Includes bibliographical references / Aim: The overall aim of the study was to investigate the performance of the EQ-5D-Y, a self-reported Health Related Quality of Life (HRQoL) outcome measure, in children between eight and twelve years of age. The study objectives were to examine the measure's psychometric properties of criterion validity, discriminant and concurrent validity, when used on children with different health statuses, and to determine its ability to detect change within the different groups over a period of time. The study also set out to determine whether a life event had an impact on HRQoL, and whether children and their therapists or parents shared the same perceptions of HRQoL. The feasibility of using the EQ-5D-Y as a routine, additional, physiotherapy assessment tool was monitored. The study also assessed the usefulness of the collected data to the therapists administering the measure to children under their management. Method: A longitudinal, analytical descriptive study design was used. Typically developing children attending a Main Stream (MS) school (105), children with lifelong physical disabilities at a Special School (SS) (35), chronically ill children at an institution (CI) (32) and acutely ill children in hospital (AI) (52) were recruited. The EQ-5D-Y was the primary outcome measure, and was administered at baseline and again at three monthly intervals, or, in the case of AI children, at admission and discharge. The PedsQL as a parallel HRQoL measure, the WeeFim as a functional measure and the Faces Pain Scale (FPS) to monitor pain were used. A self-designed questionnaire was completed by the therapists treating the children to assess feasibility and usefulness of the EQ-5D-Y. Data analysis: Descriptive statistics were used to describe the sample and the health conditions of the participants. Reliability of the measures was determined at different time intervals by Cohen's kappa coefficient for dimension scores. Spearman's rho and Intraclass Correlation (ICC) were used to determine reliability of Visual Analogue Scale (VAS) scores and also total scores of the measures over time. The same analysis was used to compare self-reports and proxy reports. Kruskal-Wallis ANOVA by ranks, median scores and mean rankings were used to examine discriminant validity between known groups, using the same outcome measure and convergent validity between similar dimensions on different outcome measures. Responsiveness was described by examining the effect size of the Wilcoxon Signed-rank test. The VAS score was compared against the ranking of different levels of the dimensions, across groups, using Kruskal-Wallis H statistic. A discrepancy between changes in VAS and changes in Worried, Sad or Unhappy (WSU) dimension were examined after three months to determine whether these were related to life events and/or changes in management of health condition. The clinical feasibility of using the EQ-5D-Y and its usefulness as an additional evaluation tool in providing a holistic assessment of the child's condition was established by analysing the frequency of positive responses on the questionnaire. Results: A total of 224 children were recruited. The level of problems on the dimensions was associated with institution and in all cases, apart from Mobility, the AI children reported more problems. The EQ-5D-Y only demonstrated discriminant validity between the MS children and AI children. The MS group scored significantly lower ranked scores on all dimensions and a significantly higher VAS (better overall HRQoL) compared to the AI group with more problems on each dimension and lower VAS. When comparing VAS across the mean ranking on each dimension, it was found to be significantly correlated at the AI only. Convergent validity between EQ-5D-Y and PedsQL was evident only at the AI for all similar dimensions. The other groups demonstrated convergent validity with some, but not all of the dimensions. Convergent validity was evident between the EQ-5D-Y VAS and total scores of PedsQL and WeeFim (p<.05 in all cases) across institutions. The treatment effect over time was largest in the AI. For all groups, there was limited agreement between proxy and self-report at a dimension level, except for Mobility with moderate to good agreement. Even though the proxy and self-report VAS scores demonstrated good (.58) ICC overall, at an institutional level, this was only significant in the MS children. The EQ-5D-Y only took five minutes to complete. Six of the nine therapists who took part in the study, found the measure easy to apply, used the information in the management of the child and would continue to use it in future. Conclusion: The performance of the EQ-5D-Y, as determined by the psychometric properties, was variable. It could discriminate between children with an acute illness and children in the MS school. In addition, good convergent validity was demonstrated in the AI children and the largest treatment effect was observed in these children. However, it does not perform as well in children with no health condition or chronic conditions and should be used with caution in these groups. HRQoL did not appear to be linked to a life event. It is recommended that both proxy and self-report measures be taken into account when assessing a child's HRQoL but these should not be used interchangeably. It appears to be feasible and useful to include the EQ-5D-Y in routine assessments. It was concluded that the EQ-5D-Y self-report can be used with confidence as an outcome measure for acutely-ill children.

Introduction and Aims: Children born prematurely (≤ 36 weeks gestation) are at risk of poor developmental outcomes and are more likely than their full-term (FT) peers to have behavioural, physical and/or cognitive limitations. In order to deliver effective interventions, therapists need to have a sound understanding of the problems experienced by children who were born prematurely. Presently, very little is known about the functional problems of young school aged children, living in the Free State province of South Africa, who were born prematurely. Methodology: This study was conducted in 15 randomly selected schools located within in a 100 km radius of Bloemfontein. Two groups of children in grades R, 1 and 2 (age range: 5-8 years) were recruited, the first group (PREM group) consisted of children having a history of premature birth (≤ 36 weeks). The second group consisted of full term children (FT group) who were matched for age and gender to the first group. The PREM group was categorised into three subgroups according to prematurity status: late premature (34-36 weeks, LP), moderate (MP) to very premature (29-33 weeks, VP) and extremely premature (≤ 28 weeks, EP). A self-designed questionnaire was used to record demographic and medical information obtained from parents. The questions were related to antenatal factors, birth and medical history of the child. The Movement Assessment Battery for Children second edition (MABC-2) and MABC-2 Checklist were used to evaluate functional motor problems in children. The European Quality of Life Dimension Scale- Youth version (EQ-5D-Y) was used to determine the Health Related Quality of Life of the children and the Strengths and Difficulties Questionnaire (SDQ) was used to describe the behavioural and emotional status of each child according to their parents and teachers. Ethical approval was obtained from the University of Cape Town Research Ethics Committee (HREC REF: 694/2014) and permission to conduct the study within schools was granted by the Free State Education Department. Informed consent and assent was obtained. Parents were interviewed by a research assistant using the self-designed questionnaire. A different researcher then tested all children using the MABC-2 and assisted each child to complete the EQ-5D-Y. The parents and teachers each completed the SDQ and teachers completed the MABC-2 checklist. Statistical analysis was conducted using SAS® Version 9.4 and STATISTICA 10. The data were summarized using descriptive statistics (i.e. number of available data (n), mean, and standard deviation, minimum, median and maximum). The Mann Whitney U test was used to compare groups (PREM vs FT groups) and the Chi-square test was used to determine any association between groups and 5 descriptive variables. Comparisons between prematurity subgroups were conducted using the Kruskal- Wallis ANOVA. Results: 122 children participated in this study: 61 FT children and 61 PREM children. The PREM group consisted of 23 children who were classified as late premature, 27 who were moderate to very premature and 11 children who were extremely premature There were no differences between groups in terms of age (U = 1760, z = -0.51, p = 0.610), gender (Chi = 0.03, df = 2, p = 0.86), grade level (Chi = 0.386, df = 3, p = 0.98) and socioeconomic status [as defined by mothers level of education (Chi = 3.79, df = 2, p = 0.15) and school quintile (Chi = 5.22, df =2, p = 0.07)]. Differences were found in terms of maternal age at delivery (PREM = 31.9 years [SD=5.2] vs. FT = 29.02 years [SD = 3.5] df = 120, t = -3.61, p < 0.001). As expected, the PREM group had a significantly lower birthweight compared to the FT group (PREM = 2201g [SD = 748] vs. FT = 3132g [SD = 406], df = 120, t = 8.54, p < 0.001). 96.7% of those in the PREM group were born via C/section (p < 0.0001). Apart from one case of respiratory distress, the FT group reported no neonatal complications. As expected, more candidates in the PREM group were more frequently hospitalised (Chi = 34.605, df = 2), and cases of CP were reported. The APGAR scores were significantly different between FT and PREM groups at 1min (p<0.0001) and 5min (p<0.0001) Regarding motor performance, there was a significant difference in MABC-2 Total Standard Scores (MABC TSS) (U = 1425.0, z = 2.23, p = 0.026) and the MABC-Checklist Total Motor Scores (U = 1016.5, z = -4.32, p < 0.0001) with FT group performing better and reporting less functional motor problems than the PREM group. Regarding HRQoL, we found that groups were also significantly different in terms of the Mobility domain of the EQ-5D-Y with the Prem group reporting more problems than the FT group (Chi = 6.31, df =1, p = 0.012). No differences were found between groups with regard to the Looking After Myself (Chi = 2.03, df =1, p = 0.153), Usual Activities (Chi = 0.00, df = 1, p = 1.0), Worried/Sad/Unhappy (Chi = 1.22, df =1, p = 0.541), and Pain/Discomfort (Chi = 3.59, df = 1, p = 0.165) domains. In terms of emotional-behavioural status, we found no differences between the two groups in terms of Parent Total Difficulties scores (U = 1791.50, z = -0.351, p = 0.725) as well as Teachers Total Difficulties Scores (U = 1518.0, z = -1.751, p = 0.08). However, the FT group scored lower than the PREM group on the emotional domain (U = 1404.0, z = -2.33, p = 0.02) indicating less problems and higher on the prosocial domain (U = 1335.0, z = 2.68, p = 0.007) indicating more positive factors in this group. On examination of the PREM sub groups, we found no differences in Parent Total Difficulties Score between groups (p = 0.377). When we compared parent versus teacher SDQ scores, 45 (73.8 %) cases where the parent and teacher were in agreement with the "normal" assigned score. In addition, there were 2 (3.3 %) cases were the parent and teacher respectively assigned a score of "abnormal" and "borderline". Regarding the Impact scores, parents/caregivers reported that the difficulties (emotional, conduct, hyperactivity, peer and prosocial problems) did not have an impact on a child's friendship (p = 0.2889), classroom learning (p = 0.2325), leisure activities (p = 0.3585) or their home life (p = 0.1248). In contrast, teachers' responses indicated that the difficulties had an influence on classroom learning (p = 0.0030) but not friendships (p = 0.2374). Discussion: The late premature group made up a bigger proportion of the premature group. This correlates with the PPIP report, where the same trend was noted for the South African premature population (Pattinson, Saving Babies [PPIP], 2012-2013; Kalimba & Ballot, 2013). Findings from this study correlated with literature on PREM children being more at risk of decreased motor function when compared to FT peers (Hack et al., 2002; Chyi et al., 2008; Stephans & Vohr, 2009; Van Baar et al., 2009; Hornby & Woodward, 2009; Van Baar et al, 2013). Fine motor skills is essential in a child's daily activities and very important to function at school. This study indicated a deficiency within fine motor and balance domains within the PREM group. Maternal age surfaced as predictor of motor performance as younger mothers (< 19 years) have an increased risk of low birth weight and premature infants (very and extremely premature) (Schempf, Branum, Lukacs & Schoendorf, 2007; Gibbs, Wendt, Peters & Hogue, 2012; Kalimba & Ballot, 2013; Fall, Sachdev, Osmond, Restrepo-Mendez, Victora, Martorell, Stein, Sinha, et al., 2015; Benli, Benli, Usta, Atakul, Koroglu, 2015). Literature on older mothers (≥ age 35) also showed an increased risk towards premature birth (moderate and very premature) with more medical conditions (such as hypertension and diabetes)-this was not the case in this research (Schempf et al., 2007; Gibbs et al., 2012; Kalimba & Ballot, 2013; Fall et al., 2015; Benli et al., 2015), however it is reported that PREM infants from older mothers show somewhat better outcomes of infants later in life (Schempf et al., 2007; Gibbs et al., 2012; Kalimba & Ballot, 2013; Fall et al., 2015; Benli et al., 2015). Other findings from this research indicated that, from the teachers' perspectives, PREM children showed a greater tendency towards emotional and prosocial behaviour impairments, than the FT population. This align with literature where premature infants are mentioned to be more susceptible to behaviour performance problems at school-age (Kerstjens et al., 2012; Bos et al., 2013; Moreira et al., 7 2014). In this research, the extremely premature group had more behavioural problems which had an impact on theses children's leisure activities, peer, and classroom learning. Conclusion: Our findings suggest that PREM children have more motor problems than FT children and that the very preterm group showed the highest risk for motor problems. Maternal age also indicated to be an influencing factor where mothers younger than 19, as well as mother over 35, both indicated a risk for premature birth, resulting in low birth weight. Other risk factors influencing function in the PREM, apart from low birth weight, indicated by the results were factors like respiratory distress, apnoea, haemorrhaging and the exposure to post-natal steroids. According to teacher's perceptions, the children in the PREM group, tended to show more behavioural and emotional problems that those of the FT sample.

Aim: The study aimed to record the recovery patterns of gross motor function following acquired brain injury (ABI) in 17 participants, aged two to 14 years, receiving physiotherapy intervention at a paediatric intermediate care facility in the Western Cape, South Africa. Objectives of the study were to explore if factors such as age at injury, time since injury, intervention type, injury severity, gender, and the health- related quality of life of the child and caregiver were predictive of improvement of motor function and participation. Methods: A quantitative, longitudinal, prospective cohort design with repeated measures was employed. The children received physiotherapy either intensively or intermittently within eight months post brain insult. The Gross Motor Function Classification System (GMFCS) was used to classify the children according to their functional abilities. The Gross Motor Function Measure 88 (GMFM88) was used to assess changes in the child’s gross motor function. The Paediatric Evaluation of Disability Inventory (PEDI) evaluated functional performance in daily life activities (participation). The EQ-5D-Y proxy version and the Caregiver Strain Index (CSI) evaluated the health-related quality of life of the children and caregivers respectively. Assessments were performed at Baseline, Week 3, 7, 9 and 13 after admission to the study. Analysis: Descriptive statistics were used to describe the demographic data of the participants. Non-parametric analysis was performed to determine the time points at which the greatest improvement occurred because the sample was relatively small to support an adequately powered randomized intermittent trial. The GMFM88 was the primary outcome measure and the changes in score over the 13-week study period were plotted graphically in an attempt to identify patterns of improvement. The change in score from Baseline to Week 3 was also used as the dependent variable in investigating the determinants of short term improvement between the five measurement time points. Scatterplots and Spearman’s rho were used to investigate the relationship between changes in GMFM88 score from Baseline to Week 3 and the age of the child at injury, time from injury and Baseline GMFM88 score. The Kruskal Wallis ANOVA for ordinal data was used to establish whether there were differences in all the outcome measures at the different time points: between Baseline and Week 3, between Week 3 and Week 7 and between Week 7 and Week 9 and, if significant, a post-hoc Sign test was done to see where the differences lay. The effect size was calculated by dividing the z value by the square root of the total number of observations at both time points. Simple regression analysis was used to determine the variance in Week 9 GMFM88% score accounted for by the Baseline score. Results: Seventeen participants met the inclusion criteria and were recruited. There were more boys (n=14) than girls (n=3) admitted with brain injury and the majority of the total sample (n=14) were drawn from families with minimal financial resources. Although no differences were found between the two intervention groups, the greatest improvement in GMFM88 scores was observed within the first three weeks of intervention, regardless of the time since injury. Three patterns of recovery were identified through plotting the GMFM88 scores: Group A, included participants with a high baseline score who showed sustained but small improvement until reaching the ceiling score; Group B, participants who started with lower scores and then improved considerably; and Group C, participants who started with low scores and showed slower and smaller improvement. Most participants (n=13) returned to near normal motor function after Week 9 (over 90% on the GMFM). Four participants did not show the same improvement: The Week 9 GMFM88 score was less than 60% in one participant and less than 30% for the other three. In this study, participants who showed the greatest improvement were those children on GMFCS levels three and four. The Baseline GMFM88 scores were significantly correlated with other time points (rho=0.886 at Week 9 and 0.748 at Week 13), but not with the change in scores. The effect size of the change in GMFM88 scores from one time point to the other were all measured as medium (effect size of 0.5 but less than 1.3) and the largest effect size was seen between Baseline and Week 7 (effect size=.660). Change in score from Baseline to Week 3 was not predicted by gender, cause of injury or method of intervention delivered (intensive or intermittent). The Baseline motor score accounted for 86% of the variance of the Week 9 GMFM88% score and each point in the baseline score increased the Week 9 score by .94. The PEDI Mobility Score demonstrated a similar pattern of improvement to the GMFM88, but the pattern in progression of the PEDI Self-care domain was less clear. The EQ-5D-Y Proxies indicated that at Week 13, at least five children still had problems in one or more of the dimensions, with the greatest number (n=-8) having problems with the Usual Activities and Worried, Sad, or Unhappy domains. The older (above age nine years), higher functioning children made less gains in their functional abilities. The greatest cumulative cause of strain reported by the thirteen respondents, was a change in the former self of the child, followed closely by financial strain and work adjustments. The caregivers of the children in Group C, the most disabled group, experienced double the strain at Week 13 than caregivers of children with mild and moderate brain injury. Although not correlated at Baseline, the CSI was negatively correlated with the proxy EQ-5D-Y reported visual analogue general health scale at Week 13 (n=10, rho=-724, p=.018) .655, p=.021). Conclusions: Although, most participants in the study regained physical functioning, approximately 25% admitted for rehabilitation with ABI might have significant residual motor damage and require on-going rehabilitative support. Although there were no other factors identified which predicted the outcome, these children could be identified based on poor GMFM88 scores on admission to rehabilitation. The EQ-5D-Y indicated that at Week 13, eight of the 12 proxies reported that participants had problems with anxiety and depression. Rehabilitation might therefore need to include a greater emphasis on self-care and mental health of the child, even when motor control has been established. Planning of long-term support should start early to maximise recovery and reduce the stress on caregivers. The study findings cannot be generalised due to the small sample size, but the results should alert therapists at the Facility to the possible long-term outcomes of children admitted with ABI. The study findings can assist with the formulation of patient specific and family centred rehabilitation care plans for children admitted with ABI at the Facility.

The purpose of this study is to determine whether a community based rehabilitation exercise programme had an effect on pulmonary function, exercise tolerance and Health Related Quality of Life (HRQoL) in patients diagnosed with Pulmonary Tuberculosis (PTB). The prevalence of PTB in South Africa is one of the highest in the African continent. Assessing the effectiveness of the programme could provide further methods in improving compliance to pharmaceutical medication as well as an improvement in the morbidity experienced after diagnosis of PTB.

The increased life expectancy of people living with HIV/AIDS (PLWHA) has meant that the disease has changed status from a terminal to a chronic condition. Along with this shift, increased attention has been given to maximising the quality of the prolonged life. A common, long standing problem impacting quality of life in PLWHA is that of pain. Investigating pain in PLWHA was therefore the core subject under study in the current thesis. The thesis consists of four main components. Firstly, a theoretical framework for pain as a biopsychosocial phenomenon from which current literature on the aetiology and management of pain in this population was reviewed. Secondly, to gain an understanding of whether pain was a problem in the English and/or Afrikaans speaking urban and rural population of PLWHA, a prevalence study was conducted. Thirdly, an investigation assessing the efficacy of the use of a biopsychosocialy informed intervention for the management of pain in this population was conducted. And finally a qualitative study exploring the experiences of adult women living with pain and/or HIV was studied. The findings of the prevalence study showed that urban participants (with a prevalence rate of 42% (CI:34-50%) n=151) were 8.1 (CI:3.7-17.9) times more likely to experience pain than their rural counterparts (with a prevalence rate of 8% ((CI:4-15%) n=96). From this it was concluded that pain is indeed a problem in the urban community, whereas it was not as big a problem in the rural community. This prompted the researchers to conduct the intervention study in the urban population. The intervention study however suffered from a small sample size (N=32 having given consent, but only n=17 attending baseline data collection) which limited analysis. Upon reflection, the small sample was a result in and of itself, and could be considered as an indication that interventions need to be strongly informed by what is deemed (un-)acceptable by the community in which they are run and tested. As such, a conclusion was made that the ‘one-size-fits-all’ approach to the management of pain in HIV/AIDS may not be the solution. With this result from the intervention study, as well as the vastly different pain prevalence rates seen in the prevalence study, a qualitative study was added. Using a purposive sampling technique, seven participants (three from the urban site, and four from the rural site) who were HIV positive, with (n=4) and without (n=3) pain, were interviewed and their responses analysed and compared. With the use of the Morse model, the qualitative study gave insight into how pain and/or HIV influenced the experiences of Afrikaans and/or English speaking women, and also highlighted the role that stigma/support plays in their experiences with pain and HIV. From all three studies it is clear that pain in HIV/AIDS is complex and requires specific community tailored approaches.

Includes abstract. / Includes bibliographical references. / The aim of this randomised clinical trial over 12 weeks was to determine if the gradual transition (accompanied by calf muscle training), from conventional to minimalist running shoes 1) increased the risk of lower limb pain or injury and 2) improved lower limb muscle function (endurance, flexibility and power) in experienced distance runners. In addition, the effects of the transition on runner satisfaction were studied. To determine whether there were significant differences in lower limb injury incidence and pain, calf endurance, lower limb muscle flexibility, lower limb muscle power, footposture index, hallux ROM and participants’ satisfaction with the type of running shoes and performance between an experimental group, that ran in minimalist shoes, and a control group that ran in conventional shoes. (b) To determine whether there were significant differences in lower limb injury incidence and pain, calf endurance, lower limb muscle flexibility, lower limb muscle power, foot posture index, hallux ROM and participants’ satisfaction with the type of running shoes and performance between groups over time.

Includes bibliographical references. / Chronic non-specific low back pain (NSCLBP) is a common low back condition affecting a large proportion of the population suffering from low back pain (LBP). Exercise therapy is recommended as the first line treatment for NSCLBP but no type of exercise has been found to be more effective than another in improving pain and function outcomes. Low back pain trials have compared heterogeneous exercise types to date. Pilates mat classes are a popular form of exercise taught by therapists. The aim of this study was to compare outcomes of an eight-week supervised Pilates mat programme with those of a similar non-supervised home exercise programme with regard to pain intensity, function, medication use, health related quality of life, adherence, and participant satisfaction with such exercise programmes in treating NSCLBP. A randomised control trial was done to compare the effect of a supervised Pilates at programme with a non-supervised home programme of similar exercises. The programmes were comparable for both the type of exercise and the participation duration of programmes (per week) and included the same fourteen exercises with gradual progressions. The Pilates classes were held twice a week for a 45 minute class and the home programme required doing the exercises for 30 minutes, three times a week, for an eight-week period. All participants were women who had been suffering from NSCLBP for longer than six weeks and who had volunteered to participate, or were referred by a therapist. The participants were screened and randomly allocated to the respective groups: a supervised exercise group (SEG) and a home exercise group (HEG). All the individual sessions and the supervised classes were held at a multi-disciplinary centre, which housed both a private physiotherapy practice and a Pilates studio. Outcome measures were measured at baseline, four weeks, eight weeks and 12 weeks by an assessor who was blinded to group allocation. The primary outcomes of pain and function were measured using the Pain Intensity Numeric Rating Scale (PINRS) and the Roland Morris Disability Questionnaire (RMDQ) respectively. Change in medication was measured as a percentage change in medication; mobility of the pelvis and lumbar spine was measured using the fingertip-to-floor (FTF) test; health-related quality of life was assessed using the EQ-5D questionnaire, and the confidence to perform certain tasks was measured using the pain self-efficacy questionnaire (PSEQ). Additionally, patient satisfaction was measured at eight weeks using the Better Backs Patient Satisfaction Questionnaire, and adherence was measured by calculating a percentage of the maximum adherence.

Background: Specific Learning Disorder (SLD) is described as a neurodevelopmental disorder affecting academic performance and/or activities of daily life including reading, writing or calculation skills during formal years of schooling. There is strong evidence that Developmental Coordination Disorder (DCD), presenting as a disorder affecting motor skills, may be co-morbid with other neurodevelopmental conditions, including SLD. Children with SLD and co-morbid DCD (SLD/DCD) are considered a unique group. Learners with SLD/DCD experience a significant, negative impact on daily tasks such as selfcare, play, leisure and schoolwork. Neuromotor Task Training (NTT), a form of intervention, has been reported to be effective in reducing the activity limitations in children with DCD. However, information regarding the most effective treatment to improve function and behaviour in learners with SLD/DCD, who attend special schools, has not yet been investigated. The aim of this study was to evaluate the efficacy of task-orientated NTT group intervention programme on motor performance, behavioural profile and health related quality of life (HRQOL) of children with SLD/DCD attending a School for Learners with Special Education Needs (LSEN) in Cape Town, South Africa. Method: A quantitative, quasi-experimental design with pre- and post-tests was used. Learners were included if they presented with a primary or secondary diagnosis of SLD plus DCD (scoring at or below the 16th percentile on the Motor Assessment Battery for Children 2nd Edition (MABC-2) and a functional motor problem, as identified by the MABC checklist), aged between 6–10 years and grade 1-4. Learners were allocated to either NTT (n = 18) or Usual Care (n = 18) groups. The Usual Care (UC) group continued with normal activity, but did not receive physiotherapy. The MABC-2, parent and teacher Strengths and Difficulties Questionnaire (SDQ) and self-reported European Quality of Life 5- Dimensions questionnaire for Youth (EQ-5D-Y) were used to assess performance pre- and post - intervention. The NTT program was implemented for nine weeks, with two 45-60 minute sessions per week. Results: There was a significant difference in Total Standard Score (TSS) between NTT and UC groups (p=0.048). In the NTT group, the mean TSS (p < 0.001) and Balance score (p= 0.02) significantly improved over the intervention period. The control group did not show any significant changes over the intervention period while receiving UC. The intervention group did not show any significant changes in Behavioural Profile (SDQ) over the intervention period while receiving NTT, according to v teachers. The results indicate that the intervention group showed a significant change in Behavioural Profile (SDQ) in the Behaviour/Conduct domain (p=0.01) over the intervention period while receiving NTT, according to parents. There was no significant change in HRQOL according to the self-report EQ-5D-Y. Conclusion: The results of this study showed that a task orientated programme (NTT), presented in small groups, has a positive effect on motor performance in learners SLD/DCD.

Introduction Phantom limb pain (PLP) is described as painful sensations felt in the missing portion of an amputated limb. PLP occurs in up to 85% of amputees, making it the most common painful condition secondary to amputation. PLP interferes with sleep, mobility, and work, general activities of daily living and enjoyment of life. Current pharmacological and non-pharmacological interventions have shown limited efficacy for reducing PLP, perhaps because they do not effectively target the mechanisms that have been proposed to underlie PLP in people who have undergone amputations. Graded motor imagery (GMI) is a cortical mechanisms-based intervention which aims to reduce PLP using a graded sequence of strategies including left/right judgements, imagined movements and mirror therapy. The aim of this thesis was to investigate whether the GMI programme is effective for reducing PLP and disability in people who have undergone amputations. Methods A single blinded randomised controlled trial was conducted at Somerset, Khayelitsha and Victoria hospitals in Cape Town, South Africa. The experimental group underwent a 6-week GMI programme where each phase was carried out for two weeks, during which the patient received treatment for 30 minutes on two separate days of the first week (at least one day apart) and continued with a structured home-exercise programme during the first week until the end of the second week. The control group continued with routine care. Data on the outcomes- PLP severity, pain interference with function and health-related quality of life were collected at baseline, 6 weeks and 3 months by a blinded outcome assessor. Results The study recruited 21 participants from which 11 and 10 were randomly allocated to the experimental and control groups respectively. Within group analysis showed that participants in both the experimental and control groups had improved pain severity scores immediately after treatment and at 3-month follow-up. The between-group analysis showed that the experimental group had significantly greater improvements in pain immediately after treatment (p=0.02). However, there was no difference between groups at 3-months follow-up (p=0.14). To explore clinically meaningful improvements in pain, the Number Needed to Treat (NNT) were calculated using a cut-off of 3 points on a 0-10 scale. The NNT were 2 [95% CI: 1.1 – 6.5] and 3 [95% CI: 1.9 – 7.1] immediately after treatment and at 3-months follow-up respectively. For pain interference with function, within group analysis showed that participants in the experimental group had significant improvements immediately after treatment and at 3-month follow-up. The between-group analysis showed that the experimental group had significantly greater improvements in pain interference with function immediately after treatment (p=0.007) and at 3- month follow-up (p=0.02). The NNT were 1.4 [95% CI: 1 – 1.8] and 1.9 [95% CI: 1.1 – 6.5] immediately after treatment and at 3-months follow-up respectively. For disability, the experimental group had significantly fewer problems with mobility than the control group at 3 months (χ2 = 9.8; p= 0.04). Conclusion The results of the current study provide support for the use of GMI to treat PLP based on the proposition that PLP is driven by cortical mechanisms and that GMI effectively targets these mechanisms. On the basis of the significant pain reduction within the GMI group, the lack of serious adverse effects, and the ease of application, GMI may be a viable treatment for treating PLP in people who have undergone amputations. While more studies using rigorous methodology, including sham treatment, larger sample sizes and a more generalisable sample, are required, the efficacy of GMI coupled with its affordability and low risk, suggest that it is applicable in a resource-constrained primary health setting in South Africa.

Introduction The number of South Africans aged 60 years and older is increasing. The National Development Plan (NDP) aims to raise average life expectancy to 70 years by 2030. In response to similar global trends, the World Health Organization (WHO) developed the global Active Ageing Policy Framework (AAPF) to inform the actions taken by countries to address the needs of older persons, acknowledging the different contexts and cultures. The WHO recommended that the framework should have been evaluated to test its applicability and use in member countries by the first half of the twenty-first century. In South Africa, Senior Service Centres for Older persons were set up in communities to provide services to enhance the achievement of the goals of the AAPF. Unfortunately, little information is available on how the framework has been applied to inform services offered in African countries, including South Africa. This study explored services provided by Service Centres for Older Persons in the Western Cape using the WHO framework on Active Ageing as a guide to the services. The study was conducted in two phases. Aims In the first phase, the study explored the characteristics of Service Centres – the organisational structures, the types of services offered, the profile of the managers, and their perception of the needs of the members of the centres. In the second phase, the study explored the profile of the members of these centres by determining their socio-demographic profile, health and psychosocial characteristics. Methodology In phase 1, forty-one service centres were selected by stratified random sampling to proportionally represent the five districts and the Cape Metropole in the province. Only 35 service centres consented to take part in the study. In phase 2, a sample of convenience was recruited from 3 051 registered members at the 35 service centres. Only 625 members consented to participate. A cross sectional, descriptive research design was utilised to collect data on the characteristics of the service centres from the managers, using a modified self-developed questionnaire. To explore the profile of members of the service centres, a self-developed questionnaire and two standardised questionnaires namely, World Health Organization Quality of Life-BREF (WHOQOL-BREF) and World Health Organization Disability Assessment Schedule II (WHODAS II), were administered. Data analysis Descriptive statistics were used to analyse the responses to the closed-ended questions in phases 1 and 2 of the study, and data presented as frequencies. Similarly, responses to the open-ended questions were summarised and themes were identified. In phase 1, quantitative and qualitative responses were analysed according to the WHO Active Ageing Framework. In phase 2, the data generated were analysed according to the WHO International Classification of Functioning, Disability and Health Framework (ICF) model. Results Services offered to members at the centres in the six categories of determinants of the AAPF included the following: • Health and social care systems – Limited screening programs were provided as part of health promotion and disease prevention services. • Behavioural – Physical activity/exercise programmes were most common, but no programs addressed healthy eating habits, tobacco and alcohol abuse, or adherence to medication use. • Personal factors – Services were provided to enhance members’ cognitive skills. • Physical environment – No services were offered on falls prevention. • Social environment – Different types of social support programmes were offered, including meeting education and literacy needs of members through the provision of Adult Basic Education Training (ABET). • Economic – Some centres offered members opportunities for formal work and volunteering, while some provided income generation activities. Most of the managers had high school education but expressed the need for training to manage these centres. The managers perceived the needs of the members would relate to health care, social support, inactivity, isolation and safety among others. The summary of the profile of the 625 members of the centres are presented in the domains of the ICF model: • Personal factors – The members were predominantly widowed women with a mean age of 74.1 ±7.51 years (range 60–100 years). Most members displayed good lifestyle habits and engaged in various leisure and physical activities. Members were also satisfied with themselves, their health, bodily appearance and quality of life and reported a variety of aspirations for their future with and without possible future-orientated behaviours. • Health conditions – Hypertension, arthritis and diabetes were the most common health problems reported by members for which they took medication. Falls were not common among members although the majority feared falling. • Body structure and function – Most members expressed good cognitive function, could concentrate and follow conversations, and reported no hearing, visual or bladder problems. Members also reported good postural balance. • Activities and participation – Members were satisfied with their abilities to do daily activities, participate in the community, and learn new tasks. • Environmental factors – Most members resided with their children or family for various reasons, including needing care for themselves or to provide care to their children and/or extended families. Discussion and conclusion Using the WHO AAPF as a guide, it was found that services provided by Service Centres for Older Persons in the Western Cape, although varied, were deficient at most service centres. The managers responsible for providing these programmes were women with limited skills who needed more education and training to be able to manage the centres appropriately. The members of service centres, despite presenting with health challenges and multi-morbidities, indicated aspirations for the future. In view of the goals of the National Development Plan (NDP) to increase life expectancy of older persons to 70 years by 2030, a more comprehensive exploration of the profile of older persons will assist the managers of the Service Centres to respond more appropriately to the diversity of needs and interests of members.