Thesis (PhD)--University of Stellenbosch, 2001. / ENGLISH ABSTRACT: "Quality" has different meanings to different people. Even quality experts do not agree on a single definition: Juran's definition of quality revolves around his concept of "fitness for use", Crosby defines quality in terms of performance that produces "zero defects" and Deming defines quality as a "never ending cycle of continuous improvement". One element, however, that is common to all three approaches is that management must accept and demonstrate leadership if quality is to be achieved. Quality is rarely thought of as others perceive it. What is apparent is that if providers of care wish to maintain leadership in defining quality, they need to - Actively participate in the public debate about quality. Review the way in which they have been defining quality. Question whether their definitions are aligned with what the purchasers of health care define as being important. Develop meaningful measures of quality and data collection systems that will allow them to demonstrate quality and value. - Willingly share data not only on outcomes, and also measures that are specific to individual procedures and service providers. The PhysioFocus practice accreditation programme attempted to achieve the above factors. By realising the goal of the research this was determined. The goal of the research was to evaluate the PhysioFocus practice accreditation programme and to make recommendations on the educational programme for accreditation in private physiotherapy practices. This goal was realised by means of an exploratory and descriptive research design with a qualitative orientation. The evaluation of the PhysioFocus practice accreditation programme was performed by means of a validated evaluation instrument. The group interview revealed components of the PhysioFocus practice accreditation programme that require remediation. Recommendations included professional-ethical issues, business management and legislative issues. The recommendations will be implemented by the PhysioFocus practice accreditation committee. The PhysioFocus practice accreditation learning programme was evaluated by means of a semi-structured questionnaire, containing eleven questions and a section for comments. The general consensus was that the PhysioFocus practice accreditation programme is essential in private physiotherapy practice in South Africa. The implementation of the PhysioFocus practice accreditation programme resulted in the facilitation of quality physiotherapy; professional and personal development; monitoring of quality improvement processes; and the evaluation and remediation of these processes. This supported the central theoretical assumption of the research. Concerns were voiced about the lack of standards, lack of quality improvement skills, the public image of the physiotherapy profession and the lack of basic business management training. The researcher concluded that the implementation of the PhysioFocus practice accreditation programme is essential in private physiotherapy practice in South Africa. At present the current PhysioFocus practice accreditation programme does not address all the needs of private physiotherapy practices. Recommendations based on the research included remediation of the current PhysioFocus practice accreditation programme, formal education included business management, professional-ethical-Iegal issues, standards and scientific methods to analyse process variation and the development of improvement strategies in quality improvement. Other recommendations include informal education, physiotherapy management and structured quality improvement activities. The issue of the image of the professional physiotherapist was also addressed. Topics for future research were identified. The uniqueness of the research lies in the fact that this is the only physiotherapy practice accreditation programme implemented in South Africa. It is also the only physiotherapy practice accreditation programme in South Africa that has been evaluated. / AFRIKAANSE OPSOMMING: "Gehalte" het verskillende betekenisse vir verskillende mense. Selfs kenners op die gebied van gehalte stem nie saam met 'n enkele definisie nie. Juran se omvattende definisie is "gebruikswaarde", terwyl Crosby gehalte in terme van produksie, naamlik "zero defek", definieer. Deming definieer gehalte as "'n nimmereindigende siklus van voortdurende verbetering". Die een aspek wat al drie die kenners egter gemeen het, is dat bestuur leierskap moet aanvaar en demonstreer indien gehalte bereik wil word. Geen twee persone ervaar gehalte eenders nie. Indien diensverskaffers leiding wil behou ten opsigte van gehalte-definiëring, sal hulle verplig wees om: aktief deel te neem aan openbare debat oor gehalte; die aanvaarde definisie van gehalte te herevalueer; die aanvaarde definisie van gehalte op te weeg teenoor dié van die mediese hulpfonds-administrasie; gehalte- en data insamelingsisteme te ontwikkel om gehalte en waarde te bewys; en gewillig alle data te deel - nie net uitkomsdata nie, maar ook data wat spesifiek op individuele prosedures en diensverskaffers van toepassing is. Die PhysioFocus praktyk-akkreditasieprogram het gepoog om bogenoemde te bereik. Die navorsing het gerealiseer deurdat die doelstelling bereik is. Die doelstelling van die navorsing was om die PhysioFocus praktykakkreditasieprogram te evalueer en aanbevelings te maak vir 'n leerprogram vir die akkreditasieprogram. Die doelstelling het gerealiseer deur "n verkennende en beskrywende navorsingsontwerp vanuit 'n kwalitatiewe oriëntasie. Die evaluering van die PhysioFocus praktyk-akkreditasieprogram het deur middel van 'n gevalideerde evalueringsinstrument geskied. Die groepsonderhoud het areas van die PhysioFocus praktyk- akkreditasieprogram wat remediëring benodig, geïdentifiseer. Aanbevelings het professionele-etiese aspekte, besigheidsbestuur en wetlike aspekte ingesluit. Die aanbevelings sal deur die PhysioFocus praktykakkreditasiekommitee geïmplementeer word. Die evaluering van die PhysioFocus praktyk-akkreditasieleerprogram het deur middel van 'n semi-gestruktureerde vraelys met 11 oop vrae, tesame met 'n afdeling vir opmerkings, geskied. Die algemene aanname was dat die PhysioFocus praktyk-akkreditasieprogram noodsaaklik is in privaat fisioterapiepraktyk in Suid-Afrika. Die implementering van die PhysioFocus praktyk-akkreditasieprogram het gehalte fisioterapie, professionele en persoonlike ontwikkeling, die monitering van gehalteverbeteringsprosesse, asook evaluering en remediëring van hierdie prosesse, tot gevolg gehad. Dit het die sentraalteoretiese aanname van die navorsing ondersteun. Daar was egter kommer oor die gebrek aan standaarde, die beeld van die fisioterapieprofessie, asook die gebrek aan besigheidsbestuuropleiding. Die navorser het tot die gevolgtrekking gekom dat die implementering van die PhysioFocus praktyk-akkreditasieprogram noodsaaklik is in privaat fisioterapiepraktyk in Suid-Afrika. Die huidige PhysioFocus praktykakkreditasieprogram voldoen nie aan al die vereistes van privaat fisioterapiepraktyk in Suid Afrika nie. Aanbevelings vanuit die navorsing sluit die volgende in: remediëring van die huidige PhysioFocus praktyk-akkreditasieprogram; formele opleiding, insluitende profesionele-etiese-wetlike aspekte; standaarde; wetenskaplike metodes om die praktykprosesveranderinge te analiseer; en die ontwikkeling van 'n gestruktureerde gehalteverbeteringstrategie. Die beeld van die fisioterapieprofessie is ook aangespreek. Onderwerpe vir toekomstige navorsing is geïdentifiseer. Die navorsing is uniek omdat die PhysioFocus praktyk-akkreditasieprogram die enigste akkreditasieprogram vir fisioterapie in Suid Afrika is. Dit is ook die enigste fisioterapie-akkreditasieprogram wat in Suid Afrika geëvalueer is.

Patient and caregiver education is recognized as a critical component of stroke rehabilitation and physical therapy practice yet the informational needs of stroke survivors and caregivers are largely unmet and optimal educational interventions need to be established. The objective of this dissertation was to develop a theory and model of “Rehabilitation Education for Caregivers and Patients” (RECAP) in the context of physical therapy and stroke rehabilitation, grounded in the experiences and perceptions of stroke survivors, their caregivers, and physical therapists. Qualitative research methods with a novel grounded theory approach were used. Potential constructs of RECAP were identified from existing research. Next, semi-structured interviews were conducted with 13 stroke survivors and 12 caregivers from rural Appalachian Kentucky, a region with high incidence of stroke and lower levels of educational attainment. Lastly, 13 physical therapists, representing inpatient rehabilitation, outpatient, and home health, were recruited and participated in pre-interview reflection activities and interviews. Data analysis involved predetermined and emerging coding and a constant comparative method was employed. Verification strategies included self-reflective memos, analytic memos, peer debriefing, and triangulation. The theory generated from this dissertation is: physical therapists continually assess the educational needs of stroke survivors and caregivers, to participate in dynamic educational interactions that involve the provision of comprehensive content, at a point in time, delivered through diverse teaching methods and skilled communication. This phenomenon is influenced by characteristics of the physical therapist and receiver (stroke survivor/caregiver) and occurs within the context of the physical therapist’s professional responsibility, the multidisciplinary team, a complex healthcare system, and the environmental/socio-cultural context. The RECAP theoretical model depicts the relationships between the core and encompassing constructs of the theory. The RECAP theory and model presents a significant advancement in the study of patient and caregiver education in physical therapy in stroke rehabilitation. This research provides a springboard to inform future research, guide RECAP in stroke physical therapy practice, design optimal educational interventions, develop training tools for entry-level curriculum and practicing clinicians, and to potentially translate to the practice of patient and caregiver education for other rehabilitation professionals and patient populations.

Patient satisfaction is one of the indicators of the quality of care being given to the users of a service. It can also be used as benchmarks for ensuring the delivery of quality physiotherapy services in health facilities. Physiotherapists have been involved in treatment of persons suffering from low back pain for decades. Treatment approaches are varied, but all have the common goals of pain relief, rehabilitation, and prevention of recurrence of low back pain. The purpose of this study was to investigate the satisfaction of low back pain sufferers with the physiotherapy services they receive. The study was carried out in selected public hospitals in Nairobi and the Central Province in Kenya.

Background: Fall risk increases with age and visual impairment, yet the oldest-old adults (>85 years) are rarely studied. Partnered dance improves mobility, balance, and quality of life in older individuals with movement impairment. Objective: The aim of the study was to determine the feasibility and participant satisfaction of an adapted tango program amongst these oldest-old adults with visual impairment. Exploratory analyses were conducted to determine efficacy of the program in improving balance and gait. Methods: In a repeated-measures, one-group experimental design, 13 older adults (7 women; age: M = 86.9 years, SD = 5.9 years, range = 77–95 years) with visual impairment (best eye acuity: M = 0.63, SD = 0.6 logMAR) participated in an adapted tango program of twenty 1.5-hour lessons, within 11 weeks. Feasibility included evaluation of facility access, safety, volunteer assistant retention, and participant retention and satisfaction. Participants were evaluated for balance, lower body strength, and quality of life in two baseline observations, immediately after the program and 1 month later. Results: Twelve participants completed the program. The facility was adequate, no injuries were sustained, and participants and volunteers were retained throughout. Participants reported enjoyment and improvements in physical well-being. Exploratory measures of dynamic postural control (p < .001), lower body strength (p = .056), and general vision-related quality of life (p = .032) scores showed improvements following training. Discussion: These older individuals with visual impairment benefitted from 30 hours of tango instruction adapted for their capabilities.

Evidence-based recommendations for interventions to reduce fall risk in older adults with visual impairment are lacking. Adapted tango dance (Tango) and a balance and mobility program (FallProof) have improved mobility, balance, and quality of life (QOL) in individuals with movement impairment. This study compared the efficacy of Tango and FallProof for 32 individuals with visual impairment (age: M = 79.3, SD =11 [51–95 years]). Participants were assigned to Tango or FallProof to complete twenty, 90-min lessons within 12 weeks. Participants underwent assessment of balance, dual-tasking, endurance, gait, and vision-related QOL. The balance reactions of participants in both groups improved (p < .001). Endurance, cognitive dual-tasking, and vision-related QOL may have improved more for Tango than FallProof. Group differences and gains were maintained across time. Both programs could be effective options for motor rehabilitation for older adults with visual impairment because they may improve mobility and QOL while reducing fall risk.

BACKGROUND: Vestibular rehabilitation (VR) improves symptoms and function in some but not all patients with bilateral vestibular hypofunction (BVH). OBJECTIVE: The purpose of this retrospective study was to examine change following vestibular rehabilitation and to identify factors associated with rehabilitation outcome in patients with BVH. METHODS: Data from 69 patients with BVH were analyzed. Factors studied included patient characteristics, subjective complaints and physical function. Outcome measures included symptom intensity, balance confidence, quality of life, gait speed, fall risk, and dynamic visual acuity. Bivariate correlations were used to examine relationships of patient characteristics and baseline measures with outcome measures. One-way ANOVAs were used to compare outcomes in patients with BVH versus unilateral vestibular hypofunction (UVH). RESULTS: As a group, patients with BVH improved in all outcome measures except disability following a course of vestibular rehabilitation (VR); however, only 38-86% demonstrated a meaningful improvement, depending on the specific outcome measure examined. Several factors measured at baseline - age, DGI score, gait speed and perceived dysequilibrium - were associated with outcomes. For example, greater age was related to higher DVA scores at discharge; lower initial DGI scores were related to higher Disability scores at discharge. Compared to patients with UVH, reported previously [9], a smaller percentage of patients with BVH improve and to a lesser extent. CONCLUSION: Consideration of baseline factors may provide guidance for setting patient goals. Further research is needed determine what factors predict outcome and to develop more effective treatment strategies for those patients who do not improve.

As early career researchers, we all want to be successful in securing our first big grant and publishing our research findings in the most prestigious journals. To achieve this success, we need to be able to understand why our grants proposals weren't funded in a grant cycle and why we are asked to make major revisions to the manuscript that we spent so much time on already. Even worse is when we get an outright rejection and don't understand why. A very important skill as a researcher is to be able to interpret the comments from grant and manuscript reviews objectively once we recover from the initial reaction of sadness, frustration, or even anger. This session will provide strategies to tackle the reviewers' comments that will hopefully lead to a successful resubmission.

The use of low-cost interactive game technology for balance rehabilitation has become more popular recently, with generally good outcomes. Very little research has been undertaken to determine whether this technology is appropriate for balance assessment. The Wii balance board has good reliability and is comparable to a research-grade force plate; however, recent studies examining the relationship between Wii Fit games and measures of balance and mobility demonstrate conflicting findings. This study found that the Wii Fit was feasible for community-dwelling older women to safely use the balance board and quickly learn the Wii Fit games. The Ski Slalom game scores were strongly correlated with several balance and mobility measures, whereas Table Tilt game scores were not. Based on these findings, the Ski Slalom game may have utility in the evaluation of balance problems in community-dwelling older adults.

This work reports the use of a head-motion monitoring system to record patient head movements while completing in-home exercises for vestibular rehabilitation therapy. Based upon a dual-axis gyroscope (yaw and pitch, ± 500-degrees/sec maximum), angular head rotations were measured and stored via an on-board memory card. The system enabled the clinician to document exercises at home. Several measurements were recorded in one patient with unilateral vestibular hypofunction: The total time of exercise for the week (118 minutes) was documented and compared with expected weekly exercise time (140 minutes). For gaze stabilization exercises, execution time of 60 sec was expected, and observed times ranged from 75-100 sec. An absence of rest periods between each exercise instead of the recommended one minute rest period was observed. Maximum yaw head velocities from approximately 100-350 degrees/sec were detected. A second subject provided feedback concerning the ease of use of the HAMMS device. This pilot study demonstrates, for the first time, the capability to capture the head-motion “signature” of a patient while completing vestibular rehabilitation exercises in the home and to extract exercise regime parameters and monitor patient adherence. This emerging technology has the potential to greatly improve rehabilitation outcomes for individuals completing in-home gaze stabilization exercises 1 .

Abstract available through Journal of Vestibular Research.