Cross-cultural validation and formulation of key evidence-based back pain messages for Zambian nurses.

RATIONALE: Workplace attitudes among nurses with back pain disability are usually unsupportive as nurses tend to rely on passive approaches like pain medications and taking sick leave to manage the impact of their back pain experiences. AIMS AND OBJECTIVES: To lessen the burden of back pain disability, this paper aimed to collate information from publicly accessible health resources such as posters, pamphlets, and electronic resources and cross-culturally validate this information for nurses in Zambia. METHODS: Focus group discussions were used to produce the validation data for this study's qualitative research design. For cross-cultural validation, deductive analysis was carried out using Herdman's framework for Conceptual Equivalence, Item Equivalence, and Semantic Equivalence. RESULTS AND CONCLUSION: The 14 messages on back pain given to the participants were reviewed to enhance clarity, applicability, and acceptability. Messages with similar meanings were merged, reducing the total number to 7. The revisions made to the 14 back pain messages aimed to improve understanding, acceptability, and relevance within the contexts and circumstances in which nurses' practice. This is important because the messages adapted for use in low- and middle-income countries like Zambia are equivalent and applicable to those originally developed in high-income countries.

Nurses' beliefs about back pain, their coping strategies and participant activation for self-management.

Background: Back pain affects nurses' physical, social and emotional well-being, as they encounter difficulties in executing their social and occupational duties. Objectives: Our study investigated the impact of a cross-cultural back pain campaign on nurses' beliefs about back pain; activating the participants to self-manage; coping strategies; sick leave claimed; and frequency of doctor visits. Method: A single sample pre- and post-test design was used. The intervention was a 12-week educational campaign based on evidence-based back pain messages. Primary outcomes were measured by their beliefs about back pain and their activation to self-manage. Analyses were conducted using SPSS version 27.0 software, and significant differences from before and after the campaign were analysed using the Chi-square test at a 0.05 significance level. Results: There were no significant differences in the age, gender and work hours of the nurses who participated before and after the campaign, except for their professional work settings (< 0.05). All secondary outcomes improved significantly after the campaign, and outcomes on beliefs about back pain showed significantly positive changes in six of the 14 items, while all questions pertaining to patient activation improved significantly. Conclusion: The 12-week back pain campaign, based on contextualised, evidence-based back pain messages for Zambian nurses, motivated the participants to self-manage their back pain. However, not all beliefs about back pain changed positively after the campaign. Clinical implications: The findings of this back pain education campaign show promise as a strategy to improve knowledge, behaviours and beliefs about back pain in African settings.

School-based interventions to improve spinal health of children and adolescents: a systematic review.

BACKGROUND: The prevalence of spinal pain is high in children and adolescents attending school. There are no evidence-based guidelines to promote spinal health (spinal pain and spinal well-being) in schools. PURPOSE: This study aimed to 1) determine the usefulness of school-based interventions in promoting spinal health in children and adolescents and 2) synthesize the evidence in a user-friendly infographic. METHODS: A search was performed across eight databases from the inception of the databases to August 2019 for full-text English-language articles which assessed the effect of school-based interventions on spinal health. Spinal health outcomes included pain limited to the spinal area including lower back, upper back, neck, and neck-shoulder pain, and impacts of spinal pain (e.g., absenteeism from school). Studies were appraised for methodological quality (PEDro scale and Johanna Briggs Institute checklist). The usefulness of interventions was based on meta-analyses; calculated effect size; the number of spinal health outcomes; and the direction of the (summary) effect of the intervention. RESULTS: Twenty-two studies were included. Four interventions were identified: 1) exercise; 2) education; 3) the combination of exercise and education; and 4) furniture. CONCLUSION: School-based exercise is most useful to promote spinal health in the short term, followed by a combination of exercise and education, and education-only interventions.

Perspectives of spinal health within the school setting in a South African rural region: A qualitative study.

BACKGROUND: Spinal pain is one of the leading causes of morbidity globally. There is an increase in the number of children and adolescents who experience spinal pain and the lifetime prevalence of adolescent spinal pain varies between countries. In Africa, one in two adolescents experiences spinal pain and the prevalence is increasing. OBJECTIVE: This study reports on the knowledge and perspectives of school-attending children, adolescents, teachers, and parents/guardians regarding spinal health. METHODS: We conducted a descriptive qualitative case study with an interpretative and phenomenological approach. Data coding, management and analysis was done using ATLAS.ti computer software. RESULTS: Ninety-three participants (66 women and 27 men) were enrolled in the study. The barriers associated with students' spinal health were multifactorial, including low levels of physical activity, dangerous gameplay, sports risks, poor ergonomics, school bags, insufficient knowledge, and pregnancy risks. Participants proposed strategies to improve spinal health including the provision of students' lockers, advice on appropriate school bag types, embedding spinal education in the curriculum, general advocacy for spinal health, and integration of technology in teaching and learning. CONCLUSION: There is a need for further engagement on school-based spinal health promotion programs that consider local socio-economic, educational, and cultural factors.

Nurses back pain beliefs, coping strategies and factors associated with participant activation for self-management of back pain.

AIMS: To determine the back pain beliefs, coping strategies and factors associated with participant activation for self-management of back pain amongst nurses working in peri-urban district healthcare centres. DESIGN: A descriptive cross-sectional study design. METHODS: Data were collected between February and March 2020 using a self-administered questionnaire. Descriptive data analysis was done in Stata version 20.0. Back pain beliefs, participant activation and coping strategies were presented using relative frequencies and percentages. Odds ratios at 5% significance level were used to test association of factors for participant activation for self-management of back pain. RESULTS: Majority of the participants had experienced back pain which lasted 3 days for half of the participants. Further, pain medication was commonly used to cope with back pain. In addition, age, gender and work-setting were significantly associated with participant activation for self-management of back pain. CONCLUSION: Participants' coping strategies for back pain were linked to the conveyed back pain beliefs which demonstrate that participants believed in rest and lengthy periods of time off work for back pain. However, participants acknowledged that taking an active role in determining one's health and function is vital. This highlights the importance of self-management support for health behaviour change amongst nurses. IMPACT: The study addressed back pain beliefs, coping strategies and participant activation for self-management of back pain amongst nurses in peri-urban healthcare centres. Majority of the participants experienced back pain which lasted 3 days. Pain medication was commonly used to cope with back pain. Age, gender and work-setting were significantly associated with participant activation for self-management of back pain. Although this study was conducted in Zambia, outcomes from this study may be of benefit to nurses in similar settings. Further, the research provides insight to the international body of knowledge on the process and appropriateness of international research in resource-constrained settings.

How to contextualize training on guideline-uptake for your setting.

One knowledge translation method, of putting evidence into practice, is the use of clinical practice guidelines (CPG). The purpose of this brief report is to describe an 8-step process of "how to" contextualize a training programme to increase CPG-uptake for a targeted audience in a clearly defined setting. This process may assist implementation practitioners to fast-track the development of contextualized training to improve CPG-uptake.

Time as a barrier to evidence uptake-A qualitative exploration of the concept of time for clinical practice guideline uptake by physiotherapists.

BACKGROUND: Lack of time has consistently been reported as a major barrier to effective research evidence uptake into clinical practice. There has been no research to our knowledge that explores time as a barrier within the transtheoretical model of stages of change (SoC), to better understand the processes of physiotherapists' uptake of clinical practice guidelines (CPGs). This article explores the concept of lack of time as a barrier for CPG uptake for physiotherapists at different SoC. METHODS: A six-step process is presented to determine the best-fit SoC for 31 physiotherapy interviewees. This process used an amalgamation of interview findings and socio-demographic data, which was layered onto the SoC and previously identified time-barriers to CPG uptake (few staff, high workload, access to CPGs, evidence-based practice as priority in clinical practice, 'time is money' attitude and knowledge on the use of CPGs). RESULTS: The analysis process highlighted the complexities of assigning individuals to a SoC. A model of time management for better CPG uptake is proposed which is a novel approach to assist evidence implementalists and clinicians alike to determine how to progress through the SoC and barriers to improve CPG uptake. CONCLUSIONS: To the authors' knowledge, this is the first attempt at exploring the construct of (lack of) time for CPG uptake in relation to the physiotherapists' readiness to behaviour change. This study shows that 'lack of time' is a euphemism for quite different barriers, which map to different stages of readiness to embrace current best evidence into physiotherapy practice. By understanding what is meant by 'lack of time', it may indicate specific support required by physiotherapists at different stages of changing these behaviours.

Tailored training for physiotherapists on the use of clinical practice guidelines: A mixed methods study.

INTRODUCTION: Clinical practice guidelines (CPG) are vehicles for translating evidence into practice, but effective CPG-uptake requires targeted training. This mixed methods research project took a staged evidence-based approach to develop and test a tailored training programme (TTP) that addressed organisational and individual factors influencing CPG-uptake by South African physiotherapists treating patients with low back pain in primary healthcare settings. METHODS: This multi-stage mixed methods study reports the development, contextualisation and expert content validation of a TTP to improve CPG-uptake. Finally, the TTP was evaluated for its feasibility and acceptability in its current format. RESULTS: The TTP (delivered online and face-to-face) contained minimal theory, and focussing on practical activities, clinical scenarios and discussions. Pre-TTP, physiotherapists expressed skepticism about the relevance of CPG in daily practice. However, post-TTP they demonstrated improved knowledge, confidence, and commitment to CPG-uptake. DISCUSSION: The phased-construction of the TTP addressed South African primary healthcare physiotherapists' needs and concerns, using validated evidence-based educational approaches. The TTP content, delivered by podcasts and face-to-face contact, was feasible and acceptable in terms of physiotherapists' time constraints, and it appeared to be effective in improving all outcome domains. This TTP is now ready for intervention to a wider audience.

Single leg hopping in children with fetal alcohol spectrum disorder: Dynamic postural stability and kinematics.

BACKGROUND: This study compared dynamic postural stability (DPS) and lower limb kinematics during single leg hopping (SLH) performed by typically-developed children from urban and rural settings and children with Fetal Alcohol Spectrum Disorder (FASD) from a rural setting. METHODS: Typically-developed nine-year-old children from an urban (n = 27) and rural setting (n = 14) (controls), and nine-year-old children with FASD from a rural setting (n = 14) (cases) performed SLH and landing on a pressure mat. Motion analysis systems described 1) Spatiotemporal and centre of pressure parameters (COP) and lower limb sagittal plane kinematics. Descriptive results are presented in median and ranges and differences between groups were determined by Kruskal-Wallis and Mann-Whitney U statistical tests. The level of significance was p < 0.05. RESULTS: During hopping, the urban controls had longer stance and swing times (p < 0.001) than the rural groups. The urban controls remained in greater hip flexion compared to the case group (p = 0.02). The urban controls landed in more plantarflexion at initial foot contact (IFC) than the cases (p < 0.001) and the rural controls (p = 0.03). The rural groups landed with greater knee extension at IFC than the urban controls (cases p = 0.04; rural controls p < 0.001). During the landing motion, the urban controls moved into more hip flexion compared to the cases (p = 0.015) and the rural controls (p = 0.026). The cases displayed greater COP anteroposterior values during landing compared to both control groups, but the case group displayed the fastest time to stability. CONCLUSION: The different hopping strategies observed provides an indication of the movement capabilities of these groups.

Do changes in psychosocial factors, lifestyle factors and sitting posture influence the likelihood of musculoskeletal pain in high school computer users?

OBJECTIVES: Adolescents regularly engage in screen-based activities. Complex factors influence adolescents' growth, and habitual sitting posture. The association between over-time changes in their sitting posture, and upper quadrant musculoskeletal pain (UQMP) is poorly understood. This study tested the association between change over 12 months in seated posture angles (neck flexion [NF]; craniocervical angle [CCA] into flexion and extension; and thoracic flexion [TF]), UQMP, and predictor variables (anxiety and depression; sport activity, music participation; computer use). METHODS: A one-year prospective longitudinal study enrolled 211 asymptomatic 15-18-year students. 3D motion analysis captured postural angles while students worked on desktop computers, at baseline and 12 months later. Height, weight, computing time, sport and music participation, and depression and anxiety were measured at both time periods. UQMP in the previous month was captured at 12 months. The association between over-time change in sitting posture angles and predictor variables was determined using linear regression analysis (r2 ; p-values). The association between predictor variables with UQMP, and predictor variables on the association between postural angles and UQMP was assessed using logistic regression models (Odds Ratios [95%CI]). Significant confounding effects were determined when the addition of a predictor variable to the posture-UQMP model significantly changed the Likelihood Ratio chi square value. RESULTS: N = 153 students (72%) completed the study (48 with UQMP). Significant associations occurred between head flexion (HF) and body mass index (BMI) (r2= 4.20, p = .01); NF and computer use (r2= 2.87, p = .036) and CCA and music participation (r2= 9.99, p = .047). Music participants and non-participants in sport or music had increased risk of UQMP with CCA changes into flexion (OR 12.0) and TF changes into extension (OR 7.6) respectively. CONCLUSION: The association between over-time-change in sitting posture angles and UQMP is not influenced by anthropometrics, psychosocial factors or time spent computing. Music students, and students not participating in sport, require further postural analysis.

A user-friendly clinical practice guideline summary for managing low back pain in South Africa.

BACKGROUND: Clinical practice guidelines (CPGs) provide conveniently packaged evidence-based recommendations to inform clinical decisions. However, intended end-users often do not know how to source, appraise, interpret or choose among CPGs. Moreover, it can be confusing when recommendations on the same topic differ among CPGs, in wording, intent and underpinning evidence. OBJECTIVES: This article reports on the processes of: (1) identifying current CPGs for acute and subacute low back pain (LBP) to fit the needs of South African physiotherapists, (2) collating and summarising CPG recommendations to produce a user-friendly end-user product and (3) testing the utility of the summary CPG document on South African physiotherapy clinicians to efficiently determine acceptability, appropriateness and feasibility to inform clinical decision-making. METHOD: An adapted approach was followed by systematically searching online CPG repositories and online databases for LBP CPGs; screening and critically appraising identified CPGs; summarising recommendations from relevant CPGs and organising them into clinical practice activities. Feedback on utility was obtained from 11 physiotherapists. RESULTS: Three high-quality, international CPGs provided 25 recommendations on the assessment and management of acute and subacute LBP relevant to South African physiotherapy practice. They were organised into 10 headings. Physiotherapy user feedback suggested that this document would assist in clinical decision-making. CONCLUSION: Organised recommendations extracted from multiple, relevant CPGs provide an end-user-friendly resource for physiotherapists treating LBP. CLINICAL IMPLICATIONS: Collated and organised CPG recommendations may effectively assist South African physiotherapists' clinical decision-making in assessing and managing patients with acute and subacute LBP.

Factors influencing clinical practice guideline uptake by South African physiotherapists: A qualitative investigation of barriers and facilitators.

RATIONALE: Clinical practice guidelines (CPGs) should provide busy health care professionals with easy-to-use tools that support efficient uptake of current best evidence in daily clinical practice. However, CPG uptake rarely occurs at the speed of evidence production. The aim of this study was to explore the factors influencing CPG uptake among South African (SA) physiotherapists (PTs). METHOD: An exploratory, descriptive qualitative study design was used, within an interpretative research paradigm. A phenomenological approach was taken, as the study aimed to explore the phenomenon of CPG uptake by SA PTs and how the themes and subthemes related to each other within this phenomenon. Semistructured interviews were undertaken via telephone calls that were audiotaped and independently transcribed. An inductive and deductive thematic content analysis approach was taken where the transcript content was analysed by hand. FINDINGS: Thirty-one PTs from the private, public, and education sectors participated in the interviews. The main themes identified were resources, training, and organizational factors. The SA PT workforce, particularly that in the public sector, is limited and patient load and need is high. Time to implement and stay up-to-date with current evidence were barriers for many interviewees. Participants also perceived CPG uptake as not being financially rewarding. Training in CPG uptake was mostly perceived as a facilitator, and the PTs felt that they would be more inclined to implement CPGs if they felt more confident in how to source and use CPGs, particularly if they were incentivized to undertake such training. Roles, responsibilities, and power in the health care team were perceived as being both organizational barriers and, conversely, facilitators, depending on work environments. CONCLUSIONS: The findings of this study generally concur with previous studies about PT barriers to CPG uptake; however, it provides novel information on barrier contexts in one LMIC with complex PT service delivery.

A systematic review on self-management education campaigns for back pain.

BACKGROUND: Evidence-based clinical practice guidelines on back pain recommend early management and use of approaches that emphasise self-management, psychological and physical therapies. Lately, mass media campaigns, addressing misconceptions about back pain, have been conducted in developed countries. OBJECTIVES: This study retrieved and synthesised the contents of back pain messages and described the outcomes and effectiveness of the media campaigns. METHOD: Seventeen key words and 10 electronic databases were used to conduct a search between February and July 2018. Authors screened titles, abstracts and full-text articles independently to identify eligible studies. Data were reported using narratives because of heterogeneity in the outcomes. RESULTS: Appraisal of articles was done using the Physiotherapy Evidence Database scale for randomised controlled trials (RCT) (one) or the Joanna Briggs Institute checklist for non-RCT (four). The campaigns were conducted in the general population in Australia, Canada, Norway, the Netherlands and Scotland. The message 'stay as active as possible' increased participants' awareness and influenced their health beliefs and healthcare utilisation behaviours resulting in reductions in sick leave days, work disability, healthcare utilisation and claims. CONCLUSION: The back pain campaign message 'stay as active as possible' increased participants' awareness and influenced their health beliefs and healthcare utilisation behaviours. Even though the campaigns were done in high-income countries, their contents and methods are transferable to developing countries. However, their implementation must be tailored and efficient and cost-effective methods need to be explored. CLINICAL IMPLICATIONS: Providing information on back pain can contribute to significant changes in sickness behaviours and beliefs.

Learning styles of physiotherapists: a systematic scoping review.

BACKGROUND: Understanding students' learning styles, and modifying teaching styles and material accordingly, is an essential to delivering quality education. Knowing more about the learning styles of physiotherapy learners will assist educators' planning and delivering of learning activities. The purpose of this scoping review was to explore what is published about physiotherapy learning styles. METHODS: An adapted Arksey and O'Malley framework was applied to undertake this systematic scoping review. Nine electronic databases (CINAHL, BIOMED CENTRAL, Cochrane, Web of Science, PROQUEST, PubMed, OTseeker, Scopus, ERIC) were searched using the keywords: 'learning styles' and 'physiotherapy'. English-language, primary research articles that investigated physiotherapy learners' learning styles were sought. RESULTS: Of 396 potentially-relevant articles, 15 were included in this review. The studies mostly reflected undergraduate students (910 undergraduates, 361 postgraduates, 23 professionals), in developed countries. Nine articles used the Kolb's experiential learning theory (ELT); one study applied Honey and Mumford's approach; two studies used the Gregorc model of cognition and three studies did not specify an underlying theory. Outcome measures included different versions of Kolb's Learning Style Inventory, the visual-aural-read/write-kinesthetic questionnaire, Gregorc style delineator, Felder Silverman's Index of Learning Survey, and Honey and Mumford's Learning Style Questionnaire. The preferred physiotherapy learning styles, according to the ELT, seem to be Converger (learns "hands-on" and applying previously attained knowledge) and Assimilator (gathers and organises information to make the most sense). CONCLUSIONS: Both physiotherapy learners and physiotherapists have specific learning styles of active participation, underpinned with practical examples of theoretical concepts. More research is needed in developing countries, and on postgraduate and professional physiotherapy learners' learning styles. Also, further research should focus on defining and describing physiotherapy learning styles in a way to be used as an industry standard; and developing valid and reliable learning style outcome measures applicable across physiotherapy learners and settings.

The amount of postural change experienced by adolescent computer users developing seated -related upper quadrant musculoskeletal pain.

BACKGROUND: Improved techniques of measuring sitting posture have not led to a more comprehensive understanding of poor posture, nor its association with pain. There is also an evidence gap regarding critical thresholds of sitting postural change over time related to pain production. This paper describes postural angle changes over a 12-month period, and describes the process of placing defensible cut-points in the angle change data, to better understand associations between posture change over time, and onset of upper quadrant musculoskeletal pain (UQMP). METHODS: This paper reports on data captured at baseline and 12-month follow-up, in adolescents in school using computers. Four sitting postural angles, head flexion (HF), neck flexion (NF), craniocervical angle (CCA) and trunk flexion (TF), and self-reported seated UQMP in the previous month were captured at each time-point. Research questions were: 1) What is the magnitude and direction of change in each postural angle over 12 months? 2) What are best cut-points in the continuous posture change distribution to most sensitively test the association between posture change and UQMP? 3) Is gender-specific cut-points required? The 12-month posture angle change data was divided into quintiles (0-20th%; 21-40th%, 41-60th%, 61-80th%, >80th%), and the odds of UQMP occurring in each posture change quintile were calculated using logistic regression models. RESULTS: Two hundred and eleven students participated at baseline, of which 153 were followed-up at one year. Both males and females with postural change into extension (which represents lesser flexion range) were more at risk for the development of UQMP, than any other group. The best cut-point for HF was 40th% (≤-3.9°), NF was 20th% (≤-2.9°) and TF was 40th% (≤-1.1°). For CCA however, change at or beyond 40th % for extension or beyond 60% for flexion was associated with UQMP. CONCLUSIONS: Identification of critical postural angle change cut-points assists in considering the pain-producing mechanisms for adolescents using desk top computers.

The postural stability of children with foetal alcohol spectrum disorders during one-leg stance: A feasibility study.

BACKGROUND: Postural control may be impaired in children with foetal alcohol spectrum disorders (FASD). The study assessed the protocol feasibility in terms of (1) recruiting children with FASD in a rural, small town; (2) using the measurement instruments in a real-life setting; (3) the one-leg standing (OLS) task and (4) presenting preliminary results on postural stability of children with and without FASD. METHODS: Nine-year-old children diagnosed with and without FASD were invited to participate. Twenty-eight children performed OLS. Feasibility outcomes included recruitment, measurement instrument use and task instruction. Postural stability outcomes included standing duration, centre of pressure (COP) and body segment acceleration. RESULTS: Participants recruitment was feasible in terms of the (1) ability to sample a reasonable participant number in a rural town setting and the capacity to increase the sample size if more schools are included in the sampling frame and (2) use of assent and consent forms that were appropriate for this population. The measurement instruments were user-friendly, cost-effective and time-efficient. Instructions for the task require amendment to address foot placement of the non-weight-bearing leg. There was a significant difference between cases and controls on mean COP velocity (p = 0.001) and the pelvis segment acceleration in the mediolateral direction (p = 0.01) and the anteroposterior direction (p = 0.027). The control children took longer to achieve postural control. The girls demonstrated a significant difference for the COP anteroposterior displacement (p = 0.008) and velocity (p = 0.049). CONCLUSIONS: The recruitment of children with and without FASD in a rural, small town and the administration of measurement instruments in a real-life, school-based setting was feasible. However, the verbal instructions for the task require revision. The male control group took longer to achieve postural control because the task was performed differently between the two groups. However, the case girls were slower to achieve postural control than control girls though performing the task similarly.

Training programmes to improve evidence uptake and utilisation by physiotherapists: a systematic scoping review.

BACKGROUND: Research training programmes are a knowledge translation (KT) intervention which aim to improve research evidence uptake by clinicians. Whilst KT training programmes have been reported to significantly improve evidence uptake by physiotherapists, it is unclear which aspects of training optimally assist KT into physiotherapy practice. The purpose of the review was to establish the body of evidence regarding KT training programmes to improve physiotherapists' use of evidence-based practice (EBP) and clinical practice guidelines (CPG). METHODS: A systematic scoping review was undertaken in line with the adapted Arksey and O'Malley framework. Nine electronic databases (CINAHL, BIOMED CENTRAL, Cochrane, Web of Science, PROQUEST, PUBMED, OTseeker, Scopus, ERIC) were searched. Targeted keywords identified primary research articles of any hierarchy, that described the nature and impact of KT training programmes for physiotherapists. Where systematic reviews were identified, the component primary studies were considered individually for relevance. Critical appraisal was not undertaken due to the nature of a scoping review, and data was reported descriptively. RESULTS: Ten systematic reviews were identified (yielding four relevant primary studies). Five additional primary studies were identified (two randomised controlled trials, two non-randomised controlled trials and one pre-post study) which were not included in the original systematic reviews. This provided nine eligible primary research studies for review. The KT strategies were all multi-faceted. Interactive sessions, didactic sessions, printed material and discussion and feedback were consistently associated with effective outcomes. When KT strategies addressed local barriers to EBP utilisation, there were better success rates for EBP and CPG uptake, irrespective of the outcome measures used. There were no consistent ways of measuring outcome. CONCLUSION: Multi-faceted KT strategies designed to address local barriers to knowledge translation were most effective in improving EBP/ CPG uptake among physiotherapists.

Effectiveness of exercise in office workers with neck pain: A systematic review and meta-analysis.

BACKGROUND: Non-specific neck pain is a common health problem of global concern for office workers. This systematic review ascertained the latest evidence for the effectiveness of therapeutic exercise versus no therapeutic exercise on reducing neck pain and improving quality of life (QoL) in office workers with non-specific neck pain. METHOD: Seven electronic databases using keywords, that is, 'office workers', 'non-specific neck pain', 'exercise' and/or 'exercise therapy', 'QoL', 'strengthening', 'stretching', 'endurance', 'physiotherapy' and/or 'physical therapy', were searched from inception until March 2017. Heterogeneous data were reported in narrative format and comparable homogenous data were pooled using Revman. RESULTS: Eight randomised control trials were reviewed and scored on average 6.63/10 on the Physiotherapy Evidence Database (PEDro) scale. Five studies performed strengthening exercise, one study had a strengthening and an endurance exercise group, one study performed stretching exercise and one study had an endurance intervention group and a stretching intervention group. Five and four studies reported significant improvement in neck pain and QoL, respectively, when conducting strengthening exercise. When performing endurance exercises, one and two studies reported significant changes in neck pain and QoL, respectively. The one study incorporating stretching exercise reported significant improvement in neck pain. The meta-analysis revealed that there is a clinically significant difference favouring strengthening exercise over no exercise in pain reduction but not for QoL. CONCLUSION: There is level II evidence recommending that clinicians include strengthening exercise to improve neck pain and QoL. However, the effect of endurance and stretching exercise needs to be explored further.

The three-dimensional kinematics and spatiotemporal parameters of gait in 6-10 year old typically developed children in the Cape Metropole of South Africa - a pilot study.

BACKGROUND: Functional gait is an integral part of life, allowing individuals to function within their environment and participate in activities of daily living. Gait assessment forms an essential part of a physical examination and can help screen for physical impairments. No three-dimensional (3D) gait analysis studies of children have been conducted in South Africa. South African gait analysis laboratory protocols and procedures may differ from laboratories in other countries, therefore a South African data base of normative values is required to make a valid assessment of South African children's gait. The primary aim of this study is to describe joint kinematics and spatiotemporal parameters of gait in South African children to constitute a normative database and secondly to assess if there are age related differences in aforementioned gait parameters. METHODS: A descriptive study was conducted. Twenty-eight typically developing children were conveniently sampled from the Cape Metropole in the Western Cape, South Africa. The 3D lower limb kinematics and spatiotemporal parameters of gait were analyzed. The lower limb Plug-in-Gait (PIG) marker placement was used. Participants walked bare foot at self-selected speed. Means and standard deviations (SD) were calculated for all spatiotemporal and kinematic outcomes. Children were sub-divided into two groups (Group A: 6-8 years and Group B: 9-10 years) for comparison. RESULTS: A significant difference between the two sub-groups for the normalized mean hip rotation minimum values (p = 0.036) was found. There was no significant difference between the sub-groups for any other kinematic parameter or when comparing the normalized spatiotemporal parameters. CONCLUSION: The study's findings concluded that normalized spatiotemporal parameters are similar between the two age groups and are consistent with the values of children from other countries. The joint kinematic values showed significant differences for hip rotation, indicating that older children had more external rotation than younger children.

Effectiveness of resistance strength training in children and adolescents with ≥30% total body surface area: A systematic review.

PURPOSE: Children and adolescents with burn injuries are at risk of living with social, educational, physical and psychological impairments. The systematic review aimed to ascertain the effectiveness of resistance strength training on muscle strength and lean body mass (LBM) in children and adolescents with burn injuries. METHOD: Five databases were searched. Randomised controlled trials with an intervention defined as a supervised, individualised resistance exercise programme were sought. The outcomes included muscle strength and/or LBM. The PEDro scale was used to describe the methodological quality. Comparable data were combined using RevMan©. RESULTS: Seven papers were included in the review with an average methodological appraisal score of 5.7/11. Comparable data were combined for muscle strength and LBM. The meta-analysis revealed no significant clinical difference between the exercise and standard care groups after 3 months of strength training for both muscle strength (p = 0.43) and LBM (p = 0.60). CONCLUSIONS: There is no conclusive evidence to support the benefit of strength training for children and adolescents with burns injuries in terms of muscle strength and LBM. However, it appears that isokinetic training might benefit children and adolescents with burns, but more studies investigating the effect of isokinetic training are required.