Philosophiae Doctor - PhD (Physiotherapy)

Permanent URI for this collection

https://hdl.handle.net/10566/11503

Browse

Browsing by Issue Date

Filter results by year or month
Now showing 1 - 20 of 50
  • Thumbnail Image
    Item
    The development of a multidimensional instrument to assess the severity, functional limitation and psychosocial restriction in individuals with chronic headache
    (University of the Western Cape, 2003) Diener, Ina JH; Amosun, Seyi Ladele
    Headache disorders constitute a public-health problem which impacts on individuals and society. The functional limitation and psychosocial restriction, caused by chronic headache, may be a more reliable indication of the severity of the disorder than the pain intensity and temporal headache pattern itself. Evaluation of all these parameters may improve health care for individuals suffering from chronic headache. The ultimate purpose of this study was to develop and validate a multidimensional questionnaire to assess the severity and impact of headache in individuals suffering from chronic headache. The study was carried out in six phases, each stage building on the previous ones. A quantitative retrospective review of 450 patients' clinical files was executed to identify the elements of complaint of these patients. This was followed by a literature review of existing headache-related health measures and construction of a theoretical framework for the study. A questionnaire was developed based on these findings. This questionnaire was then tested for face and content validity in a chronic headache population sample (n=60) and physiotherapists working with these patients (n=18). The questionnaire was further refined by a small qualitative study, making use of small group discussions (n=10). After the suggested modifications were made, the Multidimensional Chronic Headache Questionnaire (MCHQ) was tested for stability in a group of chronic headache patients (n=21), who completed the questionnaire twice with a one-week intervening period with no intervention. It was then tested for responsiveness, where patients completed the questionnaire prior to, and after, an episode of treatment. The Wilcoxon Signed Rank Sum Test was used to detect significant differences (and hence responsiveness). Lastly, all the MCHQ's (n=148) that were completed during the course of the study were analised to establish the homogeneity of item content (Chronbach alpha values), and the construct validity of the instrument in terms of item structure (exploratory factor analysis). The retrospective review of patients' perceptions of the severity and impact of their chronic headache indicated that many of the patients experienced moderate to severe limitation of function and psychosocial restriction. Although many domains of headache-related health were represented in published questionnaires reviewed for this study, no instrument that assesses both the perceived severity and a wide range of impact was found. The MCHQ was developed from this study to measure these parameters. The items in the questionnaire were based on the retrospective study and existing questionnaires utilised in the chronic headache population. The face and content validity of the first draft of the instrument was found to be good. The stability of the questionnaire was very good, with Pearson's correlation coefficients of greater than 0.9334 for all repeated items. Responsiveness was very good, with all items found to be responsive to change (with probability values of p0.6647), and preliminary construct validity was suggested by demonstration of eight distinct factors that were clearly interpretable (one in the severity and seven in the impact domain). These suggested that severity is unidimensional, and that seven dimensions of impact are assessed in the MCHQ (functional limitations, two emotional dimensions, relationship restrictions, and three headache trigger dimensions). Positive linear correlations between severity and impact suggested that the higher the severity, the more severe the impact on the individual's quality of life (r=0.5183; p<.OOOI). These tests suggested preliminary construct validity for the questionnaire. The researcher concluded that severe and frequent headache has a considerable impact on the individual and that the multiple facets of headache-related health can be measured appropriately using this instrument. The Multidimensional Chronic Headache Questionnaire is a new instrument to assess headache-related health in terms of both severity and multidimensional impact on individuals, which can be utilised in a once-off health assessment as well as an outcome measure for therapy.
  • Thumbnail Image
    Item
    Toxicological and antifertility investigations of oleanolic acid in male vervet monkeys (chlorocebus aethiops)
    (University of the Western Cape, 2003) Mdhluli, Mongezi; van der Horst, Gerhard
    Introduction: Plant extracts and herbal preparations are often marketed as natural and safe alternatives to conventional medicines for the prevention and treatment of a variety of ailments, without proof of efficacy and safety. Cardiovascular, hematopoetic, hepatic and renal impairment resulting from the use of conventional drugs is widely acknowledged. However, there is less awareness of the potential toxicity of herbal preparations and other botanicals, many of which are widely perceived by the public as being effective and harmless, and are commonly used for self medication without supervision. In addition, potential interactions between herbal medicines and conventional drugs may compromise with patient management. In the safety evaluation of most substances, non human primates are preferred to rodent species for preclinical animal safety studies, because of their biological similarity to humans. They are regarded to be the best metabolic models for humans in a broad range of investigations. Additionally, a disadvantage of using small animal species in toxicological testing is that they require higher doses of drugs and more frequent administrations than in larger species. In light of these considerations, vervet monkeys are used here to investigate toxicity of a plant-derived triterpene, oleanolic acid. The focus is to determine effects of different concentrations of this triterpene on the cardiovascular, hematopoetic, hepatic and renal systems. Materials and methods: 12 male vervet monkeys used in this study were equally divided into four groups, i.e. three treatment groups (4, 10 and 25 mg/kg bodyweight), and one control group. Each individual in a treatment group received a specified concentration of oleanolic acid in food for 16 weeks. Monkeys in the control group received the vehicle (food) alone. Bodyweight, body temperature, respiratory rate, heart rate, systolic pressure, diastolic pressure, and mean arterial pressure were recorded from ketamine-anaethetized monkeys at baseline and every second week until week 16.
  • Thumbnail Image
    Item
    Physical inactivity among high school learners in Belhar - a public health concern
    (University of the Western Cape, 2004) Frantz, José Merle; Amosun, S.L.; Travill, Andre; Dept. of Physiotherapy; Faculty of Community and Health Sciences
    For many decades, the World Health Organisation had highlighted the growing importance of chronic non-communicable diseases in developed and developing countries, with an increase in lifestyle-related diseases. Physical inactivity has been identified as one of the risk factors, in addition to other leading risk factors like diet, and the use of tobacco and alcohol, contributing to the occurrence of non-communicable diseases like cardiovascular diseases, cancers, obesity and type 2 diabetes mellitus. Based on the researcher's observations while living in Belhar community for more then ten years, it was hypothesized that the level of physical inactivity among adolescents could become a public health problem in the future if not addressed immediately.
  • Thumbnail Image
    Item
    Perceived constraints to physical activity among paramedical institution students in Uganda
    (University of the Western Cape, 2005) Nizeyimana, Eugene; Phillips, Julie; Dept. of Physiotherapy; Faculty of Community and Health Sciences
    Research has clearly shown that all individuals will benefit from regular physical activity. Unfortunately, young adults including college and university students are not physically active on a regular basis worldwide. In the developing world particularly in Sub- Saharan Africa, physical inactivity along with tobacco use, poor diet and nutrition are increasingly parts of today’s lifestyle. Physical activity declines with age and the most important decline appear to be during the transition period from high school to university and during university years. The aim of this study was to assess the level of physical activity, to investigate the perceived constraints to physical activity and to determine whether socio-demographic characteristic have an influence on participation in physical activity and perceived constraints to physical activity among paramedical institutions students in Uganda. A cross-sectional study with descriptive quantitative design was conducted. Four hundred (400) paramedical institution students were selected using a stratified random sampling technique. A self-administered questionnaire adopted from the literature was used to collect the data. A response rate of 90% was obtained. Descriptive and inferential statistics using the statistical package for social sciences were used to analyze the data. The relationships and associations between different variables were determined by carrying out significant tests using chi-square tests. Alpha level was set at 0.05. The mean age of the sample was 22.44 years (SD = 2.03). Males constituted 73.9% and females constituted 26.1% of the sample. Students from eight (8) health professional courses participated in the study. Over half (59%) of participants were classified as physically active and 41% were classified as inactive or sedentary. For male participants, lack of the right equipment to exercise and wanting to do other things in their free time were perceived as the major constraints to physical activity. For female participants, lack of motivation and tiredness after exercise were perceived as the major constraints to physical activity. The findings of this study demonstrate that there is an influence of socio-demographic characteristics such as gender, year of the study and different departments/schools on participation in physical activity and perceived constraints to physical activity. They also indicate the need of health promotion intervention aiming at promoting physical activity among paramedical institution students in Uganda.
  • Thumbnail Image
    Item
    The physical needs of the elderly with regard to physiotherapy services in the Livingstone District, Zambia
    (University of the Western Cape, 2005) Malambo, Pasmore; Marais, M.R; Dept. of Physiotherapy; Faculty of Community and Health Sciences
    The purpose of this study was to identify the physical needs of the elderly with regard to physiotherapy services in the Livingstone district in Zambia. The objectives were to determine the knowledge of the elderly on the role of physiotherapy in the care of the elderly; the barriers to utilization of the services; the prevalence of physical problems and it also examined associations between education, knowledge and utilization of physiotherapy services in the district.
  • Thumbnail Image
    Item
    The need for physiotherapy support for teachers in inclusive education for the inclusion of learners with physical disabilities in selected schools in Zambia
    (University of the Western Cape, 2005) Kashimba, Sally Salome; Struthers, P.; Dept. of Physiotherapy; Faculty of Economics and Management Sciences
    The purpose of the study was to explore the need for physiotherapy support for teachers in selected inclusive schools in Zambia. The study aimed to determine teachers skills and teachers attitudes as they included learners with physical disabilities in their classrooms.
  • Thumbnail Image
    Item
    Health risk behaviours among black adolescent females in the Strand: A mixed- method investigation
    (University of the Western Cape, 2005) Phillips, Joliana Selma; Malcolm, C; Amosun, S.L
    In South Africa there are currently 44.8 million people under the age of 20 years accounting for approximately 44% of the total South African population. Literature has indicated a number of lifestyle behaviors which account for most of the mortality, morbidity and social problems in adolescents. These behaviors include tobacco uses, unhealthy dietary behaviors, physical inactivity, alcohol and other drug use, risky sexual behaviors, and behaviors that result in unintentional and intentional injuries. Adolescent women are profoundly affected by a number of health risks related to their behavior. Many of these also affect their male peers such as smoking, drinking, use of other drugs, and violence, but have a special effect on women because of either higher prevalence or a relationship to other risks. Another set of risky behaviors are those uniquely linked to women's reproductive potential. The health of young people today, and the adults they will become, is critically linked to the health related behaviors they choose to adopt. It is thus vitally important for health professionals to address adolescent health issues with targeted health-related interventions and effective health-promoting programmes. The heightened adverse health effects of many risk behaviors for adolescent women and the unique risks associated with being female point to the need for gender-specific prevention efforts. The purpose of this study was to investigate health risk behaviours among black female high school learners. The study used a mixed method approach, specifically the sequential explanatory strategy. Quantitative data was collected using two self-administered questionnaires assessing six domains of health risk behaviours including cigarette use, alcohol use, drug use, sexual activity, behaviours leading to violence and behaviours related to physical activity.
  • Thumbnail Image
    Item
    Paradox of risk: sexuality and HIV/AIDS among young people with physical disabilities in Nyanga, South Africa
    (University of the Western Cape, 2007) Wazakili, Margaret; Mpofu, R. M. B.; Devlieger, P.; Faculty of Community and Health Sciences
    The current study aimed to describe the paradox of risk through an exploration of the experiences and perceptions of sexuality and HIV/AIDS among physically disabled young people in Nyanga, South Africa. This is against the background that AIDS has become a national and global crisis, which requires all people to participate in efforts to contain the pandemic. Yet literature indicates that young people with disabilities are not participating in such efforts. There is also an assumption, that physically disabled young people do not experience challenges in expressing their sexuality and accessing HIV/AIDS prevention services, to the same extent as other disability groups such as the blind and those with intellectual disabilities. Hence there was a need to explore disabled young people’s own understanding of risk and the factors that hinder or support their participation in existing sexuality education and HIV/AIDS prevention programmes. It was also important for this group to suggest ways in which they may participate in such programmes. A qualitative case study design was chosen as the appropriate means for achieving the aim of the current study. This design allowed me to study disabled young people without separating them from their context. In this way, a comprehensive understanding of this group was realised. Multiple methods of data collection from multiple data sources were employed, a feature that helped to discuss the ‘case of disabled young people’ in-depth and breadth. Policy and programme documents and relevant literature were reviewed for relevant information on sexuality education and HIV/AIDS prevention services for disabled young people. Fifteen disabled young people between the ages of 15 and 24 participated in individual in-depth interviews and in focus group discussions. Pertinent issues that arose from individual interviews were discussed with 15 parents, 15 senior citizens, five sangomas and five counsellors in focus group discussions of 4-10 members each. Similar issues from focus group discussions were taken up with eight key informants in more individual in-depth interviews for confirmation and clarity. Textual and contextual features of the Atlas.ti computer programme for analysing qualitative data were used to organize and analyse data. The textual features were used to code data and write memos, while the contextual features were used to link the codes and to form networks from which categories and themes were generated. Themes and sub themes were used to answer the research questions and meet the objectives of the study. The study has revealed a complex interplay of contextual and individual factors that combine to create situations of risk for disabled young people. These factors affect disabled young people’s experiences of growing up and participation in existing sexuality education and HIV/AIDS prevention programmes. Contextual factors include cultural beliefs and poverty, while individual factors include sexual behaviour and attitude towards HIV risk. I found that disabled young people have limited access to education and other social amenities, which in turn affect their experiences of life in general and sexuality and HIV/AIDS. The study has revealed that the paradox of risk lies in the contradictory scripts and attitude towards the pandemic at contextual and individual levels. The belief that disabled young people are asexual is common in Nyanga, yet society targets this group for sexual exploitation and rape. In the face of an epidemic that has crippled the fabric of society, and in spite of the widespread availability of HIV/AIDS awareness programmes, most disabled young people still do not have accurate factual knowledge about HIV/AIDS. Yet accurate information is one of the prerequisites for making informed decisions about HIV/AIDS prevention. Furthermore, gender differences make the experiences described above more serious for disabled young women who suffer discrimination and sexual abuse even from fellow disabled young men. Although most disabled young people indicated that they are aware of the gravity of the pandemic and that they personally feel threatened, they are not taking preventive measures against contracting the infection; they have adopted a fatalistic response to risk. Participants argue that in the same way they are not able to protect themselves from going hungry, or living in shacks, they also cannot prevent getting infected with HIV, which they equate to any accident over which they have no control. Disabled young people expressed the need to participate in mainstream education systems, sexuality education and HIV/AIDS prevention programmes. They also pointed out that there will always be disabled young people who require separate programmes because of special disability circumstances such as inability to travel to clinics/centres. In order to meet disabled young people’s expressed wishes, I have recommended in this thesis, a community-based sexuality education and HIV/AIDS prevention programme that focuses on the whole community instead of individuals only so as to deal with contextual and individual factors of risk. Such a programme encourages dialogue and participation as opposed to the information giving approaches from experts. A guideline that existing HIV/AIDS intervention programmes can use to include disabled young people’s special circumstances, has been presented.
  • Thumbnail Image
    Item
    Paradox of risk: sexuality and HIV/AIDS among young people with physical disabilities in Nyanga, South Africa.
    (University of the Western Cape, 2007) Wazakili, Margaret; Mpofu, R. M. B.; Devlleger, P.
    There is also assumption, that physically disabled young people do not experience challenges in expressing their sexuality and accessing HIV/AIDS prevention services, to the same extent as other disability groups such as the blind and those with intellectual disabilities. Hence there was a need to explore disabled young people's own understanding of risk and the factors that hinder or support their participation in existing sexuality education and HIV/AIDS prevention programmes. It was also important for this group to suggest ways in which they may participate in such programmes.
  • Thumbnail Image
    Item
    Impact of a lifestyle physical activity intervention on school going children's physical activity participation
    (University of the Western Cape, 2009) Figaji, Tamara Ann; Phillips, Julie; Dept. of Physiotherapy; Faculty of Science
    Associated with physical inactivity and obesity are numerous other health risks which have become a major health concern. A steady decrease in the levels of physical activity during childhood and adolescents have been noted in various parts of the world. The picture of low physical activity levels in developed countries is no different in developing countries. Children spend the majority of their day at school therefore a school setting is ideal to conduct physical activity intervention studies The primary aim of this study was to measure the effect of an intervention programme on the physical activity participation levels among school going children and adolescents. The study was carried out at an urban independent Catholic school. The sample, which was conveniently selected, which included 100 learners from grade 5 to 7 with parental consent. A quantitative approach using a quasi-experimental design was used in this study. Baseline data included levels of physical activity participation, Body Mass Index (BMI), hip-waist ratio, and socio-demographic variables. Physical activity was assessed with the Modifiable Activity Questionnaire for Adolescents. The Promoting Lifestyle activity for Youth (PLAY) programme was implemented at the school. This process-oriented programme shifts the focus from fitness toward regular participation in daily physical activity, and it is not intended to replace a comprehensive physical education programme.
  • Thumbnail Image
    Item
    The rehabilitation of stroke patients at community health centres in the Western Cape
    (University of the Western Cape, 2010) Rhoda, Anthea; Mpofu, R.M.; DeWeerdt, W.; Dept. of Physiotherapy; Faculty of Community and Health Sciences
    The rehabilitation of stroke patients can occur at different settings. These include in-patient settings, such as stroke units or general rehabilitation wards and out-patient settings, such as out-patient departments attached to hospitals, day hospital departments and the patients’ home. In South-Africa, day hospitals have been upgraded and are now referred to as Community Health Centres which provide comprehensive health services to the population. In the Western Cape these centres are faced with the rehabilitation of stroke patients who have been discharged early from hospital during the acute stage or who have never been admitted to hospitals. To date there is a lack of best practice guidelines and formal evaluations in terms of efficacy and effectiveness of rehabilitation at these centres. The aim of the study was therefore to investigate the rehabilitation of stroke patients at Community Health Centres in the Metropole Region of the Western Cape. The structure, process and outcomes (SPO) model was used as a conceptual framework in this study.
  • Thumbnail Image
    Item
    Exploration of needs, problems and living experiences of older persons in Uganda: implications for policy and decision making
    (University of the Western Cape, 2010) Nankwanga, Annet; Phillips, Julie
    The purpose of the study was to explore the needs, problems and living experiences of the older persons in Uganda and their implications for decision making and policy. The study was an exploratory descriptive cross-sectional study that involved triangulation of both qualitative and quantitative approaches. It was guided by five objectives, which included: exploring the living experiences of Uganda' s older persons living in both rural and urban settings; identifying the barriers to these people's effective participation in society; establishing the mechanisms that they use to cope with the barriers; evaluating the extent to which their needs are addressed by policy; and proposing policy strategies needed to address their plight. The study sample consisted of two purposively selected sub samples of 165 older persons for qualitative data and 50 key informants for quantitative data. The key informants were selected from Ministries of Gender, Labour and Social Development; Urban, Housing and Physical Planning; Agriculture; Health; Education and Sports, Public service, and nongovernmental organizations dealing with the older persons in Uganda. Data were collected using in depth interviews with older persons, self administered questionnaire to key informants and documentary review. The qualitative data was analyzed using content analysis including documentary review, while the quantitative data was analysed using the frequency option of the descriptive method of SPSS, and graphical method of the Excel programme. Results show that the living experiences of most of Uganda's older persons are characterised by pathetic economic, health, social, housing and accommodation, water supply, and sanitation conditions. The barriers to the effective participation of these people in society take the form of age-related prejudices, problems, and limitations faced at personal, household and community levels. They basically include constraints to the physical fitness, healthcare, economic status, food security and nutrition, and realization of accommodation and housing conditions desired by these people to live a life by which they can effectively participate in society. Other barriers include: large numbers of grandchildren most of whom are orphans left behind by the older person's children claimed by the HIV/AIDS pandemic and community members ignoring them as helpless people who have outlived their usefulness. Accordingly, the coping mechanisms used by these people were established as the psychological, physical, healthcare, and economic ways by which they deal with each of the aforementioned barriers. A review of development policies such as PEAP, PMA, NAADS, HIV/AIDS policies among others revealed that a number of policies and programs in Uganda exclude the older persons from active participation. Findings show further that though the extent to which the Constitution of Uganda government recognizes the plight of the older persons is appreciable, it is largely insufficiently translated into policy action by which the plight can be effectively addressed. A number of strategies were therefore proposed to help address this insufficiency, thereby solving the needs and attending to the barriers facing these people in an effective policy manner. The strategies focused on improving older persons' physical fitness, access to healthcare, economic capacity, food security and nutrition, and housing and accommodation. Other strategies focused on dealing with the impacts of HIV/AIDS and community prejudices held against older persons. The study was concluded by observing that although the quality of the living experiences of Uganda's older persons can be improved by dealing with the barriers faced by these people, the mechanisms that they use to do so are not adequate. It was also noted that there was need to translate the constitutionally recognised plight of the older persons into effective policy action. Consequently, it was recommended that the proposed policy strategies should be adopted and translated into the needed policy action. Further research was also recommended into the legal implications and funding implications of the proposed policy strategies.
  • Thumbnail Image
    Item
    The effect of a sports-based HIVv prevention programme on HIV risk related behaviours among high school learners
    (University of the Western Cape, 2012) Wasiu, Awotidebe Adedapo; Phillips, J.S.; Lens, W.
    Background: The Human Immunodeficiency virus (HIV) has become a global public health challenge amid the growing concern of adolescent risky sexual behaviour, influenced by biological and psycho-social factors. There is an increasing demand for adolescent sexual risk reduction interventions, especially in sub-Saharan Africa which remains the hub of HIV epidemic worldwide. Sport-based HIV prevention programme has been identified as one of the interventions, in addition to other approaches to provide young people with appropriate HIV knowledge and skills to either delay or reduce risk-taking behaviour. Despite the potential of sport-based programme for sexual risk reduction, there is limited information on how to adapt it to meet adolescent needs in terms of design, contents, and delivery. This information is necessary to provide sufficiently strong evidence to support widespread implementation of sport-based programme, especially in rural African schools. Therefore, the study aimed to measure the impact of a sport-based HIV prevention intervention in the reduction of HIV related sexual risk behaviour among rural high school learners aged 13-18. Method: The overall study design was a concurrent mixed method, utilizing both the quantitative and qualitative approach. The population for the quantitative and the qualitative studies was made up of two high schools in a predominantly “Coloured” community in Ceres. Two classes each were randomly selected from grades 8-10 in both intervention and control school. The intervention was developed through a process of focus group discussions with the Grassroot Soccer (GRS) staff and it was guided by the Social Cognitive Theory. The intervention was delivered to grade 8-10 learners by GRS peer facilitators using the GRS generation skillz curriculum that consists of 12-week sessions in the intervention school. Quantitative data were analysed with multivariate statistical techniques and qualitative data with thematic analysis approach. Results: The data that assessed the behavioural and protective factors to understand why learners in rural schools engage in risky sexual behaviour showed that about 27.2% of the learners reported being sexually active. Of the sexually active learners, 48.7% reported engaging in sex by 14 years or younger and nearly 42.2% reported multiple sexual partners with significant higher proportion of boys than girls. Nearly 55.2% of the sexually active learners reported irregular condom use and 46.3% did not use a condom at the last sexual encounter. The majority of the learners (87%) did not know their HIV status. Being male (OR = 6.60;95% C I = 1.62 – 26.84) and peer influence (OR = 3.01; 95% CI = 1.97-4.60) were the strongest predictors of reporting sexual intercourse and early sexual activities before the age 15 respectively. Though the knowledge of HIV was low, those with greater knowledge of HIV were more likely to use a condom at last the sexual encounter (OR = 1.22; 95% C I =1.03-1.44). The learners who participated in sport-based intervention were 1.43times likely to report higher self-efficacy to refuse sex compared to the control group (OR = 1.43; 95% C.I =1.07-1.92).The process evaluation indicated that the sport-based intervention was well received among the learners as it gave them free space to freely express themselves. Conclusion: The findings have shown that sport-based intervention can be successfully implemented in school and is a promising approach to reduce risks associated with risky sexual behaviour in learners. However, the quality of the programme delivery was hampered by irregular session‟s schedule and language of instruction. The process suggests for a longer exposure period and because of social-cultural diversity, learners must be provided with the ownership of the programme in schools.
  • Thumbnail Image
    Item
    Blended learning in physiotherapy education: designing and evaluating a technology-integrated approach
    (University of the Western Cape, 2012) Rowe, Michael; Frantz, Jose; Bozalek, Vivienne; Dept. of Physiotherapy
    Background: Practice knowledge exists as a complex relationship between questions and answers in a context of meaning that is often intuitive and hidden from the novice practitioner. Physiotherapy education, which aims to develop patterns of thinking, reflection and reasoning as part of practice knowledge, is often based on didactic teaching methods that emphasise the learning of facts without highlighting the relationships between them. In order to improve health outcomes for patients, clinical educators must consider redesigning the curriculum to take into account the changing and complex nature of physiotherapy education. There is some evidence that a blended approach to teaching and learning may facilitate the development of graduates who are more capable of reflection, reasoning and critical thinking, and who can adapt and respond to the complex clinical environment. The purpose of this study was to develop principles that could be used to guide the design of blended learning environments that aim to develop capability in undergraduate physiotherapy students. Method: The study took place in a university physiotherapy department in the Western Cape in South Africa, among undergraduate students. Design research was used as a framework to guide the study, and included a range of research methods as part of that process. The problem was identified using a systematic review of the literature and a survey of students. The design of the blended intervention that aimed to address the problem was informed by a narrative review of theoretical frameworks, two pilot studies that evaluated different aspects of blended learning, and a Delphi study. This process led to the development of a set of design principles which were used to inform the blended intervention, which was implemented and evaluated during 2012. Results: The final results showed that students had undergone a transformation in how they thought about the process and practice of learning as part of physiotherapy education, demonstrating critical approaches towards knowledge, the profession and authority. These changes were brought about by changing teaching and learning practices that were informed by the design principles in the preliminary phases of the project. These principles emphasised the use of technology to interact, articulate understanding, build relationships, embrace complexity, encourage creativity, stimulate reflection, acknowledge emotion, enhance flexibility and immerse students in the learning space. Discussion: While clinical education is a complex undertaking with many challenges, evidence presented in this study demonstrates that the development of clinical reasoning, critical thinking and reflection can be enhanced through the intentional use of technology as part of a blended approach to teaching and learning. The design principles offer clinical educators a framework upon which to construct learning environments where the affordances of technology can be mapped to the principles, which are based on a sound pedagogical foundation. In this way, the use of technology in the learning environment is constructed around principles that are informed by theory. However, clinical educators who are considering the integration of innovative strategies in the curriculum should be aware that students may initially be reluctant to engage in self-directed learning activities, and that resistance from colleagues may obstruct the process. Conclusion: The development of clinical reasoning, critical thinking and reflection in undergraduate physiotherapy students may be enhanced through the intentional use of appropriate technology that aims to fundamentally change teaching and learning practices. Design research offers a practical approach to conducting research in clinical education, leading to the development of principles of learning that are based on theory.
  • Thumbnail Image
    Item
    The evaluation of processes of care at selected rehabilitation centres in the Western Cape
    (University of the Western Cape, 2013) Mlenzana, Nondwe Bongokazi; Frantz, J.
    Following the introduction of the Health Act of 1995, the Primary Healthcare Package for South Africa, a set of norms and standards was developed in 2000, to ensure good quality of care and to act as a guide to provide good service at this level of care. Related to this, and bringing health services to the people, was the aspect of rehabilitation. It was highlighted that rehabilitation services should be restructured and strengthened in order to improve access to these services for those who did not have them before. This led to the development of the National Rehabilitation Policy in 2000, which focused on improving accessibility to all rehabilitation services, in order to facilitate the realisation of every citizen’s constitutional right to have access to healthcare services, but this policy was not implemented. During 2002, the Department of Health produced a strategic plan for the reshaping of public health services in the Western Cape. This initiative, Healthcare 2010, the Future for Health in the Western Cape 2020, mapped the way forward to improve substantially the quality of care provided by the health service. This plan was based on the primary healthcare approach and aimed to shift patients to more appropriate levels of care. It became evident that in order to move forward with the 2020 vision, there needed to be a greater understanding of the current situation. This study focused primarily on the aspect of rehabilitation, with a specific focus on systematic review and three dimensions of the process of care, namely patient information; service provider information; and realised access. These dimensions assisted in evaluating the rehabilitation service in order to understand what was happening in the delivery of rehabilitation services, focusing on the experiences of patients with physical disabilities, as well as service providers and caregivers, and realised access that included satisfaction of all participants in the rehabilitation centres. Hence the aim of this study was to evaluate the process of care at three selected rehabilitation centres in the Western Cape Province within the contextual framework of the National Rehabilitation Policy (NRP) and the United Nations Convention Rehabilitation Policy for People with Disabilities (UNCRPD). To assist in achieving this aim, objectives were developed as follows: to determine the reported barriers and facilitators to rehabilitation services through a systematic review; to determine the profile of patients with disabilities accessing rehabilitation services at three rehabilitation centres in the Western Cape Province; to determine the profile of service providers providing rehabilitation service to patients with disabilities attending rehabilitation centres in the Western Cape Province; to explore clients’ perceptions of and satisfaction with the rehabilitation services; to explore caregivers’ perceptions of and satisfaction with the rehabilitation services; to explore the experiences of service providers with the rehabilitation services; and to map the links between the experiences and perceptions of the key stakeholders. This was an evaluation study, which was primarily descriptive, with the focus on process evaluation. Process evaluation provides an indication of what happened, and why. The study was conducted at three rehabilitation centres in the Western Cape Province. Voluntary participation of patients, service providers and caregivers was gained by signing a consent form. Both qualitative and quantitative methods of data collection were used in this study. Questionnaires were used for quantitative data collection and SPSS version 17 and 21 was used to analyse the data. Focus group discussions and in-depth interviews, which were based on interview guides and tape recorded, were used to gather information on experiences and perceptions of all the participants. Quantitative data capturing was checked for errors by using excel spread sheets, where data was entered twice in two different spread sheets and checked for differences, as responses were coded by using numbers. Qualitative data was checked for errors by following the trustworthiness process where data was transcribed verbatim, and where necessary translated by two different translators to ensure accuracy. The researcher consulted with the supervisors during data analysis to enhance quality in the coding process and identification of themes and relevant quotations. Results showed that barriers to rehabilitation outnumbered facilitators of the rehabilitation process. There was a gap identified in the profile of the patients with regards to their rehabilitation needs. Records of the patients had missing information posing a challenge to data collection and possible presenting a distorted picture of service provision. However, records showed that not all rehabilitation professionals were not consulted during the rehabilitation process of care. Ninety-five percent (95%) of the clients consulted with physiotherapists, whereas only 4% consulted social workers. Rehabilitation service providers did not reflect a rehabilitation team. There was a shortage of rehabilitation service providers, in that some centres had full time staff while other centres only had sessional rehabilitation professionals. Service providers were negligent with some of the processes to be followed when consulting clients, such as getting consent to treat the patient and educating patients regarding their ailments, which then affected satisfaction of the patients. However, there were also positive aspects like treating patients with respect and allowing patients to ask questions during consultation. Caregivers on the other hand were satisfied with the rehabilitation process, as they found the centre easily accessible for their family members and were involved in the rehabilitation of the patients. In conclusion, the rehabilitation process was satisfying to the participants of this study. The main challenge that patients and caregivers experienced was financial constraints. Staffing remains a problem in rehabilitation centres in the Western Cape Province, as there were not enough staff for rehabilitation service delivery at these selected rehabilitation centres. Other staff members were not utilised during the rehabilitation process. These findings raise issues for the Western Cape Department of Health to consider regarding rehabilitation, as people with disabilities are not receiving optimal care. The study makes recommendations to the Department of Health in the Western Cape Province regarding the improvement of the rehabilitation process of care.
  • Thumbnail Image
    Item
    Stroke rehabilitation outcomes in hebron - Palestine
    (2013) Amro, Akram; Rhoda, Anthea; Abdeen, Ziad
    Aim: To investigate strokes, epidemiology, stroke characteristics, use of care and rehabilitation outcomes, and factors predicting these outcomes in stroke patients in Hebron city, in southern Palestine. Design: A one-year hospital-based, observational, descriptive, case-control, cohort study. Sample: One hundred and thirty nine (139) stroke patients were recruited from two main hospitals in Hebron city (Alia and Al-Ahli hospitals). Procedure: Objective assessment, patient interview, file screening and observation of the recruited cases was performed, risk factors were recorded and impairment, functional activity and participation were captured at baseline (T1), three months (T2), and six months (T3).
  • Thumbnail Image
    Item
    Designing and determining the effectiveness of a health promotion programme for clients with type 2 diabetes mellitus from an urban South African community
    (University of the Western Cape, 2013) Steyl, Tania; Phillips, J.S.
    Diabetes mellitus, an international pandemic, is one of the greatest threats to global public health. It is estimated that 70% of patients with diabetes are living in developing countries. Since the inception of the Primary Health Care approach in South Africa in 2004, the number of patients with diabetes has doubled to an estimated 1.5 million South Africans. The overall aim of the study was to develop, implement and determine the effectiveness of a health promotion intervention for adult clients with type 2 diabetes mellitus from a South African urban community. The overarching design of the study was that of mixed methods, specifically the parallel mixed design. The first phase of the study was to determine the current practices regarding the management of diabetes mellitus and the study sample comprised of three hundred and thirty five adult clients with type 2 diabetes mellitus and eighteen health care professionals of randomly-selected community health centres (CHCs) in the four sub-structures of the Cape Metropolitan District. Data was collected from the adult clients with type 2 diabetes mellitus with structured, self-administered questionnaires and focus group discussions while semi-structured interviews were done with the health care professionals. The second phase of the study aimed to design a health promotion programme and both a review of the literature and a Delphi study were done to develop the proposed programme.
  • Thumbnail Image
    Item
    Determining the feasibility of a prehabilitative injury prevention programme for netball players in South Africa
    (University of the Western Cape, 2013) Pillay, Tanushree; Frantz, Jose; De Clercq, Dirk
    Background: The South African government has taken a stance to prioritise sporting codes within South Africa that report high participation and is inclusive of the population demographic of South Africa. Netball has been highlighted as one of these sixteen named sporting codes. Linked to the high participation of netball players in the sport is a high prevalence of injuries, which is well documented throughout the literature. Injury management within a South African context presents a number of challenges due to the current environment of health care in the country as well as an array of barriers that directly impact the netball players themselves as well as netball as a federation. Injury prevalence results in a need to both manage and prevent sporting injuries. The purpose of this study was to develop an injury prevention programme for netball players in South Africa and to establish the feasibility of such a programme for implementation. Method: The study took place under the auspices of Netball South Africa and the injury prevalence data was collected at a national netball tournament at the University of Pretoria. Sequential mixed methods was used as a framework to guide the study, and included a range of research methods as part of that process. The problem was identified in two phases using a cross sectional self-administered questionnaire and a qualitative aspect using semi-structured interviews. The design of the injury prevention programme that aimed to address the problem was informed by a systematic review of literature. The process that guided the development of the injury prevention programme was intervention mapping. This process led to the development of an injury prevention programme that included a coach’s educational booklet, an injury prevention exercise protocol and an administrative structure of a National Physiotherapy Association. The evaluation for feasibility for the implementation of the injury prevention programme was evaluated via a Delphi study.
  • Thumbnail Image
    Item
    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.
  • Thumbnail Image
    Item
    Development, implementation and evaluation of youth development programmes to address health risk behaviour among grade 8 to grade 10 learners in selected schools in the Paarl area.
    (University of the Western Cape, 2014) Pharaoh, Hamilton; Jose Frantz; Smith, Mario
    Background: There is consensus internationally and among South African researchers that engagement in health risk behaviours amongst the youth is a concern from a public health perspective. It is evident that much health risk behaviours are established during adolescence, and may continue into adulthood, affecting health and wellbeing in later life, and some preventable health behaviours may be contributory causes of morbidity and mortality. Research into the development t of programmes can play a major role in reducing health risk behaviour amongst the youth and also provide a key learning opportunity should this be driven with bigger impetus by the building of research knowledge. Research knowledge needs to inform all stakeholders as to the best evidence-based possibilities that can assist in creating the behavioural change that is envisaged. This study therefore aimed to design, evaluate the feasibility of, and implement, a comprehensive youth development programme that will help to equip learners with the skills to change health risk behaviour in selected schools in the Paarl area, through input from all the stakeholders. The objectives of the study were to 1) obtain baseline information of grade 8 –10 learners about the health risk behaviours they engage in, and the extent to which learners manage personal situations; 2) explore the views of stakeholders regarding the type of health risk behaviours learners engage in, and reasons for engaging; 3) To determine the content of school-based interventions reported in literature, and its effectiveness in reducing or delaying these behaviours amongst the youth; 4) To design a youth development programme based on the views of the stakeholders and literature; 5) To evaluate the feasibility of the youth development programme designed in objective 4; 6) To implement a youth development programme. Method: This study adopted Intervention Mapping as a framework that translated into a five phase study. Each phase informed the next and the findings culminated in the proposed youth development programme for grade 8-10 learners in the Paarl area. Phase 1 used a survey to obtain baseline information about the health risk behaviours that youth engage in and the extent to which learners manage personal situations. The survey was administered using the face-face method and included a demographic questionnaire, the Youth Risk Behaviour Surveillance Survey and the Life Effectiveness Questionnaire. Descriptive statistics such as Frequencies and cross tabulations were performed, as well as inferential statistics including Multiple Regression analysis and Chi-square tests. Phase 2 entailed concept mapping using focus groups and individual interviews with stakeholders to determine their perceptions of the health risks learners engage in and the reasons for their behaviours. The sample included learners, teachers, and community representatives. Thematic analysis was conducted with transcriptions of the focus groups. Phase 3 entailed a systematic review of the literature reporting on interventions aimed at delaying and or preventing engagement in health risk behaviours amongst youth. Phase 4 entailed the triangulation of the findings from the first three phases into a draft programme. Phase 5 included a Delphi study with life skill trainers and experts in the field of health risk programming for adolescents. The Delphi survey was conducted in two rounds. After the feedback in round one, revisions were made to the draft programme to develop the final programme. Results: The results in phase 1 resonated with the findings in the existing body of literature with regards to the health risk behaviours that learners engaged in. Smoking, drinking, sexual activity, drug use, physical inactivity, crime and violence were the most prominent HRBs reported by learners in this sample. Regression analyses indicated that the combination of the LEQ`s life skill domains (Time management, Achievement, Emotional control, Social competence, Active initiative, Self-confidence, Intellectual flexibility and Task leadership) significantly explained between 25% and 56% of the variance in the health risk behaviours (smoking, drinking, drug use, sexual activity). Gendered patterns in engagement with drinking, drug use and risky sexual behaviour was empirically supported by the results of Chi square tests. Drinking and drug use was significantly more prevalent with male learners whilst risky sexual behaviour was significantly more prevalent amongst female learners. Results from phase 2, represented by a concept map suggested that the development of programme content should start with contextual relevance achieved by understanding the range of HRBs youth engage in. This in turn allows for an exploration of the pathways in which engagement has come about. The second and third quadrants illustrate this through their focus on the reasons why youth engage in HRBs and the places where they are exposed to HRBs respectively Once the content has addressed what they do and why they do it, the process of skills development can commence to combat engagement in HRBs. The resultant concept map has four quadrants where each quadrant represents a concept map that corresponded to the themes identified was conceptualized as interacting with one another. During the systematic review process it was identified that effective interventions included the following elements: multi-theoretical approaches, multiple HRBs as targets, gender differentiation, and life skills. In phase 4 a concept map was created that assisted with the design of the programme. The findings from the Delphi study ratified the components included and determined that it was feasible. The recommendations included independent facilitators who have been trained in a specific skill set, avoiding the blurring of the boundary between teachers and facilitators, and a distinction between grades for the purposes of conceptualizing and presenting the programme. This resulted in the researcher augmenting the proposed programme to include independent facilitators; peer mentors; a staggered or tiered programme. These augmentations were substantial and made an immediate implementation not feasible. The scope of the revisions for developing a tiered or staggered programme was adopted as a recommendation, but was outside the scope of the present study in fulfilment of the requirements for a doctoral degree. Thus the final or revised programme only represents the initial level for grade 8 learners and the development process will continue using the same methodology in post-doctoral research. These include the development and accreditation of the training resources, selection and training of faciltators, and the clarification of the relative standing of facilitators in the school environment. Discussion: Health risk behaviour engagement, the factors influencing that engagement and the development of a diverse youth development programme to delay, reduce or prevent it is in itself very complex. Add to it the fact that the youth live in an ever-changing environment where negative role modelling and exposure to health risk behaviour is an everyday occurrence. Structures have been identified in this study that can play a vital role in designing a youth development programme, as well as build on existing programmes. This study incorporated intervention mapping as a participatory design using both quantitative and qualitative methodologies that speak to a high level of rigour and methodological coherence. The study yielded a rich data base with clear directives for future research that will make a significant contribution to the attempts to impact youth development programming and health risk behaviour amongst adolescents. Conclusion: The findings of this study suggest that a multi-theoretical approach to programming that includes gender differentiation and the targeting of multiple HRBs is likely to be more effective in the reduction, delay and prevention of health risk behaviour amongst learners in grade 8-10. The resultant programme is tiered or staggered and differentiates between grades in conceptualization and implementation of the programme. The study presented the programme for the first tier with grade 8 learners and made clear recommendations for the way forward. The study makes an important contribution in its use of participatory methodology that includes stakeholder participation to create a more robust and comprehensive programme.