UWCScholar :: Browsing by Author "Rhoda, Anthea"

Browsing by Author "Rhoda, Anthea"

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Academics’ knowledge and experiences of interprofessional education and practice
(Health and Medical Publishing Group, 2016) Julie, Hester; Hess-April, Lucia; Wilkenson, J.; Cassiem, Wagheda; Rhoda, Anthea
BACKGROUND. Interprofessional education (IPE) can be seen as the vehicle to address the health and social problems of society through collaborative approaches. Since IPE should be facilitated by educators who are skilled in this area, faculty development initiatives should be based on the principles of IPE and collaborative practice (IPECP). OBJECTIVE. To explore academics’ knowledge and experiences of IPECP. METHODS. The study used an exploratory descriptive design and the appreciative inquiry framework underpinned data gathering and analysis. The data were collected using workshops, and the participants of the workshops shared their knowledge and experiences of IPECP, which were audio-recorded and analysed using thematic analysis. Ethical clearance was obtained from the University of the Western Cape, Cape Town, South Africa. RESULTS. The analysis revealed three themes: knowledge of IPE; experiences of IPECP; and enablers of IPECP aligned to the dream and discovery phases of appreciative inquiry. The findings revealed that academics were knowledgeable about the concept of IPE and that their experiences with IPECP ranged from clinical supervision to research. Regarding enablers of IPECP, they provided important input, which could facilitate IPECP in a university faculty. These included competencies for IPECP, professional development and a common practice framework. CONCLUSION. The academics who attended the faculty development workshops were knowledgeable about the concepts of IPECP. They concluded that for IPE to be effective, a common practice framework should be adopted in the faculty to inform specific teaching and learning strategies and outcomes.
Accuracy of clinical neurological examination in diagnosing lumbo-sacral radiculopathy: a systematic literature review
(BMC, 2017) Tawa, Nassib; Rhoda, Anthea; Diener, Ina
BACKGROUND: Lumbar radiculopathy remains a clinical challenge among primary care clinicians in both assessment and diagnosis. This often leads to misdiagnosis and inappropriate treatment of patients resulting in poor health outcomes, exacerbating this already debilitating condition. This review evaluated 12 primary diagnostic accuracy studies that specifically assessed the performance of various individual and grouped clinical neurological tests in detecting nerve root impingement, as established in the current literature. METHODS: Eight electronic data bases were searched for relevant articles from inception until July 2016. All primary diagnostic studies which investigated the accuracy of clinical neurological test (s) in diagnosing lumbar radiculopathy among patients with low back and referred leg symptoms were screened for inclusion. Qualifying studies were retrieved and independently assessed for methodological quality using the ‘Quality Assessment of Diagnostic tests Accuracy Studies’ criteria. RESULTS: A total of 12 studies which investigated standard components of clinical neurological examination of (sensory, motor, tendon reflex and neuro-dynamics) of the lumbo-sacral spine were included. The mean inter-observer agreement on quality assessment by two independent reviewers was fair (k = 0.3 – 0.7). The diagnostic performance of sensory testing using MR imaging as a reference standard demonstrated a sensitivity (confidence interval 95%) 0.61 (0.47-0.73) and a specificity of 0.63 (0.38-0.84). Motor tests sensitivity was poor to moderate, ranging from 0.13 (0.04-0.31) to 0.61 (0.36-0.83). Generally, the diagnostic performance of reflex testing was notably good with specificity ranging from (confidence interval 95%) 0.60 (0.51-0.69) to 0.93 (0.87-0.97) and sensitivity ranging from 0.14 (0.09-0.21) to 0.67 (0.21-0.94). Femoral nerve stretch test had a high sensitivity of (confidence interval 95%) 1.00 (0.40-1.00) and specificity of 0.83 (0.52-0.98) while SLR test recorded a mean sensitivity of 0.84 (0.72-0.92) and specificity of 0.78 (0.67-0.87). CONCLUSION: There is a scarcity of studies on the diagnostic accuracy of clinical neurological examination testing. Furthermore there seem to be a disconnect among researchers regarding the diagnostic utility of lower limb neurodynamic tests which include the Straight Leg Raise and Femoral Nerve tests for sciatic and femoral nerve respectively. Whether these tests are able to detect the presence of disc herniation and subsequent nerve root compression or hyper-sensitivity of the sacral and femoral plexus due to mechanical irritation still remains debatable.
Accuracy of magnetic resonance imaging in detecting lumbo-sacral nerve root compromise: A systematic literature review
(BioMed Central, 2016) Tawa, Nassib; Rhoda, Anthea; Diener, Ina
Background: MRI is considered to be the diagnostic tool of choice in diagnosing nerve root compromise among patients presenting with clinical suspicion of lumbo-sacral radiculopathy. There exists controversy among researchers and clinicians regarding the diagnostic utility and accuracy of MRI in detecting nerve root compromise and radiculopathy. This review evaluated 4 primary diagnostic accuracy studies that specifically assessed the accuracy of MRI in detecting nerve root compromise, as established in the current literature. Methods: Eight electronic data bases were searched for relevant articles from inception until January 2014. All primary diagnostic studies which investigated the accuracy of MRI in diagnosing nerve root compromise among patients with low back and referred leg symptoms were screened for inclusion. Qualifying studies were retrieved and independently assessed for methodological quality using the 'Quality Assessment of Diagnostic tests Accuracy Studies' criteria. Results: Four studies qualified for inclusion in this review. The sensitivity of MRI in detecting lumbar nerve root compromise was very low at 0.25 (95 % CI) while the specificity was relatively high at 0.92 (95 % CI). Conclusions: There is lack of sufficient high quality scientific evidence in support or against the use of MRI in diagnosing nerve root compression and radiculopathy. Therefore, clinicians should always correlate the findings of MRI with the patients' medical history and clinical presentation in clinical decision making.
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, Anthea
BACKGROUND: 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.
The adaptation and contextualization of the bridges stroke self-management intervention for patients living with stroke in the Western Cape, South Africa
(University of the Western Cape, 2018) Groenewald, Ryan Clive; Rhoda, Anthea
Background: Many patients with stroke feel ill-prepared for discharge from stroke rehabilitation, despite having undergone extensive periods of therapy. From the available research, there is clear evidence that disease specific self-management interventions (SMI) are effective at changing targeted behavioural outcomes, and ultimately improve patient participation restrictions, using self-efficacy principles. A stroke SMI, originally developed by the Bridges Organization to address participation restriction in patients living with stroke in the United Kingdom (UK); was successfully adapted and contextualized for the New Zealand stroke population. A similar stroke SMI could have equal positive benefits for the South African stroke population but would need to be contextually relevant. Aim: This study aims to adapt and contextualize the original UK Bridges stroke SMI workbook for implementation with the South African stroke population. Method: The qualitative, exploratory study is conducted in five phases. Thirteen healthcare professionals (Phase 1) and 12 patients with stroke (Phase 2) are engaged with by the researcher using focus group discussions to understand their views on the implementation of self-management intervention in the local context; and one-on-one interviews with local South African patients living with stroke are conducted to explore their experiences (Phase 3) and build contextually relevant local vignettes. The adaptation and contextualization process of the Bridges stroke SMI workbook to the South African context occurs using the participant feedback and built vignettes from Phases 1 to 3. Consensus on the adaptation of the workbook is then reached through the use of an expert panel for peer-review (Phase 4), and a final focus group discussion with local healthcare professionals in the field of stroke rehabilitation (Phase 5) to produce the final South African Bridges stroke SMI workbook. Phase 1 and 5 participants were conveniently selected; while purposive sampling was applied for Phases 2 and 3. Throughout the various study phases, a thematic analysis procedure is employed by the researcher to analyse and interpret the themes identified through the qualitative data collected. A deductive approach was employed by the researcher for the focus group discussion data of Phase 1, 2, and 5; and an inductive approach to the data from the interviews in Phase 3. The trustworthiness criteria of credibility, transferability, dependability, and confirmability were applied.
Attitudes of health science students towards people with disabilities at Kilimanjaro Christian Medical Centre (KCMC) in Tanzania
(2010) Sheriff, Insiyya Djamil; Rhoda, Anthea
The effects of disability on the individual not only include physical, psychological and emotional adjustments but also negative attitudes of able bodied people towards persons with disabilities. The attitudes of healthcare professionals towards persons with disabilities could affect rehabilitation outcomes as well as the reintegration of these people into society. The aim of the study was to investigate the attitudes of health science students towards persons with disabilities at Kilimanjaro Christian Medical Centre (KCMC), in Tanzania. An explorative quantitative research design using a cross-sectional survey was used. The study sample (182) included all Physiotherapy, Occupational Therapy, Nursing, Medical and Optometry students. Data was collected using the Attitudes Towards Disabled Persons Scale,consisting of 20 items rated on a six-point Likert Type Scale. A demographic questionnaire which included questions relating to the contact of the students with persons with disabilities was also administered. Descriptive and Inferential statistical analysis was conducted using the Statistical Package for the Social Sciences version 15.0. Permission to conduct the study was obtained from the Higher Degrees Committee and the Senate Research Grant and Study Leave Committee of the University of the Western Cape. Further permission was requested from Ministry of Education, Research and Ethics Department in Tanzania and the authorities of the respective Health Sciences programmes to include students in the study. Information obtained was handled with confidentiality and anonymity, and the students had the right to withdraw from the study at anytime.The results revealed that the sample consisted of more females (58%) than males (41.2%).The majority of the participants were between the ages of 20-29 years. The highest response rate was from the medical students (29.1%) followed by the physiotherapy students (27.5%).The Optometry and physiotherapy students had more positive attitudes than the rest of the health science students who participated. The mean score on the ATDP scale was 59.01 (12.3) with scores ranging from 18 to 90. The results therefore revealed that overall the students had a neutral to negative attitude towards persons with disabilities. With regards to the contact of the students with persons with disabilities 26.9% of the participants responded that they had had a long talk with a person with a disability while only 17.6% of the students responded that persons with disabilities visited their homes. The mean contact score was 22.72 indicating that the students had a slightly above average contact with persons with disabilities. No association was found between the attitude and contact mean scores.Information obtained in this study could be used to influence the curriculum of Health Science Students at Kilimanjaro Christian Medical Centre.
Barriers and facilitators to utilisation of rehabilitation services amongst persons with lower-limb amputations in a rural community in Kwa-Zulu Natal
(University of the Western Cape, 2017) Naidoo, Ugendrie; Ennion, L.; Rhoda, Anthea
An estimated 387 million people worldwide already have diabetes mellitus (DM), with those numbers rising to an estimated 592 million people by the year 2035. The prevalence of diabetes mellitus continues to increase with the largest increase seen in low- and middleincome countries, such as South Africa (Shaw, Sicree,& Zimmet, 2010; Peer et al., 2012; International Diabetes Federation, 2014; Bertram et al., 2013; Mayosi et al., 2009). Lowerlimb amputation is a common complication of uncontrolled diabetes mellitus (Moxey et al., 2011) and there is a marked increase in the incidence of diabetes mellitus in rural areas in South Africa. The impact that the amputation has on the individual's life can be devastating since the amputation of the limb is likely to be accompanied by a profound sense of loss. Rehabilitation can assist to retrain physical and functional abilities, psychological and emotional adjustment issues, as well as social and community reintegration (Manderson & Warren, 2010). Therefore, comprehensive rehabilitation is vital to mitigate the negative impact that a lower-limb amputation has on a person. Persons with disabilities who live in rural areas experience challenges accessing health services and rehabilitation (Harris et al., 2011). Even though challenges with accessing healthcare in rural settings are well documented, there is no literature specifically pertaining to persons with lower-limb amputations in a rural South African context.
Barriers experienced by service providers and caregivers in clubfoot management in Kenya
(SAGE Publications, 2015) Kingau, Naomi Wanjiru; Rhoda, Anthea; Mlenzana, Nondwe
Disability in childhood remains a challenge globally. Linked to this disability is an apparent increase in the prevalence of infants born with congenital clubfoot. Clubfoot can, however, be effectively managed but this management faces various challenges. This study aims at exploring the barriers experienced in Kenya.In-depth interviews were conducted with 20 participants. Informed consent was sought. Field notes were taken and the interviews tape-recorded. The interviews took 45 minutes to 1 hour. They were transcribed verbatim and analysed by thematic content.
Barriers to reintegration experienced by stroke clients post discharge from a rehabilitation center in Malawi
(University of the Western Cape, 2012) Chimatiro, George Lameck; Rhoda, Anthea
Stroke is a worldwide medical emergency, and the trend in its incidence is rising. Stroke leads to activity limitation and participation restriction among stroke clients. However rehabilitation of stroke disability has been found as lacking emphasis on reintegration issues, resulting into stroke clients facing different barriers to reintegration in the community after discharge. There is limited information about experiences of stroke clients in the communities after discharge from rehabilitation centers in Malawi. The current study was conducted to explore the barriers to reintegration experienced by the clients post discharge from a rehabilitation center in Malawi. A qualitative research was adopted to explore the perceived barriers to reintegration at Malawi Against Physical Disabilities (MAP) Kachere rehabilitation centre in Blantyre. In-depth interviews were utilized to capture data from perspectives of eight stroke clients, eight caregivers and seven service providers. The data was analyzed by means of content analysis. The findings of this study show key barriers that challenge community reintegration at two levels: individual and environmental. At individual level the barriers include impairments mainly depression and anxiety and physical weakness; and personal characteristics such as denial, gender and comorbidity. At the environmental level stroke clients experience attitudinal barriers by people in different settings of the community, poor terrain, long distance to places of interest, inaccessible structures and poverty. From the findings, therefore, stroke client experience wide range of barriers in both the activity and participation domains of community reintegration.Based on the key findings, recommendations have been made along three broad lines. To decrease barriers to reintegration, service providers could use the findings to consider equally addressing the potential negative contextual factors to reintegration when managing stroke clients, a shift from purely medical model approach to management of stroke. To increase rehabilitation services the government of Malawi could address the problem of limited funding to rehabilitation organizations and put measures to increase number of rehabilitation personnel at community, district and national levels. Further research in the area of community reintegration and development of a model of stroke care and rehabilitation in the country has also been recommended with view to improving stroke care and enhanced community reintegration post stroke in the country.
Challenges experienced by mothers of children with cerebral palsy in Ndola, Zambia.
(University of the Western Cape, 2012) Singogo, Carol; Rhoda, Anthea
About 10% of children world-wide experience developmental disorders and require access to the health care system. These disorders also require extensive care giving, often throughout childhood and into the adult years. Cerebral palsy (CP) is one such chronic condition, and can serve as a major cause of childhood disability. It is the commonest cause of neurological impairment in childhood and is associated with functional limitations and lifelong disability. Providing the high level of care required by a child with long-term functional limitations can become burdensome and may impact on both the physical and psychological health of the care giver. To prevent problems suffered by mothers of children with CP, it is important to explore the challenges experienced. All studies conducted previously on cerebral palsy in Zambia focus on impairments and difficulties experienced by children with CP and none of the mothers’ challenges have been explored. The aim of this study therefore was to explore the challenges that mothers of children with cerebral palsy experience in Ndola, Zambia. The study was conducted at two rehabilitation centers (Twapia and Mushili) under the Community Based Rehabilitation (CBR) catchment area in Ndola. A qualitative research design was employed. The mothers were stratified and purposefully selected and interviews were stopped once theoretical saturation was reached. Permission to conduct the research was obtained from relevant bodies and ethical issues were observed throughout the study. Sixteen (16) mothers of children with CP were interviewed. In-depth interviews were done using an interview guide which was designed after extensive review of literature. The interviews were audio recorded. The recorded data was transcribed verbatim and thematic analysis was used to analyze the data. The results showed that the mothers faced many challenges which included emotional, physical health, socio-economic, environmental, misdiagnosis of the condition of their children, marital problems and lack of implementation of policies regarding children with CP by the Zambian government
The challenges experienced by persons with physical disabilities who live in Chifubu Township in Zambia.
(University of the Western Cape, 2010) Sakala, Mary Seliya; Rhoda, Anthea
People with physical disability experience various challenges which include physical, social and attitudinal challenges. These challenges which limit the inclusion of persons with physical disabilities in society are a result of barriers and the physical impairment itself. These factors also cause activity limitations and participation restrictions. Despite the United Nations declaration of 1993 for equalization of opportunities for people with disabilities, not much has changed. It is with this background that the researcher aimed to explore the challenges experienced by people with physical disabilities living in a low cost location of Zambia. Qualitative research methods were employed using a phenomenological approach to gain an in-depth insight of these challenges from participants' Iived experiences. Twenty participants were purposively selected for three focus group discussions, and eight of the twenty participants took part in the in depth interviews. The data was organised and analysed using the thematic method. Results of the study showed that participants in this study were challenged with architectural barriers due to designs, they lacked formal education, specialised skills, and most of them were unemployed and financially dependent on others. The negative attitudes of families, service providers, and the community in general resulted in discrimination and limited the participation and involvement of people with disabilities in the mainstream activities. The cultural beliefs of the participants in the research influence the manner in which society perceives persons with disability and treat them. Limited access to information about HIV/AIDS and the myths about the cure of the pandemic makes people with disabilities more vulnerable and at risk of being infected. The information regarding challenges experienced by people with disabilities gained in the study could be used by the policy makers for implementation of the UN declaration of equalization of opportunities for people with disabilities.
The challenges experienced by persons with physical disabilities who live in Chifubu Township in Zambia.
(University of the Western Cape, 2010) Sakala, Mary Seliya; Rhoda, Anthea
People with physical disability experience various challenges which include physical, social and attitudinal challenges. These challenges which limit the inclusion of persons with physical disabilities in society are a result of barriers and the physical impairment itself. These factors also cause activity limitations and participation restrictions. Despite the United Nations declaration of 1993 for equalization of opportunities for people with disabilities, not much has changed. It is with this background that the researcher aimed to explore the challenges experienced by people with physical disabilities living in a low cost location of Zambia. Qualitative research methods were employed using a henomenological approach to gain an in-depth insight of these challenges from participants' Iived experiences. Twenty participants were purposively selected for three focus group discussions, and eight of the twenty participants took part in the in depth interviews. The data was organised and analysed using the thematic method. Results of the study showed that participants in this study were challenged with architectural barriers due to designs, they lacked formal education, specialised skills, and most of them were unemployed and financially dependent on others. The negative attitudes of families, service providers, and the community in general resulted in discrimination and limited the participation and involvement of people with disabilities in the mainstream activities. The cultural beliefs of the participants in the research influence the manner in which society perceives persons with disability and treat them. Limited access to information about HIV/AIDS and the myths about the cure of the pandemic makes people with disabilities more venerable and at risk of being infected. The information regarding challenges experienced by people with disabilities gained in the study could be used by the policy makers for implementation of the UN declaration of equalisation of opportunities for people with disabilities.
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.
Coaching for publication in higher education: views of the coach
(Nova Southeastern University, 2011) Frantz, Jose M.; Phillips, Julie; Rhoda, Anthea
Purpose: Mentoring is a professional development approach that can be effectively used in improving publication outputs among academics. The challenge to develop academics in the area of publication is essential. This study highlights the role of the mentor in the process of encouraging academics to improve their skill in publishing. Method: Participatory action research was used in this study. Nine academics, with the authors as mentors, participated in a support group over a 10-week period and monthly follow ups for 12-months. Results: Key aspects identified by the mentors were information sharing, providing and receiving feedback, and continuous support and motivation. Support in developing novice authors does not end when the manuscript is submitted but has to be maintained throughout the process until publication. Conclusion: Mentoring can assist in the development of academics regarding the skills for writing for publication
Conquering the publishing silences of black academic women
(University of the Western Cape, 2006) Rhoda, Anthea; Maurtin-Cairncross, Anita; Phillips, Julie; Witbooi, Sally
Although women fulfil and play meaningful roles in the academic life of universities, their contributions have seldom been acknowledged. The voices of women outside of the dominant western context of knowledge production such as women in South African historically black universities(HBUs), remains largely maginalized. Women at these HUBs have indicated a need for mentoring and support to assist with their scholarly endeavours
Contextualization of a physiotherapy clinical practice guideline for stroke rehabilitation in Kenya
(University of the Western Cape, 2018) Kingau, Naomi Wanjiru; Rhoda, Anthea; Elbadawi, Mohammed; Mlenzana, Nondwe
Stroke is the third leading cause of death and disability worldwide. Eighty five per cent of strokes occur in developing countries, and it is estimated that the prevalence will increase in future. Evidence based rehabilitation programs inherent in clinical practice guidelines has the potential to improves functional activities, and participation. However Kenya does not have this guideline. Most clinical guidelines are developed in the western world, and reflect developed world healthcare systems and resources that are not always appropriate to developing nations. Likewise, guidelines are costly to produce. Kenya lacks the resources and the expertise for de novo guideline development. It is therefore appropriate and cost effective to contextualise the available high quality recommendations.
The correlation of the self-reported Leeds assessment of neuropathic symptoms and signs score, clinical neurological examination findings and magnetic resonance imaging findings in patients with Lumbo-sacral radiculopathy
(University of the Western Cape, 2014) Tawa, Nassib; Rhoda, Anthea; Diener, Ina
Lumbo-sacral radiculopathy (LSR) is clinically defined as low back and referred leg symptoms accompanied by an objective sensory and/or motor deficit due to nerve root compromise. LSR is a common condition encountered by physiotherapists in clinical practice and the assessment and diagnosis remains a challenge owing to the complex anatomy of the lumbo-sacral spine segment and the various differentials. Moreover, LSR imposes a significant impact on patients’ health, functional ability, socio-economic status and quality of life. There are several diagnostic tools and procedures which are commonly utilised in practice, including diagnostic neuropathic pain screening questionnaires, clinical neurological tests, electro-diagnostics and imaging. However, the diagnostic utility and correlation of these tests have not been fully explored and remains debatable among clinicians and researchers in the fields of musculo-skeletal health and neurology. The aim of this study was to determine a correlation of the S-LANSS score, clinical neurological examination (CNE) findings and magnetic resonance imaging (MRI) reports in the diagnosis of LSR among patients who presented with low back and referred leg symptoms. The study was conducted in three phases. In phase one, two systematic literature reviews were conducted; firstly, to establish the evidence-based accuracy of CNE in diagnosing LSR, and secondly, to establish the evidence-based accuracy of MRI in diagnosing LSR. In both systematic literature reviews, the diagnostic tests accuracy (DTA) protocol was used in planning, design and execution of literature search, selection of relevant studies, quality assessment, data analysis and presentation of the results. In phase two, clinical validation of an adopted S-LANSS scale and lumbar MRI reporting protocol were established, and a standardised evidence based lumbar CNE protocol developed.The face and content validity of the original S-LANSS score was established among a sample of Kenyan physiotherapists and patients who presented with low back and referred leg symptoms, using both quantitative and qualitative research designs. This was followed by a test-re-test reliability study on the adapted version of the S- LNASS score. The face and content validity of the adopted lumbar MRI reporting protocol was established among a sample of Kenyan radiologists followed by an inter-rater reliability. An evidence-based lumbar CNE protocol was developed; standardised and inter-examiner reliability was also examined among a sample of Kenyan physiotherapists. Finally, in phase three, a cross-sectional blinded validity study was conducted in six different physiotherapy departments. Participants (patients, physiotherapists and radiologists) were recruited using strict in- and exclusion criteria and data was collected using a pain and demographic questionnaire, the S-LANSS scale, the CNE protocol, the Oswestry Disability Index (ODI) and the MRI lumbar spine reporting protocol. Data was captured, cleaned and analysed using SPSS version 21. Descriptive analysis was done using frequencies, means and percentages, while inferential analysis was conducted using Spearman’s rank correlation coefficient test r to establish the correlation between the diagnostic tests. Cross tabulations, receiver operating curves (ROC) and scatter plots were used to establish the sensitivity and/or specificity of S-LANSS scale and individual CNE tests as defined by MRI. In phase three, which formed the main study of the research project, a total of 102 participants were recruited in this study with a gender distribution of 57% females and 43% males. The majority (67%) had neuropathic pain according to the S-LANSS scale and their pain intensity ranged from moderate (4-6) to severe (7-9) as recorded on a Numeric Pain rating Scale (NPRS), and was more common among manual workers. Similarly, patients whose pain had a neuropathic component had moderate to severe disability. The S-LANSS scale and lower limb neuro-dynamic tests were the most sensitive tests 0.79 and 0.75 respectively, while deep tendon reflexes were the most specific tests (0.87). The S-LANSS and CNE correlated fairly but significantly with MRI (r=0.36, P=0.01).LSR is a common condition and its assessment and diagnosis remains a clinical challenge among physiotherapists. MRI is a high-cost diagnostic tool but is being used by many clinicians in making decisions regarding the management of patients. Rapid and low-cost neuropathic pain screening by the use of the S-LANSS scale, together with use of evidence-based CNE of neuro-conduction and neuro-dynamic tests may be used in confirming nerve-root related MRI findings. These may be used in making a decision on whether to manage a patient conservatively using pharmacological agents and manual physiotherapy and therapeutic exercise, or consider surgery in the initial management of patients with clinical suspicion of LSR. This is especially valuable in the resource-poor settings like Kenya and other sub-Saharan African countries where MRI is costly or unavailable.
Determinants of return to work and the development of a return to work programme for stroke survivors in Osun state, Nigeria
(University of the Western Cape, 2019) Olaoye, Olumide Ayoola; Soeker, Shaheed; Rhoda, Anthea
Background: Stroke is acknowledged globally and among Nigerian rehabilitation researchers as a public health problem that leave half of its survivors with significant neurological deficits. The attendant sequelae of stroke affects the functional ability, limits activity performance and participation of stroke survivors within the community. The inability to re-establish pre-existing roles after stroke further poses additional challenges on the society, friends and families of the stroke survivor with regards to cost and burden of care. Although stroke disrupt the career pathway of working age survivors briefly, recurrently or permanently; a systematic pathway that facilitates job placement and retention at work for stroke survivors could reduce the devastation and burden caused by unemployment following stroke. As this vocational rehabilitation pathway and programme is currently unavailable for stroke survivors, this study aimed to design a RTW intervention programme that could facilitate the work re-entry for stroke survivors in the state of Osun, Nigeria. Method: The study utilized a multi-phase mixed method research design that was guided by the Intervention Mapping (IM) framework to achieve its objectives. This consisted of three iterative phases that informed one another with the findings culminating into the developed return to work programme for stroke survivors in Osun State. Phase one used a convergent mixed method parallel approach to obtain baseline information on the RTW process, the impairments, activity limitation, and the participation restrictions experienced by stroke survivors in Osun state, Nigeria in two distinct stages that involved a cross-sectional survey and qualitative interviews. The cross sectional survey administered questionnaires that included the Work Rehabilitation Questionnaire, the International Classification of Functioning, Disability and Health (ICF) Brief Core Sets for vocational rehabilitation (VR) and the Work Impact Questionnaire (WIQ) using the face to face method. Descriptive statistics such as measure of central tendencies and frequencies as well as inferential statistics such as logistic regression analysis were performed on the questionnaire data. The qualitative study involved concept mapping using in-depth interviews with stroke survivors who have and those that have not RTW. The transcripts from the in-depth interviews were analysed using the thematic content method. Phase two entailed a scoping review of literature that reported on interventions aimed at facilitating RTW of stroke survivors. The last phase of the study involved a Delphi study with experts in the field of stroke and vocational rehabilitation. The Delphi survey was conducted over three rounds with the final draft of the RTW programme emerging at the third round. Results: Two hundred and ten stroke survivors with mean age 52.90±7.92 responded to the quantitative stage of the phase thereby yielding a response rate of 76.36%. Sixty three point eight percent of the respondents had returned to work with half of them in full time employment (32.9%) while 36.2% had not returned to work. The majority of the respondents identified that travel to and from work (43.8%) and access at work (43.3%) had an impact ranging from ‘quite a bit’ to ‘extreme’ on their ability to work on the WIQ. The results from the quantitative stage further showed that more than ten percent of the respondents experienced complete problem in four components of activity and participation domains of the ICF brief core sets for VR and these include remunerative employment (21.4%), acquiring new skills (17.1%), non-remunerative employment (16.7%), as well as acquiring, keeping and terminating jobs (14.3%). Similarly, energy and drive functions (41.9%) and higher level cognitive function (36.2%) were indicated as culminating in moderate to severe problems in more than a third of the respondents while the “performance of complex interpersonal relationship” and “exercise tolerance function” resulted in no or little difficulty for the respondents. The findings from the logistic regression analysis showed that the combination of side of body affected by stroke (left), type of vocational rehabilitation programme, symptoms of stroke, environment, body function impairments as well as activity and participation problems were the factors that predict RTW after stroke. The logistic regression model significantly explained 55.0% to 75.4% of the variance in RTW after stroke and correctly classified 89.0% of all the cases/respondents. Results from the qualitative stage of the first phase suggests the lived experience of returning to work after stroke to have entailed three themes that was represented by a concept map. The first theme revealed that “it was difficult to live with stroke” for the survivor. The second theme revealed that the stroke survivors’ environment could either worsen or lessen the difficulty experience while the third theme highlighted the various issues that directly impacted on the resumption of worker role of the participants. The scoping review phase (phase two) identified that RTW interventions for stroke survivors falls into three core components which includes 1) intervention components that interface with the stroke survivor; 2) intervention components that interfaced with the workplace and; 3) components that describe strategies of implementation. These core components are interventions that could guarantee an effective RTW for strokes survivors when included in a RTW programme. In the third phase which was the concluding phase of the study, 13 experts in the field of stroke and vocational rehabilitation unanimously agreed at the third round of Delphi that the content of RTW programme for stroke survivors should include an assessment phase, work intervention training phase, work test placement phase and clients full participation in worker role phase that will span a 12 week duration. The developed RTW programme, conceptualized as Stroke Return to Work Intervention Programme (SReTWIP) was designed to be individually tailored to meet the need of the stroke survivor and implemented by an interdisciplinary team that will include the OT and PT as key members. Equally, the stroke survivor is expected to be involved in the decision making process throughout the duration of the SReTWIP. And finally, the programme is to be coordinated by a case manager who will be a member of the interdisciplinary team. Conclusion: It can be concluded that 63.9% of stroke survivors in Osun State, Nigeria return to work. Problems pertaining to lack of energy and drive functioning; higher level cognitive functioning; acquiring new skills; handling stress and psychosocial demands; travel to and from work and access were the common body impairments and problems with activities and participation restrictions that the stroke survivors encountered. Similarly, the study concludes that a multi-faceted programme, the SReTWIP, comprising of four interconnected phases of interventions that targets multiple factors such as personal and environment factors influencing work resumption is likely to be more effective in facilitating quick RTW after stroke.
Determining the process of rehabilitation and the outcomes of patients at a specialised in-patient centre in the Western Cape
(University of the Western Cape, 2012) Conran, Joseph; Rhoda, Anthea; Dept. of Physiotherapy
The World Health Organisation estimates that the majority of the disabled population resides in the developing world, but most of the research on outcomes of patients originates from the developed world. In the light of the differences in healthcare structures and function, especially rehabilitation between settings and countries, it is imperative to have an understanding of the functioning of patients at discharge with the objective of measuring the level at which outcomes are met. The aim of this study was therefore to determine the process of rehabilitation and the outcome of patients following in-patient rehabilitation at a facility in the Western Cape. A quantitative research design was employed to address the objectives. Self-administered questionnaires were developed to collate information pertaining to the demographic-, socioeconomic- and medical profile of patients and data extraction sheets collected information relating to the process of rehabilitation and the impairment status of patients on admission. With regards to activity and participation, a longitudinal study design was used, which utilised standardised outcomes measures. The sample consisted of all patients with stroke and spinal cord injury admitted within a three-month period, and all ethical principles relating to research on human subjects, as stipulated in the Helsinki Declaration were adhered to during data collection, with ethical clearance obtained from relevant authorities. The SAS and the Microsoft Excel Package 2007 were used to analyse the quantitative data elements. Descriptive statistics using frequencies, percentages, ranges, means, and standard deviations and inferential statistics using chi-square, student T-tests and correlation tests, for determining the predictors of functional outcome, were calculated. There were 175 patients, whereof 82 were patients with stroke and 93 with spinal cord injury, with 143 (76 presenting with spinal cord injury and 67 with stroke) meeting the inclusion criteria on admission. The mean age of those with spinal cord injury and stroke was 34.14 and 52.95 years. Most of the patients with spinal cord injuries were single (73.68%), whereas the majority (53.73%) of patients with strokes were married at the time of injury. All patients were managed by the doctor and the nurse, with most of the patients receiving physiotherapy, occupational therapy and social assistance from the social worker. With regards to recreational activities, 46.87% of patients with spinal cord injury and 39.39% of those with stroke attended the learn to swim programme, and 29.68% of patients with spinal cord injury attended the wheelchair basketball sessions. The mean length of hospital stay for patients with spinal cord injury and stroke was 73.11 and 51. 62 days, with most of the spinal cord injured patients (80.26%) and stroke patients (82.08%) discharged home without follow-up rehabilitation. The most prevalent impairments on admission of the spinal cord injury cohort were muscle weakness (75.0%), bladder incontinence (71.1%) and reduced sensation (69.7%), whereas patients with stroke presented mostly with muscle paralysis (80.6%), abnormal tone (76.1%) and aphasia (50.8%). Functional limitations experienced by the participants included, mobility, stair climbing and transfers. The participants experienced participation restrictions in the following domains, leisure activities and employment. A clinical significant improvement was noted in execution of functional task of patients with spinal cord injury (p< 0.0001) and stroke (p< 0.0001) between admission and discharge. A significant statistical change was also detected for the participation elements of both stroke and spinal cord injury cohorts. Functional ability on admission was found to be a predictor of functional outcome of the stroke diagnostic group at discharge, whereas the multiple redictor model of functional outcome of the spinal cord injured cohort at discharge was significant with remaining variables of functional outcome score on admission (p<0.0001) and bladder -and bowel impairment(s) (p=0.0247). The study findings suggest that despite the significant change in activity and participation, most of the patients were discharged home without further follow-up for rehabilitation, irrespective of the activity limitations and participation restrictions still experienced at the time of discharge. The latter finding questions the duration of the length of hospital stay, which does not allow patients to be independent in all meaningful activities and participatory actions and roles by the end of inpatient rehabilitation. The study findings could assist authorities to adapt the existing rehabilitation programme and referral process .
The development of a return to work intervention programme for stroke survivor (SReTWIP): A Delphi survey
(Springer Nature, 2020) Olaoye, Olumide Ayoola; Soeker, Shaheed Moghammad; Rhoda, Anthea
Even though clearly defined pathways for vocational re-entry are well recognized for conditions such as mental health, musculoskeletal dysfunction (MSD) and traumatic brain injury (TBI), none has been identified for stroke. There has been a lack of consensus regarding such clear pathways to vocational re-entry and the essential contents of return to work (RTW) interventions for stroke survivors. As part of a larger study aimed to design a RTW programme for stroke survivors, this study describes the concluding process through which Stroke Return to Work Intervention Programme (SReTWIP) was developed.

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