ABSTRACT
BACKGROUND: Pelvic organ prolapse (POP) is a multifactorial, poorly understood condition impacting quality of life (QOL). The pathology and aetiology might imply population-specific differences in domains of the International Classification of Function, Disability and Health (ICF). There is, however, a lack of research in this regard in South Africa. OBJECTIVES: To describe the dysfunction, activity limitations, participation restrictions and contextual factors in South African women with POP. METHOD: One hundred women were conveniently sampled in a primary health care setting. They completed a self-compiled medical and exercise history questionnaire, the standardised Prolapse-Quality of Life (P-QOL) questionnaire and the Visual Faces Scale. The stage of prolapse was determined by the Pelvic Organ Prolapse Quantification (POP-Q) Scale. Means, medians, standard deviations, percentages and frequencies were calculated. RESULTS: Eighty-six per cent had a stage III POP, 57% had overactive bladder, 50% had constipation, 37% had stress urinary incontinence, 31% had urge urinary incontinence, 32% had incomplete emptying and 30% had anal incontinence. Comorbidities included cardiovascular disease (65%), depressive symptoms (12%) and hypothyroidism (18%). Other contextual factors included limited physical activity (80%), an increased body mass index (29 kg/m2), older age (59 years) and unemployment (80%). Quality of life was affected in the severity, social, emotional and sleep/energy domains (median scores were 66.7% - 33.3%). CONCLUSION: The dysfunction domain of the ICF was similar to other populations with POP. Activity and participation restrictions included social, emotional and sleep/energy aspects. Contextual factors seem to be population-specific, possibly leading to differences comparing QOL amongst different populations. CLINICAL IMPLICATIONS: Activity and participation restrictions, as well as contextual factors, may differ in different populations with POP. Interactions between contextual factors and movement impairment should be considered during management and be further investigated.
ABSTRACT
BACKGROUND: Patellar tendinopathy (PT) is a common chronic pathology of the knee, with a high prevalence in athletes and the general population. OBJECTIVES: The objectives of this article were to systematically investigate all the evidence applicable to the intrinsic and extrinsic causative factors and rehabilitation of PT, and then integrate and link rehabilitation with the main causative factors identified. METHOD: The Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines were followed. Various tools were used to evaluate the methodological quality of the eligible articles. Data were interpreted descriptively, and the causative factors and rehabilitation of PT were analysed. RESULTS: Twenty studies were included in the review. The distinctive factor responsible for PT is the mechanical theory. Seven intrinsic and four extrinsic risk factors were identified, with the main intrinsic risk factors being muscle flexibility and strength, and extrinsic risk factors being acquisition and level of skills. PT can be treated with numerous different therapeutic modalities, although eccentric muscle training showed exceptional results. The intrinsic and extrinsic risk factors can only be transformed and reduced by rehabilitation, which is inevitable to improve PT pain and function. CONCLUSION: The essence of an integrated management protocol for PT is to identify the dominant contributing factors, whether intrinsic or extrinsic, and to reduce the load on the patellar tendon by modifying these factors by either rehabilitation intervention or direct modification of the equipment or environment to obtain a positive outcome towards pain management and function.
