UWCScholar :: Browsing by Author "Ennion, Liezel"

Browsing by Author "Ennion, Liezel"

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Barriers and facilitators to utilisation of rehabilitation services amongst persons with lower-limb amputations in a rural community in South Africa
(SAGE Publications, 2018) Naidoo, Ugendrie; Ennion, Liezel
BACKGROUND: Persons with disabilities who reside in rural areas experience challenges accessing and utilising health services and rehabilitation. Due to the high prevalence of diabetes mellitus in rural regions, the risk of having a lower-limb amputation is increasing. Comprehensive rehabilitation is vital to mitigate the negative impact that a lower-limb amputation has on a person. OBJECTIVE: To explore the barriers and facilitators to accessing rehabilitation experienced by persons with lower-limb amputations in a rural setting. STUDY DESIGN: A qualitative descriptive approach was used to collect and analyse data. Methods: Data were collected from 11 conveniently sampled participants from three sub-district hospitals in the rural iLembe district, Kwa-Zulu Natal, South Africa. Data were collected using semi-structured interviews to explore the barriers and facilitators perceived by persons with lower-limb amputations in a rural region. RESULTS: The three main barriers identified in this study were environmental factors, financial constraints and impairments. These barriers negatively impacted the participant’s utilisation of rehabilitation. The two main facilitators identified were environmental facilitators and personal factors which aided participant’s utilisation of rehabilitation. CONCLUSION: Access to rehabilitation was mainly hindered by the challenges utilising transport to the hospital, while self-motivation to improve was the strongest facilitator to utilising rehabilitation.
Community experiences of persons with lower limb amputations in Malawi
(University of the Western Cape, 2018) Mpezeni, Stella; Ennion, Liezel
Persons with lower limb amputations (LLA) experience different challenges in the community. These challenges include the physical, psychological and social function of an individual. Little is known in Malawi on what persons with lower limb amputations go through in the communities where they live. Therefore, the study aimed at exploring and determining community experiences of persons with LLA in Malawi. The study sought to address the following objectives: 1) To determine the functional and psychological status of persons with LLA in the community; 2) To explore and describe experiences on social participation of persons with LLA in the community; 3). To explore experiences on community re-integration following LLA. A mixed method approach was applied where quantitative and qualitative data were collected simultaneously to provide a more holistic overview of the experiences of persons with LLA at one point in time. The study setting was Queen Elizabeth Central Hospital (QECH) and Kamuzu Central Hospitals (KCH) (500 miles), located in Malawi. A sample of 180 participants was recruited to participate in the study. Three self-administered questionnaires (socio-demographic questionnaire, OPUS module of lower extremity functional status, and a Beck’s depression inventory scale) and a semi-structured interview guide were used for data collection. Thematic data analysis was used to analyze qualitative data, while quantitative data was analyzed using descriptive and inferential statistics. Ethical clearance was obtained from the University of the Western Cape Biomedical Research Ethics Committee (BMREC) and College of Medicine Research Ethics Committee (COMREC). Permission to conduct the study was obtained from KCH (500 miles) and QECH. Privacy andconfidentiality was strictly observed such that data obtained was anonymous. It was kept in a secure place, and electronic data was secured using a password.
Experiences of lower limb prosthetic users in a rural setting in the Mpumalanga Province, South Africa
(SAGE Publications, 2018) Ennion, Liezel; Manig, Sarah
BACKGROUND: Ambulation with a prosthesis is the ultimate goal of rehabilitation for a person with a major lower limb amputation. Due to challenges with prosthetic service delivery in rural settings, many patients with amputations are not benefitting from prosthetic interventions. Inaccessibility to prosthetic services results in worse functional outcomes and quality of life. Learning from the experiences of current prosthetic users in this setting can assist to improve prosthetic service delivery. OBJECTIVES: To explore the experiences of lower limb prosthetic users and to understand the importance of a lower limb prosthesis to a prosthetic user in a rural area of South Africa. STUDY DESIGN: A generic qualitative approach and an explorative design were utilised in this study. METHODS: A semi-structured interview guide was used to collect data from nine prosthetic users in a rural area in the Mpumalanga province of South Africa. Interviews were audio-recorded, transcribed verbatim and analysed thematically. Demographic details and information related to acute in-patient rehabilitation were analysed descriptively. RESULTS: All participants were independent in activities of daily living with their prosthesis and participated actively in their community. Participants reported that their prosthesis was essential to their functioning. High travel cost was highlighted as a barrier to the maintenance of their prosthesis. Patients were dissatisfied with being unemployed. CONCLUSION: Prosthetic intervention positively influences function, independence and community participation. Challenges relating to the accessibility, cost and maintenance of prosthetics should be a priority to ensure continued functional independence for prosthetic users.
Incidence and common causes of major lower limb amputation at a hospital in a sub-district of the City Cape Town municipality.
(University of the Western Cape, 2024) Kaylor, Timothy; Ennion, Liezel
Background: Major lower limb amputation (LLA) is a life-changing event described as the loss of a limb at or proximal to the ankle upwards. The amputation itself is a change in body structure but has a significant influence on many activities, participation in activities and quality of life. Optimal functional outcomes for persons with a major LLA require intensive long-term rehabilitation and costly assistive devices such as prostheses. Due to the high costs associated with it, the increasing number of persons with major LLA places a burden on the resource-limited public health system. In order for the provincial department of health to plan to provide sufficient human and financial resources and procure enough assistive devices such as prostheses, the need for these devices and the incidence of major LLAs should be established. The study aims to determine the incidence and common causes of major LLAs in adults and children who underwent major lower limb amputations at Tygerberg Hospital over one year from 19 December 2019 to 20 December 2020.
Lumbo-pelvic neuromuscular control for the prevention of recurrent hamstring injuries in sprinting
(University of the Western Cape, 2023) Kerspuy, Wade; Ennion, Liezel
Introduction: Hamstring injuries are the most prevalent injuries that occur in sport that require sprinting and acceleration (Small et al., 2009). A bigger concern is the high rate of recurrent hamstring strains (Comfort, 2009). The concern is that conventional hamstring rehabilitation may be inadequate, to reduce the prevalence of a recurrent hamstring injury. This study will explore if lumbo-pelvic neuromuscular rehabilitation is currently included in the rehabilitation programmes aimed at the prevention of recurring hamstring injuries in athletes involved in sprinting sports, and secondly, if consensus can be reached amongst experts on the inclusion of lumbo-pelvic control in the prevention of recurrent hamstring injuries. Methods: The study was conducted in two phases. In the first phase a Scoping review was used to determine if lumbopelvic neuromuscular rehabilitation was used in the rehabilitation of hamstring injuries to prevent recurrent injury in sports that involve sprinting, and which types of exercises are commonly used. The second phase consisted of a Delphi study, which was conducted in three rounds of online surveys. Experts were asked if they thought lumbo-pelvic neuromuscular control was important in the rehabilitation of hamstring strains to prevent recurrent injuries, as well their views on specific lumbo-pelvic neuromuscular exercises.
The modular socket system in a rural setting in Indonesia
(Lippincott, Williams & Wilkins, 2018) Giesberts, Bob; Ennion, Liezel; Hjelmstrom, Olle
Background: Prosthetic services are inaccessible to people living in rural areas. Systems like the modular socket system have the potential to be fabricated outside of the prosthetic workshop. Objectives: This study aimed to evaluate the patient's performance and satisfaction with the use of the modular socket system, and the technical feasibility of its implementation in a rural setting. Study design: A quantitative longitudinal descriptive study design was followed. Methods: A total of 15 persons with a lower limb amputation were fitted with the modular socket system and followed over 4-6 months. Performance was measured using a 2-min walk test, 10-m walk test and mobility and function questionnaire. Satisfaction was measured by the Socket Fit Comfort Score, Prosthesis Evaluation Questionnaire and EuroQoL 5 Dimensions 5 Levels. Notes on technical feasibility were taken at the moment of fitting ( t0), at 1-3 months post fitting ( t1) and at the end evaluation at 4-6 months post fitting ( t2). Results: Performance did not change between t0 and t2. The comfort of the socket fit reduced between t0 and t2. Satisfaction with prosthesis and general health status stayed constant over time. The average fitting-time for the modular socket system was 6.4 h. Conclusion: The modular socket system can be considered a useful alternative for use in rural settings. Clinical relevance The use of the modular socket system is feasible and can improve accessibility to prosthetic technology in rural areas. Experienced prosthetic users were satisfied with the performance and the device. The shorter manufacturing time and use of only hand-held tools makes it an ideal alternative for use in remote and rural settings.
Participation restrictions and vocational needs amongst persons with a lower limb amputation in Cape Town, South Africa
(University of the Western Cape, 2017) Wing, Yu Tak; Ennion, Liezel; Phillips, Julie
Vocational rehabilitation relates to rehabilitating a person with an amputation back into actively participating in society. Although vocational rehabilitation is important, before it can be implemented, the participation restrictions should be identified. Even though lower limb amputation surgery is commonly performed in South Africa, and given the high unemployment rate in the country, no research has been done into the participation restrictions and vocational needs of a person with a unilateral lower limb amputation in the Western Cape. The aim of this study was to determine and explore the participation restrictions and vocational rehabilitation needs in terms of hobbies, sport activities, employment and employment needs of persons with a unilateral lower limb amputation (LLA) in the Western Cape. The objectives were to: 1) Determine the participation restrictions of persons with a unilateral LLA in the Western Cape. 2) To explore the vocational rehabilitation needs of persons with a lower limb amputation. A mixed methods approach, and an explanatory sequential design was used in this study. The study was conducted in two phases. The first phase utilised a quantitative approach and the WHODAS 2.0 was used as the instrument to collect data. The second phase aimed to explain the data collected in the first phase in more depth, and semi-structured telephonic interviews were utilized to collect the qualitative data. The study was set in the Cape Metropole region of the Western Cape. Participants were recruited from Tygerberg Tertiary Hospital and a private sub-acute rehabilitation centre. In the quantitative (first) phase of the study, 50 participants were conveniently recruited to participate. In the second phase eight participants were purposefully selected from the pool of 50 participants from the first phase of the study who consented to participate in the second phase. Quantitative data was analysed using SPSS vs. 22 and analysed for descriptive and inferential statistics. Qualitative data has been analysed using Creswell's seven step process of thematic analysis. Ethical clearance has been obtained from the University of the Western Cape, permission to access patients' details has been obtained from Tygerberg Tertiary Hospital and private sub-acute rehabilitation centre. Written informed consent as well as permission for audio recording during the telephonic interview was obtained.
Participation restrictions and vocational rehabilitation needs experienced by persons with a unilateral lower limb amputation in the Western Cape, South Africa
(AOSIS, 2019) Yu, Tak Wing; Ennion, Liezel
Vocational rehabilitation (VR) aims to rehabilitate a person with an amputation back into actively participating in society. Even though lower limb amputation (LLA) surgery is commonly performed in South Africa (SA), little research has been published on the participation restrictions experienced by and vocational needs of persons with LLA in the Western Cape (WC). The aim of this study was to determine and explore the participation restrictions and VR needs of persons with a unilateral LLA in the WC.A mixed-methods approach and a sequential exploratory design were utilised to collect data from 50 persons with an LLA. Participants were conveniently sampled within the Cape Metropole region of the WC, SA. The World Health Organization Disability Assessment Schedule 2.0 (WHODAS 2.0) tool was used to collect the quantitative data, and telephonic interviews were conducted for qualitative data collection.
Prevalence of concussion and adherence to return-to-play guidelines amongst male secondary school rugby and hockey players
(AOSIS, 2021) Taf, St. John; Ennion, Liezel
Concussion injuries are common in contact sports. Young players can suffer lifethreatening complications if concussion is not recognised and managed.To determine the prevalence of concussion amongst secondary school rugby and hockey players and describe players’ knowledge and adherence to return-to-play guidelines.A mixed-method approach included Phase A, which utilised a questionnaire completed by 221 players (n = 139 rugby; n = 82 hockey) between 13 and 18 years of age, and Phase B, which utilised three focus group discussions of 15 participants who had suffered a concussion.
The process of rehabilitation for 0-6 year old children with cerebral palsy at Kenyatta National Hospital, Kenya
(University of the Western Cape, 2018) Ngota, Daniel Odhiambo; Ennion, Liezel
Introduction: Cerebral palsy is one of the leading causes of disability globally. The number of new cases of children with cerebral palsy (CP) is on the increase. Rehabilitation is the most common intervention used to help children with CP in Kenya. Early initiation of the rehabilitation process, and involvement of the family are important for optimal functional outcomes for children with cerebral palsy. This study aimed to establish the incidence of children under six years old with CP at the physiotherapy and occupational therapy department at Kenyatta National Hospital, Kenya in 2015. This was done in order to establish the need for rehabilitation services. Furthermore, the study aimed to explore and describe the direct patient process of care as part of the current rehabilitation process followed for children with CP from the age of 0to 6 years in order to identify any room for improvement. Study population and Methodology: Data were collected in two phases. Phase A consisted of collecting information pertaining to the number of new cases (incidence) of children with CP under six years of age in 2015 treated at the therapy (occupational and physiotherapy) departments at KNH. For this purpose, all records of children with CP under the age of six years at the rehabilitation department in 2015 were included and reviewed. For Phase B, a mixed methods approach and a parallel convergent design were used to explore the direct patient process of care component of the rehabilitation process.
A qualitative study of the challenges of providing pre-prosthetic rehabilitation in rural South Africa
(SAGE Publications, 2017) Ennion, Liezel; Johannesson, Anton
BACKGROUND: There is a known shortage of rehabilitation staff in rural settings and a sharp increase in the number of lower limb amputations being performed. A lack of adequate pre-prosthetic rehabilitation will result in worse physical and psychological outcomes for a person with a lower limb amputation, and they will not be eligible to be fitted with a prosthesis. OBJECTIVE: To explore therapists’ experiences with providing pre-prosthetic rehabilitation in a rural setting. Study design: A qualitative descriptive approach was used to collect and analyse data. METHODS: Data were collected from 17 purposively sampled therapists in five district hospitals in a rural community in South Africa. Data were collected in two rounds of focus groups to explore the challenges of providing pre-prosthetic rehabilitation in rural South Africa. Results: The main themes identified in the study were (1) a lack of government health system support, (2) poor socioeconomic circumstances of patients and (3) cultural factors that influence rehabilitation. These themes all negatively influence the therapists’ ability to follow up patients for pre-prosthetic rehabilitation after discharge from hospital. A lack of adequate pre-prosthetic rehabilitation is a substantial barrier to prosthetic fitting in rural South Africa. Patients who do not receive pre-prosthetic rehabilitation have a poorly shaped residuum or other complications such as knee or hip joint contractures which disqualifies them from being referred to prosthetic services. CONCLUSION: Therapists involved in this study identified the most important barriers to patients having access to prosthetic services.
Recommendations of behavioural facilitators for success in a physiotherapy clinical practice module: Successful students’ perspectives
(PubMed, 2020) Ennion, Liezel; Hess, Danelle
Background: Students struggle to bridge the gap between theory and application thereof in clinical settings. Exploring the behaviours of students who have been shown to be successful in the clinical practice module of physiotherapy could provide an insight into what facilitated their success. Sharing this information with other students could assist with decreasing anxiety and improving student success. Objectives: The objective of this study was to explore behaviours that facilitate student success in a physiotherapy clinical practice module from the perspective of high-achieving students. Method: Data were collected at the University of the Western Cape’s physiotherapy department in South Africa. Ten students with the highest marks in clinical practice from the 2016 and 2017 final-year cohorts were purposively selected and invited to participate in two different Nominal Group Technique (NGT) discussions. In total, 14 students consented to participate in the study. A demographic and socio-economic status questionnaire and an NGT discussion were used to collect data. Participants analysed the NGT discussion data themselves by ranking facilitators in order of priority. Results: Doing pre-block preparation, self-reflection and having a good rapport with patients as well as personal motivation and coping strategies were identified as the most important behavioural facilitators for physiotherapy students’ success in a clinical practice module.
Recommendations of behavioural facilitators for success in a physiotherapy clinical practice module: Successful students’ perspectives
(OpenJournals Publishing AOSIS (Pty) Ltd, 2020) Ennion, Liezel; Hess, Danelle
Students struggle to bridge the gap between theory and application thereof in clinical settings. Exploring the behaviours of students who have been shown to be successful in the clinical practice module of physiotherapy could provide an insight into what facilitated their success. Sharing this information with other students could assist with decreasing anxiety and improving student success.
Roles of physiotherapy in primary health care: Awareness and perceptions of other health care professionals in Rivers East Senatorial District, Rivers State, Nigeria
(University of the Western Cape, 2019) Akeneh, Ukari Josiah Smith; Ennion, Liezel
BACKGROUND: Access to basic health care services through the primary health care (PHC) settings, was affirmed as a fundamental human right by the World health organisation (WHO) in 1978 in Alma Ata (Kazakhstan). Internationally, interdisciplinary collaboration among health care professionals (HCPs) have been the preferred approach to addressing the health and psychosocial needs of the populace. The PHC being the first point of contact for most Nigerians and the cornerstone of health care policies in Nigeria, covers promotive, preventative, curative and rehabilitative services. Although, Physiotherapy has ideally qualified personnel to contribute to the attainment of the goals and objectives of the PHC policies, these services are mostly carried out by other HCP’s subdivided as clinicians (medical doctors, dentists, nurses/midwives, optometrists, pharmacists, radiographers, laboratory scientists) and clinical assistants (pharmacy technicians, radiography technicians, laboratory technicians and community health extension workers). Physiotherapy services are mostly concentrated at tertiary and secondary health care settings. AIM: To determine the awareness and explore the perceptions of clinicians and clinical assistants employed in the type 3 primary health care (PHC) settings of Rivers East Senatorial district of Rivers State, Nigeria, regarding the roles of Physiotherapy in a PHC setting.
Tailoring a pre-prosthetic training course for community health workers in a rural setting within South Africa
(University of the Western Cape, 2022) Pagel, Jarryd Erich; Ennion, Liezel
More than a third of South Africa's population resides in rural areas. The attraction and retention of suitably trained medical professionals is a problem faced almost universally by those living in rural areas. Access to qualified health professionals by people in rural areas is a pressing matter, especially when faced with mobility barriers imposed by lower-limb amputation. The World Health Organisation has strongly advocated for the implementation of a communitybased approach to rehabilitation in developing countries. A community-based approach to rehabilitation aims to improve access to health services by utilising local resources in resourcepoor settings and training community members to provide basic rehabilitation.
Understanding the rehabilitation needs of persons living with a lower limb amputation in rural areas of the OR Tambo district of the Eastern Cape, South Africa
(University of the Western Cape, 2018) Manig, Sarah Mary; Ennion, Liezel; A., Bergsma
Background: Globally, the leading cause of lower limb amputation is diabetes mellitus. In South Africa, there is a rise in diabetes-related lower limb amputation with a marked increase in the number of persons with diabetes mellitus in rural areas. However, there is no information on the number of people who are living with a lower limb amputation. An amputation does not only have an impact on a person’s physical functioning but can result in poor quality of life, dependence and exclusion from societal participation. Rehabilitation and prosthetic interventions are known to facilitate those with a lower limb amputation to return to independence in activities of daily living, improved quality of life and inclusion in society. Access to health care is very challenging for persons living in rural areas. Challenges to accessing health care include limited rehabilitation staff, harsh terrain and far distances from services, a lack of access to transport, or the lack of confidence in the service provided by the healthcare institutions. For optimal and patient-centred outcomes, rehabilitation services are of paramount importance. Due to the challenges with providing services in rural areas, community-based rehabilitation is the ideal model for providing rehabilitation to persons with lower limb amputation in rural settings. In order to plan an appropriate community-based approach to rehabilitation, establishing the prevalence of disability and patient-specific needs are imperative. Aims of the study: The aims of this study were firstly, to determine the period prevalence of people living with a lower limb amputation within the rural OR Tambo District of the Eastern Cape in order to determine the need for services and secondly, to gain a deeper understanding of the rehabilitation needs of persons living with a lower limb amputation within the rural OR Tambo District of the Eastern Cape.
The use of a direct manufacturing prosthetic socket system in a rural community in South Africa: a pilot study and lessons for future research
(Sage Publications, 2017) Ennion, Liezel; Johannesson, Anton; Rhoda, Anthea
BACKGROUND: Challenges exist with the provision of appropriate mobility assistive devices in rural areas. The use of the direct manufacturing prosthetic socket system is a possible solution to these challenges. OBJECTIVES: The objective of this study was to test and explore the clients’ perspectives with the application of this device. Study design: Within a mixed-methods approach, a longitudinal sequential explanatory design was applied. METHODS: The Orthotic and Prosthetic User’s Survey was administered to explore the use of the direct manufacturing prosthetic socket system in terms of function, health-related quality of life and client satisfaction. A conveniently selected sample of 21 individuals who suffered a unilateral trans-tibial amputation was included. Data were collected at 1, 3 and 6 months post fitting, and two focus group discussions were also administered. RESULTS: Of the 21 participants recruited, 11 returned for follow up. Although participants reported favourably about the prosthesis, their scores were generally worse than the norms with regard to function and quality of life. Participants highlighted the need for improvement in the cosmetic appearance of the prosthesis. CONCLUSION: The direct manufacturing prosthetic socket system could be considered as an alternative technique of socket manufacturing for individuals living in rural areas due to the shorter manufacture time and promising initial results, but further research on this topic with a bigger sample is recommended.

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