Browsing by Author "Joseph, Conran"
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Item Activity limitations and factors influencing functional outcome of patients with stroke following rehabilitation at a specialised facility in the Western Cape(African Health Sciences, 2013) Joseph, Conran; Rhoda, AntheaBACKGROUND: Determining the functional abilities and factors influencing outcome of patients with stroke following rehabilitation are essential for the planning of future interventions and services in order to optimise recovery. OBJECTIVES: To determine the activity limitations and factors influencing functional outcome of patients with stroke managed at a specialised rehabilitation centre. METHODOLOGY: A longitudinal study design was used to determine the functional outcomes of patients admitted to the centre on admission and discharge. A data gathering sheet was developed to collect information pertaining to the demographicand medical profile and process of rehabilitation, whereas the Barthel Index was used to collect data relating to functional abilities. For analysis, descriptive statistics as well as inferential statistics (Student t test) were utilised to determine the paired differences. Six prognostic factors influencing functional outcome were selected and tested using linear (bivariate) regression. RESULTS: The mean Barthel Index scores on admission and at discharge were 58.85 and 81.59 respectively. A significant improvement was noted in the execution of functional task of patients with stroke (p< 0.01) between the data collection points. Despite the significant overall improvement, results show a high prevalence of dependence with walking and stair climbing at discharge. Only functional ability on admission (r=0.49) predicted a favourable functional outcome at discharge. CONCLUSION: This study highlights the limitations of younger stroke survivors and the need for continued rehabilitation following in-patient care. It further underscores the administration of a functional rating scale on admission in order to aggressively manage activity limitations.Item Activity limitations and participation restrictions four years after traumatic spinal cord injury in Cape Town, South Africa(University of the Western Cape, 2018) van Wyk, Vania; Joseph, Conran; Mlenzana, NondweThe distressing event of Spinal Cord Injury (SCI) leads to complete or incomplete injury, and results in many complications such as such as neurogenic shock, cardiovascular disease, temperature regulatory problems, respiratory complications, dysphagia, thromboembolism, and pressure ulcers amongst others. These complications limit the individual’s functioning and participation. Participation is fruitful and meaningful when you are actively involved in a specific activity. To understand the lack of participation within a specific setting, it is important to know what the limitations in activities are, and what causes these limitations. The goal of rehabilitation should be to reintegrate patients back into the community so that they can fulfil their roles. Aim: The aim of the study was (1) To determine included participants’ socio-demographic and injury characteristics; (2) To describe healthcare services received by people living with long-term Traumatic Spinal Cord Injury (TCSI) over the past 12 months; (3) To determine the point prevalence of common activity limitations of survivors of TSCI four years after injury; (4) To determine the point prevalence of participation restrictions of survivors of TSCI four years after injury; and (5) To determine factors associated with activity limitations and selected participation restrictions four years after injury.Item Changes in activity limitations and predictors of functional outcome of patients with spinal cord injury following in-patient rehabilitation(AOSIS, 2013) Joseph, Conran; Mji, Gubela; Mlenzana, Nondwe; Rhoda, Anthea; Statham, S.; De Wet, C.The purpose of this study was to investigate the changes in the activity limitations of patients following in-patient rehabilitation and the factors influencing functional ability as measured by the Spinal Cord Independence Measure III (SCIM III). A longitudinal study design was utilised to study the change in functional abilities of patients with spinal cord injury between admission and discharge. A convenient sampling strategy was employed, in which every consecutive patient admitted to the rehabilitation centre within a three month period was eligible for the study. Demographic-, medical, and process of rehabilitation data were collected and collated from the patients' medical records using a data gathering sheet that was validated and tested for reliability. Functional abilities were measured by the SCIM III. Seventy-six patients met the inclusion criteria, consisting of 58 paraplegics and 18 tetraplegics. The mean age of this cohort was 34.14 years. A significant difference (p<0.001) in functional ability was detected for the total sample, with only12.5% of patients independent in walking ability and 28.12% in stair management. Four (4) factors were found to be predictors of functional outcomes on bivariate analysis, but when considered together in a multiple regression model, only functional status on admission remained correlated to functional outcomes. Conclusion and implication for practice: Significant improvement in functional abilities of persons with spinal cord injury following in-patient rehabilitation was observed. However, mobility and stair-management limitations were the most prevalent at discharge. Lastly, a lower functional status should be better targeted to optimise functional ability in the future. Future research should be directed towards illuminating whether personal factors or rehabilitation inefficiencies are responsible for the limitations observed at discharge.Item Client perspectives on reclaiming participation after a traumatic spinal cord injury in South Africa(Oxford University Press, 2016) Joseph, Conran; Wahman, Kerstin; Phillips, Julie; Wikmar, Lena NilssonBACKGROUND. The development of rehabilitation services promoting participation in people living with a traumatic spinal cord injury (TSCI) is of major concern for physical therapists. What the client sees as effective participation, barriers, and facilitators might be different due to their particular context. This study was conducted to gain insight into the experiences of attaining an important outcome in a developing context. OBJECTIVE. The aim of this study was to explore the experiences of reclaiming participation in community-dwelling people with TSCI in South Africa. DESIGN. This was an explorative, qualitative study with inductive content analysis. METHODS. Individual semistructured interviews were conducted with 17 adults living with a TSCI in order to explore their experience of participation. The verbatim transcripts were analyzed, and the end result was an overall theme that included 4 emerging categories. RESULTS. The theme “participation possibility” denotes the eventual involvement in life situations. Within this theme, there were 4 categories that emerged as a representation of essential aspects along the continuum of reclaiming participation: (1) dealing with the new self, (2) a journey dominated by obstacles, (3) the catalyst of participation, and (4) becoming an agent. Dealing with and recognizing these intervening conditions seem critical for clients to reconstruct the meaning that is necessary for a broader conception of participation. Limitations. The transferability of these findings to dissimilar contexts may be limited. CONCLUSION. Client perspectives on reclaiming participation after injury affirm the notion of eventual participation, with each person finding strategies to succeed. In order to help clients reclaim participation, health professionals should develop contextually sensitive programs that include peer mentoring and reduce the influence of hindering factors.Item Cost-effectiveness of the HiBalance training program for elderly with Parkinson’s disease: analysis of data from a randomized controlled trial(SAGE Publications, 2018) Joseph, Conran; Brodin, Nina; Leavy, Breiffni; Hagstromer, Maria; Lofgren, Niklas; Franzén, ErikaOBJECTIVE: To determine the cost-effectiveness of the HiBalance training program for managing Parkinson’s disease (PD)-related balance and gait disorders. DESIGN: Cost comparison design following the randomized controlled trial comparing a novel balance training intervention with care as usual. SUBJECTS: A total of 100 participants with mild–moderate PD were randomized to either the intervention (n = 51) or the control group (n = 49). INTERVENTION: A 10-week (three times per week), group-based, progressive balance training program, led by two physical therapists. MAIN OUTCOMES: All program costs were collected for both groups. Cost-utility was evaluated using quality-adjusted life years (QALYs) and cost-effectiveness measures were the Mini Balance Evaluation Systems Test (Mini-BESTest; assessing balance performance) and gait velocity. Incremental cost-effectiveness ratios were calculated and a probabilistic sensitivity analysis was conducted. RESULTS: The between-group difference in QALYs was 0.043 (95% confidence interval (CI): 0.011–0.075), favoring the intervention group. Between-group differences in balance performance and gait velocity were 2.16 points (95% CI: 1.19–3.13) and 8.2 cm/second (95% CI: 2.9–13.6), respectively, favoring the intervention group. The mean cost per participant in the intervention group was 16,222 SEK (€1649) compared to 2696 SEK (€274) for controls. The estimated incremental cost-effectiveness ratios were 314,558 SEK (€31,969) for an additional QALY, 6262 SEK (€631) for one point improvement in balance performance, and 1650 SEK (€166) for 1 cm/second increase in gait velocity. Sensitivity analyses indicated a high probability (85%) of program success. CONCLUSION: In terms of QALYs, the HiBalance program demonstrated a high probability of cost-effectiveness in the short-term perspective when considering the willingness-to-pay thresholds used in Europe.Item The development of a health care decision-making model to improve survival of persons with traumatic spinal cord injuries (tSCI)(University of the Western Cape, 2022) Boggenpoel, Blake; Joseph, ConranA scarcity of data exists regarding the processes of care and its effects on mortality and the functioning of patients with traumatic spinal cord injuries (tSCI). To improve survival rates of these patients, one will need to identify processes or personal factors that may cause early mortality and worsen function. Furthermore, these process and personal factors concerning mortality may vary between contexts primarily due to process aspects differing, which should be explored to develop fit-for-purpose decision-making models.Item Epidemiology of and challenges experienced by individuals surviving a traumatic spinal cord injury with community reintegration in Tanzania(University of the Western Cape, 2018) Swai, Joseph; Phillips, Julie; Joseph, ConranA traumatic spinal cord injury (TSCI) often occurs unexpectedly and causes considerable disability. This condition requires specialized care that is delivered in a time sensitive manner. Data on the incidence, causes, mortality and injury characteristics of TSCI are important for gauging demand for health care and social support services. Unfortunately data on the incidence and causes, as well as functioning such as participation and integration into society, of TSCI are sparse in developing countries such as Tanzania. The overall aim of this study is to determine the incidence, causes, mortality and injury characteristics of TSCI, and to explore the challenges experienced with community reintegration after injury in Tanzania. Both quantitative and qualitative research paradigms were used. The quantitative phase of the study was conducted at Kilimanjaro Christian Medical Centre (KCMC), a referral and teaching hospital in northern Tanzania. The study population was all patients admitted to KCMC with a TSCI from 1 January 2011 to 31 December 2015 (five year period). Quantitative data were collected retrospectively using a data extraction sheet designed by the International Spinal Cord Society which consisted of the following sections: participants’ characteristics (for example age, gender, duration of hospital stay, causes of injury and vertebral injuries) and injury characteristics (location of injury and completeness of injury). Differences between groups (stratified by year) was analysed using both descriptive and inferential statistics. The population for the qualitative phase was based on those included in the quantitative phase. Purposive sampling was used to select adults (over the age of 18 years) with TSCI who were managed at KCMC. Qualitative data were collected by means of individual, semi-structured interviews, and lasted until theoretical saturation was achieved. Thematic analysis was used to derive themes (categories) explaining the latent perceptions of community reintegration and its influences.Item Evaluation of a new clinical performance assessment tool: a reliability study(AOSIS publishing, 2012) Joseph, Conran; Frantz, Jose M.; Hendricks, Candice; Smith, MarioClinical practice is an essential requirement of any graduate physiotherapy programme. For this purpose, valid and reliable assessment tools are paramount for the measurement of key competencies in the real-world setting. This study aims to determine the internal consistency and inter-rater reliability of a newly developed and validated clinical performance assessment form. A cross-sectional quantitative research design was used, which included paired evaluations of 32 (17 treatment and 15 assessment) student examinations performed by two independent clinical educators. Chronbachs alpha was computed to assess internal consistency and intraclass correlation coefficient (ICC’s) with confidence intervals of 95% were computed to determine the percentage agreement between paired examiners. The degree of internal consistency was substantial for all key performance areas of both examinations, except for time and organisational management (0.21) and professionalism (0.42) in the treatment and evaluation examinations respectively. The overall internal consistency was 0.89 and 0.73 for both treatment and assessment examinations, indicating substantial agreement. With regard to agreement between raters, the ICC’s for the overall marks were 0.90 and 0.97 for both treatment and assessment examinations. Clinical educators demonstrated a high level of reliability in the assessment of students’ competence using the newly developed clinical performance assessment form. These findings greatly underscore the reliability of results obtained through observation of student examinations, and add another tool to the basket of ensuring quality assurance in physiotherapy clinical practice assessment.Item Exploration of the experiences of persons in the traumatic spinal cord injury population in relation to chronic pain management(MDPI, 2023) Williams, Tammy-Lee; Joseph, Conran; Nilsson-Wikmar, LenaChronic pain amongst individuals with traumatic and nontraumatic spinal cord injury (SCI) has high prevalence rates, with severe impact on the activities of daily living, mood, sleep and quality of life. This study aimed to explore the experiences and challenges of chronic pain management amongst the traumatic spinal cord injury (TSCI) population in the Western Cape region of South Africa. A qualitative descriptive approach was chosen for the study, in which 13 individuals living with TSCI were purposively recruited and interviewed telephonically. An inductive thematic analytic approach was used. The results indicate ineffectiveness of standard pain management, with a lack of education regarding pain physiology and pain management strategies as well as unbalanced decision-making between clinician and patient. Thus, patients develop coping strategies to survive with pain. Current pain regimes are suboptimal at best, underpinned by the lack of clarity or a mutually agreed plan to mitigate and eradicate pain.Item Exploring the key performance areas and assessment criteria for the evaluation of students' clinical performance: a Delphi study(AOSIS Publishing, 2011) Joseph, Conran; Hendricks, Candice; Frantz, Jose M.BACKGROUND: Evaluating students’ clinical performance is an integral part of the quality assurance in a physiotherapy curriculum, however, the objectivity during clinical examination have been questioned on numerous occasions. The aim of this study was to explore the essential key clinical performance areas and the associated assessment criteria in order to develop a reliable clinical assessment form. METHODS: A Delphi study was used to obtain consensus on the development of a reliable clinical performance assessment tool. The study population consisted of purposively selected academic physiotherapy staff from the University of Western Cape as well as supervisors and clinicians involved in the examination of physiotherapy students from the three Universities in the Western Cape. Findings from the Delphi rounds were analysed descriptively. Fifty percent or higher agreement on an element was interpreted as an acceptable level of consensus. RESULTS: Eight key performance areas were identified with five assessment criteria per key performance area as well as the weighting per area. It was evident that evaluators differed on the expectations of physiotherapy students as well as the criteria used to assess them.CONCLUSIONS: The Delphi panel contributed to the formulation of a clinical assessment form through the identification of relevant key performance areas and assessment criteria as they relate to undergraduate physiotherapy training. Consensus on both aspects was reached following discussion and calculation of mean ranking sores. IMPLICATIONS: This process of reaching consensus in determining clear criteria for measuring key performance areas contributes to the objectivity of the process of cilia examinations.Item Health status and functioning after traumatic spinal cord injury in South Africa: Comparison between a private and a public health care funded cohort(University of the Western Cape, 2018) Jeftha, Tarryn Kim; Joseph, ConranIntroduction: A spinal cord injury is the damage to the spinal cord that alters functional independence. Two different systems of care for the management of health conditions are available in private and public care in South Africa. A better understanding of health and functioning of individuals in the two systems is crucial to help address inequality between the two systems. The aim of the study was to describe the health status and functioning of persons with traumatic spinal cord injury (TSCI) in the Western Cape province who received public-funded care compared with those in the Gauteng province who received private care. Methodology: The study entailed a cross-section comparison between a government-funded cohort in the Western Cape and a private cohort in Gauteng, two of the provinces of South Africa. Self-administered questionnaires and standardised outcome measures were used to collect the data and to ensure validity and reliability. Data were captured on Excel and then transferred to SPSS (Statistical Package for Social Sciences) for analysis. Ethical clearance to conduct the study was obtained from the Biomedical Research Ethics Committee of the University of the Western Cape.Item Implementation of the HiBalance training program for Parkinson’s disease in clinical settings: A feasibility study(Wiley Open Access, 2018) Joseph, Conran; Leavy, Breiffni; Mattsson, Sara; Falk, Lynn; Franzén, ErikaBACKGROUND: Translating evidence into practice requires adaptation to facilitate the implementation of efficacious interventions. A novel highly challenging balance training program (HiBalance) was found to improve gait, balance, and physical activity in persons with Parkinson’s disease (PD) in an earlier randomized controlled trial. This study aimed to describe the adaptation process and feasibility of implementing the HiBalance program for PD within primary healthcare settings. METHOD: Feasibility was assessed in terms of study processes and scientific evaluation. Nine persons with mild–moderate PD were enrolled in this pre–post feasibility study. The dose of the original program was adapted by reducing therapist-led training sessions from three to two times weekly. Outcome measures were substituted with ones more clinically feasible. One group (n = 5) received HiBalance training three times weekly for 10 weeks while another (n = 4) trained twice weekly plus a once weekly home exercise program (HEP). Balance performance was the primary outcome, while secondary outcomes (e.g., gait speed, physical activity level, concerns of falling, and health-related quality of life) were also evaluated. RESULTS: Regarding process feasibility, attendance was high (approximately 90%) in both groups, and experiences of the group and home training were positive. Newly selected outcome measures were feasible. The scientific evaluation revealed few adverse events and no serious injuries occurred. Concerning outcomes per group, the average change in balance performance and gait speed was equal to, or exceeded, the minimally worthwhile treatment effect commonly used in PD. CONCLUSION: The findings support the feasibility, in terms of process and scientific evaluation, of the adapted HiBalance program for implementation within clinical settings. A sufficiently powered study is required to ascertain whether the newly proposed program offers similar short and long-term effects as the original program.Item Incidence, aetiology and injury characteristics of traumatic spinal cord injury in Stockholm, Sweden: a prospective, population-based update(Foundation for Rehabilitation Information, 2017) Joseph, Conran; Andersson, Nina; Bjelak, Sapko; Giesecke, Kajsa; Hultling, ClaesOBJECTIVES: To update the incidence rate, aetiology and injury characteristics of acutely-injured adults with traumatic spinal cord injury in Stockholm, Sweden, using international standards of reporting. Study design: Prospective, (regional) populationbased observation. SUBJECTS: Forty-nine consecutively enrolled individuals. METHODS: A surveillance system of newly-injured adults with traumatic spinal cord injury was implemented for an 18-month period. The International Spinal Cord Injury Core Data Set was used to collect data on those who survived the first 7 days postinjury. RESULTS: After an 18-month period, 49 incident cases were registered, of whom 45 were included in this study. The crude incidence rate was 19.0 per million, consisting mainly of men (60%), and the mean age of the cohort was 55 years (median 58). Causes of injury were almost exclusively limited to falls and transport-related events, accounting for 58% and 40% of cases, respectively. The incidence has remained stable when compared with the previous study; however, significant differences exist for injury aetiology (p = 0.004) and impairment level (p = 0.01) in that more fall- and transport-related spinal cord injury occurred, and a larger proportion of persons was left with resultant tetraplegia, in the current study, compared with more sport-related injuries and those left with paraplegia in the previous study. CONCLUSION: The incidence rate appeared to remain stable in Stockholm, Sweden. However, significant changes in injury aetiology and impairment-level post injury were found, compared with the previous study. There remains a need for developing fall-related prevention strategies in rehabilitation settings as well as in population-based programmes.Item Levels and patterns of physical activity in stroke survivors with different ambulation status living in low-income areas of Cape Town, South Africa(Taylor & Francis, 2020) Joseph, Conran; Rhoda, Anthea; Conradsson, David MoulaeeLittle is known about physical activity (PA) in people with stroke living in low-income areas. The aim of this study was to characterize and contrast the levels and patterns of PA between stroke survivors with different ambulation status living in low-income areas in Cape Town, South AfricaItem Mapping two measures to the International Classification Of Functioning, Disability and Health and the brief ICF core set for spinal cord injury in the post-acute context(Taylor & Francis, 2016) Joseph, Conran; Phillips, Julie; Wahman, Kerstin; Wikmar, Lena NilssonOBJECTIVE: To evaluate the extent to which the rehabilitation outcome levels (ROL) and the spinal cord independence measure (SCIM) III could be mapped to the International Classification of Functioning, Disability and Health (ICF) and the brief core set for spinal cord injury (SCI) in the postacute context. METHODS: Two professionals used the published protocol to map the concepts derived from both measures to the ICF categories. Further, the endorsed categories at the second level of the ICF were used to determine the coverage of the Brief ICF Core Set for SCI. RESULTS: Three items of the ROL could not be conceptualised within the ICF, while the rest were mapped to 42 second-level categories, mainly to the activity and participation domain. All the items of the SCIM III were mapped, yielding 52 ICF categories, mostly at the third level (32). For the mapping to the Core Set for SCI, the ROL covered five and the SCIM III all nine categories of ‘activities and participation’ included as the candidate categories of the brief version. Conclusion: In terms of content, the ROL appears to be a more global measure of functioning, compared with the SCIM III that covers specific ‘activity’ aspects as proposed in the Brief Core Set for SCI. It is thus recommended that standardised measures, such as the SCIM III, be used due to its conceptual underpinnings and coverage of important aspects.Item Outcome evaluation of highly challenging balance training for people with Parkinson disease: A multicenter effectiveness-implementation study(Wolters Kluwer Health, 2020) Leavy, Breiffni; Joseph, Conran; Löfgren, NiklasIn order for people with Parkinson disease (PwPD) to benefit from neurorehabilitation research, interventions tested in research settings require assessment in real-world clinical practice. There is little evidence for whether efficacious exercise interventions for PwPD remain effective when transferred to standard clinical settings. The aim of this study was to assess the clinical effectiveness of the adapted HiBalance program on balance control and gait among PwPD.Item Outcome measures used to assess disability post stroke within the framework of the ICF: a literature review(University of the Western Cape, 2011) Joseph, Conran; Rhoda, AntheaBACKGROUND: The use of outcome measures has been associated with good practice among clinicians and as a research instrument. These measures can be utilized to assess- and manage patients, observe progress, determine the effects of certain intervention and for research purposes. This scholarly paper investigates the most commonly used outcome measures along the continuum of care, and further provides additional information that will assist researchers and clinicians to decide on the most appropriate outcome measure in a South African Healthcare. METHODS: Literature of the past 10 years dealing with outcome measures was reviewed for this study. The types of papers in this review were systematic reviews, narrative reviews, scholarly papers, longitudinal and cross sectional. RESULTS AND DISCUSSION: Included in this review are four impairment, five activity/disability, two participation restriction and four quality of life outcome measures. Although a number of these measures have been used in the South African setting, it is not clear whether they have been validated for the local context. Few translated versions relevant to South Africa are available and not all measures are freely available, which could limit the use thereof. CONCLUSION: This paper successfully describes the commonly used outcome measures and aspects that should be taken into account when deciding on the appropriate measure.Item Psychosocial reintegration following traumatic spinal cord injury in South Africa: The influence of employment, injury characteristics and living situation(The Journal of Spinal Cord Medicine,, 2022) Nizeyimana, Eugene; Phillips, Joliana; Joseph, Conran1Department of Health and Rehabilitation Sciences, Division of Physiotherapy, Stellenbosch University, Cape Town, South Africa, 2Department of Physiotherapy, University of the Western Cape, Cape Town, South Africa Objectives: To determine the influence of employment, injury characteristics and living situation on psychosocial reintegration in individuals who sustained a traumatic spinal cord injury (TSCI) in South Africa. Design: A cross-sectional exploratory survey. Settings: Communities of the Cape Metropolitan Area, South Africa. Participants: A total of 108 community- dwelling adults, between ages of 19 and 71 years, who have sustained a TSCI more than 1- year ago. Outcome measures: : The Sydney psychosocial reintegration scale (SPRS-2). Results: The SPRS-2 and domains mean (SD) scores were: (1) Overall SPRS-2 of 27.87(13.4); (2) Occupational activity of 8.62 (4.8); (3) Interpersonal relationships of 9.80 (5.1); and (4) Living skills of 9.45 (4.9). Multivariate regression analysis resulted in two significant independent variables, namely employment and living situation. Employment alone explained 24.3% of the variance in the overall psychosocial model, 25.6% in the occupational activity model, while employment together with living situation explained 24.2% of the variance in the living skills model, with those employed reporting better psychosocial reintegration and those living in informal dwellings reporting poorer psychosocial reintegration. Conclusion: Employment and living situation strongly influenced psychosocial reintegration following a TSCI, indicating the important role of socio-economic status for psychosocial adaptation after injury. As employment plays a significant mediating role, and living in informal dwellings negatively affect psychosocial reintegration following a TSCI, rehabilitation stakeholders and policy makers need to continue lobbying for social and political change that support employment opportunities and provide accessible housing for persons with TSCI.Item Self-management strategies employed by stroke survivors in the Western Cape, South Africa(University of the Western Cape, 2019) Smith, Janine Lynette; Rhoda, Anthea; Joseph, ConranIschaemic heart disease and stroke were the leading causes of death and disability globally, accounting for a combined 15 million deaths. Disability following a stroke is complex and multidimensional. Disability and functioning post stroke can be conceptualized within the framework of the International Classification of Functioning, Disability and Health (ICF). The involvement of the individual in their rehabilitation and recovery is essential. Therefore, it is a necessity for individuals, particularly in a low resource setting to engage in selfmanagement activities. Bandura’s social cognitive theory based on self-efficacy, forms the basis of self-management programmes. Self-management relates to one’s ability to manage one’s consequences post stroke, and self-efficacy has been proven to be pivotal in the management and improvement of long-term conditions. The aim of the study was to explore the self-management strategies employed by stroke survivors in the Western Cape, South Africa through an exploratory, qualitative design. Prior to the commencement of the data collection phase, ethical clearance was sought from the University of the Western Cape Research Ethics Committee. Participants were recruited from an urban and rural area in the Western Cape. An interview guide was developed based on previous literature. Interview questions were related to 1) what self-management strategies were adopted to address activity limitations and participation restrictions and 2) strategies used to address environmental challenges.Item Strengthening health systems for persons with traumatic spinal cord injury in South Africa and Sweden: a protocol for a longitudinal study of processes and outcomes(Frontiers Media, 2018) Conradsson, David; Rhoda, Anthea; Mlenzana, Nondwe; Wikmar, Lena Nilsson; Wahman, Kerstin; Hultling, Claes; Joseph, ConranBACKGROUND: The provision of specialized care in a time-sensitive manner has shown to be crucial for survival and recovery of functioning after a traumatic spinal cord injury (TSCI). However, little is known about the provision of TSCI care in different international contexts; information which is required for strengthening policy and practice. AIMS: The overarching aim of this study will be to explore health care processes and outcomes of TSCI care in South Africa and Sweden. Specific aims will be to: (1) describe acute processes of TSCI care, (2) determine acute- and long-term outcomes of TSCI care, and (3) identify predictors for survival, secondary complications, and functioning 12 months post-injury. METHODS: A prospective (regional), population-based cohort study where adults with an acute TSCI will be recruited over at least a 1-year period from the City of Cape Town, South Africa, and Stockholm, Sweden. The anticipated sample size inclusive of both international contexts will be 200 participants—based on a power calculation for detecting differences in mortality. Information on the nature and timing of processes of acute care (e.g., transfer logistics, spinal surgery, and specialized SCI care) will be collected on acute care admission and discharge using a standardized form. Survival status, secondary complications, neurological symptoms, functional status, activity, and participation as well as health-related quality of life will be collected at discharge from SCI acute care and at 12-months post-injury. Secondary complications and functioning will be compared between South Africa and Sweden using inferential statistics. To address mortality specifically, the indirect standardization method for differences in mortality between contexts will be used whereby Stockholm will serve as standard for specialize care. For the assessment of factors related to mortality and other outcomes (e.g., neurological and secondary health conditions) multivariate regression analyses will be used to determine independent risk factors.CONCLUSION: This study offers a unique investigation of the relationship between health care processes and outcomes of TSCI care with the aim of strengthening management guidelines for SCI in South Africa and Sweden.