Occupational Therapy

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Arbeidsterapie aan die Universiteit van Stellenbosch 1961 - 1974
(Health and Medical Publishing Group (HMPG), 1975) Dyke, A. P.
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.
Clients’ subjective experience of their participation in rehabilitation at an out-patient community rehabilitation center
(Occupational Therapy Association of South Africa, 2016) Kloppers, Maatje; Pretorius, Blanche; Vlok, Elizabeth Daphne
Introduction: Rehabilitation services in South Africa are governed by various policies. It is important to evaluate these services to assess if the services are achieving their aims as set out in these policies. The evaluation should include the outcomes that clients achieve by participating in rehabilitation services. Method: The findings presented were obtained as part of a larger mixed methods descriptive study and this paper will focus on clients’ subjective experience of participating in rehabilitation. Convenience sampling was used to select 78 clients from the five most prevalent diagnostic groups seen at the centre. Semi-structured interviews were conducted, transcribed and analysed by means of basic content analysis. Results: Clients commented on the emotional impact that participating in rehabilitation had had on them and on the physical changes it had brought about. Clients experienced a high level of satisfaction with the service and enjoyed participating in rehabilitation. The knowledge, skills and confidence that they gained enabled them to be more independent in Daily life activities and to share this knowledge with others in their community. Conclusions: The results emphasise the importance of providing rehabilitation services for persons with disabilities that are based in their community. It will be useful in further service and policy planning for persons with disabilities.
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.
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 ethnography of the Vona du Toit Creative Ability Model (VdTMoCA) in the South African occupational therapy context
(Stellenbosch : Stellenbosch University, 2022-12) Zelda, Coetzee; van Niekerk, Lana; Duncan, Eve; Stellenbosch University. Faculty of Medicine and Health Sciences. Dept. of Health and Rehabilitation Sciences. Occupational Therapy.
ENGLISH SUMMARY: Background: The Vona du Toit Model of Creative Ability (VdTMoCA) influenced South African occupational therapy education and practice for over 40 years. Limited empirical evidence for the Model exists. A first study verified the original levels of Creative Ability in 2010. Philosophical assumptions underpinning the Model are not known, nor whether they align with the original assumptions. Increasing utility of the Model warrants verification for practitioners to practice confidently when using the VdTMoCA. With little empirical evidence, the Model may resemble a sacred text. Methods: Critical ethnographic methodology was chosen to elicit critical encultured interpretations about the ontological, epistemological, methodological and axiological philosophical assumptions underpinning the VdTMoCA for three generations of occupational therapists: the Progenitor, first- and second-generation respondents. First-and secondgeneration respondents were selected by criterion sampling. Collected data included original academic documents, ethnographic interviewing and observations. Data was analysed inductively, deductively and across cases using five levels of analysis. Findings: Three themes describing the creative ability mindset emerged: “humans and their reality”, “creative ability and practice” and “application [of creative ability] in occupational therapy”. The findings show intergenerational agreement with the Progenitor’s original philosophical assumptions about the Model when used with persons with a medical condition, accessing a Westernized healthcare service context. Outliers arose when the Model was interpreted in its original form for community living where different cultures and unequal resources are present. Conclusions: Findings suggest philosophical and theoretical expansions of the VdTMoCA to include how creative ability is/can be developed for practice in naturalistic contexts. Specifically, the assumption that “motivation to do”, a patterned motivational response, arises not only between people (P) and their occupations(O) but is also stimulated from the relationship with contexts(C). Therefore, motivational factors present in naturalistic contexts must form part of the motivational dimension (P0C) for intervention.
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.
Development and feasibility of an educational intervention to improve participation for people with spinal cord injury from Gaza, Palestine
(Stellenbosch : Stellenbosch University, 2023-12) Abu Mostafa, Moussa Kleib; Plastow, Nicola Ann; Savin-Baden, Maggi; Stellenbosch University. Faculty of Medicine and Health Sciences. Dept. of Health and Rehabilitation Sciences. Occupational Therapy.
ENGLISH SUMMARY: Background: Many people with Spinal Cord Injury (SCI) in Low and Middle-Income Countries (LMICs) such as the Gaza Strip of Palestine are discharged prematurely from inpatient rehabilitation settings with inadequate skills in Activities of Daily Living (ADL). This gap may result in severe complications, e.g., pressure injuries, muscle contractures, incontinence disorders, and urinary tract infections. Consequently, participation of people with SCI (PW-SCI) in chosen purposeful activities may be limited and community participation may be restricted, leading to occupational deprivation and occupational imbalance. Resources allocated for the rehabilitation of SCI in the Gaza Strip are limited, and thus do not meet the multiple needs of PW-SCI. Moreover, many resources of health education for SCI were developed in high-income Western countries, which made them irrelevant for PW-SCI from low to middle-income countries with predominantly Islamic faith. Aim of the research: This study aimed to co-develop and evaluate the feasibility and initial effectiveness of an ADL education manual for use in inpatient SCI rehabilitation in Gaza, Palestine. Research question: Can a complex educational ADL intervention co-developed for and with patients with SCI treated in inpatient rehabilitation settings within the Gaza Strip optimise rehabilitation outcomes? Objectives: 1.To determine the effect of ADL education for inpatients with SCI in a rehabilitation setting through a systematic review and meta-analysis. 2.To co-develop an evidence-informed ADL education manual for PW-SCI (SADL-eM)using Participatory Action Research methods. 3.To test the usability of clinician-rated rehabilitation outcome measures, and acceptability of the SADL-eM, in a feasibility study. 4.To test procedures, estimate recruitment and retention, and initial effect of the SADL-eM in a pilot randomised controlled trial. Postdoctoral work this includes conducting a randomized clinical trial (RCT) while avoiding back draws of the current study. The researcher will recruit the sample from the Gaza Strip community-dwelling PW-SCI population with specific inclusion criteria to improve the reliability of the collected data. Methodology: The researcher adopted the UK Medical Research Council (MRC) framework for developing complex interventions that involve four phases, namely: development, feasibility and piloting, evaluation, and implementation. The researcher selected the study design for each phase according to the overall aim and study objectives. After obtaining the necessary ethical approval, the researcher in the development phase employed a systematic review and meta-analysis design to identify the current evidence base. Then, the researcher conducted a qualitative study that employed Participatory Action Research (PAR) to co-develop the educational model/intervention (Spinal Cord Injury Activities of Daily Living education manual). Within the feasibility and piloting phase, the researcher conducted a feasibility study to test the usability of clinician-rated rehabilitation outcome measures and patient acceptability of the SADL-eM, and a pilot study to test the procedure and to estimate recruitment, retention, and initial effectiveness of the SADL-eM.
The development of Hopscotch : an early intervention programme to improve motor skills and academic performance of grade R children in the West Coast of South Africa
(Stellenbosch : Stellenbosch University, 2022-04) Van der Walt, Janke; Plastow, Nicola; Unger, Marianne; Stellenbosch University. Faculty of Medicine and Health Sciences. Dept. of Health and Rehabilitation Sciences. Occupational Therapy.
ENGLISH SUMMARY: There is a high incidence of motor skill impairment in low socio-economic areas. Motor skill impairment among pre-school children effects their functional development, including play, social development, and academic skills and progress. These children need therapeutic input; however, therapy resources are often not accessible and motor skill impairment may remain unrecognised and untreated. This study aims to develop an accessible evidence-based motor skill intervention for grade R children in a rural low socio-economic area of South Africa, namely the West Coast. It is a five-stage study with a sequential mixed-methods design and using the theoretical model of complex intervention development. Firstly, in the absence of prevalence data for motor skill impairment in South Africa, a prevalence study using a cross-sectional descriptive study design and multi-stage cluster sampling was conducted. The study showed a high prevalence of motor skill impairment at 14.5%. Significant influencing factors identified were gender (male), lack of playground equipment, low weight and height and low socio-economic status of an area. Next, a scoping review was conducted to investigate the key elements of motor skill interventions for pre-school children. The PRIMA-SCR design was used to identify 45 studies through structured data-base searches, followed by title and abstract screening according to inclusion and exclusion criteria. The identified key elements were summarised in a proposed framework for intervention planning. A three-round Delphi study conducted with experts in the field of motor skill intervention followed on from the scoping review. The aim was to determine what the components of a feasible, cost effective motor skill intervention for pre-school children in the rural low socio-economic West Coast area would be. Consensus was reached at 75% or mean >4. A school-based, small-group intervention, facilitated by teachers under guidance and supervision of therapists was proposed. The Hopscotch motor skill intervention programme was subsequently developed, following on from the informative reviews. The result is a cost effective, school-based, 12 week intervention. A task-shifting approach was adopted where teachers facilitate the programme under the supervision of therapists. The study concludes with a protocol paper for an exploratory randomised controlled trial to determine the preliminary effect of the Hopscotch programme. A cluster randomised stepped wedge trial design is proposed to provide two randomised clusters of schools the opportunity to potentially benefit from the programme. It is envisaged that further research to evaluate the intervention will follow the pilot study. The Hopscotch motor skill-intervention programme may be a feasible solution to provide children in rural low socio-economic areas with much needed cost-effective, yet high quality intervention. The development of this complex intervention is a fluid, ongoing process and its preliminary effect is yet to be determined. The outcomes of this study suggests further research in the areas of culturally sensitive screening tools, inclusivity of intervention groups and feasibility of roll-out to other areas.
The effect of a repeated course of constraint-induced movement therapy, implemented in the home environment, on the functional skills of a young child with cerebral palsy
(Occupational Therapy Association of South Africa, 2012-12) Hamer-Rohrer, Ursula; Smit, Neeltje; Burger, Marlette
The lack of research in South Africa related to the use of Constraint-Induced Movement Therapy (CIMT) motivated this single-system (A-B-A-B-A) study. The aim was to investigate whether a repeated course of CIMT would improve self-care, play and functional skills of a young boy with asymmetrical cerebral palsy (CP). The subject’s less affected arm was placed in a sling for a period of six hours during the intervention phases. The duration of the CIMT was 10 working days, followed by a two-week withdrawal phase. This sequence was repeated once. The subject was engaged in play and self-care activities in his home environment during the intervention phases. The Pediatric Evaluation of Disability Inventory (PEDI) was used to assess the subject six times: at the start; before and after interventions; and after the last withdrawal phase. The minimal clinically important difference (MCID) was calculated between the first and last assessments to determine the effectiveness of the CIMT. The critical 11 points difference was reached in the PEDI self-care domain for functional skills (such as dressing and washing) and in the social functioning domain for caregiver assistance (indicating that the caregivers were giving less assistance with regards to participation in household chores, communication and play ability).
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 enhanced individual placement and support (IPS) intervention based on the Model of Human Occupation (MOHO); a prospective cohort study
(BMC (part of Springer Nature), 2020-07-08) Prior, Susan; Maciver, Donald; Aas, Randi W.; Kirsh, Bonnie; Lexen, Annika; Van Niekerk, Lana; Fitzpatrick, Linda Irvine; Forsyth, Kirsty
Background: Employment is good for physical and mental health, however people with severe mental illness (SMI) are often excluded from employment. Standard Individual Placement and Support (IPS) is effective in supporting around 55% of people with SMI into employment or education. Current research considers enhancements to IPS to improve outcomes for those requiring more complex interventions. Clinicians need to better understand who will benefit from these enhanced IPS interventions. This study offers a new enhanced IPS intervention and an approach to predicting who may achieve successful outcomes. Methods: This prospective cohort study included people with SMI who participated in an enhanced IPS service and had prolonged absence from employment. Secondary data analysis was conducted of data gathered in routine clinical practice. Univariate analysis coupled with previous research and clinical consultation was used to select variables to be included in the initial model, followed by a backward stepwise approach to model building for the final multiple logistic regression model with an outcome of successful or unsuccessful goal attainment (employment or education). Results: Sixty-three percent of participants in the enhanced IPS successfully attained employment or education. Significant relationships from bivariate analyses were identified between outcomes (employment or education) and seven psychosocial variables. Adapting Routines to Minimise Difficulties, Work Related Goals, and Living in an Area of Lesser Deprivation were found to be significant in predicting employment or education in the final multiple logistic regression model R2 = 0.16 (Hosmer-Lemeshow), 0.19 (Cox-Snell), 0.26 (Nagelkerke). Model χ2(7) = 41.38 p < .001. Conclusion: An enhanced IPS service had a 63% rate success in achieving employment or education, higher than comparable studies and provides an alternative to IPS-Lite and IPS-standard for more complex populations. Motivational and habitual psychosocial variables are helpful in predicting who may benefit from an enhanced IPS intervention supporting people after prolonged absence from employment.
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 factors shaping family involvement in promoting the participation of adults with substance use disorders in meaningful occupations
(Stellenbosch : Stellenbosch University, 2019-04) Chikwanha, Theodora Mildred; Van Niekerk, Lana; Ikiugu, Moses; Stellenbosch University. Faculty of Medicine and Health Sciences. Dept. of Health & Rehabilitation Sciences. Occupational Therapy.
ENGLISH SUMMARY : Background and rationale: Approximately 60% of re-admissions at the main acute mental health units at two of the referral hospitals in Zimbabwe comprise of adults with substance use disorders. Occupational therapy management of individuals recovering from substance use disorders at these institutions begins in the acute phase when clients are hospitalised. There are no rehabilitation programmes with defined minimum care standards in which occupational therapy is available to people with substance use disorders. Follow up of clients in their homes is also not possible due to limited financial and human resources. There is therefore no further psychosocial support or follow up rehabilitative care for clients with substance use disorders post discharge, their families take over the caring role. Aim: In this study, I explored the influence of the family on rehabilitation outcomes by examining the extent to which family involvement promoted participation in meaningful occupations by adults recovering from substance use disorders. Specific objectives: The specific objectives of this study were to: - Explore how a family member’s substance use affected his/her occupational patterns as well as those of other family members - Investigate what made it difficult or easier for families to support a family member who was undergoing occupational therapy to help modify substance use behaviour - Investigate how involvement of family members in occupational therapy interventions influenced participation in meaningful occupations by adults with substance use disorders - Develop a treatment framework for family based occupational therapy interventions for substance use disorders in the Zimbabwean context Methodology: This study was positioned within a decoloniality perspective. A qualitative design using a narrative inquiry approach was used to conduct this study. Fourteen family units with an adult family member recovering from substance use disorders participated in the study. Purposive maximum variation sampling was used during recruitment. Narrative interviews on the family`s experiences of living with an adult family member with a substance use disorder were conducted. Data were transcribed and analysed using interpretive narrative analysis strategies. Results: The theme “Reconstructing occupational participation through transactions enacted within the family context” emerged as the overarching theme during data analysis. The overarching theme comprised of two subthemes namely i) Occupational disruption from an intrapersonal and interpersonal perspective and ii) The centrality of the family in creating opportunities for participating in occupations. Exploring the connections between these subthemes and the overarching theme afforded the exploration of factors shaping family involvement in promoting the participation of adults with substance use disorders in meaningful occupations. Conclusion: The findings indicated that the family is extremely important in the management of substance use disorders. Through support from family members, the relatives who were recovering from substance use disorders were able to identify new occupational opportunities and reconstruct occupational participation. The new opportunities for occupational participation facilitated future participation in occupations that were health enhancing. These findings provided useful insights into the occupational therapy services that would be contextually relevant for individuals recovering from substance use disorders in Zimbabwe. A treatment framework which is occupation based and initiated by the families was proposed as a sustainable approach to providing post discharge occupational therapy services.
Exploring service providers’ perspectives on the prevention and management of fetal alcohol spectrum disorders in South Africa : a qualitative study
(BMC (part of Springer Nature), 2018-11-06) Adebiyi, Babatope O.; Mukumbang, Ferdinand C.; Cloete, Lizahn G.; Beytell, Anna-Marie
Background: Fetal alcohol spectrum disorder (FASD) is among the leading causes of developmental and intellectual disabilities in individuals. Although efforts are being made toward the prevention and management of FASD in South Africa, the prevalence remains high. The sustained high prevalence could be attributed to several factors, including the lack of policy for a coordinated effort to prevent, diagnose and manage FASD nationally. In this study, our aim was to explore the perspectives of service providers (health and allied professionals, teachers, social workers) on the prevention and management of FASD towards developing a guideline to inform policy. Method: Guided by the exploratory qualitative research design, we purposively sampled relevant service providers in the field of FASD prevention and management for focus group discussions. Nine of these discussions were conducted with to eight participants per discussion session. The discussants were asked various questions on the current and required interventions and practices for the prevention and management of FASD. Following the Framework Method, data were transcribed verbatim and analysed using the thematic content analysis approach. Results: Our findings show that aspects of the prevention and management of alcohol-related conditions are present in various policies. However, there is no clear focus on coordinated, multi-sectoral efforts for a more comprehensive approach to the prevention and management of FASD. The participants recognized the need for specific requirements on broad-based preventive awareness programs, training and support for parents and caregivers, inclusive education in mainstream schools and training of relevant professionals. Conclusion: Comprehensive and coordinated prevention and management programs guided by a specific policy could improve the prevention and management of FASD. Policy formulation demonstrates commitment from the government, highlights the importance of the condition, and elaborates on context-specific prevention and management protocols.
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 factors that affect the transition from student to health professional : an integrative review
(BioMed Central, 2021-11) Opoku, Eric Nkansah; Jacobs‑Nzuzi Khuabi, Lee-Ann; Van Niekerk, Lana
Background: The nature of a new health professional’s transition from student to health professional is a signifcant determinant of the ease or difculty of the journey to professional competence. The integrative review will explore the extent of literature on the factors that impact the transition of new health professionals into practice, identify possible gaps and synthesise fndings which will inform further research. The aim was to identify research conducted in the last two decades on the barriers, facilitators and coping strategies employed by new health professionals during their transition into practice. Methods: Whittemore and Knaf’s methodological framework for conducting integrative reviews was used to guide this review. Sources between 1999 and 2019 were gathered using EBSCOhost (including CINAHL, Medline, Academic Search Premier, Health Science: Nursing and Academic Edition), PubMed, Scopus, Cochrane and Web of Science, as well as hand searching and follow-up of bibliographies followed. The Covidence platform was used to manage the project. All studies were screened against a predetermined selection criteria. Relevant data was extracted from included sources and analysed using thematic analysis approach. Results: Of the 562 studies identifed, relevant data was extracted from 24 studies that met the inclusion criteria, and analysed to form this review. Thematic analysis approach was used to categorise the fndings into theme areas. 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. Conclusion: The transition into practice for new health practitioners has been described as complex and a period of great stress. Increasing clinical and practical experiences during education are required to support new health professionals in the process of closing the gap between learning and practice. Continued professional development activities should be readily available and attendance of these encouraged.

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