Research Articles (Physiotherapy)

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Relationship between cognitive ability and performance fitness of professional football players in Enugu State, Nigeria
Eleje, Chiedozie; Nweke, Martins C.; Ekowa, Juliet Lucy; Okeibunor, Chinyere Oluchi; Enebe, Amaka; Ojukwu, Chiiebele Petronilla (LAM Publications, 2026-06-24)
Cognitive ability is widely regarded as a critical determinant of success and performance in football. Competitive football demands a high level of physical fitness, prompting players to engage in rigorous training to meet the physiological requirements of the game. However, despite intensive physical conditioning, on-field performance often remains suboptimal, suggesting that factors beyond physical fitness may contribute significantly to optimal competitive performance. This study examined the relationship between cognitive function and performance levels among professional football players. A total of 60 players from three football clubs in Enugu, Nigeria, participated in the study. Cognitive function and performance levels were assessed using the Trail Making Test, Pro-Agility Test, 20-m Sprint Test, and Running-Based Anaerobic Sprint Test. The findings revealed a significant relationship between executive function and speed performance (p = 0.000, rho = .560), while a weak relationship was observed between executive function and pro-agility performance (p = 0.013, rho =-319). Overall, cognitive function did not appear to play a substantial role in the general performance of professional football players. Nevertheless, the ability to control gameplay at high speed may be associated with stronger cognitive ability.
Epidemiology of ranger injuries among members of the Game Rangers Association of Africa : service-related risk and the call for targeted prevention strategies
Viljoen, Carel Thomas; Van Mechelen, Willem; Sykes, Leanne M.; Clark, James Robert; De Bruin, Louise; Mushonga, Tafadzwa; Janse van Rensburg, Dina Christina (Elsevier, 2026-09)
OBJECTIVES : To determine the epidemiology of ranger injuries, risk factors for injury, and health support needs among members of the Game Rangers Association of Africa (GRAA). METHODS : We employed a retrospective cross-sectional design to collect data online using a questionnaire developed specifically for this study. We used convenience sampling to include 120 rangers aged 18 years or older who were actively working in Africa. RESULTS : Our findings showed a career injury prevalence of 52 % and period prevalence (past 12 months) of 33 %. The lower limb was the most frequently injured anatomical region (38 %), followed by the upper limb (31 %) and trunk (19 %), specifically affecting the hand (19 %), ankle (14 %), and foot (13 %). The most common injury types included skin lacerations (29 %), followed by muscle injuries (23 %), and fractures (10 %). Working for more than 15 years as a ranger is associated with an increased risk for career injury (OR=2.63) compared to working for 10 years or less. Injuries resulted in a median of 7 days (IQR=0–20 days) lost from work, with most injuries requiring either emergency medical care (31 %) or consultation with a medical doctor (26 %). Rangers need better equipment, cardiovascular fitness training programs, safety training, and mental health support. CONCLUSION : One in every two rangers associated with the GRAA sustains an injury across their careers, with a third of rangers reporting being injured in the past 12 months. Working more than 15 years as a ranger was associated with an increased risk for career injury. Our findings should be used in conjunction with sound clinical reasoning to aid in the development of future injury prevention strategies for rangers working in Africa.
Effect of aerobic exercise on depression symptoms and quality of life in patients with major depressive disorder : a systematic review protocol
Bin Muaythir, Saad; Bello, Bashir; Mshunqane, Nombeko; Ramano, Enos Morankoana; Magida, Nontembiso (BMJ Publishing Group, 2026-06)
INTRODUCTION : Major depressive disorder (MDD) is a prevalent mental illness characterised by persistent sadness, loss of interest in activities and cognitive impairment. While pharmacological and psychotherapeutic treatments remain the standard for MDD management, non-pharmacological interventions, such as aerobic exercise, have gained attention for their potential benefits in reducing depressive symptoms and improving quality of life. Although several studies have explored the effectiveness of aerobic exercise in managing MDD, there is still no comprehensive synthesis of the existing evidence. This study aims to synthesise existing evidence on the effects of aerobic exercise interventions in the management of individuals diagnosed with MDD. METHODS : The systematic review will be conducted in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses Protocol (PRISMA-P) guidelines. A comprehensive search will be conducted across Cochrane, Medline, PEDro, CINAHL, Scopus, Web of Science and BioMed Central databases. Search terms will be developed using the Population, Intervention, Comparison, Outcome and Study design (PICOS) framework, incorporating keywords and Medical Subject Headings related to ‘Major Depressive Disorder’, ‘Aerobic Exercise’, ‘Depression’, and ‘Quality of Life’. Only intervention studies, including randomised controlled trials, quasi-experimental and pre–post intervention studies, will be included involving adults aged 18 years or older diagnosed with MDD according to standardised criteria (eg, Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition and International Statistical Classification of Diseases and Related Health Problems -10 (ICD-10)). For included intervention studies, the comparator will be standard care, placebo or no-exercise control groups. The primary outcome is change in depressive symptoms, and secondary outcomes include quality of life, anxiety and stress-related biomarkers. Three independent reviewers will screen studies, extract data using Covidence software (Veritas Health Innovation in partnership with Cochrane) and assess study quality using the updated Cochrane Risk of Bias 2.0 (Rob-2) tool alongside the Grading of Recommendations Assessment, Development and Evaluation (GRADE) approach. If feasible, a meta-analysis will be conducted using RevMan V.5.4 (Cochrane's Review Manager), with effect sizes determined by mean differences, standardised mean differences or ORs, depending on the outcome type. This study is currently at the proposal stage, with article searches expected to begin in November 2025 and data extraction anticipated to be completed by January 2026. ETHICS AND DISSEMINATION : No ethical approval is required as this review uses existing published data. Findings will be disseminated through a peer-reviewed journal and presented at academic conferences. PROSPERO registration : CRD420251151897.
Efficacy of low-intensity pulsed ultrasound in surgically managed lower limb fractures : a randomised controlled trial
Magida, Nontembiso; Myezwa, H.; Mudzi, W.; Musenge, E.; Khan, S.A. Mohamed; Graham, Marien Alet (Universa Press, 2026-04-09)
Although there have been improvements in surgical fixation techniques, the process of fracture healing continues to pose challenges, especially for patients with additional health issues. Low-intensity pulsed ultrasound (LIPUS) has been proposed as a non-invasive method to facilitate faster bone recovery; however, its effectiveness in clinical settings remains unclear. This study aimed to assess the impact of LIPUS on the healing of lower limb fractures. A double-blinded, prospective, randomised controlled trial was conducted in two hospitals in Gauteng, South Africa. The study was approved by the University of the Witwatersrand (M150236). Ninety-four individuals aged 18 years and older with lower limb fractures were consecutively recruited and randomly assigned to either the LIPUS or control group. The intervention group underwent 20-minute LIPUS sessions every alternate day for a duration of 20 days during their hospitalisation, followed by follow-up after discharge. Callus formation, cortical bridging, fracture gap, and overall radiographic healing were evaluated at 6, 12, and 18 weeks. An intention-to- treat analysis was performed to accommodate missing radiographs and loss to follow-up. No statistically significant differences were found between the intervention and control groups concerning callus formation, cortical bridging, fracture gap, or overall healing at any assessment time. A high rate of loss to follow-up and unavailability of radiographs diminished the analysis’s power. LIPUS did not show a notable improvement in fracture healing when compared to standard care. Its clinical use may need to be reevaluated, especially in low– and middle-income countries, where cost-effectiveness is a crucial factor.
Analysis of the effectiveness of the Sport Mental Health Assessment Tool 1 (SMHAT-1) among endurance and ultra-endurance runners
Thuany, Mabliny; Valero, David; Weiss, Katja; Rosemann, Thomas; Knechtle, Beat; Viljoen, Carel Thomas; Scheer, Volker (Elsevier, 2026-09)
The Sport Mental Health Assessment Tool (SMHAT-1) is a screening tool aiming to identify mental health issues in elite athletes. The tool is composed of two steps, starting with a short triage questionnaire (Athlete Psychological Strain Questionnaire (APSQ); step 1), followed by subsequent disorder-specific screening instruments (step 2) only if APSQ yields positive results. SMHAT-1 has been successfully employed in various sports settings; however, no studies assessing this screening tool have been examined in endurance (ER, distance runners 21.1–42.2 km) and ultra-endurance runners (UER; >42.2 km), where the prevalence of mental health issues is high. We examined the coherence of the SMHAT-1 overall assessment and the validity of the APSQ screening tool in ER/UER. This is a cross-sectional study, in which 601 ER and UER completed the SMHAT-1 (triage tool APSQ, and all subsequent disorder-specific screening questionnaires) via an online survey. APSQ and screening outcomes were dichotomized using established cut-offs. APSQ performance as a triage tool was evaluated by comparison with disorder-specific screening outcomes. Agreement was assessed using confusion matrices, classifying cases into true positives (TP), true negatives (TN), false positives (FP), and false negatives (FN). We sampled 601 runners (37% female), with a mean age of 42.8 ± 10.1 years. The proportion of FP was 20.14%, and the proportion of FN was 37.43%. Overall, the coherence between APSQ triage and the aggregated screening outcome was 66.89%. A higher concentration of alcohol use, sleep disturbances, eating disorders, and drug use symptoms was observed among FN cases. The APSQ is not suitable to identify ER/UER with a higher risk of mental health symptoms, especially for disorders related to alcohol use, sleep disturbances, eating disorders, and drug use symptoms. The use of the SMHAT-1 screening component (step 2) is more appropriate, although it does not assess for other specific conditions prevalent in this group of athletes.
Navigating adversity : non-completion and evacuation of trail runners at the 2022 Magoebaskloof Forest Marathon
Maleka, Thabo; Jansen van Rensburg, Audrey; Viljoen, Carel Thomas; Ramkilawon, Gopika Devi; Ramagole, Dimakatso Althea; Nair, Anoop; Janse van Rensburg, Dina Christina (South African Sports Medicine Association, 2026-04-22)
BACKGROUND : Trail running occurs on natural, uneven terrain. The literature is limited in exploring factors that contribute to trail runners not completing a race. OBJECTIVES : This study firstly investigated self-reported reasons for runners who did not finish (DNF) the 2022 Magoebaskloof Forest Marathon across 10km, 20km, 34km, and 50km distances, and secondly assessed runners' evacuation methods. METHODS: A descriptive cross-sectional study of consenting trail runners (n=429) who completed the post-race DNF survey (10km, 20km, 34km and 50km distances). Within two weeks post-race, runners reported whether they finished, reasons for discontinuing and evacuation methods. We report numbers (n) and point prevalence (%). RESULTS : Of the 228 runners who completed the post-race survey, 16 (7%) DNF. DNF runners entered the 34 km (19%) and 50 km distance (81%) and were aged 31–50 years (94%). No DNFs occurred in the 10km and 20km races. Approximately 27% did not meet cut-off times, while 19% got lost despite trail directions. Other contributing factors included pre-existing and new injuries (23%), illnesses (15%), and inadequate training (8%). While 50% of the DNF group had >5 years total running experience, only 19% had >5 years of trail running experience. Runners who finished the trail race had significantly more trail running experience than those who DNF (p=0.0082). The primary evacuation method was hiking back to the nearest aid station (63%), with 19% subsequently transported by shuttle. CONCLUSION : Multiple factors may have contributed to the race non-completion. Many DNF runners started with injuries or illnesses, inadequate training, or limited trail-running experience. Event planners should improve measures to prevent runners from getting lost. These findings emphasise the importance of preparation, navigation skills, and race management in ensuring trail running safety and success.
Prevalence of self-reported shoulder pain and shoulder function among uninjured CrossFit athletes in Pretoria, South Africa
Dawood, Muhammad; Meyer, Edwin Ernest; Moatshe, Tshegofatso Prudence (South African Sports Medicine Association, 2026-06-22)
BACKGROUND: CrossFit is a rapidly growing sport characterised by high-intensity functional movements that place substantial demands on the shoulder complex. Although shoulder injuries are frequently reported, the prevalence of self-reported shoulder pain and shoulder function among uninjured CrossFit athletes remains unclear. OBJECTIVES: To determine the prevalence of self-reported shoulder pain and to describe shoulder function among uninjured CrossFit athletes in Pretoria, Gauteng. METHODS : A cross-sectional study was conducted among CrossFit athletes recruited from gyms in Pretoria. Participants completed a sociodemographic and training questionnaire. Pain presence and severity were assessed using the Numeric Pain Rating Scale (NPRS), based on current shoulder pain intensity. Shoulder function was assessed using the Penn Shoulder Score (PSS). Descriptive statistics (means, standard deviations, frequencies, and percentages) were used to summarise the data. Chi-square tests were used to explore associations between shoulder pain and selected demographic and training-related variables. RESULTS : Sixty-eight participants provided valid responses for pain analysis, while all participants completed the PSS. The prevalence of self-reported shoulder pain was 76% (95% CI: 64%-85%), with a mean NPRS score of 2.97 ± 2.75/10, indicating predominantly low-intensity pain. Shoulder function was generally preserved, with a mean total PSS of 87.8 ± 12.2 (out of 100). Shoulder pain was significantly associated with previous shoulder injury (p < 0.05). No significant associations were found between demographic or training-related variables and shoulder function. CONCLUSION : Self-reported shoulder pain is highly prevalent among uninjured CrossFit athletes despite largely preserved shoulder function. These findings suggest that athletes may continue training despite experiencing pain, highlighting the importance of routine screening and early intervention strategies.
The undergraduate external examination process and the perceptions of examiners at the physiotherapy departments in South Africa
Ntsiea, Mokgobadibe V.; Mostert, Karien; Titus, Adnil; Joseph, Conran; Manie, Shamila; Van Wyk, Heleen; Tshabalala, Muziwakhe; Chetty, Verusia (AOSIS, 2026-06-26)
BACKGROUND : Variations in external examination processes across South African universities may challenge the validity of physiotherapy assessments. Our study explores external examiners’ understanding of moderation and academic standards. OBJECTIVES : This study aimed to describe the examination processes and external examiners’ perceptions of academic standards in South African physiotherapy programmes. METHOD : A descriptive cross-sectional survey using a self-administered questionnaire sent to all eight universities that offer a physiotherapy degree in South Africa. The total population size was 103. RESULTS : Practices include appointing the same external examiner for up to 2 years (n = 4), using the same examiner for reassessments (n = 3), and assigning examiners across all modules regardless of expertise (n = 2). Five institutions allocate clinical blocks specifically, and four expose students to all clinical areas. External examiners assess all third- and fourth-year students at five institutions and receive procedural orientation via written guidelines (n = 5). Feedback is typically shared orally (n = 5) or in a university-formatted written report (n = 3). A 10% mark difference is acceptable at two institutions; others lack clear criteria. Internal and external marks carry equal weight, and two universities apply sub minima for clinical safety and effectiveness. Moderation samples span high to low scoring scripts (n = 4). Contingency plans for examiner cancellations are in place at all institutions. Indicators of good performance include evidence-based practice (88%), alignment with departmental outcomes (71%), and meeting examiners’ assessment expectations (50%). CONCLUSION : Clarification of the external examiner’s role is needed in the absence of formal guidelines from governing bodies. CLINICAL IMPLICATIONS : Findings can guide consistent competency standards and also support the Health Professions Council in evaluating physiotherapy training institutions.
Shoulder pain in amateur fast bowlers : a case example illustrating opportunities to embed prevention in undergraduate physiotherapy education
Dawood, Muhammad A.; Olivier, Benitta; Cochrane, Maria Elizabeth (AOSIS, 2026-04-30)
BACKGROUND : Health professions education is undergoing a paradigm shift from a predominantly curative focus towards prevention and health promotion, in line with global health priorities such as Sustainable Development Goal 3 (SDG3). Physiotherapy curricula, however, often still devote limited attention to preventative competencies. OBJECTIVES : The objectives of this study are to identify risk factors for shoulder pain in amateur fast bowlers and illustrate how such evidence can inform the integration of preventative competencies into undergraduate physiotherapy curricula. METHOD : A prospective, longitudinal cohort study was conducted during the 2018–2019 amateur cricket season. Thirty-nine male fast bowlers completed baseline musculoskeletal screening and weekly online questionnaires documenting injury incidence. Physical assessments included shoulder range of motion, scapular control, muscle strength, endurance and stability tests. Data were analysed using t-tests, Mann–Whitney U tests, chi-square and/or Fisher’s exact tests. RESULTS : Nine participants (23%) sustained shoulder pain during the season. Risk factors associated with injury included scapular dyskinesia, decreased internal rotation, increased external rotation, glenohumeral internal rotation deficit, poor endurance and reduced isometric muscle strength. These factors demonstrated moderate-to-large effect sizes. CONCLUSION : The identification of modifiable risk factors for shoulder pain demonstrates the value of embedding screening skills into undergraduate physiotherapy curricula. Teaching students to assess and address risk factors fosters a preventative orientation that extends beyond sports injuries to broader health contexts. CLINICAL IMPLICATIONS : Incorporating risk factor screening into training equips physiotherapy graduates with practical skills for early detection and prevention, thereby reducing the burden of preventable conditions and aligning education with the objectives of SDG3.
Self-perceived competence and readiness of undergraduate physiotherapy students in treating patients with spinal cord injury
Mashola, Mokgadi K.; Bauermeister, Tamsyn; Urio, Clare N.; Michael, Alexandra; Masindi, Rabelani; Mpe, Kgaogelo M.; Dippenaar, Lorraine; Mostert, Karien (AOSIS, 2026-04-30)
BACKGROUND : Physiotherapy management is a necessary core aspect in spinal cord injury (SCI) rehabilitation, and undergraduate preparation for adequate application is imperative. Objectives: To determine physiotherapy students’ self-perceived competence and readiness in treating patients with SCI. METHOD : This study included 48 fourth-year students enrolled in a Bachelor of Physiotherapy degree in South Africa. Students completed a QualtricsXM online survey consisting of 32 questions self-compiled from the Assessment of Physiotherapy Practice (APP) tool and the Dundee Ready Education Environment Measure (DREEM) questionnaire to determine self-perceived competence and readiness to treat SCI patients. Descriptive (frequencies and means) and inferential data (independent t-test and Fisher’s exact test) were analysed using SPSS v26 at a 0.05 level of significance. RESULTS : Students reported 70% self-perceived competence and 73% readiness to treat SCI patients. Theoretical knowledge was perceived as adequate (p < 0.01), and students who completed their SCI clinical block perceived themselves as more competent in treating patients with SCI (p < 0.01). They were able to clinically reason and adequately differentiate between diagnoses (p < 0.01) and safely perform treatment techniques (p < 0.01). CONCLUSION : Students who completed their SCI clinical block had higher self-perception of competence to differentially diagnose SCI and to treat SCI patients safely, compared to those who had not. CLINICAL IMPLICATIONS : Hands-on experience of SCI patient care is encouraged before SCI clinical block rotation. In cases where there are limited clinical placements, universities are recommended to augment written case scenarios with finite supervised patient exposure.
Reaching a consensus on a patellofemoral pain syndrome self-management programme for recreational cyclists in Saudi Arabia : a modified Delphi study
Masoudi, Ameen; Bello, Bashir; Chemane, Nomzamo; Useh, Ushotanefe; Magida, Nontembiso (AOSIS, 2026-02-28)
BACKGROUND : Recreational cycling is increasingly popular in Al Madinah, Saudi Arabia. However, many cyclists lack structured self-management programmes (SMPs) to address patellofemoral pain syndrome (PFPS), a common overuse injury that significantly affects knee function and cycling performance. Despite the growing interest in cycling, a critical gap remains in culturally relevant, evidence-based SMP. OBJECTIVES : Our study aimed to develop expert consensus on the essential components of SMP for recreational cyclists with PFPS. Method: Our study employed a two-round modified Delphi to develop expert consensus on the components of an SMP for recreational cyclists with PFPS. A panel of 25 experts, comprising physiotherapists, biokinetists, sports medicine professionals and exercise physiologists, participated in Round 1, with 19 experts (76% retention) completing Round 2. The process involved rating proposed programme objectives, principles, outcome measures and pain relief strategies using a four-point Likert scale. Consensus was defined as ≥ 70% of respondents selecting either ‘disagree’ to ‘strongly agree’. RESULTS : Consensus was reached on strengthening exercises (88%), evidence-based practice (84%), pain education (84%), PFPS education (92%) and knee pain management (92%). Round 2 results were streamlined and ranked according to pain, function, adherence, cultural resources and engagement supports, following clarifications and the addition of new items from experts. CONCUSION : Our study establishes an evidence-based, region-specific framework for self-managing PFPS among recreational cyclists. CLINICAL IMPLICATIONS : The proposed programme is designed to enhance adherence, reduce the risk of injury and improve cycling performance. Future research should evaluate the effectiveness of this approach, its scalability, outcomes and integration into national sports and rehabilitation strategies.
Experiences of physiotherapists audited by South African medical funding schemes
Meyer, Lesley; Van Staden, Werdie; Mostert, Karien (AOSIS, 2026-02-13)
BACKGROUND : Forensic auditing safeguards patients’ funds by investigating billing irregularities of claims submitted to medical schemes. However, billing irregularity audits can be misguided, as indicated in a study conducted in Australia, Canada and the United States. Negative consequences were reported, including attrition, and patients funding their treatments out of pocket. Medical professionals were penalised, without forensic auditors considering alternative explanations for the alleged irregular billing patterns. Small medical practitioners, unable to defend themselves financially, closed their practices, leaving patients without medical care. In South Africa, the experiences of physiotherapists who underwent forensic audits have not been examined. OBJECTIVES : This study explored physiotherapists’ experiences of forensic auditing by medical scheme administrators. METHOD : An analytical qualitative study was conducted to interview 14 physiotherapists. Three focus group discussions and 11 individual interviews were conducted. A semi-structured open-ended interview guide was used, analysing the data via open and axial coding. RESULTS : The first five themes that emerged captured the adverse experiences of physiotherapists. These were (1) ‘unfairly persecuted, judged and penalised’; (2) ‘overpowered and oppressed’; (3) ‘naively entrapped between a rock and a hard place’; (4) ‘distressed with a knife over your head’ and (5) ‘detrimental and hurtful’. In the sixth theme, ‘seeking remedies pre-emptively and preparedly’, the participants made recommendations to prevent similar unwanted experiences. CONCLUSION : Physiotherapists experienced significant emotional, financial and professional detriment at the hands of South African medical scheme administrators. CLINICAL IMPLICATIONS : The quality of care provided by physiotherapists is adversely affected when forensic audit-related distress occurs.
Effectiveness of mindful breathing exercises on symptom reduction and quality of life in individuals with major depressive disorder : a systematic review
Bin Muaythir, Saad; Mshunqane, Nombeko; Ramano, Enos Morankoana; Bello, Bashir; Magida, Nontembiso (AOSIS, 2026-05-22)
BACKGROUND : Major depressive disorder (MDD) is a global cause of disability, with many patients experiencing suboptimal response to conventional treatments. Mindful breathing exercises, a simple and scalable technique, have emerged as a promising non-pharmacological intervention for alleviating depressive symptoms and improving quality of life. Objectives : To evaluate the effectiveness of mindful breathing exercises on symptom reduction and quality of life in individuals diagnosed with MDD. METHOD : A systematic search of Cochrane Library, MEDLINE (PubMed), PEDro, Index to Nursing and Allied Health Literature (CINAHL), Scopus, Web of Science and BioMed Central databases was conducted from inception to September 2025. Our review was conducted in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Eligible criteria were intervention studies examining the effects of mindful breathing on depressive symptoms and quality of life in individuals diagnosed with MDD. Two reviewers independently screened the studies, extracted the data and assessed the methodological quality using the Cochrane risk of bias tool. A narrative synthesis was conducted because of heterogeneity in outcome measures and intervention protocols. RESULTS : Two studies involving 179 participants met the inclusion criteria. One study combined cognitive behavioural therapy with breathing exercises, demonstrating improvements in sleep quality, psychiatric symptoms and heart rate variability. Another study demonstrated a significant reduction in anxiety. CONCLUSION : Mindful breathing exercises are beneficial in alleviating symptoms of depression and anxiety, as well as enhancing physiological indicators in people with MDD. CLINICAL IMPLICATIONS : Our review highlights breathing techniques as an affordable, non-pharmaceutical option to conventional treatment; however, more research with rigorous outcomes is needed.
Association between sociodemographic and injury factors in community reintegration following spinal cord injury : an analysis of two datasets
Mothabeng, Joyce Diphale; Eleje, Chiedozie; Nweke, Martins C. (AOSIS, 2026-03-26)
BACKGROUND : Community reintegration after spinal cord injury (SCI) is influenced by personal and injury-related factors. However, data from two South African studies examining these associations have not been jointly analysed. OBJECTIVES : Our study aimed to examine the association between sociodemographic and injury-related factors and community reintegration among people with spinal cord injury (PWSCI). METHOD : Secondary data analysis was conducted using two cross-sectional South African datasets comprising 182 PWSCI. The datasets met the predefined homogeneity criteria and were analysed separately and as a pooled dataset. Community reintegration was measured using the Reintegration to Normal Living Index (RNLI). Descriptive statistics were used to summarise participant characteristics, while Chi-square and Fisher’s exact tests were applied to examine associations between explanatory variables and community reintegration outcomes. RESULTS : In the pooled analysis, better community reintegration was significantly associated with younger age (< 55 years), female sex and employment (p < 0.05). Participants with thoracic and lumbar injuries showed higher levels of reintegration than those with cervical injuries although this association was not statistically significant. Injury severity and aetiology were not significantly associated with community reintegration. CONCLUSION : Younger age, female sex and favourable social circumstances, particularly employment, are associated with better community reintegration among PWSCI. These findings highlight the importance of considering the sociodemographic context and injury characteristics when planning rehabilitation and community-based support interventions. CLINICAL IMPLICATIONS : Early identification of older and unemployed PWSCI may help clinicians target individuals at a higher risk of poor community reintegration and guide tailored rehabilitation strategies.
The reporting of injury epidemiology and risk factors in women's rugby : a scoping review
Bellingan, Lenel; Sewry, Nicola Ann; MacMillan, Candice; Viljoen, Carel (Elsevier, 2026-03)
OBJECTIVES : To map the methodology in currently available scientific literature on injury epidemiology and injury risk factors in women’s rugby union. DESIGN : A scoping review was conducted according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews guidelines. METHODS : Studies reporting injury epidemiology or injury risk factors in women’s rugby union were included through a search across nine databases. Studies were screened based on the eligibility criteria, and data were extracted and analysed from the studies that were included. RESULTS : Out of 3259 records produced, 55 studies met the inclusion criteria. There was an increase in publications over the last decade, but a lack of studies across Africa and South America. Most studies (n = 17; 31 %) used unique injury definitions, and collected injury data using clinical assessment (n = 26; 47 %). Twenty-five different injury incidence measures were reported, and 33 (60 %) studies reported injury prevalence. Thirty-one (56%) studies investigated risk factors associated with injury in women’s rugby. Sixteen (52 %) studies pooled the data for males and females or rugby fifteens, sevens, and tens. CONCLUSIONS : Current research on women’s rugby injuries highlights several gaps, including limited research across certain countries, pooled data reporting, and univariate risk factor analysis without injured-uninjured player comparisons. Despite existing consensus statements for injury in female sports, studies used varied reporting of injury incidence and prevalence, with most studies using their own study definitions and reporting methods. Future research should follow published guidelines and focus specifically on women’s rugby.
Physiotherapists’ challenges with implementing the policy to screen, identify, assess, and support learners with physical disabilities
Sibuyi, Makwena M.; Mathye, Desmond; Tshabalala, Muziwakhe D.; Mshunqane, Nombeko (AOSIS, 2026-03-03)
BACKGROUND: Challenges persist in implementing the policy to Screen, Identify, Assess, and Support (SIAS) individuals with physical disabilities, particularly in rural provinces of South Africa. The challenges are compounded by the existing imbalance in the distribution of physiotherapists where the majority work in the health sector. However, physiotherapists are well-equipped to assess functional limitations and adapt school environments to support inclusive learning and participation. OBJECTIVES: The study explored the challenges physiotherapists experienced in implementing the policy to SIAS learners with physical disabilities. METHOD: Seven physiotherapists employed by the provincial Department of Education participated in a qualitative, single exploratory case study utilising virtual focus group discussions. Data were analysed with a six-step approach to inductive thematic data analysis on ATLAS.ti version 19 software. RESULTS: Two overarching themes with sub-themes emerged: (1) Poor knowledge of the SIAS policy as a result of lack of in-service training and fear of transfers through the Rationalisation and Redeployment policy; and (2) lack of interprofessional collaboration because of unclear roles and responsibilities, and absence of support structures with regard to the School-Based Support Teams, Circuit-Based Support Teams, and District-Based Support Teams. CONCLUSION: Ongoing in-service training, defining roles and responsibilities of physiotherapists and improving the functioning of support structures are essential for effective policy implementation. CONTRIBUTION: The study bridges the gap in research on the participation of physiotherapists within the SIAS policy framework. Participation of physiotherapists would optimise support for learners and improve educational outcomes.
A novel respiratory muscle trainer to enhance pulmonary strength in wheelchair athletes : a pilot randomized controlled study
Subramanian, Thiagarajan; Mani, Suresh; Human, Anri (Termedia Publishing House Ltd., 2025-08-26)
INTRODUCTION : Wheelchair athletes often face challenges related to respiratory function due to the high physical demands of the sport and limitations in core muscle engagement. This study introduces a novel Respiratory Muscle Trainer (RMT) device, designed to enhance endurance and overall performance in this population by strengthening the respiratory muscles, and evaluates its effectiveness for improving sports performance in athletes with wheelchairs. MATERIALS AND METHODS : A pilot randomized controlled trial study was conducted among wheelchair athletes. Twelve participants were divided into an intervention group (n = 6) using the respiratory muscle trainer and a control group (n = 6) performing conventional training, for four weeks. The RMT device provided adjustable resistance for both inspiration and expiration, promoting progressive overload training. The outcomes comprised maximal inspiratory pressure (MIP), maximal expiratory pressure (MEP), forced vital capacity (FVC) and forced expiratory volume in first second (FEV1). RESULTS : The intervention group showed significant improvements in MIP (from 62.3 ± 12.4 to 75.6 ± 10.8 cmH2O) and MEP (from 78.5 ± 15.2 to 90.2 ± 12.7 cmH2O) compared to the control group (p < 0.05). Improved pulmonary function was noted, as indicated by FVC and FEV1 (mean differences of 0.2 L and 0.3 L). Functional performance measures such as changes in wheelchair propulsion efficiency and endurance during sport-specific tasks represent functional outcomes related to cardiovascular and muscular performance. CONCLUSIONS : The RMT device effectively improved respiratory muscle strength and functional capacity in wheelchair athletes. Its incorporation into training regimens may enhance performance and respiratory efficiency, contributing to better competitive outcomes.
Lived experiences of male recreational cyclists with patellofemoral pain in Al Madinah, Saudi Arabia
Masoudi, Ameenr; Useh, Ushotanefe; Chemane, Nomzamo Charit; Bello, Bashi; Magida, Nontembiso (MDPI, 2026-02)
BACKGROUND : Patellofemoral pain (PFP) is a prevalent overuse injury among recreational cyclists worldwide. Despite its ubiquity, little is known about the lived experiences of people with PFP, especially in Saudi Arabia, where healthcare and cultural factors may have a specific impact on how the condition is managed. The aim of this study was to explore the lived experiences of recreational cyclists with patellofemoral pain in Al Madinah, Saudi Arabia. METHOD : A qualitative, descriptive design using reflexive thematic analysis was employed. Eleven male recreational cyclists aged 28-44 years diagnosed with PFP were purposely recruited from Al Madinah Physical Therapy Centre. Female participants were excluded due to cultural constraints regarding sports participation. The participants consented to participate in the study and to be audio recorded. Data were collected through semi-structured interviews using an interview guide. The interview data were transcribed verbatim and thematically analysed using Atlas.ti, version 24. RESULTS : The thematic analysis revealed six themes highlighting the multidimensional impact of PFP. The participants described localised mechanical impairment with rapid onset during activity and persistent symptoms lasting up to two weeks. Pain was exacerbated by eccentric loading and cycling-specific stressors, such as uphill riding, leading to significant anxiety and avoidance behaviours. To maintain activity, these cyclists employed adaptive strategies, including bike modifications and self-management. Notably, PFP imposed substantial cultural and social burdens, hindering spiritual practices, specifically Salah (prayer) postures, professional duties, and family caregiving. While the participants demonstrated resourcefulness through a hybrid of physiotherapy and independent research, pharmacological relief was viewed as a transient solution. CONCLUSIONS : Patellofemoral pain imposes significant multidimensional burdens on recreational cyclists in Al Madinah, which are exacerbated by cultural practices. Physiotherapy offers targeted interventions for pain relief, functional restoration, and participation enhancement, necessitating the need for culturally sensitive management programmes. HIGHLIGHTS Public Health Relevance—How does this work relate to a public health issue? • This study explores the lived experiences of male recreational cyclists with patellofemoral pain (PFP), a condition that significantly limits physical activity, a key determinant of health. • Understanding real-world challenges faced by cyclists with PFP provides insights into barriers that hinder sustained physical activity in an active population. Public Health Significance—Why is this work of significance to public health? • The findings reveal that culturally grounded factors influence symptom management, help-seeking behaviour, and exercise participation among cyclists in Saudi Arabia, which is an understudied population. • By capturing patient-centred perspectives, this study contributes essential qualitative evidence that can inform the design of more responsive, context-specific health and rehabilitation strategies. Public Health Implications—What are the key implications or messages for practitioners, policy makers and/or researchers in public health? • The insights generated from this study can support physiotherapists and healthcare planners in developing tailored self-management and injury prevention programmes that promote safe and sustained physical activity. • The findings highlight gaps in awareness, early interventions, and access to appropriate physiotherapy care areas that can guide policy, practice, and future community-based health initiatives.
Preseason injury epidemiology and associated injury risk factors among South African junior provincial rugby players : a prospective cohort study
Meyer, Kyle; Garnett, Daniel; Janse van Rensburg, Dina Christina; Fletcher, Lizelle; Viljoen, Carel Thomas (Taylor and Francis, 2026)
BACKGROUND : The preseason period in rugby plays a key role in athlete preparation for the demands of the sport during the in-competition period. Epidemiological data pertaining to rugby have focused mainly on senior elite professional with little evidence available for junior elite professionals, and even less during the preseason period. This may limit the ability of stakeholders in the sport to understand the effects of injury on participants during the preseason period. OBJECTIVE : To determine the epidemiology, clinical characteristics, and associated risk factors for injury among elite male junior provincial rugby players in South Africa during a 14-week preseason period. DESIGN : A prospective cohort study. METHODS : Data collection procedures were in-line with consensus statements in sports and rugby. Prospective injury data related to 53 male participants were collected. Descriptive statistics was used to describe clinical characteristics of injury, cross-tabulations were created to investigate risk factor associations, and logistic regression was used to model the risk factors. RESULTS : The overall injury prevalence was 75.5%. The incidence of match play injuries (149.26/1000 h) were higher than training injuries (23.32/1000 h). Injuries to the lower limb (48.8%) and muscle/tendon injuries (48.2%) were most commonly reported injuries by anatomical region and tissue type during the preseason period. When controlling for age and playing position, baseline injury was associated with a higher risk of sustaining a subsequent injury during preseason. Age, baseline injury, and playing position showed no statistically significant association with injury risk. CONCLUSION : A high number of training and match play injury incidence were recorded for elite male junior provincial rugby players. Baseline injury was associated with a higher risk of sustaining a subsequent injury during preseason when controlling for playing position and age.
Psychological profile of trail runners associated with running-related injuries : a prospective study
Gajardo-Burgos, Rubén E.; Sánchez, Raimund; Besomi, M.; Viljoen, Carel Thomas; Janse van Rensburg, Dina Christina; Bascour-Sandoval, Claudio (Sage, 2026)
BACKGROUND : Trail running has increased in popularity due to the benefits of physical activity in nature. However, trail running has an inherent risk of running-related injuries (RRI). It is known that athletes with certain psychological traits have a greater tendency to suffer injuries; however, this is unknown in trail runners. The main objective of this study was to identify trail runners' psychological profiles and to compare the proportion of RRI across these profiles. HYPOTHESIS : Trail runners with psychological profiles of high stress, precompetitive anxiety, mental fatigue, competitiveness, and poor sleep quality are at increased risk of RRI. STUDY DESIGN : Prospective cohort study. LEVEL OF EVIDENCE : Level 2. METHODS : A Gaussian mixture model cluster analysis was performed on 202 trail runners (55.5% male; aged 38.7 [33.4-46.2] years) with psychological stress, cognitive and somatic anxiety, self-confidence, mental fatigue, sleep quality, and competitiveness measured 4 weeks before participating in a race. The proportion of RRI during the race was recorded and compared across clusters. RESULTS : Overall RRI proportion during competition was 11.3% (n = 24). The most common RRI were muscle (41.7%) and tendon/bursa (16.7%) injuries, affecting primarily the knee (33.3%) and lower leg (20.8%). Five psychological profiles were identified. Cluster 1 (competitive runners with moderate psychological stress and mental fatigue, low sleep quality and anxiety, and high self-confidence) had a higher RRI proportion than Cluster 3 (similar traits but lower psychological stress, mental fatigue, and higher self-confidence; 21.2% vs 3.2%; P = 0.02). CONCLUSION : Certain psychological profiles in trail runners were associated with higher RRI risk. CLINICAL RELEVANCE : The medical team or trail running coaches should monitor runners with psychological profiles with higher psychological stress, mental fatigue, and cognitive anxiety, as well as lower self-confidence and sleep quality, to design strategies to reduce their risk of RRI.

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