Masters Degrees (Occupational Therapy)

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Die bepaling van die stressore en behartigingstrategiee van die arbeidsterapie studente aan die Universiteit van Stellenbosch
(Stellenbosch : Stellenbosch University, 2000) Kemp, Rene; Van Greunen, A.; Kotze, T. J.v.W.; Stellenbosch University. Faculty of Medicine & Health Sciences. Dept. of Occupational therapy.
ENGLISH ABSTRACT: The main aim of this study was to investigate the stressors experienced by occupational therapy students at the University of Stellenbosch and the coping strategies used by these students to manage their stress. The possible relationship existing between the coping strategies and certain mediators of stress, namely self esteem, Type A personality, optimism and locus of control, was also investigated. The sample consisted of 151 occupational therapy students at the University of Stellenbosch. A package of questionnaires was completed by each student. This package included a stressor questionnaire, "Self-Esteem Scale of Rosenberg" (SES), "Jenkins Activity Survey - Student version", (SJAS), "Revised Life Orientation Test" (LOT-R), "Internal-External Locus of Control Scale" (I-E), "Cope Scales" and a Biographical questionnaire. The results indicated that students intensely experience the stressors "limited free time" and "fear of failure". The most important academic stressors were "theoretical and practical examinations and tests" and "academic work load". The most important clinical stressor in especially the third and fourth years of study was the "volume of written requirements". The students' self esteem was distressingly low (an average of 7.28 for a possible score of 10, which indicates a low self esteem). The students' self esteem did however, show an increase from the first to the fourth year of study. The B.Occupational Therapy IV students showed a significantly higher Type A personality than did the B.Occupational Therapy I students. The students' "optimism" and "locus of control" did not differ in the four different years of study. The functional coping strategies used most commonly by students are "religion", "positive re-interpretation and growth", "active coping" and "planning". The maladaptive coping strategies, "seeks social support for emotional purposes", "focus on and ventilate feelings" and "mental disengagement" are also often used by students. "Denial" and "alcohol and substance abuse" are not commonly used by students. A negative relationship between avoidance behaviour and self esteem and Type A personality exists in the B.Occupational Therapy I students. There is also a negative relationship between "seeks social support for instrumental purposes" and "optimism". In the B.Occupational Therapy II students, a positive relationship exists between self esteem and "positive re-interpretation and growth", "active coping", "planning", "religion" and "restraint coping". A similar tendency was noted in the B.Occupational Therapy III and B.Occupational Therapy IV students. In conclusion, some recommendations are made to enable students to effectively cope with their stressors.
Better when I’m playing developing the playfulness and social play of learners with autism spectrum disorders through play-based occupational therapy
(Stellenbosch : Stellenbosch University, 2024-03) Rautenbach, Gaby; Plastow, Nicola Ann; Hoosain, Munira; Stellenbosch University. Faculty of Medicine and Health Sciences. Dept. of Health and Rehabilitation Sciences.Occupational Therapy.
ENGLISH SUMMARY: Background: Play is essential to a child’s optimal development; therefore, occupational therapists use it to achieve play-related or functional goals. Without the foundational motivators of playfulness and social play, play engagement and consequently, play skills may be limited. Elements of playfulness, and social play skills may be difficult for children with autism spectrum disorders (ASD) to demonstrate during play engagement. These aspects could perhaps be even more limited in children with ASD who require high levels of support and those living in Low- and middle-income countries (LMIC) such as South Africa. Play-based occupational therapy interventions could improve playfulness and social play of learners with ASD, resulting in more opportunities for practicing play and social skills, therefore influencing overall occupational performance and satisfaction. Objectives: This study aimed to determine the effectiveness of play-based interventions through two phases. Phase one involved a systematic review of literature investigating the effect of play-based occupational therapy interventions on the playfulness, social play, and occupational performance of learners with ASD. Phase two outlines a study protocol which aims to evaluate the effect of a play-based intervention on the playfulness, social play, and occupational performance of learners with ASD in Gauteng, South Africa. Methods: Phase one used a systematic review of 12 quantitative studies, following PRISMA guidelines, to explore the effect of play-based interventions on playfulness and social play and strategies contributing to successful interventions. It was registered with PROSPERO (CRD42022349695). The databases PubMed, EBSCOhost, OT seeker, Scopus, Sabinet, Cochrane, and ProQuest were searched, and 12 eligible studies were assessed for methodological quality and intervention reporting quality using the JBI and TIDieR checklists, respectively. Phase two was informed by the results of phase one. The study will use a within-subject-repeated-measures design to implement the Playbox Africa Intervention with learners (aged 3-8 years) who have ASD, in a school in Johannesburg, Gauteng. The Test of Playfulness (ToP) and modified version of the Canadian Occupational Performance Measure (M-COPM) will be outcome measures for playfulness, social play, and occupational performance. The protocol follows the SPIRIT (2013) guidelines for interventions. Results: The systematic review found moderate to strong evidence for 11 of the 12 studies, that play-based interventions improve the playfulness and social play of learners with ASD. Six key principles to developing successful interventions were highlighted, as well as the Playboxes Joint Play Approach which demonstrated high feasibility. It was found that only one study was conducted in an LMIC (Anu et al., 2019) and only two studies involved learners with high support needs (Dionne & Martini, 2011; Fabrizi, 2015). These aspects informed the intervention protocol which was developed by incorporating the most recent evidence regarding play-based interventions, and culturally adapting an existing intervention to the study context, according to the TIDieR checklist requirements. A product of Phase 2 is the development of Playbox Africa, a culturally adapted and evidence-informed elaboration of the Playboxes Joint Play Approach (Marwick et al., 2021). Conclusion and Recommendations: Play-based interventions can improve playfulness and social play if certain principles are followed. These include combining social, free, and structured play, using caregivers to model the play, toys of interest and video-modelling, and considering the level of support of the learners, as well as the duration of the intervention. There remains a significant gap between theoretical knowledge regarding play interventions and implementation in practice and research. It is imperative that play-based interventions targeting playfulness and social play are further researched and implemented, especially for children with ASD who have high support needs, in LMIC.
The content validity of the Community Mobility Assessment Tool for Individuals (CoMATI) in the context of the Cape Town Metropole
(Stellenbosch : Stellenbosch University, 2019-04) Van der Vlugt, Kirsti; Swanepoel, Lizette; Jacobs-Nzuzi Khuabi, Lee-Ann; Stellenbosch University. Faculty of Medicine and Health Sciences. Dept. of Health & Rehabilitation Sciences. Occupational Therapy.
ENGLISH SUMMARY : Introduction: The Community Mobility Assessment Tool for Individuals (CoMATI) is an occupational therapy assessment tool that evaluates an individual’s ability to use public transport in the Cape Town metropole. The content of the CoMATI consists of an Interview Report Format and four assessment protocols for persons who ambulate, persons who use a wheeled device, persons with cognitive impairment and persons with visual impairment. As the psychometric properties of the CoMATI are not known, the purpose of the study was to establish the content validity of the CoMATI. Methodology: A quantitative methodological approach was used. A panel of occupational therapists (N=5), considered to be subject matter experts (SMEs), were recruited on the basis of peer acknowledgement. The SMEs used a Content Validity Rating Scale to rate each item on the Interview Report Format and the four assessment protocols as Essential; Useful but not essential or Not necessary for evaluating performance of public transport use. Additional space was provided for feedback. A content validity ratio (CVR) was calculated for each item using the method described by Lawshe (1). To compensate for chance agreement, the researcher regarded a CVRcritical= 0,573 to be the lowest level of CVR to indicate that the item may be considered relevant. A content validity index (CVI) was calculated in order to evaluate the degree to which the content in the Interview Report Format and each assessment protocol was representative of the domain of public transport. The CVI was calculated as the average agreement among SMEs. For a new instrument such as the CoMATI, the researcher was seeking 80% or better agreement. Results: The Content Validity Rating Forms were completed by all SMEs and no items were omitted. There was total agreement from SMEs regarding the relevance of certain items. For those items where full agreement on relevance was not achieved, the items were considered to be useful but not essential by only one of the five SMEs. Conclusion: The results of the study determined that all items in the CoMATI had a high degree of content validity and may be considered to be relevant and representative to the domain of public transport use. Three reasons that certain items were considered less relevant than others may be that items may either not have been adequately performance based, may not have had the same degree of influence in excluding an individual from public transport use, or may not have been relevant to certain individuals. Occupational therapists using the present version of the CoMATI may have to rely on clinical reasoning to determine which of the available items are more relevant for an individual’s performance of public transport use.
A critical review of the validity of the Credibility Assessment Tool (CAT) and its application to the screening of suspected malingering
(Stellenbosch : University of Stellenbosch, 2011-03) Theunissen, Karen Sunette; Kemp, Rene; Pretorius, Blanche; University of Stellenbosch. Faculty of Health Sciences. Dept. of Interdisciplinary Health Sciences. Occupational therapy.
ENGLISH ABSTRACT: Malingering, the intentional simulation or exaggeration of symptoms for secondary gain, has a significant financial impact on disability insurance given its prevalence. Multidisciplinary professionals involved in disability determination therefore require a tool which would assist in the screening of suspected malingerers. AIM: The Credibility Assessment Tool (CAT), a tool which was developed as part of the Performance APGAR, was reviewed in terms of its validity and application to the screening of malingering. Research objectives included the review of face and content validity through a literature review and concept analysis, as well as the review of construct and concurrent validity by comparing the results with the operationalised malingering construct and available malingering protocols. The adapted Slick criteria as proposed by Aronoff, applicable to chronic pain, neurocognitive, neurological and psychiatric symptoms, was identified as the most suitable criterion standard for use of comparison. DESIGN: The research design was a descriptive analytical design, which was performed retrospectively with a report review from insurance referrals to the researcher. Informed consent was obtained from insurers who legally own the reports. A saturated sample of convenience of 184 cases with depression and pain as predominant symptoms were analysed. Recall bias were minimised through omission of personal identifiers and the use of a peer check of 20 random cases. Results in the peer check were suggestive of poor inter-rater reliability, rather than recall bias. METHOD: Cases were analysed according to the guidelines from the respective authors of the CAT and adapted Slick criteria, however this was further defined to ensure that the study could be replicated. RESULTS: Face validity was adequate in terms of purpose, item selection and association between consistency criteria, however require improvement in terms of standardised instruction and weighting of the scale. Content validity was rated as adequate to excellent, given that it supports criteria linked to the malingering construct. Construct validity was adequate as demonstrated by association between concepts obtained through concept analysis. Correlation between the CAT and adapted Slick was strong (r>0.5) however caution is expressed that this requires further research. CONCLUSION: Recommendations for further research included the review of content validity with subject experts, criterion and predictive valid through a case-control study of known-groups, as well as the reliability of the CAT, and the use of specialised ADL indices for malingering detection. Adaptation to the CAT was depicted in the proposed Consistency Assessment Tool.
The effect of an occupational therapy mental health day treatment centre on the use of in-patient services in the Western Cape, South Africa.
(Stellenbosch : Stellenbosch University, 2015-12) Engelbrecht, Riekie; Plastow, Nicola; Botha, Ulla; Stellenbosch University. Faculty of Health Sciences. Interdisciplinary Health Sciences. Dept of Occupational Therapy
ENGLISH ABSTRACT: Background: The high number of mental health care users requiring care, the quick turnover in psychiatric hospitals and the scarcity of community-based mental health services are some of the factors that have led to a dramatic increase in the number of high frequency users of in-patient psychiatric services. In an attempt to address these issues, an occupational therapy-led day treatment centre was established at Stikland Hospital in the Western Cape province of South Africa. The aim of this study was to determine whether attendance at an occupational therapy-led community day treatment centre for mental health care users affects the use of in-patient services in the Western Cape Province of South Africa. Methods: A pre-test/post-test quasi-experimental study design was used to determine the benefits of the occupational therapy-led day treatment centre. Total population sampling was used. Forty four mental health care users participated in the study. The number of admissions and number of days spent in hospital before and after occupational therapy intervention were compared using statistical analysis. Results: The analysis showed a significant difference in the number of admissions (p = .00) and the number of days spent in hospital (p = .00) before and after the occupational therapy intervention. There was a decrease in the number of admissions of 62.3% after intervention. Twenty-five participants (56.8%) had fewer admissions after intervention than before. Total days spent in hospital for the group showed a decrease of 74.6% after intervention. Days spent in hospital became shorter by up to 7 months after occupational therapy intervention. This indicated a medium effect size (r = .436) for number of admissions and a large effect size (r = .504) for number of days spent in hospital after intervention. The frequency of attending the day treatment centre had no influence on number of admissions (p = .410) or on the number of days spent in hospital (p = .579) after intervention. Conclusion: The findings suggest that an occupational therapy-led day treatment centre is effective in reducing the use of in-patient services within the Western Cape, South Africa. In addition providing a range of opportunities for meaningful participation may be more important than the intensity of treatment when promoting recovery.
The effect of integration of the fear paralysis reflex on the occupational performance of children referred with handwriting problems
(Stellenbosch : Stellenbosch University, 2024-03) Bence, Jenine; Sheik Ismail, Arifa; Plastow, Nicola Ann; Stellenbosch University. Faculty of Medicine and Health Sciences. Dept. of Health and Rehabilitation Sciences. Occupational Therapy.
ENGLISH SUMMARY: Background: Unintegrated primary reflexes and subsequent delayed cortical maturation leads to behavioural and learning problems in childhood and throughout the lifespan. Rhythmic Movements from Rhythmic Movement Training International (RMTi) significantly improved the integration of the Fear Paralysis reflex and lead to significant improvements in occupational performance of children. RMTi Rhythmic Movement Training is used by few occupational therapists in few countries. No evidence to demonstrate the effectiveness of the Fear Paralysis reflex integration nor research on the Fear Paralysis reflex per se were found. Method/design: This randomised clinical trial evaluated the change in occupational performance from the child’s perspective using the Canadian Occupational Performance Measure after 6 hours of RMTi Fear Paralysis reflex integration. A time series crossover with random allocation and delayed treatment period 2, and a pre- to post-study design, was used. Participants included 14 children aged 8-9 years referred with handwriting problems, attending four public schools in Cape Town, South Africa. Repeated Canadian Occupational Performance Measure assessment was at baseline test 1 and 2, mid-intervention test 3, two weeks post intervention test 4 and at 12 to 15 weeks post intervention test 5. Pre- and post-assessments included the RMTi and Masgutova Neuro-sensory-motor Reflex Integration® (MNRI®) Fear Paralysis reflex assessments, the Short Sensory Profile sensory processing, the Interactive Metronome® neuro-timing, and the Systematic Detection of Handwriting (SOS-2-EN) problems. Intervention included eight, weekly individual RMTi Fear Paralysis reflex integration sessions with an occupational therapist, and a carer led RMTi Home Support Fear Paralysis reflex programme 3 to 4 times per week. The caregivers were usually present during the assessment and intervention sessions. Those caregivers who could comply, experienced the 4 RMTi Home Support Fear Paralysis reflex integration movements before demonstrating these on their child. Findings: RMTi Fear Paralysis reflex intervention statistically significantly improved the Fear Paralysis reflex integration (p=0.003), sensory processing (p=0.025) and handwriting speed (p=0.001). Handwriting quality and neuro-timing did not improve. Within participant repeated measures analysis showed that the RMTi Fear Paralysis reflex intervention statistically significantly improved the occupational performance of participants, from the child’s perspective and from the caregivers’ perspective. Children statistically significantly improved in their performance (p=0.002) of a range of occupations that they identified as important and increased statistically significantly in satisfaction (p=0.01) with their performance. Similarly, the caregivers’ ratings of performance (p=0.007) and satisfaction (p=0.01) for occupational performance problems they observed in their children, also statistically significantly improved. Results were clinically and statistically significant. Discussion: All 14 participant children presented with an unintegrated Fear Paralysis reflex, lack of sensory integration, low levels of performance and satisfaction in daily activities, and poor handwriting, pre-intervention. Fear Paralysis reflex integration could shorten the therapy period needed to improve occupational performance including handwriting. Caregiver involvement in RMTi Home Support under guidance of therapists could promote parent empowerment in fostering development of their child.
An evaluation of the incidence and absenteeism rates of health care workers reporting flu-related illnesses at an academic hospital in the Western Cape: a retrospective cohort study
(Stellenbosch : Stellenbosch University, 2017-12) Obike, Ude Emma; Carstens, Sydney Ernest; Stellenbosch University. Faculty of Medicine and Health Sciences. Dept. of Health & Rehabilitation Sciences. Occupational Therapy.
ENGLISH SUMMARY : Introduction: Seasonal Influenza -related illnesses impose a heavy burden on society. Vaccination programmes are the most effective strategy for preventing the illnesses and have been recommended for certain high- risk groups. Healthcare workers involved in the care of these vulnerable patients may be infected clinically or sub-clinically with Influenza. They are therefore urged to accept influenza vaccination as part of the broader control of Influenza policy. This study evaluates the willingness of uptake and the impact that influenza vaccination campaigns might have among healthcare workers in a tertiary health setting. Objective: To determine the proportion of voluntary vaccine uptake among healthcare workers as well as describing any potential differences between this vaccinated population and their randomly selected unvaccinated controls. Methods: A retrospective cohort study investigating the incidence of flu and its related illnesses, including its impact on absenteeism rates in the seasonal flu years of 2013 and 2014. The study setting was Tygerberg Academic Hospital, Parow, Western Cape. All vaccinated employees during the study period were compared to matched unvaccinated controls in a 1:2 ratio. Employees who got ill during the study period were sourced from the facility’s Human Resource database. Illness incidence and absenteeism rates were extracted from this outcome database and analysed to determine trends between study arms as well as between occupational categories. Results: A total of 4.6% and 2.8% of employees accepted vaccination for the seasonal flu years of the 2013 and 2014 respectively. The study population was 1020 with 340 healthcare workers in the exposed arm. Overall, there were more employees that fell ill compared to those that remained healthy during the study period (700 vs 320). For all instances of Influenza and related illnesses (clinically specified) illnesses, there was no statistically significant difference between the vaccinated and unvaccinated study groups [RR 1.06, 95% CI (0.87- 1.28), p=0.28]. The frequency of illness in the vaccinated was less than that observed in the controls (79 vs 164, z-score=2.04 p-value= 0.041). About 60% of all sick leaves had no clinically specified diagnosis while the incidence of clinically specified illnesses was 32.65% among the vaccinated and 30.88% in the control group. This therefore placed the true incidence rate of influenza-related illnesses between 32,647 to 69,706 /100,000 population per year in the vaccinated and 30,882 to 68,088 /100,000 population per year in the unvaccinated. Conclusion: There was very low response to calls for influenza vaccination despite unexpected high reports of influenza-related illnesses in our study setting. Among healthcare workers, a higher proportion reported illness incidents and consequently had higher absenteeism rates compared to those that remained healthy during the study duration. These variables did not differ based on vaccination status perhaps due to the low acceptance rate. Healthcare workers are encouraged to partake in the seasonal flu vaccinations to minimise influenza transmission risks to vulnerable patients.
An exploration of the occupational-life-trajectories of five young men in the Heideveld community
(Stellenbosch : Stellenbosch University, 2013-03) Du Preez, Karlien; Watson, Ruth M.; Bester, Juanita; Stellenbosch University. Faculty of Medicine and Health Sciences. Dept. of Interdisciplinary Health Sciences. Occupational Therapy.
ENGLISH ABSTRACT: Heideveld, a suburb that forms part of the “Cape Flats”, is plagued by high levels of crime, gangsterism, unemployment and relative poverty. I became specifically interested in the occupations of the young men in Heideveld, as I often observed them loitering in the streets, at an age when they should have been in school, studying or starting a career. This led me to wonder about the repertoire of occupations that they had performed over the course of their lives, i.e. their occupational-life-trajectories. I became interested in the influence that the environment and their personal attributes had on the occupations that they performed over time. Guided by the Person-Environment-Occupation model as a conceptual tool I decided to explore the occupational-life-trajectories of men between the ages of 20 and 25 throughout the course of their life, up to their current age. At the organisation where I volunteered during my time in Heideveld, there was a weekly programme for the children and young women (aged 12 to 22), but nothing for young men, which prompted my interest in doing research about this age group. My initial thinking was to form the theoretical basis from which an occupation-based intervention group could be developed. I intended to explore what had motivated occupational participation throughout their lives, how certain occupations developed over time and the influence of the environment on their occupations. Snowball sampling was applied to gain access to the participants. Using a qualitative approach I combined a method called PhotoVoice with individual, narrative interviews, in order to collect data on the occupational-life-trajectories of five young men from Heideveld. PhotoVoice is a participant-based method that allowed the interviewees to take photos of occupations that they have performed throughout their lives. The photographs were used to facilitate the interview process along with two or three guiding questions. Within-case and cross-case analysis were used to find themes that pertained to the aims of the study. I uncovered five themes in my analysis: “Ons gee nie krag weg nie/We don’t give away power”, “Ons het saam geloop/We ‘hang out’ together”, “Ek het baie probleme by die huis gehet/I had many problems at home”, “Die lewe is swaar hier buite/Life is hard out here” and “Ek wil net uit hierdie plek kom/I just want to get away from this place”. I found that the environment played a large role in the occupational-life-trajectories of the participants. I also found that the participants’ sense of masculinity, gender and identity affected their occupational choices and participation. I explain the peer nature and motivational factors influencing gangsterism and drug use as they manifested in the young men’s lives. I concluded that an occupation-based intervention programme might address certain aspects such as occupational choice and exposure, but that wider, more long-lasting intervention was necessary to truly make a difference in the occupational-life-trajectories of young men in Heideveld. After taking the support structures in the physical environment into consideration, recommendations were made in terms of the family unit, the peer group, education, skills training and community empowerment. Furthermore, as the organisation already serves boys between 10 and 14 years and a greater impact may be possible at this life stage, more detailed recommendations were developed regarding a possible occupational therapy intervention programme.
Exploring the experiences of mothers on their daily occupations while having a child on the spectrum of autism
(Stellenbosch : Stellenbosch University, 2013-03) Laminette, Elana; Bester, Juanita; Vlok, E. D.; Stellenbosch University. Faculty of Medicine and Health Sciences. Dept. of Interdisciplinary Health Sciences. Occupational Therapy.
ENGLISH ABSTRACT: Prior to the commencement of this study, an abundance of information on the topic of autism spectrum disorders and its symptoms, its prevalence and the effect on the family’s psychosocial- and emotional wellbeing were available. However, studies to describe the impact of a child with autism spectrum disorder on the occupations of families were limited, especially within the South-African context, and the researcher could find no information describing the impact of such a child specifically relating to the daily occupations of their mothers. This qualitative study used a phenomenological approach to explore how mothers with children on the spectrum of autism experience the impact of the child on their own daily occupations, and the meaning they derive from these experiences. Purposive sampling was used in selecting eleven mothers whose children attended therapeutic and medical follow up at one of the tertiary public hospitals in the Western Cape. In-depth semi-structured interviews following an interview guideline were conducted with each of the participants. The interviews were audio taped, and thereafter transcribed verbatim. A process of open coding was used to analyze the transcribed interviews. The findings emerging from the data-analysis process, uncovered three themes, namely ‘mothering as an identity’, mothering as an occupation’, and ‘making sense and moving forward’. These themes emphasized the immense changes the mothers had to face with regards to their occupational engagement, as well as on a personal level due their children’s diagnosis of autism spectrum disorder. It also brought to light the factors influencing the experiences and actions of mothers, shaping their mothering identities, as well as their needs and barriers in terms of successful participation in their everyday occupations. The study reported on the occupational risk factors these mothers face, as well as the enabling elements with regards to successful and meaningful occupational engagement. Occupational therapists working with children should be especially conscious of the inseparable relationship between the occupations of the child they are treating, and the occupations of the primary caregiver when implementing therapy programs. Only through ensuring the successful and meaningful participation in occupations of both the mother and the child, the occupational therapist will be able to improve the health and well-being in the one or the other. Careful selection and collaborative goal setting when planning therapy programs are therefore essential.
Exploring the transition from student to clinician by the first cohort of locally trained occupational therapists in Ghana
(Stellenbosch : Stellenbosch University, 2020-03) Nkansah, Opoku Eric; Van Niekerk, Lana; Jacobs-Nzuzi Khuabi, Lee-Ann; Stellenbosch University. Faculty of Medicine and Health Sciences. Dept. of Health & Rehabilitation Sciences. Occupational Therapy.
ENGLISH ABSTRACT: Background : The nature of a new clinician’s transition from student to clinician is a significant determinant of the ease or difficulty of the journey to professional competence. Transition into practice for the new graduate has been described as a complex experience characterised by periods of stress and anxiety. In Ghana, after several failed attempts to establish occupational therapy services, the Ministry of Health in collaboration with the University of Ghana started an undergraduate programme in Occupational Therapy in 2012 (the first of its kind in the West African sub-region) to educate occupational therapists locally. This exploration of the experiences of transition into practice for the first cohort of locally trained occupational therapists was important because they worked autonomously and in a self-directed manner in their first year of practice after graduation, in a country where occupational therapy had not been established. Aims and objectives: The aim was to explore the experiences of the first cohorts of locally trained occupational therapists during transition from being students to clinicians within the first year of their practice in Ghana. The objectives were to explore the challenges and facilitators of their transition, the coping strategies employed to effectively manage the challenges they encountered and their experiences of continued professional competence. Methodology: The research comprised of three stages; stage one was to develop a systematic scoping review protocol to explore the factors that affect new clinicians’ transitions into practice. In stage two, the scoping review was conducted to synthesize literature published in the last two decades on the transitions of new clinicians into practice. The focus was to determine the challenges and facilitators of new clinicians’ transitions from student to clinician and the evidence-based coping strategies that can be employed to ease the transition. Stage three was a phenomenological study aimed at exploring the transition from students to clinicians by the first cohort of occupational therapists in Ghana. Two in-depth interviews were done with each participant. Inductive content analysis was used to analyse the data into four overarching themes. Ethical approval was obtained from the Health Research Ethics Committee of Stellenbosch University prior to conducting this study. Results: In the scoping review, 562 studies were initially identified, relevant data was extracted from 24 studies that met the inclusion criteria and were analysed to form this review. Four overarching themes emerged namely: systems and structures, personal capacities, professional competence and mediating processes. Each theme revealed the barriers, facilitators and coping strategies of transition into practice among new health graduates. In the phenomenological study, four themes emerged: ‘Being “new” in a new profession’, ‘Introducing occupational therapy into a medical model health system’, ‘Personal and professional competence,’ and “The future is bright”. New graduates found continued professional competence activities essential for successful transition into practice. Conclusions and recommendations: New graduates needed assistance to translate knowledge into practice. New graduates lacked adequate supervision given the lack of practicing occupational therapists to fulfill supervisory roles. What was evident from the findings is that, well-organized collaboration between undergraduate university educators, leadership and management of health facilities, other health professionals and the new graduates can facilitate a successful transition into practice. Future research is needed to explore the transition of other cohorts of occupational therapy graduates to explore if they had similar experiences. This will allow for a more holistic understanding of students transition into practice to generate further suggestions to enrich occupational therapy education and practice in Ghana.
Exploring the value of mentorship programmes as a preventative strategy for prenatal alcohol use for at risk women in the South Africa
(Stellenbosch : Stellenbosch University, 2021-03) Zietsman, Linda; Cloete, Lizahn; Fredericks, Jerome Peter; Stellenbosch University. Faculty of Medicine and Health Sciences. Dept. of Health & Rehabilitation Sciences. Occupational Therapy.
ENGLISH SUMMARY : Introduction: The high prevalence rate of FASD is well-known in South Africa, especially in certain areas in the rural Western Cape with an estimation of about 180-260 children in 1000 being affected. Literature confirms that there is poor recognition and response to the epidemic of FASD, and that a response from public health, which could include occupational therapy, could benefit many. Occupational therapy could be a valuable contributor to maternal health during the prenatal stages considering their holistic, client-centered approach. There have been many preventative strategies implemented to lower the prevalence of FASD, and one of them is by the means of mentorship programmes for at-risk mothers in high-risk communities. At-risk women face many barriers in accessing adequate healthcare services and mentorship programmes could potentially provide the necessary care and support at-risk mothers need to improve their maternal health. There is a need for exploring the value of these mentorship programmes to further assist with the development of successful prevention strategies for FASD. Methodology: A qualitative, explorative case study has been done on community-based mentorship programmes for at-risk mothers in South Africa, with a focus on the Western Cape. The study population has been field experts within the mentorship programmes, as well as mentors and mentees. Data has been collected by the means of an online focus group discussion of field experts (n=4), and SMS-journaling of mentors and mentees over a period of three weeks (n=6). An inductive analysis approach was used. The data was analysed according to themes, sub-themes and codes using content analysis. Ethical clearance has been obtained. Credibility has been ensured by member checking and peer examination. Data triangulation was ensured by using multiple data collection methods. Transferability has been ensured by thick description. Findings: There were four main themes that emerged from the collected data. These themes were (1) “It’s not just a generic programme”, (2) “Our pregnant women are struggling out there”, (3) “It has been a wonderful challenge to be a mentor” and (4) “What I will say that does not work”. Discussion: The most valuable components of a mentorship programme as studied is the client-centered, holistic approach while building empathetic, trustworthy relationships and supporting and empowering the at-risk mothers. This relationship between the above-mentioned components is transactional in nature, and one cannot function without the other. It is also important to consider the contextual challenges that at-risk mothers face in their daily lives, including unemployment, poverty, crime, violence, gangsterism and household abuse which often leads to poor coping mechanisms such alcohol and substance abuse. It is also important for the mentors themselves to feel supported and empowered throughout the mentorship programme to add to the success of a mentorship programme. It also became evident that prevention of FASD should not only start with at-risk mothers, but preventative strategies, such as education for primary school learners, should be implemented. The accessibility of mentorship programmes should also improve to reach more at-risk mothers. Conclusion: In conclusion, mentorship programmes should include a client-centered, holistic approach while building strong relationships between the mentor and the at-risk mother. It is also important to support and empower the at-risk mother as she experiences a range of adversities and challenges and focus should be given to her mental well-being. This requires a shift from the problems within the person, but rather to that of the environment. Occupational therapy can play a vital role in the fields of maternal health and can assist at-risk mothers to achieve client-centered goals and create supportive environments. This could assist in the success of these programmes, and success of these programme could benefit the public health system in decreasing the prevalence of FASD in those communities.
Factors that affect the persistence of Master of Occupational Therapy students at Stellenbosch University
(Stellenbosch : Stellenbosch University, 2014-04) Sheik Ismail, Arifa; Troskie-De Bruin, Christel; Bester, Juanita; Stellenbosch University. Faculty of Medicine and Health Sciences. Department of Interdisciplinary Health Sciences. Occupational Therapy.
ENGLISH ABSTRACT: The retention and throughput rates of postgraduate students are a national and an international concern. There is a tendency for postgraduate students, irrespective of which Master of Occupational Therapy programme they are registered for, to have difficulty in completing the thesis or research assignment, resulting in delayed throughput or non-completion. This study aimed to understand and describe from the postgraduate student’s perspective, what factors facilitated or hindered the completion of the Master of Occupational Therapy programmes. Qualitative research using a phenomenological design was used in order to obtain a rich description of the students’ lived experiences in the M-programmes so as to gain insight into their experiences. Purposive sampling was used and data was generated by means of in-depth, one-to-one interviews. The findings have shown that numerous factors in various combinations at different points in time during the study period shaped the experience of the mature, female, part-time postgraduate student. Participants were intrinsically motivated to engage in studies as they desired the growth in their professional knowledge and skills. The experience of supervision varied depending on how the student and supervisor were matched and on the student’s expectations and needs of the relationship. The development of critical thinking and writing skills required effort and time, which influenced the postgraduate student’s motivation, retention and throughput rate. Within the work environment very little negotiation for study opportunity was possible. Although this negotiation was far more likely within the home and with family, household and family responsibilities persisted over the long study period of two or more years. This study has shown that the main hindrances to the completion of studies are the lack of time and the demands of the multiple roles that the mature, female part-time postgraduate student has to contend with.
The feasibility of occupational therapy visual art groups for children (8 – 12 years) with learning differences in a low-resource setting in the Western Cape, South Africa
(Stellenbosch : Stellenbosch University, 2024-03) Conolly, Naomi Beth; Hoosain, Munira; Plastow, Nicola Ann; Stellenbosch University. Faculty of Medicine and Health Sciences. Dept. of Health and Rehabilitation Sciences. Occupational Therapy.
ENGLISH SUMMARY: Introduction: There has been a worldwide increase in the prevalence of learning differences, increasing the demand for feasible and effective services that support these children’s development and functioning. However, very few children have access to specialised individual interventions. Art is a well-known therapeutic medium that has the advantage of being adaptable to different clients, cultures, and settings, to develop prerequisite skills required for individual growth and participation in everyday life. Group interventions may be more feasible for low-resource settings regarding time, human resources, and costs. However, feasibility testing is needed before high-quality effectiveness evaluations can be recommended for art group programs in low-resource settings. Aim: To determine the feasibility of occupational therapy visual art groups for children aged 8 to 12 years with learning differences in a low-resource setting in the Western Cape, South Africa by 1) synthesising the available international research and 2) conducting a feasibility study. Methods and analysis: The systematic review was structured according to the PRISMA 2020 systematic review reporting guidelines, and registered on PROSPERO. Eight electronic databases were screened for eligible primary data sources, with no limiters. Two independent reviewers completed the title/ abstract and then full-text screening phases, using Rayyan software. The feasibility study used a case series design with convenience sampling to select eight participants (aged 8 to 12 years) with learning difference/s within a low-resource community in the Western Cape, South Africa. The SPIRIT guidelines for interventional trials were used to improve reporting. Participants attended eight weekly 45-minute visual art groups designed by the primary author. Feasibility was assessed in terms of demand, acceptability, and practicality through Likert-scale measures during caregiver interviews. Limited efficacy was evaluated using the Creative Participation Assessment (CPA), the Canadian Occupational Performance Measure (COPM) with caregivers, and the Child Occupational Self-Assessment (COSA) with participants. Results: All 20 articles included in the systematic review reported effectiveness outcomes, indicating decreased problem behaviours, and improved emotional well-being, social interaction, self-expression, cognitive and motor development, and caregiver attachment for children with learning differences. The heterogeneity of the data prevented a meta-analysis of effectiveness outcomes. Six articles reported feasibility criteria. Evidence synthesis led to the AR3T principles, which serve as a framework to guide the development of the art group intervention. The pilot study found the intervention was in demand, acceptable, and practical, and could be effectively implemented in the low-resource community selected for the study. The data also showed signs of limited efficacy, as participants made a clinically and statistically significant improvement in their level of creative participation (CPA) and occupational performance (COPM) from pre- to post-intervention. The COSA showed trends of improvement, especially for older children, but the results did not reach significance. Conclusion: Art group interventions have the potential to be a feasible and effective low-resource intervention that can be utilised to promote the development of children affected by learning differences. Further feasibility and effectiveness testing with larger sample sizes are required to refine the intervention and determine the extent of its therapeutic effect.
Female mental health care users perspectives of their occupational engagement at a tertiary psychiatric facility
(Stellenbosch : Stellenbosch University, 2021-03) Sonday, Haseena; Cloete, Lizahn; Stellenbosch University. Faculty of Medicine and Health Sciences. Dept. of Health & Rehabilitation Sciences. Occupational Therapy.
ENGLISH SUMMARY : Introduction: The prevalence of mental illness, burden of disease in South Africa is increasingly high, a global trend amongst other low-and middle-income countries, affecting more females than males. Poverty, crime, intimate partner violence and the existence and co-morbidities, such as HIV, make people in previously disadvantage areas, particularly females, more vulnerable to mental illness. South Africa’s legislation, and vision for mental health, outlined in Healthcare 2030 exemplified the improvement of tertiary psychiatric services and patient experience, in the face of decentralisation. Despite this, readmission rates remain high, a complex phenomenon, for which the reasons are multifaceted. One of the reasons cited is that the lack of meaningful occupational engagement for patients in mental health care leads to a deterioration of mental health and subsequent relapse and readmission. The aim of the study is to explore female mental health care users’ perspectives of their occupational engagement in the pre-discharge ward at a tertiary psychiatric facility. Methodology: The study is grounded in a constructivist paradigm. A qualitative method of inquiry investigates the subjective underpinnings of meaningful occupational engagement of mental health care users. The collective case study used data from interviews, the Activities Clock, participant observations and the programme in the pre-discharge ward. Five (n=5) participants were included in the collective case study. Inductive analysis was used to analyse data. A four phased analytical strategy, thematic, content, within-case and across-case analyses was performed. Credibility was ensured through member checking. Data triangulation was ensured by using multiple data sources. An audit trail and thick descriptions were used to ensure transferability. The findings of the study were verified amongst other researchers in the field, ensuring confirmability. Reflexive journaling was used to bracket the researcher’s thoughts and feelings. The study received ethical approval and adhered to sound ethical practices. Findings: Two themes emerged. The first theme, “this is not a prison, it’s a hospital”, demonstrated mental health care users’ experience of dehumanisation in the pre-discharge environment. Mental health care users experienced gross human rights violations in the number of restrictions they were subject to, the lack of privacy and freedom enforced by staff in the pre-discharge ward. The second theme, “we need to do more” highlights that mental health care users were unstimulated, bored, and frustrated in the pre-discharge ward. There were not enough opportunities for meaningful occupational engagement in the pre-discharge ward. Discussion: Tertiary psychiatric facilities situated in the medical model violated the occupational and human rights of mental health care users and creates an environment ill conductive for occupation-based practice. Navigating mental health care users’ rights to freedom and privacy, with the responsibility of healthcare providers to offer a safe and caring environment, that is supportive of the recovery of mental health care users in the pre-discharge ward, remains a challenge. Conclusion: Tertiary psychiatric services should embrace a shift in paradigm from a dominantly medical model towards an occupation-based practice and recovery approach, in an environment that is less restrictive, that creates opportunities for meaningful occupational engagement, within a human and occupational rights framework.
The impact of a sensory developmental care programme for very low birth weight preterm infants in the neonatal intensive care unit.
(Stellenbosch : University of Stellenbosch, 2010-03) Nieder-Heitmann, Esther; Smit, Neeltje; Kirsten, G.; University of Stellenbosch. Faculty of Health Sciences. Dept. of Interdisciplinary Health Sciences. Occupational Therapy.
AFRIKAANSE OPSOMMING: AGTERGROND Dit is bekend dat vroeggebore babas met ŉ baie lae geboortemassa ŉ hoër insidensie van ontwikkelings-, gedrags- en mediese agterstande en verskeie leerprobleme toon teen die tyd dat hulle skoolgaande ouderdom bereik. Kommer bestaan ook oor die omgewingseffek van die neonatale intensiewe sorgeenheid op die sensoriese ontwikkeling van die vroeggebore baba en hoe dit tot bogenoemde agterstande kan bydra. Daar is verskillende benaderings wat daarop aanspraak maak dat hulle die probleem kan oplos, met kangaroemoedersorg (‘kangaroo mother care’) en ontwikkelingsorg (‘developmental care’) wat in die literatuur uitgesonder is as besonders belowend. Met die aanvang van hierdie studie was daar nog geen empiriese studies in die literatuur gerapporteer wat enige aansprake van hierdie benaderings bevestig het nie. Daar was dus ŉ behoefte vir ŉ empiries-nagevorsde program wat prakties in die neonatale intensiewe eenheid toegepas kon word met die oog op die vermindering van omgewingstressors ten opsigte van die vroeggebore baba se sensoriese sisteme. DOEL Die doel met die studie was om die invloed te bepaal van ŉ Sensoriese Ontwikkelingsorgprogram (‘Sensory Developmental Care Programme’), wat ŉ spesifieke kangaroemoedersorg- protokol insluit, op die sensoriese ontwikkeling van die vroeggebore baba met 'ŉ baie lae geboortemassa tot en met die ouderdom van 18 maande (gekorrigeerde ouderdom). METODOLOGIE ŉ Ewekansig-gekontroleerde studie is uitgevoer. Die studiesteekproef het bestaan uit 89 vroeggebore babas met ŉ baie lae geboortemassa wat in ŉ periode van 24 maande toegelaat is tot die neonatale eenheid van Tygerberg Hospitaal in Kaapstad, Suid-Afrika. Die babas is gewerf op grond van sekere kriteria en is dan daarna ewekansig aan een van twee groepe toegeken: 1) die intervensiegroep het sorg ontvang volgens die Sensoriese Ontwikkelingsorgprogram vir 10 dae; en 2) die kontrolegroep het ook vir 10 dae die standaardsorg van die eenheid ontvang. Die intervensiegroep het uit 45 babas bestaan, van wie 22 die studie voltooi het, terwyl die kontrolegroep uit 44 babas bestaan het van wie 20 die studie voltooi het. Beide studiegroepe is opgevolg op 6, 12 en 18 maande (gekorrigeerde ouderdom), by welke geleentheid die Sensoriese Funksietoets vir Babas (‘Test of Sensory Functions in Infants’) telkens toegepas is vir die assessering van sensoriese ontwikkeling. Op 18 maande (gekorrigeerde ouderdom) is ŉ assessering met die Griffiths Ontwikkelingskaal ook gedoen om funksies in die ander ontwikkelingsareas van die babas te bepaal. Toetsresultate is geanaliseer met behulp van herhaalde ANOVAmetings en die Bonferoni t-prosedure om die effek van die Sensoriese Ontwikkelingsorgprogram op die sensoriese ontwikkeling van die babas tot en met 18 maande (gekorrigeerde ouderdom) te bepaal. RESULTATE Die resultate van die vergelyking van die prestasie van beide groepe (groep-effek), gemeet met behulp van die Sensoriese Funksietoets vir Babas, is van groot belang vir hierdie studie. Die intervensiegroep het betekenisvol verskil op die totale telling (p<0.00), sowel as op die volgende vier van die vyf subtoets-tellings: respons op diepdruk (‘tactile deep pressure’) (p<0.03); motoriese aanpassingsreaksies (p<0.03); visuele tas-integrasie (p<0.00); en respons op vestibulêre stimulasie (p<0.01). GEVOLGTREKKING Die resultate van die studie dui aan dat die babas in die intervensiegroep baat gevind het by die Sensoriese Ontwikkelingsorgprogram met betrekking tot hul sensoriese funksies tot en met die ouderdom van 18 maande (gekorrigeerde ouderdom). Die Sensoriese Ontwikkelingsorgprogram het geblyk prakties sowel as suksesvol te wees met betrekking tot sy doel. Die Program sou daarom met vrug in ander neonatale intensiewe sorgeenhede aangewend kon word.
The impact of an eight-week progressive resisted exercise program in adolescents with spastic cerebral palsy
(Stellenbosch : Stellenbosch University, 2004-04) Unger, Marianne; Faure, M.; Frieg, A.; Stellenbosch University. Faculty of Medicine and Health Sciences. Dept. of Interdisciplinary Health Sciences. Occupational Therapy.
ENGLISH ABSTRACT: Muscle weakness is a problem for many young people with spastic cerebral palsy (CP). Many studies have reported that selective strength-training programs can improve muscle strength. However, most of these studies are of single group design and do not adequately control for confounding variables. Objective: To determine the impact of a comprehensive strength training program targeting multiple muscle groups on adolescents with CP, using basic inexpensive free weights and resistance devices. Method: A randomised clinical trial evaluated the effects of an eight-week strength-training program on 31 independently ambulant adolescents with spastic CP, with or without walking aids, from Eros School (19 males, 12 females; mean age 16 years 1 month; range 13 - 18 years). The Kin-Com dynamometer, 3-D gait analysis, the Economy of Movement test and a questionnaire was used to evaluate selected muscle strength, the degree of crouch gait, free walking velocity and stride length, energy consumption during walking and perceptions of body image and functional competence. Twenty one subjects took part in the strength-training program and were compared with 10 control subjects. Results were analysed using repeated measures ANOVA and bootstrap analysis. Results: Compared with the control, significant improvement in the degree of crouch as measured by the sum of the ankle, knee and hip angles at midstance (p=0.05) and perceptions of body image (p=0.01) were noted for the experimental group. Significant trends were also noted for isometric knee extension muscle strength at 30° as well as for hip abduction at 10° and 20°. Walking efficiency, -velocity and stride length remained unchanged as well as perceptions of functional ability. Conclusion: A strength-training program targeting multiple muscle groups including upper and lower limbs as well as the trunk, can lead to changes in muscle strength and improve the degree of crouch gait with improved perception of body image. Successful participation in such a program at school may motivate children with CP to continue with home-based basic strength training. Strength training alone did not decrease oxygen consumption during walking and inclusion of aerobic exercise is recommended.
Lived experiences of caregivers of children with autism spectrum disorder in Kenya
(AOSIS, 2019) Cloete, Lizahn; Obaigwa, Evans O.
Background: Autism spectrum disorder (ASD) is a global public health concern. In African countries such as Kenya, there is a greater need for establishing support services for developmental disorders such as ASD. The emotional, social and economic burden of ASD on caregivers is unknown because of a number of challenges. Citizens of Kenya have a unique view of disability and inclusion. Objectives: To explore the perspectives of caregivers who are responsible for caring for both family and children living with ASD and to highlight the needs of children with ASD as well as the needs of their caregivers. Method: A qualitative, descriptive phenomenological study utilising focus group discussions (FGDs) was conducted. Verbatim transcription was used. QSR N ’Vivo 10 was used to organise and analyse the data. Content analysis was used to identify important ideas and concepts. Results: One theme, namely ‘the burden of caring for children with ASD’, was identified. Children with ASD and their caregivers experience isolation and stigmatisation. Conclusion: Occupational therapists in Kenya should collaborate with the relevant national and global stakeholders for the promotion of the inclusion of children with ASD and their families. Responsive and context-appropriate occupational therapy interventions may begin to address service barriers.
Occupational balance of mothers and fathers raising a child with special needs in Flanders
(Stellenbosch : Stellenbosch University, 2017-12) Engelen, Anne-Marie; Sheik Ismail, Arifa; Bester, Juanita; Stellenbosch University. Faculty of Medicine and Health Sciences. Dept. of Health & Rehabilitation Sciences. Occupational Therapy.
ENGLISH SUMMARY : After the birth of a first child, a new role appears. Successful integration and performance of this parent role will positively affect the well-being of both parents, which in turn will enhance child and family well-being. Being a parent of a child with special needs, leads to extra parental occupations. A new distribution of all these different occupations within the occupational pattern urges and can be viewed from three different perspectives, namely: occupational areas, occupational characteristics and time use. The aim of the study was to explore occupational balance as experienced by mothers and fathers rearing a child with special needs in Flanders. Objectives related to this study were to explore the influence of occupations on the occupational balance of mothers and fathers and to explore the differences and similarities between ‘mothers’ and ‘fathers’ perceptions of occupational balance. A qualitative research methodology with semi-structured interviews of 12 parental couples was used. Participants were selected by purposive sampling through chain referral. Once both parents agreed to participate voluntarily a semi-structured interview was conducted, audiotaped and transcribed verbatim. Results, obtained through thematic analysis, showed that extra time for special needs was primarily found in the change of the occupational pattern. So called we- and me-time occupations were reduced. We time was lacking most, as both parents prioritized facilitating the me-time of their spouse above the joyful moments together as a couple. As so called necessary support was already provided by the grandparents, asking extra assistance to obtain time as a couple felt uncomfortable and therefore was often ignored. Although gender related differences were limited, generally mothers were less active at the labour market but conducted more household, care and support activities when compared with fathers. Gender dissimilarities were available in special needs caring and supporting activities. Direct care and support were mainly provided by mothers while fathers were more active in indirect care. To give an example the father takes care of the siblings (indirect care) while the mother is attending the child’s therapy (direct care). Besides the three above mentioned perspectives to view the occupational pattern and to determine the occupational balance, two perspectives were added. Specific characteristics of an individual parent, labelled as personal factors had an effect on the occupational pattern, on the perception of the desired and needed occupations, on the coping strategies and therefore on the perceived occupational balance of each parent. External factors of support were components of support to be transmitted from one individual to another. On the one hand giving support and on the other hand receiving support had an influence on the occupational pattern and balance. Some occupations had to be included while other occupations could be skipped as they were conducted by someone else. To conclude two perspectives namely, personal factors and external factors of support were added to the concept as initially used in this study. All five perspectives are intertwined and used to view the occupational pattern towards the subjectively perceived occupational balance which is a layered and dynamic concept. Focusing on the occupational balance of both parents provides new and valuable information in order to improve parents’ occupational balance.
Occupational injuries reported at Tygerberg Academic Hospital: 2008-2014
(Stellenbosch : Stellenbosch University, 2017-12) Andrews, Blanche Nathalie; Meintjes, Willem Albertus Jacobus; Stellenbosch University. Faculty of Medicine and Health Sciences. Dept. of Health & Rehabilitation Sciences. Occupational Therapy.
ENGLISH SUMMARY : Background: Occupational injuries constitute a huge burden worldwide with significant cost implications. The highest rates and numbers for occupational injuries are found within the healthcare industry in many countries. There is a lack of up-to-date South African statistics. Methods: A retrospective cohort study with a cross-sectional component was performed at Tygerberg Academic Hospital. PERSAL and injury on duty data was analysed for a seven-year period ranging from 2008-2014. Results: A total of 6971 employees contributed 21206.99 person-years from 1 January 2008 to 31 December 2014. Of these employees, 574 individuals sustained 715 injury events. Statistically significantly higher injury rates were found among Non-Clinical staff compared to Clinical staff for most variables assessed. Non-Clinical staff had a 1.91 times increased risk of injury relative to Clinical staff (p<0.001). However, Nursing Professionals had 1.4 times higher odds of injuries with worse outcomes (as measured by the number of sick days reported) (p=0.021). Conclusions: Evidence based interventions need to be implemented to protect the South African healthcare industry workforce. Particular attention should be given to the musculoskeletal injury events among Nursing professionals. More research is required to confirm and clarify the trends identified within this research project.
Occupational therapy assessment of the upper limb : trends in South Africa
(Stellenbosch : Stellenbosch University, 2014-04) De Klerk, Susanna Magdalena; Pretorius, B.; Buchanan, H.; Stellenbosch University. Faculty of Medicine and Health Sciences. Dept. of Interdisciplinary Health Sciences. Division of Occupational Therapy.
ENGLISH ABSTRACT: Introduction: This research was conducted to establish the assessment practices of occupational therapists working with clients with upper limb injuries and/or conditions. This was done to get an updated account of frequency and variation in the use of various assessment tools as well as reasons offered for infrequent use. Methodology: A quantitative cross-sectional survey design was used. A convenience sample of therapists attending courses was recruited for the study. A questionnaire was developed for the study and face and content validity established through pilot testing. The questionnaire consisted of three sections containing demographic information and questions about upper limb assessment practices. Descriptive statistics were calculated for numerical and categorical data to describe the demographic characteristics and to identify the measurement tools that were used most frequently. The Chi-Square test of associations was used to determine whether there were any associations between frequency of use and demographic factors. Results: Questionnaires were completed by 81 (71%) respondents. Twenty-two (27.2%) of the respondents had more than five years’ experience in the field of hand therapy while the remainder (n=52, 64.2%) had less than five years. The more experienced therapists worked in the private sector (n=49, 60.5%) with two (0.03%) experienced therapists being employed in the public sector. The diagnoses that were seen most commonly were nerve injuries (90.1%), fractures (88.8%) and tendon injuries (85.1%). Of the 81 respondents 15 (18.5%) held post graduate qualifications in the field of hand therapy. Goniometry (68 of 81, 84.0%), manual muscle testing (62 of 81, 76.5%) and testing for flexor digitorum profundus and superficialis function (61 of 81, 76.3%) were used most frequently. Performance tests were used infrequently or not at all. The most common reasons for non-use of performance tests were that they were not available in the practice setting or respondents were not familiar with them. Significant associations were found between frequency of using measurement tools and practice setting, years of experience and holding a post graduate qualification in the field of hand therapy. There was a significant association between working in the private sector and using a dynamometer (p < 0.001), and working in government settings and frequent use of the test for localisation (p = 0.021). Therapists with more than five years’ experience in the field of hand therapy were significantly more likely to use Semmes Weinstein monofilaments (p = 0.034) as were those holding a post graduate qualification in hand therapy (p <0.001). Conclusion: The results of this study have serious implications in terms of the upper limb assessment practices of occupational therapists, especially in the context of evidence-based practice which has become crucial not only for the credibility of the profession, but also for its survival. Information obtained through this research could aid to guide education and training at an undergraduate and post graduate level and assist to direct a research focus for hand therapy in the South African context.

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