Browsing by Author "De Klerk, Susan"

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    Cognitive interviewing during pretesting of the prefinal Afrikaans for the Western Cape disabilities of the arm, shoulder and hand questionnaire following translation and cross-cultural adaptation
    (Hindawi, 2019) De Klerk, Susan; Jerosch-Herold, Christina; Buchanan, Helen; Van Niekerk, Lana
    When patient-reported measures are translated and cross-culturally adapted into any language, the process should conclude with cognitive interviewing during pretesting. This article reports on translation and cross-cultural adaptation of the Disabilities of the Arm, Shoulder and Hand (DASH) questionnaire into Afrikaans (for the Western Cape). This qualitative component of a clinical measurement, longitudinal study was aimed at the pretesting and cognitive interviewing of the prefinal Afrikaans (for the Western Cape) DASH questionnaire highlighting the iterative nature thereof. Twenty-two females and eight males with upper limb conditions were recruited to participate at public health care facilities in the Western Cape of South Africa. Cognitive interviews were conducted as a reparative approach with an iterative process through retrospective verbal probing during a debriefing session with 30 participants once they answered all 30 items of the translated DASH questionnaire. The sample included Afrikaans-speaking persons from low socioeconomic backgrounds, with low levels of education and employment (24 of 30 were unemployed). Pragmatic factors and measurement issues were addressed during the interviews. This study provides confirmation that both pragmatic factors and measurement issues need consideration in an iterative process as part of a reparative methodology towards improving patient-reported measures and ensuring strong content validity.
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    Introducing early active mobilisation following flexor tendon repair in the context of care in a developing country : a randomised feasibility study
    (Occupational Therapy Association of South Africa, 2019-08) Buttle Naude, Amy; De Klerk, Susan
    Introduction: Flexor tendon injuries remain one of the most difficult hand injuries to manage post-operatively. Early active mobilisation protocols are considered ‘best practice’ internationally but have not been well researched in the developing country context. The feasibility of such research, and use of these protocols, need to be determined by considering the potential for improved functional outcomes for patients, together with various contextual and resource challenges. Purpose: To explore aspects of feasibility related to the recruitment, consent and retention rates in consideration of a future definitive Randomised Control Trail. In addition, preliminary results of an early active therapy protocol compared to an early passive therapy protocol were reported on, together with patient satisfaction and demographics. Methods: A parallel randomised pilot trial design was used. Thirty-one participants were recruited into one of two therapy groups (active or passive). Fourteen of these participants completed their therapy and eight-week assessments including: Total Active Motion, grip strength, the Michigan Hand Questionnaire and the Smith Hand Function Evaluation. 95% Confidence intervals examined feasibility data. Non-parametric data analysis was done primarily using medians and ranges. Results: Feasibility results of 37% recruitment rate, 97% consent rate and 45% retention rate, did not meet the criteria for success, deeming a trial in the present design, not feasible. Discussion: Due to the dearth of research from public health clinical settings in developing countries, this study contributes rich contextual data, but the challenges discussed need to be addressed before further research will achieve success.
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    Non-attendance of occupational and physiotherapy appointments at Western Cape Rehabilitation Centre : a description of associated factors
    (The Occupational Therapy Association of South Africa, 2019-12) De Klerk, Susan; Eloff, Lize; Naude, Zani; Boon, Andrea; Carelse, Megan; Steward, Michaela; Zaidi, Minal
    Introduction: Occupational therapists and physiotherapists use outpatient follow-up appointments to continue and monitor the effectiveness and outcome of therapy interventions. Attendance of follow-up appointments is essential, as non-attendance has negative implications for both the patient and the healthcare facility. Methodology: This retrospective, cross-sectional study made use of a period sample of all outpatients with scheduled appointments between January and December 2017 (n = 837) at the Western Cape Rehabilitation Centre (WCRC). Children under the age of 18 years were excluded. Descriptive statistics were used to describe the identified variables of the sample. Logistic regression was used to determine the adjusted odds ratio for the association between non-attendances and identified covariates. Results: The sample population of 837 patients, included 516 attenders and 321 non-attenders. Factors that had an association with non-attendance included hospital classification, diagnostic category and impairment according to ICD 10 coding (p ≤ 0.05). Conclusion: This article describe factors associated with non-attendance of outpatients to scheduled occupational therapy and physiotherapy appointments at the WCRC. Further research is needed to determine the reasons for non-attendance at institutions such as WCRC which will assist in the implementation of strategies to reduce high non-attendance rates.
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    Occupation based hand therapy in the South African context : challenges and opportunities
    (Occupational Therapy Association of South Africa, 2016) De Klerk, Susan; Badenhorst, Elretha; Buttle, Amy; Mohammed, Fairuz; Oberon, Jeanette
    Occupation-based hand therapy (OBHT) is an approach to practice that integrates multiple frames of reference, while remaining rooted in an occupational therapy perspective. There are a number of benefits and challenges that have been recognised in hand therapy settings. The use of an occupation-based approach in the field of hand therapy is of interest to all occupational therapists practising in this field. This commentary explores the challenges and opportunities of OBHT as an approach in the assessment and treatment of clients with hand conditions in the South African context. The authors describe OBHT, explore the barriers in practice and propose guidelines for such an approach in our context. Recommendations are made to enhance the understanding and practice of an OBHT approach in everyday hand therapy practice within South Africa.
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    Occupational therapy hand assessment practices : cause for concern?
    (Occupational Therapy Association of South Africa, 2015-08) De Klerk, Susan; Buchanan, Helen; Pretorius, Blanche
    Introduction: Assessment is critical for measuring improvement, or lack thereof, and demonstrating the outcome of intervention. In response to the lack of research in this area, this study aimed to determine the assessment practices of occupational therapists working with clients with hand conditions. Methods: A quantitative cross sectional survey design was used. A convenience sample of occupational therapists was recruited from five provinces. Respondents completed a questionnaire developed for the study that comprised demographic information, assessments used, frequency of use and factors influencing assessment choice. Data were analysed with Statistica version 11. Results: Eighty-one respondents (n=114) completed questionnaires representing a 71% response rate. Goniometry (84.0%), manual muscle testing (76.5%) and testing for flexor tendon function (76.3%) were used most frequently. The most common reasons for not using assessments were lack of availability and unfamiliarity. Conclusion: It is of concern that the assessment practices of participants in this study focussed primarily on the assessment of body function and structure with few therapists using activity and participation measures. This could seriously limit the evidence needed to verify the outcomes achieved through occupational therapy intervention in the treatment of hand conditions.
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    Occupational therapy intervention intosteo-arthritis of the carpometacarpal joint of the thumb in the South African context
    (Occupational Therapy Association of South Africa, 2017) Teuchert, Robyn Michelle; De Klerk, Susan; Kotze, Marianne; Nieuwoudt, Hester Cecilia; Otero, Manja; Van Zyl, Nicola
    Introduction: The carpometacarpal joint (CMCJ) plays a pivotal role in thumb function and essentially, hand function. Investigation concerning the most preferable occupational therapy treatment approach for osteoarthritis (OA) of the CMCJ was therefore indicated. Factors that affect the course of treatment in the South African context were to be identified. Methodology: A descriptive qualitative research design was implemented with a purposive sample of occupational therapists in the Western Cape. Semi-structured interviews were held. These were transcribed and analysed. Results: A fixed treatment regimen was not followed by participants of the study. Factors contributing to the choice of treatment emerged from the data. These included the source of the referral, aspects of the OT process and the patient. Results demonstrated that it would not be practical to set up a rigid regimen, due to the diverse nature by which OA of the CMCJ presents in patients as well as the contributing factors participants reported to impact intervention. Discussion: The compilation of a basic guideline is proposed. Each phase of the occupational therapy process according to the stage of OA of the CMCJ should be included to provide meaningful intervention. A proposed guideline is presented based on the results of the study.
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    Shared decision making and the practice of community translation in presenting a pre-final Afrikaans for the Western Cape Disabilities of the Arm, Shoulder and Hand (DASH) questionnaire : a proposal for improved translation and cross-cultural adaptation
    (SpringerOpen, 2019-08-14) De Klerk, Susan; Jerosch-Herold, Christina; Buchanan, Helen; Van Niekerk, Lana
    Background: Translation and cross cultural adaptation of patient reported outcome measures (PROMs) involves a step referred to as harmonisation, following forward and backward translation of the measure. This article proposes the introduction of methods not previously included in the process of harmonisation. The aim of the study was to introduce shared decision making (SDM) and the practice of community translation (CT) during the harmonisation of the Afrikaans for the Western Cape version of the Disabilities of the Arm, Shoulder and Hand (DASH) questionnaire, a PROM that measures symptoms and activity and participation in persons with upper limb conditions. Methods: A broader approach to harmonisation is proposed by incorporating CT and SDM in addition to existing methods toward harmonisation. Participants (n = 8) involved in the harmonisation meeting included the principal investigator, a linguistic expert, occupational therapists with knowledge of the target population, context and the DASH questionnaire and members of the target population with and without upper limb conditions. A partnership was formed with the participants (a principle of SDM) and the principles of non-parallel CT and the CT approach were applied during harmonisation. Employing CT principles ensures that the norm for the translation is set by the population the translation is intended for. Results: Forward and backward translation of the DASH questionnaire presented a version of the measure in the target language for consideration during harmonisation. There were however a significant number of conceptually problematic items on the version presented at the meeting. Only seven items (7 of 30) remained unchanged. Conclusion: SDM and CT was used during the harmonisation of the Afrikaans for the Western Cape DASH questionnaire. Both these practices could have relevance in the translation and cross-cultural adaptation of PROMs where the translation is intended for persons from low socio-economic backgrounds and low levels of education.
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    Workplace-based rehabilitation for upper limb conditions in the South African context
    (Occupational Therapy Association of South Africa, 2019-08) Hoosain, Munira; De Klerk, Susan; Burger, Marlette
    Workplace-based rehabilitation is a growing field of practice internationally and locally. This commentary discusses the current barriers and facilitators facing South African occupational therapists wanting to implement workplace-based rehabilitation with upper limb conditions. An overview is provided of current international practice in the field and relevant factors in the South African context. Recommendations are made for development in this field in clinical practice, research and education in South Africa.