Recurrent implant fractures in total hip arthroplasty: a yes-you-yan case report

This case report describes a single patient with recurrent implant fractures of his left total hip replacement. According to our knowledge this is the first patient in literature with recurrent implant fractures. This is a rare phenomenon as reason for revision. Risk factors for implant failure of total hip replacement include a lack of proximal support, a distally well fixed stem with proximal debonding, malalignment of the stem and raised BMI.

Advanced osteoarthritis of the hip as reason for extensive asymmetric leg edema: a rare case report and review of the literature

An enlarged iliopectineal bursa (IB) can cause pressure on iliofemoral veins. Clinical presentation can manifest as asymmetrical lower extremity edema. This case report demonstrates extensive asymmetrical leg edema caused by femoral vein compression based on iliopectineal bursitis (IB-itis) associated with advanced osteoarthritis (OA) of the left hip joint with an outline of relevant current literature. A female patient presented with left hip pain and edema in the leg. X-ray showed severe OA of the left hip. Computed Tomography (CT) concluded a cystic abnormality at the left iliopsoas muscle associated with the joint consistent with IB-itis, associated with a degenerative left hip joint. Hybrid total hip replacement was performed. At three-month follow-up her left leg showed no longer signs of extensive edema and she walked without the use of walking aids. IB-itis is mostly associated with rheumatoid arthritis (RA). There are no reports which only describe OA as cause of IB-itis. Extensive asymmetrical leg edema can be caused by venous compression of the femoral vein by an IB-itis. If the latter is the consequence of advanced hip OA, a total hip replacement can yield excellent clinical outcomes both functionally and with regard to the edema.

Prosthetic hip-associated cobalt toxicity: a systematic review of case series and case reports

Prosthetic hip-associated cobalt toxicity (PHACT) is caused by elevated blood cobalt concentrations after hip arthroplasty. The aim of this study is to determine which symptoms are reported most frequently and in what type of bearing. We also try to determine the blood level of cobalt concentrations associated with toxicological symptoms. A systematic review was conducted on the 10th of July according to Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. A methodological quality assessment (risk of bias (RoB)) was performed. Primary outcomes were the reported symptoms of cobalt toxicity and the level of cobalt concentrations in blood. These levels were associated with toxicological symptoms. A total of 7645 references were found of which 67 relevant reports describing 79 patients. The two most used bearings in which PHACT was described were metal-on-metal (MoM) bearings (38 cases) and revised (fractured) ceramic-on-ceramic (CoC) bearings where the former ceramic head was replaced by a metal head (32 cases). Of all reported symptoms, most were seen in the neurological system, of which 24% were in the sensory system and 19.3% were in central/peripheral system, followed by the cardiovascular (22.1%) system. The mean cobalt concentration for MoM-bearings was 123.7 ± 96.8 ppb and 1078.2 ± 1267.5 ppb for the revised fractured CoC-bearings. We recommend not to use a metal-based articulation in the revision of a fractured CoC bearing and suggest close follow-up with yearly blood cobalt concentration controls in patients with a MoM bearing or a revised fractured CoC bearing. Level of Evidence: Level V, systematic review.

The effect of contract-relax-agonist-contract (CRAC) stretch of hamstrings on range of motion, sprint and agility performance in moderately active males: A randomised control trial

Background: Although stretching is done routinely to prevent injury during explosive sport activities, there is some concern that effective stretching might negatively impact on performance. Objectives: This study’s main objective was to investigate the impact of a specific stretch (CRAC), in which the muscle to be stretched, hamstrings, is actively contracted then relaxed. This is then followed by the antagonist muscle (quadriceps) contracting. Secondly, the impact of the stretch on performance was examined. Methods: A randomised control trial was used. Forty healthy active males between 21 and 35 years of age were assigned to either receive three repetitions of CRAC or rest. Hamstring flexibility and the Illinois Agility Test were the primary outcome measures. Results: The intervention was effective in improving hamstring flexibility by 37% immediately post-application and this was maintained for eight minutes thereafter. It had no significant effect on agility or sprint times. Conclusions: CRAC applied to stretch the hamstring muscles of active males resulted in a large increase of active knee extension range of motion, without decreasing performance. CRAC appears to be a safe and effective method of increasing the length of the hamstrings pre-sport activity and should be utilised by sports physiotherapists if deemed necessary and beneficial following initial assessment.

The effect of the contract-relax-agonist-contract (CRAC) stretch of hamstrings on range of motion, sprint and agility performance in moderately active males: A randomised control trial

Background

Although stretching is done routinely to prevent injury during explosive sport activities, there is some concern that effective stretching might negatively impact on performance.

Objective

This study's main objective was to investigate the impact of a specific stretch, the contract-relax-agonist-contract (CRAC) stretch, in which the muscle to be stretched, namely, the hamstrings, is actively contracted and then relaxed. This is followed by the antagonist muscle (the quadriceps) contracting. Secondly, the impact of the stretch on performance was examined.

Methods

A randomised control trial was used. Forty healthy active males between 21 and 35 years old were assigned to either receive three repetitions of CRAC or rest. Hamstring flexibility and the Illinois Agility Test were the primary outcome measures.

Results

The intervention was effective in improving hamstring flexibility by 37% immediately post-application and was maintained for eight minutes thereafter. It had no significant effect on agility or sprint times.

Conclusion

CRAC, when applied to stretch the hamstring muscles of active males, resulted in a large increase of active knee extension range of motion, without decreasing performance. Therefore, CRAC appears to be a safe and effective method of increasing the length of the hamstrings pre-sport activity and should be utilised by sports physiotherapists if deemed necessary. It was also shown to be beneficial following the initial assessment.

The intervention process in the European Fans in Training (EuroFIT) trial: a mixed method protocol for evaluation

BACKGROUND

EuroFIT is a gender-sensitised, health and lifestyle program targeting physical activity, sedentary time and dietary behaviours in men. The delivery of the program in football clubs, led by the clubs' community coaches, is designed to both attract and engage men in lifestyle change through an interest in football or loyalty to the club they support. The EuroFIT program will be evaluated in a multicentre pragmatic randomised controlled trial (RCT), for which ~1000 overweight men, aged 30-65 years, will be recruited in 15 top professional football clubs in the Netherlands, Norway, Portugal and the UK. The process evaluation is designed to investigate how implementation within the RCT is achieved in the various football clubs and countries and the processes through which EuroFIT affects outcomes.

METHODS

This mixed methods evaluation is guided by the Medical Research Council (MRC) guidance for conducting process evaluations of complex interventions. Data will be collected in the intervention arm of the EuroFIT trial through: participant questionnaires (n = 500); attendance sheets and coach logs (n = 360); observations of sessions (n = 30); coach questionnaires (n = 30); usage logs from a novel device for self-monitoring physical activity and non-sedentary behaviour (SitFIT); an app-based game to promote social support for physical activity outside program sessions (MatchFIT); interviews with coaches (n = 15); football club representatives (n = 15); and focus groups with participants (n = 30). Written standard operating procedures are used to ensure quality and consistency in data collection and analysis across the participating countries. Data will be analysed thematically within datasets and overall synthesis of findings will address the processes through which the program is implemented in various countries and clubs and through which it affects outcomes, with careful attention to the context of the football club.

DISCUSSION

The process evaluation will provide a comprehensive account of what was necessary to implement the EuroFIT program in professional football clubs within a trial setting and how outcomes were affected by the program. This will allow us to re-appraise the program's conceptual base, optimise the program for post-trial implementation and roll out, and offer suggestions for the development and implementation of future initiatives to promote health and wellbeing through professional sports clubs.

TRIAL REGISTRATION

ISRCTN81935608 . Registered on 16 June 2015.

The development of an intervention to manage pain in amaxhosa women living HIV/AIDS

The profile of HIV/AIDS has changed from that of a terminal illness to one of a chronic debilitating disease which has the potential to become terminal.

The efficacy of two task-orientated interventions for children with Developmental Coordination Disorder: Neuromotor Task Training and Nintendo Wii Fit Training

Neuromotor Task Training (NTT) and Nintendo Wii Fit Training (Wii training) are both task-based interventions used to improve performance in children with motor coordination problems. The aim of this study was to compare the efficacy of these two interventions on the motor performance, isometric strength and cardiorespiratory fitness (aerobic and anaerobic capacity) of children with Developmental Coordination Disorder (DCD) attending mainstream schools in a low-income setting. A pragmatic, quasi-experimental study design was utilized. Children between the ages of 6-10 years, who scored at or below the 16th percentile on the Movement Assessment Battery for Children-2 (MABC-2) and whose teacher reported a functional motor problem, were allocated to either NTT (n=37) or Wii training (n=19) groups depending on school of attendance. The MABC-2, a hand-held dynamometer, the Functional Strength Measure, the Muscle Power Sprint Test and the 20m Shuttle Run Test were used to assess performance at baseline and after the intervention. The main findings show that the mean motor performance scores of both groups improved over the study period. However, significant differences in improvement were detected between groups, with the NTT group showing greater improvement in motor performance, functional strength and cardiorespiratory fitness. No improvements in isometric strength were seen in either group. The Wii training group showed significant improvement in anaerobic performance. This study provides evidence to support the use of both the Wii Training and NTT for children with DCD. However, in comparison to Wii training, the NTT approach yields superior results across measures of motor proficiency, cardiorespiratory fitness and functional strength. The decision to use either approach may be influenced by resources and time constraints.

The essential role of physiotherapists in providing rehabilitation services to people living with HIV in South Africa

Despite increased access to highly active anti-retroviral therapy (HAART) in South Africa, there remains a high risk of people living with HIV (PLHIV) developing a wide range of disabilities. Physiotherapists are trained to rehabilitate individuals with the disabilities related to HIV. Not only can South African physiotherapists play a significant role in improving the lives of PLHIV, but by responding proactively to the HIV epidemic they can reinforce the relevance and value of the profession in this country at a time when many newly qualified therapists are unable to secure employment. This paper offers recommendations that may help to fuel this response. These ideas include enhancing HIV curricula at a tertiary level, designing and attending continuing education courses on HIV and researching Southern African rehabilitation interventions for HIV at all levels of practice. furthermore, it is vital that physiotherapists are at the forefront of directing multi-disciplinary responses to the rehabilitation of PLHIV in order to influence stakeholders who are responsible for health policy formulation. it is hoped that this paper stimulates discussion and further ideas amongst physiotherapists and other health professionals in order to improve the quality and access to care available to PLHIV in South Africa.

Monitoring vital signs using early warning scoring systems: a review of the literature

AIM

To evaluate the need for, and the development and utility of, pen-and-paper (Modified) Early Warning Scoring (MEWS/EWS) systems for adult inpatients outside critical care and emergency departments, by reviewing published literature.

BACKGROUND

Serious adverse events can be prevented by recognizing and responding to early signs of clinical and physiological deterioration.

EVALUATION

Of 534 papers reporting MEWS/EWS systems for adult inpatients identified, 14 contained useable data on development and utility of MEWS/EWS systems. Systems without aggregate weighted scores were excluded.

KEY ISSUES

MEWS/EWS systems facilitate recognition of abnormal physiological parameters in deteriorating patients, but have limitations. There is no single validated scoring tool across diagnoses. Evidence of prospective validation of MEWS/EWS systems is limited; neither is implementation based on clinical trials. There is no evidence that implementation of Westernized MEWS/EWS systems is appropriate in resource-poor locations.

CONCLUSIONS

Better monitoring implies better care, but there is a paucity of data on the validation, implementation, evaluation and clinical testing of vital signs' monitoring systems in general wards.

IMPLICATIONS FOR NURSING MANAGEMENT

Recording vital signs is not enough. Patient safety continues to depend on nurses' clinical judgment of deterioration. Resources are needed to validate and evaluate MEWS/EWS systems in context.

Does the South African Physiotherapy Journal fulfill the needs of its constituency? A retrospective article review

Professional  journals  are  used  to  disseminate  the  knowledge of scholars in the profession and to provide clinicians with guidance for best practice.  This  article  aimed  to  retrospectively  review  the  role  of the  South African  Journal  of  Physiotherapy  and  its  contribution  to  the profession.  An archival  research  design  was  used  to  collect  information from  the  archives of  the  South  African  Society  of  Physiotherapy website.  The  information  was retrieved  using  a  data  capture  sheet and descriptive  statistics  were  used throughout  to  establish  frequencies  for the  relevant  information.  During  the identified period, 170 articles were published. The greatest number of papers originated in South Africa (81%), 8% from the rest of Africa and 11% written by international authors. Authors with a Masters degree contributed almost 50% of the papers and those with doctorates were responsible for at least 25% of the papers. Most of the papers presented original research (81%) with secondary research such as reviews and scholarly papers accounting for 19% of the total. The most common speciality area addressed through research  was  linked  to musculoskeletal  conditions.  The  journal  appears  to  have  provided  an important  platform  for  South African academics and emerging researchers to publish their findings. It is suggested that the journal should give preference to papers that deal with issues that are unique to South Africa and sub-Saharan Africa, as these are the least likely to be published elsewhere. In addition, the journal should emphasise papers that will advance the profession.

Reliability of ultrasound imaging for the measurement of abdominal muscle thickness in typically developing children

Introduction: A bdominal muscles are key to both posture andgait in both children with typical development (TD) and with disabilities.Ultrasound (US) imaging is a potential non-invasive method for investigatingactivity in these muscles. This study therefore aimed to determine the inter-tester and intra-tester reliability of B-mode US for investigating transverseabdominus (TrA ), rectus abdominus (RA ) and external- (EO) and internaloblique (IO) muscle activity in children with TD. Design: A  prospective cor-relational descriptive study.  Participants:  Eighty six, 6-13year old children from one private and one public mainstream school. Outcome measures: Two sets of B-mode US images where captured per subject during rest and during head-up, resisted head-up and resisted sling activities. Intra-class Correlation Coefficients (ICC) and standard error of measurement (SEM) were used to analyse the data. Results: Good correlation was found for both test - retest condi-tions for all four muscles tested during rest: 0.91(TrA ); 0.90(IO); 0.91(EO); 0.94(RA ) for intra-tester reliability and0.74(TrA ); 0.88(IO); 0.74(EO); 0.83(RA ) for inter-tester reliability. Repeatability of thickness measures during activity however showed variation in recruitment patterns. A  significant correlation was found between age and BMI andresting abdominal muscle thickness (p<0.001). Conclusion: The study supports the reliability of US measurement of resting abdominal muscles and of the RA  under active conditions in children aged six to 13. However the stability o measurement of the other muscles under active conditions still needs to be established.

How compliant are beverage employees to occupational health and safety regulations?

This observational study was undertaken to identify thehealth and safety violations of employees at a specific beverage manufac-turing company.  A  site inspection and observation of all employees employedat this specific beverage company was conducted by the researcher over 2 days. Employees were observed for 12 hours per day with the morningshift on Day 1 and the afternoon shift on Day 2. A  sample of conveniencewas used in that every employee who was present on those days was included. Descriptive statistics were used to analyze the data set. There were a total of 212 employees and 332 behaviours observed during thisstudy period. Unsafe handling and behaviour was observed in 55% of observations. Incorrect manual lifting techniques was the most frequent health and safety violation observed. In the 48 manual lifting behaviours observed, correct practice was observed in only three cases.  It is clear thatmore healthcare education and practical training is required in the area of manual lifting techniques. It is clear that more practical training is required in the area of manual handling.

Motor development in children living within resource poor areas of the Western Cape

Introduction: In 1986, Irwin-Carruthers tested 681 BlackAfrican babies from the Western Cape and concluded that the South African sample was in advance of the Denver sample both in fine and gross motor behaviour. This study was to determine whether the motor development of isiXhosa speaking children from the same area was still advanced compared to their North American counterparts.Method: The Bayley Scales of Infant Development-II were administered to 86 children attending well baby clinics, between the ages of 1-36 months.Results: The mean motor developmental quotient was 92 (SD=15). Twenty eight percent of the sample was either significantly or mildly delayed. No socio-economic or maternal characteristics were associated with this score.Conclusion: The reasons for the decrease in performance are not clear. The socio-economic situation of the mothers was poor and there were a large number of single mothers whose sole source of income was government child support grants.  It is likely that the cause of the decrease is multi-factorial. The mothers are clearly in need of emotional and financial support. It is suggested that the introduction of stimulation programmes might be useful inreducing the long term impact of this delayed development.

Injury profile of employees at a specific beverage manufacturing company: a retrospective study

This article reports on important information pertaining tothe prevalence of occupational injuries. At present very little data existson the prevalence of occupational injuries in South Africa.  A retrospective study was undertaken to detail the occupational injuries sustained by employees at a specific beverage manufacturing company.The aim of this study was to determine the mechanisms, type, classification, anatomical site, frequency and time of injuries at this beverage company.The sample consisted of all employees that reported to the occupational health clinic with occupational injuries during the six-month review period i.e. July 2004-December 2004. Results of this review were computed in a self-complied injury data spreadsheet. The data was presented descriptively and the level of significance was set at 0.05.  Incorrect lifting of manual materials was reported as the most common mechanism of injury. Repetitive strain injuries were the most common type of injury. The spine/trunk was the site of 48 (66.7% of regions) injuries with the most frequently injured regions being the back (43.1%) and neck (22.2%). Most of the injuries were sustained during the month of December (27.8%). It is recommended that aggressive health promotion and injury prevention strategies be implemented to reduce the burden of occupational injuries at this specific beverage manufacturing company.

An investigation into the health-related quality of life of individuals living with HIV who are receiving HAART

The health authorities have recently accepted the routine provision of highly active antiretroviral therapy to persons living with AIDS in South Africa. There is a need to investigate the impact of HAART on the health-related quality of life of people living with HIV/AIDS (PLWHA) in a resource-poor environment, as this will have an influence on compliance and treatment outcome. The aim of this study was to explore whether HAART is efficacious in improving the self-reported health-related quality of life (HRQoL) in a group of PWLA in WHO Stages 3 and 4 living in a resource-poor community. A quasi-experimental, prospective repeated measures design was used to monitor the HRQoL over time in participants recruited to an existing HAART programme. The HRQoL of 117 participants was determined through the use of the Xhosa version of the EQ-5D and measurements were taken at baseline, one, six and 12 months. At the time of the 12-month questionnaire, 95 participants had been on HAART for 12 months. Not all participants attended all follow-up visits, but only two participants had withdrawn from the HAART programme, after two or three months. At baseline, the rank order of problems reported in all domains of the EQ-5D was significantly greater than at 12 months. The mean score on the global rating of health status increased significantly (p < 0.001) from a mean of 61.7 (SD = 22.7) at baseline to 76.1 at 12 months (SD = 18.5) It is concluded that, even in a resource-poor environment, HRQoL can be greatly improved by HAART, and that the possible side effects of the drugs seem to have a negligible impact on the wellbeing of the subjects. This bodes well for the anticipated roll-out of HAART within the public health sector in South Africa.

A pilot to investigate the use of the icf in documenting levels of function and disability in people living with hiv

Objective: The study was a pilot study aimed at investigating the use of the International Classification of Functioning, Disability and Health (ICF) checklist developed by the World Health Organisation in determining the function of individuals living with HIV in a township near Cape Town.Methods: Twelve participants attending the HIV clinic were examinedusing the ICF checklist.Findings: Areas of the ICF in which problems were noted included emotional functioning and energy and drive. Four participants complained of increased sensitivity to sound. Several respondents (three) reported difficulties in relationships with community members, with less having problems in family and intimate relationships. Conclusion: The ICFwas found to be time consuming and many codes were not relevant. Some of the concepts were not well understood by the participants. However, despite limitations, the use of the ICF in a resource poor setting formed a useful framework within which to examine the functional problems of HIV infected individuals. In the absence of any equivalent unifying framework within which to classify health and health related states, the use of the ICF merits further investigation.

Assesing motor impairment of the trunk in patients with traumatic brain injury: reliability and validity of the trunk impairment scale

Introduction: Literature regarding trunk assessment after Traumatic Brain Injury (TBI) is limited. The Trunk Impairment Scale (TIS) is a newly developed tool which is intended to assess static and dynamic sitting balance and trunk co-ordination.Aim: It was the aim of this study to examine the reliability andvalidity of the TIS in TBI patients.Methods: Thirty TBI subjects were recruited from within arehabilitation setting. Two researchers observed each subjectsimultaneously, but scored independently. Each subject wasre-examined by one of the raters.Results: Kappa and weighted kappa values for all items ranged from 0.34 to 1. All percentages of agreement were 70% or higher. Intraclass correlation (ICC) coefficients for the sub-scale scores were between 0.72 and 0.88. Test-retest and inter-rater reliability for the total TIS score (ICC) was 0.88 and 0.95, respectively. The 95% limits of agreement for the test-retest and interexaminer measurement error interval were -4,4 and -3,3, respectively. The construct validity was evaluated by means of the Spearman rank correlation coefficient between the TIS and the Barthel Index (r=0.59, p=.0007).Discussion and conclusion: Fair to perfect item agreement was found but the reliability of certain items requiresfurther attention. Acceptable sub-scale and total TIS reliability and validity justify the use of the TIS in TBI treatmentand research.

Ethical issues relating to qualitative research

Qualitative research or naturalistic research has moved from the sidelines into the mainstream of health research and an increasing number of qualitative research proposals are being presented for ethical review Qualitative research presents ethical problems that which are unique to the intensive hands-on paradigm which characterises naturalistic research. This paper briefly outlines the most common methodologies used in this research. The four ethical principles of benevolence, non-maleficence, autonomy and justice will be used as a framework to explore specific ethical issues related to this form of inquiry. The need for scientific rigour will also be explored as research that is scientifically unsound can never be ethical.

Some thoughts on practising physiotherapy in a multi-cultural country

Physiotherapists in South Africa are often confronted with ethicalissues, which arise from the multi-cultural nature of the society. This paper discusses the ethical theory of cultural relativism in an attempt to highlight the complexities of making moral judgements across cultural, ethnic and religious boundaries.

An investigation into the physical accessibility to wheelchair bound students of an Institution of Higher Education in South Africa

PURPOSE

A descriptive cross-sectional study was undertaken to establish the ease of accessibility to wheelchair bound students of the campus of a large institution of higher education in South Africa. Accessibility was defined not simply in terms of access to buildings, but also of the added time and distance traveled by wheelchair bound students on the campus.

METHODS

Five different faculties were randomly selected and typical routes travelled by a first year student in each faculty established. The shortest possible distances were mapped out for each faculty and measured using a metre wheel. For those in wheelchairs, this distance included the distance to ramps and to lifts. Mean speeds were used to determine the time taken to travel the measured distances. A checklist was used to measure the physical accessibility of the 18 buildings concerned.

RESULTS

The total mean distance traveled between lecture theatre changeover by wheelchair-bound students was 402 metres (range 278-689 m for the different faculties), which was a mean difference of 66 m (range 11-145 m) longer than for ambulant students. The mean time taken was 17 minutes (range 11-28 minutes), which was 11 minutes (range 8-19 minutes) longer than for ambulant students. The Faculty of Mechanical Engineering fared the worst, at 689 metres and 28 minutes between changeover. Two of the 18 buildings measured were fully accessible, while three were completely inaccessible. Inaccessible toilets were the most common problem.

CONCLUSIONS

Wheelchair-bound students consistently had to travel further and for longer times between lecture theatres in all the faculties measured. The students would therefore be unable to reach their lectures within the 10 minute time allocated by the university. The inaccessibility of the buildings limits the full integration of wheelchair-bound students into campus life. Certain administrative changes might assist in improving the ease of accessibility. Architectural adaptations, although more costly, might also prove to be effective.

Disability in an urban black community in Zimbabwe

PURPOSE

This study was undertaken to establish which health conditions are primarily responsible for disability and morbidity in a high-density area in Harare, Zimbabwe.

METHOD

House-to-house screening visits were followed up by medical examination and interview of those identified as having a functional limitation.

RESULTS

Information was obtained during screening on 10,839 residents. Of these, 608 were examined by medical professionals. The rate of disability/morbidity was 5.6% for the whole sample. Headaches and migraine were the most common problem. These were followed by back pain, hypertension and osteoarthritis. HIV/AIDS was the fifth most common condition. Depression, based on responses to a screening tool, was evident in one-third of the subjects. Common activity limitations included difficulty with the performance of housework activities and with walking. HIV/AIDS resulted in the most severe activity limitation, in that cognitive functions were also affected.

CONCLUSION

The middle-aged and elderly with osteoarthritis and young women with depression constitute vulnerable groups who are not in a position to demand services. The older women particularly need assistance as they are bearing the double burden of their own degenerative conditions and the results of the HIV/AIDS pandemic.

The reliability of the Shona version of the EQ-5D

BACKGROUND

There is an increasing need to have locally applicable health related quality of life outcome measures that are both reliable and valid. The aim of this paper was to present the Shona version of a Health Related Quality of Life Measure, the EQ-5D (Euro Quality of Life--5 Dimensions) and to examine the reliability and validity of the translated instrument.

METHOD

Thirty eight test-retest responses from randomly selected members of a high density suburb in Harare were analysed. The measures of agreement (Kappa statistic) between the two sets of scores were very high and ranged from 0.78 to 1.00 for different domains of activity. The correlation between the two sets of scores in the section of the instrument that calls for valuation of health state on a visual analogue scale (VAS) was high (Spearman's rho = 0.793). It is suggested that, based on this small sample, the EQ-5D is a reliable measure of HRQoL and can be utilised in studies in a high density Shona speaking population.

A bridge between cultures: A report on the process of translating the EQ-5D instrument into Shona

There is an increasing need in medical research for outcome measures that are both locally applicable and internationally recognised. The European Quality of Life 5-dimensions (EQ-5D) has been found to be a valid and reliable instrument for describing health related quality of life in Western societies. The paper describes the process of translating the EQ-5D into Shona, the language spoken by the majority of Zimbabweans. The EuroQoL group has developed a protocol for translation that was followed rigorously. Issues such as conceptualisation of health concepts cross-culturally, semantic equivalence (the transfer of meaning across languages) and specific idiomatic expressions are discussed. It is concluded that if the translation process is not adequately addressed, researchers may be guilty of simply imposing notions of health and quality of life across cultures. Consequently, the results will not provide meaningful insights into the cultures under study.

Provision of physiotherapy services at the sixth All Africa Games

The provision of physiotherapy services to guest nations by the host nation, Zimbabwe, at the sixth All Africa Games is examined. There was a high rate of pre-existing injury. Ice, the Cryocuff, and ultrasound were the most frequently used tools, and should be made available to physiotherapists at all multisport events. It is recommended that collection of epidemiological data be standardised to allow comparison between events.

Appreciation of community-based rehabilitation by caregivers of children with a disability

Evaluations of community-based rehabilitation (CBR) programmes generally focus on quantitative data. To gain insight into the determinants of the outcomes, process-oriented data are needed. From the literature six variables have been identified that possibly correlate with the evaluation of CBR by caregivers of children with a disability. These variables are: (1) traditional beliefs, (2) impact of a child with a disability on the caregiver, (3) community involvement, (4) perceived ability to teach the child, (5) attitude towards various health services, and (6) expectations for the future of a disabled child. The study was done in the CBR projects in Zimbabwe. Seventy-five caregivers were interviewed. Background, perceived abilities to teach and expectations of the caregivers were very different. This study revealed a significant correlation between the appreciation of CBR and the attitude towards various health services, and between the perceived ability to teach and the expectations for the future of the child.