Despite the evident advantages of assistive technologies, many are still abandoned within the first few months of use. The key to changing this may lie in the assessment process, which has been described as the most consequential phase in the provision of assistive technology [14]. The purpose of this research was to create a protocol for the assessment and delivery of individualized access technologies based on the concepts of response efficiency theory. The protocol was applied with three children, ages 12 to 14, who were seeking new access technologies. The results suggest that a protocol based on this theory will result in a technology that is appropriate to the user, and as a result will be less likely to be abandoned and will contribute to goal achievement and potentially improve participation.

No description available.

Despite the evident advantages of assistive technologies, many are still abandoned within the first few months of use. The key to changing this may lie in the assessment process, which has been described as the most consequential phase in the provision of assistive technology [14]. The purpose of this research was to create a protocol for the assessment and delivery of individualized access technologies based on the concepts of response efficiency theory. The protocol was applied with three children, ages 12 to 14, who were seeking new access technologies. The results suggest that a protocol based on this theory will result in a technology that is appropriate to the user, and as a result will be less likely to be abandoned and will contribute to goal achievement and potentially improve participation.

This thesis investigates computerised cognitive training in older adults, with a focus on training working memory and fluid intelligence. A series of studies is reported, with two broad aims. The first was to develop and validate outcome measures appropriate for use in this population, and the second was to examine whether established gains in cognitive functioning generalised to everyday life. In relation to the first aim, two studies were conducted which concerned the development of a sensitive measure of organisational abilities within a computerised paradigm, the Games Evaluation Task (GET). A further study made use of an existing naturalistic measure, the Multiple Errands Task (MET, Shallice & Burgess, 1991), and investigated whether it was possible to obtain reliable ratings of performance on the basis of video footage taken from the participant’s perspective by means of a body-worn camera. Both the GET and MET were used as outcome measures in the subsequent training studies. In relation to the second aim, three studies of cognitive training are reported. The first is a case study of a man with problems in working memory and time perception following a stroke. He underwent training on an intensive working memory package within a single-case experimental design that incorporated an active control condition. This approach was then extended in a larger sample of healthy older adults, who trained intensively on tasks that focussed either on working memory, or fluid intelligence and problem solving. In the final study participants trained on a combination of both working memory and fluid intelligence tasks. In addition, they watched training videos that focused on teaching various cognitive strategies. The aim of this video supplement was to help participants draw links between the computer training and real-life situations, and hence to foster generalisation of any benefits to everyday life. The thesis concludes with a general discussion which examines the major findings of the studies presented, their clinical applications, the limitations of the research and possible future directions.

No description available.

The use of outcome measures by rehabilitation professionals has been advocated for many years; however, routine use is still lacking. Literature on the factors influencing the use of outcome measures locally is limited; therefore, the purpose of this study was to determine the factors that influence the use of outcome measures by community-based physiotherapists in Gauteng Province. While 75 community-based physiotherapists from Gauteng Province invited to participate in the study, 48 community-based physiotherapists responded. A descriptive cross-sectional approach was used in this study. A validated questionnaire was piloted to test its applicability to the South African setting. Thirty-seven per cent of the participants used at least one outcome measure in practice. Support from colleagues and positive attitudes were identified as factors that facilitated the use while lack of knowledge, lack of skills and lack of time were identified as barriers towards the use of outcome measures. The only statistically significant relationship found was between the lack of knowledge and the lower level of use of outcome measures. In conclusion, it was evident that there was poor usage of outcome measures by community-based physiotherapists in Gauteng Province and the barriers identified ranged from individual level to organisational level. Recommendations are made regarding policy for the implementation of policies and guidelines on outcome measures and monitoring thereof in form of audits. Special interest groups could offer courses on outcome measures and physiotherapists be encouraged to undergo postgraduate education. Therefore, the researcher suggests that continuous training be provided within the workplace and outcome measures be adopted. / Dissertation (MPhysiotherapy)--University of Pretoria, 2017. / Physiotherapy / Mphysiotherapy / Unrestricted

Monitoring results is the final step that determines the impact of an evidencebased practice (EBP) decision. A variety of health outcomes can be expected to change following rehabilitation; therefore, outcome measures (OMs) are a major focus of EBP in rehabilitation. For instance, in patients with hand injuries, physiotherapy (PT) services focus on enabling patients to improve their functional use of the traumatized hand. Examining current practice of physiotherapists (PTs) in Saudi Arabia with respect to use of EBP and OMs can serve as a basis for understanding any identified gaps in knowledge before the full effect of translation and adoption of new patient self-reported outcomes (PROs) instruments can be seen in clinical practice. Therefore, this thesis was designed in two phases, incorporating two papers, to address EBP and PROs and their adoption in the evolving PT practice in Saudi. The first paper is a survey that aimed to determine the current self-reported attitudes, skills, and knowledge of PTs in Saudi Arabia toward EBP and outcome measures, including PROs. The second paper describes the process of crosscultural Arabic translation and adaptation of the Patient-Rated Wrist and Hand Evaluation (PRWHE) and reports estimates of the psychometrics properties of the translated measure. Finally, the thesis addresses overall areas of limitations and includes suggestions for future refinement and research in order to foster and facilitate EBP implementation in the cultural context of the evolving physiotherapy profession in the health systems of Saudi Arabia. / Thesis / Master of Science Rehabilitation Science (MSc)

No description available.

Unicompartmental knee replacement (UKR) is the principal alternative to total knee replacement (TKR) in the treatment of end-stage knee osteoarthritis. It involves less tissue resection, resulting in lower rates of morbidity and faster recoveries compared to TKR. However, UKR has a significantly higher revision rate compared to TKR. As a result, whilst over a third of patients are eligible for UKR, only around 8% receive it. A comprehensive comparison of matched patients undergoing TKR and UKR was undertaken using a large dataset from the National Joint Registry for England and Wales (NJR). Failure rates (revision, reoperation, complications and mortality), length of stay and patient-reported outcomes (PROMs) were studied. Whilst patients undergoing TKR had lower reoperation and revision rates, they had higher rates of morbidity and mortality, longer hospital stays, and inferior PROMs compared to UKR. The main reason for revision in UKR was loosening. In view of the high revision rate in UKR, NJR data was studied to identify modifiable risk factors for failure in UKR. Important patient factors were identified including age, gender and pre-operative function. Surgeons with a higher UKR caseload had significantly lower revision rates and superior patient-reported outcomes. Increasing usage (offering UKR to a greater proportion of knee replacement patients) appears to be a viable method of increasing caseload and therefore of improving results. Surgeons with optimal usage (around 50% of patients, using appropriate implants) achieved revision/reoperation rates similar to matched patients undergoing TKR. Two clinical studies were conducted to establish whether the use of cementless fixation would improve fixation and reduce the revision rate of UKR. Cementless UKR was demonstrated to be safe and reliable, with PROMs similar or superior to those demonstrated in cemented UKR. Patients with suboptimal cementless fixation were examined and pre-disposing technical factors were identified. Finally, using NJR data, the effect of the introduction of cementless UKR on overall outcomes was examined. The number of cementless cases was small, and no significant effect on implant survival was demonstrated. However, patients undergoing cementless UKR demonstrated superior PROMs. These studies demonstrate that UKR has numerous advantages over TKR in terms of morbidity, mortality and PROMs. If surgeons perform high volumes of UKR (achievable by increasing their UKR usage), these advantages can be attained without the large difference in revision rates previously demonstrated. Cementless UKR is safe and provides superior fixation and outcomes in the hands of high-volume surgeons. Further work is needed to quantify the revision rate of cementless UKR, and to assess its results in the hands of less experienced surgeons.

Introduction The use of Patient Reported Outcome Measures (PROMs) to measure the effects of care is being advocated increasingly in clinical settings. Current patient data capture involves completion of paper questionnaires which is costly and environmentally perplexing. New innovations are required to balance the challenges of introducing data capture directly from patients while considering budgets, access to Information Technology, and the capability to use technological devices. Methods Two qualitative studies were undertaken to identify the views of patients and clinicians concerning electronic PROM data capture in osteopathic practice. One qualitative study involved patient interviews to identify their views on a selection of specific PROMs. Clinician focus groups and interviews (osteopaths, chiropractors, and physiotherapists) were undertaken concerning their views and experiences of using PROMs. Scoping of PROMs in musculoskeletal practice was undertaken followed by a systematic review of one identified PROM. The review and qualitative work informed the development of content for a mobile and web app for capturing PROM data. The app was piloted to evaluate feasibility, and the clinimetric performance of the included PROMs. Feedback from the pilot informed revisions to the app prior to implementation into osteopathic practice. Results Clinicians (n=46) identified a range of barriers and facilitators to PROM use. Patients (n=22) while generally more enthusiastic than clinicians welcomed the opportunity to provide feedback and although undaunted by the use of technology highlighted the need for assurances concerning confidentiality of data, and limits on data sharing. The systematic review identified good measurement properties for the Bournemouth (BQ). Piloting of the app involved 257 participants contributing 404 data returns: it performed well requiring minimal revision prior to implementation. Conclusions The app performed well demonstrating great potential for further development to collect outcome data in a musculoskeletal clinical setting.