A study was undertaken at Ngwelezana hospital to determine the requirements for a cost effective physiotherapy service for patients with stabbed chests. Forty male patients between the ages of 16 and 60 who had sustained unilateral penetrating stab wounds to the chest which required intercostal drainage were randomised into one of two groups on admission to Ngwelezana hospital.The patients in group I received physiotherapy immediately after insertion of the intercostal drain, while the patients in group 2 received physiotherapy 12 to 24 hours after insertion of the drain. Mean duration of intercostal drainage in group I was 2.35 days while that of group 2 was 7.55 days. This represented a significantly shorter drainage time for the patients who had been treated immediately after insertion of the drain. Patients were discharged from hospital on the day that the intercostal drain was removed. No complications were experienced by the patients in group 1 while four patients in group 2 developed an empyema.The cost of the patients in group 2 exceeded the costs of those in group 1 by R78 728.00. It is thus imperative that patients admitted with stabbed chests should have physiotherapy immediately after insertion of the intercostal drain.
Aims: To determine the exercise capacity of patients suffering from pulmonary tuberculosis infection and then compare thisvalue to the normal. To determine if the regression equation for TB is comparable to that of patients with chronic obstructive pulmonary disease(COPD). To provide guidelines for clinical practice of physiotherapyshould exercise capacity be found to be reduced. Methods: Thirteen black, male subjects between the ages of 19 and 35 years were included in the study. Each subject completed the shuttle walking test in order to determine his VO2peak. This was then compared to historical data for VO2peak. A subgroup of five subjects took part in a treadmill test to calculate a regression equation for VO2peak for TB patients. Results: Exercise capacity, measured as VO2peak, is reduced by an average of 57% when compared to the normal.The mean (SD) VO2peak for this group of thirteen patients is 19.09 (8.19)ml/kg/min. The shuttle walking test is a validand reliable test to determine the VO2peak of patients with pulmonary tuberculosis. Although a trend is evident the regression equation for pulmonary TB is based on a small sample size. Conclusion: Although the exercise capacity of patients with PTB is markedly reduced it does not seem to impact on their function. Based on the above results, a preliminary recommendation is that a pulmonary rehabilitation program is not necessary for patients with pulmonary tuberculosis. Although not originally an aim of the study it isalso evident that the role of the physiotherapist with respect to pulmonary tuberculosis may be one of education.
A sample of 62 patients at a hypertension clinic at a tertiary care hospital was interviewed to establish which factors contributed to poor knowledge. Patients were interviewed to establish basic demographic data, their own risk factors, various psycho-social factors as well as their knowledge of the disease process and risk factor management. A step-wise logistic regression was done to establish which factors were predictive of the knowledge of patients with hypertension. It was found that a good quality of life (p=0.003); normal sex-life (p=0.00); home language of English or Afrikaans (p=0.002); educational status (p=0.00) and annual income (0.01) were predictive of patients’ knowledge. Patients with a better quality of life had better knowledge than those with a poor quality of life (p=0.05).
In 1998 the Gauteng Department of Health notified the Physiotherapy Department of the Johannesburg hospital that the number of physiotherapy posts would be cut from 43 full-time posts to 22 full-time posts. This cut in workforce made it essential to re-evaluate the services rendered in order to meet the needs of the hospital. An audit of the number of inpatients on a given day was conducted in June 1998. In addition to this the number of patients requiring physiotherapy and the time needed to treat them was determined. A second study established the time spent by physiotherapists in direct patient care, indirect patient care and “social” activities. From the results of this audit it was established that 22 full-time physiotherapists would not be able to provide a comprehensive physiotherapy service. Since the completion of this audit the number of physiotherapists at the Johannesburg hospital has decreased further with no re-appointments due to cuts in the Gauteng health budget. It is the opinion of the authors that many hospitals in South Africa are in similar positions and that more studies need to be done at hospitals to determine the need for physiotherapy in other hospitals.
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