Dissertation submitted to the Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, in fulfillment of the requirements for the degree of Master of Science in Occupational Therapy, June, 2014. Johannesburg / Purpose: The aim of this study was to determine the perceptions of and the clinical application of models by a specific group of occupational therapists with a particular focus on the Kawa Model. Method: A single descriptive case study design with embedded units, related to model application by occupational therapists who attended a Kawa Model workshop, was used. Quantitative data provided information about general model use within occupational therapy and first impressions of the Kawa Model. Qualitative data were obtained to explore the clinically application and suitability of the Kawa Model in the South African context. Main findings: Several factors were identified as having an influence on the use of models by occupational therapists in general, with similar influencing factors related to the application of the Kawa Model being identified. Factors include habituation versus experience, experience and clinical reasoning, practice context and client characteristics.

The aim of this study was to establish whether a splint programme is effective in preventing the deterioration of already evident swan neck and boutonniere deformities in rheumatoid arthritis (RA). A randomised clinical trial was done on 34 RA patients with swan neck and 34 RA patients with boutonniere deformities. The literature revealed that several factors such as age, gender, socio-economic status, time after onset of the illness and lifestyle could influence results. Care was taken to allocate, as far as possible equal numbers of patients with these attributes to the experimental and control groups. It became clear from the literature that swan neck and boutonniere deformities could manifest themselves in different forms and stages or grades of deterioration. Various splints to halt the downward spiral of the deformity were recommended, without proper scientific verification, by the authors. No specifications as to which splint was recommended for which form or grade of deformity or instructions for wearing of the splints were included. For the study the PIP hyperextension splint and the three-point-PIP extension splint was chosen for the swan neck and boutonniere deformities respectively. Patients were followed up for one year. Results were marginally positive for the prevent ion of swan neck deformities by the hyperextension splint programme, but results for the three-point PIP extension splint programmes were negative for grade I boutonniere deformities. Loss of flexor muscle strength was evident in almost all the groups (experimental and control) but more so for grade I swan neck and grade I boutonniere deformities. The variability of measurements were found to be large. Many possible sources of variation were identified, which included biological differences between people, different courses the illness could take and a weak test-retest reliability of some goniometer measurements. This fact and the relatively small sample subgroups caused some results to be not significant on the 5% level. From the significant findings, and other not significant tendencies that were too persistent to ignore, linked to the different manifestations and grades of swan neck and boutonniere deformities, recommendations were made. These suggestions will have to be tested by experimentation.

Submitted by Luciana Sebin (lusebin@ufscar.br) on 2016-09-27T12:58:22Z No. of bitstreams: 1 DissPCB.pdf: 2182133 bytes, checksum: 0d803e42f6e00f5f3239b7eb0ed02752 (MD5) / Approved for entry into archive by Marina Freitas (marinapf@ufscar.br) on 2016-09-27T19:53:55Z (GMT) No. of bitstreams: 1 DissPCB.pdf: 2182133 bytes, checksum: 0d803e42f6e00f5f3239b7eb0ed02752 (MD5) / Approved for entry into archive by Marina Freitas (marinapf@ufscar.br) on 2016-09-27T19:54:03Z (GMT) No. of bitstreams: 1 DissPCB.pdf: 2182133 bytes, checksum: 0d803e42f6e00f5f3239b7eb0ed02752 (MD5) / Made available in DSpace on 2016-09-27T19:54:10Z (GMT). No. of bitstreams: 1 DissPCB.pdf: 2182133 bytes, checksum: 0d803e42f6e00f5f3239b7eb0ed02752 (MD5) Previous issue date: 2016-02-23 / Conselho Nacional de Desenvolvimento Científico e Tecnológico (CNPq) / The Latin American social issue was built historically by the social relations and concentration of power and wealth of minorities, dominant classes and sectors. Latin America, characterized by economic inequalities and social vulnerabilities, becomes intervention stage of the professionals involved with the social reality and the effectiveness of social policies, as the occupational therapist. The first occupational therapy courses arose in some countries in the region as a technical profession in the 1950s with the support of foreign teachers. Focusing on a scrap from the Latin American context, except the Brazilian reality, this study aimed at understanding how it is carried out the graduate training of occupational therapists to work with contemporary social issues. In 2014 and 2015, period of this study, occupational therapy graduate education was present in 13 countries, in 72 courses, except those allocated in Brazil. To apprehend this scenario, there were employed three moments of data collection and analysis of its results: systematic survey of scientific literature selected in journals of the field and in two occupational therapy congresses held in the region; mapping of the 72 undergraduate courses through the investigation of electronic websites and questionnaires applied with their coordinators, obtaining 40 questionnaires; and conducting 23 interviews remotely with teachers who discuss about social issues in their subjects. The results revealed that the discussions present in the academic formation and scientific literature about the occupational therapeutic activities in socially vulnerable territories, are still scarce and not very representative among the other areas of expertise of the profession, especially those of biomedical nature. Nonetheless, it is observed that has expanded a movement guided in theoretical reflections, more critical and questioning about the use of precepts of individualistic nature towards the social needs of the region. It is considered necessary to develop theoretical and methodological frameworks specific in occupational therapy in Latin American countries, except Brazil, to work with the social question. It is hoped that the study can help to reduce borders between Brazil and the other countries in the region and stimulate new studies in the area regarding the occupational therapy themes and the social issue. / A questão social latino-americana construiu-se historicamente pelas relações sociais e concentração de poder e riquezas por minorias, classes e setores dominantes. A América Latina, caracterizada por desigualdades econômicas e vulnerabilidades sociais, se faz palco de intervenção de profissionais envolvidos com a realidade social e a efetivação de políticas sociais, como o terapeuta ocupacional. Os primeiros cursos de terapia ocupacional surgiram em alguns países da região como uma profissão técnica na década de 1950 com apoio de professores estrangeiros. Enfocando um recorte do contexto latino-americano, excetuando a realidade brasileira, o presente estudo teve como objetivo conhecer como é realizada a formação graduada de terapeutas ocupacionais para o trabalho com a questão social contemporânea. Em 2014 e 2015, período de estudado, o ensino graduado de terapia ocupacional estava presente em 13 países, em 72 cursos, com exceção daqueles alocados no Brasil. Para a apreensão deste cenário, lançou-se mão de três momentos de coleta de dados e análise dos seus resultados: levantamento sistematizado de produções científicas selecionadas em periódicos da área e em dois congressos de terapia ocupacional realizados na região; mapeamento dos 72 cursos de graduação por meio da investigação dos sítios eletrônicos e aplicação de questionários com seus coordenadores, obtendo-se 40 questionários respondidos; e realização de 23 entrevistas à distância com professores que realizam a discussão sobre questão social em disciplinas. Os resultados revelaram que as discussões presentes na formação acadêmica e na produção científica a respeito da atuação terapêutico ocupacional em territórios vulneráveis socialmente ainda são escassas e pouco representativas dentre as demais áreas de atuação da profissão, principalmente àquelas ligadas à clínica. Contudo, observou-se que tem se ampliado um movimento pautado em reflexões teóricas mais críticas e questionadoras da utilização de preceitos de cunho individualista frente às necessidades sociais da região. Aponta-se necessário o desenvolvimento de referenciais teórico-metodológicos específicos da terapia ocupacional nos países latino-americanos, com exceção do Brasil, para o trabalho com a questão social. Espera-se que o estudo possa contribuir para diminuir fronteiras entre o Brasil e os demais países da região e estimular novos estudos na área a respeito da temática terapia ocupacional e questão social.