Philosophiae Doctor - PhD (Physiotherapy)

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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.
Behavioural and protective factors contributing to the risk and vulnerability to HIV/AIDS among individuals with spinal cord injuries in South Africa
(University of the Western Cape, 2019) Lloyd, Jacobus; Phillips, Julie
HIV/AIDS has made a huge impact on human development and sexual reproductive habits in this century in the world and especially in sub-Saharan Africa. It has only recently been acknowledged that HIV/AIDS has an equal if not greater effect on or threat to people with disabilities. Survivors of traumatic spinal cord injury (TSCI) with resultant disability are incorrectly believed to be sexually inactive, unlikely to use drugs or alcohol and at less risk of violence or rape than their non-disabled peers. This group can thus be described as economically, educationally and socially disadvantaged, which in itself, suggest that they are a high-risk group for HIV infection. The overall aim of this study is to examine the factors that could contribute to the risk and vulnerability to HIV/AIDS among individuals with spinal cord injuries in South Africa. The specific objectives of the study are to assess the behavioral and protective factors that could contribute to risk and vulnerability to HIV infection among individuals and spinal cord injuries; and to explore the socio-cultural issues that might increase individuals with spinal cord injuries’ vulnerability to HIV/AIDS. The design of this study was a mixed methods design, particularly the sequential explanatory strategy was used will used in this study. The study was conducted in four (4) conveniently selected provinces (highest prevalence of SCI). The Quad-Para Association of South Africa’s (QASA) provincial databases was used to invite individuals with SCI to participate in the study. Data for quantitative part of the study was collected by means of self-administered questionnaires. The questionnaire consisted of various sections requesting for information on: Demographics; HIV-Knowledge (HIV- KQ-18); Sexual behaviours; Sexual communication and negotiation skills; Self-efficacy to refuse sex. Separate binary logistics analysis was done to assess which of the selected factors are associated with risky sexual behaviour. The forced entry method approach was used to determine which of these factors have the greatest productive power to predict sexual risk behaviour. No “a priori” sample size was developed for the qualitative part, but participants were recruited until saturation has been reached of all the categories. Consenting participants were visited by the researcher for data collection in the environment indicated by the participant. Permission to conduct the study was obtained from the Research Ethics Committee at the University of the Western Cape (UWC). The study was conducted according to ethical practices pertaining to the study of human subjects as specified by the UWC and Faculty of Community and Health Sciences Research Ethics Committee of the UWC.
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.
Building a health-promoting schools conceptual framework model as a strategy to address barriers to learning and to promote healthy development of school-aged children
(University of the Western Cape, 2014) Ntagungira, Egide Kayonga; Struthers, Patricia; Van Hove, Geert
After suffering almost total collapse. Rwanda has made impressive post-genocide progress. Many children of school going age are now attending school, but regrettably, only half complete primary school. High numbers of orphans, disabled children and a growing number of children from child-headed households still suffer the consequences of the poverty inherited from the past. Health problems include HIV/Aids, STIs, malaria, tuberculosis, enteric diseases, mental health problems, hunger and malnutrition. Use of drugs and substance abuse, unwanted pregnancies, lack of support services, unavailability of teaching and learning materials, inflexible curricula and poor teaching methodologies also contribute to learning breakdown. It is against this background that this thesis was conducted to investigate the development of a health-promoting schools model to provide an appropriate strategy to address barriers to learning and to promote healthy development of school children in Rwanda. Two research questions were the focus of this research, first, how does a health-promoting schools model provide an appropriate strategy to address barriers to learning and to promote healthy development of school-aged children in Rwanda and second, what are the participants’ views on and understanding of the model and its potential use in their schools? A mixed methods research design that employed both qualitative and quantitative approaches was used. The study followed sequential implementation: Phase 1 was concerned with the identification of the components for the model. It was a case study of four schools, two rural schools and two urban schools in Kigali City. The sample included 60 teachers, pupils, principals and parents from schools and nine key informants who were policymakers from the Ministries of Education and Health and Social Welfare, line institutions and the UNICEF. Data collection strategies included focus group discussions, semi-structured, in-depth individual interviews, a transect walk and observations. Data analysis was through content analysis. Eight themes emerged out of the data: school leadership and management; school health policies; pupil wellbeing; school partnership with parents, families and local communities; school health services; factors affecting teaching and learning for all children; teacher wellbeing; and a healthy physical school environment. These themes became the components that informed the development of a health-promoting schools model. In Phase 2, the degree of understanding of this proposed model and its components were investigated in each school community.
A conceptual and organisational framework for internationalisation at a selected South African university
(University of Western Cape, 2021) Arowoiya, Ayorinde Ibukun; Phillips, Julie
Internationalisation is an important worldwide phenomenon, and amongst others, presents as a major trend in higher education and continues to be on the agenda of higher education providers worldwide. It is significant for the sustainability of higher education at a national level, and subsequently, the contribution that higher education makes to the development of a nation, its people and its ability to compete in the global market. Internationalisation within universities continues to develop apace as institutions move from equating international strategies with international student recruitment to developing mature internationalisation agendas that incorporate recruitment, research collaborations and capacity-building.
Contextual model for in-patient stroke care and rehabilitation in Malawi
(University of Western Cape, 2020) Chimatiro, George Lameck; Rhoda, Anthea J.
Stroke is a known health challenge for the public as it is both incapacitating and fatal to many people world over. Malawi, one of the developing countries has stroke as the fourth leading cause of death, and is fast becoming even more significant due, primarily, to lifestyle changes and nature of healthcare practices. For these reasons, and particularly, the negative impact on quality of life, the management of people with stroke is a critical area of interest. While research activity throughout the world has advanced acute stroke-care interventions, patients in Low to Middle Income Countries (LMICs) benefit less from evidence-based stroke care practices due to less conventional applicability to the setting and continuing medical care and rehabilitation challenges. This doctoral project applied the results of a Diagnostic and Solution Phases to the development of a contextual model for in-patient stroke care and rehabilitation (MoC) in Malawi.
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.
Designing a community reintegration programme for individuals with a traumatic spinal cord injury in the Cape Metropolitan area
(University of the Western Cape, 2018) Nizeyimana, Eugene; Phillips, Julie
Spinal cord injury (SCI) is a devastating condition often affecting young and healthy individuals around the world. This debilitating condition not only creates enormous physical and emotional suffering to individuals but also is a significant financial burden to families and society at large and it affects quality of life. Successful community reintegration following spinal cord injury is considered an important goal of rehabilitation as this has been positively associated with self-esteem, life satisfaction and quality of life. The overall aim of the study was to design a community reintegration programme for individuals who sustained a traumatic spinal cord injury (TSCI) in the Cape Metropolitan Area. The design of this study was a mixed method design including four phases. The first phase of the study was to determine the base line information regarding reintegration into communities after sustaining a TSCI and included 108 participants. Data was collected by use of self-administered/interview administered questionnaire. The results of this phase demonstrated that community reintegration of individuals who sustained a traumatic spinal cord injury was relatively low and employment was found to be a statistically significant variable influencing community reintegration following the injury. The second phase of the study aimed to gain a deeper understanding of how employment and other factors influence reintegration into communities after the injury.
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.
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.
The development of a health care decision-making model to improve survival of persons with traumatic spinal cord injuries (tSCI)
(University of the Western Cape, 2022) Boggenpoel, Blake; Joseph, Conran
A scarcity of data exists regarding the processes of care and its effects on mortality and the functioning of patients with traumatic spinal cord injuries (tSCI). To improve survival rates of these patients, one will need to identify processes or personal factors that may cause early mortality and worsen function. Furthermore, these process and personal factors concerning mortality may vary between contexts primarily due to process aspects differing, which should be explored to develop fit-for-purpose decision-making models.
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.
Development of a policy brief to facilitate the implementation of the physical activity/sports policy in Rwanda
(University of the Western Cape, 2018) Mukaruzima, Lela; Frantz, José M.
The importance of health enhancing physical activity participation (HEPA) has always been emphasized globally, as one of the means to reduce the risk of Non-Communicable Diseases (NCDs) occurrence. In Africa, it is more relevant currently, due to the growing burden of NCDs that is coupled with the existing encumbrance of communicable diseases. In Rwanda, specifically, there are limited national strategies to promote health-enhancing physical activity. Consequently, the level of physical activity among Rwandans, especially government office workers, is likely to diminish, which could possibly be attributed to the rapid urbanization that comes with lifestyle changes. Basically, most people tend to abandon the traditional labour-intensive activities, which are associated with high energy expenditure, to more sedentary activities. Therefore, the need to promote health enhancing physical activity participation is crucial. Physical activity participation is an intricate and multifaceted behaviour that may not be viewed from a linear perspective. This current study adopted a socio-ecological framework to assess the factors that influence Leisure Time Physical Activity (LTPA) among government employees in Kigali City. The study used an exploratory, sequential, mixed methods of qualitative and quantitative designs, in order to comprehensively explore and understand the research problem. Qualitatively, a Case study and exploratory design was used to collect data, specifically from the Rwanda Sport Policy and its implementing stakeholders. Quantitatively, a cross-sectional, descriptive design was used to assess and describe the levels of LTPA among government workers in Kigali City, as well as highlight the various factors that influence, or limit, their participation.
Development of an evidence-based physiotherapy treatment protocol for acute non-specific neck pain in Ethiopia
(University of the Western Cape, 2022) Banata, Roba; Rowe, Michael
Although neck pain is increasingly being considered as an important public health problem in Ethiopia, there is no treatment protocol guiding physiotherapy practice for acute non-specific neck pain (NSNP) in this setting. This means that every physiotherapist treats patients based on their own knowledge of what constitutes best practice. The problem of clinical inconsistency is further compounded by the fact that the field of physiotherapy is still in its nascent stages in Ethiopia, where a recently expanded physiotherapy curriculum is yet to be fully implemented. In recognition of the fact that evidence-based treatment is now considered clinical best practice by physiotherapists worldwide, this thesis is premised on the idea that it is necessary to have an evidence-based treatment protocol that can guide physiotherapists’ decisions when treating these patients. Moreover, a new and young curriculum offers the option of including new and evidence-based physiotherapy.
The development of an instrument to assess return-to-work among post-stroke survivors
(University of Western Cape, 2021) Ibikunle, Peter Olanrewaju; Rhoda, Anthea
Return-to-work (RTW) after an injury or illness is influenced by physical, psychological and social factors. Therefore, a need exists to develop a contextualized multi-perspective and objective measure for the assessment of return-to-work among stroke survivors. This current study comprised three phases, with each phase intended to address various objectives in the process of developing and validating a psychometrically sound measure, to assess return-to-work in stroke survivors. In the first phase, qualitative data collection methods were employed with various stakeholders and key informants, to finalise the conceptualisation, scale construction, and domain identification of the intended instrument. In-depth interviews were conducted with stroke survivors, their caregivers, employers and rehabilitation professionals. The data generated were analysed using the Atlasti.version 7. The results were used to construct the instrument.
The development of design principles to guide the development of clinical reasoning in physiotherapy education
(University of the Western Cape, 2021) Hess, Danelle; Rowe, Michael
Clinical reasoning is enigmatic; however, students need to learn how to do it, educators need to be able to develop it, and experts need to explain how they do it. Health professions educators have described clinical reasoning as a skill required for health professionals. Clinical reasoning has been used synonymously with terms such as clinical judgement, critical thinking and clinical decision-making. Broadly speaking, clinical reasoning refers to the thought and decision-making processes associated with clinical practice and particularly choosing a course of action for a patient. Possible strategies for developing clinical reasoning and the use of certain learning tasks in the development of clinical reasoning in undergraduate health professions students have been highlighted. However, there are still areas of research to consider.
The development of guidelines that incorporate interprofessional practice principles into rehabilitation services at a primary health care facility
(University of the Western Cape, 2022) Kock, Luzaan; Mlenzana, Nondwe
There has been a global shift to an interprofessional model of care as interprofessional practice (IPP) has been highlighted as an innovative way to fight the challenges faced in the health system. The implementation of IPP is targeted at all employees who participate in the provision of healthcare services. IPP can happen at all levels of health care. The primary health care (PHC) level is seen as the core of a sustainable health system, and this study focused on the PHC level. Creating equal access to high-quality, patient-centred healthcare to the entire population is the goal of the provincial health plan known as Healthcare Plan 2030.
Development of standards for undergraduate occupational health in a physiotherapy curriculum: A case in Kenya
(University of Western Cape, 2020) Wanyonyi, Nancy Eileen Nekoye; Frantz; Kangethe, Simon
Occupational health (OH) in physiotherapy is well known for addressing workrelated musculoskeletal disorders (WRMDs), which are high in number according to the available statistics (Fingerhut, Concha, Punnet, Steenland, & Driscoll, 2014). The introduction of the Bachelor of Science in Physiotherapy degree in Kenya in 2010 created a good platform for the development and review of occupational health content in the curriculum
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.

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