Development and feasibility of an educational intervention to improve participation for people with spinal cord injury from Gaza, Palestine

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dc.contributor.advisorPlastow, Nicola Annen_ZA
dc.contributor.advisorSavin-Baden, Maggien_ZA
dc.contributor.authorAbu Mostafa, Moussa Kleiben_ZA
dc.contributor.otherStellenbosch University. Faculty of Medicine and Health Sciences. Dept. of Health and Rehabilitation Sciences. Occupational Therapy.en_ZA
dc.date.accessioned2023-11-28T12:02:19Z
dc.date.accessioned2024-01-08T20:46:07Z
dc.date.available2023-11-28T12:02:19Z
dc.date.available2024-01-08T20:46:07Z
dc.date.issued2023-12
dc.descriptionThesis (PhD)--Stellenbosch University, 2023. en_ZA
dc.description.abstractENGLISH 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.en_ZA
dc.description.abstractAFRIKAANSE OPSOMMING: Agtergrond: Baie mense met spinaalkoordbeserings (SKB) in lae- en middelinkomstelande soos die Gazastrook van Palestina word voortydig ontslaan uit binnepasientrehabilitasie-instellings met onvoldoende vaardighede in aktiwiteite van daaglikse lewe (ADL). Hierdie gaping kan ernstige komplikasies tot gevolg he, byvoorbeeld drukbeserings, spierkontrakture, inkontinensieversteurings en urienweginfeksies. Gevolglik kan deelname van mense met spinaalkoordbeserings aan gekose doelgerigte aktiwiteite beperk word en gemeenskapsdeelname kan beperk word, wat lei tot beroepsontneming en Aktiwiteitswanbalans. Hulpbronne wat toegewys is vir die rehabilitasie van spinaalkoordbeserings in Gazastrook is beperk en voldoen dus nie aan die veelvuldige behoeftes van mense met spinaalkoordbeserings nie. Daar is baie hulpbronne vir gesondheidsopvoeding vir spinaalkoordbeserings ontwikkel in Westerse lande met 'n hoe inkomste. Hierdie is irrelevant vir spinaalkoordbeserings van lande met 'n lae tot middelinkomste met oorwegend Islamitiese geloof. Doel van die navorsing: Hierdie studie het ten doel gehad om die haalbaarheid en aanvanklike doeltreffendheid van 'n ADL-onderwyshandleiding vir gebruik in binnepasiënt- spinaalkoordbeserings-rehabilitasie in Gaza, Palestina, saam te ontwikkel en te evalueer. Navorsingsvraag: Kan 'n komplekse opvoedkundige ADL-intervensie wat saam ontwikkel is vir en met pasiente met spinaalkoordbeserings wat in binnepasientrehabilitasie-instellings binne die Gazastrook behandel word, rehabilitasie-uitkomste optimaliseer? Doelwitte: 1. Om die effek van ADL-onderwys vir binnepasiente met spinaalkoordbeserings in 'n rehabilitasie-omgewing te bepaal deur middel van 'n sistematiese oorsig en meta-analise. 2. Om 'n bewys-ingeligte ADL-onderwyshandleiding vir persone met spinaalkoordbeserings (SADL-eM) saam te ontwikkel met behulp van deelnemende aksienavorsingsmetodes. 3. Om die bruikbaarheid van klinikus-gegradeerde rehabilitasie-uitkomsmaatreels en aanvaarbaarheid van die SADL-eM in 'n uitvoerbaarheidstudie te toets. 4. Om prosedures te toets, werwing en behoud te skat, en die aanvanklike effek van die SADL-eM in 'n loods gerandomiseerde beheerde proef. Nadoktorale werk sluit dit in die uitvoer van 'n gerandomiseerde kliniese proef (RCT), terwyl die terugtrekkings van die huidige studie vermy word. Die navorser sal die steekproef werf uit die Gazastrook-gemeenskapswonende PW-SCI-bevolking met spesifieke insluitingskriteria om die betroubaarheid van die versamelde data te verbeter. Metodologie: Die navorser het die UK Medical Research Council (MRC) se raamwerk gebruik vir die ontwikkeling van komplekse intervensies wat vier fases behels, naamlik: ontwikkeling, haalbaarheid en loodsing, evaluering en implementering. Die navorser het die studieontwerp vir elke fase volgens die oorhoofse doel en studiedoelwitte gekies. Nadat die nodige etiese goedkeuring verkry is, het die navorser in die ontwikkelingsfase 'n sistematiese oorsig en meta-analise-ontwerp gebruik om die huidige bewysbasis te identifiseer. Daarna het die navorser 'n kwalitatiewe studie gedoen wat deelnemende aksienavorsing (PAR) gebruik het om die opvoedkundige model/intervensie (Spinal Cord Injury Activities of Daily Living education manual) saam te ontwikkel. Binne die uitvoerbaarheids- en loodsfase het die navorser 'n lewensvatbaarheidstudie gedoen om die bruikbaarheid van klinikus-gegradeerde rehabilitasie-uitkomsmaatreels en pasientaanvaarbaarheid van die SADL-eM te toets, en 'n loodsstudie om die prosedure te toets en werwing, behoud en aanvanklike doeltreffendheid van die SADL-eM te skat.af_ZA
dc.description.versionDoctorate
dc.format.extentxvi, 339 pages : illustrations, includes annexures
dc.identifier.urihttps://scholar.sun.ac.za/handle/10019.1/129055
dc.language.isoen_ZAen_ZA
dc.publisherStellenbosch : Stellenbosch University
dc.rights.holderStellenbosch University
dc.subject.lcshSpinal cord -- Wounds and injuries -- Patients -- Rehabilitation -- Palestineen_ZA
dc.subject.lcshSpine -- Diseases -- Treatment -- Palestineen_ZA
dc.subject.lcshPhysical therapy -- Palestineen_ZA
dc.subject.lcshPatients -- Rehabilitation -- Palestineen_ZA
dc.subject.nameUCTD
dc.titleDevelopment and feasibility of an educational intervention to improve participation for people with spinal cord injury from Gaza, Palestineen_ZA
dc.typeThesisen_ZA
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Doctoral Degrees (Occupational Therapy)