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A dissertation submitted to the Faculty of Health Sciences, University of the Witwatersrand, in fulfilment of the requirements for the degree of Master of Science in Medicine, Johannesburg, 2017 / Objective: Physical activity (PA) is recommended in the management of osteoarthritis (OA) to reduce pain and improve function. Total volumes of PA and sedentary behaviour (SB) have been described in people with knee OA, but detailed information about the patterns of accumulation of PA and SB in knee OA populations is lacking. The purpose of this study was to objectively assess the patterns of accumulation of PA and SB and to explore associations with subjectively measured functional outcomes and quality of life in patients with knee OA. Methods: End-stage knee OA patients (n = 87, 65 ± 8.8 (mean ± SD) years, body mass index 34.4 ± 7.8 kg/m2) with Kellgren-Lawrence-defined grade 3-4 radiographic OA, wore an Actigraph and an activPAL accelerometer for 24 hours a day for 7 consecutive days. Total volumes of SB, light physical activity (LPA), moderate to vigorous physical activity (MVPA), and different bouts of SB, LPA, and MVPA were assessed. Self-report questionnaires were used to assess patient-experienced pain, function, quality of life and activities of daily living were the Western Ontario and McMaster Universities (WOMAC) osteoarthritis index and the Knee Injury Osteoarthritis Outcome Score (KOOS). Results: Of the 87 knee OA patients only 76 and 65 had complete Actigraph and activPAL data respectively. The participants had a mean (SD) age of 65.0 (8.8) years, were mostly women and most were classified as being obese with an average BMI of 34.4 (7.8) kg/m2. The Actigraph mean (95% CI) of awake wear time was 15.6 (15.1-16) hours/day, SB 10.9 (10.5-11.4) hours/day, LPA 4.5 (4.1-5) hours/day and MVPA 8.2 (3.3-13) min/day. Approximately 7% of patients met the current recommended PA guidelines. The activPAL mean (95% CI) of sitting time, standing time, stepping time and number of steps were 9.3 (8.5 – 10.1) hours per day, 5.0 (4.4 – 5.6) hour per day, 76.5 (66.6 – 86.3) minutes per day and 2489 (2130 – 2848) minutes per day respectively. There were variations in the hourly patterns of movement behaviours. Participants were significantly less sedentary between 6 am and 9 am compared to the grand mean of sedentary time per hour over the day (p<0.01) and were significantly more sedentary per hour from 3 pm to 7 pm (p<0.05). Significant correlations were found between WOMAC pain scores and Actigraph measured SB (r=0.277, p=0.031), LPA (r=-0.240, p=0.043), MVPA (r=-0.242. p=0.042), number of steps (r=-0.282, p=0.020), number of breaks in bouts of SB greater than 20 minutes (r=-0.292, x p=0.016), average duration of breaks in SB (r=-0.277, p=0.024), average duration of MVPA bouts (r=-0.326, p=0.012). Significant correlations were also found between WOMAC activity of daily living scores and Actigraph measured LPA (r=-0.206, p=0.048), MVPA (r=-0.246, p=0.029), number of steps (r=-0.286, p=0.010) and average duration of MVPA bouts (r=-0.383, p=0.002). Significant correlations were found between WOMAC pain scores and activPAL sitting time (r=0.029, p=0.02), and stepping time (r=-0.029, p=0.01), between self-reported WOMAC activity of daily living score and stepping time (r=-0.309, p=0.02), between KOOS activity of daily living score and stepping time (r=-0.276, p=0.004), and between KOOS quality of life score and stepping time (r=-0.263, p=0.008). Conclusion: This study describes novel detail of the patterns of activity and sedentary behaviour in patients with knee OA. The use of two accelerometers gives a detailed account of daily activity and the variation throughout the day, highlighting when interventions to improve activity might be most effective. Therefore, interventions should target the long bouts of inactivity in this population. Since even healthy populations of older adults struggle to meet current recommended PA guidelines, it may be important to shift attention from meeting recommendations of MVPA to creating feasible suggestions of doing more light activity and breaking more sedentary time in knee OA patients. / XL2018

Previous studies suggest there are numerous benefits of horticultural therapy programs. The current study explored the benefits of a horticultural therapy program with elderly populations at two facilities in Bowling Green, Kentucky. Fifteen participants attended a 2-hour session on horticulture techniques once a week for four weeks. Using a pretest to posttest study design, changes in participants’ cognition, quality of life, and loneliness were assessed. The pretest was administered verbally by the researcher before the first session and the posttest, including a series of questions about satisfaction with the program, was administered after the last session. Items on each assessment included the Mini-Mental State Exam, the Assessment of Quality of Life, and the Revised UCLA Loneliness Scale. Findings suggest that participants’ cognitive ability significantly improved after participation in the program while quality of life and loneliness perception did not significantly improve. Participants perceived the program as positive and enjoyable.

With the increase of students with disabilities attending post secondary education, it is important to have an understanding of how satisfied a student with a disability is with college. At present, the research on college satisfaction focuses on specific variables and how the specific variables moderate or mediate college satisfaction; however, there is limited research in the area of college satisfaction and students with disabilities. To address the current gap in research, the purpose of the current study was to address if there was a difference in overall satisfaction in students with a disability compared to students without a disability. Further, analysis of group differences in relation to domain scores was conducted, and how variables such as entrance status, gender, ethnicity, ACT scores, and grade point average mediate college satisfaction for students with disabilities. Additionally, it was important to examine the relationship between disability status and overall satisfaction, as well as examine the relationship of the 4 domains (e.g. Instruction and Life Skills, Quality of Student Services, and Quality of Undergraduate Experience) and overall satisfaction. Survey data were collected from 2009-2014 Undergraduate Survey from the Office of Institutional Research and Effectiveness at a university in the southeastern United States. The results indicated a statistically significant difference between students with disabilities and students without disabilities in regards to perceptions of services provided, and undergraduate experience. Specifically, individual with disabilities are more satisfied in the area of services provided compared to students without disabilities, while students without disabilities are more satisfied with their undergraduate experience compared to students with disabilities. Further, numerous relationships were found between variables such as gender, ethnicity, entrance status, academic proficiency, and overall satisfaction. Lastly, instructional and life skills, quality of student services, quality of academic advising, and quality of undergraduate experience scores load onto the latent variable of overall satisfaction as hypothesized.

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Introduction The Breatheasy© Tracheostomy Program based at the Red Cross War Memorial Children's Hospital, Cape Town, manages children mostly from poor socio-economic backgrounds. In our resource-limited setting, it is unclear how these families cope with the demands of a tracheostomised child. We aim to assess the quality of life (QOL) of tracheostomised children and their families as the first study of its kind in a low-resource setting. Methods A descriptive, observational study was done to assess the QOL of tracheostomised children managed by the Breatheasy© Program over 10 months. Children with tracheostomies for longer than 6 months, complex syndromic children, and home ventilated children were included. The validated Paediatric Tracheotomy Health Status Instrument (PTHSI) was utilised, where a higher score, implied a better outcome. Results A total of 68 families were recruited. In 57 (85.1%) of the carers, the highest level of education achieved was primary or high school. Twenty-seven (42%) families reported having an annual household income of less than $675 US Dollars (ZAR10,000). Sixteen (24%) resided within informal housing. The mean scores for the 4 PTHSI domains were: physical symptoms 24.8/35 (70.9%), frequency/financial impact of medical visits 14.2/15 (94.7%), QOL of child 8.8/15 (58.7%), QOL of carer 62.3/85 (73.3%); the overall score was 110.2/150 (73.5%). There was no significant correlation between total PTHSI and annual household income, carer's educational status or type of housing. Children with a concomitant major medical condition had a significantly poorer total PTHSI scores (p-value 0.024). Conclusion Tracheostomy care compounds challenging socio-economic circumstances. In our experience, with adequate training, home-care nursing is not necessary. Despite difficult living conditions, the Breatheasy© Program empowers children and their families to live independently of the hospital system and appear to be thriving. The decision to perform a paediatric tracheostomy should not be influenced by the carer's education level, socioeconomic status, or on the basis of formal or informal housing. Children with major medical comorbidities represent a group that requires more support.

Work-life balance goes hand-in-hand with the quality of life and the quality of working life and the level of satisfaction with thereof. Recent survey that took place in the Czech Republic in 2018 attempted at measuring the quality using the index of the quality of life and the index of the working life quality. The questionnaire developed by the World Health Organization and the set of questions proposed by Vinopal aiming at measuring the subjectively perceived quality of working life. The aim of this work is firstly to test the functionality of the two indices, the quality of life index and the quality of working life index, and then examine the existence and potential strength of the relationship between them within the selected subgroups of population. The work builds up on two basic pillows. The first pillow deals with the defitions of the explored phenomena. The concept of quality of life is explored at different levels: philosophical, sociological, subjective and objective. Then the rationale for developing a tool that measures the quality of life is described, including the variations of the Czech adaptation of the questionnaire. In the following chapters, the phenomenon of the quality of working life is introduced with special focus on the explanation of the dual nature of the concept and...

We hypothesized that HIV-related stigma would be related to poorer HIV-related quality of life (HIV-QOL) in people living with HIV (PLWH), and that this relationship would be stronger in women living with HIV (WLWH) than in men living with HIV (MLWH). 105 PLWH completed an online survey including measures of demographics, HIV-related stigma, and HIV-QOL. Results suggest that higher levels of HIV-stigma were associated with poorer HIV-QOL, and that in some cases, this relationship was stronger for WLWH than for MLWH. It is possible that WLWH have unique HIV-related experiences affecting their quality of life that are not shared by MLWH.

Nursing home resident choice in daily life is recognized as vital to resident quality of life and quality of care. Advocacy and policy activities to promote resident choice abound, yet little research exists to guide nursing home staff in how to enable resident choice on a moment to moment basis. Our three studies developed conceptual and practical tools to elucidate the factors, challenges, and behaviors involved in enabling resident choice. We first crafted a conceptual model, the “REAlizing Resident CHoice (REACH)” model, as described in the first paper. The REACH model identifies the factors influencing staff efforts to enable resident choice and the broader contextual dimensions within which the resident-staff member relationship exists. The REACH model was developed through a literature review of 1,969 abstracts and expert opinion. The second study assessed 1) tensions nursing home staff members encounter when trying to enable resident choice and 2) resolutions employed in the face of these tensions. We conducted semi-structured, qualitative interviews with 26 staff participants in two Veterans Health Administration (VHA) Community Living Centers (i.e., nursing homes). Participants highlighted intra-personal, inter-personal, and organizational tensions that affected their resident choice enabling efforts. Resolutions to these tensions focused on preventive practices, education, reinforcement, deliberation, collaboration, and leadership. A formative assessment tool, the “Supporting Choice Observational Tool (SCOT),” was developed in the third study. The SCOT provides nursing home staff with detailed, non-graded feedback on how to offer and enable resident choice in-the-moment. We created the SCOT using the following methodologies, in order: ethnographic observation, tool piloting, expert panel consultation, and a representational algorithm. SCOT results can inform discussion amongst co-workers and supervisors on how to advance their resident choice enabling efforts. These three studies address an important research gap. They provide scientifically grounded concepts and tools to assist nursing home staff, researchers, and policy makers in advocating for and instituting resident choice. The REACH model can be used to frame future research, and future studies can be undertaken to validate the SCOT. Findings from the second study could improve quality improvement initiatives targeting tensions and resolutions in enabling resident choice. / 2018-02-17T00:00:00Z

The purpose of this thesis is to examine how rehabilitation interventions, specifically physiotherapy (PT), occupational therapy (OT), and speech and language pathology (SLP) or a combination of these interventions affect quality of life (QoL) in people with amyotrophic lateral sclerosis (ALS). The purpose of the first study (Chapter 2) was to synthesize qualitative research through a qualitative meta-synthesis on the potential of rehabilitation interventions to maintain and/or improve QoL from the perspective of people with ALS. The literature search for this study was conducted using the SPIDER strategy and five articles were included. Four themes emerged: 1) the concept of control; 2) adapting interventions to disease stage; 3) struggles with interventions; and 4) barriers between healthcare providers and patients. The evidence suggests that from the perspective of people with ALS, PT, OT, and SLP interventions, or a combination of these interventions have the potential to be beneficial in the management of people with ALS and to optimize QoL. The systematic review (Chapter 3) aimed to determine the effectiveness of rehabilitation interventions, in particular PT, OT and SLP interventions or a combination of these interventions, on QoL in people with ALS. The PICO search strategy was used and six studies were included: three RCTs, two cohort studies, and one cross-sectional study. A narrative synthesis of interventions was conducted as the included studies were not sufficiently similar thus data extracted were not adequate for conducting meta-analyses. Need to briefly discuss interventions, which outcomes you included and inconsistency in results across studies. Due to the limited evidence, it was difficult to determine the exact effects of the interventions from each rehabilitation field to affect QoL for people with ALS. The evidence suggests that more research is required; currently therapists need to rely on their clinical expertise, expert opinions, and theoretical models to select the most effective interventions to sustain or improve QoL in people with ALS. Future research needs to take into consideration the needs of people with ALS to evaluate the impact of rehabilitation interventions on QoL. / Thesis / Master of Science (MSc)