Magister Scientiae (Physiotherapy) - MSc(Physio) / Introduction: A spinal cord injury is the damage to the spinal cord that alters functional independence. Two different systems of care for the management of health conditions are available in private and public care in South Africa. A better understanding of health and functioning of individuals in the two systems is crucial to help address inequality between the two systems. The aim of the study was to describe the health status and functioning of persons with traumatic spinal cord injury (TSCI) in the Western Cape province who received public-funded care compared with those in the Gauteng province who received private care. Methodology: The study entailed a cross-section comparison between a government-funded cohort in the Western Cape and a private cohort in Gauteng, two of the provinces of South Africa. Self-administered questionnaires and standardised outcome measures were used to collect the data and to ensure validity and reliability. Data were captured on Excel and then transferred to SPSS (Statistical Package for Social Sciences) for analysis. Ethical clearance to conduct the study was obtained from the Biomedical Research Ethics Committee of the University of the Western Cape.

The purpose of the study was to investigate the prevalence and effects of vision impairment co-existing with other comorbid conditions. Utilizing the 2008 National Health Interview Survey, the most recent nationally representative data including expanded vision, health conditions, and activity questions, this study examined the effect of vision impairment co-existing with selected comorbid conditions among non-institutionalized older adults age ≥ 55 years. Specifically, this study compared 4 groups: (a) older adults with neither vison impairment nor comorbid conditions, (b) older adults with vision impairment only, (c) older adults with comorbid conditions only, and (d) older adults with both vision impairment and each of the comorbid conditions to examine the prevalence and effect of vision impairment and comorbid conditions on selected mobility and vision activity limitations, and participation restrictions. Using complex sample techniques to conduct frequency analyses and logistic regression procedures, this study compared these groups of older adults to document the likelihood of experiencing mobility and vision activity limitations, and participatory restrictions. These results suggest that older adults reporting vision impairments are a heterogeneous population, overwhelmingly use corrective lenses, and experience substantial mobility and vision activity limitations, and participatory restrictions; however, relatively few report using low vision aids or rehabilitation services. In addition, these results revealed, even when controlling for age, sex, race/ethnicity, marital status, region of residence, and health status, older adults with vision impairment and any of the selected comorbid conditions were statistically significantly more likely to report mobility and vision activity limitations, and participation restrictions. Moreover, when comparing older adults reporting vision impairment co-existing with comorbid conditions older adults reporting either vision impairment only or a comorbid condition only, the results suggest vision impairment had the largest statistically significant effect on the likelihood of mobility or vision activity limitations, or participatory restriction in 29 of the 44 logistic regression analyses. These findings are significant as vision impairment is framed as a public health concern, and can inform improvements in programs and services for older adults. Finally, these findings highlight the need for expanded research examining the effect of specific eye diseases and comorbid conditions among older adults.

This study explored the emerging Self-Imposed Activity Limitation (SIAL) theory among community dwelling elders. This theory was examined using the proposed Aging Well Conceptual model which was guided by Baltes' Selection, Optimization with Compensation model, Markus and Nurius' Envisioned Possible Selves theory, Kuypers and Bengtson's Social Breakdown Syndrome model, Bandura's Self-Efficacy theory, and Rotter's Locus of Control theory. The objectives of this study were to explore the relationships among multiple variables in a hierarchical model and to examine the explanatory power of the SIAL variables in predicting elders' well-being.A correlational descriptive design with a causal modeling approach was used employing Structural Equation Modeling (SEM) techniques. The Aging Well model was tested through a secondary analysis of the National Survey of Midlife Development in the United States (MIDUS) database selecting respondents aged 65-74 years.Two research questions guided this study. Research question one, how well does the Aging Well model fit with empirical sample data, was explored. The Aging Well model statistically approximated the MIDUS data after theoretical and statistical modifications and explained 76% of the variance of elder's well-being. The mediating effects of SIAL variables were determined by nested alternative model testing. Research question two, are the proposition statements in the Aging Well model valid, and was demonstrated empirically by the expected patterns of correlation and covariance among most of the variables in the Aging Well model.SIAL as a composite factor had a large positive effect on elder's well-being. Elders' perceived constraints and perception of aging had no direct effect on well-being. The influences of these two factors on well-being were mediated by a common factor, SIAL. These findings supported the emerging SIAL theory by suggesting that the optimal use of SIAL would lead to adaptive outcomes promoting elders' well-being. In addition, SIAL mediated the effects of elders' sense of control and perception of aging on well-being. The full range of SIAL could not be examined due to limitations inherent in secondary data analysis.

Studier visar att sexuell hälsa upplevs som ett relevant arbetsområde inom arbetsterapi men i nuläget är det många arbetsterapeuter som utesluter ämnet i sitt dagliga arbete, även inom habilitering. Syfte: Syftet med studien var att beskriva i vilken utsträckning arbetsterapeuter inom ungdoms- och vuxenhabilitering i Sverige arbetar med sexuell hälsa samt deras uppfattning om ämnet. Metod: En kvantitativ enkätstudie där deltagarna rekryterades genom ett icke slumpmässigt bekvämlighetsurval. Undersökningen bestod av 71 arbetsterapeuter som arbetar inom ungdoms- och vuxenhabilitering i Sverige. Data analyserades i statistikprogrammet IBM SPSS Statistics. Resultat: 53 deltagare hade aldrig utfört någon intervention relaterat till sexuell hälsa. 35 hade tagit upp ämnet med en patient någon/några gånger per år. 38 uppgav att deras patienter aldrig hade tagit upp ämnet med dem. 37 instämde delvis att de är bekväma med att ta upp frågor gällande ämnet. 55 ansåg att de inte har tillräckligt med kunskap för att kunna arbeta med ämnet. 42 ansåg att sexuell hälsa är en del av deras arbetsområde. Slutsats: Arbetsterapeuter inom habilitering är i behov av mer kunskap och verktyg för att kunna arbeta med ämnet på ett professionellt och tryggt sätt. Arbetsterapeuter har kompetens att arbeta med ämnet vilket kan ge patienterna möjligheten till en god sexuell hälsa. Genom tydligare riktlinjer på arbetsplatsen, mer undervisning i grundutbildningen samt utbildning via verksamheten kan arbetet för den sexuella hälsan gynnas för patienterna. / Studies indicate that sexual health is seen as a relevant work area within occupational therapy but it’s currently several occupational therapists that excludes the topic in their daily work, also within habilitation. Purpose: The purpose with this study was to describe the extent to which occupational therapists within youth and adult habilitation in Sweden work with sexual health and what opinion they have about the topic. Method: A quantitative survey where the participants were recruited through a non-probability convenience sampling. The survey consisted of 71 occupational therapists who works within youth and adult habilitation in Sweden. Data was analyzed in the statistical program IBM SPSS Statistics. Results: 53 participants had never implemented any intervention related to sexual health. 35 had addressed the topic with a patient some/a few times per year. 38 stated that their patients never had addressed the topic with them. 37 partly concurred that they were comfortable with addressing questions regarding the topic. 55 considered that they did not have enough knowledge in order to work with the topic 42 considered sexual health as a part of their work area. Conclusion: Occupational therapists within habilitation need more knowledge and tools to be able to work with the topic professionally and safely. Occupational therapists have competence to work with the topic which can give patients the ability to have a good sexual health. By implementing guidelines, more training in basic education and education in the workplace, the work with sexual health can improve for the patients.

ABSTRACT Speech-language pathology practice in the acute hospital setting has changed dramatically over the last 25 years. A significant increase in the number of referrals and a broadening of the speech-language pathologist’s caseload to include patients with dysphagia has meant there has been less time to see hospital inpatients with communication disabilities. This change in practice has caused speech-language pathologists working in the acute hospital setting to question their role in relation to patients with communication disabilities in the acute hospital setting. The thesis applies the World Health Organization’s International Classification of Functioning, Disability and Health (ICF) framework to explore the role of speech-language pathologists in the acute hospital setting, specifically the acute hospital stroke unit, in relation to patients with communication disabilities. The ICF proposes that a health condition can be understood in terms of four separate components. These components are Body Structures and Functions, Activities and Participation, Environmental Factors and Personal Factors. Whilst the distinction between body structures and body functions within the ICF Body Functions and Structures component is clear, there is less clarity about the relationship between the ICF concepts of activity and participation in the ICF Activities and Participation component. Therefore, the first part of the thesis explores the conceptual similarities and differences between the concepts of activity and participation generally and communication activity and communication participation in particular. This discussion concludes that the ICF concepts of activity and participation are distinct concepts that are considered separately in this thesis. Following this conceptual clarification, the thesis applies the ICF framework to patients with communication disabilities in the acute hospital stroke unit. Specifically, patients with communication disabilities are described from the perspective of communication-related body functions within the ICF Body Structures and Functions component, communication activities within the ICF Activities and Participation component and communication-related environmental factors in the ICF Environmental Factors component. It is important to understand how many patients experience a communication disability in the acute hospital stroke unit so that adequate supports can be developed. Therefore an efficient way of identifying patients in acute hospital stroke units with a communication-related body function impairment such as hearing, vision, speech, language and/or cognitive communicative impairment was required. Hence, the first study describes the development of ICF compatible scales, called the OHW scales, to rate a patient’s degree of speech, language and cognitive communicative impairment. These three rating scales were called the OHW scales because they reflect the WHO framework and also represent the authors’ initials. The concurrent validity and interrater reliability of the OHW scales were then investigated. Results indicated that the OHW had acceptable levels of concurrent validity against standardised measures of speech, language and cognitive communicative impairment. The speech and cognitive communicative OHW scales also demonstrated moderately high interrater reliability, but exact agreement on the OHW language impairment scale was low. At a minimum, the OHW scales were valid measures of speech, language and cognitive communicative impairment and therefore they were used by the researcher to determine the number of patients with communication-related impairments in the acute hospital stroke unit. Patients in acute hospital stroke units may have communication-related impairments, such as speech, language or cognitive communicative impairments as a consequence of stroke. Patients may also have communication-related impairments (e.g., in hearing, vision and cognitive communicative) due to ageing and age related illnesses. Therefore, the second study of the thesis describes the number of patients with communication-related impairments in acute stroke units, regardless of the cause. Of the 69 patients screened, 88% had a mild or more severe communication-related impairment. In addition, 69% of inpatients, screened on two or more measures, had multiple communication-related impairments. Although many patients in acute stroke units have communication-related impairments, what may be particularly important is how many patients experience difficulty communicating their healthcare needs with healthcare providers in acute hospital stroke units. The ICF describes a person’s ability to carry out an activity, such as communicate healthcare needs, as an activity limitation. The ICF describes activity limitations in four different ways. Two ways are capacity with assistance and performance. Capacity with assistance indicates the person’s highest probable level of function in an activity given assistance and performance indicates a person’s level of function in the context of everyday life. Therefore, the third study of the thesis details how many patients experienced capacity with assistance limitation, that is, difficulty communicating their healthcare needs given assistance, and performance limitation, that is, difficulty communicating their healthcare needs during everyday healthcare routines. Results indicated that 51% of 65 patients had a capacity with assistance limitation and 57% had a performance limitation. Strong and significant relationships were found between patients’ degree of communication-related impairments and their degree of communication activity limitation, in both capacity with assistance and performance. Furthermore, the presence of a communication-related impairment accounted for up to 77% of the variance in a patient’s capacity with assistance limitation. Such impairments only accounted for up to 32% of the variance in a patient’s performance limitation. This finding suggests that other factors, such as environmental factors also affect a patient’s ability to communicate, particularly during everyday health care routines. In light of this, a review of the literature on the range of environmental factors that influence communication between patients with communication-related impairments and healthcare providers in the acute hospital setting was conducted. The review of the literature indicated the need for research on the environmental factors that influence communication between patients and healthcare providers in the acute hospital stroke unit. Therefore, the final study of the thesis investigates this further. This study employed a focused ethnographic methodology to identify the range of environmental factors that appeared to influence communication between patients and their healthcare providers. Seven themes were identified including the healthcare providers’ knowledge of communication-related impairments, skills, attitudes, and individual characteristics. Other themes included the presence of family, the physical environment and hospital systems and services. In summary, this series of studies indicates that the majority of patients admitted into acute hospital stroke units have a communication-related impairment and approximately half to two thirds of patients experience difficulty communicating their healthcare needs with healthcare providers. Whilst having a communication-related impairment increases the likelihood that a patient will experience difficulty communicating with healthcare providers, other factors, such as the communicative environment also appear to play an important role. Speech-language pathologists working in the acute hospital stroke unit may have an important role in identifying patients who are experiencing difficulty communicating their healthcare needs and supporting these patients and their healthcare providers to communicate in optimal ways. Further research is required to demonstrate that improving a patient’s ability to communicate with his or her healthcare providers improves a patient’s health outcomes. With this evidence, speech-language pathologists may be more able to support patients with communication disabilities to get the healthcare they deserve.

Introduction: Gout affects approximately 15% of Maori and Pacific men, these men being at risk of early onset, severe disease with formation of gouty tophi and joint damage. Gout most frequently affects the foot, particularly the big toe and midfoot. This disease initially presents as self-limiting attacks of severe joint inflammation, and in the presence of persistent hyperuricaemia, tophaceous disease may also develop. Tophi are collections of monosodium urate crystals surrounded by chronic inflammatory cells and connective tissue. Tophi typically occur in both subcutaneous tissues and within affected joints, and may cause pain, cosmetic problems, mechanical obstruction of joint movement, and joint destruction. Despite the predilection of gout to the foot, the impact of gout on foot function is currently unknown and only case studies relating to hallux pain, tibial sesamoid pain and longitudinal tears in peroneal tendons have been reported in the literature. The aim of this study is to assess the intra-tester reliability of certain biomechanical tests to evaluate foot structure and function (plantar pressure measurements, gait parameters, range of motion at the ankle and first MTPJ and the foot posture index) in individuals with gout and to assess the differences between disability, impairment, foot structure and function between individuals with gout and non-gout controls. Subjects: A total of 25 patients with chronic gout with a mean age of 61.2 (11.7) years old were recruited from a rheumatology clinic within the Auckland District Health Board. A further 25 age-and sex-matched controls with a mean age of 57.3 (12.2) years old were recruited from AUT University. Methods: Disability, impairment, foot structure and foot function were assessed for the gout and the control group. Disability and impairment was assessed using the Health Assessment Questionnaire, Foot Function Index, Leeds Foot Impact Scale and Lower Limb Task Questionnaire. Foot structure was investigated using the Foot Posture Index, first metatarsophangeal joint (MTPJ) dorsiflexion, ankle dorsiflexion movement, subtalar joint and midtarsal joint motion, Foot Problem Score, tophi count and muscle strength of extrinsic and intrinsic foot muscles. Foot function was investigated using an in-shoe pressure system measuring mean peak plantar pressures and pressure-time integrals. Temporal-spatial gait parameters were evaluated, as well as peripheral sensation and vibration perception threshold. Plantar pressures were assessed using the Tekscan pressure insole system, gait parameters were measured using the Gaitmat walkway system, peripheral sensation and vibration threshold were assessed using 10gm monofilament and biothesiometer respectively. Intra-tester reliability was investigated using ICC, Standard Error of Measurement and Smallest Real Difference in the gout group for key measures (Foot Posture Index, first MTPJ dorsiflexion, ankle dorsiflexion movement, peak plantar pressures, pressure-time integrals and gait parameters). To investigate the significant difference between the groups, the left and right foot in gout were compared with the left foot of the control group using ANOVA with post-hoc comparisons. Non-parametric tests were used for muscle strength, peripheral sensation and Foot Problem Score and motion at the subtalar and midtarsal joints for comparison between the groups. Walking velocity, cadence and disability and impairment scores between the groups were assessed using an independent t-test with 95% confidence intervals. Significance for all these measures was set to 0.05 except for Chi square where a significance of 0.02 was set. Results: The ICC for the intra-tester reliability was excellent with low measurement error for the measured outcomes. The gout group recorded significantly higher disability and impairment scores than controls (p<0.01). Significant differences between the two groups were recorded for vibration pressure threshold, muscle strength, Foot Problem Score, first MTPJ dorsiflexion, foot motion and gait parameters (p<0.05). Significant differences were demonstrated under the toes for mean plantar pressures and under the lateral heel, midfoot and hallux regions for pressure-time integrals in the gout cases (p<0.05). Conclusions: Individuals with gout have reduced quality of life due to greater disability and impairment. The gouty foot is slightly supinated with reduced dorsiflexion at the first MTPJ. Rearfoot and forefoot motions are limited with a high incidence of digital deformities and dermatological lesions. The foot function in gout is characterized by reduced walking velocity, cadence, step and stride length. The plantar pressures are reduced under the toes with increased duration of loading under the hallux, lateral heel and midfoot regions. Further research using three-dimensional gait analysis is recommended to quantify motion at the foot and ankle joints and also to ascertain the role of proximal joints. Future work could be undertaken to evaluate the impact of acute gout on objective measures of foot function, and to determine predictors of poor foot function in patients with this disease. This will allow further work to investigate or formulate a podiatric management plan in conjunction with pharmacological therapy to improve impairment, disability and function in chronic gout.

abstract: In rehabilitation settings, activity limitation can be a significant barrier to recovery. This study sought to examine the effects of state and trait level benefit finding, positive affect, and catastrophizing on activity limitation among individuals with a physician-confirmed diagnosis of either Osteoarthritis (OA), Fibromyalgia (FM), or a dual diagnosis of OA/FM. Participants (106 OA, 53 FM, and 101 OA/FM) who had no diagnosed autoimmune disorder, a pain rating above 20 on a 0-100 scale, and no involvement in litigation regarding their condition were recruited in the Phoenix metropolitan area for inclusion in the current study. After initial questionnaires were completed, participants were trained to complete daily diaries on a laptop computer and instructed to do so a half an hour before bed each night for 30 days. In each diary, participants rated their average daily pain, benefit finding, positive affect, catastrophizing, and activity limitation. A single item, "I thought about some of the good things that have come from living with my pain" was used to examine the broader construct of benefit finding. It was hypothesized that state and trait level benefit finding would have a direct relation with activity limitation and a partially mediated relationship, through positive affect. Multilevel modeling with SAS PROC MIXED revealed that benefit finding was not directly related to activity limitation. Increases in benefit finding were associated, however, with decreases in activity limitation through a significant mediated relationship with positive affect. Individuals who benefit find had a higher level of positive affect which was associated with decreased activity limitation. A suppression effect involving pain and benefit finding at the trait level was also found. Pain appeared to increase the predictive validity of the relation of benefit finding to activity limitation. These findings have important implications for rehabilitation psychologists and should embolden clinicians to encourage patients to increase positive affect by employing active approach-oriented coping strategies like benefit finding to reduce activity limitation. / Dissertation/Thesis / Ph.D. Psychology 2012

Aim:  The overall aim of this thesis was to explore the development of a video-supported interactive learning model for movement awareness among nursing students. Methods:  Study I was a cross-sectional survey regarding prevalence and impact of musculoskeletal symptoms (MSS) among nursing students. In the remaining three studies a learning model was developed and explored; II - the inter-personal interaction (qualitative content analysis), III - the students’ experiences of using the learning model (phenomenological hermeneutics), IV - the students’ learning processes (hermeneutic approach). Results: 143 of the 224 respondents in study I reported MSS during the previous 12 months and of those 91 reported impact on physical daily life activities. The odds ratio for reporting MSS study year 3 was 4.7 (95% CI: 2.1 – 10.7). Study II shows that the students’ movement awareness and self-analysis developed when encountering their own movement through video feedback. Studies III and IV show that the facilitator’s reflective and responsive approach appears to be essential in creating interaction and a permitting learning atmosphere. The students became emotionally and cognitively challenged and personally engaged, were motivated to change by discovering details in their movements and gained a greater understanding of the relationship between their own movements and current or risk for future MSS. They also experienced emotional, cognitive and bodily confusion, which was interpreted as a necessary step in the changing process. Conclusion: MSS among nursing students appears to be a problem and education regarding ergonomic movements and principles is suggested to be emphasized in the nursing curriculum. The video-supported learning model enabled encountering and discovering one’s own body and movement in different ways, which facilitated reflection and motivation for change, which was supported by the facilitator’s reflective approach. The learning model, which could contribute to multifactorial ergonomic interventions, could also support movement awareness and learning in practical learning situations within education and rehabilitation. Further research needs to study the model in different contexts and in relation to MSS prevention.

Fatigue is a distressing, complex, and multidimensional sensation, that is common in individuals with chronic obstructive pulmonary disease (COPD), and impacts negatively on their functioning and quality of life. Limited research has been conducted to examine how various factors may influence the different dimensions of subjective fatigue experienced in these individuals. Four dimensions of subjective fatigue including: emotional, behavioural, cognitive, and physical, were examined in a convenience sample of 42 participants with COPD who attended an outpatient pulmonary rehabilitation program. The primary purpose of this feasibility study was to determine the proportion of individuals experiencing the four dimensions of fatigue, and to examine the relationships between these dimensions of fatigue and various influencing factors (dyspnea, depression, anxiety, sleep quality, activity limitation, heart rate, and oxygen saturation). The secondary purpose was to compare the four dimensions of fatigue by sex, supplemental oxygen use, smoking status, and severity of dyspnea, and to examine the relationships between the four dimensions of fatigue and age, the number of co-morbidities, and the amount of pulmonary rehabilitation received. Self-report questionnaires were used to measure fatigue (Multidimensional Fatigue Inventory MFI), anxiety and depression (Hospital Anxiety and Depression Scale HADS), and sleep quality (Pittsburgh Sleep Quality Index PSQI). Pulmonary rehabilitation health records were accessed to collect data on the remaining variables. The majority of the participants (61.9% - 81.0%) experienced moderate levels of subjective fatigue in all four dimensions. Moderate to severe levels of physical fatigue were experienced in 95.3% of the participants. The only significant relationship was between anxiety and emotional fatigue; all other relationships were statistically insignificant. There were no significant differences between sex, supplemental oxygen use, smoking status, and severity of dyspnea on the four dimensions of subjective fatigue. Many of the participants had probable presence of clinical anxiety (42.9%), where the prevalence of anxiety was nearly twice as high as depression (21.4%). Findings from this study can be used by healthcare professionals to gain a better understanding of fatigue in individuals with COPD who attend pulmonary rehabilitation, and help in developing effective interventions for reducing the distressing effects of fatigue.

Fatigue is a distressing, complex, and multidimensional sensation, that is common in individuals with chronic obstructive pulmonary disease (COPD), and impacts negatively on their functioning and quality of life. Limited research has been conducted to examine how various factors may influence the different dimensions of subjective fatigue experienced in these individuals. Four dimensions of subjective fatigue including: emotional, behavioural, cognitive, and physical, were examined in a convenience sample of 42 participants with COPD who attended an outpatient pulmonary rehabilitation program. The primary purpose of this feasibility study was to determine the proportion of individuals experiencing the four dimensions of fatigue, and to examine the relationships between these dimensions of fatigue and various influencing factors (dyspnea, depression, anxiety, sleep quality, activity limitation, heart rate, and oxygen saturation). The secondary purpose was to compare the four dimensions of fatigue by sex, supplemental oxygen use, smoking status, and severity of dyspnea, and to examine the relationships between the four dimensions of fatigue and age, the number of co-morbidities, and the amount of pulmonary rehabilitation received. Self-report questionnaires were used to measure fatigue (Multidimensional Fatigue Inventory MFI), anxiety and depression (Hospital Anxiety and Depression Scale HADS), and sleep quality (Pittsburgh Sleep Quality Index PSQI). Pulmonary rehabilitation health records were accessed to collect data on the remaining variables. The majority of the participants (61.9% - 81.0%) experienced moderate levels of subjective fatigue in all four dimensions. Moderate to severe levels of physical fatigue were experienced in 95.3% of the participants. The only significant relationship was between anxiety and emotional fatigue; all other relationships were statistically insignificant. There were no significant differences between sex, supplemental oxygen use, smoking status, and severity of dyspnea on the four dimensions of subjective fatigue. Many of the participants had probable presence of clinical anxiety (42.9%), where the prevalence of anxiety was nearly twice as high as depression (21.4%). Findings from this study can be used by healthcare professionals to gain a better understanding of fatigue in individuals with COPD who attend pulmonary rehabilitation, and help in developing effective interventions for reducing the distressing effects of fatigue.