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There is limited research available on the use of outcome measures in intensive care units (ICU) ... more There is limited research available on the use of outcome measures in intensive care units (ICU) in a South African setting.The Chelsea Critical Care Physical Assessment tool (CPAx) is a measure of morbidity related to physical function and assesses respiratory function and functional abilities of critically ill patients. The objectives of this study were to establish the effect of the use of the CPAx tool on ICU and hospital length of stay (LOS) in the care of critically ill patients; to establish the usefulness of the CPAx tool according to patient admission diagnosis; to determine if a relationship exists between CPAx scores and severity of illness or general morbidity during ICU admission; and to establish physiotherapists' perceptions and views towards the use of the CPAx tool in their daily clinical practice in ICU. The study consisted of two parts. Part one was a quasi-experimental design with a historical matched control group. Part two was a survey-based design. The study took place in a South African public sector hospital. Twenty six participants each were recruited into the experimental and control groups. Participants from the control group were matched with participants in the experimental group according to age, gender, diagnosis and acute physiology and chronic health evaluation (APACHE) II scores. CPAx scores and sequential organ failure assessment (SOFA) scores were calculated for participants in the experimental group on alternate weekdays during their ICU stay. Comparisons of ICU and hospital LOS between the study participants and historical control group were done using an independent t-test. Pearson's correlation coefficient was used to determine if a relationship existed between CPAx scores, APACHE II scores or SOFA scores. A p-value ≤ 0.05 was deemed statistically significant. A questionnaire was developed and was completed by the research assistants who administered the CPAx tool to participants in the experimental group in order to determine their perceptions of the tool.
South African Family Practice
Background: Surgical resection is a common treatment for patients with colorectal cancer. Patient... more Background: Surgical resection is a common treatment for patients with colorectal cancer. Patients undergoing surgery are at risk of functional deterioration as a response to surgical stress. Furthermore, patients with cancer often present with systemic problems as well as a functional decline. The study aimed to create a framework for preoperative education for patients undergoing colorectal cancer resection.Methods: Five databases were utilised to find intervention-based studies describing the content, mode, setting and timing of delivery of preoperative education for patients undergoing abdominal surgery. Physiotherapists were purposively sampled to participate in a focus group session using a seven-step nominal group technique (NGT) with the goal to reach consensus on the proposed content of a preoperative patient education programme.Results: Seventeen studies were reviewed. Results indicate that the mode and timing of the education provided are heterogenous. Content included in...
African Health Sciences
Background: Lifestyle-related factors have been linked with risk for colorectal cancer. Data desc... more Background: Lifestyle-related factors have been linked with risk for colorectal cancer. Data describing the relationship between lifestyle factors of South African patients who present with colorectal cancer and their survival is sparse.Objectives: The objectives were to describe the profile of patients with colorectal cancer; to determine the association between lifestyle-related factors and survival, and to compare results of patients in the private and public sectors. Methods: A retrospective review and secondary analysis of information of patients with colorectal cancer were conducted. The independent samples t-test and Mann Whitney U test were administered to determine differences in the clinical presentation. Pearson’s Chi-Squared and Eta (η) tests were used to determine the association between survival and lifestyle-related factors.Results: Data of 441 patients were included. When compared to the public sector cohort, patients in the private sector cohort were older (p=0.0110...
South African Journal of Physiotherapy, 2021
Background: For patients with colorectal cancer, surgical resection of the primary tumour remains... more Background: For patients with colorectal cancer, surgical resection of the primary tumour remains the best treatment option. Surgery for colorectal cancer is being performed on patients who would previously not have been considered as suitable candidates. It remains to be seen which factors influence hospital length of stay (LOS) and the development of acute postoperative complications in South African patients. Objectives: The objectives of our study were to determine the modifiable factors that influence patients' development of postoperative complications and hospital LOS and, to identify the types of postoperative complications that develop. Method: A retrospective review and secondary analysis of information in an existing database of patients with colorectal cancer were conducted. Regression analysis statistics were used to determine the predictors of postoperative outcomes. The level of significance at which testing was performed was set at 5% (p ≤ 0.05). Results: Data of 125 patients were included. Surgical site infections and postoperative paralytic ileus were the most frequently reported postoperative complications. Preoperative vigorous-intensity physical activity (p = 0.048, β =-0.000) and functional performance status (p = 0.05, β = 0.926) significantly predicted hospital LOS and the incidence of postoperative complications, respectively. Conclusion: Preoperative physical activity and functional performance levels are predictors of acute postoperative outcomes in a private South African cohort of patients with colorectal cancer. Future research which includes other modifiable factors is required to make informed suggestions for changes in clinical practice. Clinical implications: Patients requiring surgery for colorectal cancer should be screened for signs of physical deconditioning and referred for physiotherapy intervention before elective surgery to optimise their recovery.
South African Journal of Physiotherapy, 2018
Impact of the Chelsea critical care physical assessment (CPAx) tool on clinical outcomes of surgi... more Impact of the Chelsea critical care physical assessment (CPAx) tool on clinical outcomes of surgical and trauma patients in an intensive care unit: An experimental study',
There is limited research available on the use of outcome measures in intensive care units (ICU) ... more There is limited research available on the use of outcome measures in intensive care units (ICU) in a South African setting.The Chelsea Critical Care Physical Assessment tool (CPAx) is a measure of morbidity related to physical function and assesses respiratory function and functional abilities of critically ill patients. The objectives of this study were to establish the effect of the use of the CPAx tool on ICU and hospital length of stay (LOS) in the care of critically ill patients; to establish the usefulness of the CPAx tool according to patient admission diagnosis; to determine if a relationship exists between CPAx scores and severity of illness or general morbidity during ICU admission; and to establish physiotherapists' perceptions and views towards the use of the CPAx tool in their daily clinical practice in ICU. The study consisted of two parts. Part one was a quasi-experimental design with a historical matched control group. Part two was a survey-based design. The study took place in a South African public sector hospital. Twenty six participants each were recruited into the experimental and control groups. Participants from the control group were matched with participants in the experimental group according to age, gender, diagnosis and acute physiology and chronic health evaluation (APACHE) II scores. CPAx scores and sequential organ failure assessment (SOFA) scores were calculated for participants in the experimental group on alternate weekdays during their ICU stay. Comparisons of ICU and hospital LOS between the study participants and historical control group were done using an independent t-test. Pearson's correlation coefficient was used to determine if a relationship existed between CPAx scores, APACHE II scores or SOFA scores. A p-value ≤ 0.05 was deemed statistically significant. A questionnaire was developed and was completed by the research assistants who administered the CPAx tool to participants in the experimental group in order to determine their perceptions of the tool.
South African Family Practice
Background: Surgical resection is a common treatment for patients with colorectal cancer. Patient... more Background: Surgical resection is a common treatment for patients with colorectal cancer. Patients undergoing surgery are at risk of functional deterioration as a response to surgical stress. Furthermore, patients with cancer often present with systemic problems as well as a functional decline. The study aimed to create a framework for preoperative education for patients undergoing colorectal cancer resection.Methods: Five databases were utilised to find intervention-based studies describing the content, mode, setting and timing of delivery of preoperative education for patients undergoing abdominal surgery. Physiotherapists were purposively sampled to participate in a focus group session using a seven-step nominal group technique (NGT) with the goal to reach consensus on the proposed content of a preoperative patient education programme.Results: Seventeen studies were reviewed. Results indicate that the mode and timing of the education provided are heterogenous. Content included in...
African Health Sciences
Background: Lifestyle-related factors have been linked with risk for colorectal cancer. Data desc... more Background: Lifestyle-related factors have been linked with risk for colorectal cancer. Data describing the relationship between lifestyle factors of South African patients who present with colorectal cancer and their survival is sparse.Objectives: The objectives were to describe the profile of patients with colorectal cancer; to determine the association between lifestyle-related factors and survival, and to compare results of patients in the private and public sectors. Methods: A retrospective review and secondary analysis of information of patients with colorectal cancer were conducted. The independent samples t-test and Mann Whitney U test were administered to determine differences in the clinical presentation. Pearson’s Chi-Squared and Eta (η) tests were used to determine the association between survival and lifestyle-related factors.Results: Data of 441 patients were included. When compared to the public sector cohort, patients in the private sector cohort were older (p=0.0110...
South African Journal of Physiotherapy, 2021
Background: For patients with colorectal cancer, surgical resection of the primary tumour remains... more Background: For patients with colorectal cancer, surgical resection of the primary tumour remains the best treatment option. Surgery for colorectal cancer is being performed on patients who would previously not have been considered as suitable candidates. It remains to be seen which factors influence hospital length of stay (LOS) and the development of acute postoperative complications in South African patients. Objectives: The objectives of our study were to determine the modifiable factors that influence patients' development of postoperative complications and hospital LOS and, to identify the types of postoperative complications that develop. Method: A retrospective review and secondary analysis of information in an existing database of patients with colorectal cancer were conducted. Regression analysis statistics were used to determine the predictors of postoperative outcomes. The level of significance at which testing was performed was set at 5% (p ≤ 0.05). Results: Data of 125 patients were included. Surgical site infections and postoperative paralytic ileus were the most frequently reported postoperative complications. Preoperative vigorous-intensity physical activity (p = 0.048, β =-0.000) and functional performance status (p = 0.05, β = 0.926) significantly predicted hospital LOS and the incidence of postoperative complications, respectively. Conclusion: Preoperative physical activity and functional performance levels are predictors of acute postoperative outcomes in a private South African cohort of patients with colorectal cancer. Future research which includes other modifiable factors is required to make informed suggestions for changes in clinical practice. Clinical implications: Patients requiring surgery for colorectal cancer should be screened for signs of physical deconditioning and referred for physiotherapy intervention before elective surgery to optimise their recovery.
South African Journal of Physiotherapy, 2018
Impact of the Chelsea critical care physical assessment (CPAx) tool on clinical outcomes of surgi... more Impact of the Chelsea critical care physical assessment (CPAx) tool on clinical outcomes of surgical and trauma patients in an intensive care unit: An experimental study',