Bridging the gap from inpatient rehabilitation to sustainable health and wellness in spinal cord injured individuals

Vermaak, Candace (2016-12)

Thesis (PhD)--Stellenbosch University, 2016

Thesis

ENGLISH ABSTRACT : Background: A spinal cord injury is a devastating and life changing neurological event that present multiple challenges throughout the life of the affected individual. One of the challenges is being physically active and more specifically healthy living. Physical activity has many benefits and plays an essential role in community reintegration, which is considered the final outcome of the rehabilitation process. In South Africa this outcome is seldom achieved due to the lack of physical activity opportunities. Without regular physical activity the physical gains that were achieved in hospital are easily diminished or lost and this is a major concern as it ultimately affects health and wellness. Objective: To determine the barriers and facilitators to physical activity and whether an intervention designed to reduce the barriers can be successful in promoting health and wellness in people with a spinal cord injury. Design: An experimental research design incorporating both quantitative and qualitative methodologies was used to execute the study. Methods: A self-developed research questionnaire was distributed to people with a spinal cord injury in the Western Cape, South Africa in order to identify the barriers to physical activity. The results from the research questionnaire were used to design a 16 week intervention which was implemented in two different environments (formal exercise setting and community based setting) and its success was measured by physical tests, the reintegration to normal living index questionnaire and the research questionnaire. Subjects: Fifty seven people with a spinal cord injury completed the research questionnaire and 16 participants partook in the intervention. Results: In the beginning (pre-intervention) the most important barriers were the environmental barriers and included problems with accessibility and lack of facilities, lack of transport, and the weather. The most reported facilitators were personal, which included a desire to be active, to improve self esteem and because physical activity made them feel good. Based on the results from the research questionnaire the intervention was implemented and showed that the participants from both groups improved their physical abilities (strength, endurance and functional abilities) and their satisfaction with community participation. The barriers that were identified prior to the intervention were also considerably reduced, especially in the community based group. The participants also agreed that physical activity was beneficial and important and that they would like to stay physically active post-intervention. Discussion and Conclusion: People with a spinal cord injury face many barriers in being physically active, however, by reducing the barriers a community based physical activity program can be successful in introducing people with a spinal cord injury to a life of healthy living and wellness. Although some of the environmental and program barriers remained, the personal facilitators that were identified were enough to ensure physical activity adherence.

AFRIKAANSE OPSOMMING : Agtergrond: ‟n Spinaalkoordbesering is ‟n verpletterende neurologiese gebeurtenis wat die res van die betrokke individu se lewe ingrypend verander deur veelvuldige uitdagings daar te stel. Een van hierdie uitdagings is hoe om fisies aktief en spesifiek gesond te leef. Fisiese aktiwiteit het verskeie voordele en speel ‟n noodsaaklike rol in die herintegrasie by ‟n gemeenskap, wat as die einddoel van die rehabilitasieprogram gesien word. In Suid-Afrika word hierdie uitkoms egter selde bereik vanweë ‟n gebrek aan geleenthede vir fisiese aktiwiteit. Sonder gereelde fisiese aktiwiteit kan die fisiese vordering wat in die hospitaal behaal is maklik verminder of verloor word; ‟n groot besorgdheid aangesien dit gesondheid en welstand affekteer. Doelwit: Om die hindernis en fasiliteerders van fisiese aktiwiteit te bepaal, asook om vas te stel of ‟n intervensie met die doel om hierdie hindernisse te verminder, kan bydra tot die bevordering van die gesondheid en welstand van persone met ‟n spinaalkoordbesering. Ontwerp: ‟n Eksperimentele navorsingsontwerp wat sowel kwantitatiewe as kwalitatiewe metodes insluit, is vir die ondersoek gebruik. Metodes: ‟n Vraelys is ontwikkel en aan persone in die Wes-Kaap, Suid-Afrika, wat aan ‟n spinaalkoordbesering ly, uitgedeel om die hindernisse tot fisiese aktiwiteit te identifiseer. Die resultate uit hierdie navorsingsvraelys is gebruik om ‟n intervensie te ontwerp wat in twee verskillende omgewings geïmplementeer is (‟n formele oefeningsituasie en ‟n gemeenskapgebaseerde situasie). Die geslaagdheid van die intervensie is getoets deur middel van fisiese toetse, die vraelys wat herintegrasie in normale leefstyl toets, asook die navorsingsvraelys. Subjekte: Sewe-en-vyftig mense met ‟n spinaalkoordbesering het die vraelys ingevul en 16 deelnemers het aan die intervensie deelgeneem. Resultate: Voor die intervensie was die belangrikste hindernisse die omgewingshindernisse wat toeganklikheid en gebrekkige fasiliteite en vervoer, asook die weer, ingesluit het. Die fasiliteerders wat die meeste aangedui is, was persoonlik, insluitende die behoefte om aktief te wees, om die selfbeeld op te bou en om goed te voel as gevolg van oefening. Op grond van hierdie resultate is die intervensie geïmplementeer en is aangetoon dat deelnemers vanuit beide groepe sowel hul fisiese vermoëns en hul bevrediging uit gemeenskapsdeelname verbeter het. Die hindernisse wat voor die intervensie aangedui is, is ook aansienlik verminder, veral in die gemeenskapsgebaseerde groep. Die deelnemers het saamgestem dat fisiese aktiwiteit definitief voordelig en belangrik is en dat hulle na afloop van die intervensie fisies aktief sou wou bly. Bespreking en gevolgtrekking: Mense met ‟n spinaalkoordbesering staar verskeie hindernisse in die gesig wanneer dit kom by fisiese aktiwiteit, maar deur die hindernisse in ‟n gemeenskapsgebaseerde aktiwiteitsprogram te verminder kan mense met ‟n spinaalkoordbesering gehelp word om weer aan ‟n lewe van gesondwees en welstand voorgestel word. Hoewel sekere omgewings- en ander programbeperkinge bly staan het, is die persoonlike fasiliteerders wat geïdentifiseer is, genoeg om te verseker dat daar vorentoe by fisiese aktiwiteit gehou word.

Please refer to this item in SUNScholar by using the following persistent URL: http://hdl.handle.net/10019.1/100037
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