Masters of Science - Msc (Physiotherapy) / Vocational rehabilitation relates to rehabilitating a person with an amputation back into actively participating in society. Although vocational rehabilitation is important, before it can be implemented, the participation restrictions should be identified. Even though lower limb amputation surgery is commonly performed in South Africa, and given the high unemployment rate in the country, no research has been done into the participation restrictions and vocational needs of a person with a unilateral lower limb amputation in the Western Cape. The aim of this study was to determine and explore the participation restrictions and vocational rehabilitation needs in terms of hobbies, sport activities, employment and employment needs of persons with a unilateral lower limb amputation (LLA) in the Western Cape. The objectives were to: 1) Determine the participation restrictions of persons with a unilateral LLA in the Western Cape. 2) To explore the vocational rehabilitation needs of persons with a lower limb amputation. A mixed methods approach, and an explanatory sequential design was used in this study. The study was conducted in two phases. The first phase utilised a quantitative approach and the WHODAS 2.0 was used as the instrument to collect data. The second phase aimed to explain the data collected in the first phase in more depth, and semi-structured telephonic interviews were utilized to collect the qualitative data. The study was set in the Cape Metropole region of the Western Cape. Participants were recruited from Tygerberg Tertiary Hospital and a private sub-acute rehabilitation centre. In the quantitative (first) phase of the study, 50 participants were conveniently recruited to participate. In the second phase eight participants were purposefully selected from the pool of 50 participants from the first phase of the study who consented to participate in the second phase. Quantitative data was analysed using SPSS vs. 22 and analysed for descriptive and inferential statistics. Qualitative data has been analysed using Creswell's seven step process of thematic analysis. Ethical clearance has been obtained from the University of the Western Cape, permission to access patients' details has been obtained from Tygerberg Tertiary Hospital and private sub-acute rehabilitation centre. Written informed consent as well as permission for audio recording during the telephonic interview was obtained.

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.

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.

BACKGROUND: Knee osteoarthritis is a chronic disease that frequently results in pain, activity limitations and difficulties performing social and community activities. Despite the growing prevalence of arthritis and associated participation restrictions, few studies have measured the long-term impact of the environment and psychological factors on participation restriction in this population. METHODS: Participants from the Multicenter Osteoarthritis Study (MOST) self-reported participation at baseline, 30, 60, and 84 months using the Instrumental Role subscale of the Late Life Disability Index. For study 1, participants’ environmental features were assessed at baseline from the Home and Community Environment questionnaire administered in the MOST-Knee Pain & Disability study, an ancillary study of MOST. The relative risk of participation restriction at 60 months due to community mobility barriers and transportation facilitators was calculated using binomial regression, adjusting for covariates. For study 2, baseline levels of positive and negative affect were assessed with the Center for Epidemiological Studies Depression Scale. The relative risk of incident participation restriction over 84 months due to 1) low positive affect (vs. high positive affect), 2) high negative affect (vs. low negative affect), and 3) combinations of low/high positive and negative affect (vs. high positive affect/low negative affect) were calculated in separate analyses using binomial regression, adjusting for covariates. RESULTS: In study 1, 69 (27%) of the 322 participants developed participation restriction by 60 months. Participants reporting high community mobility barriers at baseline had 1.8 times the risk [95% CI: 1.24, 2.73] of participation restriction at 60 months, after adjusting for covariates, whereas the risk due to high transportation facilitators was not significant. In study 2, 470 participants (26%) had incident participation restriction over 7 years. The adjusted relative risks of incident participation restriction over 7 years across the three analyses were: 1) low positive affect (vs. high positive affect): RR: 1.2 [95% CI: 1.0, 1.4], 2) high negative affect (vs. low negative affect): RR: 1.5 [95% CI: 1.3, 1.7], 3) low positive affect and high negative affect (vs. high positive and low negative affect): RR: 1.8 [95% CI: 1.4, 2.1]. CONCLUSIONS: These studies highlight that people with knee osteoarthritis who have certain contextual features, such as environmental barriers or low positive and high negative affect, are at increased risk of participation restriction over time. / 2018-07-07T00:00:00Z

<p>The World Health Organisation estimates that the majority of the disabled population resides in the developing world, but most of the research on outcomes of patients originates from the developed world. In the light of the differences in healthcare structures and function, especially rehabilitation between settings and countries, it is imperative to have an understanding of the&nbsp / functioning of patients at discharge with the objective of measuring the level at which outcomes are met. The aim of this study was therefore to determine the process of rehabilitation and the&nbsp / outcome of patients following in-patient rehabilitation at a facility in the Western Cape. A quantitative research design was employed to address the objectives. Self-administered&nbsp / questionnaires were developed to collate information pertaining to the demographic-, socioeconomic- and medical profile of patients and data extraction sheets collected information relating&nbsp / to the process of rehabilitation and the impairment status of patients on admission. With regards to activity and participation, a longitudinal study design was used, which utilised standardised&nbsp / outcomes measures. The sample consisted of all patients with stroke and spinal cord injury admitted within a three-month period, and all ethical principles relating to research on human&nbsp / subjects, as stipulated in the Helsinki Declaration were adhered to during data collection, with ethical clearance obtained from relevant authorities. The SAS and the Microsoft Excel Package&nbsp / 2007 were used to analyse the quantitative data elements. Descriptive statistics using frequencies, percentages, ranges, means, and standard deviations and inferential statistics using&nbsp / chi-square, student T-tests and correlation tests, for determining the predictors of functional outcome, were calculated. There were 175 patients, whereof 82 were patients with stroke and 93&nbsp / with spinal cord injury, with 143 (76 presenting with spinal cord injury and 67 with stroke) meeting the inclusion criteria on admission. The mean age of those with spinal cord injury and stroke&nbsp / was 34.14 and 52.95 years. Most of the patients with spinal cord injuries were single (73.68%), whereas the majority (53.73%) of patients with strokes were married at the time of injury. All&nbsp / patients were managed by the doctor and the nurse, with most of the patients receiving physiotherapy, occupational therapy and social assistance from the social worker. With regards to recreational activities, 46.87% of patients with spinal cord injury and 39.39% of those with stroke attended the learn to swim programme, and 29.68% of patients with spinal cord injury attended the wheelchair basketball sessions. The mean length of hospital stay for patients with spinal cord injury and stroke was 73.11 and 51. 62 days, with most of the spinal cord injured patients&nbsp / (80.26%) and stroke patients (82.08%) discharged home without follow-up rehabilitation. The most prevalent impairments on admission of the spinal cord injury cohort were muscle&nbsp / weakness (75.0%), bladder incontinence (71.1%) and reduced sensation (69.7%), whereas patients with stroke presented mostly with muscle paralysis (80.6%), abnormal tone (76.1%) and aphasia (50.8%). Functional limitations experienced by the participants included, mobility, stair climbing and transfers. The participants experienced participation restrictions in the following&nbsp / domains, leisure activities and employment. A clinical significant improvement was noted in execution of functional task of patients with spinal cord injury (p&lt / 0.0001) and stroke (p&lt / 0.0001)&nbsp / between admission and discharge. A significant statistical change was also detected for the participation elements of both stroke and spinal cord injury cohorts. Functional ability on&nbsp / admission was found to be a predictor of functional outcome of the stroke diagnostic group at discharge, whereas the multiple&nbsp / redictor model of functional outcome of the spinal cord injured cohort at discharge was significant with remaining variables of functional outcome score on admission (p&lt / 0.0001) and bladder -and bowel impairment(s) (p=0.0247). The study findings suggest that despite the significant change in activity and participation, most of the patients were discharged home without further follow-up for rehabilitation, irrespective of the activity&nbsp / limitations and participation restrictions still experienced at the time of discharge. The latter finding&nbsp / questions the duration of the length of hospital stay, which does not allow patients to be independent in all meaningful activities and participatory actions and roles by the end of inpatient rehabilitation. The study findings could assist authorities to adapt the existing rehabilitation&nbsp / programme and referral process . </p>

<p>The World Health Organisation estimates that the majority of the disabled population resides in the developing world, but most of the research on outcomes of patients originates from the developed world. In the light of the differences in healthcare structures and function, especially rehabilitation between settings and countries, it is imperative to have an understanding of the&nbsp / functioning of patients at discharge with the objective of measuring the level at which outcomes are met. The aim of this study was therefore to determine the process of rehabilitation and the&nbsp / outcome of patients following in-patient rehabilitation at a facility in the Western Cape. A quantitative research design was employed to address the objectives. Self-administered&nbsp / questionnaires were developed to collate information pertaining to the demographic-, socioeconomic- and medical profile of patients and data extraction sheets collected information relating&nbsp / to the process of rehabilitation and the impairment status of patients on admission. With regards to activity and participation, a longitudinal study design was used, which utilised standardised&nbsp / outcomes measures. The sample consisted of all patients with stroke and spinal cord injury admitted within a three-month period, and all ethical principles relating to research on human&nbsp / subjects, as stipulated in the Helsinki Declaration were adhered to during data collection, with ethical clearance obtained from relevant authorities. The SAS and the Microsoft Excel Package&nbsp / 2007 were used to analyse the quantitative data elements. Descriptive statistics using frequencies, percentages, ranges, means, and standard deviations and inferential statistics using&nbsp / chi-square, student T-tests and correlation tests, for determining the predictors of functional outcome, were calculated. There were 175 patients, whereof 82 were patients with stroke and 93&nbsp / with spinal cord injury, with 143 (76 presenting with spinal cord injury and 67 with stroke) meeting the inclusion criteria on admission. The mean age of those with spinal cord injury and stroke&nbsp / was 34.14 and 52.95 years. Most of the patients with spinal cord injuries were single (73.68%), whereas the majority (53.73%) of patients with strokes were married at the time of injury. All&nbsp / patients were managed by the doctor and the nurse, with most of the patients receiving physiotherapy, occupational therapy and social assistance from the social worker. With regards to recreational activities, 46.87% of patients with spinal cord injury and 39.39% of those with stroke attended the learn to swim programme, and 29.68% of patients with spinal cord injury attended the wheelchair basketball sessions. The mean length of hospital stay for patients with spinal cord injury and stroke was 73.11 and 51. 62 days, with most of the spinal cord injured patients&nbsp / (80.26%) and stroke patients (82.08%) discharged home without follow-up rehabilitation. The most prevalent impairments on admission of the spinal cord injury cohort were muscle&nbsp / weakness (75.0%), bladder incontinence (71.1%) and reduced sensation (69.7%), whereas patients with stroke presented mostly with muscle paralysis (80.6%), abnormal tone (76.1%) and aphasia (50.8%). Functional limitations experienced by the participants included, mobility, stair climbing and transfers. The participants experienced participation restrictions in the following&nbsp / domains, leisure activities and employment. A clinical significant improvement was noted in execution of functional task of patients with spinal cord injury (p&lt / 0.0001) and stroke (p&lt / 0.0001)&nbsp / between admission and discharge. A significant statistical change was also detected for the participation elements of both stroke and spinal cord injury cohorts. Functional ability on&nbsp / admission was found to be a predictor of functional outcome of the stroke diagnostic group at discharge, whereas the multiple&nbsp / redictor model of functional outcome of the spinal cord injured cohort at discharge was significant with remaining variables of functional outcome score on admission (p&lt / 0.0001) and bladder -and bowel impairment(s) (p=0.0247). The study findings suggest that despite the significant change in activity and participation, most of the patients were discharged home without further follow-up for rehabilitation, irrespective of the activity&nbsp / limitations and participation restrictions still experienced at the time of discharge. The latter finding&nbsp / questions the duration of the length of hospital stay, which does not allow patients to be independent in all meaningful activities and participatory actions and roles by the end of inpatient rehabilitation. The study findings could assist authorities to adapt the existing rehabilitation&nbsp / programme and referral process . </p>

Persons with deafblindness experience difficulties in daily life and they experience service to sometimes barrier. The overall aim of this thesis is therefore to discover, evaluate and explain: 1. mechanisms that might have impact on participation restrictions for people who have visual and hearing impairment i.e. deafblindness and 2. mechanisms that might barrier service to these people. Service is used as an umbrella term for health care, education and certain service for persons with disabilities. Materials from multiple sources have been used: literature (Study I No 96 papers). Interviews (Study I and V) with 32 and 3 adults with deafblindness respectively. Questionnaires (Study II and III): answered by 33 and 34 adults and youth with deafblindness. Patient records (Study IV and V): records from 9 and 3 adult females with USH I respectively. Materials mostly retrospectively cover the period from 2005 and about 40–50 years. Both quantitative and qualitative methods were used. International Classification of Functioning, Disability and Health (ICF) were consequently used as a framework to describe as well as a tool to analyze mechanisms. Further, the Ecological approach, Disability as a laminated system and Life course approach were used in order to evaluate and explain mechanisms. The conclusions that can be drawn from an ecological, laminated and life course approach are: Participation restrictions for people with deafblindness are far-reaching and are embedded in a complex process of interaction between the person with deafblindness and the environment. Services entail systematical barriers. In order to improve service it is extremely important to understand the role of participation restrictions in deafblindness. Primary activity limitation is to not see and hear enough for comprehension. Hence, not taking part in the visible and audible world is primary participation restriction. Performing activities without basic information includes risk. One important aspect of deafblindness is exposure. Persons with deafblindness require rehabilitation in a life perspective. In order to increase people’s participation and protection requirement of individually adapted support and assistive devices is necessary. ICF and the UN convention support service alterations.

Magister Scientiae (Physiotherapy) - MSc(Physio) / The World Health Organisation estimates that the majority of the disabled population resides in the developing world, but most of the research on outcomes of patients originates from the developed world. In the light of the differences in healthcare structures and function, especially rehabilitation between settings and countries, it is imperative to have an understanding of the functioning of patients at discharge with the objective of measuring the level at which outcomes are met. The aim of this study was therefore to determine the process of rehabilitation and the outcome of patients following in-patient rehabilitation at a facility in the Western Cape. A quantitative research design was employed to address the objectives. Self-administered questionnaires were developed to collate information pertaining to the demographic-, socioeconomic- and medical profile of patients and data extraction sheets collected information relating to the process of rehabilitation and the impairment status of patients on admission. With regards to activity and participation, a longitudinal study design was used, which utilised standardised outcomes measures. The sample consisted of all patients with stroke and spinal cord injury admitted within a three-month period, and all ethical principles relating to research on human subjects, as stipulated in the Helsinki Declaration were adhered to during data collection, with ethical clearance obtained from relevant authorities. The SAS and the Microsoft Excel Package 2007 were used to analyse the quantitative data elements. Descriptive statistics using frequencies, percentages, ranges, means, and standard deviations and inferential statistics using chi-square, student T-tests and correlation tests, for determining the predictors of functional outcome, were calculated. There were 175 patients, whereof 82 were patients with stroke and 93 with spinal cord injury, with 143 (76 presenting with spinal cord injury and 67 with stroke) meeting the inclusion criteria on admission. The mean age of those with spinal cord injury and stroke was 34.14 and 52.95 years. Most of the patients with spinal cord injuries were single (73.68%), whereas the majority (53.73%) of patients with strokes were married at the time of injury. All patients were managed by the doctor and the nurse, with most of the patients receiving physiotherapy, occupational therapy and social assistance from the social worker. With regards to recreational activities, 46.87% of patients with spinal cord injury and 39.39% of those with stroke attended the learn to swim programme, and 29.68% of patients with spinal cord injury attended the wheelchair basketball sessions. The mean length of hospital stay for patients with spinal cord injury and stroke was 73.11 and 51. 62 days, with most of the spinal cord injured patients (80.26%) and stroke patients (82.08%) discharged home without follow-up rehabilitation. The most prevalent impairments on admission of the spinal cord injury cohort were muscle weakness (75.0%), bladder incontinence (71.1%) and reduced sensation (69.7%), whereas patients with stroke presented mostly with muscle paralysis (80.6%), abnormal tone (76.1%) and aphasia (50.8%). Functional limitations experienced by the participants included, mobility, stair climbing and transfers. The participants experienced participation restrictions in the following domains, leisure activities and employment. A clinical significant improvement was noted in execution of functional task of patients with spinal cord injury (p< 0.0001) and stroke (p< 0.0001) between admission and discharge. A significant statistical change was also detected for the participation elements of both stroke and spinal cord injury cohorts. Functional ability on admission was found to be a predictor of functional outcome of the stroke diagnostic group at discharge, whereas the multiple redictor model of functional outcome of the spinal cord injured cohort at discharge was significant with remaining variables of functional outcome score on admission (p<0.0001) and bladder -and bowel impairment(s) (p=0.0247). The study findings suggest that despite the significant change in activity and participation, most of the patients were discharged home without further follow-up for rehabilitation, irrespective of the activity limitations and participation restrictions still experienced at the time of discharge. The latter finding questions the duration of the length of hospital stay, which does not allow patients to be independent in all meaningful activities and participatory actions and roles by the end of inpatient rehabilitation. The study findings could assist authorities to adapt the existing rehabilitation programme and referral process . / South Africa

Malgré l’amélioration du taux de survie, les survivants de la leucémie aiguë lymphoblastique (LAL) pédiatrique souffrent toujours de séquelles de la maladie et des traitements, dont au niveau neuromusculosquelettique (NMSQ). L’objectif de ce mémoire était de décrire les déficiences, limitations d’activité et restrictions de participation que présentent les survivants de LAL pédiatrique à long terme ainsi que d’explorer la prise en charge usuelle en physiothérapie de ces séquelles NMSQ. Le premier article est un d’étude descriptive rétrospective. Les résultats de cette étude supportent les séquelles NMSQ documentées dans la littérature en plus d’apporter des précisions sur les différences entre les survivants présentant ou non une ostéonécrose de la hanche. Le niveau d’association a également été évalué entre certaines variables de déficiences et limitations d’activité. Le second article est une étude de cas unique. Cette étude a permis de constater que, bien que les physiothérapeutes d’un des centres spécialisés en hémato-oncologie pédiatrique du Québec soient expertes dans le domaine, il n’existe actuellement aucune prise en charge standardisée des séquelles NMSQ des survivants de la LAL à long terme. L’identification des barrières et facilitateurs à l’implantation d’une prise en charge perçue comme optimale par les physiothérapeutes apporte des pistes de solution pertinentes à l’amélioration des pratiques. Les projets de recherche présentés dans ce mémoire permettent de constater que les déficiences et les limitations d’activité des survivants de la LAL pédiatrique sont importantes. Les physiothérapeutes sont parmi les détenteurs d’enjeux clés dans l’optimisation de la prise en charge de cette population grandissante. / Although survival rate has improved, survivors of childhood acute lymphoblastic leukemia (cALL) still suffer from late adverse effects related to the disease and its treatment including neuromusculoskeletal (NMSK) morbidities. The aims of this research were to describe the impairments, activity limitations, and participation restrictions of long-term survivors of cALL and explore current physiotherapy clinical practice regarding these NMSK late adverse effects. The first manuscript is a retrospective descriptive study. Results of this study confirm the long-term NMSK late adverse effects documented in the literature and provide additional information about differences between survivors with and without hip osteonecrosis. Furthermore, relationships between some variables of impairments and activity limitations were identified. The second manuscript is a case study. A focus group with expert physiotherapists in pediatric hemato-oncology from a specialized centre revealed that standardized clinical practice guidelines for the management of long term NMSK late adverse effects of survivors of cALL are lacking. Identification of barriers and facilitators to the implementation of clinical practice perceived as optimal by physiotherapists provides relevant solutions to improve long-term care of this population. Findings from these studies highlight that impairments and activity limitations of survivors of cALL are important. Physiotherapists are key stakeholders in optimizing long-term care of this growing population.