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Article: The profile of people undergoing lower limb amputations at Groote Schuur Hospital.

Limakatso, Katleho / Tucker, Jenna / Banda, Lennie / Robertson, Cheyne / Parker, Romy

2024 Volume 13, Page(s) 1152

Abstract: Background: The annual incidence of lower limb amputations (LLA) at Groote Schuur Hospital is rising gradually. However, little is known about the sociodemographic and clinical profiles of people undergoing these limb amputations.: Objectives: To ... ...

Abstract	Background: The annual incidence of lower limb amputations (LLA) at Groote Schuur Hospital is rising gradually. However, little is known about the sociodemographic and clinical profiles of people undergoing these limb amputations. Objectives: To collect and analyse data to describe the sociodemographic, health and amputation profiles of people who have undergone LLA at Groote Schuur Hospital. Method: A descriptive retrospective chart review was conducted using a sample of 107 participants who had undergone LLA at Groote Schuur Hospital between January 2019 and July 2020. A customised assessment tool was used to extract data on the sociodemographic, health and amputation profiles of patients who had LLA. Data were analysed descriptively. Results: Sixty per cent of the patients who had undergone LLA at Groote Schuur Hospital were women. Most of the patients were over the age of 60 years and had not completed school and were pensioners or unemployed, with very low income and multiple co-morbidities including poorly controlled diabetes. Conclusions: Complications because of uncontrolled diabetes were the primary indication for LLAs at Groote Schuur Hospital. Therefore, health literacy projects are indicated to address chronic diseases of lifestyle, which, in turn, may reduce the overall burden of LLA, particularly on the South African under-resourced healthcare system. Contribution: The results of this study may help us identify key factors that predispose patients to LLAs. Consequently, this may help us identify key areas for prevention and better management of diseases that can result in complications that indicate the need for amputation.
Language	English
Publishing date	2024-02-14
Publishing country	South Africa
Document type	Journal Article
ZDB-ID	2733893-9
ISSN	2226-7220 ; 2223-9170
ISSN (online)	2226-7220
ISSN	2223-9170
DOI	10.4102/ajod.v13i0.1152
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Article ; Online: Context counts: Investigating pain management interventions in HIV-positive men living in a rural area.

Reardon, Cameron / Wadley, Antonia / Parker, Romy

African journal of primary health care & family medicine

2023 Volume 15, Issue 1, Page(s) e1–e11

Abstract: Background: Pain remains a prevalent and burdensome complaint for people living with human immunodeficiency virus and/or aquired immunodeficiency syndrome (LWHA). Positive Living (PL), a multimodal pain intervention, reduced pain in female South ... ...

Abstract	Background: Pain remains a prevalent and burdensome complaint for people living with human immunodeficiency virus and/or aquired immunodeficiency syndrome (LWHA). Positive Living (PL), a multimodal pain intervention, reduced pain in female South Africans LWHA. We investigated the efficacy of the PL programme in South African males living with human immunodeficiency virus and/or acquired immunodeficiency syndrome (MLWA) in a rural community. Aim: To determine the effects of a multimodal pain intervention in MLWHA. Setting: Various primary care clinics in Manguzi, Kwa-Zulu Natal, South Africa. Methodology: Therapeutic relationship (TR) intervention alone or in combination with the PL programme were allocated to HIV-positive men between the ages of 18-40. Pain intensity and interference were the primary outcome measures. Secondary outcome measures included physical function, health-related quality of life, depressive symptoms and self-efficacy. Results: Forty-seven men (mean age 35 ± 3 years) were recruited with baseline mean pain severity of 5.02 (± 3.01) and pain interference of 4.6 (± 3.18). Nineteen men were allocated to the TR intervention alone, 28 were allocated to the TR intervention and PL programme. Attendance at the intervention sessions varied from 10% to 36%. No changes in any outcomes were recorded. Conclusion: Poor attendance at the intervention and follow-up sessions make these results an unreliable reflection of the intervention. Contextual factors including internal migration and issues around employment were identified. These may influence healthcare utilisation for MLWHA living in rural settings.Contribution: Unmet healthcare needs of MLWHA in a rural community have been identified. If we are to 'leave no one behind', healthcare interventions should account for context and be 'rural-proofed'.
MeSH term(s)	Male ; Humans ; Female ; Adolescent ; Young Adult ; Adult ; Pain Management ; Quality of Life ; HIV Seropositivity ; Acquired Immunodeficiency Syndrome ; Pain
Language	English
Publishing date	2023-05-09
Publishing country	South Africa
Document type	Journal Article
ZDB-ID	2526836-3
ISSN	2071-2936 ; 2071-2936
ISSN (online)	2071-2936
ISSN	2071-2936
DOI	10.4102/phcfm.v15i1.3678
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Article ; Online: Treatment Recommendations for Phantom Limb Pain in People with Amputations: An Expert Consensus Delphi Study.

Limakatso, Katleho / Parker, Romy

PM & R : the journal of injury, function, and rehabilitation

2021 Volume 13, Issue 11, Page(s) 1216–1226

Abstract: Background: Phantom limb pain (PLP) is common and often accompanied by serious suffering. Current systematic-review evidence suggests that recommended treatments are no more effective than placebo for reducing PLP. Given the difficulty in conducting a ... ...

Abstract	Background: Phantom limb pain (PLP) is common and often accompanied by serious suffering. Current systematic-review evidence suggests that recommended treatments are no more effective than placebo for reducing PLP. Given the difficulty in conducting a meta-analysis for nonpharmacological treatments and the weak evidence for pharmacological treatments for PLP, consensus on the first-line management of PLP needs to be reached using alternative methods. Objective: To reach expert consensus and make recommendations on the effective management of PLP. Design: A three-round Delphi design was used. Setting: The study was conducted using e-mail and Google survey tool as the main methods of communication and providing feedback. Participants: The study included 27 clinicians and researchers from various health disciplines who are experts in PLP management. Method: Data were collected using three sequential rounds of anonymous online questionnaires where experts proposed and ranked the treatments for PLP. A consensus was reached on the treatments that were endorsed by 50% or more of the experts. Results: Thirty-seven treatments were proposed for the management of PLP at the beginning of the study. Consensus was reached on seven treatments that were considered effective for managing PLP and on two treatments that were considered ineffective. Graded motor imagery, mirror therapy, amitriptyline, sensory discrimination training, and use of a functional prosthesis were endorsed by most experts because of the available backing scientific evidence and their reported efficacy in clinical practice. Cognitive behavioral therapy and virtual reality training were endorsed by most experts because of their reported efficacy in clinical practice despite indicating a dearth of scientific evidence to support their ranking. Citalopram and dorsal root ganglion pulsed radiofrequency were rejected owing to a lack of relevant scientific evidence. Conclusion: The results of this study suggest that the nonpharmacological treatments endorsed in this study may have an important role in the management of PLP.
MeSH term(s)	Amputation ; Consensus ; Delphi Technique ; Humans ; Imagery, Psychotherapy ; Phantom Limb/therapy
Language	English
Publishing date	2021-02-26
Publishing country	United States
Document type	Journal Article ; Research Support, Non-U.S. Gov't
ZDB-ID	2608988-9
ISSN	1934-1563 ; 1934-1482
ISSN (online)	1934-1563
ISSN	1934-1482
DOI	10.1002/pmrj.12556
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Article ; Online: Chronic pain in female breast cancer survivors - prevalence, characteristics and contributing factors: a cross-sectional pilot study.

Shabangu, Nelisiwe / Thebe, Tselane / Casey, Michelle / Wesselmann, Ursula / Parker, Romy

BMC women's health

2023 Volume 23, Issue 1, Page(s) 613

Abstract: Background: While the global incidence of breast cancer is increasing, there is also an increase in the numbers of breast cancer survivors and in survival duration, as early detection programs are implemented, and treatments are optimized. Breast cancer ...

Abstract	Background: While the global incidence of breast cancer is increasing, there is also an increase in the numbers of breast cancer survivors and in survival duration, as early detection programs are implemented, and treatments are optimized. Breast cancer survivors in several countries commonly struggle with a range of symptoms (fatigue, insomnia, depression) with 25-80% of survivors suffering from chronic pain. There is a paucity of literature reporting on breast cancer survivors in South Africa. In this pilot study we aimed to determine the prevalence of chronic pain in female breast cancer survivors attending the breast oncology clinic. Methods: A cross-sectional survey was conducted of all breast cancer survivors attending the Groote Schuur Hospital Breast Unit during one month in 2019. 44 female breast cancer survivors (median age 60.5y) completed a sociodemographic questionnaire, the Brief Pain Inventory, Pain Catastrophizing Scale and measures for neuropathic pain (DN4), health related quality of life (HRQoL; EQ-5d-3 L), physical activity (IPAQ), depression and anxiety (PHQ4), and screening questions to evaluate sleep, happiness and perceived discrimination in the language of their choice. Results: The prevalence of chronic pain (pain on most days for more than three months) was 59% (95%CI 44-72), a significantly higher number than the 18,3% prevalence of chronic pain reported by South African adults. 39% of the women were classified as having neuropathic pain. The median pain severity score was 3.75 (IQR = 2.75-5) and the median pain interference with function score was 4 (IQR = 2.9-5.4). The women were experiencing pain in a median of 2 different body sites (IQR = 1-3). The women with pain were more likely to be unemployed or receiving a disability grant, had significantly worse HRQoL, and significantly worse scores for risk of depression and anxiety. Conclusion: The results of this pilot study suggest that chronic pain may be a significant burden for South African breast cancer survivors. Routine screening for chronic pain in breast cancer survivors is recommended with a larger study indicated to explore this issue further.
MeSH term(s)	Adult ; Female ; Humans ; Middle Aged ; Breast Neoplasms/complications ; Chronic Pain/epidemiology ; Cancer Survivors ; Cross-Sectional Studies ; Pilot Projects ; Quality of Life ; Prevalence ; Survivors ; Neuralgia ; Surveys and Questionnaires ; Depression/epidemiology
Language	English
Publishing date	2023-11-16
Publishing country	England
Document type	Journal Article ; Research Support, N.I.H., Extramural
ZDB-ID	2050444-5
ISSN	1472-6874 ; 1472-6874
ISSN (online)	1472-6874
ISSN	1472-6874
DOI	10.1186/s12905-023-02766-6
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Article ; Online: Current pediatric pain practice in Nigeria, South Africa, Uganda, and Zambia: A prospective survey of anesthetists.

Bhettay, Anisa / Gray, Rebecca / Desalu, Ibironke / Parker, Romy / Maswime, Salome

Paediatric anaesthesia

2023

Abstract: Background: Children in hospital experience significant pain, either inherent with their pathology, or caused by diagnostic/therapeutic procedures. Little is known about pediatric pain practices in sub-Saharan Africa. This survey aimed to gain insight ... ...

Abstract	Background: Children in hospital experience significant pain, either inherent with their pathology, or caused by diagnostic/therapeutic procedures. Little is known about pediatric pain practices in sub-Saharan Africa. This survey aimed to gain insight into current pain management practices among specialist physician anesthetists in four sub-Saharan African countries. Methods: A survey was sent to 365 specialist physician anesthetists in Nigeria, South Africa, Uganda and Zambia. Content analysis included descriptive information about the respondents and their work environment. Thematic analysis considered resources available for pediatric pain management, personal and institutional pain practices. Results: One hundred and sixty-six responses were received (response rate 45.5%), with data from 141 analyzed; Nigeria (27), South Africa (52), Uganda (41) and Zambia (21). Most respondents (71.83%) worked at tertiary/national referral hospitals. The majority of respondents (130/141, 91.55%) had received teaching in pediatric pain management. Good availability was reported for simple analgesia, opioids, ketamine, and local anesthetics. Just over half always/often had access to nurses trained in pediatric care, and infusion pumps for continuous drug delivery. Catheters for regional anesthesia techniques and for patient-controlled analgesia were largely unavailable. Two thirds (94/141, 66.67%) did not have an institutional pediatric pain management guideline, but good pharmacological pain management practices were reported, in line with World Health Organization recommendations. Eighty-eight respondents (62.41%) indicated that they felt appropriate pain control in children was always/often achieved in their setting. Conclusion: This survey provides insight into pediatric pain practices in these four countries. Good availability of a variety of analgesics, positive pain prescription practices, and utilization of some non-pharmacological pain management strategies are encouraging, and suggest that achieving good pain control despite limited resources is attainable. Areas for improvement include the development of institutional guidelines, routine utilization of pain assessment tools, and access to regional anesthesia and other advanced pain management techniques.
Language	English
Publishing date	2023-12-11
Publishing country	France
Document type	Journal Article
ZDB-ID	1086049-6
ISSN	1460-9592 ; 1155-5645
ISSN (online)	1460-9592
ISSN	1155-5645
DOI	10.1111/pan.14818
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Article ; Online: State of the art: What have the pain sciences brought to physiotherapy?

Parker, Romy / Madden, Victoria J

The South African journal of physiotherapy

2020 Volume 76, Issue 1, Page(s) 1390

Abstract: Background: Pain is the most common reason for patients to seek help from a health care professional. In the past few decades, research has yielded gains in the Pain Sciences - multiple fields of scientific research that, when integrated, help to ... ...

Abstract	Background: Pain is the most common reason for patients to seek help from a health care professional. In the past few decades, research has yielded gains in the Pain Sciences - multiple fields of scientific research that, when integrated, help to clarify what causes and influences human pain. Objectives: In this article, we discuss the key areas in which the Pain Sciences have shifted the physiotherapy profession. Method: A narrative review of the Pain Sciences literature was conducted. The review analyses how the Pain Sciences have influenced physiotherapy in several categories: assessment; clinical reasoning; treatment; research rigor and building the profile of the profession. Results: Scientific research on pain has largely converged in support of three 'game-changing' concepts that have shifted the physiotherapy profession's understanding and treatment of pain: (1) pain is not a signal originating from bodily tissues, (2) pain is not an accurate measure of tissue damage and (3) the plasticity of the nervous system means the nervous system itself is a viable target of treatment. These three concepts have influenced physiotherapy assessment and treatment approaches, and research design to consider pain mechanisms using patient-centred models. Conclusion: The Pain Sciences have shifted physiotherapists' assessment and treatment approaches and shifted the status of the physiotherapy profession. Ultimately the Pain Sciences have embedded interdisciplinary teams and expanded physiotherapy practice. Clinical implications: We believe that the pain sciences should be embedded in undergraduate and postgraduate education and training of physiotherapists (including the three key concepts regarding pain) to benefit physiotherapists and their patients.
Language	English
Publishing date	2020-02-24
Publishing country	South Africa
Document type	Journal Article
ZDB-ID	1055412-9
ISSN	2410-8219 ; 0379-6175
ISSN (online)	2410-8219
ISSN	0379-6175
DOI	10.4102/sajp.v76i1.1390
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Article ; Online: Physical activity in physiotherapy students: Levels of physical activity and perceived benefits and barriers to exercise.

Kgokong, Diana / Parker, Romy

The South African journal of physiotherapy

2020 Volume 76, Issue 1, Page(s) 1399

Abstract: Background: Physiotherapists have been identified as key role players in health promotion, prevention and treatment of non-communicable diseases.: Objectives: The aim of this study is to describe the perceived benefits and barriers to exercise and ... ...

Abstract	Background: Physiotherapists have been identified as key role players in health promotion, prevention and treatment of non-communicable diseases. Objectives: The aim of this study is to describe the perceived benefits and barriers to exercise and their association with levels of physical activity (PA) in physiotherapy students attending university in the Western Cape province of South Africa. Method: This study follows a quantitative, cross-sectional, survey design. Two hundred and ninety-six participants were recruited from three universities in the Western Cape. Participants completed a demographic questionnaire (DQ), Exercise Benefits and Barriers Scale (EBBS) and the International Physical Activity Questionnaire (IPAQ). Results: Female students accounted for 83% of the sample. Out of the 296 participants, 58% lived off-campus and 65% were involved in sporting activities six hours per week. The median score on the EBBS was 136 (54-167) for all years. Responses with the highest agreement for perceived benefits were associated with physical performance. Alternatively, responses with the highest agreement for perceived barriers were associated with physical exertion. Only 37.5% students engaged in high PA. Conclusion: Undergraduate physiotherapy students in the Western Cape across all three universities do not engage in adequate PA. In this group of students, benefits associated with high PA related to physical performance and barriers associated with low levels of PA related to physical exertion. Clinical implications: Physiotherapists who do not practise what they preach are not effective role models and may not be effective in obtaining behaviour change through PA-related health promotion.
Language	English
Publishing date	2020-04-29
Publishing country	South Africa
Document type	Journal Article
ZDB-ID	1055412-9
ISSN	2410-8219 ; 0379-6175
ISSN (online)	2410-8219
ISSN	0379-6175
DOI	10.4102/sajp.v76i1.1399
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Article ; Online: The Efficacy of Graded Motor Imagery and Its Components on Phantom Limb Pain and Disability: A Systematic Review and Meta-Analysis.

Limakatso, Katleho / Cashin, Aidan G / Williams, Sam / Devonshire, Jack / Parker, Romy / McAuley, James H

Canadian journal of pain = Revue canadienne de la douleur

2023 Volume 7, Issue 1, Page(s) 2188899

Abstract: Introduction: Graded Motor Imagery (GMI) is a non-invasive and inexpensive therapy used to treat Phantom Limb Pain (PLP) by sequentially activating motor networks in such a way that movement and pain are unpaired. The objective of this systematic review ...

Abstract	Introduction: Graded Motor Imagery (GMI) is a non-invasive and inexpensive therapy used to treat Phantom Limb Pain (PLP) by sequentially activating motor networks in such a way that movement and pain are unpaired. The objective of this systematic review was to critically appraise relevant data on the efficacy of GMI and its components for reducing PLP and disability in amputees. Methods: We searched 11 electronic databases for controlled trials investigating GMI and its components in amputees with PLP from inception until February 2023. Two reviewers independently screened studies and extracted relevant data. Study-level data were entered using the inverse variance function of the Review Manager 5 and pooled with the random effects model. Results: Eleven studies with varying risk of bias were eligible. No eligible study considered left/right judgement tasks in isolation. Studies showed no effect for imagined movements, but positive effects were seen for GMI [weighted mean difference: -21.29 (95%CI: -31.55, -11.02), I Conclusion: Our findings suggest that GMI and mirror therapy may be effective for reducing PLP. However, this conclusion was drawn from a limited body of evidence, and the certainty of the evidence was very low. Therefore, rigorous, high-quality trials are needed to address the gap in the literature and inform practice.
Language	English
Publishing date	2023-05-17
Publishing country	United States
Document type	Journal Article ; Review
ISSN	2474-0527
ISSN (online)	2474-0527
DOI	10.1080/24740527.2023.2188899
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Article ; Online: A retrospective audit of pain assessment and management post-caesarean section at New Somerset Hospital in Cape Town, South Africa.

Munsaka, Effraim F / Van Dyk, Dominique / Parker, Romy

South African family practice : official journal of the South African Academy of Family Practice/Primary Care

2021 Volume 63, Issue 1, Page(s) e1–e6

Abstract: Background: The most common major surgical procedure performed worldwide is the caesarean section (CS). Effective pain management is a priority for women undergoing this procedure, to reduce the incidence of persistent pain (a risk factor for postpartum ...

Abstract	Background: The most common major surgical procedure performed worldwide is the caesarean section (CS). Effective pain management is a priority for women undergoing this procedure, to reduce the incidence of persistent pain (a risk factor for postpartum depression), as well as optimise maternal-neonatal bonding and the successful establishment of breastfeeding. Multimodal analgesia is the gold standard for post-CS analgesia. At present, no perioperative pain management protocols could be identified for the management of patients presenting for CS at regional hospitals in South Africa. This audit aimed to review the folders of patients who underwent CS, with particular reference to perioperative pain management guidelines for CS. Methods: A descriptive, retrospective, cross-sectional audit was conducted. Three hundred folders (10% of the annual number of caesarean procedures performed) from New Somerset Hospital, a regional hospital in Cape Town, South Africa were reviewed. Results: The women were a mean age of 30 years (standard deviation [s.d.]: 6.2). Median gravidity was 3 (interquartile range [IQR]: 2-3) and parity was 1 (IQR: 1-2); 52% had previously undergone a CS. In 93.3% cases, spinal anaesthesia was employed for CS. Pain assessment was poor, with only 55 (18%) patients having their pain assessed on the day of the operation. Analgesia was prescribed in over 98% of the patients, however, medication was only administered as prescribed in 32.6%. Non-steroidal anti-inflammatory drugs (NSAIDs) were prescribed in 5% of cases. None of the patients received a patient-controlled analgesia (PCA), transversus abdominis plane (TAP) block, or wound infusion catheter as supplementary strategies. Conclusion: Pain management for post-CS patient at this hospital is lacking. There is the need for the implementation of a structured assessment tool to improve administration of analgesics in these patients. In addition, the reasons for the omission of NSAIDs from the analgesia regimen requires investigation. Hospital requires post-CS pain protocols to guide management especially in resource-limited settings.
MeSH term(s)	Adult ; Analgesia, Patient-Controlled ; Analgesics, Opioid ; Cesarean Section/adverse effects ; Cross-Sectional Studies ; Female ; Hospitals ; Humans ; Infant, Newborn ; Pain Measurement ; Pregnancy ; Retrospective Studies ; South Africa/epidemiology
Chemical Substances	Analgesics, Opioid
Language	English
Publishing date	2021-09-30
Publishing country	South Africa
Document type	Journal Article
ISSN	2078-6204
ISSN (online)	2078-6204
DOI	10.4102/safp.v63i1.5320
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Article: A history of depression in patients attending a chronic pain management clinic in South Africa: A retrospective chart review.

van Vreede, Joseph J / Parker, Romy / van Nugteren, Janieke

The South African journal of psychiatry : SAJP : the journal of the Society of Psychiatrists of South Africa

2022 Volume 28, Page(s) 1673

Abstract: Background: Chronic pain and depression are closely related conditions, which commonly exist as comorbid disorders. Understanding the prevalence of depression in patients presenting with chronic pain is vital for effective pain management.: Aim: Our ... ...

Abstract	Background: Chronic pain and depression are closely related conditions, which commonly exist as comorbid disorders. Understanding the prevalence of depression in patients presenting with chronic pain is vital for effective pain management. Aim: Our study aimed to establish the prevalence of a history of depression in patients presenting with chronic pain to a chronic pain management clinic at a tertiary academic hospital and to describe the characteristics of patients with both conditions. Setting: Groote Schuur Hospital, Chronic Pain Management Clinic, Cape Town, South Africa. Method: A retrospective review of 665 medical charts of consecutive patients accessing the clinic over a 7-year period was conducted. Baseline, patient-centred data were collected. Results: Of the 665 charts, 623 were analysed. The median age of patients was 53 years. The prevalence of depression in patients presenting with chronic pain was 32%, three times higher than the national life-time prevalence in South Africa. The majority (77%) of patients with chronic pain and depression were female ( Conclusion: The high prevalence of a history of depression in patients presenting with chronic pain in our study, emphasises the importance of looking for and understanding the interrelation of the physiological, psychiatric, psychological and socio-economic factors that are common to both depression and chronic pain. Pain relief alone is insufficient to ensure optimal rehabilitation of these patients and integrating the management of their depression should improve patient outcomes and overall well-being.
Language	English
Publishing date	2022-04-29
Publishing country	South Africa
Document type	Journal Article
ISSN	1608-9685
ISSN	1608-9685
DOI	10.4102/sajpsychiatry.v28i0.1673
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