Masters Degrees (Physiotherapy)
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- ItemFunctioning and satisfaction with health services of persons living with spinal cord injuries in the Western Cape during the COVID-19 pandemic(Stellenbosch : Stellenbosch University, 2024-03) Du Plessis, Herné; Titus, Adnil; Joseph, Conran; Stellenbosch University. Faculty of Medicine and Health Sciences. Dept. of Health and Rehabilitation Sciences. Physiotherapy.ENGLISH SUMMARY: Background: Spinal cord injuries (SCI) are a severely disabling condition caused by spinal damage due to trauma, disease, or degeneration. As a result, several changes in activities and participation are noted in individuals with SCI. The outbreak in the COVID-19 pandemic forced several changes within the health system to mitigate the spread of the virus, this included changes in service provision at a government-funded specialized in-patient rehabilitation centre in the Western Cape (WCRC). Given that rehabilitation is a critical component for the optimisation of functioning and good health, the complexity surrounding the decisions to limit access to primary healthcare, including rehabilitation at community level, during a pandemic are significant and should be investigated. Aim: To report on the unmet functioning needs and satisfaction with health and rehabilitation services of persons living with SCI, who have been discharged from a specialised rehabilitation centre, in the Western Cape, during the first year of the COVID-19 pandemic. Methods: A descriptive cross-sectional study was used to determine the unmet functioning needs of PWSCI, as well as their satisfaction with utilised health care services. Inclusive sampling was followed, and telephone-based survey was performed. Data on injury characteristics, demographics and socioeconomic profiles, secondary health conditions, activity limitations and participation restrictions, mental health states, and quality of life were collected using a combination of the International SCI Community Survey questionnaire and questionnaires from a previous related study. Satisfaction with health-care services was also evaluated. Data were analysed using descriptive and interferential statistics. Results: Thirty-five participants were included in the study. Sixteen (45.7%) of the individuals had SCI caused by an assault, with 57.1% having tetraplegia and 62.9% having incomplete SCI. The majority of participants (60%) were between the ages of 18 and 30, and 27 (77.1%) were men. The unemployment rate after injury was 94.3%. Spasticity (65.7%), muscular and joint pain (62.9%), and chronic pain (45.7%) were the most common secondary health conditions. The majority of participants (62.9%) reported difficulty walking, transferring from the floor (62.9%), and transferring from bed to a wheelchair (57.1%). For bowel movements, 94.3% of participants utilised suppositories, while 40% used indwelling catheters. In terms of activity and participation, the majority of participants reported difficulties standing unaided (82.9%), managing stress (54.3%), taking public transit (54.3%), and caring for others (51.4%). Happiness was the most common positive vitality and emotional well-being experience (80%), whereas fatigue was the most common negative (82.9%). Approximately 46% of participants reported that their health related QOL was satisfactory. Self-satisfaction was highest at 74.3%, and contentment with living conditions was lowest at 48.6%. Overall, health care staff were lauded for their treatment and communication skills. With 85.7% satisfaction, WCRC provided the best health care services. Conclusion: This study highlighted that there are still unmet functioning needs observed during the first year of the COVID-19 pandemic. The findings suggested that rehabilitation regimens for PWSCI should prioritise addressing the direct consequences of a SCI. It highlights the importance of expert SCI treatment, including multi-disciplinary rehabilitation initiatives, especially in times of crisis.
- ItemSelf-reported function and hip extension gait biomechanics in adults with unilateral trans-femoral amputations using different socket designs in two South African metropoles : a cross-sectional study(Stellenbosch : Stellenbosch University, 2024-03) Smit, Elmari; Berner, Karina; Fisher, Dominic; Stellenbosch University. Faculty of Medicine and Health Sciences. Dept. of Health and Rehabilitation Sciences. Physiotherapy.ENGLISH SUMMARY: Background: Unilateral trans-femoral (TF) amputation significantly impacts mobility and biomechanics, often leading to secondary complications like lower back pain. In South Africa, Ischial Containment (IC) is the standard prosthetic socket design, but it may restrict hip mobility during gait. The Direct Socket (DS) design is proposed as an alternative, aiming to improve hip mobility and patient satisfaction. However, limited evidence exists on how DS design impacts subjective and objective mobility outcomes for TF amputees. Aim: This study aimed to describe self-reported mobility function and objectively-measured sagittal plane hip extension gait biomechanics based on different prosthetic socket designs (IC and DS) in adults with unilateral TF amputations in Cape Town and Tshwane. Additionally, it aimed to correlate objective and subjective results and compare the groups (intra- and intergroup). Methods: This cross-sectional study, with an analytical component, sampled participants with TF amputations through quota sampling. Participants underwent eligibility screening, including determining K-levels, measurements of hip range of motion (ROM) and dynamometry. Participants completed questionnaires (Walking (WQ35), Climbing Stairs (CSQ15), Rising and Sitting Down (R&SDQ39)) to assess perceived disability. All participants were fitted with a loaner Rheo knee and Vari-Flex foot before optoelectronic motion capture (OMC) gait analysis. OMC outcomes included temporospatial parameters (TSP) and stance phase hip extension kinematics and kinetics. Results from the screening and OMC were correlated with the subjective findings. Statistical significance was considered at 5% and effect sizes (ES) were calculated to evaluate clinical significance. Data were described using medians and interquartile ranges (IQR). Statistical analyses included Wilcoxon signed-rank tests, Mann-Whitney U-tests, Kruskal-Wallis H-tests, and Symmetry Index (SI) calculations. Results: Ten predominantly male adults (median age 54 (IQR 39-57)) participated, with three using IC and seven using DS sockets. Percentage of perceived disability showed a moderate ES (ES = -0.470, p = 0.183) favouring the IC socket design. Gait speed, cadence, stride length, step length and step time did not differ significantly between socket designs. Significant differences in ES were observed for step length and step time (ES = -0.748; p = 0.018) when comparing within the same group SI values showed the IC design to be more symmetrical for all TSP except step time, where DS was more symmetrical. Worse self-reported function was strongly correlated to longer step time (rS = 0.754, p = 0.012), lower cadence, shorter step length from amputated-to-sound limb, and slower average gait speed (range rS = -0.681 to -0.723, all p<0.02). Maximum hip extension for amputated and sound limbs showed moderate and small ES, favouring IC (ESs 0.324 to 0.252, p = 0.383 to 0.517), while hip flexion-to-extension ROM and kinetics showed small effect sizes without statistical significance. Conclusions: No definitive superior socket design emerged. This study highlights the complexity of selecting a prosthetic socket design (IC or DS) for TF amputees, emphasising the need to consider individual patient factors and functional status (K-level). However, due to the small sample size and restricted generalisability, further research with larger cohorts is necessary to validate these findings and provide more robust evidence for clinical decision-making.
- ItemTheperceptions of patients with osteoarthritis at a public community rehabilitation centre in the Cape Metropole for using digital technology in rehabilitation(Stellenbosch : Stellenbosch University, 2024-03) Prins, Gabriela; Louw, Quinette; Ernstzen, Dawn V.; Stellenbosch University. Faculty of Medicine and Health Sciences. Dept. of Health and Rehabilitation Sciences. Physiotherapy.ENGLISH SUMMARY: Background: Access to rehabilitation services is a significant global challenge, especially in low-and-middle income countries (LMICs) where resources are limited. Telerehabilitation (TR) has emerged as a promising method to expand accessibility, but barriers like infrastructure and digital literacy have hindered adoption among LMICs patients. Aim: The study aimed to understand patients' perspectives regarding the use of digital technology as part of their OA rehabilitation at a public community healthcare centre in the Cape Metropole Area. Methods: The research consisted of conducting a systematic review and a primary study. The systematic review included studies (excluding secondary reviews) available in English with any information on the perspectives and experiences of TR for people with data regarding TR in these studies were also extracted. The findings of the review were used to explain any concepts arising from the primary study. A qualitative descriptive study design was used with 10 OA patients from a public community rehabilitation centre in South Africa. Data collection included semi-structured interviews and patient-reported outcome measures (PSFS, ASES-8, and EuroQol EQ-5D-5L) on functioning and quality of life. Transcribed interview data were coded in Atlas.ti. 22.2 and analysed using thematic analysis. Results: Seven moderate-to-high quality studies (2010-2022) were included. Telerehabilitation was found to facilitate personalized, detailed care and accountability through regular check-ins. TR enabled self-management by allowing familiar home exercise with remote guidance. Minor technical challenges did not disrupt perceived user-friendliness of technical applications. Visible improvements in functioning and reduced pain/fear were noted, although some preferred in-person sessions. The findings found that the people valued efficiency, accessibility and family involvement with TR but identified needs for training and cultural adjustment. Primary study: Participants demonstrated limited awareness and exposure to TR, as well as minimal digital literacy and skills. Scepticism was shown when comparing the effectiveness of TR to in-person rehabilitation and valued physical interactions with health professionals. However, some recognized potential benefits of TR for accessibility, convenience, family involvement and improving community health in the long term. Willingness existed to try TR with sufficient training. Conclusion: With targeted efforts addressing identified barriers around awareness, technological literacy, clinician readiness and resource availability, perspectives on TR may shift positively from uncertainty towards endorsement of this expanding approach for simpler rehabilitation access in LMICs.
- 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.