Browsing by Author "Joubert, Robin Wendy Elizabeth."

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A comparative study to determine the immediate effects of paraffin wax and moist heat therapies on pain, joint range of movement and grip ability in adults with rheumatoid arthritis afffecting the hands.
(2013) Ramsudh, Thirusha.; Ramklass, Serela Samita.; Joubert, Robin Wendy Elizabeth.
Physiotherapists use many treatment modalities in the management of rheumatoid arthritis of the hand. Two commonly used heating modalities are moist heat and paraffin wax therapy. The aim of this study was thus to compare the immediate effectiveness of moist heat therapy and paraffin wax therapy in the management of the rheumatoid hand. A quantitative, pretest – posttest design was used to compare the effects of paraffin wax and moist heat therapy on pain, joint range of movement and grip ability in adults with stage II rheumatoid arthritis, affecting the hands. One hundred and fifteen subjects at a district/regional provincial health care institution in the Ethekwini metro district were randomly allocated to two groups. Fifty six subjects in Group 1 were treated with paraffin wax therapy, using the drip-wrap method and active hand exercises and in Group 2, fifty nine subjects were treated with moist heat therapy and active hand exercises. Pre- and posttest measurements were taken in all subjects. Pain was measured using the numerical pain rating scale and intrinsic hand joint range of movement was measured using a metal short arm goniometer and the dorsal approach. Hand span and grip ability were also measured. Results revealed that both treatment modalities were effective in helping moderate pain, increase joint range of movement and improve grip ability in the adult rheumatoid hand. Paraffin wax improved joint range of movement significantly more than moist heat therapy in 25% of joints (p≤0.05). Right hand span was also significantly improved (p=0.013) by the application of wax. No statistically significant differences were found between the effects of paraffin wax and moist heat therapy on pain and grip ability however the findings of this study suggest clinical significance as both modalities improved pain perception and grip ability in the rheumatoid hand.
An evaluation of the criteria and procedures used for selection of occupational therapy students at South African universities.
(1997) Joubert, Robin Wendy Elizabeth.; Parekh, Angina.; Concha, Marj.
The existing selection criteria and procedures applied at universities training occupational therapists in South Africa are not meeting the country's need for selecting students who adequately fulfill the demographic mix which represents the South African population. The aims of this research were: to investigate the existing criteria and procedures used for the selection of occupational therapy students; to establish recommendations with regard to how these criteria and procedures can be adapted to allow for more appropriate and equitable selection of students, and to obtain opinions from qualified therapists about those characteristics deemed most important for them to possess in the current South African Health System. A combination of quantitative and qualitative methodology was adopted. A survey was undertaken to obtain basic information and statistics about the numbers of applicants selected, and the existing selection criteria and procedures currently used to select occupational therapy students in South African universities. A series of two focus groups for each of the eight existing universities were carried out i.e. one incorporating the views of lecturers and clinicians and the other the views of students. The purpose of these groups was to obtain existing and emerging views of qualified therapists and students on current selection processes, what could be recommended to make selection fairer for disadvantaged applicants and what specific characteristics of qualified therapists would be most desirable in the current health system. The results indicate that the proportion of African students admitted into occupational therapy degrees is still far below numbers of other race groups, particularly white South Africans. That existing selection criteria and procedures are still dominated by eurocentric influence, particularly in the historically white universities, although there are definite attempts on the part of all occupational therapy training centres to overcome this, and that there are serious problems related to recruitment of African applicants which are partly the cause of the low numbers of African applicants. Characteristics deemed most desirable in qualified occupational therapists included many, most significant were: flexibility, particularly a special ability to be able to adjust to all types of people and cultures which included good communication and interpersonal skills; the ability to be assertive where appropriate; a "life-Iong-Ieamer" attitude including a visionary mentality/attitude; creativity and inriovative thinking; perseverance, determination and good management skills.
Indigenous fruits from exotic roots? : revisiting the South African occupational therapy curriculum.
(2007) Joubert, Robin Wendy Elizabeth.; Naidoo, Zaiboonnisha.; Samuel, Michael Anthony.
This thesis explores the origins of occupational therapy in South Africa and how its birth, at the end of the Second World War, in a post-colonial era, with an emerging apartheid government, gave rise to an epistemology that was flawed from the start. It was flawed by virtue of its origins within a Eurocentric, paternalistic and male dominated health milieu which itself was strongly under the influence of the reductionistic and prescriptive medical model. It was flawed by virtue of the unnatural and oppressive nature of the country’s governance at the time in which everything, including health care, was designed primarily to benefit those of European descent and disadvantage those of any form of brown skin descent. It was flawed in that it did not collaborate in the design of curricula and research with the very people it served, namely, people with disabilities and black South Africans. Using historical and other relevant documentation, own life experiences, focus groups and the narratives of people with disabilities as data, this thesis attempts to expose the flawed layers described above and exactly how this impacted upon the epistemology of occupational therapy in South Africa. It also explores the changing face of occupational therapy globally and locally as a changing interface between what was then, what is becoming and what has to become in the future. The thesis ends with a flexible model that has multi-dimensional properties that provide multi-dimensional possibilities both in portraying the historical influences upon professional development and in plotting identity and curricula changes. It suggests some inherent principles essential for restructuring the occupational therapy identity and curriculum to meet this identity. It draws sustenance from the resilience that the developing South African occupational therapy profession has displayed, despite all these odds, and attempts to reconcile the errors of the past with the fast-changing face of modern day occupational therapy as it relates to professional practice, theory, contexts, policy and research in South Africa today.
An investigation to establish the flexor tendon rehabilitation protocol use amongst Occupational Therapists in South Africa.
(2012) Venter, Jane.; Joubert, Robin Wendy Elizabeth.; Prinsloo, Ancil.
The aim of this study was to investigate which protocols Occupational Therapists (OT’s) use when rehabilitating clients after flexor tendon repairs, and to investigate the therapist’s knowledge regarding these protocols, to guide therapists and institutions in using effective methods within the South African context. A questionnaire was sent to OT’s in South Africa. Of the 32 responses, 50% had more than 10 years experience and 50%, less experience. 81.2% were private practitioners and 28% worked in government. The trend of protocol use was as follows: 18.8% used a Duran-type passive mobilization protocol, 25% used a Kleinert-type protocol - a passive flexion protocol (but labelled an active mobilization protocol in literature as it allows active extension of the fingers), 28.1% used Early Active Mobilization and 3.1% used an Immobilization-type protocol. 64.5% of the sample used static splints, 9.7% used dynamic splints and 25.8% used a combination. Most (83.3%) continued the splint at 4 weeks but only 26.6% were using the splint at 6 weeks. At week 1, 30% allowed active flexion of the fingers, whereas at week 4 and 5, 60% allowed active flexion. The referring doctor and confidence in one’s own skills were the main factors influencing protocol choice. Resources available influenced the protocol choice, which can be problematic in South Africa. Access to literature was mostly through textbooks (90.6%), although journal articles were accessed (internet - 50%, hard copy - 62.5%). More than half of the sample attended courses regularly. Most therapists were happy with their outcomes, regardless of which protocol used. Therapists need to build their confidence, realising the efficacy of various protocols is similar, according to research. Thus whatever factors influence protocol choice, they will likely not be critical to good outcomes.
Justice and equity in the allocation of health resources for mental health in the eThekwini health district.
(2006) Phehlukwayo, S. M.; Joubert, Robin Wendy Elizabeth.
Aim The aim of the study was to establish if resources for health care were distributed in a manner which reflected justice and equity for people with mental illness at primary health care (PHC) level where mental health services were integrated into general health services. This was done by establishing if relevant South African health policy and legislation makes relevant provisions for the transformation of health care service in line with primary health care principles. Selected health care system delivery strategies were analysed to establish if these reflect justice and equity in the distribution of health resources within a particular health district. Finally, an appropriate workload criteria was used to establish how currently employed health personnel were allocated in terms of skill mix per population size within a selected health district. Methodology The study was conducted in eThekwini District in the Durban Metropolitan area. A combination of descriptive and analytic study designs were adopted using the Health Systems Research(HSR)l as the framework for the study. The descriptive component was used to set the context for the study. The analytic component was used to establish the causal link between mental health policy provisions and the current distribution of health resources. Human resource allocation was used as the indicator for mental health resource allocation.2 Simple random sampling method was used to select six sampling units of Primary Health care (PHC) areas from the sampling frame of three Sub-Districts which constituted eThekwini District; namely North, South and West Sub-Districts. Mental Health Policy and related Legislation was analysed to establish how these made provisions for resource allocations in mental health care. The South African Workload ratios from Rispel et.al. in WHO (2003) 3 were used to determine personnel allocation per level of care and per population size served. The distribution of personnel was calculated using the fulltime equivalent scale (FTE).4 The geographical location of health facilities was established from the District maps to determine the location of mental health personnel. Results At policy level, even though relevant health legislation makes specific provisions for the development, distribution and management of human resources, the literature review indicated that there are still gaps in policies for human resource production, distribution, management and health service delivery. At implementation level research findings indicated marked understaffing across all primary health care levels. Results also showed that the total number of currently employed health personnel in most sample PHC areas fell below the norm recommended for the population size. In addition, integrated primary health care service was mainly offered by one health discipline compared to the recommended personnel skill mix of eight health disciplines. On the other hand, there was also an underlying historical over-concentration of health facilities in urban-based areas compared to rural based areas.
Kinesio Taping® of the metacarpophalangeal joints and its effect on hand function in individuals with rheumatoid arthritis.
(2015) Roberts, Sarah Catherine.; Ramklass, Serela Samita.; Joubert, Robin Wendy Elizabeth.
Background Rheumatoid arthritis (RA) is a chronic systemic disease that affects the hands bilaterally, resulting in inflammation, pain, joint instability, diminished grip strength and difficulties with function. The metacarpal joint (MCP) is commonly affected in the hand. The effectiveness of Kinesio Taping® on taping of the MCP joints has not been established in assisting with the symptoms in the hand. Aim To determine the effectiveness of bilateral Kinesio Taping® of the MCP joints on pain, range of motion, grip strength and hand function in elderly individuals previously diagnosed with RA. Methods / Design A repeated measure experimental design was used for the study over a seven week period with the experimental group (n = 30) receiving bilateral space correction Kinesio Taping® of the MCP joints and the control group (n = 31) participating in joint protection (JP) workshops. The Kinesio Tape® was worn for 3 days per week with four applications during the data collection process. For the control group, 2 hour JP educational-behavioural workshops were run weekly for four weeks. Weekly assessments were completed for grip strength, ulnar deviation and pain (VAS), and two pre-intervention assessments and one post-intervention assessment was completed for the Michigan Hands Outcomes Questionnaire (MHQ). Results Kinesio Taping® of the MCP joints has shown a significant decrease in pain (P=0.00) and range of motion (P=0.00 bilaterally). Joint protection was found to have a significant difference in grip strength and in the work and ADL sections of the MHQ. No significant difference was found between groups after intervention in the majority of outcomes except for grip strength where a significant difference was found. The level of significance was set at 0.05. Discussion and Conclusion This study has shown that Kinesio Taping® of the MCP joints is an effective conservative intervention that can be used to improve pain and MCP ulnar deviation in individuals with RA over a 4 week period. This is completed through a space correction application of three days, with the tape being reapplied weekly. Kinesio Taping® can be therefore included into Occupational Therapy standard practice especially when the aim is to decrease levels of pain in the MCP joint but it may not be effective to ensure a long term effect on pain. Therefore, in order to ensure ongoing pain relief as well as to ensure maximum functioning in ADL, the taping should be used in conjunction with other therapy interventions as part of the total rehabilitation process. Further, Kinesio Taping® in conjunction with JP programmes would work effectively together to minimise pain and maximise participation in valued occupations, especially in the newly diagnosed client. Further research into the use of Kinesio Taping® in people with RA is recommended.
Preparedness of graduates in occupational therapy for clinical practice : perceptions of students and supervisors in a KwaZulu-Natal case study.
(2013) Naidoo, Deshini.; Joubert, Robin Wendy Elizabeth.; Van Wyk, Jacqueline Marina.
Background: Investigating the development of competent occupational therapists through an academic programme and fieldwork placement is an emerging field in South African occupational therapy research. It is an essential aspect of educational research, as new graduates are often required to work autonomously during their community service. Aim: The aim of this study was to explore the perceptions of the final year University of KwaZulu-Natal occupational therapy students and their clinical supervisors’ regarding their undergraduate education and preparedness for independent clinical practice. Methods: Seventeen final year students and seven clinical supervisors participated in focus groups and semi-structured interviews. Document analysis was used to explore the Health Professions Council of South Africa evaluation report of the undergraduate programme and methods used to assess the final year students. The conceptual framework was based on the World Federation of Occupational therapist Minimum Standards for Training Occupational therapists and deductive reasoning was used to analyse the data. Findings: Most final year students and clinical supervisors felt that students were partially prepared for clinical practice and lacked confidence. The students’ level of confidence was linked to the areas of occupation therapy that they enjoyed and their positive experiences during fieldwork placements. Curriculum design and content were some of the areas highlighted as needing review. Conclusion: The overall perception of both the clinical supervisors and the students was that the new graduates would be able to cope with basic clinical practice. However, there were aspects of the curriculum that could be improved to ensure that the new clinicians have more confidence and are equipped to deliver an occupational therapy service that specifically meets the need for diverse African healthcare settings.
Toward access, success and equity in health science education : a KwaZulu-Natal case study.
(1999) Stewart, Rene.; Brookes, David W.; Bhagwanjee, Anil Mohanlal.; Joubert, Robin Wendy Elizabeth.
Aim: This study aims to generate recommendations for enhancing the access and success of historically disadvantaged students to health science education at UDW, based on barriers identified within diverse schooling contexts and local conditions at UDW. Methodology: A case study approach was used to select five former DET schools within the DFR to constitute the sample of historically disadvantaged schools for this study. In order to capture the specific ecological milieu, social and cultural conditions pertaining to rural, urban and informal settlement contexts, three schools were strategically selected from each of these contexts (i.e. Sobonakhona, Ilanga and Inhlanhlayethu High schools respectively). In addition, two former DET schools that displayed relatively high achievement rates were also selected (i.e. Vukuzakhe and Zwelibanzi High schools), in order to contextually understand how barriers to positive educational outcomes might be overcome. A multistage sampling procedure was used to sample 40 standard seven and 40 standard ten scholars from each of the selected schools (n=400) and a purposive sampling procedure was used to obtain a sample of teaching staff involved in career counselling and/or science education in each school (n=16). In addition, saturation sampling was employed to obtain a sample of second year African students in the Faculties of Health Sciences and Dentistry at UDW (n=73). A combination of quantitative and qualitative data collection methods was employed, with questionnaires being administered to standard seven and ten scholars as well as to historically disadvantaged health science students. In addition, a total of five focus groups were conducted with teaching staff from each of the selected schools. Results and discussion: It was evident that a complex and interwoven web of factors impacted on the access and success of historically disadvantaged students in health science education at UDW, including, inter alia, inadequate school instructional resources; limited community economic resources; a paucity of educational opportunities and experiences in the home environment; poverty status; low levels of self-efficacy in academic skill; inadequate school career counselling; university selection procedures with a eurocentric bias; adjustment difficulties in the transition from secondary to tertiary education; financial difficulties; a paucity of 'in-group' academic role models; inadequate ADPs and negative conditions in campus student residences. These results are discussed and interpreted within the context of relevant empirical literature as well as a taxonomy derived from over 60 multivariate school-effects studies undertaken in developing countries, comprising four dimensions, viz. ecology, milieu, social system and culture. Conclusions: On the basis of the findings of this study, recommendations for enhancing the access and success of historically disadvantaged students to health science education at UDW are offered. While these recommendations pertain to a broad range of stakeholders, including the Education Ministry, the schooling sector and higher education institutions, particular attention is paid to the development of practical recruitment, selection and retention strategies to be employed by UDW and its Faculty of Health Sciences. Finally, the limitations of the study are discussed and recommendations for future research in this field are offered. KEY terms: access, success and equity; historically disadvantaged; health science education; educational outcomes.
The use of an English language assessment test on South African English additional language (EAL) speakers from an indigenous language and cultural background : a critical evaluation.
(2013) Mdlalo, Thandeka.; Flack, Penelope Susan.; Joubert, Robin Wendy Elizabeth.
The aim of the study is to provide an in-depth interrogation and critique of the use of language assessment tools on populations from indigenous language and cultural backgrounds, culminating in a framework for guiding the adaptation of language assessment tools to be culturally and linguistically relevant for the indigenous South African populations on which they are used. As South Africa is a multilingual and multicultural country, it contributes to understanding the factors that need to be taken into account for acquiring reliable and valid findings with multilingual and multicultural populations. The isiZulu language and culture is used as a basis for the study as the study is conducted in KwaZulu-Natal. This study critically evaluates the assessment of English Additional Language (EAL) speakers who are from an indigenous linguistic and cultural background, using an English expressive language screening tool, the Renfrew Action Picture Test (RAPT) as an example. The cultural and linguistic relevance of this commonly used screening tool is interrogated from four different viewpoints, firstly, the perspective of the children, who are the target population of the tool; secondly, that of the parents and community, who play a significant role in the socialisation of the children; thirdly, from the perspective of the academics from an indigenous language and cultural background, who provide an academic perspective of the tool; and finally, Speech-Language Therapists (SLTs) who administer the tool and interpret the findings. This study uses a mixed methods approach. Multiple data collection methods are used, such as a survey, focus group, individual interviews, test administration and consensus methods. The survey and Delphi technique form the quantitative parts of the research methodology. Patterns of responses from all the sources are analysed and interpreted. Methodologically, the research is unique as it uses children as a source of primary data collection. Children, in research, are usually only used in the administration of the test and their opinion of the tool is not sought. In this study the voice of the children is the main contributor to the data collection. The findings also show that adults, who are often relied on as primary data sources in research on language tools used on children, may have certain misconceptions about children’s knowledge and views. A key finding of this study is that the cultural and linguistic background of the child assessed plays a crucial role in determining and interpreting the responses to the presented material of the language assessment tool. The conscientisation of the Speech Language Therapist and the redefining of her role emerge as pivotal aspects facilitating change. Based on this finding, recommendations, such as that the therapist equips herself with knowledge of the language of the client, the cultural and linguistic background of the child assessed, the type of bilingual that the child is, are made so that the reliability and validity of the findings are not compromised.
Visual perceptual abilities in obstetric brachial plexus palsy : an investigation of the incidence and a comparative analysis.
(1998) Nukanna, Ornissa.; Naidoo, K. S.; Van Vuuren, Santie.; Joubert, Robin Wendy Elizabeth.
Obstetric brachial plexus palsy, a traumatic birth palsy, results in the paralysis of the upper limb/s. The birth injury is treated at the Brachial Plexus Clinic at King Edward VIII th Hospital, where the Candidate forms part of the Rehabilitation Team. In keeping with worldwide trends, the focus of treatment was on rehabilitation of the upper limb/s. During the course of treatment of these patients, it was observed that the performance of these children varied from excellent to poor. This observation, has not been recorded previously, hence a Research study was initiated to invesitigate this aspect of performance. The study comprised thirty children, between the ages of four and seventeen, whose paralysis was assessed in the conventional pattern. In addition, the visual perceptual abilities of these children were assessed in a variety of batteries, catering for the wide age range. These were: Developmental Test of Visual Motor Integration (1989), Motor Free Perception Test (1972), Developmental Test of Visual Perception (2nd edition), Test of Visual Perceptual Skills - Upper and Lower levels ( Gardner), Jordan's Left-Right Reversal Test (1974), Clinical (Ayres) and General Observations. Although traditionally viewed as a physical disorder, the results of the study indicate that children with obstetric brachial plexus injury present with a significant incidence of below average performance, against the normal population, on most of the assessment batteries. No significant relationship could be established between the severity of the lesion and visual perceptual abilities, owing to the disproportionate numbers of children amongst the different lesions. Further research is required to support and consolidate the findings of this study. It is also recommended that Occupational therapists screen for visual perceptual deficits in such injuries, thus facilitating holistic patient management.