A dissertation completed in partial compliance with the requirements for a Master's Degree in Technology Chiropractic, Durban Institute of Technology, 2006. / Neck pain is a common problem, globally, as well as in South Africa. Zulu is the first language of a very large proportion of the South African population, and as such, addressing the needs of this population group with respect to neck pain is a priority. Many reliable pain indexes exist in English to record the degree of disability with regards to neck pain. These are invaluable tools in aiding the health practitioner to assess the progress of treatment and the severity of the patient's disability. Two of the most credible and frequently used indexes are the Canadian Memorial Chiropractic College Neck Disability Index (CMCC NDl) and the Short Form McGill Pain Questionnaire (SFMPQ). However, no such scale exists in Zulu. The purpose of this pilot investigation was, firstly, to analyze and critique the Zulu translations of the CMCC NDl and the SFMPQ in order to establish their face validity. Secondly, to establish their concurrent validity ensuring that the translated questionnaires are specific and sensitive enough to use as tools in data collection when compared to their English counterparts. Thirdly, to make recommendations for further improvement in terms of the Zulu questionnaires and lastly, to make recommendations for further studies for improvement in terms of the use of these questionnaires as research tools amongst the Zulu speaking population of South Africa. Firstly, the CMCC NDl and the SFMP questionnaires were translated into Zulu by means of a focus group. These versions were then assessed by means of a focus (or discussion) group, to assess their face validity. Changes were made to the original translations according to the recommendations of this group. These versions were then assessed with regards to their concurrent validity with the original English versions. Fifty volunteers, who were literate in both English and Zulu and who have suffered with neck pain, filled in both the Zulu and English versions of both questionnaires. / M

ABSTRACT The two disorders of Restless Legs Syndrome (RLS) and Periodic Limb Movements (PLM) are well recognised as fairly common neurological disorders. The presentation is of a sensory and motor component suggestive of a state of hyperexcitability of the nervous system. The underlying abnormality is believed to involve a dopamine deficiency but many of characteristics of the disorders have not been adequately described or quantified. I investigated, firstly, the possible reasons for the gender bias in the prevalence studies and found that women were more likely to have some associated conditions which may be related to RLS as well as a higher symptom load when compared to men subjects with RLS. I then looked at the problems of analysing the sensations occurring in RLS. Due to the lack of an adequate measuring tool and the possibility of a relationship between the sensations of RLS and those of pain, I used a validated descriptive pain questionnaire (the McGill pain questionnaire) to measure the sensations of RLS. Subjects with RLS were able to describe the sensations with the pain questionnaire and severity indices calculated from the McGill correlated well with measures of RLS severity but not with other intensity measures for pain. In the area of motor events I investigated the possibility of creating a classification system for the muscle activations documented as PLM. I recorded multiple muscle groups in the legs during sleep and devised a classification using sequence of activation and timing of activations from the different muscles. I also used the classification to show subtle changes in the leg activation patterns associated with change in sleep stage.

Aim of the Study The aim of this study was to determine if the nursing interventions of patient education and multidisciplinary coordination of care were able to improve pain control in the cancer patient in an acute hospital setting. Background of the Study The role of the nurse in cancer pain management has been defined as being that of an educator, coordinator of care and advocate. A nurse with adequate knowledge of pain and its application to the cancer population and functioning in the role as defined is believed to be able to overcome many of the barriers that exist in implementing adequate analgesia and improve pain management in cancer patients. Design of the Study A randomized experimental control group design was utilized. The study comprised 3 experimental groups and one control group incorporating pre and post testing. The Intervention of the Study Experimental group one: subjects received education regarding their pain management which was tailored to meet their specific needs. Experimental group two: subjects underwent a pain assessment and construction of a care plan which was communicated verbally to the treating medical and nursing team and followed up with a written report which was documented in the history and sent to the treating medical physician. Experimental group three: subjects received the combined interventions administered to groups one and two. Control group four: subjects were assessed and all information was record in the same manner as for the experimental groups. The control group received their usual care during the study and their pain scores were measured at the same time intervals as the three experimental groups. Instrumentation The Wisconsin Brief Pain Questionnaire was used for the assessment of all subjects. The McGill Pain Questionnaire was used as the outcome measure following intervention. Data Analysis A one-way analysis of variance was used to detect the differences between the intervention groups and the control group. T-Tests were used to detect the differences between the groups incorporating a Bonferroni adjustment for frequent T tests. Results The main effect demonstrated a significant difference between the treatment groups and control at a significance level of 0.002. T-Tests showed no significant difference between control and communication groups and no significant difference between education and combined groups. A significant difference was detected between education and control and between combined and control. Conclusions Nursing interventions of patient education, coordination of care and advocacy can significantly improve cancer pain management. Intervention was tailored to meet the specific patient needs based on findings from the assessment and was dependent upon an adequate knowledge base. The nursing intervention of education was the most powerful of the three intervention types and its success was in tailoring to each individual. However, it is believed that with further recognition of the role of the nurse as coordinator of care will lead to greater improvements in cancer pain management.