- ItemDemystifying cultural competence in the physiotherapy profession : a scoping review and concept analysis(Stellenbosch : Stellenbosch University, 2023-03) Truter, Christel; Joseph, Conran; Louw, Quinette; Stellenbosch University. Faculty of Medicine and Health Sciences. Dept. of Health and Rehabilitation Sciences.ENGLISH SUMMARY: Background: The ability to engage with patients from different cultural backgrounds and worldviews is accepted as a fundamental skill in healthcare professions, including physiotherapy. The term cultural competence is a critical principle in numerous international policies on healthcare and training outcomes of students as a mechanism to strengthen healthcare provision towards patient-centred care. Aim: This study explores defining attributes of cultural competence in physiotherapy practice to better understand the meaning structure and dimensions. Methods: A scoping review methodology with a concept analytical framework was used to describe the use of the term and its derivatives and the meaning structure in terms of antecedents, defining attributes, consequences, and empirical referents. The methodology included five steps, namely (1) motivation for selecting the concept, (2) identifying the research question and objectives, (3) identifying the relevant papers, (4) study selection, (5) charting the data, collating, summarising, and reporting the results. Five electronic databases were searched for information published from 2007-2021 to achieve this. The last search was done in August 2021. Results: Ten journal articles were included in the review, mainly from the UK and Australia. The term most frequently used in the literature is cultural competence. Antecedents, defining attributes and consequences of the concept of cultural competence were identified in the concept analysis. Defining attributes were categorised as cognitive or socio-behavioural competency, which can impact intrapersonal, interpersonal, organisational, societal levels or a combination of two or more levels. Eight competencies were respectively identified in both the cognitive and socio-behavioural domains. The competencies of reflection on one’s cultural background, values and acknowledgement of different worldviews and the mastery of cultural knowledge, values, beliefs, and behaviour of the ‘other’ are underlined in the included papers in the cognitive domain. Furthermore, the competencies in the socio-behavioural domain of incorporating individualised culturally competent care based on respect, trust, acceptance, empathy, and accountability in practice are most frequently discussed. Conclusion and implications: The central findings of this study demystified the concept of cultural competence in physiotherapy practice by highlighting eight cognitive and eight socio-behavioural attributes. Furthermore, these 16 attributes were spread across different levels of manifestations, namely on the intrapersonal, interpersonal, organisational, and societal levels. The findings provide a theoretical grounding for cultural competence by identifying its defining attributes in the physiotherapy literature to date. Physiotherapists need to learn how to develop the cognitive and socio-behavioural competencies of cultural competence. Healthcare environments need to provide them with adequate support to develop the skills and behaviours to provide culturally competent care to clients. Healthcare institutions must incorporate culturally competent care into their philosophy and goals and provide resources, instruments, and training to improve physiotherapists’ ability to provide culturally competent care.
- ItemThe unmet functioning needs of persons with long term traumatic spinal cord injury in Kenya(Stellenbosch : Stellenbosch University, 2023-03) Lijodi, Brenda Ayuma; Joseph, Conran; Titus, Adnil; Stellenbosch University. Faculty of Medicine and Health Sciences. Dept. of Health and Rehabilitation Sciences. Physiotherapy.ENGLISH SUMMARY: Background: Spinal Cord Injury (SCI) is damage of the spinal cord due to trauma, disease, or degeneration, leading to activity limitations and participation restrictions of the individual in the society. In Kenya, there is only one referral hospital for spinal cord injury rehabilitation After discharge, follow up in the community is rarely done. There is therefore a need to better understand the unmet functioning needs of persons with SCI in Kenya. Aim: To determine the unmet functioning needs, in terms of health status (secondary medical conditions), activity limitations, and participation restrictions, as well as the prevalence of environmental challenges of community- dwelling of persons with TSCI (PWTSCI). Methods: : A cross-sectional design was used to determine the health status and functioning of persons with SCI (PWSCI). A report of the secondary medical conditions (SMC), activity limitations, participation restrictions and environmental barriers was compiled using the International Spinal Cord Injury Community Survey (InSCI) questionnaire. The demographic information was summarized using descriptive statistics. Inferential statistics, i.e., measures of association, were done to ascertain differences in sub-groups, for example, sex, level of injury, completeness of injury, and duration of injury Results: 66 (73%) were categorically male and 24 (27%) females, with a male to female ratio of 2.8:1. The mean age at the time of injury was 32.04 years (s.d. 9.60), while most of the participants were in the 31-45 age group. Economically, 40% of the participants received a monthly income of less than 1100 Kshs (approx. 11 USD). 90% had paraplegia and 66% of participants presented with complete SCI. In terms of secondary medical conditions, the most common reported were bladder dysfunction (60%), sexual dysfunction (57%), pain (44%), and bowel dysfunction (47%). The least reported complications were injury caused by loss of sensation (3%), autonomic dysreflexia (9%), and postural hypotension (12%). The leading SMC in males was sexual dysfunction at 62% while in females, bladder dysfunction at 70%. The leading SMCs among participants with tetraplegia, paraplegia, complete and incomplete injury was bladder dysfunction. Most of the participants experienced activity limitations in toileting (76%), dressing the lower body (63%), dressing the upper body (59%), and bladder management (56%). Participation restrictions reported by most of the participants were using public transportation (90%), standing unsupported (83%), and getting to destination (76%). The leading participation restriction reported by males and females, participants with tetraplegia and paraplegia, complete and incomplete injury, was using public transportation. The prevalent environmental barriers experienced by the participants were inadequate finances (96%), inaccessibility to public places (92%) and lack of adaptive equipment for long distance transportation (90%). Inadequate finances was the most prevalent barrier experienced by both the male and female participants, participants with tetraplegia and paraplegia, and those with complete and incomplete injury. Conclusion: This study highlighted the unmet functioning needs of PWTSCI in Kenya, which will require strengthening of health services, improved access to care, and improved intersectoral collaboration between healthcare, social welfare services, transportation, and infrastructure. Rehabilitation services should also be more community oriented to increase community participation.
- ItemThe impact of prosthetic limbs on children with bilateral lower limb amputations using the lived experiences of two adult prosthetic users and healthcare practitioners(Stellenbosch : Stellenbosch University, 2023-03) Zantsi, Siphosethu; Joseph, Conran; Ennion, Liezel; Stellenbosch University. Faculty of Medicine and Health Sciences. Dept. of Health and Rehabilitation Sciences. Physiotherapy.ENGLISH SUMMARY: Background: Major lower limb amputations can have a life-changing impact on an individual’s functional mobility. The literature supports the view that children with lower limb amputations, even bilateral amputations, have the potential to be highly functional with a prosthesis. However, there is insufficient research to demonstrate the impact of prostheses on children with bilateral lower limb amputations. This challenges the screening and prescription requirements currently in use which tends to hinder the equitable distribution of prosthetics among people with bilateral lower limb amputations. Aim: The aim of this study was to explore and describe the constructs that determine the impact of prosthetic interventions on children with bilateral lower limb amputations. Method: A multiple-methods approach was adopted for this study which consisted of a secondary scoping review and a primary qualitative study. The scoping review used Arksey & O’Malley’s (2005) five steps to explore and described the constructs used to evaluate the prosthetic impact in children with lower limb amputations in current literature. The information obtained from this review was then used to design the qualitative study. A qualitative approach and descriptive design were also taken for this study. Semi-structured interviews were conducted with two groups of key informants. Group A (five participants) consists of physiotherapists and prosthetists who have experience rehabilitating children with bilateral lower limb amputations. Group B (two participants) include adult prosthetic users who have undergone bilateral lower limb amputations in childhood. In total, seven individuals participated in the study. The interviews were conducted virtually and were recorded, transcribed and analysed using deductive analysis. Results: The findings from the scoping review showed that the constructs and outcome measures used to evaluate the prosthetic impact in children with lower limb amputations had a high focus on physical function as an outcome and were limited in evaluating other constructs of impact in prosthetic intervention, with little focus on the qualitative experiences of prosthetic users, specifically relating to satisfaction, quality of life, and other socio-relational constructs. There was also a low number of children with bilateral amputations included in the studies. The qualitative study exploring the experiences of children who are prosthetic users identified the constructs that impact children with bilateral prosthetic limbs; these include mobility, activities of daily living, physical participation, education, body image, quality of life and socio-economic participation. Challenges that impact prosthetic use are also explored and include personal and environmental challenges such as finances, prosthetic equipment, availability of resources and supportive relationships, as well as pain. Conclusion: While physical function has been a consistently evaluated theme in prosthetic rehabilitation, this study provides other areas of impact that healthcare providers might not assess or consider in their decision-making on prosthetic prescription. The emerging themes are holistic and encourage the use of the International Classification of Functioning, Disability and Health (ICF) model which could be helpful in developing a holistic outcome measure that is appropriate for children with bilateral lower limb amputations. It is hoped that this can provide evidence to improve the distribution of necessary resources to optimise equality among the vulnerable children with bilateral amputations.
- ItemThe manual motor control of South African children with and without foetal alcohol spectrum disorder during a pegboard task(Stellenbosch : Stellenbosch University, 2023-03) Abrahams, Adrian Ian; Burger, Marlette; Dr Brink, Yolandi; Stellenbosch University. Faculty of Medicine and Health Sciences. Dept. of Health and Rehabilitation Sciences. Physiotherapy.ENGLISH SUMMARY: Introduction: Foetal alcohol spectrum disorder (FASD) refers to a group of conditions caused by prenatal alcohol exposure (PAE) during pregnancy. Children with FASD have impairments with fine manual motor control when completing a task. These impairments may have a negative impact on these children's ability to execute tasks. Three-dimensional (3D) kinematics is increasingly being used to analyse and assess upper-limb motor tasks. The aim of the study was to use the most feasible and informative approaches while using a motion analysis system to describe manual motor control during a pegboard task in children aged nine to ten years diagnosed with FASD and children without FASD; and the secondary aim was to perform a preliminary analysis comparing spatio-temporal and 3D kinematic parameters between the two groups. Methodology: Participants completed a 16-hole pegboard task in which they reached for and placed individual pegs in the corresponding holes as quickly as possible. A MyoMotion measurement system was used to describe 1) spatio-temporal parameters (duration) and 2) 3D kinematic parameters (joint range of motion). 3D kinematics included range of motion of the shoulder, elbow, head, neck and thoracic in three different planes. Line graphs were used to display the results. The mean and standard deviation (SD) of the continuous variables were also provided in table format. The two-sample Hotelling's T2 test was used to determine if there were any significant differences in spatio-temporal and 3D kinematic characteristics between the FASD and no FASD groups (significance level of 0.05). Results: Thirty-seven children participated: 25 children (FASD) and 12 children (no FASD). The spatio-temporal results revealed that children with FASD completed the pegboard task slower overall; were slower when using the left-hand compared to the right hand; but were faster to perform the transport phase when using the right hand. The 3D kinematics results showed that children with FASD displayed greater elbow flexion/extension and shoulder abduction/adduction range of motion (ROM) when using either the right or left hands; greater flexion/extension and internal/external rotation ROM when using the right hand; greater head and neck side flexion and neck flexion/extension during the right-hand trials; and greater neck flexion/extension during the left-hand trials. Compared to the no FASD group, children with FASD had approximately 10 degrees more neck side flexion ROM during the right-side trials. There were no statistically significant differences between the groups in any of the spatio-temporal or 3D kinematic joint parameters. Conclusion: These findings suggest that children with FASD might find completing the pegboard task more difficult when the using the left (non-dominant) hand than the right hand and utilise different movement patterns when completing the pegboard task (as seen by the differences in joint ROM). Future research should be encouraged to use objective assessment methods to further describe the motor control abilities of children with FASD when completing a fine motor control task i.e. the pegboard task as it will help in the development of evidence-based therapies for these children.
- ItemCompetency framework development in healthcare : a physiotherapy perspective(Stellenbosch : Stellenbosch University, 2023-03) Mocke, Marieke; Unger, Marianne; Hanekom, Susan; Stellenbosch University. Faculty of Medicine and Health Sciences. Dept. of Health and Rehabilitation Sciences. Physiotherapy.ENGLISH SUMMARY: Background: Across the globe, countries are challenged to design healthcare systems that succeed in delivering equitable healthcare to their citizens. A competent health workforce has been cited as essential to address the burden of disease and improve the health of individuals and communities. Competency frameworks are important tools to describe such a workforce, reporting the skills, knowledge, behaviours and attitudes needed to meet the population’s health needs. However, for the profession of physiotherapy, consensus on competencies is not clearly defined. This poses a challenge to the development of physiotherapy competency frameworks. Understanding the global perspectives on physiotherapy competencies may assist in the development of competency frameworks that are applicable to the local context. Aims: The aims of this thesis are to identify and synthesise published physiotherapy competencies, and present a conceptual thematic framework which may guide the future development of contextually relevant physiotherapy competency frameworks. Methodology: Two separate phases were undertaken to accomplish the research aims. In phase 1, a document review of all published physiotherapy competencies was conducted. All competencies from these documents were extracted and collated within the structures of the Canadian Medical Education Directions for Specialists (CanMEDS) and the World Health Organization Rehabilitation Competency Framework (WHO RCF). Phase 2 utilised an inductive approach to thematically analyse the competency statements from the WHO RCF dataset compiled in phase 1. Results: The document review identified 20 documents for inclusion, with the first published in 2008 (Ireland) and the latest in 2021 (Latvia). The majority of current physiotherapy competency documents, and thus the descriptions of physiotherapy competencies, originate from high-income countries. The competencies extracted from all included documents could be accommodated within both the WHO RCF and the CanMEDS framework, suggesting that either may be used for developing competency frameworks for the physiotherapy profession. From the WHO RCF dataset, a conceptual thematic framework was developed consisting of 17 themes and 59 sub-themes. Conclusion: With the changing profile of the burden of disease, healthcare systems and the role of the physiotherapist must evolve. Adequately describing the competencies for physiotherapists to excel in their work is foundational to the credibility of the profession not only among health professions but within society. This thesis provides an updated perspective on physiotherapy competencies and serves as a springboard from which to define contextually relevant physiotherapy competencies. This conceptual thematic framework can aid in the development of a physiotherapy competency framework in any setting.