Department of Health and Rehabilitation Sciences

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Accuracy of clinical neurological examination in diagnosing lumbo-sacral radiculopathy : a systematic literature review
(BioMed Central, 2017-02-23) Tawa, Nassib; Rhoda, Anthea; Diener, Ina
ENGLISH SUMMARY : Background: Lumbar radiculopathy remains a clinical challenge among primary care clinicians in both assessment and diagnosis. This often leads to misdiagnosis and inappropriate treatment of patients resulting in poor health outcomes, exacerbating this already debilitating condition. This review evaluated 12 primary diagnostic accuracy studies that specifically assessed the performance of various individual and grouped clinical neurological tests in detecting nerve root impingement, as established in the current literature. Methods: Eight electronic data bases were searched for relevant articles from inception until July 2016. All primary diagnostic studies which investigated the accuracy of clinical neurological test (s) in diagnosing lumbar radiculopathy among patients with low back and referred leg symptoms were screened for inclusion. Qualifying studies were retrieved and independently assessed for methodological quality using the ‘Quality Assessment of Diagnostic tests Accuracy Studies’ criteria. Results: A total of 12 studies which investigated standard components of clinical neurological examination of (sensory, motor, tendon reflex and neuro-dynamics) of the lumbo-sacral spine were included. The mean inter-observer agreement on quality assessment by two independent reviewers was fair (k = 0.3 – 0.7). The diagnostic performance of sensory testing using MR imaging as a reference standard demonstrated a sensitivity (confidence interval 95%) 0.61 (0.47-0.73) and a specificity of 0.63 (0.38-0.84). Motor tests sensitivity was poor to moderate, ranging from 0.13 (0.04-0.31) to 0.61 (0.36-0.83). Generally, the diagnostic performance of reflex testing was notably good with specificity ranging from (confidence interval 95%) 0.60 (0.51-0.69) to 0.93 (0.87-0.97) and sensitivity ranging from 0.14 (0.09-0.21) to 0.67 (0.21-0.94). Femoral nerve stretch test had a high sensitivity of (confidence interval 95%) 1.00 (0.40-1.00) and specificity of 0.83 (0.52-0.98) while SLR test recorded a mean sensitivity of 0.84 (0.72-0.92) and specificity of 0.78 (0.67-0.87). Conclusions: There is a scarcity of studies on the diagnostic accuracy of clinical neurological examination testing. Furthermore there seem to be a disconnect among researchers regarding the diagnostic utility of lower limb neurodynamic tests which include the Straight Leg Raise and Femoral Nerve tests for sciatic and femoral nerve respectively. Whether these tests are able to detect the presence of disc herniation and subsequent nerve root compression or hyper-sensitivity of the sacral and femoral plexus due to mechanical irritation still remains debatable.
Achieving universal health coverage for people with stroke in South Africa : protocol for a scoping review
(BMJ Publishing, 2020-10) Van Niekerk, Sjan-Mari; Inglis-Jassiem, Gakeemah; Kamalakannan, Sureshkumar; Fernandes, Silke; Webster, Jayne; English, Rene; Smythe, Tracey; Louw, Q. A.
Introduction Stroke is the second most common cause of death after HIV/AIDS and a significant health burden in South Africa. The extent to which universal health coverage (UHC) is achieved for people with stroke in South Africa is unknown. Therefore, a scoping review to explore the opportunities and challenges within the South African health system to facilitate the achievement of UHC for people with stroke is warranted. Methods and analysis The scoping review will follow the approach recommended by Levac, Colquhoun and O’Brien, which includes five steps: (1) identifying the research question, (2) identifying relevant studies, (3) selecting the studies, (4) charting the data, and (5) collating, summarising and reporting the results. Health Systems Dynamics Framework and WHO Framework on integrated people-centred health services will be used to map, synthesise and analyse data thematically.
Approaches toward learning in physiotherapy
(AOSIS Publishing, 2013-11-11) Keiller, L.; Louw, A.
The aim of this study was to investigate the approaches toward learning of undergraduate Physiotherapy students in a PBl module to enhance facilitation of learning at the Stellenbosch University, Division of Physiotherapy in South Africa. This quantitative, descriptive study utilized the revised Two-factor Study Process Questionnaire (r-SPQ-2f) to evaluate the study cohorts’ approaches toward learning in the module. results of the data instruments were analysed statistically and discussed in a descriptive manner. There were a statistically significant greater number of students who adopted a deep approach toward learning at the commencement of the academic year. Students showed a trend toward an increase in their intrinsic interest in the learning material as the module progressed. Students in the Applied Physiotherapy module (ATP) started to shift their focus from a surface learning approach to a deep learning approach. further research is needed to determine the long-term changes in approach toward learning and the possible determinants of these changes. This can be done in conjunction with the implementation of quality assurance mechanisms for learning material and earlier preparation of students for the change in the learning environment.
Arbeidsterapie aan die Universiteit van Stellenbosch 1961 - 1974
(Health and Medical Publishing Group (HMPG), 1975) Dyke, A. P.
Are lifestyle cardiovascular disease risk factors associated with pre-hypertension in 15–18 years rural Nigerian youth? : a cross sectional study
(BioMed Central, 2015-11) Odunaiya, N. A.; Louw, Q. A.; Grimmer, K. A.
Background: Cardiovascular disease (CVD) is a public health concern worldwide. Hypertensive heart disease is predominant in Nigeria. To effectively reduce CVD in Nigeria, the prevalence of, and factors associated with, pre-hypertension in Nigerian youth first need to be established. Methods: A locally-validated CVD risk factor survey was completed by 15–18 year olds in a rural setting in south- west Nigeria. Body Mass Index (BMI), waist-hip ratio and systolic and diastolic blood pressure was measured. Putative risk factors were tested in gender-specific hypothesized causal pathways for overweight/obesity, and for pre-hypertension. Results: Of 1079 participants, prevalence of systolic pre-hypertension was 33.2 %, diastolic pre-hypertension prevalence approximated 5 %, and hypertension occurred in less than 10 % sample. There were no gender differences in prevalence of pre- hypertension, and significant predictors of systolic pre-hypertension (high BMI and older age) were identified. Considering high BMI, older age was a risk for both genders, whilst fried food preference was female-only risk, and low breakfast cereal intake was a male-only risk. Conclusion: Rural Nigerian adolescents are at-risk of future CVD because of lifestyle factors, and high prevalence of systolic pre-hypertension. Relevant interventions can now be proposed to reduce BMI and thus ameliorate future rural adult Nigerian CVD.
Assessment for incipient hospital-acquired deconditioning in acute hospital settings : a systematic literature review
(Medical Journals Sweden AB, 2019) Gordon, Susan; Grimmer-Somers, Karen; Barras, Sarah
Objectives: To systematically identify literature reporting on assessment instruments relevant for incipient hospital-acquired deconditioning during acute hospital admissions; evaluate their psychometric properties; and identify individual assessment items to form the basis of a comprehensive acute hospital test battery for hospital-acquired deconditioning. Design and data sources: Systematic evidence scan of MEDLINE, CINAHL, PubMed and Google Scholar from database inception to January 2018. Study selection: Papers reporting psychometric properties of assessment instruments to detect change in body function and structure, relevant to hospital-acquired deconditioning were selected. Included instruments should assess one or more elements of hospital-acquired deconditioning, reflect the short time-frame constraints of acute hospital admissions, and be able to be applied by any healthcare provider. Quality evaluation: Evidence of psychometric properties and utility were assessed using a validated instrument. Data extraction: Hospital-acquired deconditioning assessment items. Results: Eight potentially-relevant instruments were identified, with moderate-to-good validity and utility, but limited evidence of reliability. These instruments reported a total of 53 hospital-acquired deconditioning assessment items. Seventeen items with measurement periods greater than 3 days were excluded. The remaining items measured anthropometrics, gait, balance, mobility, activities of daily living, and skin integrity. Conclusion: These assessment items provide the basis of a multifaceted evidence-based test battery to comprehensively and repeatedly assess acute hospital inpatient function for incipient hospital-acquired deconditioning.
Benefits of curriculum renewal : the Stellenbosch University physiotherapy experience
(Health & Medical Publishing Group, 2014-10) Unger, Marianne; Hanekom, Susan D.
Background. Driven by a changing healthcare environment, the Division of Physiotherapy (Stellenbosch University) reduced core content and adopted a multimodal approach to teaching and learning. The benefits of curriculum renewal, however, are seldom investigated despite ongoing internal appraisal. Evaluation of the BSc Physiotherapy programme was considered incomplete without determining the worth of the programme. Objectives. To determine whether there was a change in students’ perception of the impact of the programme on personal development; and whether the programme prepared them for community service. Methods. A descriptive comparative desktop analysis was conducted in which the data from the Faculty’s Programme Evaluation process were compared between students enrolled in the old curriculum (2006) and students enrolled in the new curriculum (2011) using pooled data and t-tests to compare responses between the two groups. A level of significance was set at p<0.05. Results. A significant increase in scores was noted for various graduate attributes developed as a result of the programme, such as critical thinking, clinical reasoning, communication and sourcing information (p<0.01). Similarly, students scored their perceptions related to programme structure significantly higher (p<0.01). No change was reported regarding students’ ability to maintain a balance between studies and other activities. Scores pertaining to their perception of readiness for community service or professional practice remained the same with both cohorts believing they were well prepared. Conclusion. The renewed format seemed to benefit students greatly in assisting the development of graduate attributes. Students were significantly more satisfied with the structure of the renewed curriculum and – despite extensive changes – the principles-based multimodal approach to teaching and learning was perceived as effective for preparing students for community service. Programmes undertaking curriculum renewal should not only focus on the curriculum content but also develop a variety of learning opportunities to facilitate the development of graduate attributes. The next cycle of evaluation should however reflect on clinical practice.
Biomechanical risk factors associated with iliotibial band syndrome in runners : a systematic review
(BioMed Central, 2015-11) Aderem, Jodi; Louw, Quinette A.
Background Iliotibial band syndrome is the second most common running injury. A gradual increase in its occurrence has been noted over the past decade. This may be related to the increasing number of runners worldwide. Since the last systematic review, six additional papers have been published, providing an opportunity for this review to explore the previously identified proximal risk factors in more detail. The aim of this systematic review is thus to provide an up to date quantitative synthesis of the trunk, pelvis and lower limb biomechanical risk factors associated with Iliotibial band syndrome in runners and to provide an algorithm for future research and clinical guidance. Methods An electronic search was conducted of literature published up until April 2015. The critical appraisal tool for quantitative studies was used to evaluate methodological quality of eligible studies. Forest plots displayed biomechanical findings, mean differences and confidence intervals. Level of evidence and clinical impact were evaluated for each risk factor. A meta-analysis was conducted where possible. Result Thirteen studies were included (prospective (n = 1), cross-sectional (n = 12)). Overall the methodological score of the studies was moderate. Female shod runners who went onto developing Iliotibial band syndrome presented with increased peak hip adduction and increased peak knee internal rotation during stance. Female shod runners with Iliotibial band syndrome presented with increased: peak knee internal rotation and peak trunk ipsilateral during stance. Conclusion Findings indicate new quantitative evidence about the biomechanical risk factors associated with Iliotibial band syndrome in runners. Despite these findings, there are a number of limitations to this review including: the limited number of studies, small effect sizes and methodological shortcomings. This review has considered these shortcomings and has summarised the best available evidence to guide clinical decisions and plan future research on Iliotibial band syndrome aetiology and risk.
Building capacity for development and implementation of clinical practice guidelines
(Health and Medical Publishing Group, 2017) Louw, Q.; Dizon, J. M.; Grimmer, K.; McCaul, M.; Kredo, T.; Young, T.
Robust, reliable and transparent methodologies are necessary to ensure that clinical practice guidelines (CPGs) meet international criteria. In South Africa (SA) and other low- and middle-income countries, upskilling and training of individuals in the processes of CPG development is needed. Since de novo CPG development is time-consuming and expensive, new emerging CPG-development approaches (adopting, contextualising, adapting and updating existing good-quality CPGs) are potentially more appropriate for our context. These emerging CPG-development methods are either not included or sparsely covered in existing training opportunities. The SA Guidelines Excellence (SAGE) team has responded innovatively to the need for CPG training in SA. We have revised an existing SA course and developed an online, open-access CPG-development toolkit. This Guideline Toolkit is a comprehensive guideline resource designed to assist individuals who are interested in knowing how to develop CPGs. Findings from the SAGE project can now be implemented with this innovative CPG training programme. This level of CPG capacity development has the potential to influence CPG knowledge, development, practices and uptake by clinicians, managers, academics and policy-makers around the country.
Building capacity in primary care rehabilitation clinical practice guidelines : a South African initiative
(BioMed Central, 2018-09-29) Louw, Q.; Grimmer, K.; Dizon, J. M; Machingaidze, S.; Parker, H.; Ernstzen, D.
Background: The large number of South Africans with disability who cannot access good quality rehabilitation presents a public health and human rights challenge. A cost-effective, efficient approach is required to address this. Implementation of high-quality, contextually relevant clinical practice guidelines (CPGs) could be a solution; however, this requires significant investment in innovative capacity-building. Methods: A qualitative descriptive national study was conducted to explore the perspectives of South African stakeholders in rehabilitation, regarding CPG capacity-building. Twenty rehabilitation professionals (physiotherapists, occupational therapists, speech language therapists, podiatrists, rehabilitation managers or directors) were interviewed. Transcribed interview data were analysed using a deductive content analysis approach, mapping findings to an international capacity-building framework to produce new knowledge. Results: Capacity-building is required in content, purpose and construction of locally relevant CPGs, as well as personal, workforce and systems capacity. Principles and strategies were derived to underpin implementation of CPGs that are user friendly, context specific, relevant to the needs of end-users, and achievable within available resources. Collaboration, networks and communication are required at national, provincial and regional level, within and between sectors. A central agency for CPG methods, writing, implementation and evaluation is indicated. Conclusion: South African rehabilitation can benefit from a multi-level CPG capacity-building focusing on performance, personal, workforce and systems issues.
Challenges to infection control in early communication intervention : a scoping review
(AOSIS (Pty) Ltd., 2022-08-03) Achmat, Bilqees; Gerber, Berna
Background: Personal protective equipment (PPE) and infection prevention and control (IPC) measures are crucial to preventing the spread of coronavirus disease 2019 (COVID-19). This study used a scoping review to investigate the challenges that exist when speech–language therapists (SLTs) use IPC measures for providing early communication intervention (ECI). Objectives: To describe existing, recent literature on PPE and IPC measures used in early intervention through a scoping review (steps 1–5) and to consult local clinicians to investigate how SLTs who provide ECI in South Africa relate to these findings (step 6 of the scoping review). Method: A scoping review was performed which followed the PRISMA-ScR framework. Because of limited literature on PPE and IPC measures used by SLTs in providing ECI, the inclusion criteria were adjusted to include PPE and IPC measures used by healthcare workers (HCWs) who provide early intervention to the population of infants and toddlers up to 3 years old. At the time of the review, articles were not older than 10 years and were published between 2011 and 2020. The scoping review included a consultation with South African SLTs who provide ECI, including during the COVID-19 pandemic. A pilot study was conducted prior to the consultations. Seventeen clinicians were included in total. Data from both the pilot study and main consultation were transcribed and analysed in the results using thematic analysis. Results: Fourteen articles were included in the study. The scoping review of existing literature identified challenges to implementing IPC measures, namely the care and behaviour of young children, infrastructure and system challenges, poor compliance and lack of training and a lack of standard IPC protocols. Clinicians in the consultation phase confirmed these challenges and reported that IPC measures did not consider ECI populations nor the settings in which services were provided. Suggestions from the literature for improved infection control included hand hygiene, improved supplies and infrastructure and education and training. Clinicians in the consultation added practical suggestions for implementing IPC measures within ECI, which included an increase in parent-led intervention as well as cleaning and disinfection strategies. Conclusion: This study identified challenges and recommendations of SLTs who use PPE and IPC measures whilst providing ECI. Understanding these challenges can benefit ECI services and future research efforts focused on improving ECI services whilst maintaining IPC standards.
Children with HIV : a scoping review of auditory processing skills
(Public Library of Science, 2019) Dawood, Gouwa; Klop, Daleen; Olivier, Elrietha; Elliott, Haley; Pillay, Mershen
Introduction: Auditory processing disorders can negatively affect academic performance in children. They can result from a number of aetiologies, including the human immunodeficiency virus (HIV). Although studies in paediatrics are limited, research suggests that HIV-infected children display poorer auditory processing skills than uninfected children. Methods: The aims of this study were to scan the peer-reviewed literature on auditory processing skills in HIV-infected children, to describe how auditory processing was tested, how auditory processing skills were reported, and to identify gaps in current evidence. This systematic scoping review was conducted using a modified version of Arksey and O’Malley’s framework. Key words comprised ‘HIV’, ‘auditory processing’, ‘hearing’ and ‘child’. Electronic databases were searched for relevant articles published from 1 January 2000 to 30 April 2018, and reference lists of included studies were pearled. Two researchers reviewed the articles and extracted data on sample descriptors, auditory processing testing procedures, and auditory processing skills. A third author collated the results and resolved discrepancies. The American Speech-Language-Hearing Association description of auditory processing skills framed the analysis. Results: Five articles were included in this review (three from Brazil, one each from Mexico and Tanzania). Samples, and methods of testing were heterogeneous. Three studies reported on localization abilities, while gap detection thresholds, performance on dichotic tasks and speech discrimination scores were reported in one article each. No one study tested all areas of auditory processing skills and there was limited information about the auditory processing skills required for learning. Conclusion:This review highlighted the current sparse evidence-base for auditory processing in HIV-infected children. It identified the need to standardise testing procedures, measures of auditory processing skills, and sample selection.
Choreographing life-experiences of balance control in people with Parkinson’s disease
(BMC (part of Springer Nature), 2020-02-10) LaGrone, Sofie; Joseph, Conran; Johansson, Hanna; Enberg, Birgit; Franzen, Erika
Background: Parkinson’s disease (PD) is a devastating neurodegenerative disorder. Reduced balance is one of the cardinal symptoms of PD, predisposing people living with PD to experience difficulties with the execution of tasks and activities, as well as hindering their involvement in meaningful life areas. The overarching aim of this study was to explore how deficits in balance control manifest in everyday life and how it is managed by people with PD (PwPD). Methods: Qualitative description was used as methodology, and in-depth interviews were conducted with 18 participants, between the ages of 46 to 83 years, with mild to severe PD. Interview transcripts were analyzed using qualitative content analysis, following an inductive approach. Results: One theme emerged from the analysis: Increased planning—choreographing life. Within this overarching theme, two categories were identified, namely Limitations in mobility and New restricted functioning in everyday life, each with 3–4 sub-categories. The categories described how PwPD handled decreased balance control in their everyday life by using motor and cognitive strategies as a consequence of not trusting their body’s capacity to control balance. Activities in everyday life, as well as the ability to partake in leisure and social activities were profoundly affected. Conclusion: People with mild to severe PD used strategies to handle decreased balance and they choreographed their lives around their individual current state of mobility and balance. The knowledge gained from this study can be used to develop targeted interventions addressing the nuances of balance deficits in everyday life.
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.
Clinical educators' self-reported personal and professional development after completing a short course in undergraduate clinical supervision at Stellenbosch University
(Health & Medical Publishing Group, 2013-05) Schmutz, Anna Maria; Gardner-Lubbe, Sugnet; Archer, Elize
Background. In 2007, a Supervision Course in Undergraduate Clinical Supervision was developed at the Faculty of Medicine and Health Sciences at Stellenbosch University in South Africa. The target group was inter-professional clinical educators that are involved in student education on the clinical platform. Although the course participants were professionals and specialists in their own fields, the majority of clinical educators have very little or no knowledge of adult education. The Supervision Course aims to develop clinical supervision skills of clinical educators by exposing these supervisors to basic principles of education and specifically clinical teaching, resulting in quality education for undergraduate students. The aim of this study was to determine the impact of this short course on the personal and professional growth of the clinical educator. Methods. A qualitative study was performed, including an open-ended questionnaire that provided opportunity for the clinical educators to elaborate freely on their strengths, weaknesses and areas of desired improvement before and after the Supervision Course, and a semi-structured individual interview after the Supervision Course. The questionnaire data were categorised according to strengths, weaknesses and areas of desired improvement. An inductive approach was used to analyse the qualitative data. Key themes that emerged from the interviews were identified and grouped together in categories. Results. The results are summarised in table format to identify themes with supporting quotes. Conclusion. Although a small sample, this study demonstrates the personal and professional growth reported by attendees of a clinical supervision short course.
The clinical effect of hippotherapy on gross motor function of children with cerebral palsy
(AOSIS Publishing, 2013-12-11) Little, K.; Nel, N.; Ortell, V.; Van Wyk, H.; Badenhorst, M.; Louw, Q. A.
Background: Cerebral palsy (CP) is the most common cause of physical disability affecting gross motor function (GMF ) in early childhood. Hippotherapy is a treatment approach aimed at improving GMF in children with CP. Several systematic reviews have been published showing an improvement in Dimension E of the Gross Motor Function Measure (GMFM ) after hippotherapy. However, these reviews failed to evaluate the clinical effect of hippotherapy in improving GMF in children with CP. Objective: To critically appraise the evidence of hippotherapy to ascertain whether it is a clinically meaningful approach for children with CP. Methodology: Five computerised bibliographic databases were searched. Predetermined inclusion and exclusion criteria were set. The PEDro scale was used to assess the quality of the studies. A revised JBI Data extraction tool was used to extract data from the selected articles. Revman© Review Manager Software was used to create forest plots for comparisons of results. Results: All studies used the GMFM as an outcome measure for gross motor function. The added benefit of hippotherapy is a minimum 1% and a maximum 7% increase on the GMFM scores. However, all 95% confidence intervals (CI ) around all the mean differences were insignificant. Conclusion: The clinical effect of hippotherapy on the GMF of children with CP is small. Larger studies are required to provide evidence of the effect of hippotherapy within this population.
Clinical practice guidelines for the management of chronic musculoskeletal pain in primary healthcare : a systematic review
(BioMed Central, 2017-01-05) Ernstzen, Dawn V.; Louw, Quinette A.; Hillier, Susan L.
ENGLISH SUMMARY : Background: Up-to-date, high quality, evidence-based clinical practice guidelines (CPGs) that are applicable for primary healthcare are vital to optimize services for the population with chronic musculoskeletal pain (CMSP). The study aimed to systematically identify and appraise the available evidence-based CPGs for the management of CMSP in adults presenting in primary healthcare settings. Methods: A systematic review was conducted. Twelve guideline clearinghouses and six electronic databases were searched for eligible CPGs published between the years 2000 and May 2015. CPGs meeting the inclusion criteria were appraised by three reviewers using the Appraisal of Guidelines Research and Evaluation (AGREE) II. Results: Of the 1082 records identified, 34 were eligible, and 12 CPGs were included based on the inclusion and exclusion criteria. The methodological rigor of CPG development was highly variable, and the median domain score was 66%. The median score for stakeholder involvement was 64%. The lowest median score was obtained for the domain applicability (48%). There was inconsistent use of frameworks to aggregate the level of evidence and the strength of the recommendation in the included CPGs. The scope and content of the included CPGs focussed on opioid prescription. Conclusion: Numerous CPGs that are applicable for the primary healthcare of CMSP exists, varying in their scope and methodological quality. This study highlights specific elements to enhance the development and reporting of CPGs, which may play a role in the uptake of guidelines into clinical practice. These elements include enhanced reporting of methodological aspects, the use of frameworks to enhance decision making processes, the inclusion of patient preferences and values, and the consideration of factors influencing applicability of recommendations.
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.
Community integration of adults with disabilities post discharge from an in-patient rehabilitation unit in the Western Cape
(AOSIS Publishing, 2017) Gretschel, Dietlind; Visagie, Surona; Inglis, Gakeemah
Introduction: Community integration is an important outcome of rehabilitation, because the ultimate focus of rehabilitation is to enable people to participate in their life roles. Aim: To determine community integration scores achieved by adults with disabilities post discharge from an in-patient rehabilitation centre in the Western Cape Province. Method: Fifty-nine individuals participated in this cross-sectional study. Community integration was determined using the Reintegration to Normal Living Index (RNLI). Descriptive analysis of age, gender, medical diagnosis and RNLI scores was performed. Kruskal–Wallis test and t-tests were used to determine whether there exists any relationship between age, gender, medical diagnosis and RNLI scores (p < 0.05). Results: Participants’ mean age was 45 (± 15.9) years. Of the study participants, 54% were women. The most common diagnosis was stroke (41%), followed by spinal cord injury (30%). The mean overall RNLI score was 66.3 (± 25.5). Persons with brain trauma (stroke or head injury) had a mean of 60.9 (±20.3); those with spinal cord injury had a mean of 75.2 (± 25.8) and those with peripheral impairments had a mean of 65.5 (± 30.5). The RNLI domains ‘personal relationships’ 73.45 (± 31.6) and ‘presentation of self’ 72.13 (± 35.4) recorded the highest mean scores. The domain ‘work or meaningful activities’ had the lowest mean score 52.54 (± 35.3). ‘Community mobility’ (59.9; ± 34.6) and ‘recreation’ (57.3; ± 37.2) also had mean scores below 60. No statistically significant relationships were found between age, gender and medical diagnosis and RNLI scores. Conclusion: The relatively low mean scores indicate that participants achieved poor community reintegration.
Contextualised strategies to increase childhood and adolescent vaccination coverage in South Africa : a mixed-methods study
(BMJ Publishing, 2020-06-04) Wiysonge, Charles Shey; Mahasha, Phetole Walter; Ndwandwe, Duduzile Edith; Ngcobo, Ntombenhle; Grimmer, Karen; Dizon, Janine; Burnett, Rosemary J.; Cooper, Sara
Introduction Despite the unparalleled success of immunisation in the control of vaccine preventable diseases, immunisation coverage in South Africa remains suboptimal. While many evidence-based interventions have successfully improved vaccination coverage in other countries, they are not necessarily appropriate to the immunisation needs, barriers and facilitators of South Africa. The aim of this research is to investigate barriers and facilitators to optimal vaccination uptake, and develop contextualised strategies and implementation plans to increase childhood and adolescent vaccination coverage in South Africa. Methods The study will employ a mixed-methods research design. It will be conducted over three iterative phases and use the Adopt, Contextualise or Adapt (ACA) model as an overarching conceptual framework. Phase 1 will identify, and develop a sampling frame of, immunisation stakeholders involved in the design, planning and implementation of childhood and human papillomavirus immunisation programmes in South Africa. Phase 2 will identify the main barriers and facilitators to, and solutions for, increasing vaccination coverage. This phase will comprise exploratory qualitative research with stakeholders and a review of existing systematic reviews on interventions for improving vaccination coverage. Using the findings from Phase 2 and the ACA model, Phase 3 will develop a set of proposed interventions and implementation action plans for improving immunisation coverage in South Africa. These plans will be discussed, revised and finalised through a series of participatory stakeholder workshops and an online questionnaire, conducted as part of Phase 3.

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