Philosophiae Doctor - PhD (Physiotherapy)

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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 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 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 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.
Empowering community health workers to improve their health behaviours using a self-management approach
(University of Western Cape, 2021) Johnson, Levona; Frantz, José
South Africa and the Western Cape Province are under severe strain with an increasing quadruple burden of disease, and a deficit in the number of professionally trained healthcare workers available to meet the health needs of the population. Risky health behaviours have contributed to the rising prevalence of non-communicable disease, which in turn has largely contributed to the burden of disease. Community health workers are key frontline workers, who have been specifically appointed as links between the professional health force and the communities, to act as change agents and advocate for improved health behaviours. Taking into consideration that more than 80% of the population is dependent on the public health system, and in particular, the primary healthcare sector, these laypersons have a mammoth task to fulfil.
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 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.
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.
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.
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.
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.
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.
The effectiveness of diabetes self-management education training among individuals with type 2 diabetes mellitus in rural Nigeria
(University of Western Cape, 2021) Said, Yusuf; Philips, J.S.
Type 2 Diabetes Mellitus (T2DM) constitutes the highest percentage of diabetes cases. It has become a serious global problem due to rapid cultural and social changes, ageing, increasing urbanisation, dietary changes, reduced physical activity and unhealthy behavioural lifestyles. Furthermore, unidentified diabetes has been found to be common in many parts of Africa, including rural Nigeria, due to factors such as poor accessibility to health facilities, cultural barriers and high rates of health illiteracy. The overall aim of this study is to determine the effectiveness of the Diabetes Self Management Education (DSME) programme among individuals with T2DM in Jigawa State, Nigeria.
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
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.
Evaluating the feasibility of the expansion of community based rehabilitation into the physiotherapy curriculum in Ahfad University for women Sudan
(University of the Western Cape, 2020) Abdelnour, Hassan; Rhoda, Anthea
Community Based Rehabilitation (CBR) is used internationally, to address the lack of access of People with Disabilities (PwD) to rehabilitation services. Physiotherapy is one of the rehabilitation services offered to PwDs at community level, through CBR. In Sudan, Ahfad University for Women (AUW) offers a Bachelor degree in Physiotherapy, which integrates a CBR module into the curriculum, since 2007. The aim of this current study was to investigate the CBR components of the current physiotherapy curriculum at AUW, to determine whether they should, and could be expanded. The Mix method study design was employed, with a mixed research methodology, containing both qualitative and quantitative approaches for data collection. The components of CBR, present in the current physiotherapy curriculum at AUW were identified, using the constructive alignment framework, and content analysis for data analysis. The PWD’s needs of rehabilitation services in Sudan were established, using a questionnaire survey among users at various rehabilitation centres in Khartoum State. The CBR components that needed to be adapted in the physiotherapy curriculum at AUW were identified, using focus group discussions and in-depth interviews with AUW physiotherapy students and a CBR expert. Finally, the CBR components were revised and adapted, using a collaborative approach during workshops with AUW staff and clinicians. It was concluded that, in order to address the rehabilitation needs of PwDs, the CBR module needed to include additional components, to align the course content, teaching and learning techniques, as well as assessment tasks, with the intended learning outcomes of physiotherapy students. The components in the CBR matrix, such as livelihood and empowerment, were deemed important to provide students with knowledge, skills and competence. Additionally, providing information about assistive devices was deemed vital in rehabilitation. A significant relationship (P<0.05) was observed between the provision of information on assistive devices, and the maintenance thereof, as well as the benefits to users, respectively. Ultimately, commencing CBR placements in the fourth year, as is currently the norm, was deemed too late; therefore, it was suggested that community visits in the first and second years of physiotherapy studies, be included in the CBR course curriculum.
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.
Medical students’ response-ability to unjust practices in obstetrics: A relational perspective
(University of the Western Cape, 2019) Mitchell, Veronica Ann; Rowe, Michael; Bozalek, Vivienne
This study is located in the fourth-year obstetrics curriculum that undergraduate medical students at the University of Cape Town, South Africa, traverse, and in which they are initiated into the knowledge and skills of practical obstetrics practices in local birthing facilities. I investigate student learning and what contributes to students being rendered in/capable when they find themselves immersed in the high levels of prevailing injustices to women in labour. Disrespect during the intrapartum period is a local as well as global problem which has actually reached epidemic levels. Drawing on the theoretical frameworks of posthumanism and feminist new materialism, and using post-qualitative inquiry and non-representational methods, I put forward a novel perspective for interrogating responsibilities in terms of students’ ability to respond to unjust practices they observe, I discern what matters for student learning, exploring the troubled practices that emanate through/with/from the curriculum-student relationships in the past/present, and what it means for the future. Assemblage thinking provides a relational tool to understand the impact of the curriculum, assessment processes and other materialising forces that have agency as students are becoming-with human and more-than-human bodies. An initial survey was followed up with interviews and focus groups with students, midwives, educators and administrators. My study revealed hidden aspects of student engagement with their curriculum in obstetrics. What emerged was that students are entangled in a mesh of forces influencing their ability and capacity to respond to the injustices they witness. These forces arise from the discursive and material practices and the in-between relationships that are generated in the learning processes. The study also brought to the fore the intensive forces of affect that appeared to be obfuscated in terms of students’ response-abilities. My findings foreground how reciprocal relationships matter and that a relational ontology can provide helpful insights to engage with responsibility, response-ability and social justice. Students’ capacity to respond to the injustices they witness is limited by multiple forces that include the curriculum itself and other materialising forces generated, for instance by floors, beds, curtains and the student logbook. Time is also a crucial issue amidst the tensions emerging in the complex and risky process of birthing. What matters to students, such as their assessment needs, appears to undermine their efforts to offer care and to promote social justice. Affect plays a powerful part in shaping students’ actions, yet there are few opportunities for acknowledgement of affect. I used drawings as data-in-the making. The process of drawing contributed an extra material force to the study illuminating the power of an affective pedagogical approach for fostering students’ capability to respond to injustice. This socially just pedagogy as well as classroom performances and online collaborative engagement contributed to a collective effort to engage with obstetric disrespect in an innovative and empowering manner that gave voice to students’ experiences and the emerging forces. My study contributes to the field of medical education by opening up a relational perspective to issues of social justice and responsibility that moves beyond individualist and human-centred conceptions of student learning. Through a relational ontology, students’ clinical encounters can be conceived as enactments of the multiple prevailing forces. Each moment matters.
The risk for cardiovascular disease following traumatic spinal cord injuries in the Cape Metropolitan in South Africa
(University of the Western Cape, 2018) Naidoo, Marc Anton; Phillips, Julie
Given the devastating and debilitating impact of spinal cord injuries (SCI) globally and the effects on any population, its impact extends far beyond just the victim to people and institutions surrounding them and supporting them post-injury. Of growing concern is the increased risk that individuals with SCI have been seen to have a three-fold greater risk of developing cardio-vascular disease (CVD) than their able-bodied counterparts. Prevention strategies to curtail the onset of CVD in the SCI population is limited, and often developed for individuals from developed countries. The overall aim of this study was to assess and explore the need to implement CVD prevention programmes in a regional South African population with individuals after sustaining a traumatic spinal cord injury (TSCI). The study employed a mixed methods approach and was conducted in four (4) phases. Permission and ethics clearance were obtained from the Research Ethics Committee at the University of the Western Cape (UWC) and the Western Cape Department of Health. Phase One of the study utilized a questionnaire to collect TSCI incidence data of which 108 of the eligible 132 cases consented to take part in the study. The demographic findings of this study indicated that a person sustaining a TSCI in the Cape Metropolitan area in South Africa is most likely to be a male, young (20 to 29 years of age), from a Black African or Coloured race group and living in the Cape Flats suburbs. The male to female ratio was 6.2:1. The main cause of TSCI was assault at 58.33% (n=63) with males accounting for the majority of cases (88.89%, n=65). According to the AIS classification, ASIA A and D were the most common classification seen in 38.89% (n=42) and 39.81% (n=43) of the cohort respectively. Phase Two utilized a questionnaire and looked at CVD risk factors of the original cohort. A large portion of the cohort was engaged in high-risk behaviours, i.e. smoking and alcohol consumption. A low number of individuals reported a baseline history of hypertension diagnosis prior to their TSCI (5.56%, n=6). Phase Three of the study emplored semi-structured interviews and a focus group discussion to explore the experiences of persons with a TSCI regarding their ability to be physically active once reintegrated back into the community. Despite understanding the associated benefits of physical activity, several barriers to being physically active were reported; factors within their homes, access within their community, and transportation. The present study’s findings illustrated a growing concern among the SCI population for increased risk for developing CVD due to decreased physical activity. Phase Four of the study utilised a scoping review to identify CVD prevention programmes for individuals with a TSCI. Physical activity has been shown to have numerous health benefits of which reducing the risk of CVD is one. Engaging in physical activity, whether it be structured, unstructred or through a sporting activity can play a major role in combating the onset of CVD. Other tools used in reducing the onset of CVD were seen to be self-management strategies of which contrayer views were seen both for and against their use. Conclusion: Better education during the rehabilitation phase might be a key component to individuals with TSCI injury making more informed decisions about prioritising physical activity as they attempt to reintegrate back into their respective communities. The removal of socio-environmental barriers could allow motivated TSCI individuals better access to choosing how to increase their physical activity levels.
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.

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