Evaluation of the functional rehabilitation outcomes of clients after receiving physical rehabilitation at TC Newman community day centre

Felix, Rochelle Karen (2014-04)

Thesis (MScMedSc)--Stellenbosch University, 2014.

Thesis

ENGLISH ABSTRACT: Introduction: Rehabilitation is an important tool in helping persons with disabilities to recover and attain functional independence as far as possible in achieving a good quality of life. However, scarce rehabilitation services and barriers may prevent full attainment of functional outcomes and impact on quality of life. Even though guidelines exist for rehabilitation services there remains a need to standardise documentation of outcomes, implementing appropriate outcomes tools and defining expectations for rehabilitation. Headcounts alone cannot fully account for rehabilitation services. The NRP echoes monitoring and evaluation of rehabilitation services, so as to measure its effectiveness and relevance. A lack of clear understanding of rehabilitation outcomes may result in it being overlooked during planning for resources. While on the other hand outcomes can be used to motivate for more rehabilitation services. Aim of the Study: The aim of the study was to evaluate the functional rehabilitation outcomes of clients after receiving physical rehabilitation at TC Newman Community Day Centre. Method: Study Design: A pre-test, post-test descriptive longitudinal study using mainly quantitative methods of data collection was applied. Study setting: The research was conducted at TC Newman CDC. Study Population and Sampling method: Study participants were those presenting with one of the five most prevalent conditions at TC Newman CDC, indicated from therapist’s data working there, during 2008/2009. Pre-tests were administered to 114 participants adhering to the inclusion criteria. Only 12 participants of the 114, returned for follow up assessments. The low return rate of participants was a critical concern for the researcher, which led to the inclusion of home visits (8) and telephonic follow up (16), to increase the number of responses from the outcome measures and to determine why participants did not return for follow up appointments. Only 20 participants completed the preand post-tests. Data collection instruments: Data collection instruments used in the study, on demographics, were designed by the SANPAD research group and validated by rehabilitation experts. The study further used validated functional diagnostic specific outcome measures to answer the research question. Data collection process: Pre-tests and post-tests were administered at TC Newman CDC by a trained research assistant. The telephonic follow up and data extraction from the patient folders were done by the researcher. Home visits were administered by the research assistant, with support from the researcher. Data analysis: Quantitative data was analysed by a statistician from the University of Stellenbosch. Qualitative data obtained from the telephonic follow up was thematically analysed, to identify why clients did not return for their follow up appointments. Results: Despite the low return rate, results indicated an overall improvement in functioning, with mobility, as the one area of functioning demonstrating significant improvement after rehabilitation. Participants that returned for follow up sessions also indicated feeling better after receiving therapy. In addition to transport and income, environmental factors having the most influence on participants attendance to follow up therapy, were health systems challenges such as appointment systems, poor follow-up and inadequate documentation. Overall participants indicated they experienced their rehabilitation positively. Conclusion: Contextual factors should be taken into account when planning rehabilitation services, to ensure optimal access and the best possible outcomes for clients needing rehabilitation. Even though rehabilitation services at TC Newman CDC are available, the extent of accessibility is questionable, thus it is important to look at how rehabilitation services are delivered.

AFRIKAANSE OPSOMMING: Rehabilitasie word erken as ‘n belangrike proses om persone met gestremdhede so onafhanklik moontlik te help funksioneer en sodoende die bes moontlike kwaliteit van lewe te hê. Beperkte rehabilitasie dienste en omgewingsfaktore, mag daartoe bydra dat toeganklikheid en uitkomste vir rehabilitasie soms beperk is. Alhoewel daar riglyne vir rehabilitasie is, is daar ‘n behoefte vir gestandardiseerde meetinstrumente, dokumentering van uitkomste en ‘n pakket van dienste wat gelewer moet word. Koptellings, van hoeveel pasiënte gesien word by ‘n fasiliteit, is nie ‘n aanduiding van wat die uitkomste van dienste is nie. Die Nasionale Rehabilitasie Beleid, benadruk die belangrikheid van monitering en evaluering van dienste, om sodoende , die effektiwiteit van die rehabilitasie te bepaal. Indien rehabilitasie dienste nie goed geevalueer en verstaan word nie, kan dit ‘n negatiewe effek hê, wanneer dienste en hulpbronne vir hierdie dienste beplan word. Doel van studie: Die evaluering van funksionele uitkomste van deelnemers, nadat hulle rehabilitasie ontvang het, asook om die struikelblokke vir rehabilitasie te help identifiseer. Metodologie: Studie ontwerp: ‘n Beskrywende metodologie was gebruik. Vraelyste wat vir die navorsing gebruik was, is deur ‘n opgeleide veldwerker geadministreer. Dit het ‘n voor- en, na-toets wat ongeveer 4-6 weke later geadministreer is. Plek van studie: Navorsing het plaasgevind by TC Newman Gemeenskap Gesondheid Sentrum (GGS), die enigste buite pasiënte rehabilitasie diens, in die Paarl. Studie populasie en sampel: Deelnemers in die studie het pasiënte ingesluit, met die vyf (5) mees algemeenste diagnoses wat geïdentifiseer was gedurende 2009, deur terapeute werksaam by TC Newman GGS. Een Honderd en Veertien (114) deelnemers het aan die aanvanklike evaluering deelgeneem, waarvan net twaalf (12) deelnemers vir die herevaleueirng opgedaag het. Hierdie beperkte (12) getal deelmeners, het daartoe bygedra dat die navorser tuisbesoeke (8) en telefoonopvolg(16) gedoen het, om sodoende die hoeveelheid deelnemers te probeer vermeerder, asook om te bepaal, hoekom pasiënte nie vir hulle opvolg sessies opgedaag het nie. Instrumente gebruik, met die insameling van data: Instrumente het gefokus op demografiese en funksionele uitkomste van deelnemers. Die demografiese vraelyste was deur die SANPAD navorsingsgroep ontwikkel en die vraelyste vir funksionele uitkomste was bekende instrumente en diagnosties spesifiek. Proses gebruik in die versameling van data: Die aanvanklike en herevaluering van deelnemers was geadministreer deur ‘n opgeleide navorsingsassistent. Telefoniese opvolg en versameling van data uit deelnemers se lêers is deur die navorser self gedoen. Tuisbesoek is deur die navorsingsassistent geadministreer met ondersteuning van die navorser. Data analise: Kwantitatiewe data was geanaliseer deur ‘n statikus by die Universiteit van Stellenbosch. Kwalitatiewe data was volgens temas geanaliseer deur die navorser deur gebruik te maak van die terugvoer vanaf die deelnemers tydens die telefoniese opvolg. Resultate:Ten spyte van die lae terugkeersyfer, was daar ‘n beduidende verbetering in die uitkomste van deelnemers t.o.v hul mobiliteit. Deelnemers wat geherevalueer is, het aangedui dat hulle beter voel nadat hulle terapie ontvang het. Sosioekomoniese faktore soos vervoer en inkomste het ‘n negatiewe invloed gehad op bywoning. Uitdagings geïdentifiseer in die gesondheidssisteem was: afspraaksisteme, swak opvolg en onvoldoende dokumentasie. Gevolgtrekking: Omgewings- en persoonlike faktore moet altyd in ag geneem word wanneer rehabilitasie dienste beplan en gelewer word, om sodoende optimale toegang en die bes moontlike uitkomste vir pasiënte te verseker. Ten spyte daarvan dat rehabilitasie dienste by TC Newman GGS beskikbaar is, het hierdie studie bewys dat die mate van toeganklikheid vir dienste bevraagteken kan word en dus is dit belangrik om te kyk hoe word rehabilitasie dienste gelewer.

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