackboard Collaborate platform. The data were analysed manually through thematic analysis. Results: Two main themes emerged, namely skills and cognitive processes. Conclusion: Lecturers and clinicians perceive that clinical readiness in 3rd-year students is demonstrated by their ability to apply appropriate clinical skills and sound reasoning to provide effective patient care. Clinical implications: Clear expectations of 3rd-year physiotherapy students are beneficial for lecturers and clinicians who supervise them and for students to understand their clinical readiness. This clarity ensures that students receive the necessary guidance and are assigned patients suitable for their skill level. Additionally, the information gained from the focus groups will be used in the next phase of the umbrella study, which aims to develop a clinical readiness diagnostic assessment tool for 3rd-year physiotherapy students.

Background: The pectoralis minor muscle (PMM) length is critical for shoulder movement and stability, often implicated in dysfunction and pain. The pectoralis minor index (PMI) quantifies this muscle’s length relative to body dimensions. Typical PMI values range from 10.0 cm to 12.5 cm in healthy adults, with data for Kenyan populations. Objectives: This study aimed to establish baseline PMI values among healthy 18–24-year-old university students in Kenya, examining variations by side dominance and sex to support clinical assessments. Method: A cross-sectional descriptive study recruited 289 healthy young adults from Jomo Kenyatta University of Agriculture and Technology (JKUAT) using stratified and simple random sampling. Data were collected through a self-developed, interviewer-administered questionnaire, achieving a 93.4% response rate. PMI values were measured in three postures: supine, relaxed, and standing. Results: In the standing relaxed position, the PMI mean was 10.6 cm on the dominant side and 11.2 cm on the non-dominant side, with significant variation indicated by a 95% confidence interval. A paired t-test revealed a significant difference between dominant and non-dominant sides (p < 0.0001). Conclusion: Baseline PMI values for Kenyan young adults show significant differences by dominance and sex. These findings provide a foundational reference for assessing PMI in clinical settings, supporting physiotherapists and clinicians in evaluating and treating shoulder dysfunction using precise muscle length data. Clinical implications: Establishing baseline PMI values assists physiotherapists in identifying deviations, enabling targeted interventions for shoulder dysfunction. Keywords: pectoralis minor index; shoulder dysfunction; shoulder pain; muscle length; baseline PMI values.

A spinal cord injury is a life‐changing experience that results in functional limitations and an increased risk of secondary health conditions. People with spinal cord injury identify pain as the most devastating health problem following their injury that not only affects their social life but their mental well‐being as well. This study is aimed at exploring the lived experience of living with pain by community‐dwelling manual wheelchair users with spinal cord injuries. An explorative qualitative design was used to explore their experiences. In‐depth interviews were recorded and transcribed, and the data were analysed using inductive thematic content analysis in the MAXQDA v2020. Fifteen manual wheelchair users with paraplegia participated in this study, and four themes were identified from their experience of living with pain: pain constantly lurks, pain is worse than the direct consequences of the SCI, pain is restrictive, and life continues despite the pain. Categories and subcategories included the participants being one with the pain; pain interfering with sleep; feelings of anger, isolation, and suicidal ideation; and uncertainties about what the future holds living with pain. Living with pain after SCI is a challenging feat, and effective management of pain is necessary to improve not only functioning and mobility but also mental health and life satisfaction.

Background: Pain after spinal cord injury (SCI) is debilitating and has been reported to be difficult to treat, despite pharmacological interventions. Pain medication misuse (PMM) and associated individual factors among people with spinal cord injury (PWSCI) are scarce. Aim: To determine PMM and the associated factors in PWSCI. Setting: Homes of community-dwelling manual wheelchair users with SCI in South Africa. Methods: Community-dwelling PWSCI (n = 122) were consecutively sampled and the Pain Medication Questionnaire (PMQ) was used to determine PMM. Descriptive statistics, Fisher’s exact test, independent t-tests, and simple linear regression tests were performed using SPSS v27. Testing was conducted at the 0.05 level of significance. Results: Eighty-five per cent of the participants reported the presence of pain and 48.1% of them used pain medication. Forty-four percent of people who used pain medication scored ≥ 30, indicative of serious aberrant drug-taking behaviours. Opioids were mainly used for neuropathic pain and in combination with other types of medications such as anticonvulsants and non-steroidal anti-inflammatories (44.0%). Pain severity and the type of pain medication were found to be predictors of PMM (p < 0.01 respectively). Conclusion: Pain relief after SCI remains difficult to achieve, with an evident high risk of PMM, which may lead to long-lasting side effects, dependency, or overdose. Contribution: This study has shown the need for the assessment of the potential risk of dependency before prescribing pain medication, particularly opioids to PWSCI.

The African Journal of Primary Health & Family Medicine welcomes submissions that encourage scholarly exchange between family medicine and primary health care researchers and practitioners across Africa and the developing world, whilst providing a contextual and holistic view of family medicine as practiced across the continent.

Background: Pain after spinal cord injury (SCI) is common and is likely to continue throughout life with varying levels of severity.Objective: To determine the presence of pain, the sociodemographic and injury profile of community-dwelling manual wheelchair users.Method: This quantitative correlational study used a sociodemographic and injury profile sheet and the Douleur Neuropathique 4 Questions (DN4) questionnaire to document demographic, SCI profiles as well as pain characteristics. Pain severity was determined using the Numeric Rating Scale. Data were analysed using the Statistical Package for the Social Sciences (SPSS) v27 at 0.05 level of significance.Results: The pain rate was 104; 85% of 122 participants and mainly in those with complete SCI (77.9%). Neuropathic pain was more common (76; 62.5%) and significantly associated (p 0.05) with higher pain severity. Pain was mainly in one area of the body (59; 48.4%) but occurring in up to five areas. The most painful area had a mean severity of 6.7/10; was more common in the lower limbs below the injury level (48; 39.4%); and was burning in nature (40; 32.7%).Conclusions: Pain after SCI is as problematic in the South African context as it is globally. With the rising SCI prevalence in the country, understanding pain and its presentation is important for holistic management of a person with SCI.Clinical implications: In-depth assessment of pain should be conducted and appropriate management interventions for specific pain types be prescribed to effectively reduce pain.

Trail running involves running on varying natural terrains, often including large elevation gains/losses. Trail running has a high risk of injury, and runners often participate in remote regions where medical support is challenging. The aim of this study was to determine the epidemiology, clinical characteristic, and associated injury risk factors among trail runners. A modified Oslo Sports Trauma Research Center Questionnaire for Health Problems (OSTRC-H) was used biweekly to collect running-related injury (RRI) and training history data prospectively, among 152 participants (males n = 120, females n = 32) over 30 weeks. We report an overall injury rate of 19.6 RRIs per 1000 h and an RRI mean prevalence of 12.3%. The leading anatomical site of RRIs was the lower limb (82.9%), affecting the knee (29.8%), shin/lower leg (18.0%), and the foot/toes (13.7%). A history of previous RRI in the past 12 months (p = 0.0032) and having a chronic disease (p = 0.0188) are independent risk factors for RRIs among trail runners. Two in three trail runners sustain an RRI mainly affecting the knee, shin/lower leg, and foot/toes. A history of previous RRI in the past 12 months and a having chronic disease is independently associated with RRI among trail runners. These results could be used to develop future RRI prevention strategies, combined with clinical knowledge and experience.

Background Trail running is characterised by large elevation gains/losses and uneven varying running surfaces. Limited information is available on injury and illness among trail runners to help guide injury and illness prevention strategies. Objective The primary aim of this review was to describe the epidemiology of injury and illness among trail runners. Methods Eight electronic databases were systematically searched (MEDLINE Ovid, PubMed, Scopus, SportsDiscus, CINAHL, Health Source: Nursing/Academic, Health Source: Consumer Ed., and Cochrane) from inception to November 2020. The search was conducted according to the PRISMA statement and the study was registered on PROSPERO international prospective register of systematic reviews (CRD42019135933). Full-text English and French studies that investigated injury and/or illness among trail runners participating in training/racing were included. The main outcome measurements included: trail running injury (incidence, prevalence, anatomical site, tissue type, pathology-type/specific diagnosis, severity), and illness (incidence, prevalence, symptoms, specific diagnosis, organ system, severity). The methodological quality of the included studies was assessed using an adapted Downs and Black assessment tool. Results Sixteen studies with 8644 participants were included. Thirteen studies investigated race-related injury and/or illness and three studies included training-related injuries. The overall incidence range was 1.6–4285.0 injuries per 1000 h of running and 65.0–6676.6 illnesses per 1000 h of running. The foot was the most common anatomical site of trail running injury followed by the knee, lower leg, thigh, and ankle. Skin lacerations/abrasions were the most common injury diagnoses followed by skin blisters, muscle strains, muscle cramping, and ligament sprains. The most common trail running illnesses reported related to the gastro-intestinal tract (GIT), followed by the metabolic, and cardiovascular systems. Symptoms of nausea and vomiting related to GIT distress and dehydration were commonly reported. Conclusion Current trail running literature consists mainly of injury and illness outcomes specifically in relation to single-day race participation events. Limited evidence is available on training-related injury and illness in trail running. Our review showed that injury and illness are common among trail runners, but certain studies included in this review only focused on dermatological injuries (e.g. large number of feet blisters) and GIT symptoms. Specific areas for future research were identified that could improve the management of trail running injury and illness.