Thesis (MScMedSc)--Stellenbosch University, 2012. / ENGLISH ABSTRACT: Lower limb amputations cause multiple physical, psychological, environmental and socioeconomic
barriers. Individuals who have suffered a lower limb amputation require
comprehensive rehabilitation to ensure social integration and economic self-sufficiency. In
addition, constant monitoring and evaluation is an essential part of human service delivery
programmes. However, the amputation rehabilitation programme offered at Elangeni an outpatient
rehabilitation centre for clients with physical disabilities in Paarl, Western Cape, South
Africa is not monitored, and has not been evaluated since its inception in 2000. Thus, the
current study evolved to describe and evaluate the rehabilitation programme for persons with
lower limb amputations at Elangeni.
A mixed method descriptive design was implemented. All persons who received
rehabilitation, after a major lower limb amputation at Elangeni, between 2000 to 2011, were
included in the study population. In addition, the physiotherapist and occupational therapist
that provided amputation rehabilitation at Elangeni, at the time of the study, were interviewed.
Thirty participants who met the study inclusion criteria were identified. Quantitative data was
collected using a researcher designed, structured demographic questionnaire, an
International Classification of Function checklist based questionnaire and a participant
rehabilitation folder audit form. Two interview schedules one for clients and one for therapists
were used for guidance during semi structured interviews. Quantitative data was entered
onto a spread sheet and analysed by a statistician using Statistica, version 8. Qualitative data
was thematically analysed according to predetermined themes.
No programme vision, mission or objectives could be identified for the amputation
rehabilitation programme. Poor record keeping practices and a lack of statistics were found.
Rehabilitation was impairment focused with no attention given to social integration. Clients
who received prosthetic rehabilitation showed improved functional ability with regard to
picking up objects from the floor (p = 0.031) getting up from the floor (p = 0.00069), getting
out of the house (p = 0.023), going up and down stairs with a handrail (p = 0.037) and moving
around in the yard (p = 0.0069), climbing stairs without a handrail (p = 0.037), going up and
down a kerb (p = 0.0082) walking or propelling a wheelchair more than 1km (0.0089) and
walking in inclement weather (0.017). A lack of indoor mobility training had a statistically significant negative impact on the
participants’ ability to lift and carry objects (p 0.011), standing up from sitting (p = 0.042),
getting around inside the house (p = 0.00023), picking up objects from the floor (p = 0.00068),
getting up from the floor (p = 0.0072), getting out of the house (p = 0.0016), going up and
down stairs with a handrail (p = 0.019), moving around in the yard (0.0013), going up and
down stairs with-out a hand-rail (p = 0.019), getting up and down a kerb (p = 0.0022), walking
or wheeling 1km or more (p = 0.0032) and using transport (p = 0.0034). Failure to address
community mobility during rehabilitation had a statistically significant negative impact on all
aspects of community mobility scores except doing transfers and driving.
In conclusion, for the study participants, Elangeni failed to provide rehabilitation according to
the social model of disability and Community Based Rehabilitation principles. It is
recommended that managers, service providers, and clients re-consider the purpose of
Elangeni and develop a vision and objectives for that service. In addition, management
should take an active role in service monitoring and evaluation and provide guidance and
mentorship to therapists. / AFRIKAANSE OPSOMMING: Onderste ledemate amputasies impak negatief op `n persoon se fisiese, sielkundige en
sosiale funksionering. Individue wat ’n amputasie ondergaan het benodig omvattende
rehabilitasie om sosiale integrasie en ekonomiese onafhanklikheid te verseker. Konstante
monitering en evaluasie is ’n essensiële deel van rehabilitasie programme. Nietemin die
amputasie rehabilitasie program wat by Elangeni aangebied word, word nie gemoniteer nie
en was nog nooit geëvalueer nie. Dus het hierdie studie dit ten doel om die rehabilitasie
programme vir persone met onderste ledemate amputasies by Elangeni te beskryf en te
evalueer.
Kwantitatiewe en kwalitatiewe navorsingsmetodes is in kombinasie gebruik in die studie. Alle
persone wat rehabilitasie by Elangeni ontvang het na ’n onderste ledemaat amputasie, sowel
as die terapeute wat by Elangeni werk, het die studie populasie gevorm. In totaal het 32
persone aan die studie deelgeneem. Kwantitatiewe data is met behulp van `ʼn demografiese
vraelys, `ʼn ICF gebaseerde vraelys, en `ʼn leer oudit vorm ingesamel. Twee onderhoud
skedules, een vir die kliënte en een vir die terapeute, is gebruik as riglyn tydens insameling
van kwalitatiewe data. Kwantitatiewe data is statisties ontleed deur ʼn statistikus wat gebruik
gemaak het van Statistica 8. Voorafbepaalde temas is gebruik tydens tematies ontleding van
kwalitatiewe data.
Geen program visie, missie of doelwitte kon geïdentifiseer word nie. Swak rekord houdings
praktyke was gevind. Rehabilitasie het gefokus op die fisiese en nie op sosiale integrasie nie.
Die kliënte wat prostetiese rehabilitasie ontvang het, het statisties beduidend beter gevaar
ten opsigte van optel van voorwerpe van die vloer af (p = 0.031), om van die vloer af op te
staan (p = 0.00069), om uit die huis uit te kom (p = 0.023), om trappe met `ʼn handreling te
klim (p = 0.037), om op die erf rond te beweeg (p = 0.0069), om trappe sonder `ʼn reling te
klim (p = 0.037), om by sypaadjies op en af te gaan (p = 0.0082), om meer as `ʼn kilometer te
loop of met die rolstoele te ry (0.0089) en om in ongure weer te loop (0.017).
`ʼn Tekort aan heropleiding van mobiliteit binne die huis het `ʼn statisties beduidende impak
gehad op die vermoë om goed te dra (p 0.011), op te staan van sit af (p = 0.042), in die huis
rond te beweeg (p = 0.00023), voorwerpe van die vloer af op te tel (p = 0.00068), van die
vloer af op te staan (p = 0.0072), uit die huis uit te kom (p = 0.0016), trappe met `ʼn handreling te klim (p = 0.019), in die erf rond te beweeg (0.0013), trappe sonder `ʼn handreling te klim (p
= 0.019), by `n sypaadjie op en af te gaan (p = 0.0022), meer as 1km te loop of met die
rystoel te ry (p = 0.0032) en om vervoer te gebruik (p = 0.0034). `ʼn Gebrek aan heropleiding
van gemeenskapsmobiliteit het `ʼn statisties negatiewe impak gehad op alle aspekte van
gemeenskapsintegrasie behalwe die doen van oorplasings en bestuur.
Rehabilitasie praktyke was nie gebaseer op die sosiale model van gestremdheid en
Gemeenskap Gebaseerde Rehabilitasie beginsels nie. Dit word aanbeveel dat diens
verskaffers, kliënte en bestuurders oor die fokus van rehabilitasie by Elangeni moet besin.
Daar moet ʼn visie en doelwitte vir die diens ontwikkel word. Voorts moet bestuurders van
distrik vlak ʼn aktiewe rol speel in die monitering en evaluasie van dienste en mentorskap aan
terapeute verseker.
| Identifer | oai:union.ndltd.org:netd.ac.za/oai:union.ndltd.org:sun/oai:scholar.sun.ac.za:10019.1/20029 |
| Date | 03 1900 |
| Creators | Fredericks, Jerome P. |
| Contributors | Visagie, Surona, Gcaza, Siphokazi, Stellenbosch University. Faculty of Health Sciences. Dept. of Interdisciplinary Health Sciences. Speech-Language and Hearing Therapy. Centre for Rehabilitation Studies. |
| Publisher | Stellenbosch : Stellenbosch University |
| Source Sets | South African National ETD Portal |
| Language | en_ZA |
| Detected Language | English |
| Type | Thesis |
| Format | 164 p. |
| Rights | Stellenbosch University |
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