Levels of community integration achieved by adults with disabilities post discharge from a specialised in-patient rehabilitation unit in the Western Cape

Gretschel, Dietlind (2016-03)

Thesis (MPhil (Rehabilitation))--Stellenbosch University, 2016.

Thesis

ENGLISH ABSTRACT: Background: Community integration is one of the most important outcomes of rehabilitation. Rehabilitation services should strive to optimise community integration of persons with disabilities through the processes of functional restoration, prevention of secondary complications, provision of assistive devices and/or environmental modification. Studies conducted in South Africa show that rehabilitation services in the country often do not achieve community integration of persons with disabilities. The need to quantify the levels of community integration of persons with disabilities who received in-patient rehabilitation was identified. Aim: To determine the levels of community integration of adults with disabilities post discharge from a specialised in-patient rehabilitation unit in the Western Cape Province. Methods: A quantitative, cross-sectional, descriptive study design was used. Individuals discharged from the rehabilitation centre between 1 September 2012 and 30 November 2012, who met the inclusion criteria, made up the study sample. Fifty-nine individuals participated in the study. A demographic and medical data sheet was used to gather information from the participants’ medical folders. Levels of community integration were determined with the Reintegration to Normal Living Index (RNLI). Descriptive statistics on the variables age, gender and medical diagnosis as well as scores of the various RNLI domains, subscales and the overall RNLI score are presented in graphs and tables. To determine if a relationship existed between the variables age, gender and medical diagnosis and levels of community integration, interferential tests (t-test and Kraskal-Wallis tests) were applied. A P-value of <0.05 was observed as statistically significant. Results: Fifty-four percent of study participants were women. Participant’s median age was 43 with an interquartile range of 35 to 57. The most common diagnosis was stroke (41%) and spinal cord injury (30%). The median overall RNLI score for the study population was 71.30 with an interquartile range of 53.24 and 87.50. The RNLI items personal relationships and presentation of selfrecorded the highest median scores (88.89). The RNLI items work and related activities scored the lowest median score of 55.56. Home mobility, community mobility, travel out of town and recreational activities also had median scores below 70. No statistically significant differences could be found when examining the relationships between the variables age, gender and medical diagnosis and the domains, subscales and the overall RNLI scores. Conclusion: The results of this study show that persons with disabilities, who received inpatient rehabilitation and were discharged into their home and community environments, achieve lower overall RNLI scores than persons with disabilities living in well-resourced countries such as the United States of America (USA) and Canada. Rehabilitation professionals may need to adjust rehabilitation programmes offered to improve community integration outcomes of clients. Low levels of integration in areas such as community mobility, and participation in social and meaningful work activities might be an indication that persons with disabilities still face many barriers in the communities. Persons who suffered a traumatic brain injury or a cerebrovascular accident (CVA) achieved lower levels of community integration in comparison to persons who suffered a SCI or have an impairment of the peripheral neural/muscular system(s).

AFRIKAANSE OPSOMMING: Agtergrond: Integrasie in die gemeenskap is een van die belangrikste uitvloeisels van rehabilitasie. Met rehabilitasiedienste moet gestreef word na die optimalisering van gemeenskapsintegrasie van mense met gestremdhede deur middel van funksionele herstel, die voorkoming van sekondêre komplikasies, die verskaffing van hulpmiddele en/of omgewingsveranderinge. Navorsing in Suid-Afrika dui daarop dat rehabilitasiedienste in die land dikwels nie die mikpunt van die gemeenskapsintegrasie van mense met gestremdhede haal nie. ʼn Behoefte om die vlakke van gemeenskapsintegrasie van mense met gestremdhede, wat as binnepasiënte rehabilitasie ontvang het, te bepaal is ge-identifiseer. Doelwit: Om die vlakke van gemeenskapsintegrasie van volwassenes met gestremdhede, wat rehabilitasie in ʼn gespesialiseerde rehabilitasie-eenheid in die provinsie Wes-Kaapland ontvang het, te bepaal. Metodes: ʼn Kwantitatiewe, deursnee, beskrywende studieontwerp is gebruik. Die deelnemers het bestaan uit individue wat tussen 1 September 2012 en 30 November 2012 uit die rehabilitasiesentrum ontslaan is en aan die maatstawwe vir insluiting voldoen het. Altesaam 59 mense het aan die navorsing deelgeneem. ʼn Demografiese en mediese datavorm is gebruik om inligting van die deelnemers se mediese verslae te versamel. Die vlakke van gemeenskapsintegrasie is bepaal deur die Reïntegrasie tot Normale Lewe-indeks (RNLI) te gebruik. Beskrywende statistieke van die veranderlikes ouderdom, geslag en mediese diagnose, asook die tellings van verskeie RNLI--domein subskale en die algehele RNLI-tellings word in grafieke en tabelle aangebied. Om te bepaal of die veranderlikes ouderdom, geslag en mediese diagnose ʼn statisties beduidende impak op gemeenskapsintegrasie gehad het, is interferensietoetse (t-toetse en Kraskal-Wallis-toetse) aangewend. ʼn P-waarde van <0.05 is as statisties beduidend beskou. Resultate: Vier en vyftig persent van die deelnemers was vroue. Die mediaan-ouderdom van die deelnemers was 43, met ʼn interkwantiele bestek van 35 tot 57. Die algemeenste diagnoses was beroerte (41%) en rugmurgbeserings (30%). Die mediaan- algehele RNLI-telling vir die navorsinggroep was 71.30, met ʼn interkwantiele bestek van 53.24 en 87.50. Die RNLI-items persoonlike verhoudinge en self-presentasie het die hoogste mediaantellings van 88.89 opgelewer. Die RNLI-items werk en verwante bedrywighede het die laagste mediaantelling van 55.56 gehad. Mobilitiet tuis en in die gemeenskap, buitestedelike reis en rekreasiebedrywighede het ook mediaantellings van minder as 70 gehad. Geen statisties beduidende verskille kon gevind word toe die verhoudinge tussen die veranderlikes ouderdomme, geslag en mediese diagnoses en die domeine subskale en algehele RNLI-tellings ondersoek is nie. Bevinding: Die resultate van dié navorsing toon dat mense met gestremdhede wat as binne-pasiënte rehabilitasie ontvang en ná hul ontslag na hul tuistes en gemeenskapomgewing teruggekeer het laer algehele RNLI-telllings behaal het as mense met gestremdhede in lande soos die Verenigde State van Amerika en Kanada, waar goeie hulpbronne bestaan. Rehabilitasie diensverskaffers sal waarskynlik rehabilitasieprogramme wat aangebied word moet aanpas sodat die resultaat van kliënte se gemeenskapsintegrasie verbeter kan word. Lae vlakke van integrasie op gebiede soos mobiliteit in die gemeenskap en deelname aan sosiale en betekenisvolle werkbedrywighede kan dalk ʼn aanduiding wees dat mense met gestremdhede steeds hindernisse in die gemeenskappe ervaar. Mense wat ʼn traumatiese breinbesering opgedoen het of in ʼn serebro-vaskulêre ongeluk (SVO) betrokke was, het laer vlakke van gemeenskapsintegrasie bereik vergeleke met mense wat rugmurgbeserings opgedoen het of wie se perifere senu/spierstelsel(s) aangetas was.

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