Magister Scientiae (Physiotherapy) - MSc(Physio) / Stroke is the second leading cause of death globally and the consequences on human and economic health are of major concern. The aim of this study was to determine and explore the participation restrictions experienced by stroke patients. The study populations were stroke patients living within the community in Western Cape, South Africa. A mixed methods approach was used to collect data in this study which consisted of two phases. For the first phase, the descriptive, observational cross sectional design was used to determine the participation restrictions of stroke patients living within the community and the factors associated with community with respect to integration. In this phase, an interviewer- administered questionnaire was used to collect data; the instrument for this study is the standard World Health Disability Assessment Schedule 2.0 (WHODAS 2.0) for disability assessment which includes the International Classification of Functioning Health and Disability (ICF) concept in disability assessment which has been tested and found to be reliable and valid, to determine various participation restrictions among stroke patients living in the society. While in the second phase of this study, two focus group discussions were conducted at the selected community health centre; these participants were conveniently selected from those who participated in the first phase of the study. This was conducted to retrieve in-depth information on difficulties encountered in participating in daily life situations. The Statistical Package for Social Sciences (SPSS) was used for descriptive and inferential statistics. Chi square and Anova t-test was used to determine the association between the demographics statistic and participation restrictions. Alpha level was set at 0.05. For qualitative findings, audiotaped interviews and note taken were transcribed and translated into English; the expressed ideas were coded and reduced into subthemes, themes and categories. Ethical clearance and permission to conduct study was sought, consents from participants were sought, clearly stating the right to participate and withdraw from the study was respected and anonymity and confidentiality has been ensured. The result of the study showed that participants encountered difficulty with cognition, (23.3% of participants reported severe difficulty in learning a new task; 20% reported severe difficulty analyzing and finding solution to day to day activities), mobility (34% acknowledged difficulty walking a long distance like one kilometer after stroke), self-care ( 44% indicated difficulty staying alone for few days after stroke, while the majority, 61% complaints of difficulty with getting dressed by self), getting along with people with the majority of the difficulties (36%) are sexual activities, household activities with major complaints (46.6% and 31.4%, for severity and exemption respectively) in getting needed household work done, severe difficulty (51.7%) reported in relaxation and pleasure after stroke, 50.8% been financially restrained after stroke, 40% with difficulty in joining in the community activities, 39.2% severely affected by people perception towards them and 25.8% of the participants indicated extreme time spent on health; all difficulties investigated within the society 30 days after the incidence of stroke. However, the result of the qualitative phase reported the participation restrictions experienced by the participants. Difficulty in cognition was reported, which promotes indiscipline among family members. Limitation in activity level such as in mobility (walking for a long distance, standing from a sitting position), in self-care (washing the whole body, eating, staying alone after stroke), in getting along (maintaining friendship, sexual activities), in household activities and work activities was reported. Participants experienced difficulty in joining in community activities, emotional fluctuations, poor perception of attitudes of others after stroke, excessive use of time on health conditions, increased financial impact of health condition and burden impact on family was reported. Environmental barriers such as transportation and toilet facilities were reported. The current study findings suggest appropriate and specific programmes should be aimed at improving participation among stroke survivors in the community.

The overall aim of this doctoral thesis was to explore an assessment of participation according to the International Classification of Functioning, Disability and Health (ICF) in people with a mild intellectual disability. Study I used secondary data and explored how participation can be assessed. Study II-IV explored participation empirically regarding 68 everyday activities from all nine life domains according to the ICF. Study II explored assessment of self-rated participation by investigating to what extent perceived ability, actual performance and perceived importance correlated. Study III-IV explored the contribution of perceived importance to an assessment of participation; study III by investigating frequencies of everyday activities regarding performance and importance separately as well as regarding combined measures of performance and perceived importance, and study IV by comparing proxy ratings with self-rated measures regarding ability and measures of participation. Study III also correlated measures of participation with a single-item measure of subjective general well-being and study II and IV investigated internal consistency in terms of Cronbach’s alpha. Study II and III included 55 and 69 individuals with intellectual disability respectively. Study IV included 40 individuals with intellectual disability and 40 proxy persons. The informants from the target group were partly the same. Study II and IV supported the suggestions from study I that participation should be assessed by self-ratings and study II found that this is an appropriate method also to people with a mild intellectual disability. Study III showed that participation is related to subjective well-being. Study III-IV found somewhat different results if measuring participation as performance solely or as a combination of performance and perceived importance. Overall, the results of the thesis suggest that performance solely might be sufficient to assess participation at a group level but in a clinical context, when the knowledge of a certain individual is of interest, the perceived aspect of involvement is necessary to include in an assessment of participation.

Magister Scientiae (Physiotherapy) - MSc(Physio) / Stroke is the third leading cause of death and disability worldwide. The Uitenhage Provincial Hospital admits many stroke patients. To date, no in-depth study has been conducted on stroke patients admitted to the Hospital. This study identified the profile of stroke patients admitted to the Uitenhage Provincial Hospital and explored the challenges that these patients experienced post stroke. A concurrent mixed model design was used to collect the data. Firstly retrospective data was obtained by means of a quantitative data gathering instrument designed by the researcher. The information obtained, included data relating to demographic characteristics, reported risk factors relating to stroke, stroke onset-admission interval and length of hospital stay, as well as information relating to the process of physiotherapy. Secondly quantitative prospective information was collected by means of the Barthel Index, the Modified Rankin Scale and the Facilitators And Barriers Survey. The sample for the quantitative phase was drawn from medical records of 168 stroke patients admitted to the Uitenhage Provincial Hospital from the 1 of January 2008 up to and including the 31 of December 2009. For the second prospective quantitative part of the study, participants were selected conveniently from the admitted patients. In the qualitative phase, nine participants taken of the sampled participants were selected. The Microsoft Excel 2007 Package and the SPSS 18 for social sciences were used to analyse the quantitative data. Means, standard deviations, frequencies and percentages were calculated for descriptive purposes and the Chi-square test was used to test for associations between variables. Qualitative analysis began with the transcription of voice recordings and the translation of relevant Afrikaans transcription into English. Emerging categories were identified within the pre-determined themes. Permission and ethical clearance was obtained from the Higher Degrees Committee and the Senate Research and Grants and Study Leave Committee of the University of the Western Cape and permission to conduct this study was also obtained from the Medical Superintendent of the Uitenhage Provincial Hospital. Altogether 461 patients had been admitted with stroke during the relevant period, but only 168 could be included in the retrospective quantitative study. The mean age of the participants was 61,54 years; 59% were females and 41% males. The majority of the participants (86,9%) were admitted on the same day of stroke onset, and the mean length of hospital stay was 7,38 days. Hypertension was the most common reported risk factor, at 79%. Only 165 of the participants received physiotherapy while hospitalised, with the mean total physiotherapy sessions being 2,56 sessions. In 90% of the cases, physiotherapy sessions were discontinued due to the patient being discharged from the Hospital. The mean Barthel Index score was 81,46 and the family care domain of the Modified Rankin Scale was the most affected. Participants experienced participation restrictions and activity limitations due to stairs, gravel surfaces and kerb cuts. During the qualitative interviews participants reported activity limitations related to walking and activities of daily living. The participants also experienced participation restrictions, which included dependency on others, decreased social support and an array of emotions experienced post stroke. The current study’s findings suggest that the discharge of patients from the hospital post stroke should follow a mulitidisciplinary approach. Rehabilitation professionals should play an active role in the discharge process in providing patient and caregiver education.

Magister Scientiae (Physiotherapy) - MSc(Physio) / Cerebro-vascular accidents or stroke remain a leading cause of death worldwide accounting for 5.5 million deaths, leaving individuals disabled in many aspects of functioning. The International Classification of Functioning, Disability and Health (ICF) is a framework that assesses disability in relation to impairments, activity limitations, participation restrictions and environmental factors and many individuals post stroke have reported restrictions in these areas. Literature has proven that participation restrictions post stroke are very common, which means that individuals are not able to return to their normal functioning as before. Once these individuals are discharged into the community, supportive networks become an essential aspect aiding participation. There is some literature present which shows positive relations between social support and participation, however this is minimal. The aim of this study was to determine participation restrictions and social support in patients with stroke, living in the Western Cape. To further understand the relationship between social support and participation restriction post stroke, a systematic review was conducted. The databases searched were Ebscohost full text, which included CINAHL +, Health Source: Nursing, Academic edition, Medline, Psych articles and Soc index, Science Direct, Biomed Central, Google Scholar, Cochrane Library, Pedro Central, and Wiley Online between the years 2001 - 2013. Once the methodology of the review was completed, a total of three articles were the only articles that met the study‟s inclusion criteria and were included in the review. These articles highlighted the importance of the quality and quantity of social support on participation. The review presented level 4 and 6 evidence, based on the hierarchical evidence model which showed a positive relationship between social support and participation. Thus, social support is found to be an important factor aiding participation. The methodology of the survey included a target population of all individuals attending the Community Health Centres in the Southern Western and Klipfontein Mitchell‟s Plain Metro District Health Service who were sampled by convenience. This study was cross-sectional in design, using descriptive surveys. All individuals diagnosed with a stroke and living in the community for at least six months were included in this study. The World Health Organisation Disability Assessment Schedule 2.0. (WHODAS 2.0.) was used to determine the participation restrictions in the participants, while the Social Support Questionnaire 6 (SSQ6) was used to determine the individual’s social support. Completed questionnaires wereanalysed using the Statistical Package for the Social Sciences (SPSS) version 23 where descriptive statistics were used to define continuous and categorical variables. The Pearsons correlation test was used to determine the association between social support and participation, with significance set at 0.05. Confidentiality was maintained throughout the study and participants were required to provide verbal and written informed consent. All questionnaires and consent forms were available in English, Afrikaans and isiXhosa to accommodate all participants. Participants were assured that their participation in the study was completely voluntary and that their agreement, refusal or withdrawal would not impact their treatment at the Community Health Centre. A total of 106 participants met the inclusion criteria for this study and agreed to partake. An equal number of males and females participated, with a mean age of 61.5 years. The results showed that 89.9% of participants in the study were classified as having low levels of social support, with family support playing an important role in the social support of participants (P=0.000). The majority of participants (30.2%) indicated that their children, and families, were the people providing the most support to participants. Caregiver strain and burnout was highlighted as an aspect of importance. The majority of participants (51.8%) were severely affected in the domain of participation, reporting common problems joining in community activities (28.3%), emotional status (18.9%) and financial status (45.3%) which affected participation adversely. Extreme difficulty with concerns of barriers in the community (19.8%), and time spent on health condition (8.5%), with regard to participation were reported. It has been highlighted that many participants had not returned to work post stroke, a factor to consider when planning interventions in the clinical setting. When comparing the respective domains of the WHODAS 2.0., mobility, household activities and participation was discovered to be amongst the highest scoring domains. Pearsons correlation test between social support and participation produced a non-significant result (P = 0.146). This study outlines that although an insignificant result was obtained, the participants (10.1%) who scored the highest for social support had only been moderately affected in the domain of participation. A limitation of this study include design, and it is thus recommended that additional studies be conducted in the form of controlled trials to determine the effects of social support on participation restrictions post stroke.

<p>The overall aim of this thesis was to describe (1) needs for occupational therapy among persons with self-perceived activity limitations and/or participation restrictions due to long-term/recurrent pain, and (2) treatment interventions in occupational therapy to meet demonstrated needs. The Liss’ model for assessing health care needs was used as a structural scheme. A randomly selected sample (n=10,000) from the Swedish general population aged 18-58 years was the foundation for the study population with and without pain. In addition, occupational therapists were included (n=109). Data collection was made by postal questionnaires. The results showed a prevalence of 26 % and an incidence rate of 0.07. Demographic characteristics of the sample were female gender, ages 40-58 years and fewer years of education than those without pain. Pain in shoulders/lower back of searing/aching/gnawing character was the most frequently reported. A majority of the respondents reported affective/emo-tional effects of pain mainly of depressive character and they had previously been on sick leave due to pain. Women reported higher frequencies of self-perceived activity limitations/ participation restrictions due to pain, more difficulties with intermediate ADL, perceived higher job demands and had longer sick leave than men. Men perceived poorer social support than did women. Needs for occupational therapy were reported mainly as a consequence of activity and temporal imbalance. High health care consumers reported higher frequencies of needs/problems than did low health care consumers. The main goals and interventions suggested by occupational therapists to meet the needs in pain management focused on increased knowledge of handling daily occupations with the purpose to reduce pain, maintain competence/improve performance of home maintenance, reduce consequences of pain and increase knowledge how to handle effects of pain.</p>

The overall aim of this thesis was to describe (1) needs for occupational therapy among persons with self-perceived activity limitations and/or participation restrictions due to long-term/recurrent pain, and (2) treatment interventions in occupational therapy to meet demonstrated needs. The Liss’ model for assessing health care needs was used as a structural scheme. A randomly selected sample (n=10,000) from the Swedish general population aged 18-58 years was the foundation for the study population with and without pain. In addition, occupational therapists were included (n=109). Data collection was made by postal questionnaires. The results showed a prevalence of 26 % and an incidence rate of 0.07. Demographic characteristics of the sample were female gender, ages 40-58 years and fewer years of education than those without pain. Pain in shoulders/lower back of searing/aching/gnawing character was the most frequently reported. A majority of the respondents reported affective/emo-tional effects of pain mainly of depressive character and they had previously been on sick leave due to pain. Women reported higher frequencies of self-perceived activity limitations/ participation restrictions due to pain, more difficulties with intermediate ADL, perceived higher job demands and had longer sick leave than men. Men perceived poorer social support than did women. Needs for occupational therapy were reported mainly as a consequence of activity and temporal imbalance. High health care consumers reported higher frequencies of needs/problems than did low health care consumers. The main goals and interventions suggested by occupational therapists to meet the needs in pain management focused on increased knowledge of handling daily occupations with the purpose to reduce pain, maintain competence/improve performance of home maintenance, reduce consequences of pain and increase knowledge how to handle effects of pain.